Cat's Sugar Still High ...(Re-posting for new member)

Received as PM, re-posting in main health forum.
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Hello everyone! My name is Oksana and I'm new member. I wish to all yours lovely cats to get well soon!
I need your advice,please.

My Siamese cat is 14 years old. He has been diabetic since April 2016. When he was diagnosed his weight was 4.5 kg and level of sugar was 24. However, he was an active cat. Vet had put him on Hill's Prescribed M/D food and 1U of Caninsulin twice a day. During this period of time my cat twice was in the vet hospital according his pancreatitis. Both time he was discharge without any future pancreatitis home treatment.

At this moment my cat's weight is 3 kg. His back legs very week, which means he has the diabetic neuropathy. Sugar still unstable 14-16 after Morning injection and 24-30 before Evening injection. I give him 2.5U twice a day, because our vet think that insulin increasing might harm. Latest fructosamine test showed 560.Going to do acromegaly test.

What else I need to do?

Thank you.
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Hello Oksana, and welcome!
(So glad you made it over to here from FB.)

It sounds like you are testing your cat's blood glucose at home. That's great!
We have a spreadsheet here that you can enter your cat's test results onto if you wish. That will make it much easier for you (and us) to see what's going on with your cat's blood glucose. If you'd like help setting that up there are folks here who can help you.

Some questions for you:
Are you testing your cat's blood glucose before each insulin shot?
Are you also managing to get some 'mid-cycle' tests (in between insulin shots)? And if so, do you know how low your cat's blood glucose is dropping on the current dose of insulin?

It sounds like your cat may indeed have neuropathy (although other things, such as potassium deficiency can also cause leg weakness). Many of us have found that giving methyl B12 (methylcobamin) can help with neuropathy.

Which country are you in, Oksana?

Eliz
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Hello Eliz!
Thank you for the quick response.
I live in London.
I'm testing my cat's glucose level once a week to do glucose curve and if I see his behavior has change.
The lowest level was 8.4. That day his glucose was "jumping" up and down.He had been vomited few times.But this happened just once.
Could you,please, write it the trade name of this methyl B12, then I can order thru ebay?
How can I find a spreadsheet?

 

Hi Oksana and welcome to FDMB,

It's great that you are testing but doing a curve once a week really doesn't give you the information you need to figure out dosing. Glucose levels are fluctuating all the time and can be influenced by food, stress, activity, other health issues, etc. A curve is a snapshot of one's day's BG while random testing gives you a movie with far more detail. Sometimes too much insulin can look like too little and without pre-shot and mid-cycle testing, it's impossible to figure out what is going on.

We strongly recommend testing before every shot to ensure it is safe to give insulin and at random times (around expected nadir) during each cycle. At 2.5u of Vetsulin, I don't think you need to pursue testing for acromegaly. While not all acromegalic cats require large doses of insulin, testing usually isn't done until the dose exceeds about 5-6u twice daily or the pattern of readings is suggestive of the problem.

Fructosamine tests are like short films rather than a full length movie even though they give you an average over a short period of time. A few very low or high periods will influence the result as will other blood values. I had my cat declared regulated using the fructosamine test when my random readings showed she clearly was no where near regulated so I personally don't think it offers much while one is trying to bring kitties numbers down.

The spreadsheet is available HERE. If you have any problems getting it set up, just holler and we'll get you some help. THIS documentation explains the spreadsheet and how to use it.

The methylB12 is called Zobaline. I'm not sure if it's available thru Ebay but a search will take you to their website and other sites where you can order it.

 

Hi Oksana,
If you're in London that means we're (almost) neighbours.

Many folks here use the 'Zobaline' form of methyl B12 that Linda (Mr Worfmen's Mom) mentioned above. But it can be expensive for folks outside the US to buy (the cost of it now means that import duty is payable on it in the UK, and the Post Office also charge for dealing with the import duty )

Another option is Dr's Best methylcobalamin which is available from a number of places in the UK. 'Bodykind' often sell it at a good price, and postage is free in the UK:
http://www.bodykind.com/product/474...4M-fsFHOpJdkxoCP3Tw_wcB#ctl00_cpBody_contents

The Dr's Best is half the strength of the Zobaline, so you need two of these to equal the Zobaline dose (3mg).
Also, Zobaline contains a little folic acid as well as the B12. If you want to, you can give folic acid also to 'mimic' the Zobaline formula. I think Bodykind do folic acid liquid (drops) that are the right dosage to add.
Fortunately, methyl B12 has no flavour, and so most cats don't mind it in their food at all.

Eliz

 

OK,I see.The vet don't know for shore that this is an acromegaly, because Roma's(this is my cat name) current insulin dose still small?I've called the vet today,they said that first we need increase an insulin, then do an acromegaly test.
I going to start to measure level of sugar before every shot.
I've found the spreadsheet.Thanks a lot!
I'm soo happy to find this site!!!

 

@Elizabeth and Bertie Good to know you have an alternative for Zobaline in the UK. I've bookmarked this for future reference. We are not so lucky here in Canada. I know one Cdn. member was trying to mix her own B12 and Folic Acid and putting it into capsules because of the exorbitant delivery/import costs we incur here.

 

To be honest, I think you need to find a better vet. Ask around for a vet that is a specialist in FD.

The best time to test is just a while before shot time. First, test then feed. Wait about 30 minutes before giving the shot so the food can work with the insulin. If the blood glucose is less then 225, wait 30 minutes and test again. if the numbers have not come up, it is better to skip the shot. As time goes by, you will learn when it's safe to give a partial dose. While you are waiting, post here and someone can help you with this.

 

Oksana, the "stall and retest" reading of 225 mg. in US measure scale (12.5 mmol in our measure scale) is what donnalea uses with her pet meter which reads higher than a human meter and we don't know what meter you are using. If it is a human meter then the "stall and retest" reading would be 11 mmol or 200 in US measure scale. Perhaps you could set up a signature with some pertinent information so we can ensure we provide you with references for your particular meter type.

To set up a signature, (the lighter grey text you see at the bottom of most posts), hover over your user name up in the upper right corner of the screen. This will cause a menu to drop down and you then click on "signature" in the left column. This opens up a text box for you to type in details about Roma and yourself. You can include info like Roma's name and date of diagnosis, his diet, any other health concerns, the type of insulin you are using, the type of meter you use to test and your general location (i.e. UK) is also helpful so recommendations can be geared to what's available to you. The signature only allows for 3 lines of type so we often separate each item with a "|" or "/" to fit everything in.

 

Thank you very much,Eliz!We're neighbors.We leave in ESSEX.

 

Her on B12 and Folic Acid?We will do everything for our babies!

 

Roma's glucometer has showed"Hi", which means that level of sugar very high .Next insulin shot in 1 hour 20 minutes.His general condition is OK.What do I heed to do?

 

Oksana, give your regular dose. When you get your spreadsheet set up, we can give you much better advice. Without being able to see the 'history', we really can't tell you much....that is the tool that allows us to see into Roma's sugar dance.

 

Roma is beautiful!


Mogs
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I try my best to do the spread sheet correctly.

 

Oksana, even if you do it wrong to start off, we can help you get it fixed. That's not a problem at all. It's just the only way we can see enough information to help you well.

HUGS! You really CAN do this!

 

Can you,please,send it an example to me.For the clear picture.

 

Do you mean you'd like an example of the pattern seen with Acromegalic cats? These cats often require large amounts of insulin and until you get to a high enough dose, their cycles look flat with little to no movement and/or they might hold a dose getting nice numbers for while and then suddenly need more insulin for no apparent reason because the tumour that causes acromegaly is pulsative meaning it puts out the offending hormone more at some times than others. There was an interesting discussion of acromegaly and IAA in this thread which you might find helpful to read.

 

My Murphy had acromegaly. He was on 50 units of insulin twice daily. He slowly built up to that as the disease progressed

 

50!That is sounds too much!

 

Eventually,I've founded how to fill the spread sheet properly!

 

.This is Roma's spread sheet. We live in UK .That is why numbers different from US.

 

Oksana, my first thought when looking at Roma's spreadsheet is that you were getting some better numbers at a dose of 2.5u than you are at 3u. If you look at the readings where you have taken a pre-shot number and mid-cycle tests, Roma is getting a decent drop in BG but then often times bouncing back up higher than he started. I'm really wondering if he is on too much insulin. Sometimes too much insulin can look like too little. You are missing a lot of pre-shot numbers so there isn't a lot of data to be able to judge exactly what might be going on. If I were you, I'd be inclined to back up to 2.5u again, get pre-shot tests before every shot and take mid cycle readings between +3 and +6 randomly (you don't need to take readings at each hour every day) and at +8 post shot to see what the pattern looks like. With a bit more data, it should become easier to determine what's going on with Roma.

Your current spreadsheet is only viewable by anyone who has Excel or the necessary software. It would be easier for others to offer advice if your spreadsheet was shared in Google docs with the automated colour coding intact so that anyone on the board could view it. If you want some help setting it up in Google docs, please let us know and we'll get you the help you need.

 

Hi
Thank you for the quick respond!ON 29/09 I switched him to his Hill's M/D back.Maybe,that is why his sugar begun to fluctuate?
Will do like you said.I have some version how to use Google docs, but it is had to understand.Do you have some easier version,please?

 

Is Roma on the canned or dry Hill's M/D? What food was he on before you switched back? Different foods can have an effect on BG levels not only due to carb content but also by specific ingredients. Like human diabetics, some cats are more carb sensitive than others so yes it's possible that is part of the equation. There are a number of supermarket brands of food that might be better choices for Roma than the RX diets and less expensive too.

HERE is a link to an amazing amount of information about UK food choices.

Oksana, I'm going to tag our tech wizardess to help get your spreadsheet set up.

@Marje and Gracie Can you please help Oksana get a spreadsheet set up. Thank you!

 

He is on both wet and dry.We use to give him Hill's W/D,but he started to loose weight then we switched him to Hill's M/D back.Thanks a lot!

 

Oksana, the Hill's M/D is about 18% carbs which is too high for a diabetic cat. The W/D is a whopping 37% so definitely way too high too. I don't think there is a low carb dry food available in the UK. It would be better to feed only the canned food. If you do remove the dry, it's likely Roma's insulin dose will need to be reduced and you will need to keep an eye on his BG levels to keep him safe as you switch him over.

 

We did this in the past left him only on wet food,we was hungry all the time.

 

Unregulated kitties are hungry all the time because they can't effectively get the nutrition out of their food so it is often necessary to feed a bit more than you normally would until you find the right dose of insulin and start seeing some better numbers. Feeding multiple meals/snacks of canned food can be accomplished with an automated feeder or by freezing canned food in an ice cube tray and leaving out cubes out so kitty can go graze as it thaws. I think sometimes they get so antsy for food, that too is stressful for them and can cause some BG elevation.

 

I've been injected him 3U since 08/10/16.Is it safe to switched him to 2.5U to soon?

 

Does snacks do you give separately between main meals?

 

You can safely take Roma back to 2.5u and re-evaluate after a few days. If you are going to remove the dry food, it would be prudent to reduce the dose from 3u anyway as that may cause Roma's numbers to go down naturally.

What many folks do is split the day's food allowance up between either 4 or even 6 feedings a day with larger portions pre-shot and smaller portions for snacks between the main meals. So for example, if you want to do 4 feedings, divide his daily allowance into 6 portions and give Roma 1/3rd (equivalent of 2 portions) of his daily food allowance at each pre-shot meals and 1/6th at 2 snack times. I do 6 feedings a day so I split food into 8 portions and feed 2/8ths at each shot time and 1/8 for each of 4 snacks. Just make sure Roma does not eat for the 2 hours before you do the pre-shot testing as you don't want any food influencing those readings to ensure it's safe to give the insulin.

 

Thank you!Unfortunately,,I have no chance to feed him 4-6 time a day,because most of the time we're at home Morning and Evening time.

 

Oksana.....I'll be more than happy to do a Spreadsheet for you. It just takes me a few minutes. If you'd like me to do this, please send me a private message by clicking on "Marje and Gracie" under Gracie's picture at the left and then click on "start a conversation".

 

If I decided to switch Roma to another kind of wet food how can I measure how much I have to give it to him a day?

 

You can calculate how many calories Roma needs per day using this formula.

(ideal weight in pounds X 13.6) + 70

Check the can of new food or their website, as they may provide info about the calories in the food. If the info is not available on the can or website, you can send an email to the company and ask. Some cats are more active and need more calories ad vice versa. The trick is to track Roma's weight and if he needs to gain weight, feed him more than the formula suggests. If he needs to lose feed him a little less but bear in mind that an unregulated cat may need more food (calories) than this formula suggests because they can't get all the nutrition out of the food they consume so you may want to wait till he is better regulated before reducing his intake to promote weight loss if it's needed.

We have re-opened the Caninsulin forum HERE so come join us over there where there are other pet parents using the same insulin and you'll get lots of assistance to help Roma get regulated and feeling better.

 

Thanks a lot!

 

Thanks a lot!

 

His ideal weight is 4.5 kg which is equivalent of 9.1 pounds.According to the formula him need 110.95 calories a day.M'I right?

 

Oksana, I calculate about 205 calories per day. 4.5kg would be 9.9 pounds. 9.9 X 13.6 = 134.6 +70 = 204.6 calories.

 

Your total bigger that mine. Roma will love it!Thanks a lot!Now trying to solved out which food to choice.

 

Actually....that is not what I would do. That is not Dr. Lisa's preferred method as she states that forumal will give you a very generous amount of calories which might be ok if he's thin. I would on,y use that forumla as a starting place if you have no way to know how many calories you are currently feeding.

There are other instructions on Dr. Lisa's site that I found to be a better way to determine the number of calories he should get. If I had used the formula, both of my cats would be too fat.

Is Roma currently at a good weight or is he too heavy or too thin? First, weigh him. You can do this by weighing yourself and then hold him and weigh yourself again. Or the best way is to just buy an inexpensive baby scale. Once you get his weight, try to figure out how many calories you are currently feeding him using the labels on the foods. Then use the labels on the new food to determine how much of it he needs to eat the same number of calories he eats now.

If he is a perfect weight, feed him the same number of calories of the new food. If he needs to gain weight, slightly increase the calories, feed the new food for a week, and then weigh him again. Repeat until he gets to the weight you want and then stop increasing the calories.

If he's heavy, you'll want to decrease the number of calories. This is what Dr. LIsa says about weight loss in the cat:

Sorry to cut and paste but it's the best way to explain it.

 

Roma was 4.5 kg in April 2016.After was diagnosed with diabetes he has started to loose weight.On this moment hi is 3kg.

 

Roma definitely needs to gain some weight back. Do you have any idea how many calories he is eating right now? If so you can use that as a gauge to determine how much of the new food to give him so that you are increasing his daily calories to promote weight gain. The key is to keep weighing Roma to ensure that he is not gaining more than he needs to and once he gets to his ideal weight, then you'll have to reduce his calories to maintain his weight. As he gets better regulated, his food needs will decrease as his body starts utilizing his food better.

 

According to label on the Hill's M/D 1 can of wet food constains 162 kcal. I give him 1/2 of can twice a day plus 15 g of dry Hill's m/d food twice a day.I have tried to calculate how much kcal contains in 30 g of dry food.On the pack says that 3954 kcal/kg,493 kcal/cup.I give him 15g which is 1/6 of the Hill's measure cup.It means 15 g contains 82.1 kcal. Actually I'm not very shure that 493kcal/cup means Hill's measure cup..

 

Based on your calculations, you have been feeding roughly 162 + 82 = 244 calories per day but the problem is that a cup is a measure of volume while grams are a measure of mass. So to accurately figure out the calories in 15g of the dry food, fill a cup with the dry food and weigh it to see how many grams are in a cup. This will tell you how many grams of the food provide 493 calories. Then you can figure out how many calories are in 15g of food.

Weigh Roma, keep feeding the same calories for a few days and then re-weigh him to see if he is maintaining, losing or gaining weight. Then adjust accordingly. If he is maintaining or losing, up his calories a bit... if he's gaining which you want him to do, stick to the same, calories but monitor his weight to be sure he doesn't gain too much. Once he hits his ideal weight, you will need to lower his caloric intake a bit to find how many calories he needs to maintain his ideal weight. Much of this exercise is trial and error so the key is to make changes slowly and keep monitoring Roma's weight.

 

Hi!I've ordered a scale for weight Roma and food scales also.182g contains 493kcal/cup,which means 15g contains 40kcal.M'I right?

 

Yes, I get 40.6 calories so you are right. So you've been feeding around 200 calories per day. Raise his calories intake from the 200 to get him to gain weight but do so slowly and track his weight once or twice a week to see how he is doing. Once he's gaining a little then stick with it.

 

Is it safe to increase the food and stay on 2.5U?Because our vet say,that if we increased food need to increase an insulin.

 

You should increase the food intake gradually whilst maintaining the dose and weigh weekly until he hits his ideal weight, continue and if he gains reduce the food a little. Unregulated cats need more calories as they are not able to use the food efficiently. It isn't as simple as increase the food and increase the insulin at the same time. Are you home testing? Can you set up a spreadsheet to track his numbers, the numbers will indicate if and when the dose needs to change and we can help with that.

 

Alexi,at this moment I have only EXCEL version of Roma's spreadsheet. Please,find attached.

 

Have just ordered Granata Pet Veal&Rabbit from Zooplus.Hope Roma will like it.

 

Sorry but I can't open your spreadsheet, I will see if @Marje and Gracie can help with sorting out a google spreadsheet for you which will make life easier. If you don't have a google account can you set one up.

 

I'm trying right now to send thru google

 

src="https://docs.google.com/spreadsheet...single=true&amp;widget=true&amp;headers=false"></iframe>

 

Oksana

Unfortunately, that is not the way we access spreadsheets here and they have to be linked to your signature block so we can always have them available.

I believe I might have offered before to do one for you and the offer still stands. Please just send me a private message.

Edited to add: the SS you have linked above is not the World SS and so it isn't doing the conventions to mg/dL. I can copy and paste the info from this SS into the proper one and link it in your signature if you wish....again..just send a PM.

 

I can see it - but it is the US spreadsheet which is why everything is light green because the US numbering system is different, we'll get you sorted as we are conditioned to be alarmed when we see that colour. I see you can generally get mid cycle numbers during the day but don't get the pre-shot numbers, these are important as you need to know if it is safe to give insulin. For now I would hold the dose and try to get some more data, Roma's numbers have been a bit all over the place but this is not unusual when you are starting out, but you do need to consistently getting the AMPS and PMPS every day.

 

Thank you,I have no chance to take his AMPS and PMPS every day because of my working shifts.I'll try.Once again.I have to monitor every day pre-shots numbers and how many time a week I have to take a mind-cycle number?

 

If you can't get a pre shot number then get a mid cycle number that day and any others you can manage, it is all data and over time you will see the patterns start to emerge, please do take up the offer of sorting out your spreadsheet, to send a PM just click Marje and Gracies name under the picture, write your message and press send - she can do it in next to no time!

 

Oksana

I've had a chance to look at his spreadsheet since I fixed it for you and you added numbers. I am wondering if he is not overdosed?

He has gotten some blue numbers at 2.5u and then you see these red and black numbers. That indicates to me that he is going lower at some place in the cycle and then his liver gets panicky and releases hormones and more sugar to bring his BG back up (because it has become accustomed to higher numbers). We call this "bouncing".

It's hard to discover the low numbers if you aren't able to test a bit more. Once he gets into a lower number, he can then have six cycles afterwards of high numbers from bouncing.

It takes a test at every preshot and then random tests during the cycles to discover where he might be going lower.

Also keep in mind that if you change food from the canned and dry foods you are giving him now, which are higher carb, his insulin needs will also be less. I would make any food changes very slowly but I'd also try to get a few more tests each cycle, and definitely a preshot every single cycle, so you can see if he needs less insulin.

 

Ok,I'll keep this in my mind.I'm switching him from Hill's M/D wet and dry to Granata pet wet food.

 

That's a big change in carb load. I recommend doing the transition very slowly with intensive BG monitoring.


Mogs
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I've started today.The BG +3 was 9.9.Will monitor during the day.