10/19 - Freya still struggling to get regulated

[Tim & Freya]

Previous Thread

It's been a couple months since I posted and wanted to give an update for Freya. We've slowly tapered her up to 2U daily. Last week she had a couple of days where her curves were looking good, and I was hoping we were finally getting somewhere. But since then, she's back to being inconsistent. Her vet even said she's the most difficult one she's had to get regulated.

She's strictly getting low carb food (Pates/Dr Elsey's CleanProtein for crunchies). She just won't eat very much and she keeps losing weight. Before her diagnosis she was at 12lb and as of last week she's down to almost 9.5lbs, which is really concerning me. She's actually reduced her trips to the litter box the past couple weeks but has had a couple of incidents of wetting herself while she sleeps. Twice in the last two weeks she's also vomited, but it was entirely water/saliva.

She's been on the 2U dose for almost two weeks now, I'm going to keep her at that for at least a few more weeks to see if she starts normalizing. I'm afraid to go any higher since she did actually dip down to the low end of normal last week. You'll note on her spreadsheet I attached a Libre 10/6, but it basically read 400 for the entire time. I did checks with the AlphaTrak before each dose and comparing the readings decided I didn't trust what the Libre was showing, so took it off and didn't put down the numbers from it.

The vet contacted an internist and they were suggesting to possibly switch to IDeg, but reading up on that it doesn't seem to have a lot of clinical studies for cats. It also seems to have an unknown length of effect, and the dosing could be anywhere between 18-24 hours depending on the cat's metabolism. For the moment I'm more comfortable staying on the Lantus and holding at this dose for several weeks to see how she does.

My main concern right now is her weight loss, and whether I should just feed her whatever she will eat, even if it's higher carb to get her weight stable.

 

[Connie & Parker & Moonie]

Previous Thread

It's been a couple months since I posted and wanted to give an update for Freya. We've slowly tapered her up to 2U daily. Last week she had a couple of days where her curves were looking good, and I was hoping we were finally getting somewhere. But since then, she's back to being inconsistent. Her vet even said she's the most difficult one she's had to get regulated.

She's strictly getting low carb food (Pates/Dr Elsey's CleanProtein for crunchies). She just won't eat very much and she keeps losing weight. Before her diagnosis she was at 12lb and as of last week she's down to almost 9.5lbs, which is really concerning me. She's actually reduced her trips to the litter box the past couple weeks but has had a couple of incidents of wetting herself while she sleeps. Twice in the last two weeks she's also vomited, but it was entirely water/saliva.

She's been on the 2U dose for almost two weeks now, I'm going to keep her at that for at least a few more weeks to see if she starts normalizing. I'm afraid to go any higher since she did actually dip down to the low end of normal last week. You'll note on her spreadsheet I attached a Libre 10/6, but it basically read 400 for the entire time. I did checks with the AlphaTrak before each dose and comparing the readings decided I didn't trust what the Libre was showing, so took it off and didn't put down the numbers from it.

The vet contacted an internist and they were suggesting to possibly switch to IDeg, but reading up on that it doesn't seem to have a lot of clinical studies for cats. It also seems to have an unknown length of effect, and the dosing could be anywhere between 18-24 hours depending on the cat's metabolism. For the moment I'm more comfortable staying on the Lantus and holding at this dose for several weeks to see how she does.

My main concern right now is her weight loss, and whether I should just feed her whatever she will eat, even if it's higher carb to get her weight stable.

Sorry to hear that Freya's been losing weight. Do you think she feels unwell or that she just doesn't like the food? Moonie was losing weight on pates because she hated the texture (though in Moonie's case, we have the opposite problem with weight so it wasn't as big of an issue). There are LC shredded or even gravy options if Freya prefers those textures. If she likes gravy, the Weruva OMG Gravy lines are amazing and they publish % carbs on their website. Personally, if it were my cat, I'd rather feed slightly higher carb (even getting up to 10%) and just shoot more insulin than worry about them losing too much weight.

If you think it's not about the food, you may want to consider anti-nausea meds like ondansetron or appetite stimulants like mirtazapine.

Finally - I don't give dosing advice, but I will say cats' insulin needs can change and you may want to get someone experienced to review Freya's SS and dose. What gave Freya a lower than 90 number last week may be lower than what she needs today, and she's run high for about a week now on this dose. We had the same issue a few days back where I had to increase from a dose that gave her a lime the previous week, and it really freaked me out at first. It's always a moving target with feline diabetes!

 

[Staci & Ivy]

Previous Thread

It's been a couple months since I posted and wanted to give an update for Freya. We've slowly tapered her up to 2U daily. Last week she had a couple of days where her curves were looking good, and I was hoping we were finally getting somewhere. But since then, she's back to being inconsistent. Her vet even said she's the most difficult one she's had to get regulated.

She's strictly getting low carb food (Pates/Dr Elsey's CleanProtein for crunchies). She just won't eat very much and she keeps losing weight. Before her diagnosis she was at 12lb and as of last week she's down to almost 9.5lbs, which is really concerning me. She's actually reduced her trips to the litter box the past couple weeks but has had a couple of incidents of wetting herself while she sleeps. Twice in the last two weeks she's also vomited, but it was entirely water/saliva.

She's been on the 2U dose for almost two weeks now, I'm going to keep her at that for at least a few more weeks to see if she starts normalizing. I'm afraid to go any higher since she did actually dip down to the low end of normal last week. You'll note on her spreadsheet I attached a Libre 10/6, but it basically read 400 for the entire time. I did checks with the AlphaTrak before each dose and comparing the readings decided I didn't trust what the Libre was showing, so took it off and didn't put down the numbers from it.

The vet contacted an internist and they were suggesting to possibly switch to IDeg, but reading up on that it doesn't seem to have a lot of clinical studies for cats. It also seems to have an unknown length of effect, and the dosing could be anywhere between 18-24 hours depending on the cat's metabolism. For the moment I'm more comfortable staying on the Lantus and holding at this dose for several weeks to see how she does.

My main concern right now is her weight loss, and whether I should just feed her whatever she will eat, even if it's higher carb to get her weight stable.

Hi Tim, it looks like she could use more insulin (although I don't give dosing advice). She's spending most of her time in higher numbers (300's).
It's good her peeing has gotten better.

You will want to increase her calories, not necessarily her carbs to have her eat more (unless she will just eat more of that food)
Has Freya had labwork lately?
Has she been tested for hyperthyroid (checked her T4 level) or has she had pancreatitis (can cause them to not feel well and not want to eat)?

Mirataz (transdermal ear med) can help with appetite stimulation, but you want to make sure she's not nauseated before you give that (with giving ondansetron can help with naseau) if needed.

Just some things to discuss with your vet.
Let us know if you have more info or questions.
Hope she eats better for you!!

 

[Wendy&Neko]

When is the last time Freya had blood work done? Vomiting water/saliva, if it's tinged yellow could be bile, possibly acid tummy. Kidney issues are another thing to be investigated, on top of what is mentioned above.

Like the others, I can see that Freya could use a dose increase. One of the side effects of hyperglycemia is not being able to get insulin into her cells and thus not able to absorb her nutrition. Meaning, weight loss. The day she went lower was a vomit day, lower calories might have impacted her blood sugars. SLGS is our more conservative dosing method and it says to increase after a week if nadirs (plural) are not in the 90-149 range.

Regarding food, does she show any preference for wet vs dry? Have you tried some of the low carb shredded or chunky foods? How about trying toppers like crumbled freeze dried chicken breast, or other meat.

 

[Tim & Freya]

When is the last time Freya had blood work done? Vomiting water/saliva, if it's tinged yellow could be bile, possibly acid tummy. Kidney issues are another thing to be investigated, on top of what is mentioned above.

Like the others, I can see that Freya could use a dose increase. One of the side effects of hyperglycemia is not being able to get insulin into her cells and thus not able to absorb her nutrition. Meaning, weight loss. The day she went lower was a vomit day, lower calories might have impacted her blood sugars. SLGS is our more conservative dosing method and it says to increase after a week if nadirs (plural) are not in the 90-149 range.

Regarding food, does she show any preference for wet vs dry? Have you tried some of the low carb shredded or chunky foods? How about trying toppers like crumbled freeze dried chicken breast, or other meat.

Thanks everyone for the replies.

For food, I've literally tried every possible low carb wet food I can find, and she simply doesn't love any of them. The Fancy Feast Gourmet Naturals Beef in Gravy (~7.8% carbs) and the Purina One High Protein Tuna (~6.6%) seemed like winners for a while, but she seems to have turned off them now. She doesn't seem to like the pate texture so that's difficult as well. Freeze dried treats are a no also. Just to make sure it wasn't a nausea issue, I had her try the old Royal Canin last night and she scarfed it down. It's super high carbs though and her pre-shot reading this morning was the highest yet (586).

She does like both dry and wet, and she will eat the Dr Elsey's at least. Just not enough of it to keep her weight up, I think.

The vomit was entirely clear and was right after she had drunk some water.

It's been a little over a month since her last bloodwork. Kidney values were all good, thyroid was good. The vet did think she had some pancreatitis readings which is why we skipped bexacat, though she doesn't seem to have any sensitivity when palpitating her stomach area.

I'm thinking I'll give her until end of this week to see if numbers come down before increasing more. It's been really difficult. The readings are just all over the place and I can't make any correlation to how her body will respond each day. Like when her numbers go up during the cycle after a dose, it makes me question whether the injection worked at all.

 

[Wendy&Neko]

When things happen that could impact her BG, like her getting some high carb dry, might be worth noting in the Remarks section so you can see any correlation. It's also possible she hit the blues last night and is bouncing on top of it all today.

Pancreatitis could explain some of her lack of interest in new food. Whenever my last kitty had a pancreatitis episode she would eat the junk food. Typically pancreatitis can benefit from anti nausea meds and pain relief. A Primer on Pancreatitis

Like when her numbers go up during the cycle after a dose, it makes me question whether the injection worked at all.

Or she's bouncing, like the PM of 10/13. It's a good idea to sniff the injection site if you think there might have been a "fur shot" or miss. If you do a fur shot, it's worth noting on the spreadsheet. Lantus is a depot style insulin and fur or missed or reduced shots all impact the depot and hence what the BG numbers will look like.

Once she gets closer to a better dose, her numbers will be less "all over the place". By the way, that is the #1 most common phrase from people with recently diagnosed cats. Very common.

 

[Clarice & Mami Cat]

One of the side effects of hyperglycemia is not being able to get insulin into her cells and thus not able to absorb her nutrition. Meaning, weight loss.

There are LC shredded or even gravy options if Freya prefers those textures. If she likes gravy, the Weruva OMG Gravy lines are amazing and they publish % carbs on their website. Personally, if it were my cat, I'd rather feed slightly higher carb (even getting up to 10%) and just shoot more insulin than worry about them losing too much weight.

Like the others, I can see that Freya could use a dose increase.

Hi Tim, just as Connie mentioned above, there are some LC wet food options with a higher carb content. They’re still LC, just not as low in carbs. If you can find a texture and “style” of wet food that she likes, that might help her maintain her weight. I think it is a game changer to find a wet food they like, even if a bit higher in carbs: it is important for the cat and to our peace of mind.

When blood glucose levels are extremely high, glucose can’t be properly used by the cells. Even if the cat eats a lot, she can remain extremely skinny (and often hungry and uncomfortable). It was the case with mine, for example.

Finding the right dose and providing adequate nutrition go hand in hand.

For the moment I'm more comfortable staying on the Lantus and holding at this dose for several weeks to see how she does.

The experienced ones here will guide you and explain why it might not be needed to hold the same dose for several weeks, in case the dose is not suitable for her at a certain moment.

After some time, it tends to get better, though. And you start to understand her patterns, bouncing and other details.

Good that you prefer to continue with Lantus, in my personal opinion.

I hope Freya can feel more comfortable soon.