? Next choice requesting help and information please

Hi,
I'm going to ask the vet to try another insulin. I don't understand the depot and I don't understand bouncing. My cat's numbers get higher as the insulin doses increase.
If I'm understanding part if what I read, changing to low carb food, reducing his dex, and starting insulin*(on the same day)* may have given his liver panic and increased his blood glucose.

The vet seems to be doing a bit of sliding scale:
Sunday 1u 2xdaily
Monday 1.5u 2xdaily
Tuesday 2u 2xdaily

Maybe an insulin match.

What other insulins have you used?

 

The depot is a tricky concept. Have you read the yellow information stickies at the top of the Lantus main page? Unfortunately, cats can bounce on any insulin, not just Lantus. It's more a characteristic of the cat than the insulin although many settle down more once they're better regulated.

That's a lot of factors changing on one day. All of them can affect BG. It's usually best to change to low carb wet food before starting insulin if possible because that alone can drop BG levels. Dex can raise BG so lowering that dose might cause a lowering of BG too. Of course insulin is meant to drop BG. So, yes, too many changes all together and that might be why the BG numbers are high.

This isn't what we call a sliding scale. This is the dose being raised over three days. Sliding scale dosing refers to a method whereby the dose is adjusted according to what the AM and PM BG readings are. This isn't the best way to dose Lantus. It works best when the same dose is given consistently for a period of time. In my opinion, the Lantus dose has been raised by too much too quickly. The recommended starting dose is 1 unit twice a day and that dose is held for a week. After a week a glucose curve is done - ie., taking BG measurements at 2 hours intervals over the course of the 12 hours between doses. Based on that curve the dose might be adjusted by 0.25 u up or down.

Lantus is a very good insulin and many cats do very well on it. I wouldn't give up on it so soon. Please go read the information in the yellow stickies on this forum to learn more about it. Come back and ask any/all questions you have. There's a lot to absorb so take it in small bits. We can help you get your kitty on track with Lantus.

One last thing: getting a cat regulated on insulin can take some time - weeks or months. You have to decide to be patient and recognize that you're in a marathon.

 

Ive read them over and over and I don't understand them.

I think I'm more equipped to do a sliding scale. Look at the bg humbler give the shot.

My emotional health is stretched very thin. My cat is getting thin, now doesn't want to eat, but he's ravenously eating if he gets babyfood. Babyfood raises his blood sugar. And I can't do the google stuff for a spread sheet. I'm failing my cat.

He may have a better chance to live if I can do insulin I understand and them he can eat.

 

Can you post a list of specific things you find confusing? We can help if we know what you don't understand.

Sliding scale dosing is actually more demanding on the owner to "read" the data and make dosing decisions. The two Lantus methods (TR or SLGS) pretty much spell out what to do when. Easier on the human.

We all understand the anxiety, frustration and confusion that dealing with a diabetic cat causes, especially if you have other challenges in your life. What WILL help immensely is learning as much as you can, making a plan with our help and posting here for support or advice. You'll feel less powerless and that alleviates a lot of anxiety.

You seem set on using a non depot insulin. What, specifically, makes you think these would be better? I have experience with both so maybe I can help.

 

I feel you pain, as I read on your yesterday's thread that you are the only caregiver and are burning the candle at both ends. If you could let Chris help you set up a SS it would be so much easier for us to help you and easier for you to see the trends and patterns when it is on a color coded SS.

Kris is right, bouncing can occur with every insulin. It is just what they do until their bodies get used to working more efficiently with the exogenous insulin. Your vet should not be raising the dose daily like he is doing and not in .50 increments. We raise the insulin in increments of .25 units so we don't go over the best dose and overdose kitty. Your kitty hasn't been on Lantus that long and with the inconsistently dosing it's hard to know what the insulin needs are yet and not being able to see the numbers in a SS in a disadvantage to us to help you.

My cat started off on ProZinc an we switched to Lantus after 6 months and I am so glad we did. Lantus in my opinion is easier to understand and work with and has the highest rate of getting a cat off insulin than the other insulin. The reason I think it is easier is that there is established protocols to work with. It is also a gentler and longer lasting that the other insulins. I would recommend to stay with the Lantus and see about getting the SS set up so we can help you better.

And keep asking questions as that is how we all learned.

 

Here is yesterday post so that peeps can see what transpired. We post the previous thread to the present one which helps us know the story.

HERE

 

Thanks for this! I hadn't read the previous thread. I can see that this is a very difficult situation.

 

Thank you for connection things. I don't know how to tie things together.

 

My apologies to the original poster if I came across as being bossy. It wasn't my intenton. I was trying to clarify some of the issues for you. I know how overwhelming all this is and having a plan can help.

 

If you would try following the SLGS protocol and give it a try I believe things will settle down and you won't have to worry about a hypo. The sliding approach doesn't work with lantus. It's part of the problem. My mom was very sick and in and out of the hospital for the three years Max was on lantus. I lost Max in October and my mom in November of last year. I know how hard caregiving is. I was lucky to share it with caregivers and my sister but it was still very stressful. If you start a ss and let people here guide you, it will be easier to manage. We care.

 

You seem set on using a non depot insulin. What, specifically, makes you think these would be better? I have experience with both so maybe I can help.

It's an if-then situation. If x is y then do abc. It's logical.

He needs his bg reduced now. He has had surgery and his body needs the lower bg and less wear and tear on his organs.

 

you won't have to worry about a hypo.

The highs need to be brought down

 

Spreadsheet:
A very nice person offer to set it up. At this time, I don't have a way to maintain it once set up. If what I have so far will help, I'm willing to send it to someone e.

 

This is exactly how the Lantus protocols on here work: if AMPS is "x", then do "y". If nadir is above/below "a" then do "b". The difference is that doses are held a minimum of 3 days (TR protocol) and the same dose is given AM and PM.

With sliding scale dosing of non depot insulin like ProZinc or Vetsulin a dosing guideline is set up such that if AMPS is between "a" and "b", give dose "x". However, that sliding scale is NOT set in stone. It has to be tried and revised frequently. It's a moving target and requires a lot of thought on the part of the owner. Also, a bouncy cat will react one way to the scale at one point in time and then do something totally different at another time.

If you want a firm set of dosing guidelines to try that will (possibly) make it easier for you, either TR or SLGS with Lantus is the way to go. Maybe read the protocols to see what you think?

 

Another suggestion: post on the main health forum and/or in the ProZinc and Vetsulin forums to ask about sliding scale dosing, how people do it, some of its advantages and disadvantages, etc. In general, cats that are "easier" - ie., less bouncy - can do well with it whereas tricky cats tend to get very erratic with it.

 

I'm so sorry for all you're going through with your kitty. I understand the uncertainty, fear, and feelings of panic. Most of us on here have been where you are, and some days I still feel that way. I don't want to add more pressure or make anything harder for you (It's hard to not follow your vet's recommendations. After all, they are the educated professionals. We have wonderful vets, but if I was following my vet advice with Callie's treatment we would have had several emergency room visits already.), but the people on here know what they're talking about. I'm not exaggerating when I say that without their help and expertise, and concern, Callie wouldn't be here. Only trying to give you my personal experience, not trying to make it any harder, and definitely not judging even a tiny bit. This is just hard!

Since your cat will eat baby food and has food allergies, I was wondering if he would eat any of the Beech-Nut Classics. The meat varieties have no carbs, and so shouldn't raise his BG. I only bought the kinds that are 0 carbs. I hope if you can give that a try, it helps. It's really worked for Callie when she won't eat anything else.

 

Unfortunately, this isn't true. Even with a non depot insulin and sliding scale dosing you can have a big drop to hypo numbers. That's because a cat's body is a very complex system and the response to insulin can, and will, vary day to day - some cats more than others.

 

While Beechnut doesn't contain carbs, not all cats like it. Mine never have. Gerbers is low carb. You need to add taurine if used long term and it's not a complete food.

 

I started out with Novulin R and then Novulin N. After reading about the rapid BG drops with both of them, I thought Callie would be safer with the Lantus. My vet thought so also, saying it seems to work for cats better than the Novulin. It's a difficult decision to make since there is so much new information to absorb all at once.

 

Good morning,

Thought I would chime in, I completely understand how your feeling right now. It was only about a year and half ago when we were dealt the problem of debities with our kitty.

I'm going to try and explain it the way I understand it, I could be wrong in my explanations, yet this is my best understanding.
Bounce? This can happen when your cat numbers get lower then what they have been. Meaning let's say your cat had been in the 400-500 range for a long period and they drop into the 300 range for a day. Your cats body can/will dump glucose into their system as a protection and shoot their numbers up again. This can last from a day to a few days.
Depending on your BG meter there is a number where you are to start giving high carbs to get the cat safe again. On my meter it's 50. My kitty was a bouncing fool for a long time. Now they only last a day or so. It's taken over a year to get this under control.

Food? Dry food is a killer to our cats. One way or another you have to get rid of this. We battled for months trying to get dry food out of our house because we have two other cats who ate it. We no longer have dryfood in our house.
One nibble on dryfood can send your kitties numbers from the 100 to 500 range. It's crazy to see this happen.
If you want to make sure your kitty has food while your gone leave wet food with some water mixed in it. This is what I do.

Finding the right food can seem overwhelming. Trust me on this! I'm still dealing with it today.
You will see LC= low carbs MC=medium carbs HC= high carbs. Food is broken down into these three categories.

We were using BFF tuna and having great luck until our cat became allergic to fish. We are back on fancy feast chicken only patty. The fancy feast turkey patty says it is higher protein and lower carbs and with our cat it sends her numbers sky rocketing.
Just about any and all gravy food is HC and only to be used to bring their numbers up quickly. You will do this by squeezing the juice from the food and just give the juice.
Food is everything to our kitties. One day your kitty will eat less and send their numbers plummeting while others days they eat too much and shoot high. Controlling their food is a priority. I'm dealing with this problem daily.

On the food note. Because we are tracking our cats numbers so closely I had noticed that the food I was getting online in bulk was sending our cat numbers up compared to the store bought. I even went as far as contacting the manufacture an online distributor regarding this problem. Both assured me the food online is the same as in the stores. This is when I emailed them my SS and asked them to explain my cats higher numbers. Since then our online food has been the same as store bought.

The right insulin?
When our ordeal started the vet had our cat on fast acting insulin and almost killed our cat. After finding this group I had my vet switch to lantus. It is a slow releasing insulin that takes place over a 12 hour period. It takes a few days before you see it working. Our cat has become so sensitive to the amount of insulin we give her that only a pindrop more or less has major affects on her. I had to get calipers to get it right every time.

Spreadsheet
This is a must, you need to track the cats numbers as much as you can. A patter will form in their numbers and help with what needs to be done. If the vet says this is not necessary, find a new vet!
Knowing what and how your cat is acting to the insulin is very important.

Vet
This is the most critical thing you can do. Our other vet cost us $15,100 todate in vet bills for their incompetent. We then learned that the steroid our first vet gave our cat when we adopted her a year and half ago was most likely the reason she became diabetic. We now have a new vet that is a cat clinic for only cats. I could go on a major rant about our other vet and I won't. Just put it this way, most vets get a total of 4 hours of training for diabetes. 2 hours for cats and 2 for dogs and this was done while they were in school. This is the extent of their training unless they go to seminars to learn more. Most don't because most people when they find out their pet has this just puts them down and gets a new pet. This is the reality of vets and their knowledge of this disease.

Remember to take a big breath, hold it and blow out. You need to be as relaxed as you can. I'm saying this because there were a lot of times where I was in a major panic and had no ideal wth I was doing. Freaking out does not help, I know this because regardless of the amount of times I had freaked out it never helped. Go figure.

Your getting a crash course in feline diabetes. It can and will be overwhelming. The amount of information you need to know will stress anyone out. Take baby steps. Everyone has been in your shoes, I'm still having to ask questions because I'm not 100% sure my thinking is correct.

The last thing I'll leave you with is trust the folks on here.
They are battled tested with regards to this problem. They will be there for you through thick and thin.
They will stay up all night making sure you and your kitty are safe and hand you over to another member the next morning. I'm saying this from past and current experience. I had members on here whom I have never met or talked to in person stay up all night with me making sure my cat was safe. The next morning they handed me to another member to take over during the day. I'll take the folks on here over an army of vets any day of the week.

Hope I was able to help
Remember your no longer alone, you have an army of crazy cat lovers at your side.

 

Thank you all for your support.

Vets: I don't find many vets in his corner for this and for his other elements. When I took him to the u for surgery, every vet in the practice said the wouldn't do it if it was their pet. Before that, I was told nobody did the surgery he needed. I didn't accept that in this day and age the surgery wasn't done on animals. My wounds are fresh from the surgery. Approx 9 animal (all species) have the surgery done per year.

I have an excel spread sheet I made. So, with my limited tool box and the cat's immediate need. Fast acting insulin can bring him some relief, is my hope.

 

Hi
On the spreadsheet, let one of the members on here set it up for you. I have given access to a few members to help me with mine. You will want to keep good notes on feeding and vomiting. As well as other notes of things that happen.
This will help show a pattern of what is going on.

I completely understand about vets, I had four different vets at two different locations tell me to put my cat down.
They were clearly wrong and I was right.

The reason for the long acting insulin is to bring them down safely over slamming them down. Our vet had the mindset they needed to get her numbers down now. This caused a crap load of other problems such as kidney failur, she turned bright yellow, gums turned dark gray. At one point I had to take control because everything the vets were doing made things worst. One of the vets even paid for his tech to come to our house and pick up our cat to run tests on her. He did not believe the cat was still alive. During our meeting he said he was treating her numbers while I was treating the cat. Clearly I was right and he was wrong.

If I was you I would be looking for a cat clinic where you live, if none, start calling around and ask what experience does the vet have with feline diabetes prior to bringing the cat into see them.

Our last vet was more like an ER with almost never seeing the same vet twice. The final straw was when I was given a newer vet to this location and I showed her my spreadsheet and was explaining about the reductions I had been giving our cat. The vet said I should never increase or reduce her insulin without the advise of the vet first. I lit this vet up!
I was over me knowing more then them and paying them for a visit. Enough is a enough!

I then started with a series of questions.(note to self, if I ever start asking a series of questions this is to make you look like an idiot)
I then had to explain to this vet that her line of thinking would have killed my cat if I followed her advise. Please read all of my cats file notes prior to me seeing her and me.
After this last visit I asked my wife to find us a new vet.
The new vet was sent all of our cats records. She read through them prior to our visit. She explained to me that most vets follow this same procedure because this is what they were taught. She said I was correct is everything I had done and that it looked like I was keeping things under control, good job.
She also noted that the steroid that was used on our cat most likely caused this problem. She explained that this storied is knowned for causing debities. She would have never used this on our cat.

 

Is there someone that I could text a photo of my line graph and they could post it? People would be able to get a feel for the patterns?

 

My reply will bring your post forward on the forum for others to see. Hopefully someone will be able to help.

 

Hi, first of all I really want to say welcome, whether it doesn't seem like it we do understand what you are going through, is stressing and scary to say the least, but and you are not alone in this, we will try and help you the best we can.

I know every one of us has a very particular situation, and I'm not trying to say mine is like yours or worse or anything but I will like to tell you that I too have a full time job, plus I live in a really big city with the most crazy traffic you can think of, which means to the time I spend in work I have to add an hour or an hour and a half of driving from and to work, and some workaholic bosses who think meetings at 10:00 pm at night are ok (seriously they are crazy). My sisters helps me now and then but she can't test or shoot, so I kind of get an idea of what you are saying, and I don't want to tell you is easy or anything but It can be done, yes you may not be able to have all the control or tests that others in the forum do and you may have to cut yourself some slack and go a little bit slower just to keep your kitty safe, but that is ok, the protocols still work.

So take a big big breath and I would recommend you take a closer look at the SLGS protocol it ends being more simple to follow than trying adjust your dose every time.

I also as some others have mentioned before would not recomed that you change the dose so often and by such big amounts it can be really dangerous.

My vet also when he saw the first days Babu's numbers got nervous and asked me to to handle Lantus like some other insulins and the way they usually do with dogs but after 3 days of the experiment ( I showed him the test results I was getting, plus some really technical articules that some very nice people here help me get for him to read ) he agreed things were worse if handled that way and agreed to let me follow the protocol

On more practical matters you could click on the "Upload a File" button at the bottom of the page ( near the Post Reply one )and it would allow you to add a photo to your post

 

I am not sure how to interpret this chart. Maybe someone else will be able to understand it.

 

The values you are graphing are from different days?, the same day different hours? What dose were you giving when you got those values?

 

Breaks in the line graph are where I did control solution and the numbers were not relevant.

 

Will give more info in a moment. Just got home. Must kiss, hug, love, hold, test and feed the furry feline.

 

Numbers next to the blue line are the bg value. The numbers at the bottom mean nothing, generated by excel.

Each bg value since initially starting insulin is given.

The highest bg value is 450; lowest 151.

 

If you change the title line of your post to something like "Need help reading BG graph" someone with the knowledge/ability might come across it faster.

 

• How many days of BG measurements does this graph cover?
• How many times per day was the BG tested?
• When did the tests happen relative to meals, insulin injections, etc.
• What was the insulin dose when the BG tests were done?

In order to interpret your data we need to know these things.

 

For what you are saying this values are from different days if I'm understanding correct.

When is the date of your first value the one on the excell X-axis No 3? and the last?

Does the graph include morning and night tests? Which ones are morning and which ones are night?
Are you testing more than twice a day?

What was the dose when you got the 151? And the day before that number?

And for the 450?

 

Could someone please help her set up a spreadsheet or do it for her?
I forget who did mine on here or I would help her myself.
Then have her plug these numbers into that spreadsheet. It would help resolve everyone's questions on times and dates.

 

With the exception of those single high/low numbers the rest all cluster in a fairly narrow range with an average that's probably about 300 - 310. That can mean that the insulin dose is too low or too high. Too high a dose causes bouncing which others have posted about on this thread and your other one on the main health forum.

Do you have a computer at home? I think @Chris & China offered to set up a spreadsheet for you. That would be very helpful.

 

Some answers to thread questions:

If the day looped in red has 1 or 2 numbers, insulin was given. Usually 1u with the exception of #151. Below 200 and I wasn't comfortable giving insulin.

Usually comes from:
I think first home dose had nothing in it and I didn't read the markings correctly, so gave .5u additional. Also, have some bubbles in syringe at times.

If there are 3 or more numbers in the loop, is was wanting data. The first and last numbers are usually the numbers before injection.

362, 309, 354, 358, 325
were an attempt at a curve, interrupted by an unplanned vet visit

First number in the red loop would be the first reading in the morning.

Today's numbers
amps. =369
+2. = 293
+11.5 =344
pmps =372

No computer at home. Internet connection via phone or work. Work blocks all things google.

Clarification: if a red ring has only 1 or 2 data points, insulin would be given each time as they represent am and pm reading. (Exception 151).

 

You could set up the SS from your phone and access it from where ever you are, you will have to install google drive and google sheets, create your account and once you've done that I'm sure some can help you set up the SS

Is your phone iphone, android or windows?