New Diagnosis: Kitty

Hi everyone,

I'm sorry for the huge post. I don't know how detailed I should be.

My name is Corey, my cat named Kitty was recently diagnosed with diabetes. She will be 10 years old this August. I don't remember exactly when I noticed her pre-diagnosis symptoms, I believe the onset was gradual. I started seeing her laying with her head in her water dish drinking for 15 minutes straight and making gulping noises. I wasn't sure what was going on but I didn't think much of it in the beginning. She started becoming ravenous when it came to eating and drinking. I couldn't wash my hands in the sink without her begging me for water and I couldn't keep her away from her brother's food. What alarmed me was when I noticed she was dropping weight quite dramatically. At that point I began researching her symptoms and scheduled her an appointment with a vet. From my research, I suspected diabetes, but I didn't know much about how diabetes is treated in cats. Long story short, he diagnosed her with diabetes, kept her for the day for a glucose curve, and sent me home that evening with a prescription for Novolin N, 3 units twice a day. He didn't even give me a demonstration on how to administer it. Luckily I have experience injecting humans with vaccines (I'm a pharmacy technician) and so I was able to watch a few YouTube videos and I began my journey of treating my cat for diabetes. Also, I knew nothing about home testing at this point, he told me to come back in 2 weeks to check her glucose again.

Now, of course I did tons of internet research that night. Everything I was reading was telling me her dose is high and that I needed to change her diet right away. I spoke with the vet tech the next day and she told me not to change her diet, feed her exactly the same, we just need to focus on getting the glucose under control. I decided to go with their advice for the first two weeks, after all they are the ones with the advanced medical degrees. At the next visit he checked her glucose and it was still high. (mind you, he shaved her leg and used a syringe to get blood for the glucometer/test strip. Why would he do it that way when he could just use her ear for a small sample of blood?) He wanted to increase her insulin but I insisted we change her diet first. Was I wrong to want to do this? It feels wrong going against what the vet wants to do, but all the information online told me that we weren't going at this treatment the right way. He sent me home with a bag of Purina Pro Plan Vet Diets DM dry food (which he told me he doesn't even recommend) and he told me to call him in a couple weeks if she's still drinking too much. I transitioned her to the new food, but I knew she was still being overfed and I really wanted to switch her to canned food.

I started transitioning to canned food this Monday (3/28) and I began testing her glucose at home twice a day before meals. I watched many videos on how to home test and so far I've been pretty successful, although sometimes it takes a few pokes and I feel bad for making her bleed, but her ears seem to be starting to bleed easier now that I've done it a handful of times. Now, I'm getting nervous because I feel like I'm going at this without any guidance from the vet. I've read Dr. Lisa's information about transitioning to wet food while already on insulin. I understand that hypoglycemia is a big concern, and I'm very worried about it.

At this point, I'm feeding her 1/4 (one fourth) cup of the Purina dry food twice a day, along with 1 can of Fancy Feast classic pate twice a day with the dry food. She loves canned food and gobbles it all up in minutes, and she snacks on the dry food and its usually gone within 4-5 hours. I don't know if I jumped too quickly with how much dry food I took away. I'm still giving the full 3 units twice a day because her numbers have still been high. I forgot her insulin Monday morning (so mad at myself, I had a doctor appointment and completely forgot and it was several hours later when I remembered so I skipped it). So her glucose Monday evening was 356 mg/dL. Tuesday morning it was 350 mg/dL. Tuesday evening it was 296 mg/dL. This morning it was 345 mg/dL and tonight it was 285 mg/dL. I checked it again right after she ate her canned food tonight and right before giving insulin, just out of curiosity, and it had raised to 327 mg/dL.

I'm nervous about transitioning any further with the canned food because I know it is much less carbs than the dry food and I feel like I'm approaching this without the vet's guidance, but I haven't felt like he's interested in helping me change the diet. He hasn't even mentioned home testing. Should I call them and tell them what I'm doing, that I'm testing the glucose at home, and see if they will give me advice then? I don't feel like he knows the proper way to treat a cat for diabetes. I live in a small town, there is only one other vet in town and there is no guarantee they will treat my cat the right way either. Can I or should I be doing this without a vet's guidance? I don't know how to adjust her insulin dose if I start seeing much lower glucose numbers. Do you think I should take her to the other vet?

Again, I'm sorry for the huge post. I just didn't want to leave anything out. Am I going crazy? I just want to do what's best for my cat but I'm so nervous that I'm doing this wrong and it doesn't help that I feel like I have no support from the vet.

Thank you for any advice you can provide and feel free to correct me in any places I was wrong, I'm still learning about all this. I'll answer any questions you need me to.

 

You're totally normal so stop questioning your sanity. The sad truth is that vets get less than 1 day of education on diabetes in school and that covers all species. Vet schools only have 4 years to teach everything so they can't spend weeks on each disease, the different types of treatment for that disease, how it differs in different species, etc.

A LOT of us here just do our own thing with the diabetes and just use our vets for other things and to write our scripts. The people here do nothing but live and breathe feline diabetes 24/7/365 so they know what works (and what doesn't).

The biggest red flag I see is your vet is prescribing an insulin that is one of the worst for most cats. It's OK for dogs but with a cats faster metabolism, Novolin just isn't a good choice and 3 units is a HUGE starting dose. Most cats should start at 0.5 to 1.0 unit. Novolin, Vetsulin and Humulin are all insulins that haven't been recommended for use in cats in several years. The 2018 AAHA Guidelines on diabetes management recommend Glargine (Lantus, Basaglar, Semglee) or ProZinc for cats.

In a perfect world, as long as there aren't any ketones in the picture, a newly diagnosed cat should do the diet change FIRST....before starting insulin. That's when it's safest to do it and also allows the caretaker to get used to testing, see what effect the diet change has and learn what their cat's BG is when they're home, not stressed out at the vet which can raise the glucose up to 200 point. Just like our blood pressure is higher at our doctors, our cat's react to stress by having higher blood glucose numbers. We're not talking about keeping them off insulin very long....a few days of nothing but low carb canned food and you'll know whether your cat is going to need to start insulin or not.

Since you're already giving insulin, the diet change does need to be slow and with frequent testing. The D/M kibble is also too high in carbs so you need to work your way off that and get Kitty eating only low carb canned foods. Your vet can't tell you what you can feed your own cat and you're the one that holds the syringe so it's always your choice who you want to listen to.

I live in a very small rural town with 2 vets who are both mixed practice vets that see more cows than cats so I ended up going to a vet over an hour away who was willing to give me a script for Glargine. I got it filled at a pharmacy in Canada where it's 1/3 to 1/2 the price and they deliver to the US (takes 7-10 days). Another nice thing is they only require a script once. You don't need a new one every year like we do in the US.

You can call around and ask how the vet treats their diabetic cat clients. Just tell the receptionist that you'd like to talk to the vet and would they call you back to discuss it. (don't expect to talk to the vet right away...they usually do call-backs after hours....and if they never call you back, that should tell you something too). Here are some Vet Interview/Screening Topics you can use.

Hang in there. There's lots of help here and some great people that have no other motivation than to help you help Kitty live a long and healthy life.

 

I'm new here too.
I experienced the same vet issues. No information and being told to do this not that. The whole while my gut was saying so many things like normal blood testing in done in humans especially before a shot, so why not in cats. My best adcice because I myself did it is to find a vet that is willing to work with you. I did and its been so great. We debate but Jack is my cat and in the end with the help of this group my journey and Jack's is getting easier.

 

Hi Corey and Kitty and welcome to the forum. I agree with what Chris has said.
You need to find a vet who will swap you to Lantus, Levemir or Prozinc.
Novolin N is not a suitable insulin for cats at all. It is a fast acting harsh insulin which does not last the 12 hours that the longer lasting more gentle insulin do.
Are you testing the BG, then feeding and waiting 1 hour before giving the dose of insulin?
With Novolin N you need to make sure there is food aboard for when it hits fast. And I would give snacks at +2 and +4 every cycle to make sure the BG doesn’t drop too low.
Also I would suggest you get a test in about 4 or 5 hours after the dose (+4 or +5) to see how low the dose is taking Kitty. She could be dropping low during the cycle and bouncing up high at the end and you won’t know unless you are testing.
I am also concerned about the high dose she was started on. The normal starting dose is 1 unit.
You don’t have to tell the vet you are hometesting ….that is entirely up to you. Remember you are Kitty’s advocate and she is relying on you to speak up for her.
I would also do the swap over to the low carb wet food but gradually so the BG doesn’t drop too much. And monitor the BG closely while doing this.

I would suggest you look at our spreadsheet and if you can set that up and fill in any data you already have, we can help you a lot more.
Here is a link to the spreadsheet and the hypo kit…..have you set up a hypo kit yet. If not it is very important you have one set up in case of low numbers. HELP US HELP YOU
Keep asking questions, we are happy to help.

 

Hi and welcome to the forum. Your story is one we see here time and time again, most vets just don't know that much about how to treat feline diabetes unfortunately. This place is a godsend! I was so lost, overwhelmed and depressed before I found this group of literal angels. I am pretty new here myself so just wanted to chime in and say welcome, you will get absolutely blasted with truckloads of information here so take a deep breath and take it slow.

 

Thank you all for the replies. Its comforting knowing that there are people out there willing to help me through this.

I'm going to contact my current vet and ask if they will prescribe insulin glargine or ProZinc. I'm not even sure if his office carries ProZinc since he didn't give me a choice of insulin, he just sent me off with Novolin N. If he will not prescribe anything else then I will reach out to the other vet clinic and as for a callback from one of their vets (they have 3 in that office) to discuss those options with them.

Exactly how slow is slow? I've started to transition her off the DM dry food but she's still getting 1 days worth of that (1/4 cup twice daily) along with 1 can of Fancy Feast classic pate twice daily. I've read many places that Fancy Feast classic pate is good choice for diabetic cats that is also economical. Should I keep her at her current regimen for feeding for a few days while I get some more number on my spreadsheet?

I'm testing the BG, then feeding and waiting 30 minutes before giving the dose of insulin. I thought I had read elsewhere that 30 minutes was sufficient. I don't always have a full hour to wait but I can try to start waiting an hour when possible if its really important.

With the new canned food (Fancy Feast classic pate), she loves it and she always gobbles up the whole can within 10-20 minutes, and then she has the 1/4 cup of DM dry food to snack on later which I've noticed is usually gone by about the +3-5 hour mark. Is the can of FF enough food aboard for when the Novolin N hits? Once she is off the dry food and only on canned, what constitutes a snack? Do you mean treats? I have freeze dried chicken that she seems to enjoy sometimes but she doesn't always like them, sometimes she just bats them around the floor. Or do you mean some kind of a more substantial snack?

On work days, I always come home on my lunch break, but the time fluctuates based on my schedule so my post AMPS test on workdays will fall between the +5 and +7.5 marks. On days off, I can definitely hit the +4 or +5 hour mark.

I figured I was okay to proceed at the 3 units since I have been giving it to her twice daily for 3.5 weeks and her numbers are still quite high (300s and high 200s). Do you advise that I drop it lower at this point? I want to continue her transition to only Fancy Feast classic pate but I am nervous and not sure about how to approach it. Its been two days now that she's been on 1 can FF and 1/4 cup DM dry food twice daily.

Thanks, I have set up my spreadsheet. Unfortunately, I haven't been home testing very long and I wasn't being very good at record keeping, so I'm starting fresh today. I will be consistent with updating the spreadsheet with my numbers. Just for clarification, the +1, +2, +3, ..., +11 columns are the number of hours post insulin administration correct? Or is it post AMPS or PMPS? Also, the AMPS and PMPS are before feeding, correct? I have most of the items on-hand for the hypo kit, other than the high carb canned food. I will grab some the next time I am out.

On a side note, Kitty seems particularly hungry this evening, following me into the kitchen anytime I go there. I typically give her insulin at 8am and 8pm but today had to give her morning shot at 7:30am. I noticed on my lunch break, she finished the last of her dry food around 12:30. So she is going around 7.5 hours without food. Is this okay for her to go without food this long? I understand that meal feeding is preferred over free feeding for diabetic cats, so I would think its okay, I just don't know how long is it okay for her to go without food. Is her hunger tonight anything I should be concerned about?

P.S. These past two days since Kitty has been getting canned food and less dry food, it seems like she is drinking less and I am finding less clumps in the litter box. This is a good thing, right?

 

Here is the BEGINNERS GUIDE TO NOVOLIN
This is part of what it says With an insulin with an early onset, it is important that your cat has eaten before you give a shot. Generally, you want to feed your cat and give a shot an hour after your cat has eaten. The order for this process is:
(1) test, (2) feed, (3) wait 60 min, (4) shoot

[QUOTE="Corey and Kitty, post: 2932313, member: 35937"]figured I was okay to proceed at the 3 units since I have been giving it to her twice daily for 3.5 weeks and her numbers are still quite high (300s and high 200s). Do you advise that I drop it lower at this point? I want to continue her transition to only Fancy Feast classic pate but I am nervous and not sure about how to approach it. Its been two days now that she's been on 1 can FF and 1/4 cup DM dry food twice daily.[/QUOTE]
I’m not a Novolin user but I’ll see if @FrostD can help with the dose.

No, a snack is not a treat….keep those for when you are testing the BG. A snack is a tablespoon of canned food….approximately. It depends on if your cat is a good weight or needs to put on weight. Start with a tablespoon and go from there.

The +1 is one hour after the dose. +5 is 5 hours after the dose.
AMPS, PMPS are the BGs you get before feeding and giving the dose.
Well done getting the hypo kit set up.

is she under weight? It is best to feed most of the food in the first half of the cycle when the insulin is strongest. However if she is really hungry and asking for food a bit later than that is ok to give her a snack. I would also test the BG then to see it has not dropped. One of the signs of a low BG is extreme hunger..

That is good news. Dry food makes cats drink more because it has very little moisture in it and it is high carb as well. You should be seeing the abG go down a bit if you are reducing the dry. Make sure you are monitoring the BG closely…..try for two tests a cycle if you can. And if the BG is low, test again to see it is not still dropping.

 

She weighed in around 12 - 12.5 pounds on March 7th. I believe this is around where her ideal weight is. Although she only weighs that much because of the diabetes, she used to weigh in around 17 pounds until the diabetes caused weight loss. Her following me into the kitchen started when I got home from work, it was within 2 hours of her usual feeding time. I should not feed her in the 2 hours leading up to meal time, correct? I tested her before feeding and it was 312 so I don't think low BG was the cause of her hunger.

 

I've not used Novolin and to be honest it scares me. Normally I'd say 3U seems too high, but today's data seems to be ok...

That said, sometimes it takes some time for those dry high carbs to come out of their system. I'd have expected a little wiggle by now, but with just the one day of data it's hard to say if today was maybe a bounce. Just stay on top of the testing is about the best advice I can give unfortunately.

Let me tag @Larry and Kitties and see if he has any thoughts

 

Tonight she finished all of her food (1 can FF and 1/4 cup Purina DM dry food, roughly 300 calories of food) by 10:00pm, just 2 hours after her dose of insulin. Her BG reading at this time was 254, down from 312 PMPS. From what I understand, Novolin N peaks around 4 - 6 hours after administration. Is it okay that she will be heading into the peak without any food left?

I just weighed her on my home scale by weighing her and myself together and then subtracting just my weight. I did it twice, one time I got 15.5 pounds, the next I got 13.5 pounds, so I'm not sure how accurate my measurements are. I'm pretty sure the vet told me she weighed around 12.5 pounds when he weighed her in his office just 3.5 weeks ago. I don't know if that is an ideal weight for her, but she used to be much more overweight at around 17-18 pounds, so I assume 12.5 pounds is pretty good. The vet did tell me that I should see her start to gain weight once I started the insulin. I don't want to keep giving her more food when she's already eating 300 calories twice a day. I don't want to make her overweight again. I just worry that she doesn't have enough food in her for the amount of insulin.

 

Probably. If you can, test hourly til +6. If you need sleep, I'd try to get a nap in for an hour now, then test.

That was a relatively small drop to +2, but she also had a lot of food/carbs - so still a bigger drop than I'd have "expected" (I use the word loosely because Novolin can cut right through those carbs). It's possible as some start to wear off you'll see blues, possibly greens.

 

So I just checked her again at +3 and she's at 206. I'm a bit worried, although, I've never checked her at these intervals before (I'm normally sleeping at this time) so for all I know, this is what happens every time I dose her. I'm not sure what I should do at this point.

 

That is still an ok (appropriately slow) drop. Now the trick is, those wet food carbs are going to start wearing off on you. Catch a nap, test in an hour.

Unfortunately I have to get to bed, hopefully @Bron and Sheba (GA) can peek back in on you. I don't necessarily think you're heading for the a danger zone, but I'm not experienced with Novolin to say that with complete certainty (unfortunately nobody here is, really). I know the broken/no sleep stinks, but this will give us huge information on if her dose is ok or not.

Are you home during the day most days?

When do you next plan to scale back on the dry food?

(^these also factor into dosing)

As for the food, I would let her eat a little more. It takes a little while to become overweight, and it sounds like she's actually a bit underweight if the vet expects her to gain weight.

Also, a tip - often if they come to you asking for food in that first part of the cycle, it's because they can feel the BG dropping or getting low. Sometimes its just because it's lower than they're used to, but I always grab a test because you never know

 

Okay, I'm going to try to take a nap. Kitty is so fed up with me poking her ears right now. I hate that I have to use Novolin N right now. I'm actually at work during the day most days. I am off Sundays and Mondays so I am home then. At this point, I'm afraid to make any more progress on the food transition without making a change to the insulin dose as well.

 

I hope I'm not posting too frequently. I didn't nap, I couldn't. I just checked her at +4 and its now 192. I'm feeling more comfortable since it seems to be slowing down (I know it can be unpredictable). That jump from 254 to 206 in 1 hour scared me. I will take a nap now. I'd like to at least get her +5 and +6 numbers. That will put me at about 2:00am and I have to get up at 7:00am. So I should still be able to get 5 hours of sleep if all goes well. This is what coffee is for! I feel so bad for Kitty. Her ears are bloody and she let out a little whine this last time.

Update: +5 reading is at 215, seems the curve is going back up now.

 

Hi Corey and Kitty,
Welcome! I am also new here and I have delt with similar struggles...I can tell you right away you are not crazy and you are not alone. The only thing I think my Dr. did right was prescribe us lantus...other than that she left me in the dark alot and most everything I learned was from here.
Now my Dr. has quit in the middle of Buddy's new diagnosis and her new replacement Dr. finally called me back today....I think I have to call around first thing in the morning and start looking for a new practice. He talked to me for 25 min and I found him to be very intense and controlling (not sure if that is good or bad)... and he did all the talking. I am a very shy person and hate to question Drs.

my only advice i can give is just take one day at a time, get plenty of rest in. welcome again!

 

HI Corey I am around if you need me.

 

Thanks Patty, its comforting to know that I am not alone. I hope you and your cat are doing well.

Thanks, I just recorded the +6 reading which was 269. I think that's going to be it for tonight. Kitty needs a break, she's been such a good girl, she seems to have given in to the testing. She's not even pulling away anymore when I touch her ears. I don't want her to resent me for this. The only thing I wonder now is if anyone has advice on how I should proceed when it comes to her next dose/feeding.

 

I think you can go to bed now. Just leave a small snack out for her. She won't resent you. Sounds as if she is getting used to it. Are you giving her treat with the tests?
For the AMPS, I would test at the normal time...remember you need to wait 1 hour after feeding before giving the dose. If you have concerns, just post and ask for help.
You can post as often as you like. We don't mind.

 

Hi,

I think I need help, I checked her AMPS at 7:00am and it was at 338. She ate 3 ounce can of FF classic pate and 1 hour later I checked BG again just before giving insulin and it has actually gone down to 322. I haven't given her insulin yet because the number went down instead of up. Is this due to variance in the meter? Am I still safe to give her insulin? Should I not be testing after she's been fed and before her shot? Is the AMPS sufficient enough to determine if she's okay to shoot?

 

Update: I waited 20 minutes and checked again and its now 288. Also, I have to leave for work in about 20 minutes.

Regarding her food, she has only eaten 3 ounces of FF, she hasn't touched any of her DM dry food.

 

I would give some more food now and give a lower dose of the Novolin. I am not a Novolin user ….we have very few here. I would go with 1 unit and keep testing during the cycle.

If you don’t have any Ketostix to test for ketones in the urine , I would get some from a pharmacy or Walmart’s, collect a urine sample and follow directions on the bottle.

 

tough to get that expert advice at this time of day, most of the senior members seem to not be around early AM

however I can tell you that 338 and 322 are pretty much considered the same due to the variance yes. 288 is a slight drop

@Bron and Sheba (GA) still around?

[edit] nm you posted same time I did ha

 

I think you added some more info after I answered you post.
Are you able to come home and test her at all?

 

Yes, I'll be able to come home and test her at approximately 1:30pm which is in 5 hours.

 

If you leave wet food out for her and some dry food, do you think she will eat it?

 

She may, she usually snacks on the dry food that I leave out. I'm not sure if she will eat more wet food.

 

Ok leave out some dry food for her and I think 1 unit should be OK to give her, seeing you are not going to be there to monitor the BG until +5.
Are you happy with that?

 

Okay, I informed work that I'm going to be a little late, so I bought a little time. She ate a few bites of DM dry food and I checked her BG at 8:50am and it was up to 301. I'm going to give her 1 unit, although its an hour past her usual dosing time so I will now be checking her around the +4.5 mark. I'll add a bit more dry food to her bowl just to be safe.

Good news, I called her vet, he was very receptive to prescribing a different insulin. I requested insulin glargine and he said he will write the prescription and I can pick it up later. Should I fill this locally just so I can have it now. I know it will be more expensive, but getting it from Canada can take a while. I'm going to need help transitioning to this new insulin.

Unfortunately, he said he did not want to provide advice over the phone about her current insulin dose. He said he would only recommend changes to her insulin dose if I were to bring her into the office so he can check her BG himself. He said that home testing with human meters can be unreliable (shrug).

 

Good.

That’s great news. you can get a biosimilar insulin to Lantus called Semglee which is much cheaper.
I don’t live in the US so I can’t comment on prices really but do ask for a cartridge (what is used in a pen) not a bottle as it is better.
I’ll tag @Diane Tyler's Mom as she lives in the US and can help you much more with purchasing the Lantus.

The human meters are very reliable. That’s all the vets ever used until the pet meters came along in the last 7 to 10 years.
Don’t worry we can help you with the dosing and also when you do the swap over to the Lantus.

 

Thanks for all of the support. I've been a pharmacy technician for the past 12 years, so I am very familiar with the pricing, vial vs pen, etc. The pharmaceutical manufacturer Mylan actually makes a generic version of Semglee now, it is simply called Insulin Glargine (see attached image). Its packaging looks identical to Semglee but it is even cheaper due to being marketed as a generic of Semglee. So you are recommending that I get the pens?

 

Yes, get the pens. Since they are smaller volume than the vial, much less chance it'll go bad before you can use it all. Then there's some of us that blow through a pen a week

I can't speak to these new generics, but most of us find the insulin is still good long past the "use within X days" after opening.

 

Update on her BG, at +4.25 she's at 284 and she only received 1 unit this morning of Novolin N.

Now, this morning when I was talking to the receptionist at the vet, she was the middle person between the vet and I. I explained to her what insulin I wanted, she asked the vet, she told me he said yes he would write it and I could pick it up this afternoon. I called them this afternoon before driving there and they said the prescription isn't ready yet because the vet wants to speak to me personally and he will call me when he's not in appointments. I am nervous because I'm not sure what he's going to ask me and I don't know how to explain why I want to change insulins without somehow offending him. I don't really know what I am talking about other than that the AAHA stopped recommending Novolin N for cats in 2018 because they found that its duration doesn't meet 12 hours in cats. I don't think he really knows how to prescribe it because the receptionist was asking me what dosage I would want and what concentration. I told her its a U-100 insulin, biosimilars are Lantus, Basaglar, and Semglee, and that it would likely be a dose ranging from 1 - 2 units twice daily. I'm still awaiting a call back from the vet himself.

I read the information here: https://www.aaha.org/aaha-guidelines/diabetes-management/treatment/cats/

I just hope that I can convey that information to him so that he will be on board with it.

 

I would just say you did some reading, and the recommended insulins (per that AAHA publication) are Lantus, Levemir (I think Lev is on there can't remember), and ProZinc. And that glargine is commonly used because it has sufficient duration and high remission rates (https://www.aaha.org/aaha-guidelines/diabetes-management/treatment/insulin-therapies/)

I guess glargine does come as U300 as well but absolutely do not do that ha u100 only. He may say ProZinc (U40), I'd just say hey I just bought all these U100 syringes and stuff

Sometimes they get nervous prescribing things if they've never used it before...my vet had never prescribed Levemir, but he was willing to give it a shot because he knows I am on top of everything (has a link to my spreadsheet). But I specifically chose my vet based on other FD caregivers' recommendations, and he has always worked with me.

At this point I think he's more staying out of my way than anything

 

The AlphaTRAK Glucometer by Abbott (Zoetis has since purchased rights to the AlphaTrak meter) a leading manufacturer of human diabetes testing products, was introduced in 2006.

 

Is the AlphaTRAK glucometer worth the added cost? The strips are 10x the cost of ReliOn strips. Are the AlphaTRAK glucometer readings more accurate?

 

Personally I would go with a human meter. The dosing methods here on the forum are based on the human meter. The human meter is just as accurate as the pet meter. I’m sure they would not allow humans to have meters that were not accurate. The difference is that the pet meter runs a little but it higher. You can buy a ReliOn prime mere from Walmart for $9 and 100 strips for $17.88

 

Nah. Only difference is human meters tend to read a little lower than AT, but our dosing methods factor that in

 

we started out with an Alpha Trak 2, as per our vet. The experts here at the FDMB asked if we would be open to switching to a human meter because the dosing methods are based on those numbers -- we said we'll do whatever is best for Hendrick -- so we did. No problemo!

If you look at Hendrick's spreadsheet you can see where we used the AT2 and where we used a human meter. Strips are so much cheaper!

 

Hi everyone, I want to start asking questions about transitioning Kitty to Insulin Glargine. Should I continue that here or should I start a new thread in the Lantus forum?

Also, I don't know if its noteworthy, but the past day and a half I have noticed that when I do a preshot BG reading an hour before shot time, and then I check the BG an hour later right before the shot I have been getting nearly identical readings. During this first hour of feeding she only eats the FF so I'm assuming that means the FF isn't spiking her BG in that first hour. I don't know if it means anything, I just thought it was interesting.

 

even though I've been posting here about 3 months I am not sure -- the Lantus forum seems like it is more about the daily threads (called condos) where people report their cat's BG numbers and get dosing guidance if need be. But you do see people post other non-condo threads from time to time...those condos definitely dominate the page though, there are a lot of them! I say go for it, post it over there see how it goes. I'll give your thread some love!

That is interesting and the way I read that is this: Kitty doesn't have much of an impact to her BG from the low-carb stuff like FF pate. This is good to know, as I have learned over the past few months it is important to have an idea how my cat reacts to carbs and to low carb -- in particular for when you start dealing with the lower numbers and trying to carefully keep the cat in the green but not go too low.

 

I would post over there with a link to this thread - I would title it "4/2 - Kitty - Switch from Novolin to Glargine Dose Advice" and tag it with the "?" prefix

It's a little interesting the food doesn't spike her more...could be due to meter variance, but lately I'm noticing most cats tend to have an individual "top end" limit...like how you see Kitty really isn't going above 350, and we know the Novolin has been worn off for hours.

 

Hi, I hope everyone is doing well.

A few questions. I'm off from work and going to be home the next two days.

Would it be beneficial to perform a curve while she's still on Novolin N?

If so, are there any special instructions or is it just test BG every 2 hours throughout the cycle?

If its every two hours would it be better to do +1, +3, +5, +7, +9, +11 or +2, +4, +6, +8 +10?

Is testing every 1 hour better or is it not necessary to do it that often?

I just don't want to keep bugging her every hour if it really isn't necessary, but I will do it if there is some benefit. I've got the technique for collecting a blood sample down to a science and I can get it on the first try almost every time, so she doesn't mind it too much, she's actually started purring when I do it now. It's funny, she's handling this whole diabetes thing a lot better than I am (but I'm getting used to it).

Regarding her transition to canned food. Her current diet is one 3oz can Fancy Feast Classic Pate and 1/4 cup (plus a little more) Purina DM dry food; and she gets these twice a day. I've stalled at these amounts because I'm not sure how to approach moving forward with it. Would it be advisable to continue the transition while still on Novolin N or would it be better to wait until she on Insulin Glargine?

About the Fancy Feast, I have seafood varieties, and I have poultry and beef varieties. Do I need to be considering calories? The reason I'm asking is because the seafood varieties range from 82 - 88 kcal per can while the poultry and beef varieties range from 96 - 101 kcal per can. Depending on which ones I feed her there could be a difference in her daily caloric intake and I'm not sure if this matters. Fancy Feast's feeding guidelines say on all cans to feed an average sized cat 1 can per 3 - 3.5 pounds of body weight daily. With her being around 12 - 13 pounds, on the high end it would be around 4 cans per day. Is this what I'm aiming for as a goal for her transition to canned food?

A question on the spreadsheet, since the AMPS and PMPS are 1 hour before I give her shot because I have to feed her and wait 1 hour before shooting, should I also be recording these same values on the previous cycle's +11 column since technically these are the same thing?

I think that's all the questions I have for now, but I'm sure I'll remember some more in about 10 minutes.

Again, thanks for all of the help and support!

 

As for food - I would hold and let the Lantus board help you out there. I am 99.9% sure they'll tell you to switch insulin, hold the food as-is for 5-7 days to see where she's at, then resume the transition.

I wouldn't worry too much about the calorie difference - I just set new food out if I notice it's gone (like when I do feed the salmon one, he eats it all - but will leave some of the poultry ones).

Yes technically that would be a +11, but I really wouldn't worry about it since you'll be transitioning.

I wouldn't do a curve, there's enough data there is say for the Lantus board to help you out with transition dose

 

Kitty is at 296 this morning, her lowest pre shot reading so far. There are about 40 minutes until shot time. She did have a similar pre shot reading at 312 on 03/31/2022 and she only dropped to 192. Its probably still okay to give the full 3u. Thoughts? I don't feel like at this point her numbers will go low enough to be in any danger, and I'm going to be home with her most of the day today. I may have to leave once or twice for a couple quick errands but I should be around for most of the cycle.

EDIT: It just dawned on me, I opened a new bottle of test strips this morning. Could this have something to do with the lower number?

Also, I tested again an hour later and she was at 300 so the same as AMPS, I went with the full 3u again.

 

I doubt the new strips have anything to do with the reading.

I would suggest getting a +2 or a +3 just to have a handle on where Kitty's numbers are heading.

 

Okay, thank you. I will keep an eye on things.

Regarding ketones, with my situation of having two cats in the house, and a 40+ hour work schedule, I don't think I will ever be able to do any regular frequency of urine testing. I'm interested in getting a ketone meter, but I do see the strips can be pricey. With the fad keto diet for humans, there seems to be a few new ketone meters on the market. Can I get any ketone meter? I'm specifically interested in the Keto-Mojo meter because its strips are considerably cheaper at just $0.80 per strip. There is a video here of these people comparing this meter to the Precision Xtra meter, the results seem to be good, but I'm no expert. Just wondering any thoughts on this meter and if anyone has used it. I also can't find anywhere on the Keto-Mojo website that specifies the blood sample size, but the users in the video claim that the Keto-Mojo uses significantly less blood than the Precision Xtra.

Also, in order to determine if the cost is feasible, I need to know how often I should be testing for ketones? Is this a once a day thing or is it more or less often? Or is it based on certain conditions?

 

Hi everyone,

Kitty's glucose has dropped from +8 on the morning cycle to now PMPS. Its feeding time, but haven't started yet because I've never had this happen before and wanted advice. Should I feed her and check again in 20 minutes (her canned food doesn't usually affect her BG levels) or should I just check again in 20 mins just to make sure its rising or staying the same? She was at 296 this morning and received the full 3u, but I've just never noticed a drop from +8 to +11.

 

I would proceed as normal no stalling or anything

 

Okay, thanks for the quick response. I just get nervous when things don't fit the pattern that I'm used to seeing. Any idea where today's lower numbers could be coming from?

 

I'd consider that flat really, factoring in meter variance (up to 20%).

It's possible her body is getting more "used" to the insulin, but honestly sometimes odd things just happen. It's complex biology after all!

But now an important note - I would only shoot the full dose over 250 (coincidentally that's also what dosing sticky says). Reason being - you can tell from the last few days that she would likely end up right around 90 at nadir if you shot full dose at 250. We do not want her any lower than that. We try not to skip as that throws things out of whack, so I would say in the 200-249 range try 2U if you're around to monitor... otherwise do something like 1U. I would skip anything under 200 for the time being

 

Hi,

Just wanted to check in. I found a small amount of puke this morning. It was just 15 pieces of undigested dry food and what I'm assuming is water. It was on the couch, so it got absorbed so its hard to tell how much liquid it was but there was a wet spot surrounding the food. It happened at some point while I was sleeping but it was still wet so I assume it was sometime early this morning. I fed her as I normally do this morning and she ate up all of her FF pate with no issues. I have two cats so I don't really know which one it was, it was on the couch that she normally lays on, but the other cat does occasionally lay there too. If I assume it was Kitty, is this something I should worry about?

I'm back to work today, so I wont be around to check on her until about +5.

Also, her BG dropped from 347 to 297 an hour ago when I fed her, to now when its time for shot. I hate when it does this. Why does it go down when it should be staying around the same? It makes me nervous giving her shot.

 

Technically within meter variance.

Sounds like a "scarf and barf". As a one time thing, not worrisome in terms of health. The only thing it impacts is shot, need to make sure she eats a decent amount before the shot. You didn't mention specific times so I'm not sure if/how it relates to shot.

If it was that hour before shot try to get her to eat a bit now just in case it was her

 

Sorry, I should have been more clear.

It happened sometime between +5 and +11 of yesterdays PM cycle, so it was late last night while I was sleeping. It wasn’t anything to do with this morning’s feeding.

 

How much would be a good amount to scale back at this point? Should both AM and PM feeding be exactly the same? Is it too big of a jump to just remove the 1/4+ cup of dry and give an extra can of wet? If that's too big, maybe 1/8 cup dry and another 1/2 can of wet? I just worry because if I start this change tomorrow morning, I have to leave for work and wont be back to check on her until around +5. And you mentioned scaling back the Novolin in order to do the food transition?

 

Well, the "proper" way would be more like the 1/8 cup dry you mentioned, then a few days later gone completely.

Now if it were me, I'd just go cold turkey and see if she'll go for it...

Yes to reducing Novolin dose - removing the very high carb dry food will lower BG on its own, we just don't know how much (it's pretty unpredictable for every cat). What's your schedule look like Thursday and Friday?

Does she eat the dry at a certain time (in terms of +3, +5, etc) or does she graze?

 

My schedule is about the same for the rest of the week, no days off until Sunday - Monday.

So I put down the canned and dry food at the same time for each feeding. She eats the canned food immediately and usually finishes most of it within 10-15 minutes, and its definitely all gone within the first 30-60 minutes. She's usually good for a while after that and doesn't touch the dry food until a little bit later and just grazes on it for several hours. I come home for lunch for an hour usually somewhere around +5 to +7 and there might be a little dry left but never very much, that's why sometimes I give her a little more than 1/4 cup because I don't like her being without food from +5 to +7 onward. Occasionally she will still have a small amount of dry food left around the +10 mark, but its never very much.

 

Okie dokie. I changed my mind. Knowing this, I think the dry is what is keeping her afloat midcycle and muting the nasty drops we usually see on Novolin.

So my official, final recommendation at this point is to switch to Lantus whenever is convenient, starting with SLGS. You'll hold the starting dose for a week unless a reduction is earned, then at that point I'd change food next weekend assuming you're home.

The blood ketone meter will be a perfect warning system for you, lots of us use it. @Hendrick's mom and dad is a perfect example. Anecdotally the baseline for most cats seems to be around 0.4-0.8. When it starts creeping above that we increase food and fluids to help flush them out. Once.yoibget around 1.5 or higher we really start to raise an eyebrow and stay on top of it. There are two papers in the DKA post (linked in your main forum post) that say :

• Study 1: blood ketone reading of 2.55mmol/L or higher is 94% accurate in diagnosing DKA, and values below that are 68% accurate at ruling out DKA
• Study 2: blood ketone reading of 2.4mmol/L or higher is 100% accurate in diagnosing DKA, and values below that are 87% accurate at ruling it out
• @Suzanne & Darcy going to tag you since I finally re-read them, and I know Darcy got much higher without going into DKA.

 

I'm not sure if the vet checked her urine for ketones when she was initially diagnosed, if he did it must have been negative because he didn't mention anything about it. I know he checked the urine for glucose though. I have no reason to believe she has ketones. I've checked her urine once and it was negative on my test. I just thought that part of the formula for DKA is not enough insulin, so I get nervous since I'm going to be changing the insulin. Are ketones something I should be worrying about? Are you saying that in the 0.4-0.8 range is okay? How often should I check for ketones?

 

They usually don't check blood ketones unless they're hospitalized for suspected DKA, it's usually just a urine dipstick for regular labs.

When unregulated we do recommend testing daily for ketone-prone cats, maybe twice a week for others. When regulated, once a week. I know the strips are expensive, but I would baseline get 3 straight days of readings (just once a day) and base future testing frequency on what happens those few days.

My cat has never been above 0.6 unless he was sick, and even then I don't think he went above 1.2. I would say LO-0.6 is a good range. And he was very much unregulated for a long time. On the flip side, we've had cats that are mostly regulated that just jump all over with ketones. For whatever reason some cats are just prone to them.

I wouldn't worry much. DKA is not enough insulin + inappetence + underlying stress/infection. As long as she's eating, good. Stay on top of any signs of illness. Ketones are still a decent risk at the dose/insulin you're on now, I don't view Lantus as any more risky. In fact, it should let you get her better regulated and lower risk long term.

We're usually pretty good at determining a Lantus starting dose that nearly mimics the prior insulin...Novolin probably the trickiest one, but it should end up close. And if ketones do start rising, we'd potentially look at increases that are "outside the rules"

 

When you say “ketone-prone” do you mean cats that have presented with ketones in the past?

On a slightly different topic, but still relevant if I have to start blood testing for ketones. I’ve noticed today that I’ve struggled getting her ears to bleed. They were bleeding so well and today it’s been difficult. I noticed on one ear she has a small bump when I rub the area I usually test from. I try to vary the spots that I use but maybe I am getting too close to the same spot each time? I hope I’m not harming her.

 

Ketone prone is just cats that keep coming up with ketones. If she didn't have any at diagnosis, and your one test so far was good, it's probably ok (but no guarantees). I tagged Kyle (Hendrick's dad), if he gets a chance to pop in you can see he tracks it on his SS, he was randomly jumping around with ketones for awhile. If I recall correctly, Hendrick was diagnosed by being hospitalized with DKA to begin with.

I wish I knew why some days they bleed better than others, it seems to related to activity level a bit (I have a harder time when they've been sleeping vs up and about). Bump is possibly something like a blood blister? Not oozing like it's infected or anything right? Maybe just an odd poke and got a little swollen. I do try to rotate ears and test spots. So first test will be left ear halfway up, #2 right ear halfway up, #3 back to left ear but maybe 2/3 the way up, so on and so forth. I don't think you're harming her...early days can be a bit rough, but it should be smooth sailing pretty soon as her ears form more capillaries.

 

We try to cap threads at 50 posts just for ease of readability, if you need anything tomorrow can you start a new post please?

 

Yeah Hendrick spent 2 nights in the hospital with DKA so I was testing ketones every day after he was discharged. But these days we test every couple weeks.

Re: those poor ears -- we also do like @FrostD , move around the ear, from ear to ear, but also from side to side on each ear. The side with more hair is more difficult and i use more vaseline but at least it gives the other side a rest.

I noticed that some of the stuff linked on this site says to use the marginal vein but I have avoided that, pretty sure @Diane Tyler's Mom said try not to hit that, it causes bruising and such.

 

50 seems very low to me. I get not having threads with hundreds of replies and pages of stuff but a thread can hit 50 very quickly

just my .02