How do I know when my kitty is in remission

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Mum of two felines

Mum of two felines

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Buzz is the second SS below. This weekend I've taken him completely off dry food and feeding 2 meals and 2 small meals. Yesterday when I gave him his 1 unit he went down to 31 so today I gave him .5 and he went down to 26. Do I stop giving him his injections? I go back to work tomorrow so I won't be around if he gets that low again! My vet doesn't believe in home monitoring - he's not even sold on me going totally canned. I am feeding him canned prescription diet w/d and I just know if I could get the approval to move to friskies he would be in remission. Oh, what do I do? I know the vet won't believe me if I call and say and tell them his glucose levels. :(
 
I am feeding prescription diet w/d canned. Not the best for him, but I can't tackle the insulin tracking and his diet together with the vet. I have to choose the lesser and I know the canned is very expensive, but if I can get him OTJ I won't mind. Then, maybe the vet would listen to me about his diet.
 
The W/D canned you've been feeding is high carb at about 25% carbs and is overall a lousy food.

If you look at the ingredient list, you'll see "powdered cellulose" which is nothing but a fancy word for "sawdust"

Buzz looks like an excellent candidate for being diet controlled and the only thing he may need to live a long, OTJ life is the switch to a low carb food....Friskies pate's, Fancy Feast Classics and 9-Lives pates are all low carb and (in my opinion) contain better ingredients than the W/D

You don't need your vets "approval" to change foods....just make sure if you change to low carb, you're testing frequently (especially if you continue giving ANY insulin at all)

It will be hard for your vet to argue with you if the results are positive! (although we know some of them still will)

With Buzz, I think it's very much worth getting him off the W/D and onto a low carb canned diet and stop the insulin for now....see how he does. Going into the 20's and 30's on the AlphaTrak, the high carb W/D is probably the only reason he's still alive....those are WAY too low

If he can stay in normal numbers (68-about 150 on the AlphaTrak) for 2 weeks, he's considered "in remission"
 
I just looked at both spreadsheets - whose is the first one? That one looks almost as crazy for numbers...from 12 units to 3 in just 2 days and still with a reading of 30 on just a fraction of the dose from 2 days ago! I would agree with Chris that switching the food may well be all that's necessary...but I think that might actually apply to both cats, not just to Buzz. I didn't even ask my vet about switching food - they managed to sell me just 3 cans of DM (I opened one and tried giving it once to no avail and went out and bought Friskies pates the next morning based on advice from all the great people here). I just didn't mention food to them at all until weeks and weeks later at a check up - they asked what Rosa was eating, and I just told them she was getting Friskies pates. By then, her numbers spoke for themselves and no-one argued with me. :)
 
I've replied on your other thread (and I've also put a request out on the board for members with Novolin experience to come to your assistance as soon as possible).

Please can you put back the higher carb food and get dosing advice as soon as possible. For the numbers you're seeing on Buzz's BG readings, they are in the NORMAL RANGE FOR A NON-DIABETIC CAT who is not on insulin! I urge you to get advice before giving any more insulin to Buzz and also getting advice about reducing Woody's dose further.


Mogs
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@Mogs.....she's currently feeding W/D canned from what I understand

I agree with you though that the high carb food is probably the only thing that's kept her kitties alive with those super low numbers

My point was that IF you go to a low carb food, that may be all that Buzz needs to be able to be OFF insulin completely
 
@Chris & China - That's exactly how I read your post, Chris. :) Sorry if I caused any confusion. I'm just being a bit of a Ma Hen on this one and trying to cover all bases because I'm worried about the insulin situation.

If Buzz were mine and I knew the full situation re risk of infection, ketone status, etc., I'd withhold and monitor closely. Looking at the response to the dose reductions in both kitties I wonder whether the only reason Woody's a bit higher is that he might be more carb sensitive than Buzz (but that is pure conjecture on my part - no evidence base). As I posted above I don't know Novolin but I'm wondering about Woody: could the dose reductions also result in a drastic reduction in glucose production by the liver and could that then cause additional difficulties? (Asking the question - don't know the answer.)


Mogs
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We'll , I am not giving Buzz his insulin until his BG starts rising. I believe the reason why my kitties weren't going into their moderate symptoms was I was told to keep dry out so they could eat if they started feeling bad. The problem I seem to have now is I have 19 strips and my order won't be here til Wednesday. I know, I shouldn't run out, but I wasn't paying attention when I was doing both their curves. I started with close to 80 strips and have used 60 in the last 3 days. Checking twice when those numbers were low and sometimes my kitties shook their ears/heads and lost the drop of blood and wasted a strip.

My plan is not to give Buzz insulin and I'll check before every feeding. That will use 5 of those strips.
With Woody I'll test before feeding, +2 hours and + 5 hours tonight and maybe reduce insulin in the am back to 3 and check at + 8 when I get home from work. Then test before feeding and again at +2 and +5 tomorrow and Tuesday. That will use 14 of those 19 strips I have. Hopefully I don't need to start Buzz back on insulin if so I'll be out checking him and possibly running out :(. I will keep dry out for Woody, but not Buzz unless he starts needing insulin. They will be separated for the daytime.
 
You might want to get a human meter to use as backup for those times when you run out of strips. Get one from someplace local where you can get strips on short notice. Many here use the relion meters from walmart. Target also has one people use called the up and up.. Human meters run lower than pet calibrated meters, but most people here use human meters and will understand those numbers. Just make clear what meter you are using when posting here or when talking to your vet. It's best to stick to one meter but if you you're low on strips you gotta do what you gotta do. Some people use the freestyle lite strips in the alphatrak meter and claim there isn't too much variance. It might be a good stopgap until you get more alphatrak strips. There was a recent thread about what code to use.
 
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Hi there,

I'm glad to hear about Woody improving and I very much support your decision to skip insulin for Buzz. It's a very good idea to keep the two kitties separate and to keep Buzz on the lower carb food. I would not give Buzz any more insulin until you have got advice from your vet (and hopefully from someone with Novolin experience here). He is in 'non-diabetic' numbers. Be sure to tell this to your vet.

Re the insulin dose, the higher number before a dose is due is not guiding you well about safe dosing. Numbers might be rising high at the end of the cycle to counteract how low Woody went earlier in the cycle and the insulin is just dropping his his numbers like a rock again as soon as it's administered. Right now you need to look at the nadir - how very low the dose is taking Woody - to make safe dosing decisions. As you saw last night after giving 5 units again even though the preshot test was nearly 300 Woody's BG completely tanked to another dangerously low number within a couple of hours.

The 3 unit dose you gave yesterday morning took Woody dangerously low yet again so THE 3 UNIT DOSE IS STILL TOO HIGH. I'm not a vet and I haven't used Novolin but if Woody was my cat and I was treating with Novolin and got numbers that low I would reduce the dose below 3 and still monitor BG closely. I would also be sure to feed higher carb food. It is better to have a cat a bit higher for a short time than dangerously low for a minute.

You must keep Woody's blood glucose levels ABOVE 68. Any dose that takes him below that number is too high and must be reduced - AND STAY REDUCED.

Please feed him higher carb food and continue to do so until you get decent advice on the Novolin dosing.

Please always test at +2 at the very latest. Woody starts going low early in the cycle. Keep monitoring. (See below for human meter info.) If Woody is under 100, keep testing every 30 minutes. If he goes to 68 or lower:

1. Give Woody a small amount of honey or karo immediately to bring his numbers up quickly. (NB - the honey/karo will wear off quickly. It's not enough on its own to keep Woody in safe numbers. See point 2.)

2. Immediately after the honey/karo feed Woody some of your w/d canned food. This will help to raise his numbers in the medium term and doesn't wear off as fast as the honey/karo.

3. For the numbers you've been seeing, I would also give Woody some high carb kibble at this time (to help keep numbers up later in the cycle) and make sure he has free access to food with a lot of carbs all the time.

Please test frequently to keep Woody safe because he stays low for a long time. Please leave high carb food out for him all the time until you sort out a lower, safe dose for him.

If Woody only gets his lowest reading (nadir) in the 100s it would be better and safer right now. You can monitor his urine for ketones.

I note you're low on test strips. As Billy's Mom recommends above get to a store (or preferably ask someone else to go for you) and buy a human meter and plenty of test strips. If you need to go yourself make sure Woody is at an OK number and leave lots of high carb food out for him to graze. (If you don't have urine test strips for ketones it would be wise to pick up some of these when you go for the meter.) Get home as quick as you can and test Woody as soon as you get back.

As Billy's Mom advises above, human meters read lower than the Alphatrak but for now I would still advise you to not let numbers go below 70 on a human meter either (much safer in these circumstances). When you start using human meter strips put a note in the spreadsheet so that people replying to your posts will know what the readings mean.

I assume that you'll be ringing your vet about dosing this morning. Please keep us posted with how you get on and ask any questions that you can think of. We'll do all we can to help you.



Mogs
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I use Vetsulin, which is a lente insulin just like Novolin, and it works in much the same way, with the same actions. I can't imagine why your vet started your kitties on such high doses, much less why he told you to increase Woody's dose to 15 units when his BG was 226. That's WAY too much insulin! On top of that, vet stress can raise BG by as much as 100 pts, as well, and your vet should have taken this into consideration. We recommend not giving any insulin at all if BG is under 200, unless you have a lot of experience with insulin dosing.

I am very scared for Woody. I am not a vet and I am in no way giving dosage advice, but I have to stress to you that these high doses have a very great potential to bring about the death of your Woody! If he was my cat, I would drop his dose to a MUCH lower amount, and adjust upward from there, if need be. Better high for a day or two than too low for even a moment, those lows can kill!!!

I left my vet of many years because we disagreed on almost every aspect of treating my cat's diabetes. She over-prescribed insulin doses, she did not believe in home testing and did not want me to do it, particularly, and we clashed in a big way over which food was appropriate and acceptable for a diabetic cat. He is doing great with the help of the wonderful people here and a new vet. Something for you to think about.

Please keep us posted. Fingers and paws crossed that all goes well! :):):)
 
@Mum of two felines, I'm fairly new too so I don't have advice. But I do have experience having a vet who is set in her ways and does not approve of home testing or changes to low-carb diets. This made my first 3 weeks treating Callao very stressful on a number of levels. I felt strongly that I should be doing home testing and changing diet, so I ended up finding a vet who is willing to work with me on these things. We've seen dramatic improvements with Callao since switching her to a low-carb wet food on Jan 28 (recent, I know, but we're excited nonetheless). Prior to the switch, her curves could drop from >500 to <60 in 2 hours after a "low" dose of insulin (1 u Lantus, which we were giving twice a day). With the food switch over the weekend, I monitored her closely while also dropping her insulin dose significantly (0.1-0.4 u twice a day) to avoid her going hypo. Her curves since the switch have been soooo much better, none of these wild swings yet that we used to see almost daily before the switch.

However you decide to treat your kitties, I hope you can find a vet willing to work with you. You know your cats best, and you are their only voice and advocate to the human world. Stay strong and know that you are a wonderful mum to your babies!
 
Well I called the other vet in town and the only difference between the two is she wants me to bring my kitties in every 2 weeks, 5 hours after they have eaten and had their injection. They want owners to feed prescription hill food but will consider the canned. Not interested in changing to another vet just to go through the fight I will currently have with the one I already have. He's been their vet since they were kittens and was my Pom's vet for 16 years. So, I'll start looking in the larger town 35 miles south of us, uuggggghhhhh. I guess if I don't find one there I can go 4 hours west to Colorado Springs. Pretty bad that K-State is so reverend here and no one is open to home monitoring and working with the owners of pets.

And while I'm on the rant of how irritating our vets are in this small town, I went to the pharmacy (because it's 40 minutes to the Target one way) to pick up the free style lite strips. You want to know how much this pharmacy is charing for 50? $86 flipping dollars!!!!!!!!! I will make sure I never run low again!!!!(then business owners wonder why people go out of town to shop)
 
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I'm sorry to hear that you're having difficulty finding a supportive vet. :( I went through similar when Saoirse was first diagnosed. We moved to a practice nearer home shortly after her Dx and her new vets are much more progressive in their approach to feline diabetes. It's certainly a big help.

Very good to see Woody in safer numbers today on the 1 unit dose. What did you feed him today?



Mogs
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Thanks for the info.

Was that a higher proportion of the w/d canned than you were feeding when Woody's numbers went really low over the last few days?

Also, how are you doing for testing supplies (glucose test strips and ketone strips)?

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Mum of two felines said:
I guess if I don't find one there I can go 4 hours west to Colorado Springs. Pretty bad that K-State is so reverend here and no one is open to home monitoring and working with the owners of pets.
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I know you probably don't want to do that, but if you decide it's necessary then I'm happy to refer you to my vet in Colorado Springs.
She's not an expert in diabetes, but she was the one who introduced me to this site, told me there were options other than prescription diet, gave us Lantus (the best insulin for kitties) when we started on it, and had her tech teach me how to home test - while she would do curves there, she explained to me that having her do it was less accurate because of stress.
She's really great, and willing to work with us. She definitely seems a lot more knowledgeable about diabetes than many of the vets I hear about on this site.
Just let me know if you want her name and I can pass it along.
 
Critter Mom said:
Thanks for the info.

Was that a higher proportion of the w/d canned than you were feeding when Woody's numbers went really low over the last few days?

Also, how are you doing for testing supplies (glucose test strips and ketone strips)?

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I was just feeding w/d over the weekend. Of course I put out the dry when he got too low.
 
Critter Mom said:
Thanks for the info.

Was that a higher proportion of the w/d canned than you were feeding when Woody's numbers went really low over the last few days?

Also, how are you doing for testing supplies (glucose test strips and ketone strips)?

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I went to the little pharmacy here in town because Target is 40 minutes away, one way. I got the freestyle lite for $85 for 50!
 
Thanks for the clarification on the food situation and glad to hear you got some supplies. Is it just the Freestyle strips that you purchased? Or did you get both the meter and the strips?
 
Critter Mom said:
Thanks for the clarification on the food situation and glad to hear you got some supplies. Is it just the Freestyle strips that you purchased? Or did you get both the meter and the strips?
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After $85 I decided I'd just code my alphatrax. I looked at other human meters and the pharmacy had all of the test strips at the same price.
 
I'm going to tag Linda (@MrWorfMen's Mom) to see if she can offer you some advice on using the Freestyle strips with the Alphatrak meter. (I've not done so therefore I don't know about coding and any other special considerations that you may need to be aware of when using Freestyle strips with the Alphatrak.) I'd suggest that you don't change the mix of Friskies and w/d that you're giving now until you get input on this. If you want to continue with the food transition, I'd suggest only changing the ratio very slightly each day (per my previous posts) and monitor closely throughout. If you are going to change the proportions I suggest that you do so on a daytime cycle (assuming that you're able to test frequently enough to keep Woody safe). With the non-native test strips in the mix I'd suggest not letting Woody go below 90 until you get a better idea of how the Alphatrak and Freestyle strips are working. Linda may have more input on this.

If Woody were mine and I was working with a harsh insulin like Novolin I would be inclined to be very, very conservative about insulin dose. Watch the insulin dose very carefully, pay heed to the nadir blood glucose levels, and post for help if Woody goes low again.

I need to sign off for the night. I hope all goes OK.


Mogs

EDITED TO ADD:

I just had a quick look at Woody's spreadsheet and I see you've increased his dose to 2 units Novolin. I recommend in the strongest terms that you don't reduce the number of carbs in his food until you know what that dose is going to do. And monitor him very closely.
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Hi and belated welcome to FDMB. Are you sure you only got 50 strips for $85 because even with our dollar tanking here in Canada (when compared to US $), it's just under $80 for 100 strips but the box here is exactly the same size as the box for 50 AT strips. If that's what they charged you for 50, that is highway robbery! YIKES! For that you could buy AT strips!

I am not advocating use of the FS strips in the AT meter, but they will work. Since you need to do so , it is imperative that you have your AT meter set on one of the cat codes (known codes are 08, 37, 38, and 93) to get a reasonably accurate result. Do NOT use the code on the FS strip vial as that is for use only with older FS human meters or the 07 code mentioned in the AT meter literature because it applies only to the older AT meters.

If you choose to continue using the FS strips in the AT meter, it is also imperative that you keep some AT strips on hand to do baseline checks of your results with the same drop of blood, each time you open a new vial of FS strips or alternately, use AT meter control solution to ensure the strips are readings within the expected range. Also double check any unexpected, especially low FS strip readings using an AT strip. I haven't read everything on your thread yet but I'm assuming you ran out of AT strips due to events requiring more testing than usual so for now you could just take a second reading with an FS strip to double check.

I did cross checks of the two strip types with the same drop of blood and found my results to be within about 8% on average (they topped out at 10% and many were within 5%. Others who use the FS strips in the AT meter have indicated results within about 5%. The difference may depend on the code each of us had our meter set to or on how high or low readings are. I myself was dealing with rather high readings when I did my cross checks.

I am 99% sure the FS and AT strips are the same and the only thing different is that the AT meter needs the right code to give you the most accurate reading. All meters have an allowed variance in their results of up to +/- 20% and using the FS strips in the AT meter adds another variance into the picture so your results, while in the ballpark, may not be as accurate as is possible. If there are only 4 cat codes (we don't know exactly how many might exist), then you stand a 25% chance of getting pretty accurate readings. The AT strips are batch tested to determine the correct code for each batch which is why they are so much more expensive than the FS strips.

If you have any other questions about this, please don't hesitate to holler.
 
MrWorfMen's Mom said:
Hi and belated welcome to FDMB. Are you sure you only got 50 strips for $85 because even with our dollar tanking here in Canada (when compared to US $), it's just under $80 for 100 strips but the box here is exactly the same size as the box for 50 AT strips. If that's what they charged you for 50, that is highway robbery! YIKES! For that you could buy AT strips!

Yes, $85 for 50!!!! I am furious why they cost so much. I ordered strips through amazon and they were on 29 for 50. Ggrrrrr. I thought that maybe I got an old batch, but when I got home the amazon strips were newer by a month. Another reason my home town is irritating me. Can you imagine being a diabetic in this town!
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You have my complete empathy. Our dollar has tanked and I darn near collapsed at Walmart today picking up a few groceries and Menace's insulin. I think everything here has increased by about 25%. We never had nearly the bargains for strips that are available in the US but our insulin has been much cheaper. I think it just cost me an extra $10 for Menace's insulin today too. I don't want to think about being a diabetic either!
 
Don't be disheartened just yet. After those low numbers, Buzz may be bouncing and if you still have higher carb food (w/d?) in the mix, that would have a bearing too. I notice Woody has taken a pretty steep dive tonight so you need to keep an eye on him tonight. If you need/want to go to bed soon, perhaps a little extra food for Woody would help level him out but I'd make sure he is rising before letting my guard down. I think the 2u tonight may have been a bit much. Woody likely bounced today after that 37 last night making it look like the 1 unit wasn't sufficient.

You are getting quite the workout between the two of them! :blackeye:
 
MrWorfMen's Mom said:
Just noticed Woody appears to be rising now! Thank goodness as they really are making you work hard these days! I'd make sure Woody is continuing to rise before hitting the pillow!
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And to top it off they both picked up some type of an infection. Their eyes are matted and they are now on antibodies. Buzz's temp was 103, Woody was 102.5. They are beginning to dislike my chair, lol.
 
I know those numbers are concerning and you don't want either of them staying in the 200 and 300's any longer than necessary but if they both have infections, that alone can raise their numbers. It's far better for them to be in those higher numbers for few days than too low for even a second so I wouldn't determine doses based on one day of higher readings! Both of them have proven they get to normal numbers and go really low with too much insulin on board so with an infection in the picture, you really just have to ride out those higher numbers and monitor closely. When the infections clear, the numbers will no doubt start dropping again.
 
MrWorfMen's Mom said:
When the infections clear, the numbers will no doubt start dropping again.
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If you're dealing with an infection BG numbers could drop unexpectedly when a cat recovers; yet another reason to be cautious with your dosing and feeding. Diabetes management requires patience: as is oft noted here it's a marathon, not a sprint. Dose safety must always be the first and most important principle.

Make sure your cats get plenty to eat and plenty of fluids. Mix some water into their food to make sure they're properly hydrated. With the infection in the mix it is vitally important that you test daily for ketones. (If you don't have the urine test strips your local pharmacy should carry them; get some ASAP.) Be doubly careful about testing Buzz for ketones while waiting for the infection to run its course. Please, please post for Novolin dosing advice if his numbers trend upwards - and remember that a tiny dose made his BG completely tank. If either of your cats go off their food even slightly or if they show trace ketones contact your vet ASAP for advice on when to bring them in for examination. If either of them show more than trace ketones you need to take them to a vet immediately for treatment. (Without emergency treatment they would be at very high risk of developing DKA - diabetic ketoacidosis.)

The numbers you need to really, really, really worry about are the 20s, 30s, 40s, 50s and low 60s. Having a cat running a little high is not ideal and brings its own set of challenges and cautions but a hypo can kill in minutes.

If you haven't done so already, please print out and study the following document then keep it somewhere you can grab it quickly in an emergency:

How to Treat Hypos: They Can Kill

Here is another document which provides details of things you need to have in your hypo toolkit:

Hypo Toolbox


Mogs
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I just took a look at Woody's spreadsheet. If he was bouncing it looks as though he's cleared it - that's a huge drop between pre-shot and +2 this morning. Please monitor him as closely as you can with plenty of testing over the next hour or two...he could very well be heading low again today.
 
I just wanted to offer a suggestion with the vet--many people here have arrived at FDMB to discover that their vets were not recommending the right treatment for their cats. It doesn't necessarily mean the vet is a bad vet, just that they haven't gotten up to date on the current treatment recommendations. Vets are general practitioners, and they have to know a lot about many different animals. Some vets are grateful when you do your own research and bring them up to speed--and some still insist on continuing a course of treatment that is not good for your cat. So I would try bringing your vet the sources of the information we are giving you, and see what happens. If he changes his tune and will work with you the way you want, then he may be a keeper. If he doesn't want to work with you, move on to the next vet and do the same thing. I think you'll find most vets will change their minds once you bring them information they can trust (and not just the word of the crazy internet cat people:cat:).

Here's a link to the AAHA guidelines to print out. I'll highlight the parts you'll want to point out to him.

On food (p. 217-218):
Limit carbohydrate intake.18-21
  • Dietary carbohydrate may contribute to hyperglycemia and glucose toxicity in cats.
  • Provide the lowest amount of carbohydrate levels in the diet that the cat will eat.
  • Carbohydrate levels can be loosely classified as ultralow (<5% ME), low (5% to 25% ME), moderate (26% to 50% ME), and high (>50% ME).
and

Canned foods are preferred over dry foods. Canned foods provide:
  • Lower carbohydrate levels.
  • Ease of portion control.
  • Lower caloric density; cat can eat a higher volume of canned food for the same caloric intake.
  • Additional water intake.
Dr. Pierson's chart with the carb levels in prescription and commercial cat foods can be found here. You can point out that the carb levels in the Hills W/D are way too high for a diabetic cat, while many commerical foods have acceptable carb levels.

On Insulin (p. 218):

The insulin preparations with the appropriate duration of action in most diabetic cats are glargine [i.e. Lantus] (U-100) or the veterinary-approved human protamine zinc insulin (PZI U-40).31

This panel does not recommend the veterinary-approved porcine zinc (lente) insulin [i.e. Vetsulin] suspension as the initial treatment for the cat, because its duration of action is short and control of clinical signs is poor.

Humulin has a similar duration of action to Vetsulin, so it is not a recommended insulin for cats. I've attached a second article for you to print out (at the bottom of this message) that discusses the proper dosing and treatment with the recommended insulins for cats, Lantus, Levemir, and Prozinc.

On Home Testing (p. 218):

Home monitoring of BG is ideal and strongly encouraged to obtain the most accurate interpretation of glucose relative to clinical signs.34 Most owners are able to learn to do this with a little encouragement, and interpretation of glucose results is much easier for the clinician.

and

  • Use extreme caution when interpreting a "high BG" in the cat. It is important to discern between stress hyperglycemia and hyperglycemia that needs treatment. Use all laboratory findings and the clinical examination when evaluating response to insulin
  • Be aware that chronic insulin overdose may not only result in clinical hypoglycemia (seizures, coma), but also the development of sustained hyperglycemia and insulin ineffectiveness following secretion of insulin antagonists (catecholamines, glucagon, cortisol, growth hormone) that combat hypoglycemia.35
  • In-clinic blood glucose curves (BGCs) are more likely to be affected by stress hyperglycemia than BGCs generated at home. Veterinarians should be cautious of high glucose results and subsequent overzealous increases in dose.
If these don't bring your vet around to the correct treatment recommendations that you want to do, then it's definitely time for a new vet. I would bring the other vet (who wants to do the in-clinic curves every 2 weeks) the same information and see if she will work with you with the treatment that YOU want to do. Most vets are good vets and want the best outcome for the animals they treat--I think once they have the same information you do you'll have a much easier time.
 

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When I adopted Badger about 1 2/2 years ago he had erratic BGs. Sometimes little decrease and sometimes a PS would be less than 50. He was on about 5-7 units of insulin. I tried Lantus, Levemir, N, BCP PZI and ProZinc. BCP together with a little N seemed to work the best. All this time hid did have polyps in is left ear which were tried with Baytril Otic. Last September I bit the bullet and had a dental done but only secondary to surgical removal the polyps. After tying different antibiotics to get the ear infection resolved after removal (pus came out during removal), I can maintain Badgers BG below 150 with about 2.2 units of insulin twice daily
 
Darn it! Mogs you were correct 2 is way too much! I thought with the 451 that the 2 wouldn't take Woody too low, wrong again!!! I am glad we have a snow day today so I can be monitoring him. Ggrrrr!!!! I guess 1 unit is what I'll stick with for a while.
 
manxcat419 said:
I just took a look at Woody's spreadsheet. If he was bouncing it looks as though he's cleared it - that's a huge drop between pre-shot and +2 this morning. Please monitor him as closely as you can with plenty of testing over the next hour or two...he could very well be heading low again today.
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And he did!!! Gave him Karo and food!!!
 
So glad you are home today! Sometimes snow days are a blessing! 2 units is obviously more than Woody needs so ignore those high numbers and stick with a lower dose for now!
 
As I stated before, I am not a vet, and cannot give dosing advice However, I can tell you what I would do if this was happening to my cat. If Woody was my cat, I would put him on just 1 unit twice a day, for at least the next 3-4 days, to see if his BG won't level out. His having numbers in the 200-300s for a few days wont hurt him (a lot of vets even consider a cat well-regulated if he is below 250) but those drops into numbers below 68 have the very real potential to kill him. And factoring in an infection makes this even more potentially harmful. I know 1 unit doesn't seem like much, and you may ultimately need to increase it, but insulin is a very powerful hormone (not a medicine) and it's always best to start low and only increase in incremental doses. It is also imperative, in his case, to stay with one dose for a few days, until you start to see how he responds, and can determine his nadir (lowest point in the cycle). I know it's tempting to want to increase his dose every time you see a high number, but for now, if he was mine, I would let it ride out for a few days at 1 unit.
 
Mum of two felines said:
Darn it! Mogs you were correct 2 is way too much!
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I am always super cautious about my own little one and I extend that caution to the kitties here. I don't know much about Novolin at all but, like Lucy (@Squalliesmom), Saoirse's first insulin was Caninsulin (a.k.a. Vetsulin). Caninsulin's action can be very harsh and, like Novolin, it can drop BG like a rock so I do have some experience of massive BG drops and the impact of changing diet from w/d to a low carb food through my treatment of Saoirse.

In the early stages of Saoirse's treatment when I was transitioning Saoirse to low carb food from w/d (the dry version - even higher in carbs than the w/d canned) I wanted to reduce the dose to leave a safety cushion so that Saoirse would not go too low, as I had no idea of how the reduction in carbs would affect her BG levels but I had read the warnings. (Dr Lisa Pierson of catinfo.org cannot stress highly enough how big an impact the drop in carb load can have on a cat's blood glucose numbers.) It was very early days and I still had a lot to learn and I was not yet sure of how to manage her insulin doses. Our vet at the time advised me to stick with the 3 unit dose she was on even though I was changing her food. I didn't think that was wise but I didn't trust my own judgment. Reluctantly I followed his recommendation. Thankfully I was home testing because that night Saoirse's blood glucose fell from a preshot of 310 down to 77 within three hours of the dose (measured on Alphatrak 2) - a drop of 233 points . You'll note that 77 is above the nominal 'hypo threshold' of 68 for Alphatraks. Saoirse had a symptomatic hypo at the 77 - ABOVE the nominal threshold! When I went to do her 'before bed' BG check I could wake her but she was not properly responsive. When I picked her up her body was limp and heavy. Had I not been home testing I might have just thought she was sleepy. Home testing saved her life that night (and I'm very grateful to the FDMB members who helped me that night).

I skipped insulin completely the next day and evening because I was scared and much too exhausted to be sure of staying awake to feed Saoirse through another low. I spoke to the vet during the day and he advised a drop down to 2 units for the following day. The preshot the following morning was 400 so I gave the 2 units per the vet's instructions. Five hours later Saoirse's blood glucose was at 113 - a drop of nearly 300 points!!! I was guided by the preshot (as advised by the vet) instead of the nadir - but I didn't know to the differ then. With harsh insulins you need to take both into account but ALWAYS the nadir should trump the preshot as a guide to dosing decisions.

For information, Saoirse went from 3 units BID to 1.0 IU AM / 0.5IU PM within 3 days of starting the diet transition (hence my advice to you to get a safe dose FIRST before even attempting to reduce the amount of carbs in Buzz and Woody's food).

After that second - even bigger - drop I made the decision to use Saoirse's data - specifically the nadir data - to guide my dosing decisions. I continued to discuss her dose with the vets for a little while but always, always, always the final decision on what dose to give was dictated by Saoirse's LOWEST blood glucose levels, and I gave less and less weight to the vet's input. It may be that I have given her less than was optimum at times but with this approach there is always tomorrow to refine her dose. I do seek opinions here from time to time but ultimately it is Saoirse's blood glucose data that 'calls the shots' in this house. This approach has served us very well and it has kept my beloved girl safe. :)

As I have advised in earlier posts, I'm not a vet but I do care passionately about the safety and well-being of every cat on this board. I try to use my own experience - good and bad - to shorten learning curves and also to save others from the difficulties I've encountered along the way. I hope I have been able to help you a little bit.


Mogs
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Both my cats were on dry w/d during the day because I knew they dropped but I was at work until last Friday. Now they'll only get it if they go hypo. I am feeding them canned w/d with only a 1/3 friskies. So, do I just go back doing only w/d? They are both eating more at the scheduled times with the friskies pâté mixed in. The reason I'm not keen on the vets advice is he wanted to up Woody's level to 15 from 13 last week when he test 226 at the vets at +9. They went from1 to 13 in 12 days when Woody was in the hospital to set his amount. It seems he's only concerned with the high number and the number he's reading at his office.
 
Just to add to what Mogs said, when Squallie was first diagnosed my vet at the time put him on 5U of insulin to start, and then increased it to 7U a few days later (I was feeding the high-carb Prescription" dry food the vet had recommended). At the time I was unaware that I should transition him very slowly to low carb wet food, and I made the switch to fast. Thank heavens I was home testing! Squallie had a hypo and I was terrified, but thanks to the wonderful people here who talked me through how to handle it, major disaster was averted and he survived it. After that event his insulin went from 7U to 2u, and ultimately down to 1U. For various other health reasons his BG is very high right now, in the 400-500s, and I have just today raised his dose from 2 to 2.5U. His nadirs till this point have been in the low to mid 100s, at their lowest. I will not increase his insulin again, if needed, until 3-5 days have passed and I can see exactly where that dose will take him.
 
My inclination food wise would be to not change anything for a couple of days while holding the dose at 1u. That way you can see what that dose is doing and whether any further changes in dose are needed without having the food situation complicating things further. Once you know what 1u is doing, then you could slowly start transitioning them over to a higher ratio of Friskies to w/d until you have them on Friskies exclusively. When do you go back to work? My concern is that the removal of the large amount of carbs in that dry food has already had a huge effect on their BGs and Friskies I believe is lower in carbs than the canned W/D so removing the W/D totally now may lower their insulin needs even more. With both not feeling well, now is not the time to be adding more complications into the puzzle. One step at a time to keep the boys safe! This is a marathon NOT a sprint!
 
Mum of two felines said:
Both my cats were on dry w/d during the day because I knew they dropped but I was at work until last Friday. Now they'll only get it if they go hypo. I am feeding them canned w/d with only a 1/3 friskies. So, do I just go back doing only w/d? They are both eating more at the scheduled times with the friskies pâté mixed in. The reason I'm not keen on the vets advice is he wanted to up Woody's level to 15 from 13 last week when he test 226 at the vets at +9. They went from1 to 13 in 12 days when Woody was in the hospital to set his amount. It seems he's only concerned with the high number and the number he's reading at his office.
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I'm sorry, there's no way to put this nicely - I think your vet had a bout of temporary insanity when he upped Woody's dose from 13 to 15U based on a BG of 226, taken at the vet's, at +9 hrs! First of all, a BG of 226 should not warrant a dose that large (it"s a HUGE dose!) unless your cat is insulin-resistant. Secondly, BG taken at the vet"s have a tendency to be a fair bit higher than usual due to stress. And thirdly, at 9+ hrs there is a very strong probability that BG is rising, or starting to rise, from an earlier, lower number. That lower number is the one you need to know before making any big changes.

AT this point I would stick with the food that you have been feeding them and NOT worry about transitioning to low carb until you have Woody's dose figured out. Best to tackle just one problem at a time, and that is the most pressing one.
 
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