New Member - Mel and Ollie (Melbourne, Australia)

[Mel Harvey]

Greetings! My name is Mel and my fur baby Ollie (5yo) was diagnosed two weeks ago.

Indicators prompting me to visit the vet:

• Excessive thirst
• Excessive hunger
• Excessive urination (sometimes outside the litter tray)

Appears the ONLY symptom Ollie didn't exhibit was weight loss. He remains a large fur baby at 8.5kgs (18lbs). He was never vomiting, listless or 'not himself'. He has been a consistently happy, snuggly baby.

Dx was delivered on a Friday, after blood tests on the Thursday and a urine sample from the Friday morning. Our vet gave the option of immediately commencing insulin twice daily from the Saturday, or delaying until Monday when she would have him in the clinic for the day to complete a glucose curve. I chose the latter as I felt very uncomfortable administering insulin on the basis of one blood test reading and one urine specimen.

The glucose curve on the Monday had the following results:

9.00am reading of 28.1 (fasted)
9.50am 4 units insulin administered (Optisulin / Glargine 100 IU/ml)
11.00am reading of 23.1
1.00pm reading of 23.0
3.00pm reading of 19.0
5.00pm reading of 18.3​

We were told these readings are very high, hence the insulin dosage. Subsequent research here and via other online resources has me immensely concerned about his dosage :-(

At discharge we were taught how to administer the insulin. We were also shown how to test the blood by making a small prick to the ear. HOWEVER, we were assured we wouldn't need to routinely do this ourselves at home. It was arranged for Oliver to return the following Monday for another glucose curve.

Oliver was home with us for the week, with 4 units of insulin administered twice daily. It was "recommended" we change his diet to the Hills m/d Gludosupport wet food. I questioned whether this food would be best and asked what the carb content is. The vet said that's not really important.

The second glucose curve was done, with the following results.

7.45am 4 units insulin administered at home
9.00am reading of 26.1
11.00am reading of 16.6
1.00pm reading of 16.4
3.00pm reading of 19.0
5.00pm reading of 24.3​

I was so upset when I picked him up and saw these readings. How/why are they still so high? I am so confused.
The vet did not consult with us when we collected Oliver. We were instead handed a note from the nurse to tell us to increase his dosage from 4 units to 5 units twice per day. This seems so wrong. But I am not a vet, so am I to blindly accept without question?

We were asked to bring Oliver into the clinic today at 1pm for a blood glucose reading. The vet said that 1pm is the time his levels seem to 'drop' and wanted to test again.
I declined. I noted that I feel it is counter-intuitive to put him through the stress of a 20 minute car ride to do the test and likely get an inaccurate reading because of him being stressed.

I would appreciate any advice/guidance to help me communicate my concerns and wishes to my vet. Specifically:

• Is there a resource which will tell me the carb content of the Hills m/d Glucosupport and the Royal Canin Diabetic wet food? I have consulted the resource list and concluded that I can comfortably feed him Fancy Feast classic and Ziwi Peak options that have less than 10% carbs. I would like to be able to show my vet some clear evidence to support that the foods she is encouraging me to feed him are unsuitable.
• Recommendation for a suitable blood glucose monitor I can purchase in Australia. Vet has recommended the Alphatrak Dog/Cat unit for $185AUD. My concern is that the testing strips retail for $73.95 for 50 - almost $1.50 per strip. If I am testing several times per day this will become very expensive.
• Should the initial insulin dosage protocol be to start low and slowly increase to find his ideal dosage? I am very concerned about the 4 units twice per day initial dosage which has been increased to 5 units twice per day.
• How could I go about interviewing other vets to try and find one who will offer to care for and treat Oliver in a way that aligns with the protocols in this group?

Finally, thank you for offering to read through our situation and provide advice. I appreciate your assistance.

Mel.

 

[Bron and Sheba (GA)]

Hi and welcome to the forum Mel and Ollie.
I live in Sydney.
I am really glad you have found us as I am concerned about the large dose of insulin the vet has put Ollie on.
The recommended starting dose of insulin is 1/2 to 1 unit twice a day. Yikes…5 units after a week!
Don’t worry though, we can help you.
Here is what I would do

• I would buy a human glucose meter from a pharmacy. They are much cheaper to run than a pet meter and the test strips are cheaper. I used to buy my strips on eBay, once I knew which ones to buy. This meter from Abbott is a good meter https://www.pharmacydirect.com.au/a...MI-6G1jKas_wIVc5TCCh2ckAGGEAQYAiABEgLscvD_BwE
• You will also need a box of 100 test strips which could come with the meter…ask about that. And also box of 100 lancets size 26 or 28 gauge to prick the ear. And some cotton balls to hold behind the ear when you test.
• I would get the meter sorted out and start testing. This will then tell you what is happening with the blood glucose (BG) . Ollie could be bouncing from dropping low and then bouncing back up high again and unless you are testing you would not know. Here is an explanation about bouncing

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).

• I would set up a spreadsheet (we can help you with that if you like) and when you start getting BG data you can add it to the spreadsheet. He is a link about the spreadsheet, the signature and getting a hypo kit set up. HELP US HELP YOU
• The food that the vet has given you, especially the dry food is high carb and unsuitable for diabetic cats. Diabetic cats need canned foods that are 10% or under carbs. Most of us feed around 4-7% carbs. The fancy feast classic and Ziwi Peak canned foods are perfect…but because you are on such a big dose, I would wait until you are hometesting before doing the swap over as the BGs can drop a lot with the change over to low carb foods. Or if you reduce the dose, you could feed the low carb canned food. I would not waste my time trying to convince the vet that the FF and Ziwi Peak foods are better. Vets get their nutritional training from the big food manufacturers who promote their prescription foods and most vets think they are better.
• Are the syringes you are using the U100 3/10ml insulin syringes?
  
• Do you remember if the vet mentioned ketones at diagnosis? I would go to the chemist tomorrow and buy a bottle of Ketostix and test the urine for ketones. It’s a simple test. Just read the result exactly 15 seconds after you dip the strip into the urine and read it against the colours on the side of the bottle.
  
• I would reduce the dose of Optisulin to 1 unit twice a day.
• I would start hometesting and post here every day and we can help you with the dose. There is no need to find another vet at this point. You have the insulin. With testing you need to test before every dose to see that it is safe to give the dose. And then test during the cycle to see how low the insulin is taking the BG.
• There will be no need to to go to the vet for curves once you are hometesting the BGs. Himetesting, and feeding a low carb diet are the two things that will help Ollie and will keep him safe.
  
• Keep asking questions, we are very happy to help.

I’m heading to bed as it is late. See you tomorrow
Bron

 

[Sienne and Gabby (GA)]

Welcome to FDMB.

To be honest, if your vet was using the weight based formula for the initial dose of glargine, her calculations were not far off. The. Tight Regulation Protocol that was developed at University of Queensland, uses a weight based method for the initial dose. (Initial dose = 0.25 x ideal weight in kilograms) For a cat that weighs 18 lbs, this calculates out to approximately 4.5u.

The prescription foods you've been using are in the range of what we would call "medium carb" - 13 or 14%. We recommend a low carb diet which is under 10%. Your vet's reaction about the food is odd. I always wonder what a vet would say if you suggested that the vet feed their diabetic infant ice cream and cookies. I think keeping track of Ollie's blood glucose numbers as you change out the food will be helpful. However, if you do switch over to lower carb food, please be careful. You will likely need to lower the insulin dose.

Before you drop the dose to 1.0u like @Bron and Sheba (GA) suggested, please read over our sticky note on dosing methods. What Bron suggested is compatible with the Start Low Go Slow (SLGS) method. There is also Tight Regulation (TR) which is a bit more aggressive about dosing but also has research supporting its use. SLGS was developed here.

 

[Diane Tyler's Mom GA]

Welcome Mel and Ollie
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 10 or 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
Here is a video one of our members made testing her kitty
She's using a pet meter ,but as Bron suggested to get a human meter you won't have to code it like you have to do with a pet meter
VIDEO: How to test your cat's blood sugar

 

[Christie & Maverick]

Hello and welcome to the forum! I’m glad Bron stopped by, she has the inside scoop on food and supplies in Australia, along with some good suggestions to get you started. There is a lot of information and lots of people who can help you here. Ollie is a big boy at 8.5kg . I believe that would mean a calculation by weight of just a wee bit over 2u, so the starting dose of 4u by your vet does seem to be overly generous.

 

[Mel Harvey]

Hi and welcome to the forum Mel and Ollie.
I live in Sydney.
I am really glad you have found us as I am concerned about the large dose of insulin the vet has put Ollie on.
The recommended starting dose of insulin is 1/2 to 1 unit twice a day. Yikes…5 units after a week!
Don’t worry though, we can help you.
Here is what I would do

• I would buy a human glucose meter from a pharmacy. They are much cheaper to run than a pet meter and the test strips are cheaper. I used to buy my strips on eBay, once I knew which ones to buy. This meter from Abbott is a good meter https://www.pharmacydirect.com.au/a...MI-6G1jKas_wIVc5TCCh2ckAGGEAQYAiABEgLscvD_BwE
• You will also need a box of 100 test strips which could come with the meter…ask about that. And also box of 100 lancets size 26 or 28 gauge to prick the ear. And some cotton balls to hold behind the ear when you test.
• I would get the meter sorted out and start testing. This will then tell you what is happening with the blood glucose (BG) . Ollie could be bouncing from dropping low and then bouncing back up high again and unless you are testing you would not know. Here is an explanation about bouncing

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).

• I would set up a spreadsheet (we can help you with that if you like) and when you start getting BG data you can add it to the spreadsheet. He is a link about the spreadsheet, the signature and getting a hypo kit set up. HELP US HELP YOU
• The food that the vet has given you, especially the dry food is high carb and unsuitable for diabetic cats. Diabetic cats need canned foods that are 10% or under carbs. Most of us feed around 4-7% carbs. The fancy feast classic and Ziwi Peak canned foods are perfect…but because you are on such a big dose, I would wait until you are hometesting before doing the swap over as the BGs can drop a lot with the change over to low carb foods. Or if you reduce the dose, you could feed the low carb canned food. I would not waste my time trying to convince the vet that the FF and Ziwi Peak foods are better. Vets get their nutritional training from the big food manufacturers who promote their prescription foods and most vets think they are better.
• Are the syringes you are using the U100 3/10ml insulin syringes?
  
• Do you remember if the vet mentioned ketones at diagnosis? I would go to the chemist tomorrow and buy a bottle of Ketostix and test the urine for ketones. It’s a simple test. Just read the result exactly 15 seconds after you dip the strip into the urine and read it against the colours on the side of the bottle.
  
• I would reduce the dose of Optisulin to 1 unit twice a day.
• I would start hometesting and post here every day and we can help you with the dose. There is no need to find another vet at this point. You have the insulin. With testing you need to test before every dose to see that it is safe to give the dose. And then test during the cycle to see how low the insulin is taking the BG.
• There will be no need to to go to the vet for curves once you are hometesting the BGs. Himetesting, and feeding a low carb diet are the two things that will help Ollie and will keep him safe.
  
• Keep asking questions, we are very happy to help.

I’m heading to bed as it is late. See you tomorrow
Bron

Thank you for your comprehensive reply @Bron and Sheba (GA).

• I have read through the spreadsheet information and will start recording Ollie's BG data when the unit arrives. I am looking forward to sharing the spreadsheet as I feel very strongly about having some knowledgeable support to assist me.
• Ollie is currently eating the Fancy Feast Classic tins. We still have some of the Hills m/d tins, however, he was not keen on this food.
• The syringes are U100 0.33ml x 12.7mm BD Ultra Fine syringes (which I think are the same as what you have asked).
• I think the vet mentioned there were ketones in his urine. I am, however, unsure what this means or whether this is 'good' or 'bad'. Using these sticks, do I need 'pure' urine? Ollie is an indoor cat and great at using the litter tray. We use the clumping clay type of litter.
• I have reduced the dose to 1 unit. Have not yet started testing as I have not received a testing kit yet. Will commence as soon as it arrives.

Thanks again.

 

[Mel Harvey]

Welcome to FDMB.

To be honest, if your vet was using the weight based formula for the initial dose of glargine, her calculations were not far off. The. Tight Regulation Protocol that was developed at University of Queensland, uses a weight based method for the initial dose. (Initial dose = 0.25 x ideal weight in kilograms) For a cat that weighs 18 lbs, this calculates out to approximately 4.5u.

The prescription foods you've been using are in the range of what we would call "medium carb" - 13 or 14%. We recommend a low carb diet which is under 10%. Your vet's reaction about the food is odd. I always wonder what a vet would say if you suggested that the vet feed their diabetic infant ice cream and cookies. I think keeping track of Ollie's blood glucose numbers as you change out the food will be helpful. However, if you do switch over to lower carb food, please be careful. You will likely need to lower the insulin dose.

Before you drop the dose to 1.0u like @Bron and Sheba (GA) suggested, please read over our sticky note on dosing methods. What Bron suggested is compatible with the Start Low Go Slow (SLGS) method. There is also Tight Regulation (TR) which is a bit more aggressive about dosing but also has research supporting its use. SLGS was developed here.

Hi @Sienne and Gabby (GA) Thank you for your reply.

I am a bit confused regarding the TR protocol. I thought it was based on ideal weight, which we have been told is 6 kilograms for Oliver. So the initial dose being calculated at 0.25 x 6kg = 1.5 units. I have done some further reading and have found a paper which outlines a starting dose of 0.5 units per kg of ideal both weight could be appropriate given his high readings. Even so, this would indicate a starting dose of 3 units.

How do people normally make the decision regarding which dosing method to use?

Thanks.

 

[Mel Harvey]

Welcome Mel and Ollie
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 10 or 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
Here is a video one of our members made testing her kitty
She's using a pet meter ,but as Bron suggested to get a human meter you won't have to code it like you have to do with a pet meter
VIDEO: How to test your cat's blood sugar

Thank you so much for this information @Diane Tyler's Mom, it is really helpful. When I always thought I would struggle most with administering an injection, testing the glucose levels is causing me much more anxiety :-(

 

[Mel Harvey]

Hello and welcome to the forum! I’m glad Bron stopped by, she has the inside scoop on food and supplies in Australia, along with some good suggestions to get you started. There is a lot of information and lots of people who can help you here. Ollie is a big boy at 8.5kg . I believe that would mean a calculation by weight of just a wee bit over 2u, so the starting dose of 4u by your vet does seem to be overly generous.

Hi @Christie & Maverick, thank you for your reply.

Ollie is indeed a big boy - no chance of not knowing he is there when he snuggles on my chest at night

I have been told by the vet that his ideal weight is 6kgs - I thought the calculation of the insulin dose is based on ideal weight, not current weight. Would love some clarification on that.

So much to learn. So stressful when I am bearing the weight of all of this learning by myself. But if I wait for my family to step up and assist in this regard then Ollie's health would likely deteriorate

 

[Bron and Sheba (GA)]

I have been told by the vet that his ideal weight is 6kgs - I thought the calculation of the insulin dose is based on ideal weight, not current weight. Would love some clarification on that.

here is what the TR protocol says about the starting dose of insulin
How to determine an initial starting dose for glargine or detemir when following the Tight Regulation Protocol:

• the formula is 0.25 unit per kg of the cat's ideal weight
• if kitty is underweight, the formula frequently used is 0.25 unit per kg of kitty's actual weight

So if Ollie’s ideal Weight is 6 kg that is 0.25 x 6=1.5 U twice a day

If you are following the SLGS method:
Starting Dose:

• 1u BID if kitty is not on a wet/canned low carb diet
• 0.5u BID if kitty has been switched to a wet/canned low carb diet

 

[Mel Harvey]

here is what the TR protocol says about the starting dose of insulin
How to determine an initial starting dose for glargine or detemir when following the Tight Regulation Protocol:

• the formula is 0.25 unit per kg of the cat's ideal weight
• if kitty is underweight, the formula frequently used is 0.25 unit per kg of kitty's actual weight

So if Ollie’s ideal Weight is 6 kg that is 0.25 x 6=1.5 U twice a day

If you are following the SLGS method:
Starting Dose:

• 1u BID if kitty is not on a wet/canned low carb diet
• 0.5u BID if kitty has been switched to a wet/canned low carb diet

Thank you @Bron and Sheba (GA)

So the determining factor is now whether we adopt the TR protocol (1.5 units, twice per day) or the SLGS method (3 units, twice per day).

Are there factors which would indicate one method is preferable to another?

Thanks.

 

[Bron and Sheba (GA)]

Thank you @Bron and Sheba (GA)

So the determining factor is now whether we adopt the TR protocol (1.5 units, twice per day) or the SLGS method (3 units, twice per day).

Are there factors which would indicate one method is preferable to another?

Thanks.

The SLGS is 0.5 units if you are feeding wet low carb food or 1 unit if you are feeding dry food. You don’t multiply it by anything. As you are already giving a much larger dose, I would not go back to 0.5 units.

With TR you have to test at least 4 times a day. Once before each dose and at least once during every cycle. It’s a more aggressive dosing method than SLGS. With TR you have to feed wet low carb food.
You can increase the dose each 6 cycles if the BGs indicate you need to.

With SLGS you test before every dose to see it is safe to give the insulin.
You hold the dose for 7 days and then do a curve before deciding if you need to increase. If you are testing quite a lot you might not need to do the curve as the BG numbers will tell you if you need to increase.

It depends what you are going to be comfortable doing …are you at home at all during the day or are you away all day?
If you are not comfortable doing one of the methods you can swap to the other.

 

[Sienne and Gabby (GA)]

I think both Christie and I were assuming the initial weight you gave for Ollie was his ideal weight. You are correct, though, the weight based formula for TR is based on a cat's ideal weight unless the cat is underweight.

To add on to what Bron noted, with either TR or SLGS, you need to test at least 4 times a day. Many of us who follow TR do test appreciably more because the approach is more aggressive. It's more aggressive from the standpoint of the dose reduction point is lower and you can increase the insulin dose sooner. However, what I found that made it appealing is that it is based on published research and has documented results for cats reaching remission. SLGS has been used here for quite some time. It was a dosing method that was developed here. Cats do go into remission with this approach, as well. As for Bron asking if you're home all day, I work full time and worked full time throughout Gabby's life. I used TR. There's actually a post on the Lantus forum about working/going to school and using TR. It is, however, a choice. You can always switch to the other dosing method regardless of your initial choice.l

 

[Diane Tyler's Mom GA]

Thank you so much for this information @Diane Tyler's Mom, it is really helpful. When I always thought I would struggle most with administering an injection, testing the glucose levels is causing me much more anxiety :-(

You're very welcome, you will become a pro in no time
Here is a post by another member with some more testing tips:
https://www.felinediabetes.com/FDMB/threads/9-9-bailey-amps-117-5-62.252712/#post-2851043

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 small pieces of plain boiled chicken
More testing tips below

http://www.felinediabetes.com/FDMB/threads/hometesting-links-and-tips.287/