Introducing Julia

[Elizalphabeta]

Hello - I've visited this site before but this is my first message - I wanted to share first of all my thanks for the immensity of this resource. Julia is not my first diabetic cat, but she is proving more complicated than my last. She is 19 years old, has IBD and pancreatitis, she's been taking steroids consistently for about 3 years. Her hydrolyzed dry food diet was the only thing she could tolerate - that's over now! Onto the DM! She received Celencia for joint pain roughly 3 months ago - which triggered a cascade of revelations - with pain relief came a return of constant purring, which then revealed a breathing issue - she has asthma! With wildfire smoke, it got quite bad - which upped the dosage of her oral steroid medication to prioritize her breathing - that seemed to kick diabetes into full gear. (I knew it might be coming - especially as her son, who also had IBD - was never treated with steroids as his pancreatitis never got too bad and he was always a cookie monster with little to no threat of him ever stopping eating- he was put on the hydrolyzed dry diet - which after a time seemed to push his prediabetic nature over the edge. When he became fully diabetic - over a three-month period, ultimately was cured by one this miraculous Royal Canin VR Select Protein food and he went into remission quite quickly...then the pandemic stopped the food supply chain, and other foods brought back all the original issues, and then a whole lot of other complications happened, and he didn't survive.) Was very sad - yet - Julia survived him and she is like the energizer bunny who has easily used up more than half of her nine lives over the past 19 years - the stories! She is a late-in-life "adventure cat" (after her son died I prioritized quality of life and got her just out there living life) who now even goes on field trips to the beach and the park and meets all the dogs - she loves it and she's a hoot - but all these recent challenges with her new diabetes are quite considerable - especially as I have to maintain a fairly high steroid dose PLUS I'm supposed to have introduced 2x daily steriod puffers...(I haven't had the capacity to start her on that with all the rest of everything but will get a tutorial soon to boost my confidence) I thought I'd have to put her down twice in the past months - after a very bad 2-week pancreatitis bout while trying to continue to give her insulin - just wild - and managed to switch her after a lot of home cooking adventures and appetite stimulants and brupenorphine- and then followed by total gasping breathing attacks at 5 am - with wobbly neuropathy and movement issues...but then she just keeps bouncing back, looking so pleased with herself and wanting to go outside and meet up with her puppy friends in the park. She's hard to keep up with - and so I'm really digging deep right now with your resources - as much as I can - and thanks to you filling my brain with all this advice while following my vet's instructions (even tho sometimes her BG just seems too low for me and I back off - he wants me to be aggressive - he seems to trust me - but it's hard to always feel confident - especially with her reluctance to eat bc of pancreatitis and when she can't catch her breath, and when I do actually have to go to work sometimes!! What a wild adventure. So - thank you in advance for your help with any questions I bring and thanks again for the wealth of knowledge you have all developed and shared here! Bless - all of you - Love Julia and Liz

 

[Ale & Bobo & Minnie (GA)]

Hi Julia and Liz,

Julia is adorable and what a character! I can picture everything you described

can you tell us what insulin she’s on and what dose? Minnie also had IBD and asthma. The inhaler is not as difficult as it would seem at first. I started getting her used to me just holding it over her nose and mourn without any medication at first and I always rewarded her with a low carb treat afterwards like I did with home testing. She got used to it pretty fast. Cats are amazing that way!

Here is a helping us to help you link. If you noticed, our members have some basic information about their cat's in their signature. This helps us to not pester you by asking the same questions (your cat's name, insulin type, date of diagnosis, etc.) repeatedly. We also have a link to our spreadsheet in our signature. We are very numbers driven. The spreadsheet is a record of your cat's progress. By linking it in your signature, we can follow along and provide feedback should you need the help. Are you home testing her?

 

[Bron and Sheba (GA)]

Hi and welcome Julia and Liz,
Looking forward to hearing more about Julia.
What glucose meter are you using and when you say the BG seems too low...how low is this?

 

[Elizalphabeta]

Thank you both for your quick replies @Ale & Bobo & Minnie (GA) and @Bron and Sheba (GA)!!

My work has been intense - and we had a tough week so it was hard for me to answer quickly.

Also - forgive me also if things I say aren't clear - I realize I may not have the lingo quite right yet. I'm in Canada and using the mmol BG numbers.

To answer your questions:
Type of insulin: Lantus.
Am I home testing; YES - I'm using the AlphaTrak2 with the pet strips ($$)
DOSAGE: Short Story - between .75 - 2 Units over the past 3 weeks, .08 - 1.5 units just this last week. Long Story: The instructions that the vet gave me originally to start at was 1 unit twice a day with meals - as best I could. (Julia was having trouble with meals bc of pancreatitis, and we hadn't gotten her consistently eating a commercial cat food. She was also really constipated so I was introducing roughage like some steamed zucchini mixed with boiled chicken - so - sugar in her diet). During all that - she was staying in the 18-20 mmol (sp?) at mid-day. THEN: The vet upped it to 2 units if she ate, 1 unit if she didn't. We did that for a while - once I managed to get her on Purina DM - then things got lower and meals easier. THEN dosage protocol was:
> 10 and eating = 2 units
> 10 not eating = 1 unit
< 10 and eating = 1 unit
< 10 no eating = 0 unit

At that point it wasn't made clear to me that the BG level informing dosage the should be the Nadir. So I made some mistakes. Plus, I was just asked to get a midday reading each day- but I now believe that mid day actually isn't her nadir - only 2- 4 hours after eating is I think.

For example - I think I gave 2 units at a time based on what I now understand to be a preshot number! Then, another time, within 2 hours of shooting - her BG went down at its lowest to 3.3. So that freaked me out. Yet the Vet said it was fine, and when I reviewed with him what I was doing in the chart I keep - he said - no problem. Stick with this protocol, things look stable and under control.

However - I couldn't sleep at night. I would leave out food - make her eat more food with snacks left out and with appetite stimulants. I found that was pretty freaky. I haven't given her 2 Units since that reading. I also started reading about the Start Low Go Slow method. I am using the AlphaTrak pet meter, so I can't really follow that exactly, but it's informing my approach.

Because I've been reading more about curves, I am trying, as best I can to get readings more frequently and judge where her nadir is - hard to do while at work! This weekend might be able to be definitive with a full 5 test curve!

So far as I can tell, she goes low quickly, but then the level climbs up, by 6+ she's back up at the preshot level. ( I think? )

I realize what I am doing is all over the map right now - I'm inconsistent and only getting BGs when I can. Likely frustrating to see for all you pros!!
My goals this long weekend are to:
1. Get a sense of what is going on, curve wise - doing a full curve at the suggested hours I've been reading about here, to really confirm my suspicions about when her Nadir seems to be hitting.
2. Zero in on the best dosage. This may just be my intuition/experience - but at this point, I believe somewhere between 1.25 and 1.5 might be the sweet spot??
3. Get a Freestyle Libre on her - I'm just burning through the tabs - and that would be a human meter...for what it's worth.
4. Switch from my own homemade Excel tracking spreadsheet to the one you offer on here so I can share what's happening with her a bit more easily with all you folks
5. Upload deets about her to the information section as you helpfully suggested - meds, diagnosis date, the old chart, my new chart - (and of course some charming photos bc she's my delight!)

So to answer about "too low" 3.3, 3.4, 4.6s on the Alpha Trak2. Seems super spooky to me!

ALSO - I really want to say I think my vet is an excellent vet - very knowledgable - he is super smart and has saved my cat's life many times when I was getting advice to put her down - but this is a complicated situation!!

QUESTION: Has anyone has noticed insulin effectiveness/duration affected by the timing or dosage of oral steroid use - I'm wondering if that's why the insulin isn't having much duration...esp as I'm going to be starting the steroid puffers soon too! I try to give the steroid an hour before eating to try to make sure I'm manaing the pancreatitis - But I think that might mean her steriod is coming in right when I give the insuling 1 hour to 1.5 hours later.

THANK YOU - Once I get my chart going and info up I'll flag it for you. Thank you so much again for being here and asking questions!

 

[Elizalphabeta]

I am having trouble entering information in my profile - it is telling me an error occurred and to contact the administrator. I'll share this here for now: IBD & Pancreatitis: April 2020. Diabetes: June 2nd, 2023. Medications: Prednisone: .05 ml, twice daily. Solencia: once a month. Cerenia: when required. Cyproheptadine: when required. Lantus: TBD. I'll also attach my CHART FOR JULIA

 

[Marje and Gracie]

I am having trouble entering information in my profile - it is telling me an error occurred and to contact the administrator. I'll share this here for now: IBD & Pancreatitis: April 2020. Diabetes: June 2nd, 2023. Medications: Prednisone: .05 ml, twice daily. Solencia: once a month. Cerenia: when required. Cyproheptadine: when required. Lantus: TBD. I'll also attach my CHART FOR JULIA

Can you please send me private message and I’ll fix this all for you. Just click on “Marje and Gracie” to the left and then “start a conversation”.

 

[Bron and Sheba (GA)]

ALSO - I really want to say I think my vet is an excellent vet - very knowledgable - he is super smart and has saved my cat's life many times when I was getting advice to put her down - but this is a complicated situation!!

Most vets are great, but with diabetes, they are frequently lagging behind with the latest information. They have many animals and diseases to contend with.

Has anyone has noticed insulin effectiveness/duration affected by the timing or dosage of oral steroid use - I'm wondering if that's why the insulin isn't having much duration...esp as I'm going to be starting the steroid puffers soon too! I try to give the steroid an hour before eating to try to make sure I'm manaing the pancreatitis - But I think that might mean her steriod is coming in right when I give the insuling 1 hour to 1.5 hours later.

Steroids can affect the insulin but we just work around it.

So to answer about "too low" 3.3, 3.4, 4.6s on the Alpha Trak2. Seems super spooky to me!

To find out the US numbers that are used on this site, you multiply the mmol/l number by 18.
So 3.3 x 18 =59.4
3.4x18=61.2
4.6x18=82.8
When using the alphatrak meter, any number under 68 is too low and you need to feed some honey, Karo, and or high carb to bring the number up over 68. And you earn a reduction in dose if it goes under 68.
If you are following SLGS dosing method you would reduce the dose if the BG falls under 90. (5)

The vet upped it to 2 units if she ate, 1 unit if she didn't. We did that for a while - once I managed to get her on Purina DM - then things got lower and meals easier. THEN dosage protocol was:
> 10 and eating = 2 units
> 10 not eating = 1 unit
< 10 and eating = 1 unit
< 10 no eating = 0 unit

Lantus like consistency so chopping and changing the dose is not a good idea.
If you are having trouble getting Julia to eat, she may be nauseated and may need some ondansetron or cerenia for nausea and an appetite stimulant.
Once we can see the spreadsheet and the data, we will be in a better position to help you.
If she is dropping to 3.3 and at other times is really high, then she is bouncing, which is perfectly normal for newly diagnosed cats, but we need to find a dose that she can consistently have.

• Bouncing - Bouncing is simply a natural reaction to what the cat's system perceives as a BG value that is "too low". "Too low" is relative. If a cat is used to BGs in the 200's, 300's, or higher for a long time, then even a BG that drops to 150 can trigger a "bounce". Bouncing can also be triggered if the blood glucose drops too low and/or too fast.The pancreas, then the liver, release glucogon, glycogen and counter-regulatory hormones. The end result is a dumping of "sugar" into the bloodstream to save the cat from going hypoglycemic from a perceived low. The action is often referred to as "liver panic" or "panicky liver". *Usually*, a bounce will clear kitty's system within 3 days (6 cycles).

If the 2 units is dropping her down to 3.3, you need to reduce that dose to 1.75 units.
Do you have a hypo kit set up with some honey/Karo, high carb food in it?

 

[Ale & Bobo & Minnie (GA)]

Most vets are great, but with diabetes, they are frequently lagging behind with the latest information. They have many animals and diseases to contend with.

Steroids can affect the insulin but we just work around it.


To find out the US numbers that are used on this site, you multiply the mmol/l number by 18.
So 3.3 x 18 =59.4
3.4x18=61.2
4.6x18=82.8
When using the alphatrak meter, any number under 68 is too low and you need to feed some honey, Karo, and or high carb to bring the number up over 68. And you earn a reduction in dose if it goes under 68.
If you are following SLGS dosing method you would reduce the dose if the BG falls under 90. (5)

Lantus like consistency so chopping and changing the dose is not a good idea.
If you are having trouble getting Julia to eat, she may be nauseated and may need some ondansetron or cerenia for nausea and an appetite stimulant.
Once we can see the spreadsheet and the data, we will be in a better position to help you.
If she is dropping to 3.3 and at other times is really high, then she is bouncing, which is perfectly normal for newly diagnosed cats, but we need to find a dose that she can consistently have.

• Bouncing - Bouncing is simply a natural reaction to what the cat's system perceives as a BG value that is "too low". "Too low" is relative. If a cat is used to BGs in the 200's, 300's, or higher for a long time, then even a BG that drops to 150 can trigger a "bounce". Bouncing can also be triggered if the blood glucose drops too low and/or too fast.The pancreas, then the liver, release glucogon, glycogen and counter-regulatory hormones. The end result is a dumping of "sugar" into the bloodstream to save the cat from going hypoglycemic from a perceived low. The action is often referred to as "liver panic" or "panicky liver". *Usually*, a bounce will clear kitty's system within 3 days (6 cycles).

If the 2 units is dropping her down to 3.3, you need to reduce that dose to 2.75 units.
Do you have a hypo kit set up with some honey/Karo, high carb food in it?

You mean drop from 2 to 1.75?

 

[Bron and Sheba (GA)]

You mean drop from 2 to 1.75?

Yes! Thanks. I've corrected it

 

[Elizalphabeta]

To find out the US numbers that are used on this site, you multiply the mmol/l number by 18.
So 3.3 x 18 =59.4
3.4x18=61.2
4.6x18=82.8
When using the alphatrak meter, any number under 68 is too low and you need to feed some honey, Karo, and or high carb to bring the number up over 68. And you earn a reduction in dose if it goes under 68.
If you are following SLGS dosing method you would reduce the dose if the BG falls under 90. (5)

THIS IS IMMENSELY HELPFUL - THANK YOU!

 

[Elizalphabeta]

Lantus like consistency so chopping and changing the dose is not a good idea.
If you are having trouble getting Julia to eat, she may be nauseated and may need some ondansetron or cerenia for nausea and an appetite stimulant.
Once we can see the spreadsheet and the data, we will be in a better position to help you.
If she is dropping to 3.3 and at other times is really high, then she is bouncing, which is perfectly normal for newly diagnosed cats, but we need to find a dose that she can consistently have.

• Bouncing - Bouncing is simply a natural reaction to what the cat's system perceives as a BG value that is "too low". "Too low" is relative. If a cat is used to BGs in the 200's, 300's, or higher for a long time, then even a BG that drops to 150 can trigger a "bounce". Bouncing can also be triggered if the blood glucose drops too low and/or too fast.The pancreas, then the liver, release glucogon, glycogen and counter-regulatory hormones. The end result is a dumping of "sugar" into the bloodstream to save the cat from going hypoglycemic from a perceived low. The action is often referred to as "liver panic" or "panicky liver". *Usually*, a bounce will clear kitty's system within 3 days (6 cycles).

If the 2 units is dropping her down to 3.3, you need to reduce that dose to 1.75 units.

ALSO - HUGELY INFORMATIVE. I've linked my personal spreadsheet for now - hope to figure out the one this board provides this weekend and start using it ASAP. Also - I'm going to try to stick to 1.25 for this next week. It's hard to get the .25 exact with my syringes - it is marked by .5 increments...I'll try to find more detailed ones.

 

[Elizalphabeta]

Do you have a hypo kit set up with some honey/Karo, high carb food in it?

This is an excellent question, and it may sound just so irresponsible, but I don't have anything formally on hand like that. I've been using her hypo dry kibble when I get scared which is mostly rice and tends to shoot levels way up, and have molasses on hand? But nothing in a kit form I can grab quickly. I'll make something!

 

[Hendrick Cuddleclaw]

I don't think you are going to find syringes with smaller than .5 unit increments, for the .25u dosing adjustments people either use dosing calipers or just eyeball it as close as they can.

 

[Ale & Bobo & Minnie (GA)]

For the hypo, you just need to make sure you have honey or Karo and a few cans of medium and high carb foods. FF tuscany has rice and so its HC and FF Florentine would be considered MC. The dry food takes a long time to actually be digested and raise the bg so not the best in a pinch when you need to bring them up fast. Honey and Karo do that but they also wear off quickly.

 

[Marje and Gracie]

I am having trouble entering information in my profile - it is telling me an error occurred and to contact the administrator. I'll share this here for now: IBD & Pancreatitis: April 2020. Diabetes: June 2nd, 2023. Medications: Prednisone: .05 ml, twice daily. Solencia: once a month. Cerenia: when required. Cyproheptadine: when required. Lantus: TBD. I'll also attach my CHART FOR JULIA

Thanks for posting a SS but it’s not the one we use. Ours is formatted specifically for the info we need. We also use mg/dL here and not mmol/L but our World SS allows you to enter it in mmol/L and converts it to mg/dL to use here.

I am happy to do a SS for you if you PM me but we do need to get this changed ASAP. Thanks so very much.

 

[Elizalphabeta]

When using the alphatrak meter, any number under 68 is too low and you need to feed some honey, Karo, and or high carb to bring the number up over 68. And you earn a reduction in dose if it goes under 68.

Thank you for this info! It just came into immediate use just now...she fell to 3.6/65. A half hour later post molasses got to 4.3/77...I'll give her some kibbles now and will keep watching. Had NO idea she'd gone that low until I took the reading...As for HC&MC foods - it's hard to feed her other foods (esp FF sadly) bc it triggers IBD/Pancreatitis and when that happens, I'm in a pickle...

 

[Ale & Bobo & Minnie (GA)]

What are the foods she can eat that are not dry?

 

[Bron and Sheba (GA)]

With the drop to 65, Julia has earned a reduction in dose to 1 unit, which is her new dose moving forward.
It is fine to use honey/ Karo to bring the BGs back up. If you have IBD to deal with, it can be tricky to find a suitable high carb wet food but keep looking for one. But it is fine to use the honey/Karo; I would feed some of her normal food with the honey/Karo.
Pancreatitis should not be affected by using a high carb food.

 

[Elizalphabeta]

Thank you @Ale & Bobo & Minnie (GA) and @Bron and Sheba (GA) for the advice and support - so scary. What is Karo? Molasses is what I have around and she seems to like the malty taste. To answer your question - Julia was actually, until now, never supposed to eat anything except the RC Multifunction Renal Hydrolized dry for the IBD. That allowed me to reduce her steroid dose...then with asthma - more steroids - and then...diabetes! After trying Tiki Cat and cooking my own food and losing my mind - by some miracle - she is tolerating the Purina DM!! Huzzah. I suppose I also could make my own high-carb food - I used to for flare-ups using chicken and rice/oatmeal... I reduced
tonight's dose by .25 and am now observing closely...

 

[Bron and Sheba (GA)]

Karo is a corn syrup used in the US and can be substituted for honey. Molasses takes longer to break down into glucose than honey, so honey works quicker to bring up the BG than molasses, so it might be better to get a small jar of honey to have on hand. Although the molasses will work, just takes a bit longer.
Just using her low carb food and having the honey to add to it when you need high carb food is acceptable. We do have some IBD cats that have that for their high carb option.
When you give the honey/ molasses give a teaspoon of low carb food with it. Just be aware that honey/ molasses wears off after an hour/ hour and a half so the BGs could drop again so always keep testing.

 

[Elizalphabeta]

Karo is a corn syrup used in the US and can be substituted for honey. Molasses takes longer to break down into glucose than honey, so honey works quicker to bring up the BG than molasses, so it might be better to get a small jar of honey to have on hand. Although the molasses will work, just takes a bit longer.
Just using her low carb food and having the honey to add to it when you need high carb food is acceptable. We do have some IBD cats that have that for their high carb option.
When you give the honey/ molasses give a teaspoon of low carb food with it. Just be aware that honey/ molasses wears off after an hour/ hour and a half so the BGs could drop again so always keep testing.

Got it. Thanks and will do!!