Zeke - Recently Diagnosed July 2013

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MrZ

MrZ

Member Since 2013
Mr Zeke was recently diagnosed with diabetes (7/13) during his annual checkup. His previous annual was in June 2012. Zeke is 11 years old and shares a home with two other kitties, both 1 year older than him - all exclusively indoor. Sometime within the past year we decided to switch from Iams Indoor Weight Control dry (which we'd been feeding because Zeke was tipping the scales at 22 lbs) to Iams Senior dry thinking the change in formula would be best due to the age of all three. Their diets are supplemented with a morning treat of wet food (Wellness -all varieties), which we've been doing for many years. During the course of the past year, after the switch to the Senior formula, we noticed an increase in litter box activity, specifically in liquid waste. Thinking back, it seems to have happened quite soon after the switch to the Senior formula - through it could have been several months afterwards. Unfortunately we dismissed this increase in activity as just an adjustment to the change in diet and didn't think anything more about it.

So although Zeke was just recently diagnosed, it’s possible he’s been diabetic for up to a year now. Well, here we are trying to right this wrong. Upon diagnosis, we eliminated all dry food and have been feeding him the grain-free low-carb formulas of Wellness. Zeke has been on Lantus since 8/18. First week was 1 IU but the second week our vet increased to 2 IUs. His BG readings are all over the board (record low of 79 last night, with a record high of 525 this morning). We're pretty much at a point where we think we need to adjust his insulin but are not quite certain exactly what to do. We've studied the Protocol from the uq.edu website, for regulation on Lantus using the AlphaTrak2 glucometer (as that’s the meter we’ve been using ). We're a little confused about whether we need to increase by 0.25 IU or not. Despite a nadir of 79 last night, his highs consistently exceed 200mg/dL on a daily basis.

Our vet historically has been great but she only works on Saturdays and her response time on emails is not immediate (often not even within 24 hrs) . Additionally, managing diabetes does not appear to be her specialty and she never even brought up the option of the Tight Regulation Protocol – we found it on our own. We live in Houston, TX, and are hoping that maybe someone on the FDMB has a vet they could recommend to help us through this process. We would greatly appreciate.
 
Re: Recently Diagnosed

Great! you're home testing! I know you didn't ask for it but, here are some glucose reference ranges used for decision making using glucometers. Human glucometer numbers are given first. Numbers in parentheses are for non-US meters. Numbers in curly braces are estimates for an AlphaTrak.

< 40 mg/dL (2.2 mmol/L) {< 70 mg/dL for an AlphaTrak}
- Treat as if HYPO if on insulin
- At nadir (lowest point between shots) in a long term diabetic (more than a year), may earn a reduction.

< 50 mg/dL (2.8 mmol/L) {< 80 mg/dL for an AlphaTrak}
- If before nadir, steer with food, ie, give modest amounts of medium carb food to keep from going below 50 (2.8).
- At nadir, often indicates dose reduction is earned.

50 - 130 mg/dL (2.8 - 7.2 mmol/L) {80 - 160 mg/dL for an AlphaTrak}
- On insulin - great control when following a tight regulation protocol.
- Off insulin - normal numbers. (May even go as low as the upper 30s (1.7 mmol/L){60s for an AlphaTrak}; if not on insulin, this can be safe.

> 150 mg/dL (8.3 mmol/L) {> 180 mg/dL for an AlphaTrak}
- At nadir, indicates a dose increase may be needed when following a tight regulation protocol.

200 mg/dL (11.1 mmol/L) {230 mg/dL for an AlphaTrak}
- no shot level for beginners; may slowly reduce to 150 mg/dL (8.3 mmol/L) {180 mg/dL} for long-acting insulins (Lantus, Levemir, and ProZinc) as data collection shows it is safe

180 - 280 mg/dL (10 - 15.6 mmol/L) {may be 210 - 310 mg/dL for an AlphaTrak}
- Any time - The renal threshold (depending on data source and cat's renal function) where glucose spills into the urine.
- Test for ketones, glucose is too high.

>= 280 mg/dL (15.6 mmol/L) {may be >=310 mf/dL for an AlphaTrak}, if for most of the cycle between shots
- Uncontrolled diabetes and thus at risk for diabetic ketoacidosis and hepatic lipidosis
- Follow your insulin protocol for dose adjustments
- Test for ketones; if more than a trace level of ketones, go to vet ASAP.
 
Re: Recently Diagnosed

As far as dose adjustments for Lantus, these are made on the nadir, the lowest point between shots. It will help if you will post a few recent days of your numbers like this:
date
AMPS (morning pre-shot test result); dose
+1 = any test result taken 1 hour after the shot
+2 = any test result taken 2 hours after the shot
+# = any test result taken # hours after the shot
PMPS (evening pre-shot test result);
This will let us see a bit better what is going on.

The typical routine here is to test, feed, and shoot, all within about 15 minutes. Additional feeding may take place through the 1st 10 hours after a shot, then we like to pick up the food so the next pre-shot test isn't influenced by eating. Try this for a day or so to see how that affects the pre-shot tests

Tracking your numbers on our spreadsheet may help you see patterns in the glucose tests, plus if you share it, others may give you feedback. The spreadsheet automatically color codes the glucose values based on the range it falls within. Instructions are here.

Food - glad you've ditched the dry; you're right, that may have contributed to the problem. Dr Pierson has a lot of good info about feline nutrition at Cat Info, including a terrific PDF file of food composition values. The Wellness canned is generally below 10% calories from carbohydrates; there are others you may wish to check, too.
 
Re: Recently Diagnosed

Hi and welcome. I just wanted to pop in and let you know I know a long time member that lives in Houston. I sent her a message on facebook to ask her if she had a vet referral and she does and would happily share. She said she'd pop on here later this afternoon when she could or you can send her an email before then if you'd like. Her name is Celia. I'll private message you her email address. If you reload your page you'll see up to the upper left of the page it should say that you have a message. Just click on that and it will take you to your inbox here on the board. It's like email but just within the confines of this message board so you'd go to your regular email to send her a message
 
Re: Recently Diagnosed

Hello and welcome to the board!

We might be able to see better whats going on if you do the spreadsheet that BJ asked for. It will give us a better picture. Let me know if you ned help with it!

However given you are using an Alphatak and he dropped below 80, that sounds to me like he would qualify for a 0.25IU dose decrease as per the protocol ( under 80 on an alphatrak = under 50 on a human meter). Also the reason he went to 525 after that was likely a bounce since he went too low:

Bounces - what are they and is my cat doing them?
When a cat isnt well regulated or is first diagnosed, the blood glucose has probably been high for a while. As the insulin starts to take effect and numbers start to come down, the liver has to learn to adjust to the lower numbers. We call this "liver training school". But before it relearns that low numbers are ok, when the BG drops to a number lower than the liver is accustomed, or if BGs drop low, or if the BG drops suddenly, the liver”panics” and reacts by releasing counterregulatory hormones and glucagon. This drives the BG back up. This is what we call a "bounce". Bounces can take up to 72 hours to clear so we are generally careful about increasing doses during the bounce. Once the bounce clears, then you can see the "real" numbers and determine if the dose needs to go up or down.

Wendy
 
Re: Recently Diagnosed

Hi Zeke and his caregiver and welcome to the board. Lots of experience here to help you out.

Would you tell us your first name please?

When the protocol talks about the peak, it's not talking about the highest number you get. It's talking about the maximum effectiveness of the insulin. Peak and nadir are synonymous.

You might find this Sticky Lantus & Levimir - New to the Group, Please Read from over in the Lantus TR forum to be helpful with terminology and other information.

Based on that 79 you got, the fact you are using an Alphatrak, and the protocol we follow, Zeke is due for an automatic reduction of 0.25U in his dose as Wendy already indicated to you.

You may find this write-up on our modified version of the protocol a bit easier to understand. It's also from a Sticky from the Lantus TR forum.
"General" Guidelines:
•Hold the initial starting dose for 5 - 7 days (10 - 14 consecutive cycles) unless the numbers tell you otherwise. Kitties experiencing high flat curves or prone to ketones may want to increase the starting dose after 3 days (6 consecutive cycles).
•Each subsequent dose is held for a minimum of 3 days (6 consecutive cycles) unless kitty earns a reduction (See: Reducing the dose...).
•Adjustments to dose are based on nadirs with only some consideration given to preshot numbers.

Increasing the dose:
•Hold the dose for 3 - 5 days (6 - 10 consecutive cycles) if nadirs are less than 200 before increasing the dose by 0.25 unit.
•After 3 days (6 consecutive cycles)... if nadirs are greater than 200, but less than 300 increase the dose by 0.25 unit.
•After 3 days (6 consecutive cycles)... if nadirs are greater than 300 increase the dose by 0.5 unit.

Reducing the dose:
•If kitty drops below 40 (long term diabetic) or 50 (newly diagnosed diabetic) reduce the dose by 0.25 unit. If kitty has a history of not holding reductions well or if reductions are close together... sneak the dose down by shaving the dose rather than reducing by a full quarter unit. Alternatively, at each newly reduced dose... try to make sure kitty maintains numbers in the normal range for seven days before reducing the dose further.
•If an attempted reduction fails, go right back up to the last good dose.
•Try to go from 0.25u to 0.1u before stopping insulin completely.
Click to expand...
 
Re: Recently Diagnosed

Thanks to you all for the quick responses. The info regarding the bounce is so appreciated. I'd read about the bounce and what you recommended about reducing the dose makes sense. Also, thanks for the spreadsheet template. I will transfer the data I've already compiled to that spreadsheet. The grouping is a great visual to see how Zeke's doings. Please see the attachment for readings I've recorded.

Thanks,
Laura & Mr. Z
 
Re: Recently Diagnosed

Hi Laura!

Ok cool.the spreadsheet is so helpful!!! thanks!

Do you want to put the sheet in Google docs to save people saving it to their desktops? Some peoples computers might not like that.. also I am not sure BJ gave you the updated SS instructions so see here how to do it: http://www.felinediabetes.com/FDMB/viewtopic.php?p=179835. Deb might be able to help with this? :)

Also can you add to your signature a few more bits of data that will really help us - esp the Alphatrak info! i.e.
Lantus. Wellness canned. USING AN ALPHATRAK.

You can totally see the bounce here. Its almost textbook. You have that low green and a steady rise to a nasty black. Now he is surfing at red and pink. That bounce could take a few days to clear.

The protocol says to reduce the dose by 0.25IU whenever you drop under 80 (cos of the AT). So thats 1.75. However since you raised the dose from 1 to 2 units, it looks like you may have missed the right dose. So maybe you even want to drop to 1.5 and see how that goes.

Do you have syringes with 1/2 unit markings?

Wendy
 
Re: Recently Diagnosed

I saw your PM, that your PMPS is 283. The reason I am saying drop by 0.5 is that you went from 1 unit to 2 units when the protocol says increases of 0.25 so you may have skipped past the right dose. 2 units is too much. Plus you didn't say if your syringes had half unit marking so I thought it would be easier for now to give 1.5.

Wendy
 
Re: Recently Diagnosed

Thanks. Ok, we did the 1.5IU (we hope). Zeke jumped as we were dosing so we're not sure if he got it all. I guess we'll just have to see how tonight goes. We only had the 1 unit syringes so I ran out about 1 1/2 hours ago to try and find the 1/2 unit syringes but had no luck. So we opted for the 1.5IU dose.
 
Re: Recently Diagnosed

You can get 1/2 unit marking syringes in most pharmacies although we have discovered the pharmacists don't always know that. You should have 1/2 unit markings on these..

For U-100 syringes (Lantus, Levemir), get 3/10 cc, half-unit marked, short needle, 30-31 gauge ie
Relion 3/10cc 30 & 31 gauge short
BD Ultra fine 3/10cc short
Terumo Thinpro Insulin Syringe 31G 3/10cc
Kroger 0.3cc 8mm, 31 gauge.

Also lantus is a depot insulin which means it takes a few days to build up in, or drain from the cats system. So we might not see the impact of this dose for a few days and any drops before then could be a result of the 2iu still hanging around. This is also why consistency is important with lantus... To allow the depot to establish. And if you did do a fur shot tonite you might not even see the impact of that for a couple of days..
Code:

Wendy
 
Re: Recently Diagnosed

Wendy thanks! The 1.5 iu looks to have been the right choice. Well see if the depot effect of the 2.0 IUs will pop up in the next day or so.

Getting ready to take his AMPS for today but here's what we got last night:

PMPS 283
+ 2 183
+4 152
+6 144
+7 153
+11 203

OK, so here's my question. Now that we've decreased the dose due to his nadir of 79, how long should we continue dosing at 1.5 iu? Referring to the protocol, it appears we should continue at this dose and adjust only if his nadir rises above 200mg/dL or his BG <80, correct? So, if drops below 80 at any point during the cycle, then we reduce again, correct?
 
Re: Recently Diagnosed

Yes, stay at the 1.5U dose for a minimum of 6 cycles, UNLESS the BG drops below 80 with the Alphatrak. We may suggest you hold that dose longer, depending on how long it takes the bounces to clear.

Wendy is spot on. Classic text book bounce going on there.

If you need some help getting the SS setup in Google and/or in your signature, PM me. I've done this for other folks.
 
Re: Recently Diagnosed

Deb, I tried to PM you but the message is just sitting in the Outbox (not Sent). Yes, I could use your help setting up Zeke's ss in my signature.
Thanks,
Laura
 
Re: Recently Diagnosed

heres the protocol below.

You have to look at the nadirs for the 3-5 days and kinda average them out - if they are all pink then its a no brainer to increase. But say they all yellow but 2 are a green 81. I think I would be holding that dose a little longer because you dont have a lot of wiggle room to have him drop any lower than 81 which will happen if you raise the dose. Also as Deb said, we may wait for teh bounce to clear to get a good picture.

Deb and I have looked at hundreds of sheets and can help advise on this - just keep us updated . As can the Lantus board which has more experienced dosing members on it. You might want to take a peek at it once you are all set up with a SS.


Increasing the dose:
•Hold the dose for 3 - 5 days (6 - 10 consecutive cycles) if nadirs are less than 200 (blue green) before increasing the dose by 0.25 unit.
•After 3 days (6 consecutive cycles)... if nadirs are greater than 200, but less than 300 (yellow) increase the dose by 0.25 unit.
•After 3 days (6 consecutive cycles)... if nadirs are greater than 300 (pink red) increase the dose by 0.5 unit.

Reducing the dose:
•If kitty drops below 40 (long term diabetic) or 50 (newly diagnosed diabetic) reduce the dose by 0.25 unit. If kitty has a history of not holding reductions well or if reductions are close together... sneak the dose down by shaving the dose rather than reducing by a full quarter unit. Alternatively, at each newly reduced dose... try to make sure kitty maintains numbers in the normal range for seven days before reducing the dose further.If an attempted reduction fails, go right back up to the last good dose.
Click to expand...
 
Re: Recently Diagnosed

Sorry Laura, I was actually working all day today. Yup, Saturday and Sundays I work sometimes.

I sent you a PM, telling you what I would need to do the setup for you. Sorry it took so long, but work was busy with merchandise coming in, customers to help, and working a bit on new orders for the shop.
 
Re: Recently Diagnosed

Hello everyone. I've made some changes as per your suggestions. I have uploaded Zeke's ss to my signature and added additional information. Please let me know if you are not able to see his ss or if there is any additional information I should add that would be helpful. I've updated his BG info through +6 today (116). Typically, his peak is at +6 but today it actually went up from his +5 BG of 103. We're anxious to see his PMPS BG (whether it will be <200, >200,>300 or other). Initially, our impression is that going down to 1.5u was the right move, however we're trying to not get too excited. I've seen enough posts to understand that kitty's BG can be very up and down while following the protocol. I am sure we will continue to reach out to you for advice as we continue on the road to helping Zeke get OTJ.

We're so thankful for this wonderful MB and all the very caring and knowledgeable individuals who commit their time to helping others who find that their kitty is now a member of FD club. You are a godsend. God bless.

BTW - What is your opinion of the shelf life of Lantus? We keep ours in the box, in the frig (only steady shelf not the door). Is the life only 28 days after opening or as long as it's still clear, with no signs of contamination or particles, can we use longer?
 
Re: Recently Diagnosed

Your SS works fine, I have read only access to view it. Good job!

Zeke is looking good on this 1.5U dose. Nice to see some of those blues! Lets give it the minimum 6 cycles before thinking about a change in dose.

BTW - What is your opinion of the shelf life of Lantus? We keep ours in the box, in the frig (only steady shelf not the door). Is the life only 28 days after opening or as long as it's still clear, with no signs of contamination or particles, can we use longer?
Click to expand...
People here have used the Lantus for 4-6 months after opening it with proper storage. This info is from one of the stickies in the Lantus TR forum. STICKY: LANTUS & LEVEMIR - INFO, PROPER HANDLING, & STORAGE

If there are any complicating medical conditions, like CKD or pancreatitis, etc. those are nice to see in the signature.

If you update the user control panel, profile tab, edit profile, location field and put your country, state/province, city/town or metro area that would help. We like to know that for those low numbers and staying with you. Nice to know what the time difference is and weather we can commit to helping you or need to leave for work and find someone else to help.
 
Re: Recently Diagnosed

At least 4-6 months in the fridge - just keep an eye on it for cloudiness, floaters etc. Or if you suddenly see weird BG levels around that time that might indicate that its not working as well. I have had 4 months but was using it for 2 cats so twice as many draws! remember too - dont shake or roll it.

This dose is looking good so far - especially since you are using the alphatrak.

Wendy
 
Re: Recently Diagnosed

OK, so Zeke is at 158. He hasn't eaten for about 1.5 hours. We've been giving him his shots at about 7:30AM/PM but we woke up late this morning so he didn't get his shot until 9am. We'd like to get him back to the 7:30 time but figured we'd do 8:15 today, and shave off time tomorrow AM/PM to get him back to 7:30 schedule on Tues (9/3). Because it doesn't look like he got above 200 today, and he's at 158 right now, should we wait a little or is it ok to give him his 1.5u now? Would appreciate your thoughts?
 
Re: Recently Diagnosed

You can move the shot by 15minutes each time or half an hour a day, otherwise shooting early acts as a dose increase.
 
Re: Recently Diagnosed

Thanks Wendy. We only gave him his shot 15 minutes early. He ate about 2 tbls before his PMPS - his BG went from +11 158 to PMPS 173. Because of his low numbers today, we're gonna be watching him closely tonight. We've noticed that he gets very sleepy soon after his shot. Is this typical?
 
Re: Recently Diagnosed

I've updated Zeke's ss for tonight's readings so far. Here's a recap:
PMPS = 173
+3 = 106
+4 = 99
I've been feeding him canned salmon and wellness at every opportunity to avoid him going hypo. Am I being too paranoid? Should I just have stood by the sidelines to see what his BG would have naturally done based on the current dose? In other words, if I hadn't been encouraging him to eat, might his BG have dropped below 80 indicating that an insulin decrease is warranted? Wouldn't I want to have that information so I can adjust to the appropriate dose?

Well, I'll be testing for the next two hours. We'll see what happens with his BGs. Just wondering what your thoughts are on this? Also, I thought I'd seen a post or article about shooting low numbers. Can someone send me the link?

Thanks,
Laura
 
Re: Recently Diagnosed

Nothing wrong with being cautious, or "paranoid" as you stated! :-D You are still learning how Zeke reacts.

Looks like Zeke bounced high with that 316 at +11! Maybe too much food. Was it HC, MC or LC? Any karo or other simple sugar given?

The link on shooting low is from over in the Lantus TR forum. It's one of the stickies. Here is the link to Sticky: Lantus & Levimir Shooting and Handling Low Numbers.

The 80 BG number with the Alphatrak has a built in safety factor. It's not that your cat will hypo at an 80 or a 70 on the AT, but it's that you need to be more aware and feed some food to keep your cat's BG numbers level, maybe bring up a tiny bit. We call keeping the low numbers more steady "surfing" because you are "riding the wave".

That food may be LC (low carb), MC (medium carb), or HC ( high carb). It all depends on when in the cycle the low number occurs and how long you have until nadir and if you can be around to test.

At this point, since you are new and gathering data, feeding your cat to keep the numbers up is a wise thing to do. You are still learning how your cat reacts not only to the insulin, but to the different carb levels in the food. We are not trying to prevent those reductions with feeding food, we are trying to keep your cat safe. As you learn how your cat reacts to the insulin and food, how early they drop, how far they drop, you will be better able to guide the numbers.

As always, ask here for guidance on those low numbers. We are willing to help you anytime. If no one is here (holiday weekend, late at night), try posting over in Lantus TR forum. There are often west coast members up and around to help you.

This has some nice lessons on feeding low numbers. I copied this from something Marje said when advising on Tashie over in the Lantus TR forum. Marje explained it very well. some of this is specific to the depot insulins, like Lantus and Levimir and does not apply to non depot insulins like Prozinc.

I've changed the numbers to Alphatrak specific ones. These numbers are all 30 points lower if we are talking about a human meter.

Lesson One...Feeding Low Numbers

The other day, we fed your cat HC at 84 @+3.5. Usually we say, feed LC unless they are below 80. But....there are exceptions:
• a fast drop to a lower number
• a new kitty with little data and a nervous caregiver
• a low number really early in the cycle

Take a look at Gabbys SS. Gabby generally has an early nadir and likes to drop early and fast. You can see how Sienne uses HC with her to slow her down.

The goal in a newly dx cat (dx less than one year) is NOT to prevent a reduction; it's to keep them safe and try to minimize the bounce that comes with a really fast and steep drop.

If you get a 84 midcycle from a glide down, you would use LC food. You will also learn what your cat reacts to best. For instance, I used a lot of HC gravy, food, karo when Gracie was newly dx and on Lantus. But then I figured out she responded really great to 10% food. I never use HC or gravy and restrict the use of karo to really, really low numbers (50s/low 60s) when I want her up fast. ECID...learn what your cat responds to and use what she needs.

If you get a 84 late cycle, you might not need to feed OR a tiny bit (1 tsp) of LC might work beautifully. So consider:

1. How fast is she dropping
2. Where is the number in the cycle
3. How does she respond

And lastly....feed the 70s. If you get a 70s number at PS, do not feed, retest in 15 mins. If she is not above 80, feed 1 small tsp LC and retest in 30 mins. In the meantime, you will be posting and asking for help.

MORE ON FEEDING LOW NUMBERS AND WHEN
One thing to think about is where in the cycle does the low number come, what food should you feed, how full is the depot?

I'd say any time you get a 80 or less early in the cycle, you might want to feed HC unless the cat is one that just likes to surf flatly in the 80s. If you get a 80 mid cycle or after nadir, you might just try LC.

BUT...if the depot is full...and numbers keep dropping after the initial HC wears off, after mid cycle, you might need to give a little more HC after nadir.

The other thing to remember is once they've earned a reduction and you are tired, you can feed a large amount of HC to bring them up and abort the cycle.

Lesson Two...Feeding the Curve (dives)

We have some champion diver kitties in LL. They especially like to dive when they are clearing a bounce which appears to be Tashies modus operandi. It helps to try and flatten the curve so they don't scream down and then swoosh back up because they took such a dive. If you look around at different SSs, you will see people feeding their cat on a front loaded schedule. This is to flatten the curve.

If a cat doesn't dive and has fairly flat cycles, they can be free fed and don't need a plan to manage the curve. But if they dive, you might want to think about dividing the number of calories/day into the two cycles and then feed mini meals on a schedule.

Most will feed a portion at PS, +1, +2, and +3 to control the dive. I did this when Gracie was on Lantus and Sienne does it with Gabby. (I still feed on a schedule for her lev onset). It doesn't flatten the cycle over night but patience and it does help. You will also have to see what best helps your cat. Maybe it's PS, +2, +3....and since you work, you may need to use an auto feeder.
Click to expand...
 
Re: Recently Diagnosed

Last night we only feed LC Wellness with some canned salmon (in water only). I got a little uneasy with a 106 at +3. His nadir is usually +6 and can easily drop > 20 w/in the +3 to +6 timeline. That’s why I was encouraging him to eat (LC - just to avoid a huge drop). Guess it might have worked too well since his nadir occurred at +4 and AMPS is 370. I don’t want him going hypo but I also don’t want to give him HC unless I feel it’s totally necessary to avoid hypo.

The food variable/affect is something we’re still trying to get an understanding of. A few food-related questions:

Is it crucial that we always stick to a routine of test, feed, shoot (all within 15 minutes)?

Also, how much should we feed? No more than a certain amount and if so what’s the amount?

What’s the minimum amount of time we should withhold food prior to shot? 1 or 2 hours?
We have an established morning routine with all three cats and just want to know how much we have to adjust for optimum BG control for Zeke. Just FYI, because our other two cats tend to graze, we leave LC food out all night which Zeke has access to as well, just in case he feels he needs to eat (especially to avoid huge drops or hypo).

Now that Zeke’s on a LC diet exclusively, we have noticed that he does not eat as often as before. However, because we have two other kitties that are graze eaters, we always have food out (we use a Frosty Bowlz to keep the food fresh) so we do not know exactly how much Zeke is eating. Is it necessary for us to control when and how much he eats throughout the day/night? We hope not as this would be very difficult given the current situation. Would like to know your thoughts on this.

A question regarding insulin:
We keep ours in the fridge. So we like to prepare the syringe and let the insulin warm up at room temperate (appx 1 hr) before shooting. If we get in a bind time wise, would it be ok to warm the insulin by gently streaming warm water on the syringe shaft a few minutes before shooting?

Thanks Deb for the advice and information you provided. I’m printing it out for reference.
 
Re: Recently Diagnosed

Good job last night. Lets hope he clears the bounce soon.

Do you have HC food and syrup in the house? Then you are prepared if he does drop too low and are able to bring him up before he shows any symptoms since you are testing.

Is it crucial that we always stick to a routine of test, feed, shoot (all within 15 minutes)?
Click to expand...
You dont want to wait more than 30 minutes between test and shoot as the BG can change in that time.
I free feed my boys which means that they graze all day long except for that 2 hour window before each shot. I test and shoot. They may or may not eat after but I do keep an eye on them to make sure they are eating in general as I dont want to shoot and then find they havent eaten for 12 hours.

Also, how much should we feed? No more than a certain amount and if so what’s the amount?
Click to expand...
Per day we have a formula based on their weight but generally I would weigh him every couple of weeks and change food accordingly since really how much they need to eat depends on how well regulated they are. the formula is : Required calories per day = [13.6 X ideal weight in lbs] + 70

What’s the minimum amount of time we should withhold food prior to shot? 1 or 2 hours?
Click to expand...
2 hours because you want the food to have cleared their system and not be impacting your preshot test

We have an established morning routine with all three cats and just want to know how much we have to adjust for optimum BG control for Zeke. Just FYI, because our other two cats tend to graze, we leave LC food out all night which Zeke has access to as well, just in case he feels he needs to eat (especially to avoid huge drops or hypo).
Click to expand...
Great! Grazing is good because it is less stress on the pancreas than it would be with a big meal. Let Zeke free feed too. Just take it up 2 hours before his shot.

A question regarding insulin:
We keep ours in the fridge. So we like to prepare the syringe and let the insulin warm up at room temperate (appx 1 hr) before shooting. If we get in a bind time wise, would it be ok to warm the insulin by gently streaming warm water on the syringe shaft a few minutes before shooting?
Click to expand...
Since its such a small amount of insulin it doesnt need warmed as he shouldnt feel it whether its cold or not. At the most I would let it sit out is 15 minutes. Also if the insulin sits too long in the syringe it can react with the lubricant in there which isnt good.

Wendy
 
Re: Recently Diagnosed

Is it crucial that we always stick to a routine of test, feed, shoot (all within 15 minutes)?
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I don't think I'd use the word crucial. The routine for Lantus should be test, feed, shoot (TFS). Like Wendy said, if you go too long after your test, retest if you can to check the new number. Sometimes your schedule will require you to switch your times around as to when you do TFS. We recommend time changes of 15 minutes per cycle or 30 minutes a day to get back on schedule. Even though 12/12 is ideal, not everyone can do that every day. You do the best you can with your other life responsibilities.

Also, how much should we feed? No more than a certain amount and if so what’s the amount?
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Well, at the beginning, your diabetic cat can not process all his food. Not enough insulin. Zeke may be especially hungry and if so, you might need to feed him up to 50% more than a regulated or non-diabetic cat. The formula Wendy gave you was for maintaining weight for a cat. Zeke may need to gain or lose a bit, but don't concentrate on that too much for now. Just be alert to his weight and give him more food if he needs it. While it's not good for a diabetic cat to be overweight, you need to get the diabetes under control a bit more before you think about any needed weight loss.

You may be interested in this discussion some time ago about feeding a diabetic cat. The upshot is basically that some limits do need to be placed on the food consumption for a the diabetic cat to help with the BG control. You need to find a happy medium.

What’s the minimum amount of time we should withhold food prior to shot? 1 or 2 hours?
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Ideally, 2 hours before the shot. It's not always possible, especially if you are working or free feeding. Again, you do your best to take the food away 2 hours before the pre-shot tests. All other tests, we expect to be food influenced.

Is it necessary for us to control when and how much he eats throughout the day/night?
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Only to the point where you want to make sure Zeke is getting enough food to maintain a healthy weight. Some people meal feed, some free feed, some use timed feeders, some put out frozen cat food 'cicles. It all depends on your lifestyle and what your cats are willing to do. Personally, my 2 civies are hoovers and the food disappears in a couple of minutes. That is why I meal feed.

A question regarding insulin:
We keep ours in the fridge. So we like to prepare the syringe and let the insulin warm up at room temperate (appx 1 hr) before shooting. If we get in a bind time wise, would it be ok to warm the insulin by gently streaming warm water on the syringe shaft a few minutes before shooting?
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I never found it necessary to warm the insulin. It's such a small dose, the cat doesn't even usually feel it going in under the skin.
 
Re: Recently Diagnosed

Less than 2 hrs away from his pm shot and his BG has been dropping since typical nadir of +6. He's eaten very little since about 8am this morning, only about a tblsp of LC wellness at + 7.5. Additionally, he threw up around +4. I'm gonna need some advice about what and how to shoot if he remains at 166 +10 or even worse continues to drop. He seems to be feeling well but a bit sleepy today. Not surprising as I'm new to the TRP and having had little sleep the last couple of nights, waking him often to take a reading. He's what happened today (also on his ss):

AMPS 370
+3 344
+4 314
+6 246
+7.5 181
+10 166

I'm probably jumping the gun on getting a little nervous, but I'd rather reach out for advice now as I still have about 1.5 hrs before PM shot. Please let me know if I should not have used the 911 icon yet. Just wanted to make sure and get someone's attention.
Thanks,
Laura
 
Re: Recently Diagnosed

It's a little early to know what you should do at PMPS, but you basically have 3 options.

Test and if <175, hold the shot, hold the food and retest in 20-30 minutes. This is because we want to know if that PMPS is a rising or falling number. (175 was your last lowest number you shot)

1. give the full dose. Depends on what the BG is at PMPS
2. reduce the dose by about half. Sometimes called a BCS (big chickin shot) but it can keep your cat safe.
3. skip the shot entirely

So some questions for you. Do you have plenty of test strips? Some HC (high carb) food on hand? Can you stay up to help surf the numbers and keep your cat safe?

Good suggestions on what to do depend on these answers.

ETA: so that everyone can see that 911 as they scan the board, you need to go to your very first post in this topic, click on the little edit button on the right, and change the post icon to the 911. The way it is now, the 911 is buried way down in your post and not very visible.
 
Re: Recently Diagnosed

Its a good idea to draw our attention to it early. Now I am hoping you havent fed. We dont want any food in his system for the next two hours prior to the shot so we can know if this number isnt influenced by food and stall if need be

Let us know the answers to Debs questions - we will need to know that if you do need to shoot low

Meanwhile here is a primer. http://www.felinediabetes.com/FDMB/viewtopic.php?f=9&t=147
Wendy
 
Re: Recently Diagnosed

Ok, his BG is up a bit. +11 171. I have an unopened can of 50 strips as well as probably 12 in the can I'm using now. I have food at 13% & 15% (MC, right?) and 17% (HC, right?), pill pockets and maple syrup as well. Yes, I can stay up with him if need be. I would rather do that than skip the dose - that would set us back, wouldn't it? The thing I'm just a little nervous about is that he had drops at +10 and +11 today so I think it might be an all nighter. How will I know for sure? Ok, we're about 15 minutes away from PMPS reading. We'll see where we are.
 
Re: Recently Diagnosed

Sounds like a plan

When did you last feed?

We do want to shoot if we can to maintain momentum.
Remember you shot a 173 yesterday so you already did this.. shouldnt be so scary..

Did you read the primer?

Wendy
 
Re: Recently Diagnosed

I picked up the food about 1 hr 45 minutes ago. I don't think he ate within 30 minutes of my picking up the food based on where he was lying. I couldn't get him to eat much about 4 hrs ago. That was most likely the last time he ate. What's different about today is that he hasn't eaten much and that he had those late cycle drops.
 
Re: Recently Diagnosed

ok - so remind me - when did he least eat? Your 4 hour comment worried me if he hasnt eaten for many hours? (more than the usual 2 that is)
 
Re: Recently Diagnosed

Ok This is not normal protocol for this but I want to be sure he is going to eat before you shoot in case he isnt eating at all. So feed him now and let me know if he eats. Dont shoot yet.

let me know

Wendy
 
Re: Recently Diagnosed

He spent most of the day sleeping. He just ate. Sorry, my husband filled the bowl so I don't know how much exactly. Maybe a tablespoon of LC wet wellness. So should we shoot?
 
Re: Recently Diagnosed

you mean now? yes. Once we sprinkled dried salmon on top of his food he ended up eating about 2 tablespoons. Ok to shoot or are you worried about something?
 
Re: Recently Diagnosed

We just gave him a little more food, he's eating it without any urging.
 
Re: Recently Diagnosed

Great ! I don't want you shooting a cat that's not eating at all as he could drop way too low that's all. Anyway I think you are good now. Get a+2 for sure though. I will be keeping an eye out for it so let me know.
 
Re: Recently Diagnosed

Great Wendy. Thanks! I will definitely be posting updates. He's eaten a lot PS. He's making up for today.
 
Re: Recently Diagnosed

Great.. Probably just the furball then. My guys don't eat when they have a furball.. Afterward they make up for it.

See you in a couple of hours.
Wendy
 
Re: Recently Diagnosed

I'm gonna take a nap while my husband takes over kitty sitting duties. He's not familiar with logging on to the FDMB but will be updating Zeke's ss in google hourly. I'll be back on line in 3 hours to see if you've left any posts. Of course, he has my permission to wake me immediately if Zeke's BG falls below 100 before I wake. Talk to you in 3.
 
Re: Recently Diagnosed

Strange - BGs didn't move as expected.

+4 194 (1 Tbsp LC - Zeke wanted food)

Still up above PMPS. We'll continue testing.
 
Re: Recently Diagnosed

Crazy:

+ 4 194 Above PMPS of 188
+ 5 240 What? Really? Was it the LC food?

Will continue to gather data
 
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