04/23/24 New Member Teja 17y female newly diagnosed as of today

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Malia

Malia

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Hello everyone, my name is Malia and my beloved Teja was recently diagnosed with diabetes today. Her glucose seemed high so we did the fructosamine ? test and it came back elevated. So we slapped a continous glucose monitor on her and it just came back with "HI". It scared the tar out of me.

Thankfully Teja had an amazing internal med doctor who walked me through what comes next. She had her first dose, one unit of lantus today at 3:30pm pacific time and I am currently monitoring her sugars slowly coming down and her resting comfortably for the first time in days.

Teja is a special case. She had kidney disease that is well managed. She has food allergies and suspected IBD. However, her team of vets, yes she has a team of specialists all lead by her internal med vet, are starting to change their minds about IBD and food allergies. At the end of February of this year, Teja present with gallstone blockages in her bile ducts and had to have emergency surgery. Her gallbladder was not healthy and they believe is what was causing the inflammation of her IBD. During her surgery her pancreas took a pounding, and rhe surgeon told us to expect either pancreatitis or blood sugar regulation issues, like diabetes. So here we are.

Teja just met with a veterinarian nutritionist and we are working to develop a diet for her, since she has to eat low fat due to her lack of a gallbladder, eat a novel protein due to food allergies and now, low glycemic carbohydrates due to her diabetes. I'm lucky, she's always been an eater and a bit of a chonk. So hopefully her diet will be something she will like once we get it started. For now she eats Royal Canin (RC) PR wet food and RC hydrolyzed protein for cats with kidney disease.

Yup, she's 17, but a young 17 and is the light of my small world. I'd do anything for her. Which is why I am here. I want to learn about this disease and how I can help her. I don't have any questions just yet, but I'm here for the support that I am not alone. That is what is so hard, doing this all on my own and I don't have anyone to talk to about this new lifestyle.

Thank you so much for this support group!
 
Hi Malia and Teja and welcome to the forum.
Lantus is a good insulin for cats. It needs to be given 12 hours apart so you might find the 3.30 am and pm time slot difficult. You can move it forward 15 minutes a cycle until you get to the desired time.
We have a spreadsheet you might like to set up which will help you keep track of the blood glucose levels. We can also help you with dosing if you would like.
We have 2 dosing methods for Lantus which I will link below along with the information about the spreadsheet.

diabetic cats need a low carb diet of 10% or under carbs. The RC hydrolysed protein you mention looks like it is 17% carbs which is high carb and not suitable for diabetic cats. Can you ask your nutritionist if a high protein, low carb, low phosphorus food would be suitable? Weruva cat food brand have a low phosphorus selection of cat foods which is also low carb you might like to look at.

Make sure you have a hypo kit set up with some high carb food and some honey or Karo in case of low numbers.
Here is the link to the spreadsheet, the signature and the hypo kit
HELP US HELP YOU
And here is the link to the 2 dosing methods for Lantus
LANTUS DOSING METHODS

Here is the low phosphorus Weruva cat food

We are happy to help in any way.
 
Oh my goodness, thank you! I have so much to read and look over. This is all super scary and a total unknown to me. I didn't even know what a normal cat's BG level is. I don't even know what to shoot for. I honestly know nothing.

Thank you for the diet suggestion. I have reached out to my nutritionist to see what we can do. I looked at the royal canin selected protein rabbit to find the carb content. Are we looking at the carb (NFE) on as fed basis or dry matter? Because I think this is higher carb too, 14% dry matter base. She has food allergies (which cause intense pain and inflammation for her) to pretty much most fish and farm animal food out there. So rabbit and duck are safe so far. But duck is super high in fat, which we have to work up to due to no gallbladder, and I have to watch the phosphorus levels. This is an incredible balancing act I've got before the diabetes.

I have so much to read and learn. Thank you for showing me where to start.
 
Venison may also be an option. Ask your nutritionist about ZiwiPeak food. They have both Venison and a Rabbit and Lamb flavor that may be novel proteins. Another possibility may be a raw or partially cooked diet. You can source proteins if you need to or if there's a butcher in your area, some carry a wider array of protein. Pork may be an option for your cat since it's not an ingredient in many commercial cat foods. There are pre-mixes that have all of the supplements needed to make a raw diet nutritionally complete.
 
Sienne and Gabby (GA) said:
Venison may also be an option. Ask your nutritionist about ZiwiPeak food. They have both Venison and a Rabbit and Lamb flavor that may be novel proteins. Another possibility may be a raw or partially cooked diet. You can source proteins if you need to or if there's a butcher in your area, some carry a wider array of protein. Pork may be an option for your cat since it's not an ingredient in many commercial cat foods. There are pre-mixes that have all of the supplements needed to make a raw diet nutritionally complete.
Click to expand...

Thank you so much for your suggestions. I have looked into raw, which is why I'm working with a nutritionist on this. Teja has to have a low fat diet as well because she doesn't have a gallbladder. And now, low carb, lol. Its a good thing cats are obligate carnivores. I will be making her cat food for sure, lol. She has so many conditions to work with now. The last thing I want to do is hurt her, or worse, with what she eats or the medicine she takes. Which is why I am here, to learn from all of you. Thank you again.
 
I feed my cats a home made raw diet. You have a lot more control as to what goes into the food.
to make a raw diet lower phosphorus you can add a cooked egg white each day. It is low phosphorus and high protein. I used to give Sheba 1/2 a cooked egg white mashed up in her raw diet a day.
 
This is exactly what I am looking to do myself. Make her meals and transition her safely to a raw diet. She 17 with a few conditions, so I want to make sure I do it right. I'll mention to the nutritionist the egg white suggestion. I do know that we have to watch out for certain fats as it can cause GI issues. I do know that egg whites are an amazing source of protein especially for kitties with CKD. Thank you for suggesting it!
 
Bron and Sheba (GA) said:
I feed my cats a home made raw diet. You have a lot more control as to what goes into the food.
to make a raw diet lower phosphorus you can add a cooked egg white each day. It is low phosphorus and high protein. I used to give Sheba 1/2 a cooked egg white mashed up in her raw diet a day.
Click to expand...

Hey, I'm not sure if I can reply here or if I need to make a new post. Would you be able to guide me? It's day 3 for us with insulin. And I'm scared I'm doing everything wrong. I am looking at her libre 2 readings and I don't know how to interpret them. I am afraid of insulin and hurting her and I have no confidence in myself with this. And I need to get some fast because she is counting on me to get this regulated. I have asked her internal med vet so many questions, so many text messages I feel like I am becoming a nuisance at this point but there are so many unknowns. I am trying to read as much as I can, while also trying to take care of her correctly and work. I work from home so I can obsess over her all day. There is so much to read! I've done my fair share of medical support for my kitties, but this is my first sugar cat. And it's just her and I in this (I do have other kitties, but it's just me as a human here) and I've got to make sure we get this regulated. I feel like I'm spinning my wheels and going nowhere. Help.
 
Sure I can help you. The first thing you need to do is set up your spreadsheet and enter your BGnumbers so we can see it all. Then we can help you with dosing and anything else. Also if you can set up your signature and tell us all about Teja.
Information on how to set up the SS and signature here. If you have any trouble let us know and we will help you
HELP US HELP YOU
 
Hi @Malia , this is Bhooma from the FB group. I can help set up your spreadsheet and signature. Will send you a PM with the details I need. Look for it in the Inbox at the top right corner of this page. :-)

It's great that you are posting here and getting help from Bron!
 
Hi @Malia, I've set up the spreadsheet. Since you are using the Libre, you will have a lot of data. Don't worry about entering all of it in the SS. Mainly we need preshot values and some readings in each cycle - mainly the nadirs since Lantus dosing is based on how low a dose takes the cat.

@Staci & Ivy and @Evey also use the Libre, so you could check out their spreadsheets.
 
Hello Everyone, my apologies for the delay. Today was the first day I actually got to sit down and do my spreadsheet. I am so sorry for the lateness of this. It has been almost a couple of weeks since diagnosis and I have been working to get used to this. A few things have come up since we last chatted.

First, we have changed her diet and eating fashion. She no longer gets dry food as I saw that spike her glucose. She also is eating Hill's Rx diet d/d wet food. She eats 6 times a day, 4 hours apart. She eats around 1am/pm, 5am/pm and 9am/pm. Her nutritionist wants her eating a total of 1 and 1/4 can of the d/d a day, but she has been eating a bit more than that. We started the new diet on 04/30. We started the feeding schedule 05/01. I have just completed cooking her homemade recipe created just for her. We will be slowly transitioning her to the new food over the course of the next 3 weeks, if she will eat it. But she will be eating on the same time schedule to make sure she is getting enough. Her recipe is nutrient dense but we have to see how it will affect her glucose.

Second, Teja is on prednisolone. She has been on prednisolone since the first week of March, so just about 2 months now. She is getting 5mg of prednisolone once daily at 6:30pm. She was put on the steroid after her surgery as an anti-inflammatory since she was eating food she was allergic to. I noticed a huge spike in her numbers when she would recieve the once daily dose. She would go from 100s to over 400 in the space of 4 hours. Then it would stay high until morning, when it would come down as the steroid wore off. Or this is what I assumed. I am not sure if it is visible on the spreadsheet, but I noticed it. I talked to my vet about prednisolone and wanting to start a tapering process to get her off of it. My vet is hesitant to do so at this time because she thinks the steroid will help her with the new diet adoption. I said I wasn't comfortable with the spike, and neither was Teja. So she said we could break up her 5mg dose to 2.5mg dose twice daily. We started this the evening of 05/03. The spike isn't as high but now she is consistently high.

Third, she had a night where she got to 60. That was beyond scary. She had no symptoms at all. She does tend to drop from time to time, or head down. My vet seems to think that her pancreas is still working. This scares the crap out of me because she can drop 50 points in 30 minutes. She has a slow metabolism, so the food she eats takes 2.5 hours to 3 hours to start making glucose available for her. So getting her to eat her way out of a low moment means I have to start a long time before it gets low. I will give her a few pieces of her old dry food (like 3 or 4) to see if that will get her numbers up. I am not going to lie, but I freak out when she gets into the 100s because if her pancreas decides its time to help, then things can go bad.

I really think that her diabetes is being made worse by the insulin resistance caused by the steroid. But I don't know. I need help on how to make the right adjustments. I feel like my vet isn't really partnering with me in this. She tells me I am doing a good job, but she hasn't sat with me and discussed diabetes in felines. I got a hand out. I freaked out and took her to the EV and there a tech took time out of her day to just share information about feline diabetes. We need help. I am not sleeping and constantly monitoring because of her sometimes working pancreas, so I can step in and get some food in her so she doesn't get too low. Please help us.
 
Hi @Malia, sorry that no one responded sooner. You want to start posting on the Lantus forum now that you spreadsheet and signature are set-up:
Lantus / Levemir / Biosimilars

Have you thought about Budesonide for Teja's IBD? For many cats it doesn't affect the BG in the way that Pred does. I'm going to tag @Wendy&Neko and @Margaret (and Pearl) for advice on timing of the Pred (when to give it in the cycle).

I don't think you are seeing insulin resistance. You are seeing high numbers from the pred. You just need to get her to a good dose. Is there a reason you reduced the dose to 1.5U this morning?

I don't think Hill's Rx diet d/d wet food is low carb. Is that the food she is being transitioned to?
 
Timing of pred is what works for your cat. We have a saying here ECID or each cat is different. How they metabolize the steroid can differ. Once you have figured out when the pred impacts her blood sugars, use that to your advantage. I've seen people give it at night so they know kitty won't go as low then and can get some sleep. I've also seen some give it in the morning, so kitty would be safe while they are at work.

I'd second the budesonide option. My Neko needed a steroid but her heart could not take prednisolone, so she was on budesonide. It didn't impact her blood sugars at all, though it does for a few kitties. We've also had some kitties go off of insulin when they switched to budesonide. ECID.
 
Bandit's Mom said:
Hi @Malia, sorry that no one responded sooner. You want to start posting on the Lantus forum now that you spreadsheet and signature are set-up:
Lantus / Levemir / Biosimilars

Have you thought about Budesonide for Teja's IBD? For many cats it doesn't affect the BG in the way that Pred does. I'm going to tag @Wendy&Neko and @Margaret (and Pearl) for advice on timing of the Pred (when to give it in the cycle).

I don't think you are seeing insulin resistance. You are seeing high numbers from the pred. You just need to get her to a good dose. Is there a reason you reduced the dose to 1.5U this morning?

I don't think Hill's Rx diet d/d wet food is low carb. Is that the food she is being transitioned to?
Click to expand...

Hello Wendy and Bhooma,

Thank you for replying, I really appreciate it. I am sorry it has taken this long to get back to the post. It has been so crazy lately.

When it comes to the prednisolone, we have started to taper her off of it. She was prescribed it after her gall bladder surgery. She was over hydrated with IV fluids and had a pleural effusion. Her internal med doctor thinks we can safely taper her off of the steroid over the next 2 weeks. I'm terrified. She is on a super low dose (1mg twice daily for this week, then every other day for the last week). This has been since Friday that we have made this switch. Her glucose went super high then dropped super low. And now she is in a normal range. She is getting 3 units twice daily, but that's when she was getting 5mgs of prednisolone and her glucose was consistently 300+. This low dose of steroid is giving low numbers. I'm going to update her chart here momentarily. I'm worried to give her 3 units as that brought her down earlier today from 350 to 60 in the space of 4 hours right after her insulin.

I don't know how to judge what is best when giving insulin. Is there a rule of thumb?

Also, she has a nutritionist and we will be doing a specific diet for her once we complete the tapering off of the steroid. At this time with her food allergies the canned d/d is our best option.

Any help or guidance is greatly appreciated.

Thank you both!
 
At the top of Lantus forum you'll find some yellow starred Sticky Notes. There is a lot of information in there, but worth reading. In particular is one that describes the dosing methods we use here. If you are still feeding some high carb food, which the d/d is, you have to follow the Start Low Go Slow dosing method. The dosing methods are what guide us in deciding how to change the dose. However, we'll need an up to date spreadsheet of numbers to be able to help you. The last spreadsheet entry says you were giving 1.5 units. I can say that SLGS says you immediately lower the dose by 0.25 units if they go below 90.
 
Wendy&Neko said:
At the top of Lantus forum you'll find some yellow starred Sticky Notes. There is a lot of information in there, but worth reading. In particular is one that describes the dosing methods we use here. If you are still feeding some high carb food, which the d/d is, you have to follow the Start Low Go Slow dosing method. The dosing methods are what guide us in deciding how to change the dose. However, we'll need an up to date spreadsheet of numbers to be able to help you. The last spreadsheet entry says you were giving 1.5 units. I can say that SLGS says you immediately lower the dose by 0.25 units if they go below 90.
Click to expand...

Thank you so much for your quick reply. I have updated my spreadsheet. And I am going to take a look at the insulin page you suggested. Thank you!
 
Malia said:
Thank you so much for your quick reply. I have updated my spreadsheet. And I am going to take a look at the insulin page you suggested. Thank you!
Click to expand...
Is your vet guiding you with dosing? You also want to start posting on the Lantus forum and we can help you with dosing. I see you shot only 2U tonight?
 
Yes, I only did 2 units last night because I was terrified of giving her too much with 3 units. I will work to update her spreadsheet for last night's numbers.

My vet is guiding me with dosing, but we changed her dose of prednisolone to start tapering on Friday, just before the weekend. So my vet isn't available. When she was on her full dose of prednisolone, it would raise her glucose over 400 from 100. Now that we are at the lowest dose, it isn't affecting her glucose as much. Also, because she has less steroid, she is eating less. She is supposed to eat 1 and 1/4 can a day to maintain her calories. But she isn't eating as much.

So many things to balance with her. I am actually going to switch up her food back to Royal Canin PR to see if I can get her excited about food to eat more.

I will post the the Lantus board as soon as I update her spreadsheet. I'm trying to work today, as it is Monday, so I am juggling that plus all of this. Her AM shot is coming up.
 
Bandit's Mom said:
Is your vet guiding you with dosing? You also want to start posting on the Lantus forum and we can help you with dosing. I see you shot only 2U tonight?
Click to expand...
Wow! I have been reading on the lantus forum the sticky notes and found the basics sticky! Holy cow! So much I don't know! Like the bouncing effect. I think this is what my Teja has been going through with her ups and downs. Because it always seems that when she comes rocketing down, that she goes right back up for a day. I had no idea. So much to read and learn. Thank you!
 
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