Blood Glucose Yo-Yo

Discussion in 'Feline Health - (The Main Forum)' started by scienceofcats, Feb 28, 2018.

  1. scienceofcats

    scienceofcats Member

    Joined:
    Feb 28, 2018
    Hey guys. So, my little black cat Lola (4 years old) has been diagnosed with diabetes. Her blood glucose is all over the place... could use some advice. I have a spreadsheet for her that you can access here. Some background information:

    • Lola is 4 years old and is a rescue cat; she was born on the streets but was rescued @ 2 months
    • Severely asthmatic (diagnosed last summer; takes 3.75 mg prednisolone in the morning by mouth)
    • 6 weeks after starting on 2.5 mg prednisolone, developed weak hind legs, severe dehydration, and changes in the liver and gallbladder consistent with cholangiohepatitis - prescribed antibiotics (4 weeks) and 1 mL of 50 mg/mL ursodiol oral suspension to prevent recurrence
    • Developed rapid breathing in September and was diagnosed with pneumonia secondary to asthma; prescribed antibiotics and increased to 3.75 mg prednisolone
    • Last week, developed abdominal distension and was found by X-ray to have eaten far too much (polyphagia); co-occurrence with increased urination (polyuria) prompted us to urinalysis with culture & sensitivity
    • Culture was negative, but urine was found to have a great deal of sugar
    • Blood tests performed; found dehydration, high blood sugar (24 mmol/L), and other changes consistent with feline diabetes mellitus
    • Prescribed 1 unit ProZinc insulin every 12 hours
    • Advised to do glucose curve at home after 7 consistent days of twice daily insulin

    My understanding is that it's generally a good idea (despite my vet saying it's not necessary) to test blood sugar before every insulin dose, so that's what I'm doing. Originally, my vet said to not give insulin when her blood sugar was less than 20 mmol/L until she could confirm the correct cutoff with an internal medicine specialist. After consulting with the specialist, she advised that I should give 1 unit of insulin if either 1), Lola eats at least half of a portion of wet food and her bG>8 mmol/L, 2) Lola eats only a little bit of wet food and her bG>12 mmol/L, or 3) Lola doesn't eat and her bG>14 mmol/L. For reference, I am feeding her twice daily before insulin with a high-protein, medium-fat, low-carb (8% dry matter) wet food and then leaving Purina DM dry food out during the day, which all of my cats eat now.

    There's a chance that her diabetes is caused by, or being worsened by, the prednisolone, which is known to cause insulin resistance. We are going to try to taper her down, but only after we have had her on insulin regularly for a little while. Anyways, how do her numbers look to you guys? Would you give different advice? Any advice is much appreciated!
     
    Last edited: Feb 28, 2018
    Reason for edit: Condensed and added more information.
  2. Sharon14

    Sharon14 Well-Known Member

    Joined:
    Aug 16, 2015
    Welcome! I’m glad you’re hometesting before giving insulin. It would be helpful if you could get more spot checks between shots as well so we can see how low the dose is taking her. Yes, the steroids can make the diabetes harder to treat and you may need to give her more insulin than you would if she didn’t need it, but if she can’t be weaned off, then you’ll just have to dose around it. There are others here with cats that have both asthma and FD, maybe if you put the asthma in your title they would have some ideas for you. Have you seen the sticky’s in the prozinc forum? You may want to post there too. http://www.felinediabetes.com/FDMB/forums/prozinc-pzi.24/
     
  3. Olive & Paula

    Olive & Paula Well-Known Member

    Joined:
    Sep 6, 2015
    Welcome. One thing stands out for me. The DM dry food is very high in carbs and if it for free feeding the glucose will be all over the place. Most kitties do best with smaller more frequent meals throughout the day if you can manage it. Classic or pate food, with no gravy or sauce. Pick up all food 2 hrs before shot time testing.
     
    Sharon14 likes this.
  4. scienceofcats

    scienceofcats Member

    Joined:
    Feb 28, 2018
    I figured that might be the case. Are there better dry foods to use? My vet and the specialist she consulted with thought it would be best to leave food out to reduce the risk of hypoglycaemia - if Lola gets hypoglycaemic, she will automatically feel the desire to eat to fix it.

    I suppose taking the food up 2 hours before testing could be done, at least in the evening, and I could take it up an hour before testing in the morning. Is that enough time? Also, should I be testing her before or after feeding?
     
  5. Sean & Rufus

    Sean & Rufus Well-Known Member

    Joined:
    Jan 10, 2018
    This is theoretically zero carb : Young Again
    This one is 4.69% carbs: Dr Elsey's
    they both are pretty spendy, but my both of my cats like each one
     
    Last edited: Feb 28, 2018
  6. Olive & Paula

    Olive & Paula Well-Known Member

    Joined:
    Sep 6, 2015
    There some ways to leave wet food out. You can freeze portions and leave them out so as they thaw she can eat it. Also an automatic feeder you can set at intervals where you can put wet food in and put an ice cube in it to keep it fresh. There is a dry food called Young Again that can only be ordered from manufacturer. Tell them you need the low carb for a diabetic cat. They will send samples out.

    You would test before feeding, right before you give shot. So test, put food down while you draw up the insulin, then give it while she's eating. Test/feed/shoot is our mantra.
     
  7. scienceofcats

    scienceofcats Member

    Joined:
    Feb 28, 2018
    I know, but unfortunately, I’m a biochem grad student stuck in the lab all day, and as much as I’d like to, I really can’t escape... however I could do additional tests on the weekend. For what it’s worth, on the first day, she started out at 24 mmol/L before insulin and was at 7.4 mmol/L after 4.5 hours. I am going to do a proper glucose curve next weekend after she’s been consistently on insulin for >7 days, as I’ve been advised that the curve really wouldn’t mean much before that, and I don’t like sticking her more times than I absolutely have to because it’s not pleasant for her... does that make sense?

    I will do that, thanks for the advice. :)
     
  8. scienceofcats

    scienceofcats Member

    Joined:
    Feb 28, 2018
    Thank you! This sounds like a brilliant product. I can’t really leave wet food out because my other cats are very picky and refuse to eat the diabetic wet food, and I’m afraid they’d lose a bunch of weight. So this dry option sounds good - I will request samples.

    Alrighty. I usually feed Lola in another room (my side bedroom) than I test her in (on my dining room table), and the additional problem is that Lola won’t eat alone - she gets lonely and needs me to be there while she eats. So what I could do is test her in the dining room, feed her in the side bedroom, let her go for 5 mins while I draw up insulin, and then give her the shot. Does that make sense?
     
  9. Olive & Paula

    Olive & Paula Well-Known Member

    Joined:
    Sep 6, 2015
    Sounds good. Since you need to be with her to eat, can you test her on the table then sit with her there while she eats? Bring the insulin and food in there?
     

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