Starting my cat on Lantus - need help/suggestions please! super stressed/worried

Hi all,

first time posting on here so bear with me.

My cat, Molson, was diagnosed with diabetes at the vet at the end of February, his BG was 20.

Since then i have tried a diet change to see if that could help, i have been feeding him the vet DM wet food and Fancy Feast pate. i have been using the One Touch Human tester to check his levels and they have ranged from 14 - 20 when i test him at home. Unfortunately, i don't think the diet is helping, so i am resorting to starting him on insulin.

I was going to take him to the vet to start him but from my research and things I have read online here and on Facebook, I am thinking I can start it on my own (plus save me some money from vet charges). I have contacted my local pharmacist and they have Lantus (Glargine) and syringes I can purchase from them.

I want to start in two weeks. I am saying two weeks because my husband is away on a business trip next week and I am due with a baby at the end of April, so I really want to start Molson on insulin while I have the support of my husband to help me.

I am very nervous to start and find I am losing sleep over this, (it could also be my pregnancy hormones lol)

Below are some questions I have and if you have any tips and tricks please let me know!

- I was going to start with 0.5 units of Lantus, is this a good start?
- my plan is to get the pens and use syringes instead of the pen tip
- can I give him Lantus while I feed him wet food? I am wondering if it might be easier to shoot him while he is eating
- do I need to have his eating schedule very tight or can i free-feed him? If possible I prefer to free-feed him because life can get in the way sometimes and I have always free-fed him
- right now I am only giving him the DM wet food and Fancy Feast, should I stick with that diet? I was going to continue with the fancy feast for sure because he loves that, the vet DM food he doesn't love, and i hear dry food isn't the best
- when I first start him on insulin how often should I test him? pre-shot for sure, how many times after? 3 hours, and 9 hours after? and for how long do I need to keep an eye on him with regular tests? a week or a few days? i also work full time right now.
- How often do I test once he has been on it for a while? What is the recommended time that his body should be "used" to the insulin? Once he has been on it for a week or once he's been on it for a few days?
- When should I start noticing his BG levels drop?
- What happens if he were to skip a dose? I will likely be in the hospital having my baby when he will need a shot or two and I don't think I have anyone to give him one.

Any tips and tricks send my way hoping this message board can ease some anxiety i have!

 

Hi and welcome!

I’m going to try to answer most of your questions

• .5 is a great starting dose and Lantus is a great insulin for cats
• Make sure you get 1/2 unit marked syringes and the right ones for Lantus
• Because Lantus is a gentler long lasting insulin you don’t have to feed and wait so it’s totally fine to shoot while your cat is eating
• You don’t need a strict feeding schedule. Most of us feed the 2 largest meals around shot times and then smaller meals throughout the day
• Transitioning away from dry food is ideal but if you’re starting insulin and doing that, you’ll need to home test his bg to make sure his numbers are safe to give insulin, which sounds you’re planning to do. I think the DM food is too high in carbs so I’d stick to fancy feast classic
• You should to the preshot tests and we recommend at least 2 more tests during the day. Ideally, you want to switch around the times so you can try and figure out his nadir at the beginning your can test even more but 4 times a day at least always
• As far as how long till his numbers drop, it really depends because every cat is different so there’s no answer there. You’ll post asking for advice if you think you should increase the dose and having all the data in a spreadsheet will help us guide you

With a diabetic cat you need

• A low carb wet diet that is 10% carbs or under. Most of us use around 4-7% carbs, which Fancy Feast is.
• A suitable insulin such as Lantus or Prozinc which are long acting, more gentle insulins than the old insulins.
• We recommend hometesting the blood glucose with a human meter…it is not necessary to use a pet meter which is expensive to run and is no better. It will keep your kitty safe and you will know how the dose is working for your kitty. Only testing every so often will not tell you what is happening in between those times and an awful lot can happen in even a day.
• HELP US HELP YOU has information about the spreadsheet, signature and hypo box which you will need to be able to look after your beloved kitty properly

 

Most cats go off the DM wet quite quickly.

Pick up food two hours before shot time because you do not want the test at shot time to be carb influenced.

Waving from Ontario. Welcome to the best place you never thought you would ever be.

 

Thank you SO much for your response!

I am going to ask my pharmacist about Lantus or Prozinc and might go with that more cost effective option. so the Prozinc one i can give while he eats as well?

you said "Only testing every so often will not tell you what is happening in between those times and an awful lot can happen in even a day." should i start with testing 4 times a day (pre shot Am and PM and then after the shots? so 4 total, is that enough?) I also don't want to test too much and hurt his poor ear

On the days that i am not home and can't test him 4 times a day, is a test pre-shot enough? so that would be two tests a day before each shot?

 

Welcome to FDMB!

There is great information regarding Lantus in the sticky notes at the top of the Lantus forum. There's an overwhelming amount of information in those posts but it will help you to get familiar with the way Lantus works. The information will be a solid addition to what Ale noted.

I doubt you will be able to get Prozinc from a human pharmacy. It's an animal insulin. Lantus, on the other hand, is widely available. Also check the price on the biosimilar/generic for Lantus -- glargine. The price for Lantus is much less in Canada and I suspect the price for the generic will also be less.

 

Starting at four times a day is good and then after 2 weeks on insulin, I’d try to do a curve on a day you’re home like maybe the weekend. That’s when you test every 2 hours for 12 hours. I’d start with preshot tests and maybe a +4 or + 6 during the day. It would be great if you could get at least one more test in before bedtime like at +2 after the pm preshot. When you’re not at home, can you get the evening +2 at least?

 

Hi Catrina, welcome to the forum.

I want to encourage you to keep in touch with your vet about this stuff. Some vets are behind on the best treatment for diabetic cats, so you'll want to make sure you're doing the best thing for your Molson. But, there can sometimes be complications from diabetes that you won't be able to handle on your own. Keeping your vet informed of what you're doing will make a big difference if you ever end up in a situation where you're out of your depth.

Have you done any tests for ketones? Skipping a dose is never good, but sometimes life happens. If there's any risk of DKA, skipping a shot is very dangerous. If you run into that, you might need a plan to board Molson at the vet while you're at the hospital, or teach someone to be ready to give him his shots while you're away.

I wouldn't delay starting treatment more than a couple weeks though. The sooner you start, the more likely you can get Molson into remission, and the less risk of complications.

I give Pumpkin her shot while she eats. She's very food motivated, so she doesn't even notice the injection while she focuses on stuffing her face. If Molson is a picky eater, you might have to consider the chance that he associates the shot with whatever food he's eating. I definitely wouldn't introduce the injections and a new food at the same time.

Having a newborn and a newly diabetic cat sounds incredibly stressful. Sending you lots of good wishes!

 

Hi and welcome to the forum.
I would not put off starting the insulin for 2 weeks unless you are going to test the urine for ketones daily while you wait.
Diabetic cats who are not getting insulin they run the risk of developing ketones in the blood/urine which if not treated can develop into DKA (diabetic ketoacidosis) which is a very serious illness and can be fatal. The treatment if ketones appear is to start insulin.

 

Hi Catrina - Just checking in to see how things are going with Molson.

 

Hi Jacques and pumpkin!

thanks for checking in.

i started Molson today with 0.5 Lantus, you can view his spreadsheet here:
https://docs.google.com/spreadsheets/d/1Op0qlsciomCAsK_NwyYsPWsoeBHScPljT-Rz9vezv3c/edit?usp=sharing
Let me know how to share my spreadsheet if that link doesn't work.

How do you think he did?

AMPS - 17.3
+3 - 14.3
+6 - 12.5
+8 - 17.5
PMPS - 20.1
+2 - haven't tested yet

At first i was excited that his numbers were going down, and also hoping they weren't going down too fast too quick, but then they started rising his PMPS was higher than his AMPS is this a good sign or bad sign or? i know it's the first day and i might need to be patient but i want to know that it's working atleast

 

This looks like a great start! It's normal for the blood glucose to start going back up partway through the cycle. Lantus is longer-acting than other insulins, but most of the action still happens in the first few hours. You just found your first nadir at roughly +6/12.5!!!

Going up further is also normal. Metabolism is a complicated process with a bunch of different systems working in different ways to regulate it. When the body sees blood sugar going down, the pancreas and liver react by releasing stored glucose and converting other nutrients into glucose. If your cat's body gets used to high blood glucose levels, it can get a bit "panicky" when it sees the lower numbers and raise the blood glucose back up. That's called a "bounce" and it's extremely normal, pretty much expected really. Things will settle down within 1-3 days usually.

Keep holding this dose for a week with tests before every shot and some tests mid-cycle. As long as lowest value stays above 90 mg/dL (5 mmol/L), just hold the the 0.5U dose. If Molson goes below 5 mmol/L, you'll want to reduce the dose by 0.25U immediately on the next injection. If he stays at nice and safe values, after about a week you'll be ready for your first dose adjustment.

Lantus builds up in the body, so you could see even more activity in the next few cycles. Definitely don't skip on testing right now. You want at least one mid-cycle test every day to start.

When you get a minute can you update your spreadsheet with your insulin and the dosing protocol you're using? You'll probably want to use Start Low Go Slow to begin with. (Details here: https://www.felinediabetes.com/FDMB...-low-go-slow-slgs-tight-regulation-tr.210110/)

 

One other thing. The PM cycle can often go a bit lower, so folks suggest doing a test right before bed if you can manage it (hopefully that puts you around +4 or so). Especially to start while you're learning how Molson's body reacts to the insulin.

 

Exactly!

You're still going to see that daily up and down pattern for quite a while. It'll take a least a month, sometimes quite a few months for his BG to be mostly flat. But, usually within a 1-3 days the insulin going up even higher than before should work itself out. For your very first week things will be bouncing around a bit and it'll be hard to see patterns.

Especially when there's puking, it's best to shoot after you've seen them eat. Giving the insulin when they're off their appetite can be tricky. If Molson is ever not eating before their shot and you aren't sure what to do, post a new thread mentioning the puking and you're stalling in the title and hopefully someone will give you advice soon.

Exactly! Lantus dosing is based on the lowest BG of the cycle. That's because we have to always keep their BG in a safe range, and while high is not good, too low is potentially deadly. So we adjust the dose based on how their body is currently reacting to make sure our kitties stay safe.

Molson's reactions are going to be pretty inconsistent at least to start, so you want to keep doing regular testing between shots until you see a pattern start to show. Like today, he's completely flat at +4. Maybe he's just been flat all day, or maybe he had a nadir at +2 or +3. Hard to say for sure.

The SLGS guidelines say to do pre-shot tests every day and then do a curve (testing every 2 hours for 12 hours or every 3 hours for 18) to decide whether to adjust the dose. But, if you can test more, it's really better to do test more early on. The better you know how Molson reacts to the insulin, the more ready you will be when he throws you a curveball. Once you see some consistent patterns, you'll be ready to back down on the testing. At that point, ideally you get a test near his predicted nadir every day, and do a curve once a week or so.

It's really best to start with slow 0.25u increases for now. It's not going to be good for Molson and it's going to give you a lot of stress you don't need with everything else going on if you take him too low.

Do you have syringes with half unit markings? You could try practicing with water if you're unsure about getting the plunger in the middle of the 0.5 and 1.0 marks.

 

Thanks for updating your spreadsheet! One more piece of homework: updating your signature.

If you hover over your name at the top there's "Signature" item in the menu that drops down. Add the info listed at the end of this page: https://www.felinediabetes.com/FDMB/threads/new-how-you-can-help-us-help-you.216696/

You can see my signature or most other members' posts for examples.

That'll make it easier for everyone to give you the right advice based on Molson's specific situation.

 

You will want to link your cat's spreadsheet to your signature. The instructions are toward the bottom of the post on how to create a spreadsheet. It's also a part of the post that Jacques linked.

 

i believe i have updated my signature, can you confirm if it is working?

 

I see the spreadsheet link. You need the first line as well with all the info from the page I linked.

 

Okay i think i got it now! let me know if you can't see it


Molson seems to be consistent at 16 all day today even after giving him the insulin, is this normal? did i not inject the insulin properly maybe, or is it maybe good that his levels aren't increasing atleast.. it's stressing me out that it's not changing much and i'm having a hard time testing him now.

 

I can see it now. Can you update the diet part with the specific food Molson is eating? That's important if you ever run into trouble.

These first couple weeks are about figuring out what's normal for your cat. I had to raise Pumpkin's dose all the way up to 3.25U before she started showing much of a change after her injection. Some people have that kind of experience, others see the BG drop like a rock even with just 0.5U.

It's certainly possible you missed and got a "fur shot". If you ever think that happened, don't do another injection. You can never be sure how much you did inject and you don't want to give too much. Best to err on the side of too little.

Keep working on your technique so that you can see the needle going into the skin. You might need to part his hair a bit before injecting. If you see the needle go all the way into the skin, you know for sure that you didn't miss.

Diabetes is a chronic disease and it just takes some time to figure out how to manage it. You're honestly doing really really well already. Take a look at my spreadsheet. I was injecting Pumpkin blind for the first week because she wouldn't let me test her. I tried every day, and couldn't make it work. I know how stressful this whole thing is (I'm still going through my own diabetes diagnosis stress!) but you really are off to a good start and should feel proud of how much progress you've already made.

If Molson is getting upset about the testing, it's okay to take a breather and focus on the pre-shot tests for a day or two. Make sure he gets a treat and lots of love every time you test him, even if it doesn't work. Don't force it unless there's an emergency that requires an immediate test (like dangerously low BG). Over time you'll both get less stressed out and it'll just become a natural part of the day.

While his BG is still high it would be good to get some ketone urine test strips (some brand names are ketostix or diastix) and test his urine every couple of days. As long as the ketones tests are negative, the high BG isn't immediately dangerous. It's not good, but it's not immediately dangerous. If you do see a positive ketones test, some members who are more experienced can help you with next steps.

 

i didn't feel any wet on his fur so i don't know if i got a fur shot or not, but that is good to know not to do another injection if i'm not sure.

This is all a relief, thank you so much.. your support means a lot. i was able to test him so maybe it was my own stress that was making it more difficult

hmm yeah, i don't know much about the ketones and have never tested that. what does it mean if it's positive? what do people do if it's positive? what are some symptoms to look out for and how can i prevent them?

 

This is a good place to read up on ketones: https://www.felinediabetes.com/FDMB...oacidosis-dka-and-blood-ketone-meters.135952/

The best way to prevent it is to give Molson lots of food (until you get him regulated he's going to need more than he needed before his diagnosis), lots of water, and follow your SLGS dosing protocol to get his insulin dose dialed in.

If you do see a positive test, post a new thread right away with ketones in the thread title and you'll get some help. I've never dealt with it before, but some experienced members who know how to handle it will help out. Also give your vet a call because you might need to take him in for immediate treatment, especially if you're seeing serious symptoms. Most cats with high BG don't have ketones though, so you don't need to worry that any high reading is a sign of ketones. It's just something to stay on top of so you can catch it early if it does happen and keep Molson safe.

 

Ketones can test slightly positive -- you want the numbers to be trace or none at all. If larger than that, getting water and food into your cat is important. I'd also speak with your vet. Ketones are typically the result of an underlying infection or inflammation + not enough calories + not enough insulin. They are a signal that your cat's metabolism is off. If ketone levels are too high, some electrolyte values are disrupted and the condition can be life threatening. However, it can be corrected with appropriate treatment. The big issue is if ketones are present in a big way, your cat may need to be hospitalized and the treatment can be very expensive. We tend to be pretty aggressive about encouraging member to avoid problems with diabetic ketoacidosis (DKA) as much as we can. Testing for ketones is a good approach to prevention!

 

Hello Catrina and welcome! If you don’t have a ketone meter, you can also pick up Ketostix which you can pick up at any human pharmacy and you can check your cat’s urine. Here are some tips on how to catch urine.

Tips for Catching Urine

The basic recipe for DKA is not enough insulin + inappetance + infection or other systemic stress