? Confused about what is going on with my diabetic cat

Hello, my 12 year old cat, Leo, was diagnosed a little over two years ago and it took about six months to get him regulated (highest BG numbers in the 200 range, dropping to ~90 at lowest point). He was on 3 units of Lantus 2x a day at the time.

Over the following year I tested regularly and began tapering the insulin down as his BG values improved. I got him down to 1 1/2 units 2x a day. I also put him on a diet and he lost about 3-4 pounds (originally weighed 16 pounds).

I noticed he was getting a little too skinny so I began upping his food (he is on canned low/no carb food 2x a day and gets low carb dry food at night as a treat).

His BG started to go up which I attributed to the increase in food so I changed insulin slowly until he was at 2 1/2 units 2x day. This kept him in the range of ~200 high point, ~80 low point.

Everything was fine for about 4 months then suddenly he had what the vet assumed was a hypoglycemic episode - his BG was at 60 when I took him to the emergency vet. They had me drop his insulin down to 1 unit.

Ever since then his BG is in the 400s at the high point and I've never gotten it below 250 at the low point (i.e. six hours after giving insulin). I test his urine with glucose strips regularly and they are always negative. I have had one recently that was trace.

I upped his insulin about a month ago to 1 1/2 and have seen no improvement. He does seem to be drinking a bit more but again, his urine tests show no glucose.

The insulin itself is "fresh" - about a month old at this point.

So after that incredibly long story, my questions are:

*Any idea why his numbers don't seem to reflect the increase in insulin?

*The vet seemed unconcerned with the higher numbers (I did a curve a couple weeks after the ED visit). I thought I needed to shoot for numbers closer to 200s at high point, 100 at low point?

*With his numbers being higher, why am I not seeing positive urine glucose strip results?

*Is it safe for his values to be so consistently high? I'm worried that long term damage is happening that is going to end up taking years off his life.

Any insight would be appreciated. I gave him 2 units this morning to see what would happen (he tested around 378 at 5am and three hours later was only down to 357). I am going to test again shortly but I guess I would have expected to see a more dramatic drop.

Thank you!
Sandy

 

Hi Sandy,

Do you have a spreadsheet with Leo's BG numbers? Any chance of a link? It'd help members to give you better information.

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Attached is the curve I did back in April when he was still on 1 unit.

I have also attached the curve I started today. At time of insulin he was at 378. Six hours later and he is at 331.

In between I have been doing random testing (different times of the day) and have never seen his number fall below 290.

 

Thanks for the links. Ideally we need to know a bit more.

Do you have a written record of the spot checks and the doses? If you do, it would be really helpful if you could fill in one of our spreadsheets (uses Google docs and works like an Office spreadsheet - easy to share with members here - no need to upload files all the time). Seeing more data will help members here to help you understand Leo's patterns of response to Lantus and maybe suggest a way forward.

Here's a link to our Spreadsheet guide. It'll walk you through how to set one up. If you decide to fill one in and get stuck, just post back here for help.

Create a Google BG Spreadsheet

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No idea if I did this right so please let me know
https://docs.google.com/spreadsheets/d/12ITFnOjQm361plCzi-SjXvPhZ-bMpXRAuqDuc_d1Zjw/edit#gid=0

 

You need to change the "permission" so we can see it. Go to the top right corner where it says "Share" and click..a new box will open. Go to the very bottom of that box and hit "advanced" and change it to "anyone with the link can view"

 

Thank you, please try again.

 

Yep, works now!! Good job!

 

Hi again, Sandy.

Sterling work on getting Leo's spreadsheet up so quickly! Nice one.

I'm not sufficiently experienced to interpret the data you've provided, but I'm sure that other members will be able to comment further. I'd suggest that you put a question mark prefix on your thread title to attract more attention to it. Here's how:-

1. Go to the first post in this thread.

2. Click on Thread Tools (on right hand side of screen).

3. Click on Edit Title.

4. Click on "No Prefix". You'll see a drop-down box of prefix icons. Choose the question mark icon and save your changes.

I hope someone will be along to help soon.



Mogs
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@Chris & China -

Chris, do you know who might be able to help Sandy with dosing? She hasn't had any responses to her questions. I'm not experienced enough to know how to help.

 

Thank you. I went ahead and emailed my vet since Leo's BG was so high tonight even after increasing to 2 units. Hopefully she will have some ideas for me. I appreciate your assistance and the spreadsheet is great - definitely going to use that going forward.

 

What prompted you to take him to the emergency vet where they read 60? That's not necessarily low #. I'm assuming he was having symptoms of hypo too? Don't take my advice but if one dose was working great and the new dose is not working I would go back to the old dose, and perhaps break his meals up during the day to keep the BG a bit more level? Anyone have thoughts on this?

Also I think you mean KETONES instead of glucose in regards to the urine tests. Ketones can take time to develop. Luna has them but her levels were uncontrolled for quite awhile before I got into home testing. I think all you need to worry about here is that if she does NOT have them then that is a good thing and don't worry about it but continue testing while her #' are >300.

If you look at my spreadsheet Luna is always high, even going from 2 units to 5 units twice a day. There are many things that can cause this, and it's just a matter of having patience (I'm having trouble with this myself) with her body and how it's reacting to everything. I can't get her under 200 whatsoever except once and she usually sky rockets to 450 after she goes below 300. Patience is a virtue in this evil diabetes game.

I'm sure she's been uncontrolled for too long and her blood work stated her liver #'s were about 50% too high, but the vet wasn't concerned and we're at work correcting that with medication - so don't worry too much!

 

Hi Sandy,

I'm sorry you didn't get a prompt response here on this board today. If you don't get any responses soon, I'd suggest starting a new thread on the Lantus & Levemir Insulin Support Group board. It tends to get a greater number of experienced Lantus user eyes on it because there's usually more traffic on that board. I'd recommend giving the thread a title like "Lantus - High Numbers - Dosing Advice Needed" and again use the question mark prefix to let people on the board know you have a question that needs answering.

I'm glad you find the spreadsheet helpful. Going forward, it would help if you could get the following tests and record them in your spreadsheet:

1. AMPS - Morning preshot test - check BG before feeding and giving AM insulin dose.

2. Mid-cycle test for AM cycle (can be a spot check anywhere in the cycle but preferably where you suspect the nadir BG is occurring - helps to do spot checks at different times on different days to build a fuller picture).

3. PMPS - Evening preshot test - check BG before feeding and giving AM insulin dose.

4. Mid-cycle test for PM cycle (can be a 'before bed' test, or you could set an alarm to get a spot check during the night).

As you build up the above data over a period of days it will help to better identify how Leo's responding to his insulin dose(s).

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ETA: When you get a chance, it would be really helpful if you could add Leo's insulin type and also the type of meter you're using to measure his BG into your signature. That way anyone responding to your posts will be able to tell at a glance what Leo's setup is and also to understand his data properly.

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Yes, he had signs of hypoglycemia (pacing in confusion, acting like I wasn't there). I actually thought he'd lost his sight at first because he couldn't find food that I put right in front of him.

I am talking about the at home strips you use - I guess I never really understood what they did - the vet suggested them after the ED visit.

The part that has been frustrating for me is the vets don't seem to be concerned with the high numbers. One vet told me not to be so focused on the numbers but I guess since numbers is the only measurement I have, I can't help but focus on them. They also have said not to change the amount of insulin given from day to day so I am feeling very helpless. I don't want to screw something up and make him go into a hypo state again but I don't want to ignore potential damage being done to his body because his numbers are so high.

Leo is also always hungry which I think is a side effect. He licks stuff out of the sink if I don't remember to run the water after I've dumped something in there. It's hard to see him so desperate. But his weight is fine as far as I can tell.

I guess I will just keep testing and adjusting the dose as best I can. Thank you for your input!

 

"Ever since then his BG is in the 400s at the high point and I've never gotten it below 250 at the low point (i.e. six hours after giving insulin). I test his urine with glucose strips regularly and they are always negative. I have had one recently that was trace".

When you get like a 400 reading are you testing the blood for this # or the urine? When it says negative/trace I would assume you're referring to ketones, which is something that happens when the blood sugar is too high for too long, or from dehyrdration, or from lack of insulin, etc. There's some good reading on ketones throughout this site but if it's NEGATIVE don't worry, but still be informed. Are you testing urine for blood glucose levels or blood? Just curious as I'm a newbie at all of this too.

Someone here said something like "treat the cat, not the numbers" but I think you have a right to be frustrated.

Go into the LANTUS subforum on this website and peruse around the stickies. Check out specifically the TIGHT REGULATION PROTOCOL sticky over there. I think this could really help you out. From my understanding it takes 6 cycles (3 days with 2 shots a day) for lantus insulin to 'stabilize' in the body, so you want to wait 6 cycles typically before changing doses. For example when you went from 2 to 2.5 today that wouldn't typically be advised.

Someone also told me that insulin is NOT medication. It is a hormone. You cannot expect results like you might expect them if giving a medication. Insulin #'s can fly all over the place while new doses are being adjusted to. Please look at my spreadsheet with Luna to see what I'm talking about. I can't get her to do anything reliably thus far, and am at 5 units twice a day and still seeing #'s over 300.

Luna is also a FIEND when it comes to food, she'll eat all the food in the fridge if I let her. Sometime's its just their personality.

Basically what I would do if I were you (which I was like 2 weeks ago):

Keep testing as much as you can. Read that TIGHT REG PROTOCOL and the SLOW AND STEADY protocol in the Lantus forum. Choose one, and stick to it, and keep testing as much as you can! Also read a bit about KETONES and WHAT TO DO in case of hypo emergencies (all of this is in the lantus forum). You can adjust doses yourself without the vet as long as you are home-testing per whatever protocol you choose. Read about NADIR'S and what they are (lowest point during the day in BG levels after giving insulin) because that is how you adjust doses.

 

Take a look at my signature link Secondary Monitoring Tools for some other assessments you can make to evaluate how he's doing.

 

There are a couple different types of urine strips available, and I think there is some confusion to what type you are using.

Ketone strips test for ketones which can lead to a complication that can sometimes happen in diabetics. Its good to test for these once in a while to make sure you catch the complication early if it happens.

Urine glucose strips test for sugar in the urine which happens when the blood glucose goes over a certain amount and spills into the urine. This is called the "renal threshold" and is different for every cat. One cat might have urine glucose at 200 blood sugar. One might not have it until 300 or more. The test is useful in some situations, but if you are testing the blood sugar, there really is no reason at this point to test the urine glucose. It won't tell you anything the blood sugar won't. Vets sometimes recommend these strips to people who don't home test the blood glucose.

When blood sugars are high for a length of time, it damages the cells in the pancreas that produce natural insulin. This causes the cat to become more insulin resistant. We refer to this as glucose toxicity. So it's possible because the dose reduction you had left him uncontrolled for a while, that 2 1/2 units is no longer going to send him hypo, you might end up going quite a bit higher even. Small dose changes are the key either way for figuring out the right dose and that takes some time.

It's not good for numbers to be consistently high as complications are more likely. Sometimes it's unavoidable, so we all do the best we can. Some cats never get good numbers but symptoms improve. Normal numbers for a cat are 60-120 on a human meter. Are you using a human or pet glucometer?

Lantus is a long acting, depot insulin. That means it takes a couple days to build up in the system, and gradually brings down the sugars over that few days. It's very different to the mealtime insulin that human diabetics take which brings blood sugars down over a couple hours. Because of this, it sometimes takes -days- for a change to be seen. There is a dosing protocol in a sticky under the "lantus and levemir" forum that explains a little more how most of us do dose changes. Roughly, we wait anywhere from 3-10 days depending on the circumstance before we judge if a dose is working or not. It takes at least 3 days to see the full effects. I would stick with whatever dose you have at the moment, and keep testing carefully. In a few days, post again here so people can help you with the next dose change.

 

@Meya14 -

One of the best posts I have ever read here.

 

Thank you for the responses.

I'm using ketone strips to test Leo's urine.

I spoke with my vet this morning and she has suggested I do 2 units for a couple of weeks, then do another curve and see where things are at.

I appreciate all the input - Leo just celebrated his 12th birthday and every time I see those high BG numbers I stress about how many future birthdays this disease is going to rob him (and me) of.

I will keep at it and hope for the best. Good luck to everyone!

 

Keep testing at home, and hold the dose that the vet said. After about 10 days, post another post here before you make a change and you can get everyone's input, and you'll have more to discuss with your vet. Generally, we step the doses up by 0.25U or 0.5U to avoid drastic changes, and to get us close to the perfect dose. Waiting too long in between dose changes will leave the sugar unregulated during that time, so 2 weeks is a bit on the long side. If he drops below 90 at any time, you can post here and ask for help, sometimes that means a reduction needs to be made.

 

Happy Birthday, Leo!



I've had the same worries as you. Here's to getting Leo regulated and ready to celebrate many, many more birthdays.


Mogs
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So sweet - thank you!

 

Thank you, I will.

 

Pssst! It's tuna-flavoured.

 

Can you let us know what Leo is eating these days? Total amount of food per 24 hrs? What does he weigh - and what is his optimum weight?

 

Canned, grain free Instinct food (5 oz 2X a day) and 2-2 tsp dry food (Evo low carb) at night as a treat. He weighed 16 pounds a year ago but I got him down to 12 which the vet seems to be okay with.

 

So sorry for delay in getting back to you: TERRIBLE internet problems here! Anyway ...
HAPPY BIRTHDAY, LEO!!! (And now for a lot of thoughts ...)

That's really good that you got him down to 12 lbs ("which the vet seems to be ok with." But ... the vet also seems to be unconcerned with higher #s, too, right? Hmm...)

Here's my take on it:
1) Leo is hungry all the time because his diabetes is - as yet - not well-controlled.
2) You may actually be feeding him a bit too much daily: The Instinct cans are 5.5 oz = 11 oz./ day + 2 teaspoons/ .33 oz dry = base total of 11.33 oz. food/ day.

Today, Bat-Bat is slender (but not emaciated) @ 11 lbs (and she’s a long, rather large-boned cat); her diabetes is well-controlled & she's very nearly in remission; she is fed 2.25 cans (6.75 oz.) of FF Classics (turkey & giblets) per day. (She used to be fed Purina d/m 5.5 oz. cans - which are about the same protein/fat/carb ratios as the Instinct grain-free - on d/m she got 1-3/8 cans daily. Switched to FF because of the expense of d/m; works fine.) She was fed 2 times daily @ AMPS/PMPS consistently throughout treatment until we achieved glycemic control (NO snacks/ no treats - unless she was having a hypo event, at which time I'd feed a little to bring her BG back to safe level & retest to be certain of that.) She is only recently on 4 mini-meals/day --- because now she is micro-dosed on an "as needed" basis (you can see this on her SS): AM & PM meals ("pre-shot" meals) + other two meals given after +4 am & pm (she has generally nadirs between +3.5 & +4 since her glucose became well-controlled). The pm +4 meal is the smallest.

Bat-Bat used to weigh in at 18 lbs! When she tore her ACL jumping from a high spot, vet said, "You know ... she should lose a few pounds.” (Too bad he didn't also check her glucose at that time; I was clueless back then!) My vet thought 13-15 lbs. would be “okay.” (Hence, I believed 13 lbs. was ok; we were was wrong about that, too.)

To give you some perspective on cat weight: Imagine yourself 5'1" tall and weighing 120 lbs, but you know you should weigh 100 lbs. Your cat is does not stand quite as tall as your knee and should weigh, let's say (for easy math purpose only) 10 lbs, but currently weighs in @ 12 lbs. An extra 10 pounds on your 5'1" frame is roughly equivalent -ratio-wise - to an extra single pound on a cat … so the difference between 12 lbs. and 10 lbs. on a cat (2 lbs) is somewhat similar to the difference between 120 lbs & 100 lbs. on a human (20 lbs.) See what I mean? An additional pound doesn't look like very much to us on a cat, but it can make a pretty big difference when you're trying to achieve BG control in a diabetic kitty.

A caveat here: Make certain you have ruled out any other medical conditions, and any factors that could impact your treatment plan: For example, when was the last time Leo's teeth were checked? (Undiagnosed dental disease can really make it very hard to get a cat regulated on insulin.) Is Leo on any other meds or supplements? (Sometimes these contain sugar, disguised as "flavoring" on the label.) Do you have a walk-about snacker at home? (May sound silly, but you'd be surprised at how BG can rise in a cat who patrols the floors looking for a fragment or two of dropped potato chip/cracker!) Is Leo an only pet, or do you have another? (If so, could Leo be getting into your other pet's rations at times?) Does Leo get to go outdoors alone? (If so, you have no idea what he may have eaten while out there.) Is Leo a super-active kitty or a couch-potato? (Couch potato-cats don't need as much fuel as hyperactive kitties.) So these are just some of the scenarios you might ponder in trying to troubleshoot your problem ...

Hate to say this, but from what you said in your first post, I'd be alarmed at any vet who "seemed unconcerned" about higher BG #s, especially in a known diabetic cat. You might get a copy of Leo's records and start looking for a vet who is a little more attentive about the signs of recurring diabetes.

I've found it most helpful to have changed my way of looking at Bat-Bat's food: In treating her diabetes, now I’ve come to perceive food more like medicine, just like the hormone insulin that I give her is medicine. Even on low-carb canned foods: how, when & how much you feed can make a real impact getting a cat's BG under control. What works for Bat-Bat is a tight regulation approach & careful portion control. But every cat is different - and you need to discover whatever plan works best to help your kitty’s numbers come down.

A question: Did you do regular BG testing/keep detailed records two years ago, and also last year when you began tapering his insulin down? (And if so, could you put those into a spreadsheet? Would be most helpful to everyone trying to help you here if we could get a peek at that data.)

Hope this is in some way of use to you. Sending healing vibes to Leo! Best of luck to you in getting him on track - & please keep us posted.