Introducing Big Ted

[Jaimee]

Hi and thanks for having me in the forum.
Big Ted is my 15 Devon Rex, who was diagnosed on 2nd July. Our vets have little experience with diabetic cats.
So far, we're doing bg levels at home, and since Im a worrier, I try to do his urine ketone test every second day. Ted is very patient.
The vet has him on Lantus 3u morning & 1u night. I've been told to only to give the 1u if his levels are over 180 . Sometimes he's over and sometimes he isn't.
He is usually high 450 in the mornings- especially if he didn't have the night shot. It doesn't make sense to miss shots when the aim is to level him out!

He won't eat the m/d food they recommend. At the moment he's eating R/C pouch food , FF classic & FF broths because it's either that or have him not eat at all. I've taken his beloved R/C indoor dry food away, but I let him have a few pieces of R/C Diabetic dry food as a treat after bloods. They also told me strictly 2 meals a day but I've got him on 4x smaller meals. I don't want him feeling hungry all afternoon (when he's dipping) waiting for his evening meal.

He is showing signs of feeling better, so it must be working. He started washing himself again, is talking to us and doesn't sleep so much anymore. He's up on his toes again at the back. The ketone smell has gone from his breath too. He still drinks a lot very early morning (2am-ish)

I did have 2 grandchildren here yesterday & his bg went up & he slept a lot. Obviously stress affects him. I don't blame him... Lol they stress me too.
It's not as scarey as it was last week, but I still have panic moments- like tonight. I think I missed & got it in his fur instead

 

[Larry and Kitties]

Welcome. It is good that you are home testing and you dropped the dry except as treats.
Lantus (and Levemir) are depot insulins and they build up in the body. Thus, the same dosage AM and PM is usually best. An exception would be a very load pre-shot BG.
How was the 3/1 unit dosing determined?
Since he is high in morning a 2 unit AM and PM might be best.
Most of us here (not me) keep are BG and other info in a spreadsheet. See:
viewtopic.php?f=6&t=50130

 

[Merlin]

Welcome Jaimee and Ted to the Feline Diabetes Message Board (FDMB). Also glad to see that you are testing daily. The spreadsheet is a great way to gather data. We test always before each shot (i.e. test, feed and shoot all in about 10 minutes). When I first joined and still today, I like to read other kitties spreadsheets. i learned so much from them even though I know that each cat is different (ECID). This website has so much information and very experienced people to help you. Before you know it, you may be able to teach your vet a few things. Here is another great site to read regarding feline nutrition. The wet food that is advised can be bought in any store and is all at least under 10% carbs (I only get food that is 5% or under carbs) like Friskies Special Diet Turkey & Giblets and Fancy Feast Classics.

Nutrition Website: Catinfo.org

 

[Los Gatos]

Fortunately for me my cat can get "pet neck" where the collar rubbed away the fur. I think I've had my share of fur shots and until I can be sure I'm hitting him all the time, I'll keep his neck clipped.
Not the prettiest thing you can do to your cat but keeps them safe.
Good luck

 

[Jaimee]

Thanks for the welcome.

The 2/1 was determined after 5 days of the vet doing 2 hourly bg tests between 8am & 6pm.

The first day he went in, he was 31 (550) and he had ketones in his urine. They gave him a 3u shot, and there after, his morning levels were always about 26 (460). The first 2 days at the vets, his afternoon levels were down to 3.5 (60) so they wouldn't give him any insulin before he was sent home for dinner at 6pm.
He was on 2 meals only (m/d which he hated and would only eat a spoonful if I hand fed it to him) while he was there. My suspicion is that his low evening numbers were because he was very hungry. They kept saying they couldn't understand why he was so low. It looked pretty obvious to me!!

Then he started to have afternoon levels of 10-ish (180) at his lowest ( maybe that was because I started to take his own breakfast in because I figured anything was better than nothing) so they introduced the 1u at dinner time. I think they only did this to shut me up because I kept asking WHY he wasn't on 2 shots a day. The answer was "because we are doing what the book says to do"...... (hmmm ''what'' book I don't know)

I bought him a Freestyle lite meter and learned how to do his tests. I took it to the vets with me on the last day and we tested with their meter and Teds using the same blood sample (the one they took from his arm). Teds meter came out lower by at least 4 (72) everytime, but as we got lower numbers the difference was smaller. Teds meter is closer to theirs in the lower readings.

So, they sent him home on a 3u/1u split with the instructions "give 3u morning after breakfast & only give the 1u IF his bg levels are over 10 (180) at dinner time"
That's where we're at right now.

Im feeding him 4x small meals, doing the 3u morning, and testing before the night shot to see if he needs it. If anyone can suggest a way to even up his shots, level him out and make him better, Id be grateful. I dont think I'll have much hassle from the vet. I'll probably just have to ask for the Lantus and they wont even question what Im doing with it. Im fairly certain Ted & I are in their "too difficult" basket.
edt to add: Even though hes a Devon Rex and prone to 'bald areas' he still has a hairy neck. I'll shave a bit so I can see where Im shooting. He already looks patchy so it wont matter.

 

[Deb & Wink]

Hi Jamiee and extra sweet kitty Big Ted and welcome to the message board.

You might want to hop over to one of the other forums here, the Insulin Support Group, Lantus (glargine) Tight Regulation forum and read up on the insulin depot and how it works. You'll see that Lantus works best if the same dose can be given every 12 hours. Otherwise that insulin depot is constantly draining and refilling.

There is lots of other good information in that forum too. At the top of the forum, there is a group of topics that start with the word STICKY. I'd suggest that you read through those.

He won't eat the m/d food they recommend.

Yeah well, no surprise to those of us here. We've seen many a kitty that didn't like or got tired of the mainly liver based flavor of that Hill's M/d food. The Fancy Feast classic pates and even the Friskies pates are lower in carbs than the M/d food.

Are you testing around the mid-cycle, somewhere in the +5 to +7 hour range after the shot? To determine when your kitty Big Ted has his lowest BG reading or nadir? That is what the Tight Regulation protocol uses for determining dosing changes. You may find that that 3U in the morning are bringing him down too low. Most kitties don't need more than 1U as a starting dose of insulin. Betcha he's bouncing off low numbers.

You may want to read and print off a copy for reference of the AAHA Diabetes Management Guidelines for Dogs and Cats, a vet journal published article from 2010. Has some of the current recommendations on treating diabetes in our pets. Maybe print off a copy for your vet too,

 

[Jaimee]

I've tested him right now and he is 5.3 (95). His meter tests low, so he may really be a bit higher which would put him in the 'normal range! I will do another one in the morning. I'm planning on dividing him up to equal doses. Based on the way he's been bouncing, I think 1.5 per shot might be a good place to start.

 

[KPassa]

How are things going these last few days with the 1.5u dose?

You might want to look into getting a different meter since the freestyle has been reported to not work so great on felines. I believe the Accu-chek and the Bayer Contour models are the ones used most outside the US.

 

[Jaimee]

We're doing ok. I think. I shouldn't have given him a shot tonight, but I did I'll be keeping an eye on him and doing bloods to be sure. He was 7.3 (thats about 132? ) at shot time. Full 12 hours since his morning one. I didn't know what do do. He's eaten dinner, and is sleeping now. It's all too scarey.

 

[BJM]

Between +5 to +7 hours post shot is when Lantus has the lowest glucose level in many cats. Testing during that period will identify if you need to intervene with higher carb food orKaro/honey/etc.

As you collect mid-cycle data, you will find it is possible to "shoot low to stay low" if you decide to follow the Lantus Tight Regulation protocol, described in that forum.