New here diagnosed a month ago! Frustrated!!

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Robyn & Mika

Robyn & Mika

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Hello everyone and thanks for a great forum, I have learned alot reading all the blogs!! I have a 12 year siamese that was diagnosed on 7/20/11. We started him on 3 unit of Lantus insulin on 7/21/11, twice a day. Switched his already wet food to Fancy Feast (varieties under 6% carbs.) His first BG numbers were in the high 400's. The three units of insulin didn't touch them. After 10 days at 3 units, the vet increased insulin to 5 units twice a day, BG still over 400. We were on 5 units twice a day for 10 days, and vet increased the units to 7 twice a day. I did home testing on Saturday (second time), and saw numbers from 371 to 275. Vet just increased the insulin to 8 units last night and wants me to home test again after 5 -7 days. Is this not a ton of insulin?? I read the blogs where cat owners have their cats on 1 - 1.5 units of insulin and are still on dry food and can wean their cats of the insulin fairly quickly. Am I just being impatient? I changed his food immediately and have been very regimented with the insulin. Is there anything more I can do to help get my cat off the insulin? The vet said he needs more insulin because he weighs 17.3 pounds?? I am starting to wonder if I will ever get him off the insulin. Help, any advice would be greatly appreciated. Thank you.
 
There is a very good chance that you cat is getting too much insulin, unless there is an underlying health reason for that MUCH insulin. Especially if you have him on a low carb/high protein diet, and thus his liver keeps dumping stored sugar to try to save itself from going into hypo.

Personally if he was my cat, I would drop his dose back to 1u twice a day, 12 hours apart and keep testing him at home to see where that gets you. Cats are not dosed based on weight, that is for dogs. Most cats never need more than .5u to 1u twice a day of Lantus. Now there are certain health conditions that do require higher doses of insulin, but they are fairly rare.

Mel, Maxwell, Musette & The Fur Gang
 
Have you tested him for Acromegaly? A lot of those cats who suffer from Acromegaly are large cats, and also needs high doses of insulin. I would test him for that. Others here know more about Acro as it it also is called in short.


Also, not to discourage you but some cats just never will be insulin independent. My Simba is one of those and he has been taking daily insulin now for 5 years. I've just learnt to live with the fact that he will always need insulin.
 
Insulin is not dosed based on weight. It's dosed based on home testing the BG's.

You are using a great insulin. Changing to wet food also a great thing to do. I agree with Mel - it sounds like you could be giving too much insulin and the fact that the vet keeps increasing by 2 units at a time is crazy.

When starting on ANY insulin, we recommend starting at 1 or 1/2 unit. Home testing and then after a few days, you can always change the dose accordingly. And when changing the dose, we recommend doing so in 1/2 unit increments.

Unless your cat is tested for IAA or acromelogy and really needs a high dose (which in some cats can be as high as 40 units), you very possibly could be giving way too much insulin and run the risk of a hypo incident.

So if you are willing - how about starting over at 1 unit. Yes, you may see some crazy high numbers for a couple days, but if you give it a chance, you may also see that this is working.

Also, are you home testing? And are you testing more than just before giving the shot? This information is vital in helping us to help you determine the best dose and when to change it for your cat.

What do you say....
 
Are you home testing? This step is vital in determining if the dose is too high. Too much insulin looks exactly like too little insulin if you're not testing daily. If you're not home testing I urge you to either please start right away, or drop that dose down dramatically until you are able. As others said, most cats don't need more than 1u unless they have a complicating medical condition. If your cat hasn't been diagnosed with acromegaly or cushings, the dose you're shooting is dangerous.

Check out the stickies in the Lantus forum for more information about the insulin you're using and dosing guidlines: http://felinediabetes.com/FDMB/viewforum.php?f=9

Starting doses should be 1u, and raised in .25u-.5u increments based off of daily home tests. If you aren't familiar with home testing, we have a ton a resources and tips here to get you started!

Just out of curiosity, is your Siamese a big cat because he's naturally big or because he's a bit obese? I ask because my Bandit used to weigh about 19 lbs, when he really should have weighed 12.5. If a starting dose is determined by weight, it needs to be the cat'sideal weight, not their current weight.
 
You guys are awesome! I knew it was too much insulin! He has not been tested for acromegaly, so I will look into that. I have only tested him twice every two hours for 10 hours to produce a glucose curve. We are in Winter Haven, Florida - how do I find a vet that specializes in feline diabetes?
 
africanbb said:
You guys are awesome! I knew it was too much insulin! He has not been tested for acromegaly, so I will look into that. I have only tested him twice every two hours for 10 hours to produce a glucose curve. We are in Winter Haven, Florida - how do I find a vet that specializes in feline diabetes?
Click to expand...


Start a new thread (NEW TOPIC) with the title "Seeking vet near Winter Haven, FL"

Don't leave off the "FL", because there is also a Winter Haven, CA !!!
 
You guys are awesome! I knew it was too much insulin! He has not been tested for acromegaly, so I will look into that. I have only tested him twice every two hours for 10 hours to produce a glucose curve. We are in Winter Haven, Florida - how do I find a vet that specializes in feline diabetes?
Click to expand...

If you have already done one curve, can you reply with the numbers. Jumping to say automatically you are giving too much insulin is a common reaction but not necessarily true. I was told the very same thing in the past, but it was wrong advice.

Are you testing for ketones? I am glad you are home testing, so if you could set up a spreadsheet that others on this site use for tracking BG test results, it will be clear if you are giving too much insulin or need to give more.

With such constant high BG numbers, it is very important for you to test for ketones. I think you can pick up a box of Ketostix at any pharmacy.

You have eliminated food as a possible source for high numbers, which is great.

If you drop the dose and testing shows that there is no improvement with numbers, here are the sheets for testing your cat for high dose conditions - acromegaly and IAA. It is best to have both tests done as you cat could have one, the other, or both, and it makes a difference in how you manage the diabetes later.


IAA Test
IGF-1 (Acro) Test
 
I performed a glucose curve on Mika on Saturday, 8/20/11, and below are the results:

6:30 AM – Food
7:00 AM – 7 units of insulin
8:35 AM – 371
10:50 AM – 275
1:00 PM – 335
3:00 PM – 334
5:00 PM – 319
6:30 PM – Food
7:00 PM – 333 (right before insulin)
 
Actually, I want to clarify Hillary & Maui's quote:
Insulin is not dosed based on weight. It's dosed based on home testing the BG's.
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The initial dose is a generally based on weight:

From the Sticky post:
Using a weight based formula for determining a starting dose of Lantus or Levemir:
- the formula is 0.25 unit per kg of the cat's ideal weight
- if kitty is underweight, the formula frequently used is 0.25 unit per kg of kitty's actual weight
- if the cat was previously on another insulin, the starting dose should be increased or decreased by taking prior data into consideration
- Online Calculator for Converting Pounds to Kilograms
Click to expand...

So initially it's based on weight (and taking other things into consideration like if the cat has another health issue). Once you're on Lantus, then the dosage is driven by blood glucose levels.

There's a chance that you may have surpassed its optimal dosage. Junior was on 2U and moved up to 5U. Did that for 6 weeks before I scrapped the whole thing and started over at 1.5U. Turned out he never needed more than 1.5U (you can see my spreadsheet in my signature). Every cat is different and you may want to consider starting over with theRand Protocol, which is what alot of us have use here.

Good luck!!!
 
Assuming a optimal weight of 13lbs, he should have started out at 1.5 units and gone up in 0.5 increments from there. How do you know when you are giving your cat too much insulin? I took his dosage down from 8 units yesterday morning to 3 units. The more I read, the more I think I need to take him down to 1.5 units and work back up in 0.5 increments as necessary based on frequent BG home testing. I am terrified I am going to kill my cat. Stressed for sure!! Is it okay to just reduce the dosage so quickly? Can't thank you all enough!
 
africanbb said:
Assuming a optimal weight of 13lbs, he should have started out at 1.5 units and gone up in 0.5 increments from there. How do you know when you are giving your cat too much insulin? I took his dosage down from 8 units yesterday morning to 3 units. The more I read, the more I think I need to take him down to 1.5 units and work back up in 0.5 increments as necessary based on frequent BG home testing. I am terrified I am going to kill my cat. Stressed for sure!! Is it okay to just reduce the dosage so quickly? Can't thank you all enough!
Click to expand...

Does he have any history of ketones, or infection? Are you testing for ketones? If there's no history of ketones, no infection, and you're testing his urine for them, I think it is safe to drop the dose. In fact, I think it's dangerous to shoot that much insulin right now. Please make sure you're testing for ketones, though. You can pick the strips (ketostix) up at any pharmacy.

Here's a link to the dosing guidelines for Lantus: http://felinediabetes.com/FDMB/viewtopic.php?f=9&t=1581. Increases are made in .25u-.5u depending on the nadir, or the lowest number of the cycle. If the nadir is in the 200s or less, increases are made in .25u. If they are above 300, increases are .5u. Lantus also works best with consistency, so you want to make sure you're shooting on a 12 hour schedule and holding the same dose for at least 6 cycles before increasing. Decreases are automatically made if you get any number below 50.

With Lantus, you want to test at least three times a day. Before each shot, and then another test about 6 hours into either cycle. However, if you can get more mid-cycle tests you're even better off. For many cats the nadir falls about 6 hours into the cycle, but some have it early, around 4 hours in, or later, at around 8 hours. In the beginning you're going to want to get a few tests in to see where his nadir usually is.

If you can get a spreadsheet up (here are instructions: http://felinediabetes.com/FDMB/viewtopic.php?f=6&t=18207&start=0), you can post in the Lantus forum for dosing advice. There are many experienced people there that give excellent advice, which is very valuable when you're starting out. There are also people on the board that have cats that need high doses, so if it turns out that he does have a high dose condition (which is not the case most of the time but it does happen), then they can let you know when it's time to consider them as a possibility. The first step is definitely dropping that dose and raising it safely, according to the protocol.
 
Yep, I also agree with Julia's post. Ditto on the the Lantus forum.

I, too, was terrified of starting over and risk killing my cat. What did it for me was that my cat simply was not getting any better at 5u. For me (and this is just me only -- not speaking for anyone here), I'm convinced that my vet would've killed my cat at the rate we were going. He's a good generalist (like a primary care doctor) but didn't have enough depth to provide the expertise I needed. So I just shut my eyes, said a prayer, cut my vet off for a month, and followed the guidance of the folks on this board.

One thing I want to note that it's possible that your cat could go up to 8U again. It's unusual but possible. Julie1220's cat Punkin is now at 14U but that's actually the right amount for her cat. She's using the blood glucose data to drive her decisions and making 0.5U adjustments at a time. Starting over will help you fine tune the right amount.

I know it's really overwhelming. You're in great hands here.

Bonnie
 
I have not been testing for Ketones - another term I need to become familiar with. Will do my homework tonight! Thanks again for all the great advice. I dropped Mika to 3 units last night, and am going to drop him to 1.5 units and work our way back up from there per the recommended dosing protocol.
 
At the top of the page, under the logo with the cat and the words, The FDMB, you will see, two lines down, "User Control Panel." Click on it and when it comes up, select "Profile." Put your city, state (or city, country) in the field labeled "Location." Your location will appear to the right on all your posts and save you the trouble of answering the question again and again.

So you can share blood glucose test results with us, on the the FDMB Index Page, click on Tech Support, then click on the topic, "How to Create Your Own SS and Publish It in Your Signature." If you enter your test info into this spreadsheet you will be sharing it with all of us.

Lana
 
Welcome!

When a cat has ketone problems, it is frequently very severe. My S'mores went from perfectly fine to near death in ~24hours! If you don't know anything about ketones, your cat is probably not super sensitive. If you can get a ketone test that shows a negative, if it were my cat, I would drop down to the right starting dose and move up slowly from there.

Good luck!
 
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