New Member-May 25-Dosing question

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Beth and Toby

Beth and Toby

Member Since 2022
Okay, first time posting here. I’m pretty much flying blind here since my vet is really no help. My cat Toby was diagnosed in early December. I listened to my vet and started him on .5 units of Lantus and tested him one day a week, 6 hours after his insulin shot. The vet said that would tell us if the insulin was working. Every two weeks I would increase his dose by .5 because he was always in the 300 or 400s. This went on until I got to 4 units and my vet basically told me to see a specialist because she couldn’t help me anymore. Around this time, I got my cat on Prozac because he was super hard to test and freaked out about everything. I started trying to test him more too. At around 4.5 units, I really started testing AM and PM and doing mid shots. I have never seen anything below 300 on any test that I have given. We are now up to 6 units and still in 300 or 400’s +4,+6 and +8. My question is…should I start all over at 1 unit since I’m
testing more now? I don’t know if he’s getting too much or not enough. I’m very lost. Thanks.
 
Hi and welcome to the forum Beth and Toby.
No I would not start over again. This is not a good idea.
What I would do is to set up a spreadsheet and I will give give you a link to it.
If you could put in at least a couple of weeks data into the SS so we can see what is happening, that would be helpful. If you have any trouble setting up the SS I will get someone to help you..just ask.

Also set up your signature and tell us all about Toby so we can get a picture of things and we won’t have to keep asking you about Toby. Your Signature will sit below all your posts so we can see. Have a look at mine which is in paler writing below my post.

What type of glucose meter are your you using?
What food are you feeding? Are you feeding a low carb wet diet or dry food?
Do you give snacks during the cycles?

I would recommend you always test before every dose of insulin to make sure it is safe to give the dose and then get a test in each cycle somewhere between +4 and +7 when the insulin is normally at its strongest.
HELP US HELP YOU has the links you will need.
Bron
 
Beth and Toby said:
around 4.5 units, I really started testing AM and PM and doing mid shots. I
Click to expand...
What do you mean by this? Are you saying you gave extra insulin during the cycles? Or that you did extra testing?
I would definitely not give extra insulin, if this is what you are saying. Giving insulin more often than twice a day at 12 hour intervals is dangerous.
 
Bron and Sheba (GA) said:
Hi and welcome to the forum Beth and Toby.
No I would not start over again. This is not a good idea.
What I would do is to set up a spreadsheet and I will give give you a link to it.
If you could put in at least a couple of weeks data into the SS so we can see what is happening, that would be helpful. If you have any trouble setting up the SS I will get someone to help you..just ask.

Also set up your signature and tell us all about Toby so we can get a picture of things and we won’t have to keep asking you about Toby. Your Signature will sit below all your posts so we can see. Have a look at mine which is in paler writing below my post.

What type of glucose meter are your you using?
What food are you feeding? Are you feeding a low carb wet diet or dry food?
Do you give snacks during the cycles?

I would recommend you always test before every dose of insulin to make sure it is safe to give the dose and then get a test in each cycle somewhere between +4 and +7 when the insulin is normally at its strongest.
HELP US HELP YOU has the links you will need.
Bron
Click to expand...

I am not super tech savvy so I’ll have to have my hubs help me with the spreadsheet. I was using the Alphatrak 2 and just started the Relion classic due to the Alphatrak strips being crazy expensive. I’ll still use the A2 on weekends for curves. Since December, I have tried every low carb food under the sun. My cat is super picky. We are now eating Tiki succulent chicken and Dr. Elseys dry chicken. Oh, and a bit of baby food on top because he won’t eat it otherwise. He gets fed every 4-5 hours because he’s crazy hungry all of the time. I now do test before every shot, and try to go mid tests on Friday-Sunday.
 
Beth and Toby said:
Doing mid shot testing. Not more insulin.
Click to expand...
Ok, that’s good. Just needed to check. We call that testing during the cycle so as not to cause any confusion.
Once we can see your data, we will be able to help you, moving forward.
Thanks for setting up your signature….very helpful.

I see you have written down you are using an alphatrak meter and a ReliOn meter. I would recommend you choose one or the other as using both is confusing as the pet meter runs higher than the human meter. And you can’t really compare the numbers. You
The alphatrak meters are a lot more expensive to run than a human meter, which I’m sure you have found out….and the human meter is just as good and our dosing methods are based on the human meter numbers. If you are happy to continue with the alphatrak meter, that is fine, but if you want to swap to a human meter, that is OK as well, but I would choose one or the other for everyday use.

Beth and Toby said:
I am not super tech savvy so I’ll have to have my hubs help me with the spreadsheet. I was using the Alphatrak 2 and just started the Relion classic due to the Alphatrak strips being crazy expensive. I’ll still use the A2 on weekends for curves. Since December, I have tried every low carb food under the sun. My cat is super picky. We are now eating Tiki succulent chicken and Dr. Elseys dry chicken. Oh, and a bit of baby food on top because he won’t eat it otherwise. He gets fed every 4-5 hours because he’s crazy hungry all of the time. I now do test before every shot, and try to go mid tests on Friday-Sunday.
Click to expand...

Would you like me to get someone to set up the spreadsheet for you? @Bandit's Mom can do it in 5 minutes and she would be happy to help you. She will come online in a couple of hours and will contact you.
That is good you are feeding low carb food.
I would recommend not feeding for the 2 hours before the preshot BG as we don’t want the BG to be food influenced.
It is fine to feed him during the cycles…we recommend that. During the first half of the cycle is best when the insulin is strongest. And then maybe a snack at +8 or 9, then nothing til the next preshot BG. Are you adding any warm water to the food to fill him up? A teaspoon of warm water each snack might help I’d he will eat it with the water added.

Once we can see some data we can help you. We rely heavily on data to help people…that is why we like to have the spreadsheet and the signature set up.
Would you mind putting what you feed into the signature please…also any existing illnesses…thanks.
 
Bron and Sheba (GA) said:
Ok, that’s good. Just needed to check. We call that testing during the cycle so as not to cause any confusion.
Once we can see your data, we will be able to help you, moving forward.
Thanks for setting up your signature….very helpful.

I see you have written down you are using an alphatrak meter and a ReliOn meter. I would recommend you choose one or the other as using both is confusing as the pet meter runs higher than the human meter. And you can’t really compare the numbers. You
The alphatrak meters are a lot more expensive to run than a human meter, which I’m sure you have found out….and the human meter is just as good and our dosing methods are based on the human meter numbers. If you are happy to continue with the alphatrak meter, that is fine, but if you want to swap to a human meter, that is OK as well, but I would choose one or the other for everyday use.



Would you like me to get someone to set up the spreadsheet for you? @Bandit's Mom can do it in 5 minutes and she would be happy to help you. She will come online in a couple of hours and will contact you.
That is good you are feeding low carb food.
I would recommend not feeding for the 2 hours before the preshot BG as we don’t want the BG to be food influenced.
It is fine to feed him during the cycles…we recommend that. During the first half of the cycle is best when the insulin is strongest. And then maybe a snack at +8 or 9, then nothing til the next preshot BG. Are you adding any warm water to the food to fill him up? A teaspoon of warm water each snack might help I’d he will eat it with the water added.

Once we can see some data we can help you. We rely heavily on data to help people…that is why we like to have the spreadsheet and the signature set up.
Would you mind putting what you feed into the signature please…also any existing illnesses…thanks.
Click to expand...

My husband is helping me with the spreadsheet now. Should be posting it soon. I do water down his food. Only way he will eat it. He’s so difficult!
 
Beth and Toby said:
https://docs.google.com/spreadsheets/d/1Q1-a-s7ga9VPx5uJ-iBt8MDX57LDByR0h1KDLmvpn0g/edit

Here it is. The last few days I’ve used the Relion, so I’ll start a new spreadsheet for that soon. I know I don’t have a lot of mid tests, but my cat hates testing so getting more than 2 a day is difficult. I don’t have many during the day either because I’m gone all day at work.
Click to expand...
Thanks so much for that. That was quick!
In regards to the testing, are you giving Toby a treat every time you test?
We suggest always doing the tests in the same place so the cat gets used to the idea that that is where the tests will be, and if you give a treat, he will soon come to associate with tests with a treat. My Sheba used to come running every time she heard me at the testing equipment as she knew she would get a treat.
Have a look at post 3 and 5 in this thread from the other day where Merlin asked his caregiver to do a test.
https://felinediabetes.com/FDMB/thr...ntinued-from-merlin-saga.263536/#post-2953420

Do you think you would be able to get one test in every cycle during the cycle? That way we will be able to see how low the dose of insulin is taking Toby. Lantus dosing is based on the nadir or lowest point in the cycle, not the preshot number.
Lantus is a good insulin for cats.
How old is your Lantus? Is it the same one you got at diagnosis?
And do you keep it in the fridge (not the door) and not shake or roll it?
 
Bron and Sheba (GA) said:
Thanks so much for that. That was quick!
In regards to the testing, are you giving Toby a treat every time you test?
We suggest always doing the tests in the same place so the cat gets used to the idea that that is where the tests will be, and if you give a treat, he will soon come to associate with tests with a treat. My Sheba used to come running every time she heard me at the testing equipment as she knew she would get a treat.
Have a look at post 3 and 5 in this thread from the other day where Merlin asked his caregiver to do a test.
https://felinediabetes.com/FDMB/thr...ntinued-from-merlin-saga.263536/#post-2953420

Do you think you would be able to get one test in every cycle during the cycle? That way we will be able to see how low the dose of insulin is taking Toby. Lantus dosing is based on the nadir or lowest point in the cycle, not the preshot number.
Lantus is a good insulin for cats.
How old is your Lantus? Is it the same one you got at diagnosis?
And do you keep it in the fridge (not the door) and not shake or roll it?
Click to expand...
I have tried everything to help him with testing. He has treats he loves, but his fear far outweighs his love of food. He’s just been a timid cat since I got him from a rescue. I will keep trying though. Do you mean test him mid cycle every day? Like in the evening? I guess I only tested him on the weekends because I read that Lantus is a depot insulin and you really wouldn’t see it’s effect until like 5 days after a new dose. So I figured that would give me a true indication of it was working. I always tried to test him 4-6 hours after insulin…does that seem right? Even when I was only testing him once a week, it was always 6 hours after. I just picked up a new vial a week ago and yes, it’s always in the fridge and no to shaking or rolling.
 
Keep persevering with the testing. I know it can be harder with some cats, but you are doing a really good job getting all those tests in.
Yes, if you could get a test in each cycle, that would be helpful to let us see what is happening during the cycle. It does not have to be +6 it can be anywhere from +4 to +7.. I would vary it. For the pm cycle, try getting a before bed test in each night. That will give useful information.

Beth and Toby said:
I guess I only tested him on the weekends because I read that Lantus is a depot insulin and you really wouldn’t see it’s effect until like 5 days after a new dose. So I figured that would give me a true indication of it was working.
Click to expand...
Yes Lantus is a depot insulin and it can take 6 cycles or three days for the depot to fill again once the dose has been increased. But we see many many cats respond to a dose increase before the three days is up. So I would test every cycle.
What we are looking for with Toby, it to see if he just needs more insulin or if he is dropping low somewhere during the cycles and bouncing back up high afterwards. Bouncing can happen when cats drop too fast, too low or lower than they have been used to. This causes the body to panic and dump stored glucose and regulatory hormones into the system and that shoots the BG up high. There is nothing you can do once a bounce has happened except wait it out. It can take up to 6 cycles for the bounce to stop. If you are only doing the preshot BG, it can look as if the cat just needs more insulin, but the cat could be dropping low and bouncing up high again by the end of the cycle.
Because Toby has been in high BGs for so long, his body could be reacting to drops into lower numbers that we consider still high but his body thinks they are too low. Does that make sense?
We need to eliminate this first, before we would suggest a dose increase.
 
Bron and Sheba (GA) said:
Keep persevering with the testing. I know it can be harder with some cats, but you are doing a really good job getting all those tests in.
Yes, if you could get a test in each cycle, that would be helpful to let us see what is happening during the cycle. It does not have to be +6 it can be anywhere from +4 to +7.. I would vary it. For the pm cycle, try getting a before bed test in each night. That will give useful information.


Yes Lantus is a depot insulin and it can take 6 cycles or three days for the depot to fill again once the dose has been increased. But we see many many cats respond to a dose increase before the three days is up. So I would test every cycle.
What we are looking for with Toby, it to see if he just needs more insulin or if he is dropping low somewhere during the cycles and bouncing back up high afterwards. Bouncing can happen when cats drop too fast, too low or lower than they have been used to. This causes the body to panic and dump stored glucose and regulatory hormones into the system and that shoots the BG up high. There is nothing you can do once a bounce has happened except wait it out. It can take up to 6 cycles for the bounce to stop. If you are only doing the preshot BG, it can look as if the cat just needs more insulin, but the cat could be dropping low and bouncing up high again by the end of the cycle.
Because Toby has been in high BGs for so long, his body could be reacting to drops into lower numbers that we consider still high but his body thinks they are too low. Does that make sense?
We need to eliminate this first, before we would suggest a dose increase.
Click to expand...
I get what you are saying. I guess I figured because the 9 times I tested him mid/ish in the last couple of weeks that it showed he really wasn’t bouncing. But I can try getting a mid test every day for the next week. I can only do evening though. I leave the house at 6:30 AM and don’t get home until 4:30 PM and his shot times are 5:30 and 5:30. So I can only do days on the weekends. I have to work to keep up with this expensive kitty!
 
Beth and Toby said:
I get what you are saying. I guess I figured because the 9 times I tested him mid/ish in the last couple of weeks that it showed he really wasn’t bouncing. But I can try getting a mid test every day for the next week. I can only do evening though. I leave the house at 6:30 AM and don’t get home until 4:30 PM and his shot times are 5:30 and 5:30. So I can only do days on the weekends. I have to work to keep up with this expensive kitty!
Click to expand...
Yes it is harder when you have to work! But what you suggest is good.
It could well be that he isn’t bouncing, but we need to confirm it.
There are a couple of conditions that can cause higher BGs but let’s eliminate this first.
How old is Toby, by the way?
Do you think you could link his SS to the signature please?
 
Yeah, I have used this chart since Dec. I went to Petsmart and bought a couple of cans of everything in stock on that entire list. He maybe liked 4 out of the 30 different kinds I bought. Then I would buy a bunch of stuff he liked and he would stop eating in after a few weeks. This has been going on for 6 months now. He’s about to drive me crazy!
 
Bron and Sheba (GA) said:
Yes it is harder when you have to work! But what you suggest is good.
It could well be that he isn’t bouncing, but we need to confirm it.
There are a couple of conditions that can cause higher BGs but let’s eliminate this first.
How old is Toby, by the way?
Do you think you could link his SS to the signature please?
Click to expand...
He’s about 6-7 (rescue wasn’t quite sure of his age when I got him 3 years ago ). He’s so young…it makes me so sad. And he’s not obese. I don’t know why he got so unlucky. I started a new spreadsheet with the Relion so I’ll link both. Thank you for all of your help! I really appreciate it!
 
Beth and Toby said:
He’s about 6-7 (rescue wasn’t quite sure of his age when I got him 3 years ago ). He’s so young…it makes me so sad. And he’s not obese. I don’t know why he got so unlucky. I started a new spreadsheet with the Relion so I’ll link both. Thank you for all of your help! I really appreciate it!
Click to expand...
Very happy to help. Keep posting and asking questions.
He is a beautiful boy. We will help you get sorted out.
 
Beth and Toby said:
Yeah, I have used this chart since Dec. I went to Petsmart and bought a couple of cans of everything in stock on that entire list. He maybe liked 4 out of the 30 different kinds I bought. Then I would buy a bunch of stuff he liked and he would stop eating in after a few weeks. This has been going on for 6 months now. He’s about to drive me crazy!
Click to expand...
Do you think he is nauseated? Does he sniff the food and walk away or smack his lips?
Was he always fussy with food?
 
Bron and Sheba (GA) said:
Do you think he is nauseated? Does he sniff the food and walk away or smack his lips?
Was he always fussy with food?
Click to expand...
I don’t think he is nauseated, but vomiting is another issue I’m having with him too. Since he’s moved to low carb wet food, he’s had more hairballs and vomiting in the last few months then in the whole time I’ve had him. Before diabetes he ate Halo Holistic Seafood Medley for Sensitive Stomachs and he probably had one hairball every 6 months. Now we have one every week followed by several bouts of vomiting. Do you have a spreadsheet for puking ‍♀️
 
Beth and Toby said:
I don’t think he is nauseated, but vomiting is another issue I’m having with him too. Since he’s moved to low carb wet food, he’s had more hairballs and vomiting in the last few months then in the whole time I’ve had him. Before diabetes he ate Halo Holistic Seafood Medley for Sensitive Stomachs and he probably had one hairball every 6 months. Now we have one every week followed by several bouts of vomiting. Do you have a spreadsheet for puking ‍♀️
Click to expand...
Are you brushing him frequently?
Hairballs and vomiting can go together, can't they?
 
Toby has the cutest face. He is very lucky to have found you. I am not a vet and a very new member here so I cannot offer too much advice. But I did want to mention two things. My friend has a maine coon kitty who has too many hairballs and too much hair everywhere (she has a baby and the air purifier does not do much). She shaves her cat once or twice a year and it works for them (cat is 15 now and doing well). Not fully shaved but just enough. It is not recommended really to do so because they regulate their temperature though their fur. I would not do it but my cat is not long haired. What I do though, I have catgrass that I plant (use organic seeds) and it works for my Henry. Sometimes he still gets one furball here and there and I put a little olive oil or butter on his paws so he licks them. My baby is super picky as well so I am rotating and putting on his food 1) sprinkled raw dried freeze morsels from stella and chewy (many flavors); 2) Fortiflora; 3) Bonito Flakes; 4) Orijen treats (raw freeze dried); 5) Ziwi air dried treats (omg he is crazy about this one I just got it); 6) cooked shrimp (his favorite); 7) raw chicken; 8) PureBites Mixers Chicken Breast in Water Cat Food Toppers. He was dry food addict and have to do this to be able to do TR and remove dry kibble. My vet recommended Koha pates and while they look healthy, Henry would not touch them. Hope you will find some food he will like that will help with hairballs /vomiting.
 
Bron and Sheba (GA) said:
Keep persevering with the testing. I know it can be harder with some cats, but you are doing a really good job getting all those tests in.
Yes, if you could get a test in each cycle, that would be helpful to let us see what is happening during the cycle. It does not have to be +6 it can be anywhere from +4 to +7.. I would vary it. For the pm cycle, try getting a before bed test in each night. That will give useful information.


Yes Lantus is a depot insulin and it can take 6 cycles or three days for the depot to fill again once the dose has been increased. But we see many many cats respond to a dose increase before the three days is up. So I would test every cycle.
What we are looking for with Toby, it to see if he just needs more insulin or if he is dropping low somewhere during the cycles and bouncing back up high afterwards. Bouncing can happen when cats drop too fast, too low or lower than they have been used to. This causes the body to panic and dump stored glucose and regulatory hormones into the system and that shoots the BG up high. There is nothing you can do once a bounce has happened except wait it out. It can take up to 6 cycles for the bounce to stop. If you are only doing the preshot BG, it can look as if the cat just needs more insulin, but the cat could be dropping low and bouncing up high again by the end of the cycle.
Because Toby has been in high BGs for so long, his body could be reacting to drops into lower numbers that we consider still high but his body thinks they are too low. Does that make sense?
We need to eliminate this first, before we would suggest a dose increase.
Click to expand...
This is the new spreadsheet with the Relion monitor. Based on what you see from last spreadsheet and this one, do you think I should go up to 6.5 units. He’s been on 6 for a couple of weeks now. Or should I stick with 6 for longer. Thanks!
https://docs.google.com/spreadsheets/d/11iL93FwYyC5Z6xB4i5ejzWnzzQ9951i89VWXhAiqw3c/edit
 
Beth, a couple of questions. Is Toby eating any dry food or is it all wet low carb. I think you said he had some dry food, so will need to follow the Start Low Go Slow dosing methods
I will link it below for you to look at. If you are happy with that can you put SLGS in the signature and the SS please.
Also would it be possible for you to do a curve today or tomorrow so we can see it first before increasing the doses.
A curve is AMPS and then every 2 hours until PMPS.
I think he does need an increase but we really need to see some more tests from during the cycle.
DOSING METHODS
Both TR and SLGS in this link. Look for the SLGS method
 
Bron and Sheba (GA) said:
Beth, a couple of questions. Is Toby eating any dry food or is it all wet low carb. I think you said he had some dry food, so will need to follow the Start Low Go Slow dosing methods
I will link it below for you to look at. If you are happy with that can you put SLGS in the signature and the SS please.
Also would it be possible for you to do a curve today or tomorrow so we can see it first before increasing the doses.
A curve is AMPS and then every 2 hours until PMPS.
I think he does need an increase but we really need to see some more tests from during the cycle.
DOSING METHODS
Both TR and SLGS in this link. Look for the SLGS method
Click to expand...
He does eat Dr. Elseys dry. However, I did a test this week and took it away from him for several days and he just ate Tiki succulent chicken. His numbers didn’t really change. I will try to do a curve, if he’ll let me. Good thing he’s super cute, cause he’s very difficult!
 
Beth and Toby said:
He does eat Dr. Elseys dry. However, I did a test this week and took it away from him for several days and he just ate Tiki succulent chicken. His numbers didn’t really change. I will try to do a curve, if he’ll let me. Good thing he’s super cute, cause he’s very difficult!
Click to expand...
Dr Elseys is low carb so it probably wouldn’t make a difference to the BGs if you took it away. But if any dry if being fed you can’t do the TR method. Thanks for doing the curve.
 
Bron and Sheba (GA) said:
Dr Elseys is low carb so it probably wouldn’t make a difference to the BGs if you took it away. But if any dry if being fed you can’t do the TR method. Thanks for doing the curve.
Click to expand...
I didn’t think I was going to get that last number because he was so over getting poked, but somehow I managed it. So here is my curve. Is is odd that his numbers really don’t move much? Like it’s not so much a curve as a slight wavy line? I’m thinking I should go up to 6.5 units…what do you think? Again, thanks so much for your help!
https://docs.google.com/spreadsheets/d/11iL93FwYyC5Z6xB4i5ejzWnzzQ9951i89VWXhAiqw3c/edit
 
Thanks for doing the curve. Well done!!
Yes I would go to 6.5 units.
Are you able to put the new SS into the signature as well please. If you can’t, I’ll ask @Bandit's Mom to help you. Can you also put SLGS into the signature and SS please?
Let’s see if the new dose helps. It is possible he could have one or both of two conditions that cause the need for more insulin. I’ll tag @Wendy&Neko as she is very experienced in these conditions.
 
Beth and Toby said:
Do you have a spreadsheet for puking ‍♀️
Click to expand...
I call it the vomit log. :rolleyes: Date, description of vomit, how soon after food and what protein. Helped me narrow down if there were offending proteins causing the vomits. I wonder if Toby needs to try something else other than chicken, which can be a common allergen.

As for dose, I agree with Bron on the 6.5 units. When people get over 6 units, and are feeding all low carb food, with no other issues like needing a dental, we suggest that they get their cat tested for a couple secondary endocrine conditions that can mean a cat needs more insulin. Note cats with these conditions don't all have higher doses, but most cats with higher doses have one of these conditions. The first is called acromegaly (more properly hypersomatotropism, but that's a mouthful), which is caused by a benign tumour on the pituitary gland that causes excess growth hormone to be produced. That in turn eventually causes the diabetes. About one in four diabetic cats has this. The second condition is called IAA or insulin auto antibodies. It's an antibody reaction to injected insulin. Both conditions are tested by a blood test, both sent to Michigan State University if you are in North America. There are treatments for acromegaly should that come back positive. IAA you mostly have to wait out for it to go away.
 
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