Thabbo ... had a rough summer

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Thabbo

Thabbo

Member Since 2015
Hi!
I am Thabbo's mom and try to find out what I can to understand his diabetes a little better ....
Thabbo is my 15y old european shorthair cat whom I brought with me and his brother to the US 8 years ago.
Thabbo had a rough summer because of his developing diabetes. I suspected something already in March - you know lots of drinking and urination - and had him checked out at that time point => he had normal blood glucose levels. So, I just watched him, then he developed hunger spells and would try to eat whatever he could get into, even fruit! ... brought him to the vet again in May => still normal blood glucose, in fact his full blood work came back 'normal'.
In July, he had another bad hunger spell and ate onions (!!!) out of the hot frying pan ... after consulting the internet I found out that onions are severely poisonous to cats (it destroys the red blood cells), took him to the vet and they sent him straight to ICU for 10 days. He was lucky to survive 100% damaged red blood cells and somehow dodged the bullet of a blood transfusion. They did daily blood-work and his glucose levels were for the first time slightly elevated, however, given the stressful environment, they still were not convinced... 3 weeks ago, the last follow up blood-work finally revealed healthy red blood cells *yippee* and also glucose levels of 360 *yikes* BUT finally we have proof that he is diabetic and have something to work with.
Oh, and two weeks ago he had another hunger spell, jumped into the sink while some food was prepared and stabbed his eye .... he really needs a break ... and my checkbook as well ....
We started out with a food change, first we had the m/d and then I found out that Merrick's food has way less carbs, so we switched again, but that did not do the trick. We started him on insulin (2units in the morning) two weeks ago and increased his dose on Monday to 3 units. I check his Glucose 3-4 times a day and it is all over place at this point.

I hope to find some answers and input here, so that Thabbo can have a few more happy years together with his brother

Karen
 
Here is one thing that I don't understand:
Why is his glucose spiking 10-12 after a shot when he had NOTHING to eat in between?
I feed him around 7am and then again around 7pm and I always check his glucose levels before he eats.
Today he had 284 in the morning => food and 3 units of insulin => 92 at noon (no food) => 427 at 7pm before his dinner => 324 one hour after his dinner (no shot)
The spike in the evening happens every day, I started a chart that you can access here.
 
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Hi Karen and Thabbo....welcome to FDMB!:)
I am so sorry you have had all this misfortune, but you have come to the right place. We will be able to help you.:bighug:
If you could answer a few questions that would be great please. Thanks:)

What is Thabbo's weight?
What insulin are you using?
Are you living in the US?
What glucometer are you using?

It is great you are home testing the blood sugars. Here is a spreadsheet we use and if you could use this one it would be much easier to work things out. If you have trouble setting up the SS let us know and someone will help you.
http://www.felinediabetes.com/FDMB/threads/fdmb-spreadsheet-instructions.130337/

Not sure what insulin you are using yet, but cats need insulin twice a day 12 hours apart to maintain a good blood sugar level. That is why you are having so much trouble with having high BSLsin the evenings.
Also three units is a lot of insulin to start with. We recommend you start with around 1 to 1.5 units twice a day depending on the weight of the cat. And then the dose is adjusted according to how low the blood sugar goes.
He looks like he is responding well to the insulin, with the 90 at noon.

It is great you have also changed the food to low carb.....are you using canned, wet food?
We also suggest you give several smaller meals during the day instead of one big meal twice a day. It is better for the pancreas.

Anyway first we need to find out what insulin you are using and what Thabbo's weight is and go from there.
Looking forward to hearing back from you.
 
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Thanks :-) I'm happy that I found you guys!

here are some answers:
Thabbo's weight is 9 1/2-10 lbs
we use vetsulin
yup, I'm living in the US now
I use alphatrek2 - my vet uses the same ...

I feed Thabbo 3 times per day, which is the best I can do with my regular working schedule. He eats in the morning, mid afternoon and at night.

I'll transfer my results into the chart you all use and will ink it to my profile tomorrow.

We started him on one dose, because my vet hoped, that this might be enough to get him out of it. I'll call in later and see that we get Thabbo on a twice a day dose. I will also discuss with her that I want to be more in charge of the dosing. My vet wants me to do this as independent as possible, but with Thabbo's recent medical history I really try to be on the super cautious side....


Karen
 
Vetsulin is a fast acting (harsher) insulin. It usually does not last 12 hours, in fact, sometimes it only last as long as 8-9 hours. The nadir (the point in the cycle where your numbers are the lowest) sometimes tops out as early as +4 (four hours after shot). You might want to consider changing insulins after this bottle is gone to a more longer lasting insulin such as Lantus, Prozinc or Levemir. Maybe you can talk to your vet about those selections as well.

Great job in home testing and data collection. Glad you are going to convert to the spreadsheet we all use here. It is very helpful when we are looking at one format.
 
Thanks for your input on the vetsulin!
I discussed it with my vet and she got really frustrated, because their reference material shows that vetsulin is slow acting and should be given once a day - she showed me the studies they use as reference ... wow!!!!
We now kind of teamed up and research what we can find ... I'm happy that she supports me and takes me serious but I also feel a little overwhelmed ...
Anyways, we decided to go with two shots per day now and I'll do a glucose curve over the weekend.

I'll start the new chart tonight with Thabbo's first evening shot ... Let's hope we finally are on the right track!
 
Vetsulin, aka Caninsulin, was developed on dogs which have a slower metabolism than cats.
We have a guide on using Vetsulin herd this may help you use it more optimally. In particular, it can help to test, feed, then wait a bit before giving the insulin.
 
Welcome!

You can find out how Vetsulin works by getting tests in around 3/5/9/12 hours after the shot, and then later in the cycle 15-17 hours after the am shot. Very likely you will see a drop earlier in the cycles, perhaps a low point in that 5-7 hour after the shot and then a rise to the 12 hour mark. If you don't give a shot after 12 hours, you are very likely to see the numbers continue to rise until the next shot. That pattern - a drop and then rise and then high for the final 12 hours will feel like a roller coaster, from high to low to high again. Instead, you want a smile shaped curve from higher levels pre shot to a lower number mid cycle, then back up to about the same level as the preshot 12 hours before.

We generally consider a cat regulated if they are in the lower 200s at the pre shot test and double digits 5-7 hours after the shot (but not below 50 which is approaching hypo territory). That's the first range you aim for.
 
we are making progress :)
the evening dose put him between 90-110 for multiple hours! *yay*
his AMPS was at 199 and the lowest he has been since testing started => lowered the morning dose and now (+2h) he is at 135! hope he won't drop too far now ...
It feels so weird to learn all this stuff on the go while 'using' my little boy as a guinea pig.
 
We do suggest that new diabetics not get a shot under 200 until you have enough data to know how low thaw dose might take them. (Your 199 was fine). Unless he drops below 50 midcycle, he should be okay. If he drops in the 60-70 range, you might give him a little of his regular food to keep him more level.
 
he just dropped to 64 at +3h .... gave him some kibble and hope it wont drop further ... will check in 30 minutes again ....
update: dropped to 60 after 30 more minutes => gave a little bit of food with a small drop of honey because we are still 1.5h away from his normal low point...
 
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You are doing great in keeping Thabbo stable. The honey should bring him up pretty quickly but it doesn't last long so you want to make sure that you continue testing and possibly give a little bit of his regular food. Looks like he has definitely earned a reduction in dose. Keep us posted.
 
Hi Karen,
Looks like you are making progress since you first posted! That is great news.
Was wondering....do the vet reduce the dose when she changed it to twice a day injections? Looking at your SS you have 1 unit for the PM cycle on 10/9 then back to 2 units on 10/10?
Also if you are using the Alphatrek monitor I would have thought that would have meant a reduction with 64 on the am cycle of 10/10.
I don't know anything about vetsulin but maybe @Merlin and @Sue and Oliver (GA) can tell me.
 
Yes totally agree with the reduction and the 2 units appeared to be too much for the 199. Even though 67 is at the very lowest of the AT number, it was a little too early in the cycle. As mentioned above, I would definitely reduce and since you are now shooting every 12 hours, may want to consider cutting the dose in half with monitoring. Remember that we typically do not suggest to shoot anything under 200 (although 199 was close) until you get more data.
 
I was on 3 units in the morning without the evening shots - he almost did not respond to the 2 units when only given in the morning - and with adding the 1 unit at night we reduced the morning dose to 2 units... obviously too much now.
I am amazed how sensitive his metabolism all of a sudden reacts. The little drop of honey sent him back up to 300+ now... so I plan to give 1 unit tonight and then only 1 in the morning...
 
If it was my cat, that is what I would do. It is almost like starting over but it is better to go low in dose and go slow. You are doing great in testing so you will be able to tell how Thabbo is doing throughout the 12 hours. Getting a 300 number is a bounce and is pretty much expected after going low. It is due to the system saying that this is too low so I am also going to produce glucose, so that is another reason why you got a high number at PM. Some kitties will bounce for a few cycles after a low number and some don't bounce afterwards. So since this is a bounce, you don't want to give any extra insulin and I think what you decided is a good decision. It might be a good idea to get one more test in before you go to bed. This is to ensure that Thabbo will have safe numbers for you tonight.
 
yes, I plan to test him for 3-4h after his evening shot. I was surprised how well he reacted last night after his first shot and now I want to make sure that today's roller coaster does not continue during the night.

I will keep you updated how his 1unit tomorrow will work out :-)

Thanks a million for all your great information!!! Makes me feel such much better that I don't have to go through this alone, you guys rock!!!
 
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Hey Karen. Before I went to bed I checked on Thabbo's SS. He sure did drop hard at +2. I am not too familiar with Vetsulin, but that is what I read about Vetsulin that it is harsh and drops you hard in the first couple of hours. I also read that Vetsulin nadir is a little earlier than other insulin's like in the +4 range. A good drop is 50% for the nadir so as you can see, he did that at +2 which is way too early, again. Anyway, I am sure you will know what to do but if he gets close to 80, I would start slowing him down with a tsp of your own food or even medium carb food. Just a little because you don't want him to get full. Also, tomorrow AM, you may want to consider reducing again, if he goes low tonight. Maybe a .75u or even a 0.50. I will check your SS one more time, before I go to bed, here in a few minutes, just in case you captured another test.
 
With Vetsulin, you do want to test him, feed him and then shoot - once you are sure he has food in his tummy and won't be gracing you with it again. :arghh: Then, if his pattern is that he has that sudden, early drop, give him a snack of his regular food 2-3 hours after the shot and you may be able to flatten it out.
 
this morning he was up at 364 again so I ended up giving him 2 units. hope it will work better than yesterday ...
 
I would plan to watch him carefully early at +2/3 to be sure he doesn't drop fast and then in the 5/7 hours to see how low he goes.

His higher number this morning was most likely a bounce. His body wasn't used to the low numbers last night so it released extra glucose which caused his number to bounce higher. Lowering the dose this morning might have given you a flatter, safer cycle. It may be that your two units will work fine, but I would keep an eye on him.

This dosing thing is hard. Your job is to look back at his numbers in the previous cycles. When he had this preshot, where did this amount of insulin take him? Too low or too flat and high or just right? Then you use that information to help you decide how much to give the next shot.
 
so far going down nice and slowly ... 259 at +2h
update: 124 at +3h ... so that is similar to yesterday ... bracing myself for another intervention! will give him a little bit of food right now to slow the drop. I guess, now I KNOW that 2 units is too much for him - even with a high number to start with.
 
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Hi there. Yep that is the wonder of data collection....now you know. Holler if need anything.
 
124 at +4h ... yay. It looks like I start to get the hang of it. Now I can hope for a smooth curve for today and no bounce, right?
Thank you all so so much for all your input, I feel so much more in control of this whole situation now!
:cat:
 
Thabbo said:
will give him a little bit of food right now to slow the drop
Click to expand...
So did you give Thabbo just regular food at +3? If yes, one can hope for no bounce but you never know. Thabbo has been in those nice blue numbers before so it shouldn't freak out his system and you didn't have to intervene. He may run higher at the end of the cycle just because Vetsulin typically doesn't last the full 12 hours.

Are you still feeding him Merrick food? Which ones?
 
yes, I gave him only a fork of his regular food and some low carb kibble (1teaspoon) because I hope that helps to keep things more level for today.

I decided to switch to BFF after I read in a different part of this forum that Merrick changed the formula on the types we have available here in our country store. Thank goodness, Thabbo's tummy never cared about switching diets.... he didn't even react to the 6oz. of onion ... or when we tried to make him throw up! He might still think that hydrogen-peroxide is a treat ?! crazy cat ... :facepalm:
 
Ok as suspected this morning when he dropped fast, 2 units is too much... he bounced up again and ended up with 440 PMPS! so I gave 1 unit with his dinner and will stick with 1unit in the morning, no matter how high his AMPS will be - unless he drops below 200, right?. I hope that will do the trick... ?
 
I think I would go with the 1u just to try and settle him down. He may be high tomorrow am but you can try the 1u for the next 2-3 cycles to see how he does. If you can catch a "before bedtime" test tonight that would be good. I suspect that he does need more than 1u but who knows? After the 2-3 cycles of 1u, and if need be, you can slowly increase by 0.5u for another 2-3 cycles to try to get into those greens safely. It just may take some "trial" time to figure out what he needs but what is encouraging that he is responding very well to the insulin and sometimes almost too well! :)
 
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no crazy numbers today! no good low numbers either, but I guess getting him on a flatter and longer lasting curve is more important at this point, right? I'm curious if he will get lower numbers as he will hopefully stabilize and not bounce around like a yoyo?
 
Well that was a pretty uneventful day. It is good to see that the nadir could possibly be +5. It is also good to know how he did with 1u. Tomorrow AM, he will be on 1u for three cycles. If nothing changes, you may want to consider an increase of 0.5u if you could monitor...nice and slow and hopefully he won't bounce. Just so you know, I am going on vacation starting tomorrow for about 9 days. If you have any questions, you may want to open a new thread. You are doing a great data collecting and it sounds like Thabbo is doing really well too. I hope it continues and will be checking how he is doing when I get back home.
 
I'm with Cindi. It is probably time to increase a little. If adding 0.5 makes you nervous, you could try to eyeball 0.25. Regardless, be sure to increase on a monitor when you can get a few tests in, just in case he decides to surprise you and drop lower than we expect.

For reference, we generally consider a cat regulated if they are in the lower 200s at preshot and in double digits at nadir, but not below 70-80 on your AlphaTrak. That's your first goal; then you work to finesse him lower.
 
Hope you have a great vacation! Thanks for your input :) I hope to be able to report good progress when you are back!
I don't syringes with 0.5 units yet :( and my vet advised against eyeballing ... but she was trying to find syringes with half units, hope to hear from her tomorrow.
 
Many of us do use the U100 syringe so we can get the little doses like .2, .4, etc. and many others just eyeball there U40 syringes because jumping a whole unit is too big of a jump and it creates bounces in some cats. You can get the U100 syringes at Walmart. They have the orange caps and mine are 31 gauge, 3/10 ml (capacity) and 8mm (length).
 
With conversion, each 0.5 tick mark on a U-100 syringe equals 0.2 units of a U-40 insulin.
How do we know?
U-100 = 100 units per mL
U-40 = 40 units per ml, or 40% of the concentration of the U-100.
Adjust each U-100 tick mark to 40% of what it measures and you get the U-40 dose.
 
Great info! I will probably try it tomorrow, I will wait and see how he does today after 24h of not bouncing around :-)
The plan is to very slowly increase the dose until he reacts with nice numbers without dropping too much in between - hopefully! Would be nice, if it would be that easy ...
 
Update: I discussed everything with my vet today and we decided to go with Lantus now. Hopefully we can get him better regulated now
The Lantus U100 and I have the U100 3/10 syringes now ... started with 1unit tonight. Looks like I gave another weekend of BG curves in front of me.
Is there anything I have to look out for with this new insulin?
 
Lots! There are a number of stickie posts in the Lantus forum about using it optimally.

It takes 5-7 days of the same dose to get stable initially, then 3-5 days for changes after that.

The nadir, or lowest glucose level is how you determine if a dose needs changing after the waiting period. It tends to happen around +5 to +7 hours post-shot.
 
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