New to FDMB-weird curves-rebound?

Status
Not open for further replies.
hollymayb

hollymayb

Member Since 2010
Hi Everyone,

My name is Holly & DH is Sean & DB cat is Max (7 yrs, 11.5 lbs) & civilian Leo (4 yrs, 14 lbs). Max was diagnosed a month ago, and we still don't have him anywhere near regulated. We're worried, confused & frustrated. Please help if you can. I'll try to be concise while including all the pertinent info.

Long story short, Max showed all the signs of DB, but we didn't put it all together until his hind legs became weak. Vet did full blood panel, ex-rays & urine, the only problem was BG of around 480 (no ketones). The vet put Max on Lantus, starting at 1 unit, twice a day & asked us to do a curve. After an unsuccessful home curve (we were having problems getting samples) we had the vet do one in the office. This is all within the space of 4 days. The vet's idea of a curve was to pump him full of insulin until his BG was within the safe range (14 units in 1 day), and told us to give him 5 units, twice a day, and had us up to 6 units, twice a day, about a week after diagnosis.

After the shock of the diagnosis wore off, I started doing some research online, and found that our vet was going about things much differently than was recommended by this site & others. After witnessing what we now think were a number of small seizures, we confronted the vet about his recommended dosage, and asked if Max might be experiencing Somogyi rebound. The vet didn't know what that was. Max tested as low as 60, and as high as 460 in the same day.

We stopped seeing the vet, & interviewed some others. Unfortunately, all recommended a high fibre diet, and didn't know what a rebound was. We decided to go rogue. Maybe not the best idea, but it seemed to us that our vet's advise could kill our cat, so we couldn't do much worse for now, until we find a better vet.

We have him on a very high quality low-carb (grain-free) kibble (now!), with high protein wet food when he gets his shots (1 Tbs). We reduced his insulin to 2 units, twice a day but quickly increased to 3.5 because we were scared by the high readings (490ish). We did a full curve with readings every hour after 2 weeks @ 3.5 units twice a day.

We decided to raise his insulin to 4 units twice a day because he still wasn`t getting low enough at his nadir. We did another curve yesteday, but the results were not looking good. (I`ll attach below) We know advise can`t replace a vet, but we can`t see an alternative right now. Our best option for a new vet is a clinic 1 hr away, and we will try it if we can`t get Max regulated soon. Symptom wise, Max has made a remarkable recovery- his eating & drinking habits are back to normal, and his personality is back to being the sneaky but lovable guy we hadn`t seen in so long. His rear legs are still weak though.

Any advise is greatly appreciated!! Do you think we have him on too much insulin (are we seeing a rebound?) or too little? I know some of you will say we need to stop guessing and take him to a vet, but we've already spent $2000 in vet bills, not including DB supplies, and even if we knew of a knowledgeable vet, we can't afford to go for another couple weeks. This morning we backed him off to 1 unit, and his AMPS was 21.2 (381).

Thanks in advance,
Holly, Sean, Max & Leo
 
First, welcome to the site.

Next, you are saying your vet gave Max 14units of insulin in one day? OK that is NUTS.

So, nice ss you have set up! It's good you have that going.

What about starting from scratch? Start Max at 1unit BID and leave it at that dose, following the protocol many use on this site?
Tight Regulation Protocol

With Lantus, there's a shed, and you likely have alot in there so it might be an idea to go down in dose, drain it, and work your way up slowly to find the right dose for Max.
It could very well turn out to be 3unit BID, more or even less, but the way to find out would be to START LOW AND GO SLOW. You will then not miss the perfect dose for Max.
LANTUS & LEVEMIR – INSULIN DEPOT –AKA- STORAGE SHED

And the vet that gave Max 14units of insulin ... scratch that vet and get one that will not be taking such drastic actions that could harm.

Here are some more links for you:
Binky’s Food ListsIf
get rid of the dry foods. All bad.

Profile Creation
New to the Group
List of Hypo symptoms
 
Just to elaborate on what Gayle said -

Dump the vet - idiot in my opinion

Dump all dry food and any prescription foods

Start over with 1 unit and give it time to work and settle in, then with our help, we can adjust accordingly.

Also, you don't have to make yourself or your cat crazy by testing every hour of each day.

How about, for next cycle - you start over with 1 unit, and get the following tests in - +2, +6, +9.

And for the cycle after that again 1 unit and try for a +2, +4 or 5 and +10.

In the beginning with data collection, the idea is to vary the times you test - however a +2 is always a good test to get, so we can see how the insulin is working.


And post here daily, one posting (or condo) per cat per day. Make your subject look like the others - so it will read something like this:

6/20 Max AMPS 381

And as you get a test in, edit the subject line to include the new test and post a reply as well, this will bump it to the top of the page - if you only edit your first post then it won't bump to the top.

Hope this helps.
 
Thank goodness you did your research. I haven't a clue what your vet was thinking about but that vet could have killed your cat or had you induce a hypoglycemic crisis at home. That said, welcome to Lantus Land. I suspect we can do much better by Max and help you to feel confident in managing his diabetes.

If you are looking for a vet, I'd suggest mentioning here and opening a post on the Health board indicating the city and state/province where you live. If people have a vet they can recommend, they will give you suggestions. There are many people here who have fired their vets because, well, they weren't offering competent help. Or, like with my vet who is great, recognizes that I've accumulated a great deal of information about feline diabetes and I'm following a protocol that has current veterinary research to support its use. (The only thing she tells me is that I test too much and I laugh at her!) With the advice your now former vet has given you, if you wanted to follow that vet's recommendations, I think I can safely say most of us would be working very hard to convince you to go "rogue" or to find a vet that knows considerably more about managing feline diabetes.

The dosing protocol that's in Gayle's link (i.e., Tight Regulation Protocol for Lantus & Levemir) recommends a starting dose that's based on ideal weight:
(dose = 0.25 x kg ideal weight)​
If Max's 11.5 lbs is close to his ideal weight, his starting dose of Lantus would be 1.25u. Would you be open to starting over? We encourage a start low, go slow approach to dosing so that you find Max's optimal dose in a safe and progressive manner. In this way, the likelihood of hypoglycemia is minimized.

We would strongly advocate getting rid of the dry food. Even the better quality dry foods play havoc with blood glucose (BG) levels. They hang around in the system for a long time. Please take a look at the website on feline nutrition. It's author, Lisa Pierson, is a vet with a particular interest in feline diabetes and is a strong proponent of a species appropriate diet. She writes convincingly (IMHO) about the myths associated with feeding dry food. (We also have spreadsheets that we can link for you of kitties here who transitioned off of dry - including high quality dry - onto canned food and the difference the diet change made on their numbers.)

Lantus dosing is not typically changed on a day to day basis. Doses need to be held in order for dose changes to be established and for you to evaluate their effectiveness. This is how a depot drug works. I am concerned that as Max's shed builds, you may see a big drop in numbers due to the high starting dose. You're already seeing more numbers in the 200 range. Lantus does take patience. Don't expect miracles overnight. This is a long acting insulin and it will not drop BG numbers immediately. If dosing is done safely, numbers drop incrementally.

I also want to encourage you to get at least one, if not more tests, in the PM cycle. Many cats have lower numbers at night. You could potentially miss a dose reduction by not testing at night and, you are missing half of your data without PM tests. At the minimum, please get a test in every night before you go to sleep.

Please ask questions. We're here to help. Visit our condos (it's what we call our threads -- one condo, per cat, per day) and look at our spreadsheets -- it's a great way to learn. Post often. And again, welcome.
 
Hi Holly, Welcome to FDMB! You have come to the right place for help and advice. Many people on this board have had similar experiences with vets who don't understand Feline Diabetes, much less know how to treat it (but pumping in 14 units of Lantus to establish a curve may top them all!!). The suggestions given above are to start Max over from scratch. The initial dose might need to be adjusted, but our dosing experts will be able to figure this out if you keep your spreadsheet up to date. The timing of the shots (every 12 hours) is important because Lantus likes consistency. If you follow the protocol (see the informational "sticky"--New to the Group), you will gradually work your way up to Max's ideal dose. When you need help, just ask. There are many knowledgeable people on this board who will help you with dosing issues. Those of us not so knowledgeable can offer help and support in other ways. Don't worry right now about 'going rogue' without a vet. Many of us have done just that when it comes to Feline Diabetes. If Max has other medical problems, by all means see a vet, but unless you are able to find one who understands FD, it's much better to stick with this board!
So, again, welcome to you, Max, Sean, and your civvie Leo. Post every day and if you need dose advice or have a "panic" situation, put a remark to that effect in your subject line. Someone will be along shortly!

Ella & Stu
 
welcome to Lantus Land!

The others have said it all. I hope you will stay with us. I'm sure we can help you get this figured out.
 
Hi: Welcome to LL. You have been given all the information necessary here. We have all been at the point you are at. I personally would have a dead cat without this board. Now, she is on OTJ trial. My only comment is Tuffy does not do things normally but, I've had all the help I need here. Good luck, don't get discouraged it is a lot of information to digest. Also, I agree on ditching the dry. It is all high carb or too many carbs for a diabetic kitty. Also, if you would fill in a profile and check in with Kathy and Kitty and Lantus Land Roll Call and provide her your information that would be great. Good luck.
 
You've already gotten excellent advice. I'll add that you need to test before every shot and try to get spot checks done within every cycle - the idea is to get the pre-shot number plus a number that's as close as possible to nadir, for every cycle. Of course, many of us can't get all that because of work, sleep, etc., but we do the best we can. Doing curves on the weekend or whenever is important too, especially in the beginning when you're trying to figure out when your individual cat's nadir is. Don't test every hour, though, every two to three hours is plenty.

Agreed that you need to go back to 1 unit and start over, increasing by no more than 1/2 unit no more often than every three days. It's all spelled out in the protocol you've been given links to. Try not to worry too much about the high numbers you're seeing - it's normal for it to take weeks or even months to get good regulation. I know first-hand how frustrating and stressful the process is, but if you follow the protocol you will reach the right dose and see those numbers come down, promise.

And agreed that if at all possible the dry food should be discontinued. There's no dry food that's as good for a diabetic (or any cat, really) as a decent low-carb canned food. Unfortunately this includes even the high-quality dry kibbles marketed as low-carb.

The high-fiber diet some vets recommended to you is old-school advice based on treatment for diabetic dogs. Cats do best with a low carbohydrate diet of canned food. Someone gave you the link to the Binky's Food Lists but here it is again: http://binkyspage.tripod.com/canfood.html You can also get a good idea of carb content by reading the ingredients - if anything like wheat gluten, corn starch, etc. shows up in the first six or so ingredients you know it's got too much carbs.

Unfortunately many, many, MANY vets know next to nothing about treatment for diabetes in cats. Frankly I don't understand this. Many discourage home testing, some don't know what kinds of insulin are best, way too many don't know how to calculate dose or what role diet plays. If you ask here on FMDB someone may be able to recommend a good vet for you, but frankly in this situation you can do fine using a vet only to give prescriptions for insulin and syringes and getting advice here for dosing until you feel confident making your own decisions.

Oh, and you should look into getting syringes with half-unit markings. From your spelling I suspect you're not in the USA, but hopefully it's still possible for you to buy them online - it's pretty hard to find them in a local drugstore. You may also be able to buy test strips and even insulin online at a better price. I can get strips in particular at half the price online as at a drugstore.

Oh oh, and you should look into getting Methylcobalamin for Max, for his weak back legs. It's a form of vitamin B-12 that helps heal the nerves that have been affected by high blood glucose and many FD cats have benefited from it. If you can get capsules you can sprinkle the powder inside on his food - if all you can get is tablets you can crumble them and mix them in his food. I think 5 mg a day is the usual dose. Just make sure it's Methyl B-12 and not another form.

BTW, I also have a civvie named Leo!
 
HI Holly,

Happy Father's Day to Sean and welcome to Lantus Land to you and Max. I'm very new myself, so won't be offering much advice...except to say TOSS THE DRY FOOD! It's unblieveable how even a small amount of dry food can mess up the BG. Meadow was given a very small amount of Innova EVO dry by my husband the other day and her BG levels went into the red. We're still trying to get her regulated on Lantus, but the dry definitely affects the levels. Also want to make sure you test before each shot. Meadow had a BG of 42 one morning and had I not tested her and blindly given the shot, she may have gone hypo on me. There were a few times I shot without testing, but that was before I found this group and was going by what friends were telling me they did with their diabetic cats.
Can't tell you how knowledgeable and supportive the group is here. They have kept me from totally losing my mind many times and help me through some stressful times.
Good luck to you and Max.
 
Hi Holly and Max. Wow you guys have had quite the trip already. I've been around quite a while but have never heard of what your vet tried before. Max is one very lucky kitty to have a Mom who knew when to question what is obviously very bad advise.

The others have given you excellent advise. I agree starting over is really needed here. By the way where are you located? You mentioned your kitty's sugar was 21.8. Are you from outside the States by any chance. If you let us know your approximate location one of our members may be able to recommend a vet for you.

Welcome and hang in there. Better days are ahead.
 
Thank-you all for your excellent advice, warm welcome & support!

We've started Max back at 1 unit, twice a day, and will document our pre-shot tests. As we both work full-time and have an hour long commute, it's going to be difficult to get very many extra readings each cycle. We'll do our best, and do another curve next weekend to see how he's doing on the change of dosage.

Max is full of energy today! He really looks well, and is very affectionate. He keeps jumping over to his testing table and giving us 'the look'. (The look says 'hurry up already and test me so I can have a treat!!!!!)

We're going to look into wet food, but we're not sure we can afford it. The canned food we use now is $1.50/can for 3 oz, and our boys would need 2 tins each per day, and frankly, I spend less to feed us humans. If we can't swing the wet food, I'll look into home cooked meals and do a little research. Does anyone cook for their cats? Does anyone recommend a less expensive, but high quality wet food?

Barb- We're around Vancouver, BC, Canada. Any neighbours?
Camille- Thanks for the B-12 tip! My pharmacist does pet compounding, so I'll check with him! Syringes with half-unit markings?! That would be fab!
Sienne- Thanks so much for the dosage information- we'll look into how to measure that.
Hillary- That timeline for testing is very helpful!
Gayle, Ella, Libby, Barbara, Meadow, and anyone I've accidentally missed- thanks for all your wisdom and words of support!

We have a lot of reading to do, so I'll sign off. Have a great evening!

Holly, Sean, Max & Leonidas (King of Sparta)
 
Holy moly! That's expensive food you are feeding ... is it gold plated???

I feed mine friskies and get the 5.5oz cans and lost of the bigger13oz cans. The small ones I get when on sale for 3/$1 and the big cans are 99cents.

Binky’s Food Lists

Keep in mind that there are many cats that are diet controlled and you won't see that happening by feeding dry foods.

Look through the above link and you can do even like I do ...print out a copy of the sheets and take them with you when shopping.

There is no way I could afford the price you pay ... Oliver eats up to 30oz a day!

I do feed him raw chicken chunks; he loves it so much that I would like to get him onto a raw diet ... just need to find the supplements to add to the raw and we will start. There are some links around for raw diets but I have to look them up.

I am still shuddering at that first vet you mentioned; I wonder how many animals he has harmed?
Don't worry about tests during your work days; lots of people cannot test until evenings and weekends.
My commute is an hour one way so most days I test then am out the door. Often I get home shortly before their pmps. I get at least the before bed test , and do any curves on the weekends.
The 3 most important tests will be your amps, your pmps, and your before bed test.
 
There are quite a few Canadians here. Off the top of my head, I don't know if there's anyone from Vancouver.

Many of the people here feed either Fancy Feast or Friskies. Both have low carb (LC) varieties and are a reasonable quality food. If you want the high priced spread, Wellness comes in larger cans and may be more economical in the bigger sizes. You will want to stock up on Fancy Feast in the gravy varieties that are high carb (HC). We use the gravy (in the grilled and marinated varieties) to steer low numbers. It's important to have several cans on hand at all times. Janet & Binky's list also has a page for what foods are available internationally.

I feed primarily a raw diet and give Fancy Feast as snacks. I purchase a pre-mix of supplements so Gabby and my civvie get a nutritionally balanced and appropriate raw diet. I buy skinless and boneless chicken and grind it myself and then freeze 1/4 cup patties. I have a grinder attachment for my mixer but you could probably use a food processor. I use Feline Future's Instinct premix and it's available in Canada.

Many of the people here work full time. And you're right, getting in tests can be challenging. Since it's not likely to be possible to get tests in during the day, do what you can during the PM cycle. You may also want to consider getting a timed feeder. It's been invaluable for me with making sure that there's food during the day when I'm not at home.
 
Gayle, can you tell me why the before bed test is one of the most important tests to get? That reading would be at the +4 or +5 mark (for me anyway), the same as when I would take a reading in the morning after AMPS. Are the readings I would get overnight that much different from the daytime readings? I may just have to set my alarm for every 2 hours during a night when I have no work the next day to see what her BG's are then. Just trying to understand the dynamics of all this still. ;-)

Gayle and Shadoe said:
The 3 most important tests will be your amps, your pmps, and your before bed test.
Click to expand...
 
Obviously the 2 tests needed above all would be the amps and pmps.
The others are all going to contribute to your knowing what you kitty is doing with the insulin.
Many go low at nite or overnite, and usually by +3 or +4, you are seeing some reaction to the pm shot.
There are times that the numbers drop alot, or enough to be a concern, so it is good to see what's going on before bed and limit the amount of time that you are not monitoring. Many cats do not show any signs of being low; I have tested Shadoe a few times and found her green and that's a worry. If I had not tested, I would not have known and would not have been able to feed her to try and raise her numbers. That's why it's a good idea to test just before you go to bed.
What if you tested and got a number in the 50s? I bet you would want to stay up and see if you could bring up Meadow's numbers, right? And then you would go to bed relieved. There are a few people around here who could tell you about their sleepless nites and they never would have known if they had not tested before bed. Nobody wants to wake to a kitty who's had too low numbers while they slept. I keep thinking Randi/Max had some low nites.

Sure it may still happen while you sleep but why miss an opportunity to fix the problem before it happens. We can't test when we are out or working or sleeping, but when we are there, it's best to check.
 
Hi again, Holly,

I just began to order from http://www.petfooddirect.com Prices are fantastic. Service is extraordinary. I checked their info. page and they also ship to Canada, but you have to place your order by phone: (this is from their frequently-asked questions page) "Do you ship to Canada?
Yes, but you must place your order over the phone. Call us toll-free at 1-877-PET-FOOD (1-877-738-3663)"

Good luck. I was able to get a case of 12 6-oz. cans of By Nature 95% Turkey and Turkey Liver (Stu's favorite food) for US $7.21. This is an extraordinary savings over the price in shops. The food was on sale, but even the normal price was cheaper than shops. And you can set up automatic shipments and get 15% savings. check them out!

Ella & Stu
 
Wow! Thanks everyone for your food suggestions!

We've been supplementing Max & Leo on 'Wellness' canned cat food, which must contain gold filings or something judging by the price. We'll have to print out that list of wet foods & their nutritional values & hit up the pet food store. We're also really concerned about where the food is manufactured, and where the ingredients are sourced. We're not buying anything made from ingredients shipped from overseas. I'll do a bit more reading & let you guys know what we decide.

Max's reading have been in the red all day. Should we be worried or is this just what happens while he's adjusting to the new dosage? As I mentioned before, he seems to be doing well, and the only notable change is a slight increase in appetite.

Thanks, & g'night!

H, S, M & L
 
Max's reading have been in the red all day. Should we be worried or is this just what happens while he's adjusting to the new dosage? As I mentioned before, he seems to be doing well, and the only notable change is a slight increase in appetite.
Click to expand...
it's really too soon to tell much about the 1u dose since max is coming off a higher dose. continue posting every day. let's give max's body a chance to adjust before making any more dose adjustments, k?

in the meantime, please check his urine for ketones... daily if possible. let us know right away if max shows even a trace of ketones.


you've already received tons of excellent advice. just wanted to stop by to say hello and welcome to the group!
hope to see you posting often...
 
Hi Holly

Just wanted to welcome you to the group...and another Max kitty :mrgreen:

The only thing I can add is that Lantus likes consistancy, so just keep at it, and try not to bounce the dose around.
 
I see your point, Gayle. Makes a ton of sense. Since my guys eat dinner around 6-7pm, they usually get a small snack right before I hit the sack around 11pm just so they aren't sleeping on an empty tummy. My habit was to test Meadow before bed anyway, so I am glad I was doing it right. :)
Thanks for the explanation!
 
Holy Crap!!!
Welcome to LL and you have the most awesome help here!!!
I too am only diagnosed since April 19, and Doodles is also 7, but not as big :-D
I too am doing this ALL with the help of these awesome people!!! My vet had her on all the wrong food and Humilin N. Although I am working to change her mind :-D
Doodles is her only patient on lantus. I keep her updated on doodles SS, but that's about it.

I do know how over whelming this is...but it does get better, you start to learn the language, the weird bounces...all I can say is document, document, document. I keep a seperate food journal. This way you will know what works and what doesn't.

The food is huge, I got my binkey's list and hit WalMart, they have great sales FF (fancy feast) 30 cents a can.
No dry food at all!!! It was a transition for her brother (biological, DB free) but they are the better for it for sure!

You can do this!!!! And I'm so glad your kittie is feeling better today. I think starting from scratch is the best way! 14U in one day holy sh*t, I'm freakin just hearing that!!!!
I know I won't take Doodles back into the vet, it was awful, it took her 3 days to come out of her funk. The testing is really important ECID (each cat is different) and will help with dosing. You are
in great hands like I said with all these wonderful sugar kitties and beans!!!

Will check on you later and welcome you saved your cat!!!!!

I just lost a very loved Walter (guenia pig) because my vet gave me the wrong advise!!! I'm still upset about it! This was one week before Doodles diagnosis. Needless to say I'm glad I'm here, my friend Lori saved us and introduced us to lantus....I'm one happy bean!
 
Holy Crap!!!
Welcome to LL and you have the most awesome help here!!!
I too am only diagnosed since April 19, and Doodles is also 7, but not as big :-D
I too am doing this ALL with the help of these awesome people!!! My vet had her on all the wrong food and Humilin N. Although I am working to change her mind :-D
Doodles is her only patient on lantus. I keep her updated on doodles SS, but that's about it.

I do know how over whelming this is...but it does get better, you start to learn the language, the weird bounces...all I can say is document, document, document. I keep a seperate food journal. This way you will know what works and what doesn't.

The food is huge, I got my binkey's list and hit WalMart, they have great sales FF (fancy feast) 30 cents a can.
No dry food at all!!! It was a transition for her brother (biological, DB free) but they are the better for it for sure!

You can do this!!!! And I'm so glad your kittie is feeling better today. I think starting from scratch is the best way! 14U in one day holy sh*t, I'm freakin just hearing that!!!!
I know I won't take Doodles back into the vet, it was awful, it took her 3 days to come out of her funk. The testing is really important ECID (each cat is different) and will help with dosing. You are
in great hands like I said with all these wonderful sugar kitties and beans!!!

Will check on you later and welcome you saved your cat!!!!!

I just lost a very loved Walter (guenia pig) because my vet gave me the wrong advise!!! I'm still upset about it! This was one week before Doodles diagnosis. Needless to say I'm glad I'm here, my friend Lori saved us and introduced us to lantus....I'm one happy bean!
 
Status
Not open for further replies.
Back
Top