? Need help with dosage for Raja the savannah

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Arman Matin

Arman Matin

Member Since 2017
Hi everyone

thank you so much in advance for all your help. I am so grateful for this forum.

background:
Raja is a sweet 16 year old cat who has been with me since a kitten. He is the most affectionate social butterfly with curiosity to match. We took walk around Brooklyn every day and he was always eager to take walks. He has had some form of URI all his life which would flair once in a while. His diet has mostly been raw/poached chicken, and low carb dry food along with occasional Wellness can food.

He always had a great appetite and full of energy.

First symptoms showed up about a year or so ago when i noticed he wasn't lifting his tail up. After visiting the vet they concluded it was probably age related. His weight was 20.8 lbs from 22 which was also attributed to age.

Second time I noticed something was about seven months ago when he started dragging one of his feet slightly.
Slowly he showed no interest in wanting to walk. I also attributed this to old age. He weighed the same 20.9

soon after i started noticing that his spine and legs were lacking muscles mass

Three months ago he had an ear problem which turned out to be yeast infection. After taking him to the vet he weighed in at 16.4 lbs a weight loss of four pounds in three months. Multiple tests started to figure out the cause. He has a UTI , crying and trying to pee everywhere. Initial antibiotics doesnt work. Possible deeper issue with ear which might require ultrasound. Possible internal aspects which are not showing up in the bloodwork.
My schedule with work didnt allow me to take him to the vet every week. But as symptoms increased he was diagnosed with diabetes. No a terrible high number i was told. over 500. I need to learn whats next as she wanted to put him on humilin,

Took me 3 days to research. In the meantime Raja stopped eating and I rushed him after work to the vet after 24 hours of no food. He was severely dehydrated and looked awfully sick. He was given some IV, much stronger antibiotics, appetite inducer and in my insistence prescribed Lantus. His weight was at 14.8 and the vet was pretty close to hospitalizing him.

Luckily the weekend was here and I didnt have work the following week. So me and my girlfriend out all our love and attention to his care. We hand fed him for two days mostly poached chicken and finally he started showing signs of vitality. He is still being fed by hand as in food is brought to him but he gets up to drink a lot of water and pee a lot. We are using Alpha track 2 for measuring and as I was using a 28 lancet i felt like i was doing too much damage to his ear so i had to wait for the 32 gauge to arrive so there are gaps in the test.

Initially i started with the vet recommended 3 dosage and thought he might need more. So I gave him 3.5 and then felt like he had too much insulin in his body and decided to drop it to 2.5 before adjusting to 3 again. Of course my anxiousness played a part and now I am perplexed as how to proceed.

Should I continue at 3 or increase. did I start too high ? I need help.

Also I started giving him liquid B12 3000 mg per day for the last five days. His legs havent shown improvement rather it has worsened daily. This is such a emotionally sad process to go through....

Please look at the data i provided knowing I made mistakes with lots of gap ( i hate pricking him with the huge lancets) and I look for your support and advice.

Much Blessings

Arman

i have a FB page with some of his pics:
https://www.facebook.com/Raja-367124150044203/?fref=ts

also most importantly the spreadsheet

https://docs.google.com/spreadsheets/d/1d0UwLeteTVIt5gF5xGfNauL1zMpBuTaJXfvExR8g9JA/pubhtml
 
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Hello and welcome!

What a story! Your love and devotion for Raja (who is a very handsome fellow indeed!) shine through in all you write! You have definitely come to the right place to help figure out how to manage his FD.

I'm sorry that I am not really experienced enough to give specific dose advice-- I can see that you started off high, and that there have been a lot of changes in a short period of time, but I can't tell you where to go from here, whether to keep going with the current dose or try starting from a lower one. I will say that with Lantus (an excellent insulin for cats), consistency and patience really pays off. On this site, we recommend small (0.25U) changes in dose, and have two protocols (Tight Regulation, or TR, and Start Low Go Slow, or SLGS) to help guide dosing changes in a systematic way so that you don't miss the perfect dose. If you haven't already, take a look at the "stickies" for those protocols and try to figure out which one would work best for you and Raja.

As for the pokes-- I know! It feels awful at first to poke them. But it really doesn't hurt them as much as a finger poke for a human, and you just have to remember, you are trying to help them, not hurt them. And for their end, treats go a looooooooong way in making them accept and even (believe it or not!) look forward to the testing! My own cat, who has been off insulin for months now, is constantly running over to the "testing spot", hoping that maybe today is a day when we do a poke and treat-- I think she'd be thrilled if we went back to several tests a day, as long as she got the treats, too! It really does all get easier.

Again, I'm sorry I can't offer more specific dosing advice, but I'm sure someone here will be along to offer some ideas for how to proceed. I'll be keeping an eye on your and your sweet Raja!
 
Thank you so much Nan.

I looked into the protocols but by the time I started the insulin he was in such a bad shape that I went with the vet recommended dosage of 3.
 
Hi there and welcome!
I am going to tag 1 of the experts to help guide you.
There are several amazing advice givers. If you would put the "?" icon in the title of your thread you may get more expert eyes on your situation. Go to thread tools on the top right and drop down to select the ?
Raja is a beauty!
@Wendy&Neko
 
Hi Arman,

What breed is Raja? He is gorgeous. We can help you - hang in there.

First, all of your poking will stimulate the growth of new capillaries, and then you'll be able to get blood with every poke. Usually takes a couple of weeks of poking.

I'm glad you dropped back to the 3.0u. The single most important test on your spreadsheet is that blue 107. On an Alpha Trak that is in normal range, so we would've suggested you hold the dose at that point and give him a chance to settle in on that dose. I think you are ok on that dose for the moment - it will take a few cycles (3ish days) for the depot to settle in on the 3.0u dose and then you'll be able to see what it's doing.

Are you checking him daily for ketones? I think that's important at this point - you can buy glucose testing strips (ketostix) at any people pharmacy to test his urine.

Zobaline will help with his neuropathy (leg weakness). You can buy it online - it usually takes a month or more before progress happens, but it's not uncommon for a cat to come back up on their toes with consistent use.

What are you feeding him now and when - is it on a schedule? What is his current weight?

Last - can you get one test before you go to bed every night? That test can be very revealing - Lantus dosing is based upon how low the dose takes the cat, and often those lowest numbers happen in the pm cycle.

Hang in there - everything gets easier as you learn more. Ask as many questions as you have - people here are happy to help. Here is also a thread "Where Can I Find?" to help you find information that we use most often in this group. You've gotten the right spot now to get help for Raja. :bighug:
 
I can not offer advise I am a newbie myself. But he is gorgeous!!! The people here are brillant and so helpful. Wishes of healing and hope to you and your beautiful boy. This is the place for that.
 
Hi Arman, and welcome to Lantus and Levemir Land - the nicest place you never wanted to be.

Raja is very handsome - I just love Savannah cats, but I have heard that they can be a handful.

We are more than happy to give you all the help we can. You have already gotten some excellent advice. You will find many more kind, caring people here that will chime in as you go along. I know this is scary and overwhelming, but you aren't alone. We have all been there.

There is a LOT of great info on this site, and it will take a while to absorb it all. Keep at it, though, as the more you learn, the more equipped you will be to help Raja. Keep in mind that our two methods were written with a human meter as a reference, so your numbers will be slightly different. We can help you figure that out. Ask lots of questions. We don't mind answering them at all. Julie gave you a great link, and I'm going to add a couple more:

First, to help you with testing: http://www.felinediabetes.com/FDMB/threads/hometesting-links-and-tips.287/.

Next, to help you figure out what we're saying: http://www.felinediabetes.com/FDMB/threads/l-l-land-slang-dictionary.162551/.

Lastly, here is a post we recently put together to help new members get the most out of this site: http://www.felinediabetes.com/FDMB/threads/updated-tips-for-new-members.173572/.

We're glad you found us!
 
Raja is gorgeous! I love Savannahs (I have two Bengals-would love to have a Savannah, as well!)

Sometimes hind-leg weakness can be caused by potassium deficiency, which is not uncommon in cats with FD. If Raja has not had bloodwork done lately it might be a good idea to have your vet do some tests and check his potassium levels.
 
Thank you for all your responses. Here are mine.
Raja is an amazing savannah and i love the breed. My other cat is a Bengal and they are amazing too.

Current weight at vet 15 lbs two weeks ago), ideal weight 20 lbs ( he was 23 at some point)
Ketone check daily ( negative result)
current diet and in fact majority of his life ( raw/boiled chicken) currently being hand fed in bed ( he can walk but prefers it in bed..oh boy)
!!!! current insulin (lantus) dosage 3 feel like i need to increase it ? by .25 ? !!!!!!!
i will track nadir point for night time.
!!! Using alpha track2 but getting too much deviation on the same test. two strips will show 520 and 620 which is a high error rate in my opinion. should i get a new system ?!!!!!
currently on liquid b12 . ordered zoabaline
potassium deficiency : will check from last test results
 
Also looking at the chart initially with 3 units i assumed he was having a Symogi effect as his rates fluctuated so low and then so high. But I am not sure. Especially considering a nearly 100 point reading deviation on the alpha track. So i decided to lower dosage but it didnt seem to help.
 
Allowable meter variance is 20%-- unfortunately, that means that once you get into higher numbers, you can have a pretty substantial variation in readings from test to test (20% of 500 = 100pts!). We're generally more concerned about accuracy on the lower end anyway, where there is a risk of hypoglycemia. At the higher end, really the important thing is just that the numbers are too high, whatever the "true" blood glucose is.

I think the general consensus is to keep with the 3 for now (experts: correct me if I'm wrong), do that dose consistently AM and PM for a few days to see where it takes you. Aim for a pre-shot BG reading for each shot (for safety), and then at least one mid-cycle test-- we dose Lantus based on the low point in the cycle, so those mid-cycles are critical (they don't have to be exactly in the middle, in fact it's good to take readings at different times on different days to get a fuller picture of the patterns).
 
Also: many people here use human glucose meters (mostly because of the $$$$ involved in buying strips for the Alphatrak-- it adds up!). Advantages and disadvantages to either meter type, but the important thing is to pick one to use consistently-- it's too hard to compare between "human" and "pet" numbers.

Also also: Raja sounds like quite a character!
 
Arman Matin said:
current diet and in fact majority of his life ( raw/boiled chicken) currently being hand fed in bed ( he can walk but prefers it in bed..oh boy)
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They will take advantage of you if you let them, for sure! :rolleyes: Are you feeding just plain chicken exclusively? I'm concerned because there are certain nutrients, the main one being Taurine, that are very important for a cat to get regularly, and they aren't contained in plain meat. There are several products on the market you can combine with the meat to give Raja what he needs. We have a lot of people here that feed raw diets (I'm not one of them at the moment), and I'm sure they can share with you the names of those products and more information. The good news is that, as Raja's numbers get a little better, he should feel better and be more willing to eat on his own. Hopefully ;).

I'm really glad you ordered the Zobaline. I feel it made a huge difference for my Cinco, and many people here say the same about their cats.

Getting a human meter will be very helpful in cutting the cost of dealing with FD. Alpha trak strips are ridiculously expensive. Another benefit to a human meter is you can but the strips in any pharmacy, unlike AT strips. This can be very important if your cat is running in low numbers and you are testing a lot, only to find you are running out of strips. The Relion brand, sold by Walmart, is very popular here.
Arman Matin said:
potassium deficiency : will check from last test results
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There is a tab on the spreadsheet where you can record the results from Raja's bloodwork. There is a set of reference numbers already there, but if you vet uses a different range, you can adjust them on the sheet. Many of us post the results there every time our cats get bloodwork run, as it helps us to spot trends and issues. We also have a couple of people here that are very knowledgeable about these things and can point out potential issues, or reassure you.

I have asked some other veterans to look at your SS and give you their thoughts about the dose. If you are following SLGS, you are supposed to hold each dose for one week, unless you get a BG below 90, in which case you would reduce by .25. Since you didn't start on the recommended initial dose amount, though, it might not be unreasonable to make an adjustment early. I'd like to see what some others think.

May I ask what your reasoning is for choosing SLGS? Is it because, when you are working, you are unable to test during the day? TR isn't for everyone, but it does offer the option of making dose changes as frequently as every three days, which can help get your cat into better numbers faster. Many people here are able to follow it and still work full time. It does help if you have a partner, though, and it sounds like your girlfriend loves Raja, too.


 
Thank you so much for your response. I can go with TR. Its just that I might not be able to test during the day every day. My partner could help me for sure as she love him. I am a little unsure of approach from having high BG numbers. For the immediate time being I have done his curve so I know how he is reacting, but I dont think he is getting enough insulin if his numbers are still staying high. So I can start the regiment of slowly increasing dosage. I just dont know whether I started it right using the vet recommended 3 units
 
Welcome Arman and Raja :cat:
Often cats will go lower at night. I got most of my tests in the evening cycle during the workweek and during the day on weekends when I had days off.
Since you increased his dose tonight, I would try to get at least one mid-cycle test if you can.
 
By your SS, I see you went up to 3.25 tonight. The consensus, and I agree, was to stick with 3.0 units for now. Especially since you can't get any night time tests. Many cats go lower at night. My Neko for three months in a row went low at night, enough to earn reductions, then bounced during the day. If I'd just looked at her daytime data I would have thought she needed increasing instead of the reductions she was asking for. Even a +2 or +3 test will give a good idea what is happening on a dose. Since you've upped the dose, those mid cycle tests will be even more important.

Back to Tricia's point on diet, eating just pure meat is not a balanced diet. Even in the wild their diet include organs and bones. There are many premixes available that you can add to raw meat to make a balanced diet. I am currently using the EZComplete premix by FoodFurLife, though I have used another one. If you can, I'd ditch the dry food you mentioned above. Eating dry and raw is not a good combo, as they take different times to process in the digestive system and it can be hard on them to have the raw at the same time as dry.
 
Thank you so much. I am going to test him tonight to see how he is reacting during the night mid points. You are probably right about not having enough night time data. I am so confused about the direction as I hate to see him having such high numbers and it affected him so drastically. So naturally I am thinking he doesnt have enough insulin. And at the same time I remember the drop he had one the second day when I gave him 3 u insulin. His second day shot and I dont know whether he experienced a symogi effect for the next days onward and now I am caught in a vicious cycle.
 
The part that is bothering me so much is not knowing whether 3 U was too high to begin with or not. And I didnt have enough knowledge at that start point and I was really scared about how he looked that I just went with it.
 
I'm glad you are checking daily for ketones. On the right side of the spreadsheet is a column for comments. Please note the negative ketone tests there - otherwise everyone will continue to ask you about it.

Night cycle checks are essential, for the reasons that several of us mentioned above. It's very common for cats to go lower at night.

Arman Matin said:
The part that is bothering me so much is not knowing whether 3 U was too high to begin with or not. And I didnt have enough knowledge at that start point and I was really scared about how he looked that I just went with it.
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While it was a little higher than either our Tight Reg or Start Low Go Slow guidelines would have started at, it does look like it was probably ok. I'm still looking at that blue 107 on your Alpha Trak.

There are times when high numbers don't mean that a cat needs more insulin. It's a bit counter-intuitive - as are other things with insulin - but high numbers do not always mean more insulin is needed.

Here is a link that includes 2 of those occasions - one is when the dose is increased, sometimes there is an increase in blood sugar for a day or so. We call that "New Dose Wonkiness" or NDW. Another time is when a cat "bounces" - what you are calling Somogyii. Take a look at the first 2 posts in this thread for more of a description of both of those.
 
I wanted to go ahead and post that since I see you are online now.

I think Raja is likely bouncing. His body has gotten used to being in high numbers and when it hit that blue 107, his body perceived that as a hypo. Even though that is not a hypo number - his body experienced it as though it was. In response, the body released stored sugars and counter-regulatory hormones to bring his blood sugar back up high, where it now perceives it as normal range.

Bounces can last as long as 3 days, especially in a case like yours where the cat has likely been diabetic for a while before being diagnosed, and the body has gotten used to being in high numbers.

What was the date he was diagnosed?

Take a look at his spreadsheet and cover up that blue 107. Without that one test, we'd have all thought that he was constantly high. But that one test suggests that 3.0u is enough to get him pretty close to a good nadir on this dose. The way to help a cat get over bouncing, and for his body to get re-accustomed to normal numbers, is to keep bringing their blood sugar back into normal range.

Also, that one test basically controlled his blood sugar for the following 3 days. When he got to that range, then bounced, that was very likely to last 3 days. I don't see it coming down after 3 days, so I'm looking at the pm cycle - that's the reason I'm encouraging you to get a test there before bed. He could be clearing the bounce and starting a new one during the night. Now this doesn't mean that you have to test all night long. We can do some educated guessing about what happens in between tests, depending on the situation. What helps me is to see both preshot tests, and ideally at least one mid-cycle test in each the am and pm cycle. If you see a yellow test, then I'd test again in another hour or two to see if his blood sugar is dropping. You can see from the tests around the 107 that he didn't stay in blue numbers very long at all. The more he gets there the longer that time *should* stretch out. At first a cat might touch down and bounce again within just a couple of hours, then bounce for 3 days. As time goes by, the time in normal range will stretch out into several hours and the bounces will hopefully (in most cats) flatten out and they may only bounce to 200 instead of 600, and the bounce may resolve within an hour or two instead of lasting for days. Patience and diligence gets you there.

Things I would suggest:
- pm cycle test every night before you go to bed
- if you get a yellow test, try to follow it up with another test shortly afterwards
- add diagnosis date and essential info to your signature block
- add test data to the spreadsheet - there is a separate page for labs, meds & ketone tests can go on the regular spreadsheet page
- read any links that people give you and take a look at the stickies
- ask as many questions as you have - we don't mind.
- monitor his weight so he doesn't continue to lose weight. It needs to stabilize.
- either add in a commercial cat food or the additives that cats need to go along with home made cat food, as Tricia & Wendy explained

When he was first diagnosed and really sick, did you hear that he had ketones or something called "DKA" or "diabetic ketoacidosis?" Breath smell like nail polish remover (acetone)?

And just to clarify, none of us are "experts." We have experience with diabetic cats and Lantus and/or Levemir. We are all lay-people, not vets. It's your responsibility to read through information, ask questions and decide what works for you.

Hope some of that helps.
 
One more thought, since I'm on a roll . . . ;) . . . a cat that is overdosed will sometimes respond with higher blood sugar too. That is a third circumstance where high numbers do not indicate more insulin is needed.

One more reason why being certain one can answer the question "how low is this dose getting my cat's blood sugar" is so important before a kitty's dose is increased.

If you are really worried about having started at 3u, one choice is to decrease his dose to fit either the Tight Regulations starting guidelines or the Start Low Go Slow guidelines, depending on what you're feeding him and which you are most interested in. If he continues to eat dry food then SLGS is the only option for a dosing guide. If you want to do that, you can, and if it's clearly not enough insulin then we could help you increase more quickly than usual. It usually takes 4-6 cycles (2-3 days) for a larger dose's depot to reduce and equalize with the new, smaller dose - then we can see what the cat's blood sugar would be on that new smaller dose.

When people come here with a larger-than typical dose to start with (which is common), often it seems to be helpful just to slow things down, hold the dose constant, and get tests in so we can get a better picture of what's going on. You've got more than enough day tests for us to see that clearly - adding the before-bed test will help us see the picture much better.
 
julie & punkin (ga) said:
I'm still looking at that blue 107 on your Alpha Trak..
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I know I look at that 107 to. In fact i did another strip right before that which showed 77. I counted it as an error and i retested it to be 107. Also that night the test was at 266 the only day I ever had any low number. And Since that day and when i read about the symogi effect I couldnt help but think that he is on too much insulin. But as I didnt have any way to judge the data I kind of blindly went a little up and a little down and now up trending.

Did I miss a sweet spot below 3 especially around 2 or less than two. My reason for thinking this way lies on the fact that on the second day he showed the best response to the dosage and based upon how Lantus might depot does that mean that maybe he had the equivalent of 2 units in him and anything above that caused him to go into the Symogi effect ? I could be way off.. just a hunch
 
Arman Matin said:
I know I look at that 107 to. In fact i did another strip right before that which showed 77.
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That supports even more that the high numbers we are seeing are from bouncing, rather than indicating that the dose is too great. I would drop back to 3.0u until you have some night cycle tests - I'd want 3 evenings in a row.

If 3.0u can get him to 77AT, that is a number that would call for a dose reduction for those following SLGS, and 68AT calls for a dose reduction for those following Tight Reg guidelines. Nothing there would suggest that Raja needs a dose increase.

Good job retesting - it's a good practice to retest if you get a puzzling test result or one that seems out of context.
 
Hi Arman.

I see the cavalry arrived while I was out. :) You've been given some great input by some very experienced people. I know it's a lot to absorb. If any of it confuses you, ask questions. I know we keep saying that, but you get a lot of info thrown at you when you first come here, and you're already upset and confused because your precious furbaby is sick, so if you understood everything the first time you read it, we'd wonder what planet you were from!

It appears to me you've already done some good research and learned a lot - you're way ahead of many new members when they come here!

One request for you: when you post tomorrow (Tuesday), can you please start a new thread? We ask each member to do one thread per day, because if you keep posting on the same one for days it gets really long and hard for others to follow. When you create your new thread/condo, it will help if you can link this thread in the first post. If you need help to do that...you guessed it...ask! ;)
 
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