unable to stabilize BG

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lkcbyer

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I have a very thin nine year old neutered male cat that was diagnosed two years ago with diabetes but we have not been able to bring his glucose levels into normal range yet. At first he was on Vetsulin then Prozinc and now for the last month he has been on Glargine. We have just increased the glargine to 3 units. The lowest glucose reading I have been able to get on him recently was 450 after being on the glargine for a week. I have tried to do BG curves but if it is over 600 my glucometer reads Hi and it is usually Hi. Although I have been trying to feed him soft food, meat or fish, I have several other cats that self feed a dry food called Taste of the Wild and he does occassionally still eats some of that. He was a mostly outdoors cat but two winters ago it was so bad that I brought him in. At that time I was feeding a cheap grain based cat food and by spring he was looking very thin and was diagnosed with the diabetes. My vet is trying but we just don't know what to do anymore. Any suggestions?
 
How did you arrive at 3 units? Was it by small increments ie .25 or .5 or by going up one unit at time? That could be a factor, in that you missed his ideal dose and are now seeing the somogily rebound.

There is also a possibility that your cat could be a high dose cat, meaning he could possibly be an acro cat. There are tests that can be done for that.

Go here to read more about this: http://www.felinediabetes.com/FDMB/viewforum.php?f=12

how was he doing on the other two insulins and how did you change his dose then?

The dry food of course, is not a good thing to give him. No matter the quality or price, it interferes with the body's ability to lower the bg.

Read this about dry food. Dr. Lisa's web site on basic feline nutrition and raw diets: http://catinfo.org/

Give us some more information and we will do our best to help you.
 
I have a high dose cat and have had difficulty in finding his correct dose. The principles are the same though - low carb food (as much as he wants while he is unregulated), small increases in his dose so that you don't pass his optimum, holding each increase for several days to see its true effect, and Lantus needs to be given 2 times a day on a fairly regular 12 hour schedule.

It is excellent that you are testing. Could you set up a spreadsheet so that the Lantus experts can see your data? The ss is a bit tricky to get going but there are experts for that too! Just ask for whatever help you need.

All the people on this board live with feline diabetes all day, every day. Noone has all the answers, but the depth of experience here means that someone will at least have the right questions to ask your vet. I have confidence that your kitty can be helped by many on this board, especially on the Lantus support group.
 
I am using the glargine with human syringes and have been increasing it only a half unit, which is really hard to determine, after a week with no changes, per my vet's instructions. The reason he is now on the glargine is because they stopped producing the Vetsulin and we were not getting anywhere with the prozinc. I actually was able to get some readings in the mid 400s and 500s when we initially started on the Glargine but it did not last. I work full time so, I try to do curves when I am at home on the weekends and also try to take his BS in the evenings before and after his shot but it is always Hi, so over 600. I have been feeding him hi protein, 14%, no carb soft food and try to remember to pick up the dry food when he is in the house but it doesn't always get done. My vet and I just can't seem to get him figured out.
 
Which type of food are you feeding? There is a list of foods and their carb content on this web site
http://www.felinediabetes.com/diabetic-cat-diets.htm
If you are feeding one of the prescription foods from the vet, it may not actually be low carb. Most people choose foods from the list that have carbs of 10 or less.

Even the occasional dry food can boost the blood sugar. I'm not sure how much dry you think that he is getting, but it could be part of the problem.

The other thing ot consider is some other aggravating condition. Does he need a dental? Might he have some other infection? There are 2 conditions that can also result in a difficult to regulate or high dose cat - acromegaly and insulin resistance. There are specific tests for both of these, and you may want to ask your vet about them.

edited for spelling
 
lkcbyer said:
I am using the glargine with human syringes and have been increasing it only a half unit, which is really hard to determine, after a week with no changes, per my vet's instructions. The reason he is now on the glargine is because they stopped producing the Vetsulin and we were not getting anywhere with the prozinc. I actually was able to get some readings in the mid 400s and 500s when we initially started on the Glargine but it did not last. I work full time so, I try to do curves when I am at home on the weekends and also try to take his BS in the evenings before and after his shot but it is always Hi, so over 600. I have been feeding him hi protein, 14%, no carb soft food and try to remember to pick up the dry food when he is in the house but it doesn't always get done. My vet and I just can't seem to get him figured out.
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The three most common reasons for not being able to regulate are 1. feeding dry food, 2. too high a dose of insulin, and 3. having an infection or needing a dental. These are the factors you need to eliminate before determining if he is a high-dose cat.

I used to feed the Taste of the Wild dry before Bandit was diagnosed so I called to get the as-fed values back then, and it figured to be around 20% carbs. You'll need to get under 10% carbs to lower his BG and regulate. The only way to do that is to get rid of all the dry, period, and feed a lower carb wet food. 14% is too high. I try to stay between 2-6% carbs with Bandit.

If you can't keep him from getting into the dry food because of your other cats, you may need to switch all of the cats to a wet diet as well and ditch all the dry period. It's far healthier for the cats to feed a cheap, grain-free or low carb wet food than the most expensive dry you can find, and will save you money on vet bills in the long run. You can free-feed wet food also, by freezing or adding water. Or you can do feeding times if they're all good eaters of wet food. I know how much I paid for Taste of the Wild, and it actually works out to be less money to feed low carb Friskies in the big cans than that. I fed the grain-free flavors of Fancy Feast but I recently switched to the 13.5 oz cans of EVO grain free wet food because it was cheaper and the food is better quality. Take a look at the cat food nutrition charts: http://www.felinediabetes.com/diabetic-cat-diets.htm. Pick anything under 10% carbs, but I prefer less than 6% because Bandit is very carb sensitive.

When you switch the food, and this is very important, you must reduce his insulin dose to 1u or 1.5u and start over. The diet change can almost immediately lower is BG by 100-300 points.

I work 60 hours a week and I'm in grad school, so I know how hard it can be to get tests. With glargine, you need to get at least three numbers every day--the AM pre-shot, the PM pre-shot, and a test 6 hours after the shot in either cycle. I used to test, go to work, test when I got home, and then test 6 hours after the PM shot. And I would do a curve on the weekend. The reason you need that test 6 hours in is because glargine dosing is determined by the when the insulin peaks, not the pre-shot. If you don't get that number, you have no idea if you are giving too much or too little insulin, because too much insulin will keep his numbers high as well (his body dumps glucose in his system to compensate for the high dose.

I hope you'll set up a spreadsheet and post in the Lantus (glargine) group! There are dosing experts there that have brought nearly 200 cats (including my own) into remission since 2008. Good luck!
 
Hello there!

I am new to the board too! Before Willy and I found our way here, we were having a really hard time with Willy's BG's and it seemed like every vet we went to had different advice and a different treatment plan and they just weren't producing the results we hoped for. I can tell you from experience, most vets have a difficult time giving advice about FD. They have an idea of how treatment should go but every cat is different. They have to know so much about many types of animals, it's really hard for them to know the best treatment for each animal in every single situation.

The people here live this disease every day and are very eager to provide you with information that you can look over yourself or discuss with your vet. My current vet is a very knowledgeable woman, but she didn't seem to take me seriously with what I thought and wanted to try. Today I brought her a copy of Willy's spreadsheet and a copy of the Lantus (glargine) dosing protocol I have been following (thanks to the wonderful people here) and we discussed it. For the first time since Willy's diagnosis, I feel like I have someone on my team! She was super eager to read over the information I brought her and her attitude was completely different.

Since we've joined the forums, we have gotten Willy's BG from 300-400 range down to the 100-200 range thanks to the help of the amazing people here. We are on a (pretty) high dose, currently 5.25u BID. We will most likely be increasing still. There ARE cats that are on a higher dose (even than us) in the Lantus forum but most seem like they don't need such a high dose. I am not sure about your situation and I am far from an expert... are you regularly home testing? what food are you feeding? where on the cat are you giving your shots? how did you arrive at your dose and how often have you been increasing? is there any other conditions your kitty has (including needing dental)?

There is a lot of information and resources available on the Lantus forum about dosing, Lantus (and how it works), handling Lantus properly (I was doing everything wrong!), syringes, etc. There are also many knowledgeable people there that can answer your questions and help you with dosing suggestions and information. I really encourage you to Set up a spreadsheet and Set up a profile.

I hope to see you over in lantus land!!

Stephanie&Willy

I forgot to add, the spreadsheet has been an extremely valuable tool for us. I cannot stress enough how helpful it really is!
 
EVO dry food is the lowest carb available at 8%.

I used it during a very long transition to all canned food

All my cats now have the low carb canned food available 24 hours per day. The "civilians" aka non-diabetics get some EVO dry for treats sometimes.
 
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