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kate&tigger

Member Since 2012
I have been reading on the message board and other various links suggested by folks in response to my last post. Such alot of info! Very overwhelming! Thank you all for replying and directing me to good information. I have a couple of questions: What are the goal blood glucoses I should be shooting for? There seem to be conflicting opinions in different articles. One said 50 was not too low. I find that hard to believe, knowing what I know about human diabetes. Can anyone direct me to a scientific source that will back that up (something the vet will believe, in other words!)?

How much should I be feeding Tigger a day? He currently weighs about 11 lbs and I would say he is actually under weight, or at least under-muscled. I can feel his ribs and shoulder blades under his fur and his sternum is very prominent. He once weighed 14 lbs which was way too much... Currently I have opted to give him half a can of Little Friskies cat food (one of the <10% cals from carbs types mentioned on Binky's list) twice a day and about 1/4 cup of IAMs kibble a day( he used to have a cup).

His AM blood sugars-all pre-shot- have been 562, 254, 225, 427,414, 93, 378, 56, 306. His PM blood sugars, again all pre-shot have been 363, 401, 489, 143, 372, 330, 293,178,357. I started out at 3 units of levemir every 12 hrs and increased to 4 units. I stepped it back the day he hit 56 (no hypo symptoms and a noontime BS was 118. The morning he was 93 a noontime reading was 125. I confess to giving him a couple of tablespoons of extra food those days out of fear of hypoglycemia. Does it look like he is trending ok? I figured he had some rebound hyperglycemia after those lows and my feeding him extra. I have tried to hold the insulin steady at 4 units and have now segregated him from the other cats so he can't get their food. ( I have a renal kitty who needs to be able to eat more so have to have food out for her!) I am gonna watch him over the weekend and make sure the lack of extra food doesn't make a big difference. Hard to tell how much of her food he was getting.

Thanks in advance fo your help!

kate&tigger
 
Hi Kate,

Is there a reason you're still feeding him kibble? You need to get that out of his diet. I never expected to get my Ruby diet controlled, but 4 or 5 months after switching to all canned, she's now been off of insulin for about 3 months! It took a lot of frustration and pretty regular freak-outs (as many here witnessed :smile: ) but we got there.

- Amy
 
Its good that you've reduced the dry.

It will be okay to completely remove the dry as soon as I go get more eyes with Levimir experience to come advise you
on dosing.
They will most likely want to decrease it because of the food change.


You can be feeding more canned than you are for your daily total.
Are you on a scheduled feeding or freefeeding?

When you are feeding can have an influence on the numbers , especially the dry kibble.
 
The average cat should eat about 7 oz / day divided up how every many times you feed. that's a 10-12 lb cat at a healthy weight.

If you are able to do 4 meals a day, it is better for their blood sugar as it keeps their bg levels more even.
Having large amounts of time in between raises the bg. It becomes feast or famine for the body.
Snacks should now be pure protein. No more pounce or greenies , they are high carb.

Until you cat is regulated on the insulin, it's okay to give a little more food if your cat is hungry.
The diabetes has been starving your cat for a while and your sugarbaby needs time to replenish.
Once everything is getting back to normal, your cats appetite will go back to normal.

Save your special treats ( tuna or shrimp or purebites ... whatever your cat loves) for testing time. It will help your cat
to be more willing to let you poke them....
 
Welcome to FDMB. This is a very proactive and friendly forum to help you get your kitty regulated and hopefully, off the insulin.

First, it is not ok to give your cat more food than you normally would or to feed him as much as he can eat until he gets regulated. Here is an important post about feeding your diabetic kitty: Feed Kitty as Much as They Want???

Also....every cat is different and so I do not think it is a good idea to use a set amount of food/day that applies to every cat that is at a normal weight. Cats, like people, metabolize food differently. And calories are calories so feeding more in canned food than you do dry does not make sense. If the calories you are giving in dry maintain weight, then feed the same number of calories in canned food.

Dr. Lisa's site at http://www.catinfo.org has alot of great information about feeding, obesity, diabetes, UTIs, etc. Her recommended formula for calculating calories needed is:
Required calories per day = [13.6 X optimal lean body weight in pounds] + 70

I have found this to be quite generous. I used it as a starting point for my cats. After one week, I weighed them and they had gained weight so I decreased their food a little bit; waited a week, weighed. And continued
until I got them stable where they weren't gaining or losing weight.

While feeding several times a day might keep a non diabetic cat or a person's bg level, I wouldn't agree with that in regard to a diabetic cat. You are introducing insulin and that changes things. Look at SSs and you'll see that, except for the really tightly regulated cats, most of the kitties here do not have a level BG. What feeding multiple, small meals a day does do is take the pressure off the healing pancreas.

His starting dose seems really high to me. We do not dose based on the PS nor do we increase a dose by 1u at a time. Regardless of either protocol used, that is too much, too fast. It's easy to go over a kitty's "fitting" dose by going up that much. Our increases are much more conservative....typically .25u every six cycles unless kitty's nadirs are above 300. Then we would only increase, in general, by .5u every six cycles.

Most of us in the Lantus Tight Regulation Insulin Support Group follow the Tight Regulation (TR) Protocol. There are many levemir users in this forum (including Gracie and me) because it is a very active forum with someone there almost 24/7.

The TR protocol was developed based upon the premise that a cat's pancreas may be able to heal and return to producing insulin if the cat's BG is kept in a normal range, ie, 50-120. Caregivers following this protocol adjust insulin doses following the protocol guidelines, to aim for that range. Basic information on the TR is here TR Protocol. If you want to follow the TR protocol, we strongly encourage you to post daily in the Lantus TR insulin support forum for a while to learn more about how it all works. The starting dose for those following the TR protocol is .25u/kg of kitty's ideal weight. If kitty is underweight, the formula frequently used is 0.25 unit per kg of kitty's actual weight.

Requisites for following a TR protocol with Lantus or Levemir include:

• Kitty should be monitored closely the first three days when starting Lantus or Levemir. Blood glucose levels should at least be checked at pre-shot, +3, +6, and +9. More monitoring may be needed.
• Learn the signs of and How to treat HYPOGLYCEMIA and prepare a HYPO TOOLBOX.
• Test regularly for ketones and know about DIABETIC KETOACIDOSIS (DKA).
• Use U-100 3/10cc syringes with half units marked on the barrel for fine dosing.
• Feed a high quality low carb canned or raw food diet.
• Feed small meals throughout the day. Some kitties adapt well to free feeding.

The Start Low Go Slow (SLGS) protocol has caregivers start with an initial dose based upon the BG at diagnosis and whether kitty has been transitioned to a wet low carb diet, hold that dose for a week or two while testing for ketones regularly, being consistent with food and shooting every 12 hours. Once a week a curve is done (test every 2 hours for one cycle) to check for the lowest point. The low number in that curve determines any dose change for the following week. Basic information on the SLGS protocol is here SLGS. If you want to follow the SLGS protocol, you can post for advice on the TR ISG, the Relaxed Lantus or Main health for guidance and support.

Regardless of which protocol or forum you choose, we ask that you do a Spreadsheet as soon as possible and link it in your signature. That will enable us to help you especially with those low numbers.
 
Hi, depending on where you are in treating FD. When you are just starting out we are more conservative. Until you have enough data to understand how the insulin effects your cat we recommend skipping the shot when the preshot is lower than 150 on Lantus and Levemir. Once you are more familiar with your cat's reactions we start to shoot lower and to try to keep the BG levels in the normal range 50 to 120.

  • -- How long have you been giving insulin?
    -- Are you getting any other tests than the preshots? Levemir isn't dosed on the preshot test, but on the nadir, that is, the lowest point in the cycle.
    -- We also change dose in .25u or .5u increments, not in full units.
    -- When you do change dose it can take 3 days before you see how it will actually work, since these insulins form a reserve or as we call it a shed. Until this is reestablished you can see "wonky numbers". The BG can actually go up w/ an increase in dose until the shed is balanced.

It would help if you could set up a spreadsheet on Google Docs. The instructions are in the stickies at the top of the forum.

As for food, do get rid of the dry. As for how much, just like w/ people you need to think in terms of calories , not number of cans. The food lists show the calories per can and it can vary a lot. It can be anywhere from 24 to 45 calories per ounce. Most cats need between 20 and 30 calories per pound of ideal body weight per day. It depends on the cat as Marje said, inactive cats need less, very active cats meed more. So for maintenance Tigger would need between 220 and 330 calories a day, more if he needs to gain weight.
 
Hi Kate,
Please bear with me as this could get long.

First of all, please do not change his diet off dry food until you lower the insulin dose. 4U is an unreasonably high amount of Levemir if that dose was not arrived at via the standard method, which is starting at 1U, conducting curves and raising or lowering the insulin doses according to the nadir/lowest point in the curve.

The preshot readings you listed, while not nadir readings, are enough evidence for me to tell you 4U is too much for Tigger. Anytime you get 400s for one preshot and then 56 for another, you are on the roller coaster of too much insulin.

The problem with these results is that although you have gotten some good blood glucose values, there is no steadiness to them. It is not good for a cat to be in the 400s one day and under 100 the next. That is not how Levemir is designed to work. It is designed to maintain fairly level blood glucose throughout the day. A proper dose can achieve that. A good "target" nadir is 80, with preshots maybe 50 points higher. That would be a fairly level curve on Levemir.

Why did you start out at 3U? Was that the vet recommended dose? We see that dose stated from newbies quite often here. I don't know where vets are getting that from, insulin should not be dosed by weight and even if it is, it should be "ideal weight", which is rather subjective given the different feline body types. Lantus is similar to Levemir and the AAHA guidelines list the best starting at 1U twice daily. http://www.aahanet.org/PublicDocuments/AAHADiabetesGuidelines.pdf

I highly suggest doing 3 things -
1. lower the dose to 1U
2. Change diet to low carb canned food only
3. Test before every shot, as you've been doing, PLUS get BG checks during the cycles, particularly between 6 and 10 hours after the shot. If you get +6 then +8 one day, do +7 and +9 another day. As long as you keep the dose steady, you will get a much better picture of how the insulin is working and a much better understanding of how to manage doses.

Also, Levemir doses should not be increased by 1U at a a time. (There are special circumstances, such as acromegaly, but they probably don't apply to Tigger) When on doses below 2U, the maximum increase should be .25U. Levemir works best by using a step-up approach. You must start at a low dose like 1U and if needed gradually increase the dose until the blood glucose begins to level out over the course of a cycle.

This board is astounding at helping members understand how the insulin is working and where to go from where you're at. Right now you are in a precarious place with a marvelous insulin. 4U of Levemir can be dangerous for a cat which may need only 1 or 2U of insulin not only because of the risk of hypoglycemia, but because an overdose hypo on Levemir will last a long time and may be difficult to get the cat out of hypoglycemic numbers.

Besides the Lantus ISG section, there is one specifically for Levemir as well. http://felinediabetes.com/FDMB/viewforum.php?f=10

Hope this helps guide you. Levemir is a good, gentle insulin, but I call it the Gentle Giant because it can also be powerful.
 
Hi Kate,
I'm glad some of our more experienced have come to check on you.
I'm sure you will get more input.
As you are reading and learning, stop and ask specific questions and then it won't feel as much like a bombardment.
It is a lot to change all at once but the good thing is you can take it at your pace.

I would say to follow the advice you have below, the 1, 2, 3,.
Go low and go slow is better than what the vet does when they give some vague instructions and send you out the door
not knowing what you are doing.
Ask questions about each area when you get bogged down and you will have the basics figured out in the next few weeks.

If your vet won't support you, there are others.
Tell us where you are and maybe someone knows of a better vet.
Vets aren't used to patients getting so involved because so many people don't put the time in to learn more.
Yours may change his mind when he sees you are determined to help your sugarbaby.

If you need help getting a spreadsheet, ask. There are people who help with that.
You want to get that baseline going so you know how your kitty reacts and everyone here can see how it's going.
You want to get the food change in place and then those with experience with your insulin can weigh in and tell you
when it's time for an increase.
And when you've got that much together, you will want to post on the insulin support group for Levamir.

I hope the pieces are falling in place for you.
 
Thank you all for the replies. I am impressed by the passion and dedication, not to mention the knowledge of the message board members. Let me see if I can answer some questions and fill in some background. Tigger has been diabetic and on levemir for almost 4 years now. His dose as assigned by his vet after performing several curves was 3 units every 12 hrs. ( he weighed 14 lbs at that time and had access to alot of dry food). After 2 trips to the ER with hypoglycemia his dose was lowered to 2 units and there it stayed for a couple of years. He seemed to do ok at this level or at least was asypmtomatic of diabetes during this time. I need to mention that he lives in a cattery with 2 other cats. It is spacious, heated and airconditioned and has a large enclosed out-door run attached. The disadvantage is that he is not under close observation though I try and spend a certain amount of time with the cats every day. I also work a 40 hour week and have an African Grey parrot and 2 cockatiels to attend to as well as house and garden duties--not to mention my husband would like a minute everynow and then! Having said all this I am determined to get his diabetes under control and give him the best life possible. I increased his insulin over the past couple of weeks---obviously too much too fast--- because his blood sugars were 500-600 when I took him to the vets for a routine check. I had noticed weight loss and increased urination so knew something was afoot.

I will certainly cut out the dry food from his diet but my understanding was that dietary changes should be slow. I had ample evidence of that today when I did not give him any and he crashed on me. I found him wandering blindly in his run and had to spoon sweetened tuna juice into him before he would even eat. His sugar was 55 which is supposed to be allowable but I suppose he is not used to "normal". 30 mins and 1/2 can of catfood later he was up to 124, but still wobbly. I am writing this and then going out to check on him again when I am done. I think someone answered my next question which was, should I now give him any insulin? Some where one of you all said it was ok to hold the insulin if blood sugar was <150. Is that correct? I obviously need to check out the levemir protocol as suggested. I also need to develope more patience....

I will set up the spread sheet tomorrow. I am a bit intimidated by all the instructions but will figure it out I am sure...

Thank you all very much. I need to go back and re-read the replies because once again there is so much information to absorb.

kate&tigger
 
Thank you all for the replies. I am impressed by the passion and dedication, not to mention the knowledge of the message board members. Let me see if I can answer some questions and fill in some background. Tigger has been diabetic and on levemir for almost 4 years now. His dose as assigned by his vet after performing several curves was 3 units every 12 hrs. ( he weighed 14 lbs at that time and had access to alot of dry food). After 2 trips to the ER with hypoglycemia his dose was lowered to 2 units and there it stayed for a couple of years. He seemed to do ok at this level or at least was asypmtomatic of diabetes during this time. I need to mention that he lives in a cattery with 2 other cats. It is spacious, heated and airconditioned and has a large enclosed out-door run attached. The disadvantage is that he is not under close observation though I try and spend a certain amount of time with the cats every day. I also work a 40 hour week and have an African Grey parrot and 2 cockatiels to attend to as well as house and garden duties--not to mention my husband would like a minute everynow and then! Having said all this I am determined to get his diabetes under control and give him the best life possible. I increased his insulin over the past couple of weeks---obviously too much too fast--- because his blood sugars were 500-600 when I took him to the vets for a routine check. I had noticed weight loss and increased urination so knew something was afoot.

I will certainly cut out the dry food from his diet but my understanding was that dietary changes should be slow. I had ample evidence of that today when I did not give him any and he crashed on me. I found him wandering blindly in his run and had to spoon sweetened tuna juice into him before he would even eat. His sugar was 55 which is supposed to be allowable but I suppose he is not used to "normal". 30 mins and 1/2 can of catfood later he was up to 124, but still wobbly. I am writing this and then going out to check on him again when I am done. I think someone answered my next question which was, should I now give him any insulin? Some where one of you all said it was ok to hold the insulin if blood sugar was <150. Is that correct? I obviously need to check out the levemir protocol as suggested. I also need to develope more patience....

I will set up the spread sheet tomorrow. I am a bit intimidated by all the instructions but will figure it out I am sure...

Thank you all very much. I need to go back and re-read the replies because once again there is so much information to absorb.

kate&tigger
 
Kate

The fact that he was in the 500/600s and then also has days when he is confused and wobbly tells me he's probably getting way too much insulin. Also, we don't recommend doing curves in a vet's office due to the stress. The higher numbers there almost always result in the kitty getting too much insulin.

While every cat is different and he could have had hypo symptoms at 55, it would be unusual. It makes me wonder if he was much, much lower and brought himself up.

If you have any problems getting the SS up, please PM me and I'll help you. Just click on the "PM" button under Gracie's avatar and send me a message. It's not as intimidating as it seems and can be done in less than 15 minutes.

"Overwhelmed" is a such an accurate subject for FD. We all start there; we all feel that way for the initial weeks. We all work, have other pets, husbands or companions, kids, homes, aging parents.....so we understand. But we all make it through those first weeks of learning on the board. It's a steep curve and even though you've been doing the shooting regimen a while, really learning takes a bit of time at first. But then you will continue to learn a little bit each day.
 
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