BG Levels Going Up During Transition to Raw Food

Hi,

I have a diabetic cat named Corduroy. I have been feeding him canned MD for the past two years, with pretty good results. However, I've still needed to give him insulin throughout. I have been researching a lot about how a raw food diet can potentially cause cats' diabetes to go into remission, so I ordered Feline's Pride "Raw Made Easy Kit 1." I mix this with ground raw turkey, half thigh and half breast. I have been doing this for about two weeks now. However, his BG levels are higher now than they were when he was on MD. This is also with a lot of ups and downs in between, which has proven very difficult to regulate with the insulin. Last night, he went hypoglycemic, so I had to inject Karo syrup into his mouth. This was after only giving him one unit when his BG was 381. It had dropped down to 67 within four hours, hence the insulin shock. Overall though, since starting this raw food diet, his BG levels have been super high, 300-400 plus. It has made me think that I shouldn't have gone to raw food, and that maybe I should go back to MD. It is quite stressful, because although I don't want his BG to be too high for a long period of time for fear of kidney damage among other things, I also don't want him to go back into a hypoglycemic episode. Does anyone else have experience with this or with Feline's Pride or MD? Any help would be greatly appreciated.

Thanks,
B.

 

I can tell you my experience with it. I use the Felines Pride raw kit also. I started using it several month ago when Katie started getting sick due a change in the commercial raw food diet I was giving her and I had to start making the food myself. But she has also been on a raw diet for 6 years prior to that, so it was not that drastic of a change. But it has made a huge difference in her insulin requirement.
Katie was dx with diabetes in May 2012. She was getting 2 units Lantus BID. Eventually it was increased to 2.5 units and never really was regulated until about a year later after I started using the Felines Pride raw mix. Suddenly she started requiring less insulin (over a year since diagnosis!), I started slowly decreasing it and she is now, 3 months later, on only .25 unit BID or no insulin at all. I think it has to be the homemade raw with the Felines pride premix that made the difference. - So that's our story.

Of course every cat is different, but maybe Corduroy is actually requiring less insulin and is bouncing?

 

I don't believe feeding a raw diet is causing the problems. Rather, I'm wondering what else may be going on. I don't know any details about your cat's situation, insulin, dose, etc.

Maybe if you can share some of that with us, we can better help you. Do you have a spreadsheet with his numbers that you can share?

Another thing to consider, how old is the insulin you are using? It is possible that it could have gone or is going bad and that can produce wonky numbers.

Also, would you please go back to your original post and remove the 911 icon - we try to reserve that icon for true emergencies - such as immediate hypo event and help need, dka, etc. Thanks!

 

Hello there!

What kind of meter are you using? 67 isnt in hypo territory unless you are using an alphatrak.

However it does sound like he may be bouncing. (definition below) It may take a few days for the bounce to clear. Reason for it is that his insulin needs may have dropped since you moved to a lower carb food ( MD is 14%). .

What insulin are you using?

let me know

Wendy


Bounces - what are they and is my cat doing them?
When a cat is first diagnosed, the blood glucose has probably been high for a while. As the insulin starts to take effect and numbers start to come down, the liver has to learn to adjust to the lower numbers. We call this "liver training school". But before it relearns that low numbers are ok, when the BG drops to a number lower than the liver is accustomed, or if BGs drop low, or if the BG drops suddenly, the liver”panics” and reacts by releasing counterregulatory hormones and glucagon. This drives the BG back up. This is what we call a "bounce". Bounces can take up to 72 hours to clear so we are generally careful about increasing doses during the bounce. Once the bounce clears, then you can see the "real" numbers and determine if the dose needs to go up or down.

 

First of all, I would like to thank you, Katiesmom, Hillary & Maui and Wendy & Tiggy, for responding to my post. I really appreciate any help that I can get, so thank you again. I apologize for posting with a "911" icon. I guess, to me, it feels like an emergency, but I understand that, in the scheme of things, this doesn't constitute as an emergency. In truth, I am not experienced posting on forums, this being only my second or third time in my entire 40 years of living I am going to attempt to answer the questions that you asked as best I can, and I apologize in advance for the length of this post. I just want to be thorough.

1. Corduroy's situation: Corduroy is a 15-year-old Maine Coon, who happens to be diabetic. He weighs, on average, about 10.5 lbs. He seems to be quite healthy, other than his diabetes, chasing after our red laser light, grooming himself, wanting to go outside on his leash, etc. He has shown symptoms of neuropathy, however, in that when he is eating his food, his back legs want to splay out a bit. This has been going on since his first episode of diabetes. He has also had quite a few dental issues in the past, having had a canine tooth pulled, as well as a few teeth in the back of his mouth due to reabsorption. I should add, that when checked for ketones in his urine, the vet found none. The last check was on June 6, 2013.

2. Insulin type: Lantus Solostar (glargine).

3. Dosage: When first diagnosed during the summer of 2012, we varied between two and three units twice a day (12 hours between each dose). Soon, we found three units to be too much, and slowly, he kept needing less and less until he went into remission for about a year. At this time, I was also feeding him Hill's Prescription Diet m/d canned food, prescribed by our vet, with whom I kept in close contact. When he went into remission, because I had been researching to find the best canned cat food out there that I could afford, I switched him to Wellness. This is what I fed him for the year that he was in remission. However, this past spring, I noticed that he was urinating a lot again, looking scrawny and not grooming himself. So I checked his BG levels, and sure enough, they were high again. This is when, along with consultation from our vet, I started administering Lantus again, as well as going back to feeding him m/d. I felt terrible because I assumed (and still do assume) that feeding him Wellness caused his diabetes to come back.

Since then, Ive been feeding him m/d and giving him Lantus. This second time around, however, I started out giving him two units, and never had to give him three again, as giving him three units before seemed to make his BG levels go too low. I have kept a log the entire time. Here's what a typical three days looked like when his second bout with diabetes began (again, I apologize for the length of this reply, but want to give you the information you asked for):

4/26/13
6:11 am - 385 - 2 units
10:51 am - 258 - 0 units
1:08 pm - 328 - 2 units
4:36 pm - 331 - 0 units
8:05 pm - 235 - 1 unit
10:53 pm - 186 - 0 units
11:58 pm - 176 - 0 units

4/27/13
7:09 am - 415 - 2 units
9:12 am - 394 - 0 units
12:00 pm - 387 - 2 units
4:54 pm - 64 - 0 units
6:05 pm - 61 - 0 units
8:54 pm - 76 - 0 units
(at this time, he was not showing any signs of hypoglycemia)

4/28/13
12:07 am - 248 - 0 units
7:13 am - 547 - 2 units
12:14 pm - 294 - 0 units
7:02 pm - 337 - 2 units
9:36 pm - 432 - 0 units
11:46 pm - 328 - 0 units

Recently, before starting him on raw food, while he was still on m/d, it looked like this:

8/18/13
9:21 am - 183 - 0 units
2:43 pm - 125 - 0 units
7:14 pm - 154 - 0 units
10:41 pm - 237 - 0 units

8/19/13
8:07 am - 392 - 1 unit
8:19 pm - 145 - 0 units
11:58 pm - 204 - 0 units

Now, since feeding him Feline's Pride Raw Made Easy Kit 1, mixed with turkey thigh and breast, half and half, it looks like this:

8/27/13
8:41 am - 214 - 0 units
12:14 pm - 227 - 0 units
6:43 pm - 381 - 1 unit
11:07 pm - 67 - 0 units (This is when he was unresponsive. When I finally woke him up, he was walking around as if he were drunk, very wobbly. I know that a BG level of 67 wouldn't normally put him in the hypo range, but he definitely was. I had to give him Karo syrup twice, along with some m/d canned food that I had saved from before)

8/28/13
12:09 am - 124 - 0 units
1:26 am - 90 - 0 units
3:55 am - 150 - 0 units
9:26 am - 431 - 0 units (I am now a bit trepidatious to give him even one unit)
1:07 pm - 453 - 0 units
2:33 pm - 450 - 1 unit
10:17 pm - 389 - 0 units

8/29/13
12:30 am - 441 - 0 units
4:11 am - 435 - 0 units
8:09 am - 492 - 1 unit
12:07 pm - 352 - 0 units
9:56 pm - 254 - 0 units
11:44 pm - 204 - 0 units

8/30/13
9:13 am - 460 - 1 unit
11:33 am - 318 - 0 units

As you can see, I've been checking him a lot to see if I can make sense out of his numbers. I've also just learned about the Somogyi Effect, in which the body's natural defenses go into effect, causing falsely high BG levels due to a quick onset of hypoglycemia. In this case, as you all probably know, I would need to give him less insulin, even when his BG levels are high.

I realize that his levels are high, which is definitely not good, but with the consideration of the possible Somogyi Effect, along with the fear that he will have another hypo episode, I have been very cautious in giving him even one unit.

4. How old is the insulin?: The insulin is from when he was first diagnosed in the summer of 2012. Currently, we are still using the same pen that we started with. On the side, it says that it expires in October 2014. The other pens that came in the package have been stored in the refrigerator the entire time, as instructed by our vet.

5. What kind of meter?: We are using a Bayer Contour meter along with the Contour test strips.

6. Bouncing: Wendy, in reference to this, from what you wrote, it seems that this mainly happens upon first being diagnosed. Do you know if this can this happen while transitioning to a new, next-to-nothing-carb food as well?

Lastly, you all might be wondering why I changed his food at all, due to his levels being pretty good while on m/d. In answer to this, I changed to Feline's Pride raw food because I have been reading Dr. Lisa Pierson's website. On this, she mentioned Feline's Pride as being one of the best raw foods out there, in addition to a raw food diet being better for diabetic cats in general. She also mentioned that most all commercial cat foods, prescription ones included, have a very high carbohydrate content, which exacerbates feline diabetes. However, I am thinking about going back to feeding him m/d because I don't want his levels to stay high for fear of permanent damage to his kidneys.

Thank you in advance for reading this long post, and I really appreciate the replies that I have already received

Sincerely,

Brigitte

 

Dont apologise for the 911. How were you to know? Corduroy is special to you and its important you keep him safe. I would rather people were more worried than blasé!

Ok so

Neuropathy - People here have had success with methylcobalamin B12 pills. Get them from any health food store just make sure no sugar or xylitol in them cos thats toxic. Or buy the cat version zobaline. Takes 4-6 weeks to work and works better if the cat is regulated

Dental - how are his teeth now? Tooth infections can spike blood sugar and exacerbate diabetes.

Food - was it Wellness grain free canned? At 4-6% calories from carbs wellness grain free varieties are actually lower carb and a better choice than the M/D at 14%. Other wellness varieties are higher carb. Otherwise I wonder if its a tooth infection that caused this. But I see you are now giving raw so thats even better.

Remission - unfortunately its much harder to get a cat back into remission after it falls out. It will take more closer BG monitoring and aggressive dosing. We can help with this if you want.

Ok this post itself is getting too long.. Going to do another one on BG and dosing. i LOVE that you home test a lot - that will help immensely.
Wendy

 

Ok BG and dosing

Were you dosing three times a day? Never seen that before. Lantus lasts 12 hours in a cats system so its normally dosed twice a day every 12 hours. I am glad you arent doing that now.

Usually hypo symptoms happen under 40 but he could have been lower before you measured him.The syrup raised his numbers but usually it only lasts up to an hour. What happened after that looks like a bounce. This bounce can last up to 72 hours and I suspect it kept going through the 29th at least. I know my notes say when first diagnosed but from experience, they keep doing this for a while until bouncing into remission or regulation. And they will definately bounce if they drop dangerously low.

So given he appeared to have a hypo I would drop the dose if I were you - to 0.5. And try to give it every 12 hours (give or take 30mins) unless he drops under 50 (or has another hypo!)

Pens - an opened pen usually lasts up to 6 months so I would start a new pen - but only for bacteria reasons - it looks like it is working fine. Another reason to drop the dose because if it has lost some of its potency and he still had a hypo on one unit.....

Wendy

PS can you set up a spreadsheet? It will help us help you better plus you can share with your vet. Heres how but let us know if you need help: http://www.felinediabetes.com/FDMB/viewtopic.php?f=6&t=18207

 

Since you are testing, here are some glucose reference ranges used for decision making using glucometers. With Lantus, the between shot tests and seeing how low he goes, are the key numbers to evaluate.

Human glucometer numbers are given first. Numbers in parentheses are for non-US meters. Numbers in curly braces are estimates for an AlphaTrak.

< 40 mg/dL (2.2 mmol/L) {< 70 mg/dL for an AlphaTrak}
- Treat as if HYPO if on insulin
- At nadir (lowest point between shots) in a long term diabetic (more than a year), may earn a reduction.

< 50 mg/dL (2.8 mmol/L) {< 80 mg/dL for an AlphaTrak}
- If before nadir, steer with food, ie, give modest amounts of medium carb food to keep from going below 50 (2.8).
- At nadir, often indicates dose reduction is earned.

50 - 130 mg/dL (2.8 - 7.2 mmol/L) {80 - 160 mg/dL for an AlphaTrak}
- On insulin - great control when following a tight regulation protocol.
- Off insulin - normal numbers. (May even go as low as the upper 30s (1.7 mmol/L){60s for an AlphaTrak}; if not on insulin, this can be safe.

> 150 mg/dL (8.3 mmol/L) {> 180 mg/dL for an AlphaTrak}
- At nadir, indicates a dose increase may be needed when following a tight regulation protocol.

200 mg/dL (11.1 mmol/L) {230 mg/dL for an AlphaTrak}
- no shot level for beginners; may slowly reduce to 150 mg/dL (8.3 mmol/L) {180 mg/dL} for long-acting insulins (Lantus, Levemir, and ProZinc) as data collection shows it is safe

180 - 280 mg/dL (10 - 15.6 mmol/L) {may be 210 - 310 mg/dL for an AlphaTrak}
- Any time - The renal threshold (depending on data source and cat's renal function) where glucose spills into the urine.
- Test for ketones, glucose is too high.

>= 280 mg/dL (15.6 mmol/L) {may be >=310 mf/dL for an AlphaTrak}, if for most of the cycle between shots
- Uncontrolled diabetes and thus at risk for diabetic ketoacidosis and hepatic lipidosis
- Follow your insulin protocol for dose adjustments
- Test for ketones; if more than a trace level of ketones, go to vet ASAP.

 

Hi B,

I have fed my cats raw for 15 years, to prevent health problems, so I was very surprised when recently one of them was diagnosed with diabetes, and turned out to have acute pancreatitis, because there sure wasn't a lot of carbs in his diet. However, I changed the type of meat I was using, and saw a big difference. I believe my cat became allergic to beef, as he's now fine with other types of meats. One day I gave him some calf liver, and he became ill again for a few days. So as a suggestion, give another type of meat a try.

I also stopped using the premix I was using, because the formulation had changed to include xanthan gum, which might possibly not be good, as:
"Xanthan Gum is made by fermenting corn sugar with a bacteria, Xanthomonas campestris"
"Nutritionally, xanthan gum is a carbohydrate with 7 grams of fiber per tablespoon. This may cause bloating in some people."
"Xanthan gum may be derived from a variety of sources such as corn, wheat, or soy. People with an allergy to one of the above, need to avoid foods with xanthan gum, or to ascertain the source."
Source: http://blog.fooducate.com/2010/09/23/10 ... -additive/

Now, I don't use a premix. I have gone back to sourcing my own vitamins and other supplements, so that I can control exactly what my cats get.

Best wishes to you and your kitty!

Lara

 

Thank you Wendy & Tiggy, BJM and Lara for replying with some very helpful information.

Wendy: I was dosing three times a day, but it wasn't for very long. I was trying different things because his BG levels weren't lowering like they should have and I was (and still am) worried about them being too high for a long period of time.

Regarding the .5 dosage, I actually played around with the pen yesterday to see if I could get only a half dose out of it. It is designed to give one unit, two units, etc. I think that I can give him only a half unit if I squeeze a little out before injecting. Also, I am going to start a new pen.

Regarding the spreadsheet, my husband and I are working on putting it together, so we should be able to have it up within the next couple of days.

BJM: Thank you for the guidelines. I am planning to buy Ketostix tomorrow to test for ketones. He is above 280 a lot, which scares me to death in reference to ketoacidosis and hepatic lipidosis, but I don't know how to control it. It makes me panic when I think about it.

Lara: I was actually thinking about either trying only turkey breast without the thigh, or chicken, so I'm glad you mentioned it. I just checked the ingredients in the pre-mix that I'm using, and it appears to have no xanthan gum in it.

Again, thank you for all of your replies. You don't know how much I appreciate it.

Sincerely,

Brigitte

p.s. - My husband and I have been checking his BG levels every couple of hours today, and I plan to do it again tomorrow just to get a better sense of what is going on if possible.

 

Those pen tips are very inaccurate though - I would strongly recommend you buy some syringes. The pens idea of 1/2 unit could vary each time by up to 1 unit. The key to Lantus working well is consistency and this isn't going to help at all.

Also we tend to change doses in 0.25IU increments as cats are so sensitive to small dose changes... 1 unit might not be enough but 1.5 is too much! Those small changes are unlikely to be possible without the syringes.

Are you in the US ? You can get syringes with half unit markings in most pharmacies including Walmart.

You want 3/10 cc, half-unit marked, short needle, 30-31 gauge syringes ie
- Relion 3/10cc 30 & 31 gauge short
- BD Ultra fine 3/10cc short
- Terumo Thinpro Insulin Syringe 31G 3/10cc
- Kroger 0.3cc 8mm, 31 gauge

Fantastic!

Wendy

 

Thanks Wendy! I am going to go out and get some syringes. I wrote them down, so I am armed Like I mentioned, we've been checking his BG levels all day, every two hours, and although it went down from 460 at 9:13 a.m. to 206 at 1:55 p.m., it has done nothing but go back up to 424 at 7:40 p.m. since then. I am going to give him another dose around 8:45 tonight, but I'm on the fence about whether or not to give him a half a unit or one. Yikes, this stuff is worrisome!

 

One unit is too much remember. You don't want another hypo... If he was my cat i would be erring on the safe side. Better too high for a day than too low for a minute.

 

I don't think if I would eliminate the thighs. Breasts don't have enough calories or fat in them to be the only meat in the diet. Dr. Pierson says no more than 15% breasts.
I use only chicken and I don't use the the breasts at all except as a treat. I make Katie's food using chicken thighs only, a few ounces of chicken liver, egg yolks, with the Feline's Pride premix. If you notice any constipation issues, you can add a little psyllium powder too. Psyllium has also been used to help regulate/lower blood sugar levels in people with diabetes and many say with cats too.

Basically follow Dr. Pierson's recipe for amounts.

Hope this helps.

 

Since you are on the fence, just thought I would chime in in case you missed this earlier- Wendy also mentioned another reason to reduce the dose...since you are starting a new pen, it may be stronger than the older pen you have been using because the older insulin has lost some of it's potency.

 

Hi everyone,

Thanks again for replying to my post. After having been terrified of having his BG levels too high for too long, I have decided to go back to feeding him Hill's m/d canned. I know that it gets a bad review in reference to carbs (I figured it to be about 9%), but at least with this, his BG levels were getting into the normal range, seeming to become almost insulin-independent. Last night, after giving him one unit (his BG was 475), and checking it every hour afterwards, it only lowered to 428. I have been reading that with a raw food diet, their BG levels should go down dramatically, but unfortunately, it is only making it skyrocket. I understand that there may be other problems to look into, e.g., type of raw meat, dental issues, etc., and I have made an appointment with my vet for a check of his teeth again, but these levels have been too high for too long. I'm very afraid that it will cause kidney damage.

Again, thanks for all of your help. Also, I'm still working on the spreadsheet with his numbers, and I plan to post it as soon as I can.

Sincerely,

Brigitte

 

The m/d is 14%. We recommend for remission or regulation that people choose foods under 10% carbs.

Please dont change the food to the m/d.. I honestly think having looked at hundreds of sheets that your low carb raw food was working and the skyrocketing is in fact bouncing because he is now getting too much insulin! and the reason you saw the 67 was that he may have decided he doesnt even need the insulin any more! remember the high numbers you are seeing now are a direct response of being too low and will pass. Maybe google "somogyi"

Can I suggest you stay on the raw a little longer, set up your spreadsheet and let us advise? I think we can get him better regulated and maybe into remission.. .

Wendy

 

Hi Wendy,

Thanks for your response, and I'm not trying to be difficult, but I want to discuss with you a little further in order to gain more knowledge of this if possible. I truly appreciate your interest and time.

"The m/d is 14%. We recommend for remission or regulation that people choose foods under 10% carbs."

- Upon reading about how to calculate the total dry matter carbs in a canned cat food, I figured the m/d to be 9%. At this point, I am wondering why his numbers were getting to a normal range (and seeming to become almost insulin-independent) if this food is a bad choice.

"I honestly think having looked at hundreds of sheets that your low carb raw food was working and the skyrocketing is in fact bouncing because he is now getting too much insulin!"

- For the most part, I have only been giving him one unit every 12 hours, if even that. I know that you will be able to tell more when I get the spreadsheet posted. However, this is confusing as to how that is too much, especially after a day such as yesterday, where it pretty much stayed in the 400s, even after giving him one unit. I have read up on the somogyi effect, but again, it's difficult to understand how I'm giving him too much insulin. On a similar note, I went to my local Rite Aid last night, immediately after reading your post, and gathered information about syringes. I've also been reading that PZI
(Protamine zinc insulin) is better for cats as it comes from beef and pork instead of humans. What is your take on this?

He has also developed a rash on his skin since feeding this raw diet. They are little bumps everywhere. I just feel like everything has been going drastically wrong since starting this diet, and I'm really ready to throw in the towel for fear of permanent damage, especially since he seemed to be improving on m/d. If I stay on a raw food diet, I am wondering if I should change the meat, and if so, what kind? Also, I'm not sure of the ratio I should be giving in reference to the thighs and breast.

Thanks in advance for your help.

Sincerely,

Brigitte

 

As I said in my earlier post, Dr. Pierson says no more than 15% breasts. Maybe switch from turkey to chicken. Some people use rabbit.
I use only chicken and I don't use the the breasts at all except as a treat. I make Katie's food using chicken thighs only, a few ounces of chicken liver, organic egg yolks, with the Feline's Pride premix. If you notice any constipation issues, you can add a little psyllium powder too. Psyllium has also been used to help regulate/lower blood sugar levels in people with diabetes and many say with cats too.

Basically follow Dr. Pierson's recipe for amounts. Her website is at http://www.catinfo.org/?link=makingcatfood
It is quite helpful.
Also, if you add chicken liver, you dont need to use the small capsule that comes with the Felines' Pride premix (vitamin a & d), because you will get the vitamins from the liver.
Many doctors think raw is the best food for a diabetic cat. Remember, as in any diet change, you may not see the improved results immediately, it make take a little while.
When I switched Katie from the commercial raw to the homemade raw, it was about a month later when her insulin requirements started to decline. I have no idea why the homemade made the approvement, the commercial stuff was very similar. I guess it's the extra love I put in it cat_pet_icon

 

Hi Katiesmom,

Thank you for the information. Did Katie, by any chance, have any allergic skin reaction when transitioning to the raw food with Feline's Pride? Just wondering if you've had any experience, or have heard anything of the sort.

Thanks again,

Brigitte

 

No skin reactions with either of my kitties. You have been feeding him turkey, does he tolerate other turkey cat foods okay? The Premix is simply vitamins and bonemeal, I dont know what could bother him. You could try switching to chicken.

2007 I started the kitties on the ready -made frozen Feline's Pride. They ate mostly chicken, turkey just occasionally. They ate that for 5 years until I started them on RadCat frozen raw in January 2012. I switched because they seemed to like the Radcat better and it was boneless, the Feline's pride wasn't and the bones were constipating to them. Then Katie was diagnosed with diabetes in May 2012. I continued with the Radcat until March 2013, but started making it myself then with the Feline's Pride premix because RadCat made a change in their food that was making Katie vomit. Like I mentioned before, her insulin requirements started decreasing in April/May.

I wonder if it's something else causing a skin reaction. You started him on the raw about the time you started him back on insulin, right?

Have you started a new pen yet? I ask because you mentioned you are using the SAME pen you used in summer 2012 when he first was diagnosed. That's over a year old, and most people only use the same pen/vial for 6 months max. I have no idea if old insulin could do anything like a skin rash, or if any bacteria or something could have gotten in it, but I wonder if that could be causing the skin reaction? I dont know, just a thought, but I def would start a new pen ASAP.

Is he itching too?

I know you are struggling with what to do, what to feed, sometimes it's so hard to know what is the right thing to do, and you just want what is best for your baby darlin. I second guess myself all the time and never feel like I am doing the right thing. All we can do is do our best.

 

Lantus actually has a much higher remission rate, over 90%, than PZI 37-50% remission rate.

Reference numbers are from this slideshow by the University of Queensland researchers. http://www.uq.edu.au/vetschool/content/clinic-stlucia/feline-dm.pdf

 

No worries - we just want whats best for your cat...

When calculating % calories from carbs we use the "as fed" values not the total dry matter. Dr Lisa Pierson DVM who is an expert on cat foods (see her list http://www.catinfo.org/docs/FoodChartPublic9-22-12.pdf) has contacted the company and done an analysis on this food and it shows as 14% as fed and 16% based on dry matter.

The spreadsheet would really help - if you can mark when you fed the DM and when you started raw that would help too. Then I can check out these normal numbers you were seeing on the higher carb food.

Based on the spreadsheet I might also be better able to explain the whole bounce phenomenon to you as well. Its hard to do these things in writing sometimes :smile: but I will try below. Let me know if it makes sense or if there are any points that don't!

For now too I would stick to Lantus. It has a good success rate for cats going into remission (especially with home testing and a low carb food - i can provide a paper on it if you like?). PZI is good too but I think together with this forum, we may be able to tweak things to get him regulated.

Really need that SS

If it helps, here is a site on making your own cat food : http://www.catinfo.org

you are doing great though - keep asking questions.. bounces below

Wendy

PS bounces
- Ok so what happens is the cat blood sugar drops low. Say to 67. The liver hasnt seen normal cat numbers for a while. Its used to these diabetic high blood levels. It now thinks high blood sugar levels of 300+ are normal. Its wrong! Normal healthy cats are 50-130.

- So as a reaction the liver panics and actively makes the blood sugar rise. It does this for up to 72 hours. Even if you shoot insulin in this time, the liver will continue to create sugar to counteract it. The cat will almost seem to not be responding to insulin in this time at all - or very little.

- After a while (as much as 72 hours) the liver calms down. And the cats blood sugar will drop again. If you are testing every few hours you may see numbers start to drop... But if it drops low, guess what ?... the liver panics again! and up goes the sugar...

- The drop can happen really quick and is easy to miss. Cats can start the morning at 300+ , drop to below 50 middle of the day and be back at 300+ by night.. and without testing middle of that period you would easily miss it. However by looking at your sheet many of us can identify if this is the case.

- Also the liver will do this if the cat drops dangerously low (under 50) or if the cat has a hypo.

Does that make it any clearer? Once we see your SS we should be able to tell.

 

Hi Katie,

Yes, he seems to tolerate other turkey cat foods okay, but just today, I bought some chicken thighs, w/o the bones, because, per your reference to Dr. Lisa Pierson's recipe, I thought I'd try that to see if he like it. He seems to.

So now, I'm thinking about trying her recipe and buying the supplements from iherb.com.

I have started a new pen as of today, but actually, he's been on the insulin, the old pen, since April. I just started the raw food with Feline's Pride, on 8/23/13. The rash (bumps) seem to have started around that time. I too am confused as to what could be causing this. I left a message for Jennifer at Feline's Pride today to ask her if she has heard of BG levels going up and/or rashes. Nothing else in his diet/life has changed. Regarding the itching, I don't really see him itching that much out of the occasional ear itch

Thank you for the empathizing words. It really is difficult to know what to do, and I feel like I may be putting his health at risk because I chose to take him off of m/d, which seemed to be working fine. I just want to do what's best for him; he's been my buddy since he was six weeks old

Sincerely,

Brigitte

 

Hi Wendy,

Here is the spreadsheet for Corduroy's BG levels. If you need more information, please let me know. I really appreciate you taking the time to look at it.

https://docs.google.com/spreadsheet/pub ... utput=html

Also, in your earlier post tonight, you asked me to include the times when I fed the raw food and the DM. It may not make a difference, but I want to make sure that you know I'm not feeding them DM, I'm feeding them Hill's Prescription Diet m/d, canned. Like I said, it may not make a difference, but thought I'd let you know.

Again, thank you and have a good night!

Brigitte

 

Hi Brigitte!!

Glad to see you're testing so often! That's half the battle! Now to get working on the other half...an appropriate dose schedule. The spreadsheet you're using isn't set up the way most of ours are. If you look in my signature below, you'll see China's SS link and you'll see the differences and hopefully see why ours makes it easier for us to quickly scan other people's Spreadsheets and have a good idea what to advise them. Here are some directions on getting a spreadsheet set up like the ones we use here. http://www.felinediabetes.com/FDMB/viewtopic.php?f=6&t=18207

I've having some trouble figuring it your current one. It looks like you're not giving the lantus every 12 hours but have been skipping around some. It's
really important to give Lantus every 12 hours (as close as possible) so we can help you learn how your sweet kitty reacts to insulin and the food

Somali effect is a fairly highly debated subject around here though...some believe in it, others do not

You will need to get off the M/D and decide if you're going Fresh Feed only, Wet Canned Feed only or a mix of those and then make sure you shooting the same amount of insulin every 12 hours. Once he's totally off the M/D, his numbers are going to be a bit wonkey for awhile until the new food "settle in" so you start to get some data with only these foods, and only shooting insulin every 12 hours

 

I suspect you used this one because your triple dosing wouldnt fit the other SS. Let me try and put it into our format best I can and then you can update it from there?

Wendy

 

Ok I only did from the day before the hypo as its really hard with the triple dosing and the inconsistent shot times etc. I am not sure I even got it right ?

https://docs.google.com/spreadsheet/pub?key=0AmWmpHZ2Pu8QdFhKVF9vSmpIRlRTUGxSamhkSENvYWc&output=html

So heres what I would do based on my experience -

1. Lantus works best on consistency. It only lasts 12 hours in the cats system. It is also a depot insulin - which means that it takes 3 days for a new dose to build to optimal levels in the cats system. You wont see the best effect of the dose for 3 days. So give the 1 unit, every 12 hours (give or take 30mins at the most!) for the next few days. This will also allow any bounce to clear.

2. Personally I would switch back to the raw now but we can keep the m/d for now (sorry I called it DM I meant m/d but its still 14% - i got that right). It might set his regulation back a bit and keep his numbers high but if we dont see good results then we can switch back to the raw.

If we dont see any lower numbers by tomorrow morning I personally would change the food back before we try a dose change.. especially since you were seeing some nice greens on the raw. First time you had a hypo right? Tells you the raw was doing something to bring his levels down..

But if you really still want to give the higher carb food we can certainly start increasing the dose tomorrow to compensate for the high carbs..Would be a shame though since my experience of many cats tells me the M/D is going to keep his numbers too high.

Let us help you and maybe we can make a difference. The remission window is about 6 months from diagnosis so its not too late yet.

Wendy

 

Hi Wendy,

Thanks so much for taking the time to look over his numbers and create the spreadsheet. I didn't know that you all used a specific type of spreadsheet, which could definitely be due to my lack of research on it before I started my own. Today, however, when I mustered up the energy, I was going to convert it to your spreadsheet, but you beat me to it

I tried to decipher it the best I could, and although most of it makes sense, I have a couple of questions:

1. What does "PMPS" and "AMPS" mean? And, what does it mean when you say that it was early or late?

Below, I'm going to address the points that you brought up:

"It is also a depot insulin - which means that it takes 3 days for a new dose to build to optimal levels in the cats system. You wont see the best effect of the dose for 3 days. So give the 1 unit, every 12 hours (give or take 30mins at the most!) for the next few days. This will also allow any bounce to clear."

- I didn't know that Lantus is a depot insulin. With this said, I actually gave him two units this morning at 9:20 am. His BG was 424, and from the previous few days, I see that it hadn't gone down with one unit. I am REALLY afraid of what these high numbers are doing to his kidneys, etc., so my decision came from wanting to give his body a break from the high levels. On a related note, although I understand the concept of the Somogyi Effect, I have heard conflicting reports as to whether or not it even exists.


"Personally I would switch back to the raw now but we can keep the m/d for now (sorry I called it DM I meant m/d but its still 14% - i got that right). It might set his regulation back a bit and keep his numbers high but if we dont see good results then we can switch back to the raw."

- I have decided to put him back on m/d for the time-being in hopes that his itchy skin rash will go away
(another problem that started at the same time I started feeding the raw). Someone suggested that he may be allergic to turkey, so this is my first step in finding the culprit. I know that while he was eating m/d, he had no skin rashes. Once the rash goes away, hopefully, I plan to make my own cat food using chicken thighs along with Dr. Lisa Pierson's recipe. The supplements she refers to are pretty cheap on iherb.com.


"First time you had a hypo right? Tells you the raw was doing something to bring his levels down.."

-He actually had a hypo once before, during his first bout with diabetes, which I cannot seem to find the log for, unfortunately, during the summer of 2012 when I was feeding him only m/d.

Ugh, my head has been spinning trying to figure out what's right for him! It was with much debate this morning as to whether or not to give him two units. Now, I feel as though I've done the wrong thing again! Don't get me wrong, I truly truly appreciate your help...it's just sooo worrisome :sad:

Sincerely,

Brigitte

 

On a different, but related note, has anyone had experience with Ketostix? Do you know if they're accurate, or will I simply put myself into a frenzy on a Sunday afternoon if it falsely shows positive (as I've heard it can)?

Thank you,

Brigitte

 

You brought up a good point, many people here don't believe in somogyi. However we all believe in bounces which is a little different because the bounce is triggered by a number that , unlike somogyi, isn't necessarily too low.. Just lower than the body is used to. I have seen this bouncing in many many many cats... Even my own..see Tiggys sheet in my signature.

AMPS is a.m. Pre shot test
PMPS is p.m. Pre Shot test

When I said early and late it's because you gave the shot less than the usual 12 hour periods.

Maybe read this protocol.... http://www.felinediabetes.com/FDMB/viewtopic.php?f=9&t=1581

Are you intending to keep at the 2 units? I hope not given he has a hypo before on just 1 unit. But Like i said the key to lantus is consistency to let the depot build up so I would recommend you pick a dose and stick to it (read the protocol) for 3-5 days unless he drops under 50.

Personally I would make that new dose be 0.5 unit as he already had a hypo on one unit and I am very concerned that once the bounce clears he will have another one. .. Especially on 2 units!! It's way more dangerous to be too low, than too high.. better too high for a day than too low for a minute.

If we find after 3 days that the 0.5 isn't working then we can slowly and safety increase...

Wendy

Ps what did you get ketones or sugar since they test for both? Retest as long as urine is fresh (less than 30mins old). Use plain water as well to check strips are ok.

 

Hi Wendy,

If I'm reading Tiggy's SS correctly, you gave him/her (sorry) 5 units for a BG level of 112? Are you using Lantus as well or is this a different type of insulin? Just curious.

Thanks for clearing up the AMPS and PMPS.

No, I don't plan on keeping him at 2 units. I'm just so afraid of his BG being so high for so long that I thought it might give his little body a break. At this point, I second-guess everything I do and never feel like I'm doing the right thing. Right now, like I said earlier, I'm feeding him m/d again due to the skin rash, but that's ANOTHER question prying on my mind: Is it the Feline's Pride pre-mix giving him a rash or is it the turkey? If it's indeed the turkey, I would think about using the pre-mix again, but this time with the chicken thighs I bought yesterday. But what if it's the pre-mix? Ugh. Also, I wonder if the allergic reaction could be causing his BG levels to raise. There are so many variables. However, I guess the only way I'll really know what it is, the turkey or the pre-mix, is to keep using the pre-mix but with chicken thighs.

Thanks,

Brig

 

Yes we are using lantus. Tiggy has a condition called acromegaly which means he needs high doses because he has a tumor on his pituitary gland. Most cats only need 1-2units. Tiggy is a rare case. Plus I have been working with his diabetes for two years and so know when I can shoot and when I can't. I have lots of data to know what he will normally do.. Although sometimes he does surprise me too!

Here is a better example of a bounce.https://docs.google.com/spreadsheet/lv?key=0AgeCZLDfWCugdExCMTB5Wi1VeEpyZW9tSURLcTMtYXc
See July 9th? AMPS was 203, by +5 he was 81 and +7 was 76. Good chance he dropped lower between +5 and +7 too. Anyway he bounced to a PMPS that day of 445. He then stayed in pinks, reds and yellows for almost 3 days before another green on the 12th. The low greens on the 9th triggered that bounce. And he bounced again after that too on the 17th, 21st.... Until he bounced into almost remission. He is on an OTJ trial right now.

Too high is better than too low. Too low can kill fast. Too high takes time to damage the cat.

Really I strongly believe the higher BGs are likely due to bouncing,too high carb food and inconsistent dosing. Trust me, you have been doing it your way for months and you came here for advice because you didnt like how that was going. How about trying it our way for a week or two? It won't hurt him and could do him good!

Ie. .. 0.5 units. Every 12 hours give or take 30mins. Raw food or something low carb canned if you are worried about the rash ie fancy feast classic pâtés, or wellness grain free canned.

Wendy

Ps are you using syringes to withdraw the insulin? Or are you using needle tips that come for the pens?

 

"Too high is better than too low. Too low can kill fast. Too high takes time to damage the cat."

-I'm glad you said this because all I keep thinking of is damaging his kidneys and I start to panic.

"Really I strongly believe the higher BGs are likely due to bouncing,too high carb food and inconsistent dosing. Trust me, you have been doing it your way for months and you came here for advice because you didnt like how that was going. How about trying it our way for a week or two? It won't hurt him and could do him good!"

-Yes, that is true, and thank you for reminding me. I have decided to go back to the Feline's Pride pre-mix, but this time with ground chicken thigh instead of turkey. However, I'm having a very hard time getting Corduroy to eat anything now, including the m/d or the chicken thigh. He's actually acting sort of like he's beginning to be hypo, but I just tested his BG and it's only 204. Could he be going hypo at that BG level? I know the last time he went hypo, his BG was at only 67. He's acting sooo lethargic. Man, this past week has been hellish!

"Ie. .. 0.5 units. Every 12 hours give or take 30mins."

-I will do the best I can to give him .5 units, but the pen only gives doses in 1 unit increments. I tried to contact my vet yesterday to ask him to prescribe the Lantus vial, but no luck. I tried to get it the other night w/o a prescription to no avail :sad:

Brig

 

No Brigette...we consider anything under 50 "too low", so you're safe. 204 is still a "high" number..although it could be a lot worse

If you're using the Lantus solostar pen, go to a pharmacy and get some u100 insulin syringes with 1/2 unit markings. WalMart carries them (about $14 for 100) Ask for 3/10cc, u100 insulin syringes with 1/2 unit markings. 5/16" or 1/2" long, 31 or 30 gauge needles.

You can pull the insulin out of the pen just like you do a vial. Just take the cap off and there's a rubber stopper like you'd see in a vial. Actually the pens aren't exact enough for our kitties when as little as .25 unit can make a BIG difference. They're set up for humans who are likely to be on big doses, and a drop off here and there isn't going to make much of a difference.

 

Okay, I'm going to go buy some of those syringes as soon as possible.

Thanks again,

Brigitte

 

I am confused.. Didnt you say earlier you were going to buy some syringes? Nag nag You can withdraw the insulin from the pens like we do!

See pic for how to do it.



That's another reason for the issues you are having, the dial a dose is too inaccurate.

Wendy

 

Also can you get a test in an hour? I am wondering if his bounce is clearing..

 

Yes, I did say that I was going to get them the other night, but that's when I went to the pharmacy and they told me that I needed a prescription for the vial, so thinking that I couldn't use the syringes w/o the vial, I didn't get either. I had no idea that I could draw the insulin from the pen with a syringe. You have to remember, the information that you're giving me is pretty new to me still ;-)

I've actually been checking him almost every hour to hour and a half anyway, poor thing. So, yeah, I can do that. :smile:

 

Oh, and I've got another question while I'm thinking about it. I was looking over the carb contents in all the canned cat foods per Dr. Lisa Pierson, and yes, I see that m/d is 14 while Fancy Feast is anywhere from 1-5. My question is this: Why does Fancy Feast get such a bad wrap as being "kitty crack"? I've heard this many times from various people.

Another question is: I wonder why, when he first got diabetes, back in the summer of 2012, his BG levels went down with Lantus and m/d, even going into remission, and then when I started feeding him Wellness Grain-free, he turned diabetic again?

I'm going to try it your way, but I just don't understand the above-described events :?:

I know I have a lot of questions. Sometimes people take this as being defiant, but it's not meant to be. I just have a difficult time doing anything w/o knowing why.

 

I just checked his BG, and it's 243 at 4:51 p.m. The time before when I checked it, it was 204 at 3:39 p.m.

 

The best answer I can give you is "we don't know". However, when a cat has been in remission, it's harder to get them back under control a 2nd time (or 3rd or 4th)

Every cat is different..Corduroy was 2 years younger, his pancreas could have been still working a little...there are just too many variables to say for sure.

What time did you give his AM dose? Also, since you haven't been giving the same dose, every 12 hours, his numbers are going to be a bit wonky. That's why we stress that you find a schedule you can test/feed/shoot every 12 hours. That's also only 39 points in a little over an hour. Meters can vary up to 20% on the exact same sample, so 243 is basically the same number as the 204

Lantus works on a "curve"....Your Pre-shot numbers will be higher...then somewhere in between +4 and +8 (generally), you'll hit the "nadir" (the point in the cycle where it's working it's BEST, but the time it nadirs can change from cycle to cycle). Once you're past the nadir, it starts to rise again. Picture a "smile". Preshot times at the tops, nadirs at the bottom of the "smile"

 

Where do you live? Some states here in the US require a prescription for syringes. Other states do not.

My vet calls it that too! She wasn't laughing after I got my foster cat Wink into remission in just a few short weeks after changing his diet and feeding him the Fancy Feast. This was after various high carb vet recommended dry foods and about 4 months unregulated following the vet's advice at the shelter.

Some reasons I can think of as to why it is called "kitty crack" is because cats love it so much! Not all the Fancy Feast canned foods are good. A lot of them are too high in carbs (gravy, sauce styles) and vegetables (Florentine style) that cats don't need to eat.

It has a lot of byproducts in it. That keeps the price down. I'd rather feed a canned food with meat by-products than ever feed a dry food to my cats again.

Around here, we call the dry food "kitty crack" because cats love the animal digest coating on it and gobble it up. Without that yummy coating, I don't think may cats would even touch dry food.

 

Chris and China,

I gave his AM dose at 9:20 this morning. I will give him another at 9:20 tonight. However, following Wendy's advice, I am going to only give a half unit with the syringes I bought tonight at the pharmacy.

Thank you again for the time and consideration you are giving to my Corduroy. This goes to all of you :smile:

 

Great. Now you need to put on those patience pants.

Wait 3 days minimum before changing dose unless he drops under 50. Keep testing though and let us know the results.. The spreadsheet will come in handy here.

We aren't sure whether that 1unit the caused the hypo even was 1 unit because you were using the pen tips. It may have been more. And 1/2 unit using syringes may not be enough. But we need to give it the three days for the depot to build. And any bounces to clear.

So you may see high numbers. Don't panic. As long as you are testing his pee for ketones, and they are negative, then these short term highs won't hurt him..

 

I totally agree! I'm just happy you got the syringes and can start to shoot those numbers in between whole units that the pen's "dial a dose" doesn't let you!

They can be more sensitive to the insulin after a low number, and we always want you to be safe first! We can help you work getting better control as you go. We'll see where the numbers lead us after 3-5 days at regular and consistent doses :mrgreen:

If you drop below 50 again, it's another automatic dose decrease, so we'd be trying .25 unit

 

So, I tested him tonight at 9:39 and his BG was a whopping 413 :!: At any rate, I gave him a 1/2 unit, or the best I could given the syringes that were available to me. The story behind that: When I went to the pharmacy and asked for a syringe with 1/2 unit increments, he told me that they don't exist. So, I still had to get syringes with 1 unit increments. At least this way, I can get a little closer to a 1/2 unit.

Wendy, how do you test your cat for ketones? Just wondering, because I almost bought Ketostix tonight, but have no idea how to get a fresh urine sample.

 

Yes, there are insulin syringes that have the 1/2 unit markings on the barrel. You want the 3/10 cc syringes. Made for children. Walmart Relion line have the 1/2 unit markings. Some monojects, some BD's, others too.

 

Okay Deb, I'll head to Walmart tomorrow in search of them. I appreciate your help :smile:

 

Ask for any of these as they all should have 1/2 unit markings (even if the pharmacists don't know this!)
- Relion 3/10cc 30 & 31 gauge short
- BD Ultra fine 3/10cc short
- Terumo Thinpro Insulin Syringe 31G 3/10cc
- Kroger 0.3cc 8mm, 31 gauge


Collecting urine tips..
https://docs.google.com/document/d/1quta5WLEjdO0Y_t2dAYSwN84h-LNZWxOdtVsJDKZ16A/pub

 

The staff at Wal-Mart don't always realize they have these 3/10cc syringes with the 1/2 unit markings on the barrel. Have them open a box to confirm for you. If I remember, the center logo on the box is kind of a pinky purple color. Those are the ones I got for my cat Wink.

 

Thanks Deb and Wendy,

Whew! Is it ever difficult to get a syringe with a 1/2 unit marking on it around here! Anyway, after having been told that they don't exist at Rite Aid, I went to Walmart today (that place gives me hives). The pharmacist there also told me that I would have to get them from a pet supply store as humans never need a 1/2 unit. So, while grocery shopping at Kroger, I thought I'd check their pharmacy. Lo and behold, they had 'em :!: She said that they carried them for diabetic babies.

So, even without the 1/2 unit markings, I gave him as close to 1/2 unit as I could last night and this morning. Tonight, I'll be able to use the new ones. Could someone tell me if these numbers are considered bounces just so I can gain a better understanding?

Last night at 9:39 pm - BG 413 - 1/2 unit
This morning @ 12:39 am - 404 - 0 units
This morning @ 9:13 am - 399 - 1/2 unit
Today @ 1:00 pm - 301 - 0 units
Today @ 4:02 pm - 325 - 0 units

By the way, I'm feeding him 1/2 Fancy Feast and 1/2 ground chicken thigh (he doesn't seem to take to the chicken very well by itself right now, so I'm trying to "trick" him ;-) )

Thanks for all your help,

Brigitte

 

I am thinking he should have come down from a bounce by now but I really need that spreadsheet so I can look for holes where it could be

Otherwise 1/2 unit might not be enough but lets continue for 6 cycles before making a change to give the dose a chance to settle - do you think you will get a chance to work on it? I started one for you so maybe Deb knows a way I can transfer that to you and you can simply update it?

Wendy

 

Hi again Brigitte and extra sweet Corduroy!!

First, no, this isn't a bounce. Bouncing is when you get a lower number (or drop quickly, even if it doesn't go TOO low) and the liver "panics". Corduroy's liver has gotten used to high numbers and when the insulin brings it too low, the liver releases hormones and glucogen (sugar) to bring it back up where it's been "used to".

If you look at the spreadsheet Wendy set up for you, you'll see on the PM cycle on 8/27, his blood glucose dropped to only 67 after being "used to" the high 300's, low 400's. His liver said NO!! That's too low!! ....and flooded his body with those hormones and glucogen. That next morning, you had a 450..THAT'S a bounce! It can take up to 72 hours for "new" diabetics to "clear a bounce"...which means for the next 72 hours, you have to remember that if you're seeing high numbers, it may be because of those chemicals the liver released days ago. Corduroy's spreadsheet

Once the diabetes gets better controlled, the bounces won't be as high, and will take less time to clear. China used to bounce into the 400's and take pretty much the full 3 days to clear....Now she only bounces into the 200's and clears them within a couple of cycles (usually)

Does that make sense?

Also, if you'll continue to use the spreadsheet Wendy set up for you, it'll help everyone here a LOT to see what Corduroy's numbers are doing and what kind of "trend" he's on. You should be able to "edit" it, and just put the numbers you get at AMPS and PMPS, how much you gave in the "U" column and your tests at the appropriate time. If you need help with it, send her a private message. I'm sure she'll be happy to help you!

Edited to add..I see Wendy replied while I was typing. Deb (from Deb & Wink) is the spreadsheet whiz she's suggesting you contact to see about transferring it so you can work on it

Since we're all over the world here, instead of using time zones, we use the "+ system"....so 2 hours after you do your AMPS/feed shoot, whatever number you get when you test would be your +2. If you took a test 3 hours later, that'd be +5

Example...AMPS is at 9AM. +2 would be 11am. +5 would be 2pm..+10 would be 7pm.....then at 9PM (your PMPS time) the clock starts over...so +4 would be 1am, +7 would be 4am and +9 would be 6am

 

Walgreen's brand also has 1/2 unit markings

 

Wow....wonder what they do when someone has a human baby on tiny doses?? With that kind of "service", no wonder WalMart gives you the hives!!

 

Hi all,

I will be working on that spreadsheet within the next couple of days, but I have to use my husband's laptop to do this as my tablet is very aggravating to use for things such as these.

Re: Walmart...ugh grr_red

 

Corduroy is a beautiful kitty! I just saw the photo, and he is very handsome.

 

Aww, thanks Lara He's my baby cat_pet_icon

I have another kitty named Joe, but he's had a clean bill of health. I will put his pic up sometime along with Cords'.

 

Hi all,

I am sitting down to start Corduroy's SS with the template that you use. However, I am wondering how I enter the days when I gave him insulin three times. I just want to be sure before I get started.

Thanks so much!

B

 

Lantus works best on the same dose, given 12 hours apart. The spreadsheets are set up that way because of that fact. The protocol we use (that's shown to get 84% of newly diabetic cats off insulin completely) is only set up for twice a day dosing. Doses are held for 6-10 cycles before dose changes are advised unless you get a blood glucose number under 50 during any one cycle, then you decrease .25 unit.

Is there a reason we don't know of that you're shooting 3 times a day?

 

That was before, she isn't doing it now. I think you will need to be creative with the SS.. Add comments to support what you did, and /or put the dose in the column at the time you gave it. For that period it doesn't need to be that accurate... Its more now that you are dosing every 12 hours consistently that we want to see it more accurate so we can really tell what's going on.

Wendy

 

Yeah...I totally missed the "gave" it 3 times a day...and instead read "give" it

My deepest apology

We look forward to how Corduroy does with the new protocol!!

 

Thanks Chris and China and Wendy,

Okay, I will get creative with it. Like I said, I don't think it was an enormous amount of times that I shot three times, but I guess I'll see when I really get into it ;-)

I've got two more concerns that I would like to voice, however. Chris and China, you just said in your post that you recommend waiting for 6-10 cycles before you change doses. Tonight was Corduroy's 6th cycle and because his BG levels have seemed to be slowly going down, resulting in it being 208 at 9:07 pm, I tried to only give him .25 of a unit because I was afraid that if I gave him a half unit again, it might go too low tonight while we're sleeping (although lately, I've been keeping him in the room with us and setting my alarm for every hour to check on him up, until about 3:30 every morning). This has resulted in me being a very tired mom;-) At any rate, I'm hoping I didn't do the wrong thing?

My other concern is this: At the same time I started feeding him raw organic ground turkey thigh and breast with the pre-mix from Feline's Pride, he developed a rash (little bloody-looking bumps all over his skin that he constantly scratches). Someone said that he might be allergic to turkey and to try another meat. However, I'm not sure if it's the turkey or the pre-mix. As I might have mentioned earlier, right now I'm feeding him just Fancy Feast Savory Salmon hoping that this rash will go away. Has anyone heard of an allergy to a specific meat? Could he be allergic to all raw meats? If so, I wouldn't want to invest money in a meat/bone grinder for future raw food recipes.

Thanks for your time,

B

 

Remember...normal values for a "controlled diabetic" are 50-130. The reason we say "no shot" at 200 for really new people is just for safety until we all have a chance to get to know how each cat reacts to both insulin and food. As you get more data (and more comfortable), we'll be having you learn to shoot when he's even lower!! (yes..even below 100!!..but don't worry about that right now)

The tight regulation protocol is designed to try to get them (and keep them) into those "normal" numbers as much as possible. When they're blood sugars are in those numbers, the pancreas has a chance to "heal".

Once you get your spreadsheet up and running, it'll be a lot easier for us to guide you. We need to see the numbers Corduroy gets during the cycles to determine if he needs more, less or just more time at the current dose.

You didn't do any harm, but the only time we reduce by .25 is when they go below 50 at any time during the cycle. Shooting the .5 tonight would have most likely been perfectly safe, but as I said, since we don't know where his nadir is (the point in the cycle where the Lantus is working it's BEST), it's hard to say. It's much better that he's too high for a day, than too low for a minute!!

Also, you don't need to test every hour. If you don't let him eat for 2 hours before doing your pre-shot tests, then shoot/feed, at +2 you can get a good idea of what kind of cycle you can expect. If the number is similar to the Pre-shot number, it's probably going to be a "normal" (or quiet!) cycle. If there's a big difference between the Pre-shot and the +2, you can expect an "active" cycle...where you'd want to do more testing. A lot of times for the PM cycle, we want to see a +2 and a test before you go to bed...if that test is a nice safe number, get some sleep!! There will probably be other opportunities for you to stay up all night and test...don't kill yourself off now!

If he doesn't drop below 50 tonight, I'd probably go back up to the .5 for your AMPS and hold it again...let us get a good look at his spreadsheet to see if we think he needs to go up to .75

IF he's below 200 at AMPS time, don't feed him and start a new post and ask for help!!

Yes..allergies to one ingredient are totally possible. Even if it's something he's had before, an allergy can develop at any time....but I think my first reaction would be that it might be something in the pre-mix myself....I've never tried the raw diet though, so have no experience with it specifically

If he was allergic to all raw meat, he'd be allergic to it if it was cooked too, so I think you would have seen signs of that long ago..and had a very hard time finding anything he could safely eat!!

 

Chris and China,

Ugh, I guess I didn't see this before this morning and I fed him and gave him .5 unit :!: His BG was 193. Why did you say to ask for help?

Brigitte

 

I think you're fine. That 193 was so close to 200, I don't expect Corduroy to drop too low. When people first start to home test and gather data, we suggest a shoot/no shoot threshold of 200 until you know how your cat will react to insulin.

If he had been much lower, 150 or less, then you might have wanted to give less insulin or even skip the shot if the BG was really low. That would have been my recommendation, to cut the dose back to keep Corduroy safe.

The don't shoot, don't feed, stall and ask for advice is a way to get more input on the dose for Corduroy and to keep him safe.

ETA: Would you be willing to add some information to your signature to help us out? Your name, cats name age and sex, insulin and meter used, any complicating medical conditions, food you are feeding would be very helpful for us to see at a glance in your signature.

 

As Deb said, since you're still very new, and we don't know how Corduroy reacts to insulin, it's just something we recommend so during that 30 minutes you're "stalling", you can get someone else's advice to help you through it. It also kind of lets us know you're doing something "new" (for you) and we can try to keep an extra eye out for you during the cycle just in case.

Here in the FDMB, it's all about being safe first!!

You're doing fine Brigitte!

 

Okay ladies, I think I need some help here @-) I just tested Corduroy's blood and his BG was 139. What should I do? I'm really afraid to give him any insulin right now, especially since I have to work early in the morning. Can anyone help?

Thanks so much,

Brigitte

 

Stall, don't feed, test again and post the number.

I think you will be safest if you skip the dose of insulin for today. Depends on that 2nd test.

 

Thanks so much Deb and Wink :!: I really appreciate the help :smile: I will test him again before I go to bed, which unfortunately, will be pretty soon (around 10:30 or 11). I will post the number then, but I don't expect you to be up waiting ;-) I will probably just have to skip tonight. I'm very happy that he's getting into the lower numbers though. I've had a crazy busy week at work, but on Sunday, I should be able to get the SS posted.

 

Brigitte,

What we mean when we say "stall, don't feed and retest" is that at your normal preshot time, if you get a number you're concerned about (that "No shot" number..usually 200 for newbies) that instead of going ahead and feeding, you "stall the shot", don't feed anything and retest in 30 minutes. That way if the number is going up, we can advise you to probably go ahead and give the insulin. If it's going down, we might advise to stall another 30 minutes, or skip the shot...or even give a BCS dose (big chicken shot)....that's giving some insulin, but not a "Full dose".

We don't want you to feed while you're stalling so the next test (in 30 mins) isn't influenced by food.

The one thing you do have to remember though is if you stall, you will need to change your test times too. So if your schedule is normally 8am/8pm for shots, if you "stall" for 30 minutes on the PM dose, you'd have to change your AM schedule to 8:30 so each shot is given 12 hours apart. You can work your way back to the schedule you want by "going back" 15 minutes per cycle after that. So using this example, if you stalled at PMPS for 30 minutes, you'd give the AM dose at 8:30, the next PM dose at 8:15 and the next day's AM dose would be back at your 8am schedule.

What Deb was suggesting is that you don't give the PM dose (since it was under 200), don't feed the cat, and retest in 30 minutes...then let us know what number you got so we could advise you of your options.

 

Hi Chris and China,

I didn't see your message until now. However, I just tested him again and his BG is 111 now, so it's gone down even more. And this was about and hour and a half after feeding him. I will not give him a dose tonight. Should I go ahead and test him again tomorrow morning at 9, the same as usual? By the way, thank you for clearing up the "stall" for me :smile:

 

Yep definately skip tonite and you can shoot on schedule tomorrow, assuming of course if he is over 200.

Put the 139 as your PMPS,and the 111 at +2 with 0 or skip in the dose column.

Also remember to never feed for two hours before the shot either because you want to make sure the preshot test isn't influenced by food.

Wendy

 

Good idea on skipping tonight! It will drain his depot a little

Yes, in the morning you can start your schedule wherever you want it since you're not shooting tonight, so if 9/9 works best for you to test/shoot/feed, then that's where you'd start.

That is, of course, if he's high enough to shoot tomorrow!

 

Hi all,

Okay, I just tested Corduroy's blood, and his BG is 172 at 8:19 pm. I'm going to stall and not feed him for 30 minutes to see if it's going up. Is this right? By the way, this is after 12 hours and only giving him .25 unit this morning at 8:13 am :!: Things are looking up. Again, thanks so much for all of your help

 

Sounds good.

Any news on that spreadsheet?

Wendy

 

That's perfect Brigitte!! Let us know what you get when you retest!

Glad my explanation of "stalling" helped you

I know we keep harping on it, but once you get the spreadsheet going, it'll make it easier for everyone (including you!) to really see how your kitty is doing and what the next step might need to be

You're doing GREAT!!

 

Hi Chris and China and Wendy,

Regarding the SS, I will be able to work on it tomorrow and Monday. Unfortunately, I've not been able to do anything but monitor Corduroy and work (I've been working A LOT lately), so tomorrow is the first day I will have to work on it. But, believe me, it's a priority :smile:
Okay, so this time, at 8:58 pm, it was 168. It went down 4 points during the last half hour. I will do the same, not feed and retest. Should I do this until I go to bed?

 

4 points is within meter error so he probably is surfing. Remember that longer you stall, means the next shot will be off schedule too since it needs to be 12 hours from when you do shoot. How much can you wait without being too off schedule?

Wendy

 

Hi Wendy,

I was shooting around 9:00 every morning and night, so I really can't wait much longer I guess in order to stay on schedule. Should I test again now? It hasn't been another half hour (maybe only 15 minutes actually). This morning, however, I tested and shot at 8:19 am because I didn't shoot at all last night. Can you advise on what I should do at this point?

Thank you so much,

Brigitte

 

Probbaly skip again as I am not comfortable having you shoot low as we don't have that sheet set up so don't have enough data . But as soon as you do, it will be time to learn to shoot low. It's something all newbies need to learn.. How to shoot low to stay low.

Maybe read this primer.. http://www.felinediabetes.com/FDMB/viewtopic.php?f=9&t=147

 

Okay Wendy,

Thank you sooo much for being there :!: It is such a great thing that you all do here on this forum, and it is greatly appreciated. I will work on (and hopefully finish) the SS tomorrow as I am anxious to get it to you. Do I need to start it all the way back to April or should I start it within the last few months?

Have a good night,

Brigitte

 

The more data the better so April if you can do it...

 

One thing you'll never hear here is "too much data" Brigitte!!

Give Corduroy a scritch from me and China

 

Okay, will do Have a great night ladies.

 

Start with the most recent weeks worth of data, and work your way back as time permits. Yes, I might be nice to see data back to April, but the more recent data will be more relevant. I'd enter 1-2 weeks of data for now, and more as your time permits.

 

I posted Corduroy's SS in my signature. I have July 1st through now finished. I've been working backwards so that you will have the most current information. I hope it is correct. I put a lot of notes because I wanted you to know the AM and PM times that I checked him. Some of them are very sporadic :sad:

 

Good job Brigitte! Keeping it up to date will help everyone when you need dose advice too!

I'd like to invite you to go ahead and come over to the Lantus board. It will make it easier for you to get advice, as well as will keep you from getting quite so lost in the Main Health board. Of course you can continue to post in the Main Health board if you like.

Lantus Tight Regulation Board

Each day, we start a new post (they're called condo's) with the date, cats name and your AMPS number in the subject line and in the body of the post you can give more of a "Whole Cat Report" (WCR) where you just let us know how Corduroy is feeling..the 5 P's..purring, preening, playing, peeing and pooping and how his appetite is...just anything you think would be helpful and let us know more about your cat.

If you decide to come over tonight, you could start with 9/9 Corduroy AMPS 260,+2 120,+3 72,+5 81 which covers today's numbers so far and if you get a PMPS you can add that too...if you run out of room, just take out some of the mid-cycle test numbers since we can see them on your spreadsheet too...add "New Member" too (if you run out of room, just take out some of the mid-cycle test numbers since we can see them on your spreadsheet)

I think if you get a number at or over 200 tonight, it'd be safe for you to go ahead and shoot .5 and then hold that dose for at least 6-10 cycles. If it's under 200, stall and ask for help. That's what we're here for!

 

Thanks Chris & China!

I will come over to the Lantus Tight Regulation Board tonight. I have to admit though, that I'm a little skittish about giving him .5 if he's at 200 nailbite_smile

 

Hi ladies,

I'm in the middle of cooking dinner right now, so I don't have time to start a new post in the Lantus forum unfortunately. I will start that tomorrow morning. However, I just wanted to run his PM # by you. When I checked it at 8:44, it was 100. I'm thinking that I shouldn't shoot. Is this correct?

 

When is his next shot time? I guess the better question would be where in the cycle is the 100? If it's his PMPS, (or +11.5) then you should probably skip it tonight. Eventually (if he still needs ANY insulin) you'll need to learn how to shoot when you get those lower numbers, but if he's only gone from 81 at +5 to 100 at +11 or PMPS, I think you'd sleep better if you skipped


If it's +10 from the AM cycle, you'd want to get another test in at the PMPS time and then decide.

Let me see if I can find someone with more experience at these low numbers to help

 

Great job on the spreadsheet! It's so useful!

I do notice you increased dose again though. Remember lantus is a depot insulin. That means it takes a few days to build up or drain in his system and so takes a few days to see the true impact of a dose change. The key is consistency. So I would try 0.25 again but hold this dose a few days to see how it settles.. Even if you see highs!. Change only if drops below 50 which would be an immediate decrease.

You may end up increasing after that time but it will give you a chance to shoot consistently which is how lantus is meant to be dosed.

For tonite skipping is an option if your PMPS is that low. You could shoot 0.25 but be ready to test a lot and have syrup and extra strips ready. Let us know if you plan to do this so we can find someone to sit with you

Wendy

 

Hi Chris & China, that was his PMPS, so his shot would have been at 8:44 pm. I think I will skip it tonight since it's already so low.

Hi Wendy, I have been under the impression that I should be giving .5 units every 12 hours. I guess I'm a little confused as to whether it should be .5 or .25 :? I might have missed something when reading the earlier posts and got .5 in my head.

Thanks to both of you for your help! And thanks for offering to find someone to sit with me, but I think I'm going to skip tonight's dose. I can't believe that there is a forum out there that is so helpful

Good night,

Brigitte

 

We need to find you a dose you can give consistently for now. As a newbie I don't think you are ready to start shooting 0.5 every 12 hours... because that would mean you needed to shoot even though the last few nights were low numbers. Over time you will learn to do this because you need to learn to shoot low to stay low.

So for now I am suggesting a lower dose of 0.25 to see how he does. And if it works then great, if not we will have to teach you shooting low sooner rather than later.

Wendy

 

Okay Wendy, I'll give him .25 starting tomorrow morning. I will also start posting on the Lantus forum.

Thanks again,

Brigitte