Newly Diagnosed -- Need Help ASAP

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D & Baby

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My cat was diagnosed a few weeks ago, given Clavamox to control an infection and we just started Lantus yesterday.

Cat had his initial curve in the vet's office yesterday and the numbers were high -- in the 300s. The last draw was at 5:20 pm. He ate before going in the morning, but did not eat at the vet's office at all. At home, I forced him to eat half a can of cat food and some deli turkey slices and gave him his second shot of the day. He seemed fine.

This morning, after not eating all night, I put food down and he would only lick it and nibble a few bites. I heated it, tried a few different types and finally opened a can of salmon. He ate about a tablespoon or so.

Unsure of whether to give him a shot or not, I tested his blood sugar and it's only 112. (I literally just did this.) I'm going to test again right now and will post results. But I'm unsure about the shot now. I don't know what to do.
 
No shot with a BG of 112 on a new cat especially if the cat is not eating. Clavomox, like most antibiotics can make a cat not want to eat. Also. the stress of being at the vet all day yesterday does not help. I would call he vet and ask for advice since the vet might not be available tomorrow.
 
It's very good that you are testing.

I agree with Larry -- you don't have the data to shoot this low. Your instincts are also on target. Hold off on food and re-test in 20 - 30 min. What's your dose of Lantus?
 
I just tested again -- 184 and a few minutes later it was 127.

He's been off the antibiotics for a week or so. He was diagnosed, went on the antibiotics to clear the infection, then it took over a week before we could get him in for the initial curve, get the Lantus, etc.

He's been eating fine since being off the Clavamox -- it's just yesterday (at the vet and after) and this morning he seems not to want to eat. I seriously considered bringing in rabbit parts that one of my outdoor cats caught last night to see if he'd eat those.
 
Do you have ketone test strips and can you test for ketones, just in case?
Infection, inappetance, and higher numbers, just make me want to rule those out.
 
How much does your cat weigh? That dose is rather high for an initial dose unless your cat is huge! For a starting dose of 2.0u, your cat would need to weigh approx. 17.5 lbs.

There shouldn't be that kind of variance between tests taken within minutes of each other. Are you sure both were good tests? Also, what kind of meter are you using.
 
Two units is a little high for a starting dose. I would drop it down to 1 unit when he starts eating. The stress of being at the vet can typically raise the BG so it is usually not representative of what is is at home.
 
I'm using the Relion I saw suggested here and tested like I read about/saw here. I tried it a few times before, so I think I'm doing it right. Poking his ear, putting the strip up to the tiny blood drop.

He was larger than 17 pounds (closer to 19 and a tad over weight, but he is just big) cat prior to getting this disease, he is just under 13 now and too skinny. I thought 2 sounded kind of high based on what I'd read here -- but the vet seemed super up on everything else so I didn't come back and double check.

I don't have ketone strips.
 
Based on the formula in the Lantus Tight Regulation Protocol for the initial dose, your vet may technically be correct given your cat's previous weight -- providing that was his ideal weight. So, on the one hand, good for your vet! Since you're getting low numbers already, as others suggested, the curve at the vet may have been influenced by vet stress. You're already seeing numbers in the 100s. Given those numbers, I'd suggest lowering the dose so you are able to shoot twice a day. You could start at 1.0u, again as others have suggested, since it sounds like eating is a little dicey right now.

A few more questions...

You're already off schedule for your shot. Can you afford to slowly migrate back your shot time (i.e., 15 min. per shot) in order to get back on schedule? If you are able to shoot, are you going to be home to test? Do you have a stock of strips and high carb food? (Or, if no HC food, do you have Karo syrup, honey, maple syrup, etc.) if you should need to steer the numbers?)

Oh, and get another test.

(The Relion is a good meter.)
 
Hi d and baby
if i am reading this right you just started shooting yesterday? What times were those shots given, and at what time did you get the low reading this morning?
carl
 
Just took it again (and had a time of it, as he was patient for the first few but getting ticked off so I had to re-do it several times). It was 118.

Yes -- yesterday was his first shot ever.

His first shot was at 8:20 am. Last shot was 8:40 pm. (Later than I wanted because he getting him to eat before turned out to take a while.)

First low reading this AM was probably 8:45 - 8:50 (again, because I thought he'd just eat and he wouldn't so that took me a while).
Took it again 9:15 and 9:20 and now again at 10:15.

So it was like this:
8:45 - 112
9:15 - 182
9:20 - 127
10:15 - 118
 
As far as getting back on schedule for shots -- I'm home all weekend (i.e. not leaving town but won't be in the house all day, every day). But on Tuesday I have to go into work, although I may be able to go in late if I have to. Wednesday/Thursday work from home. Friday I have to go back in the office.
 
And I do need to work backwards so that he's getting shots closer to 7 am -- the vet also suggested going backwards 15 minutes per night, which would have worked out great if the darn cat would have eaten. Although, hindsight, if he had eaten fine I'm not sure I would have tested so I guess it's a blessing in disguise.

Still not sure what to do right now. Hold off on shots until tonight - provided I can get him to eat? And then what time do I do it?
 
Ok couple of things.
You should test first then feed.
And always always get a test before shots.
we'll figure out the schedule
Carl
 
I really think this is still too low for you to shoot. Generally, we recommend that when you're first starting out and don't have much test data, that you do not shoot below 150. Since you'll be skipping this morning's shot, you can shoot at any time you want this evening. I would suggest starting at a dose lower than what your vet recommended, though.

It will help you a great deal if you set up a spreadsheet. It will allow you to keep track of your cat's numbers and, if you're planning on continuing to post here, it will allow us to more effectively help you. The template and instructions are in the Tech Support forum.

More questions...
What are you feeding your cat? (Is Baby your cat?) The vast majority of us feed low carb, canned food. The website developed by Lisa Pierson, DVM on feline nutrition is a wealth of information on nutrition and general feline health. There are two resources for finding low carb foods: Janet & Binky's list and a recently developed list that contains values for newer foods.

Are there any heaith issues? I'm particularly wanting to know if your cat had diabetic ketoacidosis. If so, we should re-think not shooting.

Once you have your spreadsheet set up, you may want to consider posting on the Lantus board. We are very numbers driven there so having a spreadsheet is important. In the meantime, there is a great deal of information there that may help you understand the ins and outs of using Lantus. Here's an overview of what's contained in the linked sticky notes.
  • 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.
 
Baby is my cat. He is eating wet food from one of those lists -- Two varieties of Fancy Feast Classics (um, liver and chicken and a turkey variety) and Purina Tuna one. We tried various high protein-low carbs from the natural food store, but he was not keeping them down very well, even after the clavamox was done. So I went with the cheaper food and he likes it better and it's more affordable, so that's where we're at now. Although the canned salmon and natural deli turkey I resorted to last night and this morning are not cheap at all.

As far as the ketoacidosis -- I don't know. We initially took him to the vet because he was peeing alot (which I didn't realize at first, I had bought newer, cheaper kitty litter and thought it was the litter) and drinking a lot of water and losing weight (normal for him in the summer) but all of it combined made me think diabetes. (Plus him peeing outside the box in front of me.)

So, he was diagnosed with a urinary infection (although she said it was probably caused by the diabetes -- I just assumed it was a regular infection...?) and prescribed the clavamox and a change of diet to see if it would help. The infection cleared, the diet didn't help and that brings me to today.

No other health issues that I'm aware of...
 
So, tonight, I test him, feed him, test him again and then give him maybe 1 unit?

But if he is still below 150, I should skip the shot?

And how much should he eat before I give him a shot? How soon after eating do I test him?
 
D and Baby,
Assuming that the answer to Sienne's question about other health issues (DKA especially) is "no"....

Lantus is very dependent of a strict 12/12 dosing schedule. You will read about that in some of the links she provided for you.

Going forward - Because you skipped the shot this morning, and because you have only been shooting lantus for one day, it should be easy to adjust your schedule. What you need to determine is when the 12 hour schedule works for you. If it is like 7am and pm, then the next shot Baby should get (assuming he needs one), is at 7pm tonight.
What you'll need to do is check him about an hour or an hour and a half prior to then, and then check him just around 7. That will determine what his BG is doing as shot time approaches. After you get the pre-shot test, feed him. Then post here with the results. He could get his shot while, or just after he eats, assuming he eats okay.

Another important thing with lantus is that not only do you test just before shot time, but also between shots. At least once right around the middle of his cycle (called +6 here). That is the point when his BG would typically be at the low point (nadir). With lantus, dosing is based on the nadir BG more than on the pre-shot BG numbers.

Let us know about the questions Sienne posted, and we can move forward from those answers.
Carl in SC
 
OK, while I was posting, you were answering!
Tonight, test him about 5:30 or 6, then test him just before "dinner" at 7. As far as how much? What is normal? If he just licks the food and walks away, then there's still something going on with his tummy. Just post here with the results of those 2 tests, and about how well he eats.
At that time, people can determine whether or not you should shoot. Assuming you will shoot, the dose should be 1u rather than 2u.
I have to go cut the grass (yay!) but I'll be online, and so will lots of others, by the time test and shoot time comes around this evening.

Carl
edit - changed kitty's gender to "he"....
 
You don't really need to worry about Baby's blood glucose (BG) levels until closer to your PM shot time (PMPS - PM Pre-Shot). What I would do, though, is put some food out throughout the afternoon up until about 2 hours before your shot time. Make a note about how much food is out and how much (approximately) Baby eats.

If your cat isn't eating, there could be something else going on so it's important to know how much he's eating. Does Baby like freeze dried chicken? It's a great, low carb treat and many cats love the stuff. Crumbling it on top of food is often a good inducement to get them to start eating. Likewise, the water off of canned, low sodium tuna, heating up chicken broth and spooning it on food, some rotisserie chicken, well...you get the idea.

Just to tweek what Carl said, with Lantus, we test, feed, and shoot all within close proximity. With Lantus, you have a longer window before the insulin starts working. I would get your pre-shot test and post. Do not feed until you know that it's safe to shoot. If Baby's numbers are over 200, you're fine to shoot. If they are below 200, please post so we can provide some input.

If, for some reason, there's no one around who is answering your post, please do two things. First, read the link in my previous post on Shooting & Handling Low Numbers. There's a section on low pre-shots in that post. Also, cross-post on the Lantus Board. Given that it's a holiday weekend, you want to maximize the possibility that someone will see that you need help. Both Health and Lantus are usually busy boards but with a holiday, it can be unpredictable.
 
I am aiming for 7 pm/7 am, so at 5:30 or 6 (PT) I'll test and then go from there. Based on what I'm reading here, if it's over 200 and he eats, I give one unit. If it's over 200 and he doesn't eat, I don't give a shot. If it's below 200, I don't give a shot.

And I'll post no matter what in case anyone is around, (I'm on the West coast, so I'm behind most of you by about 3 hours), because I am flying blind here and feeling overwhelmed.

I can't tell you how much I appreciate all the help.

I'll be offline for a while here, but will be back later. Thanks again.
 
Dear Sienne,

Sienne and Gabby said:
Do not feed until you know that it's safe to shoot.
Click to expand...
I humbly, respectfully, and strongly disagree. D needs to get Baby eating. Period.





Dear D, and, of course, you too, sweet Baby,

Welcome to the place you never, ever wanted to be! And, how awesome you're home testing! Welcome to the Vampire Club as well!

You're like a Triple Play Of Parenting!!!

Love and encouraging hungry hugs for Baby -- the encouraging hugs are for you both,
Deb and Nikki -- and, Giz, forever dancing in my heart...
 
Deb415andNikki said:
Sienne and Gabby said:
Do not feed until you know that it's safe to shoot.
Click to expand...


I humbly, respectfully, and strongly disagree. D needs to get Baby eating. Period.
Click to expand...

You do not want to shoot Lantus into a cat that is not eating. Likewise, if someone is new and unsure if it's safe to shoot, it is best to have someone with more experience provide input. If the pre-shot numbers reflect a food spike, then your decision to shoot is based on faulty information. Further, if you do then shoot on the basis of a food spike, you are putting someone with limited experience in steering the numbers in a cycle in a very precarious situation especially since she has already noted that she does not have high carb food in the house. I would refer you to the sticky in the Lantus ISG that relates to how to deal with low pre-shot numbers. One of the options is to stall in order to see if numbers are rising independent of food -- in other words, stall and do not feed.

There is a balance between whether a cat is eating and giving insulin. My experience is with N and with Lantus. I don't know what insulin your experience is based on. However, I would think that with the shorter acting types of insulin, knowing that you are not shooting into a food spike is just as important. Similarly, I doubt that you would shoot any insulin if the cat is inappetant until you were sure you could get food into the cat.

You have also taken one sentence out of context. The preceding paragraph in the post your quoted addresses how much and/or whether Baby is eating today. I also noted that if Baby is not eating that this can be a larger problem.
 
Hi and welcome!

You are getting some great and experienced advice, especially from Sienne.

The food question is a bit complicated because it depends on the details. You do need to get Baby eating, besause if cats go for a day or more without eating, they can get into serious health problems very fast. On the other hand, once the cat is eating OK, you need to be careful about feeding just before shot time, or it can be impossible to figure out the right decision.

I'm sorry this cannot be a cut and dry advice, but if you keep posting, and provide all the food and other info you can, the team here can give you advice based on many many years of experience. But it will just be advice, not an answer, because every cat is different (ECID), and it will not be long until you are the leading expert on your cat!
 
Hey, can you please take the personal discussion outside of the new users post? I know you are both trying to help, with orders of magnitude more experience than me, but arguing credentials and civility is not helping D. Posts can be edited if you want to...
 
I am fine with differences of opinion, just please don't anyone get hissy and not respond because of it. ( :smile: that's a cat joke, no reflection on anyone here - I just couldn't resist!) I'd rather get responses with arguments than none at all at this point.

Cat has still not eaten (other than the salmon and bite or two of wet food this AM), but I have not been putting any food down for him as I thought I should wait until closer to the shot time. He is lazy, but not lethargic. Acting pretty normal if not just a little tired. But still alert, easily woken, talking to me like normal, etc.

I have some turkey that I will feed him if he won't eat cat food. And tuna juice I can put on his flaked tuna cat food (or even mix in straight tuna just to get him to eat now). But I'm still looking at an hour and 45 minutes before I test him pre-food.

Would the Lantus itself make him not want to eat? Because Thursday he was eating normal. And Friday he ate okay pre-vet, pre-shot. Friday night, he did eat a little but I had to coax more into him and bribe him with the turkey. And again today with the bribing -- the only difference between Thursday and after is the vet/insulin shot.
 
The lantus itself should not make him not feel like eating. Insulin is not a drug with side effects. It is a hormone whose only side effect should be to lower his BG.
Carl
 
If he has not eaten, then that is a much bigger issue than lantus dose. Get him to eat whatever you can!!

I've not heard of Lantus or other insulins causing eating problems. It could be stress from the vet, but once not eating starts, it becomes a bad feedback loop that causes more eating problems. You need to break the loop by getting him to eat.

Just keep track of exactly what he eats and get as many BG reading as you can, and we'll make the best dosing decision possible.
 
It sounds like you are feeding just at shot time. FWIW, many of us feed several small meals during the first half of the cycle. Just do what you can to not feed 2 hours before shot time. Food, that late in the cycle, may influence your pre-shot test.

Lantus doesn't generally cause side effects. For some cats, if they have been in higher numbers, like Baby was at the vet, having those numbers come down and now sitting in a much healthier range, can make a cat feel weird (for lack of a better word). As they get used to being in a better range of numbers, they'll feel better. Unless there is some other explanation for Baby's not eating, she may feel a little "off" today.
 
It's usually hard to scare the experienced people away on this forum :lol: :lol: I'm glad it does not scare you away either.

How's it going?
 
So, at this point, I am going to try to feed him and then what? Since he is below 150 I gather that I should not give him a shot?

I wasn't purposely not feeding him -- he did not eat much this AM, then while I was away, he acted like he wanted something but wouldn't eat when my husband gave him food. Then when I posted again I thought I should probably hold off because what if he ate something a few hours before shot time and then didn't want to eat before the shot? But maybe that was wrong thinking on my part...I have no idea!
 
Latest test was 136.
When was the previous test and what was the #?
If you haven't fed yet, please wait a few more minutes.
Carl
 
I didn't see your post and I'm a bit freaked by him not eating so I got him to eat one and a half slices of deli turkey.

These are all the tests I've done today:
8:45 - 112
9:15 - 182
9:20 - 127
10:15 - 118
6:45 - 136
 
that's what i would do given that he's running in some darn fine numbers already. the numbers are certainly good enough that pushing insulin isn't an emergency in my opinion with the data we have. if nothing else you can test him an hour or two after eating and see if there's any pancreas response to the food

i don't really like so much inappetance so i would still urge picking up some ketostix if you can this weekend and getting in a test or two for those. can't recall if someone explained those? basically it's a dipstick you put in fresh urine and watch it change colors and compare it to a chart on the bottle they came in. fairly easy and while the glucose numbers are great and normally low enough to not necessarily raise a red ketone flag, the inappetance is.

btw, i'm west coast too (southern california) so will try and check back in to see what new number you got
 
I'm with Cindy, these numbers are plently low enough that you should forget about insulin until either A. he is eating well, or B. then numbers climb at least into the 200s.
 
I'll get ketostix tomorrow and see if I can test. I have other cats, so it's not as easy as it might seem.

Given that he's gone several weeks with higher numbers, I was thinking it would be better to not have the shot and recheck him in the morning. So I'm glad to have others confirm that it's a good idea.

I'm so glad there's a fellow West Coaster -- I'm in Washington.
 
there's a few of us on the board, just not sure who would be around on a holiday weekend. lori and tom for instance is down here in so cal with me as are a few others, carol & yoshi, lisa & merlyn and others are further north in california and let's see, emmy & dude are in oregon, karen & smokey are in washington as is another new person that just joined in the last week or so

my Mousie started on the streets and is none too fond of us humans although she's gotten better since i took her in 8 or so years ago and get this, if i try to stick a ketostix in her pee while she's going, the little weasel will actually run out of the box while still going. so what i do is when i spot her in the box, i grab a stix and play sly while she's doing her business, not letting her know i'm watching. as soon as i hear the pee stop, i dive in with my stix, she bolts, and i get the puddle before it soaks in. ohmygod_smile

some people can do it while kitty is peeing, some use a long handled ladle/spoon to catch a sample, some use fish gravel in the litterbox so the pee doesn't soak in, oh so many ways to get that sample. matter of trial and error in the beginning, and cleaning up pee if yours bolts like mine will :-)
 
Oh, jeez. I'm not sure I can get it, but I can try. I thought I'd just be able to stick the stick in the litter.
Baby and his remaining litter mate (we lost a third to cancer 2 years ago) are 14 and are my indoor cats. My first children, to be honest. I also have 3 indoor/outdoor cats who are 3 years old that we adopted after someone abandoned them as kittens in a field near our house. They were feral and it took a long time, but they are friendly with us humans now and pretty lovey, too. But not the same as my old guys.
 
I have to admit, I never succeeded catching S'mores :oops: :oops: :oops: :oops: , I ended up using the non-absorbing litter trick, but it means you have to clean and dry each time you want a reading...

Testing every couple hours is probably plenty, you really want to focus on getting the food straightend out first, and if the testing is bothering her, it could get in the way of getting the eating train going. You're not going to shoot tonight anyway, and since you are 24 hours after your last shot, you should not expect dramatic swings due to Lantus wearing off (it's mostly, but not all, gone at this point).
 
D,
You should pay close attention to how much food he eats between now and tomorrow morning. If he continues to not have much of an appetite, there may be something going on that might need addressing rather quickly. There doesn't seem to be a logical reason for him to not be eating.

Also, especially with this being a Holiday weekend, you may find in the morning that you can get a quicker answer (especially if you need a quick answer) by posting in the Lantus forum. That place is always busy! Your (and Baby's) situation now with lack of appetite and borderline "shoot, no-shoot" numbers will be best served by getting experienced lantus eyes on your threads as quickly as possible.

That doesn't mean you can't keep posting here as well. :smile:
Once again, welcome to the board!
Carl
 
Hello D,
I just wanted to add something... My civvie Slappy decided one afternoon not to eat...that was on a Thursday and by Saturday, we had a vet visit.. She was admin. fluids, b12 and had blood work done...senior panel as she is 15. All was fine but her thyroid...it was hi... Long story short, I was offered some help which I took to 'burrito' her in a big towel. I bought some droppers because the vet gave me this huge syringe that did not work.... I did use some AD from the vet and some meat only baby food and the droppers/burrito worked. Now my civvie has never ever ever ate wet food.... She now eats wet food on her own!!!! :smile:

It took 3 weeks of the burrito treatment before she would actually eat on her own.... She is now getting some meds rubbed in her ear for thyroid and eating AD still. We will work on going to the low carb that Sugar Bean has to have.

Perhaps you could use the burrito method for Baby until she will eat on her own?? I never thought it would work with Slappy but it did and she is now out from under the bed, out from hiding in the bedroom and spare room and is mingling!! She has not had dry food for 3 weeks.

I really did not think she would make it. I could not get her to eat ANYTHING!!! And even discussed a tummy tube for her. I thought this might be an idea for you to consider. I also bought a Magic Bullet and pureed her food. I love that machine - it really does work!

Good luck with Baby and make him behave and EAT. ;-)
 
8:15 - 186

Thanks so much for the replies. Really -- it is so helpful and appreciated.

I will post on the Lantus forum tomorrow (and here) depending on how things go.

I think I am done testing for the night. I'm going to see if I can continue to get him to eat some food. I was pleased by his response to the turkey, but he seemed full fast. Maybe he just needs to start feeling normal after the insulin brought his blood sugar down. Who knows? I'm wishing now that we'd put off the initial curve until after the weekend but I wanted to get him started on the insulin sooner rather than later since we'd already had to wait due to the infection. I just don't understand what could have happened in one day that would cause such a lack of appetite. It baffles me.

I'm glad your Slappy is doing well now. If I have to feed Baby with a syringe or whatever, I will -- short-term, anyway. But I won't go the feeding tube route. I had to do that with my cancer-cat and in hindsight, I believe I should have done hospice and let him go peacefully. That is an entirely different situation, I know, but it has colored my views on extending pet lives.
 
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