frustrated

Hello all. I need a little advice with a frustrating cat/vet situation. Here's the story.

Cat: Scoop
Diabetic : about a year now
Insulin : Lantis
Dose: 2 units/twice a day
Food: 1/4 cup Science Diet MD dry twice a day
B/G: it's been a while since I have done one (been out of town), but they always start out high, go to about 200 then back to high right before next injection.
Hometesting with alphatrak and glucotest strips

What worries me is that he has NEVER received below a 200 bg. He is always in the 300-400 range or high. Even an hour after I give the shot he's still very high. What really is strange is after we give the shot he seems to be hypo (very lethargic, a little glossy at time, wont climb the stairs) but when I test him he's at 300-400! Ug!

I am frustrated because my vet doesn't seem to know a lot about cat diabetes. She seems to always be doing research before she answers any questions (which is good and bad I suppose). I feel that there is more we can be doing, upping to dosage - something!

She also thinks he has cataracts - possibly because of the diabetes? Anyone had an experience with that? She said she'd never seen cataracts in a cat.

Also, how long is too long for lantis to be viable past expriation? At 4 units a day we have a bottle for months, I feel this may contribute to his regulation being difficult.

Any advice would be great! We are thinking about taking him to am internal medicine specialist - maybe they have more experience.

 

IMHO, it's the food. I am convinced that Science Diet gave Oliver diabetes. Look at the ingredients - it's all grains. What cat would choose to graze in a wheat field? We advocate feeding our kitties meat. See this website written by a vet: http://www.catinfo.org She explains why wet, lo carb food is best for any cat, but especially diabetics.

When we changed Oliver over from dry to wet, his bg levels dropped 100 points overnight. That said, don't change the diet unless you are planning to step up the bg testing - at the minimum before every shot and at the nadir (lowest point in the cycle)

Give it a try - what do you have to lose?

 

I am betting that a large part of his high numbers problem is the fact that he is on MD, which is 13% in carbohydrates.
For a diabetic feline, the daily carb value should be not higher than 8% - preferably even lower if possible.
My now diet controlled kitty does not get foods that are over 5%.

My suggestion would be to change your kitty over to canned lo-carb Fancy Feast, Friskies, or 9 Lives, or something similar -
***BUT*** NOT BEFORE YOU ARE HOME TESTING REGULARLY AS YOU MAY NEED TO REDUCE HIS INSULIN DOSEAGE!

A diet lower in carbs oft times reduces the need for insulin and this can cause a hyopoglycemic issue if you
do not know what your cat's bgl is pre-shot and at nadir.

See these links for the breakdown of carbs/protein of many different kinds of cat foods, (Janet & Binky's Food Charts) :
http://www.felinediabetes.com/diabetic-cat-diets.htm

~M

 

Hi, and welcome.

First, I am not a Lantus user, so please take the advice of actual Lantus users on dosing, etc.

Second, congratulations on home-testing already!! And, from what you've said you're doing, it looks like your vet is more up-to-date on diabetic cats than many that we see here, which is good.

Lantus is a good insulin for cats, but it needs careful monitoring at the beginning to gather enough data upon which to base dosing, and the dosing needs to be tweaked carefully. My suspicion is that you'll need to start over and adjust the dosing again; you'll have to listen to the Lantus folks on exactly what you should do there.

Things you can improve on: ditch the dry food. Seriously. It's bad quality and it's high-carb and it's bad for diabetics. Go to Janet and Binky's food charts. Print them out, go to the store and -- assuming Scoop doesn't have any other health issues -- pick up a selection of foods that are less than 10% carbs. Bring them home and have Scoop taste-test them. You're looking for foods that are less that 10% carbs (assuming no other health issues), that Scoop likes, that are easily available in your area and that fit your budget.

As an example of how much diet can affect BG levels and the need for insulin: due to other health issues, my Gwyn's base food for quite a while was canned A/D, which is 13% carbs. When we finally managed to switch her base food to Wellness Chicken (3% carbs), her insulin needs dropped from 4 units twice a day to 2 units twice a day. Getting off the high-carb dry food can have a big effect on Scoop's diabetes.


> Hometesting with alphatrak and glucotest strips

Yay for home-testing. I wouldn't bother with the glucotest strips, as the information they give is neither current nor accurate; it's just an average of the past few hours. You'll get much better results from home blood-testing.

Depending on your budget, you may want to look into getting a human glucometer. Yes, the AlphaTrak is being marketed as specially designed for cats and dogs, but it's not really any better than the human glucometers that you can pick up at any pharmacy. Plus, the meters you find at human pharmacies are less expensive, and their test strips are cheaper and easier to get. So switching to a human glucometer is something I'd seriously consider.


On Lantus: it's a bit more finicky than some of the other insulins out there, but a lot of folks are having good success with it. I'd recommend posting Scoop's BG numbers and letting some of the Lantus folks here on the boards give you dosing advice. You'll also want to go to the Lantus forum (use the 'Jump To' box in the lower right corner) and read the sticky posts on 'New to the Group', 'Handling and Storage', and the 'Storage Shed'; those will give you a *lot* of info on how Lantus works and how you can use it to best effect.

If you're thinking about getting a new vial of Lantus, might I suggest considering getting either pens or cartridges instead of a vial? They're a little more expensive initially, but they tend to be much more economical in the long run.

Anyway, those are my suggestions. We're here to help you help Scoop, so feel free to ask anything you want

-- Jean and her Gwyn

 

Hi there!
welcome to the FDMB!

I'm going to toss you some links that are also posted in this board Lantus forum and Health Links board.

First thing - home testing - great!

2nd: diet, not so good, please read thru the Nutrition link, majority if not all, vet prescribed dry food is loaded with carbs and krack (kitty krack)
A low carb wet food diet is your best choice for diet. BUT you dont want to drop the dry food cold turkey
Really read this link carefully: Transitioning From Dry Food

3rd: are you testing for ketones? I'm concerned about the lethargy you are seeing. I hope others will offer feedback on this.

Most vets do not know much about feline diabetes, but it is getting better, you'd be amazed at how many of us have returned to our vets with spreadsheet on hand and watch the vets jaw drop because kitties are doing well, or even better - in remission.

Your vet should prob confirm her thoughts on cataracts, I hope she's wrong thou.

Do you have a record of past and recent BG numbers? If you do, you'll want to set up a spreadsheet that gets linked to your signature - this allows others to view your progress and safely offer feedback on dose based on nadir/peak, Lantus is not based on preshots, but rather the lowest point in a cycle.

Spreadsheet Instructions
FDMB HEALTH LINKS
Nutrition & Diet Links
Tilly's Protocol: Modified Version
Proper Handling & Storage of Lantus/Levemir
Lantus & Levemir Insulin Depot AKA Storage Shed
Lantus & Levemir Data Ready To Shoot Low Numbers this one coincides with a spreadsheet - the data you collect is very important!

Read read read and ask all the questions you have, lots of people to here to help!

 

Hi there,
OK Ronnie gave you alot of good links, definitely read the one about food and changing over to wet food because you may see a BIG drop in numbers, just from changing from dry to wet. I know for a fact that the dry food can cause HIGH numbers because my Shadoe has stolen some dry from my civvie, and Shadoe's numbers ZOOM up high! It will definitely make a good difference to Scoop.
If Scoop eats some wet now, start the transition over, but do it safely.

Getting a spread sheet together would be awesome! If you can put the numbers you have so far onto a sheet using the link given by the others, it will be easier to help you.
You mentioned that Scoop is high still 1hr after his shot but that is expected. My Shadoe does not start to react to the shot until maybe 3hrs after her shot, and my Oliver sometimes takes 4hours! It will not register right away - see the below to compare to what you have seen.
Example of a typical curve:
+0 - PreShot number.
+1 – Usually higher than PreShot number because of the last shot wearing off. May see a food spike in this number.
+2 - Often similar to the PreShot number.
+3 - Lower than the PreShot number, onset has started.
+4 - Lower.
+5 - Lower.
+6 – Nadir/Peak (the lowest number of cycle).
+7 - Surf (hang around the nadir number).
+8 - Slight rise.
+9 - Slight rise.
+10 - Rising.
+11 - Rising (may dip around +10 or +11).
+12 - PreShot number.

The above is just an average; not all cats will follow the same pattern, but it's a decent guideline.

Another question: the dose you are giving is 2units twice a day? How long have you been at this dose or did you start at this dose and stay at it with no changes. If the 2units is not enough, you will be able to see that fact when you look at your spreadsheet and all of your test results. You could then be able to consider increasing Scoop's dose.

Do you mean that you test just before his shots and it's never under 200 or that you have tested at other times after his shots and never get any test result under 200.

what do you mean by it's been a while since I have done one - do you mean a curve? If yes, then you could see better numbers just by changing his foods to wet and if that change does not lower them enough, you could slowly increase his dose by following the protocol link given to you earlier.

Any container of Lantus, vial or cartridge will likely not be any good after a month or so. Lantus is guaranteed for approx 28days once you open it/start using it, and another insulin you may see mentioned is Levemir which is good for about 42days, once opened.
Some people may say that they have used their containers a bit longer but if you see your numbers looking worse and your Lantus is past that 28day mark, you may as well try a new container.
With smaller doses, you are wasting your money by getting a 10ml vial because it will expire before you use even half of it, at 4unit per day. You will be better off getting a package of 5 cartridges, each being 3ml. The unopened cartridges are good until the expiry date on the package, maybe 2011 or something like that, but once you start to use a cartridge, the clock starts ticking to that 28day mark.

 

WOW! I can see a light! I am so relived this is something I have control over. I will definately look into the food. The DH is not the most reliable person when it comes to being strict on his food intake - but he needs to see how this can seriously effect him. (We have 4 cats and the other three do NOT appreciate only eating 2 times a day!) I am also going to look into getting our others off the crap we feed them now. Besides, the other three will NOT appreciate Scoop getting wet food and them getting crappy dry food - diet change for all!

I will also look at putting up the glucose curves. This diet thing seems to be the main problem - so it's a start. Thanks everyone I'll keep you posted!

 

Oh, we love converting people!

Another thing that might help is a timed feeder. Lots of us love the PetSafe5. With it, you can feed wet, lo carb several times a day. That is an great thing for a diabetic, to have smaller meals over the day, to help with blood sugar lows and highs. We put frozen Fancy Feast in the feeder at night so we don't have to wake up first thing in the morning to feed Niko!

 

I have 8 cats living here now. 2 belong to youngest daughter who moved back home last month. One belongs to first born daughter who moved back home 2 years ago. The other 5 belong to hubby and me. All 8 eat the same exact thing at the same exact time as my diet controlled diabetic/CRF kitty, Stormy Blue. Trust me, they all got used to the food and twice a day feeds very quickly.....

~M

 

HOLD UP! Our vet said to only feed every 12 hours, that way he has insulin after each meal. When do you give the insulin? If you don't wake up to feed how do you know if he ate? (With four cats who knows what goes on when we are sleeping). Now I am confused ah!

 

cats on lantus do not need to be on a strict 12-12 schedule; in fact, smaller meals throughout the day are much better as they don't overwhelm the system.

 

Ditto what Jen said. Also, I only have one cat so my life is easier...Sorry, didn't mean to confuse you.

 

> HOLD UP! Our vet said to only feed every 12 hours, that way he has insulin after each meal.
> When do you give the insulin?

For most of the older, harsher insulins, you need to make sure the cat ate to offset some of the fast, steep drops the insulin gives. With some of the newer, more gentle insulins, you don't need to worry about this nearly as much.


> If you don't wake up to feed how do you know if he ate? (With four cats who knows what goes
> on when we are sleeping). Now I am confused ah!

Either free-feeding or giving several smaller meals through the day should be fine. And you'll know that it's safe to give insulin by doing a pre-shot blood sugar test.

 

I free feed my girls wet food - I put out the wet food and leave it out until it's dinner or breakfast time, at which time, I pick up the used bowls, scrape out any uneaten food and put out fresh wet food in clean bowls (didn't want you to think I reuse dirty ones).

I have three cats and it took a very long time to get everyone off dry food.

If you look at Maui's ss, and look down to her OTJ trial one, you will see that it got aborted because she ate dry food. Also if you go to the Lantus forum and read this post by Meadow, you will see what else dry food does to a cat.

viewtopic.php?f=9&t=17539

 

A Pre-shot blood test is out of the question. DH can barely get through giving the insulin without passing out and I am not always available (or awake) to give his shot. What about 2 big meals with insulin and a few snack meals throughout the day? (I see the other 3 cats nodding in approval as I type).

What is confusing is when you SHOULDN"T be giving food?? Something about an insulin peak? I feel so naive! ugg!

 

This is the same thing that I do. I mix up a BIG batch of food and 1/4 water, plop it into 2 large bowls in the kitchen,
a small bowl in my room for Stormy Blue, a small bowl in Miranda's room for Zeus, and a medium bowl in Tiffani's room for her two cats, Sugar and Tinkerbell.
12 hours later, I gather up all of the bowls, clean them out, do it all over again. There is always a small amount of food in all of the bowls left between feedings.. so they are obviously not going hungry between fresh feeds.

~M

 

To be blunt here - but pre-shot tests are probably the MOST important of all of the bgl tests.
Would you blindly give yourself, or your child an injection of insulin w/o knowing the bgl?
Would you take the risk? If not, why would you do that to your cat?

~M

 

Testing twice a day is not within reason for my household. Sorry - but it's not. This isn't a person or a child. His dose hasn't changed in a year, his numbers are always high. When his numbers go down, ever, then we can talk. I don't really see how testing a cat who is treated but not regulated can benefit anyone. First things first people - I already have a huge list of wrong doings...let's start there.

 

I do not want to make you angry, or upset, but you do not KNOW what his numbers are UNLESS you test him every day.
How do you know he has not had numbers below 300? Have you ever run a curve on him at home?
Have you made it a routine practice to test him AM pre-shot, 6 hours later, PM pre-shot, and once again, 6 hours later?
Unless you are doing the above, you honestly do not know what his daily reaction is to the dose of insulin that you are giving him.

Do you live anywhere near Dallas? If you do, I'd be glad to take him for a few days to test him for a curve.

~M

 

Yes actually I have done many BG curves - again numbers were never below 300. I think we have already determined he is on the wrong diet for low numbers anyway. I am in the animal care profession (exotics, not vet med) and there has to be a realism point that comes into play when managing animals. Thanks everyone for the information.

 

Just please, please be careful You are about to feed him foods that are lower in carbs than his current diet.
If his BGL is not checked frequently with this change in diet, and if the insulin is not reduced concurrently
with the lower carb diet, the end results could be disastrous.

Collectively, on this board, you have people with hundreds of years of experience in treating diabetic felines.
We want to HELP you and your baby. Please listen to the advice you that are being given, and put that advice into practice.

I wish you and Scoop well.

~M

 

When you change to a high protein - low carbohydrate diet, the blood sugar / insulin needs can change a LOT -- so it is safer to test blood sugar at least twice per day at injection time. (a quick ear prick doesn't take long)

When I changed my first diabetic cat, Norton, over to low carb canned food -- his insulin needs reduced by 5 units!!! If your kitty drops that much, he might not need insulin anymore and become diet-controlled.

Most of us use a human glucometer -- the test strips are much less expensive and more readily available than the Alphatrack

Re: feeding -- I have 5 cats - 2 of whom are diabetic (adopted through this board) We dole out 3 large cans of Wellness (2 to 4% carbs flavors) in the morning and it sits out all day for "free feeding". At bedtime, we check and add some if needed. There is usually some food left the next morning.

 

I have thought about this thread since last night. Obsessed might be a better term, actually. In fact, I woke up crying from a nightmare over this thread this morning. In all honesty, I am in fear for Scoop and his health if you do not regularly test him at least pre-shot with applying a diet change to low carb foods.
I am begging you here: Please, please, test Scoop at least twice a day - pre-shot if nothing else. To do otherwise is risking his health and his well being.

~M

 

Wow - I never said I wasn't going to pre-shot test him when I changed his diet. I said I don't pre-shot test him currently. Relax.