Discussion in 'Welcome to the Group - Post an Introduction Here' started by Julio's Mom, Jan 23, 2016.
Hi, I am new and wish to just express my thanks for being there for support.
Hello and welcome to FDMB. So sorry you are dealing with a diagnosis of feline diabetes but glad you found us! This place is a treasure trove of information with heaps of hands on experience from an extraordinary group of people! You will find lots of tips and tricks and all the support you need to help you get Julio on the road to improved health.
We'd love to know a little more about Julio like his age, when he was diagnosed, diet, if insulin has been prescribed and if so, what type and dose, whether you are home testing (we strongly advocate home testing here to keep our fur kids safe!), other health concerns and any other information you'd like to share (like your name). Looking forward to getting to know you and Julio who a real cutie! Looks a little like my middle fur child.
Hello and welcome to the FDMB Julio's Mom!
How can we help?
Hey there and welcome to the Forum, the best place you never wanted to be. There is a lot of information to be learned here. How about if you tell about Julio ( Linda posed some questioned in post #2) and then we can really help you.
Hiya Mom Welcome! Ohhh, Julio is BEAUTIFUL!
You can't go wrong here. Lots of folk who've had diabetic cats for years, (and some like me that are brand new at The Dance) They've already saved my kitty's life, and have done so for so many others as well. They'll have you and Julio waltzing through the whole process in no time, flat! We want to hear all about Julio, and you, and how you came to be together. In the meantime, slide over to the main forum and start learning how you can best take care of your kitty!
Julio is probably 11 years old? when I acquired him. He was diagnosed about 3 weeks ago, and he is on 2 units of Lantus twice daily. He has been eating DM something from the vet, but I have started him on Fancy Feast (50 grams each feeding) twice a day. The vet had me do a +5, and a +12 glucose test and seemed happy with where he is at. He told me that I would test +12 every 3rd week. I have 6 other kitties and would love to know more about cat food and how to separate them when feeding and whether canned cat food can be bought in larger cans like dog food sized? Or if anyone has any suggestions on homemade food. My screen name is Elsa.
Fancy feast is good, but your kitty might need to eat more often than twice a day. It would really be a good idea to home test. Then you can really keep on top of things. Diabetes is a disease of fluctuation..and things can change in a heartbeat..a new person coming to visit, a storm, another health crisis..... You will want to avoid HYPOs at all cost...because they can kill your kitty.
Why don't you put everyone on Fancy Feast? It would certainly make your life easier. Cats are obligate carnivores..they were designed to eat meat, not dry food, which because of it's nature must have some kind of carbohydrate binder. (Cats don't naturally eat fruits and veggies either, in spite of what the pet food industry would have you believe.) Cats aren't programmed to drink enough water, either..their origin is as a desert dweller....so they go through life being chronically dehydrated, which can also cause problems down the road.
Some canned foods can be bought in larger cans, yes. Nine Lives does. I believe Friskies does as well. But opening a couple of small cans a few times a day isn't so bad. It's an easy way to be sure everyone gets enough at each meal.
Again, welcome to the FDMB. Poke around and read the posts, to learn more of how we take care of our furkids!
To be frank, based on those instructions, I don't think your vet understands treating diabetic cats very well. While I am glad he is at least having you test, he is not having you test enough. Dosing is based on the lowest reading during a 12 period after the shot. While that low point may be at 5 hours post shot, it can be earlier or later and often changes somewhat from day to day so one test on a single day doesn't tell you much of anything. And testing at 12 hours post shot 3 weeks later makes no sense to me whatsoever. That means for three weeks you are just blindly giving a powerful hormone with no way to gauge if it's safe to do so.
We strongly recommend testing before each shot to ensure that it is safe to give kitty insulin and to get at least one mid cycle test daily at different hours post shot to figure out when the lowest point is occurring and how low the glucose reading goes on the dose given. Without that testing you really don't know if it's safe to give insulin or whether the dose is too low, too high or just right. As Jeanne says, glucose levels are constantly fluctuating so only by monitoring daily can you ensure Julio is safe.
The other reason for testing is that changes in food can cause changes to the cat's glucose levels and how much insulin they need. The DM may have been what the vet ordered but I believe it is higher in carbs than the FF, so switching to FF could have lowered Julio's insulin requirements to go down. Not sure what the time line to the food change is in relation to the vet being happy with Julio's numbers but I would strongly urge you to be home testing regularly before making any further diet changes.
Happy to find this support group. Our cat Socks was diagnosed with diabetes about 5 months ago. He was reasonably controlled with 1 unit Lantus twice daily. Until he crashed and went into appetite loss, sudden weight loss, hepatic lipidosis and high ketones in his urine. Scared us to death. After several days in the emergency vet, and $5000 later, we have converted his insulin to Prozinc- which seems to be working better- but still subject to large swings in blood glucose. We are monitoring it with an Alphatrack at 4 hour intervals, but can't yet seem to get his average below 500.
But that's not what I came to talk about. I'm a retired engineer, trained in physics, and well versed in techniques for process control in chemical manufacturing. I'm also a diabetic. I know how to use process measurements to predict and control chemical processes, one example of which is biological metabolism. I use this to control my own insulin requirements based on blood glucose levels and carbohydrate intake. It works for me.
Now I wonder why process control techniques are so lacking in the practice of veterinary medicine? Online, I can find many opinions about insulin types and dosage, recommended carb levels in cat food, and protocols for adjusting insulin in diabetic cats. And there are more opinions than data, even from people claiming to be DVM's. Strong opinions. Little data.
People, there are modern, mathematical techniques out there which are used to maintain and control chemical processes, that rely on monitoring of key variables ( e.g. blood glucose, carb intake, activity level) to predict with high accuracy the optimum insulin dose that minimizes future blood sugar while preventing a crash at the nadir. Why are these control algorithms so lacking in the education of vets, so how can we make it better?
Unfortunately I think that veterinary practice is seen more as a business and less of a medical institution requiring better training and regulations. While the average vet may go to school for 8 years, they are studying multiple species, without much development into specialization, yet.
So you have vets out there that come out of medical school, then depend on the pet food industry, and the pharmaceutical indurtry, to do their research for them. They aren't required to do anything more.
If these vets were human doctors, it would be like expecting them to take care of humans, martians, venusians, and altarians, if these aliens were to exist. You just can't do many things as well as you can do one specific things.
As more people are willing to sink money into their pets to keep them healthy, better regulation will develop. But the public needs to speak up and demand better care for each species they own. If we all just say "OK" to our vets and do as they wish, without questioning, they won't feel the pressure to do a better job.
Again, having to work on multiple species is a prime issue, and I think that should stop. Its time we had more vets dedicated to just cats, just dogs, just horses, etc..then and only then will they have the time to really pursue and legislate more precise information on one species, rather than depending on foxes to guard the henhouses while they try to be all things to all animals...and by those foxes, I mean the pet food industry, and the pharmaceutical industry. They're by their very nature as public stock oriented companies, both more interested in their bottom line.
#1. Stop viewing veterinary practices more as private businesses than medical institutions. Animals aren't seen as important as people. Case in point...we have pet 'owners' instead of 'guardians'. The very denotation of Owner implies property instead of living creatures.
#2. Insist on veterinarians choosing a species instead of trying to cover many. Of course, all this is going to end up costing the consumer/patient guardians more money..but that may be the price we have to pay to get everything better monitored and regulated. This means more of us will have to consider owning multiple animals to be out of reach, because soon their bills will equal those of our own selves and family members. And here come the insurance people, ready to take up the slack
Much of what is on the web is old school methods for treating diabetic felines. Most vets do not treat that many diabetic cats so they are not always up to date on the latest recommended protocols and often times they are trying to make things as simple as possible for the caregivers because sadly, if they don't, the cat may simply be given a death sentence which I'm sure doesn't sit well with most vets. Thankfully we have a protocol here that has proven to have great success rate of regulation and even remission but all or even most vets are not aware of it. As Jeanne says, vets are really trying to be experts at a lot of stuff and it just isn't possible to be good at and up to date on treating everything for multiple species. .
The other problem is there has not been and probably never will be , enough research done on feline diabetics to make the same kind of control used by humans possible in cats. Cats have a totally different metabolism to that of a human making them a little more complicated to regulate and by their very nature, they are not as "controllable" as a human. You can decide to get exercise every day of a certain duration and intensity and figure out what works for you but how would one ever quantify that in a cat. One day they're running around like they are on drugs acting crazy, chasing a fly, finally catching it and gobbling it down. OOPS! were there any carbs in that snack and if so how many? Then the next day, the same cat spend the whole day curled up on the sofa like a couch potato and won't play no matter how much you try to engage them. What about those days when kitty gets up and decides they don't like any of the food being offered to them and barely eats enough to even get their shot or worse, don't eat and you can't give the shot? Unfortunately, I just don't think cats will ever be the co-operative research candidates we wish they would be and their regulation is never going to be quite as precise as is possible in co-operative humans.
Well shucks...and here I was hoping to find someone who would help me calculate the calories/carbs/protein/fats in all the bugs cats eat, so I could publish a kittycarb counter. Let's see... what about a caterpillar? They're all protein, right?
Gee, we could get problems like that into school textbooks. "If Jeanne's cat Dottie ate 4 crickets, three cabbage butterflies, and an earthworm, how many grams of Fancy Feast would she have to give up for the next three days in order to stay on her diet?
I'd be happy if vets were just more willing to work with their owners, instead of pretending their word is Law, "I'm right and you're wrong, and it's my practice, so THERE!" NEXT PATIENT!
Isn't it sad that so many vets seem to have that attitude?! Maybe the first lesson in vet school should be, you don't know everything now and you won't when you graduate either, so don't blunder through trying to treat stuff you don't handle on a frequent basis. Do some research!
I also was trained in chemical engineering and so your response really engaged my interest. Although, I must admit that I have not really worked in the field since college, I do remember some of what you have referred to. I was particularly struck with what you said in the third paragraph about how many opinions there are versus facts out there with so little data.
I was also frustrated to find that there is very little information about the caloric value of the different cat foods. The only resource I could find was linked to this site. After using the data from that outdated sheet and realizing that he was getting shortchanged in food, I have returned Julio to the original Purina DM that I get from the vet at 50 grams twice a day. He is still getting 2 units of Lantus twice daily. (My goal was to determine on a per-feeding basis the different costs of the wet cat food so that I could decide what was the most cost effective.)
If you wanted to share some of your knowledge, I would be very appreciative. If nothing else, it would serve as a reminder of what I learned, but never really applied in college. I would be willing to share my spreadsheet, also, but would like to have better numbers to use for caloric values. A sample is attached.
Jeanne and Mr Worfmen's Mom,
I also found your posts to be informative and thought-provoking, but since I am new at this, and am still learning, however, it feels overwhelming yet. The vet has suggested that I also monitor Julio's weight. I have yet to buy a scale, but plan to. Luckily, Julio eats all that I feed him and seems to be happier, more involved with playing, moving about from room to room and interacting with the other cats and me. He is acting more like himself and that is good to see.
I work during the day and am not home to feed him more often (to be fair, the vet's office had suggested an additional feeding), but I have hesitated to invest in automatic feeders. (I would rather not put out wet food in a feeder anyway and the logistics of letting Julio free-feed dry food which has too little information in caloric value just adds another variable that I just don't how to deal with just yet.)
I don't want to drive myself crazy with worry either, and I very well could. I don't want to add doubting my vet to the growing list of things: insulin vs calories balance, dry food vs wet, how to take glucose readings and how often, how active is my cat, how much can I afford to spend and how to budget for it, what am I going to do if I take vacation ...
Elsa, it's good to hear that Julio is acting more like himself now but it sounds like you still have a lot of questions and are still feeling overwhelmed. Every cat is different as is every owner so you have to figure out what works for you and Julio. We can help you with all aspects of dealing with Julio's diabetes. I would suggest you post (start a new thread) over in the health forum (HERE) with any specific questions you might have about testing, diet, vacation ideas etc . That forum has more traffic and your post will get more attention there.
@chemical engineer- I didn't find a name in your post, and also could not access your spreadsheet. I'm thinking that I don't know how to use this site very well. Regarding carb values in cat food, here is a very extensive list, covering every brand I've heard of and more.
I'm still trying to establish a baseline for Socks, since his BG data is extremely noisy- much more so than for people. BG values can change, up or down, by 300+ units in 4 hours. Will need a couple weeks or more of data at a given insulin dosage to see any predictable trends.
As a first step in determining sensitivity to dosage, if you have BG measurements at different dosage levels, and you can assume that his average carb intake is about the same throughout the periods, you could use the the spreadsheet to run a regression of BG vs. dosage units. Excel will do that for you; plot dose on the x- axis vs. BG on the y-axis, then click on the plot and tell Excel to run a trendline through the data, and show you the equation. The coefficient of "dose" tells you the average change in BG per 1 unit change of dose. Don't worry at this stage about time delays, if the data covers multiple days at each dosage.
If you also have timelines of caloric intake and carbs in parallel columns, Excel will do a multiple linear regression of BG against all those inputs. This function is available in the Analysis Toolpak, which you can download from within Excel. The coefficients of input variables are the resulting sensitivities to each of those inputs. To allow for the time delay of BG vs food and/or insulin intake, I would first time- shift the BG readings so that the BG values line up with the control inputs performed about 4 hours earlier. You might try different regressions with different time shifts, to see which- if any- gives the best fit (the largest value of r-squared).
Any more sophisticated control algorithm than this is probably impossible or not worth the effort. To control my own BG, I used multiple linear regression of time-shifted BG vs. insulin and cards, and learned that 1 unit of Novolog insulin would drop my BG by 50 units, and that 6 grams of carbs would have the opposite effects. Every meal, I estimate carbs, divide by 6, and give myself that many units. Hopefully, this could also be done for cats.
The alternative is to experimentally find a balance between BG, insulin, and food type/quantity, then rigidly control all of the variables on a schedule that never changes. Given the nature of cats, however, I doubt that they would cooperate.
Best of luck.
Wow, my little head is spinning all around after that. I'm impressed and feeling like a pea brain. Right now I'm just so glad that I feel comfortable enough with Sparkle's numbers and dosage that I can actually sleep 6-8 hours.
@Sparkle- I looked at your spreadsheet, and her BG numbers seem about as wild as Socks'. I did some averaging, and your data suggests that each additional unit of Lantus corresponds to a drop of about 130 units in average BG. The numbers also are a little less variable at the higher dosage. It appears to me that you could safely target an average BG of 260, which would correspond to 2.5 units, twice per day. I certainly would not go there in one step- maybe try 2 units for a while, to see that the numbers never drop below 100.
As with all advice from the internet, first get your vet on board. Good luck.
@greese007 I think what you are proposing is extremely dangerous.
Lantus dosing is NOT based on average BG over time or how much a unit of insulin drops the cat's BG based on that average. Lantus is a depot insulin so when dosing is changed there is a lag time before that depot is either built up (increase) or depleted (decrease) and therefore you don't always see exactly how effective a new dose is for a few cycles. There is also an overlap in the insulin action from each dose due to that depot unlike an in and out insulin. Dosing is based on how low a dose takes the cat during any cycle with due consideration of the pre-shot readings. While those calculations might work for you using Novolog, it would be a very serious mistake to use that calculation to dose a cat with Lantus or any other insulin for that matter!
As I said before, it's a totally different ballgame with a cat when you cannot "control" their food intake and activity as precisely as you might do for yourself. I' d bet most human diabetics are not regimented enough to be able to use such a calculation. Dosing a diabetic cat is NOT the same as dealing with a human and should not be approached in the same manner. Some cats have an extraordinary change in their regulation with tiny changes in insulin dosage which is why we raise doses slowly and dose according to how low the dose takes the cat at nadir!
@Sparkle PLEASE DO NOT raise your cat's dose based on any such calculation. It could be catastrophic!
@Sparkle I would definitely follow MrworfMens Mom's advice! She has had much more experience in diabetic cats than greese007.
Please listen to the advice MrWorfMen's Mom has offered. You don't know me, but I've been an active member experienced with Lantus and Levemir use in felines almost 10 years. Please continue posting in the Lantus and Levemir Insulin Support Group for the most up-to-date info on treating diabetic cats. I'm sure greese007 means well, but the advice he's given you is downright scary!
Wow! I'm glad I looked for the whole thread as I only got the increase post in my email. I have to admit, as a newbie I thought what they said made sense, but am glad I looked here first. I did a tiny dose increase last night. I'm in no hurry as Sparkle has multiple issues that we are working on and as long as I see improvement, I think Mom and cat are happy going slow. One of my big issues is that Sparkle wants to eat a lot of food at one time. Trying to get him to eat smaller amounts more frequently made for a very grumpy boy. He does have access to what the other cats have left, so I do think he eats other than our 12/12 meals, but I know it would be so much better for him to do smaller and more often.
We haven't even been on this dance for a month so maybe if his mouth issues get much better and we all get used to the new food and schedule, I'll be able to introduce a new change over time.
The civies are all very ready to eat the buffet at 12/12, but then they back off when they are full. Sparkle wants to eat till he explodes, I think.
Thank you for all the replies. I greatly appreciate it.
@Sparkle So glad you saw our messages re: the dangers of trying to dose using any calculations like those proposed. I was seriously concerned and so were Jill and Mum of Two Felines! Small increases can sometimes make dramatic changes to BG readings, so patience is the name of the game. I think you've been posting on Lantus/Levemir forum and that is the best place to get advice on any dosing questions. The folks there have been a monumental amount of experience and can help you learn to read your own cat's patterns so you understand what is going on and how to deal with it.
On the food front, sometimes it just takes a lot of patience and fortitude to get kitty used to a new feeding schedule. You'll find a way to sort that out through trial and error.
Since this was just meant to be an introduction by Julio's Mom and has kind of been hijacked at this point, I suggest any further questions or concerns be posted either on health or the Lantus board.
Sorry Julio's Mom!
As I suggested, talk to your vet before making changes. That's what I do. I also monitor BG every 4 hours after a dose, day after day, to spot nadir times and/or any time trends in the average. Being a Lantus dependent diabetic myself, as well as a process engineer, I'm pretty good at interpreting the numbers. And I share my data with my vet because, after all, he also is basing his recommendations on those same numbers. He eyeballs them, I use data analytics. But you need to do what makes you comfortable.
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