New Member + New Cat - need some help

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sullim4

Member Since 2023
Hi all,

Apologies for the length and the detail - I just want to ensure you all know everything that we know.

Last month, we adopted a senior cat that we were fostering named Sally. She was diagnosed with diabetes at the shelter and had a slightly elevated SDMA value which made them think CKD, and was deemed "unadoptable" due to the chronic conditions. So, we took her in given she's such a sweet cat.

We had a couple weeks before her vet appointment and got into a rhythm of feeding her 2x cans of BFF OMG Chicken Cloud 9 + 1x Weruva Phos Focused per day. She has no teeth... so she's solely on wet food.

We brought her into the vet on October 27. They ran bloodwork and her BG was 480. This was at about 5pm, about 5h after getting a can of the phos focused food. Interestingly, her SDMA, creatinine, and BUN were all within normal limits in this test.

On October 31, they brought us in and prescribed 2 units, twice daily of Lantus, showed us how to give her the juice, etc. We started on Nov 1 and got into a rhythm of feeding 1.5 cans in the morning, shooting 15 mins later, then 12 hours later rinse and repeat. They said we didn't need to do any in-home testing (which seems counter to advice here) and to stick with the dosing until they could get us in for a curve, but to watch for signs of a hypo. We saw nothing obvious, although she is an older cat that likes to snooze. She was playful when we would play with wand toys, etc.

They had us in last Monday, 11/13 for a curve. Their 9am reading was a 60 on the AlphaTrak so they immediately fed her something and got her BG back into the 200s. They reduced her dose to 1.5 units and gave us the option of a freestyle libre or bringing her back a week later to see how she was doing for another curve.

We opted for the former (and got proper half unit U100 syringes), and they installed the Libre today about 3.5 hours ago. We fed her at 7am (1.5 cans of the BFF) and gave her the 1.5 units of Lantus 15 minutes later. When we were first able to test about 2.5 hours ago... the Libre was showing 61. We immediately fed her a can of food and have the following readings from the Libre:

T0: 61
T + 5 min: Ate 1 can of food
T + 1h: 109
T + 2h: 80

So she is dropping again. I'm obviously new at this, and our cat is new to us... and I'm trying to wrap my head around what could be going on here. It seems like the 1.5 units is too high, but she's about 2 hours away from her next dose and I'm wondering what to do.

Any thoughts/help here? I also assume I should get a home testing kit, any recommendations for that?

Thank you so much!
 
Hi and welcome to the forum to you and Sally.
First up, can you retest the BG again and let us know what it is.
It’s important to make sure Sally’s BG is rising and not falling again.
I would also feed her some more food.
P I will list this first before continuing becasue I want you to see it as soon possible
 
Thanks - yes, she's dropping (I re-tested after posting, it read a 62) and I just fed her again. She happily ate about half of it, that was maybe 5-ish minutes ago?

Her BG is now reading 86... can it rebound that quickly, or is the Libre just finnicky?
 
sullim4 said:
Thanks - yes, she's dropping (I re-tested after posting, it read a 62) and I just fed her again. She happily ate about half of it, that was maybe 5-ish minutes ago?

Her BG is now reading 86... can it rebound that quickly, or is the Libre just finnicky?
Click to expand...
Yes that can happen if you have fed some food.
The libre can be a bit unreliable when BGs are under 100.
Keep monitoring
 
It certainly looks as if Sally is getting too much insulin at the moment.
I would definitely look at hometesting the blood glucose (BG) as it is the best thing you can do to get Sally regulated and healthy again.
If you are in the US I would recommend looking at getting a ReliOn premier meter from Walmart. They are only about $9 each. And then you will need a box of test strips to go with the meter and a box of lancets.get size 26 or 28.
And some cotton balls to hold behind the ear when testing and to dab the ear after the test.

Here is a link to HOMETESTING
If you could set up a spreadsheet and signature, when you have time, that would be a great help to us and will enable us to help you. If you have any trouble setting up the spreadsheet, I can get someone to help you with it.
Here is a link to information for new members and includes the link to the SS and signature.
HELP US HELP YOU

It is good to hear the later tests showed normal readings for the kidney.
With diabetes, we recommend you feed a diet of low carbs that are less than 10%. Most feed around 4 to 7% successfully. I will give you a food chart to look at and you can choose some food. Also look for some cans of food that are Meduim carb 11% to 15% and some high carb 16% and above for your hypo kit which I would set up straight away. You never know when you might need it. Also get some honey or Karo for the hypo kit.
FOOD CHART

Now about the dose of insulin.
I would drop the dose to 1 unit and see how Sally goes with that. However, she may not come up high enough to give a dose this next time. She will need to be over 200 for you to be able to give the dose safely.
She could also bounce after that big drop, which would mean she goes up high. I will tell you about bouncing next time
Can you let us know how she goes in the next 2 hours so we can decide if it is safe for her to have the next dose.
I might ask @Bandit's Mom to help you with the SS as we really need to get that up and running.

I don’t want to overwhelm you with too much at once.
I’ll watch for your posts
Bron
 
Thanks so much for the information. I will get the SS set up when I have a spare moment. We fwded all the results to our vet, who got back to us just now (we're on pacific time in the US). Her recommendation is to hold off on insulin until Friday to get an idea of what we're dealing with.

She's dipping again - at 70 now. So I suspect at the very least, we're not giving a shot tonight and we'll know more in the morning. I have the Karo syrup at the ready in case it does dip any further but we're 10.5 hours after her last shot of Lantus right now so I hope it's not going to fall too much lower.
 
sullim4 said:
Thanks so much for the information. I will get the SS set up when I have a spare moment. We fwded all the results to our vet, who got back to us just now (we're on pacific time in the US). Her recommendation is to hold off on insulin until Friday to get an idea of what we're dealing with.

She's dipping again - at 70 now. So I suspect at the very least, we're not giving a shot tonight and we'll know more in the morning. I have the Karo syrup at the ready in case it does dip any further but we're 10.5 hours after her last shot of Lantus right now so I hope it's not going to fall too much lower.
Click to expand...
Just keep feeding her a snack each hour and more food if she drops. Looks like you will be skipping the next dose.
I would not stop the insulin until Friday. The reason being that diabetic cats who need insulin and don’t get it, can develop ketones, which can turn into DKA (diabetic ketoacidosis) which can be deadly.
We have seen cats that have had their insulin stopped by vets and then the cat gets ketones that are not picked up until the cats has gone into DKA. So that’s why we like to test for ketones and not stop insulin abruptly.
Did Sally have a fructosamine test done at diagnosis for the diabetes?
What I would do is buy a bottle of Ketostix from Walmart or a pharmacy and test the urine for ketones each day. That way we can see if any are developing and take action.
I would see what the BG is each cycle (preshot) and decide each cycle if she needs Insulin.
She may need less than 1 unit of insulin. Vets often don’t go lower than I unit but we go down to 0.75, 0.5, 0.25, 0.1 and a drop before stopping.
Keep posting so we can help you. We see lots of kitties arrive here with a similar story to Sally’s.
 
Alright, I've set up the spreadsheet... I have to admit it killed me a bit to use Google since I actually work on Excel for that big company in Redmond :D.

We're at PMPS right now I think? 12 hours since her last dose (7:15am here, it's now 7:15pm) - she's testing at a 98 and I've tried to go back and make the spreadsheet reflective of the bumps and valleys of the afternoon (we scanned the freestyle frequently when we saw the low numbers and then fed her).

She's been stable for an hour, I fed her about a third of what she normally eats in the evening about 1.5 hours ago, and now she's getting the rest. I assume we are sticking with no insulin tonight, and then evaluate tomorrow? I assume I should test after she eats her meal this PM, up until we go to bed?
 
Well done getting the SS set up and data added.
Yes, skip the dose but keep an eye on the BGs because they are wobbling about a bit. I’d give her a few snacks during the pm cycle as well.
I won’t be around for the AMPS as I live in Australia and will be fast asleep but hopefully @Bandit's Mom and/or @tiffmaxee will be around to help you with the dose.
Can you put the insulin type and the meter type into the SS please?
Thanks!
 
It would be a big help to us if you can set-up your signature? It's basically a summary of the information we need about your cat to give you advice. The spreadsheet and signature are the things we look at when asked for advice. It saves us asking you the same questions again and again especially when the question is time critical like stalling or low numbers. It also saves you the effort of giving us the information every time you post!

Here's how you can set-up your Signature:
  • In the Menu, under your user name, click on Signature.
  • Add info we need to help you:
    • Caregiver & kitty's name
    • DX: Date
    • Name of Insulin (do not include dose or frequency)
    • Name of your meter
    • Diet: "LC wet" or "dry food" or "combo"
    • Dosing: TR or SLGS or Custom (if applicable)
    • DKA or other recent health issue (if applicable)
    • Acro, IAA, or Cushings (if applicable)
    • Spreadsheet link. Please put the signature link on the bottom line of your signature information, on its own, so it is easy to find.
  • Please do not put any information about your location in the signature for security reasons. If you wish to add your country location, please add it to your profile.
  • There is a limit of two lines. You may separate info with commas, dashes, | etc.
  • Be sure to click the 'Save Changes' button at the bottom.
 
Welcome. You have come to the right place. I’m on the same time zone as you. Thank you for adopting a senior with medical issues.

I’m in your time zone. What time do you give insulin?
 
We've been giving at 7:15-7:30 or so, depending on when she finishes eating.

We gave her the remainder of her food tonight at 11h45m after her last Lantus shot. 2 hours later, she is now at 119 on the Libre. I will get one more measurement tonight before we go to bed, and update the thread tomorrow morning. I've updated the sheet with the data.
 
Alright, last night before we went to bed, she was at 147. She was fed at 7pm and that was taken at 9:50pm.

Right now (6:53am), I haven't fed her yet and she is at 183. The Libre seemed to capture data at regular intervals as it shows a dip until about 2am, then an eventual rise. 2am would be 18 hours after her AM shot of 1.5U yesterday.

Here is a link to the chart: https://1drv.ms/i/s!AiE-zPjgcQ0wh5Y45ohEcSQTUGOy9g?e=N7vavv

I am going to feed her now, but it's pretty clear to me that 1.5U is way too much, but 0 is also not enough. She hasn't hit 200 though so I am curious what the opinion is here.
 
I think 183 is close enough to shoot. It would have been better to stall without food and test again in a half hour though. I would shoot 1.0 if you can test until the bg starts to rise.
 
I talked it over with my wife - we are going to skip this morning to see what her "unaltered" curve looks like, monitor closely for DKA, and move from there. I also want to send this data to our vet for her opinion as it seems clear to me that she needs some insulin.

Edited to add - My current theory is that she was just overdosed initially. When she was at the shelter in early October for her dental work, they spot checked her BG level during an exam and it was in the high 200s... 280-ish I think. Her UA was ++ for glucose. Later in the month, like I said, her BG was in the 480s and +++ for glucose on the UA. I wonder how much of that 480 was stress induced and if she should have just been started on a lower dosage.
 
Ok. I do think some insulin will be needed. I suggest you read the stickies on the lantus forum, a great place to learn. Normal bg for a cat who is not on insulin is about 50-100. Tge way to keep your cat safe is by testing and having plenty of supplies. When I first started I thought my cat would be difficult to test and hide so I did not test. I brought him to the vet a few times for mid cycle tests. I bought a meter for just in case and brought it there and it read 60. That scared me. My vet had me do the test and I became a testaholic. Max in,y had one curve by the vet and that was after his first insulin dose. Max actually was easy to test. Special all meat freeze dried treats really helped. While many like the Libre which was not available when he was diagnosed, it tends to read lower than other human meters when under

if you get a bg close to 200, we suggest you stall without food and recheck in 20-30 minutes so the test is not food influenced. When new if still under 200 or going down it’s best to skip. That changes with data.
 
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So we're at +6 now after when we'd normally give her insulin. We fed her at that time instead.

The numbers so far:
+1: 224
+2: 264
+3: 224
+4: 205
+5: 215 (possible mini stress event occurred here with unfamiliar noise)
+6: 186

So... what to make of this? That 186 is 30 hours after her last dose of Lantus. I also want to say... the Libre is great, it's amazing to get the numbers like this and get some insight into what's going on this frequently.
 
See what the bg is in 6 hours. Right now it’s higher than we like to see. But clearly not bad. Normal would be approximately 50-120. A low carb diet just might get her there. Please add a signature with what you are feeding.
 
Are you testing the urine daily for ketones with the Ketostix?
Remember there are smaller doses than the 1 unit that we use all the time.
It is is possible Sally needs less than 1 unit. S
Looking at the numbers, it is obvious Sally needs some insulin.
 
I tend to agree with you. We're going to go with .5U in two hours and she how she responds to it overnight... that's the advantage of the Libre. She's starting to go up a bit higher after she got into a small bit of our other cat's food... I've been diligent about it but this was one time I missed.
 
So far, so good with 0.5.

I attached her curve overnight with the Libre. Nadir (85-ish?) seems to have hit a little before midnight, or around +4.5. I'm not sure what the spike is right before 3am but she headed back down, and is now back over 200. I scanned a few times and she's been around 200-210. We will be giving her the 0.5U dose shortly.

I will be curious to see what the cumulative impact will look like over the day.
 

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Alright, she dipped again today. We gave her the 0.5U dose and fed her at the same time.

The spreadsheet is updated but this is what she looks like from the Libre:
AMPS: 202
+1: 186
+2: 159
+3: 114
+4: 113
+5: 64

I just fed her. I re-scanned again with the app to see if it was a flaky test and I got a 71... so that's the general neighborhood she seems to be in.

I'm not sure how to proceed here... any thoughts? Am I just being too cautious with the 64?
 
Hi Mike...Have you looked at the 2 dosing methods? If you are going to follow SLGS you will need to reduce the dose to 0.25U becuase the BG dropped under 90..
If you are following TR you stay with the same dose unless the BG drops under 50.
Have a look and let us know if you have any questions about the methods. Its important to choose one and follow it.
DOSING METHODS

Are you giving snacks during the cycles?
 
SLGS. We have some freeze-dried treats we have been giving her.. but it hasn't been more than a few. We feed her 2 times a day, half in the morning and half in the evening right before her shot.

So yes, it looks like a dosage decrease down to 0.25U. Is this reaction to insulin normal for a new diabetic? Should we order a fructosamine test? She didn't have this done and she has been through a ton of trauma lately which might have led to the high numbers at the vet. Her owner died, she got picked up by animal control, brought in to the shelter, had dental surgery... it's a lot for a poor cat to take in two months. And she's definitely not as confident as our other cat.
 
sullim4 said:
We have some freeze-dried treats we have been giving her.. but it hasn't been more than a few. We feed her 2 times a day, half in the morning and half in the evening right before her shot.
Click to expand...
I would recommend you give her snacks during the day as well as the 2 main meals
So at +3 and +5 each cycle...I would give her a couple of teaspoons of normal low carb food. This helps keep the BGs from dropping too low and is better for the pancreas. and I'm sure she will be happier.

sullim4 said:
SLGS. So yes, it looks like a dosage decrease down to 0.25U. Is this reaction to insulin normal for a new diabetic? Should we order a fructosamine test? She didn't have this done and she has been through a ton of trauma lately which might have led to the high numbers at the vet. Her owner died, she got picked up by animal control, brought in to the shelter, had dental surgery... it's a lot for a poor cat to take in two months. And she's definitely not as confident as our other cat.
Click to expand...
Yes reduce the dose to 0.25 U each cycle.
Poor Sally, she has certainly been through a lot, but how lucky is she to have found you!!

If she didn't have a fructosamine test done at diagnosis, it would not hurt to have one done. However, I'm not sure if it would be useful at this point though as it is now 3 weeks since diagnosis and she has been getting insulin and that would affect the result. The reason to get a fructosamine test in the beginning (at diagnosis) is to find out what the BGs have been doing for the past couple of weeks and that test is not effected by stress. A test now would just give you the average of what the BGs have been these last couple of weeks. And your SS is giving us a lot more information than a fructosamine test would.
She was put on too much insulin to start with. The normal starting dose is 0.5 or 1 unit depending on the type of food given. If she was being fed a wet diet, she should have started on 0.5 U.

It is not uncommon for a diabetic, who has been swapped to a low carb diet to behave as Sally is. Do you know what food she was eating before?
Some cats take ages to respond to insulin and others respond quickly. Some lucky cats who are swapped to a low carb diet don't even need insulin.
You can see when you have skipped a dose her BGs are too high. The normal BGs for a cat are 50-120
She is doing remarkable well though.
 
Bron and Sheba (GA) said:
Do you know what food she was eating before?
Click to expand...

This is the million dollar question. We wish we knew. I suspect, whatever it was - it wasn't great. The reason I say this is that she begs for human food like no other cat I've ever seen. Our other cat, who might get a bit of plain salmon or a shred of chicken once a month or less... knows better and doesn't do it. But Sally has no shame!

She only spent about 10 days at the shelter. My wife volunteers there - they get fed whatever gets donated. She was on a wet food only diet there but again - they might be getting something like a high quality food from Weruva or they could be getting Walmart's private label food.

0.25 units it is. We go to bed at PMPS+3 so I will feed her a small supplement after scanning her with the Libre. She's at 151 at +11 right now... looking at the data it seems like there is a decent shot that she goes up. However, if she doesn't... is that shootable? I'm inclined to think no based on her performance today starting out at 202... but we can stall since the USA is heading into a 4 day long weekend.
 
Bron (and everyone else that's helped) - I also want to thank you. I really appreciate the help and the guidance. This is all new to the both of us, and while I really like our vet, she doesn't live/breathe/eat this every day. She was actually quite excited to get a Libre on a cat to see the curves because I guess they've had a high failure rate with them getting scratched/licked/bitten off. Sally's had no issue with it so far.
 
If she is under 200 at PMPS I would skip the dose and start with the 0.25 in the morning.
It is great she wants to eat. Believe me...a diabetic cat that likes to eat is a gift!
It is a pleasure to help you.
Vets have so many other animals and conditions to treat. If your vet can learn through Sally that would be a real plus as many vets see few diabetic cats and are not always up with the latest treatments.
 
Hi Mike,
I see you are still giving 0.5 U of insulin.
As you are doing SLGS you need to reduce the dose every time Sally drops under 90, which she did yesterday morning cycle when she dropped to 64.
Both the drop under 90 and the fact you are having to keep skipping doses because the preshot is not high enough is telling you the dose needs to be reduced.
I would recommend you drop the dose to 0.25 U and stay there unless she drops again.
 
Hi Bron,

We changed her feeding schedule a bit (same quantity, but giving her 4 meals per day rather than the 2 we were previously) and I wanted to test that with the 0.5U dosage. Part of me was wondering if she bottoms out because she's not getting much of any food during the day or night.

The data from yesterday and today is encouraging... she hasn't dipped below 100 but she's also solidly in the blue range towards the second half of the cycle.

We have an automatic feeder on the way which should hopefully make feeding more consistent and easier going forward.
 
sullim4 said:
Hi Bron,

We changed her feeding schedule a bit (same quantity, but giving her 4 meals per day rather than the 2 we were previously) and I wanted to test that with the 0.5U dosage. Part of me was wondering if she bottoms out because she's not getting much of any food during the day or night.

The data from yesterday and today is encouraging... she hasn't dipped below 100 but she's also solidly in the blue range towards the second half of the cycle.

We have an automatic feeder on the way which should hopefully make feeding more consistent and easier going forward.
Click to expand...
Ok. But please be mindful she could drop lower. Feeding snacks is an excellent idea. You could also give 2 snacks each cycle which would be even better but make them in the first 7 hours of the cycle.
 
I think we're starting to get the hang of this.... :D. At least in terms of food controlling the low-ish numbers, anyway.

The Libre has been a lifesaver. She's developing patterns during the day and we can see that pretty clearly with all the data. There's no way we can test hourly like this with a traditional glucometer but we'll aim for 2-4 per day.
 
sullim4 said:
I think we're starting to get the hang of this.... :D. At least in terms of food controlling the low-ish numbers, anyway.

The Libre has been a lifesaver. She's developing patterns during the day and we can see that pretty clearly with all the data. There's no way we can test hourly like this with a traditional glucometer but we'll aim for 2-4 per day.
Click to expand...
That’s good.
Just be aware that while snacks certainly help keep the numbers from dropping too low, if the dose is too high, or becomes too much, the BGs will drop regardless of the routine snacks. :)
 
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