3/8 Smudges - switch protocol? AMPS 171 +5 68

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Jenni

Jenni

Member Since 2015
I will be doing some curve testing this weekend to find out if Smudges' nadirs have changed. Just got a 68 at +5. That is the lowest number he's had so far which I am super happy about. It could be because he has not eaten since 6:30 am and/or because he did start eating the Evo wet food with his kibble last night! Very happy about that! That brand actually wants to stay in his stomach which is super awesome! Hopefully it stays that way. He was really excited about it the first couple times I gave it to him now he seems a little less excited about it and I'm not sure if he will continue eating it but I will continue trying it. Worst case scenario he definitely enjoys eating the Evo low-carb kibble which is certainly better than where we started.

So initially I started with the slgs method but would like to change to tight regulation. I was afraid I would not be able to test often enough but after reading the post about working full time and tight regulation, I believe it can be done. I can test him at 6 am, 6 pM and 10pm with the option of staying up later to get a nadir around midnight if necessary.

So with all of that being said I am wondering about his dosage. Right now we are at 1.25 lantus and I'm wondering if I should remain at that dose or make a change. I was thinking it might be best to wait through the weekend to see if the addition of wet food will affect his nadirs. Any thoughts?
 
Generally, making 1 change at a time for a couple days helps you identify the effect of that change and compensate if the insulin dose needs adjusting.
 
With a green nadir like that, you wouldn't want to change the dose now if you're going to try TR

That's an excellent nadir!

If he continues eating the lower carb food, he may even earn a reduction soon!
 
Hi Jenni - if you want to switch protocols, just change the note in your signature. Maybe make a note in the remarks section of your spreadsheet as well so we know when you made the switch.

68 is a pretty awesome nadir! :D I'd offer him some low carb food to see if he'll keep surfing there. The more time he spends in the greens, the more his pancreas will heal. I'd also test again within the hour, to make sure he's not going lower. As Chris says, I'd stick to this dose for now. Wet food can definitely change his insulin needs, and he may in fact go below 50 soon, which would mean a dose reduction. :)
 
Well, I think we may be on a bit of a rollercoaster ride. His typical nadirs are over 100. I think the 68 may be due to the fact that he had not eaten since 6 a.m. (5 hours). On the weekends or when I am home, I do not let him free feed due to my other kitty's kidney issues. Her dietary needs are pretty much the opposite of Smudges so I just feed them separately every couple of hours. During the weekdays while at work I have to physically separate the kitties so that they can each have access to their own food throughout the day.

I was ecstatic when I brought home the new Evo Cat/Kitten wet food and Smudges really liked it. I was over the moon when he kept it down--no vomiting! Score! Unfortunately, his interest in the wet food waned the following day and by day's end he didn't want it anymore. Very frustrating...

Given that Smudges has a terrible time keeping wet food down, I'm thinking that I may just keep him on the Evo dry and every few days see if he will eat some of the wet to change things up a bit. He likes the food--his tummy likes the food--he just seems to lose interest some reason. I wish he could just tell me what the deal is! I've tossed out so many different flavors of cat food already and Evo isn't exactly cheap. I also cannot find it in the smaller 3 oz cans so I had to throw most of it away today. I've tried several of the tips for transitioning to wet and most of them work for the first day or two but then we're right back to kibble only. Because he had lost a couple of pounds since last fall, I'm just happy he is eating and enjoying the low carb kibble.

I'm just not sure what to do at this point:

1) Keep Lantus dose at 1.25 and hope I can get him to eat wet food every once in awhile which may or may not affect his BG numbers
2) Increase Lantus does to 1.50

To make matters worse, my CRF kitty (who absolutely loves wet food) has decided that she wants to eat Smudges' food instead of her own. I can't let her do that because it won't meet her specific nutritional needs so she just gives me that stubborn look and often refuses to eat her own food.

Why do kitties have to be so fussy difficult?! Just eat the damn food! Argh!

Oh, before I forget. Smudges' left ear has become a really good bleeder. However, it has started to bleed alot more than necessary with just one poke. Looking at the surface of the back of his ear, it seems a little cracked or wrinkled in the area where he gets poked. Is this normal?
 
I would hold his dose for the moment, and if you see it rising (ie, you stop seeing green nadirs) overall from eating the dry food, then you could adjust the dose to compensate. But for now, he's doing great at the 1.25u.

Did you try pulverizing the dry food and sprinkling it over the canned? that works for some kitties.

I haven't experienced that with the ear, but it's typical for it to begin to bleed better once a couple of weeks of poking has passed and it's grown more capillaries. I don't know about the wrinkling question. I always put neosporin with pain relief ointment on punkin's ears every night when he was headed for bed, wiped any remaining off in the morning, and his ear was like new.
 
Thanks Julie. I put Neosporin on after each test. I thought maybe it was wrinkly from buildup of the cream but it doesn't seem to be. I've mixed the dry with the wet and he liked that the first night, now he just ignores it all. I'll try the pulverizing part today...lol. Thank you!
 
We have lots of kitties here with various stages of kidney failure too (seems to come with diabetes pretty regularly) as well as people with non-diabetics with CKD too

They feed them the same low carb food as the diabetic gets and have seen them really improve! With kidney disease, water is the important ingredient, not some fancy "prescription" diet, so if your kidney cat likes the wet food, add some extra water and let her have it! I bet you'll see good results!
 
@Chris & China @Wendy&Neko @julie & punkin (ga) :
A Reminder...

Hi Jenni. Someone brought your thread to my attention. I see you would like to switch from practicing SLGS to the TR Protocol. That's great. I hope you'll see even better results than you're seeing now with TR. However, I wanted to post a reminder that there are requisites to following the Tight Regulation Protocol with Lantus or Levemir. One of them seems to have been forgotten:



REQUISITES WHEN FOLLOWING A TIGHT REGULATION PROTOCOL WITH LANTUS OR LEVEMIR:
  • Kitty should be monitored closely the first three days when starting Lantus or Levemir.
    Blood glucose levels should at least be checked at pre-shot, +3, +6, and +9.
    More monitoring may be needed.
  • It will be necessary to test kitty's blood glucose levels multiple times per day.
  • Use U-100 3/10cc syringes with half units marked on the barrel for fine dosing.
  • Feed a high quality low carb canned or raw food diet. <----------------------------------- Forgotten?
  • Feed small meals throughout the day. Some kitties adapt well to free feeding.


The Tight Regulation Protocol is an advanced method of bringing BG numbers down as quickly as safely possible. These requisites aren't something we made up. They are part of the protocol itself and there are good reasons for each of them. Each of the requisites provide a safety net of sorts. Feeding a dry food diet removes one of the safety nets.

I understand wanting to switch protocols (many do), but for safety's sake, I strongly suggest exercising a little caution by giving more time to switching from a mostly dry to all wet food before changing protocols/methods. I think it would be better to switch methods when you're feeling more confident in Smudge wanting to eat an all low carb wet food diet. What do you think?

In any case, good luck transitioning Smudge to a wet diet! :)

 
I have to agree with Jill. I applaud you in wanting to be more aggressive in getting Smudge's numbers down! I'm one of the biggest TR advocates there is, but one of my cats (Kris Kringle) was eating dry food so I could not follow Tight Regulation for him. It was a lower carb dry food and thought I could at least get him close to tight regulation, but it quickly became obvious that trying wasn't safe. His patterns were too unpredictable for me to be comfortable letting him hit the 50s because I couldn't always pull him out easily.

I ended up trying to keep him above 60, and I also did not shoot as low as I did with my other cats. He was well regulated, but not tightly regulated. It's a tradeoff I had to make for KK's safety and health because in his case, removing dry food wasn't really an option. I hope you'll be able to successfully transition Smudge because I do think Tight Regulation is the way to go for most cats, but in the end you have to do what works for both you and your cat.
 
Hi Jenni - Jill brings up an excellent point. Could you put some notes on either the Remarks section of the spreadsheet or in your signature to remind us that the food transition to wet is still a work in progress.

From this weekend's numbers, it looks like Smudges numbers are leveling out and looking much better. That 68 you got yesterday would be a reduction on the SLGS protocol. I've copied the protocol here and highlighted some of the relevant pieces:

After 1 week at a given dose perform a 12 hour curve, testing every 2 hours OR perform an 18 hour curve, testing every 3 hours
Note: Random spot checks are often helpful to "fill in the blanks" on kitty's spreadsheet.
  • If nadirs are more than 150 mg/dl (8.3 mmol/L), increase the dose by 0.25 unit
  • If nadirs are between 90 (5 mmol/L) and 149 mg/dl (8.2 mmol/L), maintain the same dose
  • If nadirs are below 90 mg/dl (5mmol/L), decrease the dose by 0.25 unit
  • As your cat's blood glucose begins to fall mostly in the desired range [lowest point of the curve approaching 100 mg/dl (5.5 mmol/L) and pre-shot value around or below 300 mg/dl (16.6 mmol/L)], do lengthen the waiting time between dose increases. If you decide to change another factor (e.g., diet or other medications), don't increase the insulin dose until the other change is complete (but do decrease the dose if your cat's glucose numbers consistently fall below 90 mg/dl (5.0 mmol/L) as a result of the change). Don't be tempted to rush the process along by increasing the dose more quickly or in larger increments-- no matter how high your cat's blood glucose is! Rushing towards regulation will cost you time in the long run, because you may shoot past the right dose.
Lather, Rinse, and Repeat!
 
Thanks for all the great information. Unfortunately, it sounds like I am unable to switch protocols at this point since Smudges will not consistently eat wet food. It is still very much a goal of mine but not one that I can count on at this point. For whatever reason, he just prefers the kibble right now.

I am still confused about the dosing though. He has only had one day (yesterday) with a nadir below 90 so shouldn't I at least keep him on the same dose or increase slightly until he gets the lower nadirs consistently before decreasing his dose? Getting those readings will be tough because of his insulin schedule. I work during the week and cannot get those daytime readings and would have to wait until midnight or so to get them at night. That would not be ideal since I usually get up at 5 a.m. This is frustrating...

What is the magic number (length of time) that he should be getting below 90 before I can confidently decrease? It seems like if I decrease now, his BG would go right back up. He is mostly in the blues now with a couple of yellows here and there.
 
julie & punkin (ga) said:
You're stuck in a spot, aren't you Jenni?

I think the best plan here is for @Jill & Alex (GA) or @Libby and Lucy to give you advice on how to proceed with the dose.
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No, I won't give dosing advice because I have noticed that any time I do, the rest of you stop helping that caregiver. That isn't fair to Jenni or Smudges. What I will say is that according to the information I have seen you posting several times, which seems to be a group consensus, people have to choose between TR and SLGS. In this case the caregiver isn't able to choose TR at this time, so that seems to leave SLGS.
 
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Libby and Lucy said:
No, I won't give dosing advice because I have noticed that any time I do, the rest of you stop helping that caregiver. That isn't fair to Jenni or Smudge. What I will say is that according to the information I have seen you posting several times, which seems to be a group consensus, people have to choose between TR and SLGS. In this case the caregiver isn't able to choose TR at this time, so that seems to leave SLGS.
Click to expand...
Ditto... for the same reasons.

Libby and I don't post much any more. We mostly take care of moderator type duties. However, if we see something going on that can do harm or potential problems in the making... we will speak up.... as we should... as anyone who spots a problem should. After all, this is exactly why we have a peer reviewed message board.

Jenni, so sorry for hi-jacking your thread. Anything said is said to help you keep Smudge safe while you transition to an all wet food diet.
 
I simply want to do what is best for my cat. I will do whatever I can to reach our goal of remission. If that means increasing his dose to consistently bring his BG down the that is what I will do. I cannot count on his willingness to switch completely over to wet food when it is obviously such a problem for him. I won't stop trying but I cannot count on that happening. I also don't want to do nothing or stay at the same dose of insulin without getting better results. I know that if I talk with my vet she will say something completely different from the things that are posted on this board and it is all too much information for a person to handle who has no experience with diabetes.

I'm at my wits end and I just don't know what to do. I'm simply asking for advice on the best course of action to take to help my cat feel better.
 
Jenni, both the TR Protocol and the SLGS Method are designed to keep kitty safe while working towards regulation. One is advanced (TR) and the other takes a slower path (SLGS), but both methods can get Smudge where you want him. TR requires a low carb wet diet. Both methods require mid-cycle testing for making dose adjustments when using Lantus or Levemir.

Simply offering an opinion...
from what you've told us, following the SLGS method appears to be the safest route to take at this time.
 
Hi Jenni,

I don't use Lantus and didn't follow either protocol, and you don't know me from Adam. With that bit of self - promotion, all I can tell you is I've been hanging around for almost four years and I read a lot all over the board...

I'm at my wits end and I just don't know what to do. I'm simply asking for advice on the best course of action to take to help my cat feel better.
Click to expand...

I think this is the best piece of advice I've seen on this condo.

I understand wanting to switch protocols (many do), but for safety's sake, I strongly suggest exercising a little caution by giving more time to switching from a mostly dry to all wet food before changing protocols/methods. I think it would be better to switch methods when you're feeling more confident in Smudge wanting to eat an all low carb wet food diet. What do you think?
Click to expand...

As far as what your vet might say, how good is your vet about explaining the logic behind what they advise you to do? If they tell you something, and will explain in detail "why" they advise something, maybe post what they say here and ask for feedback?

Carl
 
Safety always needs to come first. Since you need to follow slgs at the moment I would take the reduction for going under 90. If it fails no worries you can just take Smudges straight back up again.

You should definitely not increase the dose right now or you could end up coming home to a hypo kitty. Particularly as you integrate more wet food which should bring his numbers down further.

You mentioned that his nadirs are generally over 100 but that's not what I'm seeing. Since he got his first green number half of the lowest numbers you've caught have been greens.

IMHO Smudges is looking really good and you should feel quite pleased, he's moved from predominantly pinks and yellows to blues and greens in a very short time. Not that I don't understand the frustration in not being able to sort it all out in a week or two :bighug:
 
Hi Jenni,

I think Smudges is looking good on the current dose.

As for the wet food, think about it this way...do you like to eat the same food day in, day out? Maybe he wants a little variety in flavors to keep him interested in the wet food. If you ultimately want to switch to TR, which I totally understand your desire to do so, keep offering the wet food. Some tricks that some have seen work to encourage their interest -- pulverizing the dry food as Julie suggested above, also...sprinkle some parmasean cheese on top. Some people have found that will entice the cat to eat it as well. It took us a little bit of trial and error to get Cobb to switch from his beloved kibble. We probably tried 8 different kinds before we found one he would eat. I basically just took up his dry food one day and said, enough is enough. He whined for a day or two, but then started eating the wet food because that was the option he had and he was hungry. Sounds kinda mean, but it worked for us.

Stick with it. You'll find something that works! And we'll still be here to help you make the transition on protocols if, and when, you decide to do so!

~Suzanne
 
Jenni

Here is my thinking on this and it's just my opinion. Just as TR is guidance, so is SLGS. You hold the syringe and you can make the decision on the dose....you don't need anyone's permission. :) I do agree that you should stick with SLGS until Smudges is off dry.

SLGS is pretty clear that you should reduce the dose once he goes below 90. But I do think we have to consider circumstances and we know that, generally speaking, if a cat isn't eating, the insulin is going to drop the BG. My suggestions below are based upon the premise that you know he's going to eat....especially when you are gone and can't monitor his eating.

I would be tempted to hold the dose but I would only do this if you continue to get at least one nighttime test other than PMPS and I would even suggest that if it is possible to do (depending on your work schedule), I'd try to get an out the door and in the door test on work days. The other thing I would suggest is that you do focus on getting a curve once a week and that means tests spread out through the cycle.....so you need to get more than just a couple midcycle tests. If you catch him below 90 again on this dose, I would reduce to 1u. If you are able to switch him entirely to wet food, you will have to up the testing to make sure he isn't dropping too low....or lower the dose to be sure he is safe when you are gone.

There are other approaches to FD management but the two we typically suggest here for new members are the TR protocol, if requisites are met, and SLGS if they aren't or if the CG doesn't want to do TR. You will also find more experienced members, like me, who started with TR and have learned their cat needs a little different approach but those members have scads of data and know their cat and can customize the dosing.

Again, this is only my opinion and I would suggest you weigh it the same as other opinions you've received and determine what is best for Smudges with what you, as the CG, know about him.
 
Marje and Gracie said:
Again, this is only my opinion and I would suggest you weigh it the same as other opinions you've received and determine what is best for Smudges with what you, as the CG, know about him.
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I agree with Marje. All of us have opinions, but none of us are vets nor do we have crystal balls which allow us to predict what will happen with any reliability.
We're simply here to help, but decisions are ultimately yours to make.

I also know making dosing decisions can be tough when kitty has only been on insulin for a few weeks. It just hasn't been enough time to know much of anything about Smudge's response to insulin and/or to have accumulated much data to predict or even recognize patterns. Not yet, but you'll have it before you know it!

However, I have to say, I am extremely impressed with the Diet/Notes section of Smudge's spreadsheet. Kudos to you for recording in such detail. You've done a great job! I wanted to mention that tab on his spreadsheet because it's pertinent to this situation and I'm not so sure everyone has seen and read the information you've so carefully recorded. Like Marje said, please use THAT information... "what you, as the CG, know about him", as well as input from others, to help you make the best decisions possible while you're accumulating more data and transitioning Smudge to an all wet diet. Not eating, vomiting... these issues can pose a real threat for any kitty under the best of circumstances.

Smudge has already dropped below 90. Given the circumstances you're dealing with... better safe than sorry. A reduction is the safest route to take, but it's up to you. In the interest of safety, there's never any shame or harm in slowing things down for a short time while making adjustments to his diet. It's temporary... just till you're able to make a successful transition from dry to low carb wet foods or at least feel confident he'll eat and keep the food down when you're not home. I'm sure watching Smudge possibly exhibiting hypo symptoms a few weeks ago was scary for both of you.

Just some thoughts for your consideration...
wishing you & Smudge the best and hope to see you posting often!
 
First of all I want to thank everyone who responds to my posts. I feel like I have very little support or guidance from the vet clinic and will be making a change soon. Diabetes is completely foreign to me and prior to this diagnosis, I knew absolutely nothing about it and still know very little. I appreciate the time taken out of your busy day to read and respond. It means quite a lot to me.

I just returned home from work and it appears that Smudges did not eat a lot of his food today. I did a plus 11 test and he came up as 88. I trust that people on this board know quite a bit more about diabetes then I probably ever will and so I don't have a problem reducing the dose if that is what is best for him. I just wanted to confirm the decrease. It sounds like I should decrease from 1.25 to 1.0 but would like confirmation prior to giving head shot in less than an hour. Is this correct?
 
Jenni said:
I feel like I have very little support or guidance from the vet clinic and will be making a change soon
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If you are otherwise happy with your vet then there's no need to change. Very few vets have their heads properly wrapped around FD which is not surprising as they are cross species general practitioners. Most of us don't use the vet much for the diabetes, that's what the board is for :) In a way little guidance from them is better, for people that are receiving advice from their vet it can be difficult at first to ignore it and go with what the board is telling you since the vets are supposed to be the experts. You won't need a vets input on dosing, feeding etc when you have all the real experts here.
 
Jenni, you've gotten lots of good advice. Smudge's blood sugar is looking pretty good and I think you're getting a good feel for things.

Most vets don't have a lot of diabetic cats to care for - many people euthanize their cats upon diagnosis. I agree with Serryn, that if you like your vet otherwise and feel like s/he is competent other than the dosing, you might want to stick wtih them. I had so many errors done with punkin with our first vet - who I thought was great otherwise, that I felt I had to change for his sake. When I switched vets to one who had 2 diabetic cats at home, even she didn't hometest. She zipped them to the clinic and put them on a glucose drip when they had symptomatic hypos. Not the way I wanted to deal with things! But I stayed with her because I learned how to adjust punkin's dose here and once you've got the hang of it, you really don't need someone outside telling you what to do with the dose. You learn to look at the spreadsheet and compare it to the guidelines, and it becomes fairly obvious (most of the time) how to adjust the dose. For the rest of his issues my new vet was wonderful.

Just take it one step at a time and things will get easier! :bighug:
 
Thank you all for the support and encouragement. It's a very emotional time and I foresee a lot of ups and downs. Two dogs, two kitties (1 diabetic, 1 kidney disease) and a lot of vet bills. It can be difficult to manage it all alone.

I've wanted to change vet clinics for some time now. The only reason that I still go there is because they are close to home and have urgent care hours. I get a different vet every time I go and haven't felt a good rapport with any of them. After receiving the diabetes diagnosis and questioning if the insulin dosage was too high to start at 2.0 units 2x/day, the vet became obviously irritated and blew me off. I told the front desk that I was not interested in having anymore appointments with her. After the "hypo" incident and several phone calls to the clinic I am now communicating with another vet there. And while I am not "unhappy" with her, I'm not just completely comfortable with her. Our previous vet was awesome but unfortunately he is now retired which is why I switched. Other than referrals from other people and my previous vet, I just don't know what the best clinic option is for us. I'm afraid it will just be trial and error and that just doesn't feel very good. My pets are really my "kids" and finding an awesome vet who really cares about animals is a priority for me.

Anyway, thanks again for all of the great advice and messages! Hugs to everyone!
 
Jenni, where are you located? We might have a member who lives in the same vicinity who might he able to recommend a vet?

Carl
 
Hang in there Jenni. You are a great mum to Smudges and your other furry babies and hopefully you can find a vet you are comfortable with and who is a good vet too.
 
Hi Jenni,
Smudges preshot numbers are looking very nice! Is there any way you can get any mid-cycle tests to see what the 1u dose is doing in between shots?
How is Smudge doing as far as digestive issues? Has the diarrhea stopped? Are these numbers from a dry evo diet? I looked but didn't see any recent notes on the "diet" tab.

Hope all is well,
Carl
 
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