Cat not responding to Glargine Insulin

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HeidiBroward20

HeidiBroward20

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Hi. I'm new here. I don't have ready access to any vet other than one that can do simple things. Diabetes is WAY out of his league. I suspected Blackie had diabetes for a long time... but for various reasons I won't go in to, I held off confirming it. He was eating fine and peeing fine. Until 2 weeks ago. Then he started drinking water like a fish. That was when I got concerned. Blackie is a rescue American Shorthair. We are not sure of his age but I suspect around 16 years. He has been a beloved member of our pride for 7 years now. He has always been heavy. He weighs 24 pounds right now. I mostly feed him raw ground chicken breast with raw eggs and other goodies of various types of vitamins in it. I do not freeze the meals. One chicken breast vacuum packed will last a long time in the fridge. I live in Southern Ecuador and while there is access to Insulin, there is not ready access to vets and I am struggling with the language as it is. I took Blackie down last Wednesday for a blood draw, and here we can take our own blood samples in to the lab and they will test for animal or human. I took over a fresh sample of his pee and his blood. His mg/dl was 420 - he had also eaten the high protein breakfast about 2 hours before that. I got insulin and started him on it the next day at 1 unit, .25 on the 100IU syringe. There has been no change to his mg/dl except that it has gone higher on that dose. I upped it to 1.5 units starting last night. I give it 2x a day. I tested his blood with my newly purchased glucometer this morning before feeding him....... 505 mg/dl. I checked it again at 3pm and it was 419 mg/dl. There is no way I can get any other kind of insulin for him down here.

I am thinking of raising the dosage to 2 units a day starting tonight. My feeling is I have waited too long to treat his diabetes and I might be too late as he appears to not be responding. Since he weighs 24 pounds, maybe 4 units a day would be what he needs to start bringing it down to the 250 - 300 range. If I could get it in that range I would feel really happy. Maybe American Shorthairs are more prone to diabetes?

LIke I said earlier, I do NOT have a vet to consult about this treatment process. I am on my own. I do have a WA State number down here thanks to Magic Jack. So if anyone feels inclined to call me it is 360 567 6178. We are on Eastern Time Zone.
 
I do not understand what you mean by " 1 unit, .25 on the 100IU syringe."?
What capacity insulin syringes are you using? U1100 insulin syringes come in:
- 100 unit/1CC capacity. Those are marked every two units
- 50 unit/1/2 CC capacity. Those are marked every unit
- 30 unit/3/10 CC. Those are marked either every unit or every half unit.

How long on the one units?. It can take the body 3-5 days to build up Lantus/Glargine to see consistent effect.
Can you post the BGs in relation to when the shot was given and when fed.
For example, the BG right before show would be either AMPS pr PMPS. BGs in between would be +X BG where the X is hours after shot and BG is the measured BG
 
Thanks for your reply. I started on the 100 unit /1CC syringe and only gave .25 of the 1 unit measurement. Then thanks to the advice of some great folks here, I searched for the 30 unit/3/10 cc syringe. I have been using that one now for 2 days. On that one I give up to the 1st 1/2 mark 2x a day. It's been 6 days - tonight will be the end of the 6th day.
 
Clarification... it's been 2 days on the 1 unit 2x a day. So maybe give him 1Unit through tomorrow and if he still has super high readings, up it on Thursday morning?
 
0.25 of the first marking on a 100 unit syringe is 1/2 unit.
I would increase to 1 1/2 units Thursday if you do not see an improvement on 1 unit
 
Hi Heidi and extra sweet Blackie!

Lantus (glargine) takes 5-7 days before you will really know how it's working (when you first start). If I'm counting right, it looks like Blackie has been on it for 6 days?

Do the syringes you were able to buy (the 30 unit ones) have half unit markings? We usually only make changes in dose of .25 to .5 unit so it helps to have the half unit markings.

We have a great spreadsheet that will really help us to help you determine how Blackie is doing. Here are some instructions on Setting up a spreadsheet. If you have trouble with it, let us know! We can get it set up for you and then transfer it to your name to continue entering data.

There are 4 tests that are really important. Testing before every shot (the Pre-shot) test to make sure they're high enough to give insulin, and then at least 1 test at +5 to +7 during the AM cycle, and a "before bed" test on the PM cycle.....+5 to +7 is 5 to 7 hours after the shot....we use the + system here since everyone is in different time zones. We need to know how low each dose is taking him, so we're looking for the "nadir" (the lowest point in the cycle) which is usually about 6 hours after the shot, but varies from cat to cat. Of course the more tests, the better! There's no such thing as too much data!
You say you tested at 3pm....how many hours after the shot was that? (for example, if you shoot at 9am, 3pm is +6)

It's important that you give the same dose every 12 hours for at least 3 days now so it has time to really see how it's doing, and get at least those 4 tests in. We can help guide you on dosage from now on so you don't have to worry about dealing with a vet. You're actually very lucky to be able to get Glargine! It's one of the best insulins for cats!

If you have any questions, please ask! The people here are great!

Edited to Add...Here are some pictures of doses.....The 6th picture shows 1 unit and the 7th picture shows .5 unit....I'm still not quite sure what dose you're giving. Syringe pictures
 
hi heidi!

how is Blackie behaving? is he acting fairly normally, or sickly? the drinking excessively and eating a lot is normal for any unregulated cat, but other than those, how does he seem?

You have to go slow with adjustments of Lantus, but you may have started at too low of a dose for such a big boy. His 24lbs = 10.9kg and the formula for starting with Lantus is 0.25u/kg of the cat's IDEAL weight. What weight do you think he should be at? If his ideal weight is 12lbs (5.5kg), that would be a starting dose of 1.375, so we'd suggest you start at 1.25u per shot.

Take a look at the Tight Regulation Protocol page - look about 5 paragraphs down for the PDF that is called "Management of Diabetic Cats Using Long-Lasting Insulin." It's the latest publication of the protocol that we use to treat cats. (you don't need an AlphaTrak, however, we "speak" in human glucometers.) The premise of tight regulation is that if a newly diagnosed (less than 1 year) cat is kept "tightly regulated" meaning that their blood sugar is kept in normal range (50-120), their pancreas has the ability to heal and the cat may be able to go off of insulin and be just diet controlled. That's a pretty powerful incentive for most people to give it a try. Even people who work find ways to get enough tests in to try to get their cat tightly regulated.

If you're interested in that, as soon as you get a spreadsheet set up, i'd encourage you to post to theTight Regulation Insulin Support Group and we can coach you in what you need to know to manage Blackie. We rely heavily on the spreadsheets - individual numbers don't mean as much as numbers in context, both relative to when the cat last ate, and what the rest of the numbers are in the past 3 days. So if you can use the link that Chris gave you and get his numbers on the spreadsheet as best as you can, that would be awesome.

"General" Guidelines:
Hold the initial starting dose for 5 - 7 days (10 - 14 consecutive cycles) unless the numbers tell you otherwise. Kitties experiencing high flat curves or prone to ketones may want to increase the starting dose after 3 days (6 consecutive cycles).
Each subsequent dose is held for a minimum of 3 days (6 consecutive cycles) unless kitty earns a reduction (See: Reducing the dose...).
Adjustments to dose are based on nadirs with only some consideration given to preshot numbers.
Click to expand...

Sometimes numbers are high because the cat's blood sugar has gotten low and the body has reacted to a perceived hypo. It doesn't need to have gotten into a dangerous range - if his body has gotten used to 400's and he gets to 200's, his liver might react to send him back to 400's. When we see his numbers on the spreadsheet we can tell if that's happening or if he needs more insulin. That's why it's important for us to see his numbers in context on the spreadsheet. If you need help with that, just say so. There are people who can help you set it up - just say so if you're having trouble.

The raw diet is great! You don't need to change his food.

He's awfully heavy - i don't think American Shorthairs are prone to diabetes, but his weight may be a problem. Cats need to lose weight VERY slowly, though, so don't just take off with that yet.

Sounds like you've got the right syringes now. Consistent dosing is important with Lantus, so you may want to keep a used syringe with colored water (tea?) in it to show the dose. If you don't have 0.5u markings, then the comparison syringe is even more helpful.

what glucometer are you using?

Make sure you have a hypo kit put together, just in case you need it. Here's a link to the New to the Group? yellow starred sticky that will have lots of good information. At the bottom of that page is a link to what should be in a Hypo Toolkit. When you've gone through it and the TR page, also look at Lantus & Lev, Info, Proper Handling & Storage. Lantus needs to not get contaminated, so you want to watch the video on that page and read the info so when you draw up Blackie's dose, it keeps the Lantus from getting contaminated. If you take care of it, it should last for several months.

so - i hope i haven't overloaded you!

---lots of reading - you don't have to memorize it, but just take a look.
---get a spreadsheet or ask for help if you have trouble.
---and tell us what glucometer
---how much you think Blackie should weigh
---let us know how he's behaving/feeling.

Keep asking questions and we'll do our best to help you. We do diabetes 24/7 - we can teach you what you need to know to help Blackie, even in Ecuador! We have members all over the world here. Welcome!

There's often someone online here - we can help you with managing his insulin dosing. You won't need a vet for it.
 
This is important as I am seriously getting confused on the dosages: the first 1/2 mark on the 30Unit/3/10cc is actually 1/2 a unit for people. For cats, isn't it just over 1 unit in the U-40 measurement conversion? I thought 1 Unit of people Insulin equaled 2.5 Units for cats? Or are we measuring it simply as human units for simplicities sake? Meaning, when it is said that cats usually start out at 1 Unit, is that one HUMAN Unit or do we convert the unit to the U-40 Insulin measurement and adjust the dosage using a U-100 syringe accordingly? I have been giving him up to the first .5 mark or a little over on the 30 Unit 3/10cc U-100 syringe. If I move the dosage up to the 1 mark is that not 2.5Units in U-40 conversion? The U-40 vs U-100 and the number of units to use for the cat with the U-100 syringe is what is confusing me.

If the first .5 mark on the 30 Unit U-100 syringe is what we call a .5 unit for Blackie, then I have not given him enough as I have only gone just slightly over that so far, thinking that the .5 mark was actually just over 1 Unit for cats. Jeesh. I went to the link Chris and China White gave me and now I see that I need to throw out my U-40 thoughts and just measure in people Units. So tonight, I will give Blackie up to the 1 Unit mark on the 30 Unit 3/10cc syringe. aye yai yai. I was never good in Biology lab either.

Here is the link to my spreadsheet: https://docs.google.com/spreadsheets/d/ ... 1896019009
I could not figure out how to change the link to just "Blackie". I couldn't find the control panel on the spreadsheet page. Also, the first few days I gave him insulin, I didn't have a Glucometer to measure. So the chart starts at 3 days ago. There is nowhere to put when feeding time is that I can see, so I put it in the remarks. I will keep practicing and hopefully get the knack of it soon.

I have goofed on the insulin dosage as I have given him at the most only 1 unit so far. Tonight I will give him 2 units. I go to bed really early, so won't be able to test the after affects of the 7pm'ish shot as testing 1 hour after that is silly. Daytime will have to be it for me, at least for now, until I can teach my husband what to do, as he stays up usually until 10ish.

Blackie also tested with a bacteria infection. Today is the end of a round of antibiotic for 7 days. He has perked up the last couple of days a bit, probably due to the infection being gone. He always has been a very lethargic and slow moving cat right from the day we rescued him. He always has been large but has gained about 8 pounds I guess, since we rescued him in '98 off the road. He is a very muscular, stocky cat, so it's hard to say what his lean weight would be. Probably 18 pounds? He has better days, where he is a little frisky and playful, but most of the time he just trundles slowly around and loves to cuddle. He has always had bad dandruff on his back... probably from long term diabetes? I add olive, coconut, wild alaskan salmon oil, and raw butter when I make his food so he gets plenty of oils. Maybe this will recede if/when the insulin starts to bring down his BG.

I am using an Accu-Chek Perfoma Nano glucometer, it's what the best pharmacy here in Ecuador recommended, after researching online, I fear it is an older model but oh well, I did the best I could at the time. It seems to work fine. I take my BG too for practice.

I have downloaded the Management of Diabetic Cats PDF and will read it when my brain un-freezes from all this other stuff today!!

I figure ANYTHING I do for him will be a help as long as I follow instructions. I am excited to see if 2 units will get his body to respond. I might even get up in the middle of the night tonight just to test him.

Thank you thank you thank you all!
 
Please do NOT give 2 units tonight, if you've only been giving 1 unit so far. That's too much of an increase. If you already did, please try to get some tests in! We don't want Blackie going too low!

We don't EVER increase dose in whole units...Usually we go in .25 or .5 unit increments.

Glargine is a U100 insulin (at least it is in the rest of the world) so you should be using the U100 syringes and measuring just like human doses. 1 unit is 1 unit

Don't worry about changing your spreadsheet link to read "Blackie"....as long as the link is there, that's all that counts

Tests you need to get:

ALWAYS before giving insulin....that's the AMPS and PMPS tests (AM Pre-Shot and PM Pre-Shot)
During the AM cycle, at least 1 test somewhere between +5 and +7 (5 to 7 hours after the shot)
During the PM cycle, at least a "before bed" test (just in case he's going too low and you need to set an alarm to wake up for more tests)

We can help you get Blackie better controlled...it's just going to take a little time and patience!

Edited to Add...what you can do to help us out is put some information in the "Signature" block (like where you see our information below this post) You just go to the top left side of the page and find the "User Control Panel". Once there, you go to "Profile" and then "Edit Signature"
A new little box comes up and you can add:
Your name & cats name
Diagnosis date (if you know)
type of insulin
type of meter
Food you're feeding
Any other health problems
The Link to your spreadsheet!!

Then just hit "submit" and we won't have to keep asking those same questions over and over again!
 
Ok. Updated signature block. Thank you.
Ok. Just checked PMPreShot - 445. Blackie ate a lot one hour ago. Giving 1.5 Units at 7pm Insulin is warming up right now.

I will check another blood test before I go to bed in a couple of hours.
 
I'm not sure why, but your spreadsheet link isn't working

Try going back to your signature again and Click on the URL tab and then "paste" your link in between the Your link here[url] and then "submit" again I think that might be the problem
 
i can see your spreadsheet - good job getting the link fixed!

the insulin issue is confusing - i actually had a similar situation when i started, because i started with ProZinc, which needs u-40 syringes and then switched to Lantus, which needs u-100 syringes.

it's not that they are pet or human insulins, although they are, it's how concentrated the insulin is. You want to match the insulin concentration with the syringes that are made for that concentration. For the sake of simplicity, let's just talk in u-100 units, because you're using Lantus and you're using the correct syringes (u-100) now.

Now that you're at 1.5u, stick there for 6 shots total. Lantus works best with consistent dosing, so it's helpful to try to be consistent in the dose unless you have a reason to change it. I look at the guideline about starting Lantus a little differently - i don't think that staying at 5-7 days is necessary in every case. These are guidelines. If Blackie remains high, i would suggest that we increase him after 6 shots total at 1.5u. It's not good for him to stay high like this any longer than necessary.

"General" Guidelines:
Hold the initial starting dose for 5 - 7 days (10 - 14 consecutive cycles) unless the numbers tell you otherwise. Kitties experiencing high flat curves or prone to ketones may want to increase the starting dose after 3 days (6 consecutive cycles).
Click to expand...


If you are confronted with a preshot number of less than 200, please hold off on feeding or shooting him and post here or on the Lantus/Lev Tight Reg forum to ask for help on how to proceed.

You're doing great getting tests in! A +1 isn't necessary at this point, but it's not silly and at some point you'll want to get some tests then. A +1 tells us if a cat's blood sugar spikes (goes up) from the carbs in the food. Some cats do and some don't - but it's important information to have. For the moment he's just high, but our goal will be to get him into normal numbers, assuming you want to try for remission (do you?) A great way to look at the spreadsheet is to consider it a jigsaw puzzle. You don't need every piece of the puzzle to see what the picture is, but if you have enormous blank areas, you may have trouble deciphering things. We encourage people to get a variety of tests in.

Initially my husband didn't do much with punkin's blood sugar care. I had him help me hold punkin still while i tested or shot, but as time went on, he tried testing first and then eventually shooting. Before long he was 100% involved in all of it - which gave me some much-needed freedom! Perhaps if you can get your husband to just watch you and hold Blackie still, he'll eventually move to being more involved.

Your meter is fine - i'm not familiar with that exact model, but Accu-Chek is a good brand. Putting eating times in the comments section on the right of the spreadsheet is perfect. thank you!

It's helpful to have any background information, especially health-related, on a profile, or on the spreadsheet. I'm unclear on exactly what date he started insulin - even if you have no tests, would you put it in as best you can on his spreadsheet? For a profile, you can just use a google doc and then attach it to your signature as Chris suggested, just like you did with the spreadsheet. If you want an example of what we're looking for that is helpful, take a look at the profile for punkin that is in my signature line. We just want all the background in one spot - it's very helpful when we're giving you advice.

For example, the weight gain you described is very important. Has he lost any weight since becoming diabetic? or has he continued to gain weight even while unregulated? His body shape that you described is also important. The infection that coincided with the diagnosis is important too. Infections can increase blood sugar. It would be great to include the info on the antibiotic (what AB and what dosage?) in the comment section too - sometimes blood sugar can really come down when the antibiotic kicks in.

Yes, dandruff and icky hair go along with high blood sugar. that will improve as he gets regulated. Great idea to include the oils in his food - that will help too.

ok - so to summarize:

- a profile page with medical info attached to your signature is super helpful
- stick with 1.5u for 6 shots total for the moment
- get some random tests in - i actually like the +2/+3 tests (2-3 hrs after each shot)
- if you get a preshot test of 200 or less, don't feed him, post here or on the TR forum and ask for help

:-D you're doing great. The learning curve on Feline Diabetes is very steep. We all get it - it's very hard at the beginning and an overwhelming amount to learn. it gets infinitely easier as you learn more! keep posting here and asking as many questions
 
One more quick "rule" ....We don't want you to feed for the 2 hours prior to Pre-shot tests, so we know the number isn't influenced by food, so take any food up after +10 so that when you do your pre-shot tests, they're as accurate as possible.

I see on your spreadsheet that you fed at 6pm and then tested/shot at 7pm. That means that his PMPS was going to probably be higher than it would have been if he hadn't just eaten.

Generally, we test/feed/shoot all within about 10 minutes. Test to make sure they're high enough to give insulin, feed to make sure they're going to eat for you, and then shoot the insulin.
 
In a perfect world, but doesn't really work in the real world if I am going to keep the insulin shots 12 hours apart. Sometimes he is feeling ill and won't eat when it time for the shot. I have resorted to giving him a few Greenies when that happens. Sometimes he is hungry between. This morning his BG at 7AM was 551. I fed him and then shot him.

I don't think I can get him off insulin as he is old and has probably had diabetes for a long time. Maintenance is my goal.

I have two other cats. The night time is the time when everyone is more active and eat the dry food in the wee hours. I guess I could pick it up if/when I get up to pee around 2/3am. IF Blackie eats, like he did this morning, it means he did not eat any dry food as if he had, he wouldn't have eaten so much wet. So this morning, I KNOW that the 551 reading was not influenced by him eating between 5am and 7am. In the day time, Blackie doesn't even go near the dry food. He prefers his yummy homemade raw chicken meat with all kind of yummies added.

I still think I should increase his dose tonight to 2 units. He is simply not responding at all to the lower dosage. With his readings not getting below 400 in the past week, since I started all this, I highly doubt increasing to 2 units will put him into a hypoglycemic response.

Re Julias response below... Ok. I will dose 1.5. It is most likely that Black Bear has had high blood sugar for a very long time, so having it a little longer probably won't hurt him any more than it already has.
 
I would not increase the dose yet. Lantus needs consistent dosing for it to work--it can take up to 72 hours to see the effects of a dose. If you raise the dose too quickly, you end up with blood sugar just as high as if you have too low a dose. Most cats do not need much more than 1u of insulin; I would stick to 1.5u for at least 3 days before you raise the dose.

Hypoglycemia is a very real danger, and I would urge you to be cautious. It's better for your cat to have high blood sugar for a few days than to drop too low for even a minute. Also, raising the dose too quickly is counter-productive. Again, too much insulin will leave blood sugar just as high as too little insulin. Lantus requires a bit of patience.
 
Heidi, i just edited my previous post because i said that ProZinc used u-40 syringes and then i switched to Lantus, which uses u-40 - NOT. Lantus uses u-100 syringes. Sorry about that! Sometimes you get typing and . . . well anyway, you've got the right syringes now.

You just gave a huge clue in your last post as to why Blackie's numbers don't seem to be responding. The dry food that's available. Some cats are carb sensitive and even a few kibbles, literally 5 crunchies, will send their blood sugar high and keep it there. I'm going to pull a spreadsheet for you for a cat that lived in a house with 13 kitties total. The mom was certain he wasn't eating any dry food, but when she got rid of the kibble for the entire house, he went from 5.5u to off of insulin in 2 days.

Look at Scooter's spreadsheet here - notice the difference between the colors of the spreadsheet above 2/18 and after. Yellow-Pink-Red-Blacks are numbers that are 200 and over. Blues and greens are 100's and less. The non-diabetic cat runs somewhere 30's-90's most of the time. Linda was sure he wasn't interested in the crunchies the other cats ate, but on 2/18 she removed it from the whole house, and look what his blood sugar did. He had a shot that night (5.5u) and another one the next morning (5.0u) and that was it. Dry food can really increase blood sugar dramatically and it can sustain it there for a full day. Depends on how carb sensitive a cat is, but we encourage people to get rid of the dry food from a house completely, or feed it only to cats under supervision and pick it up to make certain the diabetic cat doesn't even get one bite.

I'd continue to hold his dose for 6 shots at the 1.5u, but i would remove the possibility of him being able to get into any dry food at all. not even one spilled crunchie on the floor. I don't blame you for being concerned about his high numbers - they are concerning - but would you try the dry food removal first? i suspect you're going to see a dramatic difference. I had a big boy like that - and he never passed up food if it was around! :lol:
 
julie & punkin (ga) said:
I'd continue to hold his dose for 6 shots at the 1.5u, but i would remove the possibility of him being able to get into any dry food at all. not even one spilled crunchie on the floor.
Click to expand...

I second this! I was giving Lantus dosing advice to a friend of mine who had a diabetic cat named Syd. While Syd only was given low carb wet food to eat, my friend continued to keep dry food upstairs in her house for her other cat. She thought Syd was safe because he hadn't been able to climb stairs or jump onto the counter where she kept the dish in nearly a year because of his neuropathy. Syd started to go into remission, and during his first off-insulin trial everything looked great until his numbers suddenly shot up into the 400s again. I asked her if there was any way he was getting into the dry food, and she insisted there was no way. Sure enough, she called me the next day because she had found Syd upstairs, on the counter munching away at the dry food. As his diabetes improved, so did his legs and his appetite!

I can't give Bandit a single dry cat treat or his numbers will shoot up. A lot of diabetic cats are very sensitive to dry food and treats because they contain wheat, rice, corn, and sometimes even corn syrup. None of the Greenies Brand treats are diabetic safe (with the exception of the Duck & Pea dog pill pockets, if you ever need to use pill pockets for your cat). Bandit gets these treats which he loves and are diabetic safe: http://www.orijen.ca/cat-food/freeze-dried-cat-treats/. You can also pick up any sort of freeze dried meat treat, and that would work, too. If the ingredients are 100% meat, it's a diabetic safe treat.
 
it's so nice to see you, julia! :YMHUG:

for treats, i simmered chicken breasts - just plain ones from the grocery store - then cut them in 1/2" cubes, froze most and kept a couple of tablespoons out in the fridge for pokey treats. punkin loved them. Of course, i had to give them to my non-diabetic cat at the same time that punkin got any!

The Dog pill pockets - the duck and pea ones, are really smelly! but they are good to have available. I trained my cats to eat little tiny empty balls of pill pockets so that when i have to give pills to anybody, i just wrap in a bit of pill pocket and throw it on the floor.
 
Wow. What stories about dry food! So I guess your cats all starve between the time you go to bed and get up? This is the time mine are very active and I didn't want them to be hungry during the night. For sure I will give no more Greenies to Black Bear! Unfortunately, he doesn't like the Freeze Dried Beef or Chicken I have for the other two (and thanks for the link, I haven't seen this brand before so will look into it - I pay a literal FORTUNE for the ones I buy). LuLu can't eat raw meat - she vomits it up, so what to feed her. She is also always eating grass. I have checked her for parasites but she is ok. She seems to only be able to eat 1 teaspoon of canned cat food at a time. I also have a 5 month old kitten. I feel terrible not giving any of them anything to eat for 9 or 10 hours. Now my predicament is worsening. I was just talking with my husband Paul today about buying only the highest protein (oxymoron right?) dry food available in Ecuador.So you are suggesting I cold turkey everyone from dry food? What about my growing little boy? Maybe I could put out the freeze dried treats when I get up to pee. This will cost a LOT of money in the end, but it might be worth it.
 
I leave canned food out for 12 hour stints. All 15 cats seem to be doing well on it.
 
My feeling on canned cat food has been that it is just as bad carb wise for cats as the dry food. That's why I make my own food. I buy the canned because LuLu doesn't seem to be able to digest the raw meat. Hmm. I will try some experiments. Maybe I will leave some canned food out when I go to bed, and when I get up to pee, if noone has touched it, I will stir it up a bit and put some freeze dried treats down too.
 
That's the idea!

We all just keep experimenting until we find what works best for our family...both human and furkid!

Hopefully you'll find something that works well for all of you!
 
Chris is right, just experiment to see what works. I fed punkin at preshot and again 3 hrs later, both day and night cycles, and beyond that all he got was boiled chicken treats. I always checked him around +4 or +5, so he got some extra chicken then, but then yes, he went until the next shot without eating. he didn't starve - and he was a big boy!

Many kitties do ok with grazing, but if you've got a cat who will eat food the moment it's put down, you can't count on them grazing. You'll have to watch and see what happens with Blackie's blood sugar, but many cats who eat much with carbs in the second half of the cycle (from +5 or 6 until the next shot) will see their blood sugar rise as a result. The insulin wanes in the second half of the cycle, so feeding then can (depending on the cat) make their blood sugar be higher at the next shot time. Some cats graze - mine didn't, so i didn't leave food out. If i set it down he ate it immediately.

when you've got a kitty that can only eat a spoonful at a time in the mix, that definitely makes things more tricky. She may need a different plan than the rest. Blackie may need a different plan than the rest too.

i had one other cat with punkin, and she ate on the same schedule, but she'd have starved if he could've gotten to her food. I fed them on a schedule, 7am/7pm, 10am/10pm, with him in one room behind a closed door and her in another room. With a lot of cats that's more difficult. What some people do is put the food down and whatever isn't eaten in 1/2 hr gets picked up til the next time to eat. If you consider in the wild, cats would be hunting for their food and would no doubt go several hours in between eating.

The best we can do is give you suggestions to try on what works well with diabetic cats - you'll have to figure out how to make it work with your household.

Keep asking questions!
 
by the way, as far as canned food goes, i don't know how well our manufacturer's food list will do for you. The most updated one for North America is http://www.catinfo.org. You might look there and see if anything on the list is available in Ecuador. The lowest carb canned foods are the ones that are called pate, or classics. They're the traditional kind of cat food that comes out of the can in a solid chunk, with maybe a little jellied looking broth around it.

The gravy foods have more carbs in them - it varies from can to can, but definitely anything with the word "gravy" in it, or if it's loose in the can with gravy, is a higher carb food. Most of the gourmet sounding canned cat foods are either medium or high carbs. You won't be able to tell by the labels on the cans. There is a list on the site here that has the carb contents of canned foods available around the world, but i don't think it's been updated for a while.

The gravy canned foods can be used to bring up blood sugar that has gotten low. You'll want some cans of these kinds, or something like karo syrup (corn syrup), honey, maple syrup, for times when Blackie's blood sugar gets low and you need to pull it up.

In general, diabetic cats need low carb canned or raw food for their primary food. Dry food is much higher in carbs, usually, than low carb canned food. Some dry foods are as high as 50%ish carbs. Most people here feed in the 5%ish carbs for their main canned food. Anything less than 10% is considered low carb.
 
Oh good on the news that the pate is the lowest. That's what I always buy. I am feeling overwhelmed and very sad about having to keep making pin cushions out of Blackies ears. I look at them with a flashlight and there are red blotches all over the place. Tonight I had to stick him 7 times as I either got no blood or too little blood. I started crying. Poor guy. I am NOT going to stick him again tonight. His BG was way up again anyway and he didn't eat ANYTHING since 4pm, when he only licked a little of his yummy homemade wet food. I have decided to take up all the dry food until further notice. Even for LuLu and Renny Benny B. I haven't had the strength to see LuLus beautiful face looking up at me pleading for her "fix". Maybe now that Blackie needs all this stuff for diabetes it can motivate me to prevent the same from happening to her. Maybe she vomits and eats grass BECAUSE of the dry food, not the meat! Send me hugs and candles. I am going to need it! Going to bed now. Our darling Meka Ragdoll girl was stolen down here last October and we have been grieving and crippled and searching and aching for 7 months, and now dealing with all this. See http://www.shipshapesystems.com/Meka.html for pictures. I have been so deep in grief, and even suicidal often, that I have been going to bed at 7am for months now. I finally have been able to stay up until 9ish, but tonight, I'm done. Having to hurt Black Bear to help him is leaving me raw and full of tears. We have no children, are in our 50's, our cats are our family and children and loves. So it is very very hard. We have burned a candle for Meka for over 8 months now 24 hours a day. Thank you for your support on Blackies diabetes, I would be truly lost down here without it. Goodnight kind souls!
 
((((heidi))))

what a struggle this has been for you! i'm sorry for your loss of Meka - it's never easy to lose the little ones we love. Meka is gorgeous - what a beautiful face. let's hope she is safe somewhere and someone is taking care of her. :YMHUG:

for Blackie, just know that what you're doing is going to keep him safe and help him heal. i told myself that so many times when we were starting out. When we started, punkin would hide under the furniture and i'd be pulling him out by his arms, hoping i didn't dislocate anything. I didn't, and we faithfully gave treats after every poke, and he did get used to it. it eventually becomes routine. at one point i was testing him while holding the phone on my shoulder, and i thought i'd finally made it if i could manage them at the same time. You'll get there too!

a hint - when you're done testing, always staunch the spot for a few seconds with firm pressure. we cut paper towels in little 1/2"x2" strips and kept a stack by the testing supplies. that will help prevent bruising. it helps to know that the poking you're doing, that seems to be doing nothing, is actually stimulating his body to grow capillaries in his ears. The first couple of weeks everyone struggles to get blood. After the capillaries grow, you'll get blood pretty much every time. It takes about 2 weeks for that to happen.

you have to take care of yourself so you can take care of your furkids! if you have cats that won't eat anything except dry, as hard as it is, you need to keep giving them the dry food. as long as he'll eat canned or raw, just keep the dry food from Blackie. cats can't tolerate a rapid weight loss, so even if one of them needs to lose weight, it's got to be very slow. keeping cats eating is important.

tomorrow is a new day. it gets easier - we did this for 2.5 years before punkin passed away, and i would go back to it in a heartbeat for the rest of my life if i could have him back. of course we never get that opportunity, but my point is that it will become routine for you and won't be nearly so stressful as it is right now. the starting of this feline diabetes is like a crash course in college, but fortunately, you have us to teach you and coach you on the little things that will make it easier.

Sleep well - seee you tomorrow!
 
It does get easier, Heidi, I promise! I was a wreck the first few weeks Bandit was diagnosed. He fought me tooth and claw with the testing, but he finally came around it became no big deal. Putting pressure on the spot for about 20 seconds after poke helps quite a bit to prevent bruising. I also put a tiny bit of polysporin ointment + pain relief on the poke spot after, and that helps a bit.

So I guess your cats all starve between the time you go to bed and get up?
Click to expand...

Of course not! Bandit eats 4 times a day (every 6 hours), which is the same feeding schedule he had on insulin. I would get a test at 7am when I got up, and then I would feed him and give him his insulin at the same time. He would get another test and a shot at 1pm, when his insulin was peaking, and we'd repeat this again at 7pm and 1am. If I am in bed at 1am (I usually go to bed around 10pm on weeknights), then I freeze his 1 am meal, and put it in an timed automatic feeder to be released at 1am. Bandit is a VERY food motivated cat, so believe me, he lets you know if he's hungry! Sometimes I'll give him a snack at 10pm of Fancy feast appetizers (which can also be used as treats) if he seems super active that day, but other than that he's just fine with his scheduled feedings. Cats eat small, frequent meals in the wild and don't have 24 hour access to food, so a little normal hunger isn't a bad thing, and can actually be very beneficial to the cat's behavior and health. It helps puts them on a more regular Play/Eat/Groom/Sleep schedule.

Also, leaving wet food out to free feed is an option, too. Unfortunately, I can't do that because Bandit is so food crazy. He is formerly obese (when I free fed him dry food) and will eat and eat both canned and dry food until he vomits, and then continue to eat some more. So we are very strict with the amount of food he gets per day and his regular, frequent feeding times. If he has to go longer than 6 or 7 hours without eating, he'll tear my house apart.
 
Thank you both Julie and Julia for your encouraging words on all fronts, Meka and Blackie. Blackie has growled the last couple of shots and on the 7Pm shot he tries to hide in the garden. I am lucky it is him and not LuLu, as SHE would be impossible to deal with. Blackie is pretty laid back as things go and is such a trooper. I will put pressure on the sticks now, and I am sooo encouraged to hear that the "splotches" will grow more capillaries so I don't have to keep going for the vein on the edges of his ears! I will look for a timed feeder but I highly doubt they will have such a thing down here. I agree, not free feeding all the time would be better for the cats. With no dry food all night, Blackies BG was still way high this morning, although 35 points lower! Still above 500. The insulin seems to bring it down to the 300's for just a few hours and then it goes right back up again. I still think 2 units would be better for him, but I will stick to the advice, and wait until after 6 shots of 1.5U.
 
It is possible you'll need to raise the dose in a few more shots, but Lantus needs to build up a reservoir under the skin before it will start working to lower blood sugar. That's why we wait at least 72 hours (6 shots or 3 days) to raise the dose. Sometimes you don't see the effects of a dose change for days after you raise the dose, so you don't want to raise the dose until you know for sure.
 
We know it's hard to be patient, and hold off on increasing that dose of Lantus/Glargine insulin, but it's the best thing for Blackie.

Here are some "patience pants" for you to wear, from my vast and expansive lending closet.

I didn't know your favorite color, so hope the rainbow colored ones are a good match for you. ;-)
 

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hahahaha - Heidi, it's an ongoing joke around here that people need patience pants. we've all worn them, although i must say i've never had such beautiful ones as those, Deb! :lol: You're very kind to share your beautiful ones with Heidi!
 
Black Bear knows I am trying to help him and he is cooperating. He was outside in the dark tonight and when I called him he came in for his check up, shot and dinner.
 
What the hell is going on? Blackie was stabilizing nicely at 300 and so I upped the dose .5 this morning, and this afternoon he was almost 600! He is on the downslide now but just barely. Gave him another 2.5 tonight. He still has a long way to go to get under 150 which is my goal. He absolutely DID NOT eat any high carb food today that could have spiked it. Maybe it just does that in the beginning sometimes? I see an earlier post that too high a dose can spike the BG too. But I did not hastily raise it. I had Blacks on 2 units for 1 night and then 4 days before raising it.
 
there are a few possibilities.

- is there any possibility at all that he could've gotten any dry food? seriously, any at all - even a couple of crunchies?

- he could be bouncing. i have seen many, many cats who in the beginning ONLY go low at night and spend their days bouncing from the low numbers at night. If you can get a before-bed test every evening, say a +3 - +5 that will let us know if that's happening. I know you go to bed early, but this is really important to figure out a way to get some test in the pm cycle. cats can have completely different pm cycles. really.

- it could be New Dose Wonkiness. For some reason some cats respond to a dose increase with higher numbers for the first day after the increase. you just wait it out. The second post in this link gives an explanation of bouncing.

- we could simply not be at the right dose yet. Some cats need more - it's very individual

I would've also increased, but i'd want to be sure he's not going low at night first. If we can be confident he's not going low at night, you could increase after 6 shots at a given dose. That speed of increasing can get them out of high numbers faster, but really - i know i'm beating a dead horse here, but it is that important - you have to be certain he's not going low at night. Low numbers at night can cause high numbers during the day. Many people post here daily to get advice.

I would encourage you to do these things:

- continue your testing as you've been doing and add one evening cycle test between +2/+3 and +7.

- make sure there's absolutely no other food available except the raw or low carb canned that he can get to.

- test daily for ketones while he is this high. You can find Ketostix at pharmacies (for people). Some people can catch the urine stream and either put a ladle to catch some or stick the ketostix in the stream. i had a temporary box (inside a plastic bag) with of dry lentils (you can use that, dry beans, gravel, anything non-absorbent etc.) and when punkin peed, i could tip the box and test the urine.

Hang in there Heidi - it's grim to see these high numbers, but we've seen them in other cats too. We will stick with you and he will get into better numbers. :YMHUG:
 
Thank you for the detailed post and for taking the time to do it and for the links. I will just get up and test him in the night for a few nights. I get up to pee anyway at least a couple of times, so will just do it then. If the times don't work, I'll set my alarm. Unfortunately, here in Ecuador, they look at you like you have 4 eyes and 2 heads when asking for a ketone pee strip. They don't have them here. I will get some brought down for me from the US.
 
I have a small baby sock that I partially fill with rice and tie off. I heat this sock about 15 seconds in the microwave and then hold it to me cats ear. This helps to dialate the capillaries so that they bleed easier. After getting the blood I hold pressure about 30 seconds and then rub vaseline onto the ear. This keeps it soft and prevents is from becoming sore. My cat tolerates it very well. Three things to think about with regard to dry food...1. it lacks moisture 2. it is higher in carbohydrates 3. most dry food have a high content of plant based protein. My cat was addicted to dry food when she was first diagnosed. It took a week to 10 days to transition her from dry to wet. It also took some time to adjust her feeding schedule and portion allotment. Regimenting her schedule was paramount to bringing her sugars into control. Within 8 weeks of going on the glargine her sugars stay within a consistent range. Her coat shines. Her dry , scaley skin is resolving. She is drinking and peeing within normal limits. And her old personality has reemerged. I believe that switching her to a wet food regiment made a remarkable impact in stablizing her sugars and bringing her back to a healthy state. Any change takes time to adjust to. And, make only one change at a time so that you know whether or not it is truly working. I lok forward to seeing better results for your cat in future updates. Jane and Stewey
 
Thank you for your support and input of experience. All heard and recorded in my brain! I'll have to find something that works for Black Bear and me. This is exhausting and very, very expensive. Down here, 50 test strips costs $47.00. That is going to add up fast. And regular canned food down here is only available at one store, and it is $2.40 for one small can. During the day I feed Blackie my own homemade wet food. At night, I am learning and experimenting. Time will tell. It appears that his BG is slowly coming down again after the increase to 2.5. I'll ride it out a few more days and see how it does.
 
LOL! Here is my wet food recipe: 1 3 lb (more or less) raw fresh chicken breast ground, 1/4 teaspoon Taurine, 1/4 Teaspoon Vitamin E, 1 4000 IU D3, 3 ground Nutri-Cat Vitamins, Oil from 4 1000 mg Wild Alaskan Salmon Oil capsules, 2 or 3 raw eggs, 1/4 teaspoon sea salt, 1/4 teaspoon lysine powder(one of my cats has herpes), 4 drops iodine, 2 tablets complete B-Right, 1/8 teaspoon spirulina, 1/8 teaspoon wheat grass powder, 1/2 teaspoon each of slightly melted raw butter and coconut oil, 1/2 teaspoon extra light virgin olive oil, a pinch of raw bee pollen, 1 sachet FortiFlora. All mixed together really well with an electric beater. I don't freeze this. It lasts in the fridge up to 3 days easily. To serve a portion, I add water and warm it to room temperature on the stove. I got the basics of the recipe from Michelle Bernards book 'Raising Cats Naturally'. She says you can freeze it, but I found out in research that freezing meat reduces it's nutrition by 88%. Sometimes I throw in a raw chicken liver too. Depends. Chicken livers don't last long before stinking, so if it is just on market day and I make up a batch of food, I add one. If not, I leave it out. I also don't grind up bones anymore to put in the food. I do use a Tasin Grinder, but find that the bones make little hard pieces and the cats don't like it. With all the rest I put in, they should be fine.
 
yikes, heidi - that is expensive! i know American Diabetes Wholesale doesn't sell internationally, but I wonder about Walmart.com. You might investigate if you can get strips mailed there. Otherwise if you have someone who comes to visit from the US, perhaps you could have an order sent there and brought to you. ADW is an affiliate with http://www.mrrebates.com and their diabetic supplies are pretty cheap. If you register first with mrrebates you can can get a percentage back after you've spent a certain amount. It sounds like a US visitor might be apossibility for you, if so, that's going to be a much cheaper way to get supplies. I bought everything through them - these http://www.americandiabeteswholesale.com/product/terumo-thinpro-insulin-syringe_5891.htm syringes have 1/2 unit markings and a thin barrel, which makes changing doses by 1/4 unit much easier, the generic Arkray strips that match the Relion meter, and the lancets, which are fairly cheap everywhere here. The generic strips I used were 250 strips for about $70. Punkin died a year ago, so i don't know the current prices, but it's far less than what you're paying. Our brand name strips in the stores are about what you're paying for strips now.

I understand about making it work for your family - i just want to make sure you understand (because new people never do) that low numbers can cause high numbers. Or high numbers can be from not enough insulin to counter whatever carbs they eat. There are also some conditions that cause the need for more insulin than the average cat. The only way to know which situation applies to your particular cat is through looking at enough data.

Sounds like you're doing the best you can - i think you're off to a good start. Feline Diabetes is a tough disease, but it becomes manageable and easier as you get more experience and understand more.
 
Well, his numbers are still really high. I had him on 2.5 for 6 days. Upped it to 3 today. I'll keep close watch. Thanks for the info on the supplies. I figure even if I can get his bg to stay in the 100's I have a huge accomplishment.
 
Have you read over the Tight Regulation protocol for Lantus?

For the first dose, you hold for 5-7 days. At each dose increase, you want to hold that for 3 full days, then evaluate the nadir for adjustment. With high nadirs after 3 full days, you can increase 0.5 units at a time; with lower nadirs, you increase 0.25 units at a time.
 
YAAAAAAAYYYYYYYY!!!! We've gotten into the 100's today!!

Today, for the first time since beginning June 12th, Blackie has reached the 100's!!!!!!!!!! Blue, blue, what a wonderful color!! I have had mostly only black and red on his chart so far. It sure has taken "going low and going slow" patience beyond my comfort zone! He is now up to 6 units 2x a day. He obviously has had very, very bad diabetes and for a long, long time. Poor guy. I am finally breathing a sigh of hope that we may be able to stabilize Blackie in the low 100's, still going up into the 400's on the night shot test. We are finally going in the right direction. Thank you all for your assistance in the beginning when I had no clue how to begin!! After we get stabilized, IF we ever get there, I will be looking at all the information available concerning the next phase, maintenance and then the possible next phase, remission and what to look for in that case.
 
Just looking at his spreadsheet and notice that you don't have any pm tests in - are you able to get any pm tests?

I also noticed that you take the am tests at the same time each day - how about varying the times, a bit to see what other times his bg is at - instead of taking at +6 take a +5 or +4 or +7 or +8....it helps to see more patterns.

I haven't read through all the posts on here so I don't know all the history.

I do see that when you raise the dose, you raise a conservative amount 1/2 unit that's good. Cool you are making your own food for him, bet he loves that.
 
now that you're seeing blue numbers, heidi, you want to slow down the dose increases. 1.0u increases are large enough that you might miss a good dose. Go back to 0.5u increases, even at 6.0u a 0.5u increase is large enough.

typically we suggest people get their cats tested for acromegaly and insulin autoantibodies (iaa) when they get to a 6u dose. there's something going on that is causing a need for that much insulin.

i hope things have improved in your own life in the past month. earlier you'd said you weren't able to get pm cycle tests, but Hillary is so right - night cycles can look completely different than the day cycle and cats typically go lower at night. you could easily have some low numbers in there. if there is any way you can get a test in the pm cycle, it's going to give you more confidence that your dosing is appropriate. Without some tests in the night cycle, it's hard to know if 6u is appropriate or not. Most cats get 1-3u per dose. He could also have a high dose condition.
 
Thanks for the suggestions. I will have my husband test him around +3 in the evening. We don't plan to raise the insulin any more for a few more days and if we do, it will be .5 as advised. Blackie is still all over the map though, with his BG. Yesterday he was low in the evening... and all night he only had accessible some dry Diabetic Royal Canin food, but this morning he was 456. WTF???? I am feeling that perhaps it is too late for him and that his system is not going to come around. As for testing for the acromegaly and insulin autoantibodies (iaa) I will see what I can do here. I might be able to get it tested here but I doubt it. I now only feed Blackie his Royal Canin Diabetic wet and dry, and my own homenade raw chicken food. But since this mornings reading was so off the charts, I am feeling despair.
 
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