Help: Dosage Trouble!

Miriam Van Scott

Miriam Van Scott

Member Since 2020
Harriett was diagnosed May 14, 2020 and went on 2 units Lantus 2ce a day. Long story short, that was too much (according to home BG monitoring on a ReliOn Prime human meter, which my vet doesn't approve of.) Now she's on 1 unit 2ce daily, but I'm having the same problem she had on 2: she's missing every other shot because her BG is too low for insulin.

For example, she'll be at 285 at 7am so she gets her dose, then when she'd due for another shot at 7pm, her BG is only 67 so I don't give insulin. She got last night's shot, but today her morning BG was 120 so no insulin. The result is she's really only getting 1 unit every 36 hours or so. In between, her BG hasn't gone over 300 and hovers in the mid to high 200's during the day. She hasn't gone below 50 since resetting the dosage to 1 unit.

I'm hesitant to call the vet because he wants Harriett back on the Royal Canin dry (I transitioned her to wet food) and he said he thinks her 'ideal dosage' will increase to 4 units 2ce a day, which seems HUGE for a 7 lb cat! When she was on 2 units her BG would bounce from highs in the 400s to lows in the 40s, and I don't want to go back to that.

In between meals (she gets 3 a day, 1 can Sheba pate for breakfast, 1/2 for lunch, 1 for dinner) Harriett is STARVING!!!! She sits beside her food bowl literally all day mewing to be fed. Her body feels like a skeleton wrapped in fur. It's heartbreaking, but the vet also said she should be getting less food, not more, until she's regulated.

Help!!!! I don't know what to do about her 'missing' shots, the dosage, feedings, etc. ANY help would be greatly appreciated! Thanks!
 
Hello Miriam!
The aim is to give insulin every twelve hours, so what about starting with .5 units (1/2 unit) every time? Then if that's not enough, raise to .75 if or when appropriate. However, for anyone to be able to give you good feedback, they would need to see a spreadsheet for Harriet. That would help me too. Another option might be to reduce the dose to .75 now so you might get to quit skipping shots.
Have you read through the stickies at the top of the Lantus forum?
As BG regulates, your kitty should start gaining weight. I don't like the idea of the hard food with more carbs AND more insulin to match. Your goal is to get her regulated, then maybe off insulin by decreasing the dose back down.
I would feed her what she wants as long as its low carb - just don't feed within 2 hours of AMPS or PMPS.
Welcome - so glad you came to this place!
 
Thank you! I'm not a technical person and couldn't figure out how to do the spreadsheet, but I am keeping a log of all her shots, BG readings (including how long it's been since her last meal / last dose,) etc

I'll try dropping the dosage back a bit, hope she'll get back to every 12 hours!
 
Hi. Nobody can give you dosing advice without seeing a spreadsheet. If you need help there are people who can get one set up for you in just a few minutes. Just ask. We also need you to read the dosing methods to see which you will follow. Going down to 67 is safe but too low to shoot for a new diabetic. We would ask you to not feed and stall, don’t shoot , wait 20 minutes and test again to see if going up. On SLGS you would reduce. While again I can’t give dosing advice without a spreadsheet, in this case I would go down to .75 to see if you get preshot numbers you can shoot every cycle.

Until regulated she will be starving so she needs more food since she’s not overweight. I hope this helps.
 
Miriam Van Scott said:
Thank you! I'm not a technical person and couldn't figure out how to do the spreadsheet, but I am keeping a log of all her shots, BG readings (including how long it's been since her last meal / last dose,) etc

I'll try dropping the dosage back a bit, hope she'll get back to every 12 hours!
Click to expand...

I’ll tag someone who can help with the spreadsheet.
@Marje and Gracie
 
Thankfully we have some technical people around here. I was slow joining because I was intimidated by the SS. I spent about 4 hours getting all set up, but it helped a ton in the following months.
I'm back and forth a lot, but I want you to get all the assistance you need.
Hope you have a good day - Harriet is precious btw!
 
Yikes --- I just got an email from my vet saying I need to put her BACK on the Royal Canin dry food ( 1/2 cup per day spread over 3 meals), increase her dosage to 3 units 2ce a day, do this for 7 days then come in for another BG curve. When she was on the dry food her BG levels were a mess, and now at least she's semi-stabilized in the 200s. I'm afraid if I jump her back to 3 it's going to kill her. Plus I don't want to go back to dry and 1/2 cup a day is hardly anything.

Oh, he also said I'm 'not ready' to test her BG at home and it's 'dangerous' until she's regulated (by going back to the vet for weekly BG curves) and when I AM ready, I have to use the AlphaTrack meter.

I just feel like whatever I do, it's going to be wrong and Harriett is the one who's going to suffer for it.
 
Miriam Van Scott said:
Yikes --- I just got an email from my vet saying I need to put her BACK on the Royal Canin dry food ( 1/2 cup per day spread over 3 meals), increase her dosage to 3 units 2ce a day, do this for 7 days then come in for another BG curve. When she was on the dry food her BG levels were a mess, and now at least she's semi-stabilized in the 200s. I'm afraid if I jump her back to 3 it's going to kill her. Plus I don't want to go back to dry and 1/2 cup a day is hardly anything.

Oh, he also said I'm 'not ready' to test her BG at home and it's 'dangerous' until she's regulated (by going back to the vet for weekly BG curves) and when I AM ready, I have to use the AlphaTrack meter.

I just feel like whatever I do, it's going to be wrong and Harriett is the one who's going to suffer for it.
Click to expand...

This happens around here more than you can imagine. Any vet that says not to test does not understand FD or Lantus and is downright dangerous! I was afraid to test at first and was going to my vet a few times a week. I bought a meter though and brought it to his office and he convinced me to test! If you like this vet for other issues then keep him but otherwise I’d find a new vet ASAP.

Dry food does not work well to get cats into remission. Your vet just wants to make money. Sorry for being so blunt. The only curve my vet ever did was after the first shot of insulin. Testing at home and if necessary doing a curve at home is more accurate because the stress of being at the vet’s office is taken out of the equation. Once I started trusting the experienced people here and the protocol my vet managed Max’s other issues and I managed FD. He showed my spreadsheet to all his students! And he’s a board certified internist!

Get a spreadsheet started and read TR. It gives the best chance for remission in my opinion. OMG 3 units without testing is reckless and begging for a life threat hypo! We increase in .25 increments. Heck under 50 calls for action and shooting that without testing would make me find a new vet tomorrow and I’m not being dramatic. PLEASE don’t follow that advice and keep testing.
 
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Miriam, I'm sorry -- don't stress over my initial reaction!! Common sense does say 3 units BID is way too much insulin for Harriett. You are the best advocate for her and you can do the right thing for her. I started out with the AlphaTrack because I wanted those feline readings. However, the protocol here uses the human meter, and most people can give more precise advice if human meter readings are in your spreadsheet. Under 50 is low for the human meter and under 68 for the AT. The cost difference is huge - 5x more expensive in some cases for AT strips. However it is your choice!

Checking BG at home has saved numerous kitty's lives.

I had a rough start with my vet. I now see a partner of his, who is very open to my knowledge of FD. She takes care of Tina in many ways, but the diabetes part is all mine. She was very happy when Tina got OFF insulin! I've shared other feline health knowledge with her that I learned here on these forums. We have mutual respect and it's so helpful.

Take one step at a time and lets see what others think:bighug:
 
Yeah there's no way I'm giving her 3 units twice a day, OR putting her back on the Royal Canin dry food! She's doing so much better on wet pate and 1 unit per day, it makes no sense to reverse all that. And to limit her food intake to a dozen or so chunks of dry kibble 3 times a day seems downright cruel.

I'm going to email him explaining my treatment plan, why I think it's best, show the good results so far and let him know I'd like him to partner with me on getting Harriett healthy. We'll see what he says, but if it's anything other than "great idea - look forward to working with you!" I'm finding a new vet.

And in the meantime I'm going to give Harriett as much Sheba pate as she wants!

Thanks everyone
 
Welcome, Miriam.

I'm with Wendy. Ignore your vet.

First, as for dose. With a newly diagnosed cat on Lantus, the initial dose is based on the cat's ideal weight The formula is initial dose = ideal weight (in kilograms) x 0.25. For your 7 lb kitty, this works out to 0.75u.

If your vet continues to have hissy fits over what you're feeding Harriet, please suggest he read this website on feline nutrition. It's written by a vet who has put considerable time and effort learning about the nutritional needs of cats. The bottom line is that cats are obligate carnivores -- they do not need carbohydrates in their diet. These are the ingredients in the Royal Canin: Dehydrated poultry protein, barley, wheat gluten, maize gluten, soya protein isolate, tapioca, animal fats, hydrolysed animal proteins, vegetable fibres, chicory pulp, minerals, fish oil, psyllium husks and seeds, fructo-oligo-saccharides, soya oil, marigold extract (source of lutein). Sources of carbohydrates: barley, tapioca. Aside from the fact that these are not great ingredients, it includes no muscle meat. In addition, cats have a very limited thirst drive. In the wild, they get their moisture from prey. There is very little moisture in dry food. And to make matters even worse, the approximate carb content of the Royal Canin dry food is 31.8%. We recommend that a diabetic cats regular diet be no more than 10% carb and most people here feed their cat about 5% or so carb.

Given the above, you might ask your vet if he would consider feeding his diabetic infant cookies and ice cream. I bet not. With the amount of carbs in what he's suggesting you feed Harriet, the likelihood that she would go into remission is about zero. It's no wonder he thinks Harriet would need 4.0u of insulin given the amount of carbs. (Your vet needs to start doing some reading and stop listening to the cat food reps who come by the office.)

IMHO, the only way to keep your cat safe is to home test. Humans do not give themselves insulin unless they first test their blood glucose (BG). How else would you know if it's safe to give a shot? Some of the publications regarding Lantus advocate for home testing as a means of getting your cat regulated if not into remission. Other veterinary organizations also advocate for home testing regardless of the insulin being used. It is costly for you to keep bringing your cat to the vet's office for a curve. It's costly and unnecessary especially since many cats experience "vet stress" (as well as stress from the car ride) and their numbers are artificially high. The vet then increases the dose based on inflated numbers and you end up overdosing your cat. (How long has your vet been in practice? And when was the last time he did any continuing education on feline diabetes? How many cats has he gotten into remission?)

At this point, I would politely nod my head and smile and ignore the vet. He may be great for many other things but feline diabetes is not his strength.
 
Miriam Van Scott said:
Yeah there's no way I'm giving her 3 units twice a day, OR putting her back on the Royal Canin dry food! She's doing so much better on wet pate and 1 unit per day, it makes no sense to reverse all that. And to limit her food intake to a dozen or so chunks of dry kibble 3 times a day seems downright cruel.

I'm going to email him explaining my treatment plan, why I think it's best, show the good results so far and let him know I'd like him to partner with me on getting Harriett healthy. We'll see what he says, but if it's anything other than "great idea - look forward to working with you!" I'm finding a new vet.

And in the meantime I'm going to give Harriett as much Sheba pate as she wants!

Thanks everyone
Click to expand...
Good for you Miriam, I would definitely find a new vet, he sure sounds like he doesn't know what he's talking about.
Like a few people here said there are members here that would set up a spreadsheet for you and we can explain to you how to use it, it's very easy
I will tag two members who can set it up for you
@Marje and Gracie
@Chris & China (GA)
 
Miriam

If you read the instructions for the SS and need help, please send me a private message and I’m happy to do it. Click on my user name to the left and then “start a conversation”.

Welcome to L, B,L!
 
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