? Hoping for some advice

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C.W. Gortner said:
I seem to have a better grip on the situation than they do, with all their diplomas and credentials.
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Unfortunately, that's the rule, not the exception around here. The sad facts are that vets only get 5 hours of "formal" education when they're in school on diabetes, and that is for both dogs and cats! And since they see more diabetic dogs, they tend to treat their cats like small dogs. Unless they have a special interest in feline diabetics, even if they do get continuing education, it's usually for dogs.

The reason this forum seems to know more is because the people here deal with this disease 24/7/365...where most vets might only see a handful of diabetic cats in their entire career. We also have the time to research on the latest treatments.

To be fair, vets can't really stay up to date on the latest treatments for every disease in every type of animal they see. If they tried, they'd never have time to see actual patients!

SO glad to hear Mommy is acting so much better and eating so well!! Hopefully she'll be home tomorrow and you can get to the serious work of treating her the best you can and she'll have many more years of love to share with you!
 
Her BG bouncing around a bit during the first weeks on Lantus isn't unusual, right? I mean, logic tells me that as her body has been accustomed to very high BG, it's going to resist a little at first, take some time to adjust and auto-regulate. I'm not clear on why they'd expect her to fully regulate in the 200s at such an early stage of her treatment. They expressed concern that she wasn't staying low enough for long enough, but she only just had her first injection. She went into the 190s on the pump but she justy had her second injection at 9 p.m. tonight, so I've called to get the most reading on her and am waiting to hear back.
 
C.W. Gortner said:
We went to see Mommy tonight. She's looking and acting so much better, brighter and very alert. She ate a full can of FF Salmon, too. She was hungry. She's now on Lantus 1u 2x day, just starting today, and her BG has been bouncing around a bit; it hit 330 at one point, but then dropped to 255. Still, she was first hospitalized at a skyrocketing 700+, so even 330, while not ideal, is a definite improvement. The attending vet tonight - thankfully, Dr Dick had gone home - mentioned to me that Mommy might be "hard to regulate". Excuse my French, but it's been less than 24 hours since she was taken off the insulin pump and onto subcutaneous injection. How the **** can they know if she's hard to regulate at this stage? If Lantus doesn't get her BG low enough, then try Lemevir. Try Vetsulin. DO your jobs! I was about to read them the riot act, but seeing as she's there for another 24 hours, I held my rapier tongue. Honestly, you'd think I was the vet. Just by being on this forum for a week, I seem to have a better grip on the situation than they do, with all their diplomas and credentials.

FYI: Here's a picture from tonight of my cat-at-death's-door (not); the beauty we almost decided to euthanize because of Dr Dick's dour prognosis. As you can see, she is nowhere near dying at this point - though she did pee on me, as they brought us to see her in a little visiting room with no litter box and she'd been hydrated like a hippo.
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Take a look at some of our spreadsheets....MOST CATS BOUNCE around especially on the beginning. Numbers in the 300-400... Are the norm, esp the first few months. Now you said she had ketones, so that's a reason for her to stay the extra night, but numbers in the 300's are what you should expect to see for preshot numbers at thus stage.
 
C.W. Gortner said:
I'm not clear on why they'd expect her to fully regulate in the 200s at such an early stage of her treatment.
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This is NOT realistic. Your kitty has been to hell and back and it's very early days. The time taken to achieve regulation varies widely among cats and I'm not sure most vets appreciate this fact. My guy was diagnosed 2 years ago and I'm still working on getting him more stable. He's particularly tricky but you can get somewhere even if your kitty is hard to regulate. If you're willing to take on her FD treatment yourself with help from this forum you'll make progress for sure.
 
Kris & Teasel said:
This is NOT realistic. Your kitty has been to hell and back and it's very early days. The time taken to achieve regulation varies widely among cats and I'm not sure most vets appreciate this fact. My guy was diagnosed 2 years ago and I'm still working on getting him more stable. He's particularly tricky but you can get somewhere even if your kitty is hard to regulate. If you're willing to take on her FD treatment yourself with help from this forum you'll make progress for sure.
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Thank you, everyone, SO much! I don't what I'd do without this forum as I navigate this upheaval. Specialist Dr Dick called this morning. He tried to be more personable, so I think he realized I wasn't amused by his previous icy, dour demeanor. Her BG is in the mid-400s this morning. He's upping her Lantus to 2 units twice a day, which he felt is appropriate, but he did add that yes, it's to be expected that she'll bounce around quite a bit. So, he at least acknowledged that. He told me the primary goal right now and in the foreseeable future is to keep her from developing ketatones again, and it doesn't take much insulin to prevent that. Her renal value (creatine) is 2.4, which he says isn't great, but about the best that we can expect at this point, given her overall condition, though it may lower a bit more over time. Her RBC is a bit low, too, but again, he said that if she continues to eat well and puts on weight - her appetite remains good - then that, too, should improve. He appreciated that I let her stay another night but added she's "very nervous" in the hospital and that could skewer values. Perhaps once shes back home and at ease, her overall clinical picture will improve. He didn't sound very encouraging in this respect, but I don't think he has it in him to be encouraging. I think his modus operandi is to emphasize worst case scenario, as if he fears giving false hopes or expectations that might come back to bite him in the ass.

If all remains as above throughout the day, he'll discharge Mommy this evening. I brought up the fact that based on my copious research here and elsewhere, Lantus is a depot insulin and its efficacy really can't be fully determined for at least 5 to 7 days, as it takes time to build up in the cat's system. He was dismissive of that, saying that typically in most cats - he cites "typically, in most cats" often, like a catchphrase - Lantus is effective from onset of treatment. Whatever. I didn't care to argue with him, I just asked that should it not prove as effective as claimed, could we switch her later to another insulin? Yes, he said, there are, of course, other insulins to consider.

Between my cat's illness and dealing with him, I need a Xanax drip.
 
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C.W. Gortner said:
Thank you, everyone, SO much! I don't what I'd do without this forum as I navigate this upheaval. Specialist Dr Dick called this morning. He tried to be more personable, so I think he realized I wasn't amused by his previous icy, dour demeanor. Her BG is in the mid-400s this morning. He's upping her Lantus to 2 units twice a day, which he felt is appropriate, but he did add that yes, it's to be expected that she'll bounce around quite a bit. So, he at least acknowledged that. He told me the primary goal right now and in the foreseeable future is to keep her from developing ketatones again, and it doesn't take much insulin to prevent that. Her renal value (creatine) is 2.4, which he says isn't great, but about the best that we can expect at this point, given her overall condition, though it may lower a bit more over time. Her RBC is a bit low, too, but again, he said that if she continues to eat well and puts on weight - her appetite remains good - then that, too, should improve. He appreciated that I let her stay another night but added she's "very nervous" in the hospital and that could skewer values. Perhaps once shes back home and at ease, her overall clinical picture will improve. He didn't sound very encouraging in this respect, but I don't think he has it in him to be encouraging. I think his modus operandi is to emphasize worst case scenario, as if he fears giving false hopes or expectations that might come back to bite him in the ass.

If all remains as above throughout the day, he'll discharge Mommy this evening. I brought up the fact that based on my copious research here and elsewhere, Lantus is a depot insulin and its efficacy really can't be fully determined for at least 5 to 7 days, as it takes time to build up in the cat's system. He was dismissive of that, saying that typically in most cats - he cites "typically, in most cats" often, like a catchphrase - Lantus is effective from onset of treatment. Whatever. I didn't care to argue with him, I just asked that should it not prove as effective as claimed, could we switch her later to another insulin? Yes, he said, there are, of course, other insulins to consider.

Between my cat's illness and dealing with him, I need a Xanax drip.
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2.4 creatnine is stage 2 ckd. He most likely has more years ahead of him.... That's not super high. Down the road things like sub q fluids will help... For now low phosphorus food, vitamin b 12 (that will help with neuropathy AND mild anemia), and add extra water to his food and extra water bowls around the house.
 
JanetNJ said:
2.4 creatnine is stage 2 ckd. He most likely has more years ahead of him.... That's not super high. Down the road things like sub q fluids will help... For now low phosphorus food, vitamin b 12 (that will help with neuropathy AND mild anemia), and add extra water to his food and extra water bowls around the house.
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Any specific type of vitamin B-12 for cats that you can recommend? Unfortunately, she loves FF Classic Pates of any fishy variety and I need to keep her eating. She will sometimes eat beef and poultry but she's finicky (from feral to princess in 7 years :); the only way we got her to eat at the hospital was enticing her with FF Classic Salmon Feast, which she devoured. I know fish-based foods are higher in phosphrous than is good for her, but her weight is a grave concern to everyone involved. From 9 lbs last year in April, she's now down to 6.1. They said she was "emaciated" so I need to put weight on her and keep her eating regularly, especially with insulin on board.
 
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Well, at least she did finally pee last night. Too bad it was on you. When Little Dude was at the vet for a week, he kept holding it. Then he got it all over himself (poor Dude).

For the internist to not know details about insulin is tragic. I think many vets don't spend enough time dealing with diabetes in detail. It is unfortunate that many humans gain their knowledge from this site instead of from their vets. But I'm glad this site is here, as I learned a lot. And we haven't discussed Acromegaly yet. Hardly any vets know details about that.

For B12 - Zobaline. Do a search in the forum, it is a common topic. Leo was on it for awhile.
 
C.W. Gortner said:
Any specific type of vitamin B-12 for cats that you can recommend? Unfortunately, she loves FF Classic Pates of any fishy variety and I need to keep her eating. She will sometimes eat beef and poultry but she's finicky (from feral to princess in 7 years :); the only way we got her to eat at the hospital was enticing her with FF Classic Salmon Feast, which she devoured. I know fish-based foods are higher in phosphrous than is good for her, but her weight is a grave concern to everyone involved. From 9 lbs last year in April, she's now down to 6.1. They said she was "emaciated" so I need to put weight on her and keep her eating regularly, especially with insulin on board.
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You have to deal with the most pressing issue first and that's getting her to eat and keeping her eating. Enough food and enough insulin are the weapons against ketone formation. Feed her whatever she'll eat willingly. Once she's past this crisis you can address the specific dietary needs of a kitty in early stage kidney disease.
 
Kris & Teasel said:
You have to deal with the most pressing issue first and that's getting her to eat and keeping her eating. Enough food and enough insulin are the weapons against ketone formation. Feed her whatever she'll eat willingly. Once she's past this crisis you can address the specific dietary needs of a kitty in early stage kidney disease.
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That's exactly what the specialist just told me when he called. He was more personable, too. They're discharging her this evening. She's coming home with a scrip for 2 units of Lantus 2x daily - she was increased to 2 units today, and it dropped her BG to 310; an anti-nausea medication, 1/8 of a pill once a day for 5 days, then two days off, and an appetite stimulant. He's also giving me a scrip for a once-weekly B12 injectable that he says can be challenging to find locally, just because many pharmacies don't carry it, so to shop around online for it; but it wasn't urgent, he said. I don't need to start the B12 right away. Basically, he said, we need her to keep eating. If she eats less than usual, he said it was okay to drop her dose to 1 unit 2x a day and make note of it. His main concern seems to be her appetite, which makes sense. He's not the friendliest dude on the planet but he is an excellent clinician by all accounts, so I guess I'm going to bite my cheek and deal with him for now, as he's been handling Mommy's case these past three days.
 
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The Zobaline B12 is tasteless. It is a small tablet. You crush it and sprinkle it into their food.

Plus injectable B12 is readily available. I got some directly from my vet when Leo was having issues.
 
C.W. Gortner said:
That's exactly what the specialist just told me when he called. He was more personable, too. They're discharging her this evening. She's coming home with a scrip for 2 units of Lantus 2x daily - she was increased to 2 units today, and it dropped her BG to 310; an anti-nausea medication, 1/8 of a pill once a day for 5 days, then two days off, and an appetite stimulant. He's also giving me a scrip for a once-weekly B12 injectable that he says can be challenging to find locally, just because many pharmacies don't carry it, so to shop around online for it; but it wasn't urgent, he said. I don't need to start the B12 right away. Basically, he said, we need her to keep eating. If she eats less than usual, he said it was okay to drop her dose to 1 unit 2x a day and make note of it. His main concern seems to be her appetite, which makes sense. He's not the friendliest dude on the planet but he is an excellent clinician by all accounts, so I guess I'm going to bite my cheek and deal with him for now, as he's been handling Mommy's case these past three days.
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So glad he's coming home!!! Here's a link to the zobaline. Zobaline™ (for Diabetic Cats) 3 mg x 60 tabs https://www.amazon.com/dp/B008G3LI2M/?tag=felinediabetesfdmb-20
 
If the nausea medication is cerenia there is no need to take two days off. That is the old protocol. Ask which nausea medication and post here later for advice on dosing of it. The fatty liver is definitely due to tge big drop in weight so it’s impirtant to keep her eating and deal with food changes later. All this is very encouraging.
 
C.W. Gortner said:
Her renal value (creatine) is 2.4, which he says isn't great, but about the best that we can expect at this point, given her overall condition, though it may lower a bit more over time
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China's creatinine was at 2.5 in Oct 2015.....in March 2016 it was 2.2 and in July 2017 it was 2.2.....and her SDMA (the newest test for kidney disease) was normal ....10 (on a scale of 0-14) in March '16 and only 9 in July '17

I wouldn't worry too much about the 2.4.....that's pretty normal for an older cat
 
tiffmaxee said:
If the nausea medication is cerenia there is no need to take two days off. That is the old protocol. Ask which nausea medication and post here later for advice on dosing of it. The fatty liver is definitely due to tge big drop in weight so it’s impirtant to keep her eating and deal with food changes later. All this is very encouraging.
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The nausea medication is cerenia.

Where do people buy their insulin? I just got her Lantus 100 ml vial at Walgreens. $338! I need a cheaper source, as at her current dosage, this vial will only last 25 days.
 
I called the pharmacist. It is 1000 units. 100 units per ml x 10 ml vial = 1000 units. Which should last her 200 days at her current dose and that I can afford.
 
C.W. Gortner said:
I called the pharmacist. It is 1000 units. 100 units per ml x 10 ml vial = 1000 units. Which should last her 200 days at her current dose and that I can afford.
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The insulin might not retain its potency after 4 to 6 months. You might end up discarding part of the vial. That's why many people but pens and use their internal cartridge as a mini vial from which to draw insulin. That cartridge is 3 mL and you can use it all up before it poops out. The pens are sold in a 5 pack. Many US people here order from Canada because Lantus is a lot cheaper here.
 
Kris & Teasel said:
The insulin might not retain its potency after 4 to 6 months. You might end up discarding part of the vial. That's why many people but pens and use their internal cartridge as a mini vial from which to draw insulin. That cartridge is 3 mL and you can use it all up before it poops out. The pens are sold in a 5 pack. Many US people here order from Canada because Lantus is a lot cheaper here.
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I asked Dr Dick about the pens and he said the vial was more economical, but I'll get the pens next time. For now, I'll refrigerate the vial. Should I place it in a baggie or do anything else to help maintain its durability?

I'm losing my mind. This is SO much to take in . . . I know it'll settle down once we have her on a schedule that works, but right now I feel like I'm stumbling in a tunnel.
 
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C.W. Gortner said:
I asked Dr Dick about the pens and he said the vial was more economical, but I'll get pens next time. I'll refrigerate the vial. Should I place it in a baggie or do anything else to help maintain its durability?
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Put it in a small baggie, stand it up in a small container and put it near the back of a shelf in the fridge, not the door - too much jostling from the door. Some people wrap the vial in bubble wrap or similar.
 
2U may also end up being too much....we only increase in .25 unit increments so we don't bypass what could be a "perfect" dose. Small changes in dose can make a big difference!!

Once she's home, her numbers may come down quite a bit too....just being under stress at the vets office can raise some cats blood glucose 200 points!
 
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Mommy is finally home. She drank a lot of water from her bowl as soon as she arrived - which freaked us out a bit, but I suppose she was thirsty - used the cat box, and then promptly went to hide under the bed. I think she needs to de-stress from the hospital stay, but we'll try to entice her to eat a bit later, as her next dose of insulin is at 9 p.m. (CA time), so little over an hour from now.

She looks so much better, more alert and bright-eyed, but after three days in the hospital, she's acting almost like the scared feral she was when I first brought her home 7 years ago. The vet techs cuddled and petted her at the hospital, they showed me pics, so she definitely had human-touch contact there, especially at night - and what's even more surprising, she let them do it. Maybe she's just bewildered at the moment. Her son Boy came up to see her, sniffed her butt, and waltzed away, as if to say, "Oh, you're home."

Cats.
 
I get Levemir pens from Alan Hamman on the Supply Closet subforum. He's reliable, and they are a huge discount from Walgreens. He also sells Lantus. I haven't bought from a store in over 18 months.
 
So happy Mommy is back home with you and looking better :bighug::bighug::bighug:
As far as "stumbling around in a tunnel" you can lean on us AND we'll try to lead the way as best we can.

Also, whenever you're ready, you can start posting over in the Lantus/ Levemer Forum. The LL Forum is full of people with tons of experience treaty kitties using that particular type of insulin.
 
C.W. Gortner said:
She came out to eat - good sign! - and I'm ridiculously proud to say that I gave her her first at-home 9 p.m. insulin dose. I was a bit of a nervous Nellie shooting her, the dose itself is so tiny and the needle so fine, it's like insulin for Lilliputians, but she seemed quite nonplussed by it.
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That's great!
 
I dosed her again this morning. She pee'ed a lot last night, not huge volumes (in fact, less volume by far than before this crisis) but more often. I think she wasn't peeing very much at the hospital, except when she peed on me. At around 4:34 a.m., she meowed at us in bed, where we were passed out from the last few days of stress. She was hungry and gobbled up a full can of FF. In my sleep-deprived haze, I forgot to just add her pills (which need to be cut into minute slices with a pill cutter) to her food at that time. So, this morning, while she took the insulin fine, she wasn't interested in eating; and as if she knew that I needed her to take her pills, she crept back under the bed to sleep and refuses to emerge. Being an ex-feral, she's always been far more active at night, so I'll just attempt to get her anti-nausea and appetite stimulant into her later. I left the food with the pills out on her tray in case she gets hungry, in case.

Oy.
 
That's good news that Mommy ate some more food. I hope she continues to improve.
 
She ate another can of FF today, too, and I managed to give her her pills hidden in the food. But she hasn't pooped yet. At the hospital, they had to give her an enema (yesterday) because she was backed up. Should I be concerned or wait another 24 hours to see if she poops? I know the appetite stimulant they prescribed, Mirtazapine, lists constipation as a potential side effect, but pancreatitis can cause it, too, and she had that. I just want make sure I'm doing whatever I can for her. I saw on the forum that some people here use Miralax, 1/8 teaspoon mixed into the wet food, but I don't want to get ahead of myself and add stuff ad hoc to her regimen.

Forgot to add, I did call the hospital and they told me it wasn't a serious concern right now, as she had a "large" bowel movement there yesterday and it might take another 24-48 hours for her to poop again. I'm so hyper-vigilant at this point, even no poop gets me in a tizzy! :)
 
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I’ve used Miralax a lot. It’s mild and can take a few days to work. It’s a dose to effect drug so if too little won’t work and too much will cause loose stool. 1/8 teaspoon once a day is the usual starting dose. Check with your vet but it should be fine. Skipping a day here and there is not alarming but after all she’s been through recently you want her as comfortable as possible. We are almost all helicopter moms and dads around here.

Here’s a site devoted to ‘‘tis should you be interested:
felineconstipation.org
 
Thanks! I'll try some Miralax tomorrow if she doesn't poop. I don't want to schlep her back to the hospital for a $350 enema, as they suggested if she fails to deliver. We have a follow-up appointment with Dr Dick next week on Tuesday, and that'll be traumatic enough. Otherwise, she appears to be doing well. She lets me give her the shots like a champ and today, she ate nearly 3 full cans of FF. She's still peeing a bit more than I'd prefer, but her volume of urine is significantly reduced from what I was seeing at the onset of this crisis - which were large, thick pancakes of urine-soaked litter, though she never flooded the box as others have reported with diabetic cats. She's being very affectionate and she's purring, especially when we play our new game of 'I give you a shot, and you give me a shot.' I shoot her and then put the food plate before her, cooing that now it's her turn is to eat, which she does. She's always been a nibbler/grazer cat, so I have to keep wet food available for her at all hours. Thank god I work at home! If anyone but another crazy cat person could see me, baby-talking my feline into eating . . . But she's such a fighter. She almost died 4 days ago and today, she's following her son Boy around and eating pretty well, all things considered.

She must be feeling better, too, because when she was sliding downhill last week, Boy wouldn't leave her side until we rushed her to the vet. Now, he's acting nonchalant; being a cat, he has a much better sense of these things than humans. I think he knew she was collapsing because looking back, his anxiety those last few days was evident. I'm now watching him as a gauge of her overall well-being.

My AlphaTrak 2 arrived late tonight, so I'll start spot-testing her BG tomorrow, though Dr Dick didn't want me to start home testing until after our follow-up appointment, for reasons that remain unclear. I suspect he thinks I'll panic if her BG is high and change her dose or something equally heinous to him, though I'm still too wary to adjust her insulin until I get a trend of how her BG is reacting to the current dosage.

I really appreciate from the heart all the advice and care you've all given me. This has been a steep, desperate learning curve for me, and the forum has helped save my sanity. I feel more in control than I otherwise would, if the forum wasn't available. I don't know what the future holds for her, with all her issues, but as long as she's willing to fight, so am I. Bless all of you and your cats.
 
So glad you will start testing today. The danger is getting too low and not being too high. It’s important to test before insulin and food to make sure she’s not too low to inject and then get tests between 4-7 hours after as lantus is dosed on the lowest point in the cycle, the nadir.

Eating shows she’s far from ready to check out. It sounds like she is recovering well. Miralax is mild and won’t hurt her. If no poop this morning I’d start it. It’s tasteless so you can put it in her food.
 
She actually pooped a little last night. She is more energetic and eating a lot, which she wasn't doing the week leading into the crisis. Unfortunately, she's drinking more than I think is okay, about 2 cups of water a day. She's also peeing about every 2 hours or so, not massive amounts but still . . . I'm measuring her water bowl, which holds 3 and 1/2 cups of water. On the upside, she's more active, especially at night - which is quite common for her - as well as hungry, so I'm just feeding her as much as she wants because she lost so much weight. She ate a full can of FF overnight and then another this morning, so her appetite stimulant is definitely working.

I tried to BG test her this morning before her shot, and it was a bust. I had everything ready with the AlphaTrak 2, coded the meter to the strip, put in the trip, pricked her, and managed to massage up a bead of blood. But in my haste, I smeared the blood onto the test strip and received an error 2 message, probably because I didn't touch the strip to the blood but actually tried to scrape it up, which smeared the blood on her ear. So, I screwed up and lost a test strip. She tolerated the process, but then Boy sauntered into the room, curious, and she just wanted to get away from me to join him. I know it takes practice and patience to test, so I'll try again later at the 4 hour-mark, as I went ahead and dosed her since it was time for her a.m. shot, and she still seems symptomatic to me. She's on 2 units of Lantus twice a day and only weights 6 lbs at this point, so I'm not sure if it takes a few days for Lantus to build up in her system. I read about the depot part of the insulin, but when I asked Dr Dick about it, he waved it aside, saying Lantus was merely a slow building insulin after each shot, as in, it starts to work a few hours after the shot.

I feel like an idiot, but the BG testing makes me nervous, probably because it's a prick, blood, and I need to practice to get the hang of it - on $3 test strips!
 
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Yes, Lantus is a slow building insulin. After a couple of days, you can really start to measure effectiveness.

The blood testing will become easier. If you take too long after inserting the strip, it will time out. You can try that with a strip, and measure it on a second hand. Once it times out, you just reinsert the strip.

You can get FreeStyle Lite test strips for AlphaTrak 2 - on ebay. The last lot I bought was $93 for 300 strips. So around $0.30 a strip.
 
Hi all, Mommy's follow up appointment went fine - and resulted in another highway robbery on my wallet. But I am concerned that at 12:23 p.m., which was about 3 1/2 hours since her 9 am shot, her BG as measured at Dr Dick's was 132. That's great, but significantly lower than what I'd gotten around the same time a few days ago. Dr Dick was nonplussed - "She'll bounce around a lot," he drawled - but I am not. If she's going that low only 3 hours after her first morning dose and has been on Lantus 2 units 2x a day for over a week now, shouldn't we consider adjusting (as in, lowering) her dose? Dr Dick said no, and again, while supportive of my home testing her BG, expressed concern over how daily regular home testing would affect my bond with her. I had to reply, "You're her doctor. You concern yourself over her blood tests and let me worry over our bond." What a condescending putz.

So. I'm going to home-test her now before every shot and at the 6 - 8 hour point going forward. I'm thrilled she went so low, but I don't want to risk a hypo episode that ends becoming another thousands of dollars emergency. Have I mentioned how much I hate vets? Dr Dick spent little more than six minutes examining her, had her taken back for blood work, and charged me $500.

I'm done with him. I'm returning to my regular vet, since the cat he thought last Saturday was dying is clearly not.
 
"You're her doctor. You concern yourself over her blood tests and let me worry over our bond."
You are 100% correct.

The 132 measurement is a bit low, but not abnormal. There can be some bouncing around. If you want us to help, please start typing in the preshot numbers, and whatever mid-term values you get. Otherwise it is challenging for any of us to provide dosing advise.
 
132 could mean anything. It all depends on where you caught her in the cycle, whether she was stressed at the time, etc. Institute regular checking at home at various places in her cycle. 2u of Lantus with a 132 number by itself based on where she started out wouldn't worry me, because of the way Lantus works -- if you look at the curve, it slow-releases over a 24 hour period, with a bit of delay at the beginning and trailing off at the end, thus the reason it's given at 12 hour intervals. So her blood sugar isn't going to suddenly crash, you'll get plenty of warning, assuming you're doing the testing. Get enough numbers to figure out your cat's curve, then dosage can be adjusted to move the curve -- but slowly, because nothing happens fast with Lantus. Just breathe, and relax a bit, you're past the hard part and nothing really bad is going to happen fast now.
 
Happy New Year everyone! Hope you had a lovely holiday season.

Update on Mommy: she's eating very well and has already gained back some much-needed weight. She looks much better, too: bright eyed, acting more like herself - more energetic and affectionate, going downstairs to hang out at night with Boy. Her usual routine. All seems to be going well, thank Bastet. However, she's still peeing and drinking a bit more than I'd prefer at night, less overall than before her diagnosis, but similar volume at times, such as two large-size paddies in the box last night, which is consistent with how it's been. Definitely less pee / less volume during the day, however, though she's always more active at night. So, the pee part is still worrying me, even if her other clinical signs are much improved. I've also been switching her injection sites, trying to shoot her more in her flank or tented skin on her lower back, as her scruff seems to result in less absorption, based on my obsessive watching of her pee routine. If I give her a flank shot (never the same site twice, of course, but within acceptable range of each other) she sometimes pees less, but of course this is totally unscientific. Sometimes, no matter where I happen to shoot, it makes no difference, and she just pees more or pees less.

As you'll also see from my pathetic spreadsheet, establishing home testing on a regular schedule has been tougher than I'd assumed. She doesn't like it; if she sees me enter her suite with the little black bag with the monitor, she scampers right under the bed. It might be that my first ham-handed attempts disagreed with her; then again, she's still a cat. I've had to start hiding the monitor, etc. in my pocket and lure her with kisses and nibbles of food, to calm her down so she won't wiggle or attempt to flee. Also, the prick on the ear does seem to hurt her, though I try to be very gentle. I'm using Neosporin but probably need to get one with a better numbing agent; that said, I did manage to snag her this morning for a BG spot test. Her a.m. shot was at 8:15 and at 10:43 a.m. this random test was 119. Now, that seems pretty low to me, all things considered. I'm not complaining and it's only one test, but she'd eaten almost a full can of FF about an hour earlier plus her shot, so I figured she'd run higher. I realize I have to focus on trends, not one random test, so I'm trying to figure out how we get over this home-testing hump. It may just require patience and time for her to adjust, as my technique improves. Her labs from her vet follow-up, which I've added to my spreadsheet, were good: her BG was 97.

She's still on .2 units of Lantus twice a day.

Thanks for all your support during the crisis. You helped save my sanity!
 
C.W. Gortner said:
All seems to be going well, thank Bastet.
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Like it! :cool:

C.W. Gortner said:
Also, the prick on the ear does seem to hurt her,
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Are you supporting the back of the ear with something? (I use a folded 1" strip of kitchen paper (4-ply when folded) wrapped around my index finger; others use little flat cosmetic cotton pads.) The bit of support really makes a difference because it makes it much easier to get a blood sample really close to the edge of the ear. With a bit of practice you can freehand the poke with a lancet and use an action similar to that you might use to prick a balloon. If you're sometimes catching the marginal ear vein when poking that might be the cause of the discomfort.

C.W. Gortner said:
However, she's still peeing and drinking a bit more than I'd prefer at night, less overall than before her diagnosis, but similar volume at times, such as two large-size paddies in the box last night, which is consistent with how it's been. Definitely less pee / less volume during the day,
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We've found that cats tend to have a particular style: some typically run lower at night, some lower during the day. Trouble is, without enough BG data to understand what's going on it's hard to tell. For example, Mommy may actually be running lower during the daytime cycle but then bouncing up to higher numbers on the night time cycle (and producing more pee). Be sure to keep asking for hints and tips about home testing techniques. It might be worth posting on the Lantus board for more input - and suggestions on how to improve success rates when trying to test a difficult kitty! :)

In the meantime, it might be a good idea to do spot checks on Mommy's urine to see whether there's any glucose present. That would at least tell you whether her BG levels are breaching the renal threshold. The only other thing I can suggest is getting the vet to run fructosamine tests to give you an idea of how well/poorly Mommy has been regulated over the previous couple of weeks.


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