Jakob Has Hit a Plateau - Any Suggestions?

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Glynnis

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Hello All,

It's been quite some time since I've had a chance to log in to FDMB. I work full-time and go to school part-time and it's been a busy month. Jakob has been steadily improving. He wasn't showing much progress initially and the vet increased his insulin (Lantus) dosage from 2 u twice per day to 2.5 u twice per day which seems to have really helped him. He is now showing readings between 6.2 and 7.8 mmol/L but I can't seem to break down past 6. My vet has indicated that he wants to see his BG in the range of 5 mmol/L. Is this an unrealistic expectation? I'm currently feeding Jakob Fancy Feast Seafood Supper twice daily. He doesn't get any treats either. Is there anything else I can do to help decrease his BG, or is it really just a waiting game now? I'm pretty pleased with how far he has come since first being diagnosed in January but want to do anything I can to improve his numbers.

I appreciate your help.

Glynnis
 
Glynnis,
Are those numbers from pre-shot tests, or are any of them from the mid cycle or nadir tests? Lantus dosing is based on the nadir readings primarily, so if you don't know how low Jakob goes in the middle of his cycle, there's no way to figure out if the dose is too high or too low. But a 6.0 is 108 US number and 7.8 is 148? (I think the multiplier is "18"?). Those numbers are actually in the "normal" BG range or close to it. I understand the vet wants 5.0. but you're pretty close. Do you have your numbers in a spreadsheet you can share with us? It would make more sense if we could see the total picture so that we could try to help you figure this out...

Carl
 
My vet has indicated that he wants to see his BG in the range of 5 mmol/L. Is this an unrealistic expectation?
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That is not in any way an unrealistic expectation. Kitties are going into remission pretty regularly here, many of them using the same insulin.

I'm currently feeding Jakob Fancy Feast Seafood Supper twice daily.
Click to expand...

Just a couple points on that. One, although the seafood flavors tend to have the lowest carb values, too much sea food/fish is not ideal. Will he only eat that flavor, or will he eat some others that are only 3-4% carbs?
And one thing that seems to help is to feed more than twice a day if possible, because that spreads the BG increase brought on from food more evenly throughout the daily cycles. Some people who can't be there to feed 3 or 4 times a day use auto-feeders, or they freeze food and let kitty eat it as it thaws so they aren't getting all the BG boost in just two parts of the day.

Carl
 
How frequently are you testing him? As Carl stated, Lantus is dosed based off of the nadir (lowest number of the cycle, about 6 hrs after the shot), so if you aren't getting those tests at least once a day you're not truly seeing how low he is dropping. Too much insulin will keep BG just as high as too little insulin. If the numbers you're getting are before his shots, then it's very possible his dose is too high.

2.5u is a higher dose for a cat on a low carb, canned diet. Most cats on a canned diet don't need much more than 1u of insulin. That's why I'm concerned the dose might be too high, especially if you didn't get to that dose based on daily nadir tests. I know how hard it can be to get them when you're super busy (I also work a full time job, a part time job, and go to grad school), but once you get into the routine it takes very little time. Because my full time M-F job is an hr away from my home, I couldn't run home and get the nadir test at lunch time (1pm), so I used to set an alarm to get up at 1am to the nadir in the PM cycle, and then do a full curve in the AM cycle when I was home on the weekends.
 
If you're not already, adding a small amount of a crushed chromium tablet (about 1/20 to 1/10 a human dose) to wet food will help with the BG regulation -- it doesn't force the numbers downward, but will help your cat's body self-regulate better. We're also having a lot of success using 'Mellit' herbal drops for diabetic cats, a couple added to the food twice daily (available here, with user reviews: http://www.petwellbeing.com/products/cat-diabetes).
 
Glynnis said:
Hello All,

It's been quite some time since I've had a chance to log in to FDMB. I work full-time and go to school part-time and it's been a busy month. Jakob has been steadily improving. He wasn't showing much progress initially and the vet increased his insulin (Lantus) dosage from 2 u twice per day to 2.5 u twice per day which seems to have really helped him. He is now showing readings between 6.2 and 7.8 mmol/L but I can't seem to break down past 6. My vet has indicated that he wants to see his BG in the range of 5 mmol/L. Is this an unrealistic expectation? I'm currently feeding Jakob Fancy Feast Seafood Supper twice daily. He doesn't get any treats either. Is there anything else I can do to help decrease his BG, or is it really just a waiting game now? I'm pretty pleased with how far he has come since first being diagnosed in January but want to do anything I can to improve his numbers.

I appreciate your help.

Glynnis
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I know that you were home testing, so I am hoping you can put the numbers you have into the sheet that most people use around here to track how their cats are doing.
If you want to aim for remission, get off insulin, you'll need to know how Jakob's using the insulin.
You've got good numbers now, but it depends on where along the cycle you got those numbers.
If it was just before shots, that's great; if it's a few hours after shots, then you have more of a ways to go.

If you can create a Google sheet, and plug in your test numbers, you may also get them from your meter, people here will be able to see what's happening with his numbers and will be able to give you some suggestions.
Create your Spreadsheet

One way to get more even numbers is to spread out the daily food total.... split up those 2 cans into maybe 4 meals and a few snacks. if you ask any human diabetic, they will tell you that smaller and more frequent meals will help to get a more even curve.

If you have the numbers written down, you can post some in here.
 
Thank you everyone for all of your replies! I will try to address all of your questions. If I miss one, it's not intentional.

I have been recording Jakob's numbers in a spreadsheet, but it's not nearly as detailed as the one you have provided. Just provides basics: time, BG and any comments. I also graph his glucose to make it easier to see any fluctuations, etc. I will start using this spreadsheet, but are there instructions somewhere on how to use it? I think I get the gist of it, the +1, +2, etc. are the number of hours elapsed? U = units, and then AMPS and PMPS are morning and evening... not sure what the PS stands for, pre-shot?? Sorry if I sound like a blundering idiot, but I want to make sure I get this right. I looked at a few other people's spreadsheets, but a lot of them seem to vary.

His pre-shot values have been between 7.5 mmol/L and 7.8. The last few curves I've done (taking his BG every 2 hours) he's gone as low as 6.2 and 6.3 at the 6 hour mark but doesn't seem to deviate much in that range of numbers climbing back up into the 7's as we hit hours 8 and 10. I'm not terribly unhappy with these numbers as just a few months ago he was reading in the low 20's.

Jakob is not picky - I picked Fancy Feast Seafood Supper because it had the highest protein content and lowest fat content out of the options that were available to me at the time. He has absolutely no trouble putting on weight, so I try to keep him on as low of a calorie count as possible. I'm also in a bit of a transition phase. I was feeding him the Hill's diabetic, low fat low carb wet food, but it's getting too expensive. I know I didn't have to feed him that for as long as I did, but I didn't feel confident enough to switch his food. He has improved significantly; he is more alert, runs around everywhere, uses his litter box far less and just seems generally happier. I'm now a little more comfortable finding something that will work for him at a more reasonable price. I also picked up a few cans of Veterinary Select Felo Dietary Management for Cats which still has a higher protein value, but is also a little higher in fat (I also can't seem to find this one in Janet & Binky's food charts.) I've tried both this one and the Fancy Feast with Jakob and neither one seems to have had a negative effect on his BG or demeanor.

I think that about covers any questions there were for me and I thank you all again for your support!

Cheers,

Glynnis
 
Would it be possible for you to get one more test daily at about 6 hours after either the am or pm shot? Getting the nadir once a week in the curve just doesn't provide enough information to show how the insulin is really lowering his BG. This is because cats can get stuck in rebound cycles--where they will have one cycle where they drop low, and then several cycles where they shoot up high because they dropped low. If you happen to be testing only at the preshots, and only doing a curve once a week, then you're likely missing those "low" numbers, if they're occurring. Which means you could be giving too much insulin. Too much insulin will keep BG just as high as too little.

The Hills M/D canned contains corn starch, and is too high in carbs for a diabetic cat. This could also be your problem. However, please make sure you're getting nadir tests and lowering the dose when you remove the M/D. Insulin needs can drop unexpectedly when higher carb foods are removed and cause a hypoglycemic insulin if the dose is not lowered.
 
I have been recording Jakob's numbers in a spreadsheet, but it's not nearly as detailed as the one you have provided. Just provides basics: time, BG and any comments. I also graph his glucose to make it easier to see any fluctuations, etc. I will start using this spreadsheet, but are there instructions somewhere on how to use it? I think I get the gist of it, the +1, +2, etc. are the number of hours elapsed? U = units, and then AMPS and PMPS are morning and evening... not sure what the PS stands for, pre-shot?? Sorry if I sound like a blundering idiot, but I want to make sure I get this right. I looked at a few other people's spreadsheets, but a lot of them seem to vary.
Click to expand...

If you start out with the template and fill in the info you have to start, in time, you will think of things that YOU want to record for Jakob.... I added a column beside ps (yes, preshot) for meds that I gave at the same time as shots, and you can use the comment field at the far right for stuff about vet visits and food given or you can even add another column if you want one for just foods.
So long as you have the dose given at each shot, the time of the shot, and the BG numbers when tested, that's the bare minimum... just like what you have been keeping.
If you are keeping the numbers in an excel sheet, you can attach a link to that sheet with past info into your signature, and then you can start the Google spreadsheet for numbers going forward.
Create your Spreadsheet

Sometimes, it's just not possible to get a +6 often, except on weekends when you are home so just get what tests you can. When working, I could not get a single +6 in the day time and I was not about to stay up late for the +6 in the evening and then be tired for work. I did curves on the weekend and got plenty of numbers, and in the evenings during the week, I got a couple tests done, and for sure a before bed test. If that was a +4, so be it. It was sometimes later, but if the numbers were fine, I went to bed.

It's sounding like you are getting terrific numbers, and if you are lucky, maybe you will be close to being off insulin soon. It will be easier to know for sure what Jakob is doing when we can see the BG numbers on the Google sheet. Numbers like 7.5 and 7.8 are terrific ps numbers, and with +6 around 6.2, you are looking at some nice surfing.
 
Well that's good to hear. I appreciate all of your advice and encouragement. I usually do a morning test before insulin and another when I get home from work again pre-shot and then one last one at bedtime. Unfortunately, I do not work close enough to home that I can feed him throughout the day or take his BG. I do all of his curves on weekends. I will try and get his numbers posted in the SS this weekend.

Have a nice evening everybody!

Glynnis
 
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