New Member, vet "education" visit today

Status
Not open for further replies.
Cali S

Cali S

Member Since 2022
Hello all!

First and foremost, thank you so much to this message board and its phenomenal resources! I feel like I have a decent understanding of my cat's new diagnosis and what steps I should take moving forward. Secondly, I apologize for my verbosity, it's a problem.

I've been emailing back and forth with my vet while getting my kitty's (Faraday!) glargine pen sorted, and as I picked that up yesterday evening, we're off to the vet in an hour or so to be educated. Aka, I really need to learn how to give insulin injections.

As you can see from my SS (I hope), I have started AM and PM glucose monitoring to get into the routine of at least doing that. I was excited to see some "lower" numbers (in the 300s) now that we've completed a slow transition away from HC kibble (Faraday has a very sensitive stomach, so we took it very slow).

I am currently bribing Faraday to stay still for his glucose monitoring by giving him freeze dried chicken. Is this a viable technique moving forward for when I need to increase my tests per day? I generally still take 4ish pokes to get a good sample from him, which I'm hopeful that as me and his ears get used to doing this, I'll be able to accomplish quickly while he vacuums up the chicken.

For now, however, I have to try a couple more pokes while I feed him his proper meal and he's sitting still for longer.

For a main question - is TR possible if you can't free feed and/or give your cat multiple small meals throughout the day? I have two dogs and one additional cat, all of whom will definitely steal any food left out in no time at all, so we have very regulated meal times twice a day. Does this mean that SLGS is a better option for us?

My vet has loosely laid out her plan as purina DM + high dose insulin and recheck curve in 7 days. The RX we filled states 2.5U every 12 hours. According to my home scale, Faraday is approximately 10lbs/4.5kg at the moment, though hopefully we'll get a more accurate reading today for dosing purposes.

I will stop there for now. I apologize if I've missed answers to these kinds of questions on the MB somewhere, but there is just so much information here, it's hard to get through it all!
 
Hi and welcome to the group, kudos to you for being way, way ahead of 99% of new members -- Signature, spreadsheet, and home testing already. Seriously wow. Took me like a week to get in line with just two of those three things. Home testing came last.

I am pretty new here, not one of the expert advice-givers but wow, 2.5U that is a LOT of insulin to start off a newly diagnosed kitty. Standard is to start on 1U 2X/Day. I mean you're seeing pink pre-shots without ANY insulin...you may want to try to discuss with your vet the possibility of starting on a lower dose. Lower isn't harmful and you can increase as you need, seeing as you are doing home testing already.

I am going to tag a few senior members regarding that starting dose because it is maybe very dangerous.

@tiffmaxee

@FrostD

@Bandit's Mom

@Bron and Sheba (GA) (might still be up on a Sat night?)
 
Welcome to you and Faraday. That is WAY too high a starting dose for a 10 pound cat. It should either be 1.0 if TR and .5 if SLGS since you are feeding a low carb diet. My 14 pound cat was started at 1.0 which was low but his numbers also were not off the charts. Would it be possible to get an auto feeder with a chip so that only he could open it?

You don’t need Purina DM. There’s nothing magic about it. Any low carb canned food is fine and just as good. You can check out the food lists and feed under 10%. Get one on the lower end and one around 7-9% as well as a food 10-15 and a few cans of high carb over 15% for your hypo kit.

Lantus is a depot insulin so will build up over the first 5-7 days. Will you be home over the weekend so you can test a little more often? Freeze dried treats are perfect for after testing and as treats.

We like lots of info and questions. Your intro is perfect. Do you work away from home? Can you adjust your shot time so you can get a test 2 hours after he gets his shot? If so you could feed again before you leave.
 
tiffmaxee said:
@Hendrick Cuddleclaw You gave really good advice!
Click to expand...

200w.gif
 
tiffmaxee said:
Welcome to you and Faraday. That is WAY too high a starting dose for a 10 pound cat. It should either be 1.0 if TR and .5 if SLGS since you are feeding a low carb diet. My 14 pound cat was started at 1.0 which was low but his numbers also were not off the charts. Would it be possible to get an auto feeder with a chip so that only he could open it?

You don’t need Purina DM. There’s nothing magic about it. Any low carb canned food is fine and just as good. You can check out the food lists and feed under 10%. Get one on the lower end and one around 7-9% as well as a food 10-15 and a few cans of high carb over 15% for your hypo kit.

Lantus is a depot insulin so will build up over the first 5-7 days. Will you be home over the weekend so you can test a little more often? Freeze dried treats are perfect for after testing and as treats.

We like lots of info and questions. Your intro is perfect. Do you work away from home? Can you adjust your shot time so you can get a test 2 hours after he gets his shot? If so you could feed again before you leave.
Click to expand...

Thanks to @Hendrick Cuddleclaw and yourself for replying so speedily!

I'm intrigued by the idea of an autofeeder with a chip, so I'll look into that, but I think for now we're going to try and make things work with the two meal times.

Thanks for the reassurance on the Purina DM - I certainly suspected this was the case. I'm using Merrick Purrfect Pate with carbs between 2 and 4%, which is lower than Purina DM, so I feel decent about not using that food. We may switch over to FF for $$$ though. I will be sure to pick up some higher carb options beyond the HC kibble we have on hand.

Myself and my spouse work away from home, and I think I could manage a 5am shot time to get a +2 if you think that's valuable, but I think I might have trouble getting home to do the 5pm. 6/6 would be most comfortable for our schedule, and I could stretch our mornings a little to get a +1.5 read.

I'm planning on starting this PM and monitoring as extensively as kitty will let me through the weekend. I have no plans that will put me out of the house for longer than 2 hours.

After talking with the vet this morning, she was "talked down" to 2U to start. She has apparently had really good remission rates with her "aggressive" treatment plan, and feels that especially with my monitoring, Faraday should be fine. She requested PS numbers and +4 after a week to see how things are going (more data is okay, but that's what she bases most of her decisions on).
 
That’s still a high dose and our TR is aggressive.

Lantus generally onsets starts working, around +2 fir many cats so that test would let you know if it’s an active cycle. I worry about beubg so aggressive and not being home all day. You don’t want a symptomatic hypo while you are away from home. Some cats have a strong response to the first few shots. For others it takes 5-7 days. For all the depot fills by day 5-7 and you will not be home. Better a few days too high than a day too low and the need for an ER visit and glucose drip if you are lucky enough to get home in time. Sorry for being so blunt. When cats bg drops too much we feed them hc to avoid a hypo. You will only be feeding and leaving.
 
I'm VERY new too. I just wanted to chime in that for the first two and a half months after my kitty was diagnosed on 1/3/22, I only followed the Vet's office advice (which btw differed between Vets in the same office) on everything. I regret that decision.
Being here has been the best progress I could have hoped for. Cleo (my kitty), my husband and our wallet are sooooo better off listening to and heeding the guidance of the members on this message board. Remember, YOU hold the syringe and YOU are the caretaker. There's more power in that compared to maybe a day and half of Vet School class on diabetes.
I'm sure you heard that "practice makes perfect". Well here, the members are managing feline diabetes 24/7. Its just a bit more practical and hands on knowledge of this condition that most Vets ever could see in his/her practice in a lifetime. Just my (not so) humble opinion.
Hope to see you around! Best of luck to you, your family and Faraday. What a SWEET looking kitty!
 
Hendrick Cuddleclaw said:
that is the part I don't get -- we define monitoring as being home with the kitty to keep an eye out for any signs of a hypoglycemic condition and also able to test every few hours.
Click to expand...

Yeah, it is definitely making me worried that we'll be heading back to work right at the start of cycle 6 and who knows what his numbers will be doing. @tiffmaxee I'm definitely afraid of what you outlined happening. I just emailed my vet to let her know that I'm much more comfortable starting with a 1U dose.

@Angela & Cleo thank you for your input - I do feel like the combined brain power over here is a much more reliable resource than the vet (who Faraday met for the first time today - we'd seen one of the other vets in the practice previously, but only the vet we saw today oversees the diabetes treatments apparently).

My vet said she "always starts cats on 0.5U/kg", but I'm free to do 1U if that's what makes me more comfortable. So I'm glad she's willing to be flexible with me! I feel much better about going home and give Faraday his first dose now (well, at 5:30)!!
 
Last edited:
Cali S said:
Yeah, it is definitely making me worried that we'll be heading back to work right at the start of cycle 6 and who knows what his numbers will be doing. @tiffmaxee I'm definitely afraid of what you outlined happening. I just emailed my vet to let her know that I'm much more comfortable starting with a 1U dose.

@Angela & Cleo thank you for your input - I do feel like the combined brain power over here is a much more reliable resource than the vet (who Faraday met for the first time today - we'd seen one of the other vets in the practice previously, but only the vet we saw today oversees the diabetes treatments apparently).

My vet said she "always starts cats on 0.5U/kg", but I'm free to do 1U if that's what makes me more comfortable. So I'm glad she's willing to be flexible with me! I feel much better about going home and give Faraday his first dose now (well, at 5:30)!!
Click to expand...


oh thank goodness, I am SO relieved to hear that!!

We have six cats and bought six Surefeed chip feeders, oof. They are near $200 a pop. However, they work great and we love them.

Regarding your earlier question about SLGS or TR -- TR requires a LOT of testing. I am not sure how you would do TR if working full time but I have read that it can be done...I just don't really see how unless able to pop home from time to time maybe. We are doing TR with Hendrick -- take a look at his spreadsheet, but I work from home. I've never really thought about TR requiring you to be around to feed but we definitely do feed Hendrick at +1 (1 hour after insulin) +2 and often +4...depending on how the insulin is working. If he is low, he gets food. Regardless of TR or SLGS it is good to be able to have food the kitty can access if their BG drops due to the insulin hitting.

Some people have had good luck with the Freestyle Libre, it is a sensor that is glued to the kitty to measure blood glucose 24/7. I don't think you can see the data remotely however, I believe the app requires a bluetooth connection. So that wouldn't help you see a cat's BG from afar.



-Kyle
 
Last edited:
Cali S said:
just emailed my vet to let her know that I'm much more comfortable starting with a 1U dose.
Click to expand...
Hi and welcome and good for you advocating for Faraday. I agree totally with starting at 1 unit. Better to be sure than sorry. It’s no fun getting kitties here that arrive having been given too high a dose.
You can always start with SLGS and change to TR at a later date if that suits better.
I would also recommend thinking about giving him some snacks during the cycles. It’s better for the pancreas and helps keep the BG from dropping too low.
You are pretty organised which is great….lucky Faraday!
 
Bron and Sheba (GA) said:
Hi and welcome and good for you advocating for Faraday. I agree totally with starting at 1 unit. Better to be sure than sorry. It’s no fun getting kitties here that arrive having been given too high a dose.
You can always start with SLGS and change to TR at a later date if that suits better.
I would also recommend thinking about giving him some snacks during the cycles. It’s better for the pancreas and helps keep the BG from dropping too low.
You are pretty organised which is great….lucky Faraday!
Click to expand...

Thanks! Do you think snacks with BG readings would be good? If I'm going to be doing 2-3 readings in between PS numbers, will that be sufficient?
 
Cali S said:
Thanks! Do you think snacks with BG readings would be good? If I'm going to be doing 2-3 readings in between PS numbers, will that be sufficient?
Click to expand...
Yes, I would start with that and see how that goes. Don’t forget the pm cycle as well. Just don’t feed for the 2 hours preshot as we don’t want the preshot BG to be food influenced. Usually better to feed during the first 6 or 7 hours when the insulin is strongest.
 
I'm going to give a bit of history. When the TR Protocol was first developed, the starting dose base based on weight: 0.5 x cat's ideal weight in kilograms. So, for Faraday, the initial dose would have been 2.25u. HOWEVER, this was based on cats who were hospitalized and there was veterinary coverage 24/7 to monitor their blood glucose (BG) levels. Shortly after, the authors of the protocol realized that this would be dangerous for caregivers who were learning how to manage their cat's diabetes at home. The starting dose was revised. It is now 0.25 x cat's ideal weight in kilograms or in Faraday's case, this would calculate out to approximately 1.0u. So, it's no surprise that your vet gets good results with a very aggressive starting dose but it's not safe for those of us who are not at home 24/7 to keep an eye on their cat's BG numbers. We're all about safety! And frankly, seeing that Faraday is at 111 at +4 today, I'm very glad you opted to start at 1.0u.

I would also suggest getting a +5 test. The lowest point in the Lantus cycle (i.e., the nadir) is typically around +6, give or take. However, this varies both on the cat and other factors including because cat's like to be unpredictable. Some cats routinely have early or late nadirs. My cat's nadir was around +3 except for those times when it wasn't. (You can see Gabby's spreadsheet in my signature.)

Just a word about testing. Both SLGS and TR strongly encourage that you test at pre-shot times and at least once during each cycle. The rationale is that Lantus dosing is based on the lowest point in the cycle and not on the pre-shot number. TR is more aggressive than SLGS and as a result, people do tend to test more but it's not out of the question if you're not home during the day. I used TR for 6.5 years and worked a full time job. My test time was a 5:00 which allowed me to get several tests before I was out the door in the morning. You may find this information on using TR if you work full time useful.
 
Status
Not open for further replies.
Back
Top