What to try next...

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aurora72

Member Since 2018
Hi all,
I keep coming across this site when googling things to do with feline diabetes so thought it was about time I joined and asked for help...
Our 15 year old cat Delphine was diagnosed with diabetes last year - around September I think. She's on ProZinc and is now on 6 units twice a day, which seems a very high dose? It has gradually crept up over that time. She does seem to be responding to the insulin a bit in that her weight has increased again (she loves her food anyway, but was ravenous all the time and lost a lot of weight) but her blood glucose levels are still really high and don't seem to be improving at the higher dose. We seem to be in constant contact with the vets and they've been really good so far, but I don't feel like what we're doing is working so I was after a bit of advice about what to try next really... I've read about bouncing and that her dose might possibly be too high, but we did a few spot checks yesterday evening and there was no real nadir in her cycle. I feel like I'm out of my depth with all this...
Any help would be appreciated!
 
6 units is high and some cats need that much, but to be sure you need to be hometesting daily and it helps to record the data in our spreadsheet so we can see what’s going on. Here are the instructions to set it up. If you need help setting it up, just ask and someone will do it for you
http://www.felinediabetes.com/FDMB/threads/fdmb-spreadsheet-instructions.130337/
Also what are you feeding. Some vet prescribed diets are actually too high in carbs for our sweet kitties and can result in needing a higher insulin dose.
 
Welcome! I'm glad you've finally come here for help. :) Starting a structured blood glucose testing routine at home and logging your numbers in the spreadsheet will give us the data we need to help you. I resisted doing things the FDMB way for many months after my guy's diagnosis. I like my vet a lot but the usual advice of "try dose x for a week then do a curve" got me nowhere. It was only when I came here and started testing the way it's recommended to do it and logging BG numbers in the spreadsheet that I learned why I had zero success following my vet's instructions.

Here's a handout I made up for new members. It looks overwhelming so read it over a few times and ask a lot of questions. I guarantee this is the way to get Delphine under better control.
______________________________________________________________________________________________

It would help us if you set up your signature (light grey text under a post). Here's how:
  • click on your name in the upper right corner of this page
  • click on "signature" in the men that drops down
  • type the following in the box that opens: kitty's name/age/date of diabetes diagnosis/insulin you're using /glucose meter you're using/what he eats/any other meds or health issues he has.
Another thing that will help us help you now that you've started BG testing at home is to set up a spreadsheet like the one we use here. We can all see it and look at it before offering advice: http://www.felinediabetes.com/FDMB/threads/fdmb-spreadsheet-instructions.130337/

.................................................................................................................................................................................................................................

Here's the basic testing routine we recommend:
  1. test every day AM and PM before feeding and injecting (no food at least 2 hours before) to see if the planned dose is safe
  2. test at least once near mid cycle or at bedtime daily to see how low the BG goes
  3. do extra tests on days off to fill in the response picture
  4. if indicated by consistently high numbers on your spreadsheet, increase the dose by no more than 0.25 u at a time so you don't accidentally go right past a good dose
  5. post here for advice whenever you're confused or unsure of what to do.
.................................................................................................................................................................................................................................

Here's an explanation of what we call "bouncing". It explains why a kitty's BG can go from low to sky high:
  1. BG goes low OR lower than usual OR drops too quickly.
  2. Kitty's body panics and thinks there's danger (OMG! My BG is too low!).
  3. Complex physiologic processes take glycogen stored in the liver (I think of it as "bounce fuel"), convert it to glucose and dump it into the bloodstream to counteract the perceived dangerously low BG.
  4. These processes go into overdrive in kitties who are bounce prone and keep the BG propped up varying lengths of time (AKA bouncing).
  5. Bounce prone kitty repeats this until his body learns that healthy low numbers are safe. Some kitties are slow learners.
  6. Too high a dose of insulin can keep them bouncing over and over until the " bounce fuel" runs out and they crash - ie., have a hypo episode. That's why we worry so much about kitties that have had too high a starting dose prescribed by the vet and the owner isn't home testing.
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Here are some tips on how to do urine ketone testing (VERY important if BG is high and kitty isn't eating well!):
  • put the end of the test strip right in his urine stream as he's peeing
  • slip a shallow, long handled spoon under his backside to catch a little pee - you don't need much
  • put a double layer of plastic wrap over his favourite part of the litter box and poke some depressions in it too catch pee.
Most test strips have to be dipped and allowed to develop for 15 seconds before viewing the colour change in very good light.
 
Well this is the thing, and I realise it makes it hard for anyone to give advice really :( There are a couple of things - we had a baby in July and so it's all been a lot going on, and my husband has been taking care of all the diabetes stuff while I've been looking after a velcro baby. I'm really not good with injections etc but he's out at work all day. so we don't get to regularly check - we can start doing it at weekends though. The other thing is that she was a rescue cat and was so nervous when we got her - she gets really stressed in certain situations and so we obviously don't want to cause her even more unnecessary stress. She's a difficult kitty!

Symptoms at the moment are:
weight still not where it should be
Weeing outside the litter tray
Walking on front hocks - this is very recent and intermittent
High BG

The vet recently did another blood test which came back with possible pancreatitis and she now has antacids to help with that.

We thought she was doing ok but then decided to check levels yesterday and got a shock that they were so high :(
 
Lots of useful info here: http://www.felinediabetes.com/FDMB/threads/hometesting-links-and-tips.287/

You have a lot on your plate with a baby, etc. What we recommend looks very onerous and time consuming from the outside but it really does become routine quickly. The whole test, feed, inject process can take as little as 10-15 minutes. Once you're practiced at testing (and kitty has learned to be more cooperative) a test can take less than a minute.
 
Hi there & welcome. When I first saw this forum; really couldn’t believe how many people were dealing with diabetic kitties. And how to help them! Of course I was overwhelmed- I didn’t know if I was capable & I had a fighting mad cat at first! That was in August 17. Now it’s sooo much easier! In no time you will understand the way this works & how your can can be acclimated. Ask all the questions you need & everyone is here to help! Kris & Sharon has given you a starting point & are both very knowledgeable. Kris has helped so many of us with dosing. Good luck to you.
 
Thanks so much for replies - I'll try to make sure we at least do a pre-insulin reading and one before bed (which should be mid-pm cycle), then a full curve at the weekend.
I've put in the few readings we've already taken into the spreadsheet -do you recommend sticking with 6u or dropping right back down to 1u and starting again?
 
aurora72 said:
Thanks so much for replies - I'll try to make sure we at least do a pre-insulin reading and one before bed (which should be mid-pm cycle), then a full curve at the weekend.
I've put in the few readings we've already taken into the spreadsheet -do you recommend sticking with 6u or dropping right back down to 1u and starting again?
Click to expand...
Thanks for this! I wouldn't drop any lower than 4 u right now. It might be too high a dose but we can't be certain just yet. The 6 u is very likely too high. What does your kitty eat? The best diet is wet low carb food. Many people feed Friskies or Fancy Feast pates (below 10% carbs which is what you want). With very few exceptions, dry food, including that sold as a diabetic diet by vets, is too high in carbs. If she eats kibble, don't change that until you try a 4 u dose for a few days and work at getting the data from the basic testing routine.

Switching to an all wet low carb diet can have a significant effect on BG. She could drop too low if you switch while she's at 4 u.
 
I would recommend testing ketones daily until glucose is under control. It is done with urine dip sticks you can buy in any pharmacy over the counter.

There are several ways to catch urine. 1. Holding a ladle under cat when they go (impossible for me). 2. Put plastic wrap on top of litter and make a small well in it (my cat is a digger so this didn't work). 3. If your lucky cat will go in an empty clean box. 4. Put lentil beans (rinsed off) in a clean box. Not a lot but enough if you kitty likes to scratch (works great for us). Dip the stick, match the colors. Anything over trace you should contact your vet.

Start training Delphine to a routine. Same time, same spot every time for testing. Rub and play with ears then give a low carb treat afterwards. She will start associating the yummy treat with her ears being touched. Turn beep off on the meter. If using Lancet device, click it during ear rub so she gets use to the sound. Then after a few times you get the actual test, rub ear, give treat. Voila Delphine will cooperate. Smokey never had to be trained, he just sat and loved the attention. Olive (current kitty took 2 1/2 days to train). Occasionally gives me hard time, she just wants her head and ears rubbed, doesn't like it when I stop to actually poke her.
 
We're in the UK and I can't find those low carb cat foods available here - I'll try and find an equivalent. At the moment she's on the diabetic food the vet told us to get (https://www.hillspet.com/cat-food/pd-md-feline-canned) , which we gradually introduced by mixing with her usual food, Felix As Good As It Looks (https://www.purina.co.uk/cat/felix/cat-food/as-good-as-it-looks) which actually seems to have a lower carb content than the diabetic one. We did make that transition recently, so is it worth switching back gradually to the Felix to see if that improves things?
She does have dry food but we've really been trying to limit the amount she has - that's a mix of iams and the dry diabetic one.

I've ordered some ketone test strips so we can check that - she has had blood and urine tests done recently at the vets so I'm hoping she's clear.

It does feel like she's not doing too well at the moment, she's just not herself... which is frustrating because it really felt like things were improving for a while :(
 
aurora72 said:
We're in the UK and I can't find those low carb cat foods available here - I'll try and find an equivalent. At the moment she's on the diabetic food the vet told us to get (https://www.hillspet.com/cat-food/pd-md-feline-canned) , which we gradually introduced by mixing with her usual food, Felix As Good As It Looks (https://www.purina.co.uk/cat/felix/cat-food/as-good-as-it-looks) which actually seems to have a lower carb content than the diabetic one. We did make that transition recently, so is it worth switching back gradually to the Felix to see if that improves things?
She does have dry food but we've really been trying to limit the amount she has - that's a mix of iams and the dry diabetic one.

I've ordered some ketone test strips so we can check that - she has had blood and urine tests done recently at the vets so I'm hoping she's clear.

It does feel like she's not doing too well at the moment, she's just not herself... which is frustrating because it really felt like things were improving for a while :(
Click to expand...
Definitly don't give her the iams dry... That one is REALLY high in carb. It's like cookies for cats. Even the perscription one is 14% which is more than she should have.

Great job getting the spreadsheet going! If you are committed to doing more testing we can surely help with dosing advice.

Congrats on the new baby!
 
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