NEW with MANY Questions

[RenaRF]

I'm not new to the board (my sweet Clide was a diet-controlled diabetic and I do home test - we lost him to cancer in early March of this year. ) but I am new to the whole "Give insulin / don't give insulin / if BG is X, give Y insulin etc.

I'm fostering the awesome Henry. Henry has been being treated and stabilized at the vet's from 4/7/13 - yesterday, 4/17/13. He came in with BGs over 600. His owner declined to treat him, so we have brought Henry in under rescue and he has been given over to my care.

Initial treatment at the vet's was 1u of Lantus every 12 hours with frequent BG checks. They also switched him to the Royal Canin diabetic wet food - 14% calories from carbs - not my favorite choice but I'll revisit that issue in my questions. In putting him on the Lantus he was really all over the map BG wise - 500s for highs, 70s for lows. As those gaps and swings started closing a bit, they knocked him back to 1/2u Lantus every 12 hours. They still saw some pretty huge swings, so two or three days ago he went to 1/2u of Lantus once daily. Yesterday at morning BG check, he was like 254. They gave him the 1/2u and he dropped to the low 60s. SO. Their guidance to me was that I NOT give him any insulin if his BG was was below 300 on my meter (which is, of course, different than the under 200 rule of thumb. But every cat is different, right?

So this morning I tested him - it was very difficult to get blood from his ear! Grrr! But he was VERY patient with me, and eventually we got it done. His BG was 262 at 8am, so I did NOT administer insulin and I fed him. I will retest at noon today (in about half an hour).

So my questions are this:

1. Given that he's only been on Lantus for about 11 days now, is it wise to totally not give him insulin? I had read advice to go with .25u in a circumstance like Henry's. I'm hesitant to strike out and do anything on my own here - but I'm worried that I'm basically interrupting his insulin when he's very new to it, and that I'm undoing whatever good was done.

2. If, at noon, his BG is ABOVE 300, should I give the insulin then?? How does this work? Do I need to wait until tomorrow AM despite what periodic 4-hour results are to give insulin? What if I give insulin at noon and then at 4pm he is still over 300? Do I give it then, too? I would imagine not - but I'm looking for the rules and guidelines here in this situation.

3. I want to change his diet. I don't have to do it right away, but it needs to happen. I think the RC diabetic is way too high in carbs, and the ingredients are crap. I want to get him onto the Merrick low carb varieties. But I'm worried about doing that and trying to get my head around getting him regulated.

4. Finally - if he's consistently coming in under 300, should I just switch his diet and try to make the change to OTJ status from there?

Ugh. I'm confused.

Rena

 

[Anne & Zener GA]

Rena, you have a heart of gold to foster sweet Henry. Good for you for getting a spreadsheet going too. Lantus should be given every 12 hours, so your best bet is to pick a time that you can shoot am and pm and stick to that. How much does Henry weigh and how much should he weigh?
Liz

 

[beggargirl]

Hello. I'm sure someone more qualified and knowledgeable about lantus dosing will stop by soon.

Generally you give lantus at the same times twice a day. If you skip a dose because they are too low you generally wait until the next shot time. If you are interested in doing some reading before someone pops by, I would recommend checking out the Lantus tight regulation board.

What glucometer are you using?

With those low numbers, to me, it just sounds like it is the diet that is keeping the kitty high. Switching to an all low carb diet might bring him under control.

It sounds like you have a great vet.

Good luck and thanks for stopping by!

 

[RenaRF]

Rena, you have a heart of gold to foster sweet Henry. Good for you for getting a spreadsheet going too. Lantus should be given every 12 hours, so your best bet is to pick a time that you can shoot am and pm and stick to that. How much does Henry weigh and how much should he weigh?
Liz

Hi Anne.

Ok - So Henry weighs 13 lbs., and frankly he should put ON a bit of weight - 1/2 - 1 lb. would probably get him to idea weight. He's a BIG cat - tall and long, big frame. So 13lbs is a bit light for him.

I did NOT give insulin this am. I took his amps at 8am - it was 262, and the vet said don't shoot under 300 for Henry specifically. I just rechecked his +4, and it was 144. What the heck?

Rena

 

[RenaRF]

Hello. I'm sure someone more qualified and knowledgeable about lantus dosing will stop by soon.

Generally you give lantus at the same times twice a day. If you skip a dose because they are too low you generally wait until the next shot time. If you are interested in doing some reading before someone pops by, I would recommend checking out the Lantus tight regulation board.

What glucometer are you using?

With those low numbers, to me, it just sounds like it is the diet that is keeping the kitty high. Switching to an all low carb diet might bring him under control.

It sounds like you have a great vet.

Good luck and thanks for stopping by!

Hi! Thanks so much - I kind of figured that would be the answer (every 12 hours), but wanted to ask.

I am using a Freestyle Lite meter. I took his amps reading (262) at 8am. Did NOT dose, fed him 3oz of the Royal Canin diabetic wet. I retested at +4, and his BG was 144. I don't know what to make of that, frankly. Pretty big danged drop without any insulin given.

The last insulin he received was YESTERDAY morning 4/17, 1/2U given AM with pre-shot BG reading of 252. At retest, he had dropped to like 62 (!!). Hence the reason for the "no shot if under 300" guideline. But I'm pretty confused as to why he's 144 now with no insulin given. Any ideas??

Rena

 

[terri1962]

Rena

The best place to pose these questions is on the Lantus forum. They know this insulin better than most vets. Some people over there have been using it for years.
Bless your heart for taking Henry in and trying to help him. I sure do hope you get him balanced out soon, but as I said the Lantus forum is more busy and they can give the best advice.

Terri

 

[Ann & Tess GA]

How wonderful that you are taking on Henry and his care. :YMHUG: :YMHUG:

It sounds like he got a good start at the vet, but that they still are thinking in terms of preshot BG for dosing. Lantus and Levemir are dosed on the lowest BG reading of the day, not preshot. Are you able to get mid cycle tests to see how low his BG is dropping?

Just MHO but 300 is too high a don't shoot number, in LL we use 150 with the tight regulation protocol for new members. Those of us that are used to our cats' responses will shoot as low as 50. That said, most vets don't have many clients that are willing to closely monitor their cats, so they play it safe and set a high number. So I think it depends on how able you are to monitor Henry.

I'd try to get in some mid cycle tests to see when he nadirs and just how low he goes.

Lantus is also a depot insulin, it builds up a reserve that is slowly released in the body and every time the dose is changed or skipped that depot needs to re-balance. Initially we try to give it a week and then 3 days for every dose change. During that time BG levels can actually go up w/ an increased dose before settling down. Lantus does not like to be rushed or changed frequently.

It is also very important to keep to as close to a 12 hour schedule as possible. More than 15 minutes either way can effect the depot as an increase or decrease. So unless you can regularly change Henry's shot time noon and midnight I would wait until his regular shot time to give the next dose.

On the food, changing to a low carb diet is ideal, however as he is getting insulin you should change slowly. Lower carb food can make a dramatic change in BG for some cats, so you need to carefully monitor BG during the switch. Dr. Lisa has recently put together an updated food list at http://catinfo.org/Look on the right hand side of the page for the link to the Protein/Fat/Carbs Chart. Most of us try to stay below 10% carbs, around 4% or 5% is even better. Merrick is good, so is Wellness, EVO and a new fave for many cats is Weruva. You could also consider raw food, they are on the charts too.

Good luck and thank you for taking henry in.

 

[RenaRF]

How wonderful that you are taking on Henry and his care. :YMHUG: :YMHUG:

It sounds like he got a good start at the vet, but that they still are thinking in terms of preshot BG for dosing. Lantus and Levemir are dosed on the lowest BG reading of the day, not preshot. Are you able to get mid cycle tests to see how low his BG is dropping?

Just MHO but 300 is too high a don't shoot number, in LL we use 150 with the tight regulation protocol for new members. Those of us that are used to our cats' responses will shoot as low as 50. That said, most vets don't have many clients that are willing to closely monitor their cats, so they play it safe and set a high number. So I think it depends on how able you are to monitor Henry.

I'd try to get in some mid cycle tests to see when he nadirs and just how low he goes.

Lantus is also a depot insulin, it builds up a reserve that is slowly released in the body and every time the dose is changed or skipped that depot needs to re-balance. Initially we try to give it a week and then 3 days for every dose change. During that time BG levels can actually go up w/ an increased dose before settling down. Lantus does not like to be rushed or changed frequently.

It is also very important to keep to as close to a 12 hour schedule as possible. More than 15 minutes either way can effect the depot as an increase or decrease. So unless you can regularly change Henry's shot time noon and midnight I would wait until his regular shot time to give the next dose.

On the food, changing to a low carb diet is ideal, however as he is getting insulin you should change slowly. Lower carb food can make a dramatic change in BG for some cats, so you need to carefully monitor BG during the switch. Dr. Lisa has recently put together an updated food list at http://catinfo.org/Look on the right hand side of the page for the link to the Protein/Fat/Carbs Chart. Most of us try to stay below 10% carbs, around 4% or 5% is even better. Merrick is good, so is Wellness, EVO and a new fave for many cats is Weruva. You could also consider raw food, they are on the charts too.

Good luck and thank you for taking henry in.

Hi. Thanks for replying - I guess I should post this on the "loose" Lantus regulation board?? I'm retesting at +4 and +8 then again with pmps. the last time Henry got Lantus was yesterday am, 4/17 - 1/2U. His amps was 262 and his +4 was 144. He was fed immediately following his amps (8am). I'm not sure why he dropped, and I'm deeply, ridiculously concerned about dropping his BG too low.

When he was initially admitted at the vet's, he was over 600 and the first few days that seems to be his amps level, between the very high 400s to low 600s. That has leveled out. Is there a possibility that 11 days of Lantus and monitoring have set him on a course, along with the diet change (albeit I don't like the current diet)? My preference would be to switch him to Cowboy Cookout or Grammy's Pot Pie (Merrick - 5% and 7% calories from carbs respectively). The current Royal Canin prescription diet is wet only, but 14% calories from carbs. If he stays below 300 (and I do take your point on it being high and vets and what have you, but I am really freaked about my lack of experience with insulin and potential hypo), should I start the switch sooner than planned? I was going to try to give it a week of whatever - insulin if needed, monitoring etc. - before even trying to switch his diet.

 

[beggargirl]

I've made a post asking some Lantus folks to stop by here.

 

[Ann & Tess GA]

I'm retesting at +4 and +8 then again with pmps. the last time Henry got Lantus was yesterday am, 4/17 - 1/2U. His amps was 262 and his +4 was 144. He was fed immediately following his amps (8am). I'm not sure why he dropped, and I'm deeply, ridiculously concerned about dropping his BG too low.

Getting that many tests in is good and you could try tight regulation. The drop to 144 at +4 is actually a very good Lantus curve. Typically onset starts about +2 and will be at peak effectiveness (nadir, lowest BG level) around +6 to +8. Then BG tends to rise as the insulin wears off and you are back to the next preshot. W/ tight regulation we strive to keep our cats' BG below 200. That is the renal threshold. BGs consistently over 200 can effect the kidneys. Normal BG for a cat is 50 to 120.

With regard to the 12 hour schedule, cats' metabolism s are much faster than humans who do use Lantus once a day. It just doesn't stick around in cats' system long enough for 24 hour dosing. If Henry only needs half a unit a day it is better to divide it into 2 doses. We generally also adjust doses by .25U increments. You can get syringes w/ half unit markings and then eyeball it from there.

I'd start the food change by slowly mixing in the lower carb food, gradually increasing the percentage and monitor as you are doing. If Henry goes to low for your comfort, post on the Lantus tight regulation board. It is the most active board here and there is almost always someone there who can help.

 

[Denise & Honey]

hi Rena

if you switched to a low carb wet food - the Merrick's you listed are excellent - you would need to test him regularly.
As Ann said, he could drop 100 points by that switch which could really lower his mid-cycle numbers.

You could start the change slowly - giving part Royal Canin and part Merricks - AND testing.
You may want to get a +2 to see if it will be an 'active' cycle, ie. if he is lower at +2, he's probably going to keep dropping.
+3 is onset so again, a good indicator of the cycle.
You don't want to get to +4 and be really low and then have to take dramatic action.

Example of a typical Lantus curve:
+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 (may dip around +10 or +11).
+12 - PreShot number.

You can post on either lantus site. The Tight Regulation one is busier so you'll get more responses - just use a question mark icon and put 'newbie dosing help' and Henry's name.
You can link to this condo by using the URL tags when in edit and putting the url inbetween, eg. [/url]http://felinediabetes.com/FDMB/posting.php?mode=reply&f=28&t=93568[/url] (remove the first slash character in first url tag)

 

[RenaRF]

hi Rena

if you switched to a low carb wet food - the Merrick's you listed are excellent - you would need to test him regularly.
As Ann said, he could drop 100 points by that switch which could really lower his mid-cycle numbers.

You could start the change slowly - giving part Royal Canin and part Merricks - AND testing.
You may want to get a +2 to see if it will be an 'active' cycle, ie. if he is lower at +2, he's probably going to keep dropping.
+3 is onset so again, a good indicator of the cycle.
You don't want to get to +4 and be really low and then have to take dramatic action.

I so appreciate the feedback. So what's important here, I think, is that the last time he was given insulin was YESTERDAY - 4/17. .5U Lantus in the AM. He is now more than 24 hours after that shot, and his numbers - with the exception of the amps - are in the 100s. Amps was 262. +4 144. +6 111. I just fed him again because he was bugging the crap out of me. I'll get another reading at 5pm ET (+9) and see how that is after food. I'm wondering if I'm in a magical place where I can use all diet, no insulin? Only time will tell - I'm working from home tomorrow as well, so should be able to get 2 hour readings.

 

[KPassa]

Welcome! And what a great name for a cat! :lol: ;-) haha_smiley (I have a Henry, too )

...the last time he was given insulin was YESTERDAY - 4/17. .5U Lantus in the AM. He is now more than 24 hours after that shot, and his numbers - with the exception of the amps - are in the 100s. Amps was 262. +4 144. +6 111.

Honestly, this does sound like he might become diet-controlled. Since you haven't given him a shot in over 24 hours, now might be the perfect time to get him off the Royal Crap Canin and onto the Merricks. That 6-8% difference in carbs might be all he needs to push him down from that AMPS high of 262 into more normal numbers. (Diet-controlled, as I'm sure you remember with Clide, is when they can maintain under ~150 without insulin).

 

[RenaRF]

Honestly, this does sound like he might become diet-controlled. Since you haven't given him a shot in over 24 hours, now might be the perfect time to get him off the Royal Crap Canin and onto the Merricks. That 6-8% difference in carbs might be all he needs to push him down from that AMPS high of 262 into more normal numbers. (Diet-controlled, as I'm sure you remember with Clide, is when they can maintain under ~150 without insulin).

Hard to totally know, but I have more numbers to provide. I couldn't get it done every two hours, so the intervals are a bit wonky.

8a, amps: 262
- Fed 3oz Royal Canin wet diabetic formula, 14% cal from carbs
+4, 144
+6, 111
- Fed 3oz Royal Canin wet at 2:30p
+8.5 (approx 4:30p), 174

I'll probably hit him again right about 8p. I would LOVE getting him diet controlled. Clide stayed pretty much in the 90-110 range on diet alone. Henry's an eater, too!!

 

[KPassa]

These numbers aren't bad at all, considering you're feeding him 14%. He might need a smidge of insulin still, but I think it might be a good idea to hold off on the insulin a bit while you transition him to better food, that way you don't have to scramble around trying to find the right dose, then lower it in conjunction with lowering his carb intake. Otherwise, it's much more work, much more stress for both of you, and you risk him going into hypo.

Are you testing for ketones?

 

[tuckers mom]

Rena,

Can you get his vet records? The numbers you are seeing seem to indicate his pancreas is working and with diet change he could go into remission but I'd like to know why his BGs got so high in the first place. If he was jus on a bad diet for a while and a new diet will help, great, we see that all the time with newly placed FDs.

However if he was brought in a had an infection, tooth ache, belly ache, things like that, I'd be interested in seeing if they were addressed. If you switch his food from the script stuff to canned only which folks here can guide you towards or perhaps what sweet Clide used to eat, his sugars may drop even more so I'd be conservative with dosing until you get to know him better.

Plus we have stress from him losing his folks, living at the clinic and now with you. In a few days or week when he relaxes a bit, that too will drop his numbers a little. Or I should say it usually will drop the numbers.

 

[RenaRF]

Rena,

Can you get his vet records? The numbers you are seeing seem to indicate his pancreas is working and with diet change he could go into remission but I'd like to know why his BGs got so high in the first place. If he was jus on a bad diet for a while and a new diet will help, great, we see that all the time with newly placed FDs.

However if he was brought in a had an infection, tooth ache, belly ache, things like that, I'd be interested in seeing if they were addressed. If you switch his food from the script stuff to canned only which folks here can guide you towards or perhaps what sweet Clide used to eat, his sugars may drop even more so I'd be conservative with dosing until you get to know him better.

Plus we have stress from him losing his folks, living at the clinic and now with you. In a few days or week when he relaxes a bit, that too will drop his numbers a little. Or I should say it usually will drop the numbers.

Yes, I can go get a full copy of them tomorrow. It's a bit complicated as he was first under his owner's name, then under Petsmarts' name, then under my name - but I'll have them put it together.

A bit of background I did get is that the former owner indicated that he wasn't happy when boarded in the past. That can certainly take BGs up. I don't know what he was eating while there prior to diagnosis, but I may be able to get that. The vet also indicated that although this is not an immediate requirement, he's definitely going to need a good dental cleaning.

I'll get all the info and post it here when I have it. Thanks!

Rena

 

[RenaRF]

Hey everyone. I really appreciate your feedback.

I'm updating Henry's spreadsheet as I take readings. This morning's pre-shot number was lower than yesterday's - 210. His +2 was 219. Because of my inexperience, I am following the vet's initial advice that I not give insulin unless he comes in over 300, which thankfully hasn't occurred. I am still feeding him the Royal Canin diabetic wet, 14% calories from carbs. I'm going to try to get BG readings every two hours today - and if stays pretty reasonable, tomorrow I'll try him on the lower carb Merrick foods - Cowboy Cookout (5%) and Grammy's Pot Pie (8%). The last time Henry received insulin was Wednesday morning, 4/17 - the dose was .5U of Lantus.

I'll get his records (hopefully) today if I get a break in my work schedule to run over and pick it up.

Rena

 

[tuckers mom]

How's water intake/output? Drinking too much, urinating too much or just fine?

Let's keep track of that for a bit too.

I agree with no insulin in the short term, change the food over, get him used to you, but if he stays in the 200s for a few more days you may want to discuss here with folks whether a token dose might be good. I'm thinking less than the .5, just a tiny amount. But still, because of the kitties I've seen outside of FDMB who may not necessarily be diabetic, I might do as your doing while the food is being changed to the lower carb.

I'm not a vet nor an expert, these are simply my thoughts on this.

 

[RenaRF]

How's water intake/output? Drinking too much, urinating too much or just fine?

Let's keep track of that for a bit too.

I agree with no insulin in the short term, change the food over, get him used to you, but if he stays in the 200s for a few more days you may want to discuss here with folks whether a token dose might be good. I'm thinking less than the .5, just a tiny amount. But still, because of the kitties I've seen outside of FDMB who may not necessarily be diabetic, I might do as your doing while the food is being changed to the lower carb.

I'm not a vet nor an expert, these are simply my thoughts on this.

Water intake is normal - not even remotely what I would consider excessive. He is peeing big amounts of pee, but not massive. Some of his pees are what I would consider more or less normal for his size, and others slightly larger than I might expect.

I'm heading to get his +4 reading right now.

 

[Venita]

Hi Rena,

I am, by proclivity, one of the "relaxed" people. Maybe even a rebel. I tend to think it's best to go with what a cat seems to need rather than by what some academically researched protocol says "the average study cat" should have every 12 hours.

To directly answer a question you have asked a couple times but I haven't seen anyone answer (but I am not always as observant as I should be). There is a very good reason why Henry's blood glucose (BG) levels would drop from his AM level to +4 after that.

(BTW, we use the terms AMPS or PMPS if those are the BG measures before a shot--PS or pre-shot. If it is a measure taken but no insulin is given, we call it AMBG (morning blood glucose) or PMBG (evening blood glucose) and the +time number is measured from when the last insulin shot was given, even though it may have been days or even weeks before.)

If a body's pancreas is functioning, when the body becomes aware that the BG is rising, the pancreas goes to work and releases insulin to counteract the rising BG and open the cells to accept the glucose nutrients and thus remove them from the blood. A well-functioning pancreas will often bring the post-food BG level down to pre-food or fasting levels within 2-4 hours after the meal (depending on the carb load of the meal, the level of exercise, and other factors I discuss later such as emotional/physical stress and previous steroid use).

Folks with diabetic cats often do what they call a "food test." If the fasting AMBG or PMBG level is only a touch high, they will feed a small amount of low carb food to see whether the associated rise in BG level will "signal" the pancreas to release insulin and bring the BG level down.

Without knowing you were doing it, you did a food test on Henry. Four hours after eating a medium-carb meal, his BG level had dropped 120 points. Two hours after that, it was down another 30 points. At that point, you gave him another medium-carb meal and he was probably snoozing during the afternoon (as cats are prone to do). At +2.5 after that meal and with no exercise, his BG was then back up another 60 points. Really very good given the carb load, the short time after the meal, and the lack of exercise at that time of the day.

I am seeing Henry as a cat that will go into diabetic remission. His pancreas is working...maybe not on all 8 cylinders, but working. Given my "relaxed" proclivity, and his fasting BG levels, I also likely would withhold insulin and just watch his numbers. I also would lower the carb load of his food, as you say you want to do. No time like the present, when you don't have to worry about exogenous (coming from outside the body) insulin combining with low-carb food and a partially functioning pancreas to come together to potentially put him into a too-low (hypoglycemic) BG level.

With my last diabetic, Ennis, I fed low-carb food as often as every 3-4 hours. I could do that as I am a daytime slacker (don't work for money) and Ennis would paw me awake for feedings during the night. I felt those small frequent meals helped to keep his partially functioning pancreas "awake" and contributing what it could--thus keeping his BG numbers level and his insulin dosage very low.

I like the guidance Henry's vets gave you. They want to keep him healthy and safe at the same time they are working with someone new to giving insulin. It seems they understood what was happening with his body given their frequent BG tests. It is the vets that give similar advice without having the data to support it that trouble me.

I agree with what Tucker's Mom said, that there may be some underlying dietary or emotional/physical stress factor that threw Henry into temporary but prolonged hyperglycemia. Please check his vet records to see what might be see-able in that regard. (Especially important, check the bloodwork and urinalysis for evidence of an infection.) Another thing to look for is whether Henry recently (within the last 6 months) was given any steroid medication. That also can throw a cat into temporary but prolonged hyperglycemia.

 

[KPassa]

If a body's pancreas is functioning, when the body becomes aware that the BG is rising, the pancreas goes to work and releases insulin to counteract the rising BG and open the cells to accept the glucose nutrients and thus remove them from the blood. A well-functioning pancreas will often bring the post-food BG level down to pre-food or fasting levels within 2-4 hours after the meal (depending on the carb load of the meal, the level of exercise, and other factors I discuss later such as emotional/physical stress and previous steroid use).

Folks with diabetic cats often do what they call a "food test." If the fasting AMBG or PMBG level is only a touch high, they will feed a small amount of low carb food to see whether the associated rise in BG level will "signal" the pancreas to release insulin and bring the BG level down.

Without knowing you were doing it, you did a food test on Henry. Four hours after eating a medium-carb meal, his BG level had dropped 120 points. Two hours after that, it was down another 30 points. At that point, you gave him another medium-carb meal and he was probably snoozing during the afternoon (as cats are prone to do). At +2.5 after that meal and with no exercise, his BG was then back up another 60 points. Really very good given the carb load, the short time after the meal, and the lack of exercise at that time of the day.

Thank you, Venita! :YMHUG: I had wanted to post about the "food test" but I couldn't remember how long it took before you'd see the numbers dip, so I was hoping someone with more knowledge would post on it. This is fantastic information!

 

[RenaRF]

With my last diabetic, Ennis, I fed low-carb food as often as every 3-4 hours. I could do that as I am a daytime slacker (don't work for money) and Ennis would paw me awake for feedings during the night. I felt those small frequent meals helped to keep his partially functioning pancreas "awake" and contributing what it could--thus keeping his BG numbers level and his insulin dosage very low.

Venita - thanks for that. I'm testing every 2 hours today. 8a was 210 and then I fed. 10a was 219. 12p was 158. I'll test again at 2p and if he's under 200, give him some of the Merrick. I have a timed feeder - I used it for Clide so that he could eat consistently throughout the day and night, small amounts of low carb wet at regular intervals. It seems to me I might need to break that back out.

Rena

 

[RenaRF]

Oh and let me ask - I take it that since he hasn't had insulin since the morning of 4/17, I don't have to worry about a hypo-esque BG drop with the lower carb Merrick food?

Rena

 

[tuckers mom]

With no insulin given you don't have to worry about a hypo from insulin.

 

[RenaRF]

WOOO.

4pm reading, 127. 6pm reading, 135. Fed low carb Merrick at 2pm (started with Grammy's Pot Pie, but Henry is picky and didn't like it - went with Ocean Breeze instead). I'm pretty pleased!

Rena

 

[KPassa]

Looking good already! :thumbup

Just remember to try not to feed cats fish more than once or twice a week.

 

[RenaRF]

Looking good already! :thumbup

Just remember to try not to feed cats fish more than once or twice a week.

Yes, I'm careful with the fishy food. BUT. Henry isn't all that enthused with the Grammy's Pot Pie (chicken). I'll try the Cowboy Cookout tomorrow (beef) and see if he digs that. He ate that Royal Canin like he hadn't eaten in weeks - hope I can get him to like something that is better for him!

BG tonight was 140. Woo!

 

[Wendy&Tiggy(GA)]

How is Henry doing? I cant access his SS - can you share it? Also did you ever change the food ?

 

[KPassa]

How is Henry doing? I cant access his SS - can you share it? Also did you ever change the food ?

For sharing the spreadsheet, you want to use a different link than you currently have in your signature. To get this link, within the online spreadsheet, go to File -> Publish to the Web. Make sure the box "Automatically republish when changes are made" is checked and copy the link that appears in the bottom section under Get a link to the published data (it should start with "https://docs.google.com/spreadsheet/pub..."). This is the public link, which allows anyone to view it like a webpage (instead of needing to log into their Google account).

(And to answer your question, Wendy, from the spreadsheet, it looks like the food was fully switched over yesterday. ;-) )

 

[Wendy&Tiggy(GA)]

Ok cool - numbers arent too bad. Edited to add - are you still using the freestyle lite? it might be giving you flat numbers ie he could be higher than you think

Now next question, is he getting any food overnight? If not, you might want to provide some to help support his pancreas overnight. maybe freeze some and let is defrost as a mid night snack.

 

[hmjohnston]

I read through the whole list for one thing and there it is at the bottom- the meter :lol:

Know that the freestyle light meter WITH THE BUTTERFLY strips do not show an accurate HIGH reading over 300 and has led to some problems- however Henry's numbers seem to be lower than that so the issue might not be anything to worry about. There are other freestyle meters and they do okay with feline diabetes.

This was once again confirmed as recently as three months ago on the board with the cat being in the 200's but still hungry, drinking, peeing as an unregulated cat.

Glad to see Henry is getting better.

 

[KPassa]

Now next question, is he getting any food overnight? If not, you might want to provide some to help support his pancreas overnight. maybe freeze some and let is defrost as a mid night snack.

Yes! I thought I typed it up, but I must have gotten distracted and only imagined I typed it up. ohmygod_smile :lol: This is where that "food test" Venita posted about comes into play.

If a body's pancreas is functioning, when the body becomes aware that the BG is rising, the pancreas goes to work and releases insulin to counteract the rising BG and open the cells to accept the glucose nutrients and thus remove them from the blood. A well-functioning pancreas will often bring the post-food BG level down to pre-food or fasting levels within 2-4 hours after the meal (depending on the carb load of the meal, the level of exercise, and other factors I discuss later such as emotional/physical stress and previous steroid use).

Folks with diabetic cats often do what they call a "food test." If the fasting AMBG or PMBG level is only a touch high, they will feed a small amount of low carb food to see whether the associated rise in BG level will "signal" the pancreas to release insulin and bring the BG level down.

Without knowing you were doing it, you did a food test on Henry. Four hours after eating a medium-carb meal, his BG level had dropped 120 points. Two hours after that, it was down another 30 points. At that point, you gave him another medium-carb meal and he was probably snoozing during the afternoon (as cats are prone to do). At +2.5 after that meal and with no exercise, his BG was then back up another 60 points. Really very good given the carb load, the short time after the meal, and the lack of exercise at that time of the day.

So, basically, if he's not eating enough overnight, his numbers might be higher come morning because the pancreas isn't being stimulated by food to naturally produce insulin.


From the spreadsheet, it also looks like Rena switched to the Accu-Chek Aviva on the 21st. ;-)

 

[RenaRF]

How is Henry doing? I cant access his SS - can you share it? Also did you ever change the food ?

Hi Wendy! I believe I made his spreadsheet public - let me know if you can access it.

I DID change his food. He's been on the Merrick low-carb diabetic appropriate wet food since last Friday. You can see on his SS that some of his AM numbers are "spikey" - but his average through the day is in the lowish 100s - 120-140.

 

[RenaRF]

Ok cool - numbers arent too bad. Edited to add - are you still using the freestyle lite? it might be giving you flat numbers ie he could be higher than you think

Now next question, is he getting any food overnight? If not, you might want to provide some to help support his pancreas overnight. maybe freeze some and let is defrost as a mid night snack.

Hi again Wendy! I actually switched meters on Saturday or Sunday because others had warned that the Freestyle Lite might be inaccurate outside of normal range. I am using the AccuCheck Aviva now.

Rena

 

[Deb & Wink]

Hi Rena,

I have one small request. Would you please put 0 (zero) in the U columns on your spreadsheet to indicate that you are not giving insulin. It's a quick way for those of us reviewing the spreadsheet to see no insulin is being given without going over to read the information in the remarks column.

Thanks.

The numbers are higher than we would like to see in a cat not using insulin. Sometimes, just a microdose, like of 0.1 units, can help to keep the BG levels down and assist the pancreas in healing those beta cells. We have pictures that will show you what that tiny amount of insulin looks like. It really can help. I did that with my foster kitty Wink.

Good luck on the vetty appointment this afternoon. Let us know how it goes and what the vet thinks about Henry's BG numbers and insulin or not.

 

[tuckers mom]

I'm not sure I would microdose just yet. He's only been there a week, he's lost his home, then went to boarding and now with Rena.

His diet has completely changed from whatever he may have been eating to what he is eating with Rena. These may be stress numbers.

He's different from a kitty who has lived with his person his entire life. He's learning to trust and not sure if he is safe right now. Rena, I trust you and know you have a heart larger than most, but Henry might not be there yet.

How do you like the Aviva? It was one of my favorite meters, I used to joke that it could pull blood from three feet away because it sips so fast and well.

I'm not a vet or an expert, but I have been owned by 9 diabetic cats, most adopted as FDs.

 

[RenaRF]

I'm not sure I would microdose just yet. He's only been there a week, he's lost his home, then went to boarding and now with Rena.

His diet has completely changed from whatever he may have been eating to what he is eating with Rena. These may be stress numbers.

He's different from a kitty who has lived with his person his entire life. He's learning to trust and not sure if he is safe right now. Rena, I trust you and know you have a heart larger than most, but Henry might not be there yet.

How do you like the Aviva? It was one of my favorite meters, I used to joke that it could pull blood from three feet away because it sips so fast and well.

I'm not a vet or an expert, but I have been owned by 9 diabetic cats, most adopted as FDs.

I found the butterfly zipwick thingy on the Freestyle Lite strips easier, frankly, but that doesn't matter a hoot if the reading is incorrect. My biggest issue is easily getting blood the first time I poke. Poor Henry's sweet ears are like pincushions! And yes, I'm backlighting them and all that stuff!!

Rena

 

[Venita]

Hi Rena,

I had suggested that you might want to read up a bit on the Dawn Phenomenon. This is a Wikipedia article about it in humans. There is a stub article about it in the Diabetes in Pets Wikia here.

I was firmly convinced that my first diabetic Maxwell had dawn phenomenon. He was not an evening/nighttime eater, but his morning numbers were always higher than his evening numbers, even when he was OTJ.

 

[tuckers mom]

Rena, when I test Kiki I rub her ear for moment to warm it, poke the ear and then let her shake her head. Don't do that if you are nervous about a droplet landing on the wall or in your hair, but we've got it down now.

I poke, she shakes and that draws blood to the spot. Then I do a quick "milking" of the area, push from above and below and squeeze the droplet.

Some of my kitties liked to rush the process, for them I would put the droplet on my fingernail and test that. For my patient kitties I can leave the droplet in place on the ear and test that.

 

[RobinCot]

Hi Rena

I had inquired about taking Henry and the rescue group said he was secure so they sent me Snoball. I am also in Northern, VA (Burke). I tried Merrick foods but my kitties and sugarcat sniffed and walked away. They do however love anything with a Weruva label. I am also transitioning my cats to Raw food and while my cats are resisting - Snoball gobbles it up. He gets a plate of Raw Rabbit every night and he has shown great weight gain in the one week that I have had him. I add a lot of water to the FF pate's and the raw food that I give him and he hasn't touched the water bowl. I am making a batch of Raw Duck tonight and some Raw Chicken later in the week. Let me know if you need me to do anything as I am also new and local.