First post, kind of urgent

Hi everybody! Almost all that I think I know about feline diabetes I learned from here and I am forever grateful for this wonderful community. I’m Calin and my best friend was diagnosed back in the beginning of February. He’s obviously a cat and his name is Zigmund, also known as Zhiga or Zhigulin, will be 8 years old in August. He went blind a couple of years ago (most likely progressive retinal degeneration which could be common to Russian blue – which he is, sort of). As for diabetes, it was actually my diagnosis (excessive drinking and peeing, not so much eating like mad but I observed a slight decrease in weight) confirmed by a vet. Now, the vets are clueless around here but this one did one good thing, he prescribed Lantus.

Since there’s not much time left until his PM shot, I’ll go straight to my question. We worked our way up to 2U twice daily and yesterday we managed to test him several times, human glucometer. The results were 347 at +3, 108 at +6, 207 at +9 and 252 PMPS at +12. Today AMPS 281, didn’t manage to get + 6 for various reasons, bought a better glucometer and did a test at +9 which was 122. Wife is at work until 9 PM and the shot is scheduled for 8 PM, can’t test PMPS. Since I don’t think his BG will rise at an acceptable level for us unexperienced (I would only feel safe to inject at over 250) what do you say?

Skip? Test at 9PM and if it’s over 250 inject one hour late full dose (2U)? Or? Many, many thanks!

 

Hi Calin and Zigmund. So sorry you havent received a reply yet!!! I see many views, but please understand we don't all have the knowledge to offer dosing advice, so we won't do so. Wondering if you skipped, or gave a token or late dose? Please keep us updated, someone will be on to help you. In the meantime if you can set up some info, it will really help. Check the Links of "Help us Help you" and you can set up your signature. You find this by clicking on your user name in top right of this thread, options pop up. Also the link to set up a spreadsheet, all of your readings can be entered there and this history will help you get help. Please keep posting and asking questions. There are people from every time zone here, so please be patient

 

Hi Calin and Zigmund and welcome to the forum.
Sorry no-one got to you on time to help you. You were correct in questioning if you should give the dose or not. The BG could have risen to an acceptable level at the next shot time after the +9 of 122, but as you could not test (why was that?) it may have been better to skip the dose as long as there were no ketones at diagnosis.
What would help us a lot and would help you, would be if you could set up a spreadsheet and add the data you have so we can see what is happening. We would love to help you with the dosing but would need to see data, as I'm sure you would appreciate. I'm giving you a link to lots of good information for new members...

HELP US HELP YOU

Do you have a hypo lit set up?
We recommend to always test before every dose to see it is safe to give the dose and then try and get some tests in during the cycles to see how low the dose is taking Zigmund as dosing is based on the nadir or lowest point in the cycle, not the preshot BG.

What type of food are you feeding him?
If you find the preshot is too low you can always stall, dont feed and test again in 20 minutes to se if the BG is rising. And post and ask for help. Change the subject line if you post to reflect the problem and to alert us.
Keep asking questions. If you dont have much support from your vet, we can definitely help you here
Bron

 

Thanks a lot for the answers, I'm in Eastern Europe so it's quite a big time difference.

Until I'll manage to find the time for a SS, today is another interesting day. So, we skipped the PM shot, the reason for not being able to test is that my wife is in charge and she's at work until 9PM, scheduled shot is at 8. There's two of us needed, Zigmund doesn't particularly enjoy the test though he's cool. Wife handles the lancet and I'm working the meter.

After the skipped dose, AMPS was 388, consistent pee overnight and water drinking. I have been testing ketones in urine since almost the begining and there was never any. He kept his weight and lately even put on some. Now, after that AMPS of 388 we shot the usual dose of 2U Lantus. Next test was at +6 and surprise, it was 67. Latest was at +9 with a value of 92. Basically we are almost in the same situation as yesterday. Can't test at 8, could test and 9 and then what? Again, many thanks.

 

So did a test at +13 came back 302 and we injected 1.75 U (BD micro fine Demi 0.3 ml syringe). First time trying to spot .25 graduation, how do you do it properly? Hope he'll be fine overnight.

 

Can you tell me what type of meter you are using please.?
What type of food are you feeding? Are you feeding before you test and giving the insulin?
Are you giving snacks in the first half of the cycle.? A snack is a teaspoon or two of low carb food.
You have the correct syringes which is good. For 1.75 U you just have to eyeball the amount. It is halfway between the 2 units and the 1.5 units. I’m going to ask @Bandit's Mom to help you with the spreadsheet so you can get started with it. She will contact you.
I think it is good idea you reduced to 1.75 U
Keep posting and asking questions

 

We started experimenting with a feline/dog calibrated meter, Vetmate but managed to get only three readings. All where at +6 and all were around 450 with Lantus 1.5U twice daily. Then it started throwing errors, but these tests made us to increase to 2U. Then we got an Akku Chek Active which we used a few times but it is a nightmare to put the blood on the strips, poor Zigmund suffered. The third one which we use now is great, easy to collect the blood, it's Contour Plus Elite.

Food, I know, dry is no good but he does not want anything else, except meat (preferably raw) and some ham types. We managed to change from Royal Canin Savour Exigent to Purina Pro plan VD DM dry which has 19% carbs (I know, I know...) which is about half of that Royal Canin. And it felt immediately. Mind you we were not doing BG but I was watching closely the clinical signs and urine with Diastix and Ketostix. And of course he is a grazer.

 

HI Calin, Do you think you could add the signature please?
It will show up as the small faint writing you can see below all posts...have a look at mine. It tells us all about Zhiguin ...food, type of meter, insulin, date of diagnosis and more.
You will find the link in this link
HELP US HELP YOU

A raw diet would be very good to use if you think he would eat it. You would need to add a supplement to ensure it was nutritionally complete. If you are interested I will give you more information. Ham is most likely too high in salt so I don't think I would feed that on a regular basis..
19% carbs is still high carb and if you could possibly swap him over to a low carb diet, I'm sure he would need much less insulin and would have a much better chance at remission.
So the meter you are using at the moment a human meter, so if the BG drops under 90 you need to reduce the dose. If you change the meter to a pet meter you need to tell us as the spreadsheet is different.
We have 2 dosing methods here. Because you are feeding dry food, you can only do the START LOW GO SLOW (SLGS). Here is a link to both the dosing methods for lantus...Look for SLGS. I would suggest printing it off for you to refer to more easily.
Lantus Dosing methods

 

Have you ever tried scooping up the blood droplet onto a clean nail? It may make it easier to be able to test with one person at home only because you wouldn’t have to hold him to get the meter up to his ear. You prick and collect the blood with the nail then take your time to get the blood from your nai with the meter. Just a thought.

 

@Zhigulin welcome to FDMB!

Thanks for setting up the Signature and SS. Did you start testing on March 12th? If not, could you add all of March data to the SS? It would be informative to see what he did in the last few days on various doses.

This is the list of low carb foods available in the UK and it has some dry food options as well. You could check if they are available in your country. People in Western Europe use sites like Zooplus to order food. I think Zooplus Germany has the most variety and ships internationally.
https://docs.google.com/spreadsheets/d/1J5JpMe6TDXrHq_aTl9hUtHy6Gs9oRBqlz4nPGKxtySA/pubhtml

 

Dont forget to get some tests in during the pm cycle as well as the am cycle. A before bed test is a good idea. If that test is lower than the preshot BG you might have to get up later and test again to see it’s not dropping too much.

 

@Zhigulin
How are things going?
Looking at the spreadsheet, I can see you have not got any tests in doing the pm cycle. Don't forget to get at least a before bed test as mentioned in post 11 above.

 

Many thanks for the question. It's a bit complicated at night, now his PM shot is at 9. Yesterday he had 206 at AMPS which makes me think he was in the green during the middle of the night. This low number (for us) prompted a reduction and his level rose to 427 PMPS. (Could have been a bounce?). This morning he was back to yellow and full dose of 1.75. I'm not sure what dose to inject if PMPS will be around 200. What do you think?

 

Well, it looks like Zigmund is in a safe place for his PM shot.

I'd encourage you to give some thought to shot times if it's difficult to get tests past your PMPS time. Getting at least one test during each cycle, in addition to the pre-shot test, is important. Lantus dosing is based on the lowest number in the cycle (i.e., the nadir) and Lantus typically has it's nadir somewhere in the neighborhood of +6. However, nadirs can and do move around. Many cats experience lower numbers at night so if you're not testing, you're missing half of your data. I also wouldn't assume where the numbers may have been. If you have some time to look at other member's spreadsheets you can see how variable their cat's blood glucose numbers are.

You mentioned that Zigmund likes raw food. Have you ever considered feeding him a raw diet? If that's a consideration, there are pre-mixes that you add to the food that contain all of the necessary supplements to make the food nutritionally complete for cats.

 

We are back with a question. Saturday night we transition to daylight saving time here. His PM shot is around 8, so Sunday it will be 9AM if I'm corect, this means in reality there are 12 hours between Sat. 8PM and Sun. 9AM. Can we shoot at 9 then on Sunday and keep the 9 to 9 schedule? In the meantime I think Zigmund is kind of unpredictable with his BG values. Thank you.

 

Yes, you can shoot at 9am on Sunday morning since that will be 12 hours from his PM shot, like you said. You can either stay with 9am and 9pm going forward or slowly work back to 8am/8pm by advancing his shot time by 15 mins per cycle.

Zhigulin has earned a reduction to 1.5U by dropping below 90 on 3/23. Does he get small meals every couple of hours in the first part of the cycle? That will reduce drops and the consequent bounces.

It would also be good if you can get a test before bed every night. Will that be possible? With tests only in the day you are only seeing half the picture. Cats are nocturnal creatures and many go lower at night and bounce in the day.

 

I'm back with a question. Today's AMPS was 413 and then at +6 we got 61. By the SLGS protocol I should decrease with 0.25 but he is kind of unpredictable, I'm thinking of keeping the 1.5U that he's on to now until I see (hopefully) consistent yellows pre shots. Have a look at the SS. What do you think? Thank you.

 

It’s going to take time

I would reduce the dose to 1.25 units with that drop to 61. The 61 is telling you the dose is too high. The high BGs you are seeing are from bouncing.
Are you giving snacks during the cycles as well as the preshot meals?
I would also encourage you to get tests in during the PM cycles as well. We have no idea how low Ziggy is dropping at night. He could be dropping much lower. Only testing will tell you.
Getting a before bed test in every night is a good habit to get into. And if that test is lower than the preshot test at the pm dose, then I would get up later and test again because that is telling you the cycle is most likely to drop further.
I will give you the definition of bouncing. At the moment he is not used to the lower numbers and he freaks out and bounces when he drops lower. The way to overcome this is to follow the SLGS dosing method and let him get used to the lower numbers safely. It’s going to take time! Not just a couple of weeks.
Here is the definition of bouncing

• 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).