? A little help?? Feeling a bit frustrated

So it seems I am going backwards with Sketch. When first diagnosed I changed his diet to all wet low carb and his #'s dropped from high 400 and low 500s to mid 300's to low 400's. With no further drop the decision was made 4/4/17 to start the insulin (lantus) @ 1 unit once a day. (SLGS) His #'s stayed in the mid 300's. After consulting the vet we went to 1.25 units twice a day 4/30/17. Numbers went up to mid 300s to mid 400's. Again consulted with vet and increased dose to 1.5 u twice a day on 5/13/17. Again numbers increased and some symptoms got worse (drinking mostly and energy dropped) One time on 5/17 I thought maybe he was going Hypo so I tested him about an hour after his shot and dinner meal and it was 559 which I just wanted to make sure he wasn't crashing and knew he had eaten and numbers could be driven up partially by that. Checked him the next morning 5/18 before shot and he was 561 (highest I've seen since home testing) although he had some food left out so I'm not sure when he ate it and he was at the end of the Lantus cycle....just wanted to make sure he wasn't low before shooting. Later that afternoon about 9 hrs after shot and 3.5 after food he was 433. Today 7.5 hrs after shot and 5.5 after meal he was 427.
He had a vet visit this past Monday after and altercation with another cat and got a long acting antibiotic shot. He was also partially sedated for examining as he's a tough cat for the vet to deal with but that also gave them the opp to draw some blood and do a fructosamine test which the results came back today @ 650 so very high. The vet (who I have total faith in) reviewed Sketch's BG test data and has recommended increasing dose to 2 units twice a day. I mentioned he has seemed to be down on energy and drinking more but eating has been normal (good). I've checked the areas where he had a couple minor bites but everything looks ok. The vet thinks the lack of energy is probably due to the higher #'s which would make sense.
Has anyone run into the increasing #'s while increasing dosage or does anyone want to offer their advice???
I'm wondering even though the Lantus pen I am dosing from is only 40 days old and been refrigerated if it could be loosing potency???

 

Hi Jeff,

I don't see a spreadsheet - do you have one? It is easier to see the trends and to see how low of a dose takes him during the cycle. I can say in my case - my numbers went up with the increased insulin dose when I was not testing enough to know how low Jones was going and I was giving too much!

 

Tracy thanks for your reply....I don't have the spreadsheet that the site provides. Sketch is a difficult indoor / outdoor cat. The tests I have performed and have on my records are usually close to the supposed midway of the lantus cycles and mostly at least 3.5 to 5 hrs after food. So I have tried to replicate time in cycle and meal time as close as possible for some consistency when he is avail to test. It just is frustrating instead of getting him closer to regulated I seem to be getting further away and I can see he doesn't feel as well...tired and less energy. His numbers were lower with just his diet change before insulin.

 

I wish I had an early on fructosamine test # to compare to the 650 test this week. It would be interesting to see if there was an increase relevant to the BG increase I have seen associated with the lantus dose increase.

 

I hope someone with more experience comes by but I am thinking even the 1 unit was too much, especially if you can't get those tests in to see where he is at. The nadir can move just to add some extra mystery to the experience. Jones has moved from anywhere from +5 to +12.

ETA: I am not an expert!

 

Does the insulin look cloudy or have little floaties in it?

 

Jeff it is a big help to others to give dosing suggestions if you had a spreadsheet. For instance, your mentioning all high numbers but do you ever get numbers in the 200's or less.

He could be a cat needing high dose shots. There are a few, and if that's the case you definitely need advice from someone successfully dealing with it. Even though the acromegaly board doesn't get much traffic, if you made a post on it looking for help it would probably stand out to those dealing with high doses and they might be able to help you realize if your likely a high dose need. If so you'll most likely need to increase quicker and test frequently doing so, and for that you definitely need an experienced high doser to help. But getting that spreadsheet going is important to help them help you.

So my advice is post on the acromegaly board and get the speadsheet going.

 

With high numbers you definitely want to be testing for ketones frequently.

 

Thanks for your input. Have never seen #'s in the 200's. 314 is the lowest I've seen and he was on a lower dose then. I understand what you are saying regarding the spreadsheet but as I have mentioned previously Sketch is a difficult cat to test. I have been fortunate to be able to give him his injections with less resistance. Until a year or so ago he couldn't even be picked up. Now I am the only one that can pick him up and handle him. I am a bit concerned if every time I am picking him up I am sticking him it will break the trust he has built up in me. So testing every couple hours for an accurate spreadsheet curve as many of you with more tranquil cats are able to obtain is probably not going to be possible. If I can get two tests a day and two injections a day that may be the best I can hope for and all the data I'll have to work off of.

 

Since he goes outside, are you certain he's not getting into any other food?

 

Good question! But I've talked to all the neighbors that have cats in the area and according to them non of them free feed outdoors. But its always a possibility.

 

Many cats begin to like being tested, especially if they get fed or treats immediately after. I would say I test usually 5-8 times in a day and well over 95 % of the time he shows up on his own. I just grab the test kit and unzipper it.

Basically insulin can kill or seriously hurt a cat. Might even be the next shot that does it and without testing your at a big disadvantage in preventing it. Especially if your cat came to need high doses. Many of those cats are well over 10 units twice a day. But if you don't get sufficient insulin in your cat the high sugar will lead to something fatal.

Even showing two weeks of spreadsheet test data results of just three tests a day (the two preshots and a random test either in am or pm cycle in the 2nd to 6th hour after one of those shots) would be a big help to someone trying to help you.

I would say for now, that if you decide to increase that you only do so in 1/4 units and hold for a week. That's what you do under the SLGS protocol. The 1/2 unit increase is too much at a low dose unless special circumstances apply, such as immediate danger from presence of ketones or your cat was identified as a high dose cat that needed to go up faster.

Tight Regulation protocol would allow you to increase more quickly but do that method safely you need frequent tests each day.

So if you do decide to increase just up it to 1.75 and at least visually monitor him at +2, +4, and +6 or something approximate to that.

 

So what you are recommending is to disregard the vet recommendation to increase from 1.5 to 2.o units even though his fructosamin test was 650 and his BG numbers from the tests I've gotten this week are over 400 with two in the mid500'S?
He does get treats after testing and shots.....but I'm not sure he's going to be like your cat and look forward to it!!! lol
I'll work on seeing if I can get 3 tests a day

 

Not cloudy and don't see any floatees....but have just oedered a fresh pen just in case

 

Try and get the tests on slightly diferent hours every day to try and fill in the blanks just that may help figure out whats going on

 

Yeah half unit increase is too much, if you were to test using minimum requirements for Tight Regulation protocol you could increase 1/4 now and another quarter three days from now if still needed.

You also should read the sticky posts about what you should have on hand for your emergency hypo kit. Something high-sugar in a syrup, several cans of something like fancy feast gravy-lovers, about 20 test strips, and know the location and phone numbers of the closest 24 hour ER vet. Eventually you will have a need to quickly bring his blood sugar up.

 

When I started dosing my cat I was going to test less frequently than what you are doing. Was just going to do a curve once a week on the weekend.

 

I resisted the spreadsheet for all of 2 days once I began testing and insulin. I tried other phone apps, and they just weren't what I wanted. They know what they are doing in here, and the spreadsheet is easy. I have it on both my spouse and my phone as editable, so we can both keep track and administer care.
So even if you were just testing at insulin times the spreadsheet is handy for a history.
As a side note, my stubborn grouchy 'ol gal comes running (and she's a big girl, she didn't run anywhere), yes running when I reach for the test kit. I am using the Fancy feast one ingredient salmon treats. They are individually wrapped and I keep several in the kit. I hope it goes as smoothly for yours and you can get him feeling better faster and allow you to get some data.

 

Yes...I have hypo kit on sight. Karo, maple, syringe, test strips and tester will get some FF gravy lovers tomorrow but have some high carb wet and dry on hand (what he used to eat.)
Just wondering how many units are actually considered "high dose"?? I got the feeling that my vet didn't consider Sketch to be a high dose cat at 2.0 units and thought that was still pretty conservative. Advised it would probably take a week to reflect in testing...obviously if I observed him acting strangely then to test to see how low he may have gone. But again given the vets demeanor and no over cautioning about the increase causing a crash I didn't get the feeling that given his numbers this was a big jump or high dose.

 

Was able to sneak up and get a pre bedtime test. Sketch had 2.0 units at 6:15pm its now 11:35pm...he had his pre bed meal about a half hour ago his BG is 361 now so down a bit from the 427 earlier today and just about in the middle of the evening Lantus cycle...he had some treats and went back to bed...he wasn't happy I woke him up to poke his ear but based on what you were telling me about jumping his dose I was a bit worried.

 

Glad you got the test in last night! Be sure you are completely relaxed when you test. If you're thinking he doesn't like this, you may be projecting your nerves to Sketch. We don't worry about a high dose cat until you hit 6u BID. I've seen many cats get to 5+u before they hit the right dose. Many then came down in dose and even went OTJ, so don't lose hope.

 

Jeff, I didn't test much when I first started a year ago but I was getting a lot of 300 or higher tests. Boo is a big cat, long, tall, 20 lbs and not overweight now. And I quickly had him to 1.5 units for a bit. A year later and he's never been over 2 and that wasn't long. If you look at my US 16 tab on my spreadsheet and look at the results I was getting, they aren't too different than what your getting now.

a month later and he's hitting green test numbers at the same 1.5 dose as he was getting pinks and reds a month before.By September he's hitting a 38 at +2 at a 1.75 dose. So all cats are different and there is no reason to believe your cat follows same path as mine. But you can kind of sense if I had risen to 2 units and did little testing, maybe my cat would have died sometime around there, or even before, right?

The SLGS stands for Start Low and GO SLOW. There's reasoning behind why its safe to test lightly with it and not with the Tight Regulation. Its similar in fashion to driving a car, cars can kill, however you can drive safe or drive dangerously close to killing yourself or others.

Cats can bounce off of low numbers to them, not just low numbers like 50 or 60. So a number like 275 or 300 could be causing your cat to be uncomfortable and try to manufacture sugar itself. Its like Tracey&Jones was saying about maybe the dose being too high already. The higher numbers may indicate a bounce from uncomfortable numbers, and an increase is causing a higher bounce.

Maybe its that or maybe its not enough insulin. Your cat needs time to adjust to dosages. Maybe the 1.5 was too much and now 1.75 would be too much even more. The 2 could actually be crazy high. There are many cat owners here posting for advice during hypos following the vet advice. Some of those cats die. The night before new years eve just past. Three cats had hypo scares, one of those cats died.

There are many people here that are glad they departed from their vets advice. Insulin can save your cats life, it can else end it, or leave him deaf or blind. If your cat had ketone problems there would be a need to rush to lower test levels.

 

Good morning...Thanks again for your advice and I understand what you are saying. I think that I will in fact cut his dose back after studying the test results I've had since he was diagnosed and started home testing. His numbers were somewhat steady although higher in the 300's but not in the high 400's and 500's but #'s started increasing with dosage increase to 1.5 U twice a day. Then last night to 2.o U despite his # dropping to 361 @test last night which I've never tested at that time before. So since I've heard cats often go lower at night maybe that was a result of the hour of the test and not the increase. So at this point I think I will drop back to 1 unit twice a day for a week and attempt to test 3 times a day plus see how he seems to feel. Thinking possibly as has been mentioned that maybe I skipped past the ideal dose for him and he is bouncing. Would love to get this guy regulated and know he is feeling better. Frustrating to feel I'm going backwards despite trying to be relatively vigilant of his treatment. Thanks to all and I will keep you posted going forward.

 

Your not really going backwards. I myself in your situation might just drop to 1.25 for the weekend. Can you do a mini curve such as 2,4,6 or 3,5,7 for a day or two? I'm not sure if you mentioned ketone test results. Whether he has ketone issues or not would determine how much risk you might take trying to drop his bg levels.

 

I forgot about my other question. Are you certain that your low-carb wet food is actually low-carb. What is it your actually feeding?

 

Also, it wouldn't scare me to increase to 1.75 units if you were to always get preshots, +2 and +4's and be ready,willing, and able to battle low sugar levels for an entire cycle or more if low sugar did result. If you did that for a week you would know better if you were too high or too low. My hunch is that 1.75 is needed, but then again maybe you were already too high. Frequent testing with needed intervention measures taken if needed as I mentioned would keep him safe if you were too high.

If you can't be sure you would be alerted and be able to intervene, the slgs protocol is my best suggestion for you to follow.

 

Feeding FF classic, Friskies Pate's both on the 2017 list as low carb...and some Rad Cat raw (but very expensive so every other week he get some and loves it)

 

But to be fair he is outdoors a good portion of the day by his choice so as someone pointed out maybe he is finding an additional food source. I mentioned that I have spoken with my neighbors that have cats and they aren't free feeding their cats where the food would be available to Sketch...however he does have a large territory so can't 100% guarantee he doesn't have an alternative source.

 

I would start working on your concerns of your cat getting freaked out by testing. That seems to be the main issue holding you back from taking the quicker to regulation route of the Tight Regulation protocol. I can't guarantee it, but if you always feed him or give him treats(even 10-12 pieces of high carb kibble) after a test; I think he will come voluntarily to the test if he hears any sounds hinting a test is coming up.

Once he starts willingly showing up to tests than there is nothing but your own availability holding you back from a quicker regulation.

However, the SLGS method should get you close to where you need to be in a reasonable amount of time. You need to be aware of ketones happening or not though especially with numbers over 300.

 

Yes working on it with his fav treat sliced turkey.....have been able to test him a couple times daily for the last few days. Have started FDMB spread sheet and will try to test at diff +#'s to try to get a clearer picture and then share it on signature. Went with 1.25 Units tonight. I will have to ask vet regarding ketones as to the results to the urine sample.

 

You can get urine testing strips at most pharmacies. I've never used them, instead I got a free Freestyle Precision Neo from the abbot diabetes canadian website, which can also use ketone test strips for blood. However they are $2.50 cdn a piece here. I only test once a month because he never tested even at a trace amount. Until last week, he tested 0.6 which is the low number suggesting trace ketones. So i tested again today and got 0.5. which is close but still under the threshhold trace level.

Are you able to get your spreadsheet to allow public viewing. If so, placing a link to it in your signature could be helpful to others when offering you some guidance.

Also, your frustrations aren't going to end when you get your cat into better numbers. I'm a year into this and just like you my numbers were trending up so i've been micro increasing the past two weeks and the numbers still get worse and not better. But the big picture with Boo is good, he is much heathier then when he was diagnosed he went from an overwieght 30 lb cat to a scrawny 13 pounder in just months. Now he's healthier(20 lbs) and drinks almost never as opposed to gulping water almost continuously.

 

I'm really glad he's liking the treats enough to get you some extra tests!
If you'll be doing a bit of testing it might be a good idea to get the neosporin with the pain relief (I'm pretty sure I saw Yong suggest it somewhere on these boards). That will allow the treats to keep working well
I'm still working on getting data that will help out my kitty too, so good luck to us both!

 

Many people get good results with the neosporin for the ears. I got some for Boo thinking he would benefit from it. I've applied it four times to date. And each time we went from me being his best friend to him absolutely hating me.

 

Yikes that's terrible BabyBoo! Do you have an alternative that works for you instead? So far Fabby has been distracted enough by the salmon treat that I could do anything right then... (I wait until after to give her the treat.)

 

Usually Boo's ears stop bleeding within 5 seconds of the test with paper towel compressed and two hours later when I retest there is no visible mark. He never shows any signs that his ears are bothered. However once a month or so I notice an ear prick or two hangs around with a bit of redness so I feel I should put something on his ears to ward off infection. Its tough love time then, he doesn't like it and he walks away ignoring me. He gets over it though the very next time he's hungry, I am his best buddy again.

 

When I get some more data (maybe a week) I'll link the SS for public viewing in my signature. Right now it only has three days worth with two tests each day at varying + #s. I have older tests like once every few days but don't think they are relative for whats going on now. Starting tomorrow I'm going to shoot for three tests a day.
I know this process is always in flux but once I can get to see some improvement or control I will feel better.

 

I've used the neosporin with pain relief with no problems, but others have had some issues with allergic reactions. Here's a recent thread with a little info
http://www.felinediabetes.com/FDMB/threads/neosporin-pain-relief.172215/

 

Jeff, have you considered possibly going with the TR prtocol for a few weeks or maybe a month, then scale back to doing less testing and use the SLGS method at that point. You most likely would get to a closer to regulated point much faster. For instance if you do start back with 1.25 units and only increase after a week it will be four weeks until you have a weeks worth of data on 2 units. Which is what your vet suggested, and my hunch is your probably going to need to get to that point as well.

However, with the TR protocol, if Sketch is a big 20 pounder like Boo you would actually start at about 2 units and be doing so with a safe method because of the increased testing and monitoring used. Here's the starting dose guideline from the TR sticky post guidelines.

STARTING DOSE:
The weight based formula for determining a starting dose of Lantus or Levemir when following the Tight Regulation Protocol:

• the formula is 0.25 unit per kg of the cat's ideal weight
• if kitty is underweight, the formula frequently used is 0.25 unit per kg of kitty's actual weight
• if the cat was previously on another insulin, the starting dose should be increased or decreased by taking prior data into consideration

 

Reading this sticky post may help convince you that the TR method is doable for you for at least a month.
http://www.felinediabetes.com/FDMB/...ion-possible-with-a-full-time-job-yes.129378/

 

Yes...I had read that formula on the Lantus page....Sketch is right @12.2lbs....not over or under. so given that converted to kg = 5.53kg x .25=1.38U. He had started at 1.0U then raised to 1.25 then to 1.5U and I think the vet felt that with the two higher BG tests and Fructosamine test (650) the bump to 2.0u would be the way to. I want to confirm a few things with the vet next week before edging back up to that dose and hopefully have something closer to a curve going in the testing that will support it.
The hard part is as I previously mentioned Sketch is indoor/outdoor (and very insistent on being outdoors in good weather) so he's difficult to monitor. I keep him in at night so early morning is best for his test and shot before he goes out at about 6:15AM....then he will sometimes show up early afternoon for a snack which is another opportunity if I'm around....then dinner time for his evening shot and poss test...then he comes in for the night around 10PM so poss evening test.
I have taken the new approach to trying to get him to show up at regular times by using treats. If it was still winter it would make it easier to form a regular protocol because he spends most the time indoors then both day and night!
I went with 1.25U again this AM and waiting for a poss +4 opportunity.
Thanks again for your input.

 

Hi wishing you a nice sunday, I suggest you put the SS in your signature even if it only has a few test in it, every bit of information helps and it will help everyone to know what's going on, hey 3 days of information is quite a bit. you are doing great with the testing considering he comes and goes, and do consider that the SLGS protocol also works so if you can't get enough tests for TG go for the SLSG and since you are able to get some extra tests besides the preshoots even if you cant' keep him around for a full curve every week (get as many as you can on curve day though ) , the extra tests will help.

With Babu even though I had him lets say at my mercy for a curve, since he was a diver and a bouncer often on the weekends when I could do it ( I work full time) the curve was not much good since he would of course be clearing the bounce ( part of being a cat, since he is an indoor cat he couldn't sabotage the curve by going away, he then managed to bounce it) , so those in between tests at different hours during the week helped me a lot

 

Got two tests today at +3 (403) and +9 (463) after his 1.25 units this morning. Gave another 1.25U at 6:15 tonight and will try to test +5 tonight again (I'm hoping that may be around his nadir) Will probably have enough data to attach the SS to signature tomorrow . May move him back up to 1.5U in another few days if he stays in the 300s or 400s and see if he bounces

 

You've done a great job so far do attach the SS to your signature it will make it easier for everyone to monitor him.

As for the bounce it happens when the kitty either goes very low or has a big drop even if the number is not very low for example for a kitty that has been having numbers around 400's getting to 250 or 300 specially if it is a fast drop can be interpreted by his body as too low since he is not used to lower numbers and then after dropping he may bounce (not all kitties bounce) then is when you'll see very high numbers again.

Hope this makes sense