Edwin dosing questions, new diagnosis

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bsmith

bsmith

Member Since 2015
I just started Edwin on Lantus last night. He's 10 lbs and received 1 unit. The vet wanted me to do two 1 unit shots per day.

His preshot reading last night (ReliOn confirm) was 203. +5 reading was 59, at which time I gave him some canned food he really likes to get him to eat. (I've also read all the hypo information and have karo syrup on hand.)

This morning his reading was 149, so no shot. I'm sure glad I'm testing. The vet suggested going to a single 1 unit shot per day, but others here have suggested going to 0.5 units. I'm also going to start +2 and +6 testing, as suggested by others here, in addition to the preshot testing.

Any thoughts about 1 unit versus 0.5 units? Also, his food situation is complicated by stage 2 kidney failure.

He's acting happy and normal so far today and was acting normal last night too. I have an introduction post up at http://www.felinediabetes.com/FDMB/threads/hello-from-edwin-first-lantus-shot-tonight.132396/ with more information.
 
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You will want to split the dose in half (.5u) and give it twice a day.

To help explain why: the problem with giving only one shot a day with any insulin in cats is that cats metabolize it too fast so, in theory, that would be like a human getting insulin only every other day.

Add to that, the depot effect of insulins like Lantus and Levemir and once daily dosing will basically make the depot useless (you might as well use an in-and-out insulin instead) and it will be harder to see how the insulin is actually working.
 
For CKD and diabetes, I know a lot of people feed the Friskies Special Diet Pates because they're both low in carb and low in phosphorus. Recent studies have come out that it's the phosphorus levels you need to worry about and not the protein levels. In fact, cutting back on protein leads to muscle loss. I think someone already provided you with a link to Tanya's CRF page? He's a link directly to the page where she covers diet.
 
Thanks for the links. I emailed my vet with your information about doing the 0.5u dose twice a day. That idea makes more sense to me too. Also, given that his last BG was 149 mg/dL ~12 hours after his shot, what should I wait for his BG to get to before resuming insulin?
 
Although I don't have the experience to advise on the dosage I think I would go for the 0.5 unit twice a day as suggested by others to start with and work up from there if necessary . That way you will still provide good coverage but Edwin shouldn't drop as low. It is great that you are testing him.

I don't know about how long to wait. I guess until he gets to over 200. Or maybe you just miss this dose altogether? Hopefully others will chime in. He doesn't have a history of ketones does he? I see that you were shooting at midnight and midday. Maybe you could use this to move it to another time if it would work better for you.
 
We recommend for new members whose cats just started insulin or who may have just started testing to hold off on shots for numbers below 200 and to stall and see if it's a rising number and post here first for advice. Once you've gotten more data on how he reacts to the insulin, then this "no shot" limit can be gradually lowered.
 
There has been no history of ketones. Although, his initial BG reading at the vet was 400 (stress? different scaling? blood draw rather than ear prick?). Last night he was at 203, which is why I went ahead with the shot. At 149 today, I knew for sure to hold off. I'm just wondering now how far above 200 I should be before restarting insulin?

I'm a bit of a night owl, and my sleep has been extra funky lately, which is why I tend to be testing later and gave the dose later. If need be I'll see how much I can shuffle my schedule. Edwin and I tend to keep similar schedules anyways. Plus, it's probably better for him if I do the ear pricks when fully awake. The shots I could do half asleep, but for time being I want to be awake to monitor him afterwords. Since its been suggested I test at +6 also, I'll probably move shot time earlier. If his BG doesn't go up by this evening we'll probably just skip today and consult with the vet again tomorrow.

Still looking for an answer to how far above 200 I should be before resuming insulin.
 
We use 200 because it is generally a "safe" cutoff. If you're going to be around to monitor, I would suggest giving just .5u, whether it's 203 again or 253.

If his BG is still lower than 200 tonight after the skipped shot from this morning, then you might very well be looking at a kitty who is trying hard to go into remission.
 
Okay, Mr. Edwin has apparently decided he doesn't want to be diabetic anymore. Test tonight was 183. My vet said to give him the shot no matter what the number was, but that just seems plain goofy to me. I'm not giving him a shot. Any dissenting advice about skipping this shot too?

We'll see what tomorrow's number says and maybe double check at the vet that my meter is not just way off. I'll also order the control solution for the meter, but that won't get here for awhile. When I tested myself last night I was 66 after a long nap and not eating much all day (however, I've had blood sugar strangeness in the past). I just tested my mother and she is 110, 4 hours after eating. She's perfectly normal and has no blood sugar issues so the meter seems to be performing fine. Do you know if they'll check your meter at the Walmart pharmacy?
 
Yep, no shot tonight. Did you also change diet recently? Any chance he might have had an infection of some sort or a steroid shot?
 
Same diet as always (same for about 3 years). Only other meds are Adequan and Tramadol. No infection that I can tell, eating fine, eliminating fine, no watery eyes or sneezing or coughing. Urinalysis and blood tests a week and a half ago showed no infection. Acting happy and normal. Even his hair pulling seems to have stopped. I'm confused too. Maybe the special Bach flower treatment mix I started giving him last week is magic? Beats me, but I'm not complaining.

Also is there some issue with the spreadsheet template? As far as I can tell it's zero bytes. No data.
 
Actually, come to think of it, the only the I've done differently in the past few days was change the yogurt in his Tramadol mix back from vanilla to plain. Could 2 ml a day of yogurt with some added sugar make that much of a difference?

Just calculated it. The difference between vanilla and plain yogurt for 2 ml/day is only about 0.17 g of sugar/day. Pretty small. Of course the cat is small too.
 
I've read recently that just one or two bits of kibble can cause the blood glucose level to go by over 100 points so I am going to say yes I think it cat here is a thread in the technical section about spreadsheet problems.
 
Evening PS 152, so no shot since we're still begining and don't have enough data yet. I'd try to do 0.25 u, but it's just not possible to measure that. Does any one know of needles that go smaller than 3/10 cc? Any other suggestions? I guess for now I'll just stick with 0.5 u once per day. How much data should I collect before even considering dropping the Lantus shot limit to 150?

The spreadsheet template is still showing 0 bytes. Am I the only one having this issue?
 
I think for now, even though it's not standard, just keep doing what you're doing and only give shots when he's over 200. It really seems he has a sputtering pancreas that is helping keep his numbers down (a great sign that remission might be in your future), but it's also preventing you from being able to give shots BID (twice daily).

There are no smaller syringes or smaller increments besides .5u markings. Do your current syringes have the .5u markings or are you having to eyeball it? If they do have .5u markings, then it's easier to get that syringe halfway between the 0 and the .5u for a .25u dose.

The key is not accuracy, but consistency. As long as you consistently have the same volume for each shot, it doesn't have to be exactly .25. Some people use dosing calipers, some people count drops, some people use a ruler, some people use a comparison syringe with colored water to help them keep the dose consistent from shot to shot (and all of these also help to counteract any line discrepancies on the syringe itself). I use a combination of all the above, depending on what dose Mikey is at. Play with it for a bit and figure out which method is easiest in helping you draw up the correct dose every time.
 
And I'm not seeing your link to a spreadsheet. Is that what you mean is 0 bytes or are you trying to still create a spreadsheet?
 
I do have syringes with the half unit markings. I guess I'll get out my magnifying glass and see if I can eyeball a 0.25 u dose. That and counting drops might be my best bet. I'll also give the colored water comparison syringe a try if I think I can regularly get a 0.25 u dose. I'll look up dosing calipers. I have regular calipers, but I am unfamiliar with dosing calipers. (Just looked it up, dosing calipers and regular calipers are the same thing. I'll go find my digital pair. I'll bet that's easier than counting drops.)

For the zero byte spreadsheet sheet, I mean that when I go to download the spreadsheet template the file says it contains zero bytes. There is nothing in the template file at all. No template information or formatting to start from, just an empty file. I'm wondering if others are having this issue too or if it's just me and I need to try to download it from somewhere other than my tablet. I posted this issue in the tech forum too.

Thanks for all the good ideas. This forum has been incredibly helpful.
 
bsmith said:
Evening PS 152, so no shot since we're still begining and don't have enough data yet. I'd try to do 0.25 u, but it's just not possible to measure that. Does any one know of needles that go smaller than 3/10 cc? .... How much data should I collect before even considering dropping the Lantus shot limit to 150?...
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We eyeball 0.25 units; no retail syringes measure that minutely. You'd need an autoclave for the research/lab syringes that do.
If you have a couple of nadir period values which show the lowest is above 150 mg/dL, start by dropping your no shot limit to 175 mg/dL (9.7 mmol/L) on a human glucometer.

Just checking: You need to have a Google Drive Account and be logged in.
You download the file to your device/computer; then you immediately upload to your Google account. Do not enter data on your local device/computer.

Understanding the spreadsheet/grid:

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)
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.

It is merely a grid for storing the info; no math required.
 
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Last night's PS 152 (so no shot), this morning's PS 281! Gave 0.5 u Lantus. 281 is way higher than anything I've gotten before. I think his pancreas took the night off.

Figured out the spreadsheet issue too. On a mobile device make sure to use the desktop version of the Google docs website, not the mobile version of the website.
 
+3 test down to 170. Good to see as 281 was higher than I've ever tested him. Spreadsheet figured out and posted in signature. The spreadsheet sheet instructions are a bit different if doing it from an iPad. I can post them in tech if anyone is interested.
 
Ohh, my goofy cat. AMPS 281, 0.5 u Lantus,+3 170, +6 88. PMPS 317 and gave 0.5 u Lantus. Where are these high numbers coming from all of a sudden? No changes to diet unless this is the change from 1/4 can of Friskies (chicken and ocean white fish with cheese) to Friskies (ocean white fish with cheese), which I changed to last night. However, there was no spike after feeding last night. Prefood BG 105, fed 1 hour later, prefood +6 152. Tonight prefood BG 88, fed then, prefood +6 317.

So confused. His pancreas is acting like the alternator I once had in my car, which was only "alternately" bad. It would act up until I took it into the shop and then it would work and test just fine.

Here's the real question. Going down to 0.25 u is obviously out of the question now. However, should I try going back up to 1 u, from 0.5 u, when his BG tests this high? The only thing that I worry about is how reactive he is to the Lantus. When I previously gave 1 u, I had to not dose for an entire day and a half before his BG rebounded enough to safely dose again. Also, today he went from a PS of 281 to 88 at +6 after giving 0.5 u.

Any suggestions? Any other changes that I should be looking for (he's eating, drinking, eliminating, and acting normally)? Have you seen this type of behavior in other cats?

Thanks
 
It could be the seafood spiking BGs. IIRC, @MommaOfMuse has a kitty that can't do seafood for that very reason.

No, hold the .5u for a minimum of 5 days/10 cycles. You've been having to skip shots up till now so the depot hasn't had time to build. Because of this, you won't see the full effect of the dose for 5-7 days initially.
 
In fact, if you get a BG under 50 at any point, you will want to decrease the dose further to .25u. That 88 today is a lovely nadir.
 
I've been wondering about him and fish lately. In the past few months he's seemed less into it. The canned food that was associated with the lower numbers had fish too, but less of it. I'll try a canned food with no fish tomorrow and see if that helps. I had not heard of fish spiking BG before. Very good to know. If this is what it is, some other kitties will be getting a nice donation of canned food with fish.
 
AMPS back down to 161, so no shot again. Last night he only ate half of the ocean whitefish and after KPassa's good insight I took the rest of it away. We'll go with no fish tonight and see what that does.
 
Got rid of the ocean white fish with cheese and Edwin's numbers dropped dramatically. Gave 0.5 u Lantus last night, but no Lantus today as his numbers were not high enough. Also, I just noticed that the Friskies beef and liver dinner with cheese, which I started after stopping the fish, has fish as its 5th ingredient. That must be what makes it "dinner." I'm going to have to start reading the fine print on the labels.

At least he didn't really eat his canned food tonight. He ate it last night and afterwords his numbers were high enough for a shot. Tonight he just licked it a bit and took a bite or two. He's eating his dry food fine, but sometimes he's just not into certain wet foods after the first night. This isn't unusual.

Let's go to the canned food stock. Okay, three cans without fish and one of them is the shredded type he doesn't seem to like lately. Well, I was going to switch him over to Friskies special diet canned for his kidneys, as suggested by others here, anyways. I guess I'm just going to do that sooner than I thought.

I'll go give him some Friskies mixed grill and see if he'll go for that. Any other food suggestions for no fish canned foods for cats with kidney issues?
 
Also, I just noticed that fish meal is the 8th ingredient in the Hill's dry k/d. I may have to talk to the vet about this after seeing how his BG numbers react after feeding canned food with no fish for a few days.
 
My Mikey is allergic to red meats and I only feed them seafood once in a while so I created this sorted food list from the Catinfo.org list and separated out the protein types in separate tabs: foods that contain "red meats," poultry only, and foods that contain seafood. It might help you get started on narrowing down the options.
 
BJM said:
Mixed Grill runs about 11% calories from carbohydrate.
By the way, having a CRF cat doesn't automatically mean you must feed a prescription diet. Pop over to Tanya's Feline CRF website and cross check the food list there with the one at Cat Info for foods that meet the low phosphorus, low carb criteria.
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Wow, that's a lot of info to sort through. The one good thing about the dry k/d is that Edwin really likes it. It is pretty high in carbs though. With the mixed grill, I was just going with what I had on hand at the moment. Trying to avoid fish is tricky as they sometimes slip it in when it's not expected, like in the beef and liver with cheese. It's also 1/4 can. The majority of what he is eating is the k/d.

Thanks to all who have sent links and other ideas.

Just looked at his test results and it looks like mixed grill may be spiking him a bit, but maybe not. When I look at his food I gave it to him at AMPS+6, PMPS up to 226, but when I look at the food at PMPS +2 almost none is gone. It's licked at bit and maybe 1/4 - 1/3 gone. Hmmmm... Befuddling. Still can't get him on a schedule where I can dose twice a day even though I've gone down to 0.25 u at a time.
 
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Another no insulin day. AMPS 137, AMPS +6 159, PMPS 161. I've been through the food list and hope to talk to the vet and then be able to go out to get the foods that qualify as low carb/low phosphorus/no fish. Hopefully Edwin will eat them.

I'm not sure how my vet will feel about me wanting to take Edwin off Hill k/d. I'm thinking of changing to Hill Senior 11+ Indoor Age Defying. Slightly higher phosphorus % (0.60 [senior indoor] vs 0.50[k/d]), but lower carbs % (30.7 vs 44) and higher protien % (35.2 vs 27.8), and no fish. (Except for fish oil. Does that make a difference?) The dry food data is taken from Tanya's felinecrf.org page. (Please note that there is a Hill Senior 11+ Indoor Age Defying and a Hill Senior 11+ Age Defying listed there.) I'm still sorting through canned foods.

Any opinions on the dry food change? Is it a good trade off - slightly higher phosphorus for lower carb and no fish? I'm hoping, given his trend towards days where his BG is too low for insulin, that a diet change may make the difference.
 
BJM said:
Young Again is developing/has developed a low carb "senior" dry food with fewer of the problematic minerals. You might check them out.
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Thanks. I checked out their website, but it does not seem that they are offering that product yet. Thanks also for all the links and information you've sent my way. You've been very helpful in sorting through all this new (to me) cat health information.
 
I have been communicating with a Young Again rep, and she says the the Senior formula will hopefully be available next week. I received a sample of it. My cat initially went at it, but now he is not so interested. He's just been extra picky lately, so who knows? You should contact them to get a sample.
 
ursa68 said:
I have been communicating with a Young Again rep, and she says the the Senior formula will hopefully be available next week. I received a sample of it. My cat initially went at it, but now he is not so interested. He's just been extra picky lately, so who knows? You should contact them to get a sample.
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Thanks for the heads up. I'll contact them about a sample. It's good to know it will be available so soon. Do you know if it contains fish?
 
You should be able to ask them directly; just tell them your cat is "allergic" to seafood and they should be able to help. From everyone who has contacted Young Again directly, I've only heard fantastic things about their customer support.
 
No, they didn't send me an ingredient list, only the nutrient composition. They have been very helpful every time I've contacted them.
 
KPassa said:
You should be able to ask them directly; just tell them your cat is "allergic" to seafood and they should be able to help. From everyone who has contacted Young Again directly, I've only heard fantastic things about their customer support.
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ursa68 said:
No, they didn't send me an ingredient list, only the nutrient composition. They have been very helpful every time I've contacted them.
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In the nutrient composition did they give the % of phosphorus? Edwin is in stage 2 kidney failure already, so that's important. Do you know of any good review sites that look at YA? I've been googling about a bit.

I'll give YA a call tomorrow. I'm trying to figure out what the price difference will be between YA and Hill k/d. YA says an 8 lb bag lasts a month to a month and a half. The k/d 8.5 lb bag lasts 2 months or so (I think). I always seem to have vet receipts about, but they all seem to have mysteriously vanished. I bet Edwin took them. Always blame the cat. I'll have to call the vet and get them to look at their records.

(Edwin' sister Irene, who passed, used to love to shred paper. I didn't need to buy an actual shredder. I'd just put the papers into a specific box and she'd take care of them for me. Worked well, except for that one time my cat really did eat my homework.)

Edwin continues to not really want to be diabetic. No shots at all yesterday, today's AMPS 258 (gave 0.25 u), tonight's PMPS 149. I'm really hoping that some food changes might sort this out. Even if the YA food is pricier, it would still be cheaper than 10 ml Lantus vials, needles, and test strips. Plus, it's way less work. I'm all for the lazier option if it works.
 
The YA Mature has .58-.65 of Phosphorus in the dry matter analysis. My Colby is showing signs of early renal failure, as well, so I've been looking for foods w/ the lower phosphorus. I hope this works for you. I think I might be able to get Colby to eat it as an alternative, but he will always crave the high carb kibble that the other kitties get. Poor guy.

I'm attaching the file for the YA analysis. I hope it works!
 

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ursa68 said:
The YA Mature has .58-.65 of Phosphorus in the dry matter analysis. My Colby is showing signs of early renal failure, as well, so I've been looking for foods w/ the lower phosphorus. I hope this works for you. I think I might be able to get Colby to eat it as an alternative, but he will always crave the high carb kibble that the other kitties get. Poor guy.

I'm attaching the file for the YA analysis. I hope it works!
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It works. Thanks! I'm wondering if I should try a food that is lower in carbs than his current k/d before trying to take him down to "zero" carbs. Maybe that would make the transition easier. However, if there is no fish in this, still haven't called, I might just get a sample and see if he goes for it.
 
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I emailed them just now to ask about the fish, in case you don't get a chance to call. I've been communicating with one of their salespeople, Jen.

That's funny about your shredding cats. My sister has a cat who chews on everything! She has to wrap all of the electrical cords in thick plastic. He also ruined a book collection when he was staying at someone else's house--chewed all the corners.
 
ursa68 said:
I emailed them just now to ask about the fish, in case you don't get a chance to call. I've been communicating with one of their salespeople, Jen.

That's funny about your shredding cats. My sister has a cat who chews on everything! She has to wrap all of the electrical cords in thick plastic. He also ruined a book collection when he was staying at someone else's house--chewed all the corners.
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Thanks for emailing. I was out all afternoon. I finally got some canned food that meets the low phosphorus/low carb/no fish specifications.

As far as the shredding, I have a very expensive leather bound book whose corners are all missing. Mmmm... leather. At least my cat stayed away from electrical cords. We had a friend's dog locked in the garage for a bit, while we went out briefly, and he chewed through all the live wires by the garage door. Didn't bother the dog a bit, but he wasn't a terribly smart dog to begin with.
 
Finally got Edwin started on friskies special diet low carb no fish canned a week ago. Tonight started mixing in Hill's science diet senior 11+ indoor age defying in with his regular Hill's k/d. His numbers tonight have been through the roof. Way higher than ever before.

PMPS 355
0.25 u Lantus
PMPS +2 411
Must have been fur shot another 0.25 u Lantus
PMPS +4 349
PMPS +6 344 (edited post to add PMPS +6, 2 fur shots? 2?)

What in the world is going on? He's acting fine, so at least there's that. Is this a reaction to the new dry food? I started switching him to the new food because it's lower in carbs, but still very low in phosphorus for his kidney failure issues. The age defying doesn't have fish, but does have fish oil. The k/d has actual fish meal as an ingredient.

Is there an issue going on also with the Friskies special diet beef and chicken entree? His numbers have been higher the past four days I've been feeding it. No fish there. Some other ingredient? Has his pancreas decided to go on vacation? I'd think about upping his dose, but sometimes 0.25 u drops his numbers like a rock.

And what's with all the fur shots I've been giving all of a sudden? I even gave one with his Adequan the other week. At least with 0.2 ml you know immediately that you missed, as the meds go geysering all over.
 
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Might depend on the glycemic index of the carbohydrate source(s). Some carbs are more easily digestible than others and can shoot up the glucose quickly; others are a bit slower.
 
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