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JeanW

JeanW

Member Since 2017
Pretty Girl and I have been on a long and twisted path trying to get her regulated. Sorry this is so long!

She was diagnosed about a year ago and I have been to 5 different vets. The current one seems to be one of the better ones of the group but as we know most vets know very little about FD and nutrition. The vet is with an animal hospital that seems to be pretty good.

I've been away from the board and am back and trying to educate myself some more and get expert advice. Also tonight I've realized I need to find yet a different vet.:banghead:

Previously Pretty Girl was on Lantus pen insulin with 1 unit twice a day and she would lay in a heap for 5+ hours after the shot and it was scary. None of my vets seemed to think this was a bad thing. :arghh: Her BG numbers were elevated nearly all the time at 500-600.

Pretty Girl had a diabetic emergency at the end of May and was at the animal hospital for 10 days and then in hospital boarding while I was out of town for another 2-1/2 weeks. They fed her Purina DM food 1/2 can twice a day and gave her Lantus via syringe 2 units in the morning and 1 at night. Her numbers are always elevated at the vet and hospital.

She was much more healthy when she came home but with a little neuropathy. And she was ravenously hungry since they don't free feed her as I do. She's been home for about 2 weeks. At first I tried to do better about following the vet's instructions but have realized once again that they don't know best.

I've been feeding her mostly Nature's Logic Chicken Feast which is real wet food, low carb and no synthetic crap. Her BG numbers are consistently lower than they've been in more than a year and she looks, acts and feels better than she has in a long time.

The vet's office strongly recommends that I home test only once per week at +6 hours. It's a good thing I didn't follow that advice. :blackeye: I could tell she wasn't feeling well and think she's had several lower BG moments. I found her behind the washer 3 nights ago which is highly unusual. I gave her some food and could tell she felt MUCH better right away.

The vet will not work with me and told me again last week to always always always give 2 units morning and 1 at night. When I tested her PMPS Friday she was at 195 - the lowest I've ever seen it. I did not feel comfortable giving her a shot and didn't. Now I'm testing morning and night (sometimes can't get a reading in the morning) and am scared to give her a shot when her numbers are low 200s or less.

I really believe the Nature's Logic wet food and 1 shot a day in the morning is the right solution but am unsure the best way to get there. Can I get y'all's feedback and advice? How do I know the "safe" number at which it's ok to give a shot?
 
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you are using lantus, you should not be skipping injections due to poor eating when her numbers are so high. with lantus, it is a slow long lasting insulin so it doesn't matter if they eat at shot time, it is more important IMO that they at least eat around their nadir/peak time if they tend to go very low.. her numbers will never get regulated if you skip injections and don't give her two injections per day 12hrs apart (give and take an hour max), unlike humans, lantus only lasts up to 12hrs with most cats.

every cat reacts different to insulin even at different times, so there is technically no 'safe' number, my cat can get the same dose and not go very low and poof one day that same dose went into hypo numbers. however a usually considered safe to shoot based on my diabetic vet specialist is:
-with Lantus you give full dose above 150, half dose between 100-150, no dose under 100.. this however was based on pet meter readings not human ones and also on 1 unit of Lantus i do believe.
-check BG before each injection (and no food 2hrs prior to bg reading, i free-fed so ignored that part for first few months) and check BG around 4-6hrs after each injection, given i could not check my cats nightly bg at 6hrs, i sometimes felt more comfortable giving only half a dose at night when bg was between 150-200 until i knew how my cats BG reacted to insulin better.

for now i would suggest you start over at 1 or 1.25 unit 'twice' a day for the next 7 days with no skipping dose and give it on time if possible, check BG around nadir time 4-6 hrs to see how low your cat's BG goes when lantus is suppose to lower it the most. all cat's nadir are different though, my cat goes lowest 2-3hrs after injection during day but, does not during night. at end of 7 or 10 days due a curve during day (or at least check bg 2hr after injection, 4hrs after and 6hrs after if you can't do a proper curve yet...if you can start checking bg every 2hrs up to 6th or 8th hour right away when possible, it will help you see how insulin is affecting her and make you less scared about injecting her around upper 100 thru 200's. after 7-10 days if BG is still above 200 the majority of the time, up dose to 1.50 for next 7-10 days and repeat upping by .25 afterwards every week until you find the dose that keeps your girl under 200 all the time, however if numbers still go in red/or black after first 10 days, you should really give her that 2 unit your vet recommended. make sure to be consistent in given injections and i highly recommend you buy syringes instead of using pen needles, syringes will be more accurate everytime (you really can't tell if pen is given out right dose afterall) and syringes will allow you to give .25 incremented doses too.

got this darn face cream making my eyes bug out and i can barely see clearly so hopefully my long comment makes sense.
 
Thanks for your response. I wasn't clear with my original post. Her numbers presently are mostly in the 200-300 range currently. And I am using syringes and the AlphaTrak pet meter.

Back in March when I was using the Lantus pens her numbers were consistently in the 500-600 range and were there for many months. By contrast, 200-300 seems good to me even though I know it is still high. Her numbers haven't been in the red-black zone in at least 6 weeks.

Her wet food is good quality food but is quite low in carbs. I am at work during the day and not at home to check her BG more than once during the day. I believe her nadir is at about 3 hours after the shot as that's when she comes looking for more food.

It scares me.
 
If you are concerned about Pretty Girl needing/wanting food when you are not home, I would recommend you buy an automatic timed feeder which can be programmed to open when you choose. You can buy on EBay.

Are you following the Start Low, Go Slow protocol or the Tight Regulation Protocol?
You can read about these in the yellow stickies at the top of the Lantus page. You would do well to follow one of these two protocols.
Lantus is not dosed on the preshot, or a sliding scale, but on the NADIR and chopping and changing the dose often is not good. Lantus works best when the dose is the same night and morning and is only changed when you are increasing or decreasing the dose. Lantus needs to be given twice a day.

I would recommend you start testing the blood sugar before EVERY preshot and INBETWEEN the cycles as much as you can. This is the only way you will be able to see how she is reacting to the insulin as it can change during the day and it can change from day to day. Once you have plenty of data in the SS you will be able to see how she reacts with lower preshots.
You have no mid cycle BSLs that I can see so we do not know how she is reacting to the insulin.

Looking at your SS it looks like you are only giving her insulin once a day, sometimes night and sometimes morning.
If you are worried 1 unit twice a day is too much start with giving her 0.5 unit (1/2 unit) morning and night. You will soon know if it is too little and can increase after three days.
Test before every preshot and if it is lower than you are comfortable with shooting, stall, don't feed and post for help. Make sure you write HELP in the subject line.
Then test inbetween the cycles when you can...I know you work....but fit in as many tests as you can in the PM cycle and weekends.
Think about buying an automatic feeder so she can eat when you are not there.
Don't be discouraged, you are doing well:)
 
Thanks for the suggestion for the automatic feeder. I will look into it tomorrow.

I will re-read the protocols and try to get on track with one of them. I believe Start Low, Go Slow is what we want to follow.

After bringing her home from the animal hospital I consistently gave her two shots a day for the first 2 weeks or so (wasn't using the spreadsheet). Then we had a couple of scary experiences the middle of last week. I got the replenishment of AlphaTrak test strips and found her number under 200 before feeding and shooting - I was not comfortable giving her a shot at that number and I've had trouble following a schedule since then. I know the wet food I'm feeding is less carbs than the prescription wet food.

I will begin testing before every shot and start with 1/2 unit morning and night and see how we get along. Thanks for your advice and encouragement. It IS hard not to be discouraged.
 
Was the medical emergency DKA?
If so you need to be testing for ketones in the urine and definitely not skipping any shots.
Also if it was DKA it might be better to give her more insulin each dose and adjust the carbs in the food.
Can you confirm if it was DKA please as we do things a bit differently if it was :)

ETA it is safe to shoot a number under 200. As you gather more BSLs you will see how Pretty Girl responds to insulin and you will be able to safely shoot lower numbers.
 
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Good advice above. Lantus is ment to be dosed the same day and night... Not 1 unit then 2 units. Please do reread the protocols.
 
No, her medical emergency was not DKA. And she was tested for that at the time and did not have it.
 
There was someone on the board in just the last few days that posted they were cleaning out because Sebastien was moving in, and they had automatic feeders. They would give for the cost of shipping, but I don't remember who that was.
 
I gave Pretty Girl 1/2 unit this morning as discussed above. But her AMPS number was quite high.

Do I need to stay at 1/2 unit morning and night for 3 days before increasing?
 
JeanW said:
I gave Pretty Girl 1/2 unit this morning as discussed above. But her AMPS number was quite high.

Do I need to stay at 1/2 unit morning and night for 3 days before increasing?
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I am glad she didn’t have DKA. But still I think you should test for ketones while she is high. You can buy a bottle of ketostix from the pharmacy for about $10. Just every couple of days unless she is showing ketones. Test by collecting a urine sample.

You skipped the dose last night so Pretty Girl is probably high partly because of that. Yes stick to the same dose 1/2 unit night and morning for 3 days unless she drops low. If you can record all the BSLtests you get on the SS, that will be very helpful to us.
Are you following the Start Low Go Slow or the Tight Regulation protocol? Can you put it in your signature when you decide please so we can see. Thanks.
Also try and get some in between tests as that will tell us how she is reacting to the insulin. Thanks
Well done!:)
 
So tonight her PMPS number was 260. And after eating Purina DM I gave her 1/2 unit.

Thanks for all the feedback and advice. I am scared most of the time but praying I am doing the right thing.:nailbiting:
 
JeanW said:
So tonight her PMPS number was 260. And after eating Purina DM I gave her 1/2 unit.

Thanks for all the feedback and advice. I am scared most of the time but praying I am doing the right thing.:nailbiting:
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That is a much better preshot compared to last night. Are you able to get a few tests in this cycle at about +4 and maybe +6?
That will tell us how she is going on the 1/2 unit insulin. If you can get the extra tests over the next few days while she is on the 1/2 unit it will give us a picture of what is happening.

It would help too if you could write a few things in the remarks column of the SS such as what food she was given, if she is well, lethargic, happy etc and if you had to give her extra food if she dropped low. This not only helps us but is good data for you to look back on at a later date.

If you have decided on the Start Low Go Slow protocol, could you pop that in your signature so we can see that while helping you, thanks.

Please don't be scared. You are doing the very best things for Pretty Girl to get her regulated.
She is gorgeous and looks a sweetheart.
 
I was not able to get any tests in last night's cycle. It was already late and I'd had a difficult day. But will try to get some tonight.

Her preshot number tonight was very high which is also scary. I don't know why it was so high unless maybe she found some leftover food before I came home from work. I always test, feed and shoot upon getting home.

I wrote some things tonight in the remarks column and have separate columns devoted to the food she eats AM and PM. Since she free feeds she eats when she needs/wants to. I think the Nature's Logic is better for her but it is low carb and I am concerned about how that and the insulin relate to each other. She ate Nature's Logic the last part of last week and seemed better than she had in a very long time but we also had some scary moments when she clearly felt terrible.

Thanks for your kind comments about Pretty Girl. She really is a great cat - beautiful and so sweet.
 
I resisted the urge to increase the dose when her preshot number was so high. Was that the right thing to do?

Now an hour and a half after the shot she mostly seems pretty good - up and walking around, etc. I will test at the 3 hour mark and will know more.
 
She could possibly have bounced from a lower number than she is used to number during the day while you were at work. Because there are no tests we can't be sure.
It is also possible she needs more insulin.
Try and get the tests in tonight.....if she is bouncing she could stay higher for up to 6 cycles. Make sure there is plenty of water for her to drink.,
Are you testing for ketones?
JeanW said:
I resisted the urge to increase the dose when her preshot number was so high. Was that the right thing to do?

Now an hour and a half after the shot she mostly seems pretty good - up and walking around, etc. I will test at the 3 hour mark and will know more.
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Yes it was the right thing to do.
We don't increase the dose on the preshot number but the nadir which is the lowest point in the cycle...that is why we would like to see some tests during the cycle.
You are doing well. You don't have to stay up at night to get the tests. I used to set the alarm, get up, test and go back to bed. If the BSL is very low you would need to check again an hour or two later depending on the drop and the BSL number. But if you are unsure, always post and put HELP on your subject line and someone will help you.:)
 
JeanW said:
I resisted the urge to increase the dose when her preshot number was so high. Was that the right thing to do?
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Yeah.....Lantus dosing is based on how LOW it takes them, not the Pre-shot numbers, but I'm sure you sure don't like seeing that ugly black number!

It's important to make sure there's nothing she shouldn't eat around the house....if there is, these kitties will find it!!!!

Yo Pretty Girl.....From one "pretty girl" to another....White cats Rule!! ~ China
 
Bron and Sheba said:
Yes it was the right thing to do.
We don't increase the dose on the preshot number but the nadir which is the lowest point in the cycle...that is why we would like to see some tests during the cycle.
You are doing well. You don't have to stay up at night to get the tests. I used to set the alarm, get up, test and go back to bed. If the BSL is very low you would need to check again an hour or two later depending on the drop and the BSL number. But if you are unsure, always post and put HELP on your subject line and someone will help you.:)
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Yes, she could have bounced. The vet would say she needs more insulin. It's also possible that the free feed of the Purina DM is not the right thing to leave out during the day - I think she does better with the Nature's Logic low carb during the day but I don't know that.

There is plenty of fresh water available. I have ketostix but so far have not been successful testing for ketones.

I will post with HELP in the subject line in the future for more immediate help.

Chris & China - no, I hate seeing that black number. So scary. She had black numbers for months and I thought we'd left them in the past.

No, there was nothing out kitties shouldn't eat other than the prescription free feed wet food.

And, YES, white cats rule!!! Your girl is pretty too.
 
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Could you leave out both foods for her? Does she eat only when she needs it or is she a greedy guts. I could never leave food out for Sheba...she would eat the lot all at once...timed feeder was the only way with her.

Will she let you near the LB when she pees? You could try putting a large spoon under her to catch some urine.
 
Yes, I could leave both foods out for her without a problem. That is a great suggestion, Bron and Sheba, and I will do that. She eats only when she needs/wants it and will leave food if she's full or doesn't feel good or whatever.

No, she won't let me anywhere near the LB when she pees. Not anywhere close at all - that is the problem. Or even if I could get close to the box I couldn't get close to her!
 
JeanW said:
No, she won't let me anywhere near the LB when she pees. Not anywhere close at all - that is the problem. Or even if I could get close to the box I couldn't get close to her!
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Try scrunching up some plastic just under the litter and hopefully when she goes you will catch a bit.
Does she have a favourite spot to go in the LB?
Someone posted yesterday that they had buried a small container in the litter in the cats favourite spot and the cat had obliged by peeing in the container!! Just looked for the post but can't find it....it was brilliant.
 
Bron and Sheba said:
Someone posted yesterday that they had buried a small container in the litter in the cats favourite spot and the cat had obliged by peeing in the container!! Just looked for the post but can't find it....it was brilliant.
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That really is brilliant. Thank you.
 
My vet sold us a cup of the non-absorbent litter they provide for customers who need to bring in urine samples. You put it in a clean litter box instead of regular litter. When the kitty pees, the urine is in a puddle and very easy to dip a keto stick in. The staff wanted to give us the litter for free, but the office manager insisted on charging $6. It was still worth it for the ease of testing. We just rinsed it off and kept it for future tests.
 
Beck and Grandpa said:
My vet sold us a cup of the non-absorbent litter they provide for customers who need to bring in urine samples
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A lot cheaper option and just as effective is using aquarium gravel that's been thoroughly rinsed or even something as simple as dried beans/peas that have been rinsed and allowed to dry
 
Chris & China said:
Yeah.....Lantus dosing is based on how LOW it takes them, not the Pre-shot numbers, but I'm sure you sure don't like seeing that ugly black number!
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It occurs to me that maybe tonight's black number was an error - bad test strip or something. What I could have done - but didn't think about it - is wait 10 minutes and test again to see if it was a similar number. Lesson learned for next time.
 
I tested at the 3.5 hour mark - a mistake in some ways as that did not ease my worry to go to sleep - and her number was 503. :-( So clearly her nadir must not be at 3 hours. But I am leaving out food and have to go to bed. Have had a horrendous day for all other reasons.
 
JeanW said:
I tested at the 3.5 hour mark - a mistake in some ways as that did not ease my worry to go to sleep - and her number was 503. :-( So clearly her nadir must not be at 3 hours. But I am leaving out food and have to go to bed. Have had a horrendous day for all other reasons.
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If she is bouncing it will stay high for a few cycles probably. They don't have a nadir when they are bouncing. They just stay high.
I hope tomorrow is a better day for you. :bighug:
 
Need your advice here. Pretty Girl doesn't seem very good tonight. Numbers remain high.

I will get up at 4 am and pick up the food so the AMPS is a more true number.

Per the Start Low Go Slow protocol, I need to hold this 1/2 unit for a week which would be through Saturday. Then do a curve on Sunday and look at increasing it.

Does that sound right? Trying not to freak out.
 
We really need to see some BSLs taken during the cycles to see how low the insulin is taking Pretty Girl.
At the moment it is very hard to tell if she needs more insulin or if she is dropping low during the cycle and bouncing.
The most important thing you can do at this point is to get those tests for a few cycles so we can see what she is actually doing in between the shots.
Do you think you would be able to do this?

While she is high you need to test for ketones. I know you said she didn't have them but it is worth while checking while she is higher.
 
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