Sophie - diagnosed April 14. Adjust insulin?

[Celle]

Hi all,
Sophie is 14.5 years old, diagnosed mid-April.
Commenced on Lantus 2 units twice daily (approx 6 a.m. and 6 p.m.)
Diet changed to raw meat/fish and Fancy Feast Classic, plus an occasional small amount of Royal Canin Diabetic cat food.

Her highest BG was 26.8 mmol/L (482). This has come down to 19.5 to 11.9 (373 to 214) with one at +8 of 9.4 (169). She's mostly in the yellows or the low pinks.
She's feeling better in herself. She's stopped hiding in the cupboard all day, has come out, and is sociable again. She purrs a lot now, but she's still eating a lot (she's a grazer) and peeing a lot. Her coat looks in better condition.

We saw the vet on April 23 and he said to keep Sophie on 2 units twice a day for about another 2 weeks, as he expected her BGs to continue to come down. They haven't really (see spreadsheet).
I can't get an appointment to see the vet again until Monday.

I increased Sophie's insulin to 3 units this morning (the Lantus pen can only alter the dose one unit at a time) as I will be at home with her all day and I can keep an eye on her.

It still takes two of us to do the ear pricks. We've only been testing her BG once per day (vet's advice) but I will test her twice today , at +6 and PMPS.

An increase from 4 units to 6 units per day seems like a big jump, so I'll continue to give her 3 units in the morning and 2 units in the evening, making a total of 5 units in 24 hours, until we see the vet on Monday.

Does that seem reasonable?

 

[Bobbie And Bubba]

Hi and Welcome! So glad you found this site as there is a lot of good information and experience with diabetic cat here. Take a bow for learning to test your kitty's BG's . I know it's not easy with some kitties to be poked in the ear, but they do get use to it. Something you can do to get Sophie more comfortable with it, is to designate an area that will be the testing area. Take her to that spot. Rub her ears lightly and when she gets squirmy and had enough, let her go but give her a low carb treat. Lots of us use Purebites, dehydrated chicken or salmon as the treat or you can poach some chicken and cut it up into bite size pieces to give as a treat. Soon she will associate the ear rubbing with a treat. Do this a few times a day and then actually test her . It really desensitizes them to the testing.

Please always test your kitties BG prior to each injection. It is so important to know if it is safe to shoot insulin. First starting off, you won't be shooting anything under 150 until you have enough data to know how your kitty reacts to the dose. With out testing her first you don't know if it is safe or not.


Also, a lot of us, myself included use the pens, but we don't use the screw on needles because 1: you can't do a dose in between a unit and 2. they are cumbersome to use. So, what we do is get U100 syringes and we draw out the amount of insulin so we can draw in increment of .25 of a unit which is what we suggest to increase and decrease by. Anything over .25 of a unit can easily have you go over the best dose and too much insulin can look like not enough insulin.

A lot of kitties go lower during the PM cycle. So, getting a test in at least before you go to bed to make sure she is safe. And during the AM cycle if you could get a mid cycle test to find how low the insulin takes her ( nadir) would be helpful so you will know how to adjust the insulin.

Your vet in so wrong with his advice to only test once a day, but then most of all of our vets were the same. Safety first. And if your weren't concerned, you would 't have sought out this forum. I am glad you are here.

As far as the dose for now, it's hard to know what would be a good dose as you don't have a lot of data. Some of those higher numbers could be from bouncing after she saw a lower number. Counter regulatory hormones get dumped by the liver to help bring them down. The more they stay in normal numbers the bouncing lessens. I know I am throwing a lot at you.

Read all the stickies at the top of the Lantus , Basaglar, and Levemir Support Group to arm yourself with more information.

How much does she weight and do you know what her number was when she was diagnosed?

Hoping some other eyes from veterans will be able to give an opinion about dose. But, I would definelty not increase any more until you have some more data. If it were my kitty, I would drop back to 2 units and get as much testing in to fill in the blanks on the SS to know how low the insulin is taking her.

Lantus needs consistency and you need to shoot the same dose in the AM as the PM or your mess up the depot and won't know if the dose is the right dose or not.

Please keep posting and asking question as that is how we all learn.

 

[Celle]

Thank you for the advice.
Since it still takes 2 of us to do a BG, I can't do an AMPS test - hubby is a zombie until about 9 a.m.

I don't intend to do frequent BG testing. Since Glargine is a long-acting insulin, I don't think it's necessary.
I'm a nurse and I have treated diabetic humans and my experience there tells me that more frequent testing is necessary with short-acting insulins, but not so much with the long-acting ones.
I also don't agree with adjusting insulin doses according to the BG, although I would withhold a dose if the BG was too low. I agree that the body needs to get accustomed to a consistent dose.


For us, it['s about quality of life for Sophie. She's an elderly cat and she hates the ear pricks. When we tested 3 times/day, she started to run away from us all the time. With testing once/day, she's happy and sociable. Keeping her alive won't be an option if the treatment makes her miserable.

We are going overseas for 4 months in mid-August and by then I cannot have a cat that needs frequent testing. The owner of the cattery is experienced (she used to run our local SPCA kennels and cattery). She has had diabetic cats before and giving insulin is not a problem, but she will only test twice a week. So, we have to get Sophie stabilized by early August.

 

[Bobbie And Bubba]

I'm a nurse and I have treated diabetic humans and my experience there tells me that more frequent testing is necessary with short-acting insulins, but not so much with the long-acting ones.

Here's the difference: Cats have a better chance to go into remission than humans. If you follow with Tight Regulation protocol ( which give a higher remission rate) or Start Slow Go Slow method ( SLGS) to adjust the dose according to the protocol or method , you can get your cat into remission. (Bubba has been off insulin 3 times and knocked out of remission to a bad tooth)

It's all your call and what you need for you and your cat. My advice was for optimum feline diabetic control and regulation.

Let us know how we can help you.

 

[Sienne and Gabby (GA)]

Celie --

We have nurses and vets and other medical professionals on this board. I'd urge you to look at members' cat's spreadsheets. There's 6.5 years of data on my spreadsheet along with instances where Gabby's numbers started at 400 in the AM, dropped into the 40s at nadir and zoomed back to the 400s by PM shot time. Yes, a Lantus curve should be flat but that's not always the case. Testing is the only way to keep Sophie safe.

I have a serious doubt that there is an endocrinologist that would tell anyone to test BG levels only once a day, regardless of which long-acting insulin a human is using. I have plenty of diabetic patients and there isn't one who tests only once/day.

And Bobbi is on point -- humans don't go into remission. Cats can and do.

 

[tiffmaxee]

When Max started insulin I said I would not test at home. I was taking him to my vet for tests at the beginning and when I saw he was at 60 my vet handed me the needle to test Max. Had I not tested I am certain he would have had active hypos that could have been deadly and he generally dropped low at night! I strongly suggest you get some tests mid cycle and before each shot and see what your data shows you.

 

[Gill & George]

Firstly Hello and Welcome

An increase from 4 units to 6 units per day seems like a big jump, so I'll continue to give her 3 units in the morning and 2 units in the evening, making a total of 5 units in 24 hours, until we see the vet on Monday.

Does that seem reasonable?

I've just looked at the SS and seen that you have taken the dose from 2u BID to 3u BID. Given the limited numbers you have got I think this is a very risky move. It is a 50% increase in dose. Even in TR which is considered to be an aggressive approach to dosing dose changes are only done in 0.25u increments.
I worry that you may run the risk of your kitty being overdosed, by the time she shows symptoms of hypo you could be in an emergency situation, or worse if you are not home.
As Bobbie mentioned, I would get the syringes so you can change dose in smaller increments.

We are going overseas for 4 months in mid-August and by then I cannot have a cat that needs frequent testing. The owner of the cattery is experienced (she used to run our local SPCA kennels and cattery). She has had diabetic cats before and giving insulin is not a problem, but she will only test twice a week. So, we have to get Sophie stabilized by early August.

Cross that bridge when you come to it, would she not be willing to test every day at least before insulin shot? Have you already discussed with her? If you were vacationing for a short time, then it would worry me less, a lot of us have had to board our cats for a week or two with minimal or no testing and we can usually make a dose adjustment to compensate and keep the cat safe. Four months is a long time in FD and so much can and will change, my best advice would be to start to look now for an alternative where someone can test more frequently perhaps ambg and pmbg running a curve weekly, minimum? When I had to go away for two weeks, I left my guy with my neighbour, she house sits for us and she tests before shot and also midcycle if needed, my regular cattery, was/is happy to give shots but won't test so as far as I was concerned that wasn't a risk I was willing to take.


As a nurse whose had diabetic patients, I would ask you: Would you give an infant an insulin shot without taking a BG reading first? And if you did give an insulin shot and the child had a hypo, what would position would your regulatory body take if that child's parents made an official complaint?

Since it still takes 2 of us to do a BG, I can't do an AMPS test - hubby is a zombie until about 9 a.m.

You are not alone with finding it difficult to test, with a little perseverance you will likely get her to cooperate or even come to you for the test. My kitty is elderly, 15-17 when he was first diagnosed, he's now 18-21. We followed TR and he went into remission, out of it now after a steroid shot. He learned to come to me when I rattled the test strips. It took a bit of encouragement, but with positive reinforcement we got there.


Are you doing a lot of possitive reinforcing? Treats, cuddles anything she likes, whatever rocks her boat.
Also try desensitizing her to the pokes by just rubbing her ears, no pokes, give her a treat, or cuddles (whatever works for her)
If it take's two of you to test and Hubby can't help till 9am, could you change shot time 9am/9pm schedule? that way you would have some help?
It sounds like of the dosing methods we use SLGS would be a better fit, at least in the beginning, but even with that you would minimum need to test ambg and pmbg and run a curve weekly before deciding on a dose change.


FWIW and to illustrate why your thinking could land you in trouble, George had his very first dark green, quite unexpectedly at ambg, I shot, but because I knew he was low I monitored and fed to keep him safe. and anecdotally he had his very firs lime green (below 2.7) at +3 in the pm cycle that morning he was yellow (12/ at ambg, 174/ 9.7at +6 7.5/134 @pmbg
I was doing TR so aiming for regulation and numbers in the 50-100 range, so this required more careful monitoring and aggressive dosing. But I was monitoring to keep him safe. For those not able to do so the SLGS method allows you to adjust dose more slowly and within limits that will keep kitty safe with limited testing. Changing the dose by increments larger than 0.25, with the numbers you are seeing, and with the testing that you are able to do, I fear you are courting disaster.

I hope that you are not upset by my above thoughts, they are based on my experience here on the board and in treating my cat. I felt I should share as I would not forgive myself should something go wrong. I hope you will take me at face value and not feel that I am picking on you in any way.

I hope that I/we will be able to help get your old girl on a good/safe regime.

 

[Amy&TrixieCat]

I will add my "welcome to the group" as well!

One other thing to remember is that cats metabolize medications differently from humans. In the case of insulin (specifically Lantus), they metabilize it about twice as fast, hence the need for BID dosing, as opposed to humans who only need SID dosing with Lantus.

You are correct in that Lantus is a long-lasting, and technically a "gentle" insulin...but that doesn't mean that hypos can't happen. Testing is the only way to truly keep a diabetic kitty safe, since they can't tell us when they are feeling funky from low blood glucose. And unfortunately, a hypo can happen very quickly. That, and as Sienne pointed out, a kitty can drop from the stratosphere into potentially dangerous numbers and pop back up to the stratosphere with in a single 12-hour cycle. That is why we so strongly encourage testing.

Testing does not have to be overly-frequent, though, especially once you learn how she responds to insulin. We encourage testing before each injection, and one other test at some point during the cycle; those two tests can point you in the direction of whether or not additional testing during the cycle may be warranted.

There are things to make testing an easier process for both you and Sophie...things like always testing in the same location, and giving her treats and loving or whatever she associates with happiness every time you try to test (even if you have an unsuccessful test). While a few kitties do remain stubborn about it, the vast majority actually do ultimately adjust very well to the process, and most even look forward to it. My Trixie would actually come running when she heard me gather her testing supplies....I kid you not. And when I first joined this group and people told me their kitties looked forward to testing, I did not believe it at all....but it turned out to be true. And then it does just become part of your daily routine. I'm sure others would love to share the tricks they've developed to make testing a pleasant and bonding process.

We are here to help you help Sophie...

 

[Celle]

How much does she weight and do you know what her number was when she was diagnosed?

She weighed 4.6 Kg about 3 weeks ago. She has put back some weight since then. I'll have her weighed again on Monday.
Before she lost weight last year, she had been weighing between 5.1 and 5.2 Kg for at least 7 years.

She lost a lot of weight while in the cattery last year, going down to 3.6 Kg. The cattery owner took her to the vet, where she stayed for 2 days, having lots of blood tests, X-rays and even a CT scan. Everything tested completely normal.

The cattery owner brought Sophie and my other cat into her own house, treated them like her own cats, changed their diet (adding in fresh, raw meat), gave them lots of love, and let them sit by the fireside. Sophie regained much of her lost weight, and gained more when she came home.

A couple of months ago, Sophie started to lose weight again, and she had become noticeably thin. Her fur started to look scruffy as well. That's when I took her back to the vet and she was tested again, for kidney failure and diabetes. Her kidneys are OK, but her Fructosamine level was 534 (29.5 mmol/L).

Thank you all for your advice. It is appreciated.

 

[Celle]

One thing I have to explain.
I'm not deliberately ignoring the collective experience and wisdom of this forum. I am taking some on board, as well as thinking and researching. I am also taking the advice of a very experienced vet, who has been in practice for over 30 years and who has treated cats with diabetes many times.

But what we decide to do has to fit in with our own situation, and having a cat who needs to be monitored closely just won't work for us. We have to get her stabilized and doing well by mid- August.

It's also about quality of life for Sophie, and when we tested her 3 times a day she was getting fearful of us and not enjoying life at all. She turned from a friendly, sociable cat into a scared cat who ran away whenever she saw anyone. With less frequent testing, she is happy again, and is starting to trust us again.

Because we have family scattered around the country and also a daughter who lives in England, we do travel. We go to England once a year, to stay with our daughter. It's the only time we see her and her family.

We have to have a cat that someone else apart from us can take care of. The cattery we use will look after Sophie, if they aren't full, but Andrea, who owns it, prefers to test less frequently - also on advice from a vet.
I would hate for Sophie to die in the cattery while we are away. I would feel I'd abandoned her.

Sophie has had 14.5 years of a good life. We decided to give her a trial of treating her diabetes, with a view to prolonging her life, but we cannot keep a cat who needs attention 24/7.
We're both elderly ourselves and our time for visiting grandchildren is probably limited, too. When it comes to a choice between grandchildren and Sophie, the grandchildren have to come first. It would break my heart to put Sophie to sleep, but if her diabetes can't be controlled without super-close supervision, that may be what has to happen. We won't come to that decision easily.

 

[MindyC]

One thing I have to explain.
I'm not deliberately ignoring the collective experience and wisdom of this forum. I am taking some on board, as well as thinking and researching. I am also taking the advice of a very experienced vet, who has been in practice for over 30 years and who has treated cats with diabetes many times.

But what we decide to do has to fit in with our own situation, and having a cat who needs to be monitored closely just won't work for us. We have to get her stabilized and doing well by mid- August.

It's also about quality of life for Sophie, and when we tested her 3 times a day she was getting fearful of us and not enjoying life at all. She turned from a friendly, sociable cat into a scared cat who ran away whenever she saw anyone. With less frequent testing, she is happy again, and is starting to trust us again.

Because we have family scattered around the country and also a daughter who lives in England, we do travel. We go to England once a year, to stay with our daughter. It's the only time we see her and her family.

We have to have a cat that someone else apart from us can take care of. The cattery we use will look after Sophie, if they aren't full, but Andrea, who owns it, prefers to test less frequently - also on advice from a vet.
I would hate for Sophie to die in the cattery while we are away. I would feel I'd abandoned her.

Sophie has had 14.5 years of a good life. We decided to give her a trial of treating her diabetes, with a view to prolonging her life, but we cannot keep a cat who needs attention 24/7.
We're both elderly ourselves and our time for visiting grandchildren is probably limited, too. When it comes to a choice between grandchildren and Sophie, the grandchildren have to come first. It would break my heart to put Sophie to sleep, but if her diabetes can't be controlled without super-close supervision, that may be what has to happen. We won't come to that decision easily.

Hello Celle, I completely understand your point of view. I have been there twice now with my Max. I didn’t believe it at 9yo that he could go into remission from diabetes. I had 2yo and 6mo old children at that time, and I thought I would lose my mind with the diabetes. It’s a steep learning curve. Our lives didn’t fit into 12 hour increments, and even with the schedules of work and an infant, the cat’s shot schedule felt impossible to keep. It turned out we only needed to keep it for 6 weeks. SIX weeks. He went into remission in 4 weeks, the remaining 2 were his micro-dose trial. Had my vet (newish and young) not pointed me to this forum, he wouldn’t have gone into remission, but rather would have died from an insulin overdose. He went from 2U to .2U in a single week.

He stayed in remission for 9 years, and came out of it a little over 2 months ago. We started with a different, short-acting insulin because of his age and how sick he was at the time (he 17 and has chronic kidney failure), combined with a vacation about a month later. When we left for that vacation I was afraid he wouldn’t be alive when we came back. He was though, and we switched him to Lantus about a month ago. I didn’t expect remission this time, and I still don’t...but I’m starting to have hope he’ll do it again. He earned a dose reduction 2 days ago, and seems to be looking like he might do it again soon. And thanks to this board and the group, we’ve been able to find a medication for his arthritis that doesn’t increase his kidney damage. He has the potential at 17 for at least a few more years if he manages remission and the arthritis meds work.

My ending thought is this: if you’re willing to put in the time to encourage testing complacency and follow either of the dosing protocols (I started with SLGS and switched to TR about a week or so later), you could give her years without insulin. She could go into remission before August, or she could be well regulated enough by then that preshot testing is enough. You could get her to the point where you won’t have to worry about being gone and away from her. But you’ll have to put in the work now to do it. You have time. Diabetes could become a non-issue by August.

 

[Celle]

Diabetes could become a non-issue by August.

Thank you Mindy,
That's a very comforting thought, but I don't hold out a lot of hope that it will happen for Sophie.
I still think that her problem started last year, even though nothing showed up on all her tests. Something must have caused such a huge weight loss. We were overseas for almost 3 months, but we have left the cats in this cattery for that length of time before and they did well. It's a superb cattery, with everything you could wish for the cats. Andrea doesn't just feed and water the cats. She grooms them and plays with them, and gives them lots of affection.
My girls have a condo all to themselves, with an indoor and an outdoor area.

I'm really conflicted about what to do.

 

[MindyC]

Thank you Mindy,
That's a very comforting thought, but I don't hold out a lot of hope that it will happen for Sophie.
I still think that her problem started last year, even though nothing showed up on all her tests. Something must have caused such a huge weight loss. We were overseas for almost 3 months, but we have left the cats in this cattery for that length of time before and they did well. It's a superb cattery, with everything you could wish for the cats. Andrea doesn't just feed and water the cats. She grooms them and plays with them, and gives them lots of affection.
My girls have a condo all to themselves, with an indoor and an outdoor area.

I'm really conflicted about what to do.

It’s possible the weight loss was from stress. The older they get, the more easily they stress. Max used to be fine riding in a car, and now going anywhere outside the house becomes a catastrophic event. His last vet visit required them to give him a bath when he got out of the carrier.

I understand being conflicted, it’s the nature of loving your pet and wanting the best for them. We have been very concerned about Max’s quality of life ad well. I’ve said many times on this board that we aren’t looking for heroic measures to prolong his life...but ultimately he’s still in there, staring out at me. If a little insulin helps him do that, and some meds for arthritis, then I can’t say no. He hasn’t told me he’s ready to stop fighting yet. It’s not something with a terminal diagnosis yet. That’s when we decide if the treatment is worth it or if we let him go.

And in the last month alone, he’s gained a pound. His coat has gotten shiny and soft again. He’s starting to venture back out into other areas of the house (he has been living pretty much in our living room, with forays into the dining room to eat). We thought we were instituting nursing home care for him (I had stairs built for him to get up to the feeding table, and we moved a litter box up from the basement), but it turns out he has arthritis and had a really bad infection...which triggered a relapse in the diabetes.

I know testing is hard. I’ve been lucky that it hasn’t been with Max. But when it comes down to it, you love her, and right now she needs a little help. It isn’t thousands of dollars of surgery, or chemotherapy or radiation. It’s just some insulin. Isn’t it worth it to try?