Newly Diagnosed Kitty

I have an older cat that I recently rescued. He was trapped at a local feral site and brought to me when the ladies doing the trapping found that he is friendly. When he came to me, he had a serious upper respiratory infection and was on antibiotic injections (PEN G) for 7 days. He seemed to be doing better but then he started vomiting and lost weight. I took him back to the Vet who diagnosed Diabetes. I was told to put him on a low carb, canned food only diet. It took him a couple of days to really eat the canned food. The Vet had me start checking his glucose numbers ( I use a One Touch Ultra for humans) and give him two units of Lantus insulin if he was over 200. His first number was 411. I gave him the insulin. I tested again about 12 hours later and he was at 43. I did not give him any insulin but I did feed him. I tested him 6 hours later and his glucose was at 20. I fed him again. I tested him about 1.5 hours later and his glucose was at 37 so it appeared it was on his way back up. He was asking for food so I gave him a small amount. I tested him 8 hours later and his glucose was at 245. As today is Sunday, I was worried that if I gave him the full dosage, he would drop too much so I only gave him 1 unit. I will test again in about an hour as I have been reading that Lantus insulin is at its peak 6-8 hours after injecting.

Am I the right track or is there something else I should be doing?

Monica

 

So I just tested again and his blood glucose is back down to 42. Was 1 unit too much insulin?

 

Do you have any gravied food to feed him? I would try that until some of the other more experienced come along, also do you have any Karo syrup on board? If he gets to low you will have to rub some on his gums.
It is also possible he can be what they called diet controlled, by feeding low carb food which is what you seem to be doing.
I will ask for some help from the Lantus board as I really can not give dosing help.

Terri

 

Yes 1 unit might be too much although I am concerned he dropped to 20 without the insulin? is that right?. I am asking some experienced members to come look. How is he doing now?

When is your next shot due? Please test and give us the numbers before you shoot. They will likely have you reduce dose. Also how many strips do you have in the house?

 

How long ago did you give the shot?
How much time after that did you get the 42?

 

Monica:

You don't want your kitty's glucose levels to drop below 50. Numbers in the 40s give you very little margin for error and numbers below 40 are dangerous. With low numbers such as these, you need to be monitoring often and giving your cat high carb food to bring the numbers into a safer range.

Here are instructions for handling low numbers.

I suspect the change to a low carb, canned food diet is bringing your cat's numbers into a better range. Lantus peak (or nadir) varies with every cat and it can vary from cycle to cycle. My cat typically has an early nadir (3 - 4 hours after her shot) except for those times when she doesn't.

 

I tested him 6 hours after feeding him which is when I got the 42. He is due for his next shot @7:30 PST. I will test him before I give him more insulin.
I have Karo syrup and high carb food but he was not showing any symptoms other than he was hungry. Now that he is eating again, he is always hungry. He seems like he is doing ok. No signs of lethargy or wobbling. I just tested him again and he is at 58. I have not fed him yet tonight.

Monica

 

Hi Monica,

Was it also 6 hours after the shot?
Are you feeding just twice a day at shot time or does he eat several times a day? Not sure if someone has already asked that or not. But you can feed multiple times a day if you choose to. You just don't want him eating in the two hour period leading up to his shot times. It's best if the test at shot time is "free from food".

 

Please post your number before you shoot, so we can advise. We don't want another scary low.

 

I was testing him before I gave him the insulin I would feed him after the injection. Should I wait to feed?

 

So I tested him and he is 58. I have not fed him yet but this is his normal time to eat. I have been giving him three small meals a day. Morning, early evening and the night time before I go to bed. I always test him first.

Monica

 

Ok hold off on feeding and wait 30minutes and test again, we want to see where he is going. Dont shoot yet. Please come back here and post. I am getting some dosing experinced members over here but i suspect they will tell you to skip this shot since he is so low.

 

No, that sequence is fine. There's no set "rule" but most people will test, then feed, and shoot the insulin either while kitty has his face in his food, or right after he's finished eating. After you do this for a while, you can do the whole sequence in 5 minutes easy.

The exception to that would be if you test and get a lower number. At first, we recommend "no shot" if you get a reading below 200. At least until you have been doing this for a while and have a good idea of what to expect from a given dose. If that should happen, what we suggest is that you don't feed yet, and "stall" for 30 minutes. Then test again to see if the number has come up over 200 on it's own. If so, then you can feed, then give the shot once he's eaten.

 

Wow, and right after I type that, you see it!

58 is way too low for a shot.

Because you don't have a great deal of data to go on, I would say that you should skip the shot tonight. But see if anyone else has any suggestions first.

 

Hi Monica. Welcome.
If it is now 11 hours since you last gave a shot and he is at 58, then skip the shot tonight.
Tomorrow, you may want to start over at something like 1/2 unit, and see how he does.
Always make sure you have lots of test strips and cans of high carb gravy food handy for just in case.
Post to keep us updated so we can help you, and test often especially if he is below 100.
We will help you to help your kitty.

 

Thank you all! I tested him again and he is still 58 so I gave him a about 2 ounces as he was really bugging me for food. No shot tonight and I will test him again later to see what changes.

 

Welcome to the boards, Monica! ZOIKES on the 20! I'm glad you were testing and are posting here - whew! It sounds like he has had quite a tough time lately, but you're getting him back on the right track. What is your kitty's name?

 

.

 

Diabetic cats are usually quite hungry because they cannot use the glucose from the food they digest. Essentially, the cat is starving. It would be OK to feed a bit more maybe 3-4 oz per meal. When he starts getting regulated, he'll start leaving food and you can reduce what you feed.

Check my signature link Secondary Monitoring Tools for some other helpful methods of assessing him.

 

Welcome and great job on handling the hypo!

Was this diagnosis based on a Fructosamine test? How long has it been since he's been off the meds? I'm wondering if maybe he's a transient diabetic and once the infection cleared up and the steroids left his system (and he was switched to wet, low carb food), his BG levels started returning to normal.... (The higher, diabetic numbers might even be caused from bouncing.) :?:

 

Thank you everyone for your help. The kitty's name is Oggie. Not sure how old he is, the Vet just said old. His BG was 355 this morning. I gave him .5 units of Lantus. This afternoon his BG level was 95. I just gave him about 3 ounces of food and will check again tonight when his next dose is due.

R,
Monica

 

Sounds like a nice curve today. You might be dealing with a low preshot tonite so if you see under 200 dont shoot, dont feed and come back here with the reading so someone can coach you what to do.

meanwhile can you set up a spreadsheet? I will help you track trends, us watch you and you can also show your vet. Heres how : http://www.felinediabetes.com/FDMB/viewtopic.php?f=6&t=18207

 

Hi. I tested Oggie and his BG was 119. I fed him 2 1/2 hours ago. I think no insulin tonight?

R, Monica

 

I wouldn't. You don't have enough data to know how he will behave and we don't want another low number. However we need to get you set up With a spreadsheet so we can start to know his patterns.

Also maybe get a test in a couple of hours .. Will be interesting to see where he goes from here without the insulin.

Do your syringes have half unit markings?

 

My syringes do have half unit markings. I am working on the spreadsheet and will share later tonight.

R, Monica

 

Ok great. Now don't get stressed if/when you see a high number tomorrow morning. Give him the same dose as today and He should come down again. Edited to add.. Unless he is under 200 then don't feed don't shoot and post here again for advice. Also I have asked some more experienced people to come over and confirm dose.

Looking forward to seeing the sheet. Let us know if you need help

Wendy

 

How much does he weigh? Starting dose for lantus, for the tight regulation protocol many of us use, is .25u/kg of ideal weight. If he is underweight, then it would be .25u/kg.

However, given all the changes made lately, I am wondering if it might be better to take him down to .25u so you can safely shoot twice a day. Then we could see how he does. Numbers can get wonky when you are only able to shoot once a day.

The SS would help immensely so thank you for working on it.

 

Here is the link to the spreadsheet.
https://docs.google.com/spreadsheet/ccc ... sp=sharing

Just tested him this evening and he is 284. He only had .5 this morning. His next dose is due in 2 hours Should I wait to feed until his next dose time? He is really hungry or at least he tells me he is. ;-)

R, Monica

 

.

 

Oggie weighs 6 lbs. He is very underweight though. He should weigh more like 10 as he is a big boy.

R, Monica

 

Well once he is regulated he should start to put weight back on. Did you get a before bed test tonite? Would be good to see how this dose is sitting on him.

Also have you chosen a protocol? We have two..

Regulation Protocol – get him regulated fast - more aggressive method.http://felinediabetes.com/FDMB/viewtopic.php?f=9&t=1581

SLGS – Start Low go Slow – slow and steady towards regulation.(relaxed) http://binkyspage.tripod.com/SLGS.html

Both have forums here that you can post on for dosing questions

Let us know on the test and what you think or if you have questions on the protocols...
Wendy

 

I did not do another BG reading last night. Fell asleep watching TV. Here is an updated spreadsheet. https://docs.google.com/spreadsheet/ccc ... sp=sharing

His BG was at 300 this morning. Gave .75 and tonight his BG is 119.
I put him on a very low carb diet as recommended by my Vet. His numbers appear to be going down even when he does not get the insulin.

R, Monica

 

Thanks for the links! I found them very helpful. It aslo helps explain what the Vet was talking to me about. I think she was recommending the tightly regulated protocol as she had me take him off all dry food. I give him only canned food with no carb type additives. Sort of like the Feline Atkins diet. I think she got the insulin dosage wrong though. He survived his initial low numbers though and I think we are now on the right track.


R, Monica

 

Maybe not, it takes a few days for an insulin dose to settle, you should let it sit a week at one dose before increasing. I would have held the 0.5 units for a couple more days.. Especially since his number was low tonite. I now worry about him dropping too low overnight, please get a test in ASAP and let us know how it is. When did you feed?

You will probably want to keep an eye on him tonite with more testing. We also don't recommend newbies shoot under 200 without lots of data.

Wendy

EDITED TO ADD: sorry, did u shoot tonite or no?

 

No I did not shoot last night. I was told not to give him insulin if he was under 150. I forgot to add that I test him two more times last
night and he was holding at 79.


R, Monica

 

Those numbers are really encouraging!

Is he eating and drinking OK? Playing/Purring? Preening/grooming himself? Output - pee and poo - normal?

 

I don't really know what normal is for Oggie. He was on a downward spiral when I got him. He is always hungry and very vocal. His poo is normal, but he still drinks and pees a lot. He is very affectionate and easy to work with, likes a good cuddle. He does not play but he is old. He ignores the other cats. He has just begun grooming himself so his coat is somewhat ragged but it is starting to shine a little. He is no longer dehydrated. He purrs when I stick his ear, he purrs when I inject him, he purrs when he relaxes next to me.

R, Monica

 

Tried to buy syringes with the 1/2 mark at my local pharmacy. What fun. They were not very nice and I think they lied to me. Enough complaining!

I want to order the U100 .3cc syringes with 1/2 mark but I am not sure what to order.


R, Monica

 

I updated the spreadsheet with todays numbers. https://docs.google.com/spreadsheet/ccc ... sp=sharing

He started the day at 194 so I gave .25. 12 hours later he is at 119. I am not sure if this is good or not.

R, Monica

 

Walmart carries the 3/10 cc U-100 syringes with 1/2 unit markings. ReliOn is the name behind the pharmacy. Double check them but you used to have to ask for the 1/2 unit ones but seems they all come that way now...at least in the 3/10 cc ones. I usually buy 3 boxes at a time.

 

That is wonderful - look how easily he gets between 50 and 150. The more he does that without needing insulin, the more diet controlled he is.

 

Would be nice to find a dose she could give twice a day though.. Should she keep the current dose for a few more days to let it settle, or decrease it so she can give a dose more consistently?. Thoughts..

 

Looking at the data so far what I observe & think is
1) 0.25 seems safe - he doesn't go too low at this point
2) if we set the no shoot level to 150 ( top end of normal for a diabetic) and go with 0.25 it may work
3) this kitty may go off the juice, so monitoring for hypo, even at this low of a dose, is important
OR he'll settle into the dose and it'll be right for him

 

Monica - can you add the spreadsheet link to your signature?

Also can I invite you over to the tight regulation forum to get some more eyes on you? http://felinediabetes.com/FDMB/viewforum.php?f=9

There we like people to post often so the members can keep an eye on both of you and advise dose.

Wendy

 

Oggie was a little higher this morning at 229 but he seemed to remain steady at around 100. I will test again tonight before bed. He certainly has more energy today. He did not want me to poke his ear for the blood test. He came and jumped on my lap and chased off my cat Inky. Nice to see him feeling better.

I added a link to Oggie's spreadsheet to my signature as requested.

I was able to find the 1/2 unit marked syringes online. I hate shopping at Walmart and will do anything to avoid them. The test strips for the OneTouch Ultra are expensive! I borrowed it from a diabetic friend so I am going to buy my own and return hers.

I will check out the tight regulation forum and post there also.

Thank you all for your support.

R, Monica

 

When you post there make sure you put "new here" or "new member" or somwthing in your subject so people can welcome you. No maybe go with a ? Icon to ask what they think of your dose etc

If you decide to post daily you do it like this

Subject : 3/29 oggie AMPS xxxx +3 XXXX - put your readings in your subject
Content: a brief update on how oggie is doing, as well as questions etc.


Wendy