Introduction Post for Lantus Forum - Koa on Raw Food with increasing BGs

[sunvsmoon]

Hello -

I am here to help my kitty Koa. He has been through quite a bit with his diabetes. He was diagnosed a few years ago and went into remission. Then, he was put back in insulin late last year after a pancreatic episode. We started with ProZinc, transitioned him completely off of dry food, and on to different types of wet foods (I used a chart I found to switch his foods up to something higher in protein, moderate in fat, and low in carbs). Nothing seemed to be helping (through glucose curves at the vet and at some very difficult ones done at home) so he was switched to Lantus by his vet about a month ago. He fully transitioned over a week's time frame from canned food to raw food (Rad Cat - which he LOVES) about a month ago. I thought for sure the raw food would help his diabetes significantly. He had his teeth cleaned, several removed due to an infection, about 3 weeks ago. I felt awful - it is so hard to tell when something is hurting them. At that time, they checked his kidney, liver, etc. values and everything appeared normal. I also thought his numbers would go down with the tooth infection under control with the antibiotic shot.

I've done three curves on him so far and his numbers just seem to be going up. I am confused and sort of at a loss (and worried) which is why I've joined. I am having a hard time trusting his vet at this point as they tried to put him on some "special" diabetic cat food which had a carb count through the roof. I have gotten pretty good at testing for ketones at home after his ER scare so those are under control.

I have already created the spreadsheet per instructions and entered in the numbers and notes I have started taking at home once he switched to Rad Cat. As you can see, his pre-shot number for the curve I started this morning was 515 which is the highest number I've ever seen him have and is also what led me to this forum by trying to find things on Google. He has definitely been drinking more water lately and seems like he can't get enough to eat. Should I increase his insulin dose again starting tonight? Any suggestions from this point forward would be much appreciated.

 

[Gill & George]

Hello and welcome.

I would stick to the 2u of insulin for the moment, lantus is a depot I will. And it can take up to 6cycles to see the effect of the dose.

You don't need to do a curve everyday, but I would recommend getting a couple of tests in each cycle ( am and pm) if that's at all possible. Unlike prozince with lantus we base dosing on how low the dose is getting kitty, rather than the preshot numbers.
It's really important to get a test in the evening as well, a lot of folk get a test just before they head to bed, for me that was a +4+5(11/12pm) because I shot at 7am/7pm, shooting early in the morning meant I could monitor the pm cycle till +4/+5, and if I was really tired in the morning. I could go back to bed for an hour.

If you haven't read the stickies at the top of the forum, I'd recommend taking a look. As he's on an all wet low carb diet, (btw my vet also wanted bfg on 'diabetic kibbles', we agreed to disagree on that point) you could do TR, as long as you feel comfortable with that for a dosing method, it's certainly the dosing option that enables you to move more quickly up the dosing scale,. It does require a little more monitoring than slgs, so you will need to assess if it's a good fit for you, there's also a sticky on how to do TR when you've got a full-time job, also a good read if your schedule and being able to monitori adequately concerns you.


How much prozince was he on?
Do you have numbers for that?

I'm just heading to bed, it's 1am here, I'll check back with you in the morning, keep asking questions.

 

[Tricia Cinco(GA) & Harvey]

Hi and welcome to Lantus & Levemir Land, the nicest place you never wanted to be.

Great job setting up your spreadsheet and testing at home.

This is the best way to not only help Koa, but to keep him safe. I see you are using an Alpha Trak meter. As you read the "Stickies" that Gill mentioned, keep in mind that our guidelines are written based on a human meter, so there may be some things that are a bit different for you. We can help you figure those out.

It's good that you're testing for ketones, especially with Koa still running in higher numbers.

You have made a couple of dose changes in the past few days, which generally will result is some very wonky numbers. The Tight Regulation protocol, which is considered pretty aggressive, recommends you change doses no more frequently than every three days (unless a reduction is earned). This is because, as Gill mentioned, Lantus is a depot insulin and it takes about three days for the depot to adjust to each new dose. Therefore, you can't tell what the dose is actually doing until that much time has elapsed. I would recommend that you stick with the 2 units for now, unless Koa drops below 50 (or 90 if you choose to follow the Start Low Go Slow method).

We very strongly encourage all members to ALWAYS get a test before shooting insulin, morning and evening. This is the only way to be sure it is safe to shoot. It's recommended that you withhold food for two hours before the shot, so that the number you get is not influenced by food. This only applies to your preshot test, not to mid-cycle tests.

There is a lot of information on this site, and it can be overwhelming, especially when you are already stressed about your kitty's health. Read as much as you can, and ask lots of questions. The only dumb question is the one you don't ask! Here is a post we put together to help new members get comfortable with this forum - http://www.felinediabetes.com/FDMB/threads/updated-tips-for-new-members.173572/.

We're glad you found us, and we look forward to helping you help Koa.

 

[sunvsmoon]

Hi and welcome to Lantus & Levemir Land, the nicest place you never wanted to be.

Hello and welcome.

Thank you both for the welcome and advice! I started reading through all of the pinned posts and got a bit overwhelmed so need to come back to it tomorrow (Friday night after a long week at work) so I can fully absorb and take some notes I will keep his insulin at 2U for now. Lantus seems to be a different insulin than ProZinc and I was treating them the same, so am looking forward to learning more about depot insulins.

How much prozince was he on?
Do you have numbers for that?

As for ProZinc, he was all over the place. His vet increased his units from 1U to 4U (in 1U increments which I've also come to realize is way too fast) in a matter of a month or so which I didn't know at the time was too rapid for the amount of readings I was providing the vet on Koa. It is a huge weight knowing that you are ultimately responsible for your fur child's health because most vets it seems really don't handle things correctly I am sure I can call the vet and they'd have the glucose numbers I provided to them on file. I would hope they would also have the insulin units being provided at that time to provide a more complete picture. I've learned to take my own notes in the past month or so after realizing I will need to be Koa's own vet! I know he was eating wet food, but don't know what kind/% of carbs based on the chart.

 

[Bronx's dad (GA)]

So awesome you decided to take the reigns. Kinda sad many folks just follow whatever the vet says and don't do home testing.

 

[Tricia Cinco(GA) & Harvey]

Thank you both for the welcome and advice! I started reading through all of the pinned posts and got a bit overwhelmed so need to come back to it tomorrow (Friday night after a long week at work) so I can fully absorb and take some notes

Don't worry. Most of us were totally overwhelmed the first couple of times we tried to read all the stickies! Just take your time, go back and re-read and ask lots of questions.

It's good that you realize you need to be Koa's advocate. In the vets' defense, they only get about 5 hours of training on diabetes in vet school, and that covers both cats and dogs! Unless they specialize or have a lot of patients with FD, most of them only know the basics and don't fully understand the difference between short and long lasting insulins. If you're lucky, your vet will be open to learning more and work with you as you expand your knowledge. If not, you'll learn the "nod and smile" technique many of us have had to adopt - let the vet give you his/her advice and then come back here and follow the guidelines! You need to keep a good relationship with your vet, as you'll need scripts for insulin and help with other issues.

Lantus seems to be a different insulin than ProZinc and I was treating them the same, so am looking forward to learning more about depot insulins.

Yes, it's very different. The depot makes it a whole new ballgame. We recommend making dose changes in increments of .25 units (except in the case of cats on very high doses and sometimes when the numbers are really high). That doesn't sound like much, but it's a lot in a cat.

I am sure I can call the vet and they'd have the glucose numbers I provided to them on file. I would hope they would also have the insulin units being provided at that time to provide a more complete picture.

If you are able to get that info, add it to the top of your spreadsheet and be sure to indicate that it was on ProZinc, and when you switched. If you need help doing that, just ask. We have some people here that are awesome with the spreadsheets.

 

[sunvsmoon]

I've read the stickies and think I am going to try out the start low, go slow method as it seems to fit with what Koa has been doing already. I usually work more than full-time and the ear pricks stress Koa out to no end (he really hates them - I use the warm washcloth, vaseline, lots of pets afterwards, etc.), both two more reasons I would like to continue/start with this approach. I did read about tight regulation as well so if he needs to be switched to that eventually, I am more than willing.

I've kept him on 2U for almost 6 cycles now. I took a +5 from him yesterday and it was 397, so pretty darn high for being close to that nadir time period. I am going to take a +6 from him today. He seems really, really thirsty still so am very anxious to determine what to do next. No ketones as of yesterday. As his nadir's appear to be significantly above 150, would you recommend increasing his dose by .25U (or even .5U because his numbers are so high) if his nadir today is still high? Or keeping him at 2U for a few more cycles? I'm just concerned with his numbers and thirst level.

My other question is about switching meters. Since I have been using the AT meter and analyzing his numbers based on those readings, would it be a terrible idea to switch mid-attempt at regulation to a human meter (Relion)? I am almost out of sticks which is why I ask. I know the ranges would be different.

Lastly, I am going to call the vet tomorrow and ask them for the curve numbers I provided them with while he was on ProZinc.

 

[Gill & George]

I took a +5 from him yesterday and it was 397, so pretty darn high for being close to that nadir time period

They don't always have their lowest number at +6, George nadired as late as +13 and as early as +2, when he got well regulated then he regularly nadired at around +5+6

The nadir is simply the lowest number in the cycle, often with lantus that can be around the +6 mark, but some cat's can regularly nadir much later or much earlier.
Bubba was a late nadir kitty.
@Sienne and Gabby (GA) Gaby was nortorious for diving early in the cycle.
Bubbas ss
Gaby's SS

Or keeping him at 2U for a few more cycles? I'm just concerned with his numbers and thirst level.

I truly get your concern, but with the data you have at the moment I think it could be risky. We simply have enough data to support if she is going low or not.

With SLGS you would hold for a week anyways, but you need to always be getting a test before you give insulin as an absolute minimum, shooting blind, can prove to be very dangerous. Think of human diabetics, they would always test their BG before taking an insulin shot.
Additionally, and if you are able to, it will help with dosing decisions, if you can grab spot checks, whenever you can, a +2 or +3 or a +10 or +11 can be just as informative as a +6 and sometimes even more informative. It's not a prerequisite, but it will help you when it comes to making decisions. Remember that there is also a pm cycle, I would strongly recommend getting a test just before you head to bed in the evenings, cats often have lower numbers at night.
Then, after a week on a dose, with SLGS you would need to do a curve before making a decision on the dose. So SLGS would see you hold a dose for a minimum of 7 days.


If you could find a way to get a couple of tests in each am and pm cycle (any time, doesn't need to be at +6) and if you decided to follow TR, we could guide you with dose changes, it's the only method that will allow you to move more quickly up the dosing ladder. When you start to see better numbers, if it's all too hectic you could back off and follow SLGS to give yourself some breathing room with your hectic schedule.

But even if you wished to follow TR, with the limited data I don't feel comfortable recommending a dose increase at this moment in time.

 

[Gill & George]

My other question is about switching meters. Since I have been using the AT meter and analyzing his numbers based on those readings, would it be a terrible idea to switch mid-attempt at regulation to a human meter (Relion)? I am almost out of sticks which is why I ask. I know the ranges would be different.

You could change now, just be sure to make a line in the SS to indicate it and you would need to change the formating for the lime green range, that's the only one that's different on the ss.

 

[sunvsmoon]

They don't always have their lowest number at +6, George nadired as late as +13 and as early as +2, when he got well regulated then he regularly nadired at around +5+6

Interesting...I'll start grabbing more sporadic numbers from him versus just aiming for the +6 hour mark. I definitely need to try to get more later at night before heading to bed as I almost always take them during the day. I'll keep him at 2U and get some more numbers in the spreadsheet (starting tonight). How do your kitties handle their ears being poked so much? Koa absolutely hates it and his ears show it and I haven't even been doing it on a daily basis. I am worried I am doing it wrong, or maybe it just looks worse than it is.

You could change now, just be sure to make a line in the SS to indicate it and you would need to change the formating for the lime green range, that's the only one that's different on the ss.

I went ahead and ordered the Relion Micro. Is there any danger in switching from an animal to human meter in such a fluctuating cycle? Also, is there a specific range somewhere on the board I can reference to start following and interpreting? I am so used to using the AT2 as that's all I've ever used. I will make sure to break it out in the spreadsheet.


Thank you!!

 

[Bronx's dad (GA)]

Interesting...I'll start grabbing more sporadic numbers from him versus just aiming for the +6 hour mark. I definitely need to try to get more later at night before heading to bed as I almost always take them during the day. I'll keep him at 2U and get some more numbers in the spreadsheet (starting tonight). How do your kitties handle their ears being poked so much? Koa absolutely hates it and his ears show it and I haven't even been doing it on a daily basis. I am worried I am doing it wrong, or maybe it just looks worse than it is.



I went ahead and ordered the Relion Micro. Is there any danger in switching from an animal to human meter in such a fluctuating cycle? Also, is there a specific range somewhere on the board I can reference to start following and interpreting? I am so used to using the AT2 as that's all I've ever used. I will make sure to break it out in the spreadsheet.


Thank you!!

Not sure if there is a conversion chart here since the difference between the 2 vary depending on the #. (A 50 on a human meter equals about 68 on AT2, but 400 on a human meter equals about 480 on an AT2). Just make sure you specify in you sig and on a line on Koa's SS. Most people buy the strips at Walmart but I found even better prices on eBay.

 

[Gill & George]

Koa absolutely hates it and his ears show it and I haven't even been doing it on a daily basis. I am worried I am doing it wrong, or maybe it just looks worse than it is.

To minimise bruising, I applied firm but gentle pressure to the test spot with a cold compress, and counted to ten. That seemed to do the trick for George.

It's not available in Europe so I never used it, but some members use Neosporin with pain relief.

Not sure if there is a conversion chart here since the difference between the 2 vary depending on the #.

There isn't a conversion chart. Marje did extensive side by side testing with Gracie of a human and AT meter and there wasn't a constant difference between numbers at high numbers. Hence no conversion chart.

The important thing to remember is high is high, it doesn't really matter if the nadir is at 250 or 300 the dosing the decision is the same.
As Paul says the important number on the AT is 68/ which is the reduction point for TR, (50 on a human meter)

Interesting...I'll start grabbing more sporadic numbers from him versus just aiming for the +6 hour mark. I

I remember being perplexed by this too when I started.

 

[sunvsmoon]

I am grabbing a +3 from Koa before heading off to bed and continuing to enter the readings in to the chart. I work during the day, so will get some more sporadic readings when I am home for the weekend in a few days and hopefully those numbers will help more to determine what to do next with his dosage.

I feel like Koa's numbers started going up when I began feeding him raw food (they weren't particularly low before either though). Is this possible? I thought raw food would do the complete opposite and am just discouraged to see the high numbers. I know all cats are different, but just curious if anyone has any insight on this. Maybe it's the switch from canned to raw food coupled with a switch to a new insulin and getting his teeth cleaned and removed all within a few weeks of each other...I am also hoping there's not another underlying infection somewhere. The vet gave him an antibiotic that lasted for about 2 weeks to help with his teeth being removed and said the rest of his blood work looked fine. I really wish they could speak and tell us what was wrong!

 

[Gill & George]

I am grabbing a +3 from Koa before heading off to bed and continuing to enter the readings in to the chart. I work during the day, so will get some more sporadic readings when I am home for the weekend in a few days and hopefully those numbers will help more to determine what to do next with his dosage.

Good job getting those before bed tests. Getting the spots checks in when you can will be a great help.

Have you been getting the PS tests in the evening? There's nothing on the ss.

It's really very important to always get the PS tests (amps and pmpps), even though we base the dosing on how low the dose is getting kitty, it's really important to know it's safe to shoot, or if in fact you are shooting a lower than normal number.
eg even though Koa has been high for a while, he will at some point hit a dose where his numbers will just drop, and when it happens it'll probably seem like it came from nowhere and as I said in an early post he could hit a blue/green as late as +12 in the cycle. If he were to suddenly go blue one PS, though it would likely be safe to shoot, you would need to know, because hew would probably need to be monitored if you do shoot, or you might need to leave out higher carb food for him to munch on to keep him safe while you are out, otherwise you run the risk of him having a hypo when you are not there and have gone out to work.

George had about 4 weeks of high red pinks when he first started on insulin, and when he got a blue it came from absolutely nowhere. It took another 4 weeks before he was consistently getting into low numbers. I tested a lot, you don't need to do that, I was home and able to test and I guess I just tested a lot because I was desperate to see some better numbers.

To illustrate how you can get a low blue number out of nowhere at pre shot, take a look at tab for 2015 6/12/2015, See how I got that 135 at pmps. Up until then the lowest PS I'd had was 283 (the only yellow PS since I'd started) Retrospectively, hindsight is a wonderful thing, I had some very clear clues that things were starting to move, his overall range had dropped a bit, but really, it was a complete shock to me at the time, I still remember how I was shaking like a leaf when I shot that first blue (there's a link to the thread for the day in the ss, so you can see how it transpired, I sound a lot more calm than I felt LOL), but I did it with the help of some of the experienced members, as it turned out that cycle went quite smoothly but that's not always the case, Julie who was helping me gave some excellent links in some of her posts, I recommend reading them when you get a chance.

Have you made a decision on the meter? Those AT strips are expensive, you can save quite a lot of $$$ if you make the swap.

One other question, apart from the excessive drinking, how is he?
eating well?
Does he seem off in anyway?

We often ask for a WCR (whole cat report), they are more than just their numbers, sometimes it's important to remember that.
You'll often see
Are all the 5 p's in place?
purring
peeing
pooing
preening
playing