12/27 Azure AMPS 426

Amanda Wenger

Amanda Wenger

Member Since 2020
Hi! We are new to diabetes and home testing. Azure is currently prescribed 1 unit of Lantus once per day. Her numbers sometimes get into the 100s but not below that from what I have seen. I am questioning why she is only getting insulin once per day since the 2010 recommendations suggest he starting dose for Lantus at 1 unit every 12 hours. I'd really like to see her numbers return to a more normal level and once a day doesn't seem to be doing it. Should I add a second dose?

Thank you!
Amanda & Azure
 
Hello and welcome to you and sweet Azure. You are right that we all do two doses a day. I have seen single dosing work in less than a handful of cases and then when cats were on very tiny doses, which doesn't describe Azure yet.

I'm not sure we'd suggest 1 unit for both doses, without seeing what her blood sugar data has been like. Would it be possible for you to enter the data in a spreadsheet like the rest of of us have? The following post describes how to set up the spreadsheet, and how to fill in your signature to help us help you: New? How You Can Help Us Help You!
 
Thanks so much for your response! I have started a spreadsheet but don't have a lot of data in it yet - I just got my meter last week and am getting the hang of using it. The vet did a curve last Wednesday but I don't have the numbers for that yet. They just said her lowest numbers were in the 100s. They sent off a fructosamine test but the results of that have not come back yet. The needles I have right now do not have 1/2 unit increments on them. I have ordered some with smaller units on them but have to get approval from the vet before Chewy will process the order.
 

Attachments

The spreadsheet you have attached is a format that comes from a FB group, not ours. It is very similar, because they took ours and modified it. Unfortunately the modifications cause the spreadsheet to die on certain devices (like tablets). On one hand it's a good idea you don't have a lot of data yet, cause then you could switch to our spreadsheet fairly quickly. These spreadsheet instructions contain the link to our template, as well as the instructions on how to attach it to your signature, so that people who don't have Excel on their computers can also see it.

Other important things to include in your signature is date of diabetes diagnosis, type of meter you are using, type of food being fed. They all are factors we consider when helping with dosing. We also have two different dosing methods for Lantus here. Check out the Sticky Note on Dosing Methods at the top of this forum to see what might be best for you. All the Sticky Notes are a good read.

I do see on the spreadsheet that you are feeding hydrolyzed dry and urinary food. Is there a reason for that? Both are rather higher in carbs than a diabetic should eat. Feeding dry food limits you to following the Start Low Go Slow Dosing Method.

If you don't have 1/2 unit marked syringes yet, it will be tricky to dose in smaller amounts. However, there are a couple methods people have used. One is to use digital calipers to measure the dose Dosing with calipers , one is to count the number of drops in 1 unit dose and remove 1/4 of those drops to go down to 0.75 units. I could probably think of other methods too. If you are using the BD syringes there is an insulin measuring paper guide.
 
Ok thank you so much! I have updated the signature and will work on getting the new spreadsheet set up. I am still giving her the RC dry food because she gets calcium oxalate urinary stones and needs a more alkaline diet to prevent them from growing. Unfortunately, high protein diets are acidic and the opposite of what she needs for her urinary issues. I’m working on switching her to alkaline water and researching lower acid meats - but those are often not anti-inflammatory which would be more ideal for her lymphoma. It’s been really tough trying to strike a balance with all her needs. Because of all that, I am fine with the Start Low and Go Slow dosing method. Lastly, I do have BD needles. Where would I find the paper guide for measuring?
 
Great job on the signature. Looks like poor Azure has a lot going on. Is she not on prednisolone or budesonide for the small cell lymphoma? Usually a steroid is part of the standard treatment. On my third cat with SCL. :rolleyes:

Does the RC or urinary s/o come in a wet food format? Typically those are somewhat lower in carbs than the dry and just better overall or the cat. Have you been to the Catinfo web site yet? The author is a vet specializing in feline nutrition, and has a page on urinary issues. Of note, the consideration of phosphorus in diet as well. My non diabetic had urinary issues so I had to feed a diet both he and Neko would eat, so lower carb and low phosphorus.

The insulin ruler is here: https://www.diabetes-katzen.net/insulinruler.pdf
The description of how to use the ruler is in the document called Management of Diabetic Cats with Long Lasting Insulin (2013) is linked in the Sticky Note on Dosing Methods.
 
Thank you so much for the links and information! Azure was on prednisolone for about 6 weeks but that's what caused her diabetes so she was weaned off a couple weeks ago. Her oncologist seems to think the chlorambucil alone should control the lymphoma for now - which is pretty mild at this point. As a result (and because her arthritis got really bad when we stopped the steroid), I am trying to find other ways to help with inflammation: Cerenia (has some anti-inflammatory properties), Cosequin, Omega 3, and I'm looking into acupuncture, cold laser, etc.

I definitely agree with a lot of the info on the Catinfo site. I am just so terrified that her diet is going to be too acidic if it's only meat and she'll have to go through another surgery (her stones are calcium oxalate). When I adopted her at age 3, she was surrendered because of them and had just gone through a major surgery to remove multiple stones. I was able to keep it at bay for 8 years on that prescription dry food but a stone still eventually formed and she had a rough recovery from that surgery in October. I will look into wet options. I know for Royal Canin, there is wet SO but no wet SO + Hydrolyzed. Maybe now that her digestive issues are being treated, she would be ok without the hydrolyzed food.

I'm hoping I will hear about her fructosamine test and the vet's recommendations for insulin dosing tomorrow and I will be sure to provide an update with that information.
 
If you do find GI issues need a little help, budesonide is a locally acting steroid. My Neko could not have pred due to her heart condition, but budesonide worked wonderfully on her bowels and it did not impact her blood sugars. Small cell lymphoma cats don't need a special diet, so maybe the wet SO is the ticket. We have other kitties here that have to have certain foods for other conditions. If you have to feed the higher carb food, we'll just work around it with dosing.

Neko also had bad arthritis.I can highly recommend acupuncture for arthritis, or rather, Neko did. She was tentative at first, but once she got used to it she realized it was providing her relief. She'd lead into the vet during treatments. Lasers aren't good if there is cancer. Another thing that worked for her was Duralactin - but check with your vet before using it. Hyaluranic acid also helped - I used the Hyaflex brand. Is she getting Adequan? Cosequin doesn't help when arthritis is really bad.

Good luck with the vet discussion.
 
Good to know about the budesonide. From what I've read, it can also mess with blood glucose - maybe less so than prednisolone though so probably worth considering. Fortunately, she's not having a lot of GI issues right now. She was vomiting pretty regularly before I put her on metoclopromide in August but she rarely vomits now.

I wasn't able to talk to the internal med vet today, he was apparently out but one of the techs called and said the fructosamine was high but he isn't going to change anything right now. He says since she doesn't really have a lot of clinical signs (she is still drinking more and peeing more than usual but not SO excessively like before). I have requested the actual results and the numbers for the curve they did last week. I really don't want to wait until her next check in February to adjust the dosing. Her numbers are running in the 400s in the morning and in the high 100s/low 200s at +11 with no PM dose. I wonder if I'd be better off splitting the dose into 0.5 units AM and PM so her blood sugar would be more consistent around the clock. I can't help but think the high numbers put stress on her system. I'm planning to ask her regular vet if she is comfortable managing the diabetes.

For the arthritis, I have an appointment with her regular vet on Monday and I'm going to ask about getting a prescription for the wet SO food and Adequan injections. I'll also ask about the Duralactin. I'm going to go ahead and buy the hyalauranic acid you recommended. I agree that the Cosequin doesn't seem to be doing much and when the gabapentin wears off, she starts limping and it breaks my heart! I have an appointment with a holistic vet next week to see about acupuncture.

It's so overwhelming and I feel bad dragging her all over the area to a bunch of different vets but I just want what is best for her.
 
You aren't the first person who has had to hunt to find a vet to work with them in managing feline diabetes. Mine wasn't great, but I liked her approach for everything else. So I gave her a copy of the dosing protocol, and the spreadsheets once a week for the first while, and she let me manage the dosing. Which I did with help from here. It helped that I'd had a locum vet point me to FDMB.

We generally find that two doses 12 hours apart are better for Lantus. It's only a once a day thing for humans. Cats have faster metabolisms and the Lantus just wears off too fast for once a day.
 
I have an appointment with Azure's regular vet tomorrow to ask about her insulin dosing and Adequan injections for her arthritis. I ordered the Hyaflex and it arrived today. I'm going to give that to her with dinner so hopefully we will see some positive effects from that in the next couple weeks.

Here is Azure's spreadsheet. It does seem like her numbers are slowly coming down but I am still thinking she needs to be getting insulin 2x a day instead of once. Any questions or suggestions you have for the vet regarding this would be greatly appreciated!

https://docs.google.com/spreadsheets/d/1ajFxXPNxviOV4WFo_NNHOWxWM_AeBxpABbUoTJLyglk/edit?usp=sharing
 
Thanks, I can see the spreadsheet. The one shot a day is not doing your cat any favours. I'd to 0.5 units or 0.75 units twice a day to start. Do you have syringes with 1/2 unit markings?

Good plan to organize your questions before hand.
 
I have some ordered and they are on the way. Right now, I just have the BG syringes with whole unit marks. I can try using the paper dosing guide to measure less than 1 unit.
 
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