Insulin dosage

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bigboy

Member Since 2012
Hello everyone. I am pretty new to this website. I posted a few times about a year ago, however I lost my password and couldn't sign back on, so I made a new name.
Anyway, my cat Big boy just came home from the hospital about 1.5 weeks ago. He is a diabetic cat, about 12 years old. He was diagnosed with DKA and a possible infection. The doctors had him on fluids and antibiotics, as well as their fast working insulin. Now that he is home, we are trying to regulate his sugar levels so this won't happen again. I have seen a slight improvement since he has been home. The vet has us on 2 units as of now, 2 times a day (AM & PM). We chart his blood sugar levels twice a day. This is what it has looked like over the past week:
11/12/12- AM 240, PM 459
11/13/12- AM 393, PM 353
11/14/12- AM 383, PM 423
11/15/12- AM 206, PM 308
11/16/12- AM 452, PM 465
11/17/12- AM 309, PM 286
As of this morning his blood sugar was 273. We test him again in about a half an hr or so.
I would just like some advise on what everyone thinks we should do as far as his insulin levels? Thank you very much. We appreciate everything :smile:
 
Need a tad more info, please:
What are you feeding? We recommend over the counter low carb canned / raw food.

What insulin are you using? Lantus, Levemir, Prozinc, BCCP PZI? These are the longer lasting insulins for cats. We avoid Humulin/Novolin N as it lasts only 6-8 hours in the cat.

Please read my signature link Secondary Monitoring Tools for info on ketone testing, since he was DKA.

Also, regulation is a process, not an event. It is going to take some time to get consistency and control the glucose values.
 
Come on folks. Big Boy is a DCIN-assisted cat that went through more than $4K in treatment for DKA a couple weeks ago. DCIN has told Kelly and Dave that they have to bring BB to one of the diabetic cats forums for assistance, because the DCIN case managers do not help with dosing advice.

Big Boy is on Lantus.

If FDMB can't help Big Boy, DCIN can send Kelly and Dave to another Board for help. However this is where they opted to start. Anyone besides BJM out there to help with BigBoy?

photo+(2).JPG
 
Hello, and welcome to FDMB!

It sounds like you and BigBoy have been through a really tough time together... But well done, you, for 'grasping the nettle' and starting with hometesting so promptly. :smile:

I don't use your insulin so am unable to help with dosing advise, but I do suggest that you edit your message to add 'Lantus' to the title to attract the attention of other Lantus users. Also do consider posting in the Lantus TR forum here at FDMB as you may catch the attention of other Lantus folks who may not see the general forum.

Welcome aboard!

Eliz in UK
 
If Big Boy is already on a low carb diet, that's great. If not, a good place to start some reading is Cat Info.

Some mid-cycle tests will show how well the Lantus is working - the nadir, about 6 hours after the shot - is the lowest point in the 12 hour cycle and it is used to adjust dosing (you're aiming for no lower than 50 on a human glucometer). Just eye-balling your tests without the nadir data, I'm going to guess that the nadir is over 150. If you get a mid-day test that confirms that, then you can follow the dose adjustment protocol for Lantus in the forum (here), which may increase the dose 0.25 to 0.5 units. But you really need that mid-cycle number before changing, to make sure he isn't going too low - some cats have very wide swings from pre-shot to nadir and going too low (hypoglycema) is disastrous much more quickly than DKA is.

Lantus builds up in the system, so dose adjustments are made following the protocol which allows for about 3 days time before considering another dose increase.
 
Welcome Kelly and Big Boy!

As he is a DCIN boy I would assume that the vet chose the insulin dose based on weight. I would think it is too high to begin with but since he started off with insulin in August that could be just up dosing based on numbers and an apparent infection somewhere.

One thing I would suggest as you are home testing is to start a spreadsheet so we can know what numbers he gets and we have greater confidence in advising with dosing. And i would suggest getting more than two tests a day in. As Lantus is a long acting insulin you really need to know how low he goes on a dose so a third test is needed at the very least (about 6-8 hours into the cycle) which in turn helps us to dose.
http://www.felinediabetes.com/FDMB/viewtopic.php?f=6&t=18207 spreadsheet link

The post did not mention his food- a low carbed, canned food diet is the best and makes a huge difference on the dose as well but, as someone connected to DCIN I figure they would also give you the low-down on the proper foods to feed.

For dosing advice it is difficult. On one hand, with his high numbers you wonder if he is getting too much but on the other he just is recovering from DKA so that will most likely screw up the numbers as well. Is the infection taken care of? Do you know what he had?
 
Hello again everyone. Thank you for your replies and happy holidays!

Yes, that is the photo and article of us and our kitty big boy. He is on Lantus. He is a pretty big cat, about 13-14 lbs currently, and he is approximately 12 years old.
At first we had him on a raw food diet: raw meat, raw eggs. He loved it, however it was definitely frowned upon with some of the vets we had spoken to in the past. When we first found out he had diabetes we were pretty much "chasing numbers" as our current vet likes to call it. We were adjusting his insulin dosages to how high or low his blood sugar was. However, now we are doing a solid dose of 2 units per every 12 hours (7am & 7pm).
His numbers however are still all over the place. Our vet wants to eventually try to get him off of insulin just by what type of feeding technique we decide on using. Now we have him on Science M/D, which is a meat based prescription food. While he was at the hospital, they had put him on this food, as well as dry food which we were pretty upset and astonished with @-) , mainly since research shows that dry food is not so good for cats in general, especially kitties with diabetes.
So now, we are seeking advise from this board, and also from our current vet who seems very very involved so far with helping us. He wants us to stay on science m/d food for a while to keep him on a consistent diet. However, I am hearing a few different things, so it is all still very confusing and difficult to chose what is best for our kitty. Our vet did give us a lot of reading material on diabetic food research in cats, so I will be reading that over the next few days.

Again, thank you all for reading and posting, and if you have any additional comments/questions/statements, let me know. :-D
 
Venita and Ennis93 said:
Come on folks. Big Boy is a DCIN-assisted cat that went through more than $4K in treatment for DKA a couple weeks ago.
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Venita,
And we would have known that how?

Hi Kelly,
Glad your here. I have a couple of concerns about your vet's advice so far.

Since you are getting assistance from DCIN, it's safe to assume you are home testing. Do you have all the data you've collected so far, and are you able to put it into a spreadsheet for all of us to see?
The starting dose of 2u may or may not be a good dose. Only the data will tell you that.

The vet's choice of diet is terrible, and maybe your case manager at DCIN can call the vet and explain that Hill's M/D is garbage for a diabetic cat. Here's a link for you to share with your vet, info written by a vet who is a leader in the field of feline nutrition:
http://www.catinfo.org/?link=felinediabetes
Even the canned Hill's is inappropriate for a diabetic cat. It's too high in carbs. It also costs a fortune, and you can get much better and less expensive low-carb canned foods at the grocery store. Fancy Feast Classics are a good choice. They are all low carb.

Here is a link that you can use to set up a spreadsheet at google docs. If you need help doing this, let us know.
http://felinediabetes.com/FDMB/viewtopic.php?f=6&t=18207

It's great that you have data on the BG values at shot time. But you'll also need data from other times during the day. The most important "number", when you are using Lantus, is the number that shows the low point, or "nadir" of the 12 hour cycle between shots. That is the number that will tell you how effective the current dose is, and will tell you when that dose needs to be adjusted. Nadir, typically, would happen sometime around 6 hours after a shot. That is different for every cat, and it can change at times. But it's a good place to start.

Does your schedule allow you to get tests "in the middle", and to maintain a shot schedule that is 12 hours between shots?

Are you checking for ketones at home, using urine test strips? With a DKA episode recently, you're obviously aware of the danger and costs associated with ketones, and it isn't a place you ever want Big Boy to go back to. Did DCIN send you some ketostix?

In order for us to effectively help you, you should try to post frequently, and keep your spreadsheet (once you've made one) as up to date as you can. It's a very valuable tool in this treatment routine.

So, my advice for the immediate future:
Create a spreadsheet.
Try getting mid-cycle tests as you can, and also test before every shot.
Return the M/D Hill's food to the vet for a refund and buy some low carb canned food at the grocery store, like FF Classics or Friskees Pate varieties.
Test regularly for ketones.
Post here daily if possible.

And take a deep breath or two every day. This isn't a "huge" deal. As far as feline diseases, diabetes is very manageable, and Big Boy can have many happy and healthy years in his and your future. And you're in good hands with Venita and the rest of the wonderful people that make up DCIN. They are life savers, literally.

Carl
 
Hi Carl,

I am going to set up a spread sheet right now, and also on Sunday I am going to do a full glucose panel. I am doing home testing, twice a day morning and night. On the weekends it would be much easier to do testing during the day as well, however during the week it is difficult to test in the middle of the day. I suppose when I get home from work which is sometimes about an hour before I feed him I can test him then as well.
The vet has given me some articles on food choice, of which I am not so sure of. I think the science M/D really isn't helping much.
After getting the glucose panel this weekend, we are going to see if we need to adjust his insulin, which is looks like we should.
We did have him on a raw diet, but as said before it was very frowned upon. We wanted to get him away from canned food and dry food. The dry food is completely out of his diet as of now, however we are experimenting with science m/d.

We do have ketone strips that I am going to start using. I wanted some advice on that as well. I have never really tested his ketones at home. How should I go about doing this?

Thank you very much for your advise and response! I appreciate all of this very much. I'm going to create a spreadsheet right now and will post back soon. Thank you again.

Sincerely,
Kelly & Big boy :smile:
 
Hi Kelly,
Nice to see you!
We do have ketone strips that I am going to start using. I wanted some advice on that as well. I have never really tested his ketones at home. How should I go about doing this?
Click to expand...
It really depends on how much privacy Big Boy likes when he's using the litter box. What you have to do is catch him in the act, and place the stick in the stream of urine while he's peeing. If he doesn't mind you doing that, it's easy. Then the stick will change color if ketones are present, and there should be a chart on the box that says what each color means. Ideally, you're hoping for no change which means no ketones. If catching him using the box is a problem, then there are more ways to go about it, which we can help you with if it comes to that.

Glad you were able to remove all dry food from the diet. Even the canned m/d is higher carbs than we recommend, and if you can get him to eat canned that is lower in carbs, that will help his BG numbers becoming more regulated. I don't understand the raw diet being frowned upon, but I guess it depends on what exactly it was. Dr. Pierson's site advocates a homemade diet, and there's even a recipe she uses which combines raw rabbit and partially cooked turkey:
http://www.catinfo.org/?link=makingcatfood

Looking forward to seeing your spreadsheet. Don't worry too much about not being able to test all week in the middle of the cycles. Do what you can when you can. Getting a curve on a weekend is a great idea. Just try to work spot checks into the weekdays, like a test before the shot, and one on the way out the door, or just before you go to bed at night. Any data you are able to gather is helpful when looking at the big picture.

Carl
 
Not that I can give any dosing advice but a BIG hint on those articles your Vet gave you? What company put them out? Hills? Science Diet perhaps??? I'm just sayin..:/

Good luck and WELCOME to the BEST site on the planet to help you help your kitty.
jeanne
 
bigboy said:
Hi Carl,

I am going to set up a spread sheet right now, and also on Sunday I am going to do a full glucose panel. I am doing home testing, twice a day morning and night. On the weekends it would be much easier to do testing during the day as well, however during the week it is difficult to test in the middle of the day. I suppose when I get home from work which is sometimes about an hour before I feed him I can test him then as well.
The vet has given me some articles on food choice, of which I am not so sure of. I think the science M/D really isn't helping much.
After getting the glucose panel this weekend, we are going to see if we need to adjust his insulin, which is looks like we should.
We did have him on a raw diet, but as said before it was very frowned upon. We wanted to get him away from canned food and dry food. The dry food is completely out of his diet as of now, however we are experimenting with science m/d.

We do have ketone strips that I am going to start using. I wanted some advice on that as well. I have never really tested his ketones at home. How should I go about doing this?

Thank you very much for your advise and response! I appreciate all of this very much. I'm going to create a spreadsheet right now and will post back soon. Thank you again.

Sincerely,
Kelly & Big boy :smile:
Click to expand...

Hi Kelly,
Welcome to FDMB. You will not need to go to any other site for help.
I don't know if anyone has explained the questions asked earlier of the insulin used and the current diet..... your first post had no mention of diet or insulin. Also, several members on this board may know of DCIN, but are not frequent visitors to DCIN and are not aware of all the cats who are helped by DCIN.

So, for the diet, I would return ALL the vet food, and you can take a copy of info about food to the vet from Dr. Lisa Pierson, her site is http://www.catinfo.org/ ... I am sure that your vet will learn a great deal of info, including the value of the raw diet for cats. DRY food is the last thing to feed a diabetic cat and that alone tells me your vet knows nothing about nutrition and little about treating diabetic cats. Sadly, you WERE feeding your cat well on a raw diet, check on the recipe, etc on Dr. Lisa's site, but your vet had you put your cat on a poorer diet. On Dr. Lisa's site, she has a huge list of many foods with info that she had gathered and compiled after hundreds of hours contacting pet food companies. She knows her food.

For the insulin, because there are different insulins which have different reactions and methods by which dosing is done, it was an important question to ask you. I have not used all the insulins, so I would have more to say about the ones I have used. Lantus is one of the insulins I have used, so I am sure that others before me have already mentioned that dosing is best based on nadir.
Curve showing reaction of insulin
Example of a typical curve:
+0 - PreShot number.
+1 – Usually higher than PreShot number because of the last shot wearing off. May see a food spike in this number.
+2 - Often similar to the PreShot number.
+3 - Lower than the PreShot number, onset has started.
+4 - Lower.
+5 - Lower.
+6 – Nadir/Peak (the lowest number of cycle).
+7 - Surf (hang around the nadir number).
+8 - Slight rise.
+9 - Slight rise.
+10 - Rising.
+11 - Rising (may dip around +10 or +11).
+12 - PreShot number.
So you can see from the above that it's great to know BG at the time of shots to know it's safe to give a shot, but it's also important to know what's going on in the middle.... is Big Boy dropping too low and then bouncing up higher, is he coming down nicely and then rising again to the next shot time, or is he just staying flat with no drop in numbers.
By testing along the cycle, the above 3 situations would tell you, ... too much insulin, just enough insulin, or not enough insulin. All 3 situations could give you the same BG numbers at shot time.

Because of the history of DKA, you want to be sure to test Big Boy's urine for ketones daily by using KETOSTIX. It seems that some cats are just more prone to ketones over others.... both of my cats had long stretches of high numbers but never even a trace of ketones, and it is important to know that cats can have ketones even at lower BG numbers, so you will need to be pretty regular with testing Big Boy. You can get a container of the KETOSTIX at any pharmacy.

You can ask any questions you may have because there is nothing you can ask that someone else here has not asked or wondered in the past.

To know the road ahead, ask the man coming back.
 
Hi Everyone,

Here is the link for the chart that I started:
https://docs.google.com/spreadsheet/ccc ... lRpakU2TXc

I will be adding to it over time. I have spoken with our vet again and he and I are to discuss a change in big boys insulin, possibly tonight. On Sunday I conducted a glucose panel. That will be added to the spread sheet as well. When I talked with the vet yesterday he said he had to run some numbers based on big boys glucose panel, and figure out exactly how much he would like to alter his insulin dosage. He believes maybe a quarter or half dose more.

What does everyone think?

I also am trying out Natures Variety Raw food with big boy. The last time we did a raw diet it wasn't as whole or complete as we had liked it to be.

Does anyone have experience with this brand of raw food?
 
jt and trouble (GA) said:
Not that I can give any dosing advice but a BIG hint on those articles your Vet gave you? What company put them out? Hills? Science Diet perhaps??? I'm just sayin..:/

Good luck and WELCOME to the BEST site on the planet to help you help your kitty.
jeanne
Click to expand...

Hi JT & Trouble.
He actually is against the diet that the hospital had put us on (which was hills/science md). But what he was explaining to me was that he wanted to get bb's levels straightened out before we did any drastic changes.
One of the articles he gave me was "Dietary Recommendations for Cats with DM" By: Deborah Greco, DVM, PhD, ACVIM. Dated March 2005.
And then he gave me a couple that were actually from this website. I told him that I have been posting on here, but it was still kind of him and is always good to refresh upon.
 
I like the fancy feast classics. FF has worked well for Brie. I wouldn't try to many different foods at one time. I do understand that your vet wants you to stick with one food but the food that BB is eating wouldn't be my choice. I think your vet just wants consistency. Same food given at the same time and insulin dosing at the same time every day. As far as giving advise for insulin dosing I do not feel comfortable.

Sandy
 
Hi everyone! Thank you for everything again. It is very appreciated!!

We do want consistency, that is why we gradually switched from the m/d to a new raw food called natures instinct. Big boy has been really enjoying it so far, and it seems to be helping with his numbers.
Right at the same time we were switching foods, the insulin levels were changed, due to the outcome of a glucose panel I did at home. All of the results will be up for viewing very quickly. I am just working on the spread sheet now.

Due to this diet change however, 2.5 units seemed to be too much, so I tried 2.25, which was also too much, and 2 and a smidge. Still too much. So we went back to 2 units and now we are deciding whether the food is helping out that much because once a day, he is going either too low or is at a good level (between 80-160) to give him 2 units of insulin. The vet and I are working on stabilizing his numbers right now.

Does anyone else thing that the diet is helping this much that his insulin dosages needs to be lowered?


Again, I will post the chart and his numbers in a short while.
 
Hi - can you please update your spreadsheet to show more recent numbers? Also, in the light blue "U" column is where you put the insulin dosage in units (1.00, 2.00 etc). This is really valuable information we need to see to be able to advise you better :)

It's actually better to get the food change out of the way earlier rather than later. M/d is 13 or 14% carbs... too high. But when you remove carbs from the diet, the insulin need drops as well. Some cats drop 100-200 points with the removal of higher carb food alone. My Scooter went from 500's to mid 300's when I switched him to low carb. It's better to change the diet ASAP, while you're still on a nice low starting dose of insulin or even before you start insulin... instead of upping his insulin because he needs it to counteract the 14% carb food, and then suddenly removing the carbs keeping his BG up. This is happening to you now. 2.5 units was needed to counteract the 14% carb food, but now that you've gotten rid of the carbs, it's too much insulin!

Your goal is to find a dose you can shoot 12/12 consistently. That means no skipped shots. It's important for him to always have insulin in his system, especially if he's been in DKA before. If you're getting low preshots, skipping a shot, and then finding him spiked high 24 hrs later, you need to drastically cut the insulin dose down. You may want to go back down to 1u and work up from there, but others who have dealt with DKA may have better advice.
 
https://docs.google.com/spreadsheet/ccc ... lRpakU2TXc

Here is an updated copy of big boys numbers and insulin dosages.

You can see over the past couple of days that it has been going up and down. Mainly after giving him 2u of insulin. The vet had a theory that the food that we switched to has been helping his glucose levels. Right now, we have been trying to be consistent with the 2 units, however since he goes into a zone that is "normal", we have been hesitant to give him any insulin. Does anyone have a chart or advise on giving him dosages when he is between 80-150?

I agree that missing shots is not good, however if he is lower, like I said above, we are hesitant to give him any because we do not want him to go into hypoglycaemic shock.
 
Ah - it seems you have filled your spreadsheet out incorrectly. You have two rows for the same date. I can see the numbers bouncing a lot though. It would probably be best if you started a new spreadsheet from scratch.

Each row or line horizontally is a single day, 24 hours. In the "AMPS" column (very first vertical column after the date) is the AM Preshot number you got right before you gave insulin in the morning. In the U column (light blue one), you put the amount of insulin you gave at that shot. In the +1, +2, +3, etc. spots, you put in the numbers (if any) you got in the middle of the cycle. If you tested 6 hrs after that morning shot, put that number in the first +6 spot and so on. The "PMPS" column is the PM Preshot number - the number you got right before you gave the PM shot. Then, again, the units of insulin you gave. And then again, your mid cycle blood glucose tests.

Lantus is dosed based on your mid cycle "nadir" (lowest point of the cycle) tests - not the number you get right before you give insulin... UNLESS you are a newbie (which you are)... then we don't recommend you shoot under 200 until you know how your cat is going to respond to the insulin. Since I can't really understand your spreadsheet I will have to wait until you've corrected it to understand the data better :-D If you have any more questions about the SS, let me know. It might help you to take a look at mine or other member's to see how it's supposed to look.
 
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