High BG values

Discussion in 'Feline Health - (Welcome & Main Forum)' started by Marina & Chico, Jan 31, 2021.

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  1. Marina & Chico

    Marina & Chico Well-Known Member

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    Dear community, it is very helpful and reassuring finding someone who can help us go thru these first few days of diabetes management.

    Our 8.5 years old british shorthair cat was diagnosed with diabetes just a couple of weeks ago. Initially the vet tried to stabilize him with diet only, nonetheless shortly it was clear we have to start insulin injections as well. We feed Chico 85g of Purina Pro plan wet food every morning and evening with his insulin shot and during the day we used to give him 20g Vet life dry food. Yesterday for the first time after a while Chico was really hungry so we decided to increase the dosage of dry food to 35g (he weights 5kg so it is still under the recommended amount). After going thru this forum we decided to exclude the dry food all together and replace it with another portion of Purina pro plan - today will be our first attempt.

    The vet prescribed us Caninsulin and he didn't do any tests for ketones. We plan to try doing it though.

    Yesterday we managed to do a Glucose curve which was very helpful to us to understand what is happening to him during the day. We started our day at 25mmol/l and the nadir was reached 5 hours after the injection at the value of slightly under 8mmol/l. What was shocking to us it that we finished the 12 hours cycle with 29.6mmol/l.

    Please help us understand how long should we wait to see if the maximum values will decrease or not. We are worried not to harm him while waiting - his BG is very high.

    Additionally, after reading more about the types of insulin we understood that if we want Chico to go in remission we have to change the type of insulin but we thought of doing it later in the process when we manage to stabilize him. Nonetheless after seeing the Glucose curve we are worried the Caninsulin has too short duration to help him get better.

    Here is Chico's Spreadsheet:
    https://docs.google.com/spreadsheets/d/1xHFd0rBTyONEXSMMM6OkdCwfnsNZgm8ZbtaWrHbtCR8/edit#gid=0

    We will be very grateful for any advice on how long to wait before deciding for a change in his treatment plan.
    Thank you in advance,
    Marina & Chico
     
  2. Bron and Sheba (GA)

    Bron and Sheba (GA) Well-Known Member

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    Feb 21, 2015
    Hi Marina and Chico and a big welcome to the forum. So glad you have found us.

    First of all, it is great you are home testing the blood glucoses and thank you for setting up the signature..that is a big help.
    I can’t see your spreadsheet. Did you press the share button?
    I am going to tag @Bandit's Mom to help you get the SS up and running. She is a whizz at it. It is probably just a small thing which is stopping me see it.

    Can you also tell me what type of meter you are using to test the blood glucose please?

    In regard to the food, we recommend feeding a low carb wet food with the carb content being 10% or less. Almost all dry food is high carb and has very little moisture. Just a word of caution.........changing over to a low carb diet and ditching the dry needs to be done slowly with you monitoring the BGs closely as the BGs can drop up to more than 5.5mmol/L with the change of food.so you need to be watching closely.

    Definitely test daily for ketones while the BGs are high.

    Are you feeding Chico 30 minutes before you give the insulin? It is important when giving caninsulin to make sure there is food aboard first before injectng Because caninsulin works fast.

    I regards to the insulin when you say you are worried that the duration of the caninsulin is too short and you are wondering about a better insulin. Caninsulin is a fast acting insulin which does not have as long a duration as some of the later and more suitable insulins for cats has.
    I am guessing you are from the UK or Canada....probably the Uk becasue of the time at the moment. If you are looking for a longer acting, gentler insulin which is better suited for cats I would look at Lantus or prozinc. I know Prozinc is available in the UK and I think Lantus is.
    Chico will get a much better duration with one of those two insulins.
    At the moment caninsulin is dropping the BG down to around 8 at about +5 and then it looses its potency and by the time of the next shot, the BGis up high again. With the other insulins, they last around 12 hours so you should get a flatter curve. But it takes time for the body or get used to insulin as it is a hormone not a medication like an antibiotic.

    If you can tell me which country you are in I can give you some specific information and maybe some people who live there to help you more.
    Here is a link to information about hypos.
    Click herehttps://www.felinediabetes.com/FDMB/threads/how-to-treat-hypos-they-can-kill-print-this-out.15887/
     
  3. JanetNJ

    JanetNJ Well-Known Member

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    Jun 8, 2016
    Hi! Nice to meet you! Switching to all wet is a good plan. So is your idea of testing for ketones.

    It looks like he has a strong reaction to the insulin and then is bouncing up. Not uncommon with canisilun which is why we often suggest a gentler longer lasting insulin. His body is reacting to that sudden drop by pumping up the stored glucose to try to stop hypoglycemia. It looks like you jumped straight from 1 right to 2 units. Maybe if you tried 1.5 units some of the bouncing could slow down. You might see lower preshots. Your other option is to switch to ProZinc or lantus. Lowering the dose is also a good idea since your are cutting out the high carb dry
     
  4. Bron and Sheba (GA)

    Bron and Sheba (GA) Well-Known Member

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  5. JanetNJ

    JanetNJ Well-Known Member

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    The spreadsheet was working for me and suddenly it's not...


    Edited: oh it's working again
     
  6. Bron and Sheba (GA)

    Bron and Sheba (GA) Well-Known Member

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    Feb 21, 2015
    I can’t see the SS at all.
    Oh....I just clicked on the one in the signature and I can see it but not the one that is in the post
     
  7. Marina & Chico

    Marina & Chico Well-Known Member

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    Thank you for your answer.

    We are located in the Czech Republic. We are using the Glucolab for measuring BG.
     
  8. Bron and Sheba (GA)

    Bron and Sheba (GA) Well-Known Member

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    I am glad you are giving the insulin twice a day.
    We recommend feeding before the shot ( with caninsulin 30 minutes before) and then giving a couple of snacks during the first half of the cycle at +2 and +5 or +2 and +4 both cycles. It is better for the pancreas to have some smaller snacks and not just two big meals.
     
  9. JanetNJ

    JanetNJ Well-Known Member

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    Aaaand now is blocked again. She must be changing permissions or Google is having issues. She's got almost a 70% drop in numbers then it zooms up again. Big bounces.
     
  10. Marina & Chico

    Marina & Chico Well-Known Member

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    Jan 31, 2021
    can we consider lowering the dose if the highs are so high? we thought we should wait until the highs lower a bit and as son as the nadir is not so low it shouldn't harm him, or are we wrong?
     
  11. Marina & Chico

    Marina & Chico Well-Known Member

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    i closed the SS, maybe having it opened caused the issues
     
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  12. Bron and Sheba (GA)

    Bron and Sheba (GA) Well-Known Member

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    So a bad guess on my part:joyful:
    Is the glucolab meter a human glucose meter?

    Are you able to get canned cat foods such as fancy feast in the Czech Republic?
     
  13. Marina & Chico

    Marina & Chico Well-Known Member

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    Jan 31, 2021
    thank you for the advice, we want to start giving another portion of wet food divided at lunch and before going to bed for him to have some calories during the night
     
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  14. Bron and Sheba (GA)

    Bron and Sheba (GA) Well-Known Member

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    I am not a caninsulin user so can’t really comment on the ins and outs of it but I’ll tag @Critter Mom as she has used it.
    Janet are you a caninsulin user?
     
  15. Marina & Chico

    Marina & Chico Well-Known Member

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    The glucolab is a human glucometer. After a quick check it doesn't seem that Fancy feast is available here :(
     
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  16. JanetNJ

    JanetNJ Well-Known Member

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    I think eliminating the dry is a great idea and I hope it gives you better numbers.
     
  17. Bron and Sheba (GA)

    Bron and Sheba (GA) Well-Known Member

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    Can you tell us some of the canned food options you have available?
    Pates are usually low carb and gravy foods are usually higher carb
     
  18. JanetNJ

    JanetNJ Well-Known Member

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    I used it (well Vetsulin, same thing) for four months in the beginning and got CC into remission on it. Then used it for about a year when she came out of remission before switching to ProZinc.
     
    Last edited: Jan 31, 2021
  19. JanetNJ

    JanetNJ Well-Known Member

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    Looks like the purina pro plans are low carb.
     
  20. Bron and Sheba (GA)

    Bron and Sheba (GA) Well-Known Member

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  21. Marina & Chico

    Marina & Chico Well-Known Member

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    Concept for life, Integra, Royal canin, Kattovit, Schesir, Miamor, Animonda Carny, Feline Porta, Bozita, Smilla, Grau, Purina Pro Plan

    These are all options we can easily get via Zoohit, i am certain we can find other options if needed.
     
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  22. Marina & Chico

    Marina & Chico Well-Known Member

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    Thank you for the link
     
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  23. Bron and Sheba (GA)

    Bron and Sheba (GA) Well-Known Member

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    I would try and get some more tests in during all the pm cycles at around +5 as that is around the nadir and cats often drop lower at night.
     
  24. Marina & Chico

    Marina & Chico Well-Known Member

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    We were already considering it, we will try to do it tonight. Thank you for your suggestion.
     
  25. Bron and Sheba (GA)

    Bron and Sheba (GA) Well-Known Member

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    I think that Gill orders through someone like Zoohit so she may have some other suggestions as well. I only recognise a couple of those cat food names but I live in Australia so wouldn’t be much help anyway as far as food goes over there in Europe.

    Do you also have some higher carb foods around 15% (medium carb) and 20% (high carb) in case of low numbers and some honey in case of very low numbers?


    Great!
     
  26. Bron and Sheba (GA)

    Bron and Sheba (GA) Well-Known Member

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    If you give some food around +2 you may be able to slow down the drop in BG and help stop a bounce.
     
  27. Marina & Chico

    Marina & Chico Well-Known Member

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    To be honest, we are so far from low numbers that we didn't really manage to think about it, we are so focused to decrease the peaks...
    Thanks for bringing to our attention not to underestimate the low BGs anyway, we do have the diabetic dry food (which now we believe is the cause for high BG in the evening) and we have honey.
     
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  28. Bandit's Mom

    Bandit's Mom Well-Known Member

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  29. Marina & Chico

    Marina & Chico Well-Known Member

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    We are +3 now but i just gave him some food anyway, it is earlier than what we did yesterday, we gave him food at +5. We will give him again some later on for him not to be hungry. Hopefully this will help with the high value.
     
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  30. Bron and Sheba (GA)

    Bron and Sheba (GA) Well-Known Member

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    I would look for some wet higher carb food if you can as it is better than the dry food as a high carb alternative.
    The dry food stays longer in the system.

    I think you are more likely to find Lantus insulin than Prozinc in your country, but I could be wrong.
     
  31. Marina & Chico

    Marina & Chico Well-Known Member

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    We will ask our vet about both options.

    Thank you all again for your help and suggestions, it is very helpful.
     
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  32. Bron and Sheba (GA)

    Bron and Sheba (GA) Well-Known Member

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    We are very happy to help you. Ask as many questions as you need.:)
     
  33. Bandit's Mom

    Bandit's Mom Well-Known Member

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    Oct 18, 2019
    A lot of these feature in the UK food list. For those that don't you could use this carb calculator to find out the carb%
    http://scheyderweb.com/cats/catfood.html

    In the EU, I think your cat labels have Typical Values rather than Guaranteed Analysis (GA). GA is more of an approximation than Typical Values.
    Look at the "Dry Matter Carbohydrates:* (%)" at the end of the calculations.
     
  34. Gill & George

    Gill & George Well-Known Member

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    I'm just getting lunch ready I'll post when it's in the oven. A number of those brands have low carb options.
     
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  35. Critter Mom

    Critter Mom Well-Known Member

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    Hi Bron,

    The Czech Republic is an EU member state. The two insulins currently licensed in the EU for use in cats are Caninsulin and Prozinc so, in principle at least, they should be available in all member states.

    Assuming that prescribing regulations haven't changed in the last month, the two licensed insulins must be tried first and shown to be ineffective before vets can legally prescribe other insulins under drug cascade rules (e.g. Lantus, Levemir).

    I don't know how high the evidence threshold might be for any insulin switch in the Czech Republic.


    Mogs
    .
     
  36. Gill & George

    Gill & George Well-Known Member

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    Oct 27, 2015
    I didn't have to go through that process, it seems to be more of an issue in the UK. I just asked my vet to start on Lantus as evidence suggested that it had a better duration and as such it was going to be easier to get George well regulated, and essentially the quicker you did that the better the chance of remission.
    She prescribed Lantus.
    We have had others here from Europe that have been started on Lantus without any issues, I've only ever seen a problem with the UK. I wonder if it is more about the licensing agreement with big Pharma in UK? or perhaps it has something to do with pet insurance cover(not common here in spain at least especially for cats) hmmmm.....

    Marina I would just ask your vet for Lantus, if you want to try a gentler insulin, with a longer duration, Lantus has some great results, I wouldn't waste time, if you can help it trying to stabilise with caninsulin, it typically works too quickly, you get harsh drops and the duration just isn't there for most cats. No harm in asking, see what he/she says....
    Prozinc is a better choice, but even with that the results are often better with lantus. Make your case, show him/her the Romp/Rand study perhaps.




    I am not sure that these are bounces in the true sense of the word,
    'Not all High Numbers are bounces'
    When we see them dive down then back up and then dive back down immediately in the next cycle it's more likely that what we are seeing is a lack of duration.
    During a 'bounce' we would usually see them stay high and flat for at least one cycle. The hormones responsible for the bounce would keep the BG high pretty much irrespective of what you shoot, you will often feel as if you have done a fur shot, or for me it felt like I was shooting water.
    In Chico's case there is not enough information to say what is happening. But remember not all cats bounce.

    Marina, one very important thing to note.
    If you are removing the dry food, this often has a dramatic effect on the insulin requirement for your cat. So 2u, may drop him much lower than it has been until now. Please monitor carefully when transitioning of dry food.
    The most extreme case we have seen of that is one cat going from 5u to remission in just 24hours, and he was only getting a few snacks of dry that he was stealing of the other cats in the house, when CG removed dry from the house his numbers dived. Great idea to get rid of the dry, but do it slowly, and monitor closely that means getting a test early on in the cycle and monitoring through to nadir.

    The UK list here has many brands available throughout europe l https://docs.google.com/spreadsheets/u/1/d/1J5JpMe6TDXrHq_aTl9hUtHy6Gs9oRBqlz4nPGKxtySA/pubhtml I mostly use zooplus, but also some other online spanish provieders as the local pet stores don't stock anything suitable.
    It would also be a good idea to use HC wet food and get some of that so you can use it if Chico were to drop too low. I used Purina Gourmet Gold meat in sauce varieties (they were 25-28% carbs DM~)
    I have used animonda, integra, granata pet, kattovit, catz fine food, thrive, feringa amongst others. There is plenty of choice.
     
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  37. SashaV

    SashaV Well-Known Member

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    Vets in Denmark is required to prescribe an animal drug first, only if its proven not to work in the specific cat, the vet can prescribe a human drug. Something called cascade rule here. Don't know if it's the same in other EU country's. Sad when it's proven human insulin works better and better chances for remission.
     
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  38. Critter Mom

    Critter Mom Well-Known Member

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    Jun 16, 2014
    Hi Bhooma. :)

    Correct.

    @Marina & Chico -

    Welcome to yourself and Chico. You're off to a flying start with caring for Chico's diabetic needs! :cat:

    Here's a helpful FDMB info post which shows how food calculations are performed:

    Calculating calories from carbohydrates

    As the title of the info post suggests, when members refer to low carb foods being "under 10%", what is actually meant is that less than 10% of the calories in the food should come from carbohydrates, and sometimes that value might be less than the dry matter % of carbs.

    I see Bhooma has kindly linked the UK food list for you above. In that table, the calculations show the % kilocalories from carbs, so you'll be able to use those figures as a guide to which foods offered by Zooplus in your country should be diabetic-friendly. In addition to the brands you've listed above, Catz Finefood and Granatapet are good quality too. (Note: The Porta foods are not nutritionally complete.)

    IMPORTANT NOTE: We have had reports in the past from members in other European countries supplied by Zooplus where the formulations for similarly named products may not be the same as the formulation available in the UK so it's important to double-check the typical analysis of the food(s) you're looking to purchase. On their UK website, Zooplus usually have typical analysis figures for each product, so I would assume that similar analysis information will be available on your local website.

    Here's a helpful tool that takes all the donkey work out of calculating % of kilocalories (ME=metabolisable energy=kcals):

    Macronutrient metabolisable energy calculator



    Mogs
    .
     
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  39. Critter Mom

    Critter Mom Well-Known Member

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    I very much second this recommendation. If you can short-circuit the process, Lantus has much better duration.

    Looking at the curve you ran for Chico, he got a fairly good nadir for a newly-diagnosed cat on Caninsulin. The large variation between preshot and nadir BGs is very typical of the response of feline diabetics to this insulin. Sometimes increasing the dose may result in steeper dives to a lower nadir but the preshots can tend to stay high and, again typically, it doesn't tend to increase dose duration either. Here's an illustration of what a typical cycle might look like for a cat on Caninsulin to illustrate how BG levels change over the course of 12 hours after dose administration:


    [​IMG]

    Again echoing Gill's advice above, great care and close monitoring is needed when reducing the carb load in the diet. I'd suggest reducing the amount of dry you feed only by a few grams at a time and intensively monitor BG each day to see the impact on BG levels. Depending on Chico's response, the current Caninsulin dose may need to be stepped down as the transition proceeds. You can post for feedback and support at any time. Members will be able to see his spreadsheet data and be able to make suggestions based on Chico's data. Here's further info:

    Feline Diabetes and safe transition to a lower carb diet

    The reduction in carb load may possibly see the preshot BGs come down. FDMB recommends a no-shoot limit of 200mg/dL / 11.1mmol/L (human meter readings) for newly diagnosed cats (particularly applicable for cats on Caninsulin because it can produce such steep drops). If, as a consequence of reducing the carb load, you start getting preshot BGs below 200 then hold off on giving the dose, do not give any food and test again in 20-30 minutes to see whether BG levels have risen high enough. (This process is referred to as 'stalling'.) While you're waiting to test again, you can post for help with the dosing decision. Be sure to put in the title that you're stalling so that members reading the board will know you need help quickly. :)


    Mogs
    .
     
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  40. Marina & Chico

    Marina & Chico Well-Known Member

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    Thank you for the links, very useful
     
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  41. Marina & Chico

    Marina & Chico Well-Known Member

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    Jan 31, 2021
    We tried to remove the dry food today and at +3 hours we gave him 20g of wet food, his nadir was 13.4mmol/l (yesterday was under 8), is there any reason for us to worry more about decreasing his nadir? Maybe there won't be such high difference because the dry food we were giving him is for diabetic cats specifically and it has <20% carb, is it possible?

    At night its different, we want to measure today at +5 to check the nadir won't go too low.

    Thanks for the answer
     
  42. Marina & Chico

    Marina & Chico Well-Known Member

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    Jan 31, 2021
    Even with the risk of repeating myself, today we excluded dry food, added 20g of wet food at +3 and his nadir was at around 13mmol/l. We will see the max BG before the next insulin shot, but is it possible for us the exclusion of dry food not to have such huge impact because his dry food was for diabetic cats already or should we still keep an eye on his nadir not going too low?

    Thank you for your answer
     
  43. Marina & Chico

    Marina & Chico Well-Known Member

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    We will ask our vet and let you know if in Czech rep. it will be the same
     
  44. Marina & Chico

    Marina & Chico Well-Known Member

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    We will consult with our vet and update you on the issue
     
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  45. Critter Mom

    Critter Mom Well-Known Member

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    You need to work with the lowest nadir you've seen, Marina, for a couple of reasons.

    Firstly, sometimes when a cat starts seeing lower BG numbers than it has been used to for a while the body's protective mechanisms can kick in to make the liver release extra sugars into the bloodstream in response (a phenomenon referred to here as 'bouncing'). Numbers may remain temporarily elevated for a short time, or they might stay that way for up to 6 cycles but there's no way to tell that in advance. If the carb load has been reduced during the bounce but the dose remains the same, there is a risk that the nadir BGs might get too low when the bounce clears.

    Secondly, when higher carb food is removed from the diet numbers may continue to improve over a period of many days. Again there is no way to predict what might happen, you can only track Chico's response on each cycle (hence the need for very close monitoring to make sure he stays safe).

    Here's an example of what can happen when dry food is removed from the diet. Harrison was treated with Vetsulin (another brand name for Caninsulin) and he was transitioned to a low carb diet upon diagnosis. His numbers started to improve after a few days, but after day 10 his numbers tumbled and he had to have his dose drastically and repeatedly reduced. After only 15 days of treatment, Harrison started on a remission trial. As of this evening he will have successfully completed the trial and will be considered a diet-controlled diabetic (no current need for any insulin).

    Harrison's Spreadsheet

    We urge caution with diet transitions because results like the above are possible, so you need to keep on top of the size of the insulin dose to keep your kitty safe. :)


    Mogs
    .
     
    Last edited: Jan 31, 2021
    Reason for edit: Grammar.
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  46. Critter Mom

    Critter Mom Well-Known Member

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    Hi Sasha.

    Legally the position is the same in all EU member states (and currently in the UK unless post-Brexit there are rule changes). However, I think some vets might be more 'flexible' in their interpretation of the rules than others.

    It's worth noting that in the RVC's recent study they found that remission rates for both Prozinc and Lantus are comparable.


    Mogs
    .
     
  47. SashaV

    SashaV Well-Known Member

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    Apr 25, 2020
    Hi Mogs!

    Interesting it's the same. However, prozinc is not first choice here. Or the second really...
     
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  48. Gill & George

    Gill & George Well-Known Member

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    Oct 27, 2015
    I've run the numbers for vet life diabetic kibble and it appears to be around the 20% mark for carbohydrates, that's high carb, bear in mind that with a diabetic cat we want to keep it to below 10%, and yes it can have a huuuuge impact on the insulin requirement for your kitty, it can depend on the cat some cats are more sensitive to carbs than others, with some even a few pieces of kibble at 20% can really make them run in high BG. Every cat is different (ECID) but I have seen many cats drop significantly once the kibble is removed. I haven't come across any prescription diabetic dry food that is Low carb (under 10%) which is what our diabetic cats actually need, I bought royal canin diabetic kibble, because my vet advised it, I got home did my research and never fed it to George, that was even higher in carbs than the one you are using:rolleyes:


    Have a look at these two ss
    Scooter was the kitty that was just stealing (his owner had no idea) some kibble and went from 5 to 0 units in 24 hours when kibble was removed from the house completely.
    Scooter look at Feb 19 and here is the link to the thread for than day
    Spider
    got rid of dry starting 6/4 to 6/8 by 6/15 was OTJ

    I'm not saying it will definitely affect Chico that way, but there is a very real possibility that it is going to impact his BG, not necessarily in the first day it can take a few days to work out of their system. Without monitoring closely there is no way for you to know, you want to avoid seeing a symptomatic hypo event.


    So I think it's a fantastic idea to get rid of the dry, but just be watchful.

    As @Critter Mom has already said, we just want to keep him safe.

    have you got a link to that study? I would be interested to read it thanks. I've had a quick look and I can find a recent study comparing once daily lantus to BID PZI, which is not how we dose lantus here so wouldn't be a fair comparison.
     
    Last edited: Jan 31, 2021
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  49. Marina & Chico

    Marina & Chico Well-Known Member

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    Jan 31, 2021
    @Critter Mom and @Gill & George thank you very much for the advice, there is no way we would have stopped to monitor him but it is good to know we definitely shouldnt leave our gard down
     
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  50. Critter Mom

    Critter Mom Well-Known Member

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    Hi Gill,

    I'm tagging @Elizabeth and Bertie for you, as it was herself that I picked the information up from.


    Mogs
    .
     
  51. Gill & George

    Gill & George Well-Known Member

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    thanks mogs.
     
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  52. Elizabeth and Bertie

    Elizabeth and Bertie Well-Known Member

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    Hi Gill, I don't currently have a link, because I lost my whole page of links when my old computer died :arghh:. But it should be relatively easy to find. It's included in the results of the RVC's remission clinic research, where they trialled Lantus and Prozinc. ...There is also an interesting short podcast talk by Stijn Niessen from the RVC about insulin choices for cats. And one vet/researcher (Ruth Gostelow, if memory serves) achieved recognition for proving that Lantus didn't necessarily produce the highest rates.
    I will see what I can find...
     
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  53. Critter Mom

    Critter Mom Well-Known Member

    Joined:
    Jun 16, 2014
    Thanks, Eliz. :bighug:

    Noooooooo!!! :arghh: :banghead:

    Presumably your new list will be on Google Drive?


    Mogs
    .
     
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  54. Gill & George

    Gill & George Well-Known Member

    Joined:
    Oct 27, 2015
    OK thanks Elizabeth, I'll take another look. Let me know if you find anything
     
  55. Critter Mom

    Critter Mom Well-Known Member

    Joined:
    Jun 16, 2014
    She helped me to get Lantus for Saoirse. And she was really nice to speak with. (((Ruth))) :)


    Mogs
    .
     
  56. Elizabeth and Bertie

    Elizabeth and Bertie Well-Known Member

    Joined:
    Sep 6, 2010
    Hi again, Gill. Had a quick rummage on the old interwebs. Not very productive at the mo. So much of what used to be easily available to read online no longer seems to be accessible to ordinary folk... :(
    Will look again tomorrow...
    Did find this link (to a talk) that I posted in this forum a couple of years back though. It's a start, hehe! Info copied from original post:

    "The research work the Royal Veterinary College have done is very interesting, and has produced some very useful info, and some surprises...
    In the trials Lantus and Prozinc produced similar remission rates.
    1 in 3 of the 'general population' of diabetic cats may go into remission.
    1 in 4 diabetic cats may have acromegaly."

    Link to talk on Facebook:
    https://www.facebook.com/vettimesuk/videos/10154849470681010/

    Oh, gosh, yes, Mogs.... Lesson learned.... Still feel gutted when I think about it... But it's much harder to find things again... I keep trying search terms that 'ought' to find the same info, but they just don't.... :confused:
     
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  57. JanetNJ

    JanetNJ Well-Known Member

    Joined:
    Jun 8, 2016
    Ugh... Just had a guy out to check out a leak in my roof. Cha-ching... he thinks we need to replace the roof. Blah. hahaha I have funner things I'd like to spend 9K on.
     
  58. Critter Mom

    Critter Mom Well-Known Member

    Joined:
    Jun 16, 2014
    Tell me about it. I miss the Pet Education website. :(

    At least you had a list. I used to rely on the forum feature where you get a drop-down list of previous links posted when adding links to new posts, not realisisng that they get wiped when one is on a forum sabbatical. :banghead: Now I stick everything useful into a Google doc.


    Mogs
    .
     
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  59. Critter Mom

    Critter Mom Well-Known Member

    Joined:
    Jun 16, 2014
    Oh no! Sorry to hear that, Janet. :bighug:


    Mogs
    .
     
  60. Gill & George

    Gill & George Well-Known Member

    Joined:
    Oct 27, 2015
    https://www.researchgate.net/public...Lente_Insulins_in_Cats_with_Diabetes_Mellitus
    this is the one I found, it's just the abstract it concludes that they are the same but dosing of Lantus is just once daily....Haven't found anything else
    thanks.
    Sorry for hijacking your thread Marina.
    How is Chico doing?

    Since with vetsulin they can drop fast early in the cycle, you might want to make sure you get a +2.
    He dropped quite a bit this morning, but I'm wondering if he went lower than that yellow number you caught earlier in the cycle, see how on the 26 he dropped nearly 300pts in just three hours.... I don't think you are 'catching' his nadir. At the moment we don't know when that is happening for him.

    I
     
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  61. Marina & Chico

    Marina & Chico Well-Known Member

    Joined:
    Jan 31, 2021
    Could you please tell me if you were noticing shorter action of caninsulin than 12 hours? Chico gets these huge BGs before his PM shot and we don’t really understand jow to decrease them
     
  62. Marina & Chico

    Marina & Chico Well-Known Member

    Joined:
    Jan 31, 2021
    You were right, at about +5 pm we meassured 6.9 mmol/l even though we gave him food at +2pm. This makes us think how do the rest of you mannage these values in the night? It is weird to even consider lower dosage in the night when the oreshot value is 30mmol/l.

    this brings me to our other observation. We gave him food at +3 AM and it did increase the nadir to 13mmol/l but it increased as well the pre shot value to 30mmol/l... we will try to convince our vet today of changing the insulin type, i have no other ideas how to manage it :(
     
  63. Marina & Chico

    Marina & Chico Well-Known Member

    Joined:
    Jan 31, 2021
    No problem :)

    on the 30th we made the 2 hours interval glucose curve and we identified the +5 as being his nadir. Can the nadir change day by day?
    That is why yesterday we measured him at +5 again to catch his nadir. We believe it is higher than the previous days because usually we would feed him at +4 am and yesterday we fed him at +3 (at @Bron and Sheba (GA) advice) in order to increase his nadir and maybe manage the highs from before the evening shot.

    We would love to measure him more often but his ears are already red from the glucose curve we did the other day and we decided to give him a bit of rest and only measure the nadir.

    How often do you measure and how do you identify the nadir?
     
  64. JanetNJ

    JanetNJ Well-Known Member

    Joined:
    Jun 8, 2016
    On the beginning I got short action. If you look at my spreadsheet in 2016 you can see my high numbers in the beginning. Keep in mind I didn't test the first two months. I didn't see a preshot under 300 the first 2.5 months. It's a marathon and could take some time for the preshots to come down.
     
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  65. Gill & George

    Gill & George Well-Known Member

    Joined:
    Oct 27, 2015
    Yes it can. Until they are well regulated especially so.
    George was on lantus, his nadir usually was around +5 but he did nadir anytime between +1 and +12, it's a longer acting insulin and works differently to Vetsulin/caninsulin, I wouldn't expect you to get a really late nadir with Vetsulin/caninsulin because typically you don't get that sort of duration with it.

    But he could nadir earlier than +5.

    When I started a member recommended I apply a cold compress and some pressure to minimize bruising, this worked really well for George. I would have a damp cool cotton pad that I would pinch the test site between thumb and index finger gently but firmly and count to ten. I tested a lot (I was a bit of a junkie for data:oops:) and George's ears were absolutely fine vet was amazed at how good they look.
    Make sure you are getting the sweet spot, if you are hitting the main blood vessel that does tend to bruise more and you see more swelling.

    Check out this link for more tips


    https://www.felinediabetes.com/FDMB/threads/testing-and-shooting-tips.85113/#post-1377750

    [​IMG]

    George is in remission now so I don't :D but as I said above I tested a lot because I was home and I could and it gave me peace of mind. Lantus is typically gentler and doesn't usually cause dramatic drops (there are some circumstances when this happens, like when they are clearing a bounce and you learn to recognise that), with Canninsulin they can really dive, so I would be tempted to follow up sharp drops until I see them level out.

    I think that in these initial stages and seeing how fast he is dropping, and with weaning him of the dry, I would recommend testing early in the cycle getting a +2, then based on what you find there, decide whether you can leave it till +5 or whether you need to follow up sooner. I would at least in these initial stages, follow up any sharp drops no later than +4. (I'd be tempted to not wait and follow up at +3)

    In the same way they can nadir earlier he may also nadir after +5 so if your +5 is low, you may want to double check he's on his way up by grabbing a +6 not just assuming that he has reached the low point and will be heading up. So last night I might have got a +6 to make sure he is done with dropping. (cats often have lower cycles at night) It was good to see him hit blue at +5 last night, but we don't know if that was the lowest he dropped or if he went lower earlier or later.

    Hope that helps.
     
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  66. Marina & Chico

    Marina & Chico Well-Known Member

    Joined:
    Jan 31, 2021
    thank you very much for your advice, we will meassure +2.

    Chico is upset with us when we meassure, even if we really try to pet him and caress him before, i believe it it because he has too many pinches in his ears already and it hurts him a bit. We dont always manage to take a sample from the first attempt :( i hope it will get better
     
  67. Gill & George

    Gill & George Well-Known Member

    Joined:
    Oct 27, 2015
    It takes time for both of you to get used to it:bighug::bighug::bighug:
    does he like treats? George loves the freeze dried treats which are low carb and he always got one or two pieces when I tested him. So he would come up to me when I rattled the test strips sit on my lap and present his ear for a test because he knew he was getting a treat. It of course didn't happen straight away but he soon go the idea that poke=tasty treat.
    I also desensitized him to having his ears handled by simply rubbing them for a bit then giving him a treat. (no poke)

    I used cosma snackies freeze dried treats. Also orijen freeze dried treats, as long as they are 100% FD chicken/fish/meat with nothing added they are fine to use and will not affect his BG.
     
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  68. Marina & Chico

    Marina & Chico Well-Known Member

    Joined:
    Jan 31, 2021
    We tried first few times with treats that we had at home, but they are very high in carbs and we still didn't receive the freeze dried ones that we ordered from zoohit. Definitely will try to do the same.

    We ordered Cosma freeze dried ones, i feel much better to know it was the correct choice
     
  69. Gill & George

    Gill & George Well-Known Member

    Joined:
    Oct 27, 2015
    I'm sure chico will looooove them:D

    If your order is delayed you could try tiny pieces of chicken breast (just plain cooked no salt/spices) as a treat, some people use that instead of the freeze dried treats. The just poach/some chicken breast in water cut it up into small pieces, freeze some and keep some for use, defrosting as they need them.
     
  70. Gill & George

    Gill & George Well-Known Member

    Joined:
    Oct 27, 2015
    Have you managed to get another test today?
     
  71. Marina & Chico

    Marina & Chico Well-Known Member

    Joined:
    Jan 31, 2021
    not yet, we struggled at +2 but didnt manag, we let him be and will try in a few min again
     
  72. Marina & Chico

    Marina & Chico Well-Known Member

    Joined:
    Jan 31, 2021
    we will try that today, hopefully will help
    PS: cooked=boiled?
     
    Last edited: Feb 1, 2021
  73. Marina & Chico

    Marina & Chico Well-Known Member

    Joined:
    Jan 31, 2021
    it is at 14mmol/l and we didn't feed him yet (except the portion with insulin). This value is higher than what he had when we made the BG curve and he reached nadir with 8. I am afraid tonight it will be again in the 30s :(
     
  74. Gill & George

    Gill & George Well-Known Member

    Joined:
    Oct 27, 2015
    250@+3 in usa numbers, I would recommend you quote those (the ss automatically calculates it for you) we use the USA numbers and the hours after shot time on the forums and everyone is familiar with those, not everyone is 'bilingual'. You will get more help if people understand what they are looking at. :)

    It's a big drop, 200pts almost, I would check him again at +5 see if he is still heading down, or if he is still flat.

    A high pre shot may occur for different reasons, for instance: a bounce or not enough duration from the insulin or both, might result in high PS.

    Don't get ahead of yourself, feed as you normally would and take it one step at a time.
     
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  75. Marina & Chico

    Marina & Chico Well-Known Member

    Joined:
    Jan 31, 2021
    I checked CC's spreadsheet and i can see that you have been thru a lot, great job at managing it so well
     
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  76. Marina & Chico

    Marina & Chico Well-Known Member

    Joined:
    Jan 31, 2021
    You are right, we can get ahold of Lantus and Humulin. Our vet recommends waiting a few more days before taking the decision to make the change. Looks like we will have to monitor him thru the night until then.
     
  77. Gill & George

    Gill & George Well-Known Member

    Joined:
    Oct 27, 2015
    Just saw he got to blue in the morning.

    What was he at pmps?

    Do you think you could grab a +2 and one just before bed tonight.
    This morning doesn't look like a bounce cycle.
     
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  78. Gill & George

    Gill & George Well-Known Member

    Joined:
    Oct 27, 2015
    He doesn't seem to be getting duration and the tests you are getting will help illustrate that. You're doing a great job, and in the scheme of things a few days isn't long to wait for the change to a longer acting insulin. :bighug::bighug::bighug:

    I'm keeping my fingers and paws crossed vet will be ok to swap him onto lantus.
     
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  79. Marina & Chico

    Marina & Chico Well-Known Member

    Joined:
    Jan 31, 2021
    we still have another 1.5 hours until pmps. we can take a + 2 and then a +5.
     
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  80. Marina & Chico

    Marina & Chico Well-Known Member

    Joined:
    Jan 31, 2021
    Thank you very much for the support, we really appreciate it :)

    Our vet is young and not very experienced with diabetes but the good thing is he is very open minded and promised to consult with other colleagues about lantus.
     
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  81. Gill & George

    Gill & George Well-Known Member

    Joined:
    Oct 27, 2015
    Excellent, just st to be clear get a pmbg as well, you don't want to shoot blind.
     
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  82. Marina & Chico

    Marina & Chico Well-Known Member

    Joined:
    Jan 31, 2021
    Sure, that one is sacred but thank you for reminding us.
     
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  83. Gill & George

    Gill & George Well-Known Member

    Joined:
    Oct 27, 2015
    George was our vets first diabetic cat. She started him on gliclaside, which doesn't work for cats, and recommended dry diabetic food, do we didn't get of to a good start.
    But she was open to discussing his treatment. I just made my case, part of that was showing her that I could keep him safe by monitoring, so she prescribed lantus, I joined the board and though I shared the info, Ieith the help of experienced members I made the dosage decisions as per the protocol, and George got regulated and into remission about 5 months later, he's 21 and is still off insulin.
    I'll see if I can get you some documentation to support your case for s longer acting insulin.
     
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  84. Gill & George

    Gill & George Well-Known Member

    Joined:
    Oct 27, 2015
    Phew!
    Ive learnt never to assume anything:joyful:
    :bighug:
     
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  85. Marina & Chico

    Marina & Chico Well-Known Member

    Joined:
    Jan 31, 2021
    Wow, dosage decisions... i would be soo scared to do that, you are very brave.
    I would be very grateful for the documentation
     
  86. Marina & Chico

    Marina & Chico Well-Known Member

    Joined:
    Jan 31, 2021
    So we are at 427 pmbg today. That is such a relief to be honest, on the other hand a long night is ahead of us...
     
  87. Gill & George

    Gill & George Well-Known Member

    Joined:
    Oct 27, 2015
    Did he eat OK for you at dinner?
    I saw your notes about diarrhea on the ss. How bad is he?
    Hope it resolves.
     
  88. Marina & Chico

    Marina & Chico Well-Known Member

    Joined:
    Jan 31, 2021
    He ate dinner and we will give him some more food at +2.
    He has diarrhea for a while now but some days its more liquid than others.
     
  89. Gill & George

    Gill & George Well-Known Member

    Joined:
    Oct 27, 2015
    Poor guy.
    Has it coincided with the food change with diabetes? Or has he been on antibiotics? Or is it more of a long-standing problem for him?


    I'm just heading to bed, but I'll get some info together for you tomorrow of things you can try. I'll get that and the documentation together for you.
     
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  90. Marina & Chico

    Marina & Chico Well-Known Member

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    Jan 31, 2021
    We think its related to the change in diet.

    good night and thanks :)
     
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  91. Gill & George

    Gill & George Well-Known Member

    Joined:
    Oct 27, 2015
    Hi how are you guys doing?
    Is Chico eating OK? How are his poops?

    https://www.dovepress.com/managing-...spectives-peer-reviewed-fulltext-article-VMRR
    A review of the different insulins, includes vetsulin, PZI, Lantus, amongst others, and what the best first choice for achieving regulation quickly and safely, which in turn gives best chance of remission in newly diagnosed cats. one of the authors is J. Rand, she was involved, together with a group in germany, in devising a dosing stragegy (TR Protocol which is one of the dosing strategies we follow on the lantus forum. What is interesting in both these papers is that they stress the importance of getting a newly diabetic cat into a normal range quickly and safely and how, in particular caninsulin/vetsulin is not able to do this for many cats due to its short duration in cats, this results in kitty being hyperglycaemic for too many hours a day which is detrimental to Bcell health in the pancreas. The longer acting insulins are better at doing this, in particular Lantus.
    This describes the Romp Rand method for diabetes management wiith long acting insulins file:///C:/Users/Gill/Downloads/management%20of%20diabetic%20cats%20(5).pdf

    Both those papers should support your request for a longer acting insulin and the importance of not waiting too long.

    I have found reference to another more recent study comparing lantus and prozinc,(2017) in that lantus still has a better rate of remission, 38% versus 25%, which the researchers did not find to be statistically important. I haven't been able to get my hands on the full study yet, just the abstract.
    Everything I read suggests that a long acting insulin is the best first choice,(vetsulin/caninsulin is not long acting in a cat) though a number of articles reference the eu legislation of having to use the cascade rule may aversely affect our kitties here in Europe. That said if your vet won't change to Lantus, Prozinc is significantly longer acting and a better choice, he should be able to prescribe that as it is now licensed as an animal product, which may help you to get Chico into healthy BG for longer periods.
     
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  92. Marina & Chico

    Marina & Chico Well-Known Member

    Joined:
    Jan 31, 2021
    Chico has pretty high BG values too early in the cycle and we don't really understand why. yesterday in the night we were afraid of values lower than 124 but instead it was 403. The same thing today. We really don't know what is the cause for this worsening in BG. He had again pretty liquid diarrhea. We started giving him cooked chicken as a treat for after testing, he started being a bit more complacent to letting us measure but maybe that is what stresses him and respectively increasing his BG. He started overgrooming himself, my husband found online that it is usually a sign of stress. On the other hand, it is difficult to say he is more stressed than usual because he is very playful and reactive... Another day of a lot of questions is our house...

    Thank you very much for the links, i will read them and try to go back to the vet with it. The second link is on local disc C:, so i wasn't able to open it. Maybe you cans end it to my email:
     
  93. Gill & George

    Gill & George Well-Known Member

    Joined:
    Oct 27, 2015
    I will but I would take your email address down, so it is not public.
     
  94. Marina & Chico

    Marina & Chico Well-Known Member

    Joined:
    Jan 31, 2021
    already did, and i finally managed to edit the message to answer to parts of it separately
     
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  95. Gill & George

    Gill & George Well-Known Member

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  96. Gill & George

    Gill & George Well-Known Member

    Joined:
    Oct 27, 2015
    Last night cycle, if we assume that he stayed flat and red all cycle, may have been a bounce triggered by the sharp drop in the morning cycle.
    This morning he dropped from 560 to 193 that is a lot 367
    either the duration is up or another bounce got triggered, or possibly both. That results in BG spiking two hours later. The fast drops that canninsulin/vetsulin causes in many cats can result in this sort of cycle.

    Though some cats will still bounce on the longer acting insulins like lantus, it is not usually as dramatic as we are seeing here for Chico.
    Some of that is attributed to the fast acting vetsulin and the fact that Lantus aside from being 'gentler' and longer acting it also has a depot, which levels out the curves. Infact once regulated, the curves in lantus are almost flat

    Below is an explanation from the lantus forum sticky which covers the points above, and may help explain why for many (if not most cats) the slower acting insulins can be a better choice.


    A full understanding of the following concepts will go a long way in helping you regulate your kitty's blood glucose when using Lantus/Basaglar or Levemir:
    • Carryover - insulin effects lasting past the insulin's official duration
    • Overlap - the period of time when the effect of one insulin shot is diminishing and the next insulin shot is taking effect
    • Insulin Depot - a "spare tank" of insulin, which has yet to be used by the body
    • Lantus, Basaglar & Levemir: What is the Insulin Depot?
    • Bouncing - Bouncing is simply a natural reaction to what the cat's system perceives as a BG value that is "too low". "Too low" is relative. If a cat is used to BGs in the 200's, 300's, or higher for a long time, then even a BG that drops to 150 can trigger a "bounce". Bouncing can also be triggered if the blood glucose drops too low and/or too fast.The pancreas, then the liver, release glucogon, glycogen and counter-regulatory hormones. The end result is a dumping of "sugar" into the bloodstream to save the cat from going hypoglycemic from a perceived low. The action is often referred to as "liver panic" or "panicky liver". *Usually*, a bounce will clear kitty's system within 3 days (6 cycles).
     
  97. Critter Mom

    Critter Mom Well-Known Member

    Joined:
    Jun 16, 2014
    Hi Marina.

    It's likely due to the characteristics of Caninsulin. This insulin is capable of quickly dragging numbers down. Trouble is that fast, steep drops can sometimes trigger higher BGs in the next cycle. Also, in many cats treated with it, there just isn't long enough duration of effect, as you can see in the cycles where Chico has gone from nadir blues up to yellows - even into red - around the +7-8 mark.


    Mogs
    .
     
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  98. Gill & George

    Gill & George Well-Known Member

    Joined:
    Oct 27, 2015
    Just thinking about his poop problem, you may want to give probiotics a try.
    get some human ones from the pharmacy/healthfood shop, the link below has advice on how to manage the diarrhea and which probiotics to use to help him with it.
    I've used Sboullardi with George when he got runny poop from ab and anti inflammatory and it worked for him, he still has a maintenance dose now, he's an old cat and it has reduced the frequency of him getting runny stinky poops.

    https://www.foodfurlife.com/my-cat-has-diarrhea---what-do-i-do.html#/
     
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  99. Marina & Chico

    Marina & Chico Well-Known Member

    Joined:
    Jan 31, 2021
    Thank you, we will definitely try it.

    In meanwhile we have found that he might be intolerant to the food he is receiving, which would make sense, because the diarrhea started around the time when we switched to Purina ProPLan DM. We want to go back to our old food - Cosma in jelly, it is pure meat, <1% carbs. Nonetheless it is considered to be supplementary wet cat food. Do you have any experience with Cosma as the main food for cats?
     
  100. Gill & George

    Gill & George Well-Known Member

    Joined:
    Oct 27, 2015
    No I used it as supplementary, some of the varieties were medium carb do I used them when George went too low.

    Take a look at thrive, they're stuff has no weird additives. George gets the shredded chicken, and tuna and salmon, they are shredded in broth but both are complete foods. There are some other flavours.

    Kattovit sensitive is also well tolerated.

    do you have some though what it is in the food that is causing the issue?
     
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