Mr. Pink on Lantus

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Opticheart

Member Since 2017
So my cat Mr. Pink developed diabetes last year. Through Science Diet DM and Lantus insulin we got him into remission. I was testing twice a day and doing my own curve at home an emailing the vet.

Around the time he went into remission I changed vets because I was not happy with the service I was getting as a client of almost 25 years. It felt like I was constantly getting mugged for cash, he was misdiagnosed and when I needed someone to talk me through doing testing I could not get anyone to call me and they wanted to charge me for that and a sharps disposal container as well.

So after about six months in remission I noticed old behaviours and did a spot test and his sugar was up very high. So I informed my new vet and he said to put him on insulin again. I was doing what I thought I should be doing which was testing in morning and evening (drawing and testing blood from the ear). During his physical we also discovered he had CKD as well Stage 2. During a conversation with another vet in the practice when mine was away while we going over numbers she said I should NOT be testing him twice a day. That testing was only for curves. I was shocked and told her that this was, what I believed, the opposite of what my vet had told me.

When I finally got to talk to my vet he confirmed what she had said. That I should not be testing twice a day, every day, that I should give a steady dose of insulin twice a day, test during the curve period and adjust accordingly. He will have a curve this coming Friday so we will see how he is doing. Unfortunately with his two conditions we are not feeding DM anymore but Royal Canin Renal D which he likes to support his Kidney numbers.

I notice a lot of you test twice a day, what do you think of this advice? Is this a new practice? Is it against what you all have heard or do? He seems fine and quite frankly my cat and I are glad I don't have to prick him twice a day. I plan to keep doing what my vet suggests. I trust him. But I'm interested in your thoughts.
 
Welcome. If I hadn’t tested before shooting and had left the house I don’t think Max would have survived. His first green numbers were after going to bed with him on the rise only to wake up to a much lower number. Since lantus dosing is based on the nadir which can vary a lot he would have been overdosed most likely. This is coming from someone that was never going to test at home. To me not testing a minimum of 3 times per cycle is dangerous to put it bluntly. Did you ask your vets why they are opposed to testing daily and how you would know if your cat was headed to a hypo?
 
I'm not exactly sure why they are against. They felt that a curve was a truer representation of the blood sugar throughout the day and that Lantus is a good insulin. I will ask him again after the vet visit we are doing Friday. But both vets said not to test every day. I feed him first and then give the 2 units well before I leave. My cat is kind of a grazer and sleeps a lot too. I smell his breath to make sure he's going into ketoacidosis. And he seems fine.
 
If their goal is to keep him in the 200's and every curve shows that he's not going any lower, it might be safe to test just twice a day... unless he happens to go into remission. And if that's on his agenda, the only way you'll know is by testing mid-cycle to see how low he's going. If you're unable to get a daytime mid-cycle test on work days, that's fine, there's a protocol for that - SLGS (Start Low, Go Slow). Tests must be done before each shot to make sure his BG is high enough to safely give it, and curves are done on the weekends. But many of us find that our cats go lower at night, and if you can't get a mid-cycle test during the day, it's a good idea to get one at night.

The first vet we saw after I moved was also against home testing. I got the feeling that they'd rather I pay for them to do curves and fructosamine tests.

If you look at some of the spreadsheets here, it will be difficult to find a cat that never gives an unexpected low now and then. Even one hypoglycemic episode can be deadly if it's not detected. If I sound a little argumentative, it's not directed at you - it's at your vet for giving you dumb advice! We want all kitties to be safe here and will do whatever we can to help, so read through the stickies and keep the questions coming! :bighug:
 
Thanks. I will recheck with him in person. The thinking seemed to be that the curves were more accurate than me testing. Also maybe he didn't trust me. Out of desperation and because my doctor was out of the office so long I raised his dose myself as his sugars were just wildly all over the place, high and low. Maybe he didn't want me to do that again. That was pretty stupid I admit but everything was happening so fast. I had to take him off the food that was working, we had to find a food he liked, I just found out he had CKD and his sugars were all over the place and I was spending another fortune. This was all within a week to 10 days.
 
If "all over the place" means that sometimes it's high and sometimes it's low, it could mean that he's bouncing from low blood sugar (or blood sugar that's lower than he's used to). Chino bounced a LOT until I switched to Levemir. He spent most of his time in the 300's, dropped below 100 2-3 times each week (usually at night), then bounced back to the 300's or higher. With patterns like that, occasional daytime curves would not have been enough to catch how low he was going every so often on the same dose.

It can be hard to think straight in a stressful situation. If I hadn't found this message board when I did, I might've done the same thing. Chino's old vet said I should only test with the AlphaTrak, and because the test strips were so expensive ($1 each), I often skipped the pre-shot, testing only in the middle of the cycle. The night that I switched to a human meter, I did a curve and he went from 429 before the PM dose to 111 10 hours later! (568 to 179 on the Alphatrak.)

Following one of the protocols is the only way to safely increase the dose on your own, and dosing is determined by how low they go (regardless of how high the AM or PM pre-shot test might be). Persistent high blood sugar is dangerous, but a single hypoglycemic episode can be fatal.
 
I bought my Verio One Touch before I even heard of the Alpha Trak and I wasn't about to dole out for another. The vet tech gave me a range that the lab uses to test so I just set my glucometer to that. I said it was bouncing all over. He gets 2 units in the morning and 2 at night. I haven't tested for about 3 weeks and he's fine, really. I give him his insulin after he eats and in well enough time in the morning before I go so that if he had a reaction I would see it. I promise, I'm following my vet's advice now. I will double check to see why he recommends against testing every day. (BTW did you test before and after food? I only tested once twice a day before I refed him). But he's ok.
 
If you look at my spreadsheet, I had 2 and half days that I wasn't testing because my monitor broke. In that time, my cat went from pretty consistent yellow numbers (200's) to pretty consistent green numbers (50-99). I was really surprised to see a 75 when I got my new monitor. Everything completely changed in a span of 2 days and it would have been very unsafe to continue to be blind dosing the same amount based on numbers from a week earlier.
I'm pretty new to this but very grateful for this site and all these very knowledgable experienced people to help guide me through this. The best thing my vet did for me and my cat was to tell me about this site.
 
My meter doesn't give my results like that. It gives me a range from 4.9 to 9.0 or something like that. So the colours and numbers you quote mean nothing to me. But my cat is doing good and I will have more answers in a couple of days.
 
We hear you! We also have very bad vet experiences.
If I kept following the vet's advice, Tux would have killed.
This site and people saved Tux's life. :cat:
I'm glad that you switched to Lantus from Vetsulin. :)

Welcome to FDMB! :bighug:
 
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