Safely lowering insulin dose with diet change

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SantaCruzSPCA

SantaCruzSPCA

Member Since 2017
Hello! Thank you ahead of time for any advice. :) I put some info in my "Intro" post but I'll give a little back story here as well.

Rusty is a sweet diabetic 10-year-old boy who was recently surrendered to my shelter. His previous owners were dealing with health issues of there own and going through a move and didn't feel as though they could care for him any longer. Needless to say the shelter is not the greatest place for a diabetic cat to be but we are doing everything we can to provide a low stress environment (he's actually adjusted quite well!) with lots of attention and most importantly, better management of his diabetes...so that we can find him a home!

His previous treatment regimen (while in his home)
Insulin Type: Humulin N
Dose: 12u BID
Diet: Purina Cat Chow (dry) <-----this just makes me cringe typing it
Testing: I don't believe they were testing from home

After quite a bit of research over the last two days I now know that 12u is ALOT of insulin but also that his diet would have pumped ALOT of sugar into him as well. Which is probably why he survived without hypo-ing every day.

Moving forward...

Now that he is with us, our first change is diet. We have successfully switched him over to a "wet food only" diet (he's on his third day) but have run into difficulty finding something that he will eat, that he won't vomit, and that is also under 10% carb. We have found something that fits the first two requirements, Blue Buffalo Healthy Gourmet Pate Salmon Indoor Cat Food, but still has a few unwanted ingredients (brown rice, carrots, and sweet potatoes). I have done a few taste tests with Fancy Feast, Tiki Cat, and AvoDerm but he will not eat a bite, even if left with it for hours. I will continue to try others that I've seen listed on some of the other threads so it's a work in progress!

Now that he's on wet-food only, even if it's got a higher carb load than ideal, I would assume his insulin needs are going to decrease. We are now monitoring his glucose with Alpha Trak and are testing before shooting. However, I am uncertain of the right dose now that his diet is completely different. I've just started a spreadsheet for him, which I will attach as soon as I read the directions on how, lol.

My question is at what rate should the insulin be lowered? Do we completely start at square one and go down to 1u BID, do a curve and see where that takes him? Do we do a less drastic decrease (say start with 6-8u's)? Thoughts?

We have been taking the less drastic approach (as you can see by his spreadsheet) and are NOT proud of the near hypo on the first day due to that whopping dose! That was pre-research and we got lucky that he wasn't symptomatic...which I don't understand.

Also, due to the shelter environment, he is not monitored overnight so we have been following the rule of 200 and under, no shoot. Is that advisable? Morning AMPS are 300-400 with no previous PM shot.

Any advice is appreciated! :)
 
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It looks like you found a good dose to start over with... The lowered dose at night is a good idea until you get more data on his spreadsheet. He's lucky to have found a shelter as dedicated as yours!
 
First off, bless you for taking care of this extra sweet kitty! Have you seen this food chart? http://catinfo.org/docs/CatFoodProteinFatCarbPhosphorusChart.pdf
It can help you to choose a food for Rusty, although it looks like the Blue Salmon isn't too bad. Is he still on Humulin? It's good that you are testing and have reduced his dose. If you're worried about him at night, maybe leave a small amount of food for him to snack on.
 
So far I like what the lowered dose is doing. A complete change to low carb wet food might lower his insulin requirement more. Are you willing to consider feeding him Friskies or Fancy Feast pates? The sauce/gravy versions are too high in carbs but the pates are low enough in carbs, readily available and Rusty might like them. I know some owners are reluctant to go the grocery store route but many here feed these foods successfully.
 
You and your shelter are wonderful! Bless you! I can't give advice since I don't know enough, but I just wanted to say thank you for what you're doing.
 
I thought they switched Rusty to ProZinc. I'll go back and look for the original post. I do not know enough to give any sort of dosing advice but if Rusty isn't a big fan of the pate wet food, neither is my boy. He will eat a couple flavours once in a while but I also use the Friskies Flaked Tuna and Flaked Tuna with egg, which were listed as <8%. Maury definitely prefers those :)

Sounds like you work at an amazing shelter!:bighug:

Edit: Found original post on Introduction, clarify: was mentioned that they wanted to get Rusty on PZI. Not confirmed if that has happened yet but I think he's still on original insulin.
 
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@cashy We hope to get to that zero or low carb diet soon! I have a feeling it will change his world. :)

@StephG Thank you! This dosing business is pretty confusing and stressing me out a bit, lol. This morning we dosed without testing (as the normal employee was out sick and one of our cleaning crew jumped in to give the shot) and I decided on a lower dose just to play it safe but now he's having a very "high" day and acting off. I'm going to have to train even the cleaning staff to do the testing in order to avoid this in the future.

@Sharon14 Thanks for the link! I'm going to have to get a bunch of single cans and continue to the taste testing, and now I've got a bunch more options :) Yes, he's still on Humulin for now. We don't want to change that until we get his diet situated. Once we do, we will evaluate which Insulin would be best for him and for our shelter time constraints. We need to find something as close to 12 hours as possible because of our hours of operation and staffing. As far as offering food at night. He tends to eat only half of his evening food at the time of offering and must munch on the rest overnight. Do you think that's enough for overnight?

@Kris & Teasel I think we went a little too low today :( I feel bad but without the test results I didn't know what to do. As far as food, I'm willing to feed him anything that's low carb and that he'll eat! So far he is not a Fancy Feast fan, however, I have not yet tried Friskies...which we have...which I'll do today.

@Glennie Thank you! I am fortunate to work for a non-profit rescue-type shelter where we have more leeway for the level of animal care we can provide as well as the absence of a time-limit. It makes treating special needs animals possible. :)

@Yong We plan to make the switch to ProZinc (that will most likely be a different thread when it comes time!) but for now we are making one big change at a time and the first one for us is diet. I'll have to give the flaked Tuna a try!
 
SantaCruzSPCA said:
@StephG @Sharon14 @Kris & Teasel Do you mind taking a look at his sheet...I'm not sure what's happening :( He's defnitely more lethargic than normal. Can I give him Insulin early?
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I think he's bounced up into high numbers from the green yesterday. You also jumped up in dose from 2 u last night to 4 u this AM. Why not try 4 u tonight and both AM and PM tomorrow? It's too early to know what a good dose range is for him. All you know is that 12 u was far too much. You have to choose a low enough to be safe dose, hold it at least three 12 hour cycles and test BG AM/PM preshot and mid cycle. After three cycles, raise it by no more than 0.5 u. If your syringes don't have half unit marks you'll have to eyeball that dose. If they have half unit marks you can eyeball as low as 0.25 u increments. That's the preferred increment. Whole unit changes in dose are too large - you might go right past a good dose.

Your goal right now is to get some baseline data by keeping things as simple and as consistent as possible.
 
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Are you testing for ketones? Strange that he spiked to 500s then back down to 315 at pmps. Looks like his pancreas might be helping or the 4 units lasted longer than expected. I'm not familiar with subQ fluid and how it effects BG. In my mind I would expect it wouldn't. I do not know that's right or wrong. Maybe the excessive peeing is from higher BG and the extra fluids? I know Chuck drinks more and pees more when higher. Is it also possible the subQ session stressed him and increased his BG?
I agree with Kris & Teasel that 4 units each cycle looks safe enough.
 
Bouncing a lot yesterday. It's hard to find the right dose when they do this because their "true" response to the dose is obscured by the inflated bounce numbers. That's the reason for keeping a dose at least three cycles. If you raise a dose based on an inflated bounce number it might be too much insulin. My recommendation is to stay at 4 u today to see how he does.
 
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@Kris & Teasel I got your message a little late last night and had already given him 5u's. This morning he's way down, however, I think he's down because he didn't touch his dinner last night. He seems more interested in food today but so far he's only taken a few bites. Warming it up to "mouse body" temp now to see if that will entice him but I don't want to give Insulin with him already being that low. Is it okay to wait an hour or so?

I have not been testing for ketones but ordered strips yesterday from Amazon and they should be here today or tomorrow. I'd be really interested to see what those results are.

Edit: After warming food, he took a few more bites. And I gave him 1 temptation treat. Is still acting a bit depressed but will get up and jump to different levels in his kitty suite and do the high butt when you run your hand down his back. Not drinking excessively like yesterday. Just still not feeling like himself. Going to wait an hour, retest, and hopefully shoot.
 
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SantaCruzSPCA said:
@Kris & Teasel I got your message a little late last night and had already given him 5u's. This morning he's way down, however, I think he's down because he didn't touch his dinner last night. He seems more interested in food today but so far he's only taken a few bites. Warming it up to "mouse body" temp now to see if that will entice him but I don't want to give Insulin with him already being that low. Is it okay to wait an hour or so?

I have not been testing for ketones but ordered strips yesterday from Amazon and they should be here today or tomorrow. I'd be really interested to see what those results are.

Edit: After warming food, he took a few more bites. And I gave him 1 temptation treat. Is still acting a bit depressed but will get up and jump to different levels in his kitty suite and do the high butt when you run your hand down his back. Not drinking excessively like yesterday. Just still not feeling like himself. Going to wait an hour, retest, and hopefully shoot.
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I see you gave him the 4 u after feeding and waiting. Will you be able to test around mid cycle - +3 to +8 approximately. You need data on how low he goes with 4u.
 
Yes, I will be able to test during those intervals. I'll post results. So you suggest staying with the 4u's for at least three 12 hour cycles to get some consistent data?
 
SantaCruzSPCA said:
Yes, I will be able to test during those intervals. I'll post results. So you suggest staying with the 4u's for at least three 12 hour cycles to get some consistent data?
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Yes, that's what I suggest. You need enough data at one dose to evaluate it properly, especially when it's all new to you.
 
So we've got two pretty good numbers today, probably partially due to the fact that he's just coming back onto food slowly. He has decided Friskies (at least the Ocean Fish and Tuna) is his jam. From the food list it looks like that is a good one as far as carb load? We have been giving him small portions throughout the day to make sure he holds it down and doesn't over eat.

We will feed him a full dinner about 30 min before his evening dose and test again. What's an okay number range to go ahead and dose another 4u's?
 
SantaCruzSPCA said:
So we've got two pretty good numbers today, probably partially due to the fact that he's just coming back onto food slowly. He has decided Friskies (at least the Ocean Fish and Tuna) is his jam. From the food list it looks like that is a good one as far as carb load? We have been giving him small portions throughout the day to make sure he holds it down and doesn't over eat.

We will feed him a full dinner about 30 min before his evening dose and test again. What's an okay number range to go ahead and dose another 4u's?
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Based on the very nice green at his nadir I think you can try 4 u again tonight. Aim to get at least one test before bed. If he continues like this tomorrow at this 4 u dose, that will be his good dose - for now. ;) This isn't a "set and forget" disease.
 
I SO appreciate your help on this, it's nice to not feel completely alone in dealing with diabetes for the first time! I can't believe how little help a vet can be yet how much knowledge is out there! I'm going to have to give his evening dose about 1 1/2 hours early (because of our hours, although I'm waiting around as long as I can) because I gave his morning dose late.
 
SantaCruzSPCA said:
I SO appreciate your help on this, it's nice to not feel completely alone in dealing with diabetes for the first time! I can't believe how little help a vet can be yet how much knowledge is out there! I'm going to have to give his evening dose about 1 1/2 hours early (because of our hours, although I'm waiting around as long as I can) because I gave his morning dose late.
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Be sure to test this evening because shooting early might create some overlap with any residue of the morning dose.
 
I tested before PMPS and the number was one I felt comfortable giving the 4u's (352). His appetite is definitely back which is good. Tomorrow will be his first full day on Friskies, which is 50% lower carbs than the Blue Buffalo Gourmet he was previously on. Should I plan on just testing AMPS/Midday/PMPS? Or should I do more because of the food change?

One more question, should I be:

1) Testing, feeding, waiting 30, shoot?
2) Feeding, waiting 30, testing, shoot?
 
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SantaCruzSPCA said:
I tested before PMPS and the number was one I felt comfortable giving the 4u's (352). His appetite is definitely back which is good. Tomorrow will be his first full day on Friskies, which is 50% lower carbs than the Blue Buffalo Gourmet he was previously on. Should I plan on just testing AMPS/Midday/PMPS? Or should I do more because of the food change?

One more question, should I be:

1) Testing, feeding, waiting 30, shoot?
2) Feeding, waiting 30, testing, shoot?
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The correct sequence is:
  • no food at least 2 hours prior
  • pre shot test
  • feed
  • wait 30 minutes (because Humulin acts fast)
  • shoot.
If you can monitor today it would be a good idea to aim for tests in the +3 to +7 range to see how low the Humulin is taking him at this dose. If you really want a full picture, do a complete curve - every 2 hours tests between AMPS and PMPS. This is a fast-acting insulin that can drop him fairly low if the dose is at/near the effective dose. It can get him close to hypo numbers if the dose is too high. The food change might have a bigger effect than you know. The testing will help you discover that.
 
Glad Rusty's doing well and eating better. Sorry I didn't get the tag above but Kris has been taking great care of you!
 
@Kris & Teasel So, what do think about the 4u dose with some data behind it? It's definitely keeping him low. Too low you think?

I'm going to be at an animal care conference over the weekend and will be leaving my staff in charge, although I'm going to have them enter his numbers into the spreadsheet. We will have one big problem for at least two days...no one will be able to test him before his morning dose on Sat/Sun. Any advise?
 
SantaCruzSPCA said:
@Kris & Teasel So, what do think about the 4u dose with some data behind it? It's definitely keeping him low. Too low you think?

I'm going to be at an animal care conference over the weekend and will be leaving my staff in charge, although I'm going to have them enter his numbers into the spreadsheet. We will have one big problem for at least two days...no one will be able to test him before his morning dose on Sat/Sun. Any advise?
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If you continue to struggle to find wet food he will eat, there are two dry foods options under 10%. Evo cat and kitten in the purple bag is about 7 % carb, and my favorite Young Again Zero carb food which you can get a sample of if you ask them at Youngagainpetfood.com.
 
SantaCruzSPCA said:
@Kris & Teasel So, what do think about the 4u dose with some data behind it? It's definitely keeping him low. Too low you think?

I'm going to be at an animal care conference over the weekend and will be leaving my staff in charge, although I'm going to have them enter his numbers into the spreadsheet. We will have one big problem for at least two days...no one will be able to test him before his morning dose on Sat/Sun. Any advise?
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So far he doing well at 4 u. Humulin tends to drop them quickly from high-ish pre shot numbers to significantly lower nadir values. 'Tis the nature of the beast ...

In my opinion it would be wise to drop his dose to 3 u if he can't be tested pre shot on Saturday and Sunday. Why not make this dose change today so you can see its impact while you're there? It'll give you more confidence about dosing on the weekend. Do you move to daylight saving time this weekend? If so, you'll want to shift his dose time in half hour increments starting tonight.
 
I don't know if Kris is on right now. I've been following along this thread, and I would vote for the 3.0U dose-- I think no matter what you would like to have that lower dose on the weekend, and that drop yesterday was too close for comfort for this insulin. He's "bouncing" higher this morning in reaction to that drop, but he'll come down again.
 
I wonder if something overnight might have caused him to bounce this morning. I agree with what Kris said about going ahead and lowering his dose since he won't be able to be tested over the weekend. I just give my opinion :).
 
So apparently we are bouncing today...although he's acting normal, maybe a little "high" if you will. I'll be interested to see what his numbers are PMPS. Turns out I'll be in to do his morning test and then I'm off. He will be starting a new bottle of Insuilin when I get back. Should I be aware of anything related to new insulin? (same type as before).

Edit: @Kris & Teasel @Nan & Amber @Sharon14 His PMPS numbers are way high and it's freaking me out. This is prior to feeding. I'm feeling like I need to do 4u's tonight. What do you guys think?
 
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This is just a recent analysis of mine but I think he bounced because of his +3. I have noticed if the lowest reading in the cycle is less than half of the preshot reading, there is a greater chance you will see a bounce. So for Rusty, AMPS 494, lowest reading taken was +3: 165. Half of 494 is 247 so since he went lower than that, he bounced. It may just be my analytical brain at work ;) And obviously this will not hold true for all kitties :cat:
 
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@Yong Interesting analysis, I just cannot get my head around some of this stuff. Like...649!!! I may not sleep tonight because of that number. I ended up giving 3u's to remain consistent. It was REALLY hard not to do the 4! I just hope his AMPS aren't in the blacks. :(
 
I definitely understand, when Maury gave me a couple 600's (before I played with his food ;)) I thought my heart was going to drop on the floor. His diagnosed reading was 464, I mean yes it was still high but not THAT high. Still working on figuring out why he jumps so high when we had lower PMPS a few nights :bookworm::bookworm::bookworm:. I think you could've done the 4U tonight since you were still there to test him before the shot and will test him in the AM before you leave. The big thing is when you are gone to do the 3U since your staff will not be doing any tests. Like Rachel told me, it's safer for them to be higher for a little while than too low for a moment :)
 
@Yong It was a really good conference with some great speakers! Thanks for asking :) Seemed like we were also able to keep Rusty at okay numbers even without the morning tests. We just had a cat intake from another shelter and one of them brought a URI that he caught :( I put one of our humidifiers in his condo and covered the whole thing with a sheet and he just curls up next it, enjoying the warm steam. I think it's helping to keep the congestion loose and moving. He takes the Clavamox pills like a champ and is still eating. Fingers crosses that his appetite sticks around. This cat is pretty amazing. I wish my husband wasn't allergic to cats or I'd take him. I can literally do anything to him and he just lets it happen.

I think I'm going to hold off on starting the PZI until his URI is over. Is that advisable or do you think it matters?
 
SantaCruzSPCA said:
@Yong It was a really good conference with some great speakers! Thanks for asking :) Seemed like we were also able to keep Rusty at okay numbers even without the morning tests. We just had a cat intake from another shelter and one of them brought a URI that he caught :( I put one of our humidifiers in his condo and covered the whole thing with a sheet and he just curls up next it, enjoying the warm steam. I think it's helping to keep the congestion loose and moving. He takes the Clavamox pills like a champ and is still eating. Fingers crosses that his appetite sticks around. This cat is pretty amazing. I wish my husband wasn't allergic to cats or I'd take him. I can literally do anything to him and he just lets it happen.

I think I'm going to hold off on starting the PZI until his URI is over. Is that advisable or do you think it matters?
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It's OK to wait. At least he's getting insulin and you're testing him.
 
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