Introduction: Tilda

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Tilda

Tilda

Member Since 2023
Hello! I am incredibly thankful for this forum-- I have learned so much.

Tilda is ~14 yo female (diagnosed 10/2/23), 1U glargine BID, has always been 8lbs but went up to 12 in the last three years (stable) as we zeroed in on food/environment allergies. Early CKD, drinking a lot/peeing a lot for about a year. History of steroids. Very vocal and hungry leading up to diagnosis (~past few weeks) thought it was her ears bothering her (allergy related) and was prescribed topical steroids for 7 days. When the ears were better the behavior change persisted and we went back for a senior panel.

She was on rayne kangaroo wet twice a day with free fed hydrolyzed royal canin but I weened off the dry food since diagnosis. I had tried to get her off the dry food numerous times but always ended up with constipation...which is where we are today. I think the dry food gave her the fiber she needed and I'm currently trying to find the balance of miralax and pumpkin. Also takes fortiflora as needed, fish oil supplement, and gabapentin. I am trying to transition of portion of her food to rayne kangaroo freeze dried to lower her carb intake.

We had a vet visit this week when she had an asthma attack with some blood in the nasal spray-- the attack was short and while she does have them occasionally, we were scared this was a upper respiratory infection from a foster cat we currently have (they're 100% separate). Got 100ml fluids and prescribed doxycycline, which I haven't started due to loose stool. We've now swung to constipation 24 hrs later, notes in the spreadsheet here:

https://docs.google.com/spreadsheets/d/1lJXuNg2jTDXowT2EtPCc4VNb50Ar2V3bhu6gz_aFuDk/edit?usp=sharing

There's a lot more I could say but wanted to introduce ourselves. She'll be on two weeks of doxy-- anything I should watch out for? I'm trying to limit variables but there are so many at the moment. Open to allergy (poultry/fish/beef/pork) friendly diet suggestions as well.

upload_2023-10-12_10-52-7.jpeg


Thank you all
<3 Ali and Tilda
 

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Hi and welcome Ali to the forum to you and Tilda.
What is the gabapentin for?
If you think she has allergies, you might want to try a novel protein to see if that helps.
I don’t know the rayne kangaroo…is it a complete food?
Are you testing for ketones in the urine? If not I would recommend you do. You will need to buy a bottle of Ketostix from Walmart or a pharmacy.

S Boulardii is good for diarrhoea. It’s a probiotic so keep it 2 hours away from the antibiotic.

I would get a curve done tomorrow as it looks like Tilda could do with an increase in dose.
 
Bron and Sheba (GA) said:
Hi and welcome Ali to the forum to you and Tilda.
What is the gabapentin for?
If you think she has allergies, you might want to try a novel protein to see if that helps.
I don’t know the rayne kangaroo…is it a complete food?
Are you testing for ketones in the urine? If not I would recommend you do. You will need to buy a bottle of Ketostix from Walmart or a pharmacy.

S Boulardii is good for diarrhoea. It’s a probiotic so keep it 2 hours away from the antibiotic.

I would get a curve done tomorrow as it looks like Tilda could do with an increase in dose.
Click to expand...

Thanks! I have been testing for ketones, all negative luckily.

The doxy is for the suspected/possible URI and sneezing blood for secondary infections (she doesn't have any other symptoms).

My vet just just recommended holding off on the curve since I had two fur shots in there...I'm open to doing it today
 
She’s such a cutie!!!

when you’re shooting, are you using a light source or a flashlight aimed at the spot so you can see the needle going into the skin? I would recommend you do that. I never had a fur shot once I started doing that and also, use the tent method to pull up the skin in between the shoulders and inject there.

She’s on an asthma inhaler right? Can you add that to your signature? We like to see all meds in there. Just so you know, fortiflora is not a great probiotic at all. It’s more of a flavor enhancer. S Boulardii as Bron suggested is much better
 
Ale & Bobo & Minnie (GA) said:
She’s such a cutie!!!

when you’re shooting, are you using a light source or a flashlight aimed at the spot so you can see the needle going into the skin? I would recommend you do that. I never had a fur shot once I started doing that and also, use the tent method to pull up the skin in between the shoulders and inject there.

She’s on an asthma inhaler right? Can you add that to your signature? We like to see all meds in there. Just so you know, fortiflora is not a great probiotic at all. It’s more of a flavor enhancer. S Boulardii as Bron suggested is much better
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ah I should clarify, she doesn't have asthma-- but has similar coughing attacks (low head, stretched neck). These are minimal/infrequent but she is stuffy sounding in the last year.

I haven't been using a light but will try that! I had the fur shots when she got restless and jumped out of my lap at the worst moment.

Doing the curve today, updated the sheet.
 
She’s adorable. You can increase miralax to 2 times if you don’t see results. It’s dose to effect.
 
aligibbons said:
ah I should clarify, she doesn't have asthma-- but has similar coughing attacks (low head, stretched neck). These are minimal/infrequent but she is stuffy sounding in the last year.

I haven't been using a light but will try that! I had the fur shots when she got restless and jumped out of my lap at the worst moment.

Doing the curve today, updated the sheet.
Click to expand...
Coughing can also be heart related. If it persists and since it’s not asthma talk to your vet.
 
Finished a curve yesterday, I think I did it right?! One of our vets is suggesting waiting 3 days to increase the dose and our other vet is suggesting going up to 2U right away. (We have two vets since we live in two places, I consider the vet suggesting the 3 day wait or primary vet).
 
I agree an increase is needed. Doubling the dose is much too much. You might miss a good dose but you also risk a sympathetic hypo. It can be hard to bring the bg up and can lead to a need for a visit to the ER. With the nadirs in the 200’s a .25 increase is earned. It’s easier to increase again and not risk a dangerous hypo. It’s too soon to know how your cat will react to an increase.

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
As your cat's blood glucose begins to fall mostly in the desired range [lowest point of the curve approaching 100 mg/dl (5.5 mmol/L) and pre-shot value around or below 300 mg/dl (16.6 mmol/L)], do
 
To add to what I wrote above, cats often have lower bg at night. You only have half of the picture. I would try and get a test later in the cycle tonight. If the +2 is lower than the preshot you might see lower numbers later. That’s when the extra test mid cycle will really help find the nadir. Tonight is probably not the night to do it as your cat might be bouncing from dropping into the 200’s as it’s lower than it’s been for awhile. They react to bg they aren’t used to by the bg going high. As cats get used to lower and lower numbers fir them the bouncing gets less.
 
We make dose adjustments here by 1/4 unit not full units so you’d increase to 1.25 as Elise said. It would be good for you to read all the yellow sticky notes in the Lantus forum, especially the one on the 2 dosing methods we follow here. Elise already copied and pasted some of it for you above. You don’t need to wait 3 days from the day you did the curve. You make a dose adjustment, stick with it for 7 days, do a curve and then see what the next adjustment will be and start that right away.

https://felinediabetes.com/FDMB/forums/lantus-levemir-biosimilars.9/
 
Ale & Bobo & Minnie (GA) said:
We make dose adjustments here by 1/4 unit not full units so you’d increase to 1.25 as Elise said. It would be good for you to read all the yellow sticky notes in the Lantus forum, especially the one on the 2 dosing methods we follow here. Elise already copied and pasted some of it for you above. You don’t need to wait 3 days from the day you did the curve. You make a dose adjustment, stick with it for 7 days, do a curve and then see what the next adjustment will be and start that right away.

https://felinediabetes.com/FDMB/forums/lantus-levemir-biosimilars.9/
Click to expand...

Got it! I read through and will proceed with an increase. I am trying to wrap my head around all of it. I asked on facebook, but she's very hungry at night-- I'll try to get a number at +8 tonight. Can I cut the fast down to an hour instead of two when she's so hungry? She gets fed at night but we're both not sleeping hah
 
Do you mean no food 2 hours before the pmps? Not really because then the result will be food influenced. Can you give her at a snack at around+9? I did that with Minnie. That’s only important for the pre shot tests. For any other test it’s fine if she eats right before or anywhere near the time.

You don’t need to stay up. A + 2 or 3 is fine. I would give the shot at 7:30pm and test her right before going to bed at 10pm.
 
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Ale & Bobo & Minnie (GA) said:
Do you mean no food 2 hours before the pmps? Not really because use then the result will be good influenced. Can you give her at a snack at around+9? I did that with Minnie. That’s only important for the pre shot tests. For any other terse it’s fun if she eats right before or anywhere near the time.

You don’t need to stay up. A + 2 or 3 is fine. I would give the shot at 7:30pm and test her right before going to bed at 10pm.
Click to expand...

Totally! Giving plenty of snacks (timed feeder and all). She's still waking us up hungry hah hoping it'll balance out soon.
 
@aligibbons it looks like Tilda needs an increase
New dose would be 1.25 units
I'm going to tag Elise for you to confirm this .
I see you did a curve on 10-13
@tiffmaxee
See Elise's post #12 , post numbers are to the right of each persons post
Can you get a few tests in today during the day cycle ?
Do you have the U-100 syringes with the half unit markings?
They make it easier to adjust the dose by 0.25 units
 
Diane Tyler's Mom said:
@aligibbons it looks like Tilda needs an increase
New dose would be 1.25 units
I'm going to tag Elise for you to confirm this .
I see you did a curve on 10-13
@tiffmaxee
See Elise's post #12 , post numbers are to the right of each persons post
Can you get a few tests in today during the day cycle ?
Do you have the U-100 syringes with the half unit markings?
They make it easier to adjust the dose by 0.25 units
Click to expand...

Thanks! I do have half unit syringes and will up the dose
tomorrow, I had a bad batch of syringes with terrible bubbles. Just got new ones. I'll grab another number in an hour.
 
Posted this on FB as well... Surprised by a 135 BG this morning. I won't give a shot and will test throughout the day-- any other advice?

Thank you all! So glad I went with a small increase.
 
Did you retest just to make sure? Was that with the alphatrak?

she may have gone lower overnight. Do you think you can try to get a +2 in the evenings every night? It helps you gauge where she’s headed overnight and if it’s going to be an active cycle.
 
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Ale & Bobo & Minnie (GA) said:
Did you retest just to make sure? Was that with the alphatrak?

she may have gone lower overnight. Do you think you can try to get a +2 in the evenings every night? It helps you gauge where she’s headed overnight and if it’s going to be an active cycle.
Click to expand...

And yes, alphatrak. I checked on her last night but didn't test-- I should change her shot times so I'm awake for +2
 
Ale & Bobo & Minnie (GA) said:
I want to get more eyes on your spreadsheet @Bron and Sheba (GA) @Sienne and Gabby (GA)

some big drops from 580 down to blues. When are you feeding her and are you withholding food for 2 hours prior to the preshot tests?
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Feeding her every 2 hours ish-- she's getting rayne wet (kangaroo for food allergies, ~12 carbs I think -- trying to lower that was freeze dried ~6% carbs). Withholding for 2 hours and she is PISSED. Could stress be raising those fasted numbers?
 
Have you thought about doing TR.? You are testing enough although you need to get at least one test in during every pm cycle, and you are feeding a wet diet.
I think you are seeing some bouncing from the blue BG which are shooting the BGs up into black.
 
The bounces, especially during the early stages of managing your cat's diabetes, tend to be large. The more time Tilda spends in better numbers, the more her body will once again get used to lower numbers.

Someone had raised the question of the Rayne food. It's fine. I don't think it's widely used because it's very expensive. There are other novel proteins (e.g., ZiwiPeak has venison and a rabbit and lamb variety) that many people who have cats with GI issues use.

You really seem to have gotten comfortable with much of the diabetes management!!
 
Thank you all!

Bron and Sheba (GA) said:
Have you thought about doing TR.? You are testing enough although you need to get at least one test in during every pm cycle, and you are feeding a wet diet.
I think you are seeing some bouncing from the blue BG which are shooting the BGs up into black.
Click to expand...

I'm reading about TR now, I do have the time to test often and I'm so thankful Tilda is forgiving of the pokes and prods. She's my best buddy. Looks like with TR, the dose she's on now is accurate...I'll read more. Won't change anything for a bit.


Sienne and Gabby (GA) said:
The bounces, especially during the early stages of managing your cat's diabetes, tend to be large. The more time Tilda spends in better numbers, the more her body will once again get used to lower numbers.

Someone had raised the question of the Rayne food. It's fine. I don't think it's widely used because it's very expensive. There are other novel proteins (e.g., ZiwiPeak has venison and a rabbit and lamb variety) that many people who have cats with GI issues use.

You really seem to have gotten comfortable with much of the diabetes management!!
Click to expand...

It's so expensive but we had to switch to something that wouldn't be contaminated by shared manufacturing equipment. Ziwi looks like it could work but is comparable in price... Nice that I could get it locally though.

I hope to get more relaxed about all of this <3
 
Sienne and Gabby (GA) said:
The bounces, especially during the early stages of managing your cat's diabetes, tend to be large. The more time Tilda spends in better numbers, the more her body will once again get used to lower numbers.

Someone had raised the question of the Rayne food. It's fine. I don't think it's widely used because it's very expensive. There are other novel proteins (e.g., ZiwiPeak has venison and a rabbit and lamb variety) that many people who have cats with GI issues use.

You really seem to have gotten comfortable with much of the diabetes management!!
Click to expand...

Had our first 700 then HI reading tonight, retested after 15 min. I'll test urine for keytones if I can catch her. I had to use an old can on rayne since I was running low and am thinking the recipe is different...leading to high BG... :(
 
Also noting I stopped doxy on the 19th due to inappetence that ended up being a hairball... If that could sway things.
 
If you're unsure whether a cat food formula changed, contact the manufacturer. Rayne does put the carbs on their website but who knows how long it will take them if they need to update. If you contact them, you want the "as fed" values.
 
Ale & Bobo & Minnie (GA) said:
Are you going to switch to TR? Because then you’d be increasing her dose every 3 days and only decreasing if she goes below 50
Click to expand...
Not sure honestly. I worry about TR because I am currently about an hour away from emergency vets.

Sienne and Gabby (GA) said:
If you're unsure whether a cat food formula changed, contact the manufacturer. Rayne does put the carbs on their website but who knows how long it will take them if they need to update. If you contact them, you want the "as fed" values.
Click to expand...
Good point. I will check.
 
Hi all, is this an OK place to keep updating? I'd love some eyes on her spread sheet... we've been on 1.25 for 6+ days now. And yesterday her numbers were confusing to me.

Her regular food came Monday, she's been eating well and we've even made it almost through the night without being woken up for food. I've been trying to get her to eat more freeze dried, she seems to like it at night but not mixed into her wet food. I think the freeze dried is "sticking to her ribs" a little better since it seems to have more fiber. She's more herself these past few days!

Thanks!
 
she’s still not getting numbers under 150, so time to increase by 1/4 unit. Are you able to do a curve soon? After every 7 days you do a curve and increase. See below

Copying this again here, but you can also find it in the dosing yellow stick note on the Lantus forum:

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
As your cat's blood glucose begins to fall mostly in the desired range [lowest point of the curve approaching 100 mg/dl (5.5 mmol/L) and pre-shot value around or below 300 mg/dl (16.6 mmol/L)], do
 
You can start posting on the Lantus board to get more eyes on your spreadsheet.
Ale & Bobo & Minnie (GA) said:
she’s still not getting numbers under 150, so time to increase by 1/4 unit. Are you able to do a curve soon? After every 7 days you do a curve and increase. See below

Copying this again here, but you can also find it in the dosing yellow stick note on the Lantus forum:

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
As your cat's blood glucose begins to fall mostly in the desired range [lowest point of the curve approaching 100 mg/dl (5.5 mmol/L) and pre-shot value around or below 300 mg/dl (16.6 mmol/L)], do
Click to expand...

I agree you need to increase. Good luck with the new dose.
 
Ale & Bobo & Minnie (GA) said:
she’s still not getting numbers under 150, so time to increase by 1/4 unit. Are you able to do a curve soon? After every 7 days you do a curve and increase. See below

Copying this again here, but you can also find it in the dosing yellow stick note on the Lantus forum:

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
As your cat's blood glucose begins to fall mostly in the desired range [lowest point of the curve approaching 100 mg/dl (5.5 mmol/L) and pre-shot value around or below 300 mg/dl (16.6 mmol/L)], do
Click to expand...
tiffmaxee said:
You can start posting on the Lantus board to get more eyes on your spreadsheet.


I agree you need to increase. Good luck with the new dose.
Click to expand...


Thanks! I'll do a curve tomorrow. Is it safe to increase over the weekend when the vet isn't open or should I wait until monday?
 
tiffmaxee said:
No reason to avoid an increase because the vet is not open. The only reason not to would be if the nadir is under 150. I think you tested enough yesterday that you can increase tomorrow unless you see a BG under 150 today or tonight.
Click to expand...

Thanks! I nearly did a curve yesterday since her numbers weren't what I expected.
 
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