Testing for Luke

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Kristen ardito

Kristen ardito

Member Since 2023
Hi: I'm a new member and hoping I have done everything right, but welcome feedback if I missed something. Luke was diagnosed last month and spent 2 weeks in ER after my original vet misdiagnosed him, sent me home with vestulin and no instructions and he ended up having pancreatitis and severe low red blood cell count (anemic). After getting blood transfusion, almost losing him, and spending 20k, I'm going to do whatever it takes to get him back to health.

That being said: My "new" long term care vet has not been very helpful so I'm hoping you all can help. The good news is, she at least took him off vestulin and he has been on Lantus for a week and two days. The bad news is: she believes he should only eat Purina DM the rest of his life and that I shouldn't be home testing (if I do, she will only agree to look at his bloodwork if I buy the AlphaTrack3 but we have been doing fine with Freestyle Lite so I have no intention on switching).

Last piece of data: I put on a freestyle libra2 3 days ago. Ever since then, his numbers have been reading very high. I wondered if maybe the device took 24 hours to calibrate to his body since he wasn't acting differently. Yesterday his numbers were pretty good but got higher.

All this information is in the notes section of the spreadsheet.
  1. The date we switched to Lantus
  2. The date I switched from measuring BG with ear prick to using Freestyle Libre
  3. The date I started feeding one meal a day using Fancy Feast Classic Pate

Here's the problem: His numbers are still high. It's been 3 days on the Libre, and a week + 1 day on Lantus.
I'm using a U-100 syringe but sometimes it feels like when I put the needle in him, the plunger doesn't depress. Like it's almost already all out of Insulin just by putting needle in. This wasn't the case with the U-40, which was so much easier. How do I make sure the insulin is getting in him? It's an animal syringe.

I guess my other question is, what do I do with these high numbers? Is he at risk for catastrophic disease after a month of such wild ups and downs? I have ready literally all of the posts from the last year on the Facebook site and most of the information in the files, so I know this is a long game. I am just wondering what else I can do in the short term.

Thanks! Kristen

FYI: I have a Mac which doesn't have Excel so I re-created the spreadsheet in Google Sheets. As far as I can tell the only thing I lose is the auto color coding, but if this lost other functionality let me know and I can figure out what to do.

https://docs.google.com/spreadsheets/d/1kN1CpdMQu4Q1nxtE6J6i1YwaWDO6BjMV84AlH2RnqXg/edit#gid=0
 
Please please please do not feed him one meal a day only. Cats are grazers and do much better with smaller meals or treats throughout the day. If he had pancreatitis, know it’s also easier on their pancreas. If this was advice from the old or new vet also know it’s very old fashioned thinking that works for dogs who have a slower metabolism not cats. You’ll also avoid the huge sugar spikes by feeding more often. Most of us feed the larger meals at shot time than smaller meals or threats throughout the day. Bobo gets fed 8-9 times a day! Imagine if you became diabetic and were told you can know only eat once a day :nailbiting:

it’s not uncommon for newly diagnosed cats to be higher for a while before they get regulated. you have to pick and follow a dosing protocol, I asked that below, so you know how many cycles to wait before increasing the dose and you have to keep increasing until you hit the breakthrough dose. I’m sorry even your new vet doesn’t sound willing to work with you and doesn’t seem to know that much about feline diabetes if she’s telling you to feed a high carb food and not test. The only way to get him regulated is to test and find the ideal dose for him.

glad you are here and welcome!!!

A few notes/questions about your spreadsheet.
  • Can you please put the name of the insulin at the top instead of the unit amount
  • It would also be helpful to draw a line right where you switched to Lantus so it’s easy to see. Take a look at mine and where I indicated he started in insulin
  • Have you picked a dosing protocol, SLGS or TR? You can read about the 2 in the yellow sticky notes in the Lantus forum. Again, if you look at mine you’ll see we’re following TR.
  • I’m unclear about the 1.3 dose, how did you measure that? Here we do dose adjustments by 1/4 units so you go from 1 to 1.25 to 1.5, etc
 
About the syringes, I’ve never had that issue to be honest. I pull the plunger in and out a few times before I draw in the insulin then I look to make sure I have the right amount of insulin. I use a flashlight to see the fur and the needle going in then I push the plunger all the way in. I’ve only had a partial fur shot once because he moved and I knew that since the spot was wet and I could smell the insulin. I used the 1/2 marked ReliOn syringes with 6mm short needles

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Thanks for the response! I'll make it clear where I switched to Lantus.

Also, I'm feeding twice a day (wasn't sure how to log it). I feed him in the morning at 615 (30 min pre-shot) and evenings 615 (pre-shot). My vet attacked me when I tried to break it up into smaller feedings. I'm learning that she is not the best source of info though. He gets 115 grams of food a day so it's not a big deal to divide that into smaller meals and keep his weight managed.

I haven't picked a protocol. Let me read more about each. I thought those were guidelines - I guess I still have a lot to learn!

Oh...the 1.3 I will change. The syringe didn't have a spot for 1.25 and so I was trying to get it right in the middle of 1.5 and 1 and sometimes I felt like it was slightly over. But I'm pretty sure it was in the middle.
 
That’s what I do with Bobo. I split up the portions into smaller meals and I also give him freeze dried treats a few times a day and before going to bed so he has something in his stomach. A lot of us will leave some food out so they can eat overnight. I just got used to giving him treats when I wake up to go to the bathroom but some members have auto feeders. This is because they tend to go lower overnight. Again, the twice a day feeding is a dog thing and it does not work well for cats who have a much higher metabolism (not as bad as once but stil not ideal ha!)
 
This is really helpful. I updated the spreadsheet. I am going to stick to the SLGS method as I now believe this is what my vet started him on (although she never explained anything to me so I'm just guessing). Anyway, seems like it's best to stick to the original plan.

A couple of things I'd like to get your thoughts on:

1. He has thrown up a couple of times in the last week. My hypothesis is that he simply eats too fast as it is not accompanied by any obvious symptoms and he is still hungry. I can't find a ton of information on this. I'm hoping that by adding an additional feeding may help but frankly he's always been an inhaler of food - since he was a kitten. What are some options or can you direct me to more info on what to do if a cat occasionally throws up? Do I feed him again? My vet has been so strict with the amount I feed him so I'm curious about the wisdom of anyone outside of my vet.

2. He has been on the Lantus 1.0 for 10 full days and his numbers are mostly in the high 300s all day. Would this warrant a potential increase? He is 17-18 pounds. It doesn't seem like weight matters on the SLGS regime as it does for TR but want to check.
 
Most vets don’t follow either protocol which is why they dose by the preshot values and not the nadir to be honest. But SLGS is a good steady one while TR requires a lot more testing and monitoring as evidenced by Bobo’s ss. the weight is only a variable when figuring out the starting dose btw.

there are so many reasons a cat my throw up. Does he do it immediately after eating like he’s regurgitating the food? That tends to happen when they eat too fast. Bobo has IBD so he vomits because of it. He’s on the 2 main vomiting/nausea meds which are ondansetron and Cerenia. But if your cat is not nauseated and is eating fine, I’d be inclined to think it’s a regurgitating issue. Bobo is also on metroclopramide for that so if it persists, you may want to ask your vet for a prescription to see if it helps. If he threw up everything he ate, yes feed him again. Lantus is a grey gentle long lasting insulin but your cat still needs food onboard.

Did you ever do a curve or did either vet? He’s likely due for one of its been 10 days on the same dose and you can do that at home don’t let your vet pressure you into doing it at the office where your cat is more stressed out and the numbers won’t reflect the accurate picture. I’m not a fan of vets that try to pressure or push me into certain things. That’s when I look for a different one. I’m convinced I’ll never find a vet who knows as much or more than me about feline diabetes so I stoped looking. I consult them on Bobo’s other issues, but not his diabetes. It was the same for Minnie.

tagging someone else who may have more insight about the vomiting @Bron and Sheba (GA)

Here is a link helping us to help you link. If you noticed, our members have some basic information about their cat's in their signature. This helps us to not pester you by asking the same questions (your cat's name, insulin type, date of diagnosis, etc.) repeatedly. We also have a link to our spreadsheet in our signature. We are very numbers driven. The spreadsheet is a record of your cat's progress. By linking it in your signature, we can follow along and provide feedback should you need the help. If you don’t mind setting up your signature, that would be great and helpful for us!

This is an excellent site for diabetic cats…it has been around for more than 25 years and has very experienced people to help you.

Keep asking lots of questions.
 
Thank you! I thought I followed the instructions on how to fill in my signature - but yes, it seems like having numbers is a helpful way to give quick insight.

It does sound like regurgitation. It usually happens right after he inhales his food. It's also not always that much, and not all the time. So I'll keep an eye on it.

Regarding the curve: am I able to use the data from the freestyle libre to do a curve? Or is it only using BG from ear prick? The answer is: If Libre, I would say he is on a continuous curve since I'm monitoring all day. If it's blood draw, then no, and I can do at home. I've resisted doing one in the office due to the reasons you listed above. And yes, they have pressured me to do one in the office.

I work from home so I have a ton of structure for my cat and am fortunate enough to be able to not only do a curve, but also to monitor throughout the day.

Let me add any missing info to signature now. thanks so so so so much!!
 
The libre or manual testing are both fine for the curves.

Is there a reason why you went down from 1.5 to 1.25 and then down again to 1? If you start to follow SLGS, you’d only reduce the dose if you get a number under 90. Also Lantus likes consistency so it’s ideal to have the same dose every 12 hours unless you have a reason to reduce/increase.

it wasn’t coming up before, but I see your signature now. Thanks!
 
Yes, great question. I went down from 1.5 because I put him on that dose after reading the forums but then my vet told me to put him back. I panicked and put him back down.

The reason he went from 1.25 to 1 was when we switched him from Vestulin to Lantus. She wanted to start on the lowest dose of Lantus and "restart him from the ground up" again.

So now we have been stuck on 1. And I am pretty sure he needs more.

FYI: Just tested:

- Freestyle Libre: High
- Freestyle Lite: 273

Are those discrepancies normal? I've asked her and her only answer was for me to switch to Alpha Trak.
 
Hi Kristen,
I am going to ask @Bandit's Mom if she can swap over your SS to one of ours. It will be much easier to read. Is that OK with you?
Try and get at least one test in during the pm cycles so we can see what is happening there. Luke could be dropping lower overnight.
It looks to me as if Luke is bouncing from the lower BGs (blues and the one green). This is perfectly normal especially in newly diagnosed cats, so don’t worry. The 1 unit is bringing him down to blues and a green. There could be more green BGs we are missing.
You need to stay at 1 unit for at least 10 cycles after that green BG on 26/4. So no increase until then 5/2. But please post and ask advice about that before increasing, as things can change.
I’m glad you did not go back to a lower dose when you started Lantus as the vet suggested. That would have been a bad idea.
Please give snacks during both the cycles as well as the 2 main meals.
Information on bouncing from the Basics:
  • Bouncing - Bouncing is simply a natural reaction to what the cat's system perceives as a BG value that is "too low". "Too low" is relative. If a cat is used to BGs in the 200's, 300's, or higher for a long time, then even a BG that drops to 150 can trigger a "bounce". Bouncing can also be triggered if the blood glucose drops too low and/or too fast.The pancreas, then the liver, release glucogon, glycogen and counter-regulatory hormones. The end result is a dumping of "sugar" into the bloodstream to save the cat from going hypoglycemic from a perceived low. The action is often referred to as "liver panic" or "panicky liver". *Usually*, a bounce will clear kitty's system within 3 days (6 cycles).

Kristen ardito said:
Freestyle Libre: High
- Freestyle Lite: 273

Are those discrepancies normal? I've asked her and her only answer was for me to switch to Alpha Trak.
Click to expand...
Yes there will be discrepancies but that is quite a gap. But both BGs are high none the less.
It’s better to stick with one meter unless the BGs drop under 100, when the freestyle libre can become a bit unreliable.
Please don’t swap to an alphatrak meter. They are very expensive to run. Al vets used human meters until the alpha track meter came on the scene and they are perfectly ok to use. And our dosing methods are based on the human meter.

if you have decided to follow SLGS you need to reduce the dose if the BG drops under 90.
 
All great - wow, that makes me feel a lot better and does seem to explain why he was reading in the 100s for a few days then it popped back up.

I'm fine with switching the spreadsheet out. My only concern is will I be able to keep it updated if I don't have Excel? I can always try to use "Numbers" which is on my Mac but it also is not 100% compatable w Excel. I'm in IT so I can also try to replicate the functionality in the SS if you let me know what's missing.

And yes, I will go back to doing more tests in PM cycles. He was lower in PM cycles a few weeks ago, even on Vestulin.

One other thing: I DID reduce his dosage when I switched from Vestulin to Lantus. I went from 1.25 to 1.0. Funny thing, I fought her on that. I said I didn't think it made sense to start from scratch but she said "you always have to start again from scratch if you switch medications".

Anyway, he is back to 1.0, which is where we started when I brought him home from the ER on March 21.

I'll keep testing in the next two days and then post for advice when I'm about to increase. The increase would be in .25 increments correct?

Oh! one more question: When you say to add snacks, is that above and beyond the 115g of food I'm keeping him on or is a snack inclusive of his total food intake (just break it up more)?
 
Can’t you use google sheets like all of us? We don’t use excel, we use shared Google sheets since we have members all over the world, so it doesn’t matter what computer you’re on.

what’s his weight? The rule of thumb for daily caloric intake is 20 times ideal weight so if he’s 12 pounds he should be eating about 240 calories a day. Unregulated cats should eat more because they can’t process the nutrients in food efficiently so they eat but will lose weight. They also burn calories just by peeing since there’s sugar in their urine. Where did you get the 115g a day from? Your vet?
 
I am using google sheets. I must have screwed something up. Happy to fix it. I will take another look tomorrow when I update his evening numbers.

before he diagnosed he was btw 18-20 pounds and the vet said he was fat. He’s a Siberian so I assumed they didn’t know his breed. He has always been on ultra high quality food like tiki cat, primal, Stella and chewy. But since he ended up w diabetes from eating those food his whole life, I’m good trying fancy feast.

makes sense to feed him a bit more. I just didn’t know if that would be a setback as his body normalized. I can experiment. My vet put him on the 115g a day diet. But she never mentioned carbs so again, I don’t think she’s the subject matter expert. You guys are worlds more helpful and seem to have a lot of data driven protocols which is nice.
 
All those foods you mentioned are good and most are low carb. Sometimes the diabetes is not because of the food. Dry food can cause it for sure but it sounds like he was never on it.

FOOD CHART have a look on this chart and choose foods that are under 10%. You will also need some higher carb foods for that hypo box..information in the help us help you link. Some members like to stay as low carb as possible like 2-5%
 
Kristen ardito said:
I am using google sheets. I must have screwed something up. Happy to fix it. I will take another look tomorrow when I update his evening numbers.

before he diagnosed he was btw 18-20 pounds and the vet said he was fat. He’s a Siberian so I assumed they didn’t know his breed. He has always been on ultra high quality food like tiki cat, primal, Stella and chewy. But since he ended up w diabetes from eating those food his whole life, I’m good trying fancy feast.

makes sense to feed him a bit more. I just didn’t know if that would be a setback as his body normalized. I can experiment. My vet put him on the 115g a day diet. But she never mentioned carbs so again, I don’t think she’s the subject matter expert. You guys are worlds more helpful and seem to have a lot of data driven protocols which is nice.
Click to expand...
If his ideal weight is let’s say 15-16 pounds then, he shouldn’t be getting at least 300-320 calories a day. I’m FF terms, that’s about 3 cans a day depending on the flavor
 
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Thank you. I updated his spreadsheet - I think I had just discolored some of it. It should be closer to the one you have now.

I also took his numbers throughout the night last night. He was high all through the night (high 300s); this the AMPS was HI.

Tomorrow is the 2nd. I'm wondering if based on what you see if you think maybe I should increase tomorrow and to what number? 1.25?
 
Luke is bouncing each time he sees a blue BG. I would wait until he comes off this bounce and see where he lands before increasing. It looks like he is on the way down now. I think he is also bouncing because he is having big drops. For example this morning he dropped from hi to 284 in an hour. That is enough to trigger a bounce. So I would give him a snack at +1 each cycle to see if that helps.
Is he eating well with the preshot meals? and do you give the dose straight after the meal?
 
I have been giving him a dose 30 min after meals. Today I did also give him a snack - but it was 3 hours after meal. I can def add snacks 1 hour after cycle.

so for example, he eats breakfast at 615 and gets dose at 645. That’s also when I check BG.

he is eating great. If anything, he continues to be voraciously hungry and seems to spend his day asking for more food. Sometimes he sits by his food dish for hours. I’ve been really careful since he had pancreatitis and low red blood cell count last month and almost died. He lost a lot of weight when he was being tube fed for 2 weeks. So I’m still trying to be gradual with food increases.
 
I would feed and then give the dose of Lantus straight away. There is no need to wait with Lantus insulin.
Poor fellow, he has been through a lot. Is he still underweight?
While his numbers are high, he will be very hungry as his body cant utilise fully the food he is eating. Once he drops to more normal numbers, he should start to put on weight and be less hungry.
If he is still underweight and asking for food a lot I would feed him more.
 
I agree. As I said before, unregulated cats need more food since they can’t process the nutrients in food efficiently and will eat but still lose weight. I wound feed him when he asks for food.
 
Y'all are a life saver. I can't say that enough.

Great news! His numbers went down last night. I even caught on in the 100s at 2am. :)

And this morning it was lower than it had been as well.

Keeping fingers crossed.

PS: Thank you for asking about his health. He has been doing GREAT. He put the weight back on and is now a healthy weight. He looks fantastic given all he has gone through. That's why I'm maybe a little nutty about keeping his weight stable.
 
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Hi All: this thread had about 10 replies and I was using it for guidance. They all seem to have disappeared. Any idea what happened?

In any case, I was wondering if you could take a fresh look at Luke's numbers.

Couple of things I realized I didn't answer:

1. He is now at a good weight. He put the weight on in the past month (so ideally I wouldn't do anything that would cause him to gain more)
2. I've added small "meals" throughout the day. When he seems hungry. I measure the food and keep it small, and it's wet food.

His numbers are still high though. I've seen a few dips into the 100s but even overnight it's mostly in the 200-300s.

He is still on 1.0 Lantus.


https://docs.google.com/spreadsheet...6i1YwaWDO6BjMV84AlH2RnqXg/edit#gid=1637914808
 
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