18/1 What to do...

Trace248

Trace248

Member Since 2021
Hi Everyone! My name is Tracey and I have a diabetic cat called Nacho. He is obviously a big ginger boy as you can tell from the name haha! My question is regarding resetting his insulin. He was diagnosed November 2019 with a very high blood sugar of 35. The vets actually couldn't test his blood using their machine and had to send it away. It had a distinct white layer of fat on the top and the blood looked more pink than red. After initial diagnosis and being in the clinic for 3 days to get him stable, we originally had him on 2.5 units as per the vets instructions. We sporadically tested him at the vets and his insulin was increased slowly by them from 2.5, then 3, then 4, then 5 and then 6 units. This was over a 6 month period with no home testing, as they didn't really suggest it to me. Since then, I have bought a Alphatrak and test him at home. Last year however was the turning point for me to investigate other ideas, hence why I am here. His blood measured 2.8 one evening just before his shot, so I rang the vet and they said to still give him his shot, but reduce it to 5 units. Recently a similar situation of 6.5 before his nightly shot and I rang as I was worried. Also given the advice to still give him 5 units. Looking back I'm surprised I didn't kill him! I am currently resetting his insulin and we have dropped his insulin to 3 units. His bloods are high but steady but sitting around the 24 mark. I guess my question is should I do a complete reset to 1 unit and try the slow approach to see if we have in fact gone over his threshold too early on. Help!
 
Hi Tracey & Nacho, welcome to FDMB!

I have a few questions for you so we can advise you correctly!
(a) What are you feeding Nacho?
(b) Which insulin is he on?
(c) Why was he in the clinic for 3 days? This was in Nov 2019?
(d) Does he have any history of ketones? Do you check for them? Any Diabetic Ketoacidosis (DKA)?
(e) Any other health issues or medication he is on?

Since you have been home testing and have BG data for him, do you have a spreadsheet? If not, could you set up one as per the instructions below. I can set it up for you if you'd like.
We are pretty data driven here!
http://felinediabetes.com/FDMB/thre...te-a-ss-and-link-it-in-your-signature.130337/

We can't tell without looking at the BG number, but it looks like Nacho could be going quite low and "bouncing" from those low numbers. Bouncing is simply a natural reaction to what the cat's system perceives as a BG value that is "too low" or to an actual low number. "Too low" is relative. If a cat is used to BGs in the 200's, 300's, or higher for a long time, then even a BG that drops to 150 can trigger a "bounce". Bouncing can also be triggered if the blood glucose drops too low and/or too fast. The pancreas, then the liver, release glucogon, glycogen and counter-regulatory hormones. The end result is a dumping of "sugar" into the bloodstream to save the cat from going hypoglycemic from a perceived (or actual) low.

Welcome again and I'm glad you found us! :-)
 
Welcome Tracey and Nacho. Bhooma has asked you lots of questions so I won’t add to it. I would not reset to 1 unit until we see at least the last few weeks of bg readings. E are very data oriented here. I can tell you that younhave come to the best place fr a diabetic cat and caregiver. We will do all we can to help you.
 
Bandit's Mom said:
Hi Tracey & Nacho, welcome to FDMB!

I have a few questions for you so we can advise you correctly!
(a) What are you feeding Nacho? - Nacho is on a raw balanced wet food diet, high protein, low carb

(b) Which insulin is he on? - He is on Lantus

(c) Why was he in the clinic for 3 days? This was in Nov 2019? - He was at the vets to stabilise him after his initial diagnosis with his blood sugar so high

(d) Does he have any history of ketones? Do you check for them? Any Diabetic Ketoacidosis (DKA)? - No history of ketones, I try and catch him when he is weeing and shove a test strip under his bum

(e) Any other health issues or medication he is on? - no other health conditions that we are aware of, but he is on 2.5 mg Clomav for inappropriate urination and marking

I do have a spreadsheet on google you may be able to access if I share the link:

https://docs.google.com/spreadsheets/d/1vkjbshw5QwoCRNnkNyH3QHlC7NZhJ426M5EOKESrqrw/edit?usp=sharing

http://felinediabetes.com/FDMB/thre...te-a-ss-and-link-it-in-your-signature.130337/

He is very high not low... I am in Australia so I apologise for the numbers thing... 25 is approximately 400 in US terms I think



We can't tell without looking at the BG number, but it looks like Nacho could be going quite low and "bouncing" from those low numbers. Bouncing is simply a natural reaction to what the cat's system perceives as a BG value that is "too low" or to an actual low number. "Too low" is relative. If a cat is used to BGs in the 200's, 300's, or higher for a long time, then even a BG that drops to 150 can trigger a "bounce". Bouncing can also be triggered if the blood glucose drops too low and/or too fast. The pancreas, then the liver, release glucogon, glycogen and counter-regulatory hormones. The end result is a dumping of "sugar" into the bloodstream to save the cat from going hypoglycemic from a perceived (or actual) low.

Welcome again and I'm glad you found us! :)
Click to expand...
Hi
 
https://docs.google.com/spreadsheets/d/1vkjbshw5QwoCRNnkNyH3QHlC7NZhJ426M5EOKESrqrw/edit?usp=sharing

Nacho is on a raw balanced wet food diet, high protein, low carb
He is on Lantus
He was at the vets to stabilise him after his initial diagnosis with his blood sugar so high
No history of ketones, I try and catch him when he is weeing and shove a test strip under his bum
no other health conditions that we are aware of, but he is on 2.5 mg Clomav for inappropriate urination and marking
He is very high not low... I am in Australia so I apologise for the numbers thing... 25 is approximately 400 in US terms I think
 
I can see your answers and your spreadsheet. It’s not ours. Do you need help setting ours up? @Bandit's Mom can help. You have lots of testing to that’s great. Our spreadsheet allows us t go from world to US measurements. Our dosing methods are different as well. Would you have a look and see which one you might choose to follow please?
 
Trace248 said:
Sorry I may have posted the answers in the wrong spot... new to forums haha
Click to expand...
That's perfectly alright! :-)

Your SS is not in our format, so I'm going to change it for you. Can you PM me your google ID so that I can link the new SS to that?


And, could you please set-up a Signature?

On the left, under Settings, Click on Signature. This is where you will put information that helps us give you feedback.
  • There is a limit of two lines which may include two links; you may separate pieces with commas, dashes, | etc. This is where you paste the link for your spreadsheet, once it is set up.
  • Add any other text, such as
  • Caregiver & kitty's name (optional)
  • DX: Date
  • Name of Insulin
  • Name of your meter
  • Diet: "LC wet" or "dry food" or "combo"
  • Dosing: TR or SLGS or Custom (if applicable)
  • DKA or other recent health issue (if applicable)
  • Acro, IAA, or Cushings (if applicable)
  • Spreadsheet link. Please put the signature link on the bottom line of your signature information, on its own, so it is easy to find.
  • Please do not put any information about your location in the signature for security reasons. If you wish to add your country location, please add it to your profile.

I'm tagging @Bron and Sheba (GA) one of our experienced members in Australia and here's link with information for caregivers in Australia
https://www.felinediabetes.com/FDMB...for-aussie-feline-diabetic-caregivers.217781/
 
Trace248 said:
I have no idea where my google id is... and where do I do a signature? On this page or the spreadsheet?
Click to expand...

Your google ID or Gmail ID that you used to set-up and access the spreadsheet?

Also, on the signature, you put the date he was diagnosed so that would be Nov 2019 :-)
 
He's not really responding to the 3 units.... staying high and flat. Just tested him now (1pm) and his is still 24.4.. I just wonder if resetting him to 1 will see it he is actually on too much or too little
 
Trace248 said:
His blood measured 2.8 one evening just before his shot, so I rang the vet and they said to still give him his shot, but reduce it to 5 units. Recently a similar situation of 6.5 before his nightly shot and I rang as I was worried. Also given the advice to still give him 5 units.
Click to expand...
I don't see these readings on the SS?
 
As you can see on the 8th of this month his bloods were pretty good and then peaked just before dinner. I was wondering about the possibility of the Somogyi effect and that is why I have been reducing his insulin with help from the feline diabetes support group on Facebook. I really want as many opinions and help as I can get.... I really want to get him well!
 
Hi Trace,
I live in Sydney.......
Looking at Nacho’s SS I would not reduce the dose.

Trace248 said:
As you can see on the 8th of this month his bloods were pretty good and then peaked just before dinner. I was wondering about the possibility of the Somogyi effect and that is why I have been reducing his insulin with help from the feline diabetes support group on Facebook. I really want as many opinions and help as I can get.... I really want to get him well!
Click to expand...
Reducing the dose and resetting it is not a good idea and rarely is the problem...it will just make him pee more and drink more and you will get further behind in trying to regulate him..
I know there is another group that suggests ‘resetting’ but I would not recommend that.
It is going to be hard to help you if you are listening to two different groups who are giving you different advice. You need to decide which one you trust more.

There is no such thing as the somogyi effect in cats. It was something that was around in the 1930s and was never proven but is still referred to. There is bouncing where the cat will react from a fast drop in blood glucose, too big a drop or a drop lower than he is used to and he will dump stored glucose and regulatory hormones into the system which sends up the BG and that’s is called bouncing. Bouncing can last for up to 6 cycles. Once a cat is bouncing, you have to sit and wait for the bounce to finish. Giving more insulin does not help.
The only way we can see if your boy is bouncing is to see data from both cycles.
Can you get some tests in during the PM cycles, do you think? At the moment we have no data at all for 1/2 the story. We don’t know if he might be dropping low overnight and bouncing up during the day.

On the 8th of this month, when you said he had a pretty good cycle, you were giving him 5 units. Then you reduced the dose to 2.5 (which is half of what you were giving). What happens when you do that is Nacho will pee more and drink more and take even longer to get to his best dose. He has probably developed some insulin resistance after dropping the dose that much and you may have to go even higher again to get him responding to the insulin. But all is not lost..........
If I were you I would look at the two dosing methods we have here.....Tight Regulation (TR) and Start Low Go Slow (SLGS) and see which one suits you better
https://www.felinediabetes.com/FDMB...-low-go-slow-slgs-tight-regulation-tr.210110/

Then follow the dosing method that you choose and you will get results.
How often are you feeding him? Are you giving him snacks during the cycle as well as before the doses?
Keep asking questions, we are happy to help you. I know how confusing and overwhelming this can be, especially in the beginning but you have honestly come to the best possible place here to help Nacho. We have very experienced people here to help you.
If there is anything I can help you with that is specific to Australia as well as anything else, just let me know......great to have another Aussie!
Bron
https://www.felinediabetes.com/FDMB...-low-go-slow-slgs-tight-regulation-tr.210110/
 
Bron and Sheba (GA) said:
Hi Trace,
I live in Sydney.......
Looking at Nacho’s SS I would not reduce the dose.


Reducing the dose and resetting it is not a good idea and rarely is the problem...it will just make him pee more and drink more and you will get further behind in trying to regulate him..
I know there is another group that suggests ‘resetting’ but I would not recommend that.
It is going to be hard to help you if you are listening to two different groups who are giving you different advice. You need to decide which one you trust more.

There is no such thing as the somogyi effect in cats. It was something that was around in the 1930s and was never proven but is still referred to. There is bouncing where the cat will react from a fast drop in blood glucose, too big a drop or a drop lower than he is used to and he will dump stored glucose and regulatory hormones into the system which sends up the BG and that’s is called bouncing. Bouncing can last for up to 6 cycles. Once a cat is bouncing, you have to sit and wait for the bounce to finish. Giving more insulin does not help.
The only way we can see if your boy is bouncing is to see data from both cycles.
Can you get some tests in during the PM cycles, do you think? At the moment we have no data at all for 1/2 the story. We don’t know if he might be dropping low overnight and bouncing up during the day.

On the 8th of this month, when you said he had a pretty good cycle, you were giving him 5 units. Then you reduced the dose to 2.5 (which is half of what you were giving). What happens when you do that is Nacho will pee more and drink more and take even longer to get to his best dose. He has probably developed some insulin resistance after dropping the dose that much and you may have to go even higher again to get him responding to the insulin. But all is not lost..........
If I were you I would look at the two dosing methods we have here.....Tight Regulation (TR) and Start Low Go Slow (SLGS) and see which one suits you better
https://www.felinediabetes.com/FDMB...-low-go-slow-slgs-tight-regulation-tr.210110/

Then follow the dosing method that you choose and you will get results.
How often are you feeding him? Are you giving him snacks during the cycle as well as before the doses?
Keep asking questions, we are happy to help you. I know how confusing and overwhelming this can be, especially in the beginning but you have honestly come to the best possible place here to help Nacho. We have very experienced people here to help you.
If there is anything I can help you with that is specific to Australia as well as anything else, just let me know......great to have another Aussie!
Bron
Click to expand...
 
Hi Bron,
I guess I am concerned with Nacho's insulin being so much. Every time I say he is on 5 unit (he was on 6) people seem to freak out and I wonder whether his ideal threshold is in fact lower. I am so confused. I have seen good results with the reset thing in other cats so I guess I am willing to try anything tobhelp him. The reason I am worried it is too high is that it is so unregulated. My concern is that if he is too low and I give him such a high dose I could kill him. How do I know if the high dose wasn't making him bounce at the end of the day because it was too much. I feel like the vets went up to quickly with his insulin and that maybe that skipped the sweet point and now his body is reacring to the high insulin doses. My stomach is churning with fear I have done the wrong thing :-(
 
Hello and welcome.
Trace248 said:
I guess I am concerned with Nacho's insulin being so much. Every time I say he is on 5 unit (he was on 6) people seem to freak out and I wonder whether his ideal threshold is in fact lower.
Click to expand...
A cat needs however much insulin they need. I can show you plenty of spreadsheets of cats regulated on much higher doses. My girl got to 8.75 units. That same group that told you to reset doesn't like high doses, but I can tell Nacho's dose of 3 units is far too low. Are you testing regularly for ketones? That is a real danger if you lower the dose and he needs more.
 
Wendy&Neko said:
Hello and welcome.

A cat needs however much insulin they need. I can show you plenty of spreadsheets of cats regulated on much higher doses. My girl got to 8.75 units. That same group that told you to reset doesn't like high doses, but I can tell Nacho's dose of 3 units is far too low. Are you testing regularly for ketones? That is a real danger if you lower the dose and he needs more.
Click to expand...
And yes I test for ketones but sporadically... no problem so far.
 
Trace248 said:
And yes I test for ketones but sporadically... no problem so far.
Click to expand...
I would test everyday for ketones while Nacho is in high numbers and you have dropped the dose. It’s much easier to treat ketones if caught early than have to deal with high ketones or DKA.
Put the results of the ketones test in the remarks column of Nachos SS we can see please.
 
Trace248 said:
Hi Bron,
I guess I am concerned with Nacho's insulin being so much. Every time I say he is on 5 unit (he was on 6) people seem to freak out and I wonder whether his ideal threshold is in fact lower. I am so confused. I have seen good results with the reset thing in other cats so I guess I am willing to try anything tobhelp him. The reason I am worried it is too high is that it is so unregulated. My concern is that if he is too low and I give him such a high dose I could kill him. How do I know if the high dose wasn't making him bounce at the end of th day because it was too much. I feel like the vets went up to quickly with his insulin and that maybe that skipped the sweet point and now his body is reacring to the high insulin doses. My stomach is churning with fear I have done the wrong thing :-(
Click to expand...
Wendy is correct. A cat needs as much insulin as it needs. My Sheba was on around 6 units of insulin. I went up methodically with the dose so I knew I was safe.
As long as you are testing before every shot and during the cycles and go up in 1/4 unit increments Nacho will be fine. The reason we test during the cycles is to see how low the dose is taking our kitties. Lantus dosing is based on the nadir...or lowest point of the cycle.

Have a look at the two dosing methods I mentioned. If you are only feeding raw or canned wet food you can do the TR as long as you are willing to test both cycles. If you are feeding dry, you have to do SLGS method. If I were you I would do the TR so you can get him up into a better dose more quickly.
 
Bron and Sheba (GA) said:
I would test everyday for ketones while Nacho is in high numbers and you have dropped the dose. It’s much easier to treat ketones if caught early than have to deal with high ketones or DKA.
Put the results of the ketones test in the remarks column of Nachos SS we can see please.
Click to expand...

I have added a column for ketones to the left of Remarks. Enter in the World tab and it will pick up in the US tab as well.
 
Bandit's Mom said:
I have added a column for ketones to the left of Remarks. Enter in the World tab and it will pick up in the US tab as well.
Click to expand...
How do I report the ketones in the new colomn if I am using the urine sticks? Just with the 0 or the number on the chart? :-)
 
Wendy&Neko said:
Hello and welcome.

A cat needs however much insulin they need. I can show you plenty of spreadsheets of cats regulated on much higher doses. My girl got to 8.75 units. That same group that told you to reset doesn't like high doses, but I can tell Nacho's dose of 3 units is far too low. Are you testing regularly for ketones? That is a real danger if you lower the dose and he needs more.
Click to expand...
Wendy would you suggest I increase the dose by 0.5 units and hold for a few days?
 
Wendy&Neko said:
Hello and welcome.

A cat needs however much insulin they need. I can show you plenty of spreadsheets of cats regulated on much higher doses. My girl got to 8.75 units. That same group that told you to reset doesn't like high doses, but I can tell Nacho's dose of 3 units is far too low. Are you testing regularly for ketones? That is a real danger if you lower the dose and he needs more.
Click to expand...
I just thought his results on the 8th were weird, he was still dropping in the afternoon and then jumped from 12.9 to 21.8. This is why I thought he might have been bouncing due to too much insulin. Hence the reason I spoke to others and decided to reset to a lower number......
 
Wendy may not be online atm so I can help you Tracey and I know your PMPS is in a few minutes
I would increase to 3.5 units as the nadirs are over 300. Can you get a+3 and 5 test in tonight?
Hold the dose for 6 cycles unless Nacho drops low.

Have you had a chance to have a look at the two dosing methods yet?
 
I will try and get a 3 + and a 5+ (midnight wrangling haha) and I do think 3.5 is a good idea. I think the low and slow is probably the best but I will read it again. What do you think is the best plan of attack?
 
Trace248 said:
I will try and get a 3 + and a 5+ (midnight wrangling haha) and I do think 3.5 is a good idea. I think the low and slow is probably the best but I will read it again. What do you think is the best plan of attack?
Click to expand...
Do you work from home?
If you are able to get at least one test in during the pm cycle and some during the day I would go with the TR as you want to get Nacho back down to better numbers quicker.
You can always swap back to the slower method once you are on better numbers if you want.
 
Trace248 said:
Ahahaaaaaa I found it! Yes I agree with the insulin increase and trying this first
Click to expand...

3.5 units
Normally we go up in 1/4 unit increments but if the nadir is more than 300 we increase by 0.5 units

I think TR is the way to go especially if you are working from home and can be there most of the time. It will be better for Nacho
So the idea of the Lantus forum is to post each day. This is because a lot of people post and the posts would get too long if we didn’t do a new one each day.
So you put date, name.[Nacho] and the AMPS and a question if you like
 
Bron and Sheba (GA) said:
3.5 units
Normally we go up in 1/4 unit increments but if the nadir is more than 300 we increase by 0.5 units

I think TR is the way to go especially if you are working from home and can be there most of the time. It will be better for Nacho
So the idea of the Lantus forum is to post each day. This is because a lot of people post and the posts would get too long if we didn’t do a new one each day.
So you put date, name.[Nacho] and the AMPS and a question if you like
Click to expand...
Sounds great. I feel a lot more confident in this group and the information I'm getting. Thank you so much Bron xx
 
Be sure to get tests in both cycles. He might be going low at night and bouncing in the day. Just one before bed test every night is good. :)
 
Probably too late now, but I would have increased back closer to where you were getting blues. No matter, if you can get at least the two preshots plus two other tests per day, we can get you increasing every three days. And you'll have more confidence you aren't bypassing a good dose.
 
Wendy&Neko said:
Probably too late now, but I would have increased back closer to where you were getting blues. No matter, if you can get at least the two preshots plus two other tests per day, we can get you increasing every three days. And you'll have more confidence you aren't bypassing a good dose.
Click to expand...
I did wonder about increasing more and was hoping you were around to comment but knew Tracey was shooting at 7 pm our time.
 
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