New member, Is anyone using Toujeo?

Yuko

Member Since 2026
I just registered today. I posted on another board but nobody using Toujeo there.
It has been nearly four years since my cat developed diabetes, yet his blood glucose levels have never once stabilized.
To begin with, the first veterinarian I consulted was not knowledgeable about feline diabetes cats, and I regret that he did not receive proper treatment.
During that time, he suffered an episode of ketoacidosis and nearly died.
That vet tried many types of insulin (insulin intended for dogs first) but simply increased the dosage whenever blood glucose levels were high.
Eventually, he was administering 6 units of Levemir.
After researching and gathering information, and through my own trial, I managed to reduce the dose to 3 units, though he still experienced sudden spikes or drops in blood sugar.
Later, I moved to the U.S. and could no longer obtain Levemir, so I switched to Lantus under a vet's instructions while his levels stabilized in the 200–300 range for one month on 3 units, then became erratic again afterward, ultimately leading to a second episode of ketoacidosis.
He was admitted to the ICU and treated by an internal medicine specialist focusing on diabetes, but even after extensive testing, they could not pinpoint why his blood glucose levels would not stabilize.
We decided to try a newer insulin, Toujeo, and have been using it for five months now.
Even though, his blood glucose levels remain unstable, some days they are in the 100–200 range, other days in the 300–400 range, and there are days when he experiences sudden hyperglycemia or hypoglycemia.
In addition to diabetes, my cat has hyperthyroidism and has undergone tooth extraction surgeries due to tooth resorption, leaving him with only his upper right back teeth and canines.
He has also suffered from severe pancreatitis twice in the past. While he had a strong appetite during the first year of his diabetes, his appetite has become very inconsistent now that three years have passed.
I rarely see him begging for food or waiting for meals the way he used to.
The internal medicine specialist, having reviewed his medical history and test results from his hospitalizations, maintains that Toujeo is the only remaining option for him. However, the fact that Toujeo can only be adjusted in one-unit increments is a major issue.
Since Toujeo has such a long duration of action, I worry about the risk of hypoglycemia if my cat doesn't eat the food from the automatic feeder during the night or while we are out.
Does anyone have experience managing a diabetic cat that is difficult to treat, like mine?
I tend to do a lot of research and have tried absolutely everything for my cat so far.
He eats normal food because refused to eat all low-carb food.
When he was first diagnosed, I fed him prescription diets from Hill's and Royal Canin, but after developing ketoacidosis, he rejected both.
Since then, I have tried to feed him foods with the lowest possible carbohydrate content.
The problem is that even if he eats a food at first, he soon gets bored of it and won't touch it again.
I’ve lost count of how many different types of food I’ve tried with him!
I decided that getting him to eat is the priority, so I currently feed him what he will actually eat (Royal Canin, Pro Plan, and Natural Balance).
I would love to hear any advice you might have. Thank you.
 
We don't get very many people using Toujeo for any length of time. Since it's a U-300 insulin and can only use pens, you are right that you cannot make smaller adjustments. By the way, Tresiba/degludec) is another U-100 option. We have a few people using it.

Has your cat ever been tested for acromegaly or IAA (insulin anti-antibodies). We suggest that testing when a kitty gets to 6 units. Cats can have those conditions on less than 6 units, but at that point one or the other is very likely. Cushings is another possibility, though less common. I'm surprised if the IM vet didn't suggest that testing. There are treatments for acromegaly. Roughly one in 4 diabetic cats has it. BTW, my girl had both acromegaly and IAA. Acromegaly is a condition caused by a benign pituitary tumour that sends out excess growth hormone. Polyphagia, or extreme hunger is a symptom (think growing teenagers).

Has he ever had a GI ultrasound? The pickiness is a hallmark of IBD. Pancreatitis is a common companion to that condition. Novel proteins can help.
He eats normal food because refused to eat all low-carb food.
What food (brands, product) is he eating now?
 
Thank you for your reply. It seems Toujeo isn't an insulin commonly used for cats.
I feel that insulin administered via syringe—like the Levemir I used previously—is better because it offers more control.
My cat had many tests while in the ICU.
I have a follow-up appointment next month, so I plan to ask about them then.
If it turns out the tests you mentioned haven't been done yet, I will ask to have them performed.
He did have an ultrasound in the ICU, and they noted some thickening of the intestinal wall.
They told me that determining whether it was cancer or IBD would require microscopic examination. However, I opted not to proceed with that testing because the treatment for ketoacidosis had already been quite expensive.
Since his discharge, he has gained weight (perhaps a bit too much). He is currently eating a mix of Royal Canin, Pro Plan, and Natural Balance.
 
It is true that a biopsy is needed to determine IBD or small cell lymphoma definitively. Some cats can have an endoscopic biopsy. What you can do is try a novel protein diet along with probiotics like Visbiome and see if that helps him. Lots of information on this website: IBDKitties – Helping Save Lives…One Paw at a Time. The fact that he is gaining weight instead of losing is a clue he might be more likely have IBD. Most SCL kitties lose weight. Another add on blood test, you have had it done already is the GI panel. Sometimes pancreatitis tests are done as part of this panel. It would be good to know what his B12 levels are, many IBD or SCL kitties are low in it. Though none of my 3 were. Adding B12 can help appetite.

The blood for the acromegaly (IGF-1 test) and IAA tests are sent to Michigan State University.

Is he currently eating wet or dry foods? Also, which specific product name? High carb foods can make a major different in amount of insulin needed.

Toujeo is used by a few cat with much higher dose needs, though not usually for 6 units.
 
Thank you for the advice. When my cat was in the ICU with ketoacidosis, he got many tests to explore potential underlying issues because his blood sugar levels were difficult to stabilize given his medical history.
I believe the tests you mentioned was likely among them, but I’m not really sure, so I will ask to this with the doctor at our follow-up appointment next month.
Before developing diabetes, he was a cat who would eat anything; however, after the onset of diabetes—and dealing with hyperthyroidism, pancreatitis, and tooth extractions due to resorptive lesions—he gradually became extremely picky about his food.
I’ve lost count of how many different foods I’ve bought for him.
I was feeding him low-carbohydrate options first, but now I prioritize simply getting him to eat.
He absolutely hates wet food and will only eat dry food.
And his options for dry food are now very limited (Few of Royal Canin foods and Pro Plan), and he no longer rushes over to eat the way he used to.
Even when he asks me for food, he might take a few bites, and walk away—though he will eat if I hand-feed him one piece at a time.
His blood test results are consistently normal; his thyroid, kidney, and pancreatitis markers are all within the normal range.
I have no idea what is causing his loss of appetite. he is actually gaining a little bit weight at a time.
His appetite doesn't change even when his blood sugar levels are good. For reference, the foods he currently eats are Royal Canin (about 30% carbohydrate) and Pro Plan (about 20% carbohydrate); I’ve ordered a few other types (with 12% and 20% carbohydrate) that I haven't tried yet, so I’m hoping he’ll eat them.
 
Eating a 30% carb food will definitely mean he needs a higher dose of insulin. We had one kitty hear sneaking dry food from other cats, who was on 5.5 units of insulin that went off of insulin when the dry food was removed from the house. If he must eat dry food, Dr. Elsey's Clean Protein, Epigen 90, SquarePet PowerCat and Young Again all make options that are lower carb. Other options are freeze dried raw or air dried raw (Ziwipeak). These latter two have a number of different protein options if a food allergy is what is making him picky. Good luck, finding the foods they will eat is a challenge.
 
I really wish he ate wet food!
He didn't eat Dr Elsey's but I haven't tried other foods.
I’ve been concerned about something for a while: high-protein foods often tend to be relatively high in phosphorus. Although his kidney function levels are currently normal, I worry that feeding him a high-phosphorus diet might negatively affect his kidneys.
In fact, when he was eating a high-protein food (45% protein), his BUN levels spiked significantly; however, when I switched him to a food with around 35% protein, his BUN levels returned to normal. I am aware that there is no conclusive evidence proving high-protein diets damage the kidneys, but I feel that a lower-phosphorus diet is likely safer for kidney health.
I learned that diabetic cats sometimes to be picky their food due to nausea, and Slippery elm helps.
The sign he shows that exactly same so I ordered.
 
I just checked you mentioned the foods and he didn't eat Wyson...and I just ordered the food(SquarePet pwerCat) today!!
 
Lots of people here have kitties with kidney disease. There are plenty of foods, at least wet, that are higher in protein, lower in carbs and lower in phosphorus. Better to get his diabetes under control, so the kidneys don't have to work as hard getting the extra sugar out of his blood.
 
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