New Member-Advice on Dosing

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Unmitigatedgall

Member Since 2021
Hello All! I'm looking for some advice, but first here is the (long) back story:
Nikita (17 years old) was diagnosed with Hyperthyroidism 3 years ago. She underwent radiation iodine treatment and has had low T4 since, but our vet of 10 years said not to worry as weight gain would be the only side effect. 2 years ago we started to RV fulltime, so the cats have been seeing different vets for their checkups.
Last year at her check up she was diagnosed with CKD and put on Royal Canin Renal Dry (she would never eat wet food). She didn't love the taste, so we cut it with 25% fancy feast dry for the past year.
7/21- We brought her in for a wellness check because she was experiencing neuropathy in her hind legs and had lost weight. I had anticipated that her CKD was advancing, but she was diagnosed with Diabetes (512mg/dl glucose). She had no ketones in her urine and was put on 1 Unit of Lantus twice daily to start. Because of the CKD the vet recommended half renal/half DM food and to try to switch to wet versions of these. The vet did not recommend home testing and said to schedule a gl curve

We started the Lantus on 7/22 without home testing and planned for a glucose curve 10 days later at our next stop in Wyoming. In the interim I started researching food, realized the prescription foods were terrible and started testing wet high protein/low phosphorus foods on Nikita. After 2 weeks we found Tiki Cat Mousse and Weruva BFF flavors she liked and switched from all dry to 70% wet during this time period. The day of the curve I gave a fur shot (sigh) and we needed to reschedule for the next week.

8/5 was the scheduled day of curve we shot and fed her at 8am and dropped her off as discussed. I received a call about an hour after saying there was a misunderstanding and that the vet required a full check up prior to scheduling a curve and we needed to pick her up and reschedule. Sigh, again. I asked them to check her gl when we picked her up (+2 from shot time) and it was 132mg/dl glucose.
At this point we decided to order our own Alpha Track 2 and do the curve ourselves. We order it...and it is delayed shipping. I was paranoid about the possibility of hypo, so was feeding her every few hours and watching for signs.

8/08 she started to have have diarrhea and vomiting for a couple days. She didn't receive her 8/09 or 8/10 AM shot, but received the PM shots both days.

8/11 she was brought to the vet after receiving her AM shot and eating for solution to the diarrhea. The vet tested her gl at 11am (+4 after shot) and it was 70mg/dl. They kept her for the day for hypo and to hydrate. The vet wanted to reduce her Lantus to 1 unit shot per day. She also prescribed flortifora and started her on Thyrosyn to increase T4 levels (which she said could be negatively impacting kidneys)

8/12-8/19 she was given only one shot per day. No evidence of neuropathy and had switched to 90% wet food diet
8/20 she vomited in the morning, so did not receive her shot. As the Alpha Track 2 was finally arriving the next day we decided to wait until we could test to give her anymore insulin.

8/21-8/23 No insulin given. AM and PM tested pre meal the reading range from 118-168 mg/dl (the 168 reading was the morning I forgot to pick up the dry overnight food 2 hours prior to the AM test)

So...the question is: Is the diet change good enough? If we had never started the Lantus would it even be necessary? Or should we restart Lantus on a very small dose until all numbers are under 100 mg/dl?
 
Hi and welcome to the forum. Nikita is very pretty!
I’m so glad you are home testing. It makes it much safer for Nikita and much easier to see how the dose is affecting the BG (blood glucose)
Do you think you could set up our spreadsheet and signature please?
These two things will give us a lot of information and we will then be able to advise you about dosing.
You will find the link to both the signature and the spreadsheet in THIS link

Sometimes a diet change is enough and the cat then becomes a diet controlled diabetic. In that case she would always be a diabetic and need low carb food.
Can you list exactly what food you are feeding at the moment and how often please?

One thing I would do if you are skipping insulin doses, is to test the urine daily for ketones. To do this you will need to buy a bottle of Ketostix from Walmart or a pharmacy, collect a urine sample from Nikita and follow the directions on the bottle.
Bron
 
Signature and spreadsheet has been set up; thank you for the link!

Nikita is fed 5 small wet meals at 6:30am, 10:30am, 2:30pm, 6:30pm, 10:30pm and a small amount of dry is left out from 11pm-4am. She has a littermate brother (Birkoff) that eats the same food at the same time, so the total food split between 2 cats is:

6:30am-
1 Tiki Cat Velvet Mousse with Flortiflora sprinkled (80 cal)
10:30am-
1 BFF OMG (55 cal)
2:30pm-
1 BFF OMG (60 cal)
6:30pm-
1 Tiki Cat Velvet Mousse (70 cal)
10:30pm-
1 BFF OMG (55 cal)
11pm-
Light 1/4 cup of DM (120 cal)
1 scoop Welactin (11 cal)
The flavors vary, but each day is formulated to have about 10% carbs and low phosphorus.

I started testing ketones today; none present so far.

Nikita has not received any insulin since 8/19. Without insulin does a blood glucose curve make sense to do as she is fed at equal intervals throughout the day? Would a vet even prescribe insulin with her current numbers?
 
I'll tag
@Bron and Sheba (GA)

,
We cannot see your spredsheet
To set spreadsheet sharing permission:
* At the top right of the spreadsheet screen click on Share.

* In the pop-up dialog box click on the Get Link section.

* Change link access from 'Restricted' to 'Anyone with the link' and make sure that the permission on the right hand side is set to 'Viewer'.

* Click Done to save the changes.
 
Last edited:
@Bron and Sheba (GA)
Bron please note Stephanie has noted above

Nikita has not received any insulin since 8/19. Without insulin does a blood glucose curve make sense to do as she is fed at equal intervals throughout the day? Would a vet even prescribe insulin with her current numbers?

And before tha
8/11 she was brought to the vet after receiving her AM shot and eating for solution to the diarrhea. The vet tested her gl at 11am (+4 after shot) and it was 70mg/dl. They kept her for the day for hypo and to hydrate. The vet wanted to reduce her Lantus to 1 unit shot per day. She also prescribed flortifora and started her on Thyrosyn to increase T4 levels (which she said could be negatively impacting kidneys)
 
The amount of food you mention adds up to 451 cals so they get 225 each a day. How much do your cats weigh. In my calculations that would be enough for a 9 lb cat a day. You may need to be feeding more.
Some of the BGs are a bit high. If you are feeding higher carb food, that can make a difference. Make sure you are feeding 10% or less carbs, preferably around 5%.
Also I would suggest getting a test in 3 hours after food to see if the BG has dropped.
 
Without insulin does a blood glucose curve make sense to do as she is fed at equal intervals throughout the day? Would a vet even prescribe insulin with her current numbers?
Yes please keep testing the BG levels. And try and get some tests in during the cycle as well so we can see if the food is bring one down the BG.
At the moment I don’t think the vet would prescribe insulin, but the BGs above 150 are too high……if you are using an alphatrak meter
If you can Re look at the carbs in the food and make sure you are feeding a low carb food and not a higher carb food. That can make a difference.
 
@Bron and Sheba (GA)
I think she is asking should she be giving insulin now
This was her question
Thanks Bron


So...the question is: Is the diet change good enough? If we had never started the Lantus would it even be necessary? Or should we restart Lantus on a very small dose until all numbers are under 100 mg/dl?
 
The dry DM is too high in carbs.
In the US (waving to you from Canada), the only dry foods low enough in carbs are Young Again (you can request a sample from the company), Dr Elsey's Clean Protein, and Wysong Epigen 90.

Love your moniker.

Thanks!
Yep, I went down quite the rabbit hole on nutrition information once she was diagnosed. I’m convinced it was the Royal Canin Renal that caused the diabetes to begin with. I’ll be switching her to Dr. Elsey’s next month, but the small amount of DM she is currently having is negligible in the overall diet. I’m keeping her around 10% carbs due to her CKD.
 
The amount of food you mention adds up to 451 cals so they get 225 each a day. How much do your cats weigh. In my calculations that would be enough for a 9 lb cat a day. You may need to be feeding more.
Some of the BGs are a bit high. If you are feeding higher carb food, that can make a difference. Make sure you are feeding 10% or less carbs, preferably around 5%.
Also I would suggest getting a test in 3 hours after food to see if the BG has dropped.

Both cats are small 9 lb cats. They are 17 and have been around this weight most of their adult years. They are indoor and not super active, so the food amount is about as much as I can get them to eat.

Nikita has stage 3 CKD; I wouldn’t want to feed less than 10% carbs unless her BG were high.
 
Both cats are small 9 lb cats. They are 17 and have been around this weight most of their adult years. They are indoor and not super active, so the food amount is about as much as I can get them to eat.

Nikita has stage 3 CKD; I wouldn’t want to feed less than 10% carbs unless her BG were high.
If they are 9 lb that should be an ok amount.
I think if you could reduce the amount of carbs with the dry you are feeding, you might see the BG drop down a bit.
If you can get a few tests 3 hours after feeding in the morning for example, or at night, we can see if that brings down the BG. If it does, it means the pancreas is producing some insulin in response to the food.
 
If she were above 150 what dose should she be given? .25 U?
I would try to see if you can reduce the BG with changing over to a low carb dry (if that is what you want to feed) before giving any insulin.
An alphatrak meter reads higher than a human meter so when we see a cat going into remission being tested on a human meter, the BGs are mostly all green. But with a pet meter the normal range is higher so you can expect to see some blue.
If the change does nothing, you might be able to give a drop dose of Lantus, but I’d like to ask some others about it first.
 
I also see that the vet reduced the dose to just a dose in the morning. Lantus is a 12 hour is in cats and needs to be given 12 hours not each 24 hours.
It is far better if the vet does that, to harve the dose he says and give 1/2 in the morning and half in the night. So if he says give 1 unit a day…..give 0.5 in the am and 0.5 in the pm. bit at the moment I’d try tweaking the diet and if that doesn’t work, we can look at a very tiny dose.
How does that sound?
 
Thanks for the advice! I’ll be able to test throughout the day on Thursday and see where her numbers are a few hours after eating.
The vet wants us to stop insulin based on her numbers, but the green/blue numbers in the OTJ forum had me worried.
 
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