Boots, 8/29 Any advice

Jackie55 & Bootsie

Jackie55 & Bootsie

Member Since 2021
I have posted before but really felt criticized. I am trying to bring Boot’s blood sugars down but really am not getting much help from my vet. So I am reaching out once again. I have posted her last 28 days of BS’s and Insulin dosing. And yes I understand it is very incomplete but I am trying and sometime I just can not poke her one more time.
Does anyone have any advice what to do to help my cat? It was suggested before that her dose was increased to fast. Is there any danger in gradually decreasing her dose to determine if it makes a difference? She is not spilling ketones in her urine.
 
Hi Jackie,
One of the first things I notice, is that the fairly high dose doesn't look high enough. It looks like Boots needs more insulin. It makes me wonder if you could be dealing with Acromegaly or IAA (referred to as high dose conditions). Testing for those conditions can be done through your vet. When a kitty needs more than 5 (maybe 6) units BID, it could be a possibility.

Please try not to feel criticized - people really are trying to help your cat! But I know what you mean - feeling criticized can make me want to run! You are here and trying to get help! That is great.
The other thing I see is that your dosing isn't following protocols, whether SLGS or TR. You are taking whole unit decreases and increases, AND just remember that Lantus dosing is based on the nadir - how low it takes your cat, not what the preshot number is.

When I first started giving my cat insulin, I didn't have very helpful advice from my vet either. I was winging it, based on intuition. Thankfully I found the protocols here, and followed them. Read and review the yellow stickies - they are filled with good info to guide us, and give confidence too.

Do you have any specific questions? Ask away!
 
Thank Tina - I did read all the sticky note articles before. One suggestion was she was on too much insulin which can be just like giving her none at all.
And unfortunately she is hungry and begging and crying to be fed almost all the time. I try to limit her but sometimes I just feel bad if she is hungry.
I did read all the info about acromegaly and other than the DM she does not fit the symptoms. And to be honest even if she had it I do not think I could afford the treatment. I am struggling with all the expense as it is. I love her but she is a pet (please don’t judge)
I will look at the SLGS and TR info again but I believe it is too late for the SLGS method unless I do it in reverse to see if it would make a difference. The vet is pushing me to use a prescription food for glucose control. Has anyone used that? And are the carbs in it different than the carbs in Friskies Pate or Fancy Feast Classic Pate
 
I’ve personally had really poor experiences with prescription diets. Pretty sure that’s how my guy ended up here. My vet gave me some of the glycobalance one at first but based on most people on here, I wanted him on LC wet food. The ff and friskies pates are perfect and usually much lower in carbs even than the “prescription” food. Since you mentioned financial stuff, prescription food is crazy expensive and Boots would probably be much better off on the wet food. Also, if TR interests you, Boots should be on LC wet food.
 
Jackie55 said:
One suggestion was she was on too much insulin which can be just like giving her none at all.
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This can be a possibility when the cat is dropping too low during the cycle and you aren't catching it. But you have a lot of high numbers that you are getting mid cycle, so this isn't likely in my opinion. You could try sticking with your current dose and begin either SLGS or TR (depending on when and how often you can test). TR would be best to get Boots on track faster. That would mean you could increase tonight, or increase exactly one week after you began 5u (SLGS). But you do not want to increase more than .25 units at a time , unless using TR with the dose not bringing Boots under 300. Then you could increase by a half unit. Not your case now since you saw a yellow recently (under 300).

The vet is pushing me to use a prescription food for glucose control. Has anyone used that? And are the carbs in it different than the carbs in Friskies Pate or Fancy Feast Classic Pate
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Those prescription foods are nearly always high carb!! Makes no sense! People here would rarely agree with your vet. Some of the food they sell to diabetics is 20% carb at least! If you know the brand, someone likely knows the carb percentage.

I look forward to more input from others about dosing:)
 
When she was started on Insulin it was 1-2 units based on how she ate. Her numbers were basically the same as they are now. I had also of spread sheets but the vet kept them all
I have a bit of data from when she was on 4 unit in June - I will put it on the spread sheet so you can see. She was also wearing a Libre at the time. She seemed better with 4 units but her Fructosomine level was very high so the vet said to increase the insulin to 5-6 units depending on how she ate
I know many of you do not believe in the Fructosomine levels but in the BS results and I did not have the ability to check in then
 
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Jackie55 said:
I have posted before but really felt criticized. I am trying to bring Boot’s blood sugars down but really am not getting much help from my vet. So I am reaching out once again. I have posted her last 28 days of BS’s and Insulin dosing. And yes I understand it is very incomplete but I am trying and sometime I just can not poke her one more time.
Does anyone have any advice what to do to help my cat? It was suggested before that her dose was increased to fast. Is there any danger in gradually decreasing her dose to determine if it makes a difference? She is not spilling ketones in her urine.
Click to expand...
Hi Jackie, i wanted to offer some support and encouragement. It is incredibly frustrating and upsetting trying to treat a disease that you may know nothing about. I want to promise you that it gets better if you keep reminding yourself that everyone here is trying to help. I was doing EVERYTHING WRONG. Once i read what SLGS was, looked at the food charts and all the other stickies, i just dug in and after a while it started to pay off. My hands would shake every time i tried to prick my poor guys ears.
Filling out spreadsheets, signatures and food advice are to help the folks here give the most informed data driven advice to you.
Fwiw my cat lando would ONLY EAT dry rx food. His numbers dropped instantly when i was able to feed him wet fancy feast low carb. A few members encouraged me to try again and again to get him to eat it.
I wishing you and Boot success and all the wellwishes
 
And if you give Boots treats every time you test her, she might not be too bothered. A lot of people use PureBites chicken. I got mine on Amazon but they sell at petco. Oscar won’t eat those but someone here told me about Orijen, also at petco or Amazon, and he loves those.
 
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I'm sorry your first experience was off-putting. People are trying to help and sometimes we probably come across as a bit rigid. In a way, we are. We're very numbers driven since it's the best way we know to keep your cat safe.

My guess is that your vet is more familiar with insulin other than Lantus. They way your vet has suggested you change dosing is not based on the published research. The information in the dosing methods sticky about Tight Regulation (TR) does have links to the research or we can provide it.

One of the basics of Lantus is that it's an insulin that likes consistency. It forms a depot -- kind of like a storage tank. Every time you change the dose, it affects the tank. If you change the dose at each shot time, you never get a stable amount in the tank and it can result in wonky numbers. So, if you're following TR, you evaluate the dose every 3 days and increase the dose by 0.25u to 0.5u. It looks like your dosing has been more consistent since mid-September.

I wouldn't suggest reducing the dose. I agree that the dose was probably raised too aggressively. If you were to reduce the dose, you'd lose time and likely end up at just as high or an even higher dose. Let's just not be as aggressive with dose increases. Boots will let you know if the dose is too high.

How else can we help?
 
When I look at her spreadsheet her numbers were better when she was on 4 units. If I used the info from the TR protocol she should get about 2,25u as she is 4.5kg and her sugars are over 300. But I am terrified to drop her dose to that. But I could try her at 4.5u and see what happens. Any suggestions? Thanks.
 
Jackie55 said:
Thank Tina - I did read all the sticky note articles before. One suggestion was she was on too much insulin which can be just like giving her none at all.
And unfortunately she is hungry and begging and crying to be fed almost all the time. I try to limit her but sometimes I just feel bad if she is hungry.
I did read all the info about acromegaly and other than the DM she does not fit the symptoms. And to be honest even if she had it I do not think I could afford the treatment. I am struggling with all the expense as it is. I love her but she is a pet (please don’t judge)
I will look at the SLGS and TR info again but I believe it is too late for the SLGS method unless I do it in reverse to see if it would make a difference. The vet is pushing me to use a prescription food for glucose control. Has anyone used that? And are the carbs in it different than the carbs in Friskies Pate or Fancy Feast Classic Pate
Click to expand...
I know there is so much to read and it can be overwhelming, but if you have a chance, https://catinfo.org/ has some great information on basic feline nutrition, prescription diets as well as food charts. I'm on a very limited budget and use the LC varieties of Friskies Pate. My cats are way healthier than when I fed "high quality" dry food. I free feed the wet food three times a day, so it's available except for the two hours prior to the AM & PM shots. I give dehydrated chicken breast or chicken liver when testing. A little before testing, a little after. It helps to make a positive food association with testing.
 
Jackie55 said:
And unfortunately she is hungry and begging and crying to be fed almost all the time. I try to limit her but sometimes I just feel bad if she is hungry.
Click to expand...

If she is hungry and does not have other weight issues, it is okay to feed her multiple times a day or leave wet food out if you are not home during they day. Adding extra water to the wet food or freezing it so it thaws later in the day are popular options for keeping it moist. Diabetic cats whose BG is not under control don’t use their food’s nutrients well, so they are usually very hungry and need to eat more. Once her BG starts to get into healthier ranges, you will probably notice her eating less.
 
Librarianista said:
If she is hungry and does not have other weight issues, it is okay to feed her multiple times a day or leave wet food out if you are not home during they day. Adding extra water to the wet food or freezing it so it thaws later in the day are popular options for keeping it moist. Diabetic cats whose BG is not under control don’t use their food’s nutrients well, so they are usually very hungry and need to eat more. Once her BG starts to get into healthier ranges, you will probably notice her eating less.
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She does not have weight issues. And I am retired so I am home most of the time. My vet put her on Basaglar/Lantis insulin from the start but I don’t think she has had many diabetic cats in her practice. She and I just talked and she is willing to check Boots for Acromeagaly at her cost. I told her it had been suggested from this forum as a cause for Boots DM and her seeming resistance to the insulin. So we will check that and move forward from there. Also she has always eaten wet food and prefers it over dry. I will check my signature to be sure all that info is there.
 
I'm glad to hear your vet is willing to do the test for acromegaly. For a very cheap add on, you can also get the IAA or Insulin Auto Antibodies test. The bloodwork for that test also goes to Michigan State University. Some cats have just IAA, and the presence of IAA can change our dosing strategies. We suggest that any kitty at 6 units or above, and on an all low carb diet, get tested for these conditions. Recent research shows 20-25% of all diabetic cats has acromegaly, not all of them at 6 units or above, so it's a common enough condition.

When my Neko was diagnosed with acromegaly (and IAA too it turned out), she had exactly two symptoms of acromegaly. Her dose (6 units +) and her savage appetite. Acromegaly is caused by a benign tumour on the pituitary gland (hypersomatotropism) that sends out excess growth hormone. So these little kitties tend to have the appetite of growing teenage boys. I found out later than Neko's one tearing eye was also a sign, of soft tissue growth in her tear duct. The majority of kitties do not have any physical signs of acro on diagnosis.

There is a cheaper treatment available now for acromegaly, if needed, that a number of people here are using. It's called cabergoline, and is a daily med that helps many with both symptoms and amount of insulin needed.

As for dosing, I wouldn't reduce the dose. You've done enough testing at 6 units to show it wasn't too high a dose. In fact, the lowest numbers were in the 200's, meaning it was too low a dose. 7 units at least got you into the 100's, though higher 100's. We only look back a couple weeks to decide how to dose. Anything back in June is ancient history for dosing. A cat's insulin needs can change over time, especially if there is an underlying condition causing insulin resistance.
 
I second the suggestion to have the IAA test added on!

Minnie was tested last month for acromegaly and I got them to add on the IAA test. Neither our primary vet nor the internist knew what IAA was. Lo and behold, negative for acro and positive for IAA. Minnie was diagnosed in April 2020 and was on Lantus til January, getting up to 4u then we switched to Levemir (vet's suggestion). She's been on a dose as high 6 and now sitting around 4u.

You have my sympathies as well with the ear poking - when I started, I was almost in tears trying to get enough blood. Socks of rice, jars of warm water... well after about 6 months I can say it is not an issue. I used to have to really poke the lancet in, now I just barely press the point and usually get a sample. Also I have stuck with a meter that only needs 0.3 microliter, which definitely helps (I use the Freestyle Lite and have Novamax as a backup).

Hang in there. When I first joined, I spent ages searching for posts that had numbers in the pinks and reds like Minnie and followed them - it was so hard to see all these posts in the greens/blues/yellows. Stick with it and don't be disheartened that you saw blues before and aren't seeing them now. Easier said than done, I know but look at Minnie's numbers back in Feb/March and compare them to now.
 
Wendy&Neko said:
I'm glad to hear your vet is willing to do the test for acromegaly. For a very cheap add on, you can also get the IAA or Insulin Auto Antibodies test. The bloodwork for that test also goes to Michigan State University. Some cats have just IAA, and the presence of IAA can change our dosing strategies. We suggest that any kitty at 6 units or above, and on an all low carb diet, get tested for these conditions. Recent research shows 20-25% of all diabetic cats has acromegaly, not all of them at 6 units or above, so it's a common enough condition.

When my Neko was diagnosed with acromegaly (and IAA too it turned out), she had exactly two symptoms of acromegaly. Her dose (6 units +) and her savage appetite. Acromegaly is caused by a benign tumour on the pituitary gland (hypersomatotropism) that sends out excess growth hormone. So these little kitties tend to have the appetite of growing teenage boys. I found out later than Neko's one tearing eye was also a sign, of soft tissue growth in her tear duct. The majority of kitties do not have any physical signs of acro on diagnosis.

There is a cheaper treatment available now for acromegaly, if needed, that a number of people here are using. It's called cabergoline, and is a daily med that helps many with both symptoms and amount of insulin needed.

As for dosing, I wouldn't reduce the dose. You've done enough testing at 6 units to show it wasn't too high a dose. In fact, the lowest numbers were in the 200's, meaning it was too low a dose. 7 units at least got you into the 100's, though higher 100's. We only look back a couple weeks to decide how to dose. Anything back in June is ancient history for dosing. A cat's insulin needs can change over time, especially if there is an underlying condition causing insulin resistance.
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Wendy -
Thanks for the information. My vet did order both tests but it was not exactly cheap - $320 for both of them and she said that was their cost but if it helps with a diagnosis and a cause for the need for so much insulin so be it. My husband and I felt it was worth it. My vet also did mention the medication for treatment as an option should Boots test positive.
I will follow the TR protocol as I understand it and increase Bootsie that way. I just feel bad about all the ear pricks. She does have a ravenous appetite and I do feed her small amounts almost every 1-2 hours which brings me to another question - won’t the fact that she is eating all day push her blood glucose numbers up?? Humans titrate their insulin based on their blood glucose but Bootsie is only on Lantis insulin 2x per day. It is different for cats?? Or is it because of the insulin depot that they can tolerate eating frequently?
Thanks
 
Jackie55 said:
She does have a ravenous appetite and I do feed her small amounts almost every 1-2 hours which brings me to another question - won’t the fact that she is eating all day push her blood glucose numbers up?? Humans titrate their insulin based on their blood glucose but Bootsie is only on Lantis insulin 2x per day. It is different for cats?? Or is it because of the insulin depot that they can tolerate eating frequently?
Thanks
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An attempt to answer this from someone who takes the same dose of Lantus daily, along with Humalog (fast acting) for carbs (and to correct highs.) :) However I am a type 1 diabetic and most cats are more like type 2 people.

Example - if I take 20 units of Lantus, I can (and must) add a few carbs at onset, and a few at peak insulin times WITHOUT needing humalog. After nadir, I usually can't sneak carbs in, which is similar to our cats - and most people don't feed kitties as much later in the cycle. This is more like how we manage our cats.

If I take 15 units, I need bits of fast insulin for ANY carbs during the day.
So, the dose of Lantus for kitties should be one that covers the snacks during the day like my 20 unit example does. I hope that makes sense!

I never knew about a depot insulin before coming here. I believe the depot isn't as important to people. Or maybe I'd been ignorant for many years!

Some higher dose cats do use tiny bits of Regular insulin in addition to Lantus or Levimir, but it isn't common, and requires close guidance and extra monitoring.

Oh, and the ravenous appetite should decrease once she is more regulated; however, Acro kitties are known for being hungry.

I look forward to you getting the test results.
 
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Tina Marie and Jan said:
An attempt to answer this from someone who takes the same dose of Lantus daily, along with Humalog (fast acting) for carbs (and to correct highs.) :) However I am a type 1 diabetic and most cats are more like type 2 people.

Example - if I take 20 units of Lantus, I can (and must) add a few carbs at onset, and a few at peak insulin times WITHOUT needing humalog. After nadir, I usually can't sneak carbs in, which is similar to our cats - and most people don't feed kitties as much later in the cycle. This is more like how we manage our cats.

If I take 15 units, I need bits of fast insulin for ANY carbs during the day.
So, the dose of Lantus for kitties should be one that covers the snacks during the day like my 20 unit example does. I hope that makes sense!

I never knew about a depot insulin before coming here. I believe the depot isn't as important to people. Or maybe I'd been ignorant for many years!

Some higher dose cats do use tiny bits of Regular insulin in addition to Lantus or Levimir, but it isn't common, and requires close guidance and extra monitoring.

Oh, and the ravenous appetite should decrease once she is more regulated.
Click to expand...
Tina -
I think I read somewhere I should not feed her for 1-2 hours before her PM blood sugar check - it that true? If so how do people handle the constant meowing and begging - she is a terrible beggar, so persistent! LOL. And the “nadir” is the low point in the cycle - correct? Or do I not understand that?
 
Jackie55 said:
Tina -
I think I read somewhere I should not feed her for 1-2 hours before her PM blood sugar check - it that true? If so how do people handle the constant meowing and begging - she is a terrible beggar, so persistent! LOL. And the “nadir” is the low point in the cycle - correct? Or do I not understand that?
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My cat is Tina, and I love being called Tina! I am Jan.
You are correct - the nadir is the lowest the dose takes the cat.
The reason for not feeding for two hours before shot time, is so that the pre shot number (AMPS / PMPS) is not food influenced. I bet it is very hard to not feed when being told otherwise by your sweet cat!
If Boots does have Acro, it would help explain the hunger - also I edited late in above post . . . Most kitties aren't so hungry all the time when BG numbers are better.
 
I can sympathize with the constant hunger. My girl when she was in high numbers, on top of her acromegaly, would cruise the kitchen counters. Absolutely all food had to be locked away. Well, except fruit. If you absolutely must feed, you can do a zero carb snack, such as a freeze dried all meat treat, or a piece of baked or boiled chicken breast.

The "no food for two hours before shot time" is what we suggest to new people. When a cat eats some food with carbs, it can inflate their blood sugar for a couple of hours. If your cat is low at show time, you don't want to wonder if the number would be safe to shoot without the numbers being inflated by carbs. Once you get an idea of how many points your cats blood sugar will go up with food, then it's not so much an issue. Ditto if kitty is well over 300. A "food bump" is typically less than 100 points. For my girl her main meal bumped her up 30-40 points. Now that's her and each cat is different, as is the food they eat, so you have to experiment and find out what it is for Boots. Getting the odd +1 test may help you figure that out.
 
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