New to the forum and appreciate your advise. | Feline Diabetes Message Board - FDMB

New to the forum and appreciate your advise.

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Alec

Member since 2022
Looking for advice on Alec's spreadsheet. He is on vetsulin since last Monday, started with 2 and was told by vet this Monday increase to 3. His glucose reading increased since the unit change, please advise.
 
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Looking for advice on Alec's spreadsheet. He is on vetsulin since last Monday, started with 2 and was told by vet this Monday increase to 3. His glucose reading increased since the unit change, please advise.

https://docs.google.com/spreadsheets/d/1X3LCIrFUqEMprgaxBXj7zCnZ90QNcCwciaRTSC9n21w/edit?usp=sharing
Hi Sally I can tag a few members for you
This doesn't look like our Spreadsheet
Also the last 2 color codes on the spreadsheet are for human meters ,you are using the Alpha Trak.
Did you use our link for creating the spreadsheet
You need to be testing more often than you are for both cycles
Are you feeding first then waiting 30 minutes to give the vetsulin
@FrostD She is familiar with vetsulin

But I can try other members for you,

@tiffmaxee

@Suzanne & Darcy

@Wendy&Neko

@Bron and Sheba (GA)

Here is our SS link Alec
https://felinediabetes.com/FDMB/threads/how-to-create-a-spreadsheet.241706/

Also
vetsulin, it is really an insulin made for dogs and is not recommended for cats as there are much more suitable insulins for cats such as Lantus or Prozinc.
Link so you can read about vetsulin
https://felinediabetes.com/FDMB/threads/beginners-guide-to-caninsulin-vetsulin.231587/
 
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I would not do a one unit increase at any time. That's too much of an increase all at once to be safe. The dose should be increased by .25 units and held for one week while testing shows how low the dose is taking the cat and at what point during the cycle the lows are coming. You already saw some blue nadirs (lowest point) with 2 units. We have no idea what the 3 units will do. I would not do this with my cat. You need to keep Alec safe and take things a little more slowly and get as many tests as you can to see what's going on. Are you feeding prior to shooting the Vetsulin and if so, how many minutes prior?
 
Waiting for answers to others' questions but please go down to 2.25U. 3U is far too high and dangerous at this point in time. If the vet based the decision on an in office curve, the BG is often elevated from stress.

Additionally, with how hard and fast he was dropping, he was doing what we call "bouncing". This is when the drop lower and/or faster than their body is used to; the liver perceives it as a threat and dumps stored glycogen and counterregulatory hormones in order to spike BG back up. The effects of this can last up to 6 cycles, though on Vetsulin it's usually less. So if a curve was done on a cycle where he was high and flat, it could look like he needs more insulin....but when he clears the bounce it can easily be a hypo at 3 units.
 
Waiting for answers to others' questions but please go down to 2.25U. 3U is far too high and dangerous at this point in time. If the vet based the decision on an in office curve, the BG is often elevated from stress.

Additionally, with how hard and fast he was dropping, he was doing what we call "bouncing". This is when the drop lower and/or faster than their body is used to; the liver perceives it as a threat and dumps stored glycogen and counterregulatory hormones in order to spike BG back up. The effects of this can last up to 6 cycles, though on Vetsulin it's usually less. So if a curve was done on a cycle where he was high and flat, it could look like he needs more insulin....but when he clears the bounce it can easily be a hypo at 3 units.

Thank you so much for your advice! I reduced the does back to 2.25 U tonight, and even think I may go back to 2 tomorrow. Even though Alec just started to receive the shot last Monday, he actually showed worse symptom compared before he took any insulin. I definitely noticed he was less energetic, more hungry and drank/urined more since we gave him 3U 2 days ago.

I will start to do more tests today. Any suggestions on how frequent I should go? another challenge is he's been hungry all times, but if I need to test frequently, how can I give him some low carb food throughout the day?
 
Thank you so much for your advice! I reduced the does back to 2.25 U tonight, and even think I may go back to 2 tomorrow. Even though Alec just started to receive the shot last Monday, he actually showed worse symptom compared before he took any insulin. I definitely noticed he was less energetic, more hungry and drank/urined more since we gave him 3U 2 days ago.

I will start to do more tests today. Any suggestions on how frequent I should go? another challenge is he's been hungry all times, but if I need to test frequently, how can I give him some low carb food throughout the day?
You can feed him any time during the day except for the two hour period before the preshot tests (the tests you get before shooting insulin.). Do the test first before you feed him. Then go ahead and feed him and shoot the insulin 30 minutes later. The reason for not feeding for two hours prior to the preshot tests is so that you can have an accurate blood glucose number that is not inflated by the food. This way you will be able to make sure that it’s safe to shoot insulin (that he is not too low.).
 
Now, having said that, you may not want to feed him after his nadir. Vetsulin tends not to last too long in cats anyway, so feeding too much (and especially higher carbs) after nadir can shorten the duration of the insulin.
 
Thank you so much for your advice! I reduced the does back to 2.25 U tonight, and even think I may go back to 2 tomorrow. Even though Alec just started to receive the shot last Monday, he actually showed worse symptom compared before he took any insulin. I definitely noticed he was less energetic, more hungry and drank/urined more since we gave him 3U 2 days ago.

I will start to do more tests today. Any suggestions on how frequent I should go? another challenge is he's been hungry all times, but if I need to test frequently, how can I give him some low carb food throughout the day?
His symptoms probably were worse because his BG numbers were so high. When they’re in higher numbers they usually drink and therefore urinate a lot more. It sounds like he doesn’t feel well in the really high numbers.
 
Unfortunately because Vetsulin hits so hard and fast, the swings can make them feel quite terrible. The polyuria and polydipsia will continue until he's better regulated. Many people tend to find that when they are under renal threshold, that's when that subsides. Renal threshold is the point at which glucose spills into the urine, which for most cats is in the 200-300 range.

This is speculation, but it's possible he was more hungry on the 3U because his numbers went very low.

As for tests - focus on the first 4 hours after.you give the shot. So what we call +1, +2, +3, and +4. Some later in the cycle (+6/+8 ) will give us an idea of duration and how quickly Vetsulin is wearing off
 
His symptoms probably were worse because his BG numbers were so high. When they’re in higher numbers they usually drink and therefore urinate a lot more. It sounds like he doesn’t feel well in the really high numbers.
I am a bit stressed out by the fact that his BG became higher after starting to get the vetsulin. I am not sure if I should have Alec stay on Vetsulim for a while before the switch or should I switch to other insulin.
 
I would ask for a copy of Alec’s bloodwork. All of it. If he was diagnosed with a simple glucose reading then that’s not good because his glucose could be elevated due to stress. He should have done a fructosamine test which will show the average number from a period of about two weeks prior to the test. This is how the diagnosis should be made - and maybe it was, no way of knowing without the test results.
 
I did not skip any shots, missed several preshot testings, Alec and I are still a bit nervous with that, but I am improving.
You know, I really appreciate that you have begun testing Alec. It’s so essential and it can be scary and discouraging in the beginning. I’m impressed that you started a spreadsheet to chart his numbers. You’re doing well for a start!
 
Thanks, had another test just now. 2hr 40 mins after the PM shot. 598 down to 480. will do another one at +4 tonight.
Another thing is my vet asked to bring Alec in for a 2 weeks follow up exam (since last Monday's diagnosis), will be a day drop test - was told they will check his blood 3 times during the day, and 1 urine test. Alec will stay there from 7am to 5pm.
I am a bit hesitated bc Alec was totally stressed out every time visiting a vet, and he was never left alone without us at the vet's office. I am also not sure about 3 blood test throughout the day, are 3 times enough? I rather do a 12 hour curve at home when he is more relaxed. For now, I am really struggled with right dose and type of insulin to give and I want to focus on that first.

suggestions?
 
Thanks, had another test just now. 2hr 40 mins after the PM shot. 598 down to 480. will do another one at +4 tonight.
Another thing is my vet asked to bring Alec in for a 2 weeks follow up exam (since last Monday's diagnosis), will be a day drop test - was told they will check his blood 3 times during the day, and 1 urine test. Alec will stay there from 7am to 5pm.
I am a bit hesitated bc Alec was totally stressed out every time visiting a vet, and he was never left alone without us at the vet's office. I am also not sure about 3 blood test throughout the day, are 3 times enough? I rather do a 12 hour curve at home when he is more relaxed. For now, I am really struggled with right dose and type of insulin to give and I want to focus on that first.

suggestions?
I'll tag Melissa for you and Suzanne about your question about the type of insulin to give and the dose
@FrostD

@Suzanne & Darcy
There is no reason to take him to the vet for testing
Tell the vet you are testing him at home .Tell her he gets too stressed out which will most likely raise his BG

Melissa and Suzanne I was looking at the cat food Sally is feeding
https://www.hillspet.com/cat-food/pd-wd-feline-canned
and
https://www.hillspet.com/cat-food/pd-wd-feline-dry

Looks like she should stay with this for now I see both are high carbs until she gets more tests in ,what do you think?
 
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I did not skip any shots, missed several preshot testings, Alec and I are still a bit nervous with that, but I am improving.

Maybe this will help
Always aim for the sweet spot warm the ears up first, you can put rice in a sock and put it in the microwave, test it on the inside of your wrist to be sure it's not to hot, like you would test a babies bottle. You can fill a pill bottle with warm water and roll it on the ears also.Just keep rubbing the ears with your fingers to warm them up
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fec17d29-5ab4-44a8-912b-3a91944c3954-jpeg.57073

6. As the ears get used to bleeding and grow more capilares, it gets easier to get the amount of blood you need on the first try. If he won’t stand still, you can get the blood onto a clean finger nail and test from there.
When you do get some blood you can try milking the ear.
Get you finger and gently push up toward the blood , more will appear
You will put the cotton round behind his ear in case you poke your finger, after you are done testing you will fold the cotton round over his ear to stop the bleeding , press gently for about 20 seconds until it stops
Get 26 or 28 gauge lancets
Take a look at the lancets ,you will see one side points up, that's the side you want to poke with
A lot of us use the lancets to test freehand
I find it better to see where I'm aiming
You can also put a thin layer of vaseline on the ear ,to help the blood bead up
A video one of our members posted
VIDEO: How to test your cat's blood sugar
 
Well the food is high carb, yes, so it is not ideal for a diabetic cat. But right now if Alec is getting insulin then we don’t want to do a diet change all at once because it could cause his numbers to drop lower. Either a diet change to an all low carb preferably wet food diet should be made first, prior to starting insulin, or the diet change would have to be made gradually after starting the insulin to slowly see how the change to low carb impacts his BG numbers. He’s already started insulin though.
 
Well the food is high carb, yes, so it is not ideal for a diabetic cat. But right now if Alec is getting insulin then we don’t want to do a diet change all at once because it could cause his numbers to drop lower. Either a diet change to an all low carb preferably wet food diet should be made first, prior to starting insulin, or the diet change would have to be made gradually after starting the insulin to slowly see how the change to low carb impacts his BG numbers. He’s already started insulin though.
That's what I figured, Thanks Suzanne :cat:
 
Thanks, had another test just now. 2hr 40 mins after the PM shot. 598 down to 480. will do another one at +4 tonight.
Another thing is my vet asked to bring Alec in for a 2 weeks follow up exam (since last Monday's diagnosis), will be a day drop test - was told they will check his blood 3 times during the day, and 1 urine test. Alec will stay there from 7am to 5pm.
I am a bit hesitated bc Alec was totally stressed out every time visiting a vet, and he was never left alone without us at the vet's office. I am also not sure about 3 blood test throughout the day, are 3 times enough? I rather do a 12 hour curve at home when he is more relaxed. For now, I am really struggled with right dose and type of insulin to give and I want to focus on that first.

suggestions?
You are totally right about taking Alec to the vet for the whole day for them to run a blood glucose curve. We recommend doing one yourself at home and testing every two hours for a 12 hour period. Alec will be much less stressed. You can share the test information with your vet if they really want it.
Now as to type of insulin, if your vet is willing to prescribe it, I would recommend getting an Lantus insulin (which also has generic forms available). It is a much longer lasting and much gentler insulin than Vetsulin. It’s just much better in cats. We can tell you more about this. If you really plan to stop the insulin and trying to switch to a different one, I would recommend going ahead with the change to low carb wet food. Fancy Feast classic pates are a good (and easy) place to start. Stay away from foods with gravy because they tend to be loaded with carbs.
 
Well the food is high carb, yes, so it is not ideal for a diabetic cat. But right now if Alec is getting insulin then we don’t want to do a diet change all at once because it could cause his numbers to drop lower. Either a diet change to an all low carb preferably wet food diet should be made first, prior to starting insulin, or the diet change would have to be made gradually after starting the insulin to slowly see how the change to low carb impacts his BG numbers. He’s already started insulin though.

I am quite mad about the fact that both prescription ones are high carb! I used the chart to calculate carb for non prescription ones, but since these are all expensive Rx ones, I second guessed myself, chose to trust the vet and the brand!
Not too many things you can trust these days, sigh.
 
I am quite mad about the fact that both prescription ones are high carb! I used the chart to calculate carb for non prescription ones, but since these are all expensive Rx ones, I second guessed myself, chose to trust the vet and the brand!
Not too many things you can trust these days, sigh.
Don’t feel badly. This happens to TONS of people. Most of them are prescribed the Hill’s DM as if it were some kind of diabetic management food and it’s dietetic management. Apparently they were sued over the name and had to change it - that’s the story anyway.
 
yeah almost all of us have been there. Vet diagnoses diabetes and says feed every 12 hours, only feed this prescription food, kthxbye!

then come to find out later those foods are terrible for a diabetic cat. smh

Also, my vet insisted that after being on insulin 1 week, we were to bring Hendrick back in for a curve. People here insisted that we could do it at home but we didn't think we could. I wish we would have done it at home, that curve was pretty much pointless, his BG was stress elevated and they didnt even bother checking more than a few times before calling it off because his BG was so high.

Not to mention, they did it with ear pokes and they used the marginal vein! which caused awful bruising on Hen's poor little ears. You are way way further ahead in the game than we were, good job seriously. In regards to curves in general, if you are doing enough home BG testing with ear pokes or a Libre sensor there is absolutely no value in a curve. In fact having data from different times of day across multiple days is far more valuable than a single curve on one day.
 
Thank you so much for all the helps, tips and supports here!
@Hendrick Cuddleclaw, Alec looks just like Hendrick, sorry to know about this 1 week testing experience, I will do the curve at home.

I called my vet this morning to talk about switch to Lantus or PZI, his office said they were busy ALL DAY TODAY! I will go to their office this afternoon if nobody returns my call, and wait until someone talk to me!
 
Thank you so much for all the helps, tips and supports here!

it really is something isn't it? We felt so alone, so lost and confused and I'll be honest when he was diagnosed I felt very depressed. I felt like I caused it somehow, feeding him too many temptations.

Finding this place was like a life-preserver thrown to a drowning person...barely keeping my head above water, just struggling emotionally, mentally.....then the FDMB, like a strong, powerful arm reaching down to lift me and Hendrick up out of the water end save us.

Oh crap where's that tissue box here we go again....

glad you made it Alex is totally stunningly beautiful I love that profile pic with him, the sketch in progress, and the photo on the phone. That is one of the best profile pics I've ever seen on here hands down!!
 
My recommendation - slow diet change first. How he reacts to that will tell me a lot about whether ProZinc might work for him, or if it's better to go straight to Lantus (or it's generics, many of them now are roughly the same cost as ProZinc anyway).

This is a pretty convenient chart - https://catinfo.org/chart/index.php

You'll want your regular low carb to be between 3-7%, but we consider anything under 10% to be low carb. You'll also want to some medium carb food in the 10-15% range, and some high carb in the 16%+ range. I also like to keep some very high carb on hand, 23% + just in case - these are all for your hypo kit should he get into trouble (see link). Definitely get the kit together before transitioning.

When you're ready to transition, let me know the day or two before so I can see his numbers and advise on how to adjust dose/slowly transition food.

Another thing I haven't seen mentioned yet - testing ketones. While he's unregulated, you'll want to test ketones at least twice a week. Some people use human urine strips like Ketostix...that would never fly with my cat so I use a blood ketone meter.
 
Hete is our food chsrt
https://felinediabetes.com/FDMB/threads/dr-pierson-new-food-chart.174147/

For your hypo kit you want some
Med and High Carb food and some honey



Fancy Feast Gravy Lovers Gourmet Beef Feast in Gravy 20% High Carbs

Fancy Feast Gravy Lovers Gourmet Chicken Feast in Gravy 15% Med Carbs

Fancy Feast Gravy Lovers Turkey Feast in Gravy 15% Med Carbs

Fancy Feast Gravy Lovers Chicken and Beef in Gravy 15% Med Carbs

Good idea to mark the cans with magic marker how many carbs

Or any on the food chart.
 
My recommendation - slow diet change first. How he reacts to that will tell me a lot about whether ProZinc might work for him, or if it's better to go straight to Lantus (or it's generics, many of them now are roughly the same cost as ProZinc anyway).

This is a pretty convenient chart - https://catinfo.org/chart/index.php

You'll want your regular low carb to be between 3-7%, but we consider anything under 10% to be low carb. You'll also want to some medium carb food in the 10-15% range, and some high carb in the 16%+ range. I also like to keep some very high carb on hand, 23% + just in case - these are all for your hypo kit should he get into trouble (see link). Definitely get the kit together before transitioning.

When you're ready to transition, let me know the day or two before so I can see his numbers and advise on how to adjust dose/slowly transition food.

Another thing I haven't seen mentioned yet - testing ketones. While he's unregulated, you'll want to test ketones at least twice a week. Some people use human urine strips like Ketostix...that would never fly with my cat so I use a blood ketone meter.

Thanks!

I stay with 2U this morning, and added 3 BG readings to SS.
Since Alec has only been eating W/D Multi-Benefit Canned and Dry for less than 3 days, I transitioned to half W/D can (23% carb) with this one
Purina Pro Plan Grain Free, Natural Pate Chicken & Liver Entree Wet Kitten
3033465-center-1



https://www.petco.com/shop/en/petcostore/product/default-product-name-3035196?cm_mmc=PSH|GGL|CMB|SBU02|SH2|0|aTqN8HCvYMVou9v1JxaqmG|58700007593471809|PRODUCT_GROUP|0|0|pla-1571658041640|134591502631|15754202616&gclid=CjwKCAjwk_WVBhBZEiwAUHQCmVdM3WYvFHyrbPTZOQDfC8EVRkYX_dXlEMA3XFWGGAg4NKZGTXSJaRoC7U8QAvD_BwE&gclsrc=aw.ds. (not on the chart, but by my calculation, carb is lower than 5%). He is doing much better than yesterday, only used litter box twice so far, and the urine clumps are normal size like last week.

In terms of transition to ProZinc or Lantus, if the vet says No, I will ask for all Alec's files and talk to another vet for 2nd opinion. Not sure what's your experiences like when having the conversation with the vet.

I will start the ketones ASAP, so much to learn!
 
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Yep. I was waiting for today to have the ketone talk with you. I was trying not to overwhelm you on Day 1. But with those high BG numbers you have been getting you can first get some keto diastix and try to test his urine while he’s using the litter box. High ketones can be very dangerous and can lead to diabetic ketoacidosis (DKA) which is a life threatening condition. Hopefully Alec isn’t prone to high ketones. Since I didn’t like the idea of chasing my cat to the litter box and sticking something under his urine stream, I bought the NovaMax Plus blood ketone meter from ADW Diabetes Supply. Ketone strips are expensive, but a lot less than a DKA emergency stay at the vet.
 
Yep. I was waiting for today to have the ketone talk with you. I was trying not to overwhelm you on Day 1. But with those high BG numbers you have been getting you can first get some keto diastix and try to test his urine while he’s using the litter box. High ketones can be very dangerous and can lead to diabetic ketoacidosis (DKA) which is a life threatening condition. Hopefully Alec isn’t prone to high ketones. Since I didn’t like the idea of chasing my cat to the litter box and sticking something under his urine stream, I bought the NovaMax Plus blood ketone meter from ADW Diabetes Supply. Ketone strips are expensive, but a lot less than a DKA emergency stay at the vet.
Thanks, will Keto strips for human work, https://realketones.com/products/ke...LBDVc_8doMShxEoIcfrjDxMfulYvJi4RoChnAQAvD_BwE, or I must get one for cats? I remember seeing a page on this site last night, but forgot how to find that again.
 
Give it some time at this dose, I suspect he might be bouncing from lows.

You are feeding kitten food? It is my understanding that's too high in fat to be a regular part of their diet.
 
Some updates from my call with the vet: 1. The fructosamine test was NOT done at the time of diagnosis when they did the blood test. The vet insisted to bring Alec in for 2 wk follow up check and he will do fructosamine test then. 2. About insulin, the vet said Vetsulin is very similar to Prozinc, while Lantus will be "too expensive for you". If we have to change, he will do that after 2wk check. 3. I brought up that the increase insulin from 2u to 3U made Alec miserable, he first said it's impossible that adding the dose would lead a higher BG reading, but he insisted to stay on 3- which I did not bother to argue and I will still do 2U.

Short term plan is I will stay with current 2U for at least a week, he's been doing better yesterday and this morning, also updated Alec's SS, I will do Ketone check starting today. I will continue the low carb food.
Open question: 1. should I bring back Alec for fructosamine test next week? he will have to be there whole day though. I feel only if we have that done, the vet may prescribe new insulin, but I am still very hesitated for reasons mentioned previously, plus less trust with this vet.

Appreciate your suggestions, thanks.
 
Some updates from my call with the vet: 1. The fructosamine test was NOT done at the time of diagnosis when they did the blood test. The vet insisted to bring Alec in for 2 wk follow up check and he will do fructosamine test then. 2. About insulin, the vet said Vetsulin is very similar to Prozinc, while Lantus will be "too expensive for you". If we have to change, he will do that after 2wk check. 3. I brought up that the increase insulin from 2u to 3U made Alec miserable, he first said it's impossible that adding the dose would lead a higher BG reading, but he insisted to stay on 3- which I did not bother to argue and I will still do 2U.

Short term plan is I will stay with current 2U for at least a week, he's been doing better yesterday and this morning, also updated Alec's SS, I will do Ketone check starting today. I will continue the low carb food.
Open question: 1. should I bring back Alec for fructosamine test next week? he will have to be there whole day though. I feel only if we have that done, the vet may prescribe new insulin, but I am still very hesitated for reasons mentioned previously, plus less trust with this vet.

Appreciate your suggestions, thanks.
Totally ridiculous. This proves he doesn't know much about insulin. Vetsulin and ProZinc are formulated completely differently! Also, first of all... what business is it of his how much you spend on insulin? But he's proven that he obviously doesn't know that there are several generic equivalents now for Lantus. Well, it will be completely useless for him to do a fructosamine test, but if you think you have to do it? What about it you show him your spreadsheet in a few weeks before you take him?
 
How's it going with the LC food? Are you transitioning slowly or have you made the switch? Have you found some things he likes?
 
How's it going with the LC food? Are you transitioning slowly or have you made the switch? Have you found some things he likes?
In transition, he is not addicted to the Hill W/D and only ate them for less than a week, so it's not too hard for him. Should totally change to low carb in a few days.
 
Have you thought about seeing a different vet? This one is not helping your cat.
definitely thinking of that, the challenge is we've been living at where we are now for about 2 years, so we do not know many good vets around. Any tips on how to find one that are more experienced with FD cat?
 
definitely thinking of that, the challenge is we've been living at where we are now for about 2 years, so we do not know many good vets around. Any tips on how to find one that are more experienced with FD cat?

there's a post around here somewhere with "vet interview questions" iirc. Let me see if I can find it

this doesn't help you find an FD vet exactly, but it might help you decide between a couple different options for new vets

https://felinediabetes.com/FDMB/threads/vet-interview-screening-topics-check-list.156663/

Also, if you're comfortable sharing your location or general area, people do post on here from time to time asking if there is anyone on the FDMB from that area and if so, can they recommend a vet
 
Also wondering how fructosamine test works if anyone know? How much blood need to be collected and how many times?
 
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