? Buddy 0/21 AMPS 282 - Dosing thoughts?

[Kelly and Buddy]

Last post

I'm at a crossroads. I feel like I'm back where this all started. While Buddy's numbers weren't as high as when he was initially diagnosed, his peeing EVERYWHERE is as bad as it was back in April. He is still testing negative for ketones. Thankfully.

He's had 2 dose increases in 2 weeks. My weekend commitments last week prevented me for getting a solid 12 hour curve but I can do one this weekend. Based on comments here, I'm trying to decide how to proceed this weekend. Here are my options and thoughts:

1) Do I hold the current dose longer and get a full curve this weekend? Someone made a great point that Buddy could be dropping low during the day (or late at night) and that is causing a large bounce so I'm seeing those high preshot numbers. This crossed my mind and does concern me. On the other hand, there have been several occasions that Buddy was already rising at +4 which lead me to believe he probably isn't dropping. I'm so torn on this.

OR

2) Do I go ahead and bump him to 1 unit tonight, so I have the weekend to monitor him? I can easily be home all day and up all night Friday, Saturday, and Sunday to monitor and address potential hypo scares.

My other question/concern is if I do increase him this weekend, would it take a few days to even see how low the 1 unit will drop him and possibly result in a dangerous low once I'm back at work next week? I leave two time-release meals for him while I am gone but they are not high carb and can not predict when he will drop.

As always, I would love to hear the opinions and suggestions of the experts. When I look at some of your spreadsheets and see all of the seas of blue and green, I am amazed. I can't imagine ever getting Buddy's sheet to look like that but I'm not giving up the fight yet.

Happy Friday!

 

[Sienne and Gabby (GA)]

I had similar thoughts -- Buddy may be seeing lower numbers when you're not home to test or the red pre-shots may be unrelated. It doesn't look like his nadirs are typically all that low and even blue numbers can cause a bounce. As long as you can monitor, if this were my cat, I'd increase the dose.

Baby latches!! If Buddy is that hungry, has his weight changed? If his weight has been stable, do you have a timed feeder? Spreading out his meals may help. When was his thyroid last tested?

 

[Leah]

Take this with a whole shaker of salt, because I'm newish, but most cats run lower at night. So based on the night readings you've gotten, I'd want to go up to 1u.

Take a look at my cameron's ss when he was on 1.25 he was still bouncing. When i took him up to 1.5 he started breaking the bounces, and now we're reducing daily (the .5 from this morning and the resulting lows means he goes down to 1u tonight).

ECID, but I'd want to increase to 1u.

 

[Leah]

Oh my gosh, i just read your note about the chicken leg!

 

[Kelly and Buddy]

Oh my gosh, i just read your note about the chicken leg!

It's a never ending battle with him. I was shocked that it didn't shoot his number higher. I'm also surprised he was able to clean the entire bone and eat HALF of the actual bone. Completely gone!

 

[Kelly and Buddy]

Well, I took the plunge (and hope Buddy's numbers do too) and increased to 1 unit. Fingers crossed that it brings him down but not too low.

 

[Leah]

Keep updating, I'll be curious to see what happens!

 

[Kelly and Buddy]

I had similar thoughts -- Buddy may be seeing lower numbers when you're not home to test or the red pre-shots may be unrelated. It doesn't look like his nadirs are typically all that low and even blue numbers can cause a bounce. As long as you can monitor, if this were my cat, I'd increase the dose.

Baby latches!! If Buddy is that hungry, has his weight changed? If his weight has been stable, do you have a timed feeder? Spreading out his meals may help. When was his thyroid last tested?

I put baby latches on my list Wednesday but just haven't been to the store to buy. That WILL happen this weekend! Unfortunately Buddy's weight has gone down slightly - about 6 ounces but he is definitely underweight. He's about 8 pounds but should be about 15. Thyroid was tested in April and this summer and was in normal range. He is going back to the doctor next week for blood work, including a thyroid check.

I do have a timed feeder and give him small meals about every 4 hours. Sometimes I just feel like he never gets "full" and that makes me so sad. With that said, I think I could put out 4 cans of food and he would inhale them all. I hate that he is so miserably hungry all the time. I just don't know what else to do for him.

 

[Gill & George]

Hi Kelly,
As long as you can monitor perhaps taking the dose up this weekend so you can see how he does over the weekend might be helpful. I would still run a curve on either Saturday or Sunday, preferably on a day when his numbers are showing downward movement. His symptoms would seem to suggest that he's not spending too much time in lower numbers, looking back through the history he was seeing quite a bit of green at 1u sometime ago, he didn't earn a reduction from this dose, but with your schedule changing with term starting understandably you reduced the dose for safety, its not unusual to find that when a reduction fails that you have to go back up in dose often past the dose where you were seeing some momentum.

Are you away for the full 12hours during the am cycle? I just thought I remembered you saying that you were out of the house for 9,hrs(forgive me if I'm getting you confused with someone else)


If you are able to get a +1 or +2 before you leave or even a +10 or +11 when you get back from work spot checks at those times might help to build a picture of what's happening when you are out. A dropping +1 or +2 can help you decide what food to leave out, or if you need to feed an additional meal/meals I used to use two times feeders with double slots so I could leave more meals out for George. If George was dropping sharply at his +2 and I had to leave, I would usually give him a snack as I headed out the door, and provide furtefu snacks at +3 +4, increasing the carbs for these meals if I was worried about a low..

If you havent already, take a look at the sticky about doing the on a full time job, some great tips there even if you are following slgs.

 

[Gill & George]

I do have a timed feeder and give him small meals about every 4 hours. Sometimes I just feel like he never gets "full" and that makes me so sad. With that said, I think I could put out 4 cans of food and he would inhale them all. I hate that he is so miserably hungry all the time. I just don't know what else to do for him.

The higher bg may well be responsible for a lot of that, bfg was like that too, he stole my breakfast, toast with blueberry jam one time, but his insatiable hunger did subside as he became better regulated, he's still very food motivated. He also lost weight and muscle tone in the early days, but that came back with regulation.
He also did better (we still do this now even though otj) with two main meals at amps and pumps, then snacks at regular intervals.
We tried not to feed after +7, feeding past nadir can inflate the BG in the latter part of the cycle, so when on insulin I settled on regular snacks at +1+3,+5 The small regular snacks worked better from a hunger point of view and also helped level out his BG. Front loading his cycle with food helped mitigate sharp drops and kept him flatter. Also I learned that I could abort his cycle by feeding HC early on, this was useful if I had to leave and was worried about a drop.

That all said ECID so it is important that you learn how buddy responds to carbs and feeding at different points in the cycle, use your data at the weekend and evenings to help you with that, I noted all feeds on the as, so that I could see how the changes I made generally changed things. Having a kitty that is food motivated is a blessing when managing diabetes, I never had to worry about BFG not eating his snacks or getting too full if I needed to feed him more HC or extra meals to keep him safe.you can use his healthy appetite to your advantage.

 

[Kelly and Buddy]

Hi Kelly,

Are you away for the full 12hours during the am cycle? I just thought I remembered you saying that you were out of the house for 9,hrs(forgive me if I'm getting you confused with someone else)?

If you havent already, take a look at the sticky about doing the on a full time job, some great tips there even if you are following slgs.

I am not gone the full 12. I can get a +1.75 or 2 on most days but haven't been because historically he hasn't dropped much in the first two hours. Once I leave, I am typically gone the next 9-10 hours. I usually get home about +11.

I will definitely get a full curve tomorrow or Sunday (maybe both) just to see what's happening with the new dose.

 

[Kelly and Buddy]

The higher bg may well be responsible for a lot of that, bfg was like that too, he stole my breakfast, toast with blueberry jam one time, but his insatiable hunger did subside as he became better regulated, he's still very food motivated. He also lost weight and muscle tone in the early days, but that came back with regulation. He also did better (we still do this now even though otj) with two main meals at amps and pumps, then snacks at regular intervals. We tried not to feed after +7, feeding past nadir can inflate the BG in the latter part of the cycle, so when on insulin I settled on regular snacks at +1+3,+5 The small regular snacks worked better from a hunger point of view and also helped level out his BG. Front loading his cycle with food helped mitigate sharp drops and kept him flatter. Also I learned that I could abort his cycle by feeding HC early on, this was useful if I had to leave and was worried about a drop.

Oh, Buddy would be ALL OVER a piece of toast with blueberry jam!! I can't tell you how many loaves of bread I've had to throw away because he's sniffed them out (of bags, cabinets, etc) and been caught tearing the bag open. Brownies, pies, doughnuts, pizza, bananas, tomatoes...the list is endless!!

Interesting what you said about how you feed two main meals at amps and pmps. Originally that's what I did because I felt like it filled Buddy up (as much as possible) and I also felt like it might offset any potential drops. Once I joined this group, several people mentioned that cats on Lantus do better with smaller meals throughout the day and are better regulated since Lantus is a long acting insulin. That made sense and I changed his feeding schedule. As you said, ECID, so maybe he might be better back on a two main meal schedule with a few snacks in between. It certainly can't be much worse than he's doing now.

Just curious...what snacks do you feed?

 

[Gill & George]

Oh, Buddy would be ALL OVER a piece of toast with blueberry jam!! I can't tell you how many loaves of bread I've had to throw away because he's sniffed them out (of bags, cabinets, etc) and been caught tearing the bag open. Brownies, pies, doughnuts, pizza, bananas, tomatoes...the list is endless!!

Interesting what you said about how you feed two main meals at amps and pmps. Originally that's what I did because I felt like it filled Buddy up (as much as possible) and I also felt like it might offset any potential drops. Once I joined this group, several people mentioned that cats on Lantus do better with smaller meals throughout the day and are better regulated since Lantus is a long acting insulin. That made sense and I changed his feeding schedule. As you said, ECID, so maybe he might be better back on a two main meal schedule with a few snacks in between. It certainly can't be much worse than he's doing now.

Just curious...what snacks do you feed?

They do better generally with refureg meals throughout the day.

Initially I gave him 4meals a day, amps +6pmps +5

Then I changed to
75g (3ounces)@ amps&pmps
2tsp@+1(approx1ounce)
2tsp@,+3
3tsp @+5
I tried to feed in the same way in the am and pm cycle.

Essentially I took his daily food ration divided it into 4, he got 1/4 at amps and a 1/4 at pmps, then divided the remainder up for him to have in snacks during the rest of the day.

How much are you feeding him? With him still losing weight, is it possible he isn't getting enough?

 

[Sienne and Gabby (GA)]

If Buddy is underweight, I'd feed him more. The concern about more calories is that the kitty becomes overweight. If he's lost so much weight, it makes sense that he's hungry. In addition, with diabetes, when food is metabolized, the resulting glucose is floating around in the bloodstream and not getting into the cells the way it should. That's why Buddy is so hungry. Once he's better regulate, the insulin will allow more and more of the glucose to get into the cells and he won't be starving all the time.

 

[Kelly and Buddy]

If Buddy is underweight, I'd feed him more. The concern about more calories is that the kitty becomes overweight. If he's lost so much weight, it makes sense that he's hungry. In addition, with diabetes, when food is metabolized, the resulting glucose is floating around in the bloodstream and not getting into the cells the way it should. That's why Buddy is so hungry. Once he's better regulate, the insulin will allow more and more of the glucose to get into the cells and he won't be starving all the time.

@Sienne and Gabby (GA), I like this idea A LOT (and I know Buddy would too ). Someone else (maybe you??) suggested the same thing last week and I was going to try it. I mix two different foods so I gathered all the cans he currently gets in one day and put them in a bowl to mix, weigh and divide into his rations. I looked at how much food was in that bowl and thought "oh my goodness, that is A LOT of of food" and then talked myself out of it. Here were two of my concerns/questions:

1) How much is too much? I currently give him two 3 oz cans of FF and 1 5.5 oz can of Friskies. Total calories = about 380, which should be plenty for a 7-8 pound cat but clearly he is not gaining weight. Do you have any thoughts on how much I can give him? I am quite confident he would eat twice that, if I would let him.

2) My other concern was impact on insulin. If I increase his food, I assume his BG numbers will rise. Do I just hold his dose for the 6 cycles and adjust accordingly?

I know ECID and there is, unfortunately, no textbook answer but I seriously have no idea how much to allow him to eat. Any advice you can offer (or anyone else reading this) would be greatly appreciate.

Thanks!

 

[Kelly and Buddy]

They do better generally with refureg meals throughout the day.

Initially I gave him 4meals a day, amps +6pmps +5

Then I changed to
75g (3ounces)@ amps&pmps
2tsp@+1(approx1ounce)
2tsp@,+3
3tsp @+5
I tried to feed in the same way in the am and pm cycle.

Essentially I took his daily food ration divided it into 4, he got 1/4 at amps and a 1/4 at pmps, then divided the remainder up for him to have in snacks during the rest of the day.

How much are you feeding him? With him still losing weight, is it possible he isn't getting enough?

The schedule you list above is kind of what I was doing before switching to 6 equal meals. I would use the 2 tspish portions as his treats when I did blood checks or when I had to lock him in his room when I left.

 

[Sienne and Gabby (GA)]

This is a formula that's hidden away in the Obesity page on Dr. Lisa's website:
Required calories per day = [13.6 X optimal lean body weight in pounds] + 70

Note that this is based on optimal lean body weight. So, if Buddy is below that weight, base your calculation on his optimal weight. I think the average for male cats is around 10 lbs so 200 calories should be adequate. However, you have a cat with hyperT who's not gaining weight on almost double the amount of calories. Some of the issue with not gaining weight may be due to the FD -- Gabby lost a lot of weight prior to diagnosis, too. Having changed over to a low carb diet may also be contributing. Many cats who have been kibble addicts will lose weight on a low carb diet. Too much food is if he is gaining weight too rapidly. I think it's going to be trial and error. Maybe add either a half or one more 3oz can of food and see how he does.

I don't know how more food will effect Buddy's BG. If you are feeding after nadir, it may cause the latter part of the cycle to be a bit elevated since there's less insulin available to offset the effect of the food. However, there are cats who are grazers and we don't necessarily see numbers being that much different. The worst case scenario is you need to up Buddy's dose. Ultimately, if he's going to get regulated or go into remission, he will.

Given that Buddy hasn't gained weight, I would have a discussion about this with your vet. It may simply be that Buddy's FD and all of the other reasons combined are in play. I'd just want to be sure that there's not anything medical that's been overlooked. Do you have records of all of his lab tests? If you look on Gabby's SS, you see I kept records of her labs. It was a way for me to have everything in one place and I could look at trends. For Buddy, I'd be very curious if there's been a trend in his thyroid results.