New Member- 1.25.23 12yo Big Bijan

Status
Not open for further replies.
bijer

bijer

Member Since 2022
Hello there, my boy Bijan was diagnosed with diabetes in November of 2022. We have been on insulin therapy since the first week of December. After staying w my parents while I was traveling for work a few months this past 2022, Bijan seem to have strayed away from his normal primarily canned diet and was eating everything with the grandparents! He lost a bit of weight and was peeing a lot when I finally brought him home so we took him to the vet. My boy is turning 13 in February and I have had him since he was 1. I am very worried about his health and worry every day that I am not doing the right things for him.

I am so grateful to come across this forum of dedicated and empathetic caregivers. I appreciate the support you have offered so many in my position and am hopeful to have a community to turn to. I fear my vet who is very sweet and attentive may not have much experience with Feline Diabetes but she has been super communicative and easy to talk to:
  • Bijan was started with 2 units of Lantis, my vet recently told me increase the dosage to 3 units on 1.15 after not seeing much progress, but after reading thru the forum a bit I decided to fatten up the dosage rather than going to a full 3 (he is getting about 2.5). She told me she would like to see his numbers closer to 250.
  • We use the Freestyle libre 2 as recommended by my vet for now. But he has been reaching over biting and ripping the last 3 off (I caught him today after replacing it yesterday!!!!) the visit to the vet and pharmacy has been really stressful on him so decided to order a cat t-shirt to see if that would help. We will go back to the vet today to have it placed again once the shirt arrives. This is why you see gaps in the reporting- I had to wait for replacement meters
  • I had initially been feeding him the RC glucose balance diet (wet and dry) but after doing more research and not feeling good about the gravy and kibble. We transitioned away from the kibble and to stella & chewy freeze dried raw but he seemed to lose interest. I recently transitioned him over to a combo of 1 can fancy feast original pate and about 1/4 of S&C freeze dried salmon bites (I think this is helping in his most recent numbers and he seems to like it
  • His pp and water intake have definitely decreased
  • He seems to have lost some weight but his appetite has never really decreased
Any advice, insight or suggestions you may have to offer would be much appreciated. Thank you so much.
 
Last edited:
Hi and welcome to you and Bijan to the forum!:)
First of all, Lantus is a great insulin for cats. We normally recommend starting at 0.5 to 1 unit of Lantus to start with depending if you are feeding a wet or dry food diet.
I think Bijan is doing a lot of bouncing. I would not increase the dose as the 2.5 U is taking him down to green BGs…53 on one occasion.
As you are following SLGS I would reduce the dose to 2.25 units. With SLGS you reduce the dose if the BG drops under 90.
Lantus dosing is based on the nadir, not the pre shot.
Here is a link to an explanation about bouncing from the Basics on the Lantus page.

I am glad you have decided to swap to a low carb diet. Feeding a low carb diet (10% or under carbs) will help reduce the BG numbers and is what a diabetic cat needs.
Here is a link to CANADIAN FOODS
You should be able to find plenty of choice there. Most of us feed 4-7% carbs.
Are you feeding him snacks during the cycles as well as the 2 main meals? Diabetic cats do better with two or three snacks during all cycles. A snack is 1 or 2 teaspoons of the normal low carb food. It is best to feed the snacks during the first half of the cycles unless he dropd lower in the second half of the cycles…which it looks like he sometimes does.
Withhold food for the two hours before the pre shot BG so that the preshot BG is not food influenced.

As you are having trouble with the Freestyle Libre (and it is expensive) I would think about changing over to home testing. It sounds scary but it isn’t. And Bijan will not hate you. We can help you with this. Maybe you can try it while you have the latest Libre on.
Her is a link to HOMETESTING HINTS AND LINKS
I think the Bravo glucose meter is a good one for Canadian members.
I will tag @Wendy&Neko as she lives in Canada.

Keep asking questions. We are very happy to help you
Bron
 
Hi and welcome to the group! You have a gorgeous kitty there, what amazing eyes!

Freestyle Libres are great but have you considered doing your own testing of the BG with a handheld meter? I thought it was going to be impossible but we got the hang of it with help from people here and before you know it, it was easy. It can be very useful to be able to double-check the libre's number, or if it malfunctions or the cat removes it being able to still check the BG manually is always good.
 
Bron and Sheba (GA) said:
Hi and welcome to you and Bijan to the forum!:)
First of all, Lantus is a great insulin for cats. We normally recommend starting at 0.5 to 1 unit of Lantus to start with depending if you are feeding a wet or dry food diet.
I think Bijan is doing a lot of bouncing. I would not increase the dose as the 2.5 U is taking him down to green BGs…53 on one occasion.
As you are following SLGS I would reduce the dose to 2.25 units. With SLGS you reduce the dose if the BG drops under 90.
Lantus dosing is based on the nadir, not the pre shot.
Here is a link to an explanation about bouncing from the Basics on the Lantus page.

I am glad you have decided to swap to a low carb diet. Feeding a low carb diet (10% or under carbs) will help reduce the BG numbers and is what a diabetic cat needs.
Here is a link to CANADIAN FOODS
You should be able to find plenty of choice there. Most of us feed 4-7% carbs.
Are you feeding him snacks during the cycles as well as the 2 main meals? Diabetic cats do better with two or three snacks during all cycles. A snack is 1 or 2 teaspoons of the normal low carb food. It is best to feed the snacks during the first half of the cycles unless he dropd lower in the second half of the cycles…which it looks like he sometimes does.
Withhold food for the two hours before the pre shot BG so that the preshot BG is not food influenced.

As you are having trouble with the Freestyle Libre (and it is expensive) I would think about changing over to home testing. It sounds scary but it isn’t. And Bijan will not hate you. We can help you with this. Maybe you can try it while you have the latest Libre on.
Her is a link to HOMETESTING HINTS AND LINKS
I think the Bravo glucose meter is a good one for Canadian members.
I will tag @Wendy&Neko as she lives in Canada.

Keep asking questions. We are very happy to help you
Bron
Click to expand...


thank you so much! We are actually in Miami, Florida- I am not sure if I mistakenly wrote Canada somewhere so I apologize for that.

Bouncing:
  • I think the link to the bouncing page did not copy properly- do you mind resharing with me? I did look through other pages and am understanding its like the body trying to course correct? Is this because he is dropping too far because of the dosage or because the body is just not used to the drop yet?
  • I am going to go back in and put in more of bijans history into his chart to help with the bigger picture. From the earlier days he was mostly off the freestyle in the 400+ - 300s
  • I will reduce to 2.25 but its a bit hard to tell on this syringe. Are you saying I should have lowered from 2 rather than increasing to 3? I believe she started him on 2 because he is so large and his BG was in the 500s when he was diagnosed and for about a month we did not see much change.
  • If his BG reading is low (under 80) should I not give insulin?
Food:
  • He doesn't finish his meal during feeding times, he usually snacks on it throughout the day and finishes before the next meal &/or I have been giving him a few of these treats
  • He is getting about only 1-3% carbs between the Fancy feast and the freeze dried raw now. Should I increase this or keep it as is?
Meter
  • I will try the at home testing. he cries a bit when I poke him with the insulin sometimes so I was worried the ear testing would be tough for him. But you are right I need to be able to test if the meter comes off again! Thanks for the nudge Hendrick.

Thank you so much
 
Just looking at your SS now and I can see you gave 2.25 U when the preshot was 76. With SLGS you do not give insulin if the preshot is under 90.
Please get a +1 and a +2 BG so we can see that he is rising not falling. Lantus onsets around +2 so we want him a bit higher than the 76. Also give him a snack at +1 and +2 please

Sorry about the bouncing link. That was my error.
From the Basics on the Lantus page.
  • Bouncing - Bouncing is simply a natural reaction to what the cat's system perceives as a BG value that is "too low". "Too low" is relative. If a cat is used to BGs in the 200's, 300's, or higher for a long time, then even a BG that drops to 150 can trigger a "bounce". Bouncing can also be triggered if the blood glucose drops too low and/or too fast.The pancreas, then the liver, release glucogon, glycogen and counter-regulatory hormones. The end result is a dumping of "sugar" into the bloodstream to save the cat from going hypoglycemic from a perceived low. The action is often referred to as "liver panic" or "panicky liver". *Usually*, a bounce will clear kitty's system within 3 days (6 cycles).\

bijer said:
I will reduce to 2.25 but its a bit hard to tell on this syringe
Click to expand...
Are you using the U100 3/10 30 or 31 gauge 6 or 8 mm insulin syringes with 1/2 unit markings?

bijer said:
Are you saying I should have lowered from 2 rather than increasing to 3? I believe she started him on 2 because he is so large and his BG was in the 500s when he was diagnosed and for about a month we did not see much change.
Click to expand...
Yes I am saying that you need to reduce the dose not increase the dose. With SLGS you reduce the dose if the BG drops under 90.
bijer said:
If his BG reading is low (under 80) should I not give insulin?
Click to expand...
That is correct. Under 90...skip the dose. If the preshots are that low and the other BGs are really high, then the dose will probably need reducing so you can shoot both cycles
From the yellow stickie on SLGS
Until you collect enough data to know how your cat will react, we suggest following the guidelines in the FDMB's FAQ Q4.4:
Q4.4. My cat's pre-shot level was way below the usual value. Should I give the injection?
A4.4. There's no hard and fast rule, but if you don't have data on how your cat responds to insulin, here are some general guidelines.
  • Below 150 mg/dl (8.3 mmol/L), don't give insulin.
  • Between 150 and 200 (8.3-11.1 mmol/L), you have three options:
    • a.) give nothing
    • b.) give a token dose (10-25% of the usual dose)
    • c.) feed as usual, test in a couple of hours, and make a decision based on that value
  • Above 200 (11.1 mmol/L) but below the cat's normal pre-shot value, a reduced dose might be wise.
  • In all cases, if you are reducing or eliminating insulin, it's wise to check for ketones in the urine.
  • Above the normal pre-shot value, give the usual dose, but if the pre-shot value is consistently elevated, it's a good idea to schedule a full glucose curve to see whether a change in dose or insulin is appropriate. In most cases, the target "peak" value should not be below 100 mg/dl (5.6 mmol/L), and for some cats it might be higher.

bijer said:
He doesn't finish his meal during feeding times, he usually snacks on it throughout the day and finishes before the next meal &/or I have been giving him a few of these treats. He is getting about only 1-3% carbs between the Fancy feast and the freeze dried raw now. Should I increase this or keep it as is?
Click to expand...
I'm not sure about those treats. They look as if they could be higher carb with potato starch and peas in them. Ill ask @Diane Tyler's Mom to tell you some good treats...I don't live in the US.
The carbs in the food look fine. Do you have a hypo kit set up?

bijer said:
I will try the at home testing. he cries a bit when I poke him with the insulin sometimes so I was worried the ear testing would be tough for him. But you are right I need to be able to test if the meter comes off again!
Click to expand...
Are you giving the insulin not too deep? If it hits the muscle it hurts.
A good meter in the US is the ReliOn premier from Walmart. You will also need test strips and a box of lancets size 26 or 28 and some cotton rounds to hold behind the ear.
 
Last edited:
Bron and Sheba (GA) said:
I'm not sure about those treats. They look as if they could be higher carb with potato starch and peas in them. Ill ask @Diane Tyler's Mom to tell you some good treats...I don't live in the US.
The carbs in the food look fine. Do you have a hypo kit set up?
Click to expand...

As for treats when you test or give insulin
for treats for testing
You can give any freeze dried treats they are all low carb
Tap on this blue link and read post #64 the post numbers are to the right of each post and you can read about the freeze dried treats I listed

https://felinediabetes.com/FDMB/threads/new-to-this-i-need-advice.269452/#post-

3007388

@bijer
 
Last edited:
Bron and Sheba (GA) said:
Just looking at your SS now and I can see you gave 2.25 U when the preshot was 76. With SLGS you do not give insulin if the preshot is under 90.
Please get a +1 and a +2 BG so we can see that he is rising not falling. Lantus onsets around +2 so we want him a bit higher than the 76. Also give him a snack at +1 and +2 please

Sorry about the bouncing link. That was my error.
From the Basics on the Lantus page.
  • Bouncing - Bouncing is simply a natural reaction to what the cat's system perceives as a BG value that is "too low". "Too low" is relative. If a cat is used to BGs in the 200's, 300's, or higher for a long time, then even a BG that drops to 150 can trigger a "bounce". Bouncing can also be triggered if the blood glucose drops too low and/or too fast.The pancreas, then the liver, release glucogon, glycogen and counter-regulatory hormones. The end result is a dumping of "sugar" into the bloodstream to save the cat from going hypoglycemic from a perceived low. The action is often referred to as "liver panic" or "panicky liver". *Usually*, a bounce will clear kitty's system within 3 days (6 cycles).\

Are you using the U100 3/10 30 or 31 gauge 6 or 8 mm insulin syringes with 1/2 unit markings?


Yes I am saying that you need to reduce the dose not increase the dose. With SLGS you reduce the dose if the BG drops under 90.

That is correct. Under 90...skip the dose. If the preshots are that low and the other BGs are really high, then the dose will probably need reducing so you can shoot both cycles
From the yellow stickie on SLGS
Until you collect enough data to know how your cat will react, we suggest following the guidelines in the FDMB's FAQ Q4.4:
Q4.4. My cat's pre-shot level was way below the usual value. Should I give the injection?
A4.4. There's no hard and fast rule, but if you don't have data on how your cat responds to insulin, here are some general guidelines.
  • Below 150 mg/dl (8.3 mmol/L), don't give insulin.
  • Between 150 and 200 (8.3-11.1 mmol/L), you have three options:
    • a.) give nothing
    • b.) give a token dose (10-25% of the usual dose)
    • c.) feed as usual, test in a couple of hours, and make a decision based on that value
  • Above 200 (11.1 mmol/L) but below the cat's normal pre-shot value, a reduced dose might be wise.
  • In all cases, if you are reducing or eliminating insulin, it's wise to check for ketones in the urine.
  • Above the normal pre-shot value, give the usual dose, but if the pre-shot value is consistently elevated, it's a good idea to schedule a full glucose curve to see whether a change in dose or insulin is appropriate. In most cases, the target "peak" value should not be below 100 mg/dl (5.6 mmol/L), and for some cats it might be higher.


I'm not sure about those treats. They look as if they could be higher carb with potato starch and peas in them. Ill ask @Diane Tyler's Mom to tell you some good treats...I don't live in the US.
The carbs in the food look fine. Do you have a hypo kit set up?

Are you giving the insulin not too deep? If it hits the muscle it hurts.
A good meter in the US is the ReliOn premier from Walmart. You will also need test strips and a box of lancets size 26 or 28 and some cotton rounds to hold behind the ear.
Click to expand...

this was a really helpful explanation I appreciate it.

I am using the u 100 1/2 ML 12.7mm 30g syringes. I can ask my vet to prescribe the ones you recommend once I go thru these. Yesterday after his morning dose, which I tried to get closer to 2.25/2 and he was pretty much in the blue/green for the rest of the day even after his second meal/around the time I give him his second shot. So I skipped the shot. I noticed him dropping a little so just nudged him to eat a bit more of dinner and gave him a snack before bed. and monitored him all night and he seemed to be fine (under 150) until about 9am today (a little bit before we usually start his first dose.) This morning he is back over 400.

I am going to reduce his dose today to 2/2.25 again and see how we do.

Is it normal to only do 1 shot a day?

i have a hypo kit (a few cans of higher carb/gravy food, some dry food, and corn syrup/honey on hand if necessary).

thank you so so so so much
 
bijer said:
this was a really helpful explanation I appreciate it.

I am using the u 100 1/2 ML 12.7mm 30g syringes. I can ask my vet to prescribe the ones you recommend once I go thru these. Yesterday after his morning dose, which I tried to get closer to 2.25/2 and he was pretty much in the blue/green for the rest of the day even after his second meal/around the time I give him his second shot. So I skipped the shot. I noticed him dropping a little so just nudged him to eat a bit more of dinner and gave him a snack before bed. and monitored him all night and he seemed to be fine (under 150) until about 9am today (a little bit before we usually start his first dose.) This morning he is back over 400.

I am going to reduce his dose today to 2/2.25 again and see how we do.

Is it normal to only do 1 shot a day?

i have a hypo kit (a few cans of higher carb/gravy food, some dry food, and corn syrup/honey on hand if necessary).

thank you so so so so much
Click to expand...
@Bron and Sheba (GA)
 
I would reduce the dose for 2 reasons .. you are doing SLGS and you have dropped under 90 so an automatic reduction, and if you are finding you can’t shoot both cycles because of a low Preshot, then the best thing is to reduce the dose to see if you can shoot both cycles. So down to 2 units next Preshot.
 
I dropped down today to 2 and noticed his numbers were still pretty high for the majority of the day. It seems like maybe 2 Is not enough but anymore is too much? what do you think?
 
Remember Lantus dosing is based on the nadir or lowest point in the cycle not the preshot BG…..see post 12.
Once you earn the dose reduction you don’t go up again at the next higher preshot….which it looks like you have done in the current on cycle. He is likely bouncing from the green BGs.
 
bijer said:
I dropped down today to 2 and noticed his numbers were still pretty high for the majority of the day. It seems like maybe 2 Is not enough but anymore is too much? what do you think?
Click to expand...

once the dose is reduced you have to stick with it for a bit. With the dose change, often a kitty's BG numbers will jump around but we call this "new dose wonkiness" and it is to be expected, what you DON'T want to do is have a knee jerk reaction and put the dose right back up. It is very important to stick with the new dose to see how it is doing over time.

The parameters of SLGS specify this, but it seems you are not following those guidelines. If you want your kitty to get better, follow the guidelines and the advice from people like Bron, it will work wonders.
 
Bron and Kyle are right. You can't change the dose going by the pre shot numbers
Here is the info again when you follow SLGS method which you have listed on your spreadsheet. Can you add SLGS to your signature also

Hold the dose for at least a week:
  • Unless your cat won’t eat or you suspect hypoglycemia
  • Unless your kitty falls below 90 mg/dL (5 mmol/L). If kitty falls below 90 mg/dL (5 mmol/L) decrease the dose by 0.25 unit immediately.
After 1 week at a given dose perform a 12 hour curve, testing every 2 hours OR perform an 18 hour curve, testing every 3 hours. Note: Random spot checks are often helpful to "fill in the blanks" on kitty's spreadsheet. The goal is to learn how low the current dose is dropping kitty prior to making dose adjustments.
  • If nadirs are more than 150 mg/dl (8.3 mmol/L), increase the dose by 0.25 unit
  • If nadirs are between 90 (5 mmol/L) and 149 mg/dl (8.2 mmol/L), maintain the same dose
  • If nadirs are below 90 mg/dl (5mmol/L), decrease the dose by 0.25 unit
 
I will keep the 2 unit dosage for at least week per your recos. My concern is the history of weeks before this at 2 units does that not matter? Even though we had already been doing this dosage for a few weeks, probably an entire month but his numbers were still really high if you see earlier in the chart. He only started showing more consistent lower numbers when the dosage increased. But the Nadirs were too low. Is this because he is still new to insulin?

As far as reducing the dosage I am now understanding that I should go off the lowest read he has during the day (nadir) not the predose value. We will keep a 2 unit dosage for now but my confusion comes from him dropping very low more frequently recently before his next PMPS numbers.

Today he has already dropped to below 80. We still have a few more hours in our first 12 hour window today (just 2). Does this mean I should skip the dose if he does not come back up over 150 before PMPS? Or lower it to 1.5 if he does? My concern is giving him another dose with an already low PMPS even though we are saying to not go based off of the ps.

thank you so much for clarifying it's not that I am trying to go against the recos, I am scared of causing hypoglycemia.
 
bijer said:
I will keep the 2 unit dosage for at least week per your recos. My concern is the history of weeks before this at 2 units does that not matter? Even though we had already been doing this dosage for a few weeks, probably an entire month but his numbers were still really high if you see earlier in the chart. He only started showing more consistent lower numbers when the dosage increased. But the Nadirs were too low. Is this because he is still new to insulin?

As far as reducing the dosage I am now understanding that I should go off the lowest read he has during the day (nadir) not the predose value. We will keep a 2 unit dosage for now but my confusion comes from him dropping very low more frequently recently before his next PMPS numbers.

Today he has already dropped to below 80. We still have a few more hours in our first 12 hour window today (just 2). Does this mean I should skip the dose if he does not come back up over 150 before PMPS? Or lower it to 1.5 if he does? My concern is giving him another dose with an already low PMPS even though we are saying to not go based off of the ps.

thank you so much for clarifying it's not that I am trying to go against the recos, I am scared of causing hypoglycemia.
Click to expand...
Tagging Bron for you
@Bron and Sheba (GA)


Since Bijan's dropped under 90 during the AM cycle @+9 should he take a reduction tonight?
@Bron and Sheba (GA)
 
Last edited:
bijer said:
@Bron and Sheba (GA) his PMPS came in at 165
Click to expand...
Because you have chopped and changed the dose a bit lately it is hard to decide what dose to tell you. Todays cycle could have been influenced by the depot from last nights 2.25 units. But I think we should take the reduction because he dropped under 90 and your new dose is 1.75 units.
Are you able to monitor this cycle? Do you have higher carb foods if needed?
 
@Bron and Sheba (GA) Yes, I have higher carb food if needed and I can monitor both of today's cycles as well. Last night I did give him a reduction (1.75) I wasn't able to monitor him all night because I was sleeping part of it but I scanned a few times when I woke up. He seemed to slowly rise to the 300's until this morning at about 845 (almost 1.5 hours before his am shot) where he went high.

I'll keep tracking at 1.75 today for both cycles and keep an eye on him. Will try to get as much data as possible
 
Last edited:
@Bron and Sheba (GA) I am still wondering though why his historicals of 2 were not really successful, that is why the dose was increased in the first place to 3 by my vet. Is it that I should have reduced him earlier when he initially hit 81 on 12.31?

I am really upset that the vet had me start high rather than low. And I am making it more of a challenge to really know how to help him. I feel like such bad cat mom :(
 
Last edited:
bijer said:
@Bron and Sheba (GA) I am still wondering though why his historicals of 2 were not really successful, that is why the dose was increased in the first place to 3 by my vet. Is it that I should have reduced him earlier when he initially hit 81 on 12.31?

I am really upset that the vet had me start high rather than low. And I am making it more of a challenge to really know how to help him. I feel like such bad cat mom :(
Click to expand...
You are not a bad Mom. You were following directions from the vet. At the moment Bijan is bouncing from the 79 yesterday am, so you can expect to see some higher numbers for up to 6 cycles. Keep doing what you are doing.
You can use the remarks column in the SS to add information such as the food you fed, how Bijan is etc.
 
keep in mind that you have only been at this for less than 2 months....the FD journey is a marathon, not a sprint and you are still in the beginning stages so plenty of time to adjust and pivot, and find the right dose for bijer.
 
Thank you @Bron and Sheba (GA) and @Hendrick Cuddleclaw.

I am noticing Bijan is already testing low today around +6 (74) which according to the Lantis group is hopefully the NADIR for the day, I gave him a low carb snack for now since its not dipping too low. Will check again here shortly and record for +7

My question is should I continue reducing his dose if his Nadirs continue coming under 90? We are now at 1.75, down from 2.25 in just 3 days. How long should I keep 1.75- 1 week? or should I keep reducing until the Nadir comes in above 90 and hold?
 
Yes I would reduce the dose to 1.5 unit. If the BG drops under 90 on SLGS you reduce the dose. And he has had 4 doses of the 1.75 U so the depot should not be effecting the cycle much now.
 
Status
Not open for further replies.
Back
Top