Newbie here! Dosing and general questions

[Nancy & Huey]

Hello! My cat Huey was diagnosed about a month and a half ago and I've been lurking around here ever since. My vet had us try switching to wet food only for a couple weeks, but that didn't seem to be enough. Now that Huey's started on insulin, I thought I'd say hello and post some questions. I think I have everything (sig, ss, etc) set up but please let me know if something useful is missing. I feel VERY lucky 1) that I found this board early on and 2) that Huey's adapted to home testing and shots pretty well.

My vet seems pretty old school about diabetes management, compared to what I've been reading here and elsewhere online. He does not think home testing is accurate or useful, and believes Purina DM is the best food available for diabetic cats. His instructions were to feed Huey canned DM, give him 2 units of Lantus twice a day, and come back in two weeks. I've been going to the Humane Society clinic because they're inexpensive, but I think they just get so many patients that they don't have the resources to give every single animal cutting edge individualized treatment.

1. Obviously, I passed on the vet's testing advice and started testing Huey as soon as the glucose meter arrived in the mail. From the numbers I was getting before I got a hold of the insulin, the vet's starting dose of 2 units BID seemed too high. I started him a week ago at 1 unit BID and I'm in the middle of a curve right now, trying to decide if I should change the dose for the next week. Any thoughts? It seems like he's bottoming out around +4 or +5 but what do I do with that knowledge? Are his lows getting low enough? Would lowering the dosage actually be better, so I wouldn't be skipping as many shots? Is it too early to even tell??? I'd really prefer to follow the tight regulation protocol but I don't think I can test enough during the day to manage that. If I'm wrong, please tell me me how to do this around a regular 10-6 office job!

2. I know the human meter + stress means that home numbers are going to be lower, but there seems to be a BIG difference between what I'm getting and the lab results from the vet. Is that normal?

3. I'm testing when I can but what are the gaps I should be filling in? I seriously thought about setting an alarm for 4am to get a +7 after that Thursday night shot...

4. Should I try to find a new vet? I'm in NYC so there's a vet for every possible specialization and price point. (There's even a dog/cat specific endocrine clinic, ferchristsake!) I'm actually kinda OK with a hands-off vet though, as long as he keeps writing out the prescriptions, because I feel like Huey is not as bad off as many other cats and I have a lot of resources and knowledge available here and elsewhere. I also don't want to switch to a new vet and have to pay for all the initial checkups and tests again, and maybe still end up with another old fuddyduddy. I'm open to recommendations if anyone knows a good vet convenient to western Queens, also any advice for dealing with the current vet? I think he's doing the best he is able and I don't want to actively piss him off, I can just imagine how frustrated vets/doctors get with patients who come with page after page of Web/PetMD printouts, but I do want make my case...

This got really long so if you read this far, thanks! Research is my coping mechanism and I'd appreciate any advice anyone has to offer. Hope everyone is enjoying the last bits of your weekend!

Nancy

 

[KPassa]

Welcome! And great job on the sig and SS!

1a. You can follow TR, but just at a slower pace. We have another forum called "Relaxed" Lantus for many of us who work throughout the week and are unable to get as many tests in. Then, on your days off, you can run curves for the times you feel are missing from your weekly data and make dosing decisions as necessary.

1b. You want a dose that is safe to shoot twice a day. With the low pre-shots and the low nadirs, I think you might be able to successfully reduce the dose to .75u BID (or even .5u) and see how Huey does over the next couple of cycles. If he starts running high, just increase back to the last good dose (1u). At that point, you'll want to look into Shooting and Handling Low Numbers. For new members on the Main Health, we recommend to not shoot under 200, but to stall without feeding and test again within 20 minutes to a half hour to see if the number is "rising." With Lantus, that "stall" number can be decreased further as more data is collected and people often give shots with pre-shots in the 60s once they know it's safe to do so.

2. Yes, human meters read lower than pet specific meters, but since we're looking for a range of numbers and not the exact number, that's just fine. There's a chart that gets posted for most people with that range in comparison with pet meters that might be helpful.

3. At minimum, the 3-4 tests I recommend collecting each day are the pre-shots, one mid-cycle test (when possible) and a "before bed" test each night. Then any other tests you can get throughout the week just add to the data. What I do each week is play "fill in the blank" and try to grab tests at different times through the cycle when possible. Then, on my days off (or when I work from home), I try to get tests during hours I've missed the previous days. You do as much as you can, when you can.

4. Barring any other medical problems, you don't have to switch vets if you don't want to. Many of us here simply use our vets to write the insulin prescriptions but do everything else on our own. As long as the vet doesn't have a problem with that and is good on the "big stuff," you should be fine.

 

[BJM]

See my signature link Secondary Monitoring Tools for additional assessments you may find helpful to make.

 

[Deb & Wink]

Hi Nancy and extra sweet kitty Huey and welcome to the message board!

Thanks so much for having all that data in your signature already and having your SS up and running and home testing. I think you hit the ball out of the park, home run here for your preparedness level. Much appreciated.

1. Yes, lowering the dose as Kpassa suggested is a good idea.

2. Yup, perfectly normal to get those differences between testing at home and at the vet. Next time you go to the vet, you might want to take your own meter with you and run a side by side test on the same blood drop.

3. Testing. Any data you can add to help fill in those blank spots is helpful. I think I'd recommend trying to always get that "one last test before you go to bed test" each evening. Many cats go lower at night, so having that number could be very helpful. I might also suggest you try for an occasional +3, +3.5, +4.5 to help you narrow in on Huey's nadir.

4. New vet? You can if you want, or we can also provide you with vet journal published articles to help you bring your vet up to speed. Like the AAHA Diabetes Management Guidelines for Dogs and Cats, vet journal published in 2010. Or just keep doing what you are doing and ask for recommendations from people on this board.

Huey is looking great so far, spending lots of time down in those healing blues and greens.

Huey may be one of those cats with an early nadir, like my Wink who nadired around +3 to +4. That usually means the insulin doses are overlapping a bit and bringing the BG down early. Not a cause for concern, just something to be aware of.

How often are you feeding Huey? Perhaps you could note that on your SS.

 

[Nancy & Huey]

Hi everyone, thanks for the advice! Too bad I promptly went into auto-injector mode last night and forgot it all

Kpassa, I'm going to try reducing to .75u for this week, but I think I should have held off on last night's shot. Huey's AMPS was low and I'm not sure whether to try a smaller dose now for his evening shot. Is this something I should bring to one of the Lantus forums? Not sure what the etiquette is, if I can just drop in on days when there's a wonky preshot?

Deb, I am feeding him twice a day right before I give him his shots (makes the actual injection nice and easy if he's distracted!), noted it in the spreadsheet too.