This is NOT Bert's 1st day on Lantus-Updated-Advice Needed

Hi All,

Bert is my 8 yr. old tabby cat.
He is a new diabetic and spent the day with his vet yesterday to get him started on Lantus.
I will pick Bert up this morning, but wanted to get some advice from the "pros" before I get him.

What should I ask the vet before I bring Bert home?
I am comfortable taking his BG and giving the shot, I just do not want to screw it up nailbite_smile

I am the kind of person who will need a flip chart of sorts :lol:
Like do BG
Shoot if BG warrants it
Feed him ?? amount of food
retest BG how often??

I am sure I will have many questions and very much appreciate any help you all can give.
I will let you know when my baby is home

 

Re: Bert's 1st day on Lantus

Good morning,Kathy and welcome to LLand!
I'm not comfortable to give You a dosing advice but how much I learned You gonna start with low dose(0.5u) and see how
Bert is gonna respond. Just ask questions and somebody more experienced will stop by to answer.

 

Re: Bert's 1st day on Lantus

Hi Kathy
Welcome to the Lantus forum.

Hope you can check back often on your thread today, it's a little quiet right now, but it will be hopping in here in no time!
Few questions on Bert,
why was he at the vets overnite? Infection? Was he sick for a while?
Any other health issues?
Did your vet already start insulin and what dose?
What is typical schedule like in relation to AM and PM shots?
And what is his current weight?

I'm going to throw some links at you that you will want to check out:
The main health links page from the FDMB, includes Dr Lisa's Feline Nutrition (lots of good info on feline nutrition, the benefits of a low carb diet, the drawbacks of dry food, transition your cat to wet food and Janet & Binky's Food Charts that will help you select a good low carb wet food diet for Bert:
viewforum.php?f=14


You'll want to read the information stickies up above, including this one "New to the Group" which also includes an example of a typical curve:
viewtopic.php?f=9&t=157http://felinediabetes.com/FDMB/viewtopic.php?f=9&t=157

Also, you'll find information on how to post in this forum, every day, each cat gets their own thread(condo), so every morning you would open a new topic, that is your condo for the day. You will need to link the previous days thread, that makes it easier to go back and see what kind of day Bert had.
Each time you have a question or need to update us on Bert, you reply to your last post in that thread, and that thread gets bumped to the top.
Same if someone replies to your thread. So there's no need to open a new topic each time u have a question, just stick to one thread per day. Have a look around at other threads/condos and you will get the idea of how others post.


And lastly, here in Lantus Land, we follow the Tilly Protocol, most vets do not and will start on a higher dose. Here we like to start low and go slow, that way you don't miss Bert's ideal dose.
viewtopic.php?f=9&t=1581
http://www.tillydiabetes.net/en_6_protocol2.htm

As for collecting data, your BG tracking, EDIT TO ADD: you have a spreadsheet!! Awesome!! I just booked that..need more

Here in Lantus Land (LL for short) we encourage spotchecks, whenever you can get them! This will help build up your data and others can see how Bert is doing on Lantus.

It's going to get a bit overwhelming, but take your time! Others will be along thru out the day to offer suggestions and to welcome you!
Hope to see you posting often and we look forward to meeting Bert!

 

Re: Bert's 1st day on Lantus

Good Morning Kathy & Bert and welcome to LL.
You really are in the right place. As Ronnie said, it is a tad quiet now so take the time and read all of the stickies and info here before going to the vet.

Yes it does appear to be overwhelming but the learning curve is very quick.
Never be "afraid" to ask any question here. That is what the board is for. We are all in this together. I am a newbie from Nov, others with more experience will be by soon.

Looking forward to seeing Bert's "condo" tomorrow.

 

Re: Bert's 1st day on Lantus

I have the whole day off to be with my pal, so I will be checking in ALL day long I am sure

Bert was diagnosed around Jan. 11th.
From the day I found out he has been on wet only Wellness, so I am hoping I have the food modification covered. LOL

I will look at the stickies and figure out how to post in here, but thank you for your warm welcome.

 

Re: Bert's 1st day on Lantus

you're posting is fine Kathy!!
And take your time ok? You're doing just fine! cat_pet_icon

 

Re: Bert's 1st day on Lantus

Just stopping in to say hi...Hi! And to welcome you to LLand...the absolute BEST place for you and Bert to get help with his diabetes! :lol:

What insulin and dose are you starting with?? You may not know that yet, but if the vet gives you a dose greater than 1.0u or wants you to shoot only once a day, you may want to question how he/she arrived at the higher number. Lantus use by the vet community is fairly new and a lot of them are still dosing based on weight, which is not correct. ohmygod_smile

Please don't interpret the above as dosing advice as I'm not qualified to do that...it was only meant as a question for the vet if they give you a high starting dose. :?

 

Re: Bert's 1st day on Lantus

Kathy & Bert--Welcome to lantus land!! You will find everything necessary to manage a FD cat here--Someone is always around, 24/7..If your vet gives you info you arent sure of, please come here & ask..The Vast knowledge of this disease & people who are experiencing it every day, is here.
It's great that you are starting out here right away..Bert will be just fine, as Ronnie said, read the stickys above & ask questions..
Bert will be better before you know it!!

 

Re: Bert's 1st day on Lantus

(((Kathy & Bert)))
I remember you from over in Feline Health & commented there too!
I am sooooo excited Bert is in Lantus Land now too... I am a newbie too..
Welcome & ask any questions you have.. we are all here for you both!!

Welcome Home Bert!!! Do you know what his BG #s were at Vets? (will be different at home probably)


:RAHCAT :RAHCAT :RAHCAT :RAHCAT :RAHCAT :RAHCAT

 

Re: Bert's 1st day on Lantus

Welcome Kathy and Bert! He is so cute - your little tabby. It is wonderful that you will be home with his all day today to get used to doing spot checks and starting to record his numbers. I am a newbie from December and agree when Randi said "the learning curve it quick". This message board is amazing and you will get so much information, support, advice etc that you could ever ask for.

I will check in later to see how you both are doing. :mrgreen:

 

Re: Bert's 1st day on Lantus

Welcome Kathy!

I'm not sure where Ronnie saw your spreadsheet (SS). If you've not yet set one up, the instructions for the SS are in the Tech Forum along with how to attach the SS to your signature. It will also be helpful if you complete a Profile on Bert. The latter will provide info on any health issue, what you're feeding, etc. The instructions are also in the Tech Forum.

As Ronnie mentioned, we use the Tight Regulation (Tilly) Protocol to guide dosing decisions. The initial Lantus dose is based on Bert's ideal weight -- the dose is usually in the neighborhood of 1.0u but we'll also need to see what dose your vet started Bert on.

I would not be surprised if your vet suggested that you feed Bert a prescription diet -- either Hill's MD or Purina DM. These aren't the best quality foods and the MD is fairly high in carbs. We encourage that you feed Bert a diet of canned food that is less than 10% carbohydrate (low carb or LC). If you look at the website on feline nutrition by Lisa Pierson, DVM you will find a great deal of information about why we make this recommendation. Janet & Binky's food charts will give you a wide range of choices of canned foods that are under 10% carb and are in a wide range of prices.

It's great that you are comfortable with home testing. That will be very important. It's hard to say whether Bert's numbers will be the same at the vet's as at home. Many cats are stressed at the vet's and their numbers run higher. Likewise, if you have been feeding Bert a dry food diet, the switch to a LC, canned food diet, may have a fairly immediate effect of lowering his blood glucose (BG). This is important to know since you will be starting insulin.

Please ask questions and post daily. We'll do our best to answer and try to lessen the sense of being overwhelmed.

 

Re: Bert's 1st day on Lantus

Hi Kathy and Bert! I want to say welcome, too, and that if you are the kind of person who thrives on flip charts and schedules, you will find heaven here! We have been members only since December 21 and the difference has been amazing. My vet is great and had I listened to him, we would have been on Lantus earlier. I wanted to try Glipizide first. But right now, unless an individual vet is a specialist in this area, it is doubtful he or she will have all the data and collected experience that you will find here. The wonder of it all is that people share so willingly and are there to helo you through the rough or confusing patches.

So hang in and I'm wishing you the best of luck on your Lantus Land Adventure!

 

Re: Bert's 1st day on Lantus

lol! click on her name ("kathy") there's a link there.

Kathy - u will need to add ur SS link to ur signature so we can access it easily.
Tech forum can help u with that. Unless someone here knows right off the bat - real quick and easy how-to, please jump in!

 

Re: Bert's 1st day on Lantus

Hi Kathy and welcome! Once you get into a routine of testing, feeding, shooting, and more testing, you will be amazed how everything becomes second nature to you. Best of all, by keeping a spreadsheet and posting here every day, you'll have lots of experienced people to guide you and others to cheer you on and keep you company. You'll also find that by testing Bert at home, he'll have less stress and you'll get better information on his numbers.

I'm fairly new to all of this myself and had to find a new vet for Mally because her old one didn't even want to put her in insulin. And while my new vet is fantastic and put Mally on lantus, I'm not sure he's totally up-to-date on the dosing protocol. He gave me instructions for her dosage, which was a bit higher than she should have started out with. Rather than go by his instructions, I took the advice of people here and followed protocol by starting her out at a lower dose. The reason I mention this is because, in the beginning, I was hesitant about not following my vet's instructions to the T. However, in the few weeks I've been posting here the advice I received has been right on the mark and the best for Mally.

Good luck to you and Bert and I look forward to seeing your posts each day!!! :smile:

 

Re: Bert's 1st day on Lantus

Hi Kathy! Welcome to you and Bert!

I bet you can't wait to have him back home again....

I am so happy that you are starting right off the bat here in Lantus Land...the people here are
warm and loving and very, very helpful! I hope that you will realize that the beginning is very hard with
all the reading and whatnot. it is all so new and there is much to absorb. NO ONE can do it all in one day.

So, take a deep breath and take it one step at a time.

We are all here to help you and answer any questions as they come up.
Don't buy any food from the vet office today. Tell mthem you will pick it up later or whatever.
Enjoy your boy today and read what you can. the most important thing is that you are here and that you
will have an excellent plan to follow. There is so much experience here on this board....I think you will find comfort
here as I have.... talk to you later!

 

Re: Bert's 1st day on Lantus

OK...so I called and they wanted to keep him till 4:00 when the vet can meet with me and go over everything.
I would of put up more of a fight, but I needed to go into work for a emergency meeting so that worked out OK.

I just can not wait to see my little furry face again.
It has been so quiet here without him :sad:

I will try to figure out how to make my chart show up in my siggy.
I also will figure out how to make a profile for Bert.

I will let you all know when he is in my arms again....I CAN'T WAIT!!!

I have off till Monday now, so I have 3 days to get to know this new life for us.

 

Re: Bert's 1st day on Lantus

I am an idiot ohmygod_smile
I can not figue out how to make a profile or attach our spread sheet to my siggy

 

Re: Bert's 1st day on Lantus

You are not an idiot at all. We were all asking the same questions. :mrgreen: Check out the thread below. It is the tech support group.

Creating spreadsheets and attaching it to signature - http://felinediabetes.com/FDMB/viewtopic.php?f=6&t=16

 

Re: This is NOT Bert's 1st day on Lantus

Tell me what you all think.
I brought him in yesterday in the morning.
They tested him and he was almost 400.
They gave him some Lantus and as the day progresses(tested every 2 hours) his BG went down.

When they tested him this morning before he ate his BG was 76.
2 hours later 93
4 hours out 104
They tested him right before I picked him up and he was 107.

So they sent him home without insulin :?
They said the doctor will call me tomorrow and let me know what he wants to do.
they might just want me to monitor him and watch if it goes high again.

I am so confused....

 

Re: This is NOT Bert's 1st day on Lantus

Kathy: How much did they give him? And was it twice a day?

 

I can understand that you are confused. So would I. :-|
I have no idea, sorry. Some kind of infection that disappeared? Or... ??
Anyway.. I think I would at least keep testing her at home.
I hope some experienced guy's here can answer your question..

 

this has me really wondering how much they shot at the vets, and the fact that he dropped down to 76 this morning.
can u find out how much they gave him?

I would think whatever they gave him is leaving/or has left his system by now, anyone else? thoughts?

 

Re: This is NOT Bert's 1st day on Lantus

They only gave it to him once and they did not tell me how much...I feel so stupid for not asking more questions.
Also and this scares me, I was just cuddling with him and i thought I smelled sort of a medicine kind of breath from him.
It is hard to tell cause he just ate, but it has that medicine smell nailbite_smile

 

I would definitely call the vet and see how much they gave him and how many times. My vet gave my kitty 4U once and by the next morning his BG was still low from the overdose the day before. If you can home test I would test later tonight and in the morning. Maybe the residual insulin will wear off. (this is if they gave him alot). Just my opinion....

 

oh my, this is information, crucial information they should of told u.

easy on yourself Kathy - it isn't your fault by far.

ARG I get so mad with these vets sometimes.

:YMHUG: :YMHUG: :YMHUG: ((Kathy))

 

Yikes, yes you NEED to know how much insulin they gave Bert at the vet's office.

Can you test at home?

 

And Kathy I also forgot to add------it wasn't until I got home from the vet that gave 4 units that I realized NO ONE even showed me how to give the injections, when etc. So DO NOT feel stupid at all. It is not your fault.

 

It does seem unusual! For whatever reason, some cats do have a good response to the first shot. It's after that first shot that numbers go back up because insulin is being used to fill the shed and not just to lower blood glucose. The analogy I can think of is like jumping into a swimming pool. The water feels very cold when you first jump in but within a few minute, it doesn't feel anywhere near as cold. Bert had a big reaction to the cold water.

With his current numbers, I don't think you have data to give a shot if he remains in the low-to-mid 100s. In addition to knowing what the dose was, do you know what time the vet gave the shot. As a reference point for dose, most cats here start on a dose in the neighborhood of 1.0u (give or take).

Just out of curiosity, is your vet very familiar with Lantus? If your vet typically prescribes the shorter acting insulins, the vet may have been looking for numbers to be rising by 4 hours. Lantus' cycle is 12 hours so numbers would, conceivably, still be low at 6 hrs.

I would definitely test this evening and see if and when Bert's number rise.

Is the "medicine breath" more like alcohol or nail polish remover (acetone)? If so, call the vet. Find out what the dose was and if they tested Bert for ketones. That acetone smell is ketones. You could also smell a bit of Lantus that may have been on the syringe from when they gave him a shot. Lantus has a distinctive smell that I can't describe.

If your vet is gone for the day, you can pick up Ketostix at any pharmacy. They are inexpensive ($15?). You stick the reagent end of the stick into Bert's urine stream when he's at the litter box. Wait 15 sec. and the pad at the end will change color if ketones are present. There is a color coded diagram on the side of the bottle for comparison.

 

They gave him 4 UNITS!!!

That is bad...right :sad:

 

@-) yea, thats a lot.

it's ok, it's prob all gone by now - it was yesterday morning right?

 

Yes...yesterday.
Now is that why his breath smells like alcohol?

He just urinated for about 10 minutes when we got home. I think he did not go to much at the vets office
I do not have any strips to test his urine.

Till this vet calls me back tomorrow, should I look for anything that might mean Bert is in trouble?

I am a little sad as I thought we had found a good vet for Bert....

 

Kathy - he will be ok. He is at home with you now and comfortable. The insulin in going to wear off and you will see his numbers rise again. These vets!!! :evil:

 

Kathy said:

Kathy, don't be alarmed ok? but would u be able to test Bert tonight? And go to a pharmacy to pick up a Ketostix box?

 

He may still be a good vet, just not familiar with the Lantus protocols. You will learn everything you need to learn here I promise you. You will find yourself only needing your vet for true emergencies (god willing).

Can you run to the store to get some ketostix? They sell them pretty much anywhere (expecially since there are popular with those people who go on the no carb diets). THey are over the counter. I have seen them at Target, Walgreens, Walmart etc. It would be good to get some of those to test his urine. THat could help ease your mind if you are worried about the smell on his breath. And if you find that he does have high ketones in his urine we can tell you the next step.

Take a deep breath. Everything is overwhelming right now. But you are in good hands here. Have you felt all of the attention and warmth from all of the members here? We have all been in your shoes. Things will get better and you will get to be a pro before you know it. ((((((Kathy)))))

 

I will go get the strips, but how in the world will I get him to pee

 

well, u cant, really...u will just have to monitor him a bit to catch him in the act,
try not to stress, but breath...

 

OK..got the strips.
I will clean out his litter box.
He always likes to be the first on in there after it is cleaned :lol:

 

((((Kathy)))) you'll be ok and so will Bert. I echo what Ronnie said, please go to the pharmacy tonight and get Ketostix. You'll have to try to catch some urine, some people use a soup ladle to reach under them in the litter box, or you can put saran wrap over the litter to catch a puddle, or some cats will even use an empty litter box.

What symptoms led you to take Bert to the vet in the first place? Is he eating ok? Any signs of infection of any kind (urinary, respiratory, dental?).

eta: you're good, I see you already got the strips. :smile:

 

I'm so sorry your vet started you out on the wrong foot...I was afraid that would happen. Anytime I hear a vet keeps the cat for a day or a night for "regulation" I assume they will also OD with insulin. If they don't know you can't regulate overnight with Lantus, then they also don't know you don't dose on weight. ohmygod_smile

You're in good hands here...everything will be fine. :smile:

 

any updates? Did you get a ketone test yet?

 

If, and that's a big if, there are ketones, you want to encourage Bert to drink. You can add water to his food. The canned food is fairly high in water content already. I routinely add water to my cats' food. You can give him chicken broth or the water from canned tuna -- anything that will encourage him to drink. It helps to flush ketones if that's what you're dealing with. If you see any changes in Bert's behavior -- he becomes lethargic, is having trouble walking, or anything you view as his acting ill, you may need to take him to an emergency clinic. Ketones can be serious. But, you don't know if ketones are present so do not panic!

4 units is a lot. Bert did not hypo -- he was being monitored at the vet's office. His numbers are lower than expected due to the amount of insulin. The good news is that his numbers will come up and you can call the vet tomorrow, let him know that the numbers are back in a diabetic range, and ask him to write the prescription for Lantus. (Make sure he writes the Rx for the cartridges, not the vial. Print out the info in the sticky about Lantus if he doesn't know about the cartridges. I have a really good vet and she didn't know it came in cartridges.) When he tells you how much insulin to give Bert, ignore him. You can shoot a dose you are more comfortable with. Having the cartridges will give you at least 5 months of insulin. Since you will be home testing, there will be no need to bring Bert in to the vet's office for them to do a curve. You'll be fine.

 

I am waiting for my cat to pee ;-)

Bert is a funny guy. If a cat could be a private kind of cat, that is Bert :lol:

I follow him around and he is looking at me like I am crazy.
He is still acting hungry and he is drinking when I give him ice water in his favorite glass.
I still think I smell the alcohol breath.
I tried to get a BG on him and I am not sure if it was accurate. I thought I had enough blood and didn't so I had to poke him again and it just seemed to take a long time for the meter to say it had enough blood.

Anywho that read as a 70 BG

He will sleep with us tonight and I will keep an eye on him. I am not done stalking him for his urine yet tonight!!
LOL

The vet has not even given me a script for anything yet, so it is not like I can shoot on my own yet.
Thanks for all the reassurance that it is going to be OK.
I just feel so bad for my guy

 

Kathy
Sorry that you're first posting here was a difficult one.
As everyone said before, Bert will be fine.
You will have a lot of questions to ask the vet when you speak to them. I would want to know
why Bert was given 4u.
Now you can really see what amzing support you get here that no vet can do for us.
Go easy on yourself. Tomorrow is another day.

 

Hi, Kathy, it's...Kathy! (Kathy & Kitty, that is) Just wanted to welcome you to Lantus Land, especially because we had a similar experience when Kitty was first diagnosed.

It took us some time to move from the vet's protocol of one shot per day -- which did NOT work for us! - back down to a low dose twice daily. We went up the scale to find the right dose, and have come down nicely again.

I know how overwhelming "entry" can be. You are doing great. You're testing, and you're HERE, where you'll find all the help you need to get Bert on the road to feeling better.