Hello from Amy and newly diabetic Hershel

[Amy and Hershel]

Hi everyone, I'm Amy. My newly diabetic 8-year old Hershel was diagnosed in late July 2017. At the time of diagnosis, he was urinating outside of the litter box multiple times per day, but after switching his diet to exclusively Purina DM wet it went down to once or twice per week, and he has not has not peed outside of the box at all since September 27. He "seems" totally healthy as he is not displaying any other symptoms, but I know that's not always a reliable indicator since cats are so good at hiding their pain. He had been slightly overweight and lost a little bit of weight before his diagnosis, which he gained back after switching to the DM wet food, and I must say both his weight and coat are in great shape now and he has never looked better. He definitely pees more than my other non-diabetic cat but not to the extent that I have seen some severely diabetic cats urinating, and since I mix a good amount of water in with his wet food he doesn't often make trips to the water dish.

His vet was hopeful that the diet change alone might put him into remission as his fructosamine tests kept showing improvement after he switched to the DM (868 on July 27, 735 on August 14, 618 on August 31) but then it was back up to 700 on September 25 so the vet decided to put him on insulin. He has been on 1 unit of glargine since October 3, 2017. I've been home testing him using a pet-specific meter twice a day, in the morning and evening before his shot, and only giving him insulin if his BG is higher than 12 (I'm in Canada so using mmol/L). I will be doing his first BG curve at home some time in the next few days and I've created a spreadsheet for his levels thus far. The numbers seem to be all over the place to me. Can anyone give me any insight as to whether or not this is "normal" and any advice you may have on where to go from here? How many times per day should I be testing his BG and how often should I be doing curves? Also, he seems to be doing well on the DM but I am looking for a more affordable option and would like to transition him to Friskies pate since that is what my other non-diabetic cat eats and they tend to get jealous of each other's food, but I'm wondering if I should wait to get a handle on his insulin before making the switch.

Sorry for the long post, but I just wanted to add that I've been lurking on this board since July and have been brought to tears multiple times by the kindness and support you all show to each other. I've been incredibly emotional since learning of Hershel's diagnosis and it's been so inspiring to know that there are so many knowledgable, compassionate people taking their cats' health into their own hands and empowering others to do so. What an amazing resource this is. Thank you.

 

[Chris & China (GA)]

Also, he seems to be doing well on the DM but I am looking for a more affordable option and would like to transition him to Friskies pate since that is what my other non-diabetic cat eats and they tend to get jealous of each other's food, but I'm wondering if I should wait to get a handle on his insulin before making the switch.

The DM is OK (carb wise) but there's absolutely nothing in it that makes it any better than the Friskies pates, so save your money and go ahead and switch him over.

Check the ingredients....they are no better (and sometimes worse) than the foods you can get at your local grocery store.

I've created a spreadsheet for his levels thus far.

Good job getting that started, but since you're in Canada, you need to enter your numbers on the "World" side, not the US side. (that's why all your Pre-shot numbers turned green)....It will automatically convert the numbers on the US side for those of us in the US

How many times per day should I be testing his BG and how often should I be doing curves?

You want to always test before feeding/shooting to make sure he's high enough for insulin at all.....then get at least 1 test mid-cycle (5 to 7 hours after the shot) on the AM cycle and at least a "before bed" test on the PM cycle.

If you can get more tests than that, all the better!! There's no such thing as too much data!!

If you test often enough normally, there's no need to ever do a "curve".

Look at your spreadsheet like it's a puzzle....if you "sprinkle" pieces all over, the picture is easier to see! So (if you can) maybe one day get a +3, +6, +9 and another day get a +4, +8, etc.....getting spot checks at different points in the cycle will tell you everything you need to know without doing "curves"

 

[Tracey&Jones (GA)]

Hi Amy,

I am in Edmonton!

First, welcome! And yeah for you on home testing! The general idea is to get 4 tests per day. Always the PS tests...make sure they are high enough to give the insulin. Then you try to get a couple of mid cycle tests to fill in the gaps. Sometimes you grab a +1 while going out the door in the morning or grab a before bed +3 at night. Use the weekend for your curve and fill in your blank time slots! I tend to do a curve at least once a month and sometimes little mini-curves when trying to figure something out.

For food - I am pretty sure the Friskies pates meet the less then 10% carb target food. Have you checked out catinfo.org? Dr. Lisa has a pretty extensive food list of commercial foods and the carb%.

For you spreadsheet - you will need to enter your numbers into the world tab, then the US tab will update automatically. If you need help fixing your sheet, give a shout out. Once that is done you will see that the colour coding will make way more sense with your numbers. Usually bright green is a take action colour - you need to bump up the BG's with some mid or high carb food.

As for your numbers. Gargline is a depot insulin - part the injection is used immediately the other part is kept in reserve for later use. So you need to watch how low Hershel goes not just the PS numbers. I am wondering if 1 unit is too much to start. Do you happen to have 1/2 unit syringes or are you using the pen?

 

[Amy and Hershel]

Hi Amy,

I am in Edmonton!

First, welcome! And yeah for you on home testing! The general idea is to get 4 tests per day. Always the PS tests...make sure they are high enough to give the insulin. Then you try to get a couple of mid cycle tests to fill in the gaps. Sometimes you grab a +1 while going out the door in the morning or grab a before bed +3 at night. Use the weekend for your curve and fill in your blank time slots! I tend to do a curve at least once a month and sometimes little mini-curves when trying to figure something out.

For food - I am pretty sure the Friskies pates meet the less then 10% carb target food. Have you checked out catinfo.org? Dr. Lisa has a pretty extensive food list of commercial foods and the carb%.

For you spreadsheet - you will need to enter your numbers into the world tab, then the US tab will update automatically. If you need help fixing your sheet, give a shout out. Once that is done you will see that the colour coding will make way more sense with your numbers. Usually bright green is a take action colour - you need to bump up the BG's with some mid or high carb food.

As for your numbers. Gargline is a depot insulin - part the injection is used immediately the other part is kept in reserve for later use. So you need to watch how low Hershel goes not just the PS numbers. I am wondering if 1 unit is too much to start. Do you happen to have 1/2 unit syringes or are you using the pen?

The DM is OK (carb wise) but there's absolutely nothing in it that makes it any better than the Friskies pates, so save your money and go ahead and switch him over.

Check the ingredients....they are no better (and sometimes worse) than the foods you can get at your local grocery store.



Good job getting that started, but since you're in Canada, you need to enter your numbers on the "World" side, not the US side. (that's why all your Pre-shot numbers turned green)....It will automatically convert the numbers on the US side for those of us in the US



You want to always test before feeding/shooting to make sure he's high enough for insulin at all.....then get at least 1 test mid-cycle (5 to 7 hours after the shot) on the AM cycle and at least a "before bed" test on the PM cycle.

If you can get more tests than that, all the better!! There's no such thing as too much data!!

If you test often enough normally, there's no need to ever do a "curve".

Look at your spreadsheet like it's a puzzle....if you "sprinkle" pieces all over, the picture is easier to see! So (if you can) maybe one day get a +3, +6, +9 and another day get a +4, +8, etc.....getting spot checks at different points in the cycle will tell you everything you need to know without doing "curves"

Updated the spreadsheet! Thanks so much for your input Tracey and Chris. I too am wondering if 1 unit is too much, since his BG seems to be quite low 12 hours post-insulin. The vet initially wanted to start him at 2 units but that seemed high to me given his lack of symptoms so I am glad she changed her mind and decided to start him off at 1 unit. I am using syringes so I may attempt lower the dose to .5 units. I will definitely start testing mid-cycle to start figuring out this puzzle. I was mainly concerned that there seems to be no real consistency to his numbers so far, but I know it is still early days and it will take a while to get him regulated.

 

[Chris & China (GA)]

I too am wondering if 1 unit is too much

I'd say you definitely need to reduce if you got an AMPS of 3.1 (56)

Generally, especially in newer diagnosed cats, if they are getting Preshots that are too low to shoot, that's a really good indication that the dose is too high

I'd go ahead and drop down to .5 and get those mid-cycle tests in and let's see how he does

 

[Amy and Hershel]

Hi again, so I didn't end up giving Hershel any insulin at all today since his levels were good in both AM and PM (see spreadsheet). Crossing my fingers that he's starting to regulate on his own but I know it could be just a fluke. Would you recommend checking BG more than twice daily even on days like this where he hasn't had any insulin? Or are multiple tests only useful for monitoring the effects of the insulin? And let's say I checked him mid-day and his BG was over the threshold, and he hadn't had a shot in over 12 hours, would it then be a good idea to give him an injection at that time and adjust the timing of the next injections accordingly? I've been consistently checking him at 10AM and 10PM and only giving insulin at those times (if needed). Still getting the hang of all this, thanks so much for your help!

 

[Amanda and a Loudogg]

I always say that Knowledge is Power, so no data is bad data. I usually try to test Lou 3-5 times a day (2 times for the preshots) so I can get an idea of how he's reacting to the insulin. Obviously if you are not giving insulin, you don't need to test frequently, but it isn't bad to get an extra test or two in just to see how he's doing during the cycle. If you don't while he's not on insulin, it's not the end of the world since you don't have to worry about going hypo in this case.

If I skip a shot for Lou, I will try to get one test in during the time just to see how high/low he is. It gives me an idea of what to expect for the next preshot (will it still be high or is he regulating himself?). With that being said, I would not dose insulin outside your chosen timeframe. If Hershel is high enough for insulin in the middle of the day, for example, just wait until 10pm to shoot as needed. Hope this helps.

 

[Chris & China (GA)]

Would you recommend checking BG more than twice daily even on days like this where he hasn't had any insulin?

Yes.....he's too new and his numbers haven't been in good ranges long enough to even consider he doesn't need any insulin at all at this point

178 is high enough to be giving insulin.....just not the 1U dose since it's been taking him too low. I'd really like to see how he does on .5

let's say I checked him mid-day and his BG was over the threshold, and he hadn't had a shot in over 12 hours, would it then be a good idea to give him an injection at that time and adjust the timing of the next injections accordingly?

Not really because that can really throw off your times....Not many people can keep up shooting every 12 hours with drastic time changes like that. Yes, you can adjust, but we don't recommend adjusting more than 15 minutes per cycle or 30 minutes once a day, so if you're off by 6 hours, that's going to take about a week to work back to your "normal" shot times

It's a lot better to find a dose that's safe to give every 12 hours that doesn't drop him too low to shoot on time

 

[Amy and Hershel]

I always say that Knowledge is Power, so no data is bad data. I usually try to test Lou 3-5 times a day (2 times for the preshots) so I can get an idea of how he's reacting to the insulin. Obviously if you are not giving insulin, you don't need to test frequently, but it isn't bad to get an extra test or two in just to see how he's doing during the cycle. If you don't while he's not on insulin, it's not the end of the world since you don't have to worry about going hypo in this case.

If I skip a shot for Lou, I will try to get one test in during the time just to see how high/low he is. It gives me an idea of what to expect for the next preshot (will it still be high or is he regulating himself?). With that being said, I would not dose insulin outside your chosen timeframe. If Hershel is high enough for insulin in the middle of the day, for example, just wait until 10pm to shoot as needed. Hope this helps.

Super helpful, Amanda. I really appreciate it!

 

[Amy and Hershel]

Yes.....he's too new and his numbers haven't been in good ranges long enough to even consider he doesn't need any insulin at all at this point

178 is high enough to be giving insulin.....just not the 1U dose since it's been taking him too low. I'd really like to see how he does on .5

Not really because that can really throw off your times....Not many people can keep up shooting every 12 hours with drastic time changes like that. Yes, you can adjust, but we don't recommend adjusting more than 15 minutes per cycle or 30 minutes once a day, so if you're off by 6 hours, that's going to take about a week to work back to your "normal" shot times

It's a lot better to find a dose that's safe to give every 12 hours that doesn't drop him too low to shoot on time

Thanks, Chris. My vet told me not to give insulin unless he was below 12 mmol/L - what do you generally use as the threshold? I too would like to see how he does on 0.5U, in which case what would you suggest the minimum BG be before dosing?

 

[Chris & China (GA)]

Usually, what we suggest is if you get a PS under 150 (8.3) you stall, don't feed and post for help. Then you test again in 20-30 minutes to see if the number is coming up on it's own without food (that's a pretty good indication that the last shot is wearing off and it's safe to go ahead and shoot)

The first few times you get 150 or below, we like to have someone here with experience that's able to stay with you as long as necessary to make sure Hershey stays safe. That's kind of an unwritten rule around here.....that if someone agrees to watch you, they will stay as long as needed (or find someone else with experience to watch over you) until you're comfortable with how the cycle is going.

Also, when you shoot a lower PS number than you're used to, it's a good idea to get a +1 and +2 so IF you need to intervene, you can do it early

Most vets tell people higher "no shot" numbers because they aren't used to people like us who are willing to home test as much as needed to keep our kitties safe. They err on the side of caution to prevent hypo's, but as long as you have plenty of supplies and are able to test, you can keep your kitty safe!!

You should always have a good supply of strips (I panic when I drop below 300), a few cans of high carb foods like Fancy Feast Gravy Lovers and some Karo/honey/syrup in the house

 

[Amy and Hershel]

You guys are actual angels. I will start following this protocol. Thank you!

 

[Amy and Hershel]

Based on Hershel's numbers from today, should I be giving him insulin tonight?

 

[Chris & China (GA)]

Based on Hershel's numbers from today, should I be giving him insulin tonight?

Have you fed him yet? If not, test again in 20-30 minutes and see if he comes up without the influence of food

 

[Amy and Hershel]

Have you fed him yet? If not, test again in 20-30 minutes and see if he comes up without the influence of food

Yes, I fed him just after his PMPS - he hadn't eaten since I gave him his shot 12 hours ago and I couldn't deny him any longer! Let's say I hadn't fed him and re-tested in 20-30 minutes, what number would he need to be at in order to warrant a shot?

 

[Chris & China (GA)]

Tomorrow, I'd like to suggest you start posting on the Lantus Forum instead of here

Those of us that use Lantus generally spend a lot more time there and you're less likely to get missed.....as well as getting advice from the people with the most experience using it!

Yes, I fed him just after his PMPS - he hadn't eaten since I gave him his shot 12 hours ago and I couldn't deny him any longer! Let's say I hadn't fed him and re-tested in 20-30 minutes, what number would he need to be at in order to warrant a shot?

At this point, I'd just call it a furshot and skip until morning since you already fed him. Next time it happens, remember:

IF you get a PS under 150 (8.3) you stall, don't feed and post for help. Then you test again in 20-30 minutes to see if the number is coming up on it's own without food (that's a pretty good indication that the last shot is wearing off and it's safe to go ahead and shoot)

Just put N.S. in the U column to show you skipped on purpose

 

[Chris & China (GA)]

He may be pretty high in the morning.....IF he's above 300, you can give the .5 unit dose ONE more time (we call it "shooting through the bounce)

Otherwise, he's still earned the reduction today by dropping under 68 on the Alpha Trak, so his new dose will be .25

 

[Amy and Hershel]

Will start posting in Lantus forum, thanks again!