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I AM SO FRUSTRATED! What am I doing wrong? I can't get the BG in control. I feed 1 3 oz can of FF Classic in the morning around 6:00 am and she gets another 3 oz can around 4:00. I always give her her insulin around 20 to 30 minutes after she eats. It was just increased to 1.25 units. I am testing three times a day. I know for many of you that is not enough but it won't change the scores I am getting no matter how many times I test. Please, give me your opinions! Is this just the "bouncing" from a newly, diagnosed cat on insulin. I need help! PLEASE don't send me any more "links". I have read so many that are helpful. I just need your honest opinions. Is this normal? Is this not normal? Is it the food I am feeding her? Is her insulin dosage too low? I just want your opinions and I will take them to my Vet. Thank you. I might add one other thing that has been a mystery with my Susie from the day I brought her home from the shelter. Her urination has never been normal until the diabetes set in. She would just drip. Nothing like a normal cat. Very little urine. The vet was so concerned in the beginning that he thought it was a blockage and saw something on the ultrasound. He did surgery but it was not stones. He thought it was scare tissue from a previous surgery but we had no medical history on her. This was back in April 2019. She was fine until around the end of November 2020 when she started urinating a lot and drinking a lot of water. I knew something was not right so I took her in. That is when I got her blood test indicating she had diabetes - and other questionable test results. She has always been a happy kitty. Never shows any signs of discomfort. She is my total mystery but I want to help her with this diabetes.

 

I believe you are looking at an old rendition of the information from AAHA. Here is more recent info (click on the blue bold print). We’ve been using Lantus and Levemir here in this forum since 1996. We actually have a protocol for Lantus and Levemir that was printed in the Journal of Feline Medical Surgery and updated in a subsequent veterinary journal. I don’t mean to disparage your vet but any vet who knows even a little about feline diabetes typically prescribes Lantus or ProZinc, although ProZinc is not as good as it’s predecessor, PZI. I actually do not personally know any vet that prescribes Vetsulin other than the occasional one I see here (although it’s more common in the UK). It is difficult to get the BG under control with Vetsulin and it requires monitoring day and evening cycles.

Sadly, my baby girl passed five years ago. Initially, I fed her different Wellness canned varieties ranging from 3-10% calories from carbs and a 13% canned food to control lower numbers. Then I switched to ZiwiPeak canned food and, the last few months, I also did a homecooked balanced diet. How much you feed depends on Susie’s caloric needs. That varies by cat and takes some investigation. If Susie’s weight has been stable, you can calculate how many calories you’ve been feeding her to keep her weight stable and you will want to continue with that as much as possible. If she has lost or gained weight, I’d weigh her (it’s easy to get a pet scale), feed her a tiny bit more or less, depending on whether she needs to gain or lose weight, for a week and then weigh her again. You do this until her weight is stable where you want it but if you are decreasing her food, you want to be sure you do not decrease by more than 1% a week. Do it slowly.

As to when to feed, that depends on the cat and the insulin. Vetsulin onsets quickly and so you must have food on board before you even give her the shot. You then want to feed her at probably +1 and +2. This information will give you more detailed answers on feeding a cat who’s on Vetsulin.

I do not want to come off as being critical in any way, but please restore her SS to the full version. We need to see the entire SS. There is a reason why. If you need more room for remarks, please let me know and I’ll fix it for you. It is absolutely imperative that you test her at night. You don’t have to test her all night or as much as you do in the a.m. but cats frequently go low at night and by shooting and not testing, with the way Vetsulin works, you are really, really risking her having a symptomatic hypoglycemic episode and Vetsulin is not as forgiving as Lantus. It’s a much harsher insulin.

Ok--you asked so I will tell you.
The first thing you are doing wrong is not testing before every single shot. I cannot tell you how many times I’ve had to help members who have woken up to an AMPS of 30 or even lower. Thankfully, they tested before they shot because if they hadn’t, and they’d given insulin, their cat would have likely died from hypoglycemia. You must test before every single shot if you want to keep her safe.

The second thing you are doing wrong is not testing at night. If we can’t see what her BG is, we can’t offer you much help and neither can your vet. If she is going low at night, she could be bouncing high in the morning but you’ll never get that under control if you don’t test at night. Again, you don’t have to test all night but you need to see where her BG is headed and feed accordingly.

The third thing is not feeding her often enough. Without some carbs to work with the insulin, the BG drops fast. When it drops fast, it rises fast. I don’t know what the %calories from carbs are in the FF Classics you are feeding but alot of members use them here. It is incorrect that “it won’t change the scores...no matter how many times I test”. The BG drops and you have to feed to be sure it doesn’t drop too low because if it does, she’s going to bounce back high. When cats clear bounces, the BG drops fast and low, again. It’s a constant cycle. The more data you have, the more you understand her cycles (onset, nadir, duration) and that’s important for getting her BG under control.

I know you’ve been given alot of material but that’s what FD is constantly about....reading, learning. I still do it or else I wouldn’t be able to offer solid advice here. We are all constantly reading. If you have a few minutes to look around this site, you will see an amazing amount of information especially in the Feline Health Index and FAQs section. Many of us have worked hard to provide that information to help members with their diabetic cats.

What she is doing is totally normal. You have to remember that insulin is a hormone, not a medication. Thus, it doesn’t react as a medication. Hormones affect our bodies in different ways at different times. The best way to approach FD is to take a deep breath and understand that it is a marathon and not a sprint. It takes time and patience and data while remembering that your kitty is your beloved kitty and not just her BG. Sometimes we do get a little too data focused.

Anytime her BG is higher, she will urinate more. I don’t know why she had issues urinating before and only your vet can help you with that. But anytime the BG goes up and sugar spills into the urine, drinking and peeing will increase.

Quite honestly, Susie’s BG doesn’t look that bad. I can show you hundreds of SSs at the same time of being diabetic as Susie and they look so much worse. So pat yourself on the back for the testing that you have been doing. And note that anytime Susie is really hungry.... her BG is likely low although not always so you can’t you that solely as a means for knowing when to test.

 

Have you tried the freeze dried treats like PureBites? They come in a wide variety of protein sources and are totally fine for diabetic cats. Orijen Wild Boar treats are also low carb and seem to be a favorite with cats that don't like the texture of the PureBites type treat.

Just look at ingredients....if the only ingredient is a protein source, it's a fine treat.

 

I have to agree 100% with what Marje posted.
You have to test her BG every morning and night
Your SS should be put back to the way it was so you have the
Whole PM cycle there.. Members can't offer you much help if you are not testing at night.

 

Okay, Marje. Can you help me restore my spreadsheet? I just took a reading about 2 hours after her nighttime shot and it was 196 but I can't figure out how to restore my spreadsheet to the normal format? Showing the nighttime BG levels which I will rarely check but might want to follow the recommendations to do so. Thanks.

 

I sleep at night. Don't you all?

 

Thank you, Chris. Yes I did try the PureBites and she doesn't like them. I will look into the Origen Wild Boar treats. By the way, your kitty is very pretty. Love the black and whites, the blacks and the whites.

 

Asking for help to restore my SS.

 

One other thing on your SS where you write in for example

on 1-6-21 day cycle you put 3-1/2 hours. You should put 161 @+3.5 which means
3-1/2 hours
Also for the rest of the ones you did that way

EXAMPLE
161 @+3.25. Means 3 hours and 15 minutes
161 @+3.5. Means 3 hours and 30 minutes
161 @+3.75. Means 3 hours and 45 minutes

You can take a look at my SS
@Summer and Susie

 

I can. I’ll send you a private message because you have to allow me editing rights.

 

What time do you test in the AM and PM
Yes we do sleep at night, but sometimes if our cats drop to very low numbers we have to feed them and test again until we get them back to safe numbers

When you test her BG at night you should get another test @+1 ( 1 hour later after shooting)
If it's much lower than her PMPS you would need to feed a small meal to bring it
up. It will all depend on what that +1 reading is.
You will never get her BG under control without some tests at night

Correction made about when to check BG after giving Vetsulin. I originally said +2
which is incorrect, it should be @+1
Thanks to Marje that she caught that

 

Remember this is Vetsulin. It works differently than Lantus. Onset is usually by +1.

 

Oops sorry @Marje and Gracie , I am going to correct that.
I should have remembered that when Tyler first started out on Vetsulin

 

Not if there's a risk the cat may go too low.

In terms of night time testing, the general idea is to get your PMPS and then a 'before bed' test a few hours after the dose was administered. A test at PM+2 typically gives you an idea of how far and fast the drop is going thus far, and again typically by PM+3 you'll have a fair idea of how low the dose is going to take the cat (although it might be +4 or +5 when it hits nadir). Tests at these times will help you better gauge:

* whether your cat will be safe for the rest of the cycle while you are asleep.

* whether numbers look like they might go too low (in which case one stays up, monitors BG and steers the cat's BG levels with food until numbers rise up to a safe level and stay up without need for further feeding).

The night time mid-cycle numbers will also help you to better interpret the readings you get the following day (e.g. a fast drop early in the PM cycle may lead to higher, bounce-influenced BG levels in subsequent cycles. Being able to differentiate high numbers due to insufficient insulin versus high numbers due to bouncing will help you to make better, safer decisions for Susie's insulin dosing.


Mogs
.

 

Again, we need to remember this is not Lantus. Vetsulin can often onset very quickly by +1. Using the +2 to predict the drop with Vetsulin is not the best idea as it might be a little late.. Yes, obviously, if the BG is headed down by +2, it might likely continue but at a different rate than the drop from PMPS or +1.

 

I know full well it's not Lantus being discussed here, Marje, and I know from direct experience that it is possible to start observing a lowering effect from around the +1 mark in cats being treated with Vetsulin/Caninsulin. (Saoirse was a fast metaboliser of both Caninsulin and Lantus and usually had early onset with both.)

I didn't say anywhere in my previous post that the rate/magnitude of drop observed in a +2 reading was a predictor of the rate/magnitude of any subsequent drop in BG during the cycle. (Indeed, I went on to say that one would get a better idea of where the nadir for the cycle might land by testing at +3, and that the nadir might occur later in the cycle.) If you inferred that meaning from my post then I did not communicate effectively.

I was endeavouring in my post to give a general, broad-brush idea of the value of tests in the early part of the PM cycle and, with a couple of general examples, to convey that such tests can give a caregiver information with which to gauge whether it's OK to go to sleep or whether their cat may need additional monitoring for safety, and that they can also be an aid to interpreting significance of numbers in subsequent cycles. It appears that I have failed in this objective.


Mogs
.

 

Easy, Mogs. Thank you for recognizing that however it sounded to me, knowing about the insulins, it would be less clear to Summer.

You did say this:

 

"Thus far."


Mogs
.

 

Chris, I did try the PureBites and she did not like them. Thanks for the suggestion though.

 

I'm sorry about your kitty, Marje. I love the tribute to her at the end of her SS.

 

Okay, so you are saying I should test her BG at one hour after her nighttime shot? I can do that. I'm afraid you will be disappointed in me for one thing. I get up very early and usually feed Susie her breakfast around 6:00 am. By 3:00 pm she is very, very hungry so I will test around 3:30 and give her her last shot of the day around 4:00. I know that is really early for her nighttime shot but she needs to eat by 4:00. She was used to being fed at 3:00pm but I backed that up. I am not spreading the shots out by 12 hours except after her night shot and before her morning shot and then it is more like 14 hours between shots. By the way, I usually try to test 2 to 3 hours after her morning shot and at least two more times during the day about three hours apart.

 

Sounds almost not worth trying to get the numbers low because then you have to worry about them dropping too low. Frankly, I would be happy if I could keep her numbers around 150 as the normal range for glucose, according to my blood test information, is 64 to 170.

 

Okay, ladies, when should I test after the PM shot. +1 or +2? And should the same theory apply with the AM shot. Should I test at +1 or +2 with the Vetsulin?

 

Thank you so much, Summer.

That’s not how the insulins work. Yes, Vetsulin is a shorter-acting insulin and, if you were more experienced, you could shoot the rises but for now, you should stick to sticking every 12 hours. If you feed her more throughout the cycle, as I suggested, then she won’t be so hungry at 4. Also, if you feed her too early late in the cycle, you are shortening whatever duration she will get from the insulin.

If you don’t get the kitty into normal numbers, the pancreas doesn’t heal. The manufacturers of the AT have not set what is “normal” for cats. Many vets will quote specific numbers based on the actual lab analysis but not the AT. Also, the renal threshold (the BG at which the kidneys spill sugar into the urine) varies by cat. We have had some members here who have monitored that and found their cats spilled glucose in the upper 100s. Our mantra here is “Every Cat is Different” (ECID) and so you want to be sure you are getting them into BGs below 100 to ensure the pancreas is healing. Otherwise, there is no chance for remission. Have you thought about switching to a human meter? All of our methods of regulation are based on human meter numbers. You will find the AT strips get quite expensive and human meters are very reliable and much less expensive. There are some which only require the same amount of blood as the AT.

IMHO, I would start with +1 for a few cycles until you can see when she onsets. If, at +1, she is consistently showing a food spike, you can then try doing the first post-shot test at +2. I see you did not get an AMPS today. Again....please....I know you love your kitty. Do not skip these vital preshot tests.

 

This statement confuses me "If you feed her more throughout the cycle, as I suggested, then she won’t be so hungry at 4. Also, if you feed her too early late in the cycle, you are shortening whatever duration she will get from the insulin". So, I should give her a little food around noon so she can last later getting her dinner (around 6:00)? When is too early in the cycle? Shouldn't it be noted that she ate during the middle of the day? In the notes? I need specific instructions on what time and how much to give her during the cycle.

I bought a ReliOn meter, strips and lancets before my Vet told me to buy the AlphaTrak 2. I use the AlphaTrak because that is what he told me to buy and use and I just ordered more strips and lancets. If I use the ReliOn there will be no "setting" for cats (or dogs). Does that matter? I cannot afford to buy yet a third testing system. At least not now.

Okay, I'll test, feed and shoot around 6:00 - 6:30 am. I'll then test one hour after the shot. I'll try to get at least two more test in before her PMPS reading around 6:00, then her dinner, then the shot and one hour later I will test again.

Marje, I don't know if I am going to be able to get her into remission. I'm worried about the numbers being too low and me worrying about her and having to test all night. I need my sleep at night and what is being requested is a lot. What do people do that have to work all day and need their sleep at night? How do they possibly manage all that you are asking? Can't cats live reasonably well with numbers in the low to mid 100's, testing during the day and the shots? I know you want to see her in remission and I appreciate all that you are advising but staying up all night - testing and worrying - is asking a lot of anyone. I get up around 5:30 in the morning and I am in bed at 6:30 pm.

Thank you for fixing my spreadsheet

 

I’m sorry....it was too early for me to be posting without I’ve corrected my sentence with a strikeout. What I meant to say is that feeding later in the cycle, after nadir, can slow down the duration of the insulin and, in some cases, stop it cold.

If you look back in post #102 above, I discuss how you to determine how much to feed and also linked information with regard to Vetsulin and feeding schedules so please take the time to read that.

I always kept a record in a separate column on Gracie’s SS (linked in my signature) on how much food I fed, the % calories from carbs, and the time (in hours from shot). It’s helpful for you and the people that help you.

The ReliOn is perfect and what many members use. I also had a ReliOn I used but that model is no longer made. It doesn’t need a setting for pets. It’s a human meter. Again, the dosing methods we have here for all the primary insulins used inc Vetsulin/Caninsulin, Humulin/Novolin, PZ, Lantus, Levemir, etc were all developed using human meters so we know what numbers on those meters are safe. If/when you start using it all the time (and we suggest you pick a meter and stick with it), I can change the formatting on Susie’s SS with the ranges for human meters that we use.

Remember that with Vetsulin, you need to feed at least 30 mins before shooting. I’m assuming that’s what you mean...you will test and feed at 6 and then shoot 30 mins after she eats.

The first goal is getting well regulated. I did mention remission but that was only to let you know if that was your goal, she was going to have to be in BGs below 100 most of the time. But, first...regulation.

How do we do it? We just do....we sleep/test. If you look at Gracie’s SS, you’ll see we tested a lot at night but had to because Gracie liked to drop. I worked all but the last four months of her life and my husband worked the entire time. Were we exhausted....yes and I’m no spring chicken...I’m older than you are. We figured out how to feed her so that, most of the time when she was running in normal numbers at night, we could sleep a couple hours at a time.

But that was certainly not every night so when her BG was higher at night...we slept. If the BG is not headed down towards the mid-blue range, you can often feed a medium carb snack and sleep or leave some in an auto feeder. Most of us use auto feeders as much as possible and, believe me, most cats that are good eaters quickly learn when they come on and wait for them to open.

Everyone is afraid of normal numbers. When we were new, we both said we would never shoot below 150 and it was only a few weeks before we were shooting BGs below 100 with the help of members here. We gradually teach how to shoot lower and lower but with Vetsulin, you would not shoot as low as we do with the long-lasting depot insulins (Lantus/Levemir). Typically with Vetsulin, you wouldn’t shoot below 90 but we have ways to coach you to shoot as the BG rises above it. Also, the 90s are a good goal for nadirs with Vetsulin whereas with some of the other long-lasting insulins, we are looking at 60s-80s as good nadirs. As we teach you to shoot lower and lower gradually, any member that advises you to shoot below 200 and then later 150 will also stay with you until the BG has flattened out, helping you learn which foods to feed. It’s a promise we make here.

You can see why it becomes difficult for vets to really help with insulin. When I asked my vet why so many other vets think it’s ok for cats to be in the range of 200-300, she said it’s because they can’t spend the time on a daily basis helping with a diabetic cat. They actually have very little free time to do it and that’s why sites like ours are so important. There’s usually always someone around to help 24/7 as we have members like Mogs, @Gill & George, @Bandit's Mom, @Bron and Sheba (GA), to name a few, who live in the UK, Spain, India, and Australia, respectively, to help while the rest of us in the US are sleeping.

You’re welcome on the SS...just PM me anytime you need assistance with it.

 

This does not appear to be the case with Susie:

• There are particular considerations when using faster-acting insulins such as Caninsulin (Vetsulin) especially for newcomers or for those with little or no BG test data about how their cat responds. This is because Caninsulin/Vetsulin can sometimes drop the BG fast in the first few hours of the cycle.

Seems her early numbers, after her first shot of the day, are always the highest.

This is why I am so confused. After her first shot of the morning she gets huge numbers!

 

Thanks, Marje. I am doing my "curve" today. You can see my numbers tomorrow when I finish the testing (for tonight) which I expect to do at about 5:45 pm tonight when I do the +1 BG test after her pm shot. I don't think I will be doing any BG testing after this one. I like to sleep. Please look at my curve today (1/11) and tell me what you think. I am thinking an increase to 1.5 units might help but the last time I attempted this Susie stopped eating. Looking forward to your advice and not additional links. I will give Susie some food around noon to tie her over until around 5:00 to feed her dinnertime meal. As you said, the Vetsulin does not last 12 hours so I don't think I should try to give it at 12 hour intervals during the day. She will suffer at night though.

 

It’s because she’s going lower at night and bouncing back up. Also, without preshots and at least a before bed test, it’s difficult to know 100%. But...great job getting the +#2 last night! You can see she was already in blue numbers and likely went lower....perhaps by a lot.

 

A basic principle here is that we don’t increase the dose if you don’t know how low it’s taking her. Also, with the method we use for dosing Vetsulin, with the nadirs she is getting, we would not raise the dose for another week.

I didn’t say Susie was not getting duration. I said feeding after nadir can shorten duration. If she is headed for a 12-hour duration and you shoot early, you could be fighting really low numbers.

I don’t agree with the approach you are taking based on my experience but you hold the syringe. All of us are willing to help but we can only do so much.

 

So help me understand why, one hour after her nighttime shot, she scored 426. What the hell is going on? It does not seem like the insulin is helping her at all. I am totally lost here.

 

She’s bouncing. If you had the preshots, you would likely see they were high. When the BG drops down lower than the pancreas and liver are used to, they secrete counterregulatory hormones that dump sugar into the blood. The BG goes up and sometimes a lot. Then the bounce clears, the hormones clear out, the BG drops. It’s a cycle.

However, I see nowhere on her SS that she went up to 426 at night because I only see one test at night on her SS and that’s the +2 from last night....and it’s blue.

 

First of all, well done on today's curve! It was only a few weeks ago you were in the depths of despair about testing. You've clearly got the process down now.

If you look at today's numbers, 393 to 180 to 166 to 209 to 318, you can clearly see that the insulin is working. It's having a progressively stronger effect for several hours, and then it starts wearing off.

Look at your numbers for January 6. AMPS was 369, after which you fed her and gave her insulin. Three and 1/2 hours later she was at 161 (down 200 points), and 2 hours after that she was at 92!

Tonight's +1 of 426 was after you'd fed her and given her insulin, right? So the +1 was no doubt raised by the food but the insulin may not have started to work yet. (See today's readings and the 1/6 readings showing that the numbers really started to drop at +3 and +4.)

It would be really interesting to see what Susie's +2 and +3 would be. And that's what all the testing is about -- to see how Susie's body reacts to the insulin. I don't think anyone's suggesting that you have to do this level of testing every day, forever and ever, amen, but in these early days it's important to learn how Susie responds so you can predict what might happen down the road (like if she got a lower than usual reading one day -- you'd be able to say "yes, I know that the insulin is at its strongest in Susie at +__ , so that's when I need to keep an especially close eye on her in order to keep her safe).

Enid

 

Marge, I fed Susie shortly after she had the 426 score. She was really hungry. About 1 1/2 hours later her BG was down to 110. I will never understand this but this was my "curve" of the week and I will send it to my Vet. I'm not going to put my cat through this many test again, during the day, at least for a few days. I will try to get an AMPS tomorrow morning before all the chaos in my home with my dogs.

 

I have the 426 on SS for tonight. Please look again.

 

Susie

It looks like you are not recording the data correctly on the SS. If 318 was taken at +10 but you fed and shot 30 mins later, it needs to be recorded in the PMPS column as “318 @ +10” so we know you shot early. Otherwise, it looks like you didn’t test before your shot. Thanks!

 

Thank you. It wasn’t there before I mentioned it. I appreciate you entering it.

This is what I mean by diving into lower numbers. I’m glad you retested later to be sure she is safe. So this piece of data gives you a clue to when she onsets....+2 and how far she can drop.

 

I just got 104 tonight at 8:15 pm. This is where I get worried. When it drops dramatically. Can I go to sleep

Thank you, Enid. I am so much more comfortable with the testing now but I have to give credit to Susie. She has learned to accept it. I couldn't do it without the vaseline and I also bought something that has really helped me. It is a headlamp that I wear around my forhead so I have light directed to where I need to see her ears. My eyes are not very good and I always struggled with seeing if there was blood. Now, my headlamp shines down on her ears so I can really see if there is enough blood for the test. I am never up this late at night (8:30) but I did my last test of the night on her about 20 minutes ago. Her BG was down to 110. This is when I will start to worry. That the BG will continue to go down and I won't be awake to see if there is an emergency. I don't know how to deal with this but I do know that I need to sleep at night. I'm up at 5:30 and like to be in bed (on a normal night) at 6:30. Tonight was the exception. I wanted the curb. Anyway, thank you for your support. I really never thought I would ever become comfortable with the testing but I am now and I think Susie is doing so much better, too.

 

Hi Summer,

I go through the same thing with my cat, Sergei, all the time and I know how frustrating it can be. We start the cycle somewhere up in the mid-500s, he gets insulin, then we drop for a while. If we are lucky, once or twice a week we hit the blues; most of the time we visit the yellows for a few hours and then it's a quick journey through the reds and then back up into the black stratosphere. For a while we were in the "healing greens," and then the nail biting greens, but those were the good old days, and they did not last long. But since I know they are possible on that dose of Caninsulin (Vetsulin), I could not adjust our dose up. At some point, symptoms of hyperglycaemia returned so it became clear we had reached an impasse with Caninsulin. Our routine is 100% fixed other than activity, so you'd think the numbers would be similar from day to day, right? Wrong. Welcome to feline diabetes.

Blood glucose level is just one piece of the puzzle. Last week, after months of frustration with very unsatisfying numbers, we finally got Sergei in to see an internal medicine specialist who specialises in endocrinology and very specifically feline diabetes. Importantly, the specialist stressed not letting our preoccupation with getting the perfect BG numbers obscure our view of Sergei's overall condition. He asked us to look at a video on Youtube about the RVC Clinical Score and to track important indicators like how much the cat is drinking and peeing, how hungry he is, what his attitude and activity is like, and what his weight is doing. These are really important things and can tell a story that the blood glucose numbers are not telling. We learned at some point that our meter reads pretty high in higher numbers compared to other meters. For example, our vet's meter gives us much happier numbers. If I had one of those we'd spend a lot more time in blues. The specialist said the same thing and told us that the numbers tend to vary between meters, cycles, and days. I think they call the last inter-day variability. I don't really think about Sergei's numbers in terms of bouncing. The correlation between lows and highs with Sergei is unproven. What I do know is that when my cat's insulin wears off he just has high glucose numbers and as I understand it, that is diabetes.

Good luck to you and Susie.


Cheers,

Scott

 

I don’t really agree with all that’s said here but I would like to ask you if you are giving advice of any kind....even supportive.....we’d like to have you post your cat’s spreadsheet in your signature block. It’s helpful to other members. Thank you!

 

Hi. I'm not sure which part of my post describing my personal experience was controversial. Is posting a spreadsheet a condition for sharing one's experience and offering a little moral support? I don't believe I gave any advice in my post. I merely reported my experience, acknowledged the frustration of what I saw as a similar experience, and reported the existence of a scale that some leading academic researchers in feline diabetes often use to evaluate a patient. The RVC's Feline Diabetes Remission Clinic at University of London has done a lot of good for diabetic cats. I've seen it quoted many times here. And I don't believe I was presenting their meaning out of context. I did not advise Summer not to test her cat and I did not really offer her any advice. I was trying to let her know she was not alone.

 

Thank you so much, Scott. Yes, this is all very frustrating. A good video and looking at the four clinical areas is very important. Susie seems to be a 0 with her urine/water, a 3 with her appetite, I don't know about her weight (need a scale) and her activity level varies. When she is really hungry she is more active. What insulin and meter do you use? I have been told I should switch to Lantus and the ReliOn meter. I want to wait until I need insulin again and then hopefully my Vet will approve the change. I am currently using the AlphaTrac 2 which is also not recommended on this site. Too bad I just ordered more supplies for it. I wish I could afford a specialist Vet. I don't even know if we have one. I appreciate all the information. It helps me to realize that I am not alone in this very challenging disease.

 

You are correct and I apologize. You didn’t give advice. But, I didn’t actually say you did; I said “...if you are giving advice...even supportive.” The statement I disagree with is that you said the correlation between Sergei’s highs and lows is unknown but I am certain we could address that here. However, without a SS, we can’t and so what happens is it leaves Summer likely wondering if the same thing is going on with Susie....unknown correlation between highs and lows and it isn’t. When you see those kinds of patterns, it’s either bouncing or loss of duration.

You aren’t required to post a SS but we strongly urge you to do so. It’s helpful for everyone when you are trying to get a point across about your cat. SSs are learning experiences for everyone but especially new members. Summer would benefit from seeing Sergei’s SS so she could understand that everyone faces the same issues when starting out with FD. I can’t remember the last time I saw a SS that I thought was “different” or unique or something was going on that we couldn’t figure out.

You are also correct that the RVC Feline Diabetes Remission Clinic is well respected. I wish we had a parallel clinic in the US. And I very much appreciate you offering support to Summer.

 

hi Summer,
I was just like you with the testing. Haven't needed to do it for a while but with the rice sock, I would hold it against the underside of Angel's ear whilst gently massaging the top of his ear until it was nice and warm, and always give him treats afterwards. Freeze dried treats are low carb. I'm wondering why your vet has put Susie on Vetinsulin as that is more formulated towards dogs. To be honest Angel was heading for remission when he was on it, but did better on Prozinc. I use Alpatrak meter but with freestyle lite strips which are basically the same product. x

 

Hi Summer, I’m glad that you got some value from the video. I shared it because, as you said, not everyone has access to a specialist, and I am happy to share what I can of that experience with others so that they can maybe consider clinical approaches to the disease. I thought the video might be a helpful complement to other information you’ve received, especially after I read that your vet kept telling you to test less. My vet said the same thing to me! The video, in my opinion, contains a clue about what’s going on there. I think a lot of vets are trained to listen for certain details from their patients like, “my cat is asking me for water from the faucet ten times a day” or “I just hauled a huge bag full of litter clumps from the box; this is not right” or “my cat has lost 1 kilo this month and he eats like a horse but acts like he’s starving.” If instead they hear “my cat’s blood glucose level was 350 at +4, something must be wrong!” they may not be hearing what we really mean to say, which is, “My cat is ill, and I am worried about it.” That’s precisely what happened between me and my vet. I kept sending her glucose readings that were high and she kept saying test less. I thought she would intuit from the BG numbers that Sergei was not feeling well. She didn’t. And he kept getting sicker. Perhaps the RVC score was developed to help clients learn how to get their vets to hear them: talk about thirst and urine quantity and attitude.

You asked what insulin we are using. We started with Caninsulin (Vetsulin). They started Serg at a dose of 2.5U, which turned out to be the max he could safely take. Our lowest test came back around 60 (3.3), so we knew Caninsulin could get him down to greens. And it even seemed to have good duration. Our first curve was surprisingly lovely. He went to 108 (6) at +7. The problem was that for whatever reason, shortly thereafter the insulin just stopped having good effect and symptoms came back. We speculated about failures within the VetPen itself, failure of the particular vials of insulin, failures of administration. Everything got looked at. Specialist just noted variability and duration as possible problems. He switched us to ProZinc and said if that is not optimal then we can go to Lantus. As for our meter, we use Contour. We are in Europe, so the brands may be different than where you are. Our vet uses FreeStyle Lite and as I mentioned, there is some divergence between the two meters. Above 180 the divergence is pretty significant. Alphatrack 2 is supposed to be the meter calibrated for cats, right? To me that seems like a pretty reasonable benefit. I’ve heard the strips are more expensive, but I would be glad sometimes not to worry about how far off I am from cat calibration. You’ll get a lot of advice from people here. And they genuinely mean well. But it can be overwhelming to feel like everything you are doing is wrong. I’ve had to let that go a bit and just give myself space to do things my own way.

For the record, I’m not opposed to letting others see my data, so if you want to have a look, I’d be glad to make it available to you. My partner has asked me not to post it here publicly and since I don’t really accept dosing advice from anyone other than my vet, its value here is pretty limited. I keep my discussions here to things like helpful extra tools, moral support, and cat snack chat. It can feel like a lonely, overwhelming disease sometimes. It’s good to find a place where others understand what you are going through.

 

Hi, thanks for the clarification. I appreciate the distinction you noted in the use of "if" and completely agree with you. As for the question about correlation between lows and highs I would point out that the word I used was "unproven" not "unknown". I chose that word very deliberately because I'm personally not convinced, and some literature supports my skepticism. Correlation and causation are tricky. Somogyi is still referred to in some literature as a theory. I'm not definitively saying it's not real, I'm just saying that in my cat it is not proven.

With all due respect and many apologies, I'm not ready to repost my SS here yet. My partner has asked me not to do so, which is reasonable, given Sergei's current situation. Numbers lead to advice and advice makes it very easy to second guess my vets instructions and to get off plan. Eventually I may be happy to do so again.

 

Thank you.

If you have any chance to look around this site, you’ll see that we do not support the existence of Somogyi in cats. One of our most experienced members and a moderator, Sienne, has access to a university medical library and is in the medical field herself. She has done extensive research on this subject. Roomp and Rand have also dismissed the existence of Somogyi in cats. It hasn’t actually been proven to occur in humans but the difference between Somogyi, in its theory, and bouncing is that Somogyi results from a chronic overdose.

 

Thank you, Cassandra. I tried the sock with rice but just felt I didn't need it. I'm doing so much better with the testing now and so is my Susie. I still hate poking her ears though. I spoke to my vet earlier today about getting Susie off the Vetsulin and on Lantus. He is definetly open to doing that but we are going to wait just a little while. I'm trying to get her dinner and pm shot out to the 12-hour requirement to see if it makes a difference in the morning BG tests. He agrees that Vetsulin might not be the best for controlling her diabetes but says Lantus is very expensive. We will see what happens with her numbers in the next week and make the change if we don't see any improvement. Susie is "on and off" with the freeze dried treats. Most of the time she doesn't like them - unless she is really hungry. I have purchased the PureBites. Do you have another suggestion? I'm glad you haven't had to test in a while. Does that mean that Angel is in remission? That would be wonderful. Thank you for your support. This diabetes thing is so confusing. I hope I have some time to get it right.

 

Summer

You’ve been doing great testing last night and today. Thank you so much. You can see that Susie dropped an enormous amount in one hour last night. Any drop in excess of 50 mg/dL in an hour is a steep dive and that’s why you are seeing the BGs you are today. You can now see what we suspect has been happening....she’s dropping quickly at night which sets off a hard bounce the next day.

I use Whole Life freeze dried treats. My cats also did not like Pure Bites.

 

Scott, I have to agree with you on the advice. I appreciate the advice I am receiving on this site and it is sometimes contradictory to what my vet says so I am torn between the two. I am learning to present the advice I get on this site to my vet and we talk about it. I do think the information I receive here is probably better than my "very busy" vets but it is hard to go against his medical advice.

 

When I saw her numbers dropping last night it concerned me. That is why I did the 9:00 pm test. I could not go to sleep until I saw the number was starting to come up. Thanks for the tip about the treats. I will order her some Whole Life.

 

I order from chewy.com. They are quick, have great customer service, and you can get a smaller size to start to be sure she likes them. They also have flavors other than chicken.

 

Thanks! I get almost all my pet supplies (dogs, cat, bird) from Chewy. I honestly don't know how they get my orders to me so quickly. I think they are in Florida so that would help. Thanks, Marje. More questions: Do you have any cats now? Where did you get all your diabetes expertise? Are you a vet? I hope you have a cat or two now. I could tell that losing Gracie was very painful. I, too, have lost many beloved cats and dogs during my lifetime. I went through the kidney disease nightmare with a beloved cat two years ago. There isn't much you can do when you discover it late and that is why I always do a senior panel blood test at least once a year. I only had my Simon for two weeks after his diagnosis. I will say one thing, though. The kidney disease was "cut and dried". There were only a few things I could do to help - until the end. The diabetes, although not the "death sentence" with the kidney disease, is so, so much more complicated. One of these days I pray I will understand how all this works.

 

Marje, not happy with the +10. 5 test before dinner tonight. It was 398. I tried to hold out longer but Susie needed to be fed, again, and she is not used to this long delay in the afternoon. I do not want to cause more stress for her because I do know stress affects the numbers. Please tell me how to order Lantus from Canada? I just don't think the Vetsulin is lasting for the 11 to 12 hours that she needs. My vet is onboard with changing from Vetsulin to Lantus but tells me the Lantus is very expensive. I need advice and I need to know how to transition from Vetsulin to Lantus. Thanks.

 

You’re welcome. Chewy is great!

I have two cats now: 10 yr old Tobey who we got as a baby right before Gracie was dx with FD and who was very, very close to her and 4 yr old Livia who we got nine months after Gracie crossed because Tobey was so very sad. I’ve had cats nonstop for 59 years. I’m not a vet but I do have an MS in wildlife biology and have taught classes such as anatomy & physiology at the university level. But....I learned every single thing I know about FD from the wonderful people here. My main mentor, Jill, who was one of the first to use Lantus and the TR protocol with her kitty, Alex, and who was a long-time moderator here, suddenly passed away Sept 28, 2019. It was devastating for us all here on the board, especially those of us who had known and worked with her for many, many years. There were a couple other extremely wise people/moderators here then, as well. Sienne, another current mod, taught me a lot and she along with the third moderator, Wendy, and I have a close relationship. We share a lot of knowledge as we each find it.

I am very, very sorry about your Simon. You are smart to do the senior panels. Even with Liv, I do a senior panel twice a year and most certainly have done it with Tobey (and Gracie) for many years. I also weigh my cats every two weeks. Unlike a lot of kitties here, Gracie was not showing clinical signs of FD but a day or so before I took her in so she was dx really fast. Yes, I agree, FD is certainly more complicated. There are some great resources for CKD and my last CKD kitty was extremely stable over four years in stage 3 when he passed from lymphoma. He was not our only CKD kitty but only one actually passed from it and he actually had genetic polycystic kidney disease (PKD) which, clinically presents as CKD, but is much, much worse. It is almost I,possible to keep a PKD cat stable once they are showing clinical signs and lab values increase. They go downhill very fast.

@Sergei Thanks for the RVC video. I just got a chance to watch it and it’s quite interesting that, this forum, as far back as I know which even precedes me joining, we’ve stressed knowing the “5Ps” of one’s diabetic kitty: peeing, pooping, purring, preening, playing. When we first came on, in fact, everyone in the Lantus group would discuss their kitty’s 5Ps as we have long recognized those clinical signs are as important as the BG. While they don’t include weight loss, that became part of the discussion for each cat if it was losing weight.

 

First, check the Supply Closet on this forum. Sometimes there are Lantus pens there for sale or to give away. If there are none, here is a post regarding the purchase of insulin from Canada. You will also need to buy U100, 0.3cc syringes (most of us use 31g), with 1/2 unit markings. I wish I could recommend a specific one for you but I used Terumos and they no longer make them but you can use the search box to search “syringes” on the Lantus/Levemir ISG and you’ll get a lot of posts that recommend different ones. You cannot use the U40 syringes you are currently using. American Diabetes Wholesale (online) is where I always bought my syringes and even though they no longer carry them, they have others. I know Walmart sells ReliOn syringes of the correct specification but I, personally, didn’t like them; however, many people use them and like them. That’s what Jill always used.

Insofar as how to transition from one to the other, once you get the Lantus and set a date to start, then we will look at her SS and make the dose suggestion to you. I suggest starting on an a.m. cycle so you can test. We determine how the current dose is working on Vetsulin and then use that to suggest a Lantus dose. As an example, if a cat has been on, say, 2u of Vetsulin and seen nothing but the 300s and the caregiver had been testing enough for us to know the BG isn’t going lower than that, we’d start the cat on 2.5u Lantus. Conversely, if the cat on Vetsulin has been seeing a lot of blue nadirs, we’d start the Lantus dose at either the same dose or beck it down 0.25u depending on how low in the 100s the cat was getting. But we don’t decide until the day or so before you want to switch.

 

https://rxcanada4less.com Marks Marine pharmacy

Here is the link for Canada with the pens we use them like a vial because with the pens you can only increase or decrease by whole units, so you would just take your syringe and stick it in the little grey rubber stopper and just draw the insulin from that







Lantus Solostar Cartridges 5x3ml per box (temp. gauge. ice pack, express-air mail) Brand 100u/ml 15 ml $159.99 USD

Lantus Solostar PEN CAN (temp. gauge. ice pack, express-air mail) *single pen open box* Brand 100iu/ml one pen 3 ml $49.99 USD

Lantus Solostar PENS 5x3ml per box (temp. gauge. ice pack, express-air mail) Brand 100u/ml 15 ml $164.99 USD

Lantus VIAL Insulin (10ml per vial) (temp. gauge. ice pack, express-air mail) Brand 100u/ml 10 ml $110.99 USD


Like I said you are better off buying the 5 pack of pens
They will last you way over a year depending on how many units you give
After your vet writes the first script you won't ever need another script.
Call them and will tell you what to do
They are very nice people

Oh when you buy the pens they will have an expiration date on them
Most likely 2022 or 2023 by now.
Put them in the frig , a middle shelf
As long as you don't puncture them they will be good until the expiration date
So you are actually saving a ton of money


We also use syringes with half unit markings.
We increase or decrease by 0.25 units at a time.
It makes it easier using the half unit syringessyringes
For Lantus you will be using U-100 syringes
Have your vet write the script for the 5 pack of pens

 

https://www.adwdiabetes.com/product...100-vet-rx-half-unit-syringes-31g-3-10cc-60ct

These are from ADW Diabetes to use with Lantus if you switch

You can also post and ask what other members use

 

https://www.adwdiabetes.com/product/16367/carepoint-vet-u-100-pet-syringe-31g-half-unit

Another brand from ADW Diabetes , they ship pretty fast

I posted promo codes below

 

Management Affordable.

ADW Diabetes Storewide Promotions
ADW5OFF

Take an additional $5.00 off all orders of $50.00 or more!

DIA10

10% off your next order!

 

Thank you, Diane. Right now I am overwhelmed with a score of 521 tonight. I have never gotten into the 500's and rarely the 400's. I don't know how to handle all of this. What am I doing wrong with Susie?

 

@Summer and Susie
Hi Summer , I'm sorry but I it's been ages since I used Vetsulin
Can you try tagging members that have helped you in the past .
and ask them

 

You are seeing bouncing plus lack of duration. It also looks like +1 might have some food spike in it. You are starting to see her onset looks to be +2.

I wouldn’t make the assumption you are doing anything wrong. IMHO, Susie was probably getting into some of these higher numbers but because you weren’t testing, you didn’t know. I think she’s been diving and bouncing back up for a bit.

Just as an example, here is a kitty following TR on Lantus. Look where he started (look at his 2020 SS), then he got regulated, then tightly regulated, and he just now started an OTJ (off-the-juice) trial. Susie’s SS looks much better than his did at the same length of time being FD.

One last thing: thanks for changing the PMPS to show you are shooting early. Because shots are supposed to be 12 hours apart, if you are not giving her a.m. shot at the same time as the p.m., then it’s not at +12. If you are shooting the PMPS at 4:45, for example, and the AMPS at 6:15, then the AMPS is not at +12 but at +13.25 (12 + 1-1/4 hours after PMPS). Could you please make those adjustments on her SS to show AMPS is not at +12? Again, what you are doing with this is not something we suggest here.

I would suggest you feed Susie a little bit around +5 and then give her a few freeze dried treats at +9 to hold her over. They are very LC if you just get the meat and won’t affect her BG. Then you can be sure you are shooting at +12 each cycle. Where there’s a will...there’s a way. Cats adjust.

 

Hi Marje, The suggested operation behind the "bounce" sounds a whole lot like the suggested operation behind Symogi. That's why I connected the two in my interpretation. But never mind, it's not really the concept of "bounce" that concerns me but rather the certainty with which it is often asserted on this board. It's a convenient explanation for the higher numbers that follow lows, but is it necessarily always the correct correlation? Does "bouncing" have a scientific name? To tell someone their cat is "bouncing" involves a level of certainty that not even my specialist could give me about inconsistencies in my cat's glucose levels. Instead, the problem of inconsistency was presented to us very speculatively: "duration of insulin action might be at fault as well as this variability." To be told then here on this board that a cat is definitively bouncing seems not to be introducing adequate uncertainty into the discussion. It also might influence me to believe that I can probably correct the problem through different management or push me toward a preferred insulin and protocol. I've noticed an interactive approach on the board that moves the owner ever closer to tight regulation on glargine insulin. First up is the message that if you are on anything other than glargine your cat is at risk of x, y and z and will probably not achieve remission. That is followed by the urgency to immediately increase our testing and then increase from there. So I think it is an underlying strategy (fine to have a strategy but I think the site should be a little more open and direct about it). I have no problem with tight regulation, home testing, or glargine insulin. Each are tools with upsides and downsides. In my opinion, they are too often presented here as ideal tools to treating feline diabetes, and the only ones that will achieve the oversold probability of remission—something some reputable researchers question.

But more concerning to me is that explanations like "bouncing" and dosing advice are sometimes forcefully and incautiously given and not always based on anything more solid than some combination of speculation, hope, personal experience, a lay interpretation of literature, and perhaps a pinch of orthodoxy. This is how confidence in the protocol is sold: "I know what to do!" No physical examination of the cat is ever involved and the "experts" here often rely on biased or incomplete health histories of the cat. When one is in a confused situation with a newly diagnosed cat and everything feels urgent, it's very easy to offer advice as an act of kindness and to accept advice as an act of desperation. And in the end, should someone on the board happens to tell me to do something that accidentally harms my cat, that person never has to answer to anyone. Those are my concerns about "bounce."

 

Gideon Blue's Spreadsheet certainly did improve in the later part of the year. What did this owner do to get the diabetes in control? Was it just the length of time he was being treated? I did see adjustments in the insulin dosage. Do you think I need to adjust Susie's insulin to 1.5 units. I will try your plan of feeding her a little around +5 and then giving a few treats at +9. Anything I can do to get her to hold out the 12 hours I will but I don't like the feeling that I am depriving her of food when I can tell she is very hungry. I will be looking at the Lantus but want to use up the Vetsulin first. My vet is hesitant to switch me to a human meter. He likes that the AT is designed for dogs and cats. Did I mention that I have purchased a scale and when I receive it I can track her weight. A couple of other questions. I am worried about infection in the ear tips from all the poking. Should I be using neosporin on her ears instead of the vaseline?
Also, I still don't have an explanation for the "Dosing Method (SLGS or TR)"? I don't know what this is and what Susie is on?

 

Diane, I appreciate the coupons and contact info. I would prefer to use a vial and not the pen. I am used to vials now and used them when my husband had diabetes. Is there a problem with that. I don't know if my current syringes would be appropriate but could check with my vet or the pharmacy. I'm holding off on order the Lantus - for now. I spent a lot on the Vetsulin and would like to use that up first.

 

I assume these are for Lantus vials? Thanks, Diane. The syringes I can afford. Everything else is expensive. Never mind, I got my answer from your other post. Thanks.

 

It has been a really long time since I have used a pen. I think I would be more comfortable with the vial with the half unit markings. Thank you for all this information.

 

Thanks. I have been wanting this information for when I do switch to the Lantus vials and new syringes.

 

By the way, I'm impressed with your background! Love the MS in Wildlife Biology.
Amazing that you CKD kitty was stable for over four years in stage 3. Simon was diagnosed in stage 4 and, like he said, he went downhill very quickly. The subcu fluids seemed to make him feel better everytime but he just stopped eating and I was trying for feed him through a syringe but it was obvious that he needed to go. My vet told me I should get Susie down to 10 lbs. That was shocking to me. Last she was weighed she was 14.6. Don't cats lose weight on diabetes? So here I am trying to get her weight down, normally, but I won't know if the weight loss is from diabetes complications. Another confusing factor.

 

I think you are the first person on this site to not admonish Vetsulin. I sometimes also worry about the duration of the strength and when I get really high numbers at +1 it doesn't make sense. Thanks for offering to show me Sergei's data but I think right now I am overwhelmed with everyone's data. You can tell me if you know of any good cat treats. I know you are not in the US but I would still be interested. My cat didn't like PureBites and I just ordered from Whole Life (freeze dried). What do you buy or do you make your own? Thanks, again, for your support!

 

Sounds like it but if you read my statement in a post above, Somogyi, in theory, is caused by chronic overdose. Bouncing also known as rebound is typically caused by dropping into lower numbers than the liver is accustomed or steep dives. Unfortunately, many sources that discuss Somogyi use the term “hyperglycemic rebound” but it is not the same, in concept, as the rebound we see here which is not caused by a chronic overdose.

You are correct here but if you look at my post 147 above, you’ll see I mention lack of duration. In fact, I’m one of two currently on this board who can spot lack of duration and if you were to search “lack of duration” and my user ID in the LBL forum, you would find I’ve mentioned it many times. Sadly, members see numbers go up, they automatically assume it’s a bounce. The two of us who understand lack of duration and what it looks like can’t be everywhere to discount that. We try to stress that it’s important that members understand their cats onset, nadir, and duration. Most do not....a handful will try but most focus on nadir which is only a small part of the picture. It also takes time and studying hundreds of SSs to be able to identify loss of duration and most members dealing with diabetic cats don’t have the time to do that.

We do encourage the use of Lantus or Levemir here primarily because of their longer duration which benefits the health of the cat. They also have a higher rate of remission. They are also less harsh insulins with less of a chance of symptomatic hypoglycemia. That does not mean it can’t happen; it can and it does although if members follow our methods of regulation here and test, it is very less often to occur and thankfully, there have only been a few losses of cats due to hypoglycemia using the L insulins on this board and only one that I can think of who was a member here for a long time and got complacent. The others were new members who found us when their cat had suffered the symptoms or were already in the hospital or had passed. Tight regulation is the primary method that we support for use of the L insulins. That’s our choice on this board. There are other boards that use different methods and even sliding scale dosing of the L insulins. We use what we feel is the safest and best backed in published research. SLGS is the original method of regulation used here, until the L insulins and TR came along. Members not using the L insulins or PZ (which members can use modified dosing similar to TR) use SLGS.

I wonder if you’ve ever taken the time to read through the massive amounts of material on this board, much backed up by scientific research and referenced where we can. Is some anecdotal...certainly but we have had a lot of really smart people contribute to these documents including vets like Dr. Lisa, vet techs with solid backgrounds, other healthcare professionals with access to medical publications, and others who have taken the time to do the research through the literature. Check out our Health Forum and FAQs. Our information also comes from a relationship we share with the German diabetic cat forum which was the first to use TR as developed by Kirsten Roomp. You should google her CV. I am still in touch with her.

We do not proclaim to be vets here and it’s written on many, many stickys that we are not. I don’t spend much time on Main Health or the other ISGs than LBL but it’s frequent that members will post their vet’s exam info or their labs. We do ask how the cat is doing clinically and you can search a phrase like “ because our cats are not just their BGs” or “numbers”. Is it perfect here? No, but what site is? We strive for safety first. Our members are trying to do their best and give support. Our rate of remission in LBL cats is quite high and we do it safely. The bottom line is any member can choose which of the diabetic boards they want to post on and any member can choose to not be here. Our forum has been in existence the longest and we often get many members from other boards and FB. We’ve saved many, many diabetic kitties lives, including my Gracie, that would have likely otherwise been lost to hypoglycemia based on their vet’s advice. So you decide which is more problematic.

I’m happy to discuss with you further but you should start your own thread so we don’t hijack this one about Susie. Thanks very much.

 

She followed tight regulation. She listened to those helping here. My intent on showing his SS to you was not so you would grab onto the thought that Susie needs more insulin. It was so you could see how much worse his BG looked than Susie’s and how improvement can be attained.

I do not think you should raise Susie’s dose at this time. She hasn’t been on this dose a week yet and we still aren’t certain we’ve caught the lows but it has been helpful to see the curve and the additional BGs.

Perhaps you are not feeding Susie enough calories? Did you read what I wrote about that above? It might be that you need to try the method I suggested and give her more calories overall if she is losing weight. I’m glad you purchased a scale so you can see what her needs are. My little one, Livia, gets fed two ounces of homemade, balanced raw a day with a few Whole Life treats. She seems hungry sometimes but her weight is very stable. She is a small cat and I do not want her to be overweight and at risk for diabetes. I discussed it with my vet and she said, “Her weight is perfect and stable. I’m hungry all the time, too, but if I ate all the time, I’d be as big as a house”. Liv is really at the very perfect weight for her size and I know I’m giving her enough calories as her weight does not go up or down. Cats are smart and, as long as you know she is getting enough calories, you will have to be the strong one to make sure she stays at the perfect weight.

Almost every vet wants the clients to use the AT. Is he willing to pay the extra cost for your strips? Maybe he needs to expand his knowledge by learning about the use of human meters in pets. My vet was willing to do so and I was never, ever pressured to use the AT even though I have one. Susie is your cat. Dealing with FD can be expensive especially if the kitty doesn’t go into remission fairly quickly.

I never used Vaseline; I always used neosporin with pain relief ointment, not cream, or a similar product that Wendy sent me from Canada.

 

Not all diabetic cats lose weight. Gracie didn’t. If you follow the method of weighing, feeding for a week, adjusting food, you’ll slowly get to her ideal weight but don’t rush the food decrease. It has to be slow. Dr. Lisa is a member here and helps many members with nutrition. Dr. Lisa has valuable weight loss information here on her website. She also has great food charts you can find there as well.

I will make one other point about Vetsulin. I belong to several other FD boards (I do not post on them) just to stay aware of what is going on with different approaches, etc. As far as I can find, this is the only FD board that still supports the use of Vetsulin and by support I mean, offers an ISG where members using it can post for help. Having said that, it simply is not the best insulin for cats. Have some cats going into remission on it....yes. But, IMHO, it’s analogous to the choice between using one of those old time computers with the huge backs that jutted out and a new, flat screen fast desktop. Both work but one is much better in terms of efficiency. Still...it’s your choice.

BTW, if you are going to switch to Lantus, I’d strongly urge you to pop over to that ISG on this board and start by reading how to handle it because it isn’t the same as Vetsulin. There is no rolling or mixing required and it really shouldn’t be rolled. It would also be a good idea to start reading the stickys there a bit at a time while you wait to switch. Once you start using Lantus, we will ask that you post there instead of here on Main Health because there are more members there to help you with that insulin. That frees up the people here, like Mogs, who are excellent at helping new members.

 

Welcome, I am relatively new here too but let me tell you something, you will be absolutely amazed at what you will learn here in the short amount of time. My Nala had BG readings of the 300's and higher when my vet diagnosed her. She prescribed her the dry prescription Diet and 2 units twice a day on insulin. Checkup and new glucose curve later her readings were in the 400's! It was the dry food, too many carbs. She means well, but ultimately our vets don't have all the time it takes to educate us on this and are really just doing their best to regulate our kitty, which is a lot of trial and error which I learned can wreak havoc on kitty. With the help of this wonderful group I began self testing at home, switched Nala to strictly canned (she prefers the Fancy Feast Classic Pate and the Beyond Grain Free pate). We implemented the start low go slow method on insulin dosage, and Nala now surfs the mid to high 90s to mid to high 100's on just .75u currently twice a day. Our goal is remission. My vet wasn't exactly skeptical or against me as when I first told her I was going away from her treatment plan, just if I could keep up with it. When it was time to update her on Nala, I sent her an email with the open link to Nalas spreadsheet so she can see all her numbers, dosages, and the notes I take on her any time she wants to check in on her. She is very happy with what she sees and says we are def headed in the right direction. I hope your vet is not the type to not "allow" something, but ultimately these are just like our children and we have to do what is best for them as we are the ones who are emotionally, physically, and financially involved in their care. Basically, they can't "not allow" you to do something. It is ultimately your choice hun. And I think, no I know, you will find so much help here. These people are patient, and kind.. in the beginning I had SO MANY questions, and yes I repeated a lot of them just for the sake of making sure I understood the answer, had a few panic attacks along the way that they assured me was not something to worry over and helped me feel better. You will be ok, this group has your back!

 

I agree with this. I've found a +2 test useful with all the insulins I've used (and Caninsulin/Vetsulin was the first insulin I ever used). But I've actually found it particularly helpful with Caninsulin/Vetsulin precisely because it can often give a good indication of the blood glucose trajectory, and this is so important with an insulin that can drop the blood glucose fast and have a short cycle. Many others have also found the +2 test helpful with Caninsulin/Vetsulin. If the blood glucose is dropping fast at that point then you know you need to test again a bit later to monitor the situation, and you have the chance to intervene with food to try to slow down that drop in blood glucose.

Caninsulin/Vetsulin can have a very early onset though in some kitties, maybe even starting to work well within 45 mins of being injected. And if a cat's data shows that they have early onset, and are inclined to drop quickly, then testing at +1 or +1.5 may give useful information earlier on. (It is worth doing some tests in the first couple of hours of a few cycles just to try to determine when the blood glucose 'typically' starts to drop.)

Eliz

 

We ask people to record BG readings in shareable spreadsheets precisely so that any dosing suggestions made are based on an individual cat's actual data. Experienced members will not make specific dosing suggestions without it. In the absence of adequate data, all that experienced members replying can do is give very 'broad brush' speculation on what might be happening based on the characteristic mode of action of the insulin being used, treatment methods that have been developed over years (and in the case of TR based on published, peer-reviewed scientific studies), and general response patterns they have observed in the data of hundreds (in some case thousands) of cats whose caregivers have sought help here over the many years that FDMB has been active.

Scientific research into feline diabetes has shown that remission rates in cats treated with longer-acting insulins (glargine, detemir, Prozinc) are higher than in cats treated with shorter-acting insulins. While remission is possible in cats treated with the likes of Caninsulin/Vetsulin or NPH - and we have had cats here who fall into this category - statistically it is less likely.

When members seek help here those replying to their posts endeavour to give honest and helpful advice regarding home testing (as well as all manner of other aspects of managing a cat with diabetes). If we think that additional testing could be beneficial to a cat then we will suggest certain testing strategies. Initially the strategy will be based on the characteristics of the insulin in use (that's all anyone - veterinary professional or lay person - has to go on at first). As more data for a particular cat becomes available and its specific pattern of response to its insulin can be better understood then more tailored suggestions about testing are possible. For example, many cats on Lantus might typically reach nadir some time between +4 and +6 hours after dose administration so that's likely a good time to check how low the dose might be taking the cat (provided one's schedule permits). However, another Lantus kitty might be one that metabolises their insulin faster than is typical and thus hit nadir earlier in a cycle. Therefore testing at, say, +3 might be more likely to catch the lowest BG level for that cat. Another thing that influences testing suggestions is the caregiver's particular circumstances and we try to help members to optimise their testing to fit in with their schedules and other commitments (e.g. work, family, etc.). The more information members replying to posts have available about a particular cat and a particular caregiver's situation, the better suggestions they can make but ultimately the caregiver holds the syringe and chooses how they manage their cat (which insulin to use, what to feed, when to feed, whether or not to test, etc.).

According to the 2018 AAHA Diabetes Management Guidelines for Dogs and Cats:

In cats, diabetic remission is a reasonable goal [...] Predictors of diabetic remission in cats include achieving excellent glycemic control within 6 mo of diagnosis, using intensive home monitoring, discontinuation of insulin-antagonizing medications, and use of insulin glargine(Lantus) or detemir (Levemir) along with a low-carbohydrate diet.​

Mogs
.

 

I agree about the high cost of the AT strips as I just reordered. It appears that Lantus is quite a bit more expensive than the Vetsulin, though. I did give Susie about 1.5 oz of FF at +5.5. I like to lie down between 10:00 and noon so I will probably be closer to feeding her, mid day, around 11:30. Susie is a pretty big cat and has always had a strong appetite - even before the FD. I'll switch from the vaseline to the neosporin ointment. So I guess from something else I read that Susie's dosing method is SLGS and not TR? I still don't understand this but maybe you have already explained it somewhere.

 

Thanks, Tiffany. I agree that our vet's probably do not always know best. I was speaking to mine a couple of days ago. I mentioned that it was hard to hold off feeding for 12 hours. He said maybe she should go back on a low carb dry food. I said "no". I never want her on dry food again. He also recommended the Hill's W/D, wet and dray, which even the wet food is too high in carbs. He never says he won't allow something. He listens to me and works with me. He is willing to go along with anything I suggest. He just sometimes does not give good advice. I am feeding the Fancy Feast Classic which she really likes. I also have sent the link to my vet that shows the "real time" spreadsheet. I doubt he has time to look at it much. I am very happy with all the support I am getting on this site. I am still in the dark about a lot of things but they are becoming clearer. I really, really struggled with learning to test. It broke my heart to poke my cat's ears until they bled. Everyone on this site said I would become more and more comfortable and they were right! Thanks for welcoming me, Tiffany. Sounds like your kitty is doing very well. What insulin are you using and how long have you been treating your kitty?

 

@Sergei, as Mogs says above, "Scientific research into feline diabetes has shown that remission rates in cats treated with longer-acting insulins (glargine, detemir, Prozinc) are higher than in cats treated with shorter-acting insulins. While remission is possible in cats treated with the likes of Caninsulin/Vetsulin or NPH - and we have had cats here who fall into this category - statistically it is less likely."

I've certainly seen quite a few cats go into remission on Vetsulin/Caninsulin in the 14 years that I've been on the forum. I worked with a lot of Caninsulin/Vetsulin kitties at one time, and so because of this was much more aware of the number of remissions. But those cats that have gone into remission are usually those that only need a short time on insulin and maybe a change of diet in order to go into remission. If a cat doesn't do well on Caninsulin/Vetsulin fairly early on then it can be well worth switching to another insulin.
Statistically it absolutely is the case that better glycemic control is more likely to be achieved with longer lasting insulins, such as Prozinc, Lantus, and Levemir.
Incidentally, in the largest ever remission trial (by the RVC) it was found that Prozinc and Lantus produce similar remission rates. (It was long thought that Lantus produced the best remission rates, but this was disproved by a researcher who actually won an award for disproving it...)

 

My vet has her on ProZinc 40 and we've been on insulin since 11/30 of last year, so not quite 2 months yet. The ear poking got me at first too, but it does get easier. I think its harder on us than it is them bc Nala has never acted as if she minded it, it was always me..lol

 

Susie...could you please start a new thread in the morning; this one is getting too long. Please paste this link in your first post in the new thread (it’s the link to this one for easy reference): https://www.felinediabetes.com/FDMB/threads/new-member.240295/page-2#post-2718550

Thank you!

 

You are fortunate if your kitty doesn't mind the ear pokes. Mine tolerates it best when she is not feeling too well. When she is hungry it is a real challenge. I appreciate the info. I'm just weighing my next move with possible switching from the
Vetsulin to something else.

I'm sorry but I don't know how to start a new thread. When I click on your link it takes me to post #178

 

It’s exactly like you started this thread. Just go back to the Main Health forum where this thread is and click on “Post New Thread” and then fill in the subject line and start posting.

Please include this link at the beginning if your new text: https://www.felinediabetes.com/FDMB/threads/new-member.240295/

Once you are able to do that, I will put your new thread link in this one so those helping will know where to find you. Thanks very much.

 

New thread for Susie