Update on Chloe

Hello everyone -

Some of you will remember me from only a month ago when Chloe and I had our first experience with the scary DKA. It was thanks to this forum and eventually the help of our local vet that got us through. I truly credit this forum and the valuable assets here that saved her life. We are SOOOOO grateful.

You haven't heard much from me because she's been doing so well and we had returned to our normal busy lives. She still has her occasional "shudders" or "shakes", so that is still alarming, but they have subsided somewhat. I had intended to come on here yesterday to tell you that everything was A-OK and to thank the wonderful people for their attentiveness and assistance, but we've been noticing a turn towards the DKA route again and so I am here once again asking for advice. I feel like I should send each of you a check or gift or something for your time and for those that stayed up with me for that 2 nights getting Chloe through this. I'm just so grateful for all that each of you did, so again, thank you. Please help me keep her out of DKA again. I hope I'm just over-worried and that nothing is wrong, and I'd love to bashfully "sit in the corner" and say "Oops, it was just a fluke", but I'm not sure...

Here is what we have been doing:
* Up until yesterday she was eating a combo of the dry high-carb food and the Purina DM canned food. I'd put both out and let her take her pick. When she was coming out of DKA, the carb foods were helping, so I continued with those, and started introducing the wet again. (Ideally, I'd love to pull her out of this diabetic state and have heard/read here that some are successfully able to do that.)
* I have NOT been checking her glucose regularly. Up until 3-4 days ago, she was back to her loving self that wasn't getting into mischief (we hadn't seen this in months or even a year +, my husband thinks she just knows how close to death she came and is grateful to still be alive - could be true.) I check her glucose only every several days at best. She had been in the low 200's.
* Insulin - still Lantus and still the 3/4-1.5 unit twice a day. Admittedly, 2-3 days ago she missed a couple of doses (not consecutively).
* Food/Water - she was pretty normal on this until the last few days again and has been eating an entire bowl of food + in a day, where as before these last few days, she was grazing and eating maybe half or so a day. She is urinating more as well, but not as bad as her pre-DKA days.
* Unlike prior to DKA - she has NOT retreated, hidden, distanced herself or what not. She is used to sleeping with me, and she does every night. She follows me around as normal and seems to be her normal kitty self.

BUT - as of yesterday morning, I took away her dry cat food - attempting to get that carb-rich food out of her diet. And when I checked her glucose this AM - it was 56. I froze in my steps, my husband and I just stared at the number a bit shocked. Her last few glucose readings are as follows (sorry, no chart...) All times are in Eastern.

6/9: 7am = 123
6/11: 7am = 284
6/13: 7am = 56 - put out dry food again, still eating the wet and administered 1/2 ml of karo. NO insulin given as of yet...

(somewhere between dates of 6/9 and 6/12 she missed a couple of doses of insulin - our fault due to late schedules or forgetfulness)

So, my question is (and thank you for taking the time to read this to get a thorough update - I figured since I hadn't posted for a while, I wanted to give as much info as possible) - do I need to take her to the vet? We're trying to bounce back from the $1500+ that we spent last month and yes she was worth it, but I know he will want to run a much of tests (or I fear it) and not sure the bank account can handle too much of that with other expenditures...

Please and thank you for the advice. As always it's much appreciated.

Chloe'sMom

 

On a human meter, 56 mg/dL is just above the threshold where we start intervening with high carb foods. For a pre-shot, though, and limited test data, absolutely no shot. See my signature link Glucometer Notes for some feline-specific reference ranges. Its a d*mn good thing you were testing and caught that!

With Lantus, consistency in dose amount and schedule is key to optimal use. Once she is back up over 200 mg/dL on a human meter, you may resume insulin. Dose adjustments are based on the lowest glucose post-shot, called the nadir. This is about +5 to +7 hours after giving it, with Lantus.

Sudden food changes can have sudden results, as you discovered this morning. Ditch the high carb dry food keeping her numbers up, and you may get her to a diet-controlled state in a couple weeks. If you must use dry food, Evo Cat and Kitten (pet supply stores) or Young Again 0 Carb (internet only) are available in the US. Pop over to Cat Info for some feline nutrition reading.

 

Hi again BJM - thanks for the reply. After seeing the 56 this morning, I set out the dry again hoping to boost her up. So, you definitely think we should remove it altogether? I'm happy to do so, but the low #s are scaring me. My sister suggested that I transition slowly, as anything abrupt may cause issues. That abruptness honestly could have been what sent her into DKA last month (just my assuming though). I don't have to feed her the high carb dry food, but I had set it out as she was coming out of the DKA per my vet's recommendations. He wanted her eating anything and everything she would and she does love it, so I put it out. For fear of her regressing, I hadn't taken it away until yesterday. But, maybe my approach was too much too fast - wonder if I should transition gradually?

 

This is the dry food she has been getting: http://www.chewy.com/cat/blue-buffalo-indoor-health-salmon/dp/32064

Crude Protein 32.0% min
Crude Fat 15.0% min
Crude Fiber 4.5% max
Moisture 10.0% max
Magnesium 0.08% min
Taurine 0.15% min
Omega 3 Fatty Acids* 0.5% min
Omega 6 Fatty Acids* 3.0% min

Doesn't list the carbs...

 

Honestly, because she has had DKA (ketones twice now?) the top way to prevent this from happening again and save yourself a lot of $ at the vet is to test daily. The ability to monitor her sugars closely will show you patterns where you can intervene before it gets to a point where she is sick and where you have to spend thousands at the vet. There is a great spreadsheet tool that you can download from this site that helps you track BS.

Likely, the ketones right now are due to missing doses, so you want to try not to miss any more. You may want to transition her first to a medium carb (10%-15%) wet food so she doesn't go so low that you skip doses. Then gradually switch that for lower carb wet food. You will have to track bloodsugars more closely with food changes, and you may end up reducing insulin.

For right now, add a bunch of extra fluids to her food if possible. The ketones can be flushed out early if you increase fluids and maintain her insulin doses, if she is still eating fine.

 

Its a high carb dry (about 35% calories from carbohydrates) and is keeping her numbers elevated.

Maybe phase out the dry per Meya, and see how the numbers shake out.

Can we get you started using our grid to record your glucose tests? It will help us give you better feedback. Instructions are here.

Understanding the spreadsheet/grid:

The colored headings at the top are the ranges of glucose values. They are color-coded to clue you in as to meaning.

Each day is 1 row. Each column stores different data for the day.

From left to right, you enter
the Date in the first column
the AMPS (morning pre-shot test) in the 2nd column
the Units given (turquoise column)

Then, there are 11 columns labeled +1 through +11
If you test at +5 (5 hours after the shot), you enter the test number in the +5 column
If you test at +7 (7 hours after the shot), you enter the test number in the +7 column
and so on.

Halfway across the page is the column for PMPS (evening pre-shot)
To the right is another turquoise column for Units given at the evening shot.

There is second set of columns labeled +1 through +11
If you snag a before bed test at +3, you enter the test number in the +3 column.

We separate day and night numbers like that because many cats go lower at night.

It is merely a grid for storing the info; no math required.

 

Thanks Meya. No, she doesn't have ketones that I am aware of, but just that her glucose took s nose dive to 56. Just checked her 20 mins ago and she's at 186. She's eating the Purina DM wet food which seems to be highly recommended for diabetic cats, but also had been eating the above dry food too. Her food consumption has been elevated quite a bit lately and she's drinking a lot more again too.

 

BJM yes. I promise I will work on that later today.

I was fazing - though maybe too drastically - the dry food when she plummeted to 56 earlier this AM. Still haven't given her insulin yet ad suggested above.

 

If you haven't given insulin yet, and you are seeing symptoms (excessive urination), ditch the dry since she is eating a canned food OK. Test her today and tomorrow to see how the numbers go - before feeding, about 2 hours after eating (probably food spike), and then 2 hours after that (to see if pancreas brought it down).

And no, prescription food for diabetics isn't really any better than Fancy Feast Classic pates. It just has better marketing to vets.

A test of 56 without insulin on board is terrific!

 

In that case (no current ketones) she's probably been running high and so you're seeing the general symptoms of diabetes (increased hunger, thirst, excessive urination). I agree, you can ditch the dry, and monitor her sugars carefully until they stabilize.

 

The 56 is a great pre-shot number and definitely means no shot for Chloe this morning so you did the right thing there. And while it's important that she gets insulin because of her recent DKA, you can only deal with the number you've got at the time and this morning that meant your only safe option was to skip a dose. I think that is telling you that getting the dry food out of her diet is most likely going to reduce her insulin needs - maybe even to the point of her going OTJ over time. And while it's important that she gets insulin because of her recent DKA, you can only deal with the number you've got at the time and this morning that meant your only safe option was to skip a dose. But because she's on insulin, as Meya said, testing her daily is going to be really important to make sure she's safe while you transition her to wet food as it sounds as though that alone is going to bring her numbers down significantly.

If you can gradually get rid of the dry food, possibly even switch her wet food to one of the cheaper options (Friskies or Fancy Feast pate varieties) and test her daily to make sure she's not dropping low, you shouldn't need to go back to the vet at this point especially if you can test for ketones as well.

 

I'm working on updating the chart. But checked glucose throughout the day yesterday and in the afternoon when she went to 310, I gave her a shot (3/4 unit) of insulin. Still eating a lot, giving mostly wet food with a few crumbles of the dry (so she doesn't have a belly ache) and as of 7:15am she was at 277 before I fed her. Gave her 1 unit again and had to leave for several hours as of 11am. She still had food and I didn't check her before leaving (glucose) and when I came home at 3pmEST (just 20 mins ag0), I saw she had thrown up all over the place and her food was gone. I'm cleaning that up now (Spot Bots are amazing) and checked her glucose before more food (she's eating like a horse and drinking as much as one again) and it was 37. I thought it was a fluke and tested again immediately and it was 36. I administered 1.5mg of karo and gave her wet food (the Purina DM). I will add this to the chart and see if I can share it here. I don't know how she can go nearly 250 points from one direction to the other in a matter of several hours. I have NOOOOOO idea what is causing this? I'm so scared of another DKA episode!!!!!!

 

I will also start testing for ketones ASAP. Feeling quite overwhelmed again. She's got a great attitude and is playful, cleaning herself, and normal Chloe self, but the eating and water intake is really really excessive again.

 

https://docs.google.com/spreadsheets/d/1gimBLPCMj5bzqRc9cJEvASTGRCGwOWvxfuqJOg_QrQc/pubhtml

Hopefully I did this correctly! This is not including May's DKA, but I have the notes if I need to add that info. Please let me know if this shows up. I had a lot of AMPS, so I added a note with the corresponding times. Thanks.

 

Manxcat - OTJ? Isn't 56 and now today's 37/36 extremely low though?? And then after her 56 yesterday, she shot up into the 300's. Now granted, I gave her karo for fear of her getting into some diabetic coma. I just gave her some now too for fear of the same.

Do you think it's ok to just withhold the dry food cold turkey? The wet is a diabetic food - Purina DM. I've heard great things and while it is EXPENSIVE, it's worth it. I also know she'll eat the Friskies Salmon Pate which is low carb too.

This is her now. She seems happy... being extremely rotten laying on Mommy's crafty things!

 

I, too, would have intervened upon getting a number below 50 mg/dL on a human glucometer or below 68 mg/dL on a pet glucometer. And as noted, that earns a reduction in dose.
See my signature link Glucometer Notes for some feline-specific reference ranges using various meter types.

The spreadsheet is coming up great. If you have any past numbers and can fill in any prior tests, that'll help us see any patterns.

Ketones result as a by-product from fat breakdown for calories. Generally, you need lack of insulin, infection, and high glucose levels for fat breakdown to start happening. Usually, 1 day of elevated glucose isn't going to do it, although each cat is different.

As long as she is OK eating canned food, I would drop the dry and monitor her glucose to see if it alters. ETA: IF you aren't giving any insulin, there is no risk she'll hypo.

 

The 56 is fine - it's anything below 50 that we want to treat to bring them back up. However, although I did once shoot a dose with a reading of 57, that came from knowing 100% that it was safe for me to do that and that I could handle any low number that it caused, so skipping was absolutely the right thing to do.

The 37/36 on the other hand is very low. You do definitely want to treat that with karo and keep monitoring to make sure she comes back up and stays up! Unfortunately, I'm not going to be here this afternoon - I'm pretty much on my way out for a few hours now - but I'm sure there are people around who can help you keep an eye on those numbers.

I wouldn't take the dry food away cold turkey, especially when she's dropping low...removing that could very well make her go even lower so I'd phase it out gradually at this point. The Purina DM isn't a bad food (as far as I know), but it also isn't necessary to buy anything more expensive than the Friskies or Fancy Feast.

What is is with cats and covering crafty things with their fur? My 2 do that as well - and have done since they were kittens. It's like a magnet for them - the craft stuff comes out and they have to sleep on it! Love your picture though - she looks so happy.

Oh, and OTJ is Off The Juice (also known as diet controlled or in remission).

 

BJM - I wasn't home to know that she had dropped that low. I checked her immediately upon coming home, but I can't be here 24/7 to watch her. I can fill in the sheet some more, but it will be from approximately a month ago. I didn't notice any change in her until a few days ago. I only gave her glucose yesterday afternoon when she shot above the 300's and this morning when she was in the 270's.

 

I'm confused - who got the test when she was that low, then?

Never mind - you got that when you got home, and gave Karo, which was good.

She's really taking you for a ride right now.

 

Manxcat - I understand! I was out earlier at an airport and couldn't be home - we all have lives, so please, your thoughtfulness is noted and appreciated.

Ok, so I will incorporate some of the dry and taper off. I mean, I'm giving her less than 1/4 cup now that this has popped up, but did take it away due to other suggestions. I'm SO confused! lol I think I will give her a few small pieces here and there, but ideally, I'd like for her to be on the wet. The problem is when we leave for hours and her wet food gets gross. I don't want to give her secondary problems, so the dry is there to keep her balanced. I will need to look into a low carb dry though so that if we are gone all day, she can eat ok. I don't think it's a good idea for us to leave her at home overnight anymore. I think she'll have to be boarded unless she gets OTJ as you say!

I know, she climbs in the Christmas decor, or my husbands suitcase, and even on our good clothes. She never bothers the old things, lol!!!

 

I took the test, but like I mentioned above, she was at 277 this AM. I gave her 1 unit and food and when I came back the food was gone and her glucose was 37. That was just in a matter of 7 hours.

 

Wowza!

 

When you have a moment, could you add a few tidbits to your signature? It will help us give you feedback without having to go look in all your past posts.

Editing your Signature

In the upper right corner of the screen, within the dark blue bar, you will see ID, Inbox, and Alerts

Click on your ID.

On the left, under Settings, Click on Signature.
This is where you will put information that helps us give you feedback.
This is where you paste the link for your spreadsheet, once it is set up.
Add any other text, such as
your name,
cat's name,
date of Dx (diagnosis)
insulin
meter
general location
any other pertinent issues like if there are any food issues, history of DKA, hepatic lipidosis, pancreatitis, allergies, IBD, etc.
Click the Save Changes button at the bottom.

Always click the Save Changes button at the bottom when you have changed anything.

 

I know! I updated the chart, but I don't know if you guys can see the notes I add to the fields or not? I think I added today's info correctly - 277 in the am and 37, 7 hours post shot.

 

Is that date of diabetes diagnosis? Hmm... I'd have to dig around for that. It's been about 2 years though.

 

Approximate is fine - its more about whether it has been going on for more than a year (long term vs short term)

 

I always, always go for safety above giving the shot regardless as do most people here - look at how many shots Rosa missed in her last 2 or 3 weeks because I had to be out for the day and she wouldn't let my husband test her. Sure, I didn't like doing it - but it was the only safe thing to do, and in the end it didn't cause her any real problems. There's nothing you can do about the times you can't be home - you have to have a life yourself (and even if you chose not to, there would be things you HAD to do anyway). And there's no way you could predict a dive like she pulled today - a number in the higher 200s should have been completely safe to shoot...Chloe just obviously had other ideas this time!! I do think it's likely that Chloe is trying for another reduction already, so with that and reducing the dry food, the only thing you can do is play it safe - if that means skipping an occasional shot then so be it. Though I agree on not leaving her alone overnight while she's tending to run low numbers like that. If she'll eat the low carb dry, that could be a good choice for now - especially in the warmer weather, I've noticed the wet food getting a bit icky looking by the end of the day (not that it seems to bother the cats, but I've been trying to replace it slightly more often than every 12 hours just in case).

And agreed on the climbing in and onto things - if we're trying to pack for a trip, I can guarantee there'll be at least one cat in the suitcase on top of the clean clothes we just packed within seconds! If only they'd go for the old stuff instead.

I'll check back on this thread when I get home later to make sure you're doing OK and that you've got any help you need.

 

Just checked her glucose again - updating chart, but it's at 101. Whew....

 

Karo wears off pretty quickly. If you're past nadir, she'll start gently climbing as the Lantus wears off.

 

What is nadir? yeah, I'm sure it is the karo buzz. It wore off quickly during DKA, but if she does what she did yesterday, she'll climb into the 300's and then I'll give her a shot. I might only go for 1/2-3/4 unit this time.

 

Nadir is the lowest BG between shots

 

Nadir is the lowest glucose post-shot. It is used to evaluate the dose. For Lantus, the nadir period is roughly between +5 to +7 hours after insulin is given. It isn't a set time, just a general period. Testing then allows you to see if the dose needs adjusting.
We have 2 protocols for using Lantus
Tight Regulation
Start Low, Go Slow
Check them out and see what may work best for you.

Also, when you intervene for low numbers, it doesn't take a lot. Just 1-2 teaspoons of gravy from something like Fancy Feast Gravy Lovers can help bring up the numbers without over doing it.

 

Thanks Manxcat as always.

This is right now... You'd never know she was so low! She wasn't like this at all during DKA. It just makes me smile!!

 

She's at 203 right now. Still eating, though sleeping a lot the last few hours. Should I give insulin? Went from 37 four hours ago to 101 two hours ago and just moments ago is at 203.

 

If you include the reduction of 0.25 units off the dose for going so low, yes. She is rising pretty fast, so she may be starting to bounce. Compensatory hormones release stored glucose (glycogen) when the glucose drops suddenly or to an unfamiliar number. This raises the blood glucose for up to 3 days, which you just have to wait out.

 

Ok, so she was getting 3/4-1 unit, so I should give 1/2- 3/4? It's so crazy - prior to DKA she was getting 3 units twice a day! Ok, so the bounce might be temporary? I'm still trying to determine if this drastic up and down is serious or even what to make of it! It seems odd to me, but obviously I have a lot to learn still.

 

What did you shoot today? Drop 0.25 off of that. Aim to be as consistent in possible in the dosing.
Bounces are temporary and clear within about 3 days.

 

Ok, I'll go for 3/4 this evening. And when should I watch for her to drop again? Do I need to get up throughout the night to check her glucose you think? It's 7:45pm now.

 

With Lantus, snagging a +2 may give you a clue whether or not she is going to dive down again. If it greatly lower than the pre-shot, you'll need to monitor some overnight, or abort the cycle by feeding high carb food so you can sleep.

 

Wow, great BJM. Thanks! Sounds like a plan.

 

Once you get your spreadsheet set up, you can start posting in the Lantus/Levemir forum, where all the folks use one of these depot insulins.

 

She looks so happy in that pic. That's so lovely to see! I remember how great it was to see Rosa get back to normal after obviously feeling so ill for a while - it's just the greatest feeling in the world!

I definitely agree on getting the +2 reading when you can - we can often get a good idea of where she's likely to go over the cycle from that so it gives you a heads up if you maybe need to leave her with some medium or high carb food if you have to go out for a while. If you can post her pre-shot and +2 numbers tonight, I'll look in and help you work out whether she needs testing again later or if she's likely to be safe to be left overnight.

 

Ok, her last pre-shot test was at 7:15, which was 203, then I had someone drop by the house, so I didn't get her insulin of 3/4 given until 8pm. I just tested her now and she's at 297, 2 hours post shot.

And thanks again Manxcat!

 

That's fine - usually if the +2 is higher than the preshot, that means it should be a fairly quiet cycle (she might even bounce from the low numbers earlier today). A test just before bed never hurts just so you can sleep through knowing she's not dropping too fast at that point, but I don't expect her to do anything too alarming tonight based on that +2 number.

 

Whew, ok! I am happy to hear that. I probably will head to bed by midnight which will be +4, so that should tell me too. So, I guess the big question is what do I do in the morning? If she's super low, or super high, what would you guys recommend? She will be due for her insulin (if we go back to the every 12 hours) at 8am EST which is 9 hours from now.

 

If you get a +4 and she's still good, then you're definitely good to get some sleep. It's always nice when they have a night where they run a bit higher so you don't have to set alarms and get up a couple of times!

I'm not going to be around for your AM shot time as that's only 5am here. However, given that she might be bouncing, I wouldn't be too surprised if you see a higher number in the morning than you've been seeing recently. If that happens, you should go ahead with the reduced dose...you don't want to give her the same dose that dropped her low today and she definitely earned herself a reduction!

If she's really low, then I hope someone will be online to help you decide what to do based on how low she is at the time. You do, of course, have the option of skipping or reducing the dose further than the 0.25 reduction she earned as a one-off reduction to keep her safe if you get a number you're not comfortable giving the full dose at. Some cats can clear bounces in just a few hours as they get more used to being in normal numbers so it's possible you might get a fairly normal number from her in the morning (which would make it much easier for you to decide what to do as that way she can have her dose based on the reduction she earned today).

 

Thanks for the info again Manxcat. Do you think it's possible (totally reaching for the stars of hope right now), that she could be getting used to the wet food and not needing as much insulin? I'm not sure why she'd have these extreme high 300's and then lows in the 30's and 50's, but again, I have a lot to learn. I'm hoping that someday she can be OTJ as you put it (I totally love that btw!) and be free of this burden. I think I'll get some of that Friskies Salmon Pate too so I can make my $44 of 24 cans last longer. lol

And bouncing is when she goes extremely high from being low, correct? (Just making 100% sure I have my terminology correct). What numbers are ok to give insulin? 200 and above? Or 150+? Or? I'm not even sure what a normal cat glucose level is. I've read so many different numbers on websites, but I know that whenever they did her blood work nearly 2 years ago, it was elevated enough for them to know she was diabetic.

Thanks again!!! You're so helpful!

 

Yes, bouncing is going extremely high after going much lower than normal for that cat, from dropping very quickly, or both.

See my signature link Glucometer Notes for feline-specific reference ranges using a variety of glucometer types.

 

It might be that she's dropping even into the low 100s or upper double digit numbers and bouncing from that - cats that have been running high can bounce even from numbers in the 200s, though Chloe is better regulated than that at this point for sure. Then, if the bounce breaks, she could drop quickly again. It is, of course, also possible that the combination of diet and regular insulin is reducing her insulin needs. That's a perfectly reasonable hope to have at this point. And yes, at that price for 24 cans of food, I'd add in some of the Friskies as well - I pay about $15 for 32 cans of Friskies pate at Walmart!!

You have bouncing right. We usually give 200 as the no-shot number for a newly diagnosed diabetic, but that does reduce with Lantus as you get more experienced and have more data on what she tends to do with the insulin. Eventually, most people giving Lantus to their cats will shoot anything above 50, but that takes time and data. And the first time you shoot a low, or low-ish number we would always want there to be someone experienced who can stick around to help you if Chloe drops low. You might want to think about 150 as a no-shot number (or at least the number you ask for help) with Chloe as you've already handled some low numbers so you do have a good idea of what to do with them.

Normal cat glucose levels, generally, are between 40 and 120 on a human glucometer. BJM's document has a lot more information on that, but if you're just looking for quick numbers to refer to those are around what we'd consider normal. We don't like our kitties on insulin to go below 50 for any length of time as there really needs to be some sort of safety net to catch them before they go way too low - it can be difficult for them to bring their own numbers back up when they have added insulin in their system pushing them right back down again.

 

that was a great pic. she looks content.

some of us have made foodcicles for longer periods.... some kitties will lick it when frozen... but it keeps the food fresher longer if you are in a
warm climate.
the other trick is to add water, make the food soupy, that will also keep the food from getting dried out and undesirable.

 

Thanks everyone and good morning. I just checked her AMPS and she is at 363! Yikes, these extremes... last night almost 12 hours ago she got 3/4 unit. I'm going with the reduced dose and will see how she does. Thanks.

 

It can take up to 3 days for a bounce to resolve; that is normal. (*sigh*)

 

I just checked her at +2.5 and she's at 267. Should I check again every 2 hours, or wait until later?

 

I think I'd wait to test until sometime between +5 to +7 hours, when she is most likely to be lower.

 

She's stayed in the 200's all day. I administered 1 unit this evening, since she's been higher today. Hopefully that wasn't a bad thing to do. I'll test at +2.

 

Great ideas, thanks!

 

She's bouncing from going low yesterday. It'll calm down in another day or two.

 

Yeah, this is now day 3 - she started low on Saturday. I've pretty much taken all dry food away. She's eating through the Purina DM faster than I can put it out. Truly, I just put out 1/3 of a can for dinner (she's had the other 2/3 already today) and it's nearly gone. She runs out of food in the middle of the night, so that is why I'm tempted. Ideally, her on the high carb food isn't good, so I know I need to just give her more of the canned. I keep updating her chart - glad I have that going now. I'm still too new to understand the trends, so do we just stay with the 3/4-1unit and wet food for now? I am probably driving all of you insane, and I don't mean to. I just want to double check myself and ensure she stays out of DKA (which I thought was from really low BG #'s, but now I realize it's from really high BG #'s. Oy!)

 

You need to decide what protocol you want to follow for the Lantus.
At a minimum (Tight Regulation), you hold the same dose for 3 full days, then assess during the nadir period.
For the Start Low, Go Slow protocol, you hold the same dose longer and run a curve to evaluate the dose.

 

Shoot - I gave her 3/4 unit yesterday and 1 today - although those syringes are so tiny, I guestimate on the dosing. I think I'll go wtih the Tight Regulation, but I feel like I might be walking into a dark hole alone. I'd love to get her OTJ!

 

That's OK - just pick one of the doses and try to stick with it for a few days. Personally, I'd go with the 3/4 unit as the 1 unit dropped her low yesterday.

You're not walking into a dark hole - you've already handled low numbers and got through it. And there's no guarantee that even on SLGS you wouldn't see a very low number like that now and then - even though that isn't the aim with SLGS, our kitties do like to surprise us sometimes!! And you'll never be alone on here - there will always be someone around who can help you with any questions you've got and give you support on the days when Chloe drops low (or even just the days when you're finding it all difficult to deal with - those days happen to us all).

 

Ok, I'll switch back to the 3/4 in the AM. I just checked her +2 and she's higher like she was last night. No low #s today though, so that's good.

I know, sorry - I know I have people here, I just think that trying to follow the protocol might be tough. Sounds like a need a few more things before starting it though. I don't have syringes that have the 1/2 unit markings. And I know I'll need Lantus again, and at nearly $250 last year, I'm sure it's gone up this year.

Manxcat do you have any experience with either protocol? Seems many go with the Tight Regulation, but I'm intrigued by your kitty's success! And just like in my business - you learn what has been successful and go with it!

 

A really important note: we adjust the insulin dose based on the lowest glucose post-shot, aka the nadir. It is more of a time period, as the actual low may move around a bit.

Check our Supply Closet forum area.

 

She's definitely doing well today - no real lows and nothing too horribly high either. With her +2 being higher than her pre-shot number, it will most probably be another fairly quiet night for Chloe though, like yesterday, a before bed test is a good idea just to make sure - kitties do like to keep us on our toes some days with unexpected numbers!

The Tight Regulation protocol can be tiring at times - I'm not going to lie to you about that. There are days when they look like they might head low when you might have to get a couple of tests in overnight. But it does give you the best possible chance of getting a cat OTJ - and remember, if Chloe doesn't head in the direction of OTJ and you want to switch to the Start Low Go Slow protocol sometime in the future, you can still do that too.

Walmart sell syringes with 1/2 unit markings - as far as I know, all their 3/10 cc syringes come with the 1/2 unit markings (though the pharmacy staff don't always know that). And buying Lantus from Marks Marine in Canada is about 1/2 of the price of buying it in the USA - I believe they're somewhere around the $150 mark for a box of 5 pens at the moment, where those same 5 pens here will cost upwards of $400!!

I had Rosa on Tight Regulation (with more testing than is strictly necessary as she did like to dive on occasion, so I could never be sure that she wouldn't pull a sneaky fast drop on me if I wasn't paying attention). She did respond better to the protocol than I could ever have hoped for given her dreadful numbers for the first couple of weeks and, although I did have days where it was tough going and days where I doubted what I was doing, it did definitely work for her in the end. I have to say, much of the credit for that goes to the people here who welcomed me when I first joined, answered all my questions no matter how small they were, and were there for me on the days when Rosa was dropping low and I needed support or when I wasn't sure what to do next with her dose - I really don't think I could have kept up with the protocol without this board!

 

When you feed there is very often a food spike by about 2 hours later. That is why a drop by +2 suggests an "exciting" cycle. It is also a reason for spreading out the food into mini-meals - it keeps the food spikes from being too high.

 

I keep the food out all day, she's a grazer, but she just eats through it so fast that I now have to replenish so regularly. She will eat for a few minutes, sleep for a while, eat some more, walk away and head right back. (The life of a cat, eh!?!) LOL - Eat, sleep, and eat some more, lol. I am giving her just the Purina DM wet and adding some water like @rhiannon and shadow suggested. That seems to be helping it stay nicer longer!

 

Until she gets more regulated, she'll be more hungry because she can't use all of what she needs.

 

Thanks @manxcat419 ! Are you guys able to see the chart ok? (Just wondering if it is populating the updates ok. )

I'm about to head to bed now since it's almost 11pm, but feel ok that she's not too low. Thank you for the tips on the syringes at Walmart! And I had NO idea we could buy medicine from Canada?! I'm not familiar with the pens you mentioned, but her Lantus is in a vial. If that is cheaper and if I can order it from there, that would be amazing.

Tomorrow I hope to have time to read through the Tight Regulation after work so I can get her going on that soon. I'll work on getting the new syringes and the Friskies (the Purina DM is going out of style over here, lol!!!) and hopefully she eats it as well (she liked the salmon pate the best before) and I might find some low-carb dry food for when we're out of the house for hours at a time.

Yes, I agree, if it were not for this forum, I do believe that a month ago today, I would've lost my Chloe. Our new vet and the ER vet wanted me to put her down when I took her home on 5/14. It was really awkward, but I told them I needed to try everything. I'm thankful I found this forum and the people here got us through it. Our new vet (we had relocated) is so amazed that she's improved. When I call for the syringes, he will be even more impressed! I can't thank you all enough!

 

If your state does not require an Rx for syringes, you can just get them from a pharmacy, probably less expensively. A box of 100 U-100, 3/10, 30 gauge, short needle syringes was under $14.00 the last time I bought some.

 

Yes, I can see her spreadsheet - it's all working fine.

I think Chloe's going to be fine tonight - her numbers have been fairly steady all day which should give you a chance to get a good night's sleep. The Lantus pens are a direct alternative to the vial - it just means that, especially with a cat on a fairly low dose like Chloe is at the moment, you should be able to use up all the insulin in the pen before it stops being as effective as the pens contain 300 units each and come in a box of 5 where the vial is 1000 units which is difficult to use before the 6 months is up unless a cat is on a high dose! Your vet will be able to prescribe the pens instead of the vial, but you might have to ask them to do it that way - my vet prescribed the vial and I didn't know any better at the time and paid almost $300 for it at Costco. Though I was able to pass about 2/3 of it on to someone else whose cat is on a higher dose, so at least I didn't have to throw the rest of it in the trash.

And, as @BJM said, I didn't need a prescription for the syringes - I just went to the pharmacy counter in our local Walmart and asked for them though whether or not you can do that will depend on the laws in your state. My vet had added syringes to the prescription initially, but the ones I was given when I bought the insulin were 1/2 cc with whole unit markings only so I had to replace them almost immediately as I couldn't measure even a half unit with them never mind 1/4 or 3/4.

I'm so very glad you found this board and were able to save Chloe. Hopefully your vet will be more optimistic with any other cat that is taken to them with DKA in future - Chloe has proved to them that it really is something that cats can recover well from.

 

I'm worried that you will pick some dry off the shelf thinking it's "good" but there really aren't any. Grain free does not equal carb free or even low carbs.

there really is only one "low carb' dry that seems to do the least damage if one needs a dry food....
it's call Young Again Zero Carb
some here calculate it to actually be 5% carbs....
it seems expensive but because it's higher calorie, kitties only need 2 tablespoons a day so a bag will last quite a while. And warmer climates should
keep it in the freezer... or at least part of it until needed.
this is the one dry that we've actually seen a few kitties achieve remission status.
I think they will send you a sample if you call.... and it's only available online. You can't buy it in stores.

Evo is the next least worst.... BUT .... i haven't heard ( not yet anyway) of any cats every achieving remission eating it.


If you can manage to stay with wet only, that's truly the best option....
I just want you to have the right info..... since it's your decision.


I'm really glad you are sticking around....
this is the best place to be with FD.
It's a lot to learn really fast but it becomes second nature over time....and you gain time with your furbabies.

 

Thanks @BJM , do we need a Rx here?

@manxcat419 - Ok, I will have to look into those more. And 6 months? I thought it was good until it was gone? Our old vet, before we relocated, told me to just hold onto it until it was gone. I'll have to look to see when I last purchased the Lantus, but it was probably late last year sometime. Not until yesterday did I even know that other syringes existed. I do know that one time our pharmacy (where I lived, they required a Rx) gave us ones that were 1/100 I think? They were so large that one unit was impossible to see - let alone ones thatYes, thank you, I'm glad to be here too. I feel like I have a family of supporters, and it's just so nice! I really am excited to get Chloe OTJ and hope that she can be!

@rhiannon and shadow Ok, thanks for the info. It would be only for the days that we were out of town for hours on end (not for overnight stays) like we have coming up this weekend. But, I can try a bowl or even two of canned food with water added to help it last longer. It's warm here, but we keep the house very cool, so I will try that. I think she'll eventually slow down on the eating, once we get her stabilized. (Hopefully)

Thank you all for your continued support and help!

 

As @manxcat419 suggested above "You might want to think about 150 as a no-shot number (or at least the number you ask for help) with Chloe as you've already handled some low numbers so you do have a good idea of what to do with them." , I'm asking since her AMPS was 148, taken just moments ago. She's eating, etc, but wondering if that is too low, or a better number since she's purely on the diabetic foods?

 

There is 1 cat I know who went OTJ on a combo of Evo dry and Fancy Feast Classics - Dusty. He belonged to a woman with diabetic retinopathy and arthritis who had difficulty testing. I went over ther weekly for a few weeks, and would run a curve. He was OTJ in about a month.
When you get a low pre-shot number, stall 30 minutes and re-test, then evaluate what the glucose is doing - dropping, maintaining the level, or rising.
Starting out, you don't want to shoot a dropping number, especially if you won't be able to monitor.
Shooting a stable glucose level may be OK if you have data in your spreadsheet which show it could be safe.
Shooting a rising number is often safe; if you are starting much lower than usual, you may want to monitor the first few times.

 

If you can monitor and test through the day at 2 hour increments, go ahead and shoot. Otherwise, I'd drop to 0.5 units, as we don't have enough data to know what her best dose may be and we want her safe.
It is possible to shoot low to stay low when you have data to show it is safe. It is collecting that data which may turn your hair white! When you get it, though, you can get to the point that the numbers are near normal non-diabetic ones which helps the pancreas recover (if it can).

 

If you were lucky with it, it might last longer than 6 months but most people here seem to find it stops being as effective around then. Your vet might not have known - it's not always easy to be certain...the manufacturer says 28 days, a lot of vets say 3 months, but people here have found that up to 6 months is possible. If you're still using that original vial and it's clearly still working, then that's fine - you can keep using it. If you can get a prescription for the pens anyway, you can still go ahead and order those (unopened they're good until the expiry date) and that way if you find her numbers start rising, you'd have new insulin to use without having to wait for delivery of it.

The 148 this morning is a good number and close enough to the 150 that, as BJM said, if you can monitor it would be fine to shoot the full dose. But if you reduced for safety, that's fine too - the way Chloe's going, you'll have other chances to shoot those lower numbers soon I'm sure.

 

Well, busy day today, so I didn't shoot at the 148, and now she's coasting in the 300's. I gave her a shot at 1:15pm (so not the right time, but wanted to wait until #'s were higher) and so her next dose is due at 1:15 am.. zzzzzzz.... I just checked her 30 mins ago and she's at 316. I was almost wondering if I should shoot her now? Honestly, the 1pm/1am thing won't work for long... oy.

 

The thing you need to be careful of is that shooting early acts like a dose increase so, while she might be high now, shooting early might make her drop low later on. You could do an 18-hour shot instead of the 12 hour to get your next shot back to the morning, but with her running fairly high now I don't know if that's something you'd want to do as it would mean delaying her shot until about 7am?

 

Right, agreed. I can stay up, or set an alarm. I have about 2 hours to go. So, I'm working/surfing to stay awake. lol

 

If you're tired, I think I'd go with setting an alarm and trying to get at least an hour's sleep before her shot - there's no point in exhausting yourself when she's not going to do anything alarming in the next 2 hours. You can always work on adjusting her shot time back starting tomorrow - and you will still have the option of doing an 18 hour cycle at some point or skipping a shot if she's low enough to get back on track.

 

What numbers should I consider a skip? I feel like she's keeping me on my toes lately!

 

I think it's going to depend very much on whether or not it's a cycle you can monitor. If you can't be home with her, then I don't think I'd shoot below 150 at the moment - she definitely is throwing you plenty of surprises...our cats don't like to let us get too used to them having the same reaction to the same dose in case they finish up getting less attention if they're too predictable!

On a cycle you can monitor, especially if you've got someone here who can stick around in case she drops low, you could shoot a bit lower than that but that would really depend on how confident you're feeling at the time. Of course you can always post asking for advice if you get a low preshot - that way you'll know if there's someone who can be available until after her nadir in case you need some moral support if you decide to shoot a lower number.

 

Yes, she's keeping me alert, that's for certain! So, if she's below 150 and I can't be around to watch her, then I should skip, but if I want to get on better hours, and she's in the 200's, going 18hours might be ok? I'm going to go snooze and I'll be back in 2 hours to give her a dose. Thanks again!!!

 

Yes, that will definitely work. If she doesn't give you the opportunity to go longer between shots, you can move them back by 30 minutes a day until you get back to your preferred time too. It doesn't sound like much, but it adds up quickly and you get back to your regular shot time before you know it!

I'll be here for your shot time in case you have any questions, though I'm sure the 0.75U will be fine this time - I can't imagine her dropping 200 points in the next 2 hours, but then she is a cat!

 

You've got your signature and your spreadsheet, so if you'd like, you may start posting over in the Lantus-Levemir forum.

 

Manxcat she's at 276, so I'm thinking I will go for 3/4.

 

3/4 sounds good to me. And then try and get a least a couple of hours sleep before you test again - no point killing yourself to stay awake when she's unlikely to drop very low in the next 2 hours.