Is it ok for my cat to live in the 300s if symptom free?

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ryanms3030

ryanms3030

Member Since 2013
I have posted a few times and gotten a lot of great help from the folks here. A little background: my cat was diagnosed 2 years ago. Changed his diet and started Lantus at 1 unit 2x per day. After a couple of months he was consistently 80-150 all day and my vet started weening off Lantus until we were doing 1/2 unit once a day (which I have since learned is a bad idea).

I admittedly got apathetic with testing because I thought he was in remission. A couple of months ago he went to the vet and was over 500 and had some ketones in his blood. I got a fresh batch of Lantus and started 1 unit 2x day again and got a new ReliOn meter and did a few curves and he was getting as low as 40 on that dose so I have scaled back to 1/2 unit 2x per day. I have not had a chance to do a curve lately but do spot check and his highest seems to be around 350 right before shots but even if I test 6-8 hours after a shot he never seems to be below 250. I know those numbers aren't great but he really has no symptoms. His fur is a little matted and he has a little neurothropy in his legs but he's still able to run and jump, he's pretty active for a 10 year old cat, he eats and he is not excessively drinking or urinating like he was in the past. I hate to up his Lantus because going from 1/2 to 1 unit at a time had him going too low.

I recently read an article (that I can't find now) from a vet that said this type of regulation was fine if they don't show symptoms and a lot of cats will live with higher BGL numbers and die of other causes without ever having complications from diabetes. Another factor is that I know his teeth are not in good shape and I understand that can make regulation more difficult but the vet quoted me around $1000 to clean his teeth because of possible complications and I just can't afford that. Plus, my parents had a dog when I was younger that was put under for a dental cleaning and had complications and ended up dying a few days after it. So, I think the risk of the procedure outweighs cleaning his teeth not to mention the cost.

My question is should I be too concerned with getting him from where he is down to under 200 on a curve?
 
I would discourage that and here's why.

Glucose levels above normal cause damage to the organs - kidney damage, nerve damage (neuropathy), eye damage (cataracts/retinopathy) and heart damage. So technically speaking, the cat may die from another condition ... that may have been caused by the diabetes.
 
Actually, your cat is not symptom free. Not with that matted coat and the neuropathy.

What is the diet right now?

There are incremental steps between 0.5U and 1U. From a fat 0.5u to a skinny 0.75u to a full 0.75U to a skinny 1U. In fact, the protocol we use does not recommend increasing by 0.5U, the protocol calls for increasing in 0.25U increments.

Some people even use calipers to help them measure a consistent dose.

I agree whole heartedly with BJM. High numbers cause organ damage over time. You want to get the numbers under the renal threshold 230-280 to prevent that organ damage.

The matted coat and the neuropathy are also signs that the blood glucose is too high. The neuropathy is caused by excess blood glucose damaging the nerves. Non-diabetic BG numbers range from 40-120 or so. That 150 that your vet thought was ok is too high for a cat to be in remission.

You had your cat regulated once, why not try to do that again?
 
If you go and pick up a pack of urine glucose test strips and test his pee you will see if he is over the renal threshold. If there is sugar in his urine, then the high blood sugar is causing damage .Over time, anything over the renal threshold will cause damage to many organs. His pancreas will get more and more damaged and his blood glucose will increase. His kidneys will be stressed etc.. You are already seeing symptoms but they will get worse.

Now if I understand it the issue is 1 unit in the past was too much? That may no longer be the case since he sounds like he is too high right now, but it is possible to get 3/4unit if you have syringes with half unit markings. And indeed we normally recommend 1/4unit increases only. Can you get more tests in and show us and we can see what we think about the current dose?

Wendy
 
Thanks. He is on all fancy feast classic diet. There was about a month when I moved into my fiance's house that he had access to low carb dry food that she fed her cat. I have since eliminated that and switched her cat to the same fancy feast diet but I think the month of having some dry messed up his BGL and I'm still trying to get him back to normal.

So I should switch to .75 2x day for now? I really need to do a curve but honestly it will be a couple of weeks until I have a full day that I can do it.
 
I can understand the concern of increasing the dose by 1/2 unit, would you be more comfortable increasing by .25 (1/4 unit) instead?

You don't need to do a curve if you are testing throughout the cycle. I never did an official curve, but i did spot check at different times each cycle.

You mentioned that he has neuropathy - that means he is not symptom free - neuropathy is a symptom that he is not regulated and probably needs more insulin. in addition, you can add methyl vitamin B12 (Methylcobalamin version) to his food daily - zobaline is the feline formula -

http://www.ilifelink.com/zobaline-for_d ... blets.html

if the cat needs a dental, this could be another reason why his bg's are higher than normal. I get the fear of putting a cat under anesthesia. I take my cats to a dental specialist and don't have the general vet do dentals on my cats. I pay more for it, but I feel more comfortable knowing that someone who specializes in dentistry is handling my cats. you may want to see if there is one in your area that can do the dental for you.
 
Well, you can do spot checks to build up the spreadsheet and give us an idea of what is going on until you can do a curve.

Pick a AM/PM shot schedule that will give you time to take another test before you leave for work.

Test when you get home from work. This might be a +10 or a +11 time.
Test at PMPS
Test at +2
Test before you go to bed, which could be anything from a +3 to a +5-6 depending on your schedule.

And if you ever think something funky is going on, you can set your alarm to get a test in the middle of the night. ;-)

Not fun, but doing this gave me some peace of mind when I thought Wink might be dropping too low. Or the time he threw up after the shot, I set my alarm to wake me up every hour for about 4 hours and then every 2 hours to get a test to make sure he was ok.
 
I would up the dose to 0.75 and see how that works for him.

regarding the curve - don't focus or think about it. it honestly isn't necessary. If you can get tests in during each cycle you don't have to do a curve. really there is no rule that says you have. Look at Maui's chart, I never did one.
 
Hillary & Maui said:
regarding the curve - don't focus or think about it. it honestly isn't necessary. If you can get tests in during each cycle you don't have to do a curve. really there is no rule that says you have. Look at Maui's chart, I never did one.
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Good info, Hillary!

Doing a curve with a long-acting insulin is highly overrated. A curve with the long-acting insulins such as Lantus or Levemir will only give you a single snapshot in time.... on that day. One can actually get a better idea of what a particular dose is doing by getting random spot checks throughout the week.

For example: If you happen to do a curve on a day kitty is bouncing from a low number... you'll probably see high numbers. If you increase the dose based on that single curve you could easily over dose kitty and inadvertently cause a hypoglycemic episode. :shock:

When obtaining random spot checks you want to look for:

  • Onset - the length of time before insulin reaches the bloodstream & begins lowering blood glucose
  • Duration - the length of time insulin continues to lower blood glucose

Like Hillary, I've never intentionally set out to do a curve. Random spot checks at different times will yield much more information with the long-acting insulins. :-D
 
Thanks for all the advice. I'm going to start doing more spot checks and less curves. My only problem is that the last curve I did after upping his dose back to 1 unit 2x a day he dropped to 40 at his lowest and that freaked me out. Of course he had no symptoms of hypo and was acting fine so it makes me wonder if when better regulated he was dropping that low every day and I just didn't know. But for now I have gone up to .75 2x per day and will spot check
 
We tend to say, if you get a reading that is 50 or under, then the cat earned a dose decrease. Meaning you want to reduce the dose, not increase it.

And also dose changes are not necessarily based on just one test alone. It's why getting spot checks throughout the cycles is helpful.

Have you read the information on the Lantus page?

Here is an excerpt: viewtopic.php?f=9&t=1581

Many Lantus and Levemir users in this forum have been successful following a somewhat modified version of this Tight Regulation Protocol for the last few years. These "general" guidelines are based on anecdotal evidence and personal experiences of laypersons frequenting the forum.

"General" Guidelines:

Hold the initial starting dose for 5 - 7 days (10 - 14 consecutive cycles) unless the numbers tell you otherwise. Kitties experiencing high flat curves or prone to ketones may want to increase the starting dose after 3 days (6 consecutive cycles).

Each subsequent dose is held for a minimum of 3 days (6 consecutive cycles) unless kitty earns a reduction (See: Reducing the dose...).

Adjustments to dose are based on nadirs with only some consideration given to preshot numbers.


Increasing the dose:

Hold the dose for 3 - 5 days (6 - 10 consecutive cycles) if nadirs are less than 200 before increasing the dose by 0.25 unit.

After 3 days (6 consecutive cycles)... if nadirs are greater than 200, but less than 300 increase the dose by 0.25 unit.

After 3 days (6 consecutive cycles)... if nadirs are greater than 300 increase the dose by 0.5 unit.


Reducing the dose:

If kitty drops below 40 (long term diabetic) or 50 (newly diagnosed diabetic) reduce the dose by 0.25 unit. If kitty has a history of not holding reductions well or if reductions are close together... sneak the dose down by shaving the dose rather than reducing by a full quarter unit. Alternatively, at each newly reduced dose... try to make sure kitty maintains numbers in the normal range for seven days before reducing the dose further.

If an attempted reduction fails, go right back up to the last good dose.

Try to go from 0.25u to 0.1u before stopping insulin completely.


Random Notes:

Because of the cumulative nature of Lantus and Levemir:
An early shot = a dose increase.
A late shot = a dose reduction.

A "cycle" refers to the period of time between shots. There are 2 cycles in one day when shooting twice a day.

Sometimes a dose will need to be "fine tuned" by adding some "fat" or "skinny-ing up" the dose.
 
ryanms3030 said:
Thanks for all the advice. I'm going to start doing more spot checks and less curves. My only problem is that the last curve I did after upping his dose back to 1 unit 2x a day he dropped to 40 at his lowest and that freaked me out. Of course he had no symptoms of hypo and was acting fine so it makes me wonder if when better regulated he was dropping that low every day and I just didn't know. But for now I have gone up to .75 2x per day and will spot check
Click to expand...

Those spot checks you will be doing sound like a good plan.
 
Quick update. I increased back to .75 units 2x day for the last days. I woke up at 2am to check him last night (6 hrs after his evening shot) and he as around 70. I was in a rush this morning so I didn't test before his shot but I will test tonight to see where he is right before the shot as the Lantus wears off.
 
I would not increase anymore right now after getting that 70 BG last night. That is a normal, non-diabetic cat blood glucose number.

Would you be willing to set up our standard format google spreadsheet and track the BG numbers and dose there? It would help us to help you better.

Instructions here: http://www.felinediabetes.com/FDMB/viewtopic.php?f=6&t=18207 Please ask for help if you have a problem with the setup or signature link.
 
I wanted to give a quick update and ask for advice:

I upped his dose of Lantus to 3/4 unit twice daily and a few days ago I went up to 1 unit twice daily. Last night he was around 400 before his evening shot. I just tested him today 5 hours after his morning shot and he was at 314. I've just been doing spot checks and the lowest I've seen lately was about 150 on the 3/4 unit dose but he still seems to be consistantly around 300. Should I keep increasing? I know I should wait a week before increasing again.

Last year he was completely regulated on 1/2 unit does and same exact diet where he was 70-150 all day. I'm guessing he is getting insulin resistant? I really want to get his bgl under control but I'm also afraid to increase too much because I have to leave him alone most of the day and I can't watch for hypo symptoms a lot of the time
 
For insulin resistance, it's usually not until they're close to 10u a day that it's considered. It might just be a seasonal increase he's going through right now, it might be related to the cycle of the moon (no, seriously! some cats are affected by this), it might be any number of other things. Is he still getting fed the Fancy Feast Classic and you're sure he's not sneaking into any kibble? Have you taken him to the vet recently for a checkup? He might have an infection (i.e. dental or UTI) that can be spiking his numbers.

Deb & Wink said:
Would you be willing to set up our standard format google spreadsheet and track the BG numbers and dose there? It would help us to help you better.

Instructions here: http://www.felinediabetes.com/FDMB/viewtopic.php?f=6&t=18207 Please ask for help if you have a problem with the setup or signature link.
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If you could pretty please set up the spreadsheet Deb linked above, it would help give us a better idea of what might be going on. :-D
 
Thanks. I will try to work on the spreadsheet.

He is on 100% Fancy Feast classic. We have 3 cats and they all get the same food so no dry in our household.

We went to the vet a month ago and other then his bgl being close to 500 , everything else looked good. So I got some fresh Lantus after that and have been increasing dose and that's were we are now
 
Wendy&Tiggy said:
Let's see the spreadsheet, we want to check for bounces and so on.. How long was he on 0.75 before you Increased?
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Will do. He was on .75 for about 3 weeks and has been on 1 unit for almost a week.
 
I started a spreadsheet. I'm only 3 days in but I posted it in my signature per the instructions and just want to make sure people can access it. Thanks
 
Ok, thank you for the 3 days of data on the SS so far.

Here is what I see:
1. You test at +11 but not getting the pre-shot tests. We always advise people to get those pre-shot tests. They go in the AMPS or PMPS column depending on the time of day.
2. You have a note on 6/9 that you got a 201 30 minutes later. That should go in your PMPS column because that is the number you used for the shot.
3. Good job on delaying on 6/9 pm and retesting in 30 minutes.
4. For future reference, If the number is rising, not food influenced for the last 2 hours and above 200, you are usually ok to give the full shot. That is what you would have been advised to do if you had posted and asked for advice. Nothing wrong with giving a reduced shot. Simply another option.
5. You can always post for advice if you are not sure about shooting. Remember to put the question mark icon on the post and change the header to "dose advice needed" You need to go back to your very first post in the topic, click on the edit icon over towards the right and then you can make your changes.
6. Not bad numbers over all.
7. 6/7 PM. That's a bounce from those low pink 300's to those greens and back up to the low pinks again.
8. On 6/8 PM, Units column is blank. did you skip the shot or missed the data entry?

Any chance of getting some of that dosing history and BG numbers before 6/7? It might help us see more of a pattern.

All in all, I would say you are doing a good job on getting some test numbers.

Since your cat is more than a set of numbers, we like to know how he is feeling. How are the 5 P's? Peeing, pooping, purring, preening, and playing. Those along with the appetite give us a WCR or whole cat report.

I know you asked for some dosing advice, and were looking to see if an increase is in order. It can take up to 72 hours to clear the bounce which you got on 6/7 pm. So my advice to you for now, is to hold the 1U for this PM cycle also. It gets a little complicated, because you gave a reduced dose last night. That means the depot will need to refill a bit more and you may need to hold the dose a few more cycles beyond tonight.
 
Thanks for the advice. The 11+ numbers are actually pre shot. I always test pre shot, I just was confused about where to enter it in the spreadsheet. 6/8 pm shot was 1 unit, forgot to enter it.

His 5 p's are all good right now. He uses the litterbox regularly and not peeing excessively or drinking water excessively right now. He cleans himself obsessively and purs whenever he gets attention. And he has been playing with the other cats chasing each other around and wrestling. The only symptom that I clearly notice is that he is long haired and his fur is still not as fluffy as it is when he's healthy, still a little matted.
 
All those clinical signs look good. They mean he is feeling good! :smile:

Thanks for the clarification and I see you have corrected the spreadsheet. Now, if you test twice in an hour, like you did last night, where you got the 170 and then the 201, you can put 2 numbers in the same cell. They won't color code correctly since one of the numbers is a blue and the other is a yellow range.

What some people do is to put in the first number (which would have been your +12 or PMPS) and then right below it, the next number with the time differential. Like this

170
201
@+12.5

For future reference, please note any delayed or early shots in the remarks column. Just like you did for the AM shot today, 6/10.

early shot = dose increase
late shot = dose decrease

How are the neuropathy symptoms now? Walking on his hocks a bit?
 
I don't really notice him walking on his hocks but he does look like he walks gingerly or limps a little in his rear legs but he's still able to run and jump. Hell get up on perches that are 4 feet tall and jump back down to the ground without any noticeable discomfort. It also seems like his eyesight is getting better. I have been able to tell in the past when he seemed to have trouble seeing things in front of his face but now he is seeing birds and animals out the window and perking up and running from window to window to watch them
 
ryanms3030 said:
...The only symptom that I clearly notice is that he is long haired and his fur is still not as fluffy as it is when he's healthy, still a little matted.
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He may need a bit of help getting caught up on grooming. For mats, use a wide-toothed comb, place your fingers between the skin and the outer edge of the mat, and comb out from the ends inward. It'll be slow, so you don't tug on the mat. If you don't care about a perfect coat, a mat cutter has bladed teeth (sharp!!!) that will cut through the mats. Once the mats are gone, a boar bristle brush will help distribute the natural oils and remove dander. Lastly, a bath with some Dawn will get out the excess oils without hurting the cat. Do not bathe before removing the mats as it will make them tighten up into felt that you'll have to cut out.

If one is so inclined, shaving down the cat can get the worst of the mats and clumps out, makes bathing less difficult, and lets the coat start growing out more healthy.
 
I did pretest shot at 184 and tested 30 minutes later and got 172. I have to leave for work so I don't want to shoot anything right now. Should I skip this dose or shoot him when I go to lunch (which I can do) but that will be 4-5 hours past his regular shot
 
3 options.

1. Skip the dose
2. give a reduced dose, half the normal amount.
3. keep stalling.

But you are getting a dropping number so better to skip. If you shift the shot to 4-5 hours at your lunch time, each subsequent shot will need to be moved the same amount of time to keep on the 12/12 schedule.

You can move the shot times back 30 minutes each day.
With lantus, late shot = dose reduction, early shot = dose increase.

You're probably better off skipping this AM shot entirely and starting back up with the shots this evening.
 
Thanks for the quick response! Everyone is so helpful here, much more helpful than my vet, I'll hold off
 
Good on skipping the shot. That means you can give the PM dose at your regular time.

If your shot times have not been fitting well with your schedule of work and life, now is a good opportunity to think about changing those shot times to something that would work better for you.

Expect the BG's tonight to be higher from no insulin with that skipped shot. It's ok. We'll get your kitty back on track.

"Better too high for a day, than too low for a minute."

ETA: for future reference, if you have an immediate need or a question that may be a health emergency, please go back to your very first post in the thread , click on the little edit box over towards the right and change the icon that shows up from the default NONE. Either put the question mark icon on if it something that is not a health emergency and can wait a bit. Or put that 911 icon on it's more or an emergency situation like if your cat is dropping into low numbers and you are worried. It gets our attention quick and our adrenaline pumping.
 
Deb, It's only been a few days and he is already skipping shots.. Either he has to trial by fire and shoot low or a dose reduction might be in order so he can give the shot more consistently?
 
Wendy, he started with lantus, back two years ago. Stopped testing because he thought cat was in remission. Not all that much data on the spreadsheet but this cat has been on insulin for more than a few days.

So yes, two choices.
1. reduce the dose
2. learn to shoot low numbers

If your cat was in remission and has come out of it, you want to be more aggressive in the dose changes and get him back into remission if possible.

Therefore, you learn to shoot the low numbers. Please read this, sticky from over in ISG Lantus TR on handling and shooting low numbers. http://felinediabetes.com/FDMB/viewtopic.php?f=9&t=147
 
Deb & Wink said:
Wendy, he started with lantus, back two years ago. Stopped testing because he thought cat was in remission. Not all that much data on the spreadsheet but this cat has been on insulin for more than a few days.

So yes, two choices.
1. reduce the dose
2. learn to shoot low numbers

If your cat was in remission and has come out of it, you want to be more aggressive in the dose changes and get him back into remission if possible.

Therefore, you learn to shoot the low numbers. Please read this, sticky from over in ISG Lantus TR on handling and shooting low numbers. http://felinediabetes.com/FDMB/viewtopic.php?f=9&t=147
Click to expand...

Thanks for the link. Makes me think I should have shot him as scheduled this morning...live and learn. When he was first diagnosed I used to shoot 1 unit every 12 hours and never ever tested except for a 12 hour curve every 2-4 weeks and I never worried about going low. That was going based on my vet's care instructions. Now I've been spot checking and pre shot testing. The last curve I did was about 2 months ago after getting fresh lantus and going from 1/2 unit to 1 unit shots and at one point he dropped into the 40s with no symptoms but it still freaked me out. This morning I know if I shot him as scheduled I would have been at work for the period on the curve where he did drop low that one time so I worried about not being able to monitor him otherwise I would have just shot or shot low. I've read a lot not to shoot if he's under 200 but after reading that post I would not really be so worried unless he was under 100 at least.
 
Deb & Wink said:
Wendy, he started with lantus, back two years ago. Stopped testing because he thought cat was in remission. Not all that much data on the spreadsheet but this cat has been on insulin for more than a few days.

So yes, two choices.
1. reduce the dose
2. learn to shoot low numbers

If your cat was in remission and has come out of it, you want to be more aggressive in the dose changes and get him back into remission if possible.

Therefore, you learn to shoot the low numbers. Please read this, sticky from over in ISG Lantus TR on handling and shooting low numbers. http://felinediabetes.com/FDMB/viewtopic.php?f=9&t=147
Click to expand...

Thanks for the link. Makes me think I should have shot him as scheduled this morning...live and learn. When he was first diagnosed I used to shoot 1 unit every 12 hours and never ever tested except for a 12 hour curve every 2-4 weeks and I never worried about going low. That was going based on my vet's care instructions. Now I've been spot checking and pre shot testing. The last curve I did was about 2 months ago after getting fresh lantus and going from 1/2 unit to 1 unit shots and at one point he dropped into the 40s with no symptoms but it still freaked me out. This morning I know if I shot him as scheduled I would have been at work for the period on the curve where he did drop low that one time so I worried about not being able to monitor him otherwise I would have just shot or shot low. I've read a lot not to shoot if he's under 200 but after reading that post I would not really be so worried unless he was under 100 at least.
 
The 200 threshold for the shoot/no shoot decision is until you can gather more data on how your cat does on a dose. How far does 1 unit drop him? How far does 1.5 Units drop him?

Once you gather more data, you move that shoot/no shoot threshold downwards. Here in the Feline Health forum. the threshold is 200. Over in ISG Lantus TR, the threshold is 150. When you cat is doing well and is earning reduction after reduction, in preparation for going OTJ, you need to learn to shoot low.

Leaving out extra food, maybe some MC (medium carb) or HC( high carb) will work for you cat. Many cats will go looking for food if they feel their BG's dropping low. Again, it's knowing your cat and seeing if he does this.

It's all about how much you know about your cat and if you can be around to monitor with a dose increase or with the low numbers or if your cat will go hunting for food if you need to go to work. Know your cat!

Many people never home test. They go to the vet for curves and fructosamine tests. That can get expensive and not everyone's budget can accommodate that cost.

Vets also don't like to see cats below 150. We know, that is the only way to get your cat to remission. Studies have proven that a good long lasting insulin in combination with a low carb diet and intensive home blood glucose testing can get your cat to remission, not simply regulation. Go for the brass ring, grab it if you can. Not every cat can get to remission but why not try?
 
Starting to see some nice greens - if you can you might want to get more mid cycle tests this weekend to see if there are any more hiding in there..

Also since this is your second time around you would be advised to start posting on the tight regulation forum where the experienced dosing members there can advise you on dose. Its a great sense of community and if anyone can help its them! http://felinediabetes.com/FDMB/viewforum.php?f=9

Before that though it would help them and us if you could set up a profile. http://felinediabetes.com/FDMB/viewtopic.php?f=6&t=79123

Wendy
 
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