8/31 Tibbs from relaxed . if u could look at my SS

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tibbs5

Member Since 2014
hi folks. first time posting here. Linda thinks i am possibly giving too much insulin. i need to know of i am doing anything wrong or if i should consider switching to Levimir. his ketone tests are always negative. thanks so much for checking this out for me.

amps 522 +6 412 +9 366 pmps 320
so he has dropped all the way from amps to pmps.
i am going to get a morning plus 6 before i go to work in the morning. isn't it odd that he drops all the way to pmps?? as usual, i am confused.
Linda, you suggest i am maybe giving too much insulin? i did start this whole process out at .5 about 6 weeks ago and have been raising since then. as he is still on a small amount of dry d/m i assume this is screwing everything up. waiting for zero carb food to come in. i can't wait to see what his next plus 6 is. what do you think folks? thanks.
 
Hi and welcome to you and Tibbs!

We know that dry food, even as few as 3 or 4 crunchies can increase a cat's blood sugar for the next 24 hrs or more. What is the possibility of switching to all canned low carb food? Are you talking about Linda of Linda &Scooter? Scooter snuck crunchies unknown to Linda and he went from 5.5u to off of insulin in 1.5 very long days when the crunchies left the house completely. There is amazing power in crunchies.

That said, I don't see anything to say the dose is too high. It would be easier to be more confident on what to do about his dose if you can get at least 1 test in every pm cycle. Many cats have completely different, lower cycles at night. Because Lantus dosing is based upon how low a dose takes a cat, the night cycle is critical for us. I think for now, i'd get one pm cycle tonight and tomorrow, holding the dose for now, and revisit the dose question after you have at least 2 consecutive nights with at least one test each.

I hope you'll post daily/regularly so we can help you help Tibbs. :-D

Julie
 
thanks Julie
I did get a plus 6 last night and it was 391.
i will get another one tonight and yes he is transitioning off the dry. He was dka so i am so worried if he eats nothing at all but i am working him toward no dry at all.
thanks so much
 
Welcome to Lantus Land!

I agree with Julie -- Tibbs dose doesn't seem to be too high. Based on the Tight Regulation Protocol, you might want to consider increasing every 3 days especially given that Tibbs' nadir is in the 300s. However, you don't have very many PM tests so it's possible that his numbers are dropping at night. I'd encourage you to get a test before you go to bed every night just so you know your kitty is safe.

FWIW, not all cats have their nadir at around +6. Nadirs can vary and can change. You might want to vary your test times to be sure you aren't missing where Tibbs nadir falls (at least most of the time). If you look at Gabby's SS, you'll see her nadir is typically at around +3 or +4 -- except on those cycles when it's not.
 
lol. (except when it's not !) yes . it looks like his nadir yesterday was around +1 or +2 of the pm shot.
i will do a real curve soon. Thanks so much.
 
you don't have to do a curve, particularly, just vary up the times you're testing. Here's what I wrote recently for someone about the testing:

I think of the spreadsheet like a jigsaw puzzle. If you have only the corners and edge pieces, it's pretty hard to see what the picture is. But if you have pieces spread here and there all over the puzzle, it becomes easier to decipher the picture. That's exactly what the spreadsheet is for us. It helps us to see what the Lantus is doing when we can see the past 3 or more days with a sprinkling of tests here and there. Right now you've done a super job of getting tests in - it's giving us edge pieces and a couple of stripes down the middle of the "puzzle." It would really help to see some variety in the test times. Does your schedule allow you to get some different times? Your plan for a +4 and +8 today is super.

I'd suggest one day getting a +2 or +3, then maybe a +5 (since you have a lot of +6's), or +8, and then in the evening cycle get some different times, maybe a +4 or right before you go to bed. Your total per day doesn't necessarily need to be more tests, just vary the times. Does that make sense?

hopefully that will help you, too. When I see black numbers popping up on the spreadsheet, i usually suspect bouncing. It's hard to know what exactly is going on - some cats will barely touch down on a lower number (even 150 if their body is used to 350) and immediately zoom up high. We have plenty of cats that can have preshots at 400 and hit a 40 in between. That's why we advocate for random testing here and there in both am/pm cycles. Here's a post on bouncing if you're not familiar with it. Second post in thread. You could be seeing some New Dose Wonkiness too - first post in that thread.
 
Hi nadine!

I saw you reduced this morning. It is possible his dose could be too high, or it could be too low just as easily. Just wanted to say that the way to know if the dose is too high, too low or pretty much just right is to get enough tests in to be confident you know how low the dose is taking Tibbs. That usually is 4 consecutive days of preshots and 1-2 midcycle tests in each cycle before you can really be pretty sure.

Each time the Lantus dose is changed you have to wait to let it settle. With the tests, you will know for sure. By changing the dose, it's a bit like stabbing in the dark hoping to hit something by chance.

Reducing a dose will almost always reduce bouncing because it stops a cat from going low enough to trigger a bounce. If your goal is remission, however, the cat's body needs to get into normal numbers so their pancreas can heal.

Anyway, for what it's worth, I thought that might be helpful to you. Give a holler if you want more help. :-D
 
hi julie
thanks so much. i think i will try the reduced 1.5 units in conjunction with getting him totally off dry food. i am so hoping that taking away that dry will get his numbers down more and i will definitely take more mid cycle readings as you suggest. thank you! i will b home tues & wed of this week so i will b able to get a few more readings. i just want to b sure i'm not giving too much so i was going to go back to 1.5 where he started to get yellow and some green numbers and hold that dose for maybe a week while getting rid of dry. what do u think about this plan? thanks for all your help.
 
dry food really messes up everything with blood sugar. I don't know what Tibbs is eating, but some dry food is in the 50% carb vicinity. It could easily explain his high numbers, including the black ones. In other words, while he is eating any dry food at all, he may need more insulin, not less.

Have you seen http://www.catinfo.org? There is a section on there about how to transition a dry food addict on to canned low carb food.

We often see the suggestion on the Relaxed forum to reduce the dose in order to reduce bouncing. It works, because of what i mentioned above. But is reducing bouncing the goal, or is getting a cat into remission the goal? Newly diagnosed cats who become tightly regulated asap have an incredibly high percentage chance of going off of insulin - more than 90% in the first month, and decreasing but still very high in the first year. Take a look here, and go about 5 paragraphs down from the top of the page where there is a downloadable PDF called "Management of Diabetic Cats Using Long-Lasting Insulins." That's the protocol we follow here on TR, and it's the only protocol that's been published in a professional veterinary journal on how to dose diabetic cats. It talks in there about how to get them into remission.

All I can tell you is that if your goal is remission, you want to move quickly to get rid of the dry food, transition to canned low carb, and get Tibbs into normal numbers as soon as possible. As time goes on, damage occurs to the pancreas's beta cells which produce the insulin. Initially, the beta cells will heal and begin producing insulin again, but at some point the damage is too extensive and the cat will most likely remain diabetic for the rest of their lives.

It looks like Tibbs was just diagnosed 6 weeks ago - that's definitely still early enough, if remission is your goal.

If he were mine, I'd make the first priority getting him off of all dry food. I would've kept his dose at 2.0u while doing that. Even 3 crunchies in one day can cause some cats to go to high numbers, so I'd have left the dose alone and monitored him, while the carbs worked out of his system. Then the blood sugar tests would tell you if the dose needed to be reduced. We have kitties on here that have more than 2u doses that don't eat any dry food, it just depends on the cat. The testing is what tells us about the appropriateness of the dose. Since you've reduced the dose, just because Lantus "likes" consistency in dosing, I'd leave it at 1.5u and accelerate my efforts to get rid of the dry food.

Here is the spreadsheet of the kitty I mentioned before, Scooter. Look at his spreadsheet on 2/18 - notice that he's on 5.5u of insulin. He'd been increased appropriately per the protocol, and had gotten his teeth cleaned. Linda has 13 cats, and although the others ate crunchies, she was pretty certain Scooter wasn't eating any. But lo and behold, on the 18th the household went dry food free, and notice what happened in the days after that. Scooter went OTJ by the 20th.

Here is one where Trey got into the dog food one time: http://www.felinediabetes.com/FDMB/viewtopic.php?f=9&t=122601&p=1274806#p1274806 and his spreadsheet - look at 7/30 amps and +3. He was mostly running in green numbers and low blues, and the bite of dry dog food got him up to nearly 200.

I'm not trying to twist your arm, but i know that if your hope is to get rid of the insulin, time is of the essence, and there is no way to know all of this is people don't tell you. For some reason, it doesn't get said much, so I try to make sure that people know so they can make an educated choice. Whatever you decide, I'm always happy to take a peek at Tibbs and give you suggestions.

Enjoy the holiday! :-D
 
hi julie
remission is definitely my goal. so confusing when everyone does it differently. ok i will look at that protocol for remission and get the dry food out of here as fast as i can. it makes complete sense that the faster you get the beta cells to heal, the better the chance of remission. i def don't just want to clear the bounces, i want him off insulin. thanks for all the info. i have a science background so i love data. lol. i will read what you have given me and give it a try. thanks again. i will keep posting here too so i can get your advice.
 
awesome! i'm so glad when i started here on FDMB there was only one Lantus forum. Who wouldn't choose "relaxed"? It sounds so nice! and when you've got the stress of the newly diagnosed cat, you totally want relaxed. but nothing seems to say that if you want remission, you want the TR protocol, not relaxed.

I'm a data-nut too. It doesn't lie and is understandable once you know what you're looking for.

Looking forward to getting to know you and Tibbs, Nadine. :-D we'll see what we can do to help the little guy!
 
Hi Nadine,

I know all of the different advice you're being given is overwhelming. For what it's worth, the individuals here on the TR board helped Jersey get into remission after just a few months on insulin. Although I was scared at first to trust the advice of strangers, I soon learned that these individuals are very experienced and always put Jersey's health and safety first. They never steered us wrong, and I wouldn't hesitate to trust them with any of my cats' lives now.

When you do cut out the dry food, make sure you get in some extra bg checks. If getting rid of the dry food means that Tibbs' needs less insulin, you want to catch that quickly.

Hang in there - it really does get easier!
Shelly
 
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