? 5/24/15 Ratface - Need some advice on dosage

Status
Not open for further replies.
Ron

Ron

Member Since 2014
Good evening everyone!

I'm having trouble regulating my favourite wretched feline and I'm hoping someone could take a look at my spreadsheet to offer me some advice on insulin dosage and schedule.

A couple of weeks ago my 17 year old male cat quit eating. Where he would previously eat three or four cans of food a day, he was now eating maybe 1/2 to 1 can a day. His water consumption also decreased. Our vet told us for a cat his size, he should be drinking about 250 mL (approximately 1 cup) a day. He was averaging around 500 - 750 mL day. When his appetite decreased so did his water consumption and now he is drinking maybe 125 - 150 mL a day. He has been losing weight (not unsurprisingly) and is looking quite thin and emaciated.

After getting some sage advice from many of you, I have changed his food to a different brand (from Fancy Feast Elegant Medley to Friskies Chef Dinner and Chicken Pate), tried using oregano to stimulate his interest in feeding (worked for one meal), tried sprinkling parmessan cheese on his food (no interest in that stuff), searched for baby food without onions (apparently impossible to locate in my area), boiled chicken breast (which he'll eat on occasion) and am in the process of searching for forta flora. He doesn't seem to be in any distress, isn't walking on his hocks and while he occasionally has trouble jumping onto couches he can still claw his way up to his favourite perches (to the dismay of the purchaser of furniture).

Due to these changes I've been testing his blood fairly regularly for the past days and I can't quite get a handle on what is going on with him. For the past several months he has been on 3 units of Lantus twice a day. Once I started getting results from the blood testing (he is weaker than he used to be so it is easier to get testing done), I reduced his dosage after getting some really low numbers. I've been running that for several days now and I'm still getting low numbers, usually around the time of his PM shot. If it seemed his numbers were trending downwards I generally skipped his evening shot (see May 20 and today). If they were dropping and I couldn't be home to keep an eye on him, I skipped the shot (May 21).

I do have an appointment with the vet tomorrow morning and will get basic blood work done on him, have them check for ketones (it's been negative when I've tested with the test sticks/strips) and get a spec fPL done to see if he has pancreatitis. Our vet has been great and has worked with us to try to regulate our cat, but I gather most people just have their pet euthanized if there is a diabetes diagnosis, so in some respects we are both learning how to treat diabetic cats together.

I'm just not sure what kind of dose I should giving. If anyone could take a look at my spreadsheet and provide some advice or thoughts on how to proceed forward with dosing and any other thoughts, it would be greatly appreciated!

Edit: My previous post regarding Ratface can be found here: http://www.felinediabetes.com/FDMB/...-do-i-do-for-the-pm-shot.138186/#post-1424870
 
It looks as though he's nadiring very late in the cycle - of course leaving you with the problem of a number you can't shoot at his PM cycle. And a combination of skipped shots and maybe a bit of bouncing is taking him high by the next morning. It might be that you need to reduce the dose at each shot to let you give him the 2 shots per day to level that out, but I'm not anywhere near experienced enough on dosing to figure out if you need to reduce and, if so, by how much. Hopefully someone will be along soon who can give you some help to work out a dose that you'll be able to give him twice a day and hopefully get his numbers a bit more level between the AM and PM cycles.
 
What I'm seeing is that you're having to skip often due to low Pre-shots which tells me you need to reduce the dose until you find one that you can give every 12 hours

How much does he weigh? The starting dose for Lantus is weight (in Kg) times .25 = dose....so a 10lb cat would be 10 divided by 2.2= 4.545454....take that times .25 and you get a starting dose of 1.136....so you'd start him at 1UNIT and then hold that dose for at least 3 days (Unless he dropped below 50 during those 3 days) and then let's re-evaluate him

If you take him to the vet tomorrow, get a good weight on him while he's there so we can help determine what dose to start over with
 
Last edited:
Chris & China said:
What I'm seeing is that you're having to skip often due to low Pre-shots which tells me you need to reduce the dose until you find one that you can give every 12 hours

How much does he weigh? The starting dose for Lantus is weight (in Kg) times .25 = dose....so a 10lb cat would be 10 divided by 2.2= 4.545454....take that times .25 and you get a starting dose of 1.136....so you'd start him at 1UNIT and then hold that dose for at least 3 days (Unless he dropped below 50 during those 3 days) and then let's re-evaluate him

If you take him to the vet tomorrow, get a good weight on him while he's there so we can help determine what dose to start over with
Click to expand...

He's lost a lot of weight before he was diagnosed and then lost more while we've been trying to zero in his dosage. His top weight was around 5 kg I believe (I'll check the records at the vet tomorrow) and now he is a little under 3.5 kg, which I'll confirm tomorrow. That would work out to a dose of 0.875, I'm assuming it'll be easier to round up to 1 unit since the smallest measurement by syringe that I have is a half unit). He was running 3 units per shot about 2 weeks ago (and he'd been at that dose for months), I dropped him to 2.5 units 5 days ago and then to 1.5 units 3 days ago. How long would it take for the dosage to "stabilize" doing a big drop like that in such a short time frame?

One other question, I've been doing a lot of tests over the last 10 days and I think my cat's ears are getting sensitive/bruised. I'll try to learn the paw test, but that was even less successful the last time I tried it (scritching the cat's ears and face is acceptable, touching his feet... completely unacceptable and likely to earn me a swat.) While waiting for the dose to stabilize, could I reduce the number of tests to say, four a day to give the ears time to heal?
 
No, we'd usually suggest you start at the smaller dose....so .75 or .5 (which is easier to measure until you learn how to eyeball the "in between" doses like .25 and .75

Always safer to start out on a smaller dose and work your way up

On his ears, always press for at least 15 seconds after poking to reduce bruising and if you have some Neosporin Ointment with Pain Relief (again...the ointment only) it can really help heal those pokey spots quickly
 
Also, would you add that you're using Lantus into your signature line? Makes it easier for new people to have one place to glance and get routine information.

If you know his diagnosis date, that's another good piece of info to add to your signature line

If you look at my signature line, any of that info that you could add will be helpful
 
I would try 1.0 or .75U units now. The formula quoted above is for newly diagnosed cats, but we do have some data on Ratface on Lantus so we don't have to go back to the beginning. We do doses by .25U increases/decreases, but do that by eyeballing it. There are also some pictures of those types of doses in the New to the Group Sticky post. Since you have skipped two nights in a row, it will help drain the Lantus depot and help stabilize the dose.

Again, since you are in Canada, you can't get Neosporin with pain relief here. Try using some Polysporin Complete, it's the black and gold box. Just put a dab on the ear after the poke and it'll help heal things up. The pressure after poking really helps with the bruising.

For Fortiflora, your vet may sell it, or you can try Amazon.ca
 
Chris is "sort of" correct about dose. The information she provided is accurate if your cat is recently diagnosed and has not been using Lantus or Lev -- it's the first insulin you're using. When a cat has been on insulin, the dosage of the current insulin should to be taken into account.

Ratface was on Caninsulin and switched to Lantus. I'm presuming from the information you provided, you and your vet decreased the dose to some degree with beginning Lantus.

For a cat that's a year past diagnosis, the pre-shot numbers aren't that low. If you look at many of the subject lines or our spreadsheets, you'll see that unless you're new to FD, most of us will shoot low numbers. It takes some getting used to and some time to build up your confidence. Again, what you'll see on spreadsheets is that by shooting lower numbers you don't get precipitous drops -- often this results in flat cycles.

It's possible that Ratface is eating and drinking less because he's getting better regulated. Often cats will have huge appetites when their numbers are routinely high because the glucose resulting from food being metabolized isn't reaching the cells -- it's floating around in the bold stream. Another consideration is that with Ratface's numbers bouncing around, some cats just don't feel great when this happens.

I hope you have a good vet visit.
 
I took him in to see the vet this morning and am getting a full round of blood work done (and having them do a Spec fPL), I should get the results back on Wednesday (maybe tomorrow if I'm lucky) so I'll post the results then. I did manage to get my hands on some fortiflora and he ate nearly a third of a can of food, so hopefully that will help with the non-eating issue. Vet loved the spreadsheet and said he looked good. He' s put on a little weight (from 3.45 kg to 3.5 kg over the last 4 weeks) so that is good news. I've reduced his dose down to 1 unit and plan on giving him his shot tonight unless his levels are very low. Since I can be around to monitor him, would it be safe to give him his shot if he were under 4 mmol/L (72)?

Thanks again for all your help everyone!
 
Ron said:
Since I can be around to monitor him, would it be safe to give him his shot if he were under 4 mmol/L (72)?
Click to expand...
That's really up to you. If you can monitor, have everything on hand to deal with low numbers if they happen, and are confident you can bring his numbers back up with carbs/honey/karo if necessary then you can shoot low to stay low. At the same time, no-one's going to try and force you to shoot a low number if you don't feel confident about handling it.
 
Great news that he loves the FortiFlora.:) Many people here sprinkle a little on to get their kitty to eat. It's also good news that his weight is steady.

As for shooting lower numbers, we encourage people to post here for help, the first time they test a see a number below 8.3 (150) at shot time. Above 150 you are probably fine going ahead and shooting. Below 8.3, the answer whether you are fine to shoot depends on which method you are using to determine dosing. We have two here. One is the Tight Regulation (TR) Protocol and the other is the Start Low Go Slow (SLGS). Give them a read and see which one might be best for your situation. Given the amount of testing you do, you could use either one.
 
Status
Not open for further replies.
Back
Top