? Trying to regulate - need help finding a dose that works

[sassycatlady]

Hi, all! This is my first time posting a question, and I've deferred for awhile as I have searched the boards for advice but I'm at my wits' end trying to find a good dose for my kitty Zander (he's the white one in the picture). Long story short, and based on the data I've collected, it *appears* a good dose for him is somewhere between 2.75 and 3. 2.5U has not gotten him below anything in the pink color range; yet I've had experiences where he's gone way too low on 2.75 and 3, even though at other times I'm getting the dark greens and blues that are so exciting to see! Looking at my data, it seems he goes lower at night (which as I've learned here isn't all that uncommon), so on occasion I've had to skip a shot or lower the PM dose, which I know causes some disruption of the depot and can take a few cycles to get back on track. Luckily, when he goes into those lime greens I've been able to steer those numbers back up with high carb food (dry, though now I am trying FF gravy canned food instead for those cases), and he's never shown any super concerning behavior when he goes that low (except hunger). I would love to leave food out for him at night to avoid those situations when I can't monitor past 10pm but I have 3 other cats in the house, and they are all little monsters when it comes to food so I would have no idea who is eating it!

I'm just getting so frustrated trying to find a dose that works for Zander. I see those lime green numbers and then I lower .25U as suggested in the protocol, but then that doesn't seem like it's lowering his BG enough during the day. On the weekends when I do a curve, all his numbers seem too high, yet during the week when he starts at a "yellow" number at AMPS, I know he must be going lower during the day than what I'm getting on the weekends. And I'm at a loss at what to do. Any expert advice before I tear my hair out (and believe me I would not look good bald, so any advice is appreciated, hehehe)?

 

[Bobbie And Bubba]

Hey there! It looks like Zander is bouncing from the low last night. Your notes in the comment section said you gave a can of FF gravy which shot him up quickly. When you are steering up a low number start with just a few tsp. of just the gravy, use the lid as a shield and squeeze out just gravy. That is where all the carbs are and you don't want him to get full so he won't eat for you in case you need to steer some more.

Looks like to me that the 2.75 dose was good. He has tried the 3 u dose a few times and he's telling you it's too much. You raised it to 3 units last night while he was clearing a bounce from the previous green numbers. Remember it can take up to 6 cycle or 3 days to clear a bounce. I think I would take him back to the 2.75 dose and give each bounce from a green number the amount of cycles to clear (6) and see if he will start to level out. The more time he spends in the green numbers will help his body to not panic so much when he gets one and bounces.

Let's talk about the skipped shots. Since he has had DKA, it's going to be important to not skip insulin. Here is some info about how to handle lower numbers taken from the stickie at the top of the Lantus group. This is assuming that you will be available to monitor him. With TR after enough data, you should be able to shoot anything over 50 that you can monitor. See how on 4/21 the skipped shot he soared up. He could have still bounced up even with the insulin on board just from seeing that low number.

Some general rules when stalling (ECID):

** 50s or higher – don’t feed. The number will bump up on its own soon due to the insulin wearing off.
** 40s or lower – you have a couple of choices.

• When 40s occur at the end of the cycle, it can be beneficial to withhold food and test in 15-20 minutes to determine if kitty is on the rise or hasn’t reached nadir yet.
• If they are hanging in the 40s for a while, or if they are still dropping, it is ok to feed a tsp or two of LC and retest. This is very tricky. You want to avoid feeding too much while you’re waiting for them to go over 50, because you don’t want to artificially inflate the number with food.
  • --- Example: if kitty is 43 and you feed a whole meal, or feed some HC, and the number bumps up to 52, is that the cat’s natural end-of-cycle rise, or is it food spike? What if it is food spike? Then if you shoot the 52, when the food wears off he might drop back to the 40’s (and when insulin kicks in a couple of hours later, you might have a problem). If the 52 is the cat’s natural rise, then he will probably keep rising for the next few hours until insulin kicks in. If you can’t tell whether the number is food spike or natural rise, it’s safest to wait. Your data will help you here. Study the spreadsheet. How much food spike does the cat usually get? How many hours after the shot does the insulin’s onset usually occur in this cat? At what number is the cat likely to be when onset occurs? If the cat does drop, how easy/hard is it to regain control of the numbers? How carb sensitive is he?

** Test often (every 15-20 minutes, or at most every 30 minutes). You want to catch the rise the minute it starts. With most of our cats, once they start to rise they will really zoom. You want to get the insulin in as soon as possible, because it will be another 2-3 hours before the insulin kicks in and you don’t want to let the cycle get too far ahead of you.

Perhaps the most important guideline in shooting low is that any time you shoot your lowest ever number, you should get a +1 and +2 to give you an idea of how the cycle will go. If the +1 is not higher than PS, or if +2 is much lower than PS, that means “pay attention” over the next few hours. Those tests will also help you become even more data ready for the next time you are presented with a low preshot reading.

Using the overlap by shooting low is a great way to take advantage of Lantus/Levemir’s long, flat cycles, once you have learned to do so safely.


With TR, you will be shooting anything over 50. Start to think about lowering the number you are comfortable shooting. And you can always post and ask for help if you aren't sure. Keep gathering all the data you can to help you learn his patterns and trends. And keep posting and asking questions as that is how we all learn.

 

[Wendy&Neko]

What is Zander's regular meal schedule? Do all the rest of the kitties in the house eat the same thing now?

 

[sassycatlady]

Hi, thanks for responding! Let me address a few of your comments....

When you are steering up a low number start with just a few tsp. of just the gravy, use the lid as a shield and squeeze out just gravy. That is where all the carbs are and you don't want him to get full so he won't eat for you in case you need to steer some more

Thanks for the tip. Yes, I gave a whole can. The thought didn't occur to me to only do small portions of just gravy, but now that you mention it, it does make sense! I think I get overzealous and just want those numbers to rise, rise, rise (i.e, "more food will do that faster!"). I will try only giving small portions of the gravy next time and then monitor after that. I was giving only dry kibble for those lows, but am really trying not to give him any more dry food (he used to be a dry food addict).

You raised it to 3 units last night while he was clearing a bounce from the previous green numbers. Remember it can take up to 6 cycle or 3 days to clear a bounce. I think I would take him back to the 2.75 dose and give each bounce from a green number the amount of cycles to clear (6) and see if he will start to level out

I agree! My gut instinct was that 3 was too much; I've taken it back down to 2.75. It's more difficult to dose those quarter measurements, but I do my best with my terrible vision; having bright lights helps. I think I get inpatient with the recoveries from bounces, too, but I guess I just need to settle down and take it cycle by cycle. Rationally, what you're saying makes total sense, but emotionally I just want to see those numbers go down more quickly! I'm hoping over time he will settle into a flatter Lantus curve.

Since he has had DKA, it's going to be important to not skip insulin. Here is some info about how to handle lower numbers taken from the stickie at the top of the Lantus group. This is assuming that you will be available to monitor him. With TR after enough data, you should be able to shoot anything over 50 that you can monitor.

True, I understand w/his history that missing a shot is not a good thing. But, the thing is that most mornings I am unable to stick around and monitor him. I'm on a tight schedule and I can't sit around to get more BG readings. I usually shoot him at 6 and am out the door at 6:30 for work. So it's either something or nothing, and I was too nervous to give him insulin on some of those lower readings without being around to test/feed. At night, I could afford to wait around for the numbers to rise, but ... again, keeping to that 12/12 schedule in dosing drives me to make quick decisions because I can't easily adjust the shooting times (in the AM) during the week and I am trying to be more consistent w/his dosing schedule than I used to be. This morning for example, he was sitting on an 82 at 6AM. I gave him a reduced dose of 1U, because I don't want to skip a shot anymore and this felt like a good compromise without going over the edge. Was this a good call, you think?

 

[sassycatlady]

What is Zander's regular meal schedule? Do all the rest of the kitties in the house eat the same thing now?

Hi Wendy! Zander usually eats about a can of FF Flaked for breakfast, a snack around 4 when I get home (1/2 can of FF) and another can of FF for dinner around 6. My other cats would LOVE to eat Fancy Feast, but with 3 other cats with big appetites, I can't afford to give them all FF, so they usually get Friskies pate/shreds and/or some lower-carb dry food (which I make sure Zander does not get into! He's usually too consumed with his FF anyway ). Zander is a pate snob and will not touch it. I think he's the only cat I've ever had who refuses to eat the pate. Something about the texture, I guess. I broke out in a dance when I discovered he liked the FF flaked (this from a high carb gravy-loving canned food/dry food addict)!