BG values are all over.. is this expected?

[BrendaLovesArti]

Hello to everyone!
I introduced myself a couple of weeks ago but we wanted to wait a bit before posting here, although we have been looking at many posts in this forum.
I want to share a bit of our story so far and also start with the warning that we obviously haven't been following any of the methods shared in the forum as we are trying to work with an endocrinologist, so we are compromising with his view.

Artemisa was diagnosed at the end of August at the local vet practice. Since her glycemia value at diagnosis was in the 200s they first told us us to change her diet to dry diabetic food and control her rations to make her lose weight (she was 5.5kg and obese, she's quite a small cat) to see if that made it better. 10 days later she stopped finishing her daily ration and seemed more lethargic, so we took her to the vet and her BG was in the 300s. They started her on Humulin N twice a day after that. We had it done at the vet's so obviously she was a bit more stressed, having to travel every day. She also lost 0.5kg during this 15/17 days.
After one week we consulted with a vet endocrinologist and he told us to change to Lantus and start doing everything at home, which made us very happy. Problem is he told us to give her only one shot per day during 10 days (while adjusting her dose). This is where we compromised, even though we knew for most cats it's necessary to shoot twice a day. He also told us to get an abdominal ultrasound, which came out mostly OK (you can check the results on the spreadsheet).
She seemed much better during this time but she lost an additional 0.5kg, keeps drinking and peeing a lot. And as you can see her BG values were kind of all over.
Last week we saw him again and he finally told us to start giving her two shots a day! But starting from the current dose at the moment. So he told us to give 3U in the morning and 2U at night.
We haven't been doing for long but we notice that her values vary a lot (even after starting with two shots a day). Also, her BG at night hasn't gone down so much.
Is this normal? Is it possible that we skipped the right dose and she's bouncing? Should we start all over giving her 1U twice a day?
How long does it take for cats to have stable values? / adjust the dose?
Also, should we free feed her instead of giving her a fixed ration? We are not happy with the speed at which she's been losing weight.

I know changing her food will probably help but they don't sell any good wet food in our country, from what I've been told. I think we will try a homemade, raw food diet starting from next month but for now this is what we can do.

Thanks to everyone in advance!

 

[Wendy&Neko]

Hello and welcome. Do they sell the diabetic wet food there? It's not great, but better than the dry food. We have had another member from Argentina who fed their cat a home prepared diet.

I am glad you found a vet that switched you to Lantus. On this forum, we find shooting the same dose in the morning and evening works best. Cats vary in how long they take to get regulated, or more stable values.

 

[Gill & George]

Hello and welcome

Also, should we free feed her instead of giving her a fixed ration?

We find that with Lantus because it's slow acting most cats do better with a few smaller meals, usually in the earlier part of the cycle, some members do free feed.
However, if weight is an issue then just putting a bowl down and letting her freefeed may cause her to gain weight.

She does seem to be loosing weight a bit too quickly.
Have you read this
https://catinfo.org/?s=obesity#Safe_Rate_of_Weight_Loss

Using the formula Dr lisa supplies on her site it seems to me that you should be aiming for between 50-100g a week, so yes I would not be happy with the rate of weight loss you have experienced, have you discussed that with vet/endocrinologist?

On that link she discusses different ways you can work out what is a good amount of food to feed.
With diabetes there's the added complication that they cannot make use of the energy in the food, it ends up as glucose in the blood stream and then excreted out by the kidneys, that's one of the reasons a lot of FD cats will present with weight loss at diagnosis.
My Kitty started to gain weight and then stabilise once he became regulated, he was also obese at diagnosis, but had lost weight from his previous vet visit. I have found that it has been much easier to manage his weight, now that he is on a wet diet, this after years of trying Royal Canin and Hills dryfood for weight control, he never lost significant weight consistently, and that with a pitiful 60g of kibble, vet wanted me to reduce even more, I couldn't do it to him, the less kibble I fed the less active he was and more depressed he seemed. He would inhale his portion of kibble and then be miserable until the next feed (I feel so bad that I put him through that) on a LC wet he's a happier healthier cat and his weight is easier to manage.

The Royal Canin diabetic dry, as I know you probably have figured out is High Carb, so if this were me figuring out the homemade diet would be a priority, on Dr Lisas site she talks about homemade raw diet. When you come to make the change you will find it will improve the BG.

Figuring out the right dose from your data is tricky, here we shoot the same dose am and pm, shooting different doses messes up the patterns that we are used to seeing and analyzing, it can make the numbers wonky. I don't think I would take him back to 1u though. Are you using pen needles? or syringes? If you are using syringes, then what I would probably do is dose 2.5u am and pm. Perhaps see if your vet would be OK with that, most of them don't realize that its possible to change by the 0.25 increments that we use on this site. Most of us here have ended up following the protocol after finding that the way our vet was dosing was not working for us.

 

[BrendaLovesArti]

Nope, no diabetic wet food or any good wet from what I've been told (I've contacted other people with diabetic cats in Argentina already).

The endocrinologist says he has a lot of cats that have stabilized with the dry food but not so many that have gone into remission.
I'm guessing he told us to give a smaller dose in the evening to avoid a hypo episode at night. He has been very careful with the dose increases. But we could of course shoot the same both times.
We are using the pen for now. We couldn't find the syringes with 0.5U graduation anywhere yet, I'm still asking around. We have found the syringes with 1U measurements and bought some, but my father is the one who is injecting most of the time and he's not confident with doing 0.25U with those.

Thanks for the link Gill. We have read it and that's why we are a bit worried. We have discussed the rate of weight loss with the endocrinologist and he reasured us that Arti seems OK and that she's still overweight (which is true). He said she'll stop losing weight so fast when she's reaching her ideal weight and stabilizing. We were told to calculate the daily portion using the table that comes with the food, which means she's supposed to get 52g a day, but after our last visit he told us we could increase it to 62g.

I meant free feeding as in feeding as much as she wants to eat, not as in letting food outside all day because she would just sit right next to it and eat.. she's a glutton lol. Right now we divide her portion in 6 equal meals across the day, starting from +1 after her AM shot. The endrocrinologist told us not to leave food out at night so last time she eats is around +4 after the PM shot.