Newly Diagnosed

Status
Not open for further replies.
L

Laurie and Phoebe

New Member
Phoebe was diagnosed on February 1, after weight loss, increased thirst and urination. My vet and I believe her diabetes was caused by being on prednisolone for over 1 year, as a treatment for GI lymphoma (diagnosed via intestinal biopsy). We now believe the pathologist may have misdiagnosed her, and I feel terrible that the long term steroid use probably precipitated this diabetes. Phoebe is a bit over 15 years old, a beautiful girl with dilute tortie markings on her body and gray tabby face, legs, and tail. We have switched from free feeding dry Purina Pro Plan Indoor to canned Purina DM. She is eating between 1 to 1.5 cans of this per day, in 1/4 can increments.

I have diabetes myself, so luckily have Lantus, One Touch Ultra meter and all supplies on hand. My vet has given me the following protocol to follow, and I was wondering if anyone has ever heard of the following:

Begin with 1 unit of insulin BID - checking pre-insulin blood levels.
On day 4 and thereafter, if blood glucose levels are > 360, increase insulin dosage by .5 units (to a maximum 6 units).
If blood glucose levels are between 180 and 360, keep dosage the same.
If blood glucose levels are < 180, decrease by .5 units until reaching .5 units BID.
If levels are consistently below 180 drop to .5 units once daily.

So I am basically having to adjust the dosage with each injection. No problem for me, just wondering if this is something unusual. My vet told me that this protocol offers a great chance for an early remission...we'll see. I have found so far that 3.5 to 4 units seems to be doing the best job of keeping glucose levels in the 120 to low 200's range, pre shot.

This site is absolutely an amazing resource. We look forward to getting to know everyone.
 
Hi Laurie

Wow, you are way ahead of the game! But sorry that you have to come here at all :(

I do not agree though with your vet's protocol. Lantus is not dosed on a sliding scale like the one you've listed...PZI can be but not lantus (as far as I know). There are some very good lantus protocols and information 'stickies' over at the lantus insulin support group viewforum.php?f=9 and I'd suggest reading more over there. keep posting here though for any and all diabetes related questions

Jen
 
Hi Laurie,
May I suggest that you look at some of the spreadsheets (at the bottom of people's messages) in the Lantus insulin support group? You will see the ISGs in the Board Index. Since you are testing and familiar with insulin yourself, I think that you will quickly see how Lantus is used a cat. Lantus is usually given in the same dose 12 hours apart, and adjusted slowly (ie after minimum 4 shots). I don't use Lantus, but do use Levemir (recenelty switched). You can see the pattern in Tony's ss, although may not be exactly as Lantus would work.
 
Hi Laurie, and welcome to FDMB!

Generally speaking, we keep a dose steady for several days and make any adjustment based on Nadir -- rather than preshot blood sugar levels. The "sticky" posts at the top of the Lantus Insulin Support Group are very helpful.

Have you done a curve on Phoebe yet?

Also, there are less expensive foods (non-prescription) that work fine for diabetic cats. http://www.catinfo.org is an excellent resource for Feline Nutrition written by a veterinarian - Dr. Lisa Pierson. We feed canned or raw foods containing less than 10% carbohydrates. Since the cans don't list carbohydrate content - you can either check Janet & Binky's Food Charts (google it) which have been compiled over several years. Or choose cat food that is grain free and does not have gravy (usually thickened by wheat or rice or corn).

I feed all my cats Wellness canned food - Chicken and Turkey flavors (one of my cats has allergies, so we avoid fish and beef).
 
You need to keep the dose consistant for at least one week before making any changes in dosage. Also, only change by 1/2 unit and keep at the new dose for at least a week before changing again. Glucose readings can change from shot to shot and the dose should not be changed based on a single reading. Also some insulins such as Lantus, build up a "shed" or reserve in the system and changing doses that often can cause the insulin not to work properly.


It is also possible that because of the frequent increases, you have missed your optimal dose. 6 units is a very high dose for most cats and even 3.5 to 4 units is still high. Most cats only need between 1-2 units twice a day. When too much insulin is given, a condition can develop called Somogyi rebound. When this happens, the body is creating extra glucose to prevent itself from becoming hypoglycemic when too much insulin is give. So your BG readings are much higher than what they should be. By reducing the dose and slowly increasing over a matter of weeks, you will be able to find your optimal dose.

Have you run your own curve on Phoebe? That is the best way to determine how well a dose is working.
 
Laurie,

Welcome to the board. I share your human diabetes and used Lantus for 5 years. It is still my backup for the pump.

Lantus in cats is dosed on the nadir BG, not the pre-shot. With a pre-shot of 120, the nadir could be very low even with a preshot dose of .5 of Lantus.

Cat metabolism is faster than ours. And, Lantus in cats works best when the dose is stable. So, we start low and go slow. When I get a new cat to start on Lantus, I start at .5 or 1unit twice a day and leave them there for 5 to 7 days. I test preshot and mid cycle as often as I can. On weekends I test 4 to 5 times during the day. When I increase or decrease the dose, I do it in 1/4 unit increments.

My track record is that about half my fosters have gone off insulin (OTJ).

By the way, hope you have a separate meter for your cat. Your own doc won't know what to do with the extra reading in the memory :lol:

Good luck,

Claudia
 
It seems like your vet got some of it right. He put you on a good insulin and a good starting dose of one unit BID. This is where I believe he got the difference between a base and bolus insulin mixed up. Long acting base insulins like Lantus and Levemir are designed for long-term control of glucose and are not used on a daily sliding scale wether it is a human or a cat. The PDR recommendations for humans using Lantus is similiar to the protocal for cats except it is dosed once a day. There is an accumulative effect in humans also via the subcutaneous depot. In human diabetes management, the. Initial dose of the base insulin should also be held for at least three to five days before the dosage is changed. Many MDs will also do curves on humans to establish the nadir for base insulin use.

The sliding scale is used for the short-acting or intermediate bolus insulin. While a dual insulin system is regularly used in humans, I have only seen it used a few times in cats.

Cats do metabolize insulin more rapidly than humans or dogs, but there are always individual variations. This is why doing curves and carefully monitering BG is so important. I have a human patient on lantus that gets it twice a day. She rapidly metabolizes all the base insulins the facility tried. When I told her she was more like a cat she laughed because she says she loves cats. There may also be the exception to the rule cat that has sixteen or even twenty hour cycles on Lantus.
 
The starting dose and guidelines for increasing/decreasing look good, but the dose shouldn't be changed more than once every 3-4 days. So for example: if the numbers are a little high, increase the dose by .5 units and stay at that dose consistently for 3-4 days. Then if the numbers are still not where you would like them to be, adjust the dose accordingly, and give it another 3-4 days.
 
Status
Not open for further replies.
Back
Top