Diagnosed 1 month ago...30 days of hell. Feeling quite hopeless.

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Alex&Fayaway

Alex&Fayaway

Member Since 2015
Hi everyone,

I'm Alex, 28 y/o F, living in Denver, CO. Fay was diagnosed a month ago and we remain unregulated. She is 6 years old.

I'm type A in many ways, and yet I try to keep a feet-on-the-ground perspective, too. Which is to say, I am committed to regulating this creature that I love--and being as precise as possible--, but I'm already feeling so much like I cannot keep up with this lifestyle for more than a few months. The fact that she remains unregulated 4 weeks in, and we are now up to 4 units of Lantus twice a day, is supremely depressing. Her sugars remain in the mid-400s (where she was at diagnosis) with her nadir anywhere between 380s and 450s. I'm going through about 40-50lb of litter a week. I feel like I'm drowning.

I wonder at what point do I decide I cannot spent more money; cannot navigate an already challenging, always different work schedule to accommodate timely insulin shots. As it stands now, I cannot go away for the weekend, head out for a date, or sleep in--ever. I am the only person who can care for this cat.

My vet is okay, kind and responsive, but she doesn't seem especially knowledgable. I have so many questions about food, regulation, and the Holy Grail that is remission. Every time I ask 20 questions, 20 more pop into the head. I was hesitant to join this board at first, because as with all information on the internet...everyone has a million different opinions. Is dry food horrible or OK? Does the cat really need grain free? Does regulation happen in a week or 2 months? There is just such a spectrum of experiences. I find it really hard to tell what I should expect or if something horrible is wrong and there is just no chance for regulation, let alone remission.

The cat was not ketoacidotic, no ketones in urine, no infection, either.

What else do you want to know? I guess I'm just introducing myself. And trying to figure out how to survive this. I do not want to put the cat down. She is young, sweet, has energy, and otherwise has no medical issues. She did, however, have nearly all her teeth removed 3 years ago. I suspect the inflammatory process that was part of her periodontal disease had some effect on her immune system and insulin sensitivity.

I work as a hospice nurse...so the job is all-consuming and often very draining. This was quite a rough way to end 2014 and step into 2015.

Any guidance or thoughts are much appreciated...this seems like a pretty special community.

Best,
Alex
 
Hi..just wanna say I can relate to everything you are saying. This is all new to me and a total game changer! I'm used to being totally free and traveling a lot and now I am home bound and overwhelmed!! The litter! Ooh the litter! I have never changed a catbox this much in my life!! It's nice to have people here who understand, cuz sometimes I just wanna give up too. Hopefully we'll find the answers we need! Keep your chin up
 
Welcome, Alex! Thanks for posting an intro, and for joining us. There's a ton of things to read around here, and you don't have to do them all in one day. Ask away all health questions in the Health Forum, and know that our community will do whatever we can to help you get to where you need to be, knowledge-wise, to be on your best footing.
 
Welcome to FDMB, the best place you never wanted to be.
Diabetes can be managed, though it is a process, not an event.
4 things are needed:
You!
A decent low carb over the counter canned diet (see Cat info for why and the food list) anything less than 10% calories from carbohydrates works. Changing to that may drop the glucose 100-200 mg/dL and can drop the insulin dose 1-2 units.
A good long acting insulin for cats; you've got that. We typically raise doses in small increments of 0.25 (eyeballed) or 0.5 units.
Home testing at pre-shots and some mid-cycle tests with an inexpensive human glucometer such as the Wal.Mart ReliOn Confirm to help keep your cat safe. See my signature links Glucometer Notes and Secondary Monitoring Tools for some more details.
 
Alex, don't despair , you'll get Fays blood glucose levels down eventually. It'll probably take a mixture of the vet increasing her insulin, for now, & you changing the food she eats.
 
Welcome! I live in Westminster, so just up the road. As everyone has said, the next two elements are home testing(you'll be surprised how much information this gives you and how confident you'll feel knowing exactly how she is doing) and a wet low carb diet. See this website by a vet: www.catinfo.org. BUT don't change the food until you are testing regularly - her levels can drop dramatically and quickly with a food change. You already have a mild long lasting insulin, the third part of our protocol.

There are lots of resources here, including videos on testing, food charts etc. read, reread and ask a lot of questions.
 
Thanks everybody. I guess my concern is that her eating Hills m/d (both wet and dry, originally only wet but now with the dry too as I cannot afford $120/mo in wet food) for an entire month has not lowered her sugar at ALL. This is what it distressing. @BJM @LynRich
 
I remember posting early on that I felt very similar. For me, it was the exhaustion. Waking up for the morning dose, doing the evening dose, scheduling around her for everything, being constantly worried... I was mentally and physically overwhelmed. My husband and I are both a bit Type A about the numbers and care as well so I understand that.

My girl is another who doesn't use prescription food. Get the testing under control and then switch over to something like the Friskies pates. Much more reasonable. The peeing WILL slow down as she becomes regulated.

Hang in there. It will begin to feel less all-encompassing.
 
Alex&Fayaway said:
Thanks everybody. I guess my concern is that her eating Hills m/d (both wet and dry, originally only wet but now with the dry too as I cannot afford $120/mo in wet food) for an entire month has not lowered her sugar at ALL. This is what it distressing. @BJM @LynRich
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Alex , I'm sure just her diet wouldn't be responsible for her blood glucose not moving. You're doing all you possibly can for her, so don't feel bad *HUGS*
 
Re: Hills M/D
Hills MD dry is crap and higher than 10% calories from carbohydrates. And both canned and dry are pricey despite not being any better quality than Friskies Pates.
I'm feeding 16 cats Friskies pates in the 13 oz cans, which I get in Columbus, Ohio for between $0.80 to $1.08 per 13 oz can.
Each 13 oz can would be about 3-4 meals for your cat at a substantial savings of around 75% or so.
 
Alex&Fayaway said:
Thanks @Sue and Oliver (GA) ! We are actually in Lakewood to be precise :) curious as to whether you've found any good pet sitters in the area...
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My diabetic cat died of heart disease several years ago, after having gone into remission. Now I have only a non diabetic (we call them civies) I do use A Pet's Best Friend up here, but I don't know how far they extend south. They advertise as dealing with sick pets so they probably would do shots - not sure about testing.
 
Hi Alex,

My kitty was diagnosed last week. I am a complete newbie and have no wisdom to offer you other than you're not alone and I can totally understand how you feel that way. Sending love and light to you and your Fay.
 
We're still trying to find a regular dose but (abbreviated version) we just switched vets this past Friday and it turns out we've been dealing with kidney disease as well, which our old vet didn't bother telling us about. So while Tasha isn't regulated, we test regularly and after a month or so we DID notice a huge decrease in the water in/out situation and our stress levels in dealing with it all.
 
Wow @BJM 16 cats! I talked with vet today and she suspects that if we are still within the 400s a month in, the cat is insulin resistant. Any experience with that? I feel bit like if I'm being pragmatic about the whole thing, that is essentially the nail in the coffin.
 
Not with the dry M/D on board.
There are some high dose conditions; I don't think you're there yet with that dry M/D.
If you must use some dry, the only low carb (<10%cal from carb) are Evo Cat and Kitten dry and Young Again 0 Carb (internet only, 5% calories from carbs as we calculate it).
 
Alex&Fayaway said:
Wow @BJM 16 cats! I talked with vet today and she suspects that if we are still within the 400s a month in, the cat is insulin resistant. Any experience with that? I feel bit like if I'm being pragmatic about the whole thing, that is essentially the nail in the coffin.
Click to expand...
I would not consider her insulin resistant until I dumped the dry food.
 
Alex&Fayaway said:
Hi everyone,

I'm Alex, 28 y/o F, living in Denver, CO. Fay was diagnosed a month ago and we remain unregulated. She is 6 years old.

I'm type A in many ways, and yet I try to keep a feet-on-the-ground perspective, too. Which is to say, I am committed to regulating this creature that I love--and being as precise as possible--, but I'm already feeling so much like I cannot keep up with this lifestyle for more than a few months. The fact that she remains unregulated 4 weeks in, and we are now up to 4 units of Lantus twice a day, is supremely depressing. Her sugars remain in the mid-400s (where she was at diagnosis) with her nadir anywhere between 380s and 450s. I'm going through about 40-50lb of litter a week. I feel like I'm drowning.

I wonder at what point do I decide I cannot spent more money; cannot navigate an already challenging, always different work schedule to accommodate timely insulin shots. As it stands now, I cannot go away for the weekend, head out for a date, or sleep in--ever. I am the only person who can care for this cat.

My vet is okay, kind and responsive, but she doesn't seem especially knowledgable. I have so many questions about food, regulation, and the Holy Grail that is remission. Every time I ask 20 questions, 20 more pop into the head. I was hesitant to join this board at first, because as with all information on the internet...everyone has a million different opinions. Is dry food horrible or OK? Does the cat really need grain free? Does regulation happen in a week or 2 months? There is just such a spectrum of experiences. I find it really hard to tell what I should expect or if something horrible is wrong and there is just no chance for regulation, let alone remission.

The cat was not ketoacidotic, no ketones in urine, no infection, either.

What else do you want to know? I guess I'm just introducing myself. And trying to figure out how to survive this. I do not want to put the cat down. She is young, sweet, has energy, and otherwise has no medical issues. She did, however, have nearly all her teeth removed 3 years ago. I suspect the inflammatory process that was part of her periodontal disease had some effect on her immune system and insulin sensitivity.

I work as a hospice nurse...so the job is all-consuming and often very draining. This was quite a rough way to end 2014 and step into 2015.

Any guidance or thoughts are much appreciated...this seems like a pretty special community.

Best,
Alex
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You may have to change insulins, Scotty was on 15 units of ProZinc BID and his numbers were staying high also, I switched to Levemir and his numbers starting coming down immediately, he eats Friskies and Fancy Feast Pates by the way, I am trying an OTJ trial on him right now and hope he will be in remission in about a week, I am just sorry I waited so long about switching insulins.
 
When is she being tested? We suggest picking up the food for 2 hours before the shot, and then testing, shooting, and feeding within about 15 minutes.

To see how low the glucose goes, you have to test around the nadir, about +5 to +7 hours post shot. Dose adjustments are based on the nadir, with some consideration of pre-shot levels.

How fast were the dose increases made and how big were they? Sometimes, vets will increase by full units, when only 0.25-0.5 unit increases will locate the optimal dose. By making big increases, you skip over the optimal dose.

Can we get you started using our grid to record your glucose tests? It will help us give you better feedback. Instructions are here.

Understanding the spreadsheet/grid:

The colored headings at the top are the ranges of glucose values. They are color-coded to clue you in as to meaning.

Each day is 1 row. Each column stores different data for the day.

From left to right, you enter
the Date in the first column
the AMPS (morning pre-shot test) in the 2nd column
the Units given (turquoise column)

Then, there are 11 columns labeled +1 through +11
If you test at +5 (5 hours after the shot), you enter the test number in the +5 column
If you test at +7 (7 hours after the shot), you enter the test number in the +7 column
and so on.

Halfway across the page is the column for PMPS (evening pre-shot)
To the right is another turquoise column for Units given at the evening shot.

There is second set of columns labeled +1 through +11
If you snag a before bed test at +3, you enter the test number in the +3 column.

We separate day and night numbers like that because many cats go lower at night.

It is merely a grid for storing the info; no math required.
 
Alex&Fayaway said:
okay but she's been on exclusively the wet md for three of the four weeks. Why does the vet not think the dry is a problem? @BJM @nancy and scotty
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Alex, this made me grin...the answer - because that's what the good food salesman told the vet! They have REALLY good salespeople that fill them with all kinds of BS. :) The heavy majority of vets believe it - after all, it's based on SCIENCE! (yeah...crooked science...)
 
Haha, right. But I'd like to think vets can think critically, especially if it's simply coming down to a matter of percentage of carbs. :) @Squeaky and KT .

@BJM I don't free feed either cat since diagnosis...again, been giving my best effort to make things as consistent as possible. I may try to do the grid when I can, but I'm just not at the place yet where testing consistently makes sense--still way too high. Both of her curves revealed no change throughout the day and still in the 400s. I tested around 5pm today for ha-has (mom was here and easier to have another set of hands). Fay gets her food at 7pm and shot at 7:30pm, and she was at 337 at 5pm--lowest I've ever seen her. Tested her just before her food tonight and she was at 445. So..W-T-F! And PS - We haven't increased more than 1 unit every 7 days, sometimes longer.

I will definitely bring the dry m/d back to the vet so they can buy it back. Thanks for the info on that.
 
@nancy and scotty what have you been paying for your insulins? My bottle of Lantus was a cool $300. I was later told by a pharmacist (after a purchased it, and after I mentioned it was for a cat!!) that they could look into getting a vet rate for me. Plan B is to have a diabetic friend give me an extra bottle she has for her co-pay price ($40). Not even sure how long I can expect the Lantus I've got to last.

Maybe I will need a different insulin, how long did you wait to switch?
 
Wow that's expensive! My vetsulin ws $40. But I guess it's not a good choice for cats..I'm not sure which to use and can actually afford!
 
Alex&Fayaway said:
I talked with vet today and she suspects that if we are still within the 400s a month in, the cat is insulin resistant. Any experience with that?
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Yes, my Neko has two high dose conditions, IAA (insulin auto antibodies) and acromegaly. But several things you've said tell me you shouldn't think about that yet. We consider testing for high dose conditions if a cat has reached 6U twice a day of insulin AND:
- you are home testing and the doses were safely reached. We increase doses by .25U. By increasing in whole units you could very well have bypassed a good dose and your cat may be overdosed. If a cat is on too high a dose, she can still give high numbers. Testing at the vet clinic can give falsely high reading due to stress. My non diabetic can once tested over 210 at the vet and 53 the next day at home. You don't want to determine doses based on tests at the clinic.
- you are feeding low carb food, all under 10% and preferably closer to 5% (ditch the "prescription" dry food)
- you have ruled out any other conditions (hyperthyroidism, pancreatitis) or infection - when was the last time Fay had a dental?

Have you inquired about getting Lantus in a pen? They come in a 5-pack, but sometimes you can find pharmacies that sell one at a time for a much more economical deal.
ETA: We started on Vetsulin, but you can use the Lantus to the last drop.
 
Ordering from Canada may be significantly less expensive.
Get the pen, not the vial, as 3 mL contains 300 units, which you can use before it becomes ineffective.
 
Hi Alex and Fay,

I second BJ's opinion of the Hills dry diabetes foods. The vet who diagnosed Saoirse in June insisted that she could only eat Hills w/d Dry now that she was diabetic. w/d has even more carbs than m/d, and I thought it was NUTS to prescribe a mega-high carb food for a diabetic. I wanted to start feeding Saoirse according to the recommendations on catinfo.org. For various reasons we moved to a new veterinary practice, and one that was much more FD-aware. As I believe is their standard practice for new diabetic patients, our new vets asked their external feline diabetes specialist to review Saoirse's numbers. She was on 3IU Caninsulin BID. The FD specialist thought that Saoirse might be insulin resistant. Within a couple of days of changing to wet food, Saoirse was down to 0.5IU BID of Caninsulin and a few days later, although not fully regulated, Saoirse had to stop the Caninsulin because it posed a risk of taking her too low. A switch to Lantus and a few months of patience and Saoirse became tightly regulated then diet-controlled. In Saoirse's case, the food prescribed by her previous vet was hindering her treatment, not helping it.

Assuming that there are no other dietary considerations to accommodate, low carb, species-appropriate commercial foods is usually fine for feline diabetics. Saoirse's problems were actually caused by prescription diets. In spite of her FD and pancreatitis she looks infinitely healthier now than she has for years since switching to species-appropriate, wet low-carb food.

With your schedule, it may help you a great deal to use a timed feeder for Fay's meals. It can help with working hours and sleeping hours feeds. Timed feeds can also help a great deal with getting cats regulated, too. Many members here recommend the Petsafe 5 feeder.

I note from your opening post that Fay has been receiving Lantus for 4 weeks and is currently on a dose of 4.0 IU BID. It would be really helpful if you could let us know what the starting dose, in what increments the dose was increased and how long you held each dose before increasing further. When you're setting up your spreadsheet, it would help to include any BG test data you may already have since Fay was diagnosed. With that info, it should help members here get a better idea of how Fay is responding to Lantus.

Once the up-front costs are done with, and provided there are no complications, the cost of ongoing treatment for FD is much more manageable; home testing will save you a lot because you'll be able to run your own - more reliable - glucose curves (no vet stress influence in home readings). You can get help here with sourcing reasonably priced supplies.

Hang in there. The early weeks are the toughest going. It does get better as you learn more and as you develop a routine that works for you at home. You've found a good place to learn and get support and advice on the day-to-day practicalities of helping your little one now that she's diabetic. I'm very glad that I joined in June of last year. What I learned here played a very significant part in helping Saoirse to become diet-controlled.
 
Alex&Fayaway said:
Haha, right. But I'd like to think vets can think critically, especially if it's simply coming down to a matter of percentage of carbs. :) .....
Click to expand...

When they hear it enough, most of them believe it. The salesman convinced all the vets in our practice that the 34% carbs in the dry food was OK for diabetics because...ready for this?.....it was the science BEHIND the mixture, the complex carbs. Umm...cat's can't use complex carbs. :) Their sales method is a 'training' pitch....and they're GOOD.
 
Critter Mom said:
Hi Alex and Fay,

I second BJ's opinion of the Hills dry diabetes foods. The vet who diagnosed Saoirse in June insisted that she could only eat Hills w/d Dry now that she was diabetic. w/d has even more carbs than m/d, and I thought it was NUTS to prescribe a mega-high carb food for a diabetic. I wanted to start feeding Saoirse according to the recommendations on catinfo.org. For various reasons we moved to a new veterinary practice, and one that was much more FD-aware. As I believe is their standard practice for new diabetic patients, our new vets asked their external feline diabetes specialist to review Saoirse's numbers. She was on 3IU Caninsulin BID. The FD specialist thought that Saoirse might be insulin resistant. Within a couple of days of changing to wet food, Saoirse was down to 0.5IU BID of Caninsulin and a few days later, although not fully regulated, Saoirse had to stop the Caninsulin because it posed a risk of taking her too low. A switch to Lantus and a few months of patience and Saoirse became tightly regulated then diet-controlled. In Saoirse's case, the food prescribed by her previous vet was hindering her treatment, not helping it.

Assuming that there are no other dietary considerations to accommodate, low carb, species-appropriate commercial foods is usually fine for feline diabetics. Saoirse's problems were actually caused by prescription diets. In spite of her FD and pancreatitis she looks infinitely healthier now than she has for years since switching to species-appropriate, wet low-carb food.

With your schedule, it may help you a great deal to use a timed feeder for Fay's meals. It can help with working hours and sleeping hours feeds. Timed feeds can also help a great deal with getting cats regulated, too. Many members here recommend the Petsafe 5 feeder.

I note from your opening post that Fay has been receiving Lantus for 4 weeks and is currently on a dose of 4.0 IU BID. It would be really helpful if you could let us know what the starting dose, in what increments the dose was increased and how long you held each dose before increasing further. When you're setting up your spreadsheet, it would help to include any BG test data you may already have since Fay was diagnosed. With that info, it should help members here get a better idea of how Fay is responding to Lantus.

Once the up-front costs are done with, and provided there are no complications, the cost of ongoing treatment for FD is much more manageable; home testing will save you a lot because you'll be able to run your own - more reliable - glucose curves (no vet stress influence in home readings). You can get help here with sourcing reasonably priced supplies.

Hang in there. The early weeks are the toughest going. It does get better as you learn more and as you develop a routine that works for you at home. You've found a good place to learn and get support and advice on the day-to-day practicalities of helping your little one now that she's diabetic. I'm very glad that I joined in June of last year. What I learned here played a very significant part in helping Saoirse to become diet-controlled.
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Thanks for such a great reply -- really appreciate it. The timed feeder is a great idea, but I still need to give the insulin :) Fay's starting dose was 1.5 units twice a day (BID). That lasted for about five days. Then we went to 2 units BID, for about a week and a half. Finally, we went up to three for a week. And now finally, at 4 units BID.
 
Wendy&Neko said:
Yes, my Neko has two high dose conditions, IAA (insulin auto antibodies) and acromegaly. But several things you've said tell me you shouldn't think about that yet. We consider testing for high dose conditions if a cat has reached 6U twice a day of insulin AND:
- you are home testing and the doses were safely reached. We increase doses by .25U. By increasing in whole units you could very well have bypassed a good dose and your cat may be overdosed. If a cat is on too high a dose, she can still give high numbers. Testing at the vet clinic can give falsely high reading due to stress. My non diabetic can once tested over 210 at the vet and 53 the next day at home. You don't want to determine doses based on tests at the clinic.
- you are feeding low carb food, all under 10% and preferably closer to 5% (ditch the "prescription" dry food)
- you have ruled out any other conditions (hyperthyroidism, pancreatitis) or infection - when was the last time Fay had a dental?

Have you inquired about getting Lantus in a pen? They come in a 5-pack, but sometimes you can find pharmacies that sell one at a time for a much more economical deal.
ETA: We started on Vetsulin, but you can use the Lantus to the last drop.
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Hi Wendy,

I hear acromegaly is not as common in female cats, but the vet has suggested that to me. There aren't any physical signs, but I guess it's possible.

Where is the evidence that supports increasing only by 0.25U? How long can you wait between increases with doses that small? All my home tests with Fay have been in the 400s.

Fay only has two teeth left--nearly all were removed when she was three years old (3 years ago) because she had extensive dental disease. I think this absolutely contributed to the diabetes she has now.

No, I haven't inquired about a pen, but that's a good idea!

Let me know more about the small increase rationale, and where that comes from. I haven't heard that yet but now I am curious. I thought we were doing pretty well with the "low and slow"...
 
Squeaky and KT said:
When they hear it enough, most of them believe it. The salesman convinced all the vets in our practice that the 34% carbs in the dry food was OK for diabetics because...ready for this?.....it was the science BEHIND the mixture, the complex carbs. Umm...cat's can't use complex carbs. :) Their sales method is a 'training' pitch....and they're GOOD.
Click to expand...

yikes. well thank god for you all, then :-D
 
Wendy&Neko said:
Yes, my Neko has two high dose conditions, IAA (insulin auto antibodies) and acromegaly. But several things you've said tell me you shouldn't think about that yet. We consider testing for high dose conditions if a cat has reached 6U twice a day of insulin AND:
- you are home testing and the doses were safely reached. We increase doses by .25U. By increasing in whole units you could very well have bypassed a good dose and your cat may be overdosed. If a cat is on too high a dose, she can still give high numbers. Testing at the vet clinic can give falsely high reading due to stress. My non diabetic can once tested over 210 at the vet and 53 the next day at home. You don't want to determine doses based on tests at the clinic.
- you are feeding low carb food, all under 10% and preferably closer to 5% (ditch the "prescription" dry food)
- you have ruled out any other conditions (hyperthyroidism, pancreatitis) or infection - when was the last time Fay had a dental?

Have you inquired about getting Lantus in a pen? They come in a 5-pack, but sometimes you can find pharmacies that sell one at a time for a much more economical deal.
ETA: We started on Vetsulin, but you can use the Lantus to the last drop.
Click to expand...

Also, no indication of infection. WBC count normal and she did not have a UTI. No sores. No n/v, signs of pancreatitis, no fever.
 
Robert and Echo said:
Welcome, Alex! Thanks for posting an intro, and for joining us. There's a ton of things to read around here, and you don't have to do them all in one day. Ask away all health questions in the Health Forum, and know that our community will do whatever we can to help you get to where you need to be, knowledge-wise, to be on your best footing.
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thanks so much guys :)
 
Marciegee said:
Hi Alex,

My kitty was diagnosed last week. I am a complete newbie and have no wisdom to offer you other than you're not alone and I can totally understand how you feel that way. Sending love and light to you and your Fay.
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what a sweet tortie you have! i have one myself. good luck to you <3
 
Alex&Fayaway said:
Where is the evidence that supports increasing only by 0.25U? How long can you wait between increases with doses that small? All my home tests with Fay have been in the 400s ...
Let me know more about the small increase rationale, and where that comes from. I haven't heard that yet but now I am curious. I thought we were doing pretty well with the "low and slow"...
Click to expand...
Hi Alex,

For the evidence you've requested have a look at this forum sticky from the Lantus & Levemir ISG board. At the end of the post, you'll find an attachment to the Roomp-Rand published, peer-reviewed study on the management of diabetic cats with long-acting insulins. The PDF covers the dosing protocol used, including the adjustments of 0.25IU and, given that it relates to the use of depot insulins, recommendations to hold dose adjustments for a minimum of 6 cycles to allow time for the depot to adjust in order to judge a given dose's effectiveness. It also covers remission rates.

As you will see from reading the posts about individual cats on this forum, sometimes even finer adjustments may be needed in order to hit a 'goldilocks' dose for individual cats. For example, a given dose may cause a cat to 'bounce' - BG goes lower than the cat's body is used to, setting off a counter-regulatory response which bumps BG higher for several cycles before settling down again. The cat's dose might then be lowered by the protocol-recommended 0.25IU, but after holding the reduced dose for 6 cycles the BG may be trending upwards again (a failed dose reduction). In such a case, decreasing the dose by a hair's breadth (i.e. less than 0.25IU) may be all that's needed to smooth out the cat's BG levels. As has been mentioned above, if a cat's dose is too high that can result in high numbers because the same counter-regulatory mechanisms come into play to protect the cat from hypoglycaemia. Fine adjustment of the dose reduces the possibility of overshooting the most beneficial dose for the cat at any particular stage in the regulation process.

Regulation and remission are also possible using the Start Low, Go Slow protocol (see sticky on Lantus & Levemir ISG board), or even treatment plans based on the TR and SLGS protocols that are adapted to the needs and circumstances of individual cats and their caregivers. Unfortunately, kitties don't read a "Right Way to Be A Diabetic" manual, and not every caregiver's personal circumstances permit strict adherence to a particular protocol (Saoirse and myself being a real-world example), but in the main small dose adjustments are used in both defined protocols and also in tailored treatment plans.
 
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Critter Mom said:
Hi Alex,

For the evidence you've requested have a look at this forum sticky from the Lantus & Levemir ISG board. At the end of the post, you'll find an attachment to the Roomp-Rand published, peer-reviewed study on the management of diabetic cats with long-acting insulins. The PDF covers the dosing protocol used, including the adjustments of 0.25IU and, given that it relates to the use of depot insulins, recommendations to hold dose adjustments for a minimum of 6 cycles to allow time for the depot to adjust in order to judge a given dose's effectiveness. It also covers remission rates.

As you will see from reading the posts about individual cats on this forum, sometimes even finer adjustments may be needed in order to hit a 'goldilocks' dose for individual cats. For example, a given dose may cause a cat to 'bounce' - BG goes lower than the cat's body is used to, setting off a counter-regulatory response which bumps BG higher for several cycles before settling down again. The cat's dose might then be lowered by the protocol-recommended 0.25IU, but after holding the reduced dose for 6 cycles the BG may be trending upwards again (a failed dose reduction). In such a case, decreasing the dose by a hair's breadth (i.e. less than 0.25IU) may be all that's needed to smooth out the cat's BG levels. As has been mentioned above, if a cat's dose is too high that can result in high numbers because the same counter-regulatory mechanisms come into play to protect the cat from hypoglycaemia. Fine adjustment of the dose reduces the possibility of overshooting the most beneficial dose for the cat at any particular stage in the regulation process.

Regulation and remission are also possible using the Start Low, Go Slow protocol (see sticky on Lantus & Levemir ISG board), or even treatment plans based on the TR and SLGS protocols that are adapted to the needs and circumstances of individual cats and their caregivers. Unfortunately, kitties don't read a "Right Way to Be A Diabetic" manual, and not every caregiver's personal circumstances permit strict adherence to a particular protocol (Saoirse and myself being a real-world example), but in the main small dose adjustments are used in both defined protocols and also in tailored treatment plans.
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thank you, thank you so much! Tremendously helpful and a lot of food for thought. I hope we haven't backed ourselves into a corner by going with the vets recommended dose increases. I will say I have noticed pretty significant reduction in water consumption since we hit the four units twice daily. However, I wish we had known this before. :-/ thank you so much again for all your time!
 
Alex&Fayaway said:
Even with some dry food, it makes absolutely no sense that the cat would have no response whatsoever to the insulin.
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Hi Alex, and welcome to FDMB.

High dose conditions aside, sometimes it does take a while for a cat's body to respond to insulin. That was the case with my cat initially. It could be that 'glucose toxicity' is the cause. This happens when a cat has had high glucose levels for a while. It can make it difficult for cells to take up glucose even when insulin is present. But you may find that your cat's body just suddenly 'gets it', and the numbers begin to drop.

I think most - if not all - of us were really stressed at first when our cats were initally diagnosed. But you will find a way that works for you and your cat. Honestly!
And, if you're lucky, your cat may even go into remission. But even if she remains on insulin it is still possible to 'have a life'.

6 years old is young to become diabetic. Has your cat had any steroid treatment recently...? (Please forgive me if someone else has already asked this and I missed that...)

Eliz
 
Delighted I could do some small thing to help, Alex. I remember being where you are now and I am very grateful for the help others have given to me. It's good to be able to pay forward a little bit. :)

Delighted to hear that there's a reduction in pee output. In this sugary world, one learns to celebrate - and appreciated - all the small victories along the way! :)
 
Welcome Alex and Fay!

Both of my cats are grazers so one thing I do when I'm gone all day at work is I add water to their food so it doesn't dry out or go bad. I'll leave the food out for up to 12 hours at a time.

Alex&Fayaway said:
okay but she's been on exclusively the wet md for three of the four weeks. Why does the vet not think the dry is a problem? @BJM @nancy and scotty
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I didn't see if anyone answered this for you, but the canned Hill's m/d is 14% calories from carbs, which is still over the 8-10% we recommend for diabetics. Some cats need even lower carbs than that. My Michelangelo, for example, does best on anything less than ~5%. If I feed him something with 8%, his numbers jump up significantly.

And, you can feed all your cats the same low carb food; it's better for them all around and you might just be preventing future health issues, too. ;)

Alex&Fayaway said:
She did, however, have nearly all her teeth removed 3 years ago. I suspect the inflammatory process that was part of her periodontal disease had some effect on her immune system and insulin sensitivity.
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Any chance you've gotten a recent x-ray of her mouth since the teeth removal to make sure there aren't any remnants or splinters left in there that might be causing problems? Dental issues often make it much more difficult to regulate, either because of infection and/or pain.
 
KPassa said:
Welcome Alex and Fay!

Both of my cats are grazers so one thing I do when I'm gone all day at work is I add water to their food so it doesn't dry out or go bad. I'll leave the food out for up to 12 hours at a time.



I didn't see if anyone answered this for you, but the canned Hill's m/d is 14% calories from carbs, which is still over the 8-10% we recommend for diabetics. Some cats need even lower carbs than that. My Michelangelo, for example, does best on anything less than ~5%. If I feed him something with 8%, his numbers jump up significantly.

And, you can feed all your cats the same low carb food; it's better for them all around and you might just be preventing future health issues, too. ;)


Any chance you've gotten a recent x-ray of her mouth since the teeth removal to make sure there aren't any remnants or splinters left in there that might be causing problems? Dental issues often make it much more difficult to regulate, either because of infection and/or pain.
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Hey KPassa -- cute name. Thanks for the info and for your questions. What would you recommend for the wet if not the Hill's m/d? I've heard some different answers but would like to get yours. When you say you leave your food out, you mean the wet food with some added water? Now that I've been feeding every 12 hours, all food is wolfed down in about 2 minutes! :D

Nope, I haven't gotten a recent x-ray of her mouth. The teeth were pulled three years ago, so I do think that if there were some infection happening, it would have gone systemic long ago and poor kitty would be septic.
 
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