Rascal

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carissab

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Hi,

Our almost 10 year old cat Rascal was diagnosed last week. He was switched to the D/M food and started on 2 units of Lantus two times per day. When he was diagnosed his b/s was over 600, it came down to around 450-498 for a few days and then shot to over 600 again so the vet increased him to 3 units two times per day yesterday. Today he has been betwen 414-507. This is all so scary. I am hoping this new increase will take effect and he will be down to normal range soon. He was a huge cat and now down to 13 plbs at the vet, he does look better and is not shedding like he was. I guess I am just looking for advice and confirmation that we are on the right track.

Thanks,
Carissa
 
Welcome Carrissa,

The board is very quiet tonight but I will try to answer/ask a few things. Are the numbers from the vet or do you test at home? I can't remember - is DM wet or dry?
 
Thanks. The initial over 600 was from the initial vet visit when they took his blood trying to figure out what was wrong. He was ravenously hungry and losing muscle mass. The other numbers are from home testing. We are doing 3 times per day, before his insulin doses and then once mid day. We will be doing a curve soon. We were supposed to do it today but he was so high on Thursday night (the meter read HI and wouldn't even tell what it was) so the vet increased his dose and we are calling her on Wednesday with new numbers. The D/M is dry and wet food, he has one can in the morning and one in the evening with dry food out to graze during the day. We have 2 other cats and we went ahead and switched them all to the D/M.
 
Fantastic that you are testing at home and moving to a wet lo carb diet. Although we would prefer you change to all wet. ( See this website by a vet: www.catinfo.org)

I would suggest you post over in the Lantus forum also. They all use your insulin and should be able to help you with dose. (I haven't used Lantus) They will recommend that you read the stickies on the top of the page. They have great information on how Lantus works. viewforum.php?f=9

It may be quiet tonight. This forum certainly is. Be patient and you will get answers.
 
You are on a good insulin and know how to test at home. You are off to a good start on those two things. However, your vet rapidly increasing the dosage concerns me. Although it sounds logical to increase the dose when the numbers are so high, it can sometimes cause the opposite effect. A large dose may drop the BG too rapidly. The body responds by overcompensating and releasing large amounts of glucose producing hormones. This is called the rebound effect. You mentioned a curve before. The curve is where you chart the BG every hour or two hours after the insulin injection. When the dose is too high and you have a rebound effect, the curve looks like a V. The low point of the curve is called the nadir. Without doing any testing between injections, you have no idea how low the BG is going, For example, I have seen cases where people start at a BG of 450 go down rapidly to 50 and then sky rocket back up to 400 again before the next injection. If you don't do any testing inbetween, then you would just see the 450 and 400. It would look like the insulin had done nothing when it had in reality dropped rapidly and then increased again rapidly (rebound). I hope I am sounding coherent this time of the night.

When the BG goes under 50. or so you risk going into hypoglycemia. You might have noticed others posting about going hypo. This can be a medical emergency and can quickly kill a cat. Please read the announcement on hypos. In this past week there have been at least four or five cats that have had hypo emergencies. One of the cats died. Most of these cases were caused by cats that were on doses of insulin that were too high. Please do not let your vet increase the dose again until you know how low the BG is going in the middle of the cycle..

You should also test your cat for ketones. Diabetic Ketoacidosis is a condition in which the body begins metabolizing fat and this creates ketones. If ketones reach a certain level, this can cause the body ph to drop and become too acid. This creates a metabolic chain of events that can also lead to death. Notice in my signature I mention my cat had Diabetic Ketoacidosis twice. The high BG numbers your cat is having now can also put them at risk of DKA.

Sorry to be so long and please excuse the poor spelling. I would encourage you to go out tomorrow and buy urine test sticks for ketones. You can buy them in the diabetes section of any drug store and most larger supermarket chains also have them.
 
Carissa, welcome to the board. My cat, Simon, was diagnosed in Nov. 2010 and my vet started him off with 3 units 2x/day of Lantus based on his size (his weight was 16 pounds when he was diagnosed, down from 19). After one week, the vet increased him to 4 units, based on the curve done at the vet. At the same time she increased his insulin, I found this board and started hometesting. I'm glad I did, because Simon went from a very high number to below 50 in just 12 hours. If I hadn't been hometesting, I would have shot him with 4 units of Lantus and then gone to bed. Who knows what would have happened overnight. I went ahead and immediately reduced his dose to 1 unit 2x/day, based on the advice from the board. At first, he posted some high numbers, but if you look at his spreadsheet, you will see that he almost always tests in the blues and the greens and he is down to only a skinny .25 dose. I would probably question the high dose he was started on because most of the cats that are using Lantus start with 1 unit and then go from there. I am definitely not an expert since I am pretty much a newbie myself, but hopefully, you will get some great advice from others on this board. I'm glad you are hometesting. You will save alot of money by doing the testing at home instead of at the vets. Most of the time, the numbers the vet sees are higher because cats can be very stressed at the vets, causing the bg numbers to be higher than at home. I would also recommend slowly switching to an all canned low carb diet. I have seen a tremendous difference in Simon and my other cat (non-diabetic) since I switched them to canned. They are more active, and playful and I know it has helped Simon's bg numbers to really drop. Sorry this is so long! Good luck with everything and please ask questions. There are so many wonderful people here that can help.
 
Rascal seems to be doing ok on the 3 units of Lantus twice a day, his numbers are still not low but at least nothing over 600 for a few days. He was 448 at 7:30am, 450 at +6.5 and 413 at 7:30pm. I am sorry I haven't figured out all the acronyms yet. I dont' know how to deal with taking away the dry food altogether as he is a grazer as are the other 2 kitties in the house but we are doing the DM food so hopefully it won't be too bad. We talk to the vet again on Wednesday. He was actually 327 lowest yet at +4 yesterday so I am hopeful things will start working out. He seems happier, his coat seems better (he had started shedding a ton and that has stopped completely). My vet has a lot of experience in treating diabetic kitties so i am going to follow her advice for now and just keep hoping he keeps improving and numbers keep lowering.
 
It's great your kitty is feeling and looking better.


Changing all your cats over to wet food will be best for all of them and will help your diabetic's numbers. You can feed everyone wet food. They can graze; wet food can sit out. I freeze the wet food and leave it out to thaw.
 
I would encourage you to also go to the Lantus support group and look at some of the dosages there.Most cats are on doses of one and half units or less.The highest dose my cat was ever on was 1.5 units twice a day in the beginning.He is now down to a quarter unit. At least talk to your vet about lowering the dosage when the numbers come down.
 
I will talk with the vet about the lower dosages everyone on here seems to be using. I know that at the 2 units he was posting over 600 on daily testing so not responding to that, we gave it 10 days on that dosage, she increased as we were concerned with such awfully high numbers, especially since we changed to the DM diet. She said the higher dose would take about 5 days to show the effects and we are on day 4 and he is finally coming down on his numbers....today was 368 prior to his morning insulin and 291 + 5.5 (first time under 300 the whole last 2 weeks) so I guess it is starting to get things under control a little bit. I am sure she wants him to come down as soon as things settle down a bit for him. We home test 3 times a day right now, morning, noon and night.....we will do the curve I am sure on Saturday since he is finaly starting to get regulated a little bit.
 
The other part of the puzzle is that we encourage you to make tiny changes with insulin, particularly with Lantus. Lantus users move the dose by .25 units, not one whole unit. Here is the protocol they use: http://felinediabetes.com/Roomp_Rand_20 ... otocol.pdf Note the information on starting dose and increasing doses. You might want to share it with your vet.

We understand you want to work with your vet. And it is great that she suggested home testing and wet food.

Many cats do get tired of the DM - it is liver based and they don't like the taste after awhile. But the wet is only 7% carbs, so it isn't bad to feed. It is just expensive and the ingredients are not as good as premium catfoods like Wellness and Merrick.

If you can, I would eliminate the dry. As Dr. Lisa Peterson explains (http://www.catinfo.org): "Of course, in order to be on board with the 'preventative nutrition' argument, a person has to understand the fact that carbohydrates wreak havoc on many cats' blood sugar/insulin balance, that all urinary tract systems are much healthier with an appropriate amount of water flowing through them, that cats inherently have a low thirst drive and need water *with* their food, and finally, that cats are strict carnivores which means they are designed to get their protein from meat – not plants.

Cats are obligate (strict) carnivores and are very different from dogs in their nutritional needs. What does it mean to be an ‘obligate carnivore’? It means that your cat was built by Mother Nature to get her nutritional needs met by the consumption of a large amount of animal-based proteins (meat/organs) and derives much less nutritional support from plant-based proteins (grains/vegetables). It means that cats lack specific metabolic (enzymatic) pathways and cannot utilize plant proteins as efficiently as animal proteins."

We are just questioning your starting dose. It is more than we would recommend. And we know that cats do better on wet lo carb food.

Here is a tool that might help you and your vet. It is a spreadsheet that is color coded - a great way to share your numbers with your vet and for you to see patterns and trends: Setting up a spreadsheet
 
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