Newbie very unsure of dosing & Somoygi

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panda28

panda28

Member Since 2017
Hi there,

My cat Dave just got diagnosed last week, and I'm at a point where I don't know if I should keep following my vet's advice. We got given two charts to follow, with a glucose reading and a corresponding insulin dose (we're using glargine). I decided to use the less tight chart, just while I'm getting used to it, but I'm seriously worried if I keep following it that he'll end up going hypoglycemic in the middle of the night. His glucose is swinging, generally following a pattern of :
  • low 20s mmol/l - I give 3.5u of glargine
  • 12 hours later, 14 mmol/l - I give 2.5u
  • 12 hours later, around 3 mmol/l - no insulin
  • 12 hours later, back to low 20s
The last time it got to 14, I decided to give him 0.5u less than the chart said, and he still ended up at 2.9. Our vet mentioned the Somoygi effect, but didn't tell us how to tell it is happening, and what to do if it is. They're closed over the Easter weekend, and I don't know if I should persist with the chart, or do what some websites say and consistently dose 1.5u. We're booked into the vet next Thursday, but any advice would be great - I'm seriously paranoid, and I've been testing poor Dave multiple times throughout the night! Thanks for both reading this wall of text, and for any advice you have for a very anxious owner!
 
panda28 said:
Hi there,

My cat Dave just got diagnosed last week, and I'm at a point where I don't know if I should keep following my vet's advice. We got given two charts to follow, with a glucose reading and a corresponding insulin dose (we're using glargine). I decided to use the less tight chart, just while I'm getting used to it, but I'm seriously worried if I keep following it that he'll end up going hypoglycemic in the middle of the night. His glucose is swinging, generally following a pattern of :
  • low 20s mmol/l - I give 3.5u of glargine
  • 12 hours later, 14 mmol/l - I give 2.5u
  • 12 hours later, around 3 mmol/l - no insulin
  • 12 hours later, back to low 20s
The last time it got to 14, I decided to give him 0.5u less than the chart said, and he still ended up at 2.9. Our vet mentioned the Somoygi effect, but didn't tell us how to tell it is happening, and what to do if it is. They're closed over the Easter weekend, and I don't know if I should persist with the chart, or do what some websites say and consistently dose 1.5u. We're booked into the vet next Thursday, but any advice would be great - I'm seriously paranoid, and I've been testing poor Dave multiple times throughout the night! Thanks for both reading this wall of text, and for any advice you have for a very anxious owner!
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It is not common to give two digest doses. Can you set up a spreadsheet to share with us? Download Google Sheets app on either a phone, tablet or computer .... Here is the template. (You can see what the ss looks like by clicking the link in my signature.). It allows us to see the trends easily. It sounds like you are on too high of a dose. It's odd the vet would suggest two different doses. Typically that kind of insulin is kept the same morning and evening. It's also a VERY high starting dose as most cats start at 1 unit and gradually raise by 0.25-0.5 units slowly as needed. http://www.felinediabetes.com/FDMB/threads/fdmb-spreadsheet-instructions.130337/
 
For a newly diagnosed kitty 3.5 units is way too a high dose, especially with the numbers you are getting down to. Usually a starting dose will be 1 unit and that will be held for about 1 week until the body becomes acclimatized to external insulin. Also Lantus is a depot insulin, which takes time to build up the depot before you can see the effects of the insulin. Here is some information on how the depot works:

http://www.felinediabetes.com/FDMB/threads/lantus-levemir-what-is-the-insulin-depot.150/

Lantus is best given as a consistent dose rather than on a sliding scale, unless of course if the numbers drop too low, in which case the dose would be lowered. Dosing with Lantus is based on HOW LOW the dose gets your kitty, NOT on the preshot reading. The fact that the numbers are dropping to 3mmol (54 US) shows that the dose is too high. Are you using a human meter or a pet meter? On a human meter 2.8 (50US) is a "take action" number, meaning you want to keep the numbers from falling any lower. On a pet meter 3.8 (68 US) is the "take action" number.

Are you testing in between shots? Lantus usually will have an onset (starting to take effect) between 2-4 hours after the shot and a nadir (lowest number) between 4-7 hours after the shot. This can vary with each kitty. The fact that you have had a test of 3mmol (54 US) 12 hours after the shot shows that your kitty may have gone much lower during the cycle (time between shots) and the dose is too high. This can cause bouncing ( sometimes vets refer to this as the somygi effect) into higher numbers for a period of time since the body releases hormones which cause stored glucose to be released in response to what it sees as an emergency situation.

Please read this information on dealing with a hypo:

http://www.felinediabetes.com/FDMB/threads/how-to-treat-hypos-they-can-kill-print-this-out.15887/

I would suggest going to 1 unit and doing testing during the time between shots. If you read the"stickies" at the top of this page it will give you more information on using Lantus:

http://www.felinediabetes.com/FDMB/forums/lantus-glargine-levemir-detemir.9/

The dosing scale your vet has given you is not safe to use. Consistent testing before each shot and in between shots will keep your kitty safe. The fact that you are home testing is really the only thing that has prevented your kitty from going into a dangerous or deadly hypo episode.

Please post on the Lantus forum:

http://www.felinediabetes.com/FDMB/forums/lantus-glargine-levemir-detemir.9/

to get more attention on your post and much more information and advice from people who have a lot of experience using it

http://www.felinediabetes.com/FDMB/forums/lantus-glargine-levemir-detemir.9/
 
I think that you're giving him too much too soon for starters, that's my opinion and I'm sure that some others will weigh in here soon.
With Glargine you need to pick a dose and stick to it for at least 3 to 4 days and test him a few times during either his AM or PM cycle to see what is going on with his numbers throughout the day, are they increasing, are they staying level, are they decreasing? When does the lowest number happen, that's called the nadir. All of this is called gathering data and the more data that you gather, the more that you learn about YOUR cat and each cat is different. Right now you need to make a choice between 2 different methods of treatment. There is one called Tight Regulation which is strict and demands quite a bit of work on your part but is the best one if you want your kitty to have a chance at remission and even though it is strict it can still be done while working or going to school. Then there is the other one which called Start Low, Go Slow. I'll link them so that you can read all about them and make the choice that you think is right for you and Dave. You'll also want to start a spreadsheet and link it here so that so that we can see what is going on when you test and give insulin, it makes it easier for people on the forum to help you the instant that you ask for it, we can go and look at the history and see everything that is happening. If you need help setting that up, there are plenty of people here that can help you. Lastly, you will want to post over in the Lantus / Glargine section of the forum, all of those people specialize in that type of insulin and are better suited to help you with specific needs when they arise. As of right now no matter which method you choose, I personally suggest that you back off and put him down to 1 unit for at least 5 days straight, give him time to stabilize and see what happens.

Protocol for Tight Regulation
http://www.felinediabetes.com/FDMB/threads/lantus-levemir-tight-regulation-protocol-tr.1581/

Protocol for Start Low, Go Slow Method
http://www.felinediabetes.com/FDMB/threads/lantus-levemir-start-low-go-slow-method-slgs.129446/
 
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Thank you all so much! I've been so worried the last few days that when I'm injecting him I'm going to kill him, but figured the vet knew what she was talking about. Clearly not! We're definitely going to put him on 1u for a week. I can't believe how close he came to something going very wrong - you've probably saved his life! I'm working on getting the spreadsheet set up, and it should be ready in a couple of hours. Hopefully that can shed some light on what I should do. Thank you, thank you!
 
panda28 said:
Thank you all so much! I've been so worried the last few days that when I'm injecting him I'm going to kill him, but figured the vet knew what she was talking about. Clearly not! We're definitely going to put him on 1u for a week. I can't believe how close he came to something going very wrong - you've probably saved his life! I'm working on getting the spreadsheet set up, and it should be ready in a couple of hours. Hopefully that can shed some light on what I should do. Thank you, thank you!
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Good job getting the signature set up!

The truth is most vets don't get enough training in feline diabetes.
 
JanetNJ said:
Good job getting the signature set up!

The truth is most vets don't get enough training in feline diabetes.
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Okay, I tried to put the spreadsheet up, but for a 17-year-old I'm terrible with technology, so if anything's wrong, please tell me! Thanks again for all your help.
 
panda28 said:
Okay, I tried to put the spreadsheet up, but for a 17-year-old I'm terrible with technology, so if anything's wrong, please tell me! Thanks again for all your help.
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I see it! You did it perfectly! Wow you're only 17?
 
panda28 said:
Okay, I tried to put the spreadsheet up, but for a 17-year-old I'm terrible with technology, so if anything's wrong, please tell me! Thanks again for all your help.
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Yeah the spreadsheet makes it really clear that the dose is too high. I'd go back and stay at 1 unit (1.5 tops) twice a day and hold the dose for a few days so the deposit depletes and we see what's going on. It seems like she's going low them her body is releasing insulin to keep her safe.... This is called a bounce (somoygi). She is getting close to being too low... Very close to hypoglycemic levels. Thank goodness you are testing and skipped those shots!! Other people who are more experienced with your insulin will be able to give you more specific dosing advice from there.
 
JanetNJ said:
Good job getting the signature set up!

The truth is most vets don't get enough training in feline diabetes.
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Amen to that, most vets are spread out all over the place. They know a little bit about a whole bunch of stuff but not a whole bunch of stuff about any 1 subject. I just happened to luck out this last week and find a new doctor that specializes in cats. She's great and even she has her flaws but at least she's willing to let me teach her which is so far different from any vet that I've ever met in my life. I think I love her ♥ lol
In all seriousness though, I think that finding the right vet is crucial, it's not a top priority if you already have your insulin since you have this forum to help you, meaning that you have time to take your time and go slow in finding the right doctor. All you need to do is make some phone calls and ask some questions, PM me and I'll tell you how I did it. Other than that just focus on learning from the forum and taking it day by day and you'll do just fine. And wow, can't believe you're only 17.

Also can you please tell me what meter you are using? Nicely done with the testing by the way. It does look to me that your dose is too high and that's why you're getting these numbers going everywhere and the inconsistent dosing doesn't help. Do your syringes have half marks on them? if so it will make it much easier to dose at say 1.25 etc. With numbers that high I would like to suggest that you start with a dose of 1.25 units if you can measure that. Keep that dose twice daily for at least a week.

AND what are you feeding him?
 
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Welcome! You have amazing instincts about this for someone so young! I don't mean to sound condescending - you're much more on the ball than many older people who come here. We can certainly help you with handsome Mr. Dave.

I like Tuxedo Mom's suggestion to reduce to 1 unit twice a day and do some tests in the middle cycle time frame (a cycle is the 12 hours between AM and PM doses). Do some reading of the yellow stickies on the Lantus & Levemir forum so you learn more about how the insulin works. There are two general dosing methods and they give clear guidance on what to do when. All you have to do is choose one and start. You can switch to the other method at any time you think it would work better for you.
 
Hello and welcome!

So glad you were home testing and could catch those low numbers! It probably saved your kitty's life.

I'll just add one thing to the advice already given: while I agree that the dose should be lowered, any time you decrease insulin that much you want to make sure to also be testing for ketones. You can pick up urine test strips in any pharmacy (with the human diabetic supplies). To get the urine, you can either just hold the stick under your cat while peeing if he'll let you, use a long-handled spoon to catch a bit, or (for shy kitties), put a bit of crumpled plastic wrap in his favorite spot in the box (you just need a drop or two on the stick). In a pinch, you can also replace litter with aquarium gravel (wash and re-use).
 
Just to add: the keys to success in treating Dave's diabetes are a willingness to: test blood glucose at home and track the data; question vet's advice that doesn't seem correct and ask questions here. You've got it covered! Add to that a big dose of patience because getting Dave under control is "a marathon, not a sprint". We say that a lot around here. ;)
 
Thank you all so much once again, you're all so lovely! I feel like for the first time in a week that I actually know what's going on with him. I thought something was up, but didn't know if it was just me being paranoid. I don't know what would've happened to Dave without all your advice.

Nan & Amber said:
Hello and welcome!

So glad you were home testing and could catch those low numbers! It probably saved your kitty's life.

I'll just add one thing to the advice already given: while I agree that the dose should be lowered, any time you decrease insulin that much you want to make sure to also be testing for ketones. You can pick up urine test strips in any pharmacy (with the human diabetic supplies). To get the urine, you can either just hold the stick under your cat while peeing if he'll let you, use a long-handled spoon to catch a bit, or (for shy kitties), put a bit of crumpled plastic wrap in his favorite spot in the box (you just need a drop or two on the stick). In a pinch, you can also replace litter with aquarium gravel (wash and re-use).
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I've been testing for ketones about once a day with KetoDiastix, and have gotten negative each time, thankfully. He's been letting me catch it in a container, hopefully he doesn't get shy anytime soon! I'll make sure I keep it up.
 
panda28 said:
Thank you all so much once again, you're all so lovely! I feel like for the first time in a week that I actually know what's going on with him. I thought something was up, but didn't know if it was just me being paranoid. I don't know what would've happened to Dave without all your advice.



I've been testing for ketones about once a day with KetoDiastix, and have gotten negative each time, thankfully. He's been letting me catch it in a container, hopefully he doesn't get shy anytime soon! I'll make sure I keep it up.
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Wow only a week and you are so on everything! Your vet is good at least in that he/she got you testing for everything right from the start!
 
Sieden said:
Also can you please tell me what meter you are using? Nicely done with the testing by the way. It does look to me that your dose is too high and that's why you're getting these numbers going everywhere and the inconsistent dosing doesn't help. Do your syringes have half marks on them? if so it will make it much easier to dose at say 1.25 etc. With numbers that high I would like to suggest that you start with a dose of 1.25 units if you can measure that. Keep that dose twice daily for at least a week.

AND what are you feeding him?
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The meter is a human one, the AccuChek Nano Performa, and the syringes are u-100 ones with marks only on whole numbers. With 1.25, I'm guessing I'd give just a smidge more than the 1 mark? He gets 150g of Royal Canin Diabetic wet food (1.5 sachets) twice a day, between testing and giving insulin. No dry food. He used to freefeed, so he's hungry enough to eat all his food when I give it to him. We'll see how long that lasts before he gets sick of it... The vet also said he has to lose some weight and that I should eventually drop it to 100g twice daily, but he's begging for food so often that I just want him to get used to what he's got now before dropping it further.
 
You are doing EVERYTHING right!!! How wonderful to see a pet parent who is educating themself and questioning vet advice. As has already been said many vets have a minimal of training in diabetes which covers all animals. The one bright spot with your vet was to have you doing home-testing. GREAT JOB!!!
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ETA One thing that many people do is split up the portions of food and give several smaller meals during the day rather than just 2 meals. Since Lantus is a long acting insulin it is in the system longer and can deal with controlling food during the cycle. If a kitty has a nadir (lowest number) at for example +6 hours after the shot, people will feed several meals during that time and then hold food until the next shot time.Make sure you give at least 2 hours before the preshot testing so that there is no food influence in the glucose reading,
 
Good job getting Dave off of dry food! Many of us free feed our cats with wet food, and find that leaving food out - or giving several small meals throughout the day - works better for diabetic cats.
 
panda28 said:
The meter is a human one, the AccuChek Nano Performa, and the syringes are u-100 ones with marks only on whole numbers. With 1.25, I'm guessing I'd give just a smidge more than the 1 mark? He gets 150g of Royal Canin Diabetic wet food (1.5 sachets) twice a day, between testing and giving insulin. No dry food. He used to freefeed, so he's hungry enough to eat all his food when I give it to him. We'll see how long that lasts before he gets sick of it... The vet also said he has to lose some weight and that I should eventually drop it to 100g twice daily, but he's begging for food so often that I just want him to get used to what he's got now before dropping it further.
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Diabetic cats whose numbers are not controlled need to eat more than other cats because they can not properly utilize the nutrients in the food. It's OK to feed mid day and in the evening.... Just no food two hours before preshot testing so the numbers are not food influenced. Some people feed as much as six meals a day. Prescription wet food is fine, but expensive. Most of us feed fancy feast classic or Friskies pate foods.
 
panda28 said:
The meter is a human one, the AccuChek Nano Performa, and the syringes are u-100 ones with marks only on whole numbers. With 1.25, I'm guessing I'd give just a smidge more than the 1 mark? He gets 150g of Royal Canin Diabetic wet food (1.5 sachets) twice a day, between testing and giving insulin. No dry food. He used to freefeed, so he's hungry enough to eat all his food when I give it to him. We'll see how long that lasts before he gets sick of it... The vet also said he has to lose some weight and that I should eventually drop it to 100g twice daily, but he's begging for food so often that I just want him to get used to what he's got now before dropping it further.
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As everyone has said, you're doing a great job and for only a week in, you're doing amazingly well. The syringes that you have will work and yes just a smidge more than the 1 mark, once you can see just a sliver of light past the one mark then that is 1.25
You will find it a lot easier to dose if you can get some syringes with half marks. I know that there are a lot of places where you can order them online and I'll link a few different brands but for right now I tend to buy mine at Wal-Mart. They are Reli-On the capacity is 3/10ml and I use the 5/16" length which is called a short needle, I think it personally just feels safer to me so that I know that I'm not going to accidently inject too far or go beyond the fat layer and into the muscle. If you do end up going to Wal-Mart to get these open up the box while you're there and make sure that they have the tiny little half marks on them before you pay for them. I do this every single time because it doesn't state anywhere on the package whether they have half marks or not and the box itself is NOT sealed so it shouldn't be an issue. The syringes inside the box are inside little clear bags that you can see through so that will be good enough. That half marks make all the difference in the world, at least to me it does. I can't image dosing without it. Anyway... enough rambling already huh lol. Here are some links for ones that are online.

https://www.adwdiabetes.com/product/2552/monoject-ultra-comfort-insulin-syringes
https://www.adwdiabetes.com/product/16367/carepoint-vet-u-100-pet-syringe-31g-half-unit
https://www.adwdiabetes.com/product/6941/bd-ultra-fine-insulin-syringes

If he needs to lose weight you might try to calculate exactly how much food he's supposed to eat and start feeding him that. Chances are really good that since he was free feeding before that he was over eating so you don't have to cut back on his food right away but at least get him to eating the right amount instead of in excess. Like others have said, diabetic cats tend to do better if they are allowed to free feed on wet food or if they are fed multiple meals per day instead of only twice per day. If your cat doesn't have the restraint to hold himself back from eating all of his food at once then it will be best to feed him more than twice a day, just remember to not feed him 2 hours prior to his preshot checks.

I also second the food choice, vets are programmed to sell the prescription food because they make a commission from selling that stuff and furthermore most vets are not educated well enough on diabetic diet to be prescribing a diet anyway. You always want to look at the first 4 to 5 ingredients when looking for a food. You also obviously want to consider price along with those ingredients. I feed my cats Friskies Classic Pate and I dig it for the price. I just looked up your food and compared it to mine and with some basic math you'd spend 996.00 per year for your cat and I'd spend 281.00 per year for 1 of mine. Every time I think about how these companies are ripping people off I just want to cry because it's not fair.
And sorry that this post is so long but I went and compared the ingredients of your food and my food just to show you what to look for even if you choose a totally different brand.
These are in order of highest to lowest concentration

Royal Canin
1. Water
2. Pork by-products
3. Chicken liver
4. Chicken
5. Wheat gluten (horrible)
6. Powdered cellulose (wood shavings)

Friskies Pate Turkey & Giblets Dinner
1. Meat by-products
2. Water
3. Poultry by-products
4. Turkey
5. Poultry Giblets
6. Fish


I think that's enough to show you and you didn't know so don't feel bad. Shoot, I feel bad for showing you and potentially making you feel bad but it's part of the truth and it's one of the first things that I set out to learn about when my Peanut was diagnosed and that's why I push diet so much. It took me forever to settle on a stupid cat food and if I can help someone else then long post or not, I'm going to.
 
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Wow, Sieden, thanks for writing all that out for me! I'll definitely have to get some half-mark syringes, they sound much better to use. And to be honest, it's great to hear that I can look into getting different food, because as well as being expensive there's only one vet nearby that even sometimes stocks it, and I was worrying what to do if we run out. I don't think I can freefeed because we have another 2 cats, but I can definitely split his food up into a couple more meals each day. He's been really begging for food, so it'll be good being able to spread it out some more. With the food, is there something in particular I should be looking for, or just good ingredients? I'm guessing I'll have to trial and error a bit, because Dave's a bit funny with food - he has an intolerance to at least seafood. It doesn't sound like his current food is very good for him, so thanks for telling me so I can get onto finding something better!
 
Dave's mum,
When they are first diagnosed their bodies are literally starving because they can't properly absorb the nutrients. Many feed a few times a day (example: I do 4 feedings for my boy, it also helps umm smooth his numbers through nadir lol:cat:). Here is the food chart many use here: http://catinfo.org/docs/CatFoodProteinFatCarbPhosphorusChart.pdf
@Cherish Gallagher found an app for smartphones (guessing apps are internationally available?:confused:) if you find a food not listed on the chart or a new one while you're at the store. I use a similar formula in the link in my signature that anyone can use :)
 
When looking at the food chart, the biggest things right now are (1) no dry food, (2) carbs lower than 10% (3) something Dave will eat. When you find something he seems to like, try to transition slowly over a week. For many kitties, changing food quickly can lead to stinky poo, diarrhea, and general stomach upset.
 
panda28 said:
Wow, Sieden, thanks for writing all that out for me! I'll definitely have to get some half-mark syringes, they sound much better to use. And to be honest, it's great to hear that I can look into getting different food, because as well as being expensive there's only one vet nearby that even sometimes stocks it, and I was worrying what to do if we run out. I don't think I can freefeed because we have another 2 cats, but I can definitely split his food up into a couple more meals each day. He's been really begging for food, so it'll be good being able to spread it out some more. With the food, is there something in particular I should be looking for, or just good ingredients? I'm guessing I'll have to trial and error a bit, because Dave's a bit funny with food - he has an intolerance to at least seafood. It doesn't sound like his current food is very good for him, so thanks for telling me so I can get onto finding something better!
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http://catinfo.org/docs/CatFoodProteinFatCarbPhosphorusChart.pdf
Use this chart here and find a food on it that has 10 carbs OR less then once you have a list of different foods that fall into that category go to the store and start looking at the ingredients list. If it's not listed on the can then the company has something to hide so scratch that off of the list and move on down the line. Mainly focus on the top 5 ingredients and make sure that those are animal products, a by-product and water. Continue to look down the list and stay away from any brands that have wheat, wheat gluten, corn, flour, starch, grains and I guess that since your guy is seafood sensitive then you'll want to watch for that as well. I know that Friskies doesn't have any of the ingredients that I listed but I think that they have seafood in them. I will search for one that doesn't because I believe in their brand and it's much easier if you don't have to go through this process of search and rescue trying to find the perfect cat food. It drove me nuts doing this process. Also don't forget that some foods come in 3oz cans and some come in 5.5oz cans. I want to say that your current food works out to be around 1.50 per 3oz can and the Friskies is just .50 cents for a 5.5oz can. So after you use the chart to find your foods that fall under the 10 grams of carbs, go to a website like Petsmart or Petco and look these foods up to see how much they are. This will give you a rough estimate of how much they are per can and if they are even worth looking into. I hope that all of that makes sense.
 
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I'll update this as I find more flavors, you should see a picture of the can and what flavor it is then under that you will see a box that says
Feeding Instructions
Ingredients
Nutrition
Guaranteed Analysis
You can either click on Ingredients or just scroll down, they should already be there under that box
Also remember that once you find one that works, you don't have to buy every flavor that they have, cats can do perfectly fine on one flavor.

I tried to find some kinds in the Fancy Feast but many of them have fish and then I ran into one that didn't, it's Roasted Chicken Feast but it's still .59 cents for a 3oz can and it has wheat gluten which is an inflammatory, it also has soy which is bad for cats.

https://www.friskies.com/products/wet-cat-food/classic-pate/country-style-dinner/
https://www.friskies.com/products/wet-cat-food/classic-pate/mixed-grill/

This next brand that I found is a step up from the cheaper stuff, it's called Halo and it's pretty good stuff. The ingredients are great, there's no fish and it's grain free. It is available in a 5.5oz can and all of the flavors work out to be about 1.75 per can. It's still a little on the pricy side for me but the cans are bigger than what you currently have. The links are from Petco and the ingredients are listed on each page if you scroll down and look for the link.

http://www.petco.com/shop/en/petcos...ts-pate-ground-chicken-recipe-canned-cat-food
http://www.petco.com/shop/en/petcos...e-grain-free-shredded-chicken-canned-cat-food
http://www.petco.com/shop/en/petcos...ground-turkey-and-duck-recipe-canned-cat-food
http://www.petco.com/shop/en/petcos...d/halo-vigor-turkey-and-quail-canned-cat-food
http://www.petco.com/shop/en/petcos...ce-grain-free-shredded-turkey-canned-cat-food
 
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Okay, a couple of updates. The consistent .125u dosing is keeping his blood glucose fairly steady, and I'll be doing it for a couple more days until I reassess what he needs. He's now getting his food in 4 meals a day - at 7am/pm and 1am/pm. He seems a lot more relaxed and happier, and he's not constantly stalking around the house looking for food.

The food thing's been tricky, because not all brands are in Australia, but I found one I think looks good - the Weruva Cats in the Kitchen cans - which has good readings on the chart and is a lot easier to get than what he's on at the moment, though I'm not sure how good the ingredients are (there doesn't seem to be fillers, but I could be missing something). I'm also going to have a look into the different types of Fancy Feast and in a day or two I'll have a chance to go out and get some, and then hopefully he likes it and it doesn't cause him any problems. It was pretty shocking seeing how high in carbs some of the food we feed the other cats is, and I've definitely got a list to avoid in the future. The Royal Canin also seems to be giving him constipation, so with luck this other food will help with that too.

I really appreciate everything everyone's done to help me find a food for him. Especially thank you to Sieden for going through so many foods for me, and it's really frustrating that in Australia we have so many less options available.
 
Welcome to the FDMB! It doesn't look like anyone gave you this information yet. It can be found in the
"Links to FOOD CHARTS" sticky as well as the "LANTUS & LEVEMIR - THE BASICS: NEW TO THE GROUP? START HERE!" sticky.
The info specific to Australia may help. :)

Edited to add:
Here's the latest research disproving the existence of somogyi: Rebound hyperglycaemia in diabetic cats.pdf


Just a friendly reminder to those offering dosing advice for Lantus (glargine) regarding consistent vs inconsistent dosing with glargine: The protocols used on the FDMB suggest consistent dosing with glargine, but please be aware there are other feline diabetes message boards on the web using different dosing methods/protocols successfully... methods which may include inconsistent dosing and/or the use of sliding scales.
 
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Jill & Alex (GA) said:
@panda28
Since the dose has been reduced, I'm glad you're checking for ketones. Has Dave ever been in DKA (diabetic ketoacidosis) or had ketones?
Click to expand...

In the blood test that diagnosed him with diabetes (about a week ago) there were ketones present. He stayed at the vet for four days to be introduced to insulin, and since then I haven't had any show up in his daily urine test (with ketodiastix).

ETA: I just checked the Australian food spreadsheet, and WOW! I've just printed out a copy, and it should be super useful for finding him a food! Thanks!
 
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panda28 said:
In the blood test that diagnosed him with diabetes (about a week ago) there were ketones present. He stayed at the vet for four days to be introduced to insulin, and since then I haven't had any show up in his daily urine test (with ketodiastix).
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The recipe for developing DKA = an insufficient supply of insulin + inappetance + infection OR other systemic stresses.

Testing for ketones becomes more important than ever since the dose was dropped to 1.25 units. Try to test for ketones twice a day if at all possible. If there's even "trace" ketones present, post for help immediately.

Since you have a spreadsheet set up already, you should go ahead and post in the Lantus and Levemir Insulin Support Group. Be sure to let them know that Dave's dose was reduced per suggestions on Health and he had ketones when diagnosed, but has been negative for ketones since then.
panda28 said:
I just checked the Australian food spreadsheet, and WOW! I've just printed out a copy, and it should be super useful for finding him a food! Thanks!
Click to expand...
You're very welcome, but the real thanks go to those who put together the information. We're so lucky to have members from all over the world contribute to our site!
 
I forgot to ask...
How about testing Dave every night before you go to bed? We call those tests "before bed spot checks". Many kitty's blood glucose numbers drop at night. A before bed spot check may give you some idea if Dave may drop too low while you're sleeping. You'll learn more about what to expect and when to expect it from posting often. :)
 
panda28 said:
Okay, a couple of updates. The consistent .125u dosing is keeping his blood glucose fairly steady, and I'll be doing it for a couple more days until I reassess what he needs. He's now getting his food in 4 meals a day - at 7am/pm and 1am/pm. He seems a lot more relaxed and happier, and he's not constantly stalking around the house looking for food.

The food thing's been tricky, because not all brands are in Australia, but I found one I think looks good - the Weruva Cats in the Kitchen cans - which has good readings on the chart and is a lot easier to get than what he's on at the moment, though I'm not sure how good the ingredients are (there doesn't seem to be fillers, but I could be missing something). I'm also going to have a look into the different types of Fancy Feast and in a day or two I'll have a chance to go out and get some, and then hopefully he likes it and it doesn't cause him any problems. It was pretty shocking seeing how high in carbs some of the food we feed the other cats is, and I've definitely got a list to avoid in the future. The Royal Canin also seems to be giving him constipation, so with luck this other food will help with that too.

I really appreciate everything everyone's done to help me find a food for him. Especially thank you to Sieden for going through so many foods for me, and it's really frustrating that in Australia we have so many less options available.
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Oh man that really sucks that you are so limited to certain foods, I didn't realize that when I started looking for foods for you. At least I gave you an idea of what to look for. I don't like Weruva because only 2 ingredients are meat related, the rest is filler crap and it's way over priced. I bought some for my cats without knowing and only fed them one can. I turned around the next day and took the rest of it back to the store for a refund.

I recommend Holistic Select or any of the Wellness, especially the Wellness CORE Grain - Free if you can find that, they are far better than the Weruva. Remember that carb count only needs to be 10 or less so you don't need to shoot exactly for 1, anything between the 0 and 10 range is perfectly fine.

If you can't find a brand of food at a chain store like Petsmart or Petco then Google search "pet store" and see if there are any small places near you. That's what I did and I found this little place called Pet Palace that turned out to be a great little store tucked out of sight that I never knew was there. I go there to get my frozen raw cat food, they special order it for me. You never know what you'll find until you look. I chose those brands based from the Australian sheet so you should be able to find them. Good luck.
 
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Sieden said:
Oh man that really sucks that you are so limited to certain foods, I didn't realize that when I started looking for foods for you. At least I gave you an idea of what to look for. I don't like Weruva because only 2 ingredients are meat related, the rest is filler crap and it's way over priced. I bought some for my cats without knowing and only fed them one can. I turned around the next day and took the rest of it back to the store for a refund.

I recommend Holistic Select or any of the Wellness, especially the Wellness CORE Grain - Free if you can find that, they are far better than the Weruva. Remember that carb count only needs to be 10 or less so you don't need to shoot exactly for 1, anything between the 0 and 10 range is perfectly fine.

If you can't find a brand of food at a chain store like Petsmart or Petco then Google search "pet store" and see if there are any small places near you. That's what I did and I found this little place called Pet Palace that turned out to be a great little store tucked out of sight that I never knew was there. I go there to get my frozen raw cat food, they special order it for me. You never know what you'll find until you look. I chose those brands based from the Australian sheet so you should be able to find them. Good luck.
Click to expand...

I'm heading out tomorrow to Petbarn to have a look for different foods, and I'm pretty sure I've seen Wellness and Holistic Select there. I'll bring the list of foods and check the ingredients for any low-carb ones to pick a good one. I'm also going to start a thread in the Lantus board to get some advice on dosing.

ETA: Just quickly, if his glucose is low, is it okay to skip a shot (during this one week period of consistent dosing)? And then I'm assuming afterwards I would drop the dose by 0.25 from then on? It looks like I'm going to use the SLGS method, but I;m not certain if that should be affecting this one week.
 
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panda28 said:
Just quickly, if his glucose is low, is it okay to skip a shot (during this one week period of consistent dosing)?
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If the number is very low (green) and you don't have a lot of data you would skip the shot. If the number is blue you can try stalling without feeding for 20 minutes or so and retest to see whether the BG is coming up on its own. If it is you can give the normal insulin dose or if you're unsure, post here for advice. You said you're using the SLGS method so that means you keep a dose until a BG of 90 happens, at which point you'd reduce by 0.25 u.

Moral of the story: you could have given insulin this AM. Stalling/retesting would have been the way to go, along with asking here. Over time you'll be able to make these judgments more confidently on your own.
 
Just adding to what Kris said: you do want to avoid skipping shots if at all possible, given Dave's history of ketones. Insulin is one of the main weapons to keep those ketones from coming back.

The first few times you "shoot low" you'll probably want to do it on days when you know you can monitor and see where he goes, but you'll quickly get comfortable with low pre-shots. Lantus/glargine is a good insulin to use at low numbers-- it is often very moderate in the BG drops it produces when the cat is already low.
 
Right, thanks. His blood glucose has soared tonight, so at least I know what to do next time it happens. So if it does start coming up on its own, at what point would it be safe to actually shoot? Or is it just enough to know that is is coming up? Thanks for telling me all this, it'll help me be more confident next time I have to make a decision - and if not, I'll come straight on here to ask! The plan at the moment is to buy his new food tomorrow, and slowly ease him onto it. Once he's all good with that, I'll do a curve so that I can figure out when his nadir is, and then I should be able to dose him better.
 
panda28 said:
Right, thanks. His blood glucose has soared tonight, so at least I know what to do next time it happens. So if it does start coming up on its own, at what point would it be safe to actually shoot? Or is it just enough to know that is is coming up? Thanks for telling me all this, it'll help me be more confident next time I have to make a decision - and if not, I'll come straight on here to ask! The plan at the moment is to buy his new food tomorrow, and slowly ease him onto it. Once he's all good with that, I'll do a curve so that I can figure out when his nadir is, and then I should be able to dose him better.
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good idea about easing him onto the new food as it will naturally reduce his insulin needs so watch him carefully and adjust accordingly.

Also what I would have done on the 128 instead of skipping is given a half or even a quarter of a dose. I've learned that having something in the system to carry over through the cycle is better than nothing. When there is nothing at all, it can cause that huge spike that you saw. I've been there many times. Sometimes it only takes a drop or two in the system to carry over and keep them steady.
 
Okay, I just got back from the vet for his followup, and I'd love to get some opinions on what my vet has told me I should and shouldn't be doing.

Essentially:
  1. Not following the chart means pretty much no chance he'll go into remission (something I'm okay with if it means that I won't be dropping him so low)
  2. I shouldn't be feeding him so many times a day - 2 is best
  3. Feeding any canned food apart from Royal Canin Diabetic is a bad idea and he likely won't go into remission
  4. If I don't want to feed him that, I should instead give him 35g of cooked red meat three times a day, plus Royal Canin/ Fancy Feast if he's still hungry. Eventually he should be weaned off the extra Royal Canin. If this ends up being a long term thing, he'd also need daily paediatric supplements.
I'm still not super confident about the whole thing, but from what I've been told here, research, and reading other people's experiences I'm pretty content with the fact that points 1, 2 and 3 aren't true. What's getting me is 4 - is there anything backing this up? Should I try it for two weeks (until I go back to the vet) to see if there's an improvement? Having just bought about 40 cans of his new food (Wellness Core Grain - Venison, Beef and Lamb), and seeing that he loves even the small amount he's getting mixed in has me pretty tempted to keep on with what I'm doing! Still, I want to make sure that I'm not ignoring something that could help him. If I follow the original plan he should be fully on the Wellness in about three days, and I'll be able to do a twelve hour curve, adjusting his insulin accordingly.

Also, he's dropped about half a pound in weight, and I'm uncertain if it is because of not enough food, or because his numbers are still pretty high.

You guys have all been so helpful, and any advice I could get would be wonderful!
 
I disagree with points 1, 2, and 3. As far as 4 goes, he'd need supplementation if cooked red meat forms the majority of his diet. Canned wet food like Friskies or Fancy Feast pates are fine and feeding in multiple small meals a day is fine. Most cats prefer that. Do you know the carb level of the Wellness Core food he likes?

Lantus is a depot insulin and works to best effect with consistent dosing according to the protocols used here. Other protocols might be different and that might be where your vet is coming from. Having said that, I can tell you that my vet stressed the importance of consistent dosing when my guy was started on Lantus.

I suggest you:
  • read the yellow info stickies on the Lantus forum
  • think about which dosing regimen (TR or SLGS) would be easiest for you
  • post on that forum with everything the vet told you to do and ask for help. It's a large forum with very many highly experienced people on it.
It take courage to go against a vet's advice but you've done a lot of reading here and can see that much of what he/she said is different from what we would recommend.
 
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Kris & Teasel said:
I disagree with points 1, 2, and 3. As far as 4 goes, he'd need supplementation if cooked red meat forms the majority of his diet. Canned wet food like Friskies or Fancy Feast pates are fine and feeding in multiple small meals a day is fine. Most cats prefer that. Do you know the carb level of the Wellness Core food he likes?

Lantus is a depot and works to best effect with consistent dosing according to the protocols used here. Other protocols might be different and that might be where your vet is coming from. Having said that, I can tell you that my vet stressed the importance on consistent dosing when my guy was started on Lantus.

I suggest you:
  • read the yellow info stickies on the Lantus forum
  • think about which dosing regimen (TR or SLGS) would be easiest for you
  • post on that forum with everything the vet told you to do and ask for help. It's a large forum with very many highly experienced people on it.
It take courage to go against a vet's advice but you've done a lot of reading here and can see that much of what he/she said is different from what we would recommend.
Click to expand...

Thanks, it feels really strange to have to be questioning what my vet is saying (she's been great with our other animals), and it really helps to have some opinions from other people. The wellness food is 2% carbs according to the spreadsheet from earlier. It looks like I'll stick with what I've been doing, and then at the end of the week, once I've switched his food over, start SLGS and get some help from the Lantus forum on what dose to give him. I really appreciate your advice.
 
panda28 said:
Thanks, it feels really strange to have to be questioning what my vet is saying (she's been great with our other animals), and it really helps to have some opinions from other people. The wellness food is 2% carbs according to the spreadsheet from earlier. It looks like I'll stick with what I've been doing, and then at the end of the week, once I've switched his food over, start SLGS and get some help from the Lantus forum on what dose to give him. I really appreciate your advice.
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Good plan! :D

FWIW: My vet is very good but I don't treat Teasel's FD according to her instructions. I started off the way she told me to do things but I've learned that the FDMB way is better. I've long since gone my own way and she knows that - and she trusts me! Periodically I give her a quick update on how he's doing.
 
panda28 said:
Also, he's dropped about half a pound in weight, and I'm uncertain if it is because of not enough food, or because his numbers are still pretty high.
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Also disagree with 1, 2, and 3 :). Quite a few kitties had weight loss with diabetes and it can be due to both situations. When they are unregulated their bodies are literally "starving" because it cannot properly absorb nutrients from the food. Another reason why point 2 of 2x feeding does not work and most of us find kitty does better with snacks/lunches :cat:.
Point 4. If you don't want to feed the unnecessary prescription RC wet food, then feed him your low carb wet. Any cooked protein (red meat, chicken, etc) is not a balanced diet.

Keep up the research! :bookworm::D. The Lantus group will be more helpful than your Vet (in my opinion :p). I have relied on my Prozinc family to make the progress I have with Maury :cat:
 
panda28 said:
Okay, I just got back from the vet for his followup, and I'd love to get some opinions on what my vet has told me I should and shouldn't be doing.

Essentially:
  1. Not following the chart means pretty much no chance he'll go into remission (something I'm okay with if it means that I won't be dropping him so low)
  2. I shouldn't be feeding him so many times a day - 2 is best
  3. Feeding any canned food apart from Royal Canin Diabetic is a bad idea and he likely won't go into remission
  4. If I don't want to feed him that, I should instead give him 35g of cooked red meat three times a day, plus Royal Canin/ Fancy Feast if he's still hungry. Eventually he should be weaned off the extra Royal Canin. If this ends up being a long term thing, he'd also need daily paediatric supplements.
I'm still not super confident about the whole thing, but from what I've been told here, research, and reading other people's experiences I'm pretty content with the fact that points 1, 2 and 3 aren't true. What's getting me is 4 - is there anything backing this up? Should I try it for two weeks (until I go back to the vet) to see if there's an improvement? Having just bought about 40 cans of his new food (Wellness Core Grain - Venison, Beef and Lamb), and seeing that he loves even the small amount he's getting mixed in has me pretty tempted to keep on with what I'm doing! Still, I want to make sure that I'm not ignoring something that could help him. If I follow the original plan he should be fully on the Wellness in about three days, and I'll be able to do a twelve hour curve, adjusting his insulin accordingly.

Also, he's dropped about half a pound in weight, and I'm uncertain if it is because of not enough food, or because his numbers are still pretty high.

You guys have all been so helpful, and any advice I could get would be wonderful!
Click to expand...
I disagree with all of it
1. He wants you to follow his chart because he feels that no chart other than his is right, this shows a complete unwillingness to work with you or to learn from you.
2. I was stubborn and only wanted to feed twice a day but now I feed several times a day, I think it's more natural for a cat and helps to keep the BG level.
3. Your vet is pissing me off at this point. You DO NOT need that diabetic food, he's trying to make you feel bad so that he can make a profit and that infuriates me. STAY AWAY from prescription cat food.
4. I feed my cats raw. You can feed your cats raw beef or other red meat but beef isn't necessary, in fact, beef is very dense and can cause vomiting so it's not a good meat to start with. Cooked chicken is fine to start with but you shouldn't stay with cooked meat as it's not natural for a cat to eat cooked meat, cooking strips out some of the nutrients and makes it harder for the cat to digest.

Raw food is the best thing for your cat and there is a crazy simple way of making it by taking ground meat, chicken, turkey, beef etc and then add this powdered product to the meat
http://www.foodfurlife.com/
Then you add water and mix it up. Put it into baggies and freeze. Only pull out what you will need for 2 or 3 days. Your cat will need 4 to 6 oz per day.

Of course I meant for you to keep this in your back pocket in case you ever decide to give raw a chance after you try the Wellness.
 
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Sieden said:
I disagree with all of it
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Lots of cats have gone OTJ without those specific dietary guidelines. Alot of us here feed fancy feast or friskies and have great results. And feeding 2x daily? That's really not practical either. I would be unhappy if I was only fed 2x daily. If you aren't going to be home during the day you can always freeze some wet food and put it in a time feeder or just leave it out. Or you can use a low carb dry food like EVO Chicken and Turkey or Young Again and let him free feed while your gone. Just make sure it's all up at least 2 hours before any PS. Most vets don't have a good understanding of FD. I feel lucky. Our vets office has about 5-7 vets but only 1 deals with diabetes and he's wonderful except for too high of a starting dose, which seems to be a trend...

Also on the feeding 2x a day - if you happen to be home doing a curve and notice he's dropping to low to fast you can "steer" with food.

No experience with raw foods so I can't comment on that.

Questioning your vet isn't a bad thing. You know your cat better than anyone, and home testing will allow you to see trends in a normal environment since his BG levels are likely to be elevated at the vets office.
 
Nicely said W.K.
Freezing the wet food and leaving it out to thaw is a pretty good idea, you could put some in ice trays and make little nuggets out of it or find a square ice tray and make squares. My Primal raw comes in rectangle shaped nuggets and if I take it out of the freezer and leave one out on the counter to thaw out naturally it will only take about an hour. It will still be cold but but the cat could eat it at that point. Technically I can take a frozen one and cut it in half to speed up the process if I want to. I'm sure the same would be true for any canned food. Once it gets warm enough and the cat is hungry they will eat it. Not only that but I've left canned food out literally all day long before (12 hours at least) and my cats were fine. So yeah if you do ever have to leave then don't feel bad about having to leave food out. It's better for your cat to eat than to withhold food.
 
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