Cricket's numbers still not really moving? Too much insulin?

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Talullah1065

Talullah1065

Member Since 2016
We are now on 3 units of Lantus but Cricket's numbers still aren't going down. I did a curve on her the other day (accidentally missed one check so have a 4 hour lapse in there) but no significant changes anyway. Part of me wonders what the point is of testing her glucose every morning and evening when it's always too high. I just don't know what to do. She's on a mainly wet diet that is carb/potato/tapioca/anything bad free. She is also on Young Again Zero Carb dry because she is a crunchy addict. She's not overweight. I'm so frustrated and my son (16 years old) is beside himself with worry. Any words of wisdom or advice?

She is 1.5 years old and was diagnosed on November 30, 2016. We started with Vetsulin but quickly realized it wasn't doing much after her curve. We gave it a good try though. On the night of December 16, 2016, we started Lantus as we heard it is much better and longer acting. It definitely seems like her numbers have gotten worse since starting 3 units but the vet said not to move it up by half units. I don't know what to do. I hate seeing her like this. We found her last June, behind my work, with 3 of her kittens. She was just a baby herself. I just want to help her and I worry about what these high numbers are doing to her.
 
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Hi Tallulah and Cricket and welcome to FFMB:)

Looking at your SS ( great you have one up and running!) it looks like Cricket could be getting too much insulin.
We recommend you go up the scale of dosing in 0.25 unit increments every 6 cycles (12 hours-3 days) as if you go up faster than that or in higher doses than that, you could well miss the correct dose. Too much insulin can look like too little.
It is also really important to test before every insulin dose so you know it is safe to do so. I know at the moment he is running high but when he does start to respond, you want to know. Also testing between each dose at say +4 up to +7 after the insulin will tell us how he is responding. Try and get at least one test every cycle if you can. And don't stick to the same time...change it around.
Are you feeding low carb food? We recommend 10 % or less.
Here is a link to suitable foods
http://www.felinediabetes.com/FDMB/threads/food-links.133016/

See what others say but I think you would be best to go back to 1 unit and start again for 6 cycles and see what happens.
 
Are you testing for ketones in the urine? When kitty is running high it is a good idea to test to see there are no ketones in the urine as they can lead to ketoacidosis which is a serious illness. Here is a link to what to buy at a pharmacy or Walgreens. You just need to either stick one of the strips under Cricket as he pees or collect a bit of urine in a container and test it. It is a simply procedure.
https://www.walgreens.com/store/c/ketostix-reagent-strips-for-urinalysis/ID=prod19769-product
It is really good you are looking for ways to help Cricket. Ask all the questions you like.....we like answering questions here!:)
 
She is getting low carb food. We have become obsessive label readers...high protein, no grains, no tapioca or potato starch. It's mostly Weruva, BFF and some Fancy Feast Classics. She is also getting low carb treats when she gets her BG checked. She loves her crunchy food so I ended up splurging on ZeroCarb dry food. I'm not generally home during the day but I can probably get another reading at night before I go to bed.
 
She does have ketones in her urine. The vet said we just need to try to get her numbers down and that will get rid of the ketones.
 
I will be going back down to 1 unit and slowly increasing every 3 days. Even with the half unit markings on the 3/10 syringe, it seems like .25 will be hard to read. My vet told me specifically not to use half units when raising insulin. He said he had never seen a cat diagnosed so young and with no other problems. He's a good guy but I trust you all that have experience.
 
Talullah1065 said:
I do not know how many because the vet checked and he just told me she has ketones.
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I think it is really important that you go out and buy some of the test strips...ketostix...I mentioned above so you know how many ketones he has. More than a trace really needs to be dealt with by the vet.
I am going to tag a couple of people who know a lot about ketones...not sure if they are around at the moment but they will come on at some stage.
@Meya14 and @Critter Mom . Are you able to advise about ketones in the urine please.
@Wendy&Neko and @julie & punkin (ga) and @Chris & China may be able to advise about that and the insulin dose.
HOWEVER at the moment I would NOT REDUCE the insulin dose while he has ketones in the urine.
To try and flush out the ketones in the urine, try and get Cricket to drink as much fluid as he will. Add some to his food as well. Also make sure he is eating well.
 
Talullah1065 said:
I will be going back down to 1 unit and slowly increasing every 3 days. Even with the half unit markings on the 3/10 syringe, it seems like .25 will be hard to read. My vet told me specifically not to use half units when raising insulin. He said he had never seen a cat diagnosed so young and with no other problems. He's a good guy but I trust you all that have experience.
Click to expand...

SEE ABOVE POST. DONT REDUCE INSULIN UNTIL THE KETONES ISSUE IS SORTED PLEASE. When a cat has ketones it is really important they get enough insulin, get enough food and get plenty of water. So don't change the dose of insulin yet please.
 
She's been drinking an excessive amount of water. She lays near the water bowl and rests her chin on it. That's what made us initially realize there was something wrong (other than the fact that she has no energy and, at 1.5 years old, she looks like an elder). I just figured she continues to drink as much as she does because her numbers are so high. The vet said that as long as she is still eating and drinking she's doesn't need vet intervention.

We also add water to the wet food because my one male cat, Smokey, keeps having bacterial issues in his bladder. He was on amoxicillin for 3 weeks, then baytril for 3 weeks, ended up with a blocked bladder, had to get a catheter and flushed a few times, then refused to drink when he got home so I had to give him an IV for a week (he's only 6 years old). This all happened right before Cricket was diagnosed. Exactly, 1 month after his flushing, Smokey and I spent New Years Eve at the emergency vet, has bacteria in his urine again so he's on anti spasmodic medicine to hopefully keep his bladder from spasming and blocking while he tries to pee, and 3 more weeks of Baytril. Basically, lots of water gets added to the wet food because Smokey refuses to drink anything.
 
Poor you...you have been having a rough time with the kitties.:bighug:
And I am sorry to confuse you by changing what I was saying.
But having ketones in the urine needs to be sorted out FIRST........because reducing the insulin while there are ketones in the urine could make things worse.
While he has ketones, you need to be testing for ketones in the urine once or twice a day as they can increase rapidly and if they do, you need to be ahead of them and getting to the vet for treatment.
Are you able to go out and buy some Ketostix?

That is good he is drinking plenty of fluids.
 
Yes, I could go out and buy them tonight but, to be honest, I wouldn't be able to check. I get up at 5:30 to make sure I get Cricket sorted out as well as the others. I currently have 8 cats...bladder, diabetes, constipation, cancer, FIV+, conjunctivitis...9 litter boxes with scoopable litter. What ever happened to finding a cat and having it be healthy? I don't think I have it in me to follow her around tonight. I will go out first thing in the morning and get them though and make it my mission to find out what's going on with her ketones.
 
If the BS is high and there are ketones, then too much insulin (bouncing) isn't the problem! Please don't reduce insulin. Instead try to get some mid-cycle tests in addition to the preshot tests, and increase the insulin slowly until numbers start to come down. Unfortunately, there isn't a lot of evidence to support the somogyi effect (bouncing), and even if bouncing did occur, increasing insulin would eventually knock the numbers down anyway.

Because your cat is diagnosed so young, it's possible that her diabetes is secondary to another issue such as dysfunction in the pancreas (tumor or inherited issues), hormone producing tumors such as what causes acromegaly, inherited metabolism issues, etc. It is possible in some of these issues that higher doses of insulin are necessary for numbers to show improvement. My kitty that has run-of-the-mill diabetes gets up to 7U twice a day at times - not saying this is appropriate for your dosing, but just to show that every cat is different.

Please try to get some ketone tests at home.
 
That sounds like a good plan. I have no idea what time it is at your place! I live in Australia and it is 2.30 pm so I forget that it is probably night time where you are! :rolleyes:
My, you are busy with 8 cats all needing attention.....you are a good mama bean!
 
Thank you Meya14. I will look into that.

The vet said that all of her blood work was good other than the high BG. Initially 700. The thing he really couldn't understand was that she gained weight before she was diagnosed. Granted, she was about 11 months old, living on the streets with (3) 2 month old kittens when we found her but she gained 3 lbs. Wouldn't some of those other issues show up in blood work?
 
Acromegaly or other hormone issue may cause an initial weight gain, or changes in growth. Hypothyroidism can also lead to gain before dysfunction in metabolism such as diabetes show up.

How big is your kitty, her face looks very similar to a cat I used to have that had dwarfism. Biggest my cat ever was was about 3-4lbs.

Do you have copies of her labwork that you could upload? Maybe ask if they can email you copies if you don't?
 
Could you put the type of blood glucose meter you are using in your signature? Whether you are using a human or pet one makes a difference to some of our suggestions.

I agree that you need to get some more mid cycle tests. Looking at the spreadsheet, Cricket could be either over dosed or under dosed. We determine which way to go by seeing how low the dose takes the cat, or the nadir point. That is typically somewhere between +4 and +7. I've seen many a cat (including mine), start really high at preshot, dive down in the middle and earn a dose reduction, then bounce back up by the next preshot time.

If Cricket did not have a ketone issue and since she's eating dry, you would be following the Start Low Go Slow method for dosing. How is her appetite? Is she eating well?

Neko had acromegaly - she did not show weight gain and had very few symptoms of the disease for the first couple of years, other than needing insulin. Bloodwork just looked like regular diabetes. Typically cats are middle aged when they get acromegaly. The youngest I've seen was 4.
 
Cricket is 10 lbs right now. I can get a copy of her blood work. Luckily my vet is 5 minutes away so I can head over in the morning. She was 7 lbs when we found her in June 2016 but she was on her own with 3 babies. A coworker adopted one of the babies but I couldn't separate the sisters as they were so bonded. Unfortunately, not many people are up to adopt 2 cats so we still have them. Even though Cricket was spayed shortly after we found her, she let those little girls nurse on her for another 6 months!

She LOVES dry food which is why I researched and found ZeroCarb. I've heard a few people say their cats went into remission eating it. She doesn't care much for the wet food but, if I mix some crunchy in, she's more inclined to eat it. Sometimes she'll nibble a bit but then she digs in right after her shot.

My vet thought she was going to be a Cushings cat but her tests were negative.

I am using a human meter called Tru Metrix. I will add that to my signature.
 
This was Cricket when she was reunited with her 2ND kit (it took over a week to find out she had 3). It was 2 days after we found her. The next picture is how she looks now. She looks a little plump but she really isn't lol. She often looks like she wants to play but she has no energy.
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Just wanted to say welcome to Lantus & Levemir Land -the nicest place you never wanted to be!

Cricket is gorgeous! Her baby is cute, too.

I'm sorry you're having such a tough time. I had four cats with cancer at once - two were diabetic, one had kidney disease, two were hyper thyroid, one was blind and one had a leg amputated. I thought I had my hands full, but you beat me by a mile! :eek:

The blood ketone meter that most of us use is call a Nova Max. The test strips are expensive, but if you have trouble getting a urine test, it's worth it. DKA is very dangerous. Cinco had it when we first found him and he almost didn't make it. It was because of the people here that he pulled through and went into remission.

Your vet sounds fairly knowledgeable about FD, but keep in mind that a vet has to know about a lot of diseases in a lot of different species, so unless they are a specialist, they usually don't know a lot about any specific disease. The people here are not vets, but we live and breathe FD 24/7, many of us for years, so we know a lot and are happy to share. If your vet is the kind that is open to learning, you might tell him about this site and show him your spreadsheet when you see him. We encourage people to keep their vet in the loop of what their doing, but only you know how that would be received.

We have a lot of unique terms we use here, so to help you understand us, here is a link to our slang dictionary. As you read the stickies at the top of the L&L page, let us know what questions you have. The only dumb question is the one you don't ask. We were all new once, and we understand how overwhelming it can be.
 
With ketones in the mix, the chance of her being overdosed is not likely. Add in the fact that she is young, plus gained weight around the time of diagnosis - most cats will lose weight with high blood sugar - all of that makes me think of acromegaly. It's very unlikely that she's been tested for that yet because there is only 1 lab in North America that does the test, Michigan State University's vet school lab. The local vet draws blood it is sent to the lab for testing. Typically we suggest cats get tested for it when they get to 6u per shot. The most recent research is that 1 in 4 diabetic cats have acromegaly.

At this point it doesn't matter, except that it supports increasing her dose.

I can't stress, however, how critical it is that you get at least 1 mid-cycle test per day. The before-bed test is often a really good one to get because so many cats go lower at night. As high as she is, and with the presence of ketones, it would be good if we helped you to be aggressive with the dose, but it can only be safely done if you can increase the number of tests you are getting.

Lantus reaches its strongest point (the nadir, which = the lowest numbers) in the hours after the shot. At the shot time, typically the dose has mostly worn off and the highest numbers will be present. So your preshot tests would likely be showing the highest numbers of the cycle. Because Lantus dosing is based upon answering the question "how low can this dose cause my cat's blood sugar to go?" it becomes extremely important to catch some mid-cycle tests. Mid-cycle doesn't mean +6 - it's more helpful to get a variety of test times.

If you think of the spreadsheet as being a jigsaw puzzle, right now you have 2 vertical stripes in the puzzle. There could be an elephant hiding in the right side of the puzzle and we wouldn't know it. You don't need every piece of a puzzle to get the picture, but you need a variety of pieces. Hopefully that analogy will help you see why it's important to get some varied tests.

It's not uncommon for a cat to not have much movement in their blood sugar as they are going up the dosing scale until BAM, they begin to get close to a good dose. All of a sudden movement begins to happen and more colors will start to appear on the spreadsheet.

One comment that you made jumped out at me - what are the low-carb treats you are giving her? We cooked chicken breasts for punkin. Simmered them til done, diced 1/2" cubes for pokey treats, froze most of it and kept a couple of tablespoons in the fridge. That would last a couple of days. Pokey treats should be small - they aren't meals. I'm just wanting to confirm that what you're giving is really low carb, because once in a while someone thinks treats are low carb that aren't.

Clearly you've got your hands full with all of these special needs kitties!! Thank you for having such a big heart! I love the pic above of Cricket with her baby - had to show that one to my family. She is just a beautiful cat! The kitten too!

Hope I haven't piled too much on you. Keep asking questions and we'll do our best to help unravel what's going on in her body. Every cat has a dose that will move them - it's just a matter of how to get there safely. The single thing you could do right now that would help clear things up as quickly as possible is to add in 1-2 more tests every day, in between the shots. The more we can see, the better our help will be, and the more confidence we'll all have in how to move forward.
 
I do have a question for you: Are you using the needle tips on the Lantus pen? I'm asking because you've been increasing the dose in 1.0u increments. The pens don't give you the flexibility to draw up smaller doses. If you look at the post on the SLGS method for dosing, you'll note that we make dose changes in 0.25u increments. You can buy syringes and draw off insulin from the pen in order to raise the dose systematically. (If you're going to feed Young Again, you would need to use SLGS vs the Tight Regulation Protocol for dosing.)

I absolutely agree that if ketones are present, you do not want to decrease the dose. Given the number of cats in the house, are you sure that Cricket is eating? Ketones develop if there's an inflammation present, the cat isn't consuming enough calories, and if there's not enough insulin on board.

Like others have suggested, it would be very helpful if you could get at minimum, 4 tests per day -- your two pre-shot tests and at least one test per cycle. If you're only getting pre-shot tests, you don't know where the numbers are at nadir. Even with the curve, you still don't know if what you were seeing was a bounce. If numbers drop into a low range, drop fast, or drop into a range that your kitty isn't used to, the liver and pancreas can release a stored form of glucose and counterregulatory hormones that cause the numbers to spike. Just as an example, my kitty was a champ when it came to bouncing. At one point, her AMPS was in the 400s, by nadir she was in the 40s, and by PMPs was back in the 400s. If I hadn't gotten the tests in during the cycle, I would have been inclined to increase her dose. Knowing that she was in lower numbers at mid-cycle meant I needed to reduce her dose.

 
Sometimes she gets steak as a treat, sometimes chicken. We got new Fancy Feast treats that are just a piece of meat. Meat is the only ingredient. Sometimes she gets some Fresh Select food as a treat. It is refrigerated and sold as a raw food diet but she only likes it as treats.

We feed the cats wet food right after Cricket gets her BG tested so I make sure she is eating before I give her the shot. I try to wait half an hour after nose to food touchdown so I know she has something in her tummy. She spends her whole day on the kitchen floor right by her water dish. When she does get up, it's to find some crunchy food. We are trying the free feeding with the ZeroCarb dry and she will wander from room to room grazing.

I have the lantus pen but use syringes to draw out the medicine. I am basically at the vet every week. When I go, I always bring the hand written log to show my vet even if Cricket isn't the one being seen. He was the one who told me to up it again and only go by whole numbers. He specifically said not to raise in smaller increments so that's what I was doing. Now I know better.

This morning AMPS was 328. +5 is 307
 
I would be lying if I said she never gets carbs though. We have a 13 year old angry kitty who needs (according to her) her Temptations cat treats. My mom found Cricket on the counter one night on her back with the plastic container opened and treats flowing out around her. There is a fine line between humor and horror lol. Oh, I also got her some ZeroCarb Tru Carnivore treats. Grain free, no veggies, no plant proteins, no digestible carbs.
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Cricket and her water bowl. She drinks a lot! ZeroCarb crunchies in the bowl.
 
It looks like I have to order the Ketone meter online. Walmart was supposed to sell it but apparently not in the stores.
 
:bighug::bighug::bighug::bighug:
Welcome.
Sorry about Cricket's numbers.
Pink is better than black yesterday:bighug::bighug::bighug:.

Good job getting that midcycle test. Keep doing that, even if PS is high, some cats blood Glucose (BG) can dive by +5 and then rocket by next PS. Move those midcycle tests around, it's helpful in building a picture, an don't forget about the pm cycle, try to at least always get a before bed test, I went to bed at around Georges +5 so in the evening I would always get a +2 and a +5.

It would be a good idea to make a note on the ss in the remarks section, anytime you catch her getting into contraband, as that come sometimes offer explanations to high numbers, when you look back at the ss for patterns in BG levels.

Those Temptations are Kitty Crack, George would do anything for them!!! We don't have them in the house, they are pretty high in carbs, getting into contraband like that will play havoc with his BG. If you can find another treat that your other cat might like then I would look to replace them, George goes wild for freeze dried chicken and tuna treats, perhaps it might be worth exploring that with your other cat, mixing it in with temptations at first and then slowly removing the temptations all together.

Lets see what a couple of days of some more data tell you, at the moment with so few midcycle test the picture might look worse than it actually is. FYI George was pink red and black for about 8 weeks, take a look at 2015 tab on his ss, he's a big fluffy cat and I too started to imagine all sorts of things when I didn't get movement, hang in there.

:bighug::bighug::bighug::bighug:

Just so you know we usually start a new thread every day, it stops the threads getting crazy long, this one is getting a bit that way.:)

a title for today for cricket might go something like

Cricket amps 328 +5 307 Still stuck in the pink

If you have a question use the drop down link to prefix the title with a ?? most folk visit those threads first in an attempt to help out if they can.
In your new thread you would link the previous days thread, we do this so that it makes it easy for those trying to help to look back through the kitties history.
 
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