Need some advice please.

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Joe and Jinx

Joe and Jinx

Member Since 2012
Hi everyone, my name is Joe and I have an 11 year old male Siamese named Jinx was was diagnosed with diabetes on Apr. 19. I've been posting on the Main FDMB but wanted to start here now that I've started a spreadsheet for Jinx and thinking about altering his dosages.

For some background, his BG level when diagnosed was over 500 mg/dL and the vet recommended giving him 4u of Lantus that evening and the vet gave him 4u the following morning when I brought him in for his first curve. At his nadir, his BG level was 67 so the vet changed the dosage to 2u for which he was on for over a week. On the 30th, I did a curve at home and his results (see link below) were high and relatively flat. The vet then recommended bumping him up to 3u but I told him I felt more comfortable doing 2.5.

I gave him 2.5u yesterday morning and another 2.5 12 hrs later in the evening. His pre-shot was 469, 5+ was 284, next pre-shot was 108 so the vet recommended skipping the morning dose. I checked his level about a half hour after his usually insulin time and it had went up to 135. I check 3+ and now its at 408.

On the main board, members have recommended starting him off at 1u following the tight regulation protocol. Some mentioned the Somogyi effect being a possible factor for the high readings but in one of the links on the tight regulation board - http://www.tillydiabetes.net/en_6_protocol2.htm, it says that there are no studies to suggest that effect occurs in cats. Any help or advice on what to do would be so greatly appreciated.


Thank-you,


Joe
 
hi joe!

you're in absolutely the right place. we'll teach you what you need to know to help jinx.

great job getting hometesting and having a spreadsheet!!! let's see if we can get the whole picture so we know how to advise you best. all of this information can go into a profile, which is super helpful to have attached in your sig line so people don't keep asking you the same things over and over. here's the link on how to create that: http://www.felinediabetes.com/FDMB/viewtopic.php?f=9&t=59890

if you have trouble - just ask and we'll give you a hand.

is jinx eating only low carb canned food or is there any dry food in the mix?

does jinx have any other health issues?

has he had steroids (cortisone shot or ?)

has he had ketones? and are you testing for them at all?

has he ever had his teeth cleaned? does he need to (bad breath, vet recommendation?)

welcome, welcome, welcome! glad you're here!
 
Hi, Joe and welcome to LL! Have you read the stickies at the top of the forum?

Many vets are switching over to Lantus because that is the newest trend, but they don't really understand the differences form more traditional insulins. Lantus forms a shed under the skin so it isn't immediately available when doses are changed. Every time you change the dose the shed rebalances itself out. It usually takes 3days for that to finish, but sometimes a little longer. Also because of the carry over a small change can have a big effect, so we usually adjust dose only by .25u at a time and wait the 3 days before adjusting again. I think not only did your vet start way too high, but the doses were changed too rapidly and by too much.

Skipping shots with a low preshot is not a good plan of action as arule. Lantus likes consistency! Skipping a shot will drain the shed, but you will need 3days for things to settle down again! I think taking the dose down to 1u and gradually working up to the proper dose is a good suggestion. Others will be along soon who really have dosing down to a science.

Meanwhile, some more info here will help:
  • what are you feeding?
    Any other health problems?
    Where are you (mainly for time zone)?
    When is you next shot due?
    Can you put in a link to you posts in Health?

This is a slow time of day. I'm sure others will be along soon.
 
Thanks for all the responses everyone! I really appreciate it. I will update the spreadsheet with the vet info after I finish this post. To answer some of your questions:

-I live in Denver, CO.

-Once Jinx was diagnosed, I weened him off dry food and as of about three days ago, he was eating 100% Hills m/d (vet recommended). Based on ingredient research and members posts on the general question forum, I started give him 50% Fancy Feast Classic yesterday and will hopefully have him completely off Hills m/d within the next couple of days. Providing there are no stomach issues.

-Health problems: He's a few lbs overweight and has asthma which is being treated with approx. 1 mg (I'm quartering a 5mg pill) Prednisolone every other day. My understanding is that this complicates things; increasing glucagon production and inhibiting insulin. I'm eager to hear advice on any adjustments I should make due to this issue.

-I am giving him insulin at 9am and 9pm. I feed him at 830am and 830pm. He typically eats about 1/2 full can, and then grazes on the other 1/4 or so over the next hour or so.

-Ketones: Checked negative when he was diagnosed but I have not checked since. I got some Ketostix last night and put a little bit of paper litter (made from recycled paper, fragrance free, looks like tiny pellets) in his litter box. The next time he pees, I'm going to see how effective it is to measure the urine that way. I've read that some cats will let their guardians put a spoon or the strip itself under them when their urinating. I don't think Jinx will be down with that but I'm going to give it a shot.

-Teeth Cleaning: It's been awhile. At a recent annual exam, the vet did not say a cleaning was necessary. His breath, however, generally smells bad.

Again, thank-you for the help and I look forward to hearing from you. Jinx is due for insulin at 9pm (MST) tonight and my vet suggested keeping him on 2.5u for the next week or so. Doing a curve on Friday to make sure his BG levels are not going too high or too low. Based on previous suggestions, I am very tempted to start him at 1u but it really concerns me that his BG will spike too high. Any advice would be much appreciated.


Thanks,


Joe
 
Welcome to Lantus Land!

It certainly sounds like you've done your homework! Since no one has mentioned it, you may want to take a look at the starred, sticky notes at the top of the Board. There's a huge amount of information there along with links to even more information. It's actually a bit daunting, at first.

Great job on getting the SS (spreadsheet) up and running and getting started with home testing. I'd suggest widening the "Remarks"column so the cells on the rest of the sheet aren't quite so big. (Drag the right side of the cell margin on the cells at the top that have a letter of the alphabet in them. That will allow you to widen the column.)

If Jinx has stinky breath, chances are that a dental is in your future! Any sort of inflammation, like from gingivitis, can keep blood glucose (BG) numbers elevated. You're also correct, that steroids, like the prednisolone, can effect numbers. Has Jinx ever been tried on inhaled steroids? Often the inhaled steroids have less of an effect.

As a rule of thumb, if you are consistently having to skip a dose because your pre-shot is too low, it's often prudent to reduce the dose so you can shoot the same amount twice a day. You'll see the best response from Lantus if you can shoot consistently -- both a consistent dose and at a consistent time. Not to throw bricks at your vet, but I suspect your vet is more familiar with using some of the shorter acting types of insulin vs. Lantus, which is long-acting. Many newly diagnosed cats are started at a dose that's based on a formula (initial dose = ideal weight in kilograms x 0.25). The initial dose that your vet suggested was huge! Unless Jinx is a big cat, even 2.0u is a large starting dose. In addition, doses are typically held for 3 days in order to allow the dose to stabilize. Because Lantus is a depot-type of insulin, if changes in dose are made to rapidly, it can result in numbers that bounce all over the place.

Right now, you don't have enough data to shoot a 108. However, it was great that you tested at +1. That test told you that Jinx's numbers looked like they may have been rising (or there was a food spike). Your +3 was proof of rising numbers. If you were able to be off schedule, it might have made sense to shoot. These are the kinds of issues we can lend a hand with.

Please let us know how we can help. I hope you will continue to post on a regular basis. The people here are wonderfully supportive and very well informed.
 
we've got another cat here on prednisolone for pancreatitis and have just been talking about the topic. it can increase BG. generally, diabetic cats should steer away from any steroids - it can induce diabetes in a non-diabetic cat and increase BG in a diabetic one. there are a couple of other cats here with asthma as well. i'll ask for them to stop in and tell you what they are doing, and perhaps you can check with your vet on an alternative for jinx.

here is yesterday's post on Annie - perhaps there will be some helpful comments on prednisolone for you in there. annie's taking it for pancreatitis, so of course, some parts may be different.

had jinx recently been diagnosed with asthma and gotten the pred before he became diabetic? ie, i'm fishing to see if the diabetes was caused by the steroids.

the preshot numbers you have listed on the ss - is that test taken after he's eaten his food? generally, we test BG, get the shot ready, get the food ready, set the food down and give the shot - in that order. once you get the hang of it you can do it in a couple of minutes. i'm just wondering if those preshot numbers are influenced by him having eaten a half hour before. i would try re-synching your process so the food is given with the shot.

if your vet told you to feed before shooting, that's a reflection of how older insulins work. those insulins worked fast in and fast out, and you had to make sure the cat ate before giving insulin. lantus doesn't onset for a couple of hours, so as long as you don't have any reason to think that jinx completely won't eat (ie, he's sick and vomiting) then he doesn't have to eat before the insulin shot.
 
Since you mentioned asthma, there are inhaled meds which may be used for asthmatic cats, reducing the systemic steroid use and quite possibly lowering the glucose if you can do it.
 
Hi everyone, I cleaned up the spreadsheet. Thank-you again for the comments and advice.

I do think Jinx got diabetes from the steroids. In the beginning, I tried administering an inhaled steroid using the Aerokat but didn't have any luck. He would just take a breath or two and then stop breathing.

I really appreciate the info on the feeding and will switch to the method you suggested, Julie. Due to his recent diet change and a one time incident of not eating, I've been concerned that I'll give him insulin and he won't eat. He's been doing good as far as eating goes so I don't think that will be an issue.

My biggest concern/question is what I should give him tonight. Does everyone think I should start at 1u or keep him on 2.5u and see how that goes?
 
oh wow - thanks for changing the ss - it made it a TON easier to see what's going on.

are you able to get a mid-cycle test in pretty much every 12 hour cycle?

the Tight Reg protocol suggests starting the dose with this weight-based formula:

Using a weight based formula for determining a starting dose of Lantus or Levemir when following the Tight Regulation Protocol:
the formula is 0.25 unit per kg of the cat's ideal weight
if kitty is underweight, the formula frequently used is 0.25 unit per kg of kitty's actual weight
if the cat was previously on another insulin, the starting dose should be increased or decreased by taking prior data into consideration

Online Calculator for Converting Pounds to Kilograms
Click to expand...

I'd suggest entering his IDEAL weight, as well as you can estimate it, into the calculator and see what the suggested dose is. it does look like 2.5u is too much. when we see 108 at preshot, we know the way lantus generally works is that a few hours before that would be the lowest point. so jinx may have been considerably lower in the middle of the night.

it's also very likely that happened and it caused the 402 at +4 this morning. when a cat gets lower than they are used to, their liver will release hormones and stored sugars to increase their BG - resulting in ugly numbers sometimes, like that 402! we call that a bounce and it will clear, but it can take up to 3 days for it to disappear.

Let's see what the calculator suggests for his dose.
 
Welcome Joe & Jinx! This is the best place you never wanted to be. Glad you found us and I know you will do great.

My kitty, Tarragon, is an asthmatic cat as well who has diabetes because of steroid shots. We use Aerokat and he is one one tablet of prednisole every other day or as needed. It took Tarragon a few weeks to get used to the Aerokat. He would do the same thing. A couple of breaths then hold it. Are you using Flovent? If so, how much? Vets tend to under prescribe the dosage. We give 2 puffs of the 250 twice a day. Also, are you using albuterol before the Flovent to help open up the airways? When they are coughing, albuterol helps open them up so the Flovent can get in. Albuterol is a rescue inhaler, whereas the Flovent is a steroid. Tarragon is a hard core asthmatic so we also have to give the prednisolone as well.

Are you giving treats once the inhaler is done? That helped Tarragon suffer through the treatment knowing there was a reward. It is trickier for those of us using long term steroid pills as far as BGs go. One thing is to give the pill at nadir or midway between shots. It will require more insulin to keep their BGs down. You need to be pretty aggressive on your increases to stay on top of it, upping the dose if no movement by .25U every 4-5 days.

There is a great yahoo group for feline asthma I can direct you to if you want to join. Good luck and welcome again. This is a great board and it is always nice to know there are others out there in the same situation.
 
Welcome Joe and Jinx,

My cat Cini Mini is also an asthmatic diabetic.

Cini Mini was given steroid injections for years for his asthma and that is what induced the diabetes. Now he's on inhalant steroids (Flixotide 250mcg) 1 puff twice a day. We use the AeroKat and I always make sure to get a minimum of 10 breaths in before I release him.I swear he knows how to count to 10 now because he jumps up after that 10th breath! Cini Mini is also on Terbutaline syrup 1/2ml twice a day to help with expanding his airways to breath better.

If you can get Jinx switched over to inhalant steroids you will notice his BG numbers going down. Inhalant steroids don't cross the blood barrier like oral/injectable steroids do.

Check out Cini's spreadsheet. He's now on 1 drop of Lantus insulin twice a day! :mrgreen:
 
According to the formula, his starting dose should be 1.25u (Jinx's ideal weight is 12-14 lbs), but I recommended in health rounding down to 1u keeping in mind that there is a diet change from the M/D going on right now. My logic is that if 1u is not enough insulin, it's easy enough to raise to 1.25u in a few days after the carbs from the M/D have all cleared.
 
Melissa and Cini Mini's Mom,

Thanks for the posts. I was giving Jinx 110 mcg Flovent adminstered through an Aerokat twice a day. Recommended dosage was 6 to 10 breaths. I would praise him and give him a treat after each dose but he would almost always stop breathing after a breath or two. I'll definitely look into the Teburtaline syrup.

Melissa, considering your giving Tarragon Prednisolone... how much insulin did you intially start him out at?
 
Julie, your theory makes a lot of sense as to why Jinx went up so high today. I appreciate the insight.

Also, I will generally have no problem with taking his BG at the afternoon nadir (3pm) but will have a harder time staying up till 3am. Do you think 2am for the evening doses will suffice?
 
Hey Joe! We just started back on the prednisolone about 5 months ago when the inhaled Flovent stopped working as well. A chest X-ray showed that his asthma had gotten worse. At that time, I didn't raise his dose. I just kept doing curves and raising his dose by .25 U every 6 cycles (3 days) until his nadir finally came down. It seems like it takes forever but it is really the only way to do it since the prednisolone affects every cat's BG differently.

Is Jinx coughing a lot? If so, I would try and get some albuterol to help open his airways. You would give him a puff of that 10 mins before the Flovent and then when he coughs. I also would increase his Flovent to the 250. Are you buying it locally? You can buy fluxotide (the Flovent generis) at 4cornerspharmacy a LOT cheaper. It is in Canada so it takes a few weeks to get it. I do have a bunch of extra if you would like me to mail you one to get going on it and you can send me one later when you get a shipment in.

It is really preferable to not have your kitty on prednisolone. However, it is the ONLY thing that helps Tarragon and breathing comes first. You will just have to adjust the insulin accordingly to make up for it.
 
Hi Melissa,

With ~1mg prednisolone every other day, his coughing is virtually non-existent. Any longer in between doses and he has breathing attacks. I really appreciate your offer to send me some Flovent, but I want to see how he does on 1u and whether there are significant fluctuations following the days I give him the steroid. I'll let you know.

Also, what is the most effective way to administer insulin at an accuracy of .25u? I've been using a 3/10mL syringe and I'm not so sure I'd feel confident measuring .25u on it. I could get close, but is there anything better?



Joe
 
Re. syringes: You need to get syringes that are marked in half unit increments. These are the syringes I buy. The Relion brand syringes from Walmart also come in half unit increments.

It's not necessary, and probably not even desirable, to always get a test at nadir -- especially if nadir is at 3:00 AM. Many of us get a pre-shot test and then re-test at +2. The +2 test is typically about the same as your pre-shot. If it's markedly lower, it tells you it could be an active cycle and you may want to get additional tests. Just like with most things, as you test, you'll begin to see Jinx's patterns. You'll get a better sense of when you need to closely monitor and when you can go to sleep.
 
Hi Joe,

You are in a really great place here with wonderful people who will help you tremendously! Jinx is lucky to have you! It's nice to see owner's so motivated to help their kitties!!!

Keep up the good work!
Jenn and Mikey
 
Hi Jenn, I feel so much better having found this board. Every single person I've heard from has been honest, caring and helpful. You're all incredible people and I truly appreciate everything.

Sienne, thanks for the info on the syringes. I'm using one's with 1/2 increments but I will get a magnifier to make sure it's as precise as I can get. Thanks for that info, Melissa.
 
Hi Joe!

I wanted to say welcome to Lantus Land. I hope you post every day and let us know how Jinx is doing & get some help from the dosing pros here. There's also a lot to read and learn. You're doing great for just starting out.

I also have an asthmatic diabetic kitty who is on Flixotide 250, 1 puff bid and Albuterol for rescue which I get from overseas. It is recommended that kitties stay on steroids the first 2-3 weeks that they start the Flovent while they are learning to use the aerokat to keep them safe and to then taper off the prednisolone rather than stop cold turkey while using the flovent if you wanted to give it another try. It is a learning curve for the cat too and now they have the new aerokats that have a flap that moves when they breathe so you can tell for sure if they are breathing or not. It's kind of hard for them not to breathe though they sometimes look like they aren't so the flap is really helpful. They do learn to count the breaths. :smile: I started out giving the Albuterol first to clear the passageways also. I don't take Racci anywhere without her rescue medicine (Albuterol) and aerokat. Flovent goes directly where it is needed and not in the blood stream so doesn't do the damage that regular steroids like prednisolone do. You might want to think about giving it another try.

Also, I find it easiest to use the thick unit bar to help me measure the .25u. On the syringes I use, Walgreens, If I bring it up from the half mark to sit almost on the half line it works out to be just about .25u.
 
Hi Joe & Jinx,
Just dropping by to welcome you to Lantus Land. Everyone here wants the best for Jinx and we will always try our best to help you. It's great that your spreadsheet is up and running and that you already have a good understanding of what to do. Keep on doing the reading. It's a lot to digest: every time I go back and re-read one of the "Stickys" I learn something new (or something I've forgotten).

Glad you've found this board,

Ella & Rusty
 
Hi everyone,

Thank-you again for all the help and encouragement!

Just gave Jinx his second dose of 1u and the pre-shot was 468. He's doing well but is getting more and more agitated with the ear pricks. He's fine once it's over though. I'll get his BG level at the nadir today (3pm MST) and will keep you all posted...


Joe
 
I'd suggest starting a new thread (we call them condos) for Jinx each day. We tend to use a format for posting that allows us to make sure you get help if you need it. If you take a look at the subject lines on the board, you'll see that the format is:

Date Cat's Name AMPS#, +time#​
So, for today, Jinx's condo would be:

5/3 Jinx AMPS-468​

As you get tests throughout the day, you go back to your first post in the condo and edit the subject line to add the information. Like Julie mentioned yesterday, it's looking like Jinx is bouncing off of the "blue" numbers. Stick with your dose. It can take up to 72 hours for a bounce to clear.
 
Joe,
When we first started, I remember reading that people wrote their cat purred while getting poked. I could not imagine, in my wildest thoughts, that Zener would ever do that. Then during the winter I started blowing on his ear to get it to bleed better and I would give him a good petting before warming up his ear for the poke and he loves that. So now, guess what? He does sometimes actually purr while getting his poke. :-D And for the most part, it goes smoothly and he's very patient about it all. We talk to Zener and tell him things, like "We need to check your blood and make sure you are safe." I think he understands that we are doing what we think is best for him and he appreciates that. I should also mention that I am someone who gets queasy just hearing anything medical or surgical or anything at all to do with blood. And now I test for BG, give insulin shots and have given several Cerenia shots which use a regular sized needle.

It will get easier, with more practice and especially as Jinx feels better. Then you will know you are helping him and it will all be worth it?
Liz, Zener's other mom
 
Thanks, Liz. I do think he realizes I'm helping him but it still makes it difficult for me. I'll take your advice and try some of those things to see if they work with him.



Joe
 
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