insulin resistant ?

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conqa

Member Since 2014
Hello,
we are looking for any help as we are desperate with our 10 years old bengal cat Twizz. He has been diagnosed with pancreatitis and diabetes melitus at the beginning of january 2014. The vet started treatment of his pancreas inflamation with Atopica, what we still give him after over two months with no visible success. We started caninsulin at the same time with 1.5 unit twice a day what we gradualy increased to 5 units twice a day. That didnt work as his blood sugars were still the same throughout - between 20 to 30 mmol/l (400 to 550 mg/dl) no matter how many units we gave him, no matter what time i did the glucose measuring, before meal or after or hours after. Then we started to use Lantus 2 weeks ago, giving him only 1.5 unit once a day in the morning for few days with the same blood glucose results. After few days we added Caninsulin, giving him 1.5 unit of Lantus once in the morning with 4 units of Caninsulin on top and 4 units of Caninsulin in the evening. To cut the long story short: Its all getting worse and worse, this morning I measured his blood glucose before any meal and that glucose meter showed letters HI, I looked in the booklet and it said its a test result of over 41.7 mmol/l (750mg/dl)! So I gave him 9 units of Lantus with his meal and later it went down to 33.1 mmol/l (570 mg/dl). Unbelivable. Seems like no insulin, no amount, big or little doesnt work. Is it even possible? I read alot about diabetes but never came across anything like this. We just cant stabilise him at all. His glucose levels went below 20 mmol/l (360 mg/dl) only handful of times in over two months. Lowest we ever masured was 17.6mmol/l (317 mg/dl).
I have to add that we use Panzym as well, he gets that with his meals to add digestive enzymes to his food (his appetite is enormous and he is skin&bone). His breathing is poor, snorts, we use asthma inhaler for cats. Yes the list is long but we love our Twizz and dont know what to do. All the vet is saying is increase increase insulin units. But its not going anywhere. Please we'll be grateful with any advice or share somebody's experience. Thank you.
 
Hello and welcome to FDMB.

You've come to the best site on the planet for advice on feline diabetes. And we will do everything we can to help you.

First off I have to say that I have never ever heard of Caninsulin and Lantus being given at the same time. These are both very different insulins and work in different ways. Did your vet explain why s/he wanted to do this?

Secondly, what are you feeding your cat at the moment? Dry food or wet food, and if wet, what brand/type of wet food?

Sometimes when the blood glucose appears consistently high it can actually be that too much insulin is being given. That might be the case with your kitty, but there isn't sufficient info to know this at the moment.


Eliz
 
Oh, forgot to say just now...

Given Twizz's very high blood glucose levels I strongly suggest that you buy a tub of 'Ketodiastix' test strips from a pharmacy. These little strips are for dipping into your cat's pee to test for glucose and - more importantly in Twizz's case - ketones. Any reading above 'trace levels' will need a vet visit pronto. Twizz may well not have any ketones present but it is advisable to monitor this, just to be on the safe side.

Eliz
 
Thank you for your quick response Eliz.
Twizz is on wet food only, usualy Felix pouches in jelly, plus cooked chicken or fish sometimes to help him with Atopica and Panzym as he hates the smells. He gets about two pouches in the morning about one in a day as he scavenges for food and we have another cat and one to two in the evening. He loves catmilk (Bob Martin or Whiskas brands), he cant get enough of it, we stoped giving it to him couple of days ago as we are not sure if it contains any form of sugar. Its hydration vs. sugar in this case i think. Obviously he is constantly hungry, only hangs around food area for last two months. He was very outdoor cat before - king of the street- now he goes out only round the house to drink water from the bucket and do his toilet business. We recenly gave him cat litter and he started to use it. Sometimes he poo there as well. That never happened before. We will try those kotenes strips, now he's doing it indoors we will be able to do it.
With the insulin, we just ran out of Catinsulin so we will probably only use Lantus. The vet said Lantus works 24 hours in cats which I dont think is true. Thats why he wanted us to give him Lantus only in the morning with Caninsulin twice a day. Its just a confusion. We would like to use Lantus only. Can we use it twice a day please?
Any help is highly appreciated.

Debbie and Martin
 
Hi Debbie,

Lantus works best when it is given every 12 hours, same dose. 9 units is a very high dose for a cat. While it is possible your cat requires that amount, the way your vet has instructed you to get to 9 units in 2 weeks is incredibly dangerous! You are most likely giving him too much insulin, his BG is dropping low and then bouncing back sky high as it's body's way of compensating. Too much insulin can also give high numbers. And the high numbers can be a recipe for diabetic ketoacidosis.

I would recommend starting over with the Lantus. Scrap the 9 units and go back to a small amount. Lantus is a depot insulin so it has built up in Twizz's system. You'll need to give the depot time to drain.

Other people will be along, and I'll cross post in the Lantus forum to get more eyes from experienced members there.

You've found the best place for feline diabetes. We'll get you and Twizz on the right track!
 
Thank you for your responses.
Looks like we will have to start all over again then. How much insulin would you recommend to start with?
 
Hi Debbie and Martin,

It may be a 'blessing in disguise' that you have run out of Caninsulin, because that makes the decision to try only Lantus an easy one! ;-)
Lantus has a reputation for being a good insulin for cats, and I'm sure some experienced Lantus users will be along soon and will be able to suggest a starting dose (or rather a re-starting dose).

We recommend feeding diabetic cats a low carb wet food, and most Felix pouches in jelly should be just fine.
However, you may want to avoid Felix 'As Good As It Looks' and any others that contain 'vegetable protein extract'. This ingredient can elevate the blood glucose level a lot in some cats. (However, if you are currently feeding Twizz any foods that contain this I'd suggest not changing the food until you have reduced the insulin dosage.)

We strongly recommend testing the cat's blood glucose level before each insulin shot. We also recommend trying to get some other tests during the day or evening to try to assess how well the insulin is working in the cat's body. Many folks here put their cat's blood glucose readings onto a Google spreadsheet that everyone can access, and if you're willing to have a go at that there are folks here who can help you do it.

Whereabouts are you, Debbie? UK? NZ or Oz...? (I noticed that you gave your initial blood glucose readings in 'mmols'.)

Eliz
 
I do not give dosing advice so can't help you there but I absolutely agree w/everything that has been said here. I too have never heard of using these two insulins simultaneously. I too think he may be dipping so low during his cycles that he is bouncing way into these high #s. Is there any way you can get some mid-cycle tests, like every few hours or so. When starting lantus I think the recommendation is @ +3, +6 and +9 minimum.

This pouched food he is getting with the jelly, is it low carb? Not all canned (or pouched) food is low carb, i.e., Friskies w/gravy is high carb, the carbs are mostly in the gravy. The pate's are low carb, and many of us feed that. I'm not saying his food is too high carb, b/c I am not familiar w/this one, I'm just saying it might be s/thg to check. So maybe the jelly contains too many carbs which would also be keeping his #s high.

I'm glad you ran out of the caninsulin and will just be using the Lantus. Others from LL should be stopping by to give you more specific advise, as tho I've been around here a long time, I do not call myself an expert.

Desi
 
Whereabouts are you, Debbie? UK? NZ or Oz...? (I noticed that you gave your initial blood glucose readings in 'mmols'.)

We are from the UK and we have done quite a bit of blood glucose readings. As I mentioned before lately we never measured below 17.6mmol/l (317 mg/dl). We got all the measurements reports from last two months in .pdf format in AlphaTRAK'er program if that would help.

Thanx everybody for this fantastic support!
 
The formula for a starting dose of Lantus:
select the lower of his current weight or His ideal weight.
Convert to kilograms if needed (pounds divided by 2.2)
Multiply by 0.25
Round down to next quarter unit.

To adjust for the other level you'd reached, IF the food is all low carb:
Maybe go halfway between that and the Caninsulin, since we're not sure if you're giving too much without any test data.

We use an online spreadsheet grid stored in Google Docs so we can share the data for review. Here are the instructions.

-----------------------------------------------------------------------------------------------------​

[Glucose reference ranges are unsubstantiated and have been removed by Moderator]


* * * * * * * * * * * * * * *​
Examples of using the chart:

Ex. You are a new insulin user and you test your cat before giving insulin. The test is 300. It probably is safe to give insulin.

Ex. You are an established user of Lantus, following the Tight Regulation protocol. You've tested around +5 to +7 to spot the nadir. It is 200 mg/dL. You probably need to increase the dose, following the instructions for the protocol.

Ex. Your cat is acting funny. The eyes are a bit dilated. You are concerned and test the glucose. The number is 35 mg/dL. ACK! The cat may be in a hypoglycemic state. You quickly follow the HYPO protocol linked in the glucose reference values chart. (which we really, really, suggest you print out and post on your refrigerator.)
 
Hi again, Debbie,

Since you're in the UK you may want to take a look at the UK food list (drawn up and maintained by Juliet (user name is 'Dr Schrodinger')) to see if the foods you are currently feeding are on that list (If they're not on the list I can work out the carb content for you if you tell me exactly which food it is). It may also give you some ideas for other foods to try in the near future.
https://docs.google.com/spreadsheet/ccc ... mWmc#gid=0

And if you want to try a glucose meter that's cheaper to use than the Alphatrak there are quite a few options out there. They are meters made for humans but work just fine for cats. One that is popular with Brits and is generally easily available at pharmacies is the Accucheck Aviva. And the test strips can be bought for around half the RRP on Ebay. Or if you wish I can send you one of my spare meters. It would be a One Touch Ultra meter, and again, the strips can be bought much cheaper on Ebay. If you'd like one of my meters just PM me your address.

Human meters and the Alphatrak do read slightly differently, as BJM said in her post above. And she's given some examples of the differences. Human meters are a heck of a lot cheaper to use though, so, if you're going to be doing a few tests, they can save a heap of money...

Are you buying syringes online? They are generally much cheaper than from your vet too...

Eliz
 
Thank you again for your replies.
Twizz is roughly 5.5 kilos at the moment, he lost a lot of weight in last three monts. According to BJM post of Lantus start formula we'll try 1.5 unit of Lantus tonight then. How long we should maintain this amount before any adjustments? Are there any safe rules of how long to stick to certain amount before we see any improvement? Does insulin react instantly? Please let me remind you that we are not new to all this and we have already been on low levels of insulin for a week or so before half a unit adjustements and so on.

And thank you Eliz for your generous offers and support, luckily Twizz is insured so we can afford all this treatment and ordering all the paraphenalia from the vets.

We should have log on to this web site long before, the people here are amazingly kind and supportive. Thanx alot!
 
Hi Debbie,

I think Sue (Sue and Oliver) may have posted the following link earlier so I apolgise to you and to Sue if I'm posting this twice:
viewforum.php?f=9

The link is to the main Lantus forum here at FDMB. If you scroll down that page a bit to 'topics' you'll see some 'stickies' at the top of that list. These are hugely informative in explaining basic (and not so basic) info about Lantus, including; how to store and use; how Lantus works etc.

I don't use Lantus but I understand that Lantus is a 'depot' insulin. That means that when you inject it into your cat some of it is used over the following 12 hours and some of it is stored in the body. Regarding the stored insulin it's rather like spooning water into an eggcup: If you imagine (excuse my crude analogy) that it takes a while for the eggcup (the depot) to fill, and then, once full, it will start to overflow. So, with depot insulins, intially the body has only the insulin that it can immediately use at it's disposal, but once the depot is full then it also starts to use the 'overflow' insulin. Because of this it takes a little while to see what the effect of a dose will be.

The 'depot' is also referred to as a 'shed' here (I don't know why! :oops: ).

Caninsulin has no depot. It's an 'in and out' insulin with a fairly short duration and isn't stored in the body.

Eliz
 
I just checked that thread, thank you. Found my answers there, we should use it for 3 to 5 days before any adjustments. We were folowing that pattern with Caninsulin until we reached 5 units with no results whatsoever. Then we added Lantus to top it up with even worse results. Ended up with 3 units of Lantus and 6 of Caninsulin in the morning. Now we ran out of Caninsulin so I gave him only Lantus, unit to unit comparison this morning - 9 units, because of his mega high blood glucose level this morning. My fault.
Now we just gave Twizz 1.5 unit of Lantus to start all over again and we will go from there every 3 days or so. Hope it will work this time.
 
Since Lantus is a depot insulin, don't expect to see a change overnight. You'll have to let the depot drain and his body readjust. His numbers may be all over the map for the next few days. Keep a close eye on him for the next few cycles. The 9 units could affect tonight's cycle and he could be very low. Be patient. You'll find the right dose now that you're on the right track! :smile:

~Suzanne
 
I will echo what the others have said. You will need to let the shed clear before you "re-boot".

Others may have different thoughts on this, but I would encourage you to use a few days WITHOUT insulin to do the food change. I had the luxury of changing food for a week BEFORE we started insulin, so I didn't have to worry about the food change impacting Grayson's BG numbers. He wasn't fond of canned food, but had a RAVENOUS appetite, so he decided it was better than NOT eating.

My vet initially wanted me to start at 2u (ProZinc), but with advice of folks here, we discussed and decided on 1u. In two years, even with extreme dosing (Grayson is insulin resistant), we have never experienced a hypo. Frequent testing and monitoring of food are key components to me being able to say that. And for our insulin resistant and/or acro kitties, when they are famished, we say "Feed the Beast!"
 
Yes Suzanne we will try to be patient even though we were patient for long enough already. Thank you for your thoughts. Hope we will get there somehow. I will keep posting the progress if there will be any.

As for Lu? I was actually thinking of doing it but we are not changing food, Twizz is on low carb food all his life really, he luckily never liked dry food so it makes it easier for us so we start over again with 1.5 unit. Looks like your cat Grayson is on a high dose of insulin. Please what dosage is he on if I may ask? Thanx.
 
If you look at Grayson's spreadsheet, starting at the top, you will see in the 4th column over, the insulin given in the morning. Halfway across the sheet, you'll see the evening insulin dose. Because Grayson has acromegaly, you'll note that 2 insulin types are used at times.
 
I know it is hard to be patient. Cobb was diagnosed last April. He is still not regulated. We maxed out what the vet wanted to do with Prozinc and have been on Lantus for 6 months now. Cobb is up to 18units twice a day Che definitely has some resistance going on there so it's not impossible that Twizz does too. We just want you to get to those higher doses safely! We are also using R insulin on occasion to help bring Cobb's numbers down. Hopefully we'll have some better answers as for Cobb after next week's vet appointment. :-)

Good luck! You and Twizz are in good hands here!
 
Hi Debbie & Martin! welcome to FDMB - you've had quite a wild ride.

I'm one of the people on the Lantus Tight Reg forum that people have been referring you to. Suzanne posted and asked for someone to come over and give you a hand.

Can you fill out one of the spreadsheets, as best as you can, with any dosing information and blood sugar numbers that you have, as soon as you're able? a little more information would help us help you better.

Most food in jelly is low-carb - generally that's the pate kind that comes out in a solid chunk. is that what you've got?

what other symptoms does Twizz (cute name!) have going on? does he have any trouble walking? the 5.5kg = 12lbs, so he's an average size kitty.

Figuring out the dosing with Lantus can take a bit of learning - we'll be happy to teach you how to "read" Twizz's numbers and figure out when to increase and when you should wait a little bit longer. It is a "depot" insulin, which means it builds up in the body and slow-releases. Diabetic cats can be difficult to get regulated, and learning how to work with the insulin gives you the best chance of that happening.

There are high dose conditions that can cause a need for more insulin than most cats. My punkin, Suzanne's Cobb and Lu An's Grayson all are like that. The tricky thing here is that the numbers of a cat that is overdosed can look very much like the numbers of a cat that hasn't gotten enough insulin yet. We look carefully at spreadsheets to try to determine which one is going on. If a cat is started at an appropriate dose and the increases are done in appropriate increments, then we can have confidence that a cat isn't overdosed. But if a cat has a high dose condition, we don't want them sitting in high numbers while we ponder moving slowly up the dosing scale.

I'd very much encourage you to get a spreadsheet started, or let us help you do that, and then post here on the Tight Reg Forum and let us help you figure out which the situation is with Twizz. Use the link that BJM gave you above and choose the "world template." we "speak" in US numbers and with that template, you can enter in mmol and it will convert it for us into US numbers.

Please ask as many questions as you have - we'll do our best to teach you what you need to know to take care of Twizz!

julie
 
Hi Debbie & Martin.
You've gotten some excellent advice already. I just wanted to welcome you and to tell you that my previous diabetic kitty, Stu, was overdosed on Lantus by his vet. His dose was raised by 1 or 2 units at a time over a very short time. His blood glucose kept going up and up until one day it plummited. We almost lost him! The folks here saved his life. We started over on the dosing scale, followed the Tight Regulation protocol, and got him pretty well regulated.

You have come to the right place to get the help Twiz needs.

WELCOME!

Ella & Rusty
 
Hi Debbie & Martin -

Grayson is currently well regulated at 6u Levemir - maintaing BGs between 70-150 most of the time. This is considered a high dose, but for him, it's a major reduction from his max, at which time we supplemented his insulin with R "regular" insulin to jump-start his response to the Levemir. Grayson's insulin resistance (IAA) resulted in extremely high dosing before he had a breakthrough in October 2012. We had been known to "swim in a sea of pinks & reds" during the first several months - even on significantly larger doses!

Our SS has multiple tabs - Jan-May 2012 was on ProZinc; the remainder on Levemir. Feel free to look through and ask any questions you may have. PLEASE keep in mind that his dosing is completely different than others here, as he is an insulin-resistant Acromegalic kitty (pituitary tumor creating insulin-like growth hormones - making his appetite and physical appearance change dramatically).

My dose increases tended to be in 20-25% increments of his dose, of which percentage-wise is normal, but dose-wise is NOT the norm for diabetics. Also Acro kitties tend to see increases faster than the TR protocal. Thus you should NOT follow the dosing techniques we used.

Please look over and ask any questions you may have. I'll pop in to check on you again later.

Lu-Ann
 
Hi Debbie and Martin

I'm also popping over from the Lantus TR Group. I think it was a good decision to drop the Caninsulin entirely and decrease the Lantus dose to 1.5u. It could take more than six cycles to see his depot drain and allow us to know exactly where he needs to be. The larger the dose, the larger the depot, and the longer it can take to drain it.

A couple of spreadsheets to show this include:
Tucker's SS; Tucker's vet started him at 6u of Humulin R and Chris actually caught the lows (24). Those lows caused him to "bounce"; in other words, the liver, panicking at the lows, released counterregulatory hormones and glucagon into his blood which raised his BG. Humulin is not a depot insulin but it took about 8-9 cycles for him to clear out all those counterregulatory hormones and drop back down to normal numbers. Even 1u of lantus was enough to drop him low and he was able to stop insulin altogether.

Teronto's SS; this one is even more interesting and could be what you are seeing with Martin. The dose was started at 10u! We don't really know what he was doing at that point but likely he looked very similar to the cycles where we had her drop his dose to 1u. He was also bouncing into very high numbers and continued to do so until the insulin was stopped.

I'm not saying that Martin doesn't need insulin. I'm just trying to show you how long numbers can be affected by (1) bouncing very high off low numbers and (2) draining of the depot.

The other thing I want to address is using Atopica for pancreatitis. Atopica is cyclosporine and is normally used for dermatitis. So you are certain your vet is using it for pancreatitis? If he were my cat and that is what your vet is using it for, I would stop using it. Long-term use of cyclosporine can cause liver issues. If he actually has pancreatitis, you might want to read the info in this Primer on Pancreatitis. It will tell you the better forms of treatment. Is he having symptoms of pancreatitis like vomiting, nausea, abdominal pain, anorexia?
 
Hi Debbie and welcome to FDMB!!

I'm another one of the denizens of the Lantus Tight Regulation board and was responding to Suzanne's request for people familiar with Lantus to stop by. You've gotten a ton of good information already.

With regard to the initial dosing of Lantus twice a day, you'll want to hold your initial dose for at least 5 days. The instructions regarding holding the dose for 3 days (6 cycles) apply once a cat is already on a twice a day dose of Lantus. The initial dose is held for a bit longer in order to allow the insulin depot to form and stabilize. As others noted, in cats, Lantus is dosed twice a day. In humans, Lantus is given once a day but a cat's metabolism is twice as fast as a humans and, as a result, the insulin needs to be given twice a day. (This is true for all types of insulin that is given to cats.) As others noted, I've never encountered Lantus being given with Caninsulin.

I also agree with Marge's observation about Atopica. It's typically prescribed for skin conditions (i.e., dermatitis). In addition, if you read the manufacturer's package insert describing the research findings with Atopica, the drug elevated glucose levels. This is likely not a good drug for a diabetic cat and it is not a drug used to treat pancreatitis.
 
Well again, we cant thank you enough for all your support, its great to meet all you guys with lots of experience with your poor kitties!!

All started with Twizz's breathing problems. On 28th of november 2013 after X-rays and rhinoscopy (camera up his nose) he was diagnosed with:
- Suspected inflammatory rhinitis and pharyngitis
- Mild bronchitis

We are using Asthma cat inhaler (aerokat) ever since.

This is Twizz's diagnosis from 10th of january 2014.
- High blood glucose - possible diabetes
- Diffuse inflammatory disease of the abdomen

This is the report:
"Ultrasound has shown changes in the area of the left adrenal gland, a large cystic mass in the area of the pancreas and bilaterally enlraged kidneys.On presentation
Twizz had elevated blood glucose and a trace of ketones in his urine. His blood acid level was too high and he was markedly dehydrated. Twizz has responded well
to rehydration and administration of insulin (1.5U Caninsulin). His high blood glucose is likely to be due to the inflammatory reaction that is occurring in his body and
may well be transient if we can manage this inflammation. (Atopica prescribed for this)
Blood samples have shown a high white cell count typical of inflammation and elevated urea due to the dehydratation. There is evidence that Twizz's glucose has been
elevated for a number of days. He is losing protein in his urine that is also likely to be a result of the inflammation that is on going.
Needle aspirates have all shown evidence of inflammation but the cause has not been identified. No evidence of cancer has been found."

Since then he has been confirmed with diabetes mellitus and pancreatitis.
We have been injecting him twice a day with Caninsulin evere since 10th of January and using Atopica. On 3rd of March we started with Panzym for digestion and vitamin B12 injections once a week. On 4th of March we started with 1.5U of Lantus once a day with 4U of Caninsulin. To clarify - we always gave Twizz Lantus only once a day - in the morning.

Twizz has never vomited, his stools are healthy and solid, we dont think he has had diarrhoea, never soiled or wet himself, he has alot of flatulence, his coat is greasy, he walks fine, he jumps fine but he lacks energy, although he has had couple of dizzy spells and his back legs went as well, urinates alot, always thirsty, constantly hungry, losing weight, can not rest for long, only rests after he filled his belly, always hangs around food area. Only goes out for a short period of time just to drink water from the buckets and to release himself. He also started to use litter tray what we recently gave him as he urinated on the sofa few times. Him being a bengal he is not as vocal and full of life and energy as he used to be.

Hope this will help a bit. We lost faith in our vet as the bloods are always high so with your help guys we would like to take it in to our own hands. I will transfer his blood glucose chart (spreadsheet) we were doing since 20th of January to the format you guys use a.s.a.p., so you could kindly have a look in his history.

We so much appreciate all your opinions and help guys! Thank you to all the people for spending their time for reading this!
 
do you know why the Panzym is being given to him? if his stools are normal i wouldn't think he needs it. It is a digestive enzyme which is given to help if there is trouble digesting food, but in the absence of trouble, which would be diarrhea, i'm not sure of the reasoning for giving it to him.

i wonder if it's because of the pancreatitis. that's not one of the tools that is usually used. Pancreatitis can often go hand in hand with diabetes. Relief for it is primarily subcutaneous fluids, pain relief, vitamin B=12, antinausea meds if the cat has stopped eating, Marje goes into it in more detail with supporting research in the post she linked for you.

Thank you for putting data over onto the spreadsheet we use. it will be very helpful.

We see a lot of cats with diabetes - this is the best site i know of for getting help for a diabetic kitty. this is what all of us do - we're not vets but we study it and live it every day and night, all year long, for years. Pancreatitis is common as well. We understand how the different insulins work and how to advise for dosing them. There are people here experienced with asthmatic diabetic cats as well - mine was not, but I'm going to flag Melissa/Tarragon to come and talk with you. Tarragon has asthma as well and is very well-controlled with his diabetes. They've been members here for about 3 years and she'll be able to help with that. There is a vast pool of knowledge here and we'll pull together to do the best for Twizz in helping him get back to his healthy self.

i'm very glad you found us. Most of us posting here on your thread post regularly on the Lantus Tight Reg forum, so I really hope you'll open a new post over there so we don't miss your updates.
 
Hello from another UKer,
You are getting wonderful advise from very knowledgable people on insulin dosing,you are in the best possible hands.
Bailey was put on Caninsulin,and like you it did very little to bring his numbers down,we thought we were loosing the battle with him,after 8 months of asking the vet to change to Lantus she reluctantly agreed,we were having readings off the scale and reading HI day in day out,it was heartbreaking,but 5 months on Lantus and take a look at Baileys ss.
Can I help you with the best choice of food in the UK that I have found? Look up Natures Menu in chicken & turkey,I also order on line from The Happy Kitty Company,they stock selected German high quality brands which are ideal for diabetic cats being grain free,the best are Granatapet,Granatapet Symphony & Macs,if you give them a call they will let you buy a small mixed amount for a special price to try.
Where abouts in the UK are you located? If you have any questions apart from dosing (am not experienced on dosing) just fire away,I will do my best to help.,don't forget to get some treats in for when you bg test,I buy freeze dried chicken dog treats,and cut them into smaller pieces.
Good Luck,keep positive,things will improve.

Diane
 
Hi Debbie!

Welcome to FDMB! You are in the right place! Putting Tizzy on lantus and following the lantus tight regulation protocol will be great for him! You will see things like his coat come back and his personality. He will be back to his old self soon.

It took a couple months for my Scooter but I followed the protocol to a T and asked the wonderful women tons of questions. You have become a member of the best place on earth. It is simple to just follow the suggestions, report it on a spread sheet and have patience. That 3rd thing is hardest for me but it worked! Scooter is now off insulin in 3 months.

Keep us posted.

Linda
 
Could you clarify with your vet if your cat has pancreatitis or exocrine pancreatic insufficienty (EPI)? These are two, very different problems. With pancreatitis, the information about treatment that Julie provided is the standard of care. Pancreatic enzymes are given only for EPI.

Was the "cystic mass" biopsied?
 
Welcome Debbie! I am popping over from the Lantus group as well. You have gotten great advice from some very experienced caregivers. Are you only on the Aerokat for Tizzy's breathing? Do they have him on Flovent? Is it keeping the coughs away? Our kitty, Tarragon, has been on Flovent 250 two puffs twice a day and is also on 5 mg prednisolone a day for his asthma. The asthma meds shouldn't be messing with his BGs if he is only on the inhaled meds right now.

Like everyone else, I have never heard of giving two insulins at once. Starting all over from scratch with just Lantus sounds like a great idea. A lot of vets don't have much experience with dosing or with clients who home test.

Again, welcome and be sure to ask lots of questions!

Melissa & Tarragon
 
Melissa & Tarragon said:
Welcome Debbie! I am popping over from the Lantus group as well. You have gotten great advice from some very experienced caregivers. Are you only on the Aerokat for Tizzy's breathing? Do they have him on Flovent? Is it keeping the coughs away? Our kitty, Tarragon, has been on Flovent 250 two puffs twice a day and is also on 5 mg prednisolone a day for his asthma. The asthma meds shouldn't be messing with his BGs if he is only on the inhaled meds right now.

Like everyone else, I have never heard of giving two insulins at once. Starting all over from scratch with just Lantus sounds like a great idea. A lot of vets don't have much experience with dosing or with clients who home test.

Again, welcome and be sure to ask lots of questions!

Melissa & Tarragon
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Hello there

Thanks for your info. Twizz has 2 puffs on his inhaler twice daily.it is a clenil modulite brown inhaler 100 preventer.This is used as a preventer for humans as well. Twizz would not take Prednisolone,he tolerates his in haler now. Yes twizz inhaler is Aerokat,not taking flovent. Dont know what that is? Twizz breathing gets shallow and he snores,no coughing. We are only giving him 1.5 i units of lantus insulin now.
Wish you all the best with your kitty
 
Sienne and Gabby said:
Could you clarify with your vet if your cat has pancreatitis or exocrine pancreatic insufficienty (EPI)? These are two, very different problems. With pancreatitis, the information about treatment that Julie provided is the standard of care. Pancreatic enzymes are given only for EPI.

Was the "cystic mass" biopsied?
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Hi There

Twizz was biopsied and no cancer was found. I will clarify with vets about what type of pancreatis. Did not know there were 2 types.Its all confusing. we did some research and we decided to give him enzymes. Vet gave us powder enzymes. 2 x 3/4 tea spoons full in food twice daily.. vets agreed and a vitimin b12 injection once a week..

Many thanks

debbie martin
 
She's asking about 2 different conditions:

1) pancreatitis, a painful inflammation of the pancreas, sometimes infectious, can be autoimmune, too.

2) exocrine pancreatic insufficiency, where the pancreas is damaged and does not produce enough digestive enzymes. With long term pancreatitis, damage to the pancreas may occur resulting in the 2nd condition.
 
Hello again good people,
I want to explain the Panzym use in Twizz more broadly. Obviously we were very shocked with Twizzes condition and him not responding to insulin at all was extremely worrying so I have done a lot of research and back then I didnt come across anything what suggested that it can be quite a common thing in cats not to respond well. So with my research I came across Exocrine Pancreatic Insufficiency and Twizz totally fitted the symptoms - bad greasy coat, ravenous appetite, rapidly losing weight, flatulence.. only thing we couldnt confirm was his stools as he was doing his business over the fence in our neighbours garden, as cats love to do (only seen his stools recently when we took the old fence down and saw Twizz's minefield with no diarrhoea history), so I asked our vet if that is not a possibility of Twizz havin EPI and he admitted that it might be so thats how we started to use it. I have to say that it hasnt improved his weight or appetite. He is still acting like he has never been fed. I came across information that the enzym should'nt harm him. We will probably stop using it and concentrate on regulation of his glucose levels and breaking down sugars in his body. I think.
As you probably noticed our vet seems to be a bit confused himself. We still dont know what to do about Atopica use. We will have more info tomorrow as we want all the documentation, test results from the vets and then we will share it with you if we come across something interesting.

Thank you all for support once again!

Martin & Deb
 
Thanks for clarifying.

If he were my kitty, I would not give pancreatic enzymes without the diagnostic tests, I would stop the Atopica if he does not have a skin condition because it is not a treatment for pancreatitis, and I would have him tested for hyperthyroidism.
 
Marje and Gracie said:
Thanks for clarifying.

If he were my kitty, I would not give pancreatic enzymes without the diagnostic tests, I would stop the Atopica if he does not have a skin condition because it is not a treatment for pancreatitis, and I would have him tested for hyperthyroidism.
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Hello there,
cyclosporine (Atopica) can be actually used for inflammation as well and it can normalize pancreatic inflammation. So we will see after next tests whether it had any impact on Twizz. Thanx for the advice about hyperthyroidism, we will suggest that to our vets. Twizz has obviously lots of stuff going on in his little body so we just have to find all the reasons why he is unwell, if possible, and it will take some time I guess..
 
Re cyclosporine, the following is from the online Merck Veterinary Manual: http://www.merckmanuals.com/vet/digesti ... imals.html

The article is called "Pancreatitis in Small Animals" and it includes this extract:

"If animals do not respond to therapy, a trial with prednisone (dogs), prednisolone (dogs and cats), or cyclosporine (dogs or cats) may be attempted. Cyclosporine is advantageous in animals with concurrent diabetes mellitus, because it has a smaller impact on insulin resistance than glucocorticoids. However, data are limited to date, and indiscriminate use of glucocorticoids or cyclosporine in dogs and cats with chronic pancreatitis should be discouraged."
 
hi everyone
Thanks to all of you for feed back..

We decided to give twizz only lantus insulin 1.5 units twice daily in the last 5 days. No more caninsulin. When i told both of our vets yesterday they said they are really concerned we will over dose twizz giving this insulin twice in 24 hours. We have started to give twizz 2.units starting from today and then again we will give another 2 units this eve. Please tell me if any of you guys are giving your kitty twice daily lantus? and have you been told by your vet its dangerous?

Thanks

Debbie, martin
 
conqa said:
... When i told both of our vets yesterday they said they are really concerned we will over dose twizz giving this insulin twice in 24 hours. We have started to give twizz 2.units starting from today and then again we will give another 2 units this eve. Please tell me if any of you guys are giving your kitty twice daily lantus? and have you been told by your vet its dangerous?

Thanks

Debbie, martin
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Hi Debbie,

I don't use Lantus but can tell who that giving 2 shots a day with Lantus is the norm here. There is a protocol for Lantus use, written by two vets of some reknown (Roomp and Rand), and I'm sure someone here may be able to point you to that information so that you can, if necessary, print it out and show it to your vet.
The protocol used by most Lantus folks here though, is, I think slightly different to that.

For your own reassurance here is some info from the Lantus forum here showing what a typical Lantus curve/cycle can be like:
(It's from this page: viewtopic.php?f=9&t=18139 )

"NOTE: Until kitty is pretty well regulated, the description below is NOT indicative of a "typical" Lantus cycle. It takes time and patience for kitty to achieve this kind of cycle! The example below is what you're working towards. A relatively flat cycle is the ultimate goal.

Example of an ACTIVE Lantus cycle for most, but not all Lantus kitties:
+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 (one of the quirks of Lantus/Levemir: some cat's blood glucose numbers dip around +10 or +11... not to be confused with nadir).
+12 - PreShot number. "
 
conqa said:
hi everyone
Thanks to all of you for feed back..

We decided to give twizz only lantus insulin 1.5 units twice daily in the last 5 days. No more caninsulin. When i told both of our vets yesterday they said they are really concerned we will over dose twizz giving this insulin twice in 24 hours. We have started to give twizz 2.units starting from today and then again we will give another 2 units this eve. Please tell me if any of you guys are giving your kitty twice daily lantus? and have you been told by your vet its dangerous?

Thanks

Debbie, martin
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Hi Debbie,

You should be giving Lantus twice a day, every 12 hours. Lantus is given once a day in humans, but a cat metabolizes it faster. It is perfectly safe if the dose is correct. Your vet shouldn't be concerned about overdose. Maybe you can provide them with the Roomp and Rand protocol so they can see it is safe.

~Suzanne
 
Guess what, my kitty and many others here went into remission (OJT) using Lantus with twice a day dosing and close home testing. It's a proven protocol, hope it works for your kitty! :-D A good insulin like Lantus, home testing and a wet low carb diet will do wonders for your kitty.
 
we also have been told by our vets once the lantus insulin vial which holds 100 units is used it has a 28 day usage and then has to be thrown. Alot of what is left will be wasted. We used to use the vet pen with smaller vial only holding 40 units when we were using caninsulin, Unfortunetly you cant get a vet pen to hold 100 units. But then we read on line it can be kept for 6 months and dosnt have to placed in the fridge.. Confused! Any info guys on this?

Thanks
 
Hi,

Lantus properly stored in the fridge keeps really well.
See here for storage and handling info:
viewtopic.php?f=9&t=151

The '28 days and then throw away' thingy is said I think because mostly, Lantus is used by humans. Humans carry their insulin supplies around with them (at room temperature). But also, thinking about it, there would be less wastage (if any) for humans because the dosages are so much higher...
 
When Lantus was submitted to the FDA for approval, they'd only done tests for up to 28 days. That isn't the same thing as saying it becomes useless at day 29.

Many of our folks use it for up to 6 months, stored a stationary shelf in the fridge. If, at the end of a vial or pen, you think it has become less effective, when you start a fresh one, decrease the dose a half unit or so, based on your data about how he's doing.
 
We used to use the vet pen with smaller vial only holding 40 units when we were using caninsulin, Unfortunetly you cant get a vet pen to hold 100 units.
Click to expand...

There is a Lantus Solostar Pen available in the US. It's essentially a miniature vial, 3 mL instead of the larger size, and is shaped like a fat ballpoint pen. I would think you would have that available in other parts of the world. Your vet would need to write the prescription differently, for the 3 mL pen instead of the 10 mL vial.

Lantus lasts somewhere between 12-16 hours in most cats. Sometimes longer. I've never heard of a cat getting the full 24 hour duration from the lantus insulin.

Most everyone here that uses Lantus, does twice a day, every 12 hours.

we also have been told by our vets once the lantus insulin vial which holds 100 units is used it has a 28 day usage and then has to be thrown. Alot of what is left will be wasted.
Click to expand...
That 28 day limit is becasue the manufacturer of Lantus, never tested for effectiveness of the Lantus beyond the 28 day period.

But then we read on line it can be kept for 6 months and dosnt have to placed in the fridge..
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3-4 months is more common for the Lantus to stay effective. Some people are fortunate and do get up to 6 months from the 10 ml vial. I always kept my insulin in the fridge, to help extend the life of the vial or pen. It's expensive, so anything I could do to try to extend the life of that vial, I did.
 
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