Was this a correct diagnosis?

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Steve

Member Since 2013
Hello all,

This is my first time here and I've spent hours reading over the material. Everyone here is doing amazing work. Thanks!

My cat was recently diagnosed with diabetes, but she doesn't exactly fit the profile. She's six years old, has been a steady 8 pounds for years, and is relatively happy and healthy. Early January, I noticed she was drinking a lot more, urinating often, and spent most of the day asleep. I immediately took her to the vet and they did blood work and found her blood sugar was very high and there was a presence of keytones in her urine.

The doctor had us start with 1 unit of Lantus twice a day. A week after her first injections, she went back to have her blood checked, and her blood sugar levels were too low. The doctor immediately switched her to .5 units of Lantus twice a day. 7 days after that visit was her first Glucose curve, but it was cancelled because her blood sugar was again too low. They treated her for hypoglycemia and sent her home only 30 minutes after she was dropped off with orders of no insulin later that day, and no insulin the next day. Now the doctor wants us to go back to 1 unit of Lantus, once a day, for the next 14 days until her next glucose curve.

Now, I'm a bit worried because we were at .5 units twice per day and her blood sugar was dangerously low. Now, the doctor has us a 1 unit once per day. Isn't that essentially the same thing? I feel like there's no difference here and I'm still overdosing poor kitty.

I would love to hear your thoughts on the whole situation.

Thank you!
 
I don't use your insulin so can't comment on dosing. You might add Lantus to your subject to attract those users. Was there a diet change to wet low carb in this period? Sometimes diet only will move diabetic cats into remission.

On thing that would really help you and us is to set up a spreadsheet to keep track. It is an easy way for you, your vet and for us to see your history and patterns at a glance. It is color coded and really helps you see the big picture. Here are the direction:

http://felinediabetes.com/FDMB/viewtopic.php?f=6&t=18207

It's a little tricky so just ask for help if you need it.
 
First off Lantus works best when dosed twice a day as it is a depot insulin, where one shot basically bolsters the next.

Second the absolutely best way to know if you little girl needs insulin at all, or how much is to let us teach you how to test her at home just like a human diabetic would.

You don't need an expensive pet only meter either, a regular human meter will do just fine for a fraction of the cost. The problem with basing the dose on curves done at the vet's is that almost all cats get very stressed at the vet's and stress will raise their BGs, so if the vet bases his dose on the numbers he is seeing in the office then when you get kitty home, she relaxes in familiar surrounding her BGs natural go down and the dose is too high, and you run the risk of hypo. But by testing her at home you will be seeing truer numbers and can base her dose off those.

Mel, Maxwell, Autumn & The Fur Gang
 
Steve

I just posted on the Lantus board to ask for someone from over there to come over and maybe look at your post and offer help. But as Sue said try to get up a spreadsheet they will want to look at that. They need to look at the previous data, dosages, dates given etc. yes and like Mel said I would buy a cheap human meter and test her at home. A lot of people here buy the Walmart Relion and strips.

Terri
 
Steve,
Do you know if they found anything else in her bloodwork at diagnosis? Any way you can get a copy of her test results? It's possible that the diagnosis is right but there's people here who can help with understanding what all the numbers mean outside of just the blood glucose numbers.
The drinking/peeing more fits , but her reaction to the tiny doses and low BGs could suggest that something else might be going on.

I'd be really nervous about going back to 1u given her history if you aren't testing her BGs over the two week period.

Carl
 
I agree that there may be something else going on. If you recently changed the diet, that would explain the lower numbers.
Do you have syringes with half unit markings? It can be tricky learning to microdose but many of us here do that.
There is a new kitty here that had to start on 0.1 unit ( basically one drop)

Seeing some bg numbers will help greatly.
 
If I understand what you've written, you are not home testing. That is something you need to do to be sure it is safe to give insulin. When just starting out, we suggest not giving insulin when the test is less than 200. As you get data to show it is safe, that no shot number may be reduced.

What are you feeding? If you are feeding any dry food, you may be able to stop the insulin if you stop the dry food. Only make this change if you are home testing, or stop the insulin at the same time. Feeding a low carb, canned or raw diet, may drop glucose levels 100 points.

Additionally, you may want to use some of the Secondary Monitoring Tools in my signature link. Urine ketones indicate fat is being broken down for calories; this may indicate diabetic ketoacidosis (DKA) which may be fatal and is expensive to treat. Urine glucose means the blood glucose level is greater than the renal threshold.
 
Wow, thank you all for taking the time to respond. Here's a bit more information. The blood sugar levels are from memory and aren't exact. I'd estimate a 5 point difference in either direction.

January 31st
Vet appointment where kitty was diagnosed as diabetic.
Kitty was lethargic, urinating and drinking frequently, but still eating and maintaining normal movements.
Presence of keytones in her urine and her blood sugar was around 350.
They would have hospitalized if she hadn't been eating.
Started 1 unit of Lantus twice daily.
Switched from dry cat food to Purina DM.

February 12th
First follow-up appointment. Kitty behaving noticeably better. Frequent drinking/urinating stopped.
No more presence of keytones.
Blood sugar levels at 36.
Moved from 1 unit of Lantus to .5 units twice daily.
Syringe was in 1 unit increments, had to eyeball a half unit.

February 20th
No noticeable changes in behavior, drinking or urinating. Seems relatively happy and healthy. Significant improvement from Jan 31st.
First glucose curve scheduled. Cancelled within 30 minutes. Blood sugar around 34. Treated at vet for hypoglycemia.
Moved from .5 units of Lantus twice daily to 1 unit of Lantus once per day.

March 6th
Next glucose curve scheduled.

That's a timeline of everything I have so far. Most of this is from notes written on pieces of paper/memory.

I haven't been testing at home. It was never even mentioned by the vet as something that should be occurring. I am leaving shortly to go out and buy a test kit and strips today though.
 
Steve

Lantus is dosed twice a day in cats, but based upon what I have read I would not give your cat any more insulin until you test her just because you don`t want to take the risk of her going into a hypo, it can be fatal.
Please get some tests with the meter and come back on the board.
Like BJM said it not suggested that you give the cat any insulin if her numbers are less than 200.

Terri
 
Hi Steve,
Glad you're going to get a meter and learn to test your kitty's blood sugar. We test at the very minimum before every injection -- because if too low -- you do not give the injection.

Your kitty may well not need insulin if you change the diet a little bit more -- the prescription DM food is actually not great -- it is ok.

Read www.catinfo.org for excellent Feline Nutrition info written by a veterinarian who posts here - Dr. Lisa Pierson.

We recommend canned or raw foods with less than 10% carbohydrates. There is a link on her page to a list of many canned foods Protein/Fat/Carb contents.

phoebe
 
I was able to take two readings today:

9:00AM - Before food/insulin: 188
1 unit of Lantus was given with food.

3:00PM - After food/insulin: 123
Six hours after breakfast/insulin
 
Steve

Just reread your post and I would almost have to think something else is going on with your kitty. She could be diabetic and just need what they call a real skinny dose which is like a drop of insulin. Lantus people could explain it the best how to skinny a dose twice a day.
Or she could have some underlying health problems that is causing ber BG numbers to rise and she is not diabetic at all such as dental issues ot something else.
I am trying to get you some help, what city are you in? If someone lived near you maybe they could help.

Terri
 
hi Steve

welcome FDMB!
I see you switched your kitty (name?) from dry to wet d/m after initial diagnosis.
That may have brought her bg down considerably - some cats drop 100 pts after the switch. Of course, the issue then is, the insulin dose...

Quick word on the d/m - you can use a cheaper brand (ie. non-prescription) and get the same benefits. Most of us use Fancy Feast classic pates but there are many other low-carb wet foods listed in Phoebe's link.

Nice numbers! Lantus nadir (lowest point) is usually at +6 so that's your 123. However, not all cats keep at +6 - her nadir could be earlier or later in the cycle.
Also, did you test soon after feeding? We try to give a gap of 2 hours from food to testing so the test result doesn't include a food spike.

Congrats on the successful testing! Now you don't need to have the curve done at the vets as you can do it at home!
 
Two very big causes for concern:

Bailey threw up her dinner tonight shortly after eating. It was the first time she's thrown up since starting Lantus so I wasn't extremely concerned, but did keep an eye on her for the remainder of the evening and gave her a little less than a quarter of a can of food. Her blood sugar before eating was at 141. Everything seemed okay until just a few moments ago when I was woken up to the sound of her throwing up again at 3AM.

I checked her box and she had two runny bowel movements today. Nothing solid in there at all.

Naturally, the vet is closed on Sundays and I have no one to contact until Monday morning.

I'm not sure what to do.
 
Steve

Do you have a emergency vet around? Is she eating this morning? Has she thrown up any more since 3am?

Terri
 
We were just woken up to the sound of her throwing up again. This time it was the white foam/bile.

If it wasn't for the throwing up, she seems normal. Very eager to eat.
 
Steve

Do you have any Pepcid in the house? Not Pepcid Complete, Give Pepcid or Pepcic AC, you can give half a tab of that. If she keeps throwing up I would be concerned. If she stops eating I would be concerned enough to find an emergency vet.

Terri
 
I spoke with the vet this morning regarding Bailey's vomiting/diarrhea on Saturday (This ceased on Sunday. No insulin was given.) The vet wants to suspend injections over the next few days and to have us do regular blood sugar checks with a followup phone call in a few day's time. She wants us to call in if Bailey starts coming in at over 350.

Her are Baileys readings from today:

8:30 - 223 - Served breakfast
11:30 - 261
4:30 - 280
 
Steve

I am not sure thats a good thing, no insulin with as high as she is. I will let the others answer to this, but your cat can develop ketones. No insulin and if she keeps getting higher not good.
Lets see what the others say.

Terri
 
Steve,

With those readings Bailey is diabetic and is going to need some insulin. But how much is the key, if I've read your previous posts correctly, you have had her on both 1u and .5u and she has dropped dangerously low, so that would say both of those doses may be too high for her.

The problem with her giving you numbers over the renal threshhold and not giving her any insulin at all is that it can develop into ketones, which can very quickly turn into DKA, and expensive if not life threatening situation.
The recipe for ketones is not enough insulin + not enough food + infection of some sort.

You may have already answered this and I may have just missed it....What is Bailey's current diet?

Mel, Maxwell, Autumn & The Fur Gang
 
Okay I found the diet, so now I have a different question...the DM is that the canned version or the dry version...if it is the dry then it is still too high in carbs, granted it is better than most drys out there but it is about 13% carbs where we try to keep our cats under 10% carbs and most myself included keep ours between 6-8% carbs.

If the DM is the dry version and no higher than she is testing right now I would stop all dry food and start her on a diet of Fancy Feast Classics, Friskies Pate Style canned or even Walmart's Special Kitty canned pate style canned foods to see if by reducing her carb load a little further is she won't come down a little more for you.

The other thing is I would get some ketostixs and be testing her urine for ketones as often as you can catch her in the litter box and if you get more than a trace get her to the vet's asap.

The other thing that could be causing those high numbers but not skyhigh like we normally see in a newly dxed diabetic could simply be an infection of some sort, how are her teeth?

Mel, Maxwell, Autumn & The Fur Gang
 
We have Bailey on the wet DM version. Previously she had been on almost all dry food but we switched her to wet food almost a month ago, even before the insulin shots started. Here is some background that goes a little further back. Bailey has always been a very healthy kitty and never needed to see a vet other than for a checkup, but lately she has had one problem after another. I keep thinking they may be linked even though the vet doesn't seem to think so.

In November she had a routine checkup with the vet and they had told us she was behind on a couple of shots. She is an indoor kitty and an only kitty, so this didn't seem to be the end of the world, they just caught her up on the shots she needed.

About a month or so later (sorry I'm not remembering the exact dates, I can try to look them up if they seem important) she started throwing up a lot. We noticed she wasn't going to the bathroom and she couldn't keep any food down. She vomited a white foam (bile) and we started to panic and of course it happened on the weekend when the vet was closed. She still seemed in good spirits despite not keeping food down so we waiting till first thing Monday to take her to the vet. They did an x-ray and didn't find anything conclusive but thought she might have a blockage in her intestine. We gave her 5 pebbles of food an hr for about a day or two and finally she passed the blockage. We were very excited because the next step would have likely been an ultrasound and surgery to remove the blockage but that was now unnecessary. Soon after we left her at my parent's house over the holidays while we were out of town for a week.

When we got back from the holiday my mom commented on how surprised she was that adding a third cat (they already have 2) really increased the amount of litter. We also soon noticed after getting her home how quickly she was going through water and how often she was urinating. Back to the vet we went. They did some blood work and noticed her bg levels were high. They looked at her data from a month before when we took her due to the blockage and saw they were also a little high then. The vet attributed this to stress/being sick when she had the blockage so they didn't think much of it. This time they said it was indicative of diabetes but she didn't fit the build one bit for a diabetic cat so they said she had pancreatitis. They put her on a liquid oral antibiotic and put her on the wet DM and within a day or two she had stopped with drinking so much and urinating so often.

This seemed to be the fix as she was completely back to her normal self on the antibiotic but after about a week of being done with it she started showing the same symptoms again. This is when we got more blood work and the diabetes diagnosis. We went in that day to get her Rx and learn how to administer the insulin.

I'll post her numbers again tomorrow after I get the readings, just thought I'd share the rest of the history, since she may have had/or may still have some sort of infection (ie antibiotics seemed to help for 2 weeks).
 
I'm really leaning towards her higher numbers being from an infection that is still brewing in there, given that the excess drinking and urination got better while she was on antibiotics but returned after they were finished.

I will be watching for her numbers this morning to see how she is doing.

Mel, Maxwell, Autumn & The Fur Gang
 
This morning's reading: 276.

Before food, and no insulin has been given since Saturday. If I feed her, I feel like she's going to jump into very high BG levels.
 
Steve

You must feed her though. I will defer to what ever Mel(Momma Of Muse) says as she has much more experience than I do. She has one diabetic cat and has had many in the past and has dealt with many issues with them.
Your cat could have infection in the teeth or possibly urinary, have they got a urine sample from her? Hopefully Mel will check in your post and your numbers throughout the day.

Terri
 
Do your syringes have half unit marks? If they do you can kind of eye-ball a .25u dose, that would give her something to help with the BGs at least for now. Especially since we suspect she still has an infection somewhere, she is going to need to eat and get some insulin so she doesn't start throwing ketones.

Also if you do go ahead and shot that .25u hopefully you will be around to test her throughout the day to make sure she doesn't start going too low again.

Mel, Maxwell, Autumn & The Fur Gang
 
She ate around 9:30 and I just gave her a .25u dose of Lantus now at 10:00. I'll be home all day to keep an eye on her and test her BGs.
 
Glad you were able to give her at least a token dose today, since her numbers are consistantly above the renal threshhold without insulin she clearly needs some insulin but probably not a lot.

I will be off and on all day today so I will keep checking in on you and Bailey. Just keep posting your numbers as you get them and I will do my best to help you figure out what is going on with her.

FYI I have 14 cats, two of which are diabetics although one has been in remission for the last 2 years, and the other is headed that way. I have some working knowledge of Lantus although my current insulin dependent girl is on Levemir, but the two insulins work fairly alike.

Mel, Maxwell, Autumn & The Fur Gang
 
Around 2 hours after breakfast and .25u her BGs are: 239

And a photo...

msdI6Ly.jpg


Edit: She had her morning BM and it was completely runny. Nothing solid at all.
 
Steve- you will find that this is a wonderful place where you can talk food, poo, and pee all in one post and no one will think twice :lol:

And Mel is a really handy person to have around looking at your post- I think her Autumn was a .1u for a while (while my Sneakers drinks units by the dozen) so she knows the micro dosing.

Syringes with the 1/2 unit markings can be purchased at Wal-Mart- they keep them behind the pharmacy desk. Before you purchase open the box and make sure they are have the 1/2 u markings as it cannot be returned (no diabetic supplies can) one purchased. You can also order on line as well.

One thing with the poo- are you checking different foods to see which one Bailey likes? Sometimes the change of food will bring about different poo- either b/c it is unfamiliar or b/c is has an ingredient her tummy doesn't like. Sneakers throws up every time I give her Friskies or 9-lives (well, the lower carb% ones). And, yes, she was a full dry kibble girl from about age 7 to 16 until dx with FD.
 
Good she is coming down nice and easy today without diving into hypo numbers...Now with Lantus it can take you from 3-5 days to see the full effect of a set dose, so for now unless she gives you a number under 200 at preshot, just hold her on that .25u b.i.d (twice a day) and keep testing her when you can and lets see where she settles on that.

With the poo problem it could be as Heather mentioned the change in food, I know when I first switched all of mine over to canned from dry they had some really runny poop for a few days. A couple of things that helped mine were Fortaflora that you can get either online or from your vet and you just sprinkle it on her food like you would salt on your own. It is a probiotic and will help put the good bacteria back in her body. Also a little raw chicken a lot of times will help firm up the poo.

I wouldn't worry about it if she only has the runs for a few days as long as she is eating and drinking well, but if it continues for more than a few days then she probably needs to see your vet to make sure she doesn't get dehydrated. You can even mix a little warm water into her canned food to help fill her up and make sure she is getting plenty of fluids. As cats are designed to get their water from their food and have a very low thirst drive. Just about none of mine drink from their water bowls since I started to add water to their canned food.

Mel, Maxwell, Autumn & The Fur Gang
 
Thank you Terri, Heather, and Mel!

She has been on the Purina DM for a little over a month now so her stomach should be adjusted by now. Her BMs were solid up until Saturday. They've been a bit runny since then though. I have been mixing in water with every meal to make sure she is staying hydrated. She hasn't really touched her water bowl since we made the switch to wet food.

I will keep an eye on her and test when I can. I'll be sure to report the numbers as well.
 
Purina DM is an okay food as far as carbs goes, but it is way over priced for what you get...Everyone here at my house eats exactly what my two diabetics eat, just plain old fashioned Friskies Pate style canned cat food. Occassionally Autumn (my insulin dependent girl) will get Fancy Feast Classics, but with 14 mouths to feed I'm just not opening that many 3oz cans 4 times a day to feed them all FF.. :lol: Seriously though you can get her far better food off the grocery store shelves for less than half the price as the DM and there is nothing magical about it, in fact the ingredients are pretty substandard, it is mostly liver and I know with my bunch not one in 14 would touch it after the novelty wore off. You can always take it back to the vet and get your money back just tell them that Bailey stopped eating it.

She is absolutely stunning, such a pretty girl. :-D As the folks here know I have a soft spot for the long haired fluffy ones well those and meezers.

Mel, Maxwell, Autumn & The Fur Gang
 
Check my signature link on Secondary Monitoring Tools for info on urine ketone testing, plus some other tactics for assessing your cat.

We find feline diabetics often may have other digestion-related problems :
- inflammatory bowel disease, where the intestines are all inflammed and tends to result in diarrhea
- hepatic lipidosis, when there insulin is insufficient so fat is broken down, the liver can't handle it, and the cat becomes jaundiced (yellow)
- pancreatitis, where the entire pancreas is inflammed, may have erratic production of enzymes, and the cat may vomit, and/or refuse to eat
 
6 hours after breakfast .25u: 267

I had thought it would have kept dropping a bit especially around the 6 hour mark. The 267 was rather surprising.

- inflammatory bowel disease, where the intestines are all inflammed and tends to result in diarrhea
- hepatic lipidosis, when there insulin is insufficient so fat is broken down, the liver can't handle it, and the cat becomes jaundiced (yellow)
- pancreatitis, where the entire pancreas is inflammed, may have erratic production of enzymes, and the cat may vomit, and/or refuse to eat
Click to expand...

-IBD may be a possibility. She's had diarrhea/liquid stool since Saturday with no explanation. She's been under no additional stress and is on the same diet.
-How would you test for hepatic lipidosis?
-The vet has mentioned getting an ultrasound for pancreatitis though. For the 30ish days she's been on a new diet/insulin, she's only thrown up on one of these days (and it was 3 times within a 12 hour period) but that's it.
 
For pancreatitits the vet can do a SNAP fPL Idexx test in the office to see if it is suspected that kitty has it.
If a cat had Hepatic Lipidosis the cat will be very sick, sometimes vomit, will not eat anything as BJM said could be jaundice but not always.
Vet can also do blood tests in the office to see if liver values ALP are elevated. they can always do ultrasound for either of these disease but there are blood test they can start with in the office that are cheaper.
If she is eating and not vomiting this is good. Appetite is a good thing. I lost my diabetic cat to pancreatitis and another cat shortly thereafter to hepatic lipidosis.
If she continues to have diarrhea you might call the vet and ask them for some metronidazole for that.

Terri
 
Note not all vets will have the SNAP fPL Idexx test. Then may have to sent out the blood for the test.
terri1962 said:
For pancreatitits the vet can do a SNAP fPL Idexx test in the office to see if it is suspected that kitty has it.
If a cat had Hepatic Lipidosis the cat will be very sick, sometimes vomit, will not eat anything as BJM said could be jaundice but not always.
Vet can also do blood tests in the office to see if liver values ALP are elevated. they can always do ultrasound for either of these disease but there are blood test they can start with in the office that are cheaper.
If she is eating and not vomiting this is good. Appetite is a good thing. I lost my diabetic cat to pancreatitis and another cat shortly thereafter to hepatic lipidosis.
If she continues to have diarrhea you might call the vet and ask them for some metronidazole for that.

Terri
Click to expand...
 
+6 for nadir is a ball park figure some cats are their lowest earlier and some later, and nadirs can and do move around some. Plus with Bailey you have just started her back on Lantus after not being on it for awhile, she has to build her shed up again which takes a couple of days to do. So she may have some kind of wonky numbers until she settles on the dose and her shed is completely filled again. It is pretty common to not see much action from the first shot or two while that shed is filling.

Basically Lantus builds up little time release crystals under the skin, in the beginning only about 10% or less is going to the cat to help lower BGs the rest of the dose is just sitting there waiting to be used or filling up the shed. Once that shed or depot is full then with each shot given she will start getting the full dose to use to lower her BGs. Sometimes it is helpful to think of it like filling a funnel, you want to pour the water fast enough to keep the level in the top of the funnel at the same height without going so fast that you spill over the top (what causes hypo) or too slow so that the level is dropping in the top of the funnel.

Mel, Maxwell, Autumn & The Fur Gang
 
Bloodwork elevations in liver enzymes and bilirubin typically ocurr with liver disease.
 
Bailey had a significant amount of blood work done before the diabetes diagnosis. The vet called it the "Cadillac" of blood tests. I'll have to ask for a copy of the results, but I believe everything came back rather normal.

Here are Bailey's evening numbers. This is about 12 hours after the morning shot and breakfast.

She's currently at 216. A .25u dose was given to her (since she was still above 200.)
 
Good job lets see how she settles out on that dose but that's not too shabby of a preshot number at all for just starting her back on insulin.

Mel, Maxwell, Autumn & The Fur Gang
 
Well, it seems like every time I think I have a grasp on the numbers, Bailey throws me a curveball. I was hoping for low 200s, or just under 200 so no insulin was needed.

This morning, before breakfast: 58. No dose was given.

Still no solid BM either. I'll be picking up a case of Fancy Feast Classics:Turkey & Giblets today and plan to start getting her on that instead of the DM.
 
Absolutely the right call on no insulin today...but boy what a pretty number to wake up too.

Steve when you get a chance can you get a spreadsheet set up for her and linked to your signature? It will help a lot for others to help guide you on her dosing. And you are always welcome to come over to the Relaxed Lantus board and post there. I normally watch that board, but I can keep popping back and forth to watch out for you over here as well.

That normal number this morning is making me think more and more that she may still have an infection that is clearing. Either that or she is going to be a little microdose kitty. My girl was on .1u for awhile until she had her dental done and went on antibiotics that drove her BGs up due to the sugar in those antibiotics but we are already back to .4u So if you need to start microdosing Bailey I can help you figure that one out to.

Mel, Maxwell, Autumn & The Fur Gang
 
Thanks Mel. I setup the spreadsheet correctly (I think) and have it linked in my signature.
I did go out any buy some FF Classics this morning. I gave Bailey a small lunch to try it out and she loved it. She's sitting at my feet currently begging for more.

I was able to get a +4 reading and she was at 127.

I'll try and move my postings to the Lantus board as well.
 
Not too shabby for not having any insulin this morning...she maybe fairly high this evening but we can deal with that if it happens. Yeah my gang all love Fancy Feast but they only get it for special occasions because with 14, I'm too lazy to open THAT MANY 3oz cans on a daily basis..lol

Spread sheet looks great except that it is the reverse order which is no big deal for me I can read it either way, but most put the newest data at the bottom instead of the top. So you might want to make a note in your signature that it is in the reverse order so if someone else looks at it they will know ahead of time to read from the bottom up.

Mel, Maxwell, Autumn & The Fur Gang
 
Steve

There is a Relaxed Lantus board and a Lantus board. You probably want to post on the Relaxed Lantus board so Mel can help you. The Lantus board follows a Tight Regulation Protocol which is a little different.
Also might want to call the vet and ask them for a presription for Metronidazole for the diarrhea.

Terri
 
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