Newly Diagnosed 9-5-14

Status
Not open for further replies.
katieroc

katieroc

Member Since 2014
My 6 yr. old Rui (Ru-ee) was just diagnosed on 9-5-14 Tested 312 at vet visit. Started him on lantus .5 units twice a day and purina dm. Numbers went down quickly to very low 100's (sometimes lower; never tested lower than 78) for several days. No insulin for days on the advice of vet. After about 2 1/2 weeks number started climbing to mid-100's and we increased dosage to 1 unit twice daily. Did curve on 9-27 (see below). Numbers kept climbing and as of 9-30 they were well into mid to upper 200's. Upped dosage to 2 units twice a day. Past 3 days they are into 300's. Had him back to the vet on Friday. Did blood work and urine culture. No results back yet. Talked to vet about getting new vial of insulin since I'm thinking it's lost potency. Vet doesn't seem to think so. Yesterday 10-4, he tested 293 in the a.m., tested 5 hrs. later at 321 and in the p.m. at 323. I think the age of the insulin is the common denominator (age of insulin and very high numbers) even though we were advised the vial would last much longer than the recommended 28 days. Believe me, I would love to have the vial last and last since it's super expensive, but I'd rather get a new vial and see if his numbers go down. At least we'd know if that's what causing these high numbers.

Stats:

DSH male-looks like Turkish Van
Sweet boy (now literally!)
Test twice a day (about 7 a.m./7 p.m) with Alphatrak 2 (test strips ridiculously expensive!)
Feed twice a day (he always wants to eat)

Curve 9-27:

7:40--177 (1 unit)
10:30--96
145--145
4:50--152
6:45--149 (.5 units)
10:00-157

We were so encouraged early on. Could he really be going into remission with a change in food and a few shots of insulin! Now it's the total opposite and very discouraging. Any advice is appreciated.
 
The Purina food is not necessary and you can get commermercia food that is lower in carbs that the Purina.
Is it Purina dry? That is high in carbs.
Here is a list of low-carb canned commercial food
viewtopic.php?f=28&t=87391

It may be that you missed the right dose. That would account for the relatively flat, high curve you recently obtained.
I would change to the low-carb food and at same time reduce the dose to 1/2 to 1 unit.
 
Thanks for the reply Larry. He's on Purina dm canned food. We took him off dry food over a year ago due to urinary tract issues and fed him commercial canned food. I'll take a look at the link you sent. Are you saying to reduce the dose from 2 units to 1 even though his numbers are in the 300's? Do you think it could be the potency of the insulin?
 
I do not think the Lantus is too For my Patches the Lantus vial was first used about six months or more ago.
What may be happening is that you are giving too much insulin. ONe indicator of that is a high, flat curve like you measured.
WHen you change to a lower-carb canned, insulin need should go down so that is why I proposed startingat 1/2 to one unit.
 
Sorry Larry. Could you repeat the first sentence of your last post. I was wondering about the potency of the insulin since I'm reading conflicting info about whether it's still good after a month. Just tested Rui for his pm bg. 332. I'm very confused about all of this. It's new and overwhelming
 
Lantus, if kept in the fridge, can last much longer than 28 days. Info on proper handling and storage is here. We've had members use vials for 5-6 months before it goes bad. Look at the insulin - is it clear? Does it have floaties in it?

I agree with Larry that the dose may be too high. Normally we do increases in .25 unit increments for cats so we don't bypass a good dose. With Lantus, it's best to stick to the same dose morning and night - since it's a depot insulin, it likes consistency. If you give different amounts you can get wonky numbers. How much does Rui weigh? What is his ideal weight? We use a weight based formula for determining starting dose.

In addition to feeding any low carb commercial food, select from under 10% carbs on this food chart, you can also feed several small meals throughout the day, with most of the food in the first half of the cycle. Small meals are easier on the pancreas.

And, you do not have to use the Alphatrak strips, unless you want to help sent the vet's kids to college. ;-) Most of us use human glucometers. Relion Confirm/Micro from Walmart is a common one because it uses a small blood drop like the Alphatrak, but the strips cost a lot less. Many of us here use a protocol that is based on numbers from a human glucometer.
 
Hi Wendy--thanks very much for all the info. I'm trying to wrap my brain around all of this!

Looking at the lantus storage info--I've been preparing the syringe wrong. I've been putting the excess back into the vial. The insulin is always refrigerated and looks clear. I don't see any floaties. Would putting the excess back in the vial make the insulin bad?

Rui is a big boy! He weighs 16 1/2 lbs. He does have a large frame, though. He has not lost any weight in the month he's been on purina dm. **It looks like the purina dm has low carbs according to the food chart. Lower phosphate. I'm assuming lower phosphate is better? If I leave food out (my husband and I both work), he vacuums it up. I have another cat as well (female-Maya) and I have to feed them separately since Rui will eat her food.

The 2 unit dose he's on now was recommended by the vet due to the higher numbers that cropped up recently. He started on 9-5 with .5 units. I've either increased or decreased the dose per the vet's instructions by .5 units. Never more than that/less than that except when he wasn't on insulin after those initial good numbers. So, if I were to decrease the amount I'm giving Rui now, the bg might actually go down? I've been giving the same amount every 12 hours. (I'm still confused with the high number/lose dose even after reading the "depot insulin" info).

I did start out by using a OneTouch meter and strips, but I got the AlphaTrak2 when I read that the AT2 was better at giving accurate numbers when the bg was low. ?? AT2 does give higher numbers than the human meter.

I would like to find a vet who has a lot of experience with FD, but I'm not sure where I can find one except for word of mouth. I haven't been successful finding that information online.
 
OK, I just reviewed some info on Symogyi effect and I think I understand (well, understand a bit better!) yours and Larry's suggestion. I'm going to mention this to the vet. Although, I think the vet did talk about this the day Rui was diagnosed, but honestly that day is a blur.

And it's phosphorus (not phosphate)! I just found that in the food list! I obviously don't have a clue what I'm talking about. confused_cat

My name is Susan btw. (I can't see where to update my profile).
 
Hi Katieroc,

Update your signature from User control panel at top under Board Index.

You will need to populate with information about your sugar kitty and a spreadsheet.

Kevin
 
To edit your signature:
Go to the top left of the screen.
Click on User Control Panel.
Click on Profile
Click on Edit Signature
A test box displays.
This is where you paste the link for your spreadsheet, once it is set up.
Add any other text, such as
your name, cat's name,
city and state,
date of Dx (diagnosis)
insulin
meter
any other pertinent issues like food issues, allergies, IBD, etc.
 
We've had people inject their insulin back into the vial when they first start. It may mean that the vial doesn't last as long, but it should still last longer than a month.

Rui is a big boy and according to our formula, he would have started on 1.75U of insulin. Kitties can be sensitive to very small changes in dose. In order for people here to help you on dosing, we'd ask you to enter your test data into a spreadsheet. There is a description of how to do that here. It produces a standard format we are used to reading.

Interesting that you started on a OneTouch Ultra. That's what my vet uses in her office because she finds it matches pretty well with the results she gets from the lab. As far as using human vs. pet meters, I've seen it referred to as the difference between imperial and metric. There are ways to convert from one to another. Below 100 on the human meter, the difference is about 18 points. The TR protocol that some of us use here specifies numbers according to human meters, as that's what most people use due to the cost of the strips.

Good luck finding a vet knowledgeable about feline diabetes. They have to know so much about so many different animals that it's hard to find one who is as knowledgeable as people here who live with FD 24 hours a day. You could post a separate topic on the main heath form here with your general location, asking for vet references near you. BJM has a list of vet interview topics in her signature if you want to start looking around. I like my vet for everything else and she leaves most of the FD decisions to me.
 
Thanks to all for the profile info. Also thanks for the spreadsheet and instructions. I'll update all this weekend. I keep a chart with Rui' s numbers but on paper. I know. Old school! His pm bg tonight is 378. This is after an increase to 2.5 u per vet last night. I guess I want a miracle for him and its not happening. I'm doing another curve on Thursday. I have no idea what's going on between these am and pm numbers. Just very discouraged and down about it all. Not a good day. Guess that happens too. But again thank you all. I appreciate your support.
 
Hi Susan,

Please do not get discouraged. We have all been where you are and with help of all the great people here, I was able to weather the storm.

You too will do just fine.

Stay the course and test often. I look forward to seeing your spreadsheet to see how you are progressing.

All the best!
Kevin
 
Hi Susan,

Hang in there. I know it's frustrating to be working so hard for your kitty and to not see a change in the numbers. We didn't see much change in Jersey's numbers for about 6 weeks after we started Lantus. It just takes time to find the right dose sometimes.

I have no idea what's going on between these am and pm numbers.
Click to expand...

How are you doing on home testing? You're getting tests before each shot, right? Are you able to get a test in between shots? We base Lantus dosing on the nadir - which is the low point in the cycle. For most cats, that's 5 to 7 hours after the shot, although every cat is different. If you can get some tests in between shots, that will tell us a lot about how well the dose is working.

Here's an example of how revealing a mid-cycle test can be: On 3/21, Jersey's PM pre-shot number was 337. A little over 6 hours later, her numbers had come down to 79. By the next morning, her numbers were back up to 372. If I wouldn't have been testing that night, I may have thought that the insulin wasn't working when, in fact, it was working quite well.

My name is Susan btw. (I can't see where to update my profile).
Click to expand...

You can go back to the user control panel - profile - edit account settings...there, you can change your username if you want to. You can also go to user control panel - profile - edit signature and put your name, kitty's name, type of insulin used, etc. if you want to.

Just take a deep breath and one day at a time! :YMHUG:
 
Go to the top left of the screen.
Click on User Control Panel.
Click on Profile
Click on Edit Signature
A test box displays.
This is where you paste the link for your spreadsheet, once it is set up.
Add any other text, such as
your name, cat's name,
city and state,
date of Dx (diagnosis)
insulin
meter
any other pertinent issues like food issues, allergies, IBD, etc.
 
Well. Just updated my spreadsheet with Rui's number. I have to say I'm truly baffled and at my wits ends, frankly. When I look at the sheet, his numbers were so promising and the past week and 1/2, they just tanked. The vet upped the dose to 3 units and wants me to do a curve (every hour) on Saturday. I did a mini-curve after his morning shot today and it's totally flat. No fluctuation at all. I just put a call in to her. I seriously don't know what to do. I'm afraid he is insulin resistant due to who knows what. He had a urine culture and blood work. All normal except for the bg, of course. The vet did a fructosamine? test, but I don't have the results yet. I really want to remain positive, but these numbers tell a different story.
 
Your spreadsheet is not public:


You need permission

Want in? Ask the owner for access, or switch to an account with permission. Learn more
 
I can see it on my PC now.

Please hold the same dose for a minimum of full days before changing it. It takes at least that long for the Lantus dose to somewhat stabilize.
 
Status
Not open for further replies.
Back
Top