advice re acquaintance injecting once daily

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Anyname

Anyname

Member Since 2010
The lady I was helping a few months ago has just returned the lantus I gave her. She won't go to a vet and doesn't use the internet. She has a friend who has a senior position in the diabetes unit of a local teaching hospital. Her friend told her that Lantus can be injected just once a day. That lantus doesn't need to be kept in the fridge and that you don't have to handle lantus carefully. She won't blood test her cat and she has taken her friend's advice and started giving Peppa 6 units of lantus once a day. I think Peppa would be about 15lbs. She's a small cat with a big tummy. She's been doing this for a couple of months now. She thinks Peppa is doing really well but thinks she was a bit "strange" yesterday so she put syrup on her Peppa's tongue - after which she was "fine".

This lady is a difficult personality - she doesn't listen to advice or opinions (from me). She trusts her friend who deals in people and not cats. She even showed me a magazine advertisement for lantus that said it can be used once a day (on people).

She is the sort of person that will get offended if I argue the point with her. I read on one site that cats need to be injected 12 hourly with lantus but that it can be used 24 hourly in people. Anyone got the energy to tell me in simple terms what this woman is doing to her cat? She's coming by this morning. I will show her LB's numbers on 4 units of lantus twice daily - his bgs are usually around 12 at injection time and 6 at the half way point. I can't imagine the mess LB would be in if I injected him with 8 units once a day. I don't wish to get myself too upset by what this person is doing but I would like to tell her some facts this morning. After that she's on her own - her cat her responsibility. Consequences are are best teachers. :roll:
 
In simple terms, the first thing I'd tell her is that:

  • A cat's metabolism is MUCH faster than a human's.
    The one shot of insulin will not last the 24 hours.

  • Lantus lasts longer if refrigerated. Cat doses are smaller so the vial or pen needs to be used for a longer time.

  • A human will use up the insulin vial quickly - usually before the 28 recommended days. That's why they say it doesn't HAVE to be refrigerated.
    But I believe the small print does say to refrigerate unopened packages (pens or vials)

  • Pharmacies always keep their insulin refrigerated.


If the cat was acting strange, and then got better after syrup... it appears the kitty was in trouble due to overdose. Probably was hypoglycemic. If she keeps doing that to her kitty it might cause seizures and brain damage.

I'm sure others can chime in with lots of ideas.

I think you are going about it in the only way you can. Make simple direct statements, and try your best - but in the end if she doesn't listen - you know you tried. (((Marilyn)))
 
Thanx. I will do just as you say. I needed to get some support from the folks here. :-| :-| :-| I think I know how to handle it - funny how when you share something it opens your mind to more idea's.
 
Two shots spaced 12 hours apart work best with the cat's metabolism. Cats and humans are not alike.
I should have been more clear about one shot of insulin. One huge shot won't last 24 hours either, but if it is TOO much it could hurt the cat.

Imagine eating ALL your food needs in just one meal a week. It would be too much all at once and probably make you feel awful.
That's kind of like shooting too much insulin with only one shot a day.
We need it spread out evenly.

Best of luck!
 
Will there be any problems transitioning back to twice a day? Going from 6 units to 3 units immediately? BTW I was horrified when she told me what she was doing. Poor little kitty!
 
Good question.
I would make sure she waits at least 12 hours from the last shot. Since this next dose will be half of the usual dose, she should be fine.

Gosh, I wish we knew what kind of numbers this kitty was throwing around. I'm guessing the kitty would go low and then bounce high. And that doesn't feel very good according to my diabetic friend. Keeping the BGs as even as possible is much more comfortable for humans and kitties.

The kitty may have gotten used the high dose and it may take a short while to get acclimated to the new lower... but EVEN dosing pattern. Since she isn't testing, it will be hard to know how the poor kitty is doing, but it has to be a lot better than the roller coaster ride he/she was on.

Good luck tomorrow! I hope she decides to listen to your good sense!
 
You could also give her a copy of the protocol. Perhaps having something "official" as it relates to cats and not humans would help.

I don't think there is any problem in her switching from 6u once a day to 3u twice a day except no one knows if that 3u twice a day is the right dose for her kitty. It sounds like she will not hometest but even at 3u bid, she could hypo her cat. Just because a cat is large, doesn't mean it necessarily needs more insulin. There was another person in LL not too long ago blindly shooting .5u/bid and her cat had had three hypos already. In a situation where she will not hometest, I am not comfortable in saying that 3u bid is ok. I think more experienced folks need to help you with that question.
 
One thing you can do is provide the article I'm attaching to this woman and her friend. It's from one of the top veterinary journals and is written by the lead researchers in the use of Lantus (glargine) in cats. It includes our dosing protocol. If they won't listen to you, maybe the actual research and science will make a difference.


What she is most likely doing to her cat is giving a shot, the cat's BG level is dropping -- likely fairly fast and possibly low -- and then since the insulin is wearing off in 12 - 14 hours, her cat's numbers will be very high by the next time she shoots. She's causing very big swings in BG levels and her cat probably feels pretty lousy. The cat is probably spending the better part of the day in high numbers, likely due to bouncing.

I don't know that 3.0u twice a day is a good route at this point. It may be that starting at 1.0 - 1.5u might make a lot more sense. (I know -- she's probably not home testing either.) You might ask her if this were a child, would she be injecting insulin without testing and expect the child to survive.
 

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Will there be any problems transitioning back to twice a day? Going from 6 units to 3 units immediately? BTW I was horrified when she told me what she was doing. Poor little kitty!
 
Hi I'm having trouble replying on my computer.. I have printed out the information for the lady who is stopping by in half an hour. I don't want to get myself all worked up over her cat - I have my own cat to do that about. I will tell her about the new vet I've had to see in order to get our cat admitted to a new cattery when we go away next month (been to a bit of effort to find the right place). I will suggest she invest in a $58 check up with this vet - just to hear a professional's opinion on dosing. Young woman vet very qualified and proactive.

I had this lady blood testing at first but she found it too demanding and made up excuses about her cats ears not being big like LB's ears and it would damage her cat blah, blah, blah. I knew it was nonsense but also knew that I couldn't argue with her. The cat is NOT a big cat. I think it's a Burmese. It's got a huge tummy and is eating too much. I will just have to be blunt with her and deal with her shock horror. I certainly think 3 units twice a day is better than 6 units once a day. When I was dropping by to test the cat I had it on 1.5. The woman adjusted the dose upwards without discussing it with me and then changed it to once a day - I'm amazed the cat has survived this long on what she's doing. !!!
 
I could not deal with a person like that; I'd be the person to say Hey, sure do what you want, but I am betting you kill your cat within a month. Good luck dealing with her.
 
I have to admit I felt sick to my stomach just from reading your first paragraph.

You got some great guidance here. Good luck!
 
I hope you can get her to cut the dose to 1 or 1.5 u bid as Sienne suggested. It's probably better that the kitty be high than hypo.
 
I found a much simpler article to give her. There was no way she would read the one I printed out from Gabby. I did my best to talk to her about twice a day injecting. My husband heard the conversation and commiserated later on the degree of difficulty I had. I really believe that she's been damaged at some point in her life - no one would be that defensive without previous harm. She isn't a bad person, she's not even stupid she's emphatic about her ability to judge for herself. She must be like this with everyone about everything and yet I see a good person in there. What she might do is consider the article in her own time. It's simple reading: http://petdiabetes.wikia.com/wiki/Lantus My cat wandered in during the discussion, looking the picture of health on 4 units twice daily. (I probably should post an update on what's been going on with LB)

I'm pretty sure her cat's bg's are high during the night. She told me that she had to move the cats bed outside at night (winter here) coz she's started peeing inappropriately inside (at night). This is all the evidence she needs to see that the dose isn't lasting 24 hours (I told her that of course - I'm not a saint). She is the sort of person who might mull over what I said, and what's been going on and change without pressure from me. The less I push her the better chance there is that she will reconsider. Phew.... Oh and since the hypo event, she's dropped the dose to 5 units once a day. I said "well it would be really good if you could divide that into two times a day". Said it with my best 'C'mon, you can do it!' look on my face!
 
Is she someone that is frugal? Perhaps you could try approaching it from the cost perspective. If what she is doing isn't working (which is what we all suspect the case to be), then she is spending an awful lot of money on insulin and supplies to do absolutely nothing. Her cat is still likely miserable, urinating inappropriately, etc. If to make that investment worthwhile, she only need to shoot twice a day instead of one, perhaps it is worth a shot?

I think of shooting once a day like this...

Each cycle, our cats take the insulin they give us, and they take some out to the back yard to put in the shed, then they use the rest of it to keep their BG in check. For the insulin to work optimally, the shed has to have so much in it. So, when Lantus is working correctly, the shed is full, and the remaining insulin is enough to keep numbers in check for the 12 hour period. Next shot, you top off the shed and then use the rest. Wash, rinse, repeat.

However, when you're only shooting once a day, it is a losing battle. When you give the shot, a big chunk goes to the shed, with a little used for present blood glucose control. But 12 hours later, when you don't shoot, the cat has to go out to the shed and take insulin out of there to try to fight the high BG#s. So the next shot, more insulin has to go to replace what was taken from the shed. Which leaves even less for BG control that cycle, but at least a little. But the shed is again depleted. In a very short period of time, you find yourself spending a lot of time and energy doing absolutely no good for cat, your nerves or your pocketbook.

Perhaps you could write your friend a note, and do your best to stay positive and commend her. She genuinely wants to help her cat, or she would have gone with the PTS route. Explain that you simply are concerned that she must be very frustrated to see her cat continuing to urinate inappropriately and appear at times, at least, to not feel well... and that you know that must frustrating given the expensive involved in treating FD. Let her know that you aren't telling her what to do, but rather sharing a perspective. Maybe you could include some printouts of condos that reflect her frustrations, or of spreadsheets of kitties that struggle and kitties that are doing well. You could include pics as well. I think Willie is a good example of a cat that really struggled in the beginning but now is the picture of health (at age 15 and with a auto-immune disease to boot!) because twice daily shooting works. Maybe seeing it in the stories of people fighting the same battles as she is would make the idea less threatening or confrontational? Most of all, tell her that it would certainly be much easier for you to sit back and say nothing, but stress that you very much care about both her and her cat and want the best for both of them, so you're risking your friendship to try to help.

You are a good person and friend to try to help this woman and most of all, her cat.
 
I thought about writing her a letter. She's not a friend, as such but my neighbour's hair dresser. My neighbour must have mentioned our cat being diabetic and she wanted to talk to me about Peppa. Her cat was very miserable when I first saw it. The problem is that the cat is a lot better than it was now it's on Lantus even on the messed up dosing, it's noticeably better than it was apparently. She now gives it raw meat and Fancy Feast and she's really upset with her vet for not telling her that dry food was bad.

The article I gave her said that Lantus generally works twice as quickly on cats as it does on humans.. It could work faster and be used up in 10 hours or last for 14 hours. As she's giving it so much at one time, could that mean it lasts even longer?

I could push the concept of getting the cat in to remission. It's off all dry food. I think that's a good carrot to dangle in front of her. She sounded interested in getting it into remission. I'll write a carefully worded letter to her. :razz:
 
I think using the goal of remission as a guiding approach to your letter is a great idea! One thing I would also point out is, even if remission doesn't happen, having a regulated cat on lower doses of insulin does tremendous good for the cat's overall health. the way I see it, there is no sense paying good money to keep a cat in numbers above the renal threshold, only to have their kidneys start giving out a year or two later.

You might also use that opportunity to point out that the best shot at remission involves informed dosing decisions, which can really only be made with hometesting.
 
Personally, I would email or talk to this nurse 'friend' of hers and let her know what he off the cuff remark is causing this cat.
 
Is the tummy shaped abnormally? Ie, is the rest of the cat fairly small and the tummy out of proportion? Are there any skin/fur issues? I ask because you've mentioned the tummy a few times now and that sets off some alarm bells for me...
 
Big appetite and pot belly, those symptoms remind me of my Shadoe.
Before she was regulated, she was eating close to 24oz/day, and she looks like a pregnant cat ready to drop a dozen kitten. She looks like a basketball on 4 little stick legs, and her face is fine featured. She has acromegaly.
The skin/fur issues make me think of cushings.
 
Hi again, Yes, this little girl cat looks disproportionate with regards her tummy - looks pregnant. I gather she also has issues cleaning herself after a bowel movement. I haven't gone into those issues with the lady as it's too difficult to interact with her. She is so sensitive to criticism and so determined she has everything under control. I find with my own cat being so full-on I really don't want to get into hassles with this woman. The lady needs to take the cat to a vet.

Sorry I didn't respond earlier - I thought this thread had come to an end - or is it my ability to do more for the lady - given how little she is prepared to budge!

marilyn
 
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