Another newbie: Felix

Felix our ADD kitty as I've always called him was diagnosed 10-02 and vet started him on 1u twice a day of Humulin N and sent us home.

About three months ago we switched his diet from FF Classics over to the shreds with the gravy. Of course once home I started researching what was ahead for our lil guy and us and stumbled upon this website. Many thanks to all who run and contribute because it's already been a wealth of information in just two short days. First of course was to get him back on his FF Classics, which he always loved anyway and already has transitioned back to them without a hitch in the eating department. We've also stopped all dry food for everyone and all seem ok with a little extra helping of Pate for lunch. Since I believe I've read every single thing I could find on this site I realized the transition to the low carb wet food should make a huge improvement on it's own, therefore I was worried about possibly going too low this first week with all the changes and insulin at the same time and ran out and bought a Relion meter, and ketone test strips.

Now we've got a follow up with the vet on the 7th and I'll address several questions I've already come up with from reading this site. First and foremost the in the insulin he chose. But in the mean time I have a couple questions I'm hoping can be answered here.

We're running BG test's prior to all shots and he doesn't mind the ear pricks too much, a little chicken treat seems to keep him from getting too upset about them. Most mornings he's running between 309-360 prior to his shot and breakfast. We've been giving his shot while eating as it's a good distraction and he doesn't even seem to notice. We haven't attempted a curve yet but have done a couple +2's just to make sure we were actually getting the shot in and not just on him. And they've been 252-280 so figure this is showing us the insulin is working at least. I know those are still high but as I've said those are strictly +2 checks, I'm guessing the +4 and maybe +6 would be lower. Just not sure when into this treatment we should consider attempting a true curve. I assume there needs to be a little time on the insulin to give it and him a chance to get used to it and everything to settle down.

My biggest concern at the moment is his reactions after the shot and eating. He's more like his old self right before we feed him which would be his highest BG#'s. Once fed and given his shot he seems to be rather lethargic. He's still grooming pretty much as always, but just wants to lay around and more or less be left alone. He's not hiding or running away, just not always looking for a lap to lay in (and he's always been a lap kitty) and just plops down on the floor, (very unlike him). Is this pretty normal with all the new stuff going on in his body?

Finally tested for ketones this morning after breakfast and the test strip showed "trace". Again, anything to be worried about at this time? Am I rushing everything and just need to chill for a few days?

Thanks again to all that run and contribute to this site. I'm amazed and what I've been able to learn in a few short days.

 

Congrats on testing! That is a hurdle for many.
You need to see how low he is going with the Humulin N. That happens around +3 to +4 hours after the shot. It should be above 50 mg/dL on a human glucometer.

 

Welcome! You are doing a great job = getting hometesting down and changing the diet. The only thing that is not ideal is the insulin. As you have probably read, regulation is difficult to impossible with Humulin as it has a fast, harsh onset and doesn't usually a full 12 hour cycle. Increasing often results in deeper harsher cycles without improving the numbers overall.

I agree with BJ. I'd get some numbers in the 4-8 hour range. He may be dropping low at some point and then bouncing back up by the next preshot. Not only do the low numbers make them feel lethargic but the roller coaster from low to high can make them feel awful.

You don't need the vet to do a curve, if that is what they are suggesting. Most cats are very stressed at the vet and stress raises blood glucose levels, so the numbers they get are usually inflated, often 100 points higher. If doses are based on those numbers, then increases can be too much. You can do the curve at home and send them the results.

The trace ketones is a little worrying. I'd add some water to the food to make a kind of gravy. Hydrating often helps with the ketone issues. But keep a close eye on him. The lethargy and the trace reading could be a warning. I'd get several ketone readings a day, make sure he is eating well and shows no sign of infection of any kind (the 3 things that can cause DKA are in appetite, infection and too little insulin. It is hard to tell about the insulin dose at this early stage and cats hide infections so you want to stay on top of the ketone testing.)

 

Thanks for the info and all the encouraging words.

Got Felix set up and populated a spreadsheet for him. Not a lot of numbers at this time but right off the bat looking like the Humulin N is doing just as everyone here says. Quick harsh drop then doesn't last long. We'll discuss this with the vet on Tue. The wife got several BG's done during the morning yesterday as well as ketone tests (which all showed clear) and we decided to give him a little break from the testing after the PM feeding and shot but will try to get a full 12hr curve this morning and see where we are exactly.

I'm guessing the quick rise and fall is whats causing his mood swings. About 6 hours after the shots till the next he's pretty much his old nutty self. Then once feeding and the shot are done he's a totally different cat, lazy somewhat withdrawn, etc. And I know, cats will be cats, but it's just not normal for this one. We jokingly call him our ADD cat because he has always been such a spaz, but that's why we love him.

Didn't mention it in the first post but he was diagnosed with feline herpes upon his rescue from the shelter 7 years ago and has been on Lysine ever since. The vet didn't think this would be an issue and so far doesn't seem to be that we can tell.

I'm sure there will be more questions and again, thanks to all for this great site and information. It should be mandatory for every vet to prescribe this site to any owner who's cat is diagnosed with diabetes...

 

Until you can (hopefully) get another insulin, I think I'd try to get his numbers a little lower. It'll be tricky because you want to be sure the nadir isn't too low and still try to get that preshot out of the reds. (the bouncing aspect will make this hard, but I think worth a try). What would you think about giving this dose another cycle or two and then, if he is still in the reds for preshot and in the 200s for nadir, when you can monitor at least for that +3-6 period, up the dose to 1.25 or 1.5? Even though you might not ever get him in great numbers with Humulin, it would be good if he was not running so high - especially with the Ketone possibility. The best scenerio is that he is just getting used to the low carb and insulin working together and will drop in a safer overall range on his own, but if he doesn't......

We generally say a cat is regulated if they are in the lower to mid 200s at preshot and in double digits at nadir (but not below 50 which is approaching hypo territory). And we think the renal threshold is around 250 (the range where the pancreas can heal) so it is great if they stay in and under that 250 range for the majority of a cycle.

Do only what you are comfortable with. It does look like the harsh changes make him feel crummy and you don't that to get worse (higher and lower) but right now, he is pretty high overall.

 

Thanks for the info Sue, although a rookie to this I was thinking the same thing on upping the dose a little. Got a pretty good read on the numbers today and was nice to actually see one below 200 for a change but still not what we're shooting for. After discussing it with the better half think we're going to wait till the follow up appointment Tues with the vet and see where that goes. For all I know we might be looking for a new vet come Tues afternoon and would hate to be caught with some problems in that situation.

I figured his fluctuating moods was probably attributed to the ups and downs he's going through atm, so we've just been keeping a watchful eye, letting him be alone when he wants and of course loving him when he's in the mood. His eating and drinking seems to be about normal and the ketone tests are still neg so that's keeping our spirits up that he's not as bad off as he could be.

Trying to keep up with the forums it seems Lantus is the insulin of choice??? Should I ask directly for it or just ask to be taken off Humulin N and see what he suggests then go from there?

Again thank you all for all the support you show and give to everyone on here. Maybe one day we'll be able to help half as much as some of you do.

 

I think I'd tell the vet that you have done research and found that there are three insulins that work best for cats (Lantus, Levemir or ProZinc) and you'd like to try one of those. Lantus does have the most studies done that show the best rates of remission. If he absolutely refuses, then I'd go vet shopping. Start a new topic asking for an Fd friendly vet in your city/state.

You can help people now. You've gotten home testing down and most new posters are struggling with that. Hearing from someone who is new to this sugar dance and has mastered this difficult part is very powerful - much more so than us oldsters giving them reassurance.

 

There are Vet Interview Topics in my signature link.

To locate candidate vets, use Google maps and do a search for "veterinarian near address" and fill in your address.

 

BJM, thank you for the links, got them all printed and going over them now, and it's funny you mention the Google search. I did one just seconds after my last post and printed those out as well. Thanks.

Sue, Thanks for the additional info on the insulin types, will do some more reading on them an hopefully will be much better prepared for the vet visit then I was last week.

Felix says to tell you all "thanks for getting my servants to calm down some". :razz:

 

Your data show the Humulin wearing off and the glucose levels skyrocketing by the next shot.

Until you can get a longer acting insulin, would you be able to shoot roughly every 8 hours? You'll get better glucose control if you can do that. You would take the total daily dose, and divide by 3 for each dose, then adjust from there.

As your vet is familiar with Humulin/Novolin, it may be possible to work with him using ProZinc or BCP PZI, which are also in and out insulins. That means there'd be some transfer of concepts from using the Humulin to using the longer acting Prozinc/PZI insulins.

 

Did a lot of calculating and unfortunately don't think there is anyway we can pull off three times a day atm. Work schedules just don't permit it. Now trust me if it comes down to the life of the cat after the vet follow up then somehow we'll MAKE it work. Seeing as the human child has grown and on her own, like so many others these lil furballs are our children now and are treated like that. :lol:

Can definitely see the hard hit of the Humulin after a couple days monitoring and how it falls off so quickly. Even tho we hadn't even discussed home testing with the vet on the initial diagnoses we're taking the numbers with us on the follow up as well as all the info gathered here to help make smarter decisions moving on with his treatment.

 

Up front costs for the various longer acting insulins are higher for Lantus and Levemir than for BCP PZI (have the vet fax them an RX and order directly from them to avoid markup) and ProZinc (Check at nearest CostCo, otherwise online).

Some folks have been successful ordering Lantus and Levemir from Canadian pharmacies, or if close enough, driving across the border to get it.

 

Grrrr, well time for a new vet apparently. Our follow up didn't go as planned. He'd never heard of Lantus, or Levermir, and swore off ProZinc due to it going on and off the market. When we mentioned we had been doing home testing his first response was, "What do you need me for then". Sooo in the mean time guessing we should just stick with the Humulin until we get a new vet.

 

Sorry about that. If you want to start a new thread with your city/state, maybe someone knows a FD friendly vet in your area.

ProZinc was off the market for a month or so, several years ago....he seems to have a long memory. If he has never heard of Lantus or Levemir being used for felines, he is way out of date.