Felix's sudden bg drop

[Susan&Felix(GA)]

Hello! I'm new here and just posted a bit about Felix in the Introductions forum. Felix was diagnosed in May 2017 during a DKA crisis.

I would love to have you experienced people have a look at Felix's spreadsheet and give me your impressions, especially about what happened on September 3. After months of tending to be in the 300s and 400s, yesterday morning Felix was at 106 and heading down fast. I kept giving him food and snacks and retesting him, and he did begin going back up after a couple hours. I'd skipped his insulin, so he eventually went way up.

I was doing a curve that day because I'd just raised him to 6.5 units of Lantus from 6 units a few days before and wanted to see if there was a response. As you can see from Felix's spreadsheet, I'd been home testing only ad hoc. His vet wasn't encouraging about it when I suggested it; he prefers to go by how the cat is feeling and looking, and Felix has been feeling and looking steadily better. So I intended to learn to home test just so I could do the curves and 'fraidy-cat Felix wouldn't have to go to the doctor as often (it takes him about a week to recover psychologically). His glucose has always been so high that I wasn't too worried about shooting without testing.

Until yesterday and his sudden drop! Now I'm sold on pre-shot testing!

Do you think 6.25 units for a week is a good plan?
Do you have tips on how to find his nadir? These every-two-hours curves are hard on us.
Why would his low points seem to be around the time of his morning shot?
Did I do right to skip his insulin that morning, although it meant he went so high later in the day?

Thank you for any advice you can give! I hope to have more consistently gathered data in the days to come.

 

[AZJenks]

Do you have a link to Felix's spreadsheet? I don't see it anywhere in your posts.

 

[tiffmaxee]

Welcome. I don't see a spreadsheet either. Which insulin are you using?

 

[Chris/China (GA)/Garfield]

Do you think 6.25 units for a week is a good plan?

That's a very high dose for only 4 months into treatment. Without more data, I'd suggest dropping back a little and starting to get as many tests as you can (within reason of course) in so we can see what might be going on ......maybe start back at 5U

Do you have tips on how to find his nadir? These every-two-hours curves are hard on us.

You don't have to do curves....doing "spot checks" at different times during the cycles will tell you as much as every 2 hours....Always do Pre-shot tests to make sure he's high enough for insulin and then get at least 1 mid-cycle (somewhere about 5-7 hours after the AM shot) and a "before bed" test on the PM cycle.....then get tests at different points when you can!

Think of your spreadsheet like it's a puzzle....if you sprinkle pieces all over it, the picture becomes easier to see!!

Why would his low points seem to be around the time of his morning shot?

I think it's likely that it's because his dose it too high and you're just not catching it

Did I do right to skip his insulin that morning, although it meant he went so high later in the day?

When you're new here, we suggest if you get a Pre-shot under 200 that you stall, don't feed and post for help. You're never wrong by skipping, especially when you don't have the data to know if it's safe or not!!

As you gather more data, that "stall" number comes down....most of us with enough data on our cats will shoot anything over 50 on a human meter...but that's after knowing how our cats respond to both food and insulin

Which insulin are you using?

She's using Lantus

 

[Susan&Felix(GA)]

Eek! Sorry--I had pasted the signature info with the link in the wrong place; I think it's fixed now.

I appreciate how quickly everyone's helping out when I hadn't even gotten you your information yet!

 

[Chris/China (GA)/Garfield]

That's better!!

The one thing I see is that you're not getting many PM cycle tests.....most cats go lower at night, so it's really important to get at least a "before bed" test on that PM cycle

You're also only getting half the picture when you don't have PM tests....and it could be the most important half!

You could hold the current 6.25 dose for a few days and get some PM cycle tests in and then maybe we'll have a better picture of what's going on

With those lows yesterday, he's also "bouncing" now....Bounces are caused by 1. dropping too low 2. dropping too quickly and 3. dropping into numbers their body isn't used to anymore (or any combination of all 3)

The liver releases stored sugars and hormones to bring them back up quickly....and it can take up to 6 cycles (3 days) for those to clear the body

 

[Susan&Felix(GA)]

Thank you, Chris. I will get in more PM cycle tests. His PM shot usually is shortly before bed, so the easiest time to get them would actually be in the morning around +10; "before bed" would be +1. But I hear what you're saying and will work on it. Actually, tonight I'll get something a little more mid-cycle, since I'm up later and his shot was earlier than his usual time (due to still adjusting back after the skipped shot).

I just looked at China's spreadsheet--looks like she's headed in the right direction. I'm happy for you both!

 

[Chris/China (GA)/Garfield]

His PM shot usually is shortly before bed, so the easiest time to get them would actually be in the morning around +10; "before bed" would be +1.

You might want to consider seeing if you can back him up an hour or two ...I know that might mean shooting earlier in the morning (and trust me, I hate mornings!!) but if you can swing it, getting a +2 can be a great test to get anytime

It can almost act like a crystal ball for what's going to happen later in the cycle

If the +2 is about the same as the PS, it's usually a pretty normal cycle....gradually down to nadir and then gradually up again

If the +2 is higher than the PS, that's usually the signal that a bounce is starting and you can probably take a break from testing as much

If the +2 is lower than the PS, that's your "early warning" that it's important to get more tests in later in the cycle

 

[Wendy&Neko]

Nadirs can and do move around, depending on what the cycle looks like. If they are bouncing or breaking a bounce, the nadir may not be in their typical spot. Also when the ca.t is mostly in high numbers, it may not look at all like it does when they are closer to being regulated.

Some cats like to nadir later. My Neko on Lantus typically was fro +7 to +9, but I saw it as late as +13. I have seen other cats who liked +2. The odd curve and those spot checks will help you figure out Felix's onset and nadir.

What kind of food is Felix eating now?

 

[Sandy and Black Kitty]

Felix was diagnosed in May 2017 during a DKA crisis.

Glad to see you are monitoring for ketones. When considering dose and feeding adjustments care has to be taken when there is a recent history of DKA in the mix.

If shots are being skipped and/or dose is being reduced monitoring for ketones should be stepped up. Keep in mind the recipe for ketone development;
Not enough insulin
Not enough calories
Infection/inflammation

 

[Susan&Felix(GA)]

That's helpful about the +2s.

What kind of food is Felix eating now?

Unfortunately, he is still mostly on dry food. Initially, the vet said monotony was the key to diabetic cats, and he advised me not to tinker with foods at least until Felix is better regulated. He'd been mostly on a Halo grain-free kibble, which was high calorie and I weaned him off that since he's gained back so much weight by now and I don't want him to get obese again.

So currently he's on Royal Canin Digestive Care dry, because two of our other cats (littermates) vomit on anything else. Those two and the other cats, too, seem to thrive on it, but I have been giving canned meals to the ones who can have it. I was reading a lot about kidney disease about six months ago, and that's when I got serious about feeding canned regularly. I was still learning about what brands were best for kidney protection and which flavors my cats would eat when Felix got diagnosed with diabetes. I have been referring to the food charts recommended here as I look for canned foods to try that would be suitable for our different cats' different needs. But you know how they always want what's in another one's bowl! (We already have the house divided up as much as we can by who can eat what and when.)

I've been mixing a little canned in Felix's dry, particularly in the mornings, when he's hungriest. Sometimes he'll eat that, sometimes not, but I'm hoping to hit upon a flavor that'll be better accepted. I just don't want him completely refusing food at meal times so that I can't give him his insulin. I've been reading about how to get a dedicated dry-food eater over to canned, and it's going pretty well with two of our cats who formerly preferred dry, but Felix is more challenging. I think there must be a cat-only forum called Keeping on Kibble that he frequents and picks up tips.

 

[Wendy&Neko]

but Felix is more challenging. I think there must be a cat-only forum called Keeping on Kibble that he frequents and picks up tips.

LOL!
We had one member with a kibble head who had good luck with freeze dried raw. But he wouldn't eat any wet so at least you've made some good progress. Which canned food are you trying? I also tried to stick to low phosphorus, low carb food as my Neko had acromegaly which can be hard on kidneys. For most of the time she was on raw food.

 

[Susan&Felix(GA)]

We've tried many canned foods; currently we're working through flavors by Weruva. Last February, I had an elderly kitty die of kidney disease, so I had gazillions of canned foods in the house because she wouldn't usually eat something more than once if she'd eat it at all. They were all flavors and textures and levels of quality, and some of them coaxed the kibble heads to branch out a little. But Felix was never tempted. Not even tuna turns his head, and this is a guy who loves to eat. He has been even more repulsed when offered raw, but now I'm going to look into the freeze-dried raw you mention.

 

[Wendy&Neko]

Primal has a line that is fairly low carb, as I think the Nature's Variety chicken is. Stella and Chewy's isn't good at giving out their nutrional information, but some people give it as a topper sprinked on top and it's been OK on the blood sugar. The ingredients list looks OK.