? New Member 01/24/2023 Insulin dosage rises - sugar rises

Hi all!
Six months ago, my Lyalya was diagnosed with diabetes.
Blood sugar was 24 mmol. We started therapy with insulin (Levemir) from 1 unit (twice a day). Blood sugar quickly dropped to 5 - 7 mmol. Vet reduced the dose of insulin to 1/2 unit, sugar rose to 7 - 12 mmol, returned back 1 unit of insulin, sugar decreased again, but began to grow over time. Added 1/4 units (1.25), sugar decreased, but then began to rise again. Now Lyalya is at 1.5 units and has sugar indicators of about 15 - 20 mmol.
Our veterinarian says that in the near future we will probably have to increase the dose of insulin even more. However, at the moment I doubt whether a mistake has been made in therapy?
Please tell me if this is normal or should I look for another vet, or do we miss something?
I would be very grateful for any information!

 

Welcome Evgenia and Lyalya sorry no one has gotten back to you yet.
If you can fill out what we call our signature ,it's information we all have at the end of our posts, we also have a spreadsheet we use to track our cats BG numbers to see how the is working and how low it's dropping. We do adjust the dose on how low they are dropping . Are you home testing ?
I will give you the link on how to set up your spreadsheet but if you have trouble setting it up just ask ,we have a wonderful member who will set it up for you in minutes

To set up your signature which you will see is at the end of everyone's post in gray, click on your name up top and then tap on the word signature and add this information

• Add info we need to help you:
  • Caregiver & kitty's name
  • DX: Date
  • Name of Insulin (do not include dose or frequency)
  • Name of your meter
  • Diet: "LC wet" or "dry food" or "combo"
  • Dosing: TR or SLGS or Custom (if applicable)
  • DKA or other recent health issue (if applicable)
  • Acro, IAA, or Cushings (if applicable)
  • Spreadsheet link. Please put the signature link on the bottom line of your signature information, on its own, so it is easy to find.
  • Please do not put any information about your location in the signature for security reasons. If you wish to add your country location, please add it to your profile.

Be sure to click the 'Save Changes' button at the bottom. If you need help urgently it is important we know these things at a glance. We don’t want to waste valuable time finding out information.

Take a look at mine


We also use a spreadsheet to track our cats BG so we know how the insulin is working and how low they are dropping so we know when to either increase or decrease the dose
We adjust the dose by 0.25 units at a time . We don't adjust the dose by going by the Pre Shots

About the spreadsheet
AMPS - means AM Pre Shot the first test you take in the AM ,you need to withhold food 2 hours before testing so it's not food influenced

Units is where you would put how much insulin you gave
+1 is one hour after giving insulin if you were to test then that's where you enter his _BG number
+2 two hours after giving insulin. ditto
+3 and so on until you get to PMPS - PM pre shot withhold food 2 hours before testing

+1 same as you do for AM cycle

We don't give times because we are all in different time zones that's why we use the + numbers
I'll give you the link to set it up , if you have trouble just ask and we have a member who will gladly do it for you


You can look at any members spreadsheet to see what it looks like, it's at the end of everyone's signature just tap on it

Link for the spreadsheet
https://felinediabetes.com/FDMB/threads/how-to-create-a-spreadsheet.241706/

@Evgenia Makarova

 

@Bron and Sheba (GA)

@Suzanne & Darcy

@tiffmaxee

@Wendy&Neko

 

Always aim for the sweet spot warm the ears up first, you can put rice in a sock and put it in the microwave, test it on the inside of your wrist to be sure it's not to hot, like you would test a babies bottle. You can fill a pill bottle with warm water and roll it on the ears also.Just keep rubbing the ears with your fingers to warm them up

6. As the ears get used to bleeding and grow more capilares, it gets easier to get the amount of blood you need on the first try. If he won’t stand still, you can get the blood onto a clean finger nail and test from there.
When you do get some blood you can try milking the ear.
Get you finger and gently push up toward the blood , more will appear
You will put the cotton round behind his ear in case you poke your finger, after you are done testing you will fold the cotton round over his ear to stop the bleeding , press gently for about 20 seconds until it stops
Get 26 or 28 gauge lancets
A lot of us use the lancets to test freehand not the lancing device
I find it better to see where I'm aiming
Look at the lancet under a light and you will see one side is curved upward, that's the side you want to poke with

A video one of our members posted, she is using a pet meter ,strips too expensive plus you have to code it
A human meter is just fine, most of us use human meters ,that's what our numbers are based on
When you get your meter can you add the name of it to your signature and spreadsheet


VIDEO: How to test your cat's blood sugar

Here is another link to read
This is a link to one of our posts on home testing.

As for treats when you test or give insulin
for treats for testing
You can give any freeze dried treats they are all low carb
Tap on this blue link and read post #64 the post numbers are to the right of each post and you can read about the freeze dried treats I listed

https://felinediabetes.com/FDMB/threads/new-to-this-i-need-advice.269452/#post-3007388

You can even give plain boiled chicken pieces

 

Hi Evgenia and Lyalya and welcome to the forum.
You have a great insulin in Levemir, so that is good.
Can you tell us what food you are feeding Lyalya? And are you just feeding before the two doses of insulin or are you giving snacks during the cycles as well?
I can see Diane has asked you if you are home testing the blood glucose. We recommend that you do if you are not already doing so.

If you can set up your spreadsheet and signature as Diane has mentioned, we will be able to tell you if the dose needs increasing or not.
If you have any trouble setting up the spreadsheet @Bandit's Mom can help you set it up very quickly. Then if you can add any BG data you already have, that would be very helpful.
Levemir dosing is based on the nadir ( lowest point in the cycle) not the preshot BG.
it is possible that Lyalya is bouncing and that could be why you are seeing higher numbers.
An explanation about bouncing from The Basics on the Land L page

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

There is no need to go to another vet unless you are unhappy with your current one. We can help you with dosing and if you need to increase or decrease.
We have two dosing methods here which we recommend you look at and choose which one would suit you better.
By following one of the dosing methods, it will take the guesswork out of it all and you will be able to get your kitty regulated more quickly.
The link to the two dosing methods START LOW GO SLOW (SLGS) and TIGHT REGULATION (TR)

 

Hello Diane!
So many things to do! Thank you so much for the information and your support!

 

Hi @Evgenia Makarova , I can make a little easier for you and set up your Signature and Spreadsheet. It will only take me a couple of minutes to do it.

 

Hi Bhooma! OMG @Diane Tyler's Mom @Bron and Sheba (GA) @Bandit's Mom I am amazed at the support I have found here. The last six months that we live with diabetes have been filled with anxiety and frustration, and a huge amount of new information. And a certain loneliness and alienation due to a misunderstanding of the problem by people around.
I will try to fill in all the necessary information as soon as possible. Of course, I will gladly accept your help in completing my Signature and Spreadsheet.
What should I do?

 

I will send you a PM with the details I need. Look for it in the Inbox at the top right corner of this page.

That's such a cute pic of Lyalya!

 

@Evgenia Makarova just wanted to confirm that you are feeding Lyalya Royal Canin diabetic dry food? It might be a little less in carbs than "regular" dry food but it's still very high in carbs. Will she eat wet food? You want to slowly transition her to a low carb wet food.

I have set up the spreadsheet. Once you have entered the test data you have, we can help you with dosing. We only need the latest data so you could start with entering the data for the last week and then enter all the data for January.

 

We switched her to Royal Canin Diabetic six months ago. We tried to give Purina ProPlan Diabetic wet, but Lyalya does not accept it in any way. Unfortunately, she is a very picky cat. May be there are any ways to transition a picky kitty from dry to wet food?

Thanks a lot for your help!

 

Will she eat any wet foods at all?

 

Perhaps she will. At a young age, she loved such an additive to the main dry food, but with age she began to refuse, she only eats dry food. But I would like to switch her to a healthier type of food for her.
It was even not easy to switch her from the old dry food to RC Diabetic dry

 

Yes, it can be very hard to switch some cats from dry to wet food. Here are some transitioning tips:
http://www.catinfo.org/docs/TipsForTransitioning1-14-11.pdf

This is the list of low carb food available in the UK and EU. It also has some low carb dry options. Don't know if any of them are available in Russia?
https://docs.google.com/spreadsheets/d/1J5JpMe6TDXrHq_aTl9hUtHy6Gs9oRBqlz4nPGKxtySA/pubhtml

The low carb dry food brands in the US and Canada are Young Again, Dr. Elsey’s Cleanprotein and Wysong Epigen 90. Some of these are available in some countries in Asia too. You could check for them as well.

It is always better for cats to eat wet food since cats have a low thirst drive and get their water from food. But if she will not eat wet food, it's better that she eat low carb dry than high carb dry food!

 

I filled in the required information, including the Lyalya Spreadsheet, which turned out to be not at all as difficult as I thought at the beginning, thanks to your help and especially @Bandit's Mom
Can anyone take a look at Lyalina's results? Do you need any more information?
Thanks again for your support!

PS. Please see the table on the tab World mmol/L. I can't remove most of the months of 22 year that are blank, so you need to scroll down the table.

 

@Bandit's Mom
Hi Bhooma there is no US spreadsheet for Lyalya for 2023 and on her World she ran out of room to enter anymore 2023 numbers
Can you take a look ,thank Bhooma
Since her kitty is eating dry food can you add SLGS to her signature and SS

 

Have you read the 2 dosing methods , you would need to follow SLGS since you are feeding dry food
Here is the link
https://felinediabetes.com/FDMB/thr...-low-go-slow-slgs-tight-regulation-tr.210110/

You also need to be getting tests in after the PM dose ,you are only seeing half the picture right now .

 

Sorry! Sorry! My bad. Instead of populating the World tab with 2023 dates, I used 2022 instead. Not yet gotten used to writing 2023 instead of 2022!
I've moved the 2023 data to new tabs. @Evgenia Makarova I think I have moved the 2023 data correctly. Please check and let me know? Thanks

Evgenia, will it be possible to get a test every day before giving insulin? AMPS and PMPS? You don't have enough data to know how low Lyalya is going on each dose. A weekly curve does not give you enough information. Without enough tests to see how low a dose is taking her, too much insulin can actually look like too little insulin. The insulin may be trying to drive the blood glucose down too low and the pancreas will release stored hormones and sugars to bring it back up fast so too much insulin can actually look like it's not enough. What is your schedule like? For the next 2-3 days, can you get 4 tests per day? 2 preshot and 2 mid-cycle? So for each cycle, you get a shot before giving insulin (PS) and one test any time between +3 and +8 to see how low she is going after getting insulin. Will this be possible?

 

I know I can't get used to writing 2023 either

 

Welcome to FDMB.

I have a couple of thoughts. First, the Royal Canin Diabetic food, if it is dry food, is VERY high in carbohydrates. It is likely what is influencing your cat's test numbers. It will be helpful to get Lyalya on a low carbohydrate (less than 10% carb) diet. There are only a handful of dry foods that are low in carbs and they may not be available outside of North America. There may be other options such as freeze dried raw foods that are available to you.

With Levemir, dosing is based on the lowest number in the cycle. We recommend getting at least 4 tests on a daily basis. You want to always test prior to giving insulin (your pre-shot test in the AM and PM) so you know whether it's safe to give an injection. You also want to get at least one test during both the AM and PM cycle. Ideally, getting a "before bed" test is helpful so you know that your kitty is in safe numbers before you go to sleep. This is information on dosing methods that we use for Lantus and Levemir.

 

Since our princess has a very strong character and her own opinion about what can and what cannot be done with her (of course, it is definitely cannot be done if needles are involved ), we need two people for all procedures with her.
I work from home, but my husband doesn't. Therefore, we cannot constantly take measurements. But, after listening to your advice, we plan to carve out several days in a row to take more measurements, including at night. I will consult with our vet about this.
Thanks again!

 

Unfortunately, here in Russia we have a terribly small selection of diabetic foods.

Royal Canin Diabetic dry/wet
VetLife Diabetic dry/wet
Monge VetSolution Cat Diabetic dry
Purina Pro Plan Veterinary Diets Diabetes Management dry/wet
Hill's Prescription Diet m/d Diabetes/Weight Management dry/wet

For all of these foods except perhaps Purina, wet options are hard to come by.

That's all

I read about dosing methods for Levemir, thanks for the link! We will think about how we can fill the Lyalya's spreadsheet with more data.

 

You need not restrict yourself to prescription food. There's nothing in prescription food that miraculously treats diabetes. Many of them are expensive, too high in carbs (especially the dry ones) and the ingredients tend to be of low quality. Any low carb (with carbohydrates less than 10%) canned food will do.

Purina Pro Plan DM wet is low carb at 6% but the dry is high carb. Royal Canin Glycobalance and Hill's M/D Glucosupport (both wet and dry) are also too high in carbs for a diabetic cat.

You want to look for any regular (non-prescription) wet food that is low in carbs.

 

Then I'll go through the list of low carb foods you gave me
I hope to find something. Unfortunately, we have a really very poor choice of food.

 

I'm in India and it's the same here. The only option available here that is not horribly expensive is Whiskas in Jelly.

Will Lyalya be interested in raw food?