? ?!?! Not doing well

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Amanda & Ham

Amanda & Ham

Member Since 2017
Ham is not doing well this morning!! He barfed up all of his dinner last night and has been very lethargic ever since.

He doesn't want to eat or drink anything. He'll take a couple of steps then he lays down. I've checked his bg and the numbers are normal for him they're not low... not sure what to do.
 
Does Ham seems to want to eat but then turns away?? If so this could be a sign of nausea.

Are you testing the urine for ketones?? If you are and there is any more than a trace showing then it would be prudent to take him to the vet ASAP. Higher glucose levels, not eating and possibly an infection can lead to diabetic ketoacidosis (DKA) which can be quite serious.

The other possibility is pancreatitis, which would require ant-nausea meds, pain relief and sub Q fluids.

If Ham is still not doing well and refusing to eat a visit to the vet might be in order. :bighug:
 
No I am not testing for urine ketones. I don't know how or even what I'd need.

No it seem he isn't interested in eating at all. I've tried food, cheese, and some milk and nothing.

I was just looking for a new vet. I'm not really sure my current vet is well educated on cat diabetes, and one closer to home that won't take a half hour to get to.

Ham has never turned away from food. He's trying to stay in dark places. I'm really worried.
 
To test the urine for ketones you would need test strips such as :

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You would need to collect a small sample of the urine and dip the stick into it. The strips pictured above has two strips on it...one for glucose and one for ketones. On this type you read the results for the ketone after 15 seconds. If it shows any more than a trace of ketones then a visit ASAP to the vet/ER would be in order.

The fact that he is refusing to eat and seems nauseous could be a sign of DKA or pancreatitis, both of which would require some medical intervention. The vomiting and lethargy can be signs of either one as well. If possible you should try to get him to the vet ASAP and have them check for ketones and a snap fPLI test which gives a yes or a no for pancreatitis. The snap test can be done in the office and gives results right away. The best test for pancreatitis needs to be sent to an outside lab but takes several days to get the results. Either one of these conditions can become serious very quickly and although there is no way to say for sure that either one of these is causing these problems it is best to be safe and have Ham checked.
 
Good luck with the vet visit. The two things to make sure are okay are the ketones ( they can test that with either a urine test or blood test. The blood test is the most accurate) and the snap test for pancreatitis. There could certainly be other issues but you do want to rule those out for sure.

:bighug: :bighug:


ETA If you have a full blood panel it will help to check other areas, such as kidney function etc. If you do have the full blood work done it is useful to add the thyroid test as well to give a better overall picture.
 
Best Of Luck at the vet.
Please make sure the vet checks for ketones. I've read posts here too many time of vets dismissing ketones as something not to worry about :banghead:
 
Ok so I called my normal vet and he said I don need to bring Ham in just give him an additional unit of insulin and again this evening. Now I have read in my research that you shouldn't give a cat insulin without them eating.
 
Amanda McMasters said:
Ok so I called my normal vet and he said I don need to bring Ham in just give him an additional unit of insulin and again this evening. Now I have read in my research that you shouldn't give a cat insulin without them eating.
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I think most of us here would suggest (strongly) that an actual vet visit is in order. Ketone status has to be checked along with assessment for pancreatitis and maybe meds given for nausea and appetite.
 
Amanda, DO NOT give insulin. You have Ham on a high dose. He needs to be seen by a vet to ensure he doesn't have ketones or pancreatitis. Both can lead to very serious and expensive conditions to deal with so if you can't get your vet to listen, please find another vet and take him there. I know you told your vet that you were using Toujeo but I'm still wondering if the vet really understands especially if he is telling you to give additional insulin when Ham is not eating at all. An additional unit of Toujeo is equivalent to 3u of Lantus. That is a huge increase for a cat who should be seen and possibly not given insulin at all right now.
 
Amanda McMasters said:
Ok so I called my normal vet and he said I don need to bring Ham in just give him an additional unit of insulin and again this evening. Now I have read in my research that you shouldn't give a cat insulin without them eating.
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What was his BG like this morning? Can't see anything on ss
Are you using a pen needle, or a syringe to give the insulin?

I think regardless of what his numbers are I would insist on taking him to the vets and having him run some tests, especially as him not eating is very unusual for him, my George never refuses food, if he were to refuse food I'd be at the vets in a flash.
 
Adding my voice in strong support of taking him in. Don't take no for an answer on testing for ketones in particular-- DKA can progress extremely rapidly, and can be fatal. I don't want to scare you, but really, you don't want to take chances on things like this, nor do you want to take chances on heavily dosing your cat with extra insulin when he is not eating.
 
For anyone following this thread, please note Amanda is using Toujeo which is the relatively new high potency version (U300 insulin) of Lantus so while the spreadsheet indicates does of 4u and 3u, those doses are the equivalent of 12u and 9u respectively.
 
I agree with Linda. I was just looking up the strengths for Toujeo and the only one listed is 300 units/ml which as stated is 3 X the normal Lantus strength and is FAR too high a dose for a more recently diagnosed kitty. Your vet does not have a good understanding of feline diabetes.

With vomiting, nausea, lethargy and refusing to eat these are all things that NEED to be addressed now. Please find another vet to get some testing done and another vet for the ongoing care

ETA The first thing that needs to be done is to rule out any chance of an infection of some sort, check for ketones and check for pancreatitis. A full blood work with the thyroid test would be in order.
 
Tuxedo Mom said:
I agree with Linda. I was just looking up the strengths for Toujeo and the only one listed is 300 units/ml which as stated is 3 X the normal Lantus strength and is FAR too high a dose for a more recently diagnosed kitty. Your vet does not have a good understanding of feline diabetes.
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I think that would be the case if she a u100 syringe, if she is dialing the units up on a pen, or using a u300 syringe(I don't think there is such a thing) then units are units, it's just the volume that's different.
upload_2017-2-1_6-47-29-png.26146
 
Gill & George said:
I think that would be the case if she a u100 syringe, if she is dialing the units up on a pen, or using a u300 syringe(I don't think there is such a thing) then units are units, it's just the volume that's different.
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Good point it would depend on the type of syringe being used However Toujeo has never been properly tested in kitties and whether the vet has the proper understanding of dosing with Toujeo is unknown. A vet who is not concerned about testing with the symptoms Ham is having and only suggests upping the dose by a WHOLE unit does not appear to have a good handle on FD
 
Still unsure of the potency of Toujeo compared to regular Lantus. From their website:

What is Toujeo® (insulin glargine injection) 300 Units/mL?


Prescription Toujeo® is a long-acting insulin used to control blood sugar in adults with diabetes mellitus.

  • Toujeo® contains 3 times as much insulin in 1 mL as standard insulin (100 Units/mL)
  • Toujeo® is not for use to treat diabetic ketoacidosis
  • Toujeo® should not be used in children
https://www.toujeo.com/
 
Tuxedo Mom said:
Good point it would depend on the type of syringe being used However Toujeo has never been properly tested in kitties and whether the vet has the proper understanding of dosing with Toujeo is unknown. A vet who is not concerned about testing with the symptoms Ham is having and only suggests upping the dose by a WHOLE unit does not appear to have a good handle on FD
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Exactly Mary Ann, although the info on it says the active ingredient glargine, just like lantus, I've not seen anyone else on the board here using it so we must remain cautious on assuming it will behave in the same way.
I do wonder about how practical an insulin it is for cats given the difficulties we have measuring the small doses they often end up on when we get to regulation or head OTJ, not to mention the small dose changes we usually make.
Amanda McMasters said:
I am not going to give Ham the insulin. I am using the pen so yes one unit is 300 units/ml.

I am also calling other vets to see where I can get him in.
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Thank you, for clarifying that you are using the pen needle designed for the Toujeo, so when you measure 1u, it is actually 1u of insulin that he is getting.
One other question, what is the smallest dose change that you can measure on the toujeo pen needle?
Good idea on trying to get him into a vet.
Tuxedo Mom said:
Still unsure of the potency of Toujeo compared to regular Lantus. From their website:

What is Toujeo® (insulin glargine injection) 300 Units/mL?


Prescription Toujeo® is a long-acting insulin used to control blood sugar in adults with diabetes mellitus.

  • Toujeo® contains 3 times as much insulin in 1 mL as standard insulin (100 Units/mL)
  • Toujeo® is not for use to treat diabetic ketoacidosis
  • Toujeo® should not be used in children
https://www.toujeo.com/
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But when we measure out a dose, on any insulin, the syringes/needles are calibrated in units not ml, so the amount of active ingredient is the same, but of course what we don't know about Toujeo is if there is any subtle differences in it's action, which might influence how a cat responds to it.
I wonder why it's not to be used in kids?
 
Gill & George said:
I've not seen anyone else on the board here using it so we must remain cautious on assuming it will behave in the same way.
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There were a few discussion on here a while back and it was suggested that it may be useful in members with high dose kitties,

Gill & George said:
I wonder why it's not to be used in kids?
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This is also a concern for me. It may be that the dosing is too strong for smaller children and our kitties are smaller than most children, so I would be worried about that as well.

Because there is no good data on using Toujeo in kitties I would be extremely hesitant about using this type. Regular Lantus is well tested and documented.
 
Toujeo is also being marketed as lasting 24 hours and while some humans can use Lantus once daily, the website specifically says the formulation of Toujeo is different. Whether that is just referring to potency or some change to the way in which it is used in the body is anybody's guess but definitely a concern given it is not to be used in children. While I seem to remember seeing something about it currently being tested in cats for use with high dose conditions, Ham has never been tested for any high dose conditions which again suggests to me that the vet is not understanding the difference between Toujeo and Lantus. All the vet saw or understood is that it is glargine.
 
I agree with the comments others have made. This insulin is very concentrated so titrating the dose by the tiny increments often needed for kitties is very difficult. I suggest you find a vet who will prescribe regular Lantus insulin to be used with U100 syringes that have half unit markings.
 
Gill & George said:
if you are taking him to a new vet perhaps discuss some of the concerns above about Toujeo.
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Also make sure the vet understands that Toujeo is u300 glargine three times as potent as Lantus. It may be in your best interests to change insulins if Lantus is out of the question right now. You can order Lantus from Canada at considerably less than it costs you in a pharmacy there but obviously it would take some time to get it so getting a different insulin in the interim might be the best option. I am very concerned that Ham is not feeling well because of the high dose and perhaps the Toujeo itself.
 
MrWorfMen's Mom said:
Also make sure the vet understands that Toujeo is u300 glargine three times as potent as Lantus. It may be in your best interests to change insulins if Lantus is out of the question right now. You can order Lantus from Canada at considerably less than it costs you in a pharmacy there but obviously it would take some time to get it so getting a different insulin in the interim might be the best option. I am very concerned that Ham is not feeling well because of the high dose and perhaps the Toujeo itself.
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Amanda, I have to add my voice to the others here and suggest very strongly that you discuss the use of Toujeo with your vet. I am very concerned that the concentration/amount of insulin that Ham is receiving is way too high for him, which can be very dangerous. I hope your vet can see him ASAP. Please keep us posted, we will worry! :bighug:
 
Just a follow up on Toujeo . I found this information on Toujeo .

"And now, apparently, Toujeo maker Sanofi doesn’t care either, because they just tore up the Unit Rulebook and threw it away. The reason that Toujeo doses 1:1 (meaning you’d take the same number of “units” that you did before) is that Sanofi has re-defined the unit. Toujeo comes only in a special SoloStar pen that actually delivers 1/3 of a unit with each click. In fact, the 450 “unit” pen actually only holds 1.5 mL of fluid, exactly half the volume of the pens we are used to. Basically, the new pen has been recalibrated to deliver smaller doses. For each single “unit” you click into the pen, you’re actually getting one-third of what you are accustomed to but of a higher potency liquid."

http://www.healthline.com/diabetesmine/ask-dmine-divide-three-carry-one-then-increase-what#2

So the 3 units of Toujeo, using the Toujeo pen would be equivalent to 3 units of regular lantue. One of the big problems is that you MUST use ONLY the Toujeo pen and can only make dose adjustments of one unit at a time.
 
Great find @Tuxedo Mom but that seems a recipe for major confusion for the diabetic community. The information also says:

"Some oddball things you need to know: Toujeo is so extended that onset of action is not for six hours, and it can take “at least five days” for the insulin-lowering action to “manifest.” Because of this, doctors are advised not to use the typical daily up-titration to adjust the dosage, but to increase every 3-4 days."
​
This would suggest re-thinking of protocols here might be necessary if using Toujeo were deemed safe for cats.

So Ham has been getting the equivalent of 4u AM and 3u PM of Lantus which are still high doses but much more reasonable than I thought.:)
 
My thoughts are that since Toujeo is relatively new and there has been no proper studies done with kitties that it would be venturing into very unknown territory to use this form of insulin. There are no proper comparison with Toujeo and regular Lantus as far as the established protocols go and being a "guinea pig" for how it works with a feline system is a bit too risque for my liking.
 
The interesting part of all this is that the ingredient list is exactly the same for Toujeo and Lantus so why it would titrate differently is a bit of a mystery but I'm guessing it has to be in the way the glargine itself is being formulated which is concerning. The documentation leaves a lot to be desired and leaves lots of room for assumptions that may not hold true.
 
MrWorfMen's Mom said:
The interesting part of all this is that the ingredient list is exactly the same for Toujeo and Lantus so why it would titrate differently is a bit of a mystery but I'm guessing it has to be in the way the glargine itself is being formulated which is concerning. The documentation leaves a lot to be desired and leaves lots of room for assumptions that may not hold true.
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Linda, I agree with you 100%. I think additional research needs to be done before it is approved for use in cats. I'm wary, right off the bat, about using an insulin that says it's not acceptable for use in children.
 
Ham has no ketones and his fructosamine was 417 and his pancreas was not inflamed so we did not check for pancreatitis. They gave him a shot of anti nausea and a shot of antibiotics. When he go home he did drink some milk. Loozing up.
 
Thanks for the update. Glad he's at least taking in a bit of fluids now and hopefully he'll want to eat soon too.
Did the vet say what kind of infection they suspected? Urinary tract infections are quite common with diabetics due to the sugar in their urine.
 
They don't think he has one due to the lack of white blood cells in his urine but just to be on the safe side. And I ask 4 times aboit him being on the toujeo or if we should change it and they said no it was fine, in a week we'd see about changing his dose.
 
I'm glad you pushed to make sure the vet understood what insulin you are using but I have to admit I'm still a bit dubious as to the vet being familiar with Toujeo so it still makes nervous. I'm also concerned that if the vet suggests upping the dose by 1/2 unit, you won't be able to do that with the pen and using U100 syringes (there is no such thing as a U300 syringe!) will make accurate dosing darn near impossible. The problem is that quite often, because our kitties are like babies size wise, a very small increase or decrease of insulin dose can make a big difference in their numbers so we usually find changing doses by as little as a 1/4 unit to avoid missing the most effective dose. Not only is drawing up small doses going to be physically problematic but it also carries a significant risk of overdosing.

Now just so we understand correctly, when you give 4u, do you mean you click the pen 4 times and for 3 units, you click the pen 3 times? I'm asking because I want to be sure we are absolutely clear on how much insulin Ham is getting currently especially since both the insulin and pen you are using are different than what we are use to here. I just want to be sure that if you want or need our assistance in the future, we are all talking the same "language" and not confusing each other.

I would still strongly recommend you consider getting the regular U100 Lantus going forward. I believe the cost for regular Lantus at Marks Marine Pharmacy in Canada runs about $175 including shipping. You can order the small 3ml vials (SoloStar pens) rather than the 10ml vial. They come in a 5 pack so you are getting 1.5 times as much insulin as you get in the 10ml vial you priced out and because it's packaged in smaller batches, it will last longer than the 10ml vial would. We use syringes to draw up the insulin instead of using the pen so we can make the smaller dose changes. By getting the Solostar pens the insulin based on your current dosing would last you about 7 months for a cost of about $25 per month.
 
We also have a Supply Closet forum here that sometimes has insulins for sale at lower prices, if cost is an issue. Just be cautious as we cannot vouch for each seller there, although some have been used repeatedly and are considered quite reputable. For safety and information's sake please read the yellow "Info" sticky at the top of the forum.
 
Amanda McMasters said:
And I ask 4 times aboit him being on the toujeo or if we should change it and they said no it was fine, in a week we'd see about changing his dose.
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I'm very curious to learn more about what kind of a dosing plan your vet intends to use with Toujeo and cats. If you don't mind, please share as you find out what kind of dosing guidelines and parameters he has in mind. The methods we use on the FDMB are all based on a U-100 strength glargine. It's all we're familiar with.
 
Yes 4 units is 4 clicks and 3 units is 3 clicks. Yes cost is an issue for me. Like I stated I stressed to the new vet asking if we should change his insulin and she said no keep it the same for now... I'm not sure. I tried diabetic cats in need for help and they didn't help at all :( and I know you all are trying to help but really can't cuz no one is using this insulin... my original vet also said I could use humulin... would that maybe be better
 
While Humulin does work for some cats it doesn't last long enough for others. I were in your shoes, I'd stick with what you are using for now and see if there is any Lantus available in the supply closet in the near future. Sometimes people switch to a different insulin, have kitty go into remission etc. and have insulin they are giving away for free or for a very reduced price. We do understand what you are using and while you are the first member to use Toujeo, we can still help you and are quite willing, maybe even excited, to do so. In fact there are probably a number of folks who will be very interested in your experience. We just think small dose changes are going to be a challenge if and when that becomes necessary. :bighug::bighug:
 
You are going to have to keep trying to get food into him. Do you have or can you get some plain meat baby food (without any onions or garlic) to try? Is there any "people" food you can offer that he likes? Tuna in water , some poached chicken or even fried chicken. Right now I think finding something to get him to eat is really important even if you have to resort to kibble or high carb food. Sometimes you just have to get them started and they will start eating again. Sometimes it helps to warm up their food so the smell is more enticing.
 
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