Kitty Bugging Me For Food Tonight

[Corey & Kitty]

So, Kitty was switched to insulin glargine yesterday morning. BG numbers have been higher than usual but the dose was dropped a bit to allow for room to begin removing the rest of her dry food in a few days.

I noticed tonight since +10 (PMPS is in 5 minutes now) she has been following me around every time I go into the kitchen (basically trying to get to the kitchen before me) and trying to get my attention, like she wants to eat. She hasn't acted like this in a while. I'm assuming it has something to do with the higher BG numbers and lower insulin?

Is this something I should be concerned about? Do I need to make any adjustments or just keep moving forward as planned? I just don't want her becoming ravenous again like she was before DX.

 

[FrostD]

It looks like you already shot, so let her eat. She will need more food while in higher numbers, but it won't take you too long to get her into better numbers if you can remove the dry (i.e. follow TR).

 

[Corey & Kitty]

It looks like you already shot, so let her eat. She will need more food while in higher numbers, but it won't take you too long to get her into better numbers if you can remove the dry (i.e. follow TR).

Yeah, I posted this right before PM shot time so I did let her eat, but it was just the previous two hours that she wouldn't stop bugging me for food. I was under the impression that I wasn't supposed to feed her for the two hours leading up to a shot. Is this correct?

Also, regarding the SLGS method. The guidelines state:

Until you collect enough data to know how your cat will react, we suggest following the guidelines in the FDMB's FAQ Q4.4:
Q4.4. My cat's pre-shot level was way below the usual value. Should I give the injection?
A4.4. There's no hard and fast rule, but if you don't have data on how your cat responds to insulin, here are some general guidelines.

• Below 150 mg/dl (8.3 mmol/L), don't give insulin.
• Between 150 and 200 (8.3-11.1 mmol/L), you have three options:
  • a.) give nothing
  • b.) give a token dose (10-25% of the usual dose)
  • c.) feed as usual, test in a couple of hours, and make a decision based on that value
• Above 200 (11.1 mmol/L) but below the cat's normal pre-shot value, a reduced dose might be wise.
• In all cases, if you are reducing or eliminating insulin, it's wise to check for ketones in the urine.
• Above the normal pre-shot value, give the usual dose, but if the pre-shot value is consistently elevated, it's a good idea to schedule a full glucose curve to see whether a change in dose or insulin is appropriate. In most cases, the target "peak" value should not be below 100 mg/dl (5.6 mmol/L), and for some cats it might be higher.

Now, for the case of being above 200 but below the cat's normal pre-shot value, a reduced dose might be wise, what is considered below the cat's normal pre-shot value? For example, tonight she was at 289, she's normally in the 300s pre-shot, although some of them have been as low as 302, so 289 isn't that far off, but she's also had pre-shot numbers as high as 352 so then 289 seems like a bigger number to be off by. I know that nadir is supposed to determine the dose, but I only have 1.5 days worth of data, but that data shows that her nadir is still too high so I don't think her dose needs to be adjusted right now for a lower pre-shot number. I'm just wondering when that would apply.

Also, I've noticed you've mentioned following TR in a couple of your replies to me. If you look at my spreadsheet, it represents how many times I will be able to test in an average week. Days off from work are different, but for 5 days a week that are work days, (ex. 4/5 - 4/9) during the AM cycle I can only test once during that cycle because of work, and it usually falls from +4 to +6. Also, my place of employment is open from 8am to 8pm and so my schedule varies. Sometimes I work 8am - 5pm, other times I work 11am - 8pm, and other times I work in between shifts like 9am - 6pm and 10am - 7pm. So technically on 11am - 8pm shifts (I usually only work this shift once a week) I could get a +2 before leaving for work and then probably a +7.5 on my lunch break. My work hours are why I chose her shots to be at 8am and 8pm because then depending on my schedule, I could give her shot a little earlier than normal when I work the early shift or a little late when I work the late shift. Some days I have to give her shot and head right out the door to work. On work days I'm not going to be around most of the AM cycle to monitor her and give higher carbs if she's dropping too low. PM cycle is a little different, of course I can make exceptions when I need to stay up later with her, but this can't be the norm, with an 8pm shot, if she nadirs around +6 that's 2:00 in the morning and I can't always sacrifice my sleep, there has to be a balance, I can't neglect my own health. I'm doing what I can, and I'm starting to feel the effects of not sleeping as much. Now, with all that being said, do you think it will be possible for me to follow TR at some point?

 

[FrostD]

Yeah, I posted this right before PM shot time so I did let her eat, but it was just the previous two hours that she wouldn't stop bugging me for food. I was under the impression that I wasn't supposed to feed her for the two hours leading up to a shot. Is this correct?

Also, regarding the SLGS method. The guidelines state:
Now, for the case of being above 200 but below the cat's normal pre-shot value, a reduced dose might be wise, what is considered below the cat's normal pre-shot value? For example, tonight she was at 289, she's normally in the 300s pre-shot, although some of them have been as low as 302, so 289 isn't that far off, but she's also had pre-shot numbers as high as 352 so then 289 seems like a bigger number to be off by. I know that nadir is supposed to determine the dose, but I only have 1.5 days worth of data, but that data shows that her nadir is still too high so I don't think her dose needs to be adjusted right now for a lower pre-shot number. I'm just wondering when that would apply.

Also, I've noticed you've mentioned following TR in a couple of your replies to me. If you look at my spreadsheet, it represents how many times I will be able to test in an average week. Days off from work are different, but for 5 days a week that are work days, (ex. 4/5 - 4/9) during the AM cycle I can only test once during that cycle because of work, and it usually falls from +4 to +6. Also, my place of employment is open from 8am to 8pm and so my schedule varies. Sometimes I work 8am - 5pm, other times I work 11am - 8pm, and other times I work in between shifts like 9am - 6pm and 10am - 7pm. So technically on 11am - 8pm shifts (I usually only work this shift once a week) I could get a +2 before leaving for work and then probably a +7.5 on my lunch break. My work hours are why I chose her shots to be at 8am and 8pm because then depending on my schedule, I could give her shot a little earlier than normal when I work the early shift or a little late when I work the late shift. Some days I have to give her shot and head right out the door to work. On work days I'm not going to be around most of the AM cycle to monitor her and give higher carbs if she's dropping too low. PM cycle is a little different, of course I can make exceptions when I need to stay up later with her, but this can't be the norm, with an 8pm shot, if she nadirs around +6 that's 2:00 in the morning and I can't always sacrifice my sleep, there has to be a balance, I can't neglect my own health. I'm doing what I can, and I'm starting to feel the effects of not sleeping as much. Now, with all that being said, do you think it will be possible for me to follow TR at some point?

Correct about withholding before shot time, I just wanted to make sure you knew you don't have to keep her to strict calories.

About TR - yes, i think you can. What I say to most people new to Lantus is do TR until you get the cat closer to the range that you want. At that point, re-evaluate if TR will or will not work for you. You can change at any time. So TR will allow you to "fast track" increases to get her to a good range, at that point you can choose to switch and slow down with SLGS if that works better for you.

About the testing - we say start with a +2 or +3. If that is flat or higher, especially in these numbers, can probably take the rest of the day/night off. If it shows a drop (like last night), good idea to get a second test just like you did.

Sometimes people adjust to the sleep or call it a sacrifice because they want their cat to be tightly regulated...others say nah nope can't do it and go with SLGS. No harm either way, but SLGS will not be without nighttime testing all the time either.

As for the preshots, I'd say as long as she keeps steadily coming down you're good to shoot anything over 200. She's a pretty flat cat thus far (that's good!)...that's not the case for all of them. Now if she all of a sudden throws you a 200 preshot tomorrow morning, that's where we raise an eyebrow because the question is - how low did she go, and is the dose ok? We'd look at the data and let you know what to do, more than likely with her patterns so far we'd say shoot

 

[Corey & Kitty]

About the testing - we say start with a +2 or +3. If that is flat or higher, especially in these numbers, can probably take the rest of the day/night off. If it shows a drop (like last night), good idea to get a second test just like you did.

Well, herein lies the problem. Most work days I can't get a +2 or +3, I give her a shot (at 8am, or a little earlier when necessary) and have to be to work at 8am, 9am, or 10am depending on the day, and even on the off chance that I could get a +2, for example when I'm working the late shift and don't have to be in until 11am, if it shows a drop I can't stick around to monitor things, I have to go to work and won't have a lunch break for 4 - 5 hours later. This is why I'm questioning whether or not I can do TR.

 

[FrostD]

Well, herein lies the problem. Most work days I can't get a +2 or +3, I give her a shot (at 8am, or a little earlier when necessary) and have to be to work at 8am, 9am, or 10am depending on the day, and even on the off chance that I could get a +2, for example when I'm working the late shift and don't have to be in until 11am, if it shows a drop I can't stick around to monitor things, I have to go to work and won't have a lunch break for 4 - 5 hours later. This is why I'm questioning whether or not I can do TR.

If I'm reading correctly, you said that the days you work you can get a +4 to +6? That is also fine.

It really is up to you, I don't mean to sound pushy. Just letting you know that (after cutting dry) you can choose to follow TR until you start getting some low blue nadirs, then rethink it. Because I know you've been concerned about her higher numbers. If she stays as flat as she been, low blue nadirs on Lantus leave a LOT of room for safety