Meow, a year OTJ, now uncontrolled

[Ang]

I posted this on the OTJ forum but it was suggested I might get more help posting it here:

Meow is about 12 years old, diagnosed diabetic last year and in remission quickly with a low carb [FF] diet and a very few doses of Insulin [Lantus].

He's had a few hiccups, mostly due to constipation but each time a dose or two got him back OTJ
We added Miralax to his diet and that seems to be managing the constipation for the most part.
During the year I did not test. I figured there wasn't much point, a random one test number, on one day doesnt' really tell you anything.... I would test when he started to look bad or act 'not himself' and treat accordingly.

But starting this past Monday 3/26 he looked off to me, I noticed a lack of BMs in the catbox [I clean once a day at least but skipped a couple days- Grrrr!], and I started testing and he was/has been in the 300s [we use Alpha Trak2].
Since Monday 3/26 he's hovered around the mid 300s, never going over 400 but also never below 230, that was for only ONE stick, on 1 unit of Lantus BID before his meals.

Please note this means he has been on 1 unit, BID since 3/26, or for a total of 11 days.
Today, 4/6 a.m. we dosed at 2 units. Again his BG numbers have not budged today, testing again at q2 hours since 5:30 a.m.

Appetite is normal if not a bit hungry 'early' [iow before it's been 12 hours], not drinking excessively. Sleeping a lot but then that's what cats do....

Maybe I was spoiled by his quick shift to remission and this stubborn lack of response is normal?
If the Lantus was 'bad' I would see him spike higher, wouldn't I? I hate that there's no way to know if it's still 'good'....
Maybe there's something else wrong [no uti- pee seems to be normal quantity, and frequency, no mal-odorous breath indicating a tooth issue, bright and alert when up ]?
Maybe there's something I am missing, not thinking of?

Thoughts? I hate to call the Vet and bother them, I hate to take him in for no reason [stress on him and $$$]. I hate to have a false sense of 'we're ok' if we're not.
I hate this disease.

Since I posted this over the weekend, we've been using a brand new pen, at 1 unit, then 1 unit a half hour before feeding to give it a running start... and today we're doing 2 units.
Before today he was running low 300 to low 400s... today he started out at high 400s and not he's hovering at 400, after 4 BGs after one dose.
{ETA bold}

*** I do not have a spreadsheet as I can't get a Gogle account set up right now, because we do not have numbers from when he was OTJ it wouldn't tell us much and the numbers now are all in the same range.***

 

[Tracey&Jones (GA)]

no mal-odorous breath indicating a tooth issue

There may be something going on underneath that you can't see or smell.

If the Lantus was 'bad' I would see him spike higher, wouldn't I? I hate that there's no way to know if it's still 'good'...

The one bad pen I had...there was just not movement in the numbers...I couldn't see a dip when doing the mid cycle tests and in general his numbers just kept increasing overall. What is the expiry date on the pen?

 

[Sienne and Gabby (GA)]

What's the expiration date on the pen. Usually, the date is quite some time after date of purchase but given that it's over a year, your insulin may be past it's expiration date. In addition, it's been open for a year. I think there's a high likelihood that you need new insulin.

I would also get your cat checked out by your vet. Often numbers are elevated if there's an infection/inflammation and the numbers may go up before you see any other major symptoms. Make sure your vet looks at Meow's teeth -- gingivitis or other dental problems are notorious for throwing a cat out of remission.

 

[Ang]

Sorry he has been seen by Vet, Saturday, including blood labs [fine] , urine [clean, no ketones] and ultrasound.
Teeth need doing but not urgent, and she wants him controlled before we attempt it.

The 1st pen I used had been used but was not expired, stored the whole time in the fridge.
Then pen #2 was unused, not expired, in the same fridge the whole time.
We are now on pen #3, that just arrived Tuesday.

 

[rhiannon and shadow (GA)]

It is possible that this has been growing unknown to you all these months without testing....

You have to remember that remission is usually only a temporary condition. Once a diabetic, always a diabetic.
We all wish for a cure but it's not there.

So I'd say you're back on the juice and hopefully you can revisit remission.

Meanwhile, start a spreadsheet ( if you need help, ask, we have some who can do it)
and start testing.... Post daily so we can help guide you. Don't do large increases by whole units even if the vet wants it.
Smaller increases are better for their progress.

the vet really does not need to wait on the dental but maybe you can convince him of that sooner than later.
You just deal with the FD and skip on the day of surgery unless they are super high. Gotta keep them from going too low on that day....

And it sounds as if you only feed meals at shot times.....

Diabetics ( and all of us really) do better if we have several small meals a day. It's less strain on their pancreas. The only time you want to abstain from food with them is 2 hours before shot time so you don't have a food influenced number at shot time.

 

[Ang]

It is possible that this has been growing unknown to you all these months without testing....
Well yes, but then again had I tested once a day, there's a likelihood I wouldn't have seen a high number that would have suggested he needed intervention either... unless you test multiple times a day.

You have to remember that remission is usually only a temporary condition. Once a diabetic, always a diabetic.
We all wish for a cure but it's not there.

Yes, I know that.

So I'd say you're back on the juice and hopefully you can revisit remission.

Meanwhile, start a spreadsheet ( if you need help, ask, we have some who can do it)
and start testing....
I am testing, q2 hours since Monday the 26, which is how I knew to restart the Lantus.
Post daily so we can help guide you. Don't do large increases by whole units even if the vet wants it.
Smaller increases are better for their progress.
I'm not sure I can do my own protocol, as in the end I DO need my Vet to be on board and aware of what we're doing and approving it.
She and I came to the increase to 2 units as a team, after trying the 30 minute headstart on the 1 unit.
I am not sure I want to rock that boat.

the vet really does not need to wait on the dental but maybe you can convince him of that sooner than later.
You just deal with the FD and skip on the day of surgery unless they are super high. Can you repeat that in English?
Gotta keep them from going too low on that day....

And it sounds as if you only feed meals at shot times.....

Diabetics ( and all of us really) do better if we have several small meals a day. It's less strain on their pancreas. The only time you want to abstain from food with them is 2 hours before shot time so you don't have a food influenced number at shot time.

I assumed so, but feeding more than twice a day is not going to be do-able. I've already limited my activities in order to do the testing I need to do to get this under control... I am interested in helping my cat, but I also have responsibilities that can not continue to be neglected.

 

[Ang]

There may be something going on underneath that you can't see or smell.




The one bad pen I had...there was just not movement in the numbers...I couldn't see a dip when doing the mid cycle tests and in general his numbers just kept increasing overall. What is the expiry date on the pen?

The first pen expiration is/was 05/2019
Pen #2- 07/2019
Pen #3 that I just got on Tuesday- 31-07-2020

 

[Tracey&Jones (GA)]

Pen #2 and Pen #3 should work...

 

[Wendy&Neko]

Since I posted this over the weekend, we've been using a brand new pen, at 1 unit, then 1 unit a half hour before feeding to give it a running start... and today we're doing 2 units.

Lantus is a depot insulin. You need to hold the same dose at least 3-5 days at the beginning to form the depot and see what the dose can do. For new people, we usually suggest holding the same dose 5-7 days. You've increased too fast and by too much. We make changes by 0.25 units at a time, especially since you did see some lowish 200's. Our dosing methods here would suggest 1.25 units, after you'd waiting the initial at least 3 days on the 1 unit. Not sure if you are using pen needles to get those whole unit changes, but we suggest using 1/2 unit marked syringes to withdraw insulin from the pen so you can get those in between doses.

As for feeding, Lantus takes a couple hours to onset. You don't need to feed 1/2 hour before hand to "give it a running start". Most people here shoot while the cat is eating. For spreading out meals, an automatic feeder (such as the Petsafe 5), is a good option. It also allows you to make sure kitty has food available for safety, during the low points of his cycle.

 

[Ang]

Lantus is a depot insulin. You need to hold the same dose at least 3-5 days at the beginning to form the depot and see what the dose can do. For new people, we usually suggest holding the same dose 5-7 days. You've increased too fast and by too much.
How? He has been on one unit BID for 11 days, 3/26 until this morning 4/6.
We make changes by 0.25 units at a time, especially since you did see some lowish 200's.
I only got one BG below 300, that was a 231. I had one outlier at 168, that I am not calling a low number as it's clearly a fluke.
Our dosing methods here would suggest 1.25 units, after you'd waiting the initial at least 3 days on the 1 unit. Not sure if you are using pen needles to get those whole unit changes, but we suggest using 1/2 unit marked syringes to withdraw insulin from the pen so you can get those in between doses.
That is what I am doing, I draw from the pen, treating it like a vial. However we are using 50 Unit/1/2 ml syringes. Getting 1.25 units isn't going to happen with these and getting 1.5 would be guessing.

As for feeding, Lantus takes a couple hours to onset. You don't need to feed 1/2 hour before hand to "give it a running start". I get that, but my Vet suggested it as a way to bump the insulin efficacy, rather than the dose. Most people here shoot while the cat is eating. For spreading out meals, an automatic feeder (such as the Petsafe 5), is a good option. It also allows you to make sure kitty has food available for safety, during the low points of his cycle.

A feeder is not an option with the other animals in the house.

{other comments in purple in body of your post}
Please note I am using Alpha-Trak.

 

[Wendy&Neko]

Without a spreadsheet, I couldn't tell he was on the same dose for 11 days. Thanks for clarifying that. I took into consideration that you are using an AT when I suggested how to change the dose. If you saw two numbers below 300 on the AT, then you definitely shouldn't have increased any higher than 1.25 units. There are 30 units syringes that make it much easier to see the half unit marks. Where are you located? Maybe we can suggest a brand for you to look for.

As for what you vet suggested on feeding, looks like he/she is used to older in and out insulins where it's recommended you feed 1/2 hour before shooting.

 

[Ang]

Pen #2 and Pen #3 should work...

I agree, as does my Vet.
We used pen #1 from 3/26 until 3/31.
#2 I used from 3/31 until 4/3 a.m. [ie 3 days] and nothing.... so we had ordered pen #3 [since we knew we were at least going to use up #2 anyway] and decided to go with that one assuming the other 2 were somehow duds.
We've been using pen#3 since 4/3 p.m. dose [so again another 3 days]

 

[Ang]

Without a spreadsheet, I couldn't tell he was on the same dose for 11 days. Thanks for clarifying that. I took into consideration that you are using an AT when I suggested how to change the dose. If you saw two numbers below 300 on the AT [Let's be clear that is 2 numbers over 11 days testing at q2 hours or around that. We skipped some because I was alone with no one to hold him and he was pretty fed up with being pricked. I have LOTS of numbers, 53 to be exact, all of them- but 2- are above 300. And of the 2 below 200, the one is not one I am considering to be accurate.] then you definitely shouldn't have increased any higher than 1.25 units. There are 30 units syringes that make it much easier to see the half unit marks. Where are you located? Maybe we can suggest a brand for you to look for.

As for what you vet suggested on feeding, looks like he/she is used to older in and out insulins where it's recommended you feed 1/2 hour before shooting.

No. She is the one who referred me here and the protocol and we have been shooting with meals all along, until the numbers wouldn't budge.
The 30 minutes was a way to try to increase efficacy without increasing dose.
She knows I am using Lantus and uses it on her cats, as does her Vet tech.

 

[Wendy&Neko]

She knows I am using Lantus and uses it on her cats, as does her Vet tech.

I almost switched to a vet who was using Lantus with her cat, as was her vet tech. Then I found out her cat hypoed because she wasn't testing enough. Vets are humans too.

Even if all the tests you had were over 300, we wouldn't increase to more than 1.5 units.

 

[Ang]

I almost switched to a vet who was using Lantus with her cat, as was her vet tech. Then I found out her cat hypoed because she wasn't testing enough. Vets are humans too.

Even if all the tests you had were over 300, we wouldn't increase to more than 1.5 units.

Define testing enough.
So you think I need a new Vet.
Who is 'we'?

It is really interesting to me why you are bringing up this one Vet you had who prescribed Lantus and had hypo'd a cat, as you suggest for lack of enough testing.

I have been testing Pre-shot, +2 post shot and often in between the am and pm shots at 2hour intervals as well
Daily.
For WEEKS.

I stated as much in my OP.

So why you would share that anecdotal information that relates in no way to my situation.... when clearly I am being far more conscientious with my care of my cat than the Vet you had a bad experience with is... beyond me. I am perplexed how that relates to my situation in any way and why you would ad that and not some helpful information or advice on where to go with my cats care given my diligent care thus far

 

[Wendy&Neko]

I don't necessarily think you need a new vet. But you know your cat best and need to take advice you get from the vet, and any suggestions from here, and do what you think is best for your cat. My vet prescribed Caninsulin to start, but was willing to work with me and learn, so I stayed with her.

"We" is the dosing protocols and methods which the members of this forum use.

 

[Sienne and Gabby (GA)]

If you would consider using U-100 3/10cc syringes with half unit markings, it will allow you to better calibrate your dose. It's very easy to miss what would be an effective dose for your cat if you increase too aggressively -- to say nothing of having numbers plummet.

 

[Ang]

I don't necessarily think you need a new vet. But you know your cat best and need to take advice you get from the vet, and any suggestions from here, and do what you think is best for your cat. My vet prescribed Caninsulin to start, but was willing to work with me and learn, so I stayed with her.

"We" is the dosing protocols and methods which the members of this forum use.

Which I am following, with my Vets guidance.
Just like you suggest. So why the second guessing of what I am doing that seems to at the LEAST not be endangering him.....
So thanks.

 

[Ang]

If you would consider using U-100 3/10cc syringes with half unit markings, it will allow you to better calibrate your dose. It's very easy to miss what would be an effective dose for your cat if you increase too aggressively -- to say nothing of having numbers plummet.

We are using 2 Units.
We will use 2 units for 7 days.

Since starting the 2 Units yesterday his numbers have gone UP.

I'm not a complete idiot.

 

[rhiannon and shadow (GA)]

I don't think any one meant to imply any thing .... it's wa-a-a-y to easy to misinterpret sometimes thinking there is a tone when there isn't any intention of one.
one gets out of practice real fast and there are so many newbies all the time who pop in.... and many disappear.
They don't stick around for the daily grind where they can get lots of support and tips and get questions answered.

numbers often go up , they can do that in response to too high of a dose... or new dose wonkiness....

I hope you will stick around.

testing enough ( in my humble opinion) is a pre-shot, a +2, some random mid cycle trying to catch the nadir, and follow up tests if numbers look like they are trending downward and safety is called for.