New Member - 9/21/23 Barb & Molly

[Barb Cates]

I apologize for the long post, I have been trying to get Molly regulated since early August with no luck.

Molly is one of 3 cats and 2 dogs. She is 6 years old and ended up hospitalized 5 times through June and July for a total period of 3.5 weeks battling very severe pancreatitis. Her vet said she was the sickest cat with pancreatitis that he had treated in 15 years that survived. During that time she was given prednisone.

Each time I tried to wean her from the prednisone, the pancreatitis would flare up and she would end up back in the hospital. Her vet kept wanting to wait until she had been off steroids for a month before worrying about her glucose levels, which were running in the 300s. He said it was unusual for a 6 year old cat to develop diabetes.

After her last stay, I insisted we start insulin - We started insulin on August 7th. She has been off prednisone since Aug 2. He prescribed Lantus and Molly wears the Freestyle Libre 2 sensor patch and I use the reader, so I am able to get lots of BG readings. Since starting the insulin, she has had no flareups! The vet gave me a protocol to follow that is much like the slow one talked about here, but wants me to adjust dosages with every injection.

Here is my basic problem: I have enough experience now to estimate the morning dose to get Molly to the low to mid 100s during the day. By the time of the second injection, it is usually in the 200s. My real problem is that she seems to have dawn phenomena as best as I can tell. During the night, her BG inevitably rises to a very high value - typically 350+ by 1-3am. Right now her injections are not quite 12 hours apart - they are around 7am and 6pm. Her dose ranges from 1.5U to 2.25U. Experience has shown that more than that (2.5U) and her BG will drop to the 50-70 range. I had read about the somogyi effect and I am now conservative so that it wont be triggered. I havent had a very low reading (below 90) for 2 weeks.

Feeding: Molly is a rescue cat and extremely food oriented. She gobbles her food (unless dying of pancreatitis) and continuously tries to eat the other cats' food, the dogs' food and people's food. She will climb up your leg and attempt to swipe the food off your fork. I have her on the DM Savory Select cans. The other 2 cats are picky eaters, they are used to free eating and I have tried to switch them to multiple feedings per day. In an attempt to keep Molly from their food while they are eating, I feed her small morsels of canned chicken/tuna or let her lap up the "water" that I get from draining the cans.

Question 1: the vet insisted that she be fed a full meal before the twice daily insulin shot. Can I instead feed her an extra meal in the late evening (split the daily ration into 3 instead of 2)? Would that help with the high nighttime BG? Are the protein snacks causing any of this problem? I will work on adding the BG values to the spreadsheet for the members to review.

Question 2: Molly is able to remove the sensor patch in about 1 minute. In order to keep it on, she wears a onesie. This makes it difficult to get to the suggested injection sites. It is not practical to remove it to give her a shot, and I cant afford her to remove the patch prematurely so she needs to wear the onesie. Anyone dealt with this issue? I wonder if I am having trouble injecting reliably, since I am stuck with her scruff.

Any other suggestions welcome and thanks for your getting to the bottom of this post.

 

[Bron and Sheba (GA)]

Hi and welcome to the forum Barb and Molly. I am sorry Molly has been so unwell.
I don’t have time to answer all your questions at the moment as I have to rush out but I wanted to let you know we have seen your post and wanted to welcome you.
Re the food…we recommend feeding the main meal before the dose of insulin and then giving a couple of snacks during all the cycles. A snack can be 1 or 2 teaspoons of low carb food. And if she won’t eat all the main meal at once it is fine to let her eat it over the next two hours. Lantus onset is usually about 2 hours after the dose is given so just make sure she has eaten it by then.

re testing. Have you thought about hometesting yourself. That is what most of us do here. It takes about a week to get the hang of it…some people can’t do it from the first go. I’ll send you a link to see what you think. Molly won’t hate you and it is very easy once you get the hang of it. HOME TESTING.
And here is a link to HELP US HEP YOU
I will come back and talk about the dose, Somogyi and other things a bit later.
Great you have set up the spreadsheet and signature…we appreciate it!
Bron

 

[Barb Cates]

Thanks for the reply and advice about feeding. I looked at the food chart and see the vet highly recommended DM Savory Selects is actually higher carb than the canned friskies I was feeding Molly and am still feeding the other 2 cats, although lower calorie. I think I will try some of the Fancy Feast Classics since it is lower calorie and lower carbs.

By home testing, do you mean using test strips rather than the sensor patch? The sensor provides continuous 24 hour BG readings at home, but I suspect that you are alluding to it might not be terribly accurate. I have wondered that myself. In particular, when the sensor has reported levels in the 50-60 range, I did not observe ANY signs of hypoglycemia. The vet did not offer the test strip option, so I would need to learn it. I also have a problem with a broken arm which means I have to do things pretty much with one fully working arm. Doing the injections is already pretty difficult. I am not sure if I could do the strip testing, but I can watch some videos and give it a try. It would mean Molly would not have to wear the onesie and offer more injection sites.

Thanks for the response. It is frustrating trying to get the BG under control. Molly is feeling a lot better and hasnt had to be hospitalized since I started with the insulin so I know even the poor control is helping, but better control would give her a more hopeful long term. She is only six!

 

[Ale & Bobo & Minnie (GA)]

Hi and welcome!

I agree with Bron. Main meals around shot times and then smaller meals or low carb treats like freeze dried treats throughout the day. It’s easier on her already compromised pancreas and it does help avoid big sugar spikes.

I know a lot of folks do have issues keeping the libre on as some cats do manage to remove it. I’ve never used it and always home tested so I have no advice for you there other than to say you’re not alone, it just depends on how badly the cat wants it off I guess! We have also noticed the libre tends to be not as reliable with the lower numbers, which can be a problem since that’s when they’re at risk of a hypo.

Home testing can be a lot easier than you think but it’s also does depend on the cat. We do have lots of tips to make it go smoother like always giving a treat immediately after to build positive association and warming up the ear to get the blood circulation going. You don’t need a pet meter. A human meter is what most of us use and the libre is actually a human meter too.

You will also need some higher carb foods for that hypo box..information in the help us help you link.

Do you think you can transfer the data you have to the spreadsheet? And are you giving the same dose in the am and pm. Lantus is a great insulin for cats but it does tend to work better with consistency.

This is an excellent site for diabetic cats…it has been around for more than 25 years and has very experienced people to help you.

Keep asking lots of questions.

 

[Bron and Sheba (GA)]

Hi again Barb,
If you have a broken arm, it might be easier to stay with the libre until you have the arm out of plaster. As Ale said, the libre can be unreliable when the BGs drop below 100, so we always say to check the BG with a hand held mete if the BG is low.
On the other hand you could start getting Molly used to having her ears touched and giving her a treat each time you do it so she starts to associate that with treats. And pick a place to do the testing and use just that spot. If you feel you want to try testing while you have the arm in plaster…go for it.

Regarding regulation…cats can take weeks and sometimes months and longer to be regulated and some never do. But as long s you are giving the insulin, that is the main thing. It is normal for an unregulated cat to have higher preshots than during the cycles. I would not worry about dawn phenomenon at the moment. There is nothing you can do about it anyway. and there is no such thing as Somogyi in cats.
Here is a link to explanations about Somogyi.

What you are seeing with the BGs going high after dropping with the larger dose is bouncing. Here is an explanation on bouncing:

• Bouncing - 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).

Regarding the dose…it is better to stay with the same dose if you can. Lantus is a depot insulin and if you keep changing the dose every time, the depot will not be able to stabilise. I would stay with 1.5 dose for a week and let us see how that goes.

 

[Bron and Sheba (GA)]

How are things going Barb with Molly?