Che is offically OTJ!!!!!!!!!

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Mr Che-san

Member Since 2013
My kitty Che was diagnosed with diabetes last Friday. My vet prescribed 3 units of Lantus bid which I started Monday. Initial BS was 468 from office visit draw. Cat also has controlled hyperthyroidism. I called office today and asked when to bring cat in again? Was told 2 weeks from start. Asked tech about home glucose monitoring but she said she didn't think this was necessary as Vet didn't mention it. Am frustrated. Been reading site information which is very helpful. Is this insulin dosing appropriate? Do I need to do home monitoring? Do I need to be concerned about hypoglycemia? So far Che is tolerating dosing well. I am RN, so am somewhat familiar with insulin and diabetes in human patients. Che's momma is worried! confused_cat
 
Re: NEW Member-BID Lantus and not checking BS?

Welcome to the board:-)

I'm not trying to sound like a wise guy, but I've seen this question asked a lot here, and have used it myself plenty of times:

(And that you are an RN and familiar with human diabetes might actually help as far as whether you think it's a fair analogy to draw?l

'If the patient was an infant, who can't in any way communicate whether their BG was high or low, would you ask their parents to just give shots and bring the baby back in for a test in three weeks?"

To me, that's what a vet is doing when they tell you not to worry about home testing, prescribing a dose, and just telling you to shoot blind for 3 weeks.

Three units BID is a higher than normal starting dose, absent other issues. The AAHA guidelines recommend .25u per kg. of ideal body weight, BID, which tends to be about 1u or so. You mentioned hyper-which may affect the dose advice, but were any other specifics mentioned at diagnosis?
 
Re: NEW Member-BID Lantus and not checking BS?

No other specifics except that renal function ok, no renal failure, minimal wt loss. Glucose in urine of course. I appreciate the input. I can't understand a vet that gives no info! I am appropriately freaked out after starting to read site materials.. I'll get a meter n talk to the vet.
 
Re: NEW Member-BID Lantus and not checking BS?

If you're in the US, you want an inexpensive monitor for home testing and one that uses inexpensive strips (that's where the glucometers will cast you the most!). Many of us use the WalMart ReliOn Confirm or Prime as these use small blood drops and have reasonably priced strips. Our shopping partner ADW (link at top of page) caries the Glucocard 01, which is an unbranded version of the ReliOn Confirm.

Here are some glucose reference ranges used for decision making using glucometers. Human glucometer numbers are given first. Numbers in parentheses are for non-US meters. Numbers in curly braces are estimates for an AlphaTrak.

< 40 mg/dL (2.2 mmol/L) {< 70 mg/dL for an AlphaTrak}
- Treat as if HYPO if on insulin
- At nadir (lowest point between shots) in a long term diabetic (more than a year), may earn a reduction.

< 50 mg/dL (2.8 mmol/L) {< 80 mg/dL for an AlphaTrak}
- If before nadir, steer with food, ie, give modest amounts of medium carb food to keep from going below 50 (2.8).
- At nadir, often indicates dose reduction is earned.

50 - 130 mg/dL (2.8 - 7.2 mmol/L) {80 - 160 mg/dL for an AlphaTrak}
- On insulin - great control when following a tight regulation protocol.
- Off insulin - normal numbers.
(May even go as low as the upper 30s (1.7 mmol/L){60s for an AlphaTrak}; if not on insulin, this can be safe.

> 150 mg/dL (8.3 mmol/L) {> 180 mg/dL for an AlphaTrak}
- At nadir, indicates a dose increase may be needed when following a tight regulation protocol.

200 mg/dL (11.1 mmol/L) {230 mg/dL for an AlphaTrak}
- no shot level for beginners; may slowly reduce to 150 mg/dL (8.3 mmol/L) {180 mg/dL} for long-acting insulins (Lantus, Levemir, and ProZinc) as data collection shows it is safe

180 - 280 mg/dL (10 - 15.6 mmol/L) {may be 210 - 310 mg/dL for an AlphaTrak}- Any time - The renal threshold (depending on data source and cat's renal function) where glucose spills into the urine.
- Test for ketones, glucose is too high.

>= 280 mg/dL (15.6 mmol/L) {may be >=310 mg/dL for an AlphaTrak}, if for most of the cycle between shots
- Uncontrolled diabetes and thus at risk for diabetic ketoacidosis and hepatic lipidosis
- Follow your insulin protocol for dose adjustments
- Test for ketones; if more than a trace level of ketones, go to vet ASAP.
 
Re: NEW Member-BID Lantus and not checking BS?

Lol, don't get freaked out. The amount of info and experience here is pretty overwhelming. I hung around for a few weeks before posting the first time.
We advocate three things above all others.
1- home testing using a human glucometer
2- a good diet of low-carb canned food.
3 - logical and safe dosing of an appropriate insulin with Lantus, Levemir and Prozinc being the best .

There's a fairly steep learning curve at first, but you'll get all the help and support you can handle. :-D

Just ask!
 
Re: NEW Member-BID Lantus and not checking BS?

Hi Che's momma and sugardude Che and welcome to the FDMB. We live feline diabetes 24/7 and have lots of practical day to day experience with managing this new sugardance you and Che are doing.

I have one very important question. What is your first name?

My name is Deb and that tuxie over to the right is my sugardude Wink. He has been a diet controlled kitty for 5 months now. We were able to stop the insulin with the help from the people here, getting Wink on the right food and home testing.

Ask any questions you may have. We'll give you the answers.
 
Re: NEW Member-BID Lantus and not checking BS?

Everyone is so helpful. Really grateful. My name is Natasha. Che is a DSH black kitty. He is 13 yrs old. He has a step brother about the same age, ZuZu, who is a black DMH. I read the AHAA guidelines on treating sugar cats. Found another vet nearby that is a member of AHAA and may be a better choice for me and Che. One day at a time. Tomorrow I'll call them and pick up a ReliOn. Not giving his insulin tonight b/c I am concerned about the high dose. His coat is dull, he is a little lethargic but drinking less water and eating ok. Want to make sure I'm not having low blood sugar overnight. You all have put my mind at ease. Thanks again. I will keep checking in! :smile:
 
Re: NEW Member-BID Lantus and not checking BS?

Once you have the meter, matching test strips, lancets you are ready to home test. It can be a little scary, thinking of poking your beloved Che's ear to get blood.

It's always a good idea to practice poking on yourself first. So you get an idea of how the lancing pen works, or you can free hand the lancet.
Three very important tips.
1. warm the ear first. A rice sock with a couple tablespoons of rice or dried beans or lentils in the toe and tied shut, warm in microwave until warm but not hot, test on your bare skin.
2. something hard behind the ear to poke against. Old pill bottle lid, small flashlight, folded up tissue to protect your finger.
3. treats for your cat for submitting to the test. Any pure protein treat is good. Lots of us use freeze dried chicken.

Here's a diagram of the area you are aiming for with the lancet.


Here's a link to some testing tips with more pictures and videos.

Here's a link to an article onhow to make your cat more accepting of the poking process.

Please Natasha, let us know how the testing goes. We'll try to give you calming, easy to follow suggestions so you don't freak out.

One day at a time, and we'll get Che feeling better and build your confidence that you can make Che act like his old self again as the diabetes gets under control.
 

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Re: NEW Member-BID Lantus and not checking BS?

Just wanted to provide update. Purchased the ReliOn glucometer and it was very affordable. Performed two blood glucose checks already! Went well once I reviewed the online tips. His sugar is high even after 3 units of Lantus - 342. supposed to peak in one hour and that was a couple hours post. did not give injection last night and Che had major PU/PD up until I checked sugar and gave insulin today. I'm off work this weekend and will try for a glucose curve. Thank you again. I feel more in control and that I can take better care of Che now. :smile:
 
Re: NEW Member-BID Lantus and not checking BS?

Hello and welcome to the forum!

What is Che being fed right now? You want a low carb canned food like Fancy feast classic pates, friskies pates or wellness grain free, because it will bring the blood sugar down in most cases. And unlike humans, that change alone can be enough to have them solely diet controlled.

Wendy
 
Re: NEW Member-BID Lantus and not checking BS?

His sugar is high even after 3 units of Lantus - 342. supposed to peak in one hour and that was a couple hours post. did not give injection last night and Che had major PU/PD up until I checked sugar and gave insulin today.

I'm just a little confused on the timing of things. The test you got that showed 342.... when was that, how many hours after the shot? And the other test you were able to get...when was it in relation to the 342?
 
Re: NEW Member-BID Lantus and not checking BS?

Yes, so first day of testing and timing has been erratic. More just to give me an idea of where he is at.
I work 2nd shift, so I tend to do shots about 12 pm and 12 am.
BS >600 at 12:40. PU/PD. Gave lantus 3 units. Fed cat.
BS 342 at 14:26 was 322. gave snack.
BS 199 at 17:37 - checked it at that time b/c he was begging for food. I also thought I heard hacking sounds, got concerned and so I checked. Did feed him moist at that time.
BS 142 at 23:50. This is after I finished work and close to when he should get his next dose of insulin.
He looks good. Alert.
I don't know whether I should give him insulin now or not. Just fed him.
I did purchase Fancy Feast Classics earlier today and have been feeding him this almost exclusively all day.
 
Re: NEW Member-BID Lantus and not checking BS?

OK, I gave Che 1 unit of lantus after nadir BS of 142. Just for overnight. leaving food out. This is all so weird.
Do I give the 3 units every 12 if the nadir is just below 200? I was confused by the "200 mg/dL - no shot level for beginners, may slowly reduce to 150 mg/dL for long acting insulin".
Is my cat going to have Somoygi's because vet started him on such a high dose?
Not giving injections in the scruff, but where is the best location? Been doing the upper back.
Yes, I am freaking out right now.
how is it that yesterday I didn't give him any insulin after 12 pm dose (b/c I was too freaked out about low blood sugars and didn't have a glucometer yet) and 24 hours later his insulin was >600? :?
Let me repeat, I'm freaking out right now. nailbite_smile
I'll be fine. Che is fine. I need to sleep.
Thank you friends for reading my stress rant....
 
Re: NEW Member-BID Lantus and not checking BS?

Stick with 1 unit for now; do not go back up to 3 units. You won't have to worry about Somogyi, which is only suggested to occur in cats.

I've shot in the loose skin around the shoulders. Others may shoot in the loose skin near the hip/flank.

This is a manageable chronic disease. Read frequently. Become familiar with blood glucose testing because it will save your cat's life. Take a look at my signature link Secondary Monitoring Tools for urine ketone testing tips and other assessments you may wish to make.

You can do this!
 
Re: NEW Member-BID Lantus and not checking BS?

No need to freak out - we can help!

We ask newbies dont shoot under 200 because they dont have the data to know how low the cat is going to go or how to handle it if they do. As such, and given these numbers I would strongly recommend you set up a spreadsheet to help us and you track him - heres how - let us know if you need help with it:http://www.felinediabetes.com/FDMB/viewtopic.php?f=6&t=18207

Heres how we put it in our format - its done by hours after the shot.. So AMPS = a.m. Pre Shot. PMPS = p.m Pre Shot. +2 is the reading you took 2 hours after the shot , +5 is the reading 5 hours after the shot and so on.

AMPS 600 3IU
+2 342
+5 199
PMPS 142 1IU

I suspect (although its limited data) with these numbers he is bouncing. I will explain that later but basically it means the dose is likely too high especially now that you have changed food.

I would recommend you keep him at 1IU now for a few days to see how that goes. You should hold the 1IU for a good 3-5 days (unless he drops below 50 which is always an automatic dose decrease!) since Lantus is a depot insulin which means it takes a few days to build up ( or drain) from his system and really see the effect of a dose change.

Wendy
 
Re: NEW Member-BID Lantus and not checking BS?

Thank you, Thank you!

Che looks great this AM.

AMPS 142 (my AM being 0030)
PS +10 104
Not giving insulin.
Fed fancy feast.

unfortunately I have hair appt at 11 AM, so no BS until later. Probably no insulin until later.
Will get ketostix also.

Will be working on the spreadsheet - tasha
 
Re: NEW Member-BID Lantus and not checking BS?

Numbers are looking good without the insulin. Let me know if you need help with the SS.
 
Re: NEW Member-BID Lantus and not checking BS?

How are things going? Has he needed a shot since Saturday?
 
Re: NEW Member-BID Lantus and not checking BS?

Did not work on spreadsheet online yet. Started one at home for now. Was stressful over the weekend. Nightmare that Che was hypoglycemic and I couldn't get a BS. Anyways, went off schedule over weekend. his BS spiked to 500 Monday AM (I was trying to get him back on a 12 and 12 schedule. Pretty good since then.

I have changed his diet a lot so am being cautious and am also more nervous. always free fed dry food. Always over fed dry food. Now switched to only wet and am probably still over feeding but part of that is fear Che will drops his BS when I'm asleep or something. At 0030 his BS was 106 but I gave 1 unit anyways and fed him. Nervous but ...If I don't give it then he seems to climb too high.

am reassessing his BS, food intake, urine output, water intake every 12 hours on a chart I made.

will get working on spreadsheet soon. Just been really overwhelmed and anxious.
 
Re: NEW Member-BID Lantus and not checking BS?

your spreadsheet works just fine.

If you could include all the tests taken to date, that will help build the data and profile of Che.

Welcome to the group.
 
Re: NEW Member-BID Lantus and not checking BS?

Can't figure out how to get back to the spreadsheet. Tried to cut and paste link into browser but can't edit doc. cannot find doc.
 
Re: NEW Member-BID Lantus and not checking BS?

You should be able to find it by going to https://drive.google.com/ and signing in.

Mr Che-san said:
I have changed his diet a lot so am being cautious and am also more nervous. always free fed dry food. Always over fed dry food. Now switched to only wet and am probably still over feeding but part of that is fear Che will drops his BS when I'm asleep or something. At 0030 his BS was 106 but I gave 1 unit anyways and fed him. Nervous but ...If I don't give it then he seems to climb too high.

Don't worry too much if you're overfeeding him. Newly diagnosed diabetics are usually ravenously hungry because their bodies aren't processing nutrients from food properly. Eventually, once the diabetes is regulated, everything else will fall into place and you don't have to worry about him being overfed.
 
Re: NEW Member-BID Lantus and not checking BS?

update Che's spreadsheet. Insulin timing inconsistent on my part. gave no PM shot but +5 BG 149, seemed to be urinating more and with increased hunger. Gave 1/2 U at +6. Will recheck close to midnight. Managing this is so weird. Che acting more like himself then ever with BG around 66-78. Would like to keep it under 200 if possible. If 0.5 U works to keep him even until midnight but BG still higher (>120), is it safe to give another 0.5 or do I wait 12 more hours. then I have him totally off schedule.

tash :?
 
Re: NEW Member-BID Lantus and not checking BS?

Wait until his regular shot time before giving him any more. Then, give him his regular dose and not any more. It might take a day or two for things to even out and he might run a little high, but you need to get him back on a schedule when you can give him the same dose him every 12 hours.

Lantus works best when dosed consistently. Lantus is a depot-style insulin, meaning a little of it begins working immediately and a little of it is held in reserve. If you're dosing too frequently or uneven doses, this depot can create numerous issues like bouncing and hypoglycemia.
 
Re: NEW Member-BID Lantus and not checking BS?

Hi Natasha and extra-sweet Che!! Welcome to the best place to be if you have a diabetic kitty...the FDMB!!

I realize you're still very new to this whole sugardance, but here's a few tips I haven't seen yet

1. always check the BS before you give a shot, and don't feed within 2 hours so the number isn't influenced by food

2. if it's under 200 (where we suggest new shooters start for their "no-shot" number), don't feed and "stall"..retest in 30 minutes and see if he's coming up, continuing down or about the same. During this time, post with your PS number and ask for Dose Advice! That's what we're here for! If you add the ? icon in your original post (that's the only one it'll show up in, so you'd have to "edit" that first one), it'll get more eyes on your question sooner...and if it's an emergency, you can use the 911! Once the emergency is over, you can go back and edit the post again and remove the 911 and go back to "None", or just the ?

3. You'll want to give the shot every 12 hours....if you DO stall, you're going to be changing your shot times to co-inside with your new times....so if you usually give at 12-12 and end up stalling for an hour, your new shot times would be 1/1...but you can get back on schedule 15 minutes per cycle, or 30 minutes per day

4. Since it looks like you just started transitioning to wet low carb foods, your numbers can tumble quite quickly...as it looks like is happening with Che..that's good news!

5. Lantus is a "depot" insulin....it can take 6-10 cycles (3-5 days) to "fill" that depot. You should not give insulin in between your regular shot times.

6. The nadir isn't the same as your Pre-shot reading....it's the point in the cycle where Lantus is working it's BEST! Most cats usually nadir around +5 to +8 but that varies from cat to cat....and cycle to cycle! One day your nadir can be at +6....the next it can be anywhere.....this is where testing really comes in handy...so you get to learn how Che responds to both insulin, and food. Some cats are very sensitive to carbs and just a little goes a long way...some can deal with them better....ECID! (every cat is different)

7. With Lantus, the Pre-shot numbers aren't figured into the dosing the way the nadir numbers are. Dosage on Lantus is based on that nadir more than anything

The protocol most of us use is called "Tight Regulation"....if you'd like to get a serious overdose of information, you could spend some time reading about it. It's strict, but it also gives the best chance of getting Che off the juice! Don't freak out by the overdose of information....it looks a lot worse than it really is, and the people here will help you every step of the way!! Tight Regulation Protocol

Again, welcome to the FDMB, and keep asking those questions as you think of them! The members here are GREAT!!
 
Re: NEW Member-BID Lantus and not checking BS?

Ah, I see you gave him half a dose at his +6 already. Since the 1u kept him low till his PMPS, I would probably drop him to .75u across the board. If he's over 200 at his next shot time, I would probably give him the newly reduced .75u dose. If he's under 200, don't feed, don't shoot. Wait a half hour and see if his numbers are going up. If he's over 150, you'll probably be safe to give the .75u dose.

Since you gave him .5u at the typical Lantus nadir tonight, you'll probably see him low at shot time tomorrow. If so, just skip the AM shot and get back on schedule at tomorrow's regular PMS time.
 
Re: NEW Member-BID Lantus and not checking BS?

Really appreciate the assistance. Every bit of information provides more insight.

Didn't realize with Lantus the nadir is considered when it is working it's "best" so to speak.

I'm skipping AM and will resume tomorrow on schedule as planned.

It will be difficult to give 0.75 IU with the syringes of have. The marker is at 0.5 and then 1.0. Have to get smaller insulin syringes. I can guestimate.

Wonder what my Vet will think of all my messing around once we get together again....
 
Re: NEW Member-BID Lantus and not checking BS?

If you're already using 3/10 cc (aka mL) syringes, that's as good as it gets. There aren't any syringes which mark quarter units. You just eyeball it as best you can.
 
Re: NEW Member-BID Lantus and not checking BS?

ok. got it. Can eyeball. Starting to calm down about things. Again, really thankful for everyone's input and the resources here. Especially spreadsheet for sharing.
 
Re: NEW Member-BID Lantus and not checking BS?

You're getting some really nice pre-shot numbers. If you can, try getting some tests during the middle of the AM cycle (anywhere from +4 to +8) so we can see how low Che might be going. Sometimes it's difficult if you're working during the day so you might have to wait for your next day off.
 
Re: NEW Member-BID Lantus and not checking BS?

I actually work second shift, so my AM shot is at midnight. My PM shot is at noon.
Che's BG PMPS 64 . I fed him and will retest. Won't give insulin if still low. I work in a couple hours. He'll probably get really high by tonight again. Why does he rebound so much if he gets no insulin? Definitely need to reduce insulin dose a little like you said before.
 
Re: NEW Member-BID Lantus and not checking BS?

It isn't rebound if he isn't getting insulin, its going high because of NO insulin and he's diabetic.
 
Re: NEW Member-BID Lantus and not checking BS?

Mr Che-san said:
Why does he rebound so much if he gets no insulin? Definitely need to reduce insulin dose a little like you said before.

You want a dose that is safe to give twice a day. Right now, it looks like you might be better off with .5u. Since you're skipping tonight's shot (64 PMPS), start tomorrow with only .5u no matter how high he is. It will still bring him down a bit and it will still let you give a PM shot.
 
Re: NEW Member-BID Lantus and not checking BS?

My thoughts exactly. At work, but seems ok per my dad who I had check on him.
 
Re: NEW Member-BID Lantus and not checking BS?

I agree with Kay -try 0.5 units and see where that takes him. Give it 3-5 days to settle in unless he drops under 50 in which case you reduce immediately. And try to get some mid cycle tests (or before bed) if you can. Want to see how low he is going.

Wendy
 
Re: NEW Member-BID Lantus and not checking BS?

Che's BG PMPS 94. not giving insulin now. Is that the right choice? Gave 0.5 U AMPS. He looks really good this AM. I can wake up at 0800 and get a +8 tomorrow to check nadir.
 
Re: NEW Member-BID Lantus and not checking BS?

Yes, that is the right choice. Still hold the dose at the .5u if/when his next pre-shot number is over 150 because it might be the residual depot causing this lovely number. Che looks like he really wants to get into remission with these low numbers. :mrgreen:
 
Re: NEW Member-BID Lantus and not checking BS?

(FYI, for future reference when you don't give a shot, we call that a "PMBG" instead of a "PMPS" ;-) Here's to hoping you two see many more AMBG and PMBG readings in your future! drinking24 )
 
Re: NEW Member-BID Lantus and not checking BS?

check Che's SS - got a +6 and +8 following overnight.
We'll be a bit off schedule today; i work a later shift and won't be home until 1 AM at best.
 
Re: NEW Member-BID Lantus and not checking BS?

Ok start 0.25 tomorrow morning if over 150, we need to find a dose you can give consistently. We will also need to teach you to shoot at lower numbers, the mantra is shoot low to stay low. But since you are pretty new, you aren't ready for that yet

Wendy
 
Re: NEW Member-BID Lantus and not checking BS?

If you get a PS number you're not comfortable with shooting (like under 200), don't feed and retest in 30 minutes. This will help determine if his numbers are still dropping, or coming back up. Post and ask for Dose Advice during that 30 minutes. (You'd want to start a NEW post for this or change the subject of this one so people know you have a new question) If you start a new post, it'll also help to put the link to this one into the body of the post so others can see what's already been discussed

It's really important to give Lantus twice a day instead of skipping every other shot. Why not go ahead and drop to .25 like Sienne suggested and hold it for at least 3-5 days (6-10 cycles) so we can all see how Che does on regular, twice a day doses?

You can always go back up to .5 twice/day, but it's important to have some regular dosing so we can help you help Che!
 
Re: 8/26 Che PMPS 94, then 84. Dose advice needed!

Well. everyone must be at work. So he did not get any insulin.
 
Re: 8/26 Che PMPS 94, then 84. Dose advice needed!

I didnt see a post?

EDITED TO ADD - sorry I didnt notice you just changed your subject line. Next time if you need immediate attention please add 911 to your first post. Ok so I am thinking you may need to try 0.1 units. Heres what 0.1 looks like..

01unit-1.jpg


Wendy
 
Che-newer member

Thanks. I'm overwhelmed right now.
I did hold food and recheck after 30 minutes.
I did two checks at the same time because I didn't believe the first number, but on recheck he was lower - 84.
I will not be attempting to shoot low for the next three days at least; I have to go into work two hours after his insulin is due. I am not comfortable doing it after his midnight dose either; I got no sleep the other night checking him and that's no good for either of us.
So I'm just plodding along.
Also, I clearly I'm finding all the lingo and abbreviations and how to post a bit overwhelming too, but appreciate all of your help.
Thanks. :YMSIGH:
 
Re: 8/26 Che PMPS 94, then 84. Dose advice needed!

Sorry I edited my post - I think you should try 0.1 - see above.

Dont worry - its a steep learning curve - it gets easier. And his numbers are pretty great so you should be pleased.

Also 84 and 96 are within error of the meter so he is pretty much flat.

I will be here in 30mins but I am thinking you skip tonite and try 0.1 tomorrow and see where that takes him. No shooting low yet.

Wendy
 
Re: Che no insulin x 24 hours?

Che's 8/27 PMBG was 71. His AMBG today is 86. Fed. Retested one hour later. It was 73. Is there something wrong with my meter? This is very strange. No PD. Was hard to tell if PU - some lakes. I may buy new strips and a different meter just to be certain...How is this possible?

Hopeful but not getting my hopes up.
 
Re: Che no insulin x 24 hours?

Test yourself and see?

I dont think its the meter though. His pancreas may be kicking in. For now lets see how it goes without insulin. You want to feed him small mini meals through the day instead of big ones to help support his pancreas. If he can sustain 50-130 for 14 days then he is in official remission. If not we can try 0.1 units again for a while/

Keep us updated.

Wendy
 
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