9/19 PMPS HI AMPS HI - Going in the wrong direction??

JennC & Diago

JennC & Diago

Member Since 2018
I posted yesterday but didn't get any comments. Not sure if we're going in the wrong direction....the curve I did on 9/13 had the nadir at 279, could this have been him settling into the 1u and I increased based on what the vet said to 2u and now it's too much?! Yesterday's nadir only got down to 450 the day before 379. Thoughts please?

Should I go back to 1u and hold for 10 days or go to 1.5 and hold? I can keep getting tests but this just doesn't seem like the right direction.
 
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Sorry you didn't get any comments on your last post. Linking it here for reference - https://www.felinediabetes.com/FDMB/threads/9-18-amps-544-nadir-450.235536/

We usually increase in 0.25 unit increments here. Would it possible to get more mid-cycle tests in - both in the AM and PM cycles - so that we know how low the dose is taking Diago? The higher numbers you see could very well be bounces from lows that could be missed without tests. Many cats go lower at night.
 
Yes, I can grab more pm cycle tests, given how gradual he drops from the times I've tested I haven't been as diligent in getting them every day. Based on the data it didn't seem like bounces.
 
When asking a question, edit your title to similar to what you did today. Yesterday's title just looks like a status and probably no one thought there was a question. And when editing your title there's a drop-down where you can pick a "?" from to let people know you have a question. Once the question is answered, you edit your title again - remove the "?" and put up your BG readings.

Hope that helps for getting answers :) Glad you are here!
 
JaxBenji said:
When asking a question, edit your title to similar to what you did today. Yesterday's title just looks like a status and probably no one thought there was a question. And when editing your title there's a drop-down where you can pick a "?" from to let people know you have a question. Once the question is answered, you edit your title again - remove the "?" and put up your BG readings.

Hope that helps for getting answers :) Glad you are here!
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Thank you so much!! I didn't realize I needed to add that to get thoughts. I'll be sure to do that from now on. Thanks!! :)
 
A +3 test should tell you if he is likely to head significantly lower and you could set an alarm for a later test. It doesn't look like he is bouncing but better to clarify that with some tests. Is he eating largely FF with the kibble as treats?

If you could eliminate the dry food, you could switch to TR which could get you to Diago's optimal dose faster.
 
Hey Jenn,

First, it really is important to get mid-cycle testing on every cycle....even if you think it's useless because you think he's too high. Get tests at different points in the cycle too...like one day get a +2, +5, +8 and the next get a +3, +6, +9...basically just sprinkle them all over. It's also very important to always get at least a "before bed" test on the PM cycle just because most cats go lower at night. Without PM tests, you're also missing half the data (and it could be the important half!) If you can get 2 tests on the PM (like +2, +4) and still get enough sleep that would be great.

All that being said, I think you could increase to 2.5 for the next 7 days since the vast majority of his nadirs are in pink or red.

Has Diago been to the vet since coming out of remission (sorry, I haven't gone back to read everything you may have posted) Dental issues and UTI's are some of the common reasons for a cat coming out of remission.

As long as the kibble is in the picture, you're stuck with the Start Low, Go Slow dosing method which means holding the dose 7 days (unless he drops below 90)

Have you tried different texture's of canned food? Some cats just don't like pate's but there are foods that are low carb that are chunky, shreds, bits and pieces and sometimes finding the right texture is the key to getting kitty to recognize it as food.

I'd sure like to see you able to use Tight Regulation with Diago but we have to get him to eat canned foods! Don't know if you've read these "Tips on Transitioning" but maybe you'll find something helpful
 
Thanks @Chris & China (GA) for reviewing. Is it important to test every day mid-cycle? I hate sticking him so many times. He doesn't complain but it's exhausting for both of us.

My main concern is, did we increase too fast to the 2u since we did get a nadir of 279 three doses into the 2u. Should we have stayed at the 1u or went to 1.5u first? I had another moderator check our spreadsheet and she agreed to move to 2u and I'm so grateful folks take the time to look. I'm only second guessing due to the numbers. I was afraid the 279 nadir was him settling into the 1u versus the 2u dose. I've read with the depot based on what happens that day look back a few days to see if any changes occurred. It sounds like that's likely not the case. I was afraid we were going the wrong direction with the dose since at 2u he's still so high and we had that small glimmer of hope with the nadir on 9/13.

He has been to the vet a few times, no UTI, teeth are good. The only thing we haven't done since Feb 2020 is bloodwork. He seems good other than drinking so much, urinating a ton (around 18x in a 24 hour period) and sleeping more when he's "HI".

I haven't tried shredded or chunky food of the fancy feast. He's so hard to change food. I started down the path of getting him solely on wet food in 2019 and it caused us to have 3+ weeks of diarrhea, vomiting, and not much eating. That's when he was diagnosed with IBD along with other symptoms. I'm so hesitant to try anything to upset his balance. I however would also love though to get him out of these high numbers. My question around this, if Lantus needs 7-10 days to settle into the dose, how is it with TR that you can increase after 3 days? Isn't that conflicting?

Hopefully you are still online, his next shot is in 30 minutes. :)
 
JennC said:
how is it with TR that you can increase after 3 days? Isn't that conflicting?
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Yes, which is why we suggest you don't belong to more than one Facebook group for feline diabetes.

TR has been proven to work and even been published in a veterinary journal. Yes, it's an aggressive protocol but it's also the best chance you can give them to reach remission (but requires feeding a canned or raw diet).

Many of the Admins/Mods in that other group you're in originally learned how to care for their own cat here. I don't know why they have changed their advice to holding each dose that long but it's not necessary and can encourage glucose toxicity to set it (where even though you're giving insulin, the body gets used to being high and you end up having to give even more to "break through" the toxicity)

Have you ever tried to figure out what causes his IBD problems? It can take time, but usually the best place to start is with a novel protein....a protein source he's never eaten before like rabbit, lamb, quail, bison, pork or kangaroo. Budesonide is also a medication that can work well in IBD without causing the problems that other steroids do (usually...ECID)

There's some Facebook groups for IBD too. Raw Feeding for IBD cats and IBD Kitties are two I recommend.

The only time it is important to hold the dose for 5-7 days is when you first start so that the depot has time to build. After that, depending on the dosing method you use, you can either hold each dose a full 7 days (SLGS) or do TR which allows more frequent dose changes.

JennC said:
Is it important to test every day mid-cycle?
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In my opinion, yes, it's important because the 1 time you don't, you might miss a test that explains crazy numbers in the next few cycles. If he doesn't complain, what makes it so exhausting?
 
Yes, we're part of the IBD Kitties facebook group and have learned a lot. We did run a few tests on him to see if there was any specific cause, nothing was found. I've tried a few proteins, I can't remember which one gave him the horrendous diarrhea. I may try and switch to the fancy feast shredded or chunky (since that one is similar to dry kibble) and see if we can get him moved over.

Regarding the exhausting comment, this is more of a general term with everything else I've had to care for him over the last 2.5 years. We've been through diabetes, inappropriate urination, stage 2 CDK, IBD, and FLUTD with him. He's my very special boy and I love him a lot. I hate having to pull him out of his tight spots he likes to sleep for testing every two hours. I understand what you are saying though.

Still of the opinion to move up to 2.5u? Maybe that 279 nadir was a fluke after we were only 3 doses into 2u? When we started Lantus, we didn't wait 5-7 days before we moved up to 1u, only 6 cycles. I was trying to start with TR but realized after posting here that we couldn't due to dry food. Could this be our issue or since we stayed on the 2u for 7 straight days this should have filled the depot?
 
JennC said:
Yes, we're part of the IBD Kitties facebook group and have learned a lot. We did run a few tests on him to see if there was any specific cause, nothing was found. I've tried a few proteins, I can't remember which one gave him the horrendous diarrhea. I may try and switch to the fancy feast shredded or chunky (since that one is similar to dry kibble) and see if we can get him moved over.

Regarding the exhausting comment, this is more of a general term with everything else I've had to care for him over the last 2.5 years. We've been through diabetes, inappropriate urination, stage 2 CDK, IBD, and FLUTD with him. He's my very special boy and I love him a lot. I hate having to pull him out of his tight spots he likes to sleep for testing every two hours. I understand what you are saying though.

Still of the opinion to move up to 2.5u? Maybe that 279 nadir was a fluke after we were only 3 doses into 2u? When we started Lantus, we didn't wait 5-7 days before we moved up to 1u, only 6 cycles. I was trying to start with TR but realized after posting here that we couldn't due to dry food. Could this be our issue or since we stayed on the 2u for 7 straight days this should have filled the depot?
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My cat also has CKD2 and IBD. He used to eat only dry food and when we switched to wet food, he would vomit a lot. However, not sure if related to that - it could be the type of proteins or other ingredients that they put in commercial cans. I tried weruva, FF, dm, md, and he kept vomiting. He was diagnosed with CKD last May and the internist recommended that we see a nutritionist given that he has many diseases and therefore different dietary needs. The vet-nutritionist came up with a diet that addresses CKD, chronic pancreatitis and diabetes and since he has been on this diet, he has vomited once in 3 months. While he was on a commercial diet, he would vomit or have diarrhea at least every two weeks. You may want to look into this after exhausting all other options. It ends up being less expensive but I do cook everyday for him. He seems in better shape overall so I am happy to do so. It has been very difficult to regulate him (see his SS) so I hear you. Djoko PS have been mostly in the black and red and he is still not regulated after 8 month so hang in there. There are solutions but it is indeed exhausting but it can get better! I am not a fan of testing my cat all the time so sometimes I use a freestyle libre device (implant made for human). Not cheap but gives you a break for two weeks and shows your some patterns.
 
The depot is full now and you're seeing what the 2U dose can do and it's not enough so yes, I'd do the 2.5 and in 7 days do an official "curve" (test every 2 hours for 12 hours or every 3 hours for 18)

Fish, chicken and beef are the top 3 proteins that cause problems (although any protein or additive can....additives can be just as bad as a protein source when it comes to IBD)

If you're in an area where you can get novel proteins (an old fashioned butcher shop is the best place to find "novel" proteins if your grocery store doesn't carry anything but beef, chicken, turkey and pork) you might want to consider trying EZ Complete.

You just add water and the mix to whatever protein source you want to try. It can take weeks to know if a particular protein is the culprit so it's not something you can rush.

There are also some limited ingredient foods that you can look into.

IBD is tough and I'm not diminishing the frustration that comes with it one bit. I'm blessed that I haven't had to deal with it in any of my cats (anti-jinx)
 
Chris & China (GA) said:
The depot is full now and you're seeing what the 2U dose can do and it's not enough so yes, I'd do the 2.5 and in 7 days do an official "curve" (test every 2 hours for 12 hours or every 3 hours for 18)
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Thank you! That's exactly what I was wondering. I couldn't find any documentation/confirmation on if after 7 days regardless of the dose the depot is full and your seeing what the dose is doing. This one sentence helped me so very much! Our vet just got back to me from my email first thing this morning and asked if we could hold the dose for 7 more days. :( I think I'm going to ask her if she'd be ok if we move up since we're not really seeing much progress. She also recommended not testing until 7 days and then perform a curve....I know better. We've been down the road before where we had to go through a hypo event so I dare not shoot before testing.

We do have a butcher shop in town that we could see about trying raw if the FF chunky or shreds don't work. With Chicken he does pretty well most of the time. He actually has had three days of soft stool since switching to Lantus on 9/4 but regular BMs the rest of the time. When we switched to FF chicken pate and Dr. Elseys' chicken his IBD symptoms went away almost completely. It's rare that we have diarrhea/vomiting episodes very often.

@Marj & Djoko, I feel your pain! I hate seeing the blacks and reds in our sheet. I know this takes time and it's all up to the kitty. Someone just gave me such a good analogy in the FB group today that we're just along for the ride, the cat's pancreas is the captain and will tell us when it's ready to work.
 
JennC said:
I couldn't find any documentation/confirmation on if after 7 days regardless of the dose the depot is full and your seeing what the dose is doing.
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The ONLY reason I'm telling you to hold for 7 days is because that's what SLGS requires.

If you can get him onto canned or raw food only and want to switch to TR, you only have to give the same dose 3 days....and if it's not getting the results you want, you can increase by .25 to .5 (depending on the nadir)
 
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