Insulin nightmare

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Linda and Tasha

Linda and Tasha

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My 11 1/2 year old, always thin cat was just diagnosed with diabetes.(she is around 7lbs- highest weight maybe 7 1/2 lbs.) Let me preface what I say by telling you I have brought up a diabetic child so I know a lot about the disease in people not cats of course.
She was started on Lantus 1/2 unit once a day to begin. I was told to wait a week to test her bg but I did a few tests 4-5 days in here and there and her numbers ranged from the 300s in the morning to the upper 100s in the afternoon (6 hours after shot) back to the upper 200s -low 300s at night. My first guess was she probably needed another shot and the Lantus was lasting around 12 hours and peeking at 6. I had been giving her shots in her hind legs. I switched to the scruff of the neck 2 days ago and after a bg of around 251 the morning at shot time, her bg went to 107 two hours later. I was a bit concerned because it seemed too fast and I had never tested her before at 2 hours after her shot. I could not test again because I had to leave (I left extra fry DM food) and tested her at 12 AM in the morning and got 315. The next day I again gave her her shot in the scruff of her neck. Two hours later she was 118. I checked her two hours after that and she was 57 and I treated her with Karo syrup waited to her bg went up to 120 fifteen mins. later and gave her some food to help prevent a rebound effect. The rest of the day she was in the mid 300s which is not surprising after having a low.
I am wondering if one, the placement of the shot in the scruff made it quicker acting and I should just give her 1/2 a unit in her leg (I have never tested at 2 hours after the shot when doing this so I don't know if it would make a difference), two if this is the wrong type of insulin for her, three if I should skip today's shot and just giver her DM food and test her, or actually attempt to give her 1/4 of a unit of insulin. I tried calling my vet yesterday but she was off and the vet I spoke to said 1/2 unit of insulin would have no effect on a cat and I should just stop giving her insulin and something else was wrong with her. (I didn't buy that in the least. My daughter was diagnosed at 3 and was on 1/2 unit a day and she sure weiged more then 7 lbs!) I am also wondering if the Honeymoon affect was going on and she was making some of her own insulin along with what I gave her. (The vet did not know what honeymooning with diabetes was.) Can anyone who might have a similar situation offer up some advise as to how to proceed today. Thank you in advance for reading this and offering your advice.

* Edit: trying .25 this morning. http://spreadsheets.google.com/pub?key= ... utput=html


~~Edited by moderator to remove 911.
 
Welcome. You are doing very good so far. It looks like you cat (what is her name?) may be starting honeymooning. It takes a few days for Lantus to really start working so the change ins shot location may not have been the greatest effect. Some people has said that the scruff is less effective than elsewhere.

You can probably increase the change of honeymooning by changing from the dry to a low-carb canned food. Changing the food like that will probably result in the need for less insulin so be carefule.

From the BG data you presented, 1/2 unit twice (bid) daily is probably too much and should be reduced to 1/4 bid.
 
Thank you for your prompt reply. I have only been giving her 1 shot of 1/2 a unit a day but realize the morning high imply it doesn't last 24 hours like it does in my daughter's case. I have been giving 1/2 a can of friskies that i found was high protien/low carb (as feed as opposed to what they put on the labels) along with 1/3 cup of the dry DM in the late evening. I will take your advice and try 1/4 of unit in the scruff again today (no evening shot yet) and see how that works. Unless you have a better idea. Thank you so much for your input!
 
Re: Insulin nightmare-Lantus user

Hi and Welcome to FDMB :mrgreen:

Your way ahead of the game!!!!!Super

Lantus is the perfect insulin to be using. It is having wonderful results in cats if used following a protocol.

Need to clarify;

You said when we started 1/2 unit.
Is she still having 1/2 unit? or more


Lantus is a long acting insulin, so you don't want it to absorb quick-scruff is fine.There's an ever going debate about this.
That 57 is almost at a level of a decrease. Here we go by a cat hitting 50 or under to get a reduction.Is this the lowest number you have had?
If so, don't decrease just yet, until changed food and got some more spotchecks in.

I'm sure with a diabetic daughter, time isn't always kind, but if you could look at setting up a spread sheet that would help us to help you more clearly.

Here are the instructions:
http://felinediabetes.com/FDMB/viewtopi ... &t=16#p103

In the meantime, you could just type;
Date
AMPS...
+2...
+4....
+6...
etc
PMPS

+2....
+6 is usually nadir (lowest point in cycle-are these terminologies the same as you use for your daughter?)
This is the number you base your dosing decisions on.
I wouldn't raise.
Also D/M-Yuck!!! Expensive and nt very good food.
If you look at the top and click on foodcharts you'll see there are way better foods that are commercial and cheap! They have low carbs.FF seems to be a popular one in USA.
That change in itself might be enough for you to get kitty diet controlled.
If you click on insulin support groups, you will see one for Lantus. At the top of that forum are various stickies giving info on how to use it-very informative.
You would hopefully be looking towards a decrease to .25u and then to .1u-do you have syringes with 1/2 unit markings?
The .1u sounds so tiny, but it means the Pancreas is having just that little bit extra help whilst healing.
If you click on some o the posts in Lantus and look at spreadsheets you can see how other people test. We've also had several come off insulin in the last fewdays and again you can see how they have gradually reduced the insulin.
The higher numbers you see are bounces from the lower numbers. Some cats clear these quicker than others.

Definitely a cat with a partially working Pancreas in my view

Keep asking questions :mrgreen:
 
Sounds to me like you're doing a great job. Typically, the onset of a scruff shot is longer, not shorter, but each cat is different. I'd drop the the dose back to 1/2 unit, twice a day, and stick with the scruff area since you're getting the better response there. [edited: just read that you were giving 1/2 unit before. So I agree with Larry about dropping the dose further and giving it twice a day.]

Once you have her stabilized, I'd remove the DM dry. Dry food, even the DM, is much higher in carbs than grain-free wet food. Plus, the carbs in the DM are the equivalent of doughnuts. But the response from removing dry can be dramatic, so you definitely need to drop the insulin dose before you remove it.
 
Just read your last post.

Can you get a test before you shoot this evening and post it before you shoot?

Do you have more Friskies? It's a popukar one here and your right, low in carbs.
Can you forget the dry D/M? I'm reading that kitty has shot in a.m and DM is given in the evening? If so, cut the D/M, But you need to get some spotchecks and might be looking at smaller dose. Posting your numbers will help us to help guide you.

Then can you get some spotchecks in and you would be looking at shooting twice a day. Insulin is processed faster by cats than humans, hence the B.I.D use.
Needs to be given consistently 12 hrs apart.
Your building up what is called a shed-explained in the stickies that I mentioned.
 
The link works but it's not the one you want to use. Anyone who uses the link above can make edits to it :o

Log back into your spreadsheet. At the top right is a button called Shared. Click on that and choose the Publish As A Web Page option. Put a check mark next to Automatically republish when changes are made. In the box below is the link you want. Copy that link and paste it into your signature, replacing the wrong one you have.

Step by step pictures are here: http://felinediabetes.com/FDMB/viewtopic.php?f=6&t=16
 
Yep spread sheet was on your last post.I think it can be edited by others, need someone who's tech to look at it.

I'd get at least one spot check in at +6. Looks like a bit of rebound from the karo you gave yesterday.
I'd go with .25u tonight (you may need to increase again, you may not. Not enough data just yet)
Cut out the dry tonight.
Get at least one spotcheck tonight of a +2 to see where Tasha is heading (cute name :mrgreen: )

Now you have spread sheet, you could open a thread in Lantus isg. Get lots more advice/support off Lantus users there.
Would copy and paste this thread into your first post so people know what has been happening.
Looking very very promising :mrgreen:
 
Think I have the spreadsheet correct now. I hope. I feel a little uncomfortable giving a second shot without more numbers yet. Tasha is hard to check when it comes to getting BG. I want to concentrate on the first 12 hours and see where we are before I start with a second shot. I am trying to err on the cautious side. I do realize I will be adding a second shot. I also have been using a syringe with 1 unit markings and need to get the smaller .5 ones. Another question regarding meters. I have heard that they correlate the same in cats to humans, but I have also heard that it isn't true. Which is it I am using a human one touch meter?
Thank you all for your help!
 
lmaty said:
Think I have the spreadsheet correct now.
Click to expand...

You have the right link now :thumbup Can you put it into your signature? That way we won't have to keep asking you to post the spreadsheet link :smile: Go to User Control Panel. Under Profile click on Edit Signature.


lmaty said:
I also have been using a syringe with 1 unit markings and need to get the smaller .5 ones.
Click to expand...

The half unit markings will make it so much easier to measure small doses of insulin :smile:

Here's are brands of half unit marked insulin syringes that members here use and where to buy: http://www.felinediabetes.com/phorum5/r ... 22,1959486 (may take a few minutes for the page to load).

lmaty said:
Another question regarding meters. I have heard that they correlate the same in cats to humans, but I have also heard that it isn't true. Which is it I am using a human one touch meter?
Click to expand...

The blood glucose meters are pretty accurate for cats. A meter can't tell the difference between cat blood and Human blood. There are pet-specific blood glucose meters but they are no more accurate than a Human blood glucose meter and cost like 10 times as much and you can't buy test strips from any pharmacy (have to buy them from vet at hugely marked up price) :-Q
 
Meters can tell the difference between animal and human blood. This is because the distribution of glucose between the liquid (plasma) and solids (cellular, mostly red blood cells) is significantly different. This is why the animal meters have different codings for canines and felines. The distribution is:

The distribution of glucose between red blood cells (RBCs) and plasma in whole blood samples is different between humans1, canine, and felines2.

Species Glucose Concentration in RBCs Glucose Concentration in Plasma
Human 42% 58%
Canine 12.5% 87.5%
Feline 7% 93%

However, human meters are accurate enough for animals.

squeem3 said:
lmaty said:
Think I have the spreadsheet correct now.
Click to expand...

snip

The blood glucose meters are pretty accurate for cats. A meter can't tell the difference between cat blood and Human blood. There are pet-specific blood glucose meters but they are no more accurate than a Human blood glucose meter and cost like 10 times as much and you can't buy test strips from any pharmacy (have to buy them from vet at hugely marked up price) :-Q
Click to expand...
 
Hi Just a couple things to add:

We typically find that Lantus needs to be given twice a day in 12 hour increments, not once a day. This could explain why you are seeing the swings.

Also, please visit the lantus forum and read the starred posts at the top - they will tell you everything you need to know about lantus handling, storage, dosing, etc.

Insulin Support Groups

Regarding meters, there was a previous discussion on the subject and this link may help. While yes, there is a difference between human and animal blood, we find that using a human meter on the cat works fine.

http://www.felinediabetes.com/phorum5/r ... ?8,1840808

There are three key factors to managing diabetes: food/nutrition, home testing and insulin

1) Feline Nutrition: Now, as far as diet - definitely dump the dry food (if you are feeding any) and if the vet recommends purchasing prescription food like DM just say "no thank you". ALL cats, and especially those with diabetes, do best on a species appropriate diet that is high in protein and low in carbs. Dry food DOES NOT fit that bill and DM food, even canned, just really isn't that great as far as quality. Most here on FDMB feed low carb/high protein canned, raw bought from a pet store or they make there own.

Here great links, one is to a food chart put together by one of our board members that breaks down the carb % and protein % of most of the commercial brand foods. You want to keep the carb % below 10% and around 7% is great. The other link is to a site by a vet "Dr. Lisa DVM" ... who also posts on this board from time to time ... there is in-depth info. there about many things, including nutrition and how to make raw food.
Nutrition/food info

The good thing with feeding your diabetic cat this way, is that it is ALSO good for any non-diabetic cat too. All your cats can safely eat the same food without worry and it may save you some costs and headaches of having to do separate feedings and keeping track of what they are eating.


2. Home testing: It is impossible to convey the value of testing your cat's BG (blood glucose) level at home. Some vets will "suggest" this, but most won't even mention it. They will send you home with insulin and an amount to shoot and maybe some instructions about hypoglycemia (blood sugar dropping to a dangerously low level).

Well, the thing is, human diabetics don't EVER give themselves insulin without checking there BG to make sure it is safe to do so, so why shouldn't it be the same for our kitties. Here on FDMB it is. You will notice that the vast majority of people here test their cat's BG at least 2x/day (before giving each shot to make sure the level is safe enough) and periodically at other times to see how the cat is responding to the current dose. We use a human glucometer, test strips and lancets - which are all very readily available and easy to use.

Our kitties get lots of love and treats for "putting up" with this and most of them actually come out to be tested on their own 'cause they want those treats . Here is a collection of great links that "Carolyn and Spot" pulled together about hometesting. See what you think ... it truly is the best way to not only keep Your cat safe but also really get a handle on this disease and help him to live a healthy life with FD (feline diabetes).

Home testing Links

3. Insulin: There are several types of insulin available. Many people, myself included use Lantus or Levimer both of which are great insulins. They are gentle insulin and given twice (BID) per day in 12 hour increments.

Please read up on the insulins available, here is a link to the Insulin Support Groups:

Insulin Support Groups

However, one caveat and again this shows how these three things are inter-related:

If you are feeding dry food or even a high carb food, BEFORE removing these foods, please make sure of your insulin dose as it will most likely need to be reduced, so as to avoid a possible hypoglycemic situation due to the removal of the dry/high carb foods that will lower the BG’s and reduce the amount of insulin required. Again, another reason why home testing is important.
 
Thanks for the info. As you may have seen earlier, I have a diabetic daughter on lantus so I know all about storage etc. Tasha is currently on .25 and I don't have enough data to know if and when to give the second shot. Many of her high numbers are more likely from a rebound of dumping due to too much insulin. I have yet to do a whole day on her bg numbers. I am a bit reluctant to do anything about the dry food yet because I am trying to keep her numbers at a good level. I must first find what her curve is like before I make too many changes. This I know from dealing with my daughter's diabetes. Dropping the dry food will be in the future once I figure out how she responds to treatment.
Again thank you all for your help. It has been invaluable! :-D
 
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