Feeling hopeless and need guidance.

Hello everybody! Charlie is a trooper, he has been acting great but he is still not even close to being regulated. I have been feeling so hopeless and need some encouragement and guidance. He is now completely on a low-carb wet food diet. He gets a can in the morning and a can at night. No dry food at all. For a while, we were thinking he was dropping super low and then bouncing, which I was able to collect numbers that proved that was the case so I continued to slowly drop his dose. He stopped dropping super low, the nadirs have been in the high 200's. But after 5 days of consistently being high, I decided to raise the dose slightly. If you look at my spreadsheet you can see occasionally he does drop lower but it never lasts long, he always jumps back up.

I've considered trying to switch to the tight regulation method but have some questions. When changing to a new method, do you calculate the dose based on weight and start from scratch? Or do you keep on the dose he has been on and adjust from there?
What is a cycle? A full day with the 2 shots 12 hours apart? or is it just one shot?

Working a full-time job I can't necessarily test at +3 or +9. I can do +6 and before or after work. So I am not sure if tight regulation is even an option for me.

I just feel hopeless. I feel like I am doing something wrong. I feel I'm stuck in this cycle of bouncing and don't know how to stop it. Charlie acts pretty good most of the time but I know that this uncontrolled diabetes is slowly damaging his body. Any guidance or encouragement you guys can offer would be greatly appreciated.

EDIT: Another thing to add, should I try waking up in the middle of the night to test? As someone who suffers from fatigue, I really value my sleep. But if you guys think it would help, I will try!

 

Tagging @Wendy&Neko since she is marvelous and has been my main helper on here.

 

You would keep the same dose and adjust from there if switching to TR

a cycle is the 12 hour period from one shot to the next, so you will see people say "day cycle" and "night cycle" referring to the two 12-hour periods

I followed Tight Regulation and my personal opinion is that Charlie would benefit from the more aggressive dosing found in TR. TR calls for a minimum of 4 tests a day -- AMPS, PMPS and then at least one other test during each cycle. More is of course, better.

As far as waking up in the middle of the night, that depends really on how that particular night is going. For example, if an evening test at about +2 or 3 showed Charlie dropping significantly and quickly, more testing that night would be good to make sure he doesn't go too low. So, maybe go to bed for an hour or two then get up and test again to make sure he is safe. I did that a few times with Hendrick.

Another reason to wake up in the middle of the night would be if you were looking to get a data point at a time when you normally are sleeping so don't test. It is good to get those off-schedule BGs now and then.

 

TR is possible with a full time job. See this: https://www.felinediabetes.com/FDMB...ion-possible-with-a-full-time-job-yes.129378/

@Jason - Kona's Dad might have some tips on TR. If you look at some of Kona's condos, she has a feeder set up for multiple small meals daily and sometimes there aren't any daytime mid cycle checks because the bean is working at the office instead of at home.

But if it just doesn't work out with your schedule, don't stress about it SLGS is a perfectly fine method. The goal is to get bgs to stay in a normal range. Remission is great but sometimes a cat just doesn't want to go there even if you're doing everything right. The most important thing is to have a happy and healthy cat

 

Thanks for taking some time to answer my questions. I think I remember someone saying that the BG tends to drop lower at night. That's why I have considered testing in the middle of the night to get an idea of just how low he is dropping. I try to stay up later on the weekends so I can see more of his PM numbers. I need to be better at PM testing during the week.

I agree that Charlie would benefit from the more aggressive dosing. Since it has been 4 days since I increased and the nadir has been 280 and up, should I increase by 0.5 units for tonight's dose?

 

Is there a feeding schedule I need to follow if I try TR? He currently gets one can in the morning and one can at night. But he doesn't eat it all at one time, it sits out for a little bit and he slowly munches during the day and night.

 

there is no specific feeding schedule for TR but as a general rule of thumb for any diabetic cat, main meals should be fed twice a day with the insulin dose, and then it is ok to give other food a few times during each cycle but food should be withheld for the last 4 hours of each cycle because the insulin is wearing off and the next dose is coming up, and you want to get a pre-shot BG test that is NOT food-influenced.

So in your case if you used a timed feeder that did NOT let him graze all night, only for the first part of the night cycle, that would be best. Regardless of TR. It is possible that your AMPS and PMPS BG tests are being bumped up by food if he gets to eat in the hours prior. If I'm understanding you right.

 

I give him food but he doesn't eat it all at once. I do not use a timed feeder. I just test, feed, then shoot twice a day. He's a slow eater but I believe he finishes before the last 4 hours of each cycle. I'll have to pay more attention and make sure he isn't eating those last 4 hours. I didn't know that so thanks for telling me!

 

Katy --

Please don't feel hopeless!! I've been here a long time. Gabby was my diabetic diva for 6.5 years. For a long time I felt like I had to be doing something wrong because she didn't go into remission despite my best efforts to get her there. This is a frustrating disease to manage. What I learned is that I just had to do my best. I couldn't control what my cat's pancreas was going to do or not do. (Well, there was the exception of her stealing honey glazed chicken but that's an entirely different issue.) Remission would have been a huge victory. There were any number of small victories that I learned to pay attention to. And, more importantly, by treating your cat's diabetes you helping him to feel better.

I think Charlie is still bouncing. He's used to being in high numbers. It's likely going to take a good deal of patience and perseverance go get Charlie used to being in a lower range of numbers. TR is more aggressive and may be a good option. I managed TR with me as the only caregiver and I was working a full time job. It's possible to do.

 

Don't get discouraged, I know exactly how you feel, you are in the right place, I saw Charlie's SS perhaps instead of you deciding on the dose to give, I highly recommend, you reach out to Suzanne & Darcy, a long time member very much experienced in dosing, you can PM her and give her the title of your post to review, she has been an angel with my Corky, and she's always respond quite fast, I am positive she will help you get your Charlie on track.
Corky likes to keep me on my toes! Thank God his only situation is Diabetes, but he gets quite crazy at the +4 when his insulin kicks in, I personally test him every 2 hours, he can surprise me at times and I also always feel I did something wrong, she is very reassuring and compassionate, she will help you with Charlie's dose to get to the yellow if not green numbers where he should be. In reference to the food, make sure you give him Fancy Feast pates only, they are low if no high carbs, check the food chart on the main Forum so you can see the low carb foods. I feed my Corky 4 times a day 2 main meals and two small meals, basically every 6 hours my last test is at +4 unless his BG is in 2 digits. Give Suzanne a shout, I still panic more often than none, Corky was diagnosed June 2nd last year, he was hospitalized 8 days he lost a total of 8 1/2 lbs. in less than a month, I had no idea about diabetes, He was overwhelmingly drinking water, he wasn't a lap cat or enjoyed being picked up but he looked great, until one day I went to give him and my Coco a treat and he didn't get up and let me walk by him without him moving away , then he actually let me pick him up and he felt like a feather, he was weighing 16.5lbs he is a very big cat, My journey began that day, today everything I do surrounds around his need and schedule. You are very brave in changing doses, I freak out if I even have a different needle, you got this. again, reach out to Suzanne & Darcy

 

I can't thank you enough for your kind words. I needed to read that. As you said, I need to remember we are doing our best. It is helping him feel better than if he had no treatment at all. Celebrating the small victories is important as well. I need to remember that so I don't feel like a total failure. It's always nice to hear that other people have struggled with getting their cats regulated so I don't feel alone. Like I said, I feel like I am doing something wrong, but I need to remember that diabetes is a roller coaster and we are in the thick of it.

I believe he is still bouncing too. But that's what makes me so stressed, I feel like I won't be able to get him to stop bouncing. I've never been a very patient person but I will keep trying. I have to do whatever it takes to make him feel better.

 

Thank you so much for replying to me. Some days I feel hopeful and on the right track and other days I just want to stay home and cry. Today is a bad day but you guys are so helpful and reassuring. I'll reach out to Suzanne. I have adjusted the dosing myself but would feel much better if I had someone confirming that I am doing the right thing. I love looking at your spreadsheet and seeing all the yellow and blue boxes. I sure hope we can get there soon. It makes me hopeful that you've been able to achieve that in a little less than a year. I'm sure Corky is feeling better and so grateful to have you in his life. Thanks again for your kind words!!

 

I'm here to cry with you, trust me I have days in the point of a breakdown, but please reach out to Suzanne as soon as possible, suggestion, don't guess dose any more, she will take you where Charlie needs to be, also I have learned that the inconsistency of dose changes also causes Charlie to have curves (bouncing) in his BG, he needs stability and right dose . I'm here for you, I can give you support and we can exchange input, but when it comes to dosing Suzanne is your gal, and remember what I said about the type of food he needs to have to lower his BG's

 

What is your work schedule like? You seem to be able to get quite a few tests in. Any more tests for today’s cycle? Where are you in the cycle right now? What hour?

I do think TR would be a good option for your Charlie. It would allow you to do dose increases every 3 days if the numbers warrant it. His body is not used to anything other than high numbers at this point. He is also eating a low carb wet food so that would allow you to follow TR with your current frequent testing. I see he has a DKA in his history. Are you testing for ketones daily? This is very important as you do not want another DKA. I used a blood ketone meter (NovaMax Plus) but a lot of people use the keto stix strips in the urine stream when their cat is in the litter box.

As to feeding. It’s good for a diabetic cat to eat multiple small meals through the early portion of the cycle but not eat after about +6 because feeding after +6 can shorten the duration of the insulin and cause numbers to rise prematurely in the latter part of the cycle. And for right now, it’s a rule that no food should be given for two hours prior to the preshot tests — just to make sure the BG tests are not inflated by food. Later when you have a lot of experience and data about how your cat responds to food/carbs you would be able to relax this rule if necessary. Of course, if he has low numbers that need to be raised with food, it doesn’t matter where you are in the cycle- you would do/feed whatever is necessary. Right now that’s not an issue. I hate to see a cat with a history of DKA in such high numbers.

 

I’m inclined to say that you should increase the dose by .5 units for the following reasons:

1) your nadirs on this dose are all above 300 (except one high yellow)
2) you have a history of DKA.

So besides the two preshots, what hours will you be able to test? To follow TR you would need a minimum of one mid-cycle test for each 12 hour cycle (more is better but that’s the minimum requirement.). Also you do not feed dry food so you are free to switch to TR if you like. What do you think?

I am going to tag @Sienne and Gabby (GA) to see what she thinks about this because I value her opinion so much.

 

I work Monday through Friday 8:30 AM to 5 PM. I test, feed, and shoot between 6:00 and 6:30 AM. So I am usually able to test +1, and sometimes +2. I try to go home during my lunch break every day but don't always have time so that is at +6. By the time I get home after work I can sometimes get a +11 test but I usually just wait until +12 where I test, feed, and shoot again. As of right now, we are at +10, but I won't be home until +11 or +11.5. I can test after PM shot at +3... maybe +4 before I start falling asleep. (Once summer is back its easier for my body to stay up a little later!)

I think TR is the way to go. I think we need to adjust more often and get this dang thing under control! You can look at the notes on my spreadsheet, I have a blood meter and I do test ketones often but not always every day. Honestly, when I get a good poke with extra blood, I'll test. If I have to squeeze his ear and work for it, I usually just test BG and not ketones. But I definitely could test daily. Is there a time of day that would be better for testing that?

You said it is better for a cat to eat multiple small meals a day and I think Charlie does that on his own. He eats a little bit, hangs out for a bit then goes back for more. I put out his food between 6:00 and 6:30 AM, when I went home during my lunch break at +6, the food was gone. So he is eating it all much before his next dose.

I hate to see his higher numbers too. Thats why I feel so lost right now. Thanks so much for your help!!

 

It sounds like you could make it work. I can tell you are dedicated to Charlie. ❤️ He seems to be grazing on his food so maybe he’s taking care of the mealtimes for you. It is possible though that later on as he gets into better numbers you will want to make sure he has snacks at specific time during the cycle using an automatic feeder. I’m sorry I didn’t see the ketone readings. Good for you! You are already on top of it and I am sure you know to watch for any changes in appetite or vomiting and lethargy, etc.

 

On the weekends you would be able to fill in some of the gaps in the spreadsheet by testing during some of the times that you normally are at work. This way we can get a fuller picture of what’s happening during the cycle.

 

Yes, on the weekends I try to test as much as I can to fill in the holes. We are getting close to his PM shot... I haven't seen anything from @Sienne and Gabby (GA).... I think I am going to increase by 0.5 units unless you think that's a bad idea!

I know I've said it a million times but I can't thank you guys enough!

 

Hi Katy - I was wondering how the two of you were doing. Don't feel stressed about the bouncing around, that is extremely common and there is only so much we can do about it. We have to try to get them to a dose (safely) where they can see normal numbers more often, and get used to those numbers. The rest is up to Charlie's body.

I agree with the 0.5 unit increase if you are going to follow TR. Please update the signature if you do so. And make sure to always get a before bed test at night.

You might also want to start posting over on the Lantus forum, to get more experienced eyes on Charlie.

 

I definitely think it’s good that you went ahead with the .5 unit increase. Paws crossed for better numbers, but don’t get discouraged if you don’t immediately. Sometimes it takes a while to get to a good dose. You will now have the opportunity to keep plowing ahead with increases, if necessary, to hopefully reduce the high numbers. I definitely agree that you should start posting over on the Lantus Levemir, Biosimilars forum because there are a lot of people over there — it’s very active with Lantus users — so more eyes on your thread. Just title your thread with the date and Charlie’s name and the his numbers or whatever you want to say — take a look at how people entitle their threads over there — and link the previous day’s thread in the current day’s thread. If you poke around over there you will see what I mean. Good luck.

 

Thanks, Wendy.

 

Sorry. It's been a bit of a crazy day and I'm just getting back over here. I agree with Suzanne and Wendy -- an increase seems like a good plan. I also think that posting on the Lantus board is a good idea. There's usually someone around 24/7 and there's a lot of knowledge that people share.