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Joe and Jinx

Joe and Jinx

Member Since 2012
Hi everyone, my name is Joe and I'm new to this board. I have an 11 year old Siamese named Jinx who was recently diagnosed with diabetes. His blood glucose level was initially over 500 mg/dL so my vet initially recommended 4 units of Glargine twice a day. During a glucose curve at the vets, his level at the nadir was 67 mg/dL. So my vet changed the dosage to 2 units twice a day. That was about five days ago. Today I performed the glucose curve at home and the initial reading before his insulin shot was 418 mg/dL, 4 hours later it was 394 mg/dL, and 8 hours after his insulin it was at 352 mg/dL. I was instructed to take another reading before his next insulin shot. I'm going to talk to my vet tomorrow to get a recommendation on a change in dosage. Based on some initial reading, his dosage needs to be increased. I'm wondering what everyone's opinion is as to how much and how long he should be on that for, before the next curve is performed. My concern is that the vet will recommend going up to 3 units twice a day. It seems to me that the smart option would be to take it slow and go about to 2.5 units twice a day. I'd really appreciate thoughts on this. Thank-you.
 
Hi Joe and welcome to the group.

Actually, the mantra on this board is to start low and go slow. Meaning, start at a low dose of 1 unit or less and after several days and tests adjust the dose as needed by 1/2 units at a time.

I would suggest that you start over at 1 unit and do home testing. Why, because by starting at 2 or even 4 or 3 units you may have missed the ideal dose and could create bouncing and what is known as SOMOGYI: This is a term to describe the process in which the body reacts to low blood sugar or a rapid drop in blood sugar. When the body perceives a fast or low drop in glucose, it protects itself by releasing natural glucagons which raise the blood sugar. When this occurs, we call it somogyi or somogyi rebound, and this rebound or high blood glucose can last up to 72 hours. Treatment is to decrease the insulin dosage by 25-50%.

You are using a very good insulin, please go to the Lantus Tight regulation page to learn more about your insulin: viewforum.php?f=9

It's great that you are home testing, and know how to give insulin, the third piece of this puzzle is Feline Nutrition:

Now, as far as diet - definitely dump the dry food (if you are feeding any) and if the vet recommends purchasing prescription food like DM just say "no thank you". ALL cats, and especially those with diabetes, do best on a species appropriate diet that is high in protein and low in carbs. Dry food DOES NOT fit that bill and DM food, even canned, just really isn't that great as far as quality. Most here on FDMB feed low carb/high protein canned, raw bought from a pet store or they make there own.

Here great links, one is to a food chart put together by one of our board members that breaks down the carb % and protein % of most of the commercial brand foods. You want to keep the carb % below 10% and around 7% is great. The other link is to a site by a vet "Dr. Lisa DVM" ... who also posts on this board from time to time ... there is in-depth info. there about many things, including nutrition and how to make raw food.
Nutrition/food info

The good thing with feeding your diabetic cat this way, is that it is ALSO good for any non-diabetic cat too. All your cats can safely eat the same food without worry and it may save you some costs and headaches of having to do separate feedings and keeping track of what they are eating.

Also, if you create a spreadsheet, here are the instructions, and attach it to your signature, it will make it very easy for everyone to follow and provide you with guidance. viewtopic.php?f=6&t=18207

Others will be along with more details and be better able to explain why you want to start over with the insulin dose.
 
Hillary,

Thank-you very much for the advice. Just a couple follow up questions...

-He's been on 2 units twice a day for over five days now. Do you still recommend starting over at 1?

-He's been on dry food his entire life but once I found out he had diabetes, I weened him off the dry and he is now eating Science Diet/Hills m/d feline formula (vet recommended). Do you still advise against this brand?


Again, thank-you very much for the advice. I really appreciate it.



Joe
 
Joe, you can give your cat canned food like Fancy Feast (make sure the cans say "classics") which you can get at the grocery store, or Wellness chicken or turkey (at pet stores) instead of the Hill's. It's more economical and better for them. Check out the ingredients of your Hill's cat food vs. Fancy Feast or Wellness.

Welcome!

Jennifer
 
When you change the food from dry to wet, the insulin needs can change dramatically as a result.

Honestly, yes, I would suggest starting over at 1 unit. You can always increase it over time, but you can't remove it once injected if it's too much. The only way to know what a good dose is, is by home testing frequently.

Go over to the Lantus forum, read the stickies (starred information) so you can become more familiar with the insulin and how it works. Also, you can get specific dosing information from the people over there.
 
Yes, as Hillary described too much insulin can keep blood glucose just as high as too little insulin. What you're aiming for is the cat's ideal dose. The only way to achieve this safely is to start out with a low dose (usually 1u), and slowly increase the dose in .25u-.5u increments. Most cats on a low carb, canned diet do not need much more than 1u of insulin.

Lantus is dosed based off of daily nadir tests (or, the lowest number of the cycle). So that's at least three tests a day--once before each shot to make sure it's safe to give insulin, and one mid-cycle check to see how much the insulin is working to lower blood glucose. The reason why it's necessary to do these tests daily is because unregulated cats will have fluxuating high/low BG from day to day until they are regulated. This is because their bodies aren't used to normal numbers, and react to them as if they are low numbers. Their livers dump glucose in their blood stream to counteract the "low" number, and it can take up to 72 hrs for this to clear from their systems. A cat becomes regulated when they finally get used to normal numbers, which is why great care needs to be taken NOT to raise the dose too quickly as a knee jerk reaction to high numbers, especially if you don't have daily data that tells you the whole story.

Your vet put your cat in great danger by starting out at 4u of insulin. I would NOT trust any more dosing advice from this vet. Lantus has a clear protocol that has been proven to be safe and effective for cats. I would print this out and bring it to your vet: http://www.uq.edu.au/ccah/docs/diabetesinfo/link4.pdf, along with the AAHA guidelines: http://www.uq.edu.au/ccah/docs/diabetesinfo/link4.pdf. I've also attached an article to print for your vet about safe and effective treatment in cats with Lantus:

No cat should ever be started on more than 2u, and that should be reserved ONLY for especially large framed cats. The average starting dose for a cat is 1u of insulin. Starting at 4u is absolutely insane, and cats can and have died from that kind of overdosing.

When dosed according to the guidelines provided, cats have an 84% chance of remission. I can tell you from personal experience that it is well worth the time you put into testing to get your cat off insulin completely. Being diet controlled is the safest and healthiest condition for the cat, as well as the most convenient for the owner. Bandit is in a better condition today than he was before he was diabetic, because it forced me to make changes to his diet that made him a healthier cat overall.
 

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Hi Joe! Just stopping by to say hello and welcome to the board! You've been given some great advice here. 4U of Lantus is way to much to start with; your vet is most likely not familiar with the way Lantus works; it does NOT work in the way that fast-acting insulins work. If you want to stay with this vet, definitely print out and share the information Julia posted. If not, you can post your area, and someone may be able to recommend a better vet!
 
I really appreciate the advice and information, everyone. This is so frustrating. I live in Parker, CO so if anyone here has recommendations for a good vet I'd really appreciate it.
 
Julia,

Thank-you so much for your post and the literature you included. It really frustrates me that my vet started him out at 4u. Your link to the AAHA guidelines appears to be the same as the first link you sent me. I haven't read it entirely yet, but if it is, can you please send me a link to those guidelines.

Also, I plan on starting him at 1u tonight. I will read the literature you sent this evening, but is there anything you'd like to stress regarding BG levels I should be concerned with. Particularly during this initial stage/s. Thank-you again for all the help, everyone.



Joe
 
The only other thing I would stress is that switching to a low carb, canned diet (less than 10% carbs) would be best done now, as you're lowering the dose. It will be much easier starting with a clean slate than trying to compensate for diet and readjusting insulin needs later on. You also want to make sure you're testing, because some lucky cats no longer need insulin just by changing the diet alone.

Educating yourself is the biggest thing you can do to help you and your cat. I followed my vet's (wrong) dosing advice for about two weeks until I read up enough to know that she wasn't dosing Bandit properly.

One very important tool that I would highly recommend you set up is a spreadsheet: http://felinediabetes.com/FDMB/viewtopic.php?f=6&t=18207

This charts your numbers in a way that makes it easy to interpret your data over time, and it provides an easy way for members here to give dosing advice, if you need it. I also found it to be an easy way to share Bandit's numbers with his vet, even though his vet didn't really offer much advice after I took control of dosing except to say, "looks great, good job."
 
Thanks again, Julia. I'll definitely start the spreadsheet. And thankfully, he's completely off dry food and on a low carb wet food. It's Hills m/d, but as per some advice I've gotten from other members of this board, I probably going to switch to Fancy Feast Classics or the Wellness brand.

I did talk to my vet about a half hour ago and explained the initial dosage guidelines you had sent and he basically said that opinions vary within the community. I am not convinced. Nevertheless, he's printing me off the literature he's based his dosing decisions on and I will pick that up tomorrow and scan it and post to this board if anyone is interested.

With regards to concerning numbers. Jinx was on 2u twice a day for 2 whole days when his appetite dropped significantly. My vet said that if that happened, I should decrease the dose to 1u. I did that but wanted to check his BG level and it read around 595 mg/dL a couple hours after his 1u of insulin. So are there numbers that are too high or too low that I would need to do something about immediately? Aside from looking for obvious changes in his behavior or other signs of hyper/hypoglycemia.


Thanks,

Joe
 
His appetite may have dropped off because of the food. The prescription food usually use liver as the main meat and most cats get sick of liver very quickly. You may want to pick up some other low carb wet and see if this helps his appetite - just try and stay away from feeding too much seafood as this isn't great for any cat. If you have a bunch of the m/d food left and Jinx won't eat it most vets will take it back for either your money back or credit to your account.

Good Luck!!
Sharon
 
Joe and Jinx said:
Thanks again, Julia. I'll definitely start the spreadsheet. And thankfully, he's completely off dry food and on a low carb wet food. It's Hills m/d, but as per some advice I've gotten from other members of this board, I probably going to switch to Fancy Feast Classics or the Wellness brand.
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Hills M/D is not low enough in carbs for a diabetic cat. It's 14% carbs, and the recommendation for diabetic cats is less than 10% carbs. 10% is even too high for many diabetics, and ideally we look for foods under 8% carbs. If you look at the ingredients for this food, you'll see that it contains corn starch and powdered cellulose (wood pulp), which are both things diabetic cat should never eat because they tend to raise blood sugar. Wood pulp should not be consumed by ANY cat, let alone diabetics. Hills Prescription Diets are notorious for actually complicating the conditions they are supposed to be treating, because they use cheap, species inappropriate ingredients as fillers in their foods to make larger profits. You can't treat an ailment caused by poor nutrition with poor nutrition. You have no idea how much I wish Hills would simply go out of business, with all the problems their food causes in cats. Hills W/D was a major contributor, if not the cause, of diabetes in my own cat.

Purina DM canned is the only prescription food suitable for a diabetic cat. However, it's pretty much the exact same thing as low carb, cheap grocery store foods, so you're paying a huge markup for just the label. You can get a premium food with human grade ingredients for less than what you pay for the DM, which is mostly liver and byproducts.

Joe and Jinx said:
I did talk to my vet about a half hour ago and explained the initial dosage guidelines you had sent and he basically said that opinions vary within the community. I am not convinced. Nevertheless, he's printing me off the literature he's based his dosing decisions on and I will pick that up tomorrow and scan it and post to this board if anyone is interested.
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I would certainly be interested in seeing whatever guidelines he's using. I am a research librarian who has done quite a bit study on the subject because of my own (and Bandit's) personal interest in feline diabetes, and believe me when I say that there has been no other recent study that says 4u is any sort of safe starting dose. In fact, everything says the exact opposite, to start at a very low dose and then raise the dose judiciously. The only explanation I can even think of is that perhaps he mistakenly figured .25u per LB of actual weight instead of .25u per KG of ideal or lean weight. If Jinx currently weighs about 16 lbs, then that's probably what happened.

Joe and Jinx said:
With regards to concerning numbers. Jinx was on 2u twice a day for 2 whole days when his appetite dropped significantly. My vet said that if that happened, I should decrease the dose to 1u. I did that but wanted to check his BG level and it read around 595 mg/dL a couple hours after his 1u of insulin. So are there numbers that are too high or too low that I would need to do something about immediately? Aside from looking for obvious changes in his behavior or other signs of hyper/hypoglycemia.
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For now, when you see high numbers, just try not to freak out and raise the dose too quickly. It can take time to get blood sugar down, and it's not something that's going to happen right away. Lantus likes consistency--so you need to stick with doses for at least 3 days, but usually longer to see how the dose is actually working.

While he has high numbers, you should be regularly testing your cat's urine for ketones. You can use human ketostix strips that you can get at any drug store. Diabetic Ketoacidosis is a very dangerous and possibly deadly complication that may arise from the combination of high numbers, infection, and dehydration. If Jinx tests for anything more than trace ketones, you need to get him to the vet immediately.

If you see a number below 50 on your meter, that is low and you should be concerned about hypoglycemia. Cats usually don't become symptomatic for hypoglycemia until it is severe hypoglycemia, which means you're already in a dangerous situation and need to get to the vet. You want to catch hypoglycemia while it's still mild hypoglycemia, which means treating it before the cat is symptomatic so it doesn't become severe. Also, any number below 50 is an automatic dose reduction. We also tell new people not to shoot a full dose of insulin if they get preshot tests below 200 until they have enough data to tell them whether it is safe or not. Once you have collected enough data to give you a better picture, this changes, but in the first few weeks you want to be very careful, especially if there is a diet change involved.

Here's a good link on how to treat hypoglycemia: http://felinediabetes.com/FDMB/viewtopic.php?f=28&t=15887

One thing you should keep on hand is a couple cans of high carb food for hypos. Anything with gravy works--I used to use Fancy Feast Gravy Lovers, because the gravy gives a good boost to blood sugar that works quickly and doesn't last for more than a few hours.
 
Thanks again for all the info, Julia.

Just got Jinx on Fancy Feast Classic tonight but I will definitely look more into the raw foods.

I am really nervous about starting him out at 1u (b/c he shot up to 595 mg/dL the last time I did it) but I plan on starting him on 1u Friday morning. I'm taking the day off and want to be home with him all day and throughout the weekend to make sure he's ok.

I also picked up some Ketostix tonight. We've always used clay litter but I picked up some litter tonight that is made from recycled paper, fragrance free, and looks like little black pellets. Do you think that type of litter will be ok for dipping the Ketostix in after he urinates or should I use something else? Thank-you again for all the help.



Joe
 
You're doing great, just remember to take a deep breath and relax... it is a lot of information to take in at once, especially when you hear your vet may not be so right. Vets need to know a lot of things about a lot of animals, where here we live and breathe feline diabetes 24/7/365 :-D

Lantus takes a while to settle... you can't determine the result of a dose from a one day curve. Lantus is a depot ('shed') insulin, which you can read more about in the Tight Regulation forum. But that means you need to hold a dose for a few days to make sure it is safe to change. I am more aggressive with my cat's dosing than most, but lots like to follow the Start Low Go Slow protocol, where you start at 1u and slowly go up from there in .25u increments.

Keep in mind, it is better for a cat to be high for a while than severely hypo for one minute. You can always add more insulin, but you can't take it out when it's in, and hypoglycemia kills very, very fast.

Even though the high numbers are yucky, you need to look at the whole picture... numbers aren't everything. I see Scooter's 300 sometimes and just wish we could have been one of those lucky cats to hit remission in a few weeks, but, then I remember what he was like before he was diagnosed... drinking and peeing a ton, horrible flaky greasy coat, skinny, weak in the hind legs, sleeping all day... and now he is a happy healthy 6 yr old kitty at 13lbs and looking at him you would never know he was diabetic. I can look past the numbers for that. Diabetes has its ups and downs, Scooter was well regulated for about 3 weeks but we've hit an up again... you just deal with it as it comes. Some say, it's a marathon, not a race...

Scooter's not shy about the litter box and quite often he will follow me in the bathroom and use it at the same time :lol: I just wait till he's mid pee so he can't stop, and then lift his tail up ever so slightly and hold the stick right in the pee stream. He looks at me like :? and finishes up his business.
 
I own the Purina Breeze: http://www.breezeforcats.com. And I love it . It might be something to consider switching to until the diabetes gets under control (although I switched permanently because I like the reduced waste and ease of use). The only caveat--this is not the litter box to get if your cat has a problem with frequent runny stools. But if that's a rare occurrence, the ease of use the rest of the time is worth the pain of cleaning up those occasional messes when they come up.

The box is slotted, and urine is collected in an absorbent pad in a tray underneath the area that holds the unabsorbent desiccating clay pellets. My vet recommends this litterbox to her diabetic cat owners because in order to get a ketone test, all you have to do is remove the pad and wait, and you have a tray full of urine. Rinse the tray and put the pad back in, and you're good to go.

Another important tip I forgot--cats with high blood glucose get dehydrated, so make sure you're getting as much moisture in Jinx as possible to help prevent DKA (Diabetic Ketoacidosis). Mix some water in with his canned food with every meal, and you might want to consider getting a pet fountain, which encourages cats to drink even when they're not thirsty. Cats don't have a thirst drive until they are already dehydrated, so you want to encourage moisture intake as much as possible to head it off. After Bandit's diabetes was under control and he was on a canned diet only (with a little added water to the food), he stopped drinking from his water dish completely. I still fill it up, but he maybe drinks out of it maybe once every 6 months.

One other thing to consider is how much Jinx weighs. What does he weigh now? Is he overweight or underweight? If so, what is his ideal weight? This might influence your decision on what food to feed, and how to approach feeding. If he's underweight, you might want to feed a higher calorie food like Wellness, EVO, or Merricks Before Grain to get his weight back up to where he should be. If he's overweight, you might want to get a food that is very high protein and low fat, like certain Merricks 5 Star Entrees. Fancy Feast is a good middle of the road food--it's average in terms of fat/protein content.

I hope I'm not overwhelming you all at once--there is a lot of information to absorb, and not all of these things need to be considered immediately, but eventually. When I started out I made a list of things to research, prioritized them, and then slowly went back over a period of months and revisited each topic. Insulin dosing was high on the list, but Bandit was a pound or two overweight and shedding that weight did help
 
Thank-you Ry and Julia.

Jinx currently weighs 16.5lbs. Three months ago, he weighed 21lbs. Unfortunately, I didn't notice the loss until it was at 4lbs. That's when I brought him in to the vet at which time he was diagnosed. He is a large-framed Applehead Siamese but his ideal weight is probably somewhere between 12-14lbs.

Julia, I updated my signature block with a spreadsheet for the glucose curve I took the other day and BG readings I just took within the past 12 hours or so. I know the recommendation is to get him on 1u and I'm leaning towards starting that tonight. When I talked to my vet yesterday, he recommended bumping him up to 3u based on the high readings on his Apr. 30 curve. At that time, he had been on 2u twice daily for a week. Instead of going up a full unit, I increased it by .5u and took 3 readings. I was not expecting to see such a significant drop. I'm going to check his BG again in another hour or so.

Please let me know if you think those numbers further indicate that I should start him off on 1u. Also, considering that's he was on 2u for awhile and now 2.5u, is it ok to drop him down to 1u right away or should it be gradual? Thank-you again. I can't emphasize how much I appreciate all of you help.
 
Joe, for urine testing, my male cat Pumbaa, allows me to put a tablespoon under him when he's mid-stream and collect urine that way. I go from the front and keep the spoon close to his body and seldom get any litter in it. (Don't worry...we have a designated "pee spoon" that will never go near my kitchen again. *LOL*)

Suze
 
Joe, you're doing a great job. My husband and I are new at this too and it sounds like you're doing everything you can for your kitty. I know it's daunting, especially if your vet is recommending one thing and you're hearing other things here. Our vet did the same, and we ended up NOT following her advice to give the cat one dose of Lantus a day--instead we posted here and got help. Many vets don't know all the info people here know because these people are living and breathing cat diabetes every day. You sort of have to be in charge of your cat's health, and fortunately it looks like you have already decided to do that. Can't believe you already did a spreadsheet, wow, I'm impressed!

Re food, raw food can be a little tricky because if your cat is a grazer, it may not be great to have it sit out for a long time. I give mine some Nature's Variety Instinct but my cat wolfs his food down! Wellness chicken or turkey or the Fancy Feast classics is a fine start. Just keep checking with people here and ask any questions you need to ask.

Your kitty is lucky to have you for his daddy!

Jennifer
 
Joe and Jinx said:
Thank-you Ry and Julia.

Jinx currently weighs 16.5lbs. Three months ago, he weighed 21lbs. Unfortunately, I didn't notice the loss until it was at 4lbs. That's when I brought him in to the vet at which time he was diagnosed. He is a large-framed Applehead Siamese but his ideal weight is probably somewhere between 12-14lbs.

Julia, I updated my signature block with a spreadsheet for the glucose curve I took the other day and BG readings I just took within the past 12 hours or so. I know the recommendation is to get him on 1u and I'm leaning towards starting that tonight. When I talked to my vet yesterday, he recommended bumping him up to 3u based on the high readings on his Apr. 30 curve. At that time, he had been on 2u twice daily for a week. Instead of going up a full unit, I increased it by .5u and took 3 readings. I was not expecting to see such a significant drop. I'm going to check his BG again in another hour or so.

Please let me know if you think those numbers further indicate that I should start him off on 1u. Also, considering that's he was on 2u for awhile and now 2.5u, is it ok to drop him down to 1u right away or should it be gradual? Thank-you again. I can't emphasize how much I appreciate all of you help.
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Yes, please drop down to 1u, twice a day. Especially since you're changing his diet! You may not think that going from 14%ish carbs down to 3-5% carbs might make a difference, but it most certainly can make a huge difference in insulin need, especially considering the source of the carbs in the M/D. It is possible that 1u is not enough, but we have no way of knowing this until we test it for a few days. That's why we gradually increase the dose in .25u-.5u increments according to the protocol. Again, I would not listen to your vet's dosing advice. He has already given you dangerous advice that could have killed your cat. Did he provide the dosing information for you that he used to determine his starting dose? I really bet you he won't because based on what you told me I think he made an error with the starting dose formula and multiplied .25u per lb of actual weight instead of .25u per kg of ideal weight like he was supposed to. That's straight up carelessness.

As explained earlier, too high a dose can keep numbers just as high as too low a dose. The only way to insure that you hit your cat's ideal dose is to start at the beginning of the dosing ladder. Bandit is also an Applehead Siamese, and his ideal weight is 13-14 lbs. That's average for a male traditional Siamese, so I'm guessing Jinx should about the same based on what you've described. Bandit was also 21 lbs and obese at one point, so he and Jinx sound strikingly similar! Bandit never needed more than 1u the entire time he was on insulin the first time (he was on it for about a year), and he never needed more than 1.25u the second time (he was on it for about a month).

So based on his ideal weight, Jinx's starting dose should have been 1.25u (12 lbs=5.4kg x .25u). We usually round that starting dose down to 1u, because most cats on a low carb diet never need much more than that. Like I said, if you start out above the right dose, you've already missed the spot where the insulin is going to most effectively lower his blood sugar. Overdosing is dangerous and counterproductive. Lantus is a depot insulin, which means it needs time and consistent dosing in order to effectively lower blood glucose. So if you're overdosing and then skipping shots because his BG is too low, you're not going to get anywhere. You must come underneath the right dose in order to adequately control his blood glucose. That's why 1u is a good place to begin. You should always err on the side of the lower dose. I understand that those high numbers seem scary, but high blood sugar can kills slowly over a long period of time, and low blood sugar can kill in a second.

Control is the key word here...managing his diabetes and getting him into remission isn't about lowering his blood glucose, it's about controlling it. And that takes time. Like Ry said, this is not a sprint--it's a marathon. He will be high for a while, until he settles on the right dose and then you'll see improvement. But you can't rush the process by starting high and then raising the dose too quickly without enough data, like you're doing. Or you'll get nowhere.

Extra lbs can keep BG slightly higher than you'd like, so he really should slowly lose the rest of his extra weight. However, when a cat has clinical diabetes you don't want to restrict food while his diabetes is uncontrolled. If you can, I would feed as much as he wants of a high protein, low fat, low carb food, as that will best help him lose weight without having to restrict his calories. Once his BG gets under control, then you can worry about portioning so that he loses the weight safely and healthily. I would highly recommend Merrick's Cowboy Cookout, Merrick's Surf and Turf, and Merrick's Grammy's Pot Pie. They are all very high protein, low fat, and lower carb (the Grammy's is 8% carbs which is a tad higher than some people like, but Bandit handles them fine. You just might want to keep an eye out on that one). Bandit has had outstanding success on these foods losing fat, gaining muscle, and maintaining a healthy weight.

Here is a link to the updated pet food nutrition chart that has the current values for Merricks: https://docs.google.com/file/d/0B8U...MyMC00Y2Y3LWI4ODMtMzhkYTkxOGM4NThk/edit?pli=1. And a link to their store locator: http://www.merrickpetcare.com/locator/.

And I hope none of that comes off as harsh, because you ARE doing an amazing job educating yourself and helping out Jinx! If you dose as recommended by the Queensland protocol (and you can get lots of advice and help with that here: http://felinediabetes.com/FDMB/viewforum.php?f=9), and you feed a low carb canned diet, Jinx has an 84% chance of remission. When proper treatment and dosing is started close to diagnosis, and there are no complicating secondary conditions, that number goes up to nearly 100%.
 
Thank-you again, Julia. I do not take anything harsh and very much appreciate the candor. I do agree that my vet made a mistake and it bothers me beyond words. I did go to his office today and he gave me the literature he referred to yesterday. I can scan and attach it if you'd like or email it to you. It's from the Veterinary Information Network (VIN.com). It says that if the initial glucose level is >360, begin glargine at an initial does of 0.5U/kg. Still, considering Jinx's ideal weight is 14lbs, that comes out to 3.1u; 3.7u if the vet based it off his current weight of 16.5lbs. Although there is no citing throughout the document, there are sources provided in a bibliography at the end. Like I said, I'd be more than happy to scan and send to you.

With that said, based on what I've read and the info/literature you and everyone else on this board has provided me, basing the initial dose off 0.25U/kg body weight is the smartest and most medically sound thing to do. One very important thing I forgot to mention (just did on the Lantus board) is that I'm treating Jinx with a steroid to control his asthma. It's ~1mg (5mg pill quartered) of Prednisolone every other day. My understanding is that steroids raise the level of glucagons and inhibit insulin. So considering that issue (of which I should have mentioned earlier), please let me know if you feel differently about starting at 1u. I assume you don't and I agree but just wanted to check. Thank-you again. Also, my spreadsheet is current now.


Joe
 
I would like to see it, thank you! I am very curious at this point!

I don't have personal experience with steroids or asthma, so might want to check with the people in the Lantus forum, but as far as I know steroid use would not increase the starting dose, so you would still want to start at 1u.

The dose can always be increased if it doesn't work (the protocol recommends holding each dose for at least 3 days, because Lantus is a depot insulin and needs time to work). You can't take insulin out of your cat, however.

I know I have read somewhere (I'll see if I can't find you some information), that obesity can make asthma problems more severe. It's possible once he gets down to a healthy weight, he may not need the steroids anymore. I do know that steroids can cause transient diabetes, so you do want to aim to get him off them if at all possible.
 
Hi Julia, the file is attached minus a couple pages due to file size. Should have everything you were interested in though. Definitely interested in hearing your thoughts after you get around to reading it. Thanks again.


Joe
 

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My cat was on Science Diet wet m/d and it really messed with her BG. If you want to placate your vet and use a "prescription" food, Purina DM is mucho better. But I've had Lily on Friskies (under 10 percent carbs on the chart) and she's been doing pretty well lately!
 
I started weaning him off Hills m/d yesterday and plan on only giving him Fancy Feast Classic starting tonight.
 
Hi Joe,
I started weaning him off Hills m/d yesterday and plan on only giving him Fancy Feast Classic starting tonight.
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That's great to hear! Not only is it better for him, but he'll probably enjoy the variety too. My cat, Bob, was also given the Hill's M/D by the vet (canned and dry). When I read about how terrible dry food is, I ditched that immediately. After a couple of days, Bob refused to eat the canned m/d (and after opening the cans for a couple of days, I could understand why. I couldn't imagine having to stick my nose in it, it was the worst smelling food I'd ever smelled. A lot of cats will eat it at first, but I guess they get burned out on the flavor, and it only comes in one flavor. The FF are much lower in carbs, and they will help Joe's BG numbers all by themselves. So, that is a good thing!

I read that attachment you provided, and I can understand why the vet determined the starting dose. It's that "line" at 360. If over, then .5/kg, if lower, then .25/kg. Makes sense. I also noticed Rand/Marshall listed as the authors. I think (and Julia would be able to tell) that it is a matter of the protocol your vet used predates the study that TR is based upon? I think they might have removed the "360bg line" at some point? In any case, thanks for posting it so we can at least understand the vet's logic.

I don't use Lantus (Bob was on PZI) so I'm no help with any dose advice, but I do know that overall, we advise "starting low", and pretty much any time someone posts for the first time and the dose is any higher than "1 unit BID", the first thing we want to know is "WHY?" We can be a little overwhelming too, but that's just because everyone wants to help, just like we were helped when we posted for the first time. Glad you don't feel we've been "harsh"!

Welcome to the board,
Carl
 
Thanks, Carl. I just gave Jinx his first dose at 1u. His pre-shot was 495 so I'm nervous but I'll check again in a couple hours and will keep a close eye on him tonight.
 
Joe,
Every one of us was nervous at the start. Pretty soon you'll be able to do this stuff in your sleep! I understand the concern or worry about numbers that seem "high" to you. The way I've always looked at it is this.... better too high for a few days than too low for even a few minutes. If the numbers continue to be high on the 1u dose, the protocol is pretty clear about when and how much to increase. So, the numbers will ultimately be numbers that look much better to you. The real problem with starting too high is that many cats never require a 2 or 3 unit dose, so when you start that high, the chances are that the "right dose" is lower, and you would have missed it. Starting at 1u, and increasing in small increments like .25 at a time based on data will make it much less likely that you will "miss" the right dose.
Don't worry, anytime you have questions about the numbers you are getting, there will be many people able to help you to figure this all out.

Keep us posted!
Carl
 
I give my cat Wiskas turkey giblets and gravy. ($.50 a can or so.) He likes it and has been on that since he was diagnosed. I took him off the dry food immediately when I found out he was diabetic. He was mad at me but he got used to it. The dry food is going to mess the numbers up, especially if you are weening him off.

Try to get him totally off and then go from there. Nothing will be stable until you do that. It took my cat 6 months to go into remission and he has been off the juice since September. Same food though.

forgive me if this was already posted, I didn't have the time to read everyone's replies to the thread.

good luck.
 
Joe, you can relax tonight.

A PMPS of 495 with a reduced dose 2X per day should not cause Jinx to drop down to dangerous "too much insulin" green levels.

Don't forget that high BG numbers are bad long-term, but low BG numbers (too much insulin) can be deadly quickly.

Do a +2 and a +4 tonight, and if Jinx is still above 200 you should be able to go to bed and have a great sleep with no stress!

I've been reading your posts, and love how much you love your Jinx and how much you have learned since the diagnosis. I'm still having a very difficult time regulating my Pumbaa, who was diagnosed on 4/3/12. Pumbaa just does not take well to dose increases. *sigh*

Suze
 
The pdf file is a composite of the various work Dr Rand has written, plus a bit of some other things.

Many of our current members follow the most current tight regulation protocol worked out by Rand and the Diabetes Katzen online forum.

Testing every 4 hours may miss the nadir, which is usually between 5 - 7 hours after injecting.
We always want you to test before giving insulin, to make sure it is safe.
We encourage you to get mid-cycle tests when you can, especially in that 5-7 hour time frame - it can be on different days, but it helps to show how your cat responds over the course of the 12 hours.
 
concrete said:
I give my cat Wiskas turkey giblets and gravy. ($.50 a can or so.) He likes it and has been on that since he was diagnosed. I took him off the dry food immediately when I found out he was diabetic. He was mad at me but he got used to it. The dry food is going to mess the numbers up, especially if you are weening him off.

Try to get him totally off and then go from there. Nothing will be stable until you do that. It took my cat 6 months to go into remission and he has been off the juice since September. Same food though.

forgive me if this was already posted, I didn't have the time to read everyone's replies to the thread.

good luck.
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Please note any food that is gravy based will be high carb. You want to keep this for the hypo kit and not feed it as a daily food.

Fancy feast classics - are fine - they are pate style and low carb.
 
I'm new as well, but just wanted to chime in and say that, at least with humans, yes, weight and asthma does come as a package(being severe asthmatic myself, I've needed to do lots of research for it in people), so the more weight, the worse the asthma. Less weight, less asthma problems. I can only imagine that it also translates to cats, but I can't exactly guarantee this. Currently looking for a reputable source to say one way or another. So getting to a better weight might help decrease the need for the steroid.

Alright, I found this pdf that backs me up on this:
http://www.winnfelinehealth.org/health/asthma.html
(click "Read complete article", it's at the bottom)

Feel free to correct me if wrong though.
 
Hi everyone,

Thank-you again for all the help and encouragement!

Just gave Jinx his second dose of 1u and the pre-shot was 468. He's doing well but is getting more and more agitated with the ear pricks. He's fine once it's over though.

Also, he's completely off Hills m/d and on Fancy Feast Classic and his stomach is responding well to it so far. I did pick up a couple cans of FF with gravy to keep on hand just in case he goes too low.

I'll get his BG level at the nadir today (3pm MST) and will continue to keep everyone posted.



Joe
 
Just got done reading everything, and Carl is right--the sources in the document your vet has are outdated.

The 2009 Rand study which I provided for you establishes the Queensland University dosing protocol for Lantus (also called Tight Regulation). This study was performed with the sole purpose of producing an optimal dosing protocol specificallyfor cats with Lantus and Levemir. If you notice, the document your vet provided does not include this study, presumably because it was not yet released at the time the author of your vet's document put it together. There is not a single article cited written after 2006.

This was the dosing recommendation for Lantus (see p. 9) until the Queensland protocol was published in late 2008. This information your vet has was superseded in 2009, when the QU website was updated to reflect the newer research. Here is what the QU website looked like in 2008: http://web.archive.org/web/20071016101057/http://uq.edu.au/ccah/index.html?page=41544. And here it is today: http://www.uq.edu.au/ccah/index.html?page=41544&pid=41544. I would urge your vet to read the 2009 Rand article and protocol I provided for you and update his dosing guidelines. Page 218 (4) of the AAHA guidelines can also be used as a guide in terms of initial dosing, as they were updated in 2010 and do include the most recent research. They also contain some very basic useful tips and advice regarding dosing that isn't listed in the dosing protocol or the Rand study.

I wanted to keep this post a reasonable length for brevity's sake, but I sent a more detailed explanation via a private message for you and your vet on why things were dosed the way they were before the 2009 Rand study, and why it was shown not to be good for the cat.
 
Make sure you reward Jinx after you test. This will get him to start looking forward to testing and not stressing over it. Maui's favorite reward is a good brushing.
 
Hey everyone, I'm not going to have a knee-jerk reaction to each BG reading I take but I certainly felt good when Jinx's nadir today was at 194. Been real busy today but will get caught up on responses to posts and emails tonight!




Joe
 
I know this is short notice but in a half hour, I have to go in to work for 5 hours or so. Based on the pre-shot and nadir today, should I be concerned that it will continue to go lower?
 
I can't tell for sure because this is a new dose, but I honestly think he will be just fine. Of course, anything can happen but considering the reduced dose and that he's already hit what is usually the lower point in the cycle, I think you're fine. Just leave him a little canned food out just in case--I freeze it and put it in an auto feeder, but if you don't have any frozen you can leave some out with an ice cube in it. If he's a gobbler and not a grazer, you may need to get a feeder for this purpose as well. If he's the type of cat that will sit and lick at a frozen piece of cat food for hours, that is.

Not sure how often you're feeding, but diabetics do best with small, frequent meals. It helps even out the highs and lows.
 
Thanks, Julia. I actually had a pet-sitter/vet tech come over and hang out with him and his Bengal sister for a little while to make sure he was ok. She checked his BG at 6:30pm and it was 258.

For the most part, I've been feeding him just twice a day and giving him a little bit of food around his nadir times. I looked into automatic wet food feeders and didn't see anything with decent reviews. If you have a recommendation for a particular feeder, please let me know. Due to my work schedule, that would make it much more easier to give him small meals throughout the day.



Joe
 
A number of folks have used the Petmate 5 compartment feeder.
They'll freeze some of the food for the later feedings so it thaws when it finally opens.
Also, lining the compartment with foil makes cleanup easy, and avoids plastic contact which may trigger feline acne in some cats.
 
We use that feeder too. Some people have had problem, but just make sure the tray is well seated and then push the advance button to double check. You can get small glass bowls at the dollar store that will fit in too, much easier to wash out then.
 
I have This auto feeder. I've had it for about 4 years now and it works great. I went through 2 other feeders (Including the Petsafe 5) that Bandit ripped apart before I found this one, which is sturdy enough that he can't break into. I've heard complaints that it's difficult to program. I've never had a problem with it, but I'm also good with gadgets. It programs exactly like an old school VCR. I also make little tin-foil bowls to put the food in, not because Bandit has a feline acne problem, but because I'm too lazy to take it apart and clean it all the time. It also has a feature where you can record your voice to play when the food is released, and a compartment to put an ice pack if you have food that's not frozen in it.

As far as I know, Bandit's the only cat here that destroyed the PetSafe feeder, so unless Jinx thinks he's a raccoon like Bandit does, that's a good feeder too and I believe it's the most popular one on the boards. It was very quiet and easy to program. Just didn't stand up to el Bandito. He would somehow get the tray to turn with his paw to get at the food early, and when I figured that out and started putting it in the next compartment over (setting it to go off twice to release the food), he somehow broke the tab that holds the lid part down. Keep in mind, though, that this is a cat that I had to buy a locking garbage can for and then barricade it with a baby gate.
 
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