? Stuck...

This is my first post. My husband and I are new to cat diabetes, though we've been cat owners forever (38 years). I was a vet tech in my college years but that was a long time ago. Our long hair tortie Allie was diagnosed in November. Our other cat, Tango, had been diagnosed in August but went into remission once we changed the food from Fancy Feast gravies to FF classics, then Purina DM.

I tried to put all the details in my spreadsheet, hope I got it filled out right.

Allie's been great in spirits and has cooperated through all of this, but we can't stabilize her. She is in good physical shape, wakes me up for her shots and doesn't hide on us. Of course her activity level has reduced, she rests her head on her water a lot, and we're just imagining all the damage being done by the constant high levels.

Our vet is part of a team with a lot of experience, she's been seen by 4 of them. At this point we expect we'll be bringing her in for another curve (it's tough for us to get that many sticks at home), and we're looking for any suggestions. Thanks.

 

Hi. Yep, by spreadsheet you have fiddled quickly too much with the insulin doses. It's by 5 and 4 you get the yellows, some green, some blue and most pinkish. You should stay on same long insulin 5 units course, for long,


But, due to these staggering high insulin doses from 5 to 7.5 you have most of, have you gotten kitty tested for Acromygelia? See in Acro Forum for more https://www.felinediabetes.com/FDMB/forums/acromegaly-iaa-cushings-cats.12/

 

Hi Molly and Allie and welcome.
Well done home testing the BG.
The first thing I notice is that you are not testing before every insulin dose.
I would really recommend strongly that you always test before every shot to see it is safe to give the dose. You would be surprised how often it isn’t.

Also you need to be getting at least one test in during the PM cycle each day as cats often drop lower at night.
Only by testing before the shot and again during the cycle as you able to tell how the insulin is working.
Spot checks every so often and one test each day at the same time don’t really tell you anything.

Also I am really concerned at how the dose has been increased.
FD is a marathon, not a race and the dose needs to be increased in small increments so you don’t go past the best dose.
We recommend increasing in 1/4 unit increments. A lot of vets will say that is too small an increase and increase in 1 unit increments, but we have a lot of success in getting cats regulated and into remission with our dosing methods.
I think you have increased too fast and by too much. I can see you went back to a smaller dose at one stage and started again.
Allie is most likely dropping low at some point and bouncing up high again ...I saw a 96 and a 161 which means she is dropping low and it is her own system which is saving herself by dumping regulatory hormones and stored glucose into her system to save herself but she can’t do that forever without finally crashing and going hypo.

I think you need to bite the bullet and start testing at home before every test and at least one else during every cycle to see what is going on.
Do you think that is possible?
A curve at the vet will not necessarily tell you anything, especially if she is bouncing that day from dropping low the day before. Also cats often get stressed at the vet and run in higher numbers there

Can you tell us what type of food you are feeding her and how often please? It is the wet food or the dry?
I’m sure we can help you.
I am not a Prozinc user so will tag @Deb & Wink
Keep asking question. Hope to hear back from you soon
Bron
BTW I had a Burmese tortoise called Ming who looked a lot like your Allie...she is gorgeous!

 

Thank you both so much for taking the time to look at her chart. No, my vet hasn't suggested any tests, but I can ask.

We started back at 1 unit when we switched to ProZinc. On hindsight it seemed like we were getting somewhere with the Vetsulin, but that was really only the last few days and we'd decided at least a week prior that we needed to switch because she kept backsliding.

She gets a little less than 1/2 can of Hills W/D, and access to Purina DM dry and Hills W/D dry for about 1 1/2 hours twice a day. She generally eats all or most of the canned food and some of the dry. I add water to it, both my cats prefer it that way. She's fed at 8 am and 8 pm, we give the shot just before she eats. I hope we can do a little more testing.

She is a beautiful cat. We rescued her from an alley at 6 months old.

 

PS - forgot that she gets a snack after testing every day at 4 and around 3 am. That would be about 6 Hills Metabolic Treats and about a teaspoon of dried chicken twice a day.

 

Hi Molly,
You don’t need your vets permission to home test the BGs.
A lot of vets do not think it is necessary but I can promise you it is the only way you will be able to get Allie sorted out safely.

The food you are feeding Allie is very high in carbohydrates. It is recommended that diabetic cats are fed a diet of 10% carbs or less. Most of us feed a diet of around 5% carbs.
The W/D dry food is a whopping 36.9%carbs, the Purina dry is 18%. It is like feeding cake and ice cream to a diabetic every day.
No wonder you have not been able to get Allie into better numbers. She needs to be on a wet or canned only diet, no dry as almost all of it is high carb. If you think she needs some dry food there we two available in the US that are low carb. Young Again zero carbs and Dr Esley are two options but again don’t start these until you are testing routinely.
You don’t need to buy expensive prescription foods. Ordinary foods from the stores is satisfactory. I will include a link at the end of this for you to look at. Look for foods 10% carb or less.
However do not stop feeding what you are feeding now until you are home testing the BGs regularly as the BGs will drop by up to 100 points or more when you high carb dry. It needs to be done slowly and with testing the BGs.

I would give the snacks in the first half of the cycle when the insulin is strongest. But don’t change anything until you have more testing aboard
I feel sure that when you are testing the BG and can remove the dry food you will notice a big difference in the BGs.
Link to food charts https://catinfo.org/docs/CatFoodProteinFatCarbPhosphorusChart.pdf

 

As @Bron and Sheba (GA) said, you've already seen green and blue, and the green was +8.
Prozinc works best around +5 to +6, so she might have earned a reduction on that day.

More testing is the only was to get her regulated and keep her safe.

 

Stick with the ProZinc. Vetsulin stings at high doses. My cat was always done with shots but once she hit six units the vetsulin made her yell. ProZinc doesn't sting. I have an alley cat named Allie too. . I do agree with the others that you should get a preshot whenever possible as well.

Some cats do need high doses.... Consider having your cat tested for acromegaly and IAA which is insulin resistance. Acro was once thought to be extremely rare, but they are finding it's more common than once thought. My cat was acro.

 

This morning she was 261 pre-shot. We'll get one overnight tonight. I've asked my vet about the 2 tests.
She hasn't been eating too much of the dry food, of course I just bought a full bag since my other cat loves it.

 

Nice to see that lower preshot.... If only he would stay in those yellows

 

Our vet asked us to do a curve so we will try to take readings tomorrow at home. Going to be really unhappy when she doesn't get a snack after. The acro test is $220 so we're considering it.

 

Why can't she have a snack? My cat loved Purebites freeze dried chicken snacks. No carb

 

She usually gets 2 snacks a day, one at 4 after her reading and one in the evening (metabolic treats and dried chicken). I didn't think we could give her a snack every hour without affecting her readings.

 

Most of us feed multiple times a day. Just withhold food 2 hours before insulin and readings.

 

just do whatever you normally do on a curve day.

 

Hi Molly,

Welcome to yourself and Allie.

If you do transition away from the w/d foods, I suggest watching Allie's BG levels like a hawk. The vet we were registered with at the time of Saoirse's diagnosis insisted she had to be put on w/d (despite my protests to the contrary). When I transitioned her to a low carb diet her overall BG range dropped by c.250 points and she went from 3IU Vetsulin BID to 0.5IU within a few days. Within a fortnight Saoirse came very close to going into remission.

The w/d truly is like kitty ice cream or cornflakes: it has an ***insane*** amount of carbs.


Mogs
.

 

We just wrapped up the curve, if anyone wants to take a look.

 

Nice job with the curve, Molly. I'm tagging @Deb & Wink to ask her to have a look at Allie's spreadsheet for you when she comes online. (I've not used Prozinc so I'm of no help to you on this. )


Mogs
.

 

You need to do those PM pre-shot tests too. And some during the night.
There's absolutely no guarantee that cycles are alike or even similar. Lots of cats go low during the night.
AM pre-shots is the last thing to go down..
I don't want to be pushy... but please test every single time before giving insulin and 2-3 times in both cycles.

 

Without context, you don't know how far a cat drops at mid-cycle. That is why we ask for pre-shot numbers always. Also, it lets you know if your cat's BG levels are high enough to give the insulin in the first place.

The curve helps. But there isn't enough data on other days, to see the trends. So I'm not able to be much help here yet.

Is there a reason you were only testing at +8? (8 hours after the AM insulin shot)

Once I was able to transition Wink off that W/d food, he went OTJ (off the juice, insulin being the juice). Diet controlled is another term for it.

Those Hill's Metabolic Treats you are feeding are very high in carbs too, ~32%. Try feeding her only the dried chicken. Or cook up some plain chicken breast or any other type of pure protein to use as a treat.

 

Your curve amps and hourly to +8


Hi again. I think I know what keeps the high bg's up in first place.

The Hill's WD food is really a Weight Loss food. But the truth is too high carbs just get stored in as fat in the body, see the horrid W/D's profile https://www.hillspet.com/cat-food/pd-wd-feline-canned

It's much better if you change to Hill's MD food. It's High protien, medium fat, low carb 15 % . See Better M/D's profile .https://www.hillspet.com/cat-food/pd-md-glucosupport-feline-chicken-and-liver-stew-canned.
BUT when changing to the MD, then, you HAVE TO directly lower the insulin to 1 Unit BID.

 

Hi Molly,

While it is highly likely that insulin dose would need to be reduced if moving a kitty from Hill's w/d to a low carb food, if Allie is on a significant dose of insulin before the changeover it could be dangerous to reduce the dose down to 1.0IU BID because it could put your cat at risk of developing problems with ketones (see FDMB ketone primer for more info). I would not recommend following such advice.

Instead I suggest that, once you have gathered adequate data and determine how Allie is responding to her insulin treatment (per Deb's post above), prior to any food change you post for help and advice about how to manage insulin dosing during the diet transition. In that way you would be able to reduce the insulin in stages and in line with the gradual reduction in carb load.

More on safely transitioning diet for a cat on insulin here:

catinfo.org - Feline Diabetes Page


Mogs
.

 

PS:

Hill's m/d is not a low carb food. The recommendation for general feeding of feline diabetics is a diet made up of foods with less than 10% of kilocalories coming from carbs.


Mogs
.

 

We are testing at 8+ at our vet's request.

A little history on our diet dance to date. Hard to re-calculate after finally stabilizing, but we'll go where we need to.

We had fed Tango and Allie Fancy Feast gravy cans for about a year before we had trouble. We’d fed FF cans previously, but more of the classics.

When Tango was diagnosed 8/21 and we read that carbs should be <10% we figured we’d pushed him over into diabetes with that food. After 8/21 we removed the dry food and fed FF classics on our vet’s advice. On 9/8 we started transitioning them to the Purina DM, since we weren’t seeing any improvement. On 10/27 we brought him in to start him on insulin. He tested 192 and we decided to wait. He’s been in remission since then. Since all that worked, and we knew the DM was >10%, we went with observed results.

Allie was diagnosed 11/5. They both got tired of the DM by December, they were just licking the gravy off. The vet suggested M/D, W/D or RC glycobalance. They liked the M/D but were soon just licking the gravy again. They weren’t crazy about the RC, but went nuts for the W/D which they’ve been eating almost exclusively since early Feb. Tango has gotten so buff on this food its amazing. He was overweight but now feels like he’s all muscle. Again, we have just been going by results, and my vet. (and of course lots of reading - TUFTS & NIH note that low carbs aren't the panacea for every diabetic cat)

So now it seems we need to come full circle and back to FF classics or something similar. Easy enough to cut down and then out the meta treats and the dry food, just not sure which canned food to try first.

 

I knew you had a thourough background.

 

You'll see a huge positive effect if you start to follow the advice from this board.
Your vet obviously doesn't know about diabetes or insulin. +8 is 3 hours too late, and you still need to test before giving insulin and during the night.
Take a look on my spreadsheet from 2020, specially look at the PM cycle. You're missing over half of the picture.

 

You might want to try mixing up the test times a bit more during the cycle, and not only that +8 that your vet asked you to do. Why only +8 would be my question, if a vet told me that.

Most cats on Prozinc nadir somewhere in the +5 to +7 time frame, but ECID.
So tests during those times are more helpful, to see what the insulin dose is doing.
In fact, if you look at your curve from the other day, the low was at +6. Nadirs change, so you can't assume that time will always be the same.

Not sure which TUFTS study you are referring to, but the one I read years ago was only done on about 10-15 cats I thought, and then didn't even test foods that were <10% carbs.

Yes, that W/d food is a weight loss food. So if your cat is very overweight, it can be an option to help them lose weight. I just wish it were lower in carbs, had better quality ingredients, and wasn't so expensive. If your cat is underweight, or at their ideal weight, feeding a weight loss food may not be your best option for the future.
As you discovered, cats get tired of the same food. So it's nice to have plenty of options, if your cat stops eating a particular brand.

Look at the food charts to look for other options. They can be found in the Health Links/FAQS forum here, and elsewhere on the message board.

 

Seems to be working...

 

Are you feeding dry?
Nice to see some PM testing too!
But I'd like to see some testing at +3 and +5 in both cycles

 

Better numbers today 3/10/21 for sure. YELLOWS!!!!