First time post, lengthy summary

[Cobden]

Our cat has been diabetic for about 2 years, and on insulin about 1.5 years. She's been on Lantus twice daily, eating DM wet (we recently switched to Royal Canin Calorie Control as that's the best food we can find in Mexico City). We tried to keep her glucose as low as possible and not being educated enough, this led to a seizure a year ago. Since then we've learned more and drastically cut back on the insulin, and now she receives 1.25 units at 9:30am and 0.75 units at 9:30pm. She eats a whole can during the day (9:30am-9:30pm) and in the evening, she eats a third (9:30-11:30pm). We try to feed small portions frequently.

With this dosage, she no longer gets as low as she did (ie, BG of 5). Her latest curve looked something like this:

9:30am: 13
12:30pm: 16
3:30pm: 18
6:30pm: 11
9:30pm: 14

We are not sure if this is the correct dosage, and if loading the dose more heavily in the morning is correct. But we are worried about her blood sugar dropping during the night, as she does not eat after 11pm. Our first priority is to keep her from dropping too low, we've given up hope of remission, but we want her to be as healthy as possible.

We're hoping for any advice from those with a similar routine/diet/etc. Or if we are on the right course, just some confirmation. We can do a curve tomorrow or Monday if anybody would like to see more up-to-date results.

Thanks a lot!

 

[Deb & Wink]

With this dosage, she no longer gets as low as she did (ie, BG of 5). Her latest curve looked something like this:

9:30am: +0.5 13 234
12:30pm: + 3.5 16 288
3:30pm: + 6.5 18 324
6:30pm: +9.5 11 198
9:30pm: + 0.5 14 252

I added US translations of your BG numbers to your curve BG numbers. (Multiple by 18).
Also, added our standardization of the hours into + (plus) times. We indicate the AMPS (morning pre-shot) then calculate additional tests based on how many hours have elapsed since that pre-shot test.

It looks like you are testing after giving the shot. We test before the shot and before food.

Different doses being given day and night are not normal.

When was this last curve done?

Is the Royal Canin you are feeding a canned food? How many ounces (grams) per can? Which of the Royal Canin Calorie Control foods are you feeding? the one with morsels in gravy (25% carbs), the high fiber (29% carbs) or the pate (14% carbs). All 3 of these are too high in carbohydrates for a diabetic cat.

We recommend feeding foods with less than 10% carbs. This list is for US foods but some may be available in Mexico. http://www.catinfo.org/docs/FoodChartPublic9-22-12.pdf Do you have the Friskies pates of the Fancy Feast classic pates in Mexico? Those are 2 low carb options that are budget friendly.

 

[Cobden]

Thanks for the translations. The tests at 9:30 were all done just before the shot and feeding (we actually give the shot at 9:30, I wrote 9 in the OP as it seemed easier, I've updated it now).

Right now she eats 225g of Royal Canin Calorie Control "High Protein". This seemed better than any of the veterinary or store brands, including Hills MD, in terms of carbs. I would prefer DM or Wellness CORE grain free, but I can't find it in Mexico and I'm not allowed to import it myself. This is recommended as intermittent food due to the low calorie count, but with 225g it is enough calories, and seems healthier than the Friskies or Fancy Feast options (which are available)...

This is more or less the can: http://www.amazon.com/Royal-Canin-Veter ... gh+protein

If it's not the best choice, we're eager to get something better.

And the same insulin dosage should be given with Lantus in the morning and evening, even though no food is eaten after 11:30pm? If so, we can go back to 1 and 1 and curve from there. The last curve was about 4 weeks ago.

 

[Blue]

Thanks for the translations. The tests at 9:30 were all done just before the shot and feeding (we actually give the shot at 9:30, I wrote 9 in the OP as it seemed easier, I've updated it now).

Right now she eats 225g of Royal Canin Calorie Control "High Protein". This seemed better than any of the veterinary or store brands, including Hills MD, in terms of carbs. I would prefer DM or Wellness CORE grain free, but I can't find it in Mexico and I'm not allowed to import it myself. This is recommended as intermittent food due to the low calorie count, but with 225g it is enough calories, and seems healthier than the Friskies or Fancy Feast options (which are available)...

So the same insulin dosage should be given with Lantus in the morning and evening, even though no food is eaten after 11:30pm?

Dosing for Lantus and Levemir should be constant, am and pm; they work better because of the depot. Frequent changes makes for ups and downs in the numbers. What about go with a 1u dose for am and pm and hold that for about 2 days then see if the steady dosing gives you more level numbers.

OK for food, check on Dr. Lisa's list and pick foods that are under 10% carbs... if the food you are feeding now is below that number, and your cat likes it, you can stick to it.... but it looks like the food you are feeding now is a higher carb, so the food may be causing higher numbers than you could get by feeding Fancy Feast pate instead. There are many people feeding Fancy Feast and Friskies pates and their diabetic cats are doing just fine.
catinfo.org/docs/FoodChartPublic9-22-12.pdf

Until your cat is regulated, in numbers closer to non-diabetic, you really don't need to be worrying about calories because diabetic cats are not capable of extracting all the nutrients from the food, so many tend to eat more until regulated. With feeding, many people use auto feeders and they just divide up the day's worth of food into several smaller meals.
You don't need to worry about no food after a certain time, but if you want, you could leave a small portion out overnight as quite often cats regulate themselves. If you are worried about your cat going low overnight, that's a good reason to leave out some food - when cats go lower, they search out food.

A number of 5 is a great number to get.... your goal is to get your cat under 6.6 at all times.
When you do a curve, you want to watch for nadir, the lowest point in the cycle, and if you get any reading that is under 2.8, your cat would earn a reduction in the dose of 0.25u.
If the lowest numbers you are getting in the cycle are above 11.1 then you should up the dose by 0.25u and if all numbers were above 16.6 then you would increase the dose by 0.5u.
One of my non-diabetic cats is usually around 2.6 all the time.

I think if you give a steady dose of 1u and change the diet to a lower carb food, your next curve will show you much better numbers.


BG Conversion Calculator

so forget about the vet food; it's not near as good as fancy feast or friskies for your cat.
none of my cats would touch DM, and it's not that great of a food either.

 

[Deb & Wink]

Ok, I believe that Royal Canin Calorie Control High Protein is the morsels in gravy version. If that is correct, than the carbs are 25%, quite high for a diabetic cat. Since you are in Mexico and Wellness is not available and neither is the Purina DM, than the better choice would be the Fancy Feast classic pate style. These are between 1% and 5% carbs and can make a dramatic difference in the BG numbers.

With a lower carb food, your cat can drop dramatically, 5.5 points (100 points US). When switching the food, be careful and monitor to make sure the BG numbers do not drop too low resulting in a hypo situation.

Here is a shortcut list of foods under 10% carbs that one of our members had posted.

all values are from Dr. Pierson's updated list

carbs in % . . last number is phosphorus ( FKD cats need under 250 phosphorus)
4% - fancy feast CLASSICS chicken feast- 546 - beware of those that are not classics ...
4%- fancy feast chopped grilled feast pate -569
2%- fancy feast cod, sole & shrimp feast pate – 787
4%- fancy feast Ocean Whitefish and tuna pate 823
1% -fancy feast Savory Salmon feast pate – 369
5% -fancy feast Tender beef feast pate -637
5% -fancy feast Tender beef and chicken feast pate -502
5% - fancy feast Tender beef and liver feast pate – 525
4% -fancy feast Tender liver and chicken feast pate -598
3% - fancy feast Turkey & giblets feast pate – 355
5% -fancy feast salmon and shrimp feast -550
4% -fancy feast kitten tender turkey feast -474
5% - fancy feast kitten tender ocean whitefish feast - 689
5% -fancy feast chunky chicken feast -637
7% - fancy feast chunky turkey feast -624
7% -fancy feast chunky chopped grill feast - 454
8% - fancy feast Flaked chicken and tuna feast - 434
0% - fancy feast Flaked fish and shrimp feast - 701
8% - fancy feast Flaked Salmon and whitefish feast - 458
7% - fancy feast Flaked Trout feast-395

8% - Friskies flaked with tuna and egg 415
9% - Friskies Poultry platter – 438
5% - Friskies Special diet Beef and Liver entree 241
5% - Friskies Special diet Turkey and Giblets dinner pate 189
5% - Friskies Special diet Beef and Chicken Entree pate 242
4% - Friskies Special Diet Whitefish dinner 351
7% - Friskies Special Diet with Salmon 228
7% - Friskies Salmon dinner classic pate 499
8% - Friskies Turkey and Giblets dinner 338
8% - Friskies Supreme Supper 416
6% - Friskies Mariner's Catch 393

3% Weruva Paw Lickin' chicken 196
9% Weruva Green Eggs & chicken 230
4% Weruva On the Cat Wok 163
5% Weruva Steak Frites 118
7% Weruva MidEast Feast 202
3% Weruva Meow Luau 253
1% Weruva Marbella Paella 253
1% Weruva Outback Grill 562
1% Weruva Asian Fusion 295
6% Weruva Polynesian BBQ 390
0% Weruva Mack and Jack 337

Weruva Cats in the Kitchen canned food
5% Tu Two Tango 343
3% La Isla Bonita 166
4% Goldie Lox 252
5% Kittiy Gone Wild 412
8% Funk in the Trunk 250
4% Fowl Ball 180
4% Splash Dance 292
8% Lamb Burger-ini 236
2% Chicken Frick 'A Zee 174
8% The Double Dip 248

5% Go! Chicken, Turkey, Duck 309

5% - Merrick Cowboy cookout 202
8% - Merrick Grammy's pot pie 237
3% - Merrick Surf n Turf 229
4% -Merrick Southern delight -328 this one has crawfish in it.
8% -Merrick Ocean Breeze 420
9% -Merrick Turducken 219

1% - Merrick Before Grain cat 96% beef – 163
2% - Merrick Before Grain cat 96% chicken – 341
2% - Merrick Before Grain cat 96% turkey – 178
2% -Merrick Before Grain cat 96% quail and chicken – 506
2% - Merrick Before Grain cat 96% salmon 439
2% Merrick Before Grain cat 96% tuna 450

5% - Wellness Kitten 216
4% - Wellness chicken 219
4% - Wellness turkey 201
5% - Wellness turkey and salmon 299
4% - Wellness Beef and chicken 226
6% - Wellness chicken & herring 303
6% - Wellness beef & salmon 207

6% - Wellness Core Kitten 255
8% - Wellness Core chicken/turkey/chicken liver 215
5% - Wellness Core Turkey & Duck 265
5% - Wellness Core Beef , Venison & Lamb 171

0% - TikiCat Koolina Luau 421 ( chicken with egg)
0% - TikiCat Puka Puka Luau 303 (chicken)

all the rest are seafood combos
1% - TikiCat Hookena Luau 337
0% - TikiCat Napili Luau 419
0% - TikiCat Hawaiian grill 300
2% - TikiCat Lanai Luau 348
0% - TikiCat Manana Grill 283
2% - TikiCat Bora Bora Luau 642
0% - TikiCat Hanalei Luau 354
1% - TikiCat Hana Luau 276
0% - TikiCat Papeeko Luau 392
0% - TikiCat Tahitian Grill 443
1% - TikiCat Makaha Luau 723

3% - Nature's variety Instinct Grain free Chicken – 302
3% - Nature's Variety Instinct Grain free Beef – 248
2% - Nature's Variety Instinct Grain free Lamb 262
1% - Nature's Variety Instinct Grain free Duck 191
0% - Nature's Variety Instinct Grain free Venison 330
? - Nature's Variety Instinct Grain free Rabbit ?

2% - Natura Evo 95% chicken and turkey 155
5% - Natura Evo 95% duck 251
6% - Natura Evo 95% venison – 416
4% - Natura Evo 95% beef – 234
3% - Natura Evo Turkey/chicken for Cats/kittens 266

8% Innova Cat & kitten 279

2% Hounds & Gatos chicken 241
9% Hounds & Gatos Beef 250
2% Hounds & Gatos Pork 403
5% Hounds & Gatos Rabbit & Duck Liver 402
3% Hounds & Gatos Lamb/chicken/salmon 225
4% Hounds & Gatos Trout & Duck Liver 366
3% Hounds & Gatos Lamb & Duck Liver 244
2% Hounds & Gatos Salmon 373


8% -Holistic Select chicken & lamb 222
8% -Holistic Select Salmon & shrimp 264

6% Nutro Natural Choice Mature Health Chicken & Turkey Formula chunks in gravy 204 this selection is being replaced but some stores have a little stock left.
new varieties replacing the old ones are supposedly all 1 or 2% carbs but waiting for confirmation....
Nutro Natural Choice Senior Soft Loaf Cod
Nutro Natural Choice Senior Soft Loaf Chicken
Nutro Natural Choice Senior Minced Cod and Tuna
Nutro Natural Choice Senior Minced Chicken and Salmon

8% Soulistic Shrimply Divine 270
4% Soulistic Double Happiness 262
3% Soulistic Polynesian Picnic 239
4% Soulistic Celestial Feast 250
7% Soulistic Upstream Dream 234
9% Soulistic Surf n Earth 255
8% Soulistic Nautical Nirvana 228

2% Purina One chicken pate 438
3% Purina One Turkey pate 469
5% Purina One Beef pate 530
2% Purina One Whitefish pate 734

9% ProPlan Turkey and Giblets 382
4% ProPlan Chicken & Liver entree 509
5% ProPlan Chunky Chicken Entree 639
2% ProPlan Whitefish & Salmon 662
2% ProPlan Kitten Chicken and Liver 436
6% ProPlan Kitten Whitefish & Tuna 522
3% ProPlan Kitten Salmon & OceanFish 462

9% Max Cat Chicken Supreme 173
8% Max Cat with savory duck 197
8% Max Cat with Savory Venison 214

8% Avoderm Chicken Chunks/gravy 234
0% Avoderm Salmon in consumme 469
1% Avoderm Swordfish in consumme 271
0% Avoderm Tuna & Prawns 278
2% Avoderm Tuna % chicken w/ veggies 241

6% Artemis Chicken 320
4% Artemis Turkey & giblets 409
8% Artemis Seafood 351

5% Halo Spot's Pate Whitefish 466 my cat does not like Halo.
4% Halo spot's Pate Chicken 303
9% Halo Succulent Salmon 227

1% Eukanuba kitten entree with gourmet chicken 253
1% Eukanuba adult Entree with gourmet chicken 239
8% Eukanuba adult Entree with Lamb and Rice 230
3% Eukanuba adult Entree with Pacific Salmon 241

7% Evolve -chicken 214
6% Evolve turkey 244
6% Evolve seafood 265

4% Natural Balance Catatouille (stew) 274
0% Natural Balance O'Fischally Scampi 244
2% Natural Balance Sea Brulee 297

5% Pinnacle Chicken and Ocean fish 175
5% Pinnacle Chicken and Tuna 221
4% Pinnacle Ocean Fish 231

3% Authority Chicken 238
5% Authority Sliced Chicken in sauce 284
7% Authority Turkey & Giblets 222
8% Authority Beef 249
7% Authority Whitefish 254
7% Authority Catfish 254
6% Authority Chicken & Liver Kitten 262

BFF (Best Feline Friends ) also made by Weruva
BFF 2% Tuna and Chicken 234
BFF 2% Tuna and Salmon soulmates 236
BFF 2% Tuna and Shrimp Sweethearts 236
BFF 2% Tuna and Bonito Be Mine 240
BFF 2% Tuna & Tilapia Twosome 240
BFF 5% Tuna & Pumpkin Valentine 243
BFF 2% Tuna & Chicken Chuckles 234

8% Dr Fosters and Smiths Chicken 204

2% ZiwiPeak Lamb 224
2% ZiwiPeak Venison 338
0% ZiwiPeak Venison & Fish 260
1% ZiwiPeak Lamb & Rabbit 280

Maybe print this out and take it shopping with you to find a lower carb food.

 

[Cobden]

Thanks for the food advice. Our main concern with the Friskies or Fancy Feast is the grains that may of these have, even if they are low in carbs on that list. Her current food "High Protein" has no grains in the list of ingredients. It also has no fish products, and she is most likely allergic to fish. We will take a look if there is a food available from that list without grains and fish and switch to that. None of the "gourmet" fancy feast is available, and that's the one that appears to be low in carbs...

This morning before the shot she was at 6.9 (124) so we are holding off for an hour to see what she is at and will dose accordingly. If it around 8-10 (144-180) we will give .25u-.5u as today we can monitor her. Are you sure she would better off getting the same dose twice daily, instead of something that matches here BG before the shot?

 

[cjleo]

Hi there,

Both Lantus and Levemir are very long acting insulins dosed based on the mid-cycle test, not the pre-shot numbers. And, because they are long acting insulins, they should be dosed the same at 12 hour intervals. So a 1u dose am and pm would probably even out the numbers.

If you get numbers under 150 preshot consistently, please take a careful look at numbers 5 to 7 hours after giving the morning insulin. They may be too low. In that case, you might want to lower the dose to .75 bid. Then recheck a curve in 3 or 4 days.

If you want to use a sliding scale based insulin, you might look at ProZinc or BCP PZI (from BCP in Houston).

Can you get Merricks in Mexico city? You might try Cowboy Cookout.

All the best,

Claudia

 

[BJM]

When you have a moment, you might find it helpful to read over the stickie posts on Lantus in the Tight Regulation forum, just to give you some good background on how it is stored and so on.

Although you are blood testing (Good job!), it also is helpful to monitor for urine ketones. My signature link Secondary Monitoring Tools has tips on this, as well as other supplemental observations you may make to monitor your cat's health.

Ketones are a by-product of fat breakdown. Too many may indicate diabetic ketoacidosis, a potentially fatal, epensive to treat complication of diabetes.