Pouchie said:
Hi, I'm Lynn, my 10 year old cat named Pouchie was diagnosed with diabetes on Feb 15. After spending 12 days at the vet starting on Novalin then switching to Lantus the last seven days. Pouchie is home this afternoon. Her BG this morning 486 after 6 units, yes 6 units, +4 - + 5 was 188. My vet is a excellent large animal vet we live in North Central Montana. Pouchie has had a hell of a couple of weeks to say the least. She was unfortunately overdosed at the vets office for a few days given 20 units at a time by accident by the tech. Her #s have scattered from the 400-37 that i know of. She is 16#s should be around 8-9#s and has neuopathy. Knowing absolutely nothing about diabetes two weeks ago, I took her in thinking she broke her ankles or back because of walking on her hocks. After the first weekend there and reading Dr Pierson info. I took fancy feast turkey and giblets to the Vets office which they mixed with some optimal dry food. She has been on Hill's Hairball senior dry for approx. 3 years regular Hairball most of her life. Hear is the good news, she is eating fancy feast good, she is home and after telling the Dr I thought 6 units twice a day was too much. He said I could pick a dose that I wanted and stay the course for a week and he would work with me. He wasn't worried about ketones as long as she is eating good. Could her body handle 12 units daily? I would like to start with 1- 2 units twice daily if that sounds right? I will take a BG reading tonight before I give the insulin. I have 3/10 syringes with 25 and 31 gauge needles. This post seems crazy I know but do you have any thoughts?
OK if you switched to Lantus only a week ago, there is no way you should be at a dose of 6 units.... is that 6units in the morn and another 6units in the evening?
Sure there are cats who need a great deal more insulin that 12units a day, but they have a condition known as feline acromegaly; they have a pituitary tumor secreting excess growth hormone.
I don't think you should be at a 6unit dose after just a week. You need to work your way up in dose slowly, and with Lantus, you need to build up a depot which takes a week, so there's no way your vet can say that this dose was reached properly. You may have passed your good dose and are now just giving too much insulin every day.
And with the diet being all over the place, the high numbers could be anything... too much insulin, effects of dry food, both or some other reasons as well.
Follow the protocol that others are using on this site...read the stickys at the top of the Lantus forum.
"General" Guidelines:
--- Hold the initial starting dose for 5 - 7 days (10 - 14 cycles) unless the numbers tell you otherwise. Kitties experiencing high flat curves or prone to ketones may want to increase the starting dose after 3 days (6 cycles).
--- Each subsequent dose is held for a minimum of 3 days (6 cycles) unless kitty earns a reduction (See: Reducing the dose...).
--- Adjustments to dose are based on nadirs with only some consideration given to preshot numbers.
Increasing the dose...
--- Hold the dose for 3 - 5 days (6 - 10 cycles) if nadirs are less than 200 before increasing the dose.
--- After 3 consecutive days (6 cycles)... if nadirs are greater than 200, but less than 300 increase the dose by 0.25 unit.
--- After 3 consecutive days (6 cycles)... if nadirs are greater than 300 increase the dose by 0.5 unit.
Follow the under 10% carbs, feeding foods from Dr. Lisa's list.
http://catinfo.org/docs/FoodChartPublic9-22-12.pdf
Keep testing before each shot, and if you can get any other tests during the 12hr cycles, they will help to know how the insulin is working.
How to do a Curve
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.
I think you should consider dropping to a 1 unit dose, am and pm, and be testing for ketones with KETOSTIX; I am not sure why a vet would say don't worry about ketones.
Sure, your cat could well need that high of a dose, but after only a week on Lantus..... I'd want to be sure.
Last but not least. Get another vet. The one you have sounds very dangerous. I have no idea why your cat had to be at the vet for so long.... unless he was extremely sick, there was no call for it.
If the vet was trying to regulate your cat there.... not gonna happen. You have no idea how long your cat has been diabetic, so it's sure not going to be under control in a few days. Some people find their cats take weeks or months before the right dose is found and the cat settles and adjusts.
Think about this. You have sore feet and you go to the dr. The dr says you have been wearing your shoes on the wrong feet. You think what??? But you put your right shoe on your left foot, and left shoe on the right foot..... do it now; how does it feel? Try to walk. I bet you switch back quickly because it just feels 'wrong'.
That's how your cat feels with the insulin given. The high numbers feel 'right', and the insulin makes him go into numbers the just feel 'wrong'. He'll bounce right back up .... into the comfy numbers, the numbers that are high.
You can't regulate in a few days. Some cats take time.
Feed the Fancy Feast exclusively. Drop dose to 1u or so. Test before every shot and try to identify nadir with other testing in the cycles. Test for ketones every chance you can with KETOSTIX.
Shop for a safer vet.
Someone there gave 20 units? Run as fast as you can from that office.