Newbie questions after initial vet consult

[Liz4Paws]

Hi again!

My husband and our newly diagnosed kitty, Nadia, all had our initial diabetic consult with our vet yesterday. Nadia was diagnosed last week based on glucose spilling into her urine, a BG level of 441 at the vet, and a fructoasmine level around 640 (I don't recall the exact amount, sorry.)

Here's a quick recap of what happened:

The vet is starting her on 2 units of Lantus twice a day, 12 hours apart. At the start of the appointment, she said it would only be 1 unit twice a day, but then changed her mind halfway through and switched to 2. We are starting her on the Lantus tomorrow - 8am and 8pm. She was switched to eating strictly FF classic for the past 5 days, but the BG levels that the vet based her dosage on was drawn prior to the diet change. Should I be concerned that 2 units twice a day this is overkill for an initial dose or does that sound reasonable?

Originally the vet said we would be doing a BG curve at the vet office but I pushed back and asked that I do it at home to get the most accurate readings. She was surprised, but pleased because she said most people aren't willing to home test, which is why they don't generally mention it as an option in their consult. She wants us to come in and calibrate our glucometer to hers, but otherwise she's completely pleased that we want to do it.

The vet said it is not necessary to monitor Nadia's BG whatsoever for two weeks on this initial dose. She said we won't see any kind of effect until then. Can you all tell me if this is correct? It seemed strange to me since I was prepared to monitor her from the moment she started on the Lantus. In fact, I plan to despite her telling me it's not necessary. Or is this also overkill?

I expressed my concerns about being at work when Nadia goes into hypo. She explained that the signs of hypo will be gradual and we'd have time to come home from work and react if she was dropping while we were gone. She said you generally have 24 to 48 hours. Is this also true?

And lastly, Nadia seems very eager and hungry when I'm dishing her up her bowl of FF - any flavor. But she only eats about half of it and walks away! I can't tell if she's getting full or if she's just bored. I mentioned this to the vet and she said I can offer Nadia her food throughout the day and it shouldn't impact her BG readings, as long as she has eaten just some (and she said it was a very small amount) prior to her shot. Does anyone know the minimum amount of FF needed to be ingested before giving a shot? At this point, Nadia isn't eating even close to the recommended amount that FF says on the side but I'm not sure how to get her to eat more. She's eating maybe one can a day, if that. Doesn't matter what flavor. Help....

She said I didn't need to only have her on wet food, some dry was okay. I thought only wet was okay?
And I asked her what to expect for remission, and she said not to expect it at all. Very few kitties go into remission. This didn't ring true with what I've read.

I'd love your thoughts on our appointment. Some of it I felt great about, some of it made me a little nervous.

Oh and one last thing - does anyone recommend a downloadable spreadsheet for tracking her BG levels at home? The one the vet gave me is very basic, and I've seen some of yours that I like better.

Thanks for reading!

 

[Dyana]

My cat J.D. eats somewhere between 1.5 to 2 cans of FF a day and I thought that was a small amount but he is not very active. I would think that Nadia should be eating at least 2 cans a day. Is she losing weight? Is she too skinny or too fat?

I would strongly strongly encourage you to test before every shot, and to try when possible to get a test two hours after the shot so you can see whether she is diving down in numbers, going up in numbers, or staying the same after eating.

Lantus normally doesn't have onset (the time when the dose starts to affect the BGs) until around +2, so you have until that time to get her to eat her food. The other insulins that were faster acting and had shorter duration would come on strong and you had to get the cat to eat before the shot, but Lantus is much gentler with a slow onset, so maybe your vet is more experienced with the other insulins.

I would try to get a mid-cycle test whenever you are able to. If you are gone during the day, then set an alarm for about 5 to 7 hours after the shot and get an evening mid-cycle test. Knowing what numbers the nadir (the lowest point in the cycle) are is what determines whether the dose is too high or too low or just right.

Make sure you always have plenty of test strips and high carb food and some karo or syrup that you keep all together with the hypo instructions in a separate cupboard or pantry.

Yes, a cat can go too low in a matter of hours. My cat (and many others) have been in the 400s at shot time, gone down to below 50 at nadir and right back up to the 400s at the next shot time.

Please keep asking your questions, that's what we're here for is to help you to help your cat.

 

[BJM]

...Should I be concerned that 2 units twice a day this is overkill for an initial dose or does that sound reasonable?..

Yes. The initial dose of Lantus is calculated from lean body weight, not the glucose level.

how much does she weigh? How much should she weigh?

...She wants us to come in and calibrate our glucometer to hers, but otherwise she's completely pleased that we want to do it...

Most human glucometers read about 30 points under lab tests and pet-specific meters. Its like readking in Celsius vs Fahrenheit.

...The vet said it is not necessary to monitor Nadia's BG whatsoever for two weeks on this initial dose....

Unsafe to trust in this, particularly since you've already switched to low carb foods. You should always be observant for sighs of hypoglycemia and be prepared to intervene by reading this

As far as the nibbling throughout the day - thats good. The food doesn't hit all at once and neither does the Lantus, so they'll match up better.

Feeding a canned diet is vastly preferred if the cat will do it. See Cat Info for more excellant cat nutrition info from veterinarian Dr Lisa Pierson.

No need to download a spreadsheet - we use Google Docs so they can be shared. Instructions here.

 

[Liz4Paws]

Thank you for your quick response! I'm SO grateful for this forum.
I hope I'm using the quote feature right to reply here.

...Should I be concerned that 2 units twice a day this is overkill for an initial dose or does that sound reasonable?..

Yes. The initial dose of Lantus is calculated from lean body weight, not the glucose level.

how much does she weigh? How much should she weigh?

She currently weighs 10.1 pounds and is dropping. The vet says she should weigh about 10 pounds. However, she has been approximately 15 pounds her whole life (quite obese) and only recently plummeted in the past 2-3 months those five pounds due to the diabetes that we had no idea she suffered from. You can very much feel her rib cage and bones. But alas, the vet says 10 pounds is ideal. I personally think more like 11-12 pounds is idea for her large frame but I'm not a vet (however I should mention have worked at animal shelters and have lots of experience with cats/dogs!)

What do you think about 2 units to start with that weight?

 

[BJM]

The formula is lbs / 2.2 to convert to kilograms (KG)* 0.25, rounded down to nearest half unit = starting dose

4.55 kg * 0.25 = 1.14 -> rounded down is 1 unit

So 1 unit given every 12 hours.

 

[Dyana]

I would start with 1 unit. And I would be sure to get the insulin syringes with 1/2 unit marks on them, as we almost always recommend doing adjustments to dosing in 1/4 unit increments. It's just a whole lot easier to be consistant when you have those 1/2 unit marks.

 

[Deb & Wink]

her on 2 units of Lantus twice a day, 12 hours apart

That is a high starting dose unless there have been ketones or DKA (iabetic ketoacidosis). If it were my cat, I would not start at more than 1U, BID. Better to start lower and increase gradually. Once you inject the insulin, you can't take it back out.

The vet said it is not necessary to monitor Nadia's BG whatsoever for two weeks on this initial dose. She said we won't see any kind of effect until then. Can you all tell me if this is correct? It seemed strange to me since I was prepared to monitor her from the moment she started on the Lantus. In fact, I plan to despite her telling me it's not necessary. Or is this also overkill?

We monitor from the very first shot given. Effects with insulin can start to be seen very quickly in some cats. Other cats, it takes longer. ECID. Every cat is different. No testing from the moment you start her on Lantus is not overkill. It's being a caring, responsible pet owner.

Please share the AAHA diabetes management guidelines for Dogs and Cats with your vet. for more current guidelines on diabetes care in dogs and cats.

I expressed my concerns about being at work when Nadia goes into hypo. She explained that the signs of hypo will be gradual and we'd have time to come home from work and react if she was dropping while we were gone. She said you generally have 24 to 48 hours. Is this also true?

No. A hypo can take very little time to develop. Most cats on Lantus do not show clinical signs of low blood glucose, even when they are low.

And I asked her what to expect for remission, and she said not to expect it at all. Very few kitties go into remission. This didn't ring true with what I've read.

University of Queensland slideshow on the different insulins and the remission rates. http://www.uq.edu.au/vetschool/content/clinic-stlucia/feline-dm.pdf I believe this is at least 5 years old. It shows a remission rate of >90% with Lantus.

 

[Deb & Wink]

New member shopping list
https://docs.google.com/document/d/11Ufa3ylqsQFrzcGUFIpzlQ4KKovZ8C9iqdbYJ1L1XcE/edit?pli=1

 

[Liz4Paws]

So much great info!

I've read through all of your responses, and much of it confirms that some very important information we were given was incorrect, just as our gut told us it might be. Also, I should add that when we first took Nadia to the vet for her weight loss, this same vet was certain she had hyperthyroidism. I point blank asked her that day, "If it's not hyperthyroidism, what else do you think it might be?" and she told me she was sure that was it. Clearly when the blood results came back, she was proven wrong. We're not that confident in her based on all of this. I feel kind of bad because she sent us home with some free donated Lantus and is very sweet, but Nadia's well being means more to me than hurting her feelings by switching to a new vet.

All of this being said, do you think this kind of misinformation warrants looking for a new vet? I know this might seem like a dumb question, but how much involvement does the vet have in this process when you're home testing?

And if the recommendation is to switch vets, how does one go about finding one locally who would be knowledgeable? I am in Austin, TX and willing to go anywhere in the metro area if we get better care.

 

[BJM]

It is impossible for a vet to keep up on every disease for every animal. The best a vet can do is either specialize in 1 area OR be willing to look it up when it is not a common issue. And feline diabetes is not that common.

If the vet is receptive to doing some continuing education on feline diabetes, share the websites and info from here, such as these:

Cat Info

2010 AAHA guidelines

Merck veterinary Manual Online
"It is usually preferable to have blood glucose testing performed at home to avoid changes in the pet's routine and the stress of in-hospital testing. Studies in both dogs and cats have shown that at-home monitoring improves glycemic control and increases the likelihood of obtaining remission in diabetic cats. In cats, high-protein diets along with insulin therapy are initiated, with reevaluation in 5–7 days. In newly diagnosed cats, insulin glargine is the insulin of choice. Glargine is a long-acting basal insulin. Used in conjunction with high-protein, low-carbohydrate diets, it is associated with remission of diabetes and discontinuation of insulin therapy in 80%–90% of cases within the first 3–4 mo of treatment." (bolding mine)

 

[BJM]

There are Vet Interview Topics in my signature link, if you decide to go vet shopping.

Google search for veterinarians in Austin, Tx If you edit the location with your exact address, it'll show the nearest ones first.

 

[Wendy&Tiggy(GA)]

Hello and welcome to the board!

You have some great advice so far. Just want to be sure all your questions are answered...

The vet said it is not necessary to monitor Nadia's BG whatsoever for two weeks on this initial dose. She said we won't see any kind of effect until then. Can you all tell me if this is correct?

No - you want to start monitoring now. You changed her food and so her blood glucose could already be dropping. Plus you can see Lantus build up the "depot" within a week if not sooner. And of course if you start now you will be able to see how the 1 unit is working and get some idea of how she is trending. And the most important - it will keep her safe. Ideally you want 4 tests a day - every time before her shot no matter what , a mid cycle (5-7 hours after the shot) if your schedule allows, and finally a before bed test.

I expressed my concerns about being at work when Nadia goes into hypo. She explained that the signs of hypo will be gradual and we'd have time to come home from work and react if she was dropping while we were gone. She said you generally have 24 to 48 hours. Is this also true?

Unfortunately no. A cat can drop fast and go hypo within a few hours. But thats where testing comes into play. If you get the tests I suggested then you will have a good idea of how she will behave and whether you need to worry. Also we advise newbies not to shoot under 200 at first to be safe as well. Once you start testing we can help you through all this.

A I mentioned this to the vet and she said I can offer Nadia her food throughout the day and it shouldn't impact her BG readings, as long as she has eaten just some (and she said it was a very small amount) prior to her shot. Does anyone know the minimum amount of FF needed to be ingested before giving a shot? At this point, Nadia isn't eating even close to the recommended amount that FF says on the side but I'm not sure how to get her to eat more. She's eating maybe one can a day, if that. Doesn't matter what flavor. Help....

I like to see free feeding or many mini meals. That keeps her blood glucose stable through the day. The only time to be careful is if she isnt eating at all, or an unusually low amount. Then you might want to skip the shot.

She said I didn't need to only have her on wet food, some dry was okay. I thought only wet was okay?

Dry spikes the blood sugar - you are correct - you just want wet. The fancy feast classic pates are perfect.

And I asked her what to expect for remission, and she said not to expect it at all. Very few kitties go into remission. This didn't ring true with what I've read.

Its not - BJs report shows many cats can go into remission in the first six months with a good low carb wet food, a good insulin like lantus, and home testing to keep on top of things. We see maybe 40-50% on this board.. its lower because many people come here as a last resort. Maybe send the report from BJ to your vet

Your vet is 50% right
Wendy

 

[Sienne and Gabby (GA)]

Hi, LIz. Betty asked me to stop by. I tend to spend most of my time on the Lantus Board. You're welcome to join us over there. If you have questions, we have a very social group who are very generous with their time and information.