Advice on next steps - what point to start insulin? (not urgent)

Brief history and where to go from here:

Fed ALL dry 2011-2017

Dec 2017 - cat in for dental, BG mid 100’s, all good, 9.5 lbs I think? Little chunky for her.

Put her on pate after dental to allow mouth to heal
After mouth healed, started back on dry left out 24/7, supplementing with wet in am and pm (low carb, just by chance)

9/1/18 - BG 254 (venous draw) at routine visit, vet said little high, but could be stress, recheck in 30 days or so, 8.25 lbs

12/13/18 - BG 312 (venous draw) at recheck, vet said since still rising let’s do fructosamine, came back 572 from same venous draw sample, no ketones in urine, down to 7 lbs., too skinny for her. Vet wanted to start Lantus.

Did research before starting insulin and found this site HOORAY!!!

12/19/18 - told vet I wanted to switch to all wet low carb and recheck BG before starting insulin, she is good with that and to check BG in a week. Started all wet low carb 12/19.

Within a day or two of taking away dry, urine output reduced and not drinking as much. Eating a lot, small meals every 3 hours or so.

12/27/18 - after eight days on all wet, low carb, able to get a home BG reading today for first time! (took sample 2 hours after meal) it came back 283 on Alphatrack 2. Not sure if that could be higher due to only 2 hours after food ? Had to bribe her with some canned salmon while testing and a big drop of blood dropped from her ear, fell to the plate, it happened so fast, just pulled the plate and touched meter to blood drop because cat was now gone and easier to get sample from plate than catch cat (90% sure blood landed on clean part of plate). Hey, it was my first success at getting blood, after yesterday’s fail.
Called vet’s and spoke with office manager. Should I still come in for BG there and talk to different vet (mine on vacation) about starting insulin now after diet change? Told her cat was at 283, down from 312 two weeks ago at vet (that was venous draw, though). She thought it may be okay to wait another week on low carb and see if any more improvement as long as I am checking her at home now and wait to talk to my regular vet who is back Jan 8. If she starts going higher, then call them.

What do you guys think? Is under 300 low enough to wait another week before starting insulin and see if I can get a few more samples for a better idea of where she really is? I don’t want to wait too long for kitty’s sake, but also don’t want to start her on a higher dose if there is a chance she may come down a little more with diet alone for another week.

How much difference in a venous draw and home test unit numbers? Maybe I should get another venous draw to compare to the 312, so comparing apples to apples?

Will try to get BG with longer fasting time, but she is eating about every 3 hours, even overnight she only goes 5 hours before she wakes me up at 3am. At 3am I am not up for testing, I can barely find the kitchen, lol.

Thanks so much for any input.

 

If she's been on low carb canned for a week, it's time to start insulin. Another week isn't going to make that much difference. As for the starting dose, we can help with that. Most vets start too high anyway. Do you have a more current weight or do you think 7lbs is about right?

Not necessary....blood is blood.

You might want to consider getting an auto-feeder like the PetSafe5....you can program it to open at 3am so you don't have to get up and find your way to the kitchen!! It's also great if you have to leave sometime for an appointment or something because you can have it open up to 5 times to offer food.

Trust me on this though....you'll get to the point where you can test without really waking up. I "sleep-tested" China quite often and the only way I know I tested her was because of the meter saving the test results!

 

Your AT meter should read fairly close to the vet's meter. Venous blood versus ear or paw prick shouldn't make much, if any, difference. Those two numbers are very similar wrt overall BG level.

Could you take away all food for about two hours prior to a meal. That should give a decent indication of how she runs.

If she's fully switched to all wet low carb food, those numbers indicate that she would benefit from some insulin support.

 

Thanks. She was actually 6.9 lbs at vet 2 weeks ago, but I have been feeding her more the last week on the wet and hoping to fatten her up a bit. I don't have a scale at home. I don't think she has lost any and from picking her up am guessing she may have put on a small amount, so I'd say 7 lbs. is pretty close.

Before I started low carb, vet wanted 1.0 1x/ day for a week to start. I know from talking to people here it is best to do 2x / day. I also read either on this board or somewhere else that if they are already on low carb wet diet the normal starting is .5 BID. Not sure if that still holds true for a 7 lb. cat, that is kind of small compared to a lot of diabetic cats that sometimes are overweight when they start treatment. I would feel safer starting her on the lowest dose possible, I don't think anything over .5 BID would be good. Also, from what I understand, her numbers are not terribly high at this point, I'd rather be safe than sorry on the dosing.

I am going to Walgreens tomorrow to see if I can use a discount prescription card for a Lantus pen, that is the only pharmacy in the area that will split a box of pens. If not, I will be ordering a vial from Marks Marine and that will take 5 days to get to me.

 

If you do, you're better off getting the pens....not only do they not break when you drop them like vials, each pen only holds 300 units (a vial is 1000) so you're able to use every drop. With the vials, unless your cat is on a pretty high dose, it's going to lose efficacy before you can use it all...and nobody likes throwing half a vial away!

Yeah, that looks good.....the starting dose is usually based on weight and that would be .75 for a 7lb cat, but we usually suggest starting a little lower.

You should also read the sticky's and be thinking about which dosing method you want to use. Tight Regulation gives the best chance at remission, but requires a little more in the way of testing. Doses can be increased as often as every 3 days if it's not getting them where we want them (after the original 5-7 days to fill the depot) . Reductions are earned if they drop below 50 (on a human meter)

Start Low, Go Slow is the other dosing method, but you'd hold the dose for at least 7 days which can leave them in higher numbers longer than we'd like, but doesn't require quite as much testing. You'd do a curve (testing every 2 hours for 12 hours) at least once a week. Reductions are earned when they drop below 90. It's also the only option if you're feeding any dry food at all.

It matters which one you use because our advice is based on the dosing method. You can change from one to the other if it's not a good fit though.

 

She's not getting any dry anymore since I changed her diet. I would prefer to test as little as possible. I am currently out of work, but I will hopefully find a job soon and if it is not really close, I will not be able to come home at lunch. Hopefully I will If I find a job less than 10 miles away, which I always have in the past, and could pop home during lunch if necessary to check on her, but that is not a given.

 

Was able to test after 5 hour fast this morning BG 257. The salmon trick only worked once, she figured out what was going on today, so had to round her up a couple times, and mild struggling, she was a little stressed for 5 minutes before test, so this number probably higher than true number due to stress.

I am encouraged because todays is 26 points lower than yesterday’s sample which was 2 hour fast, although yesterday was less stress before I poked her as she was unaware what I was doing.

My biggest problem is I am hesitating to stick her because it’s too hard to get the edge, this hesitation is alerting her and she tries to leave testing area while I am trying to locate and hit the perfect spot before she moves her head. I got on 3rd try today, the first 2 I hit the air. I am not holding her ear because that just alerts her to what I’m doing and she starts struggling. I am trying to line up lancet and quickly stick her without holding ear, and if she moves her head slightly, I hit air or further in on the ear. If I could do a 1/4 inch in from the ear edge, just inside the vein rather than outside edge, it would be much easier and I think less stressful for cat because it would be quick. That is where I got her yesterday by accident because she moved her head. Today I got outside edge on opposite ear, but again it was more by chance where the lancet hit.

The waiting to poke her and her trying to get away is causing stress, so I can’t really trust these home numbers are going to be accurate.

Anyway looks like fasting is 257 (probably actually lower). I know stress can raise BG considerably, looked at a study where stress spiked it 80 points or more even if they are just stressed for 5-10 minutes before blood draw.

She also has FIV which means her mouth is worse than a normal cat. Last dental was a year ago (5 teeth pulled). If she is having gum inflammation (likely) that could also account for part of raised BG from what I have read? Although she went several years before last dental (she was eating fine and I was really scared to put her under) and her sugar levels were always normal and not affected by gum inflammation then and her mouth was a lot worse than it is now.

 

Have you seen this? http://www.felinediabetes.com/FDMB/threads/hometesting-links-and-tips.287/

 

Frank had FIV and we had the issue with the mouth infection. He was never well enough for a dental, so we had to juggle infection/diabetes. We got to where we could tell by his behavior and BGs if he was having issues. Ideally, we would have just had the teeth removed. You work with what you got, though. We took him in as a stray and he was a total train wreck. He was approx. 15 when he was diagnosed. We had him another three years.

 

Some but not all, I will check it out. Thx!

 

If she's resisting having her ear tested, try a non-weight-bearing paw pad. Some cats just hate having their ears touched. Another suggestion would be to wrap her up in a towel like a burrito. I have to do that for Oliver's shots. 20-30 seconds of stress from being burritoed is way better for her than a couple of minutes of stress while you try to chase her around and hold her down just to get an itty bitty bit of blood.

You'll both get the hang of all of this, it'll just take some time, then something as simple as a routine BG test will become almost second nature.

 

I hear ya. Honey was a stray for her first 3-4 years before I took her in. Pregnant over and over, outside, had fleas and FIV. Poor little monkey was in sad shape. We can only deal with what they came with and try to make their lives better from there. At least I know she has a much better life now.

 

Thanks, yes burrito kitty was mentioned. Paws are not good for her, I know from nail trims. Ears will be best once I find a way that works best for her and her quirks.