Not eating enough, so skipped insulin dose, now lethargic

[Emily S.]

New Member here!
Seeking any experience or guidance. Here is some background:
11 yr old, male diabetic cat, named Merrick. He was diagnosed in November 2023 and was poorly regulated and cared for by our former vet until march 2024, when we changed vets. Merrick started on Prozinc 2x a day at varying doses until we met the new vet. He switched to Lantus 2x a day (while wearing a freestyle libre) and eventually decreased from 2x a day to 1x a day (current dose is 2.5 units per day, at PM feeding).
He started 5 mg of transdermal Prozac about 5-6 weeks ago for his anxiety and aggression towards our other cats and changed to the oral tablet about a week ago due to skin irritation. Things were humming along nicely and his behavioral issues were greatly improved. Between 1-1.5 weeks ago, he started leaving 5-15 kibbles in his bowl but only at dinner. He is on Hills Science Glycobalnce wet and dry formula and has never had an issue with appetite or finishing his meals until recently. Most of the time if I sit with him he eats a few more kibbles and then he gets his insulin (2.5 units at night only).
Tonight was much different. I prepped his meal and placed his Prozac on the top of his wet food and placed his bowl down. He went right to it and started eating. I came back about 10-15 minutes later and he was laying on the washer with at least half of his food still there, likely more than half, and the Prozac pill was still there. I scooped out the dissolving pill and some wet food and tossed it. I added another scoop of wet food and opted to give him his Prozac in a pill pouch, which he ate. I sat with him another 15 minutes as he ate some more, he ate slowly and seemed to mostly want the wet food. He finally tapped out and still had about 30-35 kibbles left.
In the midst of all this, I called my vet and the tech advised to hold the insulin tonight if he didn’t finish his meal and advised if he eats breakfast to then give insulin and if he doesn’t eat all breakfast or vomits between now and then to bring him in. After hanging up, I realized I had another question and called back to ask: if he eats breakfast and I give insulin in the AM, would I move his 1x a day insulin dose from PM to AM moving forward? They then said they didn’t realize he was only on 1x a day and if he eats breakfast don’t give insulin until the PM meal tomorrow. Now I’m doubting everything they’ve said…
Merrick has been through the ringer since November and I am worried I won’t know if/when to bring him to the emergency vet since I don’t think my vet tech is advising appropriately. We have spent thousands on ER vet visits, a very expensive “specialist”, 3 freestyle libres, lots of insulin and my monthly chewy bill is getting to be a lot.
I trust me vet, I think? But I’m concerned about receiving medical advice from anyone who isn’t checking his chart first… anyone out there have any guidance? I’m not too sure what I’m even asking at this point. Feeling defeated and sad for my boy. He is lethargic and sleepy right now. I plan to watch his trips to the litter box to ensure he’s urinating.
Thank you in advance for anything and wishing everyone out there and their babies the best.
Emily

 

[Bron and Sheba (GA)]

Hi and welcome to the forum Emily and Merrick,
I think you have been getting some bad advice from your vet.
Lantus is a twice a day insulin not a once a day insulin…but more about that later. We can help you a lot but first we need to deal with the current situation.
I am concerned at the moment about Merrick.
What does his breath smell like?
What are the blood glucose readings at the moment?
What is his current insulin dose?
Do you have any Ketostix at home to test the urine for ketones?
If you do please test Merricks urine at the first availability. I am concerned with his loss of appetite, and getting less insulin than he needs, that he could be forming ketones in his urine which would need to be dealt with immediately. Ketones can rapidly form and increase and become dangerous. I do not want to alarm you but to inform you.

IF you do not have any Ketostix to test the urine….and I am assuming it is night time where you live…I am thinking it might be best to take him to the ER and get them to check his ketones. I know it is expensive but it could save a lot more money if he does have ketones and they are not treated immediately.

 

[CORKY]

New Member here!
Seeking any experience or guidance. Here is some background:
11 yr old, male diabetic cat, named Merrick. He was diagnosed in November 2023 and was poorly regulated and cared for by our former vet until march 2024, when we changed vets. Merrick started on Prozinc 2x a day at varying doses until we met the new vet. He switched to Lantus 2x a day (while wearing a freestyle libre) and eventually decreased from 2x a day to 1x a day (current dose is 2.5 units per day, at PM feeding).
He started 5 mg of transdermal Prozac about 5-6 weeks ago for his anxiety and aggression towards our other cats and changed to the oral tablet about a week ago due to skin irritation. Things were humming along nicely and his behavioral issues were greatly improved. Between 1-1.5 weeks ago, he started leaving 5-15 kibbles in his bowl but only at dinner. He is on Hills Science Glycobalnce wet and dry formula and has never had an issue with appetite or finishing his meals until recently. Most of the time if I sit with him he eats a few more kibbles and then he gets his insulin (2.5 units at night only).
Tonight was much different. I prepped his meal and placed his Prozac on the top of his wet food and placed his bowl down. He went right to it and started eating. I came back about 10-15 minutes later and he was laying on the washer with at least half of his food still there, likely more than half, and the Prozac pill was still there. I scooped out the dissolving pill and some wet food and tossed it. I added another scoop of wet food and opted to give him his Prozac in a pill pouch, which he ate. I sat with him another 15 minutes as he ate some more, he ate slowly and seemed to mostly want the wet food. He finally tapped out and still had about 30-35 kibbles left.
In the midst of all this, I called my vet and the tech advised to hold the insulin tonight if he didn’t finish his meal and advised if he eats breakfast to then give insulin and if he doesn’t eat all breakfast or vomits between now and then to bring him in. After hanging up, I realized I had another question and called back to ask: if he eats breakfast and I give insulin in the AM, would I move his 1x a day insulin dose from PM to AM moving forward? They then said they didn’t realize he was only on 1x a day and if he eats breakfast don’t give insulin until the PM meal tomorrow. Now I’m doubting everything they’ve said…
Merrick has been through the ringer since November and I am worried I won’t know if/when to bring him to the emergency vet since I don’t think my vet tech is advising appropriately. We have spent thousands on ER vet visits, a very expensive “specialist”, 3 freestyle libres, lots of insulin and my monthly chewy bill is getting to be a lot.
I trust me vet, I think? But I’m concerned about receiving medical advice from anyone who isn’t checking his chart first… anyone out there have any guidance? I’m not too sure what I’m even asking at this point. Feeling defeated and sad for my boy. He is lethargic and sleepy right now. I plan to watch his trips to the litter box to ensure he’s urinating.
Thank you in advance for anything and wishing everyone out there and their babies the best.
Emily

Hi Emely
For now
Here is a link helping us to help you link. If you noticed, our members have some basic information about their cat's in their signature. This helps us to not pester you by asking the same questions (your cat's name, insulin type, date of diagnosis, etc.) repeatedly. We also have a link to our spreadsheet in our signature. We are very numbers driven. The spreadsheet is a record of your cat's progress. By linking it in your signature, we can follow along and provide feedback should you need the help

If you need help setting up our spreadsheet just ask.
The link in blue will also tell you how to set it up and explains how to use it, it's very easy.
You can take a look at anyone's spreadsheet

Do you see my signature about Corky's Spreadsheet below in gray letters?
Hi
For now
Here is a link helping us to help you link. If you noticed, our members have some basic information about their cat's in their signature. This helps us to not pester you by asking the same questions (your cat's name, insulin type, date of diagnosis, etc.) repeatedly. We also have a link to our spreadsheet in our signature. We are very numbers driven. The spreadsheet is a record of your cat's progress. By linking it in your signature, we can follow along and provide feedback should you need the help
If you need help setting up our spreadsheet just ask.
The link in blue will also tell you how to set it up and explains how to use it, it's very easy.
You can take a look at anyone's spreadsheet
Do you see my signature about Tyler below in gray letters?
ProZinc is an insulin with a 12 hour range, is important you cat eats before dosing, our recommendation is always have a feeding schedule, and most important Testing before dosing, most of us in this Forum test and monitor our cats Glucose with a home monitor, example, ReliOn Premier monitor and strips, Walmart is the least expensive, and very effective, Libre 2 Sensores/monitor tend to give an incorrect reading especially on low BG's, and the sensors they stop working before the 14 days or the cat tends to remove it, home testing is important to know what to feed and when to dose, and what food to feed, for appetite there is an ointment called MIRATZ, placed every day in the inner ear fold every day switching ears daily it works wonders, right away below you'll have some links about food, low carbs is very important 0-9%, and wet food there's a Drs. Food chart as well, if you read all this and you inform the Forum all there is to know about your cat, there are amazing experts that will take your baby to the journey of better health with diabeteshttps://www.felinediabetes.com/FDMB/threads/dry-food-please-consider-
more-than-just-carbohydrate-content.175004/https://www.felinediabetes.com/FDMB/forums/spreadsheets-tech-support-testing-area.6/

I personally trust this Forum and expert members more than I do Vets, you're in the right place, and welcome

 

[Emily S.]

Hi and welcome to the forum Emily and Merrick,
I think you have been getting some bad advice from your vet.
Lantus is a twice a day insulin not a once a day insulin…but more about that later. We can help you a lot but first we need to deal with the current situation.
I am concerned at the moment about Merrick.
What does his breath smell like?
What are the blood glucose readings at the moment?
What is his current insulin dose?
Do you have any Ketostix at home to test the urine for ketones?
If you do please test Merricks urine at the first availability. I am concerned with his loss of appetite, and getting less insulin than he needs, that he could be forming ketones in his urine which would need to be dealt with immediately. Ketones can rapidly form and increase and become dangerous. I do not want to alarm you but to inform you.

IF you do not have any Ketostix to test the urine….and I am assuming it is night time where you live…I am thinking it might be best to take him to the ER and get them to check his ketones. I know it is expensive but it could save a lot more money if he does have ketones and they are not treated immediately.

I hope I am replying right. Thank you for responding! I just checked his glucose with my meter and it is 131 mg/dl, which is actually good for him. He was 600-700 early on often.
His breath smells fishy and is likely because he is due for a dental cleaning. He seems to have perked up a good bit. He has been watching the birds on the feeder out the window and is now alert and rubbing up on me as I type this.
I do not have anything to test his urine, however, this is also a big concern of mine. He had his first (and so far only) UTI 7 years ago. Not sure what else is important to notate except that I usually keep an eye out in the litter box to make sure he is going and isn’t struggling while trying to. Unfortunately, I am pregnant and my wife has been keeping up with the litter boxes (we also have 2 other cats), so I have not been able to monitor as well. He is now up walking around looking for food (in the kitchen and passed by his spot where I feed him).

 

[Emily S.]

Hi Emely
For now
Here is a link helping us to help you link. If you noticed, our members have some basic information about their cat's in their signature. This helps us to not pester you by asking the same questions (your cat's name, insulin type, date of diagnosis, etc.) repeatedly. We also have a link to our spreadsheet in our signature. We are very numbers driven. The spreadsheet is a record of your cat's progress. By linking it in your signature, we can follow along and provide feedback should you need the help

If you need help setting up our spreadsheet just ask.
The link in blue will also tell you how to set it up and explains how to use it, it's very easy.
You can take a look at anyone's spreadsheet

Do you see my signature about Corky's Spreadsheet below in gray letters?
Hi
For now
Here is a link helping us to help you link. If you noticed, our members have some basic information about their cat's in their signature. This helps us to not pester you by asking the same questions (your cat's name, insulin type, date of diagnosis, etc.) repeatedly. We also have a link to our spreadsheet in our signature. We are very numbers driven. The spreadsheet is a record of your cat's progress. By linking it in your signature, we can follow along and provide feedback should you need the help
If you need help setting up our spreadsheet just ask.
The link in blue will also tell you how to set it up and explains how to use it, it's very easy.
You can take a look at anyone's spreadsheet
Do you see my signature about Tyler below in gray letters?
ProZinc is an insulin with a 12 hour range, is important you cat eats before dosing, our recommendation is always have a feeding schedule, and most important Testing before dosing, most of us in this Forum test and monitor our cats Glucose with a home monitor, example, ReliOn Premier monitor and strips, Walmart is the least expensive, and very effective, Libre 2 Sensores/monitor tend to give an incorrect reading especially on low BG's, and the sensors they stop working before the 14 days or the cat tends to remove it, home testing is important to know what to feed and when to dose, and what food to feed, for appetite there is an ointment called MIRATZ, placed every day in the inner ear fold every day switching ears daily it works wonders, right away below you'll have some links about food, low carbs is very important 0-9%, and wet food there's a Drs. Food chart as well, if you read all this and you inform the Forum all there is to know about your cat, there are amazing experts that will take your baby to the journey of better health with diabeteshttps://www.felinediabetes.com/FDMB/threads/dry-food-please-consider-
more-than-just-carbohydrate-content.175004/https://www.felinediabetes.com/FDMB/forums/spreadsheets-tech-support-testing-area.6/

I personally trust this Forum and expert members more than I do Vets, you're in the right place, and welcome

Hi,
Thank you for the reply. I was reviewing that signature link earlier trying to understand the acronyms, which confused me. Let me review it again and see if I can figure it out. Yes, I can see your spreadsheet link, cool! I checked it out, but it looks like nothing I’ve seen before. Let me work on this signature.

 

[CORKY]

I hope I am replying right. Thank you for responding! I just checked his glucose with my meter and it is 131 mg/dl, which is actually good for him. He was 600-700 early on often.
His breath smells fishy and is likely because he is due for a dental cleaning. He seems to have perked up a good bit. He has been watching the birds on the feeder out the window and is now alert and rubbing up on me as I type this.
I do not have anything to test his urine, however, this is also a big concern of mine. He had his first (and so far only) UTI 7 years ago. Not sure what else is important to notate except that I usually keep an eye out in the litter box to make sure he is going and isn’t struggling while trying to. Unfortunately, I am pregnant and my wife has been keeping up with the litter boxes (we also have 2 other cats), so I have not been able to monitor as well. He is now up walking around looking for food (in the kitchen and passed by his spot where I feed him).

One litter that is very good to observe urine complications is Pretty Litter a bit expensive but very effective you can purchase Ketone strips as well and home test the urine when he pees, try to fill out all the information about your fur ban so the expert can help you with dosing, schedules and any concerns you may have

 

[CORKY]

Hi,
Thank you for the reply. I was reviewing that signature link earlier trying to understand the acronyms, which confused me. Let me review it again and see if I can figure it out. Yes, I can see your spreadsheet link, cool! I checked it out, but it looks like nothing I’ve seen before. Let me work on this signature.

I will tag several of the expert so they can help you start up
@Sienne &Gabby (GA)
Suzanne & Darcy

 

[Bron and Sheba (GA)]

I hope I am replying right. Thank you for responding! I just checked his glucose with my meter and it is 131 mg/dl, which is actually good for him. He was 600-700 early on often.
His breath smells fishy and is likely because he is due for a dental cleaning. He seems to have perked up a good bit. He has been watching the birds on the feeder out the window and is now alert and rubbing up on me as I type this.
I do not have anything to test his urine, however, this is also a big concern of mine. He had his first (and so far only) UTI 7 years ago. Not sure what else is important to notate except that I usually keep an eye out in the litter box to make sure he is going and isn’t struggling while trying to. Unfortunately, I am pregnant and my wife has been keeping up with the litter boxes (we also have 2 other cats), so I have not been able to monitor as well. He is now up walking around looking for food (in the kitchen and passed by his spot where I feed him).

That is good he is feeling better.
And I am surprised his BG is only 131. What type of meter are you using? Is it the freestyle libre?
I would continue to offer him food. We want him to eat.
And in the morning can you go to a pharmacy or Walmart and buy a bottle of Ketostix (or equivalent if it’s from Walmart) please?
If you can test the urine and let us know what it says, that would be great thanks.

If you would like to set up a spreadsheet and signature as suggested by Corky above, we can help you with dosing and anything else to do with diabetes/cats.
Also there is no need to be feeding the prescription food. Any low carb foods are fine. And the Hills dry is 18% carbs so is high carb and not suitable for diabetic cats. However at the moment, let Merrick eat whatever he will eat as that is more important than what he eats.
Keep asking questions. I can see we can help you a lot.
Bron

 

[Bron and Sheba (GA)]

And in the morning if the BG is high enough I would give him his dose of insulin.
Can you let us know what dose you are giving him at the moment please? and if you can give us some BG data for the last few days, we can work out a suitable dose.

 

[Emily S.]

I think he may be having a medical issue, as he just attacked our older female cat and pinned her to the ground while biting her until I broke them up. He was doing this before we got him regulated on his insulin.
He is currently on 2.5 units of lantus 1x/day at dinner (it is 7:50pm central where I am). I have not been taking at home readings since he has been off the freestyle libre. Our current vet advised they can be unreliable, mostly for the glucose curves, if I am not getting readings around the clock.
I will offer him some wet food now. Can you please advise a good range for BG? I have been told different ranges and don’t know what to trust anymore.
Thank you.

 

[Bron and Sheba (GA)]

it is 7:50pm central where I am). I

Would there is any pharmacies or Walmart open tonight where you could get some Ketostix?
I live in Australia so I don’t understand central time. Because members live all over the world we use +1 +3 +6 etc which means it is 1,3, 6 hours after the dose of insulin.?.does that make sense?

I see you have the signature up…thank you!

Can you please advise a good range for BG? I have been told different ranges and don’t know what to trust anymore.

As you are using an alphatrak meter the normal range for a cat is approx 68-150
If you were using a human meter it would be 50-120

have not been taking at home readings since he has been off the freestyle libre. Our current vet advised they can be unreliable, mostly for the glucose curves, if I am not getting readings around the clock.

I completely disagree with your vet. Taking BG readings at home with a meter is the safest and most reliable way to keep Merrick safe and to see what is happening with the blood glucose (BG). Not testing is to just blindly give the insulin and hope for the best.
We encourage all our members to hometest and set up a spreadsheet. This way we can help them with dosing.
I can’t tell you the number of cats we have seen arrive here unregulated or with very low or high BGs because their vet said not to test.
We recommend you test before every insulin dose to see it is safe to give the insulin.
So the routine for Lantus is to test, feed and then give the insulin. If the BG is not high enough we suggest stalling, don’t feed and test again in 30 minutes to see if the BG is rising. And post and ask for help.
We also recommend testing at least once during all the cycles so see how low the dose is taking Merrick as Lantus dosing is based on the nadir or lowest point in the cycle.

He is currently on 2.5 units of lantus 1x/day at dinner

You would be better to divide the dose and give it twice a day as Lantus only lasts for approximately 12 hours in a cat.
Depending on what the result of a ketone urine test was, how he was eating and what the preshot BG was in the moving…I would suggest trying 1 unit Lantus twice a day and see how that goes, as long as you can monitor him during the cycle.
I would post and ask for help. How many hours til the next dose is due?
Because you have skipped a dose, if you wanted to bring the schedule forward at all, now is a good time to do it.
I will be around for the next 12 hours.

 

[Emily S.]

That is good he is feeling better.
And I am surprised his BG is only 131. What type of meter are you using? Is it the freestyle libre?
I would continue to offer him food. We want him to eat.
And in the morning can you go to a pharmacy or Walmart and buy a bottle of Ketostix (or equivalent if it’s from Walmart) please?
If you can test the urine and let us know what it says, that would be great thanks.

If you would like to set up a spreadsheet and signature as suggested by Corky above, we can help you with dosing and anything else to do with diabetes/cats.
Also there is no need to be feeding the prescription food. Any low carb foods are fine. And the Hills dry is 18% carbs so is high carb and not suitable for diabetic cats. However at the moment, let Merrick eat whatever he will eat as that is more important than what he eats.
Keep asking questions. I can see we can help you a lot.
Bron

I did a test using the test solution and it was not in the range listed. I then noticed that the LOT number on my testing solution and my test strips are not the same. This is my second test strip vial and I do not recall getting the insert with it to make sure my readings are accurate. My test strip with the solution said 150 and then the second one said 142. The range on the vial is 104-140, so my readings are incorrect.

 

[Bron and Sheba (GA)]

I did a test using the test solution and it was not in the range listed. I then noticed that the LOT number on my testing solution and my test strips are not the same. This is my second test strip vial and I do not recall getting the insert with it to make sure my readings are accurate. My test strip with the solution said 150 and then the second one said 142. The range on the vial is 104-140, so my readings are incorrect.

A result of 150 or 142 is basically the same when you take in meter variance which can be up to 20%.
I have never used an alphatrak meter so I can’t help you with the solution problem.

I would recommend when you go to Walmart to get the Ketostix, you pick up a ReliOn premier human meter as they are much cheaper to run than the alphatrak…you will also need some test strips as well to go with it. Most of us use human meters and all our dosing methods are based on the human meter readings.