newbie - need dosage help

Hello,
I have a 9 year old male cat - Fax. He was diagnosed as diabetic last spring which we controlled through food and 4 units of Lantus twice daily with little issues. In October of last year he went into remission and on vet's orders was taken off of insulin.
Fast forward to last month - we moved house and since then his levels have been out of control. He was put back on Lantus May 2 - 2 units twice daily. I do home testing (originally using Alpha Trak but now have moved to OneTouch Ultra human meter). Since May 2 he has been increased 1 unit at a time up to current dosage of 5 units (all on vet's direction).

The problem is that I cannot get his levels under control.

Here are numbers from the OneTouch from yesterday and today (these are similar to what we have been seeing since problems have started again)

preshot: 8:30 am -- 342 - 5 units
8:54 am -- 298.8
12:10 pm-- 307.8
3:55 pm -- 397.8
preshot: 6:51 pm -- 441 5 units
10:25 pm -- 370.8

TODAY:

preshot: 8:30 am - 340.2 5 units
9:05 am - 387
9:45 am - 381.6
10:45 am - 327.8

I have had suggestions from the main board that I may be giving too high of a dose. How can this be determined? He had his urine tested for infection and ketones - the tests came back fine but showed some trace white blood cells so he has done a round of anti-biotics.

Thank you

ROisin

I can almost guarantee that the dosing experts here are going to say he's on too much insulin, but you'll need to follow their instructions about what to do about it. Just keep checking back here and I know one will be on soon to help you out and give you lots of info. Welcome to Lantus Land. You'll be soo glad you found this place, trust me!!

Replies from the main message board are telling me that the M/D prescription food from the vet is not a good thing to be feeding. I am going to start the switch over to a lower carb high protein food such as EVO 95%. Does this sound reasonable?

THank you

Whatever you do, DO NOT change food until you have advice from the dosing experts here. The food you're feeding is bad, but you're giving such a high dose of insulin, the food may be the only thing keeping your kitty from going into hypoglycemia. Just continue as you have been until you get instructions from Sienne, Libby, Jill or one of the others with a lot of knowledge. The BGs Fax has now are high, but not dangerously high, so please don't worry!!

I am going to start the switch over to a lower carb high protein food such as EVO 95%. Does this sound reasonable?

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Is this a dry food? Canned food is a WAY better choice just in case no one has mentioned that (although I bet you've heard it. )

I will have to go read your other posts to learn more about what is going on. From the numbers and dose you wrote about here, I can't say whether that is an over dose or not. I just see numbers in the 300s.

Oh, I almost forgot! WELCOME! We are happy that you found this website and I'm sure you will learn a whole lot of good stuff here.
The sticky notes near the top of the page are really helpful. I know there is a ton of information and it will seem overwhelming. Start with the one called "NEW TO THE GROUP."
Read a little and ask questions about it as you go along. There are lots of good people willing to help out.

Whatever you do, DO NOT change food until you have advice from the dosing experts here. The food you're feeding is bad, but you're giving such a high dose of insulin, the food may be the only thing keeping your kitty from going into hypoglycemia.

Click to expand...

Good point. The reason Patty warned about this is because if you suddenly switch to a low carbohydrate food the insulin dose might be too much. Insulin 'handles' the carbohydrates in a body and if suddenly there are less carbs... that much insulin might take the blood glucose too low.

Usually we start with a much lower dose and work our way up to more insulin as needed.
As Patty said, those 300s aren't dangerously high at this point so wait until we all learn more about your kitty and what is going on before making any big changes in diet. Easing into things is better for your kitty.

No, we will definitely be keeping him strictly on wet food.

Welcome to LL!

Here is the link to your previous thread on Health...it will help everyone get up to speed quickly, and we won't have to ask the same questions again.

Health thread


First, I would strongly encourage you to read the stickies at the top of the forum, starting with the New to the Group sticky and the Tight Regulation Protocol sticky. There is a lot of important information there about how the insulin works, the protocol we use here, as well as how this group works and how to get the most benefit from both the group and the insulin. The other stickies are also very important, but start with those two....we know there's a lot to absorb, so please ask any questions you might have.

The dose that you started at is fairly high, most cats start out with a dose somewhere in the area of 1.0u. By starting at a high dose, and increasing by full units, it's very easy to miss the right dose....so it is quite possible that Fax is over dose. However, there ARE cats that need that much insulin (or more), so it's premature to assume that the dose is too high. This is a very data driven group, the only way for anyone here to assess the dose and give an opinion is for you to provide as much testing data as possible...the last couple of days is a good start, but it isn't enough. Do you have any other data? If not, will you be able to monitor closely for the next few days to gather some data?

While we don't want to see your cat over dose, we also don't want to reduce the dose drastically if he DOES need that much insulin....and then have you waste time working back up to a good dose, so getting data FIRST is my suggestion.

For diet....I see you are in Canada...there are a lot of Canadian members here who can help you with good choices for food. Here is a link to Jan & Binky's list of Non US foods, that may be helpful too. I use the EVO 95% foods, they are a good choice if available to you. But please don't change the diet yet, ok? With that much insulin, the food may be protecting him from hypo right now.

Does Fax have any other health issues? Any history of ketones? Is he taking any other medications? How long ago did he finish the ABs?

One thing I noticed right away is that it looks like you are not shooting on a 12/12 schedule. It's important to shoot as close to every 12 hours as you can. An early shot is like a dose increase, a late shot is like a decrease. Lantus is a depot type insulin, so consistency in dose and timing is important. If you are shooting at odd times all the time, it will lead to wonky numbers.

First posts
I see that on the Health forum that you understand about gradually changing the food along with lowering the dose. The flat numbers in the 300s could be too much insulin ... or it may be too little. So far you haven't caught any low numbers but it may happen. Glad you are testing a lot.

Glad you are feeding canned/wet food. Others have told you that the M/D is about 14% calories from carbohydrates and that is still higher than most diabetic kitties need. I always stay below 10% and usually it is around 5% calories from carbohydrates.

Wellness is a very good food, I see you used that at one time. Evo 95% is good. I use Fancy Feast classics since that is what my kitty likes to eat. He didn't like Wellness... silly boy.

edit: Laurie is a faster typist. :lol: Lots of good stuff in her post.

Thanks Laurie,
I will look at those stickies. I tried to start a spread sheet but it tells me that it can't be loaded right now.

I have other data but it is more random testing whenever we could during the day. Because it was easy to get Fax under control last spring when he was diagnosed we weren't aware that random testing isn't good enough. Since our move in mid-april any tests have given comparable numbers to those posted on this forum. I will keep testing at high frequency over the next few days to get more data for everyone.

He doesn't have a history of any other health problems (other than infected punctures from the odd fight over the years). He finished the antibiotics three days ago.

I won't change anything with his food until enough data has been taken for someone to give me the go ahead. Thank goodness for finding this site - everyone here is already more helpful and supportive then the vet clinic.

We were told that the shots need to be 'close' to 12 hours apart. That an hour or two doesn't make a difference. Obviously, another poor piece of advice. So frustrating.

Fax is usually very hungry by 6:30 pm - that is when the get dinner. Does he need to eat when he gets his dosage or can I just give it to him at the 12 hour mark (which would fall after dinner)

I would post any data that you have, even if you think it won't be helpful. It may not help, but you never know how revealing that random data can be. ;-) Just be sure to give us some idea of when in the cycle it was taken (eg. 6 hours after shot, etc.) If that's not possible, then collecting data starting now is fine.

Regarding feeding and shot time....you don't want to feed within the 2 hours before shot time, it will affect your preshot (PS) tests. Would it be possible to move your morning shot earlier?

fax said:

We were told that the shots need to be 'close' to 12 hours apart. That an hour or two doesn't make a difference. Obviously, another poor piece of advice. So frustrating.

Fax is usually very hungry by 6:30 pm - that is when the get dinner. Does he need to eat when he gets his dosage or can I just give it to him at the 12 hour mark (which would fall after dinner)

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Lantus is an insulin that needs to be on a strict 12/12 schedule...your wiggle room is only going to be about 15 minutes either way.

With Lantus, you should always Test-->Feed-->Shoot. I used to shoot Bandit while he was eating--as long as there's food in Fax's belly, its safe to shoot.

Here is our random data starting the day that he was back on insulin 2units.
The first chunk of numbers are with the Alpha Trak meter. I had to switch because the strips are on back order til June sometime - not acceptable!

May 6 9am: 363 (1 hour after dose) 2pm: 361.8 12:25 am : 383.4 (5.5 hours after dose)
2 units

May 8 6:30pm: 316.8 (preshot)
2 units

May 11 8pm: 536.4
2 units

May 12 8am: 361.8 11:30am: 370.8 (3.5 hours after dose) 10:30 pm: 316.8 (4 hours after dose)
2 units

May 13 9:30am: 424.8 (1.5 hr. after dose)
3 units

May 14 10:30am: 327.6 (2.5 hours after dose)
3 units

May 15 11:10am: 370.8 (3 hrs. after dose) 10:10pm: 403.2 (3 hrs after dose)
3 units

May 16 11:10am: 334.8 (3hrs after dose) 10:30pm: 408.6 (3 hrs after dose)
4 units

May 17 11:30am: 307.8 (3 hrs after dose)
4 units

May 18 11:25am: 284.4 (3 hrs after dose)
4 units

May 19 11:30am: 376.2 (3 hrs after dose)
4units
_____________________________________________________________________________________________________________________________
switch to OneTouch Ultra

May 20 12pm: 288 (4 hrs after dose) 1:15pm: 302.4
4 units

May 21 11:45am: 354.6 (3.5 hrs after dose) 10:55pm: 396 (4 hrs after dose)
5units

May 22 11am: 370.8 (3 hrs after dose) 12pm: 361.8 10:47pm: 433.8 (4 hrs after dose)
5units

May 23 8:30am -preshot: 342 8:54am:298.8 12:10pm: 307.8 3:55pm 397.8 6:51pm-preshot: 441 10:25pm: 370.5
5units

May 24 8:30am-preshot: 340.2 9:05am: 387 9:45am: 381.6 10:45am:327.6 12:30pm: 271.8
5 units

2:30 pm: 246.6

you're getting good help and advice from experts, so i'll just add a welcome! we'll all pitch in and help you with whatever we know. it's a great community.

i did have similar vet experience and have realized i can't be too hard on my vet. too many of them don't hardly deal with diabetes in cats and they don't really understand how lantus works. you're most important numbers are 1) pre shot - which tells you if it's safe to inject insulin and 2) mid-cycle, which tells you what fax's numbers are when they are lowest. just fyi, i didn't understand at first that the nadir (lowest point) can vary even from day to day in one cat. it hits most cats, most of the time around the middle (+6 hours after shot) but it changes. moving target just to keep your life interesting! that mid-cycle point tells the experts what needs to happen to fax's dose.

anyway, i think nearly all of us base our dosing decisions from help here, not from our vets. some understand lantus, but most don't. the people here do feline diabetes & lantus 24/7 - they get it. and every week since i've been here (end of february) i've seen cats go off of insulin because of the help here. you can trust these strangers off the internet, as against logic as that is.

so much to absorb, but we're all happy to answer questions to help you understand and help fax. glad to have you here!

Thanks to everyone for their advice and support thus far. I have been getting more and more worried about Fax along with more and more frustrated with my vet. It is a HUGE relief to have found this knowledge base - and like you say Julie - it goes against logic to trust strangers but - this feels right.

we all take our kitties to vets - they all seem to have plenty of issues to keep our vets busy and in business! ;-) but my vet has made so many mistakes, he just asks me what i'm going to do next with the dose. i'm trying to educate him so that the next diabetic cat gets better care. he's a good vet, just not with this.

I'm very glad that Laurie, CD and several other of the members here have been able to chime in. I'm at work and don't have all of my info at my fingertips. At this point, looking at the starred, sticky notes will help to get you started -- and probably cause you to feel a bit overwhelmed. There's a lot of info to absorb at the outset. Like CD suggested, the New to the Group and the Tight Regulation stickies are a good place to start. I think you will see several differences from what you've been doing: we start at a lower dose than your vet started Fax, we give Lantus on a 12 hour schedule (and being an hour or two late/early does make a difference -- an early shot is like a dose increase and a late shot is like a dose reduction), and we usually increase doses in 0.25u amounts -- not whole units.

We are very data driven here. Once Google decides to cooperate, having a spreadsheet will let you see at a glance how Fax is doing. It's also something we are very used to looking at and the color coding helps to see the trends. You may want to look at several of our spreadsheets so you can see how a variety of people test and how we adjust dose.

A quick question -- You said you are switching to Evo 95%. Were you feeding dry food previously? If you were feeding dry, be careful and test a lot if switching to canned food. Even a lower carb dry food can raise numbers and numbers will drop when you transition to low carb canned. Keeping Fax safe is paramount.

My prior vet was a wonderful, knowledgeable vet--but she still got Bandit's dosing wrong. She knew a lot, but not everything. When I changed vets, I brought the new vet a copy of the Lantus dosing protocol here. Good vets will want to learn along with you. In my opinion, the only bad vet is one that refuses to change their practice despite being presented evidence to the contrary.

Sienne and Gabby said:

A quick question -- You said you are switching to Evo 95%. Were you feeding dry food previously? If you were feeding dry, be careful and test a lot if switching to canned food. Even a lower carb dry food can raise numbers and numbers will drop when you transition to low carb canned. Keeping Fax safe is paramount.

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Sienne, he went from W/D canned (26%) to M/D canned currently (14%).

Hi again,

Google decided to cooperate and I have filled in a spreadsheet starting the day insulin was re-introduced to Fax. I have noted on there that the first chunk of readings were done on an Alpha Trak meter and the last 5 days on a OneTouch Ultra meter.

Abby and I just wanted to drop by and say hello! There truly is a ton of knowledge here on these boards and everyone wants nothing but the best for you and your cat. Abby is one of those cats that because of this board went into remission within 3 weeks when she was first diagnosed. She was in remission nearly 3 years until hyperT recently brought her out again. We're now back here and found everyone just as helpful as they've always been! It's a great support system for those inevitable nights where you just aren't quite sure what to do...we've ALL been there!

Again, welcome!

fax said:

Hi again,

Google decided to cooperate and I have filled in a spreadsheet starting the day insulin was re-introduced to Fax. I have noted on there that the first chunk of readings were done on an Alpha Trak meter and the last 5 days on a OneTouch Ultra meter.

Click to expand...

Excellent, thank you for getting that up so quickly!

A couple of other suggestions....if you are going to feed at 6:30pm, then test and shoot at 8:30pm, can you make a note about that on the SS so everyone will be aware of that? It will skew your PMPS tests, so it's important to know that they will be food influenced. If you want to try to avoid that, you could give him a small snack at 6:30...a few pieces of boiled chicken breast, or a tsp of food...just to hold him over until 8:30pm shot time. Or, as I suggested before, you could move his morning shot to 6:30am, and keep the 6:30pm shot time. There's more than one way to do things...what do you think?

The other thing is that even though you are not dropping the dose, it is still important to get ketone tests regularly. Ketone testing is one of those things like regular checkups...an ounce of prevention is worth a pound of cure. You want to know right away if there are ketones in the picture....if you catch it early, you may be able to deal with it at home or with a vet visit. If not, it could turn into an expensive, life threatening emergency....so test often for ketones for now.

I think what I will do for today is give a small snack at 6:30 and then test, feed and shoot at 8:15. Then over the next few days gradually move things so he is getting done at 7:30 am and pm.
Any suggestions for getting a ketone test with a cat that is hard to catch in the litter? He also goes outside now and then so I would never be able to catch him out there. Love it that my vet told me to get diastix and not ketostix. Looks like another shopping trip for me. When he was first diagnosed last year I was only able to get one diastix test done, and that was a stroke of luck I think!

If anyone has any suggestions on when and how I can start changing over his food to something more appropriate (I am thinking EVO95%) without putting his system into shock it would be greatly appreciated.

Welcome. I am also in Ontario.

To get a urine sample for ketone testing:
1) Stick a ladle underneath while he is going
2) Put some aquarium gravel or other small stones in an empty litter box or
3) Cover the litter box with a plastic bag and let him pee on top of the bag

I use Fancy Feast pate foods: Turkey and Giblets (green label), Chicken Feast (red label), and Liver and Chicken (yellow label). The Evo should also be fine, bit probably more expensive.

You have certainly found the best place for you and Fax.. I wanted to welcome you also..Your in excellent hands and have some wonderful ladies advising you already..Nice job getting the SS up so quickly..
I hope you have a wonderful evening!

Fax looks much like your guy photosquirrel!