04/19 Simon AMPS 331, +5 101, +6 88, +7 97, +9 203 PMPS 319

[Yvonne & Simon]

This is my first post ever on this Lantus forum so please bear with me.

Past history: https://www.felinediabetes.com/FDMB/threads/simon-very-labile-bg-dosing-suggestions-please.246231/

Synopsis: Hx IBD, started Budenoside Jan 2021. Vomiting ceased but unfortunately developed diabetes in March. Budesonide stopped, vomiting restarted, Chlorambucil started last week.

Diet: this cat is a terrible eater!!! Always has been. Confirmed, die hard kibble eater. Have tried very hard and unsuccessfully to transition to canned (did it for almost a year - he lost 2 lb from his normal 12 - vet said go back to kibble as he was going to starve self). He might take a tsp of canned at best. Have tried to keep to lower carb dry: Orijen, now Hills m/d from vet. Just bought Dr Elseys clean protein yesterday. Of course he refuses to touch it.
Have a bag of Young again on order.

Insulin: initially started on Toujeo by vet. Changed after 1 wk to Lantus. I am really scared of low BGs so was mucking around with insulin dose too much. With some encouragement from folks on this group, I have finally been trying to consistently stick to 1.5 U bid (approx past 4 days). BGs have been coming down fast.

He has given me a couple heart attacks the past couple days with the BGs dropping fast, almost into hypoglycemia range. The problem being that when this happens, he both hasn't eaten and steadfastly refuses to. I have had to force feed him a couple times now.

Sorry for long story here but just wanted to set the backstory.

For tonight, I am assuming I still give him the 1.5 units?
Do I worry about getting up in the middle of the night to test him tonight?
Are these fast drops eg like todays 331 to 112 in 3 hrs normal?
Argh!

Please let me know how to post this properly if this is way off.
Thanks!

 

[tiffmaxee]

Welcome to LLB. I’m not sure why you decreased yesterday with a 247 amps. That was safe to shoot. When you see a fast drop at the beginning of the cycle you will need to test later. If you see a lower bg at +2 it will likely require more tests. Until you get a sense of when to test post asking for help if you want to know when to test or stop testing.

 

[Yvonne & Simon]

Welcome to LLB. I’m not sure why you decreased yesterday with a 247 amps. That was safe to shoot. When you see a fast drop at the beginning of the cycle you will need to test later. If you see a lower bg at +2 it will likely require more tests. Until you get a sense of when to test post asking for help if you want to know when to test or stop testing.

I got chicken as his BG was lower than "normal" for him.
And had the scary episode with him two days prior where he started out low and ended up plummeting really fast into hypoglycemia zone (and he was acting hypoglycemic symptomatically so I ended up having to give him corn syrup because he of course refused to eat).

So I decreased the dose to 1, then rechecked in 1 hr, felt ok, and gave him the other 0.5 then. So he did get his 1.5 units, but just over an hour time period.

 

[tiffmaxee]

The

I got chicken as his BG was lower than "normal" for him. So I decreased dose to 1, then rechecked in 1 hr, felt ok, and gave him the other 0.5 then. So he did get his 1.5 units, but just over an hour time period.

Please don’t ever shoot twice again. You could end up with two nadirs. Also, if you ever think you gave if you a fur shot never shoot again either.

If the preshot is lower than usual, stall, don’t feed, and test again in 20-30 minutes. If too low, you either skip or shoot a token dose. With a 1.5 dose a token would be .25 or .50. Anything higher could still result in lower numbers that cycle. Being new it would have been fine to skip if under 150 which it was.

 

[Katherine&Ruby]

Hi Yvonne and welcome to the Lantus forum! I know how overwhelmed you feel right now but I promise it does get better. Just follow the advice of the good people here and you and Simon will be just fine. I'm glad you found us.

Firstly, it's super important that you are consistent with the dosing of Lantus. Giving the same dose twice in a 12 hour period allows the insulin to work and for you to see its effect on the cat. We have a mantra around here: Shoot low to stay low. Until Simon is more regulated, he will take deep dives from high numbers to lower ones. That's why testing is so crucial to keeping him safe. I would always get a test at +2 every night to see where he's headed for the night. If his +2 number is the same or higher than his preshot, you might have to be prepared for an active cycle. Since I'm at home most days, I try to get in 3-4 tests in the AM cycle and at least 2 tests in the PM before I go to bed in addition to the preshot tests. You're doing a fantastic job!

Secondly, I hear you on the finicky eating thing! I have a die hard kibble eater civvie in my house who has been on hunger strike for the last week because I've taken away her kibble cold turkey. She is a chronic vomiter though never diagnosed with IBD. I replaced the kibble with more canned food (she ate half canned/half kibble) and she refused to eat it. Recently I left her diabetic sister's raw food out and she went and cleaned the bowl! I feed Ruby boneless ground meat with EZ Complete. Now I have both kitties on raw food and there's very little vomiting from either of them. Have you ever thought of putting some raw food in front of Simon to see if he would like it? It might help soothe his IBD. Ruby possibly has IBD/SCL after a few ultrasounds but I wanted to treat it with a diet change before putting her on budesonide or chlorambucil and it seems to be working. The raw is super low in carbs and she loves eating it.

 

[Yvonne & Simon]

Secondly, I hear you on the finicky eating thing! I have a die hard kibble eater civvie in my house who has been on hunger strike for the last week because I've taken away her kibble cold turkey. She is a chronic vomiter though never diagnosed with IBD. I replaced the kibble with more canned food (she ate half canned/half kibble) and she refused to eat it. Recently I left her diabetic sister's raw food out and she went and cleaned the bowl! I feed Ruby boneless ground meat with EZ Complete. Now I have both kitties on raw food and there's very little vomiting from either of them. Have you ever thought of putting some raw food in front of Simon to see if he would like it? It might help soothe his IBD. Ruby possibly has IBD/SCL after a few ultrasounds but I wanted to treat it with a diet change before putting her on budesonide or chlorambucil and it seems to be working. The raw is super low in carbs and she loves eating it.

Thanks for your kind words. I indeed do feel very overwhelmed at present. I work in healthcare and am familiar with Diabetes from the other side (clinical dietitian) so have a good working knowledge of diabetes, insulin action, testing, as well as a healthy respect for both the issues associated with hyperglycemia, but more importantly how catastrophic hypoglycemia can be.
And with a very finicky fussy eater like Simon, I realize that the latter is a real possibility with him and it is very much an ongoing concern with me. I truly don't know if I am up to cutting it so close to the line with him, and having him potentially be on the verge of low blood sugars in order to be "well controlled". Remission would be nice to achieve, but not sure how feasible it is for him. I am also trying to be realistic that he is a 15 yr old cat with other chronic health issues.

Re feeding raw
I literally have tried every single feeding regimen with this cat. I have tried homemade food, raw food, people food, probably 100's of canned cat foods, sprinkling it with fortiflora etc. I fought with him for an entire year over this issue. He lost 2 lbs and ended up being a bone rack. The vet ultimately told me to give up and go back to dry because he is obviously one of those cats who would rather starve than eat anything but his kibble. And even with that, he just picks at it. He is just an awful eater. It is totally stressful.
Ironic as providing good nutrition is what I do for a living...

I honestly think his poor intake may end up determining the direction of where this all goes. I don't know that I am up to constantly watching him like a hawk and "hoping" each day that he is going to eat enough to remain stable and not become hypoglycemic.

Years ago, I had a very beloved cat in a similar situation (not diabetic but had CKD and was also a very poor eater) who I went down the path of having to force feed, and I swore I would never do that again. One day, that cat literally starting crying (with tears streaming down his face) when I came at him with a syringe, and it just totally broke my heart. I just can't go there again.

 

[Yvonne & Simon]

His PMPS was 319 (17.7). Now I am not sure what to do...