New Member: Advice needed for Rukia (Avg BG mid 20s/450s)

Discussion in 'Lantus / Basaglar (glargine) and Levemir (detemir)' started by Auora, Mar 14, 2019.

  1. Auora

    Auora New Member

    Joined:
    Mar 3, 2019
    Hi guys.

    My cat Rukia is 13 years old. She's been with me everywhere - traveled from the US, to Japan, and Australia. In late January, I had to take her to the vet after I came back from holidays and found that she was urinating blood, and having difficulty and pain while doing so. She's had UTI before, so I thought that it was probably the same thing again. Got blood-work sent away, and we went back a week later to get a diagnoses for feline diabetes. She had very high BG at the time, and ketones present. We started her on antibiotics for the UTI and 1 unit of Lantus insulin.

    It doesn't seem like she's made much progress. Her BG numbers are still high. After much frustration I started looking on the internet for answers and found this website. Until now, I've been following the Vet's advice, but I'm not happy with the results. Maybe I'm just impatient. I want my Ruki to get better as soon as possible. Can I ask for your advice?

    I've started a SS for her, and have bought a BG monitor - have been checking her at least 3 times a day. So, although she's been on insulin since mid-Jan, she only has SS results from the start of this month.

    At the same time, I also changed her over to a very low carb diet. She's currently trying out the Tiki Cat canned food that I saw on the Catinfo.org Food Chart. The Vet had originally just prescribed the Royal Canin Diabetes dry food when she was first diagnosed. Anyways, she eats well, always has. No problems switching. Although, since Jan she's lost a lot of weight. Currently at about 3.6kg (8lbs). No ketones in the urine when I test her - or if any, only trace amounts.

    I talked to the Vet again yesterday, and asked about upping her insulin because the numbers were still so high. They said that might not be a good idea, and suggested stopping the insulin temporarily, and starting back from ground 0. Is this the best thing to do??? Is 4 units too much? I mean, her BG levels are going down with the insulin - it's just not enough. I had wanted to try to start her on the Tight Regulation plan. Should I listen to the vet? What would you recommend I do?
     
    Last edited: Mar 14, 2019
  2. Bellasmom

    Bellasmom Well-Known Member

    Joined:
    Feb 12, 2018
  3. JoyBee&Ravan

    JoyBee&Ravan Well-Known Member

    Joined:
    Feb 17, 2018
    One piece of advice,stop all dry food. Read the Yellow sticky note by Dr. Pierson about why not to feed any dry food.

    Such a Cute photo of your kitty Rukie. How does she travel with you? Do you get to keep her with you on the Plane?
    Years ago I took my cat on the plane with me & he was so miserable he cried the entire time. People on the plane were not happy:(

    I would also advise you to Listen to the advice of the Experienced people here.They have been dealing with diabetes every day for years. They really do know more than the vets.
    The people that Bellasmom tagged for you are GREAT:) They will get to you as soon as they have time.

    There's a lot of information here you can read about. The more you know the easier it will be to take care of Rukie.If she's underweight & hungry you can give her more food. As long as it's low in carbs.

    Give her a small amount ,more frequently. If she eats too much & fast it will cause her to vomit.If you're not home during the day there are automatic feeders. A lot of people here that work use them. Feed Kitty.gif

    If you have trouble with fur shots sometimes Remember you can give the shot on their side . I shoot near the flank. Here's good info about shooting http://www.felinediabetes.com/FDMB/threads/testing-and-shooting-tips.85113/

    Hang in there! It sounds like you're doing pretty good so far!:)

    [​IMG]
     
    Last edited: Mar 14, 2019
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  4. Sandy and Black Kitty

    Sandy and Black Kitty Well-Known Member

    Joined:
    Dec 31, 2009
    Hello and welcome :cool:

    Please don’t stop insulin.
    Continue with the current dose and continue to monitor for ketones every day. Do not let 24 hours pass without a ketone check.

    How much weight did she lose? Was she hospitalized?

    Tight Regulation is a good method. I recommend you hold the dose at 4u 3u. Test BG several times between shots. If you have the opportunity to test as often as every 3 hours for one entire cycle please do so. The more you test, the more you will come to know how Lantus is working for her. Lantus dose adjustments are made based on nadir - the lowest BG value in any cycle.

    Since you had a fur shot this morning tonight will be cycle 1 at 4u 3u. Dose consistently each cycle. If you catch a number below 50, then a reduction is warranted.
    (Note- edited to reflect correct current dose as indicated on ss)

    Regarding ketones, when there is not enough energy from food making it into the cells, the body will breakdown fat and protein to try and fulfill the need for more metabolic energy. The excessive breakdown of these stored reserves creates a toxic by-product - ketones. As ketones build up in the blood stream, the resulting pH and electrolyte imbalances can very quickly develop to life threatening levels , a state of DKA. Enough insulin and enough calories, along with addressing any infection/inflammation is very important to avoid development of ketones.


    Hang in there and hang in here. It’s the best place to learn how to care for your diabetic kitty.
     
    Last edited: Mar 14, 2019
    Reason for edit: correction
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  5. Sienne and Gabby (GA)

    Sienne and Gabby (GA) Well-Known Member

    Joined:
    Dec 28, 2009
    Like Sandy said, please do not stop insulin. It's the worst possible thing you could do for a cat that is prone to developing ketones. (Ketones develop if there's an infection/inflammation, not enough calories, and not enough insulin.) Cats that have developed ketones once, seem to more readily develop them again. Given that you've seen trace levels of ketones, do not stop insulin.

    At this point, I'd be encouraging you to increase the dose. Both of the dosing methods that we use encourage increasing the dose by at least 0.25u. The information regarding the dosing methods is in this link. I'd encourage you to read over the methods and decide which approach is a better fit for you and Rukia. If you opt to follow Tight Regulation, you can increase by more than 0.25u.

    I realize that Sandy and I are giving you different suggestions. In part, it's not clear if you actually dropped the dose to 2.0u and the possible fur shot. (Although, I suspect at least some insulin got in given that your +4 is a bit lower than your AMPS.) Usually you want to hold the dose for a total of 6 cycles/3 days. I'm concerned about ketones which is why I'm suggesting a dose increase.

     
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  6. Judy and Boomer

    Judy and Boomer Well-Known Member

    Joined:
    May 23, 2014
    Hi and welcome to Lantus Land!
    I was reading the spreadsheet to find out when you switched from dry food to low carb canned and I noticed an entry yesterday....did Rukia eat a rubber band? Did she vomit it back up?
     
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  7. Wendy&Neko

    Wendy&Neko Well-Known Member

    Joined:
    Feb 28, 2012
    If you think you got a furshot, could you put something like FS? in the units column. I used to also enter PFS for partial fur shots.

    Starting the night of the 8th, I see 8 consecutive cycles at 3.0 units, each with a mid cycle test in there. That means the depot got full and we had enough consecutive data in a row to show that the dose was not too large. Do you have access to insulin syringes with half unit markings? If so, I'd increase up to the 3.5 unit dose. In future, please try to get a test every night before you go to bed. It's one way of filling in the picture if you cannot get tests during the day due to work.
     
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  8. Auora

    Auora New Member

    Joined:
    Mar 3, 2019
    Hi again. Just woke up to all of your messages. Thank you all in advance. I realise most of you are probably in the US but since I'm in Australia my replies might be slow :(

    Thanks :) Ruki travelled with me to Japan inside the plane - just under the seat. Truth be told she hates her carriage. The cried for a few hours - it was a long flight, but we eventually made it. The flight to Australia was much worse. Regulations dictated that she had to go as cargo under the plane. It was so stressful, for the both of us. But if you need to talk to anyone about immigrating to Australia and bringing your babies, I'm the one to ask. Pet relocation companies wanted to charge me $10,000. I did everything myself.

    Also, no problems with the shots. Ruki is an extremely placid cat. I usually poke her while she's eating. Just this day she went to switch sides of the bowl while she was eating and the needle came out. Bad timing. She also stopped eating dry food the day I started the SS (March 3). I've read majority of the stickies. She was actually on a mostly wet food diet until she got diagnosed then the vet recommended the dry food. -_-

    Thanks for the welcome :) I also thought stopping and restarting the insulin was a bad idea. That's why I've come. Hopefully I'll be able to get some sort of plan for her.
    As for her weight, she must have lost around 3kg (6lbs). She hasn't been hospitalised. She has SO much fur that she looks a lot fatter than she is. We actually didn't notice until we came back from holidays and went to pick her up. She seems to be maintaining her weight now. She hasn't lost or gained any since starting her on the insulin.

    Sorry, I should have explained why I dropped to 2 units one day. It was because the Lantus solo-star pen actually ran out of insulin. I tried to turn it to 3 clicks, but it would only go 2 - even though there was still a little insulin left inside. We went to pick up another pen that afternoon. (We have been using just the pen with the tips for her injections - but after reading here I ordered some syringes. I'm just waiting on them to be delivered)

    I've read over most of the stickies and information on the forum. I'm hoping to follow the TR plan that's here. I just wanted to make sure that's the best option for Ruki - instead of following what the vet wants to do.

    Hi there! I switched to the low-carb the day I made the spreadsheet. I was afraid that switching to low-carb would drastically affect her BG so I only gave her 1 unit to start. I thought better safer than sorry. Before making the spreadsheet, she had been on 2 units for about 2 weeks. And yes, she did eat a rubberband. It's not the first time....for some reason she REALLY likes eating them. We have no idea where she finds them either - have searched the house high and low to find any stray ones that didn't make it into the rubbish. She vomited it back up - thus the reason we know she ate it. It always comes out one way or the other.

    Yep! Thanks I'll start putting FS when that happens. I'll also try to test more, I've just been worried about bruising and/or scarring her poor ears. I had just generally been trying to test around +4 or +5. At the moment, I don't have any syringes but I've ordered some. Just waiting to get them in.
     
    Last edited: Mar 14, 2019
  9. Bron and Sheba

    Bron and Sheba Well-Known Member

    Joined:
    Feb 21, 2015
    Hi and welcome to you and Rukia to FDMB and Australia! I live in Sydney so if there is anything you need to know about things available here in Aus let me know and I will try and help.
    Re the half unit syringes.....you cannot buy them here in Australia, only the 1 unit ones.
    But you can order them from the UK and they will arrive in just over a week. These are the ones you need to order...here is the link
    https://www.hyperdrug.co.uk/BD-Micr...03ml-pack-of-100/productinfo/BDMICROFINE03ML/

    Sorry you had a hard time getting Rukia into Australia.:banghead:
    We have very strict rules regarding all animals and plant life / food being brought into this country. This is because we do not have rabies here or a lot of the other diseases that afflict animals and plant life in other parts of the world, and we need to protect our animals and crops from these diseases. :)
    I know it is frustrating for people entering Australia but it keeps our animals and crops safe.
    Hope you enjoy your time here in beautiful Australia.....
    Bron
     
  10. Auora

    Auora New Member

    Joined:
    Mar 3, 2019
    Thanks :) We've actually been here in Melbourne for about 4 years now. It was a A LOT of paperwork and research to come to Australia, but it was so worth it. I consider Australia my home now. We were in Japan for 4 years before so it wasn't as difficult as coming straight from the US. (Japan is also rabies-free). I had already done a good portion of the health checks to get her there.

    Thanks so much for the link. I had to ask my mom to buy and send me some syringes from the states because I was having difficulty finding the half-unit ones, but that link will help a ton! I won't have to bother her for it. Thanks so much.
     
    Last edited: Mar 14, 2019
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  11. Bron and Sheba

    Bron and Sheba Well-Known Member

    Joined:
    Feb 21, 2015
     
  12. Bron and Sheba

    Bron and Sheba Well-Known Member

    Joined:
    Feb 21, 2015
    I know it is a lot of work and I'm sure I would hate to do it too!....but it is worth it for Australia. We have been so lucky out here because we are a bit isolated from the rest of the world, we have been able to avoid some of the horrible diseases that are around for animals and crops. Much harder these days with air travel though!

    I'm so glad you did go to the effort to bring your Rukia here. and I am glad you are happy here. I thought she must have been diabetic before you travelled...that would have been hard.
    You will get lots of really good advice here....there are many very experienced people here...and many have had to deal with ketones and DKA which can develop from ketones if not managed....so do feel confident in their advice. I would not drop the dose either. When you have ketones it is really important that Rukia gets enough insulin, enough food and plenty of water to flush out the ketones and you are testing for the ketones EVERY day at this point. When you test for ketones, can you put the result in the SS so we can see it please....then we don't have to keep asking you.
    I see you are testing between shots both cycles....that is really good and gives us lots of data which is important when looking at the correct dose. We change the dose depending on the Nadir (lowest point in the cycle), not the preshot. But when ketones are in the picture it is a bit more complicated and needs to be looked at every day so keep posting every day and ask lots of questions as it is a steep learning curve in the beginning.
    I see she had a vomit this morning.....is she OK now?
    Bron
     
  13. Bron and Sheba

    Bron and Sheba Well-Known Member

    Joined:
    Feb 21, 2015
    I meant to add that my Harry loves rubber bands too. He hasn't eaten one (yet:eek:) but he loves to get them and stretch them and let go and hear them snap down again. It can be really dangerous if they swallow them so try and get rid of them if you can. I always think I have got rid of them all but he always finds them...especially loves the ones that are in use around things. They make the best noise when let go!:rolleyes:
     
  14. Marje and Gracie

    Marje and Gracie Well-Known Member

    Joined:
    May 30, 2010
    I would agree with Wendy that the dose needs to go up to 3.5u if you are following Tight Regulation. I’m glad you are getting the syringes because the pen tips are really best used only by humans. You can get much accurate dosing at the in between doses using a syringe.

    Welcome to FDMB!
     
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  15. Auora

    Auora New Member

    Joined:
    Mar 3, 2019

    She seems to be doing okay. Always hungry and crying at me for food though. She's been especially wingey since becoming diabetic. I typically feed her at 7am and 7pm when I shoot but I'm considering breaking it up throughout the day just to keep her calm. We have another cat who is a grazer which makes it REALLY difficult, because he never eats all of his food and the moment he leaves his bowl, Ruki will rush to finish off whatever is left. We've tried to be vigilant and put his food away as soon as he leaves - basically have to stand there and watch to make sure she doesn't go for it.

    I'll add in a Ketone column and start testing daily. Edit : Just tested now - no ketones
     
    Last edited: Mar 14, 2019
  16. Bron and Sheba

    Bron and Sheba Well-Known Member

    Joined:
    Feb 21, 2015
    Great no ketones!!!
    Yes, Do divide her food up so that she can have maybe three smaller meals during the day...and again in the evening. We recommend several smaller meals instead of one large meal twice a day. it is better for the pancreas. When the older insulins that acted fast were given it was important to make sure that the cat had plenty of food aboard before the insulin was given. But Lantus is a slower onset, longer acting insulin and it is ok to say feed half the food at preshot, then divide the rest of the food up into two smaller meals and give at say +2 or +3 and again at +4 or +5. Lantus usually onsets at around +2 and the nadir is usually around +5 to +7 but every cat is different (ECID) and some nadir much later. Only getting data will tell.
    When cats are constantly in higher numbers their bodies can't absorb all the nutrients properly so the cats are basically starved of nutrients, so you will find she will be hungry all the time...this is normal....and unless she is overweight......I would feed her some extra while she is in these high numbers. Once she comes down into more normal numbers she will be less hungry......but at the moment it is good she is hungry....we need her to eat.
    I know it is hard when you have another cat which eats at a different pace. Sheba was always a very quick eater and she would be finished and Maxie, my other cat, would be still sniffing and thinking about eating....and if given the chance, she would eat his food in a flash. As long as you are feeding both the low carb food, it wont hurt Rukia, but your other cat will get thin! Can you feed in a different room. Another option is to buy an auto feeder with a chip in it which only allows the specified cat to eat from the bowl......they are not cheap but may be worth it for your other kitty to have one then Rukia couldn't get to his food.
    Also you could add a tablespoon/ teaspoon of warm water to Rukia's food, if she would allow you to do this...... this would make her feel fuller and would add fluids to her diet.
    Bron
     
  17. Auora

    Auora New Member

    Joined:
    Mar 3, 2019
    I do feed in another room. At the moment my current routine is to feed Wednesday in the bathroom first, then take Ruki into the kitchen to her check her BG, feed her, then do her injection. By the time I'm finished with all that, Wednesday has usually eaten whatever he's wanted and walked away so I can put his food up before Ruki comes looking. Unfortunately, I'm still trying to convince my partner to change Wednesday's diet (it's his cat). He is still regularly eating dry food.

    We have a fountain that the cats drink from and Ruki does drink a lot from there, but the warm water in her food sounds good. I'll give it a try.
     
  18. Bron and Sheba

    Bron and Sheba Well-Known Member

    Joined:
    Feb 21, 2015
    Can you explain to your partner that dry food is very high in carbs ...up to 35%... and cats should have 10% or less. Feeding dry food puts constant stress on the pancreas which is the organ that is involved with diabetes. Also dry food has 7% moisture compared to 78% with wet food. This puts stress on the kidneys because cats are not great drinkers at the best of times and dry food fed cats are chronically a bit dehydrated. This can eventually lead to chronic renal failure. Cats fed canned or wet food get so much more moisture every day.
    It’s all about profit for big companies... they are the ones who provide the education for vet schools. That’s why vets love prescription foods... expensive and no better than ordinary wet food. The dry prescription food is very high in carbs.
    Hope you can convince him!
     
  19. Sandy and Black Kitty

    Sandy and Black Kitty Well-Known Member

    Joined:
    Dec 31, 2009
    TR is based on an all wet food diet. If dry is still on the scene the SLGS method is appropriate.
     
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  20. Sienne and Gabby (GA)

    Sienne and Gabby (GA) Well-Known Member

    Joined:
    Dec 28, 2009
    When Gabby was first diagnosed, I was feeding each cat different food. Given that Gabby was quite food motivated, if Gizmo didn't polish off his food, Gabby claimed his bowl. This was a bit of a problem since Gizmo was eating a very different diet. I was going nuts! Someone here made the obvious suggestion -- give both cats the same low carb food.

    You might want to introduce your partner to Lisa Pierson, DVM's website on feline nutrition. She is not a fan of dry food and has been doing a great deal of research over the years on why a canned food diet is far more appropriate for cats. She also supports foods that are species appropriate (i.e., low carb for cats since cats are obligate carnivores).
     
  21. Auora

    Auora New Member

    Joined:
    Mar 3, 2019
    I know the website. I had originally come to these forums from there. I've sent him all the related links so hopefully he'll read them and take it into consideration. Until then I've just gotta be vigilant and keep Ruki away from Wednesday's food. My strategy has been working okay so far.

    She went dumpster diving again tonight though. First, while I was cooking dinner I had some raw diced up chicken on the counter and had my back turned to the pantry. The little bugger hopped up on the counter and stole some of the chicken while I wasn't looking. THEN, while I was eating in the other room I heard the garbage bin fall over and I came in the kitchen and she was digging through it -_- Looks like she got some of the remaining chicken scraps and some avocado??? Geeze she's crazy tonight.
     
  22. Sienne and Gabby (GA)

    Sienne and Gabby (GA) Well-Known Member

    Joined:
    Dec 28, 2009
    Raw food isn't bad -- other than when Ruki is snarfing down your dinner!! If she's that hungry, you might want to consider giving her more food until her numbers are in a better range. When numbers are this high, nutrition (i.e., glucose) isn't getting into the cells and your cat will act like she's starving -- because she is. The glucose is floating around in the blood vs getting where it's supposed to go.
     
  23. JoyBee&Ravan

    JoyBee&Ravan Well-Known Member

    Joined:
    Feb 17, 2018
    Feed her,Please! Feed Kitty.gif

    My 3 cats have eaten a raw diet all their life. A few pieces of raw or cooked chicken is a lot healthier than Store bought "Treats"
     

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