Help

Hoping for some help. I have a 12 year old Siamese diagnosed with diabetes. His fasting glucose was 13.6 so started him on 1 unit twice a day. Initial response was good, first day he went to 5. Then he didn't respond as well so I waited for a while before upping his dose. He usually is quite high at the end of the day (25-30) and in the morning also. When I upped his dose to 1.5 during the day he went too low (2.5). I'm using lantus. He is on the Royal canin diabetic dry food ad lib. Now he has started going back up so increased him to 1.5 again but this morning his reader just said hi (tested twice). Not sure what to do, it's been 3 weeks

 

Hi! Welcome to L&L land =)
I am not so great at the advice part, but others will chime in and get a TON of it.
It'll probably be a lot of info, but in the end, it'll be fine.

The only piece I'll say to kick off the help is: try and ditch the dry food. Even the kind made for diabetics is pretty bad and high in carbs. Rhe carb count is important and using a lower carb food should help bring your kitty's sugar down. A number of us here use Fancy Fancy classic pates. No need to buy the prescription food (though your vet will indeed argue against that... mine always have.) There are some low carb dry food options, but truly wet food is the best.

 

Hi and welcome to Lantus & Levemir Land, the nicest place you never wanted to be.

Cass has given you some good input - dry food, no matter what kind, isn't good for cats, and especially for diabetics. Your best bet would be to see if you can switch him to a low carb canned food. There are quite a few good ones out there. I'm guessing you don't live in the US by the fact that you are using mmol/L numbers. I don't know what might be available in your area, but here is a great resource for finding diabetic friendly foods. You want to look for something that is less than 10% carbs. To read more about why dry food is bad for cats, see the rest of that website: catinfo.org. Dr. Lisa is amazing, and she occasionally posts on FDMB.

In order to properly help you, we need to know a little more about you and your kitty. What is his name? Where do you live (mainly we need to know time zone, but if you aren't in the US, it's helpful to know which country you're in)? When was your kitty born? How much does he weigh? When was he diagnosed? Does he have any other conditions or illnesses, and is he on any other medications? What kind of meter are you using?

It is wonderful that you are testing at home. It is the best way to keep him safe. It will help us - and you - to see how the insulin is affecting him if you can set up a spreadsheet and record your readings (starting with the first ones you got when you started testing). Here are the instructions. Because you are outside the US, record your numbers on the World tab, and they will be converted to US format. http://www.felinediabetes.com/FDMB/threads/fdmb-spreadsheet-instructions.130337/

I know this is very scary and confusing, and there is a lot to learn, but we can help. Try to read as much as you can - starting with the stickies at the top of the Lantus & Levemir page. Here is a link that we put together to help new members get comfortable with this forum: http://www.felinediabetes.com/FDMB/threads/updated-tips-for-new-members.173572/

Ask lots of questions. We've all been where you are, and we love to help!

 

Hello and welcome. There is lots to learn, but we can help you. Read all the Sticky Notes in this forum.

When in the day are you testing compared to the shot times? Setting up the spreadsheet will really help us help you. We determine how to change the Lantus dose based mostly on the low point, or nadir, of the cycle (time from shot to shot). That low point occurs sometime in the middle of the cycle.

 

Thanks for the comments. I live in Western Australia. Filled in the spreadsheet so hopefully should be in my signature. Using Accu-Chek Guide glucose meter (human). My cats name is Zorro and is a Siamese in a 2 cat household. He doesnt have any other illnesses. Always been a good eater then started to lose weight (and not eating) and diagnosed him 3 weeks ago with diabetes. Since starting the Lantus insulin he has been eating a lot more. I was a veterinary nurse for 15 years, but we used caninsulin and I havent used lantus before. It seems that his highs are related to his eating times (generally he likes to eat about 6am and 5pm) but as mentioned before both cats are ad libbers. I can add wet food to his regime but dont know if I could take him totally off the diabetes dry food? I was hoping to get remission as I read the studies about how many cats went into remission! Anyway would love any help or ideas.

 

@Bron and Sheba and @Girlie's mom, could you please share with Becky the names of low carb foods available in Australia? Thanks!

 

@Tara & Ivana did a list not too long ago and I know she's going to be updating it over the summer I think

Here's a list of food/supplies available in Australia/New Zealand

 

My computer's hard drive died, which is EXTRAORDINARILY boring! However, I did highlight the foods from Dr Pierson's chart that I use with the carb values and phosphorous for someone else. Just be careful with Fancy Feast: the grilled ones we have in Australia are all medium or high carbs. Excuse me for rabbiting on below and possibly repeating what others have already told you; I just copied and pasted from that other conversation I had with an Australian.

What I wrote for someone else: I get my cat food delivered from www.petstock.com.au ; https://www.mypetwarehouse.com.au/ ; https://www.petcircle.com.au/ and also https://www.petbarn.com.au/ I buy in bulk when they're having sales. Petstock has sales pretty regularly. Petstock, Pet Warehouse and Pet Circle all carry ZiwiPeak.

The best source of info for carbs in cat food is Dr Lisa Pierson's chart. Here's her post with good info and a link to the chart: http://www.felinediabetes.com/FDMB/threads/dr-pierson-new-food-chart.174147/

Does your cat have kidney issues? If so, you want to try to stay under Phosphorous 200 if you can, but that can be hard to do depending on how fussy your cat is. Girlie is, unfortunately, very, very fussy.

It's good to have a range of LC (low carb), MC (medium carb), and HC (high carb) food on hand. If your cat does a deep dive and you need to slow that down, just giving a little MC food can help with that. Bron & Sheba taught me how to do this - and it works!

Some cats drop too quickly on the really, really LC ones and actually have better and steadier numbers with a LC food between 5 - 10. Girlie was a deep and fast diver before I switched her to Levemir. You can see the food percentages and the dramas I had in her 2017 spreadsheet.

These are the Fancy Feast I use for Girlie:

• Low carb: Classic Savoury Salmon Gourmet (LC 1); Classic Ocean, Whitefish Tuna Gourmet (LC 0); Classic Cod, Sole, Shrimp Gourmet (LC 1);
• Medium carb: The Classic Grilled Filets: Prime Filet of Beef (MC 12); Prime Filet of Chicken (MC 12); Prime Filet of Salmon (MC 13); Prime Filet of Turkey (MC 13); Grilled Ocean Whitefish & Tuna (MC 13); Grilled Tuna (MC 14) - and see others over 11 and under 15% carbs I've highlighted in the attached.
• High carb: Use when in danger of a hypo, etc.: see ones over 15% carb on Pierson's list that I've highlighted. SUPER for hypo: The Cats in the Kitchen pouches. Just tear off a small corner and squeeze the gravy out and give a tsp or two of gravy; then test in 15 minutes (the hypo drill). This is much, much easier than trying to get gravy off of a can of Fancy Feast! Plus, Girlie at least adores these gravies. When they're in lime green numbers, gravy will help bring them up without filling them up.

Do you have some honey at home? A lot of people here use honey to bring their cats up when they're in danger of a hypo. I don't use honey; my vet gave me glucose syrup, and I just had to put Girlie's bib on her and then give her that via a syringe as she's so used to getting liquid meds. She's a very, very tolerant cat. I printed out the docs below and have them next to my hypo toolbox which has several cans of MC and HC food, honey, glucose syrup, and her bib. When that moment comes, my brain freezes, so I need to just go to that box and have everything there at hand. Now I feel confident and no longer scared as I know how to bring her numbers up quickly.

I still keep these on hand even though Girlie has gotten quite steady.

Once I have all of my data on my computer, I'll try to send you another document I made that puts all of the food in their carb categories with phosphorous. It just makes it easier for me to look at the carb number I want (3.g. 6%) and then find the different foods that are that percentage and then try to decide which might tempt Girlie. Yes, my bookshelf now has two shelves dedicated to different carb cat food...

Best of luck!

 

Welcome to the group! This is quite literally the best place you never wanted to be.

Two observations... If you're seeing spikes in Zorro's numbers as they relate to food, it's like that what others have noted about the carbohydrates in Royal Canin is accurate. All of the Royal Canin foods are shockingly high in carbs, including their food for diabetic cats. It's well over 20% carb. Most of us use canned foods that are under 10% carb and usually we're using foods that are under 5%.

Dr. Pierson's website goes into considerable detail about the problems with dry foods. As you know, kidney disease is a huge problem for most cats as they age. It's an even bigger problem for diabetics. Since cats have a very limited thirst drive, dry food is a further cause for dehydration. Canned foods contain way more moisture and most of us add water to canned food. In addition, at least here in the US, most of the recalls for cat food are dry food that have become rancid due to the amount of fat in the food.

That's my longwinded way of saying that both of your cats will benefit from switching them to a canned food diet. Also, having them on the same food will make your life considerably easier.

I'd also encourage you to look at the stickies, especially the ones about our dosing methods. Regardless of whether you opt for Tight Regulation or Start Low Go Slow, you will want to start getting some tests during the PM cycle. You're already seeing some low numbers. Without those PM cycle tests, there's no way to know how low numbers are dropping at night. A couple of other points... Lantus does best if the dose is consistent at AM and PM. Because it's a depot-type of insulin, every time you change the dose, it disturbs the depot. It takes several days for the depot to re-stabilize. If you shoot different amounts at each shot time, the depot doesn't stabilize and you end up with wonky numbers. Depending on which dosing method you choose, the point at which you reduce the dose varies. Regardless of the method, numbers below 50 indicate that a dose reduction is needed.

Please let us know if you have questions. We're here to help.

 

Thanks for your replies. I am changing the food and so will see how he goes with the new food. Hopefully he wont spike so much!

 

If you are switching from a mostly or all dry food diet to an all canned food diet (especially if the canned food is low carb), you'll need to monitor the BG closely for several days. We have actually had cats go into remission with just a diet change - including one that did so in a very breathtaking matter over a day and a half. Forewarned is forearmed!

 

Good luck with the food change.
I second Tricia's call for caution when making the change from the dry food, assuming you are going to a Low carb wet, the impact on BG can be quite dramatic, he has seen some low greens on this dose even with the diabetic dry, which as Sienne mentioned is pretty high in carbs, so his current dose may prove too hefty.

You've been doing a great job at getting those tests in during the day, but I would encourage you to get at least one test in the pm cycle, many cats go lower at night and with no tests at all in the pm you are missing half the picture. With the food change this will become even more important.

You may want to think about transitioning them onto the low carb wet food slowly, going cold turkey on the dry food may lead to a roller coaster ride.

 

Thanks guys, I'll be testing him later tonight approx 3.5 hours after shot. I dropped his shot a little just to be cautious so instead of 1.5 i went to 1 unit. I just gave him his mince and left him some Ziwipeak.

 

Thanks guys, I'll be testing him later tonight approx 3.5 hours after shot. I dropped his shot a little just to be cautious so instead of 1.5 i went to 1 unit. I just gave him his mince and left him some Ziwipeak.

 

If I am remembering correctly, you are only able to get syringes with one unit markings in Australia... Is that why you have been making changes in 0.5u steps???
Usually when a cats dose is below 5u BID, we change the dose by 0.25u, 0.5u can proove too big of a change in either direction, with an increase this can see kitty hit numbers that are suddenly to low, and potentially you skip past a good dose.
Conversely reducing by 0.5u can result in not enough insulin and result in numbers rising...... it really is a balancing act.

Experience on the board is that for most cats the 0.25u changes work best, so it might be worth looking in to how you can dose to that level. Those of us in Europe and US/Canada have access to syringes with 0.5u markings so we are able to just 'guess' at a dose in between the line, but with the 1u syringes, that would be difficult.

I'm not sure if it's possible to get the 0.5u syringes on line and have them delivered to Australia @Girlie's mom may have looked into that.

Other options are to use a rule to help you dose, there's one on the board that is printable(I'll see if I can locate it for you, just can't find it right now), or to dose with calipers

The Ziwipeak dry is a better choice than the Royal Canin Diabetic from a carb stand point, and I can see that having them graze on wet food might seem problematic, however, that said some members have found ways round that, by freezing food and having it thaw for example, that way they have something fresh to nibble on, or if flies are a problem in the summer, there are some feeders with movement sensors or microchip sensors that only open up when kitty approaches bowl. Some friends of mine use this type of feeder to free feed their kitty(Sadie's a grazer) wet food it keeps the flies out and the food fresh because it's covered only opens up when cat approaches and closes when they move away https://www.surepetcare.com/en-us/pet-feeder/sealed-pet-bowl, it's more economical than the microchip version, though that has the advantage that the right cat will get the right food, if you are feeding them a different diet.

Staying hydrated is really important for any cat and even more so for a diabetic cat, wo's kidneys are already working overtime, having a wet diet helps you achieve this more readily. I used to feed dry for many years, but after what I have learned with my George here and with other research I have become a convert and now all my cats get a wet high protein low carb diet. If you haven't already seen this post by Dr Lisa I'd recommend reading it, there are lots of tips there on how to keep the wet food fresh
http://www.felinediabetes.com/FDMB/threads/dry-food-please-consider-more-than-just-carbohydrate-content.175004/

 

Yes I have the 0.3ml syringes for use with 100unit insulin, but it only has 1 unit marks, which is why I am going up and down in 0.5unit increments. I'll look into getting some with the half units, might need to look to buying overseas for this. I gave him only 1 unit last night and same again this morning. So far he has been good and I got two night readings so his low was 4.1 (where i tested), not sure if he went lower?

 

Great job getting those pm tests last night.

He certainly has a dramatic flair, he likes to drop fast and low.
Because Lantus is a depot type insulin, (if I ignore the food change for now) the lower numbers you saw last night may still be a result of the depot that built up on the larger dose he has been on. Every time we make a dose change it takes the depot a while to catch up. The size of the depot is related to the size of the dose, the larger the dose the larger the depot. When we reduce a dose the depot has to empty a bit to get in line with the new dose this may take 4 to 6 cycles, again this is dependent on cat and on the size of the dose, the larger the dose, the longer it will take for the depot to catch up. So when we reduce a dose, we don't immediately see an effect on the numbers, and we may still need to be vigilant if the previous dose has taken kitty into low numbers.
(the converse is true for dose increases, and is one of the reasons we hold on to doses for the most part for at least 6 cycles, because until the depot is full and stabilised we won't see the full effect of the new increased dose)


Of course, there is the added complication of the food change here.
But FWIW I would have held the dose like you did today, shooting consistently works best with lantus so I would stick with the 1u unless the numbers tell you different, while he is hitting blue and green midcycle, I would ignore those red pre shots of his. Base your dosing decisions on how low the dose is getting him. You are getting a great spread of data, so that helps tremendously when you have to make those decisions.

I'm going to tag another member from Australia, I seem to remember she got hold of some syringes with 0.5u markings, she's not on the board much now, her kitty went OTJ @Tara & Ivana I'm not sure if she bought them from overseas of if she had someone send them to her. (thanks Tara)

 

...if you want remission WET FOOD DIET is your best bet!!!

...in fact you may have to reduce insulin because of it right off the bat... testing will show you that and will be very encouraging- I have Siamese mix...in remission - food was key!!! Use the food lists provided to you

Truly food is key... along with getting glucose down in the blood stream using insulin and letting the pancreas heal!!!

Peeps here will help tremendously!!!

 

Sorry for the delay in my reply! My computer at home is still giving me problems, and work is pretty flat out.

I get my 1/2 unit syringes (BD Microfine Insulin Syringes 0.3 ml (pack of 100) from Hyperdrug UK: https://www.hyperdrug.co.uk/BD-Micr...03ml-pack-of-100/Productinfo/BDMICROFINE03ML/

I order several boxes in one go; just use their delivery service; and they arrive within about a week in Australia. They're great! Shorter and Girlie likes them better. And they work with the insulin ruler as well.

I've attached the Management of diabetic cats document, which is great for info about dosing, the TR protocol, use of the insulin ruler, etc. It's linked to on the TR sticky: http://www.felinediabetes.com/FDMB/threads/lantus-levemir-tight-regulation-protocol-tr.1581/

Important sticky re drawing doses: http://www.felinediabetes.com/FDMB/...insulin-info-handling-drawing-fine-doses.151/

 

I can actually help with that

I'm in New Zealand @Beckyboo . We cannot get those 1/2 mark syringes directly either in New Zealand or Australia & what one can buy from Oz/NZ costs plenty.

I bought two boxes (200 syringes) of 1/2 mark (demi)syringes from Hyperdrug Pet Supplies UK. <------- click the link
They arrived quite promptly to me so would likely arrive even more timely to you.

You order online and they send you an email to check you are OK about the postage costs. Once that is OKd they take payment and mail to you.

HTH



edit....
snap @Girlie's mom

 

Just ordered 2 boxes for him. Thanks guys

 

If anyone is up now I have posted a new thread re Zorro's BG this morning - not sure what to do?