Newbie Needs More Help Please

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Tiger(GA) and Ruth

Tiger(GA) and Ruth

Member Since 2014
Hi all,
My kitty is Tiger, newly diagnosed, +/- 13y/o female,indoor Tabby. She was hospitalized early last Friday morning and put on Lantus/1 unit twice daily - Just released from the hospital last night. This morning at 6:30am, my reading was 363(SolusV2 meter and yes, I will get the WalMart meter, I only just found this forum) First unit of Lantus given at 7:00AM. I re-tested at 2:00, reading was 158;I fed a small bit of treats with a few bites of canned Purina DM, which was presribed by our vet. Just this evening at 6:30PM, my reading was 130 and the vet's office is of course closed. I want to confirm that I do not need to give the 2nd injection of Lantus??

A little background, Tiger was discovered to be hyperthyroid late February 2014 but was unable to get the radioiodine 131 treatment until March11th of this year. We also learned she was borderline diabetic at that February appointment but both regular vet and vet who gave the radio131 treatment said to get hyperthyroid treatment taken care of first. Tiger came home from her treatment after only 3 days, she was like a different cat, she was fit and had gained a pound that first week home. She started out weighing 11pounds, dropped to 9 pounds by the time she got her treatment. Last Friday she was lethargic, not eating and not even drinking and was rushed to ER where she stayed until last night. Her weight had dropped under 8lbs, but at this point, she has gained some back and is looking alert and active once again. Current food is canned Purina DM;previously Blue canned Healthy Gourmet. Due to her willingness to eat this vet food, I am continuing it until we get a handle on this condition.

I'm new at this and have only just started reading the other posts. I discovered this forum when I found Dr.Lisa Pierson's blogsite on feline hyperactivity, so glad to have found this forum!
 
Re: Newly Diagnosed/Newbie Question

Yes, I would skip tonight. We generally tell new diabetics not to shoot under 200 until they have some data.

With all her other issues, I would definitely get some ketone strips tomorrow so you can get ketone tests also.
 
Re: Newly Diagnosed/Newbie Question

Hello Ruth and Tiger, and welcome to FDMB. :smile:

Well done, Ruth, for cracking on with the hometesting so quickly. I think you're going to do just fine; and Tiger is a very lucky kitty to have you as a care-giver.

Sue mentioned about testing for ketones; here's a link to a page of pics and info about urine testing that may be useful:
http://www.sugarpet.net/urine.html

Eliz
 
Re: Newly Diagnosed/Newbie Question

Great job on the testing! You may find the following helpful.

Here's what you need to understand the glucose tests with a glucometer - human or pet-specific.

[Glucose reference ranges are unsubstantiated and have been removed by Moderator]

* * * * * * * * * * * * * * *​
Examples of using the chart:

Ex. You are a new insulin user and you test your cat before giving insulin. The test is 300. It probably is safe to give insulin.

Ex. You are an established user of Lantus, following the Tight Regulation protocol. You've tested around +5 to +7 to spot the nadir. It is 200 mg/dL. You probably need to increase the dose, following the instructions for the protocol.

Ex. Your cat is acting funny. The eyes are a bit dilated. You are concerned and test the glucose. The number is 35 mg/dL. ACK! The cat may be in a hypoglycemic state. You quickly follow the HYPO protocol linked in the glucose reference values chart. (which we really, really, suggest you print out and post on your refrigerator.)
 
Re: Newly Diagnosed/Newbie Question

Thank you so much for the quick response, welcome and additional information, what a stroke of luck to come across this forum with so many knowledgable people!! With no experience with diabetes, this is quite overwhelming, but I am the lucky one, Miss Tiger is my best friend and confidant and DH and I both know she is worth all that and more!

I haven't been able to get to Walmart to look for that other brand of meter, after reading more posts, it's making me nervous about the one I am using. When my MIL moved to a memory care unit, she no longer needed this meter, it was brand new and unopened with 100 test strips, but I will get there hopefully tomorrow or Friday.

Can I just get ketone testing strips at WalMart as well? (sorry another newbie question and probably not the last ones either) And so now I know to test before 7AM and 7PM shots, plus 5-7 hrs after the AM shot, do I need to get up at 1AM to test again or is it alright to check around 9PM? :?: Thanks again
 
Re: Newly Diagnosed/Newbie Question

Urine ketone test strips should be available at the pharmacy. Sometimes you have to ask for them. Or, you can order them online. KetoDiaStix (tests for ketones and glucose) and KetoStix (tests ketones only) are 1 brand. Generic is fine. See my signature link Secondary Monitoring Tools for some other assessments which can help you determine how your cat is doing.
 
Re: Newly Diagnosed/Newbie Question

Thank you for that keytone info, it's been a difficult week, not been able to get to Walmart and Tiger's numbers did throw us for a loop the past 2 days. I apologize, I will get a spreadsheet done ASAP, not had time to do so.

The morning after I skipped her 7PM shot on April 16th, her pre-test was 498 - gave shot at 7AM per vet; tested again at 2:00PM, down to 400. Pre-tested at 6:44 BG up to 505, gave shot. April 17th 7:00AM pre-test was 381; tested again at 1:48, BG 181. I am afraid when I test her at 7:00 tonight, her BG will stay the same or drop below 181, then I will not want to give her her shot and won't this cause her AM BG to rise dramatically again? Am I way off the track? Please help??? :?:
 
Re: Newly Diagnosed/Newbie Question

Ideally, you want a Lantus dose you can give every 12 hours, safely.

You might try eyeballing a 0.75 unit dose the next time you give insulin.

In the Tech Support forum we have instructions for creating a spreadsheet grid to store the glucose test numbers, insulin dose, and any notes you have about possible effects on the glucose.
You can read them here
 
Re: Newly Diagnosed/Newbie Question

Hi Ruth!

it's great that Tiger is responding so well to the Lantus. You do want a dose you can give safely twice a day, 12 hrs apart.

When you have some time, I want to encourage you to read the yellow starred sticky posts at the top of the Lantus Tight Regulation Insulin Support Group. You'll find the best collection of information on how to use Lantus there. There is a lot to learn but people will help you understand it. When you've got a spreadsheet set up, you're welcome to post there for help with interpreting Tiger's blood sugar numbers and how to adjust his doses.

Newly diagnosed cats who begin to follow the tight regulation protocol (to keep their blood sugar in normal numbers, ie, 50-120) immediately after diagnosis have the best chance of having their pancreas heal and becoming diet controlled. On the page I linked above, if you look at the yellow starred sticky post that's titled "Tight Regulation Protocol" about 5 paragraphs down from the top there is a PDF that you can download. It's called "Management of Diabetic Cats Using Long-Lasting Insulin." That's a great resource for explaining the whys and hows of managing a diabetic cat using Lantus. We have 3 cats right now that are on "OTJ" or "off the juice" trials to see if they are going to be successful off of insulin and remain diet-controlled. It's a successful protocol and very encouraging.
 
Not sure whether to start new post or not but here goes...

This afternoon at noon, I tested Tiger's BG and got a reading of 48; no signs of hypo, but I did give karo syrup plus gravy on her food and re-tested. I have not been able to get logged onto this forum since this weekend, I hope this post works.

Went to the vet Monday, he knows we are home testing is supportive. Vet increased Lantus from 1 unit x2, to 2units x2 if BG is over 350; said to give 1 unit if BG is under 350 but skip dose if BG falls to 200. I apologize in advance, I have repeatedly tried to download spreadsheet, even DH tried, but cannot get my computer to recognize the doc. This is our week at a glace:

4/21/2014 AMPS 181 .05 unit; +6 = 320(tested at vet) ; PMPS 494 gave 2 units ; +9 300

4/22/2014 AMPS 276 1 unit; +4 = 343 PMPS 411 gave 2 units

4/23/2014 AMPS 137 skipped dose +4 = 435 PMPS 494 gave 2 units; +3 = 359

4/24/2014 AMPS 329 1 unit; +7 = 193 PMPS 414 gave 1 unit; +3 = 371

4/25/2014 AMPS 415 2units; +5 = 48 ; +5.5 = 115; +6 = 281 ; +8 = 539 (gave Karo syrup/gravy food; called vet have not heard back)

I have called Tiger's vet, have not heard back. She is due for PMPS at 7:00PST; I am too scared to give 2 units again. My questions, Is this the reason her numbers keep bouncing, she is on too high of a dose, even at one unit?? Thanks for any advice or response.
 
Hi,

I am not a Lantus user but understand that a dose reduction is called for if the blood glucose drops below 50.
I'll post a link to your thread in the Lantus forum to try to get more eyes here for you.

Eliz
 
Tiger has indeed earned a dose reduction. 2 units is too much insulin. And unlike what your vet said, Lantus likes to have the same dose morning or evening. Otherwise you can get some wonky numbers. The key is to find a dose that you can give consistently each day and not have to skip shots. A skipped shot will also cause high numbers. BJM earlier suggested a dose of .75U. I think that's a good place to start. Do you have the syringes with the 1/2 unit markings? If so, you can find a spot between the half and full unit markings. Many of us use magnifying glasses when drawing up the dose.

You asked earlier about getting a mid cycle test at night - try to get a test just before you get to bed. That'll give us an idea how Tiger is doing on Lantus. If she's low at bed time you might have to stay up longer or snooze with an alarm.

BTW: the forum has been slow the last few days, should be fixed now.
 
Go here on the Lantus TR forum, download the PDF that is listed about 5 paragraphs down from the top of the post. This has details on how to dose with Lantus successfully. Print it out, read through what you can understand of it, and take it to your vet.

Lantus never uses a sliding scale depending on the preshot number. That applies to the older insulins, not Lantus or Levemir. You dose based upon the low point a dose gets you to.

I agree with Wendy's advice. She's a very experienced Lantus user and won't steer you wrong.
 
I agree with Wendy and Julie that 0.75 is a good dose to try to shoot consistantly every 12 hours.
Lots of vets seem to think that Lantus and Levemir are like the other insulins where you dose based on the pre shot test, but Lantus and Levemir are different and are depot insulins and they work best when given the same dose every time.
The vets are just used to the older insulins and haven't researched the way Lantus works best. I know it's hard to go against what your vet advises.
 
Hi Ruth,

I just wanted to welcome you to FDMB. I know you're overwhelmed right now - there's a ton of information to sort through! Just take a deep breath, and take it one step at a time.

I joined FDMB in January, started Lantus in February, and we just celebrated our first official day of remission today. As Dyana mentioned, it's really hard to go against your vet's advice. Sometimes, that's just what needs to be done. I went against my vet's advice - he wrote my prescription for 10 units of Lantus once a day. (I have no doubt Jersey would have been dead at this point if we had followed those instructions.) Wendy and Julie, along with a lot of other people on this board, really helped guide Jersey and I into remission. They are very experienced users and always put your kitty's safety first.

Please don't ever hesitate to ask when you have questions. We have all been where you are - confused, scared, and overwhelmed. We'll help you however we can!
Shelly
 
Thanks for the additional information and support, you've no idea what a comfort it is to have the voices of experience to call upon! My hands are shaking so badly as I type this, so please forgive my typos and such. So I took another BG reading for Tiger at 7:00PM, it was 574; I gave her .75 unit and when I just took another reading at 10:00PM tonight, for the first time ever, the meter registered TOO HIGH!!! I don't think I'll be able to sleep tonight. She isn't showing ill effects, but I am worried sick! Vet did call back twice to say reduce the dose back to 1 unit and I didn't tell him I only gave .75.
 
These high numbers are hard to see, but it is just Tiger's liver working to protect her from what it thinks are very low numbers. If you read this post on New Dose Wonkiness and Bounces, especially the second post by Julie, you'll see a great description of what is happening. Tiger's liver reacts to what it thinks are low numbers by raising the blood glucose, we call it bouncing. The good news is Tiger has a very healthy working liver. She will get over this bounce. It can take up to 72 hours. Just keep giving the same dose for at least the next 3 days, unless she goes under 50 again. I also saw a lot of black in the early days, including "High". :YMHUG: I remember how hard it is to see.

By the way, 48 is not a dangerously low number, but lower than what Tiger has been used to lately. We don't like kitties to stay that low because it gives no margin of error. Shelly's Jersey cat that is now off insulin had some numbers in the 40's in the week after she went off insulin.
 
Deep breaths. This could be the result of something called a bounce, plus we won't know for a couple of days on this dose if it's working or not.

And being high won't hurt her short term as long as you are checking her urine for ketones on a regular basis. You can get strips at most pharmacies.

So stay the course and keep testing and let us know.
 
OMG, thank you so much Wendy and Wendy - Thank goodness someone else is awake at this time of the night! It has just dawned on me when you mentioned bounce, that's what this is isn't it. Only I had not been testing her at night, and now that I read your posts, she must have been going low late at night and that's why her morning AMPS have been so high. I'll test her again for ketones when she pees later tonight. Thanks again for being here - really, I can't thank both of you enough!
 
Same time zone as you, and even almost neighbours. :-D See me waving?

Cats often go lower at night, that's why we suggest getting at least a before bed test at night if you can't get a mid cycle test.

Also, cats are more than their blood glucose numbers. We also like to hear about the 5 P's - purring, playing, preening, peeing, pooing - all still OK for Tiger? Also, still eating fine? How Tiger is acting and feeling is an important part of the picture that only you can see. And keep testing ketones daily if you can, as Wendy/Tiggy suggests, while Tiger is in higher numbers.
 
I have just a few question regarding a change in dose. After a horrible week last week, last Friday when we changed Tiger down to .75 unit of Lantus, her numbers have stayed steady, but still very high. I have updated(finally :roll: ) a spreadsheet. I think I understand to hold a dose for 10 cycles, and it has been more than 10 cycles. It has not helped that I have been unable to log onto the forum the past 2 days.

What I would like to know if it is okay to think about a dose increase. It looked like 1 unit was too much, but at .75, her 6 hour mark is not in the 200's. I am testing almost daily for ketones, but am afraid the fiasco of last week has hurt her chances of ever going into remission. Thank you for any advice.
 
I think an increase to 1.0U is a good plan. Try to hold that dose for at least 3 days, unless Tiger goes below 50.

Thanks for getting spreadsheet done, it really helps us help you. Unfortunately the board has been experiencing some technical difficulties lately but seems to be good now.
 
Okay, thanks so much Wendy, I'll increase back to 1 unit tomorrow AMPS. Had to go take MIL to the ER tonight but I am so glad to see the board is back online, what a relief!
 
Hi ruth!

We usually hold doses about 6-10 cycles before deciding on an increase, but when numbers are consistently high, we'd have had you increase after 6 cycles. I agree with Wendy about going to 1.0u. Post again after Tiger's had 6 shots and we can help you decide if you should hold the dose or increase.

You're doing a fantastic job of testing and monitoring him. If you want to post on the Lantus/Lev TR forum http://www.felinediabetes.com/FDMB/viewforum.php there will be many experienced users to help you learn how to manage Tiger's diabetes and understand how Lantus works. I'd encourage you to post there! It's nice to get to know cats and their people!

And don't worry about Tiger's high numbers - this isn't enough to prevent him from going into remission. He's still a newly diagnosed cat and definitely has a chance. Let's just get him back into good numbers as soon as possible - that's his best bet.

Good to see you again!
 
Thanks Julie- it is so good to have the experience and knowledge on this board. I looked at the Lantus board, it just didn't look like a place to ask questions? But I also want to thank you for the link to the other forum. I read it daily.

I hope I can get this next part posted - it feels like another crash, but I hope not!

So now Tiger had her increase to 1 unit starting on 5-3-2014. And wouldn't you know that morning, for no apparent reason, she went TOO HIGH for that AMPS! ohmygod_smile It has now been 8 cycles, but one of those PMPS was a definite Fur Shot :-( Her numbers have stayed flat. I showed this chart to her vet the other day; he suggested increasing to 1.5 units - I told him I was uncomfortable going up that high due to what happened on 2 units. Would it be okay to increase to say, 1.25 and see if we can break the high cycle? Another issue has come up, Tiger needs dental work but both vets have said it is too dangerous to put her under at this point - she is too thin to withstand the anesthesia. Thanks for any advice.
 
Hi again Ruth - there are a lot of people asking questions on the TR forum, so that can be a place to go once you feel comfortable doing so. You'll also get a few more eyes on Tiger if you do go there.

On that forum we follow a Tight Regulation Protocol. I don't know if you've had a look at it yet. You are testing enough to follow it if you wish. According to that protocol, unless the cat is really high, we hold a dose for 6 cycles to see how it's doing. Unfortunately, if you miss a shot or do a fur shot, the cycle count starts over. 6 cycles would be tonight. And according to that protocol, if the lowest numbers you are seeing are above 300, you increase by .5U. I know you are nervous about what happened a 2 units, but there's a big difference between 1.5 and 2.0 percentage wise. If you are home tomorrow to monitor, I'd suggest an increase to 1.5 tomorrow morning.

Do you know why the vet said she needed a dental? Is it tartar or a tooth that needs to come out? Infections can also impact blood sugar numbers. Getting Tiger into better numbers so she starts gaining weight may help. Purina DM isn't the best quality food to feed either. Have you looked at Dr. Lisa's list of commercial cat foods. Anything under 10% carbs is good low carb food. Most people feed around 4-5% carb foods. You could try something with a higher calorie count like some of the Wellness products.
 
i agree with wendy - i'd increase the dose to 1.5u in the morning. you want to get her out of these high numbers. you do a wonderful job of monitoring her, ruth, so you'll be able to keep her safe. I'd suggest that you print out Shooting and Handling Low Numbers so you have a reference to turn to in case the board is down. There have been lots of problems over the past couple of weeks that have caused the board to hang up and be non-responsive.

people ask questions all the time on the TR forum! the advantage to posting there is that you'll be seen by many people who can help you with dosing and other questions. When people update their subject lines, we can see by the numbers if newer people need help and sometimes might not realize it. i don't usually check out the main health page, just because there is more than enough to keep busy on the TR page!

i watched FDMB for a couple of months before i finally joined. The lingo had me confused, like when people talk about "surfing the green lagoon" and things like that. then i learned that the color references are about the colors of the spreadsheets, and i just decided i needed the help for my sweet punkin.

However, since Dyana, Wendy and I have posted on this thread, you're on our radar and when we check "view my posts" for answers, we see yours. We'll help you wherever you post!

Are you still using the same meter or did you buy a new one? How is Tiger acting? Sometimes with high numbers cats are very lethargic - is that what you're seeing?

the high numbers mean that the glucose is floating in the bloodstream instead of getting into the cells, which usually makes a cat feel like they are starving and they might even lose weight. is she acting really hungry? Is her weight stable now?

Sounds like her teeth might be an issue - if a cat has infection that can drive up their blood sugar. Let's hope she can gain a little weight so the dental becomes possible.
 
Oh Thank you and Bless you both!

I have read the Tight Regulation Protocol and it makes sense(until I have to increase, which scares the bejesus out of me lol) And I had printed the Hypo Alert piece and have it on the refrigerator. I will be home to monitor her, so I guess we will take the plunge.

Wendy, I knew that Purina DM Canned has liver as it's first ingredient, I found this board by reading Dr. Lisa Pierson's articles on hyperthyroid. Problem is, I have a very picky eater. Prior to Tiger's 4 days in the hospital, she rejected all food, even her high calorie Temptation Treats(which I have since thrown away) I have some cans of Halo and Fancy Feast that I might try on her later, for now, she weighs 8 pound 10 oz, a gain of 11 oz so we are getting there. I was very interested in Dr. Pierson's Raw Diet, and would be willing to make that food but as Tiger is such a picky eater, I could see me buying all that equipment and her turning her nose up to it. If I ever get another cat, that's what I think I would do. As far as her dental work, I think the vet said it involves cleaning and an extraction. He thinks she might have broken one tooth in fact. And he says that when she can gain enought to at least get back to 9-10 pound, we can at least think about dental work and he felt it would help her BG.

Thank you Julie for your input as well. I am so sorry about your kitty Punkin, I am so sad but it is so great that you take the time to come here and help people, I can say enough what that means to me and all of us in need! I was worried that Tiger could be Acro at first. So yes, it is good to hear that I am not the only one intimidated by the Tight Regulation board because I read about surfing and didn't get it at first and still feel like too big of an idiot lol! I tested the two meters side by side, the ReliOn Micro reads 3 pts higher. . I guess I've gotten comfortable with the Solus because it talks to me, it sounds weird I know. I have 200 strips left from the Solus. Tiger has a good appetite and no longer limps around the house. I moved one litter box upstairs when she got home from the hospital because I feared she couldn't do the stairs, but she still comes downstairs and looks comfortable doing so. Having a box upstairs makes testing for ketones easy since she knows that is my bathroom LOL. They gave her B12 plus something for her appetite in the hospital and it helped her to eat more. She escaped outside the other evening and enjoyed romping around in the sunshine. It was funny because I was frantically running up and down the street and here she was waiting for me by the front door, the rascal.
 
Hi Ruth,

I'm just checking back in to see how you and Tiger are doing.

I have read the Tight Regulation Protocol and it makes sense(until I have to increase, which scares the bejesus out of me lol)
Click to expand...

So yes, it is good to hear that I am not the only one intimidated by the Tight Regulation board because I read about surfing and didn't get it at first and still feel like too big of an idiot lol!
Click to expand...

I absolutely can relate to those feelings! There were times when I was scared to increase the dose, shoot low, hold the dose, etc. Just the name "tight regulation" freaked me out! The people on the TR board were absolutely wonderful, though. They held my hand every step of the way. The dose advisors never steered us wrong, and the moral support I received from everyone on the TR board was priceless. Of course, the people on the main board were wonderful, too. Shoot....I just can't say enough good things about the entire site and the people here!

Just don't be afraid to ask whatever questions you have!
Shelly
 
the name Tight Reg would scare off anyone. Let's see, would you rather have "relaxed" or "uptight?" LOL fortunately when i started there was just "Lantus Land" - so no choice. But i try to tell everyone that Tight Reg just means to get and keep your cat in normal blood sugar numbers so their pancreas can heal. The sooner a newly diagnosed cat gets their blood sugar back under control, the greater their chances for becoming diet-controlled. The most recent protocol (in that pdf) says 90% of newly diagnosed who get back in normal numbers in the first month can become diet-controlled. that's pretty good odds, in my book.

I think the 3 of us aren't the only ones scared by the TR forum, but the people couldn't be nicer and everyone looks out for each other. everyone remembers being new and how incredibly overwhelming it is to suddenly have a diabetic cat.

I'm glad you compared the two meters - i just wasn't familiar with the Solus name and some meters are more accurate than others. If you've compared it and it's accurate, i would just keep on using it.

Keep asking questions!
 
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