Introducing Sashie…looking for help and knowledge

Hi all, so glad for this board... my 16 year old Tabby Sashie was dx with FD in June, of this year. Signs were there, but it took a few vet appointments and blood panels to finally get the true picture of why was she was drinking too much water and urinating so much. She was put on Lantus 1 Unit BID, Purina DM dry, which she likes as she always preferred dry. Vet also recommended kitten can food, for the high protein content. The wet food has been a challenge, but depending on the day, she may eat Natural Choice kitten tuna & chicken formula mixed with water. I rely more on the Wellness pouches both, Salmon/tuna, Salmon/chicken formulas. Basically, I buy the pouches for the gravy, she might eat a couple of the morsels but they end usually in the trash. I know the gravy is not a good choice, but I mix it with kitten can food, which Sashie might eat. Food is a hit or miss, I have tried so many foods post dx and I am frustrated, although not giving up! Will buy Fancy Feast classic varieties today.
I have so many questions, but my biggest concern is trying to figure out how to help Sashie get regulated. I did the first BG curve in August, her BG numbers were in the 100’s with the Nadir at 56. Lantus insuling was decreased to 1 Unit 1 x daily. It was a relief for me as I work three jobs and the 12 hours BID dosage was a challenge. I purchased the Alphatrack 2 glucometer and tested regularly AM and PM. Within a month, Sashie’s numbers went up into the 300’s and 400’s. Within this time, she developed a UTI and was prescribed antibiotics. After the UTI was cleared and high numbers continued, Lantus was increased back to 1 Unit BID. Despite the change in Insulin, her numbers did not come down, and at some point within the past month, she was put on 2 Units of Lantus BID. I conducted a BG curve last week (after a couple of weeks since the last increase), BG levels went down at the 9+ and 10+ hour to 54, which concerned me and the vet. Insulin was decreased to 1 ½ Units BID. Now I need to wait a week to do another curve. I have done Pre Insulin testing and her numbers continued to be high in the 300 and 400’s. The vet is thinking that perhaps we need to change the type of insulin to Humulin, but he is going to wait for results of next BG curve, which I will do next weekend. I have read that Humulin is not a good choice…how can I help my diabetic kitty and help her vet, which we both like? Sashie acts fine, but the numbers are not looking good. I need to help Sahie fight this, at least get her on a better diet and regulated. I am fully committed and decided to post to rely on the experience and suggestions made by any of you, who have the time and experience. Please guide us! Thanks in advance for your responses.
Tina and Sashie

 

WELCOME to the best site on the planet to help you help your kitty.
I havent had a diabetic kitty in a long time so I will let others guide you. The one thing that sticks out at me is, the dry food your Vet recommended. Dry food automatically raises BG numbers. I remember Troubles dropping by 100 points over night when I removed the dry. Sashie will have to be closely monitored once you remove the dry. Others can guide you better...Anyway theres a wealth of informatin here and people happy to help. Again..welcome,
jeanne

 

Jeanne, thanks for the reply. I am anxiously awaiting for others to reply as well...especially, I need guidance with what to do before switching to another type of insulin. Maybe getting a better diet (no dry) for Sashie and continuing Lantus to see if that helps the high BG numbers. The problem is my work schedule. Gone sometimes for 12 hours. My kitty is used to free feeding dry during the day. In this house there is only the two of us, and unfortunately, she is not friendly to others. I would be worry if she can only have access to food in a 12 hour span, and then, she may not even care for the canned food! I just bought some Classic Fancy Feast in many varieties and would try enticing her to eat it. I understand seafood only a couple of times per week is the recommendation. I am trying to learn as fast as I can, but it is overwhelming! I tested for ketones today and it was negative. I hope I don't run out of time to help her. She means the world to me!!!

 

I believe Lantus is a very good insulin for kitties. And many people here use "Timed Feeders" Also you can freeze cat food in icecube trays pop the cubes out and and leave them to melt for kitty to eat later... There are others here who have like work hours. Maybe start a new thread about working hours how do you do it?

Have you posted on the lantus board here you might get more eyes that way...I will link this post there for you

jeanne

 

Hi and welcome to Lantus Land the best place to be if you have a diabetic kitty.
I don't have anywhere near enough experience to offer dosing advise. As for Humulin N all I can say is that our FC was initially put on Humulin N and did not do very well with it. We had to educate the vet on Lantus and got him to switch him to Lantus. There was a world of difference when he went on Lantus. The little I know about Lantus and Humulin N is that they are different. Humulin N reacts almost immediately. This cause our kitties BG to go down quickly but it only had about a 6 hour life for him so after the quick drop his BG went way again. This continued with each cycle which was hard on him. Lantus on the other hand is a slower reacting insulin and has a much more even reaction time. For our kittie his BG will drop slowly and level out around the +6 time and then slowly rise. It last just about the full 12 hours. It is so much easier on the kittie. Again I'm not telling you to chose either one. I just am stating our kitties results on both. I strongly suggest that you post on the Lantus Tight Regulation Board with a ? at the front of your subject line. There are some very experienced and knowledgeable people there that can give you some dosing advice. Also if you go to the tight regulation board you will see several post at the top with stars on them. I highly recommend you read them. Good luck and have a great day.

 

Changing the food to all canned- FF classics, no gravy foods, will help lower the BG in the long run- by as much as 10 points.

Specific to this area
It may sound strange BUT too MUCH insulin gives just as high numbers as too LITTLE insulin. What it does is sends the cat too low- 54- on an alpha track, no less- is too low- and their body panics and dumps a boat-load of sugar into their system to bring them out of it and they rocket high again. This can continue and most vets simply keep raising the dose thinking they need more insulin when they really need less. And since it happened so late in the cycle I think this is happening. Lantus is an EXCELLENT insulin- but insulin is just one leg of a stool that needs to be addressed for complete kitty wellness.

The next is the food- drop the dry. That can have 20-30% carbs in it- plus it is dry food which leads to UTI infections that keep coming back. Find something your cat likes- and don't take a turned up nose as a "not in my life-time!" decision- put the rest of the can in an ice food tray, add a little water, and freeze it then pop the frozen cube in a zip-lock baggie for later. It sometimes takes my cat 2 or 3 times to eat a new flavor. We have three main food lists on this site Binky's List, Hobo's List, and the newest from Dr. Lisa that have it already calculated out for you. Just add more water to it until you get about half food and half water- this makes it kind of like soupy gravy. If she has to have her crunch I think the lowest dry is called EVO and only giving her a few pieces at meal times might help for those determined crunchers.

The third leg is home testing and you are already doing that. You might want to think about getting a human meter if the strips of the alpha seem too high. A Relion Micro from Walmart as strips 100/$32 and the prime has strips 50/$9 and both are good FD meters. This allows you to test more frequently- just remember they will read lower than the alpha.

Humulin N is not worth the money spent on it for a cat as a cat uses it too fast and it is in-effective in the long run. Keep with the Lantus and change the food and you should see some changes in Sashie in the future.

 

Hi, welcome to FDMB. I agree that Lantus is a very good insulin for cats. I works differently than the insulins most vets are used to and many haven't learned how to deal w/ that yet. Lantus is dosed on the nadir, the lowest point in the cycle, not on the preshot test, which is usually the highest.

When your vet did the curve when Sashie was on 1u BID it was exactly what we look for in a Lantus curve. That 56 was low (on the Alpha track, right), but it would have been better to reduce the dose. By going to once a day shots Sashie was left w/ long periods where the was no insulin to help her pancreas, just like w/ using Humulin. For humans Lantus is given once a day, but w/ their faster metabolisms cats need it twice a day. Usually we adjust doses by 1/4 units, not whole or even half units. That is just too much of a jump and you often miss the right dose somewhere in between.

Lantus is a depot type insulin, a reserve is built up in the body and slowly released, that is how it works for longer periods. After a dose change it takes several cycles for that depot to balance out again and only then will you see how the dose is actually working.

When you can work it into your schedule I would recommend trying to get some mid cycle tests to see just where her nadir is and how low she is going. Not a full curve right now, just 4 to 7 hours after her shot. Most of us using Lantus get a preshot test to be sure the cat isn't too low to safely give the shot and then try to get a mid cycle to see how well the dose is working.

As for taking her to the vet for the curves, you can do it at home for a lot less money. Another advantage of doing the curve at home is that very often cats become very stressed at the vet and their BG goes way up, so the vet curves are often inaccurate. I know the meter you are using was recommended by your vet, but regular human meters work just as well. You just must take into account that vet meters are calibrated about 30 points higher than human meters. The strips are sooooooo much cheaper too. Many here use the Relion meters for Walmart, but there are others just as affordable and accurate. Buying strips online is a lot cheaper too.

The timed feeders work great for feeding while you are out some even have an ice pack you can use to keep canned food fresher, although w/ the closed cover it usually isn't a problem. There is a great recently updated food list put together by a vet who works w/ this board. We try to feed foods 10% or less in carbs, but many of us stick closer to 5%. Dr. Lisa's food list Since Sashie is 16 you may also want to consider a food lower in phosphorus to ease the strain on her kidneys, another major food related problem in older cats.

 

Hi there

Ok lots of stuff to digest.. sounds like you are very frustrated ! but dont give up on Lantus - we just need to make a few tweaks. I am coming over from the lantus tight regulation forum and here is my laymans advice from that...

TESTING = I agree, you need to do a few more tests particularly preshots and a nadir each day. The nadir will tell us how your cat is really doing. How low is she dropping? She may go too low and then bounce back up after! So you really need to know what she is doing.She may be doing better than you think. Based on that we only ever change dose by 1/4 unit at any one time because any more than that and you could skip the good dose! So can you take some more measurements over the next few days and let us know... before you see the vet? And get a different meter - the relion is cheap and reliable.

FOOD = Also yes you need to stop the dry. Here is a link that may help http://consciouscat.net/2011/07/25/how-to-your-cat-off-dry-food/. And try the low carb fancy feasts. My cats love it so there is no issue getting them to eat it - choose from these http://felinediabetes.com/FDMB/viewtopic.php?f=28&t=81687. I leave a pile out in the morning and they eat it all day and i give them fresh at night. I also give Wellness. And freeze dried chicken as treats.

WANT MORE HELP= if you have time please come over to the tight regulation forum! Read the stickies and create a spreadsheet. Post every day. We will use that to see how your cat is doing and the experts will respond.

 

Thank you all for the replies. I fed Sashie Fancy Feast Classic last night and put away the dry food. Not only she liked the food but this AM pre insulin Sashie's BG was 273mg/dl this is the lowest Pre insulin numbers in quite some time. Also, I noticed she was not as thirsty, thus less urination during the night. That was only one night without access to dry food, I get it...dry food has to be eliminated! Your recommendations are all excellent, and $ savings in my pocket, which is so much appreciated. I am going to freeze canned food and buy a Walmart glucometer. I am soooo relief I do not need to pay the $$ for the Alpha strips & lancets anymore. My question now is ..I understand that the readings in the Alpha meter are higher than with the human glucometers, so with changing glucometers I will be seeing lower numbers in Sashie's BG readings. For the purpose of regulating her BG levels/insulin dose, and getting a true picture of the new levels vs the old, how do I make the transition? I am planning to also post in the Lantus board...but, you have been so helpful so far that I wanted to post here as well. Again, thank you for sharing your expertise and encouragement. Your knowledge is a blessing in the sky. I will continue to post.
Tina and Sashie

 

Human meters are usually about 30 points lower than the Alpha Track. Try comparing the 2 meters from the same drop of blood a few times and you should get a pretty good idea of how the 2 relate to each other. Be sure to get some mid cycle readings as well, this is where you will actually see how well the insulin is working.

If you show your vet the numbers make sure that he knows that you are now usin a different meter.

 

Ann is right -- the AlphaTrack runs about 30 point higher than a human meter. So, an 80 on an AlphaTrack is a 50 on a human meter.

With Lantus, many of us use the Tight Regulation Protocol for making dose-related decisions. With this approach, dose changes are made in small increments -- 0.25u. This allows to gradually increase or decrease the dose so you don't miss what would be a good dose for Sashie. There is a great deal of information about Lantus and it's use in the starred, sticky notes at the top of the Lantus board. Below are links and a brief overview of what the notes contain. They will help you to get oriented as to how to best use Lantus. For what it's worth, when my cat was diagnosed, the ER vet put her on Humulin. She was not well regulated on Humulin. My vet switched her to Lantus and made the observation that Humulin was a better insulin for dogs and not good for cats. In fact, the American Animal Hospital Assn. recommends either Lantus or PZI for treatment of diabetes in cats.

• Tight Regulation Protocol: This sticky contains the dosing protocol that we use here. There are also links to the more formal version -- the “Tilly” Protocol developed by the counterpart of this group in Germany, which was also published by Kirsten Roomp & Jacqui Rand, DVM in one of the top vet journals.
• New to the Group: Everything you wanted to know about this forum and more. Info on our slang, FAQs, links to sites on feline nutrition and to food charts containing carb counts, how to do a curve and the components to look for, important aspects of diabetes such as ketones, DKA, and neuropathy, and most important, info on hypoglycemia.
• Handling Lantus: how to get the maximum use from your insulin and what to not do with it!
• Lantus depot: This is an important concept for understanding how Lantus works.
• Lantus & Levemir: Shooting & Handling Low Numbers: What data you need in order to be able to work toward remission or tight regulation as well as information if you have a low pre-shot number or a drop into low numbers during the cycle.