Newbie DX 12/15 on Lantus

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Rick & Mr. Grey

Rick & Mr. Grey

Member Since 2012
Hi from Rick, wow this site is amazing ! I am a cat man with 2 fems 8 yrs old "Butterscotch" and 4 yrs "Lima" and 1 male cat Mr. Grey. All 3 have been raised on Iams dry and occasional canned tunafish, and home made turkey, or chicken I cooked as a meal for them once in a while. Mr. Grey is male tuxedo 8 yrs old, indoor/outdoor 12 lbs. DX 12/15/12 with BGL 564. I new something wasn't right since for several months he was peeing me out of house and home and drinking profusely. Vet put him on Lantus starting at U4 twice daily.I started home testing a few days ago and I am gearing up for a spreadsheet. We gradually had to raise him and today is his 1st day of U10 twice daily. Today's 2nd pre shot/food BGL was 383. Fed him Wellness Core Grainfree Indoor then at +2 his BGL was 312. I think he also ate a little Purina DM dry before I fed the wet. So in 2 hours levels went down but why so little ? U10 seems like a big dose compared to what I've been reading here so far. It seems that we might have to raise his Lantus dose even higher soon. How high could a dose actually get to bring him to a nominal level. I will keep testing as long as I am awake tonight. Thanks community !
 
10 units? and the vet started him on 6 units? Twice a day? And he's been on Lantus for two weeks?

Can you contact your vet tomorrow? Could you please share this info with him?
http://www.aahanet.org/PublicDocuments/AAHADiabetesGuidelines.pdf

Those are the AAHA guidelines for dosing of insulin for diabetic cats. Just about every cat, by those guidelines, would start at 1 unit, twice a day. Some would start lower than that. It sounds like your vet might not be aware of the guidelines.

6 units is an insanely high dose of Lantus to start. 10 units even more so.

Do you have two weeks worth of test data? You should test before every shot, and you also need to find the low point in the 12 hour cycle, which typically happens 5-7 hours after a shot. There is a good chance that his BGs are going low in the middle. So low that they are causing his body to trigger a release of "sugar" from his liver into his blood stream to stop him from going hypoglycemic. When that happens, the BGs quickly climb higher, usually higher than you started the cycle at. This could be why his numbers at shot time seem to be high often.

Please find out if your vet is experienced with Lantus, and ask if he's ever read the Queensland protocol for treating diabetes with Lantus.
http://felinediabetes.com/Roomp_Rand_2008 dosing_testing protocol.pdf I have a sense that the answer to both those questions will be "no" when they really should be "yes".

Carl
 
Thank you for your reply, Upon my first visit he did a urine test and found sugar in his urine. Then he did a BGL test with a portable in home machine to get a level. His machine said 548. He then said we should take a blood sample and send out to a lab looks like Diabetes. Told me to come back 2 days later on Monday. I left my cat with him all day Monday so that he could give low doses and see how the cat reacts. When I came to pick up the cat he showed me the lab report which stated, ALT(SGPT) 187 H, Chloride 96 L, Cholesterol 295 H, Glucose 564 H. He explained that his glucose meter was close to lab, and that those high other numbers were reactions typical of a diabetic cat and they should subside as we lower his BGL. I'm trying to restate from my memory and I'm probably not using his words completely. He did start the Lantus that day in vet's care if I can remember at 1U perhaps, and he explained that Mr. Grey had to be with him the whole day in case he goes Hypo from the insulin. He did not tell me what Mr.Grey's BGL was at the moment I was bringing him home. I was given instructions how to shoot and I did a water shot very good, I was taught the dangers of HYPO and given print outs of instructions how to deal with Insulin overdose and how to shoot with pictures and diagrams. He also informed me to change his diet to prescription food like Purina DM and gave me a bag. I had to bring Grey back to office in 2 more days so he could test his levels as I was not doing in home yet. I went home on Monday with a 100U bottle of Lantus, instructions, 2 bags of needles and I was to dose him 2 times a day at 4 units and watch for signs of Hypo. On wednesday vet checked his levels and upped the dosage to 5U. HE even had me do another test shot to check my technique. Look I'm new at this and allot went in one ear and out the other, but I learned allot from the internet in these few weeks. When I took him in 3 days later on Saturday he tested high BGL and vet upped the dosage.I then got my own tester as he wants to charge 20 $ for a home unit test in his office !!! I called him when I was getting high readings and he told me over the phone to up the dosage and here we are at 10U twice daily. I am supposed to call him when I wake up with my results and we would schedule me to come in. I'm scared now and I'm not sure what's going on any more. Should I loose my trust in this vet ? I want to perform a curve, I want to have a meticulous spreadsheet, I want to see this Lantus bring his levels down. I have also decided to not feed him dry anything food and stick to canned food like Wellnes or home made food.
 
Oh and one more thing for the community, should I be smelling the insulin on his body. It smells like liquid band aids ??? I was afraid that means maybe I'm not shooting him correctly, but I can tell I am shooting him good. ???
 
Carl & Bob said:
....10 units? and the vet started him on 6 units? Twice a day? And he's been on Lantus for two weeks?

Carl
Click to expand...

Crikey! That is a huge starting dose, and a huge dose increase..... :shock:

Yes, your cat may well be dropping too low between shots. And that, in turn, could be causing his liver to respond by kicking glucose into the system (and also maybe glucagon, which is a sort of 'anti-insulin', that works to keep the blood sugar high temporarily).

Thank goodness you are hometesting! That, above all else, will help you to keep your cat safe.

You need more testing data. Urgently, I would suggest! And especially you need to know how low he is dropping at the peak of the insulin cycle (blood glucose nadir (lowest BG)).

Do I understand you correctly that you are intending to remove the dry food? Please do not do not remove the dry food yet! Dry food elevates blood glucose. So, removing dry food lowers the blood glucose, sometimes quite dramatically. For a cat on insulin dry food should only be removed with careful monitoring of the blood glucose levels.

Oh, I forgot to say; Welcome to FDMB!
 
Sometimes a little insulin does leak out. It would likely happen more with the hight does you are giving.
As the other have said 10 units seems too high, especially so soon.
Going from 383 to 312 in two hours is not unexpected since Lantus tends to cause not much of a drop. The Lantus builds up (shed) and the BG before a shot time drops over a few days.
Based on that data 10 units may not be that far off.
Keep getting BG reading every two hours and post the results.
 
Welcome, Rick.

I'm trying to pick my jaw up off of the floor. This seems to be an unusually high dose of Lantus. There are certainly cats that get 10u or more but they usually have what's termed a "high dose" condition. Further, Mr. Gray's dose is not being systematically worked up to this level. As a result, it's entirely possible that he needs less insulin. Frankly, I think what may be preventing Mr. Gray from experiencing symptoms of hypoglycemia is the DM dry food -- it's 14% carbohydrate. If you are, in fact, switching him over to Wellness or homemade food, please either reduce his dose of insulin or monitor your cat aggressively. Most of the low carb varieties of Wellness are approx. 4% carb and homemade is less. You may want to take a look at Dr. Lisa Pierson's website on feline nutrition. She has a recipe for homemade food that is nutritionally complete. She also has links to a food chart that contains carb levels. You want to be giving Mr. Gray low carb food that is under 10% carbs. Most of us feed substantially less than 10%.

There are several factors that it sounds like your vet has not considered with his approach to dosing.
  • First, Lantus is a depot-type of insulin. This means that doses need time to settle. When a dose is changed, we typically give it 3 - 5 days to determine its effectiveness. Rapid changes in dose result is weird numbers.
  • Based on the published research, dose changes should be made in no more than 0.5u increments. The typical increase is 0.25u. It sounds like your vet is increasing Mr. Gray's insulin by considerably more than the recommended amount.
  • For many cats whose dose is based on numbers taken at the vet's office, those numbers reflect vet stress. The BG numbers are inflated (compared to what you'd see at home) due to the stress of being at the vet's office. If this is all that the dose is based on, it's very easy to end up overdosing your cat. Now that you're home testing, you'll have better information.
  • The initial dose of Lantus can be based on a formula: initial dose = 0.25 x ideal weight in kilograms. This usually calculates out to around 1.0u. In most cases, this first dose is held for a week in order for the depot to form.
  • With a too high dose of insulin, there is the possibility that there is a drop into lower numbers toward the middle of the cycle and then a bounce back into higher numbers at pre-shot times. Lantus dosing is based on the low point (i.e., the nadir) of the cycle. Pre-shot values are important only to the extent that you need to know whether it's safe to give an injection.

The journal article I referenced is below. You may want to share this with your vet. The protocol included in the article is the same as the one Carl linked. Vets tend to be more open if you hand them the research.


I'm a denizen of the Lantus board. To be honest, I find the amount of insulin Mr. Gray is getting to be worrisome. It's particularly concerning if you are switching to low carb food and because the doses have not been raised in small, systematic increments. This makes it very difficult to know if you've missed what could be a "good dose" for Mr. Gray.
 

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Hi guys .. I just wanted to welcome you to the board, and add in with the others 10 units seems like an AWFUL lot of insulin in such a short time! Not saying there are not cat's out there that need it, but not really ever in two weeks .. I know it is hard to trust the people "online" vs the vet, but people on here deal with their diabetic cats every single day, for years on end .. while a vet may read a chapter in the book while attending college and then deal with one or two diabetic cats a year, in a quick vet appointment .. People on here know what they are doing and what they are talking about .. Just hang in there, they'll get you on the right track!
 
Hi Rick, and welcome,

I had an experience similar to yours with my previous diabetic cat. His vet started him on a high dose of Lantus and kept increasing it at very short intervals. My kitty looked and felt worse and worse and finally his numbers dropped out. If I had not found this Board, I would have lost him. Please listen to the very experienced and knowledgeable people here. Share the cited professional journal articles with your vet. If he refuses to believe you, think about finding another vet, or consider treating his diabetes more or less on your own, with the aid of the Board here. The people here deal with Feline Diabetes 24/7 and the cumulative knowledge is awesome.

Wishing good thoughts for Mr. Gray,

Ella & Rusty
 
Hi Rick and welcome to Lantus Land. The vet that dx our cat wasn't familiar with Lantus and didn't think home testing was necessary. But after giving him some information that I received from the folks in this form he change his mind and now is prescribing Lantus & home testing. He prescribed 2U twice a day but I followed the advise here and began at 1U twice a day. That was four months ago and we still are not at the 2U twice a day.

Based on my experience I must say the people on this forum are very knowledgeable and will give you excellent advise. They will always have Mr. Grey's best interest in mind when advising.

Again welcome and finding this forum is the best thing that could have happened for Mr. Grey.
 
Welcome Rick! Our vet knew about Lantus and is very open to receiving new information. I found FDMB very early on, and after she saw that I was willing to home testing very regularly, she defers to my (with FMDB's help) decisions regarding dosing. She even admitted I could teach her stuff about feline diabetes. Some vets aren't this progressive, but I think it's from lack of experience in the area or lack of willingness to learn a little more about practical use of testing and insulin with kitties.

I'll echo what others have said - I was wary at first trusting "online people" rather than my vet, but my experiences here proved this is one of the most professional and knowledgeable board I've been a part of in most any topic outside of medicine too. Please do take a step back on the dose as others have advised. If Mr. Grey really does need that high a dose of insulin, then working up to that dose using the protocol and the advice of the gurus here will give you a ton of good information in managing him no matter where his dosing needs take him.

Lisa &Leo
 
OK thanks for all responses so far. Called vet this morn had a very concerned conversation with him based on my feelings from my home testing and what I've read above. I questioned the dosage amount of 10U and we decided to lower the dose to 6U twice daily and in 1 week he wants to see him and keep him for a day to monitor and do a curve. He does not like that I am doing in home BGL testing, but then he said I'd have to keep VERY accurate data that we can refer to. In other words he rather me bring the cat in and charge me $ 20.00 for what I can do at home. He got a little defensive at one point and wondered out loud if I should look for a new vet from this forum, (that wasn't so nice ?). I might have been frustrating him a little too much over the phone. So far today as per vet, 6U Lantus @ 12:45pm I was having trouble getting blood from his both ears it either wicked into his fur or just wouldn't bleed. I poked almost 10 times wasted a few test strips as they error'd and quit to give us both a break. Will try to test again @ +3.
 
Rick,
Unfortunately, we seem to see that reaction from too many vets. Especially those that might not be big users of the internet. They appear to believe that most of the information on the 'net is from "crazy cat people". There are actually a couple of vets who post here on occasion. Some of us are very fortunate, and have vets who support home testing, support dosing protocols, and are "current" on treating feline diabetes. The best scenario is having a vet who is willing to go along for the ride and learn without feeling somehow "threatened".

Carl
 
Even 6 units is a very high dose. Most of the cats here are on 1 - 2 units per dose. If you are still feeding your cat dry food, please do not stop feeding this until you lower your dose considerably more. The dry food may be the main thing that is keeping your cat from becoming hypoglycemic.

I would recommend that you start back over at one unit twice a day. With Lantus and most other long acting insulins, you must stay at a consistent dose for at least a week before determining if you need to increase it. It takes the body that long to give it time to adjust to the new dose. Once you reduce the dose back to one unit, then you can also begin switching your cat's diet to canned or raw food and remove the dry from it. It is critical that you do not try changing the diet while at a high dose.

You want to test before every shot and shoot only after your cat has finished eating. For newbies, we recommend not giving insulin if the BG reading is less than 200. As you begin to learn how your cat responds to the dose you are giving, you will be able to lower your "don't shoot" number. If after a week at a consistant dose you determine you need to increase it, you only want to increase it by 1/2 unit. Again, you will stay at the new dose for a week before making another change. The only exception is if you see the BG levels dropping too low, then you want to go ahead and decrease the dose.

If you are still getting high readings at a high dose, it could be that your cat is experiencing Somogyi effect or rebound. In order to protect itself from becoming hypoglycemic when too much insulin is give, the body releases extra glucose to counteract the high insulin dose. So you will get high BG readings. Most likely you have missed your optimal dose. By starting over at a low dose and gradually increasing it over several weeks time, you will find the optimal dose that works best for your cat.

It sounds like your vet may not be experienced with Lantus. Lantus is a long acting insulin that builds up a "shed" or reserve in your cat's body. That is why a consistent dose is needed. Your vet will probably discourage listening to someone on the internet, but you have lots of people on this site that have been caring for diabetic cats for years. Many of us have cared for more than one diabetic cat and many of us have adopted diabetic cats. So we do understand the day to day care that is needed for a sugar kitty. We also have several vets that are members of this site and your vet is welcomed to join us.
 
Honestly, it's only week 2 and this is really wearing on me. I am a single man with 3 awesome cats. I am a professional musician and piano teacher in homes. I Live in my recording studio I do not a have a set 9-5 schedule, I live an in the moment very dynamic healthy life. It is far from self indulgence though. I practice holistic and Homeopathic health on myself, (and others sometimes), I will see an acupuncturist, and I have not had an antibiotic since 1990 in my system. I've gotten used to my cats being in optimum health as well and have had cats for 8 years this way. We were a family all very much in sync. Now it's looking like I have to be dedicated in a whole new way to Mr. Grey and as I read through various spreadsheets and the notes, my head is throbbing and I'm scared I won't be able to follow a very strict dosing schedule and feeding. I'm used to leaving out 3 bowls of dry Iams for 3 cats who feed themselves not to indulgence. I know that I can be gone overnight and they'd all still have food by the time I return the next day. My vet is scaring me, I don't know how to go from here other than what he last told me to do (see above), In 2 weeks I guess I have gone from Grey's DX to feeling no problem this will be 2 shots a day until his pancreas heals, a new diet, and then no more insulin like my friend's cat... I asked vet do we start from ground zero to clear things up and get him down from 10U he said let's do 6 U for a week now... Do I SWITCH VETS at this point ? And how would I approach a new vet anyway ??? :-( <3
 
Rick,

Where do you live (city/state)? We have members all over the world. Someone close to you might have a vet recommendation.

This disease is very overwhelming to just about everyone at first, so you're not alone in that. There's just so much information on this site that it's impossible not to be blown back by it all. Feline diabetes doesn't mean you have to restructure your entire life. Yes, some changes, like diet, and a need to be able to shoot on a 12 hour schedule need to be figured out. But we aren't chained to our cats and our glucometers. You'll need to test before every shot, and try to get a test in the middle when you can. Once a week or 2 weeks, a curve might be a good idea. It becomes a routine that you can work with and work around.

Yes, I'd look for another vet for a 2nd opinion. Unless your cat has been diagnosed with a "high dose" condition, and it doesn't sound like your vet has made that diagnosis, then the doses he's had you giving are illogical.

There's also I "questions to ask a new vet" list around here somewhere. I'll try to find it and link you.

Carl
 
We've probably all felt lost and overwhelmed and didn't what we were going to do, and somewhat in shock and wondering how we were going to do this, when our cats were first diagnosed.
Maybe Mr. Grey will be one of the lucky ones and will get off insulin.
I know when my cat was first diagnosed, I kept going from vet to vet to vet trying to find one that I thought knew somethimg about diabetes. I did not feel like any of them in my area did. Eventually, my cat had DKA and was hospitalized in Philadelphia for 8 and 1/2 days. Tomorrow will mark the 8 year anniversary since the day he was released. What a magnificent day that was to get my cat back home. Anyway, Philadelphia is over an hour and sometimes an hour and a half drive for me. The main vet at the University Of Pennsylvania School Of Veterinary Medicine where he was hospitalized heard my concerns and declared to me "I'll be his vet from now on". And, she kept making these follow up appointments for us, (often during commute hours :shock: ) and no matter how hard I tried to get them to understand I live far far away, they just didn't get it, so eventually I asked her if I could use a local vet to do the tests she wanted done and fax the results to her, and we could then discuss them via phone call in the evenings.
So, my local vet has always done what I told him I wanted done.
Eventually, the vet at the UPenn Hospital moved away to California and my local vet became our "regular" vet. He still is good about letting me do what I do for J.D.'s diabetes and is proud of how well I have taken care of him. Even though this vet is younger than I am, he calls this board "my net friends" and I am probably his only client who home tests, and maybe his only client who uses Lantus or Levemir. But 99% of the time, he works with me.
I hope you can find a vet that you are satisfied with and who will work with you and us, in the treatment of Mr. Grey.
 
hi Rick
welcome to FDMB!

Just wanted to say that it does get better!! I started 3 months ago and was completely overwhelmed - 3 cats and 2 kids under 10, plus working full time.
My cats had all had dry food left out all day and then I switched to wet food - it made sense - cats don't snack on kibble in the wild! I'd just stuck with the convenience and savings of dry food.

Anyway, after the initial nightmare of learning how to test and having to be there to check to make sure Honey wasn't dropping too low, things got so much better. She's now on 1 drop (yep, the teeny tiny bubble of a drop) twice a day and we're hoping to start a trial next week of no insulin. This doesn't happen for all cats but it does happen for more who's owners follow the advice on this site, than listening to their vet.

Like most people, I had to choose - do I follow the vet's advice or what I read on this site. I chose the latter - the combined knowledge here far outweighs that of an individual vet.
And, everyone here is a cat-person - we live, breath and miss sleep for our furry babies :-D

Hang in there!
 
I'm in the Oyster Bay, Glen Cove, Locust Valley area of Long Island New York if anybody has a vet they can recommend that's good with FDB for my Mr. Grey. Thanks !
 
As far as me removing his dry food completely, I have not, I just feed him wet first mainly then at night when I go to bed I leave a bowl of Prescription Diabetes Royal Canin out just in case. Is this ok for now since I have him on Lantus and have seen no signs of HYPO in the past 2 weeks even with all the high dosing. I also think that tomorrow I will not listen to my vet and only dose him 1U twice daily instead of 6U. I will do this for a week instead of 6U as vet instructed me. Then in one week I will either return to him for a visit or I will go to a new vet.
 
If you're going to try 1 unit, I would also try to take away the dry food (for all cats) and test as often as you can (as he will still have a large depot built up in his system from those high doses).
As far as your vet search goes; I don't know if Long Beach is close to Long Island, but you can try to send a PM to Roni and Moonie who is listed as living on Long Beach. If you click on the Members on the top of the screen, you can then sort the columns by location, and maybe find someone in your area that you can send a PM to.
Roni and Moonie have been around a long time, and may have some suggestions for you as well.
 
I just did a Members search and it looks like there are 5 people listed as living on Long Island (Page 100). I would try to send them all PMs and see what info you can get on vet recommendations.
 
Rick, welcome to FDMB. You have gotten lots of great advice already. Just a few questions and thoughts for clarification.

When are you doing the BG tests? For Lantus we test before the shot to be sure BG levels are not too low to safely shoot. Most of us test, then fed, then shoot. W/ lantus it is not as important that food is on board before the shot as it is w/ the fast acting insulins. But you should get Mr. Gray to eat within the first hour. Also try to be sure there is no food available 2 hours before the test as this can make BG rise and not show an accurate reading.

Lantus dosing is based on the nadir, the lowest point in the 12 hour cycle. Are you getting mid cycle tests? This will determine dose adjustments and may show if those high numbers you see are bounces from going too low.

What meter are you using? Human or pet? Most of us use human meters, but there are a few we have found to be unreliable, the Freestyle Lite and anything w/ the name True in it. They tend to read dramatically higher in the upper ranges.

The Royal Canin Diabetic formula was 24% carbs on the last available listing, way too much for a diabetic cat and it is adding a lot to those high BG readings. These prescription formulas were developed when the thinking was that protein needed to be restricted and fiber add. Not true, high protein foods are the best possible for obligate carnivores (i.e cats!) We try to feed less than 10% carb foods and all your cats will benefit from the lower carb canned food. Dry food is a major contributor to feline diabetes and kidney failure in cats. Wet food can be left out w/ no problem, you can also freeze cubes of food to leave out and the cats can eat them as they thaw. Another way to be sure they have food while you are asleep or out, is to get a timed feeder (or three ;-) ) The five compartment rotary ones can be programmed to open to an empty section so you don't need to worry about removing the food 2 hours before shot time, too.

Finally, if you have total dry food addicts there are dry foods to try during the transition that are lower carbs. EVO makes a dry food that is 7% carbs, but it is still dry and diabetic cats (all cats for that matter) need the extra moisture in wet food. They just don't naturally drink enough to stay properly hydrated. Prescription foods are generally not the best quality or even meeting the needs of cat w/ special dietary needs. All your cats can eat the same low carb wet food and be healthier than on the dry kibble!
 
Me again, I'm lucky to be retired and can monitor Tess a lot, but many here work and manage very well. They get the extra testing in at night or on weekends when they can. It doesn't need to take over your life. The "civvies" will do very well on the same food as Mr. Gray so no extra hassle there.

As for a new vet, remember the vet is working for you. You are your cat's advocate! We place way too much confidence in the white coat. If it were you would you want a second opinion? Just because they have the letters DVM behind their name doesn't mean that they are experts on all types of animals and all diseases. I would place my confidence in a vet with an open mind, who is willing to continue learning. The vet who dx Tess lasted 3 days! and that was only because he was closed all weekend! He had not continued his eduction on advances in treatments and had actually sold us insulin w/ an FDA warning and mfg recall!!! Then tried to say there wasn't a problem w/ it.

It is the vet's duty to stay up to date on treatments and safety. Many vets hear that Lantus is the new "insulin of choice" but don't bother to learn the new protocols which must be followed to use it effectively. If they are unwilling to learn they are not doing their job.

Sorry, I'm done ranting now. ;-)
 
Thanks for your concern Ann, I'm learning so much from this board and it's members that I've already deemed Royal Canin un useable and he never got to eat more than a few bites... It was a free bag from my vet (gee thanks). I use the Accuchek Aviva Plus for humans to test and have moved into manual lancet poking. I have gotten very familiar with the mantra," Test feed shoot". I have yet to get a good mid cycle test as my drawing blood skills are still developing. Just when I think I got it, he squirms, the blood bead touches some hair and it flattens out un able to be wicked by the test strip, arrgh ! After a few more tries he just won't stop squirming and making noises and he even passes gas. Smart because by then we both give up and take a break and I clean his ears up and hope for later a BG test. I have to cool down as you must know the blood drawing process can be the most frustrating part for both cat and owner. The area where I poke shows blood but it must be very sensitive because he DOES NOT like the feeling when the test strip tip touches his ear at the puncture and then he really flinches and I either win or loose.. Is it true that FDB is a genetically inherited disease because my vet said that it was when I questioned if feeding Iams dry for 8 years could cause FDB ?
 
Where are you poking? you want to aim for the area between the vein and the edge of the ear, we find it easier to aim freehand too. Here are a few tips we've picked up:
  • -- First off when you are just sitting together make a point of stroking and handling his ear. , he'll get more comfortable with it and won't feel you are going to poke every time you touch his ears.
    -- Try a little vaseline or even better, Neosporin w/ pain relief on the ear before the test. Apply and the wipe off, it will prevent the blood from getting drawn into the fur, but leaving too much on can clog the strip
    -- Hold the lancet at a 45º angle, barely touch the ear and twist slightly. Lancets are faceted and the twist opens up the slit letting more blood out. I like BD lancet, they are sharper and seem to hurt less.
    -- if the meter strip continues to bother him, slide the drop onto your fingernail and test from there.
    -- Take your time and be calm. Cats can tell when we are nervous and react. There is plenty of time and if the meter does turn off before you get the blood, just pull it out and push it back in. Always check to be sure the meter is still running before applying to the blood drop.
    -- Always put pressure on for 20 seconds after the test. it will seal the wound and prevent bruising. We usually test about 8 time a day and you couldn't tell from looking at Tess's ears.
    -- MOST IMPORTANT give a treat even if the test is unsuccessful. he will come to associate testing with treats and actually purr in anticipation. Honest!

As for genetically in inherited …… true some cats eat kibble all their lives and do not develop FD. However, it is unlikely, even w/ a predisposition to FD, that a cat would develop FD without inappropriate high carb foods or some other outward damage to the pancreas like steroids.
 
Welcome to FDMB.

Since you're planning to drop the insulin and do the diet change too, it would be prudent to test his urine for ketones, a byproduct of fat breakdown. Too many ketones can lead to diabetic ketoacidosis, an expensive complication of diabetes. My signature link, Secondary Monitoring Tools, has info on how to that.
 
I'd like to welcome you, too!

Many of us are here because of gaps/misinformation from our vets (myself included -- if I had followed his recommendations upon my cat's diagnosis in November, I would likely have lost her).

I'm too new to give dosing advice, but there's one thing that has helped with testing: TREATS. There are low-carb treats out there (i.e., freeze-dried chicken and tuna flakes), and they are my saving grace when it comes to testing. I give her a treat whether the test is successful or not. Believe me, initially the testing was the most stressful part for me and my cat. There were many tears and much swearing, and not enough blood. But now my cat is practically trained to hold still, and she even knows when she's going to get tested and seems to not mind it because she knows she'll get a treat. What used to be a 10-30 minute frustrating process is now done in less than a minute.

Hang in there!
~Josie
 
HI Rick -

We trained Leo that he gets a bit of plain boiled chicken (I make several breasts and freeze them), liver, etc. (all protein) and he gets a treat after each poke, successful or not. And he gets NO treats any other time. Now he comes right to the testing chair when I call, and he sits patiently. He often flinches in anticipation, but we've come to realize the's done the pain vs pleasure calculation and pleasure (treats) wins!

Good luck!
Lisa
 
I received several PMs from Rick yesterday. I'm going to try to summarize/excerpt.

Rick B said:
Sent: Sun Dec 30, 2012 1:04 am
by Rick B
So now @12:45 AM I fed Mr Grey wet LowCarb and then @ +12 I took a BGL it was 453, I am now torn weather to give him a 6 U shot as vet suggested earlier today, or a small 1U shot to continue twice daily with low carb wet food and frequent BGL testing for a week to establish a new Lantus "base line" which goes against vet's dose, or STOP Lantus for a week while feeding low carb wet and frequent BGL testing for a new base line. Vet from the DX start did not put Mr Grey on Low carb wet with testing so I never knew what his BGL was since I changed his diet to low carb wet. In my newly developed opinion, it seems that although his DX BGL was 564 two weeks ago, we should have went a week on low carb wet and home testing before starting Lantus. Do you agree ? Can I start from scratch with this idea ? and then Re-start Lantus low dosage ?

Sienne/Gabby said:
Just to make you aware, we have a convention about making sure that dose-related questions are posted on the board. This protects you from someone giving you well-intentioned but potentially problematic advice. While I spend lots of time working with Lantus kitties, I want to do some consulting with the most experienced Lantus users. It's not that I find Mr. Gray's situation overly challenging, it's that I have some concerns. His BG numbers are high. I would not stop his insulin. That could result in all sorts of health complications.

What I would encourage you to do, is to post your note on the Lantus board. What I'm thinking is that if you want to re-start at a better dose, you use the formula I provided in my initial post. Do you have an idea of your cat's ideal weight?

I'd also recommend getting a spreadsheet set up. This will give you a place to keep your test data and by linking the spreadsheet to your signature (the instructions are in the link), we will be able to follow what you're doing. The Lantus board is very numbers driven so having the information available to everyone is the best way for us to help you.
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Sent: Sun Dec 30, 2012 8:38 am
by Rick B
Mr Grey weighs 12 lbs. Being at 10u @ week # 2 his lowest home test BG was 239, reading these forums, receiving advice, not detecting any signs of hypo, and my newly home testing (when i can get a blood drop), has indeed made me question my vet's course of action prescribed. It's made me confront him resulting in his over the phone dosage lowering to 6u starting yesterday.
I just tried @7:00 am to get a BG from grey but after too many failed attempts his ears were too sensitive so I fed him wet no grains and he's sleeping now. At 11 am I will give Lantus I guess as my vet said 6U.
I will start a spread sheet, wish I was better at drawing blood. I might buy a different lancet pen today. I'm very interested in knowing his BG and its frustrating me that it's not that easy yet for me to home test.
Sienne/Gabby said:
Based on an ideal weight of 12 lbs, your starting dose would be 1.36u. You could round down or up (1.25u vs. 1.5u). If you are eliminating all high carb food and kibble, I would drop the dose back.
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Sent: Sun Dec 30, 2012 3:48 pm
by Rick B
Talking to my pharmacist friend , she was reading the Lantus feline guide somewhere online and some other resources and she had me dose him at 2u. + 2 BG 386.Do you think that was a wise choice I made ?
Thanks, Rick
Sienne/Gabby said:
I think 2u is fine. Just get some tests. It would be best if your friend who's a pharmacist sent you the links to the materials she's reading. There are some dated materials around. The links we sent you in your thread on Health are what's current. It would be best if you started a new thread either on Health or the Lantus board re. dosing so everyone can follow along.
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Sent: Sun Dec 30, 2012 6:34 pm
by Rick B
Thanks I will start a new thread as you have suggested.
Mr. Grey was so happy today, the happiest I've seen him since my vet started him on Lantus. He was playing with the other two cats, his reflexes were fast, all in all he just looked better. He even tried to sneak out side. Could this be from a 24 hour break from Lantus then the reduction in dose ?
Sienne/Gabby said:
I just heard back from one of the most experienced Lantus/Lev user on the Board. She also suggested using the weight based formula for your initial dose. It's your call if you want to stick with the 2.0u or if you want to drop the dose a bit.

The other suggestion she made was based on the lab values you posted. The ALT level is considerably outside of the normal range of 20 - 100. There is an over-the-counter supplement, denamarin, that's used to support liver function. You can get it from your vet or through Vetmarket or Amazon. Possibly, your friend who's a pharmacist could track it down for you. I'd suggest getting this started ASAP.
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I don't think anyone has given you this tip. If you get blood and are afraid he won't be sitting still long enough for you to do the test, put the drop on your fingernail. You can test it from there.
 
Update: I ordered denamarin from Amazon awaiting it's arrival. I have been studying both the University Of Queensland Centre for Companion Animal Health Dosing protocol for cats on glargine, and AAHA Diabetes Management Guidelines for Dogs and Cats special report. I've highlighted sections and Intend on presenting all documents to my vet this Saturday. I have been following the Lantus dosing protocol as I've read as closely as I can since Saturday December 29th 2012. I am collecting data based on Mr Grey's BG levels from home testing, and his feedings in a note pad in my iPhone and will enter it into an online spreadsheet as soon as I can. It seems that we're on an 11:30 am, 11:30pm dose schedule. His lower BG since 12/29 was BG 301 @930am on 1/1/13 prior to feeding and shot. I have mastered getting blood sample manually poking in 1 try !!! :-) I have used a cotton ball wet with warm water and a dab of Bacitracin to coat inner ear just prior to poking. Works like a charm now. Thanks to all those that have been giving me advice and listening to my case here.
 
Yeah, way to go Rick - welcome to the Vampire Club!
With you taking charge of Mr Grey's diabetes, things are definitely looking up for him.
:-D
 
Right on, Rick! Sounds like Mr Gray is in excellent care! I'm so glad you found us and are taking matters into your own hands. It really is the only way to fly with this situation. AND...you're obviously not alone! :thumbup
 
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