? Seeking advice on how to proceed with Buddy

[Kelly and Buddy]

I am really struggling with how to proceed with Buddy. Some of you may have already read about Buddy in previous posts but he was diagnosed in April. We started with Vetsulin but switched to Lantus in late May (and also switched vets) and switched from dry to canned food. Most of this happened when I was off for the summer (I'm a teacher) so I had the ability to monitor him regularly but that is no longer the case.

So, here is my dilemma and why I'm seeking guidance. When I first took Buddy off dry I had him on Friskies and he was doing pretty good. A few weeks ago, I decided to try FF. It dropped him dramatically; so much so that I could rarely give him 2 shots a day and even at really low doses he was dropping really low at times. This wasn't a huge deal when I was home all day but now I am back to work. I am terrified of giving any morning insulin while he is on FF because I am gone for 10 hours, on average and he has dropped so low on numerous occasions. I has hoping to keep him low and maybe get him into remission but I am so worried about him becoming hypo while I'm away that I'm thinking that may no longer be an option.

I was also struggling with the low doses. I ordered calipers and a head magnifying glasses (per suggestions here) but I still have such a hard time seeing where .25 is in my syringe and never feel super comfortable that I even have insulin. On top of all this is the expense. Feeding 4 cans of FF a day is more than $1000/year. I would find a way to make that work IF I didn't have the fear of him becoming hypo. So, I switched back to Friskies. You can see on my Spreadsheet that he drops into the "blues" between injections BUT he is getting back into the 200s by the time he gets his next shot.

So, I'm asking for your advice. I know the SLGS method says to stay the course for one week. With him still staying this high, should I definitely continue on this course until next weekend? I hate seeing him back up in the 200s but, if I wait until next weekend, I can at least closely monitor a dose increase. I also wondered if I could feed Friskies with the injection and then give FF as the in between meals. (I feed him about 3.5 ounces, roughly ever 6 hours).

Am I crazy for switching him back to Friskies since it is obviously making is BG go up? I just have to find a balance of being able to leave him safely during the day and I can not be up all night long throughout the week. I am already dragging at work and I've only been back a week.

On top of all of this, he has not gained any weight. Despite 13 ounces of food a day, he is still less than 9 pounds. He used to be a 15 pound cat. Buddy acts pretty normal, purrs all the time but is just overly obsessed with food. I think he would eat twice what he's eating now if I would let him.

Sorry for throwing so much at you. I am just so worried about him and stressed about what do for him. I can't thank you all enough for the support you provide to me and all the others on this board. I am pretty sure I would have killed Buddy weeks ago without this site. Without this group, I would be hopeless.

BUDDY'S SPREADSHEET

 

[Sienne and Gabby (GA)]

Kelly --

I have a few thoughts. First and foremost, Lantus is very different than Vetsulin. Because Vetsulin is a shorter acting type of insulin, you can base your dose on the pre-shot number and adjust the dose accordingly. If you do this with Lantus (or Lev), you never give the depot a chance to stabilize. This is why with both SLGS and TR, you need to hold the dose for several days. You'll need to decide on a dose and stick with it for a week (barring the need to reduce the dose) since you're following SLGS. Lantus likes consistency! BTW, when you have the time noted in a cell, is that when you shot? If so, what about on 8/8? Did you shoot at PMPS or at PM +4?

Some cats are very sensitive to carbohydrates. Jill's Alex was one of those cats who could get a 30 point bump in numbers from a 0 carb piece of chicken. Buddy may likewise be sensitive to carbs. Use that data to your advantage. If you're struggling between the percent carbs vs the dose, it's a matter of how you choose to proceed -- higher carb food and more insulin or lower carb food and less insulin.

A timed feeder may also be helpful as you'll be back at work. Given that Buddy is responding to carbs, this should help to ease your mind. As long as there's food available and Buddy will head to the feeder, you should be fine. I had the same apprehension with Gabby. She could have rather dramatic drops in her numbers early in the cycle. I was able to shoot early and get a few tests in before I left for work. If Gabby's numbers were dropping, she got some additional food and/or high carb before I left and she had food available in her timed feeder.

Re. Buddy's weight: When was the last time a thyroid panel was done? If he's hyperthyroid, what medication is he on and does his thyroid med need to be adjusted? Alternatively, is Buddy getting enough calories to help him gain weight? If he does, in fact, have IBS, there could be an issue with malabsorption. You should talk to your vet and/or get a cobalamin level run. One additional thought re. the IBS is that it looks like you've been feeding Buddy Turkey. Poultry is a common allergen for cats. I found this out the hard way with my civvie who was diagnosed with IBS this year. You might want to try novel proteins and see if this helps with diarrhea. Probiotics would also be a good idea. This website has a great deal of information on IBS. They promote a raw diet but there is information on supplements, probiotics, etc. that you might find helpful.

 

[Bobbie And Bubba]

Hey Kelly, I am glad that you added hyperthyroid to your signature and if he hasn't had a thyroid screening done lately, it might be a good idea. When my civvie was first DX with HyperT, he had lost weight and once we had the right dose of methimazole for him, he has gained it back.

An auto feeder will be your best friend while you are working . You will be able to set it up for several meals while you are gone to ensure he doesn't go too low. I think I would make his meals a bit closer together while you are at work , maybe every 3-4 hours. If I remember correctly, I think you had a malfunction with your feeder and were going to call the company and try it again?

As Sienne suggested, you need to find a dose and hold it according to SLGS so that the depot can get established and we know how it's working for him. It is hard to make the assumption that the Friskie raised him up so high since you switched to it right after you had 6 NS in an 8 cycle period. The depot at this point is depleted and confused. The only thing to do at this point would be to hold a dose for the required time. I think I would do .25 and see how that does.

Let's see what others think.

 

[Kelly and Buddy]

Kelly --

I have a few thoughts. First and foremost, Lantus is very different than Vetsulin. Because Vetsulin is a shorter acting type of insulin, you can base your dose on the pre-shot number and adjust the dose accordingly. If you do this with Lantus (or Lev), you never give the depot a chance to stabilize. This is why with both SLGS and TR, you need to hold the dose for several days. You'll need to decide on a dose and stick with it for a week (barring the need to reduce the dose) since you're following SLGS. Lantus likes consistency! BTW, when you have the time noted in a cell, is that when you shot? If so, what about on 8/8? Did you shoot at PMPS or at PM +4?

Yes, the time is when I give the shot so I can see why 8/8 was confusing. The +4 was when I did a BG check but it wasn't quite +4. I have changed it to say +3.5 rather than an actual time.

 

[Jill & Alex (GA)]

Adding to the great advice you've already received from Sienne and Bobbie...

To dose consistently, try loading a syringe with a colored liquid to use as a sample syringe when pulling a dose of insulin. I agree with Bobbie. I'd try to shoot 0.25u every 12 hours.

Yes, the time is when I give the shot so I can see why 8/8 was confusing. The +4 was when I did a BG check but it wasn't quite +4. I have changed it to say +3.5 rather than an actual time.

Noting times doesn't have to be exact. I found it easiest to round times to the nearest quarter hour. For example, +2, +2.25, +2.5, +2.75, +3. You get the idea.

I know the SLGS method says to stay the course for one week. With him still staying this high, should I definitely continue on this course until next weekend? I hate seeing him back up in the 200s but, if I wait until next weekend, I can at least closely monitor a dose increase.

The idea behind holding the dose for a week is to be able to accumulate enough data to support any dosing decisions you make. If you're able to collect enough data to KNOW how low the dose is taking Buddy, we *might* be able to talk about increasing the dose before a week has passed. We don't want him hanging out in high numbers any more than you do.

I also wondered if I could feed Friskies with the injection and then give FF as the in between meals. (I feed him about 3.5 ounces, roughly ever 6 hours).

Sure you can!

Hope this helps. I'm sure others will weigh in with their thoughts...

 

[Kelly and Buddy]

I did get a replacement feeder but it has one of the same issues as the first one - there is a small opening between the open slot and the next slot that should be covered. It is wide enough for a cat to easily smell the food and also wide enough to get a few claws in to pull it around. I can use alternating compartments but that gets a bit confusing. I can not imagine why in the world they would design a rotating feeder that does not align properly. The left side of the open compartment actually rotates too far to the left which is why the gap is created. If any of you that have timed feeders have a better one you recommend, I would be willing to send this one back for a refund. As it is, I am quite certain he will dig at it until he rotates it and likely tear it up because he is so food driven.

He has had his thyroid checked twice since April and his levels were fine. I need to get a copy of his labs to post here and will work on that. The diarrhea has been a problem for some time but seemed to get worse around the time he was diagnosed which made treating the FD harder because my vet was trying on single protein food sources and also a hydrolyzed protein - but neither are low carb. Unfortunately, neither helped his diarrhea so I opted for stinky horrible poo over super high BG and switched to Fancy Feast and Friskies. Since then it has improved with about 85% normalish stool. We went with turkey because my vet thought he might be allergic to chicken. I did have a food sensitivity test done on him and he showed very few food allergies. The report just came back last week and I am waiting on my copy.

@Sienne and Gabby (GA) and @Jill & Alex (GA) , you both mentioned maybe going with a .25 for a few days. He's had a .5 the past two injections and is still in the 190-290 range at all checks and just now he was at 295. He is ready for his p.m. injection; would you still drop down to .25 with him so high tonight? And, if I do, and he's even higher tomorrow, do I stay the course?

 

[Kelly and Buddy]

@Bobbie And Bubba, I meant to tag you in my last post too - particularly the last paragraph.

 

[Jill & Alex (GA)]

@Sienne and Gabby (GA) and @Jill & Alex (GA) , you both mentioned maybe going with a .25 for a few days. He's had a .5 the past two injections and is still in the 190-290 range at all checks and just now he was at 295. He is ready for his p.m. injection; would you still drop down to .25 with him so high tonight? And, if I do, and he's even higher tomorrow, do I stay the course?

My thinking was to find a dose you can shoot consistently... every 12 hours. We have to start somewhere and 0.25u seems like a good place to start. I'm concerned that starting at 0.5u BID will end up causing preshot numbers you're afraid to shoot. Will the dose require adjustment? Let's see how things go.

Just my thoughts...

 

[Kelly and Buddy]

Going with the advice of the experts - .25 it is. One last question for tonight. Should I keep him on the Friskies for a few days too so that I can tell if it's the food that made the increase or the lack of depot? My temptation is to give him FF for the +6 meals but I also don't want to change too many things at once.

Again, thanks for your information.

 

[Bobbie And Bubba]

Going with the advice of the experts - .25 it is. One last question for tonight. Should I keep him on the Friskies for a few days too so that I can tell if it's the food that made the increase or the lack of depot? My temptation is to give him FF for the +6 meals but I also don't want to change too many things at once.

Again, thanks for your information.

I think I would. I am not convinced that it's the food rather the inconsistency of doses not being giving consecutively. Let's start with the .25 dose and see how that goes. In the AM when you shoot and if you have any doubt, put a ? mark in the title and say "Dosing advice ASAP" . We are in the same time zone. Are you shooting around 6 AM? If so, I will check in on you. And can you get at least a +1 test in before you leave for work?

 

[Bobbie And Bubba]

there is a small opening between the open slot and the next slot that should be covered. It is wide enough for a cat to easily smell the food and also wide enough to get a few claws in to pull it around.

I wanted to address this. Mine does the same thing sometimes. So, I pull the food tray until it lines up perfectly with the opening and then there isn't an issue. I hope this helps.

 

[JeffJ]

No advice here, because the other advice is excellent. Just encouragement.

Diabetes is a long road. Leo just had his third diabetes anniversary (link here). I got through it with amazing help from people here, and the desire to keep Leo healthy. That is what you are doing too.

Food - I feed Fancy Feast too. I supplement with cooked chicken ($2/pound). There are other low-carb foods listed in Dr.Lisa's chart. http://www.felinediabetes.com/FDMB/threads/dr-pierson-new-food-chart.174147/unread
.

 

[Kelly and Buddy]

I think I would. I am not convinced that it's the food rather the inconsistency of doses not being giving consecutively. Let's start with the .25 dose and see how that goes. In the AM when you shoot and if you have any doubt, put a ? mark in the title and say "Dosing advice ASAP" . We are in the same time zone. Are you shooting around 6 AM? If so, I will check in on you. And can you get at least a +1 test in before you leave for work?

Thanks, Bobbie. If you think it's okay for me to back his injection back about 15 minutes, I can get a +1. Just curious, are you looking to see how much he drops by then?

 

[Bobbie And Bubba]

Thanks, Bobbie. If you think it's okay for me to back his injection back about 15 minutes, I can get a +1. Just curious, are you looking to see how much he drops by then?

Usually a 15 minute earlier shot is not a problem. Unless of course he throws you a ridiculously lower number tomorrow AM.

So what time is your shot time? Is it 6 AM. If so that is my shot time too. I will pop in and look in on you and Buddy,

 

[Kelly and Buddy]

Thanks, Bobbie. If you think it's okay for me to back his injection back about 15 minutes, I can get a +1. Just curious, are you looking to see how much he drops by then?

Usually a 15 minute earlier shot is not a problem. Unless of course he throws you a ridiculously lower number tomorrow AM.

So what time is your shot time? Is it 6 AM. If so that is my shot time too. I will pop in and look in on you and Buddy,

Usually a 15 minute earlier shot is not a problem. Unless of course he throws you a ridiculously lower number tomorrow AM.

So what time is your shot time? Is it 6 AM. If so that is my shot time too. I will pop in and look in on you and Buddy,

I will be shocked if he is low; I expect he will be in the high 200s or maybe low 300s considering he was at 257 at +5 tonight.

I won't be able to shoot until 6:30; his pm shot was at 6:45. Do you think I need a +1 reading if he is still really high?

 

[Bobbie And Bubba]

Thanks, Bobbie. If you think it's okay for me to back his injection back about 15 minutes, I can get a +1. Just curious, are you looking to see how much he drops by then?



I will be shocked if he is low; I expect he will be in the high 200s or maybe low 300s considering he was at 257 at +5 tonight.

I won't be able to shoot until 6:30; his pm shot was at 6:45. Do you think I need a +1 reading if he is still really high?

Sorry, Kelly, I was offline by the time this posted. If he is still high this morning, it will make shooting and having to leave to go to work a bit easier on you. Get whatever test you can before going out the door. Anything earlier that a +1 might not tell you too much but all info is good info.

 

[Sienne and Gabby (GA)]

My vet had me eliminate all poultry from Gizmo's diet. I'd also make sure to avoid foods with carrageenan or gums. KiwiPeak makes a pretty clean line of foods. It's expensive but you can get novel proteins (e.g., venison and a lamb and rabbit combo).

 

[Bobbie And Bubba]

Hi Kelly, I see that Buddy was 248 this morning ( saw the protein shake debacle in your comments) He'll come back down and it's looking like he's in a flat yellow cycle from last night which can indicate that they will drop lower in the next cycle or so.

This is the 2nd cycle with shooting .25. The depot doesn't get filled until about the 4th cycles. Let's see what happens with consistency and go from there.

 

[Kelly and Buddy]

Hi Kelly, I see that Buddy was 248 this morning ( saw the protein shake debacle in your comments) He'll come back down and it's looking like he's in a flat yellow cycle from last night which can indicate that they will drop lower in the next cycle or so.

This is the 2nd cycle with shooting .25. The depot doesn't get filled until about the 4th cycles. Let's see what happens with consistency and go from there.

Thanks for checking in on us, Bobbie. I really appreciate it. I did grab another reading at about 1.25 and he was up to 255. I have no idea how much of the shake he drank or if it caused him to have higher numbers; I turned around and his face was planted in the cup and he was lapping it up. I think he was only there for a few seconds BUT a serving has 99 carbs so it probably wouldn't take much....

I will stay the course with the .25 for now and continue to seek guidance from you all.

Am I the only one that struggles to see if there is even any insulin in the syringe at such low doses? Sometimes it looks like there is none in the syringe and I end up expressing it (and some always comes out) and then I start over. I don't know if there are better syringes but I've tried 3 different types and I find them all difficult to read at such low doses - even with the magnifying headset. I can't imagine trying to get down to .2 or .1. The struggle is real...LOL.

Have a great day!

 

[Beck and Philly]

I went to a local specialty pet food store and bought samples of several foods from Dr. LISA's chart. After letting Grandpa sample them, Halo came out a winner. I ordered a case of Halo plus a case of AvoDerm 3 oz tuna and crab for treats/snacks from Amazon for a better price. The AvoDerm has huge chunks of meat that are tender enough for him to eat with his few teeth. We've been seeing better numbers lately, and I feel like he's getting a quality diet. I've noticed also that my cat who is severely allergic to poultry and grain loves both of these foods. His coat is looking great and the dry, itchy skin is clearing up.

Just thought I'd share in case you think about options other than FF and Friskies.

 

[Bobbie And Bubba]

Am I the only one that struggles to see if there is even any insulin in the syringe at such low doses?

I think you are in good company with that. I am currently shooting 0.1 and I have to use magnifying glasses ( 3.0) and work under a little lamp to give extra lighting. Sometimes, like this AM, it seemed the plunger hardly moved , but I know there was insulin in it as I saw it. When I got down to 0.1 dose, I hold the plunger in as I remove the needle so to not have the small amount sucked back down into the syringe.

 

[Kelly and Buddy]

I went to a local specialty pet food store and bought samples of several foods from Dr. LISA's chart. After letting Grandpa sample them, Halo came out a winner. I ordered a case of Halo plus a case of AvoDerm 3 oz tuna and crab for treats/snacks from Amazon for a better price. The AvoDerm has huge chunks of meat that are tender enough for him to eat with his few teeth. We've been seeing better numbers lately, and I feel like he's getting a quality diet. I've noticed also that my cat who is severely allergic to poultry and grain loves both of these foods. His coat is looking great and the dry, itchy skin is clearing up.

Just thought I'd share in case you think about options other than FF and Friskies.

I would love to feed some of the higher quality food but, with 7 cats, I have to be mindful of cost. I'm trying to find a balance between cost and quality; sadly, those two don't go together so well.

Now, if anybody wants a new cat or two...

 

[Beck and Philly]

I would love to feed some of the higher quality food but, with 7 cats, I have to be mindful of cost. I'm trying to find a balance between cost and quality; sadly, those two don't go together so well.

Now, if anybody wants a new cat or two...

Oh yes. I can relate way too well. Imagine multiplying your household by three and adding a dog with poultry and grain allergies.

 

[Kelly and Buddy]

Oh yes. I can relate way too well. Imagine multiplying your household by three and adding a dog with poultry and grain allergies.

Are you telling me you have 21 cats?? If so, I am impressed!! It is all I can do to keep up with my 7. Well, technically, I have 9 cats because I have two outside strays (one tame, one feral) that now live on my back patio. I also have 2 dogs.

With all that said, if I could afford it, I would probably have 20 also!

 

[Beck and Philly]

Are you telling me you have 21 cats?? If so, I am impressed!! It is all I can do to keep up with my 7. Well, technically, I have 9 cats because I have two outside strays (one tame, one feral) that now live on my back patio. I also have 2 dogs.

With all that said, if I could afford it, I would probably have 20 also!

Wellll, technically 25 right now if I count the 4 kittens from a feral colony that we bottle fed. They're up for adoption now that they've had their first shots and tests.

Believe me, this wasn't intentional. We are involved in rescue and tried to help the innocent victims of a feral cat barn project that went bad. Grandpa and many others were in danger as the result of poor decisions by folks who meant well. We rescued Grandpa and 4 others literally hours before they were to be trapped by animal control.

As a result, Grandpa ate a carefully considered selection of food today. My roommate and I had Kraft Mac n Cheese... more from exhaustion than money, though.

 

[JeffJ]

Welll, technically 25 right now

Holy Smokes.

YOU ARE A SAINT.

I cannot imagine the amount of time it takes to handle all of that. With luck you can get more of them adopted out. They are so lucky to have you.

 

[Kelly and Buddy]

Wellll, technically 25 right now if I count the 4 kittens from a feral colony that we bottle fed. They're up for adoption now that they've had their first shots and tests.

Believe me, this wasn't intentional. We are involved in rescue and tried to help the innocent victims of a feral cat barn project that went bad. Grandpa and many others were in danger as the result of poor decisions by folks who meant well. We rescued Grandpa and 4 others literally hours before they were to be trapped by animal control.

As a result, Grandpa ate a carefully considered selection of food today. My roommate and I had Kraft Mac n Cheese... more from exhaustion than money, though.

I agree with Jeff! You are a Saint! And it makes me smile to know there are people like you out there.

 

[Beck and Philly]

Thanks, guys. A far cry from sainthood, believe me. I'm very lucky to have a friend who shares the expenses, the tasks, the triumphs, and the tears. Most of the critters that ended up here were the ones who wouldn't have survived in that situation - the elderly, the health issues, the toothless seniors, etc. Sometimes I feel like we live on the island of misfit toys. But we laugh a lot and do what we can to give these guys a taste of a home life while they're here.

I've taken up way too much of your thread. You have a lot going on yourself. You got some great advice it seems. Good luck and goodnight!

 

[Kelly and Buddy]

Hoping one of you will read my morning post because I would appreciate your advice. Wasn't sure whether to post here (so you would get an alert) or start new. Basically Buddy is down to 200 this morning from 349 last night, still on .25. I'm stalling but am slightly concerned about shooting since he has a history of weird drops and I will be gone for 10 hours. On his next reading, what do I look for? If he is still dropping, don't shoot? If he's going up, is there a number where I should feel safe shooting? Aaahh, I hate this. If only I had a job where I could at least come home at lunch.

Thoughts?