Cross posting from Intro forum: New Member - Smokey cat resembling a glucose yo-yo in early days

Discussion in 'Feline Health - (Welcome & Main Forum)' started by MyCatsAreBroken, Sep 8, 2019.

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  1. MyCatsAreBroken

    MyCatsAreBroken New Member

    Sep 8, 2019
    Repeat posting from intro forum as it seems this is probably the more proper place.

    Hi all! I am new to the group. Discovered it tonight in a moment of panic and am happy to have done so. My Smokey gal (15 years) has been thinking about becoming diabetic for the better part of this year, likely due to necessary long-term pred usage. She finally tipped over into the BG >300 range about 2.5 weeks ago, began Lantus insulin, and with that went my sanity. I am a very logical person and have had many special needs cats (cancer, heart disease, kidney disease, hyperthyroidism) so I wasn't really daunted by the diabetes diagnosis. I bought the Alphatrak, did my reading, and mistakenly thought it would be like a math problem easily solved (find right dosage, home free). I was not prepared for how quickly her numbers have risen and how inconsistently she has reacted to the insulin. I panic every time I see a new high number on the meter. I filled out her spreadsheet with my measurements and I would love for anyone to tell me that A) their cat's values were also as whack-a-doodle during the first few weeks but eventually stabilized and lived happily every after and B) ease my mind about what appears to be an alarming trend of increasing "new highs" despite being on insulin. She went from her first value in the 250s (mid-August) to her first in the 400s a week later (that is when we started insulin). Now, tonight, 15 days after starting insulin and on her first day on her new higher insulin dose, she has her first 500+ reading (WHAT?!!!). I have read a little bit on here already about "bouncing" which has eased my mind a tiny bit, but I would love to have some veterans look at her spreadsheet and tell me if her #s are panic-inducing? My vet hasn't seen the 500+ value yet but has been pretty calm about everything else up to this point, wanting to increase her dose by a half unit only every 5-7 days, which sounds pretty standard. Also, she has thankfully never had any ketones in her urine.

    She does have some complicating factors: 1) She is still on prednisolone and can't really get off of that last 2.5mg/day due to disc issues and severe arthritis/allergy to adequan injections. And 2) She has SEVERE food allergies to all things bird which eliminates all diabetes diets from contention. I am trying to transition her from her venison-based dry prescription allergy diet to canned food but the low-carb venison choices are slim and canned food isn't her favorite. Also, because of her history of food allergies and our uncertainty if there are additional things she is allergic to, I have to be very cautious with diet changes. Also, 3) I work 7 days, 60 hours a week and have been running home as I can to test her glucose but unfortunately can't often get a full curve on her.

    Let me explain some of the weirdness of her spreadsheet/dosing (this is also in the notes on the spreadsheet if you want the condensed version). She started insulin literally 3 days before I left town for a week so we started her on a 1u, 1x a day dose as that is what my pet sitter was able to handle and I didn't want to risk hypoglycemia when I was not here. During the week I was gone, he only checked her blood glucose once a day so data is scarce. When I got back, there was some wobble in her dosage as it was a holiday weekend and communication with my vet was delayed so I had to make the executive decision of how to handle her newly increased numbers I came home to. I added a small 2nd dose the first day I got home. Then the next day I increased her morning dose by 0.5 u. Then, I got an e-mail from my vet saying she wanted to do 1u every 12 hours before increasing the morning dose. So...I skipped the evening dose that night since I had given her the larger dose that morning and we embarked on the 1u twice a day. Maybe I should have left her on that dose longer, but when it had basically no effect (nadir well over 300 both days), I upped the morning dose to 1.25 u on the 3rd day (9/5). That had a better effect (mid-day nadirs of 213, 176, 252) but very short lived, often bouncing into the upper 300s/mid 400s by evening dose time. The vet said I could increase to 1.5u in the AM (she doesn't eat at night so I am hesitant to increase her evening dosage but maybe I don't need to worry about that since she doesn't seem at all prone to hypoglycemia at this time) today because I was home more of the day. As you can see, instead of getting a good response, her numbers went up to their all time high of a terrifying 552 (that was 3 hours ago, which led me to discover this group). So here I sit, having discovered this fantastic wealth of information, trying to breathe slowly and not panic, but wondering what in the world is going on with her numbers being so crazy and her response to the insulin so all over the place. Is this at all normal for starting out? Also, thanks for letting me *splat* my words at you. I promise I will be calmer next time....probably. :) Thanks for any insight you have. Seriously.
  2. (GA) Gypsy's Parent

    (GA) Gypsy's Parent Member

    Jul 24, 2019
    Welcome! You and Smokey have come to the right place. The people here have a lot of experience dealing with diabetes management! I, too, am one of those logical people, but diabetes is not a simple disease to deal with. I have a kidney cat, too and had one with a tumor in his bladder.

    This group gets a lot of eyeballs, but you might want to move this to the Lantus forum. Sorry I do see see you posted an intro. There are some guidelines for the info that is useful in the signature:

    There are stickies at the top of each forum which have very useful information. I recommend reading the sticky for the lantus forum since that is the insulin smokey is receiving.

    I know there are some studies that indicate a link between steroids and diabetes. My kidney cat also has high blood pressure and was getting 1.25mg prednisone daily. Since her diabetes diagnosis, I have cut that to every other day. Have you discussed the possibility of reducing the prednisolone dosage? Is there any significant difference between prednisone and prednisolone that would make one better for a diabetic cat?

    Diet is a very important factor with diabetes. It is important to get Smokey on a low carb diet. I'm not sure what the carb count is for the food you are feeding her. I've not dealt with food allergies with cats, just really picky eaters. Gypsy went from numbers in yellow to numbers in blue and then green simply by switching from "premium" dry food to wet food. She was never really too keen on wet food but when I tried the Hill's m/d pork flavor she loved it! (I does contain chicken fat :-(). There's a sticky at the top of this forum that has Dr. Pierson's spreadsheet with a info (% protein, carb, fat, phosphorous) for a large number of wet foods. She also has a web site that is extensive and talks about food.

    I see you have changed Smokey's insulin dosage based on pre-shoot glucose reading. This is generally not recommended; kitty's BG can react in unanticipated ways when you change dosage and generally the people here recommend sticking with one dosage for two days before changing. That's a diabetes quirk for you.

    It's overwhelming trying to read and learn; everyone who comes here is paniced and worried and wants nothing more than to help their kitty feel better. You are off to a great start with home testing and food change. Dealing with diabetes is a marathon, not a sprint.
  3. Karen&Rocket

    Karen&Rocket Member

    Feb 4, 2019
    Just want to say "welcome," and I love your avatar name lol. I'm not going to try to give dosing advice - my cat is a special case, as he has acromegaly underlying his diabetes (take a look at his spreadsheet if you want to see a rollercoaster ride!). But I get the frustration of trying to "solve" your cat's spreadsheet. There are great people who give great advice here. One thing I keep hearing is "It's a marathon, not a sprint." You're on the right track, and you'll get good advice here. Best of luck to you!
    MyCatsAreBroken likes this.
  4. Bron and Sheba (GA)

    Bron and Sheba (GA) Well-Known Member

    Feb 21, 2015
    Hi and welcome to you and Smokey,:)
    That's really good you are testing the blood sugars and have the SS up and running and have entered the BG data
    That is really helpful and will make things easier for you and us as we look for ways to help you.

    About the food first.
    If Smokey is allergic to all bird foods, there are still other options such as beef, lamb, pork, kangaroo. Have you thought about looking for some of these foods canned.
    The other option is to feed a raw diet or a home made diet. That is often successful with allergies. If you are interested in this option we can help you with ideas.
    You mention that Smokey does not eat at night.....does that mean she only eats in the morning?
    If that is correct, how do you get enough food into her to satisfy her 24 hour calorie needs.

    About the insulin.
    Lantus works best when the same dose is given consistently during both the cycles.
    I can see why you are hesitant about not giving the same dose at night if Smokey doesn't eat, but really for the depot to stabilise and for you to see better numbers, the dose needs to be consistent.
    The dose increases for Lantus are based on the nadirs (lowest point in the cycle) not the preshot. The preshot is important and we always need to test that to see it is safe to give the insulin. And then we need to test during the cycle to see how low the insulin is taking Smokey so we can tell if it is too much insulin, not enough insulin, or just the correct amount of insulin..

    There are 2 dosing methods here....the TR....Tight Regulation method and the SLGS ...Start Low, Go Slow method.
    You will find these at the top of the Lantus page. Have a read through these and see which one suits you best.
    It is really a good way of moving forward to choose a method and following it. It takes the guesswork out of things.
    Here is a link to the two methods

    Most cats take a while before you will see consistent numbers.. they need to get used to the insulin, which is a hormone, and the effect it is having on their body.

    Here is another excellent link to FAQs

    So I think our first problem which needs to be addressed and solved is how to get Smokey eating both at night and in the morning so you can give a consistent dose of Lantus.
    Is there a particular reason she only eats in the morning? Has she always only eaten in the morning?
    Is it because she doesn't like the food that is offered?
    Does she have favourite foods?
    Do you think she suffers from nausea?
    Sorry about all the questions.......but look forward to hearing back from you and hoping we can help Smokey.:)

    I think it would also be a good idea if you could buy a bottle of Ketostix (from Walmart or any pharmacy) so you can test Smokey urine for ketones. Ketones can form in unregulated cats and we recommend testing the urine for them. It is a simple just need to collect a urine from Smokey, dip the test strip in the urine and then read the test strip exactly 15 seconds later in a good light against the colours on the bottle. Anything above a trace needs vet attention.
    Ketones can lead to DKA, a serious illness in cats and by testing for ketones, it can be nipped in the bud.
    Last edited: Sep 9, 2019
    Reason for edit: added ETA.
    MyCatsAreBroken likes this.
  5. Sarah&Soph

    Sarah&Soph Member

    Jun 18, 2019
    Welcome! My kitty is intolerant to both chicken and beef, which really narrows down our options as well! I have found that the both the Instinct rabbit formula and venison formulas are diabetic friendly and do not contain any other proteins, but they are fairly pricey! When she’s being finicky and just looks at me like “What am I supposed to do with this??” when I put her bowl down, I put some Purebites freeze dried salmon treats or Vital Essentials freeze dried rabbit treats on top and that usually does the trick :rolleyes: If Smokey is a dry food fan, the Vital Essentials treats might be good, because they are very crunchy! Ziwi peaks also has some good food options, but it is an even more pricey brand
    MyCatsAreBroken likes this.
  6. Idjit's mom

    Idjit's mom Well-Known Member

    Apr 3, 2018
    Greetings again from the Intro forum.

    I would like to suggest that you create a signature so that Smokey's pertinent information is available whenever you post.

    Setting up your signature (light grey text under a post). Here's how:
    click on your name in the upper right corner of this page
    click on "signature" in the menu that drops down
    type the following in the box that opens: kitty's name/age/date of diabetes diagnosis/insulin you're using and dosage amount /glucose meter you're using/what (s)he eats/any other meds or health issues (s)he has. You can add your name, and a geographic location (sometimes the country/time zone matters) Be sure to SAVE when you are finished.

    There is a space limit for the signature and that includes the link for the spreadsheet, so if you would like to share more, you can in the Profile details area

    I see that you have a very full plate with your work hours :eek: (how on earth do you manage and I hope you sleep now and then) but when you can, visit the Lantus forum HERE and start reading about that insulin, how it works, what the depot is and the protocols used here. There is A LOT of info, and usually takes more than one reading, as you grow more educated and can absorb/use the information. We realize that's it's one step at a time, but there are marvelous people here who will help all they can.
    MyCatsAreBroken likes this.
  7. MyCatsAreBroken

    MyCatsAreBroken New Member

    Sep 8, 2019
    Thanks for your responses all. They are greatly appreciated. I will respond more fully tonight when I'm home. However, I did want to clarify: Smokey eats ALL day not just in the morning. Since I work up to 14 hour days she grazes throughout the day. She gets her caloric needs easily, so no worries there. Despite her roller coaster blood glucose numbers, she is stable in weight (if anything I'm having to watch to make sure she doesn't gain from her hunger). She just, for whatever reason has never had an appetite after about 8/9 pm. I'm definitely working on finding canned food that fits her allergy needs but because her allergies are so extreme (open/scabbed wounds all over her skin, some of which turned into inflammatory skin tumors that had to be removed/biopsied plus horrendous ear infections), I can't throw a bunch of stuff at her at once. To be responsible, it will be a VERY slow process of transitioning her to a different food and it must be done one change at a time over weeks so that I am sure she isn't allergic. :( I'm not concerned about cost; health is more important. I just want to find something that is healthy for her. :) Also, I do test for ketones already and noted days that I was able to get urine in the notes section of the spreadsheet. She has thankfully been negative, also confirmed negative by a vet urinalysis last Thursday. Finally, her pred is unfortunately not something that can be tapered. It was a very difficult process to get her down to the 2.5mg per day and she is in more pain (disc disease/arthritis) and having worse upper respiratory allergies than I would like even on that dose. She also takes additional pain medication but she needs the anti-inflammatory from the pred. I know both her food situation/pred will make her regulation more difficult but unfortunately that's what I have to work with. I am definitely trying to breathe and realize it is early days. It is just so alarming to see the number shoot back up to new high points (with no rhyme or reason) rather than going consistently down. It is bringing me comfort to look at others' sheets and see some inconsistency as well. So thank you. I'll head over to the Lantus forum when I have some time and continue learning (and I'll get my signature updated with more details as well). Thanks again!
    Kate & Toby and Idjit's mom like this.
  8. Bron and Sheba (GA)

    Bron and Sheba (GA) Well-Known Member

    Feb 21, 2015
    Great to hear back from you and find out lots more information..
    I completely understand you need to go slowly with any changes with the allergies. It can be a huge issue can't it?
    My Sheba developed chronic diarrhoea and no reason for it could be found.
    I eventually changed her over to a raw/cooked home diet where I could see exactly what went into the food and the diarrhoea stopped. The only thing with a home made diet is you have to make sure it is balanced, but with supplements on the market to add to the diet, it is not hard.

    Do you think an autofeeder would help with getting Smokey to maybe save some of her food til a bit later in the day?
    A lot of us use an autofeeder when we are not able to be at home. They open at set times and can be a lifesaver

    Good on you testing for ketones already. You sound very organised.
    The early days of FD are confusing and overwhelming but it does get much easier as you gain knowledge and you get used to the way Smokey reacts to the insulin. Smokers SS is looking pretty typical of a newly diagnosed kitty.
    You are getting lots of tests in which is great.

    Those higher numbers could be from bouncing from the blues you are seeing. At the moment Smokey thinks that the higher numbers are normal and her body needs to learn that the lower numbers are the normal ones. Bouncing can occur if she drops too fast, too low, or lower than her body thinks is normal. If this happens her body dumps regulatory hormones and glucose into her system to "save herself" and her BG shoots up. Bounces can last from 1 to 6 cycles and there is nothing you can do about them except wait them out. Bounces are normal especially in newly diagnosed cats.

    With the dose of insulin, I would drop the morning dose to 1.25 units and then give the same dose at night (1.25 units). Try and make sure she eats well in the first half of the pm cycle.
    Keep that dose for 5 days (unless Smokey drops low) and see how she goes with that.

    Do you have some higher carb food and honey or Karo at home in case of low numbers?
    You may find that honey or Karo works best for you when dealing with low numbers, if there are allergies to consider.
    If you do get a low number and can't get her to eat anything, you can always rub honey on her gums.

    We do have kitties here that need pred and it's just something that has to be worked around and the insulin adjusted accordingly.
    When you have time (I can see you are a very busy person) have a look at the 2 dosing methods as they have different numbers when it comes to reducing or increasing the dose, and how long you hold the dose before changing it. When you decide, can you put the method in your signature please? Thanks:)
    MyCatsAreBroken likes this.
  9. MyCatsAreBroken

    MyCatsAreBroken New Member

    Sep 8, 2019
    When you all talk about carb % on this forum, are you calculating dry matter carbs or as fed? I have seen Dr. Pierson's chart before and looked at it but I could not find where it specified dry matter or as fed. Thanks for any insight on that. :)
  10. MyCatsAreBroken

    MyCatsAreBroken New Member

    Sep 8, 2019
    Thanks for all of your feedback, Bron. I'm sorry if I gave the impression that I was increasing dose based solely on pre-shoot levels. It was definitely based on more than that. If you look at her chart you will see there is very little blue on there and a whole lot of pink and red. When I got back from my week-long trip and all of her readings had been 274 or above while I was gone and she was in the 400s, I figured it was time to up the dose. And then this week, at the 1.25 u level, she was still spending most of her day in the 300s and 400s though she did dip to 176 one day. I maybe could have waited out that dose a bit longer, but I wanted to do her dose change on a weekend if possible as I am home a few more hours and have a friend who can swing up and do a mid-day glucose check. I'll definitely pause at the 1.5 u dosage through this week (though it is killing me that her numbers are so far worse on the higher dose) and am working on bringing the evening dose up slowly to match the AM dose.

    Here's my question about her dainty evening eating: If she eats about 1 oz of wet food and maybe a few bites of dry after her evening insulin (all within an hour or two after getting the shot), do you think that is enough food to (I don't know the right words, forgive me) sustain her evening dose? She just doesn't prefer to eat at night. It isn't because she doesn't like the food as she is offered the same food she eats all day with the addition of the new wet food I am trying to add in/eventually transition her mostly to. And it isn't because she ate too much during the day as I have held back food and she still doesn't want it after about 9 pm. She is just a cute little, old, lady and at about 9 pm she puts herself to bed in her cat carrier where she likes to sleep at night and that's it for the food. When she hears me get up in the morning, she's ready to start in with a voracious appetite. So, yeah, just not a night eater. My gut instinct had been to keep her evening insulin dose lower because of that, but if eating within the first hour or two after a shot is good enough to keep her glucose from an extreme drop then that might not be a concern. We have a vet appointment on Friday so I'll discuss the evening dose further then. Thanks again for the reassurance about the variation in numbers in this reply and below. I definitely have to get better about not panicking when she has a flat cycle or when I see a new high number...though it is so counter-intuitive!
  11. MyCatsAreBroken

    MyCatsAreBroken New Member

    Sep 8, 2019
    This makes a lot of sense, thanks. I hope you are right and I will try to be more patient/less panicky when the number doesn't do what I expect. :)

    I do have Karo syrup sitting on the counter with her food and meds just in case of an emergency (though with her stubborn glucose levels right now it seems like it will gather dust - ha!). It is good to hear there are other pred kitties on here. I'll have to look and see if I can find some of their stories when I have a bit more time. I bookmarked both of the dosing protocols and will be deciding which I feel will work better for our lifestyle/Smokey's situation in the coming days. Thanks again for all your help. I'll probably migrate over to the Lantus board with future posts.
  12. MyCatsAreBroken

    MyCatsAreBroken New Member

    Sep 8, 2019
    Thanks so much! I think I got my signature up to snuff and I will be living on the Lantus forum in the coming days, I am sure. As for sleep, it has become less with the diagnosis but at least she waited until I am only working 7 days a week. A couple of months ago it would have been that plus finishing my Master's degree. Small blessings! :)
  13. Bron and Sheba (GA)

    Bron and Sheba (GA) Well-Known Member

    Feb 21, 2015
    Hi Valerie,
    Good to know your name!
    There was no critisism about how you raised the dose........please don't think that.....I just wanted to let you know how Lantus best works.:)

    I regard to the amount of food Smokey will eat at night....the only way you will be able to tell if it's enough is to test during the PM cycle and see over a period of time. You will find that every cycle is a bit different, so just because Smokey did something in one cycle, it doesn't mean she will do it in the next cycle....especially in the early days when she is unregulated.

    Most cats on Lantus have an onset of the insulin around +2 and the nadir (lowest point in the cycle) is usually around +6. But in saying that ECID (every cat is different) and they love to make fibbers of us all. So some cats will nadir anywhere from +4 to +12. The only way to tell where Smokey nadir is, is to test and find out. And just to keep us on our toes, nadirs can move about a bit as well on different days.

    The reason I suggested reducing the am dose to 1.25units and increasing the pm dose to 1.25 units is because we know that Lantus likes consistency and if you give different doses night and morning you will see numbers all over the place because the depot is not stable......does that make sense.?
    You are giving 1.1 units at night now so 1.25 is not a lot more, especially if you reduce the am dose to 1.25 units. In fact the daily amount will be the same......
    Here is some information on what a depot is

    If you are feeding dry food, that will eliminate you from being able to do the TR methods as only cats on wet food can do that. But the SLGS is a good method....things are done a bit slower than the tight regulation..

    If you get to swap over to all wet, you can then think about the TR method.

    Keep asking questions, we are happy to help.. we have all been where to are now and totoally understand your worries and frustrations.
    MyCatsAreBroken likes this.
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