3/26/Rags

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yo hon

Member Since 2013
3/26/13 @ 7:00 a.m. eastern BG - 520.

Eating, so far one can of ff. i found him eating the diabetic dry food this a.m. 6:00 Royal Canin Diabetic dry food. Do not know how much he ate.

Will give 2units when he is done eating.

He just ate a little under another half a can of ff, so he has had 1 and 1/2 cans approx. of ff and I have NO idea how much of the dry food.

At 8:00 a.m. I will give him his 2 units and I will call Vet to see if I can get Lantis Unsulin.
 
Sounds like a good plan. I'd like to see you get a +4, +6 and a +8 today. We already know that the insulin is working by the +2 so I don't see any need to get that value today.

Remember to update your ss today too. Would you please try a different way of entering the data? Only put the BG number in the cells. that way, the spreadsheet will automatically color code the cell based on what number you enter. It will be easier for people looking at your ss to see what is going on. Thanks.

I know you would like to get Rags off insulin if that is at all possible. the NPH insulins like Humulin and Novolin have very little chance of doing that. Better insulins that MIGHT give Rags a chance to be a diet controlled kitty are Lantus and Levimir. Successful rates of remission for those insulins are only around 30-40%. There are no guarantees.

Let me find some data for you to give to your vet to help convince him to write you that prescription. We found the Lantus savings card and you signed up and printed that last night. That is for the Lantus Solostar pens so that is what the prescription needs to request.

Lantus works totally different than Novolin so it will be a new steep learning curve. Once you get the Lantus, we will want you to post over in the Lantus ISG (Insulin Support Group).
 
Becki,

That Royal Canin Diabetic Dry has 38% calories from carbs. That is way too high for a diabetic cat. Let your other cats eat it if they like it but you need to keep it away from Rags. I got the carb percent from this website: http://www.catinfo.org/docs/FoodChartPublic9-22-12.pdf

You want to feed Rags wet/canned food with <10% carb content. The Fancy Feast Classic (pates) or Friskies Pates are good choices. My cats all love the Turkey & Giblets. My budget can afford a lot more Friskies in those 5.5 or even 11 ounce cans. I keep Fancy Feast for treats and also keep a couple of the gravy lovers cans for hypo events.

This data was gathered and updated in September 2012 by a wonderful vet, Dr. Lisa Pierson. She is one of the best resources many of us have found for cat nutrition. She is why I no longer feed dry food to any of my cats.
 
Once you get a prescription from your vet for the Lantus Solostar pens, you will need to call your local pharmacies to find one that will sell you a single pen. Not all pharmacies will do this. Try Wal-mart, Save-on, Shoprite, CVS, Walgreens, Rite-aid, Main Pharmacy, Hernando's Hometown Pharmacy, Vineland Pharmacy, Grace Pharmacy.

You may be asking yourself how I found the names of these places where you live down in NJ but I live in MA. I used this link for pharmacy suggestions: http://www.goodrx.com/ and typed in the drug name and your zipcode. It's supposed to find the best price locally.
 
As I've stated many times I KNOW THAT DRY FOOD IS BAD !!!!! When the Vet gave it to me I put it up and wouldn't let Rags eat it. It was on the table for MY GIRLS. I DO NOT FEED IT TO RAGS !! I told you the day I got it that it wasn't worth the trip, i knew it was High in carbs. also the wet food they gave me is not good either. Fancy Feast is MUCH better and I tried to tell the VET that. That's he when he told me he calls it "Kitty Cocaine". He REALLY has NO clue !!!!!

I told you I will post on my ss and I will, I just cannot do it right now. My feral cat is outside hungry, I'm gonna feed him and go back to bed cause I don't feel so hot ! I WILL post after I brush my teeth and wash my face if that is ok ? ha, ha !

I also did ALOT of research on Diabetes before I found the Board. A for the food, I already knew the food they were "giving " me, wet and dry were too high with the carbs, and the wet, the values were much better in the ff.

Goodnight!
 
Yes, Becki, I know you know about the hig carb food. I only wanted to mention it because his eating the higher carb food could raise his BG number today more than usual since he ate some "contraband".

What your vet calls kitty cocaine, we call the path to remission.

Running a little short of sleep here too. Understand there are other things in life you have to do. I need to go take care of a few things also.

I haven't updated Wink's ss in a while. Need to do that and a bunch of other things.
 
If you feel inclined, Cat Info has a PDF version of the web site that may be printed out and given to the vet. The site is written by a veterinarian, so that may give it more weight with the vet.


After having several cats deteriorate and be euthanised due to renal disease, I will never feed dry food to any of my cats again. Its horrible watching them be slowly poisoned by the inability to remove waste products from the body.
 
I said yesterday that I would try to find some articles on why you want Lantus for your diabetic cat so you would have some information to give to the vet to convince them to write you a prescription.

Here is some research that talks about Lantus, the dosing protocol, how it is the best for newly diagnosed cats, how low carb diet is key, how twice a day injections are better. These are some of the talking points you will need to convince your vet to write a prescription for Lantus Solostar Pens.

Here is the dosing protocol for Lantus from the University of Queensland Centre for Companion Animal Health : http://www.uq.edu.au/ccah/docs/diabetesinfo/link4.pdf

Here is the article that states on page 4 the Glargine (Lantus) is the preferred insulin in newly diagnosed diabetic cats. http://www.uq.edu.au/ccah/docs/diabetesinfo/article5.pdf

It also talks about the difficulty of achieving gylcemic control with the NPH insulins (Novolin, Humulin) under the "Insulin Therapy" section on page 1.
Achieving good glycemic control with intermediate acting potent insulins such as NPH, lente and ultralente is often difficult, and increases the risk of clinical hypoglycemia. Recent data indicates that the long-acting insulins such as glargine or determir provide better glycemic control and reduced risk of clinical hypoglycemia when given twice daily and combined with a low carbohydrate diet. Of the insulins available that have been studied in cats, glargine or detemir appear to be the insulin of choice.
Click to expand...

On page 3, under the section "Glargine" , third paragraph the article talks about the importance of early good glycemic control.
but superior glycemic control is achieved if insulin is injected twice daily. This is of particular importance in newly diagnosed cats in which prompt good glycemic control may result in remission, hence the recommendation for BID dosing in new diabetic cats.
Click to expand...

Another reason you want to switch is the Lantus gives Rags a better chance of achieving remission and you want to give him that chance.
It is the authors’ experience that newly diagnosed diabetic cats that have good glycemic control within the first few weeks of therapy, are very likely to go into diabetic remission. Cats that have been long-term diabetics are less likely to go into remission probably because of progressive b-cell loss
Click to expand...

Another argument you can use is you can get the Lantus for half the price you paid for the Novolin. You found a savings card from the manufacturer that will let you save money on the Solostar pens.

Let us now how that phone call and conversation with the vet goes.
 
You can return the prescription to the vet for a refund. It is guaranteed and they should give your money back. If the vet refuses, then call the manufacturer to complain and get them to refund you. All you have to say is the cat doesn't like it and won't eat it.

You can also put it outside to feed your feral cat as another option.

Remember, cats are smart, they can smell food a mile away and if they really want it, can get themselves into places you never thought possible. Putting it in a cabinet, the fridge or even outside can guarantee Rags doesn't get his paws on it.

As I wrote before - trust your instincts and what you believe is right. And follow it. Yes, it is going against the vet, but the vet is not GOD nor omniscient and is not an expert in feline nutrition. He is pushing what he was told by the food companies and believes it to be the truth. My former vet was this way and insisted I use prescription dry food for Maui. I did not. Whenever I take my cats to the vet and the subject of food comes up, I listen to what they say and if it doesn't agree with what I am feeding, then I just tell them, thanks, I have it covered.

If for any reason they have to stay overnight at the vet (usually for a dental), I pack their overnight bag and bring their food and treats, along with feeding instructions. I tell them that the cat can only eat what I supply and not to feed anything else. This seems to work out and avoids any possible mistakes with getting high carb food. Just something to remember for the future.

The sooner you can get Rags off N and onto Lantus, the better off you and he will be. Good luck with the vet. Be honest and firm.
 
11:52 a.m. eastern +4 BG 197 that's good, right? now he can have some food.

I'm getting ready to call the Vet for the Lantus SoloSTAR pen, wish me luck, PLEASE !!!!
 
yay - a nice number for +4 :-D
Yes, let him tuck in and fill himself up.

Good luck on the prescription - definitely good to get on a gentler insulin.
 
Nice number for +4, ket him chow down and best of luck with the vet today.

Mel, Maxwell, Autumn & The Fur Gang
 
Yup, agree that +4 looks like a good one for a newly diagnosed kitty.

Good luck talking to the vet about the switch to Lantus.
 
2:00 +6 Meter only states HI for BG took it twice. New meter Relion, PLEASE ADVISE !!!!!

just took it again, checked control it is BG is 400
 
did you call the vet about changing insulins yet?

I don't know enough about N to be able to advise you to give more, but if you look at yesterdays post and read through it - you will see what Hope suggested about given a token amount of insulin.

as you can see this insulin just does not last long enough and it in order to keep sane you need to get a different insulin -
 
2:45 gave 1/2 unit of Novolin N-100. will test in two hours.

yes asked Vet for new insulin, haven't heard back. She didn't even get on the phone, she spoke thru her secretary. told me to give 2 units, which I did not.
 
4:45 p.m. eastern +9 BG 497 gave him .05 unit at 2:45 p.m. what do i do now ?

The Doctor WILL NOT change his insulin. it's too expensive and I have a full bottle. Argued with me and said I NEVER listen to her. Why do I want to change his insulin? I told her longer duration and his numbers are bouncing all over. She said that's because I won't listen to her. Find another Doc if I don't like what she is doing.

Can I feed him now ? And do I stay with two Units tonight and what time do I give it to him ?

PLEASE ADVISE
 
Feeding him now is just going to make him go up more. Wait until his normal time tonight then test him, feed him, and in a 1/2 hr. after feeding given him 2 units again. His body is trying adjust to lower numbers. This takes time, nothing happens in days or even weeks.
 
as your vet is unwilling to work with you - you have to find a new vet - one that will work with you.

I suggest you put together a list of vets in your area and start making phone calls - asking questions about how they treat diabetes, home testing, insulin, etc.

the one that will work with you, is the one you go to.

sadly this is not uncommon. it is what I had to do.
 
Rather than playing phone tag and using an intermediary, you may want a sit down conversation, if you wish to keep working with her. In addition to the spreadsheet, you might provide printed documentation from veterinarians and veterinary references, such as the following to support your argument.

From the Merck Veterinary Manual
In cats, high-protein diets along with insulin therapy are initiated and the pet re-evaluated in 5–7 days. In newly diagnosed cats, glargine insulin is the insulin of choice. Glargine is a long-acting basal insulin. Used in conjunction with high-protein, low-carbohydrate diets, it is associated with remission of diabetes and discontinuation of insulin therapy in 80–90% of cases within the first 3–4 mo of treatment. NPH, lente, or PZI insulins may also be used in cats, with starting doses ranging from 1–3 units, bid. However, these insulins are not associated with high rates of diabetic remission.
Click to expand...

Send her the link, or print it out. She is not up to date and it is difficult to stay up to date on every disease in every animal. This reference should be helpful to her.


Or maybe time to start vet hunting. Vet interview topics in my signature link.

Nearby vets courtesy of Google Maps
 
At 9:09 this morning, Deb & Wink gave you a whole bunch of information on why you wanted to change insulin.

Did you present any of this information to the vet when you talked with her? Did you read and understand that information before talking to your vet?

Here is one more reason:

According to the University of Queensland dosing protocol for NPH types of insulin states " if nadir blood glucose concentration occurs within 3 hours of insulin administration, or blood glucose returns to baseline within 8 hours then change to longer acting insulin (i.e. Glargine, detemir, PZI) "

Your nadirs the last two days have been around +3 and your +6 was up above baseline. Not enough duration with this insulin.

Why you want Lantus, a better insulin for Rags:
1. better chance of remission
2. longer duration
3. cheaper price with savings card
4. less harsh on a cat (i.e. does not plummet the numbers down quickly and shoot them up quickly.
5. avoid DKA (diabetic ketoacidosis)

You will get bouncing numbers on any insulin at first. That is very common. Not a good reason.

I sought back through the posts and some of the things you told us about your vets advice. From that I picked out these reasons why you do not listen to your vet:
1. initial high dose prescribed and sent cat into hypo
2. being told what to do by the receptionist, not a vet
3. when you contacted the vet office about the hypo, was told there was no one around to help you. they were all at lunch
4. after the hypo, told to still keep giving the 5 units of Novolin N 2 x a day
5. you feel they are endangering you kitty by insisting you keep giving him this high dose even though the protocol says " If nadir blood glucose concentration is < 54mg/dl (3mmol/L) then Dose should be reduced by 50%"

If you go back and reread through your posts, you can probably come up with some more reasons than I found.

By the way, the quotes in here are from the University of Queensland Dosing protocol for cats on lente or NPH insulin. Here is the link again:
http://www.uq.edu.au/ccah/docs/diabetesinfo/link2.pdf This protocol is dated 2009 so is as current as I could find.

I would suggest that you open this link and print this out and give the copy to your vet. It would be a good idea to print a second copy for your diabetes quick reference information folder.

Trying to 'arm you with information'.
 
Becki,

You can not assume that Walmart has the Lantus Solostar pens in stock or that they will split up a box and only sell you one pen. You need to contact the dirrerent pharmacies in your area and find one that is willing to sell a single pen. Walmart will not split up the box of 5. I called the one in Vineland and they told me they will not split the box and sell a single pen.

You either need to make a lot of phone calls to find a willing pharmacy or do a lot of driving around to go in to each pharmacy to find one to split the box of 5 and only sell you one.

This is going to take some work on your part. I sent you a PM earlier about this, not sure you got it.
 
Thank you for your advise, but at this time I am not able to see a new Vet, so I'm STUCK !! She also said his keytones will only spill if he has had NO insulin or isn't eating.

This poor boy is STARVING !!!!! I have to wait until seven to take his BG, then feed, then a half hour later give him two units, correct ?

My mind is just on overload and I can' even think right. I also have a cat missing all day, so been out looking for her.
 
7:00 p.m. eastern +11.75 BG 273 He is going to eat now. then in 1/2 hour 2 units of insulin, right?
 
Please go up to my 6:49 post and click on that link to the dosing protocol. Find the text that is underlined and in blue print instead of black. Put your cursor on that blue printing. Hit the enter key. New window will appear. Print it. Twice. One for you, one to give to the vet.

Go up to BJM's post from 5:42. Open link from the Merck Vetiranary Manual she included. Print. Twice again. One for you,one to give to the vet.
 
I am going to make one more suggestion to you - there is a vet that posts on this board, her name is Dr. Lisa Pierson (yes the same vet who provided the food lists). While she is based in California, she does phone consultations. It may be worth paying for a consult to talk with her and get her to assist you from a professional level.

We are not professionals and maybe your vet will listen to another vet (they do talk the same language).

I do not see her phone number on her website, but here is her email address - DrPierson@catinfo.org

you could send her an email and ask her how much she charges for a consultation.

I am sorry that you have a missing cat - are you sure it's not hiding somewhere in the house? I hope you find him/her safe and sound.
 
i'm just trying to double check Rags insulin for tonite. I believe i was told to give two units 1/2 hour after he eats. He has already had a can and a half of ff.

Can he have more ?? not 12 hours 1/2 hours after he eats

PLEASE, PLEASE ADVISE !!!!
 
Give him 1 1/2 units tonight

for some reason he is giving a good pmps tonight if it is 273. I know he'll go up from the food but have to wonder what that 1/2 unit earlier did for him. Want to play it safe for tonight. Maybe he is through bouncing around.....don't know....but 1 1/2 units is safe for tonight.

If Rags wants more food right now, give it to him.
 
There is a way to test for ketones at home. You need to go to the store (Walmart is fine) and pick up what is called ketostix or ketodiastix. You will find them in the diabetes section of the pharmacy area - if you cannot find them, ask the pharmacist for assistance.

Then you take out one stick and put it in his pee. You can do this by catching him while he is in the midst of peeing and place the stick in the urine stream. If you cannot do that, there are other ways to catch the urine. We can tell you about the ways if you need it.

Keep the container closed only take out one stick at a time.

Did the vet test for ketones? She would have had to taken a pee sample and tested - did she do that? If she did not, then she has no idea if he has ketones or not.
 
As far as I know, no keytones were taken. He did show me the strips and told me to buy them. The drugstore doesn.t sell them cause people are not buying them. Walmart.

I had already given him the 2 units of insulin by the time I read your post. I was outside looking for my Sweetie Pie, which I still have NOT found. This is not like her !!!

I know about spooning him for keytones. When I get some money, I'll get some if I can find them. Thank you again !
 
Becki,

Remember that you have some supplies coming from me in the next couple of days including ketone test strips.

Checked the tracking info again and the package has made it from NH to CT. Estimated arrival is 3/27 - 4/1.

Then you can check for ketones. Maybe practice before then trying to catch him in the litter box and get a urine sample in a spoon or ladle or other small container. Maybe you can give me lessons since Wink Wink does not like anyone sneaking up on him in the litter box. I know I asked you to smell his breath and you said earlier today there was no acetone/nail polish remover/sickly sweet fruity odor. That would indicate no ketones.
 
Becki

Its alright to take a rest in between tests. Just try to nap in a chair or on the couch for a bit and not think about anything. Just a bit a of a stress reliever. I used to have to do that when I was taking care of my mom as it was so overwhelming. You have to take a few minutes for yourself to take care of others.
You are doing the best you can for Rags right now.

Terri
 
Sorry, I didn't know what the icons meant, I DO apologise !!!!


Rags 10:05 p.m. eastern BG 254. Good, right ?
 
Yeah, that's good but can you manage or set the alarm and get a +4? You can also feed him some more if he wants it. Insulin is working now so it will help with any food spike. Did you find your outside kitty?
 
Hi Becki,
Just wanted you to know I was here watching in case you are able to get another test before turning in for the night...
 
Suggestion: A lot of people are not comfortable with the idea, but for some people, this is the only recourse: Craigslist.org.
My Aunt's kitty is on lantus and her vet flat out refuses to write an RX for it - vet wants her to have him on prozinc.
So, she gets her lantus off of craigslist. Generally a box of 5 pens costs her around $100 and those 5 pens last her 5 months and no RX is required that way. It tends to be individuals that are selling off their own RX for whatever reason. Might be worth looking into for your baby if your vet is non-cooperative.

~M
 
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