So much water drinking

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susang

Member Since 2015
Our cat is on Lantus 3U, it was raised from 2U a week ago. He is still not regulating, readings still in the 500's. It all started with an attack of Pancreatitis, out of the blue.

Is it possible he is insulin resistant to this insulin or all insulins? These high readings and all the drinking and peeing is so hard to see him go through. He's drinking a cup of water overnight, OMG this is what we took him to the vet for to begin with.

How long after switching him to the 3U should they/we be considering changing doses or insulins. Of course the goal would be to get to remission but so far we cant get him regulated.

He is so weak, his back legs with less strength. He used to run and play just a month ago. How is this damaging him, the high BS? And the strength in his back legs, his internal organs? How long to allow this to go on with the high BG?

Sorry for all the questions but we need to understand what to do. Thanks!
 
Hi Susan. I know it has been a rough patch for you, but it can get better.

First, I want to be sure you understand how Lantus works. When you inject it, it forms small crystals under the skin. As these crystals dissolve, the insulin is released to do its job. There are usually some crystals left over at the time of the next shot. This causes a slight overlap between the shots. We call this overlap the shed or depot. It can take 5-7 days for this to stabilize at the first dose, and it can take 3-5 days to stabilize at later doses.

Looking back over your posts, I see that there may have been an issue with the insulin and you were going to replace the vial. Has that been done yet? If you've started a new container, it may take that 5-7 days to see how it is working. Also, we determine effectiveness by how low the glucose goes, not by the pre-shot numbers.

We have 2 different protocols for using Lantus:
Tight Regulation
Start Low, Go Slow
The one that can proceed fastest in dose adjustment is Tight Regulation. If you can consistently get home tests between shots, around +5 to +7 hours after the shot (its OK to vary the specific time, in fact it helps), after 2-3 days, following the rules of the protocol, the dose may be increased. We make our increases small - 0.25 to 0.5 units at a time - so we don't miss the best dose. Too much insulin can look like not enough insulin. Until you are up around 6 units twice a day, we do not become concerned about conditions which cause insulin resistance.

As far as changing insulins - until we know for sure that it wasn't a bad bottle of Lantus, and you're using under 6 units per shot, its too soon to tell. Unfortunately, there is no magic wand to instantaneously control the glucose and going too fast can miss the best dose. You have to hang in there as best you can.

The weakness in the hind legs could be mineral disturbances (often potassium), or it could be diabetic neuropathy, where the nerves are impaired by the excess glucose. A simple blood test at the vet can determine if it is a mineral (electrolyte) disturbance. Getting the glucose under control helps with this. Also, giving a specific form of Vitamin B-12, methylcobalamin, 3 mg (aka 3000 mcg) per day helps speed the recovery of nerve function. VitaCost makes a version which is safe for cats to use, with no added sweeteners(check the product details). And Zobaline is another version of this which may be used; it was developed specifically for cats.

 
BJM said:
Hi Susan. I know it has been a rough patch for you, but it can get better.

First, I want to be sure you understand how Lantus works. When you inject it, it forms small crystals under the skin. As these crystals dissolve, the insulin is released to do its job. There are usually some crystals left over at the time of the next shot. This causes a slight overlap between the shots. We call this overlap the shed or depot. It can take 5-7 days for this to stabilize at the first dose, and it can take 3-5 days to stabilize at later doses.

Looking back over your posts, I see that there may have been an issue with the insulin and you were going to replace the vial. Has that been done yet? If you've started a new container, it may take that 5-7 days to see how it is working. Also, we determine effectiveness by how low the glucose goes, not by the pre-shot numbers.

We have 2 different protocols for using Lantus:
Tight Regulation
Start Low, Go Slow
The one that can proceed fastest in dose adjustment is Tight Regulation. If you can consistently get home tests between shots, around +5 to +7 hours after the shot (its OK to vary the specific time, in fact it helps), after 2-3 days, following the rules of the protocol, the dose may be increased. We make our increases small - 0.25 to 0.5 units at a time - so we don't miss the best dose. Too much insulin can look like not enough insulin. Until you are up around 6 units twice a day, we do not become concerned about conditions which cause insulin resistance.

As far as changing insulins - until we know for sure that it wasn't a bad bottle of Lantus, and you're using under 6 units per shot, its too soon to tell. Unfortunately, there is no magic wand to instantaneously control the glucose and going too fast can miss the best dose. You have to hang in there as best you can.

The weakness in the hind legs could be mineral disturbances (often potassium), or it could be diabetic neuropathy, where the nerves are impaired by the excess glucose. A simple blood test at the vet can determine if it is a mineral (electrolyte) disturbance. Getting the glucose under control helps with this. Also, giving a specific form of Vitamin B-12, methylcobalamin, 3 mg (aka 3000 mcg) per day helps speed the recovery of nerve function. VitaCost makes a version which is safe for cats to use, with no added sweeteners(check the product details). And Zobaline is another version of this which may be used; it was developed specifically for cats.
Click to expand...
 
Thanks so much BJ, so much to understand and then things are changing everyday. We did change the vial yesterday, his first shot the vet said give 2U, 12 hours later go back to the 3U if he is okay which he seemed to be. But his morning he won't eat, just gave him a dose of the Mirtazapine appetite stimulant they gave us to have on hand. His morning dose should be in a half hour from now. Do you know how long this will take to give him an appetite??
 
Some of those things improve appetite with 20-30 minutes; others take longer. And it may vary with the cat.
Did you shoot?
 
Thanks so much for your reply BJ! Yes. The appetite stimulant kicked in after about a half hour. We gave him the 3 units after he ate the meal. It was about 45 minutes late though.

Do you know how we can go back to the normal schedule now for his next shot? Do we just go back to the usual time schedule of have to get back to it incrimentally?

His normal times are at 11am and 11pm but this mornings shot had to wait until 11:45am.
 
...oh also...besides my last message i also wanted to see what you know about pancreatits. the vet doesn't seem to have much to say but that the body has to heal itself and i remember the emergency vet said that last month too, when it was diagnosed. also, anything else to do nutrition-wise since he is losing protein in his urine? would like to see him bounce back soon, this is so hard.
 
With Lantus, it is really important to stick with the same dose a good 3-5 days before determining if it is a good dose, due to the depot overlap effects. If the previous vial were bad, you may start seeing unusually low numbers near the nadir with the new vial, around +5 to +7 hours after the shot. This becomes more likely as each 12 hour cycle passes, so be on the alert during that period. If he really does need the 3 units per shot, he may be fine; I just want you to be aware of the possibility, so he stays safe. Hypoglycemia/too low glucose kills very quickly, while hyperglycemia/too high glucose takes longer to have adverse effects.

For changing shot times, you can do 15 minutes per shot or 30 minutes once a day. You'll find with experience which works better for your cat; some are very sensitive to time changes while others are very resilient.

Pancreatitis is a nasty issue; the appetite problems and pain from it can really do a number on your kitty. We have a pancreatitis primer. There are a number of things that can be helpful - pain management, nausea treatment, and stimulating the appetite can be key, as well as B-12 injections in the form of cyanocobalamin.
 
I don't understand what you mean about how to change shot times. We had been giving the shot as close to 11AM and 11PM as possible. But we were 45 minutes late last night and this morning (11:45). So how to get back to 11AM and 11PM again. I will look at the pancreatitis primer!
 
Just to be sure I have this correct, sorry if I still might be confused:
TONIGHT 30 minutes earlier = 11:15PM

TOMORROW morning 15 minutes earlier = 11:30AM
TOMORROW NIGHT 15 minutes earlier= 11PM (which is back to his original time)

The next day morning 15 minutes earlier = 11:15AM
That day night I'm already back to schedule

The next day morning 15 minutes earlier = 11:00AM (which is now also back to his original time
 
You only need to shift by 45 minutes.
So do tonight 30 minutes earlier.
And tomorrow morning 15 minutes earlier.
And then you are back on schedule.
 
I am so overwhelmed and scared. I don't have a home testing kit at this time, haven't been told to use one by the vet although I see the importance in having one now. He is not doing well today (he has no energy and only ate because we gave the appetite stimulant, should have gone in but the vet never called back) and I have no idea if it's the return of the pancreatitis that is causing him pain, he is still drinking a lot of water but I have no idea what his BG is since we changed the vial out yesterday morning. The vet doubted it was a bad vial but said yesterday to give him 2U in the morning dose and 3 last night. After your cautions I wonder if she is just going on some instinct or what? I am/feel so ill equipped to handle this with so many variables.
 
You can do this. Many of us have felt this stressed starting out. Take it one step at a time, and exhale, then slowly inhale, and repeat a few times. It'll help you feel more calm and in control.

A lot of water drinking is consistent with poor glucose control. It can take a while to get to the optimal dose of insulin, so patience is key. In my signature link Secondary Monitoring Tools are some of the more qualitative signs of how your cat is doing.

It may turn out he does need a higher dose of insulin; by following the insulin protocol for dose adjustments, these can be made safely using home testing.
 
Hi Susan! Welcome to the last place you really want to be-- but the best place for you and your kitty. May I suggest that you start a new thread in the Feline Health/ Main Forum? (Just go to the top of the page and click on "forums"). This forum is mostly just to introduce yourself, but for the feedback, questions and support you deserve, you should pop over to the Main Forum where there will be a lot more eyes on your posts.
You can do this! We will help you.
 
Thank you so much Karen, I haven't been able to figure out how this forum works with all else that's been going on. I'll move this over to the Feline Health/ Main Forum area!
 
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