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Ozgood

Ozgood

Member Since 2014
My 8 year old cat, Ozgood, is diabetic. He was diagnosed in April of 2014. I found him along the road as a kitten and he's always had different health issues. We almost lost him in March 2013 due to liver problems. He was treated with IV fluids and steroids and made a full recovery ( no issues until about February 2014 when we first noticed him loosing weight).

His blood sugar is still way too high. He went from about 19 lbs before being diagnosed to about 11 lbs now. He had lost weight each time the vet weighed him up until a couple weeks ago when his weight was the same as it was the previous visit. Right now he's on 4 units of Novolin insulin. He was also on another kind of insulin, but I can't remember its name off the top of my head. We have 3 other cats so we feed 9 Lives Daily Essentials dry food for all 4 of them to eat throughout the day. Ozgood is fed 1/2 container of Meow Mix wet food when he gets his insulin.

The vet said the way his blood sugar changes over a 24 hour curve is normal, but both the higher and lower readings are too high. He was around 700 when first diagnosed, and the lowest he has been that we've seen is high 200s. He's generally 300-400 or higher. We have a home test kit but we've never been able to get a reading. We've tried on Ozgood's ear but he fights like crazy.

Our vet said he may be fighting an underlying condition. She wants to do a test for pancreatitis and Cushings. We've given him oral antibiotics as well as ear drops. He drinks a LOT of water. I'm at a loss about what to do. I want my baby to get better. I can provide more background, exact blood sugar/24 hour curve results, name of antibiotic, etc if needed. I'm not sure what all anyone will want or need to be able to help, so just let me know and I can dig out the information. Thank you.
 
Hi! Your sweet little Oz is most likely diabetic from the steroids. They are a cause of diabetes. His numbers are probably high because he's still eating dry food. We've seen cats go from 5.5u of Lantus to remission in 24hours when the dry food was removed from the house. The other reason his blood sugar is high at the end of the cycle is because Novolin doesn't last as long as other insulins in a cat's body. They have a very fast metabolism.

He's losing weight because his blood sugar is high. As long as it's high, the glucose which would be nourishing him is floating around in his bloodstream instead of getting into his cells. Feed him enough to keep his weight stable while we help you get his blood sugar down. Cats can get extremely seriously ill from too fast of weight loss. I'm glad it seems like he's stabilized now. He's also thirsty because his blood sugar is high. The appetite and the thirst will resolve when his blood sugar numbers improve.

Did you maybe use Vetsulin before?

The latest research is on this page, the Tight Regulation Protocol. Look about 5 paragraphs down from the top of the page for the PDF that you have to download called "Management of Diabetic Cats Using Long-Lasting Insulins." Dr. Rand is from Univ of Queensland and has been one of the foremost researchers on feline diabetes. The recommendation there is to use Lantus or Levemir because they each last around 12 hours in a cat's body.

Yes, seeing all of Oz's numbers on the spreadsheets we use would be really great. The blood sugar numbers are most important in relation to when you gave the shot of insulin Here is the link on how to do the spreadsheet. If you have trouble, just holler and someone can help you.

Cushing's is a very rare disease - it's hallmark symptom is not only high blood sugar, but skin that is extremely fragile and that tears. I've been on here for about 4 years and only know of 2 cats with Cushings. There are other reasons for insulin resistance - my cat, punkin, had acromegaly which is a far more common reason for high doses of insulin being needed.

I wouldn't go there for your kitty yet. Pancreatitis is a possibility, but if his appetite is good, that's likely not your main problem. We see plenty of cats with steroid-caused diabetes. Dry food is another culprit - it can be as high as 50% carbs - a cat's natural prey is a mouse or a bird, about 3-7% carbs. Dry food is simply too high in carbs for most cats. Chances are very good that with a different insulin that lasts longer - the Lantus or the Levemir - and some help with how to adjust his dose, you're going to find that getting his blood sugar down will improve everything.

Cats will learn to tolerate hometesting if you give them a treat with every poke, even if you don't get blood. It can be really discouraging at first when you start testing because it takes about 2 weeks for capillaries to grow in the ears. Before then, you won't get blood every time. Just persevere and know your poking is stimulating the capillary growth and in a couple of weeks you'll get blood every time. I gave punkin a piece of cooked chicken breast (like 1/2" cube) every time. Many people give freeze dried meat. The important thing is pure meat so it's zero carbs. You can also help things by putting on neosporin OINTMENT with pain relief. That numbs the ear and is a HUGE help. The ointment part will act like a vaseline slick and keep the blood from absorbing into the hair and skin. wipe off most of it before you test so the ointment doesn't goo up your test strip. I had to burrito wrap punkin for 2 weeks to test him - you can google youtubes on burrito-wrapping a kitty. We used a beach towel = you gotta pull it tight over their front legs, and i pinned punkin's front legs against his tummy, otherwise he'd try to climb out of the towel. Just know this is how you keep Oz safe on insulin. Cats can have their pancreas heal and go off of insulin, so a dose that was good before (like at the vet's) can become too much as their pancreas heals.

Also, if you remove the dry food his insulin needs will likely drop dramatically. The 4u that hasn't been enough may become too much. Testing is what will help guide you to changing his dose.

Ok, i've written you a book and hopefully haven't overwhelmed you. I don't usually help on the Main Health board - i usually just post on the Lantus/Lev Tight Regulation support group. That's for people who are trying to get their cats blood sugar regulated to keep them as healthy as possible, and hopefully to go off of insulin. We don't know which cats that will happen to, but even if they don't go off of insulin, it protects their organs.

Keep posting on this thread and I'll see your replies. It is really hard at the beginning, but it gets infinitely easier. really. :YMHUG:

We are all volunteers and laypeople, but the people on this website do feline diabetes 24/7/365. We can help you.
 
Switching to low carb canned or raw food may decrease the glucose level 100 mg/dL and decrease the insulin dose as much as 2 units, along with the possibility of going off insulin and becoming diet controlled.

As you are already giving insulin, any food changes should be done gradually (20-25% different food each day) and with as much monitoring as you can, for safety. Since he has been running high, evidence of improvement will come from decreased thirst and urination, decreased appetite, and more normalized behavior. See my signature link Secondary Monitoring Tools for numerous assessments you can make.

Also, be prepared: have a hypo kit ready in case of low numbers - high carb gravied food, Karo or other syrup, oral syringe, and directions to the nearest 24 hour vet services. A method to intervene at home may be found here.

Vet Dr Lisa Pierson discusses feline nutrition at her website Cat Info and has a food list which indicates the percent of calories from protein, fat, and carbohydrate, plus phosphorus levels here. Anything with under 10 % calories from carbohydrates is fine for regular feeding for all your cats. I feed Friskies pates, myself.
 
Wow, thank you for all the information!! And the hope :)

Ozgood was on Novolin, then glargine (I literally just googled glargine and found out its Lantus), and now back to Novolin. The vet switched him back to Novolin because the glargine wasn't lowering his blood sugar, but now it seems that neither kind has completely done the trick. I'm not sure of the exact dates when the insulin was switched, but Oz has definitely been on Novolin the majority of the time.

Curve:

10-13-14
3.5u Novolin at 8pm

10-14
8am-614
3.5u Novolin at 9am
11am-497
12pm-425
1pm-416
3pm-255
4pm-255
5pm-295
6pm-315
3.5 u Novolin at 8pm

10-15-14
8am-687
4u Novolin at 9am
105am-522
11am-382
12pm-383
1pm-298
2pm-242
3pm-214
4pm-486

We dropped him off at the vet for the tests on 10-14, picked him up that night, then dropped him off on 10-15 again. We didn't have a curve for him on the glargine.

I apologize if I've left anything out and for the short reply. I'm stretched pretty thin right now. But know that I really appreciate your replies! Even if I have to read it a few more times for it all to fully sink in :) I plan to talk to vet about Levemir, acromegaly, and work on getting rid of the dry food. Again, thank you both. I'll check back in tomorrow night.
 
Without the food change to low carb, canned or raw food, it isn't surprising that Lantus didn't seem to work.

Also, Lantus/glargine works differently from Novolin - you have to wait a good 5-7 days on the first dose, then 3-5 days on any adjusted dose, in order to evaluate the full effects. This is because it is a depot insulin, the effects overlap shot to shot, and it builds up over several days.
The initial Lantus dose is based on lean weight as follows:
What is the current weight?
What is the ideal weight?
Take the lowest weight.
Convert it to kilograms (pounds / 2.2).
Multiply by 0.05.
Round down to the nearest 0.25 units. Note that syringes do not mark 0.25, nor 0.75 units, so you may have to eyeball the dose as best you can. Magnifiers help!

Lantus doses are adjusted by the nadir, the lowest glucose after a shot. This is usually somewhere between +5 to +7 hours after the shot.
 
Lantus is an excellent insulin for cats. It's likely you didn't see the results you were hoping for only because you either didn't go up enough in dose, didn't catch the lower numbers when the curve with the vet was scheduled, or because of the dry food. It's not that it wouldn't work for him - really. If you know how to use it and how to adjust the doses, it works. You don't need to worry about acromegaly either - you have dry food in the picture and that completely explains the dose. In fact, the dose is probably not high enough to compensate for the dry food.

We know from people's experiments that dry food can cause very high numbers - even just 3 pieces of kibble can raise a cat's blood sugar more than 100 points and it can last for a day. Here is the spreadsheet of the cat I was mentioning.

Scooter lives in a household of 13 cats. Linda was pretty certain he wasn't eating the dry food because he didn't seem interested in it. She did all the right things - she got his teeth cleaned, she tried switching him from Lantus to Levemir, she fed the other cats their dry food separately from Scooter, etc. When everything else had been exhausted, she took the dry food out of the house. Turned out that Mr. Scooter had been sneaking crunchies when she wasn't looking! :lol:

He went from 5.5u to off of insulin. The day before the dry food disappeared he was in the 350's. After the dry food went away and he settled down from bouncing from the low numbers, he was in the 50's. That's the power of dry food. The day she took away the dry food was a harrowing day - she was testing every 30 minutes or so and his blood sugar wasn't coming up and staying up. But the outcome was no more insulin for Scooter.

Scooter's 5.5u on Dry Food to OTJ on Feb 19, 2014

You can scan down his spreadsheet and see that two more times he got into dry food and his blood sugar went up to 400+ from it.

Dry food can have as much as 50% carbs. It's pretty impossible to get a cat's pancreas to heal and for the cat to go off of insulin if they are eating dry food.

However, making the transition from dry food to only low carb canned food has to be done carefully. As you withdraw the excessive carbs, the insulin dose will be too large. Do it gradually while you are hometesting so you can reduce his insulin.

We can help you get going on the hometesting. It overwhelms everyone at the beginning, but once you learn how it's no harder than brushing your teeth. When I was talking on the phone while testing punkin, I realized I'd made it. It had become easy when I never thought it would be. The first 2 weeks of testing him I was dragging him by his arms out from under the furniture, hoping i didn't dislocate his arms! Then I had to wrap him in a towel and pin down his front legs so he wouldn't escape. But after 2 weeks he gave up, his ears bled every time, and I knew we were on our way. You'll get there too.

Newly diagnosed cats have a huge advantage in being able to heal and go off of insulin if they get regulated asap. Time is of the essence. Make the most of the advantage. :-D

edited to add: here is an excellent site with tips on Feeding your Cat including a link (see the right hand column or slide down the page) on Transitioning your Dry Food Addict to Canned Food.
 
Hi!

I wanted to respond to your pm here. We keep all advice in public for several reasons - one is to improve the quality of the advice. If one person makes an error, someone else will likely catch it, but also it lets everyone learn from each other.

I've been reading on catinfo.org. It seems we should get Oz on home testing before we switch him to wet food, but I'd like to get him on all wet food ASAP. Is it wise to switch him over and cut down on the insulin without a blood sugar reading? We've always feed all four cats a small portion of wet food in the morning, and they love it, so I'm hoping it will be a simple switch for everyone.

All four cats have been fed Meow Mix Tender Favorites (assorted flavors). I can't seem to find anything Meow Mix on the nutrition chart from catinfo.org. Is this a good choice to feed them? Hopefully it is because they have no issue eating it! It does have a gravy/sauce with in. Otherwise what would you recommend? It seems like there are so many wet foods that are low in carbs. Thanks!
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Yes, you want to be hometesting as you switch Oz from dry food to wet food. The insulin dose that worked with high carb dry food will be too high for low carb canned food. In order to prevent him from being overdosed, you need to be monitoring him and reducing the insulin as you reduce his carbs.

I would keep working on the hometesting - post and ask if you have questions. Everyone here has a bucket of tricks that worked for them in getting to the point of making hometesting easy. Once you get past the 2 weeks of poking that it takes to get the capillaries bleeding regularly, it becomes very easy. Those first couple of weeks can be frustrating, but really, as long as you know it's nothing you're doing wrong that's causing you not to get blood, it isn't so bad. Just persist!

I'm not finding Meow Mix on the PDF on http://www.catinfo.org either. I'm not sure why, although some companies wouldn't release information to Dr. Lisa when she was updating the lists. I can't say whether it's higher carb or not. There are lots of choices of low carb canned - the right one for you is just the one that your cats will eat and that works for your budget. Probably the most common foods I've seen people feeding are Friskies classic pates, Fancy Feast classics and Wellness low-carb versions. Even the low-carb pates will usually have a little bit of liquid around them. It might be more clear than gravy-looking, but I think rather than risking giving higher carb than you want, I'd probably look through the Low Carb Food List and choose something that's under 10% carbs. Most people go with something around 5% carbs. Zero-1% is not better than low carb. Fish isn't a great mainstay for male cats, but you can give it occasionally.

Hang in there! People are happy to help you and it gets so much easier once you bite the bullet and get the testing going. Then you can have confidence in what's going on inside of Oz's body and know you're keeping him safe. cat_pet_icon
 
From Dr Mark Peterson on Endocrine Vet:

If a change in feeding to a low-carbohydrate diet is made in a diabetic cat already stabilized on insulin, it is extremely important to realize that this will result in a lowered daily insulin dosage — often significantly (9.20). If not closely monitored—ideally with home glucose testing— severe hypoglycemia can develop in these cats because they become more sensitive to insulin after the diet composition is changed.

Therefore, when changing from a higher-carbohydrate to a low-carbohydrate diet, we recommend initially reducing the insulin dose by 30% to 50% to help avoid hypoglycemia.
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Until we can get him home tested, I wonder if we should reduce his insulin 50% (from 4u to 2u, per the article from Dr Mark Peterson) and do the switch to wet food? Or keep the dry food out and until we're sure we can home test him? His blood sugar has been so high for so long that I feel like he should be eating all wet food as soon as possible. Or take the dry food away at 8pm, give him 2u of insulin and wet food at 8am, then have the vet test him around 1pm that day? That reading would be about 17 hours after he last had dry food. Would that be enough time to see if 2u of insulin is the right amount? I guess his water intake and amount of urine would provide a clue as to what his blood sugar is also.

Assuming all 4 cats will eat a wet food from the low carb food list, are there any ill effects to taking them off dry food cold turkey, overnight? Fancy Feast Classics are all around or below 5% carbs so I'm going to try a few flavors of those to start with since I know they're available locally. Thank you both!
 
Also, would 2 portions of wet food daily be enough for a diabetic cat? Any thoughts about feeding boiled chicken or canned chicken (the human food kind)?
 
Sudden diet changes can cause significant gastrointestinal upsets. It's normally recommended to make diet changes gradually.
 
If you make the change gradually, you have time to compensate by adjusting the dose downward, rather than guessing what will work.
 
How can we help you test him at home? that's really the best way - and zillions of people have learned how to do it successfully, even with difficult cats. If you can give shots, you can test. It's so much easier than giving the shots!

One help is to always give a treat after you poke him. Oz will learn to associate the testing with the treat and he will accept it.

I'm not comfortable advising you on how to manage this without him being tested somehow. If you were testing, we'd have the numbers to go by and could suggest reductions to the dose. I'm just uncertain on how to proceed. If you were testing, you would do this switch gradually, decreasing the dry food and increasing the canned food simulataneously over the course of about a week.

The trouble with doing all of the testing at the vet's is that the BGs likely won't reflect his true situation, and basing the insulin dose upon vet tests is risky. Cats under vet stress can have increased blood sugar - as much as several hundred points.

It's also very likely that as you decrease the dry food and increase the low carb wet food, Oz's blood sugar will drop into lower numbers than he's been in a while.When that happens, Oz will very likely bounce. If the day he's at the vet's is when he's bouncing - which can last up to 3 days - dosing based upon a curve done then is also not going to be accurate.

Did Oz ever have ketones or diabetic ketoacidosis? If that's in his history we have to be more careful about how we proceed.

He was diagnosed in April and has been on dry food since then. I don't think you should rush to change things immediately - let's get a plan first that keeps him safe in the transition.
 
Okay, we'll plan to go slow with the switch. We WILL try home testing tomorrow. I can't guarantee any results tomorrow but I can guarantee we will get the ball rolling :) Oz was tested for ketones over the summer and he didn't have them.

What are the guidelines for reducing the insulin dosage? He's on Novolin. When his blood sugar starts falling due to the change in diet, how do we know how much less insulin to give him? I apologize if I've missed it somewhere.

Some good news - we picked up a couple boxes of Fancy Feast Classic Seafood Variety. 3 of the 4 ( including Oz) seem to love it! The oddball ate part of her portion. It's possible she just didn't want anymore. Oz ate a full 3oz can. It seems like we won't have trouble getting them to eat canned food. I have to figure out how big of a portion we should be feeding. Oz is the only one that's underweight, due to his diabetes. The other 3 could stand to lose a couple pounds. Is eating 2 times a day, every 12 hours, often enough for a diabetic cat or should there be a meal in the middle?

Wish me luck on testing! I'll post how it goes :)
 
to help flatten out blood sugar and try to keep it as constant as possible, you probably want to feed him more than twice a day. I'm not familiar with Novolin and dosing - one of the others can probably suggest what time is the best for feeding. I'd go with 4 times a day or so, however. Cats feel best when their blood sugar is as flat as possible.

punkin weighed about 13lbs and I fed him 3 cans of fancy feast every day. One 3oz can with each shot and 1/2 can 3 hours later. In between that second meal and the next shot, we gave him small amounts of cooked chicken breast. That's also what we used for pokey treats to help soothe his feelings after he got poked. :-D

there's not an exact formula for reducing the dosage, but we can help you figure it out as you go along. With Lantus, any time a cat goes below 50 we reduce the dose. Someone experienced with Novolin will be along to help you with dosage - that's not me.

Wishing you great luck tomorrow! I think it will be easier than you think.

Take a look at this post on Testing & Shooting Tips

There are quite a few tips on there that might help you get started.
 
This may be helpful: Humulin/Novolin Primer. It explains how to maximize your use of the Novolin. Some folks find they need to give insulin every 8 hours with Novolin NPH, due to its usual duration of 6-8 hours in the cat.
 
I'm coming to the discussion a bit late.

How long was your kitty on Lantus? FWIW, Novolin has fallen out of favor for treating diabetic cats. Lantus and Prozinc are the two types of insulin that are recommended by the American Animal Hospital Assn. for treating diabetic cats.
 

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Thanks for the links everyone! As far as a feeding timeline, we could do 8am (insulin), early afternoon (approx 1), mid evening (approx 5), 8pm (insulin). The 8's aren't an issue, but there are days where the in between feedings may have to be at a different time. We could leave food in a dish if nobody would be home for the 2 mid day feedings, but then we can't be sure who is actually eating it. However, we aren't sure who is eating the dry food during the day either.

Good news- we were able to get a bg reading! We held him in a towel and set him on the table. I held a cotton ball on the inside of his ear when I used the lancing device. No luck on the first 3 pokes. I was ready to give up until later but I got it on the 4th poke! I gave him some turkey right after. Oz tolerated the pokes very well. I don't know why he squirmed so much this summer when we tried it.

Bad news- his bg was 591. But.. We tested him at 7:40 pm, and his insulin was at 8:20 am. We just fed him and gave him 4u Novolin, so should we try another bg test in 2-3 hours? Also, we still haven't completely removed dry food from the dishes.

I think we've cleared 2 big hurdles in that we can home test him and all 4 cats will eat canned food. So, what next? I'm off tomorrow and I was considering removing all dry food in the morning and doing a few home tests. Would 4-8 hours with no dry food be enough time to see a difference in his bg reading? Should we see how much of an effect completely being off dry food has before we consider changing insulin?

Oz was on Lantus for maybe 3 weeks, a month.
 
When you switch to low carb food, you may need to cut the insulin dose in half in order for your cat to be safe.
 
now that you're hometesting, you can reduce the dry food gradually, while you are testing and reduce the insulin as you need to. I like BJM's suggestion to drop the dose in half, although if he's really nearly 600 it might be good to reduce the insulin gradually.

The reason I said "if he's REALLY nearly 600" is because sometimes those crazy high numbers are from a cat bouncing.

When you have a chance, would you start a spreadsheet? Looking at blood sugar tests in context of the when in the cycle they fall is really helpful. In other words, we look at how many hours after the shot the BG reading is from and that can give us valuable information. We also typically look at about the past 3-5 days worth of tests to help us interpret the significance of tests.

For example, if Oz was at 75 yesterday and 591 today, that would tell us that he's bouncing - his body reacted to being lower than he's become used to and it released stored sugars and hormones to counteract the perceived hypo - even though it wasn't a hypo or a dangerously low number. So we wouldn't worry about the 591 because it was actually CAUSED by him going into normal numbers.

On the other hand, if you get several tests a day in and they are all from 300-600, and we can't see any sign of a lower number in there, then we'd know that the 591 was a sign that he really needs a dose increase.

The answers will all show up in the testing. Tests don't lie.

The directions for making a spreadsheet are here. The rest of that page is for people using Lantus, so much of it won't apply to you, but some of it will. That information post is located on the "New to the Group" yellow starred sticky in the Lantus/Lev Tight Regulation Protocol Insulin Support Group.

Do you still have Lantus left? It might still be good.
 
I tried to create a spreadsheet by using "Option #1: Direct from Google Docs" but when I click on the link for the template the page won't load. I'm on my iPad so maybe that's why. I can try it again later or maybe from a desktop.

We tested him at 2pm today, 6 hours after 4u of Novolin. He was at 181. That's the lowest we've seen him. He hasn't had any dry food today. He had 1 3oz can of canned food with his shot and some small portions of turkey a few times today. I fed him about 1/3 can of canned food 15 minutes ago. He seems hungry. He's always been a beggar but he seems to be hanging around more today. I want to test him around 6, which will be +10 hours.

I won't be around to test him during the day tomorrow. Saturday I would be able to. Should we put the dry food back down for them Friday? I don't know if I have to worry about his bg going too low if it was 181 6 hours after the shot and with no dry food, but I don't want something to happen to him when I'm not around to watch him.
 
Novolin N hits its nadir somewhere between +3 to +4 hours after the shot. He likely was already on his way up at +6.

When you can't be home to monitor and you have concerns, it is prudent to back off 0.25 (eyeballed ) to 0.5 units with the N insulins as they hit very hard. If he got in trouble and you weren't able to intervene, he might not survive. Better too high for a day, than too low for a moment.

I'd really recommend going back to the Lantus. While it is true it doesn't have the dramatic drop of the N insulin, it can be used very effectively to keep overall numbers low and smooth once the dose is titrated. Your vet was expecting it to work the same way as an N insulin and it doesn't, so he didn't think it was helping. All of our Lantus members can tell you it does work if you follow a good protocol such as Tight Regulation.
 
We plan to do a 12 hour curve Saturday. We'll get everything squared away with the change in diet and see where his bg is. If he's still too high too often we'll try Lantus again.

We didn't get a bg reading at 6 because he was pretty feisty. We tested him at 8pm (+12) and he was 487. Nearly 100 points lower than last night.
 
Once you've gotten rid of the dry food, I wouldn't re-introduce it unless there was some compelling reason. You can manage him with low carb canned food. For Friday, I'd give a reduced dose as BJM is suggesting, and then leave out plenty of low carb canned food for him.

He's hungry because the nutrients from his food (glucose) is floating about in his bloodstream instead of getting into his cells and nourishing him. As his blood sugar comes down, the glucose will be getting into his cells and he won't be starving.

Try again on the ss from a desktop. That might help.
 
Update- still no dry food! I've stood my ground. We did a +12 bg test today and Oz was at 451. That's the lowest +12 we've seen. It's recommended the highest bg reading of the day be no more than 300, correct?

We'll do the curve tomorrow and I'll get my ss up and going. Assuming I can get it to work I'll enter in all the results from the curve and have it uploaded Saturday night.
 
I'm not sure where that 400 number comes from. I haven't heard that.

The first goal with a diabetic cat is to try to get them under 250 or so because that is the point that's called "renal threshold", ie, the point where the kidneys can't process the sugar in the blood anymore. That threshold varies from cat to cat, but it's somewhere in that vicinity. Above that level it spills over into urine.

For people who want to try to help their cat's pancreas heal and begin producing insulin again, hopefully to go off of insulin and become diet-controlled, the next level of control is called "Tightly Regulated." The goal for those people is to keep their cat in normal blood sugar numbers, 50-120 on human glucometers.

Let's see what his ss looks like tomorrow after your curve and go from there.
 
Okay, so we're shooting to keep him around or below 250 as much as possible to begin. I've started a spreadsheet and attached it in my signature. I have the sporadic readings from the last few days as well as the start of the 12 hour curve today. I'll keep it updated throughout the day.
 
I should also add that he's thrown up. Friday morning (about 8 hours after his Thursday PM insulin) I cut up a couple slices of lunch meat turkey and gave it to him. About 10 minutes later he threw up some of it, but it didn't look to be all the turkey he ate. No change in behavior.

This morning (about +8 for Oz again) I gave Oz and Ollie about 1/2 slice of turkey each. Shortly after, they both threw up. Neither of them threw up very much, maybe a spot the size of a half dollar, and it was all liquid. No undigested food from either of them. I've fed Oz turkey a few times a week for months and it's never been an issue for him. Could their stomachs be touchier with this switch to canned food?

One more thing. I went to pick up Oz for his +2 bg test and I thought he was going to throw up again. When I scooped him up I think it made him burp because I could smell chicken. I fed him about 1oz of canned chicken as a treat after his +1 test. He ate 3oz of canned food with his insulin this morning plus 1.5oz the other cats didn't eat, and 1oz of canned chicken. That has been since 8 am and it's now 11:30.

Is any of this reason to be concerned?
 
WOOHOO! You got a spreadsheet going! and lots of testing data on it - good job!

I don't know about the vomiting. Perhaps someone else can speak to that. If it happens again, you might want to phone your vet. It's a little odd that both kitties threw up after the turkey. Was it pure turkey, or possibly injected with flavorings, lunchmeat, etc?

When you give treats for poking, you want them to be tiny - you can imagine you might be adding a lot of calories if you give an ounce of food after each poke. Some people use freeze dried meats. I gave punkin cooked chicken breast cut in 1/2" cubes for a treat. Even a small amount will make a kitter happy.

Re the canned chicken - double check the ingredient list and make sure that there is no onion or garlic in it. I simmered chicken breasts in water, cut it small, froze most of it and kept a couple of days worth in the fridge. Super easy and you know exactly what the ingredients are.
 
Alright, we've got the curve done for today. I've included the curves that were done with Oz at the vet's office on 10-14 and 10-15. Oz was such a sweetie with the whole ordeal! I have more confidence in my ability to find out what his bg is now- feels good!

It was lunch meat turkey. I think we'll just stay away from it from now on. I checked the ingredient list on the canned chicken- no onion or garlic. We've actually been considering cooking chicken breast and giving it to all 4 cats as maybe a mid day meal.

So what do we focus on now? Some of his readings from today were actually higher than they were at the same hour on 10-14 or 10-15. Other than that he's lower now. Oz hasn't had any dry food since Wednesday morning. His bg readings aren't super low, but there's a BIG difference in the amount of water left in their dish and the amount of urine in the litter box. I filled the water up at 4am Friday, and it was over 1/2 full at 9am Saturday. Before the switch to canned food it would be almost empty in 24 hours. Now it's been staying more full for a longer amount of time. I'm off Wednesday so I will do some more bg readings throughout the day. We think we should get some more bg numbers after a week of no dry food to see if his body adjusts more than it has so far. After that we figured we could adjust the insulin dose. Since Novolin N is so fast acting- If we increase the dose Wednesday morning we would know Wednesday if he's going to become hypo from the increased dose, correct? Just triple checking to make sure the hypo wouldn't happen the next day. I figure it would happen the day of the increased dose since his pre shot bg is quite high.
 
I'm sorry you're waiting so long for answers - the thing is that Novolin isn't typically used for cats anymore. I don't know anyone using it right now so there aren't a large number of people to help you like there are with other insulins. In the Insulin Support Group for Vetsulin, Caninsulin & Humulin (which i think is similar to Novolin), there are no posts for November and only one in October.

There are many of us with experience with Lantus - are you open to going back to it? The most commonly used insulins are Lantus, Levemir and Prozinc and we have many members who can help you with any of those. I didn't see your answer about whether or not you still have the glargine (Lantus) you were using before. It's a very good insulin and provides long-lasting blood sugar control for cats. It does take some time to get to the right dose, and it takes experience to understand its action and know how to adjust the dose. However, the Lantus/Lev Tight Regulation group is very active and there would be many people there who can teach you what you need to know to help Oz. The Lantus/Lev dosing protocol is the same.

You can tell by looking at Oz's spreadsheet that the Novolin is wearing off before the end of the cycle. See how his blood sugar is at its lowest at +6 today and by +9 he's over 500? Then he's still got several hours until the next shot takes effect. The ideal cycle for a cat that's tightly regulated is almost a flat line.

I happen to have Max's ss open right now and it will work for an example. Take a look at any of the days in the past week or so. Look at the numbers going across in one day's row. You can see that on some of the days, his blood sugar has moved less than 100 points in the day and he's spent several hours at a time with his blood sugar in normal numbers (50-120).

Oz's ss isn't uncommon, so don't be discouraged. With an insulin that lasts longer you'll be able to get him into better control. I'm really concerned about you not having enough people to help you if you stick with the Novolin. I can't answer your questions as to what happens with Novolin dose increases or when you could expect to see responses.

As far as the food and water go, as your cats are getting more water from the canned food, they won't need to drink as much. Great job getting them transitioned to canned food. That alone is a huge step.

What do you think about switching back to Lantus/Glargine or trying Levemir? I just hate to see you not getting enough help.
 
If you really want to stick with Novolin N, can you give it every 8 hours? Because by +8 hours after the shot, the glucose skyrocketed to 504 - it just isn't lasting long enough.

If you follow the Tight Regulation protocol, I think it is possible to get his numbers down further, for longer. To go back to Lantus, which has a longer duration, plus overlap, I'd suggest 2.5 to 3 units, with mid-cycle monitoring and patience. You'll need 5 to 7 days at the same dose to see how it is working, due to the build up/overlap effect, aka the depot. You focus on the nadir test results, not the pre-shots. As long as he remains above 50 mg/dL on a human glucometer, he is reasonably safe from hypoglycemia.
 
Yes, we are definitely open to trying Lantus again. No, we don't have any left over from when Oz was on it before. We tested him 15 minutes ago (+2) and he was at 365. We're going to call our vet today and ask her about getting Lantus so we can try it again.

BJM- giving Novolin N every 8 hours would be tricky. Some days there would be no problem sticking to that schedule, while other days it would be tough. Since the N wears off as fast as it does and Oz's bg climbs hours before the next shot, we want to get him back on Lantus.

So for the first 5-7 days he's on Lantus will it be like he's not getting any insulin? Or will the Lantus lower his bg for the first 5-7 days, but it won't lower his bg as much as it will after 5-7 days and the depot is built up? The only time we're both around to be get a bg reading during the day is Saturday, Sunday, and Monday. I'd like to try and time it out so we could get readings from the Lantus on the weekend. Neither of us has tried getting a bg reading alone (can't say how well that would work!). We could getting evening readings (+9 to +12 hours after the AM shot) on weekdays without much issue.

Should I be looking at topics on the Lantus forum or are there some good articles I should be reading now? Thank you both!

On the food- we feed all 4 cats about 8am and 8pm. Is it okay to feed Oz randomly throughout the day as well (either canned food or chicken, no dry food)? Or do we need to be sticking to feeding at only the same time every day?
 
All of mine graze through the day; this seems to work well for them, including the diabetic.

As you start the Lantus, you should see gradual improvement each day. If possible, urine test for ketones (use a ladle and watch him right after eating, when many cats eliminate) and monitor his breath for the smell of fruit or nail polish remover (2 of 3 kinds of ketones are detectable by these 2 odors).

Although there are multiple cats, measuring the water you put down and what is remaining at the next shot time will give you an indirect assessment of water consumption change. Most cats on canned food seldom drink water, so it may be pretty obvious if that changes for your diabetic.

And absolutely go read in the Lantus Tight Regulation forum to see ways to use it, store it, and so on. It takes a while to sink in, so you may want to print stuff out.
 
Great! I'm glad you're open to switching - I think you'll find it works really well for Oz when you've got some coaching along the way in how to use it.

Here is the link to the Lantus/Levemir Tight Regulation Protocol insulin support group. Just browse those yellow starred posts at the top. Start with the "New to the Group?"

I would say that all of that info is good to look through, but it's too much too fast and it will mean more and stick with you when it's in context. So when Oz bounces, then learning about bounces will make sense. When he gets "New Dose Wonkiness", that's when it will make sense. So don't worry one bit about memorizing things, just get a general idea.

If you understand that Lantus is somewhat like a timed release insulin that will help you a lot. In answer to your question about starting on Lantus, no, it's not like he's not going to be getting insulin when he starts out. He'll be getting insulin. Some of what you inject goes immediately to lower blood sugar. Some forms a precipitate in the body and will begin to slow-release. The best description of that is on the link that is called "Lantus vs Levemir, What's the Difference?" Look here and go down to the blue heading about "Info, Proper handling & storage" and click it, then you'll find the explanation of how Lantus works.

The reason I'm suggesting Saturday is that the protocol suggests testing at preshot, +3, +6 and +9 for the first 3 days on Lantus. That should work well with your schedule.

What I would do next is to go ahead and get the Lantus. I'll get back to you about a starting dose. Then on Friday night or Saturday, if you're interested in following the Tight Reg Protocol then post there - people will hold your hand and help you know what to look out for as you begin.

You'll need u-100 syringes with half unit markings. Many people like these Terumo syringes. There is a link to American Diabetes Wholesale through the "shop" button at the top of the main page -the site gets a small percentage if you use that button. If you have u-100 that have half unit markings you can keep using them.

I'd make the switch on the Saturday so you're around. I'll get back to you with a suggestion for a starting dose. There is a weight-based formula, but we also take into account the current dose when you're already on another insulin. Let me run it by a few other experienced lantus users too. Are you thinking this Saturday?

by the way, what's your name? I know Oz, but I haven't caught your name. :-D
 
Thanks for more wonderful information you two! :) We never heard back from our vet today, but we'll call again tomorrow. Yes, I think we would be around to monitor him Saturday. I think what I'll do is read through some of the info posts on Lantus this week and hopefully get him started on it Saturday. I'm not sure what kind of timeline our vet will have as far as getting the Lantus, but I'll ask tomorrow. We've been using u 100 syringes.

Oz weighed 11.4 lbs as of 10-14-15. He weighed 18-19 before his diabetes. He's underweight now and feels pretty thin and bony :( and of course he's on 4u of Novolin N right now. Going from my spreadsheet, his bg needs to be lower during the cycle than what the 4u does for him. Hopefully that will help some with getting a dose figured out.

Should I get the Precision Xtra meter so we can test his blood for ketones at home?

And my name is Alex. :)
 
Shop around for the Lantus from a pharmacy - it is a human insulin. You want the pens (or cartridges outside the USA). Each pen/cartridge contains 3 mL, which is 300 units. You use a regular syringe to withdraw the it, not pen needles, so you can dose in less than whole units. There is a small soft gasket at one end which is where you insert the syringe.
 
I didn't see you mention that he had ketones in the past. Did he? The urine diastix are what most people use for their cats. YOu can get them at any pharmacy and you stick them in the fresh urine to test. Some people get a soup ladle to poke under their kitty. some people have an alternative box that's got something non-absorbent in it (like aquarium gravel - i used lentils) for testing for ketones.

There is a Novamax blood glucometer that also tests for ketones. If you google for it you can probably find one that the meter is free, or you pay for strips and the meter is included. Shop around if you want that option.

Does the Precision xtra measure ketones as well? I'm not familiar with that one.

As you're going through the yellow starred stickies on the Lantus/Lev Tight Reg forum, this Table of Contents might be helpful. There's a ton of info on that forum and sometimes it can be hard to remember where you saw what. You can bookmark that post and it may end up being useful. Before you start with the Lantus, take a look at the Care & Handling of Lantus/Lev sticky - there is a video on how to draw up a dose. You don't want to contaminate your lantus, so it's worth learning about.
 
BJM said:
Shop around for the Lantus from a pharmacy - it is a human insulin. You want the pens (or cartridges outside the USA). Each pen/cartridge contains 3 mL, which is 300 units. You use a regular syringe to withdraw the it, not pen needles, so you can dose in less than whole units. There is a small soft gasket at one end which is where you insert the syringe.
Click to expand...

When we had the glargine before it was in a vial like the Novolin N is. We got the glargine from our vet. Maybe the pen is how the glargine comes if you buy it from a pharmacy and since we got it from the vet it was in a vial? I had never heard of it coming in a pen before.


Oz never had ketones in the past. Can the diastix be dipped into fresh urine that's already been clumped by the litter? I'm guessing it probably wouldn't work that way? I'm not sure how he would react to us when he's using the litter box. I know I thought it would be impossible to ever get a bg reading from his ears, and we can do that with ease now, but I don't know about the litter box. Yes, the Precision Xtra measures bg and ketones through blood. It uses separate test strips for bg and ketones, but the same meter.

I tested Oz at +8.5 tonight, he was at 524. Pretty high :/ I updated his ss. On 11/8 when we did the 12 hour curve he was at 504 +9 and then dropped to 472 at +11.

Tonight I noticed a small (approximately the size of a dime) patch of missing fur at the base of his neck sort of between his shoulder blades. Can this be anything related to the diabetes or anything to be worried about?
 
You asked " Can the diastix be dipped into fresh urine that's already been clumped by the litter? I'm guessing it probably wouldn't work that way?"
Yes if the urine is still fresh.
 
It may be less costly at a pharmacy; check around.
You generally can't use all of the vial by 6 months, which is when it tends to lose efficacy, even when refrigerated on a stationary shelf.
You often can use an entire pen or cartridge, so you're not wasting any.
Yes, we know, the package insert says pitch after 30 days; that is all that was tested.
Also, the pharmacist will tell you what is on the package insert; its a legal thing.
 
hmmm, we encourage people NEVER to get repackaged Lantus. It should come from a people pharmacy. That may have been one reason why you didn't think the lantus worked before. that raises a red flag for me.

Ask for a prescription for either the pens or a vial - doesn't matter which. For tiny dose cats the pens are the most cost effective. At one time I did a comparison and at 7u per shot it became more cost effective to buy the vial. That was maybe 3 years ago, though - i don't know which is the most cost effective now. Most people buy pens. If you can find a pharmacy to sell you one, that's ideal. Pharmacies that supply nursing homes and hospitals often will break up the box of 5 pens and sell you just one. I bought them one at a time (for a short while) at a local Save-On pharmacy that was in an Albertson's grocery store.

There doesn't appear to be much rhyme or reason as to who will sell one pen and who will insist on selling a box at a time. You have to call around. Also, there is a Lantus discount card (google for it) that will give you $25 off on your prescription. My pharmacy let me use it on one pen, bringing it from $43 per pen to $18 after the coupon. When you register for Lantus discounts, your cat is your child and your child is 18. :-D

http://www.felinediabetes.com/FDMB/viewtopic.php?f=9&t=151 Look on that link about the repackaged insulin warning.

about his skin - is it where you shoot the insulin? If so, move the shooting spot around. It's important to do that anyway - you only have to move by a fraction of an inch, but do move the poking spot.

if it's not where you shoot, could it be related to flea products like frontline?
 
Larry and Kitties said:
You asked " Can the diastix be dipped into fresh urine that's already been clumped by the litter? I'm guessing it probably wouldn't work that way?"
Yes if the urine is still fresh.
Click to expand...

Thank you. Is diastix the name I should look for on the box?


Thanks for the heads about about repackaged Lantus! I'm not sure if it was repackaged the last time we got it from our vet because the label on the vial was a printed label. I don't remember exactly what was on it, but it was similar to the printed label on the Novolin N. I will now of course double check with our vet and if it's repackaged we'll get it from a pharmacy. Unless, since it's a human insulin, it only comes in pens? And if it's from the vets it would mean it has to have been repackaged? Thanks for the discount tip :)

No, I've been shooting the insulin in his hind quarters. Poor thing is so skinny :( He eats like a horse. If I'm making myself something to eat he's extremely vocal and insistent that I feed him as well. He's always been a beggar that tries to get me to feed him, but since we've removed the dry food he's even worse. He eats 3oz at 8am and 8pm, plus any leftovers from the other cats. We also feed him at least one other time, usually two other times, throughout the day.

We haven't treated him with Frontline or anything.

We heard from the vet tonight. Oz is going in Friday morning to get weighed, checked for ketones, and she's going to look at the bald spot on his neck. I have to get reading about Lantus!
 
Lantus comes in vials (10 mL), pens (5 packs of 3 mL) and in some places, cartridges (3 mL)
There are 100 units per mL, so 1,000/vial vs 1,500 units/ 5 pack if you can't get a pen or cartridge separately.

He's hungry because he doesn't have enough insulin to allow him to use all of what he eats. Until regulated, he may need up to 50% more food. Adding a tablespoon or two of water helps provide volume.
 
Is ther an issue with aiming to get Oz well regulated versus tightly regulated?

Thanks BJM. Maybe I was expecting too much too soon in regards to the food. I was expecting since his mid cycle numbers were lower he would be less hungry.
 
When he's running between 50-130 mg/dL on a human glucometer, he should be less hungry, urinate less, drink less, eat less (because he'll be able to use what he eats), have better coat condition, return to his pre-diagnosis behaviors such as grooming and play.
 
julie & punkin (ga) said:
I didn't see you mention that he had ketones in the past. Did he? The urine diastix are what most people use for their cats. YOu can get them at any pharmacy and you stick them in the fresh urine to test. Some people get a soup ladle to poke under their kitty. some people have an alternative box that's got something non-absorbent in it (like aquarium gravel - i used lentils) for testing for ketones.
Click to expand...
Please note:
Diastix are what you'd use to measure sugar in the urine.
Ketostix are what's used to detect the presence of ketones in the urine.
Ketodiastix can accomplish both.
 
thanks, jill.

Alex, just checking in to see if you've gotten the Lantus and are still planning on switching insulins tomorrow.

edited to add:

There are a couple of directions you could go with the dose. From the Tight Regulation Protocol the suggestion for a completely newly diagnosed cat is to use a weight-based formula. For Oz at 11 lbs (=5kg), the weight-based formula would suggest starting at 1.25u per dose.

Using a weight based formula for determining a starting dose of Lantus or Levemir when following the Tight Regulation Protocol:
the formula is 0.25 unit per kg of the cat's ideal weight
if kitty is underweight, the formula frequently used is 0.25 unit per kg of kitty's actual weight
if the cat was previously on another insulin, the starting dose should be increased or decreased by taking prior data into consideration
Online Calculator for Converting Pounds to Kilograms
Click to expand...

Because Oz has already been on Novolin (and Lantus before, but we don't have any information on his dose or blood sugar numbers) and he is getting into the high 100's on 4u, that information would be considered as well. Considering that, you might want to start him at 3-3.5u per shot.

It's up to you, of course, but this gives you a place to start and some things to consider. Please ask if you have questions.

Here are the guidelines for starting out using Lantus for those who are following the Tight Regulation Protocol (from the same link as above):
REQUISITES WHEN FOLLOWING A TIGHT REGULATION PROTOCOL WITH LANTUS OR LEVEMIR:

Kitty should be monitored closely the first three days when starting Lantus or Levemir.
Blood glucose levels should at least be checked at pre-shot, +3, +6, and +9.
More monitoring may be needed.
It will be necessary to test kitty's blood glucose levels multiple times per day.
Learn the signs of and how to treat HYPOGLYCEMIA and prepare a HYPO TOOLBOX.
Test regularly for ketones and know about DIABETIC KETOACIDOSIS (DKA).
Use U-100 3/10cc syringes with half units marked on the barrel for fine dosing.
Feed a high quality low carb canned or raw food diet.
Feed small meals throughout the day. Some kitties adapt well to free feeding.


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.
(Revised 10/28/2013)

"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).
Click to expand...
 
Yes, we got the Lantus. Our vet had us start him at 2.5 u. Middle ground between newly diagnosed and having been on insulin before. :)

Oz hasn't lost any more weight! He was 11.4 lbs on October 14th and 11.6 lbs on November 14th. Our vet will call us with his fructosamine level and the results of the ketone test. I'll have some bg numbers up tomorrow :)
 
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