911 New Wet Food, Lower Blood Glucose, How to Dose Tonight??

Hi everyone!

Our cat Mr. Pinkleton was diagnosed earlier this summer and we have really struggled. He lost 5 lbs and was on death's door. He has made a great rebound on Prozinc but was still eating dry food, and his numbers were still in the 200s and 300s.

Well, we just switched to the wet food version of his Hill's Science diet venison food. We do home blood testing and his result was 136. I am VERY nervous about giving him his usual dose of 4 units of Prozinc and we are going to test again in about half an hour at 10:30 pm. But we aren't going to be able to sleep if we give him a dose and worry about it going too low! Any advice??

Thank you!!
Jessica

 

Hi Jessica. Great that you are testing as you wouldn't have caught that 136 otherwise. What kind of meter are you using? What is his normal pre-shot BG numbers? We typically do not shoot under 200. If you get a pre-shot number that is 200 or below, if your schedule allows it, we stall. This means that we would test again about every 20 to 30 minutes until you get over 200. Then, you may want to consider giving a reduced dose.

Have you been giving 4u every 12 hours? What is the carb % of the Hill's Science diet food? It is a big transition when you go from dry to wet, low carb food. It could easily drop the BG numbers by 100 to sometimes 200 points. Could you give us a little more history of Mr. Pinkleton?

 

No, don't shoot. Stall. Wait 20 minutes without feeding and retest. You want to be sure he is rising and nearer 200.

You may have to skip.

 

We just did another test and his sugar is 144. We might wait and re-test in the morning? Would that be wise?

Yes, he has been on 4 units every 12 hours. He has a lot of allergies and has been on Hill's Science Diet d/d venison dry food for several years. The dry has 32.7 carbohydrate. He didn't have any appetite for the wet food previously, but we offered it to him again over the past couple of days and he loves it. The wet has 21.2 carbohydrate. That doesn't seem a lot lower -- could that make this big of a difference?

Thank you for this help!!! It's so stressful!

 

Better too high for a day, than too low for a moment.

If 12.5 hours from now would be OK for a shot, you might stall another 30 minutes and test again.

It may be more restful to just skip.

 

Yes, I think you'll have to skip. He will be likely high tomorrow but I would still reduce. My thinking is that he will be higher not only because he will have been 24 hours since his last shot, and he could bounce from a lower number than he has seen in a while. Maybe reduce by 1/2 or 1 unit less? It depends on whether you can monitor.

I don't know about the food. The wet is much higher than we would recommend; we like to stay under 10%. But it is lower than the dry so that may be what caused the drop. Imagine where he might be if you could fine a lower carb food!

 

Yes I would skip.

It could make a difference but what do you think about trying a low carb, wet food that is below 10% carbs? That is what we suggest. Have you had a chance to visit this site? www.catinfo.org It is 18 pages long and is written by a vet. Great information that also includes a list of wet, low carb food. It usually makes a huge difference by changing to a much lower carb food. The food that you are feeding is way too high which makes you needing to give more insulin. Four units seem svery high and I bet you will be able to decrease your doses if you can get a much lower carb food. Many kitties that come here are pretty stubborn and do not want to get off their dry food....but eventually, they like the wet if they are transitioned over 4-5 days.

Would you be interested in creating a spreadsheet? It would help a lot especially during a "911" time or when there are questions regarding doses. Our spreadsheet instructions are here. If you look at the signatures of the members here, you will see a link to their kitty’s spreadsheets. We keep track of all our tests. This is basically a place to collect data and help you to determine patterns, doses, etc. It also aids those that may be helping you to better understand your kitty.

 

Thanks everyone! This can all be so confusing and difficult! He was reading in the 200 and 300s while eating his dry food on the 4 units. So the lower number on the wet food is a very new and exciting development, but very scary when considering giving a large insulin dose right before bed.

We would love to have him on low carb diabetic wet food, but then we worry about risking his allergies (he has had urinary infections, loss of fur, scabs, etc when he developed food allergies in the past). Might be worth the risk? Maybe he could be insulin-free one day?

We have a blood glucose monitor that logs all of the readings and times, so that has been really handy, but I will check out the spread sheet as well -- thank you! What a relief to have found this community. The vet has been surprisingly unhelpful and not proactive. I wish they had stressed the importance of getting him on wet food more, but I think they thought there was no option with his allergies.

 

There are lower carb foods that have novel proteins. Raw is a possibility. Maybe post on Health and ask for ideas - lots of people do feed novel proteins.

Here are the directions for our Goggle spreadsheet. It is a great color coded tool.

http://www.felinediabetes.com/FDMB/threads/fdmb-spreadsheet-instructions.130337/

If you need help, just ask.

 

You might want to post on the "Health Forum" and ask about allergies. I know there are a number of kitties that may have the same issues and others may be able to help you.

 

Good morning! I just wanted to jump in and add that a lot of vets don't seem to know that wet food is necessary. I think most vets I've ever seen have told me that dry is just fine...even when I say I like wet food better, they tell me dry is fine for cats (or even better!). I've given up and now just tell them my cats won't eat dry foods. I know wet is better, so I just go with that.

 

Hi Jessica. How is Mr. Pinkleton doing this morning? What is his BG number (AMPS - AM Pre-shot)?

 

Hi everyone!

We fed him more wet food this morning and tested his sugars and he was at 498 :-/ But, I am glad that we didn't give him the insulin last night when he was at 136 because as you guys said, high is better than low.

We will just need to figure out what his new dosing should be while on the wet food now. Should we ask our vet with the new numbers? We just aren't finding them super helpful! They are shocked we are doing home blood testing ourselves. If he is testing around 200 tonight should we maybe give him 2 units instead of 4? We will test his sugars again tonight (we are out for the day) and see where we are at.

Thanks again for your feedback, this has been so helpful!
Jessica

 

I'd leave out some food if you can, just in case he surprises up with some lower numbers. Yes, I think you need to rework your dosing but it is hard to guess what is happening without those mid cycle numbers. I'd suggest we play it safe until you see how low the insulin is taking him. (for example, it would have been nice to know last night whether 136 was his lowest number of the day or whether he dropped lower than that 5-7 hours after the shot.) That extra piece of information would really help us help you figure out what the 4 units is doing.

 

Thank you for this suggestion. Yes, we definitely need the full curve to really see what is going on. Unfortunately we won't be home all day until Monday. :-/ Should we leave out dry food or wet food during the day until then?
Jessica

 

Any chance you could set an alarm at night and check his levels? It'd have to be on a night when you give him insulin, but it would at least give you an idea of how low he is going. If you're a person of a certain age like me, you're up at night at least once anyway.

I think wet food.

If you don't give insulin right when you get home, get a test when you walk in the door. That might give you some info. And one right before bed at night.

 

I'm with Sue. Trust me, I KNOW how tough it is to get those mid cycle numbers, but a nighttime test could help with that. With that low preshot number, it'd just be helpful to know how low he went. I used to set the occasional nighttime alarm to see where Gypsy went...and since I was usually up at least once if not more times...I'd run and grab a test then too!

 

A tip for doing a night check: the human body typically sleeps in cycles of 45 minutes. It is much easier to wake at the end of a cycle, than in the middle of one, so time your wake up with the end of a sleep cycle.
Example sleep times to allow yourself:
5 hours 15 minutes
6 hours
6 hours 45 minutes
7 hours 30 minutes

Pick a time that will wake you just before the likely nadir period for your cat.

 

Hey Jessica - how are things going? How is Mr. Pinkleton?

 

We are working on getting some good curve numbers over the next couple of days and trying to figure out the correct insulin dosing. He is trying Purina ProPlan Vertinary Diets DM today, but I don't love the ingredients and am a bit worried he could develop some food allergies. What is everyone's preferred low-carb wet food you would recommend?

 

I feed Fancy Feast and Friskies pates. Yes, they have animal byproducts, but I figure so do birds and mice. And the alternative for many of the higher carb foods is grain - can't see cats hunting that put as a food source.
People who want more quality ingredients may feed Wellness. Have you seen the food chart we use? We try to stay under 10% carbs.

http://www.catinfo.org/docs/FoodChartPublic9-22-12.pdf

 

I use Wellness Turkey mostly because it is lower in phosphorous (due to kidney disease) too as well as carbs. EVO food is low in carbs and phosphorous as well but my cats did not think it was tasty enough. If I didn't have to get the lower phosphorous, I would feed Friskies, Fancy Feast or 9 Lives low carb pates.

If your cat will not eat the prescription diet food, I heard that you can take it back and ask for a refund.

 

I prefer Fancy Feast, but due to having 4 cats on wet only, I have to use Friskies, 9 Lives and Special Kitty (Walmart). Good luck with the curve!

 

His blood sugar was 67 tonight after a full day of eating the diabetic wet food. He doesn't seem to love it, but he ate it. Wow, that is a low number! We will not be giving him any insulin tonight. We are going to check his numbers early in the morning and see where we are at. If his numbers are in the 300s or 400s what do you think we should do for a dose? We should have full curve numbers for tomorrow and that will be more helpful, I know.

We have a few more cans of the prescription diabetic wet food as well as the prescription venison (which is higher carbs). We will see if he will continue eating the prescription diabetic food but if not I will perhaps try the Fancy Feast.
Sincerely,
Jessica

 

That is a very low number after 12 hours since the shot. I shudder to think he might have even been lower mid cycle. So you are skipping tonight. Tomorrow even if he is high, I would reduce the dose a lot. Maybe restart at one unit or two (if you can really monitor) test every pre shot and nadir whenever you can. Then raise it slowly if needed. Better too high for a day than too low for a minute. One unit may not be enough, but two units make me a little nervous.

The food seems to be making a big difference in his levels, working with the insulin. The trick now is to keep him in safe ranges while the food/insulin works together and lowers his numbers.

 

Jessica - any chance you could put together a spreadsheet? It sure would be helpful to see the whole picture and help us with dosing questions that you may have in the future. Our spreadsheet instructions are here.

 

If you need help with the spreadsheet. Let me know. I can set it up for you.

 

Hi,

Thanks for the spreadsheet link. I'm not sure how to use it -- what do the + numbers mean??

I can tell you what happened today. We are having a tough time getting onto the wet food. Last night as I mentioned his number was scary low (67), so we didn't give him any insulin, obviously. This morning his number was up to 577. We gave him the 4 units (although I was nervous about this and wanted to give him less but my husband was freaked out about his high number). At around 2 pm his number was at 164. At 9 pm his number was 194. Should we give him 0.5 or 1 unit tonight to get him through the night without spiking and then see how that goes and increase if needed?

I almost want to go back to the dry food where we at least had it controlled on the high side. But I know if we can get him on the wet food then his numbers will be a lot lower, I just hate to see his numbers all over the place. His neuropathy continues to be terrible and he can't walk much at all. His front legs buckle under him and it's just awful to see.

 

I think I would go with one unit as long as you can get a before bed test. He may bounce later from the lower nadir.

When you skip, you need to expect a higher number, but you still reduce because you don't want the next cycle to be too low to shoot.

I would stick with the lower carb and maybe do a restart at one unit. Give one unit a couple cycles. If he is running higher, then increase by .25 or 0.5. That is much safer than trying to guess how much to reduce.

 

Your cat probably has diabetic neuropathy. My cat did too and it was severe where it not only affected his back hocks but his front legs too. Here is some additional info.

Diabetic Neuropathy: Merlin had this condition and it was really severe. The symptoms are walking on their back hocks. Severe conditions may also include their front feet. Merlin could never go more than a couple of steps before sitting down. We had to put down rugs all over the place so he wouldn't slip on the tile. To help this condition is to regulate the diabetes and to give them methyl B12; Zobaline. If you go with another product, you must make sure that there are no sugars. It is a small pink pill and can be crushed and put in his food. Today, you can’t even tell Merlin had it. He can run, jump and walks on his tippy toes now. Here is a link to Zobaline: http://www.ilifelink.com/zobaline-for_diabetic_cats-3_mg_x_60_tablets.html

Regarding the spreadsheet and how to read it. BJM has a great explanation which is below:

The colored headings at the top are the ranges of glucose values. They are color-coded to clue you in as to meaning.

Each day is 1 row. Each column stores different data for the day.

From left to right, you enter
the Date in the first column
the AMPS (morning, pre-shot, test) in the 2nd column
the Units given (turquoise column)

Then, there are 11 columns labeled +1 through +11
If you test at +5 (5 hours after the shot), you enter the test number in the +5 column
If you test at +7 (7 hours after the shot), you enter the test number in the +7 column
and so on.

Halfway across the page is the column for PMPS (evening, pre-shot, test)
To the right is another turquoise column for Units given at the evening shot.

There is second set of columns labeled +1 through +11
If you snag a before bed test at +3, you enter the test number in the +3 column.

We separate day and night numbers like that because many cats go lower at night.

The nadir is the lowest glucose between shots. There is a general period when it will happen which is specific to the insulin being used and testing then helps make sure your cat doesn't go too low.

It is merely a grid for storing the info; no math required.

 

I think a restart at 1 unit would be good. I did that with Gypsy and that was what finally worked...pushed her numbers down (she was an odd kitty and we kept having to reduce ). Sometimes a restart can help you find that dose that is perfect...

 

Thank you everyone! Yes, we do have him on Zobaline. So far, not much improvement But maybe that will come with better regulated numbers. How long did it take for your cat to get back to normal?

We need to get a different size pick for getting the blood out of his ear -- today Mr. Pinkleton finally said no, thank you, to his ear being stabbed a hundred times -- the pick is too small. He was at 477 this morning after receiving 1 unit last night, so we gave him 2 units and we look forward to seeing what this does for his numbers.

And thank you for the explanation of the chart! That is very helpful.

I can't express how helpful it has been to have this group as we go through this! It's nice to know we aren't alone, and it's great to get such good advice. Thank you again for your kind help.

 

A larger lancet should help - maybe a 28 gauge would be enough. Or 25/26.

Also sometimes Neosporin with pain relief helps.

 

If you get the neosporin, it might help the blood bead up a bit which makes it easier to get the droplet you need!

 

Neosporin with pain relief does really work, but sometimes I find I put too much on, and it seems to interfere with the blood test (I can't get the glucosometer to provide a reading) so just put a small amount on the ear