New Member/Erratic BG Curves/Suggestion for vet in Atlanta

[Marie & Kevin]

Hello everyone,

My 12.5 yo male cat was diagnosed with diabetes August 2022. Since then it has been a wild ride trying to get him under control leading to my current vet referring us to a specialist as he was still >500 all day on 2U BID of Lantus. He had a freestyle libre placed and in 2 weeks we went from 2U to 9U BID. About 4 weeks later once the freestyle was off, he was having morning vomiting after insulin and I checked a BG which was 80 so we have had another freestyle libre placed. His BG are so erratic where one morning he will be 130 but in evenings he is 350. The vet had me drop to 6U in AM when he was 140 and stay 9U in PM then we went back to 7U, 8U, 9U and this morning he is 126 again with suggestion to give 4U and go back to 9U BID tomorrow.

I am looking for a second opinion as once the freestyle is off, I cannot check a BG curve in my cat (he bites and attacks so much the vet office couldn’t even do them which is why he has the monitor). I just fear giving 9U in AM when is he 120-140 but not doing so makes him spike above 250. I feel defeated. I love my cat with my whole heart and just want him better. Any advice on good diabetes vets in the area is much appreciated.

Also, I see a lot of posts about human glucose meters. I had already bought an AlphaTrax one back in the fall for an crisis when hopefully my cat will let me test him. Will that be okay? The vet kind of chuckled that I had purchased that and karo syrup but I felt the need to be prepared for a hypo episode.

I have uploaded my spreadsheet. His sensor only has 5 more days of life and I'm feeling extremely nervous about the dose of insulin he is on without knowing his numbers before hand. Any help is appreciated

 

[Larry and Kitties]

Can you post the daily logs from the Libre data. ALso indicate the dose and time you feed and inject. Also what are you feeding?
Lantus is a depot insulin and that mean it take a few days for the effect of a dose change to be realized. If you keep changing dose like you indicate you really can't tell what a one doese does. Lantus like to use the same dose AM and PM

 

[Purrfectothecat]

Hi, My kitty is on Lantus, and based on advice here I read up on Depot-type insulin and how it works. It is a bit cumbersome to digest all of the info and can get a bit overwhelming. I am a visual person and love pictures and flowcharts. In addition to the articles and advice here, I have read up on this site which makes me understand how to interpret the Glucose curves. I am also using Libre 2 sensor to track his numbers.
see if this resource is helpful for you.
https://www.aaha.org/aaha-guideline.../resource-center/interpreting-glucose-curves/
https://www.aaha.org/aaha-guidelines/diabetes-management/diabetes-algorithms/monitoring/

 

[Diane Tyler's Mom GA]

Hello everyone,

My 12.5 yo male cat was diagnosed with diabetes August 2022. Since then it has been a wild ride trying to get him under control leading to my current vet referring us to a specialist as he was still >500 all day on 2U BID of Lantus. He had a freestyle libre placed and in 2 weeks we went from 2U to 9U BID. About 4 weeks later once the freestyle was off, he was having morning vomiting after insulin and I checked a BG which was 80 so we have had another freestyle libre placed. His BG are so erratic where one morning he will be 130 but in evenings he is 350. The vet had me drop to 6U in AM when he was 140 and stay 9U in PM then we went back to 7U, 8U, 9U and this morning he is 126 again with suggestion to give 4U and go back to 9U BID tomorrow.

I am looking for a second opinion as once the freestyle is off, I cannot check a BG curve in my cat (he bites and attacks so much the vet office couldn’t even do them which is why he has the monitor). I just fear giving 9U in AM when is he 120-140 but not doing so makes him spike above 250. I feel defeated. I love my cat with my whole heart and just want him better. Any advice on good diabetes vets in the area is much appreciated.

Also, I see a lot of posts about human glucose meters. I had already bought an AlphaTrax one back in the fall for an crisis when hopefully my cat will let me test him. Will that be okay? The vet kind of chuckled that I had purchased that and karo syrup but I felt the need to be prepared for a hypo episode.

Tagging some members for you

@tiffmaxee

@Bron and Sheba (GA)

@Suzanne & Darcy

@Sienne and Gabby (GA)

@Wendy&Neko

@Bandit's Mom

 

[Marie & Kevin]

Can you post the daily logs from the Libre data. ALso indicate the dose and time you feed and inject. Also what are you feeding?
Lantus is a depot insulin and that mean it take a few days for the effect of a dose change to be realized. If you keep changing dose like you indicate you really can't tell what a one doese does. Lantus like to use the same dose AM and PM

Thank you for responding. I'm currently working on the spreadsheet and will have it up by tomorrow AM. I am feeding Royal Canin glycobalance per my vet advice. My cat has history of urinary crystals so was on Hills c/d prior to becoming a diabetic. The glycobalance offers some protection against crystals as it has a s/o index. I agree on the rapid/quick changing but I have just been following the internal medicine vet advice. It makes me nervous because we moved so quick and they do not recommend another freestyle libre for another 1-3 months and do not encourage home checks (I have also struggled attempting myself bc my cat will attack me and I have no one to help hold him). He also charges $450 for freestyle attachments which is why I'm seeking a third vet opinion to help. Thank you again and I will get my spreadsheet up and going.

 

[Marie & Kevin]

Hi, My kitty is on Lantus, and based on advice here I read up on Depot-type insulin and how it works. It is a bit cumbersome to digest all of the info and can get a bit overwhelming. I am a visual person and love pictures and flowcharts. In addition to the articles and advice here, I have read up on this site which makes me understand how to interpret the Glucose curves. I am also using Libre 2 sensor to track his numbers.
see if this resource is helpful for you.
https://www.aaha.org/aaha-guideline.../resource-center/interpreting-glucose-curves/
https://www.aaha.org/aaha-guidelines/diabetes-management/diabetes-algorithms/monitoring/

Thank you so so much for this. Extremely helpful

 

[Larry and Kitties]

Based on your SS data it appears that 9 units is too much. It is not really possible to determine an acceptable dose since yo drastically change the do like 6 units and then 9 units. I would try 7 units AM and PM for several days unless you get a low BG which would necessitate a dose reduction. Like I said before Lantus is a depot insulin and it takes a while for the full effects of a dose change to be reflected.

 

[Larry and Kitties]

He also charges $450 for freestyle attachments which is why I'm seeking a third vet opinion to help.

You can get a script from the vet for a Libre and attach it yourself will likely need for a helper to hold the cat. A lot less expensive. This FB group has info and videos on what is need for attachment and how to attach it. Basically you need a shaver/clipper and SkinTac or similar and then just stick it on. If you watched your vet to it then you should be set. https://www.facebook.com/groups/libreforpets

 

[Sienne and Gabby (GA)]

I won't write out my reaction to what your vet is charging for attaching a Libre but suffice it to say it's highway robbery. I believe the sensor costs around $60. (You can search the cost online.)

I'm not at all clear what your vet's strategy is with respect to dosing. Lantus will typically yield weird results if doses are changed back-to-back. The insulin needs time to "settle" after a dose change. It takes roughly 3 days for this to happen. The pharmacology of glargine is such that once injected, it forms microcrystals that are deposited in the fat tissue. Most of these crystals dissolve over the course of the cycle which gives Lantus its duration. However, not all of those crystals dissolve so there is carry-over between cycles. Every time you change a dose, time is needed for the the insulin dose to stabilize. It looks like your vet's dosing strategy is not based on how Lantus work but is based on how shorter acting insulins work. Those types of insulin are pharmacologically different and you can change the dose based more on the pre-shot number. With Lantus, dosing is based on the lowest number in the cycle (i.e., the nadir).

 

[Marie & Kevin]

I won't write out my reaction to what your vet is charging for attaching a Libre but suffice it to say it's highway robbery. I believe the sensor costs around $60. (You can search the cost online.)

I'm not at all clear what your vet's strategy is with respect to dosing. Lantus will typically yield weird results if doses are changed back-to-back. The insulin needs time to "settle" after a dose change. It takes roughly 3 days for this to happen. The pharmacology of glargine is such that once injected, it forms microcrystals that are deposited in the fat tissue. Most of these crystals dissolve over the course of the cycle which gives Lantus its duration. However, not all of those crystals dissolve so there is carry-over between cycles. Every time you change a dose, time is needed for the the insulin dose to stabilize. It looks like your vet's dosing strategy is not based on how Lantus work but is based on how shorter acting insulins work. Those types of insulin are pharmacologically different and you can change the dose based more on the pre-shot number. With Lantus, dosing is based on the lowest number in the cycle (i.e., the nadir).

Thank you very much for your help. Unfortunately my primary vet who is much cheaper than the specialist is uncomfortable with the freestyle libre placement and insulin monitoring now that he is on a higher dose. I'm currently looking around for another vet who is experienced as I know its not difficult to place, but I have no one to help me and a cat who doesn't even let me brush him without attacking (he is insanely sweet otherwise).

I see you're in GA. Have you had any positive experience with vets near Atlanta?

Also, I now completely understand Lantus and how it works thanks to everyones help. Does that mean if I check the BG in AM and he is at his nadir likely from his evening dose at ~111mg/dL (using freestyle libre monitor), that I still give the full dose as long as he is eating and not vomiting? I've asked the specialist this several times and I have not received a clear response as to what I am supposed to do when he stops following in 4 days. He changes it up during the 2 weeks the monitor is on but tells me to go back to 9U/9U with no checking once the monitor is off which is very confusing and stressful for me because I'm not receiving a clear picture on how my cat is responding to his insulin.

 

[Diane Tyler's Mom GA]

I see you're in GA. Have you had any positive experience with vets near Atlanta?

The GA means gone ahead when kitties have passed, Sorry I can't help you with dosing
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.

 

[Marie & Kevin]

The GA means gone ahead when kitties have passed, Sorry I can't help you with dosing
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.

Sorry for my mistake on the abbreviation. I will get my signature updated

 

[Diane Tyler's Mom GA]

Sorry for my mistake on the abbreviation. I will get my signature updated

No problem a lot of new members make that mistake
I see on your SS you are feeding RoyalCanin Glycobalance

Hi I did a search on the forum and the members all say
(RoyalCanin Glycobalance is 14% carbs which is not a low carb food.)

Both wet and dry are too high in carbs

Are you withholding food 2 hours prior to testing AMPS and PMPS you don't want the BG to be food influenced.

Most members feed Fancy Feast Classic Pate or Friskies Pate
6% carbs or under
Here is our food chart
https://felinediabetes.com/FDMB/threads/dr-pierson-new-food-chart.174147/

I see you gave 4 units on 12-22 AM and then 9 units on 12-22 PM and 8 units this AM 12-23

I'm going to tag some members again to see if the can look at your SS and maybe suggest a dose to stay with for both cycles

Hi ladies can you please read his intro post #1. I just feel bad for him because he doesn't know what dose to stay with , his vet isn't any help at all

@tiffmaxee

@Bron and Sheba (GA)

@Suzanne & Darcy

@Wendy&Neko

@Chris & China (GA)

 

[Diane Tyler's Mom GA]

Thank you very much for your help. Unfortunately my primary vet who is much cheaper than the specialist is uncomfortable with the freestyle libre placement and insulin monitoring now that he is on a higher dose. I'm currently looking around for another vet who is experienced as I know its not difficult to place, but I have no one to help me and a cat who doesn't even let me brush him without attacking (he is insanely sweet otherwise).

I see you're in GA. Have you had any positive experience with vets near Atlanta?

Also, I now completely understand Lantus and how it works thanks to everyones help. Does that mean if I check the BG in AM and he is at his nadir likely from his evening dose at ~111mg/dL (using freestyle libre monitor), that I still give the full dose as long as he is eating and not vomiting? I've asked the specialist this several times and I have not received a clear response as to what I am supposed to do when he stops following in 4 days. He changes it up during the 2 weeks the monitor is on but tells me to go back to 9U/9U with no checking once the monitor is off which is very confusing and stressful for me because I'm not receiving a clear picture on how my cat is responding to his insulin.

@Sienne and Gabby (GA)

 

[Marie & Kevin]

No problem a lot of new members make that mistake
I see on your SS you are feeding RoyalCanin Glycobalance

Hi I did a search on the forum and the members all say
(RoyalCanin Glycobalance is 14% carbs which is not a low carb food.)

Both wet and dry are too high in carbs

Are you withholding food 2 hours prior to testing AMPS and PMPS you don't want the BG to be food influenced.

Most members feed Fancy Feast Classic Pate or Friskies Pate
6% carbs or under
Here is our food chart
https://felinediabetes.com/FDMB/threads/dr-pierson-new-food-chart.174147/

I see you gave 4 units on 12-22 AM and then 9 units on 12-22 PM and 8 units this AM 12-23

I'm going to tag some members again to see if the can look at your SS and maybe suggest a dose to stay with for both cycles

Hi ladies can you please read his intro post #1. I just feel bad for him because he doesn't know what dose to stay with , his vet isn't any help at all

@tiffmaxee

@Bron and Sheba (GA)

@Suzanne & Darcy

@Wendy&Neko

Wow that is terribly misleading that a prescription diabetic cat food isn't low carb. I will look at these options and see what may work best for Kevin. He refuses to eat wet food ever since he was a kitten. The vet also tried to get him on wet food when he was diagnosed but he would not eat.

My vet wants him eating 1c of dry food/day for goal weight of 18lb (current 19.6lbs). I was told to give 1/2 cup AMPS/PMPS, wait 15-20min to make sure he doesn't vomit then give the insulin. Kevin will not eat 1/2 cup of food at a time so instead eats 1/4 cup AMPS/PMPS and free feeds the other 1/2 cup the rest of the day. The numbers in the spreadsheet marked AMPS and PMPS is reflected ~20-30 min after eating his 1/4 cup of dry food.

I will wait for others replies on what I should do. I know the vet wants me to continue on 9AM/PM but I did reduce to 8AM/PM today. I just need something to stick with for the next 4 days while I still have the sensor but don't want to make huge changes as I will be without a monitor until I find a new vet. I could ask my current vet to place another, I don't mind paying but he seems really against it.

I hope that helps, it seems we may be doing several things wrong on our end.

 

[Chrispooky12]

Wow that is terribly misleading that a prescription diabetic cat food isn't low carb. I will look at these options and see what may work best for Kevin. He refuses to eat wet food ever since he was a kitten. The vet also tried to get him on wet food when he was diagnosed but he would not eat.

My vet wants him eating 1c of dry food/day for goal weight of 18lb (current 19.6lbs). I was told to give 1/2 cup AMPS/PMPS, wait 15-20min to make sure he doesn't vomit then give the insulin. Kevin will not eat 1/2 cup of food at a time so instead eats 1/4 cup AMPS/PMPS and free feeds the other 1/2 cup the rest of the day. The numbers in the spreadsheet marked AMPS and PMPS is reflected ~20-30 min after eating his 1/4 cup of dry food.

I will wait for others replies on what I should do. I know the vet wants me to continue on 9AM/PM but I did reduce to 8AM/PM today. I just need something to stick with for the next 4 days while I still have the sensor but don't want to make huge changes as I will be without a monitor until I find a new vet. I could ask my current vet to place another, I don't mind paying but he seems really against it.

I hope that helps, it seems we may be doing several things wrong on our end.

It sounds like you are right about finding a new vet. He's not helpful with dosing & he's having Kevin eat high carb dry food. There are 3 acceptable dry foods for diabetic cats @Diane Tyler's Mom can give you the info on them. It is best for Kevin to eat wet food maybe you could give him a tsp of wet food beside his dry food & see what he thinks. Right now with the food that you are feeding his numbers will remain high which means more insulin needed to fight off the high carbs from the food. Don't make any food changes until you are certain you will have a libre on him or you can get testing down. If you can get him on low carb dry & or low carb wet food his numbers are going to come down quickly & so will his insulin dose. Without the FDMB members helping me, my boy probably wouldn't be here right now. He immediately went from 6units to 3units once I cut out the dry food & continued to go down. Right now he has a UTI so his numbers are higher than normal for him. He's normally in good numbers under 200 & above 50 & he's a regulated diabetic kitty.

Testing him is going to be key to getting him on a lesser dose & a regulated diabetic kitty eventually. Kevin is your cat so you make decisions for him. If a different time works for you to give Kevin his shot then change it to a time that works for you, your his owner & the boss of him & his care! A libre is good to have but it sometimes shows lower numbers on there so you need to be able to test his ear for a true reading. Testing is very hard at first & stressful, I said I would never be able to test my boy, he is known as a terror at the vet. After a month of trying to test Panzer & associating treats & sometimes feeding time with it, when I tell him let's test he comes running & lays in his chewy box & let's me test him. He's not always 100% cooperative & he scratches me but we still get that # & that treat every time. We can help you with testing & dosing your kitty & getting him regulated & there's always the possibility of remission. Which we all hope for, they have helped get thousands of kitty's in remission.

Remember your in charge of Kevin your vet isn't there feeding him & giving him his shot you are.

 

[Diane Tyler's Mom GA]

There are 3 acceptable dry foods for diabetic cats @Diane Tyler's Mom can give you the info on them.

Here are some low carb dry foods ,they are about 5 or 6% carbs
None of them are cheap
You need to order them online
Dr Elseys you can buy on chewey site
https://www.chewy.com/dr-elseys-cleanprotein-chicken/dp/146269?utm_source=google-product&utm_medium=cpc&utm_campaign=12791446238&utm_content=Dr. Elsey's&utm_term=&show-search=1&gclid=EAIaIQobChMI0PvU2Zj79wIVRIdbCh3JawEkEAQYASABEgIInfD_BwE

Young again on their web site
https://www.youngagainpetfood.com
Take a look at the young again zero or the zero mature

Dr Elsey's also at Walmart
https://www.walmart.com/ip/Dr-Elsey...ViI3ICh0suwO_EAQYAiABEgJrOPD_BwE&gclsrc=aw.ds

Dr Elsey's Amazon
https://www.amazon.com/dp/B07FCJHDPR/ref=twister_B09GHFJY65?_encoding=UTF8&psc=1

the Dr Elsey's comes in different size bags
None of these can be bought in stores

Also
Wysong Epigen 90

 

[Diane Tyler's Mom GA]

@JLZ10
Can you plesse fill out your signature
click on your name up top above where it says sesrch and then tap on the word signature and add this information

• Add info we need to help you:
  • Caregiver & kitty's name
  • DX: Date
  • Name of Insulin (do not include dose or frequency)
  • Name of your meter
  • Diet: "LC wet" or "dry food" or "combo"
  • Dosing: TR or SLGS or Custom (if applicable)
  • DKA or other recent health issue (if applicable)
  • Acro, IAA, or Cushings (if applicable)
  • Spreadsheet link. Please put the signature link on the bottom line of your signature information, on its own, so it is easy to find.
  • Please do not put any information about your location in the signature for security reasons. If you wish to add your country location, please add it to your profile.

Be sure to click the 'Save Changes' button at the bottom.

 

[Diane Tyler's Mom GA]

Can someone please give some advice for this new member
Hi ladies can you please read his intro post #1. I just feel bad for this new member because he / she doesn't know what dose to stay with , his vet isn't any help at all
I realize everyone must be busy this time of year

@tiffmaxee

@Bron and Sheba (GA)

@Suzanne & Darcy

@Wendy&Neko

@Chris & China (GA)

 

[Marie & Kevin]

It sounds like you are right about finding a new vet. He's not helpful with dosing & he's having Kevin eat high carb dry food. There are 3 acceptable dry foods for diabetic cats @Diane Tyler's Mom can give you the info on them. It is best for Kevin to eat wet food maybe you could give him a tsp of wet food beside his dry food & see what he thinks. Right now with the food that you are feeding his numbers will remain high which means more insulin needed to fight off the high carbs from the food. Don't make any food changes until you are certain you will have a libre on him or you can get testing down. If you can get him on low carb dry & or low carb wet food his numbers are going to come down quickly & so will his insulin dose. Without the FDMB members helping me, my boy probably wouldn't be here right now. He immediately went from 6units to 3units once I cut out the dry food & continued to go down. Right now he has a UTI so his numbers are higher than normal for him. He's normally in good numbers under 200 & above 50 & he's a regulated diabetic kitty.

Testing him is going to be key to getting him on a lesser dose & a regulated diabetic kitty eventually. Kevin is your cat so you make decisions for him. If a different time works for you to give Kevin his shot then change it to a time that works for you, your his owner & the boss of him & his care! A libre is good to have but it sometimes shows lower numbers on there so you need to be able to test his ear for a true reading. Testing is very hard at first & stressful, I said I would never be able to test my boy, he is known as a terror at the vet. After a month of trying to test Panzer & associating treats & sometimes feeding time with it, when I tell him let's test he comes running & lays in his chewy box & let's me test him. He's not always 100% cooperative & he scratches me but we still get that # & that treat every time. We can help you with testing & dosing your kitty & getting him regulated & there's always the possibility of remission. Which we all hope for, they have helped get thousands of kitty's in remission.

Remember your in charge of Kevin your vet isn't there feeding him & giving him his shot you are.

Thank you so so much for all your advice. This group has given me hope. I spent so many nights crying and holding my cat promising him I will do whatever I need to get him better. Your story of Panzer is adorable and gives me hope.

 

[Diane Tyler's Mom GA]

@JLZ10
Thanks for adding your signature Maria , hopefully some if the members I tagged will reply back soon, Kevin is so adorable
I see in your signature that Kevin has neuropathy . You can give
Methyl B-12 for neuropathy it's tasteless ,just sprinkle it on the wet food and add water to it. Give one per day open the capsule sprinkle it on his wet food and add water and mix it up
https://www.vitacost.com/vitacost-vitamin-b-12-methylcobalamin-5000-mcg-100-capsules-6
14.49 for 100 capsules
Once you start to get Kevin's BG regulated and starting the Methyl B-12 you should start seeing an improvement
Tyler had neuropathy and he's back to walking and jumping
Took about less than 2 months, but every couple of weeks I saw improvement
I read Kevin had crystals, Tyler was recently blocked , being diabetic I wouldn't give him any of the prescription foods because of the high carbs. I now feed him this
https://www.purina.com/pro-plan/cats/wet-cat-food/urinary-tract-health-formula-beef-chicken

It's low carb . Just a suggestion . You said he will not eat wet food. Maybe you can buy the low carb dry Dr Elsey's Chicken and crumble it on top of the wet food and to get him to start eating wet and maybe down the road you will be able to take away the dry.
Keeping my fingers crossed he doesn't get blocked again
With the help from the members here Tyler has been in remission since 1-24-21

If you want to give it a go
Always aim for the sweet spot warm the ears up first, you can put rice in a sock and put it in the microwave, test it on the inside of your wrist to be sure it's not to hot, like you would test a babies bottle. You can fill a pill bottle with warm water and roll it on the ears also.Just keep rubbing the ears with your fingers to warm them up

6. As the ears get used to bleeding and grow more capilares, it gets easier to get the amount of blood you need on the first try. If he won’t stand still, you can get the blood onto a clean finger nail and test from there.
When you do get some blood you can try milking the ear.
Get you finger and gently push up toward the blood , more will appear
You will put the cotton round behind his ear in case you poke your finger, after you are done testing you will fold the cotton round over his ear to stop the bleeding , press gently for about 20 seconds until it stops
Get 26 or 28 gauge lancets
A lot of us use the lancets to test freehand not the lancing device
I find it better to see where I'm aiming
Look at the lancet under a light and you will see one side is curved upward, that's the side you want to poke with

A video one of our members posted, she is using a pet meter ,strips too expensive plus you have to code it
A human meter is just fine, most of us use human meters ,that's what our numbers are based on


VIDEO: How to test your cat's blood sugar

Here is another link you can look at
https://www.felinediabetes.com/FDMB/threads/hometesting-links-and-tips.287/

As for treats for testing
You can give any freeze dried treats they are all low carb
Tap on this blue link and read post #64 the post numbers are to the right of each post and you can read about the freeze dried treats I listed

https://felinediabetes.com/FDMB/threads/new-to-this-i-need-advice.269452/#post-3007388

You can even give plain boiled chicken pieces

We like to give a treat before testing and after so he will associate getting a treat for testing her. Try to always bring him to the same spot when you test

Even if you don't succeed at first still give him the treats

 

[Diane Tyler's Mom GA]

@Bron and Sheba (GA)
Can you please read JLZ10 intro post above and post 15 and 19 , Maria is a new member and I have been tagging members to take a look at her SS , I also noticed in her signature Kevin had DKA. Her vet has no clue
Thanks Bron

 

[Bron and Sheba (GA)]

I’m sorry I didn’t answer earlier. I didn’t get any of those tags.
First of all I am so sorry you have had such bad luck with vets. And charging so much to place a libre is outrageous.
I’m sure we can help you and Kevin.

If you are not able to do the testing yourself, I would recommend you put on another libre so you can see what the BGs are doing.
Do you think you would be able to hometest or is Kevin too difficult?
And you need to pick a time schedule that suits you, not the vet. If you want to swap to 8and 8 that is fine.

Re the food:
What you are feeding is high carb food. Would Kevin eat canned food? If not I would swap to a low carb dry food which Diane has posted about. But when you do the swap over you need to be aware that the BGs could drop up to 100 Points so please do it with us supervising and helping you.
Kevin doesn’t have to eat it all before you give the dose of insulin. It is fine to graze during the day. Just pick the food up for the 2 hours before the preshot so the BG is not food influenced.

re the dose of insulin:
As mentioned by Sienne above, Lantus likes consistent dosing not the chopping and changing that has been happening with Kevin.
Can you tell me how you have been choosing what dose to give each day?
Lantus dosing is based on the nadir or lowest point in the cycle, not the preshot.
I think that once you have been able to swap over to a low carb food, either wet or dry, and you are doing more consistent dosing , we will see a change for the better.

The vet kind of chuckled that I had purchased that and karo syrup but I felt the need to be prepared for a hypo episode.

That is disgraceful. I would get rid of that vet! Hometesting and making sure you have something in case of a hypo is not only common sense, they are two of the most important things you can do for Kevin. I would get a hypo kit properly set up in case you need it. You will find it in the link above called ‘help us help you’
I will forward to your response Marie

 

[Sienne and Gabby (GA)]

One item -- you cannot use TR if you are feeding your cat a dry food diet. TR is based on published research and the protocol specifies that the cat must be fed a low carb, canned food (or raw) diet. You will need to review the Start Low Go Slow (SLGS) method for dosing.

In addition to the foods Diane listed, you might want to see if Kevin will eat freeze or air dried raw food. Stella & Chewy's and ZiwiPeak have foods that fit in that category. There are other foods that fall in that category. Also, the feline nutrition website has an article on how to transition a dry food addict to canned food.

As for dosing.... The biggest concern that I have is that Kevin's dose was up-titrated in large increments. We raise doses in the amount of 0.25u and we give each dose time to stabilize. Your vet was raising the dose rapidly and by 1.0u. In addition, he was using a sliding scale which is inappropriate for Lantus. As a result, how you got to a 9.0u dose doesn't tell us if it's truly a good dose for your cat. The good news is you have a ton of test data so we now he was't dropping into very low numbers given the dose.

I would suggest sticking with the 8.0u dose. With SLGS, you hold the dose for a week. If you get a pre-shot number that you're not comfortable with, please post and ask for help. There are options other than skipping a shot or drastically reducing the dose. We'll help (although it's a holiday weekend and people may not be actively on the the Board).

I also want to make another suggestion. If the dose Kevin is getting is a good dose, he needs to get some additional blood tests run. He's getting a high dose of insulin. There are two conditions that can require a high dose -- acromegaly and insulin resistance (i.e., insulin auto-antibodies). These lab tests are only done at Michigan State University at their vet lab. Given what your vet charges for putting on a Libre sensor, I would cringe at how the charges for sending out labs might be inflated. (MSU does have their costs online but vets typically pass along costs for the drawing the blood and shipping.) @Wendy&Neko may be along after the holidays and will be able to offer some advice about high dose cats.

 

[Marie & Kevin]

@JLZ10
Thanks for adding your signature Maria , hopefully some if the members I tagged will reply back soon, Kevin is so adorable
I see in your signature that Kevin has neuropathy . You can give
Methyl B-12 for neuropathy it's tasteless ,just sprinkle it on the wet food and add water to it. Give one per day open the capsule sprinkle it on his wet food and add water and mix it up
https://www.vitacost.com/vitacost-vitamin-b-12-methylcobalamin-5000-mcg-100-capsules-6
14.49 for 100 capsules
Once you start to get Kevin's BG regulated and starting the Methyl B-12 you should start seeing an improvement
Tyler had neuropathy and he's back to walking and jumping
Took about less than 2 months, but every couple of weeks I saw improvement
I read Kevin had crystals, Tyler was recently blocked , being diabetic I wouldn't give him any of the prescription foods because of the high carbs. I now feed him this
https://www.purina.com/pro-plan/cats/wet-cat-food/urinary-tract-health-formula-beef-chicken

It's low carb . Just a suggestion . You said he will not eat wet food. Maybe you can buy the low carb dry Dr Elsey's Chicken and crumble it on top of the wet food and to get him to start eating wet and maybe down the road you will be able to take away the dry.
Keeping my fingers crossed he doesn't get blocked again
With the help from the members here Tyler has been in remission since 1-24-21

If you want to give it a go
Always aim for the sweet spot warm the ears up first, you can put rice in a sock and put it in the microwave, test it on the inside of your wrist to be sure it's not to hot, like you would test a babies bottle. You can fill a pill bottle with warm water and roll it on the ears also.Just keep rubbing the ears with your fingers to warm them up

6. As the ears get used to bleeding and grow more capilares, it gets easier to get the amount of blood you need on the first try. If he won’t stand still, you can get the blood onto a clean finger nail and test from there.
When you do get some blood you can try milking the ear.
Get you finger and gently push up toward the blood , more will appear
You will put the cotton round behind his ear in case you poke your finger, after you are done testing you will fold the cotton round over his ear to stop the bleeding , press gently for about 20 seconds until it stops
Get 26 or 28 gauge lancets
A lot of us use the lancets to test freehand not the lancing device
I find it better to see where I'm aiming
Look at the lancet under a light and you will see one side is curved upward, that's the side you want to poke with

A video one of our members posted, she is using a pet meter ,strips too expensive plus you have to code it
A human meter is just fine, most of us use human meters ,that's what our numbers are based on


VIDEO: How to test your cat's blood sugar

Here is another link you can look at
https://www.felinediabetes.com/FDMB/threads/hometesting-links-and-tips.287/

As for treats for testing
You can give any freeze dried treats they are all low carb
Tap on this blue link and read post #64 the post numbers are to the right of each post and you can read about the freeze dried treats I listed

https://felinediabetes.com/FDMB/threads/new-to-this-i-need-advice.269452/#post-3007388

You can even give plain boiled chicken pieces

We like to give a treat before testing and after so he will associate getting a treat for testing her. Try to always bring him to the same spot when you test

Even if you don't succeed at first still give him the treats

Thank you for the link to the B-12 supplement. I had asked my vet about it after I read a journal on it and he wasn't aware of its use so didn't want to prescribe it. I will definitely buy it. The crystals have always worried myself and my vets throughout the years but I certainly want him on a low carb diet especially since with his neuropathy he has stopped wanting to move around (I have placed yoga mats covering my hard wood as he was slipping) and now is prone to weight gain. I plan to change his diet fully once I have a new libre placed.

And thank you for the link about testing above. Everything I had read and seen mentioned targeting the marginal vein so that is what I was doing and often I wouldn't get any blood so I would end up having to stick Kevin 5-6 times before I had blood and by that time he was extremely upset. Kevin does love freeze dried treats, especially shrimp so I can buy that for him as well. Thank you for your help

 

[Marie & Kevin]

I’m sorry I didn’t answer earlier. I didn’t get any of those tags.
First of all I am so sorry you have had such bad luck with vets. And charging so much to place a libre is outrageous.
I’m sure we can help you and Kevin.

If you are not able to do the testing yourself, I would recommend you put on another libre so you can see what the BGs are doing.
Do you think you would be able to hometest or is Kevin too difficult?
And you need to pick a time schedule that suits you, not the vet. If you want to swap to 8and 8 that is fine.

Re the food:
What you are feeding is high carb food. Would Kevin eat canned food? If not I would swap to a low carb dry food which Diane has posted about. But when you do the swap over you need to be aware that the BGs could drop up to 100 Points so please do it with us supervising and helping you.
Kevin doesn’t have to eat it all before you give the dose of insulin. It is fine to graze during the day. Just pick the food up for the 2 hours before the preshot so the BG is not food influenced.

re the dose of insulin:
As mentioned by Sienne above, Lantus likes consistent dosing not the chopped and changing that has been happening with Kevin.
Can you tell me how you have been choosing what dose to give each day?
Lantus dosing is based on the nadir or lowest point in the cycle, not the preshot.
I think that once you have been able to swap over to a low carb food, either wet or dry, and you are doing more consistent dosing , we will see a change for the better.


That is disgraceful. I would get rid of that vet! Hometesting and making sure you have something in case of a hypo is not only common sense, they are two of the most important things you can do for Kevin. I would get a hypo kit properly set up in case you need it. You will find it in the link above called ‘help us help you’
I will forward to your response Marie

No need to apologize. I am just happy I have finally found the support Kevin and I need. I think I would need another libre placed to do a 24h curve with dose adjustments but once he is stable and I'm not testing hourly, I believe I may be able to get comfortable and Kevin comfortable with it after reading so many success posts. Once a cat is stable, how often do people test? Is it every 12 hrs or 8 hrs or even less? My current job allows some flexibility but on days I have to travel, I often don't get back home for 5-8 hours. I will be transitioning back into the hospital with 12 hour shifts in ~3-4 months which will complicate things, but I hope he is more stable then. That is the biggest convenience of the freestyle is that I can still get 24h of data as long as he is scanned in 8 hours.

I am going to attempt to change Kevin to wet food using Diane's suggestions above and once I have a freestyle libre on for continuous monitoring with diet change. So with food/insulin timing, I take away the food 2 hours before checking his preshot glucose, am I okay to then feed him immediately after giving the insulin?

I made the insulin changes per my vet advice based upon the daily data he looks at. It has definitely lead to Kevin being all over the place and is very difficult to find his nadir right now. I made the decision to just go down to 8U AM/PM starting 12/23 as I had 5 days left of life on the freestyle libre and felt I needed to pick a dose and stick with it. Kevin did find on the 9U AM/PM from 11/20 until 12/10 when he had the 2 vomiting episodes during which I was able to collect a BG using my AlphaTrax meter around 2 hours after he threw up his entire breakfast and his glucose was 84. He was shaking and I was traumatized but we got through it so I feel the 9U may have been a touch too high as I know 84 is still in the desired range.

I am stalling a little this morning because his current glucose is 176 and I haven't given the 8U of insulin yet. I think it is probably best that I keep it stable at 8U for reasons above but he seems to drop to his nadir from his evening dose between 7-10AM (he did this on 12/14, 12/15, 12/17, 12/18 on spreadsheet) and this makes me nervous.

He was 176 at 8:47AM and now 159 at 9:23AM

 

[Marie & Kevin]

One item -- you cannot use TR if you are feeding your cat a dry food diet. TR is based on published research and the protocol specifies that the cat must be fed a low carb, canned food (or raw) diet. You will need to review the Start Low Go Slow (SLGS) method for dosing.

In addition to the foods Diane listed, you might want to see if Kevin will eat freeze or air dried raw food. Stella & Chewy's and ZiwiPeak have foods that fit in that category. There are other foods that fall in that category. Also, the feline nutrition website has an article on how to transition a dry food addict to canned food.

As for dosing.... The biggest concern that I have is that Kevin's dose was up-titrated in large increments. We raise doses in the amount of 0.25u and we give each dose time to stabilize. Your vet was raising the dose rapidly and by 1.0u. In addition, he was using a sliding scale which is inappropriate for Lantus. As a result, how you got to a 9.0u dose doesn't tell us if it's truly a good dose for your cat. The good news is you have a ton of test data so we now he was't dropping into very low numbers given the dose.

I would suggest sticking with the 8.0u dose. With SLGS, you hold the dose for a week. If you get a pre-shot number that you're not comfortable with, please post and ask for help. There are options other than skipping a shot or drastically reducing the dose. We'll help (although it's a holiday weekend and people may not be actively on the the Board).

I also want to make another suggestion. If the dose Kevin is getting is a good dose, he needs to get some additional blood tests run. He's getting a high dose of insulin. There are two conditions that can require a high dose -- acromegaly and insulin resistance (i.e., insulin auto-antibodies). These lab tests are only done at Michigan State University at their vet lab. Given what your vet charges for putting on a Libre sensor, I would cringe at how the charges for sending out labs might be inflated. (MSU does have their costs online but vets typically pass along costs for the drawing the blood and shipping.) @Wendy&Neko may be along after the holidays and will be able to offer some advice about high dose cats.

Thank you for all your help. I posted to Bron and Sheba (GA) that currently I am stalling a little this morning because his current glucose is 176 and I haven't given the 8U of insulin yet. I think it is probably best that I keep it stable at 8U for reasons above but he seems to drop to his nadir from his evening dose between 7-10AM (he did this on 12/14, 12/15, 12/17, 12/18 on spreadsheet) and this makes me nervous. I keep trying to tell myself that it is a long acting insulin and I need the data and he was doing okay on 9U prior from 11/20 - 12/14 but I am not sure what to do.

I asked both my vets atleast 4 times about ruling out acromegaly or insulin resistance but my primary has glazed over the question and the specialist said Kevin is just a diabetic and he has plenty of cats who need 10U of insulin and he sees it all the time. Since he told my primary vet that, he no longer wanted to test for it as he is relying on the specialist for help. Once I can get into another office, I am hoping I find a vet willing to test for those things as I don't understand the reason behind not wanting to test.

He was 176 at 8:47AM and now 159 at 9:23AM

 

[Diane Tyler's Mom GA]

From the SLGS sticky
Hold the dose for at least a week:

• Unless your cat won’t eat or you suspect hypoglycemia
• Unless your kitty falls below 90 mg/dL (5 mmol/L). If kitty falls below 90 mg/dL (5 mmol/L) decrease the dose by 0.25 unit immediately.

After 1 week at a given dose perform a 12 hour curve, testing every 2 hours OR perform an 18 hour curve, testing every 3 hours. Note: Random spot checks are often helpful to "fill in the blanks" on kitty's spreadsheet. The goal is to learn how low the current dose is dropping kitty prior to making dose adjustments.

• If nadirs are more than 150 mg/dl (8.3 mmol/L), increase the dose by 0.25 unit
• If nadirs are between 90 (5 mmol/L) and 149 mg/dl (8.2 mmol/L), maintain the same dose
• If nadirs are below 90 mg/dl (5mmol/L), decrease the dose by 0.25 unit

 

[Diane Tyler's Mom GA]

Once a cat is stable, how often do people test? Is it every 12 hrs or 8 hrs or even less? My current job allows some flexibility but on days I have to travel, I often don't get back home for 5-8 hours.

From the lantus sticky
Initially, blood glucose levels should at least be checked at pre-shot, +3, +6, and +9. More monitoring may be needed.
Hopefully once you have to go back to working your 12 hour shifts he will be more stable , plus you can buy an auto feeder and set it to open at certain times

 

[Diane Tyler's Mom GA]

So with food/insulin timing, I take away the food 2 hours before checking his preshot glucose, am I okay to then feed him immediately after giving the insulin?

Yes

 

[Diane Tyler's Mom GA]

Since you have a lot of info on your spreadsheet I would start posting on the Lantus board every day a lot more lantus users there
You can introduce yourself first time posting on the lantus board
Tap on the blue link
https://www.felinediabetes.com/FDMB/forums/lantus-levemir-biosimilars.9/
Look to the right , you will see Post New Thread tap on it
Then put the Date first, then Kevin then his AMPS # and tap post
To add more tests after that for EXAMPLE 100 +2. Don't give us times
and additional tests after that , You can continue with PMPS # then and additional tests after that

Now to go back to add those tests look to the right you will see the word Thread Tools, tap it then tap Edit Title and add all your tests then tap Save.

We do a new post everyday on the Lantus Board and we also link the previous post ( your post )to the new one ,
I'll try to explain how to do it

The best that I can explain how to do it is to look up top where that picture is of that cat on the left hand side , above it will be this post in that long line where it says
https://felinediabetes.com/FDMB/threads/new-member
This is your thread you would link to tomorrow's post if you decide to post on the Lantus Board tomorrow
You copy it and then paste it on your new post tomorrow where you would begin to write something
Also write it's your first time posting on the Lantus Board

 

[Marie & Kevin]

From the SLGS sticky
Hold the dose for at least a week:

• Unless your cat won’t eat or you suspect hypoglycemia
• Unless your kitty falls below 90 mg/dL (5 mmol/L). If kitty falls below 90 mg/dL (5 mmol/L) decrease the dose by 0.25 unit immediately.

After 1 week at a given dose perform a 12 hour curve, testing every 2 hours OR perform an 18 hour curve, testing every 3 hours. Note: Random spot checks are often helpful to "fill in the blanks" on kitty's spreadsheet. The goal is to learn how low the current dose is dropping kitty prior to making dose adjustments.

• If nadirs are more than 150 mg/dl (8.3 mmol/L), increase the dose by 0.25 unit
• If nadirs are between 90 (5 mmol/L) and 149 mg/dl (8.2 mmol/L), maintain the same dose
• If nadirs are below 90 mg/dl (5mmol/L), decrease the dose by 0.25 unit

Thank you. That's very helpful to know I adjust mainly on nadirs / symptoms. I will post some of my other questions/concerns in the Lantus forum

 

[Sienne and Gabby (GA)]

Many vets retain the quite dated notion that acromegaly is a rare condition. @Wendy&Neko is our resident "expert" and has read extensively on the subject. If I'm not mistaken, about 1 in 4 diabetic cats are diagnosed with acromegaly. In my book, that's not rare. (That's from data published in 2014.) We've seen any number of vets give caregivers a hard time on this point. Usually, the "humor me" approach works. After all, you're paying for the test and more importantly, it's your cat.

I've been a member of his board for a long time -- since 2009. We encourage members to get their cats tested once the dose falls in in the 5 - 6u range. More often than not, we find the cat meets diagnostic criteria for either acromegaly, insulin auto-antibodies, or both. There are treatments for both conditions. At the very least, it is reassuring for the caregiver that their cat needs the amount of insulin that's being dosed. If you look at other members' spreadsheets, you'll see there's variability in the doses but there are not a great deal of cats who are getting large doses. Personally, I dislike when vets do not give an explanation for their decision making. I tend to think in terms of what would the vet do if he was getting the same answer about his/her child? Would they accept a "trust me, I'm the doctor" as an explanation. I suspect not.

 

[Diane Tyler's Mom GA]

Thank you. That's very helpful to know I adjust mainly on nadirs / symptoms. I will post some of my other questions/concerns in the Lantus forum

You can start posting on the lantus board starting tomorrow morning

 

[Marie & Kevin]

Many vets retain the quite dated notion that acromegaly is a rare condition. @Wendy&Neko is our resident "expert" and has read extensively on the subject. If I'm not mistaken, about 1 in 4 diabetic cats are diagnosed with acromegaly. In my book, that's not rare. (That's from data published in 2014.) We've seen any number of vets give caregivers a hard time on this point. Usually, the "humor me" approach works. After all, you're paying for the test and more importantly, it's your cat.

I've been a member of his board for a long time -- since 2009. We encourage members to get their cats tested once the dose falls in in the 5 - 6u range. More often than not, we find the cat meets diagnostic criteria for either acromegaly, insulin auto-antibodies, or both. There are treatments for both conditions. At the very least, it is reassuring for the caregiver that their cat needs the amount of insulin that's being dosed. If you look at other members' spreadsheets, you'll see there's variability in the doses but there are not a great deal of cats who are getting large doses. Personally, I dislike when vets do not give an explanation for their decision making. I tend to think in terms of what would the vet do if he was getting the same answer about his/her child? Would they accept a "trust me, I'm the doctor" as an explanation. I suspect not.

I agree, it is odd for them to deny me of a test that in the end I will be paying them to perform. I've read the exact same thing about insulin >5-6u in several diabetes journals as I'm sure you have seen as well. It will definitely be something I will fight for my cat to have testing for. Thank you

 

[Wendy&Neko]

Once I can get into another office, I am hoping I find a vet willing to test for those things as I don't understand the reason behind not wanting to test.

That sounds familiar. Vets of a certain age (like mine was at the time), were taught in school - "this is acromegaly, you'll never see it". Recent research, published in 2015, shows that in fact, one in four diabetic cats has acromegaly. Which is a benign pituitary tumour putting out excess growth hormone. Anyway, back to my vet and experience. After repeatedly asking my vet, I asked her to please humour me to get the tests done. The clinic owner, who I'd also seen for years, called them "exotic tests". My vet also talked to a local IM vet who said you don't need to test for acromegaly until the dose gets to 10 units. By the way, that 2015 paper found some cats with acromegaly on a 1 unit dose, though the average was 7 units. Neko maxed out at 8.75 units so never got to 10. Eventually, I convinced/pleaded enough that the vet ran the tests. When both came back positive, I gained a lot of respect from both the vet and clinic owner vet. A little while later, my vet figured out a second cat in her care also had acromegaly. If your vet responds to research papers, the one linked in this post might help, see post #7.

Regarding crystals, a more modern take on diet is on this food page. https://catinfo.org/feline-urinary-tract-diseases/ My second kitty was diagnosed with cystitis just after Neko's diabetes dx, his vet suggested the urinary food, but Neko kept stealing it. One food for both was the solution. Turns out the lower carb with lower phosphorus and plenty of water added was what worked for both cats.

 

[Marie & Kevin]

That sounds familiar. Vets of a certain age (like mine was at the time), were taught in school - "this is acromegaly, you'll never see it". Recent research, published in 2015, shows that in fact, one in four diabetic cats has acromegaly. Which is a benign pituitary tumour putting out excess growth hormone. Anyway, back to my vet and experience. After repeatedly asking my vet, I asked her to please humour me to get the tests done. The clinic owner, who I'd also seen for years, called them "exotic tests". My vet also talked to a local IM vet who said you don't need to test for acromegaly until the dose gets to 10 units. By the way, that 2015 paper found some cats with acromegaly on a 1 unit dose, though the average was 7 units. Neko maxed out at 8.75 units so never got to 10. Eventually, I convinced/pleaded enough that the vet ran the tests. When both came back positive, I gained a lot of respect from both the vet and clinic owner vet. A little while later, my vet figured out a second cat in her care also had acromegaly. If your vet responds to research papers, the one linked in this post might help, see post #7.

Regarding crystals, a more modern take on diet is on this food page. https://catinfo.org/feline-urinary-tract-diseases/ My second kitty was diagnosed with cystitis just after Neko's diabetes dx, his vet suggested the urinary food, but Neko kept stealing it. One food for both was the solution. Turns out the lower carb with lower phosphorus and plenty of water added was what worked for both cats.

Thank you for all this information. This forum has really empowered me with everything I need to get hope back that my cat can live a normal life.