Regulation seems to be taking a long time...Advice?

[Sonya]

Thomas was diagnosed with diabetes back in January. We have been slowly increasing his dosage of Lantus. At first he seemed to be getting better numbers, but not so much now.

He is up to 5 units twice a day, that seems like a lot to me.

We have switched feeding habits, at first he was MD wet food and free feed on the MD dry food. We eliminated the MD wet food because he got tired of the taste and started giving him Fancy Feast Classics. Next we started limiting the free feeding. Now we put out 1/2 cup of the MD dry food in the morning and 1/2 cup in the evening. We have two cats so he is not the only one eating this.

We are doing a BG today and the numbers are again not what we had hoped:

6:02 am 384 (just before the 5 units, spoonful of FF, and 1/2 cup of dry MD)
8:15 am 328
10:08 am 291
12:24 pm 285

His numbers were worst when he started on 4 units, these numbers are pretty similar to what they were at 3 units. Any thoughts? Advice? I think our next step will be to cut out the dry food entirely. Neither cat will be very happy with this, but they will adjust.

Thanks,

Sonya

 

[carolynandlatte]

Hi Sonya,

There are many reasons Thomas could be running so high. Not enough insulin? Too much insulin? Diet? Illness?

I read back through your intro post and noticed some folks mentioned switching Thomas to a low carb/wet food diet, which could increase his chance at remission. At the very least it should decrease the amount of insulin he needs. My guess is, you will continue to see higher numbers than you prefer as you continue feeding the dry food. It is very high in carbs. If/when you decide to cut out the dry food, you will want to do it slowly and monitor his BG's closely.

Do you test regularly? Just before shots? +6ish every day? Something that would be helpful for people to provide feedback is setting up a spread sheet with Thomas' tests. This will allow others (and you) see an overall picture of his patterns and what is going on. It will be easier for others to give appropriate feedback. The link to how to set up a spreadsheet is here:
http://www.felinediabetes.com/FDMB/viewtopic.php?f=6&t=18207
Let us know if you need help with it.

While numbers are running high, it would be wise to do regular ketone checks. You can get ketostix at most pharmacies. The box will look like this:

Glad you are here!

 

[carolynandlatte]

I might add...are you raising the dose 1 unit at a time, or less?

 

[Sonya]

We've been raising the dose 1 unit based on the numbers. I've added the spreadsheet to my signature. At least I hope I did! Anyway there are two curves for 4 units, partial, because we were surprised by the numbers and stopped. We thought maybe the Lantus was bad and switched to a new vial then retested with 4 units again. It turns out the Lantus was probably fine.

Yes, I think our next step is to switch to canned only. I'm thinking we should keep the units at 5 while adjusting, checking BG to make sure he doesn't drop too much.

Thanks,

Sonya (and Thomas)

PS Our other cat, Izzy, will just have to suffer with the same diet. She's kind of a diva so she will not be happy.

 

[Sonya]

Looking at the spread sheet, I'm thinking it is definitely a food issue. But that leads to another question, how much canned food should he get? He's right around 13 pounds, he was 13.26 but has dropped a bit since switching to the limited dried.

Thomas was originally a stray. Six years later he still has a compulsion to check the food dish when ever he comes in from outside. Making sure that it is still there and he still has food. Of course this has meant frequent snacking. He's always been active so it hasn't been a weight issue until now.

He is such a sweet cat and has been very good about putting up with shots and ear pricks. We were worried he wouldn't take to this life, but he has not had a problem. However, he is definitely feeling better and better as he has gone back to attacking our other cat on a regular basis. It's all her fault of course. We love both our fur babies, but she is a diva.

Sonya

 

[carolynandlatte]

Great job getting the spread sheet up Sonya! :mrgreen:

I would highly recommend (for your cat's safety) that you always check his BG before giving a shot. Always! If you could try and get another test in on ocassion midday, and one before you go to bed at night, that would also be helpful in understanding what kind of insulin needs Thomas may have. Of course, if you can get more tests...GREAT! But you are posting in the relaxed forum, so I am assuming you have a schedule which may not allow frequent testing.


Typically insulin in cats is best raised at .25, sometimes .50 increments. 1u is a very large jump in dose. :shock: There are some health conditions that may warrant a cat being increased by 1u or more at a time (acromegaly, IAA, and cushings). Can I ask if it was you, or your vet who thought insulin should be increased by 1u at a time? (not slapping any hands...just wondering! ;-) ).

Here is the protocol used in the tight regulation group. Without being able to test frequently, you may want to be even less aggressive with dosing, and use the go slow approach.

Many Lantus and Levemir users in this forum have been successful following a somewhat modified version of this Tight Regulation Protocol for the last few years. These "general" guidelines are based on anecdotal evidence and personal experiences of laypersons frequenting the forum.

"General" Guidelines:

Hold the initial starting dose for 5 - 7 days (10 - 14 consecutive cycles) unless the numbers tell you otherwise. Kitties experiencing high flat curves or prone to ketones may want to increase the starting dose after 3 days (6 consecutive cycles).

Each subsequent dose is held for a minimum of 3 days (6 consecutive cycles) unless kitty earns a reduction (See: Reducing the dose...).

Adjustments to dose are based on nadirs with only some consideration given to preshot numbers.


Increasing the dose:

Hold the dose for 3 - 5 days (6 - 10 consecutive cycles) if nadirs are less than 200 before increasing the dose.

After 3 days (6 consecutive cycles)... if nadirs are greater than 200, but less than 300 increase the dose by 0.25 unit.

After 3 days (6 consecutive cycles)... if nadirs are greater than 300 increase the dose by 0.5 unit.


Reducing the dose:

If kitty drops below 40 (long term diabetic) or 50 (newly diagnosed diabetic) reduce the dose by 0.25 unit. If kitty has a history of not holding reductions well or if reductions are close together... sneak the dose down by shaving the dose rather than reducing by a full quarter unit. Alternatively, at each newly reduced dose... try to make sure kitty maintains numbers in the normal range for seven days before reducing the dose further.

If an attempted reduction fails, go right back up to the last good dose.

Try to go from 0.25u to 0.1u before stopping insulin completely.


Random Notes:

Because of the cumulative nature of Lantus and Levemir:
An early shot = a dose increase.
A late shot = a dose reduction.

A "cycle" refers to the period of time between shots. There are 2 cycles in one day when shooting twice a day.

Sometimes a dose will need to be "fine tuned" by adding some "fat" or "skinny-ing up" the dose.

http://felinediabetes.com/FDMB/viewtopic.php?f=9&t=1581
(there is other wonderful information in the above link).

Go Slow:
http://binkyspage.tripod.com/SLGS.html

I would be very cautious and test multiple times/day (and night) while switching Thomas' food on such a high dose, and little information on how low he may be going at times. I would also make sure to be aware of hypoglycemic signs and have a kit ready: http://felinediabetes.com/FDMB/viewtopic.php?f=14&t=1122 and http://felinediabetes.com/FDMB/viewtopic.php?f=14&t=2354

The other option would be to lower the dose drastically (basically start over).

Have you had the chance to read any of the 'stickies' in the Tight Regulation Lantus board? They are definately worth looking at!
http://felinediabetes.com/FDMB/viewforum.php