? Regs, Is Lantus really not working? Vet suggests ProZinc instead

[Britta and Regs]

I’m so sorry for having so many questions at the moment, but Regs (and in this case his vet ) are driving me a little nuts.

I talked to my vet about Regs’ BG and neuropathy, and she feels that Lantus isn’t working for him and wants to switch him to ProZinc. I really like and trust my vet, but I’m not sure I agree with her on this. His numbers are definitely still very bouncy, but I know bouncing can be part of the regulation process, especially while a cat is getting used to lower numbers.

I’ve also always understood Lantus as well as ProZinc are the gold-standards in insulins for cats, but I’m hesitant to give up on Lantus too soon. She even mentioned Vetsulin again, which I personally feel is a hard no for Regs since he was on it before.

My vet also mentioned that she thinks Regs may have another condition, such as Cushing’s, contributing to his numbers. This was brought up without any testing yet, so I’m honestly not sure what to think. She would like to refer us to an animal hospital here in Orlando for further testing, but appointments are months out and I’m not convinced yet that this is where the problem lies. Of course Regs will get any testing, treatment or support he needs, I just don’t want to put him through unnecessary testing if what we’re seeing could still be part of the normal regulation process.
My guess is she just does not have enough experience with diabetes (what I can't blame her, Vets need to know so much already) and thats why I am asking here.

I would really appreciate some experienced eyes on his spreadsheet. Does Regs actually look unusually difficult to regulate, or does this still look like part of the process with Lantus and bouncing? Would you switch to ProZinc or give Lantus more time?

His neuropathy makes me want to get his BG under better control, but I also don’t want that worry to make me change course too quickly, especially because I do feel like we’re seeing progress with Lantus despite the bounces.

 

[CORKY]

First question, what are you feeding? ProZinc is an excellent insulin for cats, it is also a 12-hour insulin and gentle on the cat, I also use ProZinc. Vetsulin /Canninsulin is a dog insulin, and it hits the cat hard and fast, so that insulin is out of the question, has your vet or you tested for Ketones? Ketones also keep the BG very high; food helps lower ketone.
in regards to diet a diabetic cat needs to have a diet of wet can or raw food between 0-10% carbs, a feeding schedule is recommended to keep the insulin in check, a feeding schedule is also recommended, feeding 3--4 small meals or snacks during the day; no feeding 2 hours before shot. with ProZinc it takes about 2 cycles (2days) for the dose given to see results in the BG. so is important to keep the same dose, unless is necessary to increase or decrease, unlike Lantus, that is a depot style insulin, but it basically means some of it goes into the blood stream and some is stored and slowly released over time. It can take 6 cycles to build up the depot so you can see what the dose can do.

 

[Connie & Parker & Moonie]

Sorry if I missed the context, Britta - but have you ever considered going to TR with Regs? You definitely test more than enough for it and Regs is on an LC wet diet right? I know SLGS has worked well for a lot of members here, but I imagine TR will deliver faster results given that it's a more aggressive protocol where you can increase his dose more quickly.

 

[Britta and Regs]

First question, what are you feeding? ProZinc is an excellent insulin for cats, it is also a 12-hour insulin and gentle on the cat, I also use ProZinc. Vetsulin /Canninsulin is a dog insulin, and it hits the cat hard and fast, so that insulin is out of the question, has your vet or you tested for Ketones? Ketones also keep the BG very high; food helps lower ketone.
in regards to diet a diabetic cat needs to have a diet of wet can or raw food between 0-10% carbs, a feeding schedule is recommended to keep the insulin in check, a feeding schedule is also recommended, feeding 3--4 small meals or snacks during the day; no feeding 2 hours before shot. with ProZinc it takes about 2 cycles (2days) for the dose given to see results in the BG. so is important to keep the same dose, unless is necessary to increase or decrease, unlike Lantus, that is a depot style insulin, but it basically means some of it goes into the blood stream and some is stored and slowly released over time. It can take 6 cycles to build up the depot so you can see what the dose can do.

Hey Maria, thanks so much for your answer! Regs is only getting wet food, fancy feast pate, chunked und flaked, all three are low carb and he is getting Sheba perfect portion pate, also low carb. The only time he is getting MC/HC is when he is dropping too low or too fast and I catch that.
He is getting a big breakfast and dinner and a small lunch and night snack, the night snack just recently because he tends to drop at night @+8/9 etc.
I stay within his food free 2 hours before testing, in very rare cases he steals some treats when he is breaking in the food part of his Furbo. Oh wait, I think. the temptation treats in the Furbo are not low carb.

The only thing I'm unsure about the carbs are the chicken Churu that I need to give him the insulin, will check that though.

Regs had ketones at diagnosis, that's why the vet did not want to try the diabetes pill. But ever since I test the urine for ketones, most times once per day, sometimes twice when the glucose is high and he goes in the box and I can catch it. I asked the vet and she said as long as the urine is negative there would be no reason to test the blood, not sure if thats true.

I'm not completely against ProZinc, I heard very good things about it, I just think our vet wants to change him because she doesn't know anything about bounces and how to regulate a cat. As I said they need to know a lot of different stuff and diabetes is so complex. When you say you need to know after two days if the result is there does that mean you only give it once a day? I like if you could see the result sooner than with Lantus.

 

[Britta and Regs]

Sorry if I missed the context, Britta - but have you ever considered going to TR with Regs? You definitely test more than enough for it and Regs is on an LC wet diet right? I know SLGS has worked well for a lot of members here, but I imagine TR will deliver faster results given that it's a more aggressive protocol where you can increase his dose more quickly.

Hey Connie, Thanks for the question. I was asked a couple times here if I would consider it and I always said no, I'm too afraid that Regs would drop too low,
But now since his neuropathy is progressing (even I think after the move to the new room I just have more camera angle on him and see it more) I just started thinking about that.
I need to read the information about TR because I don't know anything about it. Not even how many times I would have to measure. If I start that I could absolutely not tell our vet, she said TR is not working with Lantus what is the complete opposite from what I'm reading here. I do feed LC unless he is very low and I get nervous, and sometimes he gets a Temptation treat, I guess we would have to cut those out and find LC treats

 

[Connie & Parker & Moonie]

Hey Connie, Thanks for the question. I was asked a couple times here if I would consider it and I always said no, I'm too afraid that Regs would drop too low,
But now since his neuropathy is progressing (even I think after the move to the new room I just have more camera angle on him and see it more) I just started thinking about that.
I need to read the information about TR because I don't know anything about it. Not even how many times I would have to measure. If I start that I could absolutely not tell our vet, she said TR is not working with Lantus what is the complete opposite from what I'm reading here. I do feed LC unless he is very low and I get nervous, and sometimes he gets a Temptation treat, I guess we would have to cut those out and find LC treats

You've probably already seen this but resending in case helpful - TIGHT REGULATION PROTOCOL (TR)

For whatever it's worth, we follow TR and it's been amazing for us. You can literally see the impact on our SS - Moonie was poorly regulated when we got her, made a ton of progress within 4-5 weeks as we followed TR, and then had a period of poor numbers as soon as we started slacking on the TR protocol. And since we've been back from vacation, we've been really strict following TR and I think we're seeing much better results.

I think what really helped me get over my nervousness was 1) testing Moonie's carb sensitivity - Regs seems quite sensitive (just based on what I've seen) which is great because you can have a lot of confidence that you can bring him up quickly if needed and 2) getting practice shooting lower and lower preshots and seeing that lower preshots often meant flat cycles (which is way less stressful than the big jumps I'd see when I was shooting only pinks and yellows)

 

[Connie & Parker & Moonie]

Hey Maria, thanks so much for your answer! Regs is only getting wet food, fancy feast pate, chunked und flaked, all three are low carb and he is getting Sheba perfect portion pate, also low carb. The only time he is getting MC/HC is when he is dropping too low or too fast and I catch that.
He is getting a big breakfast and dinner and a small lunch and night snack, the night snack just recently because he tends to drop at night @+8/9 etc.
I stay within his food free 2 hours before testing, in very rare cases he steals some treats when he is breaking in the food part of his Furbo. Oh wait, I think. the temptation treats in the Furbo are not low carb.

The only thing I'm unsure about the carbs are the chicken Churu that I need to give him the insulin, will check that though.

Regs had ketones at diagnosis, that's why the vet did not want to try the diabetes pill. But ever since I test the urine for ketones, most times once per day, sometimes twice when the glucose is high and he goes in the box and I can catch it. I asked the vet and she said as long as the urine is negative there would be no reason to test the blood, not sure if thats true.

I'm not completely against ProZinc, I heard very good things about it, I just think our vet wants to change him because she doesn't know anything about bounces and how to regulate a cat. As I said they need to know a lot of different stuff and diabetes is so complex. When you say you need to know after two days if the result is there does that mean you only give it once a day? I like if you could see the result sooner than with Lantus.

The churu is fine btw as a testing treat - I think it's 2-3% carbs on an as fed basis.

 

[Britta and Regs]

The churu is fine btw as a testing treat - I think it's 2-3% carbs on an as fed basis.

That’s so good to know, Regs loves his liquid treats and I always love to make him happy

 

[Britta and Regs]

You've probably already seen this but resending in case helpful - TIGHT REGULATION PROTOCOL (TR)

For whatever it's worth, we follow TR and it's been amazing for us. You can literally see the impact on our SS - Moonie was poorly regulated when we got her, made a ton of progress within 4-5 weeks as we followed TR, and then had a period of poor numbers as soon as we started slacking on the TR protocol. And since we've been back from vacation, we've been really strict following TR and I think we're seeing much better results.

I think what really helped me get over my nervousness was 1) testing Moonie's carb sensitivity - Regs seems quite sensitive (just based on what I've seen) which is great because you can have a lot of confidence that you can bring him up quickly if needed and 2) getting practice shooting lower and lower preshots and seeing that lower preshots often meant flat cycles (which is way less stressful than the big jumps I'd see when I was shooting only pinks and yellows)

In your SS it really seems that you got Moonies glucose under control very fast, but I did not see anything before so I don’t know how long you tried. But that’s impressive

TR sounds super complicated. I see how many people do it and everyone seems to love it and get amazing results,
It says you should measure +3 +6 and +9, how do you do that during the day when you are at work or at night? And Moonie sometimes bounces too, how do you handle bounces and bounce breaking with TR? If she goes low you need to give her more carbs, or not? And sometimes bounces stay for 6 cycles, would you officially not increase the dose after 6 cycles already? Need to read more…

I think Regs is sensitive to carbs and the point is he loves them (who does not? ) , so I assume he would eat them even if he would not be feeling well if he is low.

At the moment every green number is still so scary and even the blues make me nervous. Regs is always happy and active in blue but they freak me out. Like on Sunday when he dropped from 240 to 109 in short time, really scared me but after that he is mostly in the 300 what on the other side breaks my heart too.

 

[Sara & Khloe]

Hey Britta, I just wanted to chime in and mention that we follow TR too. I believe we compared Khloe & Reg’s when you first joined, ECID but I would say his numbers look fairly similar to Khloe’s in the beginning if you wanted to check out Khloe’s SS. I’ll admit, I was terrified of TR at the start but it has been amazing for Khloe. It did take a ton of time to figure out exactly how Khloe reacted (onset, nadir) to find the best times to test her in particular, it’s definitely a Know thy cat thing but now it’s just part of the daily routine. But I get where you’re coming from, blues were scary and greens were nerve wracking for the first few weeks for us too.
I hope you can reverse Reg’s neuropathy soon

 

[Connie & Parker & Moonie]

In your SS it really seems that you got Moonies glucose under control very fast, but I did not see anything before so I don’t know how long you tried. But that’s impressive

TR sounds super complicated. I see how many people do it and everyone seems to love it and get amazing results,
It says you should measure +3 +6 and +9, how do you do that during the day when you are at work or at night? And Moonie sometimes bounces too, how do you handle bounces and bounce breaking with TR? If she goes low you need to give her more carbs, or not? And sometimes bounces stay for 6 cycles, would you officially not increase the dose after 6 cycles already? Need to read more…

I think Regs is sensitive to carbs and the point is he loves them (who does not? ) , so I assume he would eat them even if he would not be feeling well if he is low.

At the moment every green number is still so scary and even the blues make me nervous. Regs is always happy and active in blue but they freak me out. Like on Sunday when he dropped from 240 to 109 in short time, really scared me but after that he is mostly in the 300 what on the other side breaks my heart too.

I know exactly what you mean - in the beginning, I always felt bad. I felt bad when Moonie's numbers were too high. I felt scared when they were too low. I think over time you'll get used to seeing blues and greens and desperately want to see more . I think in part, it's just time and repeated exposure - seeing is believing, and seeing Regs flourish at lower and lower numbers will help you really feel that it's not only safe but deeply desirable. For a long time, I knew intellectually that 50-120 was a normal BG for cats, but I was still anxious about seeing lower numbers.

The first time I saw a number under 100, I freaked out and gave Moonie a huge amount of Fancy Feast gravy. But seeing that it took Moonie from 96 to 142 in 15 minutes made me realize that I could bring her up very quickly, so next time, I gave her some LC food and tested in an hour when I saw a number in the 90s. Then as I started seeing her in the 90s I realized she started peeing a normal amount like my other cats in a normal stance. (She used to have a lot of accidents in the beginning and her muscle strength was not as good so she'd pee in weird positions). And when she was in the 90s, I noticed she'd play and jump around a lot more. Instead of sleeping all the time, she'd go out to the backyard with the other cats to "hunt for birds." That gave me the courage to see her in the 80s, where I noticed that she was also doing great. So on and so forth. I also realized that her cycles were much flatter with blue/green preshots, so they ended up being way less stressful.

During this process, when I was scared of the lower numbers - I often asked myself if the decision I was making was for me or for Moonie. Once I had enough data on Moonie, knew how she responded to carbs, and knew I could monitor the cycle, I started asking myself whether I was making a conservative choice because Moonie actually needed it or because the number scared me. If I wanted to get Moonie in normal numbers, I couldn't be scared to see those normal numbers you know?

I got Moonie in January this year. She was an unregulated diabetic for a year before I met her, and I didn't start following TR until the spreadsheet starts in late May. Before I was uneducated about feline diabetes and doing a lot of things that I cringe to think back on now like changing doses on preshots and testing inconsistently. So I struggled to get her regulated for 5 months, but we saw great progress as soon as we got serious about TR.

You already test more than enough for TR - the minimal testing requirement for TR is 4 tests a day. AM preshot, a test after (usually +2), PM preshot, and a test after (usually +2). Parker and I both work full-time, so we do our shot at 6am and we do her +2 at 8am before we head out for work. Fortunately, Moonie's am cycles are almost never active (20% drop or less). Then we test her at 6pm when we get home, and that gives us a lot of time to test before bed since her pm cycles are the active ones. Since Moonie drops early, I always do a +2, and if that drop is more than 50 points and/or >25%, I try to get another test in an hour. If she ever gets very close to or under 50 (this number used to be much higher like 70 but this is where we're comfortable now), I give her a tsp or two of HC, test again in 30-60 mins, and then do a final test 2 hours after (when the HC should be out of her system). Handling bounce breaks isn't any different on TR vs SLGS - most people try to figure out when their cat is most likely to break a bounce (for us, it's after repeated flat yellows and blues and almost always happens suddenly after +10) and adapt their feeding plan to pre-emptively feed before a steep drop may occur (which is why we usually do a small snack at +6 and +8 or +9 even though I know feeding after +6 cuts insulin duration).

All of this btw is based on Moonie's cycles (not generalizable to all cats) - so it may be worth having Wendy or Marje or someone experienced take a look at Regs' SS to help you figure out the right testing cadence and strategy based on Regs' cycles and your life / schedule.

In terms of increasing doses on TR, the general advice I got was (based on nadirs):

• High Blue (or higher) - Consider increase in 6 cycles
• Low/Mid Blue - Consider increase in 8-10 cycles
• Dark Green - Hold for 10 cycles
• Lime Green - Reduce 0.25 immediately

But you can always ask for feeding and dosing advice, so you don't have to figure it out all yet. In the beginning, I asked for dosing advice ALL THE TIME and regularly asked if I should be feeding LC/MC/HC multiple times a night.

 

[CORKY]

The possibility for the high BG's is definitely the gravies, when Reg has low BG, giving the gravies will make him bounce, he could be very sensitive to carbs, the best way to handle low BGs is to give 1/2tsp of low carbs, test about 1/2-1 hour after, and repeat process until he is in safe numbers, if after about 3 tests and low BG's then proceed to medium carbs, and repeat the process, We leave the high carbs honey or Karo syrup for a quick fix, to raise the BG if is 60 or less since you are using Lantus, for now, remember that a non-diabetic cats' glucose level is between 50-120 , if you give too much carb you will have a bounce. with ProZinc which is what Corky uses, I shoot in low numbers, it takes a lot of practice to achieve, but if he is in the 70's before shot, I stall the shot for 1/2 hour, food raises the BG so I re test and is safe to shoot, with ProZinc you can stall the shot up to two hours, making sure you adjust the next shot to same time, normally cats have a lower BG during the night, I have read that there's no explanation to that, I feed Corky's last meal at +4 (10:00PM), and is bed time.
The Temtation treats are extremely high carbs.
When you answered my post I remembered you had previous posts.

 

[CORKY]

I know exactly what you mean - in the beginning, I always felt bad. I felt bad when Moonie's numbers were too high. I felt scared when they were too low. I think over time you'll get used to seeing blues and greens and desperately want to see more . I think in part, it's just time and repeated exposure - seeing is believing, and seeing Regs flourish at lower and lower numbers will help you really feel that it's not only safe but deeply desirable. For a long time, I knew intellectually that 50-120 was a normal BG for cats, but I was still anxious about seeing lower numbers.

The first time I saw a number under 100, I freaked out and gave Moonie a huge amount of Fancy Feast gravy. But seeing that it took Moonie from 96 to 142 in 15 minutes made me realize that I could bring her up very quickly, so next time, I gave her some LC food and tested in an hour when I saw a number in the 90s. Then as I started seeing her in the 90s I realized she started peeing a normal amount like my other cats in a normal stance. (She used to have a lot of accidents in the beginning and her muscle strength was not as good so she'd pee in weird positions). And when she was in the 90s, I noticed she'd play and jump around a lot more. Instead of sleeping all the time, she'd go out to the backyard with the other cats to "hunt for birds." That gave me the courage to see her in the 80s, where I noticed that she was also doing great. So on and so forth. I also realized that her cycles were much flatter with blue/green preshots, so they ended up being way less stressful.

During this process, when I was scared of the lower numbers - I often asked myself if the decision I was making was for me or for Moonie. Because if I was prepared with high carb food and could monitor the cycle, not shooting a lower preshot in the blues or high greens was almost always a decision for myself, because it was less scary that way, but not actually the right decision for Moonie. If I wanted to get Moonie in normal numbers, I couldn't be scared to see those normal numbers you know?

I got Moonie in January this year. She was an unregulated diabetic for a year before I met her, and I didn't start following TR until the spreadsheet starts in late May. Before I'm ashamed to say I was uneducated about feline diabetes and doing a lot of things that I cringe to think back on now like changing doses on preshots and testing inconsistently. So I struggled to get her regulated for 5 months, but we saw great progress as soon as we got serious about TR.

You already test more than enough for TR - the minimal testing requirement for TR is 4 tests a day. AM preshot, a test after (usually +2), PM preshot, and a test after (usually +2). Parker and I both work full-time, so we do our shot at 6am and we do her +2 at 8am before we head out for work. Fortunately, Moonie's am cycles are almost never active (20% drop or less). Then we test her at 6pm when we get home, and that gives us a lot of time to test before bed since her pm cycles are the active ones. Since Moonie drops early, I always do a +2, and if that drop is more than 50 points and/or >25%, I try to get another test in an hour. If she ever gets very close to or under 50 (this number used to be much higher like 70 but this is where we're comfortable now), I give her a tsp or two of HC, test again in 30-60 mins, and then do a final test 2 hours after (when the HC should be out of her system). Handling bounce breaks isn't any different on TR vs SLGS - most people try to figure out when their cat is most likely to break a bounce (for us, it's after repeated flat yellows and blues and almost always happens suddenly after +10) and adapt their feeding plan to pre-emptively feed before a steep drop may occur (which is why we usually do a small snack at +6 and +8 or +9 even though I know feeding after +6 cuts insulin duration).

All of this btw is based on Moonie's cycles (not generalizable to all cats) - so it may be worth having Wendy or Marje or someone experienced take a look at Regs' SS to help you figure out the right testing cadence and strategy based on Regs' cycles and your life / schedule.

In terms of increasing doses on TR, the general advice I got was (based on nadirs):

• High Blue (or higher) - Consider increase in 6 cycles
• Low/Mid Blue - Consider increase in 8-10 cycles
• Dark Green - Hold for 10 cycles
• Lime Green - Reduce 0.25 immediately

But you can always ask for feeding and dosing advice, so youYou are so right I used to freak out if Corky was don't have to figure it out all yet. In the beginning, I asked for dosing advice ALL THE TIME and regularly asked if I should be feeding LC/MC/HC multiple times a night.

You are so right! I used to freak out at first if Corky's numbers before shot was 150, I would bombard this Forum till I was answered, now I shoot even in high 70's, and if Corky has a day with more than 4 blues, in one cycle, I start to worry.
I love to look at his SS Last year Suzanne and Darcy, awarded me with the Trophy "BALLS OF STEEL" I thought it has hilarious, she said I earned it for low shooting. Once you start to see those blues and greens you will feel great, this means Reg's pancreas are healing

 

[Britta and Regs]

Hey Britta, I just wanted to chime in and mention that we follow TR too. I believe we compared Khloe & Reg’s when you first joined, ECID but I would say his numbers look fairly similar to Khloe’s in the beginning if you wanted to check out Khloe’s SS. I’ll admit, I was terrified of TR at the start but it has been amazing for Khloe. It did take a ton of time to figure out exactly how Khloe reacted (onset, nadir) to find the best times to test her in particular, it’s definitely a Know thy cat thing but now it’s just part of the daily routine. But I get where you’re coming from, blues were scary and greens were nerve wracking for the first few weeks for us too.
I hope you can reverse Reg’s neuropathy soon

Hey Sara, yes I remember I just looked at your Spreadsheet. It is impressive how you got Khloe's sugars under control in only one month! How did you get over the fear minus that you did a lot of research about Khloe's sugar behavior? As soon as I even see Regs in the low yellows at night I get nervous, if he would give me a blue come with food etc. With Regs it's just so weird, almost all the time he drops late, for example his lowest point today was the PMPS but a couple days ago he dropped strong at +3 and I really don't know why because it doesn't follow any logic

Thanks I hope so too but for that I have to get the sugar under control as soon as possible. Just glad that it doesn't stop him from doing Regs stuff

 

[Britta and Regs]

I know exactly what you mean - in the beginning, I always felt bad. I felt bad when Moonie's numbers were too high. I felt scared when they were too low. I think over time you'll get used to seeing blues and greens and desperately want to see more . I think in part, it's just time and repeated exposure - seeing is believing, and seeing Regs flourish at lower and lower numbers will help you really feel that it's not only safe but deeply desirable. For a long time, I knew intellectually that 50-120 was a normal BG for cats, but I was still anxious about seeing lower numbers.

The first time I saw a number under 100, I freaked out and gave Moonie a huge amount of Fancy Feast gravy. But seeing that it took Moonie from 96 to 142 in 15 minutes made me realize that I could bring her up very quickly, so next time, I gave her some LC food and tested in an hour when I saw a number in the 90s. Then as I started seeing her in the 90s I realized she started peeing a normal amount like my other cats in a normal stance. (She used to have a lot of accidents in the beginning and her muscle strength was not as good so she'd pee in weird positions). And when she was in the 90s, I noticed she'd play and jump around a lot more. Instead of sleeping all the time, she'd go out to the backyard with the other cats to "hunt for birds." That gave me the courage to see her in the 80s, where I noticed that she was also doing great. So on and so forth. I also realized that her cycles were much flatter with blue/green preshots, so they ended up being way less stressful.

During this process, when I was scared of the lower numbers - I often asked myself if the decision I was making was for me or for Moonie. Once I had enough data on Moonie, knew how she responded to carbs, and knew I could monitor the cycle, I started asking myself whether I was making a conservative choice because Moonie actually needed it or because the number scared me. If I wanted to get Moonie in normal numbers, I couldn't be scared to see those normal numbers you know?

I got Moonie in January this year. She was an unregulated diabetic for a year before I met her, and I didn't start following TR until the spreadsheet starts in late May. Before I was uneducated about feline diabetes and doing a lot of things that I cringe to think back on now like changing doses on preshots and testing inconsistently. So I struggled to get her regulated for 5 months, but we saw great progress as soon as we got serious about TR.

You already test more than enough for TR - the minimal testing requirement for TR is 4 tests a day. AM preshot, a test after (usually +2), PM preshot, and a test after (usually +2). Parker and I both work full-time, so we do our shot at 6am and we do her +2 at 8am before we head out for work. Fortunately, Moonie's am cycles are almost never active (20% drop or less). Then we test her at 6pm when we get home, and that gives us a lot of time to test before bed since her pm cycles are the active ones. Since Moonie drops early, I always do a +2, and if that drop is more than 50 points and/or >25%, I try to get another test in an hour. If she ever gets very close to or under 50 (this number used to be much higher like 70 but this is where we're comfortable now), I give her a tsp or two of HC, test again in 30-60 mins, and then do a final test 2 hours after (when the HC should be out of her system). Handling bounce breaks isn't any different on TR vs SLGS - most people try to figure out when their cat is most likely to break a bounce (for us, it's after repeated flat yellows and blues and almost always happens suddenly after +10) and adapt their feeding plan to pre-emptively feed before a steep drop may occur (which is why we usually do a small snack at +6 and +8 or +9 even though I know feeding after +6 cuts insulin duration).

All of this btw is based on Moonie's cycles (not generalizable to all cats) - so it may be worth having Wendy or Marje or someone experienced take a look at Regs' SS to help you figure out the right testing cadence and strategy based on Regs' cycles and your life / schedule.

In terms of increasing doses on TR, the general advice I got was (based on nadirs):

• High Blue (or higher) - Consider increase in 6 cycles
• Low/Mid Blue - Consider increase in 8-10 cycles
• Dark Green - Hold for 10 cycles
• Lime Green - Reduce 0.25 immediately

But you can always ask for feeding and dosing advice, so you don't have to figure it out all yet. In the beginning, I asked for dosing advice ALL THE TIME and regularly asked if I should be feeding LC/MC/HC multiple times a night.

Thank you so much for explaining all of this Connie, especially when to increase to hold or decrease.I think I will look at the link at the German side, must have his perk being German But it really helps to know that I'm not alone in the scare of the lower numbers in the beginning.

I think that’s exactly where I am right now. I know in my brain that 80s, 90s or even the 109 Regs had the other day aren’t dangerous numbers by themselves, but when I see them I immediately think, “Okay, but what if he keeps dropping and what happen if I can't stop it?” Especially because that 109 came so early in his cycle and I wasn’t expecting it at all because he always drops late. Today the PMPS was the lowest point in his cycle again

And honestly, I’m still so confused by all of this I feel like every time I think I understand something, Regs does something completely different. Bounces, bounce breaks, nadirs moving around, when to feed, what to feed, when to increase, when to hold… it’s a lot and every time I ask a question I learn something new.. And then I’m supposed to look at his numbers and somehow know what he’s going to do next and I'm so glad I found the website because without it I would be completely alone. Our vet is not a big help and Rob thinks that Regs can run at this high numbers for the rest of his life and tells me all the time to test less.

What you said about asking yourself whether you were making a decision for Moonie or because you were scared really stuck with me. I definitely think I do that sometimes. I see a number that scares me and my first instinct is feed him, give him HC and as much as he wants that he is not going into hypo even when the number itself isn’t actually dangerous and in a healthy level and I have a happy kitty in front of me.

But I also think I just don’t know Regs well enough yet when it comes to insulin. I don’t really know how much LC/MC/HC affects him, how long it lasts, or when I can safely say “okay, he’s fine” and stop testing. I think having someone experienced look at his spreadsheet and help me figure out his patterns would help me a lot. When we were in California Wendy wrote something about his food peak normally being around 40 mg unless he starts bouncing and I never realized that.

And hearing how much better Moonie started feeling in normal numbers is honestly one of the biggest reasons I want to get over my fear. Regs’ neuropathy has gotten worse and I really want to get his glucose under better control for him. His behavior changed a little in the last weeks and I start wondering if that could be because sometimes he doesn't feel well, with him I would not know if that is the glucose, the heart failure or something else. His bloods are fine so I really don't know, maybe it's also just me hyper focusing on him. bUt in any case I just need to somehow get my brain to stop treating every blue or green number like an emergency

Thank you again for taking so much time to explain this. It really does make me feel better knowing you didn’t just magically start out being comfortable with these numbers either. Maybe eventually I’ll be the person excited about greens instead of panicking over them but I have the feeling I need to try it.
Sorry for babbling a lot!

 

[Britta and Regs]

The possibility for the high BG's is definitely the gravies, when Reg has low BG, giving the gravies will make him bounce, he could be very sensitive to carbs, the best way to handle low BGs is to give 1/2tsp of low carbs, test about 1/2-1 hour after, and repeat process until he is in safe numbers, if after about 3 tests and low BG's then proceed to medium carbs, and repeat the process, We leave the high carbs honey or Karo syrup for a quick fix, to raise the BG if is 60 or less since you are using Lantus, for now, remember that a non-diabetic cats' glucose level is between 50-120 , if you give too much carb you will have a bounce. with ProZinc which is what Corky uses, I shoot in low numbers, it takes a lot of practice to achieve, but if he is in the 70's before shot, I stall the shot for 1/2 hour, food raises the BG so I re test and is safe to shoot, with ProZinc you can stall the shot up to two hours, making sure you adjust the next shot to same time, normally cats have a lower BG during the night, I have read that there's no explanation to that, I feed Corky's last meal at +4 (10:00PM), and is bed time.
The Temtation treats are extremely high carbs.
When you answered my post I remembered you had previous posts.

I actually remember your post too! I was still so new to all of this back then that everything felt completely overwhelming. And honestly, parts of it still does today.

I didn’t realize that MC/HC could contribute to those huge numbers afterward. I always thought a bounce was basically the liver and pancreas releasing glucose and hormones in response to lower numbers. Once again I’m realizing how much I still have to learn about feline diabetes what really is scary

I definitely reach for higher carb food too quickly when I get scared. With the 109 the other day, I wasn’t scared of the 109 itself, but of where he might be an hour later because it was only +4.5 and I was so worried that I couldn't stop the drop of if I would be too late. I really need to learn how Regs responds to LC/MC/HC instead of immediately trying to stop every drop and maybe sit some numbers more out instead of feeding immediately, but I don't know how to explain my mind because every time I go into panic mode

Apparently I also desperately need to find a tasty LC treat for the Furbo because Temptations clearly aren’t the best choice, poor guy he likes them so much. I always keep a little emergency packet of honey near Regs too, just in case I ever really need it what hopefully is.... never!

His nighttime drops still worry me, especially since he sometimes decides to drop pretty late he hovers the whole night in the 300 and then @+8 he drops, I get scared and I feed MC. I probably need to use the Petlibro feeder more strategically overnight instead of feeling like I have to keep testing him all night. I even have food in there and its opening at 4am but I always get up and test him before to make sure he doesn't need different or more food

I’m also still trying to understand the differences between Lantus and ProZinc. My vet mentioned switching Regs to ProZinc, but she was supposed to get back to me today and didn’t. Honestly, I’m not entirely unhappy about that I’m really not sure I want to switch him when I’m only just starting to understand Lantus and his patterns on it. And with ProZinc we would have to start all over even I know it is very good but I'm just afraid the vet wants to switch too early.

Thank you so much for taking the time to help me and for sharing all this information with me. I really appreciate it. There is so much to learn, and having people here who are willing to explain things and share their experiences makes me feel a lot less alone in all of this.

 

[Sara & Khloe]

Hey Sara, yes I remember I just looked at your Spreadsheet. It is impressive how you got Khloe's sugars under control in only one month! How did you get over the fear minus that you did a lot of research about Khloe's sugar behavior? As soon as I even see Regs in the low yellows at night I get nervous, if he would give me a blue come with food etc. With Regs it's just so weird, almost all the time he drops late, for example his lowest point today was the PMPS but a couple days ago he dropped strong at +3 and I really don't know why because it doesn't follow any logic

Thanks I hope so too but for that I have to get the sugar under control as soon as possible. Just glad that it doesn't stop him from doing Regs stuff

It’s crazy that you point that out because that one month felt like 6 months! Like you, I felt an extreme need to regulate her fast. Khloe never had neuropathy but she did have daily inappropriate urinating during that time and I was desperate to get her numbers to look better.

As for the fear, Connie hit the nail on the head. It really was a combination of exposure and knowing how she reacted to food. Eventually I got to a point where I knew I had honey, medium carb food, plenty of test strips, and time to monitor so I just let her do what she was going to do and knew I could step in at any point and bring her back up. But it took time, lots and lots of time. Experimenting with food and at what times to offer food. I believe it took 3 limes before I stopped running around in a panic. Another thing that really helped me was both Connie and another member (Elizabeth & Mister) had joined the board around the same time as me and we learned from each other’s questions and experiences. Seth&Bell’s SS was another big one that helped me gain courage as Seth has shot some low pre-shots and I saw how Bell was the most flat afterwards.

All that to be said, there are times I still get alittle on edge with the numbers. Yesterday morning being one of them. We love our cats deeply and I think we all worry to some degree.

Every cat reacts differently and they can change at any time. For example, in the beginning you’ll see Khloe had a typical +6 nadir but today her nadir in typically +3/+4, why that changed? The world may never know.

I’m very happy to hear that despite it all, Regs is still acting himself

 

[Connie & Parker & Moonie]

We’ve all been there . I hope you’ll get someone experienced to take a look at Regs’ SS and maybe together you can come up with a testing and feeding plan that works for Regs and your schedule. In the meantime, if you see a dip into the blues, I’d encourage you to use that as a learning opportunity to experiment and understand how Regs reacts to 1 tsp of MC, LC, HC. You can try 1 tsp, wait and test after 30 mins, 60 mins, and 2 hours. I think understanding how Regs responds to food will also help you feel more confident letting him surf lower into good healing numbers!

 

[Wendy&Neko]

It says you should measure +3 +6 and +9, how do you do that during the day when you are at work or at night?

When you start Lantus, it suggests testing at those times, in the beginning. You are well past that. Can you remind me how long Regs has been on Lantus? Here we say to give an insulin 6 months before thinking about switching, Insulin is a hormone, their bodies have to learn how to work with it. Your vet was also suggesting Vetsulin, I'm glad you were a hard no for that. Also tells me something about your vet's experience with FD. . And suggesting he might have Cushings? I'd love to know why that is suspected. Does he have a bare pot belly? Issues with his skin?

Heart conditions can also cause some insulin resistance. Some cats react to Lasix with higher numbers too. All manageable by dosing.

As has been said above, learn how Reg uses the insulin (onset, nadir, and duration) and how he responds to carbs of different types. That'll give you more confidence. Moving to TR would probably be a help. Let him be in blues. When he hits low blues or greens give him some LC to see if he'll surf there. The more time in those numbers, the more he'll get used to them and eventually bounce less.

Get rid of those Temptations! Freeze dried all meat treats are usually a hit with cats.

 

[Britta and Regs]

When you start Lantus, it suggests testing at those times, in the beginning. You are well past that. Can you remind me how long Regs has been on Lantus? Here we say to give an insulin 6 months before thinking about switching, Insulin is a hormone, their bodies have to learn how to work with it. Your vet was also suggesting Vetsulin, I'm glad you were a hard no for that. Also tells me something about your vet's experience with FD. . And suggesting he might have Cushings? I'd love to know why that is suspected. Does he have a bare pot belly? Issues with his skin?

Heart conditions can also cause some insulin resistance. Some cats react to Lasix with higher numbers too. All manageable by dosing.

As has been said above, learn how Reg uses the insulin (onset, nadir, and duration) and how he responds to carbs of different types. That'll give you more confidence. Moving to TR would probably be a help. Let him be in blues. When he hits low blues or greens give him some LC to see if he'll surf there. The more time in those numbers, the more he'll get used to them and eventually bounce less.

Get rid of those Temptations! Freeze dried all meat treats are usually a hit with cats.

Thank you so much for explaining all of that Wendy.
Regs only has been on Lantus since the beginning of July, so just for three month. Before that he was on Vetsulin and had always just ups and downs and a hypo that I thankfully could catch before he got symptoms. So I would never go back to that, especially with his heart condition I believe that the constant ups and downs (500-150) are not good for that.

Lasix can have an influence on the numbers? Thats really interesting and could maybe explain why he many times is high during the day and has the pre- values are the lowest point of the cycle since he is getting lasix twice a day and by the time of the next pre it might have worn off.

Out vet just thinks about Cushing because his glucose is hard to regulate and she thinks that there might be some body steroids playing a role. He has no skin issues or pot belly and his fur is thick and shiny.

At the moment I always try to get a +1 and 2 and a plus 6, right before he gets lunch sometimes at night a +9 right before his morning snack. On the weekend I could do a curve to see how he is dropping, or not dropping. But I really consider TR now, so many cats have so amazing results with that and it might help him with his neuropathy faster. I just think the low numbers are more impressive and scary for me than for him and I somehow need to get over that.

I know that the temptations are bad for him, all the other cats love them and sometimes he steals some, But I will try more freeze dried maybe they also love them.

 

[Connie & Parker & Moonie]

Thank you so much for explaining all of that Wendy.
Regs only has been on Lantus since the beginning of July, so just for three month. Before that he was on Vetsulin and had always just ups and downs and a hypo that I thankfully could catch before he got symptoms. So I would never go back to that, especially with his heart condition I believe that the constant ups and downs (500-150) are not good for that.

Lasix can have an influence on the numbers? Thats really interesting and could maybe explain why he many times is high during the day and has the pre- values are the lowest point of the cycle since he is getting lasix twice a day and by the time of the next pre it might have worn off.

Out vet just thinks about Cushing because his glucose is hard to regulate and she thinks that there might be some body steroids playing a role. He has no skin issues or pot belly and his fur is thick and shiny.

At the moment I always try to get a +1 and 2 and a plus 6, right before he gets lunch sometimes at night a +9 right before his morning snack. On the weekend I could do a curve to see how he is dropping, or not dropping. But I really consider TR now, so many cats have so amazing results with that and it might help him with his neuropathy faster. I just think the low numbers are more impressive and scary for me than for him and I somehow need to get over that.

I know that the temptations are bad for him, all the other cats love them and sometimes he steals some, But I will try more freeze dried maybe they also love them.

Freeze dried chicken is like crack for our cats. Moonie also loves freeze dried chicken hearts and giblets, which sounds gross to me but she'll come running if she hears the bag. There's also other freeze dried protein like pork, rabbit, duck etc. if Regs prefers those.

 

[Britta and Regs]

I had the freeze dried chicken in the past and Regs loved it, but I’m afraid in the end he was a little chickened out. I have never tried hearts or giblets though, that’s a fantastic idea. And maybe I should try a different source as well to give him some variety

 

[CORKY]

It’s crazy that you point that out because that one month felt like 6 months! Like you, I felt an extreme need to regulate her fast. Khloe never had neuropathy but she did have daily inappropriate urinating during that time and I was desperate to get her numbers to look better.

As for the fear, Connie hit the nail on the head. It really was a combination of exposure and knowing how she reacted to food. Eventually I got to a point where I knew I had honey, medium carb food, plenty of test strips, and time to monitor so I just let her do what she was going to do and knew I could step in at any point and bring her back up. But it took time, lots and lots of time. Experimenting with food and at what times to offer food. I believe it took 3 limes before I stopped running around in a panic. Another thing that really helped me was both Connie and another member (Elizabeth & Mister) had joined the board around the same time as me and we learned from each other’s questions and experiences. Seth&Bell’s SS was another big one that helped me gain courage as Seth has shot some low pre-shots and I saw how Bell was the most flat afterwards.

All that to be said, there are times I still get alittle on edge with the numbers. Yesterday morning being one of them. We love our cats deeply and I think we all worry to some degree.

Every cat reacts differently and they can change at any time. For example, in the beginning you’ll see Khloe had a typical +6 nadir but today her nadir in typically +3/+4, why that changed? The world may never know.

I’m very happy to hear that despite it all, Regs is still acting himself

Sarah & Khloe is right, it takes quite a while to regulate the levels, it took almost 2 years for Corky to stabilize to green numbers, and there are mornings that his levels are 130+BGs, as well as it took me 2 years to feel comfortable to shoot even in the mid 70's I have not fed Corky any medium or high Carbs in low numbers in the low 60's even in the high 50s, I just feed 1 tsp of low carbs, and wait for his BG to raise, this way there is no bounces. You are doing great, is all trial and error, and for you to begin to be comfortable with low numbers, and this can be achieved by testing again and again, without giving high carbs, Corky is extremely sensitive to carbs, and unfortunately, he will be a lifetime diabetic, but tightly regulated. I stopped the treats altogether, I feed 4 meals a day 1/2 can of FF pates or chunky or flake, this keeps him full and happy looking forward to his meals, and keeps the insulin in check all day from shot to shot, as I said he uses ProZinc, Lantus has a tighter protocol for low numbers, but either way a non-diabetic cats' glucose level is between 50-120

 

[Britta and Regs]

Sarah & Khloe is right, it takes quite a while to regulate the levels, it took almost 2 years for Corky to stabilize to green numbers, and there are mornings that his levels are 130+BGs, as well as it took me 2 years to feel comfortable to shoot even in the mid 70's I have not fed Corky any medium or high Carbs in low numbers in the low 60's even in the high 50s, I just feed 1 tsp of low carbs, and wait for his BG to raise, this way there is no bounces. You are doing great, is all trial and error, and for you to begin to be comfortable with low numbers, and this can be achieved by testing again and again, without giving high carbs, Corky is extremely sensitive to carbs, and unfortunately, he will be a lifetime diabetic, but tightly regulated. I stopped the treats altogether, I feed 4 meals a day 1/2 can of FF pates or chunky or flake, this keeps him full and happy looking forward to his meals, and keeps the insulin in check all day from shot to shot, as I said he uses ProZinc, Lantus has a tighter protocol for low numbers, but either way a non-diabetic cats' glucose level is between 50-120

And Corkys numbers look amazing. I looked through your SS and saw the numbers you had when you started here, pretty close to Regs numbers now. That makes me a little optimistic we can get that. But I'm very sorry to hear he will be a lifetime diabetic.

I need to learn to give him LC when he is dropping, I always just panic and try to raise him as quick as I can, what (I learned now) is a bad thing tp do because he will start bouncing.

I feed the same FF pates but recently he started either being bored with it or he doesn't like the chunks in the chunked and flaked. I hope his teeth are ok. But thats why I added Sheba pate, what has a different, smooth consistency and he just loves it.
I slowly start seeing a little pattern in his glucose, especially since his bounce is gone and I measure every day at certain timepoints.

 

[CORKY]

Following the suggestions on how to handle low numbers, I am sure Reg will get there too. when you see low numbers,, I'll tell you what was told to me, when I used to run around the house like a chicken without a head;: "take a step back, breath in and breath out, cats are very sensitive to stress, you stress, Reg will stress" One of the reasons that Corky has gotten where he's at now, is because I have taken every suggestion and advice from the members of this Forum to the letter, I trust them blindly, they saved my Corky's Life, his vet of 10 years fired me when I took him for a visit after 8 days of hospitalization, I was left alone, banging it for 3 months, until I began to surf the web and found this incredible Forum. Today, Corky only goes to the vet once a year for his annual rabies shot, his diabetes has been controlled by these amazing members, that care and are completely knowledgeable with Feline Diabetes, I trust this forum Blindly

 

[Britta and Regs]

I'll tell you what was told to me, when I used to run around the house like a chicken without a head;

That was a very accurate description what I did when we had numbers under 100 for the very first time

This community here is amazing, I have gotten so many good advice here when I had questions and because of the knowledgeble people here Regs had much better days than if I would have made a decision for him. I would have skipped the shot a couple times but was encouraged and explained why it would be got to give him insulin even if he was low, and it always has been the right decision. My husband does not understand why I listen to people I don't know on the internet but I have more trust with Regs diabetes here than in our vet, even she is amazing but doesn't know a lot about this topic

 

[CORKY]

Is true skipping a shot is not option, unless it is necessary, and if/when you switch to ProZinc, you can stall the shot up tp 2 hours, so this way you can raise the BG with tsps at a time of low carbs, without having to give medium or high carbs, you'll ge the hang of once you go thru the process the first time, just by looking at the SS you can see how the process works, great example I just shot Corky with 87BG, knowing that once fed, his BG will raise, always remember that cats BGs for some unknown reason is lower during the night

 

[CORKY]

Perfect example of what I just mentioned, Corky BG was 87 at shot time right now at 8:30 his BG is 102, is a good example on how food raises the BG without medium or high carbs, and now at 9:45 his BG is at 83