New Member, 3/18/2024, 14M Birman Cat diagnosed with DKA 2/27

[djett]

@Diane Tyler's Mom and @djett, we need to get you set up with one of the dosing methods before you swap to the Lantus forum please. your SS says SLGS but your signature doesn’t say anything. Also the signature says CRD says diagnosed Aug 2024!do you mean 2023?

With a recent diagnosis of DKA I would suggest you follow the tight regulation dosing method because we can change the doses every three days if necessary and we don’t want Gucci lingering in those high numbers.
Are you testing daily for ketones?
Is the royal canin CRD food dry or wet? If it’s dry, I would also suggest you look at getting another high carb food that is wet. Weruva have some and you can look at the phosphorus levels as well and choose one that is lower.

I can see the PM preshot has come back up to 400. I would not reduce the dose. Can you monitor this cycle?
Keep in mind that the freestyle libre numbers are not reliable when they drop under 100. That is why we like you to double check any BGs under 100 with a hand help meter. I would keep tying to persevere with doing ear BG tests.
What size lancets did you get? Size 26 is the size you need get.
Also shine a touch behind the ear so you can see the veins.
You need to try and prick between the vein that runs along the outside of the ear and the edge of the ear. Try not to restrain Gucci too much if you can as that will only make him want to get away. Make sure the ear is warm. Try humming as you do the test so it calms you and Gucci. And you can milk the ear up towards the top to encourage the blood.
Remember everyone fails in the beginning. Some people have success more quickly than others. A lot depends on the cat. Try just rubbing his ears often and giving a treat so he gets used to his ears being pricked. You could try putting a tiny bit of Vaseline on the fur first so the blood pools rather than seeps into the fur.
I failed miserably in the beginning!
What is the hand held meter you have?

View attachment 69903

Thank you i've updated the spreadsheet. Gucci doesnt have teeth (see avatar) so he's always on wet food. Yes sorry I meant 2023 for CKD. The Royal Canin CKD food is wet and about 28% carbs DMA. Hills has a CKD k/d wet food thats almost 40% carbs and is probably the reason he got diabetes in the first place since I switched to that in August, I will get more of that.

I've been doing a combination of both to see what works, for example starting 4/1/2024 I switched to TR, then on 4/9 after a steep drop/bounce, increased to 2.5 and then went back to SLGS and held 2.5 for a week. Is it possible that since I recently removed hills from his diet that now he needs a lower dose?

I waited to feed/give him insulin to see what his numbers would do and at at 9pm it had went back down to 370, and now about 30min later is all the way down to 335 and still trnedning downward. So I am so confused on what give him as a dose tonight. I think anything over 2.5 will be way too much right now, and since I will likely go to sleep in the next 3-4 hrs it may be too risky. I think I am going to hold out for another 30 min to see if it continues to drop fast and then reassess. He likely won't eat much tonight as well since I had to feed him and give him Karo syrup not too long ago to raise his glucose.

Thanks,
Devin

 

[Bron and Sheba (GA)]

Are you testing for ketones in the urine? It’s important to know this as that tells us if the insulin dose and food are about right.

Regarding the dose tonight, if you are uncomfortable giving the 2.75 units, you could give a one off 2.5 unit but I would go back to 2.75 units at the following dose.we need to get rid of those red and link BGs. Try and get him to eat well tonight if you can.

With the SS, any BG tests you got before the dose need to be stacked in the PMPS column. Then you start the +1 etc After the dose is given.

[QUOTE="djett, post: 3171339, member: 39611"]been doing a combination of both to see what works, for example starting 4/1/2024 I switched to TR, then on 4/9 after a steep drop/bounce, increased to 2.5 and then went back to SLGS and held 2.5 for a week. Is it possible that since I recently removed hills from his diet that now he needs a lower dose?[/QUOTE]
It is not a good idea to swap back and forward with dosing methods. I would stick with the TR method and try and get some hand held test done. While the libre is convenient, it is not reliable under 100 as I mentioned before.
You will get used to handling lower BGs…I know it is a bit scary at the moment but we really do need to get Gucci into much lower numbers and to see daily ketones tests (at the moment). Can you put all ketone tests into the remarks column of the SS please.
I can’t see on the SS where you got rid of the Hills from his diet. Was it the wet or dry? The hills wet I don’t think is high carb.

 

[djett]

Are you testing for ketones in the urine? It’s important to know this as that tells us if the insulin dose and food are about right.

Regarding the dose tonight, if you are uncomfortable giving the 2.75 units, you could give a one off 2.5 unit but I would go back to 2.75 units at the following dose.we need to get rid of those red and link BGs. Try and get him to eat well tonight if you can.

With the SS, any BG tests you got before the dose need to be stacked in the PMPS column. Then you start the +1 etc After the dose is given.

[QUOTE="djett, post: 3171339, member: 39611"]been doing a combination of both to see what works, for example starting 4/1/2024 I switched to TR, then on 4/9 after a steep drop/bounce, increased to 2.5 and then went back to SLGS and held 2.5 for a week. Is it possible that since I recently removed hills from his diet that now he needs a lower dose?

It is not a good idea to swap back and forward with dosing methods. I would stick with the TR method and try and get some hand held test done. While the libre is convenient, it is not reliable under 100 as I mentioned before.
You will get used to handling lower BGs…I know it is a bit scary at the moment but we really do need to get Gucci into much lower numbers and to see daily ketones tests (at the moment). Can you put all ketone tests into the remarks column of the SS please.
I can’t see on the SS where you got rid of the Hills from his diet. Was it the wet or dry? The hills wet I don’t think is high carb.
[/QUOTE]

Thanks I updated the spreadsheet with the information on 4/14 when I cut out Hills. I am testing for ketones every day but his results have been coming out gray which isnt in the spectrum but some say sometimes happens. I have yet to see a ketone test show anything but the first color on the spectrum or gray. Ahh ok i understand now what the +1 numbers are for, i've been entering the spreadsheet as it was an official curve with time of day since the libre can give me those numbers in its reports. I have been pretty good at feeding at 8am and 8pm and shooting right after although there were a couple of times ilike today where i was a little late.

Based on Tanyas comprehensive guide to CKD foods, the "Hill's Prescription Diet k/d Chicken & Vegetable Stew" which I started him on in August is 38% carbs on a dry matter basis. Gucci had a dental disease early on in life and started losing teeth. I ended up getting a full dental extraction in 2017 and he's been on 100% wet food since. He will even vomit if he attempts to eat dry food.

His glucose went down to 298 and then went up to 322 so I gave him the 2.5 units a little over an hour ago. Although since then its gone down to 261 and i'm assuming the glargine will kick in within the next hour or so, so I will likely just stay up all night to try to catch it on the way down when it crashes

Thanks,
Devin

 

[djett]

@Bron and Sheba (GA) it looks like the Glargine is kicking in now. His glucose slowly went down to about 225mg and now is rapidly falling anywhere from 4-6mg per minute and is currently at 181mg with the arrow pointed straight down.

I have a few questions to help prevent a hypo Thanks alot!

1. With the glucose rapidly falling (arrow pointed down), at what reading should I start feeding him higher carb food?
2. If he's either full or #1 doesnt help, at what reading should I start applying Karo syrup?
3. If I need to give him karo syrup, whats a good dose of Karo syrup to give him when he's low?
4. Should I repeat this process of trying to feed or apply karo syrup if it falls again shortly after the first crash? Or at some point do I need to limit the karo syrup for other reasons (intestinal for ex)

I take a look at others spreadsheets and see them give high dosages (2 or 2.5 units) and the glucose still seems to stay around 60-100 while mine always falls rapidly. Is this process of applying karo syrup or high carb food normal, and should I expect to do this 2-3 times a day like today until hes into remission?

Thanks,
Devin

 

[Bron and Sheba (GA)]

Hi Devin
First of all can you fix up the SS as I mentioned above please on how to stack the Preshot numbers in the PMPS column. At the moment it is not showing the true picture, and I can’t see what his true PMPS was.

It is normal for the blood glucose to fall after giving insulin. Some cats have a steady drop and some cats drop quickly when the insulin kicks in usually around +2 to +2.5. At the moment I can’t see what the Preshot BG is.
Are you giving him low carb snacks during the first half of all the cycles? A low carb snack is a teaspoon or 2 of low carb food. This will help slow down the drop. I would give a snack at +2, +4 and +5 or 6 depending on how much he is dropping.
There is no need to give higher carb food or karo unless he drops under 50 or is dropping really fast. And I don’t think he is dropping really fast at the moment.
If he does drop really low, you give a couple of drops of honey/karo with a teaspoon of high carb and test in 20 minutes. If the BG is still under 50 you can repeat the process. If it is rising ok, you can give some normal low carb food and test again in 30 minutes. You keep monitoring for 2 hours until he is consistently up higher on his own without the help of any high carb food or karo.

If he won’t eat and he needs karo you can rub a smear of karo onto his gums. But don’t overdo it or he’ll be sick.

I would not use the word ‘crashes’. Gucci is not crashing, he is just responding to the dose of insulin.

Is this process of applying karo syrup or high carb food normal, and should I expect to do this 2-3 times a day like today until hes into remission?

Unlikely.

 

[Diane Tyler's Mom GA]

You can even check out the soulistic pates that are on the higher end of low carbs if needed. Look at the ME profile ,
https://www.soulisticpet.com/pate
When you click on one of the flavors then click on
COMPLETE NUTRITIONAL INFORMATION (link to page)soulistic

POUCHES Protein Fat Carbs Calories (3.0 oz)
Chicken and Lamb Dinner 38.60% 54.50% 6.90% 69
Chicken and Pumpkin Dinner 48.10% 42.20% 9.70% 58
Chicken and Salmon Dinner 48.3% 44.1% 7.5% 64
Duck and Tuna Dinner 54.00% 39.60% 6.40% 64

 

[Bron and Sheba (GA)]

HOW TO HANDLE LOW NUMBERS

 

[djett]

Hi Devin
First of all can you fix up the SS as I mentioned above please on how to stack the Preshot numbers in the PMPS column. At the moment it is not showing the true picture, and I can’t see what his true PMPS was.

It is normal for the blood glucose to fall after giving insulin. Some cats have a steady drop and some cats drop quickly when the insulin kicks in usually around +2 to +2.5. At the moment I can’t see what the Preshot BG is.
Are you giving him low carb snacks during the first half of all the cycles? A low carb snack is a teaspoon or 2 of low carb food. This will help slow down the drop. I would give a snack at +2, +4 and +5 or 6 depending on how much he is dropping.
There is no need to give higher carb food or karo unless he drops under 50 or is dropping really fast. And I don’t think he is dropping really fast at the moment.
If he does drop really low, you give a couple of drops of honey/karo with a teaspoon of high carb and test in 20 minutes. If the BG is still under 50 you can repeat the process. If it is rising ok, you can give some normal low carb food and test again in 30 minutes. You keep monitoring for 2 hours until he is consistently up higher on his own without the help of any high carb food or karo.

If he won’t eat and he needs karo you can rub a smear of karo onto his gums. But don’t overdo it or he’ll be sick.

I would not use the word ‘crashes’. Gucci is not crashing, he is just responding to the dose of insulin.


Unlikely.

Sure I can fix it tonight, just might take a while since I have so much info and have been using the spreadsheet as a curve reading to this point, but now I understand how you guys like to view it. I do think theres value as well seeing a curve with the times, especially for people that can continuously monitor by the hour, but I can just make a copy of the current spreadsheet to use for my own personal good. For reference until I get the spreadsheet updated and cells adjusted, his PM pre shot was 298 and he was given 2.5 units an hr later after he finally ate most of his meal.

I haven't been giving snacks on a schedule per say, but have just been leaving food out in between the big meals so he can eat when hes hungry, then I just pick up the bowls a few hours before the major meal times. I can start giving small portions of food on more of a timed schedule starting today.. Sorry for the overloading of the word crash, when I was saying crash I was referring to the rapid drop in his graph, similar to a crash in the stock market, but not crash in regards to symptoms or well being.

Questions

• What do you guys consider a fast drop? In the last couple of days I would say he drops about 100mg an hr on average (Freestyle shows arrow trending straight down) and continues to drop until I step in and take action. Is that considered high or not high enough to start feeding high carb food? Last night since I was worried about him dropping I took your advice on small amounts of food along the way and it seemed to keep him level. Last nights numbers were promising!
• At what BG reading would I start giving high carb food if hes dropping fast?

Thanks,
Devin

 

[Bron and Sheba (GA)]

Hi Devin
I would recommend you start doing some hand held tests when you see the libre giving you either fast dropping numbers or numbers under 100. We are seeing evidence that the libre is not always reliable and suggest the caregiver recheck with a hand held meter. You can then see if the BGs are really dropping that fast or if they are really that low. In our experience the low numbers on the libre often don’t translate to low numbers on a hand held meter.

Can you tell me what is the name of your hand held metr please? Is it a pet or a human meter?

Did you read the link to handling low numbers I posted above? . That will give you valuable up information as to how to manage low numbers.

Looking at the SS, his numbers are looking better. I would keep giving those snacks at the times I suggested to try and stop the fast drops. Those fast drops could be triggering a bounce which sends the BGs up high again.

Fast drops do happen and we try and stop them because they cause bounces. Anything more than about 75 an hour could cause a bounce. It’s all part of the FD dance that many caregivers find happens with their kitty. My Sheba used to drop fast in the first few hours after the shots. Feeding the curve is what is recommended to try and stop this.

We don’t recommend feeding high carb food until the BG drops under 50. Occasionally if a kitty is dropping fast despite trialling feeding the curve, we suggest feeding a food that is a bit higher than low carb (but not high carb and Karo) but something around 12% but I really can’t see anywhere on Gucci SS where he has needed that yet.

 

[djett]

@Bron and Sheba (GA) Thanks I updated the spreadsheet so now i'm doing real AM/PM preshot values and +1 since preshot starting this morning. I have an alphatrak 3 which came with 28 gauge lancets, I bought 26 gauge but im still having a really time getting blood, im like 0-25 lol!

This morning his glucose was over 400 preshot and I gave him 2.75 which brought him down to the low 100s, nadir being 87, then went back up to 123 preshot tonight. I had to give him multiple low carb snacks to keep him in a good range, but it seemed to work!
Even though he was 123, his glucose started to drop and then just went from 100 to 77 in a matter of 3 minutes so I gave him some high carb food which brought it back up to 115, but now is going down again because im assuming the 2.5 units is about to kick in. I'm not sure if he will be able to keep eating since he ate a pretty lare meal about 2hrs ago, and then a little HC food just now. So if it rapidly drops once the insulin kicks in any minute now, I'm assuming I try to feed the high carb food again for example if it goes below 60, and then rub karo syrup if that doesnt help?

I did read your link thanks for that, and I reread some of the TR docs and how to treat a hypo doc. Some content is a little vague for example "a small amount" which someone may not know exactly what is considered small, but im going to assume like 1/2 teaspoon = small. Might be a long night tonight!

Thanks,
Devin

 

[Bron and Sheba (GA)]

A small amount of food would be a teaspoon. A small amount of honey or karo would be a couple of drops.Looking pretty good so far this pm cycle.

 

[djett]

Great thanks again! I just updated the spreadsheet again, and it seems to be pretty good tonight, lowest has been 75, while highest 162, and is sitting flat at around 113 right now. He's a little more vocal and a little more wobbly than normal, but I just started him on Zobaline tonight so hopefully that plus lower numbers improve his neuropathy.

Questions:

• since I gave him 2.5 units when he was 123 preshot, and had to give him a little high carb food twice to catch his fall (about 1-2 tablespoons of Hills k/d chicken in stew 38% carbs DMA), does that mean his dose is slightly too high? The last time I had to catch his fall was about 4 hours ago and he also dropped to about 80 2 hours ago but naturally went back up without any food. Just wondering if having to catch his fall a couple of times with high carb food is normal/expected, or if I should reduce to 2.25 if preshot is in normal range? I have the needles with the .5 marks on them
• If his glucose is dropping to around 75-80 and then naturally going back up to 130 and then back down to 100 and repeating that cycle, is that an indication that his liver/pancreas are working better? I think in the past when he's gone this low, he bounced way higher over 400 slightly after, this is the first time its stayed in the normal range for 10+ hrs, although this is also the first time I didn't run for the karo syrup ha

Thanks,
Devin

 

[djett]

Right after I sent that last message, it went from about 105 to 73 in a matter of 5 minutes. Gave him some low carb food and its at 79 now, but do you know what causes that steep drop? Is that normal in TR and will his body naturally swing his glucose back up or will I always have to be here to catch his fall? I'm afraid to go to sleep or leave the house!

 

[Bron and Sheba (GA)]

Right after I sent that last message, it went from about 105 to 73 in a matter of 5 minutes. Gave him some low carb food and it’s at 79 now, but do you know what causes that steep drop? Is that normal in TR and will his body naturally swing his glucose back up or will I always have to be here to catch his fall? I'm afraid to go to sleep or leave the house!

I can’t see a 73on the SS only a 95
Remember I mentioned that numbers under 100 on the libre were unreliable. Before believing them I would check them with your hand held meter.

 

[djett]

I can’t see a 73on the SS only a 95
Remember I mentioned that numbers under 100 on the libre were unreliable. Before believing them I would check them with your hand held meter.

Just updated with numbers in between which should show a better picture. Yeah I remember you saying that, but if the numbers are dropping down fast, for example if they are at 130, then 1min later 115, then 100, then 77 which shows a trend of a fast drop and then after giving food show a trend of swinging back up the same way, is this normal with TR? Or does this indicate too high of a dose? I guess i'm having trouble understanding what is normal and what isnt, and if others are also afraid to leave the house for 5 minutes because of the drastic falls which require me to be there to feed him and get it to rise back up. Not concerned as much with a single number but trends. The arrow is a really good indicator for trends in the numbers so I always take that into account. For example I'm not worried about 75 with a flat arrow, but I do worry when I see 75 with a straght down arrow. As you mentioned it may not be an accurate number, however if its trending straight down thats a good indicator it will soon get to a real low number unless I step in or take a chance

 

[Bron and Sheba (GA)]

If you could put what you fed and when into the remarks column for today that would be helpful.
Look, I do understand that it can be scary when you see numbers dropping. My Sheba used to drop quite quickly in the earlier part of the cycles.
What I would really like you to do is try and start testing with a hand held meter, preferably a human meter, so we can see better what the BGs are really doing. We have found that the libre and the hand held meter numbers are often very different… sometimes libre numbers under 100, when tested by the hand held meters are often over 50 higher.
I can see you are swapping the dose between 2.76 and 2.5 depending on what the preshot BG is. Lantus dosing is based on the nadir not the preshot. If you keep jumping around with the dose, the depot will not stabilise.
I would pick either 2.5 or 2.75 units and stay with that dose unless Gucci drops under 50.
Are you testing each day for ketones in the urine?

 

[Bron and Sheba (GA)]

I would also start a new thread please Devin when you get a moment, as this one is getting too long. And if you could link this thread to your new one for continuity please. Thanks

 

[tiffmaxee]

Welcome to LLB. It looks like you have not tested with the hand held meter which is more accurate than the Libre in lower numbers. Are you able to draw blood?

 

[djett]

If you could put what you fed and when into the remarks column for today that would be helpful.
Look, I do understand that it can be scary when you see numbers dropping. My Sheba used to drop quite quickly in the earlier part of the cycles.
What I would really like you to do is try and start testing with a hand held meter, preferably a human meter, so we can see better what the BGs are really doing. We have found that the libre and the hand held meter numbers are often very different… sometimes libre numbers under 100, when tested by the hand held meters are often over 50 higher.
I can see you are swapping the dose between 2.76 and 2.5 depending on what the preshot BG is. Lantus dosing is based on the nadir not the preshot. If you keep jumping around with the dose, the depot will not stabilise.
I would pick either 2.5 or 2.75 units and stay with that dose unless Gucci drops under 50.
Are you testing each day for ketones in the urine?

Thanks I'll start a new thread after this post. I do test for ketones every day which always come back negatvie although a few times there was a gray color which isnt on the spectrum, which others have noted as not something to worry about.
I have been sticking with 2.75 and may move to 3 in a couple of days if Nadirs are still high since Nadirs at 2.75 have not gone below 50. It actually bounced up over 350 for about a day, but even that is an improvement since previous bounces would usually last about 3 days.

 

[djett]

Welcome to LLB. It looks like you have not tested with the hand held meter which is more accurate than the Libre in lower numbers. Are you able to draw blood?

Thank you , just curious what does LLB stand for? Unfortunately I have not been able to draw blood. A few others on this board have been trying to help me test with my Alphatrak 3 with both 28 and 26 lancets, however I just cant get enough blood from him and its been a very stressful process for us both for multiple reasons state above. He's VERY difficult and doesn't cooperate at all, I think if I had 3-4 hands I could do it but restraining with the knees isnt good enough and he won't sit still at all (picture a human trying to get out of a cage with a Lion in it, he's the human lol).

I do understand the importance of testing BG (ALphatrak 3) vs IG (freestyle Libre 3), and I have read the case study and understand theres a lag, but this is the best I can do. I understand if not being able to test real BG is a deal breaker here or required to provide assistance so no hard feelings if someone doesn't want to help, but will need to do this with the Freestyle Libre 3 as my CGM which is still better than nothing

 

[Sienne and Gabby (GA)]

LLB = Lantus, Levemir, and Biosimilars or commonly referred to as the Lantus Board. I'd encourage. you to post there.

Aside from the difficulty with the Libre with lower range numbers, there is just so much data on your spreadsheet it's hard to make sense of things. I was a testaholic as was Marje, one of the other moderators. Your spreadsheet makes us look like slackers. It's quite difficult for me to tease apart Gucci's numbers based on how your intervening with high carb food and the dose changes. This is particularly the case since your signature says you're following TR but it's not what your spreadsheet suggests. I'd encourage you to follow TR if that's what you want to do and to start posting on the Lantus board.

 

[djett]

LLB = Lantus, Levemir, and Biosimilars or commonly referred to as the Lantus Board. I'd encourage. you to post there.

Aside from the difficulty with the Libre with lower range numbers, there is just so much data on your spreadsheet it's hard to make sense of things. I was a testaholic as was Marje, one of the other moderators. Your spreadsheet makes us look like slackers. It's quite difficult for me to tease apart Gucci's numbers based on how your intervening with high carb food and the dose changes. This is particularly the case since your signature says you're following TR but it's not what your spreadsheet suggests. I'd encourage you to follow TR if that's what you want to do and to start posting on the Lantus board.

Sorry for the confusion I just recently switched to TR this week on 4/20, but yeah before that I was a little all over the place since values were always above 400 and his walking was getting worse every day. His numbers are alot better now and he's walking better and slowly becoming more himself. The High Carbs were due to an article I was linked to in regards to Hypo Mild Symptoms - https://felinediabetes.com/FDMB/threads/how-to-treat-hypos-they-can-kill-print-this-out.15887/. I'll start posting on the other thread. Thanks!

 

[Sienne and Gabby (GA)]

It would be helpful if you could insert a line on your spreadsheet and indicate on the line that you switched to TR. Alternatively, you can edit your signature and include the date that you switched. Otherwise, you have to deal with people like me who were unaware that you made a switch.

I'd urge you to think in terms of what are low numbers vs a symptomatic hypoglycemic episode. Lower numbers are something you want your cat to become more accustomed to. If your goal is to get your cat regulate or into remission, she has to spend time in normal numbers. It can be a balancing act but those green numbers should be a positive and not a reason to panic. For TR, your reduction point will be 50 so you have to get used to a new, lower point, for a dose reduction.