Advice on a few things before starting insulin (not urgent)

[Julie and Honey]

Sorry this is long, trying to cover all questions in one post. Thanks in advance!

History:

Back in September BG was around 225-250 at regular vet visit.

Recheck in December, BG at vet around 350, fructosamine from same blood sample came back 526 avg for the previous few weeks. At this point vet said in diabetic range and to start treating with Lantus. No ketones in urine sample at same visit.

Talked to vet and I asked her about doing diet change before starting insulin. Told her I was concerned insulin and diet change at same time might drop kitty too low initially. Vet was okay with this plan and said to do BG check after one week on low carb diet and go from there.

Diet prior to removing carbs: low carb wet and also had high carb dry out all the time to nibble on during day and overnight and also got about ten high carb treats per day.

Within 2 days after taking dry food and treats away, urine output was reduced by 50% and she was drinking less than she used to, she was still ravenously hungry though, I was feeding her small low carb wet meals every 2-3 hours.

Now after 5 days low carb all wet meals she is going a little longer between meals, so her hunger seems reduced (still cleans her dish, so appetite is still good). Continued reduced urine output and drinking.

I have not checked her BG since the labs at vet which was 10 days ago. I have a meter now and was planning on checking it before I take her to vet later in the week to see where we are at.

Here are some questions I need to figure out before starting insulin later this week(if still necessary):

I know diet alone can lower BG, but what I am concerned with is if her BG came down enough from just diet alone and no insulin, could that still cause bounce and when we test at vet could it show high when it really is not high and just a bounce?

If so, would a bounce from just diet change correct itself and stabilize to what her “real” BG truly is after a week or so on low carb? I don’t want a false high number due to bounce from diet carb reduction and then the vet thinks she needs to start at a higher dose.

What does the group think a safe BG number is to NOT start insulin and take a wait and see approach and periodically check her BG at home to see if it stays lower with diet alone? Under 300?

If insulin is needed, Starting dose? Initially vet wanted one unit 1 x a day for the first week. Then switching to 2 x a day after the first week. Does anyone see any problem with once a day for the first week? Only asking because I will have to go against vets advice.

Lantus Pens vs. vials - I watched the video and it was mentioned drawing from pen if you get air in there it is no good, sounds like drawing from pen is trickier than vial? I can buy pen locally (and would cost less) but would order vial from Marks in Canada as it is a lot cheaper than the US price. Ordering from Marks would delay starting insulin by a week. Would prefer pen for cost, but afraid I may screw it up and get air in it. How hard is it to draw from pen for one person alone without accidentally getting air in it?

Thanks again and Happy Holidays to everyone and their kitties!!!

 

[Kris & Teasel]

I know diet alone can lower BG, but what I am concerned with is if her BG came down enough from just diet alone and no insulin, could that still cause bounce and when we test at vet could it show high when it really is not high and just a bounce?

No, I don't think that a lowering of BG from diet would result in bouncing because the diet change would, in effect, put her into a "non diabetic" state. Her BG fluctuations in response to food, activity, etc. would be like those of a kitty with no diabetes diagnosis. She would still be diabetic but a diet controlled diabetic. Injected insulin, in contrast, would have a direct physiologic lowering effect on BG that is stronger than the overall control exerted by a low carb diet. That more aggressive effect can set the stage for bouncing.

What does the group think a safe BG number is to NOT start insulin and take a wait and see approach and periodically check her BG at home to see if it stays lower with diet alone? Under 300?

I would start testing her BG at home regularly for several days before starting insulin to get data on how she's actually doing with the diet change. You might try testing before a meal then a few hours after on several days to see what a non food influenced BG is and how quickly she returns to a good level after food. I think that if she's regularly in the 200s or higher that would be an indication that she needs some insulin support.

If insulin is needed, Starting dose? Initially vet wanted one unit 1 x a day for the first week. Then switching to 2 x a day after the first week. Does anyone see any problem with once a day for the first week? Only asking because I will have to go against vets advice.

Cats metabolize insulin quickly so twice a day dosing is better. The data you get before starting insulin can guide the starting dose decision. For example, if she hovers in the 200s a dose of less than 1 unit twice a day might be recommended. If she's hovering in the 300s or higher, the usual starting dose would be 1 unit twice a day.

Lantus Pens vs. vials - I watched the video and it was mentioned drawing from pen if you get air in there it is no good, sounds like drawing from pen is trickier than vial? I can buy pen locally (and would cost less) but would order vial from Marks in Canada as it is a lot cheaper than the US price. Ordering from Marks would delay starting insulin by a week. Would prefer pen for cost, but afraid I may screw it up and get air in it. How hard is it to draw from pen for one person alone without accidentally getting air in it?

The cartridge inside a Lantus pen can be used as a mini vial with a proper insulin syringe - no difference from using the vial. The pen mechanism is such that no air has to be injected to overcome a vacuum before drawing insulin. It's very easy to do. You can order a 5 pack of pen cartridges (the inner "mini vial") from Marks and it's better value than a 10 mL vial that might lose its potency before you finish it all.

 

[FurBabiesMama]

Hi. As I mentioned on your other post, insulin should be given to cats twice a day rather than once. If you need a resource to share with your vet, here is one: https://www.aaha.org/guidelines/diabetes_guidelines/treatment_for_cats.aspx

 

[Julie and Honey]

No, I don't think that a lowering of BG from diet would result in bouncing because the diet change would, in effect, put her into a "non diabetic" state. Her BG fluctuations in response to food, activity, etc. would be like those of a kitty with no diabetes diagnosis. She would still be diabetic but a diet controlled diabetic. Injected insulin, in contrast, would have a direct physiologic lowering effect on BG that is stronger than the overall control exerted by a low carb diet. That more aggressive effect can set the stage for bouncing.


I would start testing her BG at home regularly for several days before starting insulin to get data on how she's actually doing with the diet change. You might try testing before a meal then a few hours after on several days to see what a non food influenced BG is and how quickly she returns to a good level after food. I think that if she's regularly in the 200s or higher that would be an indication that she needs some insulin support.


Cats metabolize insulin quickly so twice a day dosing is better. The data you get before starting insulin can guide the starting dose decision. For example, if she hovers in the 200s a dose of less than 1 unit twice a day might be recommended. If she's hovering in the 300s or higher, the usual starting dose would be 1 unit twice a day.


The cartridge inside a Lantus pen can be used as a mini vial with a proper insulin syringe - no difference from using the vial. The pen mechanism is such that no air has to be injected to overcome a vacuum before drawing insulin. It's very easy to do. You can order a 5 pack of pen cartridges (the inner "mini vial") from Marks and it's better value than a 10 mL vial that might lose its potency before you finish it all.

Thanks so much!

 

[Julie and Honey]

Hi. As I mentioned on your other post, insulin should be given to cats twice a day rather than once. If you need a resource to share with your vet, here is one: https://www.aaha.org/guidelines/diabetes_guidelines/treatment_for_cats.aspx

Thanks, and I get that is preferred, just didn’t want to get in a fight with the vet if I don’t have to and was wondering for first week if it made that much of a difference. If she still wants 1 unit 1x a day to start, I’ll suggest I will do .5 2x a day. She’s been my vet for at least 20 years, but I will be seeing someone else this week as my regular vet is out for 2 weeks, hopefully the one on call won’t have a problem. I can always split the dose anyway and tell them after the fact. Just don’t want to piss the vet’s office off for not following instructions, I do like my vet.

Was given wrong info by tech already ie. to roll Lantus, which I know now is incorrect, not to inject air in vial and that it’s fine to push insulin back in vial which I now know can put some syringe lubricant back into vial and contaminate insulin. Not happy about that since they charged me $50 for this “training”...

Glad you guys know so much about this stuff, if you could only write scripts, lol. Thanks again.

 

[Yong & Maury GA]

It's always difficult to go against a doctor's orders but we want to keep our fur babies safe. With Lantus, there is even a Start Low, Go Slow method. Plus, the majority of the members here have or have had a sugar kitty that we live with and care for every day . Just like people, there is no 'by the book' treatment that works for all kitties but with so many members, we kind of collaborate our own experiences and find commonalities that have general similarities for things that work . Also, don't let the Vet convince you of 1.0U increases; we recommended increases of 0.25u or 0.5u. Even big kitties are still tiny compared to humans . Definitely learn to test and if someone says their Vet does not believe in testing, we'd ask them if they would blinding give a small child insulin without testing?

Fingers crossed that you may have a rare diet controlled diabetic but if not there are tons of resources and members to help you with your sugar dance .

 

[Julie and Honey]

It's always difficult to go against a doctor's orders but we want to keep our fur babies safe. With Lantus, there is even a Start Low, Go Slow method. Plus, the majority of the members here have or have had a sugar kitty that we live with and care for every day . Just like people, there is no 'by the book' treatment that works for all kitties but with so many members, we kind of collaborate our own experiences and find commonalities that have general similarities for things that work . Also, don't let the Vet convince you of 1.0U increases; we recommended increases of 0.25u or 0.5u. Even big kitties are still tiny compared to humans . Definitely learn to test and if someone says their Vet does not believe in testing, we'd ask them if they would blinding give a small child insulin without testing?

Fingers crossed that you may have a rare diet controlled diabetic but if not there are tons of resources and members to help you with your sugar dance .

Thanks, I may be looking for a new vet if this does not work out. Have lost confidence in practice since tech gave me a lot of misinformation. I have the feeling if I mention it they will tell me I am wrong or there is more than one way, etc. We shall see.

 

[tiffmaxee]

This happens a lot with vets. Most smile,nod their heads, and follow a protocol from here. Since cats metabolize insulin faster than humans twice a day dosing is used by most. If you are giving the same amount of insulin but divided into two doses your vet should be ok with it. Manydont realuze it’s possible to give the small doses which we use to increase and decrease but it is. I suggest buying some syringes with half unit markings.

 

[Julie and Honey]

This happens a lot with vets. Most smile,nod their heads, and follow a protocol from here. Since cats metabolize insulin faster than humans twice a day dosing is used by most. If you are giving the same amount of insulin but divided into two doses your vet should be ok with it. Manydont realuze it’s possible to give the small doses which we use to increase and decrease but it is. I suggest buying some syringes with half unit markings.

Thanks! I suppose I need to somehow let the vet think they came up with the idea, lol. Vet already knows I am a basket case about this, I’ll say it would give me less anxiety (which it would) to split dose. Too bad vets are not on this site getting better info, such a shame for a lot of kitties.