Feeling discouraged, need advice

SKittyMom

SKittyMom

Member
My 16yr old spayed female cat Bugs was diagnosed in May 2022. We have not been able to get her levels to a healthy range. As of lately she is showing more severe symptoms again (they never fully went away, just improved some) ie: her fur is a mess on her back, very matted and oily, she is drinking more water & urinating often.

She gets 1U in the morning and .6 IU in the evenings. She has been on this dose for 5 or so weeks. Per our vets recommendation we have been testing twice a day, a few times per week prior to her insulin injections. She is eating Purina Pro Plan DM - mini meals throughout the day as her appetite doesn't allow her to eat only 2x per day. So she's being fed on demand as she needs it, but we don't exceed 1/2 cup per day.

Below is Bugs most recent numbers, since our vet never suggested checking more than 2x per day, we don't have more data unfortunately. Our vet is also currently short on the strips we use to test, and so they asked that we not test more than 2-3x per day until they are able to fulfill a bigger order. Once I am able to get more, I will absolutely test more throughout the day.

Thank you so very much for the help! We are trying our best to get this managed for our girl Bugs, but it's been tough to say the least, especially given how short staffed/busy vets are right now. We are meeting/talking with them as regularly as we can but sometimes it takes a week just to get an email back - so that's been another barrier in the way of making real progress.

  • 9/30/2022 6:02am 406
  • 9/30/2022 6:15am 1U given
  • 9/30/2022 6:11pm 406
  • 9/30/2022 6:15pm .6U given
  • 10/3/2022 5:47am 440
  • 10/3/2022 6:00am 1U given
  • 10/3/2022 6:20pm 439
  • 10/3/2022 6:30pm .6U given
  • 10/5/2022 6:24am 330
  • 10/5/2022 6:30am 1U given
  • 10/5/2022. 5:32pm 471
  • 10/5/2022 6:00pm .6U given
  • 10/7/1022 5:50am 2 readings 94, 137
  • 10/7/2022 6:00am 1U given
  • 10/7/2022 5:02pm 397
  • 10/7/2022 5:30pm .6U given
  • 10/7/2022 10:52pm 173
  • 10/8/2022 6:58am 498
  • 10/8/2022 7:15am 1U given
  • 10/8/2022 6:24pm 378
  • 10/8/2022 7:00 pm .6U given
  • 10/9/2022 7:27am 166
  • 10/9/2022 7:45am 1U given
  • 10/9/2022 5:37pm 461
  • 10/9/2022 6:00 pm .6U given
 
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It’s really hard to see what is going on without more tests. How long have you been at the current dose? Without some mid cycle testing, we cannot tell how low the dose is taking your sweet kitty. Would you be willing to set up a spreadsheet and do some more tests?
 
Thanks. That makes is a little bit clearer. You are doing a good job getting the AMPS and PMPS tests. Those are the pre-shot tests in the morning and evening. It would be very helpful to you (and us) if you could get one of those every day, to make sure he's not too low to give insulin in the first place. And it would be so helpful if you could get at least one mid-cycle test each cycle. Will your schedule allow for you to do this? Also, try to pick a shot time and stick to it -- with shots being 12 hours apart or as close to 12 hours apart as you can get.

If you can get more data, then it will hopefully be possible to see if he is dropping too low and then bouncing too high afterwards as a result of that.

Having said all that, the food he is eating, the Purina DM is not really a good food for diabetic cats as it's too high in carbs. Is it the dry food? The best diet for a diabetic cat, that will reduce their blood glucose, is a low carb wet food diet. The Purina DM food is often recommended by vets. It's not really a diabetic food though -- that's why the real name is "dietetic" -- which is a name that has no meaning since "diet" is simply what a cat eats. Anyway, if you did make a switch to lower carb wet food, you would find that Bugs' blood glucose would come down. That is why you would have to be extra careful to be testing to make sure it would not drop too low with the food switch on this amount of insulin. I would probably recommend cutting the dose down and testing while a food switch was accomplished. So don't make any changes just yet. By the way, multiple small meals through the day are better for a cat on insulin anyway so don't worry about that part of things. @FrostD what would you like to add to this? I really would like to see some mid-cycle tests so we know what is happening during the cycle. We all want Bugs to be safe. You've already accomplished an important milestone by learning how to home test.
 
Oh, and another question. What kind of blood glucose meter are you using? (Please say human meter... LOL!) I am not a fan of the Alpha Trak. This is important information since there's a difference between the human and pet meters.
 
Not much else to add! I'd suggest 0.5U twice a day actually and try that for at least a week while getting as many midcycle tests as you can. That 0.6U drops him too low at night, actually from fairly high number, then he bounces during the day.

It's possible he may need a small increase after that, but better safe than sorry.
 
@Suzanne & Darcy @FrostD

Thank you so much for sharing your wisdom - you don't know how relieving it is, after months of frustration and feeling like I was getting the run around. I do have some follow up questions so we can get our sweet Bugs on the right track:

FOOD
  1. Bugs is currently on dry food. What low carb wet food what would you recommend?
  2. Historically Bugs has only eaten dry food. I've not had much success in the past getting her to eat wet food. Do you have any suggestions on making the switch?

TESTING
  1. Injections will be given at 6am and 6pm. My vet confirmed they are getting more strips so I can test as often as you all recommend. Given her injection times, when would be the most optimal time to test so we have a better snapshot of what's happening data wise?
  2. I have the Covetrus VetGlucose Gauge. Is a human monitor a better option over this brand? If yes which monitor do you recommend?

INSULIN
  1. Should I switch her to .5U 2x per day immediately or only after moving her to wet food?

Thank you again, from the bottom of my heart!
 
Food - here is list that contains carb %. Your regular low carb food should be under 10%, most of us feed in the 3-7% range. You'll want a few cans of medium carb (11-15%) and high carb (16%+) as well for your hypo kit.

https://catinfo.org/chart/index.php


Some tips on transitioning here - https://www.felinediabetes.com/FDMB/threads/transitioning-your-cat-from-dry-to-wet-food.956/

Optimal test times will be 4-6 hours after the shot. We understand "life" so just get what you can. Even if it's 8 hours after, or 1 hour after, etc - we've read a lot of spreadsheets in our time, we can fill in the blanks pretty well.

We like human monitors here mostly because they're much cheaper to use long term. Human monitors tend to read lower overall, but we do account for that when we look at dosing. Vets tend to be more comfortable with the pet meters, but we've found it really makes no difference as long as you account for the slight variation at low numbers.

I would switch to 0.5U twice a day now. Get a week or so worth of data, then switch food. She's already at such a low dose, it is very possible a food change may knock her into remission (or quite close to it). So we need to be careful and have data before we switch.
 
@FrostD

Food- Thank you for the list, carb percentages & tips on transitioning. Super helpful. Will not make a switch until you advise.

Test Times - Will follow your recommendations. I'll start utilizing the spreadsheet for tracking.

Insulin - I started Bugs on the 0.5U with her first injection this morning and will do the same with her evening injections over the next week.

I can't thank you enough. I feel such a sense of relief knowing we have guidance and a plan in place.
 
I would definitely look into feeding Weruva BFF PLAY foods for Bugs if he is suspected of having CKD. It's important to create less of a "workload" on the kidneys for older cats and definitely if they are in the early stages of CKD. I feed several of the Weruva foods to my older cats who need to have less phosphorus. They like the "Chicken, Duck and Turkey Take a Chance" flavor and the "Chicken and Lamb Laugh Out Loud" flavor. These are all low carb. Let me send you a list so you can check it out for yourself. There are several lists attached in this file. Click on the one for Diabetic/CKD cats (page 14, I think) and you will see foods that are both low in phosphorus and good for CKD cats and foods that also are low enough in carbs to be recommended for diabetic cats.

https://www.bizave.com/foodlists/Combined_Food_Lists_Feeding_Guide.pdf
 
@FrostD @Suzanne & Darcy
I want to get your thoughts on if I made the right call for Bugs this morning. At 5:45AM before eating her reading was 140. We skipped her .5 6AM injection and tested again at 7:30AM and her reading was 200. She did eat in between the tests as I totally missed that they should be fasted prior to testing. We decided to forgo her insulin this morning given those readings. Was that the right decision? Thank you as always!
 
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Well now that's curious. Any changes? Food, meds? Mostly I am wondering how low she may have went overnight, or if it was a late nadir from a bounce break.

After the 200 Id have said 0.25U - if you could monitor. I know it was food influenced, but that's a little more than just a food bump so she was rising back up naturally. Additionally, she's probably going to bounce from whatever lows she had overnight, so at least a partial dose would help offset that - but there's always a chance they don't bounce, so it's hard to predict. No harm done!
 
@FrostD
The only two changes I've made are:
1. Dosage to 0.5 am from 1.0 and 0.5 pm from 0.6.
2. Dosage time - consistently given at 6am and 6pm.

Bugs did not have food after 4pm today. I tested her at 5:45pm with a reading of 404. Bugs ate after testing, and at 6pm was given her dosage.

Would you recommend another check this evening?

Thanks again!
 
Thanks! More than likely she has a late nadir when breaking bounces.

I would take a break, but if possible get something like a +10. If she breaks this bounce/no shot combo, that will help tell us if she has a late nadir on those cycles.
 
@FrostD @Suzanne & Darcy

Morning,

I'm currently on day 4 with the recommendations made for Bugs. Her numbers still seem to not make sense. I was wondering if you could take a look at her spreadsheet to see if you can get an understanding yet. If you feel additional data is still needed, that's not a problem.

Wet Food - when should I look at making the switch?

Thanks so much!
 
First we need to solve the mystery of that low AMPS - because she could have hit very low numbers the night before. Looks like she is bouncing, please get some +10s when you can so we can see if that's a late nadir or dose took her too low.
 
@FrostD

I'll get some of the +10 readings over the next few days. Do you recommend a +10 after both AM and PM injections?

Thank you and have a great weekend.
 
@FrostD @Suzanne & Darcy

Hello, I hope you've had a great weekend.

I did the 10+readings throughout the weekend on Bugs and have her spreadsheet updated. I'm hoping with the additional numbers you can maybe get a better read on Bugs.

Should I do anything different at this point?
Should I continue with the 10+ readings and if so how many more days?

Thanks again for your guidance!
 
Any chance.you accidentally gave a higher dose 10/12 PM?

I would go ahead and start the food switch. Have you been able to check ketones?
 
@FrostD

She didn't get a dose at 10pm. Bugs only gets a dose at 6am and 6pm. We double check before each injection to ensure the 0.5 dose.

I will start the wet food transitioning process. Testing ketones is not something I have done before so I will read up on that.
 
@FrostD

Oops I totally read that wrong, thanks for clarifying. We try to be precise as possible when giving Bugs her injection, so to the best of my knowledge we have not gone over the O.5 units.

As an FYI her ketones were tested at the vet a couple months ago and at that time it was negative. But I will refer to the link provided so I can test at home.

With switching to wet food, should we continue with the 0.5 dosage and only testing pre-shot in the morning and evening (we've been doing pre-shot and +10)?
 
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SKittyMom said:
@FrostD

Oops I totally read that wrong, thanks for clarifying. We try to be precise as possible when giving Bugs her injection, so to the best of my knowledge we have not gone over the O.5 units.

As an FYI her ketones were tested at the vet a couple months ago and at that time it was negative. But I will refer to the link provided so I can test at home.

With switching to wet food, should we continue with the 0.5 dosage and only testing pre-shot in the morning and evening (we've been doing pre-shot and +10)?
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Yes, keep the 0.5U dose. Try to get whatever midcycle tests you can before about +6, nadir is the main concern now. You can stop the +10s.

Also, ketones can change as quickly as from morning to night, which is why we recommend testing about 2-3x a week if you can while they're unregulated.
 
@FrostD

Update for Bugs.
  • Ketones - Ketone test 10/20/22 result was negative. Will continue with the home tests, 2 to 3 per week as recommended.
  • +6 testing- Three +6 tests done, spreadsheet is current.
Happy to announce transitioning Bugs to wet food has been successful. Her last meal of dry food was on 10/17 in the AM.

Let me know if we should continue as is with 0.5 dose 2x daily and +6 testing. Not sure if we have found her nadir yet.
 
Awesome! I would go ahead up to 0.75U twice a day and just get those +4 to +6 as often as you can. She isn't seeing super drastic results from diet change yet, but we give it about a two week window in total.
 
@FrostD @Suzanne & Darcy

Good morning,

We've done some additional +4 tests, spreadsheet is current. We've not seen any drastic changes.
  1. Are you able to determine Bug's nadir with the additional readings?
  2. Should we make any adjustments to her current dose 0.75u two times daily?
Bugs is still enjoying her wet food.

I did a 2nd Ketone test and it was negative. Will continue with the home tests.
 
Since you are technically following SLGS, you'd hold the dose for a full week. That said, it's clear not much movement on this dose so you can increase if you'd like.
 
Sounds like a plan. You would go up to 1U next.

Essentially, you will hold each dose for 7 days. If nadirs are not dropping below 120, you will keep increasing by 0.25U.
 
@FrostD

Good morning,

Could you take a look at Bug's numbers now that a full week on current dose is completed? Should we make adjustments to her 0.75u and take up to 1.0u?

We know not quite where she should be with her numbers, but we are seeing overall improvements.

The information and recommendations you and @Suzanne & Darcy made to help us get Bugs more stable are so appreciated!
 
I'm curious how low she's going with those slightly lower preshots...nothing indicates to me that it's enough to cause a bounce so I *think* it's ok to increase to 1U. Ideally we'd have a curve or some more midcycle tests in there.
 
@FrostD if preferred before we change the dose we can start back up with the +4 or +6 to make sure no bounce. I can do that for the next several days and reach back if you think that would be best. Let me know if that sounds like a plan.
 
That is really up to you. We don't want to hold the dose longer than we have to, but you hold the syringe. It's always good to scatter the +4 to +6s in when you can.

If you want to wait, and not sure on your schedule, I would prioritize the +4 to +6 especially when you get one of those low 200 preshots.
 
@FrostD for the last few days we've been doing +4 and +6 testing after Bug's pm dose. Her numbers are lower as you'll see, with some below 200. (Spreadsheet is updated)
  • Bug's has been on her wet food for two weeks now.
  • We've been consistent with dosing at 6am & 6pm. Testing 15 minutes prior.
  • No food 2 hours prior to testing.
  • Dose is still the 0.75u. This evening we did a lower dose due to her lower reading. (I followed a guideline that was posted on the site.)
  1. Does it appear based off the numbers there is a bounce occuring?
  2. What should our next steps be at this time?
Thanks so much!
 
Aha! So yes the answer to your AM numbers is a little bit of bouncing, or alternatively a lack of duration. But it would be unusual to see a lack of duration in one cycle but not the other (AM duration is fine, given the lower PMPS).

Yes you did the right thing by trying a slightly reduced dose. But now we also know you could have shot the full dose - I suspect nadir would have ended up around 90.

Given all this - I would hold the dose for now since nadirs are 90-150. When you get a chance on a day off, I would try a full curve on the AM cycle - testing every 2 hours. That would help us see if he's having uneven cycles and see if there's anything to be done to help even them out.

Some +8s and +10s during the PM cycle would help us see when and just how fast he's rising. That can also be a clue as to bounce vs uneven cycles. Only need one of each, I know it interrupts sleep.

You are doing a great job!
 
The DM dry you are feeding is high in carbs. I would switch to Dr. Esley Clean Protein that you can get from Chewy's. Our cat was diagnosed in May and we switched Dr Esley Clean Protein dry that we leave out for her to nibble on and our cat gets wet food once in the morning and once in the evening as well. We use ProZinc insulin and we are now down to numbers that are usually under 200 with insulin and only giving 1.5 units of insulin. We started out at 525 when diagnosed back in May and she was up to 6.5 unit of insulin as of Sept now we are down to 1.5 units because she was testing so low at the vets office. Just did a test per vets orders of no insulin for 60 hrs last week and her numbers were mid 200. If you change what you are feeding I bet you will see an improvement.
 
Hi @Shelly_F
Thanks for the information. We actually switched Bugs from dry food to wet food just over a couple weeks ago after learning what our vet prescribed was not the best choice . Her numbers have improved a lot and we are on the right track now. The guidance we've received from the forum has been hugely helpful as we navigate through everything. Bugs is doing much better and we feel confident we are getting closer.

That's great news about your cat! Appreciate you sharing your journey.
 
@FrostD

We did the AM +2 cycle yesterday, November 6th. Spreadsheet is current. Could you please check her BG levels and see if there is a better understanding on the nadir? I'm concerned I may have made a mistake by dosing yesterday based off her BG levels. My understanding with a pet meter, the baseline is 235. If BG is below we should not dose. Is that correct? Thank you!
 
I do think her nadir tends to be later (+6 or later). Tonight's 300 may be indicative of a bounce from a lower number today but I don't think too low...of course I can't say that with absolute certainty. Before today's cycle I'd have said you can shoot full dose over 200, but the possible bounce has me wondering. But last night's 0.5U wasn't enough ...

Consider an increase to 1U, the data you have suggests nadir isn't going much lower than 140s.

Sorry it's not a cut and dried answer!
 
Sooo happy to see that! It's easy to lose sight of how poorly they've become until the little glimpses come back.
 
@FrostD

We had an interesting day with readings. Based off the BG levels we did not dose AM or PM. (Bugs Spreadsheet is current. ) We did several AM readings spaced 15 minutes apart which were all consistent numbers. Her pm numbers were basically the same. We tested at 5:45 pm and 6:05 pm with no change. We just did a +4 at 10 pm and Bugs is at 161. Any thoughts or recommendations for tomorrow?
Thank you!
 
I noticed when I looked at her SS earlier, was curious how it would go. It's definitely a good sign that she's staying pretty steady without insulin, but it's still in diabetic range.

Anecdotally we've found that the best remissions - assuming that's possible here - are when you can keep them on insulin support for awhile to allow the pancreas to fully heal.

When you get a preshot 150-200 I'd suggest trying a reduced dose, somewhere between 0.25U-0.5U if you can monitor. Probably 0.25U if closer to 150, 0.5U if closer to 200. And in those situations, start with a +4. If you can't monitor, you can give an even smaller dose or skip, it's up to you.
 
@FrostD

We will follow your recommendation for dosing based of Bug's current levels. We'll also do the +4 after both the am and pm dose

If Bug's BG gets in the 200 or 300ranges again, what would you recommend for her dose?
 
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