11/10 New Member - Spencer's diabetes is becoming difficult to control

[hollyjolly]

Hello! I'm new here, but unfortunately not new to feline diabetes

Spencer was diagnosed in Feb 2018 after being sick for a few months (losing weight, drinking/peeing excessively). We put him on Lantus and slowly worked our way up to 7 units twice a day (I understand from the vet that this is a pretty high dose). He was okay for about two years at this level. In December 2019 at his annual checkup we found out that his BG was around 80 mg/dL. We took him off insulin (worried about him being low and thinking he was going into remission) and I tested at home for a while. By January he was back on 3 units twice a day and by July he was up to 8 units twice a day (still on Lantus). He was stable until January 2021 (~ 6 months after getting him leveled out). I found him in one of our beds with vomit all over himself and he was not very responsive. I tested him and he was at 30 mg/dL. We gave him syrup and lots of food to bring him back up. He was taken off insulin and we resumed testing regularly, but by August he was back up to 5 units twice a day. A few weeks ago (Oct. 29) I noticed that he wasn't feeling well and tested him... 70 mg/dL. Off insulin and testing at home again. My vet asked to see him ASAP to check his liver values and urine. He has a slight UTI (he's had them before) but nothing wrong with his liver. As this has now happened three years in a row and it's taking longer and longer to level him out, she suggested an ultrasound and a consult with internal medicine. On the ultrasound we are looking for anything that could be wrong with his pancreas. And with internal medicine, we are hoping for some guidance on other ways to manage his diabetes (i.e. switching insulin, more frequent testing) or possibly testing for other conditions that could be complicating controlling the diabetes.

Does anyone else have similar experiences? I'm not sure I'm on board with an ultrasound ($$$) but I don't think trying to line him out on the same insulin is a good idea either at this point. Looking for any guidance or past experiences.

Thank you!!

 

[Diane Tyler's Mom GA]

Hi and welcome ,you and Spencer have gone through a lot, I am going to tag a few experienced members for you about being on such high units of Lantus, but first if you can fill this out where do you live?

Here is a link helping us to help you link. If you noticed, our members have some basic information about their cat's in their signature. This helps us to not pester you by asking the same questions (your cat's name, insulin type, date of diagnosis, etc.) repeatedly. We also have a link to our spreadsheet in our signature. We are very numbers driven. The spreadsheet is a record of your cat's progress. By linking it in your signature, we can follow along and provide feedback should you need the help.

@Sienne and Gabby (GA)

@Wendy&Neko

Thank you ladies

 

[Diane Tyler's Mom GA]

Here is the link to the spreadsheet we use to enter of cats BG numbers on and it will also explain how it works so members can give you advice
Do you have any BG numbers that you have taken , if so you can enter them in your spreadsheet after it's set up
If you have trouble with setting it up please ask for help we have a wonderful member here that will be happy to do it for you
You can go to any members spreadsheet and take a look to get an idea what it looks like.
You can go to the Lantus page to get a look , go to any members page ,their spreadsheet will be attached to their signature
https://felinediabetes.com/FDMB/threads/how-to-create-a-spreadsheet.241706/


Here is the page for Lantus
https://felinediabetes.com/FDMB/forums/lantus-basaglar-glargine-and-levemir-detemir.9/

You can take a look at mine but since he's in remission go to the top and tap on my 2020
Sheet, at the end of my posts it says Tyler's spreadsheet

 

[hollyjolly]

Thank you for the response! I've added a signature with some info and created a spreadsheet with all of my data over the past few years. I live in Texas.

 

[Bron and Sheba (GA)]

Hi Holly and Spencer and welcome to the forum.
When you are using the alphatrak meter, you need to reduce the dose of insulin if the BG drops below 68. That is the take action number when you need to give honey and high carb food to bring the BG up over 68.
I think you would benefit from following one of our 2 dosing methods.
It is not a good idea to just stop the insulin if the BG drops low. That is an indication that the dose needs to be reduced NOT stopped.

Just stopping the insulin completely from say 5 units risks ketones forming in the urine. I would strongly recommend you test the urine daily at the moment for ketones. It’s a simple test and well worth while and can stop the much more serious DKA.
To test the urine for ketones you need to buy a bottle of Ketostix from Walmart or a pharmacy, collect a urine sample and dip the test strip into the urine and compare it against the colours on the side of the bottle exactly 15 seconds later. If there are any ketones showing, that indicates that the cat needs insulin and food.


It looks as if you don’t test every day. Is that correct? I would strongly recommend you get into the habit of testing before every shot and again during every cycle to see how low the dose is taking Spencer. That is the only way you can keep him safe.
I see you have gone several days without giving any insulin with preshots in the 300 and 400s.
It looks as if you have restarted at 2 units but there is no testing.

This is what I would recommend.
Have a look at our 2 dosing methods HERE
Depending on which method you choose, you will either reduce the dose at 68 (TR) or 90 (SLGS)
You don’t just stop the insulin if the BG drops lower…….you reduce the dose.
We can help you with it all.
Please start today as I am concerned Spencer has gone several days with no insulin and with high BGs.
I think he will need more than 2 units if he was getting 5 units when he dropped low.

Would you be able to update the SS please as we are very data driven. also the Pm cycle is just as important as the am cycle and you need to get at least 1 test in every pm cycle to keep Spencer safe.
Please ask lots of questions
Bron

 

[Diane Tyler's Mom GA]

Thank you for the response! I've added a signature with some info and created a spreadsheet with all of my data over the past few years. I live in Texas.

Can you please add to your spreadsheet what you are feeding, is it low carb wet , what brand, any dry food?

I was just about to say the same thing @Bron and Sheba (GA) said
You have to be testing him every day and night and during each 12 hour cycle
We don't ever increase by whole units
Do you have syringes with half unit markings
His doses are all over the place,
Please read the dosing methods it's very important, you need to choose one so we can help you.


On your Spreadsheet you have
07/07/2021 - 10/28/2021. 5 units with no testing for almost 4 months
There were other times like that also
Please you have to be testing him every single day and night and at least 2 or 3 times after his AMPS and PMPS
We want to help you and Spencer and get him on the right track

 

[hollyjolly]

His diet is Royal Canin glycobalance dry food. I do use syringes with half unit markings and I have given him half-unit doses before. I do not change his dosing on my own unless I find he is dangerously low. If he's acting weird, I will usually do a few tests and send results to my vet. Typically how we have been lining him out is starting at a dose and leaving him on it for 1-2 weeks. Then I will typically curve him and send the results to my vet. Sometimes she will also run a fructosamine to make sure we are doing okay long term. Then we keep him at that dose unless he is symptomatic. Then for the past three years he ends up running dangerously low for a few months until we catch it.

I do not feel comfortable giving him any insulin when he gets so low. And while I do test him at home when he's struggling, I am not going to test him twice a day everyday.

 

[Bron and Sheba (GA)]

Hi Holly,
Will Spencer eat canned food? The dry food you are feeding at the moment is high carb and not really suitable for diabetic cats. He would do much better on a low carb canned food….doesn’t have to be a prescription diet……I can give you a List of suitable foods for diabetic cats. Look for foods with carbs 10% or under.
If you did swap over , you would need to be aware that the BG would drop and you would need to be testing closely during the swaps over and adjust the insulin accordingly.

Lantus dosing is based on the nadir….or lowest point in the cycle. Not the preshot BG. So unless you are testing relatively frequently you won’t know what is happening and the best dose to give. I don’t want to pressure you, but honestly if you are not testing before every dose, you have no real idea if the BG is a safe one to give the insulin to. And by the time a cat starts showing signs of a hypo, they are very very low and are at risk of seizures.

I do not feel comfortable giving him any insulin when he gets so low

We are not suggesting you give insulin when the BG is low. What we are saying is….when the BG is low….that is telling you the dose is too high and you need to reduce the dose. I would also encourage you to go up or down in 1/4 unit increments not 1 unit increments or to just stop the insulin cold Turkey.

 

[Diane Tyler's Mom GA]

Sometimes she will also run a fructosamine to make sure we are doing okay long term. Then we keep him at that dose unless he is symptomatic. Then for the past three years he ends up running dangerously low for a few months until we catch it.

I do not feel comfortable giving him any insulin when he gets so low. And while I do test him at home when he's struggling, I am not going to test him twice a day everyday

Fructosamine tests tell you the average of the previous two weeks, but they don't tell you what your cat is in the moment. So your cat could be very high, and crash to hypo levels mid day, and a fructosamine test will show that he's doing well. home testing and doing curves at home is cheaper than bringing your cat for frequent vet visits, too. Once i started home testing she didn't go back for a year. home testing is more accurate too because they arent stressed at home like they are at the vet, which can cause the numbers to rise.

 

[Diane Tyler's Mom GA]

I do not feel comfortable giving him any insulin when he gets so low. And while I do test him at home when he's struggling, I am not going to test him twice a day everyday

Sorry you feel that way about testing him twice a day everyday.
It's the only way to keep him safe, he could drop so low and have a severe hypo during the night and you won't know it.
I'm sorry but your vet does not know much about diabetes
There are more experienced members here that have been here for 30 years and know more than most vets do about everything.

The dry food you are feeding is really high carbs
Plus you are not following any of the 2 dosing methods for lantus
I suggest you read about them if you're interested
https://www.felinediabetes.com/FDMB...-low-go-slow-slgs-tight-regulation-tr.210110/

 

[Diane Tyler's Mom GA]

with internal medicine, we are hoping for some guidance on other ways to manage his diabetes (i.e. switching insulin, more frequent testing) or possibly testing for other conditions that could be complicating controlling the diabetes.

You said here more frequent testing , that's what we have suggested but you said
, I am not going to test him twice a day everyday

Don't know what more to say so I wish you and Spencer luck
The RC Glycobalance is very high carb. The ME profile comes out to be about 24% of calories from carbs.

 

[FrostD]

Testing really is the only way to keep him safe. Do you understand the risks of hypos? Seizures? Brain damage? Blindness? Paralysis? Death?

I'm not trying to fear monger I just want to make sure you understand what can happen. By the time they are symptomatic it can be too late, it is not a wise game plan to wait for that to happen. Just this week we have had two cats that weren't regularly being tested at home have hypos....one of whom was seizing for 8 hours, and still two days later is mostly unresponsive and hoping for a miracle.

 

[hollyjolly]

Hi Holly,
Will Spencer eat canned food? The dry food you are feeding at the moment is high carb and not really suitable for diabetic cats. He would do much better on a low carb canned food….doesn’t have to be a prescription diet……I can give you a List of suitable foods for diabetic cats. Look for foods with carbs 10% or under.
If you did swap over , you would need to be aware that the BG would drop and you would need to be testing closely during the swaps over and adjust the insulin accordingly.

Lantus dosing is based on the nadir….or lowest point in the cycle. Not the preshot BG. So unless you are testing relatively frequently you won’t know what is happening and the best dose to give. I don’t want to pressure you, but honestly if you are not testing before every dose, you have no real idea if the BG is a safe one to give the insulin to. And by the time a cat starts showing signs of a hypo, they are very very low and are at risk of seizures.


We are not suggesting you give insulin when the BG is low. What we are saying is….when the BG is low….that is telling you the dose is too high and you need to reduce the dose. I would also encourage you to go up or down in 1/4 unit increments not 1 unit increments or to just stop the insulin cold Turkey.

I'm open to trying other foods, but this food was the one recommended by my vet for diabetic cats.

If you are suggesting to lower the insulin dose (rather than stop insulin) when his sugars are low that would mean I am still giving him shots when he is so low. When I find out he is low (typically by noticing he's not feeling right) I start testing him to see where he's at. If he's low (typically less than around 70), I don't give insulin. I'll give him food and continue testing/monitoring. I also contact the vet and we usually do checks on his liver and some other blood work to make sure there isn't something else wrong. We always end up going back on insulin at a low dose and working our way up.

 

[hollyjolly]

Fructosamine tests tell you the average of the previous two weeks, but they don't tell you what your cat is in the moment. So your cat could be very high, and crash to hypo levels mid day, and a fructosamine test will show that he's doing well. home testing and doing curves at home is cheaper than bringing your cat for frequent vet visits, too. Once i started home testing she didn't go back for a year. home testing is more accurate too because they arent stressed at home like they are at the vet, which can cause the numbers to rise.

I don't rely solely (or even largely) on fructosamines. After he has had a low incident and we are starting him up on insulin again (as I described above I have been testing him, he goes to the vet to confirm nothing else is wrong), the vet will chose a low dose which I will give for 1-2 weeks. Then I will curve him at home and send her the results. She adjusts the dose based on this and we continue to do this until his curves look good. Then after he's been on a stable dose for about a month, she typically likes to run a frustosamine. If that comes back okay, he's stabilized and we stop testing. If not we may increase his dose again and keep testing. I do basically all of the testing at home (except fructosamine obviously, but we only do those after looking at the results of home testing). In fact he's only had his blood sugar tested maybe 4 times at the vet (when he was diagnosed and then annually for his check up) and he only needs fructosamines a few times when he crashes and we are trying to stabilize him.

As far as the cost goes, nothing about a diabetic cat is cheap including home testing which is ~$2 per test. I am able to test/curve at home and email my vet, so that does reduce the number of visits. But of course these remissions scares are still very expensive.

 

[hollyjolly]

You said here more frequent testing , that's what we have suggested but you said
, I am not going to test him twice a day everyday

Don't know what more to say so I wish you and Spencer luck
The RC Glycobalance is very high carb. The ME profile comes out to be about 24% of calories from carbs.

I think there's probably somewhere in the middle of testing multiple times a day everyday and only testing when he's off (as I'm doing now).

 

[Sienne and Gabby (GA)]

Just as a point for consideration, I don't believe there is a pediatrician in the US who would tell a parent to not test their child if their child is diabetic. Typically, people test several times a day -- especially with a child if that child can't communicate well about how they feel in relation to their blood glucose levels. Having a diabetic child is not really different than having a diabetic cat -- neither have an effective way of telling you that their numbers are low until it may be a dangerous situation.

There are any number of issues to consider based on the information that you provided.

• Like humans, a diabetic cat needs to be fed a low carbohydrate diet. Royal Canin Glycobalance is one of the worst offenders of being a "diabetic" food that is actually quite high in carbs. Cats also need to be on a species appropriate diet and cats are obligate carnivores -- even a non-diabetic cat doesn't process carbohydrates.
• We are strong advocates for home testing. We have an excellent track record of not having cats die from symptomatic hypoglycemia. In addition, one of the major researchers on feline diabetes who developed the tight regulation protocol for Lantus and Levemir, advocates for home testing.
• There is no magic involved in knowing when to increase or decrease a cat's insulin dose. Humans adjust their dose all the time without calling their doctor.
• Given the doses that your cat has apparently needed, high dose conditions should be ruled out. I want to temper this statement because it's not clear if the high dose need is a result of your cat eating food that is very high in carbs and high carb food and high insulin doses are correlated.

Just to clarify Melissa's (FrostD) comment, if your cat has a lower than expected or lower than safe reading and it's time for a shot, no one here would tell you to give the shot if it would be dangerous to do so. We would tell you to give some food and get the numbers into a safe range. It may be appropriate to skip that shot, give a reduced dose, or stall -- a great deal depends on the circumstances. At the next shot time, a dose reduction would likely be indicated. Because a cat's numbers drop to 80, for example, does not mean the cat is in remission and you should stop insulin. There is a reading that indicates when dose reductions are needed and the goal is to reduce doses so you are slowly tapering insulin down so it's not an all or nothing impact on your cat's pancreas. You want to support what may be a healing pancreas with insulin until the pancreas is able to function normally without benefit of insulin.

 

[hollyjolly]

Testing really is the only way to keep him safe. Do you understand the risks of hypos? Seizures? Brain damage? Blindness? Paralysis? Death?

I'm not trying to fear monger I just want to make sure you understand what can happen. By the time they are symptomatic it can be too late, it is not a wise game plan to wait for that to happen. Just this week we have had two cats that weren't regularly being tested at home have hypos....one of whom was seizing for 8 hours, and still two days later is mostly unresponsive and hoping for a miracle.

Yes I understand the risks and this is why when he's low I do NOT give insulin and continue to test until he's high again. I will confirm with my vet, but as far as I understand I can catch when he's low without testing before he's at risk of seizures and other serious side effects. I am good at understanding when my cats are sick (I have another cat that's not diabetcic) and bring them to the vet before most owners would notice anything (that's from my vet's perspective at least). I think I am good at judging his sugars by his behavior. Maybe that's an incorrect assumption, but I'll confirm with my vet.

 

[hollyjolly]

Just as a point for consideration, I don't believe there is a pediatrician in the US who would tell a parent to not test their child if their child is diabetic. Typically, people test several times a day -- especially with a child if that child can't communicate well about how they feel in relation to their blood glucose levels. Having a diabetic child is not really different than having a diabetic cat -- neither have an effective way of telling you that their numbers are low until it may be a dangerous situation.

There are any number of issues to consider based on the information that you provided.

• Like humans, a diabetic cat needs to be fed a low carbohydrate diet. Royal Canin Glycobalance is one of the worst offenders of being a "diabetic" food that is actually quite high in carbs. Cats also need to be on a species appropriate diet and cats are obligate carnivores -- even a non-diabetic cat doesn't process carbohydrates.
• We are strong advocates for home testing. We have an excellent track record of not having cats die from symptomatic hypoglycemia. In addition, one of the major researchers on feline diabetes who developed the tight regulation protocol for Lantus and Levemir, advocates for home testing.
• There is no magic involved in knowing when to increase or decrease a cat's insulin dose. Humans adjust their dose all the time without calling their doctor.
• Given the doses that your cat has apparently needed, high dose conditions should be ruled out. I want to temper this statement because it's not clear if the high dose need is a result of your cat eating food that is very high in carbs and high carb food and high insulin doses are correlated.

Just to clarify Melissa's (FrostD) comment, if your cat has a lower than expected or lower than safe reading and it's time for a shot, no one here would tell you to give the shot if it would be dangerous to do so. We would tell you to give some food and get the numbers into a safe range. It may be appropriate to skip that shot, give a reduced dose, or stall -- a great deal depends on the circumstances. At the next shot time, a dose reduction would likely be indicated. Because a cat's numbers drop to 80, for example, does not mean the cat is in remission and you should stop insulin. There is a reading that indicates when dose reductions are needed and the goal is to reduce doses so you are slowly tapering insulin down so it's not an all or nothing impact on your cat's pancreas. You want to support what may be a healing pancreas with insulin until the pancreas is able to function normally without benefit of insulin.

I suppose this is where we differ. I think there is a significant difference in having a diabetic child and having a diabetic cat. Testing is more invasive for cats and cannot be explained to them as you can with a child (other than babies I suppose, but then you're brain isn't developed enough to store memories). There is no explanation to a cat why you are pricking & squeezing their ear every hour. They are aware of what's happening and they remember, but can never receive an explanation. And while Spencer has been incredible and handled all of this so well, I don't think that's the solution long-term.

 

[FrostD]

Ok. Well it sounds like you're pretty set in what you do and don't want to do, just wanted to make sure you understood how we manage FD here, best practices we follow, and some of the risks involved with your current process. Best of luck to you and Spencer!

 

[Sienne and Gabby (GA)]

All I can suggest is to look at the spreadsheets of may of the members here. I was a testaholic. Beyond the first few days, I never had an issue with testing. The testing is reinforced by giving treats. Cat's also begin to comprehend that what we're doing, despite poking them with lancets and needles, helps them to feel better. That is something they understand. Not all learning needs to be verbal. I also had a cat who could dive into very low numbers very early in the cycle. The way I kept her safe was to test and because she was unpredictable, I tested often. She never had a symptomatic hypoglycemic event in over 6.5 years.

I'm not entirely sure how we can help you. A number of people have responded to your questions. For example, the information about diet is very straightforward yet you seem to question its veracity. You might want to look over this website on feline nutrition that's written by a vet. We're happy to discuss our experiences and provide feedback but at this point, I'm not sure what information you're looking for.

 

[Chuckington]

I'm not an expert but I will say that I don't think you necessarily need to test him multiple times every day in order to figure out how to help him. This forum is incredibly helpful in so many ways, but I don't always think it's best to tell people that they must test their cat multiple times a day to manage this condition. Its not feasible for everyone and if someone told me that I had to test Chucky every single day, multiple times a day to take care of him, he'd still be in the shelter or foster care. Where they were not testing him daily either lol.
Its also not true as a rule. Alot of people do not home test and their diabetic cats are fine.
I think it's better to try to meet people where they are than to draw a line in the sand and pretty much be like well, if you're not gonna test all day every day, then we can't help you.
Ya'll are smart people lol, there's no reason why we can't try to help this person figure this out in a way that is gonna work for their lifestyle.

With that said, I think you're on the right track about needing to test on a more regular basis to figure out like...what his arc is and how to break it.
It sounds like y'all might be moving his dose up a bit too quickly? So you give him enough and he stabilizes but then the depot gets overwhelmed and it sends him into hypo.
I doubt that he's high one day and then bam, hypo. So even if you test every other day or twice a week, logic dictates that you should be able to notice when he's starting to trend down, so you can reach out to your vet and figure out what to do. What that frequency is, I have no clue. I also understand that cats don't always go in a line, sometimes they bounce around, so it may not be exact. Although if you've done curves and you know around when his nadir is, doing your test around that time could help with consistency.
But even if it's not a perfect solution, surely, it's better than waiting for him to hit bottom.

Before springing for the ultrasound, have ya'll talked seriously about switching his insulin?
Maybe he would do better on ProZinc or something else that doesn't form a depot.

Also, are you open to switching to a human meter for unofficial testing? That would help alot with the costs at least and you'd still be able to draw a trendline with the results.
And then you could save the alphatrak for when you're doing his curves or getting results that you'll send to the vet.

 

[FrostD]

I agree with Sienne's sentiments.

Nobody is saying test all day every day. What we ARE saying however is that there are minimum requirements if you're going to follow the dosing methods we have here. And that includes testing preshots at minimum, and ideally once again in each cycle. And if you can't test often due to life, not wanting to, whatever there needs to be a curve once a week.

We cannot in good conscience make any sort of recommendations without the data to support it. What I see in the spreadsheet is doses that have been raised too much, sometimes too quickly, which leads to overfull depot, bounces, and eventually hypos when his system gets worn out. Skipped doses that risk ketones and DKA, and then too many changes in dose that never give the depot a chance to stabilize.

Lantus is a perfectly good insulin for the majority of cats when used properly/methodically. You do not adjust the dose based on preshot, unless the preshot is unusually low. You adjust it based on nadir, and that data really isn't in the spreadsheet.

 

[FrostD]

If you want to check for underlying issues I would start with IAA and acromegaly tests; however please check with your vet, one if the tests (I believe IAA) requires being on insulin for 70 days or you may not get an accurate result? I'm not sure how skipping, etc may affect that.

I'm not convinced the high dose is due to underlying condition, it is more likely a factor of diet and possibly may be too high of a dose exacerbating the issue, but I cannot say for sure without the data. If you have the money and would like to test, there is obviously no harm in doing that.

 

[Bron and Sheba (GA)]

I doubt that he's high one day and then bam, hypo. So even if you test every other day or twice a week, logic dictates that you should be able to notice when he's starting to trend down, so you can reach out to your vet and figure out what to do. What

@Chuckington ……this statement is simply not true. A cat can easily be high at the beginning of a cycle and drop to an unsafe BG number in the same cycle…..especially if they are coming off a bounce or if they are getting too much insulin. Cats don’t always conveniently trend down. Only yesterday I was helping a kitty after a hypo event when the caregiver was not testing consistently.
We are very open to helping Holly, but she is not interested in looking at any of our suggestions.
Anyone who thinks they can just observe a cat and know when he or she is running lower without any testing is very uninformed. By the time a cat starts showing signs of a hypo they are dangerously low and can have a seizure at any moment.
Yes there are many many cats in this world that are diabetic and are never tested. We don’t know how many of them have hypos and survive or die. We get some of them here after such as event. What we are doing is best practice. It’s entirely up to the individual what they want for their own cat.
I would just make sure that when you are giving advice…and you say yourself you are no expert…that the advice you are giving is good advice.

 

[Chuckington]

@Chuckington ……this statement is simply not true. A cat can easily be high at the beginning of a cycle and drop to an unsafe BG number in the same cycle…..especially if they are coming off a bounce or if they are getting too much insulin. Cats don’t always conveniently trend down. Only yesterday I was helping a kitty after a hypo event when the caregiver was not testing consistently.
We are very open to helping Holly, but she is not interested in looking at any of our suggestions.
Anyone who thinks they can just observe a cat and know when he or she is running lower without any testing is very uninformed. By the time a cat starts showing signs of a hypo they are dangerously low and can have a seizure at any moment.
Yes there are many many cats in this world that are diabetic and are never tested. We don’t know how many of them have hypos and survive or die. We get some of them here after such as event. What we are doing is best practice. It’s entirely up to the individual what they want for their own cat.
I would just make sure that when you are giving advice…and you say yourself you are no expert…that the advice you are giving is good advice.

Please don't put words in my mouth or get snippy with me.
I didn't say it wasn't possible for any cat ever.
I said I doubt it in the context of this case.
Since Spencer seems stable on his dose for some time before falling into hypoglycemia, it seems to me that if she can test him consistently and on a more regular basis, even if not every day, she might be able to catch that downward trend in progress, since it seems like he develops the issue over the course of months.

It's possible that you're right - that he will test high for months and months and then bam, he's on death's door. Entirely possible. But considering the timeline she shared, it doesn't seem likely.
It seems like there's an arc that he follows and she might have the opportunity to test him with enough frequency to interrupt it before he falls into hypoglycemia. And then she can work with his vet to adjust the dose from there, since she doesn't seem comfortable adjusting the dose herself.
That's what I said.

I get that it's not the ideal approach per the forum but it seems like a common sense and safer approach than not testing at all until he starts showing hypo symptoms.
I hope we can all agree that some testing and monitoring is better than essentially none.
So I tried to suggest a way that she can test periodically, the way that she wants to, but strategically, so she can still possibly get some picture of what is going on with him.

If this is a terrible idea and you have a better way to go about it, please share. That's what she was asking for in the first place.

But if the answer is pretty much that she has to follow the recommended protocol or there's nothing anyone can recommend or no way that anyone here can help her, I struggle to believe that.

Final point, I am not saying that what this forum recommends is not best practice. It's clear that your methodology is well researched and has worked for many cats.
But speaking realistically, what ya'll recommend is not feasible for everyone. It's just not.
But that doesn't mean that their cat is doomed lol.
What yall recommend is not the ONLY way to manage a diabetic cat. It may be the gold standard but it's not the only way and she, like alot of people, is trying to find where on the spectrum of care she can comfortably reside.

With all the knowledge on this board, I think it's weird that it's just like, welp you don't want to follow our protocols and you're hesitant about going against your vet's advice, so bye, good luck to you.
That's super lame.

 

[Bron and Sheba (GA)]

Please don't put words in my mouth or get snippy with me.

@Chuckington. I am not putting any words in your mouth. I quoted you exactly.
My reply was not meant to be snippy…….I am not a snippy person at all.
This forum is a peer reviewed board, which means we can all see what everyone is writing, and if someone offers advice which is not correct or needs further explanation, it is up to the experienced people here to correct that information.
We have many caregivers here who read through all the threads looking how to help their kitty….some don’t post but just look for information. It is our job to ensure that the information posted is correct.
We are all volunteers here, all of us have had diabetic cats, and many of us spend hours everyday helping cats around the world.
We have volunteers from all over the world so there is always someone here to help.

In the subject line Holly says Spencer’s diabetes is becoming difficult to control…..we are giving her our best answers on how to get the diabetes under control……..and it is not testing just when she thinks he is ‘acting weird’. Or getting a fructosamine test done, (which is very old school, and redundant if home testing is done)……and if the fructosamine test is ok leaving the dose as he’s stable. The fructosamine test is an average of the last few weeks BGs…the highs, the lows and the inbetween. It does not tell you if the cat has has a very low BG or a very high number. The only time a fructosamine test is good is at diagnosis, when it can confirm that the BGs have been high for the last few weeks.

If a caregiver would like help here on the forum, we ask that they set up a spreadsheet and a signature so that we can have some basic information about the kitty and some data to help with dosing. I notice you have not done either the SS or the signature. It would help if you filled them out.

Im sorry you think we are ‘super lame’. Without protocols and proper dosing methods in place, it would be a free for all and many kitties would be at risk. This is a very well and professionally run forum and we can only tell you what we have found to be best practice and safest for our kitties. We are not going to recommend or condone testing the BG only when the kitty seems weird. We are not saying the cat is ‘doomed’….what we are saying is that if you want to keep your kitty safe, we recommend hometesting before every shot to see that that the preshot is high enough for the dose……it often isn’t! And testing at least once during the cycle can tell us how well the insulin is working.
It is completely up to the caregiver if the advice is taken or not.

 

[Christie & Maverick]

FWIW, I didn't find Bron's post snippy at all, and from my perspective, I wholeheartedly agree that it is important to clarify/disagree with statements that are either incorrect, or misleading, particularly since as was noted, there are many members here on the forum, some of whom do not post specifically for help, but read information and apply that information.

I will confirm with my vet, but as far as I understand I can catch when he's low without testing before he's at risk of seizures and other serious side effects. I am good at understanding when my cats are sick. I think I am good at judging his sugars by his behavior.

Unfortunately, with all due respect, that didn't appear to be the case on January 17th. Getting 26-30s on an AT2 is dangerously low, and you did mention you found him with vomit all over himself and non-responsive.

There have been some good suggestions in this post regarding what you might want to consider doing differently, so I won't repeat them. What I will say from my perspective, why not give it a try for a while and see if you are getting better control over your kitty's diabetes, since what you have been doing up to this point doesn't seem to be working for you and as you say his diabetes has been difficult to control? You can always go back to what you have been doing if you find our approach to managing FD isn't helping you.

As Bron said previously, I think at the very least if you do decide to change to a lower carb diet (remove the dry), you may want to monitor his BG levels more closely during that time of transition, since there have been instances with kitties having a marked decrease in insulin requirements when the high carb dry food is taken out of the mix. The other thought I have on feeding, since it wasn't clear what your feeding schedule is like - depending on how you are feeding Spencer, I'd suggest you might want to try feeding him some small snacks during each cycle, if you aren't already doing so.

Since it didn't appear to have been mentioned previously, I'd like to point out that insulin is a hormone, not a drug, and many things can influence how it is metabolized, which is also why insulin needs can (and do) change.

From a personal point of view, like Bron, I too have been involved recently with a caregiver who had been managing her cat's diabetes for many years, and apparently not testing adequately enough, assuming that things were working out just fine, until they posted here for urgent help as their cat was going through multiple prolonged seizures and there was no vet open where they could get immediate assistance. I can assure you, that is both mentally and emotionally exhausting to be the "other person on the line" and trying to help a CG whose cat isn't coming out of it, no matter how much syrup was given.

Lastly, I'll post something that I read many years ago when I first joined this forum, that really stuck with me - (from moderator Jill)

"For those offering suggestions/advice: Sometimes it's best for someone offering advice or suggestions to simply walk away from a given situation. One of my favorite lines from the Suggestions for Advice Givers: "You can offer help and advice, but it's up to the other person to decide what advice to take for their cat. They won't always agree with you -- that's life. If it makes you crazy, move on to someone who is interested in what you have to say."

For caregivers: Sometimes it's in your kitty's best interest to listen and rethink/reconsider advice and suggestions made even when the comments may seem brutal... especially when the same suggestions and advice appears to follow a recurring theme. When the same advice is offered over and over again from multiple members, it may be the best damn advice you're going to get!"