Riley Update and question about dosage

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Susan & Riley

Susan & Riley

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Well there is good news and bad news.

Since Riley's diagnosis in February he's taken a turn for the better very quickly because of his insulin shots. In fact, the vet said it's the quickest positive response she's ever seen!

The bad is that I am not happy with our vet. So unhappy that after continued visits I was certain they were just out to make as much money as possible and were rude to me on several occasions.. so I stopped going and have been searching for the right vet this week.

In the meantime, Riley seems a little lethargic the past few days so I bought a BG meter and tonight, after tons of research, have done my first curve.
I am on hour 8 and very tired! :) What we do for our little friends!

I found out why he's been lethargic... His first reading right before getting his insulin shot and right after eating dinner was 81.
Not thinking properly (and because I'm new at this) I made the mistake of giving him his usual shot when I probably shouldn't have since it was at 81 and that's perfect!

So 2 hours later I did the second reading and it was down to 32. :(
But he was acting alert and even playing with me a little and I kept a close eye on him all night while doing more reading and giving him some dry food.

3rd reading was 45. Better!
The last one I just took was back down to 38 but he hadn't had any more dry food. I gave him more and he's acting just fine. I see no signs to be concerned.

I will continue to take readings for the next few hours till I see it going back up again and I know he's officially out of the red zone.

My question is... After what I have discovered tonight, should I go down to one shot once a day and lower the dose a bit? (we've been giving him two shots twice a day) I feel like he's on the road to remission and since I am without a vet right now and probably will be till next week I'm wondering what the best course of action would be at this point.

He's currently getting 2units twice a day and is on Lantus.

As always thank you in advance for the help and for this amazing forum!

Susan & Riley
 
No, do not give 1 shot a day. Lantus needs to be dosed consistently so you will need to decrease the dose so you can continue to shoot on a 12/12 schedule. Following TR protocol you should be decreasing down to 1.75u. Also, you need to get some high carb gravy food or honey/pancake syrup/high fructose corn syrup for your hypo kit. As you can see, dry food takes a while to "kick in", where the carb boost from gravy and sugary syrup are immediate. 38 is a dangerously low number and letting your cat surf in those numbers is not safe. You should be testing every 15 minutes and not slowing down until you see some consecutive rising numbers.
 
I'm glad you are finally testing him. Diabetes requires diligent monitoring, either by blood glucose testing, or using the secondary monitoring tools in my signature link religiously. Too much insulin can kill fast (hypo) and too little can kill slowly (diabetic ketoacidosis).

Please read the following and get yourself the supplies needed for handling a hypo incident - dry food doesn't work fast enough, you need karo syrup (or glucose solution or honey) and canned, high carb food with gravy that you can use to manage the hypo. An oral syringe is helpful too. How to treat HYPOS - THEY CAN KILL! Print this Out!!

edited to add: if you had reached the 2 units by following the Lantus protocol, then
[H]e has earned a dose reduction of 0.25 units, down to 1.75 units of Lantus by going below 40 on a human glucometer ... please go to one of the Lantus forums and read over how to make dosing adjustments.

And if you don't already have a spreadsheet to record his blood glucose tests and insulin doses, there are instructions here By recording your data and posting here for feedback, you may prevent this from happening again.
 
I disagree about the amount of the reduction. Since the 2u was not reached correctly using the Lantus protocol and home testing data, I would suggest lowering the dose back down to 1u twice a day and start over on the dosing scale using the protocol. As Ry stated, Lantus needs to be dosed twice daily in order to be effective. So you need to reduce the dose down to something that you can safely shoot twice a day. The only way to accurately determine the right dose is by daily home testing. With Lantus, you need to test three times a day--once before each shot to make sure it is safe to give insulin (like you discovered), and then a mid-cycle check about 6 hrs after the shot to see how much the insulin is lowering BG.

It is much safer to start over and reach the dose by coming underneath it, than to continue to shoot too much insulin and keep making reductions, especially since you've just started home testing and don't have a good picture of how your cat is reacting to the insulin. It is better numbers are higher for a little while while you safely get to the right dose than too low for a second. Determining a dose is kind of like the games on the Price is Right. You need to get as close to an ideal dose as possible without going over. When a cat hits a low number, their body compensates by dumping glucose into the bloodstream. This in turn causes very high numbers for up to 72 hours after the incident. So you can actually get much worse, higher numbers on a higher dose, if it's more insulin than the cat needs.

Most cats on a low carb, canned diet do not need much more than 1u of insulin. Many need less than that. Adjusting the dose based of testing at the vet's office usually leads to chronic overdosing, because blood glucose numbers are inflated and inaccurate due to stress. My Bandit is a 13-14 lb cat, and he never needed more than 1.25u the entire time he was on it. He's in remission now.

When Lantus is dosed properly, it has an 84% remission rate in newly diagnosed cats. Check out the stickies in the Lantus forum for more information: http://felinediabetes.com/FDMB/viewforum.php?f=9. Now that you are home testing, you do not need to spend a cent more on vet testing--not only is it a waste of money, it's dangerous for your cat because you're guessing at a dose using inaccurate data, rather than using accurate data to make an educated decision on a dose.

If you don't have some already, you should grab some ketostix at your pharmacy. Ketones are a complication that arise from high numbers, and you want to be vigilant in testing for them. Catching them early can literally be the difference between life and death, and minimal vet care needed vs. extensive vet emergency care.
 
Wow.. Thank you all for the great information. Each of you gave me knowledge that I wasn't aware of.

This morning he got to 71 which is when I finally went to sleep.
I have been slowing getting him off dry food and am now aware that that can drastically change his numbers. (the vet never told me this)
He's pretty much on all wet at this point. I was just giving him the dry over night to help boost his numbers a bit.

When he was first diagnosed he was on 1u. So I'm thinking I will follow Julia's advice and go back down to that. I didn't give him a shot this morning because of everything he went through over night. But he ate a full can of wet and now is sun bathing and happy. :)

I will spot check him in a bit and then lower him down to 1u for his evening shot.

I will also definitely go get a HYPO kit as suggested. Thanks once again!
I'm learning as I go.. All thanks to this wonderful board!
 
Don't be surprised if you see a very high number for his preshot tonight. It's his body's natural reaction from dropping too low, and should clear within 72 hrs.

This sort of reaction can also occur when a diabetic cat is first getting his dose adjusted. That's because if his body is used to high numbers, it recognizes the high range as normal, and his liver will dump glucose when he gets into a normal range. This is what we call "bouncing", and is one of the reasons why daily home testing with mid-cycle checks is important. If you're not testing, it may appear that a dose is too low when in fact his body just needs time to adjust to it and learn to recognize normal blood glucose and not panic.

Starting over at 1u twice daily, while removing the dry food and testing is a great plan. If you can get rid of the dry food now, things will be far easier for you and him. Dry food raises blood sugar 100-300 points, and even just a few pieces can cause steep rises in BG, so you see some drastic drops when it's completely removed. It's safer to start over without the dry increasing his BG on you, so you can adjust the insulin based on his actual need rather than a carb-inflated need. That way you're working up to a good dose without the increased risk of hypoglycemia from diet change.

What canned food are you feeding? FYI, the only prescription diet that is appropriate for a diabetic cat is Purina DM canned, but there are many low carb, canned commercial foods that have the same or better ingredients, at far less a price. If you're feeding Hills M/D, I would recommend changing the canned food asap as well because it is too high in carbs for a diabetic and will give you trouble regulating.
 
I did some of my own research as far as what food to give him and decided on Blue Buffalo Wilderness wet foods. It's expensive but he gobbles it up no problem. Do you have an opinion on that type of food?

Funny you should mention Hills. Before he got diagnosed with diabetes he was slightly over weight so the vet put him on hills diabetic DRY food. Less than a year later he became dreadfully sick and was diagnosed. I feel that vet played a large key in the reason why he got so sick. But thankfully it looks like he will hit remission very soon. He's doing great.

I also noticed his vomiting has slowed way down the past few days since we've taken him completely off the dry food. He always had a hard time digesting it and would binge eat.

Leaving the vet was probably the best thing I could have done for him.
I took a look at your spreadsheet for Bandit (he's adorable) and noticed when you stopped going to the vet your results seemed to get a lot better too.

Thanks goodness for this site!

Ps- I added a picture of Riley
 
We just took his BG and it was 156. Not too bad. Gave him a shot of 1u and will test him again in a few hours.

So happy to be doing this now. I feel like we are on the wave. :mrgreen:
 
Riley is sooo handsome! Siamese cats are more prone to diabetes, unfortunately. However, Bandit's been in remission for almost 2 years now and is healthier than he's ever been, so don't stress out over it. In fact, I am almost glad Bandit got diabetes, because it forced me to really research feline nutrition and make changes that have made him a healthier cat overall. :-D One other thing you also have to watch out for with Siamese cats (as I discovered with Bandit) are FORLs. This condition is very common in Siamese and Persians--my current vet told me that nearly every cat in her practice that has them are one of those two breeds. They also go hand in hand with the diabetes, and if your diabetic cat has FORLs the offending teeth must be pulled before the diabetes will improve. After Bandit got his resorptive teeth pulled, his numbers improved immensely and it was smooth sailing to remission from there.

Susan & Riley said:
I did some of my own research as far as what food to give him and decided on Blue Buffalo Wilderness wet foods. It's expensive but he gobbles it up no problem. Do you have an opinion on that type of food?
Click to expand...

The grain free Blue Buffalo foods are great feed. :-D They are a little pricy though. If there's a locally owned pet supply or grain and feed store in your area, you can get some fantastic deals on premium, human grade foods that are the same quality as BB Wilderness but cost less. I feed Bandit Merricks Cowboy Cookout, Surf and Turf, and Grammy's Pot Pie, which costs 1.40 something a can at PetCo, and I get it at my local Agway (a farm supply store) for 1.06 a can after discounts for getting 24 cans at a time, which makes it cheaper to feed than Fancy Feast! Wellness and EVO are two other good premium foods that come in 12-13oz cans which makes them very affordable. Here's a list of the nutritional content of several premium foods: https://docs.google.com/file/d/0B8Uu8g1u8Su9YTgxNGE1MDItM2MyMC00Y2Y3LWI4ODMtMzhkYTkxOGM4NThk/edit. Just stay under 10% carbs, preferably under 8%.

Here's the store locator for Merricks: http://www.merrickpetcare.com/locator/. Most independent pet stores that carry it also carry the other premium foods as well.

Susan & Riley said:
Funny you should mention Hills. Before he got diagnosed with diabetes he was slightly over weight so the vet put him on hills diabetic DRY food. Less than a year later he became dreadfully sick and was diagnosed. I feel that vet played a large key in the reason why he got so sick. But thankfully it looks like he will hit remission very soon. He's doing great.

I also noticed his vomiting has slowed way down the past few days since we've taken him completely off the dry food. He always had a hard time digesting it and would binge eat.
Click to expand...

The EXACT same thing happened to Bandit! He was also a binge eater, and if you let him he will eat and eat and eat until he barfs and then eat some more. He'll also gobble his canned food so fast he'll barf, so I feed him in smaller meals 4 times a day (which is how often a diabetic cat should eat anyway) He used to be obese, and his vet at the time put him on Hills W/D weight management food (his former vet was one of the developers of Hills Science Diets, so I thought I was going to a nutrition expert). He lost weight, but I am certain the incredibly high carb load caused Bandit's diabetes. :evil: It's incredibly sad that so many vets are contributing or worsening nutrition related ailments like diabetes, kidney disease, IBD, and Urinary Tract disease by prescribing and recommending these foods.

I think that Hills is simply awful--their food is some of the cheapest junk you can get, and they charge a premium price for it because they have spent a lot of time BSing vets into thinking it's good for cats because they put "science" in the name, and pay a lot of money to make sure their false information about feline nutrition ("it's ok to substitute corn and wood pulp for meat in cat food because the form of protein doesn't matter"). It would be like if McDonalds constantly went around to all of the pediatricians and convinced them that Happy Meals were the healthiest thing you could feed your kid, and then all these kids started getting diabetes and other diseases because they were eating junk food for every meal, so McDonalds started selling special "diabetic" happy meals--which are the exact same cheap junk food as the happy meals that got the kids sick in the first place. AND charged twice as much for them and shared some of the profit with the pediatrician that recommended their food to your kid to begin with, while your child slowly got sicker and sicker on the "diabetic" food. Sorry for the rant, but Hills really does infuriate me. Purina is guilty of the same overpricing and marketing tactics, but at least they TRY to formulate their foods so that they are actually treating the cat's condition and not contributing to it.
 
I think Riley is the true definition of nine lives. :smile:

He had Hyperthyroidism 5 years ago and had the radiation shot and was cured.
Now the diabetes.

He also had all his teeth removed with the exception of 3 canine's.
He talks and talks and talks all the time. But he's the best cat I've ever owned. He has an amazing personality.
And he really puts up a fight with all these sicknesses. 15 years old and still hanging in there!

I had another siamese named Bailey and I got him the same time I got Riley. He died 2 years ago from stomach cancer.
Riley and him were very close. And Riley was quite depressed for about 6 months and then I decided to get him another companion friend. But the new kitty just annoys him I think. :lol:

I'll keep him on the BB food till he gets sick of it. (and I'm sure he will)
Thank you for those other suggestions. I will definitely check them out.

I've noticed him scarfing down the wet food too so I have been feeding him a few times a day as well. It's been 4 days since he's last vomited and that's really great. He was doing it practically every other day before. :sad:

The more I think about all the wrong treatments the vet did for Riley the more irate I get. He also had chronic coughing episodes. I brought him in several times for that. They tested him for everything and it all came back normal. Then they said there was nothing they could do except to try laxitone. He doesn't have hairballs. He never had. I'm thinking it was also the dry food making him act that way.

As for Riley's numbers. I checked him last night before and after his 1u shot.
I already mentioned he was at 156 before. 3 hours later he was down to 94

The vet started him at 1u in the beginning. I'm not sure why she decided to up it to 2. His numbers were going down. But the 1u seems to be perfect for right now. I will check him again tonight to be sure and then I'll give his ears a rest for a few days. I feel so bad pricking them all the time.

I'm very happy to have made this connection with you. Riley seems to have almost all of the same issues as Bandit did. So if I have any questions I hope you don't mind me contacting you? You seem to know what you are doing!

Thanks again for all the wonderful useful information!
 
Of course, I'm happy to give advice! Bandit only has his two lower canines and some incisors left--he and Riley do sound a lot alike. Is there any evidence that his canines may be resorbing? If so, you definitely want to get the offending tooth/teeth pulled asap. I had to have Bandit's two remaining molars pulled last year because they were beginning to resorb, and I was scared it would knock him out of remission.
 
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