New Member - Can't get BG regulated - HELP!

Let me introduce myself, my name is Dawn and my cat is Tiger. He is a 12yo indoor cat who was diagnosed with diabetes in April 2021. As of right now, Tiger has lost almost 6 lbs in 9 months, he still walks wobbly and on his back haunches, he can't jump on the couch or my bed anymore, and he just wants to snuggle every time I sit down. I know he isn't feeling well and I need to do something... but I don't know what to so.

Here's his story... about 5 years ago, he had a urinary blockage and we almost lost him. After emergency surgery and a new diet (Royal Canin Urinary S/O) he was doing great. Chunky at 18lbs but happy and active. In April 2021, he started walking really funny and not doing much of anything at all. After a trip to the vet, blood work, etc, he was diagnosed with diabetes and I immediately started him on Prozinc (2 units, twice a day). After a couple of weeks on this, he started doing so much better. His gait was getting better and he had brighter eyes and wasn't sleeping all day. Then he went back to having issues. I did a 12 hr BG curve and his numbers started and ended around 350 and spiked to over 600 in the middle of the day. I can supply the numbers for his last 3 BG 12 hours curves if anyone wants to see it. The vet increased his dose... this has been my story since. He is good with the new dose for a couple of weeks then goes right back to where he was at diagnosis. He is currently getting 6U/2x a day. He gets a tablespoon of Blue Buffalo Tastefuls before each injection and has the dry (Urinary S/O) food available all day to him.

I've been taking the advice of my vet, which lately seems to be do a curve and increase the units. I am doing another curve this weekend (12/4) and the vet said if they are still uncontrolled we are going to try changing insulin and dosages. So, this made me start doing some research on my own. This site has been HUGE help! I've read many online reviews about the dry food I'm feeding and they were NOT positive, so I will be starting to move him and his sister to a fully wet diet (hopefully since he is a SUPER picky eater) but I really want to get him off this dry food ASAP. Going to try cold turkey today and see how that works - wish me luck.

With that said... what advice/suggestions/help can you guys give me. I'm so lost and my poor guy is so sad and not himself anymore.

 

Quickly - if you gave him his shot already do NOT switch food cold turkey, sometimes a diet change is enough to drop BG significantly

More reply in a minute here

 

Ok. So first things first, welcome! We'll get you on the right track.

6U is a very high dose, it can often indicate underlying issues like acromegaly or IAA. Has he been tested for either of those?

however, I am concerned his dose is too high and is causing the spikes. Can you provide any data you have, with the dates? Fructosamine tests, BG curves, medications, when the dose was increased and by how much. It would be ideal if you can get a spreadsheet and signature set up for us, here is a link How to Help Us Help You

As for the food - yes, an all wet low carb diet is what you want. But a cold turkey transition can cause GI upset, but more critically it can seriously reduce BG to the point it might be dangerous.

Do you home test? Do you have a hypo kit? Home testing really is going to be critical to keeping him safe. You will test right before his shot to make sure it's safe to shoot, but also ideally midcycle to see how low he is going - how low he goes it what determines the dose adjustment. The tests before his shot should be fasting, meaning no food for 2 hrs before his shot.

It sounds like he also has diabetic neuropathy, it is usually reversible if you supplement with B12, though can take a few weeks/months. @Diane Tyler's Mom when you get a chance can you post which B12 most people here use? Thanks!

Does he have any history of ketones or diabetic ketoacidosis? Any other health issues?

 

whew, that's a lot of new words for me

I'm not sure what acromegaly, IAA or Fructosamine tests are, but I'll dig through my notes and do some googling on that. I'll get those posted as soon as I can.

I'm also going to start that spreadsheet and gather all the BG curves and date on increases - thanks for the link and I'll get that to you as soon as possible as well.

I've not tested regularly at home and had a ton of trouble doing the curves, but thanks to the videos on here - I now know what I was doing wrong. I'm going to start doing them throughout the day as you suggested to get a better idea of what is happening with them. I bought the AlphaTRAX home test kit, but find that my testing kits works much easier and read that it doesn't have to specifically be a pet device.

I had no idea what a Hypo kit was, but I will be putting that together as well.

He is so spoiled with having munchies all day, getting him on a feeding schedule is going to be rough, but worth it. I also found a link in here for figuring out how much wet he needs to eat each day, so that is on my list as well.

He has no history of ketones or diabetic ketoacidosis, that I'm aware of. The vet has only done blood work once in April and it wasn't noted there. He does have neuropathy, the vet said it could be reversible, once we get him under control. I'll try anything for that - he takes about 10 steps and has to lay down, and it's like he is walking flat footed, all the way up to the joint is on the ground.

The only other health issue is the blockage and Prozinc insulin is the only meds he takes.

More to come soon!

THANK YOU!!!! From what I got at the vets office, it was just give him a shot 2x a day and everything will be fine. I wish I would have taken it more seriously back in April and found this group then! I probably wouldn't feel like such a horrible cat mom

 

A lot of us use the Vitacost brand
14.49 for 100 capsules , give 1 a day, just open the capsule and mix it in with the wet food and add water, you can start it now, and its tasteless
https://www.vitacost.com/vitacost-vitamin-b-12-methylcobalamin-5000-mcg-100-capsules-6
I have given it to Tyler when he had neuropathy, once his numbers started to improve I started to see a big difference in about a month and a half, but each week I would notice he was walking better . The neuropathy is totally gone. He's back to running and jumping .

 

It's a steep learning curve for sure! I was the same, wish I had found this group months earlier.

For now don't worry about acromegaly and IAA tests. We'll start with the basics of home testing for a few days, then consider how to do the diet change and insulin dose.

Let me know when you've got spreadsheet up and running, it would be ideal if you could do the fasting test before his shot tonight just to see where he's at.

Another thing - you should probably grab some urine ketone strips as well to occasionally check urine for ketones. This post explains better than I could. Basically if they aren't getting enough insulin (often indicated by high BG), they are at risk for ketones should they develop a secondary issue like infection or systemic stress, especially if they aren't eating enough

 

Ok, I have the spreadsheet updated the best I could. The link is now in my completed signature. Please let me know if you can't get to it, I think I shared it correctly (file/publish wasn't an option, but sharing to anyone with the link was)

This is an amazing spreadsheet, and was easy to use (once I got the values updated for the bloodwork part) More info will be added to this as I complete the home testing this week.
I put the last bloodwork results in from 11/2019 just as a reference point from when he doing well. They did blood work before pulling some teeth to make sure he could handle it.

He should get his evening shot around 9:30pm. When should I pull his food to get a fasting since right now, he is still a nibbler throughout the day?

 

I have this ordered and should be here in a couple of days. Thank you!!

 

Great thanks! Pull the food at 730, and post your PMPS (PM pre-shot blood glucose) here. For now I'm thinking hold the 6U for a few days while you get tests in, then think about diet change. But a lot depends on the numbers you get.

Those were some really big drops on the curve days, I suspect he may be bouncing a lot. Bouncing is when they drop lower or faster than they're used to, and their liver dumps sugar into their body in a panic. It's not always predictable, and it's different for every cat. It's usually marked by a very big or fast drop, then BG shooting straight back up and staying up for a few cycles. There's things to do to help avoid that, but we'll worry about that later. First and foremost want to make sure he's at a safe dose.

As for food and the hypo kit - use this list here. We define low carb as under 10%, most of us feed around 5%. Medium carb is 13-15%, high carb is 16-20%. We use the different foods to help slow down really big drops, as well as manage low numbers to prevent hypoglycemia.

 

Going to tag @JanetNJ as well for her thoughts and to keep an eye out for you

 

I can't thank you enough for your help! I don't feel alone in trying to figure this out anymore, and that is such a HUGE relief for me.

 

You're definitly not alone and your cat is very lucky to have you. Not everyone is willing to learn how to do testing and learn about nutrition. I'm confident we will get him feeling better.

 

I'm not sure what time zone you are, but you're maybe due for test soon. I'll be tied up for a few mins here but will be back around after that

 

@FrostD
I'm in shock!! It is so much easier when you do it the right way!!!

I tested on the human reader, it was 137. I've never seen it that low so I tested on the AlphaTrax as well. It was 154!!
It's been 12 hours since his last insulin injection and 2 hours with no food.

 

Hoo boy ok let me think I'll be right back

 

Honestly, with no other data to go off, my recommendation is to skip. I absolutely cannot in good conscience tell you to shoot a full 6U, I fear I'd kill your cat. For new people just starting we recommend not shooting below 200...and to compound that, he's already at 6U (usually start at 0.5-1U).

I can't even recommend shooting a small dose like 0.5U since you don't have hypo kit or variety of food (none of this is meant as criticism, just explaining the logic).

So for tonight, skip. And since we're skipping...might as well start the food transition. Please be sure to get ketone strips ASAP, when reducing insulin need to watch ketones.

Please feed him and get a +3 if you can, that will help tell me what's going on.

I think I'll be around for your AM test. Please for the love of God do not shoot before letting us know where he's at

 

Oh, boy.... I didn't see that before I did our routine... now I'm worried sick! I already gave him his shot. The vet never said to not give it to him.

I'll work odd hours, so I'll be up for at least another 3-4 hours. I will keep a close eye on him and if needed, I'll rush him to the emergency vet.

I also reviewed the Hypo kit and I have everything here except the bulb syringe.

 

Ok well he's made it this far, odds are in your favor!

Start with a +1 please.

What cat food do you have around the house (brands and flavor)? Will he eat table food? Do you have things like bread, or honey/karo syrup/ice cream? Not saying give those now, I'm just trying to be prepared

 

@Bron and Sheba (GA) @Bandit's Mom can you ladies please keep an eye out here?

Dawn just started home testing, has spreadsheet filled out to best of her ability. I am concerned the dose is too high, given the way in which the vet raised it and by how much. It is possible he's just a high dose cat. Current dose is 6U. She did shoot full dose tonight with PS of 137.

 

Ok, he is a picky eater.. here is what I have....
Canned:
Blue Buffalo Tasteful - Fish and shrimp in gravy (flaked)
" - Ocean fish and Tuna (pate)
several different flavors of the Fancy Feast basic pate

Dry: Royal Canin Urinary S/O
Crave High Protein

He did vomit pretty much immediately after the shot, he has only done this twice before and that was after trying a new flavor (beef) in the Blue Buffalo. I did attempt fancy feast before the shot, he ate some then snub his nose, so I gave him the BB pate, which he proceeded to eat 1/2 a can of.
He seems to be doing ok. Walking around, playing with toys and drinking his water (as usually).

The +1 hr will be in 30 min.

 

Ok thanks.

How much of the dry would you guess he eats in a day?

 

it is shared between Tiger and his sister Sugar. They get 1 1/2 cups total and it is almost never gone in the morning.

About to do his +1 hr...

 

His +1 is at 100.

 

Ok, that is quite a drop. proZinc usually nadirs +4 to +6 so still long way to go. How far are you from nearest vet?

In the meantime, try to get him to eat the highest carb stuff you have. Tbsp of the dry, some bread or rice if he'll eat it, sweet potato. Looking for complex carbs to help keep his blood sugar elevated for a few hours. Please also give him a drop of honey, or karo, or ice cream, something with quick sugar.

Test again in 15 mins

 

I’ll be around if needed.

 

Thanks. I've really got to get to bed - I tagged her on the FB group hoping she checks back in.

I think this will need the vet - this is a huge
ProZinc dose and very big early drop. No knowledge of when nadir may be, could be +4, could be +6.

 

Hi, a couple of houskeeping requests when you get the time. No rush.

(a) Could you please add what food you are feedind him to your Signature - that way we won't ask you again and again!
(b) Has he been on 6U from 10/26 till today? Could you add a row above that for today and mention that?

Thanks!

 

I got him to eat about a handful of his dry food and a drop of honey. He refused bread, rice, sweet potato, and is getting quite aggravated with me
I also grabbed the guaranteed analysis from the bag:
crude protein - 32.5%
Crude fat - 13%
Crude fiber - 4%
Moisture - 8%

BG is now at 54

I'm 30 min from the closest Emergency Vet, but can make it in about 20 at this time of night. hoping to avoid that as he get super car sick.

 

Vet please, now. Take your meter with you. Start rubbing honey on his gums. Keep doing it in car on the way there. Call ahead to let them know you are coming.

 

Hi Dawn! I agree with Melissa (@FrostD ) and think your best bet is to get him to an ER so they can monitor him and I'm sure they'll put him on a glucose drip.

You MAY be able to handle this at home, but I wouldn't risk Tiger's life by hoping he'll be OK

 

I also sent her a message on messenger hoping that's fastest way

 

I agree. This need a vet. It is too early in the cycle to manage a drop like this.

 

I'll get this updated tomorrow for you.
Yes, the vet bumps his 1U at a time and the most recent was 10/26. They want me to do a curve again and they will either bump again or try a different insulin. I am supposed to talk them again Monday morning.

 

Please go to the vet now. Take honey with you and rub it on his gums now.
Don’t delay

 

Unfortunately, I'm going to have to do this at home, I just don't have the money to rush him to the Animal Emergency. I've been rubbing honey on his gums. He isn't acting any different than he normally does, how soon should I test again? 30 min is our +3 hr after the injection.

 

I would test again now. And please post as we are concerned

 

If it's been 30 minutes since the 54, you need to retest now

 

Ok, I think I have a malfunction in my human meter. It kept saying invalid test strip then would give a low reading. It did that with the previous reading as well. I switched to the AlphaTrax and it came back quickly at 224

so, AlphaTrax readings: 154 at 9:45ish and 224 just now.

My heart is slowing starting to pound again....

 

You might want to apply to Care Credit. They offer 0% financing for a certain number of months (depends on the situation but at least 6 months). Another option is Scratch Pay which can also be used for emergencies but they work differently.

You can apply to Care Credit online and get an answer immediately. (and if you end up not needing it, you don't use it!)

 

Thanks! I'm going to do that.

 

I would still keep testing. Could you put the alphatrak meter readings in to to SS and mark as AT please. ,
Can you tell me when 9.45ish is in the + language and the just now + as well. I am in Australia and have no idea about your times or what they mean in how long after the dose it is….thanks

 

Sorry, yes. Still getting used to all the new language. I was just updating the spreadsheet (I was adding that into to the notes) The 9:45ish reading was PMPS. Now is +2.5hrs

 

Can you do another test to see what it is please?. I’m just concerned the 224 is not correct. Thanks

 

Ok, I just tested again with the AT and it is at 176. The human meter said 68 (with 2 errors prior to the reading). I did a control test prior to doing his reading with the AT, just to make sure and verified the code was correct for the test strips. I am so confused with these meters. I'll get a new human meter as soon as I get paid, I will try new batteries (again) and try to do a reset on it (it's been sitting for a couple of months since I don't need it anymore for myself). For now, I am going to continue using the AT.

He is eating his dry food, drinking, using the liter box and walking around as normally as he can. I decided to leave the dry food out tonight and start transitioning him tomorrow after my screw up with the injection. I will set my alarm several times throughout the rest of the night to check on him, but for now I have to go to bed. I have to be back at my computer in just a couple of hours for work (Thank goodness I get to work from home)

I plan to pull the food up when I get up in the morning, so I can get a fasting BG on him and post here before I do anything else.

I can't thank everyone enough for the help and guidance. I am so thankful for you guys! Before today, I would have just fed him, given his shot and not thought twice about it, not really knowing that I could have killed him any given night for the last 8 months......

 

I think a new meter is a good idea. If you live in the US the ReliOn PremierClassic is only 9$ with the 100test strips @17.88
I’m going to ask @Bandit's Mom to mark where you have swapped over. to the AT for now…..probably be in the morning when you have slept.
Yes I would definitely keep monitoring him as he hasn’t reached nadir yet and the honey wears off and he could drop again

 

The kibble is probably the main reason you haven't run into trouble before this. It really is the devil disguised as little round crunchy things.

 

what is nadir?

 

Nadir is the lowest point in the cycle before they start to go back up again.
Until then he could wobble up and down a bit.
So you need to make sure you have passed that before you can truely relax

 

Great job keeping him safe! Any update? Kind of obvious but you will need to reduce the dose going forward. With all the quick rise in dose it was too much.

Doses should be raised in 0.25-0.5 increments. If it were my cat I would go back to no more than 3 units, esp if you are lowering the carbs in the diet. and test consistently... Both preshots, and at least one mid cycle reading (if you're home) and a before bed test. If after several days it is not enough we could reevaluate the dose. This morning don't be surprised if the number is high from a bounce after going too low.

 

I think the prudent thing to do is assume the 54 was real. The next number could be explained by the carbs and honey, or him starting to bounce from the drop and lows.

If you don't get enough blood, sometimes the meters will give you a wonky reading vs an error. For now, aim for a drop of blood the size of a ball on a ballpoint pen (or the head of a pin). That should be enough.

I agree with Janet, we need to dose somewhere 3U or under. But right now I'm not comfortable recommending that until you can grab a variety of foods so if he drops we can bring him back up. We can always fast track him back up if the lower doses aren't working, but in 0.25-0.5U increments

What is your schedule like? What hours are you home and able to monitor?

If he's yellow this morning, I'd do 1U. Pink or higher, 2U. That way he at least gets some insulin. On a day you have the foods and can monitor all day, I'd like to try 3U.

Blue or lower, skip the shot.

 

Don't sweat it! Hes ok, that's what matters. I'd say about 85% of people come here with the exact same story as you - go to vet every 2 weeks, vet increases by a full unit, says oh don't bother changing diet or testing, then at some point something bad happens and that's usually when they end up here...sometimes when it's too late

It's fortuitous really that you just so happened to post yesterday and start testing last night! Possibly averted a very serious problem

 

Good Morning!! Tiger did fine the rest of last night, thank goodness. His current BG is 435 via AT. -- I'm waiting for response before I give insulin this morning @FrostD recommended above 2U.

I work a full time job, Mon - Fri, at home, so easy to monitor throughout the day. I also work a part time at night and on the weekends. The nights I work the part time job, I'm usually away for 5-6 hours, so no monitoring available.

 

Morning! I would do 2U and start with a +2. I don't expect anything drastic but need to start getting data about his patterns

 

ok, 2U in and I will test again in 2 hours.

 

+2 is at 406

 

Ok good. Grab a +5 and +9 if you can. He's going to stay high all day most likely because he's bouncing, but the +5 and +9 will help us pinpoint nadir and if he's coming down at all.

I didn't mention yesterday because of everything - but I suspect your curve days were done on bounce days where he stayed 300/400. Any data is good data, BUT you won't want to base dose decisions on a a single day of data, especially if it's a bounce day.

Over time what you want to do is grab different tests at different times. So one day grab a +2, +6, +10; next day a +1, +5, etc. The +2 is usually indicative of how the cycle will go (big drop, etc) but every cat is different so we have to figure out Tigers pattern.

 

I won't be able to get the +9 tonight, but the +5 shouldn't be a problem. The vet wants a 12 hr curve done tomorrow and I will work on getting more data as suggested. I will keep the spreadsheet updated as well.

It will be about 11:30 CST before I get home tonight. What guidelines should I follow for insulin doses?

 

It will depend on how today goes. He may stay high, he may come down into blue, don't know yet. Can you get a test right before you leave the house?

I won't be around at that time, but you can always post and ask for help. This thread is getting a little long so I would start a new one, tag everyone who commented in this thread.

If still pink/red, 2U again. I want to keep that dose until he breaks the bounce or you can stock up on food.

If yellow:
- if he was pink at +5 or your last test, that means he's dropping I to shot time and have to be careful. I would do maybe 0.5U.

- If he was yellow or lower at +5 or last test, it means BG is going up as it should, and I'd do 1U

 

I should note I am being very conservative here. Others may recommend slightly higher doses.

You are doing a curve at home tomorrow right, not going to the vet?

If he doesn't break the bounce, I'd actually wait to curve til Sunday if you can, that would be much more helpful to have data on a non-bounce cycle. You can either tell the vet everything that's happened, or just tell the vet something came up and you're doing it Sunday

 

yes, the curve is being done at home. I have to try to plan these curves around both of my jobs, but I can do it Monday or Thursday of next week as well. I'm pretty sure the vet won't even remember they told me to do one..

2 more questions before I start the new thread ... what is a bounce/bounce cycle? and how do I do a .5 dose on these tiny needles??

 

Bouncing is when they drop lower or faster than they're used to, and their liver dumps sugar into their body in a panic. It's not always predictable, and it's different for every cat. It's usually marked by a very big or fast drop, then BG shooting straight back up and staying up for a few cycles.

Ideally if they are at the right dose that doesn't happen much, but some cats are just bouncy. There are things you can do to help ease it, but that's a conversation for another time lol first we want to get him to a good dose with a nadir around 90.

I assume your syringes don't have half unit markings? We do recommend syringes with half units, but no need to go out and buy some, use up what you have first. If you're not sure, post a picture and we can tell you.

Just eyeball it to the best of your ability. The part of the plunger touching the liquid should be approximately halfway to the 1U line.

 

The needles box says:
U40
1/2 ml
29G x 1/2"

I can eyeball the .5 good enough, I believe.

New thread has also been started and I tagged everyone that has been very helpful so far! Thanks!!