Newly diagnosed and insulin help

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Michaela & Luna

Michaela & Luna

Member Since 2021
Hello!

My cat Luna was diagnosed about a month ago. She is 10 years old and had been prescribed steroids in October which we believe triggered the diabetes. She lost 3 pounds very rapidly and started to have symptoms of neuropathy. Her in office bcg was around 450 at diagnosis.

The vet that prescribed steroids and diagnosed her with diabetes did not recommend a diet change, home testing or a glucose curve which seemed crazy to us so we switched vets. Our new vet has asked us to do a glucose curve, which I am in the middle of completing and then I will send the results to the vet.

She is on 1 unit of Vetsulin 2x day and we have transitioned her to meal fed fancy feast pate. Today the curve has shown bgc numbers of 220-370 (so far, two more tests to be done).

My questions are:

Should I talk to the vet about Lantus? From perusing the site and Facebook group that seems to be preferred.

Why is there such a great variance when testing and should I be worried about it? Im using the AlphaTrak 2 meter. Earlier I tested twice at the same time and the first number was 320, second strip tested at 272. That's a huge difference!

Thank you immensely for any help you can provide!
 
Hi Michaela and Luna and welcome to the forum.
Lantus is a much better insulin for cats. If your vet is happy to change you over to Lantus I would do it.
There is up to a 20% variance in reading on a glucometer so it is possible to get different reading close together.

I think it’s great you are hometesting and feeding a low carb diet. The alphatrak meter is expensive to run as the test strips are very expensive. You might like to think about a human meter which is just as good and much cheaper to run.
Do you have a hypo kit set up?
I’m going to give you a link to HELP US HELP YOU which will give you links to a hypo kit, the spreadsheet to use to put in all your blood glucose data, how to set up your signature and other links.

Luna should put the weight back on once you have the blood glucose under more control. Also the neuropathy should improve. You can buy Zobaline from life link.com or Amazon which will help with the neuropathy.

Let us know I’d we can help you with anything else.
Bron
 
Welcome to FDMB!

Your instincts sound incredibly solid for someone so new to feline diabetes! The most recent guidelines from the American Animal Hospital Assn endorse either Lantus (glargine) or Prozinc for the treatment of feline diabetes. Vetsulin is no longer recommended due to its short duration. In other words, a shot does not last 12 hours so there are broad swings in a cat's blood glucose (BG) test results. Lantus has become quite expensive. There are a couple of options if you want to use Lantus. Many people order their insulin from Marks Marine Pharmacy in Vancouver. Alternatively, Lantus/glargine is now available as a generic (referred to as a biosimilar). Many people are opting to buy Semglee. If you have a Costco membership, Semglee costs around $100. The cost for Lantus from Marks is close to that same amount for a box of 5 pens (which is more insulin than in a vial).

As Bron noted, there is an allowable amount of error variance in any test due to either the meter or the strip. If you get two tests and the readings are within 20%, that's an acceptable difference. It seems like a bigger difference when numbers are higher. There was about a 10% difference between your two tests.

Zobaline is methylcobalamin (a form of vitamin B12 that's also called methyl-B12) that's been specifically formulated for diabetic cats. Along with getting a cat into lower BG numbers, methyl-B12 can help with diabetic neuropathy.
 
Thank you for all your advice! Luna started Lantus last week and she seems to be responding fairly well. She is on one unit twice a day, but sometimes at shot time she is below 90 BG and we have held the shot. It seems like the next shot time though her BG is very high. I'm wondering if it makes more sense to do a smaller dose consistently or what we can do to prevent the swinging.

Here is our current spreadsheet, we haven't switched to the FDMB spreadsheet yet but it's on my to do list. https://docs.google.com/spreadsheets/d/1X-fw1OhfDc5uHvBQSs5erba05RAjWRL6_9au3QNRnHY/edit?usp=sharing

I'm off to do some research in the Lantus message board but I am open to any info!
 
Hi Michaela, I’m going to ask @Bandit's Mom if she can have a look at your spreadsheet and help set up our SS. It is far easier to see what is happening than the one you have at the moment. Also could you put in the signature that you are using an alpha track meter please as it is important we know what type of meter you use. Thanks.

It looks like Luna is on too high a dose if you have having to skip doses. And the 48 you got at PMPS on 1/1 was very low on an alphatrak meter and is an automatic reduction in dose.
If you get a BG under 68 on the alphatrak meter you need to give some high carb food or honey to bring the BG up higher and test again in 20 minutes to see the BG is rising and reduce the dose by 0.25 units

I would reduce the current dose to 1/2 unit twice a day and see if that allows you to shoot both am and pm doses.
Another thing that you need to be doing is testing during the cycles to see how low the dose is taking Luna. Lantus dosing is based on the nadir or lowest point in the cycles, not the preshot BG. Remember the PM cycle is just as important as the am cycle for testing
Are you giving snacks of low carb food during the first half of all the cycles as well as the preshot meal? I would recommend you do.

Keep asking questions. Once we have the SS set up properly and you are testing during the cycle as well as the preshot BG and are feeding during the cycles I will suggest you start posting on the Lantus page for help but we need to get you set up properly first.
Bron
 
Hi everyone,

Thanks for all your help! I was traveling the past few days and my husband was on Luna Duty, but now I am back home and have gotten the FDMB spreadsheet/signature set up. We took Bron's advice and reduced her further to .5 U twice daily and haven't had to skip a dose yet. it's hard to eyeball .5 units on our current syringes but the new ones with half unit markings should arrive within the next day or two. I work from home (unlike my husband) so I will start grabbing some midcycle readings as I am able. Planning on doing another curve Thursday or Friday.

I think we have been almost mixing the SLGS and Tight Regulation protocols but are interested in going full TR. It was just a little scary when our vet prescribed 2 u/ 2 times daily Lantus and we saw the numbers going all over the place, so we wanted to back off and stick with .5U/2X daily for a little while and see how her body reacted.

One spreadsheet question I have: What is the number/color we are aiming for? In my brain green = good, but the way the spreadsheet is set up bright green = danger. Also, what is considered "regulated"?

Our vet wants us to bring her in again in a week or so to do a fructosamine test and check her liver enzymes which were slightly elevated at diagnosis (she was diagnosed by a different vet that we swiftly fired after reading on our own about best practice surround feline diabetes).

I will look into the cheaper Zobaline alternative! Also considering a different meter since AT2 test strips are ridiculously expensive, but for now as we figure out dosing and the spreadsheet we will stick with the expensive bugger.

-Michaela
 
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