My experience with newly diagnosed diabetic cat.

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alison

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My cat is a 13 year old Siamese that was diagnosed as diabetic about 7 weeks ago.
He has been hospitalised twice, first when he was very high when he was first diagnosed, and a second time a couple of weeks ago when he went high again with ketones etc.
He was started out on 2 units of glargine morning and night, but was still drinking a lot of water and losing weight. The vet then increased his insulin to 3 in the morning and 2 at night. Still very thirsty and his breath smelt of ketones sometimes.
After getting blood glucose readings of 23, 22 and 19 on this dose, the vet increased the insulin to 4 in the morning and 2 at night. Still got high readings, so dose was increased again and is now 4 in the morning and 3 units at night. He appears to be suiting this level of insulin. Eating well, though he only snacks on small amounts at a time, but they are regular – maybe around 8 snacks a day. He has never eaten a lot at once. Little and often is what he likes.

At first I used a Novo Pen to inject my cat. My husband is also diabetic and he had a spare pen and it seemed easier to use. However, I noticed a drop would always be left on the end of the needle after I had injected him, and sometimes another drop would ooze out before I could get the cap on the pen. The vet said I was the only person who used a pen on their cat and was I sure he was getting the correct dose etc. My son also wondered whether a syringe would give a more accurate dose. I was a little nervous about switching to a syringe as I had found the pen easy to dial up the dose and inject, but in the last couple of days I have used a syringe and I now think the syringe gives a more accurate dose and no drop is left on the end of the needle after I have injected him. Being a small animal on a small dose of insulin every drop is important as this could be a significant part of his dose.
My cats eyes look better (his third eyelid was showing a lot when he was on a lower dose and probably high most of the time. He is going outside more and seems to have a little more energy. So I am going to only use a syringe from now on. Soon I will test him in the morning and if he is still a little high we may increase his evening dose to 4 units as well, but not yet, and only ever on the advice from our vet. We want to give him time to adjust to a 4 in the am and a 3 in the pm. We have managed to get a drop of blood from him only twice, once from the back of the ear and once from the pad of his back foot. The readings were 8 and 9, so we were very pleased with those, having only ever had a 19 or in the low twenties before. This was hard to do but I think it is worth persevering because you then know for sure if he is high or low without constant visits to the vet. We use the same blood testing meter as my husband but of course you could buy one from your vet. Get him to show you how to get a drop of blood for testing. They must not get too low, like a three. This is very dangerous and can be fatal. Better to be a little high than get readings too low.

I have found the last few weeks since my cat was diagnosed as diabetic as one of the most difficult times of my life. He has had many vet visits, blood tests, hospitalised twice, and caused me so much worry. It was very difficult seeing him quite weak, not eating sometimes, and he has lost almost a kilo in weight, At his heaviest he was 6 kgs, but when was mainly around 5.7. He also looked good. He is now 5 kgs but as he is eating well on his new higher dose I think he will now start to gain some weight.
Hopefully he will continue to improve or at least stay as he is as he is now pretty good but it has only been a few days.
I wish all you people with diabetic cats the very best for your cat, and wish you the strength and perseverance to care for your cat and get his dose right. Their life is in your hands and they are completely at your mercy. Good luck to you all.
 
You have certainly had an experience with your kitty and learned a lot. You are using a good insulin.

We have some experiences that might help you also. There is a lot of research on this site about how Lantus (glargine) works best in cats. You might check out the Lantus forum and read the starred stickies on the top of the page. viewforum.php?f=9

Wondering what food you feed? We have found that wet lo carb can really bring down blood glucose levels. This website by a vet explains why: www.catinfo.org

It sounds like you have tried testing at home. It is the cornerstone of our suggested treatment protocol. Numbers at the vet are often much higher than the numbers at home because stress raises bg levels, and cats are often stressed at the vet. So we test at home and base our doses on those numbers.

Hope you will read some of the resources on this site. If you have any questions, just ask.
 
while your cat may or may not be a 'complicated' diabetic, the fact that your vet is not going about this in a truly systematic/scientific matter has definitely contributed to your difficulties, I'm sorry. I'm not saying they don't mean well, but a dose needs to be held for awhile, testing done at home to mimic normal conditions, and raises only by 0.5 units at a time, otherwise you run the chance that you miss the correct dose. You can overdose and cause high numbers that make it look like you are underdosing.

There are also other potential factors contributing like infection, acromegaly, etc., so you need again to be systematic.

If you are or will test at home, hold a dose for a week, get preshot and mid shot tests, rule out infection (especially teeth) and other contributing factors you SHOULD find things much easier!

Good luck and keep posting ok?

Jen
 
Another thing that may be complicating his progress is that when Lantus is used twice a day, the doses should be equal doses. The only way you will be able to find a dose that works well, and all day, is to keep the AM and PM shots 12 hours apart and the same amount AM and PM. That's just the way a long-lasting "shed" type insulin like Lantus works. Especially having a difference of 4u AM and 2u PM. Kitty's body can never adjust to the insulin when he's getting twice as much in one shot as he is in the other. If the vet is doing that because either the AM BG reading is higher consistently or the PM one is, that pattern is more likely due to the overall daily dosing being too high to begin with.

Carl
 
First of all, thank you for your advice, I appreciate it all and will be speaking to my vet.
His diet mainly consists of Fancy Feast tins or lean chicken and some dry diabetic food from the vet.

Today at 2 pm I managed to get a blood test from Delboy, he was 3.6 (low), this is with 4 units at 7.30 am.
I tested again at 7.30pm today - up to 24.5 (high)! I have given him 3 units at 7.30 pm.
Why could he be swinging from these extremes? Any advice would be appreciated, I am finding him very difficult to control.
Thank you.
 
The low number mid cycle can be a sign that the dose is too high. It may not have been the lowest he went in the cycle. Cats can bounce from low numbers to high numbers because their body panics at the low number and releases more glucose. Lantus works best with the same dose twice daily so you want to have a dose you can safely give twice daily.

As suggested, your dose is quite high. We suggest starting at a low dose and increasing slowly as the data you collect indicates. That is a much safer method than starting with a higher dose and risking a low number and a hypo.

You might print off some of the stickies on the Lantus forum and share them with your vet. Several of them are directly from vets/hospitals or based on their research.
viewforum.php?f=9
 
ohbell said:
wondering how Delboy is doing??? anyone heard from Alison yet??

Delboy has been good today, we tested him at +6 hours after his morning shot, and was 3.6 again - this is with 3 units rather than 4 yesterday (when we also got 3.6).
His behaviour is normal, eating, drinking, outside and happy etc, but I still feel this is a bit low. We will test him this evening before his shot and then decide how much to give him.
I will eventually get his doses the same morning and evening.
I am currently thinking of reducing his morning shot a little bit tomorrow and gradually bring it down even lower.
I Will post again with an evening reading,

Thanks, Alison.

P.S this site is very helpful!
 
Unfortunately I couldn't get a blood glucose sample tonight, must've tried at least ten times :oops:.
But have given him a 'skinny' 3 tonight. He's eating well and behaving normally. Will update tomorrow.
 
Be sure to get the ear nice and hot before poking. And use the larger gauge lancets to get a bigger hole. And always, a treat for you and the kitty even if unsuccessful.
 
Hi I have done a few more readings with Delboy. He has been fine the last couple of weeks on a 'skinny' 3 of glargine twice a day.
Because he is difficult to get blood from we didn't test for a while as he was good, but have managed to get some readings recently.

19/11/2011 : 21.2 at + 30 minutes (Evening)
20/11/2011 : 16.9 at +6 hours from morning injection (he had 3 units rather than a skinny 3)
21/11/2011 : 17.3 at + 6 hours from morning injection (3 units this morning)

Because he has been high the last few readings, I'm wondering if I am still overdosing or not giving enough insulin.
In my previous posts Delboy was dropping down low to 3.6 during the afternoons (this was a few weeks ago) but these last two afternoons has been high.

Also I have ordered some methycobalmin for his legs which should be coming this week.

Thanks,
Alison.
 
Some links

Tight Regulation Protocol
Lantus & Levemir – Insulin Depot –AKA- Storage Shed


Testing on cat’s ear
BG Conversion Calculator

Jasper-neuropathy site-B12 dose

And some info:

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.


"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.

Reducing the dose...
--- If kitty drops below 40 (long term diabetic) or 50 (newly diagnosed diabetic) reduce the dose by 0.25 unit. If kitty has a history of not holding reductions well or if reductions are close together... sneak the dose down by shaving the dose rather than reducing by a full quarter unit. Alternatively, at each newly reduced dose... try to make sure kitty maintains numbers in the normal range for seven days before reducing the dose further.

--- If an attempted reduction fails, go right back up to the last good dose.
--- Try to go from 0.25u to 0.1u before stopping insulin completely.

Random Notes...
Because of the cumulative nature of Lantus and Levemir:
An early shot = a dose increase.
A late shot = a dose reduction.

A "cycle" refers to the period of time between shots. There are 2 cycles in one day when shooting twice a day.


If you have given this dose of 3u BID time to settle, as stated above, for a good 5 days, and are still getting numbers in the 300s (between 16.7 and 22.2), then you can try an increase of .5u, or up to 3.5u. Be sure to hold each new dose for 4 to 6 cycles to give the shed a chance to fill and the new dose a chance to start working.
 
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