? Butter - is the dose too high?

[Teddi Basagoitia]

Hi, I’m new here and learning to use this site, please forgive me. My 15 year old cat was diagnosed over 2 years ago, and after trying 4 types of insulin that didn’t seem to work, he went into remission after a food change from rx science diet to a feeeze dried pure chicken diet. A few weeks ago his BG was rising and the vet prescribed Senveglo because of the issues previously with insulin. The Senveglo triggered pancreatitis and a bout of keto acidosis that required hospitalization and nearly killed him. He’s doing better now, and the vet has prescribed Lantus, 2 units daily, which he’s gotten for a week, and his BG remains around 300 as measured with an Alphtrak meter. Today the vet told me to increase the dose to 2 units twice a day. After reading a bit, I’m worried about this increase, and I’m looking for advice. Thank you!

 

[Wendy&Neko]

Your vet should have known better than to suggest Senvelgo - it is contraindicated in cats that have been on insulin before. Glad to hear your kitty (name?) got over the DKA.

The Lantus 2 units daily, was that 1 unit twice a day or 2 units once? Lantus doesn't last that long in cats and should be given twice a day.

Are you giving the Lantus with a syringe? We use half unit marked syringes here and usually go up by 0.25 units or 0.5 units at a time.

Are you home testing your kitty's blood sugars yourself? We don't decide how to change the cat's dose based on just a couple readings.

Can you tell me a bit about the food he's eating? What is the brand? A cat needs more than just mean, taurine being one example of something they need.

 

[Teddi Basagoitia]

Your vet should have known better than to suggest Senvelgo - it is contraindicated in cats that have been on insulin before. Glad to hear your kitty (name?) got over the DKA.

The Lantus 2 units daily, was that 1 unit twice a day or 2 units once? Lantus doesn't last that long in cats and should be given twice a day.

Are you giving the Lantus with a syringe? We use half unit marked syringes here and usually go up by 0.25 units or 0.5 units at a time.

Are you home testing your kitty's blood sugars yourself? We don't decide how to change the cat's dose based on just a couple readings.

Can you tell me a bit about the food he's eating? What is the brand? A cat needs more than just mean, taurine being one example of something they need.

Hi! Thank you for responding! The reason the vet thought the Senveglo would be ok was because Butterscotch had been in remission for over a year and hadn’t been on insulin during that time.
I’ve been giving 2 units of Lantus with a syringe once a day. Today the vet suggested trying 2 units twice a day. Yes I test BG at home using an Alphatrak monitor, and since I started the insulin a week ago, I’ve been testing in the morning before insulin, and again in the evening.
The food he’s getting, which made all the difference in the world, is Stella and Chewy chicken freeze dried food. This cat absolutely refuses to eat wet food, and even the prescription dried food raises his BG. This Freeze dried food is supposed to be rehydrated, which he won’t eat, but he does eat it dry.

 

[Teddi Basagoitia]

Hi! Thank you for responding! The reason the vet thought the Senveglo would be ok was because Butterscotch had been in remission for over a year and hadn’t been on insulin during that time.
I’ve been giving 2 units of Lantus with a syringe once a day. Today the vet suggested trying 2 units twice a day. Yes I test BG at home using an Alphatrak monitor, and since I started the insulin a week ago, I’ve been testing in the morning before insulin, and again in the evening.
The food he’s getting, which made all the difference in the world, is Stella and Chewy chicken freeze dried food. This cat absolutely refuses to eat wet food, and even the prescription dried food raises his BG. This Freeze dried food is supposed to be rehydrated, which he won’t eat, but he does eat it dry.

His BG, with the 2 units given in the morning, are staying around 300 both on the morning and evening readings.

 

[Wendy&Neko]

Glad to hear you are home testing. Somethings you can do to help us, one is some edits to the signature, and the other is putting together a spreadsheet showing your blood glucose (BG) test values. More into here:
New? How You Can Help Us Help You!

We determine how to change a cat's insulin dose based on the nadir, or low point of the cycle. The insulin cycle looks like a curve down to the nadir (typically but not always around 6 hours after insulin), then back up. If you are only giving one shot a day, the insulin will have long worn off after 24 hours, so he'd be high. Similarly, 12 hours after the shot in the evening, he's also be high as it's well past the peak. It might be worth doing an experiment of 1 unit twice a day. And getting some tests 4-7 hours after the shot.

Are you home testing for ketones? I'd want to make sure DKA is well behind you. We'd be more aggressive with dosing if ketones are still in the picture. Tips to catch and test a urine sample

 

[Teddi Basagoitia]

Glad to hear you are home testing. Somethings you can do to help us, one is some edits to the signature, and the other is putting together a spreadsheet showing your blood glucose (BG) test values. More into here:
New? How You Can Help Us Help You!

We determine how to change a cat's insulin dose based on the nadir, or low point of the cycle. The insulin cycle looks like a curve down to the nadir (typically but not always around 6 hours after insulin), then back up. If you are only giving one shot a day, the insulin will have long worn off after 24 hours, so he'd be high. Similarly, 12 hours after the shot in the evening, he's also be high as it's well past the peak. It might be worth doing an experiment of 1 unit twice a day. And getting some tests 4-7 hours after the shot.

Are you home testing for ketones? I'd want to make sure DKA is well behind you. We'd be more aggressive with dosing if ketones are still in the picture. Tips to catch and test a urine sample

Glad to hear you are home testing. Somethings you can do to help us, one is some edits to the signature, and the other is putting together a spreadsheet showing your blood glucose (BG) test values. More into here:
New? How You Can Help Us Help You!

We determine how to change a cat's insulin dose based on the nadir, or low point of the cycle. The insulin cycle looks like a curve down to the nadir (typically but not always around 6 hours after insulin), then back up. If you are only giving one shot a day, the insulin will have long worn off after 24 hours, so he'd be high. Similarly, 12 hours after the shot in the evening, he's also be high as it's well past the peak. It might be worth doing an experiment of 1 unit twice a day. And getting some tests 4-7 hours after the shot.

Are you home testing for ketones? I'd want to make sure DKA is well behind you. We'd be more aggressive with dosing if ketones are still in the picture. Tips to catch and test a urine sample

Thank you! I’ve given him 1 unit this morning and will test at 4 and 7 hours. I’m not testing for ketones. He was negative for a few tests after the keto acidosis situation, and his BG has been staying below 400 for the most part, so the vet felt that ketones would not be an issue.
What should be included in the signature line? I’m having trouble navigating this site for some reason, I’m sorry. I do appreciate your help very much!

 

[Teddi Basagoitia]

Thank you! I’ve given him 1 unit this morning and will test at 4 and 7 hours. I’m not testing for ketones. He was negative for a few tests after the keto acidosis situation, and his BG has been staying below 400 for the most part, so the vet felt that ketones would not be an issue.
What should be included in the signature line? I’m having trouble navigating this site for some reason, I’m sorry. I do appreciate your help very much!

Ok I did find what to put in the signature line, sorry!

 

[Wendy&Neko]

You don't need to put the current insulin dose in the signature, if you have a spreadsheet. Those of us helping out will open that right away. Also, the spreadsheet will tell us what numbers Butterscotch is seeing.

Let us know if you need help setting up a spreadsheet, we have people who can help with that.

 

[Bron and Sheba (GA)]

I’m not testing for ketones. He was negative for a few tests after the keto acidosis situation, and his BG has been staying below 400 for the most part, so the vet felt that ketones would not be an issue.

If Butterscoth was my cat, I would buy a bottle of Ketostix and test once or twice a week for ketones following a recent bout of DKA. I disagree with your vet that the ketones will not be an issue. We don’t know that, and we hope they won’t be. But it is always better to keep an eye on them and if they do reappear, you can deal with them immediately and not let them get to the stage where they are a real issue again. Cats who have had ketones, are more prone to getting them again. Just a FYI.