Very high blood glucose levels in Delboy

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alison

alison

Member Since 2011
Hi. My Siamese cat Delboy who is 14 & a half has recently become diabetic again after 14 months in remission. He was first diagnosed diabetic in Sept 2011 and was injected twice daily with Glargine until early February 2012. He became diabetic again one month ago. We started on 2 units of glargine but got a couple of high readings ( 25 and 26 ) so increased his dose gradually to 3 units twice a day but still high so have given him fat threes for a week. He is eating well and doing normal things though his third eyelid is still showing so U know he isn't quite right yet. This afternoon I got a blood sample. He was 26.8. So high. I am surprised he is even walking around. I gave him a fat one unit straight away. My question is, should I start giving him a four of Glargine twice a day. He is so high on he fat threes I have even wondered if the cartridge of Glargine could be faulty! Any advice please?
From Alison in Christchurch, New Zealand.
 
Hi Alison,

So sorry to hear that Delboy has come out of remission...

I don't use the same insulin as you (Glargine/Lantus) and so can't give specific dosing advice.

Generally, the advice here - with all insulins - is to start out at one unit (or sometimes less) and then work upwards as needed. That's to ensure that the correct dose isn't missed (when cats get too much insulin their blood glucose can drop too low and then swing up high again, so if tests are only taken occasionally and high readings are found, it can seem like the cat needs more insullin when in fact they may need less).

I have a few questions for you.
How was Delboy diagnosed this time?
Had he eaten any dry food prior to his dx?
What is he eating at the moment?
Has he had any other health problems? Infection? Or has he been on steroid treatment?

Also,
Are you testing Delboy's blood glucose before each insulin shot? And what sort of readings are you getting?
And are you getting any mid-cycle tests (ie 5-7 hours after the shot) to see how low the insulin is dropping him?

My feeling is that what is needed here is more information about how this current dosage is affecting him throughout the cycle (or indeed throughout several cycles to try to build up a picture of what's happening). If it were my cat I would not be comfortable with increasing the dosage unless I had clear evidence from my blood-testing data that it was necessary.

There will be Lantus/Glargine users around a little later when the USA wakes up. ;-)

Eliz in UK
 
Hi Elizabeth. Thanks for your comments. Delboy became lethargic and was not himself ao after a couple of days we took him to our vet because we thought we could smell ketones on his breath. He was tested at the vet found to be 25 and given two units of Glargine and a general long acting anti-biotic (convenia) before going home. That night he looked very unwell and hadn't eaten so we took him to an after hours vet who tested him again. He was 7.2 but he had not eaten all day. I had given him 2 units in the evening and he was 7.2 around 11pm.but due to his overall condition he was put on a drip and given a full blood test which showed nothing significant. His readings were slightly high for kidneys but not out of the ordinary given his age - so we are not sure if he had any underlying infection. He was not on steroids. Before being diagnosed he had been eating both dry and tinned foods.He started on 2 units twice a day, we got a high reading of 25 so we have gradually increased his dose to a fat three but still got that reading today midway between his injections of 26.8.
At the moment he is eating fancy feast cans, dine, and some biscuits. We have some diabetic biscuits that he is not keen on, and other good quality biscuits.He also has fresh chicken, fresh thinly sliced beef. And canned salmon. Amything I can think of as he likes a variety.He has had readings of 25 and 26 five times. We find it quite difficult to get the blood samples so we don't have lots of readings. I am aware of them being overdosed and going too low, then swinging high to compensate, but we don't think this is happening in Delboys case.He is drinking a lot of water but he has done for a.couple of years now. I am-amazed he is actually walking around and doing normal things when he Is so high. He must be a tough little guy. All of the high readings have been taken around 6 hours since his morning injection, ie his lowest point.We will try a get a blood sample tomorrow evening before his pm injection. Thank you so much for your advice.
 
How long has your cartridge of glargine been open?

Why was an antibiotic given if there was no infection?

You might want to read this about the adverse side effects of convenia :http://www.catinfo.org/?link=convenia

2 units is a high starting dose, even for a cat coming out of remission.

How gradually did you increase the dose?
Are there any grains, fruits, or vegetables in the biscuits you feed him? All these ingredients would be high carb and not good for a diabetic cat.
Check the label on the Fancy Feast can. Are there any grains or gluten listed? (I've read from folks in Australia that the Fancy Feast is no good down under.)

You really need to be getting more tests.

My recommendations would be:
Get at least 4 tests a day - AMPS, mid day cycle, PMPS, before you go to bed.
Set up a spreadsheet so folks here can see what is going on.
Increase only by 0.25U at a time. You may have missed a good dose.
Be aggressive on the dose increases, every 3-4 days if needed.
Monitor for ketones daily with Urine dip sticks, found at your local pharmacy/chemists.
Directions for spreadsheet set up here: http://www.felinediabetes.com/FDMB/viewtopic.php?f=6&t=18207

Too much insulin can cause high readings as well as too little insulin.
 
Hi Deb and Wink
The Glargine was opened on the 8 May at the vet when his diabetes was diagnosed again, and has been refrigerated since.
He was given an injection of convenia because the vet said there is often an underlying infection with diabetes. I had never heard of any adverse effects with it so I didn't query his use of it. I read the link you gave me about it.Scary.
His dose has been increased very gradually by a drop at a time. We only increased it when we kept getting readings of 25 and 26 They were all taken midday between his injections except one which was taken in the evening right before his injection? it was 25.6. That morning he had been given a skinny 2. So we gradually increased his dose and at fat threes we are still getting readings of 25 and 26. So this morning I gave him a 4. Am watching him closely and so far he is good. Eating well and going outside etc.
I will read the ingredients on the back of his biscuits and canned food. I buy the best I can find that he will actually eat. He has lost a bit of weight. I leave his diabetic biscuits down for him but I don't think he likes them much. I also have 2 other cats and the neighbours 2 young cats have learnt to use our cat door and I have caught them eating his biscuits.
We will try and get more readings.I really do feel we have increased his dose gradually. Thank you for your advice. I wil keep you informed of his progress.
Alison and Delboy.
 
We'd love to see you use our standard format spreadsheet and link it into your signature. This is a good way to track the dose and the BG numbers. Instructions on setup are here: http://www.felinediabetes.com/FDMB/viewtopic.php?f=6&t=18207 There are people here that can help you with the setup. Just ask.

Would you post a list of his foods? The manufacturer, food name and style (pate, mince, etc.) and I'll try to do some research and find out the ingredients are and try to determine the carb content on the foods you are feeding. We like a carb content of <10%.

I'd like to take a closer look at the food to see if this could be an issue.
 
The food is a big factor in this. You might want to try a switch to a low carb food. I am thinking foods in NZ might be the same as in Oz.. here is some info

GraceAndAngie wrote:
Wet cat food for Australians

The list below was posted to me by Vyktor's Mum, another Australian who has helped me a lot. That little list is the best guide I've found for Australians. I've also found cat food fresh mince, available near the meat section in the supermarket. That doesn't have any vegetable products in it. A lot of people talk about food spread sheets and lists here (Binky's Page is one of them) but they're not relevant to us because the food is different. Americans use Fancy Feast a lot but this isn't any good in Australia as it has grains in it.

suitable food is whiskas LOAF VARIETIES ONLY, natures gift, ultimates (except for the one with rice), the premium woolworths select and ziwi peak (this ones expensive but probably the most appropriate canned food for cats in existence). you want to avoid giving fish varieties more than a couple of times a week.


The mince and casserole Whiskers tins are high carb because the gravy has flour in it. The loaf varieties ("jellymeat", "loaf with chicken and beef", "loaf with lamb and kidney" and "loaf with chicken and turkey" and the fish ones) are the only low carb Whiskers.

The two cheapest options are the whiskers loaf tins and the cat food mince.

People talk about Ziwi Peak as being very good quality - I've never bought it. I can't tell you about Nature's Gifts, Ultimates or Premium Woolworths Select as I've never bought them either. The cat mince that I was buying seemed better quality than Whiskers as it didn't have as much jelly in it and it was all recognisably meat.
Click to expand...


Wendy
 
Hi Deb and Wink
Thanks for your advice again.
We will try and set up the spreadsheet. I don't think his food is a particular issue because ate the same food last time he had diabetes ( he had it for 4 and a half months ). It took a while but we eventually got his dose right and he did well. Eyes looked goog, he gained weight, and had energy etc. He ended up being on 3's and then 2's, as we monitored him and he gradually needed less as I think he began to make his own insulin again.
I have more readings. Yesterday am I gave him an exact 4. He was eating normally. Got a blood sample in the afternoon halfway between his injections. He was 25.9. Walking a bit slowly. Drinking quite a bit of water.
Got another reading just before his evening injection. Was Hi. Not even a number. Hated seeing that. But he seemed ok even though he was that high. Gave him an exact 4 straight away. Checked him in the middle of the night. He was fine. Sunday morning. Just got a blood sample a short time ago before his injection and before he had breakfast. It was 21.5. I know it's still high but it's the lowest reading we have had apart from a 7.2 at the after hours vet when he hadn't eaten all day. So I gave him a 4,again and will get another reading at his lowest pointing again and this evening
. I find the warm wheat bag on his ear very helpful in getting the blood sample.
I will pay more attention to his food and avoid the ones with gravy because of the flour content, but he has always liked licking the gravy.
 
Hi Wendy and Tiggy
Thanks so much for your detailed list of good food. Of all the ones you mentioned, I have only seen the whiskas loaf variety here and even then there are not so many flavours. But we do have loaf varieties. however Delboy is not so keen on them. He is very fond of licking gravy. However, I will get him mince more often, both the cat food mince plus normal mince which he seems to like sometimes. I will definitely try to avoid the gravy ones now I know the flour content would not be good for him
I will also give him fresh shredded chicken, and other fresh meat like schnitzel, and maybe lambs kidney in small portions. He is a fussy eater and tends to want to snack all day on very small-amounts rather than having 2 pr 3 normal sized meals a day.
I will check the small fancy feast cans carefully and avoid the gravy ones. Luckily they do quite a few in the classic style without the gravy. He only eats a couple of teaspoons at once, but lots of snacks throughout the day.
I am hopeful his dose of a 4 will soon kick in and his levels drop significantly.

Deb and Wink - you asked for a list of the food he has been eating.
They are Fancy Feast Salmon Feast in Gravy, Whiskas Chicken, Lamb and Veg, Whiskas Duck and Liver Casserole, Whiskas Chicken and Turkey Mince, Whiskas Simply Steamed Chicken in Sauce, Whiskas Simply Steamed Beef in Sauce,
Purina One Complete Cat Chow Biscuits, Temptations Biscuits all Flavours but he doesn't eat many of those.
I always leave down foer him Hills Science Diet Diabetic Biscuits bu he hardly eats any, so I now mix them with ones he does eat so at least he gets some. Wiith Delboy I am ususally just so relieved to see him eat anything because he has walked away from all food in the past with his diabetes on some days and my heart just
sinks with the worry of it all.
Thank you for your advice and concern. This website is such a lifeline and a comfort to me.
From Alison and Delboy.
 
The most important point with food and a diabetic kitty is that you get Delboy to eat enough. If he is being picky, give him something he likes. The insulin dosage can be worked around any food or other medical issues.

We want to get him on the best diet possible for helping to treat his diabetes, but that can take time. Make the changes as long as Delboy accepts the change.

One trick you can try with Delboy, is to mix the gravy style food in with a bit of the loaf varieties. Slowly and gradually, decrease the amount of the gravy food and increase the amount of the loaf type food. I would suggest starting with 1 teaspoon of the food he doesn't like as well.

You may be able to transition to the loaf foods in a week. It may take weeks. You may need to backtrack in how much of the two foods you are mixing together and gradually make the change again. Every cat is different.

What we do not want to ever see happen is an infection (possibly hidden), not enough insulin, not enough food. This is the road to Diabetic ketoacidosis (DKA), a very dangerous, life threatening and expensive side effect of these three conditions. Ketone testing can help catch rising ketone levels that lead to DKA.

The Fancy Feast Salmon Feast in Gravy looks like 17% carb. Too high for a diabetic cat.
No data available on the Whiskas foods because that company refused to provide typical nutrient analysis. Look for any grains or gluten in the food. This is usually an indication that the carb content will be too high.
The Temptations biscuits (what we would call treats) are also high carb. Any food that is pure protein, no spices would be better for Delboy than the Temptations biscuits.
The Hill's Science Diet Diabetic Biscuits look like they have a lot of different grains as their main ingredients. Probably too high carb for a diabetic cat.

Ingredients can be so different, depending on where you live in the world it is hard to tell if the same ingredients are in your foods in New Zealand as in the USA.

This is the best information I could get for you on the foods with the resources we use. Hope this helps.
 
Good for you on creating the spreadsheet. That was step one. I can access the spreadsheet but we want you to attach it to your signature.

That way, it will appear in every post you do and you won't have to keep putting the link in every time. One shot deal to get the SS there every time. So follow these directions.

B. Publishing your SS, aka Attaching to signature (directions by Squeem3)

1) In a new browser tab, open up your google doc
2) Click on "FILE" in the toolbar and then choose "publish to the web"

Image
3) MAKE SURE that "automatically republish when changes are made" has a check mark next to it.

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4) click on "start publishing" button.
5) if a box saying "Are you sure you want to publish this document?" appears, click OK.
6) Copy the link in the DOCUMENT LINK box. (CTRL + C or CMD + C)

7) For a simple text link, like http://spreadsheets.google.com/pub?key= ... utput=html, replace the words "link here" in the following code with the link to YOUR spreadsheet: link here

It will look like this:
Code: Select allhttp://spreadsheets.google.com/pub?key=p4nuph4W6EFUSqZA10igCfg&output=html

(go to #8 below)

7) If you would like a "word" link, such as Cosmo's SS, use the following code: text. replace "link" with your spreadsheet URL, and replace 'text' with the name of your spreadsheet.

it will look like this
Code: Select allCosmo's SS

8) Go to the "User Control Panel" at the top of this page, and go to profile tab. In the edit signature tab, paste the code you created (control v or command v) and save it.


If you have questions, post a new topic in the TECH forum and ask away! Someone will help!
Click to expand...
 
The gravy foods could well be causing the issue. With a diabetic cat you want the % carbs to be less than 10% and most , if not all. of the foods you are giving him are too high carb. Saying that though you need him to eat, so perhaps try and gradually transition him more and more to the pates. here are tips for moving them from dry to wet, but perhaps you can use the same theory for changing wet types:

http://www.catinfo.org/docs/TipsForTransitioning1-14-11.pdf

I heard the "Chef" loaf style or classic pouches are good too. And the tins of Dine. But it looks like your best option is the fancy feast classic.

Wendy
 
Great job on the SS.. are you going to try and tweak his foods to see if you can find something more low carb? Havent seen any update to the SS for a few days and was wondering how Delboy was doing..
 
Thank you for your advice re Delboy's food, Deb and Wink.

Got a reading today at 5.30pm. I chose that time because that was when I got his best reading of 17.4 on Friday. He was 23.2. I was so disappointed it had gone higher. His food has been pretty good lately. Today he had fresh mince and fresh cooked chicken and a few high protein biscuits, but not many. He has had no gravy foods today. So I don't think it's his food. Last time he had diabetes he had the same mix of food and didn't need these higher doses. I just think his diabetes is more difficult to treat this time. So now I guess I will keep him on the dose of 8 for a few more days, though I really feel like giving him a 9. He seems pretty good even though he was 23.2. I don't know how long it takes for his 8's to show in his readings. Glargine is a gentle long acting insulin and maybe it is still kicking in?
At least he seems good, no more wobbles as we have sometimes seem in the past, and he seems happy and doing normal things. Will keep you posted.
Alison and Delboy ( who is proving to be a tough little nut to crack ).
 
Have you any idea why he came out of remission? Is there any sign of infection ie UTI, teeth problems, ear infection? Or did he get steroids or something?

I do think its harder and you need to be more aggressive to get a cat back into remission, if its even possible a second time around. However I think you have been increasing the dose by too much and by too fast so that you may have missed the ideal dose and are not giving the new insulin dose a chance to settle before increasing. Glargine is a depot insulin which means a new dose takes 3 days to build up in the cats system. If you increase before that happens you never get to see if that dose worked and can skip past the good dose, and cause bouncing. We normally only increase by 0.25units every three days. And I do think Del Boy is bouncing.

Also we increase based on the nadir, or lowest point of the day. It tends to be around 5-7 hours after the shot but it varies immensely depending on the cat, and the day. My Tiggys nadirs are all over the place and quite often tend to be at preshot time!!

So here are my recommendations

1. Drop the dose back to 2 units where you were actually seeing blues. (I know it sounds scary and you want to see results now but I don't think your current strategy is working and you missed the ideal dose so he now is bouncing as his insulin is too high)
2. Start getting a few extra tests. This is key!!!! It's a good best practice to always get a preshot test, morning and night because the worst thing you can do is shoot when Del Boy is low and give him a hypo. Also get a test around mid day, and another before bed. These test will be vital in deciding dose change. Occasional spot checks at other times if u can.
3. Wait three days (unless you see a drop under 50) and try to be patient. Then increase if need be. We can help advise on that if you are strict about following #2 above

I don't think Del Boy is a tough nut, I just think another tactic is needed here.
Wendy
 
When you write "high protein biscuits", you mean dry food, right?

Given that the body is always changing, what worked before may not work now. Check the ingredient list for wheat, corn, rice, potatoes, peas, and other starches. If those are in there, you may find dropping the biscuits helps the glucose level. Just 1 or 2 pellets of dry food sends some cats glucose levels skyward.

A substitute for any kind of biscuit or kibble treat is freeze dried meat, poultry, or fish. You may find that in a large pet store or online. The dog sized version may be more economical, although you will need to break it into pieces - make sure it is only a freeze dried protein and nothing else.
 
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