Dora! I am confused...

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Dora the Explorer

Dora the Explorer

Member Since 2020
Hi all,

Will try to be brief - I have been keeping up with the spreadsheet although we test sporadically.

Dora was on 1 unit 2x day for about a week when we got our first glucometer (OneTouch) and her level was 92 so vet said go to once per day. She said not to worry about testing as long as she acts fine (she does) for about a week. It's been a week now and we tested her a few times and her levels are fairly high. In the 2's and 3's. Today we got the AlphaTrack and used it because vet said that's better(have to do what she says for now, at least) and they're still high. I feel as if I should restart the second dose but can't get hold of the vet. She is one vet at a huge practice and I finally called back and a "triage vet" is supposed to be calling me back.

I wonder if the increase is because I have added back a couple of meals during the day, the vet said feed her twice but she wasn't eating enough. Could that be why the low level?

My urine test strips came today. I got the diastix and thought the ketones were trace until I realized I had to read them at 15 seconds and not 30. It is not easy to get urine from her, she doesn't favor the fake litter. I also got some pet strips and they're terrible! They make it look as if her urine is off on everything to the point where I don't even believe it. I also captured some for the vet but without that one who we see being there, they won't take it. She isn't back till Thursday.

What am I doing wrong? Does she need two doses? Am I feeding too much? She is eating fancy feast and weruva four times a day - low carb only. I do not leave food out. She gets a very small amount of dry with her shots, but it's high protein low carb tiki cat and we are phasing it out.

Thanks for reading. She is so young and otherwise healthy that this is somewhat overwhelming. I have sick pets but Dora always has to throw us a hook.

Jane
 
Sorry to be blunt but your Vet is wrong about home testing And Using lantus only once a day? From what Ive read here thats not going to work either. I wonder if you split that unit into half dose and gave the shot twice a day if that would work. SMH I just dont get vets who say testing is not necessary.

I'm no expert but even I know that testing is the only way you can keep your cat safe.
Lets see what others have to say ok?
 
Dora the Explorer said:
She only said not to test for the first week. I’m more concerned with right now and having her on the once a day dose. This is a new vet for me so hoping for some reassurance as opposed to negativity. I’m doing the best I can.
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I dont doubt that at all. I can tell you want whats best for Dora. Heck we all do. I've just read here that Lantus is a depot insulin it needs to be dosed twice a day or the depot depletes.

Like I said I'm NOT an expert. I was just repeating what Ive read.
I apologize if I came off like I was chiding you. It was not my intent. I know how hard this is. :(
jeanne
 
Hi and welcome. Lantus is a twice a day insulin for cats. Once a day leaves half the day with no insulin.
If you just monitor a cat by it’s looks for how the insulin is working you can run into enormous trouble. By the time a cat is showing hypo symptoms they will be dangerously low. If you are testing you can catch the lows before they become a problem and intervene with food or honey.

If the BGs are too low for you to shoot, instead of going to once a day, you reduce the dose and give it twice a day.

Test before every shot to see it is safe to give the insulin and then at least once during the cycle to see how low the dose is taking the cat.
Test/feed/shoot in that order.
Give a good meal before the shot and a few snacks during all cycles ( am and pm cycles)

I would reduce the dose to 0.5 and give it twice a day. That way you are giving the same dose but over the 24 hours. It is probably not enough insulin but we can start there.

with the Ketostix or Diastix does it say to read the result at 15 or 30 seconds?
 
Hi Jane,
There is a lot of information about using Lantus insulin in a cat, in our Lantus/Basaglar/Levemir ISG forum.
You'll want to read the "Sticky" or pinned posts at the top of that forum. Lot's of good information for you there.

Good luck with getting your new vet to call you back, and hope that happens really soon. Fingers and paws crossed for you and Dora.

Dora the Explorer said:
What am I doing wrong? Does she need two doses? Am I feeding too much? She is eating fancy feast and weruva four times a day - low carb only. I do not leave food out. She gets a very small amount of dry with her shots, but it's high protein low carb tiki cat and we are phasing it out.
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Yes, cats need 2 doses of any insulin in a 24 hour period. A cycle is 12 hours, so those 2 doses would be spaced 12 hours apart.

Many diabetic cats here get fed 4 meals a day. In fact, it's what we recommend, as smaller meals are less taxing on the pancreas. You didn't say how much food is included in each of those 4 meals. Or when during the 12 hour dosing cycle you are feeding Dora her meals.

A tiny bit of dry could be keeping Dora's BG numbers a bit higher. I see you say you are phasing out the dry. That will be good for Dora, and the extra water in the wet food helps a cat's kidneys to function better.

Any type of pure protein works for test and shot time treats. Freeze dried, fresh meat, a bit of cheese or egg if your cat likes something like that.

Often what can help with the insulin dose, is to split the dose in half, and give 1/2 the dose in the AM cycle and the other half of the dose in the PM cycle. Let's see if your new vet has the same idea.

With that BG level of 71 at +5 on 5/2/20, that would have "earned" Dora a 0.25U dose reduction, using our Lantus SLGS protocol. Tiny doses like that can be really hard to measure, so you do the best you can to be consistent, and "eyeball" the amount.
 
Thank you. I’m just seeing this, for some reason. We are having some glucose swings this week so maybe it is the feeding. Interestingly, she’s eating very little dry food. Do I have to feed the same flavor of food consistently, or the same brand? We are testing out fancy feast classics and Friskies pate. Searching for a flavor that works but also balancing feeding four other cats, one 16 year old with kidney disease, hyperthyroidism, and advanced liver cysts.

Dora is still on a very small dose but now twice a day. It was adjusted last week and she seemed to be heading in the right direction until last night and this morning. Was it the food? We will watch her closely and I’ll try to make sure she eats less in her snack. She has gained a half a pound and seems to be drinking way less now.

She eats just before her am and pm shots but also at lunchtime and bedtime. As I said, she eats dry but very little. I will switch up her testing treat to see if that will help. Thanks again!
 
Hi, Jane.

You've gotten some good information already. Let me see about adding to what the others have posted.

Like others have said, giving insulin once a day, regardless of the type of insulin, doesn't really work for cats. They have a fast metabolism so a shot is effective for generally 12-hours or less. If you're dosing only once a day, it would be no surprise to see a kitty's numbers soaring for half of the day. I would have advised the same thing the others suggested -- reduce the dose and shoot twice a day.

There's an explanation for the high numbers you're seeing. When a cat isn't used to spending time in numbers that are close (or closer) to normal, their system panics when numbers drop. When Dora's number dropped into the 100s, her lier and pancreas over reacted and dumped a stored form of glucose along with counter-regulatory hormones into her blood stream. This caused the spike into high numbers. We refer to this as a "bounce." It's temporary -- bounces generally last no more than 3 days. It's also normal, albeit quite annoying for us. It's actually a protective mechanism that can help to prevent hypoglycemia.

I'd also encourage you to get at least a "before bed" test every evening. Lantus dosing is based on the lowest number in the cycle (aka the "nadir"). If you don't test at night, you're missing half of your data. Perhaps even more importantly, you have no idea how low Dora's numbers are going and whether she needs her dose reduced. Many cats experience lower numbers at night so it's important data to have.
 
Thank you! And I’m sorry if I failed to make this clear: after my original post I spoke to the vet and we have been doing a half a unit 2x/day ever since. I’ve mostly kept the spreadsheet up to date. Well, I have kept it up to date but we try to minimize the ear pricks so we continue to be allowed to do it. So the dosing is consistent unless I’m doing something wrong; but yesterday morning’s dose clearly worked or the level wouldn’t have gone down. Hoping to see a change today and I plan to make her “lunch” much smaller with zero dry-I will see what happens I guess. Meanwhile, to look at her you’d think she was perfectly fine.
 
Just an FYI -- you can test as much as you want. It's not up to your vet. I'm saying this with the caveat that I was a testaholic. You can look at Gabby's SS. I had a difficult to manage diabetic who's numbers could drop like a rock. I would smile at my vet every time she'd say I tested too much. And then I'd point to a day when Gabby's numbers dropped and asked what she would do. I had a very good understanding with my vet!!!

Also, please understand that you may be giving the same dose. It doesn't mean the numbers will react the same every time. Insulin is a hormone and it is utilized in a different way than an antibiotic, for example. Do not become complacent or you'll get a nasty and potentially dangerous surprise.
 
Oh, I understand about the testing. I’m trying to find a balance with Dora. It’s a miracle she’s being as good as she is about it and I don’t want to press our luck. She’s only been on this dose for less than a week and her numbers looked good until yesterday so I don’t think I’m being complacent- also my vet had a diabetic cat herself so I’m hoping she’s even more understanding.

I’ll add in a test for Dora at bedtime too. Do you think her dose is not high enough? I didn’t understand what you meant by complacent.

Thank you again for sharing your experience!
 
Some examples of complacency in this case would be thinking that Dora will always be high in the middle of the cycle, when her pre-shot tests are high.

Complacency could be thinking that her PM BG levels don't drop her really low, close to hypoglycemia.
Complacency could be thinking that one 12 hour dosing cycle, one day will be the same as another 12 hour dosing cycle another day or even another time in the same day.

Or that the nadir time always stays the same.

Complacency could be thinking Dora's numbers at pre-shot are high enough that you won't have to test her later in the cycle.

From 409 to 103 is over a 300 point drop. If Dora kept dropping, you would have needed to intervene with food, to bring those numbers back up. Or even make an emergency visit to a 24 hour vet, for a glucose drip and other intervention.

Complacency is switching from dry to wet food, and not realizing the BG levels can drop quite dramatically.

Have you read the "Sticky" or pinned posts over in the Lantus ISG group? Good place to start to learn more about what could happen and how to use our dosing protocols.
 
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