Need dose advise please

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MonetsMom

MonetsMom

Member Since 2013
Hi Everyone! Practically every web site I visited for information about feline diabetes recommended this forum. My cat Monet was diagnosed on October 10,2013 with diabetes. He is a 10 year old Himalayan. (I have another 10 year old Persian cat named Picasso.)
We noticed Monet drinking a lot of water and then he started peeing outside of his litter box. Took him to the our Vet and it was confirmed he had Diabetes. His BG numbers were very high 567. We gradually (over 6 days) moved Monet (and Picasso) to an all wet canned food diet (Monet is now totally on Hill's Prescription Diet M/D and Picasso on W/D). Our Vet would like Monet to weigh about 11 lbs, he is currently at 12.5 lbs. We stated using Lantus, he started on 3 units twice daily for the first 3 days, then was upped to 4 units twice daily. When our Vet did a BG curve on the fourth day his numbers were all over the place. They started at 180 and rose all day, last reading @Vets was 627 ! On Oct. 19 we started doing home testing using the AccuTrak 2 monitor. We attempted our first curve on the Oct. 19. I so wish I had found this forum prior to this ! Readings were not what we expected. First was 75 (pre-shot), then 3 hrs later 76. We were in a panic and did NOT give him his shot. We called Vet's office when they opened (it was a Saturday and they were only open until 12:00). Based on these two readings, the Vet told us to change his dosage to 3 units (2 times daily) and give him some more food. So @9:30 AM we gave him his shot (3 units). 3 hours later his BG level was at 56. Immediately gave him food. 3 hours later took BG again and it was at 77. Feed him a little again. Next BG test at 9:30 PM we got a reading of 116. We fed him and gave him his shot (3 units). The next day (Oct. 20) we testing Monet @9:30 AM and got a reading of 90. We feed him and gave him his shot (3 units). This is where things started really deteriorating. At 2:30 tested BG because Monet was not acting like himself (He was just laying around with not very much energy). We got a reading of 40 ! Yikes . . . I totally freaked out. Immediately feed him 1 tbsp of food (he did come running for his food ) I started reading on internet what to do when levels drop this much. What I kept reading is as long as his BG is not below 40 and he is not walking funny and still can move around, try and get the BG back up by feeding every hour and testing. Read to only give him Karo Syrup if he starts wobbling, being non-responsive.
So for the next few hours I was feeding him a tbsp of food. At 8:20 his BG was up to 149, so we did give his scheduled shot at 9:30PM (3 units). What a stressful last couple of days. I was in tears so much . My poor baby had to just fell horrible and there we were pricking his little ear so many times. I could not wait for Monday(Oct. 21) to come so I could call our Vet. Monday morning Monet seemed to be feeling normal again. Tested his BG at 5:45 AM and it was at 219. Called Vet @9:00 AM and he said to keep Monet on the 3 units and we would do a fructosamine test in 2 weeks. Gave scheduled 9:30AM shot ( 3 units) . At 9:30PM tested BG and it was at 78, so we feed him and did NOT give him his shot. Tuesday (Oct. 22) test BG at 5:30AM and got reading of 174. At 6:30 AM feed him and gave him his shot (3 units). Our Vet's guideline he gave us just today, says if BG is less than 60 give Karo Syrup, if less than 120 do NOT give insulin, feed, and test again in one hour. If BG is still below 80 do not give shot. We are just so overwhelmed and confused about all of this. We want to do the absolute best thing for Monet with a goal of getting him in permanent remission. I would love to hear other's thoughts and opinions on our Vet's strategy. From things I've been reading, it sounds like what we should be doing is lowering his insulin dosage but still giving the 2 shots per day perhaps ???? Our Vet actually thinks we might be seeing signs that Money is going into remission and very early remission. Any advice, experiences, etc. would be greatly appreciated!
 
Re: New Member

Welcome to FDMB.

First things first - its great you're testing - you probably saved his life.

He has earned a major dose reduction. If you continue with that dose you may kill him. Please drop the dose down to 0.5 to 1.0 units.

You need some high carb food with gravy, or Karo/other syrup.

Test NOW please.
If below 80 on AlphaTrak or below 50 mg/dL on a human glucometer, give 1-2 teaspoons of syrup/gravy.
Wait 30 min.
Test and repeat as needed.
 
Re: New Member

Now, to understand the numbers you are getting.

Here are some glucose reference ranges used for decision making using glucometers. Human glucometer numbers are given first. Numbers in parentheses are for non-US meters. Numbers in curly braces are estimates for an AlphaTrak.

< 40 mg/dL (2.2 mmol/L) {< 70 mg/dL for an AlphaTrak}
- Treat as if HYPO if on insulin
- At nadir (lowest point between shots) in a long term diabetic (more than a year), may earn a reduction.

< 50 mg/dL (2.8 mmol/L) {< 80 mg/dL for an AlphaTrak}
- If before nadir, steer with food, ie, give modest amounts of medium carb food to keep from going below 50 (2.8).
- At nadir, often indicates dose reduction is earned.

50 - 130 mg/dL (2.8 - 7.2 mmol/L) {80 - 160 mg/dL for an AlphaTrak}
- On insulin - great control when following a tight regulation protocol.
- Off insulin - normal numbers. (May even go as low as the upper 30s (1.7 mmol/L){60s for an AlphaTrak}; if not on insulin, this can be safe.

= 150 mg/dL (8.3 mmol/L) {> 180 mg/dL for an AlphaTrak}
- the lowest level pre-shot for ProZinc, PZI, or other non-depot insulins.

> 150 mg/dL (8.3 mmol/L) {> 180 mg/dL for an AlphaTrak}
- At nadir, indicates a dose increase may be needed when following a tight regulation protocol.

200 mg/dL (11.1 mmol/L) {230 mg/dL for an AlphaTrak}
- no shot level for beginners; may slowly reduce to 150 mg/dL (8.3 mmol/L) {180 mg/dL} for long-acting insulins (Lantus, Levemir, and ProZinc) as mid-cycle data collection shows it is safe

180 - 280 mg/dL (10 - 15.6 mmol/L) {may be 210 - 310 mg/dL for an AlphaTrak}
- Any time - The renal threshold (depending on data source and cat's renal function) where glucose spills into the urine.
- Test for ketones, glucose is too high.

>= 280 mg/dL (15.6 mmol/L) {may be >=310 mf/dL for an AlphaTrak}, if for most of the cycle between shots
- Uncontrolled diabetes and thus at risk for diabetic ketoacidosis and hepatic lipidosis
- Follow your insulin protocol for dose adjustments
- Test for ketones; if more than a trace level of ketones, go to vet ASAP.
 
Re: New Member

No wonder you're confused! I don't use Lantus but I can give you some general info. We suggest starting at one unit, testing every preshot and midcycle and increasing slowly as the numbers warrant. This is much safer than starting at a larger dose, getting low numbers, skipping and risking hypos. If he were mine, I would start over at one unit and get some data.

We suggest new diabetics not shoot under 200 but to wait 20 minutes, without feeding and retest. If he is rising and over 200, the shoot but maybe a reduced dose. We like to see a nice drop midcycle but over 40. We consider 40 approaching hypo territory.
 
Re: New Member

WOW....thanks so much for everyone's quick responses! Just to be clear, the consensus is I need to reduce is insulin amount Immediately....but, gradually? Since he is currently getting 3 units I should reduce to 2.5 on next shot ...then next one 2 etc. ? I am so worried right now, I hope I have not done anything wrong ...just following Vet's advise.
 
Re: New Member

The vet was wrong. And if you gave 3 units this morning, you may end up back in the hypo situation today, so snag another test asap.

What is her current weight?
What is her ideal weight?
Take the lower.
Convert to kilograms by dividing by 2.2.
Multiply by 0.25 to get the appropriate starting dose for Lantus.

I'd drop down to that number immediately.

Lantus has a depot of carryover effect; the insulin builds up with successive doses. You need to drop it now, to drain out some of the depot quickly.
 
Re: New Member

Thank you BJM...should I do the gradual reduction ...reducing each shot by .5? Monet weights 12.5 currently, vet says his ideal weight should be about 11pounds.
 
Re: New Member

No need for gradual reduction.

11 pounds is lean weight
in Kg, that's 5 kg
0.25*5 = 1.25, round down for safety - give no more than 1 unit.
 
Re: New Member

Is the meter an AlphaTrak (pet specific glucometer), or an AccuCheck(human glucometer)?
 
Re: New Member

OK - you might print out and highlight the preceding chart of reference numbers I gave you, to ID the AlphaTrak numbers.

Did you give insulin this morning?
And if yes, did you test again yet?
 
Re: New Member

We have a spreadsheet/chart on Google Docs to help us record and track the glucose levels.

Instructions are here

AMPS = morning pre-shot test result
PMPS = evening pre-shot test result
U = units of insulin
+1 = any test result 1 hour after insulin
+2 = any test result 2 hours after insulin
+# = any test result # hours after insulin
 
Re: New Member

Yes gave shot this morning at 6:30 (no shot last night because his number was at 76). Did not test this morning because I have used last test stip...new ones are on way and should be at my house by the time I get home from work at 4:30. Will test then.
 
Re: New Member

Leave a lot of food out while you are away; he's at risk for going into a hypoglycemic episode which could kill him.

Can you find anyone to stay with him?

PS - I posted over in the Lantus group to ask folks to come take a look, as I have to go to a meeting now. (I'll be back)
 
Re: New Member

My husband works from home and is there with him...We feed (hill's prescription m/d) him this morning at shot time and he ate very well...almost the whole amount. My Husband feed him a little more MD around 11:00....he said he is acting normal. I will phone him and get him to feed him again. Our Vets guideline for feeding him was about two thirds of a can of MD twice daily at around shot time. What's your thoughts on feeding and amounts. BTW....thanks so much for your help!
 
Re: New Member

I agree with BJM. I think you need to leave lots of high carb food out for him.

If you can find someone to stay with him and to possibly test him as soon as possible.... that would be the safest thing you can do for Monet right now.

I dont mean to scare you.... but he is at risk of having a hypo if his numbers drop low.


What dose did you give this morning? Sorry a little confused about that
 
Re: New Member

I think right now the biggest concern is keeping Monets numbers in a safe range especially until you can test him.

If Monet acts hungry, it could be a sign of the blood glucose being low... (some cats act hungrier when their BG number drops) so if he acts hungry I would let him eat...

These are a few symptoms of a Hypo that you should watch out for:
"The symptoms to be concerned about include but are not limited to:
staggering, uncoordinated movements, 'drunken' walk, wobbling, balance problems
ataxia - usually lack of muscular coordination, but maybe changes in head and neck movements
disorientation (yowling, walking in circles, etc.)
twitching
stupor
convulsions or seizures
coma"

Here is the link to the post about how to handle low numbers. Please bookmark this/print it out : viewtopic.php?f=9&t=147
 
Re: New Member

This morning at 7:00 he did get his shot (3units). My husband is home with him now and he says Monet seems to be acting normal. Thanks so much for your help !
 
Re: New Member

Thanks everyone for continued posers and links...you guys are awesome! I just called and made appointment to go and talk with Vet today at 3:20. I am going to share with him all the info I've learned over the past hour. I will test Monet as soon as I get home around 4:30 and post what his BG level is. My husband is feeding him now about every hour ...he is feeding him the hill's prescription w/d instead of m/d since it is higher in carbs.
 
Re: New Member

Hi Monet's mom and welcome to the FDMB! (we'd love to know your name!)

If you're going to go talk to your vet, you might want to ask if they're familiar with the AAHA Guidelines for managing feline diabetes as well as the Tight Regulation Protocol for Lantus by Vet Dr Jackie Rand of University of Queensland.

The protocol has been published and proven to get up to 84% of newly diagnosed diabetics into remission within 6 months using Lantus, so it's a very successful way to treat Monet.

The protocol we use here is a modified version,(gathered from years and years of real life statistics and following hundreds of cats) to keep kitties SAFE (number 1 rule here) as well as giving them the best possible chance at going OTJ (off the juice...insulin being "the juice")

We recommend starting at no more than 1 unit twice/day. Lantus is a "depot" insulin and it takes about a week to "fill the depot". When given, part of the Lantus starts to work, and the rest is stored in the tissues and released slowly.

Changes in dose are made in .25 unit increments...not only for safety, but because the "perfect dose" for Monet might be in between the "lines" on the syringes (which is why it's important to use U100 syringes that have half unit markings...it's hard enough to see those little .5 unit lines, so the .25 and .75 doses are even harder to see)

I strongly recommend you drop back to 1 unit and start over with Monet. High numbers take time to do damage to the organs...Low numbers kill quickly..we'd rather see them too high for a day, than too low for a minute

Good luck with Monet, and I hope you'll keep asking questions. The people here have years of real life data on treating diabetes. While it sounds like you have a pretty good vet, there's just no way for vets to keep on top of the latest treatments for every disease for each time of animal they see. The only thing we deal with here is diabetes and the diseases that tend to come with it..Like pancreatitis and kidney disease.

Edited to add..The M/D and W/D are too high in carbs for the best control...You can feed any of the foods on Dr. Pierson's Food Chart that are less than 10% carbs. These include readily available and inexpensive foods such as Fancy Feast Classics, Friskies Pate's and Special Kitty Pate's. Unless there's a specific reason to feed the "prescription diets", they really aren't good choices for diabetes. (and usually aren't good for what they SAY they're good for) Vets get a lot of their "nutritional education" from Hills salesmen..and their main goal is to sell products
 
Re: New Member

Ask your vet if he is familiar with the "Roomp/Rand" tight regulation protocol for Lantus, or the AAHA guidelines for insulin dosage with Lantus? My guess is "no" to either, because otherwise your kitty would have been started on 1u twice a day.

Those are the guidelines we normally suggest for starting dosage.

Also, the Hill's m/d... It's not the greatest food either in terms of quality or in terms of being good for diabetic cats. Your vet may not be aware of that either. There are much better choices which are lower in carbs, and much cheaper. And just as good quality. Fancy Feast classics are at least as good and are lower in carbs. Prescription food is overpriced and overrated. Most of us feed brands off the grocery store shelf.

http://www.catinfo.org is a great site about feline nutrition and feline diabetes. Share that with your vet.
 
Re: New Member

Thanks so much for the info Chris/China! This forum is AMAZING! I wish I had found it 1w2 days ago ...but I guess "better late than sorry ! " Btw... My name is Risé
 
Re: New Member

Here is a picture of Monet...
 

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Re: New Member

Also, whenever you switch to a low carb food, you may see a pretty big drop in Blood Glucose numbers. So whenever you switch foods, you will want to monitor his BG a little more carefully.
 
Re: New Member

You're welcome, and nice to meet you Risé,
Monet is absolutely beautiful :smile:
Can you tell us generally where you live (city/state), so we have an idea which time zone you're in?
 
Re: New Member

Monet is beautiful, Rise!!! What a stunner!!

I added a link in my other comment that has a list of every food you can buy and the carb percentages...you want to be under 10% carbs (Column C) ...but you should switch over gradually..over about 5-7 days so Monet's numbers don't drop too quickly just because of the food change.

You can also add Monet's picture as your avatar, although you might have to resize it. You can do that here. They can only be 90 pixels

The User Control panel is at the top left of the page. Once there, go to "Profile", and then "Edit Avatar".(you can also put where you live in the information) As long as you're in the Control Panel, it'd be great for you to add some information into your Signature Block too. (will keep a lot of us from asking the same questions over and over)..just go to "Edit Signature". Things like Your name and cat's name/age/etc, date of diagnosis, type of insulin you're using, type of meter you're using, any additional health problems, and any other information you'd like to add. As we get you using our spreadsheet program to keep track of Monet's readings, you can put that link in too. (You can see the information I have for China below in my signature, as well as others who've replied to you)

We're happy you're here and already home testing..that will make a world of difference!!
 
Re: New Member

When you see your vet, I would not be surprised if he is concerned about what we internet people have told you and possibly upset. Because of this, I would encourage you to print out the AAHA guidelines for you to read/skim over ahead of time and then go over them with him.

This is just one of the scientific veterinary resources we base our posts on. We have or had a diabetic cat at one point, and have lived feline diabetes management 24/7. Most vets will see only a few diabetic cats a year.
 
Re: New Member

Your kitty is GORGEOUS!

You''ve been getting readings of 40's and 50's on an AlphaTrak? YIKES!! Yep...your vet has you on way too high a dose.
Unfortunately this is not an uncommon story around here. (or some similar version) You have been lucky so far...you won't always (or even usually) see signs of hypo. Only way to know for sure is to test. You are especially lucky you found this board. tons of great information and wonderful, smart, supportive, people here who deal with FD 24/7. There is a lot to absorb at first, but you will get the guidance you need here to help keep your kitty safe. You just need to re-boot and start over.

Welcome to the board!
 
Re: New Member

Thank u thank u thank u for all of the support/advise ! u guys ROCK ! In fact, you might have saved Monet's life! I just got home from visiting my Vet and he pretty much agreed with everything you all have been posting. I am reducing insulin down to 1 unit! He thought we would have to eventually increase it to 2....but he did agree to start with 1. He wanted me for now to keep Monet on Hill's Prescription m/d so not to confuse where any improvements might come from. I tested BG as soon as I got home and it was 98....so I feed him Hill's w/d wet and Hill's minced chicken wet (his pre-diabetic food). Will test again around 7:00 and if BG is > 150 will give insulin (1 unit).
 
Re: New Member

Pop over to Cat Info and read what vet Dr Lisa Pierson has to say about feline nutrition. Then share the web site with your vet.

And if the glucose levels still aren't optimal, I'd go for changing the food to low carb, canned or raw wet food. I've got 14 civvies at present and feed them Friskies pates in the 13 oz cans.
 
Re: New Member

He wanted me for now to keep Monet on Hill's Prescription m/d so not to confuse where any improvements might come from.
Click to expand...

I actually don't think that is terrible advice. I understand his logic. Change one thing at a time so you know for sure if it works. Then reevaluate to see if a diet change will improve things.

Hill's m/d is listed as having 14% carbs on Dr. Lisa's chart. All you have to keep in the back of your head is that if the numbers don't look too good after a few days on 1u, then a possible "fix" is changing to a lower carb food (rather than increasing the insulin dose). Most FF classics (I only mention those because that's what I fed Bob) are 5% or less. So that's a potential thing that you could do as a logical "next step". Bob's vet also prescribed Hill's m/d. He ate it for a couple of days, then just refused to eat it anymore. That's the primary reason I went with Fancy Feast and Friskees. The bonus was that they were all lower carb choices than the m/d, so that helped Bob out too. Also, most vets will accept returns of prescription food. If you do eventually decide to "switch", you should be able to get a refund on the Hill's.
 
Re: New Member

As others have said, the M/D isn't too bad..14% but the W/D is 25% so you might want to stick with the M/D for now, or you can get some of the lower carb types of food and gradually switch over. We always say not to just switch overnight if you're already giving insulin...do it gradually....it's also just good sense so they don't have any problems with just switching foods (never mind the carbs)

Now all of the Science Diet foods (non-prescription) are too high..between 20 and 35%. (both Hills and Science Diet are made by the same people, but they're in different places on the Food chart)

Glad to hear your vet feels we are giving you good advice too! We hear so many people say that when they mention the internet, their vets tell them to stop listening to those crazy cat people and don't believe anything you read on the internet...of course they never take the time to LOOK at what we do here, and our number 1 concern is safety..period

Will look forward to seeing how Monet does going forward!
 
Re: New Member

It is probably fine to stay with the food for a few days (but not necessary) ...You really want to stay under 10% carbs from Dr. Pearson's chart on catinfo.org (linked above)
This really is as primary a part of treatment as the insulin. I was already feeding natural human grade 'health' type foods to my kitties thinking I was so up on things and informed...until my cat got DIABETES. I switched to these appropriate canned diets and was weening my cat off insulin in a matter of weeks. The low carb-high protein canned diets made all the difference in the world. It wasn't about natural. It was getting off dry totally..and feeding foods with the proper nutrient ratios. Also I started feeding mini-meals spread throughout the day which many of us here do. It is easier on their pancreas. and adding some water to each feeding helps tremendously. My cat no longer drinks water separately, but gets all his moisture with his meals. His coat became lustrous, and he never again had a recurrence of previously chronic urinary issues. Feeding him correctly took care of both things. He has been in remission/diet-controlled for 3 1/2+ years now. I will always need to feed him this way though...once a diabetic, always a diabetic.
As long as you are testing when you make the change, you are fine. No need to wait really.

Read Dr. Lisa's site. She is a feline nutritionist and a wonderful resource for so MANY things. Great primer.
 
Re: New Member

Thanks Betty and Chris for your recent posts... Will definitely start looking for better food alternatives.
 
Re: New Member

MonetsMom said:
Thanks Betty and Chris for your recent posts... Will definitely start looking for better food alternatives.
Click to expand...

Having a pre-shot test too low to shoot safely (without mid-cycle data showing you can do it) is another clue a dose may be too high. We suggest new folk not shoot below 200 mg/dL until there is enough test data showing it is safe (doesn't drop the glucose below 80 mg/dL on an AlphaTrak). As each week passes, you may be able to lower that cut-off a smidge each week until you're "shooting low to stay low", something that can be done with vigilent monitoring.

This is part of the Lantus Tight Regulation protocol and has been successful in getting a number of cats off the insulin.
 
Re: New Member

Thanks BJM ...u were the first that posted to me today...u have been AMAZING ! In fact, all the postsI have received today has left me feeling so blesses to have found you guys!
 
Re: New Member

If 89 is his pre-shot number (ie: when you usually would dose him) then definitely NO shot tonight...especially for a newbie
89 on Alpha-trak is like a 59 on human meters most of us use. WAY too low for you to be dosing him.
This is why you MUST test. You have no idea how the insulin is working unless you do.

Your instincts have been right on. Keep reading the stickies (here and on the Lantus ISG) and ask as many questions as you can think of. There is not a bad question right now. We have all been there. Once you get your arms around it, it really is very manageable.

Time will tell will tell what dose he will need. But as has been said, we adjust dose up/down by .25 increments so as not to pass the optimum dose. You will not believe how much a teensie bit of juice can do in these kitties. Some even a drop or 2 makes a difference. Who knows if you will end up at 2 or down at 1/2. You test and he will let you know what he needs.
 
Re: New Member

Thanks Betty ....I just tested Monet again and got a 98...so I feed him. Will test around 5:30am and hopefully his BG will be a bit higher. By that time 24 hrs would have passes since his last shot!
 
Re: New Member

Good Morning everyone... Monet's BG reading @5:30am was 128 ...so no shot this morning. Since I am new to this board ...would it be best for me to continue posting like this in the same place or should I be creating a new post even if in a different area?
 
Re: New Member

Nice morning glucose level. If you spot check about 2 hours after feeding, you'll see what impact food has on her glucose level. Feeding mini-meals in the first 6 hours after shots can spread out the workload for the pancreas. Some folks freeze part of the mean so it may be nibbled as it thaws. Some folks are home to do this. And some folks get a timed feeder (ex PetSafe 5, on Amazon) to do this.

You may continue posting here if you wish. And general health questions are always appropriate for the Health forum.

Once you get a spreadsheet up in Google Docs, you might move to one of our Lantus forums.

If you'd like to follow the Tight Regulation (TR) Lantus (and Levemir) protocol, folks there post a condo, or condition report daily with the date, cat's name, and the test results, editing the first post to add successive test results when they get them. Tight Regulation has worked well enough that many cats have gone off the juice - OTJ - and become diet controlled.

If your days don't lend themselves well to TR, the Relaxed Lantus forum is another place you could post.
 
Re: New Member

Just tested Monet his BG level was 201 so I gave him his shot - 1 unit....his first shot since yesterday @6:30am and his first shot with the reduced lantus amount down from 3 units.
 
Re: New Member

Yeah Rise!! That was a good decision!!

If you can get a +2 test, that's a good indicator of how active his PM cycle might be. If there's a big difference between the Pre-shot number and the +2 number, it's probably going to be an "active" cycle, and require more testing.

It will really help us going forward if you get the spreadsheet program we suggested done. It's the easiest way for you (and us) to learn how Monet responds to the insulin and food. It's also how we tell if he might need more or less insulin in the future.

You'll want to hold that same 1 unit dose for at least 3-5 days (6-10 cycles) unless he goes below 80 on the AlphaTrak (50 on human meters). If that happens, it's an automatic reduction of .25

Good luck with the reduced dose! It will be MUCH safer for him than the crazy high amount your vet started you on
 
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