At what point do I suspect cat has too much insulin? AMPS 400

I need some guidance re: overdosing.

To summarize, we increased Fay's insulin at a rate of just about 1U/week over the first month she was diagnosed, sometimes longer, as we were seeing no dip in numbers. I should have kept a better log....initially I think there were some 1/2U increases, but as she continued to not respond and I was waiting a full week with number still consistently over 400, we on average went up a full unit/week--sometimes the time frame was longer.

Some of you will say this was too fast, that I should have increased by 0.5U (per protocol found here) because her nadirs were continually over 300.

Early this week, I started finally seeing some movement in her BS--this was around 4U, twice a day....by which I mean finally seeing nadirs dip into the 200s, yippee! However, she persisted in the >200, <300 nadirs for nearly five days, so last night we went to 4.75U (roughly--I don't find the syringes with the half measurements helpful in the slightest, and even on a 1/2U syringe you are STILL eyeballing 0.25U).

Regardless, today her AMPS is 400. Her shot this morning will be 4.75U.

I guess we will press on in this way for a while, but I'd like to hear from some folks who have experienced skipping over their "ideal dose" and how they handled it--e.g. at one point did you back off? Did you go down in 1/2U increments or more (for example, we know she is still high at 4.5U, so if I went back down, would I even bother to hit this dose again?). I'm not 100% convinced that's happening for her, but I would appreciate any insight.

We were seeing some strong changes with the pu/pd, but last night the litterbox was fairly full.

Thanks in advance

Best,
Alex (and Fay =^-^=)

 

If you want to test the theory, at some point you drop the insulin to about 0.5-1.0 units ... and test for ketones like crazy and monitor the soft signs of food and water intake, urination, and dehydration (see my signature link Secondary Monitoring Tools).

Urine ketone testing works; blood ketone testing would be more accurate (ex. Nova Max) albeit the strips are pricey.

Only do it if you are able to be vigilant monitoring; it is also possible that your cat really does need the higher dose, so you'd want to be able to get back to that quickly if needed.

 

Welcome to LantusLand!

Initially, when beginning Lantus, the protocol is to start with 1u, and then increase by 0.25 units, or even 0.50 units every 6-10 cycles (3-5 days). That's ONLY IF there aren't any other underlying issues with the kitty. IF there are other issues, and the #s are still high, then the dose amount would be over 0.50u, and I would suggest asking for dosing advice for a while before doing that until you're comfortable enough to so on your own.

In your case, and since you've just joined, it'll take some time for Fay to start showing better #s, especially since you've just switched her over to a low carb, high protein diet. I would recommend transitioning her to the wet food diet slowly, though. Newly diagnosed kitties take time to respond to treatment. It also takes time to build the shed under the skin. I would suggest staying with the 4.75u for about another 3-4 cycles (perhaps a day longer if you need to) to see what happens. Also, with each new dose, you will see bouncing which means that the kitty's body is getting used to the extra amount of insulin. Eventually, the bounce will clear (usually takes a day, or 2, or perhaps 3 depending on the kitty), and then you can make another dose adjustment accordingly.

And like BJM suggested, test often for ketones, especially when #s are this high, until you can get her #s lower. Then, you can test less at a later time.

I know it's frustrating, and believe me when I say this, we've ALL been there in the beginning. Eventually, you'll hit the right dose, and she'll give you great #s. It simply takes time.. How much time is dependent upon Fay. She will tell you what she needs, and by looking at the #s, she'll be needing more insulin for a bit yet. Simply follow the protocol, and you'll both get there.

Good luck, and again, welcome!

 

Hi Alex, Welcome to L&L,
Feline diabetes is what we call a "marathon", not a sprint. Everything benefits from studied, gradual changes in dosing. Food plays a big role. I would suggest that you try to fill in the gaps on Fay's spreadsheet so that the folks here can get a better picture of how she is doing. In particular you need to get more tests in the middle of the 12-hour cycle. The nadir often falls there. Dosing changes are not made solely on the number you obtain at pre-shot times (AMPS and PMPS). If you read the "stickies" at the top of the L&L Forum, you will get a better ideal of how to proceed. The discussion of feline nutrition is excellent. If Fay currently eats dry food, you should begin a transition to low-carb, canned food. The food charts prepared by Dr. Lisa Pierson will help you find low-carb choices (see the "New to the Group" sticky).

Now, to your question about raising the dose by 1 unit every week because you are not seeing any lower numbers. If you read the protocol in the "stickies' (either the Tight Regulation Protocol or the Start Low go Slow Protocol) you will see the "guidelines" for raising and lowering the dose. Whichever protocol you decide to try, it is important to realize that Lantus is a "depot" insulin that keeps a "storage shed" of itself in the cat's body to help to even out the cycles and to keep the cat from violent bounces and crashes. This shed needs to be built when you begin to use Lantus. It takes about a week to build the shed, therefore much of the Lantus you are injecting during the first week will go into building the shed and will not be immediately available to work on the cat's blood glucose. Furthermore, every time you change the dose, the shed needs to re-calibrate itself to the new dose. This process takes a few cycles.
With all of this in mind, you can see that your raising the dose by a whole unit every week was not the way to proceed!! Please read the "stickies"! I know that some of the knowledgeable dosing people will drop by to suggest what you should do at this point. I would be inclined to begin over and follow the protocol, but, as BJM said in her post (above) you will have to carefully monitor, since you don't really know how much insulin Fay needs..

Now for the "personal-experience" story: My previous diabetic cat, Stu, was overdosed by his vet, who did not understand that Lantus is dosed differently from the older insulins. He increased Stu's dose every week by 1 unit, once by 2 units. There was no change in the high numbers until one day when Stu crashed. That was when I found this board (in January 2010). I reduced Stu's Lantus dose gradually, but if I had to do this sort of thing over again, I would start fresh, with 1 unit.

I know you'll be able to get a handle on Feline diabetes. The learning curve is steep, but it will all fall into place. Ask as many questions as you need as you begin this "adventure". There are many knowledgeable people here who will help and support you.

Ella & Rusty

 

Hi @Ella & Rusty & Stu(GA) ,

Thanks for your notes. My SS is misleading in that the cat has been on Lantus since 12/16. I'm hesitant to start from scratch, as there are still so many variables (and mostly just a consideration of her still adjusting to insulin in the first place). I want to do it right, but I don't want her to suffer and be high for any longer than she has to. How high was Stu when he crashed (the dosing I mean)?

I guess what I was trying to get at was that while we didn't increase often in 0.5U increments, we effectively increased by 0.5U twice a week (to make the full 1U per week)--and this does follow the protocol of nadirs >300. I understand this isn't the best logic, but we were waiting 14+ cycles to go up. I guess I'm wondering how likely it truly is that we have "skipped over" the optimal dose. I suppose we will never know.

Thanks again for your advice and welcome

 

Forgot to mention, I'm a nurse with crazy hours--so challenging to get numbers in the middle of the cycle! But I'm about to draw one now.

 

best way to get a urine sample for ketone testing?

 

If you were doing twice a week, that is similar to the TR protocol, so long as increases are based on the nadirs. If that is true, I wouldn't try droping the dose, just do your best monitoring.

For urine testing, many cats eliminate after eating. Using a long handled ladle may allow you to collect as he goes. Alternatively, aquarium gravel in a litter box is non-absorbent. You need to get a fresh, uncontaminated specimen, though.

 

+3 just now was 342. Not as great as the evening's +3 the other night, at 267. But I will take the "marathon" metaphor to heart and hang in there. How long has it taken your own kitties to officially regulate? @BJM and @Ella & Rusty & Stu(GA) @Angela & Blackie & 3 Others

PS - I don't want to feel like a fool tagging you all directly if you automatically receive notification of a comment in a thread that you've commented on. So let me know!

 

I marked the thread to watch, so it will flag me.
No harm, though.

 

Hi Alex!

I had a cat with a high dose condition so I'm sensitive about people suggesting reducing the dose to restart before we've got all the information. Some cats need more insulin than others.

Before we do anything in haste, could I ask you to put the info in about her dose as best as you can in the spreadsheet? When I arrived at FDMB Punkin was getting 3u or so of Lantus, but it turned out that we were using the wrong syringes, meaning his dose was about 7u. In order to gather info for people to help me, I had to call the vet to get the information from when we had tests there and recreate the dates and times of the tests, along with the dose increases.

If you have a home glucometer -which it sounds like you do - you can get the old tests/times off of the memory.

Before you change the dose any further, it would be good to get this information and let some of us take a look at it and see if there are signs that the dose is too high or if maybe, it is appropriate.

Also, let's hear a little about Fayaway's story. I see diagnosed 12/16/14 with a BG in the 440's at the vet's. What's her body build? appetite? does she snore? have a large potbelly?

When you were taking the tests and increasing her dose, it matters a lot about when in the cycle those tests were. If you can recreate about when - where they at preshot or in the middle of the cycle, for example - and put them as best as you can in the spreadsheet, i think we'll be able to untangle the web and help you with some options about what to do next.

and welcome to LL! glad to have you and Fay here!

 

Oh, and please let us know what she's eating. Is there any possibility she is getting any dry food? dog or cat dry food?

 

It'll help us give you feedback if you add a few notes to your signature, as follows:

Editing your Signature

In the upper right corner of the screen, within the dark blue bar, you will see ID, Inbox, and Alerts

Click on your ID.

On the left, under Settings, Click on Signature.
This is where you will put information that helps us give you feedback.
This is where you paste the link for your spreadsheet, once it is set up.
Add any other text, such as
your name,
cat's name,
date of Dx (diagnosis)
insulin
meter
any other pertinent issues like if there are any food issues, history of DKA, hepatic lipidosis, pancreatitis, allergies, IBD, etc.
Click the Save Changes button at the bottom.

Always click the Save Changes button at the bottom when you have changed anything.

 

Let me answer you here first and then I will try to recreate things in the spreadsheet. @julie & punkin (ga)

Lantus was started at 1.5U BID (twice daily)
After 5 days with no change in her clinical signs (pu/pd), we increased to 2U BID.
About a week and a half later, we went up to 3U BID.
Another week in, we went up to 4U BID.

5 days after 4U, still no resolve in numbers. ALL DOSE INCREASES WERE BASED ON +5 or +6 NADIRS (which I don't have in the spread sheet, but they all were between 434-460.
At this point I called the vet and we had discussion about insulin resistance, euthanasia, etc. (euthanasia discussion was because I asked). Vet did suggest she might be insulin resistant and mentioned acromegaly as well, although she didn't think that was likely (Fay is also female, so I understand it's much less common in female cats). Vet suggested I go up to 4.5U for another few days then possibly to 5U immediately after if BSs still >400 throughout the day. However, I elected to keep Fay at 4U BID for a little longer.

Miraculously, the next two +6 nadirs blood were around 330! I thought her ears must be burning about the euthanasia. So then we stayed on 4U for about 6 cycles, still with nadirs >300, so we bumped to 4.5U per protocol listed on the sticky. Then after 6 more cycles, still with nadirs from 200-300, we bumped up to 4.75U, which is where we are at now. Over yesterday and today, I've seen her numbers be higher, which is tough, but we are in it for at least a while.

Fay is 6 years old. She looks stocky, more in the way she moves, but has never been over 11.5 lbs. At that point, she used to have the little cat belly flap that wiggles when they walk--when she was diagnosed a month ago, she was 10.5 lbs....so a one pound difference--but percentage wise, quite significant. A vet three years ago told me she was a little overweight at 11.5, but at 10.5 she is considered underweight. So I'm guess an optimal weight for her is closer to 11 pounds. She has never been morbidly obese. She has also never been a bit eater--until now. She would always go crazy when I busted out the wet food as a "treat" (silly me), but both of my cats grazed/free fed on dry food for years and they never went nuts.

She had over 11 teeth extracted 3 years ago. She has just her bottom canines and a few incisors up top. She does not snore. She doesn't have a pot belly, although her belly is a little tight (like a drum); presumably d/t inflammation. She had two episodes of bloody vomit prior to diabetes dx and vet suspected pancreatitis. She was treated with an antiemetic and had no further issues. Stool normal. Urine output and water consumption were first noted about 6-7 weeks prior to diagnosis, as well as weight loss. I think by the time she was diagnosed she had been displaying symptoms for no longer than 2 months. 6 seemed young to me and I didn't want to be alarmist and bring her in right away. Hope we didn't lose too much time.

Does that help?

 

she's getting Friskies Mariner's Catch at 5% carbs, 2 cans a day divided in two feedings before her shots, which are at 7:30pm MST. Friskies initiated on Monday after @BJM gave me the what for on Hills m/d wet and dry (she started exclusively on the m/d wet for about 2.5-3 weeks, then I had to add some dry because my wallet was weeping.)

 

The only low carb dry foods with crunch are:
Evo Cat and Kitten
Young Again 0 Carb (actually 5% calories from carbohydrate; internet orders only)
And Epigen 90 may be an option.

 

On today's comments it says:

plus 3 shot at 10:45AM

I'm wondering if maybe you mean the +3 test? You didn't shoot again at +3, right?

GREAT summary - that's exactly what I was looking for - thanks! I'd like to talk with some other experienced Lantus users and see what they think as well.

 

What was going on that caused so many teeth extractions? Does she have stomatitis? Any chance there is anything going on in her mouth right now?

Does she ever leave food behind in her dish, or as soon as you put it down does she eat it all?

has she ever had steroids?

 

I'm wondering about that bloody vomit, too. So the vet thought that was caused by pancreatitis? I've never heard anyone report that connection.

The tight belly is a curious symptom too.

Using the weight-based formula, the starting dose for Lantus is 0.25u x weight in kg (10.5lbs=4.8kg) = 1.2u per shot. So ger starting dose was in the ballpark. It would've been held for 5-7 days to allow the depot to build and see what that dose could really do for her.

I think the bottom line is that you have 2 choices. We can lay out the pros and cons for you of each choice so you can make an informed decision. It's possible she's overdosed and needs to be dropped back to a starting dose while you get some hometests in to see what's going on. It's also possible that her doses were increased in too large of increments too quickly and she's overshot her ideal dose.

We have a few hours before you shoot tonight to think about her situation.

 

I wanted to pass along the conversation that happened when I arrived on FDMB with punkin, as it turned out, on 7.5u Lantus. Libby gave me some good things to think about - perhaps something here will be helpful to you as well: Punkin with wrong syringes

 

Hi Alex!

Here are some Urine Testing Tips for you with several options to try. Hopefully you'll find one that works for you!

 

Thought I'd check back with you and see if you had a chance to read any of the info and if you have questions.

It sounds from your comments that you'd like to keep going up with the dose. I especially want to make sure you read the cautions in the thread I linked about punkin with the wrong syringes if you decide that's the direction you want to go.

I also wanted to mention that we currently have at least 2 female cats with acromegaly - both Polly and Neko. So while males are more common, females aren't uncommon. There have been others as well, including some that seem petite.

 

Hi Alex and welcome to you and Fay. Is there an chance you have more data you could enter into the spreadsheet? When looking for overdosing, a couple of weeks of data makes it easier to spot than just 5 days.

You also commented that she doesn't have many teeth left and her last dental was 3 years ago. Has the vet checked her teeth lately? Dental issues can definitely cause higher numbers. I also have to comment on the following:

Neko, Polly and Crystal are all girl acrokitties here. Neko didn't have a pot belly for the first couple of years of her acromegaly and has never snored. She's a bigger girl than Polly and Crystal, but also has some Maine Coon in her. Acrocats are also supposed to be mostly short haired, but Polly and Neko beg to differ. Cats were never very good at statistics. I'm not saying Fay has acromegaly, just that it shouldn't be ruled out because of gender. We don't suggesting testing for those high dose conditions until kitty is at 6 units, and is on low carb wet or raw, has no infections (dental needed) or other secondary condition (hyperthyroid and pancreatitis are common), and has reached the dose in a safe step-wise manner.

 

Hi Alex,
Stu was up to 7 units of Lantus bid when he crashed (see below). He was not a newly diagnosed diabetic, but had been switched to Lantus from a PZI Vet insulin that had been discontinued. He had been on PZI Vet for 4 years, and his dose was about 3 units (of U- 40 insulin) bid. (PZI was not a "depot" insulin). He seemed to do OK on PZI (but I don't really know, since we shot "blind" for those 4 years and took him to the vet twice a month for blood tests. I didn't know anything.) He did pretty well on Lantus, but he was never well regulated, largely because of other health issues that did him in that same year (CRF, HyperT, Cancer). His Lantus spreadsheet is linked in my signature. It starts when I joined the FDMB and took his dose down to 5 Units. He had been switched to Lantus about 2 months earlier and was up to 7 units bid.
You have provided good information for the people who will really be able to help you. Good luck and, again, welcome!
Ella & Rusty

 

she's only on wet food now, and on Friskies, per your recommendations...

 

that's for me, just a note reminding me that it was actually 15 minutes after her true "+3" time (which we actually be 10:30). no i did not shoot again.

 

periodontal disease. vet says it does happen sometimes in young cats.
vet looked at her teeth recently and didn't see any issues. i feel that if there were slivers or remnants from her extractions, i would have seen an abscess. no steroid use.

she eats all her food.

 

what do you mean by "wrong syringes"? Wrong syringes for the type of insulin I'm using?

It's not that I have a desire to go up. There are just a lot of variables and I'm getting a lot of different feedback. I'm also repeating myself quite a bit, not to you, just in general...which I realize is part of the game. :-/ I don't want to oversell my knowledge of kitty diabetes, I don't know a lot and I am very green still. But I am a nurse and really have thought about this from many angles. I still have a ton to learn, but truthfully, I don't know what the "right thing" is. I hear people saying she may bounce around in her BSs for a while. I hear people saying I may have skipped the optimal dose. I have many comments about an ongoing infection, particularly re: her teeth -- there is no evidence of this. I also have folks saying she may still need some more insulin. I have people wanting me to test at different times -- this just isn't always feasible with my schedule.

Her PMPS tonight was 426. So I'm seeing higher numbers than her pre-shots on a slightly lower dose a few days ago. Does that mean I've gone up too much? I'm really not sure. Some here may say yes, others, again, suggest a cat's BSs might bounce around a bit.

What do you think? I greatly appreciate your many response. PS - no vomiting since that one day. We didn't do a work up for pancreatitis as her symptoms resolved rapidly and honestly, that was just in a mix of differential diagnoses.

Let me know what you think. I'm about to shoot in 1/2 hour. :-/

 

Thanks Wendy...I know I need more data. I am trying my best. Truthfully, I did not start off on the right foot with the documentation. Nadir after nadir was over 400 and I wasn't testing that frequently, so I kind of screwed myself (and all you lovely people). Vet obviously was less than helpful in getting me set up properly. Hopefully in 2 weeks we will have much more information.

 

Thanks @Ella & Rusty & Stu(GA) for your info and kindness. I see "GA" that appears to be an acronym for when a pet has passed. What does it stand for?

 

Guardian Angel or Gone Ahead.

 

That's sweet, I like that very much.

 

There's not a problem with your syringes. That was our problem when we arrived at fdmb, but the issue was the same as yours...was the dose appropriate, or was it too much? We had to decide how to proceed, just as you do. In the post I linked, Libby, who is one of our moderators and very experienced, laid out the pros and cons for us. Those same pros and cons would be factors for you to consider.

I'm not sure where you're being asked the same info repeatedly. Is that perhaps on facebook? Just fyi, dosing advice isn't supposed to be given on the Facebook group, per the fdmb webmaster. There isn't any way to know the quality of the advice or how much exp er ience the person giving advice has on fb. I've seen people that are completely new giving advice on there. It's not safe.

We can move on from here without your past history. It helps but your explanation also helps. Lantus dosing is based upon how low a dose takes a cat, so most of our focus is on getting info so we can be confident when we adjust the dose. It sounds like you've gotten some info on bouncing.

I'll go over it again since it's important to understand. If a cat's blood sugar drops into a range lower than the body is used to, the liver and pancreas release counter-regulatory hormones and stored sugars to bring the cat back up. If the cat is used to 400s, even touching 200 might trigger a bounce. Those bounces can last 3 days. During those 3 days the cat might stay in the 400s the whole time, or it might bobble around down and back up again.

The reason this is so important to understand is that you can see if only catch a test here and there, say once a day. Or say dose adjustments are done by a weekly test at the vet's, if the test happens during a bounce, a person might think the dose is too low when it might not be.

If a cat is really used to high numbers, they might drop to less than 100, for example but only stay there for an hour or 2 and then head back up high again for the next 3 days.

As a cat gets more used to hitting good numbers, that improves. The cat will stay longer in normal blood sugar and the bounces will get shorter until they stop.

A cat that is overdosed can have its body go on overdrive, continuously producing those bounce hormones to keep itself alive.

I don't mean to make the picture seem bleak but just to let you know it isn't always easy to know what's going on. That's why we use test data as our primary source for dosing decisions. That's also why people are asking you questions. Cats can be difficult to get regulated because so many things can drive up blood sugar: infection, pain, thyroid, pancreatitis, needing teeth cleaned, and yes, a high dose condition.

For now, I think if I were you, I'd read the info through in this thread, and I'd probably hold the dose while getting 4 tests per day if you can. The most important are the preshot before you give insulin and one somewhere between the shots. I'd vary the time of those midcycle tests just in case Fay has an early or late nadir. People tend to think +6, but very few cats are always st +6. A test before you go to bed can be really revealing in the pm cycle. It shouldn't take 2 weeks for us to get a decent picture of what's going on. 3 or 4 days should tell a lot.

Hope I haven't overwhelmed you. I know it's a lot to take in. Please ask whatever questions you have. Diabetic cats are pretty different from diabetic people.

 

Thanks Julie, so very much.

So the first part is, with the exception of my days off (rare occurrence these days) getting four reads a day is impossible.

The second part, I'm not sure what the value of poking the cat continuously is as long as she remains so high. Along with that -- say I poke for consistently for 3-4 days and she is still "bouncing"--yet, according to the protocol here, it calls for an increase in dosing based on her "bouncing" numbers. So where does that leave us?

I agree on testing around the +6 mark. I didn't really consider a before bed test. That's probably a good thing.

I wonder where it will end. I am willing to hang on because so many people have shared they, too, struggled for a good long time and it was hell in the beginning. But when people say "it takes a while to get a cat regulated"...I can't tell if it's the textbook 1-2 months or more like 3, 4, 5, or 6 months. To say the process isn't entirely straightforward is a huge understatement. I wish the vet had set me up a little better for the challenges...I'm not surprised. But I don't know how any single person working odd hours can manage this. :-/ I just try to be pragmatic.

I would be interested to hear your take on the value of frequent testing in advance of the cat being regulated. I understand periodic checks for dose adjustments are helpful, but again...how much or how little is enough?

 

The testing is for safety, as much as for dose monitoring. And when you're starting off, sometimes things may change quickly. Or not.

Some folks have been known to set a clock in the middle of the night to check a nadir, when daytime didn't work, especially since some cats go lower at night. If you have sleep issues, that can be a problem, though.

When there are other medical conditions, management can become complicated. Spitzer had issues with IBD-associated vomiting and diarrhea, which made his glucose fluctuate like an ADD yo yo. He got diagnosed with a form of Bartonella after the vet had thought it was feline herpes and l-lysine didn't work. He eventually was euthanized due to an excruciating blood clot to his hind legs, called a saddle thrombus, as recovery and repeat clots were likely to give him poor quality of life. I was going home at lunch to check on him because if his glucose dropped like a rock, he might need high carb and if he was able to keep food down, he might need a short term insulin bolus to let him use the glucose he had. It was stressful and chaotic and frustrating because nothing worked well for him.

 

I'm so sorry to hear about Spitzer's--and your--struggles. It will be hard for me to determine at what point I let Fay go. She's a good girl, but I will have to set some sort of time limit on her being regulated. I'm struggling outside of Fay on a thousand different levels lately. So it all swung into my life in an already trying time (it always does, right?). I want to be purposeful in my decisions about her, and would feel horrible if I made a choice to euthanize, only to have seasoned people here feel like I just didn't do things the right way. That would be crushing.

 

Think about the testing. It's easy to overlook when you can test despite a challenging schedule. Sometimes, moving shot time even by an hour means that you can get an extra test in before you leave the house. We encourage spot checks vs. trying to always test at nadir. If you can grab a test when you go out the door, when you come home, or just at random, that will help to fill in gaps on your SS (spreadsheet). That said, there are any number of people who work long hours or have long commutes. We all do the best we can. You might want to take a look at the sticky note at the top of the board that talks about using Tight Regulation and working full time.

The advantage of getting some of the additional tests is that you may be assuming that the cycles are high and flat. Gabby had been known to be in the 400s at AMPS and PMPS. If I hadn't gotten a spot check, I'd never have known she dropped into the 40s. The result of not getting that test would have been that I would have increased her dose whereas catching that drop into the 40s meant that I reduced her dose.

You're actually correct -- we don't encourage increasing the dose if the kitty is bouncing. We wait for the bounce to clear -- usually it takes up to 72 hours for a bounce to clear. The momentum of a bounce clearing coupled with a dose increase can cause a very "active" (i.e., the kitty's numbers may be dropping fast and your testing like crazy) cycle. Not all of the nuances are written into the protocol. That's why we're here!

As a nurse, I know you've seen that not everyone responds to medications exactly the same way. We have an expression here -- ECID (every cat is different). Some cats get here and they are in remission after 2 weeks -- a little bit of insulin, a change to a low carb food or the UTI or dental problem, etc. clear up and the the sugar dance is done. Others take longer and still others never achieve remission. Gabby is in that latter category. She does spend most of her time below renal threshold which is a good goal for her. As for your vet preparing you, i always wonder how many diabetics they see in their practice. We eat and sleep FD here. The collective wisdom is huge. Most vets will never see the number of spreadsheets we see or come across the number of complications secondary to FD that we we see.

 

I think the best way to manage things is really one day at a time. If I'd been told when I'd started that I'd be doing this for 2.5 years, I'd have given up. But now, looking back on it, I wouldn't have given up that 2.5 years with punkin for anything. If I could have him back, I'd do it for the rest of my life. Having a diabetic cat is this weird mix of curse and blessing. You find that the relationship you get with your diabetic cat is like you'll never have with another pet. It also isn't long before you can do this, including the testing, without hardly blinking. It becomes as routine as brushing your teeth. After a couple of weeks i was testing punkin while talking on the phone and realized I'd made it. It no longer was this enormous issue of bundling him in a beach towel while i struggled to test him. Within a short time I'd say I could test, feed and shoot him within 5 minutes tops. And the food took most of that time.

It is a very manageable disease. Really. If you look at the first of the yellow starred stickies at the top of this forum, you'll see a post on how people manage to follow TR while they work full-time. There are all kinds of little things that can make things easier for you. I found a timed feeder gave me great peace of mind. If a cat gets low blood sugar, you feed them. So if you're at work and you want some insurance, set up a timed feeder to go off.

If you give us your typical schedule, we can help you figure out how to move ahead. If you can't get enough testing in to follow the Tight Regulation Protocol, we have another option of the "Start Low Go Slow" program - it's not published in a professional veterinary journal like the TR protocol, but for folks who need it, it's a good alternative. It was developed here before the TR protocol was published. That SLGS calls for doing a curve once a week by testing every 2-3 hours for 12-18 hours and adjusting the dose based upon that.

Either plan is ok - it's just what works for your life. Lean on us and let us help you figure out how to take care of her. We've all been helped by others who taught us - we stick around to help people like you now.

 

Wow! So Gabby was in 400s and AMPS and PMPS and still be dropping into 40s between those two cycles? Is that considered regulated or is that just the rebound hyperglycemia from going so low in the middle of the cycle? Very interesting, thank you for that. And yes, I agree. If 0.5-1% of cats are diabetics...well, that's just one in every 100-200. So they start you on your way and send you out the door. The immensity and significance of this forum is not lost of me -- it's exceptionally impressive and everyone is so giving of their time. So thank you so much.

 

Oh boy..."typical schedule"--bahaha. I work for as long as I have to--it differs literally every day. About 10 hours minimum, which doesn't include commute. Everyone in the office now knows I am not as able to take additional late patients in the day because of kitty. I'm also in a challenging position of still being an hourly employee (as most nurses are). So if I don't bend over backwards to agree to take patients or drive 80 miles round trip to see someone--I may not get a paycheck that covers the mortgage. I am always home for morning and evening feeds and shots--I have made it a point to do whatever it takes, since her diagnosis, to be present for food and insulin. Admittedly, I have been rather non-compliant with these testing times because the cat is downright bonkers (I really laughed hard at your beach towel image), and when I've been up charting until 1am (as I bring a bit of work home, too), I'm bleary eyed at 7am when I pull out the food and just want to get her settled. (although sometimes those late working hours at home allow me to get more testing in--I promise I will get better). BUT, yes, I am home to do AMPS and PMPS tests. As for the rest, it's not likely to ever be consistent. As I hear more from you all, I'm seeing the value. It's just they're always high, so I wasn't entirely sure of the value during the first month.

The hardest part is that during the times I need more tests +3, +5, +6, +8 --whenever (just examples)--I'm driving around the Denver metro area like a crazy person. I can't come home often for a lunch, unless my patients are closer to my home than they are to work--then I am able to. But this is rare.

If I recall, I think the vet wanted me more to do weekly curves and adjust as needed. And so while I wasn't doing full curves (every 2), for a while once a week I was doing every 3 hours...and again, they were all over 400. So it was discouraging, and I gave up. And the vet's recommendations were not nuanced; this is when she just said, "ok, go up a full unit." Which is how we got into that thing. I am sorry to you all that I did not keep that data.

Truthfully, Julie, my life has been in flux for the last 5 years. Nursing is a second career of sorts and while it's enjoyable, it's also quite taxing (oncology and hospice). I also have some chronic medical issues myself...so you could say stress and I are old friends. So I'm suffering, kitty is suffering, and things feel bleak. I'm sure it will improve...at least I hope so. But I certainly am not able to devote the time to managing this cat that I would like to...or at least could better accomplish if I lived with someone or had a partner who could assist. And that's highly frustrating.

I'm laughing because I think this is my year of online support groups. I just completed a round of Accutane (strong acne medication)--because I didn't want to enter my 30s with a face full of zits. And the "skin community" so to speak was amazing and so helpful, and here you all are in FD land, being equally helpful and giving of your time.

I'm going to step away from the computer for a bit and attempt to paint a few walls (bought a house a few months back). Today I am home so I'll be able to grab a few more test provided Fay doesn't try to beat me up. Poor thing's ears are already looking so scabby. PS - Red blood in a sea of black is tough to spot sometimes!! Thanks again and hugs to you for being so available to me. (everyone else, too)

 

I am a fairly newbie myself. Skoots was diagnosed in April 2015. I read through your whole thread and saw several times that you mentioned you are doing this solo. While I may not be an expert on dosing, I am an expert on navigating this sugar dance solo.

I cannot tell you how many times I cried at night wondering if I was doing right by Skooter or wondering if I should give him to someone else better suited to handle this disease. At the time, my work schedule had me working from 8am to about 7pm and while I was able to come home most days to check on him, it wasn't everyday. It can be a very taxing and overwhelming process --- AT FIRST. I realized that I was the best person for Skooter because no one could love him as much as I did. Skooter hung around in some higher numbers when he was first diagnosed. He stayed on wet food for the first few months due to his IBD and my fear of giving him anything other than his rx food thinking it would hurt his IBD.

I have a very supportive vet clinic, which from what I read is not always common. The vet tech who taught me to home test actually told the vet there was no way I would be able to do it because I was so nervous. Well if you look at his 2014 spreadsheet, I would say I got the hang of it

I just wanted to say that while doing this solo is challenging, it can be done. Skooter was up to 5U BID and dry food (my vet also did weekly tests and up'd him a unit a week and I think we missed our ideal dose). Today, Skooter gets .25U BID and on an all wet diet. There are still times I wish I had someone to do this with me, take a "night shift" of testing, especially if he is dropping low and earning his reductions and the following morning, let's just say, I ain't always that fun to be around, but I have gotten used to it. To the point where I am learning how to have a life outside of work and feline diabetes. I use an autofeeder as well and feed him 5 times per cycle. I think that helps his pancreas not have to work so hard. I add a small ice cube to each compartment in his feeder to keep it cool and fresh (plus it adds a little more water to his food).

When I first started this, I never thought I would be able to have a life or have fun. I am lucky, Skooter rarely blinks an eye with a missed dose now that he is more regulated, so there have been times I have skipped a shot in order to do something fun (for example Friday night my siblings and I had a spur of the moment sibling night playing bingo). Part of the reason I am confident in being able to do that, was all the time and effort I put into the beginning of getting the tests in, to learn his trends and see what he does. I also have learned that Skooter likes to nadir early, sometimes as early as +2, which has also helped me in knowing when I can go out etc.

The support of this group, on the nights I was crying thinking I would never understand this and get into a good pattern is what got me through. Another option is to see if there are other members in your area and perhaps if you met up with them, they might be able to do some testing for you. So far my sister and her husband have learned how to shoot Skooter and I am hoping to eventually get them comfy with testing as well

Welcome to the best place you never wanted to have to be

 

Stellar job you've done! Just took a peek at your SS -- looks amazing. I think Fay would really appreciate an autofeeder, she bugs me so much throughout the day. Knowing that it's possible to keep in smaller increments throughout the day and still shoot twice seems great. The hard part is my other kitty, who isn't a wet food fan but isn't diabetic, so I'm still allowing her to eat dry food (I'll tackle her transition to better food once I get Fay under control). I don't think I can get Frances on an autofeeder with her dry or Fay is going to push her out of the way and go nuts on it.

Anyway, I love how detailed your notes are, to include the time.

Do you still think there is hope for regulation with her numbers being so high? I hope so

 

Hi Alex,

I wanted to pop in and offer my support as well. It's a tough schedule you have! I can't imagine!

If you get a chance, take a look at Cobb's SS. Especially the last tab and the one we are on now. He had a high dose condition and was in high numbers for a LONG time. He's now seeing normal numbers on 1/5th, of the dose he was on last August. Don't know if that will give you any hope to getting Fay regulated.

I agree with Julie. If I had known everything we have gone through with Cobb, I doubt we would have started any treatment. I was 7 months pregnant when he was diagnosed and we preferred to go to Cobb to test him, instead of bringing him to us. I was struggling to get down and get any blood from him!

I think we all hope for remission when we hear that initial diagnosis and find some cats achieve it. The disease can be managed. Just think about what your goal for Fay is and then you can form a plan to achieve it!

~Suzanne

 

thanks for all of that information. I think the first thing I'd do in your shoes is to get a timed feeder. Or get 2 of them - one for your other kitty and one for Fay. You can set them to open at the same time and have canned low carb in both of them. That way if Fay gets into your other kitty's food, no harm done. The one I used and loved was the PetSafe 5 Compartment Feeder.

I do want to ask more about the dry food. I thought you mentioned more about it, but i've reread this post and can't find the reference. So maybe it was from another kitty's post. Is there any possibility at all, any, that Fay could be getting into your other kitty's dry food? Even one crunchy? We've had people document a blood sugar increase of hundreds of points from just a mouthful of crunchies that can last for another whole day. If there's any possibility at all of her getting dry food, I'd either transition your other kitty to low carb canned, buy the low carb dry for the other kitty, or only feed the other kitty in a closed room and pick up the food after she's eaten and put it in a cupboard. Somehow Fay needs to not get any of it.

If you think she's getting any at all and you remove it, you also need to drop the dose back simultaneously so she doesn't overdose when the carbs are removed. Let us guide you on this if that's the situation.

We had a kitty here about a year ago, Scooter, that Linda was positive wasn't getting any dry food. He didn't show any interest in it at all. She had 13 kitties in her house, so the others were fed dry food. He had a dental done, which can sometimes make the difference in getting a cat regulated and she'd done everything by the book to get his blood sugar under control, but he still wasn't budging. He was at 5.5u and she removed all the dry pet food from the house. Scooter went from 5.5u to off of insulin in one and a half incredibly long days. It was all about the dry food. Look at Feb 19, 2014 here.

If you want to transition your other cat to low carb canned food as well, there are excellent how-to-tips at CatInfo.org, which is run by a really good vet who sometimes posts here. Look at the side-bar on the right for "tips on transitioning dry food addicts."

By the way, the reason people are vague in answering about how long it takes to get regulated is that the answer so is individual. None of us can say. We have cats come in on insulin and stay less than a week or two. Cats have the unique ability to have their pancreas heal and have it begin producing insulin again if it's not too damaged. Dogs and people are typically life-long on insulin once they begin, but cats have a good chance of healing if their blood sugar is brought back into normal numbers (50-120 on a human glucometer) as quickly as possible. So . . . there's no way to answer how long it will take.

If you can't blood tests during your work day, this is still do-able. Always getting the preshots, using the timed feeder for safety to dole out food while you're gone to work, and getting a before bed test will be enough. You might need to get more sometime, but that's the place to start. Then I'd also wait and do an every 3 hour curve on one of your days off before increasing the dose.

 

Hi Suzanne,

Thanks for your input So when you say, if you had known, you doubt you would have started treatment, does that mean you would have put him down? Julie, do you feel the same way? @julie & punkin (ga)

 

Hi Julie,

I've gotten a few readings today already! Check it out.

Nope, there is no way in hell Fay is getting any crunchies. Frances is put in a separate room (she likes to take her time, one kibble at a time) and so I give her an hour or so in there. Then I immediately pick crunchies up and put up high in a closet. This is one system I've got down pat

Fay is exclusively on Mariner's Catch by Friskies, wet food--it's 5% carbs. I could pre-load this for Frances in the feeder too, but Fay is a total bully and would probably eat all of Frances' portion before she could get to it. I guess we will figure it out eventually

 

Hi Alex and welcome!

Just to add a little trick for the auto feeders with multiple cats - I work full time and Eddie used to be a notorious early cycle diver so I relied on the feeders to ensure there was food out to keep him safe while I was at work. We have five cats, and three feeders, and I set all three to go off at the same time. Since Eddie's not shy about getting in and eating, I can be certain that he's going to get a chance to eat at least some of the food.

With two cats, you can set them to go off at the same time, but place them in different rooms, so the piggie kitty cannot be in two places at the same time to scarf all the food before the other kitty gets a chance to eat some.

 

Lol, yes -- piggie kitty. One time I actually scolded Fay and said, YOU GO BACK TO YOUR OWN FOOD RIGHT NOW. And she turned right around and went back as Frances followed me to "her" feeding room. I could have died, it was so hysterical. Thanks for your notes. What feeder do/did you use?

 

It's hard to answer that question with an absolute. I'll be honest that it was a discussion my husband and I had several times. Cobb is a high dose cat. We got to 31 units twice a day before we switched insulins and really saw progress. If we had known the expense and frustration, I think my husband would have been more vocal about letting Cobb go, but Cobb was my cat so my husband has already said I have to make that decision.

We discussed letting Cobb go when he was first diagnosed because we were uncertain of his future quality of life. We agreed to give it 6 months. Cobb was not doing well at the end of 6 months. DH and I talked, I researched and found FDMB and told him I wanted to give Cobb a little more time. I learned a ton...ie. Cobb was still on "diabetic" dry food. We took him off that and his numbers fell from the 500s into the 300s. That's when we decided these ladies really knew what they were talking about.

If I thought Cobb's quality of life had no chance of improving or that he was in untreatable pain, it would have been no question. My DH did a lot of research and found some cats go into remission. That gave us the hope we needed to jump in with treatment. And from my time here, we celebrate a cat going OTJ a few times a month. Will Fay? I don't know. But I'd guess others whose cats were on insulin for a prolonged period of time felt they never would either.

Unless you run every test when you get that FD diagnosis, which for most would be a waste of money, you can't make that kind of decision because you aren't working with all the information. You have to decide...can I treat the disease I know he has. For us, initially, the answer was "we'll try." And we were given enough hope along the way to continue trying. I would have never guessed Cobb would require so much insulin. But our work has paid off and I feel comfortable with what we've done. We did draw the line at testing for acromegaly. I felt like, if he had it and if I knew, I would pursue every option to treat it or feel guilty. We weren't in a position to treat it, so I felt better off not knowing.

That's just our experience. Everyone has their own!

~Suzanne

 

We use the PetSafe 5. We initially purchased three of them when we went on a short vacation and didn't want the petsitter to have to come in multiple times a day to feed. They're a bit spendy up front, but for us they've been WELL worth the investment - most importantly, the peace of mind that Eddie's going to have access to food and be safe when I'm not home to keep an eye on his numbers. I've read some reviewers that indicate that a very resourceful cat can "break into" it by manually forcing the feeder to turn to the next dish, but I haven't had that happen.

 

I hear you. I feel pretty clear that I can't put any more money towards serious diagnostics. It just isn't worth it...to me. I would never judge anyone here for doing all the workups they wanted. But I think to myself: will the tests change what I'm doing now? How far would I take it? Well, I wouldn't. I'm OK to manage the insulin and diet and work towards testing more often. Other conditions or challenges? Well, if I have to let Fay go, maybe that just means it was her time and some room is made for another rescue to be spared. Who knows.

 

Alex --

FWIW, I've been handling Gabby's FD for 5+ years solo. For me, one of the big advantages of getting a handle on how anyone's cat is responding to insulin is that it allows you to have s general idea of how your cat's cycles run. Gabby, for example, has an early nadir.

In a previous job, I had more flexibility with my schedule. Currently, I'm in a new job. If I need to schedule a meeting after hours, I can run home, test, feed, and shoot and go back to the office. Everyone knows that my schedule works around Gabby. I'm lucky that i have a very supportive work environment.

To answer your earlier question, if you look at Gabby's SSs over the course of her diabetes, she started out being the Queen of the Dive. It's why I get early tests. With a good deal of persistence and using a strategy to manage her numbers, her curve has flattened out considerably.

 

I would do it all again in a heartbeat. I've had cats since I was in 8th grade, and i adore them. But there was something very extraordinary about punkin - hahahaha we always joked he was psychic because he was all about eye contact. Here's one of my favorite videos of Punkin complaining cuz he wasn't being fed on time. We held out until it was obvious he'd have died within a day or so. After lots of other health issues, he finally had a fluid build-up in his abdomen that came on suddenly and squished his lungs to slivers. Not everyone needs to do everything we did, but i do think FD is a treatable disease and learning about it will hopefully help you get to the point where it doesn't seem so burdensome and overwhelming. It doesn't need to be.

And yes, I was literally pulling punkin out from under the furniture by his little arms, hoping i didn't dislocate anything, then wrapping him tightly in a beach towel so he was immobilized while i fiddled around with his ear til i could get the hang of poking down. i was convinced i had to do it to keep him alive, so i learned and i did what needed to be done.

 

There is not a thing I would do differently either. Skooter has been my companion for about 14 years, and while this disease has brought some challenges, I would not do a single thing differently. I think once you start finding a dose that starts showing improvement in her numbers, you will feel better. I remember the first time that Skooter hit the 200s, I did a happy dance all around my house, called my sister and my mom lolol....I was afraid of green numbers (double digits) and now I am addicted to them.

The beginning is very tough and that is when I questioned the most. It is difficult because you are learning a lot of stuff, it is overwhelming, the initial cost is a bit intimidating, and it can be very frustrating trying to get a cat regulated into normal numbers. Now that Skooter is pretty much regulated (though I still have hope he will come off insulin), it is just part of everyday life for us. I have very understanding family and friends and whenever we can, we plan things at least around his shot time. If I need to leave a little higher carb food in the feeder because I might be home late, so be it.

I started out with one feeder for the day time and eventually got a second one for night time (this way he was getting consistently fed at the same time each cycle). I found that Skooter's preshot numbers came down quite nicely when I started giving him a small snack at +5, which is around 330 am/pm. I did get up at 330 am for a few days to give it to him, and then decided to invest in the second feeder. Best $60 I think I have spent and I believe I have the same one that Julie had.

I hope you are able to stick it out and give Fay some time to show you that she can get her numbers in a better range.....there is tons of support here for you!

My self dx'd OCD was for once a good thing

Of course there is....like Julie said, ECID so can I give you a time table of when it will happen? No. But I do think if you are able to give it some time and get the tests in when you can, etc there is a great chance of getting her regulated. Also, there are ways to save money....buying insulin from Canada, getting test strips from American Diabetes Wholesale.....

 

So today, for example. She reached the 200s today around nadir but is back up to 400s tonight. I know we need more data, but which is a more likely scenario: 1) cat still needs more insulin or 2) getting fed only twice a day is causing her numbers to jump back higher later? I'm sure she needs more insulin, but if it's preferable to give the cat smaller, more frequent meals, I may look into that sooner rather than later.

 

I thinkmost people feed at leaSt 4 times per day. Spreading out the food helps even out blood sugar. In some cats feEdina I hate auto correct ju s t saying....feeding after nadir can drive up the bgs for the next preshot. Some cats graze nicely throughout the cycle. Some need most of their food in the first few hours of each cycle.

In your case, I'd keep it simple and feed her at preshot and something like +3 or +4. That's where the feeder will help.

We look at nadirs for 2-3 days. One cycle doesn't tell much about a dose unless the cat goes under 50.

 

Hi Alex

I haven't had a chance to welcome you and Fay yet and you are probably in bed but perhaps you'll see this tomorrow. Julie and I had a chance to talk about Fay's dose; I'm glad you've held it so far and did an awesome job getting tests today.

We've had other members with very demanding jobs do this solo. One who comes to mind right off the bat is Dyana. JD was diabetic for nine years and just recently passed away at 20 years old. Dyana has a very demanding job but she managed to handle JD's diabetes by herself and JD was a very, very bouncy kitty. JD was never really regulated but he was a happy, healthy kitty.

I always admire those who do this alone. There is a steep learning curve and it is stressful at the beginning but you will develop a routine and it will become second nature. We all just learn to incorporate it into our lives.

We've been at this four years; part of the time my husband is here to help and part of the time he is gone (he's an airline pilot) so I know what it's like to do it with someone and alone. We've been at it four years and are past the point where Gracie will go into remission but she is young so we will be doing this for a long time. It doesn't bother us just because we know we have her with us and she is happy and healthy.

We can look at hundreds of SSs and some stand out to us that a cat will go into remission quickly; some it's not so clear and then....boom....down the dosing scale they go and into remission. We just never know until it happens.

Take time to care for yourself and remember that Fay is not just her numbers.....she's the same sweet kitty you've always loved.