Newly Diagnosed, First few days on Lantus

[manors18]

My dear girl Smokey, russian blue mix at 7 yrs old, was just diagnosed. On Thurs, at the vet, 477 BG, then Friday at the vet, 544BG so they started insulin that night. 2u two times daily Lantus. I always feel bad posting to new message boards b/c I'm sure my questions have been answered a thousand times already, apologies in advance for any redundancy....

She takes the shot and eats immediately afterwards (fancy feast wet food) I haven't bought any new type of kibble yet, I have 5 kitties, and have to transition. She doesn't really eat a lot of hard food anyway, but this morning she's visited the crunchy food bowl 5 times before heading off to her normal sleeping spot for a nap. Last night before her shot, she tested at BG 161. I assume that means the dosage is good/working? Vet said I should expect 170-200 to be normal range for her...this seemed a bit high?

Is the order: test, give shot, then feed? or feed, test, then shot? Is there a number for the BG that should make me NOT give her a shot to prevent hypo risk?

A lot of my questions will probably be answered on Wednesday, the vet that originally diagnosed her went on vacation until Wednesday, and the stand-in is very young/novice and didn't know much of anything about the subject. I'm mostly just afraid to go to work, scared she will go hypo on me while I'm away and can't check on her. I'm so scared of coming home to a dead or comatose cat that I have my husband doing everything that requires leaving the house so I can check on her...and I'm beginning to think I'm driving her crazy by popping my head in every half hour to see if she's still breathing and happy.

 

[Larry and Kitties]

Welcome.
The order should be test, feed and then shoot. Sometime a kitty will not eat so you want to give the shot after eating.
a BG of 160 right before a shot might end up with the BG dropping to low since you do not have experience to know the proper dose. Two units twice a day may be too much. What was here BG this morning.
You said "I haven't bought any new type of kibble yet, I have 5 kitties, and have to transition." I would stick with the Fancy Feast for all your cats. Friskies is good too.

 

[squeem3]

My dear girl Smokey, russian blue mix at 7 yrs old, was just diagnosed. On Thurs, at the vet, 477 BG, then Friday at the vet, 544BG so they started insulin that night. 2u two times daily Lantus. I always feel bad posting to new message boards b/c I'm sure my questions have been answered a thousand times already, apologies in advance for any redundancy....

You'll find lots of info on how Lantus works for cats here: http://felinediabetes.com/FDMB/viewforum.php?f=9 Read the info stickies at the top.

It's recommended to start insulin at no more than 1 unit twice a day. Better to start with not enough insulin than too much and risk a hypo.

She takes the shot and eats immediately afterwards (fancy feast wet food) I haven't bought any new type of kibble yet, I have 5 kitties, and have to transition. She doesn't really eat a lot of hard food anyway, but this morning she's visited the crunchy food bowl 5 times before heading off to her normal sleeping spot for a nap

Are you feeding the Fancy Feast Classics? Those are low carb for a diabetic. The ones in gravy are too high in carbs.

What dry food do you feed the other cats? A few pieces of sneaked dry food will raise blood glucose levels pretty high for the diabetic cat. Can you feed all the cats canned food?

Last night before her shot, she tested at BG 161. I assume that means the dosage is good/working? Vet said I should expect 170-200 to be normal range for her...this seemed a bit high?

161 is pretty good. Do you have any more blood gluocse readings? One number doesn't tell anything. People here use an online spreadsheet to track their cat's blood glucose levels: http://felinediabetes.com/FDMB/viewtopic.php?f=6&t=18207

Is the order: test, give shot, then feed? or feed, test, then shot?

Test, feed, shoot.

Most people test and give insulin while the cat is eating. It doesn't take more than a minute to do and the cat barely notices.

Is there a number for the BG that should make me NOT give her a shot to prevent hypo risk?

If the bg is under 200 mg/dl at insulin time, do not give any insulin.

Now, experienced members often do give insulin under 200 but you're new to the diabetic cat world and don't have the blood glucose data to justify giving insulin at low numbers.

I'm mostly just afraid to go to work, scared she will go hypo on me while I'm away and can't check on her. I'm so scared of coming home to a dead or comatose cat that I have my husband doing everything that requires leaving the house so I can check on her...and I'm beginning to think I'm driving her crazy by popping my head in every half hour to see if she's still breathing and happy.

Every newbie feeels this way. Don't worry :YMHUG: As long as you test the blood glucose level before giving insulin and maybe even getting a test before you leave, your cat will be ok :smile:

 

[manors18]

I had read that wet food only was a good way to go. I'm going out tonight to get a bunch of fancy feast classic (they love garden greens, so they'll be angry about that for a while probably lol). Frankly, they're all a bit (and one is especially) overweight, so this is a good thing for all of them to eliminate high-carb food from their diet. But isn't it true that the crunchy food helps with their dental health? I guess there's treats that can do that too. (more reading to do! lol)

I just called the vet after reading your response about the 161BG and, sure enough, the technician told us to back off of the dosage. Thanks for the clue-in!! We still have so much to learn. We're going to test her again tonight and see where her sugar is, and if still 160bg the vet wants us to drop it down to 1u twice a day instead. I'm looking forward to the curve test to see where she really needs to be, but they won't schedule her for that for another week at least. Nerves are a bit frazzled, but I'm really glad this message board and site are here to help us along!!

 

[Dyana]

Welcome :razz: My very first cat was named Smokey.

You don't need to spend the money for your vet to do the curve, if you're home testing yourself. Smokey will be more stressed at the vet and the BG numbers will be elevated because of that stress (well, a few cats actually have their BG numbers go down because of stress :roll: but most go up). You can do a curve at home where she is most comfortable and test every two hours, and just call your vet with those numbers.

My cats love the Fancy Feast Medleys (with the garden greens), too, but I use them as a medium carb food, when I want to bring my cat's BG numbers up a little, because it is around 10% carbs (so hang on to a few cans and put them next to your karo along with some cans of food with gravy which are about 18% carbs).
There are lots of Fancy Feast Classics flavors, and hopefully you'll get your whole gang eating them soon.

When you have a chance, start a spreadsheet on Google Docs http://www.felinediabetes.com/FDMB/viewtopic.php?f=6&t=18207 and link it to your Signature, so that we can better help you with dosing questions and concerns.

 

[hmjohnston]

Hello!

What meter are you using? Some are great for FD and some aren't. And if you are using the Alpha track you might want to switch to a human meter as the strips are a whole lot less expensive and you can feel free to test more often.

Home test curves are the best for your cat- reduces stress because your cat is surrounded by barking dogs, being fed (or not fed at all) dry cat food, and strange, unfamiliar people who are poking her and she doesn't know why.

The fewer carbs she eats the lower her BG's will go. The only reason she hasn't hypo'd is because she is still eating the dry- especially with that 2u into a 161 :shock: So the lower dose is good until you home test regularly- most do three times+/day. One each at shot times and a mid-cycle so they know how low the cat goes on a dose- this number is used to figure out dosage. Some go for more testing :lol: .

And for range- a vet is looking for regulation which is 120-200- under the renal threshold limit and at low risk for DKA (possible but other factors in play) and worsening kidney functions. WE always try to get our kitties to OTJ- diet controlled remission- which means no insulin at all. A non-diabetic cat can run low- 40-90 on a human meter, depending on when they ate. Diet controlled is higher than that but in good numbers.

And being worried is part of the first things we fur-parents do at the beginning. Give hugs, skritches, treats at test time, pet and coddle. Having a sugar cat creates a unique bond between cat and parent. They might resist at first- this is new, they don't feel well AT ALL, they are HUNGRY (starving- literally) and here you come with the pokies :evil: . Smokey will get over it. Most cats come running when they hear the meter beep- they want that TREAT!!!

 

[manors18]

I bought a wahlgreen's branded one for humans. I know it had a ketone alert built in, but I turned it off. It brings up an interesting point, the 161BG this AM with 2u injected immediately afterwards. She's sort of self-regulating at the moment, since that dosage was too high for that number, by frequenting the crunchy food bowl -- I guess I'm sort of scared to take away the crunchy food (Meow Mix) when I'm at work during this early stage....if she's able to 'get' that she's low on sugar (feeling weird, shaky, hungry, etc.) while I'm away. Better to go too high than low while I can't watch her?

I tried to test her a few minutes ago and ended up pricking myself instead of her. Well, I tested my own BG instead since I was already bleeding, but that didn't help her too much :lol: Will have to wait until hubby gets home to help keep her in one place, but that'll be only 2 hrs away from her next dose, so I miss her "middle of the 12 hr cycle" testing today. I really really want her to get to the point where diet only will control this. I can't help but get this feeling that the insulin is introducing something more dangerous than just dieting alone, and wondering why the vet decided insulin was the best first route to go? Is it normal for vets to aim for insulin shots before trying diet changes?

 

[Blue]

I had read that wet food only was a good way to go. I'm going out tonight to get a bunch of fancy feast classic (they love garden greens, so they'll be angry about that for a while probably lol). Frankly, they're all a bit (and one is especially) overweight, so this is a good thing for all of them to eliminate high-carb food from their diet. But isn't it true that the crunchy food helps with their dental health? I guess there's treats that can do that too. (more reading to do! lol)

I just called the vet after reading your response about the 161BG and, sure enough, the technician told us to back off of the dosage. Thanks for the clue-in!! We still have so much to learn. We're going to test her again tonight and see where her sugar is, and if still 160bg the vet wants us to drop it down to 1u twice a day instead. I'm looking forward to the curve test to see where she really needs to be, but they won't schedule her for that for another week at least. Nerves are a bit frazzled, but I'm really glad this message board and site are here to help us along!!

I would like to say that the cleaning teeth with dry food .....myth, likely dreamed up by the dry food companies. For lots of food info, I would say to read the site by Dr. Lisa Pierson, a vet whose site is catinfo.org. She talks all about the dry food thing.... dry food just shatters and does absolutely nothing to clean their teeth!

About the food, Fancy Feast is good, but try to stick to the pate flavors as they are lower carb. I think the greens are more of a medium carb and the grilled and gravy flavors are high carb. It's a good idea to have some of each on hand, but just feed the low carb, and hold onto the others for feeding if Smokey has numbers pretty low.

Now, my Shadoe was quite carb sensitive, and even just a few pieces of stolen dry food would cause her numbers to jump high, so I know you say that she just gets a few pieces but even that can be bad. And the dry treats you mentioned, you should cut them out and switch her to some low carb treats - many people get the packs of freeze dried 100% chicken as it's perfect for diabetics.

I am sure the others have mentioned or will mention home testing. There is no reason or purpose for you to waste your money by taking Smokey to the vet to do a curve. Most cats are stressed at the vet office and will give stress influenced numbers. I know this for a fact just by testing my own cats.
I test before heading to the vet, again when we arrive at the vet, again just before we are leaving, and then finally 30min after we get back home. You want to guess which 2 numbers were very high? Yup, the 2 taken at the vet office. I should also mention that my other cat tested LOWER at the vet office, so their stress could cause high, low, or no difference, and to me, that's no way to decide on a dose.
I mention this testing issue because your vet is going to tell you a dose to give based on higher numbers at the vet office, so when you go home and give 2u, it ends up being too much insulin and may cause your cat to go way too low.

Most people here use ordinary glucose meters from the pharmacy. Do not get any of the FreeStyle meters or any of the house brands that have TRUE in their name as they do not give good readings for cats. The most economical ones are likely the Relion if you are in the US, and other good meters are the OneTouch, Bayer, and Accu-Chek. I most prefer the Bayer meters. What meter are you using right now? It's important to know if you are using a human meter or one of the expensive pet meters because your numbers will be different depending on the meter type.

For the sequence, the older harsher insulins required you to be sure the cat ate before the shot, but with Lantus, it's much milder so all you need to do is always test first. Later on, you may find Smokey has a lower number than usual, and you may be asked if you can delay for 30min or a short time, then test again. You are wanting to know the number is good enough for a shot, but if you feed right at the first test, and you need to delay, your next test will be food influenced, so hold the food until you have decided, give a shot or skip.

 

[manors18]

Found the booklet -- it's a Walgreen's "TRUEresult" by Nipro Diagnostics. Guess it's not a good one Tho I have a feeling that when I told the pharmacist it was for a cat, he was assuming I meant I didn't want to spend too much instead of deciding which was better for a pet.

 

[squeem3]

You can use these food charts/lists to find low carb foods:

Binky's canned food charts
Pet Food Nutritional Values list
Hobo's Guide To Nutritional Values
Dr. Lynne's Wet Food list
List of low carb gluten free Fancy Feast


Fancy Feast Classics is on the "old" Binky's chart. Avoid the gravy ones but do keep a couple gravy cans at home to use in case your diabetic is hypoglycemic. Seafood is best limited to once in awhile treats.

Generally we stick to foods that have under 10% carbs.

I bought a wahlgreen's branded one for humans. I know it had a ketone alert built in, but I turned it off.

The True/Tru ones give inaccurate readings. If you can't return the meter, you can just buy another one and tyr to give the True/Tru one away to a diabetic Human who can use it, like through FreeCycle.org.

It brings up an interesting point, the 161BG this AM with 2u injected immediately afterwards. She's sort of self-regulating at the moment, since that dosage was too high for that number, by frequenting the crunchy food bowl -- I guess I'm sort of scared to take away the crunchy food (Meow Mix) when I'm at work during this early stage....if she's able to 'get' that she's low on sugar (feeling weird, shaky, hungry, etc.) while I'm away. Better to go too high than low while I can't watch her?

I don't see Meow Mix listed on Binky's dry food chart but based on the ingredients that are typical for that brand, the carb content is way too high for a cat.

If the non-diabetics must have some dry food, feed them a grain-free low carb dry food such as Innova EVO or Wellness Core. These won't affect the diabetic cat's blood glucose as much as other dry foods. But every cat is different. Some diabetic cats are super sensitive to carbs.

You can leave canned food out for the diabetic cat to eat in case she "feels" her levels dropping too low. Most people use a programmable timed feeder. There are people here with multiple cats, including a diabetic or two, and they have ways to keep the non-diabetics away from the diabetic cat's food and vice versa.

I can't help but get this feeling that the insulin is introducing something more dangerous than just dieting alone, and wondering why the vet decided insulin was the best first route to go? Is it normal for vets to aim for insulin shots before trying diet changes?

Insulin is a hormone, not a drug. In diabetics, the insulin has to be given from outside the body.

Some vets try diet first, though they may insist on prescription junk :roll: Other vets start insulin right away and not even bother to tell the client about proper diet.

You could try diet first but the sooner your cat starts insulin, the greater the chances of remission is. A combination of both diet and insulin gives the cat's pancreas a chance to heal. Some lucky cats may only need insulin for a very short time before they go into remission and are diet controlled.

 

[Blue]

Found the booklet -- it's a Walgreen's "TRUEresult" by Nipro Diagnostics. Guess it's not a good one Tho I have a feeling that when I told the pharmacist it was for a cat, he was assuming I meant I didn't want to spend too much instead of deciding which was better for a pet.

There you go. Just pick up a Relion because the readings you will get from your current meter will not be reliable at all.

While many cats do not need insulin after a food change or for a short while so the pancreas can heal, many others will always need insulin to help the pancreas. If a cat needs insulin, that cat will not be able to survive without it. It won't take long before you and your cat will have adjusted and settled into a routine. Your cat will start to feel better and may look forward to tests and shots. I know one of mine would come out from who knows where and if I check the clock, it was likely close to her testing time.
Cats know and will appreciate feeling better.

The sooner you take away all of the dry food, all that bad crunchy high carb stuff, the sooner you may have a chance of her going off insulin.

How did your vet determine that she was diabetic? What was the test done and what was the result? if you don't know, ask your vet because if the vet said start insulin based on just the glucose in regular blood work, I would say one number does not say diabetes. If the vet did a fructosamine test, an average of the past few weeks, then your cat likely needs some insulin.

 

[manors18]

I believe it was just blood glucose coupled with our reports of her drinking a lot more water and losing about a pound of weight. They did send the rest of the blood drawn on Thursday for another test, I checked the receipt and it said "Fructosamine lab request"...but they said we wouldn't have the results of that blood test until tomorrow (3 business days). The original test that included the BG check also included other checks for what they termed "organ health" when talking to me, i.e. kidney function, etc, and told me the only # that seemed out of normal range was the sugar. After that, they didn't really say it could be anything else, and advised we start insulin today, actually. When she was whimpering and drinking water at the same time on Friday night, though, we took her back in. When she tested at 544, they told me they wanted to get started on insulin that night instead. Still wondering what the fructosamine tests will say. I do know they tested urine and found no ketones in the urine when she was there Friday. They told me this meant she hadn't been suffering from this for too long. When I speak with them again I'm going to arrange to get my hands on all the testing paperwork so I can begin keeping a file on Smokey for reference. It all just happened so fast that night

 

[Blue]

I believe it was just blood glucose coupled with our reports of her drinking a lot more water and losing about a pound of weight. They did send the rest of the blood drawn on Thursday for another test, I checked the receipt and it said "Fructosamine lab request"...but they said we wouldn't have the results of that blood test until tomorrow (3 business days). The original test that included the BG check also included other checks for what they termed "organ health" when talking to me, i.e. kidney function, etc, and told me the only # that seemed out of normal range was the sugar. After that, they didn't really say it could be anything else, and advised we start insulin today, actually. When she was whimpering and drinking water at the same time on Friday night, though, we took her back in. When she tested at 544, they told me they wanted to get started on insulin that night instead. Still wondering what the fructosamine tests will say. I do know they tested urine and found no ketones in the urine when she was there Friday. They told me this meant she hadn't been suffering from this for too long. When I speak with them again I'm going to arrange to get my hands on all the testing paperwork so I can begin keeping a file on Smokey for reference. It all just happened so fast that night

OK good; they don't know for sure if she is diabetic until that Fructo test result comes back.
There are a great deal of things/issues that could cause a high BG number, like infections or illness or even some bad teeth. It does sound like she's likely diabetic, so it's great to hear there were no other numbers out of range and also no ketones... just because there are no ketones does not mean you caught the condition early; some cats never have ketone issues, so to be on the safe side, it's advisable that you pick up a container of KETOSTIX from the pharmacy and test her urine daily for ketones. Some cats just never get ketones, despite being long term diabetics.... neither of mine ever registered so much as a trace. And ketones can occur even at lower BG so you want to be checking her urine regularly to see if she has any at all.

It's a great idea to get copies of ALL paperwork on your cat. I have a binder for each of my cats, with all past test results and even receipts for items bought, meds and also procedures like Xrays and u/s, they each have reports that I file in the binder. I can't remember all that the vets say at our appts, and THEY keep files, so why shouldn't I do the same? At home, you will be able to look back and compare recent test results to those taken in the past, and such comparisons can be very telling.

 

[manors18]

Aiming for a glucose curve testing this weekend (I've been testing at home twice a day, and while I'm not perfect at it, she seems tolerant enough that I can do it at home instead of the pressured do-at-the-vet one that I think will drive her up considerably). I was scolded by my vet today b/c I withheld insulin, and I totally respect anybody that does so here as well, but her BG continued to stay under what the vet told me I should aim for (under 200) with free feeding of Meow Mix in the diet. Last night I refused any dry food to the "population" aka other cats and fed them all the high-protein low carb fancy feast instead. They ate, they weren't happy, but they ate, and tonight, Smokey (the diagnosed one) tested at 122 BG. I'm excited about the result. Since the cease of insulin, she's never gone above 200, and now at 122 without the high-carb crap, I'm happy to see it, since the vet said a normal cat is between 80 - 150. The vet told me to do a glucose curve on Saturday, and I want to use the XLS that was suggested -- can anybody direct me to a definition of each of the columns? I'm not sure I understand anything to record aside from Date, Time, BG level, and food involved.

 

[Ry & Scooter]

Those are very promising numbers! She may still need a very small dose. 120 is on the higher end of normal, I think most OTJ kitties should be spending most of their time in the double digits (though my OTJ Scooter likes to sit in the low 100's at night for whatever reason)

The columns go:

Date: self explanatory
AMPS: means "AM Preshot", the number you get right before your AM shot (PMPS is PM Preshot)
U: units of insulin given
+1, +2, +3, etc: hours after the shot for mid-cycle BG readings
Remarks: How kitty was feeling that day, what they did, what they ate, etc.

 

[hmjohnston]

The numbers are looking good!

I hope the trend continues lower :lol: