0/15 Shurshishka 100-400, need advice

Hello lovely people,

I am looking for advice for my fur baby because I can't seem to get her numbers regulated, though I'm close about half the time. I've come to learn my vet is a complete idiot and no longer wish to counsel them for advice. Some background: Baby was diagnosed Oct 6 and spent 3 days in the ER with DKA. $3,000 and a couple of months later and here we are. For about two months or so, baby has been on 2u of insulin. Her numbers were always 400+ because we were following the vet's advice and fed her DM savory, and no matter what we did we could NOT get her BG to come down. We had a trial period of about 3 weeks trying to see what brands she liked, and she ate low-carb fancy feast for a little bit before we made the transition to Tiki Cat a little while ago. She is now solely on Tiki Cat.

Since switching her diet, we are seeing varied results. Recently, when her BG rockets to 400+ we administer 2-2.25u of insulin which brings her down 100-200. She stays at 100-200 for about two doses (or an entire day) and then rockets up to 400 again where we give her 2.25u again. Sometimes it will go up to 250-350 in which we administer 1.5. I am looking for advice for what to do in this situation, her numbers are everywhere, and my vet is recommending a 3u dose (lol) and to not shoot her if she falls below 216. Consequently we've been flying blind with her dosage as we do not want to give her enough to get her hypo.

How much insulin should I be giving her? Should I be giving her a consistent amount?

 

Hi Lizzie and Furbaby,
I’m sorry you are having so much trouble. We will be able to help you.
Looking at your spreadsheet, I’d like to make a couple of comments which will help us help you.

It is important that you not only do the BGs before giving insulin but also during the cycles as well, because we need to know how low the dose is taking Furbaby because Lantus is dosed on the nadir (lowest point in the cycle) not the preshot. Without having any data taken during the cycles means we have no idea how high or how low the BG is going during the cycles and if the dose you are giving is the correct dose.

Looking at the limited data on the spreadsheet, it does look as if Furbaby is bouncing from probably dropping low during the cycles. That is why it is so important to get those BGs during the cycles. I would suggest getting a +2, +4 and +6 to start with during all the cycles if you can. If the BG is dropping fast, you would take the next test earlier.

Lantus works best if you don’t chop and change with the dose. So you need to stick to the same dose for at least 6 cycles to let the depot fill and stabilise. If Furball dropped low you would need to reduce the dose. We recommend increasing in 1/4 (0.25) unit increments, so we don’t go past the best dose and it’s safer for the kitty. Seeing you have given 0.75 Units for the last two doses I would stick to that dose and see how she goes with getting some during the cycle tests in.

When are you feeding Furball? Are you giving snacks during the Cycle as well as before the shots.?
I would suggest giving snacks at +3 and +5 to start with and see how she goes with that.

Are you still testing the urine for ketones following the DKA in October?
With a history of DKA and being unregulated I think it is important that you still test for ketones a few times a week, and more if she seems unwell or not eating.

Can you have a look at the two dosing methods please and choose which one you would like to follow please. Choosing a method is important as apart from giving you guidelines to follow, the two methods have different reduction BGs.
https://felinediabetes.com/FDMB/thr...-low-go-slow-slgs-tight-regulation-tr.210110/

If I haven’t covered everything please keep asking questions.
Bron

 

Hi Lizzee

Welcome to FDMB! It's great that you are feeding Shurshishka LC wet and home testing. That's more than half the battle won!
Linking your previous posts here: https://www.felinediabetes.com/FDMB/threads/new-member-huge-blood-glucose-spike-after-eating.240291/
https://www.felinediabetes.com/FDMB...this-forum-saved-my-cats-life-tonight.240455/

Lantus dosing is not based on pre-shot values but on how low it take the BG. You have to find a dose that you can shoot consistently AM and PM. Getting mid-cycle tests will help you determine whether the dose is too high or not enough.
The highs that you seeing are what we call "bouncing".

Bouncing is simply a natural reaction to what the cat's system perceives as a BG value that is "too low". "Too low" is relative. If a cat is used to BGs in the 200's, 300's, or higher for a long time, then even a BG that drops to 150 can trigger a "bounce". Bouncing can also be triggered if the blood glucose drops too low and/or too fast. The pancreas, then the liver, release glucogon, glycogen and counter-regulatory hormones. The end result is a dumping of "sugar" into the bloodstream to save the cat from going hypoglycemic from a perceived low. The action is often referred to as "liver panic" or "panicky liver". Usually, a bounce will clear kitty's system within 3 days (6 cycles).
https://www.felinediabetes.com/FDMB...tion-of-bouncing-that-helped-gussie-i.184405/

We follow 2 dosing protocols here and you can read about them here:
https://www.felinediabetes.com/FDMB...-low-go-slow-slgs-tight-regulation-tr.210110/

Since you are feeding Shurshishka low carb canned food, you can follow the TR dosing protocol. It is a more aggressive protocol than SLGS and requires at least 1 mid-cycle test in addition to the pre-shot ones but it will help you reach Shurshishka's optimal dose quickly and hold good doses longer

Most of us here use human meters since the strips are much cheaper than the AT and we test a lot.

I would suggest that you begin with 1U and shoot it morning and evening. Get tests to see where it takes her and we can adjust the dose accordingly.

Lastly and most importantly, are you testing her regularly for ketones? You can do this at home with ketone testing strips (ketostix)

 

Bron, we cross posted.

 

Hello and welcome to you and Furbaby to this forum. First stop for you is our Sticky Notes on the top of the forum. One of them describes the dosing methods we use here, there are two of them. Most people pick one that suits their lifestyle and goals. Since you are feeding low carb wet, you can choose either one. To answer the last question, yes, we dose consistent amounts. We also determine how to change the dose based on the nadirs, or low point of the cycle. So that means getting more tests between the preshots, including at night, ideally a test before you go to bed.

As for dose to give, it's hard to say with the dosing not consistent to date and little mid cycle tests.

For the spreadsheet, you can enter values on the World tab, and it will automatically convert to the US numbers.

Hey ladies, I'm the third one but a slower typer.

 

I will get her started on SLGS. Thankfully, for the first time it seems her BG is holding around 180ish for the third dose in a row, so we will keep her on .75 for the time being.

To answer some questions: We give her food at 12 hour intervals. Recently what she will do is eat a part of it, cover the bowl and then return to it a couple of hours later, so I suppose she would get one "snack." We currently feed her 2 2.6 oz cans per feeding, would it be smarter to disperse these throughout the day?

We do not test her for keytones. I have the strips, but the cat litter to catch the pee is very expensive and have no other idea how to catch the pee otherwise, if it would be possible to get some information on how to do this elsewhere that would be great. She doesn't seem to be showing any signs of DKA. The last time she showed signs of DKA she was sleepy all day, though you could rouse her awake. She sleeps her normal amount these days, and even gets her zoomies from time to time.

If I might ask, what counts as regulated? My vet told me as long as its consistently under 288 it would count as regulated. Is this correct?

I will be getting a human meter next Thursday as funds are a little tight currently but I will do reading on human meters in the meantime and keep the AlphaTrak in reserve for emergencies. I will try to take more tests to fill in the bumps a little more later today because it's currently the cycle where she tends to bounce. If she does bounce I will change the units to 1u and see how she does with that. It seems the diet change has done wonders for her, but has deregulated her system substantially.

Thank you for all your help. Even though it's been a couple of months I feel like I am still new at this, and would like to get her BG regulated as quickly as possible.

 

Feeding multiple small meals is definitely much easier on their pancreas. Even human diabetics do the same. Since the nadirs or low points are some where mid cycle will help keep her safe.

You don't need special cat litter to catch the pee. You can use small aquarium gravel, washed lentils or look at this post for some other tips. Tips to catch and test a urine sample

I see you are still entering data on the US tab today. If you look at bottom of the spreadsheet, to the right there should be another tab labelled World mmol/L. Enter the data on that one for it to automatically convert to the US tab.

Your vet is right, under 300 is one definition of regulated. There are more definitions in the Basics: New to the Group Sticky Note.

 

I will try to start feeding her in portions starting tomorrow. I will also experiment with ways I can catch her pee.

I've entered in some information in the World tab, but it doesn't seem to be transferring.... am I doing this correctly?

 

The data from the World SS is showing up on the US tab, but on the first line, overwriting what you had there before. The problem is all the previous data you had on the US tab. Tagging @Bandit's Mom to see if she can help you sort it out. I think the solution might be to enter the data on the 45th line of the World tab, which would line up with today's spot on the US tab.

 

I entered it on line 51 which seems to be working thus far. When I entered it on line 50 it didnt translate all the way. I have also put some seran wrap in her litter to catch her pee. I know she usually goes after her nightly feeding and she usually naps until about +9 until she starts begging for food. So far she is holding steady at around 180 so I hope this trend continues.

 

Don't be upset if the numbers don't hold. There are lots of factors that influence BG numbers -- stress, activity, finding a crumb of contraband on the floor, and even the moon (and I'm really not kidding!). Obviously, once a cat's numbers are trending down, that can also stabilize as your cat gets better regulated. It always helps to remember that your kitty is calling the shots -- we're along for the ride.

 

I had a good chortle at crumb of contraband. If the moon really impacts her numbers it must be on our side then!

As a quick update I tested her pee for the very first time today and it came up with a negative result (yay). I tried putting some seran wrap into the litter but she didn't like it and scratched it off... I then lifted the lid and just put a strip under her pee stream. I'm very surprised she let me do that because she's always been very particular about having her pee privacy. I wonder what else the vet failed to mention that results in me giving less money to them....

She is holding steady at around 9-10 for her fourth cycle in a row. Even if the numbers bounce again, I'm very happy that things are FINALLY starting to head in the right direction. I think what led to her previous DKA was having incredibly high BG for days, if not weeks. Probably closer to 32+. In any case, we have all the strippies we need to get her sorted out.

 

It's great to see those beautiful blues today Will send you a PM for the SS issues.