New member, new diagnosis, dosage question (sanity check)

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ComfreyMyCat

ComfreyMyCat

Member Since 2021
Hey everyone - I'm so glad I found my way here!

First please let me say that Comfrey and I will follow vet advice. But we were diagnosed in the ER (Tuesday, August 24) and there was a mistake with the initial Rx and we can't see his regular vet until late September. I'm looking for a "sanity check" to see if I should call the ER a fourth time about this.

Important patient stats:
  • current weight: 5.5 kg
  • ideal weight: 5.75 kg
  • blood glucose (measured in the labs): 467 mg/dL
  • negative for ketones in urine
  • urine very dilute (he was camping his water in the usual way that untreated/undiagnosed diabetics do)
Initial RX:
  • Lantus (glargine)
  • 1 unit 2x/day
Mistake:
  • Was given U40 syringes - reading online I learned about U40 vs U100 and that glargine is a U100 insulin
I called the pharmacy at the ER and they confirmed that glargine should be administered with U100 syringes. When I went in to swap the original U40 box for a U100 box, they said that "the dose is the same" (per conversation with the Dr.) I asked, "do you mean that the amount of insulin shouldn't change, so we're giving 2.5 units per dose, or that the nominal dosage of 1 unit is the same?"

The pharm techs looked (blankly) at each other. Then one of them said, "It's still 1 unit / dose."

The math doesn't add up for me. I read the guidelines for initial dosing to be .50 / kg for blood glucose > 367 (my cat's situation) which would be 2.5 U (exactly the insulin he was getting with the U40's, although the nominal unit was 1 U with those) and .25 / kg for blood glucose < 367 (not his case, but still this would be 1.25 U with the correct U100 syringes and is still more than the 1U they've "corrected" the dose to).

Final note: I've also read that regardless of cat's size, the initial dose should be no more than 2U.

Can someone please provide a "sanity check" around the "new" dosage? Of course I'm afraid of too much and a hypoglycemic episode. I'm also afraid of under-medicating him, especially given that there is still some hope of remission with early treatment (or so I've read). I'd really like to know if the dose "sounds about right" and I'm just missing something or what's going on.

FYI: I'm looking around at BG monitors and will begin that soon as well. I just need a confirmation of sorts in the meantime.

Thank you in advance!
 
Cats here typically start on a dose of around 1 unit of Lantus, given in U-100 syringes. The starting formula can be based on cat weight, or on type of food being fed, depending which dosing method is being followed. The guidelines you quote are now what we use here. What food are you feeding Comfrey now?
 
Thanks for the reply. I found in the guidelines referenced here (https://www.felinediabetes.com/AAHADiabetesGuidelines.pdf) after posting. My initial confusion was based on this (https://www.aaha.org/globalassets/02-guidelines/diabetes/diabetes-guidelines_final.pdf - chart on page 5). It sounds based on threads I'm reading here that conservative dosage makes a lot more sense up front. I appreciate the sanity check.

Food: I left the ER with some cans of W/D and a bag of dry W/D (I returned this when I returned the wrong syringes). I was appalled that the 5th and 6th ingredients were wheat flour and corn starch in the wet. Unfortunately, I'm realizing now that his "old food" (still new to us - I was just trying to get him to eat at all) was also ~20% carb (various wet Meow Mix foods). I'm familiar with the google sheets from Dr. Pearson via catinfo.org. I'm thinking to go to the PetSmart where they have single cans of everything to find him some low/no carb foods to sample. I have a sampler pack of Tiki Cat coming today as well. I've read the caution about changing diet AND administering insulin so I also need to begin monitoring. I'm still trying to read through posts here about that, which brings me to...

Glucometer: I have a keto mojo that I bought for myself and never used (until testing it on myself yesterday to familiarize myself with testing in general). I can afford a pet-specific one but am reading mixed reviews. I have in mind to maybe start testing ASAP with the keto mojo, understanding that it will read low, while I wait to get a pet-calibrated one for him. The Alphatrak2 seems like a favorite, but I read that it turns off after two minutes. I'm worried that as newbies, Comfrey and I might need more time.

I'm reading through all the posts here and trying to self-serve so much as possible. I'll gladly take any tips/cautions/etc. in the meantime. Thank you!
 
Anything under 10% carb food is good for diabetics. It doesn't mean that 0 percent is better than 9%. Some cats do better with a bit of carbs, so something in middle of that range would be fine. While you are shopping for food, you might want to pick up something in the 15-20% for higher carb food, in case he goes low. You have the even higher carb, but that might be too much, though OK at first. Cats differ in how carb sensitive they are, and you'll have to learn what that means for Comfrey.

Here is the note describing the dosing methods we use for Lantus here:
Dosing Methods: Start Low, Go Slow (SLGS) & Tight Regulation (TR)

As for meter, most of us use human meters. The AT test strips are incredibly expensive, and you'll go through them. So pick a meter with a relatively small blood drop requirement, and cheap test strips that are easy to pick up if you need them. Plus our dosing methods are based on human meters. They were developed a while ago and the AT is a relatively newly marketed meter. AT test strips are also not readily available at your local store. If in the US, many people pick up a Relion meter at Walmart.
 
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