5/14/2014 Kiki's Charlie - Advice Needed for new member

[charliesmom]

Hi Friends,

If you can please help, we could use some advice on the amount of Lantus to shoot tomorrow morning. It is 11:50pm in Amsterdam right now and my friend will be shooting around 7am. Thank you in advance!

Here is more background:

My friend and neighbour (Kiki) has a Norwegian forest cat (also named Charlie) that was just diagnosed with diabetes. Kiki is having some challenges with the Dutch system and vets, as I did when I started. I have given her some advice on a few things based on my personal experience and the advice that everyone on the board gave me. Namely:

- Switch to all wet food (low carb) 100% and feed consistent amounts daily at fixed times.

- Preferably change vets to a vet in Amsterdam that is more specialised in diabetic care for animals (the vet I recommended is one located at Europaplein).

- Do not start with caninsulin (the standard insulin that vets prescribe here). Go with lantus or levemir since they are easier to manage and less risky.

- Start low and go slow (with the insulin amount that she'll give her cat to start with).

So far, Kiki is making great progress, and she has started out with some of the advice:

- She switched to all wet food (first she tried the Almo Nature chicken, and then recently she switched back to Hills M/D wet food because she was concerned that her cat was losing too much weight).

- She hasn't switched to a new vet yet. The vet she is using does know something about diabetes so she is giving them a try to start with since it is near the house.

- She is starting with lantus (as of today). The vet started the cat out on 4 units this morning, and kept the cat for part of the day to do a partial curve (3 tests).

For your reference, here is the history of the cat's numbers thus far. Kiki hasn't yet had time to set up a spreadsheet. I'll try to help her with that next week.

4/11 First vet visit. For 3-4 weeks prior, the cat was on a urinary diet (royal canine dry food) since the cat had been peeing everywhere and the vet thought she had bladder stones or symptoms of. Blood Glucose: 22 European numbers (396 U.S. numbers).

4/16 Switched to 100% low carb wet food (brand: Almo Nature Chicken).

4/18 Vet visit to see if diet is having an effect. Weight: 4.54 kilos (10 pounds). Blood Glucose: 19.8 European Numbers (238 U.S. Numbers).
Continued feeding only very low carb (LC) food (brand: Almo Nature chicken).

4/25 Back again to vet to check blood. Weight: 4.49 kilos (9.9 pounds). Blood Glucose: 15.4 European Numbers (277 U.S. Numbers). Continued feeding LC
Almo Nature food. Advised to continue with LC diet alone and come back to vet in a week.

5/2 Vet visit. Weight: 4.42 kilos (9.74 pounds). Blood Glucose: 16.4 European Numbers (295 U.S. Numbers). Concerned about cat's weight loss.
Started feeding Hills M/D ("weight loss low carb diabetic" liver) wet food again. Vet decided cat should be on insulin and ordered lantus to
be shipped in before next visit.

5/10 Vet visit. Weight: 4.4 kilos (9.7 pounds). Blood Glucose: 21 European Numbers (378 U.S. Numbers). Vet advises to make appointment for the
following Wednesday to get started with the insulin.

5/14 Vet visit. Left the cat at the vet the whole day. First day of starting insulin trial. A small curve was done by the vet. Weight: 4.3 kilos (9.48
pounds). Insulin given: 4 units lantus at 9:30 or 10:30am (not sure).

Blood Glucose at 10:30am: 21.3 European Numbers (383 U.S. Numbers).

Blood Glucose at 1pm: 12.5 European Numbers (225 U.S. Numbers).

Blood Glucose at 4pm: 2.8 European Numbers (50 U.S. Numbers).

Blood Glucose at 7pm: 2.8 European Numbers (50 U.S. Numbers). The vet then gave sugar to the cat and sent her home with Kiki with the following instructions:

- When you test the cat at 9:30pm, if the cat's blood glucose is below 10 (European numbers) or 180 (U.S numbers), you should shoot and give the cat half the amount of insulin (2 units). If the cat's blood glucose is above 10 (European numbers) or 180 (U.S. numbers), you should shoot and give the cat the full amount of insulin 4 units.

My intuition tells me this is not safe advice. Especially because the cat was at 2.8 a few times during the day. Kiki also explained that when she brought the cat home, it seemed very unwell. It looked completely wiped out and lethargic and the behaviour wasn't normal.

So at 9:30pm, I went to Kiki's to show her how to do the "home testing" blood test. At 9:30pm, Charlie's blood glucose was still only at 3.7 European Numbers (66 U.S.). I told Kiki that if it were my cat, I wouldn't shoot anything at all until morning. She called the vet and told the vet what the numbers were, and our perspective, and the vet said not to shoot until morning.

My question for the board is now this:

- Tomorrow morning, Kiki will do the blood test on her own before she shoots. She will then feed the cat and get ready to give insulin for the first time. What is your opinion on the amount of insulin she should be giving tomorrow? In my humble opinion, 4 units seems too high to start with given the numbers today and what happened. If it were my cat, I'd almost go the more conservative route and start with 2 units tomorrow. Your advice?

Thanks everyone!

Jill

 

[Wendy&Neko]

Re: 5/14/2014 Kiki's Charlie - Advice Needed for new membe

Hi Jill - it's so good of you to help out with another kitty with diabetes. :YMHUG: I agree that the starting dose was way too much. Getting down to 2.8 (50) on the first cycle without the depot means that was too much insulin. Good thing your friend is testing!

From the protocol sticky:

Using a weight based formula for determining a starting dose of Lantus or Levemir when following the Tight Regulation Protocol:

the formula is 0.25 unit per kg of the cat's ideal weight

if kitty is underweight, the formula frequently used is 0.25 unit per kg of kitty's actual weight

It sounds like Charlie is underweight, as forest cats tend to be bigger, so I'd go with 1.0U to start.

 

[charliesmom]

Re: 5/14/2014 Kiki's Charlie - Advice Needed for new membe

Thanks for such a quick reply, Wendy. You guys on this board truly are wonderful and responsive people.

Just for future reference (for kiki):

When you mention "without the reserve", what do you mean?

To keep it simple to explain to her, I think you mean that after you give insulin for awhile, it builds up a sort of reserve in the cat's system since some of it stays in the system. Since this is the first day the cat is getting insulin, there really is no reserve of insulin that the cat could have inside.

Correct?

 

[julie & punkin (ga)]

Re: 5/14/2014 Kiki's Charlie - Advice Needed for new membe

she said "without the depot" - which i think you have the idea correct. when you inject Lantus, it forms a precipitate. some of it is available immediately, some of it stays in that precipitate and begins to slow release. The depot (reserve) forms a size that is relative to the size of the dose. So when you start injecting the Lantus, you don't have much in the way of slow-releasing because nothing's there yet. As you continue shooting, the amount in the depot will build and equalize to the shot, and the depot will release. this helps form the flatter curves that are possible with Lantus.

Switching the food to low carb canned food makes a huge difference. It's possible the vet doesn't know that Lantus is dosed based upon the LOW point a dose can get a cat to, not the high preshot number.

I agree that now Charlie is on low-carb canned, i'd go to 1.0u. It is far less nerve-wracking to go UP the dosing scale instead of going down when you are starting. I wouldn't want to start too high.

Good for you for giving your neighbor a hand! Diabetic cat people need to stick together!

Can you help her get a spreadsheet going and print off the Low Numbers sticky, just in case she needs it?

 

[julie & punkin (ga)]

Re: 5/14/2014 Kiki's Charlie - Advice Needed for new membe

Also, this would be a good place to start so she learns how to draw up the dose (don't shake, rattle, roll, don't inject anything into the Lantus, don't see-saw the dose back and forth in the syringe, etc.) so it lasts as long as possible. There's a video that shows how to draw it up from either pens or vials partway down the page.

There is a link on this post that describes the mechanism of how Lantus works in the body as well.

Lantus/Lev, Info, Proper handling & storage

 

[charliesmom]

Re: 5/14/2014 Kiki's Charlie - Advice Needed for new membe

Thanks for all your help. I will help her get a spreadsheet going early next week. Meanwhile, I'll print off the "handling low numbers" sticky and explain it to her.

I will give you an update on Monday (unless something happens, in which case kiki may jump on here and give you an update sooner in case she has questions).

Have a great weekend,
Jill

 

[charliesmom]

Re: 5/14/2014 Kiki's Charlie - Advice Needed for new membe

Quick update:

This morning, Kiki tested her cat Charlie around 8am and she was at 17.4 European Numbers (313 U.S. numbers).
She spoke to the vet and the vet agreed for her to shoot 1 unit.

At 11am (+3), she tested the cat and the cat was at 15.5 European numbers (279 U.S. numbers).

I encouraged her to hold this dose for the weekend and to keep testing (also about 5 or 6 hours in to try to see where the cat is coming in at the lower points).

I'll update you all on Sunday night so we can get some advise on dose recommendations for Monday morning.

Then next week I'll help Kiki set up a profile on here and a spreadsheet so it's easier for all.

I may need a refresher on how to do those 2 things too, so early next week I may inquire about who to contact for both of those.

Thanks for all your help!
Jill