Time to increase insulin? Or switch insulin? And concerns of possible mild pancreatitis

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Ds0342412

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I hope I have all the relevant info in my signature! Long-ish time member, first time poster here in the forum.

My cat Lulu started insulin on the evening of 12/11/2024, the Basaglar.

Here is her spreadsheet with numbers, insulin started the evening of 12/11/2024 so please keep that in mind when reviewing. Link to Google spreadsheet: https://docs.google.com/spreadsheet...0BlutyK1WLKJvzS-FsGlY0483UdpoN9UbIXpj/pubhtml

We have increased her dosage a little over time as we are still getting higher readings. I'm not sure if she needs more insulin, or a different insulin, or something else at this point. What complicates things a little is I don't fully trust her current vet and am in search of a new one to get Lulu established with, someone who is more familiar with best practices for feline diabetes and more up-to-date. Some guidance initially given by her vet is concerning (prescribing Bexacat when Lulu had elevated ketones, so I had to push and push to say no on that, then wanting to go to caninsulin right away for insulin instead of the insulins out there that are less rough on cats, etc.).

Also, overall she's been lethargic with her breathing sounding a little louder than usual when resting. She does still get up to move around the house, just not as much or for as long. She's had diarrhea on and off a few times over the past 5 days or so. She was having diarrhea right at the beginning of January but thought it was due to a food change so we stopped the switch to the new food (we were giving the Wysong epi 90 a chance with a slow transition) and the diarrhea seemed to resolve (or so we thought). Her appetite has stayed normal and she is still getting most of her normal intake of water throughout the day (I've had to start adding a little extra water to her wet food to try to keep her hydrated). I believe she has lost some weight recently. She's hard to weigh as she won't stay still when I hold her, but on Jan 2nd she was somewhere between 12.6 and 13.0 pounds. Yesterday 1/14 she was somewhere between 11.2 and 12 pounds. When she was diagnosed as diabetic back in mid-November 2024 she was 11.4 pounds (after being 12-13 pounds and up prior to having signs of being diabetic--she was overweight previously!). So weight has done a decrease, increase, and decrease again.

I guess my main questions are where to go from here with her insulin dosing? More insulin, or a switch to a different type?

And should I be worried about pancreatitis? With the lethargy, louder breathing at times, diarrhea on and off, and continued elevated blood glucose, it's been on my mind. I previously had a sugar cat named Prince who passed away back in Feb 2023 and had battled pancreatitis a few times, so this isn't my first rodeo unfortunately.

If this thread can only focus on one side (insulin) or the other (questioning if possible pancreatitis), please let me know. My big question for the forum is regarding insulin as I will take her to the vet if she doesn't improve or gets worse (but again, have historically hard a somewhat difficult time with this vet and trusting their instructions with Lulu's diabetes--it's a lot to get into on this post).
 
Hi and welcome to the forum.
I am really glad you pushed not to give the bexacat to your kitty. The vet should have known better. That is unforgivable and is a contradiction if the cat has ketones.
Has Lulu been diagnosed with pancreatitis? with a fPL blood test?
Was she treated for that?
In regards to the insulin. Basaglar is an excellent insulin for cats. I would not change it at the moment.
Can you get some tests in during the cycles? Basaglar dosing is based on the nadir not the Preshot BG. That will help us help you. Don’t forget the pm cycle as well.
If you are feeding kibble you will need to follow the Start Low Go Slow dosing method. I’ll post it below.
Are you feeding a good meal before the insulin and then giving 2 or 3 snacks during every cycle?
Keep asking questions :)
 
DOSING METHODS for Basaglar

What symptoms does Lulu have which makes you think she may have pancreatitis?

There's some more details in the post, but the increased lethargy, louder breathing at times, diarrhea on and off, and continued elevated blood glucose despite starting insulin a month ago would be the symptoms I'm tracking.

We have 4 cats total, with 3 out of 4 having their own health issues, special diets, etc. so money is a bit tight between regular supplies and recent vet visits for all of them plus Lulu is a kitty that gets extremely extremely stressed for/during vet visits. I'm honestly surprised she's (mostly) tolerated let me testing her BG each day and administered insulin as well, though we do struggle with her some days.
 
Hi and welcome to the forum.
I am really glad you pushed not to give the bexacat to your kitty. The vet should have known better. That is unforgivable and is a contradiction if the cat has ketones.
Has Lulu been diagnosed with pancreatitis? with a fPL blood test?
Was she treated for that?
In regards to the insulin. Basaglar is an excellent insulin for cats. I would not change it at the moment.
Can you get some tests in during the cycles? Basaglar dosing is based on the nadir not the Preshot BG. That will help us help you. Don’t forget the pm cycle as well.
If you are feeding kibble you will need to follow the Start Low Go Slow dosing method. I’ll post it below.
Are you feeding a good meal before the insulin and then giving 2 or 3 snacks during every cycle?
Keep asking questions :)

Thank you! Yeah the Bexacat thing really threw me for a loop. I'm glad I trusted my gut and didn't start Lulu on it and kept pushing for insulin, especially since I've had a sugar cat previously who had periods of remission on insulin (his other health issues unfortunately took over eventually). The vet said Lulu's ketones weren't high enough to be a concern, but i read the pamphlets and information that is provided by Bexacat and those sources said otherwise.

Lulu hasn't been diagnosed with pancreatitis. We have 4 kitties, and 3 of them with special medical issues we watch over (and special diets to go with each) so between regular supplies and unplanned vet trips recently, money is a bit tight. Her appetite has stayed up, but the other symptoms I listed have me worried if she might have a mild case...but maybe I'm paranoid.

She's difficult to get two glucose tests a day out of so besides the +3 and +4 random readings sprinkled throughout the spreadsheet, there isn't more than that yet.
I'd like to try to do this today if she'll bear with me. Do I test every 2 hours? Or is it every 4? And across a 12 hour period, right? It's been a while since I attempted a curve.

She gets a meal before her morning and evening shot, plus snacks (just smaller portions of low carb pates like FF classics and FF petites pates, or a little of the Dr Elseys clean protein kibble) since she will scarf and barf if she goes too long without food. So she gets food at AM shot, lunch, afternoon, PM shot, and pre-bedtime. She has a microchip feeder so she can access wet food anytime.
 
A curve is either every two hours for one cycle (12 hours) or every 3 hours for 18 hours, your choice. Looks like you are doing a great job gathering some data today. Since she was on her way up the last test, you can probably hold off until PMPS for the next test.
 
A curve is either every two hours for one cycle (12 hours) or every 3 hours for 18 hours, your choice. Looks like you are doing a great job gathering some data today. Since she was on her way up the last test, you can probably hold off until PMPS for the next test.
Yeah I was able to get some testing in today, and am going to wrap up testing with the last number I logged (PMPS +2).
I feel bad poking her so many times in a row :( Especially since she really doesn't like it.
So it's good to see her numbers go down after her AM shot, but I worry the dose possibly isn't high enough to combat how high her sugars are staying?
 
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