Dosing advice for an unpredictable cat?

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jmalasiuk

jmalasiuk

Member Since 2014
Hi, I've been struggling to make sense of Tonka's blood sugars. He was diagnosed back in August and there seems to be no real improvement in his levels. I'm out of town for extended periods during the snow free season, and work long hours out of the house when I am in town. I try to curve him whenever I am home, and get post shot readings after his evening shots, at least. His spreadsheet is linked in my signature.

The timing of his nadir seems to be all over the place , and he's a rebounding wonder, so I can never tell if he's high because he's not getting enough insulin, or because he got too much and rebounded from a bad low (this happened at least a couple times, from the readings that I did get, although he hasn't approached a low reading in ages (that I was home to catch, in any case), or if he's getting a decent amount and his little body is just so used to the high blood sugar levels now that it won't let him get even close to normal without releasing more sugar into his system...

Right now he's taking an antibiotic (AventiCLAV) on the vet's suggestion, since his sugars were spiking considerably higher than they had been previously on the same insulin and food, and she thought the swlling in his gums might be an infection that was causing his blood sugars to spike. He seemed to be coming down a couple days ago, but since then has been even higher. I have started feeding him a mixture of his DM pate and a few other low carb foods, including the Friskies Turkey and Giblets pate, which is supposedly still 8% or less carb, but apparently higher than the DM, since his biggest meals on that correspond with his highest numbers this week. Problem is my older boy, Teeger, went on a hunger strike after too many weeks of nothing but DM, and it is getting mighty expensive too, so I figured we should try the Friskies and a few others and see how it works out if I alternate them (and both cats have no trouble with transitioning to new foods - they've eaten just about everything under the sun at some point, it seems. Tonka is a rescue cat who was found in a dumpster when he was 2 years old, and he still likes to go garbage hunting sometimes!).

I'd like to increase his dose to get him down to a better level. He's bound to keep rebounding though: how do you get their bodies used to lower blood sugar levels if they keep rebounding back up? Does they eventually stop rebounding so much? I've been afraid to increase his dose because it takes so long to get him back down after he's rebounded.

And finally, is it safe to practice the tight regulation if you can't get a daytime nadir other than on weekends? I really want to get him closer to regulated and healthier before my field season starts up again in a few months and I lose the opportunity. I do have a wonderful cat sitter who watches him carefully, but she's reluctant to test his blood sugar levels, so we have to rely on the other indicators of his levels when I'm not home, and the little trouble maker doesn't show any signs when he's too low. So rebound is actually a good thing for him. I just wish it would stick to times that it was legitimately needed.

Sorry for the long post, when all I'm really looking for is some thoughts on where his dosing should go, but I figured it best to give a bit of background, since I haven't posted in this forum before.
 
Hi. If you go to the main page for lantus there is a sticky on how to work full time and do tight regulation. I am lucky enough not to be working because Max keeps me quite busy. It took a year to get him regulated. I looked at your ss and what jumps out at me is that I don't think he is getting enough insulin. I"m sure one of the wonderful dosing pros will come along to help you. You don't want to spend too much time on a dose that isn't giving you the green Nadirs.

There is no such thing around here as a post that is too long. The more information the better. You have come to the right place.
 
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Hi, thanks. I have read the sticky (and almost everything else I can find that looks at all relevant). I've done what I can for testing by getting late night tests in for his night time nadir. I'm just wondering if that is enough to make a safe dosing estimate on, since daytime nadirs are just plain out of the question except for weekends. Once I have to head out for field work in a few months, I won't even be able to do that (is there such a thing as part time tight regulation?).

I do agree he looks like he's not getting enough insulin, so I'd like to increase him. I'm just scared to because not so long ago, he was down below 2.0 (36) on a couple occasions on the same dose of insulin and roughly the same food that he's taking in now, and he's periodically dropped down to a close to normal level even on 1.0 unit. I'd be more aggressive with his dosing if I was home more often, but since I can't figure out why he drops some days but not most days, I'm scared to do so when I'm not going to be home. Home this weekend, though, so I'll probably up his dose by 0.5 units tomorrow morning and just keep a real close eye on him in case he decides to crash.

Anyone have insights into why the lack of consistency in my goofy dude? I could take the back and forth bouncing, if only it were more predictable or understandable back and forth bouncing.
 
What jumped out at me is that when your spreadsheet first starts, you were changing dose often as well as increasing in whole unit increments....We do our increases in .25 to .5 unit increments based on the nadir so we don't skip over what might be the "best dose" for our cat

If the only time you can get mid-cycles is the weekend, then it'll be important for you to get tests when you can....right before you walk out the door, right as you come in after work, and in the evenings

Is he completely off dry food now? I see you have in your Remarks that you've left dry out for him occasionally. Even a few pieces of dry can raise some cats 100+ points

I wouldn't increase by .5, especially if you're not able to test, but stick to .25 (they're challenging to eyeball, but it can be done!)

I've underlined and italicized the part of the protocol you're on below:

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.
    • if your cat is new to numbers under 200, it is recommended to hold the dose for at least 8-10 cycles before increasing.
    • when your cat starts to see nadirs under 100, hold the dose for at least 10 cycles before increasing.
  • 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.
Click to expand...
 
Thanks Chris. I do know the increases were too much at first, now that I've been reading up more on feline diabetes since he first joined me in diabetes land. If you look at the dates, you'll see that he was actually at the same dose for several weeks at a time - I just wasn't home to test him, so my cat sitter would keep me informed of his water and food intake and litter use, instead. For dosing, I was just going off what the vet recommended looking at the readings I could get for him - she was recommending full units, but she's probably used to people aren't used to using syringes... I am, sadly, all too familiar with them, so half unit doses aren't a problem for me to measure, and I can usually fiddle long enough with the plunger to get an approximate 0.25 above or below the mark. I haven't gotten his nadir yet tonight (will be up late working so I'll get it at +6 or +7, which seems to be the latest that he nadirs (sometimes it's as early as +3). The last couple nights, it's been over 300 (16.6 in my Canadian head) at +4 to +6 and if it is again tonight and doesn't go down from there, would you think that 0.5 was still too much of an increase?
 
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Oh, and both cats are getting all wet food these days. I only left some dry out for him on a day that I was worried he was going to crash while I was away. Teeger got some dry food when he started his hunger strike, but I put it up high (poor Tonka can't jump any more because the neuropathy in his back legs is so bad, so he shouldn't have gotten into that). And now that I'm varying their wet food, Teegs is also back on all wet.
 
He got down to 9.9 (178) a few nights ago and that probably triggered a "bounce" since it's a number his body isn't used to being at.

Bounces can take up to 72 hours to clear, so I wouldn't feel comfortable telling you to increase more than the .25

When they start to clear a bounce, they can move down fast and if you've also increased the dose at the same time, you can set yourself up for a long night of testing.....as well as starting another bounce
 
You might want to look into getting some Zobaline for cats for his neuropathy

We've seen it do some pretty miraculous things! It takes some time, but it seems to work really well

I'm asking Marje to come take a look at your situation too

She's got a lot of experience and may have other ideas
 
Our vet keeps giving me the optimistic "his legs will get stronger once he's regulated" :) If only I knew that he'd get there. But I'll look into that - thanks for the reference.

I have noticed that he tends to rebound and he usually takes between 2 and 3 full days to get down from there. Only to rebound again. Which is when I've been reducing his dose or feeding a bit more, to try to at least slow the descent. I've been gathering, lately, that I should just let him bounce when he's at those safe levels and he might eventually bounce a little less over time and maybe finally stop doing so at the normal levels. Is that the case? Or can that vary too?

I still can't believe how much the cats can respond to Lantus with peaks in the cycle. In humans, Lantus is a very slow acting insulin and almost peakless. Trying to translate what I know of diabetes to the world of Cat has been challenging (and the source of many of my mistakes to date, I'm sure).
 
I'll aim for the 0.25 increase tomorrow, since his last few days' spike could be another rebound. If he stays high through the weekend though, and I want to increase him again, is getting night time nadirs adequate for knowing if he's safe to increase? I keep seeing that cats tend to go lower at night, so that should be the better time to judge his nadirs, but he tends to eat more in the evening, so it's hard to say.
 
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If he continues to have nadirs that are yellow (or worse) then yes, you'd want to increase again in 3 days

Your vet is partially right...getting the BG numbers under control will help with the neuropathy, but adding the B-12 can also help quite a lot too
 
I'll try to find it. It's quite heartbreaking to see him walking along on his haunches. Up until this fall, he was always an active little trouble maker who had no trouble jumping and climbing. He's only recently given up trying to jump into his favorite scratching post (requires a 3 foot jump or climb to get into). He was taking his usual leap at it, got his front claws hooked in and then just slid down instead of being able to push himself up with his hind legs like he used to. Then he would sit at the bottom and just looks so disgusted that it would be comical if it weren't so sad.
 
Unfortunately, they won't ship to Canada. I found a few links in an earlier FDMB postings with a few options, including ordering straight from Lifelink, but there's a ridiculous shipping charge so I'm going to check a few local sources this weekend and see if anyone carries it or something similar first.
 
If I can get him to a dose that brings him to the normal range, and just let him bounce to his liver's content, can I expect that eventually he'll rebound less in response to safe levels?
 
Welcome Jordi and Tonka!

Chris asked me to look at his SS. First, I would definitely get him on the zobaline. Sometimes getting them regulated isn't enough to counteract the neuropathy.

It's always tough to guess what they are doing during the day when you have to work. Some cats go lower at night; some go lower during the day. Some go low both cycles. I've seen some of the cats start at 400, be at 40 by midcycle, and then be up again at PMPS. Without another test during the day, we wouldn't have known they were coming down.

Is there any way that you could shoot earlier so you could possibly get a +2 test or do you work long days which would make that impossible? I think any out the door, in the door tests that you can get would help.

I think increasing him to 1.75u bid and holding it for six cycles, unless he comes down, is a good move.

One thing we will ask is if you can possibly use our template to Create a SS.

It automatically converts the world numbers to US numbers. You put the number in on the world sheet and it converts it to US numbers. We have so many members and look at so many SSs that it takes time for us to convert the numbers and see exactly where he is.

We're glad to have you all with this and will help all we can so be sure and ask questions. Of course, if you get up in the morning, and he's in blue or green numbers, I'd hold the dose and see what he's going to do.

edited to add: hopefully, as he gets to a better dose and his liver gets used to the normal numbers, his bouncing will be minimized. Some cats quit bouncing....some don't and the ones that don't will sometimes lessen it quite a bit with a good dose.
 
I'm basically out of the house by 7:15 am and not back until just before 7 pm, so the daytimes are pretty much out of the picture except for days off. No way to make it home at lunch since I work 45 minutes away. Fortunately (?) I'm a chronic late night worker, so I have ample opportunity to get him read at night. I'd be content with the weekend spot checks during the day if only he would be a little less bouncy Right now, I never know if he's at a representative level at daytime nadir or not, because I can only get one or two a week and he might be rebounding half the time.

As for the spreadsheet: arggh - I had used the template to make his spreadsheet. It used to convert to the US numbers: I remember being impressed that it did that. Not sure why it's not doing so any more. (I'm kind of a luddite when it comes to making computer programs work the way that they're supposed to; the IT people at work laugh at me all the time). It took me about half a day just to figure out how to get onto the Google page and load the template the first time and now I can't remember how I did that... sigh.
 
Hello and welcome from a fellow Canadian. It looks like somehow the US tab got removed from the spreadsheet.

As for Zobaline, it does seem that you can only get it here from LifeLink. I remember another Canadian found a source of powdered methyl B12 without sugar in a local store. You can also find some on iherb.com and they have much better prices for shipping to Canada. But I think the iherb product you need to give two caps to get the same quantity B12 as Zobaline.

As for bouncing, if you haven't heard the phrase yet, they bounce until they don't. It's up to the cat, not us. All we can do is try to find a dose where they can spend lots of time in normal numbers and get used to it.
 
Actually, you can try any place that carries vitamins for methylcobalamin (methyl B-12). You don't want B-12 since it is a specific form of B-12 that is effective for diabetic neuropathy. Just read the label carefully to make sure there's no sugar or flavoring and as little carb (e.g., rice flour or other starch is often used as a binder) as possible.

I agree with Marje. I don't think Tonka is getting enough insulin.

I don't know if this is affordable but given your hours, is it possible to have your cattier stop by during the day to check on Tonka. Does your sitter test?
 
Thanks all. I was just going to ask about the difference between B-12 and Methylcobalamin B-12 and how to know which were safe for cats. I'll look around today. If all else fails, it looks like amazon.ca still handles the Doctor's Best Methylcbalamin, which is the one that Wendy pointed out (much cheaper than on amazon, but the same $15 dollar shipping charge as Lifelink, looks like). At least I have some options if I can't find it locally. Thanks again.

My sitter doesn't want to test him (she's afraid that he'll stop liking her, since she's only there twice a day), but she's so good with the boys, and doesn't charge me any extra for taking care of medical issue animals, so I don't want to push it. That's one reason why I'm really hoping to get him stabilized before I have to be away regularly again: if he got down to a more consistent level, the secondary monitoring that she does might be enough. I keep thinking that I really ought to find them another home, but up until Tonks developed diabetes, they had each other for company, my sitter for daily attention and lovings, and everyone seemed to be just fine. And they are my only family in this city and I don't know that I could bear to not have them with me when I come home. I just hope that the life I am giving them is still better than the alternative (Teeger was a pound kitty on death row and Tonka, as mentioned before, was a Meow Foundation rescue that they'd found in a dumpster).
 
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Does anyone know how to reinsert the US tab, or will I have to start the spreadsheet up from scratch again?
 
If you shop on IHerb - pick International AirMail for a $4.45 shipping charge. Quite the savings over the $17 extra that Amazon.ca charges for the same product.

Might be easier to create a new spreadsheet, then copy your existing data over to the World Tab. Adding a new sheet is easy, there's a little plus sign on the bottom left by the sheet names. However, there is a lot of formula's in the US tab that are trickier to reproduce.
 
I could only find the $15 airmail charge on iherb, but maybe I didn't find the right tab to select a different delivery method. I'll check it again. Thanks. If I can find a gelcap version of the Methyl B-12 at the health food store though, I'm hoping that might be another sugar and starch free version, since you shouldn't need flavouring or binders in gelcaps. I'll just have to read the ingredient lists and see.

If I do have to go with mail order, I imagine getting a couple bottles would be the best bet for value on delivery. Don't imagine anyone has seen enough improvement in their cats after a month or less on the supplement to stop giving it after one bottle is used up.

I'll see if I can get a new spreadsheet made and link it. Might have to wait until later today though.
 
The US tab has a formula for the cells which multiplies the glucose test values by 18. If you're comfortable with spreadsheets, it is easy to do. Otherwise, starting a new sheet may be faster.
 
I'm heading out now on a search for kitty vitamins but will attack this when I get back.

Probably just start a new spreadsheet and insert the results from 2015 into it. Is it worthwhile trying to link the older spreadsheet for reference, and is there a way to do that? I saw a few people mentioning that they had provided a link to 2014 when they started a new 2015 spreadsheet, but havn't figured out yet how to do that.
 
The only real difference in strength. Zobaline is 3mg (or 3000mcg)and 200mcg of Folic Acid, but some people give twice that. One advantage of Zobaline is that it is a amall pill that is easy to crush and add to food. Most human methyl B-12 are in the form of sublingual lozenges which may be larger and harder to dose for a cat. The only Capsules I saw at iHerb also had something called TMG and I'm not sure what that does. Be sure to check any other ingredients, active or inactive.

You can add the link in your signature.
  • Copy the URL from the old SS
  • come back to the board
  • Hover over your name on the right in the dark blue baron top of the page.
  • click on signature
  • type old spreadsheets (or whatever you want to name it)
  • highlight the name
  • click on the link icon (7th from the left above the text box)
  • paste in the URL
  • click insert
 
Wendy&Neko said:
If you shop on IHerb - pick International AirMail for a $4.45 shipping charge. Quite the savings over the $17 extra that Amazon.ca charges for the same product..
Click to expand...

Ah, found the button to select a different delivery method. Thanks for pointing that out. I wound up ordering a bottle off of amazon.ca, to avoid having to deal with customs restrictions right off the bat, but if he doesn't reject the pills (he does love his duck and pea pill pockets), I'll look into that source and see if they have any limits on what you can have sent across - they link to a note about maximum one month supply, but if you're doubling the dose for the cats, then a 60 capsule jar would only be a month's supply either way. Just have to convince customs of that. Now if I could just convince them that 120 capsules was still just a one month supply :)

Thanks!
 
I've managed to get a new spreadsheet up for the 2015 readings, but it's not converting the last few days over to the US numbers, for some reason. Have a query posted on the tech support forum - hopefully someone will know how to fix that.

For now, though, Tonka started a very gradual descent throughout today. He was down from the equivalent of 408 at AMPS to 381 at +4, with no +1 or +2 spike after eating all of his food (3/4 of a 5.5 oz. can) this morning, But at +7, which has been his nadir on some days (he varies), he's already on his way back up (445). Would this be that "New Dose Wonkiness" I've heard about, or is his little body just refusing to recognize that he has a long acting insulin in his system?
 
When you add new rows to the World sheet, you must also add new rows to the US sheet AND you must copy the formulas of the working cells of the US sheets to the new cells you've added.
 
Yes, this could be some NDW.....Just keep with the 1.75 and we'll see if it's getting Tonka anywhere in a few more cycles

The other thing you're going to really need to consider is getting Tonka's teeth in shape. Adding an antibiotic can help if there's some infection, but the "cure" is a good dental, including x-rays to see what's going on under the gumline
 
BJM said:
When you add new rows to the World sheet, you must also add new rows to the US sheet AND you must copy the formulas of the working cells of the US sheets to the new cells you've added.
Click to expand...
Ah! Got it. There were already way more rows in the US tabbed side so I didn't even think of that. When I pulled the last row down to copy the contents, it just copied the formulas and the International numbers from those days finally showed up. Thanks BJM - now I just have to remember to do that the next time it decides to stop copying over.
 
Chris & China said:
Yes, this could be some NDW.....Just keep with the 1.75 and we'll see if it's getting Tonka anywhere in a few more cycles

The other thing you're going to really need to consider is getting Tonka's teeth in shape. Adding an antibiotic can help if there's some infection, but the "cure" is a good dental, including x-rays to see what's going on under the gumline
Click to expand...

Yup - that's on the horizon. I just need to wait a few more weeks until I can take a day off to bring him in during the day (looming deadlines right now). If they start to affect him not eating or his breath starts to smell badly, I'll definitely bring him in sooner, but hoping that a couple more weeks won't make that much difference to his 13 year old teeth.
 
It's not the teeth you have to worry about so much....it's that any infection, inflammation or pain can make the blood glucose go higher as well as making it harder to control

We've seen cats that had high numbers come down quickly after they had a good dental done
 
I honestly don't get the sense that his teeth are bothering him (not the way he chows down, and if it were an infection causing the highs, you'd think that the antibiotics would have brought him down a bit by now), but I'm going to call the vet on Monday and see if they can schedule him in since he does have tartar and needs a cleaning regardless. They'll no doubt want to run blood work on him first, since he's over 10 years old, so might as well get that process started. Maybe he really will come down after a proper dental - here's hoping. That might explain why he can drop down to a near normal level on some days and not at all on others, wouldn't it? Maybe he's not rebounding in response to the blues and it's just his body going whack-a-doodle over his teeth (the blacks following his descent to the under 2.0 (36) levels definitely seems to be rebound though ... unless reducing his dose those days was enough to send him that sky high?).
 
Make sure you get the dental done at a place that does dental X-rays first. My Neko had a dental a couple of weeks ago. I took her in for some thickening gum issues (due to her acromegaly). Her teeth looked great other than a little tartar, never any problems eating, but an X-ray showed a deep pocket in one tooth down to the jaw and a growth down there, so the tooth came out. Her numbers have since started to ease down. Sienne put together a good post on Dental Procedures.

By the way, Tonka's spreadsheet looks like a lot of kitties that are first starting out. He could be bouncing from the blues and the teeth could just add to the confusion.
 
Cats are also masters of hiding pain, so even if he's still chowing down, it wouldn't necessarily mean his mouth was in good shape

When I did China's dental last year, she was still eating just fine, without any signs she had any problems, but she came home with 8 less teeth because they were so bad
 
Thanks for all the info on your schedule and for adding the new SS. I know it is a pain but it's extremely helpful. Great job.

Good luck with the increase. I hope you can get to a good dose shortly.
 
Thanks for all the help and suggestions. And yes, we have a good vet. They do do X-rays for dental work.
 
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