New Member! Mango not responding to insulin

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B&B Aspen

B&B Aspen

Member Since 2021
We came across this site and were relieved to hear others are dealing with this and having success treating their cat(s) at home! Our 10-yr old male tabby, Mango, was diagnosed on November 1. We took him to the vet for noticeable weight loss. The vet had us start ASAP on 1U Lantis every 12 hours and recommended a switch to Royal Canin Glycobalance dry kibble which was a successful and easy switch. Two weeks later counts were getting worse, increased to 2U and then a week later to 3U dosing. After reading all of the advice on here we purchased home testing supplies from Walmart along with the Ketostrips. Have been slowly transitioning to Fancy Feast Classic Chicken mixed with the low carb dry food for now. The vet didn't really know next steps and was not reassuring. Wondering if we should get a second opinion. We haven't had the time to create the excel doc but I'm attaching his vet curve results and the few we have done at home. Any thoughts on going up or down on dosing? We understand it's moved "too fast" already but his ketones are in the low range so wondering if we should go up to 3.5U? He is so skinny and seems to be wasting away. He is eating good twice a day and happy/cuddly. If continuing at 3U for a few more weeks without any changes is best we are fine with that too. Just wanted a few opinions from the experts. Thanks for your time and widsom!
 

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I am sure some more experienced members will be by soon. I am glad to hear you have started home testing. I wasn't able to open your spreadsheet, if you are able to move the data into the ones here that would be great.

Here is a great link for getting started on this site: https://www.felinediabetes.com/FDMB/threads/index-health-links-faqs.194624/

Also, once you transition to a low carb wet food you will begin to see drops in blood glucose levels. So it is important to watch for signs of hypoglycemia. You can find more information in the link above.
 
Welcome! You're already off to a good start.

When you get a chance, please do follow the steps in the link Chris provided.

What is his current weight, and what's ideal weight? You don't have to feed just twice a day; in fact diabetics do better with multiple smaller meals. Have you determined the calories he needs to gain weight? We usually say let them eat however much they want if they're underweight and unregulated, because they do not process food the same way. But there is this post as well to help you determine whether it's best to feed however much he wants, it's not always a good idea.

What is his current food mix? How much wet vs dry? That will help determine what we do with the dose. For now, hold the 3U.

If you can, start getting at least some preshot tests. These tests should be fasting for 2 hrs for consistency, so we know if its safe to shoot. If.yoi get a preshot test thats 200 or lower please stall without feeding and ask for help. Midcycle tests are also good - we recommend at least one other test per cycle (so one during day, one at night). A +2/+3 can give you a clue how the cycle may go, +4 to +7 ish is nadir for most cats. So I would focus on those times first to see how low he may be going.

Going to tag @Bron and Sheba (GA) @tiffmaxee given the ketones
 
Can you show us a photo of a Ketostix result please?
Are you checking exactly 15 seconds after dipping the strip into the urine.?
How is his appetite? Is he eating really well for you?
If there are any ketones present we need to make sure he is eating really well so if you can get him to eat lots of snacks during the cycle, that will help keep the ketones away. He needs to be eating more than normal if you can manage that.
Also having enough insulin is important. If you could set up a spreadsheet and put all the data you have in it, that would help us a lot in determining if Mango needs any more insulin. You will find information about setting up a SS and your signature, a hypo box and more in THIS LINK
If you have any trouble with the SS I will ask @Bandit's Mom ti help you as the sooner we can get it up and running the sooner we can help you.

I would also encourage extra fluids to help flush out any ketones. If he won’t drink you could try adding a teaspoon of warm water to each of the snacks.
I would try and get 2 tests a day for the ketones if possible at the moment.
Bron
 
Welcome. I’m glad that you found us. We are very data driven so we need the spreadsheet asap. If you need help setting one up we have someone who can get it up in no time. @Bandit's Mom She will be by shortly.
How are you testing for ketones, with a meter or urine test strips? Was Mango DKA when diagnosed? If ketones are low you just need to make sure you don’t skip insulin and that he gets enough food and water. You can’t rush the dosing any more than is safe. With dry food in the picture, if you follow one of our methods it would be SLGS. If you can get Mango off the dry food then TR is an option provided you feel comfortable with the more aggressive approach. I’ll link our methods to this.

https://felinediabetes.com/FDMB/thr...-low-go-slow-slgs-tight-regulation-tr.210110/

Even with SLGS you can increase the dose every 7 days.

You are doing a great job taking care of Mango.
 
@Chris and Checkers thank you for the note. We will work on the spreadsheet and read all the warnings about hypo especially when switching to wet food.
@FrostD I am relieved to hear that we can feed him more (hopefully). He is ravishing and trying to get people food and dog food even during the day. I requested starting and current weights from the vet but he is skin and bones so I feel that eating smaller meals more often is a better option for him. He started losing hair in one place on his back last week too. Pre-shot tests were 511 on 1U then up to 659 on 2U then down to 435 and 563 since on 3U. Lowest reading I've had is 282 - 4 hours after the AM injection but usually the lowest is 304-395 before it starts climbing again in the afternoon. Sorry I'm not savvy on all the timing terms yet but will get there. He has been eating about 1/4 c wet food with maybe 3 tbs. of small kibble twice a day (12 hours apart). It is not sufficient for what he needs.
@Bron and Sheba (GA) thank you for the note also. Yes, we definitely did exactly 15 seconds on the urine strip! The plastic bag over the litter works like magic and we isolated him and put one of the nest cameras in the room so we could right when he went. He is drinking so much water that he does go a lot. Here is a picture
@tiffmaxee appreciate the other link about the methods. The vet mentioned nothing about DKA or Ketones - we just picked them up based on what we read here on this site knowing that the dosing will be a constant battle for a bit and wanting to make sure we are armed with all the information we need to help make the best decisions for him. Attaching a few pictures and my husband is working on the SS!
 

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What did the vet say about the fur?

I've always used this article as a rough guideline.for weight management: https://www.petplace.com/article/cats/pet-health/how-to-calculate-your-cats-daily-calorie-intake/

My cat is 13.5 lbs, ideal weight, regulated (in remission technically) and does about 3/4 of a 5.5oz can twice a day free fed (that doesn't work for all cats). When he was first diagnosed and unregulated he was doing about three 5.5oz cans a day

You'll want to split his food up between 4-6 meals. We usually feed the biggest meal at shot time (after testing), then 1-2 more meals before nadir (his lowest BG, for now assume it's around +6) - both AM and PM. A lot of us use 5-slot autofeeders to make life easier.
 
That looks like dermatitis. One of mine gets it on her ears at times. It could be a reaction to a protein he is eating or environmental.
 
We updated the SS with the info we have. We will hold at 3U and start daily AMPS test and a +2/3 and +6/7 to get some consistent data of how high and low he is going.
@tiffmaxee The vet has not seen him since the hair loss started. They can't see him until 12/16 unfortunately.
I will try a smaller meal with AM dose and a few smaller ones during the first +5 hours as @FrostD recommends.
Thank you so much for your support!
 
FrostD said:
Welcome! You're already off to a good start.

When you get a chance, please do follow the steps in the link Chris provided.

What is his current weight, and what's ideal weight? You don't have to feed just twice a day; in fact diabetics do better with multiple smaller meals. Have you determined the calories he needs to gain weight? We usually say let them eat however much they want if they're underweight and unregulated, because they do not process food the same way. But there is this post as well to help you determine whether it's best to feed however much he wants, it's not always a good idea.

What is his current food mix? How much wet vs dry? That will help determine what we do with the dose. For now, hold the 3U.

If you can, start getting at least some preshot tests. These tests should be fasting for 2 hrs for consistency, so we know if its safe to shoot. If.yoi get a preshot test thats 200 or lower please stall without feeding and ask for help. Midcycle tests are also good - we recommend at least one other test per cycle (so one during day, one at night). A +2/+3 can give you a clue how the cycle may go, +4 to +7 ish is nadir for most cats. So I would focus on those times first to see how low he may be going.

Going to tag @Bron and Sheba (GA) @tiffmaxee given the ketones
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Hi @FrostD we have his spreadsheet updated and I did a curve today as best I could while working. It's a little better... thoughts? A few more curves to see if it is the same? I am thrilled to have another count below 300 but we have a long way to go. I was hoping to see an AMPS or PMPS below 500. Should we be concerned with a rebound from too much or no since the AMPS is high too?
 
Great to see the SS up and running! keep testing the ketones each day and if they don’t disappear with the extra food, you may need to increase the dose of insulin
But for now stick with 3 units
 
Bron and Sheba (GA) said:
Great to see the SS up and running! keep testing the ketones each day and if they don’t disappear with the extra food, you may need to increase the dose of insulin
But for now stick with 3 units
Click to expand...
It's a great Friday! AMPS was 364 - first time ever below 500! Will monitor closely today to see how low he goes. Giving credit for this milestone to the wet food transition. We are on 90% wet now. Appreciate you all and these small "wins".
Update: +6 he was down to 106 in the blue! Will monitor closely now that he is coming lower. Have my hypo kit ready in case there is a twist the next few days.
 
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Bron and Sheba (GA) said:
Did you get a test in after the 106 @+6? Always a good idea to test again to see the BG is not dropping further.
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Hi @Bron and Sheba (GA) yes we tested +9 and it is up to 165. Of course we are going to an event tonight so my high school daughter was going to give his insulin but she can't test beforehand or after so do we just skip the dose and check his count when we are home late? And if it is not too high do we skip it altogether and test AMPS tomorrow and continue the course? If the count is not high it is probably best to skip the dose and start in the morning again? Thanks for your thoughts when you have time.
 
I hesitated to say skip as you have had some ketones in the urine but if you give the dose 4 hours later it will throw out your schedule.
Are you happy with the schedule times at the moment?
How is mangos appetite?
Also you need to get your daughter to learn to test the BGs. I taught my 9 year old granddaughter to test and we have two young people here at the moment aged 8 and 11 who test and give the insulin .
 
What did you decide to do?
If you are skipping make sure that Mango eats really well this cycle…that will help keep any ketones away.
And in the morning, if you have skipped, you can chose an earlier time to shoot if you like.
Check ketones tomorrow please.
 
Yes will check his counts when we are home and will decide then but leaning towards skipping and will do AM a little earlier. He is eating so well. Thank you and we will test Ketones tomorrow AM.
 
If it's not too much trouble, can you create a signature? The information for setting up your signature is in this post. Having the information, including the link you provided to Mango's spreadsheet, will stop us from plaguing you with the same questions over and over again. (For example, which insulin you're using, date of diagnosis, what you're feeding, any health issues....).
 
Sienne and Gabby (GA) said:
If it's not too much trouble, can you create a signature? The information for setting up your signature is in this post. Having the information, including the link you provided to Mango's spreadsheet, will stop us from plaguing you with the same questions over and over again. (For example, which insulin you're using, date of diagnosis, what you're feeding, any health issues....).
Click to expand...
Done! Please let me know if I missed anything.
 
tiffmaxee said:
If you are still feeding low carb dry please add that to your signature. BTW which dry food?
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I have transitioned his AM and PM meals to LC Fancy Feast. I am only using a few pieces of low carb dry as "treats" during testing, etc since I have a whole bag. It is Royal Canin Glycobalance. I'll add to sig.
 
Elise is correct. All of the Royal Canin foods, including Glycobalance, are quite high in carbs. You also can't follow Tight Regulation if Mango is eating any dry food.
 
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