? New Member - Need Advice, Struggling with Numbers

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Alli and Bub

Alli and Bub

Member Since 2022
Hello All!

After lurking here a while, I finally made an account! My name is Alli and my 11 y/o cat Bub was diagnosed with diabetes in August as a result of being on Prednisolone for his IBD. He's now on Budesonide and Lantus insulin for the diabetes. He was initially started at 1u 2x a day, but that has increased over time to 3u 2x a day. The increases have been made every 2 weeks as advised by the vet after regular glucose curves there.

His numbers have always been kind of all over the place with some very high points, but lately it feels all over the place. For example, the other day he tested low at around 120 (the first time he's been in the normal range since his diagnosis!) so as advised by the vet, I skipped his insulin shot, but at next dosing time, he tested HI (600+)! Today he peed outside the litter box (which has never happened before) and tested at 315. 3 hours later, his BG has gone up to 408 and I'm pretty sure I didn't give him a fur shot or anything by mistake...Hoping he doesn't have a UTI or some other infection...

Food wise, he is on Hill's z/d wet, which I know is high in carbs and would like to change, but I am having difficulty finding a novel protein wet food that is actually in stock and not more expensive than the z/d...

I have the spreadsheet in my signature to give you an idea of his numbers the past two months. Sorry the info is a bit sparse. I am trying to be more regular with testing...

Any advice is appreciated!
 
Hi and welcome to the group. Bub is super cute! We have an ASH named Chester who looks nearly identical to Bub.

So let me tell you, what you are experiencing is super common. We see this story here at the FDMB over and over again because most vets base dosing on pre-shot numbers and curves instead of how low the dose is *actually* taking the cat.

Curves are often not good enough. Especially if being done at the vet, they don't give an accurate picture of the cat's blood glucose and how the cat is responding to insulin. Regular blood glucose testing at home can really tell you so much more. Just four times a day can work wonders!!

I highly recommend you pick a dosing method such as SLGS or TR and so you can apply methodology to dose increases. Those dosing methods work very very well with Lantus in particular and many people (myself included) have seen success using those methods, either complete remission or at least achieving a point where the diabetes is well-regulated. It can be a little overwhelming at first trying to understand these methods but the people here can help you every step of the way! I needed a lot of help, reading those methods just wasn't enough for me, I couldn't quite wrap my head around what to do and when. Thank goodness for the FDMB and the literal angels who spend so much time and effort helping strangers and their cats.

I am no expert, just a guy who went all in on the advice from the experts here, followed a dosing method to the letter, and it payed off bigtime. My boy Hendrick (10 1/2 years old) is now a diet-controlled diabetic feline who no longer needs insulin shots.


You need to allow access to your spreadsheet, it is not viewable.
 
That worked, I can see the spreadsheet now. Are you able to start doing more home testing of Bub's BG? (blood glucose)

Filling in the gaps in your spreadsheet with what Bub's little body is doing during each 12-hour insulin cycle is really important. Take a look at Hendrick's spreadsheet, linked in my signature. I worked from home at the time so I did a LOT of testing but even 1-2 tests between each insulin shot would help a lot in understanding where the insulin is taking Bub and how to adjust the dose.

Lantus works like a "depot" drug in that it forms crystals in the sub-cu fat layer that release over time. When a shot is skipped it can cause a few days of odd numbers until things are back on a regular dosing schedule, so that could explain the 408.

Also, the food you are feeding is really no good for a diabetic cat. I am reading that it is 40% calories from carbs!!! Holy #$%

It is recommended by the experts that you feed your diabetic kitty food that is no higher than 10% calories from carbs. But if you change the food, be very careful, as it can make the insulin need drop drastically and then you are giving too much insulin. I'll let the true experts and gurus chime in further on this.
 
I might be able to test more during a weekend, but I work away from home so I usually can only test and feed when I leave for work and when I get back.

I would like to change the food and am open to suggestions for IBD cats! It seems a lot of the novel protein foods are out of stock or unavailable. Not sure what causes the inflammation, but I've mostly been looking for ingredients without chicken or green pea and possible carrageenan. I mostly have been feeding the z/d because it definitely shouldn't cause inflammation and is readily available.
 
Hi Alli - I also have an IBD kitty, though she does not have diabetes. It's tough to have the two combined!
Has your kitty been doing well on the z/d? I see the protein is hydrolyzed chicken, have you ever tried a novel protein that triggered issues before?
If you have not, the limited ingredient world is your (frustrating) oyster. A lot of foods marketed as novel protein will also have a second source of protein like chicken or turkey snuck in, which entirely defeats the purpose... peas are super common too.

Depending on where you are, these brands may or may not be available, but I found that KOHA has decent LID options that seem to be mostly in stock (or at least they were when I lived in Oregon). Instinct has a couple of low carb limited ingredients - lamb and turkey are LC, the others are too high (including rabbit, surprisingly). Merrick LID has two LC options: salmon and turkey. The trick is to buy a few cans locally to see how your cat does with them, then order them autoship on Chewy (or whatever other pet store you use).

Beyond the typical LID ingredients, some brands like Wellness and Weruva have LC foods that don't mix proteins, and might work for you.

You can check carb contents for a variety of brands with this handy chart: https://catinfo.org/docs/CatFoodProteinFatCarbPhosphorusChart.pdf

Hope this helps! Don't hesitate if you have more questions :D

PS: also I know people from the cat IBD forum swear by the probiotic Visbiome. I have never used it on my IBD cat, she is well controlled with 2.5mg of prednisolone daily, but might be worth a shot after you find a food that works for him (I wouldn't try changing two things at the same time).
 
Thank you for the tips! I appreciate you pointing me in the direction of some brands I can look up and the carb chart!
 
So I just tested his BG after him at the +12 mark after him being high all day and he is at 171. Last time he was low at 120, I skipped the shot, but then his BG shot up to 600+ the next morning. I haven't fed him yet. Should I feed him and give a reduced shot? Wait it out? Not sure how to approach...
 
Late to the party, but.you got great answers!

It looks like she bounced from the lower numbers on the 17th combined with the skip...the effect of high BGs can last up to 6 cycles but she cleared it a little more quickly than that. When they do clear it, it can be a long slow ride.down with nadir near shot time - which looks like it happened twice so far.

You would want to post on the Lantus forum specifically for dosing advice, more experienced eyes over there. The recommendation when starting out is you can shoot anything over 200. if you get a preshot under 200 then stall without feeding for 20 mins, then retest to see if still dropping or coming back up. From there you can either skip, give a partial dose, or give full dose. Depends on numbers, trends, ability to monitor, ability to be off schedule .

Lantus likes consistency, and 177 is pretty close to 200, so more than likely the answer would have been to try shooting full dose if you could monitor and have a hypo kit. If not, a partial dose of some sort would have been recommended. Skip is fine for now though since it's 2 hours past shot time.

Any ketones recently that you know of?

Now the caveat to everything I said above - those doses were raised by quite a bit and fairly quickly, it's possible you passed a good dose. I'll take a few Lantus users for you - @tiffmaxee @Bandit's Mom
 
Good to know I should post these future questions in the other forum!

I ended up stalling and testing again 30 mins later and his BG came back as 121, so I skipped. Just hoping he doesn't shoot back up super high like last time...

I haven't been testing for ketones, but I know around when he was first diagnosed they tested him and he was clear.

+2 hours after skipped dose, he's at 343...
 
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Welcome. Lantus is dosed based upon how low it takes a cat which often is between +4-7. Too much insulin can look like too little. There were not enough mid cycle tests at first. With the limited testing you are doing would you consider following our SLGS method? I see it was suggested earlier. I suggest you take the dose back to 2.5. You need a dose you feel comfortable shooting every 12 hours.

I will link the SLGS sticky. It will be best to start posting on the lantus forum as those of us more experienced help out there. We have a particular way of posting and I will link that sticky as well. It’s not that we are picky, but rather that way we can scan the board and see who might need help.

https://felinediabetes.com/FDMB/threads/posting-guidelines-please-read.
https://felinediabetes.com/FDMB/thr...-low-go-slow-slgs-tight-regulation-tr.210110/
 
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