Erratic blood sugars

[Ana & Frosty (GA)]

Hello all,
I am new to this message board. I scrolled through a couple of threads, but did not seem to find anyone with similar questions (there are so many posts, though!), so I figured I would go ahead and ask if anyone had similar problems.

I rescued a diabetic stray cat 2 weeks ago. He is about 8-10 years old, and we don't know anything about his past history. He was one of the "death row" cats in a shelter near me, and after thinking it over 24 hours I realized I just had to get him. I already have 2 cats and a dog all around his age, so I figured, what's another cat? Plus I am a physician assistant, so I thought I could handle the insulin part. Anyway, I am currently fostering him with hopes to adopt, but we have issues with his glucose control.

They started him off on Lantus, 1 unit twice per day. I usually give it to him with his feeding at 6a and 6p. I also check his blood sugar twice a day while he is eating, and he just had his glucose curve at the vet on Monday. The glucose curve showed the same thing I was seeing at home - blood sugars all over the place. He can be anywhere from 130 to 450 before his dose and meals at home. In the office, he started off with 140, went down to 120, and 12 hours later he was up to 540! The vet was pretty surprised at the fluctuations, and suggested we switch him to an insulin specifically designed for cats. Now, before I spend another $200 on my adorable foster, I am curious to hear if others had the same issue, and whether or not switching insulins helped?

Any advice with this would be appreciated it!

 

[Red & Rover (GA)]

Thank you for rescuing a sugar cat.

What you are seeing is called a "bounce."

• Bouncing - Bouncing is simply a natural reaction to what the cat's system perceives as a BG value that is "too low". "Too low" is relative. If a cat is used to BGs in the 200's, 300's, or higher for a long time, then even a BG that drops to 150 can trigger a "bounce". Bouncing can also be triggered if the blood glucose drops too low and/or too fast.The pancreas, then the liver, release glucogon, glycogen and counter-regulatory hormones. The end result is a dumping of "sugar" into the bloodstream to save the cat from going hypoglycemic from a perceived low. The action is often referred to as "liver panic" or "panicky liver". *Usually*, a bounce will clear kitty's system within 3 days (6 cycles).

From: http://www.felinediabetes.com/FDMB/...the-basics-new-to-the-group-start-here.18139/

As the cat's body slowly realizes that it is not in danger with lower than usual numbers, the bouncing will decrease.

 

[Carol in Chicago]

Thank you for saving him!!!

We can help you understand his BG numbers. If you are home testing, you can do you own curve. That's better both from a data perspective ( because anxiety can raise numbers), and cost perspective.

Would you be open to setting up a spreadsheet? That's the best way to get advice re: numbers and dose.

 

[LizzieInTexas]

You are a wonderful bean. Welcome

 

[Stacy & Asia]

Welcome! What have you named this very lucky cat?

Agree with all that has been said, don’t waste your time/money on curves, you can do them. Check out the stickies at the top of the forum and familiarize yourself with the dosing strategies we use here: the TR protocol which has been published in a peer reviewed vet journal and the SLGS method that was developed here. Those stickies can answer some of your questions about the numbers you’re seeing and what to expect in the beginning, hint: diabetes is a marathon, not a race, it will take time for these numbers to even out.

Is your cat on a low carb wet food diet? Check out how to set up a SS, the best way anyone can help you, and you can help yourself, is to have all that data in one place where it’s easy to see what you are looking at. Check out other people’s SSs when you get a chance, you’ll see something similar to what you are describing in many of them, especially if you go back to diagnosis.

To answer your insulin question, there aren’t any insulins made specifically for cats. There is one made for veterinary use prescribed to cats, but it was developed for dogs. There used to be a bovine? Or porcine? Don’t recall which, that was better matched to cats, but it is no longer available. Lantus is a human insulin, it is a great choice for cats, it’s long acting and gentler than many of the others.

Glad you adopted that cat and glad you found this board!

 

[Ana & Frosty (GA)]

Hi all,
Thank you for your replies. The vet did mention that if could be the Somogyi phenomenon (what I think you refer to as “bounce”), but the only thing is, wouldn’t his body adjust by now after 2 weeks of being on this regimen? ‍
I am doing a curve today myself , and will post the readings tonight. We started off at 200 this morning, in contrast to the 400s I was getting the last 2 days. This is the part that throws me off. Why is he in the 400s at T0 some days, and 200s on others? He ate and I gave him his 1 unit, so we will see..
We don’t have this issue with lantus in humans because it doesn’t really Peak like it does in cats. So my medical expertise isn’t really helpful here..

I feed him DM prescription wet food. It’s highly recommended by my vet, and my other cat is on it for weight loss. I started off feeding him fancy feast, but the result was the same. (The 2 are close with their protein content, with DM being a little higher)

 

[tiffmaxee]

Hi and welcome from me too! My Max bounced for about a year before I was able to get him tightly controlled and I caught his diabetes early as he had chronic pancreatitis and tons of blood work. Around here we find they bounce until they don’t. Some remain bouncy but I find that rare.

 

[SMM]

You are a good soul! Don't forget too that being a previous stray he'd be doubly freaked out a vet's office causing higher numbers. My Martini has been bouncing for a very long time too.

 

[Ana & Frosty (GA)]

Hello all,
I think Frosty was showing off for the forum, as these have been the best blood sugar’s I’ve seen yet. It still doesn’t make sense why at times his sugars are in the 400s before a dose, but this is what I got. I also included the sugars he’s had over the prior 3 days.

 

[Carol in Chicago]

Great numbers. You are seeing a good response to insulin. The next step will be to put this data into our spreadsheet template. Please give a shout if you need help. There is a "sticky" to explain it.

Please feel free to look at a few others ( such as mine). Link is in my signature for SS for my Rosie.

 

[Ana & Frosty (GA)]

Great numbers. You are seeing a good response to insulin. The next step will be to put this data into our spreadsheet template. Please give a shout if you need help. There is a "sticky" to explain it.

Please feel free to look at a few others ( such as mine). Link is in my signature for SS for my Rosie.

Yesterday was a good day, but this morning his sugar was 470
Yes, i was looking at your spreadsheets, but couldn’t figure out how to download it. I am using my phone, so perhaps I need to use the computer. I will look into it later.

 

[Ana & Frosty (GA)]

I initially posted the wrong spreadsheet, as I use the AlphaTrack2. Below is the link to his sugars so far using that meter.

https://docs.google.com/spreadsheet...eh0AeO_QynYDYx8LN2wH4VmQFvlcC1TtygX1y/pubhtml

 

[Carol in Chicago]

Great job getting the SS going! Do you know yet if you will follow tight regulation or start low go slow for Frosty?

 

[Ana & Frosty (GA)]

Definitely the start low/go slow. My bf and i work longer than 8 hours each days, and don’t have flexibility in our jobs to be able to come home and test mid-day during the week, so the safest way for us is to go slowly. However, my vet doesn’t want me to adjust his insulin on my own, so right now I am just gathering information. He also told me not to test daily and just do a curve every couple of weeks, but again, I feel safer by checking his levels before I give insulin. He doesn’t seem to mind, especially if I’m doing it while he’s eating. He’s only been with us for 2.5 weeks, so I’m really hoping he will become more stable.

 

[Tricia Cinco(GA) & Harvey]

He also told me not to test daily and just do a curve every couple of weeks, but again, I feel safer by checking his levels before I give insulin.

Good instincts. Must be the medical professional in you. I will never understand why vets give that advice. I would ask him, "would you give your child insulin without testing first?"

 

[Tricia Cinco(GA) & Harvey]

I feed him DM prescription wet food. It’s highly recommended by my vet

Many vets are under the illusion that "prescription" foods are better than regular commercial food. I say "illusion" because there is nothing about them that requires a prescription. In many cases, there are commercially available foods that are actually better for the cat than the one "prescribed". If the DM you are feeding is by Purina, it's only 6% carbs so it's better than some of the other "prescription" feline diabetes foods. If you are happy with it, that's great. But be aware that there are other foods out there that are less expensive and just as good for a diabetic. If you haven't already seen it, you should check out Dr. Lisa Pierson's list of commercial canned foods. She gives the carb percentage, as well as other values like protein, calories, and phosphorus. Her entire site is a very good tool to have in caring for any cat, diabetic or now, and she has been known to post on FDMB.

 

[Sienne and Gabby (GA)]

In addition to what Tricia mentioned about the range of foods available, DM may be a bit higher in protein than Fancy Feast, the DM is poor quality protein (i.e., by-products vs. muscle meat). For what you're spending on a prescription cat food, you could be buying a higher quality, human grade canned food.

Your vet should know that the American Animal Hospital Assn recommends either Lantus or Prozinc for the treatment of feline diabetes. Two weeks is not enough time to determine if Lantus is the best insulin for your cat. Given that you have no history, there's no way to know how long Frosty has been diabetic. The longer a cat sits in diabetic numbers, the more the cat's body begins to treat those numbers as the new "normal." It can make it a bit more challenging to get numbers regulated. Also, what Lantus lacks in potency (it doesn't yank numbers down), it more than makes up for in being gentle and giving excellent duration. Other insulin is shorter acting. If your vet is suggesting a switch to Vetsulin, it was originally formulated for dogs and there are a lot of people here who can fill you in on their experience. Needless to say, they are now using Lantus.

FWIW, most of us don't use our vet to make dose related decisions. Further, if you are relying on adjusting the dose based on a curve at the vet's office, you'll likely over dose your cat due to "white coat" hyperglycemia. Most cats are stressed at the vets office and their BG numbers are artificially inflated. Also, does the vet leave dry food in the kennel with your cat when doing a curve? If so, your vet is feeding your cat high carb food and numbers will spike as a result.

Is there any way you can get at least a before bed test every evening? Without any PM tests, you're missing half of your data. Having those numbers may also go a long way to explaining what you're seeing during the AM cycle.

 

[Ana & Frosty (GA)]

In addition to what Tricia mentioned about the range of foods available, DM may be a bit higher in protein than Fancy Feast, the DM is poor quality protein (i.e., by-products vs. muscle meat). For what you're spending on a prescription cat food, you could be buying a higher quality, human grade canned food.

Your vet should know that the American Animal Hospital Assn recommends either Lantus or Prozinc for the treatment of feline diabetes. Two weeks is not enough time to determine if Lantus is the best insulin for your cat. Given that you have no history, there's no way to know how long Frosty has been diabetic. The longer a cat sits in diabetic numbers, the more the cat's body begins to treat those numbers as the new "normal." It can make it a bit more challenging to get numbers regulated. Also, what Lantus lacks in potency (it doesn't yank numbers down), it more than makes up for in being gentle and giving excellent duration. Other insulin is shorter acting. If your vet is suggesting a switch to Vetsulin, it was originally formulated for dogs and there are a lot of people here who can fill you in on their experience. Needless to say, they are now using Lantus.

FWIW, most of us don't use our vet to make dose related decisions. Further, if you are relying on adjusting the dose based on a curve at the vet's office, you'll likely over dose your cat due to "white coat" hyperglycemia. Most cats are stressed at the vets office and their BG numbers are artificially inflated. Also, does the vet leave dry food in the kennel with your cat when doing a curve? If so, your vet is feeding your cat high carb food and numbers will spike as a result.

Is there any way you can get at least a before bed test every evening? Without any PM tests, you're missing half of your data. Having those numbers may also go a long way to explaining what you're seeing during the AM cycle.

Thank you, Tricia, for the good information about the food. My understanding was the DM purina food is liver based according to the label. I understand liver is a very good source of protein for cats (I read this in Dr. pierson’s Chart you recommended ). However, I did recently get him more fancy feast peté, and am currently mixing the 2. Thinking of going back to fancy feast pâté permanently due to cost, but the only thing I don’t like about it is the high fat content. It’s protein is also lower 30-40 % compared to the recommended 50. I didn’t find the breakdown for purina DM in the chart unfortunately

Sianne, I appreciate your advice. To be honest, I will probably call my vet once I have a month or so worth of numbers before I change the dose. I’ve looked through a bunch of spreadsheets on here and saw some people who switched the dose very frequently and sugars and dose kept going up and down. I want to avoid it. You’re right, we know nothing about this cat. Idk how long he has had DM and if he was ever treated. Based on the shape he was as in when he came, he definitely lost a lot of weight and had muscle wasting, so he was outdoors for a while. How long do you guys recommend to keep a cat on the same dose before deciding whether or not it works? The vet did say he uses Prozinc on his patients with good results. But I have 2 lantus pens that are almost full so i really want to use those if i can.

You’re right about the pm sugars, i gotta do
One before I go to bed. I go to bed about 3 hours after I give him his dose, and I do wonder if maybe he goes low at night. He was at 500 this morning, which is crazy. I’m waiting for more alphatrack strips right now, so might have to use the relion meter in the meantime.

The other question I have is, how much food is appropriate to feed a cat? This cat is CONSTANTLY begging for food. He was 15 lb when he came (he’s big, but not fat) And he attacks food as if he hasn’t eaten in 3 months. I have 3 other pets at home including a dog and I’ve never seen anyone behave that way around food. Either this cat was constantly being fed from the table, or he heavily relied on humans feeding him while living in Central Park. (Did i meantion he is declawed??? :’( )Maybe both... Right now he gets 5.5 -6 oz of food per meal which seems like A LOT. If I cut it down to 4 Oz he eats it in 30 seconds and freaks out and meows and begs. So there’s lots of issues with this little guy..

Thanks for all of your help!!

 

[Tricia Cinco(GA) & Harvey]

I didn’t find the breakdown for purina DM in the chart unfortunately

According to Dr. Lisa's chart, the DM has 43% protein, if that's what you meant.

his cat is CONSTANTLY begging for food

It is very typical for an unregulated diabetic cat to be ravenous. They are literally starving to death. That's why it's important to get them regulated as soon as possible.

How long do you guys recommend to keep a cat on the same dose before deciding whether or not it works?

That depends on which method you follow - Tight Regulation has you change the dose every 6-10 days, when dictated by the nadirs. Start Low Go Slow has you evaluate the dose once a week. No matter what method you choose, a month is way too long on the same dose if the cat is not seeing normal numbers (50-80 on a human meter). Your cat will develop glucose toxicity and become much harder to regulate.

I’ve looked through a bunch of spreadsheets on here and saw some people who switched the dose very frequently and sugars and dose kept going up and down. I want to avoid it.

Unfortunately, it's pretty much impossible to avoid. It's a moving target. Insulin isn't a drug, it's a hormone, so you don't just give it and see an improvement. You have to figure out, with trial and error, just how much the cat needs at that time, and the needs can change, literally daily.

’m waiting for more alphatrack strips right now, so might have to use the relion meter in the meantime.

We strongly recommend against switching back and forth, because there is no way to accurately correlate the numbers from a human meter to a pet meter - you're going to get a very, very muddy picture of what's going on. Pick one meter and stick with it. For ease of use of this forum and affordability, we recommend the human meter, but there are people here that use the pet meter successfully.

 

[Sienne and Gabby (GA)]

@Tricia Cinco(GA) & Harvey - I think Tricia meant to say that with Tight Regulation, you evaluate the dose every 6 - 10 cycles, not days. (It's 3 - 5 days.)

Tricia is absolutely correct. As much as anyone would like to prevent numbers bouncing around, there's no way to avoid it. Some cats are bouncier than others but most cats will experience some degree of numbers being a bit all over the place. It's a process of getting a cat's body to "remember" what it's like to be in a normal BG range again. Getting a cat regulated is a process. It doesn't happen over night.

Insulin is the mechanism for how the product of metabolism (glucose) gets from the blood into the cells. If the cat's pancreas isn't producing insulin, glucose (nutrition) doesn't get into the cells. As a result, the kitty is starving, literally and figuratively. As numbers get into a better range, your ravenous cat will need less food.