New to the Group - How Often Should I Test?

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Colio

Colio

Member Since 2020
Hi everyone - we are just starting this journey. Cole was just diagnosed and we are using Lantus just one shot in the morning. I'm in Canada - so his blood result today was 19.9 - still high but way down from last week when he was diagnosed.

The vet wants to have us provide at least 1 full day of blood test results - every 3 hours, so we can determine the right dosage. Outside of that, how often do people test? It looks like first thing in the morning before eating - and then what?
Thanks in advance for the advice!
 
Colio said:
we are using Lantus just one shot in the morning
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The problem with just one shot in the day is that Lantus is a depot insulin, not and in-and-out insulin. Every time Lantus is given, a little bit gets put aside to build a depot.
From:https://www.diabeteshealth.com/lantus-and-levemir-whats-the-difference/
Lantus is a basal insulin formula, which means that it lasts for a long time in the body and act as background insulin, with a slow feed that mimics the constant low output of insulin produced by a healthy pancreas.
​
Giving just one shot a day does not allow for a depot to build.

Colio said:
Outside of that, how often do people test? It looks like first thing in the morning before eating - and then what?
Click to expand...

Yes, you test before eating. Pick up all food two hours before the shot is due. That way, the test number at shot time is not food/carb influenced.
1. Test – to see if the number is high enough to shoot.
2. Feed – to make sure the cat will eat.
3. Shoot.

Three units is a very high starting dose. How much does your cat weigh? and are there any underlying conditions?

My concern is that your vet will want to switch to twice a day shots of 3 units each.
While twice a day shooting is the practice for all insulins for cats, I'm concerned that once the Lantus depot builds, the 3 units is going to be far too much insulin and this could put your cat at risk.
 
Hi and welcome to FDMB. This is a very caring and knowledgeable community.
I agree with @Red & Rover (GA)
3 units is way too high. The normal starting dose is around 1 unit twice a day. Giving the insulin only once a day means that Cole is left for 12 of the 24 hours without any insulin. Cats have a much faster metabolism than human and that is why they need insulin every 12 hours.
 
I agree with @Red & Rover (GA) 3u does appear to be a high starting dose. While it is an insulin made for humans, cats metabolize the insulin quite differently, and we do find dosing twice a day to be the best way to manage diabetes in cats. I'm sure there are exceptions to this, but likely very few cats do well on only one dose a day.

Anything you can share about how your cat was diagnosed? Symptoms? Any blood tests or urinalysis?

The methods we follow here are based on use of human meters, so thevnumbers referenced in terms of when to take reductions are different. We can help you either way, and I have used the AT2 in the past.

and as Kel said, those AT2 strips are pricey.

Waving from Alberta!
 
Colio said:
The vet wants to have us provide at least 1 full day of blood test results - every 3 hours, so we can determine the right dosage. Outside of that, how often do people test? It looks like first thing in the morning before eating - and then what?
Thanks in advance for the advice!
Click to expand...

Nothing wrong with doing a "curve" you can one that is over a 12 hour period between first preshot in the morning, then every two hours to the evening preshot, or you can do one over an 18 hour period testing every three hours, but I would start off with twice a day dosing for 7 days first. It takes 5-7 days for the depot to build and to get worthwhile info on how the low the dose is taking the kitty.

Typically we start off with a dose of 0.25u per kg of cat's ideal weight, twice a day, and see what the numbers say.
 
Good morning! Cole is one stunning cat!
Youve received some excellent advice the only thing you need is to fill in your signature with all Coles particulars. This will give anyone who comes to help all th
  • On the left, under Settings, Click on Signature. This is where you will put information that helps us give you feedback.
    • There is a limit of two lines which may include two links; you may separate pieces with commas, dashes, | etc. This is where you paste the link for your spreadsheet, once it is set up.
    • Add any other text, such as
    • Caregiver & kitty's name (optional)
    • DX: Date
    • Name of Insulin
    • Name of your meter
    • Diet: "LC wet" or "dry food" or "combo"
    • Dosing: TR or SLGS or Custom (if applicable)
    • DKA or other recent health issue (if applicable)
    • Acro, IAA, or Cushings (if applicable)
    • Spreadsheet link. Please put the signature link on the bottom line of your signature information, on its own, so it is easy to find.
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Be sure to click the 'Save Changes' button at the bottom. If you need help urgently it is important we know these things at a glance. We don’t want to waste valuable time finding out information.e info on Cole without having to ask every time you post:

WELCOME TO OUR FAMILY:bighug:
jeanne
 
Red & Rover (GA) said:
The problem with just one shot in the day is that Lantus is a depot insulin, not and in-and-out insulin. Every time Lantus is given, a little bit gets put aside to build a depot.
From:https://www.diabeteshealth.com/lantus-and-levemir-whats-the-difference/
Lantus is a basal insulin formula, which means that it lasts for a long time in the body and act as background insulin, with a slow feed that mimics the constant low output of insulin produced by a healthy pancreas.
​
Giving just one shot a day does not allow for a depot to build.

Thanks for that feedback - I think the 1 shot a day is just temporary to determine the right dose. I didn't really understand what happened on the day they kept him at the vet and gave him insulin and then tested all day - something about his levels continuing to drop right up to when we picked him up. Now they will look at the testing I do (I preferred to do it rather than have another stressful day for him at the very) and decide on the dose for 2 shots a day.



Yes, you test before eating. Pick up all food two hours before the shot is due. That way, the test number at shot time is not food/carb influenced.
1. Test – to see if the number is high enough to shoot.
2. Feed – to make sure the cat will eat.
3. Shoot.

Three units is a very high starting dose. How much does your cat weigh? and are there any underlying conditions?

My concern is that your vet will want to switch to twice a day shots of 3 units each.
While twice a day shooting is the practice for all insulins for cats, I'm concerned that once the Lantus depot builds, the 3 units is going to be far too much insulin and this could put your cat at risk.
Click to expand...

He is a Maine Coon - so a big cat but has lost a lot of weight in the last year. Currently at 8 kg and that was a big drop from his weight in August (need to find the record of that) He has something going on with his third eyelids showing - started in March and we have been though MRI, ultrasound, spinal tap etc to figure out what is going on. He doesn't have a brain tumour - but they really don't know what's going on. And blood was normal right up til July. August was a slight elevation - and then it went zooming up.

I asked about the dosage and the vet said is was moderate. How do I approach that discussion on the units with her? Advice would be welcome.

Thank you!
 
It could very well be that the 3 unit dose is not too high. But you won't know until a few things happen first.
You need to find a dose that you can give twice daily, testing preshot and a couple of tests during the cycle to try and find the nadir (the lowest point in the cycle). It can take up to 5 days for the Lantus depot to build.
Testing on a daily basis gives you a much better picture of how a cat is responding to insulin rather than the occasional one day curve or a fructosamine test.

Print off and show your vet the following articles. (This forum is good at staying on top of the research.)
From:
Glargine
Glargine (Lantus; 100 U/mL) is a long-acting human insulin analog that is soluble in acidic solutions but forms microprecipitates in the neutral pH of the subcutaneous tissue. These microprecipitates slowly release small amounts of insulin over 24 hours. In healthy cats, the duration of action is significantly longer than lente insulin (10 hours, range 5 to >24), though similar to PZI (21 hours, range 9 to >24).

Glargine is used together with a low-carbohydrate diet to minimize prandial increases in blood glucose in cats. Twice-a-day administration is recommended to provide overlap of insulin action from the proceeding injection and increase the probability of remission. The starting dose for glargine is 0.25 U/kg of ideal body weight, if blood glucose concentration is <360 mg/dL (<20 mmol/L) or 0.5 U/kg if blood glucose is >360 mg/dL. When transitioning to glargine from another insulin, for doses <3 IU direct substitution is usually suitable; however, for doses >3 IU, conservative dosing of half to two-thirds of the dose is recommended, but it will be increased within 48–72 hours if control is not adequate.

Significantly higher remission rates were achieved by 16 weeks of treatment with glargine (8/8 cats), compared with lente insulin (2/8) and PZI (3/8) in newly diagnosed diabetics fed a low-carbohydrate diet (6% of energy from carbohydrate). In 55 diabetic cats, the remission rate was 84% when glargine was started within 6 months of diagnosis using protocol aimed at achieving euglycemia. However, a recent clinical trial of 46 cats found that while a higher percentage of cats receiving glargine went into remission compared with those treated with PZI (33.3%versus 23%), this was not significantly different.​

From:
Treatment for Cats In cats, diabetic remission is a reasonable goal.4 Successful management of DM in cats consists of minimal or no clinical signs, owner perception of good quality of life and favorable treatment response, avoidance or improvement of DM complications, (specifically, diabetic ketoacidosis and peripheral neuropathy), and avoidance of hypoglycemia. Predictors of diabetic remission in cats include achieving excellent glycemic control within 6 mo of diagnosis, using intensive home monitoring, discontinuation of Diabetes Guidelines JAAHA.ORG 3 insulin-antagonizing medications, and use of insulin glargine (Lantus) or detemir (Levemir) along with a low-carbohydrate diet.4 A clinically sick, diabetic, ketotic cat should be hospitalized to initiate aggressive therapy. If 24 hr care is not feasible, the patient should be referred to an emergency or specialty hospital. Adjunct therapy for diabetic cats should include environmental enrichment using creative feeding tools such as food puzzles, particularly for obese cats. Oral hypoglycemic drugs are neither recommended nor considered appropriate for long-term use. Their use is considered temporary and only if combined with dietary modification if the owner refuses insulin therapy or is considering euthanasia for the pet. The initial approach to management of the diabetic cat is to initiate insulin therapy with glargine (Lantus) or protamine zinc insulin (PZI; Prozinc) at a starting dose of 1–2 units (U) per cat q 12 hr. The decision to monitor BG on the first day of insulin treatment is at the discretion of the veterinarian. The goal of firstday monitoring is solely to identify hypoglycemia. The insulin dose should not be increased based on first-day BG evaluation. If monitoring is elected, measure BG q 2–4 hr for cats on PZI and q 3–4 hr for those on glargine for 10–12 hr following insulin administration. Decrease the insulin dose by 50% if BG is ,150 mg/dL any time during the day. Treat the diabetic cat as an outpatient after the first day of monitoring, if elected, and plan to reevaluate in 7–14 days regardless of whether BG values are monitored on the first day. Immediately re-evaluate if clinical signs suggest hypoglycemia or if lethargy, anorexia, or vomiting is noted. See Algorithm 2, “Monitoring blood glucose levels in diabetic dogs and cats” and Table 1, “Insulin Products” for more information on monitoring and dosing.​
 
Thank you so much. I’m going to test every day several times, including the every 3 hours test day the vet wants - so I’ll give her more data than she probably expects. Appreciate the documents too.
 
jt and trouble (GA) said:
Good morning! Cole is one stunning cat!
Youve received some excellent advice the only thing you need is to fill in your signature with all Coles particulars. This will give anyone who comes to help all th
  • On the left, under Settings, Click on Signature. This is where you will put information that helps us give you feedback.
    • There is a limit of two lines which may include two links; you may separate pieces with commas, dashes, | etc. This is where you paste the link for your spreadsheet, once it is set up.
    • Add any other text, such as
    • Caregiver & kitty's name (optional)
    • DX: Date
    • Name of Insulin
    • Name of your meter
    • Diet: "LC wet" or "dry food" or "combo"
    • Dosing: TR or SLGS or Custom (if applicable)
    • DKA or other recent health issue (if applicable)
    • Acro, IAA, or Cushings (if applicable)
    • Spreadsheet link. Please put the signature link on the bottom line of your signature information, on its own, so it is easy to find.
    • Please do not put any information about your location in the signature for security reasons. If you wish to add your country location, please add it to your profile.
Be sure to click the 'Save Changes' button at the bottom. If you need help urgently it is important we know these things at a glance. We don’t want to waste valuable time finding out information.e info on Cole without having to ask every time you post:

WELCOME TO OUR FAMILY:bighug:
jeanne
Click to expand...

Thank you for the advice - I put the spreadsheet in but didn't think about the rest! I will update.
 
Is it a good thing or bad thing that Cole's level continues to drop - at 11.6 tonight (13 hours after the injection)? I think I'm looking for the low point, and then when the numbers start to climb again. Is this an unusually long time to keep going down?
thank you :cat: I'm pleasantly surprised that he's not too upset at me poking his ear to get the blood sample!
 
He is breaking a bounce.
Definition of a bounce: Bouncing is simply a natural reaction to what the cat's system perceives as a BG value that is "too low". "Too low" is relative. If a cat is used to BGs in the 200's, 300's, or higher for a long time, then even a BG that drops to 150 can trigger a "bounce". Bouncing can also be triggered if the blood glucose drops too low and/or too fast.The pancreas, then the liver, release glucogon, glycogen and counter-regulatory hormones. The end result is a dumping of "sugar" into the bloodstream to save the cat from going hypoglycemic from a perceived low. The action is often referred to as "liver panic" or "panicky liver". *Usually*, a bounce will clear kitty's system within 3 days (6 cycles).​

Basically, his body thinks the numbers are too low (even if they are not) and responds by releasing a whole pile of sugar into the system. Breaking the bounce means that the sugar dump is clearing from his system.

Tagging @Wendy&Neko regarding dosing.
 
At 8 kg, we'd dose him around 2 units twice a day to start with our most aggressive dosing method - but it requires 100% low carb wet or raw food. How is the food transition going in the house? If still some dry food in the picture, the starting dose would be 1.0 unit twice a day.
 
Wendy&Neko said:
At 8 kg, we'd dose him around 2 units twice a day to start with our most aggressive dosing method - but it requires 100% low carb wet or raw food. How is the food transition going in the house? If still some dry food in the picture, the starting dose would be 1.0 unit twice a day.
Click to expand...
Transition is going well - I think Cole is enjoying getting so much more wet food than we ever gave him before (it was a special treat) but the other boys still search for the dry. I think a few more days of tapering and then I'm going to stop the dry - probably by Monday or Tuesday.. Thanks for the dosing advice. I assume I should still ask my vet so we stay aligned or do most of you who are experienced adjust based on your knowledge?
 
Red & Rover (GA) said:
He is breaking a bounce.
Definition of a bounce: Bouncing is simply a natural reaction to what the cat's system perceives as a BG value that is "too low". "Too low" is relative. If a cat is used to BGs in the 200's, 300's, or higher for a long time, then even a BG that drops to 150 can trigger a "bounce". Bouncing can also be triggered if the blood glucose drops too low and/or too fast.The pancreas, then the liver, release glucogon, glycogen and counter-regulatory hormones. The end result is a dumping of "sugar" into the bloodstream to save the cat from going hypoglycemic from a perceived low. The action is often referred to as "liver panic" or "panicky liver". *Usually*, a bounce will clear kitty's system within 3 days (6 cycles).​

Basically, his body thinks the numbers are too low (even if they are not) and responds by releasing a whole pile of sugar into the system. Breaking the bounce means that the sugar dump is clearing from his system.

Tagging @Wendy&Neko regarding dosing.
Click to expand...

Is breaking a bounce a good thing? Sorry if these are super silly questions - it really is like learning a whole new language for me.
 
I
Colio said:
Transition is going well - I think Cole is enjoying getting so much more wet food than we ever gave him before (it was a special treat) but the other boys still search for the dry. I think a few more days of tapering and then I'm going to stop the dry - probably by Monday or Tuesday.. Thanks for the dosing advice. I assume I should still ask my vet so we stay aligned or do most of you who are experienced adjust based on your knowledge?
Click to expand...
It depends most of the veterans know their cats so a vet is only needed for other health issues. Some have vets that work WITH them on diabetes some (especially new members) go with a mixture of both.
 
Colio said:
Transition is going well - I think Cole is enjoying getting so much more wet food than we ever gave him before (it was a special treat) but the other boys still search for the dry. I think a few more days of tapering and then I'm going to stop the dry - probably by Monday or Tuesday.. Thanks for the dosing advice. I assume I should still ask my vet so we stay aligned or do most of you who are experienced adjust based on your knowledge?
Click to expand...
Good for you making the change to wet - I had 3 cats (one of whom was a kibble junkie and it took six months to convert him!!) when my girl was diagnosed. You can look forward to a huge difference in all their coat conditions - I was truly amazed at the difference.

In terms of alignment with vet - I was extremely fortunate to have a vet who would support me when I opted for a change in treatment based on what folks here taught me. Many vets are not experts on the treatment of diabetes - similar to GP’s they just have to know too many other things and in addition they have to know those things for many species. In human land GP’s refer people to specialists. I realize the importance of a good relationship with your vet, but I can only say the results I was able to accomplish for my girl through recommendations here were astounding - Genghis was in remission within 5 months. ECID and your mileage may vary, I hear of some vets — whether it’s ego, closed-mindedness, or their pocketbook — are very against trying the methods recommended here, but I have to say that any doctor (scientist) unwilling to explore methods with proven positive results I would seriously question.

Best of luck in your journey. You are in excellent hands.
 
Colio said:
I assume I should still ask my vet so we stay aligned or do most of you who are experienced adjust based on your knowledge?
Click to expand...
A change in diet from high carb dry low carb wet can make a huge difference in the amount of insulin needed. Make sure the vet knows you are doing that change. I told my vet all that I was doing with regards to dosing and diet. I gave her copies of Neko's spreadsheet and a copy of the dosing method I was following. Since I was her first client to home test, it was uncharted territory for her, which I think helped me.
 
Brashworks said:
Good for you making the change to wet - I had 3 cats (one of whom was a kibble junkie and it took six months to convert him!!) when my girl was diagnosed. You can look forward to a huge difference in all their coat conditions - I was truly amazed at the difference.

In terms of alignment with vet - I was extremely fortunate to have a vet who would support me when I opted for a change in treatment based on what folks here taught me. Many vets are not experts on the treatment of diabetes - similar to GP’s they just have to know too many other things and in addition they have to know those things for many species. In human land GP’s refer people to specialists. I realize the importance of a good relationship with your vet, but I can only say the results I was able to accomplish for my girl through recommendations here were astounding - Genghis was in remission within 5 months. ECID and your mileage may vary, I hear of some vets — whether it’s ego, closed-mindedness, or their pocketbook — are very against trying the methods recommended here, but I have to say that any doctor (scientist) unwilling to explore methods with proven positive results I would seriously question.

Best of luck in your journey. You are in excellent hands.
Click to expand...

Thank you for the encouragement - today was a harder day and Cole's levels stayed high all day. I know it will take some time for all the changes to have an impact, and to get to the right dosage and frequency. It definitely helps having people in this group who are so nice and have great advice and experience.
 
Hi and welcome to this amazing board! I am from Canada too, Ontario.

You are in the right place. This place is a miracle. My Blaze was diagnosed in August. I have embraced every single advise, encouragement, suggestion, help I have received here and Blaze is now in remission.

Vets are a hit and miss. If I had listened to the suggestions of my vet in August, Blaze would not be with me right now.

What I have learned here is that you need to do what works for your cat, dose wise and food wise. After my horrible experience with the vet I had in August, I changed vet and the one I have now is great. Only thing, he is adamant about giving Blaze the DM food. Blaze does not like it. I have tried, he does not eat it and walks away but he is hungry and I can tell he wants to eat and it breaks my heart to see him smell that food and walk away. So, I went back to feeding him his favourite FF pate which is low carb anyways and same brand of the DM, both Purina. I add a quarter of the DM in the plate and he eats both like that. Blaze is now eating lots and is happy when I say the word FOOD, he can't wait for that feeder to have food in it.

I have another cat too, Ash. It was hard at first to switch the dry food to wet, let alone the type of wet I was giving. But Ash, went along with it...well he did not have a choice...poor baby. But he is loving the FF pates now too and the dry for him (and only him) has now become a treat once in a while. Blaze is completely off the dry.

You are in the right place here, I am too new to give advise, but the only thing I can say is, listen to your gut as well, you know your cat better than anyone else. Observe everything your cat does, monitor, any little thing can give you information on how your cat is doing.

Sending you and your beautiful Cole loving energy to get through this!
 
Oh, and as far as the testing, some vets seem to think you don't need to test that often, but I think testing is incredibly important to figure out how your cat is doing with the dosage you are giving. Sometimes just the change in food makes a huge difference in their BG levels so if you are changing the food, make sure you test and see if there is a difference so that you know how to adjust the insulin. I kept my good vet informed of Blaze's BG with the spreadsheet. First of all he was happy I had one and he knew about the format of the spreadsheets we use on this board. He wanted to see it and was pleased when he saw that I tested Blaze and he was pleased to see his progress with that. Still now he told me to email it to him once a week.

:bighug::bighug:
 
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