One step forward and two steps back

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Essex

Essex

Member Since 2020
Soon-to-be-16-yr-old cat, diagnosed 3 months ago. Started on 2 units of Lantus, with no change in diet - wet gravy-based food (avg 14-18% carbs) plus dry food (41% carbs!!!). Stable on 2 units, so reduced insulin to 1 unit. Stable on 1 unit so we decided it was time to change to a lower-carb diet.

Introduced vet-prescribed Purina Pro-Plan DM - morsels in gravy (10% carbs) 1/2 large can twice a day, and dry food (18% carbs) 1/4 cup/day. All was well for 2 weeks. So we reduced insulin to 1/2 unit insulin...and then she refused to eat the wet food.

So I decided this was a good opportunity to switch to a pate-only diet. I bought several different kinds - they ranged from a low of 1% carb to a high of 4%. She's been on pate-only for 4 days now (still on 1/2 unit insulin) and now her BG is all over the place. From a high of 20 AMPS, to a low of 8 mid-day, to a PMPS of 13.2). This morning AMPS she was 19.2, so I increased her insulin to 1 unit. I can't test BG again until PMPS as I'm back at work now.

I am so discouraged as I was hoping to see a more encouraging reading after switching to the low-carb diet. I should add that she kind of self-weaned off the dry food, so I know its not that.

Any advice on what might be going on? From now until Friday I can only test her BG AMPS and PMPS as I'm at work all week. Should I base her insulin on these readings, or should she stay at a consistent 1/2 unit or 1 unit all week? I will be doing a curve on Saturday.
 
Hi @Essex

How often are you testing blood glucose usually...?
If the numbers have become more erratic after switching to the lower carb food (but the dose has remained stable at 0.5 of a unit) then I'm 'wondering' if your kitty's blood glucose is dropping too low after the diet change and is triggering some 'bouncing' (rebound)... Bouncing happens when the blood glucose drops too low and/or too fast, and the body is triggered to release stored glycogen to raise the blood glucose level.
...When the bounce wears off the body becomes responsive to insulin again. 'Bounce clearing' cycles can sometimes be very 'active' and drop the blood glucose faster than might otherwise be the case. And it can happen that the sheer speed of that drop can trigger yet another bounce...

BTW, Lantus dosing should be based around the 'lowest' number of the cycle, not the preshot numbers...
Also be aware that changing the Lantus dose, can, in itself, result in temporarily wonky numbers. There is even a name here for this phenomenon - New Dose Wonkiness (NDW)! So it can take a number of days to see the full effect of a dose change.

I don't use Lantus (but I'm sure other Lantus users will chime in soon). However, given the eratic numbers since the food change I'd suggest going back to 0.5 of a unit (or even less, let's see what experienced Lantus users say) until you've had time to do a curve and get some more data. ...Any chance you can get a 'before bed' test in the evenings..? That can often give some indication of how the cycle is likely to go...

And is there any chance you can set up one of our spreadsheets and put your recent blood test data on there...? Seeing that will make it much easier for people to help you. The link to SS instructions is here. And do shout out if you need help. There are some smart techy people who can help if necessary (sadly, I'm not one of them, haha!)
http://www.felinediabetes.com/FDMB/threads/fdmb-spreadsheet-instructions.130337/


Welcome to the forum! :cat:

Eliz

PS. Tagging a couple of experienced members who may be able to help: @Bron and Sheba (GA) , @Deb & Wink
 
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Thank you so much, E&B. I'm so glad you told me the dosage should be based on the lowest number in the cycle - I had always thought it was based on the pre-shot number!

I am comforted to learn that what she may be experiencing is a bounce, as I can't think of any other reason for the higher numbers. What constitutes a bounce? A couple of days? And is it something I just need to wait out?

I'm very comfortable with doing BG testing, however, because I work full-time, the most I can manage through the week is AM and PM pre-shot plus before bed. I test more often on weekends because I'm home more.

As far as a spreadsheet, I tend to find it all too overwhelming. Instead, I keep track manually, in a paper file.
 
I would also like opinions on how much wet food she should be eating based on her weight. She is about 12 lbs now - down from 16 last summer. Her weight has been stable since early January.
 
Elizabeth has given you some very good advice. Without more data to go on, it does sound like bounce. And Elizabeth is absolutely right. Change dose based on the low readings rather than pre-shot test. That way you aren't changing based on bounce readings, and it's easier to avoid dangerous hypo events.

Until kitties are regulated, they don't utilize their food very well. So, some of those calories are going straight into the litter box. Many members don't limit food at all until their kitty is regulated. Diabetic cats can often eat twice the food of a non-diabetic cat and not gain weight. Do you feed 2 big meals, or many small ones? Many small meals can help regulate a cats BGL, and it's safer to leave food out of use a timed feeder when you are away from home for work. A cat will naturally eat if it's BGL drops too low.

It's fine for you to keep a paper file for your own use. The thing about the spreadsheet is that it helps use give you better advice. Members are going to wary of advising a cat without a spreadsheet and signature, because no one wants to give the wrong advice at the wrong time. It's dangerous. The spreadsheet is quite easy, if you decide to give it a try. There's a template already set up. All you do is use some instructions to make a copy of the template for your cat's use, then you just click a box and add in numbers. I'm 54 years old and completely useless at these things, but even I could do it!

Having basic information in your signature also helps us give you good advice. Look at my signature. So easy to get advice when a member can see what kind of meter I'm using for Billy and what type of insulin and diet he is on.

If you want to give it a try, there's simple instructions here: New? How you can help us help you! There's even members who can set the spreadsheet up for you if you have trouble. Just give a shout out.

The reason I'm so "Go spreadsheet!" about it is that having a spreadsheet and signature set up saved my Billy's life on day five of his treatment. Having that information easily at hand let members advise me when Billy had a hypo event. I got good detailed advice about how to get his numbers back up, and when and how to reduce his dose. Now, instead of losing him early in his treatment, my Billy is in remission and doing great. The members here are awesome and more than willing to help if they have enough information to go on.
 
Essex said:
Thank you so much, E&B. I'm so glad you told me the dosage should be based on the lowest number in the cycle - I had always thought it was based on the pre-shot number!

I am comforted to learn that what she may be experiencing is a bounce, as I can't think of any other reason for the higher numbers. What constitutes a bounce? A couple of days? And is it something I just need to wait out?

I'm very comfortable with doing BG testing, however, because I work full-time, the most I can manage through the week is AM and PM pre-shot plus before bed. I test more often on weekends because I'm home more.

As far as a spreadsheet, I tend to find it all too overwhelming. Instead, I keep track manually, in a paper file.
Click to expand...
Hi the reason we would like you to set up a spreadsheet is because that is the only way we can help you with dosing seeing how the insulin is working,
We realize you can only test am and pm is because you are at work
At night maybe you can get some test in then so we can see what's going on.
God forbid your kitty dropped so low , that can be very dangerous.He could have a hypo event
Maybe you can test @+3 that is three hours after you give the insulin, then maybe @+6 that's six hours after giving the insulin. Then you can fill in the next day maybe @+4 , @+8 . Having it written down on a paper we cannot give advice if it's not on the spreadsheet. If you can't set it up we have members here that will do it for you and we can explain how to use it. Also it would be helpful to set up your signature, you can take a look at any of ours to see what information we need
 
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Thank you, J&B. I will take a look at the sample spreadsheets and see if its something I can get my head around. I really do understand that the advice you can give is only as good as the information I'm providing you.

As for meals, I can only feed am and pm because I work full time (which is also the reason I still offer dry food). Also, I have 2 cats, 1 whom will not have anything to do with pate (even when I add beef or chicken broth to it). So timed feeders are out of the question. I could start giving them larger meals, and/or add a meal before bed time if that will help.

I will add more info to my signature, as you suggested. :)
 
Signature yeah!! Hope that was easy enough for you to do.

Do you want me to contact @Chris & China (GA) for you about setting up a spreadsheet? She does them all the time.

You do need a google email account first.
Do you use your pc, tablet or a smartphone to access this message board?
 
I would very much appreciate the help! I will send you a message with my gmail address which you can forward to Chris & China. I use my desktop when I'm at work (easiest) and smartphone all other times (not as easy). :)
 
I've sent a PM to Chris and China and put your name on the PM also.
I don't think that a PM can be forwarded.

Promise to ignore any and all private info in the PM.
 
I HAVE A SPREADSHEET! That's worth yelling about, dont you think? So grateful to Chris&China for setting me up!

I filled in what few numbers I have for the last few days, since i switched her to a low carb wet food. I hope i did it correctly.

Now for the bad news. Her PMPS tonight was 26.1. I gave her 1/2 unit.

Advice is welcome.

When I get a chance I will fill in more numbers from the past, when she was on a higher carb diet.
 
Essex said:
I HAVE A SPREADSHEET! That's worth yelling about, dont you think? So grateful to Chris&China for setting me up!
Click to expand...
Definitely something to "crow about."
Essex said:
Now for the bad news. Her PMPS tonight was 26.1. I gave her 1/2 unit
Click to expand...
:(

Not the best BG reading possible. But it is what it is.
Did you skip the insulin shot on 3/1/20 PM cycle?
If you did, please put 0 (zero) in the U (units) column.

Now it's important to get some test data, to fill out some of the middle of the spreadsheet (SS). Those times between +1 and +11 will tell us how Smudge is doing on this insulin dose.
The dosing protocols we use here all require those mid-cycle numbers in order to adjust the insulin dose.

So tell me, when works for you? To do a bit more testing? You had said you work during the week,but can test more at night on on the weekend.

A test before you go to sleep every night is a good idea. Or if you get up in the middle of the night to pee, that is another opportunity for a test. We get creative here on the testing and when.

Maybe you could test when you got home for work? Or before you go to work?
 
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You had asked earlier about how much food you should be feeding Smudge. Before we can answer that question properly, we need to know some "stuff."

Is 12 pounds a good weight for Smudge? Does your vet consider Smudge underweight, overweight or just right?
(Like goldilocks and the 3 bears)

Essex said:
I would also like opinions on how much wet food she should be eating based on her weight. She is about 12 lbs now - down from 16 last summer. Her weight has been stable since early January.
Click to expand...
Is Smudge still holding steady on her weight? Do you weigh her at home? If you are like many women, we keep a human scale in our home. Hold Smudge in your arms, check weight, then let her down and note your weight. subtract first number from the second to guesstimate Smudges weight.
 
I added in the missing shot info. As for additional BG testing, I can do AMPS, PMPS and bedtime, around +3.5 or +4. On weekends I can do a lot more.

12 lbs is a good weight for her. She was quite overweight at 16 lbs, but then she lost 4 lbs quite suddenly over 2 months, which is what twigged my vet to check her for diabetes. We would like to keep her at this weight. I haven't weighed her for several weeks so I will get on that.
 
Hello from the wet coast of B.C.:)

Is it possible for you to put in a week or so date prior to what you have in the spreadsheet? Even if you don't have test data, it helps us to see the history of doses. Lantus is a depot insulin, and that depot can influence cycles after you reduce the dose.

Good to see you back at 0.5 units tonight. Once we have a bit more data we can figure out where to go next with the dose. Those before bed tests will be very important to see how Smudge is doing and give us an idea what those low points look like on this dose.
 
I've put in more data.

Although I didnt add it all to the spreadsheet, I have daily data from Dec 22, the first day she started on insulin, to Dec 30 while I was off work for the Christmas holidays. But my vet had told me to dose her according to her pre-shot numbers, so every day she was fluctuating between 1 unit and 2 units. I can add that if you think it will be helpful.

It gets spotty after Dec 30 as I was back at work.
 
So after Dec 30th, Smudge was not getting insulin?
Or only getting insulin on certain days?
Or not being BG tested?

For example, You have a row of data for 1/26/20
The next row on the SS is for 2/09/20.

What happened in between those 2 dates?
Was there no insulin being given during that time? From 1/27 to 2/8?
Or maybe you were not testing during that time.
 
She has been on twice daily insulin since Dec 22 2019, never missed a shot.
On Dec she went down to 1 unit and stayed there until January 26 2020, when we reduced her dose to 1/2 unit.

Testing was sporadic, with curves being done roughly every 2 weeks as directed by my vet.

I'm sorry my information has big gaps. Between trying to follow my vet's advice on frequency of testing, dosing, to trying not to change too much at once, to trying to bring her numbers down through diet, the spreadsheet looks terrible. It's all been very overwhelming and I'm about ready for tears.
 
No apologies needed.
Looks almost as complicated as doing income taxes, or filling our census forms.
No tears needed,simply some sleep. Time to head off to rest and hopefully that will refresh you a bit.

There are some very nice lower green and blue range numbers on the SS. That's encouraging.
We're going to let this dose of 0.5U settle in and see how well Smudge can do on it. The hardest part is trying to be patient over the next 4-6 cycles.
 
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She is 27.1 this morning! I cant figure out what's going on! She seems fine other than shes grumpier than normal. She slept quietly all night, her appetite is good, peeing is the same.

The ONLY thing I can think of is her Lantus was getting old. So I put a new cartridge in last night and she had that for this morning's shot.

I called on sick to work so I could stay home and test every 2 hours. Just have to get more test strips from the vet this morning.

Stay tuned! I'm grateful to those of you who are coaching me through all of this. I have so much to learn from all of you.
 
Hold steady on this dose for at least 6 cycles (unless Smudge drops <50).
The bounces can take time to clear.

It's also important to test for ketones daily.
We've had too many DKA cases lately, so please test and make a note of it on the SS in the Remarks column.

Feeding at +6 will cause the BG's to rise faster, since the insulin is basically used up by then.
Could you feed earlier? We know that cats get fed during the cycle, so will expect to see a bit of a rise in the BG numbers with those later feedings.

But changing the timing of the feedings can help level out the BG readings.
Many people using lantus feed a small meal at +1 and or +2.
 
I'm confused about optimal feeding. She has always been fed 1/2 small can AM and PM, and then allowed to eat free choice dry (1/2 cup per day between my 2 cats, but my non diabetic cat eats the lions share of it). Smudge has completely gone off the dry food, as of almost a week ago, and I dont feel like 1 small can a day is enough food for a 12 to 13 lb cat. I read where small meals more frequently is the way to go, so I was planning to add a mid day meal. I can ask a family member to feed the noon meal, but I cant ask them to feed more frequently than that. And I dont want to introduce something I can't keep up because of working full time.
 
Gotcha on the feeding and when you can do that or have another family member help out.

No 1 small can a food a day is not enough. Especially if it is one of those 3 ounce cans. Diabetic cats need more food than that.

12-13 pound cat at their ideal weight needs 15-20 calories per pound.
I'd at least double Smudge's food portions.

Ketones develop when a cat is not eating enough food, is not getting enough insulin, and has an infection/inflammation somewhere in the body. Like bad teeth or pancreatitis.

Ketones form when the food intake is not enough, and the cats body cannibalizes fat and muscle to provide needed energy to the cats body. Ketones are a byproduct of that cannibalization of tissue, and can build up to toxic levels in a cat and make them really, really sick. Can kill them in fact if not treated, and treated quickly.

You can get ketone urine test strips at your local pharmacy/drugstore/chemist. Look in the section where human diabetic supplies are located. People on the keto diet use them to test their urine. You need to get a fresh urine sample to test.

There are also blood and ketone meters that can test for ketones also with special strips. Not all blood glucose meters can test for both.

Urine Catching Tips
 
So will it be okay today to feed her at noon even though I'm testing every 2 hrs?

I'll read up on the ketone testing.
 
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