Starting dose considering several factors

[Julie and Honey]

Was delaying starting insulin due to seeing about dental before starting. Having some issues with my vet and someone at the vets office giving me conflicting info.

Last week vet said her numbers have come down since food change and she would be okay doing dental if her weight has come up. I weighed her Saturday and have managed to get her weight up a quarter pound in the last 3 weeks (very difficult with no Carbs). So, I am thinking vet will likely do dental,or want her to gain a little more.

Today vet tech called and said vet wants her to remain stable for another month, ie, gain or maintain weight and same BG levels as I have had for last several weeks before she will do dental. Tech also said that I would rather not start insulin. Never said anything of the sort to vet last week. Only the subject of possibly delaying insulin to do dental and then start insulin after to avoid any complications dealing with a cat on insulin going under anesthesia. Which vet agreed with! I told tech this is not what the vet and I discussed last week. This is also the tech that told me to roll Lantus, put insulin in syringe back in vial, not to inject air in vial (we are only talking vials here), lots of verifiable wrong info, so I do not trust anything this person is saying now. After getting off the phone with this person I was very upset and I am feeling I have to go somewhere else now. I like my vet and she is fine with home testing and she actually wanted a very low starting dose. Either the tech was giving her opinion or the vet told me something completely different and told the tech to tell me something else. Either way I am not comfortable.

I am afraid if I start cat on insulin then I will be afraid to do her dental if she is on insulin, but catch 22 is her mouth is possibly increasing her BG and if dental was done, she may not even need insulin. She is FIV and they are notorious for bad teeth, so don’t want to wait on dental too long, she ended up having several teeth pulled last time.

If I do start insulin I wanted to double check dosing here. I would rather be as conservative as possible on dose.

Her untreated fasting glucose is consistently about 230 (on AT meter) and highest is about 285, she is not terribly high now without any insulin (also has come down 100+ points with food change). She is only 7 lbs.

Was originally planning on starting at .5 BID since she is on low carb, but I am also concerned about dose in regard to her low weight as well as her untreated BG is not terribly high to start with.

Taking into account low carb diet, low weight of cat and starting BG well under 400 (which at that level they recommend lower starting dose), is .5 BID still the place to start or would .25 BID at least for first week be safer?

I will attempt to test 3 times a day, AMPS, +6, PMPS, but there is a chance I will not always be able to get a test. That is why I would feel safer using the least amount possible until I am sure I can consistently test her.

Thanks.

 

[Wendy&Neko]

Neko had anethesia about 9 times while on insulin. It's not that big a deal. Normally you reduce the dose the morning of the anesthesia. I think it's better to get started on insulin now. The sooner you can give her little pancreas a break by giving insulin, the higher the chances of remission, if that is a goal for you.

Is there any chance you can get a before bed test at night, even a +3. Many cats go lower at night, and since we determine dose based on how low the dose takes the cat, those night time tests are important. And feed free to mix up that +6 test, not all cats nadir exactly at +6. Somewhere in the +4 to +7 time frame is good to start.

Our Start Low Go Slow doing method, if that is what you want to follow, would have you start at 0.5 units. Tight Regulation would have a starting dose of 0.75 units for a cat her size. Since Lantus is a depot insulin, it can take several days to build the depot and see what a dose can really do.

Have you started putting together a spreadsheet yet? It would be interesting if you could get a few random tests at home without insulin.

 

[Bobbie And Bubba]

Hey there and Welcome. How frustrating that you got such conflicting info from the vet and tech.

I agree with Wendy that the anesthesia is not a big deal while kitties are on insulin. The usual is to do 1/2 the normal dose the morning of.

If she has a bad tooth or even just lots of redness and inflammation in her mouth, her numbers are not going to get stable without removing the bad tooth and/or cleaning the plaque and tartar off the teeth. So, the sooner the dental the better.

I would probably want to call and talk to the vet and get it from her mouth instead of what the vet tech is saying. Everyone needs to be on the same page for sure.

 

[Julie and Honey]

Neko had anethesia about 9 times while on insulin. It's not that big a deal. Normally you reduce the dose the morning of the anesthesia. I think it's better to get started on insulin now. The sooner you can give her little pancreas a break by giving insulin, the higher the chances of remission, if that is a goal for you.

Is there any chance you can get a before bed test at night, even a +3. Many cats go lower at night, and since we determine dose based on how low the dose takes the cat, those night time tests are important. And feed free to mix up that +6 test, not all cats nadir exactly at +6. Somewhere in the +4 to +7 time frame is good to start.

Our Start Low Go Slow doing method, if that is what you want to follow, would have you start at 0.5 units. Tight Regulation would have a starting dose of 0.75 units for a cat her size. Since Lantus is a depot insulin, it can take several days to build the depot and see what a dose can really do.

Have you started putting together a spreadsheet yet? It would be interesting if you could get a few random tests at home without insulin.

Thanks. Those numbers are without insulin. I’ve done 6 tests over last 2 weeks since moving to all wet low carb and BG range is consistently +/- 5 points of 230 after 5-6 hours no food (early am, before 1st meal of day) and +/- 5 points of 285 (mid day/afternoon) but mid day/afternoon number is also after eating during the day every 2-3 hours small meals all day long. I am now creeping quietly around the house during day not to wake her every time I walk in the room to see if I can not wake her up to get her to go say 4 hours during day without eating. Every time she wakes up she is back by her dish, some times after an hour. She is eating 7-8 times per day.

 

[Julie and Honey]

Hey there and Welcome. How frustrating that you got such conflicting info from the vet and tech.

I agree with Wendy that the anesthesia is not a big deal while kitties are on insulin. The usual is to do 1/2 the normal dose the morning of.

If she has a bad tooth or even just lots of redness and inflammation in her mouth, her numbers are not going to get stable without removing the bad tooth and/or cleaning the plaque and tartar off the teeth. So, the sooner the dental the better.

I would probably want to call and talk to the vet and get it from her mouth instead of what the vet tech is saying. Everyone needs to be on the same page for sure.

Thanks. Just thought it would be easier to do dental first because it will likely drop her numbers under 200 and at that point may not even need insulin. I have already spent over $500 on blood work, meter, strips. I was laid off and really can’t afford dental, but if that could get her in better numbers without insulin, would rather do that first rather than buy insulin I may end up throwing out after dental. If I can get a little more weight on her in the next couple of weeks and numbers stay in mid 200s avg, where they have been since diet change, I think vet will do dental. Hate to look for a new vet right now.

 

[majandra]

One potential problem is that she may not gain weight if her glucose isn't under control. It is not the lack of carbs really that is making it hard to gain. Less carbs in her system will allow her to utilize her nutrients better. It is also possible that she will have better values after her dental, and be able to eat better.

Why are you trying not to wake her?

With my girl, her dental was only a week or so from when we decided her levels wouldn't come down with food change alone, so I opted to wait until her antibiotics were done before starting insulin, in case she wouldn't need it at all. She did end up needing it. I started at 0.5U, and ended up decreasing after the first dose.
If you can monitor her the first couple doses, regardless of when dental is, that would be optimal. There are many experienced people here that can give you good dosing advice. I'm just sharing my own personal experiences in case it helps.

 

[Bobbie And Bubba]

One potential problem is that she may not gain weight if her glucose isn't under control

That is a very good point. The sooner the dental is done the better. Keep in mind that most vet practices want the blood work to be done within 6 weeks to 8 weeks of the dental procedure. You would hate to have to repeat all the BW if it goes out longer and they insist on new BW.

Have you considered applying for Care Credit? It is free and if approved you can put the dental on the card and if paid in 6 months there is no interest. It has been a life saver for me with my 4 pets .

 

[Julie and Honey]

One potential problem is that she may not gain weight if her glucose isn't under control. It is not the lack of carbs really that is making it hard to gain. Less carbs in her system will allow her to utilize her nutrients better. It is also possible that she will have better values after her dental, and be able to eat better.

Why are you trying not to wake her?

With my girl, her dental was only a week or so from when we decided her levels wouldn't come down with food change alone, so I opted to wait until her antibiotics were done before starting insulin, in case she wouldn't need it at all. She did end up needing it. I started at 0.5U, and ended up decreasing after the first dose.
If you can monitor her the first couple doses, regardless of when dental is, that would be optimal. There are many experienced people here that can give you good dosing advice. I'm just sharing my own personal experiences in case it helps.

Thanks. Good to know about dosing. I looked at Rhubarb’s spreadsheet and her numbers were very close to where my cat is now without insulin (all yellows) when you started on Lantus and looks like Rhubarb did well on .25. Can I ask what she weighed when you started her on Lantus?

Congrats you got her OTJ!

 

[majandra]

Thanks!
She was 9.2 lbs

 

[Wendy&Neko]

Something to keep in mind is the common phrase used here, ECID or every cat is different. We had one cat here who was found to be diabetic at her pre dental bloodwork, numbers in the low 200’s, ended up getting to 10 units. Sweet Polly had a secondary condition causing her to need more insulin. I am not saying that is an issue for you, but rather it’s hard to look at other cat’s numbers and assume yours will be similar. You just have to start giving insulin and see where you are end up by following the dosing method.