Dosing advice needed

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ajohnsoncat

ajohnsoncat

Member Since 2019
Hi there

thank you for reading.

just wondered if anyone can look at my Salem’s ss and tell me if the last 2 day’s have been a bounce from Sunday. Or whether I need to up his insulin. He’s absolutely fine in himself no excessive drinking or urinating. It just doesn’t make sense to me that he has one good day then several bad days.
I should add Salem is on lantus and I use the alphatrak 2.

thank you


https://drive.google.com/file/d/1WZ-x3PZXnlBRHgU-_50hJBHOzn02dusC/view?usp=drivesdk
 
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I don't really know enough about Salem to give you advice. Can you tell me about the Whiskas 11+ food you are feeding? Is it canned or dry? What is the carb content? Do you feed twice a day or many small meals? Does Salem have any other health issues? Has he gotten into any contraband food?

My general impression is the BGL readings look far too flat to be bounce, but I am not the best person for Lantus dosing advice. I'm going to tag @Deb & Wink for her advice.
 
Sticky New? How You Can Help Us Help You!

Look at that document I linked above please, while I go take a look at your boy Salem's SS.
Getting some details in your user profile signature will be an immense help to us here. Helps us to help you better.
Plus, the SS can be linked in the signature and you won't have to post it every time. Read only view for us here.

p.s. How did you find us?
 
Hi sorry

my phone been on charge. I’m completely new to this board so not really sure what I’m doing. No I always withhold food 2 hours before preshot test. I do random testing throughout the day when I can.
Sorry not sure how to do signature. I’ve seen it on the account tab. Do I just write my name?
Thank you
 
ajohnsoncat said:
I’m completely new to this board so not really sure what I’m doing.
Click to expand...
No worries. We'll help you.

Unfortunately, the SS url you gave me is cutting the SS off after PMPS +4 testing time. So I can't see any night cycle numbers after that point.
Link here on how to get the SS in your signature. FDMB Spreadsheet Instructions
copied and pasted the relevant steps for you here:
Instructions for pasting the SS link in your FDMB Signature block:

1. Login to FDMB and click on your user name in the upper right corner.

2. Select "signature”. The signature block is limited to three lines. If you have a lot of other information in your signature block, please be sure you place the spreadsheet link so it is easily located by other members (i.e. please don’t stick it at the very end of a long, detailed description of medications).

3. Put your cursor in the text box, type in your kitty’s name with the word “Spreadsheet” (e.g. Furbaby’s Spreadsheet), highlight those words, and then click on the “hyperlink" icon above the text box:



4. A text box will open that states "link"; paste your link into the box next to “URL” and click on “insert”.



5. This should result in the highlighted text turning light blue which means it is now a hyperlink to the spreadsheet and anyone clicking on it can see the spreadsheet.

6. Click "save changes" and you're done!! Great job!!!!

New to the FDMB message board, but you are on our sister facebook page. Good for you!:)

Are you using the lantus SLGS (Start Low Go Slow) or the TR (Tight Regulation) protocol for dose adjustments?
 
Thank you.
Il have to do the above on my daughters computer as google docs just crashes on my iphone.

my boy was diagnosed in August last year, he was started on caninsulin 1 unit, then 2 units then 2.5. My vet never took his blood and the testing I did he was ranging from late teens to low 30s mmol. My boy was deteriorating, lost so much weight etc. I switched vets and after my boy spending the day there for a curve and they did a fructosamine the new vet put him on lantus 2 units starting dose. That was the 2nd December. I do my own testing and we were seeing her every week up until Christmas and she would tell me to change the dose based on my numbers. I’m seeing the vet now about every 3 weeks for updates. I honestly have no idea what I’m doing to be fair. I get so excited to see those greens and blues then it’s constant highs.
I must also say that I don’t tend to get many tests in after his pm shot, but was planning on doing that tomorrow night when I’ve not got work the next morning.
Thank you
 
Juls and Billy said:
I don't really know enough about Salem to give you advice. Can you tell me about the Whiskas 11+ food you are feeding? Is it canned or dry? What is the carb content? Do you feed twice a day or many small meals? Does Salem have any other health issues? Has he gotten into any contraband food?

My general impression is the BGL readings look far too flat to be bounce, but I am not the best person for Lantus dosing advice. I'm going to tag @Deb & Wink for her advice.
Click to expand...

thank you for replying. The whiskas 11 is pouched food and is jelly based. It’s less than 3% carbs. He is fed several small meals a days. No dry food about. All my other cats are fed the whiskas 11 too. No other health issue I’m aware of he seems really well in himself. The past month he is showing signs of neuropathy in his hind legs. His hocks are not fully down but he’s not walking fully on his paws.
Sorry if I don’t reply till morning. Will need to go sleep soon as it’s quite late in the U.K. and I’ve got the alarm set early for work.
Thank you.
 
It could be a bounce. When you get the SS linked to your signature, start typing away in the text box below the latest post and then click on the "Post Reply" icon at the bottom.

I have an alert set, so I'll see that you have posted when I next log on. I'll take a look at the SS then.

Was 12/5/2019 the diagnosis date for Salem? Or only when you started to test? In other words, has Salem been diagnosed with feline diabetes for < 1 year? Or has it been longer than that? You said August. Was that August 2019? Simply looking to very the diagnosis date.

1. First of all, I think Salem may benefit greatly from more frequent dose changes. Using the TR (Tight Regulation) protocol instead of SLGS (Start Low, Go Slow).

2. Looks to me like you are using SLGS protocol and holding the doses too long.

3. You may need to adjust the dose by more than the just the skinny and fat changes to the dose you are doing now. But 0.25u increases/decreases.

4. You test frequently enough to be using the TR (Tight Regulation) protocol for Lantus. Do you have a copy of the Lantus protocol dosing document printed out?
Sticky : Dosing Methods: Start Low, Go Slow (SLGS) & Tight Regulation (TR)

5. Not sure if the food you are feeding is low carb. Did you select it from the UK food list? The one Elizabeth and Bertie put together?

Or this one,which is an older list and may be a bit outdated.
Canned cat food for EUROPEANS and INTERNATIONAL buyers
 
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https://docs.google.com/file/d/1LyY...D8LMJx/edit?usp=docslist_api&filetype=msexcelHi there.

Salem was diagnosed August 2019 where he was put on caninsulin. His fructosamine was 535. He started on 1 unit and worked up to 3. It wasn’t working. His numbers stayed high he was a bag of bones. Switched vets end of November. They did a curve and fructosamine. His fructosamine was 465 so new vet put him on lantus. I started lantus 5th dec 2019. Improvements started with clinical signs. Weight put back on, no excessive drinking but still excessive peeing. He was more lively etc. Just finding the right dose is so hard.
Whiskas 1 and 7 is on the list but I calculated the carbs in whiskas 11 to be lower. Not many supermarkets stock the whiskas 11 so maybe that’s why it’s not on the list. I order it online from pet food websites. I think I’ve added the spreadsheet. It’s a bit of a nightmare as I have to do it in excel then transfer to google docs as it just crashes on my phone. If it’s not come out right il do it in my daughters computer after work. Thank you.
 
ajohnsoncat said:
Whiskas 1 and 7 is on the list but I calculated the carbs in whiskas 11 to be lower. Not many supermarkets stock the whiskas 11 so maybe that’s why it’s not on the list.
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I have no idea what cat food list you are referring to.
We don't have a cat food list that says "Whiskas 1" or "Whiskas 7" or "Whiskas 11". In fact, there are no Whiskas foods on the UK food list I'm familiar with. Or any other food list I know of.
Could you give me a link to the cat food list you are using?

Looks like you come over to the FDMB from our facebook groups, our sister site, Feline Diabetes. You joined that group on 1/7/2020.

Tagging @Chris & China (GA) to help you out.

As I said back in reply# 10, you may want to have a look at the dosing protocols we use here.
 
Hi Deb.

Whiskas pouches in jelly 7+ is on the U.K. food list from Elizabeth and Bertie. Whiskas 11+ isn’t on the list but I do believe it has slightly less carbs.
Protein 8.5. Fat 4.7. Ash 1.6. Fibres 0.3 and moisture 84.5.

I have read the protocols for TR and screen shot them so I can refer to them.

I just don’t get why I get good numbers for a day then he goes high for a while, when he’s fed the same food even the same flavours.
Thank you
Amanda
 
For some reason, when I did a search of the UK cat food list, it did not find the Whiskas foods. But when I scrolled down the list, there they were.

Did you see this note on the UK food chart about the Whiskas? "Contains 'various sugars' and
'vegetable protein extract'. The latter may elevate blood glucose in some cats."

When a cat drops low, lower than their body is used to, there is a self protection mechanism that kicks in. Simplifying this greatly, there are compensatory hormones and different kinds of sugars released into the body to bring the BG levels back up to what the cat's body perceives as a safer, more normal BG number. We call it "bouncing."

So when Salem drops into those blue and green range BG ranges, even though he is safe at those numbers, his body no longer thinks so and dumps hormones and glucose into the bloodstream to bring the numbers back up.

Copied this from over in the Lantus ISG(Insulin Support Group) in the Sticky or pinned post at the top titled
The Basics: New to the Group? Start here!

Bouncing - 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).

That is one possible reason.
 
Second possible reason for the wide range of BG readings.
Insulin syringes are not as accurate as you may think. The lines on the insulin barrel do not always line up in exactly the same spot from syringe to syringe.

You may want to line up a few syringes side by side, and see how well the 1/2 unit and full 1 unit markings on the insulin barrel line up for your syringes.
 
Third possible reason for the wide range of BG readings.

Salem may be dropping much lower at night and you are not catching it.
With so few tests in the nighttime cycle, you might not know the BG's are dropping lower.
Many cats are more active at night and using up more glucose through their activity.
Without tests at night, you are missing half your data as Sienne would say.
 
Fourth reason for the wide range of BG readings.

Food related issues.
Salem is eating more or less on some days then others.
He is eating at different times during the 12 hour dosing cycle.
He is getting into "contraband".

Either food left out for other animals. (Although you say all your cats eat the same food)
Food dropped on the floor.
Someone is sneaking him food (one person recently found out here husband was giving her cat the leftover milk from his cereal and the remaining bits of high sugar cereal).
Food left out on the counter, he could be opening kitchen cabinets and drawers.
He could be eating some kind of cat food treats that are not low carb. Does he get any sort of cat food treat?
 
Meter and test strip related issues.

Have you ever tested yourself to see what your own BG levels are? You might want to do that, with a fresh lancet of course. Quicker than waiting for control solution from the manufacturer of you meter.

Control solution is only good for 3 months after opening. Control solution contains a set amount of glucose. The Alphatrak meter knows what that amount is. You do need to change the setting on the meter to say you are doing a control solution test. Check your user manual on how to do this.

Test strips stored properly, away from light and humidity.
Strips not past expiration date?
Top of test strip container always closed properly after you take out a strip?
Washing and drying your hands before you touch the test strips?
Fresh battery in meter?
Have you ever dropped or fumbled the meter?
Are you still using the Alphatrak meter?
You can get control solution from the manufacturer to "test" your meter. Not sure of the UK address or phone number. Found this after a search on the Zoetis website and selecting the appropriate country. https://www.zoetis.co.uk/
Customer Enquiries

If you would like to talk to us about any of our products, have a technical query about using our products or would like to report a pharmacovigilance event or product defect, please call 0845 3008034 or complete the form below and one of our representatives will be in touch.

Our technical team are available between09:00 - 17:00 Monday to Thursday, 09:00 - 16:00 Friday. For urgent out of hours technical queries please follow the instructions on the recorded message.

Those were all the "brainstorming" ideas I could come up with for now. "Bouncing" or dropping into low BG ranges at night are the 2 most likely reasons.
 
Thank you for your reply.
So much to take in. This disease must be the hardest to manage. I’m still using the alphatrak and do have control solution but did not know it’s only good for 3 months. He’s definitely not getting into any food he shouldn’t be eating. The treats he as are freeze dried treats.
Will his body ever get used to these lower numbers?
With regards to the various sugars in the whiskas, I’ve tried Salem on so many foods literally spent a fortune on food he will not eat.

I do really appreciate you taking the time for all the info. I guess it’s also waiting for Salem to feel safe in low numbers and finding the right dose.
Thank you
 
ajohnsoncat said:
I do really appreciate you taking the time for all the info. I guess it’s also waiting for Salem to feel safe in low numbers and finding the right dose.
Click to expand...
Yes, it is a combination of Salem's body getting used to the low numbers and finding the right dose.

As far as finding the "right dose" goes, that does take some adjustment.
I really do think Salem would benefit from the Tight Regulation (TR) Protocol for Lantus that we use here.
I know that you took some screen shots of the TR protocol.
You may want to print that protocol on paper.
May be easier to refer to in hardcopy.
If your daughter has a printer with her computer, maybe she can print it for you.
Or public libraries sometimes have the resources to let you sign on to the internet and print a document.
Work, friends, other family are other possibilities for printing a copy of the TR protocol.

You'll likely need to read through the protocol several times to get a basic understanding of what it says, then refer to it often.
There is also the ISG (Insulin Support Group) for Lantus that can be found here.
Link to that forum is here for you: Lantus / Basaglar (glargine) and Levemir (detemir)

Simply click on the blue highlighted text to take you to that forum.
There is a lot of information in the "Sticky" or pinned posts located at the top of that forum.
You may want to look at and print some of the other documents there.
Especially this one: The Basics: New to the Group? Start here!

ajohnsoncat said:
Will his body ever get used to these lower numbers?
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Yes, but it will take time. Treating feline diabetes is a slow and steady process. Doesn't happen in a week or 2.
Salem will even get used to lower numbers than he is getting now.

One question I forgot to ask. How old is your lantus insulin? Did you get the 10ml vial or do you use an insulin pen (pen shaped, mini-vial 3 ml)? Stored in the refrigerator? Away from light? All other proper handling and storage procedures followed?

http://www.felinediabetes.com/FDMB/threads/the-basics-new-to-the-group-start-here.18139/
 
Hi

Lantus is in 10ml vial started 1st week of February. Stored correctly etc and handled by me only. My vet has said it should be good for up to 3 months but to be honest I’ve been buying one every month. We are lucky here in the U.K. that insulin is so much cheaper here than in the USA. I just feel like it’s been 6 months and still more High numbers than low numbers although his clinical signs have definitely improved.
 
Thanks Amanda for confirming you have good fresh insulin, properly stored.

Clinical symptoms improving are a very good sign.
Now, we need to get Salem into lower numbers more consistently and maybe even to diet controlled status.
Are you up for that?
Ready to try TR? (Tight Regulation)

No idea what your work/life/responsibility situation is like. Push back and tell us when something won't work for you. We'll brainstorm and come up with alternative solutions.

For example, I'd like you to consistently get a few tests in during the PM dosing cycle, in addition to your current PMPS test.
Test number 1 should be around +2
Test number 2 should be around +6, or as late as you can test before you go to sleep.
When would that "one last test before you go to sleep" be? Stated in + hour time.
 
Hi Deb

Thank you for your reply. His shot is at 8pm and I generally do go sleep at 11pm so +3. I do set my alarm in the night to make sure he’s eaten his food from auto feeder. I’ve updated his ss and I did increase his dose yesterday morning because of the high numbers and he did have a steep drop at +3 last night I also did a +4. I actually set my alarm through the night about every 2 hours to make sure he was ok and fed him little meals. I really expected a high number this morning from a bounce but it was low so was a bit shocked.
Generally looking at his ss though when he has a good day it’s followed by several bad days.
 
Further to above Looks like he’s probably bounced with the 20.9! He was fed 1hr 45 mins before the test but don’t think that will be it as he was fed 1hr 45 mins before the 8.8.
 
So, if you get up on the middle of the night to make sue he has eaten his food from the auto feeder, is there a possibility you can get a BG test then?

Remember, Lantus has that "depot" effect. Storage area that builds up and then slowly releases insulin.
So the increase you did 2/19/2020 AM won't show the full impact until a cycle or 2 later.

What time does the auto feeder provide meals for Salem? If you could not that in our + hour format, that will help.
How much of a meal?
Are you feeding Salem past the middle of the cycle, after +6, with the auto feeder?

Specifically, would you please tell me what times you fed Salem yesterday(2/19) AM cycle, yesterday (2/19) PM cycle, today (2/20) AM cycle. And how much each time. teaspoon, tablespoon, 1/4 can, 1/2 can, number of grams, 1/2 package/pouch, 1/4 package/pouch, 1/8 pouch.

What flavor on the Whiskas 11 mature?
 
Hi Deb.

so yesterday he was fed half a sachet at shot time mixture of turkey and Tuna. Note half sachet in total. +1.5 hours before I go work I leave a quarter sachet in his bowl (all meals mixture of both flavours). Auto feeder goes off at +4 after shot time (a quarter) then + 6 hours I then feed at + 8 after work 1/4 sachet again. He’s then feed at + 10 (1/4). Shot time +12 half sachet. Fed again at +2. auto feeder at +4.5 then again +7 then I get up feed him at +10. All meals are a 1/4 unless it’s shot time then it’s half a sachet. Last night he was fed literally every 2 hours through the night because of lower numbers.

Today meal at shot time then +2.5 then +4 then I did another tiny meal at 5.5 as his number at +4 was coming down and I couldn’t get blood as he was on top of my wardrobe and seemed a bit docile so put some food up there. Fed again at +8 when I got the 20.9. Hour this makes sense.
Il post pics in next post.
Thank you
 
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I think at least part of the problem is that you are feeding Salem too much after his nadir.
That nadir varies, since cats will be cats, and the nadir will not be the same every cycle.
But, it looks to me like Salem's nadir is between +4 and +6. Maybe even earlier, at +3.

You might want to consider eliminating those feeding times after +6. Even the +6 feeding seems to really spike his BG's up really fast.

I think the food, and the timing of the food is having a big impact on the BG levels. A negative impact when fed after +5.
Do you use the auto feeder on weekends too? Or do you feed him differently on the weekends/days you are not at work?
Is Salem the only one that uses the auto feeder? Is he sequestered, kept separately from the other cats? So they are NOT eating his food? Or could they be eating the food from the auto feeder and that is why Salem is low on some days and not others?

Lets' try and control for one variable at a time. Right now, I'd like to focus on the timing of the feedings and see how much of a difference that will make.

Are you ready to do that? Are you available to try that this weekend?

p.s Blues are not really low numbers. You want to see more of those blue numbers. You want to see more of the dark green numbers during the cycle. What you don't want to see, are those bright green numbers. Then, you intervene with a small bit of food, ask for advice here, feed small bits of lower carb food to bring the BG's back up. And maybe break out the medium carb foods and/or the simple sugars you have in your hypo kit.
 
Hi Deb

thanks for looking through everything.

I probably do feed him too much but he is hungry and cries for food and I worry about ketones if he doesn’t get enough food. He had ketones once but luckily didn’t turn into DKA. With the auto feeder during the day he has only been having this whilst my mum has been away for 6 weeks since 17th Jan. She normally feeds him once at +4 whilst I’m at work. So there could be a possibility one of the other cats has been eating his dinner whilst I’m at work. I do not use the auto feeder at weekends and days off which is normally a Wednesday.

He is not separated from the other cats.

Also I did think and I’m possibly wrong here that my feeding him every 2 hours last night through the night might have stopped him from bouncing maybe?

I’m willing to try a different feeding schedule this weekend definitely, it’s just me trying not to give in too his cries.
Thank you.
 
It's not that you might be feeding him too much. But that you might be feeding him too late in the 12 hour dosing cycle.
When the insulin had mostly been used up.

Can you stop the feedings after +5?

Yes, feeding him every 2 hours last night may have slowed down the BG drop, and let him stay on a more even keel.
Could have also partially been the increased dose too, that kept Salem in lower BG numbers.

Try replacing food with attention. Redirect him from thoughts of food with play time, brushing, pets, talking to him and telling him about your day. Whatever. Sometimes, we have trained our cats that whenever they seek out attention, we feed them. So now our cats have come to expect food with every meow. Changing what you do when he meows may help.

It's called "conditional training" or "behavioral modification training" and works for cats as well as dogs.
 
It’s very true what you have said. Before I moved in with my mum my cats were fed 1 sachet every morning then 1 sachet every night each but did have dry left down 24/7. They never meowed for more food. Since moving in with my mum 7 years ago every time one of the cats meowed my mum would say the cats want feeding and from then on they were fed every time they meowed!

I have noticed my other cats have become more hungry since the dry has been taken away and with it being winter here in the U.K. they are not outside as much so possibly boredom aswel.

I do think Salem might struggle going 7 hours without food though that’s my only worry.

thank you.
 
Thank you


I will try at the weekend and see how he goes.

He loves playing with catnip bubbles and I’ve bought new batteries for the laser pen so will try and engage him more with other stuff.

One other question. I’ve been giving him doctor best fully active b12, would this effect his blood sugar?
 
ajohnsoncat said:
I’ve been giving him doctor best fully active b12, would this effect his blood sugar?
Click to expand...

Lots of people here in the USA and Canada use the Zobaline or Vitacost Methyl B12. There are always inactive ingredients. Such as Microcrystalline cellulose. Never heard of anyone here saying their cat's BG levels were higher. Can help with the neuropathy. Worth giving.
 
Thank you, anything to help him with that. It’s not overly bad but he does struggling with jumping occasionally.

I have just done his pmps test and he was 30.9, he was fed 2.5 hours before test, it just doesn’t make sense.
 
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