? vet just prescribed lantus, but... (advice?)

[LexaJoy]

Hullo! I'm Joy, and my Sherlock was diagnosed in July with diabetes. We haven't done insulin until now for a few reasons, but now we're post-surgery, settled on wet food, and mentally ready to do this thing. I think.

The vet prescribed lantus for us, but his instruction was to go with 2 units once daily and see how the numbers go. I'm a little perplexed, since reading here, I see a lot of lower starting doses, and twice daily seems to be the regular order of things. I did have a diabetic kitty two years ago and he was on vetsulin twice daily, so I don't quite know what to make of these instructions. When I cautiously questioned him, he said that 2 is a pretty typical starting dose and he's got some cats that are fine on a once daily schedule, so give it a try and see how the numbers shake out before making adjustments.

Advice? My intention was to go with the SLGS method that I've read about here, and that starting dose is significantly lower than the 2 units the vet suggested. Because I did previously lose a kitty to mismanaging his diabetes, I want to be very, very cautious and do the right thing now. Thank you in advance for any direction in getting us started on the right foot.

 

[Sandy and Black Kitty]

Hello and welcome!

How did you discover Sherlock was diabetic?

You have done your homework and yes Lantus is dosed every 12 hours. Consistency in dosing times and amounts are key.

Good job on the ss.

Looks to me like you are ready to go with SLGS. Its a time honored method but if you find its not the right fit you can always switch to TR.
So if Sherlock is eating exclusively low carb wet the starting dose is 0.5u BID.

Lantus is different than vetsulin so if you have not already done so put the way you worked with vetsulin out of your mind.

Always get a BG test before you shoot, for safety sake. Plan on at least one mid-cycle test each and every cycle
Varying the timing on the mid cycle tests will help you figure out how low a particular dose is taking your kitty-very important as Lantus dosing decisions are based on nadir values.

Your priority is to Know Thy Cat ...get to know how Lantus works for your kitty: how many hours until onset, how many hours until nadir, how much duration a dose provides...
Armed with that data you will be able to make the best dosing decisions for your kitty.

Many of us have gone up against the recommendation of a vet (or 2, or 3) Hopefully yours will partner with you in your decision to follow SLGS .

If you have all the required supplies dive right in. Plenty of experienced folks here to help you along every step of the way

 

[Bron and Sheba (GA)]

Hi Joy and Sherlock. I think I met you over on the introduction page.
Our most important thing here on the forum is to keep kitty safe, and we will help you do this.
You are correct. Lantus needs to be given twice a day because cats have a faster metabolism than humans and they need it every 12 hours.
I would change the dose and give 0.5 twice a day. Stay on that dose for 7 days testing before EVERY shot to see it is safe to give the insulin. If you can test between the shots at about +4 to +7 (alternating the times each day) to get an idea of how low the dose of insulin is taking Sherlock.
We decide on the dose on the nadir ( the lowest point in the cycle) so it is important to get these inbetween tests.

Have you been testing for ketones in the urine? I would go out and buy a bottle of ketostix from Walmart or a pharmacy and test as per the instructions on the bottle. Ketones are dangerous and it is easy to check for them and nip them in the bud.

Giving low carb food and testing the blood sugars are great. You are doing well.
I don't think your vet knows a lot about feline diabetes, maybe you might want to look around for a vet who is knowledgeable FD
Bron

 

[Phoebes (GA)]

Joy welcome. Sandy has given you some sound advise. Do you plan to test at home? That will surely give you the tools to keeping your furbaby safe. most vets do not get alot of training on diabetes seeing how they have to learn so much about all the different species. Alot of people here know much more than most vets in my opinion (for what it's worth) I was one of those who had to learn that my wonderful vet of 20 years did not know awhole lot about it and had to go against her advise. She treats everything else, and I do the research and work on the diabetic front. If you look at Phoebes ss you will see our journey. It's been hectic, but everyday you come here and learn something new in helping our babies to be healthy and I have formed an even deeper bond even with all the pokes and proddens. Once again, welcome to the best place you never wanted to be. (Someone else said that) the stickies at the top of the threads are your friends.

 

[Beck and Philly]

You've already received excellent advice above so I'll just say Welcome! Your profile pic is adorable.

 

[LexaJoy]

Hello and welcome!

How did you discover Sherlock was diabetic?

If you have all the required supplies dive right in. Plenty of experienced folks here to help you along every step of the way

Hullo! I had taken Sherlock in to the vet because he had a growth on his chin and I was hoping to get it removed, so when they ran his pre-surgery blood panel, they found his BG was high. It was difficult to do anything about it to start because they wouldn't do the surgery until his numbers were better, but also were concerned about being able to do surgery if we started insulin since he'd have to fast to be safe under anesthetic and was a whole mess, but. We switched food to get the numbers down and stable and now his chin's all better.

Thank you very much for weighing in!

 

[LexaJoy]

Hi Joy and Sherlock. I think I met you over on the introduction page.
Our most important thing here on the forum is to keep kitty safe, and we will help you do this.
You are correct. Lantus needs to be given twice a day because cats have a faster metabolism than humans and they need it every 12 hours.
I would change the dose and give 0.5 twice a day. Stay on that dose for 7 days testing before EVERY shot to see it is safe to give the insulin. If you can test between the shots at about +4 to +7 (alternating the times each day) to get an idea of how low the dose of insulin is taking Sherlock.
We decide on the dose on the nadir ( the lowest point in the cycle) so it is important to get these inbetween tests.

Have you been testing for ketones in the urine? I would go out and buy a bottle of ketostix from Walmart or a pharmacy and test as per the instructions on the bottle. Ketones are dangerous and it is easy to check for them and nip them in the bud.

Giving low carb food and testing the blood sugars are great. You are doing well.
I don't think your vet knows a lot about feline diabetes, maybe you might want to look around for a vet who is knowledgeable FD
Bron

I have not been testing for ketones, but I will need to run to Wal-Mart anyway to pick up a new set of test strips for his meter, so. It all works out. I'll add them to the list, thank you! I did just switch vets once, and this one is a lot less... erm. Intense than the last one, which is good. I'm just grateful he isn't talking a whole bunch of curves and tests and things that I think I can do at home without stressing him out at the vet.

 

[LexaJoy]

You've already received excellent advice above so I'll just say Welcome! Your profile pic is adorable.

Thank you! That's my Sherlock (the gray kitty) and his brother, Moriarty, sticking his face in on the side. They're my boys.

 

[LexaJoy]

Joy welcome. Sandy has given you some sound advise. Do you plan to test at home? That will surely give you the tools to keeping your furbaby safe. most vets do not get alot of training on diabetes seeing how they have to learn so much about all the different species. Alot of people here know much more than most vets in my opinion (for what it's worth) I was one of those who had to learn that my wonderful vet of 20 years did not know awhole lot about it and had to go against her advise. She treats everything else, and I do the research and work on the diabetic front. If you look at Phoebes ss you will see our journey. It's been hectic, but everyday you come here and learn something new in helping our babies to be healthy and I have formed an even deeper bond even with all the pokes and proddens. Once again, welcome to the best place you never wanted to be. (Someone else said that) the stickies at the top of the threads are your friends.

Hullo! I have been home testing since July, since they wanted his numbers more stable to do his surgery. It wasn't a terrible learning curve, and I do wish I'd known it was an option for my last diabetic kitty, who we lost a couple of years ago to a hypo event. I'm very, very hopeful that we can do better for Sherlock so he can live a long, happy life. Now we've just got to move to pre-shot testing daily, instead of weekly just to make sure our numbers are still steady. He's been a sweetheart about all the poking, though, so I think we're in a good place to start!

 

[Phoebes (GA)]

I do wish I'd known it was an option for my last diabetic kitty

I am so sotry about your other sugarbaby. Yay to home testing, you're already half way there.
Being a sweetheart is awesome as well. I have one of those too ask any questions you need, nothing is a stupid question here. Someone will be able to answer or at least point you in the right direction. Welcome to the dance. A pair of patience pants are always handy too. Lol

 

[Rosie & Bailey]

Welcome! Love your kitty photo!

 

[Gill & George]

Hello and Welcome to you and Sherlock,

I love the profile pick of your two babies and love their names, hope they are good pals and not mortal enemies though.

Great job with the SS, you've had some great advice, and after your experience with your first sugar cat (so very sorry about that) I can understand why you would want to take it slow.
Now you've learned to hometest, you have the tools to keep Sherlock safe.

Now we've just got to move to pre-shot testing daily, instead of weekly just to make sure our numbers are still steady.

I know that you are going to do SLGS, which as a minimum requires PS testing and a weekly curve, but I would suggest, if your schedule allows, to get at least one more test in each cycle. It will make the BG picture clearer and make you more confident when you have to make a dosing decisions. Spot checks when you can get them and a weekly curve will give you a more complete picture of your boys overall bg.

 

[Sue and Luci]

Hello and welcome to the forum! You're off to a great start! We kinda started the same way - so much to learn - but you've had previous experience so you had one up on me - unfortunate to read about your poor kitty though...with that said.

I just have to share - it seems like every vet wants us all to start at 2 u. That's like a magic number for them - maybe not for our kitty?? I too was sent home from the vet with the very same instructions - nothing about testing before I gave her a shot though - just give her 2 u twice a day - I went home and like a 'robot' shot 2 u...at 2 in the afternoon - and then started reading on this forum that the next shot was 12 hours later - uh oh. And that wasn't going to work out ....

So with lots of stumbling and fumbling and help from a lot of people here on this forum we managed to get Luci going on the right road...and she's still on it...yes it's nearly a year since her diagnosis - and 10 months since we started down the Lantus road to remission...it's a journey...so glad she's still with me to talk about it...

So, with that said, we'll be seeing you here on the forum as you post your questions and comments. It's a great group! Lots of great people here to help and sometimes just to listen and support. Try to look at other condos (the posts where people converse about all things kitty)...lots of information in there as well - you can pick up tips.

Your pic is adorbs. Wish my two cats could get along - not happening - we're a divided household and one stays out (well now in the garage or greenhouse) and the other Miss Queen Bee Luci is strictly and indoor cat.

See you around the forum...lots of good advice above - so big welcome!

 

[Rosie & Bailey]

know that you are going to do SLGS, which as a minimum requires PS testing and a weekly curve, but I would suggest, if your schedule allows, to get at least one more test in each cycle. It will make the BG picture clearer and make you more confident when you have to make a dosing decisions. Spot checks when you can get them and a weekly curve will give you a more complete picture of your boys overall bg.

This is such great advice. Bailey was diagnosed in July 2018, and I am a testaholic now (will work on that addiction for the sake of kitty's ears) but being able to look at her spreadsheet and look for patterns is really helping me to understand how her body works. I am especially trying to understand how long it takes for the insulin to work and how long it takes to get her to her nadir. The info I'm learning and the support on this forum gave me the confidence to shoot her lowest number ever, which is not that low compared to the other brave souls on the board, but I did not have the confidence to do even that just a few weeks ago.

 

[LexaJoy]

Hello and Welcome to you and Sherlock,

I love the profile pick of your two babies and love their names, hope they are good pals and not mortal enemies though.

I know that you are going to do SLGS, which as a minimum requires PS testing and a weekly curve, but I would suggest, if your schedule allows, to get at least one more test in each cycle. It will make the BG picture clearer and make you more confident when you have to make a dosing decisions. Spot checks when you can get them and a weekly curve will give you a more complete picture of your boys overall bg.

Aw, no. My boys get along just fine. They're brothers from the same litter, and usually good about cuddling each other. It's my outside kitty, Dru, who is the troublemaker when she visits.

Right now, my plan is to do testing/shooting/feeding around 3:30, twice daily. (My schedule is bizarre, but I work mental health crisis, so, can't be helped.) My wife doesn't leave home until around 6:30 or 7, so I'm hopeful that she'll be able to get a test in before she goes. She's a lot more squeamish than I am and so far, shots and testing have always been up to me, but. This is a team effort and I've got faith in her to make it happen. Then the second shot, I'm pretty home for and can test as needed until bed, which is usually around 10. I'm hopeful that it's a good schedule.

Random inquiry, for fooding purposes- we've been eating little meals through the day and I can't free feed or the dog will gobble everything up. Are little meals still okay, or do we need to swap to big meals before shots and maybe a treat or nibble somewhere in the middle?

 

[LexaJoy]

Hello and welcome to the forum! You're off to a great start! We kinda started the same way - so much to learn - but you've had previous experience so you had one up on me - unfortunate to read about your poor kitty though...with that said.

So, with that said, we'll be seeing you here on the forum as you post your questions and comments. It's a great group! Lots of great people here to help and sometimes just to listen and support. Try to look at other condos (the posts where people converse about all things kitty)...lots of information in there as well - you can pick up tips.

Your pic is adorbs. Wish my two cats could get along - not happening - we're a divided household and one stays out (well now in the garage or greenhouse) and the other Miss Queen Bee Luci is strictly and indoor cat.

See you around the forum...lots of good advice above - so big welcome!

Thank you so much! This forum is what is giving me the courage to try again. After losing my first kitty, I honestly didn't think I could do this again when they diagnosed Sherlock. Knowing I've got support here and people who can give me some direction, it's helped already tremendously.

 

[Gill & George]

Random inquiry, for fooding purposes- we've been eating little meals through the day and I can't free feed or the dog will gobble everything up. Are little meals still okay, or do we need to swap to big meals before shots and may

Good question.

With lantus little meals are preferable, usually we try to avoid feeding late in the cycle as this is the point when insulin is waning and adversely afeaff BG. I tried to not feed after +7, unless he dropped low.

The shot will onset at around +2 and peak around +6 so this is where you want to make sure there is food on board. What worked for us was main meal at PS, (3ounces) then 1 ounce at +1 +3+5. (After experimenting)
We have folk do a whole range of things it's just a question of figuring out what will work for you and Sherlock. I suggest you keep notes on what you feed when and that will help you make decisions, I kept a note on the ss for all to see, this meant that those with experience could see what I was doing and it was easier for them to help me find a better way to feed George.

The one golden rule is NOT to feed after +10, unless he was too low (ie. no food 2hrs before shot time). The reason for this is that you want to avoid the PS being food influenced, so you can be confident it is safe to shoot.

Getting your DW to help with tests will be invaluable for team Sherlock, we've had many spouses who have been squeamish, but somehow have found a way through it. Tell her we are cheering her on.