Need an experienced set of eyes to view spreadsheet

[Emily'smom]

Hi all! We are having trouble with our Emily. I apologize in advance for the long post, but I want to provided as much information as possible. Her diabetes journey began in June, and due to different circumstances (differing vet opinions, dosing issues, plummeting test numbers, and travel on our part) we cannot seem to get her regulated. Perhaps this is normal in the beginning stages?? We are frustrated and worried about our girl. She normally weighs about 6.9 lbs. Last week she was down to 6.2, she feels incredibly bony. For the last two days her eating is poor (she has always been picky and has always eaten a few bites and walked away, and finishes her portions throughout the day and night). Due to her naturally low weight, I get very concerned when she will not eat. I am currently at work and am unable to update my spreadsheet with the most recent home-test numbers. Last night her pre-test shot was 61. (7:00 pm) She hardly ate all day. I tried 5 different wet foods. After that test, I opened a new can of FF (a flavor I had not yet used) and she ate almost the entire can, quite quickly. We did not inject due to that low number. Three hours after that pre-test shot, we retested and she was now in the 200's. I don't understand this. We did not inject because now she was off of the schedule we need her to be on, due to our work schedules. I tested her at 7:00 this morning, and she was once again in the 300's (334). To my knowledge, except for the last day or so, she has not been that high in a long time. I injected .25 units of the Lantus. I was able to get another test this morning +2, and she had come down to 294. Eating well this morning - the same food as last night. I am now at work and will not be home until 6:00 this evening. Is this up/down, high/low, poor appetite at times, etc., all part of this diabetes journey? If so, I am not sure our Emily will survive this. She is so tiny to begin with. Could that low "61" pre-test last night be inaccurate? If you touch either end of the test strip can that effect the reading? Two and a half weeks after diagnoses, with Emily being on insulin (back in June) we took her in for her all day glucose curve. At her +6 she was at 60 and then started coming up. At that time, she was on a small amount of Purina DM dry, and low-carb wet, getting .5 unit Lantus, 2x per day. To be honest, those two weeks, she seemed great! She gained some weight back, her fur looked amazing, she was acting like her old self. We were pleased and happy with how she looked and was acting. But, the vet felt that "60" number was too low, (I do not know if the vet used a Pet Meter or a Human Meter, but can try and find out...I am no longer using this vet) and instructed us to stop giving her insulin. We felt perhaps she was being diet controlled. Horray! In another two weeks we brought her back for a one-time mid afternoon test (we were not home testing at this time) and she was in the mid-200s. Since then, when she has been on the insulin (which again has not been consistent) she is on .25 units, 2x per day....the idea being (and based on the vet's advice) that the .5 was too strong (hence the 60 mid-cycle number), so perhaps .25 would be perfect. Since this amount is hard to eye up (yes, we have 1/2 unit marking syringes), and both my husband and I inject, I am not certain this .25 dose is accurate each and every time. Regarding diet: Since June, i have been trying to wean her off of the prescription dry. She was resistant to this but over time she got less and less (compensated with wet), and while we were on vacation two weeks ago, the pet-sitter managed to get her completely off. She has had no dry food since. I am not convinced she is eating enough wet to manage her caloric intake. Is it possible, that this cat NEEDS some higher carb food, since in our opinion, she was doing very well on the .5 unit, eating both prescription dry and low carb wet (although according to the vet, even then, her mid-day number was too low at 60)??? Could it be that on strictly a wet food, low carb diet, and using such a small amount of insulin, but having numbers jump around and her weight dropping that she needs a different diet??? Or, a different insulin???? In addition, the new vet that we have, that strictly makes house calls, did an overall blood test to get a feel for her overall health and her thyroid (T4) levels were LOW at .8. The vet said is is pretty much unheard of in a cat, but at the time, being focused on the diabetes, did not offer more information then that. Being the thyroid is also involved in the endocrine system, is this something to consider???? I am getting to the end of my rope with worry, aggravation, frustration. Any insight and help would be greatly appreciated!! Thank you!! Mary, Ross and Little Emily

 

[Kris & Teasel]

I can't help with everything but can make a few comments based on what I've learned here on FDMB and with my cat:

Her diabetes journey began in June, and due to different circumstances (differing vet opinions, dosing issues, plummeting test numbers, and travel on our part) we cannot seem to get her regulated. Perhaps this is normal in the beginning stages??

It can take time, sometimes quite a long time, to get some kitties responding well to insulin. A June diagnosis is still very recent in the FD marathon.

Last night her pre-test shot was 61.

This is a low, but safe, number if you're using a human meter. The take action number is 50 with a human meter. However, that big drop is triggering the phenomenon we call bouncing and she's rebounding to high numbers. Many cats are bouncy and it's very frustrating and hard to control. Sometimes a smaller dose can help - there are ways of giving a dose of less than 0.25 u believe it or not. It takes practice but can be done.

At that time, she was on a small amount of Purina DM dry, and low-carb wet, getting .5 unit Lantus, 2x per day. To be honest, those two weeks, she seemed great!

Some cats actually do better on a slightly higher carb diet. Emily might be one. Yes, low carb wet is best for most but if a thin kitty won't eat and low carb gets her BG to unshootable numbers some of the time you might have to customize her feeding plan to suit what works for her. There are members here who have to dose around other health issues that require BG-raising meds. Every cat is different.

But, the vet felt that "60" number was too low,

The rule is 68 on a pet meter is take action time. This low BG at the clinic is one fact to consider in going forward but only one. There are others like her weight, what she'll eat, finding a reasonable dose of insulin, etc.

Since this amount is hard to eye up (yes, we have 1/2 unit marking syringes), and both my husband and I inject, I am not certain this .25 dose is accurate each and every time.

Consistency is key so I suggest you take a used syringe and draw up some coloured water to what you both think is 0.25 u and keep it for visual reference whenever a dose is being prepared.

She has had no dry food since. I am not convinced she is eating enough wet to manage her caloric intake. Is it possible, that this cat NEEDS some higher carb food, since in our opinion, she was doing very well on the .5 unit, eating both prescription dry and low carb wet (although according to the vet, even then, her mid-day number was too low at 60)???

Yes, she might do better on slightly higher carb food. Have you tried some medium carb wet food to see if she likes it? Check out Dr. Pierson's food chart in the yellow info stickies on the main health forum. Do you have an autofeeder to dispense several small meals through the day and night?

Could it be that on strictly a wet food, low carb diet, and using such a small amount of insulin, but having numbers jump around and her weight dropping that she needs a different diet??? Or, a different insulin????

Body weight can be a factor. Being very thin can affect their response to insulin. For example, some human "brittle" diabetics (erratic BGs) are too thin and that is part of their problem. More food, maybe slightly higher carb and more total calories might help.

I'll finish by saying again that every cat is different. Many do well on the guidelines that are described in TR and SLGS for Lantus. Some, though, will need those guidelines adapted to their specific needs, at least until they become more stable and predictable in their response to insulin. You have to try different things, one at a time, and assess the effect to find out what works for Emily.

 

[Sienne and Gabby (GA)]

Welcome to the group!

First, what type of canned food did you give Emily last night? Do you happen to know the %carb of what you fed her? It is possible that the variety of FF was higher in carbs and it brought your kitty's numbers up. Likewise, the skipped shot also will be a reason that numbers will be on the rise -- and sometimes quickly on the rise.

It can help to remember that carbs aren't the same as calories. A food can be low in carbs but high in calories. This is the case for Wellness. If Emily likes the chicken or turkey flavors of Wellness pate style food, it's high in calories and may be a good choice if you want her to gain weight. Lisa Pierson's food chart also lists the calories as well as the carbs.

Another factor is that if Emily's numbers are typically over 200, she may not feel great when her numbers are under 100. It may take her body a little while to get used to being in normal numbers again.

If your kitty likes freeze dried chicken as a treat, this stuff can be like kitty crack -- or it is for my cats. If they are being fussy, sprinkling some over their food is a pretty good way to entice them to eat.

I agree with Kris, by itself, a 60 at mid-cycle on a human meter isn't alarming. It's often alarming for vets, though, since the majority of their clients do not home test. If you home test, you have a great deal of control over the cycle since you can use higher carb food to raise numbers. I think it's too soon to make a decision about changing insulin, especially since you've only recently completed transitioning Emily to a canned food diet. Managing your cat's diabetes is a marathon, not a sprint. And Lantus, in particular, will encourage you to become patient even though you want your cat better overnight. We all really do understand.

 

[Emily'smom]

I can't help with everything but can make a few comments based on what I've learned here on FDMB and with my cat:
Thank you for your detailed reply, Kris. I appreciate it. Got home from work and tested Emily and she was at 148, which I thought was pretty good. All her food was gone, and when fed her dinner, she gobbled it up, so we gave her her shot. We will test before we head to bed to see how she is doing. I like the idea of the colored water in a syringe so we can have a visual each time we shoot...I do think that will help keep things consistent, since there are two people doing this. I did pick up some higher carb FF today ... no more than 13%. I am going to think about it for a few days before I give her any...I feel encouraged by tonight, but we'll see how the night/morning goes. I believe the Purina DM dry is 15 % or 16%, so the 13% wet, although higher than the 10% everyone talks about is still lower than what she was getting on the dry. I realize I need to be patient, but when I feel Emily's health is really becoming compromised with the weight loss, it makes me upset...like there is nothing we can do to help her. Again, I appreciate you taking the time to respond in such detail...I will keep you posted!


It can take time, sometimes quite a long time, to get some kitties responding well to insulin. A June diagnosis is still very recent in the FD marathon.


This is a low, but safe, number if you're using a human meter. The take action number is 50 with a human meter. However, that big drop is triggering the phenomenon we call bouncing and she's rebounding to high numbers. Many cats are bouncy and it's very frustrating and hard to control. Sometimes a smaller dose can help - there are ways of giving a dose of less than 0.25 u believe it or not. It takes practice but can be done.


Some cats actually do better on a slightly higher carb diet. Emily might be one. Yes, low carb wet is best for most but if a thin kitty won't eat and low carb gets her BG to unshootable numbers some of the time you might have to customize her feeding plan to suit what works for her. There are members here who have to dose around other health issues that require BG-raising meds. Every cat is different.


The rule is 68 on a pet meter is take action time. This low BG at the clinic is one fact to consider in going forward but only one. There are others like her weight, what she'll eat, finding a reasonable dose of insulin, etc.


Consistency is key so I suggest you take a used syringe and draw up some coloured water to what you both think is 0.25 u and keep it for visual reference whenever a dose is being prepared.


Yes, she might do better on slightly higher carb food. Have you tried some medium carb wet food to see if she likes it? Check out Dr. Pierson's food chart in the yellow info stickies on the main health forum. Do you have an autofeeder to dispense several small meals through the day and night?


Body weight can be a factor. Being very thin can affect their response to insulin. For example, some human "brittle" diabetics (erratic BGs) are too thin and that is part of their problem. More food, maybe slightly higher carb and more total calories might help.

I'll finish by saying again that every cat is different. Many do well on the guidelines that are described in TR and SLGS for Lantus. Some, though, will need those guidelines adapted to their specific needs, at least until they become more stable and predictable in their response to insulin. You have to try different things, one at a time, and assess the effect to find out what works for Emily.

 

[Emily'smom]

Oh boy! Just replied to your post and somehow it got deleted, Kris. LOL! Thank you for taking the time for the detailed reply...it is much appreciated! I updated the spreadsheet now that I am home. Emily tested at 148 this evening, which I was happy with. She ate all her food today, and gobbled some up at dinner time, so we gave her her shot. We will test again before bedtime. I like the idea of the colored water to have as a visual, since there are two people in the house often measuring to give her a shot. I also picked up some higher carb (13%) FF today, but I feel better about her numbers tonight and the fact that she ate all day, so I am going to hold off for a day or two with that. If she wasn't so tiny I don't know that I would be this frustrated about the diabetes...I feel because of her weight she is more fragile than a large cat and I don't want her to get so low with her weight that she is at the point of no return. I will keep you posted! Again many thanks for the response.

 

[Kris & Teasel]

Oh boy! Just replied to your post and somehow it got deleted, Kris. LOL! Thank you for taking the time for the detailed reply...it is much appreciated! I updated the spreadsheet now that I am home. Emily tested at 148 this evening, which I was happy with. She ate all her food today, and gobbled some up at dinner time, so we gave her her shot. We will test again before bedtime. I like the idea of the colored water to have as a visual, since there are two people in the house often measuring to give her a shot. I also picked up some higher carb (13%) FF today, but I feel better about her numbers tonight and the fact that she ate all day, so I am going to hold off for a day or two with that. If she wasn't so tiny I don't know that I would be this frustrated about the diabetes...I feel because of her weight she is more fragile than a large cat and I don't want her to get so low with her weight that she is at the point of no return. I will keep you posted! Again many thanks for the response.

Glad to help! I suggest you make notes about the carb level of the food she gets in the right hand section of your SS. It'll be easier to correlate that info with BG numbers.

 

[Emily'smom]

Welcome to the group!

First, what type of canned food did you give Emily last night? Do you happen to know the %carb of what you fed her? It is possible that the variety of FF was higher in carbs and it brought your kitty's numbers up. Likewise, the skipped shot also will be a reason that numbers will be on the rise -- and sometimes quickly on the rise.

It can help to remember that carbs aren't the same as calories. A food can be low in carbs but high in calories. This is the case for Wellness. If Emily likes the chicken or turkey flavors of Wellness pate style food, it's high in calories and may be a good choice if you want her to gain weight. Lisa Pierson's food chart also lists the calories as well as the carbs.

Another factor is that if Emily's numbers are typically over 200, she may not feel great when her numbers are under 100. It may take her body a little while to get used to being in normal numbers again.

If your kitty likes freeze dried chicken as a treat, this stuff can be like kitty crack -- or it is for my cats. If they are being fussy, sprinkling some over their food is a pretty good way to entice them to eat.

I agree with Kris, by itself, a 60 at mid-cycle on a human meter isn't alarming. It's often alarming for vets, though, since the majority of their clients do not home test. If you home test, you have a great deal of control over the cycle since you can use higher carb food to raise numbers. I think it's too soon to make a decision about changing insulin, especially since you've only recently completed transitioning Emily to a canned food diet. Managing your cat's diabetes is a marathon, not a sprint. And Lantus, in particular, will encourage you to become patient even though you want your cat better overnight. We all really do understand.

Hi there! Thanks so much for your thoughts and for taking the time to reply. All of the FF I feed her are in just about the same range of carbs...6% I believe. I didn't have anything in my cabinet over 10% for sure. Thank you for pointing out the carb/calorie fact. I will take a look at the chart again - I have only been looking at carb content, but perhaps there are wet foods that will be a better choice calorie wise. She HATES pate, so I am not sure the Wellness will work. The FF I give her is a little bit chunky and so she seems more apt to eat it. I also give her Merrick Thanksgiving Dinner, which she was loving and then all of a sudden wouldn't eat. Honestly, I love her, but sometimes I am so frustrated by her "finickiness". Did I just make that word up?? LOL! I do have the dried chicken treats and that was what was so upsetting yesterday....I sprinkled them on the food to entice her and she wanted nothing to do with them. Usually she will inhale as many as I would give her. Maybe she just had an off day with the up/down numbers. We will continue to plug along and I will definitely take a look at the chart for higher calorie food and see if we can't get some of that weight back on her. Thank you!!

 

[Sienne and Gabby (GA)]

Weruva makes several low carb varieties that are not pate. They are mostly shreds. They are, however, low in calories. ZiwiPeak is pate but has more texture than the usual pate-style food. It also comes in novel proteins.I think they are a little higher in carbs than most.

I've been very lucky. My guys will eat pretty much anything I put in front of them. Their standard is Wellness Turkey or Chicken. There are any number of people whose cats would easily make Emily look very unfussy. They have to put out a buffet on a daily basis and what the cat loved yesterday is inedible today and if food has ever seen the inside of the refrigerator it has clearly been poisoned. Some cats elevate finickiness to an entirely new level (and my spell check thought finickiness was just fine).

 

[Emily'smom]

Weruva makes several low carb varieties that are not pate. They are mostly shreds. They are, however, low in calories. ZiwiPeak is pate but has more texture than the usual pate-style food. It also comes in novel proteins.I think they are a little higher in carbs than most.

I've been very lucky. My guys will eat pretty much anything I put in front of them. Their standard is Wellness Turkey or Chicken. There are any number of people whose cats would easily make Emily look very unfussy. They have to put out a buffet on a daily basis and what the cat loved yesterday is inedible today and if food has ever seen the inside of the refrigerator it has clearly been poisoned. Some cats elevate finickiness to an entirely new level (and my spell check thought finickiness was just fine).

I went online and found a chart showing what the calorie intake of a 7 lb cat should be (I would love her weight to be 7 lbs!) and it was 200 calories per day. Honestly, I did not know that. In the past, because she was healthy, she just ate what she wanted to eat, and her weight was maintained. I think she is not getting that amount of calories, but mainly because she just doesn't eat that much, and really never has. Only when her sugar is high is she ravenous, and of course that is not good and she loses weight despite the amount she is eating. I will be more conscious of the amount she is eating and how many calories that is and will also look at the chart for low carb/high calorie. The Merrick she loved was higher calorie, but of course she won't eat that now. UGH!!!

 

[Meridith and Zeke]

Her diabetes journey began in June, and due to different circumstances (differing vet opinions, dosing issues, plummeting test numbers, and travel on our part) we cannot seem to get her regulated

Our dx was in mid April and we are still working on regulation, though I think we are finally getting close (knock on wood). I have been told many times, this is a dance and our sugar babies are the ones leading. If you want to see drama, check out our SS, Zeke loves bouncing! My daughter jokes that he is her bouncing baby boy lol.

 

[Sandy and Black Kitty]

I think she is not getting that amount of calories, but mainly because she just doesn't eat that much, and really never has. Only when her sugar is high is she ravenous, and of course that is not good and she loses weight despite the amount she is eating.

Insulin is what it takes to help metabolize the calories (convert to usable energy) and get the energy into all the cells of her body. Without enough insulin the excess sugars in the bloodstream spill into the urine (putting a strain on the kidneys). That's why she is losing weight, in spite of the amounts she consumes - the nutrients can't get to where they are needed.

 

[Meridith and Zeke]

It was probably into our 3rd month with this when we were finally starting to get Zeke where he was truly gaining some mass. Until then he was feeling like a bag of bones with skin, it was just horrible. He is still 5 pounds less then his normal weight (of 18 pounds!) had been before since he is a larger cat, but he feels solid now so we are happy with it.