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Nate

Nate

Member Since 2016
Hey everyone,

My name is Nate, I am new to this forum but in need of some urgent advice, so I'm skipping the introduction post (sorry for the bad etiquette).

My cats name is Floyd. He is a 4 year old mainecoon and his ideal weight is around 18 pounds. About 4 weeks ago we noticed he was losing weight and not eating or drinking. We brought him in to the vet who tested his urine, and he found that he had a bacterial infection, a bilirubin level of 7, and his blood sugar was 300, and there were ketones present in his urine. He got a long acting antibiotic injecting and some fluids via an IV, and we started treating him for for diabetes with 1 unit of lantus every 12 hours. We also had to force feed him 3/4 of a can of Royal canin rs recovery mixed with water about twice a day. The promising part is that he has been a trooper this whole time. The vet said many times how surprised he was that a cat with his issues is presenting so well. He even played with the IV cord when he was at his worst.

The good news is that the week following his diagnosis, his bilirubin levels dropped drastically, his blood sugar was 140 at the time of testing, and there were no longer ketones in his urine! Huge relief, however...

I got a glucose meter and attempted to perform a curve test based on instructions I found online. After a week of force feeding he began to eat dry food on his own, so we have been free feeding solid gold indigo moon, assuming this is ok because he still was underweight. We also have 4 other cats, so making sure he gets enough food is tough unless we isolate him.

Well, the first curve went alright. First test was 199, +3hrs after an insulin injection (increased the dose to 1.5 u) and it was down to 171, +3 to 166, +3 to 177. Increased another .5, assuming that since he is so large we just aren't giving him the right amount of insulin. Tested the next morning and it's back up, and the throughout the day similar results. Now, I have been using a true2go meter for these tests. Ran out of strips that it came with and ordered more online because they were exponentially more expensive at CVS. Bought another meter, Bayer contour next, with 20 strips to cross reference results, just to be extra safe, and the first test today came back with 295... Tested again minutes later, 250. Strange. Tested myself, 99, and another non diabetic cat, 77. Seems accurate. 2.5 units insulin +3 270, +3 240, +3 345...

Anyone have any clue as to what might be happening? We fed him wet tonight, but ever since force feeding him he hasn't shown any interest in wet food, even though he is bugging us like he's hungry. I will be up all night and plan to test him in another 3 hours. Any advice would be greatly appreciated!
 
Welcome Nate & Floyd!
I am new and can't offer dosing advice.
Someone should be able to help you shortly.
You have come to the right forum.
I have had excellent carung help from the members.
If you could set up a Spreadsheet and what type of insulin that would be helpful.
 
Welcome to the message board, the best place you never wanted to be.

Good for you for being proactive and home testing! It will help you keep your cat safe.

The dry food your are feeding is pretty high carb - likely to be around 30-40% calories from carbohydrates. This will make the numbers hard to reduce and may require careful, gradual increases in the insulin. There are very limited low carb dry foods in the US - Evo Cat and Kitten Turkey and Chicken (specialty pet stores may carry it) or Young Again 0 (available online only).

Lantus is a depot insulin and has some carryover from shot to shot. Because of this, it can take 5-7 days to stabilize on the initial dose and 3-5 days on subsequent dose changes. We've got tons of info on using Lantus effectively posted in the Lantus/Levemir section.

Can we get you started using our grid to record your glucose tests? It will help us give you better feedback. Instructions are here.

Understanding the spreadsheet/grid:

The colored headings at the top are the ranges of glucose values. They are color-coded to clue you in as to meaning.

Each day is 1 row. Each column stores different data for the day.

From left to right, you enter
the Date in the first column
the AMPS (morning, pre-shot, test) in the 2nd column
the Units given (turquoise column)

Then, there are 11 columns labeled +1 through +11
If you test at +5 (5 hours after the shot), you enter the test number in the +5 column
If you test at +7 (7 hours after the shot), you enter the test number in the +7 column
and so on.

Halfway across the page is the column for PMPS (evening, pre-shot, test)
To the right is another turquoise column for Units given at the evening shot.

There is second set of columns labeled +1 through +11
If you snag a before bed test at +3, you enter the test number in the +3 column.

We separate day and night numbers like that because many cats go lower at night.

The nadir is the lowest glucose between shots. There is a general period when it will happen which is specific to the insulin being used and testing then helps make sure your cat doesn't go too low.

It is merely a grid for storing the info; no math required.


Also, when you have a moment, could you add a few tidbits to your signature? It will help us give you feedback.

Editing your Signature

In the upper right corner of the screen, within the dark blue bar, you will see ID, Inbox, and Alerts

Click on your ID.

On the left, under Settings, Click on Signature.
This is where you will put information that helps us give you feedback. You are limited to 2 hard returns, so separate pieces by | or -.
This is where you paste the link for your spreadsheet, once it is set up.
Add any other text, such as your name | cat's name | date of Dx (diagnosis) | insulin | meter general location (city and state/province) any other pertinent issues like if there are any food issues, history of DKA, hepatic lipidosis, pancreatitis, allergies, IBD, etc.

Click the Save Changes button at the bottom.

 
I notice yours says "using a meter calibrated for feline blood" but was unaware that that was a thing. How does a meter calibrated for feline blood differ from a standard "no coding" glucose meter?
 
BJM could you please tell me how to tag members? Also how do you like a post?
Thank you!
 
Pet meters give numbers similar to what a veterinary lab would provide.
Human meters run somewhat lower. Almost all of the reference numbers in our guidelines use human glucometers as the test strips for these are much less expensive.
For human glucometers, you want the glucose to be above 50 mg/dL at the nadir, the lowest level between shots, and starting out, you do not give insulin if the test before the shot is below 200 mg/dL. Once you have data showing it is safe, you may carefully lower the no shot limit.
For pet glucometers, you keep the glucose above 68 mg/dL at the nadir.

To tag a person, use the @ sign followed by the user name.
In the lower right of a post is an option to like the post.
There is also an option to click reply, which will copy the post in a new post where you can edit out parts your don't want, and then respond.

(ps. I can only post every 7 minutes since the board was hacked last fall)

PS. See the links in my signature for notes, monitoring additions, and glucose reference info.
 
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Just for clarification, you are saying that if I test in the morning before his first shot and his BG is under 200 on a human meter, do not give him any insulin at that time? If so, when should I check his BG again after that?
 
There are some meters that are "pet only" like the AlphaTrak meter, but the strips that it uses are about $1 each

Most of us use human meters because the cost of the strips is more affordable. If you live in the US, one of the favorite meters around here is the Relion Confirm or Micro from WalMart because it takes the smallest sample size and the strips are affordable at $35.88 per 100.

All our protocols here are based on human meters so we're all very used to reporting with those numbers. What's important is to watch for "trends", not individual numbers....is the current dose getting them where we want them???

It's important to transition your cat SLOWLY to a low carb canned diet. We want our diabetics eating less than 10% carbs. Fancy Feast Classics, Friskies pates and 9-Lives ground are all low carb choices that lots of us feed.

It's very important since you're already giving insulin that you do this slowly and test several times a day to make sure he doesn't go too low. Lowering the amount of carbs in the food can lower the blood glucose numbers up to 200 points.

With Lantus you want to give the same dose for the first 5-7 days and then only increase in .25 unit increments. Insulin is a powerful hormone and even a tiny bit more can make a drastic difference in how it works.

Don't want to overwhelm you, but there's lots of great information in the Lantus Forum stickies for you to read through. Keep asking questions too! The people here are great about sharing their time and knowledge!!
 
DebG said:
BJM could you please tell me how to tag members? Also how do you like a post?
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@DebG ....to "tag" someone, just put the @ sign in first and the first couple of letter of their name...a drop down menu will come up for you to choose the correct person

To "like" a post, look over on the bottom right side of the post for the word "like"
 
I should have been here a long time ago. Should I reduce his insulin dosage because I increased too quickly? He has been on insulin since 4/21. Also, just an FYI, I purchased a 200 pack of strips for $30 for my true2go meter that was only $11 and only requires .5 microliters as a sample. So far I think I have had a better experience with that than the Bayer Contour Next, because getting enough blood has been easier and also maybe a little bit because it has been giving me better news.
 
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When the pre-shot test is below 200 mg/dL on a human glucometer and you don't have much data to know if it would be safe to shoot, you stall 30 minutes without feeding and re-test. If it has risen above 200 mg/dL, you may shoot.
Also, post for other folks to take a look at the spreadsheet once you get it up, so they have some idea of how the insulin is working in your cat.

Check my signature link Human Glucometer and Veterinary Lab Reference Numbers and Notes for some important details on glucometers
 
I am not confident that my information would be reliably accurate. I promise I will keep close tabs starting tomorrow so we can do this thing right. Also, I updated my picture so you all can see who we are fighting for. Tell me that isn't pet food model material!

If after the second test his BG still isn't higher than 200, do I feed at that point and skip the shot completely?
 
Nate said:
Should I reduce his insulin dosage because I increased too quickly?
Click to expand...

There's no way we can answer that right now. Maybe reduce back down to 2U...most cats here on on less than that

Please get our spreadsheet up as soon as you can and put the numbers you have into it....Here are instructions on getting the FDMB spreadsheet (if you have any trouble with it, let us know...we can set it up for you)

Lantus dosing is based on how LOW it takes the cat, so it's important to get tests in between the shots.

We always test before shooting (the AMPS and PMPS) to make sure they're high enough for insulin....at first we say not to give insulin if they're below 200, but to "stall", don't feed and test again in 20-30 minutes....Use that time to post for help

After the Pre-shot tests, if at all possible, get another test in mid-cycle (5 to 7 hours) after the morning shot and at least a "before bed" test on the PM cycle. Most cats go lower at night so it's really important to always get that "before bed" test in .....it'll let you sleep better (or set an alarm if you need to!!)

Of course if you can get more tests in, that's even better! There's no such thing as too much data here!!
 
The long acting antibiotic was Convenia. Keep an eye on him since glucose levels may lower some as infection is eliminated. Also, some cats have had adverse reactions to this antibiotic, so using the Secondary Monitoring Tools in my signature may give you a heads up if his health starts changing (up or down).
 
I will get a before bed reading up in the next few hours, and starting tomorrow will accurately record all data going forward and adding it to the spread sheet.

And there may not be such thing as too much data, but there is such a thing as making my big beautiful man bleed too many times for my poor heart to handle! Don't worry though, by the time Floyd is in remission, you'll be so sick of all the data that you won't ever wanna see another piece of data for the rest of your life.;)
 
BJM said:
The long acting antibiotic was Convenia. Keep an eye on him since glucose levels may lower some as infection is eliminated. Also, some cats have had adverse reactions to this antibiotic, so using the Secondary Monitoring Tools in my signature may give you a heads up if his health starts changing (up or down).
Click to expand...

It has been over 2 weeks since he received the shot. The exact date I believe was 4/19.
 
Food and water intake and output are fairly sensitive to changes in the glucose level, so noting those in the comments section of your spreadsheet is another way to track improvement.

A bit of Neosporin ointment with pain relief applied to the ear for a minute or so before testing, then wiped off, will help it heal more readily, as will applying firm pressure to the test site after getting the sample.
 
Welcome Nate and Floyd
Nate said:
I will get a before bed reading up in the next few hours, and starting tomorrow will accurately record all data going forward and adding it to the spread sheet.

And there may not be such thing as too much data, but there is such a thing as making my big beautiful man bleed too many times for my poor heart to handle! Don't worry though, by the time Floyd is in remission, you'll be so sick of all the data that you won't ever wanna see another piece of data for the rest of your life.;)
Click to expand...
LOL, speaking as a self confessed testaholic, there is no such thing as too much data, but sometimes you have to rein it in for the sake of your fur babies ears (I wasn't very good at that), BFG loves his tests (or at least the treats he gets;))
 
Thank you all SO much, I feel so much more confident after my experience on this forum tonight! I just tested Floyd's BG, and we are down from 345 to 249, 2.5 units of Lantus and 3 hours later. I have pulled the Solid Gold dry food, and now Floyd and the other cats have fresh water in a Drinkwell fountain and Wellness Core canned food available to them. If anyone thinks it is important to isolate him while attempting to regulate him I will, but I feel so much better letting him play with his 4 brothers and sisters, and figure that having him in his regular environment will yield the most natural results. Plus, other than the high blood sugar, everything seems perfectly normal with him.

Floyd has been a total champion throughout this whole process and makes testing and giving shots no problem. Heck, even when we were force-feeding he was relatively calm throughout, and even let us bathe him afterwards with kitty shampoo in the shower (no one wants to snuggle a cat that has been soaked in liquid cat food)! And still, just moments after all this torment, even when he was still soaking wet, we had a little purr machine ready for snuggle action. The first week he was diagnosed, we were devastated. The news kept getting worse and so did the prognosis, to the point that there was a possibility we would be facing the death of the sweetest cat possible at the age of 4. When he first kept his food down, and with every insulin shot, we started having hope. I never expected I'd ever be so happy to see a cat urinate and defecate in my entire life. It also didn't help that this all came to a head the day Prince died, which was also the day before my birthday. Needless to say, this put a bit of a damper on the party.

When we first got news that his blood sugar had returned to normal, the ketones were gone and his bilirubin levels had decreased faster than Dr. Jim had ever seen before, it may have been the happiest, most relieved I have ever been in my life. I will do anything to make sure Floyd is as happy and healthy as he can possibly be, and I cannot express how happy I am to have you all along for the journey. You have already helped so much!

I will gather as much information as I can on the spreadsheet and post it in the morning. Hasta mañana!
 
Hi Nate and Floyd, and welcome to you both.

Nate said:
Also, just an FYI, I purchased a 200 pack of strips for $300 for my true2go meter that was only $11 and only requires .5 microliters as a sample. So far I think I have had a better experience with that than the Bayer Contour Next, because getting enough blood has been easier and also maybe a little bit because it has been giving me better news.
Click to expand...
A bit of a heads-up about the meters you're using. Some of our members here have had problems with meters whose names have "Tru" or "True" in them. Those results might not be as reliable as the Contour Next results.

(@BJM - is it correct to say that the Tru-type meters tend to read too low? I can't remember.)

In terms of testing costs, the most popular meters used by US members here are Walmart's Relion Confirm, Micro and Prime meters. All have reasonably-priced test strips. The Confirm and Micro need a smaller blood sample than the Prime, but the Prime strips are cheaper.


Mogs
.
 
Nate said:
I have pulled the Solid Gold dry food, and now Floyd and the other cats have fresh water in a Drinkwell fountain and Wellness Core canned food available to them.
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Have you stopped feeding dry just recently? You may see a significant downward momentum in BG numbers if you have only just pulled the dry and swapped to a LC wet, when the dry works out of the system.

Usually when a cat is already on insulin we recommend removing the dry slowly, to minimize this effect. If you have just gone cold turkey with the dry just be aware that you may have to watch closely for his numbers dropping.
 
Gill & George said:
If you have just gone cold turkey with the dry just be aware that you may have to watch closely for his numbers dropping.
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Yes, Nate, it is VITAL that you monitor BG closely when food is changed to low carb. There can be an initial large drop in BG levels but they can continue to drop for several days to weeks after as the cat's body gets used to the lower carb load.


Mogs
.
 
Specifically, switching to low carb canned or raw food may decrease the glucose levels 100 - 200 mg/ dL and reduce the insulin requirement by 1- 2 units.
Because you have made this food switch, you need to be testing at the likely nadir period for Lantus, around +5 to +7 hours after the shoot.

It has been a while since the reports of issues from meters with True in the name. The Bayer brands have done well for folks as have the Wlmart and Target brands mentioned previously. I used the Confirm and Confirm Micro with the 2 diabetics I had.
 
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Nate I'd return the true 2 go strips. That meter may rest cats very low. Your Bayer Contour is likely better.
 
Ok I am back with accurate information. We are holding steady at our dose of 2.5 units of lantus, have switched him to evo low carb food after the wet food didn't appeal to him. I'm still getting really high readings, as you can now see in the spreadsheet. I'm going to get a third meter today because I'm not confident in the Bayer right now. It has given readings with 40 point differences with just minutes between them. I'm going to go to Walmart and get one of their brands as some of you suggested. Anyone have any idea why my cat may have suddenly stopped reacting to insulin?
 
It's hard to say with so little info at the moment. I know you were doing a bit of testing before have you got any other data,? however sketchy it might help to build a bigger picture.
But that blue amps makes me think that he might have gone lower in the previous cycle, and the numbers you are seeing now are a result of a bounce.
Bouncing is something that happens when a diabetic kitties numbers drop to a level that is lower than what they have become used to, this causes the liver to 'panic' and it dumps glucose and counter regulatory hormones into the bloodstream and we see BG go up.
Bounces can last for up to 6 cycles, but sometimes they clear sooner.
So for the moment, especially as you have that blue amps in there I would hold the dose.

Have you looked at the stickies on the lantus and lev forum, we use two methods for dosing

Tight Regulation Protocol and SLGS, as Floyd is on dry I would recommend you follow SLGS, for TR Floyd would need to be solely on wet LC food.

The fluctuations in numbers you are seeing may be down to meter variance, which can be 20%, at higher BG values this can drive you crazy, let's say Floyds actual BG is 300, using the same meter and the same drop of blood that could read as 360 or 230.

As you get into lower values it has less of an impact, ie if Floyd BG was at 100 it could read as 80 or 120

Don't give up with the wet food, for some kitties it can take some time to transition them, but it is well worth it. Have you taken a look at Dr Lisa's Site, she has some great tips on transitioning dry food addicts to wet.
 
Gill & George said:
It's hard to say with so little info at the moment. I know you were doing a bit of testing before have you got any other data,? however sketchy it might help to build a bigger picture.
But that blue amps makes me think that he might have gone lower in the previous cycle, and the numbers you are seeing now are a result of a bounce.
Bouncing is something that happens when a diabetic kitties numbers drop to a level that is lower than what they have become used to, this causes the liver to 'panic' and it dumps glucose and counter regulatory hormones into the bloodstream and we see BG go up.
Bounces can last for up to 6 cycles, but sometimes they clear sooner.
So for the moment, especially as you have that blue amps in there I would hold the dose.

Have you looked at the stickies on the lantus and lev forum, we use two methods for dosing

Tight Regulation Protocol and SLGS, as Floyd is on dry I would recommend you follow SLGS, for TR Floyd would need to be solely on wet LC food.

The fluctuations in numbers you are seeing may be down to meter variance, which can be 20%, at higher BG values this can drive you crazy, let's say Floyds actual BG is 300, using the same meter and the same drop of blood that could read as 360 or 230.

As you get into lower values it has less of an impact, ie if Floyd BG was at 100 it could read as 80 or 120

Don't give up with the wet food, for some kitties it can take some time to transition them, but it is well worth it. Have you taken a look at Dr Lisa's Site, she has some great tips on transitioning dry food addicts to wet.
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So it seems as though it is very likely his liver is "panicking" and that is accounting for the huge increase in BG. I got a ReliOn Confirm today, and his BG is going up, 386 the last time I checked...

Is it a bad idea to try reducing his insulin at this point? I know we increased waaayyyy too fast, so it seems reasonable to think that we shouldn't keep giving him such a high dose, especially considering the way he is reacting.
 
Come on over to the Lantus Forum and start posting there. You'll get the most experienced people advising you there

Each day we start a new thread with the date/cats name and the AMPS number as the subject line.....as the day goes on, if you get other tests in, you just "edit" the subject line and add them.

In the body of the post put the link to the prior post (so it's easy for people to quickly go back and read what's been going on) and any questions or concerns you have, as well as just a little bit about how Floyd is doing.

Also, could you add that you're using Lantus to your signature?

Question...You have 8:00pm in your +9 cell on your spreadsheet.....not sure what you mean there

I'd go ahead and hold the 2.5 for now while you're gathering data.....if it's too much, we should know in a few cycles
 
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