I am new and in need of opinions

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iBkoryD

iBkoryD

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Hello folks!

My name is Kory and I am in Denver Colorado. I have a cat named Smokey that is 10 and was over weight. He lost a lot of weight and had a bad upper respiratory disease and after getting him out of the vet they diagnosed with diabetes.

The vet put him on 2.5 units of Lantus twice a day. He was doing well for 7 days then yesterday morning he vomited once, would not eat and could barley stand or walk. I took him in to the vet and they monitored him for the day and got him eating. They really had no clue what was wrong with him and thought maybe it was pancreatitis. One thing they did do is lower his units to 1 in the am and 1 in the pm.

I don't think my vet is very knowledgeable when it comes to feline diabetes so here I am. I did some online research and am wondering if he possibly was hit by the somogyi effect?

When I brought him in his BG was 70 and I have no clue what it was prior to that because I was not doing home BG testing.. I am now though.

Yesterday before dinner his BG was 158 and an hour after dinner he was at 121. He is now on 1 unit in the am and 1 unit in the pm.
Today before breakfast his BG was 128 and an hour after breakfast he was at 106.

I guess I am wondering what you folks think caused his issue? I am also curious what your opinions are of his BG numbers yesterday and today so far?

Any comments or suggestions I would really appreciate!
 
Hi and welcome!... I am on my phone so short answer... his numbers look very good. Glad your vet reduced his dose
I am thinking it was way too high on numbers that low and that the problem he had was due to being hypoglycemic. His BG probably went too low due to too much insulin. I'll be back later.

Carl
 
Hi from Colorado Springs!

So glad you are hometesting! The numbers you are getting are normal or near normal. We consider a kitty off insulin to be normal from 40 - 120. And if he goes down after eating, it means his pancreas is working. So great news all around.

I would continue to monitor his levels. We generally tell new diabetics not to shoot under 200 at all.

Not sure about the diagnosis. Did the vet do a fructosamine test or just the blood test in the office?
 
hello and welcome!

first, i'd bet what you saw yesterday was hypoglycemia. the symptoms you describe are classic low blood glucose and the fact that the vet dropped his dose down indicates it to me too. good thing you got him to the vet.

now, as far as the numbers you are getting, those are awesome numbers already, just barely abnormal one or two of them sooooooo, i'd actually be hesitant to be shooting insulin at this point with those numbers so let's see what you are feeding. maybe tweeking the food a little to lower carb will be enough and kitty will go into remission. can you tell us what brand and flavor of food you feed and if it's dry or wet?

i'm almost sure we have other members in your area. would you like to know and/or get some input on other vets in the area if you feel the need for a new vet?
 
Sue and Oliver (GA) said:
Hi from Colorado Springs!

So glad you are hometesting! The numbers you are getting are normal or near normal. We consider a kitty off insulin to be normal from 40 - 120. And if he goes down after eating, it means his pancreas is working. So great news all around.

I would continue to monitor his levels. We generally tell new diabetics not to shoot under 200 at all.

Not sure about the diagnosis. Did the vet do a fructosamine test or just the blood test in the office?
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I saw on the FAQ that this site suggests not to shoot under 200 at all like you said. Why is that? My vet tells me to give him insulin then I read on this site not to shoot if its under 200. I have no clue what to think or believe. I am not suggesting that you or this site is wrong but what does a new diabetic do when he has different information?

All they did was a blood test in the office.
 
Short answer
People on this site know collectively more than your, or any regular vet. Shooting under 200 without the data to know it is safe can kill a cat.
Carl
 
Cindy + Mousie said:
hello and welcome!

first, i'd bet what you saw yesterday was hypoglycemia. the symptoms you describe are classic low blood glucose and the fact that the vet dropped his dose down indicates it to me too. good thing you got him to the vet.

now, as far as the numbers you are getting, those are awesome numbers already, just barely abnormal one or two of them sooooooo, i'd actually be hesitant to be shooting insulin at this point with those numbers so let's see what you are feeding. maybe tweeking the food a little to lower carb will be enough and kitty will go into remission. can you tell us what brand and flavor of food you feed and if it's dry or wet?

i'm almost sure we have other members in your area. would you like to know and/or get some input on other vets in the area if you feel the need for a new vet?
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I feed him hills science diet C/D wet food. I feed him this because he has issues with crystals in his urine. I took him off for a year and it clogged up his urethra. He only gets wet food because for some odd reason he wont eat hard food now after his vet visits. I feed him one-one and a half cans a day.

I am going to stick with my current vet for now because I have spent $1900 on him in the last two weeks and they have been lowering prices on services because I have spent so much. If I can get his diabetes regulated or if it goes into remission and he is healthy and a vet is needed in the future I will switch.
 
they educate themselves is what they do.

read, ask questions, and read some more.

i will tell you that there are hundreds of members on this board and other boards like it that have lived with feline diabetes day in and day out for years who have seen nearly every scenario possible so the info here is not fly by night info and is more real world experience than most vets ever see.

it is often said to not shoot insulin if the cat's BG levels are under 200 because we value safety. it's more critical to be careful in the beginning while you are learning about this disease and how your cat is going to handle/process the insulin. down the road as you learn how your cat reacts to insulin, the shot threshold can be raised or lowered. for instance, i do shoot insulin when my cat tests at 150 or so but i've been doing this for over 5 years now and know what she can and cannot handle.

yesterday, when your cat could barely walk, if it was hypoglycemia, they were moments away from having seizures and/or going into a coma. shooting insulin into a cat with numbers like 126 causes that and worse. you can always add more insulin but you cannot take it out of the cat if they start to go into hypoglycemic shock.
 
Cindy + Mousie said:
they educate themselves is what they do.

read, ask questions, and read some more.

i will tell you that there are hundreds of members on this board and other boards like it that have lived with feline diabetes day in and day out for years who have seen nearly every scenario possible so the info here is not fly by night info and is more real world experience than most vets ever see.

it is often said to not shoot insulin if the cat's BG levels are under 200 because we value safety. it's more critical to be careful in the beginning while you are learning about this disease and how your cat is going to handle/process the insulin. down the road as you learn how your cat reacts to insulin, the shot threshold can be raised or lowered. for instance, i do shoot insulin when my cat tests at 150 or so but i've been doing this for over 5 years now and know what she can and cannot handle.

yesterday, when your cat could barely walk, if it was hypoglycemia, they were moments away from having seizures and/or going into a coma. shooting insulin into a cat with numbers like 126 causes that and worse. you can always add more insulin but you cannot take it out of the cat if they start to go into hypoglycemic shock.
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Makes sense. I was not trying to suggest you or this site does not know what they are talking about and I am sorry if it came across that way.

At what constant BG level does damage start to occur to organs? I read anything above 130 can cause long term issues in kittys? If this is the case then I would assume not shooting under 200 could cause damage after time?
 
A normal cat off insulin can run from 40 -120 with most of the time spent in double digits. We consider a cat well regulated if they run around 200+ at preshot and 100 or below at mid cycle, on insulin. Not shooting under 200 is a baseline for new diabetics because you don't know yet how your cat will react to insulin. Once you have tested over a week or more, you have some numbers and can start to think about predicting what might happen if you would shoot at lower numbers and what dose you should consider at that number.

We are proponents of the start low and go slow approach. Start with a low dose of insulin and increase slowly as you get numbers.
 
130 is not bad. There's a point, called the "renal threshold", which I believe is 300, where damage can be caused to other organs.

After you have done this for a while, like Cindy said, you can shoot under 200 because you'll know how kitty will react to a certain dose of insulin.
2.5 is a very high starting dose. You were very lucky to catch how he was doing when you brought him in. 1u is the "standard" starting dose, so anytime someone comes here at the start of treatment, and says that the vet started kitty any higher than 1u, unless there are specific other complications that would make a higher dose logical, that usually "clues us in" that maybe the vet isn't all that versed on feline diabetes.
I wasn't trying, and hope I didn't seem, to be rude with my earlier answers. I was typing with one not so accurate finger on a keyboard I can barely see to type on! Now I'm at a PC so I can be a little more thorough.

Welcome to the board. You will be so happy you found this place in the days to come!
Carl
 
oh no, no offense or anything. i just share that because people do get a lot of differing input from their vet and when one is new to this disease, or anything really, what are you supposed to think. knowing there are so many out there with experience helps.

most kitties are diagnosed with numbers well over 300-400 and are there for many many weeks or even months actually. i can't tell you specifically at what point damage to other organs occurs but i can say that i can't think of one kitty right now i've seen who suffered organ damage from their glucose numbers being high whereas i can think of a few who have lost their eyesight, have chronic seizures, and even completely dead pancreas' due to too low of numbers.
 
carlinsc said:
130 is not bad. There's a point, called the "renal threshold", which I believe is 300, where damage can be caused to other organs.

After you have done this for a while, like Cindy said, you can shoot under 200 because you'll know how kitty will react to a certain dose of insulin.
2.5 is a very high starting dose. You were very lucky to catch how he was doing when you brought him in. 1u is the "standard" starting dose, so anytime someone comes here at the start of treatment, and says that the vet started kitty any higher than 1u, unless there are specific other complications that would make a higher dose logical, that usually "clues us in" that maybe the vet isn't all that versed on feline diabetes.
I wasn't trying, and hope I didn't seem, to be rude with my earlier answers. I was typing with one not so accurate finger on a keyboard I can barely see to type on! Now I'm at a PC so I can be a little more thorough.

Welcome to the board. You will be so happy you found this place in the days to come!
Carl
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Carl, I said that my vent does not seem to know what they are doing because of this site and all the information I had seen on it. One being dont shoot under 200 and two being this site says in many places to start at 1u morning and night and my vet started me off at 2.5 morning and night.

I did not find you rude Carl no worries! I am already so happy I found this place. :)
 
So here is a question for everyone. Lets say my kitty is always around 140-200. Do I just stop shooting all together? Or do I keep at it trying to get it closer to the 60-120 normal range?
 
Cindy + Mousie said:
oh no, no offense or anything. i just share that because people do get a lot of differing input from their vet and when one is new to this disease, or anything really, what are you supposed to think. knowing there are so many out there with experience helps.

most kitties are diagnosed with numbers well over 300-400 and are there for many many weeks or even months actually. i can't tell you specifically at what point damage to other organs occurs but i can say that i can't think of one kitty right now i've seen who suffered organ damage from their glucose numbers being high whereas i can think of a few who have lost their eyesight, have chronic seizures, and even completely dead pancreas' due to too low of numbers.
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Thanks for the information. How sad :(
 
To be fair, we live and breathe feline diabetes and probably advise 6-10 new "patients" every day. Vets have to treat many species and lots of different diseases. Few are diabetes specialists. Most get a workshop in vet school on feline diabetes. You would be surprised how many patients have gone back to their vet with a well regulated cat and lots of information to share. And often, vets listen and appreciate it.

We would suggest getting the data first. Then you can work on the dose.

We have all kind of obnoxious sayings. One is that this sugar dance is a marathon, not a sprint.
 
Sue and Oliver (GA) said:
To be fair, we live and breathe feline diabetes and probably advise 6-10 new "patients" every day. Vets have to treat many species and lots of different diseases. Few are diabetes specialists. Most get a workshop in vet school on feline diabetes. You would be surprised how many patients have gone back to their vet with a well regulated cat and lots of information to share. And often, vets listen and appreciate it.

We would suggest getting the data first. Then you can work on the dose.

We have all kind of obnoxious sayings. One is that this sugar dance is a marathon, not a sprint.
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Thanks for the info!

So for fun just as an example. Lets say for 7 days I test and he is at 180 before eating and an hour later he is at 150 and it stays within a - or + 5 for 7 days what what would you all suggest would be a proper amount of insulin to give?
 
Kory,
No, you would try to treat those numbers and get to the "normal" range. That's where the fact that we have a forum for each of the major insulin groups comes in handy. There is a special forum for Lantus users, and that is where you can get the best and most expert advice for the type of insulin you are using.
Everybody comes to this forum first, because well, that's where new people are supposed to post first! There are certain things that everybody needs to hear at first. In your case, you already know most of the "starter" things, like home testing is a must in order to safely manage diabetes, low-carb food is the best diet, shooting two times a day, 12 hours apart is how you should dose, testing for ketones in urine is very important....
You're already on board with most of that. That's actually out of the ordinary as far as "newbies" goes.

So, in order to find out the best and safest ways to manage things from here, stop by the Lantus forum, and there are a lot of "sticky" threads there for you to read, that tell you more about lantus and how it works, and how to regulate, and all sort of stuff. I used PZI, so I can't really help much with the specifics of lantus' protocol.

So far, you're actually doing great, and are pretty far along the "learning curve" on diabetes!

Carl


edit - I was refering to your earlier question on shooting under 200 ....should have quoted it.
 
Hi Kory, and welcome to FDMB. This is the best place you never wanted to be! Carl asked me to stop by since I tend to spend most of my time on the Lantus board.

I want to tweek the information that you've been getting. We tell people not to shoot below 200 when they are still new to managing feline diabetes and do not have a great deal of test data for their cat. As you collect more data, it will be safer for you to shoot progressively lower numbers. In fact, if you opt to follow the Lantus/Levemir Tight Regulation Protocol, your goal will be to shoot low numbers. This protocol has been published in a leading veterinary journal and it is the dosing method that we typically use on the Lantus board.

Many vets are more familiar with shorter acting types of insulin. The pharmacology of Lantus is very different and, as a result, the dosing strategy is very different.

Is C/D the only food that Smokey can eat without risking the development of crystals? I'm asking because it's 22% carb. That's very high in carbs. Most of us feed under 10% carb. In fact, I would say that the majority of people here feed under 7% carb. Moving to a canned food diet -- any canned food -- will have done a great to resolve the problem with crystals than you realize. Adding water to that food will also be of enormous help. This link to a website on feline nutrition is authored by a vet and has an excellent section on urinary track problems.

There is a great deal of information in the starred, sticky notes on the Lantus board. Below is an overview and links to information you may find helpful.
  • Tight Regulation Protocol: This sticky contains the dosing protocol that we use here. There are also links to the more formal versions -- the Tilly Protocol developed by the counterpart of this group in Germany and the Queensland/Rand protocol developed by Jacqui Rand, DVM and published in one of the top vet journals.
  • New to the Group: Everything you wanted to know about this forum and more. Info on our slang, FAQs, links to sites on feline nutrition and to food charts containing carb counts, how to do a curve and the components to look for, important aspects of diabetes such as ketones, DKA, and neuropathy, and most important, info on hypoglycemia.
  • Handling Lantus: how to get the maximum use from your insulin and what to not do with it!
  • Lantus depot/shed: This is an important concept for understanding how Lantus works.
  • Lantus & Levemir: Shooting & Handling Low Numbers: What data you need in order to be able to work toward remission or tight regulation as well as information if you have a low pre-shot number or a drop into low numbers during the cycle.

Please let us know how we can help.
 
iBkoryD said:
So here is a question for everyone. Lets say my kitty is always around 140-200. Do I just stop shooting all together? Or do I keep at it trying to get it closer to the 60-120 normal range?
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i would say you would keep shooting, just less insulin. it's possible to shoot less than 1 unit for instance. some use syringes that have half unit markings, some just eyeball it. for instance, my cat gets 1/2 a unit twice a day. some cats even get a drop of insulin is all. soooo, if kitty stays in the 140-200 range, you'd want it lower, you just have to figure out how much insulin is needed to get there. thus the importance of testing kitty at home. the more you can test in the beginning, the easier it is to figure out how much insulin is best for kitty so maybe see what the 1 unit twice a day does for your kitty in the coming days, or talk to the lantus forum and see if they think you should start at even less than that, log your data, and go from there.

agree with Sienne about the food. with the numbers you're getting i'd bet a lower carb food would put kitty into remission. but, having had a cat that tended to block, i can see not wanting to mess with that. my kitty was on the dry cd though for his blockages. he did end up blocking one more time on it about the same time my Mousie was diagnosed with diabetes so he was switched to the same low carb wet foods as her and he didn't have any more blockage problems. with yours on wet already i'm not sure what to tell you in regards to that. maybe see if Dr. Lisa Pierson has any info that will help with that on her catinfo.org site as she's the nutrition expert in these parts
 
Many newly diagnosed diabetic cats have Blood sugar readys between 400 - 600.

Since your kitty after one week is already below 200, you are very lucky and may only need to give insulin for a short period of time.

It is NORMAL for blood sugar to go down after eating for a NORMAL cat, because eating stimulates the pancreas to make insulin.

In many of the diabetic cats here, eating will just make the blood sugar go UP, because their pancreas isn't making enough insulin. These cats will need some insulin every day for life. My Tiggy is in this group -- he doesn't need very much, but he needs his insulin every day. (currently well controlled on 0.5u BID Levemir)

Home testing blood sugar will help a lot in getting your kitty healthy again.

Tiggy has been diabetic for 7 years, and he is a happy, healthy and playful 12 yo. (we adopted him through DCIN in 2009 after our first diabetic cat passed away from cancer).
 
Thank you all for the great information. Also thank you for taking your time to answer my questions and lending your help I really appreciate it.
 
Sienne and Gabby said:
Is C/D the only food that Smokey can eat without risking the development of crystals? I'm asking because it's 22% carb. That's very high in carbs. Most of us feed under 10% carb. In fact, I would say that the majority of people here feed under 7% carb. Moving to a canned food diet -- any canned food -- will have done a great to resolve the problem with crystals than you realize. Adding water to that food will also be of enormous help. This link to a website on feline nutrition is authored by a vet and has an excellent section on urinary track problems.
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That is a very good question that I do not know the answer to but can spend some time researching it.

Is there anyone on this board that uses anywhere close to a 22% carb diet but still can keep their kittys BG in the normal levels?
 
I feed him hills science diet C/D wet food. I feed him this because he has issues with crystals in his urine. I took him off for a year and it clogged up his urethra. He only gets wet food because for some odd reason he wont eat hard food now after his vet visits. I feed him one-one and a half cans a day.
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This is the 22% food, right? There has to be a better option..... In that link that Sienne gave you to Dr. Lisa's urinary tract info page, she specifically mentions c/d, but I didn't see a different option named (yet).
Anyone know what it is that makes c/d "good" for UT problems. Is it high or low in something specific like phosphorus or ash or something?

I'm not aware of a member who has said that their sugarcat is on a diet with a carb value that high. I know there are members who have to feed a specific type of food due to UT problems. Maybe start another thread with "Need help - best diet for kitty with urinary crystal history"? That would get the attention of those who have had to deal with the issue.

Carl
 
Lisa Pierson, DVM who is the author of the website that i linked, does provide consultation. If you are looking for alternatives to C/D, she may be a good person to get in touch with. I don't think her consultations are inexpensive but from what others have said, her knowledge is invaluable.
 
You are getting pretty good #s for 22% carbed food.

The "never shoot under 200" has always confused me too. In my first time around here, we never once tested over 200 after finding the board (in fact, we didn't have many diabetic numbers), yet we came off the insulin in a proper step down following protocol. (Sienne about kicked my butt when I cut a cycle short a dose or two on vet's advice :twisted: ) It is a newbie guideline when things are crazy and the doser doesn't have a pattern on the cat. Usually it is kind of a "hold up, let's figure things out" number, but 200 is definitely a diabetic number and should receive insulin once you have the kitty figured out. I highly recommend the ISG groups where protocols are followed and the dosing eyes hang out more and you can have a regular posting and help from people who get to know your cat.
 
I am fairly new, so can't advise. However, I am feeding Royal Canin Diabetic dry food at the moment, which I believe is at least 23% carbs, and my cat is doing well so far, if that gives you some hope!
 
Alright, I am back with more questions. :)

If I switch from my current food which is 22% carbs to something lower around 7-10% would you guys suggest testing the BG for a couple days off insulin to see where he is at? With my current numbers being so low already I wonder if changing his diet to something with less carbs would put him in to a normal range.

If i do change diets and add a bit of water is there a chance I won't have to worry about crystals in his urine in the future?
 
Thank you, I am new too and your post has been very helpful for me. Could someone help me to convert your levels as we obviously have a different measurement system in Australia, e.g my little lion had a bsl of over 30 which was apparently too high for the glucometer to read. You guys are saying that 200 is not too bad.
Thanks mel
 
Mel&fatty said:
Thank you, I am new too and your post has been very helpful for me. Could someone help me to convert your levels as we obviously have a different measurement system in Australia, e.g my little lion had a bsl of over 30 which was apparently too high for the glucometer to read. You guys are saying that 200 is not too bad.
Thanks mel
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I believe the conversion factor is 18. One reading is mg/dl, the other is in mmol/L. Divide the higher scale by 18 to get the lower numbers you're used to, or multiply your numbers by 18 to get the numbers we're used to. Your 30 is a 540 on the American scale. The 200 "don't shoot" number is equivalent to an 11.1.
 
iBkoryD said:
Alright, I am back with more questions. :)

If I switch from my current food which is 22% carbs to something lower around 7-10% would you guys suggest testing the BG for a couple days off insulin to see where he is at? With my current numbers being so low already I wonder if changing his diet to something with less carbs would put him in to a normal range.
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switching to lower carb food will definitelty make a difference and sometimes a change in food is all that is needed. my kitty had similar numbers to yours when she was first diagnosed and when i switched her from dry food to a wet food with about 4-5% carbs, she did begin to go lower on her own.

it would be a wise move to continue to test his BG during the switch to see how he reacts to the food alone without any insulin. i waited about 2 weeks after the food switch before i started giving my kitty insulin, cos even tho she was going down on her own, it wasnt low enough, and testing told me that. however she was only on insulin for a week, which must have been long enough to give her pancreas a little jump start before it was effective enough on its own
 
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