New member 10/10/20- Please help- Possible to go off insulin in very early stages?

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Nakikki

Nakikki

Member Since 2020
Hi all. I'm Nick and my cat's name is Bruce. He's 12 years old. He was put on Glargine/ Lantus 0.4ml twice daily earlier this week. I followed my vet's instructions and it's just become a potentially dangerous mess. Doing further research, I'm really not happy with the advice my vet has given and now we're in a pickle. Apologies for the long post but I'm overwhelmed.

He's taken a total of 7 doses so far, so 3 1/2 days of being on insulin. Is it possible to take him off entirely and just monitor the situation for the time being? I will, of course, be asking my vet this first thing in the morning (it's 4am, can't sleep because I decided it was too pressing to get a second opinion before just trusting the vet again). I've skipped tonight's dose, and intend to call the vet before giving another dose. If I have to give it to him, it'll be just over 30 mins late.

Now we get into the reason I ask. I think his starting dose was too high. The vet has me blindly injecting without testing blood levels and I don't have the means to do so at the moment. He hasn't had a urine test done because Bruce refuses to use the plastic litter, and I didn't push the issue because the vet said it's not important. He had a blood curve done at the vet where he read roughly 28 down to 22-23 (I'm sorry I don't know the units they use here? It might be an Australian thing? Sorry I'm a bit overwhelmed with info at the moment) but the vet said ideal should be at 9. He said levels can be raised by stress, I asked if further monitoring should be done first because my cat is a massive ball of anxiety and I'm worried the reading might not be entirely accurate. The vet just wanted him on insulin right away. On top of that, he prescribed the dosage first and then got me to change his diet from Hills Dental dry food, to Hills GlucoSupport m/d dry food. I raised concerns about changing both at once but he said not to worry about it.

Well, he hated the injections (He took the first one fine, then realised it was coming and freaked out every time) and is very stressed, so when he was a bit wonky I just assumed he was dealing with a lot of anxiety and stress. I asked the vet what signs to look for for hypoglycemia and he told me, but reassured me it was very unlikely. Bruce kept getting more and more "upset" as injections went on, and then today I was trying to pet him and he was out of it. I asked the vet if I could skip tonight's dose and he said "ok, but we need to be careful not to do that too often". The difference is night and day, he's so much more alert, he's purring, being a cheeky bugger, back to his normal self. I feel terrible that I might have been overdosing his insulin or managing his diet wrong or something. I'm second guessing myself that it could be stress, but he was just weak and glaring off into the distance while trying to get a scritch out of me earlier today, so surely not (usually he would've been crushing my hand demanding harder skritching, lol). What a mess.

Ideally, I'd like to keep the new diet (seeing as he's currently fine), go off insulin, and monitor his blood levels to get good starting readings, but I know there can be serious problems going off insulin. Maybe also switch to a new vet? Honestly I'm so new to this and my vet is downplaying all the info I'm finding online and confusing me, so I'm just so lost. I just want to start over. Sorry for the rant, and thanks in advance for any help you can offer. I should go to bed now. Also don't worry, Bruce is a happy chappy at the moment. Fingers crossed I can sort out his treatment tomorrow/today.
 
WELCOME TO FDMB!
OMG Nick I'm GLAD you found us!
You are in Australia? I'm going to tag

@Bron and Sheba (GA) shes in OZ Maybe she can help make sense of these numbers.

It does sound like you may have been giving too much insulin but its NOT YOUR FAULT. I could be wrong so hang on for more advice.

We are a group of dedicated cat lovers all having diabetic kitties. We will get this sorted you have landed in a SAFE PLACE.
BRB
 
Nakikki said:
He was put on Glargine/ Lantus 0.4ml twice daily earlier this week.
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Would it be possible for you to take a picture of one of your syringes with the stopper drawn up to where you are drawing this dose? 0.4ml would be a very large dose of insulin, and we usually measure in "units", not ml, so I'm guessing that something has gotten lost in translation, but we want to be sure.
 
Nick hold off on the insulin till we figure out whats going on with Bruce. Unless hes been in DKA it wont hurt to forgo a shot at this time.
 
Another question: did the vet ever do a fructosamine test, or was he just relying on the in-office blood glucose readings to make the diabetes diagnosis?

To answer your main question: yes it is possible for cats to go into remission quickly, especially if there is a food change involved, but we don't know yet that that is what is going on with Bruce (plus it doesn't sound like he was actually switched to a low-carb food).

The other possibility to explain his behavior is that there's something else going on with him. We want to be very careful about this, as withholding insulin from a diabetic who has another illness/infection happening raises the possibility of ketones. The fact that he's feeling better after skipping a shot tonight makes that less likely, but I'm mentioning it for completeness as we're gathering information and trying to help figure out what is going on.

And I didn't say this earlier, but welcome! So glad you found us! I hope we can get Bruce feeling better soon...
 
Hi Nick.

Welcome to yourself and Bruce.

Nan & Amber (GA) said:
Would it be possible for you to take a picture of one of your syringes with the stopper drawn up to where you are drawing this dose? 0.4ml would be a very large dose of insulin, and we usually measure in "units", not ml, so I'm guessing that something has gotten lost in translation, but we want to be sure.
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Normally, Lantus doses are set in multiples of 0.25 units. The "0.4" figure sounds really odd. I agree with Nan's suggestion above. It would be really helpful if you could post the picture as described above.

Nakikki said:
He had a blood curve done at the vet where he read roughly 28 down to 22-23 (I'm sorry I don't know the units they use here? It might be an Australian thing?
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Your units are mmol/L, also used in Europe and Canada. The US uses mg/dL (mmol/L x 18 = mg/dL).

Are you using a human or a pet meter?


Mogs
.
 
Nakikki said:
He had a blood curve done at the vet where he read roughly 28 down to 22-23 (I'm sorry I don't know the units they use here? It might be an Australian thing? Sorry I'm a bit overwhelmed with info at the moment) but the vet said ideal should be at 9.
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Fyi, these are so-called "world" units, mmol/L. While many people who use this site use these, most use the US-centric mg/dL.

To mentally convert between your numbers and the predominant numbers you see on this site, you multiply by 18. So that 28 was "504" in US numbers, the recommendation of 9 is equivalent to "162".

Once we figure out what dose you're giving, we can talk about how to get a better read on Bruce's BG numbers (in whatever units!) by home-testing his blood glucose (sidestepping all the problems of vet stress, etc.). But right now I'm most concerned about the dose and getting a pic of your syringes.
 
Ah sorry that's my bad, it's 0.04ml according to the prescription. I screwed up the numbers really bad there. Here's a pic of where I'm drawing it to.

Also Bruce is fine at the moment. He's happy to have skipped his dose. Just had a big nap, wandering around looking out the windows and having little conversations with me, watching bugs, settled into his favorite spot looking happy with himself. When he was on insulin he wouldn't behave that way, much more flat. Luckily he's been eating and drinking fine the whole time.

Thank you so much for the fast replies!
 

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Hmm, that looks like 4U, which is still a very large starting dose for a cat. Is he a big guy? Vets sometimes dose cats as if they are small dogs and go by weight, but that isn't always a good idea. We usually recommend starting doses of 0.5U to 1U, only occasionally going over that.

I'm glad you took matters into your own hands and skipped the shot. I think home-testing could be a really crucial tool for you to help figure out what's going on with him and what dose he needs going forward. Does this sound like something you'd be willing to try doing?
 
Which day of the week did Bruce get his first dose of insulin?

Was it morning or afternoon when the first dose was given?

Was the dose you skipped the one that would have been scheduled for Friday evening?

(Asking because Lantus is a 'depot' insulin and successive doses build on previous ones, so we need to get an idea of how many doses Bruce has received to date in order to better understand the current situation.)


Mogs
.
 
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Nan & Amber (GA) said:
Hmm, that looks like 4U, which is still a very large starting dose for a cat. Is he a big guy? Vets sometimes dose cats as if they are small dogs and go by weight, but that isn't always a good idea. We usually recommend starting doses of 0.5U to 1U, only occasionally going over that.

I'm glad you took matters into your own hands and skipped the shot. I think home-testing could be a really crucial tool for you to help figure out what's going on with him and what dose he needs going forward. Does this sound like something you'd be willing to try doing?
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Yeah he's a big boy. 8.45kg. Larger in size than a lot of cats in general, but also overweight. I'm happy to have a go at home testing, but whether or not I can get Bruce to participate is another issue. I probably need some tips around managing his anxiety and getting into the routine, but it'd be 100% worth it. Even just giving him a drop on the back of his neck as a once off leaves him anxious about me touching there for weeks. (Which is also why I thought this whole thing was anxiety).
 
Critter Mom said:
Which day of the week did Bruce get his first dose of insulin?

Was it morning or afternoon when the first dose was given?

Was the dose you skipped the one that would been scheduled for Friday evening?

(Asking because Lantus is a 'depot' insulin and successive doses build on previous ones, so we need to get an idea of how many doses Bruce has received to date in order to better understand the current situation.)


Mogs
.
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It was Tuesday morning when they gave the first dose and monitored him. All shots after that given on time (Tuesday night, etc), then we skipped Friday evening's dose
 
Hi Nick,

Thanks for the info.

I agree with Nan that the setting on the syringe looks like 4 UNITS of insulin.

What would Bruce's approximate ideal weight be (so that I can have a look at the dosing side of things)?


Mogs
.
 
Nakikki said:
I'm happy to have a go at home testing, but whether or not I can get Bruce to participate is another issue. I probably need some tips around managing his anxiety and getting into the routine, but it'd be 100% worth it. Even just giving him a drop on the back of his neck as a once off leaves him anxious about me touching there for weeks. (Which is also why I thought this whole thing was anxiety).
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We have lots of tips on testing... with an especially anxious cat, you'll have to go slowly and in stages to get him used to it bit by bit, but it can be done. Treats can work wonders as motivation!

Most of us around here use human BG meters for testing, not sure what you have available in Australia (Bron will know when she checks into this thread). The main things to look for are: cheap and readily available test strips, and test strips that only require a small amount of blood. You'll also need some larger-sized lancets to start out (26 or 28 gauge; smaller number = larger lancet) and a few other supplies. Likely with Bruce you'll be spending a lot of time at first just desensitizing him to the process before you even think about trying to poke him for a blood droplet, so you've got some time to get all that stuff together.
 
Critter Mom said:
Hi Nick.

Welcome to yourself and Bruce.


Normally, Lantus doses are set in multiples of 0.25 units. The "0.4" figure sounds really odd. I agree with Nan's suggestion above. It would be really helpful if you could post the picture as described above.


Your units are mmol/L, also used in Europe and Canada. The US uses mg/dL (mmol/L x 18 = mg/dL).

Are you using a human or a pet meter?


Mogs
.
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Sorry for tagging you earlier on this one Mogs I can see youve been really snowed under tonight. I just saw that Bruce was so much brighter off insulin so thought it looked strange & tried to find an expert quickly & your name popped to.mind! I promise to expand my list & stop picking on you all the time (Nan has now been added to my go to list - hee hee jt was already on it so not sure why she escaped me tagging her - I must have had a brain meltdown) !!
Gill
 
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Critter Mom said:
Hi Nick,

What would Bruce's approximate ideal weight be (so that I can have a look at the dosing side of things)?

.
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My vet was very vague about weight loss, but I think from memory another vet said to aim for "just over 7kg" about 5 years ago. I'm trying to find his older documents to see where his weight was when it was closer to ideal, but turns out 2 hours of sleep is hard to function on lol. I think 7.2kg ish would be my guess (might still be heavy? It's hard to tell because he's large). Sorry that's about all I've got for now. I'll spring back up if I find anything more accurate. Thanks so much for helping with this.
 
Nakikki said:
My vet was very vague about weight loss, but I think from memory another vet said to aim for "just over 7kg" about 5 years ago. I'm trying to find his older documents to see where his weight was when it was closer to ideal, but turns out 2 hours of sleep is hard to function on lol. I think 7.2kg ish would be my guess (might still be heavy? It's hard to tell because he's large). Sorry that's about all I've got for now. I'll spring back up if I find anything more accurate. Thanks so much for helping with this.
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So to be clear... you have not given any insulin tonight. Right?
 
Nick take a moment and give this a read. It just gets you familiar on how all this works.It also gives instructions on setting up your signature. That will appear at the bottom of all your posts. It gives at a glance information on all Bruce's particulars.
New? How You Can Help Us Help You!

We also would like you to set up a spreadsheet you can find how to do that here:
FDMB SPREADSHEET INSTRUCTIONS

You were baptized by fire today Lets hope the rest of the way is smooth sailing...

WELCOME TO OUR FAMILY:bighug:
jeanne
 
jt and trouble (GA) said:
So to be clear... you have not given any insulin tonight. Right?
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Not yet. I was advised by the vet to give him his dose now. But I'm opting to take him in there first to get a spot test done, so I'm heading there asap, and they'll probably administer the dose if his bloods come back high enough. Sorry I'm all rushing about now trying to organise everything. Still frazzled.

Also thank you for all the welcomes! Sorry I haven't set my profile up properly yet. It's been... a day. Lol
 
Update: They didn't tell me the number, but said his reading was "high" and to give his dose. He's had it a bit late now (9:45am). And I've booked in for another reading and a chat with the vet Monday evening. So, to be clear, I skipped Friday evening, and I just gave him his Saturday morning dose. They said to half the dose if he gets too lethargic or stops eating and to put honey on his gums if he goes weak. I'll be trying to chill out and keep an eye on him in the meantime. This isn't fun figuring out. Thanks again for the support. Phew
 
That info's absolutely fine, Nick.

Nakikki said:
Now we get into the reason I ask. I think his starting dose was too high.
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To confirm, I think your earlier picture looks to be set for a 4IU dose of U100 insulin (Lantus being such an insulin).

If the dose has been set as 4IU every 12 hours (q12h) then according to the dosing guidelines we follow then yes, it is too high.

I've attached below the peer-reviewed study that is the foundation of the Lantus dosing protocols we use here. Starting dose is based solely on weight of the cat. According to the study:
  • Lantus Starting dose = 0.25 units per kg of ideal weight q12h, unless the cat is underweight, in which case actual weight is used for the calculation.
If we take 7kg as Bruce's ideal weight, the starting dose would be: 7 x 0.25 = 1.75 units Lantus q12h.

Even if we take Bruce's current weight, the starting dose would be: 8.45 x 0.25 = 2 units Lantus q12h (rounded down to nearest quarter unit).

Here you can see why, even though Bruce is a large cat, we expressed concern earlier about the 4 unit q12h dose.

I'd suggest using the document below as the basis for a discussion with your vets about Bruce's dose. (Note: Your vet may be working to a different dosing protocol.) By way of general information, one of the authors of the attached study, Jacqui Rand, was based in the University of Queensland at the time. (She may still be there!)

Nakikki said:
He had a blood curve done at the vet where he read roughly 28 down to 22-23
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As mentioned above, Lantus is a depot insulin. Depot insulins gradually build up a 'tank' of insulin under the skin - a sort of 'chemical pancreas'. When starting treatment, part of each dose goes to filling the tank, and the size of the depot increases with successive doses. During each 12 hour cycle the body uses some of the insulin from the most recent dose and also some from the depot. As the size of the depot increases, it exerts a more powerful blood glucose lowering effect. For a given dose size, it takes 10 contiguous doses for the depot to reach a steady state.

For the sake of speed, I am making the assumption that the curve you describe was done when the first dose of Lantus was given at the vets. Those numbers are high but safe in that they're nowhere near hypoglycaemic. However, as the Lantus depot started to fill Bruce's BG range is likely to have got lower - at least for part of the time. Without BG readings, it's impossible to say by how much.


Nakikki said:
the vet said ideal should be at 9.
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For general information (and according to my own vet) the normal feline blood glucose reference range is 3.9-8.3mmol/L, as measured on a pet-calibrated glucometer. Your vet may be using 9mmol/L as the target for the lowest point of the cycle (i.e. looking to run Bruce 'a little hot' BG-wise to reduce risk of hypoglycaemia while on insulin).

He said levels can be raised by stress,
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Correct.


I asked if further monitoring should be done first because my cat is a massive ball of anxiety and I'm worried the reading might not be entirely accurate. The vet just wanted him on insulin right away.
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Some pointers on the steps that should be included in a diagnostic work-up for feline diabetes (FD):

* Assessment of clinical signs (may include: excessive urination and thirst (aka polyuria/polydipsia, PU/PD), excessive hunger, weight loss in spite of eating more, poor hair coat condition, lethargy, low mood).

* Initial BG spot check - may be temporarily elevated by vet/travel stress - not sufficient basis for FD Dx, just an indication that further diagnostics are needed.

* Urinalysis - check for glucose and ketones - only confirms elevated BG in the hours since the bladder was last emptied but stronger evidence than BG spot check (stress typically less likely to influence).

* Fructosamine Test - result indicative of average glucose levels over the previous number of weeks, not influenced by temporary stresses, fundamental to a sound Dx of diabetes.

If a cat is in very high numbers and producing ketones (an emergency situation) then a vet might start insulin treatment without waiting to receive a fructosamine result.


On top of that, he prescribed the dosage first and then got me to change his diet from Hills Dental dry food, to Hills GlucoSupport m/d dry food. I raised concerns about changing both at once but he said not to worry about it.
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This is a major error. Once a cat has been started on insulin then the carb load should not be changed unless the cat's blood glucose levels can be regularly and frequently checked throughout the diet transition as the insulin dose may very likely need to be reduced. (See this vet-authored site for further information on the importance of BG testing when changing diet).

Assuming the Aussie formulations for Hill's foods are the same as those in the UK:

* Hill's t/d Dental Feline Dry Diet: 33% carbs (dry matter basis)

* Hill's m/d GlucoSupport Feline Dry Diet (Chicken): 15.1% carbs (dry matter basis)

The carb load of m/d is less than half that of the t/d diet Bruce had been eating. If there was a fast/immediate switch then there is a high probability that Bruce's blood glucose levels would have been markedly reduced compared to where they were when the vet ran the curve and set the dose.

More to follow...


Mogs
.
 

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Nakikki said:
They said to half the dose if he gets too lethargic or stops eating and to put honey on his gums if he goes weak.
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:( :( :( :( :(

That is... a really really cavalier attitude.

Mogs has given you a ton of excellent information about what could be going on with Bruce's insulin dose and why we are worried about your vet's advice. We understand that, at the moment, you're pretty dependent on your vet's assessement and BG measurements, which puts you in a tough spot. It's one reason we advocate for home-testing BG-- it gives you so much more information about what is going on with your cat, and so much more control over the situation!

It's harder to get home testing started with an anxious cat, but it can be done. So, while you are in "observation" mode per your vet (sigh), how about starting the process of desensitizing him to BG testing so you can (hopefully) get that up and running soon? The way we do it is to use human blood tester meters, and poke along the edge of the ear to get the blood droplet. So:

Start by designating a "testing spot" where everything is going to happen. First step, bring him to the spot, give him a cuddle and a treat, let him go. Do that as many times as it takes for him to get the message that, hey, good stuff happens here, no need to get scared!, then move on to step two. Bring him over play with his ears a bit, then cuddle, treat, let go.

When you are actually have to do the poking, you'll want a warm ear, so if his ears are naturally cold, you can make step three the ear-warming process. Some people just rub the ears gently to warm them, or you can use a little sock filled with rice and microwaved for a few seconds.

Next step, once you have the lancets and the meter, is getting him used to them. You can mime doing the poke with the lancet without actually poking, if your meter makes beeping noises you can let it go through the testing cycle and beep while he's there, etc.

All of this can go at whatever pace works for him. Some people can get a successful test out of their cat on the first try with none of this step-by-step, others with extremely anxious cats have to go through the whole thing. Whatever you have to do.

Last tip (for now): many people find that if they're stressed about the testing process, their cat picks up on that. One thing you can do to counteract this is (believe it or not) to sing a silly song during the testing. Hard to be stressed when you are doing something silly! And again, whatever you have to do to make it work, that's fine.

Love the avatar pic, by the way! There's a cat who knows how to relax!
 
Nan & Amber (GA) said:
Last tip (for now): many people find that if they're stressed about the testing process, their cat picks up on that. One thing you can do to counteract this is (believe it or not) to sing a silly song during the testing. Hard to be stressed when you are doing something silly!
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Hi Nick
I can vouch for Nan's tip above being a good'un. I've had a few issues with injecting and BG testing Mac & after getting that tip I found that the singing or I use talking in a sing-song voice "he's such a good kitty - such a handsome kitty - such a brave kitty - yes he is" may make me sound daft but he loves the praise feeling and it also keeps him & me calm. I don't even feel daft anymore, funny what we get used to !!:)
All the best to you & Bruce.
Gill
 
Hi Nick, and welcome to you and Bruce.
I live in Australia and I am very surprised your vet has started Bruce on what looks like 4 units of insulin.......that is way to high a dose. You were right to post and ask for help.

I would also recommend you start home testing the BGs. Nan has given you some hints. It is by far the safest way to help keep Bruce safe. You can go to most chemists....the ones that sell diabetic supplies for humans and buy a human glucose test kit to take the BGs.

I am going to give you a link to Aussie information. You will find suitable meters on here and also lots of other useful information.
https://www.felinediabetes.com/FDMB...for-aussie-feline-diabetic-caregivers.217781/

Keep asking lots of questions, we are all happy to help. This is a very knowledgeable community.
 
Thank you all so much. This is incredibly helpful. I called a different vet but (as expected) they wouldn't give an opinion on the dosage. I guess my main concern in the meantime is the advice of my main vet (and also the one I called) is to not change his dose at all. But I'm like 99% sure he'll get ill again and that's not fun to deal with especially over the weekend. I'm stuck in a very awkward position of "My cat could have a nasty reaction if I keep the dose. Also my cat could have a nasty reaction if I change the dose" Super stressful and I don't know what to do, because I don't know how to adapt at all and I don't think I'm fully prepared in case of a bad hypoglycemia episode (thanks to Dr. "eh, just whack some honey on it"). I have the Hills Dental dry food and a can of whiskas and some honey but I need to dive into how to treat that.

Bron and Sheba (GA) said:
Hi Nick, and welcome to you and Bruce.
I live in Australia and I am very surprised your vet has started Bruce on what looks like 4 units of insulin.......that is way to high a dose. You were right to post and ask for help.

I would also recommend you start home testing the BGs. Nan has given you some hints. It is by far the safest way to help keep Bruce safe. You can go to most chemists....the ones that sell diabetic supplies for humans and buy a human glucose test kit to take the BGs.
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I'm looking at going to Chemist Warehouse to get one asap. Because he's a stress ball, I'll probably keep it just in case, rather than monitoring him super closely right away? Accu-chek performa with the included fastclix is one I can use right? (Their spelling of their products is really annoying me lol)

The good news is I have a bit of time before the insulin builds up again so I can figure things out a bit. He's also back on his spot on top of the couch completely stress free again lol.
 
Nakikki said:
Thank you all so much. This is incredibly helpful. I called a different vet but (as expected) they wouldn't give an opinion on the dosage. I guess my main concern in the meantime is the advice of my main vet (and also the one I called) is to not change his dose at all. But I'm like 99% sure he'll get ill again and that's not fun to deal with especially over the weekend. I'm stuck in a very awkward position of "My cat could have a nasty reaction if I keep the dose. Also my cat could have a nasty reaction if I change the dose" Super stressful and I don't know what to do, because I don't know how to adapt at all and I don't think I'm fully prepared in case of a bad hypoglycemia episode (thanks to Dr. "eh, just whack some honey on it"). I have the Hills Dental dry food and a can of whiskas and some honey but I need to dive into how to treat that.



I'm looking at going to Chemist Warehouse to get one asap. Because he's a stress ball, I'll probably keep it just in case, rather than monitoring him super closely right away? Accu-chek performa with the included fastclix is one I can use right? (Their spelling of their products is really annoying me lol)

The good news is I have a bit of time before the insulin builds up again so I can figure things out a bit. He's also back on his spot on top of the couch completely stress free again lol.
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Yes the Accu-chek meter is a good meter. You really need to test before every shot to see it is safeto give the dose and then you need to check again about 5 or 6 hours after the dose to see how low the i sulin I see taking the BG. Lantus is dosedon how low the insulin takes the BG.

One thing I would do when you go to buy the meter is to also buy a bottle of Ketostix....it is about $12 and it will measure the ketones and the glucose in the urine. It is the ketones we are interested in because ketones can form if there is not enough insulin and not enough food for diabetic cats........so if you are withholding the insulin, it is important that we know if there are any ketones present. It is just a matter of collecting a urine sample from Bruce and then dipping the test strip in it and reading the sultana against the colours on the side of the bottle exactly 15 seconds later........no later than that as it continues to change colour. Do you think you could get some of those strips as well?

We can help you with the dose. It doesn't sound as if the vets know much about feline diabetes...this is very common.
It is crazy to say not to change the dose if Bruce is exhibiting signs of a hypo. That is just plain dangerous....please don't follow that advice.

The starting dose for a cat on dry food on the Start Low Go Slow method we use here is 1 unit.
Therefore I would start off by giving 1 unit twice a day to Bruce.
You would hold that dose for a week unless he drops under 5 (90 in US numbers).
Test before every dose and again mig cycle.
So you Test, feed and then shoot in that order. I used to shoot while Sheba was eating and she didn't notice.
You can also offer a tiny low carb snack as you test the BG to distract him.

Remember you are Bruce's advocate and you are entitled to do what you think is best for him. If you are not happy with the vet advice or your gut instinct is against it, don't do it.
We help people with dosing every day many times over. We are not vets but we have all lived with FD 24/7 for many years.

Which city do you live in?
I'll be around for the next 7 hours if you need me.
 
Bron and Sheba (GA) said:
Which city do you live in?
I'll be around for the next 7 hours if you need me.
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I'm in Adelaide. Thanks so much for sticking around. The vet's advice is to half the dose to 2 units if he's showing signs like not eating, but it's a super grey area until it's obvious, and I'd rather not let it get to that point again. My guy will still eat when sick. I am worried about cutting it all the way back to 1 unit, though, too.

Once I get the tests up and running I'll be more confident with decisions I think. I'm considering just going with 2 units for the time and monitoring that, considering that's the dose they want if things are going wrong. I've put in a click and collect order for those supplies so hopefully it's ready soon.

On urine collection: Any advice around that? I have one of those small packs of non absorbant kitty litter and he avoided it (though he wasn't drinking properly at the time either). The bugger always goes when I'm not looking or occupied, too, so hard to catch it. Putting a plastic cover over his regular litter maybe? I've heard that's an option. I'm home all weekend so if I miss it, it'll only be at room temp for probably less than 30 mins. This is honestly one of the trickier things. They couldn't even get him to pee during the day when they did a blood curve.
 
Re the urine collection
You can put a small plastic container in his favourite spot in the LB and see if he'll use it, or you could try the non absorbant little litter. Not getting to it for 30 mis is ok.

Re the insulin dose.
Providing there are no ketones on the urine, 1 unit would be fine to give. That is the normal starting dose for most cats when they start Lantus.
Because we don't know what his BG is, I can't advice you to give a higher dose.
Almost all cats get stressed when they are at the vet and that raises their BG levels 5 or 6 or even more points higher than it would be if tested at home. The vets use these numbers to decide what dose to put the cat on and then the cat goes home and the BG drops because the stress goes away. This can lead to too high of a dose being ordered.
This is another reason why testing at hi,e is so important.

What time is the evening dose due?
I think you are 1/2 hour behind us in Adelaide. It is almost 4.30 pm here now.
What i would do is post and say what the BG for the preshot is.
If it is less than 11 I would stall, dont feed and test again in 20 minutes to see if the BG is rising.
If you are going to be giving the dose without testing because the meter hasn't arrived I would DEFINITELY NOT give more than 1 unit of Lantus.
 
Because I skipped last night's dose and was late injecting this mornings (injected at 9:45am), I take it I should inject at probably 9:30 or 9:15? To get as close to 12hr as possible while still trying to shift it back a bit? I don't know how shifting the times work and honestly probably not great to play with it too much right now. And yeah you're 30 minutes ahead of my time. So, technically his dose was injected 10:15am your time.

So, I should try to arrange his litter tray now and see if I can get anything. And before I give his shot I post the reading in here? I take the reading before he eats any food, too? I'm trying to mentally order everything out correctly and make sure I'm getting it all right lol

He had his 4 unit dose this morning and tbh, while it's normal for him to be sleeping all afternoon, it looks just very slightly off and I can't put my finger on it, so might be being paranoid, might be right, who knows. Just a little bit sluggish but still alert enough that he might be ok. Should I try getting a reading now? (He won't be happy if I do this a lot). Definitely not giving him the 4 units, omg I can't believe they stuck by that dose. Hopefully I can get a good reading tonight but I am likely to go the 1 unit now that I can test his urine too. Thank god for prompt click and collect.
 
Nakikki said:
Because I skipped last night's dose and was late injecting this mornings (injected at 9:45am), I take it I should inject at probably 9:30 or 9:15? To get as close to 12hr as possible while still trying to shift it back a bit? I don't know how shifting the times work and honestly probably not great to play with it too much right now. And yeah you're 30 minutes ahead of my time. So, technically his dose was injected 10:15am your time.

So, I should try to arrange his litter tray now and see if I can get anything. And before I give his shot I post the reading in here? I take the reading before he eats any food, too? I'm trying to mentally order everything out correctly and make sure I'm getting it all right lol

He had his 4 unit dose this morning and tbh, while it's normal for him to be sleeping all afternoon, it looks just very slightly off and I can't put my finger on it, so might be being paranoid, might be right, who knows. Just a little bit sluggish but still alert enough that he might be ok. Should I try getting a reading now? (He won't be happy if I do this a lot). Definitely not giving him the 4 units, omg I can't believe they stuck by that dose. Hopefully I can get a good reading tonight but I am likely to go the 1 unit now that I can test his urine too. Thank god for prompt click and collect.
Click to expand...

You can inject at 9.30 pm. Back by 15 minutes a cycle or 30 minutes a day.

Yes if you can get a reading now that would be great. It will tell us a lot.

Are you giving him snacks of food during the cycle as well as before the insulin?

For tonight, I would take a reading 1/2 hour before the shot is due so you have time to post and get advice. I will watch for you and there will be others from the US on as well by then. Don't feed him when you test him at 9 pm before we tell you what to do as you may need to stall and see if the BG comes up higher on its own. Does all that make sense?
 
Hi Nick
Mac didn't like the plastic litter beads and wouldn't go near his litter tray - the wotsit pee'd on a mat instead so we were able to put a washed plastic bag flat down there and get a sample the next time he did it. But you don't really want Bruce going elsewhere so another tip I was given (and am going to try next time) is to loosely crumple some clingfilm (eg plastic food wrap) in a patch over the litter and hopefully get some pee trapped that way.
You will probably have a day of following him every time he leaves the room in the hope that he is heading to his tray - I left that to DH whilst I was working upstairs & finally heard a triumphant call a few hours later of "got it" ( after earlier curses throughout the morning)
Best of luck - you'll find what works to get a sample from Bruce with trial & error
Gill
 
I haven't managed to get a test done unfortunately. I tried to warm him up to it and he's not happy with the lance going anywhere near him even though I was giving him tuna treats and being as calm and singy as possible and not even trying to get a sample. Gave him a little bit of food now (6:20pm) but he also had some lunch at about midday. I found some urine lose in his box from early this morning (between 8-12 hours) I think. So it was there for a while but I put a stick to it anyway to see what would happen. Negative for Ketone, Glucose was between 10-20+ (didn't get an accurate timing) but I assume it gets very out of whack if the sample is old so I'm not sure if it helps anything at all. I'm still setting it up so I can get a fresh sample.
 

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Good to get that negative ketone test even if the urine was a bit old.

Keep trying with the BG testing.
I used to kneel down and sit on my heels and put Sheba in between my knees so that she was facing away from me.
That way she was held in with one hand around under her chin on her chest and my body was doing the rest. I had everything ready to go when I got her inthat position. Then I put some food in front of her and then tested.
It may take a few days for you both to get used to it so don't worry if you aren't successful first time.
 
Thanks, that's a relief to hear. I think I'm frying my brain trying to perfect everything. One thing I did forget to check, though. The lancet has a penetration depth setting. For people they recommend starting at 2, is that ok for cats? I'm not gonna punch a hole in his ear or anything? lol
 
Nakikki said:
Thanks, that's a relief to hear. I think I'm frying my brain trying to perfect everything. One thing I did forget to check, though. The lancet has a penetration depth setting. For people they recommend starting at 2, is that ok for cats? I'm not gonna punch a hole in his ear or anything? lol
Click to expand...
If you are not getting blood you will need to adjust the depth of the lancet.
What size is the lancet? 26 or 28 is best
Are you holding a cotton ball or tissue behind the ear to brace it?
You can try milking the ear up towards the tip as well to encourage blood flow
 
I can't find the size of the lancet anywhere so, that's kind of annoying, but I'll see how I go. I do have cotton balls though so I can try that. At the moment the plan is to carry him to the bathroom so he doesn't run away (he doesn't like this, but he always runs away so I don't have much of an option). Pop a tuna treat or two in front of him and brace him with my legs. I also follow Helpful Vancouver Vet's advice to "squish that cat" and gently press down on him to get him in place and stop him running. How I manage that while doing an ear prick? We'll find out I guess. But he does seem to at least give up and let me do injections when I do that, so same theory.

I also plan to get him used to it over time by offering little nibbles by just being near it, letting me touch his ears, etc. But I have to balance this with his stress.
 
Nakikki said:
Thanks, that's a relief to hear. I think I'm frying my brain trying to perfect everything. One thing I did forget to check, though. The lancet has a penetration depth setting. For people they recommend starting at 2, is that ok for cats? I'm not gonna punch a hole in his ear or anything? lol
Click to expand...

Hi Nick
Don't put yourself under pressure to be perfect (or even very good) straightaway. I did exactly the same & you will only end up stressing yourself out. I can honestly say that these things take time. Also frustratingly sometimes when you think you have it sussed out kitty can decide not to do that way any longer. I don't say that to worry you more but so that you won't despair and think it is something you are doing wrong if it does happen.
I've always had issues since we first started on August trying to get BG tests from Mac as he hated it but even he is getting better and seems to be more obliging now.
If you search for threads with me as the author you will see some about both BG tests and injections where kind people posted back with loads of tips. The tip i has given that works best for me is to gently hold his warmed ear over my first finger then hold it in place & gently stretched with my thumb & third finger while I make the poke with the other hand and get the blood on the strip.
On the lancing tool I used to have to use the 4 setting but I now do it freehand just holding the lancet in my hand which works better for us. I have DH hold Mac lightly so he can't escape so if you are on your own between the knees maybe a good idea ad you say. I know someone on here who traps her cat between her and the sofa arm - whatever works !!
In answer to your point - yes you can occasionally find you go through the ear on accident. but don't beat yourself up it doesn't particularly bother them (few nerves there) and soon heals up
Finally - if you get a bit down about it don't be afraid to say so on here and people will send you lots of encouragement and hugs. I did & they did
Gill
:bighug:
 
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Thank you for the kind words. I had two attempts and couldn't get a reading, so I bailed on it. First one didn't hit properly. Second one only got a tiiiiiny amount out after I rubbed it. Bruce was very upset. But the good news is he's really really hungry at the moment so he didn't care after like 5 seconds when he got his bit of tuna. He's going to be back in the mess with the injection though, poor guy.
So when it comes to the injection. 1 unit then?
 
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