New to Group, need a little emotional support Kitteh Levi, last amps 256

[Mitla96]

Hi, very new to this, my cat diagnosed with diabetes after a huge dental abscess, the spreadsheet doesn’t tell all the tale (it is under new member) BUT i was so happy when I saw a blood glucose in the 200’s-my vet immediately emailed me to up him to 4 u this evening.

I always feel like I’m going to kill him when I up the insulin, but intellectually I realise he is no where near under control, and it is unlikely he will plunge. I felt like she upped him a little prematurely considering he had only been 3 days on the 3 u and he does have a bounce when I change the dose so I expect tomorrow’s BG to be up.

Also he is very thin so I have him on the low carb wet food 2 1/2 cans AND free choice Young Again dry, I may be over feeding him but he still is starving. His huge urination is better, and he is definitely better hydrated.

I ran that little mini curve just to prove to myself the insulin was still working.

Anyway, just rambling. I’m an RN so upping insulin this much is forever going to freak me out.

 

[Chris & China (GA)]

I would NOT go up to 4U

We only increase our kitties by .25 unit at a time, and then they are held at that dose for at least 3 days to see how they do. Your vet has been increasing too much too quickly.

Too much insulin can look like too little because the cat's body will self-preserve by dumping stored sugars and hormones into the bloodstream if they drop too low, drop too quickly or even just drop into numbers their body isn't used to anymore (bouncing)

I know when it comes to humans, going up 1 unit seems like nothing, but in our sugarcat's, it's a huge amount!

You need to test before EACH shot to make sure it's safe, and (if possible) get at least 1 test mid-cycle on the AM cycle and at least a "before bed" on the PM cycle (if you can't get tests during the day, it's good to get 2-3 tests on the PM cycle if at all possible)

I'd strongly suggest you stick with the 3U dose for now and try to get at least 4 tests per day (the 2 "Pre-shot" tests, and the AM mid-cycle and the "before bed" on the PM cycle) and let's see what we see in a few more days.

I know the curve you just did suggests he may need more insulin, but it's only a snapshot in time of 1 cycle of one day. If he was bouncing during that cycle, it really doesn't tell you anything.

How's the abscess healing? All healed up?

 

[PussCatPrince - GA]

Exactly as Chris and China have written.

Welcome .

 

[Mitla96]

I already gave the 4u! His abcess is completely healed, it healed so quickly it was amazing, almost like CGI. If someone could guide me I could post some pictures. The before is gruesome, though.

So, you are saying you were fine tuning when the blood glucoses were still so high?

 

[Tricia Cinco(GA) & Harvey]

Hi and welcome.

I know it's very scary when your cat is diagnosed with feline diabetes and all you see are high numbers. The thing about long lasting insulins like Lantus is that it takes a while for the depot to fill (typically about 3 days), and until it does, you aren't really seeing what the dose is doing. If you aren't familiar with an insulin depot, please read this post. This is why Chris mentioned you should hold the dose for at least three days. Also, with Lantus, you base your dosing decisions on how LOW the BGs go, with some consideration given to the preshot number (like, is it safe to shoot). If you don't get any mid-cycle tests, you don't actually know how low the cat is going, and therefore can't safely determine if he needs more insulin. We have seen a cat start out in the 400s at preshot, go down into the 40s midcycle, and be back up in the 400s at the next shot time. If you were only getting preshot tests, you'd think he needed more insulin, when in fact he was bouncing and might even need a reduction. It does sound like your vet is not very familiar with depot insulins.

So, you are saying you were fine tuning when the blood glucoses were still so high?

Changing a dose by .25 unit is not fine tuning in a cat. You'd be amazed at what a difference even .1 units can make!

You need to figure out what works with your schedule as far as testing goes, but always get a preshot test, and then try to find a time towards the middle of the cycle when you can get at least one test. If you are able to get more than one, that's great. It helps to vary when you test, too. For instance, one day get a +3 and a +6, and the next get a +4 and a +7, etc. Think of the spreadsheet as a jigsaw puzzle. If you only fill in the edges, you can't tell what the picture is. The more pieces you fill in, the clearer it becomes. A before-bed test is usually very important, as many cats go low at night. Of course, if you're gone all day, you're not always going to be able to get those mid-cycle tests, but test when you can. Once you've got more data, the folks here can help you figure out if Levi needs more or less insulin. But the most important thing is to keep him safe.

Here is a post we put together to help new members become more comfortable with this site.

 

[Janine & Floyd (GA)]

So, you are saying you were fine tuning when the blood glucoses were still so high?

I used to think like this as well. I am a vet and this is how I was taught, but it's not correct when dealing with feline diabetes. I tried managing my kitty that way for 10 months and never got anywhere, and may have cost him any chance of remission.

Make sure you share with your vet the info here and what protocol you're following. Hopefully they will get on board.

Get as much data as you can and you will keep your cat safe. Good luck- you're in the right place!

 

[Mitla96]

I am fearful that his chance of remission is lost because he was diabetic since Nov. and is only being treated now. I gave him the 4u x2 now so I figure I am committed to at least 3 days of cycle.. i am going to spend this afternoon talking to the local cat animal hospitals to try to find a more sympatico vet. It is difficult because the current vet IS the one who treated my elderly dogs seizures and did very, very well with that. I was sure sad to see that blood sugar bounce up this am.

 

[Mitla96]

Hi and welcome.

I know it's very scary when your cat is diagnosed with feline diabetes and all you see are high numbers. The thing about long lasting insulins like Lantus is that it takes a while for the depot to fill (typically about 3 days), and until it does, you aren't really seeing what the dose is doing. If you aren't familiar with an insulin depot, please read this post. This is why Chris mentioned you should hold the dose for at least three days. Also, with Lantus, you base your dosing decisions on how LOW the BGs go, with some consideration given to the preshot number (like, is it safe to shoot). If you don't get any mid-cycle tests, you don't actually know how low the cat is going, and therefore can't safely determine if he needs more insulin. We have seen a cat start out in the 400s at preshot, go down into the 40s midcycle, and be back up in the 400s at the next shot time. If you were only getting preshot tests, you'd think he needed more insulin, when in fact he was bouncing and might even need a reduction. It does sound like your vet is not very familiar with depot insulins.


Changing a dose by .25 unit is not fine tuning in a cat. You'd be amazed at what a difference even .1 units can make!

You need to figure out what works with your schedule as far as testing goes, but always get a preshot test, and then try to find a time towards the middle of the cycle when you can get at least one test. If you are able to get more than one, that's great. It helps to vary when you test, too. For instance, one day get a +3 and a +6, and the next get a +4 and a +7, etc. Think of the spreadsheet as a jigsaw puzzle. If you only fill in the edges, you can't tell what the picture is. The more pieces you fill in, the clearer it becomes. A before-bed test is usually very important, as many cats go low at night. Of course, if you're gone all day, you're not always going to be able to get those mid-cycle tests, but test when you can. Once you've got more data, the folks here can help you figure out if Levi needs more or less insulin. But the most important thing is to keep him safe.

Here is a post we put together to help new members become more comfortable with this site.

Thanks so much for this. I feel like I am committed to the 4 u now for at least 6 cycles. And I need to find a vet that is on board with half doses.

 

[Shawna & Davidson (GA)]

Each cat is different (ECID) and we all hope to get our cats into remission, sadly not all do. Davidson was DX's 4 yrs ago and most likely diabetic for months before I caught it, changed his food to low carb wet - no dry whatsoever, and his numbers dropped in half. I followed the TR here on this board and in 3 months with a ton of testing (that's me, lol) Davidson went into remission. But, 4 yrs later and a stupid tooth infection brought me back here and again trying like everyone, to get into remission. As others said, you need a lot of tests and ask lots of questions. At least you caught the FD and can work with it now with the help of many here.

It will be frustrating, especially since your numbers are still high. You're in the BEST PLACE for help and assistance, we were all at your stage at one time or another...............good luck, welcome!

 

[Steph & Quintus & L & O]

I am fearful that his chance of remission is lost because he was diabetic since Nov. and is only being treated now.

November is still reasonably recent. @Cyndy is seeing her cat Nam-kha go into remission now although she'd been on Lantus for a year (correct me if I'm wrong) but she wasn't following the protocol.

I feel like I am committed to the 4 u now for at least 6 cycles.

You're not, actually, and it could be dangerous to do so. The first thing to do is to get those PS and mid-cycle tests in, as Tricia says:

You need to figure out what works with your schedule as far as testing goes, but always get a preshot test, and then try to find a time towards the middle of the cycle when you can get at least one test. If you are able to get more than one, that's great. It helps to vary when you test, too. For instance, one day get a +3 and a +6, and the next get a +4 and a +7, etc. Think of the spreadsheet as a jigsaw puzzle. If you only fill in the edges, you can't tell what the picture is. The more pieces you fill in, the clearer it becomes. A before-bed test is usually very important, as many cats go low at night. Of course, if you're gone all day, you're not always going to be able to get those mid-cycle tests, but test when you can. Once you've got more data, the folks here can help you figure out if Levi needs more or less insulin. But the most important thing is to keep him safe.

You do not want to be filling in a depot that might end up sending your cat into a hypo.

Concretely:

I don't know where you are in today's cycle, but I would try and get a test in if you can. How long ago was the injection? We can tell you when it makes most sense to test. If you are away today, when is the first test you could get in when you get back?

Based on that test, we'd already have a little data to help us evaluate if this dose is too high or not.

In doubt, I would go back to 3.25 on the next shot and pick up from there. You can do more harm by sticking with the 4ui dose if it was too high than coming down to 3.25 if that happens to be too low.

 

[Tracey&Jones (GA)]

Your instincts as an RN are telling you something.

I agree with everyone...stick to the 3u or the 3.25 as Stephanie suggested.

Get your test data...see how he is reacting. On top of all that - how is Levi feeling?

For the food...he is not regulated so his body is not getting the full benefit of the food he is getting. Right now I would not limit his food until he gets into better numbers. Most times kitty will begin to go back down to more normal food levels once regulated.

 

[Wendy&Neko]

First off, hello and welcome. Good on you for home testing and being an advocate for Levi. We can help you help Levi. Keep on asking questions, we all know what it was like to be new.

Take a read of the yellow started Sticky Notes on this forum. We have two methods for dosing, Tight Regulation (TR) or Start Low Go Slow (SLGS). People here pick one and it gives you great guidance on how to increase the dose safely. As long as you are seeing numbers below 300, dose increases, at this point in Levi's journey, would be by 0.25 units by either dosing method. Following a dosing method helped me have a sense of control, and meant I didn't always rely on the vet who might not be working that day or couldn't get back to me on a day until after my shot time. I did share my spreadsheet at the beginning, as well as the dosing method, so she knew I was doing things safely.

Even though it's been 6 months for Levi, it's not too late for remission. But first, let's think about getting him regulated and in a healthy set of blood glucose numbers. That is a prerequisite for remission anyway. And for some kitties, like mine, there are other secondary conditions that make remission very difficult. I was just happy to get my girl in good numbers and enjoying life again.

 

[Cyndy]

I am fearful that his chance of remission is lost because he was diabetic since Nov. and is only being treated now. I gave him the 4u x2 now so I figure I am committed to at least 3 days of cycle.. i am going to spend this afternoon talking to the local cat animal hospitals to try to find a more sympatico vet. It is difficult because the current vet IS the one who treated my elderly dogs seizures and did very, very well with that. I was sure sad to see that blood sugar bounce up this am.

It's still possible for him to go in remission! My Nam-kha is doing very well now. She was diagnosed in March 2017, but I started the TR protocol only in April 2018. In a few weeks she really got better!

You will find lots of support here

 

[Olive & Paula]

You have lots of advise regarding dose. So let's talk food. You can give a low carb that has a little more calories. The ones I know are fancy feast kitten pate and Nulo brands. You can just mix a little with regular food for the extra calories. Here is a food list that has carb content, phosphorus, calorie info etc. Look for foods under 10% carbs.

http://catinfo.org/docs/CatFoodProteinFatCarbPhosphorusChart.pdf

 

[Mitla96]

You have lots of advise regarding dose. So let's talk food. You can give a low carb that has a little more calories. The ones I know are fancy feast kitten pate and Nulo brands. You can just mix a little with regular food for the extra calories. Here is a food list that has carb content, phosphorus, calorie info etc. Look for foods under 10% carbs.

http://catinfo.org/docs/CatFoodProteinFatCarbPhosphorusChart.pdf

Thank you! I like the idea of kitten pate!

 

[Mitla96]

Hi everyone, Kitteh was pretty miserable today so I wrote the following to my vet: (the reference to work- I work evening shift and swing back to day shift every two weeks for 2 days, vet and I had agreed it is better to go too long thn too short those days)

Dear Dr. ####

Please see the spreadsheet to see what worries me about the large increases in the insulin. Levi was on a nice downward trend, and had only been on the 3 units for 3 days. I did know the 256 wasn’t in therapeutic range yet, but it was the best amps he had, and I was encouraged.

He definitely has a bounce upwards whenever the insulin goes up, and he was acting miserable today.

His behavior prompted me to do the extra BGs today- he was lethargic and tremoring a little in his sleep. I was worried he was low. Now I think he was acting ill because he went high.

I will be entering another bunch of workdays starting on Thursday, and Friday to Saturday will be the day where he will go from a 12 noon dose to a 5 am dose because of my transition to days for the weekend. The last time we did that was 4/30.

I was wondering if we could even out these bounces by taking him up more slowly? I have the syringes with the .5 markings so I have the ability.

Thanks and

Worried, Janet

I am really hoping the vet will be willing to work with me on this. I am having a super amount of PTSD on this from when I was being treated for breast cancer (not to be TOO pathetic!) and my doctor (soon NOT to be my doctor)said I asked too many questions. Her answer to the above letter will speak volumes.

 

[Steph & Quintus & L & O]

So, just to make sure I understand: you are moving shot times around every two-three weeks? Lantus really works best with shots at regular times. If there is no other way you really need to plan those changes very carefully, and I would recommend doing it with the people here.

 

[Mitla96]

So, just to make sure I understand: you are moving shot times around every two-three weeks? Lantus really works best with shots at regular times. If there is no other way you really need to plan those changes very carefully, and I would recommend doing it with the people here.

Don’t worry, we have a handle on this. It ended up not being a problem.

 

[Mitla96]

Hi everyone. I am going to a different, highly recommended vet for a consult this afternoon. Any recommendations on questions for the new vet would be appreciated! Old vet's reply to my letter was reiterating that Levi needed more insulin. I am really confused about why he had gone for 3 weeks with high but definitely decreasing numbers, then just when the numbers started to go into the 200s, Old Vet freaks out and starts increasing the insulin so fast. Also, in Old Vet's email, she mentioned testing ketones? Is she just assuming I know how to do this on a cat? In the meantime, Levi LOOKS BETTER.

 

[Mitla96]

I am going to upload some pictures. Be warned, pretty gruesome. First is his facial wound the day the abscess burst after debridement. His face is in a bowl eating.

 

[Mitla96]

Second is 7 days later

 

[Mitla96]

Last is just yesterday. He is healing so well!

 

[Mitla96]

I used to think like this as well. I am a vet and this is how I was taught, but it's not correct when dealing with feline diabetes. I tried managing my kitty that way for 10 months and never got anywhere, and may have cost him any chance of remission.

Make sure you share with your vet the info here and what protocol you're following. Hopefully they will get on board.

Get as much data as you can and you will keep your cat safe. Good luck- you're in the right place!

It's still possible for him to go in remission! My Nam-kha is doing very well now. She was diagnosed in March 2017, but I started the TR protocol only in April 2018. In a few weeks she really got better!

You will find lots of support here

Thanks for this!

 

[Mitla96]

I used to think like this as well. I am a vet and this is how I was taught, but it's not correct when dealing with feline diabetes. I tried managing my kitty that way for 10 months and never got anywhere, and may have cost him any chance of remission.

Make sure you share with your vet the info here and what protocol you're following. Hopefully they will get on board.

Get as much data as you can and you will keep your cat safe. Good luck- you're in the right place!

Thank you for this. I am going to another highly recommended vet for a consult this afternoon.

 

[Mitla96]

November is still reasonably recent. @Cyndy is seeing her cat Nam-kha go into remission now although she'd been on Lantus for a year (correct me if I'm wrong) but she wasn't following the protocol.



You're not, actually, and it could be dangerous to do so. The first thing to do is to get those PS and mid-cycle tests in, as Tricia says:



You do not want to be filling in a depot that might end up sending your cat into a hypo.

Concretely:

I don't know where you are in today's cycle, but I would try and get a test in if you can. How long ago was the injection? We can tell you when it makes most sense to test. If you are away today, when is the first test you could get in when you get back?

Based on that test, we'd already have a little data to help us evaluate if this dose is too high or not.

In doubt, I would go back to 3.25 on the next shot and pick up from there. You can do more harm by sticking with the 4ui dose if it was too high than coming down to 3.25 if that happens to be too low.

Hiw do you do a .25 dose? The syringes i bought have .5 markings but are incredibly tiny markings

 

[Amanda & Shmee]

Hiw do you do a .25 dose? The syringes i bought have .5 markings but are incredibly tiny markings

I used to think this same thing. It is basically just an eyeball, in between the full unit mark and the .5. Here is a photo, and be sure to check out this sticky. They key is consistency. Try to remember how you do it the first time, and follow that lead from then on out.

I am new here too, about three months or so. You are in great hands here. To put it into perspective, this forum for Lantus and Levemir have helped almost 400 cats go into remission ("OTJ" / "off the juice!") since 2008. That is a lot of kitties!! My advice for the new vet is this - pick a protocol (Tight Regulation or Start Low Go Slow) and get familiar with it. Print it out and bring it to your vet. Explain you only feel comfortable increasing by .25 units.

I am having a super amount of PTSD on this from when I was being treated for breast cancer (not to be TOO pathetic!) and my doctor (soon NOT to be my doctor) said I asked too many questions. Her answer to the above letter will speak volumes.

WOW. What a horrible doctor!! Maybe she was just having a bad day?! I sure hope so... because that attitude is ridiculous. Asking questions is how you learn. You were not in the wrong and you will never be in the wrong here when you ask questions, that's for sure. A big piece of advice I have taken away from this group is, in the end it is your cat. No matter what the vet says, you can dose them how you'd like. Yes, the vet can refuse their service, but I would rather have a vet refuse their service and find another one then to put my pet in danger. I KNOW you can do this If you chose TR (tight regulation), there is a veterinary journal that has been published that you can print out for your vet too, to support your argument.

Good luck and hope this new vet is great!

 

[Olive & Paula]

Sometimes if you go over the optimal dose, (to much insulin to fast) the only way to get past it is to keep increasing dose until you breakthrough it and start getting the lower numbers. It sounds crazy but it does happen. When it does it's a fast downhill ride you need to be on your game to stay on top of it.

 

[Steph & Quintus & L & O]

It would make sense to test for ketones. You do that with urine strips that you can get in a pharmacy (ketodiastix for example).

 

[Mitla96]

I used to think this same thing. It is basically just an eyeball, in between the full unit mark and the .5. Here is a photo, and be sure to check out this sticky. They key is consistency. Try to remember how you do it the first time, and follow that lead from then on out.

I am new here too, about three months or so. You are in great hands here. To put it into perspective, this forum for Lantus and Levemir have helped almost 400 cats go into remission ("OTJ" / "off the juice!") since 2008. That is a lot of kitties!! My advice for the new vet is this - pick a protocol (Tight Regulation or Start Low Go Slow) and get familiar with it. Print it out and bring it to your vet. Explain you only feel comfortable increasing by .25 units.



WOW. What a horrible doctor!! Maybe she was just having a bad day?! I sure hope so... because that attitude is ridiculous. Asking questions is how you learn. You were not in the wrong and you will never be in the wrong here when you ask questions, that's for sure. A big piece of advice I have taken away from this group is, in the end it is your cat. No matter what the vet says, you can dose them how you'd like. Yes, the vet can refuse their service, but I would rather have a vet refuse their service and find another one then to put my pet in danger. I KNOW you can do this If you chose TR (tight regulation), there is a veterinary journal that has been published that you can print out for your vet too, to support your argument.

Good luck and hope this new vet is great!

It was even worse-it was my oncologist who said that! I hooked up with a GREAT new vet today, we are absolutely on the same page, we are taking the insulin back down to 3u, she says she usually sticks with doses for two weeks. We are doing the SLGS. I feel immensely relieved to have a vet who looked at my spreadsheet and said immediately “I think it was premature to take him up to 4 units”. New vet is a good communicator and said “you can call anytime” but I wont abuse the privilege!

 

[Mitla96]

It would make sense to test for ketones. You do that with urine strips that you can get in a pharmacy (ketodiastix for example).

I interviewed and immediately hired a new vet today-so gentle with Kitteh, very through exam and more on point with my feeling (and all of you guys!) that the jump to 4 u was premature. She did labs today and his ketones were negative-she doesnt feel it is necessary right now, he is eating and clinically looks better. I am very grateful for you all confirming my gut feeling that his management was awry.

 

[Chris & China (GA)]

I hooked up with a GREAT new vet today,

That's GREAT!!! It's so much nicer to have the support of your vet!!

I still think the 3U dose may be too much too, but with some more testing, we'll know for sure!!

 

[Mitla96]

Kind forum members-

The new vet was fantastic, i am feeling hopeful again! Also good news Kitteh gained some weight, from 9.1 to 9 lbs 15 oz.

 

[Mitla96]

That's GREAT!!! It's so much nicer to have the support of your vet!!

I still think the 3U dose may be too much too, but with some more testing, we'll know for sure!!

She and I talked about that, she said she wouldnt have taken him off the 2 u so soon, but since he had the best numbers on the 3 u, we are starting back there. Just her saying that made me love her-she was really debating about it. Such a different vibe than Old Vet.

 

[Kathy and TiTi]

Hi, very new to this, my cat diagnosed with diabetes after a huge dental abscess, the spreadsheet doesn’t tell all the tale (it is under new member) BUT i was so happy when I saw a blood glucose in the 200’s-my vet immediately emailed me to up him to 4 u this evening.

I always feel like I’m going to kill him when I up the insulin, but intellectually I realise he is no where near under control, and it is unlikely he will plunge. I felt like she upped him a little prematurely considering he had only been 3 days on the 3 u and he does have a bounce when I change the dose so I expect tomorrow’s BG to be up.

Also he is very thin so I have him on the low carb wet food 2 1/2 cans AND free choice Young Again dry, I may be over feeding him but he still is starving. His huge urination is better, and he is definitely better hydrated.

I ran that little mini curve just to prove to myself the insulin was still working.

Anyway, just rambling. I’m an RN so upping insulin this much is forever going to freak me out.

I see you went down to 3 and had a NS. You really do need to take this slower. It's kinda' dangerous to raise Insulin that much. I speak from experience. My vet upped TiTi I unit and she dived downward. After that, because her dose was so high, I went down .5U at a time. I don't know if anyone mentioned this yet, but the reason to go slow isn't just danger; by going so high so fast, you might go right past her correct dose.

Glad to hear you're a medical person - you'll do well! and welcome.

 

[Mitla96]

I see you went down to 3 and had a NS. You really do need to take this slower. It's kinda' dangerous to raise Insulin that much. I speak from experience. My vet upped TiTi I unit and she dived downward. After that, because her dose was so high, I went down .5U at a time. I don't know if anyone mentioned this yet, but the reason to go slow isn't just danger; by going so high so fast, you might go right past her correct dose.

Glad to hear you're a medical person - you'll do well! and welcome.

I see you went down to 3 and had a NS. You really do need to take this slower. It's kinda' dangerous to raise Insulin that much. I speak from experience. My vet upped TiTi I unit and she dived downward. After that, because her dose was so high, I went down .5U at a time. I don't know if anyone mentioned this yet, but the reason to go slow isn't just danger; by going so high so fast, you might go right past her correct dose.

Glad to hear you're a medical person - you'll do well! and welcome.

Hi, yes my new vet is on board with the go slow and low, she debated about taking him back to 2u but she wanted 2 weeks on the 3 u and today we FINALLY had a good amps again, 226!

 

[Mitla96]

Hi, hey everybody, am really liking the new vet and hoping today’s amps will be a trend. Our plan is to stick with the 3 u bid til next Friday unless he goes a lot lower then I will modify.

The link on the lantus info for clinical signs doesn’t work, but I’m assuming they are the purring, preening, eating well? He is doing SO well, face is healing and has some nice whiskers coming, AND hair growing back on his tail which has been balding since last Nov.