? Cat always hungry, BG won't regulate-Now with updated spreadsheet :)

Hi all, new member here. My cat, Mouse, has been on Lantus for about a month now, but we've been playing with the levels a bit because her glucose has just been crazy.

She was a free feeder, grain free dry foods. She now gets Tiki Cat Salmon wet. She was about 6lbs, and has put on about 2lbs since switching over.

On 2 units twice a day she would drop to below 60 halfway through the day, and have wicked diarrhea, on 1 unit twice a day she was still dipping really low in the morning and still had diarrhea, but spiking high, over 200 at night.

I stopped giving her a dose in the morning on my own because she was 160, I didn't want her going below 60 again, and let my vet know. This also stopped the diarrhea. They ran with it (my vet is awesome), but after I ran her curve, they weren't happy with her numbers and wanted her back on 1 unit twice a day. She was still spiking at night on the one unit at night.

As soon as I put her back on the 1 unit 2x, the diarrhea was back, bad.
I spoke with the vet again and was able to talk them down to 1 unit in the am and 0.5 in the pm, which seems to have solved the diarrhea, but....she's STARVING, if you ask her... constantly begging for food. She tends to sit around 150BG through the day, which is too high, but I can't keep bathing her every day.

I give roughly 10oz of food a day, so it's not like I'm starving her. I'm pretty sure I'm over feeding her, tbh, based on the can's directions.

FYI: I use AlphaTrack.

Any suggestions for helping her regulate and feel full?

 

Hello to you and Mouse!

Can't comment on the diarrhea ... I wouldn't think insulin dosage would have anything to do with it. You sure it isn't the food? Tiki Cat is good for diabetics, though we don't recommend fish as a daily staple food. Dr Lisa Pierson said this in her food chart:

As far as food, is Mouse still underweight? Unregulated diabetics need at least twice as much food as a normal cat. Normal cats average 20 calories per lb, however an underweight cat should not be restricted from eating. Are you also feeding multiple times a day? Bigger meals at shot-time but small snacks throughout the day are better on the pancreas and helps the hunger.

Lantus is a depot insulin; by not giving the same dose at AM and PM, you alter the depot and make it difficult to maintain BG. I'm glad that you're testing; 60 is way too low on an Alphatrak. This may take a little time, but could you fill out a spreadsheet for us? It will have all of Mouse's testing data so we can take a look and see what's going on. If it's too difficult, the mods here are happy to set it up for you!

Spreadsheet Instructions

 

Have you tried a food without fish? It's a common allergen for cats.

 

I didn't know about the allergens in fish, and I was curious about the mercury levels, I don't eat fish myself, I think it's gross, but she loves it more than the chicken, because it's so moist.

She originally got diagnosed when we took her into the vets for the diarrhea. Her BG was over 500. It eased up after we started insulin, and started her on the Tiki Cat. Then came back, went away, came back...so it's possible it's completely unrelated.

 

Mouse is up to about 8lbs now, so she's getting to a good weight. It's funny, because while she was underweight, she was fat. She had a nice little fat deposit on her belly that was really obvious. We even gave her an ultrasound because we weren't sure what it was, so we paid $200 to find out she was just a fat, underweight kitty. And then it was double confirmed by the vet when she was fixed, they decided to take another look at it during that surgery just to be on the safe side. She just looks bloated all the time.

 

I agree about feeding fish all the time, take a look at the food chart Panic gave you above, all the carbs and calories are listed there.
Most of us feed Fancy Feast Classic Pates they are about 2 or 3 carbs and also to give the same dose of insulin in the AM and PM

 

You don't have to feed your cat only twice a day, bigger meals at AM and PM and then a few smaller meals during each cycle

 

That's the same food chart my vet gave me I spent hours going over this before I decided on Tiki Cat. I ultimately want to stay Grain Free, since my cats have been that way for the last 10 years, and have improved a lot health wise since we did it, but I will look into switching to something other than fish, since there are additional health risks that I wasn't aware of before I put her on it. I have 3 other cats I need to feed too, and want to keep them all on mostly the same diet.

 

I've been doing that, she gets 1 1/2 cans in the am and pm, and a can through out the day. The rest of the cats get a scoop of their old dry food mixed with her wet food and a liquid topper to eat through out the day (once I get through the stock pile of dry food that I can't return they're moving to wet food only). I just read through Dr. Lisa'a post about free feeding wet food, and I might do that for her once I get her a little more stable.

 

What are the +1, +2 stuff on the spreadsheet for?

 

Just want to make sure you understood what everyone said above about same dose of Lantus in the morning and evening. If you only give insulin once a day, your cat is basically unregulated for 12 hours since the insulin only last for about 12 hours.

we start counting with the shot time. So +1 is an hour after the shot then +2 is 2 hours after and so on until you get to +11 and the next shot at the 12 hour mark

 

Yes, I did understand that. Currently, she's on 2 doses, but a smaller dose at night. However, I failed to mention that was only for this weekend to see how she did. I'm supposed to follow up with her vet again tomorrow and discuss her dose again. Her BG and spot checks have been ok even while on the funky dose.

And she was only on the single dose a day for about a week.

Now that I know what the +1, +2 things are, I can start filling out the sheet so you all can look over her numbers for the last month and you you'll be able to see why I made some of my decisions. Most of them were made after research and speaking with the vet.

Now that I've read more of the forum posts, I'd make different different decisions, like reducing her morning dose instead of skipping it. I didn't realize that was an option, so I'm really glad I found you folks!

 

Got it. Thanks for explaining it!

 

Please note, that while I did fill in the spread sheet, there are some days that I just did not document. I have my own health problems that I've been dealing with as well, so some data is incomplete. I'm doing my best over here. If you have questions, please ask.

Looking over the sheet, I see that I may not have made the best decisions now that I can see the data in full instead of one day at a time.

 

Excellent work, I love it!

So to be clear, the days where you don't list the dosage, were those days skipped or you don't have the data? If no insulin was given, please just enter "0" or "skipped" so we know.

As stated before, it's really important for Lantus to have the same AM and PM dose, because of the depot. It may be a good idea to stick to 0.5u in both the AM and PM, since I see a few days ago Mouse dropped to 100 on 0.5u and that's a really nice number for Alphatrak. We primarily use human meters on this board (they're cheaper to use) so I don't know off the top of my head what the desirable range is on Alphatrak. On a human meter it's 50-120. On Alphatrak the "take-action" number is 68. That is when you want to use carby food to bump the BG back up into safe numbers. @Diane Tyler's Mom I think has a list she can copy-paste of good Fancy Feast Gravy Lovers you should keep on-hand, which I strongly advise you to get asap since Mouse isn't a stranger to low numbers.

I'd really like to nudge you over to the Lantus forum for confirmation on dosage - they are a wonderful bunch of people who are experts on Lantus, but many don't visit the Health Forum and won't see this post. I would recommend making a thread saying New Member - Dosage Help Please , and linking to this board so they can see what's already been discussed.

Mouse has very, very nice numbers already, especially being on Alphatrak.

 

My vet wants her around the 90 range with the AlphaTrak. I thought about using a human meter, but frankly, I'm horrible with math and can't even remember simple conversions. I looked at the math for the conversion to pet on the people meters and just spaced out. We can cover the cost for the strips since we're not eating out anymore (thanks Covid), lol. I priced out the free style strips for it, and they actually cost more than the AlphaTrak strips (numbers are off by about 15 points, in my experience. We ran out and a friend came though in a pinch with her free style strips) So I just order off Amazon.

When her numbers dropped into the 70's and 60's I just gave her some of her old dry food, which she loves and still tries to get into when the boys have it. We also have a bottle of Karo Syrup on hand for her. I'm home all day, so I can keep a really close eye on her, another "blessing" of the outbreak. I'm particularly lucky that she got diagnosed while I was out of work and could monitor her so closely.

Ideally, I want her to be on the .05 dose in both the AM and PM, but I wasn't able to talk the vet I spoke with Thursday into it. 2 units bid was too much, I suppose I didn't really give 1 U bid a decent chance to normalize and I may have jumped the gun on dropping it down.

I can take this over to the Lantus forum though. Or discuss it with her vet tomorrow. It'd be nice to have more than just my conjecture to talk with her about though, lol.

 

Well you're in luck haha. There's no conversion between a pet and human meter. Human meters run a tad lower but they work just the same. All the info you find here (unless specifically stated) will be in reference to human meters. The Alphatrak is still a fairly new invention. I think of it as just an expensive way to keep your vet happy. It's fine if you want to stick to Alphatrak, just be sure to always mention it in the forums when dealing with low numbers! For most of us the cost does eat at us enough to make the switch (myself included). At $1 a strip and testing 4-5 times daily, yikes! Not to mention hypo events that can be 10+

Karo syrup is good! The dry food isn't particularly helpful in hypo events simply because it takes too long to enter the bloodstream and even longer to leave it. Enjoy that WFH Covid blessing while you can!

It's always better that you and your vet agree, but ... you are the one holding the syringe every day. Most of us handle dosing ourselves, thanks to the wealth of knowledge and experience here. I've seen too many cats overdosed and killed because they were following vet instructions. :/ Your vet can make things worse by keeping a dose too high. We have another new kitty here who, last I saw, hasn't had ANY insulin in days. The vet wanted to keep giving him 3u, despite being in non-diabetic numbers. Luckily the caregiver was testing (despite the vet saying not to bother). That's an easy way to kill a cat right there!

You can never jump the gun by decreasing. On human meters, we drop the dose when the BG goes below 90. I think on Alphatrak that's about 100-120. You can always increase if needed, but you don't want to give too much to "see if it works".

This is the 2018 AAHA Diabetes Management Guide for Dogs and Cats. Your vet should not be able to argue this, seeing as it's from the American Animal Hospital Association. This actually states that on Lantus, cats should start at 0.25 to .50 units. Your vet started her at ... 2, was it?

Yes, please post over in Lantus. It'll be nice to get extra eyes on it!

 

[QUOTE="Panic, post: 2622990, member: 27026"
Karo syrup is good! The dry food isn't particularly helpful in hypo events simply because it takes too long to enter the bloodstream and even longer to leave it. Enjoy that WFH Covid blessing while you can!

[/QUOTE]

I was unaware of that. I'll grab a few cans of high carb food to have on hand!

[QUOTE="Panic, post: 2622990, member: 27026"
It's always better that you and your vet agree, but ... you are the one holding the syringe every day. Most of us handle dosing ourselves, thanks to the wealth of knowledge and experience here. I've seen too many cats overdosed and killed because they were following vet instructions. :/ Your vet can make things worse by keeping a dose too high. We have another new kitty here who, last I saw, hasn't had ANY insulin in days. The vet wanted to keep giving him 3u, despite being in non-diabetic numbers. Luckily the caregiver was testing (despite the vet saying not to bother). That's an easy way to kill a cat right there!
[/QUOTE]

I hope to get to that point myself, or get her into remission before then. My vet actually though she might have been hitting remission already with her low numbers early on. I'm blessed with a great vet team, who knows that I try really hard to take good care of my babies, so they're willing to listen to my thoughts on her treatment. The vet you mentioned...geessh. I'd fire that one real quick. I'm learned very quickly over the last year to be an advocate for myself and those I hold dear. That would not fly with me.

 

haha...that didn't work. You'll have to show me that trick

 

Well that should have worked! XD I just highlight what I want to quote and hit the reply button that pops up.

I will say that your vet sounds a little more knowledgeable than the average vet that we see here. Hopefully they're willing to work with you on the dosage but as said, many of us just don't ask for dosing advice from them anymore and do our own thing lol.

Same! I hate the thought of challenging someone who's supposed to be smarter than me. When I stood up to my vet after she sent my low-carb food back out and insisted the high-carb prescription food was better, I thought I was going to die. xD Come to think of it she still turned around and used the high-carb during the visit AND charged me for it. Ugh. But she quickly learned after I sent her the catinfo chart I meant business and backed off.

We're cat-vocates now!

 

I love that the first thing my vet did was hook me up with a chart of all the low carb foods on the market, because even she knew that the prescription foods are garbage. I'm actually moving all my cats over to foods off the low carb list now. I've never had a wet food that all of their stomachs agreed with before. I'll probably pick up a bag of the dry food I see people mentioning for their teeth though.

 

What food? Never heard of that. Unless it's people claiming dry food cleans teeth again.

I had to do the wet food dance after switching my kitties too! My tom kept spontaneously puking after I switched to wet, not sure why. When my diabetic passed I had 4 unopened boxes of Fancy Feast that I gave him. When he ate it all up and I switched him back to his 9 Lives wet the pukes started up again I started putting two-and-two together. Not sure what it was that bothered him but he's on Friskies Pate now without issue.

 

well, dry food only works for teeth if they actually chew it, lol, which most cats don't. My punctuation was bad in my sentence. I wasn't saying that the specific dry food was good for their teeth. I was talking about the low calorie dry food, Dr Evo or some such. My boys actually do chew the dry food, occasionally.

 

Oh gotcha! XD Yes, there is Dr. Elsey's which some people use - however if you're wanting to do Tight Regulation with Mouse you won't be able to use it, even if it is low-carb.

 

Interesting. Is there a reason behind this?

 

The bottom line is that the research done on TR does not include dry low-carb food, it was done on wet/raw food. Evo, Dr Elseys, Young Again, were not on the market at the time. No studies have been done using dry, and since it metabolizes at a different rate, it's a risky thing to experiment with. TR is a very aggressive protocol and throwing in an unknown variable could have dire consequences.

The other argument is that dry is just bad in general, being water-depleted, but mainly concerning TR it's that no research has been done.

 

Stole this from one of Diane's posts ... here's the names of the food that will be good to keep on-hand.

Fancy Feast Gravy Lovers Gourmet Beef Feast in Gravy 20% High Carbs
Fancy Feast Gravy Lovers Gourmet Chicken Feast in Gravy. 15% Med Carbs
Fancy Feast Gravy Lovers Turkey Feast in Gravy. 15% Med Carbs
Fancy Feast Gravy Lovers Chicken and Beef Feast in Gravy 15% Med Carbs

Medium carb is 11-17%, High is 18%+
I would tape a note on top of each one with the carb amount and stick them somewhere away from the regular food so you don't use them on accident.

 

That's good enough reason for me.

 

Fancy Feast Gravy Lovers Gourmet Beef Feast in Gravy 20% High Carbs

Fancy Feast Gravy Lovers Gourmet Chicken Feast in Gravy. 15% Med Carbs


Fancy Feast Gravy Lovers Turkey Feast in Gravy. 15% Med Carbs


Fancy Feast Gravy Lovers Chicken and Beef Feast in Gravy 15% Med Carbs

Good to have these on hand, it's really only the Gravy you would need to feed him, or just a teaspoon of the food.
Always good to have honey in hand

 

WELCOME TO FDMB!

OMG ! You mean I'm not alone??? This is me in a nutshell.

 

Hi Allison,

I think there's a possibility that the 1 unit dose might be too high:

• AM+11 on 28 August: that 72 is just above the hypo threshold and Mouse had no insulin the night before. It's also very late in the cycle and his BG levels may have been even lower earlier in the cycle. (Did he have diarrhoea that day BTW?)
  
  
• Mouse is spending most of his time either in the top end of the normal range or just above it, so she is relatively well-regulated. She is also gaining weight. The weight gain shows that his body is now using nutrients properly. If all was well then his appetite should be pretty close to normal by now but she is still acting as though he is starving. This could also be an indication that her blood glucose levels are dropping or that his body is having a hard time keeping them at a safe level.

I would suggest you discuss with your vet changing the dose to 0.5IU twice a day, holding that dose for a week to allow time for the Lantus depot to stabilise (assuming no reductions needed) and then reviewing Mouse's response - both BG levels and clinical signs (e.g. does the 'I'm starving!' behaviour reduce). You could then always adjust the dose if necessary (reduce to 0.25IU twice a day if numbers dip too low, or increase to 0.75IU twice a day if numbers are still a little too high). If your vets are reluctant to consider this approach at first, perhaps negotiate that you trial this method for a certain period of time and if nothing improves consider a different approach.

Particularly when using a depot insulin, it doesn't just matter how much insulin you give, it also matters when you give it, because each dose is affected by previous doses. It could very well transpire that Mouse needs a total of 1.5 units of Lantus a day, but you would get very different results dosing it at 0.75IU twice a day compared to 'lopsided' 1.0IU AM / 0.5IU PM dosing.


Mogs
.

 

She did not have any issues with diarrhea on the 28th, but it did come back tonight, and her numbers were low today. I started testing every 2 hours as soon as I saw them drop to the 90 range. My vet said I shouldn't worry unless she hits 65, so i wanted to watch her closely today, especially since she hit 90 so early in the day. My vet wants her to sit at 90 for the majority of the day. I'll be happy if she's around 100-120, because she seems perkiest and playful in that range. She was pretty sluggish today.

I do try to check her BG before I give her any snacks, as I don't want to give her too much to send her too high, and it tends to be around 140 when she thinks she's starving. I don't know if that helps you at all. I tend to base the size of the snack on her BG.

With the spreadsheet you all have provided, I think I'll have a better chance of showing the vet some hard data on her stats, and I think they'll be more agreeable to lowering the dose like I've been asking them too. If was a tough fight to even get the night dose lowered, since that is when she has the diarrhea. With what everyone here has been saying, it's possible that the vet I spoke with that approved the lower night dose may not be as familiar with feline diabetes as the one I work with normally though, because it seems the wonky dose isn't as beneficial.

I will say that tonight's digestive upset was not as bad as her others have been.

I do my best to get her shots in at 7 am and 7 pm, but due to my own health issues, she's not getting them at consistent times every single day. I do make sure they are 12 hours apart though. For the most part, I'm usually only off by an hour or so.

 

This thread has the Roomp and Rand TR study attached (it's the first one).

Hopefully you won't have to, but don't be afraid to push back if your vet says "no". You are educating yourself and you hold the syringe and you pay the bills. A lot of people have "fired" their vet(s) until they found someone who would work with them. I value experience over education, and after finding this forum I stopped trying to get permission from my vet and just did what made more sense based on the experience here and the studies (done by real vets) available. C's get degrees and all that. I personally would switch to 0.5u tomorrow, morning and night, whether the vet says yes or not. Your vet seems smarter than most we get here though so hopefully they will embrace it.

Lantus especially craves consistency - from the dose to shot-time.

Since you said sometimes your health causes you to not be consistent each day, keep that in mind if numbers start looking off. For best results, Lantus dosing should alter no more than 15 minutes each cycle OR 30 mins in a 24 hr period. Anything more is like giving extra insulin on the next cycle, anything less will be like giving less than full dose. Lantus cycles affect each other greatly.

If TR is followed closely, the likelihood of Mouse going into remission within the first 6 months is greatly in her favor.

 

That's good information to know. I haven't heard back from her normal vet, but her numbers are dropping again right now, so I may just drop her to 0.5 myself tomorrow and see if it's better. I don't really want to go to sleep with her dropping below 100 again. I just gave her a beef snack, and am waiting to test her again at +6

 

I see that in the Remarks section, you've logged some of Mouse's GI upsets. If you have records of other dates when Mouse had diarrhoea it would be valuable to add those to the spreadsheet (and whether diarrhoea was in the AM or PM). It might better highlight to your vets the correlation you have observed between lower numbers and Mouse's GI disturbances. Also, it might be helpful to add brief comments in the Remarks column about when Mouse feels best (e.g. "alert and playful at AM+4"). The observations and BG data together form a fuller 'bird's eye view' of how Mouse is doing.

To your vets' credit, Allison, they seem quite progressive when it comes to treatment of feline diabetes. They provided you with a good food list from the get-go, they are keen to see Mouse quite tightly regulated and have remission as a treatment goal for her. (A lot of vets merely aim for the cat to maintain BG levels under the renal threshold and to keep them 'running hot' to minimise risk of hypos).

That said, your vets seem to now be chasing a number and losing sight of their patient a little. You're following your cat. I agree with your target, not your vets'. It's all about the cat. The entire purpose of insulin treatment is to have a cat that is happy and well. The numbers are merely a guide toward that goal.

Running in the lowest reaches of the normal BG range doesn't suit all cats. Some of them are happier and do better running a little bit higher than that but still in the healthy BG range. I wonder whether at the higher dose (i.e. the 1IU dose; the 2IU dose was too high, full stop) Mouse's little body might be 'fighting' the dose in an effort to keep her BG level in the 100-120 range (where you've observed she feels much better) and whether that strain might be making her feel 'off' in general and triggering the GI upsets at times.

Safety note: As a general precaution, when reducing insulin it's recommended to check pee for ketones (daily when BG is high until better regulation is achieved, or for first few days when the cat's regulation is better at time of reduction). More info:

Testing Your Cat For Ketones

Tips for Collecting Urine Samples

Be sure to let us know how you get on with the vets. I hope negotiations go well.



Mogs
.

 

This. This is exactly where my brain is at right now. Unfortunately, during her early days, I was on high level pain killers, so I wasn't good at paying attention to her GI issues, and my husband was dealing with most of her clean ups and vet visits, and just letting me know when I woke up from my fogs to do her shots and tests. I'm honestly not sure what days she had issues what she didn't, but I do know its part of why she got diagnosed. She was vomiting any time she had something more than water and had bad diarrhea. They suspected pancreatitis and were able to confirm the diabetes at the emergency vets, with no ketones.

Now that I'm finally off the pain killers around the clock, I'm able to pay her the attention she needs and start taking care of her properly, and was able to talk my husband through his terrible fear of needles to get him to help me with her shots so she's starting to get things a little more on schedule, and should be able to continue it if my health turns again. I've also taught my best friend how to do it, as she helped me out post-op with her glucose curve.


Side note, her AMPS is 153, so I am dropping her to 0.75 today. I don't want a repeat of the stress from yesterday. I don't have the ketone strips yet, but she sleeps at my feet all day long, and her Karo syrup is right next to me. She just ate, so I'm going to test her one more time before I give her any insulin. (I'm bad at following anyone's directions, I know the TR directions are to stall food, but the other cats are really destructive if they don't eat).

 

I just ordered some ketone strips from Walmart, and decided to order the Reli-on glucometer and strips as a backup as well when I checked the prices on them. They should be here in a couple of days. My local Wally world was actually out of stock.

 

God bless you and your hubby (your friend too) You are doing the best you can for Mouse and its paying off.
God love ya!
j.