New Member - Day 11 and no progress

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sarp & bacaksiz

sarp & bacaksiz

Member Since 2022
Hi all,

We (I and my wife) are parents of Bacaksız, an 8-year-old Tabby cat that we adopted from the streets when he was a few months old. He had fallen down from a tree and had a long time in the vet before we had him home. So he becomes severely agitated at the vet, probably because of childhood trauma. So, during his stay with us, we always went to the vet as a last resort.

When he was 4-years-old, we noticed that he was vomiting very frequently and we took him to the vet. They kept him in the clinic for almost a week to run some tests and decided that he had liver fattening. Before this visit to the clinic, we had given him grain-free kibble and the vet said that his liver may not deal with the protein content of that food, so they advised us to switch to Brit Care Lilly hepatic kibble. For a long time we used that.

Around 5-6 months ago we changed our food again to something more basic because everything was going well. And than things started to change. First, he started to limp on this left front paw. This continued for around 10 days and we decided to take him to the vet, he caused a lot of trouble and they could not properly examine and diagnose. A few days after the visit to the vet, the limping went away and we forgot about it.

Then we noticed two more major changes. First, he was drinking water a lot more than the used to, and of course urinating a lot more. Also, he lost a lot of weight (he was previously around 8.5 kg and now he is around 4.5-5 kg). We thought this was actually good, because he needed to drink more water and lose some weight. He also was sneezing more often, maybe 5-10 times a day. We just thought that this was because he was drinking more water and his nose was in water all the time.

But one day my wife noticed that his energy was much lower than usual and he had not even been grooming himself (he was normally very clean). And we took him to the vet. They did blood tests and said parameters related to his liver, kidneys and heart are not very well and his BG is too high and he might have diabetes. So, they wanted us to bring him back the next day to measure fasting BG.

The next day we couldn't take him back because he was still very agitated because of yesterday's trip to the vet. So, the day after that we were able to take him and he was diagnosed with diabetes on March 7, 2022 after a fasting BG level measured around 350 mg/dl. The vet asked us to bring him in in the evening for a week of stay at the clinic so that they can arrange the insulin dosage. And we did so.

We were at the same time reading different internet resources and consulting a friend and former neighbor of ours Ms. Fatos, loving greetings to her if she is around here as well. We learned that long-acting insulins can be a better option for cats, with higher remission rates, but it needs careful hometesting. Our vet, on the other hand, was more inclined towards using a rapid-acting insulin, NovoRapid. So, he did the dose arragenment according to NovoRapid in 6 days and suggested us to make shots twice a day with 6 U of NovoRapid. The vet also advised us to feed him with Hill's w/d and l/d (hepatic) kibble mixture. We still do feed him with Hill's hepatic kibble but we do not give w/d because he has lost a lot of weight. We also give him boiled chicken/turkey/meat alternatingly. We did not want to leave hepatic kibble because of what the other vet had told us before about his liver not being able to handle high protein food.

We really did not want to go with such an high dosage of rapid-acting insulin, so when we took him home we started admisintring Lantus with 2 U. But it showed no good results (see the spreadsheet in my signature). The next day we increased it to 3 U, because it was as if the BG were rising instead of lowering as we gave him the shots.

This evening will be the 10th full day at home, but BG values seem to not drop to reasonable levels. He is generally very relaxed during the test and the shots, which means we do not feel that the results are altered because of stress.

We are open for any suggestions.
 
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sarp & bacaksiz said:
NovoRapid
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NovoRapid is a fast acting insulin that "last for between 3 and 5 hours." in humans and is given before meals.
https://www.diabetes.co.uk/insulin/rapid-acting-insulin.html
Cats tend to metabolize insulin about twice as fast as humans. Thus the NovaRapid would be acceptable if injected 4 times a day or so.

Your spreadsheet says you are currently on Lantus which is a good insulin. All it show is starting with 3 units. That is a high starting dose and if a dose is higher it can actually raise BG so maybe you skipped the appropriate dose. A fasting BG of 350 is not that bad. I recommend that you you decrease the Lantus dose to maybe 1 or 2 or 1 ½ units but I would wait to see what others here say.
 
Bacaksiz....can you do a phonetic pronunciation for me I can't figure out how to say that...maybe Bah-CACT-siz?


Ok now that we got that out of the way, welcome Sarp and wife and kitty. This is all pretty new to me as well, what a whirlwind I tell ya what. But the people here are literally a godsend!! I was very depressed and feeling like we were getting nowhere, no progress. I know the feeling. But with the help and guidance of the people here my boy Hendrick is doing SO much better. You're in the right place.

Great job hometesting. The key is to get a few tests each cycle (a cycle is the duration the insulin works after shot), spread out a bit so you start to develop of picture of how the insulin is working, how the food is working, and how the kittah is doing overall with the current dose. You want to get at least 1 to 2 tests in addition to the pre-shot test.

A test at about 2 hours after shot is good to get an idea of how the insulin is working today, and then another test at 4-6 hours one day, maybe 8-10 hours the next, vary the times a bit so you get more data points.

The folks here are very numbers driven, I LOVE IT. But it takes some work and dedication to get the spreadsheet populated so the picture forms. Good job so far and remember, this is a marathon not a sprint, be patient. It will take some time before you start to see good results, most likely weeks to months.
 
Welcome
If you can create your signature that would be help and then I will tag some members for you
Here is a link helping us to help you link. If you noticed, our members have some basic information about their cat's in their signature. This helps us to not pester you by asking the same questions (your cat's name, insulin type, date of diagnosis, etc.) repeatedly. We also have a link to our spreadsheet in our signature. We are very numbers driven. The spreadsheet is a record of your cat's progress. By linking it in your signature, we can follow along and provide feedback should you need the help.

Do you have the U-100 syringes with half unit markings, we adjust the dose by 0.25 units, also we do not adjust the dose by how the BG is , we adjust the dose by how low his BG is dropping during the 12 hour cycles
Can you add to your signature you live in Turkey

@Wendy&Neko

@Sienne and Gabby (GA)

@tiffmaxee

You can read all about lantus here
https://felinediabetes.com/FDMB/forums/lantus-levemir-biosimilars.9/
 
You might want to add to you title New Member, to do this you will see to the right it says Thread Tools, tap that then tap Edit Title and add New Member in front of Day 11 then hit save changes
By the way the signature is at the end of everyone post in gray letters
 
Welcome. You and your kitty deserve kudus for all you have been through. :bighug: Would you be able to set up a spreadsheet? If not we have help in minutes. @Bandit's Mom Bhooma can set you up quickly. Are you using a human or pet meter?

Please get a copy of the labs and attach here. Fatty liver is caused usually by not eating enough bad rapid weight loss. I wonder if he actually has chronic pancreatitis or there’s another reason for that.

Since lantus usually reaches nadir, low point we need to see how low it’s taking kitty. Once we see the spreadsheet (and labs) we can help.
 
Larry and Kitties said:
Your spreadsheet says you are currently on Lantus which is a good insulin. All it show is starting with 3 units. That is a high starting dose and if a dose is higher it can actually raise BG so maybe you skipped the appropriate dose. A fasting BG of 350 is not that bad. I recommend that you you decrease the Lantus dose to maybe 1 or 2 or 1 ½ units but I would wait to see what others here say.
Click to expand...

This is actually what we are afraid of. He might be bouncing I think we should increase the number of measurements.

Hendrick's mom and dad said:
Bacaksiz....can you do a phonetic pronunciation for me I can't figure out how to say that...maybe Bah-CACT-siz?
Click to expand...

Ha-ha! I added something on my signature. It is something like buh-jug-siz, i as in cousin. Thank you for your kind and encouarging words. It really helps.

Diane Tyler's Mom said:
Welcome
If you can create your signature that would be help and then I will tag some members for you
Here is a link helping us to help you link. If you noticed, our members have some basic information about their cat's in their signature. This helps us to not pester you by asking the same questions (your cat's name, insulin type, date of diagnosis, etc.) repeatedly. We also have a link to our spreadsheet in our signature. We are very numbers driven. The spreadsheet is a record of your cat's progress. By linking it in your signature, we can follow along and provide feedback should you need the help.

Do you have the U-100 syringes with half unit markings, we adjust the dose by 0.25 units, also we do not adjust the dose by how the BG is , we adjust the dose by how low his BG is dropping during the 12 hour cycles
Can you add to your signature you live in Turkey
Click to expand...

I edited my signature. Added the information and the spreadsheet. We do not have U100 syringes. We have a Lantus pen with 1 unit markings on it. I think we should get the syringes. Is it possible to use the insulin in a pen with a syringe?

Diane Tyler's Mom said:
You might want to add to you title New Member, to do this you will see to the right it says Thread Tools, tap that then tap Edit Title and add New Member in front of Day 11 then hit save changes
By the way the signature is at the end of everyone post in gray letters
Click to expand...

Did this as well.

tiffmaxee said:
Welcome. You and your kitty deserve kudus for all you have been through. :bighug: Would you be able to set up a spreadsheet? If not we have help in minutes. @Bandit's Mom Bhooma can set you up quickly. Are you using a human or pet meter?

Please get a copy of the labs and attach here. Fatty liver is caused usually by not eating enough bad rapid weight loss. I wonder if he actually has chronic pancreatitis or there’s another reason for that.

Since lantus usually reaches nadir, low point we need to see how low it’s taking kitty. Once we see the spreadsheet (and labs) we can help.
Click to expand...

We will get a second lab work to check his liver and kidney condition on Saturday at the vet. I will take all results that they have including the BG values they got with NovoRapid and both results of the blood work and put them in the spreadsheet.

Thank you all for your support and messages. I was not expecting so much attention. I don't know what to say. :joyful:
 
sarp & bacaksiz said:
I think we should get the syringes. Is it possible to use the insulin in a pen with a syringe?
Click to expand...

yes that's how we are currently dosing at my house. You just use the pen same way as you would a vial: invert, insert the syringe, draw out the dose, done. In this picture the pen is NOT inverted but obviously you would flip it to draw insulin.


syringe-in-pen-pic-jpg.45006


Did not realize you are in Turkey your command of English is excellent! Bah-jug-siz. Got it!


sarp & bacaksiz said:
Thank you all for your support and messages. I was not expecting so much attention. I don't know what to say. :joyful:
Click to expand...

that's just how we roll here! I myself got sooooooooo much help, was so lost, depressed, just drowning honestly. This place was like someone pulling me out of the water as my head was going under.

And so, I pay it forward.
 
tiffmaxee said:
Welcome. You and your kitty deserve kudus for all you have been through. :bighug: Would you be able to set up a spreadsheet? If not we have help in minutes. @Bandit's Mom Bhooma can set you up quickly. Are you using a human or pet meter?

Please get a copy of the labs and attach here. Fatty liver is caused usually by not eating enough bad rapid weight loss. I wonder if he actually has chronic pancreatitis or there’s another reason for that.

Since lantus usually reaches nadir, low point we need to see how low it’s taking kitty. Once we see the spreadsheet (and labs) we can help.
Click to expand...
Hi Elise
@sarp & bacaksiz his name is Sarp he has set up her signature and SS , his kitty is in Lantus giving 3 units. He only has the pens so only can adjust by full units , no syringes , he is from Turkey don't know where he can buy the syringes with half unit markings
I wonder if anyone knows where he can purchase them
@tiffmaxee

@sarp & bacaksiz
Hi Sarp you mentioned above the get kept him for a week and started him on NovoRapid,how many units was that?
how long was he on it, then you switched to lantus is this correct?
So you started with 2 units of lantus and then upped it to 3 units
I see you said
You will get a second lab work to check his liver and kidney condition on Saturday at the vet. I will take all results that they have including the BG values they got with NovoRapid and both results of the blood work and put them in the spreadsheet

That will be helpful Sarp
 
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This is good to know if you haven't seen this already:

"Fluctuations are very common in this phase before BGs start to stabilize under consistent dosing: a typical curve of cat over the first 1.5 months on Lantus can be seen here."

It helped me understand why Leo's number were so erratic.

Looks like you're on the right path now!
 
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tiffmaxee said:
Sarp, if you get digital calipers you won’t need syringes with half unit markings. Just get some syringes. Even without half units better to eyeball mid way on a syringe than adjust in whole units. I had to adjust in 1/8 increments. That little made a difference for Max.
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Hi Elise, looking at his SS should he reduce the dose, been at 3 units for 11 days now
@tiffmaxee
Thanks Elise
 
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Hendrick's mom and dad said:
yes that's how we are currently dosing at my house. You just use the pen same way as you would a vial: invert, insert the syringe, draw out the dose, done. In this picture the pen is NOT inverted but obviously you would flip it to draw insulin.
Click to expand...

Thank you, this was important!

Hendrick's mom and dad said:
Did not realize you are in Turkey your command of English is excellent! Bah-jug-siz. Got it!

that's just how we roll here! I myself got sooooooooo much help, was so lost, depressed, just drowning honestly. This place was like someone pulling me out of the water as my head was going under.

And so, I pay it forward.
Click to expand...

Thanks :) I hope we can also reach to a point of knowledge and experience that we feel we can be of help to others soon:bighug:

Diane Tyler's Mom said:
Hi Elise
@sarp & bacaksiz her name is Sarp she has set up her signature and SS , her kitty is in Lantus giving 3 units. She only has the pens so only can adjust by full units , no syringes , she's from Turkey don't know where she can buy the syringes with half unit markings
I wonder if anyone knows where she can purchase them
Click to expand...

I called a medicals supplier yesterday and they told me that they haven't heard of 0.3 ml insulin syringes but 0.5 ml ones can be found here in Turkey. By the way, this is not very important, but I am a he. :smuggrin:

Diane Tyler's Mom said:
@sarp & bacaksiz
Hi Sarp you mentioned above the get kept him for a week and started him on NovoRapid,how many units was that?
how long was he on it, then you switched to lantus is this correct?
So you started with 2 units of lantus and then upped it to 3 units
I see you said
You will get a second lab work to check his liver and kidney condition on Saturday at the vet. I will take all results that they have including the BG values they got with NovoRapid and both results of the blood work and put them in the spreadsheet

That will be helpful Sarp
Click to expand...

Yes, we started with 2U, took frequent blood samples and all BG readings were between 391-475 mg/dl (see Mar-12,13-22 values on the SS). So, we decided to up it to 3U. But then we started to observe even higher values. Few days ago I figured this is maybe because he started to eat better, because he had lost his apeitate before our first visit to the vet and during his stay at the clinic for insuline dosage arrangement he would also not eat very well. But when he came back, he started eating very well. I think the first fasting BG level around 350 might also not be as high due to undernutrition. The vet used around 6-8 U of NovoRapid at the clinic twice a day. I will enter the exact BG values read at the clinic on the weekend to the SS, also results of both blood works.

tiffmaxee said:
Sarp, if you get digital calipers you won’t need syringes with half unit markings. Just get some syringes. Even without half units better to eyeball mid way on a syringe than adjust in whole units. I had to adjust in 1/8 increments. That little made a difference for Max.
Click to expand...

I think we can obtain digital calipers, I would have never thought about this! Thank you.
 
By the way, yesterday evening and just recently today he urinated in two different flower pots. Yesterday evening the litter boxes were not very clean and I figured that may be the reason. But today this was not the case. This has not happenned for almost 3-4 years. Do you think this could be an indication of anything significant about his health? I feel the blood work that will be done on the weekend will be very important to see if anything is up with his unirnary system.
 
We have had members from Turkey before, who used 0.3 ml syringes, for both Levemir and Lantus. Perhaps you can buy them online? The one member I was thinking of was doing 0.25 unit changes, so definitely had the right syringes, but he was from Istanbul. Perhaps better selection there? Though you should be able to get them in Ankara too.
 
Hendrick's mom and dad said:
UTI?
Click to expand...

I hope not. I think we will see on Saturday at the vet.

Bandit's Mom said:
Or anything causing him stress?
Click to expand...

Nothing we are aware of.

Wendy&Neko said:
We have had members from Turkey before, who used 0.3 ml syringes, for both Levemir and Lantus. Perhaps you can buy them online? The one member I was thinking of was doing 0.25 unit changes, so definitely had the right syringes, but he was from Istanbul. Perhaps better selection there? Though you should be able to get them in Ankara too.
Click to expand...

I searched online but no luck. I will have a friend of mine check some stores that sell medical supplies near one of the faculties of medicine in Ankara today. If we cannot find there, I would say that it is not available in Turkey at the moment.
 
These are the ones Wendy is talking about. Our members in the UK and EU use them. Do you think you can find an online retailer in another country who can ship them to you? Not sure how expensive that would be though!
http://www.alldaypharmacy.co.uk/pro...Syringe-0.3mm-(30G)-x-8mm-%2d-Box-of-100.html

sarp & bacaksiz said:
When he was 4-years-old, we noticed that he was vomiting very frequently and we took him to the vet. They kept him in the clinic for almost a week to run some tests and decided that he had liver fattening. Before this visit to the clinic, we had given him grain-free kibble and the vet said that his liver may not deal with the protein content of that food, so they advised us to switch to Brit Care Lilly hepatic kibble. For a long time we used that.
Click to expand...
@Wendy&Neko wanted to ask you if you know about a cat with liver issues not being able to eat a low carb (high protein) diet? Bacakciz in eating Hill’s hepatic kibble which is high carb for liver issues.
 
I once fostered a fatty liver kitty back to health, never heard the story about protein levels. I would be tempted to get a second opinion.
 
I have added the two blood works (dated 3 March and 26 March) on the SS.

@Bandit's Mom, I have searched for 0.3 ml syringes, I can actually order them from Germany, and it is not too expensive.

By the way, we lowered the dose to 2U and haven't seen BG levels in the 500s range ever since. But we also do not see nadirs around 300s as before. Do you think we should keep on lowering the dose? Could this be a case of bouncing due to too much insulin? On some of the previous messages @tiffmaxee and @Diane Tyler's Mom said that we should increse, so I am confused now.
 
Stick with 2 until you get the syringes as he’s constantly high is what I suggest. I would not decrease. If anything he needs more insulin.
On your spreadsheet sheet write escaped earlier than 10 seconds. What does that mean?
 
Hi, I'm not sure why you reduced the dose from 3U to 2U? He was consistently over 300 at 3U. I would have increased to 3.5U like @tiffmaxee suggested.

The only time too much insulin can look like too little insulin is if you are not getting enough tests to see how low he is going on a dose. When there are not enough tests and lows are missed, you could only be seeing the highs from boucing from lows. That is not the case here.

I would go up to 3.5U. But I think you can't do half units till you get the syringes? Can you measure half units with the 0.5ml syringes available locally?
 
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I'm not an expert at labs but I don't see anything to worry about in the liver values. His BUN is quite high - I think that could be from dehydration if he is peeing a lot because of high sugar.
I woud try a change of diet to low carb and see how he does on that as far as his blood sugar is concerned.

Is IP phosphorus levels?
 
@tifmaxee Since we use a Lantus pen and it says to keep it in at least 10 seconds. It when he runs away before 10s.

@Bandit’s Mom with 0.5 ml syringes I can do it approximately, they do not have half unit markings.

@Bandit’s Mom and @tifmaxee I do not know what IP stands for, will ask our vet and find out.
 
sarp & bacaksiz said:
@Shiloh & Rhonda (GA) We started doing it because a friend who has experience with diabetic cats suggested it to us. But since it has created some question marks with others, we stopped doing it.
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Good. It’s not advised. When did you stop? 3/23? You need to give a little more time to see what that does to the bg. It really messes with the nadir. All the more reason to not to jump up a whole unit.
 
@tiffmaxee Yes, we last did the third shot on the 23rd.

Another question, is using the syringe any different from using a pen? With the pen we tried to shoot with a 45 degrees angle, is it also the case for using a syringe? Is there any other important parts?
 
Are you home testing him for ketones? I'm worried whenever I see a cat constantly in high numbers and someone reduces the dose.

The syringe you only have to hold in the at until you've finished pressing the plunger, so you don't have to worry about him running away early. There's been one or two people report the pen needles seen to hurt their cat more.

This post has a video how to shoot using a syringe: Testing and Shooting Tips
 
@Wendy&Neko No we do not hometest for ketones. The vet tried to collect a urine sample today to check but unfortunately he had just urinated before we left. But I am planning to buy some strips for that on Monday.
 
I have two questions if anyone is around:

1) For the PM shot I tried to increase the dose to 2.5U with a syringe but I was not succesful even though I tried twice. I would not need to force the needle of the pen to the skin so much, I would enter very easily, but the two times I tried with the syringe, I felt that I needed force it in and Bacaksiz definitely felt the needle on his skin and did not like it at all. I was wondering if there are any others here that have had same difficulty switching from the pen to the syringe. Any advice?

2) As told on the previous post, I want to test for ketones at home because we are not able to regulate his BG yet. Are there any threads on the forum about practical ways of collecting urine samples at home?
 
sarp & bacaksiz said:
I have two questions if anyone is around:

1) For the PM shot I tried to increase the dose to 2.5U with a syringe but I was not succesful even though I tried twice. I would not need to force the needle of the pen to the skin so much, I would enter very easily, but the two times I tried with the syringe, I felt that I needed force it in and Bacaksiz definitely felt the needle on his skin and did not like it at all. I was wondering if there are any others here that have had same difficulty switching from the pen to the syringe. Any advice?

2) As told on the previous post, I want to test for ketones at home because we are not able to regulate his BG yet. Are there any threads on the forum about practical ways of collecting urine samples at home?
Click to expand...

Sorry for #1, I started with the syringe from the beginning so I am not much help with a transition-to-syringe situation I'm afraid :(

for #2, I have heard that people stick a ladle under the cat while they are peeing in the litter box. Never done it myself, we bought a blood ketone meter instead (Nova Max)
 
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I tried with the bevel up, but it did not work. Then I found out that the pen needles we use are 0.23 mm wide (32 g) but the syringe needle is 0.30 mm wide (30 g). The 0.3 ml syringes I found from Germany are also 30 g, I am not sure I can administer with 30 g needles, so I think I will stick with the pen for a while, until I find a better option.
 
Sorry the syringes didn't work. Sometimes Bandit flinches when getting a shot. Maybe it's a matter of practice? With the pen you cannot make dose changes in fractions of a unit.

Also, please take him back up to 3U. He needed more insulin that 3U and not less.

ETA: This sticky has some shooting tips. Maybe you can see if there is anything there that helps?
https://www.felinediabetes.com/FDMB/threads/testing-and-shooting-tips.85113/

Have you given any though to cutting out the heptatic kibble? That could really improve his numbers.
 
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Yes dear Bhooma, we will increase the dose. I just wanted to be sure and see the nadir for a couple of days with a lower dose. Also my wife is a bit worried that different people are saying different things and is very anxious that we are doing wrong by increasing his dose because many say 3-4U is very high to start etc.

And for the last few days Bacaksız himself refuses to eat kibble as long as he has wet food available. So, we removed the kibble completely and will not rely on it for his liver health, because we also give him Hepitale Forte pills and we saw improvement in his blood work. I think the slight decrease we see with 2U insulin may also be related with him refusing to eat kibble and the previous maximums >500 we had with 3U may be due to feeding with kibble.

Also, while I was desperately searching for insuline syringes from Germany this morning, I came across a shop that sells 0.5 ml syringes with 31G needles IN TURKEY. I immediately placed an order and started anxiously waiting for the syringes to arrive. Will update about that also.
 
sarp & bacaksiz said:
Also my wife is a bit worried that different people are saying different things and is very anxious that we are doing wrong by increasing his dose because many say 3-4U is very high to start etc.
Click to expand...
I saw that you got a suggestion to lower the dose when you first posted but the only time a dose reset works is when (a) the cat has been started at too high a dose and/or (b) dose increases have been taken in whole units and (most importantly) (c) there aren't any or enough tests to see how low the cat is going on the dose. Like I said earlier, this is not the case with Bacaksız. You have gotten tests at 3U and can see that his nadirs are not below 300. That means he needs more insulin and is not bouncing from lows due to too much insulin.

Sharing the spreadsheet of a cat who has just broken into lower numbers at 5U - finally!
https://docs.google.com/spreadsheets/d/1ot_QJz3Z4zrKP3BHA5iZPzcYph7SlVOxU7zR744aV5E/edit?usp=sharing

sarp & bacaksiz said:
And for the last few days Bacaksız himself refuses to eat kibble as long as he has wet food available. So, we removed the kibble completely and will not rely on it for his liver health, because we also give him Hepitale Forte pills and we saw improvement in his blood work. I think the slight decrease we see with 2U insulin may also be related with him refusing to eat kibble and the previous maximums >500 we had with 3U may be due to feeding with kibble.
Click to expand...
That is good news! How many days has it been since he is off the kibble?

sarp & bacaksiz said:
Also, while I was desperately searching for insuline syringes from Germany this morning, I came across a shop that sells 0.5 ml syringes with 31G needles IN TURKEY. I immediately placed an order and started anxiously waiting for the syringes to arrive. Will update about that also.
Click to expand...
Excellent!
 
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