New Member Bingley! and his first BG curve

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Li & Bingley

Li & Bingley

Member Since 2022
Hi everyone! So glad to have found this forum!

My 12 year-old cat Bingley was diagnosed with diabetes beginning of July, and we started on insulin July 14. Over the weekend we finally did our first 12-hour glucose curve at home, hooray!

Things that happened in those 7 weeks / some background:
  • We switched completely from dry to wet food pretty quickly.
  • Bingley stopped using the litterbox. This was beyond the leaking/incontinence that was happening when wasn’t on insulin yet. First it was just urinating outside, but pooping inside the box. Then he wasn't going in the box at all. Vet prescribed him antibiotics for possible UTI without actually testing for UTI. Covered house in pee pads.
  • Bingley started walking like he was very drunk, so we took him to the ER. He was not hypoglycemic, but did have lower-back arthritis, and a big fever. He was on an IV drip to bring it down. Aside from diabetes, all blood and urine tests came back clean.
  • ER vet switched to a different antibiotics for the UTI, even though it turned out he didn’t have uti.
  • ER vet prescribed gabapentin for his arthritis. There was also a brief mention of “diabetic neuropathy” for causing the funny walking, but it was presented to me as a “maybe? we don’t know? it’s rare? so probably not?” so I was focused more on the arthritis bit.
  • Changed up his litterbox so that he had several kinds and locations to choose from, with low entrances. After antibiotic was finished/while on gabapentin, he still wasn’t using the box.
  • Construction work in our house began. Added stress.
  • My usual vet canceled our 3-week fructosamine appointment, given all of the above. Told me to reschedule when things are calmer, whenever I felt that was.
  • Vet also told me here to feed him twice a day only, and to take his food away after 20 min. Bingley’s always been a grazer and this was not working. He also lost a bunch of weight before being diagnosed. Vet told me it’s the only way the insulin will work properly. So I either starve him by withholding food, or starve him via uncontrolled diabetes.
  • I started feeling…unsupported and rudderless.
  • I found this forum!! looking for feeding recommendations.
  • I finally found a wet food brand and flavor (BFF Play Pate chicken flavors) that he would eat mostly in one sitting, it was so delicious.
  • Construction in the house hit a delay for 2 weeks. I buy a human meter and lancets but also reschedule that fructosamine appointment.
  • Bingley started using the litterbox…IF we place him in it, usually after his am/pm meal and shot.
  • I’m too nervous to begin the ear pricks.
  • Fructosamine average came back at the highest end of “fair” just one point below “poor.” That was disheartening after 7 weeks on insulin and LC wet food.
Which brings us to these past few days. Bingley went into the litterbox on his own 3 times! (we’re still assisting him mostly). His neuropathy - and I do think that’s what it is - is still visible but not nearly as bad as before. I’ve started giving him Zobaline for cats.

And of course I finally started testing at home! I did a 12-hour curve yesterday Sep 5. There are 2 previous days of data but without AMPS. I’m hoping the preliminary data + 12 hour is still useful. Can someone can take a look at Bingley's spreadsheet and tell me if he needs an increase? It's seems pretty flat in the 200s. I’m also not sure which method to use - TR or SLGS?

THANK YOU for reading my novel and for any advice!
 
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First of all, THANK YOU for doing so much of the leg work! It saves me a lot of work :smuggrin:

So, first things first - the zobaline should help. It may take some time (months perhaps), but if it is neuropathy it should help. Do you by chance have any pictures/videos of him standing or walking you could share?

If it is arthritis (I'm a little wishy washy on these diagnoses here because these vets don't sound the greatest), you might want to consider Adequan. I would search the forum for "Adequan" and just read through what you find, a lot of.people have had great results with it but it is fairly new for use in cats.

As for the boxes, there's a few culprits and things you can try:
  • The arthritis/neuropathy making it difficult/painful. You can use a box with lower sides on one side or cut part of it for easy entrance. I also found less litter was actually better for my cat, I think the shifting of the litter under his feet made it worse (think about walking on sand on the beach)
  • The diabetes itself. Once he gets more regulated that may fix it....we had a very rough year of pee all over the house until we got regulated (which, side note - it can take months to achieve regulation, it is not like with humans). We actually had to confine him to the laundry room if he was unsupervised because at least that was concrete.
  • I'm suspicious of this whole UTI/not UTI/fever thing. Did they find the cause of the fever? Did they ever do urinalysis or bloodwork - either to confirm the diagnosis, or to confirm the infection went away?
Do you have any labs you can share?

His numbers are actually very nice. TR vs SLGS is more.personal choice, depending on how often you can test, and what your desired BG range is for him. At a dose of 2U almost 2 months after diagnosis and on LC, remission may or may not be in the cards. But if you want to try for it, TR has better chances of remission.

I personally like TR because you can adjust the doses more quickly; the downside is the testing frequency, especially when they get into lower numbers. It may or may not work with your schedule and abilities BUT it's not locked in. Once he gets into green numbers you might say hey wait, this isn't for me, and then switch to SLGS and that's totally ok.

Either method, you would wait at least another day before considering an increase (a full week of SLGS). He appeared to bounce from a lower number the night of 9/3, just don't know how low, it may have been (and likely was) a perfectly safe number.

Bouncing is when they drop lower and/or faster than they're used to, and sometimes when they spend a longer stretch in better numbers that they're not 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 can last up to 3 days/6 cycles.

You can actually start posting daily on the Lantus forum since youve already got everything started, there's a lot of experienced eyes over there.

The only other thing I'd add is checking for ketones. DKA is a very serious and life threatening disease for diabetic cats, and is caused by not enough insulin + inappetence/not enough food + underlying infection/inflammation/stress.

In his numbers, I'd test ketones 2-3x a week. If he gets sick, at least once a day. You can use urine ketone strips like Ketostix, or they make blood meters as well (but the strips get pricey). If you get a urine result above trace, or showing DKA symptoms = ER visit.

If you get a blood result above 2, you probably want to have him looked at and likely given some fluids. Above 2.4 is very nearly guaranteed DKA. In the 1-2 range, you'll want to ask us for advice on how to flush ketones and keep them away (it's usually just food upon food, and pushing as many fluids as you can).

Some cats never really throw ketones, other cats are ketone and DKA prone, and yet other cats throw a lot of ketones and never end up DKA.


Oh, the food - I'm sure you already came across the info here, but the majority of us feed multiple small meals, or free feed if you have a "responsible" cat. Typically you want the meals at preshot times to be the biggest, and then another snack around onset (+3 ish). We try not to feed after nadir (I can't quite pinpoint that yet for Bingley, but it'll make itself clear over the next week or so) because the insulin is wearing off. But some cats get hangry and do need another very small late cycle snack.

We withhold food for 2 hours before the shot, this is just to give us a consistent data point to base decisions from. You do not need to withhold food for any other tests. With Lantus you test/feed/shoot, it can all be done within 15 minutes or so (the other insulins have slightly different rules).

When you're new, we usually say if you get a preshot below 200, stall without feeding and post on the board asking advice. Then you slowly lower that number at which you shoot, as the data shows you what's safe to do.

I assume he's underweight? Do you know his ideal weight? I typically recommend this online calculator as a baseline check to see if they're getting enough calories. But, being slightly unregulated still, he will likely need more calories than the calculator shows. Diabetics cannot fully process food.
 
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Thank you so much for your reply!
To quickly answer some of the questions:

The Fever: The ER vets (spoke to 3 during the 16 hours he was there) could not determine the cause. They said it was probably viral. He was 104 and was on an IV for 12 hours so it was no small thing. Bloodwork and urinalysis was done at the time of intake but not afterwards to confirm that it went away. They shared the data with my regular vet, but she didn't follow up. I can share lab results (update it to his spreadsheet?).

Food and Weight: Yes I've ignored the 2x's/day feeding mandate and feed him snacks between AM and PM, making sure to withhold food at least 2 hours before insulin. He was actually slightly overweight before, hovering around the 14.5 lbs mark. You couldn't feel his spine :) he was very rotund. At time of diagnosis he was down to 12.5 lbs which is probably what he should be, but I don't want him any lower than that. I'm definitely tracking his calorie intake.

Litterbox - Tonight he just went into the litterbox on his own for the 4th time this week! This was after his post-dinner snack. He has taken to the box with lower sides. We've even removed our carpet of pee pads, but will probably still continue to place him in the box after his breakfast, which is when he usually goes.

Bounce - Thank you for explaining this! I was wondering why he had that drop on Sept 3 and then he then remained flat in higher numbers. So does that mean he can still have a flat reading for tomorrow Sept 7, his 3rd cycle? What kind of numbers should I expect after that, assuming I don't change the dosage?

I shared the spreadsheet with my vet, I wonder what she'll say. She suggested I do a curve but with only Alphatrak. I told her about this group :)

Dosage - I wish I had started testing earlier, but it seemed too much was going on at once to do everything at once. But we're here now and I still hope we can get him into remission! Both my husband and I work from home so there should be no reason for not trying TR...except a lot of the times I feel so bad for Bingley and the non-stop poking and prodding. I don't want to overdo it so that he hides from us. So far he has been great about his insulin injects, and surprisingly good about ear pricking (I get a lot of low growling but he doesn't fight), so maybe I'm just projecting. I don't him to hate us!
 
Bounce - it's hard to say. He may have cleared it with that 211 the other day, but I would have predicted he clear it that night (often times, a flat yellow cycle means an active cycle to follow...except of course when it doesn't :rolleyes:). But yes, tonight could technically be cycle 6, and you may end up with a blue preshot in the morning (bounce breaking cycles tend to have later nadirs, which is actually what you saw with that first cycle of testing). It'll be easier to see his patterns in another week or two.

Labs - yes add to spreadsheet when you get a chance please, no big rush.

Weight and box - good! I had pee pads taped to the walls too lol

Sounds like TR is doable for you and I'd give it a good go. Just continue to keep test times positive with low carb treats,etc. The first two weeks can be rough, but usually after that they know the drill and it's no big deal. If you think you're doing more harm than good by testing more, no problem, just back off and stay with SLGS until you get him more comfortable.

I would add TR to your signature and spreadsheet, and start posting over in the Lantus forum. Even if you don't have questions to ask or anything much to say, it's still nice to see. A lot of us skim through thread titles and "triage" - we look at the ones that jump out at us first, then we look at the ones who seem to be having a normal day. But we tend to remember each cat's trends and may notice something out of the ordinary, and usually we can remember when it's close to increases, etc (don't ask me how, I can barely remember my glasses are on my head when I need them). Point being - even if you think you don't have much to say, still post because you never know what we might pick up on
 
Oh, and a hypo kit. Don't forget the hypo kit.

Most of us stock medium carb food in the 10-15% range, high carb food in the 16-20% range, and I usually keep a few small cans of 20+% just in case
 
Hi and Welcome to the FDMB. Bingley is super adorable, I see Melissa (FrostD) is helping you out -- you are in great hands. She and others here helped me and my boy Hendrick and now he is in diabetic remission. Stay the course, listen to the expert advice given here and I'm sure good things will come for Bingley.
 
I second that - I have only been on here for a few weeks and have received sooo much help and learned so much!

Li & Bingley said:
Both my husband and I work from home so there should be no reason for not trying TR...except a lot of the times I feel so bad for Bingley and the non-stop poking and prodding. I don't want to overdo it so that he hides from us. So far he has been great about his insulin injects, and surprisingly good about ear pricking (I get a lot of low growling but he doesn't fight), so maybe I'm just projecting. I don't him to hate us!
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I had the same issue with my cat at first, and that made me really hesitant to even poke her ears. After the first week, I ended up buying tube treats (the best known is "churu" but several other brands are making them now) and giving her a few licks before and after each test and injection. Now whenever she sees me holding the tube she comes over meowing and doesn't seem to mind the poke too much now.
Best of luck with Bingley (is he named after THE Mr Bingley??) :cat:
 
Virginie said:
After the first week, I ended up buying tube treats (the best known is "churu" but several other brands are making them now) and giving her a few licks before and after each test and injection. Now whenever she sees me holding the tube she comes over meowing and doesn't seem to mind the poke too much now.
Click to expand...

We give him a Churu too! Although he's not at the stage of running over to me yet.

Yes he is named after Mr. Charles Bingley, heh. I met him when he was 6 weeks old and he seemed pleased to make everyone's acquaintance :)
 
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