newbie here- dumb dumb is gone.

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vinneesf

vinneesf

Member Since 2014
i had to put dumbdumb to sleep tonight... he had numerous issues that had gotten worse..the diabetes wasn't the biggest problem, it was the fluid in his lungs that overwhelmed him. the diuretic removed some of the fluid but the fluid immediately came back and he was at the point where there was nothing left i could do for him. i feel like i've been fighting the inevitable for the last 8 months and DD finally gave up. i could see it in his eyes earlier this week and despite my efforts, he just got worse and worse. i knew it was time... he was my best buddy for the last 17 years ever since he was a kitten. thank you so very much to everyone on here that helped me with his diabetes. i wasn't very successful with bringing his numbers under control and it was frustrating at times. i really appreciate how everyone here is so understanding and so helpful and generous with your advice and your time and attention. i wish everyone here the best






my cat just started insulin today.. he is 17y.o...weighs 15lbs and is lovingly named "dumb dumb" :) I've had him and his sister since they were kittens (his sister passed away 2 years ago). i'm not a vet or part of a rescue group or anything like that and I haven't owned any other cats so while I do my homework on what the vet tells me...my experience is pretty limited.

I've heard great things about FDMB from the feline cancer and feline pancreatits board. DD likely has mast cell disease and pancreatitis. his recent bloodwork and behavior now indicates diabetes. doctor suggested I check and log his glucose readings for 1-2 weeks to make sure its diabetes before I start insulin. all his readings were between 300-478. so today I started him on glargin lantus at 1.5 units twice a day. took a reading a few hours after the first dose and it was 311 (was 478 the night before his first dose). i'm using a bayer contour tester with those hateful annoying "sipping" strips.

he has also been on prednisolone 5mg daily since july 2013. but I have been tapering off the pred. he is down to 2.5mg every other day now. I also give him sub q's when needed, Pepcid ac, and bup for pain when needed. he also has some recent fluid buildup in his lungs. after seeing chest xray the vet is confident that the fluid buildup is not caused by chf. its likely an infection or a side effect of pred. a recent course of doxy didn't help it so maybe not infecftion?. he has a good appetite. he eats FF classic poultry pates like chicken feast and turkey and giblets. he drinks lots of water and pees a lot. always uses the box. poops are normal.

when is the best time to check his glucose and how often should I check? its always an ordeal getting him to sit still long enough for those strips to sip the blood and give me a reading. any help or suggestions would be very greatly appreciated. and any other suggestions for brands and flavors of canned food? I don't feed him dry food at all.
 
Re: newbie here- dumb dumb just started insulin today

We base the dosing of Lantus on the lowest point (nadir) of the curve. I would try to get a +2 test (2 hours after shot) and a test around +4 to +6, when you can.

Example of an active Lantus cycle:

+0 - PreShot number.
+1 - Usually higher than PreShot number because of the last shot wearing off. May see a food spike in this number.
+2 - Often similar to the PreShot number.
+3 - Lower than the PreShot number, onset has started.
+4 - Lower.
+5 - Lower.
+6 - Nadir/Peak (the lowest number of cycle).
+7 - Surf (hang around the nadir number).
+8 - Slight rise.
+9 - Slight rise.
+10 - Rising.
+11 - Rising (one of the quirks of Lantus/Levemir: some cat's blood glucose numbers dip around +10 or +11... not to be confused with nadir).
+12 - PreShot number.

There are a variety of low carb foods you can give Dumb Dumb. Someone will point you to the listing.
I'm glad you're testing as that will help to keep him safe.

Watch when you give the fluids, as sometimes I've seen fluids bring a cats BG numbers down way too fast. You want a gentle curve.
Go to the Lantus Tight Regulation Forum and read the Starred Stickys. There is a LOT of information, so take your time, and ask all the questions, you want.

Good Luck to you and Dumb Dumb.
 
Re: newbie here- dumb dumb just started insulin today

Any fluids should be given in a different location from the insulin.

You may notice a difference in insulin response when he is, vs is not, on the steroid, as those tend to increase glucose levels.
 
Re: newbie here- dumb dumb just started insulin today

Welcome Dumb Dumb and your caregiver! What is your name?

I'm Deb and that tuxedo pictured to the right is my sugardude Wink. He loves the Fancy Feast pates too. ;-)

and any other suggestions for brands and flavors of canned food? I don't feed him dry food at all.
Click to expand...

You asked about other food choices, so here is the link to the food chart we use. It's by vet Dr. Lisa Pierson. Look in the 3rd column of numbers for the carbohydrate percentages. We recommend foods with <10% carbs. Like the Fancy Feast pates you are already feeding. Or most of the Friskies pates, Wellness grain free. There are foods here to work with your budget.
 
Re: newbie here- dumb dumb just started insulin today

thanks for all the great info... i'm vince from san francisco. i've been testing his blood 4-6 hours after his shot. so far over the last couple of days his numbers aren't going down much..lowest was 311, highest 483. he free feeds. he is also on prednisolone every other day at 2.5mg. is that counteracting the insulin?
 
Re: newbie here- dumb dumb just started insulin today

Yes, the prednisolone can impact the BGs. You'll just have to counteract with a bit more insulin. The general rule of thumb is to treat the more severe condition first and the diabetes second so if DD needs treatment for other things that spike his BGs, then we just compensate for that when dosing.

With Lantus, when initially starting, it can take 5-7 days before seeing the full impact of the dose on BGs. At this point, you still have a couple of days to go before determining if we maybe need to increase/decrease this dose.
 
Re: newbie here- dumb dumb just started insulin today

his preshot test was 536 today! i know that the BG can shoot up when they are stressed out... but how quickly can it shoot up? i'm thinking these high readings could be a result of him being stressed while i'm trying to prick his ear? today it took a few pricks and he was very agitated and kept trying to bite me and get away from me. took almost 10 minutes to get a reading.
 
Re: newbie here- dumb dumb just started insulin today

Patience is key when using Lantus. It does not work overnight. Posted above - 5 to 7 days at the same dose may be needed to evaluate the dose. That number can be a result of going too low, or the pred or any infection.

Also, sometimes the insulin drops the glucose to an unfamiliar level and this can trigger compensatory hormones that release stored sugar (glycogen). We call this a bounce and the higher numbers may take 3 days to clear.
 
Re: newbie here- dumb dumb just started insulin today

Hi Vince from San Francisco! It's good to meet Dumb Dumb's bean (our slang for human being).

To help you with the testing, here are 2 articles for you, with tips on ear testing and Ear Testing Psychologythat may make Dumb Dumb more accepting of the testing.

Treats are key. Something like Halo Liv-a-little freeze dried chicken or Pure Bites freeze dried chicken or fresh shrimp or some plain cooked chicken will help train Dumb Dumb to accept the ear pokies better. What treat are you giving him now?

Yes, the BG's can shoot up with stress, although cats are usually much calmer at home in their familiar surroundings than at the vet's office with all those strangers and dogs :o and other unfamiliar animals to freak them out. If I remember the study, the BG's can go up in 5-15 minutes, be raised 100-180 points (mg/dL) and stay raised for up to 90 minutes. They gave the cats baths to stress them out. :o :shock: :o
 
Re: newbie here- dumb dumb just started insulin today

You might want to try a relion confirm or micro. The bayer contour needs 0.6 µL of blood but the relion confirm and micro need half that! Plus they are cheaper. You can only get them in walmart.
 
Re: newbie here- dumb dumb just started insulin today

i've been giving DD the lantus for 2 weeks now and his numbers aren't really improving...i understand that lantus is slow acting. so far his lowest reading was 301 and highest reading was 586. i usually do a preshot test and then another test x5/x6 after the shot. (he is finally starting to cooperate more with the ear pricking) the numbers bounce back and forth within that range of 301-586. his insulin dose is 1.5. should i increase the dose or should i give it more time? i bought walmarts relion confirm and 100 test strips and sometimes that meter just says "Hi" for the reading instead of numbers. i really like the relion meter because it doesn't need nearly as much blood as the bayer contour meter did.
 
Re: newbie here- dumb dumb just started insulin today

It seems like a dose increase in in order. However, can you post= recent BG values? Better yet would be to start a spreadsheet and enter the BGs there and then post a link to the spreadsheet
viewtopic.php?f=6&t=50130
 
Re: newbie here- dumb dumb just started insulin today

If you are consistently getting no lower than about 300 mg/dL
and you have tested in the +5 to +7 hours after the shot on most days, especially recently,
and you've been at the same dose for 3 full days or more,
then the protocol would have you increase by 0.25 to 0.5 units.

But we really would like to see the numbers in our grid spreadsheet so we see what is happening over the course of the day.
 
Re: newbie here- dumb dumb just started insulin today

I can see the spreadsheet, so good job!

Can you add the insulin dose given in the turquoise columns?

I know its difficult to test him, but both the pre-shots and the mid-cycle tests help determine how the insulin is working.

Given the steroid med for the other condition, I think going up 0.5 units (you'll have to eyeball it) would be OK as the nadirs are over 300 mg/dL.
 
Re: newbie here- dumb dumb just started insulin today

i already upped his dose from 1.5 to 2.0... so far he's had 3 days worth of shots with 2.0. his preshot this morning was 314 (8am) and i just now took it (x7) and his reading was 175. thats the first good reading he's had yet...but is that reading too soon? should i continue with 2.0 or should i back off a little?
 
Re: newbie here- dumb dumb just started insulin today

vinneesf said:
i already upped his dose from 1.5 to 2.0... so far he's had 3 days worth of shots with 2.0. his preshot this morning was 314 (8am) and i just now took it (x7) and his reading was 175. thats the first good reading he's had yet...but is that reading too soon? should i continue with 2.0 or should i back off a little?
Click to expand...

I would stick with the 2.0 units of Lantus.
So long as he stays above
- 50 mg/dl on a human glucometer
- 80 mg/dl on a pet-specific glucometer
at his lowest point between shots, he is doing great.

Would you please put the insulin and the link for your spreadsheet in your signature? That way folks won't have to go hunting for it. Also note that he is on steroids as that affects his levels.
 
Re: newbie here- dumb dumb just started insulin today

how do you all get the signature to read what you named the spreadsheet instead of showing the whole link like mine is doing?. dumb dumb is no longer on the steroids. tapered him down slowly over the last month and a half. now he is only on the lantus insulin with half a pepcid once a day and bup when needed. subq's when needed also.
 
Re: newbie here- dumb dumb just started insulin today

i just took another reading and now its 111. he's due for another shot in 2 hours...is it safe to give him another 2.0 shot in two hours? he's been sleeping soundly but just ate 1/3 a can of FF after i took that last reading.
 
Re: newbie here- dumb dumb just started insulin today

Possibly. Let's wait and see if he's over 200 mg/dL then. No more food until then, OK?
 
Re: newbie here- dumb dumb just started insulin today

now he's at 150. what do you think? i think i'm going to skip the insulin shot.. he is crashed out sleeping and has been since late this afternoon . he was pretty glazed over looking when i woke him to take a reading
 
Re: newbie here- dumb dumb just started insulin today

Did you give the injection? It looks listed on your spreadsheet.

I am not the most experienced person here and am reluctant to give dosing advice but I live on the west coast so up later than many others. You might wait a bit to see if someone else checks in but do look at BJM's chart in the meantime:

viewtopic.php?f=28&t=112849&p=1190640#p1189879
 
Re: newbie here- dumb dumb just started insulin today

i haven't given him the injection because last night he was at 500 and now at 150...seems like a big drop for overnight and i'm afraid it will drop too low if i give him another injection tonight.

that chart said "no shot limit" for = 150.. i'm not sure if that applies to lantus insulin or if that means not to give a shot?
 
Re: newbie here- dumb dumb just started insulin today

The info at 200 might be most appropriate for you tonight:

200 mg/dL (11.1 mmol/L) {230 mg/dL for an AlphaTrak}
- no shot level for beginners; may slowly reduce to 150 mg/dL (8.3 mmol/L) {180 mg/dL} for long-acting insulins (Lantus, Levemir, and ProZinc) as data collection shows it is safe
Click to expand...

And the term "no shot level" indicates that if you are at that or below you shouldn't give an injection.

Oh, and the big time mantra here is "better too high for day then too low for a minute."
 
Re: newbie here- dumb dumb just started insulin today

checked again and now its 327 so that being well above the 200 mark i decided to give him the injection. 2 hours late..ughh. i hope that doesn't complicate things. i know that i need to adjust the schedule 2 hours later in the am too. i will be keeping an eye on him thru the night.
 
Re: newbie here- dumb dumb just started insulin today

Since you gave it two hours late, that acts almost like a dose decrease so you might see slightly higher numbers tomorrow at his next shot time. And yes, you will have to wait at least an hour and a half past his regular shot time before giving it because you gave him his shot so much later tonight. ;-)

Your "homework" for the future: Shooting and handling low numbers. Ellie is right that the "no shot" number is 200 on the Main Health board for new members. Eventually, when you feel ready to move over to one of the Lantus sub-forums, that number drops to 150...and eventually even lower. I often give Mikey his full dose when he's below 100 and I'm around to monitor in case anything untoward happens (nothing yet!). Some people either gradually reduce their "no shot" limit to 190, then 180, etc.... Others throw a "pajama party" and shoot the 150 (or lower) and monitor extensively with their hypo toolkits on hand just in case. It's whatever you feel most comfortable with.
 
Re: newbie here- dumb dumb just started insulin today

just checked DD's numbers again..289. all this checking over the last 24 hours has gotten help him get more comfortable with my pricking his ears... he doesn't try to bite my hand anymore...and i absolutely love how the relion confirm meter only needs a tiny speck of blood to get a reading. i wasted so many strips with that bayer contour meter always erroring because there wasn't enough blood for a reading...also, i'm starting to get the hang of this spreadsheet thing and learning my way around here better. great support system this board has! my vet says they don't treat diabetes in shelter animals because they don't know enough about it to effectivly treat it. so its good to know that this board exists.

i've been concentrating so much on his diabetes i have to make sure i don't neglect his other issues like pancreatitis and the mast cell disease. but there isn't much i can do for those issues that i'm not already doing. i'll keep posting his numbers.
 
Re: newbie here- dumb dumb just started insulin today

thanks for the link. DD is due for another spec fpl test. those results have steadily gone up from 6.9 in july to 19.1 in december. though he was doing much worse when his specfpl was 6.9. he was doing great when it was 19.1. go figure. DD +7 is 122. just took it.
 
Re: newbie here- dumb dumb just started insulin today

i just took his preshot test and it was 136. its been in the 100's for the last 8 hours or so... i'm thinking i should not give the shot tonight, correct? update: i ended up giving him half a dose.
 
Re: newbie here- dumb dumb just started insulin today

That's fine.
When you can't stay around to monitor and aren't sure it will be safe, giving some rather than none keeps the glucose from skyrocketing.

Some folks find it less stressful to gradually lower the no shot limit by 10 to 20 mg/dL to a level where they see it is reasonably safe but doesn't require steering with food around the nadir. It has to be something that works for both you and your cat.

The AMPS may be a bit higher because of the reduced dose. You can a) go back to the dose you were using or b) use a slightly decreased dose while you get familiar with shooting a bit lower. Up to you and your comfort zone.
 
Re: newbie here- dumb dumb just started insulin today

preshot today was 152...ps numbers been improving so i just gave him half a dose. that should hopefully be just right for him. will be keeping a close eye on him thru the nadir time.
 
Re: newbie here- dumb dumb just started insulin today

Try to stick with a consistent dose AM and PM. Lantus works best that way because of the overlap between shots.
 
Re: newbie here- dumb dumb just started insulin today

i got a reading of 83 at +7. he's been under 200 for 2 days now. i'm pretty sure i don't want him to go much lower than 83... once you get fairly consistent numbers within normal range do you reduce the dose to maintain it or do you continue with the regular dose?
 
Re: newbie here- dumb dumb just started insulin today

Human or pet glucometer?

With a human glucometer, you can go down to 50 mg/dL; with a pet glucometer, 80 mg/dL is the lowest you want to go.

Given the other medical conditions, though, you may want some room for safety, as IBD can trigger vomiting which may drop the glucose levels and nauseau may reduce appetite.
 
Re: newbie here- dumb dumb just started insulin today

Yes, it may be time to reduce Dumb Dumb's dose by 0.25U. Especially with his other medical conditions, it would keep him safe.

You've bounced around on the dose a bit the last couple of days. So if this dose reduction dose not hold, that means the BG numbers go up again, then you would take the dose right back up to the 1U you were giving.

If you would please add the glucometer brand you use to your signature, we won't have to ask again. It would really help us to help you better so I hope you will consider doing this.
 
Re: newbie here- dumb dumb just started insulin today

hi, my signature should already say what insulin and glucometer i use... i can see it on my computer but i dont know maybe it doesn't show up properly or maybe i have the wrong format?

also, the spreadsheet has stopped coloring in the boxes that i enter his numbers in...how do i fix this?
 
Re: newbie here- dumb dumb just started insulin today

It doesn't stand out - perhaps a few hard returns would make it easier to perceive.

The paint roller icon will copy the conditional formatting from a working cell to an unformatted cell.
 
Re: newbie here- dumb dumb just started insulin today

Thanks for putting some spacing in your signature to get the insulin and meter you are using on a separate line. It does make it stand out better and makes it easier to see.

Some of us here have vision problems, so adding that spacing makes it easier for me to see.
 
Re: newbie here- dumb dumb just started insulin today

That did the trick; thanks.
 
Re: newbie here- dumb dumb just started insulin today

DD's preshot test 6 hours ago was "hi" . i'm assuming thats above 600 with the relion meter. i gave him his normal 1.5 dose and his BG is now at 488 at 6+. i'm worried that the shot might not have took...maybe the needle didn't get all the way under the skin but i checked and i didn't feel any moisture where the shot went in. he's looking really ragged right now. a little trouble walking and a less than happy look on his face. i know i cant give him another shot because that would be overdosing him...what else can i do in the meantime until his next dose?
 
Re: newbie here- dumb dumb just started insulin today

You are increasinging the dose too fast for Lantus. You need to stick with a dose a minimum of 3 full days, then check the nadir to see if an increase is needed.

On the 15th, you got a midcycle glucose of 83 mg/dL. Unless there was another problem such as vomiting, diarrhea, inappetance etc, that was a good number and one that probably hadn't been seen in a while. You probably should have stayed at that dose.

When a cat drops to a lower level which hasn't been experienced in a while or the glucose drops rapidly, that can trigger hormones which release stored sugar (glycogen) which then elevates the glucose back up and then some. This is called a bounce. It can take a bounce up to 3 days to clear. Until it clears, you will see higher than desired numbers.

With Lantus, you have to wait out the bounce before you increase the dose. Otherwise, you wind up giving too much insulin.
 
Re: newbie here- dumb dumb just started insulin today

so does a bounce mean that the high readings after the 83 reading are not actual high readings only temporary? so, anytime his numbers rise after a good reading is it always a bounce? how do you know which are the temporary high readings vs. the actual high readings? ...its been 3 days since that i got that 83 reading and his readings are still high. i hope my dose increase wont hurt him. i'll just feed him the high carb food...i've also got maple syrup handy just in case.
 
Re: newbie here- dumb dumb just started insulin today

If you see a green or blue test number mid-cycle followed by magenta, red, or black, chances are you may be seeing a bounce.

It can take about 3 days for a bounce to clear. Bounces appear to be unusually high numbers compared to what you've been seeing, so that's a good clue. You'd think "OMG! I've got to raise the dose", but no, doing that can make it worse. Too much insulin can look like not enough insulin because of those compensatory hormones.

And when there is not enough stored glycogen to compensate ... the kitty can crash into a hypoglycemic episode. Hypos can kill very quickly; hyperglycemia can kill slowly.
 
Re: newbie here- dumb dumb just started insulin today

DD was at the vet the other day and he has fluid buildup in his lungs that has significantly increased since his last vet visit 2 months ago. thats kind of close to when i started the insulin... i'm pretty sure its not related to diabetes but i wanted to ask this board this increased fluid buildup wouldn't have anything to do with the insulin, right?
 
Re: newbie here- dumb dumb just started insulin today

It doesn't seem related to the insulin to me, but I'm not a vet.

It seems more likely to be a circulatory, infectious, or cancerous cause.

What did the vet do? Insert a needle to draw off some of the fluid to evaluate it? Prescribe a med to help get blood pressure down? Refer you to a specialty cardiac vet?
 
Re: newbie here- dumb dumb just started insulin today

i started giving DD a diuretic today (furosemide) to help ease the fluid accumulation in his lungs... i read to be cautious when giving it to diabetic cats... is there anything in particular i should watch for or should i increase or decrease his doses?
 
Re: newbie here- dumb dumb just started insulin today

Be sure to test more and you may need to adjust the insulin dose with the use of the Furosemide (aka Lasix).

Furosemide may interfere with blood glucose control and reduce the effectiveness of insulin regular and other diabetic medications. Monitor your blood sugar levels closely. You may need a dose adjustment of your diabetic medications during and after treatment with furosemide. It is important to tell your doctor about all other medications you use, including vitamins and herbs. Do not stop using any medications without first talking to your doctor.
Click to expand...

Drug Interaction Classification

The classifications below are a guideline only. The relevance of a particular drug interaction to a specific patient is difficult to determine using this tool alone given the large number of variables that may apply.

Major Highly clinically significant. Avoid combinations; the risk of the interaction outweighs the benefit.
Moderate Moderately clinically significant. Usually avoid combinations; use it only under special circumstances.
Minor Minimally clinically significant. Minimize risk; assess risk and consider an alternative drug, take steps to circumvent the interaction risk and/or institute a monitoring plan.
Click to expand...
Quotes are from this source: http://www.drugs.com/drug-interactions/insulin-regular-with-lasix-1351-0-1146-676.html

Furosemide decreases the sensitivity of glucose transport to
insulin in skeletal muscle in vitro. Source : http://www.eje.org/content/139/1/118.full.pdf
 
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