Introduction and advice on Sonny, our sweet cat

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pgithens

Member Since 2012
Hi!

I'm Pati and we have a sweetie cat Sonny who's been a diabetic for about a year. We adopted him in June 2012 through DCIN. (hi venita!)

Since he came to live with us, hes been on Lantus and now Levemir. His dosage ranges from 0.5-1.5 if his BS is really high -over 600. Hi s blood sugars have always been hard to get right. That 1.0u can drop him from 543 to 56 in 6 hrs, or do barely anything to his BS or from 311 to 31 with 0.5u. It's been scary. We home test twice a day and sometimes during the day if he's acting like we're starving him.

He went to the vet today because he's being picky about his food and stubborn. He's lost weight and other than the slight loss of appetite, he acts normal. The vet pulled blood for a fructose mine test, which will probably come back bad.

I haven't put up a spreadsheet of his numbers yet, but will try to over the next day or so. anyone had any luck with a very insulin-sensitive cat and pills or ProZinc or any advice at all? Sonny's previous owners took him to the vet to be put down because of his dx. We were the lucky ones to adopt him....

Pati
And Sonny....
 
Welcome Pati and Sonny! I don't have advice, but I just wanted to commend you for adopting a sugar kitty! It takes a special kind of person to do that! The board isn't as active as usual due to the holiday, but hopefully somone with experience will come along soon. The spreadsheet illustrating his numbers will be very helpful - let us know if you have any trouble getting it set up. :YMHUG:
 
Welcome! Thanks for adopting a sugar kitty!

Er...how often are you adjusting the dose? Levemir doses are adjusted based on nadir values - how low he goes between shots. Levemir has a really long carryover effect - it hangs in the system and builds up with successive doses. It works best with the same dose every 12 hours. You want to find the dose you can give safely every 12 hours, and that doesn't take him lower than 50 between shots. If several days on 1.0 units results in him going very low, the 1.0 unit may be too much and the wide variation may be due to his body reacting to abruptly low glucose levels and having the liver compensate.

Depending on how much glucose test data you have, we recommend you not shoot if the pre-shot glucose is less than 200. As you collect data, you may slowly lower that "no shoot" number when it is shown to be safe to do so.
 
Yea, I should have added the dosage timing info. It's twelve hrs between doses. We don't shoot if under 200. If he's between 200-350, he gets 0.5u. If he's 350-500, he gets 1.0u. Over 500, he gets 1.5u.

His in-between shot readings have varied widely. I could test three days in a row and get different numbers. with starting numbers of just over 500, and getting 1.5u of Lantus at the time, his numbers were: 56, 200, 153. I know its not an exact science, but our foster sweetie has much more stable numbers.

Over the weekend, I will have a chance to take midday numbers again. I will post them when I get them.

Thank you for the suggestions!

More on my history....
I am a human type 1 diabetic (ha! That sounds funny!), and use short-acting insulin in my insulin pump. So I know what's Sonny is going through in a way. I think that's one reason why my husband and I wanted to help Sonny. We got lucky and he's been very tolerant of our rumblings and learning how to home test him. He even let's our kids poke him!
 
OK , you are using the Levemir incorrectly for a cat; the dose is not given on a sliding scale.

Please settle on 0.5 units and hold it for a minimum of 3 days. Grit your teeth and wait it out, as there will be a period of adjustment.
Test 6 to 8 hours after dosing as much as possible to detect the nadir, the lowest he goes.
Go to the Levemir forum to read more about how to use it correctly in a cat.
The Levemir users will be able to give you more info on using it correctly once they have the nadir test values.
 
Levemir is a depot insulin.
Successive doses build up in the body.
Its like walking up a down escalator
- keep walking at a consistent pace, you stay at a given height
- slow down, and you drop lower
- speed up and you go higher
You want to stay at the optimal level.
 
BJM is correct - hold a steady dose - start at .5u - and gather data. The way that lev works gives it a long action time even in cats (with much faster metabolisms than humans). If you shoot 1.5u on a 500 and 12 hours later he is at 225, he is possibly still dropping when you shoot .5u and then you see the 50 or lower 6 hours later and that is from the overlap of a big dose and the smaller dose.

After 3-5 days on .5u every 12 hours and stop checks as often as you can get a decision to change the dose can be made - if needed.

What food do you feed? That has a n effect too. A low carb wet (canned or raw) diet is best.
 
Thank you for that info regarding Levemir! I've tried reading the different boards and I haven't seen a case like Sonny yet. Even several people that I have talked to are baffled at his BSs and have offered little help. And we are teaching our vet more about this disease while we're learning the feline version of it. He's used to dispensing pills and on rare occasion, ProZinc for the couple of clients willing to do injections. He was shocked that we wanted and were willing to do home testing.

Okay, that's what we have been doing - at least three days at a particular dose twice a day and we didn't have any numbers that were similar. We've done this for a week or more 90% of the time. Thats why we went for a slightly sliding scale on the days that he's really high. I should clarify that he gets the higher dose only when his BS has been high at least two times in a row.

Right now, he tested at 95. Perfect number! If we don't give him anything, then tomorrow morning he will be above 350. Or he may be 125. That's what confuses us.

He gets Fancy Feast classic mixed with a bit of raw. No dry at all.1 can plus <1oz of raw. He doesn't usually eat the raw.

So, here are a couple numbers from his meter recently...breakfast is at 7am, dinner at 7pm.
am - 311, 0.5u
pm - 31 (holy crap!!!!) he got anything he wanted that night!
am - 385, 0.5u
pm - 95

So he hasnt gotten his shot in the pm tonight or last night. I know tight control is what it's about and I don't expect numbers to be the same all the time, but our foster cat has been very predictable and ranges from 115-250 typically, with an occasional unexplainable high.

Sonny was actually OTJ for a week or so and then he started with a bunch of high BSs in a row - >400 and he wasn't sick.

Since Sonny gets such a low dose of insulin, would he benefit from pills instead? Being a type 1 myself, I don't have any experience with the pills and don't know what they really do. Or possibly switching to ProZinc because it's a lower concentration?

I hope I'm not coming across as defensive, but we're frustrated and learning and baffled and want to do what's best for Sonny. He's a great cat - he hugs your neck and drools like a fiend when he's happy - and I can't believe his previous owners wouldn't even switch him to canned food.

Thanks for any insight/info/suggestions! And thank you for reading this dissertation! :D
 
Hi Pati, I'm so glad that sweet Sonny is with you. He's such a handsome little man.

He went to the vet today, correct? Did the vet say anything about this teeth? Some sugar kitties have trouble with teeth and urinary tract infections because of the sugar in their saliva/urine and the wet and warm is great for bacteria. Any bloodwork done? Check to see if white blood cell counts are up?

I'd be curious about that, some kitties get bad numbers when they are in need of a dental or have an infection brewing.
 
Hi Jennifer!

The vet did check his teeth and didn't think they were bad. A little tartar, but no red irritated gums. he's peeing normally. No other signs of infection or illness in anyway.

He did take blood to do a frustosamine test, but no CBC at this time. No reason to.

ETA: And his numbers have always been baffling - this isn't a new thing.
 
The numbers may be baffling due to inconsistent dosing of Levemir, variable carb levels in food (if he's sensitive, even 1% may alter his glucose level), plus all the normal impacts on glucose such as activity level, other health issues, and possibly, an intermittently functioning pancreas.

If you change only 1 thing at a time, it may be possible to tease out what changes have what impacts.
 
Okay, we are very consistent in what Sonny gets fed, how much, and when. The only variable has been the dosing change.

I re-read the Levemir link and that information makes me think that Sonny should get a shot of insulin no matter what his pre-meal BS reading is because the insulin takes a few hours to affect the blood glucose and by that time, the food has been digested and into the blood stream and the blood glucose is rising. This makes the mid-meal readings more important than pre-meal readings. Is this right?

I hope everyone has a wonderful and happy Thanksgiving!
 
pgithens said:
Okay, we are very consistent in what Sonny gets fed, how much, and when. The only variable has been the dosing change.

I re-read the Levemir link and that information makes me think that Sonny should get a shot of insulin no matter what his pre-meal BS reading is because the insulin takes a few hours to affect the blood glucose and by that time, the food has been digested and into the blood stream and the blood glucose is rising. This makes the mid-meal readings more important than pre-meal readings. Is this right?...
Click to expand...

OK, great on the consistency! That really helps ensure that when you change just the dose, the effect you see is do to that change.

Mostly right about giving the insulin, with the exception that if the preshot is between 150 and 200, you may need to stall and test every 15 minutes to make sure the glucose level is rising before shooting. If he is under 150, I would't shoot until you have gathered LOTS of test data showing it will be safe AND experienced Levemir users agree it will likely be safe.
 
Other users will find it helpful to see a spreadsheet of the test numbers when giving you feedback, plus the color coding helps you see patterns in the test values.
 
okay, i was able to take a few of Sonny's blood glucose values and put them in a spreadsheet. it's just the last couple days, but you can see that if he gets his normal 0.5U of insulin, he bottoms out mid-day. if he doesn't get any insulin, he goes high....

so here's the link to his spreadsheet. let me know if it doesn't work for anyone....

Pati
Sonny's spreadsheet
 
I'd lower the dose, do you have the .3 cc syringes? The barrel is a little bigger with those so you can pull up a smaller dose. I purchased reading glasses at the local pharmacy so I could see for the smaller doses.

Hopefully others will chime in and let you know what they think.

Sonny is such a lucky little man because you adopted him :)
 
I would agree with lowering the dose. You need to find the dose that allows you to shoot safely every 12 hours. Otherwise you'll just keep bouncing up and down.
 
EEEKKKSSS!!!

Please NEVER give insulin under 200!!! You are lucky he is alive!!!

A mid-cycle value below 50 means you need to adjust the dose DOWN, possibly to nothing. That really high red number is probably because he went too low the previous cycle and/or overnight and his liver poured out glycogen (short-term stored sugars) to compensate. When he is under 40, you need to start treating for hypoglycemia. Read this link over thoroughly and make sure you have supplies on hand.

Please skip tonight to let his poor body recover and stabilize. Being high for 1 night to let things settle some is OK.

If he is over 200 in the morning,please post in the Lantus forum and ask their thoughts. Lantus carries over some from shot to shot, so it builds up in the system.
 
that's why it's been so scary to us! and why i'm asking for help here.

he goes high and stays there and then for the last 3 days, he dive-bombs low with NO symptoms when he didn't drops a couple weeks ago!

when he is under 40, i do treat his lows with the supplies listed in the link. i'm a Type 1 diabetic and i know all about the rebounding with the liver glucose. it sucks if you've never experienced a blood sugar of 32 yourself.

he's on Levemir, which i'm sure acts like Lantus and carries over a bit.

but if i don't give him any insulin in the morning, he doesn't go under 200 during the day, such as on 11/26 in his spreadsheet. i've re-read the Levemir guidelines several times and it states to give the injection if the blood sugar is rising after breakfast, which i have tested for. and that i should do the same shot and food for at least 3 days in a row to establish patterns and eliminate fluke data.

i have .33 syringes and reading glasses...it's really tough to see anything smaller than that 0.5U.

more than anything, i'm venting here - not sure what other forum to do it in since we're supposed to start in this one - because as a human, i know how hard this disease is. as a caretaker of a diabetic cat, it's even harder when they show no symptoms of hypos or hypers. if i should switch to another forum, please let me know where.
 
Some ideas to mull over:

The carryover with Levemir is longer than Lantus, with a nadir that tends to be later maybe around +7 hours after the shot. With the reading glasses, try to aim for 0.25 units as you've already demonstrated that 0.5 is too much.

You might fill a reference syring with colored water for comparison.

An alternative is to slightly adjust the carbohydrate level closer to 10% while using insulin, rather than as low as possible.

Or, you might hold the insulin and feed the lowest carb food you can find and test regularly for a c3 days to see if he even needs insulin. He might need that long to clear the swings he's having from going low, then being fed hypo foods to compensate.
 
We do have a Levemir forum, though it is not quite as active as the Lantus forum.
 
Patti, he really needs a much lower dose. I would practice drawing .25u (use an old syringe and some water or something). However, he may need even less than that in order to give a consistent dose. My Cami is on .1u right now. Not kidding.

Here is a link to a post on the lev forum where I have photos and instructions for drawing these tiny (micro) doses. It's called the drop method. They do take practice and all strong reading glasses - and a good light. A back light helps a lot. http://felinediabetes.com/FDMB/viewtopic.php?f=10&t=34424#p360982

Anytime you have a cat going from 400 to 24 to 300s, that is rebound so dose needs dialing back.

I would not give insulin on anything under 150 until you have the data that shows he is either always rising fast and will be above 150 by about +2, or data that shows he will just "surf" where he is and not drop too much - this may happen as he gets closer to his best dose. And, as you get near that best dose (that we all think is lower) he probably won't climb as fast or drop as fast, so you may have to rethink what is safe for him as things change.
 
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