Diabetes - Initial Treatment - Need Advice

[Nan & Amber (GA)]

Hey--

Been there on the "whoops-- forgot to order strips with enough lead time!" mistake. So frustrating.

What I ended up doing was to just bite the bullet and going to a local national drug store chain (I don't have a Walmart near me) and buying the cheapest "starter pack" consisting of their own store-brand monitor and a few strips for about $20 (most of the time, the machine itself isn't that expensive, they want your business so you'll keep buying the strips!). Hopefully there's something similar close to you (I am never sure what is available and how up in Canada, hopefully one of our Canadians can weigh in with a specific suggestion).

You won't be able to get a pet meter that way, so your numbers won't be entirely comparable to the ones you have with the FastaCare meter, but at least you would have something to be able to keep track of what Davey is doing.

 

[Red & Rover (GA)]

A number of Canucks use the FreeStyle Lite glucometre. It is the cheapest stripwise and uses the smallest amount of blood. Available at Walmart and other pharmacies. Don't know about Costco.

Always ask the pharmacist how much the strips are. Metres can be cheap, but they get you with the strips. Also check how much blood is needed for a test. You'll waste a lot of strips if a bigger blob of blood is needed.

As @Nan & Amber noted, the numbers will be different than you are used to. Each glucometre is different - variance.

 

[Kris & Teasel]

A number of Canucks use the FreeStyle Lite glucometre. It is the cheapest stripwise and uses the smallest amount of blood. Available at Walmart and other pharmacies. Don't know about Costco.

Always ask the pharmacist how much the strips are. Metres can be cheap, but they get you with the strips. Also check how much blood is needed for a test. You'll waste a lot of strips if a bigger blob of blood is needed.

As @Nan & Amber noted, the numbers will be different than you are used to. Each glucometre is different - variance.

In Canada the Freestyle Lite meter can be had free (generally) if you buy a box of 100 strips. You also might find a coupon for a free Freestyle Lite meter if you go to www.abbott.ca. If you go to Shoppers Drug Mart on a Seniors' Day, the strips will be 20% off for a senior and tax free. The regular price for 100 FS strips is about $90 but that drops to $72 with 20% off and if you have Optimum points you can do even better.

 

[MrWorfMen's Mom]

Never hurts to have a backup meter anyway with strips that can be purchased locally and quickly if need be. We can help you with the human meter readings. You want to take action to if Davey goes below about 5.5 mmol (100 US) on a human meter right now and no shot if he is below 11mmol. Those are the main numbers you need to know about the difference for now. There is no direct conversion of pet to human meter readings.

 

[Red & Rover (GA)]

In Canada the Freestyle Lite meter can be had free (generally) if you buy a box of 100 strips. You also might find a coupon for a free Freestyle Lite meter if you go to www.abbott.ca.

Coupon: https://www.abbottdiabetescare.ca/products/freestyle-lite#WPbIJrpKQS1J8jwM.97 (I haven 't read the fine print - if they ask, just say you are picking up a new metre for your grandfather to try. He's having problems getting a drop of blood big enough.)

 

[Kris & Teasel]

Coupon: https://www.abbottdiabetescare.ca/products/freestyle-lite#WPbIJrpKQS1J8jwM.97 (I haven 't read the fine print - if they ask, just say you are picking up a new metre for your grandfather to try. He's having problems getting a drop of blood big enough.)

This is exactly the coupon I used when I got mine at a Shoppers Drug Mart. I had no problem - just said I wanted to redeem the coupon when I bought the strips.

 

[Marlena]

@MrWorfMen's Mom, @Chris & China -

My back has seized up again and I'm feeling seriously unwell. Would you be able to keep an eye out for @emjb14 and Davey? I might not be online much for the next few days.


Mogs
.

Oh Mogs, I'm really sorry to hear that!
Please take care darling, it is such a shame that I can't come to take care of you or help you in any other way as you deserve to be looked after as you are such a rock! Your knowledge and good advice is most appreciated!
Sending healing vines
Marlena

 

[Marlena]

@Critter Mom

 

[Davey's Mom]

Hi guys! Just got home from purchasing the meter (it was free thanks for the tip everyone!) and Davey's sugars so low for this time I had to check twice because I couldn't believe it. He was at 15 on the new meter at +10. I'm going to dose him the same now and I guess I should decide what to do tomorrow morning before I go to work by what I see happening this evening. Just worried about giving him too much and not being around to keep an eye on him. Thanks for everyone's help so far I never would have made it this far without it

Update - Just tested again at +1 and Daveys at 20 now (so higher) which is strange but he just ate a 1/2 cup of dry cat food not too long ago. I wonder if this is why....

On the weekend I really want to get rid of the dry food while I'm home!

 

[Mum of two felines]

The advice I've seen on here would advise you to test at +3 to see where he's going. Personally I would test at +2 but that's me.

 

[Mum of two felines]

Getting rid of the dry will help the numbers. BUT you'll have to be testing this weekend to make sure he's not dropping. If you look at my kitties' spreadsheets you'll notice the change of food dropped their numbers greatly. They both hypoed many times. Good luck and I'll be on throughout the weekend watching your transition!

 

[Critter Mom]

I see Davey's AMPS this morning was down quite substantially.

...

... but extra care is needed now - especially if Davey is declining the very high carb, dry food he has been eating up till now. Here's an example of why the worry:

The above is a snapshot of Saoirse's BG readings for before, during and after her transition from dry high-carb to wet low-carb food. She was on Caninsulin and her BG readings were taken using a pet meter, as is the case currently with Davey. (NB: I have non-standard colour coding in Saoirse's spreadsheet. Key is at top of snapshot.)

On 13.07.14 Saoirse would not eat any more dry food. Look at what happened to her BG between PMPS and PM+3 - a drop of 13 points!

The above shows just how fast and how far BG levels can fall with removal of high carb food from the diet (especially with removal of high carb dry food). Also look at how quickly and how often it was necessary to reduce the insulin dose. (Had to feel my way with this at the time because I was a novice caregiver, had minimal useful input from the vet available at the time (our main vet was away for a few days, and didn't know how even a small dose of Caninsulin could yank down high preshot BGs into very low numbers mid-cycle. I was only able to keep Saoirse safe because I was home testing throughout the transition and reducing her dose based on her data then and for several days following.)

(Note: The all-yellow cycle on AM of 20.07.14 was due to duff insulin: it had been like a sauna in the flat during the night, my fridge was useless and the insulin overheated. A fresh vial for the PM cycle showed Saoirse returning to lower numbers again on only a tiny dose of Caninsulin.)


Suggestions:

1. Contact your vet straight away and agree a significant dose reduction (possibly even a small token dose) to give in the event where you are low on test strips.

2. It was a very smart move getting the human meter. With Davey not eating the dry, high carb food and the high dose of Caninsulin this is a time when you really, really need to home test.

3. Get a supply of high carb, wet food to see if Davey will eat that instead of the high carb dry. (Contingency. @MrWorfMen's Mom - any suggested Canadian foods?)

4. Continue monitoring ketones closely (especially with a reduced dose).

Last night he was following me around like crazy looking for wet food so I have to admit I gave him a half a can more than I usually would and in turn he didn't eat any dry food last night. He had dry food in his bowl but as usual just didn't want it. I'm sure this is probably the big factor so I will need to be careful.

I just used my last [test strip] this morning and should have received them today but (just my luck) when I go to track the shipment it's not arriving until Monday due to a weather delay. I can't make changes over the weekend with no strips

Now that it's unpredictable whether Davey will eat any of the dry high-carb food, any time you're not around to monitor I suggest you make sure Davey has food available at all times - higher carb wet if necessary - and possibly reduce the dose of Caninsulin.

There is such a big difference in the preshot BG today compared to the previous cycles that extra caution is vital. With less hyperglycaemia due to the reduction in amount of dry food eaten Davey may also start becoming more responsive to insulin generally.

Safety tip: If Davey is running in the lower range mid-cycle but the preshot is high, follow the nadir values when making dosing decisions, not the preshot. (Even small doses of Caninsulin can really yank unexpectedly high PS BGs right back down to low numbers again. Also keep a close watch on his clinical signs and test him if you see any unusual behaviour - especially if he starts looking for food OR if he seems lethargic.


Mogs
.

 

[Davey's Mom]

@Mogs - Thank you for the information and I hope you are feeling a bit better today.

I was in the same line of thinking as you about a couple things last night and already took a jump on suggestion 3 I did have a few cans of high carb wet (fancy feast I bought before not realizing it was high carb) so I gave him one last night since he wouldn't eat dry and I had to go to bed a bit earlier for work today. This morning I checked twice and his sugar was testing Hi on the monitor which means over 500 based on what I read so he'd be back up to his usual numbers. Looks like the food is taking a definite toll on him so it will be interesting to see what happens this weekend. Starting tonight I will switch his diet.

 

[Critter Mom]

Starting tonight I will switch his diet.

Be sure to phase out the high carb very gradually both for insulin safety and to minimise risk of GI upset (the last thing one needs with a diabetic kitty! ).

It's a bit of a tricky situation trying to do the gradual transition while you've got enough time at home to do the very close monitoring needed to make sure Davey stays in safe numbers and managing dose reductions, too. (And ketone testing! The list is endless. )

If Davey's still eating some of the dry high carb food at the moment you've been keeping track of how much of that he has been getting and can relate the BG data gathered thus far to the carbs from that source. I'd suggest the start point being the Fancy Feast / dry high-carb combo you've been feeding, gradually reducing the amount of dry and replacing it with more of the other food. If Davey won't eat the dry food, substitute the wet, high carb instead and closely monitor BG. With the change in carb load Davey may start going low later in the cycle so watch for this.

Be prepared to adjust the dose every single cycle. If you're not able to keep monitoring go back to feeding what Davey has been eating to keep his BG levels up high enough.

Read through the hypo guide and keep a printed copy where you can quickly lay your hand on it should you need it. It's a good idea to set out all the supplies from your hypo kit in readiness. Be sure to post here for help and make sure you have the vet's emergency number handy. I'm going to be a bit hit and miss (still feeling really awful) but other members should be around to assist you.

Here's a link to Dr. Pierson's notes from catinfo.org about doing a safe food transition:

Switching a Diabetic Cat to a Low Carbohydrate Diet

Keep safe!




Mogs
.

 

[Critter Mom]

Hi EMJB,

Just checking in to ask how things are going today with Davey. That was some drop from PMPS to +4 last night!

I see his AMPS was better this morning.


Mogs
.

 

[Davey's Mom]

Hi Mogs! I'm afraid his numbers may not be improving as much as we thought For three tests I used both monitors because my strips which weren't supposed to be in until Monday ended up in my mailbox yesterday. Each time the readings were 7-8 in the difference between the Fastcare Pet and the Freestyle Lite. I'm not sure which one would be more accurate I'm hoping the Freestyle since it's giving the lower numbers!

I added the Fastacare numbers in as cell comments and am continuing to use the Freestyle numbers on the sheet. I figured it's safer to keep an eye on the numbers which are reading lower.

I started using the Freestyle on January fifth for the +10 reading after his AM dose so his AMPS test that day still was much lower than usual.

We will see how things go for the rest of the weekend.... He never leaves the food bowl now that he's having more wet he wants to eat all the time and I'm not sure how much I should limit him. The most he's had in one day is three 85G cans and I had mixed in higher and lower carb cans together. The dry food is pretty much finished he doesn't want it....

 

[Davey's Mom]

Hi EMJB,

Just checking in to ask how things are going today with Davey. That was some drop from PMPS to +4 last night!

I see his AMPS was better this morning.


Mogs
.

You are right for sure his numbers were better this morning than they day before. He on had low carb food last night. vs the night before where he had high carb.

Also he did had quite the drop like you said but the number on the Fastacare monitor read 23.2

 

[Critter Mom]

The most he's had in one day is three 85G cans and I had mixed in higher and lower carb cans together. The dry food is pretty much finished he doesn't want it....

Be thankful that Davey is enjoying his wet food! (Ask the members here with kibble addicts. )

Will you be able to monitor right through the AM cycle tomorrow? If yes, you could try slightly increasing the amount of low carb and slightly reducing the amount of high carb in the wet food 'combo' for that cycle. You'd be able to intervene if Davey were to run lower (and check the PM cycle, too; sometimes numbers continue to improve in the following cycles).


Mogs
.

 

[Critter Mom]

You are right for sure his numbers were better this morning than they day before. He on had low carb food last night. vs the night before where he had high carb.

Also he did had quite the drop like you said but the number on the Fastacare monitor read 23.2

At least you now know that the carb level in the diet is a significant contributor to Davey's higher readings. Once you complete the safe, gradual transition he will hopefully be running in a better range and that will take some of the strain off Davey's system while you work towards better regulation.

Did you notice any changes in Davey's peeing and drinking at all?


Mogs
.

 

[Davey's Mom]

At least you now know that the carb level in the diet is a significant contributor to Davey's higher readings. Once you complete the safe, gradual transition he will hopefully be running in a better range and that will take some of the strain off Davey's system while you work towards better regulation.

Did you notice any changes in Davey's peeing and drinking at all?


Mogs
.

He has been drinking bit less I find yes.

 

[Davey's Mom]

Be thankful that Davey is enjoying his wet food! (Ask the members here with kibble addicts. )

Will you be able to monitor right through the AM cycle tomorrow? If yes, you could try slightly increasing the amount of low carb and slightly reducing the amount of high carb in the wet food 'combo' for that cycle. You'd be able to intervene if Davey were to run lower (and check the PM cycle, too; sometimes numbers continue to improve in the following cycles).


Mogs
.

Good Point!

This morning he had mostly low carb and last night. He only had about 1/3 can of high carb wet in this time frame which I thought was ok because back when he was eating dry food he wasn't having very much at the end of it. I'll start checking more often tomorrow, today I did every couple hours until I noticed that he was coming back up again.

 

[Critter Mom]

Just saw PMPS! Pretty in pink!

I recommend you be extra careful on this cycle because:

- Davey went quite low mid-cycle last night.
- His carb load is reducing.
- BGs may continue to drop as the effects of the higher carb foods wear off (may flow into following cycles).
- Many cats run lower at night.
- He has already dropped by c. 5 points by +2 and could very well drop further in the next few hours.

I think it's advisable for safety that you keep testing Davey tonight till you're sure he's rising again and will stay up. Safe food transitions tend to require a bit of sleep deprivation - especially with such a significant insulin dose in the mix - but once the transition is safely completed things should hopefully become more straightforward. You're doing a great job!


Mogs
.

 

[Critter Mom]

BTW, spreadsheet tip: it's a good idea to add a brief note about what and how much you feed each day in the Remarks column.


Mogs
.

 

[Davey's Mom]

Great thanks for everything! He went down really far but then back up within the last hour which is strange because the insulin should still be dropping numbers down at +4. I've been checking on both monitors just to be on the safe side. They are only 4-5 points in the difference now between monitors so it seems as the numbers get lower the results are getting more in line which is good. I will keep an eye on him tonight

 

[Critter Mom]

He went down really far but then back up within the last hour which is strange

It's not an uncommon thing to see numbers pop up like that with Caninsulin, especially after a significant drop in the first few hours of the cycle. Also, nadir time can move around.

FYI - with Caninsulin target nadir should not be lower than about 5.6 on a human meter. The hypo threshold is 2.8 but the higher nadir target provides a necessary safety buffer for this particular insulin (allows some room for the unexpected).

If Davey's AMPS is lower than usual you should consider reducing the dose - especially if you're going to further reduce the carb load on tomorrow's AM cycle.

If AMPS is 11.1 or lower in the morning (the FDMB no-shoot recommendation) then stall, don't feed, don't give any insulin and ask for help by posting a new thread on Feline Health with title "AMPS ???? - Stalling - Need Help with Caninsulin Dosing." (Tip: If you do need to create a new thread copy and paste the URL for this thread in the opeining Include a link back to this thread so that members replying will be able to find Davey's historical info here.)

Sending wishes for a safe night.




Mogs
.

 

[Critter Mom]

PS: Remember to test for ketones!


Mogs
.

 

[Islandmomma]

If you live in Canada, you don't even need a script for Lantus....just call around and find the best price you can for a box of 5 Lantus Solostar pens and go there and ask for them

Insulin is OTC in Canada

It is?! I thought we needed a rx from the vet?!

 

[Kris & Teasel]

It is?! I thought we needed a rx from the vet?!

If you're in Canada, a box of 5 cartridges of Lantus is $125 at Shoppers Drug Mart and is available without a prescription. On Seniors' Day that can be had for 20% off and no taxes, so $100 for the box of 5. That's $20 per cartridge which is very cheap given that it'll last many months.

 

[Chris & China (GA)]

It is?! I thought we needed a rx from the vet?!

Not if you live in Canada you don't!! Just find the place with the best price and go in and ask for it!! That's one thing you guys in Canada have over us!!

 

[Islandmomma]

Not if you live in Canada you don't!! Just find the place with the best price and go in and ask for it!! That's one thing you guys in Canada have over us!!

OMG I had no idea! If anyone wants anything let me know LOL

 

[Critter Mom]

Hi EMJB,

I see Davey had fun on his trampoline at +4 last night.

Are you giving any high carb food today or are you feeding only low carb on today's AM cycle? And how is Davey feeling/behaving today?


Mogs
.

 

[Davey's Mom]

All low carb today and he's no different than usual. He gets so excited when I open a can of wet food that he near knocks me over haha

 

[Davey's Mom]

Just doing what my gut is telling me is right and hoping things go ok So far so good!

 

[Mum of two felines]

Just doing what my gut is telling me is right and hoping things go ok So far so good!

Just doing what my gut is telling me is right and hoping things go ok So far so good!

I love seeing these pink and yellows!!!! I wonder if you'll see a blue this cycle! I've been checking in this weekend!

 

[Critter Mom]

I love seeing these pink and yellows!!!!

Me, too!

Much-improved PMPS tonight, EMJB! What has Davey's peeing/drinking been like today?


Mogs
.

 

[Davey's Mom]

Thanks so much guys! He's drinking less this evening and he just came up on the couch with me and had a nap on my lap after the kids went to bed for the first time in forever

Since he switched to wet food he's hinting at me that he wants another can all the time do you guys think I should put a limit on what he's eating? He used to be bigger since he got sick he lost between 3-4 pounds. He's always loved to eat and the wet food is like a treat to him he purrs while he's eating it haha

If he gets to blue tonight and/or his AMPS is lower tomorrow than today I'm thinking I should drop insulin right? If so to 4?

 

[Critter Mom]

the wet food is like a treat to him he purrs while he's eating it

he just came up on the couch with me and had a nap on my lap after the kids went to bed for the first time in forever

Wonderful! I'm delighted to read this. For all of the worry that goes with getting our little ones better regulated there is also much joy to be had along the way. It's great that he's enjoying his healthier grub. (((Davey)))

Since he switched to wet food he's hinting at me that he wants another can all the time do you guys think I should put a limit on what he's eating? He used to be bigger since he got sick he lost between 3-4 pounds.

If Davey's underweight at the moment then it's OK to feed him extra until he returns to ideal weight. As his regulation improves he will get more benefit from the nutrients he's eating and his appetite should normalise thereafter.

Here's a body condition chart to help you assess Davey's weight:

http://www.wsava.org/sites/default/files/Body%20condition%20score%20chart%20cats.pdf

It's also helpful to track weight at home. A reasonably-priced digital baby scale is ideal for this purpose (try Amazon or ebay). Keeping a log of how much you feed every day and doing weekly weigh-ins will help you to get Davey back to his ideal weight. Once there, if he starts to gain too much then feed a little less; if he starts to lose a little weight, feed a little more.


Mogs
.

 

[Mum of two felines]

Thanks so much guys! He's drinking less this evening and he just came up on the couch with me and had a nap on my lap after the kids went to bed for the first time in forever

Since he switched to wet food he's hinting at me that he wants another can all the time do you guys think I should put a limit on what he's eating? He used to be bigger since he got sick he lost between 3-4 pounds. He's always loved to eat and the wet food is like a treat to him he purrs while he's eating it haha

If he gets to blue tonight and/or his AMPS is lower tomorrow than today I'm thinking I should drop insulin right? If so to 4?

If he were my kitty and he was in yellow tomorrow morning I would not give 6. I would hesitate to giving 4. But I don't know enough to tell you what to give. Maybe someone will be by to look at his SS. He has spent only 1 full day, today, without any wet W/D or dry, correct?

When are you switching to Lantus? I would definitely check with an experienced member before starting that insulin.

 

[Critter Mom]

If he gets to blue tonight and/or his AMPS is lower tomorrow than today I'm thinking I should drop insulin right? If so to 4?

Will Davey be unmonitored during the AM cycle tomorrow?

Also what time zone are you in and when is your AMPS test due? (Trying to see if I can be around for it.)


Mogs
.

 

[Critter Mom]

Hi EMJB,

I see things ran a bit more smoothly mid-cycle for Davey last night.

How long is it till your AMPS test?

Also, just to make sure we understand everything properly, please can you confirm that Davey was fed exclusively on the low carb Fancy Feast Classic wet food all day yesterday and that the same food will now be his regular diet.

Great job monitoring over the weekend.


Mogs
.

 

[Davey's Mom]

Hi Mogs! Sorry I didn't see your message last night I was in lala land already...

His sugar this morning was very close to what it was yesterday morning so I continued with the same routine. It was actually a tad bit higher than yesterday.

Hi EMJB,

Also, just to make sure we understand everything properly, please can you confirm that Davey was fed exclusively on the low carb Fancy Feast Classic wet food all day yesterday and that the same food will now be his regular diet.

.

Yes you are correct

Thanks!

 

[Critter Mom]

Excellent! The diet transition is a major milestone.

If you arrive home a little while before PMPS is due, it can be very helpful to snag 'in the door' BG tests. They can give you information on dose duration and also indicate whether BG is rising at PMPS (helpful for making dosing decisions).


Mogs
.

 

[Davey's Mom]

Excellent! The diet transition is a major milestone.

If you arrive home a little while before PMPS is due, it can be very helpful to snag 'in the door' BG tests. They can give you information on dose duration and also indicate whether BG is rising at PMPS (helpful for making dosing decisions).


Mogs
.

Yes I did and he's higher today than yesterday when we were home with him. 19.2 at +10 (around 5 once I got the kids settled), then 23 at PMPS and 19.6 1 1/2 hours after insulin.

His water dish was still fairly full when we got home and his litter box isn't too bad either so he's still not showing signs of excessive thirst like he was before.

 

[Mum of two felines]

Will you be able to check at +5 tonight?

 

[Critter Mom]

Hi EMJB,

It's great that you got the +10 this evening; it shows that the dose didn't last the full 12 hours. If you can get one or two more of those your vet will be able to see from Davey's data that the Caninsulin does not have sufficient duration of effect to keep him in a reasonable range for the full cycle. I'd suggest discussing with your vet the possibility of a switch to a longer-acting insulin like Levemir or Lantus. Raising the dose on Caninsulin might put Davey in a better range during period of peak effect but it would be highly unlikely to give greater duration. A longer-acting insulin would be more likely to keep numbers in a better range for a longer time each day, keep those preshot BG levels down and, hopefully, gradually get him into a much better BG range overall.

Good news on the PU/PD front.


Mogs
.

 

[Mum of two felines]

You hit blues!!!!! Are you staying at 6 or going to 5?

 

[Critter Mom]

You hit blues!!!!!

Woot!!!

Go, Davey boy!!!

@emjb14 - keep a note of what, how much, and when you fed for yesterday's AM and PM cycles to refer back to; it seems to have agreed with Davey. How were Davey's clinical signs and behaviours yesterday evening?

Wondering whether yesterday's PMPS might have been a little bounce-influenced?


Mogs
.

 

[Davey's Mom]

Good Morning Mum of Two & Mogs!

He did so good last night that I panicked a bit this morning and wasn't sure what to give him. I was thinking 5 but then started second guessing and went to 4. I had to run into work a bit late today and was able to check him at +2 and he was 17.3 so 4 was likely a bad call... I know his dose is considered high and out of the norm but it seems that he needs it so far. We will see what he is when I get home...

Hi EMJB,

I'd suggest discussing with your vet the possibility of a switch to a longer-acting insulin like Levemir or Lantus. Raising the dose on Caninsulin might put Davey in a better range during period of peak effect but it would be highly unlikely to give greater duration. A longer-acting insulin would be more likely to keep numbers in a better range for a longer time each day, keep those preshot BG levels down and, hopefully, gradually get him into a much better BG range overall.

Good news on the PU/PD front.


Mogs
.

Good news is I already talked to my vet about other insulin options long ago and I have Lantus sitting at the pharmacy ready for me to pick up You guys had suggested this option to me a while back but we had decided to hold off on switching medications until we made the necessary changes to diet.

I think I should try Lantus this weekend beginning with Friday's PM dose. If you have any concerns with this please let me know.

If I remember correctly someone had mentioned that I ask for advice on the Lantus forum about dosing when making the switch. I now trust the advice from here more than any vet in my community so would definitely be looking for input

Woot!!!

Go, Davey boy!!!

@emjb14 - keep a note of what, how much, and when you fed for yesterday's AM and PM cycles to refer back to; it seems to have agreed with Davey.


Mogs
.

Thanks so much!!!! He's on all low carb fancy feast and he had four cans yesterday and still wanted more. He's not cheap to feed that's for sure lol.. He had two in the morning and two in the evening around shot time.

 

[Critter Mom]

Hi EMJB,

It's great to hear you sounding brighter! I hope Davey's feeling better in himself, too.

He did so good last night that I panicked a bit this morning and wasn't sure what to give him. I was thinking 5 but then started second guessing and went to 4. I had to run into work a bit late today and was able to check him at +2 and he was 17.3 so 4 was likely a bad call... I know his dose is considered high and out of the norm but it seems that he needs it so far. We will see what he is when I get home...

Secondary Monitoring: Water Consumption

- Measure water left out at AMPS.
- Measure to see what's left at PMPS to see how much was consumed during AM cycle.
- Measure water left out at PMPS.
- Measure to see what's left at AMPS to see how much was consumed on PM cycle.

While a crude method, if you do this secondary monitoring it may give you some small indication of how Davey's running during the daytime when you're out at work. You need to do both cycles for a comparison check. If there's a steady downward trend in both cycles then that plus the BG data you collect should hopefully flesh out the picture of Davey's progress. (There is the possibility that BG numbers may continue to improve for several days after the diet transition is completed.)

Whenever you lower a dose it's especially important to check ketone status.

Because Caninsulin is an in-out insulin if the 4IU dose is too low then it can always be adjusted upwards if required. Thus far the 6IU dose has been OK (and it's not excessive in the way the 8IU BID dose so soon after Dx was) but if Davey's BG continues to improve as a result of the food change and also becoming more sensitive to insulin from starting to run in better numbers then a precautionary, modest reduction should hopefully be OK. There is the possibility that he may level out on the lower dose (i.e. similar nadirs but lower preshots) but only testing will show whether that will be the case.


Mogs
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[Critter Mom]

Good news is I already talked to my vet about other insulin options long ago and I have Lantus sitting at the pharmacy ready for me to pick up You guys had suggested this option to me a while back but we had decided to hold off on switching medications until we made the necessary changes to diet.

With such a significant Caninsulin dose in play and at least some BG data available then doing the food switch while still treating with the in-out, somewhat 'known quantity' insulin made more sense in case the dose needed to be adjusted downwards quickly. Had Davey been on Lantus you'd have had to juggle with the reduced carb load and the insulin depot. In the latter situation there would have been a time lag after a dose reduction while the depot was draining so it could have been trickier.

I think I should try Lantus this weekend beginning with Friday's PM dose. If you have any concerns with this please let me know.

If I remember correctly someone had mentioned that I ask for advice on the Lantus forum about dosing when making the switch. I now trust the advice from here more than any vet in my community so would definitely be looking for input

Definitely post on the Lantus board to ask for input on starting dose, especially as Davey's currently receiving a significant dose of Caninsulin at the moment.

It will take several days for the Lantus depot to fill before you can fully assess the safety and efficacy of the dose so making the changeover at a time when you can monitor more closely is better. Be sure to let the L&L people know that you can't monitor on workdays as it may have an influence on the best day to start Lantus treatment and also the starting dose.

There are two treatment methods that L&L members typically follow:

Start Low, Go Slow Method (SLGS)

Tight Regulation Protocol (TRP)

Some members start out on the SLGS method but later switch to TRP as they gather more data and become more confident in how their kitties are responding to Lantus.

There are a lot of very helpful educational stickies at the top of the L&L board to help you learn more about Lantus.

You will need different syringes for the Lantus. The best ones to get are U100 0.3ml syringes with half-unit markings. Walmart carry them in their Relion range. Here is a post by Chris with a list of suitable syringes:

http://www.felinediabetes.com/FDMB/threads/u100-syringes.169310/#post-1837598

I'd very much like to follow along with Davey's progress on the Lantus switchover but I have difficulty negotiating the L&L ISG thread index page. (I have PTSD and the 'busyness' of the board makes me feel very panicky.) I'd appreciate it if you might tag me in one of your posts there so I'd be able to find Davey's thread.


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