? Should I switch to a different insulin? Mimis AMPS 223 PMPS 281 - increase to 2 units

[Mimis mom]

https://www.felinediabetes.com/FDMB...ps-236-pmps-69-2-49-gave-reduced-dose.242912/

it’s been ages since I’ve posted. I’ve just sort of lost the energy to post and just became sort of depressed knowing Mimi will likely never outgrow this. I can’t leave her- I haven’t left her in 2 years. The one attempt I did it was for 33 hours and she didn’t eat, her ketones were rising. I intervened with fluids and got her down but it also scared me to ever leave again. I still test, inject, do all of it every day I just haven’t posted in a while..

sometimes I wonder if I’m keeping her sick.
What if she keeps bouncing because she doesn’t need insulin. Like her numbers are sometimes very flat, then she gets low, and then they go right back up again. Does that make sense? How does she still have diabetes? In a human if you completely control the diet they easily go into remission. If this is in fact type 2 diabetes and I completely control her diet, why does she still need insulin? Maybe she doesn’t?

 

[Mimis mom]

Should I switch Mimi to Levemir? Is Lantus not regulating her enough?

 

[Hshray]

I’m sorry it’s been so stressful for you…I definitely understand that.

Are you still following TR?

If so it looks like she didn’t actually earn any reductions since she was at 2.25 units at the beginning of the month. With TR you can also increase the doses sooner to get her to her ideal dose.

 

[Marina & Chico]

So sorry for the hard time you are having bouncing and regulation can be very frustrating, adding to that the impossibility to leave home for over 2 years, sounds like a full plate
It is a pity that you lost motivation to post, posting here and being surrounded by people that go thru the same helped us a lot to “normalize” what we were/are going thru, hope finding your way back here will help you a bit too
Looking at Mimi’s SS is hard to come to a conclusion if she is bouncing from lower numbers or not, it would be very helpful if you could test a +2 whenever it is possible and if that value is lower than the preshot test a bit later to see where is this dose taking Mimi so far.
I will tag some more experience people to check out Mimi’s SS @Bandit's Mom @tiffmaxee @PerfumedCatMom

 

[Katherine&Ruby]

Hi Rosa, it looks to me that Mimi needs more insulin. Your signature says you are following TR but you keep reducing her dose before she falls below 50. As a long term diabetic we usually recommend three drops below 50 to reduce with TR.

I can feel your frustration. If you can post more frequently and ask for dosing advice, we can try to help you. I see that you're not getting some midcycle tests that can give us a fuller picture of what is going on with Mimi. This is not criticism or a judgment, as we all have lives, and if you can get 4 tests in per day that would help us to help you better.

Some cats can't be diet controlled and achieve remission. The pancreas needs time to heal, and insulin helps with that. She's probably got some level of glucose toxicity and it takes simply more insulin to break through that. You've never gone above 2.25 units. Some kitties need a little more than that to get to their "breakthrough" dose.

 

[Wendy&Neko]

With a long term diabetic and following TR, the rules is actually to wait for a drop under 40, or to wait for a week in normal numbers. People with cats that don't hold reductions well (long term or not), can use the alternate method of three drops between 40 and 49 on separate days for a reduction earned. Reminder: *earning* reductions and starting OTJ trials Mimi needs an increase.

What if she keeps bouncing because she doesn’t need insulin. Like her numbers are sometimes very flat, then she gets low, and then they go right back up again. Does that make sense? How does she still have diabetes? In a human if you completely control the diet they easily go into remission. If this is in fact type 2 diabetes and I completely control her diet, why does she still need insulin? Maybe she doesn’t?

Cats don't bounce because they need insulin, they bounce when they see numbers they aren't used to, or fast drops. Lately Mimi isn't used to green. The reason she still has diabetes is that her pancreatic beta cells have not healed, and/or perhaps she has another condition causing insulin resistance. It's not unusual to have a cat be diabetic for many years. We've seen stories of cats being diabetic, but still having a great life, for 8-10 years. Humans don't go into remission like cats can.

You can also try Levemir, but it's not a guarantee of regulation. However, the majority of people who have switched to Levemir prefer it. The only issue is the later onset and nadir doesn't fit with everyone's schedule.

 

[Mimis mom]

I’ve done TR (I guess I mean I do TR but haven’t been following the rules closely) because I’ve been in a Facebook group for feline diabetes that holds doses longer and also won’t shoot a lot of time if PS is below like 100 (I’ve even heard some say if it’s below 150- which is silly)
I will admit when I see her numbers in the 200s,’while I don’t think that’s ideal it also makes me not worry about her going hypo.

question- with long term diabetic kitties- would you say their body knows how to react better to dangerously low numbers as opposed to a new sugar baby?
I mean I haven’t seen her drop into shark territory in over a year (like below 30-40) she doesn’t worry me as much with hypo like she used to but I also don’t want her other organs to hurt because her BG is always on the high side.

 

[Mimis mom]

Increased to 2 units -
Going to try and stick to TR rules, post here more ans get back to my hope Mimi will go into remission some day.


Oh! Another reason I was getting doubtful about TR is my vet was weary about having her in such low numbers. But I understand lower is probably better on her overall health

 

[Mimis mom]

Hi Rosa, it looks to me that Mimi needs more insulin. Your signature says you are following TR but you keep reducing her dose before she falls below 50. As a long term diabetic we usually recommend three drops below 50 to reduce with TR.

I can feel your frustration. If you can post more frequently and ask for dosing advice, we can try to help you. I see that you're not getting some midcycle tests that can give us a fuller picture of what is going on with Mimi. This is not criticism or a judgment, as we all have lives, and if you can get 4 tests in per day that would help us to help you better.

Some cats can't be diet controlled and achieve remission. The pancreas needs time to heal, and insulin helps with that. She's probably got some level of glucose toxicity and it takes simply more insulin to break through that. You've never gone above 2.25 units. Some kitties need a little more than that to get to their "breakthrough" dose.

You know I was worried about her being above 2.25 units - like it meant her insulin just wasn’t working because for a while she was doing well on 1.25-1.5 - then last summer I left her for 33 hours with someone to give her insulin (which was a reduced dose) and she decided to keep her body liking higher doses…

 

[Wendy&Neko]

question- with long term diabetic kitties- would you say their body knows how to react better to dangerously low numbers as opposed to a new sugar baby?

No, I mean a long term diabetics beta cells have been out of commission longer. A newly diagnosed kitty is more likely to hold reductions. The sooner you can get a cat regulated after diagnosis, the more likely the regulation, which is a requirement for remission. After that, you have to work harder to get them there.

 

[Mimis mom]

With a long term diabetic and following TR, the rules is actually to wait for a drop under 40, or to wait for a week in normal numbers. People with cats that don't hold reductions well (long term or not), can use the alternate method of three drops between 40 and 49 on separate days for a reduction earned. Reminder: *earning* reductions and starting OTJ trials Mimi needs an increase.


Cats don't bounce because they need insulin, they bounce when they see numbers they aren't used to, or fast drops. Lately Mimi isn't used to green. The reason she still has diabetes is that her pancreatic beta cells have not healed, and/or perhaps she has another condition causing insulin resistance. It's not unusual to have a cat be diabetic for many years. We've seen stories of cats being diabetic, but still having a great life, for 8-10 years. Humans don't go into remission like cats can.

You can also try Levemir, but it's not a guarantee of regulation. However, the majority of people who have switched to Levemir prefer it. The only issue is the later onset and nadir doesn't fit with everyone's schedule.

Is Levemir once a day dosing? When you say the dose doesn’t kick in until later does that mean more feeding at later times not earlier in the cycle like Lantus?
Like I feed Mimi PS , then +1 or +2, then usually +4 and maybe a +5-6. But not after that.
Where on here can I find a recommended feeding schedule because I haven’t found one when I’ve looked before. I remember Marje one time saying everyone usually feeds PS +1 +2+3 and not again till the next dose, but I read that only once and now I don’t know if that’s actually what I read…

 

[Mimis mom]

PM +1 317

 

[Wendy&Neko]

s Levemir once a day dosing? When you say the dose doesn’t kick in until later does that mean more feeding at later times not earlier in the cycle like Lantus?

Levemir is dosed twice a day like Lantus. Typical onset is +4, typical nadir is +8, with not all cats the same.

Where on here can I find a recommended feeding schedule because I haven’t found one when I’ve looked before.

That's because there isn't one. It depends on your cat. You have to learn your cats reaction to insulin and carb sensitivity and feed accordingly.

 

[Marina & Chico]

But if i can add my two cents, maybe it’s too early to consider a switch from lantus, get to a better dose and then you can decide if it does what it is intended or not. Usually we test +1 if the preshot is very low, other wise it is expected to just show you a food bump. It can easily be that today’s +1 is just a food bump. Most cats onset at +2 and thats why we test the +2: if it is the same or lower than the preshot it most of the time means an active cycle and then we take more tests accordingly; if the +2 is higher than the preshot it usually is an indication of a bounce cycle, if possible you can test +4 or +6 just to make sure she doesn’t start clearing the bounce.

 

[Mimis mom]

Hi Rosa, it looks to me that Mimi needs more insulin. Your signature says you are following TR but you keep reducing her dose before she falls below 50. As a long term diabetic we usually recommend three drops below 50 to reduce with TR.

I can feel your frustration. If you can post more frequently and ask for dosing advice, we can try to help you. I see that you're not getting some midcycle tests that can give us a fuller picture of what is going on with Mimi. This is not criticism or a judgment, as we all have lives, and if you can get 4 tests in per day that would help us to help you better.

Some cats can't be diet controlled and achieve remission. The pancreas needs time to heal, and insulin helps with that. She's probably got some level of glucose toxicity and it takes simply more insulin to break through that. You've never gone above 2.25 units. Some kitties need a little more than that to get to their "breakthrough" dose.

Only thing with the testing is I think it stresses her out. She lets me do it but sometimes I can’t get enough blood (stupid Relion takes so much more blood)
And I worry it’s stresses her out to get pricked. I have to stress I do test before every shot - it’s more so not wanting to test her more than that but I do.

 

[Mimis mom]

Levemir is doses twice a day like Lantus. Typical onset is +4, typical nadir is +8, with not all cats the same.

That's because there isn't one. It depends on your cat. You have to learn your cats reaction to insulin and carb sensitivity and feed accordingly.

that gives me so much anxiety- how can there not be a guideline? How do you discover what your car is capable of feeding schedule wise when their BG can change every day? Doesn’t it have to do with the way Lantus works? There isn’t some kind of example? If there wasn’t people would just feed their sugar cats twice a day and we know that’s not the best way when theyre on insulin? Why does everyone get automatic feeders if there wasn’t some kind of trend even the way people feed diabetic cats?

 

[Librarianista]

that gives me so much anxiety- how can there not be a guideline? How do you discover what your car is capable of feeding schedule wise when their BG can change every day? Doesn’t it have to do with the way Lantus works? There isn’t some kind of example? If there wasn’t people would just feed their sugar cats twice a day and we know that’s not the best way when theyre on insulin? Why does everyone get automatic feeders if there wasn’t some kind of trend even the way people feed diabetic cats?

Hi, Mimi -

I'm not sure what your cat is like or if you have others in the house, but I tend to only put food down twice a day and let Chloe eat when and what she wants. She was used to free-feeding dry, so free-feeding wet seemed like the best transition for us. Shot times are at 7:30, so I put a can of food down at roughly 7:15 A/P. She doesn't eat it all at once, but it stays moist most of the day. If I am home and it looks dry midday, I might add a little water to it. She doesn't like overly wet food, but you could add water to yours when you put it down to keep it moister longer. The daytime dish gets picked up when I come home from work around 5:15, which is conveniently 2 hours before her next PS test and feeding. I might leave a little less out overnight since I'm not going to get up earlier than I need to just to pick up a food dish, and it's usually emptied out by morning.

This is what works for us, but it wouldn't work for cats who gobble down their food or if other cats in the house would eat it all at once. And I think that's one of the reasons there aren't set guidelines - there are lots of ways to get to the "right" answer.

 

[Katherine&Ruby]

I used to feed Ruby at shot time, +2, +4, and +6 when I was starting out and trying to get her tightly regulated. Small meals are easier on the pancreas and it kept her hungry in case I needed to intervene with medium or high carb food when the insulin was strongest. It's recommended not to feed after +6 as that is when the insulin is waning and you don't want to work against that with food. We also tell new caregivers to pick up any food left in bowls at +10, two hours before shot time so that the number you get when you're about to administer insulin is not influence by food.

I now feed Ruby at shot time, +3, and a small +9 snack. I feed her a low to zero carb raw food, and the +9 snack is to prevent her from vomiting after too many hours of an empty stomach. I will feed her small spoons of medium or high carb food if she goes low any time during the day. This is my schedule that is tailored to Ruby's patterns. You will find your own with Mimi.

 

[Sienne and Gabby (GA)]

Rosa -

In looking over Mimi's spreadsheet, I'm hard pressed to understand how you've been approaching your dosing. It doesn't look like you're following TR -- doses are held for too long. You're not following SLGS in that you're not using a drop below 90 to signal the need for a reduction. I'm not sure which Facebook group you're listening too. I seriously doubt it's the counterpart to this group and if it is, I'm going to reach out to the admins and aske what is going on. There are a few other groups out there that are notorious for giving exceptionally bad advice. I suspect you're getting information from one of those groups and you're seeing the results on Mimi's SS.

One thing to remember about insulin, it's not a drug like an antibiotic. It's a hormone. Lots of things can influence the metabolism of insulin -- diet, activity, stress, etc. This is what makes issues like feeding so challenging. Having curves can help you to understand your cat's typical pattern. As I'm sure you've heard us say, nadirs can and do move around. You need data that's particular to your cat in order to determine what's the best way to provide meals. As an example, if you look at Gabby's SS, she had an early onset and nadir. Her nadir was often at +3 or +4. As a result, I front-loaded her food -- she got food at PS, +1, +2 and +3. It helped to buffer what could sometimes be steep drops. You need to figure this out for your cat. There are no specific guidelines because ECID.

 

[Mimis mom]

Rosa -

In looking over Mimi's spreadsheet, I'm hard pressed to understand how you've been approaching your dosing. It doesn't look like you're following TR -- doses are held for too long. You're not following SLGS in that you're not using a drop below 90 to signal the need for a reduction. I'm not sure which Facebook group you're listening too. I seriously doubt it's the counterpart to this group and if it is, I'm going to reach out to the admins and aske what is going on. There are a few other groups out there that are notorious for giving exceptionally bad advice. I suspect you're getting information from one of those groups and you're seeing the results on Mimi's SS.

One thing to remember about insulin, it's not a drug like an antibiotic. It's a hormone. Lots of things can influence the metabolism of insulin -- diet, activity, stress, etc. This is what makes issues like feeding so challenging. Having curves can help you to understand your cat's typical pattern. As I'm sure you've heard us say, nadirs can and do move around. You need data that's particular to your cat in order to determine what's the best way to provide meals. As an example, if you look at Gabby's SS, she had an early onset and nadir. Her nadir was often at +3 or +4. As a result, I front-loaded her food -- she got food at PS, +1, +2 and +3. It helped to buffer what could sometimes be steep drops. You need to figure this out for your cat. There are no specific guidelines because ECID.

I can send you the group to confirm if it’s a trusted one, on Facebook- your page is still Lantus Land?

 

[Wendy&Neko]

The Facebook group associated with FDMB is not supposed to be giving dosing advice there.

 

[Sienne and Gabby (GA)]

Lantus Land is not "my" page. You can post the name of the group here or send me the name in a PM if you're more comfortable doing it that way.

 

[Mimis mom]

Lantus Land is not "my" page. You can post the name of the group here or send me the name in a PM if you're more comfortable doing it that way.

Oh shoot I thought it was. The Facebook group connected to this page isn’t supposed to give the same advice found here?
Well the only way to share it would be a link - otherwise I don’t know if there are other groups with the same name

it’s called feline diabetes support group - has 7.4K followers. I was going to upload a picture of the group page so it’s the right one but can’t figure out how to do that on here

 

[Sienne and Gabby (GA)]

The group you're referring to was formed when the "Relaxed Lantus"forum was disbanded. Tow of the admins of the FB grou9p left in a huff. The forum that they begged for ended up with many of th Lantus regulars having to rescue cats from their advise.. They would abandon the board for weeks at a time, dispense poor advice, etc. If you notice that their rules for their FB group state you can't refer members to other FD groups, they are notorious for poaching people from the FDMB FB group.

The FDMB FB group isn't permitted to dispense dosing information. People do try to sneak it in but you don't have easy access to spreadsheet information so often the dosing advice is to backed up on what's going on with your cat.