Newbie looking for help!!

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christine&ahmin

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Hi guys,
I'm from Hong Kong and I found this wonderful forum recently.
My sweetie Ahmin was diagnosed diabetes last month, and recommended by the vet to start insulin shot twice a day at home.
He started to have 0.5 unit of lantus on 20th Jul and changed to 1 unit after he had the dental surgery on 4th Aug.
home testing for BG once or twice a week as recommended by by vet, i also test on his urine glucose almost everytime he pee.
I've been doing lots of research online recently, so now is feeding him, i hope it is, low carbs canned food. however i didn't see his bg drops a lot after the change of food.
He was 410 on the first day i took him to the vet, and now usually 270-330 at home after the dental surgery. urine glucose was about 500-1000 in early august, and drops to 50-150 in recent week.
yesterday morning, as usuall, i tested on his urine glucose and was so amazing that the testing result was negative, then i tested his BG was only 103!!! during the daytime yesterday he was between 103-150, however, his BG was rising up to 210 later on last night, and of course the sugar in urine also came back.
today, just as recent, BG back to 275 b4 insulin.
I really don't understand why Ahmin BG is so unstable? is it normal?
and i'm not quite sure the food i feeding him is really low carbs or not, since i don't see his bg drops a lot after the change of food.
I read a post in this forum which linked to a nutrition calculator http://www.scheyderweb.com/cats/catfood.html
the canned food i feeding Ahmin only contains 0.2% carbs, this number is too low seems not really make sense.
the typical analysis of the food i'm feeding Ahmin is 86% moisture, 11% crude protein, 0.5% crude fat, 2% ash & 0.3% crude fiber, and the ingredients is 37% tuna white meat, 16% chicken, 1% polysaccharide gum & 46% water.
Is this canned food really low carbs or not? and how much i should feed him a day? he usually eats 280g canned food everyday now.
Hope peoples here can give some advice to me. Thank you~
 
Hi and welcome to FDMB.

It sounds like you are off to a great start in helping Ahmin's diabetes. You are using a great insulin and your starting dose was low. Also you have a vet that supports hometesting.

However, instead of testing on a couple times a week, you want to begin testing before every shot. This will help you to accurately determine if the dose is working or even if it safe to give insulin. We recommend to newbies, not to give insulin unless the glucose reading is 200 mg/dL (11mmol/L) or higher. You will also do your own curves at home, which is testing several times between shots, and this will eliminate any unneeded trips to the vet just for testing. This is more accurate then testing at the vet's office since stress will raise the glucose levels and most cats are stressed at the vet.

What brand of food are you feeding him? A good resource to use when selecting food is Janet & Binky's food list http://binkyspage.tripod.com/canfood.html. I am not sure how many of these foods are available in Hong Kong, but hopefully some of them are. Unfortunately, pet food manufacturers do not place the "as fed" analysis on their labels, only the minimum requirements. This can be very misleading. If you have these brands available in Hong Kong, Fancy Feast Classics and Friskies are good choices. There are also other brands on the food list.

It is normal for a cats glucose levels to fluctuate during the day. Food will cause it to rise, sometimes significantly and insulin will lower it. That is why hometesting and doing your own curves is important. Every cat responds differently to food and insulin. By doing your own curves, you will learn how Ahmin responds and learn how to adjust your dose.

Hopefully this helps some. If you have not already started, I suggest reading the information under the Health Link section. Ask any questions you may have. We have all been where you are now and are here to help.
 
thanks for yr reply!
i read binky's food list b4, i was very upset that if i should choose a canned food which has lower that 10% carbs then not much choice in the list are available in hong kong, even some of the brand are available, however may not have the same flavor in hong kong :sad:
the one i'm feeding Ahmin is called "Kakato Tuna & Chicken", same manufacturer of "Applaws", it is 86% moisture, 11% crude protein, 0.5% crude fat, 2% ash & 0.3% crude fiber, and the ingredients is 37% tuna white meat, 16% chicken, 1% polysaccharide gum & 46% water. Is it appropriate for Ahmin?
yesterday he was 6.7mmol/L b4 insulin,the lowest is 4.9mmol/L +4, i called my vet b4 insulin since the reading dropped alot than the day before, she told me to keep going for 1 unit & test bg every 4hrs. Should i still keep going for 1 unit or as your advice not to give insulin if he's lower than 11mmol/L? if really not to give him when lower than 11, when should i start insulin again?
frankly, my vet are very helpful, i don't have to go to the clinic for consultation, they willing to give advice on the phone. but i need more advice, i will do as much as i can to make Ahmin recover asap!!
 
Christine,

I am really impressed with how much you have learned from your research in a very short period of time.

Lisa and Witn (GA) said:
We recommend to newbies, not to give insulin unless the glucose reading is 200 mg/dL (11mmol/L) or higher.
Click to expand...

I believe that is the recommendation for an fast-acting insulin called "humulin," but that is not a recommendation for the long-acting insulin, Lantus.

Lana
 
Christine,

On the index page for FDMB, click on Tech Support. Read the post titled, "How to Create Your Own SS and Publish It in Your Signature." This is how we keep a record of the BG (blood glucose) readings we get and share them with other people. After my signature on this post, you will see "Yoyo's SS." That is a spreadsheet of the BG readings I have gotten on my cat, Yoyo, and if you click on it, you will see them. I also am using Lantus.

It sounds like your vet wants to see a blood glucose curve for Ahmin at 4 hour intervals. You can share those results with us on your spreadsheet. Otherwise, you need to take a blood glucose reading before each shot and also try to get a reading around 6 hours after a shot. This way you will start building information on when to give or not to give a shot and whether to increase or decrease a dose. The pre-shot reading and the +6 hour reading should give you the range of BG's in a 12-hour cycle.

Lana
 
christine&ahmin said:
Hi Lana,

so, which means i should keep going for 1 unit & test every 4hrs per day since i'm giving him lantus?

christine
Click to expand...


You don't need to test every 4 hours every single day :smile:

At the very minimum, test before giving each insulin injection. So, twice a day every day.

In between those two tests, you can do as many or as few tests as you want and you don't need to do them every day :smile: Many people here work full time and have other things going on and can only test twice a day with maybe one or two random tests before bedtime.

For a blood glucose curve, test approximately every 2 hours starting from the morning insulin injection to the evening insulin injection.
 
Hi Lana,

ic....i'll work on the SS & post it online asap.

btw, how much does Yoyo eat everyday? Ahmin is eating about 250-350g (approx. 8.8-12.35oz) canned food everyday, this number is just recorded after DX, i'm not quite sure how much he ate b4 DX since he's been free feeding dry food for the pass 14 years.

christine
 
Lana & Yoyo said:
Christine,

I am really impressed with how much you have learned from your research in a very short period of time.

Lisa and Witn (GA) said:
We recommend to newbies, not to give insulin unless the glucose reading is 200 mg/dL (11mmol/L) or higher.
Click to expand...

I believe that is the recommendation for an fast-acting insulin called "humulin," but that is not a recommendation for the long-acting insulin, Lantus.

Lana
Click to expand...

Lana, until new members have collected enough data and are familiar with the Lantus Protocol, we do not suggest they give insulin if the preshot number is less than 200, even with Lantus.


christine&ahmin said:
the ingredients is 37% tuna white meat, 16% chicken, 1% polysaccharide gum & 46% water. Is it appropriate for Ahmin?
Click to expand...

Welcome Christine! I think that the food you're feeding is fine--there's nothing in the ingredients that would be a source of carbs.

squeem3 said:
christine&ahmin said:
Hi Lana,

so, which means i should keep going for 1 unit & test every 4hrs per day since i'm giving him lantus?

christine
Click to expand...


You don't need to test every 4 hours every single day :smile:

At the very minimum, test before giving each insulin injection. So, twice a day every day.

In between those two tests, you can do as many or as few tests as you want and you don't need to do them every day :smile: Many people here work full time and have other things going on and can only test twice a day with maybe one or two random tests before bedtime.

For a blood glucose curve, test approximately every 2 hours starting from the morning insulin injection to the evening insulin injection.
Click to expand...

With Lantus, you need to test at least 3 times a day--before each shot, and then a test in either cycle about 6 hours in to collect the nadir, or, the lowest number in the cycle. Gathering a few other tests throughout the cycle is also helpful.

Christine, it sounds to me like his blood glucose has lowered enough to where you need to fine tune your dosing a little bit more using tight regulation. Please use these instructions to set up a spreadsheet: http://felinediabetes.com/FDMB/viewtopic.php?f=6&t=18207&start=0. Once that's done, come over to the Lantus Forum: http://felinediabetes.com/FDMB/viewforum.php?f=9. There are many experienced people there using the same insulin that can give you detailed dose advice.
 
You are indeed off to a good start w/ home testing and a good long acting insulin. Lantus is dosed on the lowest point of the 12 hour cycle, the nadir. We highly recommend getting at least 4 tests per day, just before each shot to make sure the BG level is safe to shoot and around mid point in the cycle to see how low the insulin is taking the cat. This is the number we use to determine how to adjust the dose.

Another important thing to remember is that Lantus forms a reserve (we call it the shed) which is slowly released, so first the insulin builds up in this shed and then it is slowly released. The full effect of the insulin will not be seen until this shed is stabilized and every time the dose is changed it takes several cycles to re-stabilize. Other insulins can be adjusted on a day to day basis depending on the tests, but not Lantus. Especially at the beginning it is not uncommon for numbers to
vary considerably. When you test in relation to food can make a big difference too.

As for the low shot number, that depends on how much data you have on how the cat is responding to the insulin. Beginners are often urged to get help before shooting lower numbers the first few times. We have a Stickey for that too. :-D

To find out more about Lantus dosing, I would recommend going over to the Lantus Group forum There is a lot of great information on how the insulin works in the permanent posts (we call them Stickeys) at the top of the forum.
 
Hi guys,

I finished SS & posted a new thread in Lantus group :
viewtopic.php?f=9&t=50185

Pls kindly give me more advice on what to do next!

Thank you for the help of all fabulous members here! This is the most amazing forum i've ever been, i can feel love is all around here :-D

Christine
 
Julia & Bandit said:
With Lantus, you need to test at least 3 times a day--before each shot, and then a test in either cycle about 6 hours in to collect the nadir, or, the lowest number in the cycle. Gathering a few other tests throughout the cycle is also helpful.
Click to expand...

I am well aware of how Lantus works in cats :smile: My diabetic was on it. Unless the protocol has changed within the last 2 years, I never took a nadir test daily because I worked full time. My random bg tests were done mostly at night and on weekends and on those rare days when I had a weekday off. On weekends I didn't necessarily always take a nadir test. But I knew from curves that my cat's nadir was around 6 hours.

For those who work full time and use Lantus for their diabetic, getting a nadir test 6 hours or so after the morning insulin injection may not be possible.
 
Christine,

Your SS looks great! Your now have a record of Ahmin's pre-shot numbers. You are lucky to have a vet who supports you in home testing and also starting Ahmin off at a low dose of insulin. You now want to collect some numbers at the nadir of a 12 hour cycle. For most cats, that is 6 hours, but for your cat, it could be at 5 hours or at 7 hours. So, if you could start collecting some data mid-cycle data -- the AM cycle OR the PM cycle (it doesn't make any difference which), we will start seeing seeing how much your dose is decreasing Ahmin's blood sugar. The four hour curve is not really giving us the information we need to see in order to discover the high and low of his cycle. We usually do 2 hour curves.

As to food--- Diabetic cats are ravenous. Give him all he wants to eat. As you get his diabetes under control, his appetite will return to normal.

Lana
 
squeem3 said:
Julia & Bandit said:
With Lantus, you need to test at least 3 times a day--before each shot, and then a test in either cycle about 6 hours in to collect the nadir, or, the lowest number in the cycle. Gathering a few other tests throughout the cycle is also helpful.
Click to expand...

I am well aware of how Lantus works in cats :smile: My diabetic was on it. Unless the protocol has changed within the last 2 years, I never took a nadir test daily because I worked full time. My random bg tests were done mostly at night and on weekends and on those rare days when I had a weekday off. On weekends I didn't necessarily always take a nadir test. But I knew from curves that my cat's nadir was around 6 hours.

For those who work full time and use Lantus for their diabetic, getting a nadir test 6 hours or so after the morning insulin injection may not be possible.
Click to expand...

I also work full time (60 hours a week at two jobs), go to grad school, and have an hour commute each way to work, so believe me, I understand that it can be hard to test sometimes. To get a daily nadir, I would set an alarm, get the pm nadir test, and go back to bed since I can't run home and test for the am nadir because of my commute. I understand that life sometimes doesn't allow you to get all the tests you need, but I wouldn't advise someone to not collect the nadirs unless there is just no way they can do it. It seems like Christine is able to get the tests, she was just wondering when the best time to test was, so I was just clarifying that for her a little bit. :smile:

The more nadirs you collect, the more quickly you can safely adjust the dose, and ultimately regulate and then wean off insulin.
 
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