New Poster

Hi everyone,
This is my first post, but I don't feel exactly new to the group, since I've spent a lot of time reading posts as part of my research over the past few weeks. My oldest cat (of 4) Conan, who at 10 really isn't all that old but who has had a lot of health problems, was diagnosed a few weeks ago with steroid-induced diabetes. I had kind of been anticipating it - he has been on prednisolone daily since September 2013, and I was aware of the potential side effects. Back in October, for the first time his BG levels started testing abnormally high (that was when he had to have all his teeth removed because he had resorption disease!), and my vet (who is excellent) felt he was borderline and we needed to keep a close watch. Then in December he started losing weight - and he was already quite thin, only about 9.5 lbs, on the very low side of an ideal weight for him - the BG levels continued high. In mid January I brought him in when he stopped eating and lost even more weight, and it was clear he had tipped over the line. As discontinuing the steroid is not an option at this point, remission is not likely, and management is our goal.

I have never had a diabetic cat before, though I've cared for many CRF kitties, asthmatic cats (including administering inhalers), pancreatitis, etc. etc. Plus I have three horses, and they really are just medical disasters waiting to happen! So I have quite a bit of experience with administering medical treatment and care to animals and am not intimidated by that aspect - though I'm a little overwhelmed by the more rigid schedule demands and the potential third-party cat-care issues. But still, the diabetes is all new to me and I've had a big learning curve. And sometimes this seems just so complicated and difficult to get right - protocols and depots mismarked syringes and all the rest.

So I've reached the point now - a little over two weeks of administering Lantus (at a starting dose of 1U) and taking BG curves and spot-checks - where I'd really love a little input and advice. Even though my vet is excellent and fairly responsive, I can see there's a lot of accumulated specialty knowledge and experience here, as well as support, and I feel like I kind of need that now. Rather than write everything out twice, I figured I'd post my request for help with more details over in the Health section to begin with, but I wanted to introduce myself here first.

Jessica & Conan

 

Welcome to FDMB, the best place you never wanted to be.

There are 4 things you'll need to manage your kitty's diabetes:
- You - without your commitment, the following won't work.
- Home blood glucose monitoring with an inexpensive human glucometer such as the WalMart Relion Confirm or Target Up and Up (the pet ones will break your budget!). This saves you the cost of going to the vet for curves and done regularly, removes the need for a fructosamine test. All of our insulin guidelines use human glucometer numbers for reference.
- Low carb over the counter canned or raw diet, such as many Friskies pates. See Cat Info for more info. If already on insulin, you must be home testing before changing the diet. Food changes should be gradual to avoid GI upsets - 20-25% different food each day until switched. There are 2 low carb, dry, over the counter foods in the US - Evo Cat and Kitten dry found at pet specialty stores and Young Again 0 Carb found online.
- A long-lasting insulin such as ProZinc, Lantus, BCP PZI, or Levemir. No insulin lasts 24 hours in the cat, so giving it every 12 hours is optimal for control.

 

Hi BJM,
Thanks for the welcome - but maybe it's the one you give to everyone? Since as my sig line, linked profile, and linked spreadsheet, and even my intro post itself all indicate, Conan is already a long-lasting insulin (Lantus), I've already been doing BG curves at home for almost the entire time (not that long, admittedly) he's been on the insulin, with my AlphaTrak 2, and he (and all my cats) eat, and have for years, a home-made, no-carb raw diet. And, as I said, I've had plenty of sick kitties in the past who have required ongoing care of various sorts - fluids, medications, etc. So my commitment is definitely not an issue either.

Maybe I wasn't clear - the intro post wasn't a request for advice right here and now, just an intro, to say hi and introduce myself. I've already done a lot of research and read through many posts on this board, including all the stickies, intro posts, guidelines about how to draw and dose and measure Lantus, etc. etc. etc. I do have some questions, which are about dosing and which will require looking at my curve spreadsheets and more detailed explanation of my circumstances. I'll go put that one on the Health board - it feels like maybe it belongs on the Lantus board, but the instructions say to start on the Health board, so that's what I'll do.

Thanks!

 

Hi Jessica and welcome to FDMB. You have quite the menagerie of furkids and a vast amount of experience dealing with animal health issues so I am sure you will have no problem getting Conan better regulated. You've already discovered the immense amount of hands on experience available on this forum and I'm sure you will find all the support and assistance you need here. We have a great group of people eager to help out in any way they can.

I would like to point out to you (just in case you didn't already figure this out) that all the glucose reference numbers on this board are based on human meter readings unless specified otherwise. I see you are using the AT2 meter as I do, and while you may already know this, I just want to make sure you understand that it will read higher than a human meter. So while there are a number of folks here familiar with pet meters with years of experience dealing with feline diabetes, you should get reference numbers from your vet for things like "no shot" limits, and low readings needing immediate attention.

If your questions are directly related to dosing (I browsed your spreadsheet and notice that Conan has been all over the map reading wise) it's Ok to go directly to the Lantus/Levemir forum for assistance. Health would be for more general questions like testing, diet etc. all of which you seem to have well under control.

Looking forward to following Conan's journey and getting to know you.

 

Hi Linda, and thank you! I really appreciate your advice. I understand that pet meters are a bit different from human meters - there is actually a separate spreadsheet template for the pet meters. It seems to me like the main important difference is the higher "lower readings"; the lower reading limit (for avoiding hypo etc.) is about 18 points higher. But I will be sure to mention it whenever I post, and I also put it in my sig line.

At your suggestion I decided to go ahead and put my question post in the Lantus forum. It didn't really seem like any of the questions in the Health forum were as specific as mine. I figure if they don't like it there they can tell me! Conan's readings are kind of all over the map, and I don't know if that's because we've just begun and Lantus takes a while to even out, or because the nature of steroid-induced diabetes is that he's still got some of his own functioning but it works only sporadically, or if there's some user error involved (e.g., syringe measurement, or not always getting the dose into him even though I think I did), or if it's because of my schedule issues, which mean it's pretty much impossible to have a firm 12-12 dosing schedule - it's almost always 11-13 at best. It's baffling. But it's only been 2 weeks, so it's still quite early to draw firm conclusions I suppose.

Poor Conan. He's always been a problem child, medically.

Anyway, thanks again for the welcome. I'm not sure I can say I'm thrilled to be here - I do wish I didn't need to be - but since I have to be, I'm very grateful!

 

We used to be able to bold, color, and enlarge the text in the signatures. I have crap for vision, especially the smaller, lighter fonts in signatures, and without the extra enhancements, they don't jump out at me. Maybe my next incarnation will have better vision.

 

I tried to change the signature text formatting - couldn't find a way to do it. I couldn't even make it italic, which I wanted. Either it's too complicated for me or it's just not possible!!

 

Jessica, you are quite right in your assertion that the difference between the pet and human meters really only matters in the lower ranges. I can tell you from doing months of dual testing with both the pet meter and a human meter that I believe the cited difference of 18 points is just an estimate and not exact. My little sugar just recently had dental surgery. She is a high dose kitty (Insulin AutoAntibody positive) and far from regulated yet, I saw my first somewhat normal readings from her the day of her surgery. While she was not nearing hypo, (124 pet meter and 73 human meter) the readings were far more than 18 points apart. We don't have any clear scientific explanation/evidence of how that 18 points was determined. There definitely is no straight forward linear or percentage difference in the readings and the difference between the meters is further confounded by the 20% meter variance allowed by the FDA.

Just out of curiosity, did your vet provide you with any guidelines as to what readings you should be aiming for, when not to shoot, when to intervene/steer with some food, extra carbs etc.? So often we find vets get treatment started but don't offer enough info to keep their patients safe because they seem to assume cats on low doses won't go too low. Some vets even suggest home testing is not needed. Scenarios like these make this forum all the more valuable because the hands on experience amassed on this site is incredible!

To make your use of the AlphaTrak meter more prominent in your signature, you can create a Google doc and call it ALPHATRAK2 METER and then link it into the signature. That way it's in blue and caps and stands out more. That's how I did mine. Sometimes you have trick the "system".

My quick scan of your spreadsheet suggests to me that Conan may be bouncing a little but I am not an expert with "normal" kitty reactions to insulin. And when our cats have been sitting in high numbers for awhile, their bodies "rebel" at lower numbers by pumping out more glucose to get back to what has become "normal" for them especially in the early days. The folks on the Lantus board will be able to provide their opinions and give you some suggestions. I don't think an 11/13 schedule, while not optimal, should cause a huge problem. If memory serves, I think someone else was keeping a similar schedule successfully.

We all understand you not being thrilled about being here. We all felt that way but I assure you, you will find the group most welcoming and supportive, and you might even soon find yourself enjoying your enrollment!

 

Linda, the Lantus board people have convinced me (without too much arm twisting, admittedly) that it might be a good idea to try a human meter. I'm not averse to this - I actually really like my AlphaTrak, but since I'm in the US, the Walmart meter is easy to get and quite cheap. I don't know what my vet will think, but I suppose in the end it doesn't really matter much as long as I have some accurate measurement scale, and if it makes it easier for people to offer me help, I'll give it a try.

Until I get it, I'll continue with the AlphaTrak, for which I still have plenty of strips.

I've googled it, but I admit that I can't figure out what it means to be insulin autoantibody positive. Doesn't sound good. What are the symptoms/consequences?

The problem with the Lantus board is that it is so busy that the post disappears within minutes. I did get one or two helpful responses - which, as you suggested, mentioned bouncing - but not as much advice as I'd hoped. And once a new day begins, you have to start a new post. I don't know if it becomes more supportive when people know you, but other than learning about bouncing, I really am in the same position I was before I posted - I still have no idea how to proceed and only one additional opinion. I don't know if it would have made a difference if I had a human meter. I'm not really complaining - no one owes me anything after all - but I guess I hoped I'd find help somewhere, as I'm feeling very confused!! Not sure if I should be trying tight regulation protocols or what, and how my schedule is affecting things, and there are just so many variables!

I think of my vet as excellent, but in truth she didn't give me any of those guidelines you mentioned. Though to give her more benefit of the doubt, I don't think she expected me to be doing much measuring at first. She said to treat him for two weeks, and then to speak with her - -we'd do either a home or in-office curve at that point, but that the dose needed that much time to level out before we could reliably measure the effects it would have on his BG. So I'm thinking she figured she'd give me more guidelines about measuring when we talked again in two weeks. (For a variety of reasons that hasn't happened - mostly the fact that we had a huge blizzard, but also the fact that I did start researching and then measuring on my own right away - but I do expect to talk with her this week). So I don't think she really expected me to be doing much testing on my own before them. I think she assumed that this dose had a low risk of affecting him negatively, though she did give me instructions for insulin dosing, which among other things list the symptoms of hypoglycemia to watch out for.

So maybe better than some vets. She's an internal medicine specialist at a specialty critical care type vet center (she's been Conan's vet for his IBD and nasopharyngeal stenosis for many years, and cared for another of my renal/pancreatitis kitties before that, and I've brought other cats there for emergencies, surgeries, etc. over the years - they have oncologists, neurologists, that sort of thing), and I have a really good relationship with her.

It's funny - I have horses too (who by their nature are all just medical disasters waiting to happen at any moment!), and there is definitely the condition of insulin resistance in horses, but apparently because of their physiology the concomitant rise in blood glucose levels that would cause it to be true "diabetes" is much less common, they just have elevated insulin levels (which causes a lot of problems!), and in any event they are almost never treated with insulin.

Now I am just rambling! But it is good to have a place surrounded by others who are all in the same boat - thanks again.

 

Jessica, I'm sorry you haven't had more responses to your query but please bear in mind, it's the weekend now and still early or even night time in a lot of places where our members reside so don't lose faith. I'm sure there will be more folks along to offer some opinions. One thing you can do to make your query more obvious when people are coming onto the board is edit your title with a "?" prefix. That may get more folks to take note despite the thread dropping down the list. You are not the first to comment on this problem and won't be the last because the board is extremely busy. To their credit though, folks do search for the questions so give that a try. If you need any help doing that, holler!

I saw Julie's comments and I do think her suggestion of possibly switching to ProZinc to allow for a little more flexibility is a good option you may want to consider in the future. ProZinc can be dosed on a sliding scale and the 12/12 schedule is not "written in stone" as it usually is with Lantus. And not to sound critical of the Lantus board, but the ProZinc board is a little less "busy" and also has some remarkable folks providing guidance. I know there are several great folks over there very familiar with the AT meter (actual users).

I don't personally think what meter you use should matter but the fact is that most folks want a more economical meter and all the protocols here are based on human meter use so those of us using pet meters have to be proactive in making sure our pet meter use is known especially when dealing with low numbers. If you take comparison readings (pet and human) and graph the two, the pattern of the readings will look almost identical. In the big scheme of things, each reading by itself means nothing (unless it's very low and requires some action). It's the pattern of readings over time that gives you a sense of how kitty is doing on a dose.

If I were you, I'd probably stay with the 1u and try to get some readings in the middle hours of the PM cycle because sometimes the missing puzzle pieces are there but we are missing them because of when they occur. Some folks set alarms to snatch a mid PM cycle reading. Others consume a large glass of water and test when nature calls in the middle of the night. This isn't something you have to do all the time, but it does help to grab any opportunity to fill in those gaps in the data.

I'm really glad to hear you have a good relationship with your vet. I have a vet who works with me and I thank my lucky stars I found her. It makes this journey so much easier if it's a collaborative effort with you taking the reins since your are one on the front line.

The Insulin AutoAntibodies is one of several high dose conditions cats can have and perhaps one of the rarest. It was abundantly clear to me from the get go with Menace, that something wasn't right. First clue was that increases in dose did NOTHING and I just kept increasing and getting no where. To further compound the problem, Menace is a kibble addict and has been since she joined our family at the ripe old age of 10 weeks. I have tried everything to get her to recognize soft food as edible but she is not having it. My other two furkids are on wet diets and to my credit I managed to get my mother's cat off his kibble and he was 16 years old at the time. Despite getting Menace onto as low a carb kibble as possible, I still didn't see much if any change in her numbers. She is now up to 14u of Levemir (another depot insulin similar to Lantus) and I am just starting to get some lower numbers now. Technically, unless there is some other underlying condition which I am still testing for, it's possible to break the resistance but I can tell you I'm wearing my patience pants continually trying to get there!

Thankfully, you are seeing some lower readings so you don't need to worry about any of this but you are dealing with the other health issues which serve to complicate things a bit more for you too. Every situation is different as is every cat so in the early days, a lot of patience and trial and error is required to reach that goal of keeping our cats in reasonable numbers. As is often said here, this is a marathon not a sprint! Kitty didn't become diabetic overnight and won't get regulated overnight either. You are doing a remarkable job for someone so new to this sugar dance, so be patient. Conan may stop bouncing once his body gets more accustomed to those lower numbers.

 

Like I said, I'm not really complaining - it's not like I'm owed people's time and energy! And I have gotten another response now, which was very helpful.

From my not-too-knowledgeable perspective, it just doesn't seem that the meter should matter very much. It's just a scale, after all. And especially if I'm not following the tight regulation protocol, which I wasn't before and, after my exchanges over there, it's pretty clear my schedule is not conducive to, I'm not too concerned about the precise numbers - I'm not going to be cutting it that close to the edge. As you say, unless you're near the bottom limit, it's the pattern that's most important, as long as you know roughly where a target "healthy" range is. But it can't hurt to have another meter anyway, and it's true that the AlphaTrak strips are expensive.

Conan's numbers today do suggest a bounce, so I am going to stick with 1U. I'm going to do some further reading about ProZinc, about which I know nothing. Since it's only been a few weeks, I'm not quite ready to start considering changing things - I think I need to give the Lantus more of a chance to work, since as I understand, it can take over a month for it to start "evening out," or whatever. Even my own vet didn't think I needed to start taking curves until after two weeks. So it may be that even with my irregular schedule, this will keep him within a reasonable range - I guess it depends on his particular proclivities. It's really pretty amazing that he was on the steroid for well over two years before showing diabetic symptoms, actually.

One good thing is that I switched all my cats over to a raw diet (homemade, which is really an immense amount of work, and I wouldn't recommend it to anyone who doesn't have plenty of time and is willing to spend (those who say it doesn't cost more are lying, lying, lying!) and to research exhaustively) about 3 and a half years ago, right after we lost one of our cats (at 17, kidneys) and then got a new kitten. At that point we had 4 cats - the 3-month-old kitten, a 5-year-old, Conan (who was 7), and a 15-year-old with various health issues (kidney, liver, pancreas), who I did not switch (she would sometimes eat raw, as she liked it, but my main goal was just getting food into her). The kitten was no problem - she ate anything (we now have another kitten, now just 4 months, who also happily eats anything, including any and all raw food).

But Conan and the 5-year-old were a different story. They had been eating kibble (with occasional treats of canned food, which they did like), and it took me quite a while and a *lot* of patience to switch them over to raw. There were many times I was tempted to give up and thought it would never, ever happen. And it took me a while to figure it out, get my own system set up, etc. But I was lucky, and they were young and adaptable (or hungry!) enough, and eventually that was all they were eating. Now they seem to love it - though if I put kibble out, they'd turn their back on that raw food in an instant. It does make everything harder, especially traveling and cat care, and it's *so much work*. I sometimes wonder if it's worth it. But the diet has no carbs - no grains or vegetables, only animal products - and I'm guessing it has helped Conan more than I realized and maybe delayed the onset of his diabetes. And at least I don't have to deal with switching his diet now.

I really feel for all the newly-diagnosed who, in addition to dealing with learning how, and getting the cat accustomed, to insulin shots, BG testing, etc., also have to try to switch a cat to a new diet, especially an older or less easy-going cat. Some occasional few of them will take to it immediately, but most of them act like what you're putting in their dish couldn't possibly be edible, and it's so frustrating. There is just nothing worse than an animal that won't eat. One of my horses is almost 31, and we periodically have had to deal with his seemingly random refusals to eat - it's just the most horrible, helpless, frustrating feeling.

Maybe kind of like giving your cat 14 U of insulin with no change! I guess the only silver lining is you don't have to deal with measuring out .25 U in those ridiculous syringes...but still, that has to have been be tough. I'm glad you're starting to see results at least.

I'm doing okay because I have the advantage of having a lot of experience dealing with medical issues in both kitties and horses (who really do seem to spend their entire existence looking for ways to mortally injure themselves and drive their owners to an early grave) over the years, administering medical treatments and care, and acting in a not-quite-but-almost vet tech capacity. I'm also a pretty obsessive researcher. So those qualities give me a leg up on some of the folks that come here and are really overwhelmed, and I think the support and help the people on these forums offer to those who are in desperate need of it is just absolutely amazing. But still, there's no substitute for experience and understanding that comes with time and hands-on knowledge - that's what the people here have that I don't. And plus, sometimes there's just the need to talk with people who are coping with the same things, who understand. So I tell myself - think of this as just cultivating a new area of knowledge, and in a few years, I'll be experienced too, right?!

The things we do for our animals... :sigh:

 

I think sticking with the Lantus for a bit to see how things go is a good plan. And if you choose to keep using your AT meter and just using the human one for backup, go for it. There seems to be a bit of push back here regarding the pet meters but our numbers have been growing considerably so people are becoming more attuned to checking meter types before commenting and also to the different "reference" numbers especially when supporting someone dealing with a cat needing some steering due to low numbers. I think the problem with pet meters is that they haven't been around long enough for there to have been any protocols put together based on their readings. Funny enough, the author of the TR protocol used here suggested a pet meter is a better choice if available but then wrote the entire protocol based on human numbers. Go figure!

I admire your dedication to providing a raw diet but I am glad to hear someone finally admit it is a lot of work. I considered trying that with Menace but having tried dehydrating canned food, numerous different proteins dehydrated, raw, cooked etc. I figured I'd likely end up with a pile of meat being put out to the curb. Funny enough the only soft food Menace has ever put in her mouth was covert snacking on a peanut butter sandwich and a grilled cheese and bacon sandwich. The number of food stand-offs that have taken place here would blow your mind and of course now my hands are tied to some degree because she has to eat. I guess I should have pressed the issue more aggressively when she was a kitten but hindsight is 20/20 and I can't turn back the clock. (Oh how I'd love to do that!)

I'm a retired R.N. so while dealing with animals is very different from humans, it definitely gave me an advantage getting up to speed on all of this feline diabetes stuff too, but even now, I continue to learn from the folks here. Everyone's experience and situation is much the same but also very different in many ways so we learn from others as well as our own day to day dealings. I too really feel for the folks who land here, terrified at the prospect of poking their cat with pointy objects without benefit of a good vet who has educated them at all. It never ceases to amaze me how many folks arrive here with tales equivalent to their vet throwing a bottle of insulin along with the cat and their guardian into a raft and setting it adrift. Those of us who have good vets should feel count our blessings!

You'll get Conan sorted out and whether you just need to vent or bounce ideas off folks, it really is a good bunch here. Knowing everyone here is just as dedicated to their furkids as you are helps immensely. And before you know it, you may find yourself soothing other new members frayed nerves!

Gotta run! Last minute dinner invitation I couldn't pass up so I'd better finish my chores and get ready to go! I'll be keeping an eye out to see how things are going for you and Conan!

 

Seriously - I am a dedicated and experienced raw diet provider, even written my own programs to calculate the nutrient compositions of my food based on USDA database and compare them too AAFCO/FEDIAF, and obviously I "believe" in it from a "scientific" perspective (what cats evolved and are designed to eat), but my own view is that anyone who tells you that a homemade raw diet is "simple," that it isn't a huge amount of work, and very expensive (yes there are ways you can try to minimize it, but...), is lying or just blinded by the desire to proselytize. And doing it "right" if you care about your cats' health is far more complicated than it seems - you can't just throw them a chicken breast every meal (you could throw them a few whole live mice I suppose...). I would never try to preach someone into doing it. And while I think that theoretically it's the best thing for the cats, I have absolutely no idea if it's worth it in practice/reality!