? 2/10 Sebastian AMPS 372 +3 364. 7.5u, how much is too much?

Justin & Sebastian

Justin & Sebastian

Member Since 2019
First, I'm hoping the numbers from yesterday were the bounce? Just started the TR protocol and yesterday was his first increase.

Second, asking again from yesterday, hoping some with high dosage experience can help me out. How much is too much?

Third, can anyone explain the actual relationship between dosage and BG numbers? Until now I've been viewing it as an inverse-ratio system, eg. lower dosage = higher BG, higher dosage = lower BG. However, the fact that when looking at Sebastian's history the BG numbers are about the same whether it's been 3u, 4u, 5u, or 7u kinda debunks that theory. So now I'm starting to wonder if it's a "threshold" system, where once we find the magic number the BG will start coming down but anything below that is going to look more or less the same?

Basically just feeling discouraged that we're not seeing any improvement and wondering if it's just never gonna change and his days are numbered or if there's a light at the end of the tunnel.
 
Hi Mr F and Sebastian,

Just popping in for a quick hello, I'm reading through your previous posts and will post some of my thoughts in just a bit, I have to go feed the crew so it may be a little while, but I'll get back to you.
Just wanted to say hi first.
:bighug::bighug::bighug::bighug:
 
I will let others weigh in but looking at the ss there isn't enough data and what is there is inconsistent.

What insulin are you using? There was a large increase in dosage which might have gone past the optimal dose, to much insulin can also look like not enough insulin. Normally dose in raised 0.25 units at a time.

If your feeding the DM dry as stated in your signature that is very high in carbs and will require more insulin and more than likely glucose will never be in normal ranges.

There are high dose conditions, I don't know if you have had any testing done, but I think trying other things first should be considered.
 
Lantus insulin. There was a large increase. I had him on 7 units for years with no issues. New vet made us drop down to 3 and then we started having problems. After them being unhelpful for so long and his health continuing to decline, I put him back at 7 and while his numbers haven't changed, he looks better and has more energy.

He is on DM dry, I've tried mixing in some wet but he doesn't really take to it. And with his weight loss and DKA history I'm hesitant to attempt a diet change right now. We tried a couple weeks ago and his weight dropped even more and we started seeing trace ketones so switched back to primarily dry. He's currently about 2lbs underweight.

So at this point I'm not sure what to try. Do we progress down from 7 and see what happens? Or do we continue going up? What would be the high dose conditions to test for? He's got a vet apt on Thursday so I can get any necessary tests done then.
 
The weight loss could also be because glucoses are still to high so he isn't metabolising properly.

There is Dr Elsey dry food that is 4-6% carbs, you might consider it and Young Again dry food. Those are the only 2 dry foods suitable for diabetics. Both companies will send samples.

High dose conditions to name a few are IGF-1 (growth hormone for Acromegaly, my Olive has it) and IAA which is insulin resistance. MSU is the only place that does them in the States. So might as well have both done at same time. It will save on blood draw and mailing. Your vet draws the blood and sends it out. You can download the forms and mailing instructions and give them to vet so they can't say they don't know how to do it. And you don't have to fast kitty for 12 hrs (some say you do) make it an early morning appt and just them you did If you have to. The other is Cushing disease and that is a UCCR urine test (sent out) and if it's positive then further blood test.

https://animalhealth.msu.edu/Bin/Catalog/Catalog.exe

https://animalhealth.msu.edu/Bin/Catalog/Catalog.exe?Display

Then print out submittal forms and they are in the pancreatic and endocrine boxes.
 
In response to your question, the amount of insulin your cat needs is what your cat needs. We had a member whose cat was diagnosed with acromegaly and at one point the cat needed 60u of insulin to keep his numbers in a reasonable range. (FYI -- I think the kitty eventually went into remission.)

A couple of thoughts.

It looks like you're feeding dry food. You can't do TR if you plan on keeping Sebastian on a dry food diet. DM dry is high in carbohydrates. If you have given transitioning your kitty to a canned food diet a good try, there are better options. You might want to look into Young Again Zero Carb food. It's not really zero carbs but it's much lower than most of the other dry foods. Please don't believe the "diabetic" dry foods are necessarily low in carbs. Royal Canin, for example, is very high in carbs. Lisa Pierson, DVM has a site on feline nutrition and she discusses transitioning a cat to a canned/raw food diet.

Generally, we recommend that you get a cat tested for insulin resistance and acromegaly once the dose is over 6u. However, if you're kitty is eating high carb food, it may be worth giving a lower carb food a trial to see if there's an improvement in numbers. Paula mentioned Dr. Elsey's as an additional option to the Young Again. Just to add a bit to Paula's note above, the test for acromegaly is IGF-1 (insulin grown factor) and the test for insulin resistance is IAA (insulin auto-antibodies). Those are the tests to check off on the forms from Michigan State's vet lab. That's the only place in the US where these tests are run.

I'd also encourage you to get at least a before bed test every PM cycle. Some cats experience lower numbers at night and getting a test can help to better understand the numbers as well as insure that Sebastian is in a safe range at night.

Historically, how large were dose changes? The two dosing methods we use recommend dose changes in 0.25u increments, in most cases. There can be times if the dose is increased by too large of an amount, you end up bypassing what would otherwise be a good dose.
 
To answer your question ' How much is too much?'
They need as much as they need, we've had kitties on over 60u of insulin, but they had a high dose condition. Has Sebastian been tested for High Dose Conditions, it may be why the insulin does not seem to touch the sides. Have a look at Olives ss (in paulas signature above) Olive is on a high dose and has Acro.

You mention that he is on 1/3 cup DM Dry, I take it that is Purina? If it is that is very high in carbs, and this will be affecting his insulin requirement hugely, so that might well be the culprit for the increased insulin needs.
There are some LC dry food available that may be a better option, not ideal, a wet diet is much better for all sorts of reasons and I wouldn't strop trying to transition him it can be a long journey for many, but for hard core kibble addicts, there are better choices available in the US/Canada, I'm in Europe and at this moment it escapes me what the LC dryfood brands are. But I see that Paula has given you the names. Perhaps you might have more luck transitioning to that.
Here are some links I think you will find the info helpful/informative with regards to dry food and transitioning. If you can manage to get him off the dry as you can see with the links to Scooter and Spider, it could make a huge difference to his BG so it is best to do it very slowly. Also if you introduce a LC dry, that may also impact the BG significantly.
Another important point is that a Prerequisite for TR is that they are on a wet low carb diet.

Mr Funk said:
And with his weight loss and DKA history I'm hesitant to attempt a diet change right now. We tried a couple weeks ago and his weight dropped even more and we started seeing trace ketones so switched back to primarily dry.
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I'm glad you were monitoring and spotted the warning signs, making sure he gets enough calories is really important in light of the recent DKA history is a priority, as is that he is getting enough insulin.

Mr Funk said:
I had him on 7 units for years with no issues. New vet made us drop down to 3 and then we started having problems. After them being unhelpful for so long and his health continuing to decline, I put him back at 7 and while his numbers haven't changed, he looks better and has more energy.
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Many of us have had vets suggest 'rebound checks' and really they're a waste of time at best. I'm sorry that Sebastian got ill as a result, was this when he got the DKA?

I would suggest that you get at least one test in the evening, every evening, perhaps a before bed test. I know it seems pointless, but a lot of kitties have their lowest numbers at night, and you are only getting half the picture, I know of one member whose kitty went weeks in red in the morning and only dropped into greens at night, even earning reductions, if she hadn't been checking at night she would have taken the dose up not down, leading to kitty being overdosed. I don't think that's what's happening here, but you never know, and in any case it's a good habit to get into for when you do start to see some movement in his BG, we will try to help you unravel it all. BTW good job getting some pm tests in yesterday.

We'll have to try and figure out a way to take his dose up safely, I hate seeing him in so much red, but with dry food in the picture, that would limit your dosing method to SLGS, and that doesn't allow you to make the frequent changes that might be necessary to shift him out of this sea of red and pink.
 
Sienne and Gabby (GA) said:
In response to your question, the amount of insulin your cat needs is what your cat needs. We had a member whose cat was diagnosed with acromegaly and at one point the cat needed 60u of insulin to keep his numbers in a reasonable range. (FYI -- I think the kitty eventually went into remission.)
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That is incredibly good news. Both that the high dosage is sometimes necessary and that they can go into remission from that level. Tells me we can get there, just need to test for contributing illnesses and fix the diet.

As far as the high dosage tests, I've already printed off the forms for IGF-1 and IAA and will be getting them done on Thursday. To my knowledge they've never been done before.

I'm still trying to transition to wet, and have read Dr. Lisa's guide. The past couple days I've been adding 1/4 can of Wellness Core Turkey & Duck alongside his regular dry helping. I've had some limited success getting him to eat it when I sprinkle in forti flora so I'll keep it at.

As far as the dry food, I haven't seen anyone mention it but for a while we were giving him Canadae's Under The Sun Grain Free. We actually had him on that for most of 2017 into 2018 before seeing the new vet, who suggested the "rebound check" and that we switch to DM Dry. Is the Under The Sun not really low carb despite being grain free? I haven't checked the stores but I couldn't find it on Canadae's website so it's possible it's even been discontinued by now.

I'll definitely start getting the PMPS and at least the evening +1 and the +10 and +11 should be no trouble. Last night my daddy sense went off and I woke up at 1:25 to get the +6.

Gill & George said:
Another important point is that a Prerequisite for TR is that they are on a wet low carb diet.

...with dry food in the picture, that would limit your dosing method to SLGS, and that doesn't allow you to make the frequent changes that might be necessary to shift him out of this sea of red and pink.
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So it sounds like my plan at the moment should be to hold his dosage where it is and stop with the TR adjustments, continue getting as many readings as I can, get the tests done at the vet, and transition him to wet food.
 
Mr Funk said:
So it sounds like my plan at the moment should be to hold his dosage where it is and stop with the TR adjustments, continue getting as many readings as I can, get the tests done at the vet, and transition him to wet food.
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try to swap out the DM dry for a LC dry in the interim perhaps.
Mr Funk said:
Is the Under The Sun not really low carb despite being grain free?
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Even though it's grain free, it can have other carbohydrate, eg pototo, sweet potato, peas to name but a few, so grain free does not necessarily mean Low Carb
 
I can't find an Under the Sun dry formula. There is a grain free, dry food from the same manufacturer. I ran some rough numbers. The dry food is 35% carb. They have only the guaranteed analysis on their website so these are not the same as the "as fed" numbers, which are more reliable.

Keep in mind, grain free is not the same as low carb. The Canidae food contains potatoes and peas which are way high in carbs. This is the food I was looking at.
 
Gill & George said:
Many of us have had vets suggest 'rebound checks' and really they're a waste of time at best. I'm sorry that Sebastian got ill as a result, was this when he got the DKA?
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Meant to answer that too. I don't think so, at least we didn't get an official diagnosis at that time. About spring of last year he had a little bout where his was throwing up and eventually couldn't keep any food or water down so we brought him in, this being the first time at the new vet. They gave him some anti-nausea medicine and a sub-dermal fluid shot and sent him home and he got better. This was when they suggested resetting back to 3u and got us on the DM Dry. At the time their tests hinted at pancreatitis so we did several more tests over the next 6 months but got no firm diagnosis. Then right after Thanksgiving he got really sick, appetite decreasing over a couple of days until he stopped eating entirely and started throwing up dark fluid. We took him to a 24/7 vet with an internal medicine department and they diagnosed him with DKA and pancreatitis.
 
Here is what I used to get my non diabetic dry food fed only her entire 15 yrs off dry food altogether. It took 3 yrs of trying every food and toppings.

I started with the dehydrated mini nibs (it's a complete food) then the dehydrated patties partially hydrated (it's all about texture with her), then moved to sprinkling the dry patti on wet food. Once she had the nibs she never went back to regular dry food. It's been years now.

https://www.vitalessentialsraw.com/cat/food/
 
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The garbanzo beans and peas are high up in the list of ingredients (2nd and 3rd) respectively, the higher an ingredient is in the list the greater the content in the food, and both of those are high in carb
garbanzo 64%
Peas 14%

Running the Guaranteed analysis numbers from the food you were using, in a pet food nutrition calculator, that comes out as 41%, it's not accurate as Sienne already said, because we need the as fed values. But it does tell us it's certainly way over the 10% max recommended for a FD cat
 
So I went back and reviewed the SLGS method since it sounds like that's what I should be doing. Couple questions/notes about what I've read there.

First and probably foremost, he's always been on Lantus but I've been using a pet meter, the Alpha Trak 2. Does that mean all my numbers are bogus? I do notice wild inconsistency in the tests sometimes. Just now for his +3 I did an initial test that read 417 and then immediately a second one that was 364. The last curve we did at the vet I brought in my meter so they could validate it against their numbers at there was only about a +/-20. In the past I used to get what I call "small readings" where I wouldn't get much blood and have to use both prongs on the test strip and those would come back in the 100s then I'd immediately do a second test with a big drop of blood using only one prong and it would be in the 300s. The vet assured me that's not the case and a reading is a reading no matter what but practical experience tells me otherwise. I've gotten much better about the testing and have a sense of when I'm going to get a bogus reading based on how much blood I get.

Second, are there multiple kinds of U-100 syringes? The guide says "U-100 3/10cc syringes" but I can't find anywhere on the bag or box what says the cc. Here's what I'm using now. I do realize I need to switch to something with the 1/2cc markings.
 
Sandy and Black Kitty said:
How old is Sebastian? How long has he been diabetic? How did you discover he was diabetic?
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He'll be 10 in June. He'll have been diabetic for around 5 years at that point.

Discovered it when he got DKA. He had been losing weight for about a month or so and drinking more water but I didn't recognize it as something wrong. Then one day he wouldn't leave the water bowl and looked really bad. Took him in and they diagnosed him with DKA as a complication from being diabetic. As far as I know he's never been properly regulated since then. The vet who did the initial diagnosis didn't put much effort into it and at the time I didn't know any better. They started him on 3 units and left it at that, had us come back a year later for another curve and bumped him up to 5 and gave me my own meter (alpha trak 2) and then over the course of the next year I gradually bumped him up to 7.
 
Your bag says 50 units or less. Which is fine. It also says in bottom left corner 0.5 ml/cc volume which if fine also. There are syringes available with half unit marks or you can use calipers.
 
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When you have time, not urgent could you put the insulin you are using, the Dka with date(s) and the pancreatitis dates, and type of meter you use in your signature. It really makes a difference when given advice especially the DKA.

I posted possible food idea above. I have to run out for awhile but will follow along.

It's also a good idea if you can to make this site a routine habit until things get better. We all worry when one of our kitties is struggling.

Oh and yes Olive is acro was up to 8.75units and climbing when after months of arguing with Dr and changing vets finally started treatment, dose went down to 4.5 units when p'titis hit and caused us back up to 8.25 units in January and now just starting to come back down.
 
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Gill & George said:
try to swap out the DM dry for a LC dry in the interim perhaps.
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I am pretty sure you won't find anything under 15% carbs off-the-shelf, even in speciality stores. You will need to order online. Probably the most popular choice for LC dry is Dr Elseys' cleanProtein Chicken, which is around 5%. You can buy it from their site, Chewy or Amazon.

When I had to hard transition Thomas to wet after dental surgery, I had success with grinding up some of his kibble and sprinkling that on top of the wet food. Not ground to a powder or mixed in, peppercorn-sized chunks used as a topping.
 
Okay, someone help me out on the math here because it sounds like one of these sites is lying to me and this is going to get expensive and/or risk DKA.

Purina Pro DM Dry, what he's currently on, 605kcal/cup. I buy a 10lb bag, give each cat 1/2-2/3 cup/day and it lasts 2 cats 30 days.
Dr Elsey's cleanprotein Chicken, 544kcal/cup. The website says a 6.6lb bag will last between 52-58 days. So, 2 cats for 26-29 days.

That math isn't adding up. How does a smaller bag with a lower calorie content last about as long?
 
Mr Funk said:
Okay, someone help me out on the math here because it sounds like one of these sites is lying to me and this is going to get expensive and/or risk DKA.

Purina Pro DM Dry, what he's currently on, 605kcal/cup. I buy a 10lb bag, give each cat 1/2-2/3 cup/day and it lasts 2 cats 30 days.
Dr Elsey's cleanprotein Chicken, 544kcal/cup. The website says a 6.6lb bag will last between 52-58 days. So, 2 cats for 26-29 days.

That math isn't adding up. How does a smaller bag with a lower calorie content last about as long?
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I suspect its to do with where those calories are coming from. A cat being an obligate carnivore, is not able to properly metabolise protein from a vegetable source, so perhaps even though there is more calories in the purina, kitty cannot actually process it all. Whereas if most of the protein is coming from animal source kitty can metabolise and absorb that better, so less calories go further??
 
Mr Funk said:
Purina Pro DM Dry, what he's currently on, 605kcal/cup. I buy a 10lb bag, give each cat 1/2-2/3 cup/day and it lasts 2 cats 30 days.
Dr Elsey's cleanprotein Chicken, 544kcal/cup. The website says a 6.6lb bag will last between 52-58 days. So, 2 cats for 26-29 days.
?
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The FAQ on the Dr Elsey site has their feeding recommendations. I've always assumed there wouldn't be any consistency between what different brands suggested for feeding level. The kcal/cup probably isn't the whole story either but it does give you an apples-to-apples. I think there is much more to overall nutritional density.

Sorry about the Amazon link, I didn't see the out-of-stock notice. Dr Elsey's has a lower free shipping minimum but it's easier to find more stuff to buy on Chewy.
 
I did wind up finding the feeding guide for Dr Elsey, it's the same as DM Dry, 1/2-2/3 cup for a 12+ lb cat. I suspect the 52-58 days number is based on a smaller cat.

Anyways, ordered 2 bags off Chewy. I'll transition him to the Dr Elsey and work on the transition to wet. We have so much food right now, the shelter is gonna be real happy once we figure out what we need to keep and what we can donate.
 
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