Diabetes - Initial Treatment - Need Advice

Discussion in 'Feline Health - (The Main Forum)' started by Davey's Mom, Dec 24, 2016.

  1. Davey's Mom

    Davey's Mom Member

    Joined:
    Dec 8, 2016
    Ok sounds good thank you I will start with 6 and try to get some more BG checks in and check for ketones again. I did checks today but it got crazy here and I forgot to add them on the spreadsheet ahh!! I remember they were all in the 20's but can't remember the times....

    I will do 6 units this evening and test a few times before bed.

    Thanks!
     
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  2. Critter Mom

    Critter Mom Well-Known Member

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    Jun 16, 2014
    The Drill!

    1. Be sure to lift food for 2 hours prior to the preshot test.

    2. Do preshot BG test. (VITAL you do this for every dose - for both safety and also to enable you to assess how any dose adjustments are working.)

    3. Feed Davey then wait 20-30 minutes before giving the insulin dose.

    4. Test at +1, +2, and +3 hours after the dose was given.

    Extra tests are just for the time being to try to catch dips in BG early in the cycle. Once dose issue is sorted you'd normally do a before bed test about +3-ish after the dose was administered.

    Tip:

    Even after you get past this phase, if ever you see Davey asking for food soon after his insulin - say, at +1.5 - test his BG straight away: it can be a signal that numbers are falling early in the cycle and he may need closer monitoring.

    ** When you get a moment it would be helpful if you could add to your signature that you are using the Fastapet pet glucometer so that members replying to your posts will be able to correctly interpret any BG readings you post. **

    (Human and pet meters use different reference ranges. Note: I use an Alphatrak 2 pet meter and I use 3.9mmol/L as the point where I intervene with carbs to bring numbers back up into a safer range and prevent a hypo (my vet gave me the range 3.9 - 8.3mmol/L as the normal range for cat blood glucose levels). I suggest you confirm with your vet the correct reference range to use with your meter.)


    Mogs
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    Last edited: Jan 1, 2017
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  3. Davey's Mom

    Davey's Mom Member

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    Dec 8, 2016
    So I waited in the basement today for Davey to pee so I could use the ketone test strip and I noticed as he was peeing that his urine is very foamy. I looked this up quickly online and I'm seeing comments that this could suggest kidney failure :(. I'm getting so frustrated and I feel terrible that I have to get back to work tomorrow and such and won't be able to keep an eye on him as closely as I have through the holidays. Since I've been home the last few days I've noticed all he does is eat, drink, and lay on the floor (usually on the door mat). He used to sleep with my daughter or us or come up with one of us on the couch but he doesn't even bother now so I know he's not feeling good. He's still testing negative for ketones.

    I will have to give the vet a call tomorrow. Does anyone have an idea of what foamy urine could mean? I'm not sure when this started because I never actually see him pee, this would be the first time I have in a few months. I have to keep his litter in the furnace room away from the kiddies and I'm never in there...
     
  4. Kris & Teasel

    Kris & Teasel Well-Known Member

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    Aug 17, 2016
    I think 6 u is still too high a dose based on the very high numbers he still has. My opinion only - let's see what others think.

    I don't know what the foamy urine means, if anything. Probably best not to think kidney failure at this point. Getting his BG down is the more immediate concern. He probably feels unwell because he's so high. Good to see he's negative for ketones though.

    You could post on the Caninsulin/Vetsulin forum as well as here to see if others who use this insulin have ideas about dosing.
     
    Last edited: Jan 2, 2017
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  5. manxcat419

    manxcat419 Well-Known Member

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    Jan 14, 2015
    Foamy urine CAN be linked to kidney issues, but in a cat running high numbers as Davey is at the moment, I'd think it's more likely linked to sugar loss in his urine. You might also find his urine is 'sticky' and he tends to get more litter stuck to his paws than before he became diabetic...that's definitely something I noticed with Rosa, though I didn't put 2 and 2 together until well after her diagnosis when the problem resolved itself again!
     
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  6. Davey's Mom

    Davey's Mom Member

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    Thanks! I definitely have noticed litter stuck to his paws, that has been going on for a couple months now.
     
  7. manxcat419

    manxcat419 Well-Known Member

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    That would be the glucose in his urine then. Like I said, I only figured it out later on, but it is useful to know to be able to pass the information along...and of course I know now to look out for it with our other cats too!
     
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  8. Davey's Mom

    Davey's Mom Member

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    Sorry but I have yet another question. Has anyone ever noticed variations in their meter readings? I just tested Davey and got 25 which I thought was too high once I considered where he was an hour before so I decided to test him again just to double check. Just seconds later I got 21.1 and then on a third try I got 20.7. Does anyone know what could cause such a huge difference between my first reading and the others?
     
  9. manxcat419

    manxcat419 Well-Known Member

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    Yes, that does happen unfortunately. All meters are allowed to read +/-20% from the true value, so especially at higher numbers, you will see this sort of variation if you repeat a test. I would take the average of the readings to use for his spreadsheet - when you see one number that's a bit higher than another, the actual reading is more likely to fall somewhere between the two.
     
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  10. StephG

    StephG Well-Known Member

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    Sep 8, 2016
    Sometimes the size of the blood sample can make it a little off. If I get an odd number I usually test again with a bigger sample just to be sure.
     
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  11. Critter Mom

    Critter Mom Well-Known Member

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    Jun 16, 2014
    Hi @emjb14,

    I've been looking at Davey's spreadsheet.

    - He is definitely showing a clear response to Caninsulin commensurate with its action profile (see example curve below).
    - He is definitely not getting anything approaching adequate dose duration from the Caninsulin; it's only having a lowering effect for about 6 hrs/cycle, 12 hrs/day.
    - Dose onset appears to be relatively slow (BG still very high at +2).
    - Despite a 'proper Caninsulin curve' his BGs are very, very high - even during period of typical Caninsulin nadir.

    [​IMG]

    At this point it's a matter of conjecture whether a 'good dose' was skipped over earlier in Davey's treatment. (It is possible that with only the two (stress-influenced) BG checks at each vet visit a fast drop or low nadir early in a cycle might have been missed with the second test only catching a rebound later in the cycle. Basing dose adjustments on rebound BGs can lead to overdosing.) Right now I think more needs to be done to identify possible causes of Davey's difficulty in becoming regulated so that he will start feeling better as soon as possible.

    Although there's not much of it, the BG data gathered thus far looks as though there may be something else going on to either drive Davey's numbers sky high or to cause insulin resistance.

    First up, here is an article on rebound hyperglycaemia. It gives information on how a vet may be able to differentiate chronic rebound from true insulin resistance. From the article:

    Insulin resistance: in the case where raising dose appears to have no effect over a wide range of dosage, it can be difficult to distinguish Somogyi rebound from true Insulin resistance. One way to check is to try a small booster dose of short-acting (R) insulin and take measurements of blood at 30 to 60 minute intervals for the next 4 hours. If the R has no significant effect, insulin resistance is more likely. If the R works very well, consider that the other insulin is being overdosed.

    The above is something that I suggest might be best carried out by a vet with a lot of experience in treating feline diabetics and dealing with regulation difficulties.

    Another thing to consider is glucose toxicity. From the linked article:

    When a diabetic animal is hyperglycemic for long enough, the animal's damaged tissues may start having trouble using insulin. This in turn means that even a well-dosed animal may continue to have high blood sugar, leading to even more insulin resistance.

    Various methods through this "glass floor" have been tried, to varying degrees of success. One way is to continue gradually raising insulin dosage until the tissues pick up the insulin and start absorbing glucose, then quickly back off to a lower dose. Another is to "jumpstart" the process with a fast-acting insulin or a deliberately high dose of the regular insulin, then quickly back off to a lower dose. Another is to reduce the carbohydrate content of the food further, or to eliminate dry food entirely (even low-carb dry food), thereby presenting less of an obstacle for insulin effectiveness and reducing insulin needs. Aggressive attempts to break glucose toxicity are best regarded as dangerous and should be addressed in close partnership with a diabetes-experienced veterinarian.

    These methods may provide relief from glucose toxicity suddenly and unexpectedly, risking overdose and hypoglycemia once the "glass floor" is broken. Caregivers should be vigilant about watching for signs that the floor has broken, such as lower than expected blood glucose levels or a rebound event on a previously "safe" insulin dosage, and be prepared to immediately lower the dosage.

    [Emphasis mine]​

    The strategies listed above fall very much into the 'DO NOT try this at home!' category. Even with veterinary involvement great vigilance with home testing would be needed. (If it were my cat needing to undergo any of the 'glass ceiling' interventions outlined above I would seek to have the cat referred to a feline diabetes specialist in a hospital setting; a local general practice vet might not have the equipment or nursing cover required for safety.)

    (More to follow; just splitting the post up into smaller sections.)


    (Cont./...)

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    Last edited: Jan 4, 2017
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  12. Critter Mom

    Critter Mom Well-Known Member

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    (.../cont'd.)


    If it were my cat, these are the things I would look to do/investigate:

    1. Monitor daily for ketones / continue with home BG monitoring / keep brief journal of observations and clinical signs.

    2. Optimise Diet - be very careful!


    I would schedule a couple of days to devote to testing him and gradually removing all high carb food from his diet (especially dry high carb food). If the food is elevating numbers then transitioning him to all wet, low-carb could dramatically and quickly reduce his BG and therefore his dose would need to be reduced - cycle by cycle as dictated by improving BG numbers.

    Here is important safety advice from vet Dr Lisa Pierson about how critically important it is to monitor BG/reduce insulin as needed when going through a food transition to lower carb food:

    http://catinfo.org/?link=felinediabetes

    With such a high dose of Caninsulin in the mix, anything which suddenly and significantly reduces BG levels could greatly increase risk of hypo so great care and very close monitoring is vital. If my cat was in this position and I wasn't able to monitor a food transition myself I would look to see if the vet could take him in for a few days to do the food transition and adjust dose downwards on a cycle by cycle basis as dictated by any improvements in BG observed as a result of reducing the dietary carb load.

    Given that the current diet is Fancy Feast Classics alongside the dry kibble then the carb load in the diet from the dry kibble may not be the only thing driving the high numbers - especially with the Caninsulin dose being so high.

    NB: If a diet transition is a route you and your vet agree on I suggest it might be better to do the food transition while Davey is still on Caninsulin since it is an in-out insulin and any dose reductions needed would be more immediately effective than trying to manage the transition and an over-full L-insulin depot at the same time (not a good mix - especially with very high doses).

    3. Change Insulin

    If it were my cat giving these numbers and showing this response I would ask the vet about switching to a longer-acting insulin as soon as possible after the food transition has been completed. Bearing in mind Davey may possibly need a high dose, Levemir (insulin detemir) might be the better choice to go for because, unlike Lantus, Levemir does not sting at larger doses. (For general information, many members who switch to Levemir from another insulin often report that their cats appear to be 'happier' in themselves.)

    An appropriate dose of a longer-acting depot insulin should give greater duration of effect and hopefully keep BG at better levels for a longer period each day and hopefully stop the preshot BG levels getting as high as they currently are on Caninsulin - especially in the early and late part of each cycle). This might make Davey feel a little more comfortable while you and your vet work to determine what might be driving/keeping his numbers so high.

    4. Check for Common Drivers of High BG Levels

    The following are things a vet should check for as a matter of course in cats who are difficult to regulate. If your vet has not already done so, I suggest you ask about checking the following as soon as possible (including appropriate blood and urine testing):

    - dental disease (x-rays before and after dental surgery are important; if teeth/gums are in bad shape, referral to a veterinary dental specialist is advisable).
    - urinary tract issues (diabetics are very prone to these - especially when glucose is present in their urine).
    - chronic pancreatitis.
    - other illness/inflammation.
    - pain.

    5. Run Additional Diagnostics for Other Conditions

    If none of the 'usual suspects' can be identified as a driver of high BG levels, further investigation into the following may be warranted:

    - thyroid dysfunction (routine blood test; may need to be specifically requested as an add-on if other blood work is being done).
    - high-dose conditions: acromegaly; insulin auto-antibodies (IAA); Cushing's (specialist diagnostics needed).
    - other conditions - as guided by your vet.

    Further reading:

    - Obstacles to Regulation


    - Insulin Resistance

    - (ETA) Rebound and Overdosing

    NB: Other members may have different views and suggestions to offer you.


    Mogs
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    Last edited: Jan 4, 2017
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  13. Critter Mom

    Critter Mom Well-Known Member

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    That might be your first clue to finding more ways to help Davey. I suggest you get that checked out by your vet ASAP. I understand so well how nerve-wracking and scary it is when our little ones are poorly but I've found that the best thing to do is seek help early. The following article suggests keeping a journal of clinical signs (including litter box habits and observations - may need to move the litter box to where you can keep an eye on it for the time being), plus bloodwork and urinalysis by your vet.

    https://www.cuteness.com/article/diagnose-foamy-cat-urine

    As April says above, it may be due to glucose in the urine but it's highly advisable to get Davey checked by your vet. If, for example, it revealed bladder inflammation or infection then treating that would help Davey's blood glucose levels.


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  14. Davey's Mom

    Davey's Mom Member

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    Thank you Critter Mom for all your help! I took some time yesterday to really research things and did see a bit on somogyi and insulin resistance. Your posts have really cleared things up for me and I feel so much more educated and confident compared to a week ago. I am ready to have a good talk with my vet and will be calling today.

    I would like to switch his diet first as you've mentioned and change his insulin afterwards.

    Please note all the additional testing you've mentioned in step 4 and 5 was done at the beginning of this process but I will mention this to the vet to see if there is something we should re-check. The bill for all the testing was extremely expensive and I'm breaking the bank with everything going on so hopefully I won't need to test everything over again eek!

    This is all amazing advice thank you! I think the best route for me would be to change his diet at home over the weekend when I'm not working and can stay home, really monitor him and do regular testing. What's your opinion on insulin doses during this time? Should I stick with 6 units provided that his sugars are still off the walls?
     
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  15. Critter Mom

    Critter Mom Well-Known Member

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    Jun 16, 2014
    Two things to consider here:

    - The hyperglycaemia will make Davey feel unwell.

    - The behaviour changes you describe have been reported here for other cats whose systems Caninsulin disagreed with. (My Saoirse was absolutely miserable on Caninsulin.)

    A change to a different, gentler and longer-lasting insulin might help with both of the above.

    Tip: try to see whether Davey seems any bit brighter as the dose of Caninsulin is wearing off. If yes, then that could help you to differentiate a little between the effect of the insulin and the effect of the hyperglycaemia. Let your vet know what you observe.

    This is good news. (((Davey)))


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  16. Critter Mom

    Critter Mom Well-Known Member

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    - It would help if you could post FULL details of exactly what the vet has tested for (including tests for known high-dose conditions, thyroid function, etc.). The better the information that's available the better members may be able to suggest things which might help you and Davey.

    - What state were/are Davey's teeth and gums in? (Even a touch of gingivitis can adversely affect BG.)

    - Did Davey have any dental work done since Dx? If yes, did the vet do X-rays to check no bits of tooth were left behind? Did the vet run a post-dental full curve to check whether dose needed to be adjusted?

    - Did the vet identify and treat any underlying conditions (e.g. treat an infection with an antibiotic). Did the vet run a full curve to check for BG improvements?

    I hear you (and can fully relate) on the $$$ side of things but I think you'll need to get the foamy urine issue checked ASAP.


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  17. Davey's Mom

    Davey's Mom Member

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    Dec 8, 2016
    Thanks again! I'm waiting for a call back from the vet and thought I'd throw out another question to you. Do insulin prices vary much or are they all close to the same? Is levemir around the same price as caninsulin?
     
  18. Critter Mom

    Critter Mom Well-Known Member

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    Can you post the exact brand and variety of the kibble you're currently feeding, please. Also, can you post exactly how much Fancy Feast Classics food plus how much kibble Davey gets each day (so we can get a better picture of how much high carb food is in his current diet).


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  19. Critter Mom

    Critter Mom Well-Known Member

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    I don't know how much the insulins cost in Canada. (I'm in the UK.) I'm tagging Linda and Chris to see if they can help you with a cost comparison (@MrWorfMen's Mom, @Chris & China).

    Many US members order their Lantus and Levemir from Marks Marine Pharmacy in Canada. Details are in this post:

    http://www.felinediabetes.com/FDMB/...canadian-pharmacies.49608/page-2#post-1344374

    This should give you a guide price to compare with prices in your own area.

    The pen cartridges are much more economical in use than larger vials because they only contain 3ml insulin. Provided it is stored and handled properly the insulin in an L insulin pen cartridge can remain viable for up to 6 months. To the best of my knowledge based on reading other posts, provided one finds a reasonably-priced source for the L insulins, the cost is commensurate to - and may perhaps work out less than - cost of Caninsulin.


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  20. Davey's Mom

    Davey's Mom Member

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    Dec 8, 2016
    He eats a can a day (half a can before AM injection and half a can before PM dose) and then dry food for the rest. Probably half a cup a day I would say, sometimes more.

    He hates the dry food since I've introduced wet and only eats it once he's really hungry. He's always by his bowl looking up at me when I'm in the kitchen hoping I'll give him some more Fancy Feast so I'd love to be able to change his diet to just that.

    This is the dry food he's eating but only for the last three months or so http://petvalu.com/product/FCM00637/indoor-formula-performatrin

    Ironically enough when we started noticing excessive thirst and such it was right after we switched dry foods but we were told that this switch shouldn't have made a difference. He was just eating cheaper Walmart food for years http://www.walmart.ca/en/ip/purina-cat-chow-cat-food-for-indoor-cats-32kg/6000071263341
     
  21. Critter Mom

    Critter Mom Well-Known Member

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    @emjb14 -

    Very important question:

    With regard to overall clinical signs (mood, energy, sociability, peeing, drinking, eating, etc.) does Davey seem to you to be better in himself on 8IU or 6IU Caninsulin?

    (@Chris & China - I'm looking at the high preshot BGs here and wondering whether they might be trending upwards on the 6IU dose?)


    @Chris & China -

    I'd welcome input on this for emjb14 from you when you are next online. (Also if you have time to review my earlier posts suggesting possible ways forward from here I'd appreciate it; you may spot something I've missed.)


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  22. MrWorfMen's Mom

    MrWorfMen's Mom Well-Known Member

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    Comparing insulin prices can be a little like comparing apples to oranges. The Caninsulin you are using is U40 insulin whereas Levemir and Lantus are U100 insulins. So each unit of Levemir and Lantus contains a higher dose meaning you may use less for each dose. Overall costs are going to depend on what dose kitty needs.

    I buy Levemir pen refills which come in a box of 5 small vials each containing 3ml or 300 units of insulin. 1500 units of insulin (5 X 300units) cost me $126.38 which works out to roughly 8 cents per unit. While the initial cost seems higher, the expiry date on the insulin is generally about 1.5 to 2 years out from date of purchase so you can use up most if not all the insulin with little waste by purchasing the pen refills. Lantus pen refill costs were slightly lower (about $117 for 1500 units) but I have not bought it for quite some time so my number may be off.

    Caninsulin pen refill pricing at the pet pharmacy in Toronto ($77.78 for 10 x 2.5 ml vials) would work out to 7 cents per unit but each unit of Caninsulin has less insulin than the Levemir or Lantus so it may actually be cheaper to use one of the longer acting insulins.
     
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  23. Davey's Mom

    Davey's Mom Member

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    Dec 8, 2016
    Honestly I do not notice much of a difference other than I find his numbers have been a bit higher since I reduced his doses.

    He eats great and drinks less than he did at the beginning of his diagnoses but there hasn't been a noticeable difference between 8 to 6.

    Still is spending most of his time in the kitchen (close to his food and water) laying on the floor sleeping or watching the kids and I. He purrs while I check his BG because he loves attention and I think he's just happy that I'm at his level petting him. He used to be a huge cuddler and was always on one of our laps. He jumped up on the bed to sleep with me last night which got me a bit excited because he was doing something he would normally do but after two minutes he jumped off and left.
     
  24. Davey's Mom

    Davey's Mom Member

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    I talked to the vet today and loaded her up with all the information you guys have given me. I'm sure she was a bit annoyed with me but said she'd look into it and call me back. Shortly after I got a call and she said she spoke with her colleagues and the general consensus is to try Lantus next. She is calling it into the pharmacy for me to pick up and said once I had it to book an appointment with them. I will switch his diet as we've discussed before proceeding with this.

    She mentioned this is the first time the clinic has prescribed anything but Caninsulin and I will check but I'm sure the other vet clinic here will tell me the same. I'm a rural area and think it's going to be difficult to actually talk/see to someone experienced in the matter, we only have two clinics in the area. I've discovered most people here just put their cats down once they are diagnosed and many politely tell me I'm crazy for doing all this but I don't really care what they think!

    I forgot to mention the foamy urine so I called back and got the receptionist who told me to come pick up special litter they carry to get a urine sample and they would test it to double check.

    She said over the phone that thyroid and any other conditions were already tested for. I will try to get more information when I go there.
     
  25. Critter Mom

    Critter Mom Well-Known Member

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    :bighug::bighug::bighug::bighug::bighug::bighug:


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  26. Critter Mom

    Critter Mom Well-Known Member

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    Ask for a printed copy of the lab work for your own records. (Advisable to do this as a matter of course. :) )


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  27. Critter Mom

    Critter Mom Well-Known Member

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    I've attached below a journal article co-authored by vet and world-renowned feline diabetes specialist, Dr Jacquie Rand. It has great information about treating cats with long-acting insulins Lantus and Levemir, dose adjustments and home monitoring of BG. It is from an authoritative source and may be helpful to you and your vet.

    If the demands of the protocol in the journal article don't suit, some FDMB members follow the Start Low, Go Slow method of treatment. Here's a link:

    http://www.felinediabetes.com/FDMB/threads/lantus-levemir-start-low-go-slow-method-slgs.129446/


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    Attached Files:

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  28. Critter Mom

    Critter Mom Well-Known Member

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    @MrWorfMen's Mom, @Chris & China -

    My back has seized up again and I'm feeling seriously unwell. Would you be able to keep an eye out for @emjb14 and Davey? I might not be online much for the next few days.


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  29. Davey's Mom

    Davey's Mom Member

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    Dec 8, 2016
    Thank you! I see the starting dose is 0.5 and I'm thinking I should go right back to that starting point when I start using the new medicine. Would you agree? Looking for another opinion other than the vets so we can start off this medication on the right foot!
     
  30. Davey's Mom

    Davey's Mom Member

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    I'm sorry you aren't feeling well thank you very much for all of your help and I hope you are better soon!
     
  31. Critter Mom

    Critter Mom Well-Known Member

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    For a cat not yet treated with any insulin the start dose is low. However if a cat has already been treated with another insulin the data and dose for the previous insulin need to be taken into consideration when determining a start dose for Lantus and Levemir.

    I suggest that you post on the Lantus and Levemir board asking for advice on transitioning to Lantus from a high dose of Caninsulin. There are some highly experienced Lantus users there who should be able to give you an idea of how the changeover should be approached. (It's what I would do. :) )

    http://www.felinediabetes.com/FDMB/forums/lantus-glargine-levemir-detemir.9/

    Remember to keep testing for ketones throughout all the changes (food, insulin, etc.)


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    Last edited: Jan 4, 2017
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  32. Chris & China

    Chris & China Well-Known Member

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    If you live in Canada, you don't even need a script for Lantus....just call around and find the best price you can for a box of 5 Lantus Solostar pens and go there and ask for them

    Insulin is OTC in Canada
     
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  33. Critter Mom

    Critter Mom Well-Known Member

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    Thank you for the good wishes. :bighug: Unfortunately I have a number of long-term chronic health problems and they're all flaring badly at the moment. :(


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  34. Chris & China

    Chris & China Well-Known Member

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    I'll keep an eye out for her Mogs....you take care of yourself!!
     
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  35. Critter Mom

    Critter Mom Well-Known Member

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    Thank you, Chris. :bighug:


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  36. MrWorfMen's Mom

    MrWorfMen's Mom Well-Known Member

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    Yes @Critter Mom , I'll keep an eye on things here along with Chris. You take care of yourself.:bighug::bighug::bighug::bighug:

    When you go to the pharmacy counter here in Canada, you need to ask for the pen refills....not the Solostar pens. You don't need the pens and I think they will charge you more for them.
     
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  37. Critter Mom

    Critter Mom Well-Known Member

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    Thank you, Linda.

    :bighug::bighug::bighug:


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  38. Critter Mom

    Critter Mom Well-Known Member

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    @Chris & China, @MrWorfMen's Mom -

    I can't fathom out how to do carb calc estimates for US-style guaranteed analysis figures. Is there any chance one of you could do a carb check on these foods (especially as the current dry food seems to have tipped Davey over into becoming symptomatic).


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  39. Chris & China

    Chris & China Well-Known Member

    Joined:
    May 10, 2013
    The Performatrin Indoor Formula dry food comes in at a whopping 33.9% carbs [​IMG] [​IMG]
     
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  40. Critter Mom

    Critter Mom Well-Known Member

    Joined:
    Jun 16, 2014
  41. Mum of two felines

    Mum of two felines Member

    Joined:
    Dec 7, 2015
    That is close to the prescription diet. W/D that Buzz and Woody was on!!!
     
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  42. Davey's Mom

    Davey's Mom Member

    Joined:
    Dec 8, 2016
    So just taking that food away by the sounds of things may make a difference! I bought it thinking I was doing better by him because it was more expensive than what I was using before and wanted to feed him better since he's getting older. The manager at the pet store talked me into it ugh.
     
  43. Davey's Mom

    Davey's Mom Member

    Joined:
    Dec 8, 2016
    If I've learned anything from all of this it's research research research ....
     
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  44. Critter Mom

    Critter Mom Well-Known Member

    Joined:
    Jun 16, 2014
    Weigh the amount of the dry you feed every day starting from now. You'll need to track the amount you feed throughout the transition so you need to know how much he's getting before you start.

    You'll need to test right through the day when reducing the dry food because you may need to adjust the Caninsulin dose down very quickly.

    Post here to ask members to keep an eye on the spreadsheet and the dose. Insulin needs might start to drop within hours. (No guarantees but you need to be prepared for any drop in BG and be vigilant with the testing.)


    Mogs
    .
     
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  45. Critter Mom

    Critter Mom Well-Known Member

    Joined:
    Jun 16, 2014
    Oh, yes! :)


    Mogs
    .
     
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  46. Chris & China

    Chris & China Well-Known Member

    Joined:
    May 10, 2013
    If there's one thing to remember about food, it's that the cost of it doesn't relate to how good (or bad) it is!! Look at how expensive the "prescription" diets are and they are full of lousy ingredients and are horribly high in carbs!!

    Also, "grain free" is nothing but a buzz phrase....it doesn't have anything to do with how high or low carb the food is.....switching out corn and using potatoes instead makes it "grain free"....but it doesn't make it low carb
     
  47. MrWorfMen's Mom

    MrWorfMen's Mom Well-Known Member

    Joined:
    Feb 18, 2015
    I see Davey's AMPS this morning was down quite substantially. I wonder if the lowering of the dose set him into a steeper bounce the last few days and you are just now starting to see the results from the dose reduction. Will be interesting to see where he goes from here. Do be careful with the food changes because as Mogs has said, that alone can have a profound effect on insulin needs.
     
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  48. Davey's Mom

    Davey's Mom Member

    Joined:
    Dec 8, 2016
    Last night he was following me around like crazy looking for wet food so I have to admit I gave him a half a can more than I usually would and in turn he didn't eat any dry food last night. He had dry food in his bowl but as usual just didn't want it. I'm sure this is probably the big factor so I will need to be careful.

    Now I have a dilemma that's going to set us back a bit which I'm so angry at myself for! I ordered more test strips but was too late in doing so and now I'm in trouble. I just used my last one this morning and should have received them today but (just my luck) when I go to track the shipment it's not arriving until Monday due to a weather delay. I can't make changes over the weekend with no strips and I don't know where else to get them and a machine here without spending a fortune here ugh. I was nervous this morning when I left for work so I asked my husband (he works nights Thursdays) to keep an eye on him.
     
  49. Red & Rover (GA)

    Red & Rover (GA) Well-Known Member

    Joined:
    May 18, 2016
    Do you know anyone who is a diabetic and might have a back-up meter?
     
  50. Davey's Mom

    Davey's Mom Member

    Joined:
    Dec 8, 2016
    Hmmm maybe my Grandfather I can ask! Can you use meters intended for humans just the same?
     
  51. Nan & Amber

    Nan & Amber Well-Known Member

    Joined:
    Mar 19, 2016
    Hey--

    Been there on the "whoops-- forgot to order strips with enough lead time!" mistake. So frustrating.

    What I ended up doing was to just bite the bullet and going to a local national drug store chain (I don't have a Walmart near me) and buying the cheapest "starter pack" consisting of their own store-brand monitor and a few strips for about $20 (most of the time, the machine itself isn't that expensive, they want your business so you'll keep buying the strips!). Hopefully there's something similar close to you (I am never sure what is available and how up in Canada, hopefully one of our Canadians can weigh in with a specific suggestion).

    You won't be able to get a pet meter that way, so your numbers won't be entirely comparable to the ones you have with the FastaCare meter, but at least you would have something to be able to keep track of what Davey is doing.
     
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  52. Red & Rover (GA)

    Red & Rover (GA) Well-Known Member

    Joined:
    May 18, 2016
    A number of Canucks use the FreeStyle Lite glucometre. It is the cheapest stripwise and uses the smallest amount of blood. Available at Walmart and other pharmacies. Don't know about Costco.

    Always ask the pharmacist how much the strips are. Metres can be cheap, but they get you with the strips. Also check how much blood is needed for a test. You'll waste a lot of strips if a bigger blob of blood is needed.

    As @Nan & Amber noted, the numbers will be different than you are used to. Each glucometre is different - variance.
     
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  53. Kris & Teasel

    Kris & Teasel Well-Known Member

    Joined:
    Aug 17, 2016
    In Canada the Freestyle Lite meter can be had free (generally) if you buy a box of 100 strips. You also might find a coupon for a free Freestyle Lite meter if you go to www.abbott.ca. If you go to Shoppers Drug Mart on a Seniors' Day, the strips will be 20% off for a senior and tax free. The regular price for 100 FS strips is about $90 but that drops to $72 with 20% off and if you have Optimum points you can do even better.
     
    Last edited: Jan 5, 2017
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  54. MrWorfMen's Mom

    MrWorfMen's Mom Well-Known Member

    Joined:
    Feb 18, 2015
    Never hurts to have a backup meter anyway with strips that can be purchased locally and quickly if need be. We can help you with the human meter readings. You want to take action to if Davey goes below about 5.5 mmol (100 US) on a human meter right now and no shot if he is below 11mmol. Those are the main numbers you need to know about the difference for now. There is no direct conversion of pet to human meter readings.
     
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  55. Red & Rover (GA)

    Red & Rover (GA) Well-Known Member

    Joined:
    May 18, 2016
    Coupon: https://www.abbottdiabetescare.ca/products/freestyle-lite#WPbIJrpKQS1J8jwM.97 (I haven 't read the fine print - if they ask, just say you are picking up a new metre for your grandfather to try. He's having problems getting a drop of blood big enough.)
     
  56. Kris & Teasel

    Kris & Teasel Well-Known Member

    Joined:
    Aug 17, 2016
    This is exactly the coupon I used when I got mine at a Shoppers Drug Mart. I had no problem - just said I wanted to redeem the coupon when I bought the strips.
     
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  57. Marlena

    Marlena Well-Known Member

    Joined:
    Nov 25, 2015
    Oh Mogs, I'm really sorry to hear that!
    Please take care darling, it is such a shame that I can't come to take care of you or help you in any other way as you deserve to be looked after as you are such a rock! Your knowledge and good advice is most appreciated!
    Sending healing vines
    Marlena :bighug::bighug::bighug:
     
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  58. Marlena

    Marlena Well-Known Member

    Joined:
    Nov 25, 2015
  59. Davey's Mom

    Davey's Mom Member

    Joined:
    Dec 8, 2016
    Hi guys! Just got home from purchasing the meter (it was free thanks for the tip everyone!) and Davey's sugars so low for this time I had to check twice because I couldn't believe it. He was at 15 on the new meter at +10. I'm going to dose him the same now and I guess I should decide what to do tomorrow morning before I go to work by what I see happening this evening. Just worried about giving him too much and not being around to keep an eye on him. Thanks for everyone's help so far I never would have made it this far without it:)

    Update - Just tested again at +1 and Daveys at 20 now (so higher) which is strange but he just ate a 1/2 cup of dry cat food not too long ago. I wonder if this is why....

    On the weekend I really want to get rid of the dry food while I'm home!
     
    Last edited: Jan 5, 2017
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  60. Mum of two felines

    Mum of two felines Member

    Joined:
    Dec 7, 2015
    The advice I've seen on here would advise you to test at +3 to see where he's going. Personally I would test at +2 but that's me.
     
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  61. Mum of two felines

    Mum of two felines Member

    Joined:
    Dec 7, 2015
    Getting rid of the dry will help the numbers. BUT you'll have to be testing this weekend to make sure he's not dropping. If you look at my kitties' spreadsheets you'll notice the change of food dropped their numbers greatly. They both hypoed many times. Good luck and I'll be on throughout the weekend watching your transition!
     
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  62. Critter Mom

    Critter Mom Well-Known Member

    Joined:
    Jun 16, 2014
    :D ...

    ... but extra care is needed now - especially if Davey is declining the very high carb, dry food he has been eating up till now. Here's an example of why the worry:


    upload_2017-1-5_20-34-50.png

    The above is a snapshot of Saoirse's BG readings for before, during and after her transition from dry high-carb to wet low-carb food. She was on Caninsulin and her BG readings were taken using a pet meter, as is the case currently with Davey. (NB: I have non-standard colour coding in Saoirse's spreadsheet. Key is at top of snapshot.)

    On 13.07.14 Saoirse would not eat any more dry food. Look at what happened to her BG between PMPS and PM+3 - a drop of 13 points!

    The above shows just how fast and how far BG levels can fall with removal of high carb food from the diet (especially with removal of high carb dry food). Also look at how quickly and how often it was necessary to reduce the insulin dose. (Had to feel my way with this at the time because I was a novice caregiver, had minimal useful input from the vet available at the time (our main vet was away for a few days, and didn't know how even a small dose of Caninsulin could yank down high preshot BGs into very low numbers mid-cycle. I was only able to keep Saoirse safe because I was home testing throughout the transition and reducing her dose based on her data then and for several days following.)

    (Note: The all-yellow cycle on AM of 20.07.14 was due to duff insulin: it had been like a sauna in the flat during the night, my fridge was useless and the insulin overheated. A fresh vial for the PM cycle showed Saoirse returning to lower numbers again on only a tiny dose of Caninsulin.)


    Suggestions:

    1. Contact your vet straight away and agree a significant dose reduction (possibly even a small token dose) to give in the event where you are low on test strips.

    2. It was a very smart move getting the human meter. With Davey not eating the dry, high carb food and the high dose of Caninsulin this is a time when you really, really need to home test.

    3. Get a supply of high carb, wet food to see if Davey will eat that instead of the high carb dry. (Contingency. @MrWorfMen's Mom - any suggested Canadian foods?)

    4. Continue monitoring ketones closely (especially with a reduced dose).

    Now that it's unpredictable whether Davey will eat any of the dry high-carb food, any time you're not around to monitor I suggest you make sure Davey has food available at all times - higher carb wet if necessary - and possibly reduce the dose of Caninsulin.

    There is such a big difference in the preshot BG today compared to the previous cycles that extra caution is vital. With less hyperglycaemia due to the reduction in amount of dry food eaten Davey may also start becoming more responsive to insulin generally.

    Safety tip: If Davey is running in the lower range mid-cycle but the preshot is high, follow the nadir values when making dosing decisions, not the preshot. (Even small doses of Caninsulin can really yank unexpectedly high PS BGs right back down to low numbers again. Also keep a close watch on his clinical signs and test him if you see any unusual behaviour - especially if he starts looking for food OR if he seems lethargic.


    Mogs
    .
     
    Last edited: Jan 6, 2017
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  63. Davey's Mom

    Davey's Mom Member

    Joined:
    Dec 8, 2016
    @Mogs - Thank you for the information and I hope you are feeling a bit better today.

    I was in the same line of thinking as you about a couple things last night and already took a jump on suggestion 3 :) I did have a few cans of high carb wet (fancy feast I bought before not realizing it was high carb) so I gave him one last night since he wouldn't eat dry and I had to go to bed a bit earlier for work today. This morning I checked twice and his sugar was testing Hi on the monitor which means over 500 based on what I read so he'd be back up to his usual numbers. Looks like the food is taking a definite toll on him so it will be interesting to see what happens this weekend. Starting tonight I will switch his diet.
     
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  64. Critter Mom

    Critter Mom Well-Known Member

    Joined:
    Jun 16, 2014
    Be sure to phase out the high carb very gradually both for insulin safety and to minimise risk of GI upset (the last thing one needs with a diabetic kitty! :nailbiting: ).

    It's a bit of a tricky situation trying to do the gradual transition while you've got enough time at home to do the very close monitoring needed to make sure Davey stays in safe numbers and managing dose reductions, too. (And ketone testing! The list is endless. ;) )

    If Davey's still eating some of the dry high carb food at the moment you've been keeping track of how much of that he has been getting and can relate the BG data gathered thus far to the carbs from that source. I'd suggest the start point being the Fancy Feast / dry high-carb combo you've been feeding, gradually reducing the amount of dry and replacing it with more of the other food. If Davey won't eat the dry food, substitute the wet, high carb instead and closely monitor BG. With the change in carb load Davey may start going low later in the cycle so watch for this.

    Be prepared to adjust the dose every single cycle. If you're not able to keep monitoring go back to feeding what Davey has been eating to keep his BG levels up high enough.

    Read through the hypo guide and keep a printed copy where you can quickly lay your hand on it should you need it. It's a good idea to set out all the supplies from your hypo kit in readiness. Be sure to post here for help and make sure you have the vet's emergency number handy. I'm going to be a bit hit and miss (still feeling really awful) but other members should be around to assist you.

    Here's a link to Dr. Pierson's notes from catinfo.org about doing a safe food transition:

    Switching a Diabetic Cat to a Low Carbohydrate Diet

    Keep safe!

    :bighug:


    Mogs
    .
     
    Last edited: Jan 7, 2017
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  65. Critter Mom

    Critter Mom Well-Known Member

    Joined:
    Jun 16, 2014
    Hi EMJB,

    Just checking in to ask how things are going today with Davey. That was some drop from PMPS to +4 last night!

    I see his AMPS was better this morning.


    Mogs
    .
     
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  66. Davey's Mom

    Davey's Mom Member

    Joined:
    Dec 8, 2016
    Hi Mogs! I'm afraid his numbers may not be improving as much as we thought :( For three tests I used both monitors because my strips which weren't supposed to be in until Monday ended up in my mailbox yesterday. Each time the readings were 7-8 in the difference between the Fastcare Pet and the Freestyle Lite. I'm not sure which one would be more accurate I'm hoping the Freestyle since it's giving the lower numbers!

    I added the Fastacare numbers in as cell comments and am continuing to use the Freestyle numbers on the sheet. I figured it's safer to keep an eye on the numbers which are reading lower.

    I started using the Freestyle on January fifth for the +10 reading after his AM dose so his AMPS test that day still was much lower than usual.

    We will see how things go for the rest of the weekend.... He never leaves the food bowl now that he's having more wet he wants to eat all the time and I'm not sure how much I should limit him. The most he's had in one day is three 85G cans and I had mixed in higher and lower carb cans together. The dry food is pretty much finished he doesn't want it....
     
  67. Davey's Mom

    Davey's Mom Member

    Joined:
    Dec 8, 2016
    You are right for sure his numbers were better this morning than they day before. He on had low carb food last night. vs the night before where he had high carb.

    Also he did had quite the drop like you said but the number on the Fastacare monitor read 23.2
     
  68. Critter Mom

    Critter Mom Well-Known Member

    Joined:
    Jun 16, 2014
    Be thankful that Davey is enjoying his wet food! (Ask the members here with kibble addicts. ;) )

    Will you be able to monitor right through the AM cycle tomorrow? If yes, you could try slightly increasing the amount of low carb and slightly reducing the amount of high carb in the wet food 'combo' for that cycle. You'd be able to intervene if Davey were to run lower (and check the PM cycle, too; sometimes numbers continue to improve in the following cycles).


    Mogs
    .
     
    Last edited: Jan 7, 2017
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  69. Critter Mom

    Critter Mom Well-Known Member

    Joined:
    Jun 16, 2014
    At least you now know that the carb level in the diet is a significant contributor to Davey's higher readings. Once you complete the safe, gradual transition he will hopefully be running in a better range and that will take some of the strain off Davey's system while you work towards better regulation.

    Did you notice any changes in Davey's peeing and drinking at all?


    Mogs
    .
     
  70. Davey's Mom

    Davey's Mom Member

    Joined:
    Dec 8, 2016
    He has been drinking bit less I find yes.
     
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  71. Davey's Mom

    Davey's Mom Member

    Joined:
    Dec 8, 2016
    Good Point!

    This morning he had mostly low carb and last night. He only had about 1/3 can of high carb wet in this time frame which I thought was ok because back when he was eating dry food he wasn't having very much at the end of it. I'll start checking more often tomorrow, today I did every couple hours until I noticed that he was coming back up again.
     
  72. Critter Mom

    Critter Mom Well-Known Member

    Joined:
    Jun 16, 2014
    Just saw PMPS! Pretty in pink! :)

    I recommend you be extra careful on this cycle because:

    - Davey went quite low mid-cycle last night.
    - His carb load is reducing.
    - BGs may continue to drop as the effects of the higher carb foods wear off (may flow into following cycles).
    - Many cats run lower at night.
    - He has already dropped by c. 5 points by +2 and could very well drop further in the next few hours.

    I think it's advisable for safety that you keep testing Davey tonight till you're sure he's rising again and will stay up. Safe food transitions tend to require a bit of sleep deprivation - especially with such a significant insulin dose in the mix - but once the transition is safely completed things should hopefully become more straightforward. You're doing a great job!


    Mogs
    .
     
    Last edited: Jan 7, 2017
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  73. Critter Mom

    Critter Mom Well-Known Member

    Joined:
    Jun 16, 2014
    BTW, spreadsheet tip: it's a good idea to add a brief note about what and how much you feed each day in the Remarks column. :)


    Mogs
    .
     
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  74. Davey's Mom

    Davey's Mom Member

    Joined:
    Dec 8, 2016
    Great thanks for everything! He went down really far but then back up within the last hour which is strange because the insulin should still be dropping numbers down at +4. I've been checking on both monitors just to be on the safe side. They are only 4-5 points in the difference now between monitors so it seems as the numbers get lower the results are getting more in line which is good. I will keep an eye on him tonight :)
     
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  75. Critter Mom

    Critter Mom Well-Known Member

    Joined:
    Jun 16, 2014
    It's not an uncommon thing to see numbers pop up like that with Caninsulin, especially after a significant drop in the first few hours of the cycle. Also, nadir time can move around.

    FYI - with Caninsulin target nadir should not be lower than about 5.6 on a human meter. The hypo threshold is 2.8 but the higher nadir target provides a necessary safety buffer for this particular insulin (allows some room for the unexpected).

    If Davey's AMPS is lower than usual you should consider reducing the dose - especially if you're going to further reduce the carb load on tomorrow's AM cycle.

    If AMPS is 11.1 or lower in the morning (the FDMB no-shoot recommendation) then stall, don't feed, don't give any insulin and ask for help by posting a new thread on Feline Health with title "AMPS ???? - Stalling - Need Help with Caninsulin Dosing." (Tip: If you do need to create a new thread copy and paste the URL for this thread in the opeining Include a link back to this thread so that members replying will be able to find Davey's historical info here.)

    Sending wishes for a safe night.

    :bighug:


    Mogs
    .
     
    Last edited: Jan 7, 2017
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  76. Critter Mom

    Critter Mom Well-Known Member

    Joined:
    Jun 16, 2014
    PS: Remember to test for ketones! :)


    Mogs
    .
     
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  77. Islandmomma

    Islandmomma Member

    Joined:
    Dec 25, 2016
    It is?! I thought we needed a rx from the vet?!
     
  78. Kris & Teasel

    Kris & Teasel Well-Known Member

    Joined:
    Aug 17, 2016
    If you're in Canada, a box of 5 cartridges of Lantus is $125 at Shoppers Drug Mart and is available without a prescription. On Seniors' Day that can be had for 20% off and no taxes, so $100 for the box of 5. That's $20 per cartridge which is very cheap given that it'll last many months.
     
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  79. Chris & China

    Chris & China Well-Known Member

    Joined:
    May 10, 2013
    Not if you live in Canada you don't!! Just find the place with the best price and go in and ask for it!! That's one thing you guys in Canada have over us!!
     
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  80. Islandmomma

    Islandmomma Member

    Joined:
    Dec 25, 2016
    OMG I had no idea! If anyone wants anything let me know LOL
     
  81. Critter Mom

    Critter Mom Well-Known Member

    Joined:
    Jun 16, 2014
    Hi EMJB,

    I see Davey had fun on his trampoline at +4 last night. :rolleyes: :)

    Are you giving any high carb food today or are you feeding only low carb on today's AM cycle? And how is Davey feeling/behaving today?


    Mogs
    .
     
  82. Davey's Mom

    Davey's Mom Member

    Joined:
    Dec 8, 2016
    All low carb today and he's no different than usual. He gets so excited when I open a can of wet food that he near knocks me over haha
     
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  83. Davey's Mom

    Davey's Mom Member

    Joined:
    Dec 8, 2016
    Just doing what my gut is telling me is right and hoping things go ok :) So far so good!
     
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  84. Mum of two felines

    Mum of two felines Member

    Joined:
    Dec 7, 2015
    I love seeing these pink and yellows!!!! I wonder if you'll see a blue this cycle! I've been checking in this weekend!
     
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  85. Critter Mom

    Critter Mom Well-Known Member

    Joined:
    Jun 16, 2014
    Me, too! :cat:

    Much-improved PMPS tonight, EMJB! :) What has Davey's peeing/drinking been like today?


    Mogs
    .
     
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  86. Davey's Mom

    Davey's Mom Member

    Joined:
    Dec 8, 2016
    Thanks so much guys! He's drinking less this evening and he just came up on the couch with me and had a nap on my lap after the kids went to bed for the first time in forever :)

    Since he switched to wet food he's hinting at me that he wants another can all the time do you guys think I should put a limit on what he's eating? He used to be bigger since he got sick he lost between 3-4 pounds. He's always loved to eat and the wet food is like a treat to him he purrs while he's eating it haha

    If he gets to blue tonight and/or his AMPS is lower tomorrow than today I'm thinking I should drop insulin right? If so to 4?
     
  87. Critter Mom

    Critter Mom Well-Known Member

    Joined:
    Jun 16, 2014
    Wonderful! I'm delighted to read this. :cat: For all of the worry that goes with getting our little ones better regulated there is also much joy to be had along the way. It's great that he's enjoying his healthier grub. (((Davey)))

    If Davey's underweight at the moment then it's OK to feed him extra until he returns to ideal weight. As his regulation improves he will get more benefit from the nutrients he's eating and his appetite should normalise thereafter.

    Here's a body condition chart to help you assess Davey's weight:

    http://www.wsava.org/sites/default/files/Body%20condition%20score%20chart%20cats.pdf

    It's also helpful to track weight at home. A reasonably-priced digital baby scale is ideal for this purpose (try Amazon or ebay). Keeping a log of how much you feed every day and doing weekly weigh-ins will help you to get Davey back to his ideal weight. Once there, if he starts to gain too much then feed a little less; if he starts to lose a little weight, feed a little more.


    Mogs
    .
     
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  88. Mum of two felines

    Mum of two felines Member

    Joined:
    Dec 7, 2015
    If he were my kitty and he was in yellow tomorrow morning I would not give 6. I would hesitate to giving 4. But I don't know enough to tell you what to give. Maybe someone will be by to look at his SS. He has spent only 1 full day, today, without any wet W/D or dry, correct?

    When are you switching to Lantus? I would definitely check with an experienced member before starting that insulin.
     
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  89. Critter Mom

    Critter Mom Well-Known Member

    Joined:
    Jun 16, 2014
    Will Davey be unmonitored during the AM cycle tomorrow?

    Also what time zone are you in and when is your AMPS test due? (Trying to see if I can be around for it.)


    Mogs
    .
     
  90. Critter Mom

    Critter Mom Well-Known Member

    Joined:
    Jun 16, 2014
    Hi EMJB,

    I see things ran a bit more smoothly mid-cycle for Davey last night. :)

    How long is it till your AMPS test?

    Also, just to make sure we understand everything properly, please can you confirm that Davey was fed exclusively on the low carb Fancy Feast Classic wet food all day yesterday and that the same food will now be his regular diet.

    Great job monitoring over the weekend. :)


    Mogs
    .
     
  91. Davey's Mom

    Davey's Mom Member

    Joined:
    Dec 8, 2016
    Hi Mogs! Sorry I didn't see your message last night I was in lala land already...

    His sugar this morning was very close to what it was yesterday morning so I continued with the same routine. It was actually a tad bit higher than yesterday.


    Yes you are correct :)

    Thanks!
     
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  92. Critter Mom

    Critter Mom Well-Known Member

    Joined:
    Jun 16, 2014
    Excellent! The diet transition is a major milestone. :)

    If you arrive home a little while before PMPS is due, it can be very helpful to snag 'in the door' BG tests. They can give you information on dose duration and also indicate whether BG is rising at PMPS (helpful for making dosing decisions).


    Mogs
    .
     
  93. Davey's Mom

    Davey's Mom Member

    Joined:
    Dec 8, 2016
    Yes I did and he's higher today than yesterday when we were home with him. 19.2 at +10 (around 5 once I got the kids settled), then 23 at PMPS and 19.6 1 1/2 hours after insulin.

    His water dish was still fairly full when we got home and his litter box isn't too bad either so he's still not showing signs of excessive thirst like he was before.
     
  94. Mum of two felines

    Mum of two felines Member

    Joined:
    Dec 7, 2015
    Will you be able to check at +5 tonight?
     
  95. Critter Mom

    Critter Mom Well-Known Member

    Joined:
    Jun 16, 2014
    Hi EMJB,

    It's great that you got the +10 this evening; it shows that the dose didn't last the full 12 hours. If you can get one or two more of those your vet will be able to see from Davey's data that the Caninsulin does not have sufficient duration of effect to keep him in a reasonable range for the full cycle. I'd suggest discussing with your vet the possibility of a switch to a longer-acting insulin like Levemir or Lantus. Raising the dose on Caninsulin might put Davey in a better range during period of peak effect but it would be highly unlikely to give greater duration. A longer-acting insulin would be more likely to keep numbers in a better range for a longer time each day, keep those preshot BG levels down and, hopefully, gradually get him into a much better BG range overall.

    Good news on the PU/PD front. :)


    Mogs
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  96. Mum of two felines

    Mum of two felines Member

    Joined:
    Dec 7, 2015
    You hit blues!!!!! Are you staying at 6 or going to 5?
     
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  97. Critter Mom

    Critter Mom Well-Known Member

    Joined:
    Jun 16, 2014
    Woot!!! :woot:

    Go, Davey boy!!! :cool:

    @emjb14 - keep a note of what, how much, and when you fed for yesterday's AM and PM cycles to refer back to; it seems to have agreed with Davey. How were Davey's clinical signs and behaviours yesterday evening?

    Wondering whether yesterday's PMPS might have been a little bounce-influenced?


    Mogs
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  98. Davey's Mom

    Davey's Mom Member

    Joined:
    Dec 8, 2016
    Good Morning Mum of Two & Mogs!

    He did so good last night that I panicked a bit this morning and wasn't sure what to give him. I was thinking 5 but then started second guessing and went to 4. I had to run into work a bit late today and was able to check him at +2 and he was 17.3 so 4 was likely a bad call... I know his dose is considered high and out of the norm but it seems that he needs it so far. We will see what he is when I get home...

    Good news is I already talked to my vet about other insulin options long ago and I have Lantus sitting at the pharmacy ready for me to pick up :) You guys had suggested this option to me a while back but we had decided to hold off on switching medications until we made the necessary changes to diet.

    I think I should try Lantus this weekend beginning with Friday's PM dose. If you have any concerns with this please let me know.

    If I remember correctly someone had mentioned that I ask for advice on the Lantus forum about dosing when making the switch. I now trust the advice from here more than any vet in my community so would definitely be looking for input :)

    Thanks so much!!!! He's on all low carb fancy feast and he had four cans yesterday and still wanted more. He's not cheap to feed that's for sure lol.. He had two in the morning and two in the evening around shot time.
     
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  99. Critter Mom

    Critter Mom Well-Known Member

    Joined:
    Jun 16, 2014
    Hi EMJB,

    It's great to hear you sounding brighter! I hope Davey's feeling better in himself, too. :)

    Secondary Monitoring: Water Consumption

    - Measure water left out at AMPS.
    - Measure to see what's left at PMPS to see how much was consumed during AM cycle.
    - Measure water left out at PMPS.
    - Measure to see what's left at AMPS to see how much was consumed on PM cycle.

    While a crude method, if you do this secondary monitoring it may give you some small indication of how Davey's running during the daytime when you're out at work. You need to do both cycles for a comparison check. If there's a steady downward trend in both cycles then that plus the BG data you collect should hopefully flesh out the picture of Davey's progress. (There is the possibility that BG numbers may continue to improve for several days after the diet transition is completed.)

    Whenever you lower a dose it's especially important to check ketone status.

    Because Caninsulin is an in-out insulin if the 4IU dose is too low then it can always be adjusted upwards if required. Thus far the 6IU dose has been OK (and it's not excessive in the way the 8IU BID dose so soon after Dx was) but if Davey's BG continues to improve as a result of the food change and also becoming more sensitive to insulin from starting to run in better numbers then a precautionary, modest reduction should hopefully be OK. There is the possibility that he may level out on the lower dose (i.e. similar nadirs but lower preshots) but only testing will show whether that will be the case.


    Mogs
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    Davey's Mom likes this.
  100. Critter Mom

    Critter Mom Well-Known Member

    Joined:
    Jun 16, 2014
    With such a significant Caninsulin dose in play and at least some BG data available then doing the food switch while still treating with the in-out, somewhat 'known quantity' insulin made more sense in case the dose needed to be adjusted downwards quickly. Had Davey been on Lantus you'd have had to juggle with the reduced carb load and the insulin depot. In the latter situation there would have been a time lag after a dose reduction while the depot was draining so it could have been trickier.

    Definitely post on the Lantus board to ask for input on starting dose, especially as Davey's currently receiving a significant dose of Caninsulin at the moment.

    It will take several days for the Lantus depot to fill before you can fully assess the safety and efficacy of the dose so making the changeover at a time when you can monitor more closely is better. Be sure to let the L&L people know that you can't monitor on workdays as it may have an influence on the best day to start Lantus treatment and also the starting dose.

    There are two treatment methods that L&L members typically follow:

    Start Low, Go Slow Method (SLGS)

    Tight Regulation Protocol (TRP)

    Some members start out on the SLGS method but later switch to TRP as they gather more data and become more confident in how their kitties are responding to Lantus.

    There are a lot of very helpful educational stickies at the top of the L&L board to help you learn more about Lantus.

    You will need different syringes for the Lantus. The best ones to get are U100 0.3ml syringes with half-unit markings. Walmart carry them in their Relion range. Here is a post by Chris with a list of suitable syringes:

    http://www.felinediabetes.com/FDMB/threads/u100-syringes.169310/#post-1837598

    I'd very much like to follow along with Davey's progress on the Lantus switchover but I have difficulty negotiating the L&L ISG thread index page. (I have PTSD and the 'busyness' of the board makes me feel very panicky.) I'd appreciate it if you might tag me in one of your posts there so I'd be able to find Davey's thread. :)


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