HELP - Lantus injection after a cat throws up?

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rosannaf

rosannaf

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Hi everyone:

I would like to ask for some advice. Can I still give a Lantus injection after my cat has possibly thrown up a bit?

A little history:
My cat Nala, 11 years old, was diagnosed with diabetes this week after I noticed signs of polyuria and polydipsia. The vet did a blood test and her glucose levels were 400+. Needless to say, I am extremely scared about this.

Per the vet’s recommendation, I am changing her diet from dry food to wet Purina DM. I feed her ½ a 5.5oz can in the morning and the other ½ in the evening. The lucky part is that she loves the food. I started her Lantus on Thursday. I’m doing 2 units in the PM after she has eaten at least 75% of her dinner, and 1 unit in the AM after her breakfast. Because I’m away for work almost 8 hours a day, I didn’t feel comfortable putting her on 2 units in the AM which the vet had recommended but we agreed to just go slow first. The vet also recommended that I leave some dry food out for now in case she goes hypoglycemic. Her diet before was Nutro Max Cat Weight Control Adult food (I know, I feel terrible after I researched it), and I recently bought a new bag of dry Wellness Core grain-free. The vet advised me not to make so many changes, so I’m still using the Nutro Max and will be incorporating the dry Wellness Core slowly after a week of her on Lantus.

Nala has been doing quite well. I gave her an injection this morning at 7:50AM of 1 unit of Lantus. I came back home right now (6:00PM), and noticed a cat threw up. The problem is that I have three cats and I don’t know which one threw up. Whoever threw up didn’t throw up a lot (more liquid than chunks). Before I left the house this morning, I did notice that Nala had some minor diarrhea. I called the emergency vet and the nurse recommended that if Nala eats her dinner of Purina DM, I can give her the 2 units of Lantus still.

Nala is not showing any signs of being hypoglycemic but I’m nervous. I do not have a glucose meter. Should I follow the nurse’s advice?

Help is much appreciated,

Rosanna
 

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1- Lantus works better with even dosing -- so i would give 1u morning and night -- always time to increase later

2- Getting a tester will give you peace of mind. Request a newbie kit. Many of us donate to the Newbie kit supplies, which Lori organizes and mails out when requested. This is especially for people and cats new to diabetes to help you get started out on the right foot.

3- tonight -- since the throwup was mostly liquid -- it is PROBABLY ok to inject -- preferably 1u not 2u for beginning - but the only way to know for sure is to test the blood sugar.

If your kitty is happy to eat tonight, it should be ok to inject. If your kitty is acting sick and doesn't want to eat -- no shot.

Many here use the Walmart Relion meter - it is inexpensive and reliable, and got great marks in Consumers Reports a couple years ago.

Not to mislead -- I treated my first diabetic cat for over a year before I found this site and learned about home testing and low carb food. So I gave a lot of shots without knowing Norton's blood sugar --- we were playing with fire, but we were lucky that nothing serious happened.

Now I do test before every shot.
 
Dear Rosanna, and, of course, you too, sweet Nala,

rosannaf said:
I would like to ask for some advice. Can I still give a Lantus injection after my cat has possibly thrown up a bit?
Click to expand...
Nikki threw I think quite possibly the world's biggest hairball tonight (about an hour before her shot). And, followed it by moving over perhaps a foot and a half for a couple of after splats. Forgive my graphic-ness... It was beyond gross. I knew it was safe to give her insulin (she's on 2.25 units of Levemir -- similar to Lantus) because I home test. Her BG (blood glucose) was 301 (high for her probably because of the humongous hairball...). I also know Nikki.


rosannaf said:
Needless to say, I am extremely scared about this.
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It's okay to be extremely scared, dear Rosanna. We'd probably be worried if you weren't. Personally? I was an emotional train wreck when Gizzie was diagnosed at age 14, yet somehow we managed to dance for four more years. I was much calmer when Nikki decided to rescue me (for the most part)...



rosannaf said:
Per the vet’s recommendation, I am changing her diet from dry food to wet Purina DM. I feed her ½ a 5.5oz can in the morning and the other ½ in the evening. The lucky part is that she loves the food.
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It doesn't have to be DM canned food. It could be any low carb/high protein canned food -- Fancy Feast, Friskies, Wellness, etc. etc. Here are links to Janet and Binky Famous Food charts (including canned and dry food...):
Dry food:
http://binkyspage.tripod.com/dryfood.html
New:
http://binkyspage.tripod.com/CanFoodNew.html
Old:
http://binkyspage.tripod.com/CanFoodOld.html

It also doesn't have to be a strict twice a day feeding schedule, in my humble opinion -- especially at the beginning of receiving insulin. If Nala's used to grazing, let her graze while she adjusts to receiving insulin. You can always change her feeding schedule later, okay?

Ironically, the only cat food Giz would eat was DM canned (initially for a couple of months) and then only DM dry. I substituted the wet with grilling chicken breasts, boneless pork chops, and steak along with 1/4 cup DM dry twice a day (which sometimes she ate, and sometimes she didn't). Luckily Nikki likes cat food and eats only Fancy Feast! YAY!


rosannaf said:
I started her Lantus on Thursday. I’m doing 2 units in the PM after she has eaten at least 75% of her dinner, and 1 unit in the AM after her breakfast. Because I’m away for work almost 8 hours a day, I didn’t feel comfortable putting her on 2 units in the AM which the vet had recommended but we agreed to just go slow first. The vet also recommended that I leave some dry food out for now in case she goes hypoglycemic. Her diet before was Nutro Max Cat Weight Control Adult food (I know, I feel terrible after I researched it), and I recently bought a new bag of dry Wellness Core grain-free. The vet advised me not to make so many changes, so I’m still using the Nutro Max and will be incorporating the dry Wellness Core slowly after a week of her on Lantus.
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I'm liking your vet for going slow first, for recommending you leave out some dry food -- for now -- and for not making so many changes at once. Once Nala begins getting used to insulin, and you start home testing (nudge, nudge...), you'll both be better equipped to make informative changes to both her diet and dose. All that said, without that dry food, I'm not comfortable with the 2 units starting dose either.


rosannaf said:
Before I left the house this morning, I did notice that Nala had some minor diarrhea. I called the emergency vet and the nurse recommended that if Nala eats her dinner of Purina DM, I can give her the 2 units of Lantus still.

Nala is not showing any signs of being hypoglycemic but I’m nervous. I do not have a glucose meter. Should I follow the nurse’s advice?
Click to expand...
Here's a little known fact about DM dry, so perhaps it also holds true for DM wet. The DM, in Giz's day, stood for Diabetic Management. It was less known to also stand for Diarrhea Management. Perhaps that is why the ER suggested gving Nala her full evening dose.

My most humble suggestion, dear Rosanna, is also to not make too many changes at once. Let Nala get used to the insulin before making any more food changes. Just feed her what she's used to/or likes eating. Get a meter and start home testing and then transition to new food s-l-o-w-l-y.

And, I'm with Phoebe regarding the same dose morning and night while you adjust the food deal. I'm also with Phoebe regarding 1 unit twice a day until you know what the transitional food change means to Nala. Cats are such creatures of habit. Changing their diet can mean volumes to a diabetic cat...


Welcome to the place you never wanted to be; but, will be blessed for having found.

Love and encouraging hugs for you and Nala,
Deb and Nikki -- and, Giz, forever dancing in my heart...
 
Thank you to you both, Phoebe_Tiggy_NortonGA and Deb415andNikki, for your quick and thoughtful responses! You can imagine that I’m a nervous wreck and the information available on this site is so helpful but very overwhelming! My first instinct is to change everything, but I know I have to take a deep breath and start sloooowww no matter how tempted I am to change to the “best” food, “best” insulin dosage, etc.

After I spoke to a friend who is a pharmacist, I am switching her dosage to 1u of Lanthus until I can get a clear idea of blood sugar. After some research (ironically too much information can make a person crazy), I will be purchasing a FreeStyle Lite blood glucose monitoring system (it’s on sale at the Walgreen’s next to my work and the strips aren't too expensive online). I’m hoping that I’ll be OK getting the measurements and not be too scared about it. I have read all the great information on this site on how to get a good measurement on a cat.

Thank you for your advise on looking for other canned food alternatives. I’m deciding to stick with the DM canned for now since Nala has had it for a few days and actually enjoys eating it. Per other’s recommendation, I had also purchased some Fancy Feast Classic for my other two cats (Gizmo and Kitty) but they are not eating it at all. Since Nala is actually enjoying the DM, I think I will leave her on it for now until I get some blood sugar measurements. Nala’s vet is away for a few weeks, so she will be getting a fructosamine test when she comes back.

One last question, if I’m unable to inject Lanthus to her stomach, is injecting closer to her shoulders OK? I know I’m not injecting to her scruff area, but does anyone have a picture of where around the shoulders I should inject around?

The funniest part of all of this is that I’m in the medical profession and have done injections and blood testing before. However, the thought of doing it to my own cat just scares me and makes me nauseous vs. doing it on one of my patients.

Thank you again for your kind words and support. It means A LOT to a nervous cat mom here!

Rosanna
 
Hi and welcome!
I am too new to give too much advice, but I am glad you are going to be getting a glucometer and will be testing blood glucose levels to see how your cat is responding.

Noxin only ended up getting injections for a few weeks, but during that time all injections he got were in the scruff area. He would barely notice the injections. It is my understanding that you do not want to inject into muscle. Is there a reason you do not want to shoot the scruff? More experienced eyes and voices will be by shortly I'm sure to answer any questions you have.

If you have done shots and such before on people, then home testing your kitty should be easy for you I would think. I am a biology nerd, and was almost happy to try out my new glucometer 'toy'. I know it was really important for me to remain calm around Noxin when testing his blood glucose. Cats can sense nervousness and if mommy is all afraid, then Oh My Gosh, what is happening? But when I approached him in a matter of fact "hey this is the new routine, and oh by the way TREATS and Love!" sort of way, he learned to love testing time, and is more often than not waiting at his testing spot before I am.

Edit: Also, if you start hometesting soon and regularly (at least before each shot) and record all the values, I don't know that the fructosamine in a few weeks will even be necessary, since all the fructosamine test does is give you a snapshot of your cat's Blood Glucose levels over a matter of a few weeks, and you will already have detail and specific values.

Edit 2: In order to get my cats to switch to wet fancy feast from a dry diet I had to mash the fancy feast with a fork and mix it with a bit of water. For some reason they will chew on dry, but prefer the wet to be a consistency that they can lap up before they will touch it. I think you will find a few people here mix the wet food up a bit for their cats.
 
Hi beggargirl:

Thank you for your advice, anything is really appreciated.

I will be receiving my glucose monitor in the mail tomorrow so I’m happy and nervous about it. It makes me relieve that I won’t be shooting Lantus “in the dark” but also I’m worried if I’ll be able to get good samples.

The reason I didn’t want to inject into the scruff was because I read this article on felinediabetes.com:
http://www.felinediabetes.com/injections.htm

“Most people, including veterinarians, make the mistake of injecting the insulin into the scruff of the neck. This area has a very poor blood supply and insulin absorption is thus rather erratic from this area. Use an area further back around the hips or flank or, ideally, on the sides of the stomach.”

I showed the article to the vet and she advised that Nala’s temperament probably would not allow me to shoot her near the stomach. I’ve been shooting a bit lower than her scruff area and Nala hasn’t minded too much. I’m interested in shooting around her hips if I’m able to find some visual aid online that will help me aim. I'm interested if people's personal experience has seen difference in shooting around the scruff vs. other areas of the body.

I will ask my vet if the fructosamine is a good idea in a few weeks. If I’m able to get blood sugar measurements before each injection, I think that will give us a better idea how she’s doing.

I tried wetting the fancy feast – still no go. Nala happily loves her wet DM food. Gizmo will eat the wet food if I either sprinkle his cosequin supplement on it or I smash up his favorite treats and sprinkle it on top. The problem is Kitty who I thought would be the easier to convert because she usually eats anything. I’ve tried smashing up treats, feeding her treats with the wet food (like dipping chips in salsa), and she will just eat the treat and spit out the wet food! I’m trying not to lose hope.

Thank you all again,

Rosanna
 
hi rosanna! welcome!

my cat is on lantus too - and i use the freestyle lite meter - absolutely love it. no complaints at all about it. it only takes a tiny bit of blood to sample, which is really nice. btw, best prices i've found for strips is at Hocks.com. they're about $28 for 50 strips - at our local drugstore the same strips are $68.

when you begin hometesting it can be tricky getting a blood sample. if you have any trouble at all, please ask for help. all of us have a bag of tricks that help us get blood. the other thing is that as you poke her ears they will grow more capillaries and then you'll get blood every time. at first it can be hard.

i do shoot in the scruff, although i know of the recommendations not to. i think quite a few of us do - for me it's an issue of doing the best i can. my cat is a little bugger to inject and i've had to use every trick i can figure out to make it work. i think as long as you inject into fat it's probably ok.

anyway, you're in the right spot now. we'll help you get organized and get Nala on track! All of us here do feline diabetes 24/7 - some have been doing it for years and years! as strange as it is to trust strangers online, i did it and am SO glad.
 
Hi Rosanna!

It's possible they just don't like the Fancy Feast that much...most of the flavors of FF and Friskies have liver as an ingredient (as does the DM), and some cats will turn their noses up at it. I would recommend going to the pet store and getting a sampler of different kinds of wet food without liver, maybe with some different animal sources (e.g. venison, duck, poultry, rabbit, beef, lamb), and see if there are any winners. If you do find one, you can always move to a big can so it's more cost effective for you.

There's nothing wrong with the canned DM, but a lot of cats get sick of it after a while because of the liver content. But if your cat likes it now, no reason to rock the boat :-)
 
Thank you julie1220 and Julia & Bandit for your advice! I always feel better after speaking to anyone on this board that can offer their help. I truly am thankful for everyone taking the time to read my posts and it helps me not be so worried! I actually slept the entire night last night since Nala has been diagnosed last week. I had been waking up every few hours to make sure she was breathing, and she was a bit annoyed with me.

@julie1220: I received my FreeStyle Lite blood glucose monitor today. I tried it on myself and was surprised how little of a sample I needed! But I wasn’t able to get a sample from Nala today before her evening insulin shot. After she ate a bit, I started rubbing my fingers around her ear to warm it up. I set the lancet on “2”, and I’m not even sure if I aimed it correctly. I then I set it on “3” and for sure the needle went through and went through the other side (thank goodness I had a gauze). However, there wasn’t enough blood for the monitor to work. I tried massaging the ears to try to get some more blood but Nala had enough at that time. I probably spent about 10 minutes at that time so I figured to let her just be and gave her some extra love. Do you find more luck if you warm the ear even more? My vet had recommended maybe getting a warm towel and putting it against her ear for 3 minutes (I’m not sure if Nala can stay that still for that long). I read that some people fill a sock with uncooked rice and place it in the microwave or even just use a lamp. I’m not even sure I’m aiming for the right place so I guess I’ll have to review the things I’ve found online. The YouTube videos make it look so easy!

Thank you also for the recommendation to buy the test strips. I had found them online for similar in cost of the hocks.com. My local Walgreen’s was selling a box of 50 strips for $73!

@Julia & Bandit: I think you are right – the liver is probably what my other two cats are turning their noses against. My non-diabetic cat Kitty will start running to the food, and when she’s within 1 foot and smells the food, it looks like she smelled the worst thing in her life. My other non-diabetic cat Gizmo will eat Fancy Feast only if I sprinkle something extra on it that he likes. I will look through Janet and Binky Famous Food charts but I’m really overwhelmed by the information. What percentage am I looking for in a low carb/high protein canned food? Even though the other two cats are not diabetic, I would like to find a good option because I see Nala sneaking over to eat their food when I’m not looking over her, ha!

The good news to report is that I’m noticing less signs of diabetes in Nala – she’s not walking on her hocks, she’s drinking less water, and she’s not urinating so much that I have to switch out the entire litter box even week! So I’m staying positive! I’m so happy and grateful that I found this board and cannot express how glad I’m at for any response since I know that takes up people’s time and energy.

Thank you again!

Rosanna
 
Wow - so many positive things already! Good for you. You asked about carb content - most people aim for the 6 - 10 range. You'll find that there are lots to choose from.

About getting blood - yes, warming the ear is important. The rice sock mentioned by others is just a thin sock with a tbsp or so of rice and put in the microwave until very warm but not hot. Test on the inside of your wrist. If your kitty will let you hold this for about 15 secs, it will help with blood flow. Also, if you get a little drop you can milk the ear a bit to make it bigger. Some people scoop the blood onto their thumb nail and then test it from there - great idea for an antsy cat. And don't forget the treat - blood or no blood.
 
Hi everyone and thank you Just-As-Appy for your response:

I’m so happy! I got my first glucose measurement today! I gave Nala extra kisses and treats for being so patient with me. I warmed the ear with a warm wash towel and she was fairly tolerant. I will try the sock/rice trick the next time since not too much blood came out.

I was so excited that I got a measurement that I stayed up and started Nala’s SS. How often should I be testing her? +1 +2 +3, whenever I can? I know for sure I should test before giving her meds but what about the other times?

Also, is there a list of good diabetic treats I can feed Nala?

Thank you again!

Rosanna
 
rosannaf said:
@Julia & Bandit: I think you are right – the liver is probably what my other two cats are turning their noses against. My non-diabetic cat Kitty will start running to the food, and when she’s within 1 foot and smells the food, it looks like she smelled the worst thing in her life. My other non-diabetic cat Gizmo will eat Fancy Feast only if I sprinkle something extra on it that he likes. I will look through Janet and Binky Famous Food charts but I’m really overwhelmed by the information. What percentage am I looking for in a low carb/high protein canned food? Even though the other two cats are not diabetic, I would like to find a good option because I see Nala sneaking over to eat their food when I’m not looking over her, ha!
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Anything under 10% is ok. Bandit is super carb sensitive, so I have to keep to keep him under 6% carbs, but every diabetic cat is different with how many carbs they can handle. Having your non-diabetic cats on food under 10% is good for their health, too. You'll want to check the ingredients on the back of the cans when you get to the store to see if they have liver in them. The only Fancy Feast flavor that doesn't have liver in it is the Tender Beef & Chicken--have you tried that one with them? With the way you describe your other cats behavior with the wet food, my guess is they just don't like the food, which means they probably won't like Friskie's, either.

I've had great luck with EVO, Wellness, and Merricks. All have store finders on their websites so that you can find places that sell them. Usually you can find all three at the independently owned pet store in your neighborhood, and they're cheaper than the chain stores. PetSmart carries the Blue Buffalo 95% varieties, which also went over well when my cat Gabby lost her appetite because of stomach cancer (she wouldn't eat anything with liver in it during her last 6 months). The winner of the bunch with her was definitely Merricks Cowboy Cookout, and Merricks Surf-n-Turf. When she had no appetite and wouldn't eat any of the foods she liked before, she still wanted to eat those two right up until the end. She would still occasionally nibble at Nature's Variety Instincts Venison, Rabbit, & Lamb Formulas, too.

I just switched Bandit over to the EVO 95% foods (Venison, Beef, and Turkey & Chicken) because I found that buying the big 13.5 oz cans at my local pet store worked out to be cheaper per oz than buying Fancy Feast at PetSmart, and it's a better quality food. Do you have a locally owned store like that near you?
 
Congrats and welcome to the Vampire Club,

As far as how often to test, most days, right before shots and again at about +6 to try to find out what her nadir (lowest point) is. When you can any spot checks you can get in just adds to your wealth of information on how the insulin is working. Then when you have a full day with her you can run a curve which is basically checking bgs every two hours for one 12 hour cycle. Which is basically what happens when you take them in for a full day of testing at the vet's office. If you run your own curves at home you get truer numbers and can keep those stressful and expensive vet trips to a minium.

Mel, Maxwell and The Fur Gang
 
rosannaf said:
I was so excited that I got a measurement that I stayed up and started Nala’s SS. How often should I be testing her? +1 +2 +3, whenever I can? I know for sure I should test before giving her meds but what about the other times?

Also, is there a list of good diabetic treats I can feed Nala?
Click to expand...

With Lantus you'll want to get at least the AMPS, the PMPS, and at +6 in either cycle daily. If you can get in some other random tests during the cycle to see where's she's at, that's going to help you even more (like a +2, +4 or +5). Any extra tests you can get in will only help you out. But those first three tests are the ones you want to make sure you get every day, and you'll want to do a curve (test every 2 hours for a 12 hour cycle) at least once a week.

Here's a list of low carb treats: http://www.felinediabetes.com/FDMB/viewtopic.php?f=14&t=9172

I give Bandit Beefeaters freeze-dried chicken and salmon that you find in the treat section at PetSmart.
 
Hello again everyone and thank you again to Julia & Bandit for your advice again and MommaOfMuse:

@ Julia & Bandit: I did try the FF Tender Beef and Chicken and my other two nonsugar cats are still turning their noses to it. I believe that they just don’t like the smell and/or texture of wet food. I was able to find the Merrick Cowboy Cookout and Surf-n-Turf at my local Petco. My cat Gizmo (nonsugar) is quite sensitive and threw up a lot although I gave him only a teaspoon. For now, I am just going to feed my two nonsugar cats their regular dry food that I’m converting from Nutro Max WC to Wellness Core. (I’m doing 75% Nutro to 25% Wellness). I don’t have any local pet store, but the big chains (Petco and Petsmart) have been pretty good about stocking most of the brands you had mentioned already. Thank you also for the link to the low carb treats – I was able to find one brand and Nala thankfully loves it.

@ MommaOfMuse: Thank you for suggesting to run a 12 hour cycle. I did it my first cycle last week and it wasn’t too bad. Nala didn’t appreciate it too much though. I’m not sure if it is something I can do every week but I will try my hardest.

One final question, I’m not sure if it’s OK I post this here or I should cross post this on the Lantus board. Nala gave me a low nadir today – the lowest one I ever got. Her AMPS 334 and +6 was first 69(!) and I retook it after she woke up a little more at 85(!). She was in a pretty deep sleep when I had wakened her to get the measurement. I gave her some treats, put out some more dry food, and then her +8 was 167. She is not demonstrating any of those signs of hypoglycemia. What should I do? I know I’ve been leaving less dry food for her to graze on during the day. I’m worried because I need to work tomorrow and won’t be able to do a 12-hour curve tomorrow or a +6. Help?

Rosanna
 
That's a really pretty nadir. But since Maxwell was only on Lantus a very short time (2 days once he got home to me) I can't help on the dosing advice, but 69 at +6 isn't too scary, now 69 at +2 that is scary. But usually by +6 she should be starting to rise again. Since you are really new at this dance, and don't have a ton of data on her low numbers I would cross-post to the lantus folks.

Mel, Maxwell & The Fur Gang
 
@MommaOfMuse: Thank you for your quick reply. I can't help but sometimes "refresh" the page to see if anyone responds to my questions and since this is all new to me, I'm quite nervous of any results. I will follow your advice and repost on the Lantus board. Thank you again!

Rosanna
 
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