6 months and BG levels still not under control

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Hi everyone

Austin is my almost-13-years-old sable Burmese. He's been an inside cat since he got hit by a car at about 6 months old.

On 21 December 2009 the vet confirmed he is diabetic. In the 6 months prior, he had had his teeth cleaned (bad breath) and we'd treated him for arthiritis, to no avail.

The vet started Austin on 3/4 unit twice a day of Lantus intially and upped it to 1 unit twice a day in Feb 10.

At our last blood glucose curve day a few weeks ago the vet changed Austin to Lantus in a cartridge pen (from vial and syringe), 1 unit twice a day.

Austin's next BF curve is this Thursday.

In all this time, Austin's BG levels have never returned anywhere near normal. At the last curve a few weeks ago his levels never can under 26 (not sure what measurement that is. We are in Australia, if that helps any).

My question is, it's been 6 months now since Austin's diagnosis. Surely we should be seeing some improvement by now?

He's currently on Hills m/d dry and 1/2 can of Hills m/d wet a day. The last few days he's been eating non-stop (not pee'ing as much, though, but still a lot)
 
had to post this in 2 parts for some reason....

Anyways...so his diet is the same each day.

The last week or so he's also been very unsteady in his hind legs.

Is this all sounding really bad? Is it likely we will never get his BG under control? Anything else we should be doing?
 
Hi Mel, welcome to the board.

I'm in South Africa so a few hours behind you but most members are in the States, so just give them some time to wake up and come and post here. Australia measures blood glucose in millimols, the US measure it differently. To convert to the US number you times your number by 18. The 26 you referred to would then translate to 468, which is very high. For a kitty that is still at that number 6 months into diagnosis I would seriously question the vet, and or there is something else happening there.

We follow a very successful protocol on this board that aims at regulation and remission but it is a bit overwhelming at first to absorb everything. Don't stress. The most imporant thing is hometesting Austin. You need to know what his glucose is doing everytime before you shoot. A human diabetic would never think about giving himself insulin without knowing his blood glucose, and a cat should not be different. You will then want to set up a spreadsheet to monitor his readings. There are links on the Tech forum to help you do that.

Most vets are not specialists in diabetic management, they are like GP's, and to top it all off, they have to treat different species, there is no way they can know all the latest information and treatment methods on everything.

Everytime you take Austin to the vet to test, he is being tested in a stressful environment, his BG will be much higher than at home in reality, The vet is making dosing desisions off that number which is not correct to begin with.

Another important consideration for diabetic cats is what they eat. Dry food is like feeding pizza to a diabetic cat. It's got way to many carbs, even the fancy vet bought ones. Go to janet and Binky's food charts and select some low carb wet food to transition Austin onto. However, you should be hometesting when you transition, as going low carb will result in his numbers going down, and you need to know that you can still safely give him insulin.

More experienced members will come along soon and give you all the links to the information. In the meantime go to the Lantus section under Insulin Support Groups, read all the stickys that will be a great start.

The weakness in his hindlegs sounds like neuropathy, which is a problem with cats that have high BG's for a long time. Austin need to be lowered properly soon.

I'm confident that you will find a solution and help Austin through this board, it's helped many many diabetic cats inclding my own Max that is heading for remission. Stick around, help will be here soon.
 
Agree with Supermax about the food. When we changed Oliver over from dry to wet lo carb, his numbers came down 100 points overnight. Here is the link to Janet and Binky's charts: http://www.binkyspage.tripod.com/canfood.html Most of us feed Fancy Feast (no gravy), Friskies or Wellness. Not sure what is available in your part of the world, but we do have members there so they will chime in. You are looking for a food that is under 10% carbs.

The other part of the story is that we hometest our kitties. Testing at the vet is stressful (the car ride, the noises, the smells) and stress raises bg levels. Besides that, it is expensive. Here is a website with good intro info: http://www.sugarcats.net/sites/harry/bgtest.htm and here is a video that shows you how: http://www.youtube.com/watch?v=_zE12-4fVn8 When you test before you shoot, you can be sure that it is safe to give insulin. And when you find Austin's lowest point in the cycle (his nadir) you can see exactly how your dose is working.

Lastly, go over to the Lantus support group. viewforum.php?f=9 They all use Lantus and can give you tips. Also the stickies at the top of the page have excellent info on how Lantus works.

So read, read and read some more. Find out everything you can. You are Austin's best advocate in this fight. You can do this. We'll help you. We have all been where you are and survived!
 
OK, well here are some concerns that I have:

1) feeding dry food of any kind is just not good for a cat (diabetic or otherwise). The food is way too high in carbs and your goal is low carb, high protein.

2) prescription food - be it canned or dry again is just not good for your cat. It's too high in carb, made with crappy ingredients and way too expensive.

You can get what you need by using commercially available foods in your local pet store.

Take a look at this link, it will give you lots of insight into why prescription and dry food are horrible for cats:


Home testing: WE cannot stress enough the importance of home testing. Honestly, it's easy to do, you just have to get over your fear of poking the cat's ear, hurting the cat, etc. Once you get over this fear, and learn to test, you will be so empowered with this information that you will be able to - see for yourself how the insulin is working or not working. Avoid all the vet visits and wasting your money on curves and other silly tests that honestly won't tell you anything real - why - because you took the cat out of his home, stress free enviroment and put him in a stressful one by transporting to vet, being at vet, etc.

Also, BG's are not based on just one or two tests, rather it's based on building data and seeing trends/patterns over time, which will help tell you when to change the dose.
You can pick up a meter kit at any human pharmacy and yes, using a human meter to test on an animal is just fine. What you want to get is a meter that will "sip" the blood and require the smallest amount possible.

In addition, get lots of strips - that go with that meter - as you will need them and always good to have on hand.

Lancets - the pokie things they look like push pins - pick up a box of 50 or 100 - they are cheap and you only want to use one lancet per test (while you may poke a few times for one test - that's fine), just plan on one lancet per test and you'll be good.

Also get antibiotic ointment with pain relief is fine - this is typically found with first aid supplies (band aids).

Pick up keto stix or keto diastix - so you can test the urine for ketones.

Once you have all this, you will be set to learn how to home test and we can help you with that process.

Then set up your spreadsheet and come over to Lantus Forum, where we can help you with your dosing.

 
Hi there!
I am not at home right now, so I can't add some more links for you, but one of them is for setting up a profile. I am sure there are things that people are going to ask you over and over, so sticking them all into a profile and attaching it to a signature is good to do.

For sure the dry food has to be cut out; many cats have improved numbers and others don't need any insulin once they are diet controlled.

If you have any of the numbers from any testing done, you can mark them into your spreadsheet when set up.
If you click on the links in my signature for my two cats, you can see the sorts of info in their profile that is helpful to know and also you can see the numbers I record when home testing them.
Note that I put both numbers in a box because being in Canada, my vet likes to see the 18.2, and not the 256. You can put both and then everyone's happy.

I think that once you are all set up, you will be well on the way to getting Austin on the road to regulation. It is most likely that Austin's not getting enough insulin and once you find his dose, everything will fall into place.

Hang in there; you are definitely in the right place, here on this board.
 
I know very little about Lantus, so I've asked some Lantus-familiar folks to come over and see if they can help. I do know that Lantus is a relatively 'fragile' insulin and needs special handling; if it doesn't get that handling, it becomes less effective. I'm wondering if that might be part of the problem. I also know that Lantus is supposed to have a shelf-life of 28 days once the vial has been opened, and that may be contributing as well (though some folks treat it very gently and can get more than 28 days from a vial or cartridge/pen).

If you visit the Lantus forum , there are some posts stickied to the top of the page giving information on how to handle Lantus, how it works, etc. You may want to read over those. You might also consider passing the links on to your vet, so they can become more familiar with Lantus and have more luck with other diabetic patients in the future. (Lantus doesn't work quite like the other insulins that your vet is probably more familiar with.) You can find the Lantus forum by going to the 'Jump To' list at the bottom of the page and selecting 'Lantus (glargine)'.

Also, many of the folks here on the boards are from the US and measure BG in mg, not mmol like many other places. If you need to, you can use the conversion chart / calculator here to convert to and from US units.
 
Hi and welcome to FDMB

Although that 468 is high, it is an average of kittys blood glucose over the previous 1-3 weeks. He could be going lower at various points.

Hilary has given you the low down on hometesting.

Hills food is not the best (not to mention the cost!)

If you go to your private board control, look for members-Andrew and Mim are from Oz and they use Lantus. I think their still here. They have been doing this for over a year so will be able to give you tips on what food you can get in Oz that's good low carb (and definitely wet only!)

Don't fret-even though you haven't got regulation doesn't mean you can't get it.

I'll try and find Andrew too and ask him to come and post.

If kitty is having problems with his hind legs this can be neuropathy-caused by high glucose values. You can give methyl B12 to help with this. Hilary is the expert I always call on for this! I know she's used it and knows which type is best for kitties.

I will say one good thing for you vet-he didn't start out on a massive dose of insulin like a lot of vets or increase quickly. It does sound likely he needs an increase in dose, but the best way to figure this out is to start hometesting. It isn't as hard as it sounds.
Just need to get yourself human glucometer, test strips and penlet (though a lot of beans-us humans) like to free hand.
Vet can not tell you you are not allowedto do this, he's your kitty.
The fructosamine tests your having done just don't give you the info you need to make informed dosing decisions and as has already been said, a lot of kitties BG's raise through the white coat syndrome (Lucky could go up by over 100 points-useless info!!!)

Please keep asking questions and we will do all we can to help you.
We're allfrom all over the world so sometimes the board is busier at certain times than others but always someone around.

I'd put a smiley, but the board has gone a tad weird on me tonight!!!
 
Mel_Austin said:
Hi everyone

The vet started Austin on 3/4 unit twice a day of Lantus intially and upped it to 1 unit twice a day in Feb 10.

At our last blood glucose curve day a few weeks ago the vet changed Austin to Lantus in a cartridge pen (from vial and syringe), 1 unit twice a day.
Click to expand...

Is one unit twice a day the highest dose he's been on? If so, he's probably just in need of a dose increase by now.
 
Deanie and Boo (GA) said:
he's probably just in need of a dose increase by now.
Click to expand...

Agreed. Why don't you try posting over in the Lantus forum, and you'll get PLENTY of help over there- promise! You'll catch on to all of our Lantus Land nuances quite quickly. People over there can address your dosing issues much better.

One thing I ran into with the lantus pen cartridges that you may want to watch out for. Are you administering the insulin with a syringe (ie: drawing it out of the pen then injecting) or are you using the autodial (ie: twist to the right dose then push to administer)? With such small doses, the pen is HIGHLY inaccurate. We found that the 2 units we thought we were administering was more like 1 unit! Syrings have their differences, but are still WAY better than the autodialer.

Looking forward to seeing you over in LL (lantus land)!!
 
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