New to all of this. Could use some help

Hello My name is Adam and my cats name is Atreyu. He is around 10 years old and was diagnosed last Wed. I have the Lantus Pen and was told by the vet to give him 1 unit of insulin twice a day. I finally got my Alpha Trak 2 Meter in the mail and just started checking his glucose. He has been a great sport about letting me take samples and doing the injections. One problem is his glucose is around 400mg on the meter. I used the solution that came with it to make sure that the meter itself and strips are correct which they are. After I give him an injection his glucose doesn't really seem to be going down much. Probably anywhere from 15-20mg. I called the vet to see if he needs a higher dosage. I did a curve test today and he has been around 400 all day. Is it possible that the lantus doesn't go well with his system? Possibly a different insulin will drop him a lot more? Or is it normal for the insulin to not drop the glucose that much? Would it have to be upped to 4+ units twice a day? I feed him about a half a can of Royal Canin canned food around insulin time in the morning and in the evening and leave some Royal Canin dry food in his dish throughout the day. I work 12 hour rotating shifts so its tough to manage but try my best to keep on top of it all. I have another cat that is actually his Birth mother so I keep a little food out for her too of the Royal Canin. Also is it bad for the lancet to prick through the vein all that way in his ear? I try setting the lancet to a shallow poke so its not going through all the way but trying to get it to just tap it to get enough blood out. Any info would be appreciated as I'm new to all of this and just want to help my buddy as much as I can. Thanks.

 

Hi Adam and Atreyu and welcome. What a beautiful cat Atreyu is (and I love his name)!

It sounds as though you're already off to a great start, managing the testing and the shots.

Most (if not all) cats need some dose adjustment when they start insulin. The 1 unit starting dose is just that - a safe place for most cats to start. From there, you need to gradually adjust his dose until you find one that works for him. I wouldn't suggest switching insulins until you give Lantus a fair try - it is one of the better insulins for cats. It's likely that the 1 unit twice a day just isn't quite enough for him right now. There are 2 protocols that we use on here with Lantus - Start Low, Go Slow (SLGS) and Tight Regulation (TR). Here are the links to both

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

http://www.felinediabetes.com/FDMB/threads/lantus-levemir-tight-regulation-protocol.1581/

It is a lot of information to take in all at once and I found it helped to bookmark the link for the TR protocol which I've been following with Rosa so I can refer back to it when I need to. The protocols do explain how to adjust the dose based on the cat's nadir (the lowest point the insulin takes them to in the cycle) but there are always people here who'll help you if you're not quite decided on dosing too.

Most of us make a point of not feeding dry food at all as it is too high in carbs for a diabetic cat, and a lot of us don't feed the prescription wet food either. There are plenty of affordable alternatives available in the regular cat food brands such as Friskies or Fancy Feast pate varieties. Switching to a low-carb wet food diet only can take a whole lot of points off a diabetic cat's number (I'm sure I've seen a number of 100 and maybe even higher quoted on here somewhere). That can, of course, reduce the cat's insulin requirement. Wet food, mixed with some water, can be left out for a full 12 hours (the cats here will eat it well beyond that point too given a chance) and I've found it still looks fresh at the end of the day though I think that has to be because the water I add stops it from drying out. Or you can use a timed feeder to make sure he gets regular meals while you're out at work.

As to his numbers not looking great, my Rosa was diagnosed in January with an initial reading at the vet of 680. If you take a look at her spreadsheet (in my signature) you can see that I really struggled to get her numbers down at all to begin with, then we suddenly hit the right dose and she started coming back down the dosing scale...pretty quickly for a while too!

With testing, I've pierced through Rosa's ear a lot of times - it really is difficult to get the perfect depth to get enough blood to test without doing that at least some of the time. It really doesn't seem to do any harm at all - it still heals up quickly and doesn't seem to bother her in the slightest. If you feel that you want to give his ears a break and he'll tolerate it, you can always switch between testing his ears and his paw pads (I tend to switch around because there are days when I test Rosa a lot).

Just one small point I would like to make - most of us here use a human glucometer which gives different numbers than the Alphatrak (a human glucometer will generally read about 30-40% lower). If you're posting for help about numbers, you will want to make it clear that you're using the Alphatrak because at certain points that will change the advice you're given.

 

This info is very helpful. As far as the other brand canned food goes are most canned wet foods pretty close in nutrients as far as carbs? Is the fancy feast pate a certain type compared to a regular fancy feast canned food? I wasn't sure if the royal canin diabetic food was a good brand or not. I would like to get some cheaper canned food but atreyu seems to love it. He typically just licks the gravy out of the cans on other brands I've given him throughout the years and leaves the chunks. Are there any certain type of treats I could get for him that won't raise his levels too much? If you are using a different meter that reads 30-40% lower than an alpha trak do you have an equation you need to figure out? I'm a bit confused on that. With the alpha trak I want the numbers to be under 200 on that correct?

 

Wet food does vary a lot. The list that a lot of us use to choose suitable food is here http://www.catinfo.org/docs/FoodChartPublic9-22-12.pdf

What you're looking for is food that is under 10% carbs as dry matter percentage. Anything that comes in under 10% is fine for a diabetic cat. A lot of people prefer not to feed seafood or fish much if at all, but I haven't found it to cause Rosa any problems with her numbers - I think it varies very much depending on the individual cat. What you will want to do is get the pate type food, not the gravy - the gravy foods are the ones we use as high carb to bring low numbers up quickly. If he usually only likes the gravy, you can do what I do with wet food (my 2 only like the gravy too) and mix in enough water to turn the whole thing into a soupy, thick gravy type consistency.

I use, as do a lot of people here, the Pure Bites treats that you can get from Petco. Because they're just freeze dried meat, salmon or shrimp they're naturally high protein and very low carb. They're useful to have around at test time so that he learns to associate being tested with something good.

I hope @BJM won't mind me doing this, but I've attached the link from her signature to glucometer notes - this explains how to read the numbers from the human and pet glucometers and understand them https://docs.google.com/document/d/1oI_34_EgqeKdpyttFW0oLoG1mbw16IkATAWHhoQD2JU/pub

You are looking for numbers under 200 (but over 68) on the Alphatrak for good regulation. As long as people here know you're using the Alphatrak, they'll know how to advise you on the numbers you're getting.

 

I should have added - I really hope I'm not overloading you with information and links here. It's difficult to know how much to give - I'm an information freak and always want to know everything about everything, but I know that's too much for some people. Please let me know if I'm going too fast with all the links!

 

So much to take in and slowly understand over time. Hoping to catch on much sooner than later. I appreciate the help and information given.

 

Its fine. I'm the exact same way. I like to know everything with what I get into and the why I'm doing things not just because out of routine. I don't believe I mentioned this but the Royal canin dry and canned food I have is the "diabetic" kind if that makes a difference at all.

 

That's good - it helps to know I'm not just handing over half a ton of information that's overloading your brain. I tend to do the "wow, so much to learn" for about 3 seconds, then get on with reading it and figuring it out. I absolutely have to know why on just about everything and the science and reasoning behind how everything works.

I don't doubt that the Royal Canin diabetic food is better than a lot of the other prescription options, but I have been told that they're still higher in carbs than a diabetic cat should ideally have. The biggest problem that seems to happen is that a lot of vets aren't nutritionists so they're given the hard sell by the food companies and go along with it. Certainly when my vet tried to prescribe Hills Science diabetic food for Rosa, they told me they were discussing it with "their" nutritionist. I then found out that the nutritionist doesn't work for the vet at all - they work for Hills Science, so it's really no wonder they recommended one of their foods!

With all that said, if Atreyu will eat the diabetic food and doesn't want to try other wet foods for now, it is important that he eats something. Anything you can get him to eat is way better than him going without meals. I have Rosa, her twin Regan and the other cats in the house (even though our housemate won't believe it of his two) eating a mixture of different Friskies pate varieties. And they were all total dry food addicts until Rosa was diagnosed in January. It did take some time and experimenting with different flavors - for a while the only one they'd eat was the flaked Tuna or Tuna and Egg flavors but I eventually managed to get them to try and like some of the others too. They still have a preference for anything with fish in it (the Mariners Catch and Salmon flavors disappear in seconds), but they'll also eat Turkey and Giblets, Turkey and Liver, the Mixed Grill flavor (which Rosa really shouldn't have as it's just over the 10% but I allow it occasionally because she likes it) and the Poultry Platter. They have had one or two others as well and will pretty much accept whatever I give them now.

I was about to say I have to get some sleep and I'd catch up with you with any other information you need tomorrow, but as Rosa's just decided to throw me a curve ball and drop to 77 at her +6 test (safe, but I don't want her any lower if I'm leaving her to her own devices for a few hours), it looks like I'll be back in an hour to make sure she's OK for the night!

 

Hi Adam and welcome to FDMB. You are off to a great start managing Atreyu's diabetes. You have a very good insulin with a low starting dose and are hometesting.

As April mentioned, dry food is high in carbs. It is amazing how much the BG levels can spike even with just eating a few pieces of it. I would suggest removing the dry from his diet before changing your dose. If after a few days you still do not see a significant drop in his levels, then consider increasing the dose. You want to increase it by small increments, only 1/2 unit at a time. Wait at least a week before increasing it again. It may take that long before his body adjusts to the dose change.

 

Important note: We want the food under 10 % CALORIES from carbohydrates, not weight.
And yes, changing to a low carb, over the counter, canned or raw food may drop the glucose 100-200 mg/dL and may drop the insulin dose 1-2 units, depending on the cat.
You've been pointed to my signature link Glucometer Notes.
See also Secondary Monitoring Tools for some tips on urine testing. You may want to pick up some KetoDiaStix or generic so you can monitor for ketones and glucose in the urine. Ketones, if more than a trace, may indicate a medical emergency called diabetic ketoacidosis. It is expensive to treat and can be fatal. If the cat is not eating, appears ill, and has high ketones, get to a vet asap.

 

Thanks for the insight on the food manxcat. I will have to take a trip to the pet store and try some of the FF and friskies pate cans. Pretty sure my vet said i can return any unopened cans. Lisa, I'm still figuring out the best way to keep him eating but not over eating especially with the other cat around and while I'm away at work so that they both aren't going without food for over extended periods of time. BJM, would pet stores carry the ketone test strips/kits typically?

 

Oops, you're right of course. The DM value over-restricts on a lot of brands because it gives a higher % - I really should have noticed that when I was posting. Exhaustion catching up with me there (3-4 hours sleep a night maximum for the last 6 weeks and I grabbed the wrong column when I was looking at the link).

I think Royal Canin do have the same money-back offer as Hills on cans that haven't been opened - Rosa completely refused to touch the Hills diabetic food, but then I found out she didn't need it anyway and switched her to the Friskies. I was able to return the ones I hadn't opened so got the money back for all except the one I'd tried her with.

A timed feeder, or freezing some of the food and putting it out frozen for them to eat when it defrosts might help to stop them eating everything all at once and going hungry the rest of the day.

And you can get Ketostix (those measure ketones only) or KetoDiastix (those measure ketones and glucose in urine) from Walmart.

 

Another trick for serving the canned food while you are away is to prepare it (add water - I always add 1/2 - 1 can of water to each can of food), and freeze it. You can freeze it in ice cube trays, plastic bags or containers.

Once frozen, put out the portion you want to use and it will take 2-3 hours to thaw -- this will ensure that the cats get "fresh" food later on in the day. by adding water, you cover several things - making sure they are getting enough water in system, keeping the food moist longer and keeping it fresher longer so it doesn't dry out.

If you get a timed feeder, you can still put the frozen food in the feeder and it will open when you set it, this will ensure that they don't eat it too soon and you can space out the meals accordingly.

 

I'll look around for the timed feeders. Good news is Atreyu likes the pure bites treats. I looked at the food chart. Still figuring that out. I got a can of this in poultry flavor assuming this is the right low calorie/carb food since the cans themselves don't say much http://m.petsmart.com/h5/hub?id=food-health/canned-food/purina-friskies-tasty-treasures-pate-cat-food-zid36-1594/cat-36-catid-200027?var_id=36-1594 and also got a can of this in chicken feast roasted which the label said pate under it but thinking its just roasted..http://m.petsmart.com/h5/hub?id=food-health/canned-food/fancy-feast-roasted-adult-cat-food-zid36-12862/cat-36-catid-200027?var_id=36-12862

 

Tasty treasures is a new product and don't think it's on the food chart yet. I'm thinking that this may be a higher carb food and one that you may not want to use. If I were to use Friskies - I would stick with the classic pate style and would not purchase the new types of products or go in for the hype of the cheese and bacon and whatever else they are coming up with....

The fancy feast roasted varieties - are on the high end or above what we consider acceptable carb level -- 10% or less is acceptable and as low as possible the better -- per the chart the roasted range from 9 - 12% and if it were me -I wouldn't use it.

I would stick with the classic pate style and be safe that way.

 

I plan on buying all friskies pate and seeing what flavors he will eat. He is constantly hungry but try not to feed him all of the time either. I don't really like to give him the dry food too much but when the dish is somewhat empty he seems to freak out but if I leave food in there he will eat the dry food quite often and I want to keep his levels down. Any methods that I can try? I try to feed my other cat out of a separate dish so that she can get food too

 

I think the timed feeder will be the way to go for you the petsafe 5 compartment feeder is very popular and I think you'll want the five compartments with your long shifts at work. How far away from home do you work? I ask because lantus really prefers to be dosed 12 hourly and if you work 12 hour shifts I'm wondering how close to that you can get. You may be better off using PZI or prozinc which are more forgiving about the time than lantus

I noticed someone mentioned increasing lantus in .5 unit increments. We actually only do that when numbers are very high increases are generally done in .25 unit increments. You will need to get yourself some u100 insulin syringes (for lantus I think the P insulins use u40 syringes) to dose appropriately. Even on a 1 unit dose you are better off drawing it from the pen using a syringe for accuracy. If you check out the lantus/levemir insulin support group forum you will find a bunch of useful 'stickies' at the top that explain lantus - how it works, how you should handle it, how we dose etc.

Also you do want to keep some high carb wet food and/or syrup on hand in case of low numbers.

We have a fabulous spreadsheet for you to record your BG test results which can be found here http://www.felinediabetes.com/FDMB/...te-a-ss-and-link-it-in-your-signature.130337/

 

I live about 8 minutes from work. I bought the petsafe 2 meal pet feeder today. So with the pens you are saying the units you set it to is not as accurate as the syringes?

 

Pens are more accurate that syringes but pens only dose in one-unit increments.
http://care.diabetesjournals.org/content/22/1/137
http://www.ncbi.nlm.nih.gov/pubmed/20515311

 

We adjust the insulin doses in 0.25 unit increments because cats are quite small and larger increases may overshoot the best dose. Insulin pens don't adjust in 0.25 unit increments.

 

Pens stored in the fridge, as we do since it takes a cat a lot longer to get through the insulin than a human, rather than at room temperature are not accurate in dosing even in single unit increments - see the bottom of this post http://www.felinediabetes.com/FDMB/threads/lantus-levemir-info-proper-handling-storage.151/ posting from iPad, doesn't look like the link worked but you can find the post in the lantus/levemir insulin support group forum about how to handle and store Lantus - it is a 'sticky' - stuck to the top of the forum.

It would be good for you to poke around in the other stickies there too when you have a little time.

It's great you live so close to work