newbie, introducing Shishi, unregulated need help

Hello FDMB members

Its great to be here, and I would like to thank you ahead for your time. I am new here and open to suggestions.

I adopted Shishi when she was 3 months old at a shelter. Shes a Grey and white DSH now at 10 years old, spayed and weighs at 13lbs. Free fed since adopted, but diet changed when diagnosed with diabetes.

She was diagnosed with diabetes on Feb 01 2010, and she has been on lantus since. Her diet is hills prescription m/d wet 1/2 can 2x daily, and hills prescription m/d dry 1/8 cup 2x daily. Number of meals in a day is 4.

She gets injections 2x daily with wet food, and is currently on 4 units. She is on lantus u-100 and I use u-100 needles. She gets injections at the back between shoulder blades.

Im not sure if you want me to convert to mg/dl for FDMB but all of my equipment is in mmol/l and I'm used to mmol/l up here in Canada.

At the time of diagnosis, she had PO and PU and neuropathy, she was on 1 unit of lantus, 2x daily. Pre injection BG was all over the place 6 - 18 mmol/l, About a month down the road (March 2010) Pre injection BG was more steady 5.5 - 9 mmol/l and the vet and I established that 1unit is the right dose for shishi. PO and PU and neuropathy was under control at this time.

Cost is a issue with test strips. During March we decided we would test BG every 4 days instead of 2-4x a day. Everything was fine until end of March when her preshot BG is around 11-19 mmol/l

From then it was increased to 2 units and still preshot BG is around 11-19 mmol/l.

2 weeks later it was increased to 3 units and same story. At this time we thought it might be somogyi rebound, took her off lantus for 4 days.

Preshot BG during the 4 days with no lantus was around 15-19 mmol/l, she was then put back on 1 unit and monitored closely. Preshot BG with 1 unit was 15-19mmol/l, we estabilshed she was not on rebound. I also used a new bottle of insulin to rule out possible insulin contamination.

As the weeks went by, increasing 1 unit every 2 or 3 weeks, she was eventually put on 6 units of lantus, and sometimes there are wild swings in BG, but they never last for long. And the trend of 16-21mmol/l pre injection kept coming.

Somewhere around June she started to exibit PO and PU, and we tested urine for concentration, it was less than normal. Antibiotics were given because of hints of a kidney infection. I could not afford the ultrasound.

Antibiotics were given for 6 weeks and urine tested again, and it was just enough to be concentrated. Her kidney infection seems to be the right diagnosis. But PO and PU still evident even when urine is concentrated.

A month later her urine is not concentrated again. Vet advised it was a kidney infection again, but wants to wait a bit to give antibiotics.

Around End of July we tried to see if it was rebound again, and we stopped insulin for 1 week. During this week the same deal happened. Pre injection BG was 15-21mmol/l, but this time she would start to not eat, and I can see neuropathy setting in, and lethargy was present.

I took her to the vet and had her urine done to make sure there are no ketones, I was assured by the vets that stopping 1 week of insulin was not going to induce ketoacidosis. She tested negative for ketones, which was reassuring. She has never tested positive for ketones ever.

So we started her on 1 unit of lantus again, and monitored closely curves were done and Preshot BG is around 18-21. Somogyi was again ruled out, Shishi started to feel better and was eating and neuropathy and lethargy subsided. we explored the possibility of poor injecting technique, and I brought all my equipment and did it in front of 2 technicians at the vet. My technique was good.

So as the weeks went by,increasing by 1 unit every 2 weeks. slowly increasing to 5 units now, and here we are today. Still unregulated and still PU and PO but no neuropathy and no lethargy. The game plan is now to have her go up to 10 units slowly, hoping we wont get there.

And this is why I have came to you guys for help. To see if you have any other advice or to tell me if this is normal, or what my other options are so I can better ask my vet. So I thank you all again for your time and advice.

 

Welcome. You will probably get better results if you ditch the dry and only feed canned. You really do not need the prescription food. A low carb (less than 10%) is good. Here is a site that gives yo the cars in canned food:
http://binkyspage.tripod.com/canfood.html
Also, you need t get BGs between shots to see what is going on between shots.

 

Welcome, Will.
I am in Ontario as well. On this board everyone uses the US system of BG numbers, so that we have a common frame of reference. You can multiply your Canadian numbers by 18 to arrive at the US equivalent.

There are cats who have medical conditions which cause them to require high doses of insulin. It is also possible that with the way you have been increasing doses, you have overshot Shishi's ideal dose. The dry food that you have been feeding, and any infection that may be present can both cause BG numbers to rise quite a bit. As Larry said, You cannot get a true picture of the effect a dose is having on your cat without regularly testing between shots. Lantus dose is not based on pre-shot values. It is the nadir, or peak of insulin action, that tells you most about how your dose is working.

Was the kidney infection diagnosed only by urine concentration? Was a urine culture done? Was any bloodwork done to check if the kidney function was normal? It would help to get an idea if a urinary tract infection is still present, and causing the BG numbers to go up.

If you navigate to the Lantus insulin support group, you will find a lot of information in the "stickies" at the top of the page regarding the use of Lantus. It would be worthwhile to read through those.

 

I have no advice but wanted to WELCOME you to the BEST site on the planet to help you help Shishi. Much experience and knowledge here.

so WELCOME!
jeanne

 

HEY! Hi there! Another Ontarian... awesome! I am in downtown Toronto.
OK here we go... I'll proceed to drown you in links and we will has Shishi feeling better soon.

Home testing is vital. Tests should be done before every shot because the day is going to come when Shishi will be too low to give a shot. Just like for humans, testing before each shot is important. The 3rd shot that is important is the before-bed shot because some cats tend to run low at nites.
More frequent tests really are not needed and you can always do your own curves on the weekends if you like to see how things are going. I'll end that by saying it's a relief to know you are testing.
I made myself a sheet of all the numbers so that I could post on this site using numbers the others recognize, but I put both on my spreadsheets. I take a copy of my spreadsheet to each vet visit, just to keep her updated.
I used this converter:
BG Conversion Calculator

Food's really important - you know about the carb thing it seems but you will want to stop feeding all the dry foods, even the dry snacks. They really can make a HUGE difference in numbers. One thing to mention is that when you remove the dry food, you are going to see a drop in BG numbers, so the dose you are giving may drop. One person was giving around 20u shots and feeding dry foods. After a switch to all wet, low carb, those shots came way down! My Shadoe eats just a mouthful of dry foods and her numbers will jump HIGH.
Some food links:
Binky’s Food Lists
Feeding Your Cat: Know The Basics of Feline Nutrition
Others may have additional links.
Scrap the rx food from the vet; lousy ingredients and way too expensive. Look at Binky's food list and pick out some low carb ones. You can go with Friskies or 9lives and also fancy feast but get the pate ones, not the gravy or grilled ones. You can see the good ones on Binky's list.
Food's important.

Alrighty, once you are testing regularly and have some good curves recorded - you can set up a spreadsheet in Google to track your numbers - click on the links in my signature to see mine for Shadoe and Oliver - here's the link:
Spreadsheet setup instructions

There are stickys with lots of info on Lantus you can read - here they are - you can find them at the top of the Lantus/Levemir group on this site:
Tight Regulation Protocol
LANTUS & LEVEMIR – INSULIN DEPOT –AKA- STORAGE SHED
Lantus&Levemir – Data Ready to Shoot Low Numbers

OK so Shishi's numbers may be high now, but you never know when the numbers may drop too low, so here's info to keep handy on hypo that you should print if possible:
List of Hypo symptoms
How to treat HYPOS – They can kill! Print this out!
Jojo’s HYPO TOOLKIT

Finally, the reason that brings me to post to you is the high dose you are giving Shishi - I have two high dose kitties, and went through the same going back down in dose to be sure we had not missed the good dose.

There are tests that you can have done, if you have switched to all wet low carb and still find that you are getting high flat numbers even though you are increasing the dose.

Here are the links with info on the tests that you could have done:
IAA Test
IGF-1 (Acro) Test

The tests are pretty simple. You have your vet draw the blood, package it up and Fedex it to MSU lab for testing.

These tests tell you whether Shishi has an insulin resistance condition and if testing positive, you have a reason for the higher dose. It's good to know this info because it means that Shishi has a functioning pancreas, unlike other feline diabetics.

This post is definitely not any canned reply - it's a mish mash of stuff. It likely seems like alot, and there are some things I have missed to mention.

Look it all over and ask any questions you may have; there is always someone around who can give you a hand or just some support.

Welcome to the site.

Edited to add:
no need to be spending lots of cash on vet visits for things you can do on your own, like testing for ketones.
Go to the pharmacy and pick up a box of Ketostix - you can test Shishi's urine yourself and if you see even a trace on the test strip, post here and then decide if a vet visit is needed.

 

Hi fellow Canadians and welcome to FDMB.
You have been given great advice especially about the dry food.
When Max was diagnosed all dry food was removed from the house and
my 3 kitties (well 4 now) only eat Fancy feast classic pate.

I will caution you though that you are giving Shishi a "higher dose" of insulin and by
remving all the dry food could really reduce her BG levels immensely, causing a hypo reaction
with so much insulin.

Have a look at Max's spreadsheet that is in my signature and you will see that we had
gone up to 6u. He was considered a higher dose cat (not a high dose cat) and now he has
been off insulin since April.
All with the help of this board. My vets did not support me in my dosing and testing.
You can see by my ss (spreadsheet) that I was a testaholic.
Do you have access to the US? The walmart relion is very economical and the money goes to the test strips.
Ask away and read the "stickies" in the lantus group form to see how we do dosing here.
Testing is essential here, especially pre shots (no food 2 hours before a shot) and as many spots as you can.

 

Hi to you! I'm new, too so I have no advice. But the folks on here are great and soooo helpful! We aren't regulated yet either, but it's only been over a week for us. I hope someone here can help you figure your kitty out! You've come to the right place!

 

Wow guys, Thanks for the support and informative reply. I think I can safely say I came to the right place and its great to be here.

I will convert my numbers to the US numbers so that everything is the same across the course. And I will start to test preshot and in between shots.

Larry and kitties, Thanks for the link and I will figure out what food to give Shishi next using Janet and Binkys.

Linda and bear man, as for the kidney infection, a urine culture was done and it came back negative, Vet said that most of the time it will come back negative but we try for it anyways. Blood work was done aswell, but I forgot about the results regarding kidney function. Will call and find out.

Jt and trouble, thanks for the warm welcomes.

Gayle and shadoe, thanks for all your links, and it will take me a while to process through them. The vet assured me that feeding M/D dry was okay, but I was always doubting this decision. I will start to cut the dry food all together and monitor BG closely and see if things start going down.

I am sure my vet and I will have conflict of interests very soon, and this is the very reason I came here. My interests is for Shishi to receive the best care possible within my abilities.

Thanks for the tip about the ketostix, I will start testing for that aswell. And I will try to figure out the spreadsheet in the meantime.

Randi and max, I had a feeling I was giving Shishi a high dose of lantus, and was starting to worry, I wanted to cut out all the dry food but the vet kept reassuring me that the dry food was okay. I now know that I have the option to cut out the dry food.

I don't have access to the US, but will try to find a better food for Shishi and carry the savings to test strips. For now I want to change 1 variable at a time, and keep her only on M/D wet, and monitor BG closely. I am sure my vet won't support this but I wanted to cut the dry out all along. I will also read the lantus stickies.

Charliemeow, thank you for your warm welcome, and I definitely feel I am at the right place.

Thanks again for all the help guys.

 

Hi Will,
I had made myself a conversion sheet in Xcel so it was simpler to record. If you don't have Excel, one could be made in Google docs.

Your numbers are pretty high, but the ones that tell you how it's going are the lowest point in the cycles, the nadir is the number used for dosing decisions. You may get 18.3 at both pre-shots, but what's happening in between?
If you tested every 2hrs, you may see just high flat numbers and no dip in the middle. This type of curve would say "nope, need more insulin".
If you tested every 2hrs, and you see the numbers go down, down, and then up, up, like in the below example, then you can see maybe the dose is ok or even too high.
But without seeing in the middle, you can't really tell what you need to do.

Here's more that may tell you a bit about any curves you do:
How to do a Curve
Example of a typical curve:
+0 - PreShot number.
+1 – Usually higher than PreShot number because of the last shot wearing off. May see a food spike in this number.
+2 - Often similar to the PreShot number.
+3 - Lower than the PreShot number, onset has started.
+4 - Lower.
+5 - Lower.
+6 – Nadir/Peak (the lowest number of cycle).
+7 - Surf (hang around the nadir number).
+8 - Slight rise.
+9 - Slight rise.
+10 - Rising.
+11 - Rising (may dip around +10 or +11).
+12 - PreShot number.
Don't worry if your numbers have the nadir earlier or later or maybe you just can't see one, people here can help you sort out what your numbers are saying.

For test strips, we can't get Relion here in Canada, but once you have an idea on how Shishi reacts to insulin, you will know when you need to test. You sure don't need to test as often as I do (testaholic, me) but it's addictive, the urge to know what's the number now! During the week, I can't test as I am at work, and evenings, I head to sleep early, so my curves are done on the weekends.
For meters, I am currently using Bayer Contour, but I also have OneTouch meters and a Precision and a couple Aviva ones too. I get most of my stuff at Shoppers Drug Mart because I make good use of their Optimum points card. With the cost of syringes and strips and insulin, why not let the points add up because every few months, I get my pack of insulin free, just using my points! If you don't have an optimum card, for sure get one.

For your tests at the vet, see if you can get copies of the past ones, and be sure to get copies of all other tests and results.
I keep a binder for each of mine because I want to be able to compare the changes.

And as for your vet not supporting you, well,welcome to the club. Not many vets know all that much about feline diabetes, at least they sure don't have the experience you will find around this site.
I have my vet pretty well trained now. My vet did not know a thing about testing for high dose issues, and I had to take the info I got here and tell my vet how to arrange for the tests to msu. I kept getting put off until I demanded the tests be done.
They told me Shadoe 'does not look acro' so why test ... they were pretty shocked when she tested positive. And when I said I wanted Oliver tested, I had ZERO problems and the tests were shipped off right away.

Please remember that Shishi is YOUR cat and YOU are the paying customer; the vet is to provide services to you, as requested.
There are dozens of people here who can relate to the resistance you may get from your vet.

 

Welcome Will and Shishi!

You found a great place. You already have received lots of information and I have nothing to add but hello from mid-town Toronto!

 

Thanks for the great tips.

As for her kidney infection diagnosis, it was mostly from the urine concentration. The kidney function at that time was normal, and there was no urinary tract infection at that time either, and the urine culture came back negative at the time. After 6 weeks of antibiotics, vet measured urine concentration again and it seems to be concentrated. The vet concluded that the antibiotics worked and Shishi had a kidney infection.

I have been testing in between shots in the past 2 weeks. Usually 4 hours after A.M injection. The values are usually 322, 302, 347, 360, 349, 388, 367, 289. These values are usually every 3 days apart and at this time she was on 4 units 2x daily, but now will change to everyday and will run a curve real soon when I stop the dry food.

The last curve I ran was in Aug 6, 7 and 8, Shishi was off insulin for 1 week from July 31 - Aug 6. I decided to take a curve on the last day without insulin, and 2 days after giving insulin to see how she responds. She was put on 1units of lantus 2x daily on the 7th and 8th.

I will put these into a spreadsheet when I figure it out, for now I will just post them here.

On Aug 6
12:11 BG 322 1/2 md wet
16:27 BG 307
18:01 BG 288 1/8 cup md dry
20:04 BG 311
22:07 BG 311
23:40 BG 284 1/2 md wet
Aug 7
05:23 BG 268 1/8 cup md dry
12:20 BG 307 1 unit, 1/2 md wet
14:50 BG 325
16:54 BG 325
18:24 BG 286 1/8 cup md dry
20:32 BG 289
23:00 BG 300
23:50 BG 320 1 unit, 1/2 md wet
Aug 8
06:06 BG 320 1/8 cup md dry
12:16 BG 282 1 unit, 1/2 md wet
14:22 BG 311
16:00 BG 320
18:02 BG 277 1/8 cup md dry
19:50 BG 295
23:47 BG 318 1 unit 1/2 md wet
Aug 9
06:00 1/8 cup md dry
12:56 BG 302 1 unit 1/2 md wet
15:55 BG 356
17:47 BG 336 1/8 cup md dry
21:32 BG 372
Aug 10
00:12 BG 376 1 unit 1/2 md wet

I ran curves during April and May and they were of similar fashion. The nadir was around 4-6 hrs after A.M injection and usually around 262 - 306. So I started to test around 4 hrs after A.M injection to watch for this, the nadirs recently have been 289-388.

Great tip on the Shoppers optimum points, I did not know you could redeem test strips and will start to collect points.

For now I am still trying to decide on what wet food to substitute the M/D dry with. Will cut out all the dry food all together and see how things go from there.

 

Yup, the numbers look high but then with the dry food in the picture, it's likely part of the problem.

When I was switching to all wet, what I did was take a printout of Binky's list with me to Petsmart. I had marked the ones that were below 10% carbs and then I got a can of about 10 different kinds LOL. Shadoe got a wide choice of foods, and the ended up liking fancy feast a bit but mostly the friskies. Lucky for me, she turned up her nose at the expensive foods which was good because she was eating like a hog!

Lots of people can give you the brands their cats eat, but their cats are not YOUR cat. For snacks, I feed mine fresh chicken. Oliver loves slivers/chunks of raw, but Shadoe prefers hers steamed.

Good luck on setting up your spreadsheet and I hope you find some good foods that Shishi deems worthy of eating!

For fluids, to get enough into Shishi, you can try watering down the wet foods. I know that my two prefer it - I call it their soupy slop - and it's the best way to ensure they are getting enough fluids.

As you make the changes, you will very likely see improvements in Shishi before you see those numbers get better, but don't worry, they will come down.

While tests before each shot should be done, the ones in between can be staggered so you can get different glimpses of Shishi's curves. I mostly do ps, +3 +6 +9 but sometimes, I'll so +4 and +8.

You said she was off insulin for a week? What was the reason for that? Just wondering. With no insulin in the system, she would have to build up her shed again, so it would be just like starting all over again.

Anyways, I hope you have good luck finding foods that she likes because then you can start to cut back and then remove the dry foods.