Binx - A Few Questions

[kelsey&binx]

Hello Everyone! Binx and I are back since his diagnosis last month. I've felt we were really managing things well until recently. I'm wondering if I'm just being too critical, as I know it's a marathon and not a sprint. But I had some questions to see if I can be doing anything differently or better for Binx.

1. Food - He's currently on Friskie's Pate. Sometimes a bit of Dr. Elsey's kibble as a treat and churu treats. If I'm desperate to either distract him or get him to eat, I will also give some of the Delectables Gravy food toppers. I'd like to help his numbers go even lower. Would a change from Friskie's to Fancy Feast make a difference, since I'd only be going from 4-6% carbs to 0-1%? I read up on the low carb vs. no carb info, but that seemed to indicate it making a difference in the reverse direction.

2. Monitoring - I was set to go out of town this weekend for the first time since he was diagnosed. He's not bad for me to BG test, but he's really a one woman man, so I put a Libre on him Monday afternoon so we could use that to dose his insulin while I was gone (my trip was unrelatedly canceled, so I've been able to continue to test him this weekend.) But since I've had that on, I feel like I'm either over-analyzing so much data or now just having enough data to see that his BG isn't trending the way I'd like it to. Very frequently, his BG will not drop at all after his insulin dose, or even will go up! I don't feel like I'm seeing a "curve" like should be expected. I'm not sure if me having my first fur-shot Tuesday morning has anything to do with the days since then being pretty high.

Also, the Libre is frustratingly inaccurate, consistently 40-70 points higher than what he reads on the meter. Is this common or could I have a bad sensor? I'm trying to figure out if I need to factor this in when I'm instructing on how to dose when I actually do go out of town in a few weeks. I can attach his Libre data if that's helpful, although I have the hourly average entered into Binx's spreadsheet as well. Thank you!

 

[Wendy&Neko]

Most of us feed in the 3-5% carbs range. Each can, due to manufacturing differences, might be out a couple % from what is posted, so I wouldn't worry about just a couple point difference in carbs. A couple things to consider though. Some cats are very carb sensitive, and some not. You have to learn what works for your cat. You can try a couple cans of a lower carb food and see if it makes a difference. Track carefully food experiments in the Remark section of the spreadsheet and see if you notice a difference. Food experiments can take a couple weeks to see something. Some people found they couldn't feed the Dr. Elsey's because it bumped the numbers too much. But ECID - every cat is different. And another thing to throw in the mix, some cats do better on slightly higher carbs, this post has more on that topic:

• Feeding Low Carb vs Lower Carb Foods

I am really happy the Libre was not around in my time, and that it was hard for me to get test strips. I cross border shopped for test strips, had to plan lots in advance. It got me to learn my cats cycles and learn to be strategic about when I really needed to test. I spend quite a bit of time analyzing Neko's spreadsheet, especially before bed, trying to answer the question "is it safe for me to sleep the night through".

Your are right that often the Libre doesn't always match the blood glucose meter. Manufacturers are allowed to be about 20% out, so if kitty is above 200, that can be as much as 40 points. But both 200 and 240 are still above normal numbers and it doesn't matter whether it's 200 or 240. Where you really need to care is those numbers under 100. Many people actually report the Libre reports lower than the hand held meter. We recommend comparing the two types of meters in numbers under 100 as that is where you may need to take action with food.

Since Lantus is a depot style insulin, a fur shot or reduced shot will impact how the cycles play out. More here: What is the Insulin Depot? Another thing to consider is the phenomenon we call bouncing, which is something cats do and is very common. Definition here:

Bouncing is simply a natural reaction to what the cat's system perceives as a BG value that is "too low". "Too low" is relative. If a cat is used to BGs in the 200's, 300's, or higher for a long time, then even a BG that drops to 150 can trigger a "bounce". Bouncing can also be triggered if the blood glucose drops too low and/or too fast.The pancreas, then the liver, release glucogon, glycogen and counter-regulatory hormones. The end result is a dumping of "sugar" into the bloodstream to save the cat from going hypoglycemic from a perceived low. The action is often referred to as "liver panic" or "panicky liver". *Usually*, a bounce will clear kitty's system within 3 days (6 cycles).

Think of bounces as a chance for you to ease up on testing and get out of the house and do something for you.

 

[kelsey&binx]

Yeah I’m thinking it’s a combo of the fur shot and just having much more data than I’ve had since we started. Now I’m over-analyzing!

I guess my big-picture question, and probably one that is ultimately for my vet, is what is the overall goal here? I would obviously love for him to go into remission, but I know that’s not always achievable for every cat. But are where his numbers at now good? Should I be changing things up, striving for better numbers?

I know I’m lucky we’ve not gotten close to a hypo scare yet. But that makes me think his numbers are too high consistently?

 

[Wendy&Neko]

First thing you have to do is decide if you want to follow the vet's guidelines for dosing, or follow one of the dosing methods we use here for Lantus. More detail here: Dosing Methods: Start Low, Go Slow (SLGS) & Tight Regulation (TR). The locum vet that got me switched to Lantus from Caninsulin told me to follow what was done on FDMB. . If you were following one of the dosing methods here, it looks like you could increase the dose to 1.25 units. We don't use the sliding scale the vet has told you to follow as we find it can lead to wonky numbers for Lantus.

The more time that Binx can spend in normal blood sugar numbers, the higher the chances for remission. First step before remission though, is getting him regulated and spending more of his time under 200. It doesn't look like 1 unit will do that.

If you do a fur shot, could you put FS (fur shot) in the units so it's easy for us to find. Reducing the dose in any way does impact the depot and can have an impact on what we might suggest for dosing.

 

[kelsey&binx]

I got some Fancy Feast and he likes it, so we will try that for a bit to see if that helps. I don't give him much Dr. Elsey's - just 8-10 pieces every now and then as a snack/treat.

So following the SLGS, I would do 1.25U regardless of the preshot number, as long as it's over 200 and nothing if under 200?

 

[Wendy&Neko]

So following the SLGS, I would do 1.25U regardless of the preshot number, as long as it's over 200 and nothing if under 200?

Yes on the 1.25 units.

When you are new to SLGS, you don't shoot under 200. Once you have more data, there is a section further along that document that gives you alternatives for lower preshot numbers. Eventually, you don't shoot if under 90, but obviously with a lot more data on how Binx responds, and you lower that number gradually.

 

[kelsey&binx]

Ok perfect! I just uploaded more Libre data into his sheet and I hate seeing him not being below 200 in days. I’m going to try this out, thank you so much for your help!