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Suzanne & Cobb(GA)

Suzanne & Cobb(GA)

Member Since 2013
I hope I'm posting correctly. I've been lurking on this board since Cobb, my 12 year old tabby cat was diagnosed with diabetes back in April.

Some history...

Cobb has been on several different types of food during his life. The food ping-pong started when he had a blockage in his urinary tract back in 2007. We removed it and he went on prescription dry food. I relocated and found another cat-only vet and they said he weighed too much (around 19 pounds at the time). They switched him to wet w/d food. He lost several pounds in a year and they freaked out and put him back on the dry. Not surprising, he gained the weight back. It was then that he started to refuse to eat wet food at all. Another relocation and I was told the w/d was never what he should have been on for weight control and now he's been diagnosed as diabetic.

I know his weight directly contributed to this.

He is currently eating Evo low-carb due to his wet food aversion. However, we have reintroduced Royal Canin diabetic into his diet and he seems to be tolerating that pretty well, so hopefully we can soon wean him off the dry food entirely.

Since his diagnosis Cobb has been on both Prozinc and Lantus insulin. His initial numbers were in the 500s so we started with a low dose (1-2 units, twice daily) of Prozinc. His numbers were initially dropping into the 300s, but the vet didn't seem happy about it, so we continued to increase -- ultimately maxing out on what we could give with the Prozinc (12 units/twice daily). She now has him on Lantus. After starting at 6 units twice daily, we've increased to 10 units.

We are using the iPet glucometer for weekly/bi-weekly glucose curves. We are consistently getting a HI reading at the start of the curve (8am) - which is a reading above 600. Today it dropped to 513, and 2 hours later had rebounded back into the 600/HI range.

I'm coming to you now because we are literally at our wit's end. It doesn't seem like the insulin is helping - although his behavior since we started the insulin is much better. He is coming around, not as lazy, and loving like he was several years ago.

I trust the vet, but I don't feel like 20 units of insulin a day is reasonable for a 17 pound cat!

I'd love to hear others' experiences/suggestions. Lantus is too expensive to be injecting twice a day with no response on the glucometer. His numbers haven't been in the 300s since we started increasing, but the vet says it isn't Somogyi rebound. I specifically asked about that during our last disappointing curve.

Any help anyone could provide I'd be MOST appreciative!!
 
Hello to you and Cobb, and welcome to FDMB!

That is a lot of insulin, and there are some cats that, for various reasons, need very high doses. But those are in the minority.
Has Cobb been tested for specific high dose conditions, such as Acromegaly?

And may I ask, how exactly did your vet make those dose adjustments/increases? In what increments, and over what time period?

Even though the vet does not think this looks like 'somogyi', I don't think there's enough data here to rule out the possibility that Cobb is actually getting too much insulin.

Are you testing Cobb's blood glucose before each shot? And are you getting any mid-cycle tests maybe 5 - 6 hours after the shot at all?

Sorry for all the questions!

Eliz
 
Hi,

Thank for your quick response!!

The answers to your questions...

1. Cobb has not been tested for Acromegaly to my knowledge. I'm guessing it is not done during a regular visit. I will ask about this when I send my next curve to the vet.

2. The vet has been increasing, usually two units at a time whenever we do a glucose curve, which is every 2-3 weeks. (We got off briefly in June/July when I had a baby.) We started with 2 units/2x daily of Prozinc in April. Maxed out at 12 units/2x daily at the beginning of September when we switched to Lantus.

3. I periodically test Cobb's glucose before his morning shot. Maybe once or twice a week. Every time I do a pre-shot test it comes back with a high reading. I very rarely do a mid-cycle test. Although his BG does drop -- sometimes into the 400 range at that time.

Here's a look at his last three glucose curves:
10/31
8:30a - 600 (gave 8 units of Lantus)
10:30a - 533
12:30p - 541
2:30p - HI
4:30p - HI

10/20
7:30a - HI (gave 6 units of Lantus)
10:30a - 414
1:30p - 319
4:30 - HI

10/4
7a - 522
9a - 558
11a - 389
1p - 544
3p - HI

I am currently in the middle of today's curve...his readings so far --
8a - HI
11a - 513
1p - HI
 
That is a lot of insulin. There is of course the possibility, as Elizabeth said, that he is a high dose cat. Here is some info on high dose conditions: http://www.felinediabetes.com/FDMB/viewtopic.php?f=12&t=375 Do any of the symptoms sound familiar?

There is the chance also that he was increased too fast and went over a good dose and now is bouncing, but most likely there would be a low number somewhere midcyle to cause the bounce. The only way to figure this out is to start testing consistently at home. ( We consider the vet numbers unreliable as most cats are stressed at the vet and stress raises bg levels, sometimes 100 points.) If he were mine, I would test before each shot and then again in the 5-7 hour range to see what his numbers look like. You could reduce the dose for a few cycles to see if the numbers are better, but if you do, monitor carefully and test for ketones daily.

If he still runs consistently high, I think I would have him tested for a high dose condition.

Just for reference. Most Lantus cats here are under 2 units. Regulated cats are in the 200+ range at preshot and under 100 at midcycle. We like to start low and go slow - starting at one unit and increasing by .25 or .5 as the home numbers indicate. Cats with high dose conditions usually take 6+ units, sometimes up to 18+ units.
 
Welcome Cobb and his mommy!

Usually when we see a cat on such a high dosage, there can be a few things going on.
  • Still eating high carb food. Is the Royal Canin wet or dry? If dry, this is probably one of the culprits as there is only a small handful of dry food that's low enough in carbs for a diabetic. It would be best if you can get him eating wet food again and it doesn't have to be expensive. Fancy Feast Classics, Friskies pâtés, and Wellness grain-free are a few OTC brands that work just fine for diabetics.
  • Has an infection or illness causing high BGs. Things like Dental infections or UTIs can cause higher BGs and often make it difficult, if not impossible, to regulate. Other conditions that may require the use of steroids can also impact BGs.
  • The "right dose" was bypassed and the overdose is causing the higher numbers and/or insulin resistance. Since your vet raised the dose by not just 1u at a time but by 2u, this is a very real possibility. We usually only raise/lower doses in .25u increments.
  • A high dose condition like Elizabeth mentioned. You will have to request this be tested for specifically, but I don't think we're at that point yet.

As for testing, I don't think you're going to be able to see the full picture on how Cobb is really reacting to the insulin by running a curve on him one day every week or two since we have no idea how he's reaction throughout the rest of the week and he could very well be bouncing on the days you happen to run the curves, especially if the dose is too high.

With Lantus, the best times to test each day are pre-shot to make sure he's high enough to give the shot (over 200) and mid-cycle tests, once during the AM cycle about 5-7 hours after the shot (when you're able to) and once during the PM cycle as a "before-bed" test. Lantus is usually dosed on the lowest point/nadir of the cycle, which is why these mid-cycle tests are so important. Then, grabbing some more tests whenever you're able throughout the week will help fill out the data even further.
 
Just a clarification...we do the glucose curves at home, not the vet.

Regarding the high dose conditions...definitely not Cushings, per the symptoms. Possibly Acromegaly? I plan to ask the vet about this when today's curve is done.

Oddly enough it looks like he is bouncing on today's curve...
8am: HI
11am: 513
1pm: HI
4pm: 537

So I'm not sure what's going on there.

However, if he was getting too much insulin, wouldn't he have a hypo episode?

Yes, it is dry Royal Canin. We are working to transition him back to wet food, although the vet has told us to leave the dry food out in the event he has a hypo episode (not that I see that happening with these odd curves).

I do know that the insulin is doing something though because he is no longer acting like he is starving. Before we started the insulin, he would eat and eat to the point of throwing up -- he no longer does this.

Also...we did add a new baby to the family in June -- which is right around when we started getting these HI readings. We gave Cobb a chance to get used to the new baby and didn't want to increase the insulin because of stress from the baby.

His curve prior to the baby's arrival was:
5am: 526 (3 units of Prozinc)
8am: 203
11am: 432
2pm: 592
5pm: 564

The one just after the baby was:
8am: 563 (4 units of Prozinc)
11a: 535
2pm: 508
5pm: 322
8pm: 539

We all then assumed the higher numbers were due to baby stress. The next curve all readings were HI after the vet had us increase to 5 units of Prozinc. That is when we started getting the HI readings.

Is that possibly when we started giving too much insulin?

I realize there could be an underlying medical issue -- we don't have the money to do ultrasounds, CTs, and MRIs at the moment. Plus, we would have to anesthetize Cobb and he almost died while he was under anesthesia when he got his bladder blockage out.

I really am at a loss. These HI readings are so concerning, and I don't want to just cut his insulin without the vet being a part of that decision. As I mentioned, last time I mentioned I thought we'd overshot his optimal dose, she disagreed.
 
Well, the first thing I would try is to get rid of the dry. It can certainly raise numbers. (recently we had a PZI cat rocket up 200 points over her usual numbers when she got into some dry.) if he will eat just wet, I would take away the dry for a few cycles when you can monitor. See if the numbers go down (it can take a few cycles)

If you're going to stick with the same dose, watch that he doesn't drop low. If he were under 40, you'd intervene with honey. We don't use dry to bring up numbers; it stays in the system too long.

I do not understand your vet reasoning with the dry. That'd be like telling a human diabetic to eat donuts if they go low, instead of daily monitoring and reducing the insulin if they go low. :mrgreen:
 
Yeah, I know it doesn't make sense. She wants us to put the dry food in foraging toys so the cat has to work to get it. Cobb (even when he wasn't diabetic) is a lazy cat, lol.

Cycles...what exactly is a cycle? How long is a cycle?
 
A cycle is from preshot to preshot -12 hours. There are low carb snacks you could try in the toy - Purebites(freeze dried meat) is crumbly and crunchy enough to work. Stella and Chewy's treats also are crunchy /crumbly.

My Oliver (a Maine Coon) was 16 pounds and overweight, having been fed Science Diet Light for years. I bought him every toy on the market but he just wasn't a cat who played. When we switched to an all wet, low carb diet, he lost 3 pounds within a year and was at a healthy weight.
 
Ok! We're going to take his dry food away tonight and give him the wet only and see how that works for the next few days and then do a full curve for the vet on Wednesday. I'll also do a pre-shot and mid-cycle prick those days just to make sure his BG doesn't fall too low. I'm home from work so I'll be able to monitor him throughout that time.

Thanks for all of your help so far! Here's hoping for better numbers this week!!
 
cobbsmom said:
However, if he was getting too much insulin, wouldn't he have a hypo episode?
Click to expand...
Not necessarily. Too high a dose can also result in high flat numbers or low numbers that he bounces back up from and can result in a couple of days with high numbers.

cobbsmom said:
Yes, it is dry Royal Canin. We are working to transition him back to wet food, although the vet has told us to leave the dry food out in the event he has a hypo episode (not that I see that happening with these odd curves).
...
Also...we did add a new baby to the family in June -- which is right around when we started getting these HI readings. We gave Cobb a chance to get used to the new baby and didn't want to increase the insulin because of stress from the baby.
Click to expand...
Was this also around the time you switched back to dry?
 
Was this also around the time you switched back to dry?
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No. He's been on dry for years. I switched to wet food only back in 2009 when I moved to FL. The vet said he was overweight. So I moved him to wet food. He lost weight, but the next year the same vet said he'd lost too much weight and wanted him to put some back on so she switched him to w/d dry. He had been on w/d wet.

Then we moved to Georgia, where we are now. We weren't happy with the first vet he visited -- they tried to take stitches out of him -- he didn't have any and when we said it was the wrong cat, she still proceeded to come in and try to take out these nonexistent stitches. So when she told us he was borderline diabetic in 2012, you can understand how it was difficult for us to trust that information. However, they gave us a list of OTC wet food that would be good to move him on. We gave him probably a dozen different kinds -- he refused ALL of them to the point where he would not eat, no matter how hungry and the food would spoil.

At that time we read about EVO and started getting that since it was a lower carb dry food.

When we bought our house we found a vet that we like and, so far, trust. She diagnosed him as diabetic and said to move him to Royal Canin diabetic dry since he wouldn't eat the wet food. But gave us a bunch of wet food to try. She said she wanted to try the insulin first since he wouldn't eat it. We got him used to the shots and testing -- then had the baby -- and are now working to switch him onto wet food entirely.

I've taken up his dry food for the night...gave him a small can of the Royal Canin diabetic wet. He's a big cat - 17 pounds - so I'm hoping that will tide him over until tomorrow morning.
 
I'd feed him as much as usual or a little more. Unregulated diabetics are hungry as their bodies aren't processing food well. Oliver at 16 pounds got 2.5 cans of Fancy Feast daily.
 
Sue and Oliver (GA) said:
Well, the first thing I would try is to get rid of the dry. It can certainly raise numbers. (recently we had a PZI cat rocket up 200 points over her usual numbers when she got into some dry.) if he will eat just wet, I would take away the dry for a few cycles when you can monitor.
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I agree with Sue; let's try on getting him off dry completely for a couple of weeks and see how he does with some more daily testing at pre-shots and mid-cycle. If he's still not any lower, then we'll be able to look at the other options and get him tested possibly for Acro or some other high-dose condition (IAA or EPI possibly?).
 
Hi Cobbsmom,

Great advice there from Sue and Kay. (Oooh, I just love this forum! :smile: )

I woke up this morning thinking about something that you wrote in your first post.
If I've understood you correctly; Cobbs numbers were in the 300's, then the dose was increased, and the numbers went UP.
To my simple little mind that has all the hallmarks of too much insulin. (That is, unless there was another unknown factor concidentally raising the blood glucose at exactly the same time.)

If your vet was increasing the dose in 2 unit increments (?) then it may well be that the dosage went beyond the 'right' dose.

It will be interesting to see if there is any change in Cobb over the next few days.

What's your name BTW?

Eliz
 
Hello and welcome. My kitty has acromegaly. If you do decide to get Cobb tested, you have to get a blood sample send to Michigan State University for an IGF-1 test. Most vets have been trained that acromegaly is rare, but recent research has shown it's more common than originally thought. My vet thought I was wasting money on expensive tests and was more surprised than me when the results came back positive. She has since recognized a second acrocat in her practice.

FYI, Neko didn't really show any of the symptoms other than extreme hunger (hard to differentiate from unregulated diabetic hunger) and her high dose. We got to 8.75 units, but we got there in either .5 or .25 unit increments, so we know we hadn't passed the good dose. I made sure she was on a low carb wet food, had her teeth checked and b/w to confirm no infection first before we got the IGF-1 test.

High doses definitely do not always mean high dose conditions. Just this last week someone here started fostering a cat that was on 11 units of Levemir twice a day, eating dry food, overweight, but not getting tested. After less than a week, she now has him on wet food and it looks like he going to get less than 1 unit after tonight. He was way overdose and the dose was increased too fast.
 
If I've understood you correctly; Cobbs numbers were in the 300's, then the dose was increased, and the numbers went UP.
Click to expand...

His numbers at the nadir sometimes fell into the 300 range, sometimes not. They always started in the 500 range. I really think the vet is going off the pre-shot number and trying to get that lower since it is so high.

It was only after we had the baby that we started getting the HI reading. He had been at the same dosage (I'd have to look back to see what it was then) for several weeks because we didn't have time to do a BGC and we weren't doing daily readings.

However...some good news to report this morning! We took away his dry food last night (which led to a hungry cat at 2am), BUT...his AMPS was 505. Again, I'd have to look back, but I think that's the lowest it has ever been.

BTW...my name is Suzanne. :smile:
 
Still really high but good it came down a little. Every cat is different. Some respond to a food change overnight; some take a few cycles. It's a good idea to keep checking his levels and keep feeding the wet and see if things improve.

You might increase his food intake a little if he is keeping you up at night. How much is he eating each day? What kind of wet?

Anytime you can get a ketone test, it's a good idea. With Oliver, we would fill a clean litter box with aquarium gravel and leave him alone with it. He couldn't stand not to christen a clean box. :-D The gravel wouldn't absorb the urine so we could swoop in and get our sample.
 
I'm going to check his levels several times today.

Right now I don't know exactly how much wet food to give him. He was free feeding (per the vet) dry Royal Canin diabetic. It was an auto feeder that deployed 3x a day. No idea how much he was actually eating, but he wasn't scarfing it down and then acting hungry like he did prior to starting insulin therapy.

Last night we gave him a 3oz can of RC diabetic wet around 7/7:30 and a small handful of dry. My husband fed him 3oz at 3:30 this morning when he left for work. He seemed hungry at 2am so I'm guessing the food fills him for about 6 hours.

I could use some direction on how much to feed since we've taken the dry food away. He weighs 17 pounds.

Also, his AMPS number is still really high but lower than normal so it's encouraging.
 
cobbsmom said:
I really think the vet is going off the pre-shot number and trying to get that lower since it is so high.
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Lantus dosing is based moreso on the nadir than on the pre-shots. Your vet is probably more familiar with ProZinc and that's why he was basing the increases off of pre-shots.

I believe the RC wet is still too high in carbs. From the catinfo.org FD page, she mentions that Purina DM wet is the only "prescription" food that seems sufficiently low enough in carbs (under 10%) for diabetics:
There is nothing magical about the veterinarian-prescribed diabetes-management diets. In fact, several of them such as Hill's m/d and w/d (dry and canned), Purina DM dry, and Royal Canin DS (dry) are far too high in carbohydrates making them very inappropriate choices for all cats but especially diabetic patients. Purina DM canned is sufficiently low in carbohydrates (~7%) but it is expensive and it is predominantly liver which should not make up the bulk of a cat's diet. There is absolutely no reason to spend money on this product.
Click to expand...

So, if you switch Cobb to an even lower carb food than the RC wet, you'll probably start seeing even better numbers. Just make sure you're monitoring closely! Cobb's need of insulin might decrease significantly and it might happen fast, so we want to be able to decrease the dose in conjunction with the drop in numbers so he doesn't overdose on insulin.

cobbsmom said:
Right now I don't know exactly how much wet food to give him. He was free feeding (per the vet) dry Royal Canin diabetic. It was an auto feeder that deployed 3x a day. No idea how much he was actually eating, but he wasn't scarfing it down and then acting hungry like he did prior to starting insulin therapy.
Click to expand...

You can still free-feed the wet. Cats seem to self-regulate their food intake pretty well when they're on low carb, wet food (they usually don't overeat). Just add water to it so it doesn't get dried out. Some people also mix it with water and freeze it and then leave the "meatcicles" out for the kitty to gnaw on as it defrosts. Timed feeders also work great with wet food. If your kitty has always been a grazer, there's no reason to stop him from grazing now. ;-)
 
Also, since you're getting so many more tests in now, it'd be helpful if you could create a spreadsheet for us to easily view the numbers you're getting across each cycle.

How to use the spreadsheet:
KPassa said:
Questions on understanding how to use the spreadsheet get asked a lot, so I thought I'd share a quick run-down of spreadsheet-specific terminology:
  • Fur shot: when the syringe needle pokes through almost like a sewing needle through fabric and it is unknown how much, if any, insulin actually made it inside the cat. Usually detected by wet fur or the smell of insulin (it smells like band-aids or scotch or antiseptic). IT IS ALWAYS ASSUMED THAT THE CAT GOT THE INSULIN AND YOU NEVER GIVE ANOTHER SHOT. It is always better to miss a shot than to give too much insulin.
  • AMS/PMS: morning (AM)/evening (PM) shot
  • AMPS/PMPS: morning pre-shot test/evening pre-shot test (it's assumed the shot is given within 15 minutes or less of this test).
  • +1, +2, +3...: How many hours after a shot, i.e. +1 would be one hour after their last PS (pre-shot) test
  • BG/BS: Blood Glucose or Blood Sugar (numbers). Usually used in relation to testing and dosing and what "level" or "point" the cat is at. Used in a sentence: "Michelangelo's BGs have been high so I've been increasing his dose."
  • AMBG/PMBG: morning/evening Blood Glucose. Used when no shot has been given at the regular shot time.
Click to expand...
 
Sue and Oliver (GA) said:
You could reduce the dose for a few cycles to see if the numbers are better, but if you do, monitor carefully and test for ketones daily.
Click to expand...

I also just wanted to point this out again in case you missed it. With numbers that consistently high, it's very important that you're testing for ketones. Here are some urine catching tips that might be of help.

ETA: You can find ketone test strips for relatively cheap at Walmart (I think they're around $5). Since you're using an iPet and we're having you test a lot more, I'm sure you're daunted by the price of the iPet test strips. :o While you're at Walmart, you might also want to invest in a ReliOn meter and matching test strips as this will save you a considerable amount of money. :thumbup Most of us here use human meters, so this won't be a problem for us, however, if you're worried about the meter numbers matching your vet's, then you could use the iPet on the days your vet wants to see a curve and use the ReliOn for all the rest of the time.
 
Ketones are a potentially dangerous condition that can occur, especially when a cat is running higher numbers. It is cause by the body breaking down fat instead of sugar and it's most easily detected in the urine. BG testing will only show if the numbers are high; it won't show if ketones are present. If ketones are present, it can lead to a dangerous and potentially fatal condition called Diabetic Ketoacidosis (DKA) and usually hospitalization and fluids are required. The sooner you catch any ketone build-up and the sooner you seek treatment, the better. This is why testing for them is so important.
 
cobbsmom said:
I got the spreadsheet in my signature. Let me know if it doesn't show up correctly. Looks like we're starting to see some change.
Click to expand...

Can see the spreadsheet perfectly, well done. And that lower number is good news indeed!
Keeping fingers and paws crossed here that this is just the beginning of an improving story for Cobb. :smile:

Eliz
 
We are DEFINITELY seeing improvement since the food switch. This morning's AMPS was 399!!! That is the lowest it has EVER been in the morning.

Now I just wished the vet had pushed the wet diet more emphatically instead of saying the dry would be okay. ERG!!

At the moment I'm still giving the 10units/twice daily, per the vet. I think I'm going to do a full curve and send it to her tomorrow. Hopefully we can start reducing the dosage.

Question to all of you -- it does sometimes take a few sticks to get a drop of blood out of his ear (we've been doing this for about 7 months). Now with more frequently daily testing will the bleeding get easier? His left ear doesn't really bleed at all so I'm stuck with only his right ear. And I'm afraid it is getting torn up with the constant pricks. I warm up his ear. And I brace his ear against an empty pill bottle. I am currently still using the lancet pen because it was easier when we were first getting started. Any suggestions on making this easier and not having his ear torn up?
 
That improvement is tremendous news, Suzanne!

And yes, it will get easier to get blood from the ear. In response to all those teensy weensy pin pricks the ear grows more blood vessels (angiogenesis, I think it's called). It almost seems that the ear 'learns' to bleed! It's quite probable that you will no longer need to warm the ear at some stage.

It's a good idea to put pressure on the test site for a good few seconds after the test (I press it between my fingers against a little piece of cotton wool). That will help prevent bruising. And some folks here use Neosporin to help heal the ear in the early stages.

Great job, Suzanne. :smile:
 
cobbsmom said:
At the moment I'm still giving the 10units/twice daily, per the vet. I think I'm going to do a full curve and send it to her tomorrow. Hopefully we can start reducing the dosage.
Click to expand...
Remember, if at any time he drops below 50, it's an automatic dose reduction. We want to keep him safe!

cobbsmom said:
Question to all of you -- it does sometimes take a few sticks to get a drop of blood out of his ear (we've been doing this for about 7 months). Now with more frequently daily testing will the bleeding get easier? His left ear doesn't really bleed at all so I'm stuck with only his right ear. And I'm afraid it is getting torn up with the constant pricks. I warm up his ear. And I brace his ear against an empty pill bottle. I am currently still using the lancet pen because it was easier when we were first getting started. Any suggestions on making this easier and not having his ear torn up?
Click to expand...

I also use a lancing pen and I pretty much only test Mikey on his right because he doesn't really like me messing with his left ear. We've been at it for over a year of testing 5-20 times a day and you can't even tell I test him. I don't even have to warm the ear beforehand any more. As Eliz said, it's very important to make sure you apply pressure after you're done as this helps stem the bleeding and reduce bruising.
 
Can you get a before bed test? Many cats go lower at night that during the day. And I find we learn a lot more with more 3-4 tests a day instead of once a week curves..

I usually recommend 4 tests a day

- always before the shot - this is mandatory as you don't want to shoot when too low. As a newbie this too low number is 200 but is reduced over time once you have the data to know if its safe.
- mid cycle - 5-7 hours after morning shot depending on your schedule. This is to see how low he is going. The low point "nadir" is what you base dose changes on since you don't want him dropping too low (under 50).
- before bed (2-3hours after Pm shot) to get an idea of what his overnight plans are. If this number is less than the pre shot test number you may want to set the alarm for a test a few hours later as this implies an active cycle.

Also you have seen the impact of a move to wet. Now imagine what a lower carb wet can do...!
Wendy
 
I'll try to get a before bed test tonight...around 10p eastern. Depends on what the baby has planned in terms of waking up and crying. :-(

But that will put us at 5 tests today...I'll update the spreadsheet afterwards.

Also, what is an active cycle??
 
Now you have two babies to get up at night for.. Humans and cat ;) I would test the cat when you are up anyway with the baby.

Active cycle is when the cats blood sugar drops down.. Could be low... Could be too low.

Wendy
 
Wendy&Tiggy said:
Active cycle is when the cats blood sugar drops down.. Could be low... Could be too low.

Wendy
Click to expand...

So their BG doesn't always drop after they get their insulin? I thought (at least I was told) it should bottom out 6 hours after each shot. Is this not true? Could I have been providing non-active cycle BGCs to the vet all this time? If day time is not an active cycle, what is going on during that time?

Since his BG is going down (it was 345 for his PMPS!!), what do I do if it drops below 200 overnight? Obviously I would not want to shoot the huge amount of insulin I'm currently giving! But how would I figure out what to shoot? You've mentioned that the Lantus dose is based on the nadir, not the peak. (I'm sure I'm getting ahead of myself with these questions, but since his numbers are dropping so much so quickly - at least in my mind - I want to be prepared in that event!)
 
No it doesn't always drop. If the dose isn't high enough they can sit flat. Or if the cat is bouncing then they could be going up. Bouncing explained below. Also not every cat nadirs at +6, it varies by cat and by day. So spot checks are handy.

No need to worry unless he looks like he is going to drop under 50. Get a test at 10pm and let us know and we will see what he's doing. If it's lower, then set the alarm too.

Wendy

Bounces - what are they and is my cat doing them?
When a cat isnt regulated, the blood glucose has probably been high for a while. As the insulin starts to take effect and numbers start to come down, the liver has to learn to adjust to the lower numbers. We call this "liver training school". But before it relearns that low numbers are ok, when the BG drops to a number lower than the liver is accustomed, or if BGs drop low, or if the BG drops suddenly, the liver”panics” and reacts by releasing counterregulatory hormones and glucagon. This drives the BG back up. This is what we call a "bounce". Bounces can take up to 72 hours to clear so we are generally careful about increasing doses during the bounce. Once the bounce clears, then you can see the "real" numbers and determine if the dose needs to go up or down.
.
 
Here's an example of a Typical Lantus cycle:
+0 - PreShot number.
+1 - Usually higher than PreShot number because of the last shot wearing off. May see a food spike in this number.
+2 - Often similar to the PreShot number.
+3 - Lower than the PreShot number, onset has started.
+4 - Lower.
+5 - Lower.
+6 - Nadir/Peak (the lowest number of cycle).
+7 - Surf (hang around the nadir number).
+8 - Slight rise.
+9 - Slight rise.
+10 - Rising.
+11 - Rising (one of the quirks of Lantus/Levemir: some cat's blood glucose numbers dip around +10 or +11... not to be confused with nadir).
+12 - PreShot number.

In comparison, you can also have an Inactive Cycle (where the numbers barely move) and an Active Cycle (where the numbers start to drop early and continue dropping). What you've been seeing with most of your curves are Inactive Cycles. That's why it's so important to test daily vs. weekly or bi-weekly because depending on the cycle you run your curve on, you might have picked one of the Inactive Cycles. In your case, specifically, I'm thinking it had more to do with the high carb, dry food that was keeping his cycles "inactive" (or at least looking like they were).

If he drops below 200 overnight, that would be a great sign that the diet change is working its magic. What you don't want him to do is drop below 50. If it's his pre-shot you're worried about, at any time he's under 200, we always tell people to stall:
  • Don't feed
  • Don't give the shot
  • Create a new post in this forum and/or the Lantus forum for help with a subject something along the lines of "Under 200 pre-shot - what do I do?"
  • Test again in 15-30 minutes to see if it's a "rising" number and/or if he gets over 200 (depending how close to 200 his original pre-shot was)
 
Erg...just tested at +2.5. BG is at 482. What gives?? I'll try to get another test when I wake up in the middle of the night to feed my human baby. :-)
 
Looks like the AM dose has worn off before the PM dose has started to kick in. Not too much cause for concern since it's still early in the cycle. Paws and fingers crossed that he comes down for you when you test him later tonight! :-D
 
Wendy&Tiggy said:
Any idea when he ate?
Click to expand...

Yes, sorry. I didn't see this until this morning. He ate at 7:30 -- right before his shot actually.

I got a read at about +7 after his PM shot, and then this morning's AMPS -- both were under 400, but not by much. Did I miss the nadir?
 
Looks like we're hanging in the 300s today. Still high, I know, but definitely an improvement!

Given what we've seen over the past few days, what do you think?
 
I think he's feeling better. He's been jumping up on our bed at night, which he was younger. And I think he's moving around the house more because I've noticed he isn't isolated to our bathroom as much any more. That's where his food is. I'll have to check with my husband regarding the litter -- we go through a TON so hopefully the lower numbers will lead to less urine output there!

He does still scarf down his meals though. So there's several hours during the day when there is no food out. We're talking about the freezing/put out and let melt possibility.
 
Are you still feeding the RC wet? If so, I think you'll get much better results by switching to a lower carb food, like Fancy Feast Classics or Friskies pâtés. You might want to start mixing it in with the RC first and slowly wean off the RC entirely over a few days. You can also return any unused RC for a refund.
 
KPassa said:
Are you still feeding the RC wet?
Click to expand...

At the moment, yes. We are going to go to the store on Friday and get some of the Friskies. My concern is the last time we tried to get him to eat it, he refused and he is eating this food. But we are going to try it as soon as we can get to the store.
 
I think PetSmart is having a massive Friskies sale on Friday for like $0.39 a can, so perfect timing! :thumbup

Try starting with mixing just about 1/4 Friskies to 3/4 RC to start with and then slowly increase the amount of Friskies and that might work better on getting him to eat it.
 
Awesome. Thank you!!

Question...should I continue to post in this thread or start a new one when I have updates? Just curious as to the message board etiquette!
 
That's a tough question. :lol: Some people start a new thread when something has changed (i.e. you switching completely over to wet food and are now getting lower numbers) and then post a link to their previous thread. Other people might continue posting in the same thread to keep all the information in one place, but that can lead to multiple pages worth of information. Personally, once a thread gets more than a page long, it makes it easier for me to miss something that someone has already said and it can take a while to go back through all the posts to find it. Basically, it's entirely up to you and your preference. ;-)
 
Ok, so we are seeing a huge improvement in Cobb's numbers. We started the week in the 600s and are now getting readings in the 200s. Our lowest so far today -- 6 hours post shot.

I know most of you (myself included actually) think the dosage that the vet has him on is too high, and he could theoretically be bouncing. I'm not sure we're seeing that just yet. At what point should/can I start decreasing the amount of insulin he gets? (At 10 units/2x a day even the Lantus vial, which has 1000 units empties quickly.) I'm afraid even with the numbers we're getting now the vet is going to want to up the dosage to get those higher numbers lower, and not focus on the nadir.
 
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