Hi all, I'm Amanda and my cat is Zach. He's 10 years old, about 12 pounds. Zach was diagnosed with diabetes December 2023. At the time he was eating dry food only and was not overweight. I had adopted him when he was 8 and I had no previous experience with owning cats, so I didn't know how important wet food was. As per the vet's instructions, Zach was transferred to Purina DM wet food and started on Lantus 0.5 units twice a day. We went back to the vet for a glucose curve every week and Zach was responding well, sugars were coming down but slowly but surely. We settled on 2 units twice a day and there he stayed for 1 month. At the 1 month check, his sugars were way back up in the high 20s range. Vet increased him to 3u twice a day, then 4u, then 5u. It was around this point that I switched Zach to frisks pate, as I can't afford Purina dm long term. All of these increases happened about 1 week apart, and showed little to no improvement in Zach's glucose levels. At this point, I was not home testing. I had asked my vet multiple times whether they thought that I should have been doing home testing and they essentially advised me I didn't need to. Naively, I trusted that. I was planning to eventually get a glucometer and begin the home testing but I felt comfortable at that time trusting the vet that it wasn't necessary right now (big mistake!). After 5u didn't seem to be having any effect on Zach's levels, they bumped him again to 6u, twice a day. After 1 week, back we went to the vet for another glucose curve. First reading 16mmol, next one 19. At this point, zach and I are frustrated but my vet said that now we can try keeping him on this dose for 1 month. On March 21st (11 days after his last vet visit), I rushed Zach to the emergency for hypoglycemia in the middle of the night. He had 2 seizures when he arrived there, and his sugars were so low that they couldn't even get a reading. Zach stayed there for around 18 hours while they worked to get him stabilized, before I could bring hime home. Needless to say, this was traumatizing for me and for Zach. I was filled with tremendous guilt for not home testing, but also anger toward my vet for not advising me how important it was to do so. Since that incident, I have obviously learned to home test. I test before every insulin shot. His numbers were high, so I started by giving 2 units (emergency vet instructed me to do 3 units but I wanted to tread even lighter given what happened), unless I had a glucose reading of 10mmol or lower, then I did not give insulin. His numbers were very random. High high to lower than 10. I spoke to my vet, who suggested I try dropping back to 1 unit. So currently Zach is on 1 unit of Lantus, twice a day with testing before each shot. But his numbers aren't budging. He remains in the 18 to 23mmol range. I don't know what to do. I feel stuck between a rock and a hard place. Should I seek a second opinion from another vet? Does anyone have similar experience with difficulty regulating? Any words of wisdom? Thank you everyone!
Welcome to FDMB! I am so sorry for what you and your kitty went through. Unfortunately, you do not have the only vet who does not encourage home testing. I don't know if it's a matter of having you take your cat to the vet for a curve or what the rationale is. OTOH, we are huge advocates for home testing for just the reason you experienced. It is the best way to keep your cat safe. On that note, let me make a recommendation. It's important to test before giving your cat an injection. The AM and PM pre-shot tests let you know if it's safe to give insulin. What it doesn't tell you is how low the dose is taking your cat's blood glucose (BG) levels. That low point, the nadir, is how you decide whether you need to decrease your cat's dose. What you're likely seeing with what seems to be random numbers is what we refer to as a "bounce." If a cat drops into lower numbers or numbers that what his body is used to, the liver and pancreas dump a stored form of glucose along with counterregulatory hormones into the blood stream. These cause numbers to spike upward and it can take several cycles for the numbers to come back down. Insulin needs can and do change. Even for a cat that is tightly regulated, there may be some variability in the dose. Also, we do not encourage changing doses in large amounts and 1.0u is a large amount for a dose change. We suggest dose changes in 0.25u (in general) increments. Let me also suggest you take a look at this post on helping us to help you. You've already got your signature set up. The next step is setting up a spreadsheet. This is the best way for you to track Zach's progress and it lets us follow along and make recommendations. You may also want to take a look at the sticky notes at the top of the Lantus forum. There's a wealth of information in those posts to help you understand how Lantus works, our dosing methods, etc. Please let us know how we can help!
Thank you so much for your detailed reply! I am planning to do a curve tomorrow so that would show me the nadir number and give me a better picture. What confused me with his numbers was there were of a couple of days where I would administer AM insulin (his sugars were very high) and then by PM shot 12 hours later, his number was too low to shoot. I'm going to work on getting them into a spreadsheet so people can see these numbers. I was hoping to get to a place where I don't need to test before every injection (he is getting tired of me poking his ears), but is that something most people do always - even when they're considered regulated/at the correct dose? I probably will test anyway since the scare that we had and where you mentioned that insulin needs change. Thank you
Ton allow us to better help yu it is recommended that your create and use a spreadsheet ton record you cat's BG. See: https://felinediabetes.com/FDMB/for...g-area.6/#:~:text=HOW TO CREATE A SPREADSHEET https://felinediabetes.com/FDMB/for...ng-area.6/#:~:text=HOW TO USE THE SPREADSHEET I you need help setting up a SS then ask and someone will crearte one for your use.
The SS is fine. I do not see any BG between shots. That info is needed to see what is going one. As already discussed at low does we usually change dose by ¼ unit increments. From your SS it seems 1 unit is not enough but 2 units is too much.
To answer your previous question, unless your cat goes into remission, you’re looking at testing about 4 times a day every day. That’s just your new normal. You’re def not getting the full picture with the preshots only and you don’t know how low the dose is taking him. Are you able to start testing at around +5,+6 every day and also getting a before bed test every noght? You mentioned he’s getting tired of testing, are you giving him a low carb treat immediately after each test to build up positive association? how often are you feeding him now?
Unfortunately with my work schedule, I can't test him at +5, +6 during the week. I can certainly do that on the weekends though. I will start to do a before bed test as well and that would give me at least 3 BG levels each day. I'm planning for a full curve tomorrow. I do give him a treat each time and honestly he's pretty good for it. I just feel bad poking him so much. The vet tech said I should be able to poke only once each day and get the rest of the readings from drawing blood from a scab, but it never seems to form a scab? As you mentioned, I have to accept this is my new normal. I put food out for Zach 3 times a day (morning, supper and before bed). Zach has never been that interested in food, he is very much a grazer.
Hello Amanda, I'm sorry for what happened to you and Zach. If you can't test him regularly, you can use FreeStyle Libre to monitor Zach's blood sugar. It's a continous glocose monitor. very convient and it can help you find the nadir number a lot easier. you don't have to prick his ears so many times. But readings from FreeStyle Libre sensor are not always 100% accurate. If the readings is under 3 or the preshot number is really low, it's strongly suggested to test the cat's BG using an acutal glucometer. I got a sensor that had readings 0.1 higher than the glucometer while i got another one that had readings lower than a glucometer. From my personal experience, the sensor's readings are no more than 0.5 higher/lower than the glucometer.
Thanks for this, I was curious to hear personal experience with the freestyle libre. My vet seemed to think that the freestyle libre doesn't stay on very well and probably wouldn't stay on Zach (ie Zach would find a way to get it off him) for more than 24 hours and so I'd have to keep going back to the vet to get it placed? Did you have yours placed by the vet or do you place it yourself at home?
I have mine placed by the vet but I know many people place the sensor by themselves. They use 3M Vetbond Tissue Adhesive to make it stay firmly. The vet did a pretty good job at placing the sensor on my kitty. It never comes off. I also hear crazy stories like the cat destroy one sensor a day. I guess it depends on the cat and where you place the sensor.
If you look at any of the spreadsheets linked in my signature you’ll see how much I was testing sometimes every 30 minutes when his numbers went too low, and it was never an issue with him or his ears. Are you getting enough blood and warming up the ear before testing? You can certainly alternate ears and even the location of the prick on the ear. Are you aiming for the sweet spot? I know some other folks couldn’t test midday like you because of work like @Sienne and Gabby (GA) would get a test in before leaving the house for work. What are your shot times right now? most cats are grazers and that is totally fine. It’s better for diabetic cats to eat smaller meals or snack throughout the day. It’s easier on their pancreas and also helps avoid big sugar spikes. Most of us feed the main meals at shot times and another 3-4 smaller meals or snacks. Can you get an auto feeder so he has access to food while you’re at work? As someone else already mentioned, it looks like he needs more than 1 and less than 2 units. If you’re going to increase the dose based on the curve, please only increase by 1/4 unit so you’d be going up to 1.25. Have you had a chance to read the yellow sticky notes on the lantus forum, particularly the one in the two dosing methods we use here? hope the curve went well!
Perhaps I could try having them place the freestyle and see how he makes out with it - although the vet did say he would want to actually sedate Zach for the procedure($$$) since he's uncooperative at the vet. But then at least I would know whether he would keep it on or not. I don't know, I'm all mixed up. I did multiple readings today so far, but I didn't do a full curve because his AMPS number was too low so I did NS. I ended up giving him his 1U dose later in the day after I saw his numbers going up. Was that the wrong thing to do? Typically shot time is between 6:30 and 7AM (leaving for work 7:40am) and 7PM. But today where I was home and doing testing and seeing his numbers rise, I ended up doing his shot around 12pm. Do I have to wait until 12am for his PM shot? Or could I give a lesser dose at the regular 7pm time and then test before I go to bed. I'm not sure how to proceed. I have been looking into auto-feeders as well. I do make sure to massage with warm rice sock and alternate ears/location, he's just very squirmy and getting annoyed at me. It's tough to keep him still to get the prick, but not impossible. I haven't had a chance to read over the Lantus dosing methods yet, that is my next project! Thank you everyone for your feedback and assistance, its invaluable!
I'm currently learning how to test . . . but why test so much? What do you do with that information of low blood sugar every 30 minutes? And I've read to do an all wet food diet, so how do you do snacking throughout the day with dry food? My vet told me no snacking through the day because Lantus is slow release for 12 hours, so this is a bit confusing.
Wow, sedation. Have you tried Feliway Spray to help calm and comfort him? I wonder if it would help him to calm down. I also tried playing cat relaxing music to my cat when she is anxious. I can't speak for other cats, but I think the music works for my cat (and myself lol). There are lots of cat relaxing music on Youtube. I guess it won't hurt to try.
What you want to do is give wet food snacks during the day. Wet or raw food is much better for them. As for how to feed mid day, it depends on the cat. If yours is a natural grazer, leave out watered down wet food. If a hoover (like my Neko), you get a automated feeder scheduled to open at certain times, like near the nadir or low point so food can keep him safe. The Petsafe 5 or Catmate 5 compartment feeders are popular models here. You can put an small gel pack below the rotating feeder, or add part of an ice cube to the food to keep it cool and add water during the day. If you keep having to skip shots because the number is lower than you are comfortable shooting, it's best to lower the insulin dose. Yes, you have to wait 12 hours for the next shot. There is a little wiggle room, about 1/2 hour in a day or 15 minutes per shot. Don't give a smaller dose if less than 12 hours. What is your "no shoot" number? On this forum we use 200 as the number below which you don't shoot. Until you get more data.
