New Member - Toulouse

Status
Not open for further replies.
Toulouse’s Mom

Toulouse’s Mom

Member
Hi new member and mom to a newly diagnosed diabetic kitty, Toulouse.:cat:

I am very new to all of this and it all feels very hard. (We are at the end of 3 weeks after being diagnosed.)

I am currently figuring out the best dosage for my best friend. He is on Lantus insulin and when our vet originally diagnosed him they suggested 2 units twice a day. We brought him into the vets almost every day for 2 weeks with a bit of rollercoaster numbers and unfortunately saw 4 vets in one practice so they would each suggest a different dose each day (sometimes 1 units twice a day, sometimes 1 unit a day, sometimes 'maybe no insulin today'). It all felt a bit inconsistent, but we did that for 2 weeks and then finally got a Libre 2 monitor to connect. The last vet we saw told us to watch the Libre 2 and if it was over "hi" consider 2 units and if it was over 260 but under 'hi' to consider 1 unit.

This 3rd week we traveled for Thanksgiving and tried to base our 12 hours doses on what we were reading on the monitor (as mentioned above). We had two instances where the monitor was reading in the 40s & 50s which gave us quite a scare as we were in a different state with a 40 minute drive to any emergency vet. For that reason, we went a few mornings with no insulin and then even cut the dose back to .5 units twice a day.

All that to say... I am now home with the best buddy and he is in good spirits, but I am an absolute mess trying to figure out if I am doing this whole thing right. Should I bring him back to the vets this week and have them help me understand a better dosing plan or if it is normal to feel like I am guessing and checking at this point?

Toulouse is my best friend and I am nervous about messing any of this up. I am very grateful to have this group to learn from. Thank you :cat: (currently working on getting my spreadsheet added to my signature)
 
Hi and welcome to the forum.
What type of food are you feeding Toulouse?
Are you giving him 2 main meals before the insulin?
I would also recommend you also give him 2 or 3 snacks during each cycle. A snack is a teaspoon or two of low carb food.
I can see by the spreadsheet that you have been jumping all over the place with the doses of insulin. Lantus works best when the same dose is given as it is a depot insulin. Changing doses all the time can mess with the depot. I’ll give you a link to the depot below.
I can see that he has dropped down into the 40s. The libre is not very reliable in the lower numbers under 100. I would suggest you get a ReliOn premier meter from Walmart and learn to hometest. You will also need some test strips and a box of 100 lancets size 26 or 28. And some cotton balls to hold behind the ear when testing.

Did the vet mention ketones at diagnosis?
Lantus dosing is based on the nadir or lowest point in the cycle, not the Preshot. Because you have had low numbers when giving 0.5 unit even after a skipped dose, I would try giving 0.25 unit twice a day and see how that goes (as long as he didn’t have ketones at diagnosis.)
At the moment he is running high. I think from a missed dose and from bouncing so don’t be tempted to give a higher dose.

We have 2 dosing methods here. Once we have more information from you we can help you decide which one suits Toulouse. :)
 
Bouncing explanation
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
 
Welcome to FDMB. In the beginning of this journey, it's all very overwhelming! It really does get easier.

The first thing I would suggest is that your vets all go to a continuing education course on feline diabetes and using Lantus. And, they really should read each other's notes so they stop contradicting each other. Lantus is a great insulin for feline diabetes but it's not the same as some of the older types of insulin. Unlike other insulin, as Bron posted, it forms a depot. This is what gives Lantus its longer duration and more gentle action. In addition, Lantus likes consistency. What that means is you need to do your best to keep shot time consistent because changes in shot time have an effect on the depot. Likewise, you need to keep the dose consistent unless a dose reduction is indicated. It takes a minimum of 3 days for the depot to stabilize after a dose change. If you change the dose more rapidly, you can end up with wonky numbers.

What the vets are telling you about adjusting the insulin dose based on your pre-shot blood glucose reading is not good advice. Lantus dosing is based on how low the dose brings the numbers. Typically, the low point is around the middle of the 12-hour cycle.

I don't think you mentioned what you're feeding Toulouse. We recommend a low carbohydrate diet -- foods that are under 10% in carbs. Most of our members feed their cat a food that's in the neighborhood of 5%. Many of our members feed their cats Fancy Feast pate style canned food. There are lots of food options, though. This chart has a list of most of the canned foods available in the US along with nutritional info, including carbs. If you are feeding Toulouse dry food, you will want to slowly transition over to a low carb diet along with monitoring his blood glucose since a switch to low carb can drop blood glucose levels.

I'd suggest taking a look at the sticky notes at the top of the Lantus forum. The notes will give you a good grasp of how Lantus works, dosing methods, etc.

In addition, I'm linking a post on helping us to help you. You've done a great job with getting your spreadsheet set up. We need a bit more information in your signature and the post provides information on what to include besides the link to your spreadsheet.
 
Thank you all for your responses! I am already feeling more at ease knowing there are so many kind and helpful people here in this group.

Toulouse is eating 3/4 can of Royal Canin wet food in the morning and at night (we are working up to 1 can in the AM and 1 can in the PM, but slowly adjusting to this due to his habit of gorging and then not keeping it down). Theoretically these are supposed to be around the 12 hours marks when we give him the insulin, but still trying to figure out how to dose him twice a day without his numbers dropping when I'm away for work. We also have a dry Hills Glucose support that we've been sprinkling a few pieces in throughout the day as he has been on an automatic feeding schedule for years and we are trying to adjust. (Prior to his diagnosis, Toulouse was on a Weight Loss Dry Food - Hill's Prescription Weight Loss r/d, which looks like it was super high carb?) He is also just a very hungry boy in general (and very vocal as he is a Tonkinese), so is there a better way to sprinkle in some snacks that will not hurt the work the insulin is doing?

The vet did not mention Ketones at diagnoses. Should I be bringing him in to be tested for this?

I am going to try to purchase the other monitor for at home testing mentioned above to compare with our Libre 2. I also have a spare phone I am going to connect so we can keep an eye on it while away at work.

Updated my signature as well. Continuing to read all of your resources you have shared and so appreciate your kindness and support! :) I am super determined to get this right!
 
Sienne and Gabby (GA) said:
Welcome to FDMB. In the beginning of this journey, it's all very overwhelming! It really does get easier.

The first thing I would suggest is that your vets all go to a continuing education course on feline diabetes and using Lantus. And, they really should read each other's notes so they stop contradicting each other. Lantus is a great insulin for feline diabetes but it's not the same as some of the older types of insulin. Unlike other insulin, as Bron posted, it forms a depot. This is what gives Lantus its longer duration and more gentle action. In addition, Lantus likes consistency. What that means is you need to do your best to keep shot time consistent because changes in shot time have an effect on the depot. Likewise, you need to keep the dose consistent unless a dose reduction is indicated. It takes a minimum of 3 days for the depot to stabilize after a dose change. If you change the dose more rapidly, you can end up with wonky numbers.

What the vets are telling you about adjusting the insulin dose based on your pre-shot blood glucose reading is not good advice. Lantus dosing is based on how low the dose brings the numbers. Typically, the low point is around the middle of the 12-hour cycle.

I don't think you mentioned what you're feeding Toulouse. We recommend a low carbohydrate diet -- foods that are under 10% in carbs. Most of our members feed their cat a food that's in the neighborhood of 5%. Many of our members feed their cats Fancy Feast pate style canned food. There are lots of food options, though. This chart has a list of most of the canned foods available in the US along with nutritional info, including carbs. If you are feeding Toulouse dry food, you will want to slowly transition over to a low carb diet along with monitoring his blood glucose since a switch to low carb can drop blood glucose levels.

I'd suggest taking a look at the sticky notes at the top of the Lantus forum. The notes will give you a good grasp of how Lantus works, dosing methods, etc.

In addition, I'm linking a post on helping us to help you. You've done a great job with getting your spreadsheet set up. We need a bit more information in your signature and the post provides information on what to include besides the link to your spreadsheet.
Click to expand...

Welcome to the Forum, so sorry for what you have thru, and kitty so much street, but you are not the only one, we all go thru some or more stress and we learn by trial and error, as long as it does not our precious best friend on danger here any concern you may have Toulouse, there are many dose experts like Bron, Sienne, Suzanne, that can guide you along to get Toulouse back to good health and great numbers, as Born motioned home testing is very very important The Libre a total different situation with that, they are not reliable reading Glucose numbers, they tend to fall off or stop working before the 14 days, on High numbers the monitor will go as hi as 365 after that it will only read HI and in the low numbers is a disaster it reads almost 15-20 than reality, I used it at first, the low alarm I had it on 90, yet in the middle of the night the alarm would go off so forth, the Human ReliOn Premier monitor and lancets, is the best stress free to actually know where he stands on BG's, Also the food you feed is very important that diabetic cats consume wet can foods (there are other home options)
that are between 0-10% carbs, below is the link for Food list we refer to, on the third column, you will have the carbs per food, you should also create what is called a HYPO KIT, this should contain Karo Syrup or Honey, a syringe that can measures 1ml+ to give the syrups, some Medium carb foods between11-15% and some High Carbs between 16-24%(gravies) , it come in handy when/if the BG reaches 50 or lower, although the feeding protocol is healthier than a quick fix, we can help you with that if needed, and if you are switching to wet low carb it is important to go slow and test before each dose and a few more times during the day, until you see a good result on the food switch, you do not want to be caught by surprise, we are here for you, it is very overwhelming at first, but in this Forum you can be sure if in any doubt you post your concerns and there will always be someone to guide you along, the faster you create your signature and spreadsheet, we will be there right along with you, try catching up on all valuable information the sticky notes in the Main Forum. We would also like you to create a spreadsheet, link below so we can monitor his insulin intake food, and BG's to guide you correctly, all members can access reading to Toulouse spreadsheet for review :bighug::cat::cat:
https://www.felinediabetes.com/FDMB/threads/dr-pierson-new-food-chart.174147/
https://www.felinediabetes.com/FDMB/threads/how-to-create-a-spreadsheet.241706/
 
Last edited:
The Royal Canin canned food is 14% carbs which we consider a medium carb food. (Over 15% is high carb.) You may want to take a look at the food chart and opt for something lower in carbs. I would hold on to the Royal Canin since it's good option if Toulouse's numbers drop into a lower range.

Many members use freeze dried protein treats to entice their cat to eat. There are all sorts of options. I've seen chicken (most common) along, with people mentioning minnows, liver, shrimp, rabbit, turkey, etc. Another option is bonito flakes. I've sometimes seen these at a pet food store but more commonly (and a lot cheaper) at Asian grocery stores.

You may want to give some thought to getting a timed feeder. There are several options -- a 2 slot type and one with 5 slots. I found a feeder to be quite helpful.

I'm not sure if this post on managing the Tight Regulation Protocol with a full time job will help. This dosing strategy may be more aggressive than what you're interested in but it has a good deal of research to support its use. What's written may give you some ideas, though and address your concerns about being away from the house during the day. I worked a full time job throughout Gabby's diabetes. I also didn't work that far away from home so if I went out for "lunch," I could run home to check on Gabby. I also adjusted my shot time so I was able to get tests in before I left the house.
 
Super helpful, thank you all!

As I’m navigating all of this, I’m trying to determine if I should lower his doses per 12 hours. We are going to the vet on Thursday morning, but between now and then I feel like I’m wavering between how many units I should give him. It’s about time to give him insulin now, and his Libre 2 is reading 361. My gut tells me I should be doing something lower than 1 unit. I’m not sure if any one is able to advise, but thought I would ask!

Thanks again for all the advice!

Update: I went with .5 units tonight and hoping to do so again tomorrow. I have a CareSens that is in the mail to arrive tomorrow and hopefully will feel more comfortable comparing to those numbers
 
Last edited:
Status
Not open for further replies.
Back
Top