Newly diagnosed! Hello!

[kim and simon]

Hi everyone, just introducing myself!
My 12 year-old boy Simon was diagnosed on Thursday. I suspected something was wrong in December because he had pretty dramatic polyuria/polydipsia. WOW! (I had two carpal tunnel hand surgeries in December, so I did not get around to dealing with this until this week, 1/5/12). He had a blood glucose in the mid 400s at the vet, and very low K and Cl. Along with the urination and thirst, we felt it was enough to confirm the decision to start insulin.
Our vet has prescribed one unit of Lantus twice daily. Also a K supplement for a week. We've switched to canned food and the vet gave us a copy of the Janet/Binky list. I gather that's a good sign that he knows what's going on. I've been feeding him foods with less than 10 carb and greater than 45 protein.
As a little bit of background, I'm a part time (people) dentist. I've always been a cat person! Simon was my first cat on my own as a single adult. Now I'm married with three kids 6 and under, a chocolate labrador, Simon (he looks like a siamese mix--we call him simonese), and Molly, a calico cat (also 12). She's not diabetic but is overweight, so I'm feeding her the same as Simon.
So. . .my household is busy. Husband and human kids will come first, but I do want to do what I can to help Simon. I may not be able to religiously test his blood. Our vet actually did not insist on my testing his blood at home, but I have figured out how to do that and am gathering some data. I'm not sure what to think quite yet. As a dentist, I am experienced with needles (insert evil laugh here) and I got my BG on his ear on my first try!

Questions--it seems that the wet foods with the optimal breakdown are mostly grocery store brands. Is this ok? I've always fed at least premium pet-store brands.
Vet requested that we come back for a fructosamine test in two weeks. Conveniently, we'll be skiing on that date. Is it best to board my cat over that time with the vet or have a knowledgeable family member do his shots and just delay the fructosamine until two weeks, 4 days after diagnosis? I read that stress raises their BG.
How soon can his dosage be changed if I am taking blood sugars and have good data? I read that Lantus can take awhile to regulate them and should perhaps be kept low for a week.

I am intrigued by the prospect of remission and I want to do a really good job up front to see if we can get Simon off insulin. How often does this happen? He is still a spry guy and does not seem to have been diabetic for long. He doesn't seem to have any bodily damage apart from greasy, flaky fur.

Thanks in advance!

 

[Teresa and Poopy]

Poopy and I welcome you to the best place you and your kitty Simon could have found! cat_pet_icon The folks here are super friendly and have tons of day in and day out knowledge they share freely. Great place to be!

Great news on the vet giving you the Binky food list! Woot! And good on you for already doing BGs! Woohoo! You might want to set up a spreadsheet to help track the numbers, and make it easier for others to help you when you might need it. :smile: Let us know if you want to do that and we can help.

I can't address the Lantus questions as Poopy uses ProZinc, but I'm sure other Lantus users will be on and can share their knowledge.

Welcome again! cat_pet_icon

 

[squeem3]

Welcome :smile:

Our vet has prescribed one unit of Lantus twice daily. Also a K supplement for a week. We've switched to canned food and the vet gave us a copy of the Janet/Binky list. I gather that's a good sign that he knows what's going on. I've been feeding him foods with less than 10 carb and greater than 45 protein.

Great vet :thumbup Here's another food list you can use: https://docs.google.com/leaf?id=0B8...MzhkYTkxOGM4NThk&sort=name&layout=list&num=50 It lists some higher end brands that may not be on either of Binky's charts.

Our vet actually did not insist on my testing his blood at home, but I have figured out how to do that and am gathering some data. I'm not sure what to think quite yet. As a dentist, I am experienced with needles (insert evil laugh here) and I got my BG on his ear on my first try!

Wow! Great that you are testing :thumbup Keep track of the blood glucose levels so you can track trends. Most people here use a Google spreadsheet. Instructions are here: http://felinediabetes.com/FDMB/viewtopic.php?f=6&t=50130 Once you have one set up you can share it with your vet.

Questions--it seems that the wet foods with the optimal breakdown are mostly grocery store brands. Is this ok? I've always fed at least premium pet-store brands.

The higher end foods are just as good: Nature's Variety, Merrick, Wellness, Innova EVO, etc. Some people stick with grocery store brands (Fancy Faest, Friskies, etc) because it is more affordable for them.

Vet requested that we come back for a fructosamine test in two weeks.

Since you are testing at home, you don't need to do a second fructosamine. The fructosamine only tells what the average blood glucose level has been for the past few weeks. If you test blood glucose levels daily, you can share your spreadsheet with the vet and save some $$.

Is it best to board my cat over that time with the vet or have a knowledgeable family member do his shots and just delay the fructosamine until two weeks, 4 days after diagnosis? I read that stress raises their BG.

A family member can take care of your cat if you show him/her how to correctly measure insulin and give the injection and how to blood glucose test. Or, there may be a member who lives near you and can help out. What general location are you in?

How soon can his dosage be changed if I am taking blood sugars and have good data? I read that Lantus can take awhile to regulate them and should perhaps be kept low for a week.

I am intrigued by the prospect of remission and I want to do a really good job up front to see if we can get Simon off insulin. How often does this happen? He is still a spry guy and does not seem to have been diabetic for long. He doesn't seem to have any bodily damage apart from greasy, flaky fur.

Depends on the cat :smile: Since you are using Lantus and will be going to a low carb canned food diet, the chances of remission are pretty good. There is info you need to know about how Lantus works in cats. All that is over on the Lantus board at the top: http://felinediabetes.com/FDMB/viewforum.php?f=9 Just read the stickies there and keep posting here on Health for now.

 

[Marje and Gracie]

Good evening and glad you found us. Sorry that Simon has to be here but it is the best place you never wanted to be

Lantus is a long-acting insulin that we shoot every 12 hours. It works best with consistency on dosing and on shooting. Here is info on the starting dose:

Using a weight based formula for determining a starting dose of Lantus or Levemir:

the formula is 0.25 unit per kg of the cat's ideal weight
if kitty is underweight, the formula frequently used is 0.25 unit per kg of kitty's actual weight
if the cat was previously on another insulin, the starting dose should be increased or decreased by taking prior data into consideration

Please note that it says "ideal" weight unless kitty is underweight. So, assuming Simon is not underweight, if Simon's ideal weight is 10lbs (4.5 kg), then his starting dose is 4.5 x .25u = 1.125u so we'd start him at 1u.

Lantus (and levemir) have an insulin depot under the skin. The depot (AKA storage shed) must be filled first before the kitty starts using the daily injections. So for the first 5-7 days while you are injecting, the shed is filling. Once the shed is full, then the kitty starts using the insulin you are injecting. During that time, you will likely see high numbers and think nothing is happening. Be patient

it seems that the wet foods with the optimal breakdown are mostly grocery store brands. Is this ok? I've always fed at least premium pet-store brands.

It depends on what you are feeding. Many of us in the Lantus Insulin Support Group (ISG) feed Wellness chicken, turkey, and beef/chicken. They are 4% calories from carbs. EVO 95% chicken/turkey and EVO 95% beef are lower in carbs. Most of us feed foods with less than 5% carbs. Here is a link to some of the foods: Canned Food Nutritional Values

Vet requested that we come back for a fructosamine test in two weeks. Conveniently, we'll be skiing on that date. Is it best to board my cat over that time with the vet or have a knowledgeable family member do his shots and just delay the fructosamine until two weeks, 4 days after diagnosis? I read that stress raises their BG.

If you hometest, you will have better info than a fructosamine test and we typically recommend against it. A fruc test gives you an average BG over a few weeks' time. If you are hometesting, you have real time data. Insofar as boarding him or having someone come in, you will need to have someone who can test him. I think the best thing to do is get Simon started, do a Spreadsheet so we can look at it and help you, and then figure out what is the best approach for him while you are gone. If you can send me a PM (click the "PM" box under my Gracie's pic to the right), I can quickly help you set up a spreadsheet that we can all view. This will help us immensely in helping you and Simon.

How soon can his dosage be changed if I am taking blood sugars and have good data? I read that Lantus can take awhile to regulate them and should perhaps be kept low for a week.

Most, but not all of us, in the Lantus ISG are using the Tight Regulation protocol. I would recommend this "starting the dose" method whether you decide to follow TR or not.

"General" Guidelines:

Hold the initial starting dose for 5 - 7 days (10 - 14 consecutive cycles) unless the numbers tell you otherwise. Kitties experiencing high flat curves or prone to ketones may want to increase the starting dose after 3 days (6 consecutive cycles).
Each subsequent dose is held for a minimum of 3 days (6 consecutive cycles) unless kitty earns a reduction (See: Reducing the dose...).
Adjustments to dose are based on nadirs with only some consideration given to preshot numbers.

It's very important to note that we determine dosing by nadir, with "only some consideration" given to preshot numbers. This is different from other insulins like Prozinc where they dose based on preshot.

Regarding remission:

The tight regulation protocol was tested in 55 diabetic cats for Lantus/glargine and in 18 diabetic cats for Levemir/detemir from the
German-Katzen Forum. Owners measured blood glucose an average of 5 times daily and adjusted insulin dose based on the protocol. An overall remission rate of 64% was achieved in the cohort. Significantly higher remission rates were observed if good glycaemic control was achieved soon after diagnosis: 84% for cats started on the protocol within 6 months of diagnosis went into remission, and only 35% for cats that began more than 6 months after diagnosis.

But we also say "every cat is different" (ECID) and it's difficult to determine who will go into remission when. We recommend that you always get a preshot number.....please do not give insulin without knowing he is at a safe number. For new kitties just starting out, we recommend that you don't shoot anything below 200 without posting and asking for help. We also highly recommend at least a mid-cylce test as often as you can and at night, a before bed test.

Please let us know how we can help.

 

[Sienne and Gabby (GA)]

Welcome to FDMB!

People have been providing you with a wealth of information. There's even more info on the Lantus board. The links to the starred, sticky notes and an overview of what they contain is as follows:

• 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.

With Lantus, you want to stabilize your initial dose and give the insulin depot 5 - 7 days to form. Once you are past the initial period, if you are following the Tight Regulation Protocol, you evaluate the dose every 3 days unless lower numbers indicate that a dose reduction is warranted.

It may be helpful if you keep track of your cat's test data in a spreadsheet. Most of us use the template that's in the Tech Support forum. Please let us know if you have questions.

 

[kim and simon]

thank you thank you! lots of great info to go through! I'm starting a spreadsheet now!

 

[kim and simon]

I have a very few BG's to start out with and I'm hoping you can see my SS now. I'm wondering if the 99 at +4 hours I just got is too low for only being on our third day, given this storage shed concept.

 

[Teresa and Poopy]

Woohoo! Look at you go with such a pretty spreadsheet up and working! \M/

I can't say much about Lantus since I've never worked with it. I can share a normal, non-diabetic cat blood glucose ranges from 40-120. So 99 isn't a bad number but am unsure of how the Lantus is effecting your numbers. I'm sure someone will be on shortly to help out.

Have you posted this question over in the Lantus group? Not all Lantus users check the Health page. :smile:

 

[kim and simon]

Thank you! I will post at Lantus board to introduce myself.

 

[tuckers mom]

Your sweet kitty was just diagnosed with diabetes and you've switched to canned food and are hometesting, this is fantastic.

I don't want to make you nervous but regarding your trip, I would be careful about having a petsitter give injections while you're away. With the change in diet insulin needs can be greatly reduced. For some cats it can be a quick change. I would be worried about giving insulin and then leaving her alone.

I'd also like to mention that you should get the potassium rechecked. I'm not sure why a K supplement for only a week without a recheck. Potassium can often go lower just by starting insulin so if you already have a K problem, keeping an eye on it to determine whether supplementation needs to be increased or stopped is important. Too much K will cause heart troubles, too little and you start to effect nerve and muscle cells.

If you do go over to the Lantus TR ISG please make sure to note the potassium and the trip.

 

[kim and simon]

Your sweet kitty was just diagnosed with diabetes and you've switched to canned food and are hometesting, this is fantastic.

I don't want to make you nervous but regarding your trip, I would be careful about having a petsitter give injections while you're away. With the change in diet insulin needs can be greatly reduced. For some cats it can be a quick change. I would be worried about giving insulin and then leaving her alone.

I'd also like to mention that you should get the potassium rechecked. I'm not sure why a K supplement for only a week without a recheck. Potassium can often go lower just by starting insulin so if you already have a K problem, keeping an eye on it to determine whether supplementation needs to be increased or stopped is important. Too much K will cause heart troubles, too little and you start to effect nerve and muscle cells.

If you do go over to the Lantus TR ISG please make sure to note the potassium and the trip.

Thanks!
Here is my Lantus board post.