? Bouncing

[Ter and Sally]

Hi new to group Terri and Sally, also called The Bee. Has anyone had a quick drop on Lantus? I wasn't expecting that could happen. We test with Alpha Trak.
A very brief background: Sally is about 12, diagnosed as diabetic July 2014. BG then was in the high 400's and fructosamine was over 600. I started her solely on FF Classics and then on PZI a few days later and she was in remission in 2 weeks. She stayed in remission until late summer this year.
Late August she just seemed a little different, her coat was dull and getting a little matted, which happens to her in late summer but not as pronounced as it was this year. No pu/pd as when she was diabetic the first time. Slight weight loss we noticed of only a few ounces. Tough to weigh because we don't have a baby scale here, I get accurate weight at work when I need to but she doesn't do well in the car (I'm a vet derm tech).
Bloodwork was all normal, US showed what I was told was abnormal pancreas but typical of a cat that is diabetic. I know the US doctor personally and he is the best in the area so feel confident about the comment. BG was 290 from the lab but fructsamine was in the 400's showing good regulation prior couple of weeks. UA did have glucose but no infection present. No pu/pu; as a matter of fact since she had been on FF in two years I swear we never saw her drink, and she only now drinks once in awhile.
The vet that cares for her would normally not start a cat on insulin with those results except for the ultrasound and the fact that she was already on low carb food.
Two choices Lantus or PZI-we started PZI because we knew she had gone into remission on that. He wanted her to go on 1U bid which I thought was high for her numbers. The day I started her amps was 222; I jumped in with both feet and gave her the 1U. She was great all day. I tested her pmps was 57 so I said no shot tonight we'll retest later and start on 0.5 U in the morning.
From then on we have been on a rollercoaster.
We tried the 0.5, then went to 0.25, numbers were not consistently in normal range and she kept bouncing. We found this out when doing the curve with 1 full unit; the only time she has had high numbers is when her dose increased. We finally had her backed down to 0.25 bid but numbers were now in the 300's and 200's with no long duration.
Brought her to work a few days before Christmas to check her weight and run blood. She had weighed 8.25 # in late September before we started insulin and now weighed 8#. She looks good at that weight but weight loss has to be from the high rebounds I would think. Fructosamine which been normal was now in the 500's, fair regulation. UA normal, but obviously glucose detected.
Decided to finally go with Lantus. The vet had already suggested it before Christmas; he had also mentioned it about a month into the PZI but from reading posts here I thought it may be too early to change.
Started Lantus last Saturday. He wanted to go with 1U but I was fearful of that because of our PZI experience. Started her on 0.5. Amps was 358 at 6:45. Because it was the first day and I had read about the depot I didn't test until later; pmps was 138, Didn't give the evening shot. Regrouped for next day to give 0.25 a try to start and glad I didn't do the 1U.
I thought last week that this was going to be a nice comfortable insulin for The Bee. She looked better to me, although it may be my imagination ever thinking she looked worse because I knew her numbers.
Lacking the ability for spreadsheet at the moment: Sunday went this way-Amps 395, 2:30 270, pmps 248. Monday: Amps 164, 10:45 124, 11:45 108, 12:45 160, 1:45 154, 6:45 272, Tuesday amps 300.
For Tuesday and Wednesday we were able to just do the am and pm bg's which were in the 300's in the am and 200's in the pm.
Thursday we started at 324 amps, 12:45 was 154 and the pmps was 179. We gave the 0.25U as normal and were of course disappointed when we did yesterday amps and it was 446. In our experience with her this usually means rebound so we stayed with our dose. Pmps last night was 554 and we were devastated. We kept with the 0.25 because of the depot and because it has only been a week on this. Stayed up the best we could to test her.
Rapid drop from the pmps (at 6:45) to 8:45 last night when her bg was 378. By 9:45 she was 444 then stayed in the mid to high 300's for the rest of the night. This morning she was 386. We thought the depot brought her down too fast now that she has some insulin stores. Decided to try 0.125U and see how it goes today.
Did we make a mistake?
I'm so very sorry about this long post; I tried to be as brief as possible especially since I don't have a spreadsheet. Her numbers are going down today but probably due also to the depot from this week. Trying to prevent rebound....which she consistently had on PZI and we thought this would be different. I am fearing that our reasoning is starting to go out the window and wanted to ask for your help. Are we nuts going to such a low dose so soon? I think my vet would think so but I know how vets are and to be fair he doesn't know her and her body like we do. She didn't drop drastically today. Amps today 386, 8:03 391, 9:06 261, 10:00 339, 11;06 322.

 

[tiffmaxee]

Welcome. I suggest you read the lantus stickies, SLGS, TR, and shooting low numbers. Your BG readings are nowhere close to normal which on a human meter is 50-120 and slightly higher on a pet meter. The dosing is based upon whether or not dry food is being fed and the nadir, and not based on preshot numbers or how fast they drop. If feeding dry food the only approach we suggest is SLGS. So what are you feeding her? How often can you test?

If you need help setting up your spreadsheet there are folks here that can help. All you need first is a google account. Let me know and I’ll tag some people to help you.

So Sally is not getting enough insulin in my opinion. Achieving a second remission is harder than a first and you need to be more aggressive. Lantus can onset anywhere from +1 to +3. Take a look at a typical cycle in the stickie.

 

[Ter and Sally]

Hi thank you. I've actually read the stickies, before we started the Lantus and we are doing SLGS. She only eats FF classics. Not necessarily looking for remission, I know it's possible but being in vet med for so long know that it's not always achievable, lots of variables. Just looking to stabilize and get off the rebounds. Just really confused because every time we have raised insulin dose she has plummeted and rebounded.
And really working on exhaustion to be honest.
And yes, we are not changing the dose of Lantus based on pre shot numbers that's why we stuck with our starting dose until today; we were getting normal range numbers this week until what we think was a typical Sally rebound overnight Thursday.
I'll try to set up a google account, thank you.

 

[tiffmaxee]

When you say she plummeted, how low did she go? So your last cycle shows she’s not within the desired renal threshold. I hope you do set up a spreadsheet as tgat data will help us help you.

 

[Ter and Sally]

When on PZI she would go down to 50/46 and then rebound; her nadir would be about +5; that was on 1U. We had tried the 1U twice in these last 4 months. Even on 0.5U she started going down quickly in the cycle and then would shoot up, for instance on 12/23 she went down to 83 by 11:15 and was back up to 187 by 12:15. This is why I suspect rebound now even though I understand Lantus is totally different from PZI.
My reading from Thursday 1/18 was Amps 324 (6:45 am). We test/feed/shoot. We have been giving 0.25U, so did the injection. My husband was able to test at 12:45 and that was 153. Happy with that, and the Pmps at 6:45 pm was 179. Did the injection of 0.25 at 7 pm as usual. Next morning Amps was 446 so assumed had rebounded overnight but thought best to continue dosing as we have been doing because just starting. What I think is a plummet was that her Pmps was 554 at 6:45 and after giving my 0.25 u as usual she was 378 at 8:45 only 2 hours later. I thought that was a lot in 2 hours---I was looking for a slower onset I guess.
Way didn't expect even that 500 reading especially since when I got home last night she looked great and did her normal stuff. You;s never even know there was anything going on with her. Like I said no pu/pd or anything that upon looking at her seems out of the ordinary.

 

[Ter and Sally]

When you say she plummeted, how low did she go? So your last cycle shows she’s not within the desired renal threshold. I hope you do set up a spreadsheet as tgat data will help us help you.

She is higher today (300's) than she has been all week but I am thinking that is more because of what I think is the rebound effect which would make those numbers stay higher for a few more days, if I read the stickies right. Just scared at the up and down, going from the normal ranges this week to the 400/500--wouldn't that be harder on her body going up and down so much and would it be better to try to bring those numbers back down slowly?

 

[Ter and Sally]

When you say she plummeted, how low did she go? So your last cycle shows she’s not within the desired renal threshold. I hope you do set up a spreadsheet as tgat data will help us help you.

One confusing thing about this is that she has had higher numbers since I started her back on insulin.

 

[Steph & Quintus & L & O]

One confusing thing about this is that she has had higher numbers since I started her back on insulin.

could be because of the bouncing?

 

[Sienne and Gabby (GA)]

Welcome to the group, Terri.

I hate to be a pain in the neck but I am so acculturated to reading spreadsheets that I'm having a tough time following text information. In part, we don't use the time on the clock. We describe time based on how many hours your are from shot time (i.e., +2 is two hours after an injection). If there's any way you can transfer all of your information to a spreadsheet it will be a huge help to those of us that routinely open your spreadsheet before we make any suggestions.

To answer your question about whether anyone has had a quick drop on Lantus, let me ask for a bit of clarification. Do you mean:

• a drop after only a few days of using Lantus
• a drop early in the cycle
• a fast drop in numbers

In retrospect, it may not really matter which of those questions you were asking since the answer to al of them is "yes." Some cats have a marked response to a change in insulin. Some cats using Lantus have an early nadir -- my cat's nadir was at +3 except those times when it wasn't. And, numbers can swing wildly. Gabby had at least one cycle where her AMPS was in the 400s, she dropped to the 40s, and she bounce back into the 400s by PMPS. If I didn't understand your question, let me know what I missed.

Bounces (which is what we call what I think you're referring to as "rebound") are normal for many cats. You're correct in that some cats don't feel particularly great due to swings in numbers and others don't seem to mind. With Lantus, the lovely flat, regulated cycle doesn't often happen overnight. It can take months.

 

[Ter and Sally]

Welcome to the group, Terri.

I hate to be a pain in the neck but I am so acculturated to reading spreadsheets that I'm having a tough time following text information. In part, we don't use the time on the clock. We describe time based on how many hours your are from shot time (i.e., +2 is two hours after an injection). If there's any way you can transfer all of your information to a spreadsheet it will be a huge help to those of us that routinely open your spreadsheet before we make any suggestions.

To answer your question about whether anyone has had a quick drop on Lantus, let me ask for a bit of clarification. Do you mean:

• a drop after only a few days of using Lantus
• a drop early in the cycle
• a fast drop in numbers

In retrospect, it may not really matter which of those questions you were asking since the answer to al of them is "yes." Some cats have a marked response to a change in insulin. Some cats using Lantus have an early nadir -- my cat's nadir was at +3 except those times when it wasn't. And, numbers can swing wildly. Gabby had at least one cycle where her AMPS was in the 400s, she dropped to the 40s, and she bounce back into the 400s by PMPS. If I didn't understand your question, let me know what I missed.

Bounces (which is what we call what I think you're referring to as "rebound") are normal for many cats. You're correct in that some cats don't feel particularly great due to swings in numbers and others don't seem to mind. With Lantus, the lovely flat, regulated cycle doesn't often happen overnight. It can take months.

No pain in the neck at all! I've been busy setting up my spreadsheet!! And sorry, I wrote my bg's and I forgot to do the +1etc, I knew that and just forgot, so tired. It was even tough for me to read when I looked at it. And your answer is very helpful. And yes I meant bounce sorry---

The question about the drop was a quick drop in numbers. Last night there was a drop of about 175 in + 2 and it looked like it brought on a bounce. I thought that drop was too fast?

Tiffmaxee had mentioned help in setting it up but my husband figured out how to get the app, a real process of you are using a Fire tablet. I just don't know how to get it to you now. So I need help with that!

I started with my PZI experience when we first started. I wish I could have shown her bg numbers prior to starting because they were the most consistent. But I suppose even though she was lower than renal threshold and her fructosamine was normal and would have been coming out of remission anyway it was correct to start her on insulin.

could be because of the bouncing?

That's what I think but why bounce? Used to higher numbers? Too rapid movement of numbers? Or did she get real low as she has in the past??

 

[Steph & Quintus & L & O]

I just don't know how to get it to you now. So I need help with that!

In the app, when you're on your spreadsheet, look for an option somewhere that says Share & Export, and see if there is "Link sharing" in there. Turn that on, if there is. You want "anybody with the link" to be able to read (not edit). Once Link sharing is on, look for a menu item that says "Copy Link" (it might be just under Link sharing).

Then you can paste that link here, or even better, edit your signature and put it in there with a summary "bio" of your cat (like you'll have seen that other people have): Signature

That's what I think but why bounce? Used to higher numbers? Too rapid movement of numbers? Or did she get real low as she has in the past??

Either... or... Hard to say, seeing the spreadsheet might help people give you a better guess.

 

[Ter and Sally]

In the app, when you're on your spreadsheet, look for an option somewhere that says Share & Export, and see if there is "Link sharing" in there. Turn that on, if there is. You want "anybody with the link" to be able to read (not edit). Once Link sharing is on, look for a menu item that says "Copy Link" (it might be just under Link sharing).

Then you can paste that link here, or even better, edit your signature and put it in there with a summary "bio" of your cat (like you'll have seen that other people have): Signature



Either... or... Hard to say, seeing the spreadsheet might help people give you a better guess.

Thanks!!!! Just did that!!!!!

 

[Sienne and Gabby (GA)]

Thanks -- your spreadsheet (SS) can be seen.

Bounces occur for several reasons. The numbers may drop low (e.g., in the 40s). The numbers may drop into a range your cat isn't used to spending time in. So if your kitty is typically in the 300s and drops into the 100s, her body may overreact. The other reason is because there is a fast drop in numbers.

A bounce is a protective reaction. Your cat's liver and pancreas interpret any of the above changes as dangerous (i.e., potentially hypoglycemia) and a stored form of glucose (i.e., glycogen) along with counterregulatory hormones are released. This caused BG levels to rise. It can take approximately 3 days for the bounce to clear. As our kitties become better accustomed to being in a normal BG range, the bounces clear more quickly and the bouncing levels out.

I want to strongly encourage you to get at the minimum a before bed test every night. Many cats like to experience lower numbers at night. In addition, if you don't test during the PM cycle, you are missing half of your data and you don't know if Sally is in safe numbers.

 

[Ter and Sally]

Thanks -- your spreadsheet (SS) can be seen.

Bounces occur for several reasons. The numbers may drop low (e.g., in the 40s). The numbers may drop into a range your cat isn't used to spending time in. So if your kitty is typically in the 300s and drops into the 100s, her body may overreact. The other reason is because there is a fast drop in numbers.

A bounce is a protective reaction. Your cat's liver and pancreas interpret any of the above changes as dangerous (i.e., potentially hypoglycemia) and a stored form of glucose (i.e., glycogen) along with counterregulatory hormones are released. This caused BG levels to rise. It can take approximately 3 days for the bounce to clear. As our kitties become better accustomed to being in a normal BG range, the bounces clear more quickly and the bouncing levels out.

I want to strongly encourage you to get at the minimum a before bed test every night. Many cats like to experience lower numbers at night. In addition, if you don't test during the PM cycle, you are missing half of your data and you don't know if Sally is in safe numbers.

Thanks -- your spreadsheet (SS) can be seen.

Bounces occur for several reasons. The numbers may drop low (e.g., in the 40s). The numbers may drop into a range your cat isn't used to spending time in. So if your kitty is typically in the 300s and drops into the 100s, her body may overreact. The other reason is because there is a fast drop in numbers.

A bounce is a protective reaction. Your cat's liver and pancreas interpret any of the above changes as dangerous (i.e., potentially hypoglycemia) and a stored form of glucose (i.e., glycogen) along with counterregulatory hormones are released. This caused BG levels to rise. It can take approximately 3 days for the bounce to clear. As our kitties become better accustomed to being in a normal BG range, the bounces clear more quickly and the bouncing levels out.

I want to strongly encourage you to get at the minimum a before bed test every night. Many cats like to experience lower numbers at night. In addition, if you don't test during the PM cycle, you are missing half of your data and you don't know if Sally is in safe numbers.

Thanks Sienne we go to bed super early because of my horrible commute to work so can do that on the weekend. we are going to get as late as we can tonight. The difference in looking at those numbers on the ss and just on paper is incredible. when she was in remission her normal bgs ran in the 117-120 range and nadir was around +4 or +5; she only had a couple of readings of 90 or thereabouts. Average nadir was 120-130. Does it make sense that this would be a possible bounce number for her now? Or now that she is out of remission may things be a whole new situation maybe? Just for your opinion, I know nobody can really have a set answer, I'm just sick of hearing my own thoughts! I keep looking at her bgs from just before we put her on insulin and they were so much better back then than they have been on average now I keep wondering if I should have delayed putting her back on or if I am just kidding myself. Probably the latter. If she really didn't need it I would think she would be having the numbers she had back when she was going into remission.
After remission we kept her on q 12 hour feedings no deviation and no treats, we treated it just as though she were still on insulin. My big fear is not just the possibility of hypo but the high bounce numbers, they scare me mostly because many years ago I lost a diabetic kitty to a spike while I was at work. My husband found him seizuring and I was able to come and get him and bring him to work because I worked only 7 miles away at that time, but there was really nothing we could do being a small non emergency practice. He was so high he didn't register on the glucometer. Those high numbers just frighten me. Although things are so much different nowadays, this was back before longer acting insulins and PZI. And before we started better control with canned food.
Looking at my numbers I really don't know what to think! But it seems as though she doesn't necessarily bounce off the higher numbers but at the lows.
I feel like I have to get this under control now but I know you can't rush it. Just getting tired from the strain. And I don't even have the issues that a lot of people are dealing with here, so bless everyone.

 

[Sienne and Gabby (GA)]

Let me clarify -- the lows cause the bounce. Sally's liver and pancreas "panic" and dump glucose into her system which caused the numbers to spike. For example, the 48 on 11/11 resulted in numbers bouncing to 599 at PMPS.

Let me toss out a couple of ideas... Can you get your AMPS earlier? That way your evening shot time is a bit earlier and you can get some additional tests? Does your husband go to sleep at the same time? Could he get a test in? Even if you get a test at PM +2, that could let you know if Sally's numbers are dropping.

I'm not sure why you're lowering Sally's dose. I don't see any numbers that indicate her dose needed to be lowered.

Just an observation about your note on Sally's spreadsheet. It is entirely possible for a cat to have a pre-shot value in the 400s, drop to the 40s by mid-cycle, and be back in the 400s (or more) by the next shot time. If you don't have the opportunity to watch the low number, you can end up increasing the dose when a dose reduction is indicated. I'm not saying that this is what happened yesterday but it's a possibility.

 

[Ter and Sally]

Let me clarify -- the lows cause the bounce. Sally's liver and pancreas "panic" and dump glucose into her system which caused the numbers to spike. For example, the 48 on 11/11 resulted in numbers bouncing to 599 at PMPS.

Let me toss out a couple of ideas... Can you get your AMPS earlier? That way your evening shot time is a bit earlier and you can get some additional tests? Does your husband go to sleep at the same time? Could he get a test in? Even if you get a test at PM +2, that could let you know if Sally's numbers are dropping.

I'm not sure why you're lowering Sally's dose. I don't see any numbers that indicate her dose needed to be lowered.

Just an observation about your note on Sally's spreadsheet. It is entirely possible for a cat to have a pre-shot value in the 400s, drop to the 40s by mid-cycle, and be back in the 400s (or more) by the next shot time. If you don't have the opportunity to watch the low number, you can end up increasing the dose when a dose reduction is indicated. I'm not saying that this is what happened yesterday but it's a possibility.

We lowered the dose today because we thought she was getting too much and that caused a bounce, and those high numbers scared us. We were afraid of her continuing to repeat those high numbers. She was high all last night and it scared me to death.
I'm the shot giver so we do the am and pm based on when I get home from work. We always do the pmps at around 6;45 pm because I am most likely to be home by then. So the am is at 6;45 too. We can probably just try to get a later check in because of the necessity.
I was thinking of seeing what the lower dose does in 3 days. I liked those blue numbers, I'm just afraid of the black!!!! In either case that was a knee jerk reaction this morning from no sleep and fear of getting into black numbers. We are probably being too conservative and not being logical enough. I know being logical is not my strong point
The PZI experience made me start to feel sick every time we had to check her; so last week I started to feel real good when I saw nice numbers so evenly. Then yesterday!!
We will be doing a +2 in a few minutes.

 

[Ter and Sally]

Last night's +2 was a drop of 176 and tonight's was a drop of 49. We gave the 0.125 tonight to be consistent. Does it seem possible that that amount could form an acceptable depot that would bring her into numbers that could match the ones we saw on 0.25 and not have her drop so quickly or does it appear that I'm deluding myself? I thought that the stored insulin in her body was too much, am I thinking incorrectly?Forgot to say tonight's +2 was 340 so not much change in today's numbers.

 

[Sienne and Gabby (GA)]

Lowering the dose, in the long run, will not avoid a bounce and will cause Sally to sit in those high numbers that scare you.

I think part of what you're experiencing is a difference in the way Lantus versus other types of insulin work. Aside from Levemir, every other insulin has shorter duration. Thus, if you adjust the dose, you see an almost immediate response. That's not the case with Lantus. Lantus and Lev are depot types of insulin. It's the depot that gives the insulin its duration. Loosely speaking, it's like a storage tank. It causes Lantus to be gentler but it's less potent (i.e., no immediate response like an insulin with a shorter duration). It won't yank down numbers and you won't necessarily see a drop in numbers during the current cycle if you reduce the dose. Insulin cycles overlap and the dose effect is cumulative.

If you have the time, take a look at other member's spreadsheets. You'll see that bounces resolve without dropping the dose. What you're doing by reducing the dose is what some vets recommend to address chronic Somogyi rebound. The tactic doesn't work and ends up leaving the cat in high numbers overly long. (The entire concept of Somogyi was first introduced in 1938 based on a sample of 5 humans. It's never been replicated in cats and it certainly doesn't apply to longer acting insulin like Lantus.)

I do understand your fear of high numbers what you've been through. I've seen cats with high numbers here. We've never lost a cat to extreme hyperglycemia (or symptomatic hypoglycemia, for that matter).

 

[Ter and Sally]

Hi Sienne,
I was starting a message to you when I saw your message pop up.
Got some sleep last night so feel a lot better today. I was resolved to go back to 0.25 U based on your assessment. Our drop in dose was emotional--there was no basis in reality for that decision, just emotion and tiredness. Looking at that spreadsheet I could imagine what may have happened since those nice numbers the other day. And I saw that the bounce did flatten itself out over Friday night and would have probably (I'm guessing) brought her back to maybe the 200s yesterday instead of the 300s. More harm done with a couple of days of 300s than one or two spikes am I right?
And yes the dose reduction; we always used to do that with dose reductions assuming Somogyi and you hit the nail on the head--that's what's been on my mind and that's what we based our reductions on. I had always thought the Somogyi was a fact for animals till I read a little about the study, I think it was very limited and never reproduced again right? Having you tell me that just wiped away a bunch of stress.
ALSO you said exactly what I needed to hear about spiking. And I will take a look at the spreadsheets too to get a broad feel for what happens with everyone else. That's a great thing to be able to know that you are not alone.
And being able to look at my own spreadsheet over the course of 4 months and then this past week, I heard you saying, I didn't see a reason to decrease her dose...and said yeah that's stupid. It's great if I want to give her injections bid and keep her over the renal threshold! And knowing that everybody else bounces makes her not so unique. I couldn't figure out what was so funky about my cat that she kept doing that!
We were also expecting NO bounce on Lantus because we thought it was unique for Sally, being her response to PZI. I expected that nice even day like we had once this week to be a given. Didn't realize it can take even a couple of months.
So today Amps was 388 and we gave 0.25 u. Great tip in the forum about how to dose by twisting the syringe instead of pushing; lowers my stress level at shot time but I still blew a shot!
I feel better today with this knowledge and can't thank you enough for saying the exact right things to me. You have been a voice of reason for a very frightened person and we thank you for it. And I'm sure Sally's father is happy that I can go to the forum instead of having my fears keep his fears company!
Note about Lantus vs PZI; we started her last weekend and we have noticed, regardless of her numbes, that she is more like her old self personality wise. Her body looks and feels different, her expression is more true to self. She is doing things again that we haven't seen her do in awhile. Very small differences but it does make you think.
We are going to (obviously) continue amps and pmps, and spot checks here and there and focus more on night time readings. When would you suggest a real curve?

 

[Gill & George]

Hello and welcome to the the group Terri and Sally

After remission we kept her on q 12 hour feedings no deviation and no treats, we treated it just as though she were still on insulin.

Am I understanding you correctly in that you are feeding just twice a day, at shot time??

 

[Ter and Sally]

Hi thanks and yes we have always fed everyone here twice a day. When Sally was first diabetic 2 years ago we were told and had read not to make any changes, that if she ate twice a day keep it that way so as not to disrupt anything she normally does. I had also read that most people continued whatever routine that was normal for them. I've also read that any change in amount feeding or frequency would change the insulin requirement so didn't want to do that while trying to regulate her.

 

[Sienne and Gabby (GA)]

You don't have to feed only twice a day. In fact, it may level things out more if you break Sally's meals into portions and feed her several smaller meals. I fed Gabby 3 - 4 times per cycle and I do the same with my non-diabetic cat. While there may be no experimental evidence, giving all the food at one time puts more stress on what could be a pancreas that's trying to heal. If Sally tends to have an early nadir, spreading the food out early in the cycle can offset a relatively sudden drop in numbers.

With shorter acting insulin, it's far more important to make sure food is on board when your giving insulin. Lantus onset is typically around +2 so you have far more time with respect to feeding.

(And the above thanks really aren't necessary. I'm glad to be of help. It's all very overwhelming -- especially when you have to change your mindset regarding how a new insulin works.)

 

[Ter and Sally]

Thanks so much! Our big debate here is over changing her feeding routine. If I do that now will it mess up my regulation or do we just figure that will be trial and error?
I changed to bid feeding with everyone years ago with my diabetic who was on short acting insulin and just never changed the routine over the years. Cats do better I think with a few small meals.
Realized this morning how low we are on test strips so saving what I have for a night reading.
Since I'll be testing more often what is your personal opinion on human meters? I've read some threads here but still nervous to change now. That's all we used to use in vet practice.
Alpha Trak strips are the same price even though I order them directly through the distributer at work.
ADW Diabetes is actually lower than what I can then for and sometimes I can get a tiny break depending on how much I order.

 

[Gill & George]

Hi thanks and yes we have always fed everyone here twice a day. When Sally was first diabetic 2 years ago we were told and had read not to make any changes, that if she ate twice a day keep it that way so as not to disrupt anything she normally does. I had also read that most people continued whatever routine that was normal for them. I've also read that any change in amount feeding or frequency would change the insulin requirement so didn't want to do that while trying to regulate her.

Prozinc works much faster than Lantus, and I believe, that feeding twice a day is more appropriate with that insulin. I believe that many CG will feed 30min prior to shot.

Lantus is slower acting, so the feeding schedule that works best for most cats is a little different, and may help reduce the sharp drops that you have seen by +2. Most do better (get flatter curves) with small regular meals.

I wrote the above yesterday, but I didn't hit the post button. Sorry.

Since I'll be testing more often what is your personal opinion on human meters? I've read some threads here but still nervous to change now

I'm sure Sienne will also give you her take on this, she's been here much longer than I. I started with a human meter, my vet suggested it.
My understanding from comparisons some members have made with human/alpha trak meters is that there is greatest discrepancy between the readings when a cat is in high numbers, but since with the dosing what we mostly dose based on how low the dose is taking the cat, it is less important, high is high after all.
The main difference if you were to swap would be the take action number for TR which is 50 with a human meter, versus 68 with the AT. If you have read the Romp Rand study on the TR protocol (this is the one I followed with George) it's interesting to note that all data for that was obtained with human meters. It might take some getting used to those lower numbers with the human meter, if you are used to the AT both at work and at home, I know my vet almost had a coronary the first time she looked at Georges ss and he was having nice lantus curves in the 60's 50's.

 

[Ter and Sally]

Prozinc works much faster than Lantus, and I believe, that feeding twice a day is more appropriate with that insulin. I believe that many CG will feed 30min prior to shot.

Lantus is slower acting, so the feeding schedule that works best for most cats is a little different, and may help reduce the sharp drops that you have seen by +2. Most do better (get flatter curves) with small regular meals.

I wrote the above yesterday, but I didn't hit the post button. Sorry.


I'm sure Sienne will also give you her take on this, she's been here much longer than I. I started with a human meter, my vet suggested it.
My understanding from comparisons some members have made with human/alpha trak meters is that there is greatest discrepancy between the readings when a cat is in high numbers, but since with the dosing what we mostly dose based on how low the dose is taking the cat, it is less important, high is high after all.
The main difference if you were to swap would be the take action number for TR which is 50 with a human meter, versus 68 with the AT. If you have read the Romp Rand study on the TR protocol (this is the one I followed with George) it's interesting to note that all data for that was obtained with human meters. It might take some getting used to those lower numbers with the human meter, if you are used to the AT both at work and at home, I know my vet almost had a coronary the first time she looked at Georges ss and he was having nice lantus curves in the 60's 50's.

Thank you so much for your input! We have felt bad all this time keeping her on twice a day feedings but at the time after going into remission I read that it would be best not to challenge the pancreas but to keep on the feeding schedule that we had been following while she was on PZI. For all the years we had her before she became diabetic she would get fed twice a day but maybe have a little snack if she wanted (she would come and get us and then lead us to the food bin and sit there till we gave her a few pieces) maybe mid day or before bed. Ironically we were watching her weight because we didn't want her to become diabetic! She was also fed Fancy Feast as well just not enough wish I had given her canned before but probably she is just genetically predisposed anyway.
The idea of feeding more often with Lantus makes sense--I just don't know what type of feeding schedule to start; maybe you could help me with a suggestion? She maintained a weight of 9 pounds steadily on 3 oz Fancy Feast twice a day. 9 I think was just slightly heavy for her but she did look ok, not really overweight and our vet thought it was an ok weight for her. When she started to come out of remission she didn't have pu/pd---in fact she still doesn't--- but when weighed at home she weighed about 8 1/2 pounds; her weight in September was 8.25 on the cat scale where I work. Her last weight was just before Christmas (at work) and she was 8 pounds. Great appetite and bloodwork was all normal. Just not regulated. I was afraid at that time to increase food, the vet had told me to stay the same because when she is regulated the weight will come back on. She actually looks good at 8 pounds and that is probably a good weight for her but I don't want her at a weight where it will put her in peril if it takes awhile to regulate her.
It sounds like with Lantus though I may not have to worry so much about "working" the pancreas in between injections like I would with PZI and I see that most people on the forum either have several snacks throughout the day or free feed.
Sorry about this long post....

 

[Mandy & Rex (GA)]

Welcome! I had to catch up on all information you have been given so I wouldn't repeat anything. Everyone has covered the bases.

As for feeding, if 6 oz total of food a day has maintained her weight well, then you can break that up into the number of meals you would want to give, ie 4 meals a day would be 1.5 oz per meal. If she continues to lose weight, then you can bump each meal up a little bit until she becomes more regulated and gains weight.

 

[Ter and Sally]

Welcome! I had to catch up on all information you have been given so I wouldn't repeat anything. Everyone has covered the bases.

As for feeding, if 6 oz total of food a day has maintained her weight well, then you can break that up into the number of meals you would want to give, ie 4 meals a day would be 1.5 oz per meal. If she continues to lose weight, then you can bump each meal up a little bit until she becomes more regulated and gains weight.

Thank you for that--I was so afraid of doing anything different with her schedule because I had been told that with diabetic cats you HAVE to keep to a schedule; it seems as though that really isn't true, and especially since ECID! I was afraid of giving her a little more food because I didn't want to have to worry about that affecting her dosing of insulin especially as we are trying to regulate her. We have been doing a lot of our thinking on limited sleep. I freaked when I thought she dropped below 8 pounds just before Christmas and that had us heading to where I work amidst an unexpected snowstorm just to pull blood and weigh her on the cat scale--of course her weight was still 8 and her blood (thank God anyway)was normal---I had visions of fatty liver even though there was no logical reason to base that on at that point.