Newly diagnosed, is vet protocol too aggressive?

K

KatHas

Member Since 2018
Hi there,

Lucy (13 yrs) has been vomiting in recent months but otherwise happy and healthy, but earlier this week she became worryingly lethargic and stopped eating and drinking. A couple visits to the vet found that she had hyperthyroidism and diabetes. The vet said her BG was 211 when tested, but this was after not eating for 2 days and also being stressed at the vet. She also said there was sugar in her urine (she mentioned 2+ as the level)

We were prescribed 1 unit of Lantus twoce daily, and the vet said she will do a curve after a couple of weeks of this. She seems confident that we can achieve remission shortly. My concerns are:

- she said not to worry about home testing, but we don't even have baseline numbers for the cat. The nature of my job means I won't be able to be home and testing midday for the coming weeks.

- Lucy is just under 8 lbs, and she is not showing a lot of classic symptoms. She has lost 1lb in the last 2 years, her water intake was not particularly high, etc.

I'm worried about starting her on 1 unit and her going hypo after a few days, and I'm worried that even if I test at home, the unpredictable nature of my hours means I might miss a warning sign.

My vet runs a very busy clinic and has not been returning my calls. My instinct is to get home testing supplies, establish a baseline for a day or two, then start her on a half unit twice daily for the first couple of weeks. Does that sound reasonable? Am I missing something?
 
Hi - Welcome! Experts will comment further, but 2 questions they will have are what is here current diet (any recent changes)? Also any history of DKA?

Home testing is critically important, so everyone here will support you in getting up and running to do this. You can do your own curves. At home, BG numbers will not be "stress" influenced as they may have been in the vet office.

Until others comment, please read the sticky notes at the top of this page and continue to ask any questions. You will find this group loves to help.
 
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Get a meter so you can start testing. Days you work get preshots and a before bed reading. On days off get extra tests.

If you are worried them until you get the hang of testing start with 0.5 units.
 
Hi and Welcome! As Carol has asked, are you feeding low carb food now that she has been diagnosed? Have you seen the food chart that we use here? We like to see the kitties stay under 10% carbs to be considered LC. The link :

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

If you have made that change you will want to home test for sure. Just changing the diet from higher carb food to lower carb food can lower a kitties BGs by 100 points. Your gut is telling you the right thing to start home testing! If you can get a pretest always to make sure it is safe to give insulin and get a +1 or +2 ( that would be 1 hour after shot and 2 hours after shot), that information can help you to see how active the cycle will be and then you can intervene with some higher carb food if necessary.

Some that work, get up earlier so that they will have those several hours after AM shot to monitor a bit and know if they might need to leave some medium carb or high carb food for their kitty.

During the evening cycle, if you could do the same ( get a +2) and one before you go to bed, you will have a good idea how the cycle might play out.

With her numbers being in the low 200's at the vets and with a pet meter which runs higher than a human meter, I think I would start with 0.5 dose.

If you have this weekend off and have not started the Lantus yet, I would just wait until tomorrow night to start the insulin and get as much testing in as possible.

And as Carol said, read the stickies at the top of this forum and ask lots of questions. That is how we all learned.
 
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I also wondered what you were feeding. 211 isn't that high at the vet's, that can be as a result of stress, did they do any other tests like a fructosamine to see average BG for the past few weeks? If you are feeding dry food, that is quite high in carbs, you may be able to get her numbers down by changing to a lower carb canned food diet. But you don't want to do both change in food and starting insulin at the same time, the BG can drop significantly. If you can start testing at home, that would give you a better idea of next steps.
 
Most vets start at 1 unit as they don't realize that some owners are willing to use a syringe vs. the pen.

I agree with Bobbie - I would start at .5 unit. How is Lucy eating now? I see others have asked what she is eating to confirm.

And yes test at home! I learned the hard way that spot testing is not giving a true picture on what insulin dose is needed.

ETA: Was a fructosamine test done as well?
 
Welcome. Lots of us use a Relion or Confirm human meter to test at home. It will test lower than a pet meter which will help keep kitty safe when you are away. Our protocols are based upon the humam meters. Ask for a copy of the latest labs and if a fructosamine was run. It gives an average over the past few weeks. I agree with the others that there’s no need for a curve to be done at the vet’s office where kitty will be stressed which could raise the bg. The yellow stickies really explain a lot but there is so much info and it can be overwhelming at first. So ask questions. We are here to help.
 
Thank you all! The vet did not run fructosamine, but her concern was that the reading was 211 even after the cat didn't eat for two days, as well as the amount of glucose in the urine. I have no idea on DKA, though the very did not mention in when discussing the urine results so I'm thinking it's not an issue at the moment. She seemed fairly confident that this was a mild case that had a good prognosis for remission but I guess we can't really tell until I start testing.

As to everyone asking about her diet- she is a wet food only kitty but she had been on mostly Friskies pate. I looked it up on the food chart and it's something like 28% carbs, so mucho bad! She's not getting any more of that and I've moved to a wet mix that's 4-7%, which I think should help immensely. Luckily she's not too picky about food as long as it's pate style. She does tend to graze at her food rather than eat all at once, but my understanding is that this is less of a concern with Lantus?

Thank you all for your replies, I'm glad to hear that starting on a more conservatives dose and testing at home are prudent choices.
 
Chris & China said:
Do you mean the "Indoor" line of Friskies?......Yes, those are too high in carbs, but the Classic pates are all under 10% and fine for sugarcats
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Well I'll be.... yes, the classic pates, I must have misread the chart in the store. Good to know, as you can buy these anywhere. I'm still going to be supplementing with bougier (but still low carb) food as I have in the past, just to keep things balanced nutritionally and to make sure she doesn't get addicted to only one brand of food. I learned that lesson with Temptations treats the hard way.
 
I saw a separate thread on this, but if anyone wants to chime in with a recent opinion.... How long does a vial of Lantus last? I can't afford $100 every month just to throw most of it away, and I've heard lots of people have success in stretching it out, assuming careful handling. If she has to stay on long-term, are the pens a better choice?
 
A vial can last 4-6 months...sometimes longer. The only reason they say it's only good for 28 days is because that's all the manufacturer asked the FDA to test for!! The way to know if your current insulin is losing it's efficacy is to home test....if the numbers start to creep up without any other explanation, it's time to suspect the insulin is going bad.

Most of us are buying our Lantus from Canada because the price is so stupid here in the US. The pens are definitely the better buy because each pen only holds 300 units (versus 1000 units in a vial, so unless you have a high dose cat, even if it lasts 6 months you end up throwing a bunch away)

Here's the information on buying insulin from Canada

The pens come in a box of 5 and the "unopened" pens are good until the expiration date on the box...usually at least 2 years away!

We don't use the special needles designed for the pens. You just use regular insulin syringes and pull the insulin out of the pen.
 
KatHas said:
I saw a separate thread on this, but if anyone wants to chime in with a recent opinion.... How long does a vial of Lantus last? I can't afford $100 every month just to throw most of it away, and I've heard lots of people have success in stretching it out, assuming careful handling. If she has to stay on long-term, are the pens a better choice?
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Hi KatHas, we're on Day 64 of our bottle and probably have 1/3 left. We started at 0.5U, went up to 5.5U (much higher BG numbers that your one reading at the vet), and now are down to 0.75U.

I agree with everyone that home testing will help you understand what's going on. Perhaps your cat has other issues if the vet's saying hyperthyroidism (you could post your labs with your personal info stripped off if you want people to take a look)?

If you want to home test for BG, most FDMB users recommend a human meter and strips due to cost. Bonus: You can test yourself and your family! Almost all of the numbers/spreadsheets on here reflect those human meter numbers. You can pick up a Relion Confirm at Walmart for $15 and 100 strips for $35 (or just 50 for $20). You'll need lancets to poke your kitty's ears and get a tiny drop of blood for testing. There's a nice thread on that if you search for "ear pricks" on FMDB, including video. I'm a fan of the ReliOn 26 gauge lancets (usually in-stock at my local Walmart) although we started with Freestyle 28 gauge. I use a doubled up makeup cotton pad behind his ear and poke his ear from behind (AKA, the cat's looking away from me). You are poking a very shallow poke into a tiny area of the ears, so my cat doesn't even mind it (he comes down the stairs when he knows it's time). I always reward him with a few bits of freeze dried chicken.

My cat started out at 0.5U of Lantus at 483 (measured at the vet), so your cat's measured 210 does not seem like a very high number. It's not great, but you may find that at home your cat is testing in high normal (blue) ranges. At that point, perhaps addressing diet may be a good start for you as suggested above. We changed to Dr. Elsey's Clean Protein at first (low carb at 4%), and my cats really took to that. We subsequently changed to Young Again Zero Carb (with accompanying digestive issues). We are going to attempt to go back to Dr. Elsey's now that his BG numbers are blue/green.

Good luck figuring out your treatment path. It sounds like perhaps a second opinion of lab results could be beneficial.
 
Maybe you can wait for a bit, stall with the insulin a few days and see how the diet change affects her BG. Hopefully by the time this new diet settles, she wont be needing insulin or maybe start on a lower dose. :bighug:
 
Hi @KatHas ... Hope you are hanging in there on dialing in your diagnosis. We look forward to hearing back!

BTW, I should mention I had a kitty previously diagnosed with hyperthyroidism. He lasted for two years on 2 pills a day and led a good long life.
 
Is your vet treating the hyperthyroidism? Not to throw a brick at your vet, but hyperthyroid can cause your cat to have symptoms similar to diabetes and throw off fructosamine values. I'm not suggesting that you don't treat the diabetes. It can also cause insulin resistance. You need to have the hyperthyroid condition treated which could result in your cat being in remission.

 
Sienne and Gabby (GA) said:
Is your vet treating the hyperthyroidism? Not to throw a brick at your vet, but hyperthyroid can cause your cat to have symptoms similar to diabetes and throw off fructosamine values. I'm not suggesting that you don't treat the diabetes. It can also cause insulin resistance. You need to have the hyperthyroid condition treated which could result in your cat being in remission.
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Yes, I've already started her on thyroid medication. Going to pick up the meter now, I'll post her initial numbers tonight and tomorrow. You guys are making me feel much better about the whole prospect, thank you!
 
First reading, pre-feeding tonight (about 7 hours since she was last fed, though she grazes all day), is a whopping 69. :cat: I'll be testing a few times a day for the next little while but that number is not alarming, so good sign I guess!
 
JanetNJ said:
Now that you’re testing, please set up a spreadsheet

http://www.felinediabetes.com/FDMB/threads/fdmb-spreadsheet-instructions.130337/
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I'm a little unclear how to use that spreadsheet if I'm not giving insulin, but I will record the readings I'm getting by date and time, as well as feeding times. In the three readings I've taken since yesterday I've yet to see a level over 100. I used the same meter to test myself a couple of times, just to make sure it's not totally wonky, and I'm getting normal values.
 
KatHas said:
I'm a little unclear how to use that spreadsheet if I'm not giving insulin, but I will record the readings I'm getting by date and time, as well as feeding times. In the three readings I've taken since yesterday I've yet to see a level over 100. I used the same meter to test myself a couple of times, just to make sure it's not totally wonky, and I'm getting normal values.
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Wow that’s great
 
KatHas said:
I'm a little unclear how to use that spreadsheet if I'm not giving insulin, but I will record the readings I'm getting by date and time, as well as feeding times. In the three readings I've taken since yesterday I've yet to see a level over 100. I used the same meter to test myself a couple of times, just to make sure it's not totally wonky, and I'm getting normal values.
Click to expand...

Hopefully you're just on the hook for treating the hyperthyroidism, which in my experience is a lot less complicated... Good luck, @KatHas!
 
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