Need help for a co-worker's diabetic cat (a bit long)

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Allie & Myrtle (GA)

Allie & Myrtle (GA)

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Well, I know before I even start what responses I will get, to a large extent, so can I please ask for some "thinking outside the square" (do you say that in the US??)

My co-worker's 18 year old cat is on Lantus since his DX earlier in the year, and has been doing well.
However, she does not home test. Her little kids collect pee, which she tests very frequently.

I'd ask on the Lantus forum, but when I did that earlier (I know nothing about Lantus) all I got was exhortations to home-test.
It is NOT my cat. I can't make her home-test. I think she and her DH and kids devote a lot of time to him, however, and have treated him carefully and conservatively, based on what results they get from his pee (i.e. they've dropped his dose down during the time his pee was negative).

I seldom see her these days as she is working in another part of the organisation, so I've not been closely monitoring what doses they are giving him.

My question is - what would be a test for rebound (which I am currently suspecting) for a cat that is not home-tested?
He was on 1 unit BID when his pee was negative, but then his UG went up again, so they upped his dose gradually. They are now giving him 2.5 BID and his UG is fairly high.
She told me today they were going to give him 3 units BID, but I felt this might be a case of rebound (which I tried to explain to her as best i could). I told her to drop his dose back to 1 unit BID for 3 days and then terst his pee.
I am not sure if this is good advice, or the correct way of testing for rebound in a non-home-tested cat.

I'd really like some general advice about rebound (don't refer me back to the Lantus ISG!!)
She really cares about her cat, and is doing more for him than some people "out there" do, so I don't want to discourage her by saying I can't help if she won't home-test. I HAVE pointed out several times that that is the best way to go.

Grateful for any comments about what I told her to do.
 
Hi, Allie... first & foremost - I do thank you for caring enough about your coworker & her kitty to post. I am one of those "Lantus Land" people, in the beginning I was very intimated by all of this - but we all have good intentions & I apologize on behalf of any wrong impressions you got. Lantus Land is my family & have helped me, so I know nobody meant to come across as scaring you off - but we feel passionate & sometimes in messages appear insensitive when they are not. I don't recall your post, but I will say it is impossible to diagnosis anything (rebound, etc) unless we have data to work with. I agree, it is soooooooo good that your coworkers family is dedicating their time & lives to their diabetic kitty, I also agree you cannot make decisions for them to home test. The only other option I can come up with is, have them take the kitty to the vet & let the vet test? I know that may not be what you want to hear, but without data (numbers) we just cannot say what is going on. Giving blind advice without knowing real numbers is dangerous & not an acceptable way to treat any human or animal. (((Hugs to you))) please do not stop asking questions, I will & others will try to answer.
 
Well, back in 1990 with my first diabetic, there was no FDMB, no hometesting that vets mentioned, ketones were never even mentioned. Heck, I didn't even have a computer. Eli Lilly had a urine test tape, looked like a scotch tape dispenser, and I tested Patches urine every day between 2 and 3 p.m. The vet stated he always wanted to see 10% glucose and if negative, lower the dose. We also used W/D canned and dry. We survived 4 years before CRF took him and I learned to know my Patches very well. I have never used Lantus so........she either takes a chance on upping the dose and testing urine or.....she could skip one shot and see what the urine throws out after 12 hrs or she could drop the dose. Not much help and I know you are worried but they are doing all that they are comfortable with. Any chance of you going over and showing them how to hometest, maybe bring a meter?
 
Darn it - I lost a reply to Nicole into the ether!! I hate the way this happens on the new Board if 2 responses get posted at once grr_red

Sigh. What I said was, thank you for the thoughtful response - and thank you, too, Hope.
Trouble is, despite his age he hates to be handled and visits to the vet throw him into a total panic. He has to be gassed down for practically any procedure. The vet didn't even do a curve for him at the beginning because he felt that stress would distort his numbers so much. He had a blood draw for a fructosamine under anaesthetic and he is diabetic for sure.
I think this why his beans fear home-testing - that he will then refuse insulin shots. I can't help with this either, because Myrtle was semi-feral and I didn't home-test her either! ohmygod_smile
He did respond very well to treatment - from total lethargy back to purring and talking and jumping on the bed again.
They have done pretty well with the urine testing, in that they dropped his dose very gradually down from the vet's initial (!) 2.5 BID down to 1 BID, at which point he was UG negative for a couple of weeks.
I wondered if perhaps even that became too much, and so his UG went up again, and they countered that with a gradual rise in dose.

BTW, she works elseswhere in the organisation now, so I have not been in close touch with what she is doing.
I didn't think a 3 day drop back to 1 unit BID from the 2.5 BID they are on right now would do any harm, and that it would take that long for them to be able to guage (by pee) if downwards was the way to go.
 
Well, actually, Hope - I did have a meter and practised on my neighbour's docile indoor/outdoor cat! It was quite easy! (That girl was not diabetic fur shure :mrgreen: )
But Myrtle was a totally different critter - she'd slash me for touching her ears!
 
Here is a link that explains rebound: http://petdiabetes.wikia.com/wiki/Rebound

I don't know if this will help you or not. I didn't read your post on LL. But what I can tell you is, that it is almost impossible to provide relevant answers to questions when someone is not home testing. The reason is, that there is no real way to tell what is really happening with the cat's BG's and what may be rebound or hypo or too high or too low a dose, without having the data to back it up and interpret.

Doing urine tests alone, only tell how much sugar is in the cat's urine and depending on how old it is, may or may not be valid. Plus urine tests can check for ketones - are those the kinds of tests they are doing?

That is the reason for the negative responses on LL. Nobody will come out and give you any specific information, because they don't have anything to base it on. Does that make sense?

I hope this is helpful. Oh and it's thinking outside the box - not the square. But that's cute too. :cool:
 
Thanks a lot, Hilary, for the link!

I totally realise that without the data from BG testing, it is pretty well impossible to tell what's going on.
That's why I hoped someone could think "outside the square/box"!! and just confirm or reject my supposition (because that's all it CAN be) that a period as long as 3 days on a reduced dose could tell from the pee if the BG itself had gone down a bit - give a bit of a trend at least, either upwards or downwards. I'd guess that if it had gone up after three days on a much reduced dose, it probably wouldn't have been rebound.
By the way, I didn't post about THIS issue on the Lantus forum, because when I approached Lantus Land back in January when they started treating him, and asked for a bit of info. about Lantus, I mentioned that they were probably not going to home-test. So the few responses I got were along the lines that without home-testing no one could or would tell me anything at all about Lantus - it was so dangerous, etc. I felt like they might as well have said "leave the cat to die untreated or PTS if the owners won't hometest". I found that unhelpful, and then the forum rolled on at lightning speed with everyone posting about their a.m. and p.m. tests and shots and BG counts and it was like they were in a little closed world of their own - which I guess is perfectly fine - that forum is for users of Lantus after all.

That's why I approached the Health forum with this question. If there were any really old timers here who treated their cats before BG testing was the norm, I figured they might possibly still be around and have had to deal with this issue of rebound (if it IS rebound?!) from pee testing alone.

(The beans have the ketodiastix, and test for ketones also)

Don't get me wrong - I do fully understand the reluctance of people to comment without hard data.
I'll read that link about rebound - thanks again!
 
Hope this helps:
Jill & Alex said:
while i unequivocally agree with the others about hometesting...
Marshall and Rand (CENTRE FOR COMPANION ANIMAL HEALTH, The School of Veterinary Science, The University of Queensland) have come up with a dosing protocol for cats on lantus or levemir and glucose monitoring every 1-2 weeks: http://www.uq.edu.au/ccah/docs/diabetesinfo/link3.pdf.

viewtopic.php?f=3&t=504
:mrgreen:
Click to expand...
 
Thanks for that link, Mal - I'll look at that link at home. (I'm at work, and for some reason I can't get into that link from this server - can't imagine why not)

I read the thread that Jill's post was from, and was quite relieved to read Jess's post, where she said that in her position she saw Lantus-treated cats all the time that were not home-tested, and though this was by no means ideal, these cats still had a good quality of life.
I know it is true of my co-worker's cat. I believe they do their best as they see it, they love him to bits, and they are thrilled at how much happier and healthier he is. With him at the age of nearly 19, you can't be too dissatisfied about that.
 
Under the circumstances it sounds like the owners are doing the very most they feel they can do to try to regulate the cat. You're right that it's more than a lot of people would do for an 18 year old cat.

Perhaps if you give them more information about Lantus, such as the Rand info on urine monitoring(if you could print that out for them, for example) and tell them about the good track record for getting kitties off insulin it has, they might further understand why you're thinking the cat needs even less insulin now.

I think your suggestion to go back down to 1U for several days is a good one. Do you know if they're consistent on shot times? Losing that consistency may also cause BGs to go up (loss of shed), but does not necessarily mean cat needs more/less insulin. Also, what about food? Did they feed dry before or a different kind of food - for example go from a low carb canned food to a higher carb canned food? That might also result in glucose in the urine.

Remember, general guideline on glucose spillage in urine is mid to upper 200s, some say even lower. I've never used those urine sticks - do they give a range of colors for different levels? You're saying UG is high, so I'm guessing they have varying colors, but does the bottle give a BG range or just say "negative", "moderate", "high?" Would we take "high" to mean 400s? If so, then yeah, a rebound check is probably in order.

Have they considered testing urine at different times of the day? I know it wouldn't be real accurate as far as it being a curve, because of the time lapse between when glucose spills and when he pees, but perhaps they would see a point where the glucose doesn't register high, when it did earlier in the day. Make sense?

People come here for help and should get it, even if it's just brainstorming, ie, thinking outside the box.
 
I don't see it here on the new board, but on the old board there was a forum called Alternative Testing for those that tested with urine strips.

The only members name that used that forum that comes to mind in Ronnie and Moonie. ( I think that is right) Anyway, I know she eventually learned to home test, but did urine testing for quite some time. She might be helpful in advising how to determine rebound with urine strips.

I could be mistaken, so please verify this with someone that is certain, but I think urine testing is basically looking at what was going on with the body hours before when the urine collected in the bladder.

So- it seems to me, that if the urine were tested every 3 hours and the results were noted accordingly, you might begin to form a decent oicture of what's going on.

Say you test urine at 3pm, I wonder if one could safely presume the data collected reflects 3-5 hours prior?

Sorry I can't be more specific, but I think if you can find an alternative tester and work with the basic outline provided here, you might be able to get a loose picture of what is going on.

Of course, BG testing IS the most accurate, however if urine is all you can get I'd think it is better than not testing at all in any form.

Another thing you might try- which I am sur eyou have- is to direct your friend to this site and see if we can help...

Thank you for caring. :thumbup
 
Hi! Yes I am still here & available on Lantus, although I have been home testing for a long time now--
When I UG tested, I did it 3X a day--am, pm & midday, if there was any output...Rebound would be noted if cat was negative for day or two then shot up to higher mg/dl as indicated on the vial, or if you use glucotest! The urine tests are very sensitive, and if the test reads 152, it will show as the next level mg/dl from 150..You understand??
Purina's glucotest is very accurate, as are the ketodiastix but YES, you are measuring output from 3-5 hrs. ago, so the rebound might have already broken. by the time you get another reading...Getting a high reading indicates dose may need an increase, but make it a small one, as you know it is shooting sort of blind, and blood testing is so much more accurate--Like make it a fat or just add drop( AND i DO MEAN A DROP TO THE DOSE IF AT ALL)
Moonie did just fine for 11 months of urine testing, but I was quite obsessive about it & checked several times a day--Measured water intake every day, and sifted through more litter than can be imagined--Jojo' cat Bunny also lived for many many yrs. tested this way!
Please have this person PM me at Roni & Moonie for more info,as Alternative Monitoring I see isnt on this board--
But I will always help a fellow board member--
 
I responded to Melissa's PM & am just now reading this whole post!!
THAT SEEMS Like Too much Lantus to me, who UG tested for 11 months!! The lantus should be GRADUALLY increased like 0.25U at a time & wait for 6 cycles(3days) AT Least, to see if this cat comes down...When Moonie went up, Jojo would have me increase the dose just a little, down & negative for more than 3-5 days, decrease a little & try for 150mg/dl to keep cat stable...Jojo really guided me during that time, and I learned a lot!
The ketodiastix are good & cheaper..Glucotest available for $6 a pkt. fro amazon.com
I just want to say that this cat should get fructosamine test intermittantly( every 3 mths), or have vet do a bg test in the offfice , just to check where this bg is really going...Yes going to vet's office can raise bg also, but better than nothing. What are the numbers? How long on lantus?
Does any member live near this person to go over & try a bg test? Just my thoughts..
 
Thanks very much for the help! I also looked for the Alternative Monitoring group and couldn't find it on this Board.

As far as my co-worker goes - she knew I'd had a diabetic cat and told me when she suspected diabetes and then was diagnosed. I encouraged her to ask for Lantus, which is not much used here (Caninsulin was what he was going to be given). She wanted the best for him, so she got it. Not knowing anything about Lantus, I printed out what I could for her and said I might not be able to help much, but explained that she should start low and go slow. The vet was going to start him on 3 units BID and I begged her to ignore that and start on 1 BID. They kept to that dose for 10 days and gradually (in 10 day jumps) went up to about 2 BID, when his pee became negative. Then they reduced the dose down gradually to 1 BID and it stayed negative. She is very crippled with arthritis in her hands (not that she's old), so she depends on her husband to give the shots. I was there the night they gave him his first one, and her DH was like a pro. They even had cake to celebrate!
They are very careful about sticking to the timing of the shots, and her young daughters catch the pee directly on a spoon! and they test it fresh. I don't know how often they catch it - I guess with the two adults working full time and the kids at school, and the cat an outside pee-er, it might not be more than once a day at the most.
When she told me his UG had lately gone right up and they were gradually raising his dose, and had got back up to 2.5 BID, my first thought was of rebound, so I made that suggestion of dropping right back to 1 BID for 3 days, and I've sent her a print out on rebound that I found explained it well.
Who knows what is going on??? I know from my own experience of urine testing only that it is inadequate, and it is very hard being in the dark. Myrtle had regular blood draws for fructosamines under sedation and some vet spot checks (drawn from a leg vein with about 3 people holding her!) which seemed to show she was doing OK, even if a little bit high, and she was well and playful and her drinking and peeing (quantity-wise) was normal.
I think my co-worker and DH don't want to stress him out too much with vet visits at his age, and I do think they are being as careful as they can be and very receptive to advice - except about hometesting. I have referred her to this Board and she MAY have had a look, but not hometesting may have made her feel she didn't belong here!

Thanks again for the helpful suggestions!

I remember you from the old Board, Ronie & Moonie, back when you didn't hometest, but I guess you now live mainly in LL!

Edited to add - they have never fed their Misty on dry food - they disapprove of it! :thumbup He has eaten raw and canned all his life.
 
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