Glargine not helping my cat

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Katy Androski

Katy Androski

Member Since 2024
My cat Evinrude is 8 years old and weighs about 14 pounds.

Evin was diagnosed with diabetes on 11/3/23. I started giving him 2 units of Novolin every 12 hours. I switched vets to
VCA Animal Hospital and they attached a blood glucose monitor to him on 11/30/24. His glucose levels were up and down, between 312 down to below 50. My vet advised starting him on glargine, so on
1/22/24, I started 1 unit of glargine every 12 hours. I got a glargine pen from my pharmacy, and VCA transferred the
liquid to a vial so that I could use the prescribed needle. VCA said that the pen required you to insert the needle for 10
seconds, which is hard to do with a cat. After starting glargine, Evin began acting hungry and was urinating much more. He had another monitor attached on 2/2/24 and his levels were up and down between 346 and 498. I was told to increase his dose from one unit of glargine to 2 units of glargine on 2/5/24. Another monitor was attached Evin on 2/16/24. His levels were
between 354 and HI (too high to record?). I was told by the vet to increase his dose to 2.5 units every 12 hours, so I started the evening of 2/17/24.

My pharmacist told me that it should have been OK to transfer glargine between the pen and the vial. It should be OK to
use the same syringe twice in one day. It should be OK to leave the glargine out at room temperature by accident for a
short time. I feel confident that I’m giving the shots correctly, with the proper needle.

I'm feeling frustrated that things seem to be getting worse instead of better. I've been told that it can take time to get the dosage right, but it doesn't make sense that I'm giving him more glargine and his blood sugar is getting higher. Thanks for your help!
 
There is no reason to transfer the insulin from pen to vial in order to use a syringe for injecting the insulin. You just stick the end if the insulin syringe needle into the end of the pen that accepts the pen needle and draw out the insulin you need. One could reuse an insulin syringe twice but it is not recommended.
It is OK to leave out the insulin for short periods of time like to draw out the dose or you forgot to put the back in the fridge. The manufacturer or glargine says it is good for at least 28 days unrefrigerated. Moving a pen in and out of the fridge may result in air getting into the pen which could cause inaccurate dosing when using pen needles.

W/o BG values at different time like before shot and various times after shot we really can't tell what is going on. Most of use here record our BG values in a spreadsheet. See:
https://felinediabetes.com/FDMB/threads/how-to-create-a-spreadsheet.241706/
https://felinediabetes.com/FDMB/threads/how-to-use-the-spreadsheet.241653/
I would start with a new glargine pen and
 
Hi and welcome to FDMB. We can help you learn to manage Evinrude's diabetes.

There are three things that are needed to help get glucose levels under contol. A long acting insulin, home testing and a low carb/high protein diet. Glargine is a very good insulin for cats. However you do not need to transfer the insulin from the pen to a vial. You can use the pen as a miniature vial and use the U100 syringes instead of the pen needles. We also recommend using the syringes with 1/2 unit markings since dose changes should be done in .25 to .5 units instead of a whole unit. You can leave the insulin out but we recommend keeping it refrigerated to last longer. Also ignore the 28 day limit for insulins. That applies to people only. We use it until it becomes ineffective.

You are also home testing by using an attached monitor. You may want to consider getting a regular glucose monitor as a backup. We can help you learn to use it. A good inexpensive one is the Walmart Relion brand meter if you are in the US. However any human meter will work. Since the meter you are using do not last very long this will ensure you still can test in the event of an emergency.

What are you feeding Evinrude? If his diet includes dry food, including prescription food, then he is getting too many carbs and that is why you have high levels. We recommend canned or raw food only. Avoid any foods with gravy such as filets, bits, etc. Pate flavors usually are lower in carbs. Also if you vet has him on prescription food, that is not needed. There is nothing special about it and also has too many carbs.
 
I would suspect the insulin might not be good. We highly recommend not using insulin that has been transferred but use it straight out of the pen. This post from the Lantus forum has a lot of good information about Lantus, and includes pictures on how to get the insulin out of a pen into a syringe: Insulin Care & Syringe Info: Proper Handling, Drawing, Fine Dosing I agree with Larry, I would start with a new pen first before increasing. If his numbers don't come down after a few days, then think about a dose increase.

We don't use the pen needles, but instead withdraw with syringes. What brand of syringes are you using? Do they have half unit markings? That same post I linked above shows what happens to syringe when you use them multiple times. The needles degrade. By the way, I had a locum vet tell me I could use syringes 2-3 times too. Obviously, they've never had a shot themselves with used needles.
 
Are there any non-chain vet hospitals in your area? Some of the chains like Banfield and VCA aren't highly thought of (profits over quality of care, etc) but it may depend on location. If you don't feel that the VCA vets are helpful or doing what is best for your cat, seek out a new vet.

Ignore the pharmacist. Pharmacists have no clue how on using Human medicines that are prescribed for pet use. A lot of times the Human way of using a medicine is not the same way a pet would use it.
 
Every pharmacist is different. The pharmacist where I first got Lantus had a lot of feline clients. She knew more than my vet about certain things, cause my vet knew about Caninsulin. The pharmacist was the one who said only use the syringe once, sold me the 1/2 unit marked syringe, told me to keep the Lantus in the fridge. But I suspect she was an outlier in being knowledgeable about Lantus for cats.
 
Katy Androski said:
It should be OK to
use the same syringe twice in one day.
Click to expand...

This is why we don't recommend re-using needles. The needles these days are so thin it doesn't take much (just using them once) to cause damage to the needle.
z83kzEfvVF6GqR6zq4mMuo2mN8W7jqwkFmKD4MOD5gM.png
 
Thank you all so much. Here's what I got from your comments:

I must feed him canned food - but I don't have to feed him prescription canned food.

I can get glargine from a glargine pen by using my own needles. It would be a good idea to try a new pen.

I can get a human blood sugar monitor instead of getting one attached (Walmart - Relion).

This morning my vet wanted me to bring Evinrude in for 3 days boarding, at no charge so that they could monitor him. I decided not to do it, because he gets really upset at the vet (The vet requested that I give him gabapentin before I bring him in) and I don't see how they're going to monitor his levels effectively if he's really upset. I've only been giving him the increased dose (2.5 units) for 2 days, so I feel like I have to wait until it's been a week to give it a chance to work. I'm going to try to post his levels for today so far.
 
Katy Androski said:
I decided not to do it, because he gets really upset at the vet (The vet requested that I give him gabapentin before I bring him in) and I don't see how they're going to monitor his levels effectively if he's really upset. I
Click to expand...
I agree, BG tests@vet are usually raised by stress. Also for extended stays luke your vet suggested a cat may not eat normally which aggravates get BGs representative of @home.
Katy Androski said:
I've only been giving him the increased dose (2.5 units) for 2 days, so I feel like I have to wait until it's been a week to give it a chance to work. I'm going to try to post his levels for today so far.
Click to expand...
Agree. Just note that if you get BG that seems too low you should either reduce dose or skip dose.

A spreadsheet is a great format to record BG. Myfirst reply gave a reference of how to create one. If you are having problems setting up a SS you can ask here and someone will set one up for you.
 
Why can't I upload a file? I give him his shots around 7am (I know I have to start recording this precisely) and then try to give him a shot close to 7:00 p.m. (sometimes it's 5:30 p.m. because of my job).

2/16/24:
11:57 am - 458
2:03 pm - 454
4:30 pm - HI (over 500?)
6:16 pm - HI
8:03 pm - HI
9:57 pm - 454
11:58 pm - HI

2/17/24:
2:17 am - HI
4:36 am - HI
6:37 am - HI
8:09 am - 494
11:51 am - 443
1:58 pm - 416
4:01 pm - 416
6:50 pm - 354
9:35 pm - 408
11:58 pm - 431

2/18/24:
2:32 am - HI
6:57 am - 475 (right before feeding)
9:57 am - 479
5:17 pm - HI (right before feeding)
9:56 pm - HI

2/19/24:
1:10 am - HI
3:46 am - HI
5:55 am - 367
6:34 am - 399 (right before feeding)
10:00 am - 410
 
Katy Androski said:
Thank you all so much. Here's what I got from your comments:

I must feed him canned food - but I don't have to feed him prescription canned food.
Click to expand...

Yes. Any canned food that is low carb. Prescription food is not needed and have no magic ingredient that helps the diabetes. It has been said that the vet who originally created Purina DM doesn't recommend it because Purina drastically changed the ingredients so it's basically overpriced junk. It's ok to disagree with the vet about food.

Members use this food chart to find foods under 10% carbs: https://catinfo.org/docs/CatFoodProteinFatCarbPhosphorusChart.pdf The chart isn't up to date so there are foods listed there that have since been discontinued.

Raw and home cooked food are options but not everyone can or wants to feed those.

I can get glargine from a glargine pen by using my own needles. It would be a good idea to try a new pen.
Click to expand...

Yes. You don't need pen needles. Regular insulin syringe needles work. Just be sure to use U100 3/10cc insulin syringes. The ones with half unit markings are ideal so that you can measure half and quarter doses if needed.

There are pet / veterinary insulin syringes but the Human ones work just fine and, depending on brand, costs less.

All the info you need about using glargine: https://www.felinediabetes.com/FDMB...info-proper-handling-drawing-fine-dosing.151/

Are you diabetic yourself?

I can get a human blood sugar monitor instead of getting one attached (Walmart - Relion).
Click to expand...

Any Human blood glucose meter works. Relion is popular but it's only a Walmart only brand. I don't have a Walmart nearby to pop into if I run out of test strips so I use a more widely available brand, AccuChek. I can pop into any CVS or Walgreens to buy test strips if I forget to order more online.


This morning my vet wanted me to bring Evinrude in for 3 days boarding, at no charge so that they could monitor him. I decided not to do it, because he gets really upset at the vet (The vet requested that I give him gabapentin before I bring him in) and I don't see how they're going to monitor his levels effectively if he's really upset. I've only been giving him the increased dose (2.5 units) for 2 days, so I feel like I have to wait until it's been a week to give it a chance to work. I'm going to try to post his levels for today so far.
Click to expand...

Vet monitoring is not necessary unless your cat has other ongoing health issues the vet needs to monitor as well. Cats get super stressed at the vet's office and that causes blood glucose levels to be super high. A curve done at the vet's office is just going to show super high levels which may not the be same if your cat was relaxed at home.

Hold a new dose for at least week before doing a curve and then increasing or decreasing if needed.

Set up a Google spreadsheet for your cat. The instructions are here: https://www.felinediabetes.com/FDMB/threads/how-to-create-a-spreadsheet.241706/

A related info sticky: https://www.felinediabetes.com/FDMB/threads/how-to-use-the-spreadsheet.241653/
 
I bought a new pen, carefully. Read all the instructions and watch the videos, and then used my own syringe to draw insulin from the new pen. I accidentally pushed some insulin back into the pen. I don't think it was much, but now I'm worried that I ruined the glargine in the new pen.
 
I doubt that you ruined the insulin. The issue is more that there is a mechanism in the pen that keeps the insulin at the tip if the pen. You don't want air in the pen. In addition, there's silicon in the syringes so injecting insulin back into such a small container could be problematic. However, it was a one time thing. I'm suspect it will not cause a problem.
 
Thank you so much for the reassuring info. Talked to my vet this morning and she wants me to start giving him 3.5 units, which seems like a lot. But it's not helping, so I guess it makes sense to give him more.
 
Katy Androski said:
Talked to my vet this morning and she wants me to start giving him 3.5 units, which seems like a lot. But it's not helping, so I guess it makes sense to give him more.
Click to expand...
Can you fill out a spreadsheet with the BGs and doses you have so far? With that info we reallu cant say if 3 ½ units is to much but suspect it is too much. You can ask here for someone to start that spreadsheet for you.
 
Please take a look at this post on helping us to help you. There are instructions on setting up a spreadsheet and your signature. The majority of members here are uncomfortable providing information on dosing without seeing how your cat is responding to insulin. We do not want to make recommendations that could potentially harm your cat and without seeing how your kitty is reacting to a dose of insulin, we can't provide informed input.
 
Evin has been on 3.5 units of glargine for about 2 months. I want to start home testing him and I've watched the videos, but I'm unsure about how often and when I should test him. I'm also going to start a spreadsheet with this information. His urination seems under control. I've been trying to feed him every 12 hours and then I give his shot right after he eats. My vet told me to try to feed him only twice a day (every 12 hours) but he gets really hungry around 3:00. Is it okay to give him a snack in the middle of the day?
 
With Lantus, you don't need to feed him just twice a day. For diabetic humans, small more frequent meals is best, same for cats with a potentially healing pancreas. You don't want to feed it with too much food at once.

As far as testing goes, always test at least before each shot. We do test, feed, and shoot, all within 10-15 minutes. Some shoot while the head is in the bowl. Getting spot checks during the cycle (time between shots) will give you an idea how low the cat is going on that dose. We determine how to change doses based on how low the current dose is taking kitty. Lantus nadir or low point is typicall around 6 afters after the shot, but can vary by cat and cycle to cycle. A test just before bed is good, if at least 2-3 hour after the PM shot. Many cat go lower at night.

Try not to feed after the midpoint of the cycle, cause after that the insulin effect is starting to wear off. If you shoot at 9am, then 3pm might be the latest for another meal. You can always give no carb or very low carb treats such as freeze dried all meat treats. Or baked/boiled chicken breast pieces later on.
 
If you don't have the U-100 syringes with the half unit markings these aB009LTE0DOs you need since we increase or decrease by 0.25 units at a time.
You won't need a script if you order from Amazon
https://www.amazon.com/UltiCare-31-Gauge-Veterinary-Insulin-Syringes/dp/B009LTE0DO

Always keep the insulin in the middle shelf of the fridge
If you have a Walmart you can also get them from Walmart
ALL of the 3/10ml Relion syringes at Walmart have half unit marks. . You will want one of these boxes of syringes (the difference is the needle length...blue box are shorter needles than white box but both work fine). As long as the box has the purple stripe, they are the correct syringes.
upload_2024-4-12_20-17-34-jpeg.69856

  • Full and half-unit syringe scales:
49823063143_3437e9e997_o.jpg
 
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