Numbers up and down

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Hosanna

Hosanna

Member Since 2012
I am not requesting dosage recommendations, just a question: is it typical for the numbers to be going up and down as they are for Martha? They will be nice and low and I get encouraged--then next time, high--and I feel at a loss. :cry:
 
I understand your request about not asking about dose. The problem is you don't understand how Lantus works. Your observation about Martha's numbers is based on two points in time each day. You don't know how flat or how variable the cycle really is. Even your question about why numbers got progressively higher during the day yesterday might have been answered by additional spot checks. FWIW, in your previous threads, no one was giving you recommendations regarding dose. What we continue to say is that in order to have Martha get any benefit from Lantus and, more importantly, to keep her safe, you need to get tests that reflect the lowest point in the cycle.

Based on the two tests per day, your numbers are not that variable. They can largely be explained by meter variance. However, it is very difficult and bordering on irresponsible for me to attempt to interpret your spreadsheet with insufficient data.
 
I'm curious...why is the dose changing from cycle to cycle?

From what I am understanding about the L insulins is they form a depot and a particular dose could effect that cycle, and/or the next, and/or the one after that, and/or...and so on. How can you tell when a particular dose is actually being utilized? I can't tell from your spreadsheet.

I'm new to the L insulins so thought I'd ask. :smile:
 
I am new to all this, also. The thing is, I am doing the very best I can under my circumstances. Nobody can care as much about Martha as I do, but then again, nobody can understand all that is going on in my home. I am starting to feel unwelcome on this board, and I hate that because I need you so much. My emotions are on the raw side these days and I would hope that you all might remember how you felt at the beginning of this journey. I would appreciate your patience with me. I have started doing spot checks, but instead of encouragement, I get criticism for not doing enough. I am dealing with a lot of things with Martha.
Please forgive me if I am out of line with this post. I don't mean it in a bad way.
 
You're not out of line in the least. None of us know your circumstances. We all also recognize the the beginning phase of managing your cat's FD is overwhelming.

If you can get one spot check per cycle, that will help enormously. No one here wants to misdirect you or offer an opinion that endangers your cat. That's our reservation. You may want to look over the Tight Regulation protocol as well as the Start Low Go Slow approach and decide which will work better for you and Martha. That will help us to help you, as well.
 
Hosanna, everyone has started out in the exact same spot that you're at with Martha. This IS all very new to you, and it will take some time to get used to everything. Nobody's giving you criticism here. We're all trying to help you to understand this. Sure, it's not easy in the beginning, however, over time it DOES get easier. I know, and I've been at this for over 2 years, and so have others. Yes, it gets frustrating in the beginning. You'll go through ups, and downs throughout the journey. It takes a while to understand the effects of Lantus, and how it works with your kitty. Lantus is not like the other insulins that you may have tried. It DOES work, and you need to be consistent with the doses, otherwise you're going to see inconsistent #s like you're experiencing. You'll learn over time, and with consistent history on Martha's spreadsheet how to read the #s, and what affects her and what doesn't. You'll learn how to influence her #s using food, and how much insulin she'll need (as in either a fat dose, a skinny dose, or a 1/4 unit). You'll learn also how to keep Martha's weight under control, while figuring out the correct amount of food to give her in order to so. It took me a while to figure it out by myself, and so can you. I also learned by reading the Tight Regulation Protocol sticky that Sienne gave you in her post to you. It may seem hard to understand at first, but take your time, read it, and if necessary re-read it again. You WILL begin to understand it as time goes on. Everything will make sense.

You're starting to get the spot checks in each cycle, and that's an excellent start! :-D You're starting to see a bit of history on Martha's spreadsheets as you keep doing this. Would you mind getting perhaps 2 spot checks in each cycle to give the experienced people a bit better idea on how she's doing? 2 checks per cycle would be more history to show on the spreadsheet.

Keep up the excellent work, Hosanna. You are doing great, and most importantly, you ARE in the right forum to get help with Martha. Allow them to help you help her, ok? Take a deep breath, relax, and begin reading and learning. It will get easier.

On another note, what kind of food are you feeding her right now?
 
Thanks so much for not taking what I said the wrong way-- I have started a 3-hour curve today.
 
Food--I am giving her Fancy Feast Classic canned. She is getting only canned now. She gets different flavors of FF. Once in awhile I give her Friskies Poultry Platter and Whiskas Roasted turkey pate as special treat.
Speaking of treats, she gets freeze-dried treats so the carbs should be pretty low if any.
I will look over the Start Slow protocol--if I decided it is a better fit, would you still work with me?
 
Of course, we'll still work with you. We all want to help you and we all want to help Martha.
The food and treat choices look perfect.
 
Hosanna, I don't believe there's a single soul here NOT willing to help, regardless of how you choose to progress with Martha. :smile: Being able to help, though, with knowledgeable input requires a bit more information from you. That's what I hear people asking for - More information to be able to help. :smile:

Doing a curve today is fantastic! :-D

I know it's overwhelming. There's so much to learn about treating this disease. It just takes time and patience. :smile:

There's a ton of first hand knowledge, experience, and caring available from the people here. When folks say they want you to test more, it's so they can help you help Martha...not to be mean. :YMHUG:
 
Good deal! I'm looking forward to seeing what her #s are, and I'm sure that others are, too.

One other thing I forgot to mention, this takes a lot of patience. I've been flustered many times throughout Blackie's journey, and felt extremely discouraged. Others have felt the same feelings that I have felt, and you're going to feel those same feelings, too. It's all natural to feel them. Feel free to constantly ask questions, even if you need clarifcation on something over and over. Sometimes, it's best to ask the same question over and over to understand something better than to not ask it at all and get frustrated.

As Sienne has pointed out in a previous post to you, you can do a 3 hour curve if you'd like, and she's a big fan of the +2 or +3 spot checks, too. I've done a few hourly curves myself to see how Blackie does over a period of 12 hours. Yes, it means doing a lot more checks. Knowledge is power, though. :-D You should've seen me in the beginning... I was a testaholic! Now, not so much. :lol: I do the +1, sometimes a +2 check, and mostly a +3 because that's when Blackie's nadir seems to be now (the +3 that is). There are times I'll do a +4 spot check, too, but not often.

It'll get easier with time. The main thing is be consistent with the dose, get the history needed, and then the experienced people can help you with any dosing questions that you may have in the near future. Lantus likes, and thrives on consistency. It's a 12 hour insulin, and remember that it'll take time to fill Martha's shed up in the beginning so you're going to experience some bouncing #s for a bit before the shed's filled, and then she'll settle down. Also remember, with each new dose (be it up or down), and with each change of food (if you decide to switch foods in the future) you may also experience some bouncing, too. Take it in stride, and know that they'll clear, even though it'll be frustrating and may make you want to pull your hair out. :lol: I decreased Blackie's dose to 5u from 5.25u because she gave me a +39 +3 one evening 3 night's ago. She's now just coming out of that bounce, and yes, it's taken that long.

Hang in there, Hosanna. I'm liking the history that you're getting so far. Keep up the excellent work! :-D
 
Yes. you will get help either way. Ifyou decide to do the relaxed lantus , it would help everyone if you could add it to your signature
and they will see that is your preference.
You are very welcome here.
Please don't feel criticized for needing more data.
Without the data, no one knows what's happening in your cats cycle and because of that, it's almost impossible to give dosing advise when
you do need it. And there may be a day in the future when that could happen.
I'm so happy to hear that you are getting a curve in today. That is going to be a tremendous help.
It will help you to know better when your cat gets it's lowest number (nadir) during the cycle. Keep in mind that your cat can change
the nadir on you so it's not always in the same place. It can move around that's why it's important to keep testing randomly at least,
so you get a better idea of what's going on.
Think of it as a jigsaw puzzle and you've got the outer pieces in place with all the changes you have made, but now you have a lot of
pieces still out of place in the middle of the puzzle.
That data that you are collecting in your ss are your missing pieces.
We can't tell what the picture is yet ( like when you do a puzzle without the box to refer to the picture)

And posting here gets you the most eyes and help. So stay, please!
It is a lot to learn really fast and many of us have to go back and re-read the sticky's to remind ourselves of what we are supposed to do.
 
Of COURSE we'll help you. This is what this board is all about, along with making new friends, too. :-D

With regards to the Fancy Feast, in time you may decide to stick with 1 flavor, and see how it affects her #s. If you're giving several different flavors, it may be affecting her #s (ie. raising them too much, perhaps). Different foods have different carb/calorie counts. Some of the foods that you're giving her may be either medium carb (MC) or high carb (HC) which ultimately raises her #s. If she likes the Turkey & Giblet flavor, it's lower in carbs, and may help to decrease those #s a bit. I've had Blackie on Fancy Feast Turkey & Giblets for the longest time before switching her to Evo 95% Chicken & Turkey, which is either 0% or next to 0% in carbs.

Here are 2 links for food that you can look at:

http://binkyspage.tripod.com/CanFoodNew.html

http://binkyspage.tripod.com/CanFoodOld.html

They give the calories, and the carb content on each food. I hope that helps.

Here's a sticky with regards to the New Dose Wonkiness that you'll experience time and time again:

http://www.felinediabetes.com/FDMB/viewtopic.php?f=9&t=46012

Another one with dose increases:

http://www.felinediabetes.com/FDMB/viewtopic.php?f=9&t=46013

And this one is another good read:

http://www.felinediabetes.com/FDMB/viewtopic.php?f=9&t=31942

Feel free to add these to your favorites for easier referencing later on. It may not all sink in right now, but over time it will.
 
SLGS is the approach. "Relaxed" Lantus is not an approach to treatment. It would he helpful if you could note in your signature that you're following SLGS. Most of the people here follow Tight Regulation so the reminder of which protocol you're following will be very useful.

Unless Martha is very carb sensitive, the difference between 4% vs. 5% carbs in negligible. In this regard, every cat is different (ECID). Angela has a very different approach to food than I do. I feed my guys 2 flavors of Wellness. Gabby can't tolerate beef and I won't feed fish. The bottom line is to feed what Martha will eat and what fits your budget. If there's something inexplicable about her numbers, then we can look at what the reasons may be.
 
96 point drop from the preshot # to the +3. That's a nice steady, easy drop, which equates to 32 points per hour (per my own calculations anyway :lol:... I took 96 and divided it by the 3 hours to get 32 points each hour). I'm NO mathematician, either. :lol: I look forward to seeing how she's doing through the day today. You're doing an awesome job, Hosanna! :-D

And yes, I won't argue the point that Sienne made about the food. My approach is different from hers, or perhaps everyone else's. It works for Blackie, but may not work for others. It's all trial and error.
 
That looks like a lot of good reading. I also have the Stickies in my favorites and am reading as I can.
Speaking of food.....Martha does need to lose weight, she is over 13 pounds. Just about all of the fat is underneath her in her stomach area, and I know that's not good. I have spoiled her rotten over the past 3 years, especially after she got CRF. Many times she had to be hand-fed, and other things that contributed to her being spoiled. It is not necessarily working in her favor now, and I'm trying to get her beyond that.
How many calories does she need? I have no idea how to do her diet. She was always free fed until the past month.
 
Here's a cat chart that I think will help you. Unfortunately, I wasn't able to find one a bit larger than this one:

https://www.google.com/search?q=cat...FBenF0QGtpY3WAw&ved=0CGUQsAQ&biw=1024&bih=608

And here's another very helpful link with regards to feeding, and of course, weight loss:

http://catinfo.org/?link=felineobesity

With my cat Blackie, she gets almost 200 calories/day to maintain approximately 11.35 lbs (give or take a 10th of an ounce). Here's a formula that is used (or may have been updated or not, but I still use it on occasion) to calculate the amount of calories/day that Martha may need:

13.6 x weight of kitty + 70 = ?? (calories)

Here's an example. I feed Blackie Evo 95% Chicken & Turkey, which is 38.2 calories/ounce. She gets 5.2 ounces each day, which is 198.64 calories/day. Evo is about 38.2 calories/ounce. There are approximately 504.24 calories/13.2 oz. can of food. Not sure if that's as-fed, and I'm hoping that someone can come along and clarify that for me. Either way, she's getting almost 200 calories/day to maintain her current weight.

With regards to the amounts, I feed Blackie small meals 4x in the morning and again at night (including the preshot meal). The last meal is a snack meal, and she gets 0.35 oz. The other 6 meals she gets 0.75 oz. But that's her, though. You'll more than likely feed Martha at different times, and different amounts. The above is only an example which is tailored to Blackie's needs, and weight.

I've purchased a pet scale earlier this year, which has been extremely helpful in finding and maintaining her ideal weight. This is the one I purchased:

http://www.amazon.com/ZIEIS-Capacit...racy/dp/B0040I21EQ/?tag=felinediabetesfdmb-20

I like it as it has a 0.1 ounce margin of error, and I can use it for mailing, too. :lol: You may want to get this one, or a different one.
 
The formula for calculating calorie intake per day is, according the the author of the website (Lisa Pierson, DVM), "generous." However, it's a good place to start. It's best to use calories vs. number of cans of food per day since the calories vary. The links to the various food lists have the calorie counts. If it seems like you're feeding less than what the formula would dictate, figure out how much you're feeding and reduce it a bit.

The info on weight loss on Dr. Lisa's site encourages a slow, steady approach. Quick weight loss in a cat can cause other problems.
 
Sienne's right. A slow, easy reduction in weight is best for sure.

We all know this can be overwhelming at first. Take a few deep breaths, and know that you can do this. We've all been where you're at now. You're going to do just fine. :-D
 
Hosanna, when you have a moment before the next preshot test, would you mind getting another test again soon so that those experienced can see how Martha is doing, please? I'm curious to see her #s, also, and am wondering if she's still in the 100's, or if she's risen since your last test. If you can't, that's fine, too. :)
 
Angela, I did the last test at +6 and hope to do another one at +9.
Those links that I've had the chance to read over so far, are fascinating. I think I'll have earned another PhD by the time all this is over!!!!
1--What does k-kal mean?
2--re scales. I have had three baby scales and although Morelli thinks they are another comfy bed for him, Martha won't go near them. The times I've picked her up and put her on, she has flailed so hard with arms and legs you wouldn't believe. When I've tried to weigh myself + her, she wiggles and squirms so hard I can never get an accurate reading.
I don't want you to think that you have to "baby" me. Really, I'm actually a pretty tough lady.
 
Angela, I did the last test at +6 and hope to do another one at +9.
Those links that I've had the chance to read over so far, are fascinating. I think I'll have earned another PhD by the time all this is over!!!!
1--What does k-kal mean?
2--re scales. I have had three baby scales and although Morelli thinks they are another comfy bed for him, Martha won't go near them. The times I've picked her up and put her on, she has flailed so hard with arms and legs you wouldn't believe. When I've tried to weigh myself + her, she wiggles and squirms so hard I can never get an accurate reading.
I don't want you to think that you have to "baby" me. Really, I'm actually a pretty tough lady.
 
1--What does k-kal mean?
Click to expand...

Here's the scientific answer:
http://en.wikipedia.org/wiki/Calorie
But for our purposes, "kcal" and calories (small "c") are one in the same. You're probably referring to the food charts and the "% kcal from carbs" data? That is just the percentage of calories in the food that comes from carbohydrates. And we advise "low-carb" food which would be less than 10% calories from carbs. You mentioned earlier that you are feeding her primarily FF classic canned. If I remember correctly, all of the classics come in at 5% or less for carbs. So unless she is super-sensitive to carbs, any of the classics would be ideal.

Carl
 
kcal = kilocalorie or the amount of energy it takes to raise 1 kilogram of water 1 degree centigrade. That's the technical definition. Carl provided the the practical application.
 
re scales. I have had three baby scales and although Morelli thinks they are another comfy bed for him, Martha won't go near them. The times I've picked her up and put her on, she has flailed so hard with arms and legs you wouldn't believe. When I've tried to weigh myself + her, she wiggles and squirms so hard I can never get an accurate reading.
Click to expand...
Maybe if you put the baby scale in a different location it will work better. I have mine on a table against the wall in my bedroom and it's in a quiet place, and I have no problems with either of my cats. They stand still on it, and of course get praised and petted when done. I'm thinking maybe you could put it next to one of your cat's sleeping places or on the floor in a quiet out of the way area. Just a thought.
 
Super job with the curve today, Hosanna! Nice to see that Martha's cycle is pretty flat. :-D We'd LOVE to have cycles like that. We have a baby scale too. At first I just put a towel on it and it slid around so the kitties didn't like it very much. Then I put some of that rubbery stuff (that you put under rugs to keep them from sliding) under the towel and they don't mind so much. Maybe there is something about the surface that Martha doesn't like?
Liz
 
Angela--that scale looks good. I read through the reviews. Question--are the numbers good and large? I have one baby scale here now that it's almost impossible to read. I might go ahead and order this one.
Finding a place for it will be hard. I don't want Morelli playing on it and he loves to, so need a discreet place. Martha does not like to be picked up.
 
I'm curious. Why did you reduce Martha's dose this evening?

Lantus dosing works best if you keep the AM and PM doses the same. The reason for this is that Lantus is a depot-type of insulin. If you shoot different amounts at each shot time, you will end up with wonky numbers since there will never be a consistent amount in the depot.
 
Hi, Hosanna

Yes, the #s are nice and large on that scale. With regards to a few of my wigglers (Blackie isn't one of them, thank goodness), I put a hand in front of their face to keep them from moving of it. Sometimes, I'll push their butts down gently with 1 hand and place the other in front of their faces. Sometimes it works, sometimes it doesn't. :lol:

That's a very lovely curve you did on Martha today. So far, it looks like Martha's nadir is at +6. You can stagger the tests each day if you want so that you can get a better idea of her #s at different times, too. Be sure to get the before bed test, too. You're doing a wonderful job! :-D
 
Hosanna, I hope you keep the dose the same for a few days...and keep an eye out since those prior larger doses can still effect future numbers, ok? :smile:
 
Great job with the curve. I'd suggest that you pick a dose -- 1.0, 1.25, or 1.5u -- and stick with that dose for a week unless you see Martha's numbers fall below 90. (NB: Hosanna is using SLGS with Martha.) If Martha's numbers drop below 90, then reduce her dose by 0.25u.
 
Starting on 9/2 I did keep the dose at the same 1U for over a week, and saw just about all 200s. That's why I started changing it. I used a smaller dose tonight because her BGs had dropped from this morning and I worry about nighttime dosage perhaps sending her into hypo if it's too large.
 
I went ahead and ordered that scale.
According to that formula, Martha should be getting 254 calories a day. If I'm understanding correctly, that formula is based on what she SHOULD weigh instead of what she DOES weigh?? So I would have to adjust it, which would be fewer calories. How much should a 13 year old Calico weigh? I don't remember seeing anything on that anywhere.
 
Hosanna said:
I went ahead and ordered that scale.
Click to expand...

I think you'll like it. :-D

Hosanna said:
According to that formula, Martha should be getting 254 calories a day. If I'm understanding correctly, that formula is based on what she SHOULD weigh instead of what she DOES weigh?? So I would have to adjust it, which would be fewer calories. How much should a 13 year old Calico weigh? I don't remember seeing anything on that anywhere.
Click to expand...

IF you were to keep Martha at 13 lbs., the formula would look like this:

13.6 x 13 (Martha's weight) + 70 = 246.8 calories/day

If you think she should weigh less than that, say 12 lbs. for example, then the formula will look like this:

13.6 x 12 + 70 = 233.2 calories/day

Depending on the food that you're feeding Martha would depend on the amount of calories per ounce, and how many ounces a day you'd be feeding her to achieve her desired weight, or maintain her current weight. Some female cats are bigger boned than others. Blackie is bigger boned than one of her daughters, and her other daughter is slightly bigger than her sister. Each cat weighs differently. The smaller of the 3 will weigh about 5-6 lbs. at best. Her sister will probably weigh about 9-10 lbs. Their Momma, being Blackie, weighs in at 11.33-11.37 lbs. give or take.

If you take a look at the charts that I've posted in a previous thread on here, they show different body types of cats from emaciated to obese. I think they also give a description of what each stage is.

Hope that helps explain it. If not, feel free to ask more questions. :-D
 
Yes, I did study those charts and appreciate your taking the time to send them. Martha would be considered obese. She has that big tummy--but something strange about her shape---right down low, just above the tail area, it is really small. Can't figure out what this is. I think I will try to get her down to 12 pounds. I hope that will be a correct weight.
 
I've not seen any reference to weight and age. You might ask your vet what s/he thinks Martha's ideal weight would be. Some female cats do have a "pouch" (I have no idea what else to call it) as a result of neutering.

Reducing the dose at night is unlikely to have the result you're looking for. One of the advantages of Lantus is that it's long-acting and there is overlap between doses. Because of it's duration, you can't always assume that a dose change will be seen during the cycle wherein you adjust the dose. If you are concerned about Martha's BG numbers at night, I'd encourage you to get tests during the PM cycle. If numbers are dropping into uncomfortable ranges, you can then bump them up by giving her food that's higher in carbs.

Martha's numbers look great. There's a very good chance she can achieve remission -- if that's your goal. It's not everyone's goal. If it is, you may need to be more aggressive about dose and testing. If your goal is regulation, you're doing a very good job already. You will want to keep Martha's numbers below renal threshold (approximately low 200s) and you will not need to be as rigorous with your testing.
 
The pouch that Sienne's referring to is lovingly called the doolap (I think that's how you spell it). Blackie has one, all of my cats have one, even I have one. :lol:

One other thing, with each day, we start a new thread called a "condo" and we typically title it as such: 09/17 Blackie AMPS # (whatever the # would be for the day before the shot, and food). This way, the experts can quickly find your condo, and give you advice, and comment on how everything looks. Plus, you'll need to input the thread from the previous day by clicking on the link at the top, and then insert at each end, like this:

your previous link goes here

This is another way that the experts can quickly refer to the day previous if they need to. Hope that helps. If you have any questions, don't hesitate to ask. :-D

You ARE doing an awesome job. It gets easier as time goes on, and Martha will take it in stride as part of a daily routine. :-D
 
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