Introducing . . . Joe!

[WV Mom]

Joe, aka The Cat Who Thinks He's a Dog, was diagnosed with diabetes on Sunday when my daughter Lowee took him to the emergency vet because his energy was low, his eyes were dilated, and he was walking on his hocks. His bg was over 500. Ack! :shock:

I immediately started researching, found this message board, and told her to start testing his bg, switch from the bad dry food (Iam's Mature Adult, ~30% of kcals from carbs) to the good wet food (Friskies Classic Pate, ~10% of kcals from carbs). Which she did. Thank you, thank you, thank you for being here!!

On Tuesday, after seeing Joe's regular vet, she started him on Lantus. A couple of questions:

• Her vet prescribed 2 units twice a day. Start Low, Go Slow says this is reasonable for how high his bg was, but since she also switched him to lower-carb food, my daughter wondered if she might be starting him too high. Thoughts?
• His bg is still fluctuating wildly: 178 at 2 hrs pp last night, 192 at 5 hrs pp, and then 396 this morning, fasting. Is this normal as he adjusts to the insulin?

I know that absolutely everyone thinks their cat is the sweetest, bestest, and coolest, but Joe really is. He's way sweeter and cooler than my cat, Phoebe, and I threaten to catnap him all the time. :smile:

 

[BJM]

Welcome to FDMB.

Changing the diet may drop the glucose 100 mg/dL. Vet stress can elevate the glucose from 100 to 180 mg/dL. Insulin will handle what is left after those changes.

What is Joes's current weight?
What is Joes's ideal weight?
Take the lower weight.
Convert to kilograms (pounds / 2.2) if needed.
Multiply by 0.25.
Round down to the nearest 0.25 (we eyeball these on syringes)

That is the formula to estimate a starting Lantus dose.

 

[Deb & Wink]

You've got Joe (TCWTHAD) started on the right steps in this sugardance you are doing with him.

A starting dose of 2U is a bit high unless your kitty is very big. Most cats start at 1U based on the formula BJM gave you.

A food change first was good, especially since he had not been started on insulin yet. The Friskies pates are nice and low carb, inexpensive, available at many stores.

Yes, fluctuations are normal. Lantus takes 5-7 days to build up before you see the full effects of the dose.

How many days has Joe been on this 2U dose of Lantus?

Is your daughter able to test during the middle of the cycle, to find out when Joe's nadir or lowest BG (blood glucose) readings are? Usually that is in the +5 to +7 hour timeframe, but some cats nadir earlier, and some nadir later. ECID (Every Cat is Different)

 

[WV Mom]

Thank you for your replies! It's taken me this long to write again because my daughter had to board Joe for several days while she went to a wedding; so, for four whole days, we had no bg readings at all.

As it turns out, the 2U dose of Lantus the vet recommended was too high. Lowee hasn't been able to do a full 12-hour curve on him yet, but last Friday night she did do "fasting" (i.e., before feeding and dosing), 2 hr, 4 hr, and 6 hr, and 12 hr. The result was a beautiful -- NOT! -- Somogyi curve:

• 7pm: ~200
• 9pm: mid 100s
• 11pm: 90
• 1 am: 70
• 7 am: 350+

She's pulled back to 1U and is forcing herself to stay the course for a full week even though, right now, his readings are all quite high: ~250 to ~350. I *think* this is what's to be expected after such a rebound, but I need to go do some research. Maybe there are threads here about people's experiences with the Somogyi effect?

What a ride. But we're soooo glad to have other people to share it with. :YMHUG:

Hope everyone else's kitties are purrfect!

 

[Elizabeth and Bertie]

Hello, and welcome to FDMB!

Maybe there are threads here about people's experiences with the Somogyi effect?

You will find a lot of threads here that mention 'rebound' or what we more usually refer to as 'bouncing'. (We tend to use those terms rather than Somogyi.)
Bouncing is very common. We see it here a lot.

Bouncing happens when the blood glucose drops too low or too fast. "Too low" doesn't necessarily mean 'dangerously low'; it may simply be that the blood glucose has dropped lower than the cat has lately become accustomed to.
The cat's body responds to this perceived threat by putting glucose out into the system; and also sometimes counter-regulatory hormones, the purpose of which is to try to keep the blood glucose high. This can look like temporary insulin resistance and can sometimes take a few days to clear.

The data that you've given does look like a bounce. Joe dropped pretty low mid-cycle and I wouldn't be at all surprised if that gave his body a bit a fright. You may find that those numbers come back down a bit when the (probable) bounce clears.
As has been said above Lantus is a 'depot' insulin (some of it is stored in the body and released over time), so it can take a while to see the full effect of any given dose.

It would be great if you could enter your blood testing data into a spreadsheet that we use here. Then you can add the link to the 'signature' in your posts and anyone helping you will be able to see all the blood testing data at a glance. It's a very valuable tool that enables patterns to be spotted more easily. If you'd like help setting one up there are some smart techy people here who can help with that (sadly, I'm not one of them! :lol: )

Are you using Alphatrak or a 'human' meter?

Eliz

 

[WV Mom]

Human meter. She chose the Relion because the strips are less expensive.

I do plan on setting up a spreadsheet, just haven't figured out how yet. I've been studying other cats' and they're so, so helpful. Seeing a long list of dates gives me patience, and seeing how kitties progress gives me hope.

BTW, the bounce was worse than I posted. He went from 70 at PMPS+6 to 493 at AMPS. I was posting from memory. Bad idea. :-|

 

[Elizabeth and Bertie]

Human meter. She chose the Relion because the strips are less expensive.

Okey dokey.
Most of us use human meters for exactly that reason! ;-)

The only reason I asked which meter your daughter is using is because Alphatrak reads higher than human meters, and we know to make little mental adjustments if you're using the A'trak.

And that 493 does look like a bounce...
Don't worry about that. It's very 'early days'. You and your daughter (and Joe) are doing very well. :smile:

Eliz

 

[Squeaky and KT (GA)]

Welcome!

Yep, I'd say not only does Joe think he's a dog - he thinks he's a rubber ball too! I have bouncy boyz, especially my Dakota currently....we're still working to find his right dose. He flies down when the insulin starts working then Mr. Liver shows up and feeds him cake and ice cream... :roll: A bounce is the body's way of self-preservation from what Mr Liver thinks is too low or too steep of a drop. I'm very thankful you dropped it back to 1 unit.

BIG HUGS!

 

[WV Mom's Kid]

I'm extremely impatient and I want Joe to be controlled NOW, goshdarnit! Healthcare workers really are the worst patients.

The numbers Mom posted are exactly right, but the gist is there. He was 90 (PMPS + 4) then 70 (PMPS + 6) then 506 the next morning with an immediate retest of 486. He's been in the 300's (well, 1 reading of 460-something) since switching to 1 unit BID on Saturday. We are 4 hours into a 12 hour curve and his numbers have been:

AMPS: 369
+2: 322
+4: 308

More of this adventure to come. Stay tuned!

Lowee

 

[WV Mom]

I did it! Joe now has a spreadsheet, and the link is in my signature. :mrgreen:

Am I right that Start Low, Go Slow and Tight Regulation are simply different approaches to determine proper insulin dose? And the thing to do is pick one, learn it well, and follow it religiously?

How does one give a fraction of a unit? Just eyeball it?

 

[BJM]

I did it! Joe now has a spreadsheet, and the link is in my signature. :mrgreen:

Congratulations!

Am I right that Start Low, Go Slow and Tight Regulation are simply different approaches to determine proper insulin dose? And the thing to do is pick one, learn it well, and follow it religiously?

Yes. If you're impatient, and can do the testing, you'll want the Tight Regulation protocol. Otherwise go with SLGS.

How does one give a fraction of a unit? Just eyeball it?

You will need 3/10 mL syringes with half unit markings. If under 0.5 units, you eyeball it, or you lear the drop method. (Do a search from the upper right corner of the page; it'll pop up)