Newly Diagnosed, Vet Giving Contradicting Advice

Status
Not open for further replies.
B

BAMQ

Member Since 2012
Hello everyone. My 12yo cat and I are new to the diabetes world and wanted to start off our introduction with a great big thank you. Without this forum, I would be even more lost than I already am.

Bam was diagnosed with diabetes in May. The vet recommended switching his diet to Purina d/m and Fancy Feast wet for a month and recheck is BG; no improvement. From there, vet recommended oral pills twice a day for a month. Pills brought his BG down slightly but were still in the 400s. We began twice daily injections of 2u of Lantus on Tuesday. Vet said to stop feeding wet food and continue with Purina d/m but from what I've read on FDMB, he should have suggested the opposite. I've been slowly cutting back on how much dry he gets ("splash" in his bowl as a snack) and continuing feeding two cans of wet a day.

Bam has been much more playful, is actually (aka finally) sleeping through the night and is not urinating as often as before insulin was introduced. I am, however, concerned that my vet is giving improper recommendations with injections, feedings, BG numbers, etc :shock:

Although every cat is different, how much do BG levels spike after eating? Bam's levels were 561 after he ate dinner yesterday...
How long do you wait after feeding to give insulin? My vet recommended waiting an hour...

Thank you everyone!

Denise and Bam
 
Food spikes can be significant, so we recommend testing before the food and the insulin. (Think of this like your own doctor wanting a fasting glucose reading.) You are testing, so that is great!

As for your vet, he has some of it right. He has you using Lantus which is a great insulin. Stopping the wet food doesn't make sense to me, unless he is worried about your cat going too low (hypoglycemia) and he thinks the dry will balance that. It's better to start with a low dose and never risk a hypo. I never used Lantus, but I believe most people here recommend starting with 1 unit and holding the dose for about 5 days. But I'm sure someone with Lantus experience will be here soon to help.
 
Welcome Denise! It seems your vet has some things right--Lantus is a good insulin and The Fancy Feast that say "classic" on the label are all low carb and great for diabetics. However, cats should not be given glipizide (the pill) because it can further damage the pancreas. Purina DM dry is also too high in carbs for a diabetic cat and is likely keeping Bam's blood sugar high. You are doing the right thing by getting rid of the dry food.

How much does Bam weigh, and how much should he weigh (is he overweight or underweight?). I ask because 2u is the high end of recommended starting doses for Lantus, and usually only given to cats that are very large framed (like Maine Coons). The correct starting dose for Lantus is .25u per kg of ideal weight. For most cats, that works out to be about 1u.

One important thing to note with removing the dry food is that you need to be vigilant testing because you may need to lower the dose once you get rid of the dry food--cats can see a huge reduction in blood glucose levels once it's gone, and 2u is a higher than average dose for a cat on a low carb, canned diet.

If you want to read up more on Lantus and how it's dosed, check out the stickies in the Lantus forum: http://felinediabetes.com/FDMB/viewforum.php?f=9. With Lantus, dose adjustments are made in .25u-.5u increments based off the daily nadir (lowest number of the cycle). That means you want to try and get at least 3 tests a day--once before each shot to make sure it's safe to give insulin, and one test somewhere in the middle of the cycles to see how much the insulin is lowering his BG.

Here's a link to the Lantus dosing protocol (which contains the starting dose formula) if you need to print and give it to your vet: http://www.uq.edu.au/ccah/docs/diabetesinfo/link4.pdf. I would also strongly urge you to set up a spreadsheet to record your numbers, so you can use it to easily get dosing advice here and/or from your vet. It's a very valuable tool in understanding how the insulin needs to be adjusted. Here's instructions on how to do that: http://felinediabetes.com/FDMB/viewtopic.php?f=6&t=18207

Unfortunately, it's very rare that vets get every point right about treating feline diabetes. Vets are general practitioners and need to know a lot of different diseases and illnesses for several different animals, so it's impossible for them to stay current with everything. My vet had nearly everything right with Bandit--no dry food, home testing daily, a low carb commercial canned food, and Lantus. However, her dosing advice was off, and as I did more reading about how to properly dose Lantus, I ended up getting dosing advice here instead of from her until I was familiar enough with the protocol to make dosing adjustments on my own.

When the right dosing adjustments are made with Lantus on a low carb, canned diet, 86% of newly diagnosed cats go into remission! So there is definitely hope that you can get Bam's BG under control.
 
If you think your vet is up for some tech reading, here's a veterinary journal article by Roop and Rand
Lantus/Levemir testing & dosing protocol Roomp & Rand
 
How long do you wait after feeding to give insulin? My vet recommended waiting an hour...
Click to expand...

Hi Denise,
With shorter acting insulin, which also has a quicker onset of action, (like Humulin for instance), many people will feed and wait to shoot the insulin for 30-60 minutes to make sure there's food in the system to counteract the effect of the insulin. However, with a long-lasting insulin like Lantus, that waiting period is not really necessary. Most people give the shot right after, or even while the kitty is eating. So, no need to wait.

Carl
 
Thank you everyone for your words of wisdom.

Bam has always been a big boy...weighed in at 19lbs last week. Funniest thing is that he's the same size as my dog!! Might be why the Lantus dosage is higher than usual.

Have removed the m/d from his feedings, however will give him a kibble as a treat after testing. BG has gone down an average of 20 thus far!
 
Hi Denise, Jane (from the Lantus TR Group) here!

I'm glad you've phased out the dry food!! Well done. As for giving a kibble as a treat - maybe you could consider healthier options as treats, such a freeze-dried chicken treats (Halo's Liv-A-Littles are very popular)?

Also: Maybe you'd like to come over to the Lantus group and introduce yourself? There are two different forums which are specific to Lantus insulin (and Levemir insulin as well). The one I post in is the TR (Tight Regulation) forum, where we base our FD-treatment approach on the only dosing protocol that is based on clinical research and has been published in leading veterinary journals, called the Roomp/Rand or University of Queensland Protocol.

I'm reiterating some of the info you've already been given, just to make sure you don't miss important aspects. Over in the Lantus TR group, most of us use this protocol. If you have a bit of read around the LL (Lantus Land) forum, you'll realize that the TR approach gives cats their best chance at going into remission, and generally at keeping blood glucose numbers in a range that will prevent organ damage. You don't *have* to stick to the TR protocol, but most of us in LL do so, and that's why we focus a great deal on getting lots of data, having a carefully structured approach to BG testing, having a well-kept SPREADSHEET - please follow these instructions to set up your SS (spreadsheet) as soon as you can so that we are better equipped to help you. Also, when you can, please do set up an FDMB Profile so that we don't have to keep asking you the same questions :mrgreen: The TR protocol does require a certain commitment and it is on the time-consuming side, but many of us here work full-time and manage it all the same.

Here is a summary of the "Stickies" with vital information on Lantus and the TR protocol (from another post to another newbie):
There is a steep learning curve but we are here to help you. Important information is contained in the Stickys at the top of the Forum and are also quick linked here for you:
New to the Group-provides great, basic information ....a must read first :-D
Tight Regulation Protocol - as discussed above
Proper Handling and Storage of Lantus/Levemir - very important as we store our insulin in the frig, do not shake, roll, warm, prefill syringes, etc.
Insulin Depot - discussion on how lantus/levemir work
Dealing with Low Preshots - very important to have on hand
How to Handle Low Numbers - also very important to have on hand


We hope you'll come around to LL and introduce yourself!
Jane
 
I went to my vet armed with tons of information from this site. She admitted that she was not that familiar with FD. She recommended the Purina DM Rx food, which I politely declined. It's really expensive and the numbers aren't much better than just plain old dry cat for for weight management. She also admitted that in vet school they took a class on how to calculate carbs, fats, wet vs. dry, etc and they all came out more confused than when they went in... I would trust the information on this site and use what the vet recommends to compare and contrast. You know your cat and you see them every day. The vet doesn't... I LOVE my vet, but I *know* my cat and I flat refuse to give her dry food. I started feeding Kate the Fancy Feast classics by the list on this site and it has helped her tremendously. Granted her numbers are low, but we are battling Hypertrophic Cardiomyopia and FD at the same time. When I see something is not right, I take Kate to the vet and tell her everything. I talk about what I am willing to do... feed her low carb/ low sodium food, but not dry food. She usually makes recommendations based on that and we go from there. She does listen. I would go to your appointment with the articles and the foods, etc and show her/him the research you've done. You can probably reaxch a consensus based on both sides. If they aren't willing to listen, go to another vet that will.
 
Status
Not open for further replies.
Back
Top