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Angie & Fie

Angie & Fie

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Hello kitty moms and dads.
My sweet 16 year old siamese " saphire" aka Fie was diagnosed in January with diabetes. I didnt take the news well being diabetic myself. I tend to notice every little thing and last week I noticed she was "low " acting. I do test at home. Her BLDGLU was 18, I rushed her to her Dr. She brought it back up to 179 and sent her home. She said give no insulin that night and lower her dose of Glargine insulin from 3 iu to 1 iu. I did that, now my girl is having terrible times. I test her 2x daily, she eats 2 -3 cans of fancy feast daily and has access to dry but she normally doesnt eat it. She no longer chews well. As with so many others, she never stopped drinking copious amounts and urinating large volumes. She does have early stage kidney dx.
This is a over view of what has been going on since the change in dose. I will note this - Her insulin is 90 days old. Her vet says its fine and will not call in a new bottle. Obviously from my own diabetes I strongly disagree with her dr. '
Friday am - off meter so over 500
gave 2 iu glargine
Sat am- 438
gave 2iu glargine
sat pm - over 500
gave 3ui glaragine per dr
sun am over 500
gave 3 iu glargine
sun pm 489
gave 3iu glargine
Mon am 429 - her she is acting like she is " low" acting drunk, disoriented, sleeping by water bowl just really off
called dr. said do not change dose.
I did anyway. gave 1.5 iu
mon pm 246 seems I was right.
tues am- 444
gave 2 iu. she has finally had a good day. Where she is acting like herself.
Are any kitty parents experiencing this kind of fustration on attempting to control their cats condition. Any suggestions or advice on caring for her further?
I guess I should mention she uses the accucheck ultra mini meter with a ear prick collection. confused_cat
 
First, welcome to the site.
Right off the start, your insulin is very likely TOAST. Lantus should be good for about 28days, then you need to crack open a fresh one.

Now, get ready for a huge flood of info on feline diabetes!
I can't say much on any of your cat's other issues, but I'll start you off and give you some info to ready.

First, the links to info on the insulin you are using, Lantus:
Tight Regulation Protocol
LANTUS & LEVEMIR – INSULIN DEPOT –AKA- STORAGE SHED
Lantus&Levemir – Data Ready to Shoot Low Numbers

Next, a bit of info on food for your cat. I don't know what foods you are feeding, but if you look at Binky's list below, see if you can feed low carb wet foods, sticking to under 10% carbs.
Please DO keep a few cans of the high carb so that you can feed if your cat goes low again:
Binky’s Food Lists
Feeding Your Cat: Know The Basics of Feline Nutrition

What fantastic news to hear that you are already testing, but I am sure you already knew the importance!
With the protocol many follow on this site, you will see that dosing is based on nadir, so it will be good if you can do a few curves, maybe on the weekend or even some other day when you have time so that you can determine where your cat's nadir occurs.

How to do a Curve
Example of a typical curve:
+0 - PreShot number.
+1 – Usually higher than PreShot number because of the last shot wearing off. May see a food spike in this number.
+2 - Often similar to the PreShot number.
+3 - Lower than the PreShot number, onset has started.
+4 - Lower.
+5 - Lower.
+6 – Nadir/Peak (the lowest number of cycle).
+7 - Surf (hang around the nadir number).
+8 - Slight rise.
+9 - Slight rise.
+10 - Rising.
+11 - Rising (may dip around +10 or +11).
+12 - PreShot number.

it's completely impossible to regulate without testing. Cats are not great at letting you know when they are a bit low and if you wait too long, it could be too late.
Some links for hypo, signs, and treatment:

List of Hypo symptoms
How to treat HYPOS – They can kill! Print this out!
Jojo’s HYPO TOOLKIT

Don't worry about regulation because once you do some curves, add a few more tests through the cycles, remove all dry cat food, you will see how your cat is reacting to the insulin. You will not need to have your vet tell you what dose is good because you will know from your own testing.

Most people also track their BG test numbers in a google spreadsheet which others can view and give you some input on the numbers and what's going on.
 
We have a very active Lantus support group (Glargine is also Lantus) that you should check out: viewforum.php?f=9 The starred stickies under the grey line have lots of great info on how to care for the insulin, how to dose, how to deal with low numbers. Lots of vital stuff. One of the tenets is that Lantus does best with a consistent dose, every 12 hours. It has to do with the shed that is built up: viewtopic.php?f=9&t=150

If you post there, put NEWBIE in the subject line and check back often. That board moves really fast so you don't want your post to get lost. You can also read some of the threads and check out the spreadsheets to see how others are doing.

Speaking of spreadsheets, we have this google doc that is a great tool. It is a color coded spreadsheet where you can keep track of insulin given, numbers etc. It is a good tool for you and a good one for us, when you want dose advice. https://docs.google.com/previewtemplate ... ode=public It is slow to load and doesn't seem to work for every computer. If you need help, just ask.

I don't have experience with your insulin so can't offer any dosing advice. As far as food goes, if you can eliminate the dry, it is best. Some cats are super carb sensitive and it makes a big difference. You might also add water to the wet and make it kind of like gravy. It will help your girl stay hydrated. You are already doing the most important thing for her - testing at home. Glad you caught that low number!
 
hi there

a couple of things stand out for me in what you posted...

1. how are her teeth? If she's not chewing well then she has teeth issues and these absolutely should be taken care of. bad oral health leads to bad general health plus could be making regulation tougher
2. what are you feeding?
3. You keep changing the dose but that isn't how lantus works. You've already been given info so you can learn how it works, but in the meantime, pick a dose and stick with it unless you get a really low preshot or a low midcycle test in which case you should reduce.
4. Your vet is wrong and should learn more himself about lantus and storage/shelf life.
5. how bad are her kidney values?

jen
 
Jen & Squeak,
She gets yearly dentals, she just doesnt have many teeth left. Her bun is just slightly out of normal range on high side. No other blood values other than GLU are abnormal. She eats fancy feast the elegant in the green cans. I told her when I used Glargine I had to toss it every 28 days. So why not with Fie? Makes me nervous. I'm reading the links the other folks have sent. I cant be too informed I feel .
Thanks everyone for posting. I am reading what you sent.
 
Fie's mom said:
Jen & Squeak,
She gets yearly dentals, she just doesnt have many teeth left. Her bun is just slightly out of normal range on high side. No other blood values other than GLU are abnormal. She eats fancy feast the elegant in the green cans. I told her when I used Glargine I had to toss it every 28 days. So why not with Fie? Makes me nervous. I'm reading the links the other folks have sent. I cant be too informed I feel .
Thanks everyone for posting. I am reading what you sent.
Click to expand...

Welcome! The Fancy Feast Elegant Medleys a little high in carbs for a diabetic cat. I would recommend switching to the Fancy Feast Classic flavors. Here's a list of all the diabetic-safe Fancy Feast: http://www.felinediabetes.com/glutenfree.htm

And to repeat what others have said, get rid of the dry food completely. It is way too high in carbs and will make it impossible to find the right dose of insulin. I have a feeling that the day Fie had her hypo incident was probably one of the days she didn't eat any dry food.

3u was way too high a starting dose. I would get rid of the dry food and start lower. 1 or 1.5u would be a good point. Then test her at the very least before you give the AM shot, before the PM shot, and then 6 hours after one of those (of course, any extra tests will help, too!). Then you will be able to determine how the insulin is reacting on her Blood Glucose.

Your insulin is toast. Lantus never lasted longer than 30 days for me. The more economical way to do it is get a prescription for the Pens, which come in a pack of 5, each containing 3ml of insulin. You stick your U100 syringe in the top just like you would a vial, and hardly any goes to waste! If your vet won't write you a prescription for the pens, go to a different vet. My vet automatically writes prescriptions for the pens for newly diagnosed cats, and most vets will have no problem if you ask them. Also, I'm not sure what state you're in, but in many states you don't even need a prescription to buy insulin. http://www.isletsofhope.com/diabetes/state-law/state-prescription-laws.html

When my siamese Bandit was diagnosed with diabetes, his teeth were awful. I think that his diabetes contributed to the awful situation in his mouth, because now that he's in remission he hasn't had any dental problems. Maybe take a look at Fie's teeth and see if they're red and inflamed...if they are then she might just have to have the rest of her teeth pulled. They had to pull about half of Bandit's teeth before I could get him regulated.
 
when you contact your vet, tell your vet you want to get the pens or cartridges, and NOT the bottle. There is no way that you will be able to use up the bottle as you are giving a small dose and it will be no good. Waste of money for you. The pens and cartridges have 3ml I think, and the bottles are 10ml I think. You use the first container and leave the rest in the frig. The 10ml bottle will last you 30 days; the five 3ml pens or cartridges will last you 5months. Maybe you can provide your vet with info from the online site for the insulin.
Ask your vet how come the same insulin when used for humans is to be replaced after a month, then why would it last longer for a cat?
 
She just had her teeth done for the year in Feb. Whats left looks ok. No redness or imflamation. I called to get another bottle and had to fight to get that , so idk how she would feel about the pens. I live in a very rural area and she is the only small animal vet and she is 63 miles away. So changing vets isnt a option till a new one comes along. ( Unfortunately) . Cant hurt to badger to get them tho. What about my other 2 cats? They eat dry primarily. Both are young and in good health. Any suggestions on feeding so differently?
 
Gayle and Shadoe said:
when you contact your vet, tell your vet you want to get the pens or cartridges, and NOT the bottle. There is no way that you will be able to use up the bottle as you are giving a small dose and it will be no good. Waste of money for you. The pens and cartridges have 3ml I think, and the bottles are 10ml I think. You use the first container and leave the rest in the frig. The 10ml bottle will last you 30 days; the five 3ml pens or cartridges will last you 5months. Maybe you can provide your vet with info from the online site for the insulin.
Ask your vet how come the same insulin when used for humans is to be replaced after a month, then why would it last longer for a cat?
Click to expand...
I asked that same question Gayle! just like that too. :lol:
 
Your other cats can and should eat what your diabetic eats. Cats are obligate carnivores, which means they need meat, not wheat/corn/rice/soy, and they need moisture, not dehydrating dry food. Dr Lisa has a great site - www.catinfo.org for more info

Jen
 
Hiya! You've been given great info thus far and I don't want to overload... :)

I will let you know that we were diagnosed in December and used two Lantus vials before switching to the pens. The first one petered out pretty quickly (I handled it completely wrong... dropped it, left it out of the fridge overnight, rolled the vial and shot air bubbles and insulin back into at the advice of my vet, etc. ). I was very careful with the second vial and still switched out at Day 43. There are some that I know get up to 4 months out of a vial, but that is exceedingly rare.

When discussing the pen option with your vet, you need to stress that you will NOT be using the pen as it is intended for humans. Instead, you will be using the pen merely as a smaller vial. The pen has a rubber tip, just like a vial, but instead of attaching the pen needle that humans use, you will still use your u-100 insulin syringes and draw the insulin out. Just like you do with the vial. I understand, though. Our first vet we had at the time of diagnosis refused to prescribe the pens because one owner had used them as intended at some point and had horrible results (shocking.). No matter what I said, she refused. When Willie went to a specialty clinic, I got them to prescribe it, but it was pulling teeth (didn't help that the pharm tech they talked to at Costco had NO idea what she was talking about and gave them incorrect information). Thankfully, I was there for a consult with a different vet and brought my insulin... sat down with the internal medicine vet tech, showed her the pen, how I used it, etc. She was SO excited and said she would report back to the vet that it was exactly as I had said and that they would be switching over to the pens for their patients.

Since getting a new vet isn't an option, maybe you could ask for the pen prescription, see if you can find a place that will fill just one (because you are in a remote area, I would try the outpatient pharmacy at your local hospital), and offer to bring it to the vet for examination before you use it. If she doesn't agree, tell her that you will return the pens and stick to the vials. I think once she saw how it was being used identical to the vial, she'd be okay with it?

I hope you'll stop by over in Lantus Land. There is a ton of information there, as well as daily threads (or condos as we call them) that allow you a glimpse into how we all get by. This form has been literally a lifesaver for us. I look forward to learning more about you and Fie soon!
 
Angie, tell your vet to do the math.... calculate how many shots you will get from a bottle, at the low dose you are giving, subtract the 28 days from the calculation and then ask your vet for a reason why you should pay for waste.

Unless of course your vet is willing to pay for your insulin?..... I didn't think so.
what's the big deal with using pens or cartridges? It's the same insulin, just in a diff container, and less waste for you!

Give your vet a printout of the info on Lantus.....


Lantus efficacy


Storage

Unopened Vial/Cartridge system/SoloStar® disposable insulin device
Unopened LANTUS vials, cartridge systems and SoloStar® should be stored in a refrigerator, 36°F - 46°F (2°C - 8°C). LANTUS should not be stored in the freezer and it should not be allowed to freeze. Discard if it has been frozen.

Open (In-Use) Vial
Opened vials, whether or not refrigerated, must be used within 28 days after the first use. They must be discarded if not used within 28 days. If refrigeration is not possible, the open vial can be kept unrefrigerated for up to 28 days away from direct heat and light, as long as the temperature is not greater than 86°F (30°C). Open (In-Use) Cartridge system:

The opened (in-use) cartridge system in OptiClik® should NOT be refrigerated but should be kept at room temperature (below 86°F [30°C]) away from direct heat and light. The opened (in- use) cartridge system in OptiClik® kept at room temperature must be discarded after 28 days. Do not store OptiClik® , with or without cartridge system, in a refrigerator at any time.

Open (In-Use) SoloStar® disposable insulin device
The opened (in-use) SoloStar® should NOT be refrigerated but should be kept at room temperature (below 86°F [30°C]) away from direct heat and light. The opened (in-use) SoloStar ® kept at room temperature must be discarded after 28 days.

LANTUS should not be stored in the freezer and it should not be allowed to freeze. Discard if it has been frozen.

These storage conditions are summarized in the following table:

Not in-use
(unopened)
Refrigerated Not in-use
(unopened)
Room Temperature In-use
(opened)
(See Temperature Below)
10 mL Vial Until expiration date 28 days 28 daysRefrigerated or room temperature
3 mL Cartridge system Until expiration date 28 days 28 daysRefrigerated or room temperature
3 mL Cartridge system inserted into OptiClik® 28 daysRoom temperature only (Do not refrigerate)
3 mL SoloStar® disposable insulin device Until expiration date 28 days 28 daysRoom temperature only (Do not refrigerate)
 
you may be very surprised at just how long lantus will last based on a survey taken amongst lantus users on the German-Katzen Forum.
please take the time to read through this topic discussed on the Think Tank Forum: Disscussion: how long does Lantus/Levemir last once opened.

from the STICKY: LANTUS & LEVEMIR - INFO, PROPER HANDLING, & STORAGE:

HOW DO YOU KNOW WHEN YOUR INSULIN IS NO LONGER GOOD?

  • When you lose regulation for no reason.
  • If you see any hint of "floaties"/"tiny particles"... discard the insulin.
  • If insulin is cloudy or discolored, or if rubber stopper is cracked... replace insulin immediately.
  • The manufacturer of Lantus recommends discarding the insulin after 28 days of use.
    However, many Lantus users have been able to use a vial/cartridge/pen for as long as six months.
  • The manufacturer of Levemir recommends discarding the insulin after 42 days of use.
    Many Levemir users have been able to use a vial/pen for six months. However, many Levemir FlexPen users do toss the pen when the insulin gets down to about the "12" mark on the FlexPen.

this 28 day lantus myth deserves to be debunked! :lol:
if handled properly and kept refrigerated, lantus will last quite a bit longer than 28 days...
 
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