? Shasta’s Curve completed

[Shasta’s dad]

OK I uploaded Shasta's Curves. Again they are taken using a FreeStyle Libre device. We're on our fourth one as he just tore the third one off this AM. As you can see from the curves there is no consistency whatsoever. We adjusted food a couple of times. Shasta weighs about 15 lbs after losing a few pounds, he was close to 18 lbs. The weight loss is what tipped us off that something was up, along with his water consumption and soaked box. Originally he ate IAMS weight control along with some grain free mixed then a half serving of Sheba wet twice a day. He is a kibble kind of cat. When he was diagnosed four plus weeks ago, the plan was to put a Libre on him for a couple weeks to get his reading and then adjust the insulin as needed. The first week was good with 1 unit of Prozinc. He dropped immediately into the 150 and below range with that diet. We even adjusted his Prozinc to .5 units as day three he got into the low 60s on the Libre system. Those numbers are no where to be found because we changed which phone communicates with the Vet office which removed the info from the other phone. Somewhere I read that weight control food is not good for a Diabetic cat so we switched form the weight control IAMs to the Chicken IAMs along with the Sheba. He seemed starved every time we fed him. We ordered Purina ProPlan DM and Hills MD when the vet suggested we put him on a Diabetic diet. Since then we've lost all control. He developed some type of allergic reaction, as mentioned on the my original post and has chewed a bunch of his fur off. Not sure what it was from but my guess is the food. He had a shot to help with that. We switched away from all hard food and went to 2 servings of Sheba wet. He just does not want to eat all of that food but comes back a few hours later. So we added a little grain free kibble back in. As you can see from his numbers he is everywhere in the curve. The other night when my wife scanned him at 6:00 before feeding him he was below 70 and got into the 60s. She did not give him a shot at all that night. I was on the road and she was stressing to the point where she could not sleep. She fed him all sorts of food to get his BG up and with no shot that put him right back into the mid to high 400s and high 300s. We did not recover from that until the past day or two. But if you look at his chart he goes from the 400's to mid 100's with no consistency. This AM he dropped 290 points in BG level (392 to 102) in a couple hours. We're afraid to think what happens when we take the Libre off. If she gave him insulin when he was low the other night with me out of town he certainly would have crashed. The Vet said she would monitor the Libre and we would make a plan. After the Libre change we don't hear from them much. I know they have other patients but we're totally lost. They seem to be frustrated with the food changes even thought we've discussed them several time. We struggle getting blood with a lance from him. We have to stick him 4-5 time before we get blood and the way we're doing it you can see that it hurts him because he pulls back. We had hoped that 5 weeks into this we would have a much better feel for what to do, but again we're lost. I was thinking about getting some Wysong Epigen 90 kibbles to give with both the Sheba and the Fancy Feast Classic but since we’re struggling to get his BG even close to being regulated that would seem like one more variable. We don't know enough about diabetes. Having watched a 21 lb tabby shrivel to less than 6 lbs about 1.5 years ago. We don't want to see that happen again so we're hoping someone may have some suggestions.

 

[StarburstMom]

The libre is not to be used for dosing decisions for the first 12 hours. I found that written in the booklet yesterday as my cat got a new one installed yesterday afternoon and every reading had the magnifying glass and blood drop symbol for quite a while. That symbol basically means it's a questionable reading and specifically not to use it for management decisions.
Maybe redo the curve tomorrow? You don't really have to do anything to do the curve with the libre except scan at least 1x every 8 hours.

Many cats can go into remission on diet change only. That's added another variable to dosing. You may want to fill in the remarks column when you made the food changes so the experienced members can see the bigger picture.

 

[Shasta’s dad]

But he has been on them for just over 4 weeks. His first one was installed on 7/9. He peaks just under 500 and dives to the mid 100s just about every day. I have no level readings anywhere. The reading this AM where he dropped 290 pound was not on a new sensor. It was on him for over a week.

 

[StarburstMom]

When did the new one get installed? Was it more than 12 hours before your curve?The cautions and warning that state not to use the first 12 hour data for management decisions is below
https://www.freestyle.abbott/us-en/safety-information.html

I'm new myself, and don't have the knowledge yet to give you dosing suggestions, but also a Libre user.

@JanetNJ has helped me a ton.

 

[Judy & Fritz]

Curious what gauge lancets you are using. If you are having to stick him 4-5 times, you may be using too small a gauge lancet. It makes a difference, particularly if you don’t use the little holder, which I don’t. I like to see exactly where I am poking his ear. Fritz was diagnosed on 7/23. He had been on a Purina veterinary weight control food along with his non-vet canned food, and since the first ingredient of the vet food is corn, I have no doubt it contributed to his diabetes. Yes, he lost weight, but at what cost? I will never again feed a veterinary food of any kind. Horrible cheap ingredients. They do more harm than good, imo. If Shasta is a kibble kind of cat, I highly recommend Dr. Elsey’s CleanProtein dry food, it’s low carb with excellent ingredients, comes in five different proteins, and all five of mine beg for it. They get it as treats.

 

[Shasta’s dad]

When did the new one get installed? Was it more than 12 hours before your curve?The cautions and warning that state not to use the first 12 hour data for management decisions is below
https://www.freestyle.abbott/us-en/safety-information.html

I'm new myself, and don't have the knowledge yet to give you dosing suggestions, but also a Libre user.

@JanetNJ has helped me a ton.

None of his readings are from the new sensor. It was installed this afternoon after 4pm.

 

[Shasta’s dad]

Curious what gauge lancets you are using. If you are having to stick him 4-5 times, you may be using too small a gauge lancet. It makes a difference, particularly if you don’t use the little holder, which I don’t. I like to see exactly where I am poking his ear. Fritz was diagnosed on 7/23. He had been on a Purina veterinary weight control food along with his non-vet canned food, and since the first ingredient of the vet food is corn, I have no doubt it contributed to his diabetes. Yes, he lost weight, but at what cost? I will never again feed a veterinary food of any kind. Horrible cheap ingredients. They do more harm than good, imo. If Shasta is a kibble kind of cat, I highly recommend Dr. Elsey’s CleanProtein dry food, it’s low carb with excellent ingredients, comes in five different proteins, and all five of mine beg for it. They get it as treats.

This site had recommended 30 which was what I used. The Alpha came with 28 gauge and my wife has had some success with that. Still 3-4 pokes. My concern is the steep crashes he is going through and why one day out of the blue he was in the 70s. We had not seen that since we started. We hardly ever see 100s. Another concern is the difference between the Libre, the Relion and the Alpha Trak. One reading gave us 364 on the Libre, 401 on the Alpha and 317 on the Relion. Just adding to my confusion since we struggle sticking his ear. Sorry. Thanks!

 

[StarburstMom]

Another concern is the difference between the Libre, the Relion and the Alpha Trak. One reading gave us 364 on the Libre, 401 on the Alpha and 317 on the Relion. Just adding to my confusion since we struggle sticking his ear. Sorry. Thanks!

The alpha track is a pet meter and will read different, it isn't helpful comparing it with human meters (I got 165 on a human meter and 255 on a pet meter a few days ago). Also the Libre measures interstitial fluid, not blood, and is 10-15 minutes behind the blood glucose reading.. Meters have variation allowances.

The diet changes may be impacting those blood glucose numbers

 

[Bron and Sheba (GA)]

Hi, if you are following SLGS you should have reduced the dose three days ago when the BG dropped below 90

you will see different reading between the human meter and the alphatrak meter. The alphatrak meter reads higher than the human meter.
You need to stick with one meter or the other. I would recommend the human meter.
You are using the libre at the moment …correct?

I would also recommend you start adding information into the remarks column such as the food you feed and when you feed it. And your kitty is etc.

 

[Marje and Gracie]

First, you should reduce the dose immediately. He earned a reduction under SLGS by dropping below 90 on 8/3. This is for safety reasons so please reduce the dose at his next shot.

Second, the reason he is all over the place is (1) the change of food and (2) not feeding consistently for his curve.

The more consistent you are with the type of food, the %calories from carbs, and the feeding times, the more it will help him. He takes early dives so you should be feeding him every hour for the first 2-3 hours. You could just divide up his normal portion into 3-4 mini meals. Consistency in feeding is a priority.

He is diving and also getting into the 100s, so his liver is responding by dumping counterregulatory hormones and glucagon into his blood to bring the BG back up to what it has learned is “safe” which is high. That’s what we call “bouncing”. Feeding appropriately can help flatten that out. He’s also got some duration issues which might be due to the way you are feeding.

Comparing values from different meters will drive you crazy. There is no comparison so pick one and stick with it.

Have you seen the Hometesting Tips which might help you learn better how to test. The FDMB does not recommend anyone start with a 30g lancet. Some member on the board might have suggested it but it’s best to start with a 28g lancet and eventually, when the ears bleed better, move to a 30 or 31g.

Questions?

 

[Shasta’s dad]

First, you should reduce the dose immediately. He earned a reduction under SLGS by dropping below 90 on 8/3. This is for safety reasons so please reduce the dose at his next shot.

Second, the reason he is all over the place is (1) the change of food and (2) not feeding consistently for his curve.

The more consistent you are with the type of food, the %calories from carbs, and the feeding times, the more it will help him. He takes early dives so you should be feeding him every hour for the first 2-3 hours. You could just divide up his normal portion into 3-4 mini meals. Consistency in feeding is a priority.

He is diving and also getting into the 100s, so his liver is responding by dumping counterregulatory hormones and glucagon into his blood to bring the BG back up to what it has learned is “safe” which is high. That’s what we call “bouncing”. Feeding appropriately can help flatten that out. He’s also got some duration issues which might be due to the way you are feeding.

Comparing values from different meters will drive you crazy. There is no comparison so pick one and stick with it.

Have you seen the Hometesting Tips which might help you learn better how to test. The FDMB does not recommend anyone start with a 30g lancet. Some member on the board might have suggested it but it’s best to start with a 28g lancet and eventually, when the ears bleed better, move to a 30 or 31g.

Questions?

Where is the how to feed on the curve info? Not sure what feeding appropriately based on curve is. The vet wanted him eating 2.5 - 5 oz cans of wet a day. He’d never eat that much in a day. So we always try to feed him 2-Sheba perfect portions (total 2.64 oz) or 1 can of Fancy Feast Classic (3 oz) every day at 6:15 AM and PM. Both are about 3% carb. Sometimes it’s 15 minutes before or after depending upon our schedule. I travel she just started a new job. Right now we’re relying on the Libre because of the stress. Once we get the blood draw down we’ll use the meters. We have both meters. I’d like to use the Relion for cost reasons but the numbers I saw on a human to pet conversion is .65. The one time we tested both of ours it was .79 (327 Relion to 401 Alpha).

I’ll fill in all the food info in a few minutes along with today’s numbers. We’ll drop him to 1 at 6:15. What in the curve told us to drop it? I spoke to the vet twice and was told to continue with the 1.5. The curves she sees are not as detailed as mine because my wife’s phone talks to the vet every morning and every night. When I am home I scan every couple of minutes.

Thank you!

 

[Shasta’s dad]

First, you should reduce the dose immediately. He earned a reduction under SLGS by dropping below 90 on 8/3. This is for safety reasons so please reduce the dose at his next shot.

Second, the reason he is all over the place is (1) the change of food and (2) not feeding consistently for his curve.

The more consistent you are with the type of food, the %calories from carbs, and the feeding times, the more it will help him. He takes early dives so you should be feeding him every hour for the first 2-3 hours. You could just divide up his normal portion into 3-4 mini meals. Consistency in feeding is a priority.

He is diving and also getting into the 100s, so his liver is responding by dumping counterregulatory hormones and glucagon into his blood to bring the BG back up to what it has learned is “safe” which is high. That’s what we call “bouncing”. Feeding appropriately can help flatten that out. He’s also got some duration issues which might be due to the way you are feeding.

Comparing values from different meters will drive you crazy. There is no comparison so pick one and stick with it.

Have you seen the Hometesting Tips which might help you learn better how to test. The FDMB does not recommend anyone start with a 30g lancet. Some member on the board might have suggested it but it’s best to start with a 28g lancet and eventually, when the ears bleed better, move to a 30 or 31g.

Questions?

Just saw your divide food up statement sorry. Missed it on my phone. So is the Wysong Epigen 90 a good kibble? Splitting food up will not work when I’m gone and she is working.

 

[Shasta’s dad]

Hi, if you are following SLGS you should have reduced the dose three days ago when the BG dropped below 90

you will see different reading between the human meter and the alphatrak meter. The alphatrak meter reads higher than the human meter.
You need to stick with one meter or the other. I would recommend the human meter.
You are using the libre at the moment …correct?

I would also recommend you start adding information into the remarks column such as the food you feed and when you feed it. And your kitty is etc.

I’ll add the food info but it is 2 Shaba grain free perfect portions (1.32 oz total 2.64) or a 3 oz can of Fancy Feast Classic (3 oz) can every day at 6:15 am and pm - give or take a few minutes. He never wants to eat that much so we had been giving him about about 30 kibbles before the wet food. We stopped that yesterday. That means he leaves the food bowl after one 1.32 oz Sheba. I chase him with a spoon until I get the full two into him. As notes in one of my other posts the vet wanted 2 1/2 cans 5 oz cans of wet Purina MD a day. We could get nowhere near that. But he seemed to have an allergic reaction to the MD because the day after he first ate it he started chewing his hair out and grooming and scratching all over his body.

 

[Marje and Gracie]

Where is the how to feed on the curve info?

There is a lot of good info for PZ users at the top of the PZ Insulin Support Group on this board but I’d like to give you this basic post for new PZ users. It discusses feeding but because I see him diving early, it tells me he could benefit from mini meals.

We have both meters. I’d like to use the Relion for cost reasons but the numbers I saw on a human to pet conversion is .65. The one time we tested both of ours it was .79 (327 Relion to 401 Alpha).

I just want to stress to you there is no conversion between pet and human meters. You can look at my Gracie’s SS and the “Micro/AT” tab. I ran BGs on both meters just to show there is no comparison. Roomp and Rand, the authors of the tight regulation protocol for Lantus and Levemir users have also verified this.

Most members, who are working and can’t be there to feed at, for instance, AMPS, +1, +2, +3, buy auto feeders like the PetSafe 5. Kitties learn very quickly how to use them.

What in the curve told us to drop it?

The BG below 90. Because you are feeding dry still and also because you are new to PZ, we strongly recommend you follow the Start Low Go Slow dosing method.

So is the Wysong Epigen 90 a good kibble?

I’m sorry, I am not able to advise you on dry food. I feed a balanced raw diet and I am not a proponent of feeding cats dry food whether they are diabetic or not. You might want to read our feline nutritionist’s, Dr. Lisa, take on dry food.

I also am not a proponent of feeding prescription diets (Dr. Lisa’s info) and especially not the diabetic varieties. The ingredients are very poor and the Hills md is high in % calories from carbs (13%).

We have found that diabetic cats do better with more than 0-3% calories from carbs; this post provides more info.

Could you please update your signature to include the info we need as indicated in this post? We’d appreciate it and it will keep members from asking you for the same info over and over. Thank you.

 

[Shasta’s dad]

There is a lot of good info for PZ users at the top of the PZ Insulin Support Group on this board but I’d like to give you this basic post for new PZ users. It discusses feeding but because I see him diving early, it tells me he could benefit from mini meals.


I just want to stress to you there is no conversion between pet and human meters. You can look at my Gracie’s SS and the “Micro/AT” tab. I ran BGs on both meters just to show there is no comparison. Roomp and Rand, the authors of the tight regulation protocol for Lantus and Levemir users have also verified this.

Most members, who are working and can’t be there to feed at, for instance, AMPS, +1, +2, +3, buy auto feeders like the PetSafe 5. Kitties learn very quickly how to use them.


The BG below 90. Because you are feeding dry still and also because you are new to PZ, we strongly recommend you follow the Start Low Go Slow dosing method.


I’m sorry, I am not able to advise you on dry food. I feed a balanced raw diet and I am not a proponent of feeding cats dry food whether they are diabetic or not. You might want to read our feline nutritionist’s, Dr. Lisa, take on dry food.

I also am not a proponent of feeding prescription diets (Dr. Lisa’s info) and especially not the diabetic varieties. The ingredients are very poor and the Hills md is high in % calories from carbs (13%).

We have found that diabetic cats do better with more than 0-3% calories from carbs; this post provides more info.

Could you please update your signature to include the info we need as indicated in this post? We’d appreciate it and it will keep members from asking you for the same info over and over. Thank you.

To drop insulin I’m going from 1.5 to 1.25 correct? If I read correctly I should drop .25 even though the vet had me go up by .5. I’ll switch to the new dosage at 6:15. Thanks!

 

[Marje and Gracie]

To drop insulin I’m going from 1.5 to 1.25 correct? If I read correctly I should drop .25 even though the vet had me go up by .5. I’ll switch to the new dosage at 6:15. Thanks!

Correct. You’re welcome.

Thank you for updating the signature block. Love his avatar!

 

[Shasta’s dad]

Correct. You’re welcome.

Thank you for updating the signature block. Love his avatar!

So his curve for last night and today look pretty brutal. Straight up to the mid fours and down to about two fifty before heading back up to the high fours tonight. He seemed to have a good day but he did not want to eat the Sheba that he loves. Tried to spoon it to him but even the. He would not eat it. Had to open some Fancy Feast to get a couple ounces of food on him. Is that normal after a reduction in insulin to see the sharp climb? To not eat? Stay on the 1.25 even with the climb for about a week correct? Thanks!

 

[Marje and Gracie]

So his curve for last night and today look pretty brutal. Straight up to the mid fours and down to about two fifty before heading back up to the high fours tonight. He seemed to have a good day but he did not want to eat the Sheba that he loves. Tried to spoon it to him but even the. He would not eat it. Had to open some Fancy Feast to get a couple ounces of food on him. Is that normal after a reduction in insulin to see the sharp climb? To not eat? Stay on the 1.25 even with the climb for about a week correct? Thanks!

I am very sorry to not respond yesterday and I won’t be much help today. My young kitty has got something going on; we were at the vet yesterday afternoon and early evening until they could get us in. She’s worse today and so we are headed back over.

I feel it is irresponsible of me to advise anything when my head is somewhere else but, yes, under SLGS, you hold the dose a week and run a curve. Hopefully, by tomorrow, I can provide you with more info. I will tag a couple people, familiar with PZ, to post to you as well.

@JanetNJ @Deb & Wink

 

[Shasta’s dad]

I am very sorry to not respond yesterday and I won’t be much help today. My young kitty has got something going on; we were at the vet yesterday afternoon and early evening until they could get us in. She’s worse today and so we are headed back over.

I feel it is irresponsible of me to advise anything when my head is somewhere else but, yes, under SLGS, you hold the dose a week and run a curve. Hopefully, by tomorrow, I can provide you with more info. I will tag a couple people, familiar with PZ, to post to you as well.

@JanetNJ @Deb & Wink

We’ll be praying for you you guys. If you could do that I’d appreciate it. We went 1.25 this AM and he was 424 at AMS, 462 at +1, 396 +2 and has been mid 200 or below the rest of today. I am thinking of reducing the next shot if he stays low because he is well below his low 400 - high 300 shot numbers for the past 7 days.

God bless! Pray everything goes well and that they get kitty figures out.

 

[Judy & Fritz]

We’ll be praying for you you guys. If you could do that I’d appreciate it. We went 1.25 this AM and he was 424 at AMS, 462 at +1, 396 +2 and has been mid 200 or below the rest of today. I am thinking of reducing the next shot if he stays low because he is well below his low 400 - high 300 shot numbers for the past 7 days.

God bless! Pray everything goes well and that they get kitty figures out.

Let’s also tag @Chris & China (GA) , she’s amazing.

 

[Shasta’s dad]

Let’s also tag @Chris & China (GA) , she’s amazing.

When someone has a chance please look at the info above the teal colored line. I just added that as I was able to retrieve it from the trash. I lost it on my phone but found it buried in my wife’s phone. That was the first few days when we had very little input from the vet. Following SLGS we should have been down under 1 unit already the first week when he was eating Sheba and Iams kibbles. Is there a chance that he is getting too much insulin and should be down under 1 unit right now? She had us go up to 1.5 when he started rocketing up. Thanks!

 

[Diane Tyler's Mom GA]

@JanetNJ

@Panic

 

[Shasta’s dad]

@JanetNJ

@Panic

Sorry in Shasta’s spreadsheet.

 

[Chris & China (GA)]

Yesterday morning when you got the 295, you should have shot the 1.25 instead of dropping it to .75. I know the SLGS rules say:

• Above 200 (11.1 mmol/L) but below the cat's normal pre-shot value, a reduced dose might be wise.

but since you have the Libre on and can test as often as you want to, I would have stuck with the 1.25.

The problem now is that the cycle count would need to start over since you're supposed to do the same dose for at least 14 cycles

We all totally understand how frustrating this can be, but there's just no getting around the fact that it can take time, sometimes lots of it, to figure out what's going on with your cat's BG. It was a good 5-6 months before I started to see some kind of pattern in China! One thing this disease will teach you is patience.

 

[Shasta’s dad]

Yesterday morning when you got the 295, you should have shot the 1.25 instead of dropping it to .75. I know the SLGS rules say:

• Above 200 (11.1 mmol/L) but below the cat's normal pre-shot value, a reduced dose might be wise.

but since you have the Libre on and can test as often as you want to, I would have stuck with the 1.25.

The problem now is that the cycle count would need to start over since you're supposed to do the same dose for at least 14 cycles

We all totally understand how frustrating this can be, but there's just no getting around the fact that it can take time, sometimes lots of it, to figure out what's going on with your cat's BG. It was a good 5-6 months before I started to see some kind of pattern in China! One thing this disease will teach you is patience.

Aargh!! . No one was there to test him yesterday after 10 and the last time I was out of town my wife had the stress of him being at 66 when she arrived home. As you can see he was loaded with sugars after that as well because he wasn’t going back up.

So even when his sugars are much lower than his shoot number don’t change the amount of the shot for a few weeks?

 

[Shasta’s dad]

Aargh!! . No one was there to test him yesterday after 10 and the last time I was out of town my wife had the stress of him being at 66 when she arrived home. As you can see he was loaded with sugars after that as well because he wasn’t going back up.

So even when his sugars are much lower than his shoot number don’t change the amount of the shot for a few weeks?

Thank you!!!!

 

[Chris & China (GA)]

So even when his sugars are much lower than his shoot number don’t change the amount of the shot for a few weeks?

There's no pat answer for that question right now because there's not enough data on Shasta but 295 is the same as 300 so I think he was high enough to safely give the full dose.

Not "a few weeks"....you hold the dose for at least 14 cycles (7 days) unless he drops below 90 at which point he'd earn another reduction and that 14 cycle "clock" starts over.

You might want to look into getting an auto-feeder for the days you or your wife can't be there. They've saved the sanity of many a sugarcat parent! This PetSafe 5 is popular as is the CatMate 5 (which I believe comes with ice packs that go in the bottom)

 

[Shasta’s dad]

There's no pat answer for that question right now because there's not enough data on Shasta but 295 is the same as 300 so I think he was high enough to safely give the full dose.

Not "a few weeks"....you hold the dose for at least 14 cycles (7 days) unless he drops below 90 at which point he'd earn another reduction and that 14 cycle "clock" starts over.

You might want to look into getting an auto-feeder for the days you or your wife can't be there. They've saved the sanity of many a sugarcat parent! This PetSafe 5 is popular as is the CatMate 5 (which I believe comes with ice packs that go in the bottom)

Ironic, we got the auto feeder on Tuesday I just did not have time to set it up before I left. Is the thought that the cat will go and eat before they start crashing?

 

[Chris & China (GA)]

Is the thought that the cat will go and eat before they start crashing?

Most cats will go looking for food if their BG drops too low just like human diabetics often get very hungry when their running too low but having a feeder also offers you some options. You can set it to open at +1, +2, +4, +6 which would help prop up his numbers early in the cycle when the insulin is at it's strongest or you could do +2,+4,+6, +8.....both options leave 1 space empty. At +10 you have it rotate to an empty slot so that you know he hasn't eaten for the 2 hours immediately before shot time so you get a test that's not influenced by food.