Update on Norton - difficulty with BG control

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sbnadell

sbnadell

Member Since 2013
Hi all. It has been a while since I posted an update on Norton. I think the last time I posted we were able to manage his diabetes with food alone and periodic BG home testing. Last August (2014) his BG started to increase, and we started him on Lantus. His vet started him on low doses, initially 1.0 unit once a day, then eventually 1 unit twice a day. Based on his BG tests and drinking habits, we worked with the vet to modify the insulin dosage, but it did not go above 1.5 units for many months (and was at times as low as 0.5 unit). His BG's fluctuated in the mid-100's-mid-200's at shot time and in the low-100's or occasionally below (80-90's) at nadir. He tends to be lower at his evening shot time, so for a number of months we were giving him 1.0 unit in the morning and 0.5 in the evening.

In September 2014 he had a few seizures, not diabetic related, and was diagnosed with primary epilepsy and we started giving him Zonisamide once a day. After a few months we settled on the correct dosage for that, and he has not had a seizure since late November 2014. So that is good.

Back to his diabetes - after many months of stability, in March his BG shot up into the 300's, even at mid day. It did not seem like the Lantus was doing much at all. We started to slowly increase the dosage, working with his vet, eventually up to 3.0 units twice a day in June. We bundled him in his thunder shirt and took him to the vet in May for a Frustosamine, which was 475. We also replaced his insulin with a new bottle in May; the one we were using was ~3 months old. I was out of town for a week in June, so we missed a weekly BG check; when I came back and we tested him his BG was down to 76. We tested him over the following few days and he did not get a shot until his BG was back up over 150 (per discussion with vet) at then at a much lower dose. This was end of June/beg of July. We brought his insulin dose back down, and since then his BG has been up and down, we are on the phone with the vet weekly to discuss his latest BG results and what to do with the insulin. It seems that we cannot get back to a stable dose.

During all of this his weight has stayed fairly stable at ~15.3 lbs, plus or minus a few tenths of a pound. His appetite is a little up and down. He will eat fine for a couple of weeks then decide he doesn't want anything for a meal or two, which means no shot and probably just messes things up further. He has been drinking a lot and urinating more than normal for many weeks as we try to get his insulin dose at a good level. I think we are probably at the point where we need to bundle him up again and take him to the vet so they can check to see if he has a urinary tract infection. We have not been able to work out getting a urine sample from him at home.

Right now we are giving him 1.5 units twice a day. We tested him this weekend after a two week hiatus because I was out of town again. Yesterday morning at shot time his BG was 243. Today at nadir it was 350. He was half asleep this afternoon, so I don't think stress drove his BG up. His insulin bottle is again nearly 3 months old, so I think we should get another, but I don't know if that really makes a difference.

This is very frustrating. After the last time he stopped eating, we could only get him to eat by cutting out the lowest carb portion of his wet food (I was mixing very low carb Fancy Feast chicken classic with Fancy Feast grilled chicken which is ~13% carb), so now he is eating more carbs. But it was the only way to get him to eat. We actually had to even put a little of his rescue high-carb food on top of the FF grilled chicken for a couple of meals. We tried other flavors and brands, but he has no interest in anything else. We also give him a little EVO dry food, but he gets most of his calories from the Fancy Feast.

Sorry for the long post, but there was a lot to catch up on. If anyone has any advice or thoughts, I would appreciate it. I have a call into his vet who will call me back tomorrow. I just wish we could get him to a stable place again.

Thanks-
Shari & Norton
 
Sorry if this comes across as rude (I really don't mean it to) but there's really no way you're going to get Norton regulated with weekly blood glucose testing at the vets. Insulin is a hormone that waxes and wanes and the only way to get the right dose "dialed in" is to home test several times a day.

Has your vet ever discussed home testing with you? (would be surprised if the answer was Yes since most don't)

You can just get a human glucometer (WalMart's Relion Confirm or Micro are the meters a lot of us here use) and we'll teach you everything you need to know about home testing if this is something you're willing to learn to do!

Kitties insulin needs can really change all the time and only by testing more often are you going to see what's really going on in Norton's body.
 
Hi. We test him at home, not at the vet. It is difficult for us to test during the week due to our work schedules, but when he gets really out of whack we test more frequently than on the weekends (such as when his BG got low, we tested him twice a day for a number of days). We both work days though, so the only time we can get a mid-day reading is on the weekend. He also is not tolerant of BG testing to the point of testing him multiple times a day every day. So we do what we can.

We keep close contact with the vet and report in all of the BG data to we get at home. The vet really appreciates that we can test him at home. Norton is very afraid of the vet, hence the thunder shirt, which helps but we still try to avoid taking him there as much as possible.

One of the things we have discussed with the vet is that it can take up to a week for Norton to fully adjust to a change in dosage. I know a number of people do what you suggest and test multiple times a day and adjust dosage each shot. Is there an adjustment period to a dose, or not really?

Thanks-
Shari & Norton
 
We don't adjust Lantus dosing that often either....depending on the protocol you use, we either hold the dose for 6 cycles (Tight Regulation) or for one week (Start Low, Go Slow)

With any insulin, it's always important to get tests in before each shot so you know you're not shooting a number that's too low. We do have people who work full time and still do TR, but SLGS might work better for you if you can't get the mid-cycles in ....but either way, it's important to get tests on the PM cycle (at least a "before bed" test) since most cats go lower at night so if you need to, you can set an alarm for more tests later.

On SLGS, you also do a curve on your days off (every 2 hours for 12 hours or every 3 hours for 18 hours) and that can tell a lot about what's going on with Norton and his dose

We totally understand some cats aren't as easy to test as others, but most of them learn to like it (really!)....or at least tolerate it. Seems that they just don't like having their ears fooled with, so the best thing you can do is just rub their ears as often as possible and find some yummy low carb treat that they can't resist....soon they learn to associate their ears being touched with the treat and most of them will start coming to their "testing spot" when you call them...and some will even come when they hear you getting the supplies out!
 
We tested him this morning pre shot and his BG was 298. We are not both home at his dinner time during the week (it takes both of us to test him - it's a team sport). If we test him at bedtime, won't that be too soon after his evening shot to know how low he will get?

How long do you use a bottle of Lantus before replacing it? Have you found that the potency decreases after a while?

We test Norton using his pads, not his ears. It is much easier, and usually he will let us fiddle with his paws for a brief period. That is good advice though if we decide we need to switch to his ears at some point. He gets a low carb treat after testing, and also after getting his shot. Lately he's all about dried chicken.

Thanks.
 
Some folks will set an alarm in the middle of the night to check around the nadir (usually between +5 to +7 hours post shot). If you time that to be on a multiple of 45 minutes, the average time for 1 sleep cycle, it'll be easier to wake up (ex 4 hr 30 min, 6 hours, etc).
 
Well, I bundled up Norton in his thunder shirt yesterday afternoon and took him to the vet so they could get a urine sample. The vet said there was a little blood and sugar in his urine, but no ketones. She sent it to a lab for culture analysis. In the meantime, we are holding his dosage. The vet did not want to change that until we get the results from the urine culture, and since there were no keystones she feels comfortable leaving him as is. The results will be back in about a week or less.

Shari & Norton
 
Hi Shari,

Thanks for letting us know how you and Norton got on today.

I must admit I'm very curious about Norton's thunder shirt. I've never come across them before. How do they work?

.
 
sbnadell said:
If we test him at bedtime, won't that be too soon after his evening shot to know how low he will get?
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It depends on how long that is....But getting a +2 (2 hours after the shot) can tell you a lot. We see it so often that it's almost a "Rule" around here (of course ECID so until you get more testing in, we won't know how accurate this is)

If the +2 is about the same as the Pre-shot test, usually it's going to be a pretty normal cycle, with the numbers gradually going down to nadir and then gradually going back up to the next Pre-shot

If the +2 is lower than the PS, that can be your "early warning" that Norton might be going lower during that cycle, so those are the cycles it's really important to get more tests in later on

If the +2 is higher than the PS, that can signal the beginning of a bounce and those are the cycles where you can usually take a break and not test as often.

sbnadell said:
How long do you use a bottle of Lantus before replacing it? Have you found that the potency decreases after a while?
Click to expand...

If it's cared for properly, we've had vials last 6 months, but the way to know for sure that it's time to replace is to watch the numbers...if they start to drift up and there's no other reason, suspect the insulin is the reason
 
Well, Norton's urine test came back negative. We got a new bottle of insulin over the weekend and started that. We tested him in Saturday (still on old bottle) - AMPS 275, +6 284 - then again on Sunday after the start of the new bottle - AMPS 255, +6 281. The vet said to give the new bottle a week or two to see if that. Ales a difference. We are still giving him 1.5 units twice a day.

He is continuing to drink an incredible amount and also urinating a lot. I have a call in to the vet and will speak with her tomorrow about increasing his dose, and also about how we would know that his kidneys are functioning ok. His appetite is good, a bit increased actually. He meowed tonight until I gave him a little extra wet food. We are worried that maybe something else is going on.

Regarding the thunder shirt - it really works great for him.
 
Oops - somehow my reply posted before I finished it. When Norton was younger, he would be ok going to the vet. But when he got older he started to get aggressive at the vet. And when he was first diagnosed by his original vet, it was terrible. Norton was so scared he was attacking the vet, who almost had to sedate him to get some blood. It was as traumatic for us as for him.

The thunder shirt turns him from a hissing, biting, clawing beast that requires Kevlar gloves to a hissing (for effect really, he needs to keep up appearances ;) semi-immobile cat that can be managed, poked, prodded to a degree, etc. The people at the vet office appreciate it as much as we do. It is the best $40 I have spent on a wardrobe item. :)

Shari & Norton
 
I realize you've had problems with getting Norton to eat any low carb foods.
Can you tell me how much food (in ounces) you normally can get him to eat per day (24 hr period)? And what kind of a feeding schedule do you have him on? Are there any other cats in your household?
 
We fed him a diet that was in total less than 10% carbs for a long time. It was a mix of two wet Fancy Feast flavors and a little Evo dry. But the last time he stopped eating I could only get him to start back by dropping one of the wet foods, so now he's eating closer to 13% carbs or thereabouts.

We feed him twice a day. Each meal he gets one small can of fancy feast grilled chicken (82 grams at 13% carbs) and 1/2 tablespoon of Evo dry. Before we leave for work (~1.5 hrs after breakfast) we leave another 1/2 T of Evo. Norton does not always eat all of the dry. Same thing for dinner, but the additional 1/2 T of Evo is before bed, after he gets his epilepsy pill. So over the course of a day, he eats 164 g FF and ~2T Evo dry.

We've tried other brands of low carb wet food and other flavors of FF. Right now (and for many months) he is stuck on grilled chicken.

We have one other cat but they are kept completely segregated. Norton's step brother, Smokey, is FIV positive and does not get along with other cats. So he lives in what was once our guest room. Norton gets the rest of the house. It is a bit of work to entertain them both separately, but it works.

Shari & Norton
 
sbnadell said:
We fed him a diet that was in total less than 10% carbs for a long time. It was a mix of two wet Fancy Feast flavors and a little Evo dry. But the last time he stopped eating I could only get him to start back by dropping one of the wet foods, so now he's eating closer to 13% carbs or thereabouts.

We've tried other brands of low carb wet food and other flavors of FF. Right now (and for many months) he is stuck on grilled chicken.
Click to expand...

Do you have Dr. Pierson's food chart? Here it is: food chart

So he's getting about 5.78 oz. FF @ 13% carbs + 1 oz EVO per day. That doesn't appear to be too much in terms of quantity, but I'd really, really encourage you to go through the food chart & try very hard to get him to eat some kind of canned that is less than 8% carbs, or even less than that. Higher carb food is simply going to make it quite difficult for you to get him regulated, period - no matter which insulin you have him on. (And I'd assume you'd rather Norton be on a lower dose of insulin than a higher one, right?)

And for all you know, his body may, in fact, be extremely carb-sensitive. For example: My cat's BG can spike amazingly if she gets even 1% to 2% more carbs than usual! She's currently on Purina DM canned (3%) + Fancy Feast Classics turkey w/giblets (4% carbs).

I'd hazard a guess that it's the 13% carb formula that's causing a lot of your difficulty at present. (Just sayin'...) There's a very wide variety of low-carb food choices on that chart, btw.

Also, would be great if you could go to the Spreadsheet link, set up a SS for Norton & plug in your home-testing numbers, insulin doses, etc.
That way, you can see his "patterns" emerging, and if a problem arises, we'll have that data to look at.:)
 
Hm, I guess we should try to get the FF chicken classic back in the mix like before. Though now that we are modifying his dose (see below) I'm a little hesitant to mess with his food at the same time. I periodically skim the food chart for other options, but Norton is a fancy feast cat, period. Well, or friskies, which is what he ate before his diagnosis.

I spoke with his vet yesterday. She recommended increasing his dose to 2 units. We are going to try to do a small BG curve this weekend as well. Small meaning 4 BG checks over a 12 hr period. It will be interesting to see if he will cooperate. The most we've done over that stretch of time is 3.

I will endeavor to make some time to create a sheet for him. :) We track everything at home in a notebook we keep on the kitchen counter.

Thanks-
Shari & Norton
 
sbnadell said:
Hm, I guess we should try to get the FF chicken classic back in the mix like before. Though now that we are modifying his dose (see below) I'm a little hesitant to mess with his food at the same time. I periodically skim the food chart for other options, but Norton is a fancy feast cat, period. Well, or friskies, which is what he ate before his diagnosis.

I spoke with his vet yesterday. She recommended increasing his dose to 2 units. We are going to try to do a small BG curve this weekend as well. Small meaning 4 BG checks over a 12 hr period. It will be interesting to see if he will cooperate. The most we've done over that stretch of time is 3.

I will endeavor to make some time to create a sheet for him. :) We track everything at home in a notebook we keep on the kitchen counter.

Thanks- Shari & Norton
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Good luck on doing your mini-curve - I'll be rooting for you! :bighug:I've actually pulled off a full curve, 6 tests over 12 hrs, with Bat-Bat (my very fractious cat) several times; helped to alternate ears & give lots of scritches under the chin.:cat:

I don't blame you for wanting to be careful about switching to even lower carb food during a dose increase. When you do start that transition, definitely do it gradually. Back in 2013 Bat-Bat was already on a couple of units of Lantus when I had to switch her from Hill's w/d (ugh, way too high) down to Purina dm (3%); What I did was find a Wellness formula that was somewhere in between the two carb levels and started with 75% Hills/25% Wellness for 3 days, then 50/50 for 2-3 days, then 25/75, and finally 100% Wellness. Then I did the same routine all over again with Wellness/Purina dm. Took some time, but also took the worry out of lower carbs making her drop too fast while on insulin!

Am so glad you'll be putting a spreadsheet together on Norton - will look forward to seeing it!:)
 
Oh, before I forget, Shari - Take a look at my signature lines above; could you go ahead and add Norton's pertinent info in a signature for your posts?
As it helps anyone who's responding to one of your posts to be able to see that kind of info at-a-glance. Thanks!:)
 
Norton was a trooper last weekend when we did his mini-curve. His parents, however, were not at the top of their game... :( We got the AMPS BG ok, but then poked the poor guy 4 times trying to get a +3 or +4. We finally gave up and waited for the +6. By then Norton was a little annoyed. He has a stuffed bear that he wrestles with. Usually he goes for the bear's "jugular"; that day he was all about biting the bear's paws! At dinner time we had to coax him out from under a kitchen chair with a real treat to get a PMPS test (freeze dried chicken just wasn't doing it). Then we topped off the day with a +3 after his PM shot. So not bad, but more poking then we (and he) had hoped for.

We are trying again today. So far 2 pokes and 2 BG readings. :D

New sig and spreadsheet link (I think it works...) below.

Shari & Norton
 
Hi, Shari - Just took a peek at Norton's SS - it works; good job! :)
Could you go in and put his insulin doses in the chart "in the U" columns @ AMPS/ PMPS? (Ex: 1.0, 2.0, 2.25, etc.) Thanks!
 
Just updated Norton's spreadsheet (it's been a couple of months - been a bit busy). The "blues" did not last long at all... we're having challenges getting him below 300 lately. We've changed his mix of wet food to add in some of the lower carb stuff; not a lot though because we did not want him to stop eating, and the vet said she'd rather have him eating a little higher carbs than not eating. We've been slowly increasing his insulin dose with vet guidance. I think we're in for another 0.5 unit increase after yesterday's numbers. His appetite has increased too, which seems a little strange to me since his BG is not low at all.

The good news, though, is that he is just a few short days away from being a whole year without an epileptic seizure. So at least something is working right!

Shari & Norton
 
sbnadell said:
I think we're in for another 0.5 unit increase after yesterday's numbers. His appetite has increased too, which seems a little strange to me since his BG is not low at all.
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As you're still dealing with #s in the 300s, it's actually not uncommon for him to behave like he's hungry all the time - that's pretty typical until the #s start coming down. I'd say just do your best in trying to get him to eat more of the low-carb food over time and less of the higher carb, until you can get him switched over to 100% low-carb, as this can make quite the difference in helping you get his BG under control. Side note: I warm Bat's FF turkey w/giblets in the microwave, then make "gravy" :blackeye: with a little water added.
 
sbnadell said:
Just updated Norton's spreadsheet (it's been a couple of months - been a bit busy). The "blues" did not last long at all... we're having challenges getting him below 300 lately. We've changed his mix of wet food to add in some of the lower carb stuff; not a lot though because we did not want him to stop eating, and the vet said she'd rather have him eating a little higher carbs than not eating. We've been slowly increasing his insulin dose with vet guidance. I think we're in for another 0.5 unit increase after yesterday's numbers. His appetite has increased too, which seems a little strange to me since his BG is not low at all.

The good news, though, is that he is just a few short days away from being a whole year without an epileptic seizure. So at least something is working right!

Shari & Norton
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Congratulations for a year without seizures, that's wonderful! :)

Robin&BB said:
I warm Bat's FF turkey w/giblets in the microwave, then make "gravy" :blackeye: with a little water added.
Click to expand...
I also warm the food and add water, seems more palatable to them.
 
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