Jack 5/22 dosing advice

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Darlene & Jack

Darlene & Jack

Member Since 2011
Just hoping a few of you might be able to take a peek at Jack's spreadsheet. Just can't seem to figure him out. i know it takes a little time, but just looking for some advice. not sure if I should increase the dose again. We had tried a decrease due to a possible rebound and he did for a few days, then went back up. Lately his pattern is to run high through the day with little drop, then after his PM shot drop into yellows or blues. Maybe the increase up to .7 just needs a little more time to work? or should I increase again?

Some days it seems he doesn't eat too much during the day, and on those days he doesn't seem to drop much. But yesterday he ate well all day and stayed high all day.

Any thoughts and comments are appreciated! Thanks.
 
Hi Darlene & Jack,
I took a peek at Jack's ss and I see what you mean about him going lower at night. I'm still doing the sugar dance myself, but I think I would hold the current dose of .7 units. Jack may just need time to settle - going lower over night and then bouncing during the day?? Or he might need a hair more. It looks like he was starting to get some pretty blues and greens on .8, so that's why I'm thinking a hair closer to .8.
Again, I'm just looking at your ss and am still trying to figure this out myself. I'm sure the others will be on later with more solid advice. Hang in there. You're doing great! :-D
Marcy & Klinger
 
Darlene & Jack said:
Just hoping a few of you might be able to take a peek at Jack's spreadsheet. Just can't seem to figure him out. i know it takes a little time, but just looking for some advice. not sure if I should increase the dose again. We had tried a decrease due to a possible rebound and he did for a few days, then went back up. Lately his pattern is to run high through the day with little drop, then after his PM shot drop into yellows or blues. Maybe the increase up to .7 just needs a little more time to work? or should I increase again?

Some days it seems he doesn't eat too much during the day, and on those days he doesn't seem to drop much. But yesterday he ate well all day and stayed high all day.

Any thoughts and comments are appreciated! Thanks.
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Darlene, in another post a while ago I mentioned going to one unit from the .8 and then that night he went down to 58 so you were understandably worried about increasing the dose after that.

And then it was felt that possibly he missed his dose by not starting at .5 and then that was tried, successfully at first, but it didn't hold.

I would go back to the .8 dose and see what it does. And then follow the modified Tilly's protocol here. But remember this is a General Guideline. If you want to increase in smaller than .25 increments just like you have been doing since starting back on the .5 unit dose, then that would be fine too.

http://www.felinediabetes.com/FDMB/viewtopic.php?f=9&t=1581

"Many Lantus and Levemir users in this forum have been successful following a somewhat modified version of this Tight Regulation Protocol for the last few years. These "general" guidelines are based on anecdotal evidence and personal experiences of laypersons frequenting the forum.

"General" Guidelines:

* Hold the initial starting dose for 5 - 7 days (10 - 14 consecutive cycles) unless the numbers tell you otherwise. Kitties experiencing high flat curves or prone to ketones may want to increase the starting dose after 3 days (6 consecutive cycles).

* Each subsequent dose is held for a minimum of 3 days (6 consecutive cycles) unless kitty earns a reduction (See: Reducing the dose...).

* Adjustments to dose are based on nadirs with only some consideration given to preshot numbers.

Increasing the dose...

* Hold the dose for 3 - 5 days (6 - 10 consecutive cycles) if nadirs are less than 200 before increasing the dose.

* After 3 days (6 consecutive cycles)... if nadirs are greater than 200, but less than 300 increase the dose by 0.25 unit.

* After 3 days (6 consecutive cycles)... if nadirs are greater than 300 increase the dose by 0.5 unit.

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. 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.

* If an attempted reduction fails, go right back up to the last good dose.

* Try to go from 0.25u to 0.1u before stopping insulin completely.

Random Notes...

* Because of the cumulative nature of Lantus and Levemir:
An early shot = a dose increase.
A late shot = a dose reduction.

* A "cycle" refers to the period of time between shots. There are 2 cycles in one day when shooting twice a day.

* Sometimes a dose will need to be "fine tuned" by adding some "fat" or "skinny-ing up" the dose."

Also Darlene, I am not sure if you have printed off the instructions in the event a hypoglycemic event occurs. Not to scare you but just so you are prepared in case. This would be of help to your two children to have on hand too. Plus just having the higher carb food in the house (listed in the Tool Box) gives you some peace of mind too.

jojo's post on what to have in your Hypo Tool Box:

http://www.felinediabetes.com/phorum5/read.php?8,1661316,1661798#msg-1661798

jojo's list of hypo symptoms:

http://www.felinediabetes.com/phorum5/read.php?8,925783,925783#msg-925783

Melissa's post on how to recognize and treat hypoglycemia:

http://felinediabetes.com/FDMB/viewtopic.php?f=14&t=1122

One more thing...sometimes you have to go up in the dose before you can start coming down again. This is because of the glucose toxicity that has built up from the high numbers causing possible insulin resistance (I will give you a link a little later).

Also, you said before that he never had a dental before. But maybe he doesn't need one. I was just curious if your vet did in fact check the condition of his teeth when he was diagnosed with diabetes as part of his overall checkup.
 
I do have some printed out, but I need to print all of these out. I have the high carb food labeled and have the Karo syrup and honey on hand. I'm glad I have my kids to help out with testing when I'm working. I feel like we are poking him all the time, but I know that more data helps.
When Jack was diagnosed, they did look at his teeth and said he did have some tartar build up.

Thanks ladies for looking at the ss, it certainly is hard to figure this out. I think I might try going back to the .8 dose in the morning.
 
Darlene, I actually agree with Pamela, although I know it contradicts what I said previously about the .5U. Sorry that isn't working for him. I still don't think he is a high dose cat, but we need to work on regulation first.

The Tilly method is a step up approach to overcome the insulin resistance which seems to happen to cats who experience high BGs over a period of time. It has worked well for a lot of cats and is a tried and true method. It takes a good deal of home testing, which you are certainly doing very well at, so I see no reason why you can't increase the dose as Pamela suggested and still keep him safe.

As long as you are pinching his ear after each test, he should be fine in that area. Sorry you had to post on Health, but thanks for copying here too.
 
So I increased to the .8 today and had a big drop.


332 @ AMPS slight increase to .8 shot
353 @ +1
72 @ +9 no one home during the day to test...I wonder what happened in between
86 @ +10
107 @ PMPS shot .8 (i hope I'm not sorry!)
188 @ +1
146 @ +2

Will see what happens tonight. He didn't eat too much between the PM shot but just ate now at the +2 time.

So i had a question on the Tilly protocol.

"Increasing the dose...
* Hold the dose for 3 - 5 days (6 - 10 consecutive cycles) if nadirs are less than 200 before increasing the dose.
* After 3 days (6 consecutive cycles)... if nadirs are greater than 200, but less than 300 increase the dose by 0.25 unit.
* After 3 days (6 consecutive cycles)... if nadirs are greater than 300 increase the dose by 0.5 unit."

Does this mean if all the nadirs are between 200-300 you increase? If there are one or 2 that are lower or higher, do you go by the majority of the readings? With Jack, his mornings had been high, but evenings lower. Just want to be sure I understand. Thank you!!
 
Darlene & Jack said:
So I increased to the .8 today and had a big drop.


332 @ AMPS slight increase to .8 shot
353 @ +1
72 @ +9 no one home during the day to test...I wonder what happened in between
86 @ +10
107 @ PMPS shot .8 (i hope I'm not sorry!)
188 @ +1
146 @ +2

Will see what happens tonight. He didn't eat too much between the PM shot but just ate now at the +2 time.
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So did he eat this morning with the shot and after? If he didn't get enough food with his shot then did he not get enough at all? Is that why he went lower at +9?

Same thing with tonight. You said he didn't eat much with the shot on your SS but ate @ +2. Hopefully though, that is going to help him to level out even though so often he doesn't seem to get much of a food spike/reaction.


Darlene & Jack said:
So i had a question on the Tilly protocol.

"Increasing the dose...
* Hold the dose for 3 - 5 days (6 - 10 consecutive cycles) if nadirs are less than 200 before increasing the dose.
* After 3 days (6 consecutive cycles)... if nadirs are greater than 200, but less than 300 increase the dose by 0.25 unit.
* After 3 days (6 consecutive cycles)... if nadirs are greater than 300 increase the dose by 0.5 unit."

Does this mean if all the nadirs are between 200-300 you increase? If there are one or 2 that are lower or higher, do you go by the majority of the readings? With Jack, his mornings had been high, but evenings lower. Just want to be sure I understand. Thank you!!
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Good question, but I believe it means if the nadirs are consistently between 200-300. Jack's lower numbers at night are odd, but maybe going back to his eating habits, and maybe exercising more during the day when you aren't there.....?

Just checked his SS again. You might want to give him a couple of tablespoons of low carb gravy food. I am sure he will love it. Just to slow this drop.
 
I believe she means overnight his numbers get high.
My Tom has the same phenomenon...and he's such an active cat that I have thought his numbers were lower during the day while he is busy. He sleeps hard all night.
 
Jack ate fine this morning after his AM shot and before I left for work, and I assume he ate during the day, though I don't think he ate as much as usual. I have 2 other cats so it's hard to tell who eats how much. Usually at the PM shot time he eats a good amount, but tonight he did not. But from the +2 time thorough now (+5) he has eaten well in between his naps. But from his previous patterns, I found that when he didn't eat much, his numbers stayed higher.

Jack is an indoor cat and usually not extremely active, though he has his days where he runs like crazy for a while, like yesterday.

What kind is low carb gravy food? The only gravy food I have is the Fancy Feast grilled chicken in gravy, but I believe that is higher carb. Last time I had a drop I gave some of that, and then we didn't know if it was rebound or a spike from the food. I searched through the food lists again but it's late now and I couldn't find low carb gravy food.
 
I think she meant medium carb gravy food...

Tonight's cycle is nice - and actually what you want on lev if you can manage it. If you can find a dose that keeps him between 70 and 150 that would be awesome. I guess just watch for a drop lower than 40-50. For most cats, 40 would be safe, but it isn't a number I would aim for.

Just hold the .8u now and see how he settles on it (unless you get a really low number, of course).
 
I was definitely happy with yesterday's cycle, hoping it will stay that way for a little bit with no rebounds. This morning AMPS was 328. I will definitely hold this dose for now to see how he reacts. I guess I am getting braver the more I learn about Levemir on here. Never thought I would shoot a 107, but following the advice of getting frequent tests to collect data helps. But with Jack, I just never know what he will do next!!
 
So...too good to be true...here's the bounce today

328 @ AMPS .8 un
329 @ +3
434 @ +7
433 @ +9 again, didn't eat much this afternoon. my dtr was home today and said he was active a few hrs this morning, then sleeping all afternoon, warm humid day
333 @ PMPS .8 un eating well now
 
The good cycles are really good...then he likes to throw in some splashes of color on his ss! After all the low numbers yesterday I was really expecting the higher numbers today, but hoping I wouldn't see them. :sad:
 
OK, so my question now is how do I follow the Tilly method. I feel like I have 2 different cats...my morning cat and my evening cat!! What nadirs do I look at when I try to decide when to increase? Tonight is the 6th cycle at .8. Should I hold this another day, or go up to .9 or 1 un because of the higher morning nadirs? I'm thinking maybe get another day of numbers at .8 since the first day was maybe a fluke.

Any input would be great while I try to get the hang of the Tilly method. If Jack was a little more consistent it would be easier. Thanks!
 
Darlene & Jack said:
OK, so my question now is how do I follow the Tilly method. I feel like I have 2 different cats...my morning cat and my evening cat!! What nadirs do I look at when I try to decide when to increase? Tonight is the 6th cycle at .8. Should I hold this another day, or go up to .9 or 1 un because of the higher morning nadirs? I'm thinking maybe get another day of numbers at .8 since the first day was maybe a fluke.

Any input would be great while I try to get the hang of the Tilly method. If Jack was a little more consistent it would be easier. Thanks!
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Yeah, I have not understood the difference some cats have between day and night cycles, unless it has to do with feeding.
Staying at .8U for one more day certainly won't hurt. In Jack's case, it's probably better to increase in the smallest amounts possible.

I know this isn't recommended because it involves changing the dose every day and seems like it's a sliding scale, but I wonder if he received more insulin at night if his BG would lower better by next AM, then for the daytime cycle he would get a little less since he goes lower then. HIs shed would empty more and maybe he would level out better. Not something I would do for Gandalf, but I don't know that that's ever been tried with Levemir in a case like this.

Anyone else think that is worth trying?
 
Vicky I was wondering about doing 2 different dosages also since he has such a big difference, but didn't know if that could be done with Levemir. I'd be interested to see what others might think.
 
looks like you might have a break thru tonight. I would patiently stay with this dose for awhile...and the idea of changing am and pm doses seems counter productive to me since the result of any given dose is generally the dose you gave the cycle before. It would mess with the consistancy of the shed.
stick with it...I just have a good feeling you will break thru.
Lori
 
Yes...slept for a little bit and set the alarm to check him and now he is 116. Looks like he ate a fairly decent amount of food in that span of time, at least a half a can, probably more. This was his regular food, I didn't give anything higher carb.

I just never know what surprise I am going to get in the little screen on the meter! OK, back to bed now....
 
See, if he wouldn't bounce on this dose, it would be good for him! With him going down to 59 like that, it does not seem like a good idea to raise right now.

Yes, because of the overlap effect - "shed" - you get a delay in effectiveness with Lev.

Here's the thing with what I will call beyond Tilly methods - because of ECID you don't know if something won't work for a particular cat unless you try it. Just because Lev is supposed to work a certain way, does not mean it works only that way in every cat.

I wonder if people let Tilly blind them to the possibilities of Lev. If I had not tried split dosing with Gandalf to get him on later cycles when I work late, Gandalf would not be doing as well on it as he is. It was suggested to me and I tried it. Lo and behold it worked to stabilize his BGs on those days, although I note there is a rise at some point. So it's not perfect, but it works in my estimation to keep him from having to go to +14 before a shot, which was NOT working.

Darlene, it's completely up to you. Do I think it's worth a try? Yes. But maybe keep him at .8U a little longer and see if he gets a breakthrough and stops swinging on it first. Sometimes it just takes a while longer than we think it should.
 
don't get me wrong Vicki...I'm game for anything....I just understood the shed one way. Usually Tom show any change in dose the next cycle and not the cycle I change him on....so it's confusing for me that dose changing could be effective.
 
So here we go with the bounce.......

376 @ AMPS 0.8 un
378 @ +3
530 @ +10 (no one home to check him before this)
477 @ PMPS
329 @ +2

This is driving me crazy!!!!! I am willing to try anything, but not sure I understand what dose I would lower or raise if I gave different dosages. I'll be anxious to see if he drops again tonight. I really am trying to come up with anything I can to explain the difference between AM and PM, but can't come up with anything.

If it might help, I'd be willing to try a different AM and PM dose. It can't be any worse than what he's doing now! And with a 3 day w/e coming up I will be home to test more. What do you guys think?
 
He rebounded hard because of that 59. So that dose which caused the 59 is too high right now. And it's beginning to look as if he's rebounding or bouncing after every lower cycle. That's why you think one cycle is low and one is high. The high one is probably caused by rebounding.

It is not emphasized enough in Tilly that a dose LOWER than their optimum dose should be the starting dose. Which creates the conundrum - how do you know what dose is low enough to start them out at?

I'm not sure if Sheila's around this evening or not, but her experience with Beau is the best example of a cat who had great potential to go OTJ, but as long as she kept raising the dose he kept rebounding on it. It was not until she dropped the dose considerably that he began having consistent lower numbers.

She also had trouble regulating him on Vetsulin, which is why she switched to Lev. But almost as soon as she realized he needed way less insulin than 1U, he went OTJ. He was on Lev for only 3 months. He had been on Vetsulin for 2 YEARS!

So at this point we should reconsider the 2 different doses strategy, because unless we can agree on doses low enough to sidestep this rebounding, it's not going to help anyway.

I forget what dose Sheila dropped Beau to, but I don't think it wasn't any more than .25U. Yes, I am saying Jack may only need that much. He rebounds very easily not because of how low he goes, but because of how fast he drops. That also suggests the dose is too high.

I think we recommended when you started that his starting dose shouldn't be more than .5U but his numbers were high and the vet said .8U. The numbers might be higher for a while, but steady and higher is better than going low then high within 24 hrs. The purpose of Levemir is to create steadier blood glucose. The way to do that is find the dose which allows that to happen and .8U is not the ticket.

Sorry I didn't go over his spreadsheet more closely yesterday or I might not have suggested the 2 different dose thing, even though I know you didn't do it, I feel like I wasted your time when I should have been explaining what was going to happen because of that 59. if I had done that, I might have realized he was going to have a hard bounce because of how quickly he dropped and that 530 sets off the Red Alert klaxon for "Dose too high!"

I'll see if I can round up Sheila.
 
Thanks for the excellent explanation, Vicky. I guess it does make sense to think that he is actually rebounding every day. I was really afraid I would get those high numbers today after his drop last night. I just looked at Sheila and Beau's ss and saw where she dropped and what a huge difference it made.

No need to apologize, you didn't waste my time. I appreciate the time everyone here has taken to try to help.

Would love to hear what she thinks too and if maybe you guys can recommend a dosage to try.
 
Hey, Darlene (gonna try and post, but I have Jeddie across my lap and Leanne insisting on being held! So, typing with my left hand - slow!)

Here's what I think based on my experience, primarily with Beau: if the cycles (am/pm) are really different making it look like he has a 24 hr cycle, the dose is too much. What is happening is a low, followed by bounce every day even if the low isn't a dangerous low. Rebound also happens from speed and distance of the drop - things we used to see all the time on the faster insulins. Vicky is right that a drop from 450 to 70 is steep.

The fact that he can get down to 59 and back up to 500+ is a real good example of rebound. I have never seen a cat on insulin and a low carb diet get above about 300 without rebound being involved. I once tried Beau off insulin for 48 hrs when he was on vetsulin and he kept himself below 300.

I don't think shooting different doses would work with lev - although I have seen many SS where it looked really tempting. What does work is lowering the dose until the cycles even out. With Beau, I did the lowering in increments. Every time his numbers started bouncing I lowered again. I was really looking at low numbers with him because he dropped into the 30s pretty consistently when he needed a decrease - and then bounced bit from it. I just kept stepping him down until he was OTJ, but if a cat isn't ready to go OTJ and just needs less insulin I would expect the numbers to settle and even out - no more big swings.

You could also just drop him to .25u and give that a good 5-7 days to settle and see if his numbers improve. I bet they will, but the settle time is important. He will still bounce for a few days as his body adjusts to less insulin. It's important to not let another 400 or 500 in those first few days change your mind. Test for ketones to me on the safe side. You will probably have to fine tune the dose after that and I would suggest making very small changes, no more than .1u,

Also, in looking at your first day on lev (rather, Jack's first day!) he did get a good, significant response. That happened with Beau as well and a few other cats and I think is an early indication that they started too high and are going to be sensitive to lev doses and changes should be very small.

At this point I would not try to follow Tilly. It isn't working for Jack, so time to find out what will work.
 
Thanks so much Sheila for your response. It certainly makes sense the way you and Vicky explain it....so let's see what happens! This morning he was 222, the lowest AMPS in a while. I gave .3 un because it was easier for me to just draw up the .5 and let off 2 drops instead of worrying about the half drop too. I understand we may see some higher numbers but I will stick with this dosage to see what happens. I hope this is the key!

I'll buy all you ladies a round of drinks if it works!! :lol:
 
Darlene & Jack said:
Thanks so much Sheila for your response. It certainly makes sense the way you and Vicky explain it....so let's see what happens! This morning he was 222, the lowest AMPS in a while. I gave .3 un because it was easier for me to just draw up the .5 and let off 2 drops instead of worrying about the half drop too. I understand we may see some higher numbers but I will stick with this dosage to see what happens. I hope this is the key!

I'll buy all you ladies a round of drinks if it works!! :lol:
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:lol: best thing I've heard all morning!! I'll drink to that. drinking24

Thanks for being patient and trying to understand us. We all want to help jack, poor guy's been through lots of ups and downs ;-)
 
Very interesting and educational thread. My vet(s) have always instructed us to do a different dose in the am/pm. We did do that in the beginning (on Lantus), but unfortunately we don't have the data to see how that worked for Klinger.

Paws crossed that the dose decrease works for Jack. That would be awesome! :-D
 
So far so good on the lowered dose...no bounces and no extreme highs. Will keep paws crossed and praying for good numbers!
 
That actually looks very good. And he had a nadir at +9 today, which is very typical! After 2 days on .3U his cycles look much better. I know it's still higher than you want, but you should be able to eventually bring his BGs down with very small increases if he doesn't get too much better than upper 200s over the next few days. Stopping the bouncing/rebounding is the first step.

We're cheering for you, Jack! :RAHCAT
 
I like that 312 at +3 tonight, so we'll see where he's at tomorrow. Don't jump on .4U just yet. One more day might see some yellow....

One thing to keep in mind is that he could have had some shed left over from the .8U which helped him have yellow even yesterday (the 28th) morning. So essentially that has to clear out before we can really see what .3U can do for him. It's why this is sometimes a slow and agonizing process for the 'bean.

We want results, darn it! Cats always have other things in mind though. :roll:
 
Thanks Vicky. I'm ok with holding this dose for a few more days if needed. I'm happy that the bouncing all over the place has decreased. 276 at +6 was good last night too. Though I do want fast results, I can be patient right now. :-) Like you said, I think it will take a little while to get rid of the .8, and it was suggested at first to hold this new dose for 5-7 days, so my mind set was there, not on changing the dose yet. Is that still reasonable?
 
Darlene & Jack said:
Thanks Vicky. I'm ok with holding this dose for a few more days if needed. I'm happy that the bouncing all over the place has decreased. 276 at +6 was good last night too. Though I do want fast results, I can be patient right now. :-) Like you said, I think it will take a little while to get rid of the .8, and it was suggested at first to hold this new dose for 5-7 days, so my mind set was there, not on changing the dose yet. Is that still reasonable?
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It certainly is. Some cats just seem to take longer and it is not only a matter of clearing the .8U but also clearing the liver excitement too. It is a matter of making the system feel comfortable with the BG level, then when you increase slightly there isn't such a change that it sends the alert out that BGs are going too low which results in rebound.

As long as he's eating well and not suffering any infection, he's fine where he's at. The fear of ketones also seems to make some increase doses too fast. It's a rational fear, as they are dangerous, but they can happen even when the cat has lower numbers too. It takes lack of food, lack of insulin + infection to cause them, so it's a wicked cocktail.

For what it's worth he's having more normal cycles, with the downward movement of BG starting when it should be, probably +1.5 or so. It's great that you're able to get +3's. You'll be ready to shoot lower numbers eventually because of that data since you will have seen how far he drops within that time frame.

We need the cheerleader again! :RAHCAT
 
Still rebounding?? Very surprised at today's numbers.

292 @ AMPS
441 @ +9
548 @ PMPS

No one home to get readings during the day today. Another warm day, looks like he ate about the same amount as yesterday but was very playful this afternoon. Seems to be acting fine. Ketones negative this morning.
Is this dose too high too, or maybe just a fluke?
 
Oh no! Jack, you were doing so good, what happened, buddy??

I'm really missing that +3, but I understand it's not possible to do that every day. If he did go low, it's would not be how low he went, but how fast that caused a rebound. A 500+ is almost always a rebound unless the cat has been getting no insulin whatsoever for more than 24 hours.

Remember on the 16th he had a very fast climb, so the rebound is certainly possible.

Forgive me for asking because I don't remember histories very well and I see at the beginning of his spreadsheet that he was eating some wet food, but was he fed only dry food before his diagnosis? If so, there is a possibility he's a dry food diabetic and now that he's on wet food, his pancreas is healing, even with all the rebounding going on and he needs only a tiny amount of insulin to help it out.

He is getting some good action on even .3U. To drop 165 pts in 3 hours on only .3U from a 548 is very good, IMO. So I'm very leery to say definitively that he needs more insulin.

Sheila is usually on later in the evening, so hopefully she will have a look. I think she can probably read SS on tiny doses better than I can as she has experience with what tiny doses can do.

Hang in there. At least that's good that he's acting OK. How did he eat today?
 
I know...he was doing so good!

Before he was diagnosed he only ate dry food. We made the switch to all wet food immediately except for a small amount of dry the first night he was home and started dropping too low. Since then it has only been wet food. I agree in being hesitant to increase the dose...I'm afraid we'd get more rebounding. I wonder if he even needs a little less, but will be interested to see what Sheila thinks.

He ate very well this evening. Maybe his appetite is just decreasing as he is getting a little more controlled. He certainly had been eating more than my non-diabetic cats...now he seems to be more on their schedule, eating more in the AM and PM, and only a little bit during the day. He is very bright eyed and running around tonight!
 
You're very lucky that he's eating the canned food well, some cats take quite a while to transition. Have you heard anyone on the board call dry food "kitty crack?" Many cats seem addicted to it.

Since he was on a dry diet and now is not plus responds well to insulin, I'd say the chances are very good he can come off insulin. The key will be finding a dose which is large enough to help his pancreas out bu small enough so he won't drop too fast, then rebound.

If he's playing and very active tonight, when he was not doing as much previously, then the lower dose has helped him feel better since he's not riding the rollercoaster anymore. I noticed that right away when I first started Gandalf on Levemir after 2 1/2 years on PZI, which did that rollercoaster to him constantly.

As long as you're comfortable testing for ketones as often as once a day, then he might do even better on less than .3U. I just worry about that since he was DKA in the beginning. How long do you suspect he had been diabetic before that happened? Not that that's your fault, we see it a lot here because most of us don't realize something is wrong till they get really sick. Cats are very good at hiding their illnesses.
 
Testing for ketones is the hard part for me...trying to catch him when he goes. Lately I've been able to catch him in the morning, but that's not always the case. I worry about the DKA too.

I think he probably had diabetes at least a few months before he was diagnosed. He had lost some weight, but he was about 18 lbs to start with, so he wasn't getting skinny by any means. Then he started drinking more and I noticed it, but he was acting normal, happy, eating fine so I wasn't too concerned.

Yes...I was lucky he got off the kitty crack so quickly!! My other 2 cats took a few days longer to warm up to the wet food, but I was not going to try to deal with feeding them all different things. So it was all or nothing, and I was lucky they all transitioned so easily.
 
Well....this is a tough one. He was definitely rebounding on .8u. He could still be rebounding. It may be too soon to tell for sure.

I know with Beau, I went back and forth between .4u and .5u and was very frustrated because .4u didn't seem to be enough and .5u seemed to be too much. In fact, they were both too much. I just looked at Beau's SS again and I can see that he was rebounding from day one on lev and was also rebounding on vetsulin. The data that I lost on his vetsulin usage showed doses from .2u to 1.4u and no real good regulation or numbers. I did try some trial off insulin periods when he was on vetsulin, but didn't get any good results. That may be because he was still hitting 300s regularly and it was causing insulin resistance - probably as a self-preservation response more than anything. Looking at his early lev numbers now I bet I could have gotten him off insulin in about one month instead of three.

All that is said just to illustrate that it is very hard to know when their higher numbers are from too much or too little insulin.

My gut tells me that 500s don't happen without rebound in a cat that is on a low carb wet diet. since he has only been on this dose for 5 days I would say to hold it at .3u for a few more days and see if there are any changes. If there is no change then I would be inclined to raise his dose to .4u and let that settle. It might be necessary to break any insulin resistance before slowly lowering his dose again, but I would make dose changes in no more than .1u increments now.
 
So...today is day 7 on the reduced dose. I thought it was working really well until the last few days. Not sure if it's time for an increase to 0.4?
He had another spike up to 450 today. Acting fine otherwise, it's ncie and cool today, he's been very alert playing.

The only weird thing I noticed this morning was in the food. He eats Fancy Feat classic, the beef seems to be his favorite. I noticed when I picked up the food dish from last night to clean it, there were little white flecks on it (the food dish is red). I washed it then refilled it and as I was adding a little water and mushing it up, noticed these little white flecks in the food. I had a few different flavors too, so I put a different kind out tonight, didn't notice anything in the food. Maybe it's nothing, but I've never seen that in the food before.
 
Not sure about the food - could it have been bits of bone? Or, um, fly eggs? (I know that's really gross, but it happens this time of year).

I would go ahead and raise the dose, and watch for the numbers to get worse instead of better. Hopefully, the numbers will change in a way that makes it clear that either another increase or a decrease is needed. If the numbers come down a little and don't start causing wild swings then increase was right, if the swings start or there are significantly low numbers, then the dose should have been decreased.

Let's see what happens - ok?
 
Oh yuck! :shock: Well I would have to go with maybe bits of bone, hadn't thought of that. I really looked closely at it because at first I thought it might have been bugs, but the pieces seemed hard.

Sounds like a reasonable plan for the dose. I will go up to .4 in the morning and see what happens...and I'm sure I'll be calling on you for help in a few days!
 
Yeah, Sheila's right about what to watch for if the increase is working. It could just be that the .3U finally was all on its own and it just couldn't handle the BG anymore. Also, if his teeth are a problem, the insulin will not work as well sometimes. WHen he was DKA early on, did they say what caused the infection? Generally there has to be an infection for ketones to form.

Look on the ingredients of the fancy feast beef. Sometimes manufacturers put fish in a food, even if it's not a "fish" flavor. I have noticed white specks of bone in fish varieties before and wondered what they were and figured it out because they are hard yet flaky when dry.
 
He had a UTI when he was diagnosed with DKA. I know he does have some build up on his teeth, I'm not sure if my new vet does dentals. I will send her an email to check into it.

Fish is listed in the ingredients...so maybe it was some bone in the food.

AMPS was 404 this morning, increased to .4 un. Hope this helps.
 
Darlene & Jack said:
He had a UTI when he was diagnosed with DKA. I know he does have some build up on his teeth, I'm not sure if my new vet does dentals. I will send her an email to check into it.

Fish is listed in the ingredients...so maybe it was some bone in the food.

AMPS was 404 this morning, increased to .4 un. Hope this helps.
Click to expand...

Yeah, pet food is very tricky. They can literally call it one thing, but then it's another in the ingredients. As long as beef is listed before the fish, they can call it Beef Feast. There could be 1% more beef than fish and they could call it beef.

It might take till tomorrow for him to have a response to .4U. Have you looked at Laura & Harley's spreadsheet? Harley's number pattern is what Jack needs with BG slowly lowering as she increased the doses. That way you know you're on the right track and it won't cause so many rebounds.
 
But no 400s since you moved to .4U! And he's continuing his way down, instead of going up tonight after his shot, he's continued to go down at a very slow, steady rate. That's what you're looking for.

I'm interested to see what happens tomorrow on .4U. 3rd day can sometimes be the charm.
 
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