Confused

Hi all-

I posted about a week ago but have questions with home testing. Little back story...
Rufus was having issues prior to being diagnosed and we're still working on and trying to figure out the previous issues. They might be why it's hard to get his numbers lower, not quite sure. Anyways when he was diagnosed his bg was around 430. We started him on Lantus 1u am/ 1u pm. Following week at vet he was 398. moved to 2u am/1u pm. Each of the following weekly checks he's in 400's. We go from 1&1 daily to 2&1, then 2&2, then 3&2, then 3&3. Vet decides to keep him for the day and check numbers every 2 hours. Each test he's in the 400's. Does fructosamine test and comes back 450~ and "poor". We up his dose to 4&4. Next check he's 400's. He has an appt with dentist the next day so she says lets keep him at 4&4 and see what vet says and check next week. So Last Wed go in again and I arrived 30 mins too early and we didn't get his bg checked until after 45 mins there. Comes back at 503 and thinks stress has upped the number. She says let's go to 5&5. I know for a fact he's stressed every time we go, but is it impacting the numbers. Also, she point out the fructosamine test came back high, so his numbers aren't just high there.

In the mean time I check out this site and it seems like mayve we're upping doses too fast? He's be unregulated since Nov 22. I bought an Alpha Trax 2 online and should be here tomorrow. Vet thinks it's a good idea at this point too.

So, how do I know he's not getting too much insulin now? Or is that not possible? We've always checked his numbers 4 to 6 hours after am dose so that is the 1st check I'll do. If the number comes back around 400 I guess that's "good" that the vet numbers are stressed related. What number would I be wanting it to be? 200's?

 

In the beginning I was always worried about going hypo, but Vet said oh you'll know. But with his pancreatisits he's often lethargic and sometimes out of it so how would I know the difference?

 

Others will chime in but the exact same was happening with me and my vet. I reduced to 1u twice a day and saw his number dropping. 4u seems way too much too fast.

 

Thanks. That was my next question. If he's on 4&4 now, can I drop to 1&1 and start over. He responded really well after first starting and has "some" improvement since. She keeps asking me how he is acting. It's hard to say because I think the pancreatistis is more his issue then being unregulated. He's drinking way less and peeing less. Eating is always a game with him.

 

I did exactly that when my cat was first diagnosed. Not such a good idea further on tho. I listened religiously to the vet until finding this forum and I started over. Tagging some seasoned folks who can help.

@Wendy&Neko
@Sienne and Gabby (GA)
@Marje and Gracie
@Chris & China
@Tracey&Jones

 

Bump

 

I'm sorry, I might be slow today. What is not such a good idea further on? Starting him over?

 

Here is your previous thread . We post the previous conversation for you to go back as well as anyone looking to answer a question.


I think Wendy suggested getting some home tests in to determine what was going on. Rufus may indeed be a big gulper but we can't tell without the data. I take it from your post above that you are not home testing yet?

On daily testing - I like the +2 to +6 to see how the onset is and the nadir...but not every cat is the same. Then I do curves on the weekend to fill in gaps.

ETA - have you had any luck on the food situation?

 

So, first off, your vet has increased too fast. Doesn't sound like he/she has much familiarity with Lantus. We increase by 0.25 or 0.5 units at a time. And you are not alone - so many people come here in exactly the same situation as you. Cats can also test much higher in the vet's office due to stress, than at home. My non diabetic tested ove 220 at the vet's office and 55 at home the next day.

Not true - sorry your vet's wrong again. We've had cats here test in the 20's and 30's (yes that's LOW) with no visible signs. How do you know if the cat is going low - you test. And then give food to bring them up. Don't bother waiting for the AT to show up in the mail. Get to a regular pharmacy and get a meter that works for humans. If you have a Walmart near you, their Relion Confirm or Micro takes a nice small drop of blood and the test stips are pretty cost effective.

Testing your cat's sugar at home is the only way to keep him safe. Your cat may need higher doses of insulin, but maybe not and he's overdosed and might crash. If a cat is still on high carb dry food, or has certain secondary conditions, it's possible he needs 5 units or more. We can't tell which scenario is right without home testing.

 

Hi, the alpha trak is supposed to arrive tomorrow. So I plan on testing about 11:30am. He eats and get insulin around 7am. He ate the wysong rabbit for a couple of days, and then refused. Back on Fancy Feast for now, but only seafood without any turkey in it (even though meat by-broducts are listed). His stomach has not been as growlly but still gassy. I'm sure the offending intolerance is still there, but not AS bad. He's been eating well the last couple days.

 

Thanks. He's pretty low carb right now. Fancy feast 0-3 carbs per can and some temptation treats, which I'm not sure if they are bad or really bad. But only like 4 at a time a couple times a day. I have young again LID zero for when he is ready to start eating dry again.

 

The facts:

• He is now on low carb wet food with some very high carb treats thrown in (which I would drop except when trying to manipulate numbers).
• Is eating fairly consistently
• You can't test right now but hopefully starting tomorrow.
• All BG info so far is vet stressed influenced.

How much does Rugus weigh?

 

I do exactly the same. FF seafood with temptation treats (x4) when he gets his tests. I believe it’s better to use a human meter (they are free in the US) and the strips are far cheaper. Your AT strips quite expensive and you’ll need to be using a lot of them. I’d take @Wendy&Neko suggestion on that one.

 

His weight is 21.5 pounds. But he is a loooong cat. He was at 24.5, and the vet is happy that was/is losing weight. Not sure where he's supposed to be. Also, he is getting deli chicken and or roast beef sometimes.

 

The problem is that vet said no, no, no to using the human meter. She went off about some organization saying it's not right. I'm in a tough spot. I really like her, I don't want to step on toes, but I totally want to use the human meter. Maybe I could use both?

 

Vet is happy he is losing weight?? Only if he’s losing it because he’s not an unregulated diabetic. My Silver is a BIG boy and he’s lost a lot of weight and looks good thin. But losing it because he’s sick is not good.

 

You could use the AT to grab an occasional curve in to keep her happy but although she may be a lovely person she isn’t correct. I took a looong time to realize my vet just did not know diabetes as well as the folks here. Trust me. You and your cat will do better following FDMB advice.

 

I know. He is actually at the weight he was a couple years ago. I worry to everytime he loses weight. Last time he gained 6 oz. And really, I think the reason why he was losing was because of the days his pancreatitis was acting up and not eating well.

 

His weight will stabilize once his diabetes is more regulated. Try not to worry easy said I know.

 

I'm almost to the point of going to a specialist. I told her that while I'm not expert, 5 units 2 times a day seems like a lot. And $100 a month. I'll pay whatever it takes but jeez. My main concern is we keep upping it, but at some point (crossing fingers) his pancreatits won't be a huge issue and that his pancrease starts producing again. It's really hard to wrap my head around. It all started in August not feeling well, but diabetes came on from the pancreatitis and steroids. Sure he was going down that path but as of late Sept his bg was 106.

 

So he had steroids? Do steroids cause high dose conditions?

 

There are people here that do the day to day testing using the human meter and then use the pet meter for curves for the vet. That is an option. Just a note that there is no conversion of results from a pet meter to a human meter. So you may need to do double duty on the curves - get two tests from the same drop of blood.

I would say that with the food issues and the FD, that losing weight may or may not be a good thing. Of course an obese cat is not a well cat either.

Have you had a chance to read the TR and SLGS sticky notes? Each has it's own starting dose suggestion. If you are really concerned about the dosage being too high until you get a meter and testing set up, you can drop back to the starting dose suggested and then start over with your increases based upon the data collected. I am not a dosing expert so you may want to wait for more input. Once you change the dose you should hold it for at least 7 days, do a curve and then post for advice on dosage changes.

I feel your pain. Jones' FD journey started off with pancreatitis and IBD. It took 3 months to turn things around on the IBD side and by then he had FD. So we have chronic pancreatitis/IBD and FD. Still on steroids. So we dose around that.

Not necessarily. I don't think Jones is high dose however I have had to adjust dose to the increase in dosage of prednisolone. He was down to a drop for a long time (in all green and blue) before the pred increases. Now we are working out whether .25u or .5 is going to work better for him and still get him to blues and greens.

 

He was on steroids beginning on September, then stopped on Nov when diagnosed. Steroids can push you into diabetes. They mess with the pancreas. https://www.medicalnewstoday.com/articles/317015.php

 

Oh wow. Poor guy. Is the IBD cause from a food intolerance? Or from the pancreatitis? Still trying to figure all of this stuff out. It seems like everything causes the other and they all are intertwined.

 

I think that is a chicken and egg question. We originally thought he just had pancreatitis that seem to get better when done a 14 days course of AB. But the he back slide again and started vomiting again. Did more b/w, then an ultrasound which lead to the IBD diagnoses. In the end I did the allergy test to see what was causing everything. As posted before, it may not be 100% accurate but it did lead me down a path of what maybe causing the issues. Eliminated those like diary and tuna.

His IBD is pretty minor in the sense there upon physically touch there does not seem to be any inflammation and there is no stiffness to the intestines. That said, we can't seem to get him off any of the support medications. Which, all can be contributed to the pancreatitis.

From my own personal experience in the last year after picking up some "microscopic" something in Indonesia (originally diagnosed as Chron's) - I ended up with lower bowel inflammation. Which lead to upper intestine inflammation. Pain and severe potty issues. Then my appy disappeared, had a fever. As everything got overwhelmed my system decided to just stop. I ended up in the ER - dehydrated, in pain, severe diarrhea, couldn't eat and no clue what was wrong. The started me on prednisone and a very, very bland diet. Chicken/rice/potato. Veggies if boiled and soft. No sugar, caffeine, diary, alcohol. Total reset.

Long story short....the living body is a very complex system and it will go to extremes to keep alive. Then there is that tipping point. So yes, I thing the IBD ended up causing the pancreatitis which ended up causing the FD (with a kick over the edge with the steroids).

 

What you could try is printing off the stickies and showing your vet. I got to the point where I asked my vet to give me ten days following the forum advice and see what happens. She agreed. Funnily enough he went right down to normal numbers when I dropped dose.

If this were my cat I’d drop down to 0.5 or 1 unit twice per day and follow one of the two protocols on the stickies.

 

The starting dose is different under TR. It is .25u per kg of ideal weight for a newly diagnosed kitty.

@S&R - give the sticky's a read and decide on TR or SLGS. Then if you are really concerned about the dose, then you can start over using the suggested starting dose. There are qualifers for those doses as well. Once you change it will take a few days to drain the depot so be cautious.

If any questions on either approach give a shout out.

 

There are some cats who need to be on big doses of insulin. The difference between those cats and Rufus is that their dose has been systematically increased. As Wendy noted, we increase doses by no more than 0.5u. The reason for increasing by small amounts is to make sure you don't miss what is a good dose for your cat. Unfortunately, too little insulin can look a lot like too much insulin.

You said:

With any insulin, you need to test BEFORE you feed your cat and BEFORE you give insulin. If you don't test before your shoot, your cat's blood glucose (BG) could be 20 and you'd be giving a shot. You need to test before giving a dose of insulin so you know that Rufus' numbers are in a safe range. You also do not feed 2 hours prior to shot time. You do not want to have food raising the numbers so you are giving insulin to a cat who's numbers are artificially elevated. Most of us test, feed, and shoot all within about a 5 - 10 min. period. I gave Gabby her shot when her head was in her bowl. If your vet told you that food needs to be given well in advance of an injection, your vet is not familiar with Lantus. Most of the other types of insulin are shorter acting and have an almost immediate effect on glucose levels. With those types of insulin, food does need to be on board before you give a shot. Lantus is different. It takes about 2 hours for Lantus to start working so you have a window before the insulin has an effect. Testing, feeding and shooting at 7:00 AM and PM sounds like a good plan so you can get additional tests during both the AM and PM cycles.

Temptations are high in carbohydrates. Most of us use freeze dried chicken (or any freeze dried protein) as a treat. If Rufus likes canned food, I would strongly urge you to keep him on a low carb, canned food diet. While Young Again (the Zero Carb variety which really isn't zero carb but it is low carb) is lower in carbs than any other dry food, why would you put your cat back on dry food? One of the issues with dry food is that it is low in moisture. Cats do not have a thirst drive (other than when their diabetes isn't regulated). There are any number of reasons why dry food is bad for a cat. My non-diabetic cat has never eaten dry food and I would never give it to him.

 

That’s why I said “if it were my cat that’s what I would do”. I was not quoting a protocol. She has to decide on SLGS or TR first.

 

That is why I wanted to clarify. There are 3 different starting points (2 for SLGS and 1 for TR) and then all the qualifiers to those.

 

Hi! I just meant for my and his very first test I'm going to do the 11:30am. After that, the next day I will do before he eats. Unfortunately he doesn't care for the freeze dried. I know dry food isn't ideal. Beleive me though, he has always drunk tons of water since birth. He loves playing in and drinking out of the tub. The reason for the dry food is my other cater refuses wet food, so he needs the dry, and I won't be able to keep Rufus from eating it. He always has a bed time snack of 2 oz of wet food with cosequin. I also have 2 water fountains that they love to drink out of. And last but not least Rufus has food intolerance. He can't keep on the Fancy Feast. All of the venison and rabbit wet foods are high in carbs, except the wysong.

 

Oh and yeah, he does need to get off of the temptations for the fact they are high in carbs, AND the mystery meats in them. I have some hydrolyzed that sometimes he likes, sometimes he doesn't. I'm sure they are higher in carbs too though.

 

Have you tried ZiwiPeak? It has novel proteins and is low carb.

 

Never heard of them. Checked it out on chewy. I think that's out of my budget. It would cost me $400 a month!

 

Rufus must have some appetite!! (Did you notice the size of the cans? When I was using it, they came in a 7 oz can vs a 3.5 oz.) Know I wasn't spending $400/mo.

 

Well he needs about 350 cals a day, and the lamb 1 is 180 cals a can. So 2 cans a day is $187 a month. I accidentally multiplied twice in coming up the 400 Thanks for the suggestion! I filtered there selections to single proteins and this brand never showed up.

 

Oh I see why. It has mussel in it...

 

Not entirely true. Rufus is not starting insulin but has been on it a while. We take the data from the existing dose into consideration.

There are some lower cost low carb duck wet foods out there. Also a unique protein if you haven't tried it yet.

Rufus is a big boy. Has the vet said what his idea weight should be? Some breeds are just bigger.

 

Both previous vet and current vet say he needs to lose weight, but when I ask what his weight should be I never get a clear answer. He still has a belly, so I'm guessing around 19 or 20 would be ideal. He's tried duck. In fact that was the first protein I switched to after rabbit. He didn't seem to care for it but that was only 1 brand I tried.

 

I agree with Wendy. There is no rush to decide whether to do SLGS or TR. Obviously, if he is eating any dry food, then SLGS is the method that should be followed as a prerequisite for doing TR is feeding only low carb canned or raw food.

I would encourage you, Sean, to get a spreadsheet set up and start home testing. If you need help with the spreadsheet, please contact me via PM (click on “Marje and Gracie” to the left and then “start a conversation”). Most of us have been through this Alpha Trak vs human meter with our vets. My personal opinion is that I love the AT and if the strips were not so expensive and were readily available, I’d have used it all the time. But, because the strips were expensive and keeping 200 around here at a time (which I always did with the human strips) was not cost efficient, then I used a human meter. Most vets will tell you not to use it, that it isn’t applicable to cats. However, the TR protocol was used developed using human meters. For SLGS, all of the guidelines are based on using a human meter.

Vets are reticent to clients using anything but an AT because the vets themselves do not know how to interpret human meter BGs. Once I took the time to educate my vet on it, she was totally on board with the human meter.

 

Thank you so much for the info! I just received the Alpha Trak2. I'm pretty nervous to use it. Don't want to hurt my little buddy. I plan to take my first test tonight before he eats and insulin. I'm still kinda of not sure about starting over on insulin at 1 and 1. Is he going to be ok if he gets lets insulin? I haven't discussed it with the vet and I'm sure she won't like it. My plan would be to do the SLGS, but then I'll have to get a human meter. Maybe I mass majority of tests with human, and then periodic Alpha Trak so she can see those numbers. I kinda peeked at the spreadsheet. I think for me that'll be the easiest part. I cannot wrap my head around how to interpret the number you collect how you know what to dose though...I suppose practice and time will help.

 

Before deciding if you need to change the current dose, get a few tests in on your existing dose. It could be that Rufus needs more insulin, some cats do. In that case, you don't want to go backwards.

As for testing, it's harder on us than it is on them. They have very little nerves in the ear. Start by picking a special "testing place", go there with him, rub his ears and give a low carb treat, love on him, then let him go. It's amazing how fast they associate that place with treats. My Neko would come running when she heard me get the test kit ready. Cause she knew it meant a treat after. I would try practicing testing during the day, even before tonight. That'll give you a chance to practice. You also want to relax - they can sense stress.

We figure out the Lantus dose mostly by how low it takes the cat. The lows (nadirs) are typically somewhere in the middle of the cycle between shots, hence the focus on getting mid cycle tests. The spreadsheet really helps. I encourage you to take Marje up on her offer to get a spreadsheet going for you.

 

Ok, I guess I was wondering about starting over at 1 and 1, because people we're saying that his does might be too high now and that it's artificially high because of the high dose and we might have skipped over a good lower number.

 

I agree with Wendy.

Because 1 in 4 cats can be “high dose” cats, we would not want to drop his dose way back to 1u twice a day without getting an idea if the dose he is on is too high. If it’s not too high and you drop him back to 1u twice a day, you could be leaving him in very high numbers while the dose goes back up (even if we fast track it just because the right dose might be somewhere in between 1u and where he is now). If you get the SS set up and do random spot tests (we can help you determine which), then we have a better idea if the current dose is dropping him too much and he needs less insulin.

 

I'm going to get started tomorrow. Tried for today, but hasn't worked out. I'm thinking he isn't getting enough insulin. I could be wrong. Brought in urine sample today and they said it had sugar and was going to sent off to be cultured. She said stick test was 500+. Ugh.

 

I'm wondering if the tempation treats are keeping his bg up. Do you think 10-20 treats a day could be the culprit? He's prety much zero carbs from anything else. I know there are others factors, and the temptations are bad, but how bad are they?

 

Well in my condo I was told tempatation treats were a huge no no and I was only giving two per day so possibly.

 

They have many varieties but here's an ingredient list for one:

Chicken By-Product Meal, Ground Corn, Animal Fat (Source of Beef Flavor, Preserved with Mixed Tocopherols), Rice, Dried Meat by-Products, Wheat Flour, Natural Flavors, Corn Gluten Meal, Malted Barley, Potassium Chloride, Choline Chloride, Salt, Iron Oxide, Calcium Carbonate, Taurine, DL-Methionine, Vitamins (dl-Alpha Tocopherol Acetate [Source of Vitamin E], Vitamin A Acetate, Niacin Supplement, Vitamin B12 Supplement, Riboflavin Supplement, Thiamine Mononitrate, d-Calcium Pantothenate, Vitamin D3 Supplement, Biotin Supplement, Pyridoxine Hydrochloride [Vitamin B6], Folic Acid Supplement), Minerals (Zinc Sulfate, Copper Sulfate, Manganese Sulfate, Potassium Iodide).

The bold ones are carbs. 10-20 a day is not unlike feeding a small bowl of dry food. Every cat is different, some react to carbs more than others, and even in the same cat, carb sensititves can change. It just makes more sense to take these kinds of things out of his diet since the goal is to lower blood glucose, we don't need any help making it high, right?

Carbs will come in to play when numbers go low and that's when you will find out exactly how carb sensitive he is, but until then, give him the help you can to keep BGs down by swapping out high carb treats for low/no carb ones. Insulin is expensive, and if you feed higher carbs, you sure will need to use more of it.

 

Absolutely. It might not account for all of it but it could be contributing.

We use to have a member who would use Temptations to raise her cat’s BG when it was running low. One would do the trick. I don’t recall that Moonie was abnormally carb sensitive.

I would suggest you don’t raise the dose until you can test and get some suggestions on whether not the dose is too much or not.

 

Thanks! Today is the day for home testing! Wish me luck!

 

You got this! Good luck!

 

Good luck with the home testing. I hope it clears up the picture for you.

On the temptation treats. Sometimes if he is dropping too quick or in a low number I will give a half of one or a whole one depending on the numbers. And I use them for a test if he isn't feeling well. I know if he won't eat one he is very ill and a trip to the vet is in order.

 

Yeah, I know I need to stop giving them to him for a variety of reasons. I'm going to stop or only give 1 if it is needed.

 

Ok. Did my first at home test! The lancet with the Alpha Trak2 is not very good. Oh well, I can work with it. Took 5 tries to get blood. Rufus was not too caring. Numbers were not good at all. 534. But...the vet tech said number could be high because of possible uti. He also has been sneezing and yellow & green eye boogers so maybe another upper resp infection? I'll try again in a couple hours.

 

Question again. Hopefully this make sense. I tested him the am before for and insulin 11.75 hours after last shot, and his number was 610. He is on 4u am and 4u pm. Obviously this means he is not getting enough dose right? It can't be that his doses are too much. I'm a little confused over the "missing perfect dose" by upping doses bu 1 unit instead of .25 or .5

 

Too much insulin can look same as too little. Missing perfect dose: suppose he’s on 4u and he’s got high numbers. Then you up to 5u and still high numbers. At 4.25u that could be where you get good numbers. So eg 4u not enough - 5u too much - both look same. Skipped over the good dose of 4.25u. Make sense?

Not advising the dosing as I don’t know your history. Others can chime in on that.

Fyi best to start a new thread (called condo here) every day rather than continuing same over several days. People may skip past your post thinking they’ve seen it. Most do date/name of cat then recent number. Eg 1/18 Silver AMPS 248.

 

Ok. thank you. I just thought i'd go on this one cuz it has all the original numbers and how we got to 4 & 4 doses.

 

You can copy the link to this condo and paste into the new one - that's what we do.