Intro to Snowball - Need feedback please

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Snowball's Mom

Snowball's Mom

Member Since 2013
Snowball - 14 years old
Lantus - 1U 2x/day

Snowball is a 14 year old cat who was posted online by a rescue needing somebody to foster him and his brother as the owners are being evicted. He was in bad shape. He was unable to walk because all of his claws in the front grew into his paws. He went to the rescue's vet and had his nails trimmed and paws bandaged. He was found to be diabetic and initially was thought to have a huge mass/cancer in his belly that is pressing on his colon. I was told that eventually he will just stop eating because his colon has been compressed against his spine. I volunteered to adopt him and his brother, knowing Snowball probably does not have long. (His brother who is 17 is in surprisingly good shape). Just wanted to make sure he has a few happy memories in his last months and to make the transition easier for his more nervous brother.

I got him to my vet and got an ultrasound done. It was found that he did not have a mass/cancer but massive fluid build-up in his belly from congestive heart failure, has an inflamed gall bladder, and an ascending infection to his kidneys. I have never been more relieved to hear congestive heart failure as the cause for his swollen belly. At least it is treatable and it is not a painful condition. He does not know he is sick though and he remains playful and affectionate. He's taken to following me around because I probably look like a vending machine to him. All he needs to do is let me rub and play with him a while and out comes the food :-D .

So, he ends up with 5 medications (2 antibiotics and 3 for his heart), insulin and antibiotic cream for his paws. Bought a pill organizer to keep it all straight, a timed feeder to make sure he has a steady amount of glucose throughout the day. Really afraid of the hypos rather than hypers. His Lantus was started a 4 days ago. I am planning on doing his curve next week. His glucose is hanging around at 18-22 (Sorry that's Canadian so 324-396). Lowest he has been is 8.3 (149) this morning before breakfast and I almost wanted to check with my vet if that was alright because he has always been very high.

I don' t really want to adjust his Lantus dosage yet because it hasn't been a week he is on it. I am afraid of treating him like my human patients. So I am fiddling around with his meals. Right now he has a schedule as below:
9AM - insulin + 1/2 can Hill's calorie control
1PM - 1/2 can
5PM - 1/4 can
9PM - Insulin + 1/2 can
12MN - 1/4 can

I would appreciate any suggestions on devising a good feeding schedule for him so I will get steadier numbers while I wait for the glucose curve and for my vet to decide whether to adjust doses.
 
Welcome to FDMB.

First, let me give you the following reference table:

Here are some glucose reference ranges used for decision making using glucometers. Human glucometer numbers are given first. Numbers in parentheses are for non-US meters. Numbers in curly braces are estimates for an AlphaTrak.

[Glucose reference ranges are unsubstantiated and have been removed by Moderator]
 
Second, suggestions for testing and feeding.

Always test before you shoot.
As a new insulin user, please don't shoot below 200 mg/dL (11.1 mmol/L)

Lantus hits its peak effect around +5 to +7 hours after the shot, then it starts waning.

Generally, feeding in the first third or half of the 12 hour cycle pumps in calories as the insulin take effect. Feeding much after that may raise the glucose more steeply.

Whenever possible, do not feed in the +10 to pre-shot period (the last 2 hours of the 12 hour period) to get an idea of the glucose level without the influence of food.

If your cat is a grazer, leave the food out and let him do that. It tends to keep the glucose levels a tad lower, rather than spiking because of a bigger meal.

If you cat is a scarfer, an automated feeder might be useful, or freeze half of the food to be nibbled as it thaws.
 
Just in case the kidneys are at all compromised, take a look at Tanya's Feline CRF web site. You may not need it, but there is a lot of good information there and worth sharing with anyone you know who has a kitty with renal disease.
 
Thanks for the info. Yup my cat is a scarfer and he has an automated feeder. I know his sugars look really high and I should be afraid of ketones and DKA. He was just at the vet 2 days ago with a reading of 29 (522) no ketones. When he was initially diagnosed a week ago he was at 38 (684) and again no ketones.
 
One of the things that we do to track the glucose levels is a spreadsheet in Google Docs (requires a free account), that is shared in read only mode. Instructions are here. You want the World Template to use, as it will automatically enter numbers on a 2nd page as mg/dL when you enter them on the primary page as mmol/L.
 
Maira said:
..I don' t really want to adjust his Lantus dosage yet because it hasn't been a week he is on it. I am afraid of treating him like my human patients. ....
Click to expand...

That is fine. It takes about 5 days on the first dose for it to stabilize, then about 3 days for any later dose adjustments.

Once you get a spreadsheet up and going, you may want to post in one of our Lantus forums - Tight Regulation or Relaxed - to get Lantus-specific feedback on how Snowball is doing.

The Tight Regulation protocol is based on a research study of diabetic cat owners using the Diabetes Katzen forum and Lantus. It has a pretty good success rate at getting cats off insulin, at least the ones with not too complex cases. My Spitzer had several other medical conditions that made using Lantus quite difficult.

The Relaxed forum is more for folks who can't test very often, or have unusal issues with the cat, or in at least 1 case (me) were consulting with someone who couldn't test herself due to severe arthritis and poor vision. He is now diet-controlled!
 
Hello and welcome to Snoball and his bean to the message board. What is your first name?

When you say you are feeding the Hill's calorie control canned food, is that the Hill's W/d prescription food or something else? I'm asking, because that may be higher carb then is best for a diabetic cat, and some lower carb options would be of great help to your kitty Snoball.
 
Thanks Deb. My name is Maira. Sorry, I just looked at his canned food and it's actually Royal Canin Medi-cal calorie control. I have attached the googledocs spreadsheet regarding his glucose levels the past 3 days. I really appreciate your suggestions.
 
That 149 pre-shot is a red flag to me, as he may have been much lower overnight. The unfamiliar glucose level could have triggered compensatory hormones to release stored glucose (glycogen), thus resulting in much higher numbers. We call this a "bounce". It is possible he needs to go down to 0.5 units for safety and now would be the time to do it, rather than holding the dose, as the stored glycogen can become exhausted and put him at risk for a hypoglycemic episode.

We typically suggest all new insulin users not to shoot below 11.1 (200 mg/dL) as a safety measure, until they have a few weeks of data, including mid-cycle between shots, to know how low the cat goes.

* * * * * * * * * * * * * * *​
Here are some glucose reference ranges used for decision making using glucometers. Human glucometer numbers are given first. Numbers in parentheses are for non-US meters. Numbers in curly braces are estimates for an AlphaTrak.

[Glucose reference ranges are unsubstantiated and have been removed by Moderator]


[c]* * * * * * * * * * * * * * *[/c]

How to use the glucose reference values chart:

When you get a test, look for the number on the chart that either equals, or contains, the test value you have. Read the information. As needed, make a decision and act.

Ex. You are a new insulin user and you test your cat before giving insulin. The test is 300. It probably is safe to give insulin.

Ex. You are an established user of Lantus, following the Tight Regulation protocol. You've tested around +5 to +7 to spot the nadir. It is 200 mg/dL. You probably need to increase the dose, following the instructions for the protocol.

Ex. Your cat is acting funny. The eyes are a bit dilated. You are concerned and test the glucose. The number is 35 mg/dL. ACK! The cat may be in a hypoglycemic state. You quickly follow the HYPO protocol linked in the glucose reference values chart. (which we really, really, suggest you print out and post on your refrigerator.)
 
BJM said:
That 149 pre-shot is a red flag to me, as he may have been much lower overnight. The unfamiliar glucose level could have triggered compensatory hormones to release stored glucose (glycogen), thus resulting in much higher numbers. We call this a "bounce". It is possible he needs to go down to 0.5 units for safety and now would be the time to do it, rather than holding the dose, as the stored glycogen can become exhausted and put him at risk for a hypoglycemic episode.
Click to expand...

Thanks BJM. That made me a little nervous too even though it is "normal". He is pretty new to insulin in general. I divided up his evening meal so that he gets 3/4 of the can at insulin shot and 1/4can at 3+. His glucose was a little better at AMPS today at 302. Or, not exactly better but more typical for him. I should also point out that he is on antibiotics for an ascending kidney infection and cholangitis (gallbladder inflammation) so it could be making his glucose reading wonky. He will be on these antibiotics for 1 month. Also on a water pill to make him pee a lot of excess fluids from his congestive heart failure.

Also a question. The 1U line on the U-100 syringe is really small. How do you get to 0.5 units if in case I do need to do it. I will check at around 3+ or 6+ this evening to see if he is still dipping low. I am hoping the adjusted food schedule was enough to prevent Somoygi.
 
There are syringes with half unit markings. Depending on your state, you may need a prescription to get these. (Ohio does not require an Rx.)

The other thing that will help is a good magnifier - Carson Clip and Flip work well if you have glassers. They make visor magnifiers, hand held, and stand magnifiers. Try Amazon.
 
Hi Maira! Thanks for introducing yourself.

One of the things you want to look for in an insulin syringe for a cat, is the capacity. This should be 3/10 cc, which makes the lines a tiny bit farther apart then in a 5/10 cc or 1cc insulin syringe. These smaller 3/10 cc insulin syringes were developed for human children, and we find them very useful for our tiny kitties.

I'm not sure if the specific food you are feeding is low carb or not. We use this food chart compiled by vet Dr. Lisa Pierson and look for foods that are <10% carb content by calories. (third column of numbers). I do know that that company Medi-cal was taken over by Royal Canin so that may be why it is not on the list.

I did find these 3 Royal Canin foods in the food chart. The Royal Canin Calorie control is 14% carbs, Royal Canin morsels in gravy is 25% carbs, Royal Canin high fiber is 29% carbs. They are all higher in carbs then we like to see. Many cats can become diet controlled with a switch to a low carb food, <10% carbs, and a short course of insulin to help heal the pancreas.

Basically, no grains, vegetables or fruits need to be in cat foods in order for our cats to get a balanced diet.

My foster cat Wink was on the high carb foods, and once I switched him to low carb Fancy Feast pates and Friskies pates, his BG (blood glucose) levels dropped dramatically and he became a diet controlled diabetic cat.

We definitely want you to be home testing before you change the food, since the BG levels in cats can drop 100 points mg/dL (5.5 points mmoL) when you switch to a low/lower carb food option. Something for you to think about to help Snowball.

Do you live in Canada? or the US?
 
Thanks Deb. Funny how I thought to introduce Snowball and not myself. I am Canadian...hence the funny numbers :smile: I looked at Royal Canin site and couldn't find how much carbs there are. This is the nutritional info:

Approximately 100 kcal/can, 165 g/can
Analysis table - Amount
Crude Protein (g/1000 kcal) - 141.8
Crude Fat (g/1000 kcal) - 34.6
Crude Fibre (g/1000 kcal) - 16.5
EPA/DHA (g/1000 kcal) - 0.5

Minerals Amount
Calcium (g/1000 kcal) - 3.0
Phosphorus (g/1000 kcal) - 2.8
Magnesium (g/1000 kcal) - 0.2
Sodium (g/1000 kcal) - 1.6
Potassium (g/1000 kcal) - 2.8

Other nutrients Amount
Taurine (g/1000 kcal) 1.6
 
Yes, introducing the cat and then forgetting to introduce the bean (our slang for human being) is pretty common here. :lol: :lol: :lol:

I do see where in your first post you had those low numbers and mentioned those were Canadian. Missed that. ohmygod_smile

One thing that be can be very useful to those of us answering your posts, is to have some information in your signature. If you look at the end of my posts, you'll see a bunch of little tidbits of data like my name, cats name age sex, my civies (non-diabetic cats) names, Wink's diagnosis date, insulin used, meter used for testing, food fed. Having those little bits of data helps to give us a quick snapshot of your cat and helps us to help you better.

At the top of the page is the user control panel. Then select the profile tab, then select edit profile and update the location to let us know where you live. Country, state/province, closest city or general area are nice to see. Then select the edit signature part and put the tidbits of data in there and submit to save. Totally optional to do this, but it really does help us.
 
Hello there from a fellow Canadian

I think I can help a bit here

1. What syringes are you using? The BD ultra fine ii 3/10cc syringes (purple marked box) have half unit markings which help you see whats going on

2. You really want a low carb wet - many cats on low carb wet go into remission within 6 months - another reason why home testing is so important as it can then become easy to overdose the insulin. However when we say low carb we mean % calories from carbs as fed under 10%. And unfortunately all the pet food manufacturers provide is "minimums" - usually from dry matter - which is not useful at all. So you can't tell from the can. However a well respected US diabetic at vet called them and worked with many of them to actually work out the true % carbs - and thats whats in the chart Deb provided. Saying that many of us here feed the fancy feast pates, Friskies pates or wellness grain free canned - for price as much as anything!

3. What meter are you using? You want to watch out for the "lite" "true" or anything with a butterfly strip. They tend to seriously underestimate the blood sugar when the cat is over 11 or so. (200 US numbers). Many of our neighbours use the Relion brand from Walmart in the US which is good and cheap if you are close to the border ( they don't sell it in walmart here). otherwise the bayer contour is good as you can get strips cheap on ebay for like $40 including shipping for 100.

Wendy
 
Thanks Deb. I took your advice as you can see in my signature :-D

Submitted my numbers to my vet and he said increase morning to 1.5units. I will see the difference tomorrow since I am planning on doing a curve anyway. Snowball does not appreciate it. All he knows is he just got adopted and since then, moved into a strange house and suddenly his ears and his flanks are getting poked. He is not sure if the better food is worth all of this. cat(2)_steam. Plus there's all these other strange cats here and they are not exactly very friendly...which is probably why he's choosing to hole up in the basement. I don't blame him.

Was at Shoppers and Walmart today Wendy. Didn't see the half unit syringes. After reading your post, I actually did look at those syringes and rejected them because I didn't see half markings. It went all the way up to 100u instead of 50 though so does that mean if I am doing 1.5 units, I just go to 3 lines? I was afraid that meant 3 units so I didn't buy them. I think I am able to make out the space between 1 and 2 on my current syringes which is Terumo U-100 and I will make do for now. I am actually using insulinx with the butterfly strip. My vet appreciates the PDF file that it generates. I am familiar with the complaint regarding insulinx before and I believe they have resolved that. I will double check tomorrow with a different meter though to make sure.
 
The U-100 syringes you may want are labeled across the long lower edge of the box, on the side that opens as well as the top of the box:
- on the left, CAPACITY: 3/10 cc (or 3/10 mL - same thing)
- in the center, GAUGE: 30 (thin)
- on the right, LENGTH: short (8mm or 5/16")

And in the upper right corner of that side or the top, have this NDC (a national drug/product code, issued the federal government) code at WalMart: 81161-0311-72
 
Next time you are at walmart or shoppers get the BD Ultrafine ii syringes - the box even says half unit markings on them on it ( in white writing on the bottom of the purple oval on the left). Heres what it looks like:
BDsyringe.jpg


You will have to ask at the pharmacy section - sometimes they can run out too as they are popular.

Wendy
 
I am back after a busy holiday season. Thanks for all the feedback. They were very useful

My vet and I have been working on Snowball over the holidays. He is now up to 3uBID. On a hunch I divided the doses (as you can see on my spreadsheet) because it seems Snowball is metabolizing Lantus too quickly and doesn't last until his 12+. The vet seems surprised at my strategy but he couldn't deny it was leveling him off instead of getting the rapid up and downs. He may still need more lantus though. We'll see after my vet gets today's curve. Seems to be working but I would welcome an alternative. I am basically waking up 3h before leaving for work so he can get lantus 2h apart and rushing home at the end of the day and trying to stay awake to do the same. I will sustain it if needed but if there is a better way I will try it. Every 8h injection would be less injections for him but doesn't really work with my schedule and I can't get anybody else in the house to do them.

Thanks!
 
Snowball's Mom said:
...He is now up to 3uBID. On a hunch I divided the doses (as you can see on my spreadsheet) because it seems Snowball is metabolizing Lantus too quickly and doesn't last until his 12+. The vet seems surprised at my strategy but he couldn't deny it was leveling him off instead of getting the rapid up and downs. He may still need more Lantus though. We'll see after my vet gets today's curve. Seems to be working but I would welcome an alternative. I am basically waking up 3h before leaving for work so he can get lantus 2h apart and rushing home at the end of the day and trying to stay awake to do the same. I will sustain it if needed but if there is a better way I will try it. Every 8h injection would be less injections for him but doesn't really work with my schedule and I can't get anybody else in the house to do them....
Click to expand...

We call that split dosing. Several folks have used it for specific issues. It must be done very carefully and consistently and any changes need to be monitored closely.

Always do the same times, 12 hours apart - ex am and am +2 and pm and pm +2.
If the doses are not equal, always give them in the same order, ex large first, booster 2nd.
That gives you
AM - 2 units
am+2 - 1 unit
PM - 2 units
PM+2 - 1 unit

For a Think Tank discussion on Split Dosing go here

Another insulin alternative is Levemir. It tends to last longer than Lantus.
 
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