New member Intro - TipTip

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Purrfectothecat

Purrfectothecat

Member Since 2022
Hi All,
My name is Roopa and my diabetic kitty's name is TipTip. I joined this group today and wanted to introduce myself and my kitty who is diabetic.

I work full-time as an IT Project manager. I also have been doing animal rescues, rehab, and rehoming for over 24 years both here in the US and abroad. I volunteer at a local animal shelter(a non-profit no-kill shelter).
I have a knack for handling difficult cats and I typically adopt cats that are hard to manage or have medical needs and are not easily adoptable. I also do TNR, foster, etc., thru the shelter I volunteer at.

I had a 14.5 yrs cat Tabby that passed away in Sep 2020 due to aggressive GI cancer. I had a 14 yr old Calico Manx cat Mya that passed away in April 2022 due to kidney disease. She had Laryngeal Paralysis for over 10 yrs. I have another calico Riya who is asthmatic and has a birth defect in the eye. A 12 yr old boy Sylvester with idiopathic epilepsy that is in remission, a history of cystitis, and Resorptive lesions in the mouth. A 6.5yrs old girl Onyx (Anna) has severe skin allergies of unknown origin.
Additionally, I have TipTip my permanent foster boy from the shelter. He has been living with me for over 11 years in the hopes of getting adopted but a host of medical issues made him less desirable for potential adopters.
He is the one I am trying to help with assistance from you all. TipTip (in the profile pic) is a 14+yrs old boy that has an ulcerated eye, collapsible knee, no teeth, Asthma, and Diabetes. He had to get surgery done for corneal sequestration a few yrs back. He is an amazing kitty that loves me and will sit down for his shots. When the time comes for his shot, even if I am a min late, he will come and call me with his paw to remind me. He has never once hissed, or attacked me in the 2036 days he had to get his shots twice a day. He gets Lantus ( we started with 1u and now we are at 10u twice a day).
He was put on DM food but that with Insulin did not seem to help regulate his condition as proven by the increased number of units he is on over the years. I am a meticulous person with close attention to detail. I am quite organized and I have been closely following vet instructions and was under the impression his diabetes was being managed. I came across the Young again pet food and I have transitioned all of them to that along with the usual Fancy Feast Liver and Chicken Pate wet food. Except for my Diabetic kitty, I only feed the remaining kitties 4 times a day ( 2 times wet food) and 2 times dry(1/8th cup). Free feeding is not an option as one of my kitties loves to eat and the other with Resorptive lesions loses out as he eats very slowly. So, it helped one of them get chunky while the other was skinny and underweight. For TipTip, I free-fed DM food until last week. I transitioned him on 12/12/2022 to Young again LID zero mature dry and Fancy feast Chicked and Live Pate Wet food. He gets at least 6 oz of wet food a day and 1/3 cup of YA dry.
I have him on Sensor Libre 2.
They all have access to 3 stainless steel Fountains with fresh water at all times. They all drink good amounts of water.

My goal: Is to learn how to better manage his diabetes so that he can get the low-carb high protein with sufficient water in his diet so that we can either go down in units of insulin he requires (as 10 is high) or the loftiest and most ambitious goal is to get him to remission. I hope you all can help me get there. Thank you in advance. I have updated my signature with his spreadsheet as instructed.
 
Welcome to FDMB. And thank you for all of the dedicated work you do with all of the kitties!

Thanks as well for getting a spreadsheet set up. I'm linking a post on helping us to help you that contains additional useful information especially about what to include in your signature, setting up a hypo kit, etc.

If you were feeding TipTip DM dry food, it is quite high in carbohydrates. The canned food is in the lower carb range but the quality of the food is poor for what it costs. Good job on figuring out the food issue.

It's likely that we approach dosing differently than your vet -- at least from what's on your spreadsheet. I'm linking a post on Lantus dosing methods. Because your cat has dry food in his diet, you're constrained to using the Start Low Go Slow (SLGS) approach to dosing. Looking at your spreadsheet (SS), I'm not sure why you raised TipTip's dose. You were seeing nadirs that were in a very good range. In fact, with SLGS, you reduce the dose by 0.25u when numbers drop below 90. We also make dose adjustments in much smaller increments that it looks like you're used to. The majority of the time, doses are increase or decreased by 0.25u. It is entirely possible to go past what is a good dose by increasing by too large of an amount. Since a 5.0u dose was bringing your cat's numbers as low as 55, I'm concerned over what doubling the dose will do. 10.0u is a very large dose. It would be a different issue if the dose had been systematically increased. A jump from 5u to 8u and then 10u all within the space of 3 days has me holding my breath. Please monitor your cat's blood glucose carefully and if this were my cat, I'd be dropping the dose back to 5.0u and we can help with titrating up if necessary.
 
Sienne and Gabby (GA) said:
Welcome to FDMB. And thank you for all of the dedicated work you do with all of the kitties!

Thanks as well for getting a spreadsheet set up. I'm linking a post on helping us to help you that contains additional useful information especially about what to include in your signature, setting up a hypo kit, etc.

If you were feeding TipTip DM dry food, it is quite high in carbohydrates. The canned food is in the lower carb range but the quality of the food is poor for what it costs. Good job on figuring out the food issue.

It's likely that we approach dosing differently than your vet -- at least from what's on your spreadsheet. I'm linking a post on Lantus dosing methods. Because your cat has dry food in his diet, you're constrained to using the Start Low Go Slow (SLGS) approach to dosing. Looking at your spreadsheet (SS), I'm not sure why you raised TipTip's dose. You were seeing nadirs that were in a very good range. In fact, with SLGS, you reduce the dose by 0.25u when numbers drop below 90. We also make dose adjustments in much smaller increments that it looks like you're used to. The majority of the time, doses are increase or decreased by 0.25u. It is entirely possible to go past what is a good dose by increasing by too large of an amount. Since a 5.0u dose was bringing your cat's numbers as low as 55, I'm concerned over what doubling the dose will do. 10.0u is a very large dose. It would be a different issue if the dose had been systematically increased. A jump from 5u to 8u and then 10u all within the space of 3 days has me holding my breath. Please monitor your cat's blood glucose carefully and if this were my cat, I'd be dropping the dose back to 5.0u and we can help with titrating up if necessary.
Click to expand...
Thank you, Sienne. I will review this linked documentation. TipTip has been on 10 units twice a day for over 7 months. I consulted my vet who suggested I can half dose him if I feel the numbers are low (i.e. if I feel concerned that he can become hypo). So, my guideline from the vet was to keep doing 10 units for anything above 350, 300-350 to do 8u, if his numbers look between 100 and 200 do a half dose. If anything less than 100 skip it. Hence, the changes are based on the numbers I received while testing. Can you please help me understand what you mean by "You were seeing nadirs that were in a very good range"? I would not consider 12/12 numbers as he received 10 units until that morning consistently for over 7 months.
 
Hi and welcome to the forum.
I agree with Sienne
Lantus dosing is based on the nadir, or lowest point in the cycle, not the preshot BGs. The pre shot BGs are important to see that is safe to give the dose only. A sliding scale was used for the older in and out insulins but is not suitable for depot insulins.
Lantus insulin also likes consistent dosing because it is a depot insulin and chopping and changing the dose will mess up the depot.
DEPOT

Another thing to keep in mind is that cats can bounce from lower numbers back into higher numbers and this can make you think he needs more insulin when in fact if he dropped under 90, or 50, depending what dosing method you are using, he might need less.
From the yellow stickies The Basics:
  • 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).
 
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Thank you both. I dosed him 5u last night, even though I wanted to hold off. You can take a look at his numbers. I was anxious all night. But he has been doing well for now. I will continue the 5u and titer up as needed as you both have suggested. Appreciate all the info (although half of it was way above my intelligence), it was very helpful to understand how Lantus works and how to focus on the NADIR and pay only limited attention to PS numbers. Thanks!
 
I was confused by the dose changes on your spreadsheet.

As Bron noted, Lantus differs from most other types of insulin that are shorter acting. Making back-to-back changes in dose can yield less than consistent numbers. Lantus is considered a "depot" insulin. What this means is the when you give a shot, Lantus forms microcrystals that are deposited in the fat tissue. These crystals mostly dissolve over the 12-hour cycle. However, a small amount sticks around beyond 12 hours. This is what gives Lantus its long duration. It also means that when you change doses, it can take several cycles (3 days/6 cycles in some cases) for the dose to stabilize.

Please let us know if you have questions. We'll help to decipher the information!
 
Hi @Sienne and Gabby (GA) and @Bron and Sheba (GA) , Can you please have a look at Tippu's numbers and let me know how you think he is doing? And also looking at the comments column can you please confirm/clarify if I am interpreting the NADIRs correctly? Tippu gets his shots at 9:30 AM and 9:30 PM. Thanks for your insight and help.
 
As Bron noted in her post #2
Thanks as well for getting a spreadsheet set up. I'm linking a post onhelping us to help you that contains additional useful information especially about what to include in your signature, setting up a hypo kit, etc.
The signature is at the end of everyone's post in gray
If you can add that it would be helpful so members don't have to keep asking you questions
I see you are following SLGS because he is still eating some dry food
The SLGS Methods days
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 unitimmediately.

On 12-18 and 12-19 he dropped below 90 a few times, so I think you should have reduced the dose. Let's see what
@Bron and Sheba (GA)

@Sienne and Gabby (GA)

@tiffmaxee

@Bandit's Mom
Has to say about if you should reduce to 4.75 units
Bron probably will be on later she lives in Australia so it's around 4:30 AM there now
 
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Hi and welcome to the group! I also want to both welcome you and thank you for all you do for kitties in need. You are a hero, we need more people like you in this world! I'm not one of the experts like Sienne, Bron or Diane but they helped me and my kitty so much....you're in good hands with this group here at the FDMB. Love the picture of TipTip! What a cutie!!
 
It is possible he is bouncing from the lower numbers but if he doesn’t show any greens in the pm cycle tonight I would increase the dose tomorrow to 5.25 units. You will then need to hold the dose for 7 days.
Are you still feeding him any dry food? If not you could swap to tight regulation and do any increases more quickly.
Are you testing the urine for ketones? If not I would recommend doing it while he is u regulated. You will need a bottle of Ketostix from Walmart or a pharmacy if you don’t already have some.
 
I think you're interpreting where the nadir is falling. However, nadirs can and do move around as you've noticed. Generally, when people refer to the nadir, they tend to think of where it falls the majority of the time. My cat typically had an early nadir -- around +3 -- except for those times when it wasn't. (Cats hate to be predictable.)

I agree with what Bron noted. If a cat is bouncing, it can take 3 days/6 cycles for the bounce to clear
 
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