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bri4937

bri4937

Member Since 2014
Hello. My cat Phoenix and I are new to the group. Phoenix is a 1.5 year old female calico. About a month ago she started losing weight and then about a week and a half ago she became lethargic. This was a big deal because she is usually running around the house throwing anything she can find off the counters and chasing her toys. We didn't suspect diabetes because of her age, but when we tested her, her levels were over 400. Immediately started her on lantus. She went 1 week on it, and the lowest reading we ever got was 275 and that was around a +5. Just increased her from 2u to 3u yesterday. Her numbers always seem to be between 330 - 430 no matter when in the curve I take them. Waiting on blood work to come back today to see if there is anything else going on. Her sister has an auto-immune disorder, so I suspect there may be more going on. I joined the group because, eventhough it's only been about a week, I am feeling discouraged with the lack of response I am seeing from the insulin. Has anyone else had these type of results? Does anyone else have a cat who was diagnosed young? The vet said it's not common and that she may have had it her whole life.
 
Welcome! You've found the right place!

My first concern is that raising 1 unit at a time is a lot. Most people raise .25 to .5 a unit at a time. Going from 1 unit to 3 units on Lantus in a week is too quick of an increase.

Have you had a chance to read the stickies at the top of the page? They outline the 2 protocols that we follow here: Tight Regulation and Start Low Go Slow. Neither calls for an increase of that much that quickly.

Others will be along and give you some fantastic advice. I would recommend you go back down to 1 unit and hold it for 5 days. It's possible you're giving too much insulin, Phoenix's blood sugar is dropping too low and bouncing too high to compensate.

I'm headed on a long drive but will check in with you when I get home!

~Suzanne
 
Hi and welcome. I love calico cats and have an 8 yr old female - sister to my sugar cat.

Is that 2 u once a day or twice a day? My vet started me at 1 u once per day and then 2 u twice a day - so 1u to 4u. This was such a bad idea as I did start to see good numbers but he bounced back into high ones every day. Most here would encourage you to start at 0.5 to 1u twice a day and build up from there if necessary. My vet was telling me I would likely go to 3u bid (twice daily) as he was still having high numbers. But too much insulin can look the same as not enough. Most vets aren't fully experienced in knowing how to dose a diabetic cat as I found out to my cost. I concur with what Suzanne said. I would back it down to 1u and let him settle on that.
 
Hi bri (can you tell us your name?) and welcome to the L&L forum,

You will be sure to get lots of help here. I agree with Suzanne that you need to return to 1 unit and let the 1-unit dose settle. Lantus is a "depot" insulin, which means that it builds upon the dose (i.e., it is not an "in and out" insulin). It takes time for what we call the "shed" or "depot" to build it's reserve. Until the shed is built--usually about a week--you will not see Phoenix's blood glucose numbers improve. This is a very good reason not to raise a dose too quickly, and not to raise it by too much. Please do read the "stickies" at the top of the forum. They are very specific with regard to when, and by how much, to raise the dose.
There have been several young cats on the forum, even a kitten. I would have to go back and look in the old board (we just changed software and everything here is new to everyone), but maybe someone will be able to comment now.

Best of luck and a big WELCOME.

Ella & Rusty
 
Just dropping in to say hi and welcome. I'm glad you joined because you will learn everything there is to learn about FD and educate your vet before long. When you get a chance I suggest you read the stickies as Ella has suggested. My vet didn't have me come back to check Max's BG for 5 days and we started super low for his size.
 
Hi and welcome aboard.

In order to get a little more background information may I ask what food you are feeding Phoenix? Is it dry or wet and what is the brand name.

When taking blood glucose readings have you taken a preshot and pre food reading along with the other readings? What were they? Most people here record the numbers they are getting in a spreadsheet that can be shared online. Would that be something you could do? Here is the link:

http://felinediabetes.com/FDMB/thre...te-a-ss-and-link-it-in-your-signature.130337/
 
My name is Brianne. Thank you all for the advise! I have read the stickies and downloaded a spreadsheet to start recording readings. After seeing the numbers in the spreadsheet I am even more convinced she is probably getting too high of a dose. My vet has seen a lot of diabetic cats, but none have even chosen to use lantus due to the cost. I am going to back off to 1 unit twice a day and see where she is after 5 days.

Food: Phoenix was eating 1/2 cup twice a day of purina one indoor hard food and 1.5 oz of purina one canned food in the evenings. (her sister is on atopica for her auto immune disorder and gets it mixed in with the soft food) As of Sunday evening she is getting 1/2 cup of hills w/d dry food and still gets her soft food in the evening. As I am reading I am learning that this may not be the best food for her, but it was what the vet recommended. What have you found works best for your cats?

I have taken several readings over the past week or so. I have linked a spreadsheet with the numbers I had recorded. I took more readings and also had readings from the vet, but didn't get them recorded in the cautious of Christmas. They have been pretty consistently between 330 - 430. I have only had one reading below 300. I will admit my readings have not been as consistent as I would like because I am unable to take them myself. Phoenix is a young, energetic cat and is tired of having her ear stuck, so she fights it. I know this can raise her reading, so we try to do it as quickly and painlessly as possible.

Her current weight is around 7lbs and she has never been overweight. She started to gain a little weight at about 8 months at which point I started regulating her food. The vet said this may be why we didn't see symptoms until now.
 
Welcome to Lantus/Lev Land!

Being a bit of a data hound, I'd like to see Phoenix's spreadsheet (SS) before making any comments about dose. At the moment, we can't open your SS. If you look at the top right corner of your SS, there's a blue box with "Share" written in it. If you change the setting to "anyone with the link" and I think you have to fill in the URL for your SS, we'll be able to click on the link in your signature and open the SS.

Generally, most of us have started with an initial dose that's based on a kitty's weight. (That's why people asked about Phoenix's weight). The formula is:

initial dose = 0.25 x ideal weight in kilograms​

So, if Phoenix's healthy weight is 7 lb, her starting dose would be approx. 0.8u (somewhere between 0.75 an 1.0u). Another factor to consider is that it takes about a week for Lantus to accumulate in your cat's system (this is called an insulin depot) and for your cat to begin responding.

A big contributor to the high numbers is what you're feeding. For a diabetic kitty, you want carbs to be below 10%. Most of us probably feed around 5% give or take. The pate style of Purina One canned foods are very low in carbs (between 2 - 5% depending on the flavor). The Hill's on the other hand, please don't give that to a diabetic cat. The canned version of W/D is 25% carb and I have no doubt that the dry is even higher. If you want more info on feline nutrition, Dr. Lisa Pierson's website is wonderful. She also has an extensive list of canned and raw cat foods along with nutritional content in this food chart. There's a low carb food to choose from at every price point.

If you are going to eliminate the dry food, it is important to reduce the insulin dose. Because the carb content is so high an you're giving a hefty dose of insulin, if you take away the carbs, you could end up with a kitty in low numbers. Either transition out the WD slowly or definitely reduce the dose.
 
I think I have fixed the spreadsheet now. Sorry I am new to google drive.

I contacted purina about the canned food I have been feeding. I feed a couple different flavors, but the one showing the lowest carbs seems to be purina pro plan whitefish & salmon classic. Purina said Purina® Pro Plan® brand Cat Food – Finesse™ - Adult Ocean Whitefish & Salmon Entrée – Classic will have 0.50% carbohydrate. However, on Dr. Pierson's chart it appears to be 2%. Would it be reasonable to switch to only feeding this canned food? She is not a picky eater, that's her sister. She has only been on the w/d since sunday, but the food she was on before was around 31% carbs.
 
Your spreadsheet opens just fine! Thanks.

Any of the Pro Plan pate style foods are fine. It's the one's that have "gravy" that tend to be higher in carbs. FWIW, most of us don't give our cats a steady diet of fish. There are issues of mercury and some cats develop crystals on an all fish diet.

I switched my cats to canned food cold turkey (so to speak). BUT, if you switch over to a low carb (LC) diet, you MUST reduce the amount of insulin you're giving. There's no way to know exactly what the carb/insulin interaction is. For safety reasons, eliminating a very high carb (HC) food necessitates reducing the insulin dose. I'd drop Phoenix back to 0.75 - 1.0u.

I would also suggest that if you eliminate the dry food and reduce the dose, you also plan to always get a pre-shot test and at least one test during both the AM and PM cycles so we can tell where Phoenix's numbers are heading. If you are having trouble testing an energetic young cat, there are a couple of techniques we an help with (e.g.,burrito wrapping, clothes pins, using the arm of a sofa). In addition, are you giving Phoenix a treat every time you test? Many of us use freeze dried chicken as a treat.
 
A lot of us use Fancy Feast Classics pate. My fussy two will ONLY eat fish and have had nothing else the past 8 yrs and have come to no harm.
 
Hi Brianne, and welcome to LL! Your SS works now! :) I'm sorry to hear that your sweet little girls has had to join in the sugar dance. You've gotten lots of great advice so far. Lantus is a great insulin, but it requires patience! It usually takes 5 to 7 days for the initial shed to get filled and actually show how the dose is working. Also every time a dose is change ist can take up to 3 day for the new shed to balance out.

The .50% that Purina gave you was probably the As Fed number, the % of carbs in the whole can of food. Dr Lisa's lis removes the water from consideration and gives the % of calories derived from the carbs. It's a much more accurate way to calculate the carbs.

We have lots of tricks to use to get cats to accept the testing. To name just a few:
  • Get her used to having her ears handled even if you don't test. Often cats just don't like to have their ears held for the test, the poke itself doesn't bother them, but touching the hairs inside the ears "tickles". And give her a treat for allowing you to play w/ her ears.
  • ALWAYS give a treat when you test! Even if you didn't manage to get blood, give the reward. She will come to associate testing w/ treats very quickly. Most of us use freeze dried single protein treats, usually chicken.
  • Warm her ear before testing. An old sock filled w/ uncooked rice and microwaved for a few seconds. Just hold it on the ear to warm it up (the blood will flow better), theput it under the ear for support when you give the poke.
  • ALWAYS lavish praise and scritches for her cooperation!
Believe it or not our cats often sit and purr right through the testing!
 
Thanks for all the great advise! I now plan to switch to an all canned food diet and reduce the insulin to a .8 unit dose. I will try to get in as many readings as I can and try some of the techniques suggested. I have been giving her food as a treat after every test and praising her afterward. I will try an actual treat to see if that gets a better response. Getting blood hasn't been a problem even though I have been using small gauge needles. She has always been a very dramatic cat. Anything new that is brought in the house she is scared of for a couple hours. Once my husband laid tow straps on the floor and she tip toed around them for several hours.
 
Welcome, Brianna and Phoenix!

My Michelangelo was diagnosed at 6 months old so I know how much of a shock this can be, not to mention the testing! I feel you on that one. Testing was probably the hardest part for us in this Sugar Dance, so much so that I wrote up this document on ear testing psychology to share with others what worked for us.

Phoenix is quite young for being diagnosed. The majority of young cats and kittens have "transient" diabetes, meaning something else has caused them to become hyperglycemic. Usually, it's an infection of some sort or previous steroid use. Once whatever is causing the higher numbers is cleared, they go into remission. Rarely, there is an underlying medical condition that is causing the diabetes and the cat might not go into remission at all. Even more rarely, they're just born with it (like my Mikey). The odds are in your favor that Miss Phoenix might go into remission.;)

It's interesting that you mention her sister's auto-immune disorder. Do you think she might have something similar? What other tests did the vets run?
 
Can we get a few more details in your signature to help us give feedback?

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I have wondered whether she may have some type of auto immune disorder associated with the diabetes. Her sisters disorder presented through the skin. Shortly after I got her she developed an issue with her eye. Despite multiple eye drops it just wouldn't get better. She then began to lose her hair. We biopsied it and it came back as pemphigus foliacious. I think it would be a really big coincidence to have both sisters have unrelated rare disorders, but we will see.

Got the test results back and there is no indication of thyroid involvement. They did a cbc and blood panel, and while it came back with several abnormalities, the specialist said it can all be explained by diabetes. She did have a strange lump removed about two months ago. We sent it off to be analyzed and it came back with inflammatory cells, but nothing cancerous. They did further staining, but could find no indication of anything to cause an infection. We are stumped as to what it could have been. She did have a steroid injection at the time, but it was a mild dose and was also treated with an antibiotic. For now we are just going to try to get her regulated and then rerun the blood work to see where the levels are at.
 
That's curious about the lump. It might be the steroids, it might be an undetected infection. Did they check her teeth and mouth? There were a couple of young cats that had bad teeth (IIRC, one of them broke a tooth and another had some sort of infection). I've never heard of pemphigus foliacious before, but googling it shows that it's restricted to the skin, so I doubt it would affect the pancreas and/or BGs, unless it can cause infection of some sort or pain? Maybe there's another related genetic defect?

One other thing that may or may not pertain to you, but with Mikey, he's always been highly sensitive to dose increases/decreases and to this day, I can't increase/decrease by a full .25u (I have to "skinny" or "fatten" it up). So, as you're adjusting the dose, keep in mind that you may have to do so on a very slight scale.
 
Steroid shots alone can cause diabetes. It's not uncommon for cats that have steroid-caused diabetes to be able to become diet-controlled and go off of insulin, but we never know which cats will do that or which won't. It doesn't matter up front because the goal is the same regardless of the cause of the diabetes: to get the cat's blood sugar first below renal threshold (200ish) and then into normal range (50-120). When kept in that range, the pancreas has the possibility of healing. Even if a cat doesn't go off of insulin, that protects the cat's body from the damages of high blood sugar.

I agree with everything Sienne said. If you are getting rid of the dry food (which is likely a significant cause of her high numbers), I'd drop the dose, probably to 0.75u and hold it there for 5-7 days while the dust settles. We mostly adjust doses in 0.25u increments, so you might want to eyeball 0.75 as best as you can (or go with 1.0u) instead of trying for a 0.8u. If you've got 0.8u and you're trying to increase by 0.25u . . . well you might go a little crazy. You've got a small kitty - 2u might be appropriate with a dry food diet, but not once the dry food is gone. The dry food carbs may take a day or so to work out of her system, and then you should see the BGs come down.

Do you have u-100 syringes with half unit markings on them? They're pretty essential for Lantus users.

Punkin had a growth in his mouth that when removed, turned out to be inflammatory cells as well. We thought it was going to be cancer, but nope. thankfully. They said it could've started from something even like a splinter.

It sounds like your vet's directions were from experience with other insulins, where you check at preshot and adjust the dose based upon that number. Lantus dosing is different and it can take some effort to wrap one's head around it if the person is used to dosing with older insulins. Lantus dosing is based upon how LOW the dose gets a cat. Not the preshots, which are typically the highest times during the 12 hour cycle.

Here's the information for a cat beginning on Lantus:

"General" Guidelines:
  • Hold the initial starting dose for 5 - 7 days (10 - 14 consecutive cycles) unless the numbers tell you otherwise. Kitties experiencing high flat curves or prone to ketones may want to increase the starting dose after 3 days (6 consecutive cycles).
  • Each subsequent dose is held for a minimum of 3 days (6 consecutive cycles) unless kitty earns a reduction (See: Reducing the dose...).
  • Adjustments to dose are based on nadirs with only some consideration given to preshot numbers.
You're off to a good start. You've found the right website and folks here do feline diabetes 24/7/365. Keep asking questions and we'll teach you what you need to know to help Phoenix!

and welcome to the group, brianna. :)
 
Welcome Brianna & Phoenix!! Looks like you guys have an abundance of awesome advice, so we just wanted to say HI and Happy New Year! :woot:
 
bri4937 said:
Switched Phoenix's food to the canned low carb food and dropped her to 1 unit. Her +4 reading today was 199!
Click to expand...
Brianna, that's awesome! Now you see just what a difference a simple food switch can make!

If you can, grab a +6 or +7 test. That will be around her nadir and you can see how low that 1 unit is dropping her.

Great job, Phoenix!
 
Nice!! Seeing that blue must feel great for both you and Phoenix.

I'm going to be a bit of a nag about housekeeping details.

You've done a great job getting your SS up and running. The big task is to not forget to enter your data! Did you give a shot and get any tests last night? Most of us who spend a good amount of time on this board and try to lend a hand, really rely on the information in your SS. (We also tend to be very data oriented.)

Lantus dosing is based on the nadir -- the lowest test value in each of the two daily cycles (i.e., AM and PM cycles). Please do your best to get a pre-shot test and at least one test during each cycle. Getting spot checks in addition to those tests will help to figure out some of the essential information -- when Lantus onset and nadir occur and what kind of duration Phoenix is getting from an injection. It would be easy if that information was consistent for every cat. Unfortunately, it's not. One of the favorite expressions here is "ECID" -- every cat is different.

What you may not be aware of is that this board was recently moved and three of the insulin support groups were merged. What that means is that there are a lot more people posting. It will be very helpful in you can start a new thread whenever you post (i.e., a new condo every 24 hours or more vs a new post every time you want to make a comment or ask a question. Basically, it's one condo per cat per day). I post daily as do many of the people here. (It's not a requirement that you post daily. It does allow people to get to know you and Phoenix though and this is a social and supportive group. So a daily thread -- aka "condo" -- and visiting other condos does help people get to know you and it's a great way to ask for specific info is there's something in another condo that you are wondering about.) We have a particular convention for subject lines:
date your kitty's name AMPS-#, +time-#​
So, for today, your subject line would read:
1/1 Phoenix AMPS-347, +4-199
​
Having test info in your subject line really does help us to know what's going on without having to open every, single condo. What someone who is experienced may recognize as a danger sign may not occur to someone who is new to managing their cat's diabetes.
 
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