Please I need dosing advice

[Nancyco*]

Hi, I’m nancy. New to this group. My cat Bailie was diagnosed with diabetes October 30 and at the emergency vet. They put him on two units of insulin. Then I found out about the diabetes group on Facebook and I posted some thing there. They told me two units was too much and they told me he should go down to one. So I put him on one unit for two days. And then I changed him to 1.50 and his numbers were still high so then my vet upped the dose to 2u and I went back to the diabetes group and told him this and they told me I should put him back down to 1.50 so he was on 1.50 for 10 days. And I went back to the vet and she wanted him up on to. So he was on to for a week went back to the vet and she told me he needed 2.50. I am seeing his numbers really high. And I’m thinking the dose is too high. Also some background information on Bailie . he’s FIV positive has arthritis and also needs a dental with a couple of teeth removed. He also had a neurological event a year and a half ago and I’m terrified to put him under anesthesia. However I hired a anaesthesiologist specialist, who is going to be in the room via zoom whilst he undergoes his dental once they get their new machine for the OR .I get the feeling that I’m giving him too much insulin. His dose is too high. Can somebody please help me figure this out . Oh I must also say that he is a dry food junkie. He was previously getting Farmina weight management. Now I’m trying everything I can to get him on wet food and it’s very difficult and believe me I’m spending a fortune on every kind of pate u can buy ,he eats a very little of the seafood but that’s it . I bought Dr.Esleys clean protein dry and had him transitioned on that then he became constipated so I added back the Farmina weight management . Now I am gradually adding more and more of the Dr.Elseys . I think I will order Young again as I was told on the FB group that that would maybe be better for his bowels. Any ways I’m super stressed out and I don’t think my vet really knows how the Lantus works in cats very well . Does anyone have any thoughts on dosing and what Bailies numbers are ?https://docs.google.com/spreadsheets/d/1yk-jFlafVK3LPYKAl7C1Ej3q6KPPe5M4ryMiB6TOP5w/edit

 

[Sienne and Gabby (GA)]

Welcome to FDMB!

There are a couple of things to take into consideration that may be having an effect on Baillie's blood glucose (BG) numbers. If your cat needs a dental, any source of infection or inflammation is going to push his numbers higher. You might want to talk to your vet to see if an antibiotic may help with the dental issues until he can have the dental work done. (Just as an FYI, for cats that are in remission, the need for a teeth cleaning or other procedure is often what can throw them out of remission.)

Using a cat food carb calculator, the Farmina dry food is 33% carb. That's very high carb. The dry food is keeping your cat's numbers in the upper ranges. I don't know for sure that Young Again will be a better option than Dr. Elsey's. Whatever you decide, make the transition to a new food a slow transition. Many cats experience GI problems if foods are introduced too quickly.

I don't think there is an issue with your dosing. It looks like you are following the Start Low Go Slow method which is your only option given that Baillie is still eating dry food. This is our post on Lantus dosing methods. The one piece of the puzzle we don't have is whether you're seeing higher BG numbers during the day and your cat may be having lower numbers during the PM cycle. It would be very helpful if you could always get at least one test before you go to bed for the night or more accurately, a minimum of one test during the PM cycle. Many cats experience lower numbers at night. If Baillie is dropping even into the 200s at night, his numbers may shoot up during the next several cycles. Without seeing what's going on at night, you don't know how low the numbers are going and I am reticent to make any suggestions without knowing what the insulin dose is doing to your cat's numbers.

 

[Chris & China (GA)]

Just some extra info.....Nancy has been in the FD group on Facebook, but has recently posted in the Feline Diabetes Support Group who have told her she needs to do a "reset" down to 1U. That Bailey has "inverted curves" which indicate a dose that's too high.

My replies to her:
No, I don't see any real warning signals that the dose is too high. I think it's too low. What makes you think it's too high? You spent about 20 cycles at 1.5 and never got below 223. That's not the usual thing we see in a cat that's getting too much insulin. You are, however, increasing by too much. Your increases should only be in 0.25 unit increments unless nadirs are always over 300.
I also know that you are posting in different groups. This can be confusing and sometimes even dangerous because different groups do things in different ways. This group is the only one associated with the FDMB which has been helping diabetic cat caretakers for over 25 years (before Facebook was even a thing) so there is lots of information as well as experienced caregivers to help guide you. It's best to post daily (or at least every other day) so people get used to looking for you and respond better. (kind of like the squeaky wheel gets the grease). If you'll post there and let me know, I'll tag some people who have been there even longer than I have....by about double! so they have even more experience than I do (or other groups).

Chris Ronkoski the people on the other group told me that it was too high of a dose, and that it was an inverted curve.

Nancy Copeland an inverted curve starts out lower, then you give insulin and it goes up (which is the opposite of what you expect insulin to do). Even a cat on an appropriate dose can occasionally have an inverted curve, but I don't see Bailey doing a lot of inverted curves. I do see a lot of flat cycles though. But that's also why we suggest that people pick one group, until they at least understand how their insulin works, how and when to increase/decrease and start to understand the data they get by testing. Since we're also associated with the FDMB, we follow their protocols and dosing methods so it's kind of like getting 2 for the price of 1.

@Sienne and Gabby (GA) and @Wendy&Neko are two of the people I talked about having been here at least twice as long as me. You can't get better advice!

ETA: Thanks for bringing up the PM tests @Sienne and Gabby (GA) . I had intended to but was busy encouraging her to post here

 

[Nancyco*]

Welcome to FDMB!

There are a couple of things to take into consideration that may be having an effect on Baillie's blood glucose (BG) numbers. If your cat needs a dental, any source of infection or inflammation is going to push his numbers higher. You might want to talk to your vet to see if an antibiotic may help with the dental issues until he can have the dental work done. (Just as an FYI, for cats that are in remission, the need for a teeth cleaning or other procedure is often what can throw them out of remission.)

Using a cat food carb calculator, the Farmina dry food is 33% carb. That's very high carb. The dry food is keeping your cat's numbers in the upper ranges. I don't know for sure that Young Again will be a better option than Dr. Elsey's. Whatever you decide, make the transition to a new food a slow transition. Many cats experience GI problems if foods are introduced too quickly.

I don't think there is an issue with your dosing. It looks like you are following the Start Low Go Slow method which is your only option given that Baillie is still eating dry food. This is our post on Lantus dosing methods. The one piece of the puzzle we don't have is whether you're seeing higher BG numbers during the day and your cat may be having lower numbers during the PM cycle. It would be very helpful if you could always get at least one test before you go to bed for the night or more accurately, a minimum of one test during the PM cycle. Many cats experience lower numbers at night. If Baillie is dropping even into the 200s at night, his numbers may shoot up during the next several cycles. Without seeing what's going on at night, you don't know how low the numbers are going and I am reticent to make any suggestions without knowing what the insulin dose is doing to your cat's numbers.

Thanks kindly for your response . I’m going to do a couple of readings postPm cycle . How often should I post his spreadsheet here ?

 

[Nancyco*]

Just some extra info.....Nancy has been in the FD group on Facebook, but has recently posted in the Feline Diabetes Support Group who have told her she needs to do a "reset" down to 1U. That Bailey has "inverted curves" which indicate a dose that's too high.

My replies to her:
No, I don't see any real warning signals that the dose is too high. I think it's too low. What makes you think it's too high? You spent about 20 cycles at 1.5 and never got below 223. That's not the usual thing we see in a cat that's getting too much insulin. You are, however, increasing by too much. Your increases should only be in 0.25 unit increments unless nadirs are always over 300.
I also know that you are posting in different groups. This can be confusing and sometimes even dangerous because different groups do things in different ways. This group is the only one associated with the FDMB which has been helping diabetic cat caretakers for over 25 years (before Facebook was even a thing) so there is lots of information as well as experienced caregivers to help guide you. It's best to post daily (or at least every other day) so people get used to looking for you and respond better. (kind of like the squeaky wheel gets the grease). If you'll post there and let me know, I'll tag some people who have been there even longer than I have....by about double! so they have even more experience than I do (or other groups).

Chris Ronkoski the people on the other group told me that it was too high of a dose, and that it was an inverted curve.

Nancy Copeland an inverted curve starts out lower, then you give insulin and it goes up (which is the opposite of what you expect insulin to do). Even a cat on an appropriate dose can occasionally have an inverted curve, but I don't see Bailey doing a lot of inverted curves. I do see a lot of flat cycles though. But that's also why we suggest that people pick one group, until they at least understand how their insulin works, how and when to increase/decrease and start to understand the data they get by testing. Since we're also associated with the FDMB, we follow their protocols and dosing methods so it's kind of like getting 2 for the price of 1.

@Sienne and Gabby (GA) and @Wendy&Neko are two of the people I talked about having been here at least twice as long as me. You can't get better advice!

Thanks so much I will refrain from posting in the other group and just post on FDMB and your Facebook. To be completely honest I got the two of them all mixed up .

 

[Chris & China (GA)]

To be completely honest I got the two of them all mixed up .

Happens all the time. No worries!

 

[Sienne and Gabby (GA)]

This is a post on helping us to help you. It will provide you with instructions as to what to include in your signature so we don't pester you with asking the same questions repeatedly. It also has instructions for how to link your spreadsheet to your signature. If you look at my signature and Chris', you'll see the link to our spreadsheet. It saves the fuss of having to remember to post your spreadsheet. We look at members' spreadsheets a lot!!