New Diagnosis - Introducing Shelly - Advice Welcome

[Carina and Shelly]

Shelly was diagnosed with steroid-induced diabetes on 8/5. Her vet changed her steroid to Budesonide at that time. Because her BG was so high she did not feel comfortable waiting to see if the steroid change would put her into remission, though she expressed significant worry about Shelly going into remission and having a Hypo episode. 8/8 we started her on 1u Lantus 2x/day.
8/14 we started a Libre3 curve. The device lasted for four days. Two days ago we sent the data to her vet and we are waiting to hear back. She was starting to form a distinct curve but the highs are high (350+) and her lowest nadir was 121. It's been a rollercoaster of emotion. We are working on getting an FD spreadsheet started and will start testing her regularly tomorrow with an AlphaTrak3. We plan to use the SLGS method, though we are very concerned about knowing what to do when her BG is in the lower range. I have read on here that it is recommended for beginners to seek support before giving insulin at anything lower than 150 and I like knowing we can get support here.

 

[Wendy&Neko]

Hello and welcome to you and sweet Shelly.

Budesonide doesn't always improve the blood sugars differently than prednisolone, but it does in a larger percent. My kitty Neko was on budesonide and it didn't impact her blood sugars. Meaning, not a guarantee you'll see a difference, but good on your vet for trying to see if it does for Shelly.

What food os Shelly eating now? I see MC (medium carb), what food is it? Any chance she could move to a lower carb food?

If you want to try the Libre again, some tips here might help you. Getting Started With Continuous Glucose Monitors (CGMs) for Diabetic Cats. The majority of us home test with human blood glucose meters. The AT test strips are very pricey, and all of our dosing methods were developed for human BG (blood glucose) meters, back in the day before pet meters were invented. How is the testing going with the AT? We do have some people who use it, so can help with numbers you get from it.

You might want to read the Dosing Methods Sticky Note at the top of the Lantus forum, along with the other Sticky Notes, including the one on handling low numbers. Those will help you should she get in lower numbers.

If you are seeing numbers range from 121 then her numbers are higher, what you are likely seeing is something we call a bounce:

Bouncing is simply a natural reaction to what the cat's system perceives as a BG value that is "too low". "Too low" is relative. If a cat is used to BGs in the 200's, 300's, or higher for a long time, then even a BG that drops to 150 can trigger a "bounce". Bouncing can also be triggered if the blood glucose drops too low and/or too fast.The pancreas, then the liver, release glucogon, glycogen and counter-regulatory hormones. The end result is a dumping of "sugar" into the bloodstream to save the cat from going hypoglycemic from a perceived low. The action is often referred to as "liver panic" or "panicky liver". *Usually*, a bounce will clear kitty's system within 3 days (6 cycles).

By the way, seeing a 121 already is very promising.

 

[Carina and Shelly]

Thank you so much for the welcome and for the helpful information.

Shelly is on Royal Canin Pea and Rabbit (PR) prescription food. Chewy told us it was 10% carb, but I have seen some conflicting information. Unfortunately with her IBD and her propensity to develop bladder stones she needs to be on an Rx food and our options are limited. She was on Hydrolyzed Protein kibble until about 3 weeks before her diagnosis and I am wondering if that was part of the equation for developing diabetes. We recently tried the RC Pea and Duck Rx (9%) and it upset her stomach.

That being said, do you have any thoughts about how to approach sourcing a high carb food for our Hypo toolkit with Shelly's limitations? We do have some Hydrolyzed Protein treats we stopped giving her. They seemed to be increasing her blood sugar, but we weren't sure. Might those suffice?

That's good to know about the AT. Unfortunately we did not know there was a better option before we bought it. We are planning to start tomorrow with another curve and go from there.

We were able to get the Libre 3 manufacturer to send a replacement (it's en route) and we were wondering if we could pull off applying it ourselves instead of paying $40 at the vet (plus the $200 fee they charged us to read the data).

That's so good to know that seeing a 121 is a promising sign.

 

[Wendy&Neko]

According to this chart, the Royal Canin Select Protein Rabbit is 15%, so that is what we consider a high medium carb food.

Do you know what type of bladder stones she develops? It's possible the dry also contributed to that. From this website by a vet specializing in feline nutrition: Cat Urinary Tract Diseases: Cystitis, Urethral Obstruction, Urinary Tract Infection this is what is recommended:

Generally speaking, the basic diet recommendation for the average cat with urinary tract issues is a high protein/low carbohydrate canned food with added water.

Taking it one step further, if the patient has a properly documented problem with bladder stones or a large amount of crystals, look for one that is low in phosphorus – either below ~1.0-1.2% dry matter (not ‘as fed’), or below ~300 mg/100 kcal.

The reason I was asking is that my second cat was diagnosed with crystals a week after Neko got her diabetes diagnosis, so I had to try to find a food that both could eat (she stole his food). So I went with the above recommendation. In my case it was raw that has lots of novel protein options. This CKD food Chart lists foods that are diabetes friendly and also good for cats with CKD, that have to watch their phosphorus: . Although no strictly rabbit food, there are other novel proteins like pork, lamb, duck, bison. My IBD kitty that could eat rabbit could also eat turkey and lamb, but it varies by cat.

To make higher carb food, you can always add a drop of honey or syrup (karo) to it.

121 on an AT is a normal blood sugar number.

 

[Carina and Shelly]

Yes, we’ve been down the road of non-Rx low phosphorus foods (we literally had a spreadsheet we used at the store) and unfortunately she was still developing the struvite crystals. It’s super frustrating.

That is a good tip about adding the honey or karo directly to the food. I had only seen the intervention of putting it on her gums, but of course adding it right to the food makes sense.