Lots of questions! Help!

[Kchid]

My kitty Zoe was diagnosed 3 weeks ago. She’s 16 1/2. Her numbers are all over the place. She takes 2 units twice a day.
Sometimes her readings are in the 500 and 600’s. Sometimes 300’s. A few times in the 100’s. Now this is at time to inject insulin. Is this typical?

Next questions... Lantus... roll or
don't roll?
Refrigerate or don’t?
Keep for 28 days or 6 months ?
There’s so much conflicting info out there.
Help!

 

[CandyH & Catcat]

what they told me when I started on Lantus (and these know what they're talking about)

don't roll (does not need to be mixed like Vetsulin does)
yes, refrigerate
may last more than 6 months if refrigerated, may be able to use the entire contents (my vial going on 7 months)

don't inject air into the pen if that's what you're using

 

[Kchid]

Thank you candyh!
I'm not using the pen. I'm using the vial and syringe. I read on lantus website to inject air into the vial. I've also read conflicting info on that. Do you now if I should do that?

 

[Veronica & Babu-chiri]

First of all welcome and congratulations for testing at home that's a great start.

It takes a long time to get a cat regulated so is kind of normal that her numbers are not quite regular yet, but to really try and see what's going on, we would need to know all the results of the tests you are getting, are you testing mid day or only at shoot time?

There's a spreadsheet we use that will help you a lot and it will help others to help you, here's the link with the instructions (http://felinediabetes.com/FDMB/thre...te-a-ss-and-link-it-in-your-signature.130337/)

Usually at shoot time they are going to be a bit high since the effect of the insulin is starting to wear off that's why we need some extra tests or a curve once a week depending on the protocol you choose to follow, I think you could take a look at the stickies in the Lantus forum there's a lot of information there that can help you. (http://www.felinediabetes.com/FDMB/threads/the-basics-new-to-the-group-start-here.18139/)

How was the dose raised? because 2 units in a very short time since she started using insulin seems a bit high.

I'm not using the pen. I'm using the vial and syringe. I read on lantus website to inject air into the vial. I've also read conflicting info on that. Do you now if I should do that?

You don't have to do it, with the air that goes in when you get the needle into the vial (even if you are super careful just a tiny move will let some air in) should be enough to avoid getting a void inside the vial and having trouble getting the insulin out

Refrigerate or don’t?

If you do not refrigerate it then it would only last 28 days and it could be a waste of a lot of insulin, but Lantus can actually be kept out of the fridge, but if you do refrigerate it then as they mentioned it would last a long time without any problem

 

[Kchid]

First of all welcome and congratulations for testing at home that's a great start.

It takes a long time to get a cat regulated so is kind of normal that her numbers are not quite regular yet, but to really try and see what's going on, we would need to know all the results of the tests you are getting, are you testing mid day or only at shoot time?

There's a spreadsheet we use that will help you a lot and it will help others to help you, here's the link with the instructions (http://felinediabetes.com/FDMB/thre...te-a-ss-and-link-it-in-your-signature.130337/)

Usually at shoot time they are going to be a bit high since the effect of the insulin is starting to wear off that's why we need some extra tests or a curve once a week depending on the protocol you choose to follow, I think you could take a look at the stickies in the Lantus forum there's a lot of information there that can help you. (http://www.felinediabetes.com/FDMB/threads/the-basics-new-to-the-group-start-here.18139/)

How was the dose raised? because 2 units in a very short time since she started using insulin seems a bit high.


You don't have to do it, with the air that goes in when you get the needle into the vial (even if you are super careful just a tiny move will let some air in) should be enough to avoid getting a void inside the vial and having trouble getting the insulin out


If you do not refrigerate it then it would only last 28 days and it could be a waste of a lot of insulin, but Lantus can actually be kept out of the fridge, but if you do refrigerate it then as they mentioned it would last a long time without any problem

Thank you for the welcome!
That’s the dose she was started at. She’s gone too low twice. It’s very stressful.
The vet said soon I can do a glucose curve at home which I’m fine with, well other than the terrible guilt I feel poking her ears or they can do a fructosamine test.
I did in the beginning check more than at her injection times but she gets stressed and doesn’t eat so we decided to just do at injection time. She doesn’t eat that great. She has a mild case of stomatitis. She’s already a tiny cat. Normally 8 lbs. she’s down to about 6 1/2 now.
Because she has gone too low twice honestly if I check her and she’s in the 200’s I don’t give her her insulin. If she’s in the 300’s I give her 1 unit. 400’s or higher I give her the 2 units. I decided that in my own. It may be totally wrong but I don’t want to come home to a dead cat. I will take any advise. I will also look at uploading her readings. Thank you so much for the information.

 

[Veronica & Babu-chiri]

Because she has gone too low twice honestly if I check her and she’s in the 200’s I don’t give her her insulin. If she’s in the 300’s I give her 1 unit. 400’s or higher I give her the 2 units. I decided that in my own. It may be totally wrong but I don’t want to come home to a dead cat. I will take any advise.

Is always better to be on the safe side so you did right, is really better to be safe than sorry.

As they mentioned at the beginning the rule of thumbs we use is you do not shoot if the cat is 200 or less at the preshot test , as you get more data and more experience that will change but for now I think is better to stick to that.

You are using Lantus and with Lantus you have to keep the same dose (morning and night) for at least 6 cicles ( a cicle is a 12 hour period ) if you are testing a lot and for a whole week if you are testing less and doing a curve once a week (this would be determined by the protocol you decide to follow so take a look at the protocols and decide which one suits you best ), because Lantus needs consistency and you do not establish the dose based on her preshot test but in the lowest test result you get during the day ( that would be her nadir) but and this is a big but if at any time she goes under 90 you have to lower the dose in 0.25 units on the next shoot and keep the new dose again for a few cycles as mentioned before

The vet said soon I can do a glucose curve at home which I’m fine with, well other than the terrible guilt I feel poking her ears or they can do a fructosamine test.

Making a curve at home will really help you a lot to see what's going on, the fructosamine test is a very good test for the diagnose but it really doesn't help much with the dose since it gives you an average of how she's been doing in a long period of time but it doesn't give you how low she could have gone ( and actually be in danger) or how high she's been and how she is right now

That’s the dose she was started at. She’s gone too low twice. It’s very stressful.

When you say she's gone too low how low has she been?

 

[Kchid]

Is always better to be on the safe side so you did wright, is really better to be safe than sorry.

As they mentioned at the beginning the rule of thumbs we use is you do not shoot if the cat is 200 or less at the preshot test , as you get more data and more experience that will change but for now I think is better to stick to that.

You are using Lantus and with Lantus you have to keep the same dose (morning and night) for at least 6 cicles ( a cicle is a 12 hour period ) if you are testing a lot and for a whole week if you are testing less and doing a curve once a week (this would be determined by the protocol you decide to follow so take a look at the protocols and decide which one suits you best ), because Lantus needs consistency and you do not establish the dose based on her preshot test but in the lowest test result you get during the day ( that would be her nadir) but and this is a big but if at any time she goes under 90 you have to lower the dose in 0.25 units on the next shoot and keep the new dose again for a few cycles as mentioned before


Making a curve at home will really help you a lot to see what's going on, the fructosamine test is a very good test for the diagnose but it really doesn't help much with the dose since it gives you an average of how she's been doing in a long period of time but it doesn't give you how low she could have gone ( and actually be in danger) or how high she's been and how she is right now


When you say she's gone too low how low has she been?

In the 50’s

 

[Kchid]

So I guess I’ve been wrong by not giving her the same dose. Maybe 2 units is too much. I did a curve right after she was diagnosed and her lowest reading was 171 and that was 6 hours after injection. I think the challenging thing is she doesn’t alway eat a lot. The vet monitored her for 2 days for me when I was at work and the lowest she went was 398. She’s very stressed when she’s there.

Is always better to be on the safe side so you did right, is really better to be safe than sorry.

As they mentioned at the beginning the rule of thumbs we use is you do not shoot if the cat is 200 or less at the preshot test , as you get more data and more experience that will change but for now I think is better to stick to that.

You are using Lantus and with Lantus you have to keep the same dose (morning and night) for at least 6 cicles ( a cicle is a 12 hour period ) if you are testing a lot and for a whole week if you are testing less and doing a curve once a week (this would be determined by the protocol you decide to follow so take a look at the protocols and decide which one suits you best ), because Lantus needs consistency and you do not establish the dose based on her preshot test but in the lowest test result you get during the day ( that would be her nadir) but and this is a big but if at any time she goes under 90 you have to lower the dose in 0.25 units on the next shoot and keep the new dose again for a few cycles as mentioned before


Making a curve at home will really help you a lot to see what's going on, the fructosamine test is a very good test for the diagnose but it really doesn't help much with the dose since it gives you an average of how she's been doing in a long period of time but it doesn't give you how low she could have gone ( and actually be in danger) or how high she's been and how she is right now


When you say she's gone too low how low has she been?

 

[Veronica & Babu-chiri]

In the 50’s

I do think the 2 unit dose is a bit high for her, when you upload her results we could probably see a bit better what's going on but I do suggest you consider lowering the dose, for the time being maybe to 1unit

And please read the information about how to treat hypos (http://www.felinediabetes.com/FDMB/threads/how-to-treat-hypos-they-can-kill-print-this-out.15887/) because it can be really dangerous and you really need what to do if this happens , you need to have some high carbs (carbohydrate) food and some karo at hand this is a good post on what you would need for a hypo kit (http://www.felinediabetes.com/FDMB/threads/jojo-and-bunnys-hypo-tool-box.2354/)

 

[Kchid]

Ok thank you so much for the info. I will get her results uploaded a little later. I feel like I can breath a little now. I’ve been so extremely stressed about this. I feel like I didn’t know exactly what I was doing and the vet seems bothered by too many questions.

 

[Veronica & Babu-chiri]

So I guess I’ve been wrong by not giving her the same dose. Maybe 2 units is too much. I did a curve right after she was diagnosed and her lowest reading was 171 and that was 6 hours after injection. I think the challenging thing is she doesn’t alway eat a lot. The vet monitored her for 2 days for me when I was at work and the lowest she went was 398. She’s very stressed when she’s there.

Stress can really influence the blood glucose numbers and raise them a lot, Babu could go 150 points higher at the vet than what he was at home 10 minutes before, and it would take him a few hours to get it back down afterwards so tests done at the vet are not always that good because most cats get really stressed

 

[Veronica & Babu-chiri]

Ok thank you so much for the info. I will get her results uploaded a little later. I feel like I can breath a little now. I’ve been so extremely stressed about this. I feel like I didn’t know exactly what I was doing and the vet seems bothered by too many questions.

Yes please take a big breath there are lots of people here that can help you, and you can ask all you want

Most vets do not really know much about how to treat diabetic cats but most do not addmit it so they send us home with almost no information and no real help so we know how you feel

 

[Kchid]

Another question that the vet didn’t seem concerned about but I am is Zoe’s diet. She’s eating royal Canin mother and babycat. It’s small kibble and she really likes it. she’s very finicky and has the stomatitis which makes eating painful. She’s on bup for pain. Does anyone know if this food is ok?

 

[Veronica & Babu-chiri]

Another question that the vet didn’t seem concerned about but I am is Zoe’s diet. She’s eating royal Canin mother and babycat. It’s small kibble and she really likes it. she’s very finicky and has the stomatitis which makes eating painful. She’s on bup for pain. Does anyone know if this food is ok?

Diabetic cats just like diabetic people need to avoid food that has a lot of suggar or ingredients the body will turn into suggar, in the cat's case that means avoiding food that is high in carbohydrates, and unfortunately most kibble is, in this case doing some rough numbers on royal Canin mother and baby cat it is around 27 % which is way way high for a diabetic cat and is actually raising her numbers

For her you want food that is 10% or less in carbohydrates, and preferably wet ( which may make it easier for her to eat also), you will probably have to start testing with some different foods to find one that she likes and that suits her condition, you could try some pates so that she practically won't have to chew anything that may help her eat a bit more and maybe even add a bit of water to it to help her

There's a list made by Dr. Lisa Pearson that we use and that will help you know which ones are good for her, just look for the ones that are 10% or less in carbs in this list http://catinfo.org/docs/CatFoodProteinFatCarbPhosphorusChart.pdf

 

[Kchid]

Yikes! I had a feeling. Ok I looked at the list at she will eat a little fancy feast pate , the fish flavors which are very low in carbs and even the royal Canin wet food isn’t too bad. She just really likes dry.
Any suggestions on some low carb dry? The list only has wet food.

 

[Veronica & Babu-chiri]

Yikes! I had a feeling. Ok I looked at the list at she will eat a little fancy feast pate , the fish flavors which are very low in carbs and even the royal Canin wet food isn’t too bad. She just really likes dry.
Any suggestions on some low carb dry? The list only has wet food.

If possible it would be best if you can convince her to switch to wet food, it may take a while but it will really help her in a lot of ways, starting with the fact that it may be easier for her to eat, and it would help her kidneys that given her age you may want to start taking a bit more care to them, my cats even became more active when I changed them to wet low carb food (I changed the 4 cats to avoid Babu eating something he shouldn't) and since mine are really potato couches it was notorious and their coats improved ( not sure how this was good since they already had tons of hair to begin with that needed a lot of brushing but they sure looked better).

Dr. Lisa has some very good tips to transition cats from dry to wet https://catinfo.org/docs/TipsForTransitioning1-14-11.pdf

If she totally refuses I think there are some people here giving Young again zero carbs but for this you may want to open a new thread asking specifically for recommendations on dry food

 

[Kchid]

Thank you again! I was just reading Dr Lisa’s article. Excuse my ignorance about the site. How do I start a new discussion? I have a couple of things to ask about, the food and vet recommendations.

 

[Veronica & Babu-chiri]

Thank you again! I was just reading Dr Lisa’s article. Excuse my ignorance about the site. How do I start a new discussion? I have a couple of things to ask about, the food and vet recommendations.

When you are in the forum page, where you see the list of all the posts, there's a botton at the top right part of the page that says "post new thread" click on it to start a new one

 

[Kchid]

I just tested Zoe’s glucose for evening insulin and she’s at 180. I did not give it. I just don’t get her numbers being all over the place. She had about 4 or 5 steroid injections to help with the inflammation in her mouth. This was prior to her diagnosis. I wonder if her body is just trying to regulate its self?

 

[Veronica & Babu-chiri]

I just tested Zoe’s glucose for evening insulin and she’s at 180. I did not give it. I just don’t get her numbers being all over the place. She had about 4 or 5 steroid injections to help with the inflammation in her mouth. This was prior to her diagnosis. I wonder if her body is just trying to regulate its self?

Steroids can raise blood glucose and trigger the diabetes, but if she hasn't had any more shoots since then that could be causing her numbers to go lower, she may still need a bit of insulin but probably a lot less than 2 units

She may be a bit high tomorrow morning since you skipped the shot still no matter the number I suggest you take a conservative approach since we don't really know how's she reacting and maybe give 0.5 units for a few days see how she does and then later on decide if you need to raise it to 0.75 units or keep that dose

 

[Kchid]

Thank you again.