Diabetic Foster Cat--Starting Lev Dose Advice

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missyandlittlegray

missyandlittlegray

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Yesterday's post: viewtopic.php?f=28&t=36159&p=380222#p380222

Our sweet and beautiful Alex Olivia saw the vet today, and I'm posting her test results below. But we'd like advice on her starting dose of Lev. She was 485 at the vet's office and 307 when I tested her about an hour later at our shelter. Our cats are not in cages, and she had a really good time at the shelter. She purred nonstop, even when I was poking her ear. She's back in her foster home now with her lifelong friend Donovan. Although I haven't met him, I understand he's as purry and sweet as she is.

Here are her test results.
GLU 485
BUN 47
CREA 2.4
PHOS 6.1
CA 10.7
TP 8.3
ALB 3.0
GLOB 5.2
ALT 66
ALKP 44
TBIL 0.1
CHOL 113
AMYL 734
Na 160
K 6.3(? - hard to read)
Cl 124


She's eating Wellness CORE wet food and no dry.
 
Re: Diabetic Foster Cat--Starting Dose Advice

I don't use your insulin, so can't help with dose. Maybe if you put Lev in your subject you'll get some Lev users?
 
Missy, just so I understand..this kitty is not with you..right? she's with a foster mom?
in anycase if this is her first go round on insulin, meaning she has no history with other insulins, it would be a safe bet to start at 1u and test. this is a long and slow acting insulin so results may not become apparent for 4-8 hours or so.
 
ok, just read thru prior post. i still think with the high #'s and taking into consideration that 1u is ok.
that being said, it will likely change as the uti goes away. a daily round of 3 tests +4 +6 +8 and at least a +6 at night to see when and if things start to change.
i would say it's a safe bet this kitty is diabetic becuase to the best of my knowledge a non diabetic kitty would not be in the 400's because of a uti.
 
Yes, the cat is with a foster, and she's freaking out. She has absolutely no experience with feline diabetes at all. We just moved our shelter to a new location, and I brought two cats from the old shelter here. I don't know what I was thinking! Sizzle and Luna are so happy to finally be in their forever home, the thought of taking them to our new shelter just breaks my heart. But the diabetic and her buddy should be here with me, not Holly. That's not fair to her. Wish I could find another foster home for them...
 
If this is Alex Olivia's first experience with insulin, then you can use the guidelines in the Tight Regulation Protocol for Lantus and Lev (aka the Tilly Protocol). The protocol suggests a weight based formula for initial dose

initial dose = 0.25 x ideal weight in kilograms​

Unless your kitty is petite or huge, the dose is usually in the neighborhood of 1.0u.
 
She's petite. So you're saying 1 unit instead of 0.05? The vet told Holly to give her six units twice a day! We decided we didn't want to do that.
 
missy as long as she is comfortable testing...if she's not the type to do a few night time tests let her start at .5u.
better than nothing. i mean you know what her limits are and how much she cares for the kitty.
 
and HELL to the NO on 6u's
my vet suggested 3.5 u's starting dose on tom...umm, not so much.
they just don't get it missy.
 
Jen & Squeak said:
The vet wanted 6 units as a starting dose??? OMG, do they have any other vet options?
Click to expand...
We used the vet to confirm the diagnosis and do a full blood panel. We figured we'd come here for the rest of the help we needed. :)
 
From looking at the numbers without the normal ranges there, it looks like the BUN, creatinine, phosphorus, and calcium ratios are outside of the normal limits. Can you confirm this? Also, did the vet suggest any course of action to help the kidney values?

I also agree that a 1u starting dose with lots of hometesting sounds like a good plan.
 
No, the vet didn't suggest doing anything for her kidneys. :( He's not a great vet but he's very inexpensive for rescues. We were planning on getting the blood panel done there and coming here for help with the diabetes. Are you suggesting that she should see a better vet?
 
hi, this is the foster, finally made it on here.....
actually, the vet was suggesting 3U from a 40U concentration, he said he doesn't use the 100U concentration b/c it's such a tiny amount to draw up....
anyhoo, I use him for his cheap rates - we have a foster file with him.......I get the test results and do my own research (this is the first time for diabetes though).

I had a kitty with the very beginnings of kidney disease and my holistic vet suggested a small pinch of aluminum hydroxide into her wet food 2x per day....she passed about a year later (of other issues, not kidney-related) but I had blood draws 1-2 more times during that year and her numbers remained stable. does anyone have experience with using that? and would it be safe to give Alex Olivia along with the insulin?
 
Hi Holly, good to see you here.
Did you get a test this evening?
How are you and the 2 darlings doing?
 
3u is too high of a starting dose in my opinion. If there are no ketones present, then I would recommend starting with 1u twice a day. The aluminum hydroxide on the food sounds like a phosphorus binder to me, but it does not help the BUN or creatinine levels. There is a supplement called azodyl that helps eat up these byproducts so the kidneys don't have to filter them out. Another option will eventually be giving fluids, but I am not sure if the levels are high enough to warrant this right now. What I would definitely do is start adding extra water to the wet food you are giving to help the kidneys flush things. Maybe others here can offer more info on treating the kidneys.

Did your vet dilute the Levemir to a U40 concentration? This insulin is only produced in a U100 concentration and due to stability reasons, should not be diluted.
 
I think Holly might have gone to bed. I believe Alex was down to 136 tonight on 0.05 units. The vet didn't dilute the insulin. I gave Holly two new pens of Lev leftover from my GA foster, Kitty.
 
missyandlittlegray said:
I think Holly might have gone to bed. I believe Alex was down to 136 tonight on 0.05 units. The vet didn't dilute the insulin. I gave Holly two new pens of Lev leftover from my GA foster, Kitty.
Click to expand...

Do you mean half of 1U? .05 means 5 100ths of a unit! Half of 1U would be written .5U.

And although I know it's in the Tilly protocol, insulin should not be dosed by weight. The formula in Tilly for starting dose is supposed to be based on "ideal weight" also, which for some body types is hard to determine.

The reason we recommend a low starting dose of no more than 1U unless there are complications such as a concurrent infection, is that unless you begin at a dose lower than what their optimum dose is, you could easily surpass it because you have very little room to increase the dose.

If .5U was given and she achieved a 136 between 6 to 10 hours after the shot, I am glad you started with only half of 1U!

Please disregard the idea of making it a U40 insulin. Levemir is U100 and that is that. Tinkering with a good thing is not a good idea. And please do not use U40 syringes with Levemir. Yikes.

Does she have ketone strips and know how to use them? Always a good idea to test urine on newly diagnosed cats often for ketones. Often means more than once or twice a week. Ketones can develop quickly.
 
Yes, I meant 1/2 unit. Sorry... Many years ago, a vet nearly killed my diabetic cat by diluting PZI insulin. It wasn't until I came here and the board nearly had a collective stroke that I discovered why my cat was never regulated and kept getting sicker instead of better. I learned my lesson (find a new vet!), and I would never use tinkered with insulin again. I'm surprised this vet dilutes insulin. I thought vets had stopped doing that.
 
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