Advice needed for newly insulin dependent kitty in Chicago

Status
Not open for further replies.
A

Alaina and George

Member Since 2012
Hi All,

My name is Alaina and while I'm not new to the forum, this is the first post I've made. Since being released from the emergency hospital after a bout with DKA, George has been doing much better. He's eating (a lot) but that's okay, he's underweight, drinking, peeing, pooping, and purring. However, he has often had levels in the 400's in the morning. With DKA being a concern, I'd like to get him out of that 400 range and see more preshot levels in the 300's. My Vet has instructed me to give 1u if he's over 400, and .5u if he's in the 200's or 300's and to never shoot if he's lower than 180. The first time he was given an injection of the Lantus he dropped to 66 after about 4.5 hours to hypoglycemia was initially a concern as well. When I emailed my vet to let her know he was in the 400's yesterday morning she said to give 1u and then for his next feeding give .5u if in the 200-300's. Then she said if he stops eating let her know. And that was it.

So these are my questions:

1: Is this protocol as far as vet communication? Don't communicate with the vet anymore unless he stops eating?
2: Does anyone have a vet they LOVE in Chicago? Budget is somewhat a concern for me, as I don't have pet insurance.
3: Is it really dangerous as far as ketones returning with levels in the 400's as long as they drop considerably throughout the day before going up again?
4: How long does regulation typically take after DKA? He was on Humulin R (I think) in the hospital and transitioned to Lantus when he was discharged to my vet (and had the 66 reading after the very first dose) on Thursday March 21st in the AM, so it's almost been a week on the Lantus. Maybe I'm not being patient enough.
5. How do you keep yourself from not going batty? I've had this cat for 10 years (since college) and this whole ordeal is really affecting me. Yesterday was like the first night I've slept since he's been home.

Also, another concern I have is that I'm moving with my husband to Ireland in June and I won't be able to take him with us for a number of reasons. If by some miracle he goes into remission my mom may be able to take him but my dad won't allow it otherwise. So unfortunately, I have to think about giving him up for adoption which KILLS me. I love this cat so much, he has the BEST personality and he's been my faithful friend through some really tough times. Are there adoption agencies that specialize in getting a diabetic cat placed? I'd love to have an "open" adoption if it would be allowed but the best thing would be for George to be well taken care of.

Okay sorry about the VERY long post. I'm just feeling really alone right now and was thinking this was a great place to start. So glad I found the forum. Thanks in advance for your advice, encouragement, etc. :smile:
 
Re: Advice needed for newly insulin dependent kitty in Chica

Alaina

Welcome, the first thing is that your vet told you wrong about how Lantus is dosed. Lantus is supposed to be dosed same dose in the morning and same dose in the evening. If you are giving 1U in the morning you must give 1U in the evening. That is probably why his numbers are wonky.
I asked for some of the more experienced Lantus users to come over and look at your post.

Terri
 
Re: Advice needed for newly insulin dependent kitty in Chica

The vet knows nothing about Lantus. It is NOT dosed on a sliding scale! edited to add: by the protocol that has been posted here (Tilley).
Lantus is dosed with the same amount, every 12 hours as exactly as possible, and should not take the cat lower than 50 on a human glucometer or 80 on a pet-specific glucometer. The dose should not result in having to skip shots due to being to low to give insulin safely. We suggest new users not shoot if the glucose is under 200; that number is gradually lowered once data is collected showing it is safe for that cat to do so.

Lantus is also a depot insulin, where it takes 6 - 10 shots to get a balanced amount in the body (where the amount being used is offset by the amount being injected). The dose is adjusted after 5 days the first time, 3 days the times after that, based on the nadir, the lowest level between shots.

The dose is calculated as the lean weight in Kilos * 0.25, and I'd round down for safety.
Lean weight means the lower of either current weight if underweight or at ideal weight, or ideal weight if overweight.

Looking at his spreadsheet, I'd suggest 1 unit am and pm, 12 hours apart.

Diet: changing to a low carb, canned or raw diet may reduce glucose levels by 100 points or more. Pop over to Cat Info for info and a printable list of nutritional values for many foods. You want to stay below 10% of calories from carbohydrates.
 
Re: Advice needed for newly insulin dependent kitty in Chica

I'm in Chicago and I have a great group of vets! Cat Hospital of Chicago is wonderful. It's a feline only practice and an incredibly calm place. The vets stay very informed with current practices and unlike most vet practices, they are accredited by the American Animal Hospital Assn. They are not cheap (what vet is?) but you will definitely get your money's worth in terms of skill, knowledge,compassion, and dedication. Read the Yelp reviews. I use Dr. Elizabeth Czerwonky. These vets were in constant communication with me when my cat was hospitalized with DKA and thereafter once I brought Gabby home. They never have told me to not call especially if there was any question after or during an illness or procedure. I've referred several people from FDMB to this practice and everyone has been happy.

Unfortunately, your vet is giving you dosing instructions that are not appropriate for Lantus. (The instructions are appropriate for other insulin, like Prozinc but not for Lantus.) You do not adjust the Lantus dose based on the pre-shot numbers. Rather, the dose is based on the nadir. Dose is reduced only if the numbers drop below 50. Otherwise, you need to stick with your dose. Lantus is a depot type of insulin. If you keep changing the dose, it's only going to result in wonky numbers since you need to allow the dose to stabilize prior to making any adjustment. Please take a look at the information on the dosing protocol that's in the starred, sticky notes at the top of the Lantus board. If you take a look at the information regarding the insulin depot, you'll note it takes 5 - 7 days (10 - 14 cycles) for the initial insulin depot to be established. Once the depot is formed, doses need to stabilize for roughly 3 days/6 cycles.

Ketones, and DKA in particular, typically are the result of an infection + not enough insulin + not eating. Please test for ketones whenever you can stalk George to the litter box. If you don't have them, Ketostix are the best small investment you can make. They are strips that are moistened with your cat's urine and they will give you a color code to tell you whether ketones are present and if so, to what degree.

What is George's weight? You can calculate a starting dose using the following formula: initial dose = 0.25 x ideal weight in kilograms. If George is underweight, use his current weight rather than ideal weight for the calculation. The same dose should be given consistently twice a day at 12-hour intervals.

You will also want to put together a spreadsheet. This will help you to keep track of George's BG numbers and allow you to see his progress.

What did your vet tell you to feed George? We strongly encourage that you feed a low carbohydrate, canned food diet. There is a wonderful website on feline nutrition authored by a vet, Dr. Lisa Pierson. There is a link on that site to a food chart. We consider low carb as below 10% -- although most of us use foods that are in the 5% range. Fancy Feast and Friskies have several pate style foods that are low in cost and carbs.

Also, if you are going to need to re-home George, it would be best to start making inquires sooner rather than later. Diabetic Cats in Need (DCIN) may be able to assist you. Will you be returning to Chicago after Ireland and if so, how long do you anticipate being gone?
 
Re: Advice needed for newly insulin dependent kitty in Chica

Thank you guys so much. I'm having my Mom call her vet and I'm thinking of seeking a second opinion.

To give more details, George has been on Wellness Chicken or Turkey for the last 10 months and is only allowed to have treats that contain all protein although I haven't been giving him many.

He usually would snack on the canned food throughout the day instead of eating it all at once but he's been really hungry.

He weighs about 8.5 lbs and has been getting about 5.5 ounces of food a day. I would like to feed him more because he's hungry but I'm worried his BG will be even higher.

Maybe I should leave some food out each day and go to dosing 1u in the morning and 1u in the evening.

Your thoughts are appreciated.
 
Re: Advice needed for newly insulin dependent kitty in Chica

Yes, you can feed him about 50% more while you work to get him regulated.

One unit am & pm looks like it may be a good starting point.
 
Re: Advice needed for newly insulin dependent kitty in Chica

BJM said:
The vet knows nothing about Lantus. It is NOT dosed on a sliding scale!
Click to expand...

A static dose regardless of the pre-shot BG level is indeed the protocol here on the FDMB and at least one other diabetic cat board I know of. However, there are other groups and there are vets that dose Lantus based on a sliding scale. I am not trying to be disagreeable or to confuse you, Alaina, but it may be that your vet does know something about Lantus, but uses a different protocol than used here on the FDMB.

Sienne and Gabby said:
You do not adjust the Lantus dose based on the pre-shot numbers. Rather, the dose is based on the nadir.
Click to expand...

Even the sliding scale protocols are based on the "truth" that the nadir is the appropriate measure of the effect of insulin. However, those sliding scale protocols are based on the premise that if you start at a higher pre-shot number, it takes more insulin to get the BG level down to the target nadir. If you start at a lower pre-shot number, it takes less insulin to get the BG level down to the target nadir.
 
Re: Advice needed for newly insulin dependent kitty in Chica

Venita:

Is there any published research that you're aware of the supports the use of a sliding scale dose with Lantus or Lev? As you know, the Tight Regulation Protocol has empirical research and solid outcome data that supports the use of consistent dose amounts.
 
Re: Advice needed for newly insulin dependent kitty in Chica

Sienne and Gabby said:
Venita:

Is there any published research that you're aware of the supports the use of a sliding scale dose with Lantus or Lev? As you know, the Tight Regulation Protocol has empirical research and solid outcome data that supports the use of consistent dose amounts.
Click to expand...

Not that I am aware, Sienne. Given as long as I've been around, and my tenure preceded the introduction of Lantus/Levemir to North America and the study that the present FDMB protocol is based on (but not strictly adherent to), I have seen lots of advances made through anecdotal evidence. Just because big pharma or some other deep pocket hasn't funded research or because the researchers designed their study to follow Protocol A and not Protocol B or C, that is not to say that Protocol A is the only appropriate way to treat, forever and ever Amen. At least IMHO.
 
Re: Advice needed for newly insulin dependent kitty in Chica

I'm not sure where in Chicago you are (if you're in the far north burbs I can make other rec's as that's where I'm from originally), but the city proper, my friend's husband is a vet here: http://www.milwaukeeanimalhospital.org/ I've never been there, but I've heard from other friends that he's very good.
 
Re: Advice needed for newly insulin dependent kitty in Chica

I just wanted to say thanks to everyone that chimed in today and gave their advice and experience. Today George received 1u of Lantus AM and PM.

While George's numbers aren't perfect yet, he was at 253 4.5 hours post injection this morning and 277 4 hours post injection tonight. Not perfect yet but a good starting point that I feel is safer than being in the 400's and without immediate concern for hypoglycemia at the other end of the spectrum.

I am going to call Cat Hospital of Chicago and hopefully get him in for an appointment with a new Vet this Friday or early next week.

This community is so awesome. I feel so lucky that I found it!
 
Re: Advice needed for newly insulin dependent kitty in Chica

can I ask what kind of Wellness it is? Does it have "grain free" on it? Or is it cubed? minced? Want to ensure its under 10% calories from carbs.

Your vet is good in that he has you on a great insulin, and is encouraging you to home test. Great job on the SS etc. Do you want to come over and start posting in the tight regulation forum where these guys can keep a closer eye on you? Its a great community. http://felinediabetes.com/FDMB/viewforum.php?f=9

Wendy
 
Re: Advice needed for newly insulin dependent kitty in Chica

ok doky - well I would definately pop over to the TR forum and see what they think!
 
Status
Not open for further replies.
Back
Top