? Mina AMPS 411 PMPS 380

[Kathryne Johnson]

Hello!

First time posting, so I apologize if I missed any steps or if I shouldn't be posting in this board!
However, I'm hoping to get some help with my Mina.
She was diagnosed earlier this year (April), after I started noticing a lack of energy, dull fur, weight loss and just an overall feeling of being in a "funk". She still ate as normal (at the time, all my kitties were on Royal Canin HE Gastro free feeding and 1/2 cans of wet food/raw food a day) and drank what I would consider a normal amount of water for her. I think it's worth mentioning that Mina came to me as a stray about 7 years ago, and due to my past life situation, her very first vet visit with me was when she was diagnosed with diabetes.
The vet I had taken her to at the time just handed me a email print out about feline diabetes, and told me start her on .5 units of Glargine 2x daily and check back in with him in a week or so.
I, of course, jumped to the Google and started to overwhelm myself and decided to just follow the vet's prescription and take it day by day. I did, however, immediately remove the dry food from her diet and increased feeding her Vital Essential raw patties (due to cost restraints, I have now switched her over to Fancy Feast Natural Pates)
After our 2nd visit, with little to no change in her tests or overall health, we upped it to 1u 2x a day. I had also started seeking out another vet that was 1) closer to my home and 2) specialized in feline diabetes, or who at least had it listed on their website.
I thankfully found a 'cats only' vet who got me in within 2 days of calling them, and provided me with my AlphaTrak to start doing home testing, and did a feline diabetes crash course with me. She references FDMB a lot and also directed me to the message board for support and help!
After I started seeing our new vet, we increased her dosage up to 2units 2x a day and started home testing.

Mina's BG's remain consistently high, but will drop down to the mid-high 200's whenever we do a dose increase. I have only had her get to 100 once since she's been diagnosed, and have only had a handful of times for her to even drop under 250.
I find a lot of information here about BG's dropping too low and the concern for DKA but not a lot of insight for when BG's remain high even with the dietary changes, daily insulin, etc.

I'm starting to feel very discouraged, and also feeling the financial strain with the continued vet visits and food changes and I'm just not sure what I might be doing incorrectly. While I keep telling myself every cat is different, and some take time, I worry because she's up to 7.5u 2x daily, and her BG's aren't budging.

My spreadsheet is definitely a work in progress, and I'm struggling to get testing done throughout the day since I do not work from home and my fiancé is gone majority of the day. I know trying to find her nadir is pertinent to helping find her dose, so I'm hoping I can get a full days worth over the upcoming holiday.

I'm actually not even really sure what questions I have for the message board, so I think part of me is just seeking some encouragement or tips/tricks others have found helpful when trying to juggle life with a diabetic cat. But I'm open to all comments, insights, guidance, etc.

I think I did my signature correctly, but if not, here is my SS for Mina:
https://docs.google.com/spreadsheets/d/1yH0sKUdhJDhjRudm_fA9Yu2pnoUHwFYftcCa4KygAUQ/edit?usp=sharing

 

[Wendy&Neko]

Hello and welcome. I see you also had a post on the Prozinc forum. At that time, you had switched to Prozinc from Lantus/glargine. Have you switched back again? It's important for us to understand the history, and the blood glucose (BG) number associated with each insulin and dose.

In no particular order, some things lept out at me. First, no need to use the AT meter. The test strips are rather more expensive than the ones for human meters than most of us use. I'd rather there not be barriers to testing, whether it's cost of the test strips, or availability/ease of acquiring them. Most people here use human meter and test strips and have for years, well before the AT came out. For that reason, our dosing methods use human meters.

I note that there are some days in the spreadsheet that are blank. Did Mina get insulin those days? Any tests? Just wondering why they are blank. Our spreadsheet is our go to data tool, and opening it is the first thing I do when I stop in to a person's post.

We determine how to dose Lantus based on how low the dose takes the cat. Lantus is normally a downward curve, with those low numbers somewhere in the middle between the shots. That means we are very interested in seeing data for tests mid cycle. Also, many cats go lower at night that during the day, so grabbing a before bed test, if at least a couple hours after the PM shot, gives us insight into how the dose is going. This data will help us help you with dosing.

One last thing for now, I don't want to overwhelm you at first. I noticed on Prozinc forum post that you mentioned lesions on her. Does she still get them? Any chance she has a pot belly or is losing fur on her tummy? Lesions are common with a condition called Cushings, that can make it hard to get a cat regulated and they tend to need higher doses. Typically cats on doses over 6 units have other conditions present causing them to need those higher doses. My girl had two such secondary conditions, one called acromegaly and the other called insulin auto antibodies.

 

[Kathryne Johnson]

Hello and welcome. I see you also had a post on the Prozinc forum. At that time, you had switched to Prozinc from Lantus/glargine. Have you switched back again? It's important for us to understand the history, and the blood glucose (BG) number associated with each insulin and dose.

-Yes! We did make the switch back to Lantus/Glargine a few months ago, and kind of completely forgot that we did that. We were seeing the same numbers as the Glargine, if not the same but a little higher. Kind of looping in your comment from my message on the Prozinc board and lesions on her. My vet did have concerns about Mina potentially having Cushing's, and I believe she tested liver levels (?) to see if there was something off with her but I wasn't 100% clear as to which test was done. I feel the lesions may have been from flea bites, as they were mainly on her paws, base of tail and a few around her face. Those cleared up after a few weeks back on Lantus, and she does not have a pot belly but has more recently been overgrooming her belly but not to the extent of tearing her skin.

In no particular order, some things lept out at me. First, no need to use the AT meter. The test strips are rather more expensive than the ones for human meters than most of us use. I'd rather there not be barriers to testing, whether it's cost of the test strips, or availability/ease of acquiring them. Most people here use human meter and test strips and have for years, well before the AT came out. For that reason, our dosing methods use human meters.

-I've been looking into other meters, but I'm a creature of comfort and have been to nervous to make the switch. I know the Freestyle Lite (?) is supposedly the human version of the AlphaTrak, but is there another one that is better recommended?

II note that there are some days in the spreadsheet that are blank. Did Mina get insulin those days? Any tests? Just wondering why they are blank. Our spreadsheet is our go to data tool, and opening it is the first thing I do when I stop in to a person's post.

-Kind of combination of me not being home and having my fiancé give the dose and not writing it down. Also, back in October there was a misunderstanding/communication with the dosing and I was incorrectly giving her 10u 2x a day for a little over a week. Once I realized the mistake, I reached out to a local emergency vet to see if I should bring her in, but since she didn't show any signs of a) BG levels dropping (she maintained at mid-high 300's) and b) hyperglycemia, the emergency vet instructed me to stop the insulin and check BG levels. I wasn't 100% sure I should completely stop, so we skipped a dose or two and started her back up at my vets recommended 6u 2x a day. Then towards the start of November (11/07/22-11/09/22), I wasn't able to get a refill on her insulin right away due to some financial emergencies that popped up and drained me until my paycheck. Then over the Thanksgiving holiday, I boarded her at my vet's and I haven't gotten a print-out of her dosing/BG's from them to enter them into the spreadsheet.

We determine how to dose Lantus based on how low the dose takes the cat. Lantus is normally a downward curve, with those low numbers somewhere in the middle between the shots. That means we are very interested in seeing data for tests mid cycle. Also, many cats go lower at night that during the day, so grabbing a before bed test, if at least a couple hours after the PM shot, gives us insight into how the dose is going. This data will help us help you with dosing.

-Okay, I'm going to work on getting a new meter so I can start testing more throughout the day! Yes, the AT strips are so expensive so I try to use them only as needed which is a down fall on my part. I have a few consecutive days off coming up where I can buckle down to do some testing throughout the day and focus on some more PM testing.

One last thing for now, I don't want to overwhelm you at first. I noticed on Prozinc forum post that you mentioned lesions on her. Does she still get them? Any chance she has a pot belly or is losing fur on her tummy? Lesions are common with a condition called Cushings, that can make it hard to get a cat regulated and they tend to need higher doses. Typically cats on doses over 6 units have other conditions present causing them to need those higher doses. My girl had two such secondary conditions, one called acromegaly and the other called insulin auto antibodies.

-Would there be other signs of Cushings, and what test can I ask for from my vet to start looking into potential secondary conditions? I've been worried about her having acromegaly and was interested in how quickly symptoms of acromegaly start to show. I do remember a conversation with my vet about potential pituitary gland tumors that could cause a cat to be insulin resistant, but I feel like she checked something with Mina to see if there was a precursor to Acro or Cushings but didn't see anything alarming. Would you know what would be checked to see if a deeper dive would be needed should she have either of those?

I appreciate all the help! I wish I had found this community way earlier in Mina's diagnosis and I wish I could restart the whole process to get Mina on track. I feel like I've gotten so overwhelmed with all of the information and discouraged from her not making any progress that I've put it to the back burner and just keep hoping that she'll magically regulate.
Also, I don't think I replied to your message properly! I'm so sorry, I'm not sure how to get the reply message to quote yours and have my response below. I think I jumbled it all together.

 

[Wendy&Neko]

Cushings is caused by one of three things, one of which is also a pituitary glad tumour (usually benign). Another is an adrenal gland tumour, the third is from too much prednisolone. It might be time to talk to an internal medicine vet if that's an issue. Here are links to a couple posts that talk about diagnosing Cushings and the tests needed:
https://www.felinediabetes.com/FDMB/threads/how-to-diagnose-cushings.207776/
and https://www.felinediabetes.com/FDMB/threads/vet-is-stumped-but-considering-cushings.210054/

Acromegaly symptoms vary as to when they present. I've read that only 35% have symptoms on diagnosis. Neko's only symptoms when she was diagnoses were her size of dose (above 6 units) and insatiable hunger. Later I found out her one teary eye was due to soft tissue growth blocking her tear ducts. But I also hear of people with cats with pot bellies, louder breathing/snoring, kidney or heart issues, wider mouth. It really varies a lot. There is no "precursor to acro". One in four diabetic cats has acromegaly according to recent research. Cushings is less common.

The test you need to diagnose acromegaly is the IGF-1 test. Blood is sent to Michigan State University for that. While doing that, it's worth requesting the test for IAA (insulin auto antibodies), another condition that can cause the need for higher doses. Sometimes cats have IAA but not acromegaly, and the blood goes to the same place so you save on shipping.

As for the rest of the message, I can unpack (mods have editting rights). In future, highlight just the part of the text/question you want to reply to, click the "reply" that shows up, then answer. Then highlight the next question. Once I've sorted the replies, I'll be back with more answers.

 

[Wendy&Neko]

We did make the switch back to Lantus/Glargine a few months ago, and kind of completely forgot that we did that.

It looks like the spreadsheet is only from this last time with Lantus then? Good to know.

know the Freestyle Lite (?) is supposedly the human version of the AlphaTrak, but is there another one that is better recommended?

Freestyle is similar to the AT, in that it also needs just a small blood drop. A lot of people here use the Relion from Walmart, just because the unit and test strips are so much easier, and you can get more test strips in a pinch quickly if you are running low. It's fine to keep using the AT, just know that people here more often use human meters, so that's the numbers they are used to. Plus it will cost you more. Which I mention cause you had to stop insulin for a while. If you stick to the AT, you might want to consider getting a backup human meter and test strips, just in case you run low at any point and the vet doesn't have them in or shipping is slow. It's happened here.

Kind of combination of me not being home and having my fiancé give the dose and not writing it down.

Could you update the spreadsheet, for at least the last couple weeks, for where they are blank. If you deliberately did not shoot for whatever reason, put NS (no shot) or "skip" in the dose units column. That way we know it was deliberate and not just a missed entry. In the Remarks column you can mention why no shot, just as "per vet suggestion". Please contact your vet and try to get the records for dosing and any blood sugar values they have. You paid for those tests, you own them. In the mean time, you can note in the Remarks column that she was at the vet and don't have the data.

One more thing, please take a look at the Sticky Notes at the top of this forum. Including the one called Dosing Methods. People find it easier if they have a dosing method they can follow, and it help us help you too. Both dosing methods have you stick with the same dose AM and PM, unless either there is an indication the dose is too high (low numbers) or the numbers indicate the dose is too high and needs to be increased. Both dosing methods determine how to change the dose based on how low the blood sugars are going on that dose. That means getting mid cycle tests as much as you can, as that's when the insulin is strongest and the blood sugars the lowest.