Advice requested, newly diagnosed

Hi,

I am so very confused. Minnow was diagnosed Feb 7, started Lantus Feb 10 at 2 units AM/PM. He had classic signs at diagnosis, weight loss, increased thirst, excessive peeing, glucose in urine. I did one curve Feb 18, AMPS 247, onset +3, peak +9 at 182, +11 at 227. Things were fine until Feb 21 with PMPS 128, I didn’t shoot. Next day AMPS 437, I reduced the dose. This pattern continued, until Saturday with AMPS 209, I gave him .75 units, by +4 he was 52.

I panicked and took him to the ER. I posted here on Saturday after returning from the ER, I just don’t know how to link it. The ER vet said the starting dose may be too high or he’s spontaneously gone into remission, take him off insulin for 3 days, confirm he still has diabetes, and restart at .5 units and go from there. I followed up with my regular vet yesterday. I checked Minnow’s BG randomly yesterday, it was 432. My regular vet told me to stop taking pre-shot levels, just give insulin and do a curve in 5-7 days and start at 1 unit AM/PM. He said he’s never seen a hypo with 1 unit of Lantus in his career and I’m stressing myself out with readings. He also said the hypo on Saturday was nothing to worry about.

I’m not a fan of this advice, so I decided tonight I would restart insulin at .5 units and try the SLGS method as per the ER vet’s advice. I was just about to give him his shot, tested his BG and it is 127. He hasn’t had insulin since Saturday morning and the hypo. What is going on? Do I just give it to him or wait? He’s been eating low carb wet food all day. I just fully transitioned him from high carb dry food to low carb wet food yesterday, we’ve been slowly transitioning since diagnosis.

Any advice would be appreciated, I’m seriously losing my marbles.

 

I think your regular vet’s advice is horrible so good on you for not following it. Hypos can happen anytime a cat has more insulin than it needs regardless the dose!

127 is outside the normal range but it’s a low preshot so best to skip since it’s harder to monitor overnight. It may be that he just needs a tiny bit of insulin like .25 units or even less. I remember your original post so tagging a few folks to get more eyes on this @Bron and Sheba (GA) @Sienne and Gabby (GA) @Larry and Kitties

 

Original post: https://felinediabetes.com/FDMB/threads/a-word-of-thanks.274622/#post-3049358

 

Did you take any BG tests during the three days you were not giving insulin? if so can you pop them into the SS please.
The swap to the low carb food has obviously lowered the BGs.
With a preshot of 127 I would skip tonight but still get a couple of tests so we can see what is happening. try and get a test in 3 hours after the evening meal please.. I have to go out but will come back a bit later.

 

Please continue to take a preshot BG every time. it is the only way to ensure that the BG is high enough to shoot.
And I don't agree with just giving insulin for 5-7 days and then do a curve. That is putting your head in the sand and hoping for the best
I wonder how many diabetic cats he has looked after...I have seen a cat drop into 'hypo' territory on a drop of insulin. Fortunately when the caregiver is hometesting low numbers can be averted or handled quickly.
You are not stressing yourself out with readings at all. You are being a responsible caregiver. Unfortunately many vets can't handle caregivers taking the initiative and hometesting and they usually respond by either telling them they are stressing themselves out, hometesting is not needed or something else that makes the caregiver feel unworthy or stupid.
I think you are doing a great job keeping Minnow safe!

 

You have great instincts and doing a great job!
My boy would drop like a rock on any dose if he was low even .25
This forum is filled with very so much knowledge so keep asking questions if you have them...
Welcome

 

Thank you for the guidance. I skipped last night’s dose. Given the time zone differences I didn’t see these replies until this morning. I clearly need more data, I will do my best to get readings. This morning at AMPS he was 252. This dude is not making my life easy. I’d be uncomfortable giving him a dose because I have to go to work and cant’t monitor. I can do more this evening. Thank you for the help, I’d be lost without it.

 

Hi and Welcome to the FDMB!

it's a bit late now, but the advice from the experts here has always been to be very very careful with a food transition away from higher carb kibble to a lower-carb wet diet as it can have massive implications in regards to how much insulin the cat needs. In a perfect world we would all do the transition before starting the insulin, but it rarely works out that way.

It doesn't sound like your vet even considered the dietary change and the potential for a hypo because of it. Scary stuff

the response to a small amount of insulin and the diet change are actually a great sign for Minnow's future and the potential for insulin therapy to be really helpful in managing her diabetes. I am optimistic about her progress!

 

Lisa -

I want to encourage you to get tests at least 4 times per day. You always want to get a pre-shot shot test. In addition, you want to get at least one test during both the AM and PM cycles. Lantus dosing is based on the lowest number in the cycle. Trying to sort out when nadir (lowest point) typically occurs it a bit of a chore but can be helpful. You don't want to miss a dose reduction.

Your vet hasn't worked with enough diabetic cats. My kitty could drop below 40 on a dose of 1.00u or less. Of course, if your vet isn't encouraging people to home test, how would he know just how low numbers were?

You're also seeing what we refer to as bounces. When numbers drop fast and/or low, your cat's liver and pancreas overreact. They start pumping out a stored form of glucose along with counterregulatory hormones which cause the numbers to spike back upward. This is a protective response that is very annoying to caregivers. It can take several days for the bounce to clear.

 

With an amps of 252, I think you should give him insulin. I’d go with a reduced dose of .25. Not giving him insulin when he needs it it’s not good either because of he’s heading towards remission, he’ll still need some insulin until he gets there.

what does everybody else think?

 

Lisa, if you are not giving insulin, you you need to be testing the urine for ketones. It is now several days since he has got any insulin. Diabetic cats who are not getting insulin can get ketones in the urine, which is not good news. Please get a bottle of Ketostix from Walmart or a pharmacy and test the urine as per the directions on the bottle daily when you are not giving insulin.
With a Preshot of 252 you can give at least some insulin if you are not going to be there to monitor. Insulin is needed in the body for other functions apart from lowering the blood glucose.
Do you have a timed automatic feeder that you can leave food out for Minnow.

 

Hi there, I have the ketones tests but this is the one thing I have the most trouble doing. He won’t let me near him in the box, saran wrap was a failure. I do have an automatic feeder, but Minnow grazes anyway. No insulin again today, I just tested what would be +9 and he’s 173. I’ll keep testing until PM shot time. Not sure what I should do if numbers are this low, give him under .25?
Thank you for all of the responses!

 

If the BG at +9 is 173, he still needs some insulin.
As you will be home tonight, try 0.25 U and see how that goes. You will need to get a few test during the cycle.
Keep posting so we can see. and ask all the questions you need to

Try putting a small container into his favourite spot to pee in the LB

 

Thank you! This cat. My goodness. His PMPS is 122. I’m going to feed him and try BG in a half hour.

 

One half hour after eating he is 135. I’m going to give him a very small amount of insulin, under .25

 

Next time you have a lower than normal preshot...stall, dont feed and test in 20 minutes to see if the BG is rising.
When you feed, the BG is food influenced.
I would get some tests in early in the cycle to see what is happening. I can see you have got a +2 which is much the same as the preshot BG.
I would get a +3.
You can always feed some higher carb food if the BG drops too much early in the cycle.
Keep posting with the BGs.
It is very possible the change to low carb food has made a big difference and he may not ned much insulin to support him while the pancreas heals.

 

Thank you! +3 is 122. Not a lot of change. It’s late here so I’m off to bed. He has lots of food. The dose I gave was probably closer to .1 units it was so small. Thanks for the support.

 

Let us know how things are in the morning

 

I'd just thought I'd mention if money isn't too tight I'd recommend a blood ketone meter. The strips are quite expensive, about a dollar per, but in my case it was a life saver. My cat doesn't mind me collecting his pee lol, but when I want answers immediately I get them with the meter. Amazon has some overnight and same day options

 

Thank you! I will look into the ketone meter, I worry about ketones so much. I got up early for +9, he is 92! Thanks for the support!

 

Give him a low carb snack.

 

Minnow is 72 AMPS. I am not giving him a shot, obviously. He has had some food. I assume he is far out enough from last night’s shot that he will be ok?

 

Yes he should be ok. If you have to go out, leave him some food. Get a test during the cycle if you can

 

Are you using 1/2 unit marked syringes? It’s easier to eye ball 1/4 unit with them

 

I am! Thanks for the reply.

 

I wanted to share with you that I just received Minnow’s test results from his vet visit on Monday. There was no glucose in his urine, the vet assessed he has likely gone into spontaneous remission. I did point out that if I followed his advice and just gave him 1 unit without testing I’m not sure he would have been ok. Anyway, I will continue to do tests to monitor in case things change. A heartfelt thank you for the support over the past few days. I don’t know how either Minnow or I would have gotten through without this forum.

 

Hi Lisa and little Minnow,
(Really Hope I'm not overstepping here) .... I am still learning things here and only 4 months into this process of Feline Diabetes, and dont want to sound like a negative Nelly.... but reading through these previous posts just raised alot of flags for me to suggest you proceed with a bit of caution as to the vet's advice that Minnow is in 'spontaneous' remission. This could be the case?..... but more based on being a diet controlled Diabetic cat ( and not that he is actually "cured").
It's so good to know you will continue to test him!!!! . If he was my cat, I would most definitely do the same, you are only a few weeks into this process, and you wanna keep him safe.
Just wondering if the +10 reading on Mon, Feb 27 of 432 was at your vet visit? Or was this a home test? Did they test his BG on your visit? And gee, that number was only a few days ago.
The reason I post this to you, is because I too had a vet ( very nice, but little experience with feline diabetes I think) that gave me his diagnosis on a checkup, sent me home with a prescription and a Diabetic cat. started my boy on 4u x 2/day, check in 2 weeks, upped him to 5u x2 per day based on one inhouse BG check, check in 15 days. The vet assured me home testing was not really necessary, it would stress me out, stress out the cat, and I didn't need to worry about such things.
Watching my Kitkat over that month (while I was blind dosing) , I seen him come good so quick within a week or so, and then he really started to go downhill, he just wasn't the same cat a few weeks in. after finding this site and reading I took the advice I read here (against vet advice to maintain dosing), he was being overdosed and we dropped him to 2u immediately.
His diet change to low carb ... and dosage dropped quick, and Kitkat responded incredibly. Down to a single drop for a good while to ensure he had a fully healed and functioning pancreas... slow and careful. He is now on his Remission Trial, something we never may have accomplished, but it took 4 months and the advice I received her to do it.
I am so optimistic for you and Minnow, but please don't go away just yet, ok?

 

Thank you Melinda for sharing your experience. I absolutely will continue testing regularly and remain suspicious of remission myself. It could be food influenced. It might all come crashing down in a few days and I’m prepared for that. I trust nothing my vet says to be honest after the awful advice I’ve been given. The Feb 27 reading was at home. It was 10 minutes before the vet visit. No glucose in his urine makes zero sense with that number, it’s above the renal threshold.

Thanks for reaching out.

 

Moving forward with caution is probably your best bet. It's not all doom and gloom, it may not all crash down..well it could but it may not. diet alone may just sort him all out. it's possible. We all learn here that every cat is different! (ECID) Be hopeful, and go forward with vigilance on testing, Minnow will let you know. And he is the one that will be setting the pace.