My diabetic cat's BG is ranging from 44 to 468! Please Help

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Smokey'sMom

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I have a 12 year old cat who was diagnosed with diabetes 2 years ago. All seemed okay up until approx. Aug. 24, at which time he became very sick, vomiting and diarrhea. I took him to the emergency vet office. He was in DKA and was in the pet hospital from Sunday a.m. until early Wed. evening.

The vet changed his Insulin from ProZinc to Lantus glargine. He sent me home to get Smokey "regulated." I feed him wet food, Fancy Feast classic, and just a small about of Evo turkey & chicken formula dry food. This helped him get past the diarrhea. My huge problem is figuring out how to get him "regulated." I am under the impression that the amount of insulin to be given is determined by the amount and type of food he eats. For two years I've been feeding him about 98 per cent wet food, just a very little EVO kibble.

I've been keeping a daily journal since he came home from hospital and his BG is all over the place. It will be high, over 250 to 468, and then LOW down to 44 and 49!! The vet has helped me over the phone and has told me to increase the Insulin does when it's high, then told me to give him "sugar" when it gets down into the 40s range! Smokey looks better, he has gained weight, but continues to vary from drinking lots of water and urinating a lot to drinking normal amount of water, etc. However, the amount of food he's eating has not gotten back up to the maximum he was eating before hospital. He used to eat 4 cans of FF each day. Now he eats between 1 1/2 cans FF to 3 cans FF per day.

Does anybody know how I can figure out how much Insulin to give him and get him regulated? I'm really worried about him now, even though he looks better. The DKA came on so fast and I am so afraid of giving him too much Insulin and causing him to die.

Thank anyone and everyone who can help in any way.
 
Re: My diabetic cat's BG is ranging from 44 to 468! Please

Welcome Extra sweet Smokey and MamaBean too!

First.....breathe.......now, you found the right place to get Smokey 'regulated'. KT and I are working on it, not there yet but getting closer. I can't help with much, I'm too new but I do know someone will be posting shortly to answer all your questions.

Sounds like you're already home testing?

What's his dose?

We've got kitties here that are recovering from DKA, ones recovered and all kinds of experts that have been right in your shoes. Big hugs, you're in the right place.
 
Re: My diabetic cat's BG is ranging from 44 to 468! Please

Welcome Smokey's Mom,

FIrst off it sounds like you are home testing, Kudos to you that is the best way to help Smokey. With Lantus the dose is based off the nadir or the lowest point in the curve...if you could share some of the numbers you have been seeing it would be easer for us to help you, help Smokey get regulated. Normally the way we write out numbers since you are new and don't yet have a spreadsheet for us to look at would be:

AMPS: (the reading before the morning shot)
+1
+2
+3 all the +numbers represent how many hours after the insulin shot was given etc.
PMPS (the reading before the evening insulin shot)

With Lantus the nadir is normally around about +6

Also what it the dosage that you are giving Smokey? You can also test for Ketones at home, just using the same ketostixs that human diabetics use, so you can watch for the beginning signs of ketones before it developes into DKA.

Mel, Maxwell, Musette & The Fur Gang
 
Re: My diabetic cat's BG is ranging from 44 to 468! Please

my first impression while reading your post is that your vet doesn't understand how lantus works very well most likely. you don't increase just because the glucose level here or there is high. lantus likes consistency and structure. soooooo, if you can tell us the dose and post any glucose numbers you might have that will be a start? you can just do something like this because for now it is easier

september 1, 2011
8am 450 1 unit
11am 415
2:30pm 300
8pm 399 1 unit

later, or if you want to now, you will learn that the more common way of doing it is like this

september 1, 2011
amps 450 1 unit (that means the morning preshot glucose level was 450 and you gave 1 unit of insulin)
+3 415 (which means 3 hours after the last shot, the level was 415)
+6.5 300 (which means 6 and 1/2 hours after the last shot, the glucose level was 300)
pmps 399 1 unit (evening preshot glucose level was 399 and you gave 1 unit)

we do it the second way more often because of the board being a worldwide board and because of all the different time zones. make sense? and the clock starts over after every shot so if you tested 3 hours after the evening shot, it would be a +3 again. but like i said, if that sounds like too much right now, just type it out and we'll figure it out for you :-)

and also, do you test for ketones at home? with dka in your history, it is crucial to be doing this on a regular basis so the ketones don't come back and get out of control
 
Re: My diabetic cat's BG is ranging from 44 to 468! Please

Hi Smokey's Mom, and you too Smokey,
First thing - the insulin change. What sort of doses was he getting with PZI, and what are his doses with lantus? The two insulins work somewhat differently, and what works with PZI does not necessarily work with lantus (and vice versa).

Your vet telling you to just shoot high when he's high, and use "sugar" when he's low? Thank goodness you found this place! Not the best way to deal with BG. The goal is to get him so that his numbers don't go high and low, but are more "regulated". There are some terrific and very experienced Lantus users here. They're here every day, all day too. The great thing about this community is that there is always someone around to help you and your sugarcat.

As soon as you can post some numbers from his time on Lantus, there are going to be lots of Lantus vets that will help you get Smokey well.
You're in the right place. Just take a few deep breaths and soon this won't seem near as bad as it seems right now.

Carl and Bob in SC
 
Re: My diabetic cat's BG is ranging from 44 to 468! Please

Thank you all so much for your responses.

I forgot to add that Smokey developed a very serious upper respiratory infection during the DKA event. While in the hospital he wouldn't eat. They had him on an IV of "sugar" and whatever they were using to balance it when it got too high. Finally they gave him some potassium and he started to eat a very, very small amount. But he didn't eat at all for at least two days. When he came home it took about a week for him to start eating a substantial amount again.

Here are the numbers I've been keeping. Vet told me not to be BG testing several times in one day because I'm not very good at it. I've just been using the syringes I had left over for the ProZinc to prick his ear for blood. He hates it so much and I often end up puncturing my fingers as well as his ears. So I was told to test him once a day between 4:00 and 5:00 p.m.

I feed him at 7:00 a.m. and 7:00 p.m. and give him his shots at that time.

When using ProZinc he received 1 and 1/2 Unit a.m. and p.m.

(With the Glargine) Starting Aug 27, I was giving him 1 Unit in a.m. and 1 1/2 unit p.m.

Aug 29, the dose was upped to 2 Units a.m. and 2 Units p.m. Bg was 291 a.m. & 314 p.m.

Aug 30 gave him shot at 7:30, 2 Units. That afternoon his BG was 44!! Called Vet.
Aug 31 no insulin
Sept 1 - 1/2 unit a.m. and 1 unit p.m. By 7:00 his BG was 384
Sept 2 - 1/2 unit a.m. and 1/2 unit p.m.
Sept 3 - 1/2 unit a.m. and 1/2 unit p.m. - BG at 1:30 p.m. was 196
Sept 4 - 1/2 unit a.m. and 1 unit p.m. - BG at 4:50 p.m. was 368
Sept 5 - 1 unit a.m. and 1 unit p.m. - BG at 5:00 was 252
Sept 6 - 1 unit a.m. and 1 1/2 units p.m. - BG at 4:00 was 276
Sept 7 - 1 1/2 units a.m. and 2 units p.m. - BG at 4:20 was 348
(Smokey vomited that morning)
Sept 8 - 2 units a.m. and 2 1/4 units p.m. - BG at 4:30 was 387
Sept 9 - 2 units a.m. and 2 units p.m. - BG at 4:30 was 465
Vet advised that I raise the dosage because of the 465 BG.
Sept 10 - 2 1/2 units a.m. and 2 units p.m. - Didn't get BG that day
Sept 11 - 2 1/2 units a.m. and 2 1/2 units p.m. - BG 345 at 12:45 p.m.
Sept 12 - 3 units a.m. and 1 unit p.m. - BG 49!!!!!! Fed him dry food, honey, FF. He loves ice cream, which he NEVER gets, but I gave him a little ice cream because he didn't want the honey. He now pulls away from me like he's afraid I'm going to hurt him from the BG testing and trying to force feed him when he came home because he was eating so little.

The variable in all of this is the amount of food he is eating. I keep track of his food, but he simply cannot go 12 hours without eating something. If I force him to do that, he vomits a clear liquid.

Hope that answers your questions. I'm really just completely lost in trying to regulate Smokey.
 
Re: My diabetic cat's BG is ranging from 44 to 468! Please

Smokey & Mom,
Good am to you. I am not familiar with Lantis and I know that there are many that will help you. I would just suggest that you do test but get the lancets and some neosporin w/ pain relief for his little ears. That should help him and you as well.
Good luck with his regulation. I know that this site will help you and it will be no time until he is helped.
 
Re: My diabetic cat's BG is ranging from 44 to 468! Please

Yes, definitely run out and get some Lancets (26-28g), possibly a lancet device if you find it easier (about half of us use the devices, and other half find it easier to freehand), and some neosporin +pain relief. You should be able to test as many times as you want in a day with these without his ears getting sore. Also make sure you're giving a low carb treat after each test--you want your kitty to associate the testing with treats so that he will tolerate it more. Many cats become extremely cooperative after just a couple weeks. With Lantus, you need to get at least 3 tests daily--once before each shot, and one about halfway into a cycle. Of course, the more tests you can get the better, but you should be getting at least those three a day.

Here are the instructions to create a spreadsheet: http://felinediabetes.com/FDMB/viewtopic.php?f=6&t=18207. If you have any problems setting up, let us know and we can help.

Dosing with Lantus is based off of the Nadir, or the lowest number in the cycle (usually about 6 hours after the shot), not the preshot numbers. Also, I see that your vet recommended a strange dose--consistency is very important with Lantus and usually the same dose is shot at both cycles. Here is the link to the dosing protocol for Lantus: http://felinediabetes.com/FDMB/viewtopic.php?f=9&t=1581

Once you get your spreadsheet up and running and you're getting those tests in, the very experienced Lantus users in the Lantus forum will be able to help you get your cat regulated. They have a ton of experience and have helped hundreds of cats become regulated.
 
Re: My diabetic cat's BG is ranging from 44 to 468! Please

Please, please, please give the SAME dose every 12 hours! Lantus MUST be dosed that way - it builds up in the system to a somewhat stable level (we call it the shed) that you 'refill' at 12 hour intervals.

I'd encourage you to go back to 1 unit, twice a day @ 12 hour intervals, for a minimum of 3 days (*), testing pre-shot, and around 6 hours later.

And come on over to the Lantus forum to read the info on how Lantus works

* there are rules for quicker changes, but first he must be stabilized or it isn't going to work.

(edited a few times to fix my spelling!!!)
 
Re: My diabetic cat's BG is ranging from 44 to 468! Please

I also would encourage to join the lantus forum their are so many knowledgeable people their to help and advise you as you start with this new insulin
 
Re: My diabetic cat's BG is ranging from 44 to 468! Please

I, too, encourage you to join Lantus Land as there are a lot of people on there that can help you get Smokey regulated properly. If at all possible, please try and get your spread sheet set up and in your signature so that those experienced can help you better.

Also, welcome! :) You've definitely come to the right place! :)
 
Re: My diabetic cat's BG is ranging from 44 to 468! Please

Hi Smokey and Mamabean! My cat's name is Smokey too!!! My Smokey was diagnosed with FD just over a month ago and we are using Lantus. The Lantus message board has been GREAT. All of the previous suggestions are wonderful as well. I just wanted to send encouragement to you and your Smokey! Come on over to Lantus Land (LL) and they'll help you get Smokey sorted out!
 
Re: My diabetic cat's BG is ranging from 44 to 468! Please

Welcome, Smokey's mom!

There are several issues at play here. First and foremost, is Smokey eating reliably? Also, are you testing for ketones at home? If not, please pick up Ketostix. Testing for ketones simply involves sticking the strip in Smokey's urine stream (or a fresh puddle in the box) and then following the directions for how long to wait (around 15 sec.) for a result. You compare the strip with the color code on the box. You don't want to see more than a trace amount of ketones. This is the absolute best ounce of prevention you can use to avoid another episode of DKA. Also, do not be lulled into complacency that DKA only happens with high BG numbers -- it doesn't. So, testing is essential.

As others have said, blood glucose (BG) testing is also your best friend with regard to keeping Smokey safe and to getting his numbers regulated. Frankly, lots of vets think we're over zealous or hurting our cats with testing. I think if you took a poll here, the majority of people would tell you anecdotes of how their cats go running to their test spot, come when you call them, or just purr when tested. In part, we give treats when we test and cats can be very treat motivated! In addition, testing is the only way to know if it's safe to give a shot of insulin or to know how your insulin dose is effecting your cat. With Lantus, does does not depend on how much you're feeding. Food may effect BG levels but that is not the determining factor. The lowest point in the cycle is what dictates how Lantus is dosed. We utilize a tight regulation protocol, which I've linked, on the Lantus board to help guide our dosing decisions. I'd encourage you to look this over so you have a clearer sense of the difference between how Lantus dosing decisions are made in light of your experience with ProZinc.

It's hard to know if your vet has had you bring the doses up too quickly. Typically, dose increases based on the protocol we use are in increments of 0.25u. However, if ketones are present, insulin is one way to help keep them at bay. We'd need more mid-cycle tests to really know what's been going on with Smokey's numbers.

I second the idea of using lancets vs. your old syringe needles. The people here on Health can give you expert guidance on how to get both you and Smokey more comfortable with home testing. Once you have the testing routine under your belt and have started a spreadsheet, you may want to join us on the Lantus board. We are very numbers driven there so having at least some degree of comfort with home testing will be helpful.

In the meantime, there is a ton of information in the starred sticky notes that are at the top of the "Topics" section of the Lantus Board.

Please let us know how we can help.
 
Re: My diabetic cat's BG is ranging from 44 to 468! Please

You said: "Now he eats between 1 1/2 cans FF to 3 cans FF per day.". Without a lot more consistent eating the BG will be very variable like you are seeing now. You might want to restrict food a little depending upon his weight and if he still needs to gain weight.
 
Re: My diabetic cat's BG is ranging from 44 to 468! Please

I would suggest you give Smokey as much as he wants to eat. Do not worry about the amount he is eating unless he stops eating -- then that is a serious problem. Uncontrolled diabetic cats are ravenous and cannot utilize the nutrition they are eating. Once their diabetes becomes controlled, their appetites begin to return to normal.

With the older fast-acting insulins, people shot after the cat ate. Blood sugar went up with the food. Fast-acting insulin brought blood sugar down quickly. Lantus is not that kind of insulin. It is not a fast-acting insulin. Cats can be perfectly free to indulge in their preferred way of eating -- which is snacking. If my cat take one bite and walks away, that is fine -- he still gets his insulin. And as long as he eats something that day, I do not worry about it. He might eat all or he might eat 25% but as long as he is eating, I am not concerned.

You have already been told to take a deep breath. Remember that everyone here on this board has been through just what you are going through right now. All this is going to work itself out and in two months, you will be posting advice to newbies yourself!

Lana
 
Re: My diabetic cat's BG is ranging from 44 to 468! Please

Actually, minor correction of something I've seen stated several times today. You can infact overfeed a diabetic which in turn works against the insulin. However, feeding a bit extra is just fine.
 
Re: My diabetic cat's BG is ranging from 44 to 468! Please

Jen & Squeak said:
Actually, minor correction of something I've seen stated several times today. You can infact overfeed a diabetic which in turn works against the insulin. However, feeding a bit extra is just fine.
Click to expand...

These were the instructions given to me by my previous vet -- along with a lot of other outdated information. I followed his advice. My cat was exceedingly miserable and upset and started spraying in the house. I said, "Vet, be dammed," and I gave him as much as he wanted. With insulin and a low-carb diet, his appetite resolved on its own and he probably eats 1/4 to 1/3 what he was eating to begin with. Then I found out on this board that uncontrolled diabetics cannot metabolize their food appropriately, often even losing weight while eating large amounts of food. The first priority is getting a cat on insulin and providing him with a low-carb diet and the appetite will resolve itself.

Lana
 
Re: My diabetic cat's BG is ranging from 44 to 468! Please

Hello Smokey's Mom! You've already been given quite a bit of information to digest. I know it can be overwhelming, but it'll come together in no time at all.

I've taken the liberty of slotting the data you've provided in a temporary spreadsheet: Smokey's Mom Lantus Data. Please check it to make sure I've inserted the data properly. You'll want to put one together yourself and personalize it with any notes you may have.

Given the recent DKA history and the fact that Lantus does like consistency when it comes to dosing, I think it's reasonable to suggest a dose of 1.5 units shot twice a day... "IF" you're willing/able to step up the amount of blood glucose tests you're doing. Testing before every shot and getting some mid-cycle spot checks are essential to learning how low any dose is taking a kitty. Please refer to the STICKY: LANTUS & LEVEMIR - SHOOTING & HANDLING LOW NUMBERS for more information. Once you're able to obtain more data the dose may need adjusting.

The action of Lantus is cumulative meaning a single dose can affect up to the next 3 days. Dose-hopping can really muck up the works when it comes to the long acting insulins like Lantus or Levemir. Please take the time to familiarize yourself with all the Sticky's (starred posts) near the top of the Lantus Insulin Support Group.

Any kitty who has a history of DKA or is throwing ketones should be checked often for ketones. You can pick up Ketostix at any pharmacy to check Smokey's urine.

Jen & Squeak said:
Actually, minor correction of something I've seen stated several times today. You can infact overfeed a diabetic which in turn works against the insulin. However, feeding a bit extra is just fine.
Click to expand...
I agree with Jen. With Lantus, you have approximately 2 hours to get food on board before onset. Some kitties will regulate themselves when free feeding. However, feeding after nadir can often work against the waning action of the insulin in the latter part of the cycle. If kitty is begging for food in the last half of the cycle, you can often appease kitty by offering a low carb snack such as a small piece of boiled chicken. Generally, we recommend denying access to food within 2 hours of shot time. Reason being, feeding within 2 hours of shot time will most likely result in a preshot number artificially inflated by food.

As far as feeding kitty as much as they want...
If smokey is underweight, that's fine. He needs to gain weight. However, those who advocate feeding kitty as much as they want all too often end up with a cat who has to be put on a *diet*. This is a concern because many of our diabetic cats are *fluffy* to begin with... not to mention, a *fat cat* can be harder to regulate. Here's what I posted in the Lantus ISG on this very subject:


DISCUSSION: "FEED KITTY AS MUCH AS THEY WANT?"

it could just be a case of "repeat speak" commonly found on message boards, but prevailing wisdom these days seems to be to feed a diabetic kitty "as much as they want". overfeeding may be ok if kitty is underweight, but many of our diabetics are "fluffy" to begin with. :-D

i felt it was time to resurrect an old post from Dr. Lisa referencing a prior FDMB post by Hilary/Zug for your thought and consideration:


Feeding hungry..... unregulated cats
Posted by: Lisa dvm (IP Logged)
Date: April 11, 2009 02:42AM

Vic is right when she is discussing a happy medium.

From this link:
http://www.felinediabetes.com/phorum5/read.php?15,520791,532240

Please see this post:

why food should be somewhat controlled...
Posted by: Hilary & Zug(GA) (IP Logged)
Date: December 1, 2006 11:22PM


Here's a really good explanation of why NOT to overfeed/feed until "satisfied":

In general, brain cells do not need insulin to utilize glucose. A specific area of the brain, called the appetite center (in the hypothalamus), monitors the amount of glucose that circulates in the bloodstream. The lower the blood glucose level in the cells in the appetite center the greater the appetite. Unlike most of the brain cells, the ability of glucose to enter the cells of the appetite center is dependent upon insulin. In diabetes mellitus, with its lack of adequate insulin in the bloodstream, these appetite center cells don't monitor glucose levels properly, thinking the blood glucose is low. as a result, the pet develops polyphagia to correct for this perceived problem. The additional food that is then eaten further increases the blood glucose level.

from: http://lbah.com/feline/diabetes.htm#Pathophysiology

Basically, a cat that's unregulated can't really tell what's going on with its appetite, and the high BGs make the cat even hungrier. It's something of a balancing act -- you want to be sure you're feeding sufficient food that the cat is getting the nutrition it needs, especially to help reduce the risk of ketoacidosis, but you don't want to overfeed (which often happens when the cat is "hungry"). The poor cat doesn't know if it really needs food, it just knows that its brain is saying "need food now!".

Hilary

Me: Active (albeit intermittently) on FDMB since Dec 2002.
Zug (GA): B&W Japanese Bobtail, unknown age.
Diagnosed 12/18/02. Tightly regulated on PZI-VET for most of his fight with diabetes. Died of peritoneal carcinomatosis (a very invasive form of cancer) October 19, 2005, and sorely missed.


Lisa, dvm
[www.catinfo.org] Feeding Your Cat: Know the Basics of Feline Nutrition
[www.catinfo.org] Feline Diabetes
[www.catinfo.org] Feline Obesity: An Epidemic of Fat Cats
[www.catinfo.org] Feline Urinary Tract Health
[www.catinfo.org] Quality Commercial Canned Foods
[www.catinfo.org] Making Cat Food
[www.catinfo.org] The Litter Box From Your Cat's Point of View
[www.catinfo.org] Pilling Cats and Dogs - The Dangers of Erosive Esophagitis
[www.catinfo.org] TLC Cat Rescue and Adoptions - Pictures of a few of my rescued cats and kittens
[www.catinfo.org] Feeding Tubes Save Lives


overfeeding can make it more difficult to pull those numbers down. as hilary said, "The poor cat doesn't know if it really needs food, it just knows that its brain is saying "need food now!". many of our diabetic kitties are overweight to begin with. more than one of us have found feeding a diabetic kitty "as much as they want" leaves us with an even fatter kitty. obesity can also create more problems.

imho, we DO have to reach a happy medium. when alex was initially diagnosed and put on insulin i calculated how many calories she "should" be consuming using the guidelines found on Dr. Lisa's website. i started out with X amount of calories and then added an extra 3oz can to the total food consumed daily since diabetic cats do not utilize their food properly. within a few weeks of being treated with insulin, i gradually reduced the total amount fed to the amount of calories she *should* be consuming. feeding mini-meals throughout the day seemed to help satisfy her. the end result was a kitty who maintained rather than gained.

maybe it's time to re-think the advice to "feed kitty as much as they want"?

discuss...



Sorry for the length! Hope this helps. Please post often. Ask any questions you may have. We've all been where you are today. We "get it" and will help you.
 
Re: My diabetic cat's BG is ranging from 44 to 468! Please

Well, not to split hairs but you really can overfeed. We have had this issue come up before and we had one of our longtime members Hillary explained it and she is a research specialist and knows more about how bodies work than I ever will. She explained that the conventional wisdom of feeding as much as you can may at times backfire and it really does make sense if you consider how much harder the insulin would have to work if you overfed. That the cat cannot metabolize its food is the point.
 
Re: My diabetic cat's BG is ranging from 44 to 468! Please

Well, Smokey'sMom, you are getting a good introduction to FDMB and finding that there are many differences of opinion. Don't let that overwhelm you. You will find your way through it. After listening to the conventional wisdom and the opinions of the experts, it may take a little trial and error but you will find what works best for your cat. My previous vet's expert opinion was that home testing was bad, that I was torturing my cat, and he also held the opinion that I was going to cause my cat's ears to fall off. I followed his opinion that I should limit Yoyo's food, but after Yoyo offered his own opinion by spraying my house, I decided to feed him all he wanted. I found that with low-carb food and insulin, the food problem resolved itself within a very short period of time.

Lana
 
Re: My diabetic cat's BG is ranging from 44 to 468! Please

I have a similar problem with our Kitty. When it came to put him in the cattery a month ago, I was a bit confronted when it came to explaining to them how much he eats - I think I realised they would never feed him that much. 6 or 7 meals a day - around the clock feeding. This is what he demands from me. If I am not around he doesn't press husband for food the way he does me. Husband doesn't think he should eat as much but when he starts up at me I find it hard to say no to him.

My Kitty was regulated by December last yr and almost OTJ - and then his numbers started climbing and spun out of control. He's not regulated yet - but now that I've had a break away from 'the kitty coal face' I have a fresh view and intend to cut the meals down. I'm now realising that I HAVE to reduce his food intake. As one poster said: to rest their pancreas as much as possible. I have to add fibre to his diet (can I mash pumpkin I cook at home - can't get it in cans in Australia?) And fluids, sub-q if necessary - but that is not determined yet.

Obviously I had to work out how much food he needs. He weighs about 20lbs (a big ol' Maine Coon male). I think he would be underweight at less than 18 lbs. It takes a while to get one's head around all this - I can understand newbies wondering how they will ever learn it all.
 
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