6/11 Shooter - dose increase warranted?

Heather & Shooter

Member Since 2009
Could someone please look at my spreadsheet and lmk their thoughts? I've been sticking to 2 units of Levemir for quite awhile now but it seems like Shooter is bouncing or just shoots right back up to high numbers just about every time. Not sure what to do.
 
Good luck with the Lev today. I hope he's one of the (many) cat who get flatter on Lev. So far looks good. :) But hard to tell the first couple cycles as you've got the Lantus depot depleting as the Lev builds.

You know I'm not a big fan of R just to help bouncing, especially since we don't know why Fred needs so much insulin and he's not a ketone kitty. I rather we solve the bouncing problem by getting him used to normal numbers.

I've heard a number of people mention checking ketones. Is that with urine test strips?
 
I've heard a number of people mention checking ketones. Is that with urine test strips?
I use the Nova Max blood ketone meter. It is done just the same way as you test their blood glucose (meter, strip, ear prick). I would never have success in stalking my cat to the litter box (too many of them.) Plus, I like the accuracy of a blood ketone meter. It will tell you if your cat has a concerning level of ketones before it will show up in the urine strips. I have tested my kitty for ketones before and have had a positive result and the vet's urine test strip said negative. Does your kitty camp out in high numbers? If not, then it's probably not a concern for you.
 
I use the Nova Max blood ketone meter. It is done just the same way as you test their blood glucose (meter, strip, ear prick). I would never have success in stalking my cat to the litter box (too many of them.) Plus, I like the accuracy of a blood ketone meter. It will tell you if your cat has a concerning level of ketones before it will show up in the urine strips. I have tested my kitty for ketones before and have had a positive result and the vet's urine test strip said negative. Does your kitty camp out in high numbers? If not, then it's probably not a concern for you.

He either seems to bounce a lot or he spikes back up to high numbers pretty quickly after (nadir - is that when they get their lowest number of the day?).
 
He either seems to bounce a lot or he spikes back up to high numbers pretty quickly after (nadir - is that when they get their lowest number of the day?).
Oh gosh, that used to happen to me all the time when I was using ProZinc. He'd get a nadir and then just shoot right off to the moon! It got better when I switched to Lantus (now we use Lev) and when he started getting close to a dose that worked for him and got his body more accustomed to being in lower numbers.
 
Heather, I've moved your posts about Shooter back to your own post of the day. Best to keep all conversations about him in one place. Here is the link to yesterday's post:https://felinediabetes.com/FDMB/threads/shooter-amps-352-7-174-10-488-pmps-469-3-441.248470/

I'm so sorry you haven't been getting replies yet. If you have a questions, it's best to use the "?" prefix on the subject line to draw eyes to you.

Regarding bouncing, it a completely normal, and entirely frustrating, thing that newly diagnosed cats do. Best ignore it as best you can. The way to help him stop bouncing is to get him to an insulin dose where he spends more time in normal numbers, and gets used to them. It's seeing numbers he's not used to (or fast drops), that causes those bounces.

Have you decided which of our two dosing methods (Tight Regulation or TR or Start Low, Go Slow or SLGS) you'd like to follow? It'll help us help you regarding dosing if we know which one. Then put either TR or SLGS in your signature. I think he needs an increase to 2.25 units. The length of time you hold a dose differs by dosing method, but regardless of dosing method, I think it's time to increase.
 
Heather, I've moved your posts about Shooter back to your own post of the day. Best to keep all conversations about him in one place. Here is the link to yesterday's post:https://felinediabetes.com/FDMB/threads/shooter-amps-352-7-174-10-488-pmps-469-3-441.248470/

I'm so sorry you haven't been getting replies yet. If you have a questions, it's best to use the "?" prefix on the subject line to draw eyes to you.

Regarding bouncing, it a completely normal, and entirely frustrating, thing that newly diagnosed cats do. Best ignore it as best you can. The way to help him stop bouncing is to get him to an insulin dose where he spends more time in normal numbers, and gets used to them. It's seeing numbers he's not used to (or fast drops), that causes those bounces.

Have you decided which of our two dosing methods (Tight Regulation or TR or Start Low, Go Slow or SLGS) you'd like to follow? It'll help us help you regarding dosing if we know which one. Then put either TR or SLGS in your signature. I think he needs an increase to 2.25 units. The length of time you hold a dose differs by dosing method, but regardless of dosing method, I think it's time to increase.


Thank you. I actually did put a ? on yesterday's but because I still wasn't getting any replies, I removed it and created a new post.

I read through the TR and SLGS but really don't understand the difference. I'll read it again. I had another person tell me to cut back to 1.5 units. She thought he might hold steadier numbers versus dropping fast then bouncing back up over and over.
 
I had another person tell me to cut back to 1.5 units. She thought he might hold steadier numbers versus dropping fast then bouncing back up over and over.
Where did that happen? Hopefully not here. The route to solving the bouncing problem is NOT to get them used to higher numbers by reducing the dose. High and flat is not good. Going back is never the solution, and in some cases harmful if a kitty is prone to ketones.
 
Where did that happen? Hopefully not here. The route to solving the bouncing problem is NOT to get them used to higher numbers by reducing the dose. High and flat is not good. Going back is never the solution, and in some cases harmful if a kitty is prone to ketones.

Well shoot! She explained it so well too. No, it wasn’t this site. It was a feline diabetes page on FB. I already gave him his shot and only did 1.5u. What should I do tomorrow morning?
 
Pretend it's a partial fur shot tonight. Some FB groups are notorious.

As for dose tomorrow morning, it'd really help to know which dosing method you want to follow. If the answer is TR, you need to increase to 2.25 units. Given that most of the nadirs are still really high, I'd suggest the same if following SLGS.
 
If you are only feeding low carb wet food or raw, you can follow either dosing method. The main differences are the length of time you hold doses, and the point below which you reduce the dose. TR is a bit more aggressive, so you need to test more (you test enough for it). A lot of times the choice comes down to lifestyle and goals for your cat.
 
If you are only feeding low carb wet food or raw, you can follow either dosing method. The main differences are the length of time you hold doses, and the point below which you reduce the dose. TR is a bit more aggressive, so you need to test more (you test enough for it). A lot of times the choice comes down to lifestyle and goals for your cat.

I think I'll do the TR because that seems to be what more cats get into remission doing. I went ahead and did 2.25 this morning (I put it on the very bottom of the 2 line but not on the top of the 2.5 line - that's basically just a drop difference, right?). I thought you might want to see that other lady's explanation for advising a decrease in his dose. It made sense to me but I definitely agree with you that I don't want him getting used to high numbers.

"Now that I can see it, I can see your Lev problem - your dose is too high.
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It's causing lots of wiggling around and bouncing up and down. Your drops are too steep causing the liver to panic and off glucose goes on another balloon ride. Back that dose down to at least 1.5 and hold for 10 to 14 days. Levemir likes to take it's own sweet time to begin showing what a dose will do. The closer we get to a good dose, the flatter those numbers will get. I SO love my 'Velvet Beast'
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Been using Lev for 7 years

'Getting into the greens' really isn't the goal - steep dives to get there only creates more problems. That causes the liver to panic sending out bounce sugars that must wear off, insulin will not bring them down. That's normally 2 to 3 days...if there's another steep dive when that finally breaks, that dive sends the liver into panic again, Mr. Liver isn't the smartest thing - he sends more cake and ice cream to the party and up that glucose goes again.
The goal is a 'steady' cycle even if higher than desired then slowly adjusting the dose to bring it down overall. You cannot compare your Levemir chart to any other insulin type - they will look very different due to the difference in action of Levemir and all other insulins."
 
You got very poor advice on FB. What's even worse, is that dosing advice is prohibited there. I'm tagging @Chris & China (GA) whose the admin for the FB group. I suspect I know who provided you with the information and her posts are a bit of a problem.

Now, about Shooter...
In addition to the information Wendy provided and especially since you're planning on following TR, you do not want to hold a dose overly long. With Lantus and Lev and if following TR, you evaluate the dose every 3 - 5 days. If the dose you're giving isn't getting your kitty's nadirs to the range you want, it's time to increase the dose. Unless your cat is in normal numbers, you wouldn't want to told a dose that isn't doing the job for 16 days (e.g., with the 2.0u dose). Even with SLGS, you evaluate the dose after a week.

The rationale for not hanging on to a dose is that if numbers aren't where you want them, there's a tendency for glucose toxicity to develop. The term sounds a lot worse than it is. What tis means is that your cat's body gets used to being in higher numbers and treats it as the "new normal." This makes it harder to get the numbers back to the real normal and may contribute to bouncing.

Please let us know if you have questions. We're happy to help you decipher TR.
 
You got very poor advice on FB. What's even worse, is that dosing advice is prohibited there. I'm tagging @Chris & China (GA) whose the admin for the FB group. I suspect I know who provided you with the information and her posts are a bit of a problem.

Yes, she got it on Facebook, but not in the Feline Diabetes group associated with this board. I don't remember us ever suggesting a "reset" but that other group does it all the time.
 
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Hi Heather! You've gotten some great advice here from Wendy, Sienne, Bhooma, and Chris!!

If you want to see bounces in action, and eventually how BG numbers even out once you get to the correct dose (by using the protocols advocated here on FDMB and staying with advice here), then take a peek at my Pearl's spreadsheet.

I never wavered once from the advice given to me here, and you can see the success we have had with her dosing. In particular, also look at where we started and the HUGE drops we were having. You can help guide those drops down steadier by feeding once you have the data to predict when the drop might be happening. My chart notates the food given right along with the BG, and I always feed with intention, so I hope seeing this example helps give you a good picture of how an insulin like Levemir or Lantus works!
 
@Chris & China (GA)
@Bandit's Mom
My apologies for thinking that the errant post was on the FDMB FB page. The "other" group does tend to promote lowering doses due to bounces. They clearly believe in Somogyi (and probably the tooth fairy, Godzilla, and zombies running rampant). Sorry -- I just get quite tired of having members who are working diligently to get their cats healthy being given poorly researched information under the guise of personal experience.

Heathier -- you're doing great. And I am truly sorry that it's so hard to sort out reliable information from information that is far from reliable.
 
So "that other page" talked about free feeding or feeding their kitties often. Many said how awful it was for people to let their kitties cry out of hunger. They made me feel guilty, so I started feeding mine more often. Well now he wants food ALL the time! How often do you all feed your cats and how much?
 
Small meals spread apart are good, and easier on a healing pancreas. How you feed your cat depends a bit on their eating habits. Neko was a hoover, some people have grazers. If I put something down, it was gone in 40 seconds (or less - I timed her). So I used an autofeeder to spread out about 3 meals in the first part of the cycle, and she got another small snack around +9, which was closer to her nadir on Levemir. Ideally you don't want to feed carbs after nadir. At that point, the insulin effect is starting to fade. Adding carbs makes it wear off faster, shortening duration and giving you higher preshots. I found the autofeeder had a second benefit, she stared at it instead of me for more food. :p

Shooter is currently "training" you to give him more food more often. Try to resist. ;) You also need to control the amounts. If you don't already, get an ideal weight for him from the vet. Weigh him once a week or so, and see if what you are feeding him is getting him towards your goal, be in weight loss, gain, or stable. The amount you need to feed varies by cat, their weight, age, and activity level. More information on this Catinfo page.
 
Small meals spread apart are good, and easier on a healing pancreas. How you feed your cat depends a bit on their eating habits. Neko was a hoover, some people have grazers. If I put something down, it was gone in 40 seconds (or less - I timed her). So I used an autofeeder to spread out about 3 meals in the first part of the cycle, and she got another small snack around +9, which was closer to her nadir on Levemir. Ideally you don't want to feed carbs after nadir. At that point, the insulin effect is starting to fade. Adding carbs makes it wear off faster, shortening duration and giving you higher preshots. I found the autofeeder had a second benefit, she stared at it instead of me for more food. :p

Shooter is currently "training" you to give him more food more often. Try to resist. ;) You also need to control the amounts. If you don't already, get an ideal weight for him from the vet. Weigh him once a week or so, and see if what you are feeding him is getting him towards your goal, be in weight loss, gain, or stable. The amount you need to feed varies by cat, their weight, age, and activity level. More information on this Catinfo page.


LOL I like the idea of him staring at the feeder versus me. Shooter is the same. He eats SO FAST! Then goes over to the other 2 and finishes theirs.

Thanks for the info. It helps. :)
 
I use the Nova Max blood ketone meter. It is done just the same way as you test their blood glucose (meter, strip, ear prick). I would never have success in stalking my cat to the litter box (too many of them.) Plus, I like the accuracy of a blood ketone meter. It will tell you if your cat has a concerning level of ketones before it will show up in the urine strips. I have tested my kitty for ketones before and have had a positive result and the vet's urine test strip said negative. Does your kitty camp out in high numbers? If not, then it's probably not a concern for you.

What is considered "camping out in high numbers?"
 
Thank you! Trying to figure out what to do now. Seems like he bounces quite a bit. Tonight made 3 days. I'm thinking to wait another day or 2 and then if nothing changes, increase to 2.5?
 
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