starting insulin tomorrow with curve at vets

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Beta kitty

Beta kitty

Member Since 2016
My cat Beta is going to get her first insulin shot tomorrow at the vets. Her blood glucose is 270 on the vet's machine (only 128 for the same blood on Relion meter) and urine glucose 1000, but I was getting readings in the 200s at home with symptoms of incr urination and drinking. She was diagnosed 2 yrs ago but controlled with FFclassics food and I've been checking her bg monthly.

The vet wanted to start at 1 U Lantus 2x day, but I asked her to go lower to 0.5 U since Beta's bg isn't so high and she agreed. The reason the vet wants to do a curve in office is because Beta's bg isn't as high as other cats she's treated. I asked if I could just do the curve at home but vet said no. I understand her reasoning. Wondering if anyone else had a similar situation or input. Thanks. I've learned a lot from this site and told my vet about it too.
 
Well, her numbers will likely be higher at the vets due to stress - that's really common.
 
Grrrr… (directed at your vet, not you)

Because of how Lantus works as a depot insulin, you won't really know fully what it a dose is doing until after 3 days (3 days == 6 injections at 12 hour intervals). I mean, I guess technically it could make a cat tank on the very first injection, but if they truly only give a half unit, that seems unlikely if not darn near impossible. Others can feel free to correct me, but I don't see that a true curve gives any value at all on the same day as the first injection with a depot insulin...at the vet's office...where the BG will probably be higher than at home anyway...and Beta might not be eating "normally" like she would at home. Doing a curve on day 1 sounds more like a holdover from when we only used in-and-out insulins like PZI/Prozinc...because you would/could see action on that very first day.

Has anyone else had a vet tell them that they could not do a curve at home? Sure. Loads. Most of them are known as ex-veterinarians around here. They said no because either they A) want the income from you paying them to do it, or B) that's just what they were taught ages ago, perhaps they were even taught that home testing wasn't accurate, and they still believe it, or C) a combination of the two. Earlier this month we had this doozy: "We asked about testing at home and he told us that was ill advised as well, stating that the testing was not reliable and that she could die since the tests could be wrong." SHE COULD DIE??? I've never heard anything SO WRONG. That was in this thread: http://www.felinediabetes.com/FDMB/...dations-he-wont-support-homecare-help.200763/ so you can read our responses for yourself :smuggrin:

I'll look for the new guidelines that I am pretty sure now recommend testing at home, but if anyone else has that or can confirm or deny, please jump in as I am late for feeding and injections here at my house! With the new guidelines, if they say what I seem to remember they now do, you would at least have something documented and official to support your position. And if all else fails, or you aren't invested at all in this vet anyway, just find a new vet and during your pre-interview with them or their practice, ask if they support home testing AND curves. If not, move on to the next one.

Hope that helps,
Sandi.
 
Me again, found what I was thinking of, but only browsed it VERY quickly: https://www.aaha.org/public_documents/guidelines/diabetes guidelines_final.pdf

Page 10...which surprisingly does suggest a curve on the very first day of a new insulin although I still struggle to see the value in it for depot insulins. But on Page 11: "At-Home Blood Glucose Curves Obtaining a BGC at home is strongly recommended both for dog and cat owners, but even more so in the case of feline patients due to the chance of stress hyperglycemia in a hospital setting..."

I'll have to leave it to you to read it at length, but post here if you have any questions about what you see there.
 
We have seen cats tank after their first shot of Lantus. It's not common, but it does happen. I think your vet is simply being cautious since she thinks Beta's BG numbers are low to begin with. She's being careful... that could be interpreted as a good thing. However, I have to disagree with her thinking that 270 isn't a high BG value on a pet-specific meter or lab value.
 
Sandi & Whisper said:
Me again, found what I was thinking of, but only browsed it VERY quickly: https://www.aaha.org/public_documents/guidelines/diabetes guidelines_final.pdf

Page 10...which surprisingly does suggest a curve on the very first day of a new insulin although I still struggle to see the value in it for depot insulins. But on Page 11: "At-Home Blood Glucose Curves Obtaining a BGC at home is strongly recommended both for dog and cat owners, but even more so in the case of feline patients due to the chance of stress hyperglycemia in a hospital setting..."

I'll have to leave it to you to read it at length, but post here if you have any questions about what you see there.
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Thanks so much for taking the time to reply! I have done a lot of reading and I did come across that aha guidelines when I was trying to see if Beta would classify as diabetic based on the numbers of my home tests. Maybe I should print it out and take it to my vet.? Not sure if that would insult her or not. I don't know how many diabetic cats she's treated.

I like my vet and she pays attention to my concerns about Beta and suggests things to try. When Beta's arthritis quit responding to the gabapentin (and laser and acupuncture) and I asked to use adequan she was all for it. The adequan helped dramatically after 7 weeks and I was so happy to see Beta jumping up onto my lap and walking on my desk when I'm trying to use the computer. I know Beta does get stress hyperglycemia sometimes at the vet and doesn't eat while there. I'll just give her breakfast tomorrow before we go and she always has food overnight too.

Today the bg meter at the vets said 270 on the analyzer and 241 on vets Alpha Trac and my relion meter said 128 for the same drop of blood. This shocked me when I'd been getting readings all in the 200s. I think Beta was getting tired of me pricking her ear so much.

I got a pen of Basaglar for $88. I thought I was getting the Lantus but the pharmacist said this was just a good so I hope it is.
 
Jill & Alex (GA) said:
We have seen cats tank after their first shot of Lantus. It's not common, but it does happen. I think your vet is simply being cautious since she thinks Beta's BG numbers are low to begin with. She's being careful... that could be interpreted as a good thing. However, I have to disagree with her thinking that 270 isn't a high BG value on a pet-specific meter or lab value.
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Yes I do think she's being cautious. She did say it wasn't that she didn't trust me to do the bg monitoring. She said she does let patients give the first dose at home but the animals usually have much higher bg values like 500. I guess then it seems like there's less chance of bg going too low since the 500 has more room to go down than if you start at 270.
 
Agreed, let us know how everything went today! Although I obviously recommend testing every day because you just never know, Thursday (night in particular, after the evening dose) is when you should be most vigilant to see the real action on .5 units. Be sure to get a test before the evening shot, and then definitely before you go to bed on Thursday. Post here if you have questions, or you could get started over in the Lantus forum at that point if you want. There are some stickies at the top that you might want to look at, particularly http://www.felinediabetes.com/FDMB/threads/the-basics-new-to-the-group-start-here.18139/

And I don't know if you know about adjusting the injection times. Because they gave the shot at the vet today, I don't know what time of day that was. But is that time going to work for you on an ongoing basis, both AM and PM? If not, let us know if you have questions.

:bighug:
 
Beta got her first shot of 1 U Basaglar at 7:55 am at the vets and had curve done there. Gave 1 U because her amps was 384, +2: 261, +4: 289, and +6: 430. They didn't offer her any of the food I brought because that's what the vet said to do. She probably wouldn't have eaten but still I question why they did this. I'm sure you wouldn't do that to a person on insulin! Beta is used to eating several meals throughout the day, not at set times though and having food left out in the autofeeder overnight.

She's doing well, seems hungry and is drinking and used the litter box. She's a bit quiet, but probably afraid I'll leave her at the vet again. I will test her before each shot and at +3 or so at least during the day shot, probably will do more cause I worry about her. The vet said to do a curve in a week and email it to her. Vet didn't seem concerned about leaving food overnight related to giving the am dose of insulin but I know it might affect her bg values if she eats it too close to dosing time.

Will give her shot at 8 pm tonight. I'm not too worried about the actual shot since I've given her adequan shots with the big needle. More concerned about her bg levels afterwards.
 
Without food on board, and with vet stress, yeah...I still question the value of today's exercise. But what's done is done.

Give extra lovin tonight, get into a normal rhythm, and always post if you are concerned about the BG numbers you are seeing. Knowledge is power. :bighug:
 
One other thing. I see you use an autofeeder. I don't, but the suggestion that I've seen given is that you just leave the final compartment of the autofeeder (assuming it is a 5-dish feeder, not just two I think), empty and have it slide to that compartment two hours before the morning shot.
 
Sandi & Whisper said:
One other thing. I see you use an autofeeder. I don't, but the suggestion that I've seen given is that you just leave the final compartment of the autofeeder (assuming it is a 5-dish feeder, not just two I think), empty and have it slide to that compartment two hours before the morning shot.
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Thanks for the suggestion. Her autofeeder only has one compartment but she usually eats all the food by the morning. I might just give her a little less food than usual. I gave her shot at 8pm and it must have gone in because her numbers are dropping a bit at 168 ps, +1 167, +2 149. She's kind of wandering around some which is weird so I checked her bg. At the vet her lowest # was around +2 to +4 so I might stay up awhile later with her tonight to do a couple more bg checks.

I see you use Relion confirm. Have you compared it to the vets meter and found a difference? Mine is Relion Prime and it's quite a bit lower than the vets especially at the higher #s.
 
Hi!

Came across your post this evening and just wanted to say hi and welcome. For what it's worth, we went through something similar with our sugar kitty Chim when he was first diagnosed as diabetic. He'd been pretty sick for a while, we thought maybe it was a kidney issue until we got the blood work back. His BG was ~450 when they tested at the vet and they recommended 1 unit of Lantus 2x per day based on his weight and glucose levels.

We got really lucky that our vet was supportive of home testing and even running a curve without bringing him in. The first time I tried for the full curve, I checked his levels in the AM and he was at 26. Needless to say, we spent a lot of time on the phone with the vet that morning making sure we hadn't sent him too low - his energy level was stable and he didn't seem to know why we were so concerned.

From then on we adjusted accordingly with our vet and eventually learned a sort of "best instinct" approach with Chim and his insulin doses. It wasn't the most scientific of methods, but we managed to get him OTJ for several months before a cancerous lesion on his tail sent his BG levels off the grid. From then on he was fairly stable until another illness - unrelated to the diabetes - eventually took its toll.

You are definitely in the right place. Everyone here does whatever possible to be supportive and understanding. I've come in on more than one occasion to ramble and ask a million questions, and always found a very welcoming and helpful atmosphere waiting for me.

I hope Beta is doing well! :)
 
You don't know for certain when your nadir is (lowest point in the cycle), but it normally isn't until +4 to +6. I don't think that what they saw today at the vet is a good indicator. Either stay up a bit, or set an alarm to get up in a bit.

I am so glad you are testing. Be aware that normally this board does not suggest giving any insulin at all on a PS reading less than 150 or 200 until you have sufficient data, so please proceed cautiously.

Regarding meters. We are on our second diabetic cat, with a total of 8.5 years of treatment between the two. We really handle all of Whisper's diabetes stuff ourselves, so we haven't really compared. With our first diabetic we were using the Alphatrak and it was close to theirs. The human meters will read lower than theirs, and the higher the number, the bigger the difference. But we are looking for trends.

Do make sure you have read these:
http://www.felinediabetes.com/FDMB/threads/start-low-go-slow-method-slgs.129446/

http://www.felinediabetes.com/FDMB/threads/how-to-treat-hypos-they-can-kill-print-this-out.15887/

Especially be ready to act with sugar if you get a number less than 50 -- that is considered your "take action" number. Not trying to scare you, just making sure you are prepared.

Great job so far, but do keep a close eye on those numbers. You might end up reducing to 0.5 units before the week is out, but you'll just have to see where the numbers lead you.

Good night :)

Sandi.
 
+3 is 130, +4 is 106, still going down not very fast though. I agree and don't think we got any useful info from the curve at the vet. Guess I'll stay up awhile. My vet said I could give a shot if ps was in the range of 130-150, so I knew that giving the shot tonight at 168 ps might require extra monitoring. I have the karo syrup just in case but she's been eating good and she usually eats most in the evening and nighttime.:cat:
 
Excellent work, and I agree, I would have gone to bed on that 114 at +5.75. Today might be interesting. As I said, usually the 6th dose is when you truly see the action, so today will dictate we'd suggest you stay at 1 unit or not.

I won't be around much today and tomorrow, so if you have questions it might be better to start a new thread in the main forum, or get initiated over in the Lantus forum. so that you get eyes on it.

Great job, both you and Miss Beta :)
 
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