New member - Start insulin with BG of 235?

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Lynn & Mikey

Lynn & Mikey

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Hello! My cat Mikey was diagnosed with diabetes after his vet visit on September 16th. His bloodwork came back with a glucose level of 542, and his urine glucose was also very high. I immediately put him on canned, low-carb food. He quickly went back to peeing a normal amount. (He had recently been having a large amount of urine, and has gained a couple pounds in the last year.)

I purchased an AlphaTrak3 testing kit, and did several readings over the course of a day. He was mostly around 300, with a high of 350 and low of 285. My vet prescribed Lantus for Mikey. I haven't picked it up from the pharmacy yet, but ran a test this morning that came back 235! I'm thrilled with this progress! He is doing well otherwise: he is active and has a good appetite.

Would you start a cat on insulin with this reading, or expect him to go into remission staying on wet, low-carb food?
 
You are doing everything right. Would you please set up a spreadsheet and plug in whatever readings you have? I’ll link directions but if you need help we have people who can set you up. In tge meantime get a test in 3 hours after eating. If the pancreas is sputtering some food will bring down the bg in 3-4 hours. Normal bg for a cat that’s not diabetic would be between 50-100.
 
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Thanks! I've set up the spreadsheet and plugged in what I have so far. I tested again around 1, and got 262. Maybe I was being a bit too optimistic?
 
Thanks for setting up the spreadsheet. Now we need a little more information about Mikey in your signature. Since you are using an AT, add that. How old is he? Did the vet find ketones in his urine at diagnosis? Does he have any other health issues? Is he on any medication ? Was a fructosamine run at diagnosis? Has he had any steroids recently either oral or in ear medication?
It’s really good that bg has come down and it sounds like this was caught early. I am sure the food change is helping but maybe not quite enough.
 
Mikey is 9. No ketones, no medication, fructosamine was not run. Last year he had urinary issues. It was due to stress (adjusting to new kitten; they are pals now) not crystals, but my regular and emergency vets recommended prescription food. So, he had been on hill's c/d diet for a while. I had unfortunately gradually shifted to more dry food than wet over time, since he was getting bored with the c/d canned. It's upsetting that a prescription diet for one condition causes another one.
 
Max blocked when he was about 5 and was on CD as well. He preferred dry food too. He was in it way too long and when he developed chronic pancreatitis my vet told me to switch to any canned food. I’d never had a diabetic cat and he preferred foods that were in pieces and with gravy. Eventually he became diabetic and amazingly he was easy to switch to lc food but the damage was done. There’s no benefit to RX food I have learned. Quality canned, eaw or home cooked food is far better.

How is Mickey’s weight? Is he overweight or ideal weight. That will help determine a starting dose of insulin. He’s a great candidate for becoming food controlled. We use two methods for insulin here and since you already switched to lc canned food you can choose either one. I’d go for TR as it might get him controlled really quickly. Have a look at the sticky on dosing. I think you could give the food trial a little longer to see if he gets into normal range.
https://felinediabetes.com/FDMB/thr...-low-go-slow-slgs-tight-regulation-tr.210110/

What are you feeding Mickey now?
 
It's really sad that this terrible food is causing so much harm. Mikey is just under 16 pounds. Last year he was 14, and the vet recommended getting him down to 12.
 
Lynn & Mikey said:
It's really sad that this terrible food is causing so much harm. Mikey is just under 16 pounds. Last year he was 14, and the vet recommended getting him down to 12.
Click to expand...

That’s what happened to Max. Exactly. The food caused him to become overweight.
 
I'll take another look at the dosing sticky. My vet wanted to start him at 2 units, but I was leaning toward starting low. So, she agreed that starting with 1 unit would be fine.

Do you think giving it until Saturday would be okay? If he does need insulin, I want to start when I'm around to monitor him closely.
 
We dose based upon the ideal weight if following TR. Max started on 1 unit and if choose TR that’s what I would do. With SLGS you would start with .50. With the recent food change I would not start with 2 units.
How’s Mikey acting? Notice any changes for the better since the food change? Less urination, playing more etc?
 
Yes, his urination went back to normal within a couple days of the diet change. He's also had way less interest in drinking from the faucet, which he had started doing often. He has been playful, but it's hard to say if it's more than before.

If I get the Lantus pen, would it be easy to transfer to a syringe to adjust the dose? The vet wrote prescriptions for both, but after talking to a pharmacist, it sounds like the pen will be easier to get.
 
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Also, looking at the Q4 about not dosing below 150, and what to do if it's between 150-200. I know these numbers are using a human glucometer. How do these translate to the AT meter?
 
Get a pen. We use the with syringes just like a vial and you will be able to use to the last drop. Did he tell you to get U 100 syringes with half unit markings? With the changes you are already seeing I might be inclined to give the diet change a little longer. You will need to gave various types if food, middle carb and high carb in addition to your lc. Low carb is under 10%, mc 10-15, and hc anything over. You will also need karo or honey in case the bg drops too low to bring it up quickly.

You do want to be home for the first few doses and since his bg is not super high I would wait to be home. Maybe the diet change will work more magic. You will want to ideally give the insulin at least one hour and two hours even better before you go to work. Lantus is a depot insulin so it will take 5-7 days to see if the starting dose is a good one. Sone cats react strongly to the first dose.
 
Most vets do not have the U-100 syringes with the half unit markings, I'll give you a link where you can buy them without a vets prescription below.
We increase or decrease by 0.25 units at a time even though these do not have 1/4 increments they are easier to do that

You need the ones in the left
  • Full and half-unit syringe scales:
49823063143_3437e9e997_o.jpg

  • Don't reuse syringes. You'll not only run the risk of contaminating the vial/cartridge/pen, but re-using a syringe may be very uncomfortable for your cat:

You can order the U-100 syringes with half unit markings from Amazon without a doctors script
https://www.amazon.com/UltiCare-31-Gauge-Veterinary-Insulin-Syringes/dp/B009LTE0DO


We just eyeball when we need to increase or decrease by 0.25 units


Have a hypo kit ready if needed
Med and High Carb food and have honey in your house



Fancy Feast Gravy Lovers Gourmet Beef Feast in Gravy 20% High Carbs

Fancy Feast Gravy Lovers Gourmet Chicken Feast in Gravy 15% Med Carbs

Fancy Feast Gravy Lovers Turkey Feast in Gravy 15% Med Carbs

Fancy Feast Gravy Lovers Chicken and Beef in Gravy 15% Med Carbs

Good idea to mark the cans with magic marker how many carbs

Or any on the food chart. Doesn't have to be Fancy Feast just an example about the med and high carb foods



https://felinediabetes.com/FDMB/threads/dr-pierson-new-food-

10% and under is low carb
11% -15 is medium carbs.

16- 24 is high carb.
 
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Lynn & Mikey said:
Also, looking at the Q4 about not dosing below 150, and what to do if it's between 150-200. I know these numbers are using a human glucometer. How do these translate to the AT meter?
Click to expand...

The AT reads a little lower but it only matters if the bg falls low as dosing is based upon how low a dose takes a cat. So initially the no shot number is the same whether you use the AT or a human meter and it also is the same regardless of which method you use. The preshot number lets you know if safe to shoot. As you see how your cat reacts you would gradually lower that number. The dose is too high if the bg falls under 68 if following TR and 90 if following SLGS. Beyond that you can’t compare the AT and human meters. The results are closer when reading high or low.
 
That is good to know about the pen! I wasn't sure how that worked. Are the mid-high carb foods given for bg lower than 90, and the syrup for super low numbers?
 
Diane Tyler's Mom GA said:
Most vets do not have the U-100 syringes with the half unit markings, I'll give you a link where you can buy them without a vets prescription below.
We increase or decrease by 0.25 units at a time even though these do not have 1/4 increments they are easier to do that

You need the ones in the left
  • Full and half-unit syringe scales:
49823063143_3437e9e997_o.jpg

  • Don't reuse syringes. You'll not only run the risk of contaminating the vial/cartridge/pen, but re-using a syringe may be very uncomfortable for your cat:

You can order the U-100 syringes with half unit markings from Amazon without a doctors script
https://www.amazon.com/UltiCare-31-Gauge-Veterinary-Insulin-Syringes/dp/B009LTE0DO


We just eyeball when we need to increase or decrease by 0.25 units


Have a hypo kit ready if needed
Med and High Carb food and have honey in your house



Fancy Feast Gravy Lovers Gourmet Beef Feast in Gravy 20% High Carbs

Fancy Feast Gravy Lovers Gourmet Chicken Feast in Gravy 15% Med Carbs

Fancy Feast Gravy Lovers Turkey Feast in Gravy 15% Med Carbs

Fancy Feast Gravy Lovers Chicken and Beef in Gravy 15% Med Carbs

Good idea to mark the cans with magic marker how many carbs

Or any on the food chart. Doesn't have to be Fancy Feast just an example about the med and high carb foods



https://felinediabetes.com/FDMB/threads/dr-pierson-new-food-

10% and under is low carb
11% -15 is medium carbs.

16- 24 is high carb.
Click to expand...
Thank you for the link! My vet prescribed some syringes, but I'm not sure if they have the half-unit marks.
 
Diane Tyler's Mom GA said:
@tiffmaxee
Can you tell Lynn about when to feed med or high carb food please :cat:
@Lynn & Mikey I tagged Elise for you about this :cat:
Click to expand...

You would reserve hc or syrup for when the bg falls under 68. When you feed mc will depend upon when it is in the cycle and which method you follow. It also depends upon how carb sensitive Mikey is which you will learn by trial and error.

What food are you currently feeding him?
 
I've been feeding mostly the Friskies and Fancy Feast low carb options, with some Wellness Complete Health and Core to mix things up. I picked up a couple cans of Blue Wilderness, so I'll see how the cats like those.. also got a couple cans of the FF med and high carbs.

Mikey just tested 335. I think I got too excited seeing a lower number this morning.
 
I think you do need to start insulin when you can monitor which I think means Saturday. Thank you for getting set up and buying all the needed supplies. I’d get one more test tonight 2-3 hours after dinner. How often are you feeding him? Cats often have a lower bg at night so it will be worth seeing the extra night test. How many other cats do you have?
 
My cats are more grazers than meal eaters. I fed them around 7, and there is still food left. I have one other cat. Mikey usually eats at least a bit, usually more, when I put the food down though. I'm a bit concerned about him eating enough to give insulin at set times though.. I will get another test tonight. I haven't done any past around 10 so far. Would it be helpful to put the times of the tests in his spreadsheet, or would that not work? I have them written in a notebook.
 
Lantus doesn’t onset for most cats until two hours after injecting so no need to worry about not eating enough at shot time. Grazing is fine. I fed several small meals rather than a lot at once. You just want to make sure he’s willing to eat before you give insulin.

We are from all over the world here so we use +# to show how many hours after testing. For example, I gave Max insulin at 6 a.m. and 6 p.m. so +2 would be 8 :00. Are you in the US?
 
tiffmaxee said:
Lantus doesn’t onset for most cats until two hours after injecting so no need to worry about not eating enough at shot time. Grazing is fine. I fed several small meals rather than a lot at once. You just want to make sure he’s willing to eat before you give insulin.

We are from all over the world here so we use +# to show how many hours after testing. For example, I gave Max insulin at 6 a.m. and 6 p.m. so +2 would be 8 :00. Are you in the US?
Click to expand...
That is a huge relief. Thanks so much for all the guidance! It has been overwhelming. Yesterday I realized at 4:30pm that I hadn't eaten anything since breakfast because I was on my laptop reading about cat diabetes all day.

I am in the US. My tests have not been at consistent times, since we haven't started the insulin yet. I will be giving the shots at 6-6:30, so I will adjust Mikey's spreadsheet to reflect that. His low test yesterday was at 9:30am. At midnight he was at 309. We had a test fail this morning.. I'm getting the hang of it, but not to the point where it's easy every time yet. I'm thinking I will give Mikey a break from testing for a bit.. maybe a couple spot checks during the week.
 
Once you start insulin you will test at AMPS and PMPS. then random tests are actually the way to go. A +2 will often be a clue into how the rest of the cycle will go. Are you giving a treat after each poke? It’s a good idea. Your plan for testing this week is perfect. Looks like you might be on the west coast. Me too.

Freeze dried 100% protein treats are what most use for treats.
 
Yes, I'm giving treats before and after. Mikey comes up while I'm getting the supplies ready. The difficult part comes after the poke, when he's trying to get away and I'm trying to grab the device quickly. I started using a headlamp to see his little black ears better. I'm in Michigan, so on eastern time.

I'll pick up some freeze dried treats. I give him one or two greenies dental treats a day, and some wellness kittles - I know these probably are not low carb. The kittles are tiny though, and the cats love them. I hope it's okay to give them sparingly. I was also thinking of getting some Wellness core dry food to give as treats. My younger cat was also eating the cd dry and I've mostly weaned her off of it.. just a few pieces a day now for her.

I was cleaning out the cabinet where I keep their food and wand toys today, so they got in lots of playtime. The kitten, Willow, is about a year and 8 months old now. It's really cute to see them play together and chase each other. :cat:
 
I had totally overlooked treats. I decided not to get the lc dry food to give as treats. My cats don't need it.

Very strange day.. Mikey tested 575 (!!) this morning, then 208 just now. 208 is the lowest number he's had so far. He has been super hungry the past two mornings.
 
Lynn & Mikey said:
I had totally overlooked treats. I decided not to get the lc dry food to give as treats. My cats don't need it.

Very strange day.. Mikey tested 575 (!!) this morning, then 208 just now. 208 is the lowest number he's had so far. He has been super hungry the past two mornings.
Click to expand...
@tiffmaxee


Looking at Mikey's spreadsheet and those numbers it looks like she didn't start the Lantus yet since that what her signature says
 
That's correct. I haven't started Lantus yet. I'm planning to start Sunday morning, since I will be home Sunday and Monday to monitor Mikey.

The 208 is on the spreadsheet yesterday at the +10 spot, since it was about 5:30pm. This morning he was at 474, and was not eating fast like the past 2 mornings. Is it normal for bg to be higher (relatively, I know these numbers are way too high!) in the morning? I would have expected the opposite.
 
Lynn & Mikey said:
That's correct. I haven't started Lantus yet. I'm planning to start Sunday morning, since I will be home Sunday and Monday to monitor Mikey.

The 208 is on the spreadsheet yesterday at the +10 spot, since it was about 5:30pm. This morning he was at 474, and was not eating fast like the past 2 mornings. Is it normal for bg to be higher (relatively, I know these numbers are way too high!) in the morning? I would have expected the opposite.
Click to expand...
@tiffmaxee
 
Cats bg often is lower at night and higher in the morning. I know you were waiting to start insulin when you could monitor. Are you planning to start tomorrow? Use the freeze dried treats as long as 100% protein. Have a look at both methods and let us know which you intend to follow. TR requires 2 tests minimum each cycle and if possible a few more. It can be done with a full time job. It gives the best chance at remission but cats do go into remission on SLGS though.
 
I have Sunday and Monday off, so I'm planning to start Sunday morning. I will go with the TR method and start with 1 unit.

I have a long day on Wednesday, since I have a class after work. It seems like the options will be skip the dose or skip the class. Should I see how the first three days go and then decide? I have a couple friends who are very good with cats and could probably learn the testing and injection routine, but not this early into it.

Just had our first test in the blue range: 192 at 6pm!

Should I start a new thread for any questions after starting insulin?
 
Lynn & Mikey said:
I have Sunday and Monday off, so I'm planning to start Sunday morning. I will go with the TR method and start with 1 unit.

I have a long day on Wednesday, since I have a class after work. It seems like the options will be skip the dose or skip the class. Should I see how the first three days go and then decide? I have a couple friends who are very good with cats and could probably learn the testing and injection routine, but not this early into it.

Just had our first test in the blue range: 192 at 6pm!

Should I start a new thread for any questions after starting insulin?
Click to expand...
@tiffmaxee
@Bron and Sheba (GA)
 
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Lynn & Mikey said:
Should I start a new thread for any questions after starting insulin?
Click to expand...
@Lynn & Mikey

If you start insulin on Sunday start a new post and link this post to it in case members need to go back to it and read something

You can put in your title the
Date ,Mikey, AMPS BG number and any additional tests after that, and continue with his PMPS BG and any additional tests after that

To do that look to the right tap on Thread Tools then tap on Edit Title and add the additional tests then tap save

To link your previous posts
Your previous days post will always be in the URL all the way up top ignore where it says insert or cancel I'm just trying to show you where your previous days post will be
Just ignore where it says insert and cancel
Just copy your previous days post and then paste it when you do your new post





Like I said
your previous days post it will be the one all the way up top, above the pic of that cat and the picture of a bottle of insulin there, let me know if you understand it






austin-logo-240.jpg

So if you start posting on the Lantus Forum today you will copy and paste your post ( We made a mistake) to today's post

I hope you understand
 
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