Newly diagnosed and very anxious!

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mrbigsmom

Member Since 2012
My baby, Mr. Big, was diagnosed with diabetes last week(BG>600)! He is 14 years old and weighs 19 pounds. Always has been an inside cat and has always grazed his food(Purina Cat Chow DRY). The vet kept him from Thurs-Mon. Last night before bringing him home his BG was 320. They gave him his insulin(Lantus 4 units) and we brought him home. He was so happy to be home! He nibbled slightly at his food and we put it up before bedtime as doctors orders. I took his BG this am and it was 88, so I didnt give his inj. When I gave his food, which by the way the vet said not to change for the time being because of so many other changes, he nibbled one time and walked away. Drinking is still good. I called the vet and he said to give him 3 units of insulin this evening even if he hasnt eaten. Is this a good idea. Dont want hypoglycemia. Is his loss of appetite just the stress of being away from home so long??
 
Do you have any keto strips to ckeck for ketones? That is the biggest worry right now with him not eating. If he is not eating and his numbers are low I wouldn't give him an injection.

What kind of meter are you using? It looks like you are home testing which is good.
Lantus is what Mr. Big is getting? You can post directly to that board, do both boards as one should have someone on it to answer and they know more about the insulin to answer. But 4u is A LOT of insulin to give as most cats usually start out with 1u.

I'll type more.

Welcome!
 
Dont have any of those strips. I am using the Bayer Contour Meter. Is it ok to use the lancet on the paw pad instead of the ear?
 
Yes, the paw pad is an alternate test location. Have you searched YouTube for "Feline Diabetes testing"? Lots of vids there, and I'm sure there must be a couple that show paw testing.

Try to get a test about half an hour before he's due for his shot tonight and post it here. 4u, or 3u for that matter, is a pretty large dose and I'm hoping someone who has a lot of experience with Lantus will be online to help you out. It matters that he is not eating. That might indicate something other than just diabetes that his causing a loss of appetite.
I don't agree that the vet thinks dry food is okay to continue, BUT, I DO agree that you don't want to change that all of a sudden right now, especially because his doses are higher than we normally see at the start of treatment. The higher carbs in that food are probably what is causing most of his high numbers (and the vet setting the dose so high). But if you were to remove that dry food right now, the dose would be too high and dangerous potentially.

Good for you that you are home testing! If you weren't, that normal dose into that low number this morning could have been really bad.

What time would his PM shot be due?

Carl
 
Here's the official WELCOME!
Glad you found us. We can help you with your sugar cat.

For hypo's- http://www.felinediabetes.com/FDMB/view ... 28&t=15887
For the proper food (reasons to feed canned)- http://www.felinediabetes.com/diet.htm (and we have a new list that is almost finished!)
For Lantus- http://www.felinediabetes.com/FDMB/view ... 32&t=34650
For new people- viewtopic.php?f=32&t=2501

This is a lot to take in and I'm glad you started with the home testing! Offer treats and the cats come running :lol: (Sneakers does a lot for a piece of chicken). The reason I asked what meter you are using because we have found some that have incorrect readings for the BG especially high numbers- True meters and the Freestyle Lite (butterfly strips) are not good, dependable meters to use. Relion Micro or Confirm or Bayer are popular ones on the board, so is the One Touch Ultra, but the Relion strips are by far the cheapest to get unless you order online.

Ketone sticks can also be found in the pharmacy- usually in the diabetic supplies, a little bottle of 50 for $7 and it's the best insurance possible. This way we can keep an eye out for DKA (really bad illness that needs low eating, infection, and low insulin to get bad really fast and is expensive to treat on the back end and can kill).

Going onto a canned diet exclusively will also help Mr. Big slim down to his ideal weight and help his fur to get silky soft :mrgreen: .

Keep the questions coming.

Edited to correct faulty links :mrgreen: sorry about that :oops:
 
Thank u all for the help! I am freaked out right now from all the stress! His pm shot will be around 7:00 est. I am going to check his BG before the inj. I'm leaning towards not giving the inj if I am still getting such a low number. I am also going to pick up a can of Fancy Feast on the way home. He has never tried wet food but I am going to See if it will help. I think the trauma of being away from home has decreased his appetite and maybe when he's home a few days and sees he's not going back to "that Strange Place" he will do better! I HOPE!
 
Trying FF is a good idea. He may take to it really well and then a large part of your problem goes away. Some cats are like "nope, I'm not eating this stuff", but many others are thinking "OMG, where has THIS stuff been all my life!!!?" Make sure the can says "classics" on it, as those are the ones that are lowest in carbs.

I will try to get some experienced Lantus "eyes" on the board before his 7PM shot time.

Carl
 
Sometimes they will start eating the wet food off your finger at first. Sometimes it helps to add a little warm water to the food to make it a little soupy. I would leave the dry food down to see if he will start eating it also. (wet food is best for diabetics, but it is most important that he eat something)

If he is eating by this evening, I would test and post with your number. As others have said, that was a large dose to start with. (one of the reasons we test at home is that we feel numbers at the vet are often elevated by vet stress. Then doses based on those stress influenced numbers can be too high once the kitty gets home)
 
Hi welcome to FDMB! :YMHUG: It is overwhelming at first and there is so much to learn! ohmygod_smile Yes, 4u is a large dose to start on, but Mr. Big is a big cat. Definitely get the preshot test a little early and post for advice. Come over to the Lantus forum. There are some very good peeps on lantus dosing there. I know it is a lot to take in but we can walk you through it.

Starting to introduce wet food is a good idea. If he likes it , great, but do the switch slowly so you don't get a sudden drop in BG numbers. Every couple of days increase the amount of wet food a little and give a little less dry. Just put them down side by side. It took us about a week to 10 days to switch Tess over. You want to choose a food that is lower than 10% carbs for his primary food, many of us try to stay below 5%. The Fancy Feast classic flavors are good. Check out the food lists that you were given the links to, or just ask here!

Here are a lot of tips for transitioning over to wet if he doesn't recognize "that stuff" as food.

As well as the low carb classic FF, I would pick up a couple of cans of the type w/ gravy. Those are higher carb and are good to have on hand if Mr. Big's numbers get too low. For a really fast BG rise have some Karo syrup on hand , just a drop or two will bring numbers right up in a hypo situation.

Another reason we ask about what meter you are using is that there is an animal meter, the Alpha Trak, that vets push on us. It tends to read about 30 points higher than the human meters we often use here. So we need to know what type of meter you are using. Most of us go w/ the human meters because most of the studies were done using them and the strips are much cheaper. You will find that testing strips are one of the biggest expenses in all of this.
 
Welcome to FDMB - the best place you never wanted to be!

The first couple of weeks of this process are completely overwhelming so what you're experiencing is normal. The good news is that all of this will become second nature. For now, though, take it one step at a time and there are a large number of people here who are knowledgeable, supportive, and more than willing to lend you a hand.

There are a couple of basics. You've got one of the most important basics already covered -- you're home testing. The majority of us keep track of all of that test data on a spreadsheet that we attach to our signature. I've linked the template and the instructions. Having the numbers all in one place allows you to see patterns and allows us to be able to help you.

The next biggest step is food. It's recommended to feed a low carbohydrate, canned food diet. Low carb is considered under 10% carbs, although most of us feed lower than 10%. There are several charts that will give you a selection of foods.
On the last 2 lists, you want to look at the column labeled %kcal from carbs. On the nutritional values, the cat food list stops at page 5. You'll also want to have several cans of high carb (over 15%) food. We use HC to steer numbers should they drop into lower ranges.

Your cat is on a comparatively large dose of insulin. I suspect this much may be needed due to what you're feeding. There is a weight based formula that can be used to calculate initial dose:
starting dose = 0.25 x ideal weight in kilograms​
This usually works out to close to 1.0u unless you have a very large or very small cat. If you are going to transition Mr. Big to canned food, you will need to monitor his blood glucose carefully since his insulin needs could change drastically.

As for Lantus, there is a huge amount of information in the starred sticky notes at the top of the Lantus board. Links to the information and a brief description are below:
  • Tight Regulation Protocol: This sticky contains the dosing protocol that we use here. There are also links to the more formal versions -- the Tilly Protocol developed by the counterpart of this group in Germany and the Queensland/Rand protocol developed by Jacqui Rand, DVM and published in one of the top vet journals.
  • New to the Group: Everything you wanted to know about this forum and more. Info on our slang, FAQs, links to sites on feline nutrition and to food charts containing carb counts, how to do a curve and the components to look for, important aspects of diabetes such as ketones, DKA, and neuropathy, and most important, info on hypoglycemia.
  • Handling Lantus: how to get the maximum use from your insulin and what to not do with it!
  • Lantus depot/shed: This is an important concept for understanding how Lantus works.
  • Lantus & Levemir: Shooting & Handling Low Numbers: What data you need in order to be able to work toward remission or tight regulation as well as information if you have a low pre-shot number or a drop into low numbers during the cycle.
The people here are incredibly generous with their time and information. Please let us know how we can help.
 
WOW! U all r so helpful! The 7 pm BG was 232. Gave 3 units Lantus per vet. He would not eat the Fancy Feast. I will try the finger feeding method when I get home this evening though! Thanks! This am his BG was 98. So I didnt give the insulin. Why is it high at night but normal at morning? About 11 last night he ate a couple bites of dry food and drank a little water. He doesnt seem to feel bad and wants constant petting. Just still worried about the not eating.
 
Possible ideas- he could have been in a bounce and he bounced high (last night) from a low number. Until Mr Big settles in he might be riding the roller coaster. Other lantus peeps will chime in.

There should be a link to help cats transition from dry to wet but the basic premise is to put 90% dry with 10% wet on top, each day add a little more wet and less dry. In about a week or two he should be all on wet (unless stubborn- and a lot of cats are :lol: ) others just jump right into the wet like its a treat they now get to eat everyday- Sneakers was like that, i had dry there and she looked at me, looked at it, looked at the wet- headed for the wet and ignored the dry.
***please keep testing during this time, not only at shot times but spot checks throughout the day as going off high carbs WILL lower his BG- we just don't know how much.

Some tips for wet- add a little water and mash to make "gravy", microwave it for about 10 seconds to warm it (and make it smell), add grated parmesen cheese to it- just a little (I use Kraft kind in the round green tube).
 
He is a very stubborn kitty! He has never eaten anything but the cat chow, not even a treat! I have offered in the past and he just turns his nose up! That's why I am having such a hard time now! But am definitely gonna try doing the wet on top of the dry. Thanks!I'll try anything at this point! Can't test his sugar during the day because I work 4 days-10 hr shifts. Will do Fri-Sun while I am off though! Thanks for the suggestions!
 
Why is it high at night but normal at morning? About 11 last night he ate a couple bites of dry food and drank a little water. He doesnt seem to feel bad and wants constant petting. Just still worried about the not eating.

It could be that the dose is too high. It could also be due to the lack of eating much. The "not eating" thing concerns me the most. If he's not eating at all, that can lead to more problems and quickly.

Have you talked to the vet today about him not eating again? I know that yesterday, the vet told you to shoot 3u even if he didn't eat? I hope that advice doesn't continue. If he keeps refusing to eat, it can damage his liver, and can lead to hepatic lipidosis (fatty liver). Have you noticed any vomiting in the past couple of days?
Heather mention "ketones" and testing for those by using ketostix? That is also something you want to be on the lookout for.

At this point, you really need to worry about the not eating first. Even if he'll only eat dry food, he needs to be eating something if your vet wants you to continue with 3u or more of insulin every 12 hours. If he doesn't eat, that dose can quickly become far too high a dose.

Carl
 
A couple things stick out to me: One the high dose, and two, the dry diet. Right now, getting Mr. Big to eat is the main thing. If he will only eat the dry, go with that for now. http://www.catinfo.org has some great tips on transitioning to wet. The sooner you can do that, the better!

As for the AM numbers, Lantus works on a curve, so if he's in the 90's at +12 after the last shot, my concern is that he's dropping much lower in between. Are you getting midcycle tests? Most cats hit their lowest numbers on Lantus at 6 hours after the shot, but that can vary between cats, so getting tests at +4, +5, and +6 are really important.

3 units is a LOT of insulin, and is NOT indicated by the accepted protocol for Lantus at this stage. The general rule of thumb is to start at either 1Unit, or .25 units per kilogram if IDEAL (not actual) weight. The initial dose should be held for 5 to seven days, and then increased only if the numbers dictate. It seems like your vet raised the dose way too fast and this can contribute to crazy numbers. Cats get used to the higher BG numbers quickly, and when the numbers drop to what their internal meter perceives as "low" the liver dumps glucagon, a stored form of glucose, into the blood to compensate. The problem is, for diabetics, a drop of a couple hundred can produce this reaction even if it's not actually too low a number, because it's lower than the body expects. This causes a swing back to higher numbers. Personally, I'd drop back to the correct starting dose, or 1 unit if the calculation is more than that, and start over as you make the transition to a low carb canned diet.

One caveat about switching to wet food: It will likely reduced insulin needs drastically and immediately. Shooting a high dose of insulin could be very dangerous, so if you make the switch, you will need to reduce the insulin dose (I'd say to either .5 or 1 U) right away. You can always increase the dose again, but an overdose can be fatal.
 
For some of us on the board the weekend is the time we do our curves (me included!).

I get up and test/shoot early and go back to bed then get up and go to work. I do an out the door test in the morning and then she doesn't get tested during the day until I get home in time for her shot. So my testing for data is actually done in the evening times and any time I get up in the wee hours and she wants food.

She knows she doesn't get any food until she gets a test- so every time I test she thinks she's getting food. Kind of like a reverse pavlov :lol: . Bummer for curve Sundays because she wants food all day :? and Saturday I can get early checks in as I have a shorter work day.

As long as you get the data to see where Mr. Big goes on his insulin journey.

But the food is important, he does need to eat.
 
Mr Big is FINALLY eating again! YAY! Yesterday eve his BG was 282 but I just gave him 1 unit Lantus. He ate heartily last night! This morning it was 315. So I gave him 2 units. Maybe we are getting on the right track now! Thanks for all the support! Now I need a recommendation for dry diabetic food!
 
mrbigsmom said:
Mr Big is FINALLY eating again! YAY! Yesterday eve his BG was 282 but I just gave him 1 unit Lantus. He ate heartily last night! This morning it was 315. So I gave him 2 units. Maybe we are getting on the right track now! Thanks for all the support! Now I need a recommendation for dry diabetic food!

Great that your cat is eating again :smile:

Unfortunately, there is NO good dry food to feed a diabetic cat. Dry foods contain starch of some sort and the starch keeps blood glucose levels too high. Then there are the issues with feeding a food that has no water. There are some grain-free dry foods that are low in carbs that are often suggested to temporarily feed to a diabetic cat but even these can keep blood glucose levels too high. Some diabetic cats are so carb sensitive that even a few pieces of dry food can cause blood glucose levels to skyrocket.
 
Hi,

I'm a little late to the party.

I know I wanted a diabetic-friendly dry food for Basil when I started here. Because I thought dry was better for their teeth. But, once I gave in and accepted that it had to be wet (after like three hours of people here telling me LOL!) I never ever looked back. Even my civvie kitty (she does not have diabetes) began to lose weight dramatically in the wet. She went from a cat who was very overweight and always hungry to one who is satisfied by her meals and now is a normal weight.

It sounds like the change over will be impossible, but you'll manage it. You just find that you do. Do you have freeze dried chicken? Pure Bites brand is 100% from the US and my animals all ove love love it. You might want to powder up a bit of that and try it on top of the wet food to make it more enticing. Or grate a bit of cheese. I would also offer the wet and if he does not eat it right away, lift it up and try again in 10 or 15 minutes. I think they learn that if they just wait, the dry will come. If that doesn't work, repeat but give him two or three kibbles as an appetizer first and then try. My renal dog, when he gets to feeling not great, will get his appetite turned on by the tiniest crumb of forbidden cat food!

Best of luck and look forward to seeing you in Lantus Land.
 
One more quick thing: Lantus is dosed on the nadir (lowest point in the cycle), not the preshot number, and because of the way it works, you should not give a different dose based on the preshot. Please read the links in Sienne's post about tight regulation protocol (or I believe the relaxed Lantus group has established some guidelines if you don't want to go the TR route. You need to hold the starting dose (1U is a good place to start; 2 is generally too high to start with) for 5-7 days and make sure you are getting spot checks during the cycle. I know you work, but can you get a few during the night? Then, after 5-7 days and some nadir checks, you can make a determination about the next step. Preshot numbers are often the last to come down (just look at Mikey's spreadsheet!) and are not a great guide for dose for osage. Lantus works best with consistency, so you don't want to change doses between shots unless Mr. Big drops low enough to earn a reduction or has been on that dose long enough to know an increase is needed.

As for food, as has been said, no dry food is good for a diabetic (or any cat). If you have to feed it in the interim to get MR. Big to eat, that's understandable, but you should work on a switch to wet. The page I linked you to above will give you tips on transitioning to wet.

Finally, don't forget to breathe! Read some of the great links people have sent and have a cup of tea...it will all get easier!
 
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