Skye & Jackson
Member Since 2022
We have had Jack for about 4 years; he was an lost/abandoned rescue at about 2 years old (per vet guess at the time). He has always been a somewhat special needs cat - not only clingy and anxious about dogs, the outdoors, and low food bowls, but he apparently had glaucoma sometime in the past, and a suppressed or strained immune system that had him frequently sick early on (now much better with daily lysine). Then he developed urinary crystals, which led to his going on a grain free diet, then got overweight, which led to another grain free kibble but this one low-cal… unfortunately I didn’t really know or worry that low calorie in this case meant high carb! Just potato and pea starches instead of grains.
He ate this diet for about a year with no actual apparent weight loss (I couldn’t bring myself to not free-feed him as the sight of an empty bowl stresses him immensely), but then this summer he suddenly started losing weight too rapidly and drinking a lot. When I finally took him to the vet he was diagnosed with diabetes with a single test BG of 391. Yet the vet thought he might be controllable with diet, so we switched to the first of several attempts at a low carb diet (learning as I went, I started with a 13% carb “diabetic” kibble, then a 6% freeze dried real-food diet, then finally right before things really went south, a special near-zero carb kibble that he’s still on; through the whole thing he luckily was also getting no-carb wet food just because that was his favorite one). A month later he was at BG of 411 and losing his appetite, and the vet suggested we take him to the ER as she (small, single practitioner office) wasn’t set up for further diabetic work. That very night he was diagnosed with DKA, with ketones “too high to register” on their meter - this despite showing no vomiting or most other typical symptoms.
A four day hospital stay and $6000 of debt later, he came home with Lantus and a Freestyle Libre monitor, and I found a new local vet better able to help work with Jack. However, he has been extremely difficult to regulate from the word go. The ER sent him home at a dose of 1.5u bid, with which he promptly went into nadir BG levels of 50-40 about six hours after each dose, requiring oral glucose and hours of stressed-out late-night babysitting. So that lasted all of three doses! His dose was then quickly decreased every couple of days to 1 unit, then 0.5, then 0.25, because he wasn’t eating enough and therefore crashing even on low doses. After about a week of this we realized what was wrong, got him on some mirtazipine, and got him eating well again. He went back to a 0.5 dose for week 2, with stable BGs typically between 350 and 250, then went up to 1 unit bid for week 3.
This is when things started to get wonky. At first it looked promising, though his nadirs for the first few days were uncomfortably low (to me, after nearly losing him a couple times before) in the low 100 range. Then he stopped nadiring so low, instead showing short fast drops into the mid 200s, gradually decreasing in time from +4 hours post shot to +2 hours, followed by sharp spikes into the 400s.
The next week (week 4), the vet increased his dose to 1.25u bid, and Jack seemed to go into (near as I can tell) liver panic. He went into the 400s for longer portions of the day. Moving into week 5 with a change to 1.5u as well as a (short lived) move to meal-feeding, it got worse instead of better, 500+ forestalled only by even higher as well as extra doses of insulin, barely getting down into the high 300s at all. He was up to 2u yesterday (was it only yesterday?) morning… and then I was late getting him his evening dose, realized that he was actually still sliding down from the morning’s dose, and had the epiphany about the over-swing he was experiencing - although he wasn’t dropping low, he was dropping so fast as the doses increased that he ended up spiking higher and staying there longer seemingly every day. (I have now tried explaining this to my vet, but they don’t think the Somogyi effect is possible if he hasn’t actually gone hypoglycemic…)
Now we’re almost kind of starting over. Jackson is back to 0.5u bid as of today, back on free choice no-carb food (in just the last week, he actually lost most of the weight that he’d spent three weeks slowly regaining), and back into the 350-250 range. (Mostly/hopefully, as he did get up to 382 for no apparent reason mid-afternoon today… no sudden drops or high spikes though.) Obviously that’s not low enough for his long term health, and I suspect he’s actually been diabetic for at least 2-3 months before he was diagnosed, plus he did have DKA once already, so I’m really worried about that. But this is the only stability we’ve yet got. It’s been only 5 weeks since he came home from the hospital, but BG and doses have been so all over the place that it feels like months! My entire life has become centered around spending most non-work time at home, hovering over my boy, either me or other family members at my behest while I’m at work checking his glucose with the Libre reader 10+ times a day. My sleep and relationships with people and our other cats have suffered. My cousin/housemate says that I’m obsessed and not taking time to do anything else with family or household work or much of anything except sitting with Jack in my room and studying FD. (She may be right… hyperfocus on things I’m either excited or stressed about is part of my ADD.)
I have done a LOT of reading over these weeks, vet journals and pet pages and articles and studies on the insulins themselves. I’ve learned so much about the pharmakinetics and dosing of insulins, and yet this knowledge hasn’t helped forestall these problems. One thing I do know is that he’s burning through the Lantus waaaay too quickly; his fast drops (brief as they are) most recently have been starting only about 30 minutes after a dose, with the first all-too-brief nadir occurring only about an hour post-dose. At least on a smaller dose, I’m now seeing less bounce again - and his nadirs today were about +4 both times. Based on how different insulins work, I’m considering a change to Levemir, but I don’t want to jump another gun. I don’t know if I’ve just missed something with his current insulin. So much has changed so fast, back and forth, and I know so much change isn’t good for him - but neither is an average daily BG of 300 or more.
My cousin now demands I leave him on one dose for a month because that’s how her thyroid treatment dosing worked. Insulin is not thyroid hormone… but we’ve started actually fighting about it because the wild swings and worry have everyone stressed out and no one can be with him 100% of the time - we all work, albeit (thank God) different schedules. I do think I should give him a couple weeks, I just worry about him staying high so long. Am I worrying too much?
Patience is hard. I want my beloved boy to get better or at least be okay. At the start I had hopes for tighter regulation and remission, but as that goal feels ever farther away, I think now I’d just take healthy and safe and happy. I think at this point I’m definitely looking at the low and slow protocol, and starting over basically there.
Help?
He ate this diet for about a year with no actual apparent weight loss (I couldn’t bring myself to not free-feed him as the sight of an empty bowl stresses him immensely), but then this summer he suddenly started losing weight too rapidly and drinking a lot. When I finally took him to the vet he was diagnosed with diabetes with a single test BG of 391. Yet the vet thought he might be controllable with diet, so we switched to the first of several attempts at a low carb diet (learning as I went, I started with a 13% carb “diabetic” kibble, then a 6% freeze dried real-food diet, then finally right before things really went south, a special near-zero carb kibble that he’s still on; through the whole thing he luckily was also getting no-carb wet food just because that was his favorite one). A month later he was at BG of 411 and losing his appetite, and the vet suggested we take him to the ER as she (small, single practitioner office) wasn’t set up for further diabetic work. That very night he was diagnosed with DKA, with ketones “too high to register” on their meter - this despite showing no vomiting or most other typical symptoms.
A four day hospital stay and $6000 of debt later, he came home with Lantus and a Freestyle Libre monitor, and I found a new local vet better able to help work with Jack. However, he has been extremely difficult to regulate from the word go. The ER sent him home at a dose of 1.5u bid, with which he promptly went into nadir BG levels of 50-40 about six hours after each dose, requiring oral glucose and hours of stressed-out late-night babysitting. So that lasted all of three doses! His dose was then quickly decreased every couple of days to 1 unit, then 0.5, then 0.25, because he wasn’t eating enough and therefore crashing even on low doses. After about a week of this we realized what was wrong, got him on some mirtazipine, and got him eating well again. He went back to a 0.5 dose for week 2, with stable BGs typically between 350 and 250, then went up to 1 unit bid for week 3.
This is when things started to get wonky. At first it looked promising, though his nadirs for the first few days were uncomfortably low (to me, after nearly losing him a couple times before) in the low 100 range. Then he stopped nadiring so low, instead showing short fast drops into the mid 200s, gradually decreasing in time from +4 hours post shot to +2 hours, followed by sharp spikes into the 400s.
The next week (week 4), the vet increased his dose to 1.25u bid, and Jack seemed to go into (near as I can tell) liver panic. He went into the 400s for longer portions of the day. Moving into week 5 with a change to 1.5u as well as a (short lived) move to meal-feeding, it got worse instead of better, 500+ forestalled only by even higher as well as extra doses of insulin, barely getting down into the high 300s at all. He was up to 2u yesterday (was it only yesterday?) morning… and then I was late getting him his evening dose, realized that he was actually still sliding down from the morning’s dose, and had the epiphany about the over-swing he was experiencing - although he wasn’t dropping low, he was dropping so fast as the doses increased that he ended up spiking higher and staying there longer seemingly every day. (I have now tried explaining this to my vet, but they don’t think the Somogyi effect is possible if he hasn’t actually gone hypoglycemic…)
Now we’re almost kind of starting over. Jackson is back to 0.5u bid as of today, back on free choice no-carb food (in just the last week, he actually lost most of the weight that he’d spent three weeks slowly regaining), and back into the 350-250 range. (Mostly/hopefully, as he did get up to 382 for no apparent reason mid-afternoon today… no sudden drops or high spikes though.) Obviously that’s not low enough for his long term health, and I suspect he’s actually been diabetic for at least 2-3 months before he was diagnosed, plus he did have DKA once already, so I’m really worried about that. But this is the only stability we’ve yet got. It’s been only 5 weeks since he came home from the hospital, but BG and doses have been so all over the place that it feels like months! My entire life has become centered around spending most non-work time at home, hovering over my boy, either me or other family members at my behest while I’m at work checking his glucose with the Libre reader 10+ times a day. My sleep and relationships with people and our other cats have suffered. My cousin/housemate says that I’m obsessed and not taking time to do anything else with family or household work or much of anything except sitting with Jack in my room and studying FD. (She may be right… hyperfocus on things I’m either excited or stressed about is part of my ADD.)
I have done a LOT of reading over these weeks, vet journals and pet pages and articles and studies on the insulins themselves. I’ve learned so much about the pharmakinetics and dosing of insulins, and yet this knowledge hasn’t helped forestall these problems. One thing I do know is that he’s burning through the Lantus waaaay too quickly; his fast drops (brief as they are) most recently have been starting only about 30 minutes after a dose, with the first all-too-brief nadir occurring only about an hour post-dose. At least on a smaller dose, I’m now seeing less bounce again - and his nadirs today were about +4 both times. Based on how different insulins work, I’m considering a change to Levemir, but I don’t want to jump another gun. I don’t know if I’ve just missed something with his current insulin. So much has changed so fast, back and forth, and I know so much change isn’t good for him - but neither is an average daily BG of 300 or more.
My cousin now demands I leave him on one dose for a month because that’s how her thyroid treatment dosing worked. Insulin is not thyroid hormone… but we’ve started actually fighting about it because the wild swings and worry have everyone stressed out and no one can be with him 100% of the time - we all work, albeit (thank God) different schedules. I do think I should give him a couple weeks, I just worry about him staying high so long. Am I worrying too much?
Patience is hard. I want my beloved boy to get better or at least be okay. At the start I had hopes for tighter regulation and remission, but as that goal feels ever farther away, I think now I’d just take healthy and safe and happy. I think at this point I’m definitely looking at the low and slow protocol, and starting over basically there.
Help?
