Jen and Bubber

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0246

0246

Member Since 2013
Hi friends! I'm Jen, and my sugarcat is Bubber. He's a 9 year old Maine Coon. He has two kitty siblings: The Dude, a 6 year old fuzzball who had a bout of Acute Renal Failure after an undiagnosed UTI in 2009, and Aiko, a 5 year old tabby who just came home to us this summer.

Bubber was diagnosed with diabetes in August after having a spell where he was voiding unusually large amounts and was obsessed with his kitty water fountain. He had a UTI on urinalysis (but not on culture; he was treated with a round of antibiotics that cleared up symptoms) and abnormal blood work indicating a high glucose level. His fructosamine was also elevated, and he had lost weight (from ~17 pounds in the spring to 15 in August).

We immediately changed his diet - removed all dry food, and offered Purina DM and then a variety of foods similar in nutrition profile, Fancy Feast, Weruva, Tiki. We rechecked blood work at 2 and 4 weeks post initial diagnosis, and they remained abnormal but we wanted to give his body a chance to recover from the UTI and adjust to the very different diet. We checked his urine at home and he has continually spilled glucose but never ketones.

Last week we did repeat blood work and given the persistent abnormality, have begun insulin. We are using Lantus, 1 unit BID. We are also checking his glucose at home before each injection, using a ReliOn Confirm monitor.

This is basically my intro post, but I also have questions. His glucose levels have remained kind of crummy since beginning the Lantus (mid200s to high300s). I know we can't really look for miracles, but I was anticipating some change? When should I start to see that? (I know I'm being impatient. Start low, go slow. I've read lots here and am so grateful to have this resource. I'm just impatient and want my guy to be well) Bubber has been yappier and more into his fountain over the last 24 hours. He is still purring, voiding habits unchanged, he's eating well -- but I'm bringing him in tomorrow for a u/a because I'm concerned he has a UTI again. Could that explain his persistently elevated BGs even after starting the insulin? Lastly, I'm confused on when to feed, test, and shoot. The vet said to feed before shooting, so we've been doing that (feed at ~6:30, test at 7:15-7:30, shoot immediately after) -- is that right? Right now we're feeding around 3oz of wet 3-4-5 times per day (for all three cats). Is this too much? He is pretty much always hungry/begging for food, though I know some of this is behavioral.

Thank you all for being awesome and for any help!
 
Hi Jen and Bubber, and welcome to the board!

The sequence is "test, then feed, then shoot".

You want the preshot test to be prior to eating, so that the number isn't artificially high due to food raising the BG level.

What I did was test Bob, feed him right afterwards, let him eat (which never took longer than 10 minutes) and then give him his shot.

As far as how much food? Multiple small meals seem to work well for most cats. 3 to 5 feedings a day is fine. And right now, he'll need more food than normal, because a diabetic doesn't process food as well as a non-diabetic would. Just monitor his weight every week or two. If he isn't gaining weight, it isn't too much.

And yes, a UTI can be a reason for continued elevated BG numbers. Any sort of infection, or pain from something like a UTI can raise the numbers.

It does take a little while to see improvement. His numbers will get better, and it is possible that he will need a dose increase. You'll also see things like drinking less, peeing less as he gets better. It's good that you have been checking for ketones, and great that he hasn't shown any.
 
Hi Jen & Bubber and welcome to FDMB.

So far you are doing a great job caring for Bubber's diabetes. Since you just started on insulin and hometesting, you should wait at least a couple weeks before determining if you need to increase the dose. Like Carl said, it takes a little while before you start to see some improvement. If you are still getting readings in the upper 200's - 300's after 2 weeks of insulin, then you should consider increasing the dose, but only by 1/4 to 1/2 unit. We can help you make that decision after we see a couple weeks of data.
 
Welcome to FDMB.

If you're only testing before shots, you're missing some crucial data. The glucose tests between shots can guide you on dose increases, specifically, check around +5 to +7 hours after a shot to see how low he is going.

If his lowest point between shots is above 150 mg/dL, and you've been on the same dose for a couple of weeks, you may increase his dose by 0.25 units, which you'll have to estimate, as syringes don't measure that finely.

Here are some glucose reference ranges used for decision making using glucometers. Human glucometer numbers are given first. Numbers in parentheses are for non-US meters. Numbers in curly braces are estimates for an AlphaTrak.

< 40 mg/dL (2.2 mmol/L) {< 70 mg/dL for an AlphaTrak}
- Treat as if HYPO if on insulin
- At nadir (lowest point between shots) in a long term diabetic (more than a year), may earn a reduction.

< 50 mg/dL (2.8 mmol/L) {< 80 mg/dL for an AlphaTrak}
- If before nadir, steer with food, ie, give modest amounts of medium carb food to keep from going below 50 (2.8).
- At nadir, often indicates dose reduction is earned.

50 - 130 mg/dL (2.8 - 7.2 mmol/L) {80 - 160 mg/dL for an AlphaTrak}
- On insulin - great control when following a tight regulation protocol.
- Off insulin - normal numbers. (May even go as low as the upper 30s (1.7 mmol/L){60s for an AlphaTrak}; if not on insulin, this can be safe.

= 150 mg/dL (8.3 mmol/L) {> 180 mg/dL for an AlphaTrak}
- the lowest level pre-shot for ProZinc, PZI, or other non-depot insulins.

> 150 mg/dL (8.3 mmol/L) {> 180 mg/dL for an AlphaTrak}
- At nadir, indicates a dose increase may be needed when following a tight regulation protocol.

200 mg/dL (11.1 mmol/L) {230 mg/dL for an AlphaTrak}
- no shot level for beginners; may slowly reduce to 150 mg/dL (8.3 mmol/L) {180 mg/dL} for long-acting insulins (Lantus, Levemir, and ProZinc) as mid-cycle data collection shows it is safe

180 - 280 mg/dL (10 - 15.6 mmol/L) {may be 210 - 310 mg/dL for an AlphaTrak}
- Any time - The renal threshold (depending on data source and cat's renal function) where glucose spills into the urine.
- Test for ketones, glucose is too high.

>= 280 mg/dL (15.6 mmol/L) {may be >=310 mf/dL for an AlphaTrak}, if for most of the cycle between shots
- Uncontrolled diabetes and thus at risk for diabetic ketoacidosis and hepatic lipidosis
- Follow your insulin protocol for dose adjustments
- Test for ketones; if more than a trace level of ketones, go to vet ASAP.
 
Hi folks,
Bubber and I went to visit his vet today, and he has a mild UTI. This may be impacting his BGs, so we're going to treat with two weeks of antibiotics, change up my order of business (test, feed, shoot) and work on getting some midday numbers as well. Thanks very much for taking the time to comment and offer insight; this place is an amazing resource.
 
Hello and welcome to the board!

Good job on testing and food change - just want to check though - what flavours/types of food are you feeding? You seem to have done your homework - have you checked all the flavours under 10%? Check here column C: http://www.catinfo.org/docs/FoodChartPublic9-22-12.pdf

The UTI could well be the issue but also you may just need a higher dose. And I agree with Bj - best to get a few spot checks at night - for example a before bed test. Many cats drop low at night.

In addition you dont want to hold the same dose too long if its not working since glucose toxicity can set in. Heres the protocol we use which has proven success in regulating and remission in cats - we can help advise on it. http://www.felinediabetes.com/FDMB/viewtopic.php?f=9&t=1581

Let me know on the foods.
Wendy
 
Hey Wendy,
Thanks for the reply. I have seen the list and that's what we shop by; we are using lots of different foods, Weruva, Tiki, Fancy Feast classics, and Friskies pates. All under 8% with the majority under 5% carbs (he really likes the lamb-burghini which is 8, so we make an exception for that one but only one can per day max).

He is now on day five of fourteen, treating the UTI. His symptoms (water fountain obsession) have abated, so it seems to be working. His BGs are still not awesome, but he is behaving normally (5 Ps all normal) and he is not spilling ketones.

I hear what you're saying about not holding dose too long. I'm trying to get more random numbers but it's tough, we have a lot going on (terminally ill mother in law, working, I run a farm 90 minutes away). I'm hoping to get another curve on Friday, I should be home with him all day.

I think part of the problem is, I just don't understand his numbers. Tonight at 7p he was 302. I fed him, shot 1 unit Lantus, and at +4 he was 342. That just doesn't make sense to me, it's like the insulin is doing nothing. (and I'm certain it's getting in subQ. I was worried about "fur shots" and so I used a syringe to squirt 1u of water on him, and I could definitely see and feel it. I'm not mistakenly doing fur shots)

Help?
 
How long has he been on the low carb foods? no dry at all right? Not even treats

As regards his numbers - every meter reading has an error of 20% so 302 and 342 are essentially the same. So he is flat. I doubt you are giving fur shots - i always shoot - touch the spot gently and sniff. You don't smell insulin you are fine.

You might want to try to increase his dose to 1.25 tomorrow and see how that goes. As the dose takes 2-3 days to kick in properly (Lantus is a depot insulin) that means you will see whats going on when you curve him on the weekend. Meantime though try and get a before bed test every day (2-3 hours after pm shot) too.

Wendy

PS sorry to hear about your family issues (hugs)
 
We've been closely regulating his food since initial diagnosis, mid-August. He snuck into the dry food (it was in a "secure location") once, before we were testing his numbers. Since then he has no access to any dry food or treats, at all ever.

I bump to 1.25 tomorrow and I'll get those before-bed numbers too.

I really appreciate your help and kindness. It can feel like I'm juggling lots of balls and just trying to keep them in the air, and reassurance and advice is most welcome. <3
 
Welcome Jen and Bubber!!

Looks like you're doing a lot of research/reading and that's great Jen! Don't try to go too fast....remember, Bubber was probably diabetic for quite some time before you started to really notice the symptoms and get him diagnosed. Get the UTI back under control and his numbers may come down too

You're a beautiful example of a coonie, Mr. Bubber!! (I have 2 MC mixes plus my sugarcat China)
 
Thanks, Chris!

I'm trying to not be too impatient. I don't think he was diabetic for too awful long before we noticed, because his symptoms were pretty pronounced and he had negative blood work about 3 months before. I hear you though, and will try to summon my patience. ;-)

We are on day seven of treating the UTI, and his symptoms are gone now, so I'm hopeful that isn't impacting things too awful much now. I know the antibiotics themselves can impact his BGs, but given the 300s we're persistently seeing, I think a slight dose increase seems reasonable. Going to 1.25 units BID is as much as I will be willing to do without getting some reliable curve numbers, so given my work schedule over the next week, we will be holding there for a while - work is super busy right now!

Bubber was a shelter/rescue kitten and I have loved his coon-ness from day 1. Thanks for admiring him! He had a brother named Madge that was a white beauty like your China. Maybe coonies and pretty white kitties are meant to be buddies :)
 
My 2 were shelter kitties too, and I used to be a foster home for Maine Coon Rescue..that's how they came to me to start with, as foster kitties....but I fell hopelessly in love with them and just had to go ahead and keep them for myself.

I had hundreds of coonies come through here, and for the vast majority, I was just a pit stop on their way to their furever homes, but for a few, they're journey stopped at my house :-D

China's a shelter kitty too...all my animals have come from shelters...they have the BEST animals there!
 
Holding 1.25 for a few days is fine - We don't want to change too fast anyway - protocol http://www.felinediabetes.com/FDMB/viewtopic.php?f=9&t=1581says we change dose every 3-5 days unless he drops below 50 anyway i.e.

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 (lowest point of the cycle) 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. (blue green)
After 3 days (6 consecutive cycles)... if nadirs are greater than 200, but less than 300 increase the dose by 0.25 unit. (yellow)
After 3 days (6 consecutive cycles)... if nadirs are greater than 300 increase the dose by 0.5 unit. (pink red black)

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. .
Click to expand...
 
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