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Karin&Jesse

Member Since 2014
Jesse is 12 1/2 years old. She was diagnosed with diabetes Dec 16. She had been eating a lot but losing weight. She was not drinking a lot nor urinating a lot. She has few teeth, most of them have been pulled over the last few years because they were decayed. The vet checked her teeth, removed a chunk of plaque. She had an elevated BUN. We also tested her thyroid level and she was low. The vet thought that the BUN should improve if her glucose gets under control and that the low thyroid is due to her illness.

Due to her teeth I had been already feeding her FF classic and grilled or gravy lovers and have for the last few years. Now, I am only feeding classic mixed with about an equal amount of some sort of cooked meat, usually chicken or turkey. I did have some expensive no-grain dry food out but I had assumed she was not eating it. I removed it a few days ago when I found out it is high in carbs. I noticed my four other cats were gaining more weight than I wanted to see after eating this for a year, and one cat -a long hair -- was vomiting almost every night. Since I removed the dry she has not vomited. The morning after removing it, Jesse's BG was in low 100's, but then later in the day went into the 400's! Very confusing.

She was started on 2U once a day of Lantus, but was increased to twice a day after three days. I understand it should have been 2X a day from the beginning. I decided to do home testing on my own. The vet did not encourage it but maybe he isn't used to clients taking charge of their pet's treatment. I kind of guessed or used intuition at first, but now from reading information here I have a better idea of what to do.

She seemed to be doing well at first but in the last few days has higher levels. She still craves food but some days seems to feel better.

I hope to receive some moral support, here. Looks like a good place for information and help. I've learned quit a bit reading other posts and reviewing other charts. I'm guessing I shouldn't be too concerned about the fluctuations in the readings, just yet, yes,no?
 
Welcome. It was great of you to start home testing.
Based on your spreadsheet, 2 unit twice daily seems to high. I would reduce to 1 unit twice daily.
 
It's great that you have switched to the lower carb wet food, are home testing, and you already got your spreadsheet set up. Good job!
Switching to a low carb food, can have a big effect on the blood glucose numbers, so I'm glad you are testing and not just doing this blind.
As long as she hasn't had any issues with ketones or DKA, I agree with Larry, that maybe you should start over again with 1 unit twice a day. Be sure to test before every single shot. And whenever you can, try to get a test mid-cycle as well, as the dose adjustments for Lantus are based on the lowest point (the nadir) which is usually somewhere around 4 to 6 hours after giving the shot and can change from cycle to cycle. Lantus is a depot insulin, so the doses are not changed based on the pre-shot test (unless she's super low). Go over to the Lantus TR forum and read the Stickies at the top of the page, and ask any questions you have.
From your spreadsheet, it looks like she went low the night before you got that 129 pre-shot test. It is important to get mid-cycle tests at night too, if you can, as cats do tend to go lower at night time.

The fluctuating in the numbers is what we call bouncing. When the cat reaches a BG number lower than what it is used to, or drops in BG too fast, the liver will release a stored form of glucogen sp? to what it thinks is "saving" the cat. A bounce can last up to 3 days, so you will need to be patient and wait for those bounces to clear before thinking about adjusting the dose.
When you adjusted the dose from 2 units once a day to 2 units twice a day, you essentially doubled her dose. We usually do dose adjustments in quarter unit increments. Do you have the syringes with the half unit marks on them?

Let us know what questions you have, and we are here to support you and guide you.

Great job, so far, Karin.
:YMHUG:
 
Dr Pierson of Cat Info recommends no more than 20-25% substitution of plain meat as the diet will become unbalanced in nutrients. If you use slightly cooked giblets, the fibrous meat will help keep the teeth cleaner.
 
Larry and Kitties said:
Welcome. It was great of you to start home testing.
Based on your spreadsheet, 2 unit twice daily seems to high. I would reduce to 1 unit twice daily.

That's confusing. Her values are going up into the 400's and yet I should lower the dose?
 
She probably went into low numbers (for her) on the night of the 2nd and is still bouncing from that. Bounces can take up to 6 cycles to clear.
 
Dyana said:
And whenever you can, try to get a test mid-cycle as well, as the dose adjustments for Lantus are based on the lowest point (the nadir) which is usually somewhere around 4 to 6 hours after giving the shot and can change from cycle to cycle.

Confusing again about the lowest point. The lowest BG value? The BG values are higher 4 to 6 hours after the am shot.

Dyana said:
A bounce can last up to 3 days, so you will need to be patient and wait for those bounces to clear before thinking about adjusting the dose.

So, then I should or shouldn't reduce to 1 unit until the bounces clear?

Dyana said:
When you adjusted the dose from 2 units once a day to 2 units twice a day, you essentially doubled her dose. We usually do dose adjustments in quarter unit increments. Do you have the syringes with the half unit marks on them?

The vet increased the dosage based on her level 12 hours after the single pm dose. I am not too thrilled with the vet's advice, but I will not go there for now. The syringes do not have half units. I did some searching but could not find syringes with half unit marks. I have a brand new box of 100 so I need to go with that for now. Again, I'm confused. I'm not supposed to change the dosage except by small increments, but I should change from 2U to 1U.
 
BJM said:
Dr Pierson of Cat Info recommends no more than 20-25% substitution of plain meat as the diet will become unbalanced in nutrients. If you use slightly cooked giblets, the fibrous meat will help keep the teeth cleaner.

I'm working on the diet and trying to find a vitamin mineral supplement for cats to add. I do have some cat vitamin tablets that I have been crushing and adding to the food. Since I got them at the grocery store I don't know how good they are. At least they have taurine in them. I eventually want to make my own food based on Dr. Pierson's guide since feeding FF to five cats can get expensive. Since she only has one or two molars on the top and a few front teeth left she can't chew, she just swallows small things whole. I think she was swallowing the small dry pellets whole during the night. Good idea for the other cats, however.
 
Karin&Jesse said:
Dyana said:
And whenever you can, try to get a test mid-cycle as well, as the dose adjustments for Lantus are based on the lowest point (the nadir) which is usually somewhere around 4 to 6 hours after giving the shot and can change from cycle to cycle.

Confusing again about the lowest point. The lowest BG value? The BG values are higher 4 to 6 hours after the am shot.
I don't think you can really see the nadirs yet with the data you have so far, but you will eventually as you more tests.

Here is an example of a typical Lantus cycle (one that isn't in a bounce):
+0 - PreShot number.
+1 - Usually higher than PreShot number because of the last shot wearing off. May see a food spike in this number.
+2 - Often similar to the PreShot number.
+3 - Lower than the PreShot number, onset has started.
+4 - Lower.
+5 - Lower.
+6 - Nadir/Peak (the lowest number of cycle).
+7 - Surf (hang around the nadir number).
+8 - Slight rise.
+9 - Slight rise.
+10 - Rising.
+11 - Rising (one of the quirks of Lantus/Levemir: some cat's blood glucose numbers dip around +10 or +11... not to be confused with nadir).
+12 - PreShot number.

Karin&Jesse said:
Dyana said:
A bounce can last up to 3 days, so you will need to be patient and wait for those bounces to clear before thinking about adjusting the dose.

So, then I should or shouldn't reduce to 1 unit until the bounces clear?
It looks like her bounce is clearing.
I would get another test to see if she's going up or down. We often recommend a test at 2 hours after the pre shot test as this can give an idea as to whether the cycle is going to be an active cycle (see above) where more testing would be needed.

All the tests you can get, help to tell how Jesse reacts to insulin doses, carb percentages in food, when her typical nadir is, how long she normally bounces, etc.

Karin&Jesse said:
Dyana said:
When you adjusted the dose from 2 units once a day to 2 units twice a day, you essentially doubled her dose. We usually do dose adjustments in quarter unit increments. Do you have the syringes with the half unit marks on them?

The vet increased the dosage based on her level 12 hours after the single pm dose. I am not too thrilled with the vet's advice, but I will not go there for now. The syringes do not have half units. I did some searching but could not find syringes with half unit marks. I have a brand new box of 100 so I need to go with that for now. Again, I'm confused. I'm not supposed to change the dosage except by small increments, but I should change from 2U to 1U.
I think we're just trying to say that doubling the dose is a huge increase, and maybe you might want to start over at 1 unit BID (twice per day) which equals a total of 2 units that she was getting before, just split into two shots 12 hours apart.
Vets often think of dosing in measurements of whole units. By doing the dose adjustments in smaller 1/4 unit increments you can fine tune and slowly and safely get to the right dose for Jesse. And her perfect dose can change as she goes along. Your data gathering on your spreadsheet will help to tell when a dose is too much or not enough.
When a vet adjusts a dose by one test in the office, he is not seeing the whole picture (and in this case, did not see what the nadir (lowest BG reading) of that cycle was). A lot of or unfortunately I think most of the vets are more familiar with the other non depot insulins like PZI which is based upon pre-shot numbers. The dosing adjustments for the longer acting depot insulins like Lantus Levemir are based upon the lowest number in the cycle.

It's up to you. You hold the syringe. If you want to stay with 2 units BID, then I would recommend getting some more tests in, and at night time, too.

A lot of people buy the ReliOn syringes from WalMart which have 1/2 units marks. There are others brands of syringes with half unit markings. I just have always used these.
 
The 3/10 cc (or mL -they're the same) are for smaller doses and are more likely to have half unit marks.

How much does your cat weigh?
How much should your cat weigh?

I feed Friskies pates as they are about half the cost of Fancy Feast, if not less. At the Columbus, OH store, I find 13 oz cans for about $0.78 each.
 
Thanks for the very helpful explanation, Dyana.

I just checked again (+6). She is down to 90. She ate just before I checked. I will check every hour.
This is nerve racking. :-|

I'm so glad this board is here.
 
A +6 of 90 mg/dL is good for either a human or pet-specific meter. Now you need to monitor to see if she contines going lower (Lantus usually hits nadir between +5 to +7 hours after the shot).

Could you add your meter to your signature please? It helps with interpreting the test numbers.

If she gets below 50 mg/dL on a human meter or 80 mg/dL on a pet-specific meter, you will want to steer her numbers to keep her safe. Do you have some high carb gravy food, or Karo syrup? Or some flour you might use to make a gravy in a pinch?
 
Added the meter - Relion Prime
Yes, I have some gravy FF and some grilled FF which also has gravy.
also have Karo Syrup light with a syringe clipped to the bottle

I don't have an accurate weight on the cat but right now she is about 4 lbs I would guess. I'll see if she will fit on my kitchen scale. She is not a very big cat.

I will continue to test every hour today.
 
Jesse had some really nice numbers today. You can see that today, her nadir was at +9 (that's how we say 9 hours after the shot). Normally, with Lantus the nadir will be much earlier, but every cat is different and the nadir can change from cycle to cycle.
 
Here is the formula for the initial starting dose of Lantus for a cat
current weight or ideal weight, whichever is lower
convert weight into kilos (2.2 pounds per kilo)
weight in kilos times 0.25 units of insulin per kilo
round down to the nearest quarter unit for safety.

4 pounds = 1.81 kilos
1.81 times 0.25 units of insulin = 0.45 units of insulin
rounded down to 0.25U for the starting dose.

Looking at this, you can see why so many of us are suggesting you lower the dose. Looks like the initial starting dose was way too high if your cat only weighs 4 (four) pounds.
 
I'm feeling more comfortable now about the values and what is happening. I reduced her to 1 unit starting last night, and won't get panicked about the values for a few days. She weighs closer to 8 pounds than 4. It was amusing trying to get her to sit still in the little bowl of the kitchen scale. In spite of this she has gained weight in the last few weeks. She's getting good about understanding that an ear prick means a few bits of chicken. I understand that I should get a night reading but I am an extremely heavy sleeper and do not own an alarm clock. I get up really early but there are the wood stoves to get going and all the other animals need their morning thing done. I'll figure out a way.
 
That's a good report ;-)
Right now she is bouncing from those nice normal numbers she had yesterday, that she isn't used to yet.
Good that she's gaining weight, getting used to the ear pricks, and that you are feeling more comfortable.
 
Karin. I looked at your spreadsheet and see the 412 this afternoon and the note that says she is acting lethargic. Hopefully, she is acting lethargic because of the higher number, but you need to test for ketones whenever they act off, have higher numbers, don't want to eat, or act lethargic. Do you have ketones test strips? If you don't, please get some tonight, and test her. I use a washed out cup from FF Appetizers or a washed out ketchup container from McDonald's, and just wait until J.D. is "in the process" of going, and slip it under his tail. Ketones can be fatal. J.D. is a DKA survivor, that's why I am pressing the issue.

Also, please test Jesse before every insulin shot, always. I know vets don't often recommend it, but would you give your child an insulin shot without knowing what her blood glucose was first? To keep Jesse safe, you need to know she is not too low before giving that shot. If you have any questions, please ask.
 
Dyana said:
If you don't, please get some tonight, and test her.
Living 75 miles from any town means nothing gets bought tonight, in fact living way out in the country has made this a whole lot more challenging than it should be. For instance, I'm down to about 15 test strips. I did not know I would need so many or I would have stocked up. I am going to have to ration them until I can get back to town which probably will not be until Monday if it doesn't snow. As far as ketone testing, in three weeks I've only be able to catch her peeing once. It seems like she never goes.
 
See my signature link Secondary Monitoring Tools for additional assessments you may wich to make. Sometimes, ketones may be smelled on the breath as a fruity or nail polish remover smell.

If you ever smell that, see lethargy and she is not eating, get to the vet asap as there is a good chance of diabetic ketoacidosis (DKA). Ketones form as a by-product of fat breakdown for calories. Treatment requires hospitalization and is very expensive.
 
I understand about ketosis. I raise dairy goats among other things. Pregnancy ketosis is always a possibility so I'm familiar with the early signs as well as the cause -- which is different than diabetic ketosis but the symptoms and result are the same. Therefore, I used to have ketone strips around but since I never had a case of ketosis (because I prevent it with the correct diet) I never used them. They may still be somewhere in my supplies but probably way out of date, like 10 years.

Actually, Jesse is doing well. I'm trying to establish a more regular feeding schedule rather than have her beg for food all day, which she wasn't too happy about yesterday. What I thought was lethargy yesterday seemed to be more relaxed sleepiness. This morning she didn't wake me up until 4 am for breakfast rather than 2 or 3. Now that it has been six cycles of the lower dose I'll make some tests during the day today.
 
If you can ( once you have more strips) I would also recommend a test before bed - say 2-3 hours after nighttime shot. many cats drop lower at night and she could go low then. And you are missing half your data by not testing then

Wendy
 
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