Newbie - Cooper

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Gabrielle17

Member Since 2023
Hello! My name is Gabrilelle, and I'm so grateful to have found this group! :joyful: I apologize in advance if this post is too long...I have yet to learn the art of brevity...truly sorry lol.

My cat, Cooper, was diagnosed with diabetes at the beginning of March after I took him in due to excessive drinking, excessive urinating, urinating outside of the litter box, and weight loss. My vet prescribed 1 unit of Lantus twice per day, monitor via Freestyle Libre. We did not opt to change food at the time; I did not realize how important it was and the vet I suppose did not want to push anything. He was on Crave Salmon & Chicken dry food with occasional wet food of a variety of brands.

The Libre did not last. It fell off after a week, and then the new one fell off again after a day. Gave up on that method. Based on the Libre's readings during that short time being between 400 and simply "HI", she re-tested (fructosamine test, possibly?) and decided to up his dose to 2 units of Lantus twice daily and change his diet to Hills M/D Gluco Support dry food.

I saw no improvement of clinical signs after 3 weeks. Before I paid to drop Cooper off for a curve test at the vet, I decided to do some more research of my own. And here I am! I've already learned a lot. Such as the fact that the vet tech (hopefully) miscommunicated the dose on the syringe and I'd actually been giving him zero at the beginning and 1 unit later (when I thought I was giving 2)...o_O Yes, she indicated the "zero" line as the "one" line on the syringe...even after I clarified with her. I am in no way bashing, because those syringes are small, so like I said...hopefully just a miscommunication rather than her actually not knowing that. I probably should have known it, it seems logical considering it is numbered, hah! But I digress....

With that being said, Cooper is actually currently on 1 unit of Lantus twice daily. I plan to switch him to wet food completely. I was hesitant to switch right away as--from what I've gathered--it can cause his BG to go down quite dramatically. Full disclosure, I ran out of the M/D Gluco Support. I didn't want to buy a new bag since I am switching, so went back to the Crave with the I&Love&You wet food I had been feeding my other kitty (half dry and half wet). Was this a supremely bad move?

I have the Fancy Feast Classic listed in this group. I went through the "shopping list" on the Facebook group "Feline Diabetes"--I believe it is associated with this site?--and bought the ReliOn meter + supplies as well.

My main questions so far:

1. When can I switch him to wet food? I know I should switch slowly simply for GI reasons, but otherwise how soon can I do this? He is not picky whatsoever, so no issue there.

2. How often do I need to be testing his BG using the ReliOn meter? I work outside of the home 5 days a week (as I am sure most of you do), so is it okay to only be able to test a few times on days that I work?

3. How long is the insulin efficacious for kitties? My vet advised I throw away the pen after 40 days. Seems very wasteful, but of course I will do continue to do this if necessary for best results.

I have been able to get 4 readings on the meter so far, but let me know if this is not enough to answer questions. Thank you for reading this far, and thank you in advance for any advice! :cat:
 
Hi and welcome to the forum to Gabrielle and Cooper. Im glad you have found us and are going to home test the BGs and swap to a low carb diet.
Could you take a photo of the syringe you are using (showing the markings on the syringe) and also take a photo of what you are drawing up for 1 unit please?
To answer your questions:
When can I switch him to wet food? I know I should switch slowly simply for GI reasons, but otherwise how soon can I do this? He is not picky whatsoever, so no issue there.
As soon as you are hometesting the BGs you can start to do the swap to low carb wet food.
How often do I need to be testing his BG using the ReliOn meter? I work outside of the home 5 days a week (as I am sure most of you do), so is it okay to only be able to test a few times on days that I work?
Always test before every dose to make sure it is safe to give the dose. Depending when you leave for work, you might be able to get a +2 before you leave or a +10 when you get home. It is important to get tests in the PM cycles as well so always get a before bed test and if that test is much lower than the preshot test, I would set the alarm and getup and test again to see the BG has not dropped too low.
Dont feed for the 2 hours before the preshot BG so the BG is not food influenced.
How long is the insulin efficacious for kitties? My vet advised I throw away the pen after 40 days. Seems very wasteful, but of course I will do continue to do this if necessary for best results.
Are you using a pen or syringe for giving the doses?
If you keep the insulin in the fridge...not the door...it will last for 6 months.
I have been able to get 4 readings on the meter so far, but let me know if this is not enough to answer questions. Thank you for reading this far, and thank you in advance for any advice! :cat:
I can only see 2 BGs so far. We will need to see a few days of reading before we can say what is going on. Well done getting the SS up and running and the signature... that is very helpful for us.
Use the remarks column of the Ss to tell us what food you are feeding, how he is etc.
Keep asking questions
Bron
 
Welcome to FDMB!

We have an overwhelming amount of information we can guide you to so please, let us know what questions you have. The beginning of this process is without question, overwhelming and we don't want to inundate you too much!

A good place to start are the sticky notes at the top of the Lantus forum. There's information on Lantus, dosing methods, photos of syringes and more!

Many of us work (or worked) while managing our cat's diabetes. I worked full time and then some throughout Gabby's diabetes journey. There are a few things that can help. First, with most insulin, you want to always get a pre-shot test as Bron suggested. You also want to get at least one additional test during both the AM and PM cycles. Lantus dosing is based on how low the dose takes your cat's numbers so the closer to the nadir (lowest point in the cycle) is the place where it's most helpful to test. However, it's not always possible to test at nadir, especially if you work or it's in the middle of the night and you're asleep. If you look at Bron's cat, Sheba's spreadsheet or my Gabby's, you'll notice that we tested considerably more than 4 times a day. I was admittedly a testaholic. We both also followed the Tight Regulation Protocol which has the advantage of having a great deal of research to support its use but is a more aggressive approach to dosing.

I used a Lantus pen (vs a vial) and drew off the insulin with a syringe. I typically used up all of the insulin in the syringe. It would take close to 3 months to use up all of the insulin. You can use the insulin for as long as it's effective. If you see crystals (aka "floats") in the insulin, it's no longer effective. I have one pen that was a dud due to a clumsy pharmacy tech who banged the insulin on the counter.
 
Hi and welcome to the forum to Gabrielle and Cooper. Im glad you have found us and are going to home test the BGs and swap to a low carb diet.
Could you take a photo of the syringe you are using (showing the markings on the syringe) and also take a photo of what you are drawing up for 1 unit please?
To answer your questions:

As soon as you are hometesting the BGs you can start to do the swap to low carb wet food.

Always test before every dose to make sure it is safe to give the dose. Depending when you leave for work, you might be able to get a +2 before you leave or a +10 when you get home. It is important to get tests in the PM cycles as well so always get a before bed test and if that test is much lower than the preshot test, I would set the alarm and getup and test again to see the BG has not dropped too low.
Dont feed for the 2 hours before the preshot BG so the BG is not food influenced.

Are you using a pen or syringe for giving the doses?
If you keep the insulin in the fridge...not the door...it will last for 6 months.

I can only see 2 BGs so far. We will need to see a few days of reading before we can say what is going on. Well done getting the SS up and running and the signature... that is very helpful for us.
Use the remarks column of the Ss to tell us what food you are feeding, how he is etc.
Keep asking questions
Bron

Hey there! I appreciate your response!

Understood, I will definitely try to do at least four tests. And I can for sure do the tests before each shot, I planned on that at the very least.

I am using a syringe to draw up the insulin, but the insulin itself is in a "pen" rather than a vial. If I remember correctly, the vet said the benefit of this was that I wouldn't be wasting as much as it's a smaller amount.

Yes, I realized I only actually had gotten 3 tests at the time, and one I didn't add because it was at like 9pm when I was just seeing how to reader worked. Sorry for the confusion! Thank you for mentioning the "Remarks" column--I somehow missed that!

Here are the photos you requested! The syringes are U-100 3/10cc 31G, ReliOn brand from Walmart.

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Welcome to FDMB!

We have an overwhelming amount of information we can guide you to so please, let us know what questions you have. The beginning of this process is without question, overwhelming and we don't want to inundate you too much!

A good place to start are the sticky notes at the top of the Lantus forum. There's information on Lantus, dosing methods, photos of syringes and more!

Many of us work (or worked) while managing our cat's diabetes. I worked full time and then some throughout Gabby's diabetes journey. There are a few things that can help. First, with most insulin, you want to always get a pre-shot test as Bron suggested. You also want to get at least one additional test during both the AM and PM cycles. Lantus dosing is based on how low the dose takes your cat's numbers so the closer to the nadir (lowest point in the cycle) is the place where it's most helpful to test. However, it's not always possible to test at nadir, especially if you work or it's in the middle of the night and you're asleep. If you look at Bron's cat, Sheba's spreadsheet or my Gabby's, you'll notice that we tested considerably more than 4 times a day. I was admittedly a testaholic. We both also followed the Tight Regulation Protocol which has the advantage of having a great deal of research to support its use but is a more aggressive approach to dosing.

I used a Lantus pen (vs a vial) and drew off the insulin with a syringe. I typically used up all of the insulin in the syringe. It would take close to 3 months to use up all of the insulin. You can use the insulin for as long as it's effective. If you see crystals (aka "floats") in the insulin, it's no longer effective. I have one pen that was a dud due to a clumsy pharmacy tech who banged the insulin on the counter.

Hi! ^_^

I have read through a bit on the Lantus Forum, but there is a lot, so I will definitely keep revisiting that one! Thank you!

I would love to get as many tests as possible. The issue I am having now is not getting enough blood for testing many times. And I've bruised his poor ear :( He doesn't seem to notice, but I'm sure it doesn't feel good. Am I being too heavy handed if this is happening? I have been sure to be patient with warming the ear up, but perhaps I am simply too rough with the lancet. I only try 3 times before I give up and wait for the next time I'm able to test. Poor Coops.

Yes, I am also using the Lantus pen rather than a vial. Good to know that it should last me a bit longer. :) Do you happen to have a picture of the "floaters" you mentioned? I am worried that I may need to get new insulin. My vet did not let me know that if I draw up too much insulin, I shouldn't shoot it back into the pen, but rather into the sink. I was doing that before, I'm afraid...though this pen is fairly new, and I stopped doing that as soon as I read it here, I'm not sure if I already ruined it. Wish I had known because this stuff isn't cheap LOL. But alas, I love this cat dearly, so he is now in charge of my bank account. :p
 
Hi and welcome!

I always shot the excess back in before I knew better and my insulin never got ruined. Also just to give you an idea, an unopened and unused pen will last until its expiration date of 2 years or more. An opened refrigerated pen should last about 6 months as Bron said. If you’re diabetic and take the pen with you everywhere, so it’s at room temp most fo the time, then it would last only about a month. If it looks like clear liquid when you look at the pen, it’s fine.

Thanks for the pic. That is 1 unit so good job. The line just before the one you indicated in red would be 1/2 unit.

Are you warming up the ear well so it’s warm to the touch? The ears will learn to bleed over time but I want to make sure you’re a) using a larger gauge lancet like a 26 or 28 and are b) aiming for the sweet spot:
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We also always recommend giving a low fat treat immediately after the test, whether it succeeds or fail, to build positive association.

not sure where you got your Lantus pen from, but a lot of us got them from Mark’s pharmacy in Canada because it’s a 1/3 of the cost. I was getting them for about $35 each:

https://canshipmeds.com/

A lot of members have also had luck with online coupons for human pharmacies like Ride Aid and I hear Costco pharmacy also has good pricing. Lastly, you can always check out our supply closet forum. That’s where members will sell their extra supplies.
 
I think Ale meant a low carb treat (not a low fat treat!).

I'm also not sure that how long a pen lasts depends on whether or not it's refrigerated. When the pens came on the market, they were designed to not need refrigeration. Refrigeration was a major drawback of most insulin since it made travel difficult. With the pens, a consistent temperature is what's important although I do suspect that the refrigeration may extend the life of the insulin. Since cats use a great deal less insulin than a human is typically dosed, the refrigeration means you are likely able to use every drop that's in the pen.

I don't have a picture of the floaters. It looks like small pieces of ice.
 
Hi and welcome!

I always shot the excess back in before I knew better and my insulin never got ruined. Also just to give you an idea, an unopened and unused pen will last until its expiration date of 2 years or more. An opened refrigerated pen should last about 6 months as Bron said. If you’re diabetic and take the pen with you everywhere, so it’s at room temp most fo the time, then it would last only about a month. If it looks like clear liquid when you look at the pen, it’s fine.

Thanks for the pic. That is 1 unit so good job. The line just before the one you indicated in red would be 1/2 unit.

Are you warming up the ear well so it’s warm to the touch? The ears will learn to bleed over time but I want to make sure you’re a) using a larger gauge lancet like a 26 or 28 and are b) aiming for the sweet spot:
View attachment 67059

Good to hear my insulin is probably still good, thank you! It is clear!

Yes, I warm up his ear for a good 30 seconds, and sometimes warm it again if he is too squirmy while I insert the strip into the meter. I've realized that he is so frenzied over getting a treat (or getting breakfast/dinner when that is the case) that he is getting very squirmy, which in turn makes me feel the need to hurry the process. I think this is my issue as I am not able to properly aim the lancet or "poke" enough--and when I do, I do it maybe too hard. I have decided I will wrap him snugly in a towel from now on, just so neither of us gets hurt. The amount of times he has tried to eat the lancet out of my hand thinking it is the freeze-dried chicken treat...:nailbiting:

And yes, I have been giving freeze-dried chicken each time, even if I am unsuccessful! :) Thank you for mentioning finding lower prices on the insulin. I am in the U.S., but I think I saw a few resources on here that I need to look into for that!

I think Ale meant a low carb treat (not a low fat treat!).

I'm also not sure that how long a pen lasts depends on whether or not it's refrigerated. When the pens came on the market, they were designed to not need refrigeration. Refrigeration was a major drawback of most insulin since it made travel difficult. With the pens, a consistent temperature is what's important although I do suspect that the refrigeration may extend the life of the insulin. Since cats use a great deal less insulin than a human is typically dosed, the refrigeration means you are likely able to use every drop that's in the pen.

I don't have a picture of the floaters. It looks like small pieces of ice.

Is freeze-dried chicken a good choice of treat? I figured it would be good since a raw diet is considered "best" for most cats (when done correctly).
That is good to know about the pen! Yes, luckily it is still clear with no floaters! That is good to know what to watch out for. Thank you! :cat:
 
Any freeze dried treats are great and yes I meant low carb not low fat :nailbiting:

No worries!

Also...sorry...just wanted to make sure about this, if you guys don't mind! I just started switching Cooper to Fancy Feast. I gave him one can for dinner with some of the Crave dry food. His PMPS BG was 452 at 6:57pm. Now it is was 273 at 8:48pm. Is that normal for it to be such a big difference? I am only asking because he hasn't been this low since I started the home testing—which, admittedly, has only been 2 days and I don't have a lot of data yet.
 
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Thanks for posting photos of the syringe and dose. All good!
It is always good to check if there is any doubt...we sometimes have people who have been given the wrong syringes and/or are drawing up the incorrect amount of insulin.
 
No worries!

Also...sorry...just wanted to make sure about this, if you guys don't mind! I just started switching Cooper to Fancy Feast. I gave him one can for dinner with some of the Crave dry food. His PMPS BG was 452 at 6:57pm. Now it is was 273 at 8:48pm. Is that normal for it to be such a big difference? I am only asking because he hasn't been this low since I started the home testing—which, admittedly, has only been 2 days and I don't have a lot of data yet.
Sometimes yes, but I see you got a +4 and he’s staying in the 200s if seems.
 
Hello! Me again...I wasn't entirely sure if I should start a new thread yet or just continue this one.

I have collected a bit more data for Cooper boy. I was wondering if this was enough to tell us anything yet or if I need to get more readings. Just want to be sure I'm doing all that I can for him!
 
Thank you both so much! I will not be able to test him as often today as I did the past two days when I was able to work from home, but hopefully I will get at least 4 tests in.

Also, I have tried to research a bit on what numbers I should be looking for. I think I am over thinking it. I see on the spreadsheet that numbers less than 50 are "green"; however, I also see many posts about people being very concerned when their cat reaches numbers at around 100. I read in a file for Lantus specifically that perhaps 90 and lower should be cause for concern. I doubt I will be seeing these numbers soon, but I just wanted to be sure I understand what to look out for. What are "good numbers"?
 
Normal numbers for a cat are 50 to 120. You will be unlikely to get these numbers until Cooper is regulated and ready to do an off the juice ( insulin) trial.
As you are doing SLGS any time the BG drops under 90, Cooper earns a reduction.
Numbers under 100 are green and under 50 are lime green.
At the moment you are aiming to gradually reduce the BG numbers and go from red to pink to yellow to blue. This takes time and can’t be rushed.
You are doing everything right. You are hometesting the BGs to keep him safe. You are feeding a low carb diet and you are giving an excellent insulin for cats.
I would recommend you test the urine for ketones a couple of times a week. You need a bottle of Ketostix to do this. There should be no ketones in the urine. Let us know if you find any. And anything above a trace needs to be reported to the vet.
 
Normal numbers for a cat are 50 to 120. You will be unlikely to get these numbers until Cooper is regulated and ready to do an off the juice ( insulin) trial.
As you are doing SLGS any time the BG drops under 90, Cooper earns a reduction.
Numbers under 100 are green and under 50 are lime green.
At the moment you are aiming to gradually reduce the BG numbers and go from red to pink to yellow to blue. This takes time and can’t be rushed.
You are doing everything right. You are hometesting the BGs to keep him safe. You are feeding a low carb diet and you are giving an excellent insulin for cats.
I would recommend you test the urine for ketones a couple of times a week. You need a bottle of Ketostix to do this. There should be no ketones in the urine. Let us know if you find any. And anything above a trace needs to be reported to the vet.

Okay, great, that all makes more sense now! I will also start testing for ketones. :) Thanks again!
 
We also always recommend giving a low fat treat immediately after the test, whether it succeeds or fail, to build positive association.

not sure where you got your Lantus pen from, but a lot of us got them from Mark’s pharmacy in Canada because it’s a 1/3 of the cost. I was getting them for about $35 each:

https://canshipmeds.com/

A lot of members have also had luck with online coupons for human pharmacies like Ride Aid and I hear Costco pharmacy also has good pricing. Lastly, you can always check out our supply closet forum. That’s where members will sell their extra supplies.
 
Mark's is great. They put me onto the Glargine cartridges. I order a box of 5 Glargin cartridges (don't use the pen, use a syringe) at one time and each cartridge lasts about 2.5-3.0 months, the 5 cartridges last about 10 months to 1 year. Of course, this could differ depending on the number of units at each shot. I also get my boy's Flovent asthma inhalers from Mark's.
 
Mark's is great. They put me onto the Glargine cartridges. I order a box of 5 Glargin cartridges (don't use the pen, use a syringe) at one time and each cartridge lasts about 2.5-3.0 months, the 5 cartridges last about 10 months to 1 year. Of course, this could differ depending on the number of units at each shot. I also get my boy's Flovent asthma inhalers from Mark's.
I used another Canadian pharmacy for Minnie’s inhaler which was actually way cheaper than Marks :D
 
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Hi, I'm back and in need of guidance lol.

I tried to do a curve today. It seems his numbers have been all over the place this past week, though maybe it just seems that way since I didn't test as often.

I assume I need to go up to 1.5 twice a day now?

Also, he seems to be constipated lately so I did give him 1/8 tsp of pumpkin.
 
Hi, I'm back and in need of guidance lol.

I tried to do a curve today. It seems his numbers have been all over the place this past week, though maybe it just seems that way since I didn't test as often.

I assume I need to go up to 1.5 twice a day now?

Also, he seems to be constipated lately so I did give him 1/8 tsp of pumpkin.
Yes, I would go up to 1.5 U twice a day for 7 days unless he drops below 90.
Keep trying to get a test in during each cycle if you can.
I think you are doing everything right. You just haven’t reached the best dose yet. It takes time and patience. That was something I had to learn!
If he is still constipated I would increase the pumpkin. I give 1/2 teaspoon two or three times a day if needed.
 
Thank you for the encouragement! :)

So when you say "each cycle", what exactly do you mean? And do you mean a curve test or just a BG test in general? :) Sorry, I just want to make sure I'm clear lol.

I remember previously that you said he earns a reduction if he drops below 90. So that is a reduction of .25, right? I assume if he is that low at pre-shot I would skip? Though I know I won't be worrying about that for a long while yet! I am just so scared of the big bad hypo, as I'm sure everyone is lol!
 
So when you say "each cycle", what exactly do you mean? And do you mean a curve test or just a BG test in general? :) Sorry, I just want to make sure I'm clear lol.
It is good to ask questions. That is how you learn:)
A cycle is 12 hours. So try and get. Test in each cycle if you can. That way we can see how low the dose is taking Cooper. Lantus dosing is based on the nadir or lowest point in the cycle so you can see what it is important.
A curve is what you do each 7 days and consists of testing each 2 hours during the cycle. This is another way to see how low the dose is taking Cooper. The only drawback with that is if he os bouncing on the curve day.that is why those spot checks during the others days is so good.

I remember previously that you said he earns a reduction if he drops below 90. So that is a reduction of .25, right? I assume if he is that low at pre-shot I would skip? Though I know I won't be worrying about that for a long while yet! I am just so scared of the big bad hypo, as I'm sure everyone is lol!
If he drops under 90, you reduce the dose by 0.25U. If you post we can confirm that.
Getting those tests in during the cycles is telling you how he is going and you are in control. If you are ever concerned he is dropping low, or you find a lower than normal test during the cycle, test again an hour or two later.
If he is low at preshot, you would stall, don’t feed and test again in 20 minutes and post and ask for help.
From the SLGS dosing method
Until you collect enough data to know how your cat will react, we suggest following the guidelines in the FDMB's FAQ Q4.4:
Q4.4. My cat's pre-shot level was way below the usual value. Should I give the injection?
A4.4. There's no hard and fast rule, but if you don't have data on how your cat responds to insulin, here are some general guidelines.

  • Below 150 mg/dl (8.3 mmol/L), don't give insulin.
  • Between 150 and 200 (8.3-11.1 mmol/L), you have three options:
    • a.) give nothing
    • b.) give a token dose (10-25% of the usual dose)
    • c.) feed as usual, test in a couple of hours, and make a decision based on that value
  • Above 200 (11.1 mmol/L) but below the cat's normal pre-shot value, a reduced dose might be wise.
  • In all cases, if you are reducing or eliminating insulin, it's wise to check for ketones in the urine.
  • Above the normal pre-shot value, give the usual dose, but if the pre-shot value is consistently elevated, it's a good idea to schedule a full glucose curve to see whether a change in dose or insulin is appropriate. In most cases, the target "peak" value should not be below 100 mg/dl (5.6 mmol/L), and for some cats it might be higher.
I think you are ready to start posting over on the LLB forum where everyone uses Lantus, Levemir or biosimilar. If you post over there every day, they will get to know you and Cooper and will be able to help you. If every day is too hard, less often is OK bit more frequently in the beginning will help.
Here is a link to LLB page
And a link to THE BASICS, NEW TO THE GROUP
 
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