how high is high?

hi, my cat has recently being diagnosed with diabetes and we have been going through the process of trying to find the optimum level of insulin for him. we have been testing at home and slowly increasing the dosage as per the vets instructions but his glucose levels wont seem to shift. the next jump is 5 units which seems very high and i was just wondering how high people have had to go to get the glucose to drop? he is a big boy 4.7kg after a dramatic weight loss and is normally around 7-7.5kg when healthy and the vet has said it is common to end up at 1 unit per kilogram. my concern is the higher we go with the insulin the more thirsty he seems to get and the more he seems to crave food he would eat until he exploded at the moment. He is currently on wet food in the evening and hills diabetic dry in the morning(dry was recommended for his teeth health by vet) but he would happily eat wet all the time as he prefers it. should we be looking at getting rid of the dry completely or continue to up his insulin in small doses til we see a drop in glucose? thanks

 

Go to Forums, then Suggestions,Tech Support & Testing .Read the "Sticky" How to use FDMB- Basics

Hope this helps

 

We can't really give dosing advice without seeing your numbers.

Step 1 set up a signature. Click on your name at the top right corner and choose signature. Add info such as your pets name, date diagnosed, insulin type, age, food you're feeding and any other health concerns.


Step 2, create a spreadsheet and fill in any test numbers you have. So glad to hear you are testing at home. http://www.felinediabetes.com/FDMB/threads/fdmb-spreadsheet-instructions.130337/


If you have trouble setting it up let me know and I can tag someone who can set it up for you.

 

Welcome. Per my reading and reasearch, a low carb wet diet is the best thing for your diabetic cat. We transitioned Idjit to the wet food diet while supporting with insulin, and he was able to achieve remission. No promises or guarantees that this will happen, but I do know that the Hills diabetic dry is not low carb. I also have never known any cat to chew dry food thoroughly enough to ensure any dental benefit. So the dry food is impeding your progress with lowering blood glucose. There is a wet food chart in a sticky at the top of this forum, giving protein, fat, carb, phosphorus and calories. Many of us feed Fancy Feast classics and Friskies pates. I will caution, if/when you take away the dry, make sure you are testing so you see how it is affecting BG.

 

In addition to what Janet suggested your general location and time zone is always a help. I'm in Canada but metric still does nothing for me (you spoke of his weight in kg.) so my meter reads in metric as well. To convert that number simply multiply by 18. We all use metric syringes but since we all use different types of insulin it's important to remember a "unit" of insulin for me may not be the same volume as for you.
You said "the next jump is 5 units which seems very high". Did you mean up to 5 units or 5 units more? Increasing a dose of insulin by 5 units is way too much, you are correct. Getting your boy stabilized may take some time, some of us increase or decrease by as little as 1/2 unit at a time. For a short time I'd rather have a cat with higher readings than low. There is a "stickie", what we call the posts with a yellow information bar about how to deal with a cat having a HYPO episode. This is something you should print out, have a good read and then attach it to the side of your fridge.
Dry food is not recommended. I've had many cats that would not touch wet food so that may take time. The dental dry food is an empty promise just like the weight loss dry food I used to pawn off on our big fat enormous fatso cats. Wet food makes a mess but that's life with cats.
We have a cat that just eats for the sake of eating, I know what that's like. Have patience.

 

Sorry, I didn't answer "how high is high?" Off the scale is high. My meter goes to 35/630 and then just reads "HI". Noah is an "unregulated bouncer" which is something that can wait for another day.

 

Hill's m/d dry food is too high in carbs. I have used it in the past on occasions when Mia's glucose was too low. That food raises glucose - I promise you! A high protein, low carb wet food diet is best. Dry food is not the way to help your cat's dental health! I take my girls to a dental specialist who recommends the supplement 1-TDC for dental (and joint) health. He also suggested the use of Pet Smile brushless paste though I have yet to try that. Of course, things like that are for maintenance. They do not replace the need for appropriate dental cleaning and addressing of issues (like extraction for resorption).

Getting rid of the dry food could definitely have an impact on your cat's glucose levels. So, if you are not home testing yet, I suggest you start before dropping the dry food. There was someone here whose cat's insulin dose had to be dropped in half immediately after dry food was stopped. Testing is really the only way to make sure you keep your cat safe... not to mention that it is the best way to really know what is going on with the current insulin dose so that you know how to adjust it.

Please set up a spreadsheet to record your glucose test results and insulin doses given as well as a signature that includes basic info like what kind of insulin you are using and a link to your spreadsheet. This kind of information is necessary for anyone here to be able to really help you.

 

If he's willing to eat all wet food then ditch the dry food. It's to high in carbs. But DON'T do it unless you are home testing, glucose will drop possibly into hypo episode.

My Olive reached 8 units of levemir before she started to have lower numbers and she wasn't on dry food. Some will have lower readings on low doses. Some will require high doses before they start to have lower numbers.

 

Hi thank you very much for the replies. I’m am in Australia and a little lost when it comes to the different measurements meantioned on here. 5 units total is the next jump, we have slowly been going up from 1 unit in 1 unit increases. With no drop of glucose yet. Fred is approx 10yrs but we actually don’t no his age as we rescued him a few years ago from the RSPCA. The other issue is he has digestive issues so he has been on ID dry food Since we have had him as other foods have caused him to poo blood. He has had diarrhoea since been on the wet food but I’m not sure if that is caused by the food, the insulin or his digestive issues. I have attached a picture of the home testers we are using and the syringes to give you an accurate idea of his levels and the unit measurements we are going from. He is yet to shift from the highest level of glucose on the test strips at any part of the day. We noticed he did have a spike of energy and returned to normal behaviour when first diagnosed a month ago and put on insulin but is slowly becoming more lethargic and almost back to his pre diagnosed state and is continuing to loose weight.

What is the best wet food to be feeding them that is easily available here in Australia? We have been feeding him fussy cat grain free wet but I believe that also may contain to many carbs. All help is greatly appreciated it’s heartbreaking seeing them so Ill. thankyou

 

Can you get a human blood glucose meter? Urine dipstiks are not accurate at all. And how do you test before giving insulin if he won't pee? Dosing insulin is based on the lowest glucose reading in a 12 hour cycle, depending in the kind your using. Giving the amount you are without an actual reading is disaster waiting to happen. Go to the thread titled "Seizure" this was just a few hours ago. She wasn't home testing as instructed by her vet.

 

I know there are a few other members on the board that live in Australia. I'm going to tag them so they will be aware and chime in. @Tucker and @Bron and Sheba .

 

we test him multiple times a day currently with the urine strips(hes drinking so much water currently its easy to get regular urine tests) and we had him in the vet yesterday getting tested on their machine before going to the higher level but neither has shown any form of drop in glucose yet. I will inquire about getting a more accurate glucose meter When the vet re opens. The current insulin we are using is called
Glargine.

 

Hi Alexi, I'm in Adelaide, where are you? Those are the needles we have been using for our Tucker. We also use the Lantus pen for his insulin. We have 2 pens going at a time. One pen is only for when he needs to have full unit dose, the other pen we don't have a needle on and we draw up the dose when he is on a quarter, half or 3/4 dose. The food we were initially given was the Science Diet md and we found out that it has too many carbs for a diabetic cat. Now we go to Petbarn (their online shop has much better prices btw, and you can 'click and collect' to your local shop to pick up much cheaper food) and order online their BARF kangaroo or turker raw frozen food. CORE pate is another good one they put on special often. Atm, they have the BARF for 11.00 a 12 pack and in the shop it is 19.00. They also have a 24 pack of CLASSIC (NO gravy) Fancy Feast for about half price cans. We give Tucker a packet of the raw BARF and then top it with a bit of Fancy Feast and he attacks it. We bought the Freestyle Lite blood glucose monitor at National Pharmacy for about 30.00. The test strips we got for half price by buying them off of eBay. Another tip down here is if you happen to know a diabetic person they can by the strips for you for basically nothing since it is subsidised medicine....

 

Fred's urine test looks like Tucker's did on the Science Diet md dry food the vet initially recommended. Once we swapped him to the natural wet food it went to the green's. I can tell you that I've done a urine test and it came up fine, but the blood test painted a much more accurate record, and he needed an increase on his insulin. Bron has been a massive help to me as we are new to this as well, but your learning curve will be swift on this site as the people are very informed and helpful!!

 

Hi @alexi456 and welcome to FDMB.
I live in Sydney and am happy to help in any way I can.
Can you tell us your first name and also the name of your beautiful kitty.

Diabetic cats when they are first diagnosed have often lost weight. This is because they are not able to utilise all the nutrients in the food because of the high blood sugar. Once he becomes more regulated the hunger usually abates and he will start to put weight back on. This happened to my cat Sheba.....she got quite thin but went back to a normal weight.

There is a lot to learn with feline diabetes but it is a very manageable disease.
The biggest thing you can do to help your cat is to start home testing the blood sugar. The urine strips will only tell you what has been happening since he last did a wee and is not an accurate picture of the current blood sugar level.
I have got a very low level, or no sugar with the urine test strips and then tested the blood sugar and the blood test shows a high blood sugar level, because that is what is happened right at that moment, not several hours earlier. Does that make sense?
The meter I used is the Abbott Optium Neo. This is the product and can be bought at chemists
https://myfreestyle.com.au/products/freestyle-optium-neo-blood-glucose-ketone-monitoring-system/

Here are the test strips you need to go with them. If you buy them on eBay they are much cheaper. But the first time you may need to buy them from the chemist to make sure you are getting the right ones for the meter.
https://www.ebay.com.au/p/Abbott-Freestyle-Optium-Blood-Glucose-Test-Strips-100-No-Coding-Required/1729127665?iid=323311440786&chn=ps&ul_ref=https%3A%2F%2Frover.ebay.com%2Frover%2F1%2F705-139619-5960-0%2F2%3Fmpre%3Dhttps%253A%252F%252Fwww.ebay.com.au%252Fp%252FAbbott-Freestyle-Optium-Blood-Glucose-Test-Strips-100-No-Coding-Required%252F1729127665%253Fiid%253D323311440786%2526chn%253Dps%26itemid%3D323311440786%26targetid%3D309727335774%26device%3Dt%26adtype%3Dpla%26googleloc%3D9071650%26poi%3D%26campaignid%3D824379324%26adgroupid%3D43923390673%26rlsatarget%3Dpla-309727335774%26abcId%3D1123846%26merchantid%3D119146520%26gclid%3DEAIaIQobChMIxfyv8M3p2wIVwh2PCh34LAm1EAQYAiABEgKLK_D_BwE%26srcrot%3D705-139619-5960-0%26rvr_id%3D1575082143315%26rvr_ts%3D2c4364141640a9c41921cd8cfff20904
O
Whatever meter you decide on make sure that the test strips are not too expensive because they will be your biggest expense with FD. We use human meters but there is an animal meter called the Alphatrak but the test strips are twice the pric as the human meter test strips.

Here is a link to how to test the blood sugar on the cats ear. The first few times are stressful for you but it gets very easy and the cats don't mind at all. Always give them a small low carb treat after every test, even if you were not successful. Testing the blood is the only way to truely keep them safe. A lot of vets do not like you testing the cats blood but that is because they are not really up to date with all the current methods of treating feline diabetes.
http://www.felinediabetes.com/FDMB/threads/hometesting-links-and-tips.287/

A low carb wet /canned food under 10% carbs is best for diabetic cats. The dry Hills diabetic food is 15 or 16% and is too high. It has also only 7% moisture in it compared with 78% in canned foods. Cats need water, especially diabetic cats.
Here is a link to some of the suitable food available here is Australia.
http://www.felinediabetes.com/FDMB/...anned-food-suitable-for-diabetic-cats.134090/

CAUTION.....you need to be testing the blood sugar when you swap over to a low carb diet as you will find that the change of diet will effect the blood sugar and you could well have to lower the insulin dose.
Always have some honey in the house in case of very low blood sugars.
Here is a link to recognising hypos and how to treat them....but if you are testing the blood sugars you will always be in control.
http://www.felinediabetes.com/FDMB/threads/how-to-treat-hypos-they-can-kill-print-this-out.15887/

We recommend you only go up in 1/4 (0.25) unit increments of insulin because it is much safer for the cat and it ensures you will not go past the correct dose. Most vets go up in 1 unit increments but we think that is unsafe. Our first priority is to keep the cat safe. We base the increase or decrease of the insulin on the nadir ( the lowest point at which the insulin takes the blood sugar in a cycle) not the preshot. We always test before every shot to ensure it is safe to do so and then 4 to 6 hours later to see how low the insulin is taking the blood sugar.

If I were you the first thing I would do is get a glucose monitor and start testing the blood sugars....yell if you are having trouble....everyone is only to happy to help you get started.
Then I would set up a SS (spreadsheet) where you can write down all the blood sugar levels (BSLs). That way we can see how he is going and get an idea if he needs more or less insulin........too much insulin can look like not enough insulin.....so testing is the only way of finding out. Here is the link to setting up the SS. You will need to use the World SS. If you run into trouble we can help you set it up.
http://www.felinediabetes.com/FDMB/threads/fdmb-spreadsheet-instructions.130337/

Once you are testing the BSLs you can start to swap over fully to a low carb wet diet.
We can't give dosing advise without seeing some BSLs in the SS as it would not be safe but I would not increase the dose to 5 units until you are testing the BSL ...and even then it would be wise to only increase in 1/4 initial increments.

It is probably all overwhelming at the moment with so much information but it gets much better. @Tucker has only been here a few weeks and she is managing so well now she has all the things in place, and she is able to help others.

Please keep asking lots of questions. As Patty (Tuckers mum) said, it is a steep learning curve in the beginning. When you have time read all the yellow stickies at the top of the pages.

You might like to transfer over to the Lantus page next post, where everyone uses Lantus (glargine) or levemir and they post every day. They are very experienced and will be able to help and support you. Here is the link to the Lantus page
http://www.felinediabetes.com/FDMB/forums/lantus-glargine-levemir-detemir.9/

 

Thank you very much for the responses. We went out and purchased an accu check home testing unit today and will try and do our first test tonight before feeding and will update you with his levels. We tried the 5 units Friday night and Saturday morning but I believe it was possibly to high as he went very tired and lethargic on Saturday, so we skipped a dose as per vets instructions if he went like that and he has returned to normal behaviour today. Once we get the hang of the home testing unit we will try and transition him to a full wet diet as the MD dry seems to really upset his stomache and From what you have all said it is the correct way to go.
What kind of level should we be aiming for on the human testing unit? I’m a bit lost as to what is high, what’s low and what’s ideal.

 

The accu check meter is a good one and the test strips reasonably priced on eBay.
I would lower the dose from 5 units if you thought it was too much for him....at least until you are testing and can see what the dose is doing for him.
If you enter the BSLs into the SS it will make it much easier for everyone to see how he is going.
You need to test before every insulin shot to see it is safe to shoot. If you get a test below 11 (200) post, don't feed, and don't shoot, and ask for assistance. Once you get to know his BSLs better you will be able to shoot lower numbers but until you get data onto the SS, don't shoot below 11 (200)
Also get a test about 5 to 7 hours after the insulin shot to see how low the insulin is taking him.
The normal BSLs in a cat are 3 to 6.6. (50 to 120) but you could see numbers in the teens and up into the 20s to start with. Cats usually don't suddenly start getting normal numbers after starting insulin. It takes time.

 

We tried our first attempt at home testing and it was a fail we couldn’t get any blood after a few attempts and I was just wondering on what number/size people jab at we used the smallest size number 1 m. We will try again tomorrow morning and keep uodated

 

It is not uncommon to fail the first attempt. I did!
Don't worry you will get the hang of it.
Did you warm the ear first with some rice in a sock? And aim for the edge of the ear?
When you say what number, do you mean the numbers on the lancet device which you can adjust?
I found I had to turn it up a couple of numbers. Every cat is different so just try going up in the numbers.
After a couple of weeks the ears learn to bleed a lot more easily.
Well done for starting to test the BSLs.

 

I had a terrible time testing at home at first. I read somewhere (maybe here) to use a cotton ball. I put the cotton ball on the inside of his ear and prick on the outside. Might sound weird, but it really helps to get the prick. Since using it, he tends to not bruise and doesn't seem to mind it as much. I don't know what it is about that cotton ball, but it makes pricking so much easier. Hope that helps!

 

I found testing to be so hard in the beginning. Just when I thought I'd never get the hang of it, I suddenly did. Even a failed test is a successful effort. At least you tried, right? Be patient with yourself and reward him for every attempt at testing.

 

Thanks for the kind words of encouragement. We have had 3 attempts so far and his ears have had a few jabs each attempt but we can’t seem to get enough blood for a read. We’ve tried warming the ear with warm towels and rice in a sock and we are jabbing around the edge of the ear like shown, the ears are bleeding but not enough the register a result. We even tried the machine on ourselves to make sure it was working. Any other trick people could recommend?

 

Are you using a needle or the little device that the lancet goes in. I always found the lancet easier but others have found a needle easier. If you are using a lancet device, have you adjusted the depth of the lancet by changing the number on the side of it?
After you have warmed the ear, try 'milking' the ear by massaging it from the bottom to the top a few times before you prick the ear, then after you have pricked it, milk it again to get the blood up to the prick.
Don't give up, you will succeed!

 

If you're giving high amounts of insulin and you find your cat eating and drinking a lot, it could be a sign their dose is too high. Increased thirst and hunger are signs of hypoglycemia.

It will take quite a bit of practice to get blood testing down. I couldn't get regular readings for about two weeks after my cat was first diagnoses. I didn't know what I was doing and my cat didn't know what I was trying to do. But with repetition you'll get it down (just like with anything involving training animals).

You want to try to get three tests a day. One before each dose of insulin and one around the nadir, or lowest point your cat's BG will be after their shot. When this will be depends on what kind of insulin you're using. Only getting that number will tell you if your cat's BG is getting down to where it needs to be. I don't believe testing at the vet's office will offer an accurate look at your cat's BG because stress and anxiety will increase BG levels and vet visitis are usually stressful for most cats.

I've read that BG above 250 (roughly) on a human meter is when glucose begins to spill over into their urine which is what's going to cause problems. So you want your diabetic cat to be below 250 for the majority of the day. In the 100s is ideal, below 50 is dangerously low.

 

Woohoo we finally got our first home test result today it has taken Quite a few attempts but I feel like we are finally starting to get there. We got an 11.7 - 6 hours after giving him his 4 unit dose of glargine. So I’m guessing this is his low point currently? He has been on wet food and 4 units night and day for over a week now. I will start logging a spreadsheet as soon as I work out how to on my phone and if we get another successful test before his dose I’ll let you know how high he is going but Do you think it’s likely his dose will need to go up again? He is continuing to loose weight so I’m guessing 11.7 is still to high for his body to absorb food?

 

You need to download Google Chrome, Google Drive and Google Sheets from the play store first.

Until you get some more tests in, it's impossible to know. Too much insulin can look like too little!! 4U is a huge dose for such a small cat so early into this diagnosis!!!

If the dose is too high what happens is it drives his blood glucose too low and then his liver reacts to a life-threatening low by releasing stored sugars and hormones to get him back up quickly.

If he were my cat, I'd drastically reduce his dose and start getting more tests in to see how he's really doing. High numbers take a LONG time to do damage.....the low numbers kill quickly.

At 4.25kg, the starting dose for Glargine would be no more than 1U

 

Thanks for the info. He has been on insulin for a few months now we started at 1 unit and gradually have been going up with regular vet visits for blood tests and home testing using urine strips but we’ve only recently gone to home testing with a proper machine. We managed to get another test tonight and he was up to 25.3 12 hours after his morning dose. Will continue to monitor morning and night and will try and get his low point where possible. The vet wants him to come in for a day and check his curve to make sure he’s not doing the yo-yo effect you mentioned. Is there instructions anywhere for doing the spreadsheet on an iPhone?

 

There are more specific instructions for dealing with tablets/smartphones further down on the "FDMB spreadsheet instructions" page.

About 2/3rds down, look for "Instructions for Creating a SS from a tablet:"

 

i think i have finally managed to set up a spreadsheet can anyone confirm that it is working for me please?

 

It's working!!! Great job!!

But the dates are wrong.....it's July 2.....that's 2/7/2018, not 2/6/2018 (I still have trouble with the way other countries put their dates!!...LOL In the US, it's month/day/year, not day/month/year)

You have 30/5/2018 which is May 30th and 1/6/2018 which is June 1st