10yo male just diagnosed with BG of 385

Discussion in 'Feline Health - (Welcome & Main Forum)' started by griam01, Jan 1, 2014.

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  1. griam01

    griam01 Member

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    Hi my name is Amy from re Pittsburgh, PA area. My kitty Jack who is at least 10 years old (he was a stray) was diagnosed with diabetes. He was drinking a lot if water and going to the bathroom a lot so we took him to the vet. His BG was 385 and he also had a cold. The dr gave an antibiotic for the cold and glipizide and switching him to friskies Pate for his food. I have 2 other cats that I am switching to friskies as well now. I read a lot that tr glipizide is not good. I have only given him 2 doses but he seems tired. He is eating his new food but I am worries that the glipizide is doing more harm than good. Should I discontinue the glipizide immediately and just adjust the food and see how his results are next week at the vet? I don't have a meter yet but will get one ASAP. Thank you all I'm advance or your help. I am worried and overwhelmed by this. I may be reading into his symptoms too much too now that I know of his diagnosis.
     
  2. Sue and Oliver (GA)

    Sue and Oliver (GA) Well-Known Member

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    385 is not a terribly high number considering he was at the vet. But a combination of no insulin, and aninfection can lead to DKA, a dangerous condition. We don't advocate Glipizide; we think it makes the liver work harder when it is already taxed by the diabetes.

    If he were mine, I 'd get the supplies for home testing and start that, get ketone strips and test for ketones, and stop the pills. If his blood glucose levels don't improve with a wet low carb diet, then yes, insulin is best.
     
  3. Sue and Oliver (GA)

    Sue and Oliver (GA) Well-Known Member

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  4. griam01

    griam01 Member

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    Thank you for your comments. I have been reading all day today since we received the diagnosis yesterday. I did just give him his 3rd dose of the glipizide. My husband says that he seems the same as before. He plays some and is eating and drinking. I understand what the glipizide does and am worried that it could be harming him. Could the antibiotics be causing any harm with glipizide? He is on clavamox. The vet said it would be fine but this is the same one that prescribed the glipizide. He was having some sneezing with flem but no fever. He hasn't sneezed today at all. I will get the testing supplies tomorrow and try that and see where we are. I don't know if I will be able to get a good ketone since he doesn't like to go when you watch. Can I dip it in the clump able litter to test immediately after he goes to get an idea or will that be completely invalid? Thanks agin for your advice.
     
  5. Sue and Oliver (GA)

    Sue and Oliver (GA) Well-Known Member

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    Oliver wouldn't go while we were watching either. We put aquarium gravel in a clean box and left him in the room with it. He'd christen the box and we could swoop in and get in and get the sample because it wouldn't be absorbed.
     
  6. jeanene and chase

    jeanene and chase Member

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    You could try putting a layer of Saran Wrap over the litter box, but that might discourage him from using it. Getting the testing supplies and checking his numbers tomorrow will be a big help in knowing what's going on with Hom.
     
  7. griam01

    griam01 Member

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    I will try something. Out of curiosity is the insulin for cats the same for humans? Like if I had samples from a drs office would that work for the cat?
     
  8. Sue and Oliver (GA)

    Sue and Oliver (GA) Well-Known Member

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    There are two human insulins that work for cats : Lantus and Levemir.
     
  9. BJM

    BJM Well-Known Member

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    Glipizide does not help the pancreas to heal (something human's pancreas cannot do.) Really, really suggest you stop that and follow a good insulin protocol with low carb diet for the best chances of getting him off the insulin at some point.
     
    pixiegirls & Boy likes this.
  10. griam01

    griam01 Member

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    I didn't give the glipizide this morning. I also have a call into the vet to discuss doing something else. Problem is we are getting a lot of snow and cannot make it out to get the testing supplies. He is still eating, drinking and going to the bathroom. The bathroom visits seem to be producing less urine, more like a normal amount I used to see, not flooding the litter box like the past month or so. But he doesn't seem to be as "peppy" as he once was. Maybe it is the cold he has that his body is fighting off as well as the antibiotics he is on? He did play with some catnip and a string for a bit last night too. He is purring and came to bed with us (between our pillows) as usual. Again, maybe I am reading too much into it (yes, I read the letter from my cat again, I needed it :) ). Thank you all for the advice so far. I truly appreciate it!!!
     
  11. griam01

    griam01 Member

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    Well, I still haven't heard back from the vet, so I called again and they said he should be returning calls soon. But I had them fax me over Jack's original lab results so I could find out what the big picture looked like. The good new is that there are no ketones, but the glucose in the urine is 3+. I have attached a screen print of the results if someone could look at them and let me know their thoughts. I don't know exactly what I am looking at. Thanks again for all your advice and support.
     

    Attached Files:

  12. griam01

    griam01 Member

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    I heard from the vet finally last night, he said that the glipizide works more often in male cats with a lower BG and no ketones about 30% of the time. He said he prescribed it because it was new years eve and there was nothing else that could be done that last minute. We are headed back today to have his BG tested and determine where to go from here. I have noticed that his urine output does not seem to be as much as previously and the dr. said it could very well be because of his cold/infection that caused his BG to raise and that now he is being treated for that it may be coming down. Praying and crossing my fingers.
     
  13. KPassa

    KPassa Well-Known Member

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    I'm no good at reading medical charts but there's a cheat sheet somewhere online for it (I can't seem to find it now). Hopefully someone will be able to link you to it. :D

    Glipizude is not good for any cat, regardless of whether or not they're male or female.

    How is the diet and testing going? Hopefully it's just the infection causing elevated BGs and you'll be able to see them come down with the food change.
     
  14. griam01

    griam01 Member

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    We went to the vet today and this vet (the original vet not the one that prescribed the glipizide) looked at him. He gained an ounce in 4 days and his BG went down from 385 to 300. She wants him off the glipizide and to continue with just the diet change and monitor him. He was noticeably more social and upbeat earlier today. Urine output is more normal amounts but I am going to continue to monitor him and see how he does with everything. He goes back next Monday (10 days) for another blood test.
     
  15. KPassa

    KPassa Well-Known Member

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    That sounds like a good plan. If he needs insulin, make sure to get one of these three insulins: Lantus (glargine), Levemir (detemir), or PZI/ProZinc.
     
  16. BJM

    BJM Well-Known Member

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    1 oz weight change can be elimination related, ie, not a true weight change.
     
  17. griam01

    griam01 Member

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    Well..I have been testing Jack all weekend and did get a urine check in there. Ketones are still negative. His BG has been down except for one reading yesterday afternoon it said 360. This morning it was 121. It has been progressively better each draw, except for that one, so not sure if it was a bad reading or his numbers spiked. He seems better and almost back to his old self. He has one more clavamox pill today to take. I wonder if the clavamox is messing with his numbers too. I have been testing him twice a day, first thing in the morning and then sometime in the afternoon after a meal, should I be doing it more, less? We have tried 2-3 meals a day, they are adjusting. My big cat is "starving" by morning, but doesn't seem to eat all of his meal during the next two meals if I give 3 meals. Jack eats consistently during all the meals and my other cat keeps looking at me like where is the dry food, but does eat the wet food. Jack does seem to be coming back to regular routine. He still sleeps, but he is a cat. Yesterday he crawled up on my husband like usual and wanted held, and last night cured up on my chest under my chin. That was a usual for him, always a cuddler.

    Thank you again for all of your support and comments, I truly appreciate it.
     
  18. BJM

    BJM Well-Known Member

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    Very often, about 2 hours after eating, the glucose spikes. If the pancreas is working, the glucose will start to decrease after that.

    Spreading food out thinly on a large plate, and/or freezing some to be nibbled as it thaws will slow the glucose from spiking as much and put less burder on the pancreas. In other words, it is OK to leave the canned food out for 10-12 hours at a time.
     
  19. griam01

    griam01 Member

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    Thank you for this info. I wish I could leave it out. Unfortunately, my dog (with food allergies) will clean that plate faster than anything the minute the cats step away. Then he will break out. Its a tricky balance at eating at this house between the cats and the dog. LOL
     
  20. griam01

    griam01 Member

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    Well, his levels are not decreasing, they seem to be all over the place, unless I am doing something wrong with testing. Here are his numbers, let me know your thoughts.

    Initial at DR. office 12/30 11:30am 385
    Follow up at DR. office 1/3 3:30pm 300

    The rest are home readings

    1/4 12:11pm 260
    1/5 9:02am 268
    1/5 4:37pm 361
    1/5 7:13pm ketone negative urine test
    1/6 9:01am 121
    1/6 6:13pm 271
    1/7 12:09am 235
    1/7 8:15am 326
    1/7 12:32pm 273
    1/7 11:52pm 263
    1/8 8:57am 311

    Thank you again in advance for all of your assistance. I truly appreciate it.
     
  21. Sue and Oliver (GA)

    Sue and Oliver (GA) Well-Known Member

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    Well, the 121 was a nice number, but the others are higher than we like to see. We consider a cat not in diabeitc numbers if they range from 40-120 off insulin. Is he still on the glipizide? What are you feeding him?
     
  22. griam01

    griam01 Member

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    He is no longer on the glipizide as of Friday. We are feeding Friskies (Mixed Grill, Oceanwhitefish or Turkey and Giblets) wet exclusively since the diagnosis. There is no dry at all, so I have completed moved them all to wet food. I know the Fancy feast is better carb wise, but the vet said that these were must less than the dry food I have been feeding and that that is what she feeds her cats. She didn't recommend the vet food either. She said that on average I am staying below the 10% carb values which is good.
     
  23. Sue and Oliver (GA)

    Sue and Oliver (GA) Well-Known Member

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    They look okay. Here is the food chart:

    http://www.catinfo.org/docs/FoodChartPublic9-22-12.pdf

    You can feed lower - under 8 - but it is harder because you need to stay away from fish too often. So it usually means alternating flavors from different brands , which may be more expensive.

    What is your vet saying about starting insulin?
     
  24. griam01

    griam01 Member

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    We don't go back to the vet until Monday, which I am sure they will start it at that time. Do you think Monday is too long to wait to go to the vet? I am supposed to work tomorrow and Friday and she is not in over the weekend. I am sure they will start insulin on Monday as we did already discuss it. They said if his number are not down below 250 and staying there and decreasing that we would start. I have insulin here ready to go (my mom works for a dr's office so I was able to get Lantus from a drug rep.). When I discussed insulin with the vet, she said they would start Lantus and she how he does.

    You don't know how much I want to start it on my own today, but I am sure that is not advisable. :(
     
  25. griam01

    griam01 Member

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    As for the food, I know Friskies has rice in it, which is a high carb, but I also see that the 9 Lives has several that are VERY low carb and I could try those, but I thought I read that those have rice or something that I should stay away from too. The issue is that I am trying to feed 3 cats, so that is 3 cans a day total, which is adding up. If I get Fancy Feast which I have heard is highly recommended for feline diabetes, then that is 6 cans. I am trying to do what is best for him and all the rest. I am open to any suggestions. I will not go back to the dry food, but I have to factor in costs somewhere. I know I am very lucky to get the insulin, so maybe I can adjust with the food somewhere.
     
  26. Sue and Oliver (GA)

    Sue and Oliver (GA) Well-Known Member

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    Since you are hometesting, you could ask the vet if you could start on a small dose (maybe .5) and monitor carefully. Don't shoot under 200; get midcycle numbers. It would be better if you could monitor the first few days so the weekend would be best for your schedule, but I get that your vet wouldn't be available. But would Monday pose the same problems as you wouldn't be home to monitor?
     
  27. griam01

    griam01 Member

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    My husband and I both technically work from home for the most part. He travels occasionally for his job and I make sure I am home when he travels (for our son), so one of us is almost always here (rare occasions someone is not). So, he is back tonight and I have to go into the office the next 2 days to handle a few things there. I could probably get away with only going one day this week and staying home the other again, but my husband can monitor too. I found a chart for the Lantus of starting numbers and was wondering if I should start even lower than that.
    BG
    US ( mg/dl)   Metric (mmol/L)      Dose
    150 - 250.......8.3 - 13.9............0.25u 
    251 - 400......14.0 - 22.0............0.5u 
    400 +...........22.2 +.................0.75u

    I haven't worked out my schedule for next week to determine which days to go into the office, because I usually do that around my husband's travel schedule, so I am pretty flexible at this point and could work around this.
     
  28. Sue and Oliver (GA)

    Sue and Oliver (GA) Well-Known Member

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    Lantus is not my insulin. I'll post on the Lantus forum and see if someone can come over to guide you. (the Lantus forum is a good place to post daily as they all have experience with your insulin, but they will want a spreadsheet so they can see your history of numbers and dosing,when you want dose advice)

    Here is the spreadsheet info:

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

    It's a little tricky. If you need help, ask.
     
  29. Hi Amy,

    The starting dose on Lantus takes Jack's numbers into consideration, but also what he weighs can be important. So what is his current weight? And would you say he is currently under or over what his ideal weight should be?

    Also I wanted to be sure - he's eating low carb canned, he's been off Glipizyde since last Friday, and you can home test/monitor after the shots? Is he currently on any meds?

    Carl
     
  30. griam01

    griam01 Member

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    Jan 1, 2014
    On Friday he was 10lbs 1 oz, I can tell he has lost some muscle mass, as I can feel his vertebrae more than before, but he doesn't feel malnourished.

    He is off of glypizide since Friday
    He finished his Clavamox (7 days worth) on Monday
    No other medicine


    He is on Friskies pate wet food only. I did just realize I have been reading the incorrect column when judging what Friskies to give him. :( So it is lower carb than the dry food (which he went off of since 12/31). I will be switching again tonight after I can get to the store. I took the chart online and converted all the numbers onto a spreadsheet to determine what I can get at my local walmart that would be best and elimiated all fish foods. I know I will need to check the ingredients when I get there, but it looks like the following would work for me, thoughts?

    DRY MATTER % kcals/ 5.5 oz

    Brand Group Flavor P F C Phos DM kCal
    Fancy Feast Poultry Turkey and Giblets Feast 53 33 3 1.69 94
    Purina ONE Poultry Chicken Pate 52 31 3 2 93/3 oz
    Purina ONE Poultry Turkey Pate 50 23 3 1.77 95/3 oz
    Fancy Feast Classic Chicken Feast 50 23 4 2.1 91
    Fancy Feast Tender Liver & Chicken 50 23 4 2.3 80
    Fancy Feast Kitten Tender Turkey Feast 50 27 5 2 92
    Fancy Feast Tender Beef Feast 50 18 5 2.2 93
    Fancy Feast ∞ Chunky Chunky Chicken Feast 50 18 5 2.2 90
    Purina ONE Beef Beef Pate 50 23 5 2.05 95/3 oz
    Fancy Feast Chunky Chunky Chopped Grilled Feast 50 18 7 1.6 94
    Fancy Feast Chunky Chunky Turkey Feast 50 18 7 2.2 87
    Fancy Feast Tender Beef & Liver Feast 48 23 5 2 94
    Fancy Feast Tender Beef & Chicken Feast 48 27 6 2.1 94
    Fancy Feast Classic Chopped Grill Feast 45 27 5 2.3 91/3 oz
    Friskies Special Beef & Chicken Entrée 45 32 6 1.1 181
    Friskies Special Beef & Liver Entrée 45 32 6 1.1 181
    Friskies Special Turkey & Giblets Dinner 45 30 6 0.8 166
     
  31. griam01

    griam01 Member

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    Jan 1, 2014
    That pasted horribly.....basically it is sorted by order of amount of protein (highest at top) and all are under 7% carbs.

    I realized I missed answering a question...I can monitor after the shots, or my husband can. I will need to train him. :)
     
  32. griam01

    griam01 Member

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    I called into the vet and gave them Jack's numbers. She asked about how I am doing the blood tests, etc. She said she will call in the insulin script and will call me back later with instructions. She told me that once I start with the insulin that I am not to test at all for the first week. She said that the numbers will go up and down and it will not change the dosing at all, that she will not change how much or how little she gives. She didn't sound thrilled that I called and wanted to change things and start on insulin. I am worried about not testing for the first week, I would have thought it was critical to test during this time, please help me understand!
     
  33. KPassa

    KPassa Well-Known Member

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    You're right; you should be testing the first week! :thumbup Yes, with Lantus, the first 5-7 days the numbers will fluctuate greatly or will remain relatively high, so most of your data might be "off," HOWEVER, your cat can still drop low and/or have a hypo! If at any time Jack drops below 50, that is considered an automatic dose reduction. Only way to tell if he drops below 50, even in the first week, is by testing.

    Besides, it'll be a good time for practicing your testing. ;-)
     
  34. griam01

    griam01 Member

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    Jan 1, 2014
    Once I start, how often should I be testing, etc? Thank you!
     
  35. KPassa

    KPassa Well-Known Member

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    The Friskies Pates are fine, although they're a bit higher in carbs (8%) than the Friskies Special Diet.
     
  36. KPassa

    KPassa Well-Known Member

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    I recommend at minimum four tests a day:
    • AM Pre-shot to know if it's safe to give insulin. If he's below 200, you do not want to give insulin but post here first for advice. We will usually tell you to not give the shot or food, but to stall for 30 minutes and test again to see if the number is "rising." Then, depending on how close to 200, you might skip the dose, give a reduced dose, or give the full dose.
    • Mid-cycle test when possible (some days, I can't because of work). With Lantus, it "peaks" (the lowest point in the cycle) at around 5-7 hours. Some cats and even some cycles might have an earlier or later nadir/peak, so any test you're able to get about halfway (4-8 hours) through the 12-hour cycle will help pinpoint the low point.
    • PM Pre-shot to know if it's safe to give insulin. Same as the AM shot: if he's below 200, don't feed, don't shoot, but post here for advice first.
    • Before-bed test. This usually gives a heads up to how low he might be going overnight while you're asleep. Depending on this number, you might want to set an alarm in the middle of the night to test later or leave some medium carb food out for him to graze on if you're not going to be around. Cats react differently across each cycle, so it helps to get numbers across the entire day/night instead of just one cycle.

    Then, any other tests you're able to get simply add data on how the insulin affects Jack, how food impacts his BGs, if he has an earlier or later nadir, etc.... When first starting out, the more data, the better. :mrgreen:
     
  37. griam01

    griam01 Member

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    Jan 1, 2014
    Well, they called in Lantus and instructed to give him 1u every 12 hours and to not test his BG for a week. After the week, run a curve (take a draw, feed, insulin, then test every 2 hours 6-8 times). Please everyone let me know your thoughts on this, because from what I read online that 1u is a lot of Lantus for him and I am worried. Maybe I am wrong, I would rather hear from someone who is using it. THANK YOU!!!!
     
  38. KPassa

    KPassa Well-Known Member

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    1u is actually a fairly good starting dose for most kitties. Since you're testing, you'll see fairly quickly if it's too much/too little. In your case, with the recent switch to wet and most of the numbers under 300, I have a feeling it might be a bit too much and might even suggest starting with .5 or .75u instead. I'll wait for others to offer their suggestions.

    And ignore her about not testing the first week. If you were diabetic, do you think your doctor would just prescribe you insulin, tell you to take it a week, and not test your blood sugar? Besides, how is she to know whether or not you're testing?
     
  39. I agree on ignoring the "no test advice". Home testing is a very powerful tool in managing the treatment, because it let's you know at any given moment how things are going.

    And a usual starting dose can be 1u for many kitties. The weight-based formula is ".25u per kg of lean body weight", every 12 hours (AAHA guidelines for dosing). So it would be logical for a ten pound cat. Many people will start at .5u though. It is easier to start low, monitor what happens, and increase if needed based on the results over 5-7 days. I'd probably go with .5u to start. I tend to want to err on the side of caution.

    Do your syringes have half-unit markings?
     
  40. griam01

    griam01 Member

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    Jan 1, 2014
    I would prefer to err on the side of caution too. I thought 1u was too high. I would prefer to start with the .5u. The syringes I have are the Monoject 3/10mL 29Gx1/2" I show they start at 5 with the smaller lines below which I assume the first line is the 1u mark and then smaller marks inbetween which would be the 1/2 markings?

    I planned to ignore her testing advice, but wasn't sure how overboard I should go with testing. I was also curious how other Lantus mommies did this. Test in the morning, food, then give insulin and test every 2 hours after that?

    I truly appreciate all of your assistance!!!!
     
  41. Here is a link that will show you the syringe scale with and without 1/2 unit markings.

    http://www.bddiabetes.com/resource.aspx?IDX=2210

    It sounds to me like your's would match the scale on the left?
    If so, then yes, the lines to the right of the vertical center line would be whole unit marks, and the lines to the left of center would be the 1/2 unit marks.
    So you would be drawing up to the first line on the LH side.

    What you describe is what we would call a "full curve" - testing before the shot, and then every 2 hours after the shot. People don't do that every day of course, but when first starting, every three or four hours is a good idea. The first couple of days with Lantus might not tell you a great deal, as her body will most likely be adjusting to her first shots of insulin. But the point is that you will be gathering data that will help you to understand how the insulin is working, while at the same time checking to make sure her BG doesn't drop lower than you might think it will. Some cats respond pretty quickly, while others take a few cycles to show you some sort of pattern. We say "ECID" a lot here (every cat is different) because every one of them really is. There are general things you might expect to see, but each case is somewhat unique.

    Your plan is to start with insulin on Monday? By then, maybe you could post on the Lantus forum and people will know to keep an eye out for your posts and answer any questions that come up during that first cycle. Posting here is fine too, as long as you let folks know your plan so they can watch out for your posts.

    Carl
     
  42. Oh, and if you haven't been pointed there yet, there is some great info specific to Lantus found on the "Tight Regulation" forum in the "sticky threads" towards the top of the front page.

    Here is some info from the New to the Group sticky:
    http://www.felinediabetes.com/FDMB/viewtopic.php?f=9&t=18139
     
  43. griam01

    griam01 Member

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    Jan 1, 2014
    Thank you very much. I will be starting Friday/Saturday because that will put me at a longer stretch at home that I can monitor him and do the testing.

    My plan is to start with .5u and test and record his numbers and go from there.

    I am curious about the cost for Lantus, I went to pick it up at Walmart and it was $230. Is that average, is that high, I was just curious what everyone else's thoughts are.

    I truly appreciate all of your assistance and guidance, I am truly grateful for all of you.
     
  44. BJM

    BJM Well-Known Member

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    Oct 6, 2010
    That cost is similar to what others have seen for the vial in th US. The pens, typically sold in a 5 pack, are better, even with the upfront cost, because effectiveness doesn't drop before you finish a pen, whereas you might find the vial becoming less effective and not emptied by 6 months out.

    There are some savings plans out there if you Google for Lantus Savings card, etc.

    On a per unit basis, it is less expensive than ProZinc.
     
  45. griam01

    griam01 Member

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    Jan 1, 2014
    Thank you, I could also do Levimir, does anyone have any recommendations/issues with one over the other?

    I currently have a "sample" pen from the drug rep for Lantus, I haven't opened it yet, since I will be starting this weekend, but was wondering how long this will last me approximately?
     
  46. KPassa

    KPassa Well-Known Member

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    Oct 23, 2012
    Levemir is a great insulin as well. Some cats even seem to do better on Levemir over Lantus.

    Michelangelo is currently on 2u BID of Lantus and a pen lasts me to the last drop, about 2-4 months (depending on dosage). We just started a new pen on New Year's (last pen was started on 10/18).
     
  47. griam01

    griam01 Member

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    Jan 1, 2014
    I started my first this morning. We fed at 8:15ish and I gave him his first does of .5u of Lantus at 8:30, I will test every 2 hours and update the spread sheet.

    I read about all the locations to give shots, where does everyone give their shots, I see they talk about alternating, etc. I gave this shot in the scruff. I read about the slower and faster absorption rate as well. I wasn't sure if I put in other locations ( flank, side, back) do I do the same as the scruff and tent the skin and inject? I also wanted to make sure I was doing it correctly being a first timer. I did read that you should leave the shot in for a count of 10 after injecting before removing, which I did. Also, when getting the Lantus from the vial, I just put the syringe in and withdrew the amount needed and recapped for about 10 mins until they were done eating. I didn't shake or anything, is that correct? I don't know how to see if there is a bubble or air in there since the dosage is so small.
     
  48. griam01

    griam01 Member

    Joined:
    Jan 1, 2014
    Jack's numbers have come down nicely, but I know that they may continue to drop, I am going to feed them lunch soon because I don't want them to go too low either, I know it will take a while to even out, but I am so glad I did not follow the dr's advice and give him 1u.
     
  49. Deb & Wink

    Deb & Wink Well-Known Member

    Joined:
    Jan 31, 2013
    When Wink was still on insulin, I shot mostly in his flanks, all the way back towards his hips, alternating sides AM and PM. You can do only one side if that is easier.

    Yes, still tent the skin and inject. Easier when the cat is skinnier to tent the skin on the flanks or along the sides.

    As long as you get the shot it, you don't really need to hold for a count of 10. Just press firmly on the plunger so you are sure to get that tiny amount under the skin. Before you draw the insulin, moving the plunger up and down, to spread the lubricant helps the plunger to move more smoothly. With the vial, draw up a bit of air into the syringe, put the syringe in the vial, inject the air into the vial, and then turn the vial over to draw out the insulin. Keeps the pressure equalized in the vial. You may want to draw up a tiny bit more than the dose, in case you have air bubbles.

    Leaving the filled syringe out for 10 minutes is no problem. Keep the vial refrigerated to make it last longer.

    Correct, no shaking required with the lantus insulin. It's not a suspension, like the cloudy insulins (Prozinc, Humulin).

    Try pointing the filled syringe, needle up towards the ceiling. Give the barrel of the syringe a couple of quick "flicks" with your fingers. This should move any bubbles to the top of the syringe. Magnifiers may help you to see if there is a bubble.
     
  50. griam01

    griam01 Member

    Joined:
    Jan 1, 2014
    Thank you Deb, I will try the flanks this next time I think.

    One thing that I have read about Lantus is that you don't want to put air into the vial. I am actually using the pen and withdrawing from the pen and not a standalone vial, but they said putting air into it would mess it up? Again, just reading the internet. :) Maybe there is a difference with the pen and vial which is why you cannot do that. I need a magnifying glass for sure to read those numbers!!!! :)
     
  51. Deb & Wink

    Deb & Wink Well-Known Member

    Joined:
    Jan 31, 2013
    To clarify on putting air into a pen or a vial

    Vial - yes ok to put air in. You need to even out the pressure for the insulin you withdraw.
    Pen - no do not put air in. The pens already have a positive pressure in them. It helps for humans that use the pen needle tips and the dial a dose feature and actually "pushes" the insulin out of the pen.
     
  52. griam01

    griam01 Member

    Joined:
    Jan 1, 2014
    Thank you for the clarification!

    I do have a question, I have Jack's spreadsheet updated in my signature. Since this is my first time, if his numbers do not go over 250 when I do my +12 reading and ready to dose again, should I do the 0.5u again or should I lower it to 0.25u? I don't know what to do and I am due to dose within the next 10 minutes. Please help. Thank you!!!
     
  53. BJM

    BJM Well-Known Member

    Joined:
    Oct 6, 2010
    Lantus dose adjustments are based on the nadir - the lowest glucose level between shots. It should go no lower than 50 mg/dL in cats diabetic for less than 1 year.

    We want you to post here if your pre-shot test is < 200 mg/dL so we can guide you safely. To shoot under 200 mg/dL requires knowing how low the glucose is going first, to make sure if is safe for the cat.
     
  54. Deb & Wink

    Deb & Wink Well-Known Member

    Joined:
    Jan 31, 2013
    Since this is your very first day giving Jack insulin, and you already got a BG of 67 at +4, this 0.5U dose may be too high. Lantus is a depot insulin, so the dose you give in one cycle does not all go to work immediately. Once the depot builds up, you will start to see the full effects of the dose you are giving. This usually takes 3-5 days.

    With that steep drop from 309 at AMPS to 67 at +4, I'm concerned this 0.5U dose may be too much for Jack, especially with the cumulative nature of the dose.

    Are you able to monitor this evening? Testing at +2 would be a great idea. If Jack is a lot lower at that time, you may need to monitor through the night to keep Jack safe.

    If it drops too low, you need to give some higher carb food to raise the numbers up. If that happens, go back to your very first post, click on edit,change the post icon to the 911 icon, and submit the change. Then, add a new reply to your post and let people know what is going on.

    It's only the very first post where the heading and posting icon change and show up on the board. Otherwise, it's buried way down in the psot, and those of us that scan the board may easily miss that you have a urgent need. If there is no one on here on the Feline Health forum, please post a new topic with a 911 icon over in the Lantus TR group. Lots of experienced people and west coast people there, up much later than us east coast folks. There would be someone there to help you.
     
  55. Marje and Gracie

    Marje and Gracie Senior Member Moderator

    Joined:
    May 30, 2010
    Deb asked me to check in on you. If you could post a +2 test, that would be great. I'll be looking for your number. :D
     
  56. griam01

    griam01 Member

    Joined:
    Jan 1, 2014
    I did dose .5u, but I think it was a little skinny of a dose, as I thought there was an air bubble in it and when I twisted the syringe a little more came out then what I thought, it is really hard to see those lines with that small of a dose. I need to find a magnifying glass. :)

    I will be up through or around his +7 tonight as I have to do some work from home tonight. I will be posting his +2 numbers in about 10-15 minutes when I take them so they are a true +2.

    Thank you again for all of your help!!! Truly appreciate it!!!!
     
  57. Marje and Gracie

    Marje and Gracie Senior Member Moderator

    Joined:
    May 30, 2010
    Sounds great.
     
  58. griam01

    griam01 Member

    Joined:
    Jan 1, 2014
    I posted his +2 and they are higher than when I dosed him. I wonder if he barely got any insulin because of my mistake. I will be up to test him, what should I look for if he keeps rising? Even without insulin previously he has not been over 361 since I adjusted his food, or is this normal, since his body his adjusting to receiving insulin? Here are his previous numbers prior to starting insulin:

    Initial at DR. office 12/30 11:30am 385
    Follow up at DR. office 1/3 3:30pm 300

    The rest are home readings

    1/4 12:11pm 260
    1/5 9:02am 268
    .....4:37pm 361
    .....7:13pm ketone negative urine test
    1/6 9:01am 121
    .....6:13pm 271
    1/7 12:09am 235
    .....8:15am 326
    .....12:32pm 273
    .....11:52pm 263
    1/8 8:57am 311
    .....1:47pm 274
    .....10:22pm 311
    1/9 6:22am 309
    .....6:47pm 289
    .....11:15pm 286
    .....11:22pm ketone negative urine test
    1/10 6:28am 306
    .....6:42pm 311
    1/11 12:10am 294
    .....8:15am 309.....this is the morning I started the insulin

    I would appreciate your advice, thank you!
     
  59. Marje and Gracie

    Marje and Gracie Senior Member Moderator

    Joined:
    May 30, 2010
    When our kitties are diagnosed, we don't know how long their BGs has been high. But their liver had adjusted to those numbers so when we give insulin, and the BG comes down quickly or lower than what it deems as normal, it reacts by dumping counterregulatory hormones and glucagon into the bloodstream bringing the BG back up to where it feels is normal. We call this bouncing. All cats do it. Bounces can last for up to six cycles...but don't always.

    I think he's bouncing and you might see the numbers go higher than you've seen. Don't panic and whatever you do, don't dose on the preshot and a bouncy number. So if you see him really high at AMPS tomorrow, don't raise the dose :D

    If you want to get a before bed test, that's fine.

    Questions? :D
     
  60. BJM

    BJM Well-Known Member

    Joined:
    Oct 6, 2010
    I would stick with the 0.5 unit dose for now.

    Dose adjustments are based on the lowest number between shots (nadir).
    You want that no lower than 50 mg/dL.

    In about 5 days, this first dose level of Lantus will have stabilized. Then you review the next tests in the +5 to +7 hour period after the shot to evaluate the dose and if it needs adjustment.
     
  61. griam01

    griam01 Member

    Joined:
    Jan 1, 2014
    Thank you very much!!! I appreciate your comments. I will keep an eye out and I won't dose tonight. :) I will continue where I am at to allow for everything to level off. Thank you all again for all of your advice, support and talking off the ledge. :)
     
  62. Marje and Gracie

    Marje and Gracie Senior Member Moderator

    Joined:
    May 30, 2010
    You're welcome! If you get a number that concerns you, post and ask for help.
     
  63. griam01

    griam01 Member

    Joined:
    Jan 1, 2014
    His numbers increased through the night so I am assuming that I didn't get any insulin in him last night. He is coming down this morning after his first dose and his +2 so I will continue to monitor. I went back to injecting in the scruff. Just a little further down because I feel more comfortable there. I tried flank last night and didn't feel as comfortable. I will move up and down the scruff and back for now until I feel better about giving the shots.
     
  64. BJM

    BJM Well-Known Member

    Joined:
    Oct 6, 2010
    Remember, Lantus builds up. Keep a close watch in the +5 to +7 hours after the shot.
     
  65. griam01

    griam01 Member

    Joined:
    Jan 1, 2014
    Just did his +5 and it was 89
     
  66. BJM

    BJM Well-Known Member

    Joined:
    Oct 6, 2010
    Very nice!
     
  67. griam01

    griam01 Member

    Joined:
    Jan 1, 2014
    Not sure what to do his +12 is 111 from this last run. Do I dose him or no?
     
  68. BJM

    BJM Well-Known Member

    Joined:
    Oct 6, 2010
    Unless you can be home to monitor and test and intervene if he goes to an unsafe level, I would not shoot. You just don't have the data to show it is safe.

    He may need you to dose even smaller - 0.25 - which we eyeball on the syringe - or you may be fortunate and he may be able to get off the insulin.

    Or, try this: feed him and test 2 to 3 hours later. If it does not spike the glucose, he may be producing some insulin on his own.

    Glucose levels between 50 to 130 are normal for the diet-controlled diabetic cat and may not require insulin.
     
  69. griam01

    griam01 Member

    Joined:
    Jan 1, 2014
    I did feed him and tested him an hour later and he was at 220. I dosed him at 0.25u but I think I got a fur shot. :( I will need to keep an eye out and see if he continues to raise. :( I struggle with the 0.25u ones trying to figure out if I have enough in there.
     
  70. griam01

    griam01 Member

    Joined:
    Jan 1, 2014
    His +3 was 320, it is so frustrating to get a fur shot!!!!!!
     
  71. BJM

    BJM Well-Known Member

    Joined:
    Oct 6, 2010
    Been there, done that.

    Hang in there.

    A trick for the 0.25 - practice with a used syringe and some colored liquid. Carefully squeeze out equal sized drops. Count the number. Repeat until you can get the same number of equal sized drops each time.
     
  72. griam01

    griam01 Member

    Joined:
    Jan 1, 2014
    Thank you, that is a great tip, I will try that!!!
     
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