Newly Diagnosed Cat Seeking Advice

Status
Not open for further replies.
Deanna & Billie

Deanna & Billie

Member Since 2014
Hello everyone!

I am new to this community and happy to find that it exists. My cat Billie (an 11 year old girl) was diagnosed with diabetes about a week ago. I brought her to the vet on 5/1 after noticing increased appetite along with weight loss. Her blood glucose was at 310, and she had lost 2 lbs in 6 weeks.

Her vet recommended switching her diet to all canned/low carb to see if diet alone could help. Before 5/1, she was eating 3 oz of Weruva chicken canned food twice a day and was free fed Wysong Uretic dry food (uretic formula because of a history with struvite crystals). I ditched the dry food and switched her to an assortment of Hound and Gatos, Evo 95, and Tiki Cat Chicken & Egg. I have been feeding her 3-4 times a day and about 8 oz total per day. I noticed that she does seem less ravenous, but is still urinating the same amount. She had never shown an increase in thirst, so I haven't noticed any changes in thirst.

We retested her last Thursday, 5/8, a week after her first test, and her blood glucose was at 315. Her vet recommended that we continue trying the diet alone for 3 more weeks and then retest again rather than putting her on insulin right now. She said that it can sometimes take a few weeks for the diet to have an effect and thought that Billie acting less ravenous was a good sign.

I am curious to know if anyone has had experience in regulating a newly diagnosed cat with only a change in diet/no insulin. I'm especially wondering how long it might take for a change in diet to have an effect. Any advice anyone can offer is really appreciated!! Thank you so much for your time.

-Billie's mom
 
Welcome............

You'll want to know the carb count in the food you are feeing Billie and can use this attached chart - most of us feed Fancy Feast pate type food as the carbs are 3-4%

http://www.catinfo.org/docs/FoodChartPublic9-22-12.pdf

Many here will provide some great information and want to know some more information.............type of meter you are using (many use ReliOn Confirm or Prime available at Walmart) and how often you are testing. Davidson went on a wet food diet for two weeks before having to go on Lantus insulin, then was only on for 3 months and now happily in remission and OTJ (off the juice) for close to a month. Good on your vet for taking her off dry foods, as many don't. I'd test 4 times per day to see if you can catch the lowest point, and take away the food for 2 hrs before testing so that you can get an accurate read, as food spikes the BG numbers. Keep feeding in small increments, and I'd go two weeks and then see what the numbers are - you don't want to wait too long before going on insulin as you need to get the pancreas healing asap in hopes of going into remission and doing less damage. Davidson had much higher BG counts and when I switched to wet food he dropped to where you are now - so you are early in the game and that's encouraging.

You'll want to make a Spread Sheet and I'll have to find the link if someone doesn't post it soon, but take good records of the times and test results so you can enter them later and weigh Baillie a couple times per week so you can see the progress.

You're in GREAT hands here on this board as there is lots of help and this right place to be.

Shawna
 
Hi Billie and Billie's Mom!

I commend you on the steps you've taken so far! My cat, Jersey, was diagnosed in November, and my vet recommended a food change to Hill's w/d dry before we tried insulin. (Jersey had been eating Meow Mix dry up until then.) The food change didn't work for us, and I only later found out that the w/d dry was just as bad as the Meow Mix I had been feeding her. We changed to low-carb canned food in January and started insulin a week later.

I have heard that some cats can go into remission with diet changes alone, although many cats do need some insulin for a while to help the pancreas heal. I've heard some people say here that you will be able to see the full effects of diet changes within about a week.

Many of us here use Lantus or Levemir for insulin and follow what's called the "Tight Regulation Protocol." You can read more about that protocol here if you're interested: http://www.felinediabetes.com/FDMB/viewtopic.php?f=9&t=1581. The important item I want to point out is that researchers have found that newly diagnosed kitties who are started on the protocol (with insulin) soon after their diagnoses have a much better chance of going into remission. If I had to do it over again, I personally wouldn't have waited to start insulin. I would have given the food change a week or so and then started giving insulin. We were fortunate - our Jersey has gone into remission. I just think we could have gotten her into remission much faster if we wouldn't have waited so long to start insulin. My suggestion to you would be to consider waiting no more than 2 weeks (from the time you switched to all low-carb canned) before starting sweet little Billie on insulin.

I hope that helps answer some of your questions. I'm sure others will be along soon to share their experiences with you!
Shelly
 
Shawna and Shelly,

Thank you so so much for your responses!! I really appreciate your help. I am thinking that I will give the wet food diet another week while testing Billie's blood glucose at home and ask her vet about starting insulin if we are not seeing changes. All of the wet food she is eating has 2% or 0% carbs according to Dr. Pierson's chart and she seems happy with her meals, so that's good!

I haven't bought a glucometer or started home testing yet, but I plan to start that tomorrow. I have been watching YouTube videos on how to get a blood drop, and I think it will go pretty well. Billie is a sweetheart and very stoic when I need to bother her. I read that sometimes the human glucometers read a bit high or low on cats - have you found that issue with the ReliOn?

One more question - how many times a day do you feed and test your cats? I have been feeding Billie 3-4 times a day but am wondering about getting an automatic feeder to use on days when I am working longer hours.

Thank you again for your help! It means a lot to me. Happy Mother's Day!

-Deanna

PS: I read about Tight Regulation on yourdiabeticcat.net, and I do want to try that strategy. I definitely need to do more research to make sure I know what I'm doing, so thank you for that link!! I'm sure I will have a million questions about that when/if we are down that road.
 
Hi Deanna,

I'm just glad that we can help, and I'm glad you are asking questions! It seems like I asked the same questions over and over again when we first started here. I had to - the info was too much for my little brain to take in at once! ohmygod_smile :lol: Everyone here was extremely patient with me.

It sounds like you've done a great job getting on good low-carb food, and I'm so happy you're willing to test at home. That will make a huge difference if/when you start insulin. Although you certainly don't have to test right now since Billie isn't on insulin, testing at home will help you get used to the process before starting insulin and may actually give you an idea of her "true" numbers right now. Vet stress can raise numbers by quite a bit (many people say over 100 points), so testing at home removes the stress variable.

Most people here use the Relion meters because the test strips are cheaper, and they appear to be pretty accurate. Many vets recommend the AlphaTrak, which is designed for pets. The problem is that the test strips cost about a dollar each. That gets really pricey after a while! Whether you use the Relion, AlphaTrak, or another meter, we do have a chart to go by that gives us ranges for our kitties. Here it is:

[Glucose reference ranges are unsubstantiated and have been removed by Moderator]
Click to expand...

I used the Relion and was very happy with my meter. There are some other meters that don't appear to read accurately, although I don't remember the brands right off hand. Hopefully someone else can give you that information - or I'll try to track it down for you.

In terms of feeding, it's better to feed multiple, small meals per day. The smaller meals are less likely to overwhelm the pancreas. I probably fed Jersey 5 to 6 times a day. In the beginning, she was ravenous. As we got her numbers under control, she wasn't as hungry as often.

In terms of testing, it really varied. At a minimum, we recommend four tests a day - one before each shot and one around 5 to 7 hours after the shot. Jersey would sometimes stay high (what's known as "bouncing"), so I wouldn't need to test as often. When Jersey was going lower, I would test much more often to make sure she stayed in safe numbers. Right before she went into remission, I was testing her a lot. It was the only way I could keep her safe, though. It's also how I figured out that she was done with insulin!

A lot of people here actually use an automatic feeder. The PetSafe feeder is the one that I most often see recommended here, and it's the one that I ended up buying. Here's a link to it on Amazon: http://www.amazon.com/PetSafe-5-Meal-Automatic-Pet-Feeder/dp/B000GEWHNS/ref=sr_1_1?ie=UTF8&qid=1399832853&sr=8-1&keywords=petsafe 5 meal pet feeder. I was always afraid that Jersey's numbers would fall too low while I was at work, so I would set up the feeder while I was gone. Many cats will eat when their numbers fall too low.

Just one more note - we do have a shopping list floating around here for testing supplies. Have you seen that yet? If you haven't, I'll try to track that down for you. I just don't want to overwhelm you with information you've already seen!

Keep asking - these are all great questions!
Shelly
 
You can leave wet food out all day if she doesn't eat it all. Just add water to it, which will also help flush out the body and further prevent crystal build-up. The catinfo.org site has a section just on Urinary tract issues that is worth a read-through. Most of us here also feed mini meals throughout the day/night as that better helps support the pancreas. Usually, it only takes about a week to see if the diet change is working, but some cats require another week because ECID (Every Cat Is Different). So, I agree that waiting another week is not a bad idea; just don't wait too long before starting insulin after that if she needs it.

For glucometers, if you're in the US, the one that most people use are the ReliOn brands from Walmart because the test strips (where the costs add up) are the cheapest around. So those meters are just fine. :thumbup

Be careful with the yourdiabeticcat.net site because they don't believe that cats can go into hypo on low carb diets. I've seen it happen too often here to know that's not true. They also dose Lantus and Levemir (depot insulins) on a sliding scale, which does not work very well and requires a lot more intensive monitoring. ProZinc/PZI can work well with a sliding scale, but not the depot insulins, so it depends on which insulin the vet will want to start you on.
 
You are all the best! Thank you for the chart and all the information! I have been feeling very nervous, and it's so encouraging to find this support.

My game plan is to keep her on the diet through Thursday which will be 2 weeks since she started it, and bring her to the vet on Friday or Saturday to see where she is at. I have been feeding her larger servings of wet food at a time, but she never eats it all in one sitting. She usually eats some, walks away, goes back to it, eats some, walks away, etc. for a few hours, so hopefully that is okay. I also plan to get a ReliOn and test at home just to see how the stress factor of being at the vet might be affecting her. She does get very upset, especially when there are dogs barking in the waiting room.

If things haven't improved and we start insulin, I know I will have a ton of questions about that. Thank you for the heads up about yourdiabeticcat.net and caution with the sliding scale. I am already wondering what the best option might be, and I haven't quite wrapped my head around all the different strategies. I am hoping that her vet gives us some choices.

I guess my next question is - what are some things I should ask her vet if we are starting insulin? When she first was diagnosed, her vet mentioned that she considers numbers in the 200s to be "normal" for a diabetic cat, and that contradicts a lot of what I've read (especially about Tight Regulation). I don't know much more about our vet's philosophy at this point, but I'm wondering if that statement sounds right to you all. I just want to find the approach that is best and most effective for Billie. I work 8 hour shifts, but I can sometimes work from home and can adjust my schedule if I have to in order to be available for more frequent doses.

Thank you!!!!
 
Hey Deanna,

It sounds like you have a good plan in place! Jersey was a dry-food grazer and did exactly what Billie is doing now when we switched her to canned food - she grazed over several hours. Since that's what she was used to, that's simply what I let her do. Some people here have a set feeding schedule that they stick to, and it seems to work for them. I think you just have to find what works best for you and Billie.

You mentioned that you're still trying to figure out the best strategy. Are you trying to figure out which insulin (e.g., Prozinc vs. Lantus) might be best for your life/schedule? If you have questions about the insulin or the protocols, don't hesitate to ask!

Both of our vets said they wanted to see numbers under 200, too. I think they were both focused on getting Jersey regulated in numbers that were under the renal threshold (which is believed to be somewhere around 200). Maybe this is the approach a lot of vets take? Normal blood glucose levels for cats are actually between about 50 and 120. Some people do have different goals. Some people aim for complete remission (like I did), and others aim for regulation in numbers under renal threshold. There are a lot of reasons for our choices, and we all have to do what works in our own lives.

I had to be at work about 7 hours each day, so I know how worrisome that is. That's when the timed feeder really came in handy. I was also able to sneak home for a quick check every now and then when I thought Jersey might be "on the move."

I wish I could help you with a list of questions to ask the vet. Both of my vets showed little understanding of feline diabetes, and I ended up relying on the people here to help Jersey and I get into remission.

You're doing a great job getting prepared. Billie is one lucky kitty to have you!
Shelly
 
Here's a run-down of the various insulins in use for cats. The only three insulins recommended for cats are PZI/ProZinc, Lantus, or Levemir. You do NOT want any other insulin, regardless of cost. There are links in that document in how to get one of the three recommended insulins for cheaper so cost is really not that bad. Those insulins work best in a cat and are all BID (twice a day) dosing. The other insulins require more monitoring and usually TID (three times a day) dosing to work effectively in cats. They're better suited to a dog's slower metabolism.
 
Thank you again, and thank you for the insulin list!!

Shelly, my goal is also complete remission, so I am wondering what strategy works best to get on that path. I am also wondering how dosing works with a cat that grazes. I know that a lot of people give two meals a day with two corresponding insulin injections, but I don't think that would suit Billie considering her style of eating. Do cats have to have insulin every time they eat? Is it safe to leave food out for hours at a time for them to graze at with two insulin doses per day, or do grazers need insulin more often because they eat more often?

I guess those are my big questions right now. I'm also considering bringing Billie back to the vet in the next day or two. I can tell that she doesn't feel good and I don't want to keep her in that state if insulin can help her. Her vet said to give the diet more time, but you all advised not to wait too long and I think you are the experts! My gut is also telling me to get her started sooner. I may call for an appointment tomorrow.

Big congrats to you and Jersey for getting into remission!! That is super inspiring and awesome!
 
I'm so glad KPassa provided you with that link to the various insulins. I am, of course, biased because the Lantus Tight Regulation worked for us. ;-)

Don't let the feeding times worry you at this point. The only "rules" are to not feed for at least two hours before you give insulin. That way, we can see what the blood sugar reading is without the influence of food. Otherwise, people create their own feeding schedules. Most will recommend that you don't feed or feed small amounts in the second half of each cycle (i.e., beginning at about 5 to 6 hours after each shot) because the insulin is starting to wear off during the second half of the cycle. In our case, I still let Jersey eat later in each cycle - I just tried to give small snacks during those hours. Small, frequent meals are actually supposed to be better for the pancreas rather than just 1 or 2 large meals.

Most people follow the "TFS" method: Test, Feed, Shoot. We get the blood test first, and then we feed our kitties. Then we shoot the insulin. A lot of people give the shot while their cats are eating. We like to know that a cat is eating before we give the shot. Having that food on board gives the insulin something to work with.

Here's an example of a how I might have fed Jersey for a day when she was on insulin:

AMPS - Eat and get morning ("AM") shot
AMPS+1 - Eat (Notice that the +# just means hours after the shot. In this case, she ate 1 hour after her morning shot.)
AM+5 - Eat
AMPS+7 - Eat
PMPS - Eat and get evening ("PM") shot
PMPS +1 - Eat
PMPS+3 - Eat

If there was food leftover at any of these feedings, I just left it out. Somebody (I have three cats inside) would eventually come back and finish it off. I also fed Jersey at other times. Pretty much, if she was hungry, she got to eat, unless we were less than 2 hours away from the shot time. I picked up all of the food when we were 2 hours away from a shot. So... to specifically answer your questions - cats don't get insulin every time they eat. If you are using one of the longer-acting insulins that KPassa mentioned, you only give shots twice a day regardless of how many meals kitty gets. It's okay to let cats graze, too. Just pick up that food 2 hours before insulin time.

Thanks for the congrats - we couldn't have done it without this place and the people here!
Shelly
 
Thank you Shelly and Jersey!! It's all starting to make a lot more sense. I am so grateful for your help. I really can't thank you enough. I think that your dosing and feeding schedule would work well for Billie, so that gives me a really good foundation to work from. With Tight Regulation, do you change your dose based on how high or low her numbers are in each blood test, or do you always give the same dose?

I think I will take her in for another test on Wednesday or Thursday, because that will be 2 weeks since we ditched the dry food. In the next couple days, should I be looking out for any symptoms or be worried about ketones? She did have a urine test 2 weeks ago, and there was glucose in her urine, but no ketones at that point.

Thank you thank you thank you!!
-Deanna
 
No need to thank me, Deanna. So many people here helped me, and I’m just trying to pay it forward.

I have no doubt you’ll be able to find a feeding schedule that will be perfect for Billie. (Of course, we’re assuming that Billie will need insulin. Hopefully that won’t be the case!)

For Lantus, we make dosing decisions based on what is called the “nadir.” That’s the point in the cycle when the glucose levels drop to their lowest point. For most cats on Lantus, that’s somewhere between 5 to 7 hours after you give the shot. Every cat is different, though. Some reach nadir earlier than that, and some reach nadir later than that. We do give some consideration to the numbers right before each shot, but we’re really looking to see how low a dose takes a kitty. If you do end up going with the Lantus Tight Regulation protocol, you can post your numbers each day (in what we call the “condo” for the day) in the Tight Regulation forum. Experienced users will then help you decide if you need to hold the dose, increase, decrease, etc. That’s what I did – I just let them guide me and tell me the next step in dosing. (I can’t thank all of them enough!)

If you can test for ketones, that would be great. I have read that they can develop quickly so checking for them each day can be helpful. You can buy ketone test strips at Wal-Mart or a pharmacy. Just hold the test strip under the urine stream and then compare the results to the chart on the bottle. We tested for ketones with Jersey until we got her into the normal range.

Hope that helps!
Shelly
 
Hi Shelly,

I did pick up some ketone testing strips that also test for glucose, and I just got a sample from Billie. Her urine is negative for ketones, so that's good news, but the glucose indicator turned the darkest shade of brown for 2000 or more mg/dl. This was from urine that she had been holding for about 5 hours. I am wondering how much I should worry about that, and if I should take her to the vet tomorrow. I will call my vet and ask in the morning, but I'm curious to know what you think too. Thanks!

-Deanna
 
Sorry I didn't respond yesterday, Deanna. Graduation was last night (I'm a teacher), so I didn't get in until late.

That's great that there weren't any ketones! I don't truly understand the different glucose levels in the urine - I don't think we can state that, "If kitty's reading falls into this range, it means his/her blood sugar level is X." What I do know is that, when the cat's numbers are still high, the body can't process all of that extra glucose so it "spills over" into the urine. That's what you're detecting with the test strip.

How long has it been now since you made the food switch? I know it's coming up on a couple of weeks. At this point, I would probably see if your vet is willing to consider starting insulin. We don't want Billie's numbers to stay high any longer than necessary.

Have you picked up the home testing supplies yet? I don't think I ever sent you that shopping list - I'll try to track it down and post it for you.

Shelly
 
Here’s a shopping list to get you started:

1. Glucose Meter – Most people use the Relion Confirm or Micro from Wal-Mart. Some people recommend avoiding meters with “True” or “Freestyle” in the name because they may not measure accurately. Whichever meter you buy, it’s best to try to find one that requires a small blood sample. I used the ReliOn Micro, which took a .3 sample.
2. Test Strips – Buy the test strips that match your meter.
3. Lancing Device – My meter came with a lancing device. If yours doesn’t, you may want to pick one up. (Some people don’t use a lancing device.)
4. Lancets – These are the needles that you will use to poke the ear (or paw) to draw the blood. A lot of new members start with a bigger gauge like a 28g or 29g. As the ear “learns” to bleed, they can then switch to a smaller gauge like a 33g. (The smaller the number, the bigger the “needle.”)
5. Neosporin with Pain Relief – I used the Equate brand. Make sure you get the gel and not the cream. Dabbing some of this on the ear after testing can help keep the ear in good condition. (I actually used it prior to the poke to help the blood well up.)
6. Cotton Balls – These are for stemming the blood after testing.
7. Sharps Container – They have small containers that cost just a dollar or two.
8. Treats – A lot of people give their cats treats after a blood test. Make sure the treats are low-carb/zero-carb.

When you start insulin, some other items will be important to have on hand, too.
1. Karo syrup (corn syrup). This will be needed if the kitty’s blood sugar drops too low. It can bring the blood sugar up quickly. Pancake syrup can also work in the place of corn syrup.
2. High-carb cat food. Again, this will be used in cases where the kitty’s blood sugar drops too low. Most people seem to use Fancy Feast Gravy Lover’s food, which is what I also used. I marked the tops of the cans with big black X’s and put them in my testing “box.” That way, I didn’t get them mixed up with the regular food.

Others might have additional recommendations to the list. These are just some of the items from the list they gave me! I know some of these items sound scary, but home testing really isn't as bad as it sounds.

Shelly
 
Its Neosporin ointment with pain relief, not cream, nor gel.

The ointment is oil based so using a dab prior to testing, waiting a minute or two, then wiping it off, leaves a slight oily residue which helps the blood bead up.
 
Its Neosporin ointment with pain relief, not cream, nor gel.
Click to expand...

Thanks for catching that, BJ! When you squirt it out of the tube, it looks like a clear gel so that's how my husband always referred to it ("Where's the gel?")! :lol:
 
Thank you for the shopping list and advice! I'm not looking forward to it, but I will get the home testing supplies and give that a go.

On Thursday, Billie will have been on the diet for 2 weeks. I talked to her vet today, and she said that she thinks Billie's diabetes is in an early stage where more time on the diet might get it under control. She recommended trying it for another week or two. She did say that if Billie does need insulin, her goal will be to get her into remission, which is good.

I'm conflicted. I trust her, but I also see the logic in what a lot of people have said about it being easier to get diabetes under control and hopefully into remission by starting insulin sooner than later, taking the stress off the pancreas and allowing it some relief. I asked the vet if she has had success from a diet change alone over the course of a few weeks even with no improvement after one week, and she said yes. I could also try some home tests to see how her numbers are looking, then decide from there if I want to make an appointment sooner.

I will sleep on it. Any advice is welcome! Thanks so much for your help.
-Deanna
 
Hi Deanna, as being (re) new to this world as well, my previous diabetic cat having died in 1997, my advice would be that you should go at the pace where you personally feel comfortable. If you want to be more aggressive, just tell your vet. Also, there is such a deluge of information that your mind can't process it all at once.

Bit by bit, it will start to make sense. Get comfortable with home testing, transition the food, learn about how insulin works. One day, you will come back to an old post, reread it, and the information will start to click. I didn't start tight regulation until I got into the habit of glucose testing at home (the strips seem to run out abruptly every time!), brushing up on my shot technique, following a feeding schedule, and *adjusting the rest of the family to our new routine.*

Best of luck and remember, you don't have to turn into Wonder Woman overnight.
Tracie
 
Have you got any blood glucose readings from the vet or at home? Those can help guide where you go from here. Borderline readings are from 120 to about 240 mg/dL (the renal threshold where glucose spills into the urine) at the vet.

Alternatively, you might try urine testing for glucose and ketones (KetoDiaStix or generic), which shows if glucose and/or ketones gathered in the urine since the previous void. Ketones, in particular, are very concerning and more than a trace level require a vet visit. They develop as a by-product of fat breakdown for calories and too many may indicate diabetic ketoacidosis (DKA), a potentially fatal, expensive to treat, complication of diabetes.

You might add in how much water was drunk, food eaten, size of urine clumps in the litter box (photos to show the vet), and weight checks for other signs of diabetes and then your vet may get a better understanding of your cat's condition. See my signature link for more info on Secondary Monitoring Tools.
 
Hi Deanna,

I'm glad some others chimed in here and hope more will, too. It's always good to get a variety of opinions, and I hope you don't rely on just mine when making decisions.

I'm not looking forward to it, but I will get the home testing supplies and give that a go.
Click to expand...

I know it's extremely scary to think about giving insulin shots and testing at home. I was terrified. Don't let that stop you from starting insulin if you think that's what needs to be done, though. You'll pick that up quickly.

In the end, I really do believe you have to go with whatever your gut tells you - whether that is to wait or to start insulin now.

Shelly
 
Also, I find it helpful to shave alternating patches on the cat's shoulders so I can keep from giving him all of his insulin shots in the same place (human diabetics taught me to alternate locations to avoid soreness). Also, if you are new to giving shots, it is waaay easier to learn without the fur in the way.

Fingers and eyes crossed!
Tracie
 
Thank you for the advice! It's nice to hear from so many people! I scheduled an appointment for Billie tomorrow to have a quick blood test. We'll see how her numbers are looking and go from there. Hopefully, the diet is helping and she's getting better. If not, I will probably come back with a lot more questions for all of you. Thank you again for all the information you have given me so far. If she does need insulin, I feel a lot more prepared to discuss options with her vet and make a decision based on everything you have shared. I'll report back after her appointment.
-Deanna

PS: Someone asked a question about her previous numbers - two weeks ago, her blood glucose was 310, and one week ago, it was 315.
 
Billie update:

Her BG was 317 today (the same as the past two weeks), so there hasn't been a change from the diet. Her vet put her on Lantus - 1 unit twice a day. I am going to start her on it either tonight or tomorrow. Her vet wrote a prescription for a vial, but the pharmacist suggested that I try a pen, because he said Lantus only keeps for 28 days and I would end up wasting a lot of the vial. I have a pen and will use the u100 syringes with it (rather than the built in click function). Here are some of my questions to start with -

1. For those of you who use Lantus, do you refrigerate it? The vet told me to refrigerate it, but the pharmacist told me to keep it at room temperature.

2. Do you roll Lantus pens to mix the solution? The vet told me to gently roll the vial, but the pharmacist said that pens do not need to be rolled and are basically good to go.

3. What do you do if you miss a dose or aren't sure if you injected properly? I know that you definitely do not want to repeat an injection to avoid overdosing, and I know that BG going too low is way worse than BG going too high. I'm just wondering if there is any risk/danger to a missed dose.

4. I am going to get a ReliOn Micro to home test along with her injections. Her vet did not think that it was necessary or important, but I know that most people with diabetic cats strongly encourage it. I am wondering how many times a day most people test, and what you are looking for in the numbers. If a number is low, would you skip an insulin dose?

Thank you so much for any input!!!
-Deanna
 
Hi Deanna,

I'm so sorry to hear that the diet change didn't bring down Billie's numbers. I know that's frustrating.

Most people here do use the pens rather than the vial. Some have been able to buy single pens at a time rather than the 5-pack of pens. (I couldn't find a pharmacy to break up the 5-pack for me.) They draw out the insulin with a needle - just like you're going to do. It will be helpful if you get the syringes with the half-unit markings (3/10 ml/cc) rather than syringes with only whole unit markings. The Lantus actually lasts longer if you put it in the refrigerator. Although most pharmacists will tell you that the Lantus will only last for 28 days, most members here can use it for about 6 months before it starts to lose its "punch."

You don't need to shake or roll the insulin.

If you think you gave a "fur shot," never re-shoot. You're right - it's better too high for a day than two low for a moment.

Most Lantus users will tell you that it's important to get at least four tests a day - one before each shot (AM and PM) and one in the middle of each cycle. There's actually a spreadsheet we use that we enter the numbers on. I'll send you some instructions for setting one up. By using the spreadsheet, it allows others to see what's going on with Billie. They'll then be able to see patterns and help you figure out the dosing.

Did you decide that you were going to follow the Tight Regulation Protocol? If so, I encourage you to start posting over there each day. That's where most of the Lantus users "live." If you post over there, they'll be able to help you on a day-to-day basis.

Keep asking questions!
Shelly
 
Here are some instructions for setting up the spreadsheet:

1. First of all, you’ll need to set up a Google account if you don’t have one already. Here’s the link for it: https://accounts.google.com/SignUp?continue=https://accounts.google.com/ManageAccount

2. Once you set up your account, make sure you are signed in to it. Then click on this link: https://drive.google.com/previewtem...U5BVEdyU1dGZmx5bnRvdG10OWc&mode=public&pli=1#

3. This will bring up the template that you can use. In the upper, left-hand corner of the page, it says “Use this template.” Click on that.

4. Now you have your own copy of the template. At the top, left-hand corner of the page, click on “File” and then choose “Rename.” You can now change the name of your spreadsheet (e.g., “Boo’s Chart”).

5. Once you finish entering the date, numbers, etc., you will need to publish your spreadsheet. Click on “File” again and then click on “publish to the web.” A little pop-up box will appear. You will want to make sure that the box that says “automatically republish when changes are made” has a checkmark next to it. Then click on “start publishing.”

6. Now, you need to make sure other people can see your spreadsheet. Click on the blue “share” button on the upper right-hand corner of the page. A pop-up box will appear. Where it says “private,” change that to “anyone with the link can see” and click save at the bottom of the box.

7. Now we have to add the spreadsheet to your FDMB account. First copy the web address that appears in the address bar on your spreadsheet. Come back to FDMB and click on “User Control Panel” at the top left-hand side of the page. Then click on the tab that says “Profile” Next, click on the tab that says “Edit Signature.” There’s a little “url” button at the top of the box where you write. Click on it. This is what will show up in the box:



Click in between the middle brackets and paste the web address for the spreadsheet that you created.

In the end, it will look something like this: https://docs.google.com.....

Try these steps and let me know how it goes!
 
Understanding the spreadsheet/grid:

The colored headings at the top are the ranges of glucose values. They are color-coded to clue you in as to meaning.

Each day is 1 row. Each column stores different data for the day.

From left to right, you enter
the Date in the first column
the AMPS (morning pre-shot test) in the 2nd column
the Units given (turquoise column)

Then, there are 11 columns labeled +1 through +11
If you test at +5 (5 hours after the shot), you enter the test number in the +5 column
If you test at +7 (7 hours after the shot), you enter the test number in the +7 column
and so on.

Halfway across the page is the column for PMPS (evening pre-shot)
To the right is another turquoise column for Units given at the evening shot.

There is second set of columns labeled +1 through +11
If you snag a before bed test at +3, you enter the test number in the +3 column.

We separate day and night numbers like that because many cats go lower at night.

It is merely a grid for storing the info; no math required.
 
Thank you for the answers and the spreadsheet help! I just went out and got everything on the shopping list that Shelly posted, so I am all set to start testing and shooting. I think shooting will go smoothly. I did a test shot of saline solution with the vet, and it was way easier than I thought it would be. I think the blood tests are going to be the bigger challenge.

I have been reading about Tight Regulation and am definitely interested in trying it. I was confused about exactly how it works. I had read the Tight Regulation Protocol on yourdiabeticcat.net, but from the stickies I read on the Lantus TR forum, it sounds a bit different and more organized. Doses are adjusted based on blood tests/curves over the course of a few days rather than on a sliding scale based on each pre shot reading? Correct me if I'm wrong!

Other TR question - what is the difference between regular TR and relaxed TR? I saw the two different Lantus forums and read all the stickies on the TR forum, but I'm not totally clear on how relaxed TR differs. I will start posting on whichever forum makes more sense after I figure out what I'm doing.

My last question (for now!) is when should I start the insulin. I am debating whether to give Billie her first shot tonight and stay up late to keep an eye on her, or if I should wait until tomorrow morning. I have tomorrow and Saturday free, which is good. I have to leave for maybe an hour and a half tomorrow afternoon, but my boyfriend said he would come over to keep an eye on her while I'm out. I am concerned about Sunday, because I have to work a full day. I can probably get home once to check on her, but I'm still nervous about it. Should I be worried? If there is reason to be concerned, I could postpone everything until Monday and start then. I am supposed to work Monday and Tuesday, but I can most likely arrange to work from home. Her vet said that I shouldn't have to worry about a hypo episode with such a low dose, but this is all new to us, so of course I am worried.

Thank you all again!!!! I will pay it forward when I know enough to offer advice!

-Deanna
 
Hi Deanna,

I'm glad you're set up to start testing. Whether or not you want to start the insulin tonight or tomorrow is up to you. It's always hard to leave our kitties when we're giving insulin. Nothing will take away your worry completely. I worried every day. However, getting those home tests will allow you to see how well the insulin is working. If the dose is too high, you'll be able to see that and reduce the dose. That can help ease your worry.

There are a lot of testing tips. Have you read through any of those? If not, I'll try to track them down for you. I'll be honest - my husband and I never could get the hang of testing on the ear. Knowing how important the tests were, we finally switched to testing on the paw. Paw testing isn't the preferred method, but we had to do what we had to do! Because of that, I won't be able to help you a whole bunch with ear testing, but there are a lot of people who can. I can now do a blood test by myself with one hand - seriously. It sounds scarier than it actually is!

There are several feline diabetes sites out there, and all of them may have a bit of a different approach. The relaxed forum here takes a slower approach (e.g., in terms of raising doses). The tight regulation forum follows the protocol closely and takes a bit "faster" approach. You'll also probably be asked to test more with the TR protocol. Regardless of which approach you take, you can post on either board. The "Tight Regulation" forum gets the most traffic, so there will be more people around to help you. If you want to take a slower approach, you can still post on that board. Lantus isn't dosed on a sliding scale. Although the preshot numbers can sometimes help us figure out whether we need to shoot or whether we need to give a one-time reduced dose, we base dosing on the "nadir" (lowest point in the cycle).

Okay, so how does this all sound? What questions do you have? I know this is overwhelming, but you're doing great!
Shelly

EDITED TO ADD: Here is a link to more information about testing: http://www.felinediabetes.com/FDMB/viewtopic.php?f=14&t=287
 
Please use the Tight Regulation protocol we have here. We have found than Lantus does poorly on a sliding scale due to the overlap effects.
NB holding the dose constant, the overlap is stable and more predictable in its effect.

And as a note:
Shooting early overlaps more, tending to increase the effects like a dose increase would and shooting late overlaps less, tending to decrease the effects like a dose decrease..
 
Hello! So, I tried to get blood from Billie's ear a couple times with no luck so far. I watched a bunch of YouTube videos and did a lot of reading. The first time, I know I didn't prick hard enough. That may have been the problem the second time too, or maybe I just didn't get blood for whatever reason. After 2 tries, she retreated to one of her favorite hiding spots, so I'm leaving her alone for a while. I wasn't planning on starting insulin tonight - I just wanted to try to get the hang of testing her. I tested myself just to get used to sticking the needle in, and that wasn't so hard.

I'm going to post on the Tight Regulation forum just to introduce myself and Billie. At this point, I'm feeling a lot more comfortable with everything except for the blood testing. My only question for the moment is, if I can't get blood in the morning, should I still start her insulin?
 
If you absolutely must.get.blood, you may aim for the vein directly. Just be prepared to blot, because if you prick it, it will bleed profusely (hence the reason we don't generally use it).

If your hands are clean, get a droplet on a fingernail and test from there. This lets you release the squirmy cat, yet still get a test done.

I freehand the prick rather than using a lancet pen. I can see what I'm doing better.

Neosporin ointment with pain relief, a dab applied a few minutes prior to testing, then wiped off, may reduce the annoyance of being pricked.

Always give a low carb treat after testing. Many cats put up with being tested for the treat afterwards.

Use a 3 tries, then quit, plus treat.
 
Hi! Thanks for checking in, and sorry for the delayed response. I started posting in the Lantus forum so I have been hanging out over there. I did get blood this morning - her ReliOn Micro read 161, and that threw me off because I was expecting a lot higher. Her readings from the vet have been consistently 310-317. I held off on shooting this morning, but some members explained to me that the meter at the vet can read 30-40% higher than a human meter, so considering that and the stress factor at the vet, it makes sense. At 8:30pm, I tested again, and she was at 178. I gave her 0.75 units of Lantus at 8:45 and am getting ready to do another test to see how that is going so far. She ate right before I gave her insulin, and she just came out of hiding to eat again right now. I'll be testing her a few times throughout the night to make sure everything is going okay. Let me know if there is anything else I should do for now!
 
Vet stress may raise glucose 100-180 mg/dL.

Vet lab equipment may read 30-40% higher than a human glucometer as the glucose concentrations for cats vs humans are distributed differently (plasma vs red blood cells).
 
Thank you! I definitely am!

I have a clarification question about the readings that I'm posting in both threads - which numbers are the actual accurate numbers? The numbers on the vet's meter, or the numbers on my human meter? I'm assuming that the vet's meter would be more accurate for a cat, but please correct me if I'm wrong. If that's the case, should we be doing the math to translate our home readings into readings the vet would get?
 
Nope, no need to do any math here. Just add your meter to your signature and people will know.
 
Status
Not open for further replies.
Back
Top