Dropping Numbers--Diet Switch

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Reneemwriter

Member Since 2013
Hi all!
Just switched VanGogh's food to FF Classics from Friskies Pate as per sage advice from FDMB member Wendy, (Thanks!) & I can't believe the number change I'm already seeing. Just tested at 48 on the +5 PM side. VG is acting fine & I just gave him some more FF. Debated on going a little more hc, but he is acting fine & been very "kittenish" all afternoon. I certainly won't shoot if this low again in The Morning. We are currently going with .25 dosage, & also may consider dropping back to 1 drop which he'd been on for awhile. . .then numbers started to slowly creep up. . .not sure whether to be a little worried or relieved. . .that this may be an indication to attempt a 2nd OTJ trial. First trial lasted, ( I think) 9 days, but numbers again started creeping up. . .Guess I shall have to wait & see what The Morning brings! Thanx for any suggestions. . .
 
with a 48, you want to make sure and retest in 20 minutes or so in case he's dropping. i'd give a little bit of gravy to pull him up into the 50's, and keep monitoring until he's up and stable.

Sounds like you're not too new to this. Do you know directions are in the How to deal with Low Numbers sticky? Here are the directions for handling low numbers:

DON'T PANIC! or HOW TO HANDLE LOW NUMBERS

First, try to not panic. Post to the Lantus Insulin Support Group or on the Health Board. Make sure your subject line indicates you are concerned about a possible hypo and/or add the 911 icon to the first post in your condo. People who are experienced in dealing with low numbers will be there to help. After posting, remember to refresh your browser periodically to see if people have replied.

It’s important to recognize that just because your cat may be experiencing low BG numbers doesn’t mean that your kitty is critically hypoglycemic. Many cats will have low numbers and never have symptoms. It’s important, though, to bring those numbers up into a safe range. ALWAYS make sure you have a stock of test strips, high carb (HC) canned food that contains gravy and is over 15% carb such as Fancy Feast grilled, marinated, or Gravy Lovers varieties (see Dr. Lisa's Cat Food Nutritional Composition List for a full list of options), and/or a simple sugar solution such as Karo/corn syrup, honey, maple syrup, etc.

If your cat is experiencing symptoms, especially if those symptoms are severe, you need to rub Karo syrup, honey, or maple syrup on the gums or, if symptoms are very severe, administer rectally and get your cat to the nearest 24-hour emergency facility. Take the bottle of syrup with you to administer on the way if necessary. (Note that it is rare that we see episodes of symptomatic hypoglycemia with Lantus and even rarer to see severe symptoms. But, you need to know what to do should they occur.)

The symptoms to be concerned about include but are not limited to:
staggering, uncoordinated movements, 'drunken' walk, wobbling, balance problems
ataxia - usually lack of muscular coordination, but maybe changes in head and neck movements
disorientation (yowling, walking in circles, etc.)
twitching
stupor
convulsions or seizures
coma
If your cat is testing in low numbers and you are not getting a quick response to your post, there are several things you need to do. (Low numbers are under 50mg/dL or 2.8 mmol/L.)

Depending on how carbohydrate sensitive your cat is, feed approximately a teaspoon or less of gravy from high carb food or high carb food only.
(If you have a cat with GI issues, using a couple of drops of syrup plus low carb food is an alternative.)
Test again in 15 – 20 min. Depending on the numbers, give more HC food.
Repeat the above steps every 15 – 20 min. until your cat tests in the 50 mg/dL (2.8 mmol/L) or above range for 2 consecutive tests. Continue to feed in small amounts to keep numbers in a safe range.
Test in 30 - 40 min. and repeat the test and feed process until there are 2 consecutive tests where numbers are stable or rising.
Test in an hour and follow the same steps.
DO NOT become complacent. If number have risen after one or two tests, it’s important to continue testing. Numbers may bobble up and down as the HC food and/or Karo wear off. DO NOT get one test where your cat has risen from low numbers into the 50s and go to sleep or leave the house. You are putting your cat in a risky situation. When in doubt, leave HC food out.

In the case of an accidental overdose or should there be symptoms of hypoglycemia, even if you have caught this in the early stages, you may need to monitor for literally 16 or more hours. Lantus and Levemir are long acting types of insulin. This means if your cat is over dose, you will need to stay alert for hours in order to closely monitor and to keep your cat safe.

Please post your numbers. Those people who are helping you will not abandon you. In fact, they are staying up with you. The experienced people will even work in shifts to make sure your cat is safe and you have the support you need. Remember to refresh your browser to see new posts and keep posting so we know all is well.

~ written by Sienne and Gabby
 
hi renee,

i don't know you, so perhaps you already know all of this, but i feel like i would be negligent if i didn't emphasize it.

You never want to be complacent about low numbers. a cat can have a hypoglycemic episode even on very low doses. you always want to retest when you see them. When you caught the 48 tonight, VanGogh could still be going down.

Please ask if you need help with something. We'd be happy to help you.
 
AMPS was 119 this morning, so I did stay with the .25 dose. Thankfully, I'm home most of the day, so I can do several tests to see where we stand. Tried to go to bed around 3:30 & think I FINALLY fell asleep around 4:30 or so. . .only to wake up at 5:30, so this tired Sugar Cat Mama is gonna hit The Couch to see if I can catch some more zzzzz's. . . .sticking with FF Classics & trying soooo hard to get him away from the fish flavours. . .it's like pulling teeth, even with the FortiFlora!

Had the most god awful dreams that my Dad ( A HUGE animal lover & been "gone" 14 years) was trying to FORCE insulin down the throat of a blue parakeet and a grey & white cat with a terribly deformed jaw. . .jeez, where The Hell did THAT come from!? lol!
 
Nice catch on the 48 last night. I am sorry you are so tired. The new moons and full moons affect my dreams too.
It looks like VanGogh has been diagnosed for less than a year. If so, with a test in the 40s, you can reduce the dose to 0.10.
Do you think you can measure that amount?

I hope you get some sleep without dreams.
 
Is 0.10 like 1 drop? He had been on 1 drop for a while til his numbers started creeping up when I was away at Thanksgiving. I eyeball 1/4 dose, then "turn" end of syringe to get to 1 drop. I practiced it a LOT last time we did the 1 drop, so I'm sure I can do it again if that's The Dose you're suggesting. . .gonna TRY to go back to bed & set alarm for 9:30 so I can do another check at 10:00. (+3)
 
Happy New Year! It certainly sounds like Van Gogh wanted to celebrate.

I agree with Dyana -- with a cat that's within a year of diagnosis, numbers below 50 warrant a dose reduction. Since you've practiced the 0.1u dose, I'd encourage you to give it a try. I also want to strongly encourage you to get spot checks whenever you can. Lantus dosing isn't based on the pre-shot numbers -- it's based on the lowest number in the cycle (i.e., the nadir). Since you've made a switch in diet and it seems like Van Gogh is responding well, it's doubly important to catch those low numbers so you're not surprised and your kitty is safe.
 
Just tested at +3 & came up with a 96, so down from 119 AMPS, but I believe that's considered a "natural" drop in The Cycle. Will test again at +5 as I need to be out at +6. I never could figure out when VG's nadir is, as his numbers seem to wander so much. I believe it's "supposed" to be around the +6 mark? Anyway, he is one very happy, accommodating Sugar Cat! Thanx again for input! Will shoot 1 drop PM!
 
Nadirs can and do move around. There may be a "general" trend for the nadir to be at a certain point but it can change. It's also hard to know where the nadir falls if you don't have a good amount of data.
 
I think we're looking good!

AMPS = 119. +3 = 96. +5 = 93.

Numbers seem to be dropping slowly. . .naturally. . .I will test again at +7 & go with lower dose (1 drop) PMPS. Though VanGogh was on the lowest of The Friskies Pates, I'm just blown away at what a difference switching to The FF Classics has made. Thanx Wendy!!!
 
Looking good so far.

It might not just be the food -although that should help. He may have been doing this anyway but you didn't catch it cos you weren't testing as much as you are now. For example on the 24th and 25th december. However the main thing is that you did test, and you did catch the 48, and so you are reducing the dose as a result.

He may have dropped below 48 on other days and if he did he would have bounced - and the higher numbers you saw (i.e. 150+) may have been little bounces.

Anyway lets see how 0.1 does. Give it a few days unless he drops under 50 again. Keep with the testing so we can see how its working.

Wendy
 
I have the luxury of being home most of tomorrow & Friday. Work all day Saturday, then off again Sunday & Monday. Should I still test 6 times per day or only at certain times? Even tho VG is soooo good about it, I just hate sticking him so often! But I'd rather do it now if it may lead to an OTJ trial! PMPS down again 1 more point to 108!

Renee & VG
 
Here is what I do.

On the days I have to be at work all day, I get a PM +10 or +11 and compare that to the morning AMPS test. I can compare those two tests and know whether J.D. is surfing or rising or dropping and that tells me whether I need to leave out more food for him or higher carb food for him, if he is dropping. I can also leave some MC food for him in his automatic feeder to open at nadir time, if I am concerned that he will drop lower around mid-cycle.

With Lantus, it is advised that you get your PS test and then another test around +2. You can compare those two tests. If he is the same or lower at +2, then it is likely to be an active cycle, and you would probably want to test more often, than if he was rising.

I try to get as many tests as I can on may days off, so I can be more comfortable on the days I am gone for 11 hours.
You will be happy you got the extra tests in, when you are faced with a lower than normal (for VanGogh) pre-shot and have to leave for the day. All the experience you can get on the weekends (including how much MC if need be works for him), pays off.
 
Todays testing amount was perfect cos it gave us a great idea of whats going on!

A PMPS +2 is a good idea for the reasons Dyana said. Also if I were you tonite I might try for a PMPS +4 because I would be interested to see if he nadirs before +5. (last night he got a 48 at +5 and I find myself wondering if he dropped lower prior to that)
 
Bummer. Things changed & was unable to get +2 rest! Reading of 55 at +4 so I did give him some Friskies Flaked Tuna with Egg after The Reading for a little extra carb boost. I think it's still only 6-7 carbs, compared to the 1-5 he's been getting with FF. I know (in the long run) lower numbers are a good thing, but it is just making me a wee bit nervous! Though he's been VERY active the past few days, even playing with my new foster cat! ( Only here 1 week!) Will test again at +6 to see where we're heading!

Thanx ladies!
Renee & VG
 
WOW! Seems VanGogh is EXTREMELY carb sensitive!

+4 = 55 So I gave him Friskies Flaked Tuna w/Egg as I was then worried about him dropping too low.
+6 = 124 & +10 = 143! PMPS = 127.

That's a number I'm good with! Hoping to stay with The FF Classics & get him steadier. Who knows" Maybe an OTJ trial in our future! The Happiest Cat ever! So glad he came into my life at the age of 10! Sad that he was only #6.2, near death. . .I'll NEVER understand how someone could do that! He must've been a pet at one time as he was neutered. . .don't care! He's with me now & I will love him forever!

Thanks again for all your valuable input!

Renee & very happy VanGogh
 
Renee --

One alternative to consider is if you see numbers are trending down (vs. plummeting), is to get a test in 30 min. to see how fast the numbers are changing. It may have been that giving VG his usual LC food would have kept him in a good range. (The more time he spends in normal BG numbers - especially numbers in the 50 - 100 range, the better the chances of his pancreas healing.) This is a particularly good strategy if it is later in the cycle.
 
Next time he hits 55, don't feed the friskies. Just test again in 30minutes and see where he is at. He can go to 40 without you worrying unless you see any symptoms which probably won't happen unless he drops under 40 anyway.

Wendy
 
Thanks Wendy & Sienna! I'll stick with FF if he drops low again. Tho I've been dealing with this disease since mid September I still do t feel confident in ny decisions & am sooo thankful for this foru& help & advice from everyone. I'm going to get 1 more time before bed to tonight.

Thanx,
Renee & VG
 
So other than my "mini panic" at the 55 reading when I gave him MC food, VanGogh's numbers have been between 87 & 128. He was 104 PMPS, lower than he started the day. I still did give him the 1 drop, but if his numbers stay below 120(?) over~night, thinking I may attempt another OTJ trial? Or should I wait a bit longer?

And Wendy, thanx again sooo much for suggesting the food switch! I never woulda believed (you know what I mean) how much difference switching would make if I hadn't seen it for myself! I mean, I knew lower carb food would make a difference, I just didn't realize that for VanGogh at least, the difference between 5-8 carb food down to 1-5 carb food would be so dramatic!!!

Thank you!
Renee & VanGogh!
 
I think I would keep him on 1 drop for another day at least. Try to get a +2 and a +4 if you can tonight.
 
Will get at least +2 tonight. I'm not familiar with what R is!? I have an early day tomorrow but will also try to get that +4 also. Thanks for input!
 
Off to bed & finishing up a good day of numbers!

PMPS = 104. +2 = 93 and +4 = 84!

Hoping for continued good numbers tomorrow!

Thanx all!
Renee & VG
 
I looked back through your condo and I don't see anyone talking about R. It is definitely not appropriate for VanGogh! it's a different type of insulin that we use on cats that are on a high dose or unusual situations.

VanGogh is looking great. The Protocol suggests trying to maintain VanGogh on the 1 drop for 7 days of numbers under 120 unless he drops below 50. Providing the pancreas with support as long as he needs it will give him a better chance of staying OTJ. I've highlighted the related parts for you. This is from the yellow-starred sticky on the Tight Regulation Protocol.

I would not be casual about numbers in the 40's. Even cats on very small doses can go hypoglycemic. It's fine for cats off of insulin to hang out in the 40's, they often do. but a cat on insulin has to be watched carefully and brought up from the 40's. there is nothing to be gained by pushing a cat into those numbers. normal is everything under 120 - lower isn't better.

Reducing the dose:
If kitty drops below 40 (long term diabetic) or 50 (newly diagnosed diabetic) reduce the dose by 0.25 unit. If kitty has a history of not holding reductions well or if reductions are close together... sneak the dose down by shaving the dose rather than reducing by a full quarter unit. See additional notes in the next paragraph about drops into the 20s and 30s. Alternatively, at each newly reduced dose... try to make sure kitty maintains numbers in the normal range for seven days before reducing the dose further.

Please do not let yourself become complacent or blasé about drops into the 20s or 30s.
If kitty drops into the 20s, a full reduction of 0.25u (or 0.5u if kitty is on a higher dose) is strongly recommended.
If your cat drops into the 30s, a full reduction of 0.25u is recommended. There are very few exceptions given for caregivers who have collected years of data and KNOW their cat's response to the combination of insulin and food backwards, forwards, and inside out.
Caregivers whose kitties have "High Dose" conditions may find the need to reduce in whole units or more.
Please ask for advice.

If anyone suggests otherwise, they are putting your cat at risk! Our kitties are not just numbers. They are living beings who trust us to look out for them. The TR Protocol is an aggressive method in itself. The modified version of the protocol is slightly more aggressive.

Keeping YOUR cat safe is the #1 priority of the FDMB.
Let's keep all our kitties in the Lantus Tight Regulation ISG safe by suggesting and taking appropriate reductions.

If an attempted reduction fails, go right back up to the last good dose as soon as you see kitty's numbers trending upwards. You don't have to hold the reduced dose for a certain number of cycles before taking the dose right back up. The guidelines listed under the topic "Increasing the dose" do not apply to a failed reduction.

Please use common sense in this situation. The "last good dose" is not the dose that just dropped kitty into the 20s or 30s. You want to resume momentum by finding a dose in-between the dose that dropped kitty too low and the reduced dose.
Try to go from 0.25u to 0.1u before stopping insulin completely.

Cheering you guys on! Looks like he held all day today under 120! :RAHCAT
 
After a few days of most excellent numbers, VanGogh was a bit higher this morning at 135. No idea why, but I'll continue with the 1 drop & hope he can maintain those lower numbers on this dose.

He was also a bit hungrier than usual this morning. He's a VERY picky eater & I'm lucky if I can get him to eat 1/4 can of FF (5-6 times per day as he's still a few pounds underweight), so it's unusual for him to be looking for more! He ate his 1st 1/4 can (Salmon = 1% ) with The FortiFlora & some added water , then nearly finished The Can with nothing extra added! He's certainly keeping me on my toes!

I looked back & also no longer see the reference to R. It also added "NOT to copy without guidance." Perhaps they meant that message for someone else, then edited it out when realizing their error. I had never heard of R before & only know what you mentioned in your last post.

Sadly I have to work today so won't be able to do another test until at least +6. . .

Thanks again,
Renee & VanGogh
 
Sorry. You got the mention of R from my signature. I'll try to change the color or something.

I meant to get back on and let you know that we try to hold the 1 drop for 7 days of good numbers before a dose reduction to 0.
I agree with Julie on holding the dose for 14 cycles, unless he goes below 50.

He may feel himself dropping and that's why he's eating more. Or maybe just being a cat :)
 
Couldn't get away to even feed VG today but he was 88 at +10 with nothing to eat since AMPS: and was NOT hungry when I got home! But he did eat a little! And I had to run right out again! one a those days!
 
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