New to Forum - Starting Dose?

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Emily and Baby

Emily and Baby

Member Since 2013
Good evening :)

I am new to this forum and have a few questions. Zoey was diagnosed with diabetes last Thursday and I started home testing on Saturday after lots of great advice from the Health Forum section. Zoey went to the vet on Monday for the day to start insulin, but my vet feels his numbers were low and he does not require insulin but oral medication (glipizide). His numbers at the vet were 252 and 288 without eating anything while he was there. Based on advice from the forum, I have decided against the oral medication and have purchased Lantus. His numbers have been 358, 360, 346 and 333 today and he has trace amount of ketones in his urine. I had been planning on starting him on insulin on Friday when I have to day off so that I will be home to do BG tests and be with him, but I am wondering if these numbers warrant starting sooner? Please let me know if more information is needed and I will do my best to provide whatever is needed in order to decide if he can wait two days or not. If I have to take time off or stay up with him, I am willing to do that in order to help him feel better!

Thank you in advance for any and all advice!!
 
Welcome to LantusLand, the greatest place you never wanted to be. But it's the best place to help handsome Zoey-the-male cat. How much does Zoey weigh? What should he weigh? Here is a primer on ketones. The key is insulin, food and water to get the ketones flushed out. Lantus should be given every 12 hours. Have you considered what time you can shoot in the morning and evening? I am not a dosing expert but hopefully Marje or someone else will be along with some advice.
Liz
ETA: Maybe you could edit the subject line of your original post to add "trace ketones" to get more attention. Ketones are serious and need to be addressed quickly.
 
Welcome Emily and Zoey; I'm pretty new here (just over a month) so I won't give any dosing advice, but I'm sure one of the experts will be along soon to assist. This is truly the "best place you never wanted to be" - the people on this board are very loving and very good.
 
Thanks Anne and Cathy :)
He weighs 14 lbs right now and I think its a good weight for him, although he seems bony as he lost a couple pounds quickly :( I believe I will be giving his insulin at 7 am and 7 pm as I work during the day consistently and don't have to worry about shift work, which I am thankful for! I don't know when to start him on it, if it is safe to wait or not...
 
Hi Emily,
I won't offer any advice because I'm a newbie, too (my Star was diagnosed March 1, and I found this message board and started posting a few days later). Just wanted to welcome you and assure you that you will get great support and advice from the experts here. Everything is new and scary at first, but once you've been treating Zoey for a few weeks and gathering lots of data, you'll begin to see patterns in the numbers on the spreadsheet (in a helpful way, not a weird, hallucinogenic way, lol!), and you'll start to feel like you're getting a handle on this feline diabetes thing. Anyway, ask any question you have, no matter how small, and trust that someone will give you a thoughtful, well-considered answer. Welcome to Lantus Land or, as I like to think of it, the Lantus Lifeboat! cat_pet_icon
 
Emily:

The presence of ketones is worrisome. You need to talk to your vet about this. Zoey needs to be started on insulin as soon as possible. Typically, ketones result from an infection plus not enough insulin plus a cat not eating. Without Zoey on insulin, whatever she's eating isn't getting into her cells -- it's floating around in the bloodstream. Food not being metabolized properly is adding to the development of ketones. Trace ketones can rapidly get worse and I would not wish diabetic ketoacidosis on any cat. Until you talk to your vet, you need to get a ketone test at every possible opportunity. If the level increases to more than trace, you need to get Zoey to your vet or the ER. More than trace ketones cannot be managed at home. In addition, add water to Zoey's food. Water helps to flush out ketones.

The starting dose of Lantus can be calculated by the following formula:
starting dose = 0.25 x ideal weight in kilograms​
If this were my cat, I'd start insulin as soon as I could.
 
Unfortunately when I spoke with my vet, she was not in favour of insulin. In her practice she has not had experience with Lantus, only Caninsulin and did not want him on Caninsulin. When I left on Monday she agreed to read the research I gave her provided by this site but thought I was going to try the oral medication for two weeks... I think I am flying solo at this point as she had bad experiences with seeing hypo kitties from Lantus (vets usually see cats when there is a problem...) and has not used Lantus. Also she has never had a cat go into remission from diabetes, probably because she uses oral or caninsulin...

Should I be starting him on insulin tonight? He seems less interested in food even though I added warm water to bring out the smells and give him more liquid... I also have no clue how to give an injection which worries me... Wendy offered to show me and I am willing to go to her when she is available (about 2 hours away).

1. Should I just start him on it tonight??? I hate not having my vets support but I just don't think oral medication is the answer :(
2. Do I let him eat whatever he wants and not worry about the carbs right now??
 
So that would be a starting dose of 1.6u. You can go with 1.5u. If you shoot at 7 am, what tests will you be able to get before work? We reference times relative to the shot time so if you shoot at 7 and test at 9, that would be a +2 test.
Liz, Zener's other mom (I sign my posts and Anne doesn't)
 
Do you have the Lantus, syringes (make sure they match the Lantus concentration), plenty of test strips, carbs (high carb and medium carb food, or karo syrup or honey), low carb regular food? Do you know how to measure and inject the insulin?
Liz
 
Liz, to start, I won't be going to work, so I can test at whatever times are suggested for the first day. I'm also willing to change the shoot times if I need to start sooner. After the first day or once things are alright, how often should I test? I do live close to work so if I did have to leave for work I could be home at +0.5, +3, +5, +5.45, +8 and home from +9.5 until the next AM shot.
 
I believe I have everything:
Lantus pens
syringes (how do I know if they march the Lantus concentration?)
test strips (lots lol)
I will double check the carb levels of the foods I have and post back.
I do not know how to measure and inject... I have not been shown in person, can I learn from videos if need be?
 
You can adjust the shot time by 30 mins per day, either all at one shot or 15 mins at both shots. You are pretty far off your desired time now so maybe get up a little earlier in the morning and shoot at 6?
Liz
 
Check out all of the starred stickies at the top of the forum. You might want to print them out so you have them when the Internet is out or the board is down. The Lantus and Levemir one has info about the type of syringe to use and there is a great video by Julie about how to draw up the dose.
Liz
 
The foods I have range between 6 and 14, plus I have dry food he likes that is at least 30% if he can have that? And I do have the correct syringes, they are BD Ultra Fine for U-100 31 gauge shorts with 3/10ml/cc.

I can definitely get up early tomorrow and start if need be. I can stay home with him too if that is recommended? Is 1.5 ok to start with or should I start at 1.0 since he's never had any insulin?
 
I think you are ok to start at 1.5u if you are around to monitor. My recommendation is to throw out the dry food and never let it in your house again. It's terrible for cats in general and it's no good for low blood glucose because it takes a long time to get into the bloodstream and stays a long time. If all of your kitties will eat low carb wet food, they will all be much healthier. Karo syrup or honey is much better for bringing up low BG.

You will need to monitor him at least a couple of times after his shot. It's hard to plan too far ahead since each reading can change the picture.
Liz
 
Welcome to LL, Emily & Zoey,

Just a quick answer to your "Lantus concentration" question. Lantus is a U-100 insulin, so the syringes must be U-100 syringes. (I believe that Caninsulin is a U-40 insulin, so do not use those syringes with Lantus.)

Wishing you all the best. You are in good hands here tonight. It's great that Wendy is going to show you how to give shots.

Ella & Rusty
 
Hi Emily, and welcome from another Canadian and fellow insulin rebel. My vet only recommends Caninsulin, I got onto Lantus because I went in to see a locum vet to show me how to blood test and he got me onto Lantus and recommended FDMB. Neko was on Caninsulin for two months. It had really short duration. I wasn't testing right away :oops: but she was howling for food hours before dinner so I know it was wearing off early.

You asked a question about knowing if you have the right syringes. Did you get the BD Ultra-Fine II? On the box, it says For U-100 insulin, that's what you want. It also says 3/10cc (for 30 units and 1/2 unit markings), 31 guage, 8mm length needle. It's the white and mostly purple box.

As for food, it's time to donate dry food to the local shelter. None of the dry foods are low enough carbs.
 
Ok, no more dry food :) They haven't had it since Friday so they are adjusting to the wet. Gryffin likes to tell me how starving he is on this meal-feeding method but he's dramatic lol.

Do you recommend I start tomorrow morning Liz? I will stay home with him all day :) I won't be able to get hands on injecting direction by then unfortunately though :(

Just so you know, I have extreme difficulties at making decisions, so feel free to simply tell me what to do lol. I may need some hand holding :(
 
You can use the 6% (anything under 10 is okay, but the lower the better) food for his "normal" feedings and hold off on the 14% for those times when his numbers might happen to go lower during the middle of the cycles. We hold off on the higher carb food until we see a number that is a bit too low (like under 50) or when you see a drop in numbers early in the cycle (like 2 or 3 hours after the shots).

I'd try to forget that you have the dry food on hand. Yes, it will raise the numbers, but it takes a little longer for that to happen (as it takes longer to digest) and then the higher numbers tend to stick around for longer than you want them to. Occasionally, you might want to have a few bits of kibble on hand to act as a "bribe" to make him eat his canned food (you can crush a couple of them and then sprinkle the powder over the canned food). The bad part about having it in the house at all, though, is that it seems that if it's in the house, no matter how well you hide it, kitties seem to know, and they figure out how to raid the pantry. There's a good reason we call it "kitty krack" :lol:

In a pinch, a few drops of karo mixed in with his canned food can also boost the BG numbers up pretty quickly, so that's a great thing to have in the cupboard. Alternatives to karo are honey and maple syrup if you find he doesn't like the way Karo tastes.

I'm not sure on the question of 1.5u vs. 1.0u, so I'll let an experienced Lantus caregiver handle that question. I saw where Liz said that based on his weight, 1.5u makes sense. Most kitties seem to start at 1.0u I think. The important thing is that he starts getting some insulin sooner rather than later.

Glad to see you've "migrated" here to post, Emily. The great folks here will help you in any way they can, all hours day and night! And they know their stuff!
 
Thank you!

I will look at those! I just finished reading and printing all the stickies from the group, so much information! I hope I can do this correctly for him!!!
 
I was never shown how to give an injection. I did a Google search and found several videos, watched them, and gave a shot. (Ditto for how to home test.) Some videos were obviously better than others! Just be aware that you don't roll Lantus. A lot of the videos are using ProZinc which is different than Lantus so many of the "tips" don't apply. Also, most of us do not draw in to check for blood once we've inserted the needle. I give Gabby her shot when her head is in her food bowl. There's no way I could do what is suggested in some of the videos. Also, with Lantus, you do not need to give food 20 min. before injecting. (Lantus onset is later than with a shorter acting insulin like ProZinc.)

Some of the members here may have videos that they recommend.
 
Hi Emily

Liz PMd me and asked if I could help out. I'm sorry...I'm usually on the board earlier but had some kitty issues to attend to here.

As others have explained, ketones being present in the urine is a warning sign they DKA can develop. You should be watching those ketones very closely and if you start seeing any more at all, I'd get him to a vet. Things that will help are food, water, and insulin but if DKA develops, it's because there is also some kind of infection present. For tonight, Id try to get as much water in him (mix it into his food) and be sure he is eating.

Yes...I would start insulin tomorrow morning. What is his "ideal" weight? Or is he underweight? If he's underweight, we would use that. If you can let me know that info, I can help you with a dose.

It sounds like you have your supplies...be sure you have plenty of test strips; however, because lantus is a depot insulin and the first few shots go towards filling the depot, you are not likely to see any quick change in his numbers.

Glipizide is not effective in cats and can actually prevent cats from going into remission.

Please let me know your questions and post his weight and let me know if it is the ideal weight or he is underweight.

Thanks, Emily.
 
Hi Marje and Gracie :) I hope your kitty that is having issues is ok!

Zoey is 14 pounds now. I think this is fairly close to his ideal weight, he has a pretty big frame. He's eating some food mixed with water now and I will offer more once he is done and give him some cold water, he likes that :)

Do you have any videos you suggest to give me an idea on how to do an injection? I've read your post that Wendy posted as well as a few others. He is a docile cat so I'm sure he will forgive any misteps, but I hope to do the best I can for him! I might be making an early morning grocery store run for some oranges lol.

Thanks for responding :)
 
Thank you, Emily. Yes...all kitties are ok.....they just all decided to HAVE to eat at one time :lol:

I'd start him at 1.5u. A member, Julie, did a great video on drawing a dose from a pen or vial. Please read this post on Proper Storage and Handling of Lantus/Levemir. The video is embedded within the post.

I'm trying to find a good video or other resource for giving the injection. If I had not already given one to Gracie, I'd video it for you real quick. Let me see what I can find.
 
Thank you! They all make it look so easy! Is there a location that would be easier for me to inject for the first time? Most videos are of the scruff, is that a good site?
 
Actually, I don't like either of those YouTube videos because we do not insert the syringe and then pull back on it to see if you get blood and then shoot. I think those videos will confuse you. ( sorry Carl...you know you're the man!).
 
Ok, once I feel confident with injecting (by watching and reading anything you all provide), in the morning, I need to test, feed and shoot 1.5 at 6 am? What should testing look like for the rest of the day? I will be staying home so no need to worry about a work schedule :) Is there a certain amount I should feed him of his low carb wet food?
 
We always get a preshot (PS) test every cycle before we shoot. Ideally you want to test, feed, and shoot within about 25 minutes. If you put his food down so he starts eating before you shoot, he might never know when you put the needle in. So most of us test and then shoot while kitty is eating.

It's a good idea to get a +3, +6, +9 tests in the daytime cycle to start with. At night, just get a +2 or before bed, whichever is later.

Still looking :-D
 
No probs, Marje. ;-) I looked at about a dozen of them, and those were the best two I could find on short notice. Sienne had mentioned earlier that " most of us do not draw in to check for blood once we've inserted the needle." So I figured that was a good disclaimer. And also like she mentioned, most of the vids seem to be "prozinc" beans, and they do roll and shake the bottles, which is also a no-no with Lantus. I even saw on with a Lantus user who was a little rough with the vial and shook the heck out of it! nailbite_smile

SO basically..... we'll be waiting for the next "Marje's Video's" showing how to do it right with Lantus staring Ms. Gracie and not Mr. Gus this time.... :mrgreen:

Emily, if the day ever comes when you have to administer sub-q fluids to Zoey, you're going to LOVE watching Marje's boy Gus getting the "squids". Everyone who watches that video wants to fly to Arizona and steal themselves a kitty!
 
Carl...you rock! Actually, it has been on my list to do and so now, I will definitely have to do it sooner rather than later. But I won't be able to doing before Emily needs it. As wonderful as Gracie is, I don't think she would like more jooce tonight :lol:
 
Thank you for the smiles :) I'm hoping that all goes well in the morning and Zoe Bear is happily eating when I shoot him. Fingers crossed!!

Thank you for all your help! I am going to catch a few hours of sleep while I can and be up at 5 to view videos some more and get a good feeling about everything. I'm trying not to be worried about a hypo episode! Trying to think good thoughts!! I appreciate all the amazing advice and words of support! I have everything possible printed out and on hand and ready to go.

Fingers crossed all goes well and choosing this road is the best for Zoe! Keep Calm and Purr On!!!!!!!!!
 
Emily

I didn't find a video, but I found this website which as a good description of How to give an Insulin injection.

Some pointers:
  • be sure the bevel is facing up towards the ceiling
  • insert the needle parallel to the cats spine
  • dont get too steep on the angle or you will hit muscle
  • lift the skin up to pull it away from muscle

I lift up the skin/hair, roll my left hand back (I'm right handed) so the back of my palm is pointed towards the back of her head. This allows you see skin so you can inject into the skin. Be calm. Don't rub the injection area after you are done.

If you accidentally give a fur shot, do not try to give the shot again. Sometimes you get in more Insulin then you realize.
 
Thank you thank you for all your hard work searching for information for me! I will review it all in the morning and go for it! All in the name of health for my fur baby :)

Have a great night everyone! You are blessings :)
 
Emily,
This is the busiest forum on the board. Someone is here virtually around the clock, so any questions or problems, ask away. You'll get eyes on your posts.

Good luck in the morning. I'll check in after I've had my first cup. ~O)
 
Hello Emily,

Warm welcome to LantusLand. Please feel free to reach out if you need any help.
Not one of the experts but will support in any way possible!

So awesome to see your love and commitment to Zoey! :-D

~Rich
 
Not off to the best start, apparently I slept through my 5 am alarm lol. My body said three hours was not enough I guess. Going to move my start time a bit! Will post his blood glucose levels as soon as I can.

It can only get better from here!!
 
Hi Emily. I'm sorry I have to log off now and don't have time to read your entire condo. Please get a ketone test as soon as you are able and let us know what the result is. Hopefully it's negative.
Good luck with starting insulin. You're doing the best you can with your beautiful Zoey.
 
Zoey 27/03

We did it! Well, mostly! I think I lost a little as his fur was a tiny bit wet, maybe a drop... hopefully he still got most! We will have another go in 12 hours but he is purring on my lap like his normal self, so I am so happy about that! We tested (342), fed (he only ate about a 1/3 of a 5.5 oz) and shot 1.5 of insulin (at 7:40 am est).

So now I test at +3, +6, +9 for his very first day? Can I give him more food if he wants it? How much approximately if so?
 
Re: 03/27 Zoey AMPS 342 - First Day

Congrats on getting the first shot done! That dampness you noticed may have been from insulin on the outside of the syringe. There can be a drop or two on the syringe from your adjusting the dose.

You have lots of options regarding feeding. The only thing to not do is to give Zoey food between +10 and your shot time. Food that late in the cycle could influence your pre-shot number.

Most of us feed either "mini-meals" or free feed. We generally encourage you to not feed after nadir. So, if Zoey gets 1/2 of a 5.5oz can of food twice a day, you could divide each half can into thirds and feed at pre-shot, +3 and +6. Frequent, small meals are easier for a healing pancreas to deal with. The schedule I gave you is an example. You can feed however makes sense for your schedule or for the way Zoey handles insulin. (I feed Gabby at pre-shot, +1, +2, and +3 because she has early, fast drops in her BG numbers.)
 
Re: 03/27 Zoey AMPS 342 - First Day

Thanks Sienne :)

Since it is his first dose, should I be testing his BG more frequently to get an idea of how the insulin is effecting him? Or is +3, +6 and +9 sufficient?
 
Re: 03/27 Zoey AMPS 342 - First Day

Sorry I just got here.

The fact his fur was a little wet makes me wonder about your technique a little- especially when 1.5Iu are such a small amount in the syringe (it holds 30 units!) . Could be a couple of things, first if you played around with the syringe a bit first withdrawing and adding insulin and injecting out air or whatever, there may have been insulin on the outside like Sienne said. The other is that you need to inject slow and steady and hold for a few seconds or it can seep out. Anyway we will find out when you test today!

I think those testing times sound fine especially since he is starting from a high number. But if he does any weirdness we can let you know to test more.Let us know how it goes!
 
Re: 03/27 Zoey AMPS 342 - First Day

I will definitely try to hold it longer next time. I did pull up more than I needed like Julie's video suggested so it could have been from shooting a bit out before hand.

He is acting like his old self :) Sitting beside me looking out the window right now :) Everything appears to be normal so far!! He's a trooper :) I feel safe with everyone close at hand and have read everything I could about signs of hypo so I feel prepared (as much as I can be anyways!!) for any situation that arises :)

I will keep everyone updated! First GB test in about an hour and a half :)
 
Re: 03/27 Zoey AMPS 342 - First Day

Woohoo!! Well done on the first shot. :-D :-D :-D One bit of housekeeping detail - we have one condo (or thread) per cat per day so you might want to start a new one. As you can see, they can get quite long. Use the same subject as you have now. Also, include a link to this condo using the URL button. Then someone can look back and see Zoey's history, day by day. Great job!
Liz
 
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