Help with food transition and dosing

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jacereske

jacereske

Member Since 2014
I apologize for the length of this post, but it's a complicated situation.

A little over two months ago we adopted a diabetic 16 year old kitty who was scheduled for euthanasia the next day, from the shelter. She had not been receiving insulin for the 8 days at the shelter and I don't know if she was getting it prior to that either. Her BG was 570.

She spent the first night at the specialty hospital and they did an ultrasound and also diagnosed early stage kidney disease. Hill's k/d was prescribed. She came home on 2 u of Lantus twice a day.

Her BG's were still high so 9 days later we went up to 3 u of Lantus twice a day. BG's still so high so 12 days later went up to 4 u twice a day.

Her BGs are still high on 4 u twice a day. The Hill's k/d is loaded with carbs (25 - 35) so I'm guessing that's a factor.

On Sunday we took her to a new vet because of an eye injury and they tested her urine for ketones (none) and also did a fructosamine test. He looked at her kidney numbers and felt we could go off the Hills k/d and stick with Weruva low carb/low phosphorous.

So yesterday (Monday) I took her off the Hill's and she is only eating Weruva low carb canned food. Yesterday she ate very well at 7 am and 10 am, but not so well at noon or 7pm before her shot. But she ate enough that I felt comfortable giving her 4 u.

After I gave her shot I noticed some diarrhea in the box and felt relatively certain it was from her. I could tell she did not feel well and was not herself. This morning I saw her use the box and it was her having the diarrhea. However shortly after that she started to feel better. I tested at 7 am and her BG was 193. Given that she was not feeling 100% I did not shoot.

Note: I think the diarrhea was because I gave her a Weruva fish flavor.

Today she has only eaten Weruva chicken and beef flavors and I have not seen any diarrhea since early this morning and she seems to be her old sassy self. I tested 7 hours after her 193 BG and she was 499.

The vet called with the results of the fructosamine and said that her diabetes is not under control (I knew that) and that there is glucose in her urine. This is where it gets tricky as these are his dosing instructions.

3 units PM
3.5 units AM

Don't shoot if below 100 (this scares me - it seems like a pretty low floor for 3 or 3.5 units)

My concern is that with the change to low carb food, we don't really know how much insulin she needs, since she has been on the high carb Hill's since we got her. Is the 3 and 3.5 units too high? He says we shouldn't reduce it too quickly from the 4 u.

Again I'm sorry this is so long.

thanks,
Jeanette
 
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On your spreadsheet, you need to change the Permissions to "Anyone with the link"....we can't see it now

Go to the "Share" at the top right and click...a new box will pop up....at the very bottom on the right side look for "Advanced"...click there and then choose "anyone with the link" and "done"
 
Just shared it - sorry.

One thing I do want to call out, there was one day that I fed her Weruva pre-shot and at lunch and her post shot numbers were good. That was 8/10/16. After her PM shot she went back on k/d.

Also initially the new vet said to keep her on 4 u am and pm and I questioned that and asked if she would go hypo on that - he said no, but then he said the 3.5 am and 3.0 pm. And I am to call him in a week. So he may have been appeasing me.
 
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OK....first, Lantus craves consistency and does much better if it's given at the same dose both AM and PM, so no, I wouldn't give the different doses....It's a "depot" insulin which means (in simple terms) it's kind of like a timed release medication.....out of each shot some goes to work and the rest goes "in the depot" and is released slowly back into the bloodstream....each time you change the dose, you interfere with having a stable depot

Next, your vet has increased her dose too quickly....We do dose increases in .25 unit increments, never in whole units. By going up slowly, you don't take the chance that you bypass what might be a "best dose" for your kitty.

It's important to ALWAYS test before shooting....and then on the AM cycle you need to try to get a test in at mid-cycle (between +5 and +7) and on the PM cycle, at least a "before bed" test....Lantus dosing is based on how LOW it takes them, not how high the Pre-shot numbers are.

Most cats go lower at night too, so that "before bed" test is very important....it can let you know if you need to set alarms to get more tests in later to keep her safe

Since we don't know anything about her yet, I'd probably just shoot the 3 units both AM and PM and get those tests in...If she's getting too much insulin, it shouldn't take long to find out...You're absolutely correct that getting rid of the K/D is one of the best things you could do for her, but lowering the carbs could very well lower her need for insulin too so it's important that you get those tests in
 
Thanks Chris. I work full-time so can only do the mid-cycle (+5 and +7) test on weekends and on the occasional day (like tomorrow) that I work from home. I can definitely do the before bed test.

It was the previous vet that was changing by whole units. The new vet did say that we need to adjust by small units. That said, by going to 3 u we are dropping by a unit, but with the change in food from such a high carb food I think that makes sense. Would you agree?

Also would you give her 3 units if she is below 200? I didn't give it this morning, when she was 193 but she jumped to 536 tonight.
 
jacereske said:
That said, by going to 3 u we are dropping by a unit, but with the change in food from such a high carb food I think that makes sense. Would you agree?
Click to expand...

Yes...although others may disagree and suggest you stay with the 4 units until you are sure she doesn't need it, I think with as quickly as she's been increased, it's a good idea. I wouldn't suggest going all the way back to 1 unit and starting over though

jacereske said:
Also would you give her 3 units if she is below 200? I didn't give it this morning, when she was 193 but she jumped to 536 tonight.
Click to expand...

Generally, we say when you're brand new, if you get a Pre-shot under 200, you should Stall, don't feed and post for help...Soon though that number drops to 150. Make sure your subject line is clear...something like "STALLING...NEED HELP!!" usually works ;)

Lantus is a gentle insulin that doesn't generally "kick in" for several hours after the shot, but the first few times you shoot a lower number, we like to have someone with experience watching out for you. We have an unwritten rule here...If you "sign on" to help someone shoot low the first time, you stay with them until it's totally safe or find someone else to watch over them. We don't leave you hanging.

I suggest you read the sticky's at the top of the Lantus Forum.....there's lots of great information there (almost too much...you feel like your brain in going to explode after awhile.....LOL)

There's also a sticky titled "Can I do Tight Regulation with a full time job" that may have some good tips for you (even if you decide you can't do TR)
 
Keno had a BG of 285 this morning so I gave 3 u. I also found diarrhea in the box again - actually in 2 boxes. She didn't have it during the day yesterday, so I am wondering if it is whatever I fed her last night. She ate well this morning. I'm happy with the lowering of her BG but the diarrhea is concerning me.
 
Hi Sharon,

Thank you for that info!

The diarrhea just started Monday night which is also the day we switched from k/d to Weruva. Prior to that she was not having any GI issues whatsoever, so I'm fairly confident it is related to the food change.

I am going to call her vet today to see what he says. I have used probiotics in the past for our kitty who had lymphoma and they really helped her.

thanks,
Jeanette
 
Hi there Jeanette and first I want to say Bless you for adopting a 16 year old diabetic cat! You are special.

I am glad that Chris guided you to lower the dose especially since you changed the food to lower carbs. The diarrhea could be gastro upset from switching foods rapidly. Recently, I used a great pro-biotic for diarrhea called Florastor and you can get it in CVS. It is a S.Boulardii probiotic. It was a little pricey but too me, worth it's weight in gold. The therapeutic dose is 1/2 capsule twice a day and the maintenance dose is 1/4 capsule twice a day. I sprinkle right into the food as it's undetectable. I used the maintence dose for about weeks after his diarrhea ended. Some cats need to stay on it.

Another thing I use while Bubba had diarrhea was Slippery Elm Bark which you can get in the health food store. I mix it into the food also but not with the Florastor as it inhibits absorption for some medicines so I mixed it into his snacks and needs to be 2 hours apart from the Florastor. Between the two of those things he was as good as new in a few days. He had black pudding diarrhea and some vomiting and would not eat. If this gastro upset is due to food change both of those things will help and especially the Slippery Elm Bark (SEB) as it is very healing .
 
Thank you Bobbie. Adopting a 16 year old diabetic cat wasn't on my to-do list that day, :-) but both my husband and I felt that Keno was a victim of circumstance and deserved a chance at more life. We already have one diabetic cat (who is pretty much in remission), so we knew what we were getting into with feline diabetes, although Keno's kidney disease has complicated things a bit. I'm grateful for this board.

I have used Slippery Elm Bark for my precious (now an angel) kitty Chai who had small cell GI lymphoma, so I am familiar with it and I still have some but it is over a year old. I've had it in a sealed container - I wonder if it is still effective?

I appreciate the info about the Florastor - we have a CVS close by so I will check it out.

Jeanette
 
Just took a +6 reading and it's at 320. She had a snack at +3 after I tested and it was low carb food. Now she doesn't want to eat. :-(
 
Would appreciate any ideas on why she jumped to 320 at +6 after being at 197 at +3.

thanks,
Jeanette
 
Looks like she bouncing and certainly not use to blues. Any GI upset can cause crazy numbers too.

It would be helpful for you and Keno to post in the Lantus Group. Please start testing before every shot as well as mid cycle testing. It's possible those high numbers are because Keno is going lower and we have no idea without the data.
 
I think its probably a bounce too....yesterday she started out at 193 and was at 499 by +7

The key is to just keep getting her down into normal numbers until her liver re-learns that it's OK to be there....Of course some kitties bounce all the way to OTJ! (Off The Juice)
 
I have to go on a short business trip next week so this is not very good timing for this to be going on. My husband will be here but he is clueless about diabetes, kidney disease and the kidney food. If I can't get her stabilized I may need to put her back on the k/d with an increased insulin dose and start this over again when I return at the end of next week. I don't like that idea but I feel really nervous about not being here to monitor her while this is going on - the diarrhea and not eating are not things we've seen in the past.
 
I think that was what was throwing me with her jump up in numbers But, as Karen said, the diarrhea can cause some higher number especially if they have discomfort. Can you give her some pure chicken and chicken broth baby food or Turkey and turkey broth baby food. That might get her going again with eating. It did with Bubba.
 
It's more important they eat then what they eat. If the KD was fine for her I would let it be until you can be home to monitor and figure out an alternative food that won't make her ill. Just my 2 cents.
 
Hi. KD is very high in carbs. The diarrhea is likely from switching food which can cause gi issues. Can you get a copy of the labs and add them to the labs tab on your spreadsheet?
 
Bobbie And Bubba said:
Hi there Jeanette and first I want to say Bless you for adopting a 16 year old diabetic cat! You are special.

I am glad that Chris guided you to lower the dose especially since you changed the food to lower carbs. The diarrhea could be gastro upset from switching foods rapidly. Recently, I used a great pro-biotic for diarrhea called Florastor and you can get it in CVS. It is a S.Boulardii probiotic. It was a little pricey but too me, worth it's weight in gold. The therapeutic dose is 1/2 capsule twice a day and the maintenance dose is 1/4 capsule twice a day. I sprinkle right into the food as it's undetectable. I used the maintence dose for about weeks after his diarrhea ended. Some cats need to stay on it.

Another thing I use while Bubba had diarrhea was Slippery Elm Bark which you can get in the health food store. I mix it into the food also but not with the Florastor as it inhibits absorption for some medicines so I mixed it into his snacks and needs to be 2 hours apart from the Florastor. Between the two of those things he was as good as new in a few days. He had black pudding diarrhea and some vomiting and would not eat. If this gastro upset is due to food change both of those things will help and especially the Slippery Elm Bark (SEB) as it is very healing .
Click to expand...

Hi Bobbie,

I want to thank you again for the Florastor recommendation. I started Keno on it yesterday and have already seen improvment in her BMs.

Jeanette
 
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