Need feeding/testing/injection timing advice

[Nettles]

My baby Ophelia (15 years old) was diagnosed 2 weeks ago with a blood glucose reading of over 500. I have been feeding her Purina PM wet food every 10 hours (she can only finish one can a day). I started her on Lantus (2 units) twice a day. My vet said to wait 15 minutes after feeding her to give the injection. Is that correct or should I wait longer? Also, when should I test her blood? I took a reading (I just got the monitor today) about 4 hours after she ate/got her shot and the reading was 400! Is this part of the process or am I doing something wrong? Help!

 

[Larry and Kitties]

Waiting 15 minutes is fine. It depends if yo cat vomits after eating. Some do so y want to wait for that time to pass before giving a shot. If you cat never vomits then not reason to wait.
Lantus is a depot insulin so it can take a couple of days to see the full effect of the Lantus injections.
You should test before each shot to see if the BG is high enough to give a shot. SInce y did not take a pre-shot BG, it is impossible to tel what the shot did t the BG.

 

[KPassa]

Hi Ophelia and Ophelia's Owner!

Lantus is a great insulin and it's fantastic that you're already home-testing! As Larry said, it can take 5-7 days after initially starting Lantus before you see the full impact on the BG (Blood Glucose) levels.

When it comes to feeding/eating times, since Lantus is a longer-duration insulin, it's not necessary for the cat to eat at shot time. So, as Larry mentioned, as long as Ophelia is not having any appetite issues or vomiting, you can feed her at any time. The only real feeding "rule" with Lantus is that we do recommend taking up all food 2 hours before shot time so the pre-shot test is not artificially inflated from food. You might also want to check out catinfo.org for more information on Feline Nutrition and for some cheaper options than the Purina DM.

As for when to test, I recommend at minimum 3-4 tests a day.

• Always test pre-shot. With Lantus, this will be twice a day, one in the AM and one in the PM. The pre-shot number lets you know if it's safe to give insulin and/or if the dose is too high/too low.
• Mid-cycle test about 4-8 hours after the morning shot, when possible (sometimes I have to skip this test due to work). This lets you know how the insulin is working and if she's dropping too low on the dose and when her nadir/low point might be (it can move from cycle to cycle).
• Before-bed test. This lets you know how low she might drop overnight while you're asleep. If the number seems low, then you might want to set an alarm to wake yourself up in a couple of hours to test again or leave out some medium carb food, depending on the number.

Then, any additional tests you can get throughout the day/night and across the week help add data on how your cat reacts specifically to food, to insulin, to the environment, etc....

We have this handy spreadsheet that we all use that helps us keep track of the numbers. Here is some spreadsheet-specific terminology that might help with filling it out:

Questions on understanding how to use the spreadsheet get asked a lot, so I thought I'd share a quick run-down of spreadsheet-specific terminology:

• Fur shot: when the syringe needle pokes through almost like a sewing needle through fabric and it is unknown how much, if any, insulin actually made it inside the cat. Usually detected by wet fur or the smell of insulin (it smells like band-aids or scotch or antiseptic). IT IS ALWAYS ASSUMED THAT THE CAT GOT THE INSULIN AND YOU NEVER GIVE ANOTHER SHOT. It is always better to miss a shot than to give too much insulin.
• AMS/PMS: morning (AM)/evening (PM) shot
• AMPS/PMPS: morning pre-shot test/evening pre-shot test (it's assumed the shot is given within 15 minutes or less of this test).
• +1, +2, +3...: How many hours after a shot, i.e. +1 would be one hour after their last PS (pre-shot) test
• BG/BS: Blood Glucose or Blood Sugar (numbers). Usually used in relation to testing and dosing and what "level" or "point" the cat is at. Used in a sentence: "Michelangelo's BGs have been high so I've been increasing his dose."
• AMBG/PMBG: morning/evening Blood Glucose. Used when no shot has been given at the regular shot time.

 

[Nettles]

This board is wonderful! I was not given a lot of this info at the vet. Knowing that it takes time for the Lantus to work is very helpful. I'm finding, because of my own illness, that scheduling is an issue. While it was made clear that everything should be done on a tight schedule, I'm not sure if I can handle that. Is it possible to "mess up" once in a while and not kill my cat? Freaking out here.

 

[Arienna]

Sooo... As I understand it, administering a dose early, because the two doses will over lap, works like increasing the dose. Delaying the dose similarly works as a temporary decrease in dose. My vet, who nursed her own elderly cat through diabetes, said she frequently went 20 minutes either way without noticing any side effects. Your own kitty's results my vary.

 

[KPassa]

Sooo... As I understand it, administering a dose early, because the two doses will over lap, works like increasing the dose. Delaying the dose similarly works as a temporary decrease in dose. My vet, who nursed her own elderly cat through diabetes, said she frequently went 20 minutes either way without noticing any side effects. Your own kitty's results my vary.

Yes, this is correct. You can move 15 minutes each shot time or a half hour once a day. Otherwise, it can act like an increase/decrease in dose. This also means that if you do give a shot at a different time, the next shot will have to be 12 hours from that. So, let's say your normal shot times are 7 am/pm and you give a shot late at 8 pm instead. This means the next shot can be given no earlier than 7:30 am...at least not until you have the data to show you can; ECID (Every Cat Is Different). Then the shot that night needs to also be given at 7:30 pm (remember, only a half hour a day). By the second morning, you'll be back onto your 7 am/pm schedule.

 

[KPassa]

While it was made clear that everything should be done on a tight schedule, I'm not sure if I can handle that. Is it possible to "mess up" once in a while and not kill my cat? Freaking out here.

And, yes, it is possible to "mess up" once in a while without killing your cat. ;-) Just remember that it's better to be "too high for a day than too low for a minute," so if you do have to "mess up," always err on the side of caution. How much flexibility are you looking for?