Hello FDMB - newly diagnosed, have questions...

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spj

Member Since 2014
Hello FDMB community - I’m so thankful to have landed on this site after looking through SO MUCH on the internet.

Our 13 year old male cat, Todd, was just diagnosed with diabetes this past Thrs, 11/20/14. More facts about him below. But here are my two BIGGEST questions...

1) I am uncomfortable with the Lantus dose of 3 units BID - I don’t know what his ideal weight is, but the dose seems to be too high? (We also work during the day - so I don’t want the chance of him being here in between doses and not doing well on too high a dose.)
2) Should I start him on 1.5 or 2 units Lantus instead of 3? (We are getting ready to switch him over to an all wet food/low carb diet immediately and are purchasing a glucometer.)

Here is Todd's basic info:

Male/domestic breed/about 13 years (we think - he was a stray)/16.4lbs (7.44kgs) - he was not always this heavy/diet was dry food twice a day and wet whiskas pouch at night/fasting BG at vet today pre-treatment was 354./No ketones in urine/Blood tests 1.5 years ago were normal/symptoms were drinking more water/peeing/Todd has put on A LOT of weight in the last year.

Anyhow...I know my questions are asked of the FDMB ALL THE TIME, but we have to take action soon and I have been reading SO much and I need a little bit of confidence as we move forward. If there are past threads that will help, please send them to me! My specific questions are below...

While my first two questions are the most time sensitive, I also have two other questions if anyone wants to answer -

3) If the dose needs to be adjusted, can I very carefully do that myself? Whether I’m adjusting up or down?
4) What numbers am I shooting for while he’s taking the insulin?

Any input is GREATLY appreciated!!! Thank you!!!!! PJ
 
Welcome to FDMB.

Food switches before starting insulin are safer as the glucose level can drop by 100 mg/dL doing that. If he isn't showing any ketones, you might do the food change first (please check with your vet if uncertain: ketones are dangerous.) Cat Info has our food list "bible" here. Foods with less than 10% calories from carbohydrate are good for regular feeding. High carb foods with gravy may be kept on hand for managing low numbers. Any food switches should be done about 20-25% per day to avoid diarrhea, vomiting, or refusal to eat. There are a number of over the counter options which may work for you, including Friskies pates, Fancy Feast Classic pates, and more.

Vet stress may raise the glucose from 100 to 180 mg/dL. Adding that to the food contribution suggests that a diet change to low carb plus home testing might drop the glucose considerably. I suspect that starting with a lower dose than 3 units might be prudent. You can discuss with your vet your concerns about hypoglycemia and not being home to intervene, so wanting to start with a lower dose.

You can test using a human glucometer such as the WalMart ReliOn Confirm or Confirm Micro, the branded versions of the Arkray Glucocard 01 and 01 Mini available from ADW (go through our Shop Link above and it helps support this board). You compare those numbers to the reference values for your insulin protocol. There are 2 for Lantus - Start Low, Go Slow, and Tight Regulation. My signature link Glucometer Notes explains more about the references and what the numbers may mean.

Lantus starting dose calculation:
What is his weight now?
What should his weight be?
Take the lower weight.
Convert to kilograms (pounds/2.2)
Multiply by 0.25
Round down to nearest 0.25
This often comes to about 1 unit or so.
 
Welcome spj and Todd,

1) Yes, I think the 3u is high! The saying here is, start low and go slow. I don't want to advise since I'm still a newbie.

Also, switching Todd's food and starting insulin is a lot all at the same time.

This is how I did it when first started taking care of Hank. I started him on the insulin and in the mean time I started learning how to home test him. There are some great videos on YouTube but just warning you, they make it look easy. It's not hard just a little time, patience and practice. We can help you. Then when you get testing down, than go ahead and switch to wet food.

The reason is that going from a high carb food to a low carb wet food will lower his BG numbers and by not testing would put him in danger of going too low.

2) I shouldn't' dose. Purchasing a meter is good. Most people here get the Wal-Mart religion confirm or micro.

3) Yes, you can adjust yourself with help. On the main board is support groups. For Lantus there are two; tight regulations and relaxed. Big help! I highly recommend joining one.

4) On a human meter, normal for a cat is 50-120. Don't worry, it takes sometimes a little time to get there. If ever your pre shot number is 200 or below, you skip the shot. This is because you don't want to risk kitty going into hypo ( low). After 14 skipped injections, a sugar kitty is considered in remission or OTJ (off the juice).

I hope I answered your questions, basically. In the morning I'm sure more will chime in with more for you.

Kimmie
 
Using the 7.44 Kg, and the formula, I come up with 1.5 units to start.

Start on a day and at a time you'll be home to monitor. Have on hand, just in case the dose turns out to be high, some high carb canned food with gravy and some Karo syrup/honey/molasses, etc. When we test and get a number below 50 mg/dL, we intervene by giving 2 teaspoons of gravy, waiting 20-30 minutes, re-testing, and if still low, repeating the process.

Always test before you inject ("shoot"). Starting out, do not give a shot if under 200 mg/dL. As you collect test data in the +5 to +7 hours after a shot to see how low he goes (aka the nadir), you will be able to carefully adjust the dose and shoot at lower numbers.

Lantus is a depot insulin. This means the duration of effect overlaps a bit from shot to shot. Because of this, it can take 5 to 7 days on the initial dose, then 3 to 5 days on any later dose aadjustments, to determine how well that dose is working. The dose is adjusted based on how low the glucose goes, not on how high the pre-shot tests are.
 
Thank you BJM and Kimmied for responding! Before realizing you both had responded, we gave him 1 unit this morning at 7:30 a.m. It's the first dose of insulin he's ever had. We're planning on getting the glucometer today. Now I'm wishing I had waited to give the 1st dose until after seeing if wet food alone would do it...

question: Because we've given 1 unit, is it too late to try him on a wet food diet this week and see what his numbers are, and then start dosing from there? Or do I need to give the other 1 unit tonight bc I gave one this morning? So sorry - we are so new to this and I just really want to proceed with caution, but do what's best for him. I'm NOT opposed to using the insulin he NEEDS once we know what he needs. We'll do what we need to do for our boy - but I'm praying it can be handled with diet or just a little insulin/diet. Thank you!!! PJ
 
Once again, thanks for responding. My info/question from this morning is above. I'm so frustrated with myself for not logging onto the site to see any responses before doing his first dose. I knew if we were going to do the insulin we had to get him on a 7:30am/7:30 p.m. schedule before work starts tomorrow. And we have more freedom to be home at different times today.

I really am looking forward to what you have to say about him taking his first dose ever and then stopping... Thank you thank you thank you!!!!!!!
 
Hi Todd,

I I were you, if you want, I'd go ahead and give the one unit. That should be a safe dose, especially considering that, in most cats, it takes a few cycles to build up the depot of insulin. You can skip until you try the food, but if he needs insulin and his levels are high, waiting is not ideal. (did the vet give you any ideas about his levels?)

And then get the glucometer and 25-27 gauge lancets, look at the videos, warm his early thoroughly and try for a test. Once you can test for his levels, you can see right away what effect a diet change and the insulin is having and adjust accordingly.
 
No worries.

Giving 1 unit of Lantus with a food change can work. You just want to keep an eye on him to see how he handles it. Because of the build up effect, any issues are likely to arise as each day builds up the depot. So today, nothing may happen. Each successive day increases the chance he could go low, so you home test to monitor him, in that +5 to +7 hour range.

You'll want to read over and print out How to Handle a Hypo, so you know what to watch for and how to intervene. Get together your hypo kit - Karo, high carb gravied food, oral syringe, directions to the nearest vet ER - just like you have a first aid kit for your home. You hope you'll never need it; if you do, you're prepared.
 
Hi and welcome to the forum :-)

My cat is 12lb and my vet told me to give 2u once a day initially then wanted me to double it to 2u twice a day. (Firstly the vet had me change to a wet food diet for three weeks before we started on insulin so the advice not to do both at the same time is wise) I blindly went ahead and did what the vet said and gave 2u as I thought the vet had to have it right. However, 6 weeks later, my kitty was still having major high numbers and dropping fast to low numbers so I decided to listen to the forum for a ten day trial and see what transpired. Five days in, Silver's numbers are lower than they have ever been, he's perky and playing again like a kitten and I think had I remained at 2u I may not have him with me anymore.

When you're ready - I would pop over to the Relaxed Lantus group - moderator is MommaofMuse (Mel) and she can help you with dosing advice. The start low, go slow protocol has been working well for my cat and might work well for you too as I also work full time and cant be home to monitor all day as those in the Tight Regulation forum can.

viewtopic.php?f=32&t=61794


http://www.felinediabetes.com/start-low-go-slow.htm

Juliet and Silver
 
Thank you to EVERYONE, I feel so much better. I think we'll do the 1 unit, wet food, home testing, and go from there. I feel so much better today than I did yesterday - all of your advice is just invaluable! I would've just felt like I was guessing and trying to balance out what the vet was saying vs. all the research on my own. I'm sure I'll have more questions in the future, but for now I feel good about moving forward. Happy Thanksgiving! PJ
 
You can do this! So nice to see another person willing to do anything to make their kitty better. :)

The folks here give good advice... not just good advice but conservative advice. It's up to you to make the call as to what food and insulin you give him, but I haven't gone wrong listening to these fine folks yet. :) My two cents is to pay attention to Todd's behavior, he'll let you know if he's feeling better or worse. Also home testing is a very good idea, especially as you modify his diet.

Good luck and stay in touch!!!

Lor
 
Hello, team. Okay - gave Todd his second ever dose (1 unit) of Lantus tonight 12 hours from the first dose. At 7:40 p.m. At 10:10 p.m. we tested him with the glucometer for the first time ever and got a reading of 155. I realize that this is not nadir... I'm just really confused now with all of these charts. What is NORMAL for him??? AND - should we retest in a.m. before giving him more Lantus? These are his first doses ever, I see that Lantus builds up over time, and his number doesn't seem all that high on the first day? Am I totally off track here? What should my next steps be? I just don't want to overmedicate him. Thank you!!!!
 
Hi,
This might help you - it sure helped me. Its a good guide.

Always test before you shoot - test, feed then shoot.

http://petdiabetes.wikia.com/wiki/Blood ... guidelines

If you want your 911 to be seen, you need to edit your first post to add the 911 and then add a new comment at the bottom. I only saw your 911 by accident as I was coming in to check on you.

Juliet and Silver
 
Congrats on your first test and welcome to the Vampire club! 155 is a nice safe number. We generally say a cat is regulated if they are in the mid 200s at preshot and in double digits at nadir ( but not below 40 which is hypo territory). We suggest that new diabetics not shoot a preshot under 200 unless they have enough data to know how their cat would react. Now that you are testing, you'll be able to get data and start to figure out how best to get him regulated.
 
Thank you, Juliet! Your post was very helpful. I'm nervous about continuing to give him the Lantus, so I will definitely retest in the morning. I will now repost my last message using your advice. PJ
 
All of this is so helpful. THANK YOU!!!!! Okay - so we will retest in the morning first thing before doing his morning dose. The syringes I have make it hard to see anything below 1 unit (sorry - don't know the lingo for that yet), so I think I'm going to need different syringes for him if he goes below 1 unit?

If he's under 200 at morning dose, do I just skip the shot???? And then retest before he would normally get a second dose tomorrow evening? I will be at work all day tomorrow, so it makes me nervous. Sorry for all the questions - but I know that by doing this right in the beginning it's better in the long run. Thanks, everyone! PJ and Todd
 
I have a different perspective.

Lets see. 10:10 pm to 7:40 pm is 2.5 hours. To be 155 at +2.5 hours after the shot may be a bit low for just the 2nd shot of Lantus.

Just in case, have you got Karo syrup/honey/molasses or high carb gravy on hand? You might want to stay up and test him a few more times until +7 hours after the shot (2:20 AM) or until he is steadily rising. Fix yourself a pot of coffee/tea/cola with caffeine, because it could wind up a long night.


You may not need the following:
Here is the basic strategy for managing low numbers, should he get down below 50 mg/dL:
Feed 1-2 teaspoons of high carb food (this wears off fast)
Wait 20-30 minutes
Re-test
Repeat the process if below 50 mg/dL

He needs to be past the Lantus nadir, which happens +5 to +7 hours after the shot.
His glucose needs to be rising for 3 tests in a row
He needs to be in safe numbers - over 50 mg/dL
 
BJM, thank you SO much - I am really glad we didn't give up on trying to get blood from his ear tonight or we would've had no idea. I'm pretty sure we have both honey and karo syrup on hand. I'm going to pull them out of the cabinet now. Would it be helpful to give him food now or should we just wait until morning as planned as long as he doesn't go too low? Thank you!!!!!
 
Yes, if he's hungry, I'd feed him some more food.

Also, I would test him before you go to bed, to see if he is still dropping. If he is below 100 mg/dL and it isn't past +7 hours since the shot, you may want to intervene with even more food.

He might be OK. And, he might NOT be OK. No crystal balls here, I'm afraid. I just wouldn't want you to find him unresponsive in the morning. If you stay up a bit and check him, you may see he'll be fine or you'll have the opportunity to intervene.

Or, if you absolutely need to crash, put out the high carb food and let him eat what he wants to. That'll probably give you whopping high numbers in the morning, but he will be safe.
 
BJM can you post the instructions for setting up a SS. I can't find the link. spj this is a good thing to have set up so that when people are giving advice they know the data. Click on Silver's SS in my signature to get an idea as to what I mean.
 
Okay - we are headed to bed and I just tested him again at 11:52 p.m. He is 133. We are giving him some food now and will test again at 2:30 a.m. If this doesn't sound right, please let me know! He cannot STAND to be touched in certain ways, so blood testing him is a bear :) Thank you again for the information and encouragement! PJ
 
Let's get you started using our grid to record your glucose tests. It will help us give you better feedback.

Instructions are here.

Understanding the spreadsheet/grid:

The colored headings at the top are the ranges of glucose values. They are color-coded to clue you in as to meaning.

Each day is 1 row. Each column stores different data for the day.

From left to right, you enter
the Date in the first column
the AMPS (morning pre-shot test) in the 2nd column
the Units given (turquoise column)

Then, there are 11 columns labeled +1 through +11
If you test at +5 (5 hours after the shot), you enter the test number in the +5 column
If you test at +7 (7 hours after the shot), you enter the test number in the +7 column
and so on.

Halfway across the page is the column for PMPS (evening pre-shot)
To the right is another turquoise column for Units given at the evening shot.

There is second set of columns labeled +1 through +11
If you snag a before bed test at +3, you enter the test number in the +3 column.

We separate day and night numbers like that because many cats go lower at night.

It is merely a grid for storing the info; no math required.
 
Lantus hits its nadir - lowest glucose post-shot - usually between +5 to +7 hours after the shot. The nadir can vary from day to day. Based on when you said you shot, that period is betwen 12:30 am Nd 2:20 am.

With the 133, he is still dropping but not as fast. Putting out food for him should let him eat if he needs to do so. He may be OK overnight. If you are concerned, perhaps each of you might take turns checing him through the nadir - maybe a 12:30, 1:30, and 2:30 or until you see him rising, whichever comes first.

And by rising, a test needs to be more than 20% higher than the lowest test value. That's because the FDA allows meters to read within 20% of what a lab might get. Every test you get could actually represent a number 20% higher or lower.
 
Okay FDMB friends, here's where we are today...

2nd dose of 1 unit Lantus at 7:40 p.m. last night - then,

155 @ 10:10 p.m.
133 @ 11:52 p.m. (gave him a whiskas wet pouch)
203 @ 2:41 a.m.
169 @ 7:40 a.m. (ish)

Didn't give him the 1 unit morning dose bc he was only 169 and we had to go to work. I'm going to carefully read through all of your posts again and put together a plan - but did I do the right thing here? I didn't have a smaller unit syringe to do anything less than 1 unit and I knew no one would be home today. Thanks! PJ and Todd
 
Just a note here on syringes. I hate sounding like a Walmart advertisement but you can get syringes with 1/2 unit markings. I don't know if you need a prescription for them in your state or not (in Ohio we don't). I get the ReliOn 3/10mL cc 31 guage 8 mm length. These are compatible with Lantus insulin. They were about $13 for 100.

Anita and Squeaker
 
Thank you, Anita. Yes - I needed to know this. I'm so new to this that I haven't even learned all the places/websites where you can buy syringes, and just learned that I needed a different type. We got his Relion glucometer from Walmart last night. PJ and Todd
 
spj said:
Okay FDMB friends, here's where we are today...

2nd dose of 1 unit Lantus at 7:40 p.m. last night - then,

155 @ 10:10 p.m.
133 @ 11:52 p.m. (gave him a whiskas wet pouch)
203 @ 2:41 a.m.
169 @ 7:40 a.m. (ish)

Didn't give him the 1 unit morning dose bc he was only 169 and we had to go to work. I'm going to carefully read through all of your posts again and put together a plan - but did I do the right thing here? I didn't have a smaller unit syringe to do anything less than 1 unit and I knew no one would be home today. Thanks! PJ and Todd
Click to expand...

Yes, absolutely you did the right thing by skipping the dose this morning. ECID Every Cat Is Different. ECID Every Caregiver Is Different. We all have different life responsibilities and need to find the best way to help us manage our own cats.

If you had told me your cat had DKA or was prone to ketones or wasn't eating enough and had an infection, my answer would have been totally different. There are cases when you do need to give a dose of insulin to keep your cat safe in different situations.

Basically, you have 3 options.
1. Give the full dose.
2. Give a token dose.
3. Skip the dose.

As you gain more test data, you will know how low your cat goes, how your cat is reacting to the insulin. It gets easier to pick between those 3 options as you have more "clues" to support your decision. Remember, you are the one that holds the needle and knows your situation better than we ever can.

Don't be surprised if your kitty has really high BG readings this evening. That happens often when the dose is skipped.

p.s. I think you are going to want to drop that Lantus dose down. You are already getting some nice blue numbers and this is only the second shot. The insulin depot takes 5-7 days to build up and show the full effects of a particular dose.

Have you read some of the Stickies over in the Insulin Support Group, Lantus Tight Regulation? Some good articles there, including one on the insulin depot.
 
We reference our tests based on how long it has been since the shot. This is because the interpretation of what the number means depends on how long it has been since the shot. For example, 50 mg/dL is a good number for a nadir (lowest glucose between shots); it is a number that is likely too low for giving insulin.

amps = morning pre-shot (am for morning; ps for pre-shot)
pmps = evening pre-shot (pm for morning; ps for pre-shot)
+2 = any test 2 hours after the shot
+5 = any test 5 hours after the shot
And so on.
 
This is all so very, very helpful. Thank you. I'm going to get better marked syringes, test him before administering a dose tonight, and then probably lessen the dose based on what I find. I will probably have more questions later. You've all been so helpful through every step of this. PJ and Todd
 
WalMart carries U-100, 3/10 mL, 30 or 31 gauge, short or long needle syringes with half unit markings. I prefer short needle as I have stabbed myself or shot through the tent with the long ones. I prefer the 30 gauge as they are a hair less easy to bend. Your preferences may differ.

Lantus doses are adjusted based on the nadir and the nadir is often between +5 to +7 hours after the shot (each cat is different!). If you get a number below 50 mg/dL on a human glucometer, it is an automatic dose reduction of 0.25 units when following the Tight Regulation. We eyeball 0.25 and 0.75 unit increments.

Ask whatever you need to know.
 
BJM said:
If you get a number below 50 mg/dL on a human glucometer, it is an automatic dose reduction of 0.25 units. We eyeball 0.25 and 0.75 unit increments.
Click to expand...

That depends what protocol she is going to follow. Correct for Tight Regulation if you are home and can monitor frequently as TR requires. If like me, you cannot monitor that frequently and decide to follow the Start Low, Go Slow protocol, then you reduce dose by 0.5 once the cat hits 90.

viewtopic.php?f=32&t=61794

Juliet and Silver
 
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