New Bewildered Member (Merlin) continued more

Continued from
https://felinediabetes.com/FDMB/threads/new-bewildered-member-merlin-continued.263345/#post-2950561

Ok. Just back from getting a new monitor. It was much less of a @#&^ show this time. I guess this is the second, as opposed to the first, time she has fitted these, the first being Merlin’s first. She wants us to schedule his first injection for tomorrow morning at 9:30, but she asked that I bring him in fasting?!! I said “my old vet,” (as in, you guys) said she always feeds them first and then injects. She said “different people have different methods” and she would feed him an hour after insulin. She also wanted me to leave Merlin there for two hours to make sure he doesn’t hypo and that I might not know the signs. He has a new monitor now that, supposedly, will be working in 15 minutes, and we live 5 minutes away from the vets. I will be testing him too. Should I go ahead and make the appointment for 930, but feed him right before we go? If for some reason we have to wait at all, will he be ok with the food he gets before we go? Is she right? Will I really know if he hypos? Help!! Appointment made for 930…

 

Libre is working. Had the highest reading yet, 25.3. This was right after the vet and a big bowl of wet food. Very stressed little guy. I don’t want to take him back there in the morning, but I do want to start him on insulin. The vet won’t let me do the first injection, though. I think she plans to do .5 of Lantus. She will listen to me and back down up to a point. I could just feed him anyway before we drive to the vets, which is 5 minutes away. I am concerned that if we have to wait at all, he wont have enough food in his system. Or would it be ok to just feed him right after, because I will not be keeping him there for two hours afterward. I feel nervous because I have no confidence in her experience. I just want to get my hands on the insulin. But then, I am not at all qualified to make any of these decisions, and she is the trained vet…

 

"trained"

probably not as well-informed as you are at this point, seriously.

 

I

I cant seem to do anything but read about FD. I try to do and think about other things, but I cant.

 

Jill - totally feeling the same, keep scrolling through this site trying to come up to speed and reading everything. Thankfully my vet prescribed insulin and made the ‘practice round’ with her optional but most of what she said was counter to what is preached here.

Good luck with this visit!

 

That's all i did as well and still do, nearly all the time. To be honest Jill the more you read the more you will learn and you will forget what you don't need and remember what you do need.

 

I was (and still am) the same way!

Here is the link for dosing methods when using Lantus. It has a section about starting dose.
https://www.felinediabetes.com/FDMB...-low-go-slow-slgs-tight-regulation-tr.210110/

Tagging some members who helped me out with the starting dose on Lantus @Wendy&Neko @Chris & China (GA) @Bandit's Mom

 

Tough one that Jill.
What i would do is take food with you including his high carb biscuits/kibble and i would also feed him his breakfast just before you set off to the vets, his bloods will be higher though after his food but hopefully she will not notice as the Libre has only just been put on.
Hopefully others can advise more, but that's what i would do.

 

If you are following the SLGS protocol, then the recommended starting dose for a cat on Lantus - if the cat is on a low-carb wet food diet - is .5 unit. every 12 hours.

I am not sure if you have decided on which protocol to follow. If it were my cat, I would not start with anything larger than that. In fact, and this is just a personal opinion, but I might even start with .25 units because I see a lot of yellow on Merlin’s spreadsheet- so out of an abundance of caution I would probably so that with my own cat. It’s not what is written in the SLGS guidelines, but this is what I probably would do with my own cat. I would also feed my cat before taking it to the vet.

 

It looks like you are in good hands. I only hope the vet will cooperate. If you are only ten minutes from the vet, I would feed first and just not tell the vet. If the vet notices anything then say you forgot about the fasting- or say that your husband did it because he didn’t real - or my daughter is always telling me that I should just “blame the kids!”

 

I will tag in Eliz @Elizabeth and Bertie to see if she can offer any advice or provide any literature to show your vet about feeding before insulin.
Thanks Eliz.

 

Totally agree Suzanne, that not feeding really concerns me.

 

That would be great! I can say it came from “my old vet.” She doesn’t want me “googling around” information about FD.

 

So…I have to decide a protocol? I feel so inadequate to decide this huge thing. I have no idea. And I can barely grasp what the numbers mean sometimes, as its all tied up with panic and emotions. I think I need a beginner’s manual and to start at the beginning starting tonight, and all night long until his injection at 930 am. I only just figured out what lots of the acronyms mean. I have been reading this stuff non stop in all of my free time, late into the wee hours of the morning, but I still don’t know enough to choose a protocol. I wish I could just rely on my vet, but I have very little trust in her knowledge or experience with FD. I wish I did. I can’t find another vet in town to help us. I will fill in my spreadsheet with readings from the Libre and ones I take myself. (Should I distinguish between them somehow?) If something awful happens, I will rush to the only vet I know, who I don’t trust. This is not good. I’m starting to panic again…

 

Don’t panic. How many times a day can you test? If you can test both morning and evening pre shots and at least once more in the morning and evening cycles (that would be at least 4 tests per day,) then you can follow tight regulation TR which will allow you to adjust the dose more frequently (increases) to get Merlin regulated more quickly. With SLGS (start low go slow) the dose is held a little longer. It is not set in stone. A lot of people start with SLGS and then move on to TR. You can change dosing methods any time you want to if you feel it’s the best thing for Merlin. Of course, people here will be around you all the way to support and counsel you. So…. No need to panic!

 

So with the Libre you can check BG a lot. As long as it’s working

 

Keep calm Jill you are doing fantastic.
As for the protocols, don't worry, all it is is the way doses are changed/adjusted as Suzanne explained in the above post.
I have found this about administering Prozinc that mentions giving insulin just before or after a meal, also further down on the same page see the video Giving your cat an insulin injection. Maybe show your vet that if she questions you.
https://prozinc.us/cat-owners/how-prozinc-helps

 

Don't PANIC - you GOT THIS!! PLUS you have the Libre which will collect a $!*@ ton of data for you. Once you're home with Merlin, you can consult the board for dosing and asks loads of questions. You've already got a great start. You know what his BG (blood glucose) levels are after eating. AMAZING

I agree with @Suzanne & Darcy and @Teetee (UK) , and if it were me, I would feed my Cleo before going.
I lie to my vet all the time. He thinks Cleo is on 1 unit of Lantus , meanwhile she's on 3.25.

Most people (myself included) start with SLGS - START LOW GO SLOW. Emphasis on the Slow...You can also switch between protocols depending on your comfort and confidence and life circumstances (like maybe eventually a day trip).

We're with you every step of the way.

 

Here's some more info to bombard your vet with, an article written by a US vet
https://pets.webmd.com/cats/guide/feeding-tips-for-a-cat-with-diabetes
This section in particular
When Should I Feed My Diabetic Cat?
She states
“It’s very important that you coordinate your meals with the insulin dosing,” says Kathryn Michel, DVM, associate professor of Nutrition at the University of Pennsylvania School of Veterinary Medicine. “You need to have their meals timed with their insulin, so they’re absorbing those calories when the peak insulin is occurring so they don’t become hypoglycemic [have low blood sugar].”

Typically you’ll feed your cat twice a day, administering a dose of insulin right after those feedings.

 

The old vet wanted to use Caninsulin I believe? With Caninsulin you must feed and make sure they eat before shooting. It's not so important with Lantus, as it takes a couple hours to take effect. You can take food with you for kitty to eat. Our typical series of steps is the test to make sure it's safe to give the shot, feed, and shoot. But you can shoot while the cat's head is in the bowl, or practically after if you need to. Lantus is also a depot style insulin, meaning it can take 5-7 days before you see the full effect of the initial dose.

0.5 units is a good starting dose. Sounds like your current vet is on top of things.

 

Oh I am so relieved. Thanks to all of you. I just read his monitor again. It was 18.3. I will feed him when I get up around 8:00 and then a small snack before we go, how’s that? Then I will give him more when we get back from the vet (right after the shot). Is it possible to overfeed while on insulin? He’s so skinny and hungry, I’ve been feeding him at least every two hours and leaving lots of food out at night (that my other cats undoubtedly snack on). He has been sleeping through most of the night, though, I think.

I find myself wishing I had a sort of painting of a typical first day or three of insulin dosing. What to expect, what to watch for, what to do. I will be scanning that Libre a lot. I will also be poking those ears, though I only have two strips left. I wont leave the house. I have a doctors appointment for myself scheduled for Thursday at 11, but maybe I should cancel it. I will be glued to Merlin.

 

It sounds like you are all set then! I would start with the SLGS dosing if I were new.

I guess those numbers on your spreadsheet were just taken at random times (good job, by the way!). It’s going to be okay. We (the FDMB) have got your back!

 

This is the first vet I saw three weeks ago, the one who diagnosed Merlin on one blood test. I had to go back to her because no one else is accepting new patients and she had already ordered the monitor (on my advice) and insulin, which, apparently, are in high demand and hard to get. I feel better about taking Merlin now than I did three weeks ago because I am not going to let her make all of the decisions for me. I’m kind of forcing her to work with me by being nice and apparently compliant while also getting my way by subtly refusing to do it her way. She has only one other diabetic cat at her practice, and I bet they are on Caninsulin and did a 12 hour curve in the office. I feel like I am slowly educating her, through you all. But I have to be super subtle about it and say it is all coming from my “old vet” in Colorado.

 

try and get some nighttime readings too. Many members here made that recommendation to me and it certainly helps give an overall big picture. The Libre will make that super easy

 

I just want to jump in here and reassure you that you're in the right place here and you can do this. Less than two months ago I was right where you are, with basically a barn cat who doesn't even like to be held thinking: how the heck am I going to do this? Like you, my vet wasn't super helpful, sent me off with some needles, a vial of insulin a printout that contradicted the little bit she did tell me and a 2wk checkup. I came home, told my husband & got that and how much is this gonna cost look. The whole of it beginning was crazy intimidating, I told the spouse & kids I was giving it a month and honestly, was not hopeful, but here I am, 47 days later, pricking and poking with confidence, looking at the spreadsheet watching her amazing progress and still half the time scratching my head trying to make sense of this it all.

The good news is, you're off to a good start: you'll figure it out as you go along with a lot of hand holding from this amazing group, and are not at all expected to start off knowing what the heck going in. There are many methods to managing this, you'll go one day at a time & figure out what works best for YOU and your situation. Maus and I have fallen into an eating/sleeping/pricking/poking schedule that works for us (well, after last night I need to put a ? on the sleep bit ), and while it's probably not the ideal, it works for us, we're making progress and that's the important bit.

Most of all, remember to take care of yourself first and know that you're on the right path to making your kitty healthy again


ps: Artemis still doesn't like to be held

 

The thing about feeding before the shot, we initially tell people to at least not feed before what we call the preshot test for a couple hours. Food will inflate the preshot test for a couple hours. You want to know if it is safe to shoot, without being a food influenced number. If the vet is going to test, then shoot, maybe either feed that snack more than two hours before going to the vet, or wait until afterwards, of take prepared food with you for the vet to give immediately afterwards.

Good luck tomorrow. Don’t cancel that doctors appointment just yet. It can take a few days to see much of a change. People most often end up increasing the initial dose. Spend the first few days getting used to taking readings and updating the spreadsheet.

 

Ok.. I won’t feed him more than what he may have had during the night. I’ll take up the night food now, which is an hour and a half before the appointment. Thanks

 

Did it! Merlin has had his first injection of Lantus, at the vet, brought him right home and fed him.
I took up his food an hour and a half before the injection. Here are my notes from the visit:
Vet was using the formula of shooting .25 per kilo for the Lantus injection. Merlin’s weight is 5.5 kilo. She said she was using a U20 international units syringe, but I see on the package that it was a U40.
8:20 His reading on the Libre was 25
9:39 Libre reading preshot 26.1
9:48 she shot 1.5 on the syringe. (Actually my husband John did the shot—he’s so good at it!) It’s really hard to see the measurements on the syringe. I took a picture, but it’s still kind of unclear. John seems to get it, though.
10:20 At home. His reading was 25.9. He had breakfast, but only ate about a 1/4 of a tin of melting heart, which used to be his favorite a week ago. He’s now sleeping.

I will scan him often today and update the spreadsheet. We will give him his evening dose at 9:50, or can we stretch it to 10:00? I’m nervous, but not too bad as he seems just the same so far. The vet said to alert her if his number drops to 10 and we would bring him in for glucose. But I would put honey on his gums at that point, right?

 

Well Done Jill
Are you sure they are u40 syringes because from what i have read about Lantus you should be using u100 syringes.
I don't know if it makes any difference as you can convert but just to be sure i will tag a few members.
@Angela & Cleo @Bron and Sheba (GA) @Bandit's Mom @Suzanne & Darcy

 

1.5 units on a u40 syringe is equivalent to 3.75 units on a u100 syringe i think, but i hope other members will confirm.

 

Well done Jill and Merlin and John!

I'm not familiar with u20 syringes, I've only used u100 with Lantus here in the US.

 

can you manage to post a picture of the syringes?

 

They seem really tiny

 

I’m worried…. Was that too much? He seems ok.

 

A 10 on your Libre would be what we would call a 180 in US units. That’s nowhere near a hypo and is a very safe number. And yes, Lantus should be given with U100 syringes if they’re available.

 

His libre reading is now 11. Is that too low???

 

Since this dose wasn’t on a u100, can we know how much he was given?

 

Those are the wrong syringes Jill, you need u100.
I've not used Lantus or u100 syringes but this is the conversion chart for syringes and by looking at that chart Merlin received 3.75 units if given in a u100 syringe.
The 1.5 units in the u40 syringe is in my opinion a large starting dose but as i have explained i've never used Lantus so hopefully a more experienced Lantus user can help.
http://www.felinediabetes.com/insulin-conversions.htm
Just keep regular checks on him throughout the day.

 

If you are using Lantus insulin PLEASE DO NOT USE THE UNIT 40 SYRINGE. Please do not give any more doses with the U40 syinges.
You need to be using the U100 3/10 30 or 31 Gauge 6 or 8 mm 1/2 unit insulin syringes

 

I have no idea about the conversion between U40 and U100, but I hope this isn’t correct because 3.75 units of Lantus would be way too high for a starting dose.

 

Yes. This scares me.

 

I’m panicking. What do I do? That dose was too high?

 

If you gave 1.5 units of the Lantus with the U40 syringe, that is approximately 3.5 units of Lantus which is LOT.
DO you have any high carb food you can start to feed him?

 

Thanks @Bron and Sheba (GA)
Could you please check my figures about the conversion regarding Merlins dose and give any advise please as i'm not a lantus user.
Thanks.

 

What time of the day is it there?
I dont want to panic you but you need to be prepared.
If you cant manage to keep the BG from falling too much you may have to go to the vet and get a glucose drip put in

 

Thanks @Bron and Sheba (GA)
Jill is in Cork Ireland, that's UK time.

 

It’s 12:31 pm afternoon

 

Keep checking that Libre sensor and post the numbers. Do you have Karo syrup or honey and high carb food available?

 

How many hours ago now was the shot?

 

11.4

 

It was at 9:48, almost 3 hours ago

 

DO you have any high carb food you can give now?. Don't wait until the BG drops low. We need to start feeding now. Not too much as we don't want to fill him up. We will need him to eat later as well.

 

I would do as Bron suggested and start feeding small amounts of high carb food. Will he eat? I see he’s already dropped to 198.

 

Can I give him dry food?

 

he is okay right now but you should start feeding him a little of the high carb

 

Have you given him any High Carb food yet Jill?
Give him biscuits/kibble if nothing else is available
Would you update your spreadsheet at AM+3 please.

 

Wet food is better. Do you have any higher carb wet food?. If not you can add a drop of honey into the wet food to make it high carb or failing that you can feed the dry food.

 

If that’s all you have available then I would say yes. Can someone go to the store and get some high carb (usually gravy) food.

 

Tee can you advise on what kind of wet food may be available to Jill? If someone can go to the store

 

I have florentine collection medleys fancy feast (us). Is that good?

 

Remember you are hometesting Jill, so are in control. You have the tools (food and meter) to keep Merlin safe and we will stay with you until things settle down..

 

yes. Give him a teaspoon of that

 

I calculated ffeast is 13 percent carb ok?

 

He’s eating the teaspoon of ff

 

I have used a couple of things over here
Firstly there is The small cans of Gourmet Gold in gravy which is 27% carbs
https://www.purina.co.uk/cat/cat-food/product-gourmet-gold-chunks-in-gravy
Also i use Webbox lick e lix, which is about 20% carbs
https://www.webbox.co.uk/webbox-lick-e-lix-chicken

 

What are the ingredients? I would just go ahead and mix it with a little honey and feed him a tsp.

 

The tuna flavor has wheat gluten and corn starch. Hopefully some carb in there

 

I mixed a little honey in the ff. Meanwhile I found our hc box. It’s Felix original in gravy

 

So do the turkey and the white meat chicken flavors. I just checked Purina site. All have wheat gluten and corn starch. I wish I knew carb percentage.

 

Excellent! Gravy!

 

He’s 10.2 now. Should I take him to vet?

 

Check his BG 20 minutes after he ate. Post here

 

He is still in safe territory. I would check to see how the food is doing on his BG in 20

 

He mostly just licked the surface of the ff. I’m giving him a little Felix orig with gravy now

 

Doing the same Suzanne,
Carbs are on the chicken 11% and the tuna is 12.6%
I use this carb calculator
https://secure.balanceit.com/tools/_gaconverter/index.php

 

He can actually lick a tsp of just gravy and not even eat the food itself- if he’s unwilling

 

Is this the stuff Jill?

 

He’s still quite safe Jill. Just keep doing what you are doing. Don’t fill him up too much as we want him to eat later as well.
You are doing great!

 

Sorry the link is
https://www.purina.co.uk/cat/cat-food/product-felix-original-mixed-selection-in-gravy

 

Yes

 

So I am calculating we are at +3.5
Preshot 26.1 (470)
+1 18 (324)
+2 11 (198)
+3 11.4 (205)
+3.5 10.2 (183)

 

Yes

 

Feed Merlin that as it very high in carbs at 30%, just a teaspoon at a time.
Keep his numbers posted regular please.

 

Ok. I will test in five minutes. About 20 after feeding. Should I feed again now? He liked the Felix

 

I would wait. This could be a really long haul and he needs to maintain that interest in the food... or at least the gravy.

 

How are you going Jill?
Merlin is still quite safe.
I would only feed a teaspoon and then post the BG after 20 /30 mins before feeding any more. We don't want to fill him up too soon.

 

Number? Gosh I hate the waiting.... everything okay?

 

It’s 9.4

 

I’m close to taking him to vet who did this. She said to worry if it got down to 5. And then she said even if it’s 10 I should call her. Can I really fix this myself?????

 

It's still dropping. Can you rub some honey on his gums and get him to eat. What do you say, Bron? He should be coming up.

 

I’ll feed him Felix again

 

Well, 5 would still not be a hypo. Rub honey on his gums or put it in his mouth. We need to see if you can bring him up. He is still safe.

 

I would give him some more HC food. He is still quite safe. Test again in 20 minutes. He could continue to drop further for more hours yet. I would be surprised if he came up on his own at this point. I would not take him to the vet at the moment. He is doing fine and not dropping a huge amount.

 

How Many carbs in Felix?

 

I put some honey on his gums and he’s eating another spoon of Felix

 

30 percent carbs

 

Preshot 26.1 (470)
+1 18 (324)
+2 11 (198)
+3 11.4 (205)
+3.5 10.2 (183)
+?4 9.4 (162)

 

He didn’t eat it all.

 

Thats OK. How much did he eat?