New Member: implement the Start Low Go Slow method?

Status
Not open for further replies.
Barbara & Bindi

Barbara & Bindi

Member Since 2022
Over 10 years ago I had a diabetic cat and part of this forum, a lot has changed since! In March this year our 7 (almost 8) year old DHS Bindi had DKA, it took two vets to figure it out, but with intense round the clock care at home (subq fluid, temp testing, etc etc) she pulled through. She went from around 13-14 lbs to about 11.5 lbs and is holding pretty steady. She's been on 1 unit Lantus BID since mid March and I'm able to check her numbers twice a day, its always between 250-350 with sometimes a number higher/lower, but never over 380 or under 215. Even 3, 6 or 9 hours after her 1 unit, she doesn't seem to go up or down much. She eats the FF pate, and I have a mix of Wysong Epigen, Dr. Elseys and Young Again that I switched all cats to since they all are grazers and one needs low phosphorous because of her kidneys (non-diabetic cat). I can test her twice daily before insulin time, I try not to do more unless I really have to. She tolerates this routine and it works for our crazy zoo life (we have 3 cats, one new stray kitten, 3 dogs and 3 TNR cats outside. Oh and a business and full time jobs).
We have a good vet clinic, the vet encourages home testing and is open to suggestions. After the DKA was under control and he saw her BG numbers 'steady', his philosophy is that a cat can handle moderately high numbers better than going too low and I agree, not looking for a hypo emergency here... but I feel like we should be able to do better, whatever that may look like. Last week I bought a blood ketone meter and to my surprise, she has ketones in her blood but is not acting sick. She eats well, drinks normal, not lethargic, slaps the foster kitten around, does her 'normal' thing really nothing like she was mid March when she was so, so sick with DKA. Nothing like that at all, and had I not tested her for ketones, I would have never had a clue. Lowest was 0.5, highest was 5.7 on Sunday (this was the day after she had her vaccinations). I emailed the clinic to ask if they can let me know what her BK was when she has the DKA, waiting to hear back from them.
So my question is, should I try the start low go slow method to see if an increase in Lantus will bring her numbers down more so that she will be better regulated and would that improve the ketones in the blood?
 
Welcome @Barbara & Bindi
I can tag a member for you about the DKA and Ketones
You would have to follow SLGS since Bindi eats dry food also

One thing you need to be testing more than twice a day to see how the lantus is working and how low Bindi is dropping. You will never know if an increase or decrease is needed. Try to get a +2 , +4 and +6 at least , same with the PMPS , cats usually drop lower at night .
If you can fill out your signature also
To set up your signature which you will see is at the end of everyone's post in gray, click on your name up top and then tap on the word signature and add this information
  • Add info we need to help you:
    • Caregiver & kitty's name
    • DX: Date
    • Name of Insulin (do not include dose or frequency)
    • Name of your meter
    • Diet: "LC wet" or "dry food" or "combo"
    • Dosing: TR or SLGS or Custom (if applicable)
    • DKA or other recent health issue (if applicable)
    • Acro, IAA, or Cushings (if applicable)
    • Spreadsheet link. Please put the signature link on the bottom line of your signature information, on its own, so it is easy to find.
    • Please do not put any information about your location in the signature for security reasons. If you wish to add your country location, please add it to your profile.
Be sure to click the 'Save Changes' button at the bottom. If you need help urgently it is important we know these things at a glance. We don’t want to waste valuable time finding out information.

Take a look at mine

We also have a spreadsheet we use to track our cats BG in case you need advice so one of our members can look at it and help you

Hers is the link for the spreadsheet if you have any problems setting it up just ask we have a member that will be happy to set it up for you
The link will also explain how the spreadsheet works
https://www.felinediabetes.com/FDMB/threads/how-to-create-a-spreadsheet.241706/
 
Last edited:
Barbara & Bindi said:
Over 10 years ago I had a diabetic cat and part of this forum, a lot has changed since! In March this year our 7 (almost 8) year old DHS Bindi had DKA, it took two vets to figure it out, but with intense round the clock care at home (subq fluid, temp testing, etc etc) she pulled through. She went from around 13-14 lbs to about 11.5 lbs and is holding pretty steady. She's been on 1 unit Lantus BID since mid March and I'm able to check her numbers twice a day, its always between 250-350 with sometimes a number higher/lower, but never over 380 or under 215. Even 3, 6 or 9 hours after her 1 unit, she doesn't seem to go up or down much. She eats the FF pate, and I have a mix of Wysong Epigen, Dr. Elseys and Young Again that I switched all cats to since they all are grazers and one needs low phosphorous because of her kidneys (non-diabetic cat). I can test her twice daily before insulin time, I try not to do more unless I really have to. She tolerates this routine and it works for our crazy zoo life (we have 3 cats, one new stray kitten, 3 dogs and 3 TNR cats outside. Oh and a business and full time jobs).
We have a good vet clinic, the vet encourages home testing and is open to suggestions. After the DKA was under control and he saw her BG numbers 'steady', his philosophy is that a cat can handle moderately high numbers better than going too low and I agree, not looking for a hypo emergency here... but I feel like we should be able to do better, whatever that may look like. Last week I bought a blood ketone meter and to my surprise, she has ketones in her blood but is not acting sick. She eats well, drinks normal, not lethargic, slaps the foster kitten around, does her 'normal' thing really nothing like she was mid March when she was so, so sick with DKA. Nothing like that at all, and had I not tested her for ketones, I would have never had a clue. Lowest was 0.5, highest was 5.7 on Sunday (this was the day after she had her vaccinations). I emailed the clinic to ask if they can let me know what her BK was when she has the DKA, waiting to hear back from them.
So my question is, should I try the start low go slow method to see if an increase in Lantus will bring her numbers down more so that she will be better regulated and would that improve the ketones in the blood?
Click to expand...
@Bron and Sheba (GA)
I can tag a member for you about the DKA and Ketones
I'm sure @Bron and Sheba (GA) will be on soon
 
Last edited:
Hi Barbara and Bindi.
With the ketone blood meter any level over 2.4 is of concern.
A reading of 5.7 is worrying. Is she lethargic, off her food, depressed, vomiting or diarrhoea ? If so, she needs to go to the vet asap.
Here is what I would suggest:
I would give her extra to eat…..up to 1 and a half times as much a normal at the moment. Lots of snack's
I would also add a teaspoon of warm water to each snack you give to help with extra fluids.
She probably does need a dose increase but without seeing any data I can’t advise on that.
If you could set up a spreadsheet for us and enter as much data as you can for the last couple of weeks, that would be useful.
If you can’t set up the SS I will ask @Bandit's Mom to help you.
If you could get at least 1 test in around +5 to +7 each cycle that will help us a lot as Lantus dosing is based on the nadir or the lowest point in the cycle not the preshot BG.
Test for ketones twice a day at the moment.

If the vet wants you to increase the dose I would recommend you only increase it by 0.25 units at a time.
 
Bron and Sheba (GA) said:
Hi Barbara and Bindi.
With the ketone blood meter any level over 2.4 is of concern.
A reading of 5.7 is worrying. Is she lethargic, off her food, depressed, vomiting or diarrhoea ? If so, she needs to go to the vet asap.
Here is what I would suggest:
I would give her extra to eat…..up to 1 and a half times as much a normal at the moment. Lots of snack's
I would also add a teaspoon of warm water to each snack you give to help with extra fluids.
She probably does need a dose increase but without seeing any data I can’t advise on that.
If you could set up a spreadsheet for us and enter as much data as you can for the last couple of weeks, that would be useful.
If you can’t set up the SS I will ask @Bandit's Mom to help you.
If you could get at least 1 test in around +5 to +7 each cycle that will help us a lot as Lantus dosing is based on the nadir or the lowest point in the cycle not the preshot BG.
Test for ketones twice a day at the moment.

If the vet wants you to increase the dose I would recommend you only increase it by 0.25 units at a time.
Click to expand...

(sorry still learning how to set up my profile, I'm looking at all the grey signatures and can only understand half of the abbreviations...)
I think the spike in ketones was induced by some sort of colitus (all 4 cats had the same issues and received metronidazole for 5 days), she also received a rabies vaccination shortly after. so between all of that I think she was just a little out of whack. Since then over a period of 12 days, the ketones have come down and have been under 1.0 for the last week. I'm testing the ketones once a day now instead of twice a day. She stresses out easily so if I don't have to take her to the vet, I won't. I called and emailed the clinic and since she's active, eating and drinking normal and her BG is stabile, I'm taking her in for a 5-month post-pancreatitis recheck in 4 weeks. There is a limit on how much I can test her, for her sake and for mine. She does not enjoy the ear pokes even though I'm good at it, never miss and it's a fairly quick process. I don't work from home so the only days I can test at +2,4,6 etc is on a weekend. A +6 after her evening insulin would be 0:45AM which I can't do, my alarm goes at 5:00AM. She's a fairly good cat for me with testing and her shots, but I do not think she would tolerate one of the Freestyle Libre devices on her skin. For this reason I most likely will have to leave her at the dosage she's on now. Would doing a fructosamine test every so many months be a good indicator how her long term levels are?
 
Barbara & Bindi said:
sorry still learning how to set up my profile, I'm looking at all the grey signatures and can only understand half of the abbreviations...)
Click to expand...
Here is how to set up your signature
If you can fill out what we call our signature ,information about your kitty
To set up your signature which you will see is at the end of everyone's post in gray, click on your name up top and then tap on the word signature and add this information

Also please give the date when the DKA happened in your signature
  • Add info we need to help you:
    • Caregiver & kitty's name
    • DX: Date
    • Name of Insulin (do not include dose or frequency)
    • Name of your meter
    • Diet: "LC wet" or "dry food" or "combo"
    • Dosing: TR or SLGS or Custom (if applicable)
    • DKA or other recent health issue (if applicable)
    • Acro, IAA, or Cushings (if applicable)
    • Spreadsheet link. Please put the signature link on the bottom line of your signature information, on its own, so it is easy to find.
    • Please do not put any information about your location in the signature for security reasons. If you wish to add your country location, please add it to your profile.
Be sure to click the 'Save Changes' button at the bottom. If you need help urgently it is important we know these things at a glance. We don’t want to waste valuable time finding out information.

Take a look at mine

If you would like to set up our spreadsheet where we track our cats BG to see how the insulin is working and how low it's dropping in case you want advice here is the link , if you need help with it just ask
We need you to set up our Spreadsheet , I'll give you the link , if you need help setting it up just ask

https://felinediabetes.com/FDMB/threads/how-to-create-a-spreadsheet.241706/
It will also explain how to use the spreadsheet works
You then need to link your spreadsheet to your signature
 
Diane Tyler's Mom said:
Here is how to set up your signature
If you can fill out what we call our signature ,information about your kitty
To set up your signature which you will see is at the end of everyone's post in gray, click on your name up top and then tap on the word signature and add this information

Also please give the date when the DKA happened in your signature
  • Add info we need to help you:
    • Caregiver & kitty's name
    • DX: Date
    • Name of Insulin (do not include dose or frequency)
    • Name of your meter
    • Diet: "LC wet" or "dry food" or "combo"
    • Dosing: TR or SLGS or Custom (if applicable)
    • DKA or other recent health issue (if applicable)
    • Acro, IAA, or Cushings (if applicable)
    • Spreadsheet link. Please put the signature link on the bottom line of your signature information, on its own, so it is easy to find.
    • Please do not put any information about your location in the signature for security reasons. If you wish to add your country location, please add it to your profile.
Be sure to click the 'Save Changes' button at the bottom. If you need help urgently it is important we know these things at a glance. We don’t want to waste valuable time finding out information.

Take a look at mine

If you would like to set up our spreadsheet where we track our cats BG to see how the insulin is working and how low it's dropping in case you want advice here is the link , if you need help with it just ask
We need you to set up our Spreadsheet , I'll give you the link , if you need help setting it up just ask

https://felinediabetes.com/FDMB/threads/how-to-create-a-spreadsheet.241706/
It will also explain how to use the spreadsheet works
You then need to link your spreadsheet to your signature
Click to expand...

Thank you, I tried setting up the signature but not sure if it worked. I'll have to find the missing information and write down the brands of the two meters I use.
 
Barbara & Bindi said:
Thank you, I tried setting up the signature but not sure if it worked. I'll have to find the missing information and write down the brands of the two meters I use.
Click to expand...
You set it up just fine, to add the meters tap on your name up top then tap on signature and add the meters . PLEASE add that Bindi had ketones , that's important
It's best to stick with one meter when testing.

I see you have a question mark for dosing
With lantus there are 2 dosing methods and you need to pick one
Whichever one you choose to follow they will tell you when an increase or decrease is needed. If you are feeding any dry food at all you would have to follow SLGS
I'll give you the link to read about them
https://felinediabetes.com/FDMB/thr...-low-go-slow-slgs-tight-regulation-tr.210110/
Would you like someone to set up your spreadsheet for you
 
Last edited:
Diane Tyler's Mom said:
@Bron and Sheba (GA)
Bron please read post #5
Click to expand...
I updated the rest of my signature, let me know please if I missed anything Diane and if you can help me set up a spreadsheet that would be great. I track all her numbers and times on a printed spreadsheet because I'm old school haha.
No signs of any distress on Bindi at all these days, her demeaner is really good, she slaps the dogs when they irritate her, she's eating really well and has gained a few ounces (her weight is steady around 11lb 4-8oz), she's not drinking extreme amounts just regular, her coat looks good and so do her poops (which were awful when she had colitis with all the other cats several weeks ago). After the high ketones during the colitis and the vaccinations, ketones came down and stayed under 1.0 for a week but 8/1, 8/2 and this morning they were between 1.3 and 1.9. Again, not one sign that she's not feeling good and she's far from lethargic so I don't think it's affecting her at this time. I'm going to keep testing for BK as I test her BG before her AM and PM shots. I wonder if she's had these ketones going up and down like this since she had DKA in March and I just didn't know because I wasn't testing for them.
 
Status
Not open for further replies.
Back
Top