Lantus advice

Maymay

Maymay

Member Since 2018
Hi,

I have been posting in the main forum and was advised to post here, since you're the ones with the Lantus knowledge and might be able to give me some good feedback on his numbers. To make a long story short. Orlando was diagnosed on his 10th birthday, October 10th last year. He went through Caninsulin, Prozinc and then Lantus without reacting to any of them.

I found the this forum in December and decided to take matters into my own hands with the "Start low, go slow" method. Since Friday we've been in the hands of a specialist at one of the AniCura animal hospitals here in Denmark where we live. She immediately set up his dosage, and said it had been too low all along*, but she wasn't optimistic about his future. He's had terrible neuropathy almost right from the beginning (on all four legs) and has lost almost all muscle mass in his hind legs. The specialist said she'd never seen such a severe case and she was doubtful he would be able to recover from it.

Right now we're waiting for results of the blood tests she's running. She's also conferring with a colleague and their physiotherapist, and should get back to us some time this week.

For the whole, longer story, here's a link to my thread in the main forum: Orlando's story

We have been struggling with BG testing all along, but I am managing to get a few in, and his numbers are unfortunately still awful. When we were there, the specialist did feel pretty confident that she could get in within the 5-15 mmol/liter range (90-270 mg/dL range) with Lantus.

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* She set the dosage at 1/2 unit per kilo. He's lost a lot of weight and now weighs just 8.4 kilos, which is less than he should be weighing (He's a big Maine Coon). Specialist said it's important to keep the weight on him and to just give him whatever diabetic food he prefers, so since Friday, he's been eating more RC diabetic than usual.
 
Welcome. You got a lot of good advise on your previous post.

Definitely start the B12 (Zobaline) Gizmo was almost as bad as you describe. It isn't an over night cure but the neuropathy did resolve and he regained his muscle mass.

On testing.. what worked for us was testing in one location (back of couch). That was where he got his tests and he knew it. He learned the "command" "hold still" lol. I had another spot where he got his shots. I used both exclusively .

Keep posting, read the stickys at the top of the forum. Lots of beans (humans) here to help. :bighug:
 
Welcome to L&L! Lots of people here will chime in to help you and Orlando. :)

Hope to see your posts and that your testing will become more regular. I know it's hard at first - it is for everyone - but you'll both get the swing of it - promise! Luci was so awful at the start that it took two of us - I was completely exhausted after every session - and they were indeed sessions. What takes me now a minute to do - would require 15 minutes to a half hour to get her to be still, stab her ear, try to catch blood on a tiny stick...yes it was awful. In the beginning. So take heart - with practice comes familiarity. Luci always got a treat after participating - whether we were successful or not - and fortunately for me Luci likes to eat - and soon associated the tests with food - now she jumps up on the testing towel for me - often waiting there for me! I was in awe the first time she did that!!! She has learned and many times purrs right through the poke (remember it's all about the food)...not what's going on at the moment...

If you could post tomorrow like this 1/16 Orlando AMPS ### - it would be very helpful for all the peeps here to be able to help you. Add your thread from today by copying/pasting the url at the top into your thread for tomorrow. Only one thread (aka condo) is allowed per day.

Hang in there and welcome! :bighug::bighug:
 
Thank you both for the warm welcomes! I'm so touched. :bighug:

After a lot of training, Orlando is all purry as well with the testing, until I actually poke him. Sometimes he's cool about it, other times he's like "What are you doing, woman?!!??" If we could get down to the one poke per test, I think we'd be okay. Getting it down to one minute sounds like a dream. Right now I'm setting aside 15 minutes every time.
 
I would urge you to find a food -- preferably a canned food -- that's lower in carbohydrates than RC. The entire Royal Canin line is high in carbs. We encourage members to select foods that are less than 10% carb and most of us are able to find foods that are under 5%. These are "as fed" values and not guaranteed analysis values -- the latter give you minimums and maximums versus an accurate amount for nutritional information.

The jump to 4.0u may be a problem. Unfortunately, too little insulin and too much insulin can look the same. With Tight Regulation, the starting dose of Lantus is based on weight: initial dose = 0.25 x ideal weight in kilograms. Not knowing what your cat's ideal weight is, this may give you a better sense of dose.

It's also important to be testing on a daily basis. You don't know if Orlando is actually seeing some lower numbers and his body overreacts and bounces back into the higher ranges. If you can give him a low carb treat each and every time you test, it may go a long way to desensitizing him to testing.


 
Maymay said:
If we could get down to the one poke per test, I think we'd be okay.
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You will! Did you watch the video on where/how to poke? That little sweet spot on the edge of the ear does render that precious blood drop easily...didn't seem so at first - but now it's pretty easy. We use a rice filled sock that I warm for a few seconds in the microwave to place under her ear flap to warm and support it (the DCIN kit also includes a rice sock :) - I just ran across that info while I was looking at what they do with the donations - that's another story)...for now - we use the warm sock, hold it under her ear - protects my finger (yeah) and she seems to like that warm sock - she gets a little massage with it just before we get down to business - I rub it on her head and her shoulders...who knew she'd enjoy that??? Then the poke - dab the test strip on there - place tissue on blood to stop it and I always use antibiotic ointment (which Luci tries to eat)...she really loves the smell of that stuff! Anyway...that's our method - there are others. Keep reading the condos and look at the SS's of others - lot of people on here with a variety of experiences - all are happy to share - it's a journey :)
 
Thank you for your advice. I appreciate it.

I was told about the RC in here. I've been trying to switch him to canned food, but he's picky. So far we've gone through six types/varieties. The only wet food I can get him to eat in any noticeable amounts is Kattovit. I've also tried to supplement with a bit of fish, chicken etc. but nope. He's never really liked anything but his dry food, unlike our other cats.

I used to use the RC as treats only with the BG testing, grooming etc., as it's his favourite, but the specialist said he's lost so much weight to just give him the RC for now. Apart from making sure he eats enough, my feeding priority is still wet food --> Hills m/d --> RC diabetic.

The jump to 4.0 units was following the specialist's orders. I did read about too fast increases when I started the SLGS method, and I'll take it up with her when she calls, seeing how his numbers are now.

Orlando's ideal weight is probably around 9.2-9.5 kg. My main problem with the BG testing is that he's not bleeding, and then yes, he gets fed up with all the poking. Apart from the cooperation going downhill, he also has this thing where he goes off his food if he gets messed with too much. He already doesn't like the diabetic food and rarely just eats it on his own, unlike before. I luckily mostly work from home, but I've had to change my sleep schedule to make sure he doesn't go too long without food.

On a good day, I'm spending maybe 1-2 hours a day hand-feeding him and offering him wet food (which is apparently inedible unless it's completely fresh out of the can), on the bad days we're looking at maybe 3 hours without hitting his ideal daily intake. Normally, I'd be like "He'll eat when he gets hungry", but with a diabetic cat that's of course not really an option.
 
Hi Sue,

Hopefully we'll get there! I think I'm an expert on paper on how to poke. Spent hours watching videos and reading articles. If only the praxis followed the theory! Here's what I'm doing:

1. Warm up kitty's ear (I either use small Pinewood heat pads or heat up my own hands on the radiator) and massage it (he likes this part). Don't poke until ear is nice and toasty
2. Rub on a bit of Vaseline for droplet to form
3. Switched to 25 G lancets
4. Poke in the sweet spot
5. Try to massage a droplet out (sometimes it helps waiting a little for drop to form)
6. Do the double poke thing if the first poke doesn't bring results, which often doesn't bring any results either, same thing also often happens with subsequent pokes - and at some point he's just had enough of all that. Plus I don't want to turn him into a pin cushion.
7. Put pressure on ear afterwards
 
A lot of people on this forum (and probably rightfully so) recommend starting low and going slow, but for some cats that just doesn't work. If he's this high, you need to bring him down. Not all veterinarians are dummies when it comes to feline diabetic care. Sometimes it's best to listen to your vet and see what happens. Max started at 1 unit and now he's up to 5 units and I'm just starting to see positive results. If we had started at 4 or 5 instead of 1 maybe he wouldn't have developed the neuropathy in his hind legs. But then that is quite a high starting dose so I can see why my vet didn't start him there. I probably would've freaked if he'd told me to start at 4 units, but at the time Max's diabetes hadn't progressed nearly as much as Orlando's.

I'm a new diabetic cat mom, so I'm sure these guys know their stuff, but every cat is different and I think your treatment plan should depend on the results you're seeing. I'm so sorry you're going through this. It's crazy stressful!

Edit: I've never rubbed Vaseline on kitty's ear. I feel like that would slow the blood coming out if anything? Like I said before, I love my lancet device. I use the Relion from Walmart (it's a blue stick-type thing) with the ultra thin 30g lancets, set on the deepest poke setting. Yeah, the deepest. There are five settings and I thought the first (most shallow) setting would be best, but I wasn't getting results until I set it on the deepest poke setting. I use a cotton pad underneath the ear for some counter pressure and that helps a lot. Warming the ear also helps, but Max's ears are usually pretty warm anyway so I can usually skip that step.
 
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I found using ointment on the ears helped the blood bead up better. Otherwise it would sometimes just spread into the fur, or I couldn't even see the blood.
 
majandra said:
I found using ointment on the ears helped the blood bead up better. Otherwise it would sometimes just spread into the fur, or I couldn't even see the blood.
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And the ointment being mixed with the blood doesn't affect results at all?
 
Giom: Yes, it really seems to be a trial and error thing with the BG measurements. I tried with the lowest setting as well on the lancet device and saw no results, ended up with the highest - and no results either. At one point I actually poked all the setting through pieces of paper to see if the thing was actually working at all (it was).

It's not my impression that the Vaseline stops the blood from coming out. I smear on a very thin layer.

Yeah, the specialist was telling me that every cat is different. She told me about one of her other cat patients who weighs 5 kilos, is one a very high dosage for his weight, and has been doing brilliantly for years.

And likewise. It is hard. I'm not exactly new to this as I have another cat, Murphy, with diabetes (in remission), but he reacted beautifully to a 1 unit dosage of Caninsulin, and the only reason we found out he had diabetes was that he suddenly became nauseated. Orlando is a whole other ball game, though.

majandra: What kind of ointment are you using?

I won't have the time to try to run a real curve until Friday, but will try to get a few measurements in until then. Need to go to the hospital for my own medicine and blood test, which is much easier done on me than the cat...ha!
 
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I use an antibacterial ointment with pain relief.
I just put a really thin layer, and have found no differences in glucose readings when I use it vs when I don't.
 
I'm sure you tried this but I have to ask: did you try poking at different parts of the ear with the lancet device? Sometimes even on the highest setting I won't get a decent poke, but if I move up or down along the edge of his ear or even try a different ear, I can almost always get blood with another poke or two. I know, it sucks having to poke our sugarbabies all the time, but I honestly couldn't get ANY results trying to just use a lancet and poke myself. I tried that first and I was poking at his ears and he was fighting and I wasn't getting any blood. Once I got the hang of the device though it became super simple. Also: the amount of pressure and counter pressure you apply can affect lancet device results.

Edit: just had to poke my boy about 6 times! :'O He was getting pretty antsy. Got it though. Some tests are easier than others!
 
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Yup, tried that. Even did one in the middle on the inside of the ear as I saw a video where they did that (and I could see they applied a lot of pressure, because the kitty had a "ring" mark on his ear from where the device had been pushed against it).

And it does suck having to poke them. It would be so much easier if they could get a glucose monitor implant like with humans. I just read about one that only needs changing every 180 days.
 
Try and leave the Lancet devise on the ear after you poke. Keep it pushed down for a few seconds. Then try and "milk" the ear, rubbing towards the poked area with you fingers (thumb is what I used) and don't be afraid to apply pressure when doing this.

It will get easier.

I don't know why but once I got a lancet devise with a clear cap I was finally able to get better results. I even bought two extras because I preferred them.

https://smile.amazon.com/gp/product/B07582777F/?tag=felinediabetesfdmb-20

51qUuuvLgGL._SX522_.jpg
 
Sienne and Gabby (GA) said:
Just so you have the information, Royal Canid and Hill's, even the diabetic food, is extremely high in carbs. Both brands are contributing to Orlando's high BG numbers.
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I'm really sorry to hear that even the Hills is too high. I'm basically buying whatever diabetic dry food I can find here, and so far Hills has the lowest dry food carb content I could find. I can see there's a Young Again brand in the U.S. with great carb numbers, but they aren't sold in Europe and don't ship to Europe either. Any help will of course be very appreciated.
 
Aaaand we seemed to have cracked the blood sampling code! Sheer coincidence. It started this morning where I went through the usual: warm up kitty's ear, massage kitty's ear etc. Did a double poke with no blood whatsoever. Then I thought, "let's just warm his ear a little more before poke three". I put the heating pad back on the inside of his ear, and behold! A droplet formed on the outside from one of the previous pokes. I've done two tests after that and each time was a hole in one with very little fuss from kitty.

I'm so chuffed. Now if only his numbers were good.
 
The specialist just called, all his numbers are fine. His pancreas numbers are slightly elevated, but so insignificant that it should not be causing the problem. There are no signs of infection or other underlying problems.

I spoke to her about the rapid dosage increase, but she said that considering his numbers, we were taking it "slow"... to go up one unit tonight, and do a BG measurement later to check his levels. I know the protocol in here is different, and I do respect that and see the reasoning behind it, but I have decided to follow her instructions (at least for now), as she is the expert, and that yes, every cat is different.

She could not explain why he's walking better, but said that neuropathy often behaves unpredictably. She still needs to speak with her colleague and the physiotherapist, so we'll speak again next week for a follow up.

Another update is that the Zobaline I ordered was stopped in customs. Hence the delay. They're holding them until I pay the customs and handling fees, which are about as much as the Zobaline + shipping. Ugh. But so be it. Hopefully I can have them within the next couple of days.
 
Maymay said:
Aaaand we seemed to have cracked the blood sampling code! Sheer coincidence. It started this morning where I went through the usual: warm up kitty's ear, massage kitty's ear etc. Did a double poke with no blood whatsoever. Then I thought, "let's just warm his ear a little more before poke three". I put the heating pad back on the inside of his ear, and behold! A droplet formed on the outside from one of the previous pokes. I've done two tests after that and each time was a hole in one with very little fuss from kitty.

I'm so chuffed. Now if only his numbers were good.
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I always warm on the inside of the ear. I use an small, empty medicine bottle and his ear "wraps" perfectly around the round shape of the bottle. Others may have said this but typically the ears to "learn" to bleed better over time. Regardless, no matter how good you get at getting a blood sample, some days just throw you a curve ball. 90% of the time, I get blood on the first poke. Then, out of nowhere, I need 5 pokes to get blood. I hate it and I know my cat hates it but I just have to give him a little extra love and remind myself that it sure beats the alternative.

Hang in there. Glad you found this wonderful group. I'm still pretty new to all this (joined the group back in July) but I am certain my cat would be dead if not for the knowledge, advice, and support from the folks on this forum!!
 
Yes, I warm both sides as well. I have been told that the ears will start bleeding better with time, and I know there are many in here for whom it's just become a quick routine and no big deal. :)

I'm really happy to have found this group as well, only wish I'd found it sooner! People are just so nice in here. Their support and experience has definitely helped give me some peace of mind and a ray of hope.
 
Maymay said:
Hi Tanya,
Yes, I do test for ketones here and then, but not daily. He's had normal values so far.
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That's good to hear!
His numbers are so awful - I would test every pee to insure survival.

As you know, eating dry - especially RC and Hills - put cats in tremendous danger.
Let alone getting regulated. Makes it almost impossible.

Glad to hear Orlando is ketones free now.
I hope the trend stays. :)

Very best wishes to both of you!
@Maymay
 
Thank you. I'll test him more regularly. Just did one and it was luckily fine.

Yeah, I would love it if he'd eat just wet food. Just getting him to eat enough is a struggle, though. He's lost too much weight already. I spend a lot of time every day hand-feeding him and encouraging wet food eating. Basically to him, the more carbs the better. Hopefully we'll get there one day. At least now he's eating a little wet food, whereas he barely touched it before, although he's been fed wet food every night together with out other cat ever since we got him.
 
Good luck with the food transition. We had one kitty here on 5.5 units of Levemir, and when his mom banished dry food from the house, he went off insulin in three crazy days. It can make a lot of difference.
 
Maymay said:
Thank you. I'll test him more regularly. Just did one and it was luckily fine.

Yeah, I would love it if he'd eat just wet food. Just getting him to eat enough is a struggle, though. He's lost too much weight already. I spend a lot of time every day hand-feeding him and encouraging wet food eating. Basically to him, the more carbs the better. Hopefully we'll get there one day. At least now he's eating a little wet food, whereas he barely touched it before, although he's been fed wet food every night together with out other cat ever since we got him.
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Which dry food and wet foods do you feed? Sometimes what the cats are interested in, rather than carbs, is the coating that gets put on the food to make it more palatable.
 
He gets Hills m/d (barely edible according to him, but more edible than wet food) and RC diabetic (edible). Both are the lowest carb dry food I've been able to find here. He definitely has a thing with the coating. If he has licked a kibble, but not eaten it, then it becomes inedible. Crumbs are also not edible.

Wet food I'm feeding Kattovit. Sometimes he'll eat it, sometimes he'll snub it. The most he's ever eaten in one day is 1 1/4 can, but typically he'll eat 0- 1/2 can. I've also tried Hills m/d wet food (not edible at all) and four different varieties of Integra wet food (of which he will maybe eat a mouthful out of each opened portion). I've also tried boiled chicken thighs and fish, but nope. He'll eat a tiny bit and that's it. Even canned tuna (which they obviously don't get very often) doesn't hold much of an appeal. We also had a oil spray once from the vet for skin health to help address Murphy's allergies, and while Murphy loved it, Orlando wasn't excited.

He used to free-feed with no problems, so it's pretty frustrating for both of us, albeit for different reasons.
 
I am so glad testing is getting easier for you, as it's the key to managing his treatment. I had a terrible time at first, but this group and a lot of trial and error have made it easy. We all find "hacks" that help, usually by reading posts here. Once I started getting blood, my tremor made it very hard to hold the test strip and meter to his ear to get a reading. Then I read that you can actually transfer the blood to a clean fingernail and test from there. Bingo! Four months in, and Sammy runs to our test spot when I sing our special song (another tip from here, singing relaxes us both) because he love his freeze dried chicken treats. On the food issue, Sammy had had nothing but dry kibble all his life, and I worried about the transitiin. But he'd always shown an interest in grated cheddar cheese, so I sprinkled some of that on top of the pate. It worked, and within a week he was devoted to wet food. I don't need to add cheese anymore. Finally, good luck and hang in! It's tough at the beginning, but so rewarding to know you are helping your kitty enjoy life again.
 
Thank you. :)

I don't sing, but do a little rhyme instead. I've used it for all my "fake" testing and it does seem to relax him. I'll try with the cheese! He does love cheese pockets, which he obviously haven't had in a while.
 
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