Foster Cat Screechy's Diabetes Management

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Caraalex82

Member Since 2013
Hi,
Hope you all will excuse me, as this is my first post to this site.
My son, Justin, and I are fostering this really loving cat Screechy who was recently rescued from a shelter. He was so sickly when he came out of the shelter that he weighed only about 5.5 lbs. He was a very sick, unneutered boy. Our local cat rescue was trying to get him neutered, but the vet was afraid his frail health would not be good for his recovery. She wants him to weigh at least 8lbs before the procedure. Once he got diagnosed with diabetes and immediately put on Lantus to help regulate his blood sugar. I agreed to foster Screechy for a while, but he does need a permanent home.

Anyway in the last month or so, Screechy has finally reached 8lbs, but his blood sugar is still somewhat high in the 300s consistently. After reading one of the messages, I decided to try to decrease his insulin dose from 1.0 units to .5 units, because of the possiblity of rebound. I have only done that for the last two doses. Waiting to see if it help correct the blood sugar. Are there any other ideas that I can try?

I happen to know quite a bit about the disease, as it is quite similar to human diabetes (thought not exact). My son, Justin was diagnosed with Type 1 diabetes last June. Screechy is a very sweet animal and likes to nuzzle with us, and purrs incessantly! I am very hopeful for him, as he is getting stronger and stronger everyday!

Thanks for the help!
Cara and Justin (and Screechy)
 
Welcome Cara, Justin, & Screechy!

What and how much are you feeding Screechy? We strongly encourage low carb, canned or raw food. Cat info explains why.

Are you home testing? If yes, before every shot to be sure it is safe to give the insulin?
 
Thank you for taking care of Screechy!
Testing before every shot is important - otherwise we have no way of knowing if it's safe for them to get the shot. Another test that's very important is a mid-cycle test. That tells us what the insulin is doing while it's in the cat. That's how Lantus is dosed - it's based on the midcycle low number, not the preshot test. There's a lot of information about Lantus saved as sticky posts in the Lantus - Tight Regulation insulin support board.

Welcome on!!
 
Welcome!

From your previous post, it looks like he's on Lantus. It's great that you're already testing. Here's a handy link to help you set up a spreadsheet for tracking his BG numbers in. You can also create a profile for Screechy.

With Lantus, since cats metabolize insulin faster, it's given twice a day and dosing adjustments are based mainly off the nadir (lowest point in a cycle) and the pre-shot numbers. Here is an example of a typical Lantus curve:
+0 - PreShot number.
+1 - Usually higher than PreShot number because of the last shot wearing off. May see a food spike in this number.
+2 - Often similar to the PreShot number.
+3 - Lower than the PreShot number, onset has started.
+4 - Lower.
+5 - Lower.
+6 - Nadir/Peak (the lowest number of cycle).
+7 - Surf (hang around the nadir number).
+8 - Slight rise.
+9 - Slight rise.
+10 - Rising.
+11 - Rising (may dip around +10 or +11).
+12 - PreShot number.
Click to expand...

Due to Lantus being a depot-type insulin, when you change the dose, you generally want to hold it for a few cycles (~6 or more):
"General" Guidelines:

Hold the initial starting dose for 5 - 7 days (10 - 14 consecutive cycles) unless the numbers tell you otherwise. Kitties experiencing high flat curves or prone to ketones may want to increase the starting dose after 3 days (6 consecutive cycles).

Each subsequent dose is held for a minimum of 3 days (6 consecutive cycles) unless kitty earns a reduction (See: Reducing the dose...).

Adjustments to dose are based on nadirs with only some consideration given to preshot numbers.


Increasing the dose:

Hold the dose for 3 - 5 days (6 - 10 consecutive cycles) if nadirs are less than 200 before increasing the dose by 0.25 unit.

After 3 days (6 consecutive cycles)... if nadirs are greater than 200, but less than 300 increase the dose by 0.25 unit.

After 3 days (6 consecutive cycles)... if nadirs are greater than 300 increase the dose by 0.5 unit.


Reducing the dose:

If kitty drops below 40 (long term diabetic) or 50 (newly diagnosed diabetic) reduce the dose by 0.25 unit. If kitty has a history of not holding reductions well or if reductions are close together... sneak the dose down by shaving the dose rather than reducing by a full quarter unit. Alternatively, at each newly reduced dose... try to make sure kitty maintains numbers in the normal range for seven days before reducing the dose further.

If an attempted reduction fails, go right back up to the last good dose.

Try to go from 0.25u to 0.1u before stopping insulin completely.
Click to expand...

Hope this helps and please feel free to let us know if you have any further questions. :-D
 
Thanks to everyone who has posted thus far.

I received Screechy in my care about 2 weeks into his insulin regimen. I am testing him 3 time per day. He's receiving Lantus and we are currently dosing him at .75 units 2x per day. His blood sugars remain in the low to mid 300s. I'll try to remember to attach a link to the spreadsheet that the previous foster had started.

He's getting all low carb food, but the poor dear is so hungry all the time, I give him a large can of cat food 2 times a day with small amounts between. I can't do that all the time because I am away at work for an 9 hour chunk of the day. My son is helping, but spring break is nearly over. On top of everything else, the kitty has low B Vitimin and getting a B12 shot 2 time per week along with a daily probiotic for his irritible bowel. The poor dear was in such bad shape when he was rescued, but you should see him now! He is strong, bright-eyed, and his coat is looking so shiny.

Tomorrow the kitty is going over to the vet to have his neutering done. I've been told that it might help regulate him some more without all the hormones interfering. Is this true?

Thanks,
Cara
 
Have you tried making cat food cicles?

Take the food out of the can and cut it into quarters.
If using a cookie sheet you can plop it diretly onto the sheet and then cut it. You can also use a non-stick muffin cup.
Freeze.
Remove the frozen chunks from your cookie sheet/muffin cup and store in a ziploc in the freezer.
Serve a frozen chunk before you leave for work.
The food will gradually unthaw and the cat will be able to nibble at the food as it unthaws.
 
Some questions to help figure out the food side of things.

What is his ideal weight?

What does he weigh now?

How much are you feeding, total, in one day?

Is he a grazer or a scarfer?

Note: until he is regulated, he will be more hungry because he cannot use the calories due to insufficient insulin. You may need to feed 50 - 100% more for him to feel full. Spreading out the meals will help him from getting too hungry at any one time.
 
Food cicles sounds like a good idea, but I'm afraid I have ants and it might get pretty around the cat's bowl between feedings. I think that would be good for the winter.

I'm not sure about the cat's ideal weight, but he's just over 8lbs right now and i think he could probably be about 10lbs without looking over weight. His ribs and backbone are much less prominent now, but can still feel them.

Screechy eats about the equivalent of 6 cans of Fancy Feast per day. I am starting to notice him slowing down while he's eating. He used to scarf food so fast, you wondered where it went. Now he's taking more time. His blood sugar is staring to come down (in the 200s). Hoping before too long we'll be safely in the 100s with no rebound. He hasn't had a major swing in 4 days. The numbers are steady and improving.

He was also neutered on Friday and the procedure went great!

Cara
 
The trick to block ants is to set 1 dish inside another dish. Food goes in the center dish; water goes in the outer dish, making a moat. Also, a rim of petroleum jelly around the outside of the water dish further blocks ants.
 
What kind of food are you feeding? You said low carb canned but what brand/type? Also looking forward to seeing that spreadsheet to get a better idea of whats going on.
 
Screechy is on Fancy Feast Classic food. I've been following the advice and slowly increasing his insulin, and was getting reading in the 200s, but all of a sudden this morning he's back to 350.

Thanks for the ideas about blocking ants. I am going to try that along with the foodsicles. I think he'd really like to be able to eat all day long, but as soon as I put food down in front of him it's GONE! This way he can hopefully have some food all day long while I am at work and my son is at school.

I'll try to remember to post his insulin log so that everyone can see it.

Screechy is doing well, but just not progressing as rapidly as I would like. His weight is good, and he looks so much better, shiny coat, bright eyes. He is probably around 8.5lbs. When he was removed from the shelter he weighed just 5.5lbs, and was so weak.

Cara
 
Caraalex82 said:
... as soon as I put food down in front of him it's GONE! ...
Click to expand...

Budge permitting, you might invest in a PetSafe 5 automatic feeder (available from our shopping partner, Amazon, link above), which would spread out the portions over the times you select. This would help keep him from being too hungry by spreading out the food consumption, and reduce the odds of scarf 'n' barf behavior.
 
Yay to Cara for fostering a supersweet kitty! I'm doing that too.

How is Screechy doing? Is there anything else we could help you with? Any questions?

Wendy&Tiggy said:
The spreadsheet will really help. Let us know if you need help with it.
Click to expand...

With our standard format spreadsheet set up, other members on this board can look at it and try to figure out what is going on with the BG levels. Sometimes, we will as for you to get a few more tests at different times. Or sometimes trying a change in how and when you are feeding can make a difference.

If you would be willing to set a SS up, it will help us to help you better. There are also members here that set up spreadsheets for people that are having problems with the setup.

Here is the link to the Tech Forum here on FDMB that walks you through the SS setup and getting it in your signature link. http://felinediabetes.com/FDMB/viewtopic.php?f=6&t=50130

A profile that tells us more about your kitty is nice to see also. http://felinediabetes.com/FDMB/viewtopic.php?f=6&t=79123
 
Thanks for the help on the spreadsheet, I never would have figured it out on my own.

For the person who suggested the timed feeder, that was tried before. However, the clever boy figured out how to circumvent it. We are not going to try that again.

I posted the spreadsheet link in my signature. As you can see his numbers are mostly going to the 200s since I started giving him 3.0 units. Per the advice in this post I have been upping his dose slowly to make sure he stabilizes, and it has been working pretty well. I'm thinking about upping the dose again to 3.5 to see if I can get his numbers close to or into the 100s consistently. It would be pretty amazing.

I still can't believe how well this cat is responding to his treatment. His health has improved by leaps. His fur is filling out, and he doesn't look sick anymore.

I would love to get him into a permanent foster situation, or better yet, a permanent home. He's sweet and loving, but my cat doesn't want him around her home. Sad. We have to keep the two separated, and you can imagine how hard that is!

Thanks!
 
Hi Cara,

I would not increase the insulin at this point to 3.5 units of Lantus.

I was looking at Screechy's SS and it looks like you have been increasing the amount of insulin based on the pre-shot numbers. Lantus dosing increases/decreases are based on the nadir or low point of the 12 hour cycle. Most cats nadir is somewhere around the +6 time, give or take a couple of hours.

You are testing on most pre-shots (good job by the way) and then getting a few mid cycle numbers. I don't think you have found the nadir and need to do more testing in the middle of the cycle.

Also, you have been doing half unit increases. It also looks to me like you have been basing the increases on the pre-shot numbers. By doing this, you may have increased too fast and bypassed a good dose for Screechy. Quarter unit increases (0.25U) are usually better.

Another thing is, Screechy has earned a couple of reductions when his BG has dropped below 50. He is less than one year from diagnosis so he is considered a newly diagnosed kitty and falls under the "below 50 earns a reduction" part of the Tight Regulation protocol. A couple of examples of this are on 3/17 the +2 number was 46. That earned Screechy an automatic reduction of 0.25Units.

On 3/22, PM, Screechy fell to 51 at +3 and you did not test again until +6. It's very likely Screechy fell below 50 once again, earning that automatic reduction. It's also possible he went really low, a hypo situation, and his body compensated the next day by pumping out extra glucogen from the liver and sendiing him high the next day. We call this a "bounce". Looking at the SS, yes he was high the next day.

On 3/31, PM, he was a 92 and you still shot 1u. The +3 is a tiny bit higher but that was likely food influence or meter variance. Hard to tell with no +6 test but based on the 405 number for the next day, it's very likely he dropped low and bounced the next day and maybe for a couple of days. A bounce can last 72 hours more or less.

If you are around this weekend, it would be a good idea to do a curve. That is testing every 2 hours for a 12 hour period. It would also be helpful for us to help figure out what is going on, if you were able to get a before bed test. Are those recommendations possible for you to do?

Also, anytime a new member gets a pre-shot below 200 (150 if on tight regulation), we recommend you post here and ask for advice before giving the insulin.

Would it be possible for you to post more frequently? A daily condo is ideal and I would also like to suggest that you go to the Lantus Tight Regulation forum to post from now on. There are lots of experienced lantus users over there to help you figure out a dose.

Thanks for helping Screechy and lets try to get some more numbers before increasing that dose again.
 
Hi Cara

I was asked to look at Screechy's spreadsheet and here is my two cents worth. On 3/17 he should have earned himself a dose reduction dropping it back to .75u and as expected he bounced off that low, so the dose was held at 1u which is fine as many of us will shoot through a bounce, but if you do that you need to give the reduction on the next lower preshot number which happened on 3/20 except the dose was still held at 1u...with no spot checks noted between the preshots. Since we don't know for sure I will just have to assume that he went low and possibly very low that day and again bounced into the 400s by his pmps. Again since there are no midcycle numbers to base off of this is just a guess on my part, but I think you are more than likely seeing a repeating pattern of him dropping very low, bouncing back up into the high numbers as his body tries to save itself from a near hypo giving you high preshot numbers so the dose is raised again, without those midcycle checks the lows aren't being caught, so you have a vicious cycle going on where he drops low around his am nadir, bounces up by preshot, dose goes up and its rinse and repeat.

Personally if he was mine I would drop him back to 1u b.i.d., catch a ketone test on him every chance I got to catch him in the litter box and be testing him at the very least at preshot and around +6ish. And actually if I was going to be around to do it I would like to run a couple of back to back curves on him with one being test amps, +2, +4, +6, +8, +10 and pmps..then the next day getting the amps, +1, +3, +5, +7,+9, +11 and pmps just to try to find roughly where his onset is and where his nadir falls as well as how much food takes him up. Then once you know about where his nadir is generally you can fall back to testing at preshots and around the nadir to get a pretty good idea of how he is doing on a particular dose.

Again this is just the way that I would handle it if he was one of mine, and I do tend to be a little bit of a data freak. :-D

Mel, Maxwell, Autumn & The Fur Gang
 
This is interesting. I've not heard it explained quite like that. I was planning on doing a check of his blood this weekend at three hour intervals for 2 days to see what happens. I'll take your advice and drop him back to 1.0 unit and see where that takes us. Unfortunately I don't get much time at home during the week to monitor him thru the highs and lows, but this weekend I have plenty of availability to do some science with this will guy. He just hates his ear sticks so much, poor guy. :cry:

Thanks so much! I think I am understanding it much better. So here we go! I'll see how we fare this weekend.
 
Yeah I have the luxery of being able to be a bit of a testaholic since I'm home all day with my 14 cats (2 of which are diabetics, 1 OTJ and 1 trying real hard to get there). This weekend might not tell you much more than where his onset and nadir is roughly are as it will take him a couple of days for his shed to drain back to that 1u level. But again stickly speaking if he was one of mine I would hold the 1u this next week and then try the curve again when you have a day off to see if he is repeating the pattern he had back on 3/17 unless of course at any point during that week you catch a spot check and he has again dropped below 50 since he is still a newly dxed diabetic (under 1 year of being dxed).

Mel, Maxwell, Autumn & The Fur Gang
 
Hi Cara

Deb also asked me to take a look at Screechy's SS so I popped over from the Lantus Tight Regulation Insulin Support Group (ISG).

In the Lantus TR, we take doses up in very small increments (typically .25u) and hold them for at least 3-5 cycles. We don't dose on the pre shot but dose primarily on the nadir and reductions, for newly diagnosed cats, are given when the BG falls below 50.

I agree with Mel that you missed a reduction and then you started increasing the dose, increasing based on the preshot, and not holding some doses long enough. If one systematically and methodically increases the dose in small increments per our TR protocol, there is not a chance over overdose provided the caregiver is getting spot checks to catch the nadirs and so there is no need to drop the dose back to do a rebound check.

However, I tend to agree with Mel. I think it would also be wise to drop the dose back to 1u and even that might be too high. But if you get some spot checks, you'll be able to see where he's going and, hopefully, catch those low numbers and know for certain if he needs a dose reduction from the 1u. When you don't get those spot checks or any data at night, you are missing a huge amount of information. I've seen cats start at 300, be at 40 at midcycle, and be back at 300 by the next pre shot. Without that mid cycle test, the caregiver would not have known the low, and would have been tempted to continue increasing the dose based on the high preshots.

When Mel mentions a bounce, what she means is the action the liver takes in response to numbers lower than it is used to or to large drops. When Screechy was dx, his BG was high and his body had acclimated to those numbers. When the insulin starts to do its job and the numbers come down (they don't even have to be really low....just lower than what the liver perceives as normal OR numbers drop quickly), the liver releases counterregulatory hormones and glucagon to bring the BG back up to what it deems is "safe". Most cats bounce at least for a while. Screechy definitely is bouncing.

Let us know if you have any other questions. If you do catch a number below 50, I'd reduce the dose by .25u to .75u.
 
Cara - do you want to start posting on the Tight Regulation forum that Marje was talking about? There are many experienced dosing members there and they can help advise you through this. If you do move back to 1unit you may see high numbers for a while and they can advise you when and how much to increase etc even if you dont want to follow that protocol exactly. Here is the forum link:
http://felinediabetes.com/FDMB/viewforum.php?f=9

Like many of us it can be hard to get tests during the week when you are working so a few more tests at the weekend gives you so much more info! I would also set the alarm occasionally maybe twice a week for say + 6 to + 9 to see what he is doing then. I myself do that sometimes, or if I wake up naturally to use the washroom etc I go test then too and then back to bed.
 
Since you are testing at home and have a spreadsheet up if you want to move over to one of the Lantus ISG forums we can help you figure it all out. :-D Your choice on which one...either over on the TR board which is where Marje hangs out or over on the Relaxed Lantus forum where I am most days. Either one is fine there just basically a difference in protocol. Relaxed is more Start Low and Go Slow protocol and TR is pretty self explainatory it is Tight Regulation.

Mel, Maxwell, Autumn & The Fur Gang
 
Yes...your choice. The TR Protocol provides the best opportunity for kitties to go into remission. It is the only scientifically based protocol for diabetic cats. The research was published in a veterinary journal.

Start Low Go Slow is an approach...not a protocol. Doses are held for much longer. It is the primary approach which was followed on this board prior to publication of the TR protocol.

The other important difference to consider between the Lantus TR forum and Lantus Relaxed forum are the number of members. There is almost always someone on line in the TR forum...it's a very large and active group. RL is much smaller and less active...in that you may or may not find someone there the moment you need them.

Your decision.
 
I have some new numbers to look at since making the switch back to 1.0u. I will also post to the TR message board.

Is it normal for him to swing way back up to the 300s? I was hoping to catch a low at some point over the last two days, but it doesn't really seem like it. What's your take?

This is difficult for me to determine because I don't have any experience at it. I am hoping his next forster has some more experience.
For now, I'm just trying the best I can to keep him healthy.

Cara
 
Yes, numbers back up in the 300's is normal. Screechy is probably bouncing. When the BG goes too low, the body release counter-regulatory hormones and glycogen. Once the liver gets used to some of the lower numbers, it will stop going into panic mode and settle in to the new dose. This can take up to 72 hours.

Screechy was also low on the PMPS on 4/26 with a 140. We generally don't advise new members to shoot that low, but to post for advice on the message board first.

With a little more test data, we might be able to see when Screechy's nadir is. Today, you got a +5 which was low. I'd really like to see a +6 to see what he is doing then. Lantus usually has a nadir of around +6 and that is why I'm asking for a test then.

You probably work during the day so getting a test then will be difficult, unless you are close enough to come home on your lunch hour. Some people can do that. Other people set their alarms to wake them up at night to get those +6 tests.

Wendy&Tiggy said:
Like many of us it can be hard to get tests during the week when you are working so a few more tests at the weekend gives you so much more info! I would also set the alarm occasionally maybe twice a week for say + 6 to + 9 to see what he is doing then. I myself do that sometimes, or if I wake up naturally to use the washroom etc I go test then too and then back to bed.
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