Introduction - Hello from Logan and Melissa!

[Klunkers]

Hi Everyone!

We have a wonderful big cat named Logan, 13, who was diagnosed on 7/31/22. I was out of town when he was first diagnosed, so my husband informed me over the phone. We were to go back to the vet in 4 days for insulin, freestyle libre placement, and injection instructions. As soon as I came in the door two days later, my husband informed me he hadn't been eating all day and he was debating whether he should take him to the emergency vet. I took him right away, and sure enough he was DKA and we started our diabetes journey with a 2 day hospital stay. $$$$. Yikes. But he did well in the hospital and they released him with .5 Lantus and we had a follow up visit at the vet the next day to get the sensor installed.

Our vet recommended wet food if possible, but we were sure our "kibble addict" couldn't handle it so we started off with Glycobalance dry food and figured it was "diabetic food" so it must be good for him. I found the Feline Diabetes facebook group that night, and we knew in short order that we had to get him off that stuff. He has been transitioning very well to Fancy Feast Classic Pates (vet is thrilled) and is down to maybe 1/3 cup of Glycobalance a day (we are trying for all wet food for the first time today and Logan has only protested mildly...he knows what a dry food bag sounds like and I think he misses that sound more than anything!)

So far his curves have been a little unpredictable. The vet moved him to 1 unit of Lantus after the first week, and one day he dipped to 49 a few hours after his AM shot. I gave him sugar water and got him back up to 72. He was back up above 400 before his PM shot, and then he was on a 300 - above 400 roller coaster for a few days. Vet moved him to 1.5 where he's been the past 2 weeks. We did medical boarding over last weekend at their office, and he was mostly in the normal range all day (on the libre meter) and dipped down to 50 a couple of times briefly during his stay. He looked great when we picked him up. Then we started doing the 300 to above 400 roller coaster again, and finally on Friday he hung out around 150-200 for some time, and we are seeing a similar pattern today. Friday was the first day we got him onto a primarily wet food diet. Our vet says we are going to hold at 1.5 and keep going with as much Fancy Feast as he wants (he's underweight) and we are staying with the sensor for now.

Anyway, overall our kitty is looking a lot better and is awake more often and interacting with us, but the neuropathy is still bad as expected (not as bad as just before his diagnosis). Our vet has been super supportive and we check in with him via email every Wednesday and Saturday with his numbers and a rundown of how he's doing.

I just started the spreadsheet today and I know I have a lot to learn! I'm so glad you all are here.

 

[Lando demando]

Welcome! So happy to see you and logan here! Im sure the experienced members will come around to say hello, but it looks like you have the spreadsheet and signature rockin already! The learning curve is steep, but it sounds like you are off to a great start

 

[tiffmaxee]

Welcome to LLB. Do you have a meter in addition to the Libre ? You can get an inexpensive one, a Relion from Walmart. Sometimes the Libre gives funky low numbers so it’s good to check with an ear prick blood check. Sometimes the Libre fails before two weeks so you want to be able to check the bg before dosing. Max would never eat pates before becoming diabetic but adjusted to fancy feast pates quickly as well. It’s good your vet suggested wet food. Do you have syringes with half unit markings?

 

[Hendrick Cuddleclaw]

Hi and welcome to the group! Sounds like you are on your way to getting Logan regulated, I know the DKA story well, my cat Hendrick also went into DKA right around when he was diagnosed and stayed 2 nights in the vet hospital ($4500, oof). Thankfully he fully recovered and thanks to this wonderful group here and the Tight Regulation dosing method, 6 months later Hendrick went into diabetic remission and became a diet-controlled diabetic feline!

Cats with a history of DKA need a little extra monitoring and it is good to do a few things that should help keep DKA away. The last thing you want is another DKA episode and trip back to the hospital. Feeding about 150% of Logan's normal caloric need is good to help keep the DKA away, making sure Logan has plenty of fresh water to help flush out ketones, and regular insulin injections every 12 hours. Checking for ketones is really important, we used a blood ketone monitor called the Nova Max but a lot of people just use ketostix and dip them in a fresh "ball" of urine in the litter box. Or cat urine in a ladle and dip.

Read more about ketones here, being on top of this could mean the difference between life and death for Logan.

https://felinediabetes.com/FDMB/thr...and-diabetic-cats-a-primer-on-ketones.239971/


Regarding Fancy Feast pates -- just a word of caution as Logan is 13 years old. Almost all the FF pates are ridiculously high in phosphorus. Logan may not have any kidney function issues but as cats age keeping the phosphorus a little lower is easier on the aging kidneys and can help prevent onset of kidney function trouble.

 

[Klunkers]

Welcome to LLB. Do you have a meter in addition to the Libre ? You can get an inexpensive one, a Relion from Walmart. Sometimes the Libre gives funky low numbers so it’s good to check with an ear prick blood check. Sometimes the Libre fails before two weeks so you want to be able to check the bg before dosing. Max would never eat pates before becoming diabetic but adjusted to fancy feast pates quickly as well. It’s good your vet suggested wet food. Do you have syringes with half unit markings?

We only have the Libre right now. I have read about the Relion. I'm sure being absolutely paranoid about making ear pricks, having never done it, is normal, right? I still have a hard time giving injections a month into this. lol. The syringes we got do not have 1/2 unit markings, so we have been eyeballing. Which is probably not the wisest thing.

 

[Klunkers]

Feeding about 150% of Logan's normal caloric need is good to help keep the DKA away, making sure Logan has plenty of fresh water to help flush out ketones, and regular insulin injections every 12 hours. Checking for ketones is really important, we used a blood ketone monitor called the Nova Max but a lot of people just use ketostix and dip them in a fresh "ball" of urine in the litter box. Or cat urine in a ladle and dip.

Regarding Fancy Feast pates -- just a word of caution as Logan is 13 years old. Almost all the FF pates are ridiculously high in phosphorus. Logan may not have any kidney function issues but as cats age keeping the phosphorus a little lower is easier on the aging kidneys and can help prevent onset of kidney function trouble.

I definitely want to get the ketostix for him. And thanks for the reminder about the FF pates. We would like to transition him to something lower in phosphorus, but my husband is not keen on switching food right now as we just got him transitioned onto wet food exclusively and we are trying to get him to gain weight.

His numbers are drastically different just in one day with no dry food. I just started the spreadsheet on day 1 of all wet food, but the couple of days prior to that he ran above 350 consistently with a very brief dip down to 325. Last night the libre said he was 65 six hours after his PM shot, and as soon as he ate he went back up to 162. The low glucose meter going off at 2am scared the heck out of me, but I guess 62 isn't actually low for cats? Good lord, I have a lot to learn, and sleeping through the night without anxiety would be a wonderful thing...

 

[Virginie & Chewie (GA)]

I hear ya on the sleeping without anxiety dream! My kitty was diagnosed only about 10 days ago and we are one week into insulin treatment, but I can’t tell you how much this forum has helped. I learned so much in a week, and went from being anxious and full of dread at the idea of ear poking several times a day to being just a bit nervous - I would say I’m at a 3 instead of an 11 on the dread scale now

Things that have been game-changing for us: using an empty pill bottle full of warm water to warm up the ear (recommended by another member and works like a charm) and having a super special treat Chewie gets only after I poke her ear or give her a shot. For us it’s tuna churu (the cat gogurt). She used to squirm and glare at me at first when I would poke her ear, but now she knows churu is coming and she just couldn’t care less what I do and purrs the entire time.

Best of luck with Logan and welcome to the circus

 

[Ale & Bobo & Minnie (GA)]

Welcome!

you can get the 1/2 unit marked syringes at Walmart but call before you go as they tend to run out. It’s normal to feel that way about testing. 2 years into it and I still would get a tiny knot in my stomach every time I had to test Minnie. But with practice comes the feeling that you at least know what you’re doing ha! Minnie was very good about letting me test her and we have lots of tips to make the process as easy as possible for both you and Logan. I can’t speak for Libre numbers. I assume it’s a pet meter as opposed to a human meter, so I’ll let others speak to that.

Here are the ReliOn syringes:

 

[Sienne and Gabby (GA)]

In addition to getting syringes at Walmart, I would order mine online from ADW. In all likelihood, you will need a prescription from your vet no matter where you get your syringes.

It looks to me like Logan is bouncing. Bounces are very normal especially at the beginning of a cat's diabetes treatment. Essentially, what you're seeing is that the insulin is dropping numbers into a lower range by nadir (i.e., the lowest point in the 12-hour cycle). Given that your cat isn't used to being back in normal numbers, his liver and pancreas panic and release a stored form of glucose along with counterregulatory hormones which cause numbers to spike back up. You saw a high at PMPS, a drop to 65 and then numbers sprang back up. You then saw much the same thing today. It can take some cats at least 3 days to get the bounce to level out.

One thought may be to spread out Logan's food over the first several hours of the cycle. In other words, give him a few mini-meals over the first few hours versus a large meal at shot time.

 

[Ale & Bobo & Minnie (GA)]

I forgot to mention to ask about needing prescription for the syringes. Different states have different rules. I’m in California and Walmart never asked me for a prescription to buy the syringes there

 

[Klunkers]

It looks to me like Logan is bouncing. Bounces are very normal especially at the beginning of a cat's diabetes treatment. Essentially, what you're seeing is that the insulin is dropping numbers into a lower range by nadir (i.e., the lowest point in the 12-hour cycle). Given that your cat isn't used to being back in normal numbers, his liver and pancreas panic and release a stored form of glucose along with counterregulatory hormones which cause numbers to spike back up. You saw a high at PMPS, a drop to 65 and then numbers sprang back up. You then saw much the same thing today. It can take some cats at least 3 days to get the bounce to level out.

One thought may be to spread out Logan's food over the first several hours of the cycle. In other words, give him a few mini-meals over the first few hours versus a large meal at shot time.

Logan has been eating small meals on demand (1/2 can at a time) and eating about 3 FF 3 oz cans over the course of 24 hours. Our vet has advised us to let him eat as much as he wants, so we've been following along and Logan has been happy to oblige. As of yesterday, he started drinking what I would classify as a "normal" amount of water for him and also peed a normal amount. His poop is a bit softer now than it was on kibble and stinks pretty badly, lol, but he seems much happier and more interactive in general. I found one of his old toys behind the couch and tossed it to him and he was batting it around (while laying down because his legs are pretty weak with neuropathy). But seeing that made me SO happy. And then I freak out about the bouncing. This is a real roller coaster.

Looking at his numbers today, I'm concerned that he may dip too low overnight. Our vet's advice was not to dose at all if he is 180 or below PMPS. Any thoughts on this?

 

[Klunkers]

Logan update - He is doing MUCH better! We have him on 100% Fancy Feast Pate diet now, and his vet suspects he is going into remission. His most recent advice to us: If he is under 180, no insulin, if he is 180-220 give .5 and if he is above 220 give 1. We haven't had to dose him at all based on this advice for a couple of days. I had to approximate on the spreadsheet in places by just reading the chart on the Libre, but you can see how low he has been running. I bought some Fancy Feast classic gravy and he just ate about 1/4 can an hour ago and is still sitting at 52. He is super happy, is acting almost like he did pre-diagnosis (aside from lingering neuropathy that is improving). We're a bit worried about him dipping any lower at night. We have some Glycobalance dry food, greenies, and Science Diet 11+ dry food left over, but I'm not sure if any of these are a good idea. He'll eat some of whatever we put in front of him and tends to "graze" (no more than 1/4 can FF at a sitting and will go through 2 1/2 - 3 cans a day). He's had a previous DKA so we want to be careful. Thanks for any thoughts!

 

[tiffmaxee]

Since you did not give insulin this morning or tonight you don’t need to worry if his bg is low. Just feed lc. It’s been 5 cycles without insulin. He can’t have a hypo without insulin.

 

[Klunkers]

That's a huge relief. It just seemed like his numbers were very low all of a sudden. I'm hoping he is going to go into remission but we will see. He will be in medical boarding for a few days at his vet because we have to go out of town. Fingers crossed that he will continue to do well.

 

[tiffmaxee]

He does appear to be going into remission. We usually don’t go from 1.0 to an otj trial. Fingers and paws crossed it holds. Good luck.

 

[Klunkers]

Update...so far, Logan is still holding! He was in medical boarding for 4 days and he is still consistently below 100. They said he ate like a champ the entire time and no insulin. He also jumped on the bed for the first time last night. We are cautiously optimistic.

 

[tiffmaxee]

Here are our directions for an OTJ TRIAL.

DIRECTIONS for starting the OTJ trial
Start the trial on the next green pre shot.
If he/she is green at your normal test times, no need to test further until the next "PS" time; just feed small meals and go about your day. If he/she is blue at your normal "PS", feed a small meal and test again after about 3 or 4 hours. If his/her number is lower 3-4 hours after a meal, then the pancreas is working!
Post every day so we can monitor your progress and see if any tweaks are needed. He/she may have a sporadic blue number. Don't panic but post before you decide whether to shoot so we can have a discussion.
After 14 days of no insulin, we have a party!!
Sometimes the trial doesn't work the first time and we have to give a little more support in the form of resuming insulin. It's not the end of the world if that happens; we just give him/her the support needed. Our goal is a strong remission and it's better to take our time to get that than to rush into remission just to have it fail later on.
Good luck with the trial!!!
Once he/she is through the trial successfully, you enter a new phase. Your cat is still diabetic but has now become diet-controlled. Continue feeding low carb food in the manner successful for your kitty. If you decide to change his/her feeding schedule, let your meter be your guide to the best times to feed. Avoid medications with sugar in them and steroid medications unless they are medically essential. Continue testing blood glucose weekly for the first month and then monthly forever. It's a good idea to weigh him/her monthly. Weight should remain stable. If he/she seems "off" or sick, or is showing signs of diabetes (excessive drinking, eating, urinating, weight loss), test his/her blood glucose right away. Keep the teeth and gums clean and healthy; dental issues can bring a cat out of remission. If you see rising blood glucose numbers, it's time for a visit to the vet!

If you decide to give it a try he likely has completed 8 out of 14 days tonight. I can’t say for sure because he hasn’t been tested. I would suggest you start testing an Ambg and pmbg just to be sure. Good luck.

 

[Sienne and Gabby (GA)]

Wow!! What a change.

 

[Klunkers]

I’m at the vet now because he had an upset tummy for some unknown reason, but they did labs and they look fantastic. Vet said he is in remission and that the diet (FF pate) is working perfectly! He’s also an unusual case apparently (in a good way). He is even starting to jump on our bed at night and is walking MUCH better. We still have a Libre on him so we will be able to continue to watch easily for a while. He has been running between 50-60 every day, almost a straight line. I need to update the spreadsheet! Thank you for all the fabulous advice…we couldn’t have gotten here without you guys. I hope he keeps doing well but obviously we will keep monitoring things.

 

[Klunkers]

I just wanted to update you all and let you know that Logan is doing great. He did end up having to have a few teeth extracted and we had some complications from that with his jaw, but now things are going great. His neuropathy has disappeared and my cat is running around the house, playing, and jumping onto high surfaces and getting into stuff like he used to. Considering that he was near death at the beginning of August, this is nothing short of a miracle and you guys seriously saved him with your advice! I hope that it gives new members some hope. It's such an overwhelming experience, especially at first.

 

[Lando demando]

I just wanted to update you all and let you know that Logan is doing great. He did end up having to have a few teeth extracted and we had some complications from that with his jaw, but now things are going great. His neuropathy has disappeared and my cat is running around the house, playing, and jumping onto high surfaces and getting into stuff like he used to. Considering that he was near death at the beginning of August, this is nothing short of a miracle and you guys seriously saved him with your advice! I hope that it gives new members some hope. It's such an overwhelming experience, especially at first.

I couldnt be happier for you and Logan!