New to Group - Need Some Help/Advice on Food and Dosing

Discussion in 'Welcome to the Group - Post an Introduction Here' started by Scott Walker, Nov 8, 2017.

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  1. Scott Walker

    Scott Walker New Member

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    Nov 8, 2017
    Hello,

    Mittens, a ~15yo female adopted ~4 yrs ago, was diagnosed with diabetes 9/25/17. She had lost ~3 lb from her standard ~13lb and was exhibiting the classic litter box output and increased thirst that I've since learned are hallmarks of feline diabetes. She had never seemed overweight, particularly compared to our 16lb+ male cat, so we were surprised to learn of the diagnosis. But we know little about her life before adoption 4 years ago.

    Since diagnosis, we've had a lot of ups and downs, but we are in a phase where the insulin doesn't seem to be making a big impact on BG, and I'm open to advice on (1) food and (2) dosing. A not-so-brief history below:

    9/25 (t=0): Reading over 400, diagnosis, learned she had lost 3lb sometime since Feb 2017 (most recent vet visit) to 10lb+. Later that week, vet kept her overnight and started at 1 unit. BG got as low as high 200s during vet stay. Started 1u of Lantus (pen) 2x/d.

    She historically ate a mix of dry and wet, more wet. She was not a finicky eater, enjoying variety. We switched her to Purina DM wet and dry at diagnosis.

    t=12: Vet visit with elevated reading (300+) 5-6 hours after AM dose. Advised to increase insulin to 2u 2x/d. Mittens had gained ~0.4lb.

    t=20-21: Mittens was ravenous. Given her weight loss, we gave extra wet and let her self-feed.

    t=22: Mittens begins 36-hr hunger strike. She will sniff food and seem interested, but no eating. Behavior is as morose and lethargic as I've ever seen her.

    t=23: After 36 hours, I try handfeeding warmed chicken and egg, and she starts eating.

    t=24-26: Eating is better, although not great. Behavior remains depressed and lethargic, though modestly better than during full hunger strike.

    t=26: BG of 56 ~5-6 hours after AM dose of 2u. Weight was lower than diagnosis (i.e. lots of back-tracking). Given sporadic eating and low BG reading, vet advised stop Lantus until better pattern of eating. Mittens was prescribed an anti-nausea medicine and a mild appetite stimulant. Given the hypo scare, I bought home-test kit to better monitor (I was previously under hopes that she would level out at a specific insulin dose and be steady). I buy a bunch of wet food I know she likes (sardines, multiple others) thinking eating something is better than nothing and begin a varied diet.

    t=26-27: Meds seemed to restart hunger, so I restarted 1u 2x/d on t=28. Pre-food BG levels typically >400, ~5-6hrs post-dose ~300-400. I stop meds after 1-2 days as she seems fine on her own.

    t28-33: BG readings remain >400 pre-meal and 300-400 at +5-6hr after dosing.

    t34-47: Vet advises to resume 2u 2x/d. Same general pattern in BG readings: >400 pre-meal, 300-400 at +5-6hr after dosing. (We don't wake in middle of night to check)

    t48-52 (today): Increase to 3u 2x/d. Same general pattern in BG readings: >400 pre-meal, 300-400 at +5-6 hrs after dosing. 354 to be exact today.

    I don't work at home, but do have more flexibility than the average 9to5 job. I would very much like to see more progress on the BG readings but have no idea why higher doses aren't working. I'm also lucky to say that finances aren't a big concern, so open to food and other suggestions even if not super economical. Today I started a spreadsheet and will continue to update.
     
  2. Tanya and Ducia

    Tanya and Ducia Well-Known Member

    Joined:
    Feb 25, 2017
    Hello Mr. Walker, welcome to you and Mittens,

    1st - your Spread Sheet (SS) is not available for public view - so I do not know at this time what BG levels we are talking about.

    None of the BG readings taken at a vet's office are accurate - too much stress.

    We will be able to help if you can tell us more about Mittens:

    any other medical issues (apart from FD)
    what insulin she is on
    what is the current dose
    what does she eat
    and how often do you feed (yes, very important when evaluating the dosage needs)
    the 2U insulin you've mentioned might be too much - but, again, without seen the SS I can't tell..
    the loss of 3lb is bad if done too fast but if it brought a low activity, an indoor only female cat down to 11 lb - could be a blessing in disguise, depends..

    Tell us more - we are happy to be helpful - if you make your SS publicly view-able the the more eyes you'll get in to your problem..

    :bighug:
     
  3. Scott Walker

    Scott Walker New Member

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    Nov 8, 2017
    Sorry about that! It’s now open. We weren’t recording readings until today, so I don’t think the link will be helpful until we populate with more data. Directionally, as long as she is eating, we get the same results so far, now, 6-7 weeks in. Pre 7AM meal BG 400-475, 5-6 hr post 300-360. Pre 7PM meal BG 400-475. We are now on 3u 2x/d w meals, Lantus. Vet suggested keeping plenty of dry Purina DM all the time, and we have tried a variety of wet (FF classics, Wellness varieties, etc). She tends to like most wet varieties except Purina DM by itself. Sometimes we will mix in the Purina DM wet. She will usually eat a mix, but doesn’t seem to like Purina DM wet by itself. She generally goes after the wet first, rarely finishing all of it, then grazes on the dry until next wet feeding time (12hrs later).

    Mittens has no other known medical issues. The vet has done labs and even scans to rule out other possibilities.

    Thank you for your help! I know there are a lot of existing threads on here with helpful info, but my keyword searches aren’t quite doing the job!
     
  4. Veronica & Babu-chiri

    Veronica & Babu-chiri Well-Known Member

    Joined:
    Aug 5, 2016
    Hi and welcome!!

    You've arrived at a great place where there are lots of very experienced people that can help you.

    Since you are using Lantus, this is a link with great information where you can start

    http://www.felinediabetes.com/FDMB/...the-basics-new-to-the-group-start-here.18139/

    Also you may want to start posting on the Lantus/Levemir forum any questions you may want.

    For what I can see you are already home testing so congratulations on that, is a great start

    Regarding the food you want to give him one that is high protein low carbohidrates ( not the same as low calorie) there is a very good list here´s the link,

    http://catinfo.org/docs/CatFoodProteinFatCarbPhosphorusChart.pdf

    Most of the prescription diets and certainly dry food are not low carb so not really appropriate for a DB cat, you want to choose one that is 10% or less carbs in the list .

    A lot of people here feed Fancy Feast, I gave Babu Instinct either Chicken or turkey because those are the only options where I live ( there are more in the US) but it turned out great, and the fact that there are two different flavors help so that he wouldn't get bored and it was not pathe which also helped
     
  5. Tanya and Ducia

    Tanya and Ducia Well-Known Member

    Joined:
    Feb 25, 2017
    the SS is now viewable - thanks!
    There is indeed no much data to assess the dose effect.

    Did your vet told you to take tests just prior to injection? well, he/she should have done so.. otherwise you might risk hypoglycemia. The pre-shot test should be at least 2 hours from eating - otherwise you 'll get a food influenced reading & might falsely think it is ok to inject.

    I think that 3U Lantus is too much of an 11 lb cat... Sometimes too much of insulin brings about the same results as if it was not enough.

    ditch the dry food - bad for all cats, especially for a diabetic ones.

    We recommend to feed below 10% carbs/100Kcal wet canned food w/ water added. I attached the most recent food chart below.
    Beware that once kitty is switched to wet Low Carbs (LC) food only the insulin requirements get reduced significantly (some cats go into remission completely, but not all of them after transitioning to wet LC). Home testing BG is the only way to stay safe giving insulin whilst transitioning to wet LC.


    Click HERE to post any of you questions on the Lantus Forum - we are very busy and pro-active group - and there are real dose wizards who can help you to help Meetens. Personally, I think she gets too much insulin.

    But why not open a new thread on Lantus Forum titled something like "..Meetens, 11/08 do I dose lantus correctly?.." and see what other's with Lantus experience think?
     

    Attached Files:

  6. Scott Walker

    Scott Walker New Member

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    Nov 8, 2017
    Thanks to all! The food list was particularly helpful - i have printed out and will fill the cupboards with appropriate selections. I'm going to remove the dry food and use wet food with ~50%+ protein and <=10% carb from the list. Mittens PMPS (253) was lower than AMPS +6 (354), so given the trendline plus the diet change, I reduced insulin to 2u this evening and will test at PMPS +3 before bed. Her mood already seems a little better - some play at bedtime that has been missing since her diagnosis / troubles began.
     
  7. Veronica & Babu-chiri

    Veronica & Babu-chiri Well-Known Member

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    Aug 5, 2016
    You should monitor him closely since you are going to be changing his food and that could lower his numbers a lot
     
  8. Scott Walker

    Scott Walker New Member

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    Nov 8, 2017
    Yes, I am planning on many more frequent BG readings.
     
  9. JanetNJ

    JanetNJ Well-Known Member

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    Jun 8, 2016
    Read the two dosing protocols at the top of the lantus forum and choose the one you are most comfortable with. Dosage increases should be done in 0.25 increments, not whole units as even a few drops of insulin can make a large impact.
     
  10. Scott Walker

    Scott Walker New Member

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    Nov 8, 2017
    I am using the pen for now, so fractional increments aren't possible. The pen is almost out, and I will discuss the syringe method with out vet.
     
  11. Veronica & Babu-chiri

    Veronica & Babu-chiri Well-Known Member

    Joined:
    Aug 5, 2016
    You can use the pen with syringes just like a mini vial actually many of us do that you do not need to wait util you finish it to change and start dosing in 0.25 increments you just insert the syringe into the pen and take out the amount you need
     
  12. Scott Walker

    Scott Walker New Member

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    Nov 8, 2017
    We have a vet appt tomorrow where i'll ask about the syringes. Mittens had a 97 AMPS+6 reading today, so progress is being made! She went from persistent 300-400 readings to now healthy after I withdrew Purina DM dry and increased dosing from 2u to 3u (each 2x/d). If her PMPS reading is still healthy this evening, I will follow the dosing guidelines on the Lantus thread and reduce or skip the shot.
     
    Last edited: Nov 10, 2017
  13. Veronica & Babu-chiri

    Veronica & Babu-chiri Well-Known Member

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    Aug 5, 2016
    How nice he's already doing better, here's a video about using the pen with syringes

    https://www.lantus.com/using-lantus/using-the-solostar-pen
     
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