Newbie needing help with dosing

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Emma Troxell

Member Since 2021
Hi there! My cat was diagnosed about a week and a half ago after having pancreatitis. Bloodwork on 11/3 showed an elevated BG (high 300s). At the vet on 11/4 his BG was 400+ and they confirmed diabetes. They never tested his urine. At the time I was tube feeding him and they sent me home with Lantus and told me to feed him then give 1 unit every 12 hrs. A few days later he started eating on his own (fresh pet vital slice and serve pate) so he is getting better from the pancreatitis, acting much more himself. Over the past week his numbers have been getting lower. When I did the inital curve on him his PS numbers were 200+, now they are are around 150 and this morning was 131. I gave a half dose (0.5 U) and am continuing to monitor. Thankfully I have a follow up appt tomorrow morning and can ask the vet all my questions. What should I be asking?? I will also attach his spreadsheet: https://docs.google.com/spreadsheet...DsBwblgcHtLA1MqA_JkvlND6WEItl1FiNNMSR/pubhtml

Thank you in advance
 
Welcome to you and your handsome kitty. What’s his name?
How was his pancreatitis diagnosed? Was a blood test sent out to a lab or a in house test run? Pancreatitis can temporarily raise the bg. With the numbers you are seeing I wonder if he’s truly diabetic or not. It is great he started eating on his own. Max had pancreatitis for a few years before becoming diabetic. Did your bet run a urinalysis? What medication is he getting right now?
 
Thank you! His name is Mr. Lump. silly name but it just stuck LOL

basically he stopped eating on and off but it was going on for about a month - emergency ultrasound showed he was beginning to develop fatty liver and had thickened intestinal walls. they put in a feeding tube and did a biopsy at the same time. those results showed IBD and pancreatitis. the vet said she thinks it was more pancreatitis than IBD though. he was getting cerenia for nausea however i havent given it in about a week as he is eating on his own now. he is also on 0.75ml budesonide for the inflammation. i've read that can also cause diabetes in cats. they did not do a urinalysis. the blood test they used to diagnose him was done on 11/3 and they called with results on 11/4 so i'm not 100% sure if they were done in house or not, but it is a specialty and emergency center so i assume they can do it on site. the GI panels and biopsies were sent out to a lab
 
That is all very helpful information. Max became inappetent slowly when diagnosed with pancreatitis and after his first experience that was always my clue that he was having a bout. His was chronic. It is possible Mr. Lump might have had a one time acute attack or will have more and be chronic. Time will tell. Since they called the next day they sent the test out and that is very good. The in house test just gives a positive/negative so if in the gray zone you might think it’s not pancreatitis. The one that’s sent out gives a score. That being said if it’s high or on the lower end of the scale it doesn’t mean they are more or less sick .

I am glad they tried budesonide instead of prednisolone as prednisolone is more apt to cause diabetes.

Did they run a fructosamine? It will give you an idea of the bg over the past couple weeks. That way if stress caused the spike in bg it would confirm if diabetic.

I would stick with the .50 dose now. His numbers are close to normal at this point and the drop to 76 shows he might not need that much insulin. We decrease the dose with a bg reading under 68 here if using a pet meter and following TR.

Here is a link to the pancreatitis handbook.
https://www.felinediabetes.com/FDMB/threads/a-primer-on-pancreatitis.79693/
 
They did not run a fructosamine but did tell me to schedule one with my regular vet. I have a follow up to do that soon. I'll check out that guide, thank you!! I'm so grateful for this forum!
 
If you continue testing at home you won’t need a fructosamine run or a curve. You can get all the information you need at home without the stress of a vet visit to raise the bg artificially. The on.y reason I asked if one was run was to rule out a stress elevated rise in bg.
 
oh good! he absolutely hates the carrier and car rides, he throws up or poops or both :(
what are some questions i should be asking the vet tomorrow? she hasn't talked to me about dosing protocol at all. do i need to ask for a urinalysis?
 
At this point I don’t think you need a urinalysis. It’s odd if one wasn’t done at diagnosis as they should have checked for ketones and sugar in the urine. The fact he’s s stressed could very well have artificially raised his bg. You will get more accurate results at home. Don’t let them pressure you into either. The only curve my cat got was after his first shot.

I would ask for copies of the chart and all tests run. You would be surprised at how much they don’t tell you. I learned this the hard way.

What medications is he currently getting?

Looking at your spreadsheet one thing you need to be aware about. You need to test one more time at night. Many cats drop lower at night. Plus without any night tests you only have half of the picture. You don’t know the night nadir, lowest point in the cycle. Lantus dosing is based upon how low it takes your cat. You need the before insulin test to make sure he’s high enough to shoot and if it’s safe to give the full dose. Then you feed to make sure he will eat. You want a dose you can shoot every 12 hours.

Have a look at our dosing methods. I strongly suggest you do TR as it gets the best chance of remission and being diet controlled. With SLG he earned a reduction but with TR he didn’t. Since so new to insulin a hack disease was fine today and why I would stick with that dose at first.

Ask if he had ketones at diagnosis or was DKA. Ask how long he will be on budesonide.

Did he have any other health issues before diabetes and IBD and or pancreatitis?
 
I havent tested during the PM cycle mostly because it is late and I hate poking him so much, but I can try to get a +2 and maybe a +4 tonight. No health issues before this, but he was a stray we found so can't be too sure. I will be sure to ask about that. Thanks again! (also updating signature now)
 
It's kind of a fancy one because we trying anything to get him to eat again (he has a feeding tube and didn't eat on his own for about a month, he's getting it out tomorrow! yay!) and it was the first one he would eat. I think it is low carb (4%) but not sure if I am doing that calculation correctly (when adding the %s up, do I include the taurine % in this?)

I guess I will go with tight regulation - kind of flying blind since my vet told me nothing about any of this. :(

So should I stick with 0.5 units of lantus or go back up to 1 since he technically did not qualify for a reduction?
 
Emma Troxell said:
I guess I will go with tight regulation - kind of flying blind since my vet told me nothing about any of this. :(

So should I stick with 0.5 units of lantus or go back up to 1 since he technically did not qualify for a reduction?
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I will tag @tiffmaxee

If you go with TR you definitely have to get some tests in during the PM Cycle
@Emma Troxell
@tiffmaxee
I told her to stay with 0.5 units until she gets some night tests in , hope that was OK #24
 
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I guess that means I need to buy a human meter? I would rather not as I've already spent upwards of 6000 dollars on everything... but I guess they're cheap compared to everything else. Sorry, just feeling frustrated and underprepared by my vet.
 
Emma Troxell said:
I guess that means I need to buy a human meter? I would rather not as I've already spent upwards of 6000 dollars on everything... but I guess they're cheap compared to everything else. Sorry, just feeling frustrated and underprepared by my vet.
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You can stay with the cAlpha Trak if you want to
Just be aware
The “take action” number on the Aloha Trak is 68, which means to feed him a little to bring his BG up
 
Thanks Diane! I will keep that in mind. His +6 just now was 132, so he's coming back up. I probably would've been okay to stick with 1u but I'd rather be safe than sorry! I'll be sure to get some PM cycle tests in tonight. Thanks again for all your help.
 
Emma Troxell said:
It's kind of a fancy one because we trying anything to get him to eat again (he has a feeding tube and didn't eat on his own for about a month, he's getting it out tomorrow! yay!) and it was the first one he would eat. I think it is low carb (4%) but not sure if I am doing that calculation correctly (when adding the %s up, do I include the taurine % in this?)

I guess I will go with tight regulation - kind of flying blind since my vet told me nothing about any of this. :(

So should I stick with 0.5 units of lantus or go back up to 1 since he technically did not qualify for a reduction?
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Is this what you are feeding
https://allaboutcats.com/freshpet-cat-food-review
Freshpet Vital Grain-Free Chicken & Beef Fresh Cat Food, 1 lb.
Freshpet
140
2373943-center-1
 
I have no idea how to figure carbs , but found this for you posted by one of our members
Here's an online calculator:

https://secure.balanceit.com/tools/_gaconverter/index.php

Plug in the 'as fed' analysis values and it will do the rest. (You don't need the taurine value for the calculations.) You're looking for the calculated "% ME Carb" value to be less than 10.

Note: you need to manually delete the numbers from the boxes between each calculation.
 
The online tool is telling me 17% carbs, and it is also asking for something called ash which is not listed on this food. If I go by the numbers listed on the food, it comes to 5% carbs. (protein-10%, fat-6%, fiber-1%, moisture-78%)
 
Thank you! Looks like freshpet is 10% carbs. I will talk to the vet about switching to a FF pate if it’ll work with us GI issues because it seems healthier and probably way less expensive!
 
Emma Troxell said:
Thank you! Looks like freshpet is 10% carbs. I will talk to the vet about switching to a FF pate if it’ll work with us GI issues because it seems healthier and probably way less expensive!
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You can even ask members here if they have any suggestions what to feed that low carb and has GI issues you mean having IBD and pancreatitis.
There are a lot of members here with cats with IBD
 
Emma Troxell said:
I guess I will go with tight regulation - k
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I see you switched to SLGS thanks for adding that to your signature and SS Please try and get some night tests in :cat:
For SLGS

Hold the dose for at least a week:
  • Unless your cat won’t eat or you suspect hypoglycemia
  • Unless your kitty falls below 90 mg/dL (5 mmol/L). If kitty falls below 90 mg/dL (5 mmol/L) decrease the dose by 0.25 unit immediately.
After 1 week at a given dose perform a 12 hour curve, testing every 2 hours OR perform an 18 hour curve, testing every 3 hours. Note: Random spot checks are often helpful to "fill in the blanks" on kitty's spreadsheet. The goal is to learn how low the current dose is dropping kitty prior to making dose adjustments.
  • If nadirs are more than 150 mg/dl (8.3 mmol/L), increase the dose by 0.25 unit
  • If nadirs are between 90 (5 mmol/L) and 149 mg/dl (8.2 mmol/L), maintain the same dose
  • If nadirs are below 90 mg/dl (5mmol/L), decrease the dose by 0.25 unit
 
Yes, after talking to folks on the facebook page i just don't think I can handle TR right now. I am going to attempt more night tests tonight - I wasn't able to stay up late enough to get a +4. that would've been 1am for me. I am also going to buy a human meter tonight so I can be sure I'm getting the right numbers and be able to line them up with the protocol.
 
Emma Troxell said:
. I am also going to buy a human meter tonight so I can be sure I'm getting the right numbers and be able to line them up with the protocol.
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If you live in the US most of us you the Relion Premier Classic from Walmart it's 9 dollars
The test strips are 17.88 for 100 strips
At least you can just run to Walmart and pick them up , even ordering them off the internet I got them fast
 
Emma when and if you do start using the Relion let me know so you can go to your spreadsheet and the day you start using it I can tag a member and she can put a blank line above it and switched to human meter and she would also have to change 2 of the color codes up top of the spreadsheet, no big deal
 
Diane Tyler's Mom said:
Emma when and if you do start using the Relion let me know so you can go to your spreadsheet and the day you start using it I can tag a member and she can put a blank line above it and switched to human meter and she would also have to change 2 of the color codes up top of the spreadsheet, no big deal
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Will do! I plan on picking it up tonight :) thanks for all your help thus far!
 
Emma Troxell said:
Hey Diane! I just got the ReliOn meter - ready to update SS! :)
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Yay, OK I'll tag Bhooma. She will probably be on later on she lives in India and it's only 7:45 AM there
Emma you will be using this now all the time correct?
@Bandit's Mom to make the changes that have to be made
Hi Bhooma Emma just switched over to the Relion human meter
Can you make a line above to show when she switched and fix the color codes up top
Thank you Bhooma

Emma Bhooma will send you a private message so look for it up top in your inbox
@Emma Troxell

@Bandit's Mom
 
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Just so you are aware
On a human meter, 50 is your “take action” number meaning it's time to intervene with food to bring the BG up , always ask if you're not sure about something
I looked at your SS in your remarks section
What did you mean when you said this
based on a post i found 63 would likely be the equivalent for testing on a human meter
What did you mean by this
You tested with the Relion right ?
 
Emma what did you mean 63 estimated @+2?
Emma I would test him again in an hour from getting that 63 @+2
@Emma Troxell

I know you said you will try to get a +2 and +4 at night but it's too late for you
What are your shooting times? Maybe you can make them earlier so in case you have to test more often at night in case he drops too low and you have to intervene with med or high carb foods and keep testing until his numbers are in a safe range
 
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Diane Tyler's Mom said:
I see @+2 tonight Mr Lump was 63 @+2
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I see an 89 at +3 on the SS (nothing for 2). Yes, Mr. Lump has earned a reduction tonight with SLGS

There are 2 threads being responded to simultaneously - this one and the one in the Lantus forum - potential for confusion!
Shall we switch to the one in the LBL forum, Diane? Now that her SS and Signature are all setup, @Emma Troxell can start posting in the LBL forum.
 
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