New Member: Nimitz and his attendant, Gwenn

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Gwenn & Nimitz

Gwenn & Nimitz

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Hello! My name is Gwenn and Nimitz is my fluffy orange sugar baby. First, I would like to say that finding this site when he was initially diagnosed helped with my post-diagnosis anxiety so much! Now on to business...

Nimitz is a 6 y/o male. At 16lbs he is a big boy (but down from 18lbs a few years ago!). He was diagnosed on 8/20/2024 after I noticed excessive thirst and urination. His BG at diagnosis was 500+. We immediately changed from a mostly dry food diet to 100% wet, started insulin (3U glargine) twice daily, and began home glucose monitoring with an AlphaTrak 3.

The first weekend was a little rough. Nimitz has a sensitive GI system so any change in food tends to lead to poopy pantaloons and he seemed to be responding well to insulin but had some vomiting and liquid poops outside of his box (not something he has ever done before). I reduced his dose to 2.5U or skipped and called his vet and they updated his dosage to 1U/2x day.

I then had to leave for 2 weeks to travel out of the country. Most boarders where I live (SE Wisconsin, USA) do not do injection meds, but I eventually found a qualified boarder who would take him (the relief!). While in boarding he did not have any glucose monitoring as he would refuse food when they did so there is a gap in my data.

Since then we have been working through the feeding, dosing and glucose monitoring protocols and things are doing well. His numbers have been staying fairly stable, the GI disruption has passed and based on Nimitz's behavior, he is feeling much better. Annoying behaviors I thought he grew out of are back (scratching furniture while staring directly at me, morning face punches, the usual) so I think he wasn't feeling very well for a while. He went into the vet's office for a glucose curve 10/1 and from that testing they changed us to 0.5U/2x day and still seeing consistent numbers.

A few questions for those with the knowledge...
  1. What should I consider an NS threshold for insulin? I've been using my judgment based on what he's been averaging. For example, last night he was at 88 so I skipped and haven't seen any major spikes/crashes.
  2. The vet thinks Nimitz has good odds of going into remission. How do you determine when you can start testing if he is in remission? Any resources, links or insight appreciated!
  3. I don't know what method (SLGS or TR) we are on, I think it's a combo of starting slow til we find the right dosage and then TR after. Thoughts?
  4. Do you recommend getting a second opinion/getting established at a clinic that specializes in diabetic pet care?
Thank you again FDMB for being such a wonderful resource.
 
Gwenn & Nimitz said:
Hello! My name is Gwenn and Nimitz is my fluffy orange sugar baby. First, I would like to say that finding this site when he was initially diagnosed helped with my post-diagnosis anxiety so much! Now on to business...

Nimitz is a 6 y/o male. At 16lbs he is a big boy (but down from 18lbs a few years ago!). He was diagnosed on 8/20/2024 after I noticed excessive thirst and urination. His BG at diagnosis was 500+. We immediately changed from a mostly dry food diet to 100% wet, started insulin (3U glargine) twice daily, and began home glucose monitoring with an AlphaTrak 3.

The first weekend was a little rough. Nimitz has a sensitive GI system so any change in food tends to lead to poopy pantaloons and he seemed to be responding well to insulin but had some vomiting and liquid poops outside of his box (not something he has ever done before). I reduced his dose to 2.5U or skipped and called his vet and they updated his dosage to 1U/2x day.

I then had to leave for 2 weeks to travel out of the country. Most boarders where I live (SE Wisconsin, USA) do not do injection meds, but I eventually found a qualified boarder who would take him (the relief!). While in boarding he did not have any glucose monitoring as he would refuse food when they did so there is a gap in my data.

Since then we have been working through the feeding, dosing and glucose monitoring protocols and things are doing well. His numbers have been staying fairly stable, the GI disruption has passed and based on Nimitz's behavior, he is feeling much better. Annoying behaviors I thought he grew out of are back (scratching furniture while staring directly at me, morning face punches, the usual) so I think he wasn't feeling very well for a while. He went into the vet's office for a glucose curve 10/1 and from that testing they changed us to 0.5U/2x day and still seeing consistent numbers.

A few questions for those with the knowledge...
  1. What should I consider an NS threshold for insulin? I've been using my judgment based on what he's been averaging. For example, last night he was at 88 so I skipped and haven't seen any major spikes/crashes.
  2. The vet thinks Nimitz has good odds of going into remission. How do you determine when you can start testing if he is in remission? Any resources, links or insight appreciated!
  3. I don't know what method (SLGS or TR) we are on, I think it's a combo of starting slow til we find the right dosage and then TR after. Thoughts?
  4. Do you recommend getting a second opinion/getting established at a clinic that specializes in diabetic pet care?
Thank you again FDMB for being such a wonderful resource.
Click to expand...
@Bron and Sheba (GA)
@Wendy&Neko
@Sienne and Gabby (GA)
 
Hi Gwen and Nimitz and welcome to the forum.
I’m certainly glad you reduced the dose from 3 units. That is far too much to start a newly diagnosed a cat on.
Can you tell me, are you feeding just the 2 main meals or are you also giving snacks as well? If you are only giving the 2 main meals, I would recommend you start to give 2 or 3 snacks during every cycle, mainly in the first half of the cycles. A snack is a teaspoon or2 of normal low carb food.

Gwenn & Nimitz said:
What should I consider an NS threshold for insulin? I've been using my judgment based on what he's been averaging. For example, last night he was at 88 so I skipped and haven't seen any major spikes/crashes.
Click to expand...
It depends on what dosing method you are following. If it is SLGS, you don’t shoot below 90.
If it is TR you can shoot above 50. You would gradually reduce the shoot number until you reached 50 and at first you would need to be around to monitor. Shooting lower tends to give you a flatter cycle which is what we want.
Are you around during the day at all to monitor?
I think you would do better on TR and have a better chance at remission.

Gwenn & Nimitz said:
The vet thinks Nimitz has good odds of going into remission. How do you determine when you can start testing if he is in remission? Any resources, links or insight appreciated!
Click to expand...
Yes it looks as if he does have a good chance of going into remission. To achieve that you need to be following TR and reduce the dose as per the protocol down to a drop over time, depending on what the BG numbers are telling you.
Here is a link to our 2 dosing methods. When you choose one, put it into the signature and we will send you over to the Lantus page where they will help you every step of the way. DOSING METHODS

Gwenn & Nimitz said:
don't know what method (SLGS or TR) we are on, I think it's a combo of starting slow til we find the right dosage and then TR after. Thoughts?
Click to expand...
Read the dosing methods above and choose which one you think will suit you best. Both are good. The TR is a more aggressive method and gets the cat into normal numbers quicker. But you have to be testing at least 4 times a day and feeding only wet food.

Gwenn & Nimitz said:
Do you recommend getting a second opinion/getting established at a clinic that specializes in diabetic pet care?
Click to expand...
No I don’t. It looks as if you have a good vet and if you stay here and get advice daily on dosing and moving forward we can help you get Nimitz to hopefully remission…no guarantees but he is looking pretty good for a newly diagnosed kitty.
Just keep doing what you are doing, post here daily and then we’ll send you over to the Lantus page where there are experienced people to help you.
There is no need to go to the vet to have curves done if you are hometesting. You will get a much more reliable curve done at home as cats get stressed at the vet and the BGs often rise there.

You could have given the insulin with the BG of 83 as long as you were around to monitor the BG and had a hypo kit …hopefully you have one? You need to shoot low to stay low. A bit scary in the beginning but well worth it and that is the best way to get Nimitz regulated.
To get a cat into remission, you have to get him regulated first.
Here is some more reading for you
LANTUS PAGE INFORMATION
Read all the yellow stickies at the top of the page.
Looking forward to hearing back from you
Bron:)
 
@Gwenn & Nimitz
Welcome
Hypo kit if needed
Med and High Carb food and have honey in your house



Fancy Feast Gravy Lovers Gourmet Beef Feast in Gravy 20% High Carbs

Fancy Feast Gravy Lovers Gourmet Chicken Feast in Gravy 15% Med Carbs



Fancy Feast Gravy Lovers Turkey Feast in Gravy 15% Med Carbs

Fancy Feast Gravy Lovers Chicken and Beef in Gravy 15% Med Carbs

Good idea to mark the cans with magic marker how many carbs

Or any on the food chart. Doesn't have to be Fancy Feast just an example about the med and high carb foods



https://felinediabetes.com/FDMB/threads/dr-pierson-new-food-

10% and under is low carb
11% -15 is medium carbs.

16- 24 is high carb.


What a handsome fluffy boy :cat:
 
One thing that I would add is that if a cat is in normal numbers (50 - 120) and is largely in numbers below 100 for a week, you an reduce the dose by 0.25u. It looks like you can reduce Nimitz's dose.
 
Thanks everyone for the warm welcome and insightful responses. I've got my hypo box started, just need to get the medium and high-carb food options.

Bron and Sheba (GA) said:
Can you tell me, are you feeding just the 2 main meals or are you also giving snacks as well? If you are only giving the 2 main meals, I would recommend you start to give 2 or 3 snacks during every cycle, mainly in the first half of the cycles. A snack is a teaspoon or2 of normal low carb food.
Click to expand...
Currently, we are feeding the two main meals (3/4 of a 5oz can) and then I have been giving treats whenever we do blood checks (either dried minnows or a portion of a chrru tube). I will start integrating a post-meal snack, I'm sure he'll love it.

I'm still doing my reading but am pretty confident we are going to aim for the TR protocol since we have already transitioned to wet food and I am lucky enough to still work from home. Would midday dry food snacks be an issue on this front?

Another TR-related question, this time of year I tend to be home more but curious how folks manage being away from home during feed/insulin time. Last time I had to be away for dinner I had his food pre-portioned and a friend came by to serve it without any meds. I didn't see any spiking when I was able to test but it was hours later. I'm trying to make sure I'm home and available especially in the early treatment stages but not always possible.

We are planning to do an at-home glucose curve now that we've been on the lower dosage for a while. I got an AlphaTrak3 based on my vet's recommendation (what they use and before I found this site), I am thinking of getting a human meter eventually as a backup. I know most of this site works of human meter data and what I've read is the numbers tend to align better on the low side than the high. Do you think this could negatively impact our TR goals?

We have not done any ketone testing, when he was initially diagnosed his labs did not detect any but would you recommend I add this to my toolkit? Any specific recommendations?


Bonus fun fact... I finally gave in and played with the dose/button on the insulin pen. Don't do it. It made a bunch of pressure so when I went for his AM shot it filled the syringe with 10+ units that were sacrificed to the sink. o_O Lesson learned.
 
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Any dry food means you can’t do TR. For snacks use normal low carb food.
It is ok to use the alphatrak meter. It should not effect your goals.
To test ketones you just need to buy some Ketostix from a pharmacy, collect a urine and follow directions on the bottle. If collecting a urine sample is an issue there are blood ketone meters which are used like a glucose meter.
With not being there for the dose of insulin, what about teaching a friend how to test the BG and give the dose of insulin. It is a great asset if you can have a fall back option. I taught my husband who I never thought would do it and it was a game changer.

Gwenn & Nimitz said:
Bonus fun fact... I finally gave in and played with the dose/button on the insulin pen. Don't do it. It made a bunch of pressure so when I went for his AM shot it filled the syringe with 10+ units that were sacrificed to the sink. o_O Lesson learned.
Click to expand...
Are you using a pen to give the doses and not a syringe?
 
Gwenn & Nimitz said:
I found this site), I am thinking of getting a human meter eventually as a backup
Click to expand...
If you plan on getting a human meter
Here is the link for the meter and test strips so you don't have to search for them
Relion Premier Classic Meter at Walmart for 9 dollars
https://www.walmart.com/ip/ReliOn-Premier-CLASSIC-Blood-Glucose-Monitoring-System/552134103

The tests strips are 17.88 for 100
https://www.walmart.com/ip/ReliOn-Premier-Blood-Glucose-Test-Strips-100-Count/575088197
At least if you need more test strips you can run into Walmart and pick them up or if you're running low you can just order them from Walmart
@Gwenn & Nimitz

If you plan on following TR method can you add that to your spreadsheet up top
 
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If you are not using the U-100 syringes with the half unit markings
you can get U100 insulin syringes with half unit marks for $12.58/100.
You have to go into the store , you can't order them on line

Either of these 2 boxes are the ones you want (with a purple stripe)
upload_2024-4-22_23-37-23-jpeg.69946


You can order the U-100 syringes with half unit markings from Amazon without a doctors script
https://www.amazon.com/UltiCare-31-Gauge-Veterinary-Insulin-Syringes/dp/B009LTE0DO


upload_2024-10-5_9-40-51-jpeg.71138

The ones in the left is what we use

Just take the cap off the pen and use a U100 syringes and pull the insulin out of the pen! You will see a small gray rubber stopper, insert the syringe there
syringe-in-pen-pic-jpg.45006


We use the syringes because with using the pens you can only adjust the dose by whole units with a pen so we use the syringes since we either increase or decrease by 0.25 units at a time
 
Update from home glucose curve at 0.5 units. Our vet has suggested that we go down to 0.25 (@Sienne and Gabby (GA) called it) or try going off the insulin and see what the numbers are like. We're going to start the 0.25 and run another curve in a few weeks then go from there. Has anyone experienced a similar turnaround from treatment to possible remission? It feels a little too good to be true and I might be overly skeptical but plan to start digging the forums for remission discussions.

PS If I should take this update to a new board/post, let me know, thanks!
 
If you are following TR Nimitz has not earned a reduction down to 0.25 units yet. He needs to drop under 68 for that to happen.
He is definitely not ready to go off insulin. We recommend going down in doses to 0.2 unit, 0.1, and then a drop before going off insulin. That way you will get a strong remission. If you don’t get a strong remission you risk him falling out of remission. You are aiming for an all green SS.
He is looking great. You are one of the lucky ones where your kitty has read the rule book!:D
I would look again at the TR dosing methods and follow that… keep posting :)
 
Thank you for the insight @Bron and Sheba (GA)! We've been doing the 0.25 for the last few days and based on the early data, I agree it probably was too early. It was recommended by my vet (who feels that anything from 60-170 on a pet meter is pretty much a green light to lower dosage/try remission) so I'm planning to go along with that while in the initial post-diagnosis phase but will keep checking with the FDMB pros as we move forward.

I have been looking at fellow members spreadsheets and have been feeling incredibly lucky that, so far, Nimitz has responded to treatment so well.
 
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