Advice to get Jenks regulated

[AZJenks]

It's been three months since diagnosis, and I don't feel like we've even approached anything resembling regulation.

There was a mystery week at the start of the month where he was mostly blue during the day, but that number has begun to increase for no apparent reason. And his nighttime numbers seemingly refuse to budge whether he gets 2 units or 4.

Averaging the month-to-date readings:

AM(+6) 239
PMPS 389
PM(+6) 418

Other pertinent info:
All wet food diet (Friskies) since 2/2/14
Supplementing with FortiFlora
Fed 4x daily: 9am, 3pm, 9pm, 3am
He usually consumes 1/4 to 1/3 of a can per feeding, though he has eaten a 1/2 of a can on occasion.
Aside from being roused for PM(+6) test and food, he sleeps all night.

I have to confess, I have no idea what to do. So I'm open to any and all recommendations, advice, criticisms, etc. because I need to redouble my efforts to get him under control.

 

[BJM]

The numbers which determine dose increases are the mid-cycle tests around +5 to +7 hours after the shot.

For safety, we recommend you always test before you shoot. Many cats go lower overnight and may surprise you in the morning with an unexpected low.

Your best testing results will happen when you pick up all food 2 hours before the pre-shot tests.

Glucose levels often rise in the 2 hours after eating and generally start rising after the nadir between +5 to +7.

Temptations treats are not low carb and may be interfering; try freeze-dried, raw, or cooked meator poultry as a treat.

 

[Deb & Wink]

Is Jenks still difficult to test, or has he come to accept the process?

Are you still feeding him some dry food, as you mentioned on 2/11 on your SS?

You probably want to mix up the times that you test. You can't assume that +6 is the lowest point in the 12 hour cycle with Jenks. Maybe test at +5 one day, +7 another. ECID and the nadir can be different every day.

Some cats nadir earlier (Wink was around +3 to +4). Some cats nadir later in the cycle. You need to test to find out when your cat has his lowest BG reading.

Without that AMPS test, there is no context to put the mid-cycle test in. Please get that AMPS test every day.

You keep switching back and forth from 2U in the AM to 3U in the PM. That is simply allowing the insulin depot to drain and refill constantly. Lantus is best with a consistent dose.

Read the stickies in the Lantus TR forum. Lots of useful information there on using Lantus insulin most effectively.

 

[Angela & Blackie & 3 Others]

I just took a look at your spread sheet, and your doses are inconsistent which results in the shed draining, and refilling as Deb mentioned. Lantus needs to be consistently dosed in order for it to work properly, and for it to help bring those #s down. May I suggest trying an experiment of perhaps feeding the 2nd meal a bit closer to the first, say at around +5 instead of +6. The extra hour stretch may help to bring those PS #s down, it also may help for his pancreas to work along with the insulin, and it'll give him an extra hour to sleep, too, since you're having to rouse him in order to feed him. Some cats are fed only 2x/day. Mine is fed PS, and +1, and she goes 11 hours without food. Like I said, it's only an experiment, and if it doesn't work, you can always go back to the way things are.

I'm not sure what the carb content is of the Friskies that you're feeding him, and if its too high, you way want to consider switching him to a lower carb Friskies. With regards to the amount of food that you're giving him, you may want to start measuring it on a scale, instead of eyeballing it. This would also require you weighing him so that he doesn't gain too much, and you definitely don't want him losing weight, either. Sometimes, all these little things make a huge deal on trying to bring down those #s, and getting him regulated. Right now, he needs food until his #s come down, and then when he does, he'll start to not want to be as ravenous. But it takes time, and a lot of patience.

With tons of patience, he'll become regulated over time, but you need to be consistently giving the correct amount of doses every 12 hours instead of giving him 3u 1 cycle, and 2u the next. That won't work, and you'll end up having the same high #s that you're experiencing right now. I would suggest staying with 2u for now, and then we'll see how he does over the next few days or so, and go from there. Hang in there. Regulation will happen. Just have patience, ok? Feel free to join the Lantus Tight Regulation Protocol on this board. It's full of very helpful people on there who have been where you're at, and have been at this for a very long time.

 

[AZJenks]

Is Jenks still difficult to test, or has he come to accept the process?

He tolerates it.

Are you still feeding him some dry food, as you mentioned on 2/11 on your SS?

No, the dry food was a moment of weakness and after two days we took it all away again. Ever since, the diet has consisted of Friskies canned pate wet food, which are among the lowest carb versions among the brand according to the carb spreadsheet.

You probably want to mix up the times that you test. You can't assume that +6 is the lowest point in the 12 hour cycle with Jenks. Maybe test at +5 one day, +7 another. ECID and the nadir can be different every day.

How am I ever supposed to find the nadir If it isn't halfway through the cycle and can be a moving target? How many tests am I supposed to subject him to and with what frequency to find it?

Without that AMPS test, there is no context to put the mid-cycle test in. Please get that AMPS test every day.

I'm not present to do AMPS and I'm still working to persuade the other human to do it, so far without success. This is why morning dose is stuck at 2U so there isn't a recurrence of a 47 reading as there was on 2/22 w/ 3U.

You keep switching back and forth from 2U in the AM to 3U in the PM. That is simply allowing the insulin depot to drain and refill constantly. Lantus is best with a consistent dose.

Are you saying that the AM & PM dose need to be identical? Because a dose of 3U has the potential to bring him too low in the daytime, and the evening dose may have to go up because currently it doesn't seem to correlate to any BG change whatsoever. Unless I'm missing something, he appears to need less during the day than at night, where it doesn't seem to make any difference what the dose is.

 

[AZJenks]

I just took a look at your spread sheet, and your doses are inconsistent which results in the shed draining, and refilling as Deb mentioned. Lantus needs to be consistently dosed in order for it to work properly, and for it to help bring those #s down.

Does that mean that if he's getting 3U at night he should also be getting 3U during the day? What if he needs different amounts? For instance, on 2/23, 3U in the morning brought him down to 47. So while he may not respond at all to 3U at night, 3U during any given daytime period could potentially bring him too low.

May I suggest trying an experiment of perhaps feeding the 2nd meal a bit closer to the first, say at around +5 instead of +6. The extra hour stretch may help to bring those PS #s down, it also may help for his pancreas to work along with the insulin, and it'll give him an extra hour to sleep, too, since you're having to rouse him in order to feed him. Some cats are fed only 2x/day. Mine is fed PS, and +1, and she goes 11 hours without food. Like I said, it's only an experiment, and if it doesn't work, you can always go back to the way things are.

I'm open to trying anything to get him regulated. Given the things I've had to do so far, changing food by 1 hour is among the easiest! Can you help me understand how changing the mid-cycle feeding time would have an impact on BG?

There are two main reasons behind 4x daily feedings. First, to stabilize his weight. Through the diabetes process, he shed nearly 1/3 of his weight. Even today, he's down 2lbs from when he was first diagnosed. Our priority was to maintain and that meant providing him with plenty of opportunities to eat throughout the day. The second was to mitigate his constant begging for treats. His other human is powerless to resist him, so I figured that if he ate regularly throughout the day, he wouldn't have the urge to seek out treats. That part has not been as successful as I'd like. Given that he, at most, eats 1/2 can at a feeding (often less), that would mean he'd only get, at most, about 5oz per day with a 2x daily feeding. Is that going to be enough to sustain him at 20ish pounds?

I'm not sure what the carb content is of the Friskies that you're feeding him, and if its too high, you way want to consider switching him to a lower carb Friskies. With regards to the amount of food that you're giving him, you may want to start measuring it on a scale, instead of eyeballing it. This would also require you weighing him so that he doesn't gain too much, and you definitely don't want him losing weight, either. Sometimes, all these little things make a huge deal on trying to bring down those #s, and getting him regulated. Right now, he needs food until his #s come down, and then when he does, he'll start to not want to be as ravenous. But it takes time, and a lot of patience.

He only gets the classic pate styles, which are among the lowest carb versions in the brand according to the food spreadsheet floating around here.

 

[Deb & Wink]

How am I ever supposed to find the nadir If it isn't halfway through the cycle and can be a moving target? How many tests am I supposed to subject him to and with what frequency to find it?

The +5 to +7 hour range after the shot, is only an average time for the nadir or low point in the Lantus insulin cycle. By doing some testing an hour or 2 before the +6 and an hour or two after the +6, you'll get a better idea of what the nadir may be for Jenks. You do not need to do this testing all in one day. You can spread it out.

For example, one cycle test at +5 and +6. Another cycle, test at +5 and +7, another cycle test at +6 and +7, another cycle test at +4 and +8. The idea is to pick some random times outside of that +6 test to fill in some of the gaps in your testing.

You know your schedule best, so think about when you could fit this type of testing into your busy life. You may need to spread out the testing over a week or more.

Some cats even nadir earlier than the average +5 to +7. My Wink had his nadir around +3 to +4. Some cats nadir later. Around +8 to +10.

If you have a day where you'll be home, doing a curve may be beneficial. That would be testing every 2 hours, starting with the pre-shot test and keeping the testing going every 2 hours until the next pre-shot test.

 

[Deb & Wink]

Deb & Wink wrote:
You keep switching back and forth from 2U in the AM to 3U in the PM. That is simply allowing the insulin depot to drain and refill constantly. Lantus is best with a consistent dose.

Are you saying that the AM & PM dose need to be identical? Because a dose of 3U has the potential to bring him too low in the daytime, and the evening dose may have to go up because currently it doesn't seem to correlate to any BG change whatsoever. Unless I'm missing something, he appears to need less during the day than at night, where it doesn't seem to make any difference what the dose is.

Does that mean that if he's getting 3U at night he should also be getting 3U during the day? What if he needs different amounts? For instance, on 2/23, 3U in the morning brought him down to 47. So while he may not respond at all to 3U at night, 3U during any given daytime period could potentially bring him too low.

With the depot type insulins like Lantus and Levimir, the dose should be consistent for the AM and PM shots. If 3U is too much, then you may want to try 2.5U.

This sticky, from over in the Lantus (glargine)Tight Regulation forum, explains the insulin depot and why it's important to be consistent with the dose.

Also, that 47 you got could have been a bad test. If you get a number that seems out of line with previous testing, either too high or too low, it's a good idea to get another test right away.

 

[Larry and Kitties]

If small difference between AM and PM dose work best for your cat then do that. My Baily has more PM and that was best for him.

 

[AZJenks]

Also, that 47 you got could have been a bad test. If you get a number that seems out of line with previous testing, either too high or too low, it's a good idea to get another test right away.

Though I didn't notate it on the spreadsheet, that reading was confirmed by a second test at the time.

 

[Donna & Doogle]

If you cant get someone else to test at AMPS, then why not try and change the shot time so you can get it in? Not testing before shots is dangerous. I will tell you if I had not been testing at times I would have lost my kitty. On several occasions my cat Doogle would actually have two nadirs. When it was AMPS he was in the 30s and 40s. I would have probably killed my cat. So why not try and change the shot time so you can get the test in. The others are right though, Lantus needs consistency. You dont base the dose on the preshot, its based on the lowest point. If 2u isnt enough and 3u looks like to much, then try 2.5u. But some of the higher numbers could be a bounce but without more data its to hard to tell. Changing the dose is depleting the depot and then filling it and then depleteing it again. So the wonky numbers can happen from the constant change in dose. Once you start staying with a consistant dose, get a curve in after sticking with it for several day. Test every two hours and feed as normal. This will give you a good idea on how the insulin is working in the system. You will want to do this for a full cycle (12 hours). If you only have the one cat, try maybe going with Fancy Feast classics. They are actually lower that Friskies in carbs. Several are below 5% in carbs. Here is a list of FF that are 5% or lower:

4% - fancy feast CLASSICS chicken feast-
4%- fancy feast chopped grilled feast pate
2%- fancy feast cod, sole & shrimp feast pate
4%- fancy feast Ocean Whitefish and tuna pate
1% -fancy feast Savory Salmon feast pate
5% -fancy feast Tender beef feast pate
5% -fancy feast Tender beef and chicken feast pate
5% - fancy feast Tender beef and liver feast pate
4% -fancy feast Tender liver and chicken feast pate
3% - fancy feast Turkey & giblets feast pate
5% -fancy feast salmon and shrimp feast
4% -fancy feast kitten tender turkey feast
5% - fancy feast kitten tender ocean whitefish feast
5% -fancy feast chunky chicken feast

You may have better luck with it. :smile:

 

[Wendy&Tiggy(GA)]

I wouldn't change foods until you can get more tests in. I worry he is dropping low and you are missing it as I think he may be bouncing off lows. Plus dosing consistently same dose AM and PM is very important with lantus. If you find that dose takes him too low, then that dose is too high. But should be the same dose twice a day.

I usually recommend 3-4 tests a day to get a real good idea of whats going on..

- always before the shot - this is mandatory as you don't want to shoot when too low. As a newbie this too low number is 200 but is reduced over time once you have the data to know if its safe.
- mid cycle - 5-7 hours after morning shot depending on your schedule. This is to see how low the cat’s blood sugar is going. The low point "nadir" is what you base dose changes on since you don't want the cat dropping too low (under 50).
- before bed (2-3hours after Pm shot) to get an idea of what the cat's overnight plans are. If this number is less than the pre shot test number you may want to set the alarm for a test a few hours later as this implies an active cycle.

But you said you aren't around to test at AMPS - is there a way you can move the shot time? Or test before you go out? If you let us know an approx schedule we might be able to help.
Wendy