A 10-year-old cat diagnosed in June and a question about the (non)response to Lantus.

Hi everyone, I only found about this forum earlier today. I should've thought of Googling in English instead of just in Finnish before! This looks to be a quite long first post, so apologies in advance!

[Because I realise both health and nutrition products, medical practices and regulations and so forth are probably very different in here compared to USA, I have included some relevant links at the end of this post.]

Background: I'm Ville, from Finland, and my 10-year-old cat Sulo was diagnosed with diabetes in the beginning of June. We took him to the vet because the poor fellow's walking became somewhat wobbly, and he was stepping on his hocks with his hind legs. He was diagnosed with diabetes and, at least at that time, there were no additional inflammations or anything else. He's still walking that way (a condition which I learned is apparently called diabetic neuropathy). Initially he was prescribed with 1 unit of Lantus which was subsequently raised to 2 units by the vet after I supplied them with the first one-day blood glucose curve done at home. I'm now doing the second curve (1,5 weeks after increasing the dosage, because I had to wait to get more lancets) today and given the fact that we've followed the instructions on insulin injections a layman like myself. As instructed elsewhere on these forums, there's a link to Sulo's home tests in my signature. Because the meter shows mmol/l, I simply multiplied the result by 18 after reading a guide on this site.

Sulo has no problem eating. In fact, if it was up to him, he'd be eating all the time (mostly wet food). He also drinks quite a lot of water and we're actually cleaning the litter box several times a day. He's never been overweight but, instead, very slim despite being quite tall and long, hitting 4 kg (8 lb I think?) for the first time in his life when weighted at the vet in June. (When the cat was younger I used to call him a ferret because of the slimness). He is 10 years old now and sterilised though, so I guess diabetes hitting him makes sense. The cat started being constantly hungry last autumn and was also very restless and hyper-energetic. We took him to the vet (in another city than where we live now), but after quite extensive examination and blood tests etc. they couldn't find anything and said it was most likely due to stress from moving to a new place. No sign of diabetes or high blood glucose levels back then.

Cause of worry: Despite higher dosage, and following the recommended diet (more about it below), Sulo's results are higher than they were before. In fact, they're about as high as they were for the first time before starting the insulin injections.

Sulo is eating Royal Canin Diabetic food for cats, the only diet food for diabetic cats available at the vet. One that we were also recommended. I tried to look for it in the pdf chart found elsewhere on this website (it's great btw. I still have so many resources to check), but couldn't find it there so I presume it's not sold in the US. He has around 3 - 3,5 100g bags of wet food per day (in portions of 1/2 or 1/4, except in the morning when he usually gets one full bag or 1/2 before and 1/2 during the injection) and additionally has dry food of the same brand available all the time (which he nibbles every now and then, but not continuously - he's always been a wet food eater first and foremost).

I usually do the injections as my partner has tougher time trying to inject above the hind legs (our vet said the insulin wouldn't necessarily be absorbed that well if injected to the neck area). Our daily rhythm is as follows: my partner gets up around 6 am and feeds the cat, then around 8 am when I get up I give some more food and do the morning injection. Then he gets his evening injection at around 8 pm. I say 'around' because there might be 10-15 minute difference depending on work and other stuff partially beyond our control. Sulo has been to the vet twice for control and had the fructosamine tested twice (urine test were done in the initial vet visit that led to the diagnosis). The cat is okay with both the injection and the lancet when testing at home.

1. Am I panicing too early? Why there seems to be no response to Lantus? The pen only allowes increases by one unit. I will hear back from the vet early next week I suppose, after sending them today's completed curve, but I'm frankly quite nervous about not seeing any progress after more than a month of insulin injections.
2. Furthermore, should I be concerned about the state of the muscles in Sulo's hind legs? He clearly isn't using them as much as before (mostly lying around - and he used to be a very active and curious cat) and their condition hasn't really improved.
3. Is the food suitable? I have no idea what is a 'low' carbohydrate content (compared to 'high').

Thanks!

Links:
The blood glucose meter we're using (WellionVet Gluco Calea), same they use at the vet's:
http://www.wellion.at/en/animals-products/wellionvet_gluco_calea_bloodglucosemeter/

Picture of the Lantus pen:
https://5.imimg.com/data5/SN/XL/MY-13396819/lantus-solostar-500x500.jpg

The wet food (Royal Canin Diabetic Feline, the site is in Finnish, but 'Raaka-aineet', the nutritional information, seems to be in English):
https://www.royalcanin.fi/tuotteet/tuotteet/ruoat-elaeinklinikoilla/vet-diet-feline/diabetic

 

Welcome to the board Ville and Sulo. I read your first post with interest, and I am so glad you are home testing. There is a forum here for Lantus insulin users and I think it might be helpful if you posted there also. Here is the link:
http://www.felinediabetes.com/FDMB/forums/lantus-basaglar-glargine-and-levemir-detemir.9/
We have very knowledgeable and experienced members that have used Lantus and I have no doubt will be very helpful. Just copy the message posted here, go to the Lantus forum, start a new thread and paste.

 

Thank you for your response! I thought about just posting in the Lantus subforum but because I had other concerns as well, I figured I'd start from here. I will make another post there.

 

First, get rid of this!! The dry is about 32% carbs and the wet is about 21%....way too many carbs for a diabetic cat. Despite the fancy "diabetic" reference in the name, the prescription foods are lousy. Check the ingredients list! Mostly grains, some meat meal and then there's the infamous "powdered cellulose"....that's a fancy way of saying it contains sawdust.

Vets get hardly any education on nutrition (if they get any at all!!) and what they do get is sponsored by the prescription pet food industry (who are interested in ONE thing.....selling products!)

There are much better options....probably available at your local market. Here's a list of low carb foods available in the UK (and a lot of Europe) so hopefully you can find some better foods you can get in Finland

Make sure you are home testing before you switch though! Dropping the amount of carbs can drastically drop the blood glucose numbers!!

We don't use the pens as they are designed due to that problem. We buy regular insulin syringes and pull the insulin out of the pen so we can control how much we increase. Dose increases should be done in .25 unit increments, never whole units. The BD Demi syringes (3/10ml, 31 gauge) are what a lot of our European members use.

 

Thanks Chris! Yeah, I had a nagging feeling the food was way too high in carbohydrates. Cheers for the spreadsheet, some of those are indeed available in Finland either through Zooplus or actually sold at our nearby pet store.

 

Welcome! I just started using the Lantus Solostar pen. I am using the U-100 3/10ml syringes as noted above. This does allow for smaller dosing as there are 1/2 unit marks and you can eyeball to get 1/4 units. I also wipe the rubber seal with an alcohol prep pad, prior to draw, to prevent the introduction of germs into the vial. I pull out 5 units each time as this allows me to remove any bubbles from my syringe and get an accurate measurement (I am using 2 units). DO NOT push insulin or air back into the pen, just pull out what you want then remove the needle. Open pens are supposed to be kept at room temperature per manufacturer notes; I have noted a few people on this board keep their open pens in the fridge, not sure if that is advisable. ****You must use U-100 syringes assuming the Lantus on your side of the pond is the same over here in the States. There are also U-40 syringes. These are different doses. I do not recommend using a U-40 and converting, makes me nervous! Best wishes.

 

Thanks a lot! I'll look into the syringes tomorrow. Oh, and one thing I forgot to add is that I feel like there are some differences, not only in terms of veterinary practices or availability/control of medical equipment, but also in terms of culture between Finland and, say, the US. Here it is very, very rare to go against your vet's advice or improvise with the application of the said advice (same would apply if you went to see a physician about your own illness). You might, though, seek a second opinion from another veterinarian but, anyway, I constantly find myself also 'translating' all the advice and experiences I'm learning about while reading these forums (= What might this or that mean here?) Though the bottom line is, all I really care about is getting Sulo better again.

 

Huh. I don't now why my response is in the body of the quote.

 

The reason the manufacturer says to keep open pens at room temperature is because the "dial-a-dose" mechanism can sometimes "stick" if it's refrigerated.....But since we don't use the "dial-a-dose" and the needles that come with the pens, we keep it refrigerated at all times so it lasts longer than 28 days

 

Hi and welcome!

I totally agree with the advice to get rid of the Royal Canin food as soon as possible for the reasons already mentioned! Most prescription diabetic food is junk and has fillers and other awful stuff in it.

And, yes, better quality food and lower % of carbs can really lower the blood glucose numbers.

I used the Lantus pens for about 8 months and I had a similar experience with the dose getting higher and the glucose numbers getting higher and / or remaining elevated. We've been down a long and twisted path and I'm now using Lantus in the little bottle and regular U-100 syringes. While the Lantus should be the same, my cat is doing MUCH better on this Lantus vs Lantus in the pen. No one can explain why but it may be worth it for you to check into using the Lantus that is not in the pen.

My cat also has some neuropathy. I don't know the answer to your question but will be following.

Glad you're here. Keep us posted.

 

Thanks everyone! I'm really worried about the hind legs, but hopefully the vet will have some advice on what to do (except inject insulin). The cat used to be climbing and jumping all the time ('Sulo, no!' was such a common phrase in our household that the little beast probably thinks 'No' is just a nickname we've got for him), and sleeping in our feet in the bed or lying on our laps on the sofa. Now the only time he'll get on the sofa is if somebody's eating something he wants and on the bed only in the mornings to slap us in the face because he's hungry.

And Michele, true, vets can (and do) make errors. That's why I was so excited about this website and forum - to have a ton of practical information and experiences to draw from when judging what to do (and to share and talk about those experiences). But it's not easy for me to switch to that mindset to actually question the advice from the vet treating Sulo. Getting some really low-carb food today. We'll see how it goes!

 

Hi Ville, from the UK.

Just adding a few words to the responses you've had above ref vets and going against their advice... I think we are all conditioned to believe that vets are superior beings who know everything there is to know about animal health, so it can come as quite a shock to realise that they don't. Of course, they have been to vet school and studied and passed exams, but that usually just means that they're like our GPs - they know a little about a lot of things but not necessarily a lot about everything! I'm not into vet-bashing but I have seen some frankly shocking examples (via members on this board) where vets have demonstrated not only very little knowledge about FD but actually incorrect "knowledge". In most cases this comment relates to advice given about the best foods for diabetics, but also sometimes insulin dose; an error here can be downright dangerous.

It is very difficult to challenge our vets, but the more you read here and learn about the basics of FD, the better fixed you will be to discuss your learning with your vet - ideally you need to work together to get your kitty well again. Some vets are open to this, some aren't. If they aren't, you have a choice - follow what the vet says, do your own thing without telling the vet, or find a new vet. Many of us here have switched vets for one of these reasons. I myself switched vets when I wanted to try my kitty on a different insulin, after realising from what I'd read here that there might be better alternatives to what the vet prescribed (with poor results)... vet absolutely refused to take my request seriously so I found a new vet. Many of us here ignore vets' suggestions for food - that's not such a clear reason for switching vet, but it does show a lack of understanding of the disease and sounds a warning bell.

As I said, I'm not anti-vet. But the fact is that they have little actual training in FD, don't always understand treatment, and can sometimes get it wrong. And they are led by the pet food manufacturers when it comes to prescribing diet. So yes, it's not easy to suddenly realise that vets don't know everything, but having an awareness that they are not always right and do sometimes make errors will stand you in good stead as you embark on this FD journey. Ideally you want to find a vet you can trust and who will respect your own input.

Good luck and keep reading and asking questions!

Diana

 

Thanks Diana!

Just an update I'm going to add to this thread (and then make a new one next time there's something new): Sulo has an appointment with the vet tomorrow. They want to find out why the insulin isn't working as it's supposed to (ruling out other medical conditions, for example). I also asked about nutrition, and told the vet I'm going to stop giving dry food and focus on wet food with low carbohydrate (i.e. not Royal Canin). They didn't object to it, and even said it's fine to leave the dry food completely out. Apparently, according to the email response I got, the current recommended level of carbs here would be at maximum 3 g / 100 kcal (or 12% of all 'metabolised energy') - why clinics recommend Royal Canin remains a mystery (outside economic incentives).

 

Hi Ville. My vet was also anti wet food and even prescribing Lantus. I had to be referred to the RVC who are supposed to be specialists, but they dosed in 1 unit increments too and even suggested a sliding scale of doses. The only good thing they did was put Frankie on Lantus. When his dose got up to 8 units BID I decided to take matters into my own hands. The vet was shocked when I said I was putting him on a wet food only diet and no more fructosamine or dosage from her. She said she would have to research that, but I heard no more about it. She now freely admits that the whole practice is following with interest how well Frankie is doing (and my Rom who passed away a month ago from heart problems) and also is quite vocal about how I know much more than she does about feline diabetes. Oh, and Frankie's dose is now 0.5 units BID.