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bagheerathediabeticcat

bagheerathediabeticcat

Member Since 2013
Hi, everyone. I wanted to come here and say hello. I am a polydactyl bengal who was diagnosed with diabetes in the summer of last year. At first, my human treated me with Prozinc but then he switched to Levemir.

I don't mind the insulin injections, but what I do hate is the twice daily ear sticks to test my blood sugar.

I hope to be able to help humans who are dealing with diabetic cats like me. My human doesn't mind, and he doesn't get stressed out. But some humans do and hopefully he can help them.
 
Welcome!

What is your dose?
Do you get tests more often than just at food times?
What do you eat?

Sneakers is on Merrick BG 1, 2, 3, & 5, gets tested 4-7 times a day, and only has the regular # of toes. She is also on Levemir.
 
Greeting Bagheera

I am Autumn and my human gives me Levemir as well...But I love my ear pokies because I have my human well trained to give me yummy lo-carb treats before I will allow her to poke me. If she isn't fast enough getting things set up I make her give me more treats and then demand another couple after she is done just to make sure she doesn't think she can get away with annoying me without payment. :-D

Because of her being so well trained I allow her to poke me sometimes up to 6 times a day, although the usual is 4 times a day, the same as the number of meals she gives me.

Mel, Maxwell, Autumn & The Fur Gang
 
Apply a dab of Neosporin ointment (not creme) with pain relief a few minutes before testing. Wipe off, then test. The pain relief reduces the annoyance of testing and the ointmen helps the blood bead up.

Also, some active play for 15 to 20 minutes once or twice a day may help him destress. Plus, if I recall correctly, Bengals are athletic cats and enjoy toys and games.
 
Thanks for welcoming me. You humans are pawesome.

My dose varies depending on what the glucose reading is. It goes anywhere from zero, if my blood sugar is below 120 to 5.5 units if it's above 300. I only get tested twice a day. I get fed wet and dry food. I get the Nutro weight management food because it's got a very high protein content. My human checked with his vet and asked if it was okay, and they told him it was. They were surprised that it had more protein and less carbs than the stuff they sell!

My human is experimenting with wet food to give me. He had me on the Nutro weight management food for a while, but then while I'd eat it, I didn't pounce on it so he started to experiment. I don't like the PetSmart brand, even when it's the shredded beef or chicken or fish. I do like the stuff that comes in black cans. My human would recognize it but he doesn't remember the brand.

My human gives me some Greenies after I am done with the blood sugar test. But I still squirm a little. He can scruff me, and hold my ear with one hand and stick me with the other one. I don't fuss anywhere near as much as I used to but I still don't like it. But the insulin shot is no big deal.

And yes, I love to play. My human has his hands full with not just me, but my girlfriend Jacey. She is also a bengal. We love to play and chase each other around, and then we get some play time with him.
 
Hello Bagheera's human,

Just wondering..... If you're only testing twice a day (presumably before insulin shots) then how do you know how low those shots are taking Bagheera....? 5.5 units (your highest dose) is a pretty high dose.

Best wishes,

Bertie's human ;-)
 
bagheerathediabeticcat said:
...My dose varies depending on what the glucose reading is. It goes anywhere from zero, if my blood sugar is below 120 to 5.5 units if it's above 300. ...
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AACCKK!! That is incorrrect dosing for Levemir, a depot insulin, which is totally different in how it works from Prozinc. It is meant to be given in a stable dose, every 12 hours, and adjustments are based on the nadir, the lowest point in the 12 hours. What you are doing could unintentionally kill your cat.
 
Okay lets go over some of the basics here where Levemir is concerned...First off as BJ has pointed out that is absolutely the wrong way to dose Levemir...Levemir is a depot insulin or in other words it builds up time released crystals under the skin. And each shot builds on the next one, so it needs to be dosed on a consistant basis.

Second Levemir dose adjustments are based on the nadir or lowest point in the cycle not off the preshot values. All the preshots tell you is if it is safe to shoot in the first place. It is never based on a sliding scale and 5.5u is way too high if he is falling to levels that you don't give any insulin at all.

Third scrap all the dry food it is only adding to your problems, dry food regardless of the type isn't really fit to feed any cat let alone a diabetic for more info on why that is check out http://www.catinfo.org which is written by a vet who specializes in feline health. But I can tell you with 14 cats here (2 diabetics) that the best thing I did for all of them was getting them off the dry food, everyone has benefitted for the better.

Also all wet food is not created equal, you want to stay away from anything that is shredded, grilled or in gravy as they are far too high in carbs for a diabetic kitty. Everyone here eats exactly what my two diabetics eat just good old fashioned Friskies Pate style canned food, others also feed Fancy Feast Classics only, 9-lives pate style or even Wal-mart's house brand Special Kitty on the less expensive side of things as well was Wellness, & Evo canned on the more expensive side of things.

Mel, Maxwell, Autumn & The Fur Gang
 
I'm afraid I don't get you. Are you saying that I should get the same dosing regardless of what my blood sugar is? At first, when I was diagnosed last summer, my human took me to a regular vet, and that was the plan. But he wasn't able to figure it out, so we went to a specialist. She's really well known for feline diabetes treatment and she lectures on it. She's the one who came up with the treatment plan.

We talked about my feeding and decided that going all wet was not practical. Please do not judge my human because he is trying to do the best he can. He needs to leave us for long stretches for work and he has to make a real effort to make sure I am dosed at 12 hour intervals.

Whatever we are doing seems to be working. I was down to 12.5 pounds from my pre-diabetic weight of 16 pounds. Now I am back to my pre-diabetic weight.

I will have my human ask the vet -- who I will write about in my blog -- about the concerns you brought up. Thank you.
 
bagheerathediabeticcat said:
I'm afraid I don't get you. Are you saying that I should get the same dosing regardless of what my blood sugar is? At first, when I was diagnosed last summer, my human took me to a regular vet, and that was the plan. But he wasn't able to figure it out, so we went to a specialist. She's really well known for feline diabetes treatment and she lectures on it. She's the one who came up with the treatment plan.
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Not exactly. What we are saying is that you don't adjust Lantus and Levemir doses based upon the pre-shot number as they are both depot insulins; it takes 3 to 5 days at the same dose to get a stable insulin/glucose balance. Your vet may be more familiar with ProZinc and PZI which are not depot insulins and do not have any carryover beyond 12 hours.

Please read, print out, then discuss with your vet the AAHA guidelines.

What we follow here for Lantus and Levemir is based on the Roomp & Rand article; Tight Regulation Protocol
 
If your vet lectures on diabetes s/he should know that you MUST test for nadir - the lowest point in the cycle which is typically about +6 to +8 for levemir (that's 6 to 8 hours after the shot), but that nadir can vary for many reasons.

You may see our spreadsheets and see that some people (me) don't test mid cycle very often, or others that test every 2 hrs every day. I start my cats with at least three tests during the day and vary the mid cycle test times to find MY cat's nadir. Once I find that I can start adjusting the dose accordingly.

In my experience with lev (3 cats) I would NEVER vary the dose by 5.5 units from zero to 5.5u. What happens when you do that is that the 5.5u drops him like a rock and you get an unshootable preshot number below 120. Then the blood sugar spikes back up high because of two reasons. One is that Bagheera is rebounding from a low number we don't know because you are not testing midcycle and two because no insulin was given and unless the cat is headed into remission it needs insulin every 12 hrs.

By lowering the dose you can shoot the same dose every 12 hrs and maintain more stable numbers. You will find that the BG doesn't vary as much so shooting the same dose then makes sense. There might be times when the BG is a lot lower or a lot higher and we generally suggest lowering the dose a bit on the low BG until you have data showing how your cat reacts to insulin doses on the lower numbers. Many people here would give insulin on a 120.

Typical starting dose is .5u or 1u every 12 hours. It is held for 3-5 days and tests are gotten before each shot and at random times to see what the dose is doing. Changes are made to the dose looking at the nadir, not the preshot numbers, although they provide additional information as to what direction to go in (raise or lower and by how much).

Dry food has too many carbs for any cat, let alone a diabetic and will influence the BG numbers - best to avoid it. Plus, dry food is bad for all cats because of it being dry. It causes kidney failure, diabetes, IBD, urinary tract infections... just not a species appropriate diet. Sharing that information is not a judgement. It is simply a fact. I did not know this before I create my first diabetic cat by feeding him weight management dry food for 8 years. Occasionally there is a cat that even after the best efforts of their humans refuses canned food and then you have to deal with it, but most can be transitioned to canned food eventually. My Beau was a tough one, but I did it. If Bagheera will eat canned food then that is the way to go. You can leave canned food down for 12 hrs. I free feed my cats, filling the bowls about 3 times a day.

Nothing that we post to you is meant as a judgement of you, but is meant to share what we know from our collective years of treating diabetic cats. We treat them 24/7 for years and converse with each other about what works, is safe, and what isn't. The basis of treatment are the studies and protocols that BJM linked in her post - written and developed by DVMs.
 
bagheerathediabeticcat said:
...My dose varies depending on what the glucose reading is. It goes anywhere from zero, if my blood sugar is below 120 to 5.5 units if it's above 300. I only get tested twice a day. I get fed wet and dry food. I get the Nutro weight management food because it's got a very high protein content. My human checked with his vet and asked if it was okay, and they told him it was. They were surprised that it had more protein and less carbs than the stuff they sell!
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Welcome Bagheera!

Let me start by saying Jacey and yourself are quite the striking pair! Very nice blog and quite busy FB page! :cool:

And if you could put your human on for just a sec. Thanks. \M/

To Baheera and Jacey's human:

Don't know why the vet would dose Levemir like that, but it will almost certainly cause disruptive chaos as you can see from the numbers you are getting. I'd guess the vet must have started dabbling in Levemir during the prozinc shortage last year and doesn't yet have the experience to know it's not dosed anything like prozinc?

The good news is once you get this figured out, not only will Bagheera's numbers most likely be closer to where you want them, but you might be able to show the vet how it it supposed to work. :smile:

For example Chip is currently regulated on Levemir, and what you want to see is normal numbers much like Chip has been seeing for the last week or two. Also notice how consistent Chip's dose is and how infrequently it changes. You will likely also need low carb food as well, a number of options there.

The great news is you came to right place just in the nick of time. As BJM pointed out, for Levemir you will want to dose using the Roomp & Rand (Tilly) TR Protocol. And you can learn all about on this forum.

Once again welcome and best of luck. :thumbup
 
Bagheera-

Levemir is dosed based on the nadir- the lowest point of where the insulin takes you- not on the number that you get when you test before a shot. Your 300 could be from a bounce because you went too low during a cycle and the pancreas is throwing out sugar into the blood stream to keep from damaging itself. Our humans make it a point to test at a mid-cycle time to see how low we go. I'll give you a case in point but see that I am a high dose cat. I have acromelagy which is a brain tumor so my dose is higher than most cats but the concept is the same.:

If you look at my SS (link in my signature) last Friday my AMPS (AM pre-shot #) was 160 and I obviously went low during the day. Now, my human can't test me during the day as she goes to work but she tests me three or four times in the night and she knew something was up when my PMPS (PM pre shot #) was 235 and just 4 hours later (at bedtime) I was 346 :o . That 346 isn't normal for me as the levemir kicks in about +3 hours after my shot and starts to pull my numbers down. At +9 hours after my PM shot I was still high at 274 and 12 hours after my shot (time for the next one!) I was 226. Now that number was less than my PMPS and if she hadn't been testing over night my human would have never known that I went so high at all and known to lower my dose BASED on the numbers she got in mid-cycle testing. She held the same dose for 3 days- 6 WHOLE cycles ('cause I'm an acro cat and we can change doses faster than normal cats :razz: ) but she likes to hold it for 5 days- 10 cycles- because I like to hold on to that sugar!

Example 2 is just right behind it- Monday AMPS was 162 and PMPS was 177- but just a few hours later I was in the PINK and I stayed there ALL NIGHT LONG and even during the next day. As you can see my owner got an out the door before work test just to see how I was doing and I was already dropping. My PMPS for the day was 186- back into good numbers again but I have been known to roller-coaster up and down for a little bit. This dose was held for 4 days- 8 cycles- and my human thinks that with my bouncing I need another reduction- YIPPEE!!!! Working for OTJ and only have another 15u to go!!!

Now for food- I am VERY carb conscious, even a change in 1% of carb will send my numbers soaring 20-50 points above my normal level and if you feed me dry that will shoot me straight into the red (400) or black (500+). To stop my swings my human feed me only one carb count for two weeks and my BG levels evened out so she could see what was food and what was me. While she always feeds me under 8% carbs my numbers are better now that I am getting 2% carbs. Your Nutro dry is 16% carbs :o :shock: :shock: That would send me to the moon!
I do better with wet food and I have it several times a day thanks to mom freezing the food and putting it into a timer to open up every 3 hours. She even adds water to it by adding another cube of ice and it stays all nice and moist for me to eat- YUM!!! I currently get Merricks Before Grain and it has plenty of protein in it.

You can look them all up here: http://catinfo.org/docs/FoodChartPublic9-22-12.pdf

Keep asking us questions if you don't understand something. All of our humans have learned by experience and in a group about how our bodies react to food and changes in dosing. I would ask your humans specialist how many kitties she has had go off insulin with her food and dosing schedule. There is usually one or two a month on this board.
 
Hello again Bagheera's human, what's your name, by the way?
(I'm Bertie's human and my name is Elizabeth. And I really wish my cat had the reading, writing and cognitive abilities that your cat does! ;-) )

Like you, I also use a sliding scale dosage, depending on what Bertie's blood glucose levels are at pre-shot (immediately prior to the shot). But I use a protamine zinc insulin that lends itself well to that kind of variable dosing. The experience of people here is that some other insulins - like Lantus and Levemir - work better with fixed dosing. PZI insulins are dosed according to pre-shot numbers (but take the nadir (lowest number of the cycle) into account. Lantus and Levimir users here base their dosage on the nadir number, not the preshot number. With Lantus and Levemir you're looking at the 'bigger picture' and not just that particular 12 hour cycle.

But I didn't actually post to talk about insulin dosage (I'll leave that to others with experience of your insulin!) I wanted to talk about hometesting. Because I'm wondering if we can find ways to make that easier for you and your cat.

Hometesting should not really hurt your cat. There are very few nerve endings in the outer edge of the cat's ear. So if it is actually hurting Bagheera, maybe there are ways of minimising that discomfort...

Are you using a lancing device or using a lancet freehand? Whichever you are using you may find it worthwhile trying the other method to see if that works better for you.

And for some cats the issue is not actually the pain of the ear prick but the 'discomfort' of being held or restrained. Is Bagheera a cat that is comfortable with being handled? My cat doesn't like to be held so I crumble a few treats and then test him while he's munching on those.

Are Bagheera's ears bruised or sore? It's important to press firmly on the test site after the ear prick to minimise bruising. And some folks here use Neosporin afterwards.

And are you rewarding Bagheera after each test? Cat's quickly come to associate tests with treats and many beg to be tested!

I'm really hoping we can find ways to make testing easier, and possibly even pleasant for you both.
Can you talk us through your testing routine?

Elizabeth
 
Yay! Welcome! :YMHUG: I follow you on fb and am so glad you found us here!

bagheerathediabeticcat said:
We talked about my feeding and decided that going all wet was not practical. Please do not judge my human because he is trying to do the best he can. He needs to leave us for long stretches for work and he has to make a real effort to make sure I am dosed at 12 hour intervals.
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I use Lantus, not Levemir, so I'll leave the dosing/test-time advice up to those more experienced with your insulin but I can vouch for the depot-style insulins requiring consistent, twice-daily dosing based on nadirs more so than pre-shots. I'm dealing with that issue right now as Michelangelo's numbers fall more and more into normal range and I've found myself skipping a shot because of "low" pre-shot numbers and then suffering from it with higher numbers for several cycles after. I just have to screw up my courage and start shooting lower because I know that I'm messing with the depot whenever I skip a shot, which is what's causing those higher numbers as the depot refills.

No judgement here, just information sharing. :-D I fed my two previous cats expensive prescription dry food all their lives...and they both died young of CRF/CRD, which I now know was most likely caused, but definitely exacerbated by the dry food. If the only thing keeping you on dry food is the worry of leaving it out for 12 hours at a time, I wanted to share with you an informative article about dry food vs. wet food and how dry food is loaded with more bacteria and fungus than wet food, even when left out. In the wild, cats will much on carcasses of meat for a couple of days at a time. The beauty of their evolution allows their bodies to be capable of handling old, raw meat. So, leaving out raw and/or canned cat food for a few hours a day is not going to make them sick. :-D Of course you will want to add water to it to keep it from drying out, but other than that, it's significantly better than leaving dry food out. Here in Southern California, the weather is so temperate that I've never had to freeze it yet for my cats (but we'll see come summer!), so I wouldn't worry too much about learning how to make meat popsicles just yet. :lol:
 
Re: testing

Yes, there is the very rare cat that is ultimately impossible with testing, but most of them adapt to it and grow to look forward to it. Michelangelo loves test time because he knows it's treat time. About half the time I test him, it's because he was the one who came over to his test spot, wanting to be tested so he could have a treat. I think we can figure out something to make the testing easier on both of you. ;-) Check out some of these testing tips that answer most of the questions/problems that arise, sometimes problems that you don't even realize exist! If you want a second set of eyes, I also wouldn't mind driving down to help you out further if you'd like (although, it would probably have to be a weekend to avoid that pesky traffic).
 
Thank you, everyone.

I am going to have my human (his name is Tony) send the study to the vet. He'll see how they respond. He doesn't like the swings. For example, last night, the blood sugar came in at 140, so I got 2.5 units. This morning, my blood sugar was up at 380, so I got 5.5. Tonight when he gets home, we'll see where it comes in. He's been wondering if a consistent 4-5 unit dosing would do the trick but there's been so much fluctuation that it can't happen. At least according to the dosing he's received.

I am thinking that maybe the vet figures that since I eat, my blood sugar will go up? She has dosing levels for if I eat more than half my food and if I don't eat as much.

Also, I am a big boy. One of the ways my human knew something was wrong was that I was losing weight. When I was diagnosed with diabetes, I was down to 12.5 pounds. Now, I am back to my normal 16 pound weight. So I'm a lot bigger than a lot of cats, and the vet said that my dose would reflect that.

As far as the testing, both he and I are getting better with the ear sticks. He is able to scruff me with his left hand and stick me with the right, if he has to. This morning, for example, I was hungry, so I went and ate as soon as he put the food down. Since I was lapping up the food, he was able to get me without me fussing. But last night, I wasn't hungry so he had to restrain me.

After the test, he uses an alcohol pad and presses down until the bleeding stops.

You are right that I don't like to be held. And he's started to give me treats after the test, but I'm kind of meh on them.

My human is also going to talk to the vet about using a human glucometer to test. Strips seem to be a lot cheaper than for the AlphaTrak!
 
About the strips- this might help your human Tony on figuring out to keep the AT as a main one or regulate it to the back burner...

My human looks at it this way-
Upfront expenses:
Alpha track meter- $100+ to buy
strips- I think they are $2 EACH
vs
Relion Micro- $15 (Prime is only not that much more and the strips are even cheaper)
strips- store- 100/$36 ($.36 EACH) and auto shipped from ADW 250/$72 ($.29 EACH)

I get tested, on average, 5 times a day.
Alpha- 5*2.00=10.00/day, 70.00/wk, 280.00/4 wk month.
Relion- 5*.29= 1.45/day, 10.15/wk, 40.60/4 wk month.

My human saves $239.40 a month by using a human meter, on average. Sure, every 45 days my auto-ship order comes from ADW ($73 because of the auto ship discount covers most of the shipping cost) but I've built that into my budget.

But lets say you only test 3 times a day because of time constraints (both PS shots and one mid-cycle)-
Alpha- 3*2.00=6.00/day, 42.00/wk, 168.00/4 wk month.
Relion- 3*.29= .87/day, 6.09/wk, 24.36/4 wk month.

Comes to a $143.64 savings. That's a lot of cat food (or people food, utility bill, car payment...)

Plus, consider this- Walmart is easier to get to in the middle of the night (for at least half of us)- your vet isn't open at midnight if you need extra strips NOW!!! I've had many a teller say they can open those plastic little boxes for me if the pharmacy is closed.

Now- the vets don't like to use a human meter usually because the numbers aren't "accurate"- the FDA allows every meter to have a variance of 20% and that includes the PET meters. All we really need to make sure our humans get is the trend we have- they don't need to know our EXACT level but they do need to know the ballpark figure and a human meter gives them that at a much cheaper price.

And get this- a human meter may read 30 points under the pet meter. That is it- 20 points. You can test a new meter with the alpha track for a day or two to see how consistent the numbers are from each other but most people here only use human strips and dose on that anyway.

So put a little flea bite in your humans ear to start saving some money so you can try some different treats. I didn't like the freeze-dried chicken or beef myself, freeze dried white fish was so-so but then she found freeze-dried SHRIMPIES!!!! I let her cut my nails for shrimpies.
 
Oh ouchie your human uses alcohol on your ears after the pokies...I wouldn't like that either I bet that stings and worse yet makes your lovely ears smell funny and taste bad. My human just holds her finger on my pokie spot for a couple of seconds and then puts a little dab of neosporin with pain relief on mine.. and my ears are just as lovely as the first day we met and I rescued her.

I wasn't big on the commerical treats either, as I'm an old farm girl and like my treats less processed...but then my human got smarter and started giving me fresh raw chicken bites and I was in heaven. Right now we are out of my favorite chicken so my servant is making it up to me with lovely sardines packed in water.

So made if you can do like Lady Sneakers suggests and nip your human into saving some money on all those test strips he can get you better treats and some neoporin for your pokie spots and you will like it better when it is treat time ...ah...I mean test time...see I actually trick my human into testing me just so I can make her give me treats.

And we can even help your human save more money by not having to take you to the doctor too, you can always have him set up a spreadsheet, put your numbers on that and then come join the rest of us Levemir cats over on our very own ISG. We have a special place here that all the kitties use your insulin and we can help your human to figure out what your purrfect dose is and keep those wild swings from happening.

Just look at my spreadsheet down in my servants signature and you will see how well I am doing but also how long my human lets one dose hang out before she changes it.

Autumn
 
My biggest concern about the way you are dosing is the potential for a hypoglycemic attack, where the blood glucose goes so low, the cat goes into convulsions and can die or suffer permanent neurologic damage. Would you consider backing off to 2 units and holding that for a few days to see if he levels out?

Also, you should have a "hypo kit" available, should you ever observe that happening and know How to Treat A Hypo

You might take a look at my signature link Insulin Dosing Options.
 
BJM, thanks for being worried. When I first started getting Levemir, my human got really scared one time because my blood sugar dropped all the way down to 50. But I ate, and within an hour, it was back up to the mid 100s. I'll have him check, because it's in the Alpha Trak database he was keeping. So he got a scare and spent a lot of time with the vet on the phone but things turned out okay. They adjusted my dosing on the spot, though.

I have been on Levemir since the end of the summer and that was the only real scare I had. But I will make him check with the vet and send that paper to her.

And he's very careful. He's got the syrup on hand if anything really bad happens.

MommaofMuse, I am a tough cat. I am a polydactyl, and I had my dew claws removed because they kept getting ingrown into my paw pads. Well, the day after the surgery, I came home, and I went to work on the scratching post. Because I had just had surgery, my paw started to bleed.

I just licked it off and went right back to work on the scratching post. So while I don't like the alcohol, I tolerate it. Really, the only thing I don't like is the lancet, and even that I can tolerate.

My human says we are a perfect match for each other because we both have similar personalities. He played hockey for decades so he ignores pain, and so do I.

He doesn't go in to see the vet. He's got a google docs spreadsheet they set up for him and he just fills in the values. They said he could share it with others, so maybe I will get him to do that. Then he can share it with you and you can give him some advice.

Remember, though, I am a BIG boy. So what works for a normal sized cat won't work for me. Jacey is only nine pounds, and I hear that is the average size for a cat. My legs go all the way over her body!
 
I understand he is a big cat, which is why I mentioned 2 units; thats also in between the variable dosing you've been using. Smaller cats likely would be started, and often maintained, at lower levels.
 
I completely get big cats my two diabetics are large cats most likely a lot of Maine Coon in the ancestry. Maxwell is a lean mean 17lbs, and Autumn is a slim healthy 14lbs. Maxwell just celebrated 2 years insulin free on November first and Autumn is well regulated on .5u of Levemir and may very well also go insulin free at some point also. Weight only really gives us a base starting point for determing dose but every cat is different, some need more and some need less, and some get very lucky and go into remission and go completely off insulin altogether and become diet controlled. The real way to determine what dose your cat needs to be on is to test at home, get rid of all dry food, and with Levemir shoot the same dose both am and pm, hold the dose and then determine up or down by the numbers you are seeing at the nadir or lowest point in the cycle. Unless of course if you see a super low number somewhere in the cycle...then an immediate reduction is earned

Levemir doses are adjust by .25 -.5u at a time again based on the numbers seen around the lowest point in the cycle. You start low and slowly raise the dose so you don't overshoot the perfect one. The way you are shooting is very dangerous for your cat.., its great that you are home testing and are ready in case of hypo, but what if it occurs when you aren't there? High BGs kill slowly, too low can kill very quickly. Right now the only thing that may have saved you from disaster is the fact that you have dry food out 24/7. But if you do away with that completely you have a better chance of getting Bagheera into remission and off insulin altogether but not while you are shooting on a sliding scale as it would be just too risky for him.

He may be a tough cat, but I'm seriously worried about the way your vet is having you use Levemir. We all just want what is best for Bagheera and knowing what I know about the way Levemir works, I am concerned for his well being.

Mel, Maxwell, Autumn & The Fur Gang
 
Have your human to get the above info to the vet, and hopefully the vet will approve of this protocol. :smile:

In the meantime I think BJM has the right idea on the dosing.

Perhaps you could have your human try that dose for few days and he could *forget* to update the vet's spreadsheet right away?
 
Insulin doses for cats are NOT based on weight. Starting dose is .5u to 1u. Period. We have seen way too many cats started at 2u and within days they are rebounding all over the place - meaning blood sugar dropping too low, too fast or too far (like 450 to 75) and causing the body to panic and release stored sugars and hormones to prevent a hypo and that shoots the BG way up again.

All that said, maybe 2u held steady could work for Bagheera. It would be better than trying to use a sliding scale that is way to large (zero to 5.5u) even for a short acting insulin. I would definitely NOT try holding 4u or 5u as the steady dose. It is way too much and is causing the swings.

To stop swings you have to lower the dose and hold it steady until the swings stop. You actually want the numbers to be a little high - like upper 100s or 200s. That way the rebounding stops and you can slowly raise the dose and bring ALL the numbers down together. By slowly, I mean raising by no more than 20% and holding for 3-5 days.

Dose increases should follow the holding period AND a curve - testing every 2 hrs.

...but there's been so much fluctuation that it can't happen. At least according to the dosing he's received.
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Tony, the dosing you are being given is CAUSING the fluctuations. Trust me, I know what it is like to have vets you feel comfortable with and respect telling you one thing and strangers on the internet telling you another. My vets were telling me to, once again, raise Beau from 3.5u to 4u because he had numbers in the 400s. People here were telling me to "start over" at 1u. I sort of compromised in the middle, but after a month Beau's dose was below 1u. I have never taken my vets' advice on dosing since then. In fact, when I adopted Cami in October I had to take her for an FIV/FeLV test and the vet asked me what dose I was going to use. I said "a half or one unit" and he said I should start at 1u. I just nodded because I had already decided to start her at .5u, but knew they would say 1u. She never needed more than .5u. I was reducing her dose in less than 10 days and she was off insulin after 3 months.
 
Let's see if my feline brain can wrap itself around this.

What you are saying is that the dosing sticks around, and so when my blood sugar goes low, it's not a result of the previous dose but of the build up of several doses before? So if my human has been giving me 5.5 units because he's been seeing readings in the 300s (like he has now) and then it goes down to say 150, it's not because of the dose immediately preceding it. It's because of that dose combined with say, the past four or five doses before that?

My human will copy and paste the spreadsheet readings for the past few days so you can see what's going on with my blood sugar. Any interpretations of it would be helpful.
 
YES!!!
That is exactly it. The dose you are giving now really effects later on in the cycle and some of next cycles as well as Lev is a long term insulin.
You are looking at the result of the last two cycles OR more if there is swinging from high to low.

The only way to stop the swing is to settle on one dose and keep it for a good long while- 5-7 days- to know what is dose and what is food and what is Bagheera :-D
 
And sometimes there may be something called a "bounce" where BG goes lower than it's used to, then rebounds back higher than it normally would. My Chester bounces sometimes - I finally caught one on my spreadsheet! Chester's still getting regulated, so his numbers tend to run a bit high. He's starting to settle into the 300-400 range. Well, the other day, I gave him a lunch test and he was at 60. That's a pretty healthy number, but it's very low for him. That evening, he was back up over 600 - with no difference in food or anything. His liver got "spooked" and kicked out some extra BG to compensate for the low number.

Bouncing can cause big fluctuations in BG readings. I've been told the best way to deal with a bounce is to just hold the dose until the body gets accustomed to the lower numbers. That's what we're doing.
 
Exactly!!! Sometimes it helps to think of it like a funnel...Where you are trying to keep the water at the very top of the funnel, but it is always running out of the bottom. So if you pour the water in too slowly the level at the top of the funnel drops (BGs go higher), but if you pour it too fast the water spills over the top of the funnel (Hypo) but if you pour it at just the right speed the level at the top of the funnel stays even, yet the there is still water in the funnel from what you poured in a few minutes ago but as well as what you keep adding to keep it level.

With Lev you want to find that dose that keeps the water level at the top of the funnel.

Mel, Maxwell, Autumn & The Fur Gang.
 
And that's why we have our *magic* dosing protocol to precisely calculate the doses going into the funnel, to match what is going out.

Have your human get some numbers together and we will take a look. :thumbup
 
Okay, guys! Here the numbers I told you I would make my human give you.

The last two columns are the amount of food I ate and the Levemir dose I received.

bloodsugar2-21to3-7.JPG


I would love to hear your feedback.

On top of all this, my human has to get me to lose weight. I have bounced around more than the human you call Oprah has. Before I was diagnosed with diabetes, I weighed around 16 pounds. I dropped down to 12.5 at the time of my diagnosis. Now I am back up to 18 pounds, so I'm too fat now!

Head bonks and friendly paw taps to you for all your help.
 
With a depot insulin:
Shooting sooner than 12 hours acts like a dose increase because of more shot overlap.
Shooting later than 12 hours acts like a dose decrease because of less shot overlap.

You want the shots to be as close to exactly 12 hours apart as possible.

Cat info, written by a vet, has good information about weight management.
 
Many of us who use levemir follow the tight regulation protocol previously referenced. It is the only protocol based on scientific research and published in a veterinary journal. The starting dose for cats following the TR protocol is based on the ideal weight of the cat unless the cat is underweight. However, your kitty has been on lev for some time and in order to follow the TR protocol, you would need to get him exclusively on a low carb canned or raw diet....no dry food.

If you are only testing twice a day, then you are very likely missing times when your cat is going low. There are cats who do not show symptoms of hypoglycemia even though their BG might be quite low so the only way you know to feed to bring numbers up is to hometest.

It's really, really important that you give a consistent dose. Depot insulins work best with a consistent dose given at a consistent time interval. The other reason you need to hometest is because the nadir can change...sometimes cycle to cycle so just because a lev cat might nadir at +8 one cycle, doesn't mean he will always nadir at +8. Your kitty might even be nadiring at his PS which is not so rare for levemir. But even if he is, you don't make dosing decisions based on one cycle unless the kitty's BG goes low enough to "earn" a reduction.

There's lots we can and would be willing to teach you, Tony.
 
Tell your human thanks for the numbers!

I have to say this looks very promising! I think you will benefit greatly from TR dosing protocol if you human is up for it! :cool:

I suspect you will need to work out some schedule to get 3 tests daily (and preferably 4) and get the shots 12 hours apart.

But if you can convince your human to work out that little detail, we can help you feel better (all the time!) with much closer to normal numbers.

Maybe even help with the weight issue? And going off the juice is not out of the question. dancing_cat
 
Oh, getting the shots 12 hours apart isn't a problem. He will test as soon as he gets home, because that's when I want to eat. So even though the reading may come at 6 PM, the dosing doesn't actually take place until 7 PM, which is pretty much exactly 12 hours after the morning dose. I get my morning dose pretty much right after the reading in the morning.

He can probably get another test or two in on days when he's not working, but that's not every day. So the question is whether that's enough to warrant the extra ear sticks, which I consider torture.
 
We recommend no food between +10 and +12 because it can elevate the PS....resulting in the caregiver shooting a food-influenced number. The danger there is if the PS is food influenced, then you believe it is higher then it actually is and could come down after the shot.

Also...numbers can change quickly so we recommend that you test/feed/shoot within about 15 minutes. My kitty has dropped as much as 40 mg/dL between +11 and PS.
 
Good news about the 12 hours bit. And I think there are some things that can be done about the torture part. :-D

One thing might be a human glucometer which might use less blood? It sure uses less cash. @-)

As for the timing of the testing, feeding, and shooting, that should be easy to work out.

Everything is still looking good to me. :cool:

I'm thinking maybe the starting dose BJM mentioned, but we will run that by the TR master gurus just to be sure.
 
Good morning, everyone. To give you more information, my blood sugar came in at 301 this morning, so I got 5.5 units again.

Also, the my human does the testing is test the blood sugar, feed me, and then give me my shot at 12 hour intervals. So the morning shot comes at 7 AM, and while the testing might take place at 5:30 PM, I don't get my insulin until 7 PM.
 
Typically, we test, feed, and shoot within a 15 minute time frame.
The pre-shot test is to make sure it is safe to give the insulin,

Testing between shots - mid-cycle tests - lets us see how low the glucose goes and if the cat is safe from a hypoglycemic attack. The nadir, about 7-8 hours after Levemir, should be the lowest point, although ECID - each cat is different.
 
Perfect. I think my human made some of you like this confused_cat because he didn't explain things well. Even though I sometimes am eating when the ear stick comes, it's not like the food I am consuming has enough time to mess with the readings. It has to go into my stomach and be digested first!

Silly human. I will bite him for you. I already owe him one bite for his stupid WordPress plugin making my blog post look bad on Facebook. Now I have to bite him for confusing you.

I think I will draw blood from him for a change. Heh heh heh.
 
Tony

The issue is not when you are feeding in relation to the shot. It's when you are testing. A test at 5:30 is not valid for a shot at 7. The test for the shot needs to be right before the shot.
 
Dale 'n' Chip said:
So now we have a Vampire Cat on facebook?

That's turning the tables. :lol:
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When I first started out testing (and was using the expensive AccuCheck Nano strips), the few times Mikey would get away after he'd draw blood from me, I'd just test myself instead so as not to waste the strip. :lol:

(The first few weeks I started testing, I'd let him get away every now and again without a test so he'd be comforted during test time that he could escape if he wanted to. Lose a few battles, but win the war. ;-) )
 
Dale 'n' Chip said:
So now we have a Vampire Cat on facebook?

That's turning the tables. :lol:
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Muhahahaha! I did tell you I am a polydactyl, right? So I have opposable thumbs on my front paws. And since I had my front dew claws removed, my front paws are just like your human hands.

So, since my human tests me before I eat when he gets home, and that's around 10 hours after my morning shot, maybe he should test me after I eat and get a reading then? It'd be an additional data point for you. But I will not let him do it more than once or twice. I hate getting tested and getting one test just an hour after the last one is not something I'll tolerate too much.

He tells me it's for my own good, but if I'm not in the mood, it's very difficult for him to get a reading. Bengals like me are smart and can figure out ways to make it next to impossible for you humans, especially since we know you don't want to hurt us.
 
If you are only going to allow him to do one test before your shot it would be far better for you if he were to test you, set your food down and then give your shot all in one fell swoop. The problem with testing at +10 and then no shot until +12 is that if you are like many of us levemir cats you could still be dropping,my own nadir isn't until +11 so if my human (I call her mom) would test me when your human does she would think I was much higher at shot time than I really am and could possibly give me too much insulin.

So how we handle that is I come see her right before it is time for me to eat, let her poke my ear for which I have her trained to give me a yummy treat of fresh tuna, then I jump down, go into the kitchen and wait to be served dinner, while she fixes my dinner she also gets my shot ready, then after I start dining she gives me my shot. It is the same routine in the morning except in the morning I hear her buzzy thing go off so I go jump on her bed, kiss her nose and give her a good firm head bonk then run to my test spot so I can get the ear poke over quickly and get my tuna before leading her into the kitchen for breakfast.

Mel, Maxwell, Autumn & The Fur Gang
 
bagheerathediabeticcat said:
So, since my human tests me before I eat when he gets home, and that's around 10 hours after my morning shot, maybe he should test me after I eat and get a reading then? It'd be an additional data point for you. But I will not let him do it more than once or twice. I hate getting tested and getting one test just an hour after the last one is not something I'll tolerate too much.
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The suggestion is to pull food up around 2 hours before the next shot, so if your human doesn't get home till +10 (10 hours after your morning/AM shot), it's encroaching on that 2-hour food spike window. Since I leave food out for them during the day when I'm at work (timed compartments, overfeeding their morning meals, etc...), sometimes when I get home, it's past Mikey's +10 and sometimes I don't know if he's eaten recently or not. Either way, I've monitored him enough times to know that he might be slightly elevated by PMPS (evening/PM Pre-Shot test), but not enough to change whether or not I give him a shot. Some cats, however, have food-influenced numbers for much longer than 2 hours (this isn't as common, though), but the only way to know how influential food might be is to get more data (testing).

ECID, but I would think if your human feeds you at +10 and then pulls your food within 15 minutes or so, when it's finally time for your shot, your test numbers at shot time will be fairly close to the real thing. If it's possible, it might be a better idea to just move back shot time by 15 minutes so you're outside that 2-hour window.
 
My human was able to get a test of me this afternoon, and he just took another one.

At 2:41 PM, it was 282. And at 6:04 PM it was 320.

That 2:41 PM reading is pretty much at eight hours, so maybe you can use that at my nadir? And you can see how it bounced back, just like we'd expect.
 
Marje and Gracie said:
I'd just like to suggest that for Bagheera's benefit, we start to talk to Tony. Thanks :-D :-D :-D
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Perhaps Bagheera can convince his human to start a thread in the TR insulin support group for the serious talk?

I have to admit this thread has been a lot of fun, but I guess there is a very serious issue here.

I was hoping to get more expert opinions on the starting dose. So perhaps we should see if Bagheera can check if his human will start a new thread here something like "Changing Protocol: What dose do I need?" and get a full guru pow wow going with the human?

What do you think Bagheera, think your human would go for that? :razz:
 
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