I'm at a loss...

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Cindy L

Cindy L

Member Since 2016
Hi there, I just posted my intro on the newbie board, I'm Cindy and my diabetic male cat is Lucky. He was diagnosed mid February of this year. I have a few questions, I am feeling very overwhelmed as am sure so many of you were at first too. Thank you in advance for any help I receive here.
When first diagnosed, BG 585, my vet prescribed Lantus insulin, 2 shots per day, 2 units per shot.
Two weeks later Lucky's number had dropped to BG 300, Vet was not happy with that so she increased the Lantus to 3 units per shot, two shots a day.
I posted on the Facebook diabetes board then as his BG jumped to 485 and they thought this could be a bounce. They felt Vet shouldn't have increased insulin by an entire unit. If it were a bounce, would it not have straightened out by now? As this was 2 weeks ago, he is still on the 3 units Lantus 2 shots per day, and numbers are still running high. Or maybe I think they are high? I test once a day, I have not done the curve yet. It takes all I have to prick his ear, he hates it and is not trusting me. I have poked through his ear into my finger at least twice now. His BG is running on average of 375-400.
My question, is this Lantus helping, since it's not in the high 500s, that is an improvement...will it take time to become lower? or it should be lower by this amount of time.
I have removed all dry food. He eats Fancy Feast Classic, and Friskies pate. I have 4 cats, no longer free feeding. They all eat the canned food now. I feed them every 5 hours. Does this seem ok? Is it ok to give Lucky Fancy Feast for breakfast, Friskies for lunch? etc. Should I be consistent with the food brand. I felt like when I was only using Fancy Feast he became finicky and stopped eating. I did buy the Purina DM from the Vet, again he ate it for a couple of days, then stopped. He seems to like the variety. He has a healthy appetite for the most part and not constantly at the water bowl as he was when first diagnosed.
I am beginning to second guess everything I am doing, am I shooting properly, had a tutorial from vet plus watch Utube videos to be sure. The pharmacist said not to shake, mix, etc the Lantus so I try not to even disturb the bottle much. I keep it refrigerated. It is just beyond 28 days old, could this be the problem? I am using a regular human meter, Prodigy pocket meter. So the number that shows is the correct number, no difference from human to kitty number right? whatever it reads that's what it is, correct?
sorry for all the questions, I appreciate any input. Lastly, I'm guessing I need to make another appointment with the vet, (she did not want me home testing him btw). Would the next step be to increase the lantus? and feed nothing but the Purina DM? I really don't know what to do to get the numbers lower.. Thanks Cindy and Lucky
 
Welcome again Cindy and Lucky and thanks for posting on the Health forum. I am keeping an eye on one of my diabetic kitties right now so I will just cover a few points until others come along. In the beginning everything is overwhelming but it will get easier and make more sense as you go along...I promise...been there done that :)

Many vets are not well versed in feline diabetes. The usual starting dose for Lantus is 1 unit twice daily at 12 hour intervals. Many kitties will be stressed out at the vets and this can cause higher glucose numbers...sort of like the "white coat syndrome" many people have at their doctors. Your vet is increasing the dose too fast and too much. When a kitty starts on insulin it can take a while for their bodies to become climatised to having external insulin (the shots). During this time glucose numbers can sometimes drop a lot during a cycle (the time between shots) and this can cause a "bounce" to higher numbers. Since a kitty's body has gotten used to higher numbers over time the body's counter-regulatory processes release stored glucose (glucogen) to bring the levels back to what it perceives as "normal". When this happens the dose should NOT be increased, as it can cause more dropping and more bouncing.

Home testing is the best way to see what is actually happening with Lucky and how he is responding to the insulin. A test should always be done before each shot and during the cycle. With Lantus the insulin usually starts working about 2-3 hours after the shot and the nadir ( lowest glucose) is usually around 5-7 hours after the shot. This can vary with each cat which is why home testing is so useful.

Also tested protocols call for small dose increases as needed...usually no more than 1/4 unit increase and then hold that dose for a number of days, continue testing and see how the response it. For your vet to continue increasing by 1 unit each time is not good practise...Lucky could be bypassing the dose that works for him. Sometimes too much insulin can give high numbers the same way too little insulin can.

Keep reading all the stickies and hopefully others will be by soon and explain some more. I will stop back in after I deal with my kitty. :bighug:
 
Hello Cindy and welcome to the forum. You need to do a blood glucose test before you give the injection in the morning and before he eats to get and idea of what his blood glucose is and then do another one 6-7 hours later to get an idea of how the lantus is working and where his number is mid day. Then another before the evening injection and feeding. It will give you a good idea of how the lantus is working in his system. What kind of lancets are you using? Do you know the sweet spot on the ears? there is a difference between human and feline meter. anywhere from 10 to 20 points. Also the stickys in the lantus forum have a lot of good info. http://www.felinediabetes.com/FDMB/forums/lantus-glargine-levemir-detemir.9/
Setting up your spreadsheet and posting the the lantus forum with the daily bg will help.
http://www.felinediabetes.com/FDMB/threads/fdmb-spreadsheet-instructions.130337/
 
scoobydoox said:
Hello Cindy and welcome to the forum. You need to do a blood glucose test before you give the injection in the morning and before he eats to get and idea of what his blood glucose is and then do another one 6-7 hours later to get an idea of how the lantus is working and where his number is mid day. Then another before the evening injection and feeding. It will give you a good idea of how the lantus is working in his system. What kind of lancets are you using? Do you know the sweet spot on the ears? there is a difference between human and feline meter. anywhere from 10 to 20 points. Also the stickys in the lantus forum have a lot of good info. http://www.felinediabetes.com/FDMB/forums/lantus-glargine-levemir-detemir.9/
Setting up your spreadsheet and posting the the lantus forum with the daily bg will help.
http://www.felinediabetes.com/FDMB/threads/fdmb-spreadsheet-instructions.130337/
Click to expand...
Hi there, Thanks for the info, Yes I watched U tube videos on the sweet spot. I successfully did it twice this evening. I just feel so bad, he does not like his ears touched as he's always had problems with them, and here I am, just poking away at him, but I know its for his own good. I just feel like he pretty much hates me now. Anyway, he gets his insulin at 930 am, 930 pm, so at 905 this evening his BG was 415, which should have been highest because he was due for an injection at 930 pm. So now at 12:30 am, 3 hours after lantus injection when insulin should be working well, it was 365. Doesn't seem like a big drop? meanwhile he's not had any food since 630 pm. I also feel like he's not himself, normally a very social kitty, follows me everywhere, but the last 2 days has been sleeping alone in another room...It's late now and I am so stressed, I just feel helpless, I don't know if he's getting too much or not enough. I will try again tomorrow. Thanks again have a good night.
 
Tuxedo Mom said:
Welcome again Cindy and Lucky and thanks for posting on the Health forum. I am keeping an eye on one of my diabetic kitties right now so I will just cover a few points until others come along. In the beginning everything is overwhelming but it will get easier and make more sense as you go along...I promise...been there done that :)

Many vets are not well versed in feline diabetes. The usual starting dose for Lantus is 1 unit twice daily at 12 hour intervals. Many kitties will be stressed out at the vets and this can cause higher glucose numbers...sort of like the "white coat syndrome" many people have at their doctors. Your vet is increasing the dose too fast and too much. When a kitty starts on insulin it can take a while for their bodies to become climatised to having external insulin (the shots). During this time glucose numbers can sometimes drop a lot during a cycle (the time between shots) and this can cause a "bounce" to higher numbers. Since a kitty's body has gotten used to higher numbers over time the body's counter-regulatory processes release stored glucose (glucogen) to bring the levels back to what it perceives as "normal". When this happens the dose should NOT be increased, as it can cause more dropping and more bouncing.

Home testing is the best way to see what is actually happening with Lucky and how he is responding to the insulin. A test should always be done before each shot and during the cycle. With Lantus the insulin usually starts working about 2-3 hours after the shot and the nadir ( lowest glucose) is usually around 5-7 hours after the shot. This can vary with each cat which is why home testing is so useful.

Also tested protocols call for small dose increases as needed...usually no more than 1/4 unit increase and then hold that dose for a number of days, continue testing and see how the response it. For your vet to continue increasing by 1 unit each time is not good practise...Lucky could be bypassing the dose that works for him. Sometimes too much insulin can give high numbers the same way too little insulin can.

Keep reading all the stickies and hopefully others will be by soon and explain some more. I will stop back in after I deal with my kitty. :bighug:
Click to expand...
Thank you, and best of luck with your kitty. I am trying to understand how this works, so he's not going to be hypoglycemic, its not like a false positive, right? it is what it reads, but may be reading high because too much insulin will can drop the glucose too low, so the body produces extra? I'm trying to understand this, not sure if it's sinking in yet. Im just scared to death I don't know what Im doing and am I doing him more harm than good?
 
Here's something I wrote up for others that needed help with testing...maybe it'll help you too!

It can be really helpful to establish a routine with testing. Pick one spot that you want your "testing spot" to be (I like the kitchen counter because it's got good light and it's at a good height....it also already blocked 2 escape routes due to the wall and the backsplash) It can be anywhere though...a rug on the floor, a table, a particular spot on the couch...wherever is good for you. Take him there as many times a day as you can and just give his ears a quick rub and then he gets a yummy (low carb) treat. Most cats aren't objecting so much with the poking..it's the fooling with their ears they don't like, but once they're desensitized to it and learn to associate a certain place with the treats, they usually start to come when they're called! Or even when they hear us opening the test kit!

You also have to remember...you're not poking him to hurt him...you're testing him to keep him safe and understand what's going on inside his body. There's just nothing better than truly understanding what's going on inside your kitty's body and with this disease, the more knowledge you have, the more power you have against it. The edges of the ears have very few pain receptors, so it really doesn't hurt them. Also, if you're nervous and tense, it's going to make your kitty nervous and tense too. As silly as it might seem, try singing! It forces you to use a different part of your brain!

It's also important to make sure his ear is warm. A small sock filled with a little rice and microwaved or a small pill bottle filled with warm water (check temp against your wrist like you would a baby bottle) works well

Finding the right "treat" will be a great help too! Freeze dried chicken, bonito flakes, little pieces of baked chicken...whatever low carb treat you can find that he really enjoys will help him to associate the testing with the treat! China's Achilles heel was baked chicken, so I'd bake a piece, chop it into bite sized pieces, put some in the refrigerator and freeze the rest to use as needed. It didn't take long for her to come any time I picked up the meter!
 
Put a little cotton pad or a strip of folded kitchen paper under the ear to support it when you do the poke. It should increase your success rate (and save you poking your finger!).


Mogs
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Cindy

Just to give you an idea of how bouncing can work.....My Maxie girl was diagnosed diabetic about 1 month ago. A month and a half earlier her numbers were fine, since I tested her regularly because of her diabetic brother, so she was caught very early. She is on Levemir insulin which is another long lasting insulin like Lantus.

Yesterday her glucose numbers were running between 300-400 during the day. Last night 5 hours after her shot she got down to 52 (on a pet meter) and this morning before her shot she was at 454. The higher number this morning was because she went much lower than her body is used to and she "bounced" back up. This can happen with some kitties for a period of time while their bodies "relearn" to accept more normal glucose levels. IF she was tested at the vets office yesterday during the day and then again this morning it would look like the insulin was not working and some vets might want the dose raised, which would be the wrong thing to do in this case. This is why doing home testing is so important...it shows how low the insulin can get the glucose numbers. Both Lantus and Levemir insulin dosing is based on how low the dose brings the glucose levels.

Many (too many) vets do not approve of home testing, which makes no sense. If a person is diabetic they are told to ALWAYS test before their shots and several times a day in between. Why should it be any different with our kitties? Chris & China has given you some good pointers on doing home testing. I have 2 diabetic kitties that I test numerous times each day and when I first started I never would have believed that testing could end up being as routine as it is now. We are all scared and over-whelmed in the beginning but it gets better and there are some wonderful people on this site to help make it easier for you. :bighug:
 
I'm not familiar with Lantus, so I can't help you with that. But you did say that you feed every 5 hours, do you make sure there's no food for at least 2 hours prior to testing?
 
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