Switching to wet food-need dose reduction advice w/ ketones

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ajouteast

Member Since 2011
The folks at the regular board suggested that I come here and post my history and ask for some advice. Sorry in advance for the length of this post, but I wanted to give you the full picture.

Bogey is 10 1/2 years old. He was diagnosed early November 2010 after I noticed that he was drinking tons of water, urinating constantly and had developed an insatiable appetite. The vet ran blood work and did a thyroid test - all that came back normal except obviously for the diabetes. The vet started him on 1 unit of Lantus BID. After a month when the drinking, eating hadn't changed he switched him gradually to 2 units BID. In February 2011, after doing a fructosamine test, he increased Bogey to 3 units BID and eventually to 4 units BID, when the symptoms still weren't subsiding.

In late April of this year, after becoming increasingly frustrated with that vet, I switched Bogey to a new vet who treats cats only and supposedly has had far more experience with diabetic cats. Shortly after the switch I had Bogey in to the new vet to do a curve. During the curve the vet caught some urine, ran a test, found ketones and had me immediately take him to the ER hospital where he spent the next 24 hours being stabilized. All his blood work, and everything looked great and Bogey was allowed to leave the next night. Both the ER vet and the new cat vet suggested his Lantus be increased to 5 units BID. At this point I was questioning if the Lantus was working, or if there were other problems, etc. Should he be switched to a different insulin, etc. They said the Lantus was working, just not well enough and that he needed a higher dose.

After the ketone episode, and with the new vet, I started home testing. You can see on Bogey's SS that I did my first home curve on May 1st. I've reported all of the testing to the new vet, who has increased his dose two more times - now we are at 7 units BID. We just ran another thyroid test (came back normal) and a growth hormone test (waiting for results). He is having constipation issues and is now on Miralax twice a day. He has had some significant poos... but still seems to be having issues.

Bogey's symptoms have not changed since diagnosis. He drinks tons, pees constantly, and acts like he's starving. I currently feed him 2 cans of Fancy Feast Classic in the AM and 2 cans in the PM. There is Wellness Core (and was Purina D/M in the past) available to free feed. The dry food was kept because he is used to free feeding and also because I have another cat who free feeds. The new vet also like there to be some dry food available in case Bogey would throw up shortly after getting his shot, but after I've left for work.

After reading a lot here, and talking with some folks, I'm thinking I should try to eliminate the dry food and see what that does. I'm concerned about how to do this safely, especially because of his past history of ketones. I work a regular M-F, 8-6 work week and don't really have anyone to help. I will be home the next three days (Friday, Saturday, Sunday) and could spend some time working on this and closely monitoring him now... if this is enough time to try to change him over. I'd really appreciate any advice about how to do this OR even if I should be trying this. I'm so frustrated and of course, very concerned at this point. It's been 7 months and his symptoms haven't improved. His mood has increased quite a bit in the last month or so, which is great, but not the symptoms or his numbers. We can't seem to get his diabetes under control, muchless even hope for remission.

Thank you, and again sorry for the long read!
Amy
 
Re: Switching to wet food-need dose reduction advice w/ keto

Welcome to Lantus Land. You're in the right place for advice, though I'm not one of the experts. They check in often so I'm sure you'll get some help soon. Go into your post and edit it to put the "?" icon up. It's at the very top, the post icon...click on the "?" and that way the experts will see it right away and know you have a question in your post. I know you will need to get rid of the dry food. You'll be amazing at the havoc it can cause with the numbers. There are tips and tricks to get your cat over to a wet-only diet, though my cat is such a piggie he doesn't care what he eats as long as he eats!!! Again, I know someone will come on with some advice for you.

Hang in there!!!
 
Re: Switching to wet food-need dose reduction advice w/ keto

Hi Amy, welcome to Lantus Land!

My first question is about the growth hormone test - do you know what the test was? Was IGF-1 (insulin-like growth factor?). That is a test that is usually used to diagnose acromegaly (a condition that can cause a cat to need a higher insulin dose). There is such a thing as a test for growth hormone, but as far as I know that test is currently unavailable. If IGF-1 (from Michigan State University) is the test you ordered on 5/20, you should be getting the results any time now. Maybe call the vet tomorrow and ask.

How well does he eat the wet food, and how much dry do you think he eats in a day? Another question, you mentioned a distended belly, is that a new thing? Did it get smaller after he was treated for the impaction?

My first impulse is to not change his dose until that test comes back, especially since he has had ketones recently. Cutting back or eliminating the dry food is a good idea, especially if you will be home to monitor. That *could* cause his numbers to drop, so definitely wait to make the change until you will be able to monitor. In the meantime, I would try to get as many tests during the day as you can. When you are testing only at shot time, it is impossible to tell if he is dropping lower during the day and then bouncing back up, or if he is staying high all the time. It would be helpful if you can just make it a goal to get random checks as many times during the day and evening as you can, or even to do a curve if you can. Those tests will help fill in the picture and after a couple of days we'll have a much better idea of what is going on.
 
Re: Switching to wet food-need dose reduction advice w/ keto

forgot to mention - if you are going to hold this dose and cut back on dry food, please please please promise to stay around and post daily! We're going to want to help you keep an eye on his numbers with you, so if he does need a dose adjustment we can help you manage it. You don't have to go it alone, and we would rather you didn't try. It's good to have lots of eyes on your kitty.
 
Re: Switching to wet food-need dose reduction advice w/ keto

Hi again,

Yes, it was the test for acromegaly from MSU. I will give the vet a call tomorrow. In the meantime, should I give him his regular 7 unit dose which is due about now and take away the dry food? I can test during the night if it's necessary. I don't think he eats a lot of the dry, but he constantly nibbles... just a few bites then walks away, then a half hour or hour later a few nibbles.

His distended belly started a few weeks ago. That's why I actually took him in on the 20th. That's when the vet said that he was totally full up. and that his colon was so full it had actually moved to the side. His belly is smaller, but still somewhat hard to the touch. As I said, he did poo a lot in the last few days. I assume there is still a fair amount for him to get out. I was guessing that all the protein, and lower amount of fiber, was causing the constipation.
 
Re: Switching to wet food-need dose reduction advice w/ keto

Libby has given you some great advice. Are you also testing for ketones at home?
 
Re: Switching to wet food-need dose reduction advice w/ keto

Not yet, but if I'm switching to wet only, I was going to go to the pharmacy tomorrow to get the Ketostix.
 
Re: Switching to wet food-need dose reduction advice w/ keto

do you have any high carb wet food on hand? Most of us use something like Fancy Feast or Friskies varieties with gravy. Those have lots of carbs in the gravy, and are better than dry food to use when the cat drops into low numbers. The carbs tend to hit the system faster.

Just in case his numbers do drop when you remove the dry food, I would rather you do it when you are well prepared to deal with low numbers just in case they come. That means having plenty of high carb wet food on hand and plenty of test strips. Since we don't have a ton of data for Bogey, that is the safest route.
 
Re: Switching to wet food-need dose reduction advice w/ keto

Currently I just have the FF Classic. I'm actually just running out shortly to the grocery store, so I'll get some of the higher carb FF in addition to restocking the Classic. Once I have that on hand tonight should I remove the wet food?
 
Re: Switching to wet food-need dose reduction advice w/ keto

once you're well stocked then I think it is ok to remove the dry food. You might have to increase his wet food some to be sure he's getting enough calories. Then get some extra spot checks over the next few days so we can see how he's doing. Good luck!
 
Re: Switching to wet food-need dose reduction advice w/ keto

Hi Amy, welcome to LL! Libby has given you good info. Sienne asked about the ketone testing, so I just want to ask one more thing.....are you adding water to Bogey's food? Since you are giving Miralax, that extra water is important. I would make it as soupy as he will tolerate it. (Extra water is good for FD anyway.)

I hope you will post every day, I look forward to getting to know you and Bogey!
 
Re: Switching to wet food-need dose reduction advice w/ keto

Thank you! I'll give it a go. At what point should I get concerned and it be necessary to give him the higher carb wet food?
 
Re: Switching to wet food-need dose reduction advice w/ keto

Hi Laurie. Thank you for the welcome!

I was adding water for a while, but Bogey drinks constantly, so that doesn't seem to be an issue. I refresh and refill the water bowl (which is large - you could serve a salad in it) at least twice a day.
 
Re: Switching to wet food-need dose reduction advice w/ keto

We start to steer the curve when numbers are either dropping fast from blues into greens and definitely if numbers drop below 50.

This is a post on how to manage low numbers. It's helpful to have this on hand. (FYI, this isn't about low pre-shot numbers. There's different post on that topic.)
 
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