shadycat
Member Since 2012
Hello, I was here years ago with my kitty Shady who went into remission pretty quickly but unfortunately passed with lymphoma 6 years ago at 14.5 years old. Now I am back with my 17 year old Ella. She was dx a month ago and is more difficult than Shady to test, adjust diet, etc. I'm a little confused what may have brought it on, if it matters- in late January she had a small amount of vomiting followed by not eating at all for a couple of days and barely eating for about 5 days. She was on Cerenia and appetite stimulant for about a week and slowly went back to normal. From a GI bloodwork panel, my vet said she had had pancreatitis, something on the bloodwork indicated that? and also early small bowel disease which she went on low dose prednisolone for, but weaned her off the prednisolone when she was dx with diabetes. At first I thought the steroid might have brought on the diabetes but then I realized, she had pancreatitis, if that damaged her pancreas that could have caused the diabetes.
In April I noticed her drinking more, but she also has kidney disease so she drinks a lot anyway. The beginning of May I tested her blood sugar at home and it was in the 500s. Went to the vet and it was 600+. To complicate things that is part of my problem- I basically have 2 vets now. My regular vet is a mobile vet, but when I called her about Ella's blood sugar, she said she didn't keep insulin in stock and would have to order it, and also couldn't have Ella all day to do a curve (which I didn't want to do at the vet anyway), but anyway said I should go to another vet to get her started on insulin. The new vet started her on 2u Vetsulin 2x daily and I was supposed to do a curve at home, but was not successful. Ella is very difficult to test, so they put a Libre Freestyle on her. I have attached her spreadsheet, but her numbers were all over the place. Generally high, but once got down into the 100s. I'm not sure what may cause the difference in nadirs, if it is what/how much she eats? I always feed her pre-shot but sometimes she doesn't eat much. The Libre failed after a week instead of the two weeks it is supposed to last.
Based on her numbers during that week, the vet wanted to raise her dose to 3u 2x/day. I was not comfortable with that much of a jump, especially because they were going to wait a week to put another libre on and knowing I am not able to home test her easily, so I went up to 2.5u. A week later they put another Libre on, I had planned to go up to 3 u once we got the Libre on as long as her numbers weren't too low, but when I saw her nadirs were usually in the 100s I thought that was too much and stayed with 2.5. Her bg is still all over the place, sometimes the nadir is in the 100s, sometimes the 300s, and this Saturday she got right at or slightly below 50. I had been out of town for the morning and was very upset to see that, I gave her some dry treats immediately, but she was acting normal. After that I went back down to 2u that night, but then back up to 2.25 or a hair below 2.5 since then.
Part of what is hard to navigate is the two vets situation, the vet who puts the libre on and prescribed the insulin likes to use Vetsulin, and Prozinc would be her second choice. Our regular vet who has never put a Libre on and doesn't seem like she wants to start (even if she did, I'm not sure I would want Ella to be her first case), prefers Glargine and Prozinc as a second choice. It seems like the Vetsulin raises and lowers Ella's BG so quickly- from what I have read, Glargine would be longer action, is that correct? and Prozinc is similar to Vetsulin or maybe not quite as fast? So I wonder if she would be better off on Glargine. My regular vet is willing to prescribe it but she seems kind of hesitant about wanting the other vet who put the Libre on to be on board with it too, but that vet doesn't seem to use glargine much, any time I've mentioned it, she says it is too soon to switch, or if we did that Prozinc would be the next option. I don't know what to do. I could ask my regular vet to rx glargine if that would be better, but Ella is extremely difficult, almost impossible to home test, so I still need the new vet to put the Libre on, and not sure if she would want to if she isn't treating her anymore? Maybe.
Her diet is mostly wet food but the type in gravy (fancy feast grilled and elegant medleys)- I know this is high carb, but she will very rarely/almost never eat pate. I also give her dry treats to get her to sit still for shots, tried freeze dried chicken and salmon but she doesn't like it. So her diet is not low carb but I don't think I would be successful changing it.
I am open to any and all advice or observations on dose or insulin type, and anything else that may help. I need to call the vet(s) soon about her dose after she got so low this weekend. If I want to switch insulin I feel like I should soon while this Libre still has a week left on it, unless I get another put on. Edit to add that she seems to sleep and be lethargic more than usual- that is kind of hard to gauge too, at 17 she was not super active. But seems even less so now. So I worry she is feeling poorly with her extreme blood sugar ups and downs.
Thanks!
https://docs.google.com/spreadsheets/d/1mZheK9_JPaZJBHBsJJwHn-F8pyzHDB7nf-k5YDL3ac0/edit?usp=sharing
In April I noticed her drinking more, but she also has kidney disease so she drinks a lot anyway. The beginning of May I tested her blood sugar at home and it was in the 500s. Went to the vet and it was 600+. To complicate things that is part of my problem- I basically have 2 vets now. My regular vet is a mobile vet, but when I called her about Ella's blood sugar, she said she didn't keep insulin in stock and would have to order it, and also couldn't have Ella all day to do a curve (which I didn't want to do at the vet anyway), but anyway said I should go to another vet to get her started on insulin. The new vet started her on 2u Vetsulin 2x daily and I was supposed to do a curve at home, but was not successful. Ella is very difficult to test, so they put a Libre Freestyle on her. I have attached her spreadsheet, but her numbers were all over the place. Generally high, but once got down into the 100s. I'm not sure what may cause the difference in nadirs, if it is what/how much she eats? I always feed her pre-shot but sometimes she doesn't eat much. The Libre failed after a week instead of the two weeks it is supposed to last.
Based on her numbers during that week, the vet wanted to raise her dose to 3u 2x/day. I was not comfortable with that much of a jump, especially because they were going to wait a week to put another libre on and knowing I am not able to home test her easily, so I went up to 2.5u. A week later they put another Libre on, I had planned to go up to 3 u once we got the Libre on as long as her numbers weren't too low, but when I saw her nadirs were usually in the 100s I thought that was too much and stayed with 2.5. Her bg is still all over the place, sometimes the nadir is in the 100s, sometimes the 300s, and this Saturday she got right at or slightly below 50. I had been out of town for the morning and was very upset to see that, I gave her some dry treats immediately, but she was acting normal. After that I went back down to 2u that night, but then back up to 2.25 or a hair below 2.5 since then.
Part of what is hard to navigate is the two vets situation, the vet who puts the libre on and prescribed the insulin likes to use Vetsulin, and Prozinc would be her second choice. Our regular vet who has never put a Libre on and doesn't seem like she wants to start (even if she did, I'm not sure I would want Ella to be her first case), prefers Glargine and Prozinc as a second choice. It seems like the Vetsulin raises and lowers Ella's BG so quickly- from what I have read, Glargine would be longer action, is that correct? and Prozinc is similar to Vetsulin or maybe not quite as fast? So I wonder if she would be better off on Glargine. My regular vet is willing to prescribe it but she seems kind of hesitant about wanting the other vet who put the Libre on to be on board with it too, but that vet doesn't seem to use glargine much, any time I've mentioned it, she says it is too soon to switch, or if we did that Prozinc would be the next option. I don't know what to do. I could ask my regular vet to rx glargine if that would be better, but Ella is extremely difficult, almost impossible to home test, so I still need the new vet to put the Libre on, and not sure if she would want to if she isn't treating her anymore? Maybe.
Her diet is mostly wet food but the type in gravy (fancy feast grilled and elegant medleys)- I know this is high carb, but she will very rarely/almost never eat pate. I also give her dry treats to get her to sit still for shots, tried freeze dried chicken and salmon but she doesn't like it. So her diet is not low carb but I don't think I would be successful changing it.
I am open to any and all advice or observations on dose or insulin type, and anything else that may help. I need to call the vet(s) soon about her dose after she got so low this weekend. If I want to switch insulin I feel like I should soon while this Libre still has a week left on it, unless I get another put on. Edit to add that she seems to sleep and be lethargic more than usual- that is kind of hard to gauge too, at 17 she was not super active. But seems even less so now. So I worry she is feeling poorly with her extreme blood sugar ups and downs.
Thanks!
https://docs.google.com/spreadsheets/d/1mZheK9_JPaZJBHBsJJwHn-F8pyzHDB7nf-k5YDL3ac0/edit?usp=sharing
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With Vetsulin, you want to take a 0.25 reduction if they drop below 90, so I would reduce the dose back down to 2.25u. You also want to be cautious because the Libre takes a different kind of BG reading than ear pokes, and I believe the reading you get from it is delayed. As long as you are seeing the mid blues on the 2.25 I would not increase the dose. The high numbers you are seeing look to me like a combo of bouncing, which I described above, and the insulin just wearing off. Unless she drops below 90, I would hold that dose for 7 days. If she drops below 90 at any time, reduce again by 0.25u. What is your feeding schedule like for her? One thing that helped my cat when she was on Vetsulin was feeding a small snack at the onset which for her was +2. This can help slow down the huge drop, which is one thing that can trigger bouncing.
