Leo - newly diagnosed sugar cat

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Lisa & Leo

Lisa & Leo

Member Since 2012
Hi all,

Here's my introduction for Leo, our new cat who was diagnosed on 7/30/12. Leo is about 2 1/2 and 10 pounds. He was an outside cat who adopted us, and on January 1st, he showed up without much appetite and an infected tail. We took him to the emergency vet where he got 11 stitches and the Cone of Shame :-) We never intended to keep him inside (our inside cat wasn't amused), but he nearly died from the infection and we'd already been in love with him from the other side of the screen door, so we had him neutered, tested, poked and prodded. He got a clean bill of health. No FIV/FeLV. However, the entire time, he ate and peed like mad. Since the labs were clean, we assumed it was psychological - he never knew if this would be his last meal.

After 6 months and some recurrent diarrhea, he went back to the vet last Friday. He's also eating/drinking/peeing/pooping a lot, he lost 3 pounds and started being more clingy. The last couple months were a downhill slide.

After more testing, we found out Monday he is FIV positive and diabetic. (They think the tail injury was a cat fight and he hadn't yet developed antibodies so the first FIV test was negative.) His blood glucose was 584 and no ketones. They have no explanation for the onset of diabetes. That's quite a double-whammy for a poor little kitty, right? Well, after 3 days of internet cramming, here we are, having found LOTS of good info here!

Leo's going on Lantus and I'll be giving him his first dose tonight (1.5 units). He's used to Fancy Feast Classic (thankfully it's on the "good" list), so the doctor said we can keep feeding him that, but I'm taking away his crunchies for now and just feeding wet food. They suggested the AlphaTrak but I choked on the price. After reading here, I bought the ReliOn Confirm because you all have such great experience I know you'll help me with questions about the difference in values. (Thanks ahead of time on that!)

I know I'm forgetting things - been so stressed the last couple of days reading and learning, then getting the information from the vet today. Tonight will be an adventure with the first BG test, the first insulin injection ... I feel like an idiot reading all these directions and being overwhelmed. The kitchen table is full of boxes, pamphlets, manuals, test strips, etc. Well, I managed to lance myself and take my own BG reading (90!) and it wasn't so bad. Hopefully Leo will feel the same way!

Thanks all -
Lisa and Leo
 
Hi Lisa,
Nice to meet you, and I'm glad you found this site (I didn't find it until my cat had been on insulin for weeks)!

Leo has been eating dry and canned up until now?
This is just a suggestion, but if you are cutting off the dry "cold turkey", that is going to lower his BG numbers (in some cases very much so). Based on the AAHA guidelines for dosing, his dose should probably be a tad lower (.25u per kg of lean body weight), and the removal of dry food would probably indicate it should be lowered as well.
I'm going to ask others who are familiar with Lantus to come over and chime in, but I am thinking that a dose of 1u every twelve hours would be more logical and safer to start with.

What time are you planning on his first test and shot?

Carl
 
Oh, I forgot to mention...

The FF classics are perfect food for Leo. All of the classics fall into the "low-carb" category, and lots of us use them. That was Bob's menu when he was on insulin, and that and Friskees Pates are the only thing he eats now.

I'm glad you poked your finger first and found it to not really be so bad. His ears have less pain-sensing nerves than your fingertips do, so he might act surprised that Mom is suddenly poking him with sharp objects for some reason, but it won't really "hurt" him as much as you might fear.

Carl
 
I agree with Carl--1.5u is too high a starting dose for Leo. A cat that is 10 lbs and not overweight is 4.5 kg, which means his starting dose should be 1u. It's very important to start with a low, safe dose--most cats on a low carb, canned diet do not need much more than 1u of insulin. Bandit is 13lbs and he never needed more than 1.25u the entire time he was on Lantus, and most of the time he needed less than that.

Have you checked out the stickies in the Lantus forum? http://www.felinediabetes.com/FDMB/viewforum.php?f=9 There is a ton of very useful information there. Also, this thread helps explain how Lantus should be dosed--newly diagnosed cats that follow the protocol have an 84% remission rate. :smile:
 
Hi Carl and Julia - thanks for the welcome.

Leo got his first test and dose last night. I updated his spreadsheet - that's a neat thing, that it automatically colors the BG values!

I don't know how to write this exactly but
Last night 420, then 1.5u. 338 at +6
This morning 377 then 1.5u. 347 at +3

So, it looks like the insulin is actually doing something, which is great! I was worried a little about the dose so I got up in the night to check it. Then I read your post about the protocol so now I will test every 3 hours. Leo is being very tolerant of the sticks. I have to stick him several times until I get enough blood. There's either nearly nothing, or a nice drop. I think I'm hitting the vein - nothing else gives me much. I have the very fine needles. I think I read somewhere to start with the fine needles instead because more capillaries will grow as he gets stuck more? I made the rice sock which he tolerates somewhat, but he starts wiggling. I have the lancet on the deepest setting.

I wondered about the dose too, since I read the dosing here before I went to the doctor. I didn't challenge them. They said his values were so high to start with, that's the dose they chose. Plus he'd lost 3 pounds and some was water, so maybe they factored that into the dose. Looking at his first values, he's still pretty high so I'll keep monitoring every 3 hours and see if the 1.5 seems unreasonable. I'll keep his spreadsheet updated so you can see. The vet is pleased I will share his values, so I'll give them all the data for them to see too and get their feedback. They seem on-the-ball and nearly everything they said was in line with what I read here. She'd mentioned they'd returned from a workshop and half of it was about feline diabetes, so I know they are interested in keeping pace. If I mention the protocol with the first round of results, they'll probably be receptive.

Thank you for the links to the Lantus page. I hadn't gotten there yet - there is so much here to read! Yesterday was all about researching meters, getting supplies and learning. Over the next several days I'll be learning more and more.

Yes, I'm so happy FF was on the list with the right carb amount.

About the dry food - the vet didn't say one way or the other. She said that he could have a smaller feeding mid-cycle, and that we shouldn't be restricting the volume initially because his body needs to settle in to using the insulin. His primary food has always been wet, with dry for grazing. We stopped the dry on Monday when we got the diagnosis. He didn't get insulin until yesterday because we travel and they don't administer human insulin. Again, I think I'll follow the 3 day testing period and if things don't look crazy, I'll just give more wet.

Please don't think I'm ignoring your suggestions - they all make sense. I don't want to change what I started and add other variables. But please give feedback during this time!

Thanks so much for your responses and feedback,
Lisa
 
Those lower numbers aren't likely from the insulin working. Lantus has to build up a "shed", or insulin depot under the skin before it starts lowering blood glucose, so you're not likely going to see the effects of the insulin until today at the earliest. Check out this sticky for more information: http://www.felinediabetes.com/FDMB/viewtopic.php?f=9&t=150

If a cat is underweight, then the starting dose should be .25u per kg of actual weight instead of ideal weight. So his starting dose is still 1u according to the protocol.

The reason I am a bit concerned is this--.5u of insulin is a lot of insulin to a cat, even if it doesn't seem it. Cats are really small, which is why we usually make dose adjustments in .25u increments. You can put more insulin into a cat if the 1u isn't effective--but you can't take that insulin out if 1.5u is too much. It's better to be too high for a few days than too low for a second.

It's great that you're getting mid-cycle checks! :thumbup Dose adjustments with Lantus are made based on the nadir, or the lowest number of the cycle, which usually occurs somewhere around +6. You need to collect a mid-cycle test daily to truly know how the insulin is working. This is because if you dose too high and the cat drops too low in the middle of the cycle, its liver will dump glucose into its bloodstream, so then BG will be even higher than it was before. If you're not getting daily mid-cycle checks, then you won't be able to tell if the high numbers mean the dose is too high, or if the high numbers means the dose is low. If the dose ends up being too high already and you keep raising it, that can lead to a deadly hypoglycemic situation once the cat's body can no longer compensate for the low blood sugar.

That's why you always want to approach dosing from underneath the right dose (unless there's a health condition like ketones in the mix, and then you may to be more aggressive), and raise it slowly in .25u-.5u increments (depending on what his nadirs are like). While I think that 1.5u is not the safest place to start, it's not insane, but just be super cautious right now. I would make sure I get mid-cycle tests in both his AM and PM cycles, so that you don't miss him dropping too low if it happens. Too much insulin will look exactly like too little insulin unless you happen to catch that one low number with testing, and if you miss it then you're into a dangerous chronic overdose situation.
 
Julia,

Ok - makes sense. I'm learning more each time. I'll have ammo to take back to the vet. I just took a +6 and today he is

377 PS 1.5
347 +3
302 +6

His values are trending down. If they keep dropping each cycle too much, then I think I would call the vet to adjust it. I'll keep testing every 3 hours and keep an eye on him. I am working from home so I can watch out.

Any advise on the lancing? It took another 4 hits to get a spot that had enough blood. There seem to be areas where there are no capillaries! Larger lancet? I pressed it hard into his ear with my thumb on the other side the last time that worked, but I might have felt the lancet in my thumb. I also tried his back foot at the back of the big pad, like the vet suggested as an alternate site. It didn't do a thing! I think his pads are pretty thick. He started to get distressed but he is being SUCH a good kitty. :sad:
 
Actually, we suggest to start out with a larger lancet- but it has the lower numbers- 26, 28... This makes a bigger hole. The capillaries will come, no matter what you poke. But it is easier to get blood from a larger hole.

You are doing great and in a position to test frequently :-D .

One thing to file away for later, if his numbers keep acting crazy it might be b/c the food carb # you give him is crazy. My kitty was so carb sensitive that a difference of going from 5% to 2% carb in a day would make her numbers dance around like a bouncing bean :lol: . So file it away for later to just give a % of food at a time if Leo's numbers dance the cha-cha.
 
Ditto on getting larger 26g lancets. Too small lancets are biggest problem most people have when they're learning to test. I was guilty of it myself--I went out and got 33g lancets because my logic was that the smaller the lancet, the less the cat would feel it, and the more he would tolerate testing. This turned out to be the exact opposite of what I wanted to do. Cats have very few nerve endings in their ears, so it's not the feeling of the poke they care about. It's being restrained and having their nervous and scared owner do something new and unfamiliar to them. So the faster and calmer and more often you poke, the better the cat adjusts to the testing.
 
Success!

Thank you both for the recommendations. I watched the video about Buddy and his owner lancing his ear manually, without the lancing device. It worked! First try, and Leo was only mildly annoyed!!! :razz: I poked two times next to one another in the sweet spot (and ohhh was it sweet) and got a nice drop right away! Hurray! I feel so much relief. Whew! I wasn't crazy about using the lancing device - the end is so big I couldn't aim it very well. Doing manually is the ticket.

That's the +9 value - 387.

Thanks!
 
Awesome! Yes, that video of Buddy is one of the best of the "how to poke" vids. It's amazing how much excitement we all feel any time some new member finds "success!!!" with making an ear bleed :lol: Wow, we really are crazy internet cat people!

Free handing was the ticket for me too. Every time you do it, it'll get easier on you and on Leo. Congrats!

Carl
 
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