Thoughts or advice on dosing

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Tuxedo Mom

Tuxedo Mom

Member Since 2014
Although I have been here for months I finally got my spreadsheet done for Tuxie. It is only showing March but I have been testing since the beginning of December. This was as much as my tired little brain could handle doing today :)

Since yesterday's +6 hour PM was so low it was suggested that I drop his dose by .25 units tonight. I had already given his AM shot at the old dose. I have done a half day curve today and he seems pretty high and flat. With the dose reduction, how long should I hold it until considering raising it again. I go up by .25 units usually every 3-4 days if things are inactive.

Most of the last 4 months Tuxie has not had much response so I really never gave reductions much thought.

He has been testing for IAA and Cushing's...both are negative. He had a dental and two extractions done the end of February, so all is good there. He does have an inflamed pancreas..verified by ultrasound and spec fPLI...BUT he has NO signs of pancreatitis...has energy, eats like a horse, is putting on weight (even though I would like him to stay where he is...13 lbs...12-12 1/2 is a good weight for him) no nausea, not dehtdrated..etc..etc.

His vet has suggested trying prednisolone to maybe help with the inflammation, but I am concerned about adding steroids to the mix when he has no obvious symptoms of pancreatitis. He gets extra taurine, vitamin E and fish oil and monthly shots of B12.

But every now and then Tuxie throws a low(er) number just sort of out of the blue.

So any input/suggestions/thoughts would be greatly appreciated.

Thanks
 
Hello and welcome from a fellow Canadian. You've got enough data in your spreadsheet. You do a great job testing and typically the data for the last couple of weeks is all that is relevant.

None of us here are veterinary professionals but many of us have been working with our cat’s diabetes for a long time. Even those of us who have been here for a short time are here to help. This is a wonderfully supportive community.

People here pick a method or protocol to follow to determine dosing. You have the option of following the Tight Regulation Protocol or the Start Low Go Slow (SLGS) method for managing your cat’s diabetes. You don’t have to stick with whichever approach you initially choose but it is helpful to give your choice a chance so you can evaluate the results fairly.

The Tight Regulation protocol was developed based upon the premise that a cat's pancreas may be able to heal and return to producing insulin if the cat's BG is kept in a normal range (i.e., 50-120}. Caregivers following this protocol adjust insulin doses following the protocol guidelines to aim for that range. Basic information on the TR is here: . The advantage of this approach is that it is based on research published in a leading veterinary journal and has an admirable track record of getting cats who are within the first year since diagnosis into remission.

The Start Low Go Slow (SLGS) approach has caregivers start with an initial dose based upon the BG at diagnosis and whether kitty has been transitioned to a wet low carb diet, hold that dose for a week or two while testing for ketones regularly, being consistent with food and testing before shooting every 12 hours. Once a week a curve is done (test every 2 hours for one cycle) to check for the lowest point. the low number in that curve determines any dose change for the following week. This approach was the original method used in the FDMB prior to the TR protocol. It is an alternate approach if TR is not the right fit for you or your kitty. Basic information on the SLGS approach is here:

Once you've selected which one you'd like to use, it helps to put it in your signature so that people know who to advise you on dosing. With either protocol, you'd definitely go back to 4.5U after that low yesterday.
 
A couple of other things. The AlphaTrak meter and strips are rather expensive. Most of us here use human blood glucose meters and the protocols are written with those numbers in mind. One of our other Canadian members found the Bravo test strips. They are considerably cheaper than almost anything else you can find in Canada. I live close to the border so I hop across every once in a while for my test strips. And strangely enough, I've found Safeway to be the cheapest source for my insulin, lancets and syringes.

Was there a reason your kitty was tested for IAA and Cushings? Cushings is rather rare in cats. Acromegaly is much more common and recent research has shown that 20-25% of diabetic cats have acromegaly. Neko has both IAA and acromegaly. However, we don't normally suggest testing for high dose conditions (which includes IAA and Cushings), until kitty gets to 6 units of insulin.
 
Thank you for the response.

Tuxie was actually tested for IAA ,Acro and Cushing's since 2 of the tests had to be sent to the same place I had them all done. The vet who did the ultrasound thought he might be Cushing's because of the organomegaly (pancreas, liver and adrenal) and because of the distended belly. So I figured the best thing to do was test for everything to either rule it out or know what I could be dealing with. That was my decision and was not pushed or suggested by his vet.

I bought the AT meter when I went to the first vet....who I changed after a month. She did not believe in home testing..wanted me doing a vet curve every 10 days ($$$) said that Lantus was the only insulin used for cats..etc etc. So needless to say I interviewed another vet and got one who is on track with me. Since I had the AT meter I tried some Free style lite strips since they are identical and same company. I leave the AT set to cat code. I did about 30 side by side comparisons on AT/AT strip and AT/FS strip and they are close to identical. Th FS strips are about as affordable as any other ones available in Canada.

I am more inclined to use the TR protocol. I was waiting until Tuxie had his dental and extractions to make sure that his teeth weren't part of the problem. That was done at the end of February. So now I am ready to go to town on the TR. It is just that those odd low numbers freak me out. For almost 4 months I never saw a number even close to a green. And the couple of greens that Tuxie has had just seem to come out of nowhere. I have gotten so used to dose increases and flat higher numbers with not much of a nadir, so I am feeling a bit lost with actually having to do dose reductions.

I am home most of the time so I do a lot of testing. But the times I am out worry me after his drop at +6 last night. There was no warning that he was going to drop that low and if I had have been out I don't even want to think what could have happened.

I guess I have just gotten so used to higher flat numbers that I was caught off guard with such an active cycle.

BTW in spite of Tuxie's high numbers over the last 4 months he has never had any ketones. I test every day...sometimes twice.
 
Thanks for putting TR in your signature. Great news on the ketones! We've had some kitties here who stay and fairly flat, then boom, hit their magic dose. Let's see how Tuxie does on the reduction. If he doesn't hold it, get greens at the lower dose, you may have to increase him back up.

Acromegaly is a benign tumor on the pituitary gland, which sends out excess growth hormone. That's the high dose condition responsible for organomegaly. And it's responsible for a ravenous appetite (think teenage boy appetite), pot belly and weight gain even when not properly regulated. Can you tell me what his IGF-1 score for acromegaly was? IAA score? As you could expect, all things acro and IAA are special interests of mine. Cushing's kitties are more often associated with thin skin or skin tears. This article has pretty good coverage on insulin resistance in cats. Neko had very few visible signs of acromegaly, just some eye tearing and aversion to bright light, and insatiable hunger and getting into inappropriate foods (baguette, muffins, banana bread :rolleyes:).
 
Tuxie's IAA was 4 and his IGF-1 was 68. These were both done at Michigan State U and their determination was that both these numbers do not support a diagnosis of acro or IAA. I can't afford to have an MRI done or treatment if he did have a pituitary tumour...either acro or cushings.

Interesting about your Neko and the eye tearing and light aversion...Tuxie has those as well...but I had put it down to a URI since the sneezing and tearing go away when I treat it with l-lysine and occasionally the tobradex drops if the third eye starts getting red. He haad the stain test done so there are no abnormalities on his little eyeball.
AND of course...the HUNGER< HUNGER< HUNGER. I feed him small meals about every 3-4 hours when I am home. At night I stay up until almost midnite to give him a small meal but by 4AM he is crying for more food. Sleep is a forgotten practise around here!!
 
I think I will have to look into one. I can't leave out a huge bowl of food since he will just eat until it is all gone, so an autofeeder might actually let me get more than 3 or 4 hours sleep at night. I am really tired of being part of an experiment in sleep-deprivation :)
 
I LOVE autofeeders, and Neko loves her friend Otto(feeder) too. She can spend ages hanging out staring at him and that means she's not bugging me for food.:) It also means I can have a life and get out of the house. The Petsafe 5 Chris mentioned is fairly cat proof.

Try not to feed many carbs late in the cycle. The effects of the insulin are wearing off then and carbs can put the brakes on the insulin action and raise the preshots. You can do zero carb snacks like freeze dried food. Or some people will boil a chicken breast and cut it into cubes for those later in the cycle meals. Or since you are feeding raw as I am, I sometimes give Neko a bit of raw chicken neck or chicken gizzard, which doubles as a tooth cleanser. But only during the day as you can't leave those out for long. There is a small compartment under the Petsafe 5 where you can put a small ice pack for the raw, or you can put an ice cube on top of the meat. The added water when it melts is good for them anyway.
 
I will definite;y look into getting an "Otto" friend for Tuxie. My food is lightly cooked so I could freeze it into small cubes and use that. Once it hits the dish it won't last long so I won' t have to worry about it spoiling. I would "kill" to be able to get a 6 hour sleep!!!
 
For overnight if you are ever worried about low numbers, you can put medium or higher carb food in the autofeeder. That's what people who work long days do as well. I hear you on needing the sleep!
 
What a great idea!! Thank you for the suggestion. At this point I would rather that I be able to get a few nights good sleep so that I don't get worn out (any worse than I already am :( ) and end up getting sick. I will check out our local stores tomorrow and see if they carry them here.
 
That is perfect!! I will be out tomorrow and there is a Petsmart right in the area where I will be so I will definitely check it out. I just hope the unit is not too noisy or strange...Tuxie is a VERY skitty kitty and is always scared of new things. I had a stuffed kitty toy that if you squeezed the paw it meowed and purred...and not even loudly. Well Tuxie ran and hid under the bed for an hour. His litter sister Maxie on the other hand was right in there checking out the "new kitty". I can see who got all the brave genes in this family!! :)
 
The first couple of times Otto made his revolving noise, Neko ran away from it. Then I showed her there was food in it. :cool: And a great friendship was created. There will be one opening uncovered at first. Try feeding a regular meal there the first time so he associates food with it.
 
Once Tuxie sees food he will be okay. He is VERY food motivated. 10 ear pokes today and he still keeps coming to his testing spot. Considering how stressful it was when I started 3 1/2 months ago his food motivation has made testing a breeze.
 
I wanted to add my welcome! Glad you're here - and hopefully we can help you learn what you need to know to take care of Tuxie. I have a tuxedo boy named McGee - looks a lot like your Tuxie.

Those test numbers are very clearly not a problem with iaa or acro. Punkin had 7% on iaa and 281 on the IGF-1 test for acro - so he was positive for acro only. Tuxie is probably starving because his blood sugar is high. That will get much better as his higher blood sugar numbers go away.

Can you clarify on the test strips - are you saying that you used the AT with AT strips and compared them to the AT using Freestyle strips and the test results were the same? We really encourage people to use a human glucometer because our dosing documents, as well as all of the information in the yellow stickies above (like what to do when you're faced with low numbers) all use human glucometer numbers. So if you're using an AT, you've got to be always vigilant that people realize that when they're giving you advice and when you're looking at any of the documents. ATs run about 30% higher than human glucometers.

As you get into this, you'll begin to see that Tuxie has some patterns that become predictable. It helps a lot when you start to figure out that, for an example, i used Punkin's +3 as a pointer to tell me where he was going after +3. For him, that worked. On 3/9, the last time that Tuxie got a green number, he bounced and was high for 2 days, then it looks like he cleared the bounce and got into the 100's. Read in the second post here for more information on New Dose Wonkiness and Bouncing. The more he gets into green numbers, the more his body will get used to them and the longer he'll stay there.

Anyway, glad to have you here. Keep asking questions!
 
Couple of other thoughts - always as soon as I hit post! :rolleyes:

You might want to bookmark this post "Where Can I Find?" that is a table of contents to the information on the Lantus/Lev insulin support group.

There is a discussion bookmarked in the second section of that post under "feeders" that a few people were talking about some pros/cons of the autofeeders. Lots of that second section isn't relevant to you now, but you may want some of it later.

Here are the guidelines on what it means to be regulated in a diabetic cat. Remember these are in human glucometer numbers. Your tests are roughly 30-40% higher

Q6.1. What is regulation?

A6.1. There are different definitions of regulation. As hometesting becomes more common, we've been getting a better understanding of what cats and their humans might be capable of. Janet & Fitzgerald propose the following "regulation continuum":
  • Not treated [blood glucose typically above 300 mg/dl (16.7 mmol/L), poor clinical signs]
  • Treated but not regulated [often above 300 (16.7) and rarely near 100 (5.6), poor clinical signs]
  • Regulated [generally below 300 (16.7) with glucose nadir near 100 (5.6), good clinical signs, no hypoglycemia]
  • Well regulated [generally below 200-250 (11.1-13.9) and often near 100 (5.6), no hypoglycemia]
  • Tightly regulated [generally below 150 (8.3) and usually in the 60-120 (3.3-6.7) range, no hypoglycemia, still receiving insulin]
  • Normalized [60-120 (3.3-6.7) except perhaps directly after meals -- usually not receiving insulin]
There may also be an extra category of "mostly above 300 (16.7) but with good clinical signs" which occurs with some cats who are getting insulin. We don't know why it happens, but such a cat probably should not be considered to be regulated. On the other end of the spectrum, it is possible for a cat who is not getting insulin to have blood glucose as low as 40 mg/dl (2.2 mmol/L) on a home glucometer. If you have a non-diabetic cat, try testing her with the same meter to get a safe comparison figure.​
 
Thanks for your welcome and input Julie. I have been coming here for months but have been more of a reader and "peeping mommakitty" than a poster. But I am going into TR much more now so I will probably be needing assistance, especially when I start to see drops like he had the other night.


Basically the AT meter with the FS Lite strips acts the same as the AT meter with AT strips, so I know my numbers are higher than a human meter. I also cross reference the FS lite meter with FS strips and it ran pretty consistently about 35-40% lower than the AT meter. I really have too much time on my hands to do all these cross-referencings. As I told my vet I am very OCD when it comes to treating and monitoring Tuxie. Mind you I took my meter AT/FS strips to the vets and tested it against hers (One Touch Ultra 2) and it was within 5% of hers from the same drop. Since all my testings have been AT or AT/FS strips it is easier for me to follow changes using the same set-up. I have it listed in my signature that I use an AT meter.

It is just the last 3 weeks that I am really starting to follow the TR protocol. Before that Tuxie needed dental work and extractions so I wanted to get that out of the way and get the test results for the IAA and Acro before proceeding. I must say that I have not seen the amount of yellow numbers he has pulled out this month. Again tonight he may be heading for a low number again since his nadir is usually around + 6 hours. It is really nice to see some action, but I have not had to deal with green numbers before so it throws me a bit. I hope he settles in on his next test. I only had about 3 hours sleep last night and I have to go out in the morning tomorrow.

However being a walking zombie will be worth it if I can get Tuxie into safer numbers on a regular basis.
 
Looks like we were both posting at the same time. I actually did test Tuxie's sister Maxie with my setup. She had a UTI and her number at the vet's (blood draw) was 14 (250). After I got her AB I waited 4 days and retested her at home 20 minutes after eating. She was 4.7 (85) so the high numbers were from infection and stress.
 
I would go ahead and give her some food now to slow down the speed of her drop.

One thing we encourage people to do is to post their blood sugar tests in the subject line - that lets it all be summarized and seen from the main page. For example, I'm noticing that Tuxie has dropped from pmps 454 to +2/371 - a drop of 83 points in 2 hours; to +4/265 a drop of 106 points in the next 2 hours. When a cat drops fast that alone can trigger another bounce. How fast is too fast varies by cat, but anything over 50 points per hour is likely "too fast."

With a cat that likes to drop fast, we suggest people start doling out the food every hour or so to try to slow things down. So if you normally feed her 4 oz in the morning and 4 oz in the pm cycle, you might try dividing the 4oz up and giving 1oz each at preshot, +1, +2 and +3. So same total amount of food, but spread it out.
 
Thanks for the information Julie. I usually just give a bit of roast of chicken or salmon after testing and give him his 1/4 cup of food before I go to bed. But I don't want a repeat of last night so I will give him some regular food and check him again in about an hour..that will be his +6 for the PM.
 
He gets 1/4 cup at AM another 1/4 cup at AM +6 hours...1/4 cup PM and 1/4 cup PM +6. After his ear pokes he gets a little chicken, roast or salmon or a bit of bone broth.
 
One thing you might try that may improve his BGs - the insulin is the strongest in the first half of each cycle. Many people find that if they give most of their cat's food in the first half of the cycle, that puts the carbs there when the insulin is strongest. Eating after +6 when the insulin is waning can really drive up the numbers in that second half of the cycle. That *might* explain his high preshots.

I fed punkin 3oz at preshot and 1.5oz at +3, every cycle. From that point til the next preshot all he got was cooked chicken as pokey treats, or if he was really hungry i gave him a little more to help tide him over.

You might try moving that +6 meal to +3 instead. That alone may prevent the sudden drops at +4/6 that you've experienced. A lot of this kind of thing - playing with food timing - is a trial and error thing. Some people put an * in the cell when they feed their cats. Some write good notes in the comments section so they can see what works and what doesn't work. You'll have to play with things and see what works for you.
 
Wow...thanks for all the insights. I have driven myself crazy these last 4 months trying to learn EVERYTHING (not possible!!) about feline diabetes, but a lot of it comes down to how each individual kitty reacts or doesn't react. Changing the higher carb food earlier might just be the way to keep his numbers lower and more even. Tuxie doesn't really care what he eats..just so long as he gets food...LOL.

I feed Maxie with him but since she is more of a grazer I put her food on the table once she finishes what she wants at meal times where Tuxie can't get to it. That way she has food when she wants it and Tuxie can't vacuum up all her food.

I certainly have been given a lot more things to play around with. A little tweaking might just make a difference.

Thanks one more time Julie...you are a wealth of information.
 
Well Tuxie's PM +6 is up a bit most probably from the spoon of food i gave him 1/2 hour ago. But I think I a,m safe to go to bed and maybe get 4 or so hours of sleep.

Thanks to everyone who gave information and suggestions. Have a good nite all beans and kitties both! :)
 
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