Diabetes - Initial Treatment - Need Advice

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Ok sounds good thank you I will start with 6 and try to get some more BG checks in and check for ketones again. I did checks today but it got crazy here and I forgot to add them on the spreadsheet ahh!! I remember they were all in the 20's but can't remember the times....

I will do 6 units this evening and test a few times before bed.

Thanks!
 
The Drill!

1. Be sure to lift food for 2 hours prior to the preshot test.

2. Do preshot BG test. (VITAL you do this for every dose - for both safety and also to enable you to assess how any dose adjustments are working.)

3. Feed Davey then wait 20-30 minutes before giving the insulin dose.

4. Test at +1, +2, and +3 hours after the dose was given.

Extra tests are just for the time being to try to catch dips in BG early in the cycle. Once dose issue is sorted you'd normally do a before bed test about +3-ish after the dose was administered.

Tip:

Even after you get past this phase, if ever you see Davey asking for food soon after his insulin - say, at +1.5 - test his BG straight away: it can be a signal that numbers are falling early in the cycle and he may need closer monitoring.

** When you get a moment it would be helpful if you could add to your signature that you are using the Fastapet pet glucometer so that members replying to your posts will be able to correctly interpret any BG readings you post. **

(Human and pet meters use different reference ranges. Note: I use an Alphatrak 2 pet meter and I use 3.9mmol/L as the point where I intervene with carbs to bring numbers back up into a safer range and prevent a hypo (my vet gave me the range 3.9 - 8.3mmol/L as the normal range for cat blood glucose levels). I suggest you confirm with your vet the correct reference range to use with your meter.)


Mogs
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So I waited in the basement today for Davey to pee so I could use the ketone test strip and I noticed as he was peeing that his urine is very foamy. I looked this up quickly online and I'm seeing comments that this could suggest kidney failure :(. I'm getting so frustrated and I feel terrible that I have to get back to work tomorrow and such and won't be able to keep an eye on him as closely as I have through the holidays. Since I've been home the last few days I've noticed all he does is eat, drink, and lay on the floor (usually on the door mat). He used to sleep with my daughter or us or come up with one of us on the couch but he doesn't even bother now so I know he's not feeling good. He's still testing negative for ketones.

I will have to give the vet a call tomorrow. Does anyone have an idea of what foamy urine could mean? I'm not sure when this started because I never actually see him pee, this would be the first time I have in a few months. I have to keep his litter in the furnace room away from the kiddies and I'm never in there...
 
I think 6 u is still too high a dose based on the very high numbers he still has. My opinion only - let's see what others think.

I don't know what the foamy urine means, if anything. Probably best not to think kidney failure at this point. Getting his BG down is the more immediate concern. He probably feels unwell because he's so high. Good to see he's negative for ketones though.

You could post on the Caninsulin/Vetsulin forum as well as here to see if others who use this insulin have ideas about dosing.
 
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Foamy urine CAN be linked to kidney issues, but in a cat running high numbers as Davey is at the moment, I'd think it's more likely linked to sugar loss in his urine. You might also find his urine is 'sticky' and he tends to get more litter stuck to his paws than before he became diabetic...that's definitely something I noticed with Rosa, though I didn't put 2 and 2 together until well after her diagnosis when the problem resolved itself again!
 
manxcat419 said:
You might also find his urine is 'sticky' and he tends to get more litter stuck to his paws than before he became diabetic...that's definitely something I noticed with Rosa, though I didn't put 2 and 2 together until well after her diagnosis when the problem resolved itself again!
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Thanks! I definitely have noticed litter stuck to his paws, that has been going on for a couple months now.
 
That would be the glucose in his urine then. Like I said, I only figured it out later on, but it is useful to know to be able to pass the information along...and of course I know now to look out for it with our other cats too!
 
Sorry but I have yet another question. Has anyone ever noticed variations in their meter readings? I just tested Davey and got 25 which I thought was too high once I considered where he was an hour before so I decided to test him again just to double check. Just seconds later I got 21.1 and then on a third try I got 20.7. Does anyone know what could cause such a huge difference between my first reading and the others?
 
Yes, that does happen unfortunately. All meters are allowed to read +/-20% from the true value, so especially at higher numbers, you will see this sort of variation if you repeat a test. I would take the average of the readings to use for his spreadsheet - when you see one number that's a bit higher than another, the actual reading is more likely to fall somewhere between the two.
 
Hi @emjb14,

I've been looking at Davey's spreadsheet.

- He is definitely showing a clear response to Caninsulin commensurate with its action profile (see example curve below).
- He is definitely not getting anything approaching adequate dose duration from the Caninsulin; it's only having a lowering effect for about 6 hrs/cycle, 12 hrs/day.
- Dose onset appears to be relatively slow (BG still very high at +2).
- Despite a 'proper Caninsulin curve' his BGs are very, very high - even during period of typical Caninsulin nadir.

latest


At this point it's a matter of conjecture whether a 'good dose' was skipped over earlier in Davey's treatment. (It is possible that with only the two (stress-influenced) BG checks at each vet visit a fast drop or low nadir early in a cycle might have been missed with the second test only catching a rebound later in the cycle. Basing dose adjustments on rebound BGs can lead to overdosing.) Right now I think more needs to be done to identify possible causes of Davey's difficulty in becoming regulated so that he will start feeling better as soon as possible.

Although there's not much of it, the BG data gathered thus far looks as though there may be something else going on to either drive Davey's numbers sky high or to cause insulin resistance.

First up, here is an article on rebound hyperglycaemia. It gives information on how a vet may be able to differentiate chronic rebound from true insulin resistance. From the article:

Insulin resistance: in the case where raising dose appears to have no effect over a wide range of dosage, it can be difficult to distinguish Somogyi rebound from true Insulin resistance. One way to check is to try a small booster dose of short-acting (R) insulin and take measurements of blood at 30 to 60 minute intervals for the next 4 hours. If the R has no significant effect, insulin resistance is more likely. If the R works very well, consider that the other insulin is being overdosed.​

The above is something that I suggest might be best carried out by a vet with a lot of experience in treating feline diabetics and dealing with regulation difficulties.

Another thing to consider is glucose toxicity. From the linked article:

When a diabetic animal is hyperglycemic for long enough, the animal's damaged tissues may start having trouble using insulin. This in turn means that even a well-dosed animal may continue to have high blood sugar, leading to even more insulin resistance.

Various methods through this "glass floor" have been tried, to varying degrees of success. One way is to continue gradually raising insulin dosage until the tissues pick up the insulin and start absorbing glucose, then quickly back off to a lower dose. Another is to "jumpstart" the process with a fast-acting insulin or a deliberately high dose of the regular insulin, then quickly back off to a lower dose. Another is to reduce the carbohydrate content of the food further, or to eliminate dry food entirely (even low-carb dry food), thereby presenting less of an obstacle for insulin effectiveness and reducing insulin needs. Aggressive attempts to break glucose toxicity are best regarded as dangerous and should be addressed in close partnership with a diabetes-experienced veterinarian.

These methods may provide relief from glucose toxicity suddenly and unexpectedly, risking overdose and hypoglycemia once the "glass floor" is broken. Caregivers should be vigilant about watching for signs that the floor has broken, such as lower than expected blood glucose levels or a rebound event on a previously "safe" insulin dosage, and be prepared to immediately lower the dosage.

[Emphasis mine]​

The strategies listed above fall very much into the 'DO NOT try this at home!' category. Even with veterinary involvement great vigilance with home testing would be needed. (If it were my cat needing to undergo any of the 'glass ceiling' interventions outlined above I would seek to have the cat referred to a feline diabetes specialist in a hospital setting; a local general practice vet might not have the equipment or nursing cover required for safety.)

(More to follow; just splitting the post up into smaller sections.)


(Cont./...)

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(.../cont'd.)


If it were my cat, these are the things I would look to do/investigate:

1. Monitor daily for ketones / continue with home BG monitoring / keep brief journal of observations and clinical signs.

2. Optimise Diet - be very careful!

I would schedule a couple of days to devote to testing him and gradually removing all high carb food from his diet (especially dry high carb food). If the food is elevating numbers then transitioning him to all wet, low-carb could dramatically and quickly reduce his BG and therefore his dose would need to be reduced - cycle by cycle as dictated by improving BG numbers.

Here is important safety advice from vet Dr Lisa Pierson about how critically important it is to monitor BG/reduce insulin as needed when going through a food transition to lower carb food:

http://catinfo.org/?link=felinediabetes

With such a high dose of Caninsulin in the mix, anything which suddenly and significantly reduces BG levels could greatly increase risk of hypo so great care and very close monitoring is vital. If my cat was in this position and I wasn't able to monitor a food transition myself I would look to see if the vet could take him in for a few days to do the food transition and adjust dose downwards on a cycle by cycle basis as dictated by any improvements in BG observed as a result of reducing the dietary carb load.

Given that the current diet is Fancy Feast Classics alongside the dry kibble then the carb load in the diet from the dry kibble may not be the only thing driving the high numbers - especially with the Caninsulin dose being so high.

NB: If a diet transition is a route you and your vet agree on I suggest it might be better to do the food transition while Davey is still on Caninsulin since it is an in-out insulin and any dose reductions needed would be more immediately effective than trying to manage the transition and an over-full L-insulin depot at the same time (not a good mix - especially with very high doses).

3. Change Insulin

If it were my cat giving these numbers and showing this response I would ask the vet about switching to a longer-acting insulin as soon as possible after the food transition has been completed. Bearing in mind Davey may possibly need a high dose, Levemir (insulin detemir) might be the better choice to go for because, unlike Lantus, Levemir does not sting at larger doses. (For general information, many members who switch to Levemir from another insulin often report that their cats appear to be 'happier' in themselves.)

An appropriate dose of a longer-acting depot insulin should give greater duration of effect and hopefully keep BG at better levels for a longer period each day and hopefully stop the preshot BG levels getting as high as they currently are on Caninsulin - especially in the early and late part of each cycle). This might make Davey feel a little more comfortable while you and your vet work to determine what might be driving/keeping his numbers so high.

4. Check for Common Drivers of High BG Levels

The following are things a vet should check for as a matter of course in cats who are difficult to regulate. If your vet has not already done so, I suggest you ask about checking the following as soon as possible (including appropriate blood and urine testing):

- dental disease (x-rays before and after dental surgery are important; if teeth/gums are in bad shape, referral to a veterinary dental specialist is advisable).
- urinary tract issues (diabetics are very prone to these - especially when glucose is present in their urine).
- chronic pancreatitis.
- other illness/inflammation.
- pain.

5. Run Additional Diagnostics for Other Conditions

If none of the 'usual suspects' can be identified as a driver of high BG levels, further investigation into the following may be warranted:

- thyroid dysfunction (routine blood test; may need to be specifically requested as an add-on if other blood work is being done).
- high-dose conditions: acromegaly; insulin auto-antibodies (IAA); Cushing's (specialist diagnostics needed).
- other conditions - as guided by your vet.

Further reading:

- Obstacles to Regulation

- Insulin Resistance

- (ETA) Rebound and Overdosing
http://petdiabetes.wikia.com/wiki/Insulin_resistance
NB: Other members may have different views and suggestions to offer you.


Mogs
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emjb14 said:
I noticed as he was peeing that his urine is very foamy.
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That might be your first clue to finding more ways to help Davey. I suggest you get that checked out by your vet ASAP. I understand so well how nerve-wracking and scary it is when our little ones are poorly but I've found that the best thing to do is seek help early. The following article suggests keeping a journal of clinical signs (including litter box habits and observations - may need to move the litter box to where you can keep an eye on it for the time being), plus bloodwork and urinalysis by your vet.

https://www.cuteness.com/article/diagnose-foamy-cat-urine

As April says above, it may be due to glucose in the urine but it's highly advisable to get Davey checked by your vet. If, for example, it revealed bladder inflammation or infection then treating that would help Davey's blood glucose levels.


Mogs
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Thank you Critter Mom for all your help! I took some time yesterday to really research things and did see a bit on somogyi and insulin resistance. Your posts have really cleared things up for me and I feel so much more educated and confident compared to a week ago. I am ready to have a good talk with my vet and will be calling today.

I would like to switch his diet first as you've mentioned and change his insulin afterwards.

Please note all the additional testing you've mentioned in step 4 and 5 was done at the beginning of this process but I will mention this to the vet to see if there is something we should re-check. The bill for all the testing was extremely expensive and I'm breaking the bank with everything going on so hopefully I won't need to test everything over again eek!

This is all amazing advice thank you! I think the best route for me would be to change his diet at home over the weekend when I'm not working and can stay home, really monitor him and do regular testing. What's your opinion on insulin doses during this time? Should I stick with 6 units provided that his sugars are still off the walls?
 
emjb14 said:
Since I've been home the last few days I've noticed all he does is eat, drink, and lay on the floor (usually on the door mat). He used to sleep with my daughter or us or come up with one of us on the couch but he doesn't even bother now so I know he's not feeling good.
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Two things to consider here:

- The hyperglycaemia will make Davey feel unwell.

- The behaviour changes you describe have been reported here for other cats whose systems Caninsulin disagreed with. (My Saoirse was absolutely miserable on Caninsulin.)

A change to a different, gentler and longer-lasting insulin might help with both of the above.

Tip: try to see whether Davey seems any bit brighter as the dose of Caninsulin is wearing off. If yes, then that could help you to differentiate a little between the effect of the insulin and the effect of the hyperglycaemia. Let your vet know what you observe.

He's still testing negative for ketones.
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This is good news. (((Davey)))


Mogs
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emjb14 said:
all the additional testing you've mentioned in step 4 and 5 was done at the beginning of this process
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- It would help if you could post FULL details of exactly what the vet has tested for (including tests for known high-dose conditions, thyroid function, etc.). The better the information that's available the better members may be able to suggest things which might help you and Davey.

- What state were/are Davey's teeth and gums in? (Even a touch of gingivitis can adversely affect BG.)

- Did Davey have any dental work done since Dx? If yes, did the vet do X-rays to check no bits of tooth were left behind? Did the vet run a post-dental full curve to check whether dose needed to be adjusted?

- Did the vet identify and treat any underlying conditions (e.g. treat an infection with an antibiotic). Did the vet run a full curve to check for BG improvements?

I hear you (and can fully relate) on the $$$ side of things but I think you'll need to get the foamy urine issue checked ASAP.


Mogs
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Critter Mom said:
Two things to consider here:

- The hyperglycaemia will make Davey feel unwell.

- The behaviour changes you describe have been reported here for other cats whose systems Caninsulin disagreed with. (My Saoirse was absolutely miserable on Caninsulin.)

A change to a different, gentler and longer-lasting insulin might help with both of the above.

Tip: try to see whether Davey seems any bit brighter as the dose of Caninsulin is wearing off. If yes, then that could help you to differentiate a little between the effect of the insulin and the effect of the hyperglycaemia. Let your vet know what you observe.


This is good news. (((Davey)))


Mogs
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Thanks again! I'm waiting for a call back from the vet and thought I'd throw out another question to you. Do insulin prices vary much or are they all close to the same? Is levemir around the same price as caninsulin?
 
emjb14 said:
I think the best route for me would be to change his diet at home over the weekend when I'm not working and can stay home, really monitor him and do regular testing. What's your opinion on insulin doses during this time? Should I stick with 6 units provided that his sugars are still off the walls?
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Can you post the exact brand and variety of the kibble you're currently feeding, please. Also, can you post exactly how much Fancy Feast Classics food plus how much kibble Davey gets each day (so we can get a better picture of how much high carb food is in his current diet).


Mogs
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emjb14 said:
Thanks again! I'm waiting for a call back from the vet and thought I'd throw out another question to you. Do insulin prices vary much or are they all close to the same? Is levemir around the same price as caninsulin?
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I don't know how much the insulins cost in Canada. (I'm in the UK.) I'm tagging Linda and Chris to see if they can help you with a cost comparison (@MrWorfMen's Mom, @Chris & China).

Many US members order their Lantus and Levemir from Marks Marine Pharmacy in Canada. Details are in this post:

http://www.felinediabetes.com/FDMB/...canadian-pharmacies.49608/page-2#post-1344374

This should give you a guide price to compare with prices in your own area.

The pen cartridges are much more economical in use than larger vials because they only contain 3ml insulin. Provided it is stored and handled properly the insulin in an L insulin pen cartridge can remain viable for up to 6 months. To the best of my knowledge based on reading other posts, provided one finds a reasonably-priced source for the L insulins, the cost is commensurate to - and may perhaps work out less than - cost of Caninsulin.


Mogs
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He eats a can a day (half a can before AM injection and half a can before PM dose) and then dry food for the rest. Probably half a cup a day I would say, sometimes more.

He hates the dry food since I've introduced wet and only eats it once he's really hungry. He's always by his bowl looking up at me when I'm in the kitchen hoping I'll give him some more Fancy Feast so I'd love to be able to change his diet to just that.

This is the dry food he's eating but only for the last three months or so http://petvalu.com/product/FCM00637/indoor-formula-performatrin

Ironically enough when we started noticing excessive thirst and such it was right after we switched dry foods but we were told that this switch shouldn't have made a difference. He was just eating cheaper Walmart food for years http://www.walmart.ca/en/ip/purina-cat-chow-cat-food-for-indoor-cats-32kg/6000071263341
 
@emjb14 -

Very important question:

With regard to overall clinical signs (mood, energy, sociability, peeing, drinking, eating, etc.) does Davey seem to you to be better in himself on 8IU or 6IU Caninsulin?

(@Chris & China - I'm looking at the high preshot BGs here and wondering whether they might be trending upwards on the 6IU dose?)


emjb14 said:
I think the best route for me would be to change his diet at home over the weekend when I'm not working and can stay home, really monitor him and do regular testing. What's your opinion on insulin doses during this time? Should I stick with 6 units provided that his sugars are still off the walls?
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@Chris & China -

I'd welcome input on this for emjb14 from you when you are next online. (Also if you have time to review my earlier posts suggesting possible ways forward from here I'd appreciate it; you may spot something I've missed.)


Mogs
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emjb14 said:
Do insulin prices vary much or are they all close to the same? Is levemir around the same price as caninsulin
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Comparing insulin prices can be a little like comparing apples to oranges. The Caninsulin you are using is U40 insulin whereas Levemir and Lantus are U100 insulins. So each unit of Levemir and Lantus contains a higher dose meaning you may use less for each dose. Overall costs are going to depend on what dose kitty needs.

I buy Levemir pen refills which come in a box of 5 small vials each containing 3ml or 300 units of insulin. 1500 units of insulin (5 X 300units) cost me $126.38 which works out to roughly 8 cents per unit. While the initial cost seems higher, the expiry date on the insulin is generally about 1.5 to 2 years out from date of purchase so you can use up most if not all the insulin with little waste by purchasing the pen refills. Lantus pen refill costs were slightly lower (about $117 for 1500 units) but I have not bought it for quite some time so my number may be off.

Caninsulin pen refill pricing at the pet pharmacy in Toronto ($77.78 for 10 x 2.5 ml vials) would work out to 7 cents per unit but each unit of Caninsulin has less insulin than the Levemir or Lantus so it may actually be cheaper to use one of the longer acting insulins.
 
Critter Mom said:
@emjb14 -

Very important question:

With regard to overall clinical signs (mood, energy, sociability, peeing, drinking, eating, etc.) does Davey seem to you to be better in himself on 8IU or 6IU Caninsulin?

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Honestly I do not notice much of a difference other than I find his numbers have been a bit higher since I reduced his doses.

He eats great and drinks less than he did at the beginning of his diagnoses but there hasn't been a noticeable difference between 8 to 6.

Still is spending most of his time in the kitchen (close to his food and water) laying on the floor sleeping or watching the kids and I. He purrs while I check his BG because he loves attention and I think he's just happy that I'm at his level petting him. He used to be a huge cuddler and was always on one of our laps. He jumped up on the bed to sleep with me last night which got me a bit excited because he was doing something he would normally do but after two minutes he jumped off and left.
 
I talked to the vet today and loaded her up with all the information you guys have given me. I'm sure she was a bit annoyed with me but said she'd look into it and call me back. Shortly after I got a call and she said she spoke with her colleagues and the general consensus is to try Lantus next. She is calling it into the pharmacy for me to pick up and said once I had it to book an appointment with them. I will switch his diet as we've discussed before proceeding with this.

She mentioned this is the first time the clinic has prescribed anything but Caninsulin and I will check but I'm sure the other vet clinic here will tell me the same. I'm a rural area and think it's going to be difficult to actually talk/see to someone experienced in the matter, we only have two clinics in the area. I've discovered most people here just put their cats down once they are diagnosed and many politely tell me I'm crazy for doing all this but I don't really care what they think!

I forgot to mention the foamy urine so I called back and got the receptionist who told me to come pick up special litter they carry to get a urine sample and they would test it to double check.

She said over the phone that thyroid and any other conditions were already tested for. I will try to get more information when I go there.
 
emjb14 said:
she spoke with her colleagues and the general consensus is to try Lantus next.
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emjb14 said:
She mentioned this is the first time the clinic has prescribed anything but Caninsulin
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I've attached below a journal article co-authored by vet and world-renowned feline diabetes specialist, Dr Jacquie Rand. It has great information about treating cats with long-acting insulins Lantus and Levemir, dose adjustments and home monitoring of BG. It is from an authoritative source and may be helpful to you and your vet.

If the demands of the protocol in the journal article don't suit, some FDMB members follow the Start Low, Go Slow method of treatment. Here's a link:

http://www.felinediabetes.com/FDMB/threads/lantus-levemir-start-low-go-slow-method-slgs.129446/


Mogs
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Attachments

Thank you! I see the starting dose is 0.5 and I'm thinking I should go right back to that starting point when I start using the new medicine. Would you agree? Looking for another opinion other than the vets so we can start off this medication on the right foot!
 
emjb14 said:
Thank you! I see the starting dose is 0.5 and I'm thinking I should go right back to that starting point when I start using the new medicine. Would you agree? Looking for another opinion other than the vets so we can start off this medication on the right foot!
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For a cat not yet treated with any insulin the start dose is low. However if a cat has already been treated with another insulin the data and dose for the previous insulin need to be taken into consideration when determining a start dose for Lantus and Levemir.

I suggest that you post on the Lantus and Levemir board asking for advice on transitioning to Lantus from a high dose of Caninsulin. There are some highly experienced Lantus users there who should be able to give you an idea of how the changeover should be approached. (It's what I would do. :) )

http://www.felinediabetes.com/FDMB/forums/lantus-glargine-levemir-detemir.9/

Remember to keep testing for ketones throughout all the changes (food, insulin, etc.)


Mogs
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emjb14 said:
I'm sorry you aren't feeling well thank you very much for all of your help and I hope you are better soon!
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Thank you for the good wishes. :bighug: Unfortunately I have a number of long-term chronic health problems and they're all flaring badly at the moment. :(


Mogs
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emjb14 said:
He eats a can a day (half a can before AM injection and half a can before PM dose) and then dry food for the rest. Probably half a cup a day I would say, sometimes more.

He hates the dry food since I've introduced wet and only eats it once he's really hungry. He's always by his bowl looking up at me when I'm in the kitchen hoping I'll give him some more Fancy Feast so I'd love to be able to change his diet to just that.

This is the dry food he's eating but only for the last three months or so http://petvalu.com/product/FCM00637/indoor-formula-performatrin

Ironically enough when we started noticing excessive thirst and such it was right after we switched dry foods but we were told that this switch shouldn't have made a difference. He was just eating cheaper Walmart food for years http://www.walmart.ca/en/ip/purina-cat-chow-cat-food-for-indoor-cats-32kg/6000071263341
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@Chris & China, @MrWorfMen's Mom -

I can't fathom out how to do carb calc estimates for US-style guaranteed analysis figures. Is there any chance one of you could do a carb check on these foods (especially as the current dry food seems to have tipped Davey over into becoming symptomatic).


Mogs
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So just taking that food away by the sounds of things may make a difference! I bought it thinking I was doing better by him because it was more expensive than what I was using before and wanted to feed him better since he's getting older. The manager at the pet store talked me into it ugh.
 
Weigh the amount of the dry you feed every day starting from now. You'll need to track the amount you feed throughout the transition so you need to know how much he's getting before you start.

You'll need to test right through the day when reducing the dry food because you may need to adjust the Caninsulin dose down very quickly.

Post here to ask members to keep an eye on the spreadsheet and the dose. Insulin needs might start to drop within hours. (No guarantees but you need to be prepared for any drop in BG and be vigilant with the testing.)


Mogs
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If there's one thing to remember about food, it's that the cost of it doesn't relate to how good (or bad) it is!! Look at how expensive the "prescription" diets are and they are full of lousy ingredients and are horribly high in carbs!!

Also, "grain free" is nothing but a buzz phrase....it doesn't have anything to do with how high or low carb the food is.....switching out corn and using potatoes instead makes it "grain free"....but it doesn't make it low carb
 
I see Davey's AMPS this morning was down quite substantially. I wonder if the lowering of the dose set him into a steeper bounce the last few days and you are just now starting to see the results from the dose reduction. Will be interesting to see where he goes from here. Do be careful with the food changes because as Mogs has said, that alone can have a profound effect on insulin needs.
 
Last night he was following me around like crazy looking for wet food so I have to admit I gave him a half a can more than I usually would and in turn he didn't eat any dry food last night. He had dry food in his bowl but as usual just didn't want it. I'm sure this is probably the big factor so I will need to be careful.

Now I have a dilemma that's going to set us back a bit which I'm so angry at myself for! I ordered more test strips but was too late in doing so and now I'm in trouble. I just used my last one this morning and should have received them today but (just my luck) when I go to track the shipment it's not arriving until Monday due to a weather delay. I can't make changes over the weekend with no strips and I don't know where else to get them and a machine here without spending a fortune here ugh. I was nervous this morning when I left for work so I asked my husband (he works nights Thursdays) to keep an eye on him.
 
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