Flying solo with Olive for a while

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OlivesMom

Member Since 2020
Been an eventful morning. Olive's numbers didn't sky rocket through the night. Since her BG didn't reach 350 by shot time last night, we didn't give her any further insulin until this morning and we think we gave her 0.25. I say "think" because Miss Olive decided to take off just as I was pushing the plunger in. Ugh! Her BG should let me know one way or another as I test today. I learned that my AT2 test strips have taken a side trip somewhere and now won't arrive until Monday after we were notified it would indeed arrive today. Thank goodness we have the Relion as backup. It's all set up and ready to go. Only thing is, once I have to start using it it's going to mess the spread sheet up since that's set for the AT2. I'm so used to this one that it's going to be difficult knowing just where her BG is by comparison with the Relion.

Thank you for the link to the EZ Complete. I'm going to research that. I have not been successful yet in obtaining the urine sample. I turned my back for a minute and she'd jumped in the litterbox and went. So I'll have to wait until tonight and try again.

The vet called me this morning and again, she was pushing for Olive to go on the Purina DM. She's a nice woman, she really is, but for lack of better words, we are butting heads. BIG TIME. I told her I'd researched that food and found that it contained such low quality ingredients that I couldn't understand how that could be beneficial to a cat. She said she wasn't going to debate that issue with me and that she's not a nutritionist and that Olive needs it because we could very possibly get her off insulin altogether if she ate it. She definitely wants her to get off the raw food at about 97% protein and and on something at least no higher in protein than 50-60%. Said again that Olive isn't getting enough carbs which is making her BG bottom out. I do understand where she's coming from and I do agree she needs more carbs right now, but I'm so on the fence about feeding her the DM. It's the polar opposite of good nutrition for an obligate carnivore compared to raw. Am I wrong? I value all your thoughts. We'd already set up an appointment on Monday morning for a BG check and weight check in her office. Our conversation wasn't at all going as she wanted and I know as nice a person as she is, she was and has really been tired of dealing with this since I'm not playing ball on the food issue and she doesn't know how we can proceed and get Olive's BG to stabilize unless we do as she wants. From her standpoint, I get it. So I told her I'd found a holistic vet about a half hour from here and that in her opinion would it be best for us to take Olive there??? She said she was all for it because she again admitted she knows NOTHING about holistic foods or that approach and if a holistic vet can get Olive on a better diet, then she's all for keeping an open mind even though it's clear that she has DM tunnel vision. She said we'd go ahead and cancel our Monday appointment. I'm not sure how long it will take to get Olive seen by the holistic vet, so in the meantime the vet said to keep giving her 0.25 units every 12 hours unless her numbers are below 350. So we are flying solo for a while now. So in your opinions, how often should we feed Olive through the day? She eats more during the day if we give smaller meals spaced out. Right now, until we can get her to eat more (she gets full FAST on raw food) she's eating a total of 3/4 c of raw a day. We give 1/4 cup at the morning shot and 1/4 cup at the evening shot, which leaves the other 1/4 cup I can either give all at once at the midway point or divide that up into 1/8 cup portions throughout the middle of the day.
I will add that she also doesn't like that we are testing her at home. She wants that curve done in office. I didn't understand that statement. I thought home testing was better for the cat??? Eliminates stress. Plus, she ended up charging me for two phone consultations when all I did was tell her that Olive had Hypoed and I thought a half unit of insulin was too much for her. Just to answer my questions on her care was considered a consultation. Vet offices aren't allowing people inside much here, so the phone is the go-to for answers. I thought that fee charge was pretty crummy, personally. It's not like she examined Olive or ran tests. It was asking how often to feed her and the insulin questions. I think it's best for Olive to see someone else. I just hope we can get her in soon and work on her diet approach.
 
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Sorry about the disagreement with the vet. :bighug: A lot of us had to go through a period of "differences" with the vet. My vet and I agreed on where we would disagree and where we wouldn't. Diabetes treatment was mine, she got everything else. But that was after she's seen what I was doing and getting copies of the spreadsheet weekly for a while, along with copies of the dosing method I was using. I was her first client to home test - it took her a leap of faith, but she was up to learning.

DM could be better for some cats, if they are switching from dry food. ;) Still doesn't make it the best option. I didn't ask about food for diabetics, I just told the vet what I was going to do. As for raw, several small meals a day are fine when you are giving Lantus - just try not to feed in the two hours before shot time, until you have more data. Feeding in the first half of the cycle is best, as that's when the insulin is strongest. I'd also feed at similar times AM and PM if you can. The other 1/4 cup maybe start with 1/8 cup around +3 AM and PM if that works for you? Note that best times to feed is a bit of an art, depending on the particular cat. Take notes on when you feed her and see what happens. You might have to do some experimenting.

On Lantus, my cat dove the first part of the cycle, so I gave her 1/2 her cycle food at preshot, then divided the rest into a couple other portions she got in the next few hours. The early feeds in the cycle helped slow down the diving a bit.

Note that today you are seeing bouncing. Olive's body isn't used to those lovely greens she saw yesterday, so her liver is dumping sugars into her system. The bounce will pass and numbers will come down again. Keep giving that 0.25 units, or as close as you can. You can stop testing for the rest of the day, she's not going down any more.

As for the spreadsheet, did you start with the Relion today? If so, put a blank line between yesterday and today on the SS, and write on that line "switched to Relion meter" or something like that. Or if you are starting part way through the day, you can do the same thing. If you stick with the Relion, we can get one of our spreadsheet folks to change your spreadsheet to work like the ones for human meters.
 
I think it makes sense to divide up her food into snacks. As to when, you might want to experiment. Many people find that feeding some early snacks before they start diving can help tamp down the diving; maybe Olive will show a similar response (obviously, she's not diving today!).

Oop, Wendy just posted with a more detailed runthrough of everything I was going to say, so I'll just refer you to her post for the rest!
 
Wendy&Neko said:
I'd also feed at similar times AM and PM if you can. The other 1/4 cup maybe start with 1/8 cup around +3 AM and PM if that works for you? Note that best times to feed is a bit of an art, depending on the particular cat. Take notes on when you feed her and see what happens. You might have to do some experimenting.
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Okay, I'll try this feeding schedule and see what happens.
Wendy&Neko said:
You can stop testing for the rest of the day, she's not going down any more.
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Okay, thanks for the feedback. It'll be nice to give Olive a break from testing for the next 6 hours. Plus give me a chance to get some chores done uninterrupted.
Wendy&Neko said:
As for the spreadsheet, did you start with the Relion today?
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No, I still have about 9 left of the AT2 that I'm going to use up. Maybe, if all goes well those other test strips will be here before I run out, but I doubt it. In which case I'll skip a line on the spreadsheet as you suggested. Although I like the lower cost of the human meter test strips, I'd rather stick with the AT2 as a rule only because it requires less blood. I hardly stick Olive and get enough blood for the test, but after playing with the human meter on my husband and myself, it seems like it requires more blood for the test. But at least the human meter is here because I bet I'm going to need it before Monday.
 
I'm a little confused by your spreadsheet. Have you been giving Olive shots since 8/14? If so, you need to indicate the dose in the "U" column every time you shoot. If there's no dose marked, the assumption is that you didn't give your kitty a shot.

It sounds like your vet told you not to give insulin if Olive's pre-shot number is under 350. Ummmmm.....that's ridiculous. Even with the faster acting insulins (e.g., Vetsulin or Novolin N), you are able to shoot numbers lower than 350. We typically tell new members who are using Lantus to post and ask for help if your pre-shot is 200 (with the Start Low Go Slow approach) or 150 if you're using Tight Regulation for your dosing method.

My vet initially pushed for prescription food. At the time, the canned DM was higher in carbs and the dry, which she also recommended, was very high in carbs. Once I found FDMB, did some reading, and found the journal article that described Tight Regulation, I went in for an appointment and returned all of the "prescription" food. When I pointed out to my vet that the Rx stuff was higher in carbs than Fancy Feast and the ingredients in FF were better and there were human grade foods around that were lower in carbs, she asked where I found the information and I gave her the link to Dr. Lisa's site. Once she was reassured that I knew enough about FD and the role of carbs, she was fine with my feeding Gabby whatever I thought was best. We also learned Tight Regulation together and she taught all of the other vets in the practice how to use the methods. The bottom line is that I wanted a vet who would listen to me and who would be a partner in my cat's care. Informed consent is not the same thing as "do what I tell you." You are Olive's caregiver and you know her best. A curve at the vet's office is likely to be influenced by stress and give inflated BG readings.

We will happily inundate you with articles from veterinary journals if your vet needs to get some additional information about Lantus and managing FD.

I do think some vets are apprehensive about raw food diets. They are concerned about salmonella. It's not an unreasonable concern if you are buying commercially prepared raw food. I don't think it's the same with freeze dried raw but I can't swear to that. I buy fresh organic meat at a grocery. It's the same stuff I would eat (well, maybe not raw). Someone on FDMB mentioned that their vet calmed down when she realized that the member was using ground meat from the grocery. I would ask your vet what the comparison is on food recalls on raw food versus dry cat food. The dry stuff gets recalled with some regularity. It has a tendency to go rancid due to the high fat content.
 
Sienne and Gabby (GA) said:
I'm a little confused by your spreadsheet. Have you been giving Olive shots since 8/14? If so, you need to indicate the dose in the "U" column every time you shoot. If there's no dose marked, the assumption is that you didn't give your kitty a shot.
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No, Olive hasn't had insulin all this time. Once we started her on it and her BG went hypo, the vet had us stop the insulin. She told us to do a week long curve without so we could give her the numbers. That was the original vet we went to. During this time Olive's care was handed over to another vet in the clinic who supposedly had more knowledge in feline diabetes. We were told this vet was also knowledgeable in raw food. Turned out she was clueless. So Olive has been on a yo-yo of insulin and insulin amounts so when I left it blank in the "U" column, that's because there was none given.
Sienne and Gabby (GA) said:
It sounds like your vet told you not to give insulin if Olive's pre-shot number is under 350. Ummmmm.....that's ridiculous
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We have no idea what the numbers should be before making the call to give insulin. She just said as long as it's 350 or under NOT to give it. I guess since Olive has tanked to hypo, she wants her BG to be at higher levels before giving insulin???
I'd appreciate any article you wish to give me. Knowledge is power.
 
The initial dose of Lantus is based on a cat's weight -- at least with TR. The initial dose = 0.25 x ideal weight in kilograms. This typically comes out to around 1.0u, give or take. With SLGS, if there is no dry food in your cat's diet, the starting dose is 0.5u. These numbers are not written in granite. If you are more comfortable starting at 0.25u, then start there. It will take about 5 - 7 days for the Lantus depot to form. Some cats have a dramatic initial response to insulin and the numbers will then stabilize. You'll need to see what happens once the depot has stabilized.

I would suggest that if you have a pre-shot test that is below 200, you post and ask for help. Skipping the shot is only one option. You can stall (don't feed your cat) and retest to see if numbers are rising. Or, you can give a reduced dose (which will be hard if you're shooting 0.25u). People here or on the Lantus board, if you opt to post there, can walk you through the options.

Just a word about "hypo". We make a distinction between low numbers and a symptomatic hypoglycemic episode. If you want to page through Gabby's spreadsheet (there's a lot of data), you'll see she had drops into the 30s. She never exhibited symptoms of hypoglycemia. She was in low numbers. It's only a "hypo" if symptoms are present. I don't recall if Olive was symptomatic.
 
From Robyn's first thread:

OlivesMom said:
They had her start on one unit of Lantus twice a day (Her first dose was given that night at 9pm) and I started keeping a notebook handy to jot down the numbers. The next morning at her 2nd dose, her numbers went to 76 midway between insulin shots. Same things happened the following day when she now dipped to 55 and showed signs of not doing so well so I offered her food. [...] another vet told us to continue with the one unit of insulin twice daily for a few days until our vet was back in. Against my better judgement I listened and gave her the shot that morning at 9 and by 1:30pm she was throwing up, looked bad, and her BG was at 65.
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I'm thinking those may have been two symptomatic hypos. Nothing like jumping into the deep end right at the beginning of FD treatment! She's a very lucky girl that you were keeping a close eye on her and knew what to do, Robyn!
 
Yes, on the 16th and 17th when her numbers dropped to 55, then 65 the following day, she was symptomatic, it's what first alerted us something was wrong. So when I refer to being afraid she'll hypo, it's because we've watched the effects now and it scared the gee bees out of us. At numbers above that, although on the lower side of borderline, she showed no signs of diving so if it hadn't been for the monitor we never would have known. If I were to "stall" the shot while waiting to see if the numbers rise then how long can you go before you make a decision? I thought I read somewhere that you have a 2 hour window and after that you must wait to give the shot at the next regular time and that if you stalled, then it could potentially build a little excess into the next insulin shot. I recall seeing someone say something about that.
Nan & Amber (GA) said:
I'm thinking those may have been two symptomatic hypos. Nothing like jumping into the deep end right at the beginning of FD treatment! She's a very lucky girl that you were keeping a close eye on her and knew what to do, Robyn!
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Thanks, Nan! We love our fur babies. Hubby tells me I'm stressing too much, but this is all knew to me and I just want to get this right, for Olive's sake. Yeah, it was quite a way to begin...with hypos. So I've been a nervous wreck it will keep happening ever since. So I keep testing. Hopefully there will come a time when things will settle into some normalcy for Olive and for us. I'm exhausted worrying about her.
 
OlivesMom said:
Yes! Finally able to get a urine sample just now so I could test the Ketone level. It came up as "Trace.
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Did you follow the directions exactly and read it at (I think) 15 seconds? The strip will continue to darken as time goes by. It's also important to read it in a good light.

Trace is OK but anything more than that is a medical emergency. Try to get as much water into her as you can to help flush the ketones out. Lots of us add extra water to their food to increase the amount of water
 
Good for getting a ketones test done! You might want to note the test and result in the Remarks section of the spreadsheet. I know some of us will keep asking about ketones tests if we see high numbers and don't see anything in the spreadsheet. :p

I add water to the raw to increase the amount of fluids taken in orally.
 
Alright gang, It's been a fairly good day here, despite Olive's high numbers. She's been happy, happy, happy today, playing like a kitten and her ketone test was good. She's even jumping again! I've added water to her raw meal tonight and she just got 0.25IU. This time I'm positive she got it as hubby held her in place. Now it's just a matter of if we eye-balled the amount properly. Sure would help if they made quarter unit syringes. I'll be monitoring her through the night. Even though I don't actually have a vet right now, I feel like a load has been lifted by letting this current vet go today and enlisting the help of the holistic vet on Monday. Just feels right. Unless Olive bottoms out through the night, I'll talk to you all tomorrow. Thank you all for everything!:bighug:
 
Wendy&Neko said:
Good for getting a ketones test done! You might want to note the test and result in the Remarks section of the spreadsheet. I know some of us will keep asking about ketones tests if we see high numbers and don't see anything in the spreadsheet
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I modified it. I'm still having trouble in the remarks section on how to write the time down that I give food, ect. It's just easier for me to put the actual time down. Once I can figure out how to do it properly I'll go in and modify.
 
OlivesMom said:
Alright gang, It's been a fairly good day here, despite Olive's high numbers. She's been happy, happy, happy today, playing like a kitten and her ketone test was good. She's even jumping again! I've added water to her raw meal tonight and she just got 0.25IU. This time I'm positive she got it as hubby held her in place. Now it's just a matter of if we eye-balled the amount properly. Sure would help if they made quarter unit syringes. I'll be monitoring her through the night. Even though I don't actually have a vet right now, I feel like a load has been lifted by letting this current vet go today and enlisting the help of the holistic vet on Monday. Just feels right. Unless Olive bottoms out through the night, I'll talk to you all tomorrow. Thank you all for everything!:bighug:
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Best of luck with the holistic vet :cat:
 
OlivesMom said:
I'm still having trouble in the remarks section on how to write the time down that I give food, ect. It's just easier for me to put the actual time down. Once I can figure out how to do it properly I'll go in and modify.
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We all speak in "+ times" here because we're all over the world. You could say "I tested at 10pm" but there's no way for us to know 10pm in what time zone? or how long in relationship to the last shot has it been?

If you shoot at (for example) 9am/9pm that's your "Pre-Shot" times when we would expect you to feed after testing. If you feed again at noon, that's 3 hours since the shot, so you fed at +3....if you fed again at 2pm, that's 5 hours since the shot, so you'd say +5, etc. etc....all the way up to +11 and then it starts over with the next cycle.

An example would be:
AMPS 3oz FF (Morning Pre-shot 3 ounces Fancy Feast), +3 1.5oz FF, +6 1.5oz FF

Don't worry...You'll get it!....and soon, every time you look at a clock, instead of seeing an actual time, your brain will say it's + however many hours since the shot. I still think "+3" every time I look at a clock at 9am/9pm because I gave China her shots at 6am/6pm and 9 is 3 hours after the shot!

And you really don't need to go back and change everything you've already written. That's a lot of work! Just start keeping track using the + system as soon as you can.
 
I'm on another thread right now so not sure how this works but I'll ask same thing here...Olive never got too low last night like I feared would happen but this morning pre shot has been delayed ann hour already because her BG hasn't really gone up much. She was at 144. The vet had told us NOT to give insulin if under 350 so not sure what to do. We didn't know enough to question her at the time. Maybe she was going by past experiences where Olive was at BG500 or more and went hypo at the midway point. Maybe she thinks that if we give insulin at any number less than 350 that we'll really send her to her death in a hypo event. That's my best guess a ways. I really don't know what to do about this morning. Do I not give the shot and wait until tonight's cycle?
 
On your food issue with the vet. The DM might not be best quality for sure however, it is below 10% it use to be 4% but I think it's a bit higher now. What you could do to quiet your vet about it is to buy 2 cans of the pate dm not the savory dm and tell vet you will try. After a few days tell vet she won't eat it. And let it go at that. My Smokey loved the dm and ate it for quite awhile with no issues.
 
I have a thought. I know there aren't many of you who feed raw, but I was curious about something. The census seems to be that Olive isn't getting ENOUGH carbs which is why she's dropping so much even on .025 IU. Her raw food is 0.04% carb. Since she'd always been on RAWZ kibble which is like 25% carb, then went to a raw diet with virtually no carbs, it would definitely make sense her body might require more carbs right now. I have watched Olive blossom since we made the switch to raw. She's playing like a kitten now and has started jumping again, which she hasn't done in a few years. She's even getting in bed with us which she's NEVER attempted once in all these years. So I want to keep her on raw. However, if she needs more carbs, couldn't we just put a little Friskies or Fancy feast into her daily food? I don't know anything about appropriate diets at this point as it relates to Olive's needs (I know we'll find out more once we see the new vet), but I would imagine just adding a little carbs into her food would benefit at this point. Any thoughts? Those who have been following me know we pretty much fired Olive's current vet the other day and have been flying solo since while we wait to hear back from the holistic vet on Monday. She deals in both: She uses the holistic approach as a rule, but also western medicine if needed. I'll be anxious to learn what she has to say about all this.
Olive & Paula said:
What you could do to quiet your vet about it is to buy 2 cans of the pate dm not the savory dm and tell vet you will try. After a few days tell vet she won't eat it.
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I should have done just that! Because she wouldn't let that go and from the moment we butted heads on the subject our conversations felt so hostile on her end. Which is why we ultimately decided it was best to find another vet who will work WITH us.
 
In theory it sounds plausible. Maybe if you can find 2% carbs and use that for snacks, keeping raw for main meals. I

Others please chime in on this thought, how about 0.1 dose while staying on her normal food diet?
 
We generally use 200 for a cutoff while waiting for more data (eventually on Lantus you can shoot pretty low numbers, but you need to know your cat's patterns first).

You can get an immediate pre-shot test in a half hour to be sure, but as long as she's not moving downward then I think you are good to shoot.

You were asking before about the 0.1 dose-- that's the next step down from 0.25U. Tiny doses are described in the Lantus forum sticky Insulin Care & Syringe Info: Proper Handling, Drawing, Fine Dosing. The 0.1U dose looks like this:

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Might be worth trying for Olive.
 
Dropping in to say Olive did great through the night. I realized I didn't need to give her that tsp of food before bed, but I was fearful she'd drop low if I didn't so I jumped the boat. But it wasn't warranted. Once I get more data using the human meter and this new dosing, I'll feel more confident in not having to test as frequently I'm sure.
Nan & Amber (GA) said:
We generally use 200 for a cutoff while waiting for more data (eventually on Lantus you can shoot pretty low numbers, but you need to know your cat's patterns first).

You can get an immediate pre-shot test in a half hour to be sure, but as long as she's not moving downward then I think you are good to shoot.

You were asking before about the 0.1 dose-- that's the next step down from 0.25U. Tiny doses are described in the Lantus forum sticky Insulin Care & Syringe Info: Proper Handling, Drawing, Fine Dosing. The 0.1U dose looks like this:

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Might be worth trying for Olive.
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We are thinking what we actually gave her last night was closer to the 0.12 than 0.25 but man, it's just so hard to tell. We went low verses high and we can tweak from there, but I'd rather start low and get some data under our belt. So when I said I gave her a very skinny 0.25 I know it's somewhere between that and the 0.12
The new holistic vet can't see Olive until the 25th of September. She's that booked up. So we will truly be flying solo for the next month!! When I spoke to the tech, she said the vet is a firm believer in letting nutrition support and balance the diabetic body. So that was good to hear. I guess we'll just have to keep on doing what we're doing until the 25th. You guys have been like "AIR" to me and I thank you. I really don't know what we'd have done if you all weren't there.:bighug: I'll keep you updated.
 
A request, Robyn. Please can you also link Olive's previous Alphatrak spreadsheet to your signature. Alternatively please can you add the previous data to the beginning of your new 'human meter' spreadsheet, clearly label it as Alphatrak data, leave a row clear between that and clearly demarcate the starting point for the new human meter data, for example:

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Olive's response to insulin has at times been very extreme thus far, sometimes dangerously so. She has also shown signs of exercise-induced hypoglycaemia while not receiving any insulin. To get the best and safest help from members responding to your threads they need visibility of all the history and data available, especially when a cat has to date been quite unstable and has only begun to be home tested.


Mogs
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You can also hide the actual link in the code of your signature. In the options above the text box you write in, there are two symbols that look (sort of) like a paper clip and a paper clip with an "x". They're for adding and removing links to text.

So, in your actual signature you would write something like "Olive's AT2 spreadsheet", select that text, click the paperclip symbol, and then paste the full link in all its unreadable glory in the pop-up box.
 
Just sitting her wondering why her BG was at 303 AMPS and has risen so much (410 + 3.50) since the shot. Wondering if I didn't add as much into the syringe as I thought. I just fed her the 1/8 c snack. She'll get another 1/8 c snack at +8. She actually wanted more food just now. I know she would have eaten more and I KNOW she needs to put on weight, but afraid if I increase her food how that will affect everything. Would it be okay to begin feeding her a little more if she'll eat it through the day? She's currently getting 3/4 cups of raw and ideally she needs about another 1/2 cup to 3/4 cups in a day.
 
Hmmm... maybe she's bouncing from the drop last night? She didn't go too low, but she did drop fairly fast in the beginning. I'm not sure, though.

You can definitely feed her snacks if she needs them! The only time we try to restrict food is in the two hours preceding shot time. That's so the pre-shot number is free of food influence (this is most important in the beginning before Olive settles into a predictable pattern).
 
Olive is underweight and not yet regulated so she needs more food.

Remember that the glucose in the bloodstream doesn't just come from the food she's eating; the body also produces its own glucose (it's what keeps the body going between meals).


Mogs
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Nan & Amber (GA) said:
You can definitely feed her snacks if she needs them
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Critter Mom said:
Olive is underweight and not yet regulated so she needs more food.
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Okay, thank you, guys for the information. I've got the vet's words stuck in my head of them not really wanting her to eat more than twice a day but that they'd allow a third meal to slide in if needed. Then I had to "talk" them into at least diving that mid day meal into half so she could eat more often as she's used to. I know my cat! She's got me trained well, too. She'll eat the quarter cups (which is her largest portions during any given meal time) as long as I follow her around "begging" her to eat just a little more until she's cleaned her plate. She always does in the end, but it takes about 10 minutes. She has her pattern. She eats a bit in the kitchen, stops in the living room and waits for me to offer another bit, then she climbs to the top of her stairs leading to her cat tree and waits for me to offer a third time, and once she jumps into the basket at the top of the tower she'll eat the rest. It's a 4 step pattern. Ha! I honestly think Olive gets a big kick out of that. lol. My husband gets the biggest kick out of watching both of us. :smuggrin:
 
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