Goose - new member summary - DC May 2023

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Anshu and Goose

Anshu and Goose

Member Since 2023
Hi everyone, we've been a looking at this forum for a couple of weeks now, but never posted until yesterday. Our cat Goose (11, male/neutered, ginger) was diagnosed with Diabetes and DKA in May 2023. My name is Anshu (she/her) and my husband's name is Bijal (he/him). We'll probably both be using the account together and both be reading/posting everything. Thanks so much in advance to everyone for advice.

We wrote this out and realized it became way too long to expect anyone to read. The brief summary and current situation give the gist of everything. I'll post his full health history in a reply below.

>> Link to most recent thread on the Lantus forum:

Brief Summary:
After the initial diagnosis (05/11) he remained on dry food and increasing amounts of insulin, up to 3U lantus b.i.d.) with poor results and worrying symptoms. On 06/09 we started home-testing and switched to wet food (Fancy Feast Classic Chicken Pate). Started at 1 U insulin glargine, but had to drop quite rapidly because of periodic very low numbers (usually) at the 6th cycle. Presently bouncing even at 0.1U.

Current Situation and general questions:
His numbers seem to be bouncing all over the place right now. His behavioral signs are markedly improved though. He is getting more and more active and friendly and like his usual self over the past week or two. He did have a cold and more GI issues which had him down for a few days and probably affected his numbers.

From our limited knowledge and looking at other members spreadsheets, his rapid drops in numbers and reaction to even tiny amounts of insulin seems… unusual. To avoid too much cross-talk, we're posting on the lantus forum for the questions about dosing and his numbers. Our main goal right now is to get him on a stable dose.

Thanks again everyone. This board has already been so helpful to read and really reassuring to us.

Best,
Bijal and Anshu
 
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----- Long essay about his health history and more details below -----

Goose's Health History Before Diabetes diagnosis:
We adopted around April 2020 when he was age 8 (~3 years ago). We don't know his medical history before then other than that he has his vaccines. At adoption, he was significantly overweight (15 lbs), but we got him down to his target 10-11 lbs gradually by April 2022. Up until his diagnosis (May 2023) he has had no major health issues, other than occasionally vomiting partially digested dry food kibble. During his weight loss he was eating some Hill's weight loss specific (non-prescription cat food). After his weight loss, he was eating Hill's Science Adult 7+ Indoor Cat Food - dry.

Lead up to diagnosis:
Goose's vomiting started to become more frequent by April of 2023, now every 3-4 days or less. At his annual checkup in early April, the vet said his bloodwork may indicate he is trending towards diabetes and that we should do yearly bloodwork for him. She also recommended moving him to Hill's Prescription z/d Dry Cat Food for possible IBS and to stop his vomiting. During the month of April we slowly started to transitioned his food from the Hill's Adult to the z/d. By early May, Goose became quite ill and refused to eat. He started to show signs of lethargy and P/U, P/D and we rushed him to the regular vet who diagnosed him with diabetes and DKA and sent us to the emergency hospital (5/11/2023).

Early treatment 05/13 - 06/09, dry food, higher insulin doses:
He was hospitalized for 2 days because of DKA. The ultrasound also indicated pancreatitis, which the ER said explained his sudden worsening of diabetes symptoms.

Once back home, we started him on 1U Lantus (Glargine) b.i.d. (starting 5/13) As his symptoms came back, the vet increased him to 2U (5/25), and eventually 3U (6/1). He started having P/U and P/D again, so we again took him to the ER (5/28), where they said his glucose was high and he had ketones, but they did not want to hospitalize. SO they sent him home with us. A week later we did a BG curve at the vet. (using AT- no dips, values b/w 300 - 450). So far, he remained on the z/d dry food. We asked the vet for food changes, but they thought stabilizing insulin dose was a higher priority.

On 6/9, he stopped eating and had severe GI upset. We got anti-nausea and appetite meds from the vet as well as an alphatrak 2 glucometer for home testing. The vet suggested we should switch to a prescription food (Purina DM wet), but to go ahead and give him 3U and (paraphrasing) 'see what happens'.

At this point we'd been reading the forum a bit and were pretty spooked with the advice to switch food without testing. So we decided to go down to 1U and try to follow the protocols on FDMB instead.

Recent Treatment 06/09 to now, wet food, lower doses:
We started his BG measurements at home on 06/09 and switched him over to wet food.

Food:
We fed him the Purina DM wet food for one day, but since 6/10 - he has been eating Fancy Feast Classic Pate Chicken - 207 gms based on calorie calculations for his age. We had to split it to 3 meals a day and puree it, and sometimes sprinkle FortiFlora or give an appetite stimulant (mirtazapine)

Insulin after switch to wet food:
We started him on 1U insulin b.i.d., but he has been dropping concerningly fast in his insulin needs. (attach spreadsheet). We have been using BD Veo syringes (3/10 mL, 6 mm length, 31G) with 1 U markings. When we got to 0.1 U we switched to using calipers for dosing. We've ordered the UltiCare U-100 syringes with 0.5 U markings to try later this week (still with calipers).

Testing and Schedule:
  • Food: 8 AM, 3 PM, 8 PM.
  • Insulin: 8:30 AM, 8:30 PM (+- 30 mins)
  • Glucose measurements: Always before feeding and injecting insulin. At least AMPS, PMPS, before afternoon food.
  • Medicine (all as needed): Cerenia for anti-nausea, Mirtazapine as appetite simulant, Gabapentin for pain, as needed.
  • Ketone test strips: Ideally 1x daily or when numbers are high. Finally got them on 6/21.
 
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I’m tagging a few more experienced folks here for you but I’m wondering if following TR wouldn’t be better for him. You’re testing enough that you could do it. With TR you only decrease the dose when he goes under 50 on a human meter - I realize you’re using a pet meter someone will chime in with what that number would be on alphatrak. Also, I’d give him a drop instead of no insulin right now. Do you know how to measure it? You hold the plunger in and insert into the pen or vial. Then you release the plunger and it draws up one drop.

@Sienne and Gabby (GA) @Bron and Sheba (GA) @tiffmaxee @Wendy&Neko
 
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Thank you so much!
I think you're right about the TR... testing suddenly got a lot easier for us so it's probably time to just switch since that's what the goose seems to want anyway.
And thanks for the instructions on giving a drop. We are going to test again soon, if his numbers are still flat or upwards, we will do that.

Also - i realize i forgot to add the link to today's post in the lantus forum in the original post, so I will put it here in case it matters.
https://felinediabetes.com/FDMB/threads/6-21-goose-amps-106-ns-1-75-411-3-411-dosing-help.278785/
 
@Anshu and Goose
How are things now with goose?
I am glad you have swapped to a low carb diet. That is very good. And hometesting is the only way to find the best dose for Goose.
How much are you feeding him? are you giving him main meals before the insulin? and with DKA in the recent past I would be giving at least 3 snacks during every cycle. It is very important that you feed Goose lots of food after DKA.
It is food and insulin which keeps ketones at bay.

There is no need to wait 30 minutes after feeding him to give the insulin when you are using Glargine. You can test/ feed/ give the dose one after the other.
When you see a BG like 148 at +3 after a preshot of 353 on 6/28 you need to test again to see how low the BG is going. I can see by the preshot the next morning (544) that he probably dropped low and then bounced back up high.
Are you testing daily for ketones?
 
@Bron and Sheba (GA) - thank you for the inputs! Things did get a lot better with Goose. His insulin needs went up for a while till 2U, then he stabilized and started earning reductions.

We adjusted his food as his weight increased, he's current 10.4 lbs / 4.6 kgs and getting 200g of Fancy Feast Chicken Pate, in 5 servings throughout the day (total 230k kCals). We were giving him 230g till last week, but he would leave some food unfinished. He has been testing consistently negative for ketones and maintaining his weight. He has also gotten much better with appetite, so we are able to shoot him once his face is in the food bowl.

I have just posted for dose adjustment advice with his recent pancreatitis flare up here.
 
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