? [Help] Jai Jai - The Vet has suggested 1 unit of Lantus

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I want to let you know that I have just tested him before feeding him, he is now 504 (28.0 mmol/L):eek::eek::eek:
 
Hi Hollis. :)

Jai Jai's numbers are high - that could be due to the missed dose (fur shot) yesterday. That's the tricky part of using a depot insulin. It can take time for changes in dosing to manifest in a cat's BG numbers.

Based on his history of SEVERE hypos, if Jai Jai were my cat, I would not risk giving him the 1.0 IU dose of Lantus. It might be OK for one or two cycles, but then it might take him WAY too low again. Doses of 1.0IU and higher have taken him way too low time and time again.

This is just my reading of his numbers. I am a tad concerned about the 'black' numbers. I am going to see if anyone else with a lot of experience is on the Lantus board at the moment.


In the meantime can you confirm whether Jai Jai has ever shown any history of ketones? And does he have any sign of illness or infection other than his diabetes at the moment.

(FWIW - vets do sometimes get things wrong. One time in particular my gut told me to reduce a dose but I checked with my vets - and as vets go they're quite switched on to feline diabetes compared to some others we read about here - and they advised me to hold the dose I was giving. Reluctantly I followed their advice and my cat had a SEVERE hypo that cycle - if I had not been home testing she would have died overnight. Consequently I am super-super cautious with my cat and with others' cats here. Since then I have liaised with my vet about Saoirse's insulin treatment but whenever I have been in doubt I use Saoirse's numbers and the Tight Regulation Protocol guidelines to make her dosing decisions. The choice has served us well and she never had another hypo.)

Be right back ...

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Critter Mom said:
In the meantime can you confirm whether Jai Jai has ever shown any history of ketones? And does he have any sign of illness or infection other than his diabetes at the moment.
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Fortunately, he does not have the history of ketones. I test him regularly by dipsticks. We have just tested and the result is still negative. My goodness!!

He was test pancreatitis and urine culture several times but the results were negative as well.
 
I agree...I'd stick with the .5 for a total of 6 cycles and try to get as many tests in as you can (I understand he's not a cooperative patient)

If after 6 cycles at .5U, he's not getting into green numbers at nadir, we'd go up to .75 and hold again for 6 cycles
 
I told my hubby your views and he finally agrees with the dose of 0.5 units. He said it is a collective wisdom, so we do it.:cat:

I will try getting his +5 or +6 figure tonight, keep my fingers crossed.

BTW, can you teach me how to tag people?
 
Hi Hollis,

Chris & China said:
If after 6 cycles at .5U, he's not getting into green numbers at nadir, we'd go up to .75 and hold again for 6 cycles
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This is exactly the approach that I would take. In line with the published Tight Regulation (TR) Protocol, the idea is to try to keep a cat's numbers running on a fairly smooth curve using Lantus. It may be that the numbers are a little higher than we would like at first but it is much more straightforward to home in on a really good dose if the cat's BG is not wildly swinging (as Jai Jai's has). Running for the 6 cycles on 0.5 IU will help Jai Jai's liver to calm down (it has been working overtime to output glucose to protect Jai Jai from those way-too-low numbers in the last number of days on those doses of 1.0 IU or higher).

If after 6 cycles Jai Jai's numbers aren't in the TR desired target regulation range, then a small dose adjustment is made up to 0.75 IU. A further 6 cycles on this dose will allow Jai Jai's body to get used to the additional insulin and then we review his numbers again to see if this is the optimum dose.

Making dosing changes that are too big - and in Jai Jai's case 0.5 IU is most definitely way too big - is likely to produce the bouncing and swinging that you have seen to date with Jai Jai's numbers. On a 'good' dose of Lantus, his daily curves should be a lot smoother and flatter.


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I agree with the .5 as well. Aine, sorry I didn't respond, was reading over the thread.

A couple of things come to mind. 1) I don't see if you ever said whether Jai Jai drinks water on his own?
2) "Draining the vein?" You aren't even checking the vein when you prick his ear, but rather the capillaries. And unless the vet is checking his ears to do her tests, I don't understand that concern at all.
3) Is the 18 on 7/25 accurate?? If so, you definitely don't want to be giving 1 unit.
4) Lantus works best at a consistent dose AM and PM. So the .5u in the morning, and then 1u in the evening is allow the depot the drain during the day, which I believe could explain the higher PM numbers.

I would stick with the .5 for a few more cycles, then if his numbers are staying high, maybe increase to .75 rather than 1u, which was obviously too high before.

Tag people, you put a @ then with no space, start typing their name. For example, mine would be "@Shiloh and Rhonda."
 
Aftermath of last evening's fur shot, I sniff his fur endlessly to confirm if I did inject the dose........
 
I second the 0.5U. The hypos that were occurring on the higher dose were very dangerous and severe. I don't think that your vets advice was 100% wrong (ie. identifying food as a factor), but she didn't take in the whole picture and look at the numbers and that's dangerous.

I have questions regarding the food that you are feeding. Does the can say how many calories are in each can? Do you know the carb %. Also, has your cat been losing weight? I say this because sometimes these swings can be an indicator of not enough calorie/nutrient intake. Some cats don't actually absorb all the nutrients available in the food, so they need more than a normal cat. With the ultra-low carb foods there isn't those extra carbs that are quicker to absorb. Sometimes it helps to feed a medium cab food ~8% for a while until the blood sugar evens out, then slowly and cautiously reintroduce the low carb.
 
Hi, Rhonda. I have already shot 0.5 units and I will try getting his numbers at +5 or +6. Thank you for your advice:)

Shiloh & Rhonda said:
1) I don't see if you ever said whether Jai Jai drinks water on his own?
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He rarely drank water in the last three weeks, because he was given saline solution daily (the first week is 100ml, then 50ml for the following two weeks). But, I saw him drank water twice today. He drank a lot in fact. The first time was after vomiting, the second time was after the evening meal. We added 30ml of water to his meal bowl, he should not be very thirsty after eating the whole portion.

Shiloh & Rhonda said:
2) "Draining the vein?" You aren't even checking the vein when you prick his ear, but rather the capillaries. And unless the vet is checking his ears to do her tests, I don't understand that concern at all.
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It is a straight translation from what she said this morning (we are not native, I think you know that, my English writing tells you about this). Perhaps it does not accurately interpret her words. She aimed to ask me not to test so many times.

Shiloh & Rhonda said:
3) Is the 18 on 7/25 accurate?? If so, you definitely don't want to be giving 1 unit.
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I once read that Johnson & Johnson's OneTouch Ultra is quite accurate in low readings. Actually, I tested him a lot more than the records in the spreadsheet, there were times the meter showed "LOW"......according to the manual, it is below 1.1 mmol/L (<18 mg/l).
 
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Meya14 said:
I second the 0.5U. The hypos that were occurring on the higher dose were very dangerous and severe. I don't think that your vets advice was 100% wrong (ie. identifying food as a factor), but she didn't take in the whole picture and look at the numbers and that's dangerous.

I have questions regarding the food that you are feeding. Does the can say how many calories are in each can? Do you know the carb %. Also, has your cat been losing weight? I say this because sometimes these swings can be an indicator of not enough calorie/nutrient intake. Some cats don't actually absorb all the nutrients available in the food, so they need more than a normal cat. With the ultra-low carb foods there isn't those extra carbs that are quicker to absorb. Sometimes it helps to feed a medium cab food ~8% for a while until the blood sugar evens out, then slowly and cautiously reintroduce the low carb.
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This link provides the information of the canned food I feed Jai Jai. The manufacturer does not tell the calories....From the Nutritional Analysis of Chicken Breast, it tells that:

Analytical Constituents

Crude Protein 16%, Crude Oils & Fats 2%, Crude Ash 1.5%, Crude Fibres 0.1%, Moisture 80%. Nutritional Additives per 100g: Vitamin A 2800 IU, Vitamin D3 29 IU. Trace elements: Zinc 12mg, Iron 6mg, Manganese 1.4mg, Copper 0.6mg, Iodine 0.2mg, Taurine 0.

Nutritional Supplements

Per 100g: Vitamin A 2800IU, Vitamin D3 29 IU. Trace elements: Zinc 12mg, Iron 6mg, Manganese 1.4g, Copper 0.6mg, Iodine 0.2mg, Taurine 0.5g.

I also feed him Tuna, the nutritional analysis shows that:

Analytical Constituents

Crude Protein 16%, Crude Oils & Fats 2%, Crude Ash 1.5%, Crude Fibres 0.1%, Moisture 80%. Nutritional Additives per 100g: Vitamin A 2800 IU, Vitamin D3 29 IU. Trace elements: Zinc 12mg, Iron 6mg, Manganese 1.4mg, Copper 0.6mg, Iodine 0.2mg, Taurine 0.

Nutritional Supplements

Per 100g: Vitamin A 2800 IU, Vitamin D3 29 IU. Trace elements: Zinc 12mg, Iron 6mg, Manganese 1.4mg, Copper 0.6mg, Iodine 0.2mg, Taurine 0.5g.

Mineral g/100g Dry Matter Tuna Fillet
Calcium 0.90
Phosphorus 0.85
Ca/P ratio 1:1
Potassium 0.60
Sodium 0.74

He weighted 4.3kg last week (4.1 was his previous weight), he is now 4.2. So, yes, he has lost some weight.
 
Meya14 said:
Another question: Has your cat been on any other medications in the last 6 months?
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Yes, the previous vet prescribed mirtazapine to stimulate his appetite......later the vet prescribed anti-biotics (clavamox) for suspected UTI......stopped the med at the 10th cycle when the urine culture result is -ve.
 
heyhollis said:
Actually, I tested him a lot more than the records in the spreadsheet, there were times the meter showed "LOW"......according to the manual, it is below 1.1 mmol/L (<18 mg/l).
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If you had listened to your vet and not tested as much, Jai Jai might not still be here. You saved his life by testing, catching the lows and giving him food to bring his numbers back up. You made the right decisions. Don't doubt that.

I concur with Rhonda's comments about testing. You are using a lancet to sample capillary blood, not venous blood. All of us may accidentally poke the vein now and again (especially when we're learning to test :oops:), but on an ongoing basis overall ear testing doesn't involve the vein at all. Swapping ears at each test helps their healing, as does appling a bit of firm (but not hard) pressure on the ear for a short while after testing (helps prevent bruising).

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So based on the percentages, for a 5.5oz (156g) can of the foods you are feeding is as follows:

25g protein = 100
3g fat = 21
——————————
121 calories per 5.5oz can

I based it on the larger sized cans, although I'm not sure what amount they come in. How much are you currently feeding? I ask because 121 calories for 5.5oz is not very calorie dense, and if she is having appetite issues as well, she might not be getting enough calories and that may be why you are having trouble regulating her.
 
heyhollis said:
Yes, the previous vet prescribed mirtazapine to stimulate his appetite......later the vet prescribed anti-biotics (clavamox) for suspected UTI......stopped the med at the 10th cycle when the urine culture result is -ve.
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Has she ever been on steroids for anything?
 
Critter Mom said:
You are using a lancet to sample capillary blood, not venous blood.
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SERIOUSLY??? The vet assistants taught us to hit his vein!!!!!! They said that the lancet pen (28G needle) was too thin to get the blood.........they gave us some 23G needle which I was so scared of using them. I do not use the lancet pen, and I just use the lancet to hit his vein. OMG, I WILL NOT hit his vein anymore.........

I have to be very light hand every time I prick his ear. I remember the first time I made him bled out some big drops made me cry...............
 
Meya14 said:
So based on the percentages, for a 5.5oz (156g) can of the foods you are feeding is as follows:

25g protein = 100
3g fat = 21
——————————
121 calories per 5.5oz can

I based it on the larger sized cans, although I'm not sure what amount they come in. How much are you currently feeding? I ask because 121 calories for 5.5oz is not very calorie dense, and if she is having appetite issues as well, she might not be getting enough calories and that may be why you are having trouble regulating her.
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I give him 6oz a day......132 only???? I give only half of the portion to my other cats, they do not show any sign of weight loss:eek:
 
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It's not usually going to do any long term damage to hit on the vein, but you end up with a lot more blood than you need, and the capillary blood is actually more accurate for the meter. You aim just to the outside of where you see the vein instead of on the vein itself.
 
Yeah most cats need between 200 and 300 calories a day, diabetic cats need more than normal cats of the same size. I would think 132 isn't enough. If she is eating well, you could try 2 cans a day for her. If not eating well, then I would switch to a more calorie dense food, maybe a medium carb food. When she is eating more, you might have to eventually increase the insulin, but that has to be done safely, not like the vet was recommending.

http://www.wsava.org/sites/default/files/Calorie requirements simple cat.pdf
 
Meya14 said:
It's not usually going to do any long term damage to hit on the vein, but you end up with a lot more blood than you need, and the capillary blood is actually more accurate for the meter. You aim just to the outside of where you see the vein instead of on the vein itself.
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OK, can I not aim at the sweet spot? It is such a small area that makes my job even harder to get his blood. He always shakes his head and starts his revenge on my hands.
 
heyhollis said:
My hubby suggested that we follow the vet's prescription. He thinks that we should trust her profession. If otherwise, we should not take Jai Jai to the consultation. The vet's argument was that Jai Jai now had bigger meals and his figures were rising during the days on 0.5 units.

I will type in the amount of food Jai Jai at in the spreadsheet to let you to get to know more about Jai Jai's diet and dosage for the past month.

Please trust that I take your points, but we are also concerned if his numbers are unstable, he will be feeling unwell and develop other associated health problems.
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Hollis, no offence taken and your hubby makes a good point about trusting the profession. In fairness to all vets, they have so much they need to know about (and compared to a human doctor, they need to know it for many, many species). There is a link to a scholarly article on dosing Lantus in cats you can read and perhaps take to your vet - I can tell you are careful to research and get great benefits from facts so this may prove useful. It talks about reducing doses based on low BG mid-cycle results and the benefits of home testing, among other things. I am hoping that it can keep peace between you and your vet, and also give you peace of mind.

I know you have already taken the advice of the folks here but I wanted to say your dedication to Jai Jai and concern for getting him well is commendable.
 
If it's any comfort to you, our main vet has a diabetic cat of his own that he has been treating for over a decade and he thanked me for giving him tips on testing recently (and he's a terrific vet with diabetic patients - very switched on).

If you've been poking poor Jai Jai's vein, it may explain why he's not so enamoured of having his ears pricked. If you start using the sweet spot, it will probably be a better experience for him and therefore for you, too. :)

The 28 gauge lancets are exactly what you need to use, BTW.


EDITED TO ADD:

I have witnessed vet techs trying to test Saoirse. It was a real palavor and she was really scared. They had an awful job getting a blood sample from her and her ears were a mess after it.

Now I freehand the pokes - it's much easier to get closer to the edge of the ear that way. Saoirse purrs throughout the whole procedure, and it only takes about a minute or two. (I get the test station all set up before I place her there so she doesn't have time to get restless.)
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ear veins.jpg
 
Meya14 said:
Yeah most cats need between 200 and 300 calories a day, diabetic cats need more than normal cats of the same size. I would think 132 isn't enough. If she is eating well, you could try 2 cans a day for her. If not eating well, then I would switch to a more calorie dense food, maybe a medium carb food. When she is eating more, you might have to eventually increase the insulin, but that has to be done safely, not like the vet was recommending.

http://www.wsava.org/sites/default/files/Calorie requirements simple cat.pdf
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Thrive Complete has got only 1 size (75g or 2.5oz per can). It suggests giving 2 to 3 cans per day. Now, we know that he should be given more food, should I increase the portion gradually?

Jai Jai is super picky about his food. He does not eat any pate type......we bought a lot of different brands, tastes, but they are now stocked up at my kitchen.....
 
heyhollis said:
... we bought a lot of different brands, tastes, but they are now stocked up at my kitchen.....
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Now that sounds v-e-r-y familiar ... ;)


If there are any flavours that he shows even a passing interest in, hang onto a few cans of those. You may not be able to feed them day to day, but sometimes when his appetite is on the blink a food he ate before but wasn't wild about at the time may just tickle his taste buds enough to help you get something into him, even if it's only one meal (any food is important in an emergency).
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Unless your cat is the type to "scarf and barf" or overeat to the point of vomiting, then there isn't really a reason to increase the feedings gradually. 4.2kg is on the low side of average for weights, but this depends on the body type of the cat. (can anyone link the condition chart?!) I'd feed as much as she'll eat for now, at least 200 calories worth, probably more, especially if she'll eat more.
 
Brashworks said:
Hollis, no offence taken and your hubby makes a good point about trusting the profession. In fairness to all vets, they have so much they need to know about (and compared to a human doctor, they need to know it for many, many species). There is a link to a scholarly article on dosing Lantus in cats you can read and perhaps take to your vet - I can tell you are careful to research and get great benefits from facts so this may prove useful. It talks about reducing doses based on low BG mid-cycle results and the benefits of home testing, among other things. I am hoping that it can keep peace between you and your vet, and also give you peace of mind.

I know you have already taken the advice of the folks here but I wanted to say your dedication to Jai Jai and concern for getting him well is commendable.
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Thank you very much for your kind words. We read this article at the beginning of using Lantus. We read a lot at that time because our vet (the previous one) told us that he did not have much experience in using Lantus, but he agreed with our suggestion to change the insulin from Caninsulin to Lantus. This previous vet was on vacation and handed Jai Jai's case to his replacement, the current vet. She shows that she has more experience in handling Lantus actually.

Although we read (several times) the paper, but we turned out made several mistakes. If I did not accidentally fur shot yesterday, I am not able to get to know the correct way of adjusting the dose, as well as ear-prick:p

Much appreciate your help and support. I am relieved and feeling much better now.
 
Meya14 said:
Unless your cat is the type to "scarf and barf" or overeat to the point of vomiting, then there isn't really a reason to increase the feedings gradually. 4.2kg is on the low side of average for weights, but this depends on the body type of the cat. (can anyone link the condition chart?!) I'd feed as much as she'll eat for now, at least 200 calories worth, probably more, especially if she'll eat more.
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The vet said that Jai Jai is on the thin side. His ideal weight is 4.5 to 5kg. We did not understand why he did not put on weight though his fructosamine showed improvements (today is 349 - well regulated). I will give him more starting from tomorrow. But how do I manage his BG then? It must be elevating if I hold the 0.5 units.

BTW, what does "scarf and barf" mean?
 
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Once you start feeding more, you may have to increase the insulin slowly. Continue the current dose, 0.5U, for a while after you change foods (maybe a week) so you can see what happens. Then post a new thread and people can help you with the dose change if needed. It would be helpful to people to add comments in the spreadsheet for the day you increased the food and how much you increased it.
 
Critter Mom said:
Now that sounds v-e-r-y familiar ... ;)


If there are any flavours that he shows even a passing interest in, hang onto a few cans of those. You may not be able to feed them day to day, but sometimes when his appetite is on the blink a food he ate before but wasn't wild about at the time may just tickle his taste buds enough to help you get something into him, even if it's only one meal (any food is important in an emergency).
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He sticks to Thrive Complete for a whole month. We also love the food because no seasoning is added (My friend tested the taste and told me about this).

We hope that Jai Jai sticks to this brand because it is extremely difficult to find similar types here.
 
Shiloh & Rhonda said:
"Scarf and barf" means wolfing down everything in the bowl, then almost immediately throwing up. Think of it kind of like a "binge and purge" in humans if that helps?
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He sometimes scarf and barf, I start giving him a 15 minutes rest between smaller meals in order to slow him down a bit.
 
Scarf and barf means that kitty gobbles up all of his meal too quickly and vomits it all up very shortly afterwards. (One of my cats was a divil for this.)

Here's a link to Tanya's site tips for encouraging a kitty to eat.

Here's a body condition chart to help you assess Jai Jai's weight. It's really useful to get a digital baby scales like this one, so that you can monitor Jai Jai's weight easily at home. They're reasonably priced, and do the job just fine. If Jai Jai is losing weight, then you can slightly increase his food allowance; if he gains weight past his ideal weight, you can reduce his food allowance slightly.

Because Jai Jai isn't regulated yet, his body isn't yet able to use the nutrients he's eating properly. (Insulin's job is to allow glucose into the cells so that it provides energy for normal function and body maintenance). It may be that you may need to adjust Jai Jai's insulin requirements as you adjust his food allowance as you go along. You still need to hold each dose for a minimum of 6 cycles in addition to managing his calorie needs (unless he goes under 2.8 mmol/L BG, in which case the next dose MUST be reduced to keep him safe).

I'm glad you're starting to feel a bit better. :)

.
 
heyhollis said:
He sometimes scarf and barf, I start giving him a 15 minutes rest between smaller meals in order to slow him down a bit.
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That's perfect, Hollis. :) Just make sure that he eats a fair amount at the time you give him insulin. The little rest periods should be fine. Far better that he keeps it down. :)

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Jai Jai's PM +6 was 400s (23.9mmol). I was a bit worried about giving him more food. I will check his AMPS one hour later to confirm how much food to be fed.
 
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