Second Week On Insulin Glargine

Corey & Kitty

Corey & Kitty

Member Since 2022
Kitty is now beginning her second week on insulin glargine. Her numbers are still quite high, although I expected that because I reduced her dose from when she was on Novolin in order to provide some room to alter her diet.

I wanted to get rid of the dry food and so she just completed her first 24 hours without dry food. Tonight is her 3rd cycle without dry food. I've been feeding her as follows:

AMPS/PMPS: 1 can FF
+4: 1/2 can FF
+8: 1/4 can FF (I read a recommendation on someone else's thread not to give too much food after nadir so that's why I'm only giving 1/4 can at this point)
And nothing after +10.

So this amounts to 3 & 1/2 cans of FF per day. Does this sound like a good schedule and enough food? She seems happy with this amount of food, in fact, today she didn't touch the 1/4 can that I gave her at +8 during the AM cycle, so I assume she's content with the amount of food she's receiving.

Now, I've read someone saying on other threads that removing dry food can drop a cat's BG as much as 100, and I think I read somewhere on Dr. Pierson's website that removing dry food can have an immediate effect on a cat's insulin needs. So I was expecting a bit more of a drop in her numbers but there doesn't seem to be much of a change in the first 24 hours.

I want to focus on getting her numbers under the renal threshold. According to the Merck Veterinary Manual:
"The renal threshold for glucose is ~180 mg/dL in dogs and ~280 mg/dL in cats."

Similarly, Cornell University College of Veterinary Medicine eClinpath states that:
"The renal threshold for glucose is species-dependent and is reported to be the following:
  • Cats: 280-290 mg/dL in cats (lower thresholds may occur in diabetic cats, around 200 mg/dL). Some, but not all cats, with a stress hyperglycemia may have glucosuria."
I don't want the high BG to keep taxing her kidneys.

The only thing now is that I don't know if I have given the diet change enough time to see what is going to happen. I don't want to increase her insulin dose and then have the diet change drop the numbers as well. Has it been enough time since the diet change or should I wait a couple more days before adjusting the insulin dose?
 
It can take a week or two to see the full effects of the diet change. I’d wait another day before increasing. Diet changes can make a big difference. Is Kitty eating enough wet food? Was the switch difficult?
 
So the renal threshold is different for every cat, usually between 200-300, some into the upper 100s. But I'd say that being your first goal is a good idea, regulation will keep her under that the majority of the time.

Diet changes are a bit odd. I've seen it drop cats 100+ points, yes. But I've also seen some where it doesn't seem to do much (likely because they've already got glucose toxicity, have higher dose needs anyway, etc). So we always err on the side of a decent change, because otherwise you can get yourself into trouble.

I agree, I'd give it one more day. Her numbers aren't too bad for a month after diagnosis, you'll get there.
 
tiffmaxee said:
Is Kitty eating enough wet food? Was the switch difficult?
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She's eating all the wet food I'm giving her other than today when she didn't eat the snack (1/4 can) that I gave her at +8 of today's AM cycle. The switch wasn't difficult, she always loves canned food, the 1 can I gave her tonight at PMPS was gone within about 20 minutes.
tiffmaxee said:
You don’t want him to get used to higher numbers so after tomorrow I would increase.
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FrostD said:
Diet changes are a bit odd. I've seen it drop cats 100+ points, yes.
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So can the effects of a diet change happen gradually? I just don't want to have the effects of the diet change and an insulin increase compound each. After tomorrow, I'm back to work on Tuesday, so I'll only be checking her BG once during the AM cycle (somewhere around +4 to +6) for the following 5 days. SLGS suggests that I should increase by 0.25 if nadirs are greater than 150, so I'll be increasing to 2.25 units, have I got that right?
 
Corey & Kitty said:
She's eating all the wet food I'm giving her other than today when she didn't eat the snack (1/4 can) that I gave her at +8 of today's AM cycle. The switch wasn't difficult, she always loves canned food, the 1 can I gave her tonight at PMPS was gone within about 20 minutes.


So can the effects of a diet change happen gradually? I just don't want to have the effects of the diet change and an insulin increase compound each. After tomorrow, I'm back to work on Tuesday, so I'll only be checking her BG once during the AM cycle (somewhere around +4 to +6) for the following 5 days. SLGS suggests that I should increase by 0.25 if nadirs are greater than 150, so I'll be increasing to 2.25 units, have I got that right?
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I would say if you were going to see anything crazy, you'd have started to see something by now. But like Elise said, it can take up to a week or more to see full effects. You have plenty of room for safety either way, don't want her to start getting used to these numbers or hold doses longer than needed
 
*yes those spot checks are sufficient, and you would increase by 0.25U

You could even call it TR now, you are testing enough and can test enough - that would allow you to do some more rapid increases (roughly every 3 days until nadirs are in the 100s). I know I've mentioned before - not pushing, just reminding that it's an option because I know there's a lot of info to retain. You can do TR til you get her under renal threshold like you want, then change back to SLGS if that's more comfortable.
 
Congrats on the switch to all wet food. There isn't really a set amount that removing dry food will drop a cat's blood sugar, there are two many other variables that could be at play. I've seen one cat go from 5.5 units to zero in the matter of a one and a half very stressful days when the caregiver, who thought he wasn't getting dry food, caught him jumping where the dry food was. She didn't think he could jump up there, so removed the dry food from the house. That's an extreme example, the other end can see less of an impact, again for various reasons, such as carb level of the food, other conditions present.

When you talk about renal threshold, keep in mid whether the ranges you are reading are measured with a pet meter, or a human meter. Numbers will be lower with human meters.
 
So I wanted to check in quickly about Kitty's food situation. I bought her an automatic feeder. It's this one: https://www.amazon.com/Cat-Mate-C500-Automatic-Digital/dp/B01AUYLVU8?tag=felinediabetesfdmb-20

It has ice packs that sit underneath the bowl. It thought it would work perfectly, I've set it to give her a meal at +4 and +8 and then I have it turn to an empty compartment at +10 in order to prevent any food consumption for the last 2 hours of the cycle.

The problem is that she wont touch the +4 and +8 meals. She eats the initial pre-shot meal out of it, so its not the feeder itself. Her first 3 cycles on wet food only I was feeding every meal manually at the same intervals (pre-shot, +4, and +8) and she was eating all of it. Yesterday was the first day with the auto feeder and she did not eat anything other than the two pre-shot meals. I prep the feeder at each pre-shot meal with all new food and new ice packs. So, I'm thinking it has something to do with the additional meals sitting out for 4 and 8 hours. The food still looks fresh. The ice packs do a great job keeping it cold and the enclosed feeder I feel like helps with moisture evaporation so the food still looks fine, and she's eaten cold food without a problem when its fed manually.

So basically for the first 3 cycles on wet food, she was eating 3.5 cans per day, and yesterday she only had 2 cans for the whole day, I feel like 2 cans isn't enough food, or is it?. I don't want to cause problems by her not having enough food so I think I'm going to try going back to manual feeding today to see if she eats more. The only problem is that I'm not always around during the AM cycle at the +4 and +8 intervals to feed her, and its becoming exhausting staying up every night until midnight (+4) and waking up at 4 am (+8) to feed her and then waking up at 6am (+10) to make sure I take away the food (if any is left, there wasn't any left to take away when I was feeding manually).

EDIT: I even placed her in front of the bowl when it changed to an additional meal to make sure that she knew it was giving her more food, she would take a tiny bite and then leave it. I fed her a bit from the bowl off of a fork and she ate it but she seemed uninterested in eating out of the bowl.

Also, I read that adding some food manually to the bowl when it changes over and makes the sound of it rotating may help the cat associate the sound of the feeder moving with availability of food so I may try going back to the automatic feeder the next time I have days off so I can try that.

So my questions are, if she absolutely will not eat the additional meals from the auto feeder, is there some other way I can approach giving her multiple meals? Would it be okay to just give two meals each cycle? AM would be something like pre-shot meal and another meal on my lunchbreak around +4 to +7. I'd like to not have to stay up so late every night so for the PM cycle maybe I could do pre-shot meal and then give her another meal around +3, would this be too early? I don't know, any advice I will take into consideration.

Also, being that she didn't eat as much food yesterday, am I still okay to give the dose increase today? This morning is supposed to be the first cycle at the increased dose.

EDIT: I went ahead with the increased dose. I found it quite difficult to dose a quarter unit, it just looks like a tiny sliver on the syringe.
 
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Have you tried putting some freeze dried meat treats on top of the +4 and +8 meals in the feeder to make them more enticing? Is she normally a grazer or does she eat all of her meal normally when it's in front of her? You can feed her just manually if that's all you can do, but that doesn't leave food out for her around nadir if you can't make it home until later. Other options are to freeze some cat food with water (a catsicle), and leave it out to thaw for later. As she starts getting into better numbers, you may end up tweaking the timing of food. As an example, if she does a sharp drop at +2, you may want to feed earlier than +3 at night.

I'm glad you went ahead and increased today.
Corey & Kitty said:
So basically for the first 3 cycles on wet food, she was eating 3.5 cans per day, and yesterday she only had 2 cans for the whole day, I feel like 2 cans isn't enough food, or is it?. I
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How much does she weigh? Is she about the right weight, too low or too high? Two cans doesn't tell me anything, what is important is the number of calories an whether she's getting enough for her body size and what you want her weight to do.
 
Wendy&Neko said:
How much does she weigh? Is she about the right weight, too low or too high? Two cans doesn't tell me anything, what is important is the number of calories an whether she's getting enough for her body size and what you want her weight to do.
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Sorry, I should have been more specific. I weighed her at home tonight by weighing her and myself and then subtracting just myself and she was 14.2 pounds, which maybe is not as accurate as the vet. On March 7th at the vet they said she was around 12.75 pounds. Now I'm a little confused about her ideal weight, because at the visit on March 7th when she was diagnosed, the vet mentioned that once she starts insulin I may start to see her gain weight, and he acted like that would be normal. But, a couple weeks ago I was speaking to the vet tech on the phone and she told me that my cat's ideal weight is probably somewhere in the 10 - 11 pound range.

Her canned FF pate food ranges in calories from around 85 to 100 kcal per can.
 
Cats who are unregulated diabetics aren't getting all the food into their cells - think of the insulin as the key to open the cells up. And they can lose weight until they start getting closer to being regulated. If she should be in the 10-11 lb range, then it's possible she is currently overweight. Not uncommon for diabetic cats. There is lots of information on this website: https://catinfo.org/feline-obesity-an-epidemic-of-fat-cats/#How_Much_Do_I_Feed
A quote and formulas listed on this page:
Required calories per day = [13.6 X optimal lean body weight in pounds] + 70

Most female cats should weigh a nice, lean 10 -11 pounds. Most male cats should fall into the 11 -13 pound range.
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I currently have a female cat who is a good weight at 8.5 lbs, Neko was Maine Coon Cross and vet wanted her in the 13lb range. So cats do differ in ideal weight based on many things. Getting an idea from your vet based on your cat (not the vet tech) is a good place to start. If 11 lbs was a good weight, the plugging that into the formula above you get an required calories of 220 per day. Note, activity level and metabolism plays a huge part. My girl who often was in the 14 lb range, did well on 200-220 calories per day. Unregulated cats might need a bit more food, but it looks like 2-3 cats might be a good number if they have the number of calories you stated.
 
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