Newbie: Punkin's first curve was in wrong direction

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Kathy&Punkin

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I'll just jump right in here: hi everyone! What a wonderful site and THANKS! I've had Punkin's 16 years: lovely grey tabby. DX on May 20. My wonderful & highly reputable dox believes in "start low go slow:" 1u Lantus 2X daily since May 20: P's BG is 600+ still but he nevertheless shows so much improvement since first inj back in May. I am home-gluecose monitoring: Doc did a Fructosamine after 2 weeks, and the result was pretty high then he did another blood check on Saturday and I await the result. My question is: I did my first 12 hour curve today: It went in the wrong direction starting at 540 and going to 600+! I am to share the results with doc tomorrow and per his instructions, will stay at 1u dose he lets me know otherwise. I'm having difficulty with finances and hospitalization (tho P is really in pretty good shape) is out of my reach financially. But this website helps and my sister, a pharmacist, keeps me in syringes & paraphenalia. She'd send the insulin but lives 1,500 miles away and refrigeration is an issue. I'm learning so much in a short time. Thanks and I've been "lurking" here since May 20 and just registered today.
 
Hey Kathy. Welcome!
Is it possible for you to set up a spreadsheet with Punkin's BG numbers and link it for us to see?
 
viewtopic.php?f=6&t=18207
for info on setting up a spreadsheet. I had a little trouble at first, but I think that was with my gmail account.

I had issues with Cedric's first & second curves in that it would go down at +2 hrs and +4hrs, then go up, up up (although not as high as yours). I changed his diet right away.
 
Oh wow. Last night I tried for a long time to get my spreadsheet loaded with no luck-slow downloading prevented. I have a nice spreadsheet, But my first reading was yesterday--I don't know--I've been dragging my feet on using the new devices.
So here are Punkin's numbers: Vets Initial was 600+ at Vets on May 20
No measurement from then until June 12: 1U 2xdaily same time every morning and evening, of course
Sunday: June 12: PS: 540 2+:565 4+580+ 6+:600+ 8+:600+ 10+:600+
Monday (today) June 13: PS: 565 a few minutes ago.

This is a very long road--I don't expect immediate results. His alertness is better, responses are good, P/U has decreased some since DX with velocity slowed considerably. (No more mopping up the floor.) Great BMs(they are so good they could be on the cover of Smithsonian Magazine)-he's been on Science Diet Lite for several years (for overweight)and diet is a big issue b/c of a huge past battle with diarrhea - Dox recommends Science Diet MD and I will do that. Punkin has lost 2 lb since DX. Your comments are so needed. Thanks a lot. Please understand that I am working on a very old computer and if If I don't post back immediately, it could be computer issues. KH
 
Hi Kathy,

I would suggest you try to work with the diet. I am convinced that 10 years on Science Diet weight control caused Oliver's diabetes. And he never lost any weight! The Science Diet dry foods run from 20 - 40% carbs. (Janet and Binky’s chart) We try to feed around 8% carbs. On this website, a vet explains why dry food is not a good diet for diabetics. (www.catinfo.org)

Oliver was a 16 pound Maine Coon eating Science Diet weight control when he was diagnosed. When we changed over from dry to wet, his numbers went down 100 points overnight! We eventually were lucky enough to get him into remission. And the wet lo carb food we fed him meant a weight loss down to a healthy 12-13 pounds over a 6 month period.
 
Kathy,

While the MD is better than a lot of dry catfoods out there both the wet and dry forms are still to carb heavy for a diabetic cat, about 14% carbs. A diabetic really needs to be on a diet under 10% carbs. I also had a non-diabetic cat that for years had diarrhea until I took him off dry food altogether when we first discovered Muse was diabetic, then continued them on the canned food after she passed away and of course they are still on it now that we have Maxwell (my current diabetic). At least in his case it was something in the dry food that was causing the problem, I suspect grains or gluten.

If possible I would try to switch him over to an all canned diet that is under 10% carbs, especially if you are testing at home. If you haven't seen it yet here is the link to the food charts we use to pick our cat's foods, there are lots of options out there that are probably better quality ingredients and just as good if not better for managing his diabeteshttp://www.felinediabetes.com/diabetic-cat-diets.htm
 
If you feel like you must feed a prescription diet, then Purina DM canned is the only prescription food that is low enough in carbs for a diabetic cat, so ask for a script for that. As others have said, you don't need to feed a prescription diet as there are many better quality commercial foods that are suitable and less expensive. The prescription diets also contain a lot of liver, which many cats seem to get sick of quickly. Check out the link for Janet and Binky's chart and pick something under 10% carbs (And some cats are more sensitive than others; Bandit needs 6% carbs or less in order to stay in remission).

It sounds like you have a good vet in terms of dosing. The high numbers are most likely because of the dry food. Once you get rid of it completely you'll see a HUGE improvement. I would get rid of it before your vet increases the dose. Many cats' blood glucose levels drop drastically once the dry food is removed, and it's far safer to get rid of it while he's still on a lower dose of insulin. The science lite is especially high in carbs and I suspect your cat will drop by quite a bit. I think that a dry weight loss diet caused Bandit's diabetes (first Hill's W/D and then Iams weight control), and if I had my way every bag of the stuff would have a huge warning on it.
 
hi kathy,

i had to respond to you because i have a Punkin too! awesome name for awesome kitters!

i think nearly all vets recommend the purina dm - mine was on it too - but go to regular commercial canned food and you'll find he does better. I use the Fancy Feast classics - chicken feast, turkey & giblets, beef and i give the fish classics only once a week. My punkin had recurrent bladder infections about every year and now i know that dry food was part (maybe all) of the problem. I have had 2 cats on dry prescription food for chronic diarrhea. one of them passed away a few years ago, but i have a 2 year old and since switching her to the fancy feast canned her diarrhea has completely cleared up. Once you start reading about canned food/dry food and kitty guts you'll wonder why anyone ever feeds dry food. I've fed cats dry for probably 35 years and i'll never do it again - i just never knew better.

anyway, i would definitely encourage you to change the food. the Janet & Binky's list will give you the info you need to pick a low carb canned food that will be the very easiest thing you can do to help Punkin. You really can't get a hold of a cat's blood sugar if they are on dry food, or any food that is too high in carbs.

also, if you are home testing you don't need to do any more BG testing at the vet's office, including a fructosamine. you'll have accurate information, unaffected by stress, be able to show it on a spreadsheet, and you'll save yourself a lot of money. once you've got it to show the vet, they won't even ask you to do it there.

yes, you've got a wonky curve. it very likely is reflecting the food. i can't tell if you still have him on dry food or if it's the canned food of those prescription foods. i can't encourage you enough to change his food.

anyway, people here will respond to you quickly so if you come back and respond, you'll get plenty of help towards the next step.
 
All your BGs are essentially the same the meter accuracy is only +/- 20% (+/- 100 at a BG of 500). Changing to low carb should help. Sometimes it takes an increased dose to get things rolling. I experienced a similar trend with my Tonis (does not know what to do with canned food). After going to 4 units BID of Lantus switched to Levemir. I did not seem much reduction in BGs until I got to a dose of 6.5 units. He is now on 4 units.

Each cat is different too. My Smokey is on dry only DM with little Evo, and his BGs stay below 140 on 1.3 units of Lantus.
 
Gosh, Thank you everyone: My doc just sent me a note reminding me not to get discouraged: Look at the big picture, how Punkin is feeling & looking (pretty good) and he's right. However, the numbers still warrant a dosage increase: 2U twice a day.
I printed out the list of Fancy Feast options and will be going slow on any food change; a prudent move, especially with his big diahrrea problems. Taking the low carbs now into big consideration. Will let you know. Again, Thanks so much. KH
 
When you do the food change, get some fortiflora to mix in. I just had a loose stool problem with Bandit last week and the fortiflora works wonders. They should have it at your vet's office.
 
Kathy, I'd encourage you to print out the protocol that was developed by researchers in Australia working with a Feline Diabetes group in Germany that is used here on this forum to manage cats on Lantus and give it to your vet. He may not have seen it, but it's wildly successful at getting cats off of insulin entirely. Of course some cats don't, but in the study 100% of the cats who followed this protocol in the first 30 days of being diagnosed went off of insulin. the percentages decreased the longer they had been diabetic before starting the protocol - well here's the abstract on the study reported in the Journal of Feline Medicine & Surgery:

http://www.ncbi.nlm.nih.gov/pubmed/19592286
J Feline Med Surg. 2009 Aug;11(8):668-82. Epub 2009 Jul 9.
Intensive blood glucose control is safe and effective in diabetic cats using home monitoring and treatment with glargine.
Roomp K, Rand J.
Source
Department of Computational Biology and Applied Algorithmics, Max Planck Institute for Informatics, Saarbrücken, Germany.
Abstract
Human diabetic patients routinely self-adjust their insulin dose using a protocol and home monitoring, and perform equally well or outperform physician directed adjustments. The objective of this study was to report the outcome of home monitoring of diabetic cats by owners using a protocol aimed at achieving euglycaemia, using ultra-low carbohydrate diets (< or =10% metabolisable energy) and the insulin analogue glargine for >10 weeks and/or until remission was achieved. Fifty-five cats diagnosed with diabetes mellitus, whose owners joined the online German Diabetes-Katzen Forum, were included. An overall remission rate of 64% was achieved in the cohort. Significantly higher remission rates were observed if good glycaemic control was achieved soon after diagnosis: 84% for cats started on the protocol within 6 months of diagnosis went into remission, and only 35% for cats that began more than 6 months after diagnosis (P<0.001). Only one mild clinical hypoglycaemic episode occurred observed despite tight blood glucose control. In conclusion, intensive blood glucose control is safe and effective in diabetic cats using home monitoring and treatment with glargine.

PMID: 19592286 [PubMed - indexed for MEDLINE]

Here's the link to the official protocol:http://felinediabetes.com/Roomp_Rand_2008 dosing_testing protocol.pdf

Lantus is dosed differently than other insulins - adjustments are usually made by .25 units rather than whole units. One unit is a huge increase. even the best vets can't be specialists in everything they see and most don't have diabetic cats. i adore my vet - he's in a practice with 2 others including one who just completed her degree 3 years ago, and they have 1 diabetic cat besides mine. they have to know a lot about many animals and many health issues - and this is all fairly new with the Lantus. Anyway, i don't want you to feel like i'm bashing vets, because i'm not meaning to. it's just that they often aren't very experienced with feline diabetes.

you might ask your vet how many other cats he's had on lantus. Providing him with these documents might be a great way to open the conversation! best of luck to you!
 
Punkin's Progress: Got Fancy Feast Classic

Hi everyone: thanks again for so much good information and much to report: Since my first post, I got him off Science Diet Light and fully into Fancy Feast Classic: Curve yesterday's nadir 300s. Punkin's behavior, his alert-ness, mobility, P/U & P/D are all improved. But I know this is a long-haul. I will try to post his spreadsheet now.
 

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