New Diabetic Cat Mom

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NancyJac

NancyJac

Member Since 2013
Hi All,

My senior cat, Hairy, was recently diagnosed with diabetes. I've had multiple cats all my life, but this is the first one that has ever become diabetic. I'm kind of stressed out right now between the costs and the effort of trying to manage his diabetes. Have spent about $1K so far in vet bills, his food is about $75/month, $115 for a test meter, the test strips are a dollar each and the insulin is $117/vial.

I have 4 cats. Issue 1: Feeding one of them a different diet from the rest. Issue 2: Hairy is not very cooperative when being messed with. I've been trying off and on all weekend to do a blood glucose test, but I stab him repeatedly all around the edge of his ear and can't get any blood. He (and me) are so stressed out at this point, I don't even want to try it again.

Sure would appreciate any advice on how to deal with this.

Nancy
 
Hello Nancy and sugardude Hairy! Welcome to the FDMB!

First, have some questions we'd need to ask.

1.What insulin are you using? Lantus, Levemir and Pro Zinc are best for cats

2.What kind of food are you feeding? You need to feed low carb wet food (less than 10% carb) but this doesn't have to cost an arm and a leg. Friskies, Fancy Feast and Special Kitty (Pate versions only) are low carb and available at WalMart....You do NOT need to feed expensive "prescription" food! (and most of them are too high in carbs anyway!!) I have a multi-cat household too, so mostly feed these cheaper things since I don't want my sugarkitty to eat the other cats food...so everyone is on low carb!

3. Go to WalMart and get a human glucometer...it looks like you paid for an Alpha Trak and the strips are SO expensive! Keep it as a backup and get one of the Relion meters...Prime or Micro is what most of us use. The Prime has 50 strips for $9 and the Confirm are about $36 for 50

We have lots of tips on learning how to test, and ways to make it easier, so don't stress out on that. Have you tried warming his ear a little before poking? A sock with a little rice in it and microwaved will provide a nice, warm compress and help get the blood into his ear. The other thing with testing is the size of the lancets. New diabetics have much better luck with a 28 gauge lancet (most meters come with 31's and their just too tiny). Look for lancets for "alternate site testing"...they're less than $5 for 100

You don't need to spend a LOT of money at the vet...I think most of us only go to our vets now for our prescriptions and routine vet care. Glucose curves can be done at home, and are a better way anyway since the trip to the vet adds stress and brings their numbers up anyway.

Will watch for your answers and help as much as I can, as will others on this wonderful forum.
 
Hi Nancy and extra sweet kitty Hairy and welcome to the FDMB.

First, take a deep breath, hold, release slowly, deep breath, hold, release slowly, deep breath, hold, release slowly. Repeat as needed. This sugardance you have started with your cat Hairy, will take some time. We'll help you every step of the way. Lot's of experience here with dealing with the day-to-day management of a diabetic cat. We've all been where you are now. We "get it." The stress can be unbelievable, but we'll help you develop a routine and teach you how to manage.

Sound good?

I agree with what Chris & China said. I feed all 3 or my cats the Friskies/Special Kitty/Fancy Feast pate style foods at the same times becasue it made things easier. This meant some adjustments on the part of my other 2 kitties.

One correction to Chris & China's post. The Relion Confirm test strips are $18 for 50, $36 for 100. I like the Confirm over the Prime because the Confirm meter from Wal-Mart uses a much smaller blood drop.

You might want to read this write-up on Ear Testing Psychology written by member Kpassa. It may make your cat Hairy more accepting of the testing process.

Do you have low carb pure protein treats like freeze dried or fresh cooked chicken to bribe Hairy with when you are doing the tests?
 
Hi Chris and China,

Thanks for responding.

I will be using Lantus. It is on order and should arrive on Tuesday. I was trying to get Hairy (and me) use to the meter this weekend so that once he starts on insulin, he would already be somewhat use to the drill.

I have been using Purina D/M on recommendation from my vet. However, my plan, once this case has been used up it to go back to Friskie's Pate. Most of the varieties are less than 10% carbs and a couple are the same or lower as the D/M. Vet wants Hairy on high protein, so I will add some chicken or liver to their food. That will up the protein without adding additional carbs. I'm hoping that will solve the problem of feeding Hairy separate from the other cats and also bring down the cost of the food.

Yes, my vet did insist on a cat specific meter. Said the human ones are too inaccurate for cats. Will I have to test him 2-3 times per day forever, or just in the beginning of insulin use? I'm thinking that if I get a cheaper human meter maybe I could establish some sort of consistent difference between the two so could adjust the readings accordingly?

No I haven't tried warming his ears. I will try that, but am concerned that is just prolonging the time I am "messing with him" and stressing him out. I feel pretty silly about this since I work at a cat sanctuary and give sub q shots and fluids to cats all the time, but I can't hit a vein to save my life. I have the lancets that came with the AlphaTrak meter but haven't been using them. The vet said using a regular needle was easier. It is a very small needle. This is my major issue right now. If I can even test his glucose levels, I'm really stuck (no pun intended). I'll probably try one more time tonight and maybe will trying the warming up and the lancets this time.

Thanks for helping me. I'm sure I get this figure out at some point, but I am stressed about pure Hairy having to be my guinea pig.

Nancy
 
Hi Deb an Wink,

Thanks so much for the link to that article. Some very helpful stuff there. Glad to hear that Wink is managing well on Friskie's Pate. That is what I have been feeding Hairy and my other 3 all along, so that is one routine they can all keep.

Right now I can't even manage Hairy and the test equipment at the same time, so having an extra hand to bribe him with treats just ain't in the cards right now..LOL. I do plan though to get him use to food being served right after his test.

Thanks for your help.

Nancy and Hairy
 
If you give him a treat and some lovings after every test whether successful or not, he'll soon look forward to test time.

I use the Arkray Vital meter and the test strips are only $0.18 cents each, so you could test many times a day for a lot less money than that AlphaTrak meter.

I'm glad you're here. We will help you. Keep posting with questions. And if Hairy gets tired of that case of DM canned, go ahead and slowly start to transition to the Friskies pate varieties.

Hugs.
 
The DM also has a money back guarantee. You could take it back to the vet for a refund. Say your cat stopped eating it after a few days.

Yes, vets insist that human meters are not accurate enough for use in diabetic cats but our experience here is that they are. They just read differently. Probably 95% of the members here use a human meter for their diabetic cat and we do just fine. I used an Alphatrak at first and then switched to a Relion Confirm meter. You can look at Wink's SS in my signature for some comparison done between the 2 meters. At the lower numbers, it's basically a 30 point difference.

Here are some reference ranges from member BJM

BJM said:
Conceptually, it is somewhat like reading a thermometer in Celsius vs Fahrenheit. Freezing, for example, is 0 degrees Celsius and 32 degrees Fahrenheit.

Here are some glucose reference ranges used for decision making using glucometers. Human glucometer numbers are given first. Numbers in parentheses are for non-US meters. Numbers in curly braces are estimates for an AlphaTrak.

< 40 mg/dL (2.2 mmol/L) {< 70 mg/dL for an AlphaTrak}
- Treat as if HYPO if on insulin
- At nadir (lowest point between shots) in a long term diabetic (more than a year), may earn a reduction.

< 50 mg/dL (2.8 mmol/L) {< 80 mg/dL for an AlphaTrak}
- If before nadir, steer with food, ie, give modest amounts of medium carb food to keep from going below 50 (2.8).
- At nadir, often indicates dose reduction is earned.

50 - 130 mg/dL (2.8 - 7.2 mmol/L) {80 - 160 mg/dL for an AlphaTrak}
- On insulin - great control when following a tight regulation protocol.
- Off insulin - normal numbers. (May even go as low as the upper 30s (1.7 mmol/L){60s for an AlphaTrak}; if not on insulin, this can be safe.

> 150 mg/dL (8.3 mmol/L) {> 180 mg/dL for an AlphaTrak}
- At nadir, indicates a dose increase may be needed when following a tight regulation protocol.

200 mg/dL (11.1 mmol/L) {230 mg/dL for an AlphaTrak}
- no shot level for beginners; may slowly reduce to 150 mg/dL (8.3 mmol/L) {180 mg/dL} for long-acting insulins (Lantus, Levemir, and ProZinc) as data collection shows it is safe

180 - 280 mg/dL (10 - 15.6 mmol/L) {may be 210 - 310 mg/dL for an AlphaTrak}- Any time - The renal threshold (depending on data source and cat's renal function) where glucose spills into the urine.
- Test for ketones, glucose is too high.

>= 280 mg/dL (15.6 mmol/L) {may be >=310 mg/dL for an AlphaTrak}, if for most of the cycle between shots
- Uncontrolled diabetes and thus at risk for diabetic ketoacidosis and hepatic lipidosis
- Follow your insulin protocol for dose adjustments
- Test for ketones; if more than a trace level of ketones, go to vet ASAP.
Click to expand...
 
Hey there!
Welcome to the board!

Here are some ear testing tips but I would advise you buy a Walmart relion confirm or micro as mentioned above. Or an arkray. Keep the AT as backup. The relions will save you money..

Ear testing tips... https://docs.google.com/document/d/13c_CPZVKz27fD_6aVbsguadJKvjSrSAkD7flgPPhEag/pub

Also the AT lancets are probably too fine. See if you can get thicker ones ie 28 or 29 gauge. It also helps to have something behind the ear to press against.

Now you said he was getting friskies pâtés his whole life? No dry?
I am trying to see what trigger the diabetes.. Any infections? How are his teeth? Ears? Urinary tract infection? Any steroid use?

Wendy
 
Hi Wendy,

I rescued Hairy about 3 years ago so I don't have any medical history on him or know what his diet was prior to that. Vet estimates his age to be at least 15. He did have a recent UTI, treated with Orbax for 3 weeks. He is not obese, in fact has lost substantial weight lately.
 
He was diagnosed with the UTI at the same time as he was diagnosed with diabetes not quite a month ago. I took him to the vet because he had been losing weight for the last couple of months and his coat was getting very dull and matted (he is a long haired tuxie). He was on antibiotics for 3 weeks for the UTI.
 
The UTI could have elevated his numbers, but it also sounds like he might have been working on diabetes awhile anyway. One of the big things I noticed about my own was that she had started losing a lot of weight, despite eating everything in sight, drinking a lot of water, peeing excessively and her coat looked awful.

Now that she's better regulated, her coat looks better, she's been gaining back her weight, and the very first thing I noticed was less litterbox action!
Now that Hairy's UTI is over, his numbers should come down so it's all the more important that you start home testing. It really is the only way to be sure Hairy is safe!

If you have any other questions, feel free to ask! The members here all live and breathe feline diabetes, so are excellent sources of information!
 
Yes Chris, those were exactly the same symptoms Hairy had. His coat has improved a little and he isn't urinating or drinking as much, but still eating every last morsel I give him...he's going through almost 2 cans/day of the DM. His BG came down some about a week after he started on the antibiotics, but then pretty much leveled out and is still in the low 400s.
Nancy
 
The D/M is too high in carbs so I'd stop feeding it and gradually switch over to the lower carb wet foods we recommend on Dr. Peirson's Food List You can take the D/M back to your vet..they guarantee their product and you can just say that your cats won't eat it. Use the money to go get cans on the "good" list instead.

While you're out buying food, pick you up one of the Glucometers we've mentioned. They are as affordable (about $15) and the strips run from $9 to about $36 per bottle.
Also, get some lancets...for new members, we suggests getting the lancets for "alternate sites testing"...The 28 or 29 gauge are best for beginners. They work best to get the blood flow going until the earns "Learn to bleed"

While you're there, pick up what you'd need for a Hypo Kit, like several cans of Fancy Feast Gravy Loves, some Karo, honey or maple syrup, and as many test strips you can afford....there's no such thing as too many test strips!

Let us know how else we can help you!
 
Purina DM is only 3% calories from carbs which is fine.. Its the dry thats too high carb. But anyway you might as well switch to save yourself some $ - we like Friskies pates, Fancy feast classic pates and Wellness grain free canned but anything under 10% calories from carbs is good.

heres a home testing shopping list.
1. Meter ie Walmart Relion Confirm or Micro.. cheap and dont need a lot of blood.
2. Matching strips
3. Lancets - little sticks to poke the ear to get blood . new members usually start with a larger gauge lancet such as 28g or 29g until the ear learns to bleed. Optional - lancing tool.
4. Cotton balls to stem the blood
5. Neosporin or Polysporin ointment with pain relief to heal the wound
6. Mini flashlight (optional) - useful to help see the ear veins in dark cats, and to press against
7. Ketone urine test strips ie ketodiastix - Important to check ketones when blood is high
8. Sharps container - to dispose of waste syringes and lancets.
9. Treats for the cat - like freeze dried chicken
10. Karo syrup/corn syrup or honey if you dont have it at home - for hypo emergencies to bring blood sugar up fast
11. A couple of cans of fancy feast gravy lovers or other high carb gravy food- for hypo emergencies to bring blood sugar up fast

Wendy
 
After more than a week, I finally got Hairy's insulin. The first pharm I tried was out of stock but they didn't tell me that for a week! Every time I called they assured me it would be mailed that day and I would receive it the next. Then I had them send the script to my Sam's Club and whoever was manning the fax machine at Sam's club hit delete instead of print. So it had to be faxed again, and I was finally able to pick it up last night. It cost me $183.23 for the insulin and another $11.98 for the syringes. I gave him his first dose this morning, even though I haven't yet been able to get blood to do a glucose test. He was slightly over 400 on his last test done at the vet's and I am giving him 1 unit twice/day. I will try to do the glucose test again this afternoon and if I don't succeed with that, probably take him to the vet to have them test it and help me figure out how I can do it at home.

Nancy
 
What kind of insulin is it? If its lantus glargine it should be kept in the fridge (not the door). Don't shake or roll it and it will keep up to six months contrary to what the label says

Wendy
 
1 unit twice a day.

I've been trying with some needles my vet gave me. He thinks it is easier than using the lancets. I do have lancets and a tool to use with them, so going to try it with that this afternoon.
 
Needles might be too fine - as might be the lancets - at least for a beginner. You might want to go get bigger lancets at 28 or 29g. Also give the tool a try (see the tips above I gave) and if that doesnt work well you can try freehanding the lancet for more control.

Key tips
- ear has to be warm
- if freehanding needle or lancet - go in at a 45 degree angle
- Have something hard behind the ear to press against
- treats whether successful or not.
 
OMG, OMG!!!!!!!!!!!!!!

We finally succeeded in doing a BG test!!!!!!!!!!!!

This time we switched roles with me holding Hairy and my husband using the lancet on his ear and then while hubby was still holding ear, I got the blood drop onto the test strip and it beeped!!!!!!!!!!!! It still took about 3 stabs and Hairy still struggled but not quite so much with the way I held him and the lancet seems to be a little less stressful for him than using a needle. Even though it was hard, I feel way way better now that we have succeeded the first time that we can do it again at it will be a little easier each time, both for Hairy and for us.

But, now that we finally got that done, I have some additional questions.

I gave him one unit of Lantus at 9:00 this morning. We read the BG at 4:15 PM and it was 89. The last time he was tested at the vet a little over a week ago (and before he started on insulin) it was over 400. The unit this morning was his first dose ever. Is that too big a drop in BG after just an initial 1 unit dose, or is that a good thing.

I think for now at least the best we can expect with the BG testing is once a day. When would be the best time to do it? First thing in the morning before feeding and his first insulin dose? Middle of the day between the two doses? If he gets one unit a 9am and another at 9pm, is there a particular time frame where his reading is likely to be the highest or the lowest?
 
CONGRATULATIONS! Home testing can be the biggest hurdle for newbies.and thank goodness you did! That 89 is too low for a starting dose given he only has had one shot so far.

The 89 is called a + 6 since it was 6 hours after his shot. But since this is his first dose I recommend to drop him to 1/2unit. Reason is that lantus is a depot insulin which means it takes 3 days to build up in his system before you see the true impact of a dose. And a week to build up when a cat has never been on it before. So 89 is too low when the depot isn't built up yet.
Lets see how 1/2 unit does.

For testing I usually recommend..
- always before every shot as you don't want to shoot when too low. As a newbie that's under 200 for now (until we have enough data to know if its safe to do so).
- It's also a good idea to get a mid cycle test when your schedule allows (5-7hours after the shot) to see just how low he is going. Thats usually the low point or "nadir". for you That's 3pm or so but i would vary test from 2-5pm.
-I also like a before bed test 2-3hours after the evening shot to see what his overnight plans are. Say 11pm?

Now you are testing too I would recommend you set up a sheet to track readings, you can share this with us to get more advice and your vet too.. Here's how but let us know if you need help with it.. http://www.felinediabetes.com/FDMB/viewtopic.php?f=6&t=18207


Wendy
 
I don't think I can do 1/2 unit. The syringes they gave me are are marked for 1/2 units but the markings are so tiny and faint that it is hard enough to see the 1 unit markings, let alone the 1/2 unit, especially up by the needle and when the plunger gets in the way.

I realize that multiple daily testings are ideal but that just ain't gonna happen, at least not for now. It has taken me 5 days to be able to test him once! So assuming only once per day, which would be more useful: before AM shot, before PM shot, or +6 between shots?

I have a diary that came with the meter for tracking testing, feeding, and shots that I have been using. The meter also stores a running 30 days of test data and will provide averages based on parameters selected.
 
Congratulations on your first successful BG test. Welcome to the vampire club!



Lantus dose changes are based on the nadir or lowest point in the 12 hour cycle. So, you will need at least a few mid-cycle tests to know when to change the dose. The testing Wendy suggested is good.

With that low number already, your cat may not need insulin for long.
 

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Thanks for that info Wendy, but I am a bit confused. You said your opinions were based on that protocol which says it requires multiple testing daily and not to change dose for 5-7 days, and then to reduce the dose only if BG drops below 50. Yet your advice was to drop his dose by 1/2 after only a single dose and a single BG test which was well over 50, and if I am understanding correctly was at the nadir (+7).
 
Hi Deb,

So is the nadir the mid point? I think I read somewhere that Lantus peaks at 7 hours, so I assumed that BG would be at nadir 6-7 hours after a shot. Is that correct?
 
The "nadir" is the lowest point of the cycle, no matter when it happens. Typically, it's around +6, but every cat is different. And just because it happens at +6 today doesn't mean it will do the same thing tomorrow. It can "move" based on lots of factors that happen on a day to day basis.

The reasons, I believe, that Wendy cautioned you if you keep the dose at one unit are multiple.

For safety's sake, we recommend at least three tests a day. Once before each and every shot, and once "in the middle" of the AM or PM cycles. A forth test is also highly recommended, like just before you go to bed.

Yes, she may be making this suggestion based on just two numbers, but that's all the data she has to work with. One was a week-old 400, and one was an 89 at what might or might not have been the nadir of the cycle.

89 is plenty low enough, especially if the preshot number was in the 300+ range, which we don't know for sure. What you will find is that our primary concern is safety. That's why we never give insulin without testing first. And why we like a nadir test. Absent a lot of data, we will always err on the side of caution. That's why Wendy suggested a lower dose. Better safe than hypo, and until you have the data to feel you can safely give a dose, no matter how big or small the dose is, you are better off under-dosing.

"Better too high for a day than to low for a few minutes" is the way it is usually stated. High numbers aren't fatal short-term. Low numbers can be.
 
Thanks Carl for that info. So as I understand it then, you don't know when the nadir is on any given day until you test every hour on the hour every single day which seems to make the term fairly useless. I am still looking for suggestions based on my specific and realistic premise, that for now I will only be able to test once per day. I know that is not ideal but it is way it is. So, with that as a given, what would be the most useful time to test? Mid cycle after the first dose, before the first dose, or before the second dose?
 
There isn't one time, there are two times... before each injection. Pre-shot is important because you need to know that the glucose is not too low when you shoot. 200 is the number you shouldn't shoot under unless you are monitoring the cat more closely.
 
I can't give you advice as to when one test per day would be most useful. Not and feel good about the advice anyways. If my primary concern is the safety of your kitty, then telling you to test less than three times per day - before each shot, and once around +6 - would be a disservice to you and to your cat. And bad advice.

Nobody needs to test every day, on the hour, every hour. Although there have been a couple people I've seen over the past two years that tried to do just that. It isn't necessary. No, there's no way to know exactly when nadir will happen on a day to day basis. But it's typically around six hours after a shot. That's the assumption I would make until I saw data to prove me wrong.

Look, I tested my cat only twice a day, most days that he was on insulin. I never ever gave him a shot without testing first. And that had nothing to do with any advice I got here. I didn't join this board until my cat had already been on insulin for several weeks. I tested him before every shot because my vet told me I needed to do so. It is the only safe way to do this. You have to know it is safe to give a shot before you put something in their body that is going to cause their BG to drop. I didn't use Lantus. I used PZI. My understanding, from my vet, was that the numbers that matter are the preshot numbers. Turns out she was "not quite right" on that, but that's what I had to work with at the time. I should have been checking for nadir every day. With PZI, you have to know the preshot, and the nadir, so that you can tell if the dose is too high, too low, or just right. That's the only safe way to use that insulin. So, I didn't manage the disease as safely as I should have. That was me, and that was my cat. I'd never advise anyone to do things the way I did them with Bob. Not and be able to sleep at night anyway. Too much insulin can kill a cat. Shooting numbers that are too low to shoot can kill a cat. Shooting insulin without knowing what the blood glucose is before giving the shot is like driving down the freeway with a paper bag over your head. Or giving an infant a shot of insulin without testing first. Any doctor that advised a parent to do that would be out of a job. Any parent who did that should probably not have kids.

With Lantus, the dose is adjusted based on the nadir number. Dose adjustments are made based on the nadir number. The preshots aren't quite as critical, perhaps, as they are with a non-depot insulin like PZI or Prozinc. But the preshot numbers do matter with Lantus. You want to know how high or low it is before you give the shot, so that you can safely manage the next 12 hours. You can shoot lower preshot numbers with Lantus than you can with PZI, but only if you have enough data to do so safely. If you don't have sufficient data, you don't shoot a preshot number under 200 no matter what type of insulin you have. With Lantus, that number can be lower after data is available. You'll see (if you look at some Lantus spreadsheets) that people give insulin on preshots below 100. But not until they know, with data, that they can safely do that.

Some people, due to their schedules, just can't test multiple times per day. So they test at least before every shot, and once or twice a day whenever they can. With Lantus, you will find it almost impossible to manage FD without an occasional "curve". At home, not at the vet's office. Curves run at the vet's office are basically useless and a complete waste of money. The numbers can't be trusted because of the environment the cat is in. That's why we advocate home testing. Less stress. And stress can raise BGs significantly. So some people do a curve on a weekend day or night when they are able to test every three or every two hours for a twelve hour cycle. They might not follow the "tight regulation" protocol, but rather the "start low, go slow" protocol. And that's perfectly fine if that's the best option for the caregiver.
 
I guess I need to call my vet in the morning to get a definitive answer. Thanks all anyway though.
 
Thanks Carl. It sounds like we have come full circle on this. I am not asking for advice on how many times/day to test. What I was asking for was opinions on the best time to test if you are only testing once a day. And since the nadir is most likely to be at midcycle (e.g +6) this seems to me to be the most logical time to test if I am testing once per day. And if the current dosage results in a nadir of 89, which according to the charts I have seen here is in the healthy range, then the 1 unit BID dosage seems appropriate. Am I missing something?
 
If your vet tells you that you can test just once a day, and safely manage this condition.....he'd be "not quite right". And I wouldn't assume his answer to be "definitive" if he says that testing daily isn't necessary. But you hold the syringe. All we can do is give you advice or suggestions based on hundreds if not thousands of cats who have followed our methods over the past fifteen or twenty years, a significant number of which have gone into remission. Our primary focus is the safety of your cat. And we give that freely.

The protocols for lantus were developed by Roomp and Rand, at the U of Queensland, and published in medical journals. If your vet is not familiar with them, please share these links with him.

http://www.felinediabetes.com/Roomp_Rand_2008 dosing_testing protocol.pdf
http://www.tillydiabetes.net/en_6_protocol2.htm

There's also the Start Low, Go Slow approach, developed here:
http://binkyspage.tripod.com/SLGS.html
 
NancyJac said:
Thanks Carl. It sounds like we have come full circle on this. I am not asking for advice on how many times/day to test. What I was asking for was opinions on the best time to test if you are only testing once a day. And since the nadir is most likely to be at midcycle (e.g +6) this seems to me to be the most logical time to test if I am testing once per day. And if the current dosage results in a nadir of 89, which according to the charts I have seen here is in the healthy range, then the 1 unit BID dosage seems appropriate. Am I missing something?
Click to expand...

Yes, you're missing something. His preshot numbers. You have no idea if they are 200, 300, 400, or higher. Or lower for that matter. They could be 60 or 80, and still have a nadir of 89.

If they are really high, and the nadir is 89, that indicates the dose is probably too high. He starts high, goes radically lower, and then "bounces" right back up to high numbers by 12 hours after the first shot. At some point, that bounce is going to not happen, and instead of a 89, you might see a 39 at nadir. And you would need to lower the dose. You might also see a 300 the next nadir, because he's in the middle of a bounce from the 89 this cycle. And your assumption might be "well, that's a crappy number at nadir, he must need more insulin." Which would be exactly the wrong conclusion.

If he starts out a 80, has a nadir of 89, and finishes at 70, then the dose is great. But it's likely to be too much really soon, and you might see a nadir of 40 the next cycle. In which case you'd need to reduce the dose accordingly.

It's pretty much impossible to conclude anything based on one snapshot per day of blood glucose values. But it usually leads to a vet telling you that the dose needs to be increased. Or at least that's my observation from the hundreds of times I've seen people post what their vet advised them to do with the dose.
 
Lantus is a depot insulin, meaning some of the dose starts working right away and some of the dose goes into the depot. When you first start using Lantus, it takes about 5 to 7 days for the depot to fill up and for you to start seeing the full impact of the dose. Since you just started giving insulin this morning and already got an 89 around nadir, that's usually a sign the dose is too high. You still have at least 5 more days of progressively lower numbers to go and that 89 doesn't leave much room.

As for when to test, pre-shots are a must so you know it's safe to give a shot. Again, it goes back to how much room is left for the cat to drop from the insulin. 200 is considered a "safe" pre-shot number because that gives room for the insulin to bring those numbers down.

For finding the nadir (which often moves from cycle to cycle), you can do spot checks throughout the day and across the week. This gives you more of an overall idea of when your cat might nadir and how low they might have gone. For example, if you get a test four hours after you've given a shot (called a +4) and it's 106 and then you catch a test at 6 hours and it's 78, you can guesstimate that his +5 was somewhere in between. If you then get a test at +8 and he's back up to 106, then you can assume his nadir was around 6 to 7 hours after his shot on that cycle. The next day, you might only be able to grab a +7 and it's 122, for example. Then his next pre-shot is 203. You can be fairly confident that he's not going to go down again because he's already going back up as the last dose wears off.

You test when you can. Some days, I can only get pre-shots and before-bed tests. Some days, I can get 10 or more tests in. What I'm doing is building data on how Mikey reacts to the dose and a pattern starts to emerge that lets you know if the dose is too high or too low or just right. Sometimes you have to tweak the dose on a weekly basis, sometimes you can go for months on the same dose. The only way to tell is by home-testing and having the data to show what's happening.
 
Stress is exactly why I am not testing him more than once/day right now. Believe me, he stresses and struggles way more when we try to test him at home than he does at the vets office. And at the vets office, under less stress, his pre shot numbers (pre shot as in before he ever had insulin) was well over 200. I am watching Hairy closely for any hypo symptoms, but I will not put him through the stress of testing him 3 times a day or even twice a day at this point. Once he is better and less stressed by all of this, then I can look at changing that.

Just out of curiosity, where does this rule about not giving insulin if BG is under 200 come from? I have been unable to find any reference to that from either the manufacturer or any other veterinary source.

And now I am really confused. I thought by definition that nadir was the low point in a cycle whenever it occurred. So how can 89 be a nadir if his pre shot number was 60?

In any case, I'm not going to take it upon myself to change his dosage. That is what I pay my vet for. I wholeheartedly agree that I dose and one test is not enough data to conclude anything. That is exactly why I was concerned about somebody on this board concluding that I should change his dose based only on that data.
 
Good point...on the whole "lantus is a depot insulin" thing. At this point, Hairy hasn't been on insulin long enough for the depot to have been "established". So the number you got, the 89, is just a number. A beautifully nice normal BG range number though. You haven't seen the "real" effect of the 1u dose yet, most likely. A few days of data will reveal that. It's very likely that with a low-carb diet, his insulin needs could be lower than 1u. Only time will tell, but for the next few days, you'll want to test if at all possible before shots and around nadir to be safe.

Is the issue with testing that your schedule doesn't allow it? Or that it's just difficult to get successful "pokes" and get a drop of blood? If that's the primary issue, we've got all sorts of tips and tricks for successful blood-letting.
 
And now I am really confused. I thought by definition that nadir was the low point in a cycle whenever it occurred. So how can 89 be a nadir if his pre shot number was 60?
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Technically, I misspoke. Yes, "nadir", by definition, is the lowest point. I should have said "you might see an 80, and a +6 of 89, and then a 60 at the 12 hour point". The point, though, is that a cycle that starts at 80, goes up to 89, and then back down to 60 is indicative that the insulin is working really well, and will most likely continue to do so, meaning that in the near future, less insulin will be needed.

In any case, I'm not going to take it upon myself to change his dosage. That is what I pay my vet for. I wholeheartedly agree that I dose and one test is not enough data to conclude anything. That is exactly why I was concerned about somebody on this board concluding that I should change his dose based only on that data.
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But..... somebody on this board would logically tell you that the dose is probably too high and needs to be reduced. I sure as heck will say that. Because 89 is too low for comfort. You're using an Alpha-Track meter, right? Well, the low end of normal BG on a "pet meter" is 80. Anything lower than that is "hypoglycemic" by definition. So your kitty is 9 points above "too low". And all meters, even the costly pet meters, can be off by up to +/- 20%. So again, technically, that 89 might be off by 20%. It could be 71 at the low end of the variance. At this point, all I really care about is your cat's safety. So if I'm ticking you off, or sounding like Mr. Know-it-all, I apologize for that. If your vet tells you that you don't need to be concerned about an 89, and you don't need to worry about shooting 1u of insulin twice a day "blindly", then he's putting your cat's life at risk.

Yes, you are paying your vet for advice. That doesn't mean it's good advice, or correct advice. It just means it costs you money. He cost you over a hundred dollars in unnecessary expense by selling you that meter and strips.
 
Context. It's all about context. With that BG of 89 today, you have no other numbers to see a pattern, to build out the relationship between the amount of insulin and the one number you saw. Was it 500 at pre-shot? or 40? or something in-between.

Lantus is a depot type insulin. That means only part of the shot you give goes to work right away, and the rest goes into storage within the cats body. As you build up that depot, more of the shot that you give will go to work right away. It usually takes 5-7 days to build up the insulin depot. Since you have given a single shot of insulin, tested and got a 89, that 1U dose seems high in our experience.

That is why it was recommended that you reduce the dose, the depot will continue to build and the numbers will likely drop very low, lower than is safe. By all means, question your vet on the current dose you are giving and verify that is still a safe dose to give based on your low test today.
 
Carl,

Please read my 9:54 post. I realize you were probably already typing your post before I published mine.

In any case, what I felt was inappropriate medical advice was "I recommend to drop him to 1/2unit. Reason is that lantus is a depot insulin which means it takes 3 days to build up in his system before you see the true impact of a dose. And a week to build up when a cat has never been on it before. So 89 is too low when the depot isn't built up yet.
Lets see how 1/2 unit does."

I understand that long time members of this board have come across all kinds of different scenarios. But mine is that Hairy was diagnosed with diabetes a month ago. He was put on a low carb diet first which did not decrease his BG significantly. Do to significant weight loss, especially loss of muscle mass, my vet felt that we shouldn't wait any longer to get Hairy on insulin. His pre insulin BG was consistently over 400. His starting dose is 1 unit BID. Today is the first day he has ever been on insulin.
 
In any case, what I felt was inappropriate medical advice was "I recommend to drop him to 1/2unit. Reason is that lantus is a depot insulin which means it takes 3 days to build up in his system before you see the true impact of a dose. And a week to build up when a cat has never been on it before. So 89 is too low when the depot isn't built up yet.
Lets see how 1/2 unit does."
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But that is anything but inappropriate medical advice. If his very first shot of insulin dropped his BG to 89, which is barely above normal on your meter, then suggesting a lower dose is totally appropriate advice motivated by people who consider safety above all else. From people who have lots of experience with the same insulin with their cats. I have seen cats that have gone into "hypo" numbers on their very first shots of insulin. I have stayed up all night with their caregivers as they fed high-carb food for hours, or rubbed karo on their gums, testing every 30 minutes all night long, worried that their cats were going to have a seizure. No big deal for me, since I'm hundreds of miles away looking at a computer monitor. But I'm guessing their lives were a little miserable at 3 or 4 am. And had they not stayed up all night and fed "sugar" to their cats, they might have experienced seizures and they might have woken up in the morning to find their kitty had not survived the night.

Advising a reduction to 1/2 unit was great advice from the multiple people who have advised doing so. And it's exactly what I would hope to see people suggest to a new member when the circumstances warranted it. And that's speaking as a "moderator".
 
NancyJac said:
Stress is exactly why I am not testing him more than once/day right now. Believe me, he stresses and struggles way more when we try to test him at home than he does at the vets office. And at the vets office, under less stress, his pre shot numbers (pre shot as in before he ever had insulin) was well over 200. I am watching Hairy closely for any hypo symptoms, but I will not put him through the stress of testing him 3 times a day or even twice a day at this point. Once he is better and less stressed by all of this, then I can look at changing that.
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It took me about two weeks before Mikey and I got the testing down. Even then, it still took me another 3 months or so before it became routine. Don't stress yourself or your cat out and take your time. You already got one successful test in and each subsequent test you do, it will become easier for both of you. Don't try to do everything perfectly at once. Do what you can do at the moment and it gets better. "Practice makes perfect."

NancyJac said:
Just out of curiosity, where does this rule about not giving insulin if BG is under 200 come from? I have been unable to find any reference to that from either the manufacturer or any other veterinary source.
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On the Main Health Board (where we're currently posting), most members have not been testing for very long or even testing successfully. There isn't much data yet on how the cat reacts to the insulin so a pre-shot BG of +200 has proven to be the safest number for shooting when you're dealing with that lack of data. The more tests you get, the more you can see how your kitty reacts and you can drop that number further. For example, on the Lantus-specific board, the no-shot number is 150 because most people have gathered enough test data by that point to show they know how to test frequently if need be and they know how fast and how far their cat may drop on their current dose. Over time, that number is lowered even further. At this point in the game, I give Mikey shots when he's under 100 because his data has already shown that it's safe to do so. I would never recommend that for someone else unless they had the data to back it up and were willing to "shoot low."

NancyJac said:
And now I am really confused. I thought by definition that nadir was the low point in a cycle whenever it occurred. So how can 89 be a nadir if his pre shot number was 60?
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If you're asking about Carl's example above, the pre-shot was 80. 80 and 89 are pretty close to the same number when you account for the +/-20% variance on glucometers, so that's why it's a nice cycle.

NancyJac said:
In any case, I'm not going to take it upon myself to change his dosage. That is what I pay my vet for. I wholeheartedly agree that I dose and one test is not enough data to conclude anything. That is exactly why I was concerned about somebody on this board concluding that I should change his dose based only on that data.
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The one test you have gotten points at the 1u being potentially too high. As Carl said above, it's better to be high for a day than low for a moment, so the safest course of action that we can recommend is to lower the dose initially while the depot builds up and while you two get more comfortable with testing. Then, after 5-7 days, if you need to you can raise the dose again. If your vet is open to communication, definitely talk with him. Many people have vets that won't give phone consults or vets that they've left for various reasons or vets that charge for this so they don't have that advantage. It's great that you have a vet that's so willing to work with you. :thumbup He sounds like a keeper. :-D
 
It looks like you also did a food change recently? When did you switch him to the low carb? That also has a huge impact on BGs (100-200 points). So, while the 1u might have been a good starting dose with the food Hairy used to be on (and is usually the recommended starting dose), the food change alone will probably make that dose too high now. Make sure you ask your vet about that, as well. ;-)
 
Kpassa,

We tried the diet route first but it didn't make any significant difference in his BG because he has pretty much been on a low carb diet all along. The only change was not giving him access to dry food, which he had never eaten very much of anyway. He had been on the changed diet for a month before starting insulin.
 
NancyJac said:
Kpassa,

We tried the diet route first but it didn't make any significant difference in his BG because he has pretty much been on a low carb diet all along. The only change was not giving him access to dry food, which he had never eaten very much of anyway. He had been on the changed diet for a month before starting insulin.
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Ah! That makes sense. I just saw you had posted about going with the food change first while I was busy posting asking how long ago you'd done it. :lol: It can take up to two weeks before the food change is fully reflected in lower BGs, so I think you would have seen that by now. ;-) Feel free to disregard my previous comment.
 
Hope this turns out right, first time I have tried to use the quote feature.


It took me about two weeks before Mikey and I got the testing down. Even then, it still took me another 3 months or so before it became routine. Don't stress yourself or your cat out and take your time. You already got one successful test in and each subsequent test you do, it will become easier for both of you. Don't try to do everything perfectly at once. Do what you can do at the moment and it gets better. "Practice makes perfect."

Thanks for that encouragement Kpassa. THAT is what I need to hear right now, not that I am going to kill my cat because I can't test him 4 times a day.
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Do you know what size the lancets are? I got 33g lancets with my meter. They were way too small. I bought a box of 26g, if I remember correctly, and from that point on, I got blood more easily. I also found it was always easier to get blood from Bob's left ear than his right ear for whatever reason. The ears also seem to "learn to bleed" the longer you are doing testing, so it does get easier with practice and time.

Also, do you use the lancing device, or just the lancet "free-hand"? I never tried the device thing, just went with free-handing it. My vet said "if you can sew on a button, you can do it free-hand" so I tried it and it worked great.

Has anyone shared this picture with you yet?

Just so you know where to "aim".
 

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