New Bewildered Member (Merlin) continued more

Status
Not open for further replies.
Merlin’sMama

Merlin’sMama

Member Since 2022
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…
 
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!
 
Merlin’sMama said:
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…
Click to expand...
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!”
 
Suzanne & Darcy said:
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!”
Click to expand...
Totally agree Suzanne, that not feeding really concerns me.
 
Teetee (UK) said:
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.
Click to expand...
Teetee (UK) said:
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.
Click to expand...
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!
 
Merlin’sMama said:
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…
Click to expand...

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
 
Merlin’sMama said:
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…
Click to expand...
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 :woot:

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 :rolleyes:, meanwhile she's on 3.25:cat:.

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!
 
Wendy&Neko said:
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.
Click to expand...
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.
 
Merlin’sMama said:
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.
Click to expand...
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 :eek:), 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
:bighug: :bighug: :bighug:

ps: Artemis still doesn't like to be held :rolleyes:
 
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.
 
Suzanne & Darcy said:
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!
Click to expand...
Wendy&Neko said:
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.
Click to expand...
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?
 
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.
 
upload_2022-5-18_11-54-51.jpeg

upload_2022-5-18_11-55-28.jpeg
 

Attachments

  • upload_2022-5-18_11-54-51.jpeg
    upload_2022-5-18_11-54-51.jpeg
    54.6 KB · Views: 329
  • upload_2022-5-18_11-55-28.jpeg
    upload_2022-5-18_11-55-28.jpeg
    74.6 KB · Views: 303
Merlin’sMama said:
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?
Click to expand...
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.
 
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.
 
Teetee (UK) said:
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.
Click to expand...
Yes. This scares me.
 
Bron and Sheba (GA) said:
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 * mm 1/2 unit insulin syringes
Click to expand...
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.
 
Status
Not open for further replies.
Back
Top