Yoda: Worrying that I'm doing something wrong

[Karthur]

On June 25th, my cat Yoda was diagnosed with diabetes. He is an 8-year-old gray tiger who I've had since he was a baby. He's a sweetie and I need to brag on him for a minute. I am a bad asthmatic and with my husband out of the country, I'm living alone. One of my other cats had knocked my rescue inhaler off the nightstand. I had a bad attack and was crawling around trying to reach it in the dark, while wheezing and wondering if I needed to call 911. Yoda went under the bed, picked it up in his mouth and brought it to me. It was amazing!

Anyway, I'd noticed he'd been losing weight, but I thought it was a good thing because my vet had all five of my cats on a weight-loss diet. Then, I saw him pee in my bathtub and in the 8 years I've had him, he's never missed his box--not even when we had to drive 14 hours across country! I called the vet immediately and brought him in.

We've been doing Lantus. We started at .5, increased to .75 and now we're at 1.0 starting tomorrow. He's eating Hill's Prescription W/D, 1 can per day and W/D dry food is available, too, since I have five cats and they all "graze." Three of them really need to be on weight-loss-control

The vet dilutes the insulin so I can draw it easier but I read today that's not a good idea. So, when I bring him the home test I'm going to do over the next three days, I think I will say something about that.

I started home blood testing today because he gets too worked up at the vet for the tests to be any good. The vet did a urine sample today and he had "trace" amounts of ketones. His blood glucose 2 hours after his shot (in the vet's office) was 416 and when I did it at home about four hours after the vet visit, it was 311. He may have been agitated during that first home test because I was pretty stressed. I'd pricked myself a few times to practice, but I was still worried I'd mess up on him.

He's not drinking or peeing excessively and he's moderately active--I just watched him play with the kitten. I've noticed he's eating more, but I'm wondering if that's because this food is so low-cal in comparison to the Purina One he used to eat.

Is it normal for cats to have numbers like that after 1 month of treatment? Is it possible the diluted insulin isn't doing him any good? Any advice in general?

Thank you. This site has been a valuable resource so far!

 

[Ronnie & Luna]

Hi there,

Welcome to the FDMB!

Yoda sounds like a very special cat, to have helped you like he did.

I'm going to add some links for you about handling Lantus. And no - you don't want to dilute it, shake it or roll it. Please read this link:
Proper Handling & Storage of Lantus/Levemir

So how does Lantus work? With data collection (spot checks thru a cycle) you'll see how it's working on your cat.

This chart might help you with a curve and spot checks.
You can find this chart in the Lantus forum stickie New To The Group I've included all the links for Onset, Peak, Duration etc.

Learn how YOUR kitty is responding to insulin:
Onset ---> the length of time before insulin reaches the bloodstream & begins lowering blood glucose
Peak/Nadir ---> the lowest point in the cycle
Duration ---> the length of time insulin continues to lower blood glucose

How to do a Curve: you don't have to test every hour. Typically curves are every 2 hours in a 12/12 cycle. Or a mini-curve, about every 3 hours.
Depending on where the numbers are, you may have to re-test frequently and offer food to help steer numbers.

Example of a typical curve:
+0 - PreShot number. (AMPS +12)
+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.
+3 - Lower than the PreShot number, onset has started.
+4 - Lower.
+5 - Lower.
+6 - Nadir/Peak (the lowest number of cycle).
+7 - Surf (hang around the nadir number).
+8 - Slight rise.
+9 - Slight rise.
+10 - Rising.
+11 - Rising (may dip around +10 or +11).
+12 - PreShot number. (PMPS +12)

Carryover ---> insulin effects lasting past the insulin's official duration
Overlap---> the period of time when the effect of one insulin shot is diminishing & the next insulin shot is taking effect
Insulin Depot ---> (aka "storage shed" in Lantus Land) "spare tank" of insulin, which has yet to be used by the body
More on the Shed ---> Lantus & Levemir Insulin Depot AKA Storage Shed


About the diet, you'll want to read thru Dr Lisa's Feline Nutrition site. Prescription dry food is kitty crack, does not help control diabetes. In fact it causes it in majority of the cats passing thru here, including my own. Right now my cat Luna is diet controlled on a low carb wet food diet after spending only 3 months on Lantus.
You'll want to read the section on Dry Food Transitioning as well in Dr Lisa's site. Very important section.
Dr Lisa's Feline Nutrition

With multiple cats it can be a challenge to get them to eat the same food, the way I see is, I have two cats, one was diagnosed with feline diabetes, I was sent home with expensive dry vet food for both my cats. Until I found this site, I realized then - I don't want two diabetic cats. So both went on the low carb diet.
As long as dry food is available to Yoda, the numbers will reflect that.

The vet canned food is just as bad unfortunately, way higher in carbs than the store brands. Compare the carb content in the food charts linked below.

Have a look thru this link for low carb wet food alternatives. Many of us use Fancy Feast, Friskies, Wellness and others as noted in the food charts.
Much better and cheaper alternatives.
Janet & Binky's Food Charts

You will want to keep an eye on ketones, you can purchase a kit at any pharmacy and test your cat at home when he uses the litterbox.

Hope this info helps, please feel free to ask any more questions you may have. Lots of people can help, just check back often for new replies.

 

[missyandlittlegray]

I'm assuming you got the insulin from the vet since it's diluted. Can you return it now and ask for a new vial? Take the package insert or whatever you've been reading with you and show it to the vet. Yoda needs insulin that's working effectively. When you have the new insulin, come back here for dosing advice. The undiluted insulin will work differently.

Many years ago, I had a cat on PZI, which the vet diluted so I could draw up small doses. He was on the diluted insulin for months, and it wasn't until I came here that I understood why I could never get him regulated and he needed higher and higher doses. Everything changed when I started using undiluted PZI. I imagine the same would be true with Lantus.

 

[Blue]

First, welcome to the site. Now that you are here, we can start to get Yoda feeling like his old kitty self again!

I don't understand the diluting of insulin so I can't really comment with any knowledge, but it does not seem logical to me. If the insulin is dilute then you really have not been giving the amount you are saying. Also, how is it mixed - you are not supposed to be rolling it, so how does this work?
Anyways, I would tell your vet you want to be using the insulin correctly at full strength, so get yourself a package of the 5 cartridges which will be cheaper in the long run.

Print out the handling info for Lantus and give it to your vet maybe.

Ronnie has given you some great info so I won't say too much.

For food, take away ALL dry foods from Yoda and if your other cats eat wet food, then you can get rid of it completely. Even the dry treats. Many cats are very sensitive to carbs; my Shadoe cannot eat even a small mouthful of dry food or her numbers go through the roof.
That bowl of dry for grazing may be contributing to Yoda's high numbers.
You should know that there are some kitties who are diet controlled - just by changing to low carb wet food with good ingredients has been enough to keep them in good numbers and have no need for insulin.
So food is really important.
Forget about the vet food; it's not good at all and WAY too expensive. You are better to go with the Fancy Feast or Friskies low carb foods, see the food chart Ronnie gave you, and have better ingredients and lower carbs and happier kitties. All around good as you will be happier too because you will have alot of your money still in your pocket.

Be sure to ask any questions you have; there is usually someone here to give you answers.

 

[Karthur]

Thanks for the advice! Yoda is doing better.

Thank you all for the advice! I spoke to the vent about diluting Lantus and we changed that, so now Yoda gets 1 unit every morning, undiluted. He's eating wet food (I'm using up the case of Hills W/D I bought) and then we're going to go to EVO, I think. I'm still not sure what to feed him because some of the foods in the store aren't on the chart and of course none of the "usual" brands post their nutritional info. Does anyone know if Friskies Indoor Chicken Dinner is okay? I recently bought some of that.

Yoda's numbers seem good. I did a curve on him last weekend and he was in the 200s for the entire day. The highest was 274 and the lowest was 234. The last urine test was okay, I guess--no ketones, but with a slight amount of glucose. (Lowest level on the stick)

My other kitties are also eating wet food now. I feed Yoda a full can in the morning and half at night. The others get just about the same. I still have to leave a bowl of dry out for one of the kitties (Nall) who just won't touch the wet stuff and won't eat with the others. (Nall is kind of a ninja that way...only eats when he feels he's alone...) I've been trying to mix some wet in with his food, but then he won't touch it and the others will go for it since they greatly prefer the wet stuff. But, I'm still trying to work on a strategy to convert Nall.

And...here's a picture of Yoda (gray tiger kitty) with his buddy Welkin, my 1 year old Oriental Shorthair.

Thanks again!
--K