We're new :) and we need advice real bad

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Scratches123

Scratches123

Member Since 2019
I'm not sure if I'm even using this right. Brand new user, haha. My name's Alysha. My cats name is Scratches. She's eleven I believe. She just was recently diagnosed with diabetes about three weeks ago. I'm not super happy/comfortable with the treatment plan per her vet. Shes actually been acting less energetic than usual since starting the insulin and I'm quite concerned we're not going about her treatment correctly yet. Her vet put her on two units of lantus twice a day with her meals. I just started home testing yesterday. Her bg has been hanging out just above 300 or just under. But last night before dinner it was 167, so I opted to not give her the dose of insulin. Was this correct for me to do? How should I be feeding her? How many cans per day and just at shot times? How often should I be checking her bg. And how often should I be doing curves? I'm very new to this, so if you could answer in terms I would best understand, or explain to me what you mean if you abbreviate or use diabetic terms, that would be great :) . I don't want to miss my window of opportunity to find the best treatment possible for my kitty since shes just been diagnosed. I already feel my vet has messed up, sending me home with no information, just to blind inject my cat for weeks not even knowing what her bg was this whole time. Didn't give me any dietary requirements or excersize requirements. She also has neuropathy in her hind legs, which seems worse since being on insulin. My once very active, very crazy girl, now barely moves. I can tell she's still very happy, and can walk so don't get me wrong. She's fine, other than we need to get this diabetes under control before it causes any more damage. My vet told me that even though her bg was 167 last night, i still should have given her the dose of insulin after supper. I told her I won't be super comfortable doing that. Isn't 167 a decent number? Why would I shoot her with insulin if her number is good? Please correct me if i'm wrong!!!
 
Hi and welcome Alysha and Scratches. You found the right place to get answers to all your questions. Goodness, you are on top of this already, with testing. That's wonderful and congratulations.

You already have the signature set up. Next get the spreadsheet set up and the BG testing data you have so far entered.

You will see how the trends and patterns emerge, and members can review her progress before offering suggestions or advice:
http://www.felinediabetes.com/FDMB/threads/fdmb-spreadsheet-instructions.130337/
http://www.felinediabetes.com/FDMB/threads/understanding-the-spreadsheet-grid.156606/
 
Scratches123 said:
How should I be feeding her? How many cans per day and just at shot times?
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We recommend a low carb wet diet, either canned or you can consider home made. Whatever will work best for you and Scratches. What was she eating before diagnosis? What is she eating now, if you have changed anything. Unregulated cats aren't able to utilize the food they eat as well and are usually very hungry. We feed our sugar cats frequent small meals to help lessen that ravenous hunger and help prevent gastric acid problems from a very empty belly. You can use a timed feeder if you work and are away from home during the day, or for use at night too.

We use a FOOD CHART complied by Dr. Lisa Pierson, DVM from www.catinfo.org. Dr Pierson recommends " start with protein minimum of 40, fat maximum of 50, carb max of 10, and for cats with kidney issues....phos less than 300."
It's best to transition any diet change gradually, to prevent gastric upset and because introducing a low carb food can significantly lower the BG, and that might entail reducing the insulin dose correspondingly, after enough testing data has been gathered.

Here's the basic testing routine we recommend: (do what you can on work days - before bed is useful along with the essential pre shots)
  • test every day AM and PM before feeding and injecting (no food at least 2 hours before) to see if the planned dose is safe
  • test at least once near mid cycle or at bedtime daily to see how low the BG goes
  • do extra tests on days off to fill in the response picture
  • if indicated by consistently high numbers on your spreadsheet, increase the dose by no more than 0.25 u at a time so you don't accidentally go right past a good dose
  • post here for advice whenever you're confused or unsure of what to do.
We recommend removing food 2 hours before the AM preshot and the PM preshot tests, just so the test is not food influenced. If kitty is very hungry you can give a small snack at test time to make it easier.
 
I am trying to cut out the dry food. She was eating 1/4 cup meow mix indoor blend three times a day. plus two small scoops of sheba wet food. i just bought tiki cat dry food, which i am going to stop giving, and tiki cat wet food 2.8 ounce cans. says on the box to feed three to four cans per day. the vet just told me to only feed once at breakfast and once at dinner. should i feed in between as well? she also told me its not necessary to test mid day, but ive been doing it anyway because i figure whats the harm? and itll give me more information as to where her bg is throughout the day. my vet is no help. she doesnt get any food over night bc she eats it all at dinner time. i was giving her 1/4 cup tiki cat three times a day, breakfast midday, and dinner but have since cut out the mid day feeding. going to cut the dry food completely.
 
Scratches123 said:
She also has neuropathy in her hind legs, which seems worse since being on insulin. My once very active, very crazy girl, now barely moves.
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Getting Scratches' BG regulated is really going to help the neuropathy, but the addition of methyl B-12 aids the recovery.

Neuropathy: Feline Diabetic Neuropathy (weak back legs)

Look at this link: http://www.felinediabetes.com/FDMB/threads/help-for-a-newbie.219764/#post-2450580
regarding a lower cost methyl B-12 supplement alternative to Zobaline.

Since you are using Lantus, which is a very good insulin for cats, you should visit the insulin support group forum HERE and read the stickies at the top of the page. There is a whole lot of info there, Alysha, and no one expects you to learn and absorb everything right now. But start with the basics, ask Lantus related questions there in that forum, for example:
Scratches123 said:
My vet told me that even though her bg was 167 last night, i still should have given her the dose of insulin after supper. I told her I won't be super comfortable doing that. Isn't 167 a decent number? Why would I shoot her with insulin if her number is good? Please correct me if i'm wrong!!!
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The experienced and knowledgeable members will help you with the dosing questions, and the fellow Lantus users are a very supportive group.

Most of us had to read, re-read, and then repeat as things became clearer and more familiar. Scratches will benefit with all your efforts. It's a steep learning curve, but you aren't all alone out there hanging from a tree limb. :cat:
 
Scratches123 said:
I am trying to cut out the dry food. She was eating 1/4 cup meow mix indoor blend three times a day. plus two small scoops of sheba wet food. i just bought tiki cat dry food, which i am going to stop giving, and tiki cat wet food 2.8 ounce cans. says on the box to feed three to four cans per day. the vet just told me to only feed once at breakfast and once at dinner. should i feed in between as well? she also told me its not necessary to test mid day, but ive been doing it anyway because i figure whats the harm? and itll give me more information as to where her bg is throughout the day. my vet is no help. she doesnt get any food over night bc she eats it all at dinner time. i was giving her 1/4 cup tiki cat three times a day, breakfast midday, and dinner but have since cut out the mid day feeding. going to cut the dry food completely.
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We will want to gradually transition Scratches off the dry food. Are you home during the day to feed? As I told you, she's probably pretty hungry and even our sugar kitties in remission still get 3-4 small meals per day, with snacks and treats. I don't know about you, but I would really object to having only two meals a day, morning and night!

It is necessary to test during the day, your vet is incorrect. Lantus dose is based on the lowest BG in the cycle, that's the "nadir", and we suggest you test midday, and at other times during both day and night cycles. See Idjit's spreadsheet? He's in remission so we don't test alot, but you can see the +1, +2 columns. That's the number of hours since the insulin injection, and filling in those cells different times of the cycle on different days is going to let you know what's happening.

Would you consider, if you can afford, a timed feeder so that there is food available for her at night also? There are a couple of brands that feature a 5 compartment model, that you program to open at certain times. If you want to be sure that food is not available for the 2 hours before a preshot test, you just make sure the next compartment to "turn" is empty. CatMate and PetSafe are the ones I know about.
 
Scratches123 said:
i am going all in. shes really gone downhill since diagnosis and i need to get it right asap.
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Step by step, take your time, ok?..if you get in too much of a hurry, then you might miss an important step. I do know that this seems very urgent right now. I remember just being obsessed and frantically reading and reading, trying to figure out what to do next. Lost lots of sleep and it's a wonder hubby survived I was such a cranky grouch! But that didn't help Idjit. What helped was transitioning him off the dry, to a low carb canned food (we used Friskies pates and Fancy Feast Classics from the food chart), and we weren't even shooting the insulin correctly or testing correctly..you think your vet is clueless?? Ours was much more so. Our vet had us shooting once a day and recommended only testing midday a couple of times a week. Oh my!!!
 
Idjit's mom said:
Step by step, take your time, ok?..if you get in too much of a hurry, then you might miss an important step. I do know that this seems very urgent right now. I remember just being obsessed and frantically reading and reading, trying to figure out what to do next. Lost lots of sleep and it's a wonder hubby survived I was such a cranky grouch! But that didn't help Idjit. What helped was transitioning him off the dry, to a low carb canned food (we used Friskies pates and Fancy Feast Classics from the food chart), and we weren't even shooting the insulin correctly or testing correctly..you think your vet is clueless?? Ours was much more so. Our vet had us shooting once a day and recommended only testing midday a couple of times a week. Oh my!!!
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okay im starting to feel a little less lost. i just feel terrible for my little girl. should i follow the step that says for newbies, dont shoot anything less than 200 until i get more data and experience? i panicked last night when her bg was 167, like should i shoot, should i not shoot. i didnt.
 
I am not experienced with dosing, Idjit just slid into remission so fast I didn't get the hands on that most members do. But I think you did the right thing. You are going to need much more data for the veteran members to review to make recommendations. I see your spreadsheet, you just need to plug in how much insulin, on what date and the BG testing you have so far. You can't update the SS from the link in your signature, you have to go through the Google Docs/Sheets.

Of course you feel terrible, we all did/do, but what's important now is that you are doing something about it..something very postitive and proactive.
 
also, my vet told me shooting air into the lantus pen is totally fine. now ive just read that even that is wrong. almost everything shes told me to do is wrong. is she trying to give me a heart attack and kill my cat?? if i get an air bubble in the syringe, i squirt the bubble and some of the insulin back into the pen. should i get a new pen? ive only been using this one for a couple weeks, it would be a shame to have to throw it out bc of lack of instruction from the vet.
 
I have thrown a lot of info at you, and given you lots of links. Here's one that is particularly important for you to read, especially since your little darling threw you a lower BG number last night:

http://www.felinediabetes.com/FDMB/threads/new-how-you-can-help-us-help-you.216696/

Read it, if you can....print out the hypo instructions, get a hypo tool box ready. I hope you never need it, but it's better to be safe than sorry.

RE: the 167 last night..it's better to be high for a day, than too low for a minute. You did very well and have good instincts.
 
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Scratches123 said:
also, my vet told me shooting air into the lantus pen is totally fine. now ive just read that even that is wrong. almost everything shes told me to do is wrong. is she trying to give me a heart attack and kill my cat?? if i get an air bubble in the syringe, i squirt the bubble and some of the insulin back into the pen. should i get a new pen? ive only been using this one for a couple weeks, it would be a shame to have to throw it out bc of lack of instruction from the vet.
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I'm not sure about this, I would take this question to the Lantus forum and ask there. I did not use a pen.
 
Thank you for everything. So basically taking it slow is okay? i feel panicked to get everything done. should i start off with the diet change and just keeping track of her bgs? then i can step into the more in depth stuff? im very overwhelmed
 
Scratches123 said:
also, my vet told me shooting air into the lantus pen is totally fine. now ive just read that even that is wrong. almost everything shes told me to do is wrong. is she trying to give me a heart attack and kill my cat?? if i get an air bubble in the syringe, i squirt the bubble and some of the insulin back into the pen. should i get a new pen? ive only been using this one for a couple weeks, it would be a shame to have to throw it out bc of lack of instruction from the vet.
Click to expand...

Do not squirt the excess insulin back into the bottle. I copied the information below from Insulin Care & Syringe Info.
There is a lot of information there. Here is some of the highlights:

  • Do not inject air into cartridges or pens. Cartridges and pens are designed to work on a negative pressure principle.
  • If you draw up too much insulin in the syringe... squirt excess either into the air dramatically like they do on TV or into a paper towel... anywhere but back into vial/cartridge/pen. There is a silicon coating inside the syringe. It may contaminate the insulin vial with silicon.

For now, do not worry about an air bubble or two. It happens. Lantus is somewhat of a forgiving insulin and your Lantus is fine.
Just keep an eye out for the following:

How do you know when your insulin is no longer good?
  • When you lose regulation for no reason.
  • If you see any hint of "floaties"/"tiny particles"... discard the insulin.
  • If insulin is cloudy or discolored, or if rubber stopper is cracked... replace insulin immediately.
  • If the insulin has frozen, it's no longer good.
A vial of Lantus kept in the fridge and properly handled lasts longer than 28 days.
  • The manufacturer of Lantus recommends discarding the insulin after 28 days of use. However, with proper handling and refrigeration, many Lantus users have been able to use a vial/cartridge/pen for six months and longer. Some use pens and vials to the last drop.
I'm not sure where you live. Lantus is expensive in the US. You can get it much cheaper by ordering through Canada. A lot of people here do with good results. Here is that information.
 
Scratches123 said:
Thank you for everything. So basically taking it slow is okay? i feel panicked to get everything done. should i start off with the diet change and just keeping track of her bgs? then i can step into the more in depth stuff? im very overwhelmed
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Yes, absolutely!!! A popular saying here is “diabetes is a marathon, not a sprint” :cat: It is VERY overwhelming at first, especially when you come here and realize your vet has not given you good guidance (happened to me too!). Lou has given you lots of good advice to start with. Diet change is a good place to start, as that can help bring the blood glucose down, but it’s very important to test her BG because of this.
 
Idjit's mom said:
We will want to gradually transition Scratches off the dry food. Are you home during the day to feed? As I told you, she's probably pretty hungry and even our sugar kitties in remission still get 3-4 small meals per day, with snacks and treats. I don't know about you, but I would really object to having only two meals a day, morning and night!

It is necessary to test during the day, your vet is incorrect. Lantus dose is based on the lowest BG in the cycle, that's the "nadir", and we suggest you test midday, and at other times during both day and night cycles. See Idjit's spreadsheet? He's in remission so we don't test alot, but you can see the +1, +2 columns. That's the number of hours since the insulin injection, and filling in those cells different times of the cycle on different days is going to let you know what's happening.

Would you consider, if you can afford, a timed feeder so that there is food available for her at night also? There are a couple of brands that feature a 5 compartment model, that you program to open at certain times. If you want to be sure that food is not available for the 2 hours before a preshot test, you just make sure the next compartment to "turn" is empty. CatMate and PetSafe are the ones I know about.
Click to expand...
Also, scratches has no problem just eating the wet food. If I'm giving her the daily recommended dose of wet food, can I just take away the dry? Or does it not work that way? Like I said, she will have no issues with eating the wet food only.
 
It's best to reduce the dry a bit at a time, prevents tummy troubles and the chance that taking the high carb stuff away abruptly would lower the BG a little too fast. I'm glad Scratches likes the wet food, that's a gift and a feather in your cap. She is going to want to eat more than a non diabetic cat would want or need, as you get the BG regulated that should resolve. I know you want to "fix" it all right now, but it's a process and you will get there.
 
Welcome Alysha and your cute little Scratches!

Lou covered so much, she gave you all the basics and Kel full of info on insulin care.
As for the vet, unfortunately most of us faced the same issues as you; mine sent me home with insulin and dry food and told me to come back in a month to be tested...:woot:

Don't feel too stressed, take your time! Unfortunately I was on my way out, but I'll check on your post when I return.
 
Welcome Alysha and Scratches!!

You’ve gotten great advice from everyone! It looks like you’re already way ahead of the game: testing BG levels, spreadsheet set up, posting on the forum(you’re doing it right! ;)) transitioning to wet food, and giving Lantus. Awesome!

My initial thoughts about Scratches treatment plan is that the dose seems pretty high for a beginner dose. A typical starting dose with Lantus for a cat that has had his first diagnosis is 1u BID (BID=2x/day). Like Lou mentioned, there is an insulin support group for Lantus that you can post in where you can get Lantus specific guidance and feedback.

Since you are less than happy with your vet’s treatment plan, would you be open to trying one of our dosing methods here? For Lantus there are 2: Start Low Go Slow (SLGS) and Tight Regulation (TR) you can read information about both of these protocols HERE.

If you would like to try one of the FDMB methods, for now you would have to follow SLGS. That is because you are still feeding Scratches dry food and you can’t follow TR until kitty is on a completely wet diet.

Under SLGS you would start Scratches on 1u BID, hold the dose for 7 days / 14 cycles (a cycle is the amount of time between one dose and the next, because we give two shots in a day that means each day has two cycles) and then at the end of the week you would do a Blood Glucose (BG) curve (A BG curve is where you take a BG reading every two hours for 12 hours straight). Based on the lowest reading on your curve (aka peak or nadir) you can determine whether or not Scratches would need an increase or decrease in dose.

When we change dose we only increase or decrease by 0.25u at a time. Syringes with half unit markings make this much easier... do you know if your syringes have half unit markings? I believe the relion brand at Walmart are great and affordable options :)

If you find after you’ve transitioned to wet food that you would rather follow TR, that’s ok too! Whatever method you choose please add it to your signature so that members can provide relevant feedback :)

Skipping the dose for a reading under 200 was a smart idea for now, you need to gather data on how Scratches responds to insulin before you shoot lower numbers. Someday you’ll shoot numbers as low or lower than 167, but you really do need to collect data to understand Scratches patterns first. I agree you should get a hypo kit together in case of an emergency and have a good understanding of what to do in an emergency.

Because you’re following SLGS I think a curve once a week is fine, if you’re able to do more than one curve a week that is great too, the more data the better :). A tip from me is that if you do more than one curve in a week try to offset the two hour test schedule by an hour so that you can have a better idea of what is typically happening for your cat through the day.

For example:
Curve 1: AMPS, +1, +3, +5, +7, +9, +11, PMPS.
Curve 2: AMPS, +2, +4, +6, +8, + 10, PMPS.
AMPS- morning Pre-shot BG reading
PMPS- evening pre shot BG reading
+1,+2, +3 etc...- the amount of hours after the AMPS or PMPS

I know your vet told you 2 doses a day with food each time but did they let you know the importance of making sure each dose is 12 hours apart from the last one? Lantus typically lasts 12 hours in a cat, if you shoot any earlier than 12 hours after the last dose it can act like an increase and risk a dangerous situation. If you shoot later than 12 hours after the previous dose it can act like a dose decrease.

Lou gave you great info for food! You don’t have to break the bank for wet food, fancy feast or Friskies pâtés are perfect... the food list is an amazing resource. As far as exercise, the more exercise the better! It is very good for any cat to be well exercised but that is especially true of diabetic kitties.

One thing you might want to consider is testing for ketones. You can buy ketostix at any pharmacy for an affordable price, it is especially important to test for ketones if your kitty is constantly in high numbers, or when they seem really lethargic. Kitties with high ketones are at risk for diabetic ketoacidosis which is a really dangerous conditions. To use the strips you just dip them in some of Scratches pee and compare the colour on the strip to the colour legend that comes with the strips.

Come on over to the Lantus forum when you’re ready, it looks really intimidating at first but everyone there is really welcoming and will do their best to answer your questions. Ask as many as you want, re ask if you still don’t understand, we have all been in your shoes so never be shy!

You’re being an amazing caregiver! Scratches is so lucky!! Can’t wait to see Scratches progress :) good luck!!
 
Just back home! I think that with all above you're all set, but here is a quick recap:

- have your hypo kit ready
- changing wet food to dry;
- always test before AM and PM shooting; make sure no food 2 hours before those testings ;
- get a mid-cycle test and a before bed test;
- freeze dried treats after each testing;
- test for ketones when numbers are high (pink or higher) - Ketostix
- doing curves if you are going with SLGS protocol;
- update your SS so we can follow Scratches numbers and be able to help;

IMPORTANT:
- post regularly (as often as you can) on "Lantus and Levemir" Forum so we all get to know Scratches and are able to help and follow her! Even if you don't have much to say except her numbers! Make sure the history follows so we can backtrack; here is how we do it :

1. Click on Post New Thread;
2. Call up your previous condo (which is today's one) and go to the very top line of your browser's screen, where you will see the URL for the condo (www. felinediabetes.com etc. etc). Highlight this URL (right click on a PC; control click on a Mac). Click the "Edit" button and click "copy" (on some browsers, "copy" will automatically appear, so you don't have to click the Edit button).
3. In your today's condo write at the top of your post something like "Previous Condo", or "Yesterday". Highlight the word(s) you just wrote.
4. Go to the function bar at the top of the Lantus Forum and click on the symbol that looks like a chain link (7th symbol from the left). A dropdown box will appear asking for the URL. Go back up to "Edit" on your browser and click "paste". The URL will appear in the box.
5. Click on "insert".

Interesting chart (ECID: each cat is different)
+0 - PreShot number.
+1 - Usually higher than PreShot number because of the last shot wearing off. May see a food spike in this number.
+2 - Often similar to the PreShot number. Onset begins around +2 for most cats. You'll probably see an active cycle if the +2 is the same/similar OR lower than the preshot number. Continue testing!
+3 - Often lower than the PreShot number.
+4 - Lower.
+5 - Lower.
+6 - Nadir/Peak (the lowest number of cycle. NOTE: ECID. Not every cat has a mid-cycle nadir. Adjust the hours on this example to fit your cat.)
+7 - Surf (hang around the nadir number).
+8 - Slight rise.
+9 - Slight rise.
+10 - Rising.
+11 - Rising (one of the quirks of Lantus/Basaglar/Levemir: some cat's blood glucose numbers dip around +10 or +11... not to be confused with nadir).
+12 - PreShot number.

One last thing: take your time, this is not a race but a marathon and always remember that little sweet Sratches is your same little girl as before!! :bighug::bighug:

Will see you on L&L Forum! :)
 
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