struggling w/New diagnosis

[ki mendo]

My eleven year old cat is diabetic as of his diagnosis last Friday. His BG was 390. Vet said it was not likely from stress. We were told to give him 1IU of Lantus 2x a day, but not much else.
He had shots, Friday night, two on Saturday, two on Sunday, and one on Monday morning. His BG was 99 at the vet yesterday afternoon and 87 last night. The vet suggested that I not give him a dose on Monday night,if it stayed low, so I didn't.
We also have changed his food to a diabetic management can. He isn't crazy about it so he is only eating about 1 six ounce can a day. However, last night I tried a different flavor and he ate the whole thing(6oz).
This morning his BG was 396, so I dosed him. Checked it four hours later and it was 322. Checked again tonight at dosing time(11PM) and it was 202. He had eaten small amount of left over food from earlier at around 8:00PM but won't eat now. So do I dose him tonight? It's an hour past the scheduled time. Since it's bed time I won't be able to keep constant watch over him and I don't want him to crash. Can't seem to figure this all out.

 

[Julia & Bandit (GA)]

Welcome! I am so glad you're home testing--many vets do not recommend this but it is the safest and best way to care for your diabetic cat! It sounds like you have a good vet and they have you on the right track, but as many of us have learned, it's very rare for a vet to get every detail of feline diabetes treatment right.

So I have a couple of questions to better help you sort out what to do. Did your vet confirm the diabetes diagnosis with a urinalysis or a fructosamine test? If your vet diagnosed your cat based off single blood glucose readings, then the diabetes is not confirmed. A BG of 390 CAN be caused by stress. Last time Bandit had to go to the ER vet his blood glucose was in the 400s--the ER vet wanted to start him back on insulin immediately, and I said, let's test and wait out the week to see if it's stress. The vet was convinced that there was no way stress could raise him into the 400s. I know my cat, and a bath can raise him into the 300s, and this was certainly a more stressful situation than a bath. Sure enough, once he was home his BG dropped back down to normal levels and stayed there.

Are you giving insulin at 11am and 11pm every day? What type of canned diabetic management food are you using? Purina DM canned is the only prescription food that is low enough in carbohydrates for a diabetic cat (Hills M/D is still too high in carbs and will cause spikes in blood sugar). However, there is nothing special about Purina DM--it's all byproducts and pretty much the exact same thing as the liver flavors of Fancy Feast (also made by Purina), so all you're paying for is the label. Also, many cats do not like liver and get sick of it easily. Most of us feed a canned commercial low carb food because you can get a premium cat food with better ingredients for less than what you're paying for the prescription food. Here's a link to the cat food nutrition charts that show the carb content for many commercial foods; you just pick one that is under 10% carbs (but preferably under 7%): http://www.felinediabetes.com/diabetic-cat-diets.htm. Fancy Feast classic flavors are very popular here because they are all low carb and easy to find. Here's a link to the diabetic safe flavors: http://www.felinediabetes.com/glutenfree.htm.

Lantus works a bit differently than other insulins in that dose adjustments are not made based on preshot values, but rather on the nadir, or the lowest number of the cycle. Because of this, you need at least 3 tests a day to properly dose Lantus--once before each shot to make sure it's safe to give insulin, and then one mid-cycle check (usually about 6 hrs after the shot) to see how the insulin is lowing blood glucose. Most of us record our number in a spreadsheet, so that we can easily track our data and get advice from other experienced FDMB members. Here's instructions how to set one up: http://felinediabetes.com/FDMB/viewtopic.php?f=6&t=18207.

I would also urge you to head over the Lantus forum, so you can check out the stickies there. It will give you a great overview on how to handle the insulin, and how dose adjustments are made: http://felinediabetes.com/FDMB/viewforum.php?f=9.

Without more information, I don't want to give you advice on the dose, but we do recommend that newbies not shoot insulin if you have a preshot number less than 200. Given that your cat was not eating, I would have suggested to hold off on the shot. What did you end up doing? It's very likely that he may need less insulin (.5u twice a day) or no insulin at all. Quite a few diabetic cats do not need insulin once the diet is changed, and if your diagnosis was not confirmed with a urinalysis or fructosamine, it's possible that he didn't need insulin at all.