new thread - vetsulin dosing

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ittybitty said:
How do I decide when to hold insulin or give it / what would you do if he was your kitty? I know if he gets closer to 200 pre shot I could definitely give the .25u but between 140-200 I feel like it's a grey area where I don't know what the right answer is.
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It really depends on your situation, and how well you know when your cat will have his onset, nadir, how reactive he is to the different carb content of food. having the ability to monitor, having your hypo toolkit stocked and ready to go in case you need to bring those BG levels back up.

I don't know the right answer either. You have to learn how Tuko reacts. One saying we have here is ECID meaning Every Cat is Different.

Right now with the low BG levels that Tuko is getting, combined with the fact that you are transitioning him to low carb food, I would not give my cat an insulin dose when he is that low. At least not right now. Certainly not if he is refusing all food. But you have to monitor for ketones, if he is refusing to eat. Because there are serious consequences if he starts to burn his own fat and muscle tissue for needed energy. Ketones can form quickly. A cat not eating for more than 24 hours is serious too, as hepatic lipidosis can develop too.
 
@Deb & Wink

Thanks for the reply! I will continue to monitor his glucose levels and will start back either 0.1 or 0.25 U if they starts to increase (please let me know if you have a better idea!!). He has only refused food on 4/8 PM and he did eat the medium carb FF that I gave that night. Starting the next morning he has eaten his friskies like he was doing previously.
 
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@JanetNJ

He has eaten about 80-90% of meals. The only meal he refused was 4/8 PM and has eaten like normal all other times with the friskies. I'm currently at +4 for tonight and he has eaten 85% or so of his PM meal (only a little bit left) and his 1/4 can snack will open soon in the timed feeder.
 
Tuko, your mama and all of us here are glad that you are eating well again.

If Tuko keeps being up in the mid to high blue range for BG levels (>150mg/dL), you might try to give a very tiny dose of insulin. No more than 0.1U, but monitor closely. I wouldn't give him insulin if he were my cat and his BG level is close to 100-120. Give him a bit more time to settle into not getting any insulin.

The Friskies Mixed Grill flavor used to cause Wink to have slightly higher BG numbers. It's low in carbs, but some cats react to the higher organ content (liver) with higher BG levels. Supreme Supper did the same thing to him, slightly higher BG levels. The Fancy Feast (FF) Turkey & Giblets or the Chicken & Liver or any of the other FF flavors with more organ meats did NOT increase his BG levels.

My point is that the FF pates (roasted/chunky styles too) are a bit lower in carbs than the Friskies pates. Some cats do better with a bit higher carb content, and some cats do better with a bit lower carb content. You'll have to experiment to see what happens with your cat Tuko.
 
@Deb & Wink
Thanks for the guidance! The insulin for >150 is similar to what I have been thinking and I definitely would have given insulin if we started getting close to 200 again. Even the 135 tempted me this morning to give a tiny dose but I knew I wouldn't be home to monitor all day so I didn't. I know we aren't in remission now, but at what glucose level is considered remission?
If I decided to try FF.... Is there any downside to alternating between FF and friskies until I figured out what I wanted to use? Do most people use only the FF classics or do some use the roasted/chunky. I did review Dr. Lisa's food chart again. I have quite a bit of friskies I would want to use but I'm not against trying FF. I have noticed that he seems to eat a little bit more during the night and certain flavors. The one can of chicken/liver that I tried I could definitely tell he wasn't interested at first like he has been with some other flavors.
 
ittybitty said:
I know we aren't in remission now, but at what glucose level is considered remission?
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Normal cat numbers which can be anywhere in the 40-100 mg/dL range, preferably under 100 mg/dL. Symptoms of diabetes going away are another sign of remission. The excessive drinking, peeing, skin condition better, good appetite, grooming, playing, purring. Your cat "getting his groove back". Any diabetic neuropathy clearing up or improving. The rapid weight loss stopping and reversing.

ittybitty said:
Do most people use only the FF classics or do some use the roasted/chunky.
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I used both with Wink. For him, it was more a matter of getting him to realize that the canned food was edible. He was the founding member and president of DFAA, Dry Food Addicts Anonymous, and a hard case to get transitioned from dry food to wet. After he was eating wet food, I introduced more flavors and also fed both FF pate/chunky/roasted and Friskies pates.

For Wink, his favorite food was the FF Turkey&Giblets flavor - sprinkled with crushed Halo Liv-a-Little chicken freeze dried treats. Once he got better at eating wet food, I was scared that he would decide he wouldn't eat that one flavor so that is why I introduced other options to his diet.
 
@Deb & Wink @JanetNJ

If either or both of you have time to look over my SS I would appreciate it. I think we are still doing fine but would like someone with more experience than me to review. I haven't given insulin in 7 days and actually got some green numbers today. He refused food again on 4/12 but I later realized it was the same flavor he refused on 4/8 so I have taken that flavor out of my rotation. Ironically tonight he seemed less interested in the salmon dinner, which I thought he liked. He has done more grazing lately whereas when this first started he would eat as soon as I put the food down. Overall, I think he is eating enough that I shouldn't be worried. Do ya'll find that cats prefer the same flavors repeatedly or variety? I feel bad giving him the same few that he will eat but I don't want to keep trying flavors that he doesn't seem interested in. He also had one vomiting episode that I think may have been started by a freeze dried treat that was too large for him to eat and he was gagging some and then threw up later. He used to throw up hairballs/bile all the time and has only thrown up twice since the switch to wet food and neither episode has been food - just a small (quarter sized) area of white foam and a tiny bit of bile. I feel like now that he is diabetic I worry a lot more about everything he does :confused:.

I will be out of work for about 3 more weeks so if there is any advice or anything I should be doing while I am home with him please let me know. I'm also already worried about how my schedule will work because my AM and PM checks will be 14hrs apart on work days and I can't do anything about it and I won't be able to make sure he doesn't eat before his PM glucose check because I won't be home.

Thanks so much for your help along this journey!!
 
ittybitty said:
I'm also already worried about how my schedule will work because my AM and PM checks will be 14hrs apart on work days and I can't do anything about it and I won't be able to make sure he doesn't eat before his PM glucose check because I won't be home.
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Relax. You do what you can. You have to work so you can buy more cat food and catnip and toys! Plus pay the rent and utilities, buy groceries for you and all sorts of other needs. Don't sweat the later test time in the PM after you go back to those long work days.

Have you thought about using a timed feeder? Something like the Petsafe 5? So he could have a meal say 2 hours before you get home, but then the PM BG check would not have much if any food influence. Just a thought.

Not only are those mid-day greens good, but Tuko's pre-shot tests are in the very low blues. That is FANTASTIC! Yeah Tuko!!!!!

ittybitty said:
He has done more grazing lately whereas when this first started he would eat as soon as I put the food down. Overall, I think he is eating enough that I shouldn't be worried. Do ya'll find that cats prefer the same flavors repeatedly or variety?
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Grazing is fine. By not wolfing down his food immediate when you put it down for him, Tuko is telling you he feels much much better and isn't starving all the time.

I always liked to mix it up with the food flavors, but if I only had Fancy Feast Turkey & Giblet flavor, I think that Wink would have eaten that flavor for years and years with no issues.

p.s. Tuko is on an OTJ trial by the way. OTJ means off-the-juice, insulin being the juice. We usually say 14 days at numbers < 100 mg/dl. Tuko is well on his way to being there. He may need a bit longer on the trial, since he's had a few high numbers at your pre-shot test times. Without insulin on board, he can't go to low. So no need to worry about those green BG numbers.
 
@Deb & Wink

Tuko would agree with more toys - he is in love with his catnip banana. :) I honestly hate that I had never gotten him one. He has always been the cat that refused to play with actual cat toys but would go crazy playing with a q-tip.

While he is not getting insulin, when should I expect his lowest glucose levels to be throughout the day? I've also been a little surprised that his glucose levels after PMBG haven't been lower than they are.

I have the Cat Mate C200 timed feeder that I have been using for the +5 1/4 can. I could feed a little less with the AM/PM meal and do two small meals/snacks instead of one between the main meal. The tricky thing with him is even though it opens at a certain time, he may wait an hour to eat it.

That makes so much sense about his grazing now... I didn't think of it as he isn't starving. I was getting worried since he wasn't eating as much as soon as I put it down. But you are right - he is still eating just not SO hungry the minute I put the bowl down.

We would be so happy to stay OTJ! :D Fingers-crossed that this lasts!
 
ittybitty said:
While he is not getting insulin, when should I expect his lowest glucose levels to be throughout the day?
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Pre-shots should be low. And the +3 to +4 is usually lower, because that is after the "pre-shot" meal will have spiked the BG levels and come back down again. Off insulin, the normal +5 to +7 time is when cats off insulin also normally have their lows.

Paws crossed here for Tuko also.
 
@JanetNJ

@Deb & Wink

Just checking in again. Tomorrow makes the 14th day with no insulin :D! We aren't completely in the greens yet but it does keep getting better.
A few questions...
- I should keep testing as I have been until we have 14 days of AM and PM BG <100. Is that correct? Do blues during the day matter?
- Should I keep doing mid cycle tests even though I'm not giving insulin? And if so, what would be the most beneficial testing time? Try to catch the lows or highs after meals, etc?
- Lately he has skipped his +5 daytime (1/4 can) a few times.... I'm not sure if he just isn't hungry or he is being picky about the flavor or what. Is this anything to worry about or as long as he is eating something we should be okay? (I'm not sure he didn't find something in the kitchen :eek: as to why his 4/16 and 4/19 glucose levels were elevated.) He also seems to eat more at night and try to bite/claw/push the timed feeder around to break into it before it is scheduled to open even if he still has PM meal in the bowl. :rolleyes:
- Would the petsafe 5 rotate to where he couldn't access food in those 2 hrs before the AM/PM BG check? The timed feeder I have opens at the desired hour but then remains open where he could access the food indefinitely.
- I know I've asked this before - but he still has not touched his water bowl that I can see. I am adding water to his meals, I assume this is enough and he will drink if he is thirsty? It's SO different from seeing him drink constantly to never drink from water bowl.

Thanks again for all the help!
 
The testing is up to you. We usually recommend 14 days (28 cycles) for an OTJ trial,with numbers in the greens consistently. Numbers should be <100 mg/dL at "pre-shot" test time. If the BG is in the blues at the pre-shot test time, then test again after feeding but wait until the +3 to +4 time to test. If the BG at the +3 to+4 is lower than the pre-shot test, it tells you the pancreas is producing some insulin and has lowered the BG's from the food spike.

Ideally, you would have all greens, even at mid-day. Some very low blues, <120 can happen now and then and be acceptable. You do NOT want any high blues, any BG over about 130. That says something is going on. Perhaps an infection (think UTI or dental issues) or something.

If Tuko were my cat, I'd keep testing, since Tuko has had some higher blues. You want a STRONG remission.

When cats go into diabetic remission, diet controlled status, they don't need as much food. Wink went from eating around 11 ounces of food at the beginning to more like 5.5 to 6 or 7 ounces of food. ECID so a larger or smaller cat would need more or less. So no, I would not worry if Tuko skips his +5 daytime meal.

I can't help you with an answer on the Petsafe 5 and how it works. You could try using the Search function here and reading a few of the threads that come up.

When I switched my cats to wet food from dry, they rarely drank from the water bowl. It was a notable event to see one of them lapping up water.
 
So exciting! When my cat was in remission I tested once or twice a day for a while, then about 3 times a week for a month, then like once or twice a week after that. she did come out of remission after a year, so it's important you don't become lax and stop testing all together. If you start seeing the numbers creep up, then test more often.
 
@JanetNJ

@Deb & Wink

Just checking in after another week. We are getting even more green on the SS. Not sure if I can officially call us OTJ yet. I do plan to continue testing - I finally found a great deal on strips/lancets and stocked up! That 129 on 4/29 - he was in living room/kitchen - I didn't see him get into any contraband but it might have happened.

I have noticed dandruff which I searched the site and read up on some other threads.

I also feel like he is peeing more than he has been. If his glucose levels are fine is there anything I should worry about? I do add plenty of water to his food (it's pretty soupy) and he doesn't drink extra. At this point, I'm not even sure that I know what a "normal" clump of wet litter size should be since that was one of his major symptoms in the beginning was so much pee.

Thanks for any advice!! :)

Edited to add: after I posted this I went to empty his litter box and there was a clump of wet litter less than half the size of what I've emptied yesterday & today. It was the smallest one I've seen in a while!
 
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ittybitty said:
At this point, I'm not even sure that I know what a "normal" clump of wet litter size should be since that was one of his major symptoms in the beginning was so much pee.
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What is a normal sized litter clump, for a cat that does not have diabetes or kidney issues and not getting sub-q fluids?
I'd say 1 1/4" to 1 3/4" diameter is more normal. I'm basing that on my 2 new non-diabetic cats, that pee about that much, several times a day. I do feed them both wet food with water added and some dry food. (Hopefully I'll be able to transition them to all wet food, but they still like the dry too. At least it's Dr. Elsey's chicken flavor.)

Dandruff = dry skin so many people add some type of oil to their cat's diet. Brushing to distribute the natural oils in the fur can help too. Try a natural bristle hairbrush when you brush your cat. Hope you found some other useful info with your search.

Another possibility for Tuko peeing more and having a slightly raised BG level is that he has some sort of infection/inflammation. Think UTI, URI, bad teeth, etc.
 
@Deb & Wink

When you say "slightly raised" do you mean because his AMBG and PMBG are usually close to 100/under 110 or because he had 126 once. I think my only concern is his peeing and it is larger than 2" for sure. I'm going to try to track how often he is going while I am still home with him. This may sound silly but I thought about weighing the urine clumps, I don't know if that would help me at all other than knowing how consistent it is. I know he didn't go at all overnight last night so this morning it was a larger amount. He is acting like his normal self - no reason to suspect URI, just saw the vet 7 wks ago and he said teeth were fine (although I've read there can be underlying issues and he didn't do xrays or anything). I hate to put him through anesthesia/cystocentesis again to rule out a UTI. Do you think it's reasonable to continue to watch this for a bit? I also thought about putting less water in his food to see if that made a difference, what do you think? I still have his water available if he wanted it.

I'm also planning to try to add some FF flavors because I've realized I've been feeding him what he likes and it's too much fish/seafood. Then I can see how he does with the lower carb as well.
 
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I added less water to his food (and started using FF last night) this AM and he has had much less urine/smaller balls of litter. He didn’t pee overnight and has gone 3 times today and it’s 3pm. I’m not sure if there is such a thing as adding too much water to his food?!
 
ittybitty said:
When you say "slightly raised" do you mean because his AMBG and PMBG are usually close to 100/under 110 or because he had 126 once.
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By slightly raised, I mean that any BG numbers over 100 to 110 mg/dL are in that category. Ideally, you want Tuko to stay in the green BG levels. A bit of meter variance may be creeping in when he has those higher blue BG readings.

ittybitty said:
I’m not sure if there is such a thing as adding too much water to his food?!
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Some people make the food very soupy, like half food, half water.
I only add a teaspoon or so to 1/2 a can of FF wet food. That seems enough to me for my cats.
So you need to experiment with Tuko to find what he likes.

If there is any dry food in the mix, cats will often drink more water. ECID, so not every cat drinks more when on dry food.

The Fancy Feast (FF) foods are slightly lower in carbs than the Friskies. So that could bring Tuko's BG levels down a bit more overall. Since Tuko is not on insulin, there is no danger of him going hypo, so don't get worried if his BG numbers drop into the 60's or lower.
 
@Deb & Wink

Thanks! I think I was more towards very soupy and maybe he was eating/drinking it all to get to his food. I’m going to continue a little less water and see if that continues to produce normal sized pee clumps in his litter box. The ones today were about 1/3 of the size of what they have been.

We did get into the 70s today! I will be happy to continue to see lower numbers! :)

I did order the petsafe5 feeder to start using when I go back to work because I'm worried that he will keep eating and when I check it at night it may be food influenced. Since I will have more available slots to feed him from - is there any benefit to breaking his meals into more small meals or just continue what I have been doing? One primary AM and PM meal and a smaller snack at +5 AM & PM ?
 
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ittybitty said:
Since I will have more available slots to feed him from - is there any benefit to breaking his meals into more small meals or just continue what I have been doing? One primary AM and PM meal and a smaller snack at +5 AM & PM ?
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I think that continuing what you are doing is working well for now.
 
Thanks! @Deb & Wink
I’ll probably use one for a few freeze dried treats while I’m gone. My main goal in swapping was making sure he couldn’t eat in those 2hrs before BG checks!
 
@Deb & Wink

@JanetNJ

Do y’all think these 100-110s are anything I should worry about or meter variance? One time I got 105 and rechecked and got 95 but as bad as I want an all green SS... it’s not worth using extra strips and getting another blood drop from his ear just to recheck all the blues. Any other advice to get Tuko any lower or just keep giving it more time? I’ve had mostly greens but a few blues. I did indicate on the SS where I switched to mostly FF.

Thanks!
 
ittybitty said:
@Deb & Wink

@JanetNJ

Do y’all think these 100-110s are anything I should worry about or meter variance? One time I got 105 and rechecked and got 95 but as bad as I want an all green SS... it’s not worth using extra strips and getting another blood drop from his ear just to recheck all the blues. Any other advice to get Tuko any lower or just keep giving it more time? I’ve had mostly greens but a few blues. I did indicate on the SS where I switched to mostly FF.

Thanks!
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There is no difference between a 95 and a 105.
 
I'd be happy with those green BG numbers and an occasional blue BG here and there. In general, I'd say that Tuko is doing better when he is getting the lower carb Fancy Feast foods. At least his BG trends have been a bit lower since you started to add the FF to his diet.

I think this may be remission for Tuko, diet controlled status. So he is always a diabetic, but diet is keeping the BG levels low.

Here are some tips to stay OTJ (off-the-juice, insulin being the juice)
1. Never feed dry - not even treats. (freeze dried is ok, Dr. Elsey's chicken flavor dry is ok for some cats.) If you change wet food types, be 100% sure the new food is also low carb and same low carb % as your current food. Some cats are very carb sensitive and an increase from 3-6% to 8-10% can spike the BG’s. Don’t feed if you aren’t sure!
2. Weigh every 2 weeks to 1 month to watch for weight changes. Too much of a weight gain can cause loss of remission. Too much of a weight loss alerts you to other issues, such as hyperthyroidism.
3. Measure blood once a week, indefinitely if possible. You want to catch a relapse quickly. Some people only do checks every 2 weeks to a month. BG checks can sometimes alert you to other issues.
4. No steroids or oral meds with sugar - remind your vet whenever giving you any medication. Always double check. (Steroids may be needed for other medical issues. But remind your vet your cat is a diabetic, diet controlled.)
5. Monitor food intake, peeing and drinking. If increasing, a sign of losing remission. Or another medical condition like Hyper-T or kidney disease.

6. Regular vet checks for infection such as dental , ear or UTI. And get them treated quickly!

7.Continue to ketone test even if your cat is OTJ. Ketones can develop if the cat’s pancreas is not producing enough insulin, or burning off too much fat if your cat is not eating properly and other reasons.


If your cat does fall out of remission you need to be more aggressive and resolve issues/ back on insulin as soon as possible as the window for a second remission is tight if any. Pancreatitis, hyperthyroid, dental issues are the most common reasons cats fall out of remission.

"Once a diabetic, always a diabetic." They are simply diet controlled.

Congratulations!
 
@Deb & Wink

@JanetNJ

Thanks for the replies!

@Deb & Wink
I think that was what I was meaning with my original question- I knew we wanted <100 for 14 days so I was trying to figure out if these low 100s were a problem or keeping us from being considered OTJ for now. I agree- we have seen better numbers with the FF and he likes it. I actually tried to give him a can of friskies (even his favorite flavor) and he wasn’t very interested.

I couldn’t have done this without y’all! Thanks SO much!! :D
 
ittybitty said:
I couldn’t have done this without y’all! Thanks SO much!!
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You are more than welcome.

Pass what you have learned along to the next person that needs help. Even a few words of encouragement are good. Pick one new person, and see what you can do to help. "Paying it forward."
 
@Deb & Wink

A few more questions..... :)
I'm really trying to get his food/flavors sorted out. I have pretty much completely switched to FF. The one time I tried to give friskies he wasn't interested at all. I have read how a lot of people limit/exclude fish. But I've also read where liver shouldn't be a frequent item either. I know I was giving WAY too much fish when I used the friskies. He does good with FF beef, chicken, beef/chicken, beef/liver, chicken/liver. Not as interested in turkey/giblets but does eat it. I've only given FF oceanfish once and he didn't seem interested (there are a few more FF "fish" flavors I haven't tried yet). On catinfo.org - she states to stick with poultry (chicken/turkey) as the bulk of the diet and lists that beef can be an allergen for some cats but many do fine with beef.

1. So, my main question is - if beef is working fine for him it should be fine to continue, right?
2. And should I limit the chicken and beef that contain liver? I hate to limit liver/beef/fish and then be left alternating turkey and chicken only.
3. Do most people recommend a fish routine (once/week?) or completely excluding it? (I did read the reasons on the site of why she doesn't recommend feeding fish at all.... just curious what the general consensus is on here.)

Also, I've had days like 5/18 & 5/19 where he barely ate 3oz total during the day. It seems that he always eats more at night and less in the day.
4. I'm not sure if this is common, he's more bored at night, not sure if his glucose could be lower at night even though he isn't on insulin, or since he is in lower numbers he just isn't as hungry!?!

Thanks!!
 
1. Yes, beef is fine if it does not upset his digestive tract.
2. I would not limit the foods with liver in them. Cats need the organ meats for a balanced diet. I've never limited the amount of food containing liver with any of my cats.
3. Feeding fish is up to you and your cat. Some cats are addicted to fish and won't eat any other cat food flavors. Personally, I'll give my cats fish flavored food occasionally. But the Friskies pate foods all contain some amount of fish, so one of my new cats is getting some fish every day.

I have a friend with a 19 year old cat, and that cat only eats fish flavored foods. I think when a cat gets that old, let them eat whatever they want.

4. Is Tuko maintaining his weight? That is the important consideration, with him not wanting to eat much some days. I would not worry about the occasional day of diminished appetite.
 
@Deb & Wink

Thanks so much!!

And based on weighing him on scales with me holding him (and weighing both of us) he hasn’t lost or gained since diagnosis. I think I’ve only had 2 days that he ate that very limited bit during the day...
 
@Deb & Wink

Just checking in. I’m concerned about all the blues I’m getting for PMBG although I don’t know what to do because AMBG is still too low to give insulin (I think). I got sick with covid and was unable to keep up my daily routine of checking his glucoses (even though we were OTJ I liked having the data and he seemed to do better when it was consistent). When I started back checking- I’m noticing more blues than I had (though most are barely over 100 there’s a few higher). He is still acting normal, eating good, peeing the same (I think it’s still more than what you had described in an earlier post but there have been no major changes). I don’t know whether to assume this is within meter variance and don’t worry or if there could be something to it since he went so long with greens. Just looking for some reassurance.. thanks!
 
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Krista, you have to take care of yourself first, so you are able to help others. Sorry to hear you got covid, but hope you are on the mend.
I’m not particularly worried about Tuko getting those low blue BGs. I think he’s still in remission.

If you are worried about those blue BG numbers, then if you are able to, try to take a BG level three or four hours after the blues and after his meal. Just to check to see if Tuko’s pancreas is working and he’s bringing down the BG’s on his own.

If those +3 to +4 BG’s are in the green then I would not worry at all if Tuko were my cat.
 
@Sienne and Gabby (GA)

Thanks! I’m now about a month from symptom onset and things seem to be close to normal, still not 100% back though. To have been young and healthy it sure knocked me down but I also had barely gotten over mono that was diagnosed in March. SO thankful we were one of the lucky ones to get OTJ pretty quick with some wonderful help/advice I received on here! I’m not sure I could have handled all of that with insulin dosing too :eek:
 
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