First Ear Stick out of the way phew!!

Yeah, did my first ear stick today. Wanted to get a baseline BG that did not reflect the stress of taking Molly to the vets office before we start Insulin.
She did not flinch at all, took the opportunity to brush her and have some cuddle time too . She was more annoyed at breakfast being late! Her BG was 327 :sad: but her serum glucose taken by her vet on friday was 534 :cry: so hopefully by changing to wet food and starting insulin, we can get this thing under control!
Off to get Insulin teaching now!

Welcome to the Vampire Club! Great job on the first try. That is not a bad number. We consider numbers in the 500s high for new diabetics, and 200s as too low to shoot without more data, so your number is fair. Don't be surprised if the number at the vet is higher. We know that stress can raise levels and most cats are very stressed at the vet. Your number at home will be the accurate one.

Oh, well done, Lesley,

Great job! :thumbup

Great job! What a very good kitty cat_pet_icon Sounds like you're both off to a great start! Let us know how your training session went and please ask questions if you need to!

Just got back from my training session :thumbup . I,ve got lantus insulin. I have to give 2.5 units every 12 hours. they recommended the purina DM food wet and some dry if she gets picky with wet food, but my vet also said that giving the fancy feast classic or great choice (petsmart) classics would be ok too. He told me to check her premeal BG and withhold the shot if BG is less than 150 and after a few days I could do a curve. After 10days we can talk about adjusting doses,looking at her trends etc.
Well here goes...life is about to change big time for my big sweet gal! :dizcat

Hi Lesley,
Great job on the home testing!

You said the vet prescribed a starting dose of 2.5u? Asking because that's pretty high to start with. Most kitties start a 1u, some even less.
Sometimes insulin is initially dosed based on the cat's weight, so that might be how the vet got to that dose. How much does Molly weigh?

I'm going to ask some very experienced Lantus folks to pop over and offer their insight.

Carl

Carl & Bob said:

Hi Lesley,
Great job on the home testing!

You said the vet prescribed a starting dose of 2.5u? Asking because that's pretty high to start with. Most kitties start a 1u, some even less.
Sometimes insulin is initially dosed based on the cat's weight, so that might be how the vet got to that dose. How much does Molly weigh?

I'm going to ask some very experienced Lantus folks to pop over and offer their insight.

Carl

Click to expand...

Carl she weighs 15 pounds :sad:

Hi Lesley,

I don't use the same insulin as you will be using, but I really do agree with Carl that the intial dose seems rather high (irrespective of your cat's weight). I know this must sound confusing to you because your vet has said one thing and us folks on FDMB are saying something else...

Hopefully people experienced in using Lantus will chime in soon.

I take it by the frowny face that 15 lbs is too much?

In the guidelines published by the AAHA, this is what they say:

The panel recommends a starting dose of 0.25 U/kg q 12 hours, based on an estimate of the cat’s lean body weight. This equates to 1 U q 12 hours in an average cat. Even in a very large cat, the starting dose of insulin should not exceed 2 U per cat q 12 hours.

Click to expand...

Even if 15 pounds were her ideal "lean body weight", that would equate to 1.7u and would probably be rounded down to 1.5u. I think I would call the vet before shooting, ask if they are familiar with the AAHA guidelines, and ask "why 2.5u?" They might have a logical reason.
http://www.aahanet.org/PublicDocuments/AAHADiabetesGuidelines.pdf

We usually recommend that new members start at 1u, try that for several days to see what happens, while testing before every shot and at least a couple of other times during the day or night in the middle of the cycles. Lantus is a "depot" type insulin, and it takes a few shots before the level of insulin in her body becomes established.

The prevailing thinking is "once the insulin is in, you can't take it back out", so we like to start with being overly cautious rather than overly aggressive. It's a lot easier to start low and increase the dose as needed than to start too high and try to figure out how to decrease the right amount.

Carl

Carl, I got the impression that he planned to adjust it after 7-10days. maybe I will give 2units and watch her numbers. My vets office is a cats only practice so they see a lot of diabetic cats. he said that because I can home check her BG he will have a better idea of her ideal dose after 7-10days.

I agree with Carl in that even 2u is pretty high to start, even if you're getting frequent testing in. Much better to start lower and adjust the dose as you go. It looks like you're getting lower numbers just by switching to canned food. I know it's difficult, as we are telling you something different than your vet, and ultimately it's up to you - you hold the needle. However, I will tell you this. I was following my vet's directions to the letter and I was not hometesting. We were up to 3u twice a day when my cat, Buster, had a severe hypo event and I almost lost him. I'm not trying to scare you, but I do want you to understand insulin is not something to take lightly.

Good luck to you and Molly! Keep us posted!

Great job on already getting some testing in!

I agree with the others that 2.5u seems a little high to start with. Did your vet give a reason for it? Other things that can affect dosing levels: How recently did you change their diet from dry to wet? Are you still feeding her any dry at all? If so, are you planning on fully transitioning your cats to only low carb, wet food?

Hello

Good job on the ear pokes! Many new people have issues so you are off to a great start.

Many of us here feed the Fancy feast classic pates, Friskies pates or Wellness grain free as they are just as low carb, cats love them and they are cheaper. You really do not want to give dry ever.. it will mess with her blood glucose levels.

Its up to you at the end of the day what dose to start on. People here think the vet has recommended too high but it can be hard to go with faceless people you dont know on a forum as opposed to your vet. So whatever you decide, just make sure you test and hopefully you will see pretty soon if the dose is too high.

To keep your cat safe here are some recommendations:

1. test before every shot.If the preshot test is less than 200 - dont shoot, dont feed and post here immediately so we can advise!

2. Test around 5-7 hours after the am shot, and around 2-3 hours after the pm shot. Plus spot checks during the day . This way you can see whats going on before anything happens!

3. Record your results on a spreadsheet and post them here - that way we can also see whats going on and advise heres how to set up a spreadsheet If you can do this, we will move you over the to Lantus tight regulation forum where eyes will be watching you and advising daily.

4. Buy some ketone test strips to check her urine for ketones

5. Get your hypo kit set up now:
IN CASE OF EMERGENCY - YOUR HYPO KIT
Put together NOW the following items and put in an easily accessible place!
Phone number of your vet
Phone number, address and map/directions to your nearest emergency vet (or phone number of the cab company and some cash/credit card)
Karo syrup, honey or corn syrup
High carb canned food with gravy – 2-3 cans
Some favourite treats
Spare pack of blood glucose strips
Coffee for you
And print and review this

Let us know how you get on or if you have questions!
Wendy

Yipes, 2.5 is a high starting dose. Good thing you asked. My vet wanted my cat to start with 2.0 units. I am so thankful for this board, because if I had dutifully followed that advice, I imagine my girl would have been hypo after the first shot! She can't tolerate any more than 1.25 units, and that's only when she's having a pancreatitis attack. However, she does weigh 2.5 pounds less than your kitty, but truly, you do need to start lower to see how she handles the insulin.

I see no one pointed you to this article. It greatly helped me understand this whole process. Please do read it.

http://felinediabetes.com/start-low-go-slow.htm

DZ and Sarah

Can you be home to monitor her about 5-7 hours after each shot given? That is when it is likely to be the lowest glucose level (nadir).

Lantus builds up in the body. While the first few doses may be OK, later, it may be too much due to the build up and the cat vwill hypo, which can be fatal.

Thanks everyone.
I have given her 2 units last night and this morning. I changed her to wet food last week. So far she is eating it well, although I've noticed she is not a fan of the beef variety. Today she eat breakfast (3oz time of FF) 5am, then I gave her , her insulin. I set her timer on her feeder dish to open at 11am with 1/6 cup of the dry Purina DM for a snack since I'm working. my husband will feed her tonight when he get's off work. I told him not to give her a shot tonight (he is a nurse and is familiar with shots) I want to go through the procedure of getting Molly out from under the bed with him (involves a lot of shutting doors and a vacumn on a stick) and to watch him give the shot.
Iam off tomorrow so I plan to stick her preshot and 6 hours after shot. I will absolutely call my vet is her BG has fallen below the 250s .
I have already stuck the hypoglycemic guidelines on the fridge with my vets and the emergency vets numbers.
I have Karo syrup with some medicine syringes taped to it. I have some of her old dry food for emergencys, but I will get some high carb wet food.
I have a question how much wet food should I be feeding her? I would hate to underfeed her on insulin but I know she needs to lose some weight too. I have been giving her 3oz FF twice per day :?

Hi Lesley,
On the food amounts...
The only way to know, since every cat is different, is to experiment. You can keep with the can at each shot time and check her weight every week, then adjust as needed. There are formulas that calculate the # of calories per day, but ballpark about 20 calories per day per pound of ideal weight. On two cans of FF per day, she'd probably lose a little weight, and that's what you're after, right? Many people feed twice a day, while many others feed multiple small meals more frequently. We just try not to feed them in the two hours or so before we give them shots, because you want that pre-shot test to be free from any "boost" in BG from eating.

If you think this might work, you could try freezing some canned food mixed with a little water, and put a cube in the timed feeder instead of the dry. As it thaws, she can munch on it, and it'll be lower carb than the dry.

Good job on setting up for any crisis with your "hypo" kit and refrigerator "art"

Carl

I like Hilarys advice - the Purina DM dry is too high carb.