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roisin and fax

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Hello,
Greetings from Ontario.
I have a 9 year old diabetic male cat. He was diagnosed in the spring of last year - had a honeymoon period lasting from October '10 until about a month ago. Treating his diabetes last year was a whole different ballgame to this time around. We were able to regulate using Lantus with little to no issues.
We are having a horrible time trying to regulate his levels this time around. I am home testing and he is currently getting 5 units of Lantus twice daily. He was started back on insulin May 6 (2 units, we have slowly increased since then) and so far it doesnt' seem to be helping the poor guy.
I am just learning that the information given to my by our vet clinic hasn't been helpful (ie. we were told that a reading of 20 mmol/L was acceptable, which I now know isn't in the range we should be looking for).
Yesterday and today I am testing with a high frequency to get a more accurate curve in hopes that I can at least go back to the vet with pages of data rather than having to argue about how I don't want to leave him there at the clinic for testing.
The poor guy is breaking my heart - always hungry and just not himself these days.

Thanks for listening to our situation
 
Welcome back -though sorry you are here. :sad:

Have you checked out our Lantus support group? They use a protocol specifically tailored to Lantus that is very successful: viewforum.php?f=9 Be sure to start with reading the stickies at the top of the page. Usually, the suggestion is to start with one unit and work up - .25 units at a time. It may be that you started at too high a dose and that is why you are seeing high numbers. The curve might also show you if he is going low mid cycle and bouncing back up.

I assume since he was OTJ before that you feed wet lo carb?

If you post on the Lantus forum, they will want to see a spreadsheet. It helps them when you have dosage questions to see your dose and bg level history. It also helps you to see trends and patterns. We have been having trouble getting it to load. I would suggest going onto Goggle and searching google documents (templates) for FDMB spreadsheet and accessing a copy from there. Here are the directions on how to set it up: viewtopic.php?f=6&t=18207 It is tricky, so if you need help, just ask.

I hope we can help your kitty back to wellness.
 
What does OTJ mean?

We feed him diabetic wet food only. Three meals per day. Dry food is a big no no now for Faxy. Really puts things out of control.

I haven't looked at the Lantus board yet. I am just looking through the main page of the forum now. I will get there though!
 
My sister had a cat named Fax, also one called CC - Carbon Copy :roll:

My own little man Tucker(GA - gone ahead, or guardian angel) he was OTJ - off the juice, off insulin, on honeymoon, for almost a year before going back on insulin for next three years.

Often there is a reason that cats go back on insulin, dental issues, infection, some other underlying condition. Did your vet check his teeth and run bloodwork to check for infection? Is your lantus fresh?
 
OTJ means "Off the Juice" or, off insulin and diet controlled.

Are you home testing? My guess is that he is getting too much insulin. Most cats don't need much more than 1u when they are on a low-carb wet diet, and often less if they've been in remission before. He was started out on 2u, which is too high a starting dose, in my opinion. Dose increases need to be done in .25u-.5u increments. If you've been increasing by 1u, chances are you've definitely gone too high.

Here's a link to the dosing protocol that's used here. It's safe, and incredibly effective: http://www.felinediabetes.com/FDMB/viewtopic.php?f=9&t=1581 My own vet now recommends it to all of her feline diabetics.

Too much insulin looks the same as too little insulin on Blood Glucose Levels if you're not home testing. The cat's liver dumps glucose into the blood causing high blood glucose as a survival mechanism with the high dose. Three (or more) daily tests are needed in order to dose Lantus correctly--the AM preshot, the PM preshot, and a test 6 hours after the shot in either cycle (additional tests help, too).

As previously mentioned, a secondary infection can also keep BG high, and needs to be ruled out as well. If your insulin is old, then that can also cause it to lose effectiveness. If this is the case, you most definitely want to lower the dose before shooting again with new insulin.
 
Yes, Fax was off the juice from October until a few weeks ago and was getting canned low carb food.

The vet started him back on 2 units - because it was less than the 4 units he was on last year when first diagnosed. Each increase has been on vet's orders.

They did check him for other underlying conditions. He was put on a round of antibiotics for 10 days due to having some white blood cells show up in his tests. They did not find anything in particular but thought it would be safer to put him on antibiotics just in case.

Yes, I am home testing - I had to get a new meter last week (a One Touch Ultra) because I was fed up dealing with the vets office - the prices are way more than human supplies and also the test strips are on back order for a month - not something I can go without right now.

How do I figure out if he is getting too much insulin? Is it safe to just start him back at a low dose this evening?

Thanks for all of your speedy replies - I am so worried over this whole thing, he's not doing great at the moment.

Roisin
 
Ok, so I would say let's first get some data so we know if the problem is too high a dose. Can you get at least three tests a day (the AM preshot, the PM preshot, and a test 6 hours into one of those cycles?) Once you have a few days worth of data, you can tell if the dose is too high. That test 6 hours into the cycle is going to be the most telling. If you can get one 4 hours into the cycle as well, that gives you even more information.

You can organize this information by setting up a spreadsheet. Here are instructions :http://felinediabetes.com/FDMB/viewtopic.php?f=6&t=18207&start=0

Once you have this, and those numbers to look at, we'll be able to better tell what is going on.

Can you post any numbers that you already have taken? Any data at all can help. I'm wondering how high his BG is running? Was he tested for ketones? If ketones are present then you would want to be a bit more cautious in lowering the dose right away. You can test for these yourself with the diabetic Ketostix you can get at any drug store.

Nearly all of us here use a human meter...the vet meters are a waste of money. Human meters run a little low on a cat, but that doesn't matter because you're looking for patterns, not absolutely exact numbers. And running a little low is probably a good thing because it brings more attention to potential hypo incidents.
 
Oh yes, I have been testing like crazy over here!

Here are the readings from yesterday:
preshot: 8:30 am - 19.0 -- 5 units
8:55 am - 16.6
12:10 pm - 17.1
3:55 pm - 22.1
preshot: 6:51 pm - 24.5 -- 5 units
10:25 pm - 20.6

and so far from today:

preshot: 8:30 am - 18.9 -- 5 units
9:05 am - 21.5
9:45 am - 21.2
10:45 am - 18.2

They ran a urine sample when he was first brought in a few weeks ago and other that some white blood cells we were told everything else was fine.
 
Great job testing! We use US numbers here for consistency, so multiply your numbers by 18. (if you use the World spreadsheet, it will automatically convert for you.)

It does look pretty high and flat, which can mean too much insulin. I would post your numbers on the Lantus forum also and ask for newbie dosing advice. It is busier forum than this one, so keep going back to look for replies.

As already said, if you decide to go back down on the dose, be sure you are testing for ketones.
 
Just curious about the feeding schedule - how many meals and how much each time per day? Also, what type of food? (eg Fancy Feast and flavour?)
 
We only have two days worth of data so it's hard to say exactly what's going on, wrong dose, or something like an insulin resistant cat. Data so far shows numbers at 342, 299, 308, 398, 441, 371 and today at 340, 387, 382, 328

I multiplied your numbers by 18 to get numbers that I understand here in the States. You're getting very little movement. Could be the liver producing sugar to protect from going low because the dose is high, or as mentioned, could be insulin resistance.

Is your vial of insulin fresh?
 
Keep getting those +2, +4, and +6 tests. If the dose is too high, a too low number will show eventually. Did you just start testing yesterday? I'm just curious if you've been testing like this every day, or if you just started.

Testing like crazy is good at this point! The more data you have, the more you know what's going on.

I would definitely run out and get some ketostix. Testing for ketones with numbers above 300 (16.5 mmol) is very important.

Other people have asked but this is also very important--when did you start your vial of insulin? Was it recently?
 
He is on Hill's perscription W/D diabetic cat food. Three times per day - about 2 cans over the day.

I have been testing at least twice daily since the move and before that once a day to make sure he was still ok. I am finding out that the ranges the vet gave us were way too high - we were told that up to 20 mmol/L was acceptable. Not so I am learning.

Since the move the numbers that I have given for today and yesterday are all in the same range. I started testing like crazy yesterday to try and get this under control. I feel like I have been trusting the vet too much and they are not that helpful at all. It was time to take it into my own hands to figure it out.

Do I need to catch him peeing to test with a diastik? Or can it somehow be done from the litter?

Oh - the insulin was a new vial as of May 2.
 
Hill's perscription W/D diabetic cat food
Click to expand...
First off, I am not a Lantus user, but W/D is so old school from years back and is probably one of the reasons for the high dose. Others will weigh in but I would suggest you start over and switch to a canned cat food from the stores, not the vet office, and start again at 1 unit and test. Those numbers will drop and even though you are using W/D canned it is still nothing but fibre and higher in carbs.
 
fax said:
He is on Hill's perscription W/D diabetic cat food. Three times per day - about 2 cans over the day.

I have been testing at least twice daily since the move and before that once a day to make sure he was still ok. I am finding out that the ranges the vet gave us were way too high - we were told that up to 20 mmol/L was acceptable. Not so I am learning.

Since the move the numbers that I have given for today and yesterday are all in the same range. I started testing like crazy yesterday to try and get this under control. I feel like I have been trusting the vet too much and they are not that helpful at all. It was time to take it into my own hands to figure it out.

Do I need to catch him peeing to test with a diastik? Or can it somehow be done from the litter?

Oh - the insulin was a new vial as of May 2.
Click to expand...


I didn't question the food because you said he was on a canned diabetic diet which I assumed was low-carb, but now I think the problem is two-fold. His food is way too high in carbs, at 26%. W/d is not good for diabetic cats (it's a weight loss food). A diabetic cat needs food to be under 10% carbs. There are many commercial foods that are less expensive and much better for your cat.

Because of the high-carb food, he can't regulate. Here's what I would do.

1. Start testing for ketones immediately. You do need to catch urine to do this. Some people just stick the strip in the stream while they're peeing, or stick a shallow plastic container underneath once the cat starts. If those don't work you can get some fish rocks and a small litterbox from the pet store, because they don't absorb liquid and switch out the litter boxes when you need a test (you can wash and re-use the fish rocks). I use the Breeze litter box http://www.breezeforcats.com/ , which would also work really well (There's a $10 off coupon on their website right now, so it's only about $20 in the store). There's a tray that catches the pee in the bottom of the box, so all you would have to do is take out the pad when you need a test.

2. Lower the dose of insulin. If there aren't any ketones, I would go down to 1u. You want to do this before you switch the diet because getting rid of the w/d will likely dramatically lower Fax's insulin needs. Many cats automatically drop 100-200 points just from switching to the low-carb diet.

3. After you lower the dose, start transitioning out the w/d. Get a low carb canned food, something under 10% carbs off of these lists: http://www.felinediabetes.com/diabetic-cat-diets.htm Many people here feed the low-carb grain free varieties of Fancy Feast: http://www.felinediabetes.com/glutenfree.htm. That's what I fed Bandit when he went into remission, but any food under 10% is fine. Many people like EVO and Wellness because it's a higher quality protein source. You'll find that even most premium foods are going to be cheaper than the w/d, so you'll have a lot of room to choose.

You'll want to do this over the course of a week, gradually mixing out the w/d until Fax is eating just the new food.

Once Fax is off the high-carb food, I think you'll see a dramatic change in his numbers.
 
What store bought wet foods do people have success with? I would LOVE to get him off of the prescribed food - it is all byproducts and additives. And clearly, not helping him at the moment.

Signed,
Severely frustrated
 
I agree that I would drop the dose, but only if you switch to a low carb canned food such as Wellness canned or even Fancy Feast the pate varieties and do test for ketones. You can test during mid stream, I've heard of one person who uses a soup ladle and catches urine that way and tests, I put clear wrap over the litter and test the urine once the kitty pees in the box, usually some of the urine remains on the plastic wrap.

My concern is the high flat numbers, while that could be rebound, it could be the W/D, it's hard to say without more information. Your starting dose was 2U, vet moved it up based on whatever bloodwork they do, I assume. If bloodwork was done at the office could have been stress related high blood sugar from the car ride and seeing the vet.

After the antibiotics did blood get tested again?
 
I am sorry - I said he is on the W/D which he was for a while to get his weight down during remission - but he is now in fact on the M/D which claims to be low-carb diabetic food.
My mistake. But I have a hunch it might not be the best food out there for this guy.
 
Well, M/D is a little better at 14% than the W/D but still too high in carbs for a diabetic. I would still change the food. Some cats are sensitive enough to carbs that those extra carbs make a difference. I can't feed Bandit anything above 6% carbs or I see a spike in his BG.

Bandit ate Fancy Feast the entire time he was on insulin, and went into remission while still on that food. I'm just recently switching him to the EVO 95% varieties, because I discovered the 13.5 oz cans are only $1.75 at my local independently owned pet store (Ithaca Grain and Feed Supply), which turns out to be cheaper than Fancy Feast for a better quality food.

Hills prescription diets use really low quality ingredients...the only one worth anything in my opinion is the A/D, which really helps cats with fatty liver disease. The diabetic diets are absolute junk, though.
 
fax said:
I am sorry - I said he is on the W/D which he was for a while to get his weight down during remission - but he is now in fact on the M/D which claims to be low-carb diabetic food.
My mistake. But I have a hunch it might not be the best food out there for this guy.
Click to expand...

The w/d is what probably caused Fax to need insulin again. Weight loss diets are too high in carbs for diabetics. A diet- controlled cat needs to stay under 10% carbs. A diabetic cat in remission is still diabetic...just they don't need insulin if they're on a low-carb diet.

You've come to the right place, though! This is actually one of the easier problems to deal with. Once you get Fax on a low carb diet, and on the correct (much lower!) dose of insulin, he'll likely go back off insulin.

Definitely set up that spreadsheet so you can post to the Lantus forum for dosing advice. The experts there have guided nearly 200 cats (including my own!) into remission.
 
Many of us feed our cats either Fancy Feast or Friskies. There are a couple lists on this page http://binkyspage.tripod.com/canfood.html of different canned foods. Look for foods with a high number the protein column and less then 10 in the carbs column. There are many different varieties of foods on this list so you should be able to find a food for your cat.
 
My ultimate frustration is all of the poor advice given at the hefty price of a vet. We had two healthy cats until one got a urine infection and we were advised to switch from Wellness to urinary prescribed food. Since that switch we have one cat with a slow colon and the other being Fax who of course is diabetic. All I want is the best for these guys so I took the advice from the people I assumed would know best.

It looks like a local store here sells the EVO 95% food. I think I will try to switch over to that. A gradual switch is best, right?
 
fax said:
It looks like a local store here sells the EVO 95% food. I think I will try to switch over to that. A gradual switch is best, right?
Click to expand...

Absolutely. I would do it over the course of at least a week.

Check out this article for the UT problems: http://catinfo.org/#Cystitis_ Often, they can be solved by diet change as well.

Unfortunately, many vets automatically prescribe these foods because that's what they're sold on by the pet food companies. Their offices also make money selling the prescription foods. Most don't even realize that they contribute to the nutrition problem, especially with the host of feline diseases (like diabetes and urinary tract disease) caused by inappropriate feline nutrition to begin with.
 
Yes, I am aware that vets generally are just trying to get more money out of you! While I am aware of this, I found myself stuck between a rock and hard place once dealing with diabetes - I didn't know anything about it so figured that I needed to follow all directions given to a T. I am currently waiting to hear from an expert on the Lantus board before I change his food. I have been told over there that it could be the food alone that is causing such high numbers and changing the food but not dosage could cause big problems.
 
fax said:
Yes, I am aware that vets generally are just trying to get more money out of you! While I am aware of this, I found myself stuck between a rock and hard place once dealing with diabetes - I didn't know anything about it so figured that I needed to follow all directions given to a T. I am currently waiting to hear from an expert on the Lantus board before I change his food. I have been told over there that it could be the food alone that is causing such high numbers and changing the food but not dosage could cause big problems.
Click to expand...

Absolutely, I agree....like I said earlier, you'll want to first lower the dose down to 1u, then switch the food. And test for ketones while his BG is above 300. But it's a very good idea to wait for advice from the Lantus board...they are very experienced with this insulin.
 
Nothing to add, you are getting excellent help from excellent people :) just wanted to say good luck! 9 is way to young to have to be dealing with this already. Hopefully the changes suggested will get things back on track.
 
fax said:
Yes, I am aware that vets generally are just trying to get more money out of you! While I am aware of this, I found myself stuck between a rock and hard place once dealing with diabetes - I didn't know anything about it so figured that I needed to follow all directions given to a T. I am currently waiting to hear from an expert on the Lantus board before I change his food. I have been told over there that it could be the food alone that is causing such high numbers and changing the food but not dosage could cause big problems.
Click to expand...


Not sure who an expert is, but many of us can help you with food. I have 2 cats on Lantus now, my third is coming this weekend, I've been owned by 8 diabetic cats in my life. All of them have been food transitioned. Three went off insulin by diet change alone. Those who did not had other complications, one with a brain tumor, one with heart disease, another with pancreatitis, my current on insulin diabetics were recently adopted and we are working with transitioning them from tough situations to home life. Kiki lived at impound lot before a shelter cage for a long time, Ebony lived in a shelter cage from Thanksgiving to Good Friday.

You should change the food, but as I noted before I would not lower your dose until you do change the food, test for ketones and get more data. I would probably go back to your vet's original dose of 2U BID because Fax has been on a high dose for a while. I do not, however, consider myself to be an expert.
 
Nice - yet another mistake made by the vet. We've got a box of Diastix upstairs..
Any advice on getting a sample from a cat that you never catch in the litter box?
 
The only way we could get a sample was to put aquarium gravel in a clean litter box and leave him alone for awhile. Oliver would not pee while we were watching. Other people use torn paper strips and lentils.
 
Ok, this definitely wont work for many cats, but I thought I'd share just in case Fax has a similar disposition. Bandit hates baths with a passion...so much he pees whenever he thinks he's getting one. So I would put an empty litter box in the bathtub, and turned the water on like we were giving a bath. He peed in the empty litter box every time, and I got my ketone test.

I know that its very unlikely your cat has a "pee trigger" like Bandit did, especially because you dont want to traumatize your poor kitty with something genuinely scary.

I love my Breeze litter box, and I wish i had discovered it years ago because it automatically can catch urine for you and avoids such trickiness.
 
Fax is a good patient - so while I don't think he would like a bath he would put up with it! I need to set up something in the litter box - someone suggested dried lentils and strips of paper. I think I will set that up for overnight as he always seems to leave presents while we are sleeping. Problem is - we have two cats so I won't be positive its not from Angus.
 
fax said:
Problem is - we have two cats so I won't be positive its not from Angus.
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You might have to separate him in a room for the night with the collecting litterbox. That's how I had catch urine from my other cat, if I wasn't lucky enough to catch her in the act.
 
If you use the Keto-Diastix, you'll know if it is Fax's pee.......he'll probably still be throwing glucose for now and that will show up on the KetoDiastix. Now, if you use only Ketostix, that won't unless he throws ketones.
 
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