New member question

[Ramon's mom]

I recently joined and have a few questions. History: My cat Ramon became diabetic a year ago due to steroids for his pemphigus condition. We switched him to a different med (Atopica), put him on glargine and DM dry food and he went into remission within 6 weeks. For the following 6 months I had him on diet foods, mostly dry, at the insistence of a vet "nutritionist" because he was overweight. Not surprisingly in July 2018 he became diabetic again and has remained so since then. He was put on glargine again which never got his numbers under control (I home test with Alphatrak and occasionally do curves under the supervision of a vet that doesn't seem to know what to advise me about all this). In November I was sent to an Internal Medicine vet specialist. November 19 -28 he was put on glipazide but then his numbers went up, so as of Nov.29 he was put on Prozinc. My spreadsheet here starts with the Prozinc days.

I am curious what others here think of his numbers so far. The Internal Medicine vet specialist says his numbers are acceptable. She has even told me I don't need to test every day and only do a curve once a month. She said she tracks cats by their urine output and weight. She hasn't discussed food at all. He is addicted to dry food and is currently getting some DM dry, and some canned Fancy Feast and raw rabbit. I have other cats on Young Again Zero Carb dry but he is resisting that and also resisting stopping dry in general. I notice in items posted here that most of you feel that only serving canned food is essential

I'm confused about whether I should be trying to get his numbers in the green 100's and how to do that when my vet tells me the 200's are okay and that I should stick with the 1 unit Prozinc 2x a day without needing the test. Also do I need to be concerned about making sure he eats often? Thanks for any advice you can give. I have been reading stuff here but am confused about what my goals should be with Ramon.

Here is his spreadsheet: https://docs.google.com/spreadsheets/d/1LSUZl27z78QQ0a-Mz_phQeU-upmbn87WMRr1a1Y2PLc/edit?usp=sharing

 

[Kris & Teasel]

Welcome! You've had the same experience with your vets as many of us have had: feed dry food, no need to test often, be satisfied with what we regard as relatively high BG numbers, etc. It's very hard to go against all that advice, especially when coming from a veterinary specialist like an IM vet.

I am curious what others here think of his numbers so far.

Ignoring that AM pink yesterday, the numbers you have for your curve on 10 Dec are quite good. I would recommend a tiny dose increase to 1.25 units. You have to eyeball that on your syringes. It's easier if they have half unit marks but still possible without. At low dose levels like Ramon's we don't change dose by more than 0.25 u at a time because it's too easy to jump past a good dose.

He is addicted to dry food and is currently getting some DM dry, and some canned Fancy Feast and raw rabbit.

We recommend a diet of only canned/wet low carb food. Under 10% carbs as fed is best. Fancy Feast pate style foods are fine and raw is excellent but needs to have a good vitamin/mineral supplement added to it. Many cats arrive here as kibble addicts but most can be switched over gradually. We can give advice on that.

I'm confused about whether I should be trying to get his numbers in the green 100's

Ideally you aim for a nadir in the dark green range on our spreadsheet, more toward the high end if using a pet meter like the AlphaTrak because it reads higher than the human meters most of us use (to save money on the cost of test strips). Gathering test data and logging it on the spreadsheet is all geared toward having a reference to look at in order to follow the dosing methods we use here. You'll see Ramon's patterns over time, how he reacts to a particular dose, what he does when a dose is changed (dramatic or moderate response), etc.

I should stick with the 1 unit Prozinc 2x a day without needing the test.

We're very test-driven here because it's the best way to remove the "mystery" from Ramon's progress and it's the only way to know if a given dose is doing the work you want it to do while still being safe. Here's the most basic testing routine we recommend:

1. test every day AM and PM before feeding and injecting (no food at least 2 hours before) to see if the planned dose is safe
2. test at least once near mid cycle or at bedtime daily to see how low the BG goes
3. do extra tests on days off to fill in the response picture
4. if indicated by consistently high numbers on your spreadsheet, increase the dose by no more than 0.25 u at a time so you don't accidentally go right past a good dose
5. post here for advice whenever you're confused or unsure of what to do. This is useful: http://www.felinediabetes.com/FDMB/threads/hometesting-links-and-tips.287/

Also do I need to be concerned about making sure he eats often?

Many vets will say feed only twice a day but most of us feed several small meals a day. It's more satisfying to the kitty and can help stabilize the BG. As the testing steps above say, remove all food for two hours before the pre injection BG tests so you know what the BG is without it being raised from food.

I have been reading stuff here but am confused about what my goals should be with Ramon.

Many people arrive here wanting to get the kitty into remission, either the first time or again if that happened in the past. It can be harder second time around. That goal can require more aggressive dosing, more testing and so on. Some kitties will go into remission quite readily. Most do not. Achieving decent regulation of BG is a worthwhile goal. This means - ideally - BGs in the low to mid 200s at pre shot time and nadirs in the high double digits to low 100s. Most kitties can get there at least some of the time. A hard thing to grasp for many of us is that diabetes is a very dynamic disease and insulin response can and will vary quite a bit day to day. There's no perfect dose that, when reached, will be the magic dose for that kitty all the time. That's why we test a lot here.

Ask a ton of questions. There's much more advice we can give!

 

[Djamila]

Hi there, and welcome! I'm just chiming in to say hello. I agree with Kris about the dose change (and everything else, really). She's given you lots of great advice already.

I will echo her comment about the expense of the AT2 strips. It's totally fine to keep using it if that's your preference, but just know that using a human meter is just fine (and much less expensive). Welcome to you and Ramon. I'm sorry you have to be here, but I'm glad you found us!

 

[Rachel]

Good morning! I also agree with what Kris said. I think a dose change will help nudge the numbers down a bit. I'm really just here to chime in with a welcome as well! Please do ask all the questions you want. We all remember what it was like when we first started here and it can be overwhelming!

 

[Ramon's mom]

Thanks. Tonight I plan to try the dosage increase. I waited because I was switching form Alpha Trak strips to Freestyle Insulinx strips (1/3 the cost) and wanted to get through a few cycles. Mostly they work but I have had a few that were way off or didn't register anything at all. Anyway, has anyone tried to use a U-100 syringe (converted) to get the 1.25 dose? I can't really see how I can eyeball that on the U-40 syringe.

 

[Rachel]

Yes we have! We often use the u100 syringes along with this Conversion Chart. Then you can do much smaller dose increments which can help a lot. For u100 needles, you want 3/10ml capacity with half unit markings. You should be able to get them at most human pharmacies (sometimes you need a prescription I think...) or from ADWDiabetes, which is where most of us order from I think.

As for eyeballing it, you just do the best you can. Try practicing with some colored water maybe...pull up to halfway, then let a bit out until you get to what looks like halfway between. You can keep the syringe with the colored water to compare your insulin doses to. Being exactly at 1.25 isn't as important as doing your best and being consistent with it.