I brought Kitty home from vet

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Missy & Kitty

Missy & Kitty

Member Since 2013
Hey everyone,

I picked up Kitty from the vet today. He was unable to get her regulated, and he was using Vetsulin. He said that it had been removed from the market for a while, but it had recently been reintroduced, so he was using that. I told him I would rather use Lantus or Levemir, so he called my pharmacy and ordered some insulin for me there. I believe it was Lantus. I have to pick that up in a little while.

We tested Kitty's BG with my new meter and his, and there was a pretty big difference. My meter showed 30 while his showed 50 something. He pulled some blood from her arm so we could test again, and mine was 33 and his was 50 something again. I'm not sure why my meter is so much different than his, but it makes me really nervous.

I was going to feed Kitty some canned food, but since her BG is already pretty darn low, I didn't think I should give her the canned food just yet. I think I read that low carb canned food can bring a cat's BG down quite a bit, so I don't want to make her go too low. What should I do? What is your routine? Do I feed her canned food first thing in the morning, test her, give her the shot, test again during the day..I just don't know. Any advice/tips would be greatly appreciated.

Since I will be using a different insulin than the vet was regulating her with, he suggested I start out with 2 units every 12 hours. When he was using Vetsulin, he had her on between 3 and 5 units.

I asked him if he had tested her urine for ketones, and he said he had not. I asked if she could have a thyroid problem or pancreatitis, and he said the cortisone shot he had given her weeks before aggravated the pancreas, so that was another problem. I didn't notice her drinking and peeing a ton until after she got that shot.
 
Good for getting the Lantus(or Levemir). I would start with not more than one unit of insulin twice daily and make sure that you test before each shot. The 30/50 is low. How long after shot was it?
If you test before each shot (and in between shots sometimes, especially when just starting) you can change to canned now.
 
Hi Larry and Kitties!

The vet didn't tell me when he last gave Kitty a shot, and it's not noted anywhere on the paperwork that he gave me either. According to the paperwork, the last time he gave her Vetsulin was last night at 7:15 PM. Her BG was 282, so he gave her 4 units of insulin.
 
Miss E said:
...We tested Kitty's BG with my new meter and his, and there was a pretty big difference. My meter showed 30 while his showed 50 something. He pulled some blood from her arm so we could test again, and mine was 33 and his was 50 something again. I'm not sure why my meter is so much different than his, but it makes me really nervous.
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Do you know what kind of meter he was using? What kind of meter is yours?

Miss E said:
...I was going to feed Kitty some canned food, but since her BG is already pretty darn low, I didn't think I should give her the canned food just yet. I think I read that low carb canned food can bring a cat's BG down quite a bit, so I don't want to make her go too low. What should I do? What is your routine? Do I feed her canned food first thing in the morning, test her, give her the shot, test again during the day..I just don't know. Any advice/tips would be greatly appreciated.
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Food won't make her go too low.
If it is less than 5 hours since the shot, please feed her something as the insulin is still in effect and she could hypo.

Miss E said:
...Since I will be using a different insulin than the vet was regulating her with, he suggested I start out with 2 units every 12 hours. When he was using Vetsulin, he had her on between 3 and 5 units.
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The initial dose of Lantus is based on her lean weight - the lower of her current weight or her ideal weight - in kilograms (pounds / 2.2), multiplied by 0.25. Round fractional results down to the neares 0.5 units, for safety.


Miss E said:
...he said the cortisone shot he had given her weeks before aggravated the pancreas, so that was another problem. I didn't notice her drinking and peeing a ton until after she got that shot.
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Yup, steroids will do that.
 
Hey BJM,

I don't know what kind of meter he was using, but mine is a ReliOn Micro.

I called the vet to find out when they last injected her, and they said it was 7:15 AM. It's now 1:41 PM. I guess I need to feed her! Dang this is nerve-racking! nailbite_smile
 
With Lantus, we feed after the shot and often let them graze until 2 hours before the next shot.

Several small meals minimize the spike in glucose from food; you might see this about 2 hours after eating.
 
I promise sweetheart, it WILL get easier! The 'sugar dance' isn't hard, it's just different! Two weeks from now you'll look back and scratch your head wondering why you were so confused....PROMISE!

You're in WONDERFUL hands here, I just wanted to send a hug too...
 
Hi Squeaky and KT,

Hugs are definitely appreciated. *sigh* Thank you!

I fed Kitty some canned food just a moment ago. I've never seen her eat canned food, so I didn't want to give her too much and have her throw it up, and I wasn't even sure if she would like it. Well I can gladly say that she LOVES canned food. She ate it all up in about 2 minutes. I think I'll weigh her and then see if I need to be figuring up lower calories for her (she appears to be overweight, but she's not heavy when you pick her up).

BJM said:
The initial dose of Lantus is based on her lean weight - the lower of her current weight or her ideal weight - in kilograms (pounds / 2.2), multiplied by 0.25. Round fractional results down to the neares 0.5 units, for safety.
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I'll weigh her really quick and see what this comes up with. Thanks, BJM!
 
Change food gradually to avoid diarrhea or vomiting!!!!

And you can slow down scarf 'n' barf behavior by spreading the food thinkly across a large plate.

Good low carb canned foods include Fancy Feast Classics and Friskies Pates.

Because canned food has more water in it, the volume needed to provide calories will be greater than dry food (visualize a dried apple vs a fresh apple). Some cats will lose weight when transitioned to a wet food diet.
 
Ok, she weighs 4.4 kilos.

BJM said:
The initial dose of Lantus is based on her lean weight - the lower of her current weight or her ideal weight - in kilograms (pounds / 2.2), multiplied by 0.25. Round fractional results down to the neares 0.5 units, for safety.
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So 4.4 x .25= 1.1, or 1 unit. Is that correct?
 
Correct - 1 unit is where you can start if that is a) her ideal weight or if b) she is underweight, it is her current weight.

Lantus is given every 12 hours.
Always test before you give insulin. Starting out, do not give insulin if the glucose level is below 200 mg/dL. This will change after you have collected a week or so of data, with tests between shots.

The dose adjustments are based on the lowest point between shots - the nadir - NOT the preshot tests.
 
I figure that since the vet gave her a shot at 7:15, I should also give her a shot around that time tonight, if it is above 200. I will check her BG again before I go to bed; if it is high, what do I do?

If I understand you correctly, in the morning I will test her, if it is over 200, I give her 1 unit of insulin. I then feed her some canned food (spread out thin on plate-thanks for that tip). I test her BG again sometime during the afternoon, and then again before I go to give the next shot. Correct? I'm kind of a perfectionist..I like to have a plan at all times. :-D
 
Miss E said:
I figure that since the vet gave her a shot at 7:15, I should also give her a shot around that time tonight, if it is above 200. I will check her BG again before I go to bed; if it is high, what do I do?

If I understand you correctly, in the morning I will test her, if it is over 200, I give her 1 unit of insulin. I then feed her some canned food (spread out thin on plate-thanks for that tip). I test her BG again sometime during the afternoon, and then again before I go to give the next shot. Correct? I'm kind of a perfectionist..I like to have a plan at all times. :-D
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Yup.
We test, feed, and shoot if over 200 mg/dL, all within about 15 minutes when on Lantus.
Lantus hits its lowest point somewhere between +5 to +7 hours after the shot, so if you shoot at 7:15 am, you test any time between 12:15 pm and 2:15 pm, as much as you can.

The pre-test is to make sure it is safe to give insulin, not to adjust the dose. Just record it in our handy, dandy Google Docs spreadsheet/chart (instructions here). Then, if you share it, we can review your data and make suggestions.
 
Sorry I replied in your previous post, didnt realize there was a new one http://www.felinediabetes.com/FDMB/viewtopic.php?f=28&t=100222

Anyway - lantus is a good insulin but I am not sure you want to start her on it quite yet.. especially that number you got today was normal/low (normal cats sit around 40-130) and her insulin would have worn off by then. As long as she isnt on insulin you dont need to worry about a hypo.

I would do a transition to new wet food over the next few days first , and a few blood tests a day, to see how the food change goes (what type/brand are you feeding?) and then we can see if she needs insulin.

But asap get some urine ketone test strips (Also see my post at the above link and make sure you have everything in your kit that you need.) and lets test her for ketones just in case.

Wendy
 
Also let us know where she is - if she really was 33 today she might be "bouncing" tonite from that low number and you might see a high. Dont panic. Thats normal reaction cats have when their numbers drop..

ie

When a cat is first diagnosed, the blood glucose has probably been high for a while. As the insulin starts to take effect and numbers start to come down, the liver has to learn to adjust to the lower numbers. We call this "liver training school". But before it relearns that low numbers are ok, when the BG drops to a number lower than the liver is accustomed, or if BGs drop low, or if the BG drops suddenly, the liver”panics” and reacts by releasing counterregulatory hormones and glucagon. This drives the BG back up. This is what we call a "bounce". Bounces can take up to 72 hours to clear so we are generally careful about increasing doses during the bounce. Once the bounce clears, then you can see the "real" numbers and determine if the dose needs to go up or down.
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Oh. My. Goodness. I picked up the Lantus pen (U-100) at Walmart, and it was $290. I also asked for syringes, and they gave me the needles for the pen. I thought the pen was cheaper, and you just get syringes to draw the insulin out of the pen like you would a vial. Should I go buy some syringes? Holy crap, I'm in sticker shock. :cry:
 
Each pen once "opened" will last you six months if you keep it in the fridge (not the door) . Longer for the pens in the pack that arent opened - thats the expiry on the pack. You dont need the needles for the pen so dont open them and return them.

You are correct, you want the syringes to draw the insulin out like you said as they are more accurate and allow for smaller doses ie Relion 3/10cc 30 & 31 gauge short or BD Ultra fine 3/10cc short orTerumo Thinpro Insulin Syringe 31G 3/10cc.
 
I just checked her BG and it's 27. I checked it again on the other side and it's 28. She's not acting funny or anything. I don't know if this meter is off or not!
 
Test yourself with the meter. Human normal is under 130.

The pens are cheaper, individually. Did you use the Lantus savings card to purchase the pens? Should have been $25 each pen plus taxes. Some people have gone back and gotten the lower cost retroactively.

With these numbers, Kitty does not need any insulin.
 
It's saying mine is 88 mg/dL.

I was worried that her BG was too low, so I gave her some Friskies with Beef and Gravy canned food.
 
So you know the meter is working. That 88 is human normal.

You do not want to give Kitty any insulin tonight.

I think you said, that the vet gave her insulin this morning at 7:15 AM. Was that the last time she had any insulin?

If that was the last time she had any insulin, she should not hypo, even with the low numbers.

It did not hurt to give her some HC (high carb) food. Like that Friskies with gravy.
 
Your reading sounds normal for a human @ 88 so I am assuming your cat's reading is correct. If this is without any insulin, is your cat eating? I would take another reading in a hour or so cause that is VERY low.
 
The vet gave her a shot of Vetsulin at 7:15 this morning. He didn't say how many units he gave her, but he was usually giving between 3-5. She has not had a shot since. I fed her Friskies canned food close to 2:00 PM (central time), and I fed her about almost half of a small 5.5 oz. can of Friskies beef with gravy canned food just a minute ago. Should I feed her the whole can?
 
Kitty can not hypo without insulin on board. She is way to low for you to give her insulin tonight. She needs to have a BG (blood glucose) reading of over 200 before you give a shot.

You do not need to give her any more of the high carb food right now.

If she is still hungry, you can give her some low carb food like the Fancy Feast pates or Friskies pates.

Do you have control solution for the Relion Micro meter you are using? (Not many people do, so don't worry about it if you don't.)

Which style of food was that Friskies you fed her? Shreds? Meaty Bits? Prime Fillets?
 
No, do not feed her the whole can. You do not want her to get too full, where she won't eat later, if you need her to.
I would test again in 15 minutes and post the number. Do you have Karo or Syrup?
 
Hi guys,

Deb & Wink said:
Do you have control solution for the Relion Micro meter you are using?
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This meter didn't come with any, but an older meter I found in the cabinet did have some. Unfortunately, it's out of date (exp. 2005). Bummer.

Dyana said:
Do you have Karo or Syrup?
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I found an old bottle of corn syrup in pantry, but I think it's been in there for YEARS. I would bet that it's not any good any more. I have some waffle syrup and maple syrup in there though.
 
Hopefully, you won't need Karo tonight. Just buy some as soon as you can and keep it with your high carb food and hypo kit in a special place.

With a 27 and 28, I would test again 15 minutes after you gave the gravy food. You want Kitty up in the 60s to 100s. Come on up, Kitty girl.
 
Corn syrup lasts for years. As long as it hasn't crystallized, it's fine. Maple syrup works too as does honey. Not sure on some of those artificial ingredients in the pancake syrup. You can use it in a pinch.

Don't think we will need it tonight, but it's good to have on hand.

Which style of food was that Friskies you fed her? Shreds? Meaty Bits? Prime Fillets?

It would be interesting to get another test, if you can.

Wendy, does she need to make any sugar syrup if she is not giving the insulin tonight?

Dyana, why the concern with the low numbers if there has been NO INSULIN since 7:15 AM today, 11 hours ago. And that insulin was Vetsulin, not Lantus.
 
BJM said:
I think your Micro or strips might be testing too low.
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I don't know. When I take advantage of a drop of blood on myself when I accidently prick myself with a lancet or insulin needle, and test myself I am usually around 80. I would just figure that the meter is correct, for right now, and try to get Kitty's BGs up.

Dyana, why the concern with the low numbers if there has been NO INSULIN since 7:15 AM today. And that insulin was Vetsulin, not Lantus.
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I'm just concerned that the dose of Vetsulin was too high and some hypos can take a long time. I do not think a 27 or 28 is within a normal range for a cat, and I think she should try to get Kitty's numbers back up into normal range.
 
Hi Deb,

I wish I could call the vet, but he is closed for the weekend. :/ I'll get the paperwork he gave me when he was giving her Vetsulin yesterday and see what he was typically doing.
 
Vetsulin is not a depot insulin, so no worries about long duration. Typically, it is out by about 10 hours after the shot.

With those low test numbers, no need for insulin.

Tomorrow is another day ... and I'm thinking that if she is over 200 mg/dL in the morning, make the Lantus dose lower than originally calculate - 0.5 units, not 1.0 unit - because she may have gone really low on the Vetsulin and be more sensitive to more insulin for a while.
 
In order to give that 0.5U dose that BJM suggests, you will need to get insulin syringes. The Lantus Solostar pens only allow you to give the dose in 1U increments.

You could even hold off on the insulin for a few days to see how the lower carb food is working for Kitty.

Would you please get another test to see how Kitty's BG numbers are, about 30 minutes after the time you got that 52. Guestimate this to be your 6:50 -6:55 PM.
 
Ok,

On 7/15, at 8:00 AM her BG was 520, so he gave her 2 units PZI
at 1:30 her BG was 330, so he gave her 2 more units

On 7/16, at 8:00 AM her BG was 356, so he gave her 3 units
at 7:00 PM her BG was 340, so he gave her 3 units

On 7/17, it just says 7:00, no AM or PM and no reading, and he gave her 5 units
there's no time, but there's a BG of 53. He said it was a good number, but because it dropped so drastically, he thought it was too much.

On 7/18, at 7:15 AM her BG was 416, so he gave her 4 units
at 4:30, it was 94, but he said it was too low too fast again, so he gave her 3 units
at 7:15 her BG was 282, so he gave her 4 units.

He just said that he gave her an injection at 7:15 this morning. He didn't say how many units.
 
PZI is a different insulin than Vetsulin. You told us earlier that it was Vetsulin. Is the insulin used actually PZI? or the Vetsulin?
 
The paperwork says PZI next to the first entry, but when I picked her up, he was trying to give me Vetsulin. He did say that he had been using that.
 
Ok, since we are not positive which insulin Kitty has been getting at the vets, I think more tests are in order.

How about that test 30 minutes after the last one, the 52. Should be due in a few minutes.


(Sloppy record keeping at the vets BTW)
 
Deb & Wink said:
(Sloppy record keeping at the vets BTW)
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Right!?

I'll see if she'll let me test again. She's been such a good girl for me. The last one, she shook her head when I stuck her and it made a big drop of blood come out. She may not let me do it again. We'll see.
 
At this point, forget everything your vet has told you about insulin and your cat's diabetes. Vetsulin or PZI are very different than Lantus. Their method of action is different and how you dose is different. With Lantus, you don't keep giving more throughout the cycle as a means of trying to crush the numbers. I am not comfortable with how your vet was dosing your cat. None of these insulins are short-acting and the result of how he was dosing your cat put her in dangerously low numbers. You did great with getting tests and getting the numbers up. I'd encourage you to keep feeding your cat a little bit of food and re-testing in 30 min.

I don't agree with the observation that there's no insulin on board. There are overlapping doses of insulin and they've driven numbers down. I would not recommend giving your cat any insulin tonight. Instead, I'd make a trip to Walgreens and return the needle tips for the Lantus pens and ask for U100 3/10cc syringes with half unit markings. They come in ½ inch or 5/16 inch needle lengths. Needle gauges 29, 30 or 31 (31 being the thinnest).
 
Sienne & Gabby said:
There are overlapping doses of insulin and they've driven numbers down.
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Yes, there might have been overlapping doses of PZI or Vetsulin given yesterday, 7/18. There has only been a single dose of insulin given today, 7/19. At the Vet. PZI or Vetsulin.

This cat has not received any Lantus yet.
 
That was much harder to take this time. She kept rubbing her paw over the blood and wiping away the blood. *sigh*

Her BG this time was 43. She smacked the meter with her paw while I was getting the blood, so I don't know if the blood got on the strip wrong or what. I don't know anything about that stuff, so that probably sounded ridiculous.

I'll give her some more Friskies beef with gravy canned food. I gave her some Friskies pate around 2, and the Friskies beef with gravy (they were little hunks of "meat" in there) around 5:50 (central time). It's now 7:26 here.
 
Try to only give her the gravy part of the food. If you have the lid, you can put that back on top and squeeze out the gravy. Sort of like you would squeeze the water out of a can of tuna fish.

1-2 teaspoons of gravy please with one drop of syrup added.
And retest in 30 minutes.
 
Gotcha! Thank you so much for your help, everyone! You have no idea how much better I feel knowing you guys are here. I'll post results soon.
 
Leave the canned food out so the gravy is runny. It does kind of congeal in the fridge.

Do you have another can of the gravy type food you can open?

You can also set the can of cold food in a dish of very warm water. That gets the gravy to "melt."

I'll be sticking around with you tonight, until we get those numbers back up more.
 
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