Shigella spread sheet assistance

[Kelly H.]

Hello All!
I feel like I've been racking my brain to get my baby regulated (and admittedly I'm not even sure what 'regulated' means). We're fairly new to the diabetes world, hence why our spreadsheet starts December 2020 and goes into 2021 rather than being split into two separate years--I wanted all the data on one sheet to see the progress. I feel like his numbers are all over the place except for his PMPS which is always 300+ and thats just too high (correct?) My vet upped him to 2U lantus 1/7/2021 but I've read never to jump full units so I just did the 0.5 for ~1 week. when I didn't see a huge change I made the full 2U change and saw some decrease however so many times it was dramatic (below 200) and per some forums "below 200 don't shoot" so I'd only give 1-1.5U. Is this the reason for the up and down? Am I seeing the "bounce" everyone talks about from 1/18-1/20?

Sorry for such a long post I'm just worried A) I'm not doing this right B) its not working the way it should. I've learned when he acts like he's starving his numbers will be 300+ so I try to keep his belly full as that keeps his numbers low (150-250s) meaning I'm giving almost 5 cans of ff a day, in ~4hr increments. I don't mind doing this if it keeps his numbers low but I worry about his teeth and weight etc.

Thank you for any/all help!!! Spreadsheet.

 

[tiffmaxee]

Welcome to you. Please read the dosing methods sticky to see what works for you. The different doses you are giving are causing erratic bg numbers. When a cat goes lower than he is used to his numbers will go up. We call that a bounce. It’s the cat’s way of protecting itself because it thinks it’s in danger. So read the dosing methods sticky at the top of this forum, TR and SLGS.

https://felinediabetes.com/FDMB/thr...-low-go-slow-slgs-tight-regulation-tr.210110/

 

[Chris & China (GA)]

Hey Kelly!! Welcome to the FDMB....the best place you never wanted to be!

Now first, while eventually, we will need you to decide which dosing method you want to use, you don't have to make a decision tonight. Until you understand how lantus works a little better, it'll probably just confuse you even more!

Lantus craves consistency, so the dose needs to be the same both AM and PM unless Shigella earns a reduction. Also, the dose is based on how LOW it takes him, not the Pre-Shot.

The Pre-shot just lets you know if it's safe to give insulin at all...and as far as the "never shoot below 200", that's a myth that just won't die, especially on the Facebook groups.

At first, when you don't have any data or experience with your cat, if you get a PS under 200, you should stall, don't feed and test again in 20-30 minutes to see if the number goes up. Use that time to post here with a clear subject line like "STALLING! NEED HELP!" ....once you have somebody's attention, you can edit it and change it.

We have a tradition here....if someone encourages you to shoot a lower PS than you're used to, they also agree to be available to watch for updates....as long as necessary, even if it means staying up all night with you (or find someone else with experience to take over). We will NOT leave you alone until your cat is obviously safe and you're feeling comfortable with what's going on.

As you gain experience and data, learn how your cat responds to both food and insulin, that "Stall point" comes down to 150.....then it gradually reduces even more! If you look at China's spreadsheet, you'll see I'd shoot her scheduled dose if she was above 50 (on Tight Regulation). On Start Low, Go Slow, you don't shoot anything under 90 until you know your cat very well (but again, you gradually work down to shooting that low...you don't do it right away).

TR has the advantage of being more aggressive, which gives the best chance at remission because you can increase the dose by .25 to .5 as often as every 3 days. But it does require more frequent testing sometimes.

On SLGS, you hold the same dose for 7 days and then do a curve (test every 2 hours for 12 hours or every 3 hours for 18 hours) before making a dose increase. The benefit is you don't have to test quite as much, but it also means your cat might be in higher numbers longer than you'd like.

On both methods, it's important to get at least the Pre-Shot tests...One AM and one PM and then on the AM cycle, get at least 1 test somewhere mid-cycle (if at all possible)...that means testing sometime 5-7 hours after the morning shot. On the PM cycle, it's very important that you get at least a "before bed" test....usually 2-3 hours after the shot depending on what time you shoot and how late you stay up.

Most cats go lower at night, so it's very important to get at least 1 test on every PM cycle. Also, without tests on the PM cycle, you're going to be missing half the picture. That's like doing a puzzle but only filling out pieces on the left side....to see the whole picture, you need pieces scattered around everywhere!

For now, I'd try shooting 2U both AM and PM unless you get a PS under 200....then you'd want to stall, don't feed and test again in 20-30 minutes. Don't forget to post for help too!

As for the Facebook groups, they have their place, but the only one associated with this board is the Feline Diabetes Group. Listening to other groups can confuse you even more because other groups can do things differently. The FDMB has been helping diabetic cat caretakers since 1996.....Long before Facebook was even a thing!!... so you'll get the most experienced help here!

If you've posted here and aren't getting a reply (and you're a member of the Feline Diabetes Group), you can post there and say "I've posted on the board and need some help"...put the link to your post here too so people in the FB group can quickly come here and find your post.

Keep asking questions. We've all been new once and understand how confusing this all can be, especially when you're hearing one thing from your vet, one thing from here and different things from different Facebook groups.

Just a quick note about your vet though. The sad truth is that vets get less than a day of formal education on diabetes in school and that covers all types of animals. Vet schools only have 4 years to teach a little bit about a lot of different things so they can't spend weeks (or months) on just one disease in one type of animal. The people here do nothing but deal with feline diabetes and the complications that tend to come with it. We live and breath it 24/7/365....some of us for many years.

Last, but not least...breathe.....He didn't become diabetic overnight and he's not going to be cured overnight. It was a good 5-6 months before I started to see some kind of pattern with China but she ended up being the most tightly regulated cat on the board for several years. One thing feline diabetes will teach you is patience!

How can we help you?

 

[Kelly H.]

Thank you so much!! One question I have is---even up to 2U when I do my mini-curves at home (every 4hrs), I never seem to get BG below 150...most often in the mid-200s. I really expected a nadir somewhere below 100. Maybe I'm missing it and I should try 'every-2-hours' curve at home instead of his vet visits (he's ALWAYS high at the vet for obvious reasons). Would it bounce low and back up that quickly? Every time I get a 300+ reading my heart breaks a little but I try to lie to myself that ~consistent~ numbers can be just as good as low.

 

[Wendy&Neko]

Hello and welcome over on this forum.

even up to 2U when I do my mini-curves at home (every 4hrs), I never seem to get BG below 150...most often in the mid-200s. I really expected a nadir somewhere below 100

A cat needs however much insulin they need. It could be you just haven't hit his fitting dose yet. And with inconsistent dosing, you will get "wonkier" numbers. Let's see what happens when you've had consistent dosing for several days so that the depot can get stabilized.