NEW MEMBER- Stella G

Hey All,


My Stella was diagnosed in December 2023 and we have been struggling to get any sort of consistency with her numbers. Stella is a 13-year-old gal, who I took to the vet after she started peeing on everything. They did a blood/urine test (no ketones in pee) and she had a diagnosis of diabetes. She is eating various weruva wet foods and is fed twice a day before insulin (if it's being given)


At the onset of her diagnosis, we started on 1 unit of Lantus twice a day. We weren't seeing her numbers come down much, so they upped her dose to 2 units twice daily. We still weren't seeing her numbers decrease much, so they upped her dose to 3 units twice daily. At this point, I shaved a patch of fur on her so that I could more accurately administer her shots, as what I think was happening is that her numbers would sky rocket (or plummet) depending on if I had actually given her the shot or not... For the last 2 weeks, we have been in the cycle of 3 units at night, and then her BG being too low in the AM (like readings of 3-5) so that we would skip the morning shot. The vet has asked me to run a blood glucose curve starting in the morning, but I'm unsure why if she doesn't have insulin in the morning (and I will not be staying up all night to do the curve over night...) After having a frustrating convo with the receptionist today, I'm wondering what to do. It's clear that this dose is not working and the vet is not willing to say we should change the dosage until we run a blood glucose curve. I personally don't see the point in doing the blood glucose before we are on 2 times a day insulin schedule. Am I wrong in that? Don't her numbers (below) show that the dose is too high? Here are examples of her numbers over the last little while we started giving the insulin more accurately on her shaved spot:


Feb 22: AM- 8.9 PM- 20.5

Feb 23: Am- 3.7 PM- 22.6

Feb 24: Am- 4.6 PM- 20.1

Feb 25: AM- 7.3 PM- 22.0

Feb 26: AM- 4.2 PM- 24.6

Feb 27: AM- 6.8 PM- 17.3

Feb 28: AM- 8.9 PM: 23.7

March 1 AM- 8.6 PM- 21.1

March 2 AM- 8.8 PM- 16.0


As per the vet, when her number is lower than 12, we have been skipping insulin.


What are your thoughts?


Thanks in advance for any and all help!

 

Hi Witney and Stella and welcome to the forum.
You have a great insulin in Lantus and are feeding a low carb food which is great.
I am assuming you are hometesting the BGs your self…which is great!
Can you tell me what type of meter you are using…a human or pet meter?

In relation to the dose of insulin….the dose is too high.
Are you getting any tests in during the cycles to see how low the dose is taking Stella?
Lantus dosing is based on the nadir or lowest point in the cycle…not the preshot BG.
You need to reduce the dose to where you can shoot both cycles.
I would reduce the dose back to 1.5units each cycle and see if the BGs are high enough for you to shoot both cycles.
So at the next high enough preshot go back to 1.5 units and to stay there unless the BG drops under 5. If it drops under 5, the dose is too high and you need to reduce the dose by 0.25 units.
There is no point in doing a curve if no insulin is given.
What is needed at the moment is…
*Test before every preshot BG
*Get at least 2 tests in during all the cycles to see how low the dose is taking Stella. I would suggest a +3 and a +6 and another day +2 and +5. Don’t forget the pm cycle as well.

We have a spreadsheet where you can put all your data and we can then help you with dosing. Many vets have no idea about dosing with feline diabetes to be honest. We get so many cats here who need help with dosing.
HELP US HELP YOU has the link to the spreadsheet and the signature which is the small writing you see at the bottom of everyone’s posts. It tells us about Stella and everyone who help s you with dosing or other things will read the signature and spreadsheet. Have a look at the bottom of mine for both. If you have trouble with the SS I will get someone to help you with it.

Once you get the SS set up we can help you with the dosing. Please keep posting. We are here 24/7 and are very happy to help you and Stella.
Bron

 

Feeding food only twice a day is old school.
We all feed our cats the bigger meals after you test first thing in the AM ,then small snacks about 2 teaspoons @+2 ( 2 hours after giving insulin) , then again @+4
Same goes for the PM cycle. Of course if the numbers are to low and need to bring her BG up you would have to feed more often

 

We are using a Contour next EZ human meter to test her before each shot.

When I purchased the Lantus from a human pharmacy, it came preloaded in a pen. The needle tips are very small (which is why I think I am the culprit for operator error on administering the insulin to her) and the pen itself only administers doses by the unit. Is there a way to buy different syringes that I can load from the pen? Or will I need to buy new insulin?

It can be a challenge for me to get those in-between BG readings, but coming into the weekend here I will definitely do that (and get the spreadsheet set up!)

That is the same issue I have with giving her snacks- does anyone have any suggestions on how to do that when I am out of the house? Is it ok to just leave the weruva wet food out for her all day?

Thank you so much for the responses!

Whitney (And Stella!)

 

HI Whitney
You can still use the pen but with the correct needles. what you need to go out and buy is
U 100, 3/10 ml, 30 or 31 gauge, 6 or 8 mm insulin syringes with 1/2 unit markings. Make sure they have the 1/2 unit markings and are the 3/10 ml ones.
You may have to shop around to get the correct ones.

Most of us use an automatic timed feeder to feed our kitties when we are not there. Petsafe has some good ones. If the food is not to be eaten for several hours you could freeze some of it or get a feeder that has an ice pack under it.

Now how to draw the insulin out of the pen.. Make sure you keep the insulin in the fridge.

 

I left wet food out during the day for my boy and it worked well for us.

 

Where do you live? We can tell you where you can buy the syringes

 

We live in alberta Canada (alberta). Any ideas where I can buy those syringes would be greatly appreciated!
I have ordered a timed feeder to help us with that piece.
I dropped her down to 1 unit of insulin today since 2 seemed to drop her too low still. I know I need to get those syringes so I can give a partial dose (not full unit), so any advice on where to find those in alberta is greatly appreciated!
Thanks so much!

 

I found this posted by a member about U-100 syringes with half unit markings from Canada
Check out your local pharmacy for the BD Ultrafine II syringes (purple and yellow box). Those are U100 syringes. If you have a Costco near you, check them out. Or Safeway pharmacy

 

Hi Whitney! And Stella! a wave from Calgary!!!!
Most vet offices carry the 3/10 syringes, sold in box of 100. My first batch was from them @ $46 a box. They were the EliMedical brand, also 1/2 unit markings.
If you are near a London Drugs, they carry the BD brand Diane posted above, sold in box of 100 (also around $40) or in 10 paks for about $5.00.
Also Costco, and I've heard at a much better price, (I dont have a costco card or friend that does, so I have not checked their pricing. )
Possibly the Safeway pharmacy?? I checked at Save On Foods (nope), Co-op (nope) and Superstore (nope), also no at Shoppers Drug Mart
Online is also possible to find better prices, just make sure you get the correct ones

 

I'm tagging @Wendy&Neko -- she's one of our moderators and is in Canada (BC). She may have recommendations re. supplies. (Although, Melinda posted after I started typing with help regarding syringes.)

One observation based on Stella's spreadsheet (SS). We encourage caregivers to get at least 4 tests each day. You want to get a pre-shot test and at least one test during both the AM and the PM cycles. Lantus dosing is based on the lowest number in the cycle (the nadir) which is typically somewhere in the neighborhood of +6 but this can vary. This is why getting a mid-cycle test like you did today is so important. That said, you don't need to wake up in the middle of the night to get a test (unless you really want to). But we do suggest getting a test before you go to bed so you know that your kitty is in safe numbers.

It looks like you've been skipping shots at PMPS. We use a lower value than what your vet is suggesting as an initial "no shot" number. What that number is depends on whether you choose to use either the Tight Regulation Protocol or the Start Low Go Slow method for dosing. This is a link to information on Lantus dosing methods. It's also fine to have reduced the dose so you are able to give insulin twice a day and not have to skip.

 

Waving from the BC coast.

My knowledge of what pharmacy has which syringes is a little old now and is BC. But I found best pricing for those BD syringes by far in Safeway pharmacy. At the time, they were about $5 cheaper than Save on Foods, where I used to get them. Also check on line. I see you can even get them through Door Dash. But there are online pharmacies, some specializing in diabetic supplies too. We've even had members shop for supplies, syringes and blood glucose test strips, on eBay for good prices.

 

Thanks so much for the advice! I have gotten some of the syringes with half units so I can start using those! I've been trying to get a few more tests in there over the last few days. That being said, if you look at our spreadsheet, you will see her numbers are all over the place..... I'm feeling very discouraged. Does anyone have any thoughts?

I just read over the Lantus Dosing Methods more carefully. Is 5 the number I should be using to see if we should skip a dose? Do you think I should up her dose to 2.5 based on how her numbers have been recently? 3 seemed to drop her too low before I started her spreadsheet, but as I said, she seems all over the place this week. I am going to do a curve for her this weekend (it's tricky during the week for me- I'm a teacher and there's no way I can pop home during the day.) I've been leaving her food out for her 24/7 but she doesn't seem to be eating it outside of her bigger meals when I open a fresh can for her before her insulin (picky girl...)

Thanks in advance for any and all help.

 

First of all, the majority of people here are from the US, so they know mg/dL numbers. You'll find you get more help if you talk in those numbers. Obviously we have people from around the world, but we've learned to become bilingual. If you are following Start Low Go Slow, then 90 (5.0) is indeed a skip number. And it'll help us help you if you put SLGS in your signature.

By the way "numbers all over the place" has to be the most common phrase used here for recently diagnosed cat. Small note, might want to change the diagnosed date on the signature to 2022.

Per SLGS, you hold the dose for 7 days, then do a curve and evaluate how it's doing. If you are seeing nadirs in the 90-149 range, which you are, you stay with that dose.