End of Week 1 - Any Advice?

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Julie & Orange

Julie & Orange

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Orange has been on 1 unit of Lantus twice a day now since he has been diagnosed last Thursday.

I did as many BG tests as I could handle today to help see where he is at different points within the 12 hrs.

We have a vet appointment tomorrow to see how he's doing and discuss the dose he's getting. Can you guys take a look at the SS? I'd appreciate any advice going into the appointment tomorrow - what change in dose should I be expecting and is there anything else I should be asking the vet about?

I'm concerned about all the black, and the large jump in the past 3 hrs. He ate some after each test, and today I actually got him to eat a good spoonful of canned along with the dry!
 
I don't use Lantus so I won't be able to help. One thing that popped out in your post was the use of dry food.
Once you have completely removed the dry food you should be able to see BG lower. I saw you said you mixed the wet with dry. Are you I the process of transitioning? If so that is good. Especially since Orange is on insulin. Removing the dry all at once could cause the BG to really drop....maybe even drop to a very unsafe low. You want to transition the dry to canned slowly.

If you get a chance read a few tips from Dr.Pierson about how to transition the dry to canned...www.catinfo.org.

Jenn & Baxter cat_pet_icon
 
Yes, I am in the process of transitioning. Don't worry, Orange won't let me switch him quickly. He HATES the stuff. After a week of trying I'm thrilled with little bit he ate today thanks to some of the tips on my other thread.
 
I would wait to raise the dose until he has fully transitioned to wet food, and you have at least three days worth of testing to look at to see how the insulin is affecting him without the food.

If you raise the dose this week, and then next week he's no longer eating the dry food, then the dose could be too high because you raised it based off of numbers on dry food.

Dose adjustments for Lantus should be made in .25u-.5u increments, depending on the nadirs (lowest numbers of the cycle) for the previous 3-7 days.

Just make sure you're testing for ketones--you want to be safe with those higher numbers.
 
You have way more confidence is this wet food transition than I do. Don't get me wrong, I WILL get him there. I'm thinking though that the time frame will be measured in month(s), not days.
 
Good job on the tests! I know you were nervous about it...Are you finding a "technique" for getting a good bead of blood now?

Good job on the effort to transition to wet food too! Keep it up!

Your vet might advise you to up the dose based on your SS, but honestly, (and I know everyone kinda preaches the wet food) the WET food really does wonders for the BG readings. The dry food makes them jump all over the place...especially in a higher range. Blaaa Blaaa Blaaa...if you did wet food, you might need less insulin...or none at all :mrgreen:

Here are some of my kitties favorites:

Purina veterinary maintenance diet (wet food...2% carb)
Hills M/D wet (diabetic veterinary diet)
Friscas Mariners Catch, Whitefish and Tuna, Chicken
Wellness wet food.

I like to think of it like in humans...you can take more medication if a diabetic is going to eat chocolate, ketchup, hot dogs, hamburgers, french fries...etc...OR you can eat a better diabetic diet and give less insulin...maybe even no insulin...

GOOD Job today!!!!!
 
Your cat is ADORABLE!!!! I've never heard of the name Orange. So cute.

I'd stay with one unit for now and keep working on the wet food. Have you tried Fancy Feast or Friskies?
You can try sprinkling dried fish flakes on it if he's a fish guy, or freeze dried chicken (crunch it up on top of the food)
It's only been a week and you're doing great!!! Keep up the good work....and come on Orange...eat up buddy. You're gonna love the wet food! :lol:
 
Julie & Orange said:
You have way more confidence is this wet food transition than I do. Don't get me wrong, I WILL get him there. I'm thinking though that the time frame will be measured in month(s), not days.
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There was a cat awhile back, posted that their cat was getting 20units of caninsulin twice a day.
Cat was eating DRY food. As soon as the cat was switched to wet, cat dropped to something like 1unit twice a day.

There have been so many cats who have joined this site, switched to wet food, and quickly went off insulin altogether.... the ONLY change was from dry to wet food.

One of my cats, being fed wet food, if she stole just a small mouthful of dry food, just say 5 pieces, her BG numbers would jump into the high 400s.

The wet food, and low carb wet food, works.

I don't know how you are going about the transition, but if you could grind up the dry food and sprinkle it on top of the wet food, you may find Orange will have to eat some of the wet by just trying to get at the dry crumbs.

Good luck with the change.
 
Julia & Bandit said:
I would wait to raise the dose until he has fully transitioned to wet food, and you have at least three days worth of testing to look at to see how the insulin is affecting him without the food.

If you raise the dose this week, and then next week he's no longer eating the dry food, then the dose could be too high because you raised it based off of numbers on dry food.

Dose adjustments for Lantus should be made in .25u-.5u increments, depending on the nadirs (lowest numbers of the cycle) for the previous 3-7 days.

Just make sure you're testing for ketones--you want to be safe with those higher numbers.
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Everything stated here is so true. Keep working on diet change to wet food. And test for keytones with all that black. Lantus doesn't like fast changes, so try to hold the dose and change the food. Coming into the yellow again is promising. :)

Come on Orange, you can do it! Wet food is yummy!

PureBites chicken makes treats that are yummy and can be sprinkled on food (yes it says dog, but break into smaller bites and it's cat) http://www.amazon.com/PureBites-Chicken ... 845&sr=8-2 these are 100% chicken. The fish flakes are great too. http://www.amazon.com/Cat-Man-Doo-Bonit ... 945&sr=8-1 And what cat can resist salmon? http://www.amazon.com/Halo--Littles-Nat ... 028&sr=1-2 (dont get the beef - they are like little rocks, but whitefish/cod is good). And you can probably get all these at Petco or PetSmart.

Crash would do just about anything (including curve testing) for the PureBites! Hang in there!
 
big fuzz - I'm still nervous with testing, but Orange doesn't seem to mind it much so I'm musleing through it for his sake. Right now the method is put him on my lap on a chair, warm his ear with a pill bottle of hot water, back his ear with a folded tissue (took me a little while to realize that a crunched up tissue does not work), use the lancet pen, fold over tissue and apply pressure, and give salmon treat. Yesterday he got a good bead of blood on the middle setting, today nothing on that setting - I had to go all the way up to the deepest and then it went straight through his ear. I really need to work on getting gentler and more consistent with this now because his ears all all bruised up and look like a mess.


Traci and Boomer - Thanks! I think hes pretty cute too :)

Everyone - For the wet food flavors so far we have tried:
- EVO Duck
- EVO Beef
- Purina DM
- Merrick Cowboy Cookout
- Friskies Special Diet Beef & Chicken
- Friskies Falked Tuna

He hasn't seemed to like any of them more than others, but I have found out that my other kitty (who has no problem eating a full meal just of wet food) has flavors she does not like. The only 2 she wanted to eat were the Purina DM and the Friskies Special Diet. I have a shopping bag full of other brands/flavors to try, so we are trying a new one each day.

As far as tricks to get him to eat I've tried:
- putting it out on a plate (won't even take a lick)
- hand feeding (won't even take a lick)
- putting tuna flakes on top (won't even take a lick or even eat the tuna)
- sprinkling ground dry food on top (won't even take a lick)
- spreading the wet food thin across the bottom of the plate and putting whole chunks of dry food on top (he eats the dry food and licks up almost all of the wet food in the process! - but if the wet to dry food ratio is too high its a no go)
- if I warm up the wet food or add water for the method above, he sniffs it and walks away.

Since I'll be at the vet today I'll see if I can get some FortiFlora. I'll try throwing in some treats too. Honestly though, I think its going to be a LONG transition of a little more wet food, a little less dry each day on his plate. (but keep those tips coming if you have more!!)

Have you ever seen a dog with peanut butter stuck to the top of his mouth? Thats what it looks like when Orange eats the wet food - he takes one bite then its followed by about 20 air licks trying to get all of that wierd stuff out of his mouth!

I'll make sure to discuss the wet food transition with the vet and my concern with raising the dose while slowly moving to wet. His numbers are so high now though - do I really want to leave him there for a month or more during this transition?
 
Julie & Orange said:
do I really want to leave him there for a month or more during this transition?
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As long as you're testing for ketones, then yes, you want to be patient and see how the transition affects his numbers. Insulin therapy should be approached as a marathon--not a sprint. While high numbers do slowly do damage over time, a single low number can kill in an instant. Which is why it's very important you don't fast track the insulin, because you could have a dangerous hypoglycemic insulin on your hands once the dry food is finally gone. Most cats solely on a low carb, canned diet do not need much more than 1u of insulin. Dry food will inflate blood glucose 100-200 points, so it's causing those high numbers more than you think. If Bandit eats just a few pieces of dry food, his blood sugar will shoot from the 60-100 range into the 300-400 range. Just from a few pieces. You also only have a couple days of numbers--so you don't really know yet how the 1u is truly working with him. He could still be be giving you higher preshots because his body is adusting to being in the 200s mid-cycle.

I'm more optimistic that you'll have success with transitioning sooner than a month as long as you keep at it--it's just a matter of finding the right food and/or dressing it up for him with something he loves (many have given great examples--fortiflora, freeze dried chicken or salmon sprinkles, etc.). If you think the texture is his problem, I would try some chunkier foods. Merrick's Cowboy Cookout has some chunks in it but it's still pretty soppy. Did you try the Grammy's Pot Pie? It has a much more solid texture. Also, Fancy feast has a few chunkier flavors that are low carb--FF chunky chicken, chunky turkey, and chunky chopped grill. Also the FF Flaked Fish & Shrimp is chunky, so even though you don't want to feed fish for every meal, you might want to try it now, perhaps by mixing it in with another food? Also, have you tried Fancy Feast pates? I know it's strange, but many cats seem to love them and will eat them even when they refuse other pates. And they have a lot of flavors to choose from so you have more options to find a flavor he likes.

As for testing, you want to apply pressure with the tissue on the poke spot for 20 seconds after the test to stop bleeding from occurring. Also, pick up some Neosporin + Pain Relief ointment, and dab a tiny bit on the site after testing. If you do that, there shouldn't be any more bruising. Bandit used to get his ears tested as much as 10 times in one day (if it was curve day), and his ears looked just fine. If you look at his ears today, they look perfectly normal and you can even tell that he was poked 5-10 times every day for a year, so don't worry about hurting Orange. It seems like he's more ok with testing than you are. :-D You're so fortunate to have such a good cat! My hands were ripped to shreds my first week of testing, and I had to wrap Bandit in a blanket like a burrito to keep him from clawing me and trying to run away.
 
On more question, and I apologize if you said this already--but is the dry food being free-fed still or are you only giving measured amounts at feeding times? The first and most important step to transitioning is stopping the free-feeding and getting them on a feeding schedule. You want the cat's natural hunger drive to work with you. Also, how much/how frequently are you feeding? Some cats look like they're not eating enough, but the real problem is that they need smaller meals (especially with scarf & barf cats). 4 times a day is a great feeding schedule for a diabetic--you can freeze food and/or use an autofeeder for the meals you aren't there to feed.
 
I have a can of Grammy's Pot Pie - I'll give that a try next.

He was on meals twice a day (1/4 cup of his old dry prescription Hills C/D food each meal) - he's always stuffed himself with as much as he could possibly eat and puked it up when I leave it out. The vet told me to keep food out for him all the time right now though so I switched him to free feeding last week.

I'm usually not here most of the day, but I've been working from home as much as I could this week. I've been trying to just have some wet food (with dry on top) out for his normal meal times and when I'm here so that the wet isn't out too long, then I switch it to dry food only when I'm gone longer or overnight.

If I do a feeder or freeze with just wet food right now, I'm sure Charlie would eat it all and Orange would go starving.

Since I started leaving food out, he is eating soooo much. (almost no puking though - maybe because of the better quality dry?) I'm not quite sure how much has been him and how much Charlie has eaten, but I suspect he's eating almost a cup of dry and maybe an ounce or 2 of wet per day.
 
Julie & Orange said:
I have a can of Grammy's Pot Pie - I'll give that a try next.

He was on meals twice a day (1/4 cup of his old dry prescription Hills C/D food each meal) - he's always stuffed himself with as much as he could possibly eat and puked it up when I leave it out. The vet told me to keep food out for him all the time right now though so I switched him to free feeding last week.

I'm usually not here most of the day, but I've been working from home as much as I could this week. I've been trying to just have some wet food (with dry on top) out for his normal meal times and when I'm here so that the wet isn't out too long, then I switch it to dry food only when I'm gone longer or overnight.

If I do a feeder or freeze with just wet food right now, I'm sure Charlie would eat it all and Orange would go starving.

Since I started leaving food out, he is eating soooo much. (almost no puking though - maybe because of the better quality dry?) I'm not quite sure how much has been him and how much Charlie has eaten, but I suspect he's eating almost a cup of dry and maybe an ounce or 2 of wet per day.
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If you continue to free feed the dry, you will have a really rough time transitioning. I think that is your main problem. If he's scarfing down the dry food whenever he wants, he has no reason to get turned onto the new canned food. The canned food can be left out for up to 12 hours at a time (add water to keep it from drying out), or 24 hrs if it's frozen.

Since Bandit would eat and eat the canned food until he barfed, and sit and gnaw for hrs at frozen chunks if I left them out, so I couldn't free feed. I work a full time job with an hr commute in either direction, so I had to use auto feeders.

I had a scarfer/barfer (Bandit) and a picky eater (Gabby), so I got two feeders--one for each cat. I started giving both cats all of their smaller, controlled meals in separate areas at opposite ends of the kitchen, so that each cat would immediately run to their "spot" at meal times. Then when I left the feeders out, I put one in each of their spots. When they went off, Gabby would run to her spot and Bandit his, and start working on their food. Of course, Bandit would finish his first and then make his way over to try and eat Gabby's, but she would be almost done anyway so it wasn't a big deal.

Honestly, it's VERY doubtful he's going to go really low on 1u while you're at work--which is why now is the perfect time to troubleshoot and figure out how to work things out with just the canned. You don't have to keep food out all the time if it's not working for you with your other cat. If Charlie eats half of Orange's lunch portion while you're gone, it's not going do him any harm, as long as you're feeding him extra when you are home.

Once you start seeing some better numbers and/or the dose is increased, it's important that he has access to food while you're gone in case he drops a little low. But you're not there yet, and you'll either have the canned free feeding or the auto feeder situation (set to go off at his usual nadir time), all sorted out by the time you get there, so it will be fine.
 
Update - With the numbers we were seeing the vet wanted to up him to 2 units, but with the transition in food we agreed on 1.5 units instead. I got home and his last 2 pre-shot numbers are way down from what I have been seeing, so I'm holding off on the increase for now to see how he's responding. If he goes back up I'll end up upping his dose.
 
Julie & Orange said:
Update - With the numbers we were seeing the vet wanted to up him to 2 units, but with the transition in food we agreed on 1.5 units instead. I got home and his last 2 pre-shot numbers are way down from what I have been seeing, so I'm holding off on the increase for now to see how he's responding. If he goes back up I'll end up upping his dose.
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Please read the Sticky in the Lantus forum that explains how Lantus dosing should be determined: http://felinediabetes.com/FDMB/viewtopic.php?f=9&t=1581. The dose should never be raised in whole units. Even raising to 1.5u while you're in the middle of a diet change can be dangerous. Also, you don't have enough data yet to determine an increase. As you discovered, numbers can fluctuate from day to day depending on the cat's reaction to insulin, and you always want to err on the side of caution. His BG is going to lower as you remove the dry food--you don't want to add any more insulin until the dry food is completely gone. As long as you're testing for ketones, and none are present, he's not in any danger taking things slow.

There are many experienced users in the Lantus forums that can help you with dosing. Unfortunately, your vet does not seem to be familiar with the Lantus dosing protocol for cats. This isn't uncommon--my vet was wonderful, but she just wasn't familiar with how to dose Lantus correctly in cats. Here's a copy of the protocol for you to print out and give to your vet: http://felinediabetes.com/Roomp_Rand_2008 dosing_testing protocol.pdf.

I said this before, but you have to go slow or you can go past Orange's ideal dose. If you go over the amount of insulin he needs, he's then in double jeopardy, because 1. it's not going to lower his blood sugar because too high a dose will keep hisBG just as high as too low a dose, and 2. he's at risk for a hypo incident. I understand that those high numbers seem scary, but you really have to look at the big picture, not just a few pieces.
 
Right, thats why I left him at 1 unit. If it weren't for you, he would be up to 2 right now (thank you!). By the way, my husband called the vet today and they are OK staying at 1 unit right now (but didn't seem very confident that would be enough for him).

I'm saying that if I have him eating consistently for a few days and the numbers are still high (based on the nadirs), I'm going to up the dose. That seems in line with the protocol.

I did a ketone test yesterday, and he is fine. (will continue testing)

Anyway, he has another followup next week with his normal vet. Up until now he's been seeing another vet in the same office since thats who was available to see him immediately when his bloodwork came back. I'm going bring in a copy of his spreadsheet and of this protocol (I'm thinking I want to do the relaxed one right now, but I'm not sure yet) and discuss everything with her.

Also, hes starting to feel better! The vet said he's gained back 5 oz in the past week of the 1.5 lbs he lost. And yesterday he was playing!
 
Julie & Orange said:
(I'm thinking I want to do the relaxed one right now, but I'm not sure yet)
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One thing to keep in mind is that the high remission rates associated with Lantus are dependent on Tight Regulation Protocol. There is no "relaxed" protocol--the "relaxed" forum is for people that have to tweak the TR protocol or take a different approach because they are unable or have been unsuccessful in following the TR Protocol, or feel more comfortable with the Start Low Go Slowapproach normally used with Prozinc. Remission rates for following non-TR dosing guidelines are unknown.

There is also a window on those remission rates--the sooner a cat starts TR, the sooner and more likely it is to achieve remission. I would recommend you start with the TR protocol first, and then move on to a modified approach if you can't make it work for you. I work two jobs and go to grad school, and I was still able to manage it successfully with Bandit. The protocol is not written in stone, and you can tweak things as situations arise. And there are plenty of very experienced people here, who can help give you advice in following it to the best of your ability, or give you recommendations if something comes up where you need to make a change. Because of my work situation, there were a few small things that I had to tweak to make the protocol safer for Bandit, but I stuck to it as closely as I could and still keep Bandit safe.

If the problem is that you're finding the TR Protocol a bit overwhelming, please don't hesitate to post to either Lantus board and ask questions! I had to ask people for clarification and advice many times before I finally got it down--fortunately, there are always people willing to help! And believe me, everything does get easier, even though it doesn't seem like it now.
 
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