Dose suggestions? I don't like those 500+ readings.

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Pumbaa

Pumbaa

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Pumbaa has now gone 5 complete cycles at 1.25U BID.

He has tested over 500 on 3 of the pre-shots during this time.

While he's getting more numbers in the 200's than he did at the 1.00U BID, I am concerned about the 500+ readings.

Should I take him back down to 1.00U?

It's very confusing, as I read in the Somogyi rebound information that they can react this way if they are getting too much insulin.

Thankfully, I was able to do a urine test today and he has no sign of ketones after these high numbers.

Also, I was concerned this morning that, since he wiggled and moved during the injection, he may not have received his full dose. I don't know if his numbers today reflect that, or not. I thought not, since he was in the 200's until +9.

All suggestions welcome!
 
What I think I'm seeing is the affect of appetitite changes on glucose readings. When the food intake was less is when you got the blue.

The cheese is pretty high fat and may be part of what boosted the levels. Remember, fat is roughly 8.5 calories per gram versus 3.5 calories per gram for either protein or carbohydrate. If you're going to use cheese, get some part skim mozzarella, which has less fat. Or do the math to figure out how much of the other food needs to be reduced due to the calorie count.

Also, cats' digestion can break apart molecules of protein and fat to create glucose, as well as re-assemble molecules into fats (for storing energy) or proteins (to build or repair muscle tissues), with the exception of some essential amino acids such as taurine.

So no, I wouldn't take him down to 1 unit. I would try really hard to make sure the protein to fat to carbohydrate balance was the same for all foods being used and probably take him up another 0.25 units, too.
 
BJM, you are a doll for all of your patience and answering questions! I truly mean that! :YMHUG:

I just looked at Pumbaa's SS again, and don't know that I agree about diet causing those 500+ readings.

I do agree that both of the blue numbers he has achieved have been when he was eating less. Although, he and Larry are both grazers and will eat a lot during their a.m. and p.m. feedings (which is when I dose Pumbaa), they also leave a lot and go back and eat later when they are hungry.

Today, Pumbaa got the cheese at around 3 pm, and his +9 reading was taken 15 minutes later, but he didn't get anything other than sardines (packed in water, no salt) for his treats yesterday and his PMPS yesterday was 575.

Pumbaa needs to put on some weight, after what he lost when he wasn't absorbing anything. Which is why I am not regulating how much he and Larry (civilian) eat. I keep encouraging Pumbaa to eat, like a Sicilian or Russian grandmother: "Eat! Eat! You too skinny!" *LOL*

They each get a 3 oz. can of food at 6:15 a.m. and 6:15 p.m. (or half of a 5.5 oz can, depending on what I feed them), and Pumbaa will pig out, but still leave some. The balance lasts them either until around noon, or 10 pm, which is when I put out either Stella & Chewy's freeze dried raw (at noon) or some less than 7% carbs EVO turkey and chicken (before I go to bed), to tide them over and make sure they don't go hungry, since they are used to being able to graze on the dry food they used to get. (Pre-DX, each cat would get 1/4 of a 5.5 oz. can of wet food in the morning, and the rest of the day they had that nasty dry food to eat.)

Pumbaa does get treats at testing times, but, until today, I've tried to keep that to the high-protein sardines packed in water with no salt. But he's getting bored with the sardines, which is why I gave him some cheese today.

I will look at the fat content of the canned foods they are getting. I think a lot of the low-carb canned foods have way too much fat vs. protein, from what I've seen on the charts. I want to start re-introducing them to raw again, with the hope that one day, I will be able to follow Dr. Pierson's raw food recipe.

I consider myself fortunate that weaning them off of dry food was relatively easy. But still don't want them to go hungry, as they are used to having the high-carb dry food to graze on 24/7.

What do you attribute those 500+ readings to? Even not on insulin, Pumbaa never tested above 500.
 
One thing to recall about digestion - the more complex the molecule, the longer to disassemble it into what the body needs. Fats take longer than proteins, so it is possible that it impacted the evening preshot.

If weight gain is needed, the higher percentage of calories from fat may be what he needs to gain. Growth and Development, ie kitten forumulas, may be a good choice for him. Evo Cat and Kitten, Fancy Feast Turkey and Giblets Kitten, are some that come to mind.

It looks like you need to rotate through flavors to get consistent eating (which helps get your consistent testing!), which is where keeping it consistent in the proportion of calories can help. Another tactic might be to give the higher cal stuff around +3, when you're heading into the nadir region.

If you're so inclined, add a 2nd line for each day to note the times where food is put down, with LC for low carb, HC for high carb, etc. That may help you see if there are any patterns.
 
So the higher fat content right now is a good thing for Pumbaa? Whew...that is good news as I haven't been able to hunt down the higher protein/less fat wet foods to date. Just way too much going on in the last few weeks since I noticed Pumbaa's weight loss and symptoms.

You know so much, you are just amazing! Not to mention your willingness to share your knowledge with the rest of us!

Yes, I do need to rotate flavors, and I'm trying to get my boys less addicted to fish flavors. Especially now with Japan tsunami nuclear meltdown repercussions in our oceans and the BP oil spillage damage in the Gulf of Mexico causing abnormalities in fish/shrimp down there. They love FF Classic beef, thankfully. But a steady diet of this and they would start to turn their noses up, too. I used to rotate various Friskies canned foods for them every 2 days.

I have to consider that I have a civilian cat as well, who does not need to gain weight, before I switch to the kitten foods. Larry, the civilian, used to eat Pumbaa's leftovers, but now Pumbaa is eating Larry's leftovers. Larry is benefiting from this new low-carb diet, as well!

I had set up a new column on the SS detailing their feeding, and I had pulled all of their high-carb food on 4/3/12. No high-carb treats, no access to kibble left over in the drooler's bowl, no carbs sitting on my counters (or in my microwave, but my cats aren't as smart as Muse!). I've been trying to follow a low-carb eating plan, myself, since February, so it isn't difficult here to make sure there are no high carb items Pumbaa could access to raise his BG readings. And I read all wet cat food labels judiciously, to make sure they haven't added rice or potatoes or corn, etc.

So, reading the above, is there anything else you attribute the 500+ readings to other than diet or bouncing?
 
Moderately higher fat - too much isn't optimal either.

As far as explaining the highs - I'm not seeing very low numbers mid-cycle, so if it is the liver responding, you may just have to hang in there until it gets used to going lower. And if it is a fur shot, you just keep on going as you're going until you've enough data to follow the protocol and adjust the dose.

I think you're ready to start posting in one of the Lantus forums. You've got the diet changes, dose schedule, and spreadsheet going pretty well.

If you can do the Tight Regulation protocol, that has your best bet at getting Pumbaa "off the juice" and diet controlled.
LANTUS (GLARGINE) - Tight Regulation

If you have a cat with complicating conditions that affect insulin response (chronic pancreatitis, IBD, on steroids, etc), weird reactions to insulin, a schedule that just can't work for tight regulation, you might post in this forum.
"Relaxaed" Lantus
 
Pumbaa said:
Pumbaa has now gone 5 complete cycles at 1.25U BID.

He has tested over 500 on 3 of the pre-shots during this time.

While he's getting more numbers in the 200's than he did at the 1.00U BID, I am concerned about the 500+ readings.

Should I take him back down to 1.00U?

It's very confusing, as I read in the Somogyi rebound information that they can react this way if they are getting too much insulin.

Thankfully, I was able to do a urine test today and he has no sign of ketones after these high numbers.

Also, I was concerned this morning that, since he wiggled and moved during the injection, he may not have received his full dose. I don't know if his numbers today reflect that, or not. I thought not, since he was in the 200's until +9.

All suggestions welcome!
Click to expand...

What a great job you do getting tests!!! And yes, those black numbers are very hard on the eyes. :YMSIGH: He is quite the bouncer!

You have been at the 1.25 dose for 11 cycles. On 4/18 (4th cycle of 1.25) Pumbaa hit unknown territory (a blue!!!). It looks like he bounced pretty quickly to the moon! Bounces can take up to 72hrs to clear, so that would mean you could start seeing lower anytime between when the bounce started to sometime today.

Another observation is last night, he had a 200 pt drop before the insulin was 'technically' settling in. That is a huge drop and could cause a bounce. Often (but not always) a drop like that can signal an active cycle. I imagine his bounce was breaking last night. He could have gone lower than the 242 @ +4 and actually saw some more blue! Don't be surprised if you see higher numbers later today/tonight in case he reacts to last nights cycle.

I am not sure how you are feeding. It looks like *most* of his +2 and +3's are similar to preshots, so he is not typically a diver. If you do notice him diving more and more, then you may want to consider splitting his breakfast and giving some at AMPS, another bit at +1, and a tad more at +2. My cat was more likely to dive when she had high numbers, so as hard as it was I fed her more often or a bit higher carb the first few hrs to slow it down. Otherwise we just repeated the dive/bounce cycle. Again, I am not seeing this as a pattern for Pumbaa...just something to watch for since he proved last night he CAN be a gold medal diver!

Regarding dose...I'm not sure if or what protocol you are following. You are testing enough, where you could probably follow the guidelines to the tight regulation. I would go for the .25 increase, if you were still going to continue monitoring, as you are now.
Increasing the dose:

Hold the dose for 3 - 5 days (6 - 10 consecutive cycles) if nadirs are less than 200 before increasing the dose.

After 3 days (6 consecutive cycles)... if nadirs are greater than 200, but less than 300 increase the dose by 0.25 unit.

After 3 days (6 consecutive cycles)... if nadirs are greater than 300 increase the dose by 0.5 unit.
Click to expand...
http://www.felinediabetes.com/FDMB/viewtopic.php?f=9&t=1581

Hope all that helps!
 
So.Much.Information.To.Absorb. *LOL* Seriously, after 3 weeks my brain still hurts from everything I've been reading and trying to understand and absorb.

BJM: Thank you, again! I've been posting numbers on relaxed Lantus, but if doing the tight regulation is our best chance of getting him off the juice, then tight regulation it is! Thankfully, I work from home, and also thankfully, there are no other conditions that I know of that would affect Pumbaa's insulin response. And I am doing a 2-hour curve today to get a better grip on the numbers. There are days when I seem to understand his numbers, then there are days when I might as well be looking at hieroglyphics. And today, in between testing, I am looking at the various food charts to see if I can find some which have a closer ratio of protein to fat, then off to the store to stock up.


Carolyn: Thank you, too! I'm doing my best so that one day, Pumbaa might join the OTJ club! He's so worth the effort! And thank you for interpreting his off the wall numbers for me. Yes, his numbers have been higher today...all pink so far. Today is the first official 2-hour curve. Maybe that will help me with my interpretations of what is going on. Fortunately, he's been very good so far about having this done every 2 hours. Wreaks havoc on my getting things done, though, like errands. *LOL*

Still learning...I had thought a cycle was a full day. That was interesting what you said about the "diving". Pumbaa's normal way of eating is to eat a lot after the PS test, but leave food and walk away, then come back in about an hour and eat some more, and again in another hour. Usually by +6, all of the initial meal is gone, and I put out some (some=not a whole lot...not as much as the twice a day feeds) Stella & Chewy's freeze dried raw or some <7% carbs EVO turkey and chicken, as both of my cats are grazers by nature.

And yes, I am going to read up on the tight regulation, as both you and BJM suggested.

You guys are awesome! :RAHCAT
 
Pumbaa said:
So.Much.Information.To.Absorb. *LOL* Seriously, after 3 weeks my brain still hurts from everything I've been reading and trying to understand and absorb.
And yes, I am going to read up on the tight regulation, as both you and BJM suggested.
Click to expand...

You sure are handling it quite well!!!

So today, you have had a pretty flat cycle. SOMETIMES, a flat cycle can mean action in the next. Would you be able to get a +2 or 3 AND a +6 tonight ? I know those +6 in the evening cycles are tough on the beans. If you cant or just do not want to, I understand. I suggest a +2 or +3 because that will possibly give you a clue as to where the cycle is heading. +6 is the approximate nadir.

Another thought...when you see numbers lower than you are used to BEFORE the approximate nadir (+6), try to get the +6 as well.
For example:
4/20 +4 was 200. Your next test was +8 229. The +8 is when a cat is likely starting to RISE. So what happened between those 4 hours while passing through the nadir? Hmmmmm???? Then suddenly that night he is in the red! Very suspicious ;-) .

You seem very open and able to testing as much as you need to in order to collect the best data to help Pumbaa. That is very fortunate! I think you and Pumbaa would really benefit from going over to the LL tight regulation group and introducing yourself.

I have a heavy load next week and probably wont be around to post at all. Im sure I will lurk a bit and see how you are doing. ;-) Don't hesitate to keep asking for help wherever you are comfortable. This board is a wealth of knowledge.


BTW...I did not introduce myself (something I would like to remember to do!). I used Lantus on my cat for almost a year. She became diabetic from steroids, which helped her with some of her other health issues. She passed away almost 2yrs ago, not related to the diabetes.
 
Carolyn: Thank you, I'm just trying to do what I have to do. Some days I get totally overwhelmed because I do all of the shopping/cooking/errands for my elderly mom, as well as daily chores at her house. Thankfully she only lives 3 miles away. And I certainly wouldn't be doing this well had I not found this board and the wonderful people here who are so helpful!

I'll be able to get a +3 tonight, and if I should get a +6, so be it. :)

I did some reading on tight regulation today, including going to yourdiabeticcat.com and reading what they had to say about tight regulation. Haven't had time to pose any questions yet, but will introduce myself on the tight regulation board here. :)

Have a great week next week! Maybe when you peek in you'll see more blue numbers on Pumbaa's chart!

Suze
 
Suze~
I just saw your pmps. If the +3 is high like that (mid to upper 300'+) than don't stress over a +6 tonight.
Do try for the +2 or 3 and let the numbers guide you.

I do think you can raise the dose ,25u when ready.
 
Carolyn:

My old, tired body thanks you for taking the time to check Pumbaa PMPS, and advising me to not stress the +6 tonight if his BG was mid-300's. Bless you! I was trying to figure out how to stay awake until midnight and still be up at 5:55 am to get the show on the road here at 6 am. Gone are the days when I could survive, and function, on 4-5 hours of sleep, or less.

It looks like, from his +3 reading tonight, that Pumbaa will most likely only hit the mid-200's at +6.

I think I will bump him up to 1.50U in the morning. I like doing that in the morning when I can watch him all day, and how he reacts.

From today's curve, he looks like a true +6 nadir. But when looking at other random readings, he could actually be a +5 or +7. I might test tomorrow at +5, +6 and +7 to determine this.

I'm also going to post some questions about tight regulation and insulin on the main forum, since it doesn't just concern tight regulation with Lantus.

I was running out the door when I posted after your introduction and didn't get a chance to type how sorry I am that you lost Latte, and how nice you are to still come here and take people like me under your wing! You are turning the hieroglyphics of the spreadsheets into something that is starting to make sense! I thank you for that!
 
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