12/16 Sydney - Petsitting diabetic need advice

[cjaubz]

Good morning lantus land. My name is CJ. I haven't posted in this forum before but I'm a long time member and have been a mom to 2 diabetic cats. They are not the reason I'm writing. I need to lean on the power of this board and years of wisdom to verify I'm doing the right thing (sorry this is a little bit long).

My petsitter (who takes care of my diabetics) just got a diagnosis on her cat Sydney on 12/7. Edited to add: cat on Lantus. She left yesterday on a honeymoon to Aruba and requested specifically I watch her cat due to the diabetes and the new diagnosis.

I met with her on 12/7 and explained all the principals, gave links, etc. She has continued to follow the direction of her vet who has taken this cat from 1u-4u of insulin in 1 week! I did inform the owner that this carried a lot of risk with what they were doing and especially being out of town. I was told by them you know diabetes and we know you will do whats right and if you need to reduce the dose then do that.

There isn't a lot of data to go off of, but here is what I know: Almost no history on readings, the cat isn't starving, but does have severe neuropathy, no PD/some PU.
I'm sorry I don't have time for spreadsheet on him, but want to get you what I know:

12/5 approx diagnosis 450+
12/7 reading 405 (showing her how to use meter, etc)
12/7-12/14 - vet increases dose from 1.0 to 3.5u approx every 4th cycle with a +6 nadir. I don't believe this cat has had a full curve run - only spot checks at +6 for insulin adjustment :shock: :shock:
12/14 6:00pm PMPS 3.5U
12/14 7:30pm +2 158
12/15 6:30am AMPS 370 3.5U
12/15 12:45pm +6 258

Call result into vet - go to 4U!!!! :shock: :shock:
I'm not comfortable doing that. You have a cat newly diagnosed with inappropriate settling time on lantus with what appears to be a change in dose approx every 4 cycles. What happened to start low, go slow?? This cat is getting ready to bottom out and go hypo at these levels, and the owner has removed all dry food this week. Can you say disaster waiting to happen?? I know this cat is going to bottom out. I would rather have this cat a little high than hypo in ER while they are away.

12/15 6:00pm PMPS 136 2U
12/16 7:00am AMPS 175 2U

I took a wild guess and said 1. too much insulin, 2. too low PS, 3. change in food, 4. Severe neuropathy - cut dose in half and monitor preshots. If under 100 I wouldn't shoot. Please let me add due to current work constraints plus petsitting I can really only do +12 readings.

Have I done the right thing? I'm still questioning 2U, but due to visual clinical signs I was worried about dropping all the way back to 1U, but may have to reduce in the next day or so. I would appreciate any insight or wisdom. I will be back in a few hours.
Thanks,
CJ

 

[rhiannon and shadow (GA)]

Someone will come along and give you specifics about dosing.
IMHO, I wouldn't shoot 4 units either. I would have done the same as you but I would make sure to try to get more readings.
But I do know that you will want to check on ketones. Do you have any keto-stix?


In case you don't know, this will help the neuropathy. Make sure she gets this when she returns.
Zobaline

 

[cjaubz]

I have asked about ketones and owner said vet checked and cleared. 3 cat household and I'm only there every 12 hours so urine ketone catching would be tough, but i do have a blood ketone meter. Great idea - I'll take it with me tonight and get a reading. Cat still isn't comfortable with readings and shots, but is getting better.

 

[Sienne and Gabby (GA)]

CJ --

The Tight Regulation protocol does make provision for increases after 4 cycles if the nadirs are consistently above 300.

Most cats need to have their dose increased. Do it in 0.25 IU or 0.5 IU steps (0.25 IU if the cat is getting a low dose and/or relatively low BGs, 0.5 IU if the cat is getting a higher dose and/or relatively high BGs). Hold each dose for 5-7 days. However, if the cat is producing continuously high BGs (nadir always >=300 mg/dl), only hold the dose for 2-3 days before increasing it by 0.5 IU. Alternatively, if the cat is continuously producing moderately elevated BGs (nadir always >=200 mg/dl), increase the dose every 2-3 days by 0.25 IU ( if the cat is getting a low dose) or 0.5 IU (if the cat is getting a higher dose). From this point onward test for ketones once per week, or more often if the nadirs are still >=200 mg/dl.

However, to follow the TR protocol, there are a lot of things the owner isn't doing -- no dry food, more than pre-shot testing, etc. And, as you noted, it doesn't sound like the initial dose was given enough time to get the insulin depot to form and stabilize (i.e., 5 - 7 days).

Where I think the situation is critical is leaving the dose at a higher level and switching to low carb food. That IS a potential disaster waiting to happen. Just out of curiosity, would it be at all feasible to bring Sydney to your home so you could keep a closer watch on the kitty?

FWIW, when I travel, my petsitter comes in only for shots. I reduce the dose that my cat is getting because she's not there to monitor. I think reducing is safest for the cat and your peace of mind.

 

[cjaubz]

Without going into a whole another novel - here is a short story version.
I do not believe it's in our best interest for Sydney to come to my place. I have just gone through and extremely tough 4 months on 2 cats not getting along, behaviorist involved, vet involved. Bottom line my diabetic ended up in ketoacidosis for 7 days with ER treatment. The other cat was re-homed (please don't judge without knowing the whole story). I never anticipated ever, ever having to give up a cat. We did everything possible and it became life threatening to Oreo. She is just now back on track. Unfortunately not an option.
CJ

 

[Sienne and Gabby (GA)]

What a difficult situation and no judgement at all. Some cats are way too territorial to tolerate another cat in the house. A good friend's cat became quite ill with severe GI stuff when they brought a new kitten home. The kitten went back to the breeder so I get it. I just raised it as a possibility given how concerned you are over Sydney.

Bottom line, if no one is around to get mid-cycle numbers, IMHO, even the caregiver shouldn't be shooting 4u without a ton of data. You understand FD. Follow what your gut is telling you to keep this kitty safe.