? 4/12/2020 Vlad's Numbers, How am I doing?

[Kyle&Vlad]

Cat was diagnosed a couple years ago, before I found this forum. I found catinfo.org at the time though, and got him into remission using vetsulin and wet food. Vlad also was diagnosed with stage 3 CKD. About a year after remission, vet visit went well, all his numbers looked great. Vet even said if she hadn't diagnosed him with CKD she wouldn't know it from the numbers.

I moved about 3 months ago, Vlad did not seem to take the move well. He slowly started losing weight, and didn't have much of an appetite. I think he missed his old place and his room mates? Anyways, one day he started peeing out of his box about 2 weeks ago, then within a couple days stopped eating and drinking altogether. I rushed him to the vet. They said his BG was 500+, and he was severely dehydrated. Hospitalized a few days to get him hydrated and came home back on the vetsulin.

Since his previous remission, I'd discovered this forum, and I'm trying a more proactive and data driven approach. Please see the spreadsheet in signature. Usually from injection time to +8, he uses his box, or at least attempts to (sometimes he misses), but outside of that, once his BG comes back up, he starts peeing outside his box again. Only when it is above ~250 it seems.

His BG after injections are getting better each day, but his AMPS/PMPS seem to be largely unaffected. I'm hoping I'm just being impatient and that his AMPS/PMPS will start improving. I've been increasing his vetsulin by about 0.5 U each day trying to get his nadir in the blue as long as possible. Am I doing ok? Any recommendations, or am I doing ok so far? Sorry for the long post, and thank you for reading this far!

If I can't get his AM/PS under control may consider Lantus at some point. I have months worth of AMPS/PMPS from before I started using the SS, but its all hand written in a journal, the SS and this forum have been a godsend!

 

[Kyle&Vlad]

I should add, my vet said don't worry about testing (she feels that it stresses owners out too much, personally I find not testing much more stressful and kind of insane) and to just give 2 U in the AM and 5 U in the PM. This was based on her observations of him hospitalized, and I know his BG is always higher at the vet from experience, so I started at a lower dose and have been increasing incrementally, watching his nadirs.

 

[Deb & Wink]

Are you able to test at +6 or +7 today? That low of 125 could go much lower. We want to help keep Vlad safe, and not get hypoglycemic symptoms. Do you have your hypo toolkit prepped and the list of the symptoms to watch for.?

Vetsulin rarely lasts more than 8-10 hours in cats. It was developed for dogs, hence the name in the rest of the world outside the US - Caninsulin. Canine + insulin.

I'm hoping I'm just being impatient and that his AMPS/PMPS will start improving.

Pre-shot tests will be the last numbers to come down. With any insulin. Yes, you are being impatient. Want some patience pants? What is your favorite color?


We're with you 100% on the home testing, as is the (2018) AAHA Diabetes Management Guidelines for Dogs and Cats

Looking at the SS, it seems that the onset is between +2 and +3 (fairly typical for most insulins), the steep drop at +3 is causing him to bounce higher later in the cycle. And the duration doesn't seem to be much past +10, probably not much past +8, but you don't have much test data later in the cycle to tell for sure. Although his peeing outside the box may be an indicator. Pee pads outside the box work nicely.

I've been increasing his vetsulin by about 0.5 U each day trying to get his nadir in the blue as long as possible. Am I doing ok? Any recommendations, or am I doing ok so far?

I wouldn't increase any more right now. You need to let him, Vlad, clear the bounce before you adjust the dose. That 4.4U is already bringing him down pretty sharply.

Keep checking his hydration. Are you checking his blood or urine for ketones?

Why wait on the change to Lantus? It has a much better duration. Check the supply closet forum here.

 

[Kyle&Vlad]

Updated SS, steep bounce back after +8.5, and on queue he peed outside his box, going to get pee pads (and maybe some cat attract stuff for his box, can't hurt?). I may back down from 4.4U to 4U for now.

I haven't checked his ketones, I will look for strips while I'm out looking for litter and pee pads, thanks for the rec.

I only just learned about Lantus, my vet never mentioned it, and just default put him on catsulin, I only bought this vial a couple weeks ago before realizing it is probably not his best option. I'm going to call the vet tomorrow (they are mostly locked down atm here) and see if my vet will entertain me with Lantus. With all the Covid stuff going on and now losing my job I've been trying to be conservative with my money until things settle down, but I'd rather get him on the right track asap, seems like spending the money up front on Lantus could save me money and me and vlad's mental health in the long run. I see a lot of people have their lantus shipped from that Canadian pharm, I am going to try to go that route if they don't mind shipping to TX!

 

[Deb & Wink]

That Canadian pharmacy, Mark's Marine Pharmacy, is having supply problems. Getting shipments delivered to them. They order 20 of what they need and they get 4.

They are recommending Basaglar, a biosimilar to Lantus.
Thread here that talks about that.
http://www.felinediabetes.com/FDMB/threads/ot-lantus-shortage-in-canada.227890/#post-2552281

No, they have no problem shipping anywhere in the US. But they may need to use extra cold packs, to keep the insulin cold enough if it's hot already where you live in the great state of TX.

If your cat Vlad is still peeing "lakes" in the litter box, keeping it really clean can help. Scooping multiple times a day. Cleaning the sides and bottom of the box of any stuck on litter. I use a piece of paper towel on my cat's litterbox, wipe it with another paper towel, then spray the spot that sticks the most with some non-stick cooking spray and wipe the oil around. Any oil will work, to cut down on the sticking of the litter to the litter box itself. But you might want to use an oil that has less of a scent than olive oil or sesame oil. Plain old corn or canola vegetable oil works well.

I have a CKD cat, and she pees enough for three or four cats. So the box gets scooped a lot.

 

[Kyle&Vlad]

Called doc today, out of office, left a message about switching to Basaglar. Hoping they get back to me asap.

I wish he was peeing lakes in his box. I would be thrilled. Instead he's been peeing outside his box when his BG is high. I get a nice break from pee clean up for the 8 hours after his vetsulin shot though. lol. I am really looking forward to getting him on a longer acting insulin before I turn into a crazy person.

 

[Deb & Wink]

There are a couple of people in the Supply Closet forum with Lantus pens for sale. I would not purchase the box of insulin pens that are due to expire in April 2020. About $25-

30 per insulin pen is reasonable. A box contains 5 pens. Make sure the person selling the items have experience in shipping and ask how they will pack the items and if they will use cold packs in the shipping box.

Ask about how the insulin has been stored.
Also ask for overnight or 2 day shipping if possible.
Supply Closet - For Sale or Free

I am really looking forward to getting him on a longer acting insulin before I turn into a crazy person.

Life is hectic and crazy enough normally. Having a cat that pees outside of the box can be very stressful for you.

Ideas. Boot tray outside the box, with pee pads on top.
That Dr. Elsey's Cat Attract Litter that you mentioned.
Check with your vet, in case Vlad has a UTI. Very common for unregulated diabetic cats, because the excess sugar in the urine provides an idea environment for bacteria to grow.

Add another litter box. Ask any pregnant woman, with that baby pressing down on the bladder about the urge to pee. Or being inside stuck in a meeting and having that meeting drag on for hours and hours, you drank too much coffee, and you really, really have to go. The constant urge to pee can hit you like a ton of bricks. Vlad may not be able to hold the urine in his bladder as well, since he is drinking so much water, because of the diabetes.