Help with shot timing

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CalicoCat13

Member Since 2023
Hi Everyone just joined this forum and have not had time yet to complete spreadsheet.

My cat, Kit Cat was diagnosed last week. She is 12+ and 7.5 pounds. Her vet recommended we start with modified diet of Royal Cann glycobalance not insulin

She started the new diet when I was on vacation and deteriorated quickly within 5 days… Wobbly back legs and fatigue.

I changed her diet to FF classic can pate. On 11/24 evening, she was started on Lantus pen with a vet recommended dosage of 1.8 units, but we chose to start at 1 unit. We are monitoring her BG with Aplhatrax 2 .
I test and then feed her immediately before shot

11/24 PM Preshot BG was 474. Gave 1 IU
11/25 AM Preshot BG was 408 Gave 1 IU
11/25 PM Preshot 268. She did not eat so skipped this dose
11/26 AM Preshot BG was 330. I did not count long enough and there was still a couple drops at syringe tip of pen. Did not retry.

11/26 PM - Her PM shot is due at 8 PM pacific but her BG is now at 458.
She has had trace ketones in urine a couple weeks ago per vet, but have not been able to get a urine sample day
She is hydrated and moving more than yesterday but I am noticing some fatigue
Is it ok to move the 2nd shot Up earlier. I am worried she might get ketoacidosis
She is a picky eater but ate well today.
I will work on spreadsheet later this evening

Thanks in advance for guidance!!
 
Hi and welcome to the forum.
I am very surprised the vet did not immediately start insulin if there were ketones in the urine.
You are right to be concerned if Kit Cat has had a trace of ketones in the urine.

I think you need to establish if she still has ketones in the urine and how many.
Do you have a bottle of Ketostix at home?
You can also test for ketones with a blood glucose meter. Some meters do both the blood glucose and the ketones.
If you can’t get a urine test for ketones I think it is important that you take your kitty to the vet to get the test done there.
The fatigue concerns me.
How is the appetite. It is really important that cats who have ketones eat plenty of food. So offer snacks of food every couple of hours.
Are you getting any tests in to see how low the dose is taking your kitty?

If you can answer theses questions and get back to me, I will talk about the dose.
 
Thanks for the quick replies! I have ketone strips waiting for her to urinate. She went from constantly urinating and drinking to infrequent urinating and reduced drinking as soon as I switched the food to FF. I did the few tests to see if she was hydrated and no appearance of dehydration

Will wait until 8 PM pacific for next shot

So far 1 IU took her from 474 to 268 in 24 hours. I think I messed up by not giving her yesterdays evening shot. Was concerned because she didn’t eat at shot time and then I screwed up again this AM

any recommendation on type of snacks? All I am feeling is FF with added water and occasionally tuna low sodium with water
 
CalicoCat13 said:
any recommendation on type of snacks? All I am feeling is FF with added water and occasionally tuna low sodium with water
Click to expand...

Most of the members will give the Freeze Dried cat treats

Click on this link and look at post #6. Numbers are to the right
You can get any freeze dried treats ,information is there
https://www.felinediabetes.com/FDMB/threads/brand-new-many-questions-3.255627/#post-2878703

You can still give 2 teaspoons of FF as a snack or some plain boiled chicken in water
 
CalicoCat13 said:
Thanks for the quick replies! I have ketone strips waiting for her to urinate. She went from constantly urinating and drinking to infrequent urinating and reduced drinking as soon as I switched the food to FF. I did the few tests to see if she was hydrated and no appearance of dehydration

Will wait until 8 PM pacific for next shot

So far 1 IU took her from 474 to 268 in 24 hours. I think I messed up by not giving her yesterdays evening shot. Was concerned because she didn’t eat at shot time and then I screwed up again this AM
Click to expand...
Have you been able to get any ketones tests done at all?
It is important we can establish if she has ketones or not and how many. Anything above a trace needs vet attention as it can escalate to DKA.
As I said before it is really important that she eats well. I would suggest you either go to the vet or ring and ask for some cerenia or ondansetron for nausea so that she eats. It is eating food and insulin which will get rid of the ketones. Once it escalates to DKA she has to be hospitalised.

also I would get some U100 3/10, 30 or 31 gauge, 6 or 8 mm insulin syringes with 1/2 unit markings so we can safely increase the dose of insulin. Pens increase on too large amounts. You can use the same pen to get the insulin out..I will show you later how to do this.
Also you don’t want to be skipping any doses of insulin. If the preshot is too low, stall dont feed and test again in 20 minutes. And please post and ask for assistance. You can always give a half dose if she won’t eat but we need to make sure she is eating so she can get the correct dose of insulin. Can’t stress enough how important this is.
If she has ketones in the urine at the moment she may need an increase in dose of insulin so try and get that test dose.
Just want to add, it is more important she eats anything at all at the moment, even if it is not low carb as eating trumps everything! So try her on her previous favourite food.
Please keep posting
 
Welcome to FDMB.

I'm curious how the vet came up with a dose of 1.8u!! Are you using a syringe for dosing or using the needle tips on the pen? If the latter, I'd encourage you to ask your vet for a prescription for syringes. You will want to get U-100 3/10cc syringes with half unit markings. The pens only dispense in 1.0u increments and you will need to change doses in smaller amounts.

The Royal Canin Glycobalance food is, unfortunately, high in carbohydrates. Despite the name suggesting it's appropriate for a diabetic cat, the canned food is 14% carbs and the dry food is much higher (24%). We consider low carb as under 10% and most of us use foods that are in the neighborhood of 5% carb. In addition, you'r'e paying a premium price for a food that does not have premium ingredients.

If you need to move your shot time, you can do so but you need to do so in small increments. You can change your shot time in 15 min twice a day (at each shot time) or by 30 min once daily (with 24 hours separating the change in time). This is due to the way Lantus works. Lantus likes consistency! If you make rapid changes in dose or in shot times, you're likely to end up with wonky numbers.

You might want to take a look at the sticky notes at the top of the Lantus board. There's a huge amount of information in those notes about how Lantus works, the dosing methods that are appropriate for the insulin, and a great deal of other information.
 
Thank you!
Have not been able to test for ketones. She has not urinated since middle of night. Will keep trying! Thats another one of my worries. Concerned She has not pee all day! She did have a bowel movement.

I ordered the syringes above earlier today. I have 4mg odanasteron at home that was prescribed to my daughter can this be used at a reduced amount?

I wish I would have known to wait 20 min. We wanted to do half dose last night but the insulin syringes we had did not have 1/2 unit steps. So Glad I found this forum!!
I really appreciate all the help!
 
Negative for ketones. Will get the spreadsheet uploaded tonight!
Also another question the vet will only call in the Lantus vial which is 100 ml -1000 units . I told her I can pull from pen but she refused. The pen I am using now I got from a neighbor. A 100 mL vial would take her months to go through. What a waste of insulin
How long are you able to keep the vial n fridge past the manufacturer recommended 28 days.
 
Hi besides setting up your spreadsheet can you please set up your signature ,it's information we need to know about Kit just so we don't have to keep asking you these questions.
It would be helpful if you can do what we call our signature and our spreadsheet
Tap on the blue link
Here is the link so you can set up your signature and spreadsheet or you can just tap on your name up top, then tap on signature add the information below and tap Save
Here is a link helping us to help you link. If you noticed, our members have some basic information about their cat's in their signature. This helps us to not pester you by asking the same questions (your cat's name, insulin type, date of diagnosis, etc.) repeatedly. We also have a link to our spreadsheet in our signature. We are very numbers driven. The spreadsheet is a record of your cat's progress. By linking it in your signature, we can follow along and provide feedback should you need the help.
Be sure to click the 'Save Changes' button at the bottom. If you need help urgently it is important we know these things at a glance. We don’t want to waste valuable time finding out information.

If you want help setting up your spreadsheet just ask we have a member who will be happy to do it for you

That's crazy your vet won't write a script for the lantus pens.
If I remember correctly the vial should last 6 months ,just keep it in the fridge middle shelf
I know lantus is expensive in the US , if your vet would have written you a script for the pens , lantus comes in a generic form which is way less expensive , most members use it
Just to show you how less expensive the generic lantus pens are tap on this link
https://felinediabetes.com/FDMB/threads/new-member-11-8-and-i-am-tired.283363/#post-3121360 and read post #4
@CalicoCat13
 
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Diane Tyler's Mom said:
Hi besides setting up your spreadsheet can you please set up your signature ,it's information we need to know about Kit just so we don't have to keep asking you these questions.
It would be helpful if you can do what we call our signature and our spreadsheet
Tap on the blue link
Here is the link so you can set up your signature and spreadsheet or you can just tap on your name up top, then tap on signature add the information below and tap Save
Here is a link helping us to help you link. If you noticed, our members have some basic information about their cat's in their signature. This helps us to not pester you by asking the same questions (your cat's name, insulin type, date of diagnosis, etc.) repeatedly. We also have a link to our spreadsheet in our signature. We are very numbers driven. The spreadsheet is a record of your cat's progress. By linking it in your signature, we can follow along and provide feedback should you need the help.
Be sure to click the 'Save Changes' button at the bottom. If you need help urgently it is important we know these things at a glance. We don’t want to waste valuable time finding out information.

If you want help setting up your spreadsheet just ask we have a member who will be happy to do it for you

That's crazy your vet won't write a script for the lantus pens.
If I remember correctly the vial should last 6 months ,just keep it in the fridge middle shelf
I know lantus is expensive in the US , if your vet would have written you a script for the pens , lantus comes in a generic form which is way less expensive , most members use it
Just to show you how less expensive the generic lantus pens are tap on this link
https://felinediabetes.com/FDMB/threads/new-member-11-8-and-i-am-tired.283363/#post-3121360 and read post #4
@CalicoCat13
Click to expand...
Thanks! I asked for a script to take to my pharmacy but she sent to Chewy! They charge $300 for the 100 ml and 100+ for pen non generic!!
I will update sig and spreadsheet asap!
 
CalicoCat13 said:
Thanks! I asked for a script to take to my pharmacy but she sent to Chewy! They charge $300 for the 100 ml and 100+ for pen non generic!!
I will update sig and spreadsheet asap!
Click to expand...
Get the lantus pen then from chewy for 108.00 , maybe you can call them and tell them you want the pen, tell the vet you can't afford the vial ,tell her to call chewy and change it for the pen, ,Jesus
 
that’s what I did yesterday. I spoke to Chewy and they agreed that I could use the pen and that they would call the vet. They called the vet got it approved. The order was processing at 7 this morning and then the vet messaged me and said that I can’t use pen. I sent her a handout from university of Illinois vet school that shows how to draw from pen and she said it’s at the vets discretion and it shouldn’t be done.. Shortly after the Chewy order for pen automatically cancelled
I should have stressed the financial impact with vet!

should note that the pen I am using now was given to me by an awesome neighbor while I waited to receive the chewy order. This has been going on for a week now
 
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CalicoCat13 said:
that’s what I did yesterday. I spoke to Chewy and they agreed that I could use the pen and that they would call the vet. They called the vet got it approved. The order was processing at 7 this morning and then the vet messaged me and said that I can’t use pen. I sent her a handout from university of Illinois vet school that shows how to draw from pen and she said it’s at the vets discretion and it shouldn’t be done.. Shortly after the Chewy order for pen automatically cancelled
I should have stressed the financial impact with vet!

should note that the pen I am using now was given to me by an awesome neighbor while I waited to receive the chewy order. This has been going on for a week now
Click to expand...
Jeez! I'm so upset for you! One of the first things my vet did was tell me about the different insulins and then suggest a Lantus pen, not vial. It was my vet's idea before I even found this group! Your vet sounds woefully behind on current therapy.
 
@CalicoCat13, are you in the US?

If so... you can get a 5 pack of the Lantus pens or a vial for $35 through GoodRx:

https://www.goodrx.com/lantus

This is valid for pets - see their FAQs here: https://support.goodrx.com/hc/en-us...for-my-pet-Can-you-help-me-find-a-pet-coupon-

I ended up getting Sally's Lantus from Costco. I just showed them the GoodRx info when I picked up the vial. The clerk was sort of shocked that it caused the price to go down so much, but they gave it to me without any trouble.
 
@CalicoCat13 Maybe it's time to start searching for a new vet down the road.
Maybe you can start calling around to be sure that they prescribe lantus/generic
and will write prescriptions, and not use Chewy.
Your vet sure doesn't seem to be a vet that will work with you , and doesn't know too much about diabetes.
One other thing I read you said in your post
We are monitoring her BG with Aplhatrax 2 .
Since the vet is making you spend so much money on the lantus vial most of us use human meters, that's what our numbers are based on anyway.
I know how expensive the strips are for the Alpha Trak 2 is discontinued , but you can still get the strips yet but now they are really expensive.
I would buy the Relion Premier Classic Meter from Walmart , most of our members use it
 
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sullim4 said:
@CalicoCat13, are you in the US?

If so... you can get a 5 pack of the Lantus pens or a vial for $35 through GoodRx:

https://www.goodrx.com/lantus

This is valid for pets - see their FAQs here: https://support.goodrx.com/hc/en-us...for-my-pet-Can-you-help-me-find-a-pet-coupon-

I ended up getting Sally's Lantus from Costco. I just showed them the GoodRx info when I picked up the vial. The clerk was sort of shocked that it caused the price to go down so much, but they gave it to me without any trouble.
Click to expand...
Thank you! Yes I am in the US. Looking at the link now!!
 
sullim4 said:
@CalicoCat13, are you in the US?

If so... you can get a 5 pack of the Lantus pens or a vial for $35 through GoodRx:

https://www.goodrx.com/lantus

This is valid for pets - see their FAQs here: https://support.goodrx.com/hc/en-us...for-my-pet-Can-you-help-me-find-a-pet-coupon-

I ended up getting Sally's Lantus from Costco. I just showed them the GoodRx info when I picked up the vial. The clerk was sort of shocked that it caused the price to go down so much, but they gave it to me without any trouble.
Click to expand...
Ok just got the coupon! Thank you. Did Costco ask for the vet prescription? Or you just provided the DEA #?
 
That’s a great price. I am using a friend’s Alpha Trax2 and just had to order test strips . I have been testing several times a day since 11/23 . The Alpha Trax 2 test strips are $70!! Will order that monitor so I have my own Thank you!!!
 
CalicoCat13 said:
Ok just got the coupon! Thank you. Did Costco ask for the vet prescription? Or you just provided the DEA #?
Click to expand...

Costco didn't ask for it. I think they have filled scripts from our vet in the past, so it was already on file.

You should also familiarize yourself with your state's laws around veterinary prescriptions. Many states (including Washington, where I live) require them to produce a written prescription, much like an optometrist has to for glasses or contacts. If your state has such a law, and they give you a tough time about releasing the prescription, cite the law with the section number, etc. That will usually get things taken care of quickly.
 
CalicoCat13 said:
That’s a great price. I am using a friend’s Alpha Trax2 and just had to order test strips . I have been testing several times a day since 11/23 . The Alpha Trax 2 test strips are $70!! Will order that monitor so I have my own Thank you!!!
Click to expand...
You're welcome. The link sullim4 gave you is the sort of the same one I gave you in my post #13 . I'm sure you need a prescription from your vet no matter where you go and about the DEA# they will have to contact your vet for that.
 
Diane Tyler's Mom said:
You're welcome. The link sullim4 gave you is the sort of the same one I gave you in my post #13 . I'm sure you need a prescription from your vet no matter where you go and about the DEA# they will have to contact your vet for that.
Click to expand...

Something's definitely changed recently with Lantus pricing - the brand-name, not the generic. It seems like the $35 deal is now widely available at almost any major pharmacy through GoodRx, for either the pens or the vial. Our vet was similarly shocked; I guess one of her clients had just paid $360 a couple weeks ago for the same vial.

I'm tempted to stash the pens in case they somehow discontinue it or clamp down on veterinary use of it.
 
sullim4 said:
Costco didn't ask for it. I think they have filled scripts from our vet in the past, so it was already on file.

You should also familiarize yourself with your state's laws around veterinary prescriptions. Many states (including Washington, where I live) require them to produce a written prescription, much like an optometrist has to for glasses or contacts. If your state has such a law, and they give you a tough time about releasing the prescription, cite the law with the section number, etc. That will usually get things taken care of quickly.
Click to expand...
Thanks
I am in WA also. I asked the vet to provide a prescription since Chewy was too expensive and vet said she needed to examine her. If the vet submitted and approved a prescription at Chewy, why do we need another exam in order to get a non-chewy prescription. Ridiculous. Found another vet!
 
I wonder if there is a miscommunication about "using the pen" with your vet. We recommend that you not use the needle tips that fit the pen and instead, use a syringe. The pens only dispense insulin in 1.0u amounts. That is not feasible with cats. We typically change doses in 0.25u amounts.

I'd also (sadly) point out that most vets are pretty clueless about the mechanics of how insulin is dispensed (e.g., what the pens can or can't do), if a drug is available in a generic/biosimilar form, or in some cases, if you can purchase it at a human pharmacy. Likewise, they are unaware of what the costs are.
 
Sienne and Gabby (GA) said:
I wonder if there is a miscommunication about "using the pen" with your vet. We recommend that you not use the needle tips that fit the pen and instead, use a syringe. The pens only dispense insulin in 1.0u amounts. That is not feasible with cats. We typically change doses in 0.25u amounts.

I'd also (sadly) point out that most vets are pretty clueless about the mechanics of how insulin is dispensed (e.g., what the pens can or can't do), if a drug is available in a generic/biosimilar form, or in some cases, if you can purchase it at a human pharmacy. Likewise, they are unaware of what the costs are.
Click to expand...
I agree. I sent a Univ Illinois Vet school of Med Flyer showing how it’s done but didn’t make a difference in her decision.

Our new vet told us she had just learned about drawing directly from pen. New vet was also very happy to hear about Good RX. Thanks to everyone here for all of the feedback and support!! Such a great forum ❤️
 
Sienne and Gabby (GA) said:
I'm so glad you found a vet you can work with. It can make all of the difference! It's so frustrating when a vet (or MD) doesn't want to learn from their clients.
Click to expand...

Thank you!! Kit Kat ended up having a UTI which her new vet quickly treated ñ with antibiotics . The antibiotics seemed to have caused constipation. The vet was able to resolve with an enema after no success of poop on Day 6 with Miralax.
Kit Kat is also down to 0.5 IU every 12 hours and PSBG is hovering low 100s for past few days.
Today’s challenge reduced appetite hoping this is temporary and due to enema. I have given her multiple choices of FF and Sheba Pate but she takes a bite turns her head.
Thankful for everyone here and that her BG is no longer in 400s/500s
 
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