6/4/20 New Member - frustrated & need guidance

[Ashley & Chandler]

Hi everyone!

Thanks for all the helpful information I've already found on here - it's so nice to have this resource!

I have 2 feline furbabies, Chandler (FD) and Addison (Channy & Addy for short usually Lol). Chandler was DX in February of last year. We tried to adjust diet for few months before starting insulin &, unfortunately, that ended up being too long & he spent Memorial Day weekend in the emergency vet for DKA (down to ~10 lbs from probably ~17-18 lbs pre diabetic weight). Came home on 4u of Vetsulin 2x/day. He had a follow up appt. for a curve on 6/5 & they upped the dose to 5u (still Vetsulin) until we were able to get in with the internist. Once we had that appointment on 6/26, he switched the insulin to Lantus & dropped to a starting point of 1u 2x/day. Approx. a week or so later, he went for a curve & the vet upped the dose to 2u (~11.5 lbs). Approx. 3 weeks later, went for another curve & dose was upped to 3u (~12.5 lbs). Approx. a month later, another curve, another increase to 4u (~13.5 lbs). Went for another curve approx. a month later & the vet kept the dose at 4u (still ~13.5 lbs).

I held off on anything further at this point because the internist left the practice & there were none in my state (DE) at that point. My husband surprised me with a cruise for Christmas - yay! Since we would be gone for a week & someone else would be taking care of him, I decided to take him to a new vet (conveniently around the corner from me, ~5 min) at the end of Jan. so he could have a physical and another curve since we hadn't done anything since Sept.

Per this curve, she suggested upping the dose to 5u (~16 lbs now). Since we were leaving & someone wouldn't be home most of the time, I decided to hold off on the increase until we came back from vacation. Once home, I upped him to 5u, but I did so in 0.5u increments (4.5u for about a month, then up to 5u). He has been on 5u now since the beginning of March.

I only recently (like within the last 2 weeks) made the decision to start trying to home test his BG based on information I found here & because I know the urine strips are not terribly reliable (& only offer what was happening however long ago). I had been testing his urine 1-2x/day since he was dx.

I am frustrated with his BG #s. I have no idea what is going on sometimes - one day seems pretty regulated, then the next is elevated most of the day. Or sometimes it's much higher in the AM than PM or vice versa & it makes no sense to me. I have been feeding FF (classics, flaked, chunky, & roasted) basically since her was dx. I was adhering to a 12 hr meal/shot schedule before, but after some reading on here, have tried to start doing at least one smaller meal in between because he seems like he is always hungry. He also does this thing where he will walk around the house & meow/cry/howl (sometimes hard to tell), but used to sometimes do it pre-dx & has seemed to not do it as much since I've been doing the in-between meals. He is definitely a big cat in general & I know we are not technically at the 6u threshold, but wondering if I should get him tested for Acro or IAA.

Since it is still so new, my SS does not have a whole lot of information, but if anyone is willing to take a look & give me any opinions on what you think is going on & any suggestions for improvement, I would greatly appreciate it! Please feel free to also ask any questions - I'm sure I have left things out, so I apologize!

Thanks so much!
-Ashley & Channy

 

[jt and trouble (GA)]

WELCOME TO FDMB! You've found a safe place to land here. You really have been through it all havent you? I cannot give dosing advice. Lets see what our experts have to say about all this ok?
Hang on for more replies.
Again welcome we are glad you found us!
jeanne

 

[jt and trouble (GA)]

@Deb & Wink @Nan &Amber

 

[Ale & Bobo & Minnie (GA)]

Welcome and great job on setting up your signature and ss!!!

also yay for home testing. How is it going? Is he putting up with it okay? Are you giving treats, etc? I think it’s a must and you won’t have to put him through the stress of an all day curve at the vet. He’s on a pretty high dose of Lantus but it’s hard to give advice with little data and no pre shot numbers. Can you try to test him before each shot? I’m confused by the dates what’s 9/17? It would be good also to try to get some evening tests like at +2 at least

and good that you’re feeding him more than just twice a day. Most cats do better grazing throughout the day and it’s easier on their pancreas. Can you tell us what he weighs and how many calories a day he’s on?

You’ve come to the right place and welcome again!

 

[Ale & Bobo & Minnie (GA)]

I believe the FF flaky and chunky are higher in carbs than the pate fyi

 

[Ale & Bobo & Minnie (GA)]

I think I got it. The numbers in the ss are from the vet curves right? If that’s right, I’d move those up and add the year as well. Have you gotten any numbers from home testing in there? I’d move those below the curve results

 

[Bron and Sheba (GA)]

Hi Ashley and Channy and welcome to Fdmb.
I am so pleased you are home testing. It is the only way to keep Channy safe and work out what dose suits him.
I don’t understand the dates in your SS. Can you explain those please?

We recommend increasing in 1/4 unit increments so we dont miss the best dose and it’s safer for the cat.

What I would recommend moving forward is to always test the BG before every shot to make sure it is safe to give the insulin. So the routine is to test, feed and shoot.

I would also try and get at least one test in during every cycle around +4 to +7 (vary it) to see how low the dose is taking Channy. Lantus dosing is based on how low the dose is taking the BG not the preshot.

I would also make sure you get a before bed test in during the PM cycle to see that he is not dropping too low at night as cats often do. If the before bed test is lower than the preshot I would set the alarm and get up later and test again to see the BG hasn’t dropped too low. Don’t neglect the PM cycle. It is just as important as the am cycle.

I would also give him snacks during the cycles. Feed him before the shot then give him a snack at say +3 and +5 each cycle. A timed feeder is a good idea for over night. If you don’t want him to put on weight, divide the food allocation up into three lots for each cycle and give before the dose, and for the 2snacks.
The M/D dry you are feeding is high carb and could be contributing to the high numbers. But dont stop feeding it until we have more BG data and we can help you get rid of it.
It is possible that Channy is dropping low overnight and bouncing up high during the day. The only way to find out is to test during both cycles.

Do you have a Hypo kit ready with some high carb food and honey/karo? That is very important.
I think next time you start a post I would start posting over on the Lantus forum where there are a lot more people who use Lantus to help you. Here is the link
http://www.felinediabetes.com/FDMB/forums/lantus-basaglar-glargine-and-levemir-detemir.9/

Here is another useful link
http://www.felinediabetes.com/FDMB/threads/new-how-you-can-help-us-help-you.216696/

Keep asking question, we are happy to help.
Bron

 

[Nan & Amber (GA)]

I don’t understand the dates in your SS. Can you explain those please?

There's a 2019 and a 2020 tab, looks like 2019 is just vet curves, there's a little more data for 2020.

I agree with what others have said. I don't think we have quite enough data to assess the dose he's on. I think the best thing is to just keep going until we have more information. Always test pre-shot, but also, if you can, get some tests between shots. We judge the effectiveness of a dose by how low it takes the cat, and that happens sometime in the middle. I would also keep testing any time you hit a green number like you did the other day-- he might have gone even lower, even skipping the shot! [edit; why did I think you skipped? I thought there was a blank but now I'm seeing a dose of 4.75U] Lantus works as a "depot" insulin, so even when you don't give a shot, there's some residual action from previous shots that could be working.

Welcome to FDMB!

 

[Ale & Bobo & Minnie (GA)]

Bron never reads my replies lol I said that above in comment #5

 

[Bron and Sheba (GA)]

Thanks @Nan & Amber (GA). Thanks! I didn’t think to look to see if it wasn’t the correct year. I was on my iPhone and it’s hard to see some things.
@Aleluia Grugru & Minnie I was writing when you posted so didn’t see it beforehand. I think you mean #6.

 

[Ashley & Chandler]

I think I got it. The numbers in the ss are from the vet curves right? If that’s right, I’d move those up and add the year as well. Have you gotten any numbers from home testing in there? I’d move those below the curve results

Yes, I made a 2019 tab just so I have a central place for all the numbers, but they were all vet curves, so I don't know how much of it was stress vs. actual high BG #s. I had the 2019 tab first so I believe it was opening to that one instead of 2020, which is where I have some at home #s, but very few because I only started a week ago & then skipped the weekend due to being away. I moved the 2020 tab to be the first tab, so hopefully it will open to it now.

 

[Ashley & Chandler]

Can you tell us what he weighs and how many calories a day he’s on?

As of 5/27 he is 17.2 lbs. He is generally a big cat, but I'm not really sure the vet ever gave me an 'ideal' weight for him, especially since we were initially in need of putting weight on after his DKA episode (down to ~10 lbs), so they had told me back then around 300 cal/day. I'd personally say his ideal weight would be around 15 lbs, but have seen multiple versions of 'calorie calculator' values so I'm not really sure exactly how much to be aiming for. I've seen 15-20 cal/lb ideal weight for indoor cats, but I recently also saw something to the effect of 13.6 cal/lb of ideal weight +70 (I think?). So based on those 2 versions at an 'ideal' weight of 15 lbs, that would be 225-274.

I have been trying to stay within that range, although it usually ends up on the higher end. He is just always seemingly so hungry & his sister is picky & a dry food addict, so if I'm not paying attention when she walks away from her bowl, he ends up getting some of hers (the wet food is the same as his, but I usually put dry on top of hers). Because of this, I am trying to use foods that they will both eat so I don't have to worry as much if he eats some of hers. They can both be picky, so there are several of the non-seafood flavors, which are better for them, in the FF pates that they don't like. I am considering switching to Weruva, which is what I've been giving as the snacks to test out flavors to see who will eat what, but I'm not sure if that is throwing him off a bit as well or if it's just the non-classic FF that's the issue. I have only bought Weruva options that, per their website, have less that 10% calories from carbs (most that I've bought are actually less than 7%).

Welcome and great job on setting up your signature and ss!!!

Thank you!!

also yay for home testing. How is it going? Is he putting up with it okay? Are you giving treats, etc?

The testing is going ok so far. He puts up with it OK for the most part, but since its still new, his ears don't always bleed enough to get a good drop for the strip (0.5uL needed). I do use the lancet pen & just today switched to the clear cover & it has seemed to work better (I tried free handing it once & that was the worst reaction I've gotten from him & I didn't like it either, so will be sticking with the pen for now). I actually haven't had to give him treats - he has been ok with pets & cuddles so far (& of course any of them that coincide with his next round of food Lol).

 

[Ashley & Chandler]

I would also give him snacks during the cycles. Feed him before the shot then give him a snack at say +3 and +5 each cycle. A timed feeder is a good idea for over night. If you don’t want him to put on weight, divide the food allocation up into three lots for each cycle and give before the dose, and for the 2snacks.

Yes, that is one thing I have been trying to start doing. I have to look into the automatic feeders. Are they usually ones that you can set the number of hours (like if I set it up at 7am, I can do 2hrs & 5hrs) or do you have to set up the actual times (so if 7am setup, I'd have to set the times for 9am & 12pm)? Just wondering for ease of use if someone else was here taking care of him if we were gone. Also, for a multipet household, I'm not sure how well this will work since I would need one for both of them, but since she is so finicky, there is no telling if she will eat hers or if he will end up getting it (even if it's one she 'usually' likes, she has been known to decide she doesn't like it anymore).

The M/D dry you are feeding is high carb and could be contributing to the high numbers. But dont stop feeding it until we have more BG data and we can help you get rid of it.
It is possible that Channy is dropping low overnight and bouncing up high during the day. The only way to find out is to test during both cycles.

I try not to let him have the M/D dry anymore (& haven't for some time), but someone was feeding them over the weekend for us & I know he got into her food & he was given 1tbsp of dry at each 12 hr mealtime, so I don't know if that has anything to do with the wonkiness but I would've thought that it would work itself out after 4 days. I have tried to keep food details in my SS in case it helped to see a pattern at some point.

I'm not sure about him dropping low overnight, but I have been trying to get in a before bed test to see how its going. I don't believe it has ever been a case of too low safety wise, but more of a 'too low' for him type thing since he started above 600 at dx & has been seemingly still in the 300s, 400s, & 500s, so anything below 200 is probably 'low' to his body. I know the only true way to know is to test the BG, but I'm just stating my opinion. I feel like there are just SOOO many factors that can throw it off that I feel like I'll never get 'true' numbers.

Do you have a Hypo kit ready with some high carb food and honey/karo? That is very important.
I think next time you start a post I would start posting over on the Lantus forum where there are a lot more people who use Lantus to help you. Here is the link
http://www.felinediabetes.com/FDMB/forums/lantus-basaglar-glargine-and-levemir-detemir.9/

I do have high carb food & karo in the 'kitty stuff' cabinet (& honey in the pantry).
I will definitely post in the Lantus forum too, I just figured I'd put my first post on the main page like the suggestions said to.

 

[Ashley & Chandler]

Thank you all for your replies! Sorry if I missed replying to any specific questions!

 

[Bron and Sheba (GA)]

I’m not sure where you live to tell you about autofeeders. I am in Australia.
As far as I know all auto feeders can be set by the hour. There is also an auto feeder that has a microchip collar and only the specific cat can eat out of it. It is more expensive but does the job. I had one that could be set for 12 hours or 24 hours so if it was set and left and not fiddles with it should be ok for someone else to use ....as long as the battery was OK. I only reset it when the battery ran out.
I’m sure someone in the US or where ever you live can tell you about specific autofeeders.

Yes it’s good to start off on the main page, but you are pretty organised with your signature and SS set up so when you are ready move over to the Lantus page...no rush.

I’m sure now that you are here we can help you get sorted and hopefully get Channy into some better numbers.
Have you thought about which of the two dosing methods you would like to follow?

There is the Start Low Go Slow (SLGS) where you hold the dose for 7 days, then do a curve before increasing (if necessary). You can feed dry food while doing SLGS if needed, but it’s not recommended. You reduce the dose if it drops under 90.

With Tight Regulation (TR) you can increase most times after 3 days if warranted. You need to be testing a minimum of twice a cycle....preshot and once during each cycle. No dry food allowed with TR and you reduce the dose if the cat drops under 50.
You can read about it all in the yellow sticky at the top of the Lantus page.

 

[Ashley & Chandler]

I’m not sure where you live to tell you about autofeeders. I am in Australia.

I am in the US. Thanks for the info! I will be looking into them for sure.

I’m sure now that you are here we can help you get sorted and hopefully get Channy into some better numbers.
Have you thought about which of the two dosing methods you would like to follow?

There is the Start Low Go Slow (SLGS) where you hold the dose for 7 days, then do a curve before increasing (if necessary). You can feed dry food while doing SLGS if needed, but it’s not recommended. You reduce the dose if it drops under 90.

With Tight Regulation (TR) you can increase most times after 3 days if warranted. You need to be testing a minimum of twice a cycle....preshot and once during each cycle. No dry food allowed with TR and you reduce the dose if the cat drops under 50.
You can read about it all in the yellow sticky at the top of the Lantus page.

I have read about this in the sticky & I think for the time being I could do TR because I’m working from home still & probably will be for at least the summer, but it could change. I think I have a better chance with testing twice per cycle right now then doing a full curve once a week if doses change.