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[Scdal]

I really appreciate this website and the help it gives to our diabetic cats. However, I get a lot of conflicting advice. This week, Phoenix dropped to 44 BG. One person told me to decrease his dose by .25 and another by .50 units. I really feel the .25 was the best answer because now his BG is climbing higher than it has been in months. I decreased it by .50 units.
Another problem is the conflicting advice on shooting low numbers. I have been giving insulin when his BG was 84. This week, I was told by a moderator not to shoot any lower than 90. I really feel like I need to shoot lower than 90.
I really am not trying to complain but I feel it would be better to get advice from just one person or people who agree on the control methods. I would like to get Phoenix 's BG under control. This week, I feel that I took a huge step backwards. The only reason his BG is still low in the mornings is because he hasn't eaten in 10 hours.
I think I need to go back up to 8.25 units but I would really appreciate some input or someone who would be willing to offer me advice. I am not asking for someone to be available to me all the time. I don't have a lot of free time to spend on this website. I would just like someone to whom I could turn to for advice. Any help would be appreciated. I am at a loss as to what to do.

 

[thebigfuzz]

Hello!

I don’t have experience with high dose kitties, so am unable to help. Linking your last post for continuity and information.

https://www.felinediabetes.com/FDMB...se-phoenix-dropped-to-44.237373/#post-2665208

As for the no shot under 90, your signature says you are following SLGS and reductions are taken for numbers under 90 and SLGS does not advise giving insulin under 90. Other kitties may be following TR which has lower thresholds for giving insulin and taking reductions. I believe I have linked this for you before, but here are the method guidelines:
https://www.felinediabetes.com/FDMB...-low-go-slow-slgs-tight-regulation-tr.210110/

Best of luck to you.

 

[Scdal]

The shooting low numbers is part of the problem. If I don't shoot when he is low, his BG goes way high for the rest of the day. I don't want to use the TR. When Phoenix was on 8 units before, his BG stayed mostly in the yellow range for weeks. I would really like to go back to 8.25 later this week.

 

[JOJI and Kit]

I would really like to go back to 8.25 later this week.

i see that tanya gave you the method link above. and explained the no shoot under 90 part.

i can't give you dosing advice, but to call out one detail on dose holding for slgs:

Hold the dose for at least a week:​

• • Unless your cat won’t eat or you suspect hypoglycemia
  • Unless your kitty falls below 90 mg/dL (5 mmol/L).

when kit was at a higher dose, wendy explained to us the increase and decrease logic of by 0.5 units. basically she encouraged us to think about it as a percentage.

I would really appreciate some input or someone who would be willing to offer me advice.

i suggest that you add the "?" prefix to your title and add a question like
help with high doses?

so for today, your title would look like this:
[use ? prefix] 10/29 Phoenix, AMPS 143, +2 225, help with high doses?

 

[thebigfuzz]

You earned the reduction on 10/26 by going below 90, which brought you down to 8 units.(whether it should be a 0.5 or 0.25 reduction, I guess it depends and high dose kitties have the choice of the larger reduction. But, I am no expert on that) You’ll want to hold the dose for a week to see where the dose takes him. It needs time to show you what it can do. For what it’s worth, I would hold 8 for now, unless he earns another reduction.

the last couple days you had a bounce, some yellows and even some under 150. Doesn’t look too bad so far.

Yes, when we skip, the numbers can go high for the rest of the day, but the guideline is intended to keep kitty safe. Better higher for a day than too low for a moment.

I remember we had wondered about blood work for potential high dose conditions. Did you see if the blood could be drawn by a mobile vet at home?

 

[Bandit's Mom]

The shooting low numbers is part of the problem. If I don't shoot when he is low, his BG goes way high for the rest of the day. I don't want to use the TR. When Phoenix was on 8 units before, his BG stayed mostly in the yellow range for weeks. I would really like to go back to 8.25 later this week.

Hi Susan, I can understand how upsetting it is to see those ugly reds or pinks that follow the lovely streaks of greens and blues but those are bounces and will clear in up to 6 cycles.

I'm no expert, but I don't think Phoenix's numbers are higher than they have been in months. The one thing I have learnt is that feline diabetes is tricky and full of ups and downs. Just when you get used to lovely numbers, kitty could throw bad numbers and just when you start despairing of the ugly numbers, suddenly, you could see numbers coming down. A dose that was too low a week ago, could be too much today and vice versa. It's all part of the sugar dance. We just have to go where kitty leads us.

Is there a reason you don't want to follow TR? Because that is the dosing protocol that provides for shooting lower pre-shots, lower reduction points and changing doses more frequently. You test enough for TR. It would make sense for you to pick a dosing protocol and follow it. It's not the best idea to try and mix and match dosing protocols.

 

[Sienne and Gabby (GA)]

You have options if numbers are low besides skipping the shot. You can:

• Stall. Do not feed your cat and wait 15 - 20 min and see if numbers are rising. If not you can continue to stall.
• Shoot a reduced dose. If numbers are below 90, you would be reducing by 0.25u anyway but in this case, you would likely reduce considerably more.
• Skip

You also realize that if you are using pieces from the Tilly site, that it's for Tight Regulation. We do not encourage picking and choosing pieces of protocols. It's much easier if you follow one set of guidelines.

I'm also assuming that someone has suggested that you have Phoenix tested for a high dose condition. Once a cat is getting over 6.0u, we suggest getting tests for acromegaly and insulin resistance (insulin auto-antibodies).

What I will note is that we do not encourage members to have one person only who is providing guidance. While I'm likely one of the most experienced Lantus user here, I am not always readily available during the week. Everyone here has competing commitments. The moderators are experienced. Each of us has our own areas of expertise. There are also members here with close to the same amount of expertise. Any of us can be guilty of missing something on your spreadsheet or more familiar with your posts and can give a different and better perspective. There will always be a difference of opinion and it doesn't necessarily mean that one person is right or wrong. If you are unsure of who to listen to, look at their spreadsheet. Look at how long they've been here. Look at whether they have experience with Lantus.

 

[Olive & Paula]

It is a struggle. Since ECID it's hard to say any one method will or will not work.

For high dose kitties, you increase and decrease in 0.5 units. However, if you have done that and it appears not to work, let's say you done that 3 times, then maybe go with the 0.25. Doses will change, there are to many variables in FD. Is cat having an off day, was he more active today than yesterday, did he eat more or less at any mealtime, is it hot or cold out, more visitors in the house, parents having a stressful day. They are all contributing factors.

You mentioned not eating for 10 hrs, is that normal? Maybe automatic feeder would help overnight. Most cats do well if given snack @ +9. Actually smaller meals more often work better.

Ollie was high dose. There was a time where the decreases of 0.25 was to much. She did better with 0.125 decreases (it took many tries to realize it) for awhile but not permanently. I also had a higher take action number for her because of the high dose. It use to be 4% carb food would bring her right up, later down the road honey, syrup, and gravy couldn't get her up.

Did you test for high dose conditions? It does make a bit of difference in how you treat. Your mindset changes and for some people you need to tweak the method your using.

The longer Phoenix is in higher numbers the more glucose toxicity builds up. It will take longer and higher doses to break through it.

I was scared stiff of TR with my 1st kitty because I worked full time and he was a champion diver. With Ollie I realized (before the acro was known) SLGS was not going to work. TR here we come and you know what, it really wasn't any different.

I will probably get slack for this, but instead of 7 days on slgs or 3 days for TR, what about going 5 days?

 

[OlivesMom]

I'm just going to throw this out there. I've only been here since August and I'm learning each and every day that there is no such thing as being certain about anything but the fact your cat is in a constant state of change and you simply have to go with the flow. As to needing advice on dosing...I've learned not even the vets know what's right, so your best defense is to GO WITH YOUR GUT. ALWAYS go on the side of caution. Only YOU know your cat best. The people here are great. Nobody is infallible, but I can say that I trust the people here with their accumulative thoughts and experiences over any regular vet any day unless they specialize in FD, which so far I've not found any in my area. Trust your gut. I'm using the SLGS protocol too. I test enough for the TR, but I've got my hands full here so for now I'm sticking with the SLGS.

 

[Scdal]

I really appreciate your answer but I am extremely frustrated. I tried the stalling method when Phoenix had low numbers if you can access my previous posts. Phoenix's numbers continue to fall until I feed him. Several times it got to be lunch time and Phoenix still had not had breakfast. By then, I had to skip his shot. Then his BG would be high for days.

One thing about the Tilly sight is that it seems to work better for Phoenix. If he has a low number, I can go ahead and feed him. If his numbers rise, I can give his insulin. This keeps his numbers lower and he doesn't have the high peaks he has if I stall or give a reduced dose.
Like you say, every cat is different. The Tilly method seems to work for Phoenix. Right now, I would like to go back to 8.25 units. I held the 8 units for over 2 weeks before and he stayed mostly in the yellow numbers. Going back to 8 units seems like I am just taking a step backwards.

 

[thebigfuzz]

Right now, I would like to go back to 8.25 units. I held the 8 units for over 2 weeks before and he stayed mostly in the yellow numbers. Going back to 8 units seems like I am just taking a step backwards.

According to the SLGS method you have ‘chosen’, Phoenix earned the reduction to 8 units. You hold the syringe and you make the decisions, but you asked for advice and help. It may differ from what you were hoping to hear. I understand you are feeling frustrated.

what happened in the past, is not always what will happen now, as needs change over time.

 

[OlivesMom]

Here's some advice for you, but it's not free. It'll cost you roughly $50 but I bet you'll discover it was the best $49.79 you spent. Got to https://www.holisticactions.com/membership/ and pay for the Gold Membership. Once you do, you get a FREE consultation with either Dr. Jeff or one of the others of your choosing and he'll be able to offer you some help. If you scroll towards the bottom of the membership page it talks about the various vets and what they do. The website has a plethora of information of FD and if you don't like the site, you are free to cancel. There's also a free thing you can sign up for but after I paid into the Gold membership it unlocked a ton so I would definitely pay into it. I took a chance on it after I spoke to a holistic vet who directed me to it, and I'm so glad I did. It would be worth checking out at least. I understand your frustration totally. So many times I've just wanted a clear cut answer to something and it makes you want to bang your head when you can't. You have to do what works for you.

 

[Scdal]

It is a struggle. Since ECID it's hard to say any one method will or will not work.

For high dose kitties, you increase and decrease in 0.5 units. However, if you have done that and it appears not to work, let's say you done that 3 times, then maybe go with the 0.25. Doses will change, there are to many variables in FD. Is cat having an off day, was he more active today than yesterday, did he eat more or less at any mealtime, is it hot or cold out, more visitors in the house, parents having a stressful day. They are all contributing factors.

You mentioned not eating for 10 hrs, is that normal? Maybe automatic feeder would help overnight. Most cats do well if given snack @ +9. Actually smaller meals more often work better.

Ollie was high dose. There was a time where the decreases of 0.25 was to much. She did better with 0.125 decreases (it took many tries to realize it) for awhile but not permanently. I also had a higher take action number for her because of the high dose. It use to be 4% carb food would bring her right up, later down the road honey, syrup, and gravy couldn't get her up.

Did you test for high dose conditions? It does make a bit of difference in how you treat. Your mindset changes and for some people you need to tweak the method your using.

The longer Phoenix is in higher numbers the more glucose toxicity builds up. It will take longer and higher doses to break through it.

I was scared stiff of TR with my 1st kitty because I worked full time and he was a champion diver. With Ollie I realized (before the acro was known) SLGS was not going to work. TR here we come and you know what, it really wasn't any different.

I will probably get slack for this, but instead of 7 days on slgs or 3 days for TR, what about going 5 days?

I tend to agree with you on trying 5 days.

It is a struggle. Since ECID it's hard to say any one method will or will not work.

For high dose kitties, you increase and decrease in 0.5 units. However, if you have done that and it appears not to work, let's say you done that 3 times, then maybe go with the 0.25. Doses will change, there are to many variables in FD. Is cat having an off day, was he more active today than yesterday, did he eat more or less at any mealtime, is it hot or cold out, more visitors in the house, parents having a stressful day. They are all contributing factors.

You mentioned not eating for 10 hrs, is that normal? Maybe automatic feeder would help overnight. Most cats do well if given snack @ +9. Actually smaller meals more often work better.

Ollie was high dose. There was a time where the decreases of 0.25 was to much. She did better with 0.125 decreases (it took many tries to realize it) for awhile but not permanently. I also had a higher take action number for her because of the high dose. It use to be 4% carb food would bring her right up, later down the road honey, syrup, and gravy couldn't get her up.

Did you test for high dose conditions? It does make a bit of difference in how you treat. Your mindset changes and for some people you need to tweak the method your using.

The longer Phoenix is in higher numbers the more glucose toxicity builds up. It will take longer and higher doses to break through it.

I was scared stiff of TR with my 1st kitty because I worked full time and he was a champion diver. With Ollie I realized (before the acro was known) SLGS was not going to work. TR here we come and you know what, it really wasn't any different.

I will probably get slack for this, but instead of 7 days on slgs or 3 days for TR, what about pgoing 5 days?

I am going to try 5 days. I try not to feed Phoenix overnight because his BG will not fall. I would like to keep him between 100 - 200 Bg and I would be happy. Staying at one dose for too long does not work for Phoenix. I keep having to increase the dose. He started off having low numbers when he was only taking 4-6 units. But the longer I stayed at one dose, the higher I would have to go.
I do appreciate all the advice on this board. They are much better than the vet. It is just worrying to see his numbers go up.

 

[Wendy&Neko]

I think it's time for a little patience. Today is cycle six after the last set of greens. And he's rising now, he could be thinking of breaking his bounce tonight.

One person told me to decrease his dose by .25 and another by .50 units. I really feel the .25 was the best answer because now his BG is climbing higher than it has been in months.

The number one rule people consider when giving dosing suggestions as per Suggestions For Advice Givers is to "do no harm" and that means being familiar with the particular cat's circumstances. Truth is, we don't really know what's going on in Phoenix. Several times it's been suggested that you get Phoenix tested for acromegaly, but you've said your vet doesn't think that's an issue. Truth is - in my time here I think the majority of caregivers of cats with acromegaly have had to convince their vet to get the testing done. My vet didn't think it was necessary either but did it after I finally convinced her to humour me.

Staying at one dose for too long does not work for Phoenix. I keep having to increase the dose. He started off having low numbers when he was only taking 4-6 units. But the longer I stayed at one dose, the higher I would have to go.

Also indicative that there is some type of secondary insulin resistance in play.

So you ask, why are we going on about those secondary conditions that can require higher doses? It comes down to doing no harm when we give dose suggestions. Without knowing what we are dealing with, we have to err on the side of caution, especially in cats on higher doses. As caregivers of cats with high dose suggestions can attest, they can be very unpredictable. Acromegaly is caused by a benign pituitary tumour that can pulse up and down, changing the insulin requirements. One in four diabetic cats has acromegaly. Cats with IAA (insulin auto antibodies) can similarly be unpredictable when the antibodies die off. When a higher dose and thus higher depot cat earns a reduction, low numbers can go on a loooooong time. I've seen caregivers of high dose cats battle low numbers for a more than a cycle. In order to keep Phoenix safe, I will always suggest a cautious answer first. Over time, as Paula indicated, you will learn what works for Phoenix.

10/23 was your and Phoenix's first ever below 50 number. It takes time to learn how your cat reacts to carbs and how he handles reductions. Don't use just one or two examples to base you decisions on what to do.

I try not to feed Phoenix overnight because his BG will not fall.

I can see examples where this is not true. On 10/13 he was 368 at PMPS, there was no testing overnight so we don't know if he fell, but the next morning you woke up to an initial 84 reading before AMPS, then he bounced. A good indicator he went lower that night. A similar thing happened the night of 10/17. Don't let a high preshot make you think he's not going low. Neko earned her first reduction starting the day at 430 and earned several more starting the cycle even higher. Some cats like to go high just before they dive down.