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Deb and Tiger

Deb and Tiger

Member Since 2023
We discovered Tiger has diabetes when doing blood work for a dental cleaning about a month ago.
Vet started him on glargine. She suggested 3 units but we started low at 1 unit. Since them we have increased it steadily to 2 units.
She did not have us doing home tests but instead he went in once a week for a reading. First week they tested him with my hubby in the room and it was down to 190 from the original high of over 500. The next week they took him to the back for the tes and it was up to 380. At this time we were instructed to go up to 1.5 units.
The next week he was taken to the back and tested. This time it was up to 470. We then went to 2 units.
Also with the suggestion of installing a libre to get a curve. We had it installed a week ago tomorrow.
She wanted to see the curve reading done on Wednesday.
On Tuesday I practiced with it a bit and had readings of 450 down to 208. Higher readings being after he ate.
On Wednesday I did the curve and read it every 2 hours with readings of 421 high to the lowest of 223.
She looked at it on Thursday and said we needed to up his dose to 2.5. I wanted to wait until the next morning to up it so I could monitor him.
Thursday his reading after eating was 289. But during the night it had dropped to 75. Since I was concerned about upping the dose with the low readings during the night we consulted the vet. She said to still up the dose. This concerned me because the only time he was out of the green was when he ate, so we did not up the dose last night.
Friday his reading after breakfast was 429 with a steady decline to 149 at bedtime.
Now this morning I got up to a reading of 496 but with lows during the night of 35, in the red from 12 am till 3am when he got his snack from the feeder at 3am.
I don’t know what to do or where to turn.
I know he stresses easily and can tell this is stressing him, and me, out. But these readings are crazy and all the vet wants to do is up the dose! His readings definitely go up by a lot when he is stressed I have noticed.
His diet is fancy feast canned with snacks of science diet MD. Due to stomach issues he needs to eat every few hours so we have an auto feeder at night. He gets a bit of dry at bedtime and again at 3 am.
We gave him 2 units this morning because I was afraid to up it due to very low numbers last night.
Can anyone explain why the crazy readings and tell me what we need to do?
If we up the dose won’t the night numbers go even lower?
 
I’m glad you did not increase the dose. Vets dose by the high numbers and we here dose by how low the dose takes your cat in a 12-hour cycle. We also make dose adjustments by 1/4 units so it’s gradual and you don’t risk speeding right past the ideal dose. That 35 is hypo territory and I’m happy he’s okay. Anything under 50 in a human meter, which the libre is, is a take action number. That means you have to use Karo or honey and high carb foods to bring his bg back up into safe numbers. With that said, the libre can be glitchy in the lower numbers. Any chance you’d be willing to learn how to home test as a back up to the libre and to double check when you get a low bg? Was he at 2.5 units when you got the 35? I’d definitely not go up from 2 units right now. There’s also something called bouncing which happens after they go into lower numbers and it’s one of the reasons you’ll see higher numbers for a few days after the cat experienced a low bg. It's a kitty's self defense mechanism. Here is the description: 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).

feeding several meals throughout the day is perfectly fine and it’s actually easier on their pancreas. It also helps avoid big sugar spikes. I would suggest you try to transition away from dry food as it’s too high carbs for a diabetic cat. If that’s not an option, I’d look into getting a low carb dry. Only 2 I know of in the US, Dr Elsey's and Young Again Zero Carb. It’s great that you’re leaving him an overnight snack. That’s when cats tend to go lower. Is the FF you’re feeding pates? Those are low carb but any of the grilled or gravy ones are not.

Unfortunately most vets do not know a lot about feline diabetes….they have many animals to look after and they all have different diseases and treatments.

With a diabetic cat you need:
  • A low carb wet diet that is 10% carbs or under. Most of us use around 4-7% carbs
  • A suitable insulin such as Lantus or Prozinc which are long acting, more gentle insulins than the old insulins.
  • We recommend hometesting the blood glucose with a human meter…it is not necessary to use a pet meter which is expensive to run and is no better. It will keep your kitty safe and you will know how the dose is working for your kitty. Only testing every so often will not tell you what is happening in between those times and an awful lot can happen in even a day. I’m glad you have the libre for now
  • HELP US HELP YOU has information about the spreadsheet, signature and hypo box which you will need to be able to look after your beloved kitty properly
We are happy to help you with setting up the spreadsheet, sorting out what food to buy, how to transition safely to a low carb diet, how to learn to home test and much more.

FOOD CHART have a look on this chart and choose foods that are under 10%.

You will also need some higher carb foods for that hypo box..information in the help us help you link.

This is an excellent site for diabetic cats…it has been around for more than 25 years and has very experienced people to help you.

Keep asking lots of questions!
 
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I thought glargine and Lantus were the same? I had googled them which said they were.
We are feeding ff grilled tuna and whitefish. It has 13 carbs according to a chart my vet sent me a link to.

right now Tiger is so freaked and stressed I would hate to add the home testing. Literally took us years to ease his fear of us and it is reverting quickly. No playing, hides under chair for hours, hides even when hubby is around.
He was born from a stray in our yard and took us 4 year to covert him to indoor cat.
He is 11 years old and has always been serious and cautious.

should we stay at 2 units or drop it lower maybe at night?
 
It’s is you’re right. Apologies I misread. Editing my post now. Lantus is just the brand name.

Lantus works best with consistency. Was the dose 2.5 when you got the 35? Would be willing to set up a spreadsheet and plug in some of the numbers you’ve gotten from the libre so far? We really need to see the pattern on a spreadsheet to give dosing advice. We have members that can help you setting it up if needed.

what FF are you feeding and did you see my comments about the dry food? However, if you transition him off the dry, his bg will likely drop so I would wait until we can figure out the dosing first.
 
Stress can also elevate the bg. I know it feels overwhelming and you can’t understand the reason behind the high numbers, but my guess is he’s bouncing after he gets a low bg. This is all very normal at first and you’ll see improvement. You’ll also get the hang of it. There’s a steep learning curve with feline diabetes that we all had to go through but we can help you and slowly you’ll feel more in control. Lantus is a great insulin for cats and once he’s on low carb foods only, you'll be able to get his diabetes regulated. We like to say here that feline diabetes is a marathon not a sprint. It takes time but you’ll get there.
 
Welcome to FDMB.

If your kitty has a Libre, you're home testing!! The sensor may need to be replaced every 2 weeks but it's possible to do that at home.

We are big fans of home testing. You would have never known how low Tiger's numbers dropped without having those blood glucose readings. Home testing gives you data and it keeps your kitty safe.

With Lantus, the AM and PM dose needs to be the same. Lantus (aka glargine) is different than most other insulin. When you give a shot, the insulin forms microcrystals that are deposited in the fat tissue. Most of those crystals dissolve over the 12-hour cycle. However, a small amount remain and form a depot. Have that insulin in what amounts to "storage," gives Lantus its long duration and allows for overlap between the cycles. If you give a different dose at each shot time, the depot never has a chance to stabilize. As a result, you get wonky numbers.

This is a link to our information on dosing with Lantus. Depending on which of the two methods you choose to follow, you'll see that doses are held for several days unless a dose reduction is indicated. Numbers dropping to 35 definitely means you need to reduce the dose. We make dose changes in 0.25u increments.

What is likely confusing is that you're seeing low numbers then high numbers. When a cat's numbers drop low, drop fast, or drop into a range the cat's body isn't used to, the liver and pancreas release a stored form of glucose along with counterregulatory hormones. These compounds cause the blood glucose levels to spike back upward, often to high levels. We refer to this as a "bounce." It can take several days for the bounce to clear.
 
Ok good! I thought it as the right insulin.

I think the shots, trips to vet etc is adding stress. The day we did the curve, every two hours, I could tell he was stressed. Whereas the day before I just casually read it when he was sleeping next to me it was lower.

we just ordered both dry foods you suggested so we can see if he will eat either. I will change it over gradually, mixing it with his md.

yes I don’t mind setting up spreadsheet. Might need hubby to help since he is more tech savy.
 
Deb and Tiger said:
Also can you suggest a syringe that has .25 increments for this insulin? Ours reads only whole units.
Click to expand...
They only make half unit markings, but still make it easier when you need to adjust by 0.25 units
If you don't have the U-100 syringes with the half unit markings since we adjust the doses by 0.25 units at a time
  • U-100 3/10cc syringes with half unit markings are the best to use for drawing Lantus, Levemir, or the Biosimilars from vials, cartridges, and pens.
  • BD Ultra-Fine, CarePoint Vet, Monoject, GNP, UltiCare Vet Rx, Sure Comfort, and ReliOn are just some of the brands available with half unit markings.
  • I would suggest the sure comfort or the UltiCare Vet RX or if you have a Walmart by you
  • You can get the syringes with half unit markings at a Walmart. Their ReliOn Brand syringes of 0.3 cc (30 unit) capacity come with half unit markings. Cost $12.58 for a box of 100
    This is what the packaging looks like: either box is fine
    They won't say it half unit on the box but the are . open then and look before you leave the store, can't be ordered on line , need to go into the store
    :




    upload_2021-9-5_23-18-9-jpeg.62508



    Or ADW diabetes call them and tell them what you want and they will contact your vet to fax over a script , ask your vet for refills so give your vet a heads up, either one of these are fine
    https://www.adwdiabetes.com/product/1316/surecomfort-u100-syringes-half-unit-31g-3-10cc-5-16in-100ct

    https://www.adwdiabetes.com/product/5739/ulticare-u100-vet-rx-half-unit-syringes-31g-3-10cc-60ct

    Here is a coupon if you get them from ADW diabetes
    adw-coupon-dia10.jpg

    10% off your next order!

Or you can get them from Amazon and won't need a vet's prescription
https://www.amazon.com/UltiCare-31-Gauge-Veterinary-Insulin-Syringes/dp/B009LTE0DO
 
I use the Walmart ReliOn ones that Dianne posted above. It’s the top pic and it’s the most affordable. As Red said, no 1/4 marked syringes. We just eye ball it and it’s a lot easier to do that if you’re using 1/2 unit marked syringes.

Bobo loves Dr Elseys. He can’t get enough of it so fingers crossed Tiger will like it too. What is the md food? I would suggest you stick to fancy feast pates and the low carb dry food. You can also get low carb treats. All the freeze dried options are low carb like from PureBites and VitalEssential. I also found this one on Chewy that comes in bigger bags: Cat-Man-Doo Life Essentials Chicken Littles Freeze-Dried Cat & Dog Treats, 5-oz bag:
https://www.chewy.com/dp/152851?utm_source=app-share&utm_campaign=152851

Bobo also loves the Inaba Churu tuna filets. Those are LC as well.

the big plus of home testing or having the libre is no more visits to the vet. This should hopefully minimize his stress. You could just start massaging his ears to get him used to you touching them and see how that goes. You can try to slowly mimic what testing would be like to see how well he tolerates, like pressing the end of a pen to his ear or applying pressure to them. Just something to consider. If he’s food motivated, giving a treat immediately after helps build positive association. Anything you do at home will be way less stressful than at the vet.

you can click on the links in my signature to see what the spreadsheet looks like. If you can also setup your signature, that will be helpful for members to see the basics about your cat at a glance :)
 
Thanks for the info on those. Hubby ordered some from Amazon, hope they are the right ones.

I posted my spreadsheet. Numbers are as close as I could read from the libra. Hard to read their graphs sometimes.
Let me know what you think for dosing tonight. Scared he will go low again….
 
Also he was getting his snack at 4 am but we changed it to 3am last night. Probably a good thing since he went low about that time.
 
Since you got all those lower numbers last night, I think you need to go down to 1.75. Tagging @tiffmaxee to get her blessing since she was my guardian angel when it came to Lantus dosing for both my sugar kitties and she’s a Lantus expert!

So according to our dosing methods for Lantus, if you’re still feeding dry, you’ll need to follow SLGS. On SLGS, the cat earns a 1/4 reduction every time it goes under 90 on a human meter, which again the libre is. That means you’d reduce him to 1.75 after last nights lows. You then hold this dose for 7 days before making an adjustment, unless he goes under 90 again. Every time he goes under 90, you reduce by 1/4 unit even if it happens back to back like 2 days in a row. Here’s the link to the Lantus forum, I recommend you read all the yellow sticky notes, but specially the one on the dosing methods: https://www.felinediabetes.com/FDMB/forums/lantus-levemir-biosimilars.9/
 
I would not have gone up to 1.5 after that 197 last month but I’m sure that’s what your vet told you to do. We advise new members to not shoot the regular dose if they get a preshot number that’s lower than 200. The 197 is pretty close to 200 so it’s fine you shot, but there was no need to increase the dose after. If you get a lower than 200 again at shot time, you have a few options. You can install without feeding him, post here and ask for help, and see what the bg is in 20 minutes. If it’s gone up and it’s over 200, you can shoot. If not, you may consider what we call a token dose, 20% of the regular dose. If it’s really low, you may need to skip the shot.

I know you’re hot manually home testing, but we also advise to withhold the food at least 2 hours before you get that preshot bg value so it’s not influenced by food and you know it’s safe to give the shot. That’s only necessary at shot times. The rest of the day he can eat normally. Makes sense?
 
Yes that was vet instructed us to do. I questioned it but she was insistent.
Good to know about no food prior to feeding. We give shot at 8 and 8. He usually East’s at 7:30 am and 6:30-700pm because he is wanting his food. Snack is around 3pm ( 1 teaspoon canned)so he is so hungry by nite time. Also the time change hurt because he thinks it is so late. Today his appetite is off. Not very interested in eating.
So much to learn.
I will watch to see if we should do 1.75 tonight.
 
Can you move up the shot time so you shoot on an empty stomach and feed him immediately after? If you’re feeding at 7:30am and checking the bg at 8 it’s already food influenced. Can you shoot and feed at 7:30?

you should definitely go down to at least 1.75, I just want her eyes in case she thinks you should reduce even more :cat:
 
I don’t want to shoot before he eats because we have had times where he just won’t eat. Right now he should be eating a snack and he’s under the chair afraid we are going to do something. It’s so hard! He is completely catered to. You wouldn’t believe what we have gone thru with him to get him to not be afraid of even normal things . He is one big fraidy cat but also a big lover. This whole thing has caused him to loose so much trust in us, it’s breaking my heart.
 
Just posted his readings so fa today. They have stayed pretty high. He seems very stressed today. He stresses more when hubby is off from work because he only gets a shot or pills or vet visit when he is around to help me. So not sure if high readings are from stress, bouncing or what? I notice that his night time readings, when he knows nothing gets done to him, his readings are generally lower. Not sure what we can do about the stress….
 
Deb and Tiger said:
I don’t want to shoot before he eats because we have had times where he just won’t eat. Right now he should be eating a snack and he’s under the chair afraid we are going to do something. It’s so hard! He is completely catered to. You wouldn’t believe what we have gone thru with him to get him to not be afraid of even normal things . He is one big fraidy cat but also a big lover. This whole thing has caused him to loose so much trust in us, it’s breaking my heart.
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I didn’t mean shoot before he eats. You definitely want food onboard, but as Sienne noted above, Lantus needs time to crystalize once it’s in the body, so it takes about 2 hours after you give insulin for it to start to work. I meant do it at the same time. It’s okay to shoot and feed after as well. That’s even better. The issue is to not feed at least 2 hours before you check the bg and are ready to shoot. So test, feed, shoot all within minutes.
 
My money is on bouncing. By going low last night, he’s basically telling you the dose is too high for him. No much you can do about the stress or the bounce. And you don’t adjust the dose because of the bounce, you just have to wait for it to clear.
 
You test to be sure it’s safe to give insulin. Then you feed to see if Tiger will eat. He dies t need a full meal. You can feed small amounts more often if that works. I was afraid max would hide all the time if I started testing. Boy was I wrong. A freeze dried protein treat after every poke really helped.
 
Ty both for helping me. It means so much to not feel alone in this.
We will give 1.75 tonight if pre shot reading is ok and if he eats. Otherwise I will come back and ask for further instructions.
Hubby was able to get the syringes at Walmart too.
Oh, he always gets a treat ( few kibbles) after we do anything!
I am glad to drop the dose as I am so scared he will go low while I am sleeping……that is one reason I am glad to have the auto feeder for him at 3 am.
 
One more question, how early from shot time can I take test and feed him? Looking for food now but shot is 1.5 hours away?
 
Until you see what kind of a bump up in bg food gives, we suggest holding food 2 hours before the shot. Once you have data it’s not necessary. I did not feed close to shot time especially I suspected the bg might be lower than usual.
Ask as many questions as you have. Someone is almost always around to answer if find someone who might know.
 
Ty! I couldn’t hold off any longer. I took a reading, 385, and just fed him. Shot is 45 mins away.
Today His readings are the flattest I have seen. Because of bounce?
 
Get a test before you shoot as it will be good data. Bounces can last 4-6 cycles or clear quickly. He’s bouncing right now. Also sometimes you will see a high BG signaling a bounce is about to clear.
 
tiffmaxee said:
Get a test before you shoot as it will be good data. Bounces can last 4-6 cycles or clear quickly. He’s bouncing right now. Also sometimes you will see a high BG signaling a bounce is about to clear.
Click to expand...


Sorry did not see your message before we gave it and did not get it. Fingers crossed we have a good night. Ty
 
What do we dose in the morning? Do we stay with 1.75 now that we lowered it. Asking now so I know what to do at 8 in the morning….
 
Yea, we stayed out of the red! Hardly slept last night, worried that he would go low. seeing a pattern where he drops between +5-7 hours at night. i took an actual reading right after he ate his snack, 234 at +7.

thanks for the reply, I was pretty sure it would be 1.75 but wanted to make sure.
 
I was a bit confused by Elise's (@tiffmaxee) comment that,
we suggest holding food 2 hours before the shot. Once you have data it’s not necessary.
Click to expand...

You always want to refrain from giving food 2 hours prior to shot time. If you feed your cat too close to shot time, you don't know if your pre-shot reading is being influenced by food. You could end up with an artificially higher pre-shot value. If you then gave insulin, it's entirely possible that you would be giving insulin when it wasn't safe to do so.

I'd interpret Tiger's spreadsheet in much the same way as Elise. I think he's bouncing.

I would encourage you to take a look at the Start Low Go Slow dosing method. It will provide you with guidelines. We're happy to answer questions but I tend to think it's helpful to have something concrete if no one is around to give you an immediate answer.
 
Sienne and Gabby (GA) said:
I was a bit confused by Elise's (@tiffmaxee) comment that,

You always want to refrain from giving food 2 hours prior to shot time. If you feed your cat too close to shot time, you don't know if your pre-shot reading is being influenced by food. You could end up with an artificially higher pre-shot value. If you then gave insulin, it's entirely possible that you would be giving insulin when it wasn't safe to do so.

I'd interpret Tiger's spreadsheet in much the same way as Elise. I think he's bouncing.

I would encourage you to take a look at the Start Low Go Slow dosing method. It will provide you with guidelines. We're happy to answer questions but I tend to think it's helpful to have something concrete if no one is around to give you an immediate answer.
Click to expand...
I test then give food. He doesn’t get food 2-4 hours before the test.
Thx I have read that dosing method which makes total sense to me. Our vet however wanted to start him at a high dose which I argued against and started at 1 unit.
 
That's one of the problems with the Libre. You might want to think about leaning how to home test even if it's as a back up. Like with many things, Murphy's Law always comes into play at the worst possible moment. A back-up system might be a thought.
 
This is why I was encouraging you to get the back up testing supplies. I know you think he’s already too stressed but I believe it’s still less stressful than trips to the vet. In addition to being glitchy on lower number as I was saying, the libre can fall off. Some cats manage to remove it too. Just give it some thought. Baby steps.

did you try rubbing his ears to see how he tolerates that?

it seems like we’re all in agreement about the dose and the bouncing. Keep us posted on how he does on the new dose. Im glad you read up about it :)
 
I agree we need to learn to test but the thing I like about the libre is I get readings all night long, which is where his low points occur. It also is less stressful for him. Anytime we pick him up he gets stressed..
He actually likes his ears rubbed. One thing I have done is make sure he is comfortable being touched anywhere on his body.

it amazes me that just lowering by one quarter unit, the difference in him today. At 2 units he is hiding under chairs , not eating well or drinking well, jumping anytime one of us moves, totally stressed all week. Today after lowering it, he is his old self, laying out in the sun, eating and drinking well and begging when we ate breakfast. Is that normal when the dose is too high?

thank you all so much for your help and getting me “ off the ledge” yesterday.

I’ve only had 3 cats in my life, this one and his sister who were orphaned in our yard, and another cat that adopted me right before the other two. His sister developed cancer but after a year of treatments died 2 years ago. The other one lived to 17 years old but died of failing kidneys 6 months ago. Now this…..so much heartache…they are like our kids.
 
They really really are!!! I’ve also only ever had 3 cats. My first passed over 15 years ago and 3 days after I found Bobo and Minnie in a shoe box. I believe to this day she sent them to me because a) Minnie looked exactly like her and b) I was too heartbroken and I needed them to heal me. We lost Minnie last summer although she fought bravely for 2 years against everything thrown at her from pneumonia to diabetes and cardiac arrest. So Bobo is the only child now and I need him to be okay.

I can safely say everyone here gets it because we all feel the same way about our babies and we’ve all been there at the beginning of this journey when everything was overwhelming and we just wanted someone to hand hold us through it. Well, you’ve got a bunch of someones now. I’m very happy he’s acting better and you’re not looking down at that abyss anymore!

I’m not sure about the behavior question. When they go too low they can act lethargic but not sure about stressed. It does make sense that if he feels better his behavior will reflect that.

Looking forward to hearing how he likes all the new low carb foods you ordered!
 
Posted last nights number to spreadsheet and curious why so different than they have been? Installed new libre yesterday afternoon, so would that be it?
 
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