Newly Diagnosed - Peep Peep

Hi everyone, new family here with an 18 year old Maine Coon named Peep Peep. He was diagnosed 3 weeks ago. His initial blood screen after a 6 hour fast was 449. The vet put him on Lantus at 1 unit twice a day. He has always liked wet food and was eating Instinct Rabbit but we switched him to Fancy Feast Classic Pate since it is reported to have a lower carb content and the Instinct has a lot of pea protein. He really likes the FF Cod recipe and that is the one with the highest protein lowest fat content of all so we are ok with it. We ran a curve 1.5 weeks after the start of insulin treatment and it looked pretty good with pre shot at high 200's and the peak at 113. Since then his levels keep rising. Last night pre shot level was 411. We never saw that 113 again. We have bumped him to 1.5 units twice a day. Has anyone experienced an initial good result and then see it rise to almost pre treatment levels? Vet suggested to lower his calorie intake to around 280 kcals / day. (he eats a lot) and then test again in a week. Peep is 14lbs so pretty good for a medium sized Maine Coon. Peep is a very intelligent personable cat and it kills me to see him unhappy. He also has diabetic neuropathy showing weakness in his back legs. Any suggestions would help.

 

Hello and welcome. The Nature's Variety rabbit regular, not limited ingredient version is a low carb option if Peep Peep prefers rabit. This food chart contains a list of a number of the commercially available foods. Look for anything under 10%. And don't worry about 3% vs. 6%, all are good options. I also wouldn't feed a lot of fish. The Catinfo website is a wealth of info on feline nutrition.

Are you home testing his blood sugars? Or was the curve at the vet clinic? If home testing, what type of meter are you using? We'll ask a lot of questions at first, it might help if you create a signature with some of that information in it. This post gives some information on how to do that. New? How You Can Help Us Help You!

The good news is that Lantus is a good insulin for cats, and starting at 1 unit is fairly typical, though we usually make change at 0.25 units at a time. Yes, that does mean eyeballing the dose on 1/2 unit marked syringes.

There is a phenomenon we see here that can describe temporary high numbers. Here is the description of what we call bouncing:
Bouncing - Bouncing is simply a natural reaction to what the cat's system perceives as a BG value that is "too low". "Too low" is relative. If a cat is used to BGs in the 200's, 300's, or higher for a long time, then even a BG that drops to 150 can trigger a "bounce". Bouncing can also be triggered if the blood glucose drops too low and/or too fast.The pancreas, then the liver, release glucogon, glycogen and counter-regulatory hormones. The end result is a dumping of "sugar" into the bloodstream to save the cat from going hypoglycemic from a perceived low. The action is often referred to as "liver panic" or "panicky liver". *Usually*, a bounce will clear kitty's system within 3 days (6 cycles).

So depending on the timing of your testing, you could have been seeing the bounce effect.

 

Thanks for the reply. We are testing him at home using the AlphaTrak 2 meter per the vets recommendation. Let me know if you have any questions or would like me to run any tests.

 

Good for you for home testing. You don't actually have to use the AlphaTrak meter - I just say that because the test strips are really expensive. Most of us use human meters and so do our doing methods. But if you like the AT, that' fine too. We also record our blood sugar test results in a spreadsheet, that helps us see patterns in the data and helps us help you. If you want to set up the spreadsheet, the How Can We Help You link contains links to how to do that. For those that are technically challenged, we have members who can help you set it up.

Sounds like that lovely 113 might have caused a bounce. We dose based on how low the dose takes the cat, or the nadir, rather than the peaks. But it's also possible that an initial good reaction to the insulin did not last. Seeing the data in the spreadsheet will give clues as to what happened.

On the feeding, do you think Peep is overweight? My girl also had Maine Coon heritage and hung out around 14 lbs, vet didn't want her much lower.

 

I think he is at a good weight. He could loose maybe 1/2 lb but since he is so old I would not really want that. We like the AlphaTrak 2 and seems to work ok. I don't mind the price of the strips. You can send me a link to the spreadsheet. The vet doesn't seem to think doing curves all the time is valuable. He has us doing them every two weeks. Makes me nervous to wait that long so I am doing periodic checks pre shot and at +6 since that's where he had that 113. He had a 411 last night. We can tell when it's high as his neuropathy seems worse and he seems "dizzy" and just off. I am planning to keep it at 1.5 for this week as we are holding him to the 280 kcal limit and will monitor his weight to make sure he's ok with it. The FF Turkey and Chicken seems to be kind of high in fat and as I understand it, that's a no-no for diabetic cats but I am new to all of this.

I did read about the bouncing but it says 3 days it should clear. The 113 was a week ago. We've not seen even close to that since.

 

Here is the information on the spreadsheet:
Make a spreadsheet for your kitty following the instructions linked below.
If you are moving from a different diabetes group (online or Facebook) and have a Spreadsheet from that group, you will also need to use the link below to make the spreadsheet that we use in this forum. Members are available who can help you transfer all your data from another spreadsheet type to our spreadsheet.
How to Create a Spreadsheet

How to Use the Spreadsheet

Keep your spreadsheet up to date. Helpers will always look at your spreadsheet before offering advice. If it is not up to date it is hard to offer suggestion or give specific dosing advise.

 

How often do you adjust the Lantus dose? The vet says adjust and wait two weeks, do a curve and adjust again. Today his +6 was 191 and pre shot was 311. I understand the start low go slow method so is this what it means?

 

The Start Low Go Slow dosing method has you hold each dose for a week, then do a curve, and increase by 0.25 units if you aren't seeing nadirs in the 90-149 range. Nice to see he's seeing some numbers under 200 now!

 

Peep was at 154 at +3 a few days ago. Checked him today at +5.5 and was the exact same at 154. This was about 1/2 hour or so of eating1/2 can of FF. For an 18+ year old cat he seems to be in a decent mood. Neuropathy is still there.

 

You can treat the neuropathy with Zobaline. Zobaline is methylcobalamin so you can use different sources but many members use this one as it is made for diabetic cats.

The neuropathy won’t go away solely with regulation but it will help.