Dak's Introduction to the Group and Questions about BG Chart

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Jeremy & Kate

Jeremy & Kate

Member Since 2023
Good evening everyone,
Our oldest cat, Dak, was recently diagnosed with diabetes on November 3, 2023. Dak is a medium hair black cat that is 9.5 year old male cat. He is as sweet as can be and loves greeting people at the door. He was diagnosed at the vet clinic, when my wife and I noticed that he had dropped 3 lbs in about 3 weeks (17 lbs down to 14 lbs). He also was not wanting to eat and was not acting himself. His BG reading at the vet was 466 mg/dL. The vet had us start Dak on vetsulin, until we run out of the bottle of Vetsulin (then plan on switching over to human insulin, we are planning on swapping over to Lantus), at a rate of 1.0 unit every 12 hours. We have been doing home BG testing with the Contour Next test strips (human monitor). Dak was on Purina One Urinary Tract Health dry food and we switched over to Fancy Feast Classic Pate wet food, about a week to two weeks are he was diagnosed.

My wife and I wanted to see if you all have any advice or comments on Dak's BG spreadsheet so far, as we are trying to notice a trend, but are unable to at the moment. Today threw us for a loop, as it was the first time we had to skip a morning shot of insulin and was surprised to see his number not spike exponentially when we got to the evening shot time.
 
Hi and welcome to the forum Jeremy, Kate and Dak.
Great you are hometesting and are going to swap to Lantus insulin. It is a much better insulin than vetsulin.
Thanks for setting up the SS and the signature. Very helpful.
That was a very good move to swap to the FF pate foods which are low carb.
Do you have a hypo box set up in case of low numbers?
HELP US HELP YOU has info on the hypo box and other useful information.

Looking at Daks SS I can see you need to reduce the dose of the vetsulin.
Any time the BG drops under 90, you need to reduce the dose. So your new dose will be 1.25 units. Stay at that dose unless the BG drops under 90 again.
Are you testing, feeding, then Waiting 30 minutes before giving the vetsulin? If not I would highly recommend you do that because Vetsulin is a harsher insulin and the cat needs food aboard for when the insulin hits. keep asking questions :)

BEGINNERS GUIDE TO VETSULIN

Bron
 
I see you did a couple of stalls in the last few days…did you withhold food while you did this.?
When you write the stalls in the SS you stack them all in the AMPS or the PMPS column one on top of the other. And the new +1 is after the final stall.
So for this morning, you would write 156@+12; 153 @+12.5
Does that make sense?
It’s great you are putting information into the remarks column and are getting tests in during both the cycles…well done!
Are you giving a couple of snacks during both the cycles? I would suggest a snack around +2 and +4 and again any time you find the BG dropping after that. A snack is a teaspoon or two of low carb food.
 
Thank you Bron for some helpful feedback! I went ahead and adjusted the SS readings for the AMPS and PMPS times that we stalled and re-measured Dak's BG. Yes, we have a Hypo Kit together (high carb % wet food, honey and spare test strips) for Dak and make sure it is on the pet packing list whenever we travel with him! When we stalled the last few days, we did withhold food until we re-tested. We have been testing, feeding and then giving insulin after Dak had started eating for a few minutes (makes it easier to give him insulin, as he can get squirmy). We have been putting snacks out around +3 in both cycles, so Dak has something to snack on during the cycles.
We had another no shot morning, due to his readings being at 111 @ +12, then 88 @ +12.5
 
Wow. I'm impressed. You both have mastered the basics and gotten your signature and spreadsheet set up. We don't even have to try to prompt you to convince your vet to switch Dax from Vetsulin to Lantus. (FYI - Lantus is now in a generic/biosimilar form of glargine. It's much less expensive.)

The only recommendation I would make while is to get a curve done. This would mean testing every 2 hours for a 12 hour cycle. The reason for getting a curve is so you have a clearer idea when insulin onset begins and where nadir (lowest point in the cycle) falls. With Vetsulin, you may want to leave a few more snacks out early in the cycle to buffer the effect of the insulin a bit. Vetsulin has an earlier nadir and typically doesn't last the entire 12 hours cycle. Once you switch to Lantus, you'll want to do the same. The curves will likely look quite different (but that's getting ahead of things).
 
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Welcome Jeremy, Kate and Dak
You couldn't have found a better group to join.
I don't think Tyler would have been in remission since 1-24-21 if it wasn't taking the advice from the experienced members here .
I see you will be switching to Lantus eventually
If you tap in this thread in blue and look at post #4 , post numbers are to the right here is some information I posted about generic /biosimilar version ,it's less expensive in the US than Lantus
https://felinediabetes.com/FDMB/threads/new-member-11-8-and-i-am-tired.283363/#post-3121360
 
Don’t forget you need to reduce the dose to 1.25 units when the preshot is high enough to shoot.
I agree with Sienne, I would leave 2 or 3 snacks out for Dak in the first half of all cycles.
 
I updated Dak's SS with some readings today. We stalled before his PM insulin shot, due to the first PMPS being a little under 200 and to see if his numbers were increasing (which they did to 212, 30 minutes after first PMPS reading). We did reduce his insulin amount to 1.25 units. For his snacks, we have been putting out some frozen wet food, so Dak can graze on it during the first half of the cycles.

Thank you for the link Diane! I will definitely take a look at it before we switch over to Lantus.

Sienne and Gabby, we did do a glucose curve when we first started giving Dak 1.5 units (before reducing him to 1.25 units, then back up to 1.5 units). We are probably due on performing another glucose curve, but unfortunately can only do the curve on the weekends, due to my wife and I working full time.
 
Wanted to get you all's advice for the next step for Dak, based on his BG readings today (11/27/2023). My wife and I decided to skip his doses today, due to his numbers either within the normal range or numbers decreasing after stalling. What would you all recommend for Dak with his insulin (Vetsulin currently) injections (try OTJ trial, pending his upcoming day BG numbers, or reduce the amount of insulin we are giving him, etc.)?
 
I would reduce the dose to 1 unit and see if you can shoot it both cycles.
He is not ready for an OTJ trial yet. We like to make sure cats have strong remissions and that means keeping them on insulin for as long as it is safely possible.
Preshots can decrease after stalling as well as going up. This is often due to the cat needing food.
Make sure Dak is eating well…very important. Are you now completely on low carb wet food?

Any time the BG drops under 90, you need to reduce the dose.
You are doing a great job! …keep posting
 
Sounds good and yes, Dak is completely on low carb wet food. Would we still follow the normal guidelines of giving or not giving insulin, correct (If his AMPS or PMPS is above 200 or trending up to it in the upper 100's, give hime insulin)?
 
With Vetsulin, you have options with regard to giving insulin vs skipping. If the pre-shot number is lower than what you're comfortable with, you can:
  • not feed your cat and stall for 20 min or so. Re-test to see if numbers are rising. Repeat the process until it's safe to shoot.
  • shoot a reduced dose of insulin
  • skip the shot
There are caveats. You need to be able to monitor Dak's numbers if you shooting lower numbers or shooting a reduced dose. This means that your schedule not only needs to allow you the flexibility to be off-schedule at the current shot time but your next shot is due 12-hours later unless it was a minor delay in shot time. It also means that you need to have a supply of strips and high carb food just in case Dak decided he really liked the lower numbers.

Ultimately, you want to be able to shoot progressively lower numbers. As a new member, we don't recommend shooting low, especially with Vetsulin. With anyone new to feline diabetes, we want you to master the basics and there's a lot of information to assimilate before you have to deal with managing lower numbers. What I suggest is that you give thought to what number you would be comfortable shooting. You want to become familiar with how to use food to steer Dak's numbers and become confident in your ability to prevent Dak from dropping into numbers that are too low.
 
Update on Dak since 11/28: We have not been giving him insulin, due to his numbers being too low to give him insulin (<100). Crossing our fingers that his numbers stay on the track they have been the last few days! Pretty much all of his original personality (before he was diagnosed) has come back and we got him on a pretty good meal schedule so far. We trying to work on weening him off of Mirataz, to see if his appetite stays with the reduced amount of Mirataz rubbed on his ears.
 
Keep testing his BGs for 14 days to see he can keep in normal numbers.
Here are instructions for OTJ trial which you have effectively started.

Instructions for starting the OTJ trial
Start the trial on the next green pre shot.
If he/she is green at your normal test times, no need to test further until the next "PS" time; just feed small meals and go about your day. If he/she is blue at your normal "PS", feed a small meal and test again after about 3 or 4 hours. If his/her number is lower 3-4 hours after a meal, then the pancreas is working!
Post every day so we can monitor your progress and see if any tweaks are needed. He/she may have a sporadic blue number. Don't panic but post before you decide whether to shoot so we can have a discussion.
After 14 days of no insulin, we have a party!!
Sometimes the trial doesn't work the first time and we have to give a little more support in the form of resuming insulin. It's not the end of the world if that happens; we just give him/her the support needed. Our goal is a strong remission and it's better to take our time to get that than to rush into remission just to have it fail later on.
Good luck with the trial!!!
Once he/she is through the trial successfully, you enter a new phase. Your cat is still diabetic but has now become diet-controlled. Continue feeding low carb food in the manner successful for your kitty. If you decide to change his/her feeding schedule, let your meter be your guide to the best times to feed. Avoid medications with sugar in them and steroid medications unless they are medically essential. Continue testing blood glucose weekly for the first month and then monthly forever. It's a good idea to weigh him/her monthly. Weight should remain stable. If he/she seems "off" or sick, or is showing signs of diabetes (excessive drinking, eating, urinating, weight loss), test his/her blood glucose right away. Keep the teeth and gums clean and healthy; dental issues can bring a cat out of remission. If you see rising blood glucose numbers, it's time for a visit to the vet!


Is he eating well?
You will need to continue to keep him on a low carb diet for the rest of his life.
 
Yes, Dak is eating very well (often meows at us sometimes because he wants more food ha, but we dont want to give him too much that he becomes overweight again). His numbers are still in the green and looking good so far(his AM number was 54 this morning).
 
Yeah, I normally add some warm water to his food (FF classic pate). For snacks during the day, we do pate popsicles, so they have plenty of water in them also.
 
It has been a little while since we have posted an update about Dak, but we can officially say his OTJ trial was a success!! I will say also that you can tell he is feeling like his normal self now, as his "true color" has come back (wanting constant affection, getting mini "zoomies" every so often, playing with our dogs and wanting to play with us) with his numbers in the normal range.
 
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