Chewie's vet visit+TR or SLGS?

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Virginie & Chewie (GA)

Virginie & Chewie (GA)

Member Since 2022
We just came back from the vet's, and thanks to all of your help, the vet didn't think it was worth stressing Chewie out to retest blood glucose and urine. She was very impressed that I already had everything and had been testing at home. I told her it was thanks to this forum and she said she sends a link to it in the email she sends to every new diabetic kitty owner!

Chewie weighed in at 11.1lb today, much better than the 10.25lb she was three weeks ago, and she was well-hydrated and bright, so the vet was not worried about ketones. She said I could keep testing with the sticks for peace of mind, so I probably will tonight.

The insulin she gave us is a generic of glargine, she said they priced it out and it was the cheapest option for cats, and would come - she called it in to the compounding pharmacy that I use for gabapentin in tablet form. She called it Semglee insulin, and it is $99 for a pen (she didn't want to use a bottle for the same reasons you guys recommended a pen instead).

Overall I was super happy with how proactive and informed she was (she treated Chewie for her IVDD and was also the first vet to ever tell me about Adequan). She wants us to start at 1 unit AM and PM with regular BG tests (same as you recommend), then do a blood glucose curve (she's happy to let me do it at home) in two weeks.

Thoughts? Is one unit ok to start with, is that what you would normally recommend?
 
Virginie said:
Is one unit ok to start with, is that what you would normally recommend?
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We usually suggest starting at 0.5 if eating low carb canned food and 1.0 if still eating kibble.

Semglee is a biosimilar of Lantus so we dose it the same way as Lantus and Basaglar.

Wonderful to have a vet that's so up to date on treating feline diabetes!
 
Chris & China (GA) said:
We usually suggest starting at 0.5 if eating low carb canned food and 1.0 if still eating kibble.

Semglee is a biosimilar of Lantus so we dose it the same way as Lantus and Basaglar.

Wonderful to have a vet that's so up to date on treating feline diabetes!
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Great, then I will give her 0.5 units tomorrow morning, when I can keep an eye on her (she eats only low carb raw and canned).
Can’t wait to get her back to feeling better!
 
I just read carefully the description of both TR and SLGS - from what I understand, TR has the best chance I of remission but is a lot more demanding testing and monitoring wise, my question is, can TR still be effective if you dont start with it from the get go?

We will be moving from Oregon to Virginia first week of October - following a 2 days of driving/one day of rest schedule, we will be on the road for 7 days total. Given that, should I start with SLGS, and maybe switch to TR if needed once we are moved in and the kitties are settled? Between packing for the move and the cross country drive, it’s going to be a stressful couple of months for the cats and humans alike, and I don’t feel I’ll be able to test often enough for TR.
 
There is no issue when it comes to switching from one dosing method to the alternative method. To be honest, with either method, the minimum number of tests is 4 -- your two pre-shot tests and at least one test during both the AM and PM cycle. I tend to think the members who use TR do test more but as long as you are getting some mid-cycle tests in, it's fine. I moved cities with my diabetic kitty who was known for dramatic drops in numbers and got a test when we were traveling. (It was about a 7 hour drive, though.) There are also members who take their kitty on vacation so using TR is a possibility. It's all based on what makes you comfortable. While TR has a great track record for getting cats into remission, SLGS can get your cat there, as well.
 
Alright, SLGS here we go… I had planned on starting her at 7:30 but of course today she was up howling endlessly for food at 6:20 (best laid plans…). Going to test and aim to shoot and feed at 7am. Watched all the videos, read all the resources possible, wish us luck!
 
She may benefit from a middle of the night snack. Minnie used to want food super early until I started feeding her around 1-2am on my way to the bathroom. You should look into Marks Pharmacy for Lantus pens since you can get 5 for under $200 including shipping and it’s a much better deal. I was paying $105 per pen at riteaid before I found them here and my vet at the time also said that was the best priced option she knew of :rolleyes:

happy your vet is onboard with it all! :bighug::bighug::bighug:
 
Ale & Minnie (GA) said:
She may benefit from a middle of the night snack. Minnie used to want food super early until I started feeding her around 1-2am on my way to the bathroom. You should look into Marks Pharmacy for Lantus pens since you can get 5 for under $200 including shipping and it’s a much better deal.

happy your vet is onboard with it all! :bighug::bighug::bighug:
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Ha, the notorious bathroom snack :cat: One of my other cats woke me up for a snack at about 1.30am (he had chosen to snub his dinner, sigh), and of course Chewie wanted one too. I was out of LC canned and gave her a heaping spoonful of the Wellness turkey minced in light gravy (14 carbs I think), I wonder if that's what made her so hungry this morning (and maybe spiked her blood sugar, her preshot reading was high)?

Thanks for the price comparison - my vet did say she was happy to write me a script for generic glargine if I could find it cheaper elsewhere, so I think I'll report to her on Mark's Pharmacy and also using Goodrx. I'll make sure to get the script before we move, so I can stock up once we're in the new house.
 
A lot of folks here use feeders with a timer. I’d just leave about 1/2 can of wet food covered on the kitchen counter before going to bed. That was usually one of their leftovers anyway. Then I’d feed Minnie about 1-2 of that and Bobo would get the rest.

I wish I had discovered Mark’s sooner because nothing beats $38 a Lantus pen!!
 
My cat with IBD who likes to graze at her own leisure has a microchip feeder that I fill every morning and evening (and in between if she finishes). It's been a game changer, no more morning vomits from being on an empty stomach too long.
I have 4 kitties, 3 of which are gluttons, so a timed feeder wouldn't work for us.

I just tested her +2h BG and it's even higher than before breakfast... I think I'll retest at +4h, really hope it comes down. Not sure what to expect in the first few days of treatment.
 
Minnie had IBD and Bobo does too. So yeah game changer for sure once I figure that out and also removed all beef from their diet.

feline diabetes is a marathon not a sprint. First couple of days, maybe even weeks, her levels will be all over the place. Especially since you’re using a depot insulin and as we mentioned before, it takes a few days to build up. FYI, +2 should always be higher because of the food and because it takes about 2 hours for the insulin to start to work. That’s what you want to see especially at the pm +2. It’d be more of a concern if it was lower than the preshot because it would indicate she was headed too low in the cycle
 
Virginie said:
I normally feed everyone a full meal around 1-1.30pm, so I will make sure to test her before giving food. Thank you!
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Remember you only need to withdraw food for 2 hours prior to the preshot tests. No need to do that for every test. Although, I’ll admit that it just worked out that way when I was testing Minnie at +6 and then I’d just give her a snack after as a reward. But again, it’s not necessary
 
Just don’t get discouraged. You started at a very low safe dose and you’ll likely have to raise her to 1 unit. Again, just pace yourself. You’re on the right track and you’ll start to see better numbers soon. Just not tomorrow ;)
 
It’s time for Chewie’s second dose. Her BG is at 361 12 hours and 15 minutes past first shot. I’m trying to slowly move her to 7.30 or even 8am/pm, by 15 minutes increments. Since she was howling for food at 6.30 this morning it was all I could do to make her wait until 7am.

I just read the detailed instructions the vet emailed me, and it mostly matches what I found here, except they say that I should roll the Semglee insuline pen while the instructions in the Lantus forum are to NOT roll it. Just wanted to check it was okay to not roll it and I understood this right? (I didn’t roll the pen this morning)
 
that stuff about rolling the pen is old and outdated and not applicable to today's insulin glargine. In fact, as you mention -- it is recommended that you do not roll the insulin pen. Some people don't even keep it on the fridge door because they worry about the extra jostling it would get every time the door is opened and closed. We kept ours on the door though, middle shelf.
 
The vet likely copied over much of the instructions they wrote out for other insulin like Novolin. Glargine (whether Semglee or Lantus) is in solution. Many of the other types of insulin are suspensions -- you let them sit for a while and you will see the insulin separate. With a suspension, you need to re-mix/roll the insulin to get it back into a milky, non-separated liquid. In addition, compared to many of the other types of insulin, glargine is a bit more fragile. You do NOT want to agitate glargine.

One note on when to test. At some point relatively soon and intermittently thereafter, you will want to get a curve. That means you test every 2-hours for a 12-hour cycle. The curve will give you a better idea for where in the cycle your cat's nadir falls. While many cats have a nadir that's around +6, that's not necessarily true for every cat. Some cats have an early or late nadir. (My cat's nadir typically was at around +3 or +4, except when it wasn't.) In addition, nadirs can shift around. A curve will help you to figure out when insulin onset and nadir typically fall.
 
Hendrick Cuddleclaw said:
that stuff about rolling the pen is old and outdated and not applicable to today's insulin glargine. In fact, as you mention -- it is recommended that you do not roll the insulin pen. Some people don't even keep it on the fridge door because they worry about the extra jostling it would get every time the door is opened and closed. We kept ours on the door though, middle shelf.
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Is that why? I thought it was about the pen getting less cold on the fridge door. I used to keep them there and then moved them to the back of the fridge when I read about that lol!
 
Sienne and Gabby (GA) said:
The vet likely copied over much of the instructions they wrote out for other insulin like Novolin. Glargine (whether Semglee or Lantus) is in solution. Many of the other types of insulin are suspensions -- you let them sit for a while and you will see the insulin separate. With a suspension, you need to re-mix/roll the insulin to get it back into a milky, non-separated liquid. In addition, compared to many of the other types of insulin, glargine is a bit more fragile. You do NOT want to agitate glargine.
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Thanks for explaining the “why” behind it! My default is definitely to trust a community of experienced diabetic cat owners who help and advise people daily than the vet who may or may not be up to snuff (the instructions also say AlphaTrax is the only accurate glucometer lol).

One note on when to test. At some point relatively soon and intermittently thereafter, you will want to get a curve. That means you test every 2-hours for a 12-hour cycle. The curve will give you a better idea for where in the cycle your cat's nadir falls. While many cats have a nadir that's around +6, that's not necessarily true for every cat. Some cats have an early or late nadir. (My cat's nadir typically was at around +3 or +4, except when it wasn't.) In addition, nadirs can shift around. A curve will help you to figure out when insulin onset and nadir typically fall.
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I was thinking of trying a curve next Saturday, which will be the one-week mark from starting insulin, as well as a day I’m not working and can stay home all day to do it. Or better to wait until two-week mark?

Do you guys always poke in the “warm spot” on the ear? I try to alternate ears and to poke a little higher or lower than last time but I’m worried about ears getting sore. She shook a head several times after this morning’s test, despite being poked only once. If you have any advice on making it as pain-free as possible, I’d love that.
 
Yes the point of warming up the ear is to poke in the warm spot so you can get blood out. Sometimes you may prick a bit harder and they react. Minnie would almost always meow and turn her head but I would press the cotton pad and hold that spot on her ear for a few seconds to try to make it better. What gauge are you using again? The larger ones do hurt a bit more so once you feel confident to upgrade to a 30, it should be less painful for her. Are you getting enough blood every time easily? How is that going?
 
Virginie said:
Alright, SLGS here we go… I had planned on starting her at 7:30 but of course today she was up howling endlessly for food at 6:20 (best laid plans…). Going to test and aim to shoot and feed at 7am. Watched all the videos, read all the resources possible, wish us luck!
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You could get a Freestyle Libre sensor put on just for the move/trip. The Libre tends to read low in the lower numbers (greens) but it can be a good tool to monitor your sweet kitty.
 
It’s so hard to assess how hard I need to poke. Sometimes I go too softly and she doesn’t move but no blood comes up, so by default I’m trying to go a little harder. So far only twice have I had to poke her several times to get the job done. I use the rubbing method to warm up her ear (tried the washcloth in a baggie and she was NOT having it). I have had good luck milking the ear to get a good little drop, scooping it up with my fingernail and transferring to the meter while I’m holding pressure on the ear with the cotton pad. Then plenty of treats.

I have been using 26 gauge lancets freehand so far, but also have a box of 30 gauge, and tempted to just switch to those.
 
Yes, the 26 would hurt slightly more. I never got the ear warm enough that way. I used the sock filled with rice instead. I used a small sock and you can make it as small or as large as you want by the amount of rice you put inside. Mine ended up being the size of a golf ball which was small enough for Minnie to be okay with it. I also always placed it against the back of her ear so she couldn’t really see it. You nuke it for 20-30 seconds then hold it against the year. I always sang while I was doing that and testing and she was fine with it all. If it got too hot, she’d let me know by moving her ear away. I don’t know what I’d have done without the sock. Especially when I would test her outside on the deck in the winter. In fact, one time I misplaced it and couldn’t find it when it was time to test and I turned the house upside down like a mad woman looking for it. After that day, I made a backup one lol
 
Haha I can absolutely picture that :D

I think I’m getting away with it now because it’s super hot, but you’re right it probably won’t be enough come colder weather. We don’t currently have a microwave, but there’ll be one in the new house, so I will be getting on the sock train then. Think using a baby sock would work? Seems it would be perfect size wise.

I will try a 30 lancet tonight and see if it goes any better!
 
Virginie said:
Haha I can absolutely picture that :D

I think I’m getting away with it now because it’s super hot, but you’re right it probably won’t be enough come colder weather. We don’t currently have a microwave, but there’ll be one in the new house, so I will be getting on the sock train then. Think using a baby sock would work? Seems it would be perfect size wise.

I will try a 30 lancet tonight and see if it goes any better!
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I have great luck with the pill bottle. If you have a bottled water cooler it's perfect. I just use the hot tap on the water cooler and fill up the pill bottle about half way. The hot temp is just about perfect and the pill bottle has a nice smooth curve that fits snugly against the ear. If you don't have a water cooler might add a bit more prep time esp w/o a microwave.
 
AbbottTheCat said:
I have great luck with the pill bottle. If you have a bottled water cooler it's perfect. I just use the hot tap on the water cooler and fill up the pill bottle about half way. The hot temp is just about perfect and the pill bottle has a nice smooth curve that fits snugly against the ear. If you don't have a water cooler might add a bit more prep time esp w/o a microwave.
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Ohh thanks, that’s a good idea. I don’t have a water cooler but our tap water is really hot and I also have an electric kettle, so I’m sure I can figure out a happy medium temperature wise. I can test it on my wrist like for baby bottles to make sure it’s not too hot.
 
Virginie said:
Ohh thanks, that’s a good idea. I don’t have a water cooler but our tap water is really hot and I also have an electric kettle, so I’m sure I can figure out a happy medium temperature wise. I can test it on my wrist like for baby bottles to make sure it’s not too hot.
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Yep, I would love to use our tap water but it takes 3 or 4 minutes to get hot so it’s a no go for me :)
 
Suzanne & Darcy said:
You could get a Freestyle Libre sensor put on just for the move/trip. The Libre tends to read low in the lower numbers (greens) but it can be a good tool to monitor your sweet kitty.
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That’s not a bad idea… I wonder if it would stress her out more than anything else. She is pretty high on the freak out scale as it is.
Our plan for the move is two days of driving, one day of rest (we’re stopping at pet friendly hotel every night), two more days of driving, one day of rest, and finally one last day of driving to reach the new house.

The hardest part will be getting enough food into her on driving days - hopefully she will accept food when we stop for lunch. We will be packing a cooler with her usual raw, LC canned, and I will be sure to have Karo, dry food and higher carb food too just in case.
Would it be acceptable to only test preshot in AM and PM on driving days?
 
Sounds like a plan. We will have ice in the big cooler for the frozen stuff, but insulin should be kept separate, right? Cold but not frozen? I have a tiny cooler I could put a couple of ice packs in for that, shouldn’t be cold enough to freeze it.
 
For your reference, a document one of our members wrote on Travelling with Diabetic Kitties. I drove Neko to a specialized treatment in Colorado. It was three days on the road there and back, of about 9 hours each day. I was following TR at the time. As I did when we flew back to the same place. Also about 9 hours total time each way but only one day. I couldn't test her when she was in her carrier by my feet on the plane. But during the car trip I tested her at lunch or gas/pit stops for us. And made use of road side pull overs if I needed too cause her lunch test showed her dropping. I also used high carb wet food liberally to keep her safe between stops if she was getting too low for my comfort.

Both times I used a insulated lunch box, with a freezer gel pack, insulin cartridge (pen for you) wrapped in bubble wrap inside a plastic container so it didn't move and was away from the gel pack, inside the lunch box. You don't want it touching the ice packs. I also had enough room for other meds that needed to stay cold, and a part open can of cat food. When on the road, not the plane trip.
 
Thanks @Wendy&Neko for sharing your experience! It’s reassuring to know that it can be done. Even before we found out Chewie was diabetic, the plan was to offer the kitties access to food, water and a litter box on lunch break, and we made sure the longest days are not beyond 10h of driving. We are also hoping the two rest days at the hotel will allow them to rest, eat like usual and destress a bit before going back on the road. They did fine when I first moved from SoCal to Oregon but that was 7 years ago, they are no spring chickens anymore.
We will definitely be giving everyone gabapentin to minimize their stress, and will be using a big traveling “tent” instead of small plastic carriers. All in hope of making it easier on them!

Thanks also for explaining how to wrap the insulin, I was concerned about that - keeping it cold but not frozen and preventing it from being jostled. It will be an adventure for sure o_O
 
Neko had access to her litter box all the time, but only used it when we stopped. Some people set up a tent or playpen in the back of the vehicle, that gives room to sleep, and access to litter box and water. Depends on your vehicle size. I sprayed her carrier with Feliway and gave her some Rescue Remedy for Pets before we left. Neko didn't have to stay in her carrier, but preferred to.
 
I have a compact car and I think the kennel is going to take the entire backseat or a good third of the trunk if we flatten seats. Hoping it will be big enough for the four cats, might need to get an extra smaller one for Chewie. But there won’t be enough room to give them constant access to a box as we have to bring all food, meds, both our work computers, clothes for the week, etc.

Just ordered this
 
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