Need Help Newly Diagnosed

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Sam and Charms

Member Since 2013
Hi , my cat Charms was diagnosed a few months ago and my vet did not have a lot of experience with diabetes. Charms is 9 yrs old, neutered male.
My vet started him on 2 units of ProZinc, twice a day and had me test him once every three to five days at the six hour mark. His BG never got below 360 even after getting up to 6 units. At that point my vet switched him to Humulin N at 6 units twice a day with the same testing protocol. The BG at the 6 hour mark still did not get below 360. Plus he started to act sickly on this insulin. I found this site and decided to ask my vet to switch to Lantus. I told him about your protocol so he said to try it . Started Lantus at 2 units twice a day and tested preshot , +2,+4, +6, +8, preshot. Not sure if I am doing this right because BG's are going up. Charms eats Friskies Pate at 5:15 Am , gets tested at 5:30 and his shot at 5:45. I have ten cats and some of them eat Epigen , so sometimes Charms sneaks some of their food. Morning routine, cats eat, dogs go for a walk while they are eating, so then when I get back everything is less chaotic so that is why I test after feeding and then give him a shot. Started the Lantus on June 20, up until then he was getting 6 units of Humulin N twice a day. The following are Charms BG results using Lantus.

June 20 2 units AMPS 441, +2 398, +4 343, +6 405, +8 440, PMPS 444
June 21 2 1/2 units AMPS 467, +2 400, +4 417, +6 444, +8 , PMPS 441
June 22 2 1/2 units AMPS 519, +2 464, +4 432, +6 485, +8 465, PMPS 450
June 23 3 units AMPS 501, +2 415, +4 , +6 449, +8 405, PMPS 462
June 24 3 units AMPS 477, +2 430, +4 , +6 424, +8 403, PMPS 419
June 25 3 units AMPS 455, +2 370, +4 410, +6 411, +8 , PMPS 451
June 26 3 1/2 units AMPS 452, +2 459, +4 456, +6 445, +8 457, PMPS 478
June 27 3 1/2 units AMPS 425, +2 404, +4 457, +6 452, +8 439, PMPS 554
June 28 4 units AMPS 451, +2 488, +4 461

At this time I am unable to use the spreadsheet. So I plotted these results old school on a graph. Days 1-3 curve was rising. Days 4 -6 dropped. then day 7 a high flat line. day 8 not much better with a very high ending BG . I give him the shot in the neck. Please let me know what to do at this point. Not happy with results so far not sure what I am doing wrongand vet thinks I should just keep raising the insulin level. Please help!
 
You are right to question the dose. We suggest a starting dose of 1 unit or even 1/2. Never do we suggest a starting dose of 2 or more units. With home testing, over time you may need to increase and get up to 2 or 3 units, but it's done more gradually.

There are three factors you need to be aware of when treating diabetes - insulin and home testing you know, and the third is diet/food.

You didn't tell us what type of food you are feeding? Dry, prescription, wet? We highly recommend feeding a low carb wet food diet - wet can be raw or canned. We do not recommend dry food or prescription food at all.

The low carb diet is 10% or less in carbs with most of us feeding 0-7% range carbs. How do you find this, easily, Dr. Lisa Pierson made a food chart that lists the carb content among other things for most foods. www.catinfo.org is the website and the food chart is on the right side click the link food comparison chart.

In addition, read her site for the reasons why dry food is bad for cats and prescription food unnecessary expense.

Also, please take the time to visit the lantus forum group and read the starred/sticky information there that details how Lantus works, when you should adjust dose and by how much, etc.

to find the forum, click on board index at top of page, then scroll down to insulin support groups and click lantus tight regulation.
 
Hillary,

Friskies pate and Epigen were mentioned.

Also, suggest having your vet check for IAA insulin resistant antibodies. Agromegaly is a possibility.

You are changing the doses too quickly, not allowing the depot time to build up. You may have bypassed the good dose of insulin for your cat.

Lantus doses should be held for 3-5 days. And then reassessed.
 
Hi Sam and Charms,
Good for you for both changing insulin and testing at home. As for seeking information about diabetes - this board has many experienced people who are willing to give you suggestions, including how to get the spreadsheet going if you wish.

1. testing - preshot really needs to be done before food so that the number isn't influenced by the food. A few minutes might be ok, but some cats respond very quickly to food and their bg rises.

2. food - I see that you siad that you are feeding Friskies pate. Most pates are ok carb-wise for diabetics. Just to be on the safe side, you might want to check the food list complied by Dr. Lisa Pierson on her website at http://www.catinfo.org

3. insulin - Lantus is a good, long acting insulin for cats. However, the dose needs to be held for (usually) a minimum of 3 cycles which is 6 shots. Some cats take a bit longer to settle in to the dose. As you gather more data you will see how quickly Charm's body adjusts to a dose change. If you can look at the information in the insulin support group for Lantus (ISG), I think that you will find detailed information about dosing and handling the insulin.

I did not use Lantus for my cat, so am reluctant to suggest a dose change for Charm. I'm sure that someone with a lot of experience with Lantus will be along soon to help.
 
Hello, to Sam and cat Charms. We have lots of experience with different insulins so we should be able to help you.

I'm not sure what is going on but I do notice a couple of items.

You were used to using Prozinc and Humulin N but have just started using Lantus which works differently.

Probably the most difficult aspect of people switching from one of these 'in and out, intermediate duration" type insulins to a 'depot type, long duration" insulin is the concept of "for the shot you give today, the effects may not be seen for several days".

The second difference people have difficulty getting their heads around is the depot aspect. Basically, the depot is a storage area. Only part of any shot you give goes to work, the rest is stored in the depot for later use. This is what gives Lantus it's long duration of action, the slow release from the depot area. For more information on the depot, read here: http://www.felinediabetes.com/FDMB/viewtopic.php?f=9&t=150

The third difference with Lantus is, the dose changes are based on the nadir, or lowest point in the cycle. Very little weight is given to the pre-shot tests in making dosing decisions.

Because of these differences, you need to manage the Lantus dosing differently.

Some general guidelines can be found in the Stickies, over in the ISG Lantus TR forum.

First, doses should be held for a minimum of 3-5 days. ECID. Every cat is different. So dose changes will need to be made, but not as rapidly as you have made them.

I'm not sure that going back to 1U will be right for your cat. I do think we need to backtrack a bit and hold the dose longer.

Let me see if I can get a couple of the experienced people over here. Your situation is complicated because of the prior use of other insulins at high doses.

Hang in there, we will try to help figure this out for you.
 
Hi Everyone,
Thank you so much for your help. I feel better already and hopefully Charms will too soon. I read the information about Lantus and seem to have a better understanding of how it works. My vet has been advising me to make the dosage changes and I know he probably is not very familiar with Lantus either. I do want to set up the spreadsheet but I am embarrassed to say it has taken me quite a while just to figure out how to register and post to this message board! From the advice I have received so far it seems like I need to go back a few days. The curve increased up to day 3 (june 22) then was going down on day 4,5,6 and then went to a high flat line on day 7 (june 26) with the increase from 3 to 3 1/2 and has continued to rise since. What would be the best day to backtrack to ? Thank you again, this has been so stressful and I feel terrible that Charms is not getting his BG down.
 
If you need help putting the spreadsheet together, just ask, we have lots of people here who can help you set it up and then it's just maintaining....

Honestly, I would add as much data as you can to the spreadsheet as it will be helpful for everyone who views it.

And don't be embarrassed, not everyone is tech savvy, you will learn what you need and become more proficient, we can help get you started....so no worries.
 
Hi Sam and Welcome to FDMB.

I wouldn't worry about plotting the data you have on a curve. It's not essential to curve the info. Most of us are used to looking at a SS. As others have said, we have folks that are very tech savvy and can help you get your SS up and running.

Lantus is different than either Prozinc or Humulin N. While Prozinc has a longer duration, it is like Humulin N in that dosing is largely based on the pre-shot numbers. Lantus dosing is based on the lowest point in the cycle. This can take some getting used to. Lantus is also a depot type of medication. This means it takes several days to build up in Charms system. Because it's both long-acting and a depot medication, doses need time to settle and the effect of the dosing is cumulative.

The initial dose of Lantus can be based on your cat's ideal weight: initial dose = ideal weight in kilograms x 0.25. However, the dose on a previous insulin should be taken into consideration.

If you want to share information with your vet, below is a copy of the journal article which includes the Lantus Tight Regulation Protocol.


Doses actually can be raised as quickly as 2 days. However, if you are going to be this aggressive with dosing, I'd strongly encourage you to get at least a before bed test every night. You want to be sure that Charms' numbers aren't dropping during the PM cycle.
[url=http://www.tillydiabetes.net/en_6_protocol2.htm:1te9dujn][b:1te9dujn]Tight Regulation Protocol for Lantus & Levemir[/b][/url] said:
Phase 2: Increasing the dose

Most cats need to have their dose increased. Do it in 0.25 IU or 0.5 IU steps (0.25 IU if the cat is getting a low dose and/or relatively low BGs, 0.5 IU if the cat is getting a higher dose and/or relatively high BGs). Hold each dose for 5-7 days. However, if the cat is producing continuously high BGs (nadir always >=300 mg/dl), only hold the dose for 2-3 days before increasing it by 0.5 IU. Alternatively, if the cat is continuously producing moderately elevated BGs (nadir always >=200 mg/dl), increase the dose every 2-3 days by 0.25 IU ( if the cat is getting a low dose) or 0.5 IU (if the cat is getting a higher dose). From this point onward test for ketones once per week, or more often if the nadirs are still >=200 mg/dl.
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The information that I quoted is from the Lantus protocol used by the German counterpart of the Lantus group here.

Please let us know how we can help.
 

Attachments

Hi ,
Thank you again for the much needed help. Yes I am going to work on the spread sheet and I do need to ask for help. But first I am still really really confused on what dose to give Charms, I did read the Protocol before starting and thought changing at two days (only 1/2 a unit was ok , even though my vet was urging me to increase by 1 unit) because his lowest BG was significantly over 300. Now I am not sure what dose to use at all. Today his BG was always between 400-450 each time I tested. That was with the 4 units this morning. So it seemed as if I was giving him too much according the replies so tonight I just gave him 2 units. Was really not sure what to do. I always get worried before I go to bed so I do test him but not at a regular time so I do not record it. It has never been lower than 300. Thank you for providing this help and support. Please let me know how you think I should proceed. And I will try to work on the spread sheet this weekend if someone can help and not get too frustrated by my complete lack of technical abilities! Thanks
Sam
 
Sam, do you know how to read your PM's? (private messages) Go to the top left of your screen, click on new messages and look at inbox, You will have a new PM. I'll try to set up the Spreadsheet, start you off by filling it in with the data at the top of this post and linking it to your signature. After that, we should be able to help you learn how to fill it in with questions on the board here.

Would that work for you?

That 2U dose that you gave is good for now. I think you should keep that same dose for 3 days if possible. Yes, the numbers may be high for a while, but your cat is probably bouncing. Let's move the dose up slower if we can.

Are you testing the urine for ketones?

ETA: Has your cat ever had DKA (diabetic ketoacidosis)?
 
Sam PM'd me with some more numbers for the SS setup. Here are the latest readings.

June 20 2 units AMPS 441, +2 398, +4 343, +6 405, +8 440, PMPS 444
June 21 2 1/2 units AMPS 467, +2 400, +4 417, +6 444, +8 , PMPS 441
June 22 2 1/2 units AMPS 519, +2 464, +4 432, +6 485, +8 465, PMPS 450
June 23 3 units AMPS 501, +2 415, +4 , +6 449, +8 405, PMPS 462
June 24 3 units AMPS 477, +2 430, +4 , +6 424, +8 403, PMPS 419
June 25 3 units AMPS 455, +2 370, +4 410, +6 411, +8 , PMPS 451
June 26 3 1/2 units AMPS 452, +2 459, +4 456, +6 445, +8 457, PMPS 478
June 27 3 1/2 units AMPS 425, +2 404, +4 457, +6 452, +8 439, PMPS 554
June 28 4 units 451 , +2 488, +4 461, +6 464, +8 441, PMPS 449 2 Units
June 29 2 units AMPS 560, +2 464, +4 501, +6 497, +8 456
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She also said
And I do not know anything about the ketone testing my vet never mentioned it ever . Sam
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Ketone testing is by urine dipsticks. You can get that at your pharmacy counter or local drugstore.

If you do not have any ketone test strips, smell Charms breath. If it smells like nail polish remover or a sickly sweet fruity odor that is a sign of ketones. Ketones are poisons that can build up in the body. From too rapid fat breakdown. You do not want to see more than a trace of ketones on the urine test strip. With those high numbers you are getting, it's important to check for ketones, daily.

How is his appetite?
Does he have an infection of any kind? Think teeth, gums, urinary, etc?
ETA: Has your cat ever had DKA (diabetic ketoacidosis)?
 
Hi,
I will have to read up on how to do the ketone testing, but for now I did smell his breath and it seems fine. As fine as cat breath goes! His appetite is very good, he is very very hungry all of the time. I have been holding back as not to give him too much, is this wrong. How much should he be eating. He weighs about 12 pounds, but he has lost a few pounds since the diabetes started. I do not think he has an infection of any kind. Except for the ravenous appetite, excessive thirst and his coat being a little greasy he is actually very healthy acting. A little bit slower than before, but still extremely demanding. He does sneeze occasionally, but does not appear to have a respiratory infection. Great teeth. I have a lot of experience with UTI and I do not think that it is a problem either. As for the DKA , I do not know what that is, so I hope he has never had it. His BGs are scary high. Working on the spread sheet with Deb, but for now as long as you all agree I will continue with only 2 units, even though his BG is scary high. If I should be doing anything else please let me know what you all think. Thank you. Charms eats mostly Friskies pates and sneaks Epigen when he can. How much food should he be getting a day, should I spread it out, is small meals better than two meals? I give him a couple cat treats ( 2 calories each) when I check his BG , is that Ok? Sam
 
I just did Charms PMPS and it was 564. Gave him the 2 units of Lantus. Are you sure I should stray with this dose? And when do you think I will see any improvement?
 
Sam, Would you please test your own BG with the meter and a fresh lancet and let me know what it reads.

Also, please verify that the dose you give on each day was the same for the morning and evening. I'm working on the SS now.

ETA: Have your SS up in google drive, updated with the numbers I had, added it to your FDMB signature.

The link in your signature is view only. You need to update the SS over in google. PM me and I'll walk you through it.
 
Deb, the meter I am using is a One Touch Ultra 2 . I just did mine and it read 101. I did Charms with a new lancet and his was 447 and it is +2 for a time for him. I do reuse the lancets. Should I get a fresh one every time? I reduced the dose from 4 units to 2 units starting with the PM shot on June 28 after my first post. So I have given him 2 units on the PM of June 28th, Am June 29th, PM June 29th so far. I am going to take a look at the spreadsheet and then I will send you a message so I will be able to update it . Thank you so much I truly appreciate your help.
 
Thinking of all contingencies here. Your BG is normal. That is telling us the readings you are getting for Charms are correct. Think of this as a sanity check on the meter readings to verify it was working correctly. It is.


I do reuse the lancets. Should I get a fresh one every time?
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I wanted you to use a different lancet for testing you than you do for Charms. That is why the request for a fresh lancet.

Lancets do dull over time. I would reuse the same lancet for all the tests in the AM cycle, with a dip in rubbing alcohol for 30-60 seconds when I was testing Wink. The lancets aren't expensive but the cat shelter wanted to save every penny they could.

We need to get that meter in your signature. I'd also like to know where you live. Generally, what country state/province. That can go in your user control panel also. It helps us to know what the time zone differences are so we know if we can stay up with you in an emergency.

PMPS 564 +2 447 is a 117 point drop.

Sienne did suggest that you should get some overnight tests.
Doses actually can be raised as quickly as 2 days. However, if you are going to be this aggressive with dosing, I'd strongly encourage you to get at least a before bed test every night. You want to be sure that Charms' numbers aren't dropping during the PM cycle.
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One test we highly recommend, is the before bed test. Just before you head to bed, take a test and note the time in the + hour format.

I'd love to see a test later tonight at +6 if that is possible. I have no idea how exhausted you are or how busy your life is so tell me if this +6 tonight would be feasible for you to do or no way in heck will you set your alarm to wake you up in the middle of the night.

What are your normal shot times? In your local time zone and what is that time zone?
 
I updated Charms SS! Wish the numbers were better. Thank you for all the work that went into creating it. Yes my meter is working, I did wonder about that also , did not think to test myself. My BG was good but I might be in need of a sanity check also! I live in Central New York State so I am in the Eastern Time Zone. My AMPS test time is approximately 5:30 am. I explained I get up at 5:00 AM everyday but the dogs raise heck , so I put the cat food out and walk the dogs so the cats can eat in peace. I check Charms when I get back in and give him his shot which is all approximately between 5:30 - 5:45. I test again at 8:00 am, 10:00 am, 12:00 pm, 2:00 pm, then a PMPS at approximately 5:45 pm. This PMPS is done before he eats unlike the AMPS. I test sometimes before I go to bed , I will put those old readings in the chart. I will try to do a +6. Charms numbers are still really high, he is still really hungry and thirsty. He does still have attitude as he tried to escape outside last night. - Sam
 
Hi, I have updated Charms SS all day but the numbers are still high. I was wondering if he is not absorbing the insulin well , I give him the injection in the neck area near the shoulder blades . Any thoughts about that or suggestions? I am a nervous shot giver so it is the easiest place for me. Any idea when his numbers might start to come down or what expectations I should or should not have. Thank You Sam
 
Hi Sam & Charms,

Welcome! I'm a Newbie, & can't offer much advice (compared to the other really experienced wonderful folk here), but I can offer you my support.
You're doing an amazing job so far, just hang in there..

I, too, get very anxious 'holding' a dose. As other experienced people remind me, this is a marathon, & we're here for the long run. You'll have wonderful support all the way through.

I'm also switching over from Prozinc to Lantus starting tomorrow. My vet is starting me out at 1 unit, twice a day, which is lower than Tigger's Prozinc dose.

As I understand it, with Lantus, the dose should be held for at least 3 days (6 cycles) to make sure that the shed /depot or residual overlap has a chance to build up & you have the chance to see its effect. Otherwise, if you increase or decrease too soon, you might miss your best dose. An exception would be a hypo situation, & of course in any situation if you're unsure, just post here or in the Lantus forum, & ask for help & people will be able to read your spreadsheet & offer cousel. I always do that before I make any adjustment.

You mentioned you have some problems with the shots. You might want to try some dry runs for practice. Make your tent, & use your finger as the needle. When I actually do my shot, I hold my index finger parallel to the tip of the needle, so I know pretty much where its going & how far its in before I actually inject. You can also practice injecting with a towel & a syringe filled with water.

If you are unable to do an injection while Charms is eating (my Tigger hates that), iIt helps me to crumble up some lo-carb treats & rub them into Tigger's blanket so he has to 'rooch' for them - this gives me time to tent, do a dry run with my finger in the tent, then a real injection. Even better, if there is someone else in your household, they can hold treats & make sure Charms works to get them during the shot & eats them afterwards.

So, take a few deep breaths, pat yourself on the back for what you've already accomplished, & keep everyone posted!
 
Hi , thank you for the support and injection tips. I have watched a lot of videos and they make it look so easy! I was wondering if I should change the injection site but I do not really feel confident trying another area. As to the question from Larry, when Charms was on Prozinc I was only checking his BG every 3 -5 days at the +6 time and then increasing by 1 unit at a time. He started at 2 units and got up to 6 units. His BG at +6 on 6 units of Prozinc never got below 360. When I switched to Humulin N I was told to start at the same units he was at on the Prozinc (6 units) Again his BG never got below 360 at the +6 time and he acted sickly. I was getting discouraged and went looking for some help, found this site and asked my vet if I could try Lantus. Started at 2 units , all the data for Lantus is recorded on the SS. When Charms started Lantus I was only reading this message board, realized I really needed help and figured out how to join, and with Deb's help got all of Charms info on the SS. So that is mine and Charms story, wish I had found you all sooner. I am just really worried about him and these high BG readings. Not sure what to expect, hoping for some improvement, but i know I have to be patient. Just wondering if this is the normal progression . Sam
 
Sam,

Those high numbers are a concern to you I know. They are scary. They can cause damage over time but they are not as dangerous as low numbers, under 50.

How much of the dry Epigen does Charms get into? Can you tell me specifically which of the Epigen's you are feeding?

Does he have access to the dogs food?

As for the DKA , I do not know what that is, so I hope he has never had it.
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You would know if your cat had DKA. It is a life threatening illness precipitated by the production of ketones. Hospitalization is required to give IV's with electrolytes, insulin, sugar drip, etc.

I strongly recommend that you test for ketones. Even though you have said your cat has never had DKA (diabetic ketoacidosis), it is important to test for ketones. Especially with those high flat curves you are getting.

Has your vet ever mentioned testing for IAA (insulin resistant antibodies) or agromegaly?

I'm not sure that insulin resistance is there in this case because you are getting movement in the numbers, 75-110 points sometimes. Other days, you are only getting 20-40 points of movement.

Flat high numbers suggests too much insulin. It's why I suggested you go back to 2 units and hold the dose for 3 days. We are also fighting against the depot being full from those rapid increases to 4 units. It will take some time to drain the depot back down.

You said that when Charms was on the humulin N 6U, he started to act sickly. In what way?

What syringes are you using?

You asked when you should raise the dose. According to protocol, since your nadirs are >300, 3 days at the dose and then increase by 0.5U.

However, if the cat is producing continuously high BGs (nadir always >=300 mg/dl), only hold the dose for 2-3 days before increasing it by 0.5 IU.
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One suggestion I have is to hold the 2U dose until at lease PMPS tomorrow, 7/1, maybe longer. I don't know if that is the right answer or not. :YMSIGH:

I don't know, I just don't know.

Any additional test data you can get into that SS from the Humulin N and from the Prozinc might be helpful.

Also, a PM test later than that +2 you are getting. As late as you can get it before you go to bed. Around +5 to +7 after PMPS.
 
In the morning, before you walk the dog/ put the food down, get a glucose test - it will not be food influenced, so it will give you a better idea if he may be going low overnight. And during the day, pick up the food 2 hours before shot time for the same reason, to get a glucose level that is not food-influenced.

Here are some possibilities:
1) he really does need more insulin, due to diet, illness (bladder or other infection), or complicating condition (ex acromegaly, Cushings, insulin autoantibodies)
2) he is reacting to going lower than accustomed and is "bouncing" - releasing hormones to raise the glucose back up.
 
Hi Ok I wrote a reply with all the questions answered and all the old Prozinc results ( took a really long time) and when I went to preview before submitting it , it just disappeared and said I had to log in. Was pretty sure I was logged in. Does anyone know what happened so I never do that again.

I will quickly try to answer everything all over again-
Updated Charms SS with a AMPS BG before he ate and it was over 500. All of the PMPS are done when he has not had any food for 4-6 hrs and they are really high also.

Before starting on this forum I used to let him eat a little throughout the day but now I have been strict with taking the food away and his BG are higher. Does he need to eat more , and more often?

The Epigen the other cats are eating is the 60% protein no starch formula, not the 90% protein.

The dogs dishes are empty almost by the time they hit the floor. Four hard working herding dogs- ( 3 aussies and a scrappy corgi) So No Charms is definitely not eating any dog food.

My vet did not suggest IAA or agromegaly. He did want to retest his thyroid, But I have another cat with hyperthyroid, OliverJr, and although they did have some similar symptoms, I do not think Charms has hyperthyroid. He is very agile, no muscle weaknes, just hungry and thirsty, weightloss. His thyroid test in April when diagnosed with diabetes was fine.

When Charms was on Prozinc even when his BG was high he still acted like Charms. Demanding to go outside when he knows he is an inside cat, playing with the other cats etc..When he was on HUmulin N he just acted very old and had a terrible look on his face like he did not feel well.

The Syringes are 3/10 cc with the half units marked. I wrote down the ones on this site recommended for Lantus and asked the vet for RX.

I will try the later PM BGs if you really think it will help but I really really need some sleep. Charms woke me up at 4:39 today!

I have all the other Prozinc and Humulin N readings for Charms from the meter and I typed them all in to the post that disappeared, so I will do them again later.

Not sure where to go from here, once you get the old BG from Prozinc maybe that will help to decide if he needs more insulin. I will say that his BG is higher now than it has ever been. When he was first diagnosed on April 5 it was 476. Switched his food , no insulin and it went down to 410 on April 15 . Started Prozinc on April 20 and by the time it got to 6u it was 386 at the +6 time. Only saw a 500 once on Prozinc. The Humulin was started on June 6 at the 6U and bounced around more, the +6 ranged from 352 to 438 with one time going down to 282. Stopped on June 18. Started the Lantus at 2u , got up to 4u, and then went back to 2u after joining this group. All of the Lantus results are in the SS. Not sure what to do now, more insulin? -Sam
 
Have you done any urine or blood ketone tests? They form from fat breakdown. Too many may indicate diabetic ketoacidosis, a potentially fatal, expensive to treat complication for unregulated diabetes. Tips on urine ketone testing in my signature link Secondary Monitoring Tools.

With the daytime tests looking fairly consistent, I suspect an increase may be in order. If you choose to increase 0.5 units, do so when you can monitor in the +5 to +7 hours after the shot (as you've been doing during the day) to observe how low it takes him. Just in case it seems to have an effect.

If you find that an increase worked for a bit, then stopped working, you may want to read up on Insulin Autoantibodies in this forum to see if any of the descriptions seem familiar to you. If so, it can be worth discussing the particular observations with your vet.
 
Hi Sam,

Again, I'm too new to comment on Charms' BG numbers, except to say that often each increase / decrease in dose causes a pendulum effect. You need to wait for the pendulum to stop swinging to see the real effect of the change in dose. If his dose is too high too fast, & his bg drops (not far enough for a hypo, but out of his system's more recent 'comfort level', his liver can secrete hormones that mimic glucose to keep his bg elevated artificially. You don't really know for sure this is happening unless you 'hold the dose' until his system adjusts & lets the insulin do its thing. Unfortuntately, many of the symptoms for over-dosing & under-dosing are the same. I know its really scary, especially with the really high numbers. But - keep posting - you can start a new post daily if you want, & more experienced people will read your numbers & offer their thoughts.

Re. ketones & testing. You can purchase from Wal-Mart, or Amazon, or American Diebetes Warehouse (you can see the links at the FDMB home site - by clicking on the links to get to these webpages, the FDMB will receive a 'referral' from these sites) either:
ketone stix
ketone & glucose stix
multi stix (10 different tests)
These are paper strips that you would dip into Charms' urine - preferably as he's urinating. You can also put a sterile cup under his stream & then dip the paper into that. Once dipped, hold the paper horizontally (allows excess to drip off & won't melt test colors into each other) next to the colored test result sample on the container for the appropriate # of seconds. Glucose is usu. 30 seconds & Ketones is 40.

I use the multistix, so I can monitor if Tigger also has blood in his urine, & his PH.

HOWEVER, my Tigger is really private, so its rare that I catch him in the litterbox. So, I ordered a monitor similar to the blood glucose monitor at ADW that will test ketones. It is much more expensive, but it gives me the peace of mind when Tigger is getting into the higher BGs that he doesn't have ketones. After looking at all the different sites & options, I found the Nova-Max monitor & ketone strips kit w/ 2 additional free test strips were the best price. ADW threw in another 2 free strips. Here's the link: http://www.americandiabeteswholesale.co ... t_3400.htm You can also go on the Nova-max website & apply for a free meter - when I got mine, I also got 2 free ketone test strips. This meter will also test glucose, but I don't use it for that.

Also important monitoring along with the BG & ketones, is the whole cat analysis (WCA) of 5 P's: Peeing, Pooping, Preening, Purring, Playing. You definitely saw the WCA difference when Charms was on Humulin.

You also need to take care of yourself during this time. I lost 8 pounds just during the first 3 weeks of Tigger's diagnosis - couldn't eat or sleep & cried alot. Exhaustion made me spin alot & reduced my ability to make the best decisions for Tigger. So - you need your sleep - if you don't take care of yourself, you can't take care of all your cats & dogs.

So - remember to breathe & take time for yourself. You can help Charms better that way. You're doing an amazing job, & everyone's behind you!
 
Hello and welcome to the board,

I can understand you not liking the reds and blacks. Have you started testing for ketones yet? I would as soon as possible as he is at risk for DKA which is life threatening and expensive to treat.


I found a calculation that says the epigen is 10% calories from carbs so I wonder if thats the issue. Also what flavours of the friskies pates? Some are also above 10% and I wonder if he is very carb sensitive?

Wendy
 
Thank you for all the new information. I tried to read as much as I could about the other issues that might be involved but because as one member also pointed out , there are times when the BG would drop, I am hoping my vet and I just did not understand the way the Lantus worked and went too fast with the insulin. I will try to get on the ketone testing , but I never see Charms in the litter box, not sure I can do that with 11 cats total in the household, so I will have to get the other monitor device that was mentioned. I did not read up about that yet, was too stressed by the other scary stuff, so just so I can prepare myself , how often does that have to be done, and how much are the test strips. I think I should raise the insulin dose 1/2 unit in the morning, maybe. At least that sounds like what is needed to be done.

The Friskies pate is Ocean white fish and tuna, mixed grill, and turkey and giblet. I use a couple treats that are 2 calories each to test his BG. sometimes a couple more if Charms is being difficult. Sam
 
There are meters which will test for ketones too - they tend to be expensive. If the cat has ever been diagnosed with ketones, however, it can be worth it to be able to test the blood, as that is much more precise than urine testing.

Ex Nova Max is one meter that tests for ketones
 
Heres some tips on testing for ketones and catching urine. Really if you do a few tests and happen to measure other cats, as long as none of them are showing ketones you are ok!! https://docs.google.com/document/d/1quta5WLEjdO0Y_t2dAYSwN84h-LNZWxOdtVsJDKZ16A/pub
The strips are like $6 from walmart for 50 strips - so should last you quite a while. I would get them ASAP as he is so very high... i am very concerned for him - I have never seen numbers so very high as consistently as that ... although I have only been doing this 18 months.

ok the mixed grill is 11% . The others are 8 and 9%. Maybe you can try a lower carb food? How does he feel about fancy feast classic pates?

Also no more high carb treats! - go pick up some freeze dried chicken treats instead.

lastly - can we test shutting him in a room of his own for a few days and seeing if that makes a difference. I am wondering if he is getting to either the epigen or the dog food. We should know in a day or two if thats the case.

deal?

Wendy
 
Ketone testing should be daily.

I saw the notes on your SS for the food and when he had eaten in relation to the pre-shot tests. Thank you for those notes. We recommend no food 2 hours before the pre-shot tests.

I do think we want to raise Charms dose up from 2 to 2.5U tomorrow morning IF he is in red or black numbers still. If he has a pink or yellow number, I suggest you hold the current 2U dose.

He may have some insulin resistance and we may need to go up on the dose until we start hitting more pink (300-399)and yellow (200-299) numbers
 
Thank you all again for all the wonderful help and concern for Charms. I myself am a wreck about this, but trying to have hope that this will be under control soon. I will be getting the Ketone testing stuff today.
I know for a fact that Charms is not eating any dog food, and I have been very vigilant about him not getting the Epigen. My cats are all rehabilitated feral cats so some are very shy and I have to leave food out for some of them. I have been careful about not letting Charms get to it. As to the suggestion of locking Charms in a room, he is a very social demanding cat, so I am afraid this would cause him a lot of stress which might cause his BG to rise. Let me know what you think. I did not give him the treats to check his BG today. Made him some chicken breast instead until I can get the freeze dried chicken treats. Can you suggest a brand?

The PMPS was lower than it usually is 463, and then the AMPS this morning was also lower 435, so I did not raise the insulin , so we could see if this is a trend downward. I know it was still a red reading, but thought this might be the right thing to do. Let me know what you think, I cannot feel any worse than I already do about all this insulin dosing. - Sam
 
Any brand of freeze dried treats are fine, just read the ingredient(s). This is what I get and where:

http://www.kingwholesale.com/Shopping/P ... Item=22465

I get 6 bags at a time to keep the cost down and free shipping.

I found this is the least expensive place to get it.

I have seen it at Petco, so if you want to get a bag for the immediate, you can and then order these.

You can also purchase Halo Liv a Littles - you may be able to find them fairly inexpensively at Vitamin Shoppe. Yes, they have a pet section there. And of course they are available online too. Ounce for ounce, they are more than the Purebites, so it really is dependent on your wallet.
 
Thank You for the treat advice and info. Hard to do the BG without something he really wants!
Well I just did the +4 BG and it is 353!! First purple since joining and lowering the dose back to 2u . Does this mean I am on the right track. Let me know what I should do depending upon the next numbers. I will update the SS but it is going to be another crazy day here, so just want some advice in advance in case it is time to do the next PM shot . If it stays lower for the rest of the day (what range) should I stick with 2u or on what readings would it be better to increase? - Thank You Sam
 
Is he eating again?

I am still not loving his numbers. Can I make a suggestion? can you go over and start posting on the tight regulation board : http://www.felinediabetes.com/FDMB/viewforum.php?f=9

There are a lot of experienced members over there and I would like them to take a look and see what they think.

Heres how to post
Every day ( or as often as you can) you open a new thread/post. We call them "condos"
- The subject has the date/cats name and BG readings ie 07/02 Charms AMPS 435 +2 450 + 6 23534. You add a ? icon if you have a question. You can update your subject as you get a reading, or whenever

- The contents of your post have a quick update on how Charms is feeling as regards the 5Ps ( peeing. pooing, preening, playing and purring) and any questions and a link to your previous post ie : Today Charms was in a good mood, playing and eating well. But he is peeing a lot and his BG is still really high. Should I increase the dose?

For your first post put "newbie" also in your subject so everyone can welcome you!

Wendy
 
Sam,
Oh honey, I can tell how stressed you are. Big hugs to you. :YMHUG: This sugardance can be so difficult at times and you have been at it for months without seeing lower numbers. You must be so worried about Charms and how he is doing. We'll try to help all we can.

First, take a deep breath, hold, release, take a deep breath, hold, release, take a deep breath, hold, release. This will help to relieve some of that tension and stress you are feeling. It's also one of the most difficult pieces of advice to follow through on but one of the most important.

If you need to cry on our shoulders, rant and rave, complain, tell us you can't do this, please, get it all out there. We have all been there and will understand. We are not only here for suggestions on how to manage the diabetes with Charms, but to help you too.

I know those high numbers are scary to you. We'd like to see them lower also.

Even if you do not have the ketone urine test strips yet, you can always keep smelling his breath for that acetone or fruity smell. If he isn't eating much, it's even more important to check for ketones daily.

p.s. It will be very interesting to see if the +6 -+7 is still a purple number.
....but it is going to be another crazy day here, so just want some advice in advance....
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We all have those crazy days! ;-) We only make suggestions. We don't know your responsibilities and commitments. If there is ever a suggestion that we give, and you can't do us, let us know and we will try Plan B, C, D............... There are alternatives.

Well I just did the +4 BG and it is 353!! First purple since joining and lowering the dose back to 2u . Does this mean I am on the right track. Let me know what I should do depending upon the next numbers. I will update the SS but it is going to be another crazy day here, so just want some advice in advance in case it is time to do the next PM shot .
Click to expand...
Yeah! a purple number! :cool:

Just looked at Charms SS. Those are still higher numbers than we like to see. You may be on the right track. It's a very hard call because the depot may still be draining from several days ago. It can take 5 days or more to drain.

If it stays lower for the rest of the day (what range) should I stick with 2u or on what readings would it be better to increase?
Click to expand...
If Charms doesn't give you more pink numbers (300-399) today, you might consider raising his dose. He'll very likely be up in the red (400-499) range by PMPS. That is my opinion. If you get other suggestions/opinions from other people, go with them.

His body is not used to those lower numbers, so it panics. Counter regulatory hormones are released and glucogen is pumped into the blood stream.

If you do decide to go over to Lantus TR group, Marje and Sienne are two of the most experienced people over there. I highly value there opinions and suggestions. One suggestion I'm pretty sure they will make again, is to get a PM test as late as you can before you go to bed. That is because we want to know if Charms is dropping low at night, like many cats do.

If you look back in this thread, you will see that Sienne already made that suggestion, to get those PM tests, the "right before you go to bed" test.

Your life is probably so hectic, you just want to crawl into bed ASAP at the end of the day, exhausted. Take good care of yourself Sam. We want you to stay healthy and get some much needed rest.
 
Keeping my eye on Charms SS today. It looks like he has an early nadir, between +3 and +5.

I do think you want to go up from 2U to 2.5U today. Want to see those numbers down more if we can.
 
Deb, just read your post, after I was writing a reply to this mornings. Do you think I should go ahead and increase at the PM shot today or wait until the AM when I am testing more? And what do you think about the food, how much should Charms have, and should I spread it out or only feed him twice a day? - Sam
 
Sorry, the board went down for about an hour. I thought you should increase tonight. Of course, that is only a suggestion.

You know your schedule and when you will be around to test much better than any of us here do.

I definitely think Charms needs more insulin. Sooner rather than later.

If you have already given the shot for this evening, then I think increasing tomorrow morning will work ok.

I am worried about the possibility of ketones if Charms is not eating well. Ketones + not eating well + infection can lead to DKA, diabetic ketoacidosis. Smell his breath please and report back if you can.

See your PM's for the how to navigate directions you were looking for.
 
Oops - hit the wrong key & posted before I was ready ohmygod_smile

Anyway - I can't help you with the dose guidelines, but I can tell you about treats! My Tigger LOVES, LOVES, LOVES the freeze-dried chicken you can get at any pet food store to start (more expensive there), then order online for best cost. Tigger gets them after every test, shot, & dental med.

A tip passed on to me from a more experienced Member: Look for the F.D. Chicken in the DOG section - you can get a bigger bag for less $$$$. You will need to break up the pieces, though.

Good Luck, we're all rooting for you!
 
Hi , I was not sure what was happening when the board went down, (not sure I trust all this technology sometimes!) , felt a little lost, so I did not increase his dose last night because I was afraid of not testing enough over the night. I did manage to finally get a PM +6 BG and it was still high 415. I hope this adds a little more info. My shy feral cats rule the house at night , so it was a little funny to see them all out and lounging in the kitchen at midnight.
I was not able to reply last night ,but Charms breath was fine , and he is eating as much food as I will give him. He is very very hungry, I am so worried about giving him too much food , how much food should he be getting a day. I am going to get some of those lower carb fancy feast cans instead of the friskies pates, desperate to get those numbers down.
So I did increase the dose this morning to 2.5. As I reported on the SS , Charms is in good spirits today too. Still thirsty and hungry but doing all the other things. He tried to make an escape out of the window with the air conditioner again, I will have to invest in more duct tape today!
Thank you for the tips on treats and ketone tester, tried to get one locally yesterday, but no luck. Followed the links and found the Nova Max, thank you. And I found the freeze dried chicken treats too, thank you for the tip about the dog section, that really helps. My Budget is already busted this month!
I am going to try to post on the Lantus Tight regulation board today , to see if anyone has any more thoughts about Charms treatment. - Sam
 
Stick with the 2.5 units of Lantus AM and PM for 3 full days. The TR folks will let you know if you need to increase any sooner.

Check nadirs (around +5 to +7 hours after the shot) as possible. These guide the dose adjustments for Lantus.

As possible, monitor for ketones.

Hang in there!
 
Sam,

I'm getting hit by board problems also. Kept getting SQL errors yesterday, multiple times and could not get back in for some time. That is why I gave you my phone number in a PM. Another resource to reach out in case of emergency.

Good to hear you raised the dose to 2.5 this AM. You're doing fantastic with all the testing. We really appreciate it. With those high flat numbers, Charms definitely needed an increase.

We don't worry until the numbers go below 50. Then we need to support with food and a simple sugar like karo or honey. Be sure to print this out on how to deal with a possible hypoglycemic numbers in case the board goes down and we are not here to guide your through a hypo. http://www.felinediabetes.com/FDMB/viewtopic.php?f=28&t=15887

And this one in case Charms is low at pre-shot and you are not sure of what to do.http://www.felinediabetes.com/FDMB/viewtopic.php?f=9&t=147 Safest thing to do if Charms ever has a low number at pre-shot, is skip the shot. "'Better too high for a day, than too low for a minute" is one of our mottos.

Charms may need as much as 2 5.5 oz cans of Friskies pate or even more. Spread the meals out into mini-meals, 4 or more a day would help. He'll be very hungry until his numbers get regulated more.

Is he losing weight? Can you hold him in your arms, step on your bathroom scale, let him down, subtract your weight to get his approximate weight? He may need more food if he is losing weight too rapidly.

There is also a Facebook group for FDMB in case of emergency. https://www.facebook.com/pages/FDMB-the-Feline-Diabetes-Message-Board/202644379634
 
please please please go and get those ketone test strips ASAP. Call a few walmarts, order them online.. whatever. You should be able to get them at any pharmacy. Smelling the breath isnt enough - because by the time you smell it, it could be too late. DKA is very very serious and I have seen quite a few cats die from it - even after days at the vet of expensive treatment.

Wendy
 
I got the strips for now , had to try a couple different pharmacies. If it does not work out I will order the monitor . Wish me luck! -Sam
 
Hhi Sam,

Just checking in on you. Glad you got Deb riding shotgun, she's great :thumbup

I'm relieved you got the ketone strips. I have multiple cats & Tigger is very private in the litterbox, but I have been able to isolate him in a bedroom with a litterbox during most of the day (having a 3 y/o Grandson move into the house helped - Tigger's terrified of him)

Deb already gave you the link for urine testing. At first Tigger was really hard to catch in the act - he's extremely private. If you have that problem, here's one other option:

As a last resort if I don't catch Tigger urinating, I have tested the clay patties. Not a great option, but better than nothing. I am able to test glucose & ketones this way. Break the patty open if there's no fresh urine on top & gently press the strip against the center, making sure to get some moisture on the color strip, then do your timing. If you can wipe away any clay adhering to the ketone color blot, that is preferable. Again, this is not perfect by far & a last resort for testing.

Glad you found the treats! Charms is probably glad, too ;-) A little goes a long way with those, & is easier on the budget.

Good luck today, you're doing great - & I am right with you on the start-up expense, but monitoring the ketones is imperative.
 
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