Newly Diagnosed Cat - BG Remains High

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montyislay2

montyislay2

Member Since 2012
Hi I am new to this. Our cat (10 year old much loved ginger neutered male) was diagnosed on Saturday and spent 3 nights at the vets. They put him on a special diet and started insulin as well as some antibiotics for an infection - but it doesn't seem to be coming down. It reduces to about 19 and then goes back up. He's home now for a few days and back in on Monday for another curve. Is it too early to worry that he's not responding?
 
Welcome :smile:

Yes it does take time for a diabetic cat to become regulated. It does not happen overnight and definiely does not happen in 3 days at the vet's office. How long it takes varies from cat to cat and how you treat the diabetes. Some cats who follow the suggestions and recommendations of this board can go into remission with a few short weeks, others may not reach remission for a few months. Then there are cats who will always need insulin and diet to be regulated and there's nothing wrong with that :smile: Things like using a not recommended short acting insulin, feeding a poor diet, and blindly giving insulin without testing the blood glucose level are some factors that can prevent a cat from being regulated.

What insulin and food did the vet prescribe? What is the current dose of insulin? What kind of infection does your cat have?

19 mmol is pretty high. Where in the world are you? There are members from all over the world here: Canada, UK, Australia, US, etc.
 
Thanks!! We're in the southwest of the UK.

He's on 2.5 units of Caninsuline twice a day and a low carb WD diet that the vet gave us which he eats begrudgingly. We've ordered a funky glucometer which should arrive tomorrow so that we can be more precise about his levels. Vet said he had a bit of a chest infection which was treated with antibiotics. He's doing pretty well and chilling out at home and in the garden, but is still drinking a lot and yelling for food! Arrggh!
 
http://www.felinediabetes.com/FDMB/viewtopic.php?f=28&t=64843 This link will help you to find canned food in the U.K. This link will show and explain to you all about hometesting which will save you money and is the best thing you can learn to do to help your cat http://www.felinediabetes.com/FDMB/viewtopic.php?f=14&t=287

W.D. is rarely used anymore.......old school thought. Nothing but fiber and will not help. If you remove all dry food and feed only canned, you will see a rapid change and improvement but.......do not change food or remove dry till you can hometest first. Removing higher carb food whether canned or dry can dramatically lower insulin needs and you do not want to risk causing a hypo.
 
montyislay2 said:
Thanks!! We're in the southwest of the UK.

He's on 2.5 units of Caninsuline twice a day and a low carb WD diet that the vet gave us which he eats begrudgingly. We've ordered a funky glucometer which should arrive tomorrow so that we can be more precise about his levels. Vet said he had a bit of a chest infection which was treated with antibiotics. He's doing pretty well and chilling out at home and in the garden, but is still drinking a lot and yelling for food! Arrggh!
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First suggestion I would make is revise the subject of your first post to add "in UK" and you will get members closer to you to help with food suggestions.

Now Caninsulin is a lousy insulin but it has been hard for many owners to get their vets to agree to other insulins..... ask for Glargine (Lantus) as many have pushed to been able to get their vet to give them Lantus.

What meter did you order? You can easily pick up a human meter, and you don't need to get a fancy pet meter. What are the human meters available to you to purchase? Many here outside of the US use the OneTouch, Accu-Chek, Bayer countours, and a few others. Once you get a meter and test strips, many members here can help you with testing tips.

I am sure that once you add the UK in your subject, you will get more local help, owners who will know the best foods for your cat that won't cost so much and will be more like foods your cat will like to eat.
 
montyislay2 said:
Thanks!! We're in the southwest of the UK.
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There are quite a few UK members here on this board :smile: If you add UK to your subject, you'll get responses from other UK memnbers.

He's on 2.5 units of Caninsuline twice a day and a low carb WD diet that the vet gave us which he eats begrudgingly.
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Instead of the W/D, you can feed a commerical brand of canned food. W/D is not low carb anyways, The dry is around 40% and the canned is 26%. Ideally a diabetic cat should have no more than 10% carbs. As you've seen, many cats don't like the taste of prescription food.

Here are some UK food suggestions:
http://www.felinediabetes.com/FDMB/viewtopic.php?p=33786
http://www.felinediabetes.com/FDMB/viewtopic.php?f=28&t=33247
http://www.felinediabetes.com/FDMB/viewtopic.php?p=30648
http://www.felinediabetes.com/FDMB/viewtopic.php?f=28&t=68650&sid=71005fb8c27bbf59920855a6fce75067

Caninsulin works great for dogs but not so much so for cats. Better insulins to use are ProZinc, Lantus (glargine), and Levemir (detemir). Ask your vet about these. I know there are UK members here who use Lantus.

We've ordered a funky glucometer which should arrive tomorrow so that we can be more precise about his levels.
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What brand is it?

Here are the testing tips and videos: http://felinediabetes.com/FDMB/viewtopic.php?f=14&t=287

You want to test before giving each insulin shot at the very minimum. It's recommended for newbies not to give any insulin if the blood glucose level is under 200 mg/dl (9 mmol). Many people here keep track of their cat's blood glucose levels using an online spreadsheet that can be shared with other members and even with the vet. Here are the instructions: http://felinediabetes.com/FDMB/viewtopic.php?f=6&t=50130 Use the World template so you can put in your mmol numbers. The spreadsheet will automatically convert the number to mg/dl which is how the US measures blood glucose umbers.



Vet said he had a bit of a chest infection which was treated with antibiotics.
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Any infection of any kind can elevate blood glucose levels. Even bad teeth can cause high blood glucose levels. Once the infection is gone, the levels will drop a bit.

[qoute]He's doing pretty well and chilling out at home and in the garden, but is still drinking a lot and yelling for food! Arrggh![/quote]

Unreglated diabetics are always hungry so it's best to feed multiple small meals daily. One the diabetes is more regulated, the excessive hunger and thirst and urine output will go away.
 
Right - now we have our glucometer - an Aplhatrak I think. BG was 24.5 at about 11 this morning (insulin +3 hours), and now on latest reading (+6) is 31.5. Trying to get hold of vet to see if we should give him more insulin - as surely it should be going down at this time not up?? Any ideas anyone gratefully received. Am v worried.
 
The infection can raise the bg levels as can the higher carb food. I would change the food and watch the levels carefully as they should come down. How long has he been taking antibiotics? Perhaps they are not working well and a different antibiotic would be more effective.

The high numbers are frightening especially when coupled with an infection. We consider higher numbers safer over the short term than numbers that are too low, however. Are you testing for ketones daily?
 
He is no longer on antibiotics as they finished these when he was in at the vets. They tested for ketones also and this was negative - but as you say the high numbers are frightening - I feel like I should be doing something more to help him but I don't know what!!
 
Yes I went to the pet shop this morning and got some James Wellbeloved Diabetic Turkey wet food (using the cat food calculator this is 2.2% carb) but I don't know whether I can give that to him instead of what the vet gave me? Its all so confusing and I'm terrified of doing the wrong thing by him. I'm waiting on the vet to call me so that I can find out what to do. Poor Monty.

Thanks so much for your ideas though, it really does help. This has all happened so suddenly and has been hard to come to terms with. One thing I am sure of is that we will do absolutely the best thing by him, and hang the cost - I just want him to be well again.
 
Hi and welcome to the board. Many of us - myself included - have been where you are, ie very worried and not knowing what to do for the best fr our beloved little furbabies. This is a great place for information and support and I encourge you to come here as often as you need to. I'm in the UK (Surrey) and there are others who can give you more local information, but everyone who responds from anywhere else in the world will give you similar generalised advice.

First - those numbers are too high, yes, and suggest either an infection and/or not enough insulin and/or food that is too high in carbs. Frankly, the very best food you can give your cat is good old Whiskas or Felix meat or fish in jelly (has to be jelly; gravy has too many carbs) and of course you can get these at most supermarkets. It's true that you shouldn't change food unless you are home-testing BGs regularly (ie in case the lower-carb food brings about too great a drop in BGs) but at the numbers you're getting I'd say it was safe to gradually introduce a lower-carb food, testing regularly to make sure numbers aren't going too low. From what you say there isn't much chance they would go dangerously low, but if there is or has been an infection going on, that might clear up and might help the BGs... so it's always better to make any changes slowly.

Caninsulin is not, sadly, the best insulin for cats. It was made for dogs who have a different metabolism. Cats metabolise faster than dogs, so this insulin works by dropping the BGs fast - but then the insulin wears out so there is none left in the system, and numbers rise again rapidly. What we're aiming for is a more gentle insulin giving a slower drop which lasts longer. You'll get the gist.

I think all you can do for now is carry on as you are, gradually introduce the new food, test regularly and always before an shot - and report back here and we will help as much as we can. There may be nothing you can do about the insulin at present, but after a while, if BGs don't improve, you can go back to your vet armed with more knowledge and talk to him/her about changing to another one (not an easy task but it can be done!)

Best of luck
Diana
 
I believe that your vet is legally required to prescribe Caninsulin before you can use Lantus, but they can request permission to use Lantus if the Caninsulin is not working well (which it usually doesn't). It's also possible that your vet is not aware of the recent changes in insulin recommendations for diabetic cats, as most of the research on this subject just came out a few years ago. So I'm going to give you a bunch of information for you to give to your vet to read, so that you can get them on board with changing the insulin.

Here's an article for you to print out and bring to your vet on the success rate of treating cats with Lantus (glargine) vs. Caninsulin (lente).



Here's another article to bring to your vet that discusses the safe and effective way to administer Lantus. When the dosing guidelines in this article are followed, newly diagnosed cats have an 86% remission rate! But it's very important to start treatment as soon as possible, because there is a window on remission. You don't want to keep your cat on Caninsulin any longer than 4-6 weeks.



Finally, here are the dosing guidelines for Caninsulin: http://www.uq.edu.au/ccah/docs/diabetesinfo/link2.pdf. Note for your vet where it states that "Lente is the 3rd insulin of choice and NPH the 4th of choice insulin for control of diabetes mellitus in cats, behind glargine or detemir (1st choice) and PZI (2nd choice), Lente and NPH result in lower remission rates compared to longer acting insulins." Also note where it says "If nadir blood glucose concentration occurs within 3 hours of insulin administration, or blood glucose returns to baseline within 8 hours" to switch to Lantus or Levemir.

Switching the food will help bring down carb levels a lot (W/D is very bad for cats, my cat was prescribed this food for weight loss and it caused both his triaditis and his diabetes. The high carb load is especially bad for diabetics). Just make sure you're testing 2-4 hours after his shots to make sure he's not dropping too low.
 

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Hullo from Hastings E Sussex.

I cant help with insulin as the one that worked with Jazz Cat, Katy Kat and Bushey Boy is no longer made.
When Bushey came to us he was on Caninsulin 2x2u a day and throwing numbers in the region of 35 As far as he was concerned I might just as well have injected water.
As I still had some of Katy's Insuvet PZI(beef) in the fridge, I changed him to it. I also banned ALL dry food from the house (he came with a box full!) His numbers came down to a reasonable 20 ish

The main thing was the change to wet food. Any variety in jelly is good as it is the lowest in carbs

After all, when did you see a cat go out to catch an ear of corn?
Some of the dry comes in at 50% carbs.......... just like giving a kid a diet of chocolate

Hope this helps
Mary
 
Thank you all for your replies, it is good to know there is so much support being provided by this forum.

The vet has now requested we give 3 units of canninsulin, up by .5. However from reading the posts on here, your replies and other information online we realise we need to change his diet from dry, using a better low carbohydrate food, however, how do we go about this. Now that he is on 3 units, we are completing a glucose curve today, will this help us know if we can start to change the food he is eating? We are obviously concerned we may drop his sugar levels too far now he is on this higher level of insulin. If anyone can help us by describing how we would go about changing his food and what is the best way to decide when you need to slowly drop his insulin levels, as we can not find much on this process.

your help is much appreciated. I shall have to post a picture of the Monty boy today.

thanks
 
Blood glucose testing is going well (the testing bit anyway) - but the numbers do not make for happy reading:

Pre-food and insulin - 29.4
+1 hour - 25.1
+2 hours - 27.0

Next reading in 2 hours time - surely these numbers must start to come down!!??
 
First, well done for doing the testing - not everyone finds it easy at all (to say the least!)

What you are seeing here with your early curve results is not untypical. The BG has gone down a little after the shot, which is how it should be, but has then risen slightly again - it's what's called a food spike, because food intake usually raises BGs. If you can, carry on testing every 2 hours so we can see better how the insulin is working, but I'd fully expect to see a usual Caninsulin curve, ie dropping to its lowest about halfway through the 12-hour cycle (if not before) and then rising steadily again. That's why Caninsulin is not the best insulin for cats - it doesn't last long.

It's probably best to stick to the usual food while you are doing this first curve, and then, if BGs are still high, start to introduce the new food gradually and do another curve another day. Mix the new food with some of the old at each mealtime, gradually increasing proportions so that it's all the new food. It would be interesting to see a curve on that basis.

I don't think you need worry about BGs dropping too low at the moment - these numbers are still very high and unless you were to increase the insulin dose significantly and/or suddenly change to a much lower-carb food, it's unlikely that you'll see better numbers until a bit further down the road. FD is a marathon, not a sprint - you have to be prepared for a lot of trial and error but with dedication and commitment, you should be able to make a difference.

Keep going and write anytime you need to - the same people may not always be here all the time, but there is nearly always someone from somewhere around!

Diana
 
Diana - many thanks for your post and support! I'll let you know the later numbers when I've got them and to see what you make of them. May also be useful for discussion with the vet on Monday to try and persuade them to change his insulin - he's been in Caninsulin a week now and although he's much better in himself, it doesn't really seem to make a huge impact on these numbers!

I've shifted my other two (non-diabetic) cats onto the low carb foods as well which they seem to enjoy - just on the offchance that Monty grabs a bite of their food - he used to be a terrible minesweeper.
 
I dont know whether you can do a spread sheet.... I just made myself a chart with 12 or so columns, numbered for every two hours, even if I didnt check every 2 hours. Then the day before a vet visit I would do a curve, print it out and take in.

By the time we had Bushey, and I had nearly 10 years experience, I learnt to be more assertive, and the vets came to realise I knew what I was talking about. (All but one, a locum, who had been employed by a certain cat food company, who swore that only his dry food would work and ridiculed the "Catkins Diet" and was told firmly that it had worked for my THREE diabetic cats)

The mantra of this board is "Start low and go slow" when changing insulin dosage, but I'm sure you will soon get it taped. By the way, having diabetes does not change their life expectancy. Jazz, like many on this board, lived to be 20 and it was cancer, not diabetes that took him.

Mary
 
Mary - very many thanks for this and your previous posts. I have to say, his prognosis was one thing that I was worried about (almost afraid to ask) and even more reason (not that I needed anymore) to persist in getting him back to his old self. Now that we have all the kit, getting our own readings is much easier and as you've suggested, we've got a chart to keep track.

My partner is working at home next week so depending on what the vet says on Monday, that might be a good time to think about gradually introducing the lower carb food.
 
Well this really doesn't seem to be doing him any good - latest reading (+4 hours) was still 26.5. I don't hold out much hope for it going any lower. :( :sad:
 
low carb WD
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WD is not low carb and is probably contributing to the high numbers

depending on what the vet says on Monday, that might be a good time to think about gradually introducing the lower carb food.
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There is no need to wait and find out what the vet says on Monday. If you have a meter and are hometesting, now is the time to gradually remove WD and go to one of the canned foods mentioned. Watch carefully and test because you will be removing a lot of carbs and dose may be too high.
 
Yes, gradually introduce the new wet food and you should be ok - if you're testing, which you are. At numbers in the mid-20s and upwards I really don't think this dose of this insulin is going to make a drastic difference.

Try not to be disheartened at the fact that the numbers aren't dropping. You're not going to get where you want to be for a while. At present you are gathering facts and figures (ammunition!) to give the vet. He can't deny that the insulin isn't having much of an effect so will have to work with you on the next step, which will probably be to continue increasing the dose in increments of half a unit until you do start to see better drops. Some cats are what we call "big gulpers" and just need a lot more insulin than others - this is ok as long as the dose does the job. Other cats are insulin-resistant, usually due to an underlying condition, but you needn't worry about that for now, you are still at the very beginning of this journey. As I keep saying - sorry! - FD is a marathon not a sprint, and much as you would like to be seeing progress now, it is still very early days.

Diana
 
Diana - thank you again for your post- and apologies if mine is somewhat mispelled - one of my other cats is a fiend for the laptop and can't wait to go and type her own messages- hence she is trying to sit on it as I type!

We started the switch for Monty this evening - he went down to 20 at +8 and then right back up to 29 so he had a few of his vet -prescribed biscuits but mainly wet food of the 2.2% variety. We'll try and get his ears again tonight prior to bed and then of course before we give him food in the morning.

I know that I am currently running on the paranoid setting - but are there underlying issues I should be aware of and look for signs for?

Very many thanks again. #
 
Morning Catherine!

Well, 20 is better than it was at +8, isn't it - and shows that the increased dose of insulin, and/or the bigger proportion of wet food, is having at least some effect. But, going right back up to 29 isn't ideal - and really, try not to give him the "vet-prescribed biscuits" at that point. Can you look at the packet and see that percentage of carbs that food contains? I'm guessing it will be pretty high. If a switch to wet food hasn't caused huge drops - which it hasn't - then you're most probably safe to feed all or almost all of that, and try not to use the dry at all. It just won't do you any favours. You could, however, just keep some handy in case the BGs drop too low - if that ever happens you'd be wanting to give put sugar back into the system. You can get specialist stuff from your vet for this, but failing all else biscuits would be better than nothing.

Keep going as you are and keep a written log of dose, readings and food given, and a picture will start to form. I think you're getting there but I totally understand the paranoia setting and that makes it harder to see what's happening.

I wouldn't worry about underlying issues for now - that's something for the future if BGs remain stubborn despite gradually increased doses of insulin combined with wet food. There are various things, from infections to more serious diseases, which can cause high BGs and some will cause insulin resistance, but if you haven't noticed any other outward signs, that's something that only the vet can really help you with as he'd need to do tests. It's just like human medicine really - treat the obvious, diagnosed problem and if that doesn't work look at other options step-by-step. Try not to worry for now - just concentrate on getting the food and insulin combo right, which really is the only and very best thing you can do.

Keep going!

Diana
 
Morning Diana and thanks for your continued encouragement. Yesterday's figures were with him still on the MD/WD vet stuff, he's on low carb wets only as of this morning (start point 27.2). I don't intend to do the 2-hourly jabs today (poor chaps ears need some recovery time) but I'll try and do one around +6 or +8 to see if there is any difference - I guess it won't happen immediately?
 
You're very welcome, Catherine - so many of us have been where you are and know how difficult the whole thing is on many levels, so we all do our best to pass on any experience and knowledge gained. We try to be careful with what we say but obviously, take it on board in conjunction with what your vet says too. The problem with vets is that they really don't know much about FD, but on the upside, they do know your individual cat and his history.

I think you're right not to obsess about doing another full curve today. You will wear yourself out. Try to do a few spot checks in the cycle and see if you can work out what's happening with the insulin. A +4 would be interesting - the insulin should be working then but not used up. The wet food should help to lower the numbers, but with Caninsulin you may not get vastly better numbers than you are so don't be too disappointed if you don't. The thing is to make just one change at a time - eg change the food whilst keeping the same dose of insulin (which is what you're doing now), and then after the new food is completely introduced, look at the numbers again and if they are still very high you might want to try adding another half a unit to the dose. Don't be afraid to ring the vet at any time and go over some of this with him. A good vet will respect what you are doing and you can work together, with us here giving you extra support and the benefit of our experience, to get where you want to be.

Diana
 
Diana - some good news to report - at +4 today he is down to 17 - which is 10 points lower than at the same time yesterday!! I know its not perfect and will doubtless go back up later, but we'll test him again this afternoon (+8) which was the lowest level yesterday and see how we're doing. I'm just so pleased we're starting to see a response (the wet food thing clearly is helping).
 
That's great Catherine, I'm so pleased for you, I know how it feels to finally get some better numbers! And this shows that you are clearly on the right track and doing the right things. The combo of a change of food and that extra half-unit of insulin has really helped. Keep on exactly as you are. I know it's frustrating not to get perfect numbers more quickly, but believe me it is much better to take it slowly - you and your cat will get there in better shape because you have done it the right way.

Diana
 
I'm not sure what the record is, but we have had several cats on the board who have notched up 10 years on "the juice"

Most of our elderly diabetics seem to succumb to cancer or heart trouble, just as any elderly cat might.
Six months before Jazz went he was playing, jumping and catching like a two year old!

Mary
 
Hello Catherine,

It sounds like Caninsulin is working well for your cat. You are really lucky in that regard; a lot of cats don't respond well to it (can drop the BG fast and then be out of the system in about 8 hours). If, if, IF you find that it stops working well for you then another insulin you could try in the UK is Hypurin Bovine Protamine Zinc (actually made for humans). It has a longer duration than Caninsulin.

All good wishes to you,

Elizabeth in Surrey x
 
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