High BG values

[Marina & Chico]

Dear community, it is very helpful and reassuring finding someone who can help us go thru these first few days of diabetes management.

Our 8.5 years old british shorthair cat was diagnosed with diabetes just a couple of weeks ago. Initially the vet tried to stabilize him with diet only, nonetheless shortly it was clear we have to start insulin injections as well. We feed Chico 85g of Purina Pro plan wet food every morning and evening with his insulin shot and during the day we used to give him 20g Vet life dry food. Yesterday for the first time after a while Chico was really hungry so we decided to increase the dosage of dry food to 35g (he weights 5kg so it is still under the recommended amount). After going thru this forum we decided to exclude the dry food all together and replace it with another portion of Purina pro plan - today will be our first attempt.

The vet prescribed us Caninsulin and he didn't do any tests for ketones. We plan to try doing it though.

Yesterday we managed to do a Glucose curve which was very helpful to us to understand what is happening to him during the day. We started our day at 25mmol/l and the nadir was reached 5 hours after the injection at the value of slightly under 8mmol/l. What was shocking to us it that we finished the 12 hours cycle with 29.6mmol/l.

Please help us understand how long should we wait to see if the maximum values will decrease or not. We are worried not to harm him while waiting - his BG is very high.

Additionally, after reading more about the types of insulin we understood that if we want Chico to go in remission we have to change the type of insulin but we thought of doing it later in the process when we manage to stabilize him. Nonetheless after seeing the Glucose curve we are worried the Caninsulin has too short duration to help him get better.

Here is Chico's Spreadsheet:
https://docs.google.com/spreadsheets/d/1xHFd0rBTyONEXSMMM6OkdCwfnsNZgm8ZbtaWrHbtCR8/edit#gid=0

We will be very grateful for any advice on how long to wait before deciding for a change in his treatment plan.
Thank you in advance,
Marina & Chico

 

[Bron and Sheba (GA)]

Hi Marina and Chico and a big welcome to the forum. So glad you have found us.

First of all, it is great you are home testing the blood glucoses and thank you for setting up the signature..that is a big help.
I can’t see your spreadsheet. Did you press the share button?
I am going to tag @Bandit's Mom to help you get the SS up and running. She is a whizz at it. It is probably just a small thing which is stopping me see it.

Can you also tell me what type of meter you are using to test the blood glucose please?

In regard to the food, we recommend feeding a low carb wet food with the carb content being 10% or less. Almost all dry food is high carb and has very little moisture. Just a word of caution.........changing over to a low carb diet and ditching the dry needs to be done slowly with you monitoring the BGs closely as the BGs can drop up to more than 5.5mmol/L with the change of food.so you need to be watching closely.

Definitely test daily for ketones while the BGs are high.

Are you feeding Chico 30 minutes before you give the insulin? It is important when giving caninsulin to make sure there is food aboard first before injectng Because caninsulin works fast.

I regards to the insulin when you say you are worried that the duration of the caninsulin is too short and you are wondering about a better insulin. Caninsulin is a fast acting insulin which does not have as long a duration as some of the later and more suitable insulins for cats has.
I am guessing you are from the UK or Canada....probably the Uk becasue of the time at the moment. If you are looking for a longer acting, gentler insulin which is better suited for cats I would look at Lantus or prozinc. I know Prozinc is available in the UK and I think Lantus is.
Chico will get a much better duration with one of those two insulins.
At the moment caninsulin is dropping the BG down to around 8 at about +5 and then it looses its potency and by the time of the next shot, the BGis up high again. With the other insulins, they last around 12 hours so you should get a flatter curve. But it takes time for the body or get used to insulin as it is a hormone not a medication like an antibiotic.

If you can tell me which country you are in I can give you some specific information and maybe some people who live there to help you more.
Here is a link to information about hypos.
Click herehttps://www.felinediabetes.com/FDMB/threads/how-to-treat-hypos-they-can-kill-print-this-out.15887/

 

[JanetNJ]

After going thru this forum we decided to exclude the dry food all together and replace it with another portion of Purina pro plan - today will be our first attempt.

Hi! Nice to meet you! Switching to all wet is a good plan. So is your idea of testing for ketones.

It looks like he has a strong reaction to the insulin and then is bouncing up. Not uncommon with canisilun which is why we often suggest a gentler longer lasting insulin. His body is reacting to that sudden drop by pumping up the stored glucose to try to stop hypoglycemia. It looks like you jumped straight from 1 right to 2 units. Maybe if you tried 1.5 units some of the bouncing could slow down. You might see lower preshots. Your other option is to switch to ProZinc or lantus. Lowering the dose is also a good idea since your are cutting out the high carb dry

 

[Bron and Sheba (GA)]

Here is a link to a beginners guide to caninsulin.
Click on the link https://www.felinediabetes.com/FDMB/threads/beginners-guide-to-caninsulin-vetsulin.231587/

 

[JanetNJ]

The spreadsheet was working for me and suddenly it's not...


Edited: oh it's working again

 

[Bron and Sheba (GA)]

I can’t see the SS at all.
Oh....I just clicked on the one in the signature and I can see it but not the one that is in the post

 

[Marina & Chico]

Hi Marina and Chico and a big welcome to the forum. So glad you have found us.

First of all, it is great you are home testing the blood glucoses and thank you for setting up the signature..that is a big help.
I can’t see your spreadsheet. Did you press the share button?
I am going to tag @Bandit's Mom to help you get the SS up and running. She is a whizz at it. It is probably just a small thing which is stopping me see it.

Can you also tell me what type of meter you are using to test the blood glucose please?

In regard to the food, we recommend feeding a low carb wet food with the carb content being 10% or less. Almost all dry food is high carb and has very little moisture. Just a word of caution.........changing over to a low carb diet and ditching the dry needs to be done slowly with you monitoring the BGs closely as the BGs can drop up to more than 5.5mmol/L with the change of food.so you need to be watching closely.

Definitely test daily for ketones while the BGs are high.

Are you feeding Chico 30 minutes before you give the insulin? It is important when giving caninsulin to make sure there is food aboard first before injectng Because caninsulin works fast.

I regards to the insulin when you say you are worried that the duration of the caninsulin is too short and you are wondering about a better insulin. Caninsulin is a fast acting insulin which does not have as long a duration as some of the later and more suitable insulins for cats has.
I am guessing you are from the UK or Canada....probably the Uk becasue of the time at the moment. If you are looking for a longer acting, gentler insulin which is better suited for cats I would look at Lantus or prozinc. I know Prozinc is available in the UK and I think Lantus is.
Chico will get a much better duration with one of those two insulins.
At the moment caninsulin is dropping the BG down to around 8 at about +5 and then it looses its potency and by the time of the next shot, the BGis up high again. With the other insulins, they last around 12 hours so you should get a flatter curve. But it takes time for the body or get used to insulin as it is a hormone not a medication like an antibiotic.

If you can tell me which country you are in I can give you some specific information and maybe some people who live there to help you more.
Here is a link to information about hypos.
Click herehttps://www.felinediabetes.com/FDMB/threads/how-to-treat-hypos-they-can-kill-print-this-out.15887/

Thank you for your answer.

We are located in the Czech Republic. We are using the Glucolab for measuring BG.

 

[Bron and Sheba (GA)]

I am glad you are giving the insulin twice a day.
We recommend feeding before the shot ( with caninsulin 30 minutes before) and then giving a couple of snacks during the first half of the cycle at +2 and +5 or +2 and +4 both cycles. It is better for the pancreas to have some smaller snacks and not just two big meals.

 

[JanetNJ]

I can’t see the SS at all.
Oh....I just clicked on the one in the signature and I can see it but not the one that is in the post

Aaaand now is blocked again. She must be changing permissions or Google is having issues. She's got almost a 70% drop in numbers then it zooms up again. Big bounces.

 

[Marina & Chico]

Hi! Nice to meet you! Switching to all wet is a good plan. So is your idea of testing for ketones.

It looks like he has a strong reaction to the insulin and then is bouncing up. Not uncommon with canisilun which is why we often suggest a gentler longer lasting insulin. His body is reacting to that sudden drop by pumping up the stored glucose to try to stop hypoglycemia. It looks like you jumped straight from 1 right to 2 units. Maybe if you tried 1.5 units some of the bouncing could slow down. You might see lower preshots. Your other option is to switch to ProZinc or lantus. Lowering the dose is also a good idea since your are cutting out the high carb dry

can we consider lowering the dose if the highs are so high? we thought we should wait until the highs lower a bit and as son as the nadir is not so low it shouldn't harm him, or are we wrong?

 

[Marina & Chico]

Aaaand now is blocked again. She must be changing permissions or Google is having issues. She's got almost a 70% drop in numbers then it zooms up again. Big bounces.

i closed the SS, maybe having it opened caused the issues

 

[Bron and Sheba (GA)]

Thank you for your answer.

We are located in the Czech Republic. We are using the Glucolab for measuring BG.

So a bad guess on my part
Is the glucolab meter a human glucose meter?

Are you able to get canned cat foods such as fancy feast in the Czech Republic?

 

[Marina & Chico]

I am glad you are giving the insulin twice a day.
We recommend feeding before the shot ( with caninsulin 30 minutes before) and then giving a couple of snacks during the first half of the cycle at +2 and +5 or +2 and +4 both cycles. It is better for the pancreas to have some smaller snacks and not just two big meals.

thank you for the advice, we want to start giving another portion of wet food divided at lunch and before going to bed for him to have some calories during the night

 

[Bron and Sheba (GA)]

can we consider lowering the dose if the highs are so high? we thought we should wait until the highs lower a bit and as son as the nadir is not so low it shouldn't harm him, or are we wrong?

I am not a caninsulin user so can’t really comment on the ins and outs of it but I’ll tag @Critter Mom as she has used it.
Janet are you a caninsulin user?

 

[Marina & Chico]

So a bad guess on my part
Is the glucolab meter a human glucose meter?

Are you able to get canned cat foods such as fancy feast in the Czech Republic?

The glucolab is a human glucometer. After a quick check it doesn't seem that Fancy feast is available here

 

[JanetNJ]

I think eliminating the dry is a great idea and I hope it gives you better numbers.

 

[Bron and Sheba (GA)]

The glucolab is a human glucometer. After a quick check it doesn't seem that Fancy feast is available here

Can you tell us some of the canned food options you have available?
Pates are usually low carb and gravy foods are usually higher carb

 

[JanetNJ]

I am not a caninsulin user so can’t really comment on the ins and outs of it but I’ll tag @Critter Mom as she has used it.
Janet are you a caninsulin user?

I used it (well Vetsulin, same thing) for four months in the beginning and got CC into remission on it. Then used it for about a year when she came out of remission before switching to ProZinc.

 

[JanetNJ]

Can you tell us some of the canned food options you have available?
Pates are usually low carb and gravy foods are usually higher carb

Looks like the purina pro plans are low carb.

 

[Bron and Sheba (GA)]

Here is a link to the amount of carbs in canned cat foods available in the US. It has the pro plan foods listed so you can see the number of carbs in the food you are feeding at the moment.
I will also tag @Gill & George who livesin Spain but she may be able to help you with the food.
Link to food listhttps://catinfo.org/docs/CatFoodProteinFatCarbPhosphorusChart.pdf

 

[Marina & Chico]

Can you tell us some of the canned food options you have available?
Pates are usually low carb and gravy foods are usually higher carb

Concept for life, Integra, Royal canin, Kattovit, Schesir, Miamor, Animonda Carny, Feline Porta, Bozita, Smilla, Grau, Purina Pro Plan

These are all options we can easily get via Zoohit, i am certain we can find other options if needed.

 

[Marina & Chico]

Here is a link to the amount of carbs in canned cat foods available in the US. It has the pro plan foods listed so you can see the number of carbs in the food you are feeding at the moment.
I will also tag @Gill & George who livesin Spain but she may be able to help you with the food.
Link to food listhttps://catinfo.org/docs/CatFoodProteinFatCarbPhosphorusChart.pdf

Thank you for the link

 

[Bron and Sheba (GA)]

I would try and get some more tests in during all the pm cycles at around +5 as that is around the nadir and cats often drop lower at night.

 

[Marina & Chico]

I would try and get some more tests in during all the pm cycles at around +5 as that is around the nadir and cats often drop lower at night.

We were already considering it, we will try to do it tonight. Thank you for your suggestion.

 

[Bron and Sheba (GA)]

Concept for life, Integra, Royal canin, Kattovit, Schesir, Miamor, Animonda Carny, Feline Porta, Bozita, Smilla, Grau, Purina Pro Plan

These are all options we can easily get via Zoohit, i am certain we can find other options if needed.

I think that Gill orders through someone like Zoohit so she may have some other suggestions as well. I only recognise a couple of those cat food names but I live in Australia so wouldn’t be much help anyway as far as food goes over there in Europe.

Do you also have some higher carb foods around 15% (medium carb) and 20% (high carb) in case of low numbers and some honey in case of very low numbers?

We were already considering it, we will try to do it tonight.

Great!

 

[Bron and Sheba (GA)]

If you give some food around +2 you may be able to slow down the drop in BG and help stop a bounce.

 

[Marina & Chico]

I think that Gill orders through someone like Zoohit so she may have some other suggestions as well. I only recognise a couple of those cat food names but I live in Australia so wouldn’t be much help anyway as far as food goes over there in Europe.

Do you also have some higher carb foods around 15% (medium carb) and 20% (high carb) in case of low numbers and some honey in case of very low numbers?



Great!

To be honest, we are so far from low numbers that we didn't really manage to think about it, we are so focused to decrease the peaks...
Thanks for bringing to our attention not to underestimate the low BGs anyway, we do have the diabetic dry food (which now we believe is the cause for high BG in the evening) and we have honey.

 

[Bandit's Mom]

Hi Bron, only just saw the tag. Looks like the SS issue is fixed because I can see it.

Sharing UK food list:
https://docs.google.com/spreadsheets/d/1J5JpMe6TDXrHq_aTl9hUtHy6Gs9oRBqlz4nPGKxtySA/pubhtml

 

[Marina & Chico]

If you give some food around +2 you may be able to slow down the drop in BG and help stop a bounce.

We are +3 now but i just gave him some food anyway, it is earlier than what we did yesterday, we gave him food at +5. We will give him again some later on for him not to be hungry. Hopefully this will help with the high value.

 

[Bron and Sheba (GA)]

To be honest, we are so far from low numbers that we didn't really manage to think about it, we are so focused to decrease the peaks...
Thanks for bringing to our attention not to underestimate the low BGs anyway, we do have the diabetic dry food (which now we believe is the cause for high BG in the evening) and we have honey.

I would look for some wet higher carb food if you can as it is better than the dry food as a high carb alternative.
The dry food stays longer in the system.

I think you are more likely to find Lantus insulin than Prozinc in your country, but I could be wrong.

 

[Marina & Chico]

I would look for some wet higher carb food if you can as it is better than the dry food as a high carb alternative.
The dry food stays longer in the system.

I think you are more likely to find Lantus insulin than Prozinc in your country, but I could be wrong.

We will ask our vet about both options.

Thank you all again for your help and suggestions, it is very helpful.

 

[Bron and Sheba (GA)]

We will ask our vet about both options.

Thank you all again for your help and suggestions, it is very helpful.

We are very happy to help you. Ask as many questions as you need.

 

[Bandit's Mom]

Concept for life, Integra, Royal canin, Kattovit, Schesir, Miamor, Animonda Carny, Feline Porta, Bozita, Smilla, Grau, Purina Pro Plan

These are all options we can easily get via Zoohit, i am certain we can find other options if needed.

A lot of these feature in the UK food list. For those that don't you could use this carb calculator to find out the carb%
http://scheyderweb.com/cats/catfood.html

In the EU, I think your cat labels have Typical Values rather than Guaranteed Analysis (GA). GA is more of an approximation than Typical Values.
Look at the "Dry Matter Carbohydrates:* (%)" at the end of the calculations.

 

[Gill & George]

Concept for life, Integra, Royal canin, Kattovit, Schesir, Miamor, Animonda Carny, Feline Porta, Bozita, Smilla, Grau, Purina Pro Plan

These are all options we can easily get via Zoohit, i am certain we can find other options if needed.

I'm just getting lunch ready I'll post when it's in the oven. A number of those brands have low carb options.

 

[Critter Mom]

Hi Bron,

I think you are more likely to find Lantus insulin than Prozinc in your country, but I could be wrong.

The Czech Republic is an EU member state. The two insulins currently licensed in the EU for use in cats are Caninsulin and Prozinc so, in principle at least, they should be available in all member states.

Assuming that prescribing regulations haven't changed in the last month, the two licensed insulins must be tried first and shown to be ineffective before vets can legally prescribe other insulins under drug cascade rules (e.g. Lantus, Levemir).

I don't know how high the evidence threshold might be for any insulin switch in the Czech Republic.


Mogs
.

 

[Gill & George]

Assuming that prescribing regulations haven't changed in the last month, the two licensed insulins must be tried first and shown to be ineffective before vets can legally prescribe other insulins under drug cascade rules (e.g. Lantus, Levemir).

I didn't have to go through that process, it seems to be more of an issue in the UK. I just asked my vet to start on Lantus as evidence suggested that it had a better duration and as such it was going to be easier to get George well regulated, and essentially the quicker you did that the better the chance of remission.
She prescribed Lantus.
We have had others here from Europe that have been started on Lantus without any issues, I've only ever seen a problem with the UK. I wonder if it is more about the licensing agreement with big Pharma in UK? or perhaps it has something to do with pet insurance cover(not common here in spain at least especially for cats) hmmmm.....

Marina I would just ask your vet for Lantus, if you want to try a gentler insulin, with a longer duration, Lantus has some great results, I wouldn't waste time, if you can help it trying to stabilise with caninsulin, it typically works too quickly, you get harsh drops and the duration just isn't there for most cats. No harm in asking, see what he/she says....
Prozinc is a better choice, but even with that the results are often better with lantus. Make your case, show him/her the Romp/Rand study perhaps.

Aaaand now is blocked again. She must be changing permissions or Google is having issues. She's got almost a 70% drop in numbers then it zooms up again. Big bounces.

I am not sure that these are bounces in the true sense of the word,
'Not all High Numbers are bounces'
When we see them dive down then back up and then dive back down immediately in the next cycle it's more likely that what we are seeing is a lack of duration.
During a 'bounce' we would usually see them stay high and flat for at least one cycle. The hormones responsible for the bounce would keep the BG high pretty much irrespective of what you shoot, you will often feel as if you have done a fur shot, or for me it felt like I was shooting water.
In Chico's case there is not enough information to say what is happening. But remember not all cats bounce.

After going thru this forum we decided to exclude the dry food all together and replace it with another portion of Purina pro plan - today will be our first attempt.

Marina, one very important thing to note.
If you are removing the dry food, this often has a dramatic effect on the insulin requirement for your cat. So 2u, may drop him much lower than it has been until now. Please monitor carefully when transitioning of dry food.
The most extreme case we have seen of that is one cat going from 5u to remission in just 24hours, and he was only getting a few snacks of dry that he was stealing of the other cats in the house, when CG removed dry from the house his numbers dived. Great idea to get rid of the dry, but do it slowly, and monitor closely that means getting a test early on in the cycle and monitoring through to nadir.

The UK list here has many brands available throughout europe l https://docs.google.com/spreadsheets/u/1/d/1J5JpMe6TDXrHq_aTl9hUtHy6Gs9oRBqlz4nPGKxtySA/pubhtml I mostly use zooplus, but also some other online spanish provieders as the local pet stores don't stock anything suitable.
It would also be a good idea to use HC wet food and get some of that so you can use it if Chico were to drop too low. I used Purina Gourmet Gold meat in sauce varieties (they were 25-28% carbs DM~)
I have used animonda, integra, granata pet, kattovit, catz fine food, thrive, feringa amongst others. There is plenty of choice.

 

[SashaV]

Vets in Denmark is required to prescribe an animal drug first, only if its proven not to work in the specific cat, the vet can prescribe a human drug. Something called cascade rule here. Don't know if it's the same in other EU country's. Sad when it's proven human insulin works better and better chances for remission.

 

[Critter Mom]

Hi Bhooma.

In the EU, I think your cat labels have Typical Values rather than Guaranteed Analysis (GA).

Correct.

@Marina & Chico -

Welcome to yourself and Chico. You're off to a flying start with caring for Chico's diabetic needs!

Here's a helpful FDMB info post which shows how food calculations are performed:

Calculating calories from carbohydrates

As the title of the info post suggests, when members refer to low carb foods being "under 10%", what is actually meant is that less than 10% of the calories in the food should come from carbohydrates, and sometimes that value might be less than the dry matter % of carbs.

I see Bhooma has kindly linked the UK food list for you above. In that table, the calculations show the % kilocalories from carbs, so you'll be able to use those figures as a guide to which foods offered by Zooplus in your country should be diabetic-friendly. In addition to the brands you've listed above, Catz Finefood and Granatapet are good quality too. (Note: The Porta foods are not nutritionally complete.)

IMPORTANT NOTE: We have had reports in the past from members in other European countries supplied by Zooplus where the formulations for similarly named products may not be the same as the formulation available in the UK so it's important to double-check the typical analysis of the food(s) you're looking to purchase. On their UK website, Zooplus usually have typical analysis figures for each product, so I would assume that similar analysis information will be available on your local website.

Here's a helpful tool that takes all the donkey work out of calculating % of kilocalories (ME=metabolisable energy=kcals):

Macronutrient metabolisable energy calculator



Mogs
.

 

[Critter Mom]

We have had others here from Europe that have been started on Lantus without any issues, I've only ever seen a problem with the UK. I wonder if it is more about the licensing agreement with big Pharma in UK? or perhaps it has something to do with pet insurance cover(not common here in spain at least especially for cats) hmmmm.....

Marina I would just ask your vet for Lantus, if you want to try a gentler insulin, with a longer duration, Lantus has some great results, I wouldn't waste time, if you can help it

I very much second this recommendation. If you can short-circuit the process, Lantus has much better duration.

Looking at the curve you ran for Chico, he got a fairly good nadir for a newly-diagnosed cat on Caninsulin. The large variation between preshot and nadir BGs is very typical of the response of feline diabetics to this insulin. Sometimes increasing the dose may result in steeper dives to a lower nadir but the preshots can tend to stay high and, again typically, it doesn't tend to increase dose duration either. Here's an illustration of what a typical cycle might look like for a cat on Caninsulin to illustrate how BG levels change over the course of 12 hours after dose administration:

Again echoing Gill's advice above, great care and close monitoring is needed when reducing the carb load in the diet. I'd suggest reducing the amount of dry you feed only by a few grams at a time and intensively monitor BG each day to see the impact on BG levels. Depending on Chico's response, the current Caninsulin dose may need to be stepped down as the transition proceeds. You can post for feedback and support at any time. Members will be able to see his spreadsheet data and be able to make suggestions based on Chico's data. Here's further info:

Feline Diabetes and safe transition to a lower carb diet

The reduction in carb load may possibly see the preshot BGs come down. FDMB recommends a no-shoot limit of 200mg/dL / 11.1mmol/L (human meter readings) for newly diagnosed cats (particularly applicable for cats on Caninsulin because it can produce such steep drops). If, as a consequence of reducing the carb load, you start getting preshot BGs below 200 then hold off on giving the dose, do not give any food and test again in 20-30 minutes to see whether BG levels have risen high enough. (This process is referred to as 'stalling'.) While you're waiting to test again, you can post for help with the dosing decision. Be sure to put in the title that you're stalling so that members reading the board will know you need help quickly.


Mogs
.

 

[Marina & Chico]

Hi Bhooma.


Correct.

@Marina & Chico -

Welcome to yourself and Chico. You're off to a flying start with caring for Chico's diabetic needs!

Here's a helpful FDMB info post which shows how food calculations are performed:

Calculating calories from carbohydrates

As the title of the info post suggests, when members refer to low carb foods being "under 10%", what is actually meant is that less than 10% of the calories in the food should come from carbohydrates, and sometimes that value might be less than the dry matter % of carbs.

I see Bhooma has kindly linked the UK food list for you above. In that table, the calculations show the % kilocalories from carbs, so you'll be able to use those figures as a guide to which foods offered by Zooplus in your country should be diabetic-friendly. In addition to the brands you've listed above, Catz Finefood and Granatapet are good quality too. (Note: The Porta foods are not nutritionally complete.)

IMPORTANT NOTE: We have had reports in the past from members in other European countries supplied by Zooplus where the formulations for similarly named products may not be the same as the formulation available in the UK so it's important to double-check the typical analysis of the food(s) you're looking to purchase. On their UK website, Zooplus usually have typical analysis figures for each product, so I would assume that similar analysis information will be available on your local website.

Here's a helpful tool that takes all the donkey work out of calculating % of kilocalories (ME=metabolisable energy=kcals):

Macronutrient metabolisable energy calculator



Mogs
.

Thank you for the links, very useful

 

[Marina & Chico]

I very much second this recommendation. If you can short-circuit the process, Lantus has much better duration.

Looking at the curve you ran for Chico, he got a fairly good nadir for a newly-diagnosed cat on Caninsulin. The large variation between preshot and nadir BGs is very typical of the response of feline diabetics to this insulin. Sometimes increasing the dose may result in steeper dives to a lower nadir but the preshots can tend to stay high and, again typically, it doesn't tend to increase dose duration either. Here's an illustration of what a typical cycle might look like for a cat on Caninsulin to illustrate how BG levels change over the course of 12 hours after dose administration:

Again echoing Gill's advice above, great care and close monitoring is needed when reducing the carb load in the diet. I'd suggest reducing the amount of dry you feed only by a few grams at a time and intensively monitor BG each day to see the impact on BG levels. Depending on Chico's response, the current Caninsulin dose may need to be stepped down as the transition proceeds. You can post for feedback and support at any time. Members will be able to see his spreadsheet data and be able to make suggestions based on Chico's data. Here's further info:

Feline Diabetes and safe transition to a lower carb diet

The reduction in carb load may possibly see the preshot BGs come down. FDMB recommends a no-shoot limit of 200mg/dL / 11.1mmol/L (human meter readings) for newly diagnosed cats (particularly applicable for cats on Caninsulin because it can produce such steep drops). If, as a consequence of reducing the carb load, you start getting preshot BGs below 200 then hold off on giving the dose, do not give any food and test again in 20-30 minutes to see whether BG levels have risen high enough. (This process is referred to as 'stalling'.) While you're waiting to test again, you can post for help with the dosing decision. Be sure to put in the title that you're stalling so that members reading the board will know you need help quickly.


Mogs
.

We tried to remove the dry food today and at +3 hours we gave him 20g of wet food, his nadir was 13.4mmol/l (yesterday was under 8), is there any reason for us to worry more about decreasing his nadir? Maybe there won't be such high difference because the dry food we were giving him is for diabetic cats specifically and it has <20% carb, is it possible?

At night its different, we want to measure today at +5 to check the nadir won't go too low.

Thanks for the answer

 

[Marina & Chico]

I didn't have to go through that process, it seems to be more of an issue in the UK. I just asked my vet to start on Lantus as evidence suggested that it had a better duration and as such it was going to be easier to get George well regulated, and essentially the quicker you did that the better the chance of remission.
She prescribed Lantus.
We have had others here from Europe that have been started on Lantus without any issues, I've only ever seen a problem with the UK. I wonder if it is more about the licensing agreement with big Pharma in UK? or perhaps it has something to do with pet insurance cover(not common here in spain at least especially for cats) hmmmm.....

Marina I would just ask your vet for Lantus, if you want to try a gentler insulin, with a longer duration, Lantus has some great results, I wouldn't waste time, if you can help it trying to stabilise with caninsulin, it typically works too quickly, you get harsh drops and the duration just isn't there for most cats. No harm in asking, see what he/she says....
Prozinc is a better choice, but even with that the results are often better with lantus. Make your case, show him/her the Romp/Rand study perhaps.





I am not sure that these are bounces in the true sense of the word,
'Not all High Numbers are bounces'
When we see them dive down then back up and then dive back down immediately in the next cycle it's more likely that what we are seeing is a lack of duration.
During a 'bounce' we would usually see them stay high and flat for at least one cycle. The hormones responsible for the bounce would keep the BG high pretty much irrespective of what you shoot, you will often feel as if you have done a fur shot, or for me it felt like I was shooting water.
In Chico's case there is not enough information to say what is happening. But remember not all cats bounce.



Marina, one very important thing to note.
If you are removing the dry food, this often has a dramatic effect on the insulin requirement for your cat. So 2u, may drop him much lower than it has been until now. Please monitor carefully when transitioning of dry food.
The most extreme case we have seen of that is one cat going from 5u to remission in just 24hours, and he was only getting a few snacks of dry that he was stealing of the other cats in the house, when CG removed dry from the house his numbers dived. Great idea to get rid of the dry, but do it slowly, and monitor closely that means getting a test early on in the cycle and monitoring through to nadir.

The UK list here has many brands available throughout europe l https://docs.google.com/spreadsheets/u/1/d/1J5JpMe6TDXrHq_aTl9hUtHy6Gs9oRBqlz4nPGKxtySA/pubhtml I mostly use zooplus, but also some other online spanish provieders as the local pet stores don't stock anything suitable.
It would also be a good idea to use HC wet food and get some of that so you can use it if Chico were to drop too low. I used Purina Gourmet Gold meat in sauce varieties (they were 25-28% carbs DM~)
I have used animonda, integra, granata pet, kattovit, catz fine food, thrive, feringa amongst others. There is plenty of choice.

Even with the risk of repeating myself, today we excluded dry food, added 20g of wet food at +3 and his nadir was at around 13mmol/l. We will see the max BG before the next insulin shot, but is it possible for us the exclusion of dry food not to have such huge impact because his dry food was for diabetic cats already or should we still keep an eye on his nadir not going too low?

Thank you for your answer

 

[Marina & Chico]

Vets in Denmark is required to prescribe an animal drug first, only if its proven not to work in the specific cat, the vet can prescribe a human drug. Something called cascade rule here. Don't know if it's the same in other EU country's. Sad when it's proven human insulin works better and better chances for remission.

We will ask our vet and let you know if in Czech rep. it will be the same

 

[Marina & Chico]

Hi Bron,


The Czech Republic is an EU member state. The two insulins currently licensed in the EU for use in cats are Caninsulin and Prozinc so, in principle at least, they should be available in all member states.

Assuming that prescribing regulations haven't changed in the last month, the two licensed insulins must be tried first and shown to be ineffective before vets can legally prescribe other insulins under drug cascade rules (e.g. Lantus, Levemir).

I don't know how high the evidence threshold might be for any insulin switch in the Czech Republic.


Mogs
.

We will consult with our vet and update you on the issue

 

[Critter Mom]

We tried to remove the dry food today and at +3 hours we gave him 20g of wet food, his nadir was 13.4mmol/l (yesterday was under 8), is there any reason for us to worry more about decreasing his nadir? Maybe there won't be such high difference because the dry food we were giving him is for diabetic cats specifically and it has <20% carb, is it possible?

You need to work with the lowest nadir you've seen, Marina, for a couple of reasons.

Firstly, sometimes when a cat starts seeing lower BG numbers than it has been used to for a while the body's protective mechanisms can kick in to make the liver release extra sugars into the bloodstream in response (a phenomenon referred to here as 'bouncing'). Numbers may remain temporarily elevated for a short time, or they might stay that way for up to 6 cycles but there's no way to tell that in advance. If the carb load has been reduced during the bounce but the dose remains the same, there is a risk that the nadir BGs might get too low when the bounce clears.

Secondly, when higher carb food is removed from the diet numbers may continue to improve over a period of many days. Again there is no way to predict what might happen, you can only track Chico's response on each cycle (hence the need for very close monitoring to make sure he stays safe).

Here's an example of what can happen when dry food is removed from the diet. Harrison was treated with Vetsulin (another brand name for Caninsulin) and he was transitioned to a low carb diet upon diagnosis. His numbers started to improve after a few days, but after day 10 his numbers tumbled and he had to have his dose drastically and repeatedly reduced. After only 15 days of treatment, Harrison started on a remission trial. As of this evening he will have successfully completed the trial and will be considered a diet-controlled diabetic (no current need for any insulin).

Harrison's Spreadsheet

We urge caution with diet transitions because results like the above are possible, so you need to keep on top of the size of the insulin dose to keep your kitty safe.


Mogs
.

 

[Critter Mom]

Hi Sasha.

Vets in Denmark is required to prescribe an animal drug first, only if its proven not to work in the specific cat, the vet can prescribe a human drug. Something called cascade rule here. Don't know if it's the same in other EU country's.

Legally the position is the same in all EU member states (and currently in the UK unless post-Brexit there are rule changes). However, I think some vets might be more 'flexible' in their interpretation of the rules than others.

Sad when it's proven human insulin works better and better chances for remission.

It's worth noting that in the RVC's recent study they found that remission rates for both Prozinc and Lantus are comparable.


Mogs
.

 

[SashaV]

Hi Sasha.


Legally the position is the same in all EU member states (and currently in the UK unless post-Brexit there are rule changes). However, I think some vets might be more 'flexible' in their interpretation of the rules than others.


It's worth noting that in the RVC's recent study they found that remission rates for both Prozinc and Lantus are comparable.


Mogs
.

Hi Mogs!

Interesting it's the same. However, prozinc is not first choice here. Or the second really...

 

[Gill & George]

Even with the risk of repeating myself, today we excluded dry food, added 20g of wet food at +3 and his nadir was at around 13mmol/l. We will see the max BG before the next insulin shot, but is it possible for us the exclusion of dry food not to have such huge impact because his dry food was for diabetic cats already or should we still keep an eye on his nadir not going too low?

Thank you for your answer

I've run the numbers for vet life diabetic kibble and it appears to be around the 20% mark for carbohydrates, that's high carb, bear in mind that with a diabetic cat we want to keep it to below 10%, and yes it can have a huuuuge impact on the insulin requirement for your kitty, it can depend on the cat some cats are more sensitive to carbs than others, with some even a few pieces of kibble at 20% can really make them run in high BG. Every cat is different (ECID) but I have seen many cats drop significantly once the kibble is removed. I haven't come across any prescription diabetic dry food that is Low carb (under 10%) which is what our diabetic cats actually need, I bought royal canin diabetic kibble, because my vet advised it, I got home did my research and never fed it to George, that was even higher in carbs than the one you are using


Have a look at these two ss
Scooter was the kitty that was just stealing (his owner had no idea) some kibble and went from 5 to 0 units in 24 hours when kibble was removed from the house completely.
Scooter look at Feb 19 and here is the link to the thread for than day
Spider got rid of dry starting 6/4 to 6/8 by 6/15 was OTJ

I'm not saying it will definitely affect Chico that way, but there is a very real possibility that it is going to impact his BG, not necessarily in the first day it can take a few days to work out of their system. Without monitoring closely there is no way for you to know, you want to avoid seeing a symptomatic hypo event.


So I think it's a fantastic idea to get rid of the dry, but just be watchful.

As @Critter Mom has already said, we just want to keep him safe.

RVC's recent study they found that remission rates for both Prozinc and Lantus are comparable.

have you got a link to that study? I would be interested to read it thanks. I've had a quick look and I can find a recent study comparing once daily lantus to BID PZI, which is not how we dose lantus here so wouldn't be a fair comparison.

 

[Marina & Chico]

@Critter Mom and @Gill & George thank you very much for the advice, there is no way we would have stopped to monitor him but it is good to know we definitely shouldnt leave our gard down

 

[Critter Mom]

Hi Gill,

have you got a link to that [RVC research into remission rates with Lantus and Prozinc]? I would be interested to read it thanks

I'm tagging @Elizabeth and Bertie for you, as it was herself that I picked the information up from.


Mogs
.