1/10 McKenna

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Dallas

Member Since 2017
We're new here. My 12 yo cat was diagnosed with Diabetes just before Christmas. She spent 3 days in the hospital getting stabilized as she was extremely dehydrated and in Ketoacidosis. We're trying to get her regulated and I'm probably stressing more than is needed, but I am extremely worried about how high her BG continues to be. We were trying to regulate her with just testing urine (which I now know is like flying blind) and had taken her up to 3 units. The next day she was acting very bizarre, peeing on everything, seeming disoriented. We got her checked out immediately and found she had a severe bladder infection. Interestingly, the BG test showed her in a normal range and there was no Glucose in her urine. So, not sure what happened.
However, we decided to take her back down to 1 unit, once a day and get an AlphaTrak so that we could more accurately track her levels. I tried to do a curve over the weekend. It seems that her numbers are astronomical. I'm waiting to hear back from my vet. I decided to increase her dose to 2 units once a day. I'm kind of feeling like we need to split that up, though, and do 1 unit twice daily.
I'd appreciate any thoughts. Or encouragement.
I think I'm in panic mode and it would help to hear from some experienced pet parents out there.
Thank you!
 
Hello And welcome to LL.

Good job getting the ss up and running, I'm glad you've decided to start BG testing, using the urinr glucose levels isn't accurate enough.

Dosing twice a day is a better option, lantus generally doesn't have long enough duration when dosed once a day, meaning that you would find numbers rocketing.


I'm not sure what a sensible bid starting g dose would be, as McKenna has had dka, it's important that he get enough insulin, as too little could see him back in dka.

I'm going to try and get some folk experienced with dka and dosing to look in on McKenna.

Have you been testing for ketones at home?

In the meantime could you add what food you are feeding to the Sig block as well as any other health issues, date of diagnosis, age, make another of dka history, and anything else you feel is relevant in McKenna history, it'll help us build a better picture of McKenna, and therefore better help you.

Hang in there, there's a very steep learning curve, but we'll help you get there:bighug::bighug::bighug:
 
Hi Dallas,

Welcome to Lantus & Levemir Land, the nicest place you never wanted to be. You will find an amazing amount of information here about FD, and an equally amazing group of people that love cats and have lots of knowledge and experience that they will be happy to share with you.

I agree with Gill in recommending you go to twice a day dosing. Lantus works best with consistency, and you want to space your doses 12 hours apart, because that's about how long a dose generally lasts.

If following Tight Regulation, the starting dose is figured this way:
  • the formula is 0.25 unit per kg of the cat's ideal weight
  • if kitty is underweight, the formula frequently used is 0.25 unit per kg of kitty's actual weight
  • if the cat was previously on another insulin, the starting dose should be increased or decreased by taking prior data into consideration
Online Calculator for Converting Pounds to Kilograms

If following Start Low Go Slow, the dose is set this way:
  • 1u BID if kitty is not on a wet/canned low carb diet
  • 0.5u BID if kitty has been switched to a wet/canned low carb diet
  • If the cat was previously on another insulin, the starting dose should be increased or decreased by taking prior data into consideration
As Gill said, with DKA in the picture, you may want to start higher. I am not one of those that is well versed in that, so let's see if we can get someone better suited to help us out.

I don't know how much reading you've already done, but just in case, here are a few links to help you:
- New to the Group? Start Here
- Shooting and Testing Tips
- Lantus & Levemir Slang Dictionary
- Dr. Lisa's Food Chart

The most important thing I want to tell you is to ask questions. The only dumb question is the one you don't ask. We were all new here once, and we understand how scary and overwhelming it all is. We love to help, so take advantage of us!
 
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Thank you so much. I haven't tested for ketones, but it seems like that would probably be a good idea, given the extremely high numbers.
I have been reading everything I can to try and get a handle on this. Thanks for the links, there are a couple of those I haven't read yet.
I just got my BG meter on Saturday, so what's on the ss is the first information I'm getting on where she's really at since she got home from the hospital. I feel kind of guilty that I've not gotten on top of this sooner, but I guess with the chaos of the holidays, I hadn't really let it sink in yet....maybe a bit of denial that this was really happening. Ugh.
Anyway, she has been on antibiotics for the UTI for about a week and a half now and seems to be feeling much better. Our vet said to finish all of the antibiotic, which he said would take about a month. Kind of seems like a really long time and I'm wondering if it's really necessary.
Her appetite has improved markedly since getting the UTI treated. We've been feeding Royal Canin Diabetic wet food, twice daily. She eats 1 small can at each feeding. We ran out (our vet ordered more, but it hasn't come in yet) and had to switch her to Hill's M/D in the meantime. I know that's not ideal to switch foods when we're trying to get regulated, but there wasn't much choice.
I don't really know which protocol is better. I like the Start Low Go Slow approach though. But I don't know how concerned about ketoacidosis we should be and if that would affect which protocol would be the right one.
I've sent these numbers to our vet, but he's been out of the office the last 2 days, so I feel like I'm flying blind.
I really appreciate your input.
 
You don't need to feed veterinary "prescription" food for diabetics. Most of us feed commercial off the shelf low carb wet or raw food. I would make some raw as well as feed manufactured. Ideally you want something under 10% carbs. This chart here has a list of a number of the commercially available produts.

I would encourage you to go out and get some Ketostix for urine testing of ketones ASAP. They are available at any human pharmacy. You should be testing daily to make sure ketones aren't still part of the picture. One of the concerns with DKA is not enough insulin, so following a method for faster increases, if needed would be ideal until DKA is well behind you.

Are you using syringes to give the Lantus? We use syringes with 1/2 unit markings, and will make changes by 0.25 units at a time. Yes, you have to eyeball that small an amount.
 
I forgot to mention, most of us, once we've picked a dosing method, no longer rely on our vets for dosing advice. People here live it 24x7, some of us for years. I stopped asking my vet for dosing advice when I had to wait too long to get an answer. Because we have people all around the world, there's usually someone on all the time. Of the people who have responded to you today, there is one from Spain, two from the US (east and west coast) and me from Canada. :)
 
I will take a look at those foods. That is really good to know. Food has been frustrating because the prescription foods are only sold at certain stores and the closest one is quite a drive. Or I can get it from my vet directly, but obviously that has turned out to be problematic because they don't keep it on hand and if the order is delayed, I'm in trouble.
I will go get the Ketostix and start testing for that right away. She's started acting like she's starving again, so I'm concerned. She's still drinking and peeing a ton, as well.
I am using syringes to give the Lantus. I believe they do have 1/2 unit markings, so that is good to know.
I love our vet, but I don't want to have to be harassing him daily to know what to do. Plus, when he's out or busy, I'm left hanging while McKenna is potentially getting worse. So glad to have found this resource! You've all been very helpful and kind!
 
Follow up question, I just switched McKenna to 2 units Sunday evening. I'm thinking I'm going to switch her to 1 unit twice a day. Do I need to wait to do that since I'm not changing the amount? Or will any change have the potential to cause problems and therefore I should wait until Sunday to change?
 
Dallas said:
I'm thinking I'm going to switch her to 1 unit twice a day
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Based on the tests you have I would say going to 1u twice a day is a good idea. She does need insulin twice a day in order for Lantus to work properly. You would hold that dose for 7 days unless she goes under 90 at anytime during a cycle then she would earn a .25 reduction. Do you have some high carb gravy food or honey/karo in case she drops low? Do you also have the correct syringes with 1/2 unit markings?

Also, most of us feed multiple smaller meals through out the cycles instead of just at preshot time. It's easier on their pancreas and usually the kitty is happier too. Was she eating dry before insulin was started or always on wet food?

Hopefully the others will chime back in about the dose too.
 
I have both honey and karo syrup. I also have those syringes.
I've wondered about breaking up her food into smaller servings throughout the day. She has free fed on dry food her entire life, with the occasional can of wet as a treat. I think she's struggling to get used to only having food available at 2 times. About mid-afternoon, she starts sitting on the counter trying to get me to give her food. It just seems to make sense, too. I had gestational diabetes when I was pregnant with my 2 year old and the focus was on eating small meals throughout the day to keep me balanced. As long as I keep the amount consistent, that seems like it should keep her more even instead of big swings, right?
 
Dallas said:
As long as I keep the amount consistent, that seems like it should keep her more even instead of big swings, right?
Click to expand...
It certainly helps keep the curves flatter. When my Doodles was first diagnosed the vet had me do the same thing...the 12/12 schedule and he was miserable. He currently gets fed every 4 hours around the clock and he's on Levemir. Some feed every 3 hours or mix it up based on your ability and auto-feeders come in handy for over night.

Most will feed the majority of the food in the first 1/2 of the Lantus cycle with a small snack after nadir since the insulin is starting to wear off. See what works for you both, take notes and you can always adjust. Some just leave the wet food out all day and let them graze.

BTW, the Hills your feeding is 14% carbs and not sure what the Royal Canin carbs are but judging by the food chart linked above it's too high in carbs too. If you switch to a lower carb food on that list (under 10%) her insulin needs will likely drop too. You test enough but be aware of this. If you post daily or often we can help you.
 
Going to throw one more thing at you. Most of us use a human meter such as the Relion Confirm or Relion Micro from Walmart. The strips are a fraction of the cost. The TR protocol was written and published using a human meter. I have my AT as a back up. The meters will read differently because the AT is calibrated for feline blood and the human meter is calibrated for human blood. The only thing you need to know about human meters is that normal numbers for a cat are 50-120. Something to consider for your pocket book.

If you choose to stay with the AT that's fine but please add that to your signature as well because it makes a difference when we give dosing advise.
 
You've gotten lots of great advice already - welcome to the group!

One question - what is the antibiotic that she's on for the UTI? Are you giving her a suspension or pills or ?

I think starting at 1u twice a day is a good plan for the moment. If you do switch to a lower carb food, it's very likely that her insulin needs would go down. With Lantus, the dosing decisions are based upon how low any particular dose can cause the blood sugar to go. Right now we can see that the 2u can get her at least to the 120's on your AT, which will measure as less on a human glucometer. Dividing the 2u once a day into two 12 hour cycles will no doubt prevent/lessen those black numbers that you are seeing right now.

This group has many experienced people who will coach you so you can learn how to use Lantus in McKenna. Keep asking questions. I'd encourage you to post daily so we can help guide you as we see how McKenna does with the changes. I'd also encourage you to read other threads - we call them condos, for cat condos - you can learn a lot from other situations. Not all of it will apply to McKenna, but it's a great way to learn.
 
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