? Start dosing over from scratch? Or hold?

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Poodoodle

Poodoodle

Member Since 2015
Hi everyone,
I've created a spreadsheet (of poor choices and monitoring) and am trying to decide if I start dosing over from scratch with 0.25U weekly increases instead of whole units or holding at what seemed a successful curve last night, first time below 200. I have no idea which to choose. Any opinions?
 
She is eating Nutrisca, which is 38% protein/16% fat/5.5% fiber and listed a low glycemic index on the package. I planned to switch to Orijin, which has stats closer to Evo, when it ran out (42% protein, 20% fat, 3% fiber).

The feeder feeds at 4am, 10am, 1pm, 8pm, 10pm and it feeds ~1/3 cup each time. I have 2 cats that pick at it. This is PMPS +10, AMPS +4, AMPS +7, PMPS +2, PMPS +4.
I am changing this to 2am, 10am, 2pm, 10pm to make this more even. This is PMPS +8, AMPS +4, AMPS +8, PMPS +4.

I increased Pooey's consumption of wet food significantly since diagnosis, from 1.5 oz of fancy feast w/gravy to about 7.5-9.0 oz of zero carb food (Rad Cat & Tiki Cat). I've cut the dry food as a result, the prior amounts of dry food were about double.
 
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I gave her a can instead of the dry food at AMPS +4, she hibernated inside the couch (they've dug a hole underneath) but tested her when she came out, 299 @ AMPS +8.
 
Looks like she was diagnosed on 3/23 - is it possible to recreate any of the dose changes before 4/8 when the spreadsheet starts? Even approximations - I called my vet and got the readings they had taken from before I started hometesting.

It's going to take a little untangling to figure out what the next step with the dose is. Dry food carbs can raise a cat up several hundred points and keep them there for another day - some cats have shown even 3 pieces of the dry crunchies is enough to do it. So the dry food is definitely playing a role in his high numbers and his dose.

I read through your post from yesterday - first of all, stop beating yourself up over past decisions. We all work with what we know. The most important thing is to be open to learning now how to move ahead and safely treat your little Poodoodle.

As others have said, you don't want to just ditch the dry cold turkey. It will make a difference in the blood sugar, without a doubt. Likely a huge difference. There is a relationship between the amount of carbs a diabetic cat eats and the dose - so right now you've got an equilibrium. Don't do any drastic changes til we can help you figure out how to move ahead.

What is your plan about the dry food? It's by far best for her health if you can transition her fully over to canned wet low carb. Zero carb is not better for diabetic cats - in fact, it often seems like low carb is better than zero carb. The link Sienne gave you about feeding has a chart with the carb value of different foods on there. Even cheap canned food is better than dry food. Dry food is hard on their kidneys - uncontrolled diabetic cats are already dehydrated and cats do not have a strong thirst instinct. You can put canned food into a feeder without any problem.

You mentioned fiber before - if constipation is a problem you can add fiber by adding a little canned pumpkin (not pie filling) to the food. Most cats like it.

Another point about the dry food is that it definitely increases the volume of insulin a cat is going to need. We had one cat here (part of a 13 cat family) that was being fed canned food and the other cats had dry that the family thought the diabetic cat couldn't get to. When all 13 cats went to canned food, kitty went from 5.5u of insulin per shot to off of insulin in two very long, hard days. His person kept him out of hypoglycemia but she had to carb him every half hour or so for a day and a half in order to keep him safe. You don't want to be in that position - but I'm mentioning it to illustrate the power of dry food to raise and sustain blood sugar at high levels. Your insulin is also not cheap - high doses will simply cost more. My cat had acromegaly, a condition which causes a need for large doses of insulin - he got up to 15.5u per shot. That's 15 times the cost of insulin compared to most cats.

So let us know what you plan to do about the dry food. That's probably the first step.
 
I contacted a vet that does home visits and they come tomorrow. I provided the number for my prior vet and hopefully he'll have those records with him. If not I'll call them for the numbers. They told me the high was in the 600's and low in the 400's.

As far as what to do with the dry food, we got on this track because I spent about 6 years being woken to feed Pooey every 4 hours or so. She would bat at my face until I fed her. Closing the door was never an option because she dug up the carpet and clawed at the door. I've lost quite a few apartment deposits from closing the door. When I got a timed dry feeder I felt so happy to get a full night of sleep. I guess I could buy a different timed feeder (this one is what I have, it can only take dry) but I feel a little sad about it because this feeder is amazing. I gave away my cat safe wet food feeder, but will buy another.

If I dose and feed a can at 6am/6pm and get a timer to feed a can at noon and midnight.....maybe this could work and I could sleep. I hope 4 feedings would be enough for her to let me sleep through the night.

That just leaves a transition plan right, finding the right way to decrease dry, monitor, decrease insulin?
 
That's the feeder we used, and many people here use, and it's really great. You can set it to open 4 covered compartments. So it should let you sleep at night.

The one thing about it that people have complaints is that sometimes reviews say that it doesn't open fully. We found that if you set the food tray into the base, then press the manual button that allows the feeder to rotate forward one slot, you can double-check to be confident that the feeding tray is fully seated in the base unit. If the tray isn't fully seated, it won't rotate correctly. So every time we took it out, we put it in and rotated it a time or two to make sure it was in all the way. No problems ever if we did that.

I think it'd be good to see those prior test numbers if you're able to get them.
 
I love my Petsafe 5 feeder. :) And so does Neko - it's her best friend. You could even do feedings every 4 hours if you wanted.

If both cats eat evenly, it looks like each cat is getting 5/6 of a cup of dry a day. It's also important to feed low carb wet foods. The FF or other brands with gravy are usually high carb. Good to have on hand in case kitty's blood sugar goes low, but not a steady part of the diet. Take a look at the food chart for canned food less than 10%. It also OK to feed raw if you want, the food chart lists some options there with some carbs. Neko is on a raw diet (1/4 lb a day) but I've chosen some that range from 3-5% carbs. However, it's hard on the digestive system if you mix raw and dry. Raw and canned together is OK. It's also best to transition slowly. It's easier on their digestive systems and easier to keep on top of the blood sugar requirements with a gradual change. You might want to add comments to the Remarks section of the spreadsheet when you change foods. As food plays such an important role in the blood sugar numbers, it's good to track when changes happen.

Out of curiosity, how much does Pooey weight? It looks like she's getting a lot of calories per day.

As for dose, you could stick to 6U for now with the same food and get those preshot and some tests mid cycle and we may have enough information by Friday to come up with a plan. If she goes low before then (around 120 ish on the AT) we'd reduce the dose. It's also important to get some tests in the PM cycle, as a lot of cats prefer going lower then, as Pooey did yesterday. A before bed test is a good one.

Welcome to the crash course in feline diabetes. There is a lot to learn at first, but it definitely gets easier.:bighug:
 
Appreciate all of the useful info! When I feed by cats a can, Pooey eats hers and half of his. I believe dry food consumption is about an even split now that she eats so much more wet food. Their wet food is all zero carb.

At the vet visit 3/23 she weighed 12 lbs. I'd wager she's put on at least 2 lbs since then with the increased wet food feeding, but I'll know for sure after vet visit tomorrow. She used to weigh 20 lbs.

@Wendy & Niko, what does AT mean when you say 120 on the AT?
 
@Poodoodle AT stands for alphatrak, it is the kind of meter you are using (according to your signature line). Many people on here end up getting a human meter and using that instead. From what I have heard the test strips for the AT are very expensive, usually end up around a dollar a strip. I order Skooter's test strips from ADW (American Diabetes Wholesale) and can get 500 strips for around $120 to $130 I think it is....ends up being MUCH more cost effective.

I have the same timed feeder you are getting. I actually got two, one for his AM cycle and one for his PM cycle....he gets fed at shot time, +2, +4, +6 and a snack at +9 to help kick his pancreas in gear....I think set the feeder to turn at the +10 mark so he doesn't get any more food until shot time
 
I was just checking in on you guys and i'm noticing every dose is different for the last 6 shots.

It's going to be really helpful for you to understand how Lantus works. Take a few minutes and read the sticky about the Insulin Depot. You can think of the insulin depot as being somewhat like timed release. But the timed release lasts for as many as 3 days. There is a balance between the size of a dose and the size of the depot - as you increase the dose, you're also increasing the depot.

When a dose is increased, that can cause higher blood sugar for another day or two - that's called New Dose Wonkiness. We wait for the dose to settle in, for any NDW to resolve, for the depot to build to a size corresponding the new dose, and only THEN can you see what a dose increase will do to the blood sugar. That's the reasoning for the Tight Reg protocol to suggest increasing the dose every 3-5 days. With the Start Low Go Slow dosing method, it allows one week for a larger dose to settle in to see what it does.

When a dose is decreased, a similar thing happens in reverse. Right after the dose is decreased the depot from the previously higher dose is still giving out at the previous rate. That can continue to cause low numbers, even though the dose has been decreased. We wait for a few cycles until the depot has "caught up" with the newly reduced dose.

The effect of constantly changing the dose is that the depot is working in the background but it's not in equilibrium. It has the effect of rocking the boat, basically. When the dose is constantly changing, you'll be fighting to have consistent blood sugar and you won't know what dose to work from. For example, maybe Poodoodle is a cat that has New Dose Wonkiness, so that every time the dose is increased his blood sugar increases for a couple of days.

I'm not sure what you're basing your dosing decisions off of, but want to encourage you to hold a dose steady so it can settle in - also to think in terms of small incremental changes when you do change the dose. Cats can be sensitive to even 0.25u - a quarter of a unit. Think of dosing a diabetic cat as requiring finesse - a tiny amount can make a big difference, and by the same token, Lantus & Levemir don't work well as a hammer to beat down high blood sugar. They simply don't work that way.

If you decide to reduce the dry food carbs, the insulin dose will need to be reduced too. They are also in relation to each other.

If that doesn't make sense, please ask questions.
 
I would like to echo Julie's comments. Since you've shot 6 units tonight, stick to that dose for tonight, Friday, Saturday and Sunday morning. That's a total of 6 doses. Keep getting those mid cycle tests so we can see how low the dose is taking Pooey. On Sunday, post again and we can help you decide where to go next. The only exception to sticking to the same dose is if Pooey goes below 120ish on the AlphaTrak, then we'd lower the dose. Again, post for help if you see a number close to that. There is someone on here almost 24 hours a day. I'd stick to the same food for the short term, so we can remove that variable from the equation. Once the 6 unit has had time to settle in, we can see where to go with the dose and the food. It's always easiest to make one change at a time and give it time to see it's effect, before changing something else.
 
Thanks for reviewing and sharing guidance. I worried excessively the night of 4.22 between competing advice & information plus seeing lower pre shot numbers than I expected. It may have been a bad choice. Her numbers certainly got worse. I plan to stick to 6 for a while, definitely through the time frame Wendy&Neko suggests.
 
I guess at the root of my recent thoughts and decisions for the past few doses is yes, I've been uping to the does too fast, yes, I might have bypassed the right dose and yes, there is a risk of hypoglycemia. I saw a preshot number of 307 last night and thought 6 units might be too much, especially if I don't monitor through the night. Then the next dose I thought maybe go in two increments back to 6 units, 4.5, then 6. Really just making this up as I go along.

I am very grateful to the support from this forum. I am trying to take in as much advice as possible. Tomorrow we start the feeders and transition from dry food. I'll monitor glucose as much as possible, but really uncertain how to adjust dosage according to the numbers. Sounds like I hold steady at 6 units unless I see anything less than 120, and I'll do that, but worry if I don't test every 2 hours or so I might miss the 120 reading.
 
Dropping high carb dry food may reduce glucose levels 100-200 mg/dL and reduce insulin dose 1-2 units, based on individual reports here.
 
One way we can help is if you start a new thread every day. As you get test data, update your subject line. For those of us who monitor the board, having information about your kitty's progress in the subject line allows us to identify if there's something that we need/want to comment on quickly. If something catches our eye, we'll open up the spreadsheet for the bigger picture. If you look at the bulk of the posts on the board, you'll see how most people write out their subject lines.

Most of us don't stay up all night monitoring unless numbers are truly running low. I'd suggest getting a +2 or +3 test. If those numbers are substantially lower than your pre-shot number, that's a signal to get more tests. It's also feasible to set an alarm and grab a test if you're nervous. I used to stay up until all hours monitoring Gabby. Once I learned more about how she responds to Lantus, I was able to get more sleep!

If you have questions about changing a dose, please don't hesitate to post and ask. You may not get everyone in complete agreement but you should have a consensus. Until your cat is transitioned to dry food, you want to base your dosing on the SLGS approach. Regardless of whether you're following SLGS or TR, dose changes are made in 0.25u increments so you don't bypass what could be a good dose.
 
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