2 weeks in, any assistance greatly appreciated

Hi everyone,

My cat Dio was diagnosed with diabetes on 4/9/11. He was in DKA ( could smell the ketones) with a blood glucose of 405. From his vet visit in March, he had lost down to 7.7lbs from 11.3lbs. I've beaten myself up a million times over it because I work as a critical care nurse. I had changed the dry kibble in the house to a weight loss formula and knew he had lost some weight, but didn't put it all together until I smelled his breath. We have three cats in our house and their weight was good, Dio looked like he was getting sick. Anyway, my vet did not keep him or give him iv fluids. I know that his severe dehydration should have been treated, but I didn't argue with the vet over this. I generally get "you know how to do this" from our vet. And, I really don't know how to do this.

I brought him home and began lantus insulin and blood glucose checks. The dose has been 2 units twice a day and the first week, he ran in the 400's consistently regardless of it being pre-meal or 6 hours post. The second week we increased to 4 units of lantus twice a day and he is running in the 300's consistently. He is eating 2-3 cans of classic fancy feast per day. In general, his personality is bright again, his eyes are bright, he is energetic. His fur looks good again. The ketones are gone from his breath, and his nose and skin are no longer dry. He is however, starving all the time. I'm trying to keep a strict schedule of feeding, insulin and blood glucose checks and he is the best patient I could ask for. He is the sweetest cat we have ever owned and I want to do the best I can for him. The vet has been less than helpful lately and I'm thinking I need to ditch him. I've done numbers, but he doesn't seem interested in helping us. He was on vacation last week, but left without checking on Dio (the only diabetic cat he has had in awhile). Maybe I just answered myself and he isn't qualified to treat him since he doesn't routinely treat diabetic cats? We are planning on having a meeting at the vet office Monday to hammer out our issues with the vet.

I guess I need to know if I'm doing ok right now? And, I'm curious about the spreadsheet I see on some of your posts. How do you use it and where did you get it from? Is it ok for him to be so hungry all the time and will this stop?
thank you for this message board and for any assistance you can give us.

 

Hello Meredith,
I can really offer no advice as WE are new to this as well and I have no idea YET if I am doing this right! BUT I do know that everyone here is great and offers wonderful advice, so stick around and see..... Your Dio is beautiful!
Hugs to ya! mom to Ms. Bean (sugar baby) Gumpy and Slappy

 

I'm sorry no one has responded yet. Must be the holiday weekend.

In short, he is starving all the time because his diabetes is unregulated. Although his condition has improved, he is most likely suffering rebound. Read about that here: http://petdiabetes.wikia.com/wiki/Rebound and also here: http://www.vetsulin.com/vet/Cats_Monitoring_Somogyi.aspx

You have a very good insulin with Lantus, give your vet kudos for that. However, it is much better to start with a lower dose, 1U is recommended. And jumping to 4U like you have can be all kinds of trouble. Finding the proper Lantus dose works best raised in only .25U increments. Yes, 1 quarter of 1 unit. One of the best guides you must read to help you understand how to use Lantus effectively is here: http://www.tillydiabetes.net/en_6_protocol2.htm although I would caution about using the ideal weight guide to determine starting dose. 1U is best to start with.

You can get insulin syringes in 1/2unit markings. Some people get theirs from Wal-Mart, but in some states you may need a scrip from your vet.

We have a section of this board called Insulin Support Groups. There is a very active forum there for Lantus users. You may continue to post here in Health, but it sounds like you have the basics of testing down - bravo! - and are probably ready to move on to specific help with using Lantus, so you may want to introduce yourself and Dio there. http://felinediabetes.com/FDMB/viewforum.php?f=9

For now, the best thing you can do is lower dose to 1U and essentially start over. Do you know you can use ketone test strips to test his urine, as continued ketone testing for a cat which has had them is extremely important especially when you are still determining dose.

You are doing excellent for 2 weeks in because you found our message board! It is sincerely the best place for a diabetic cat parent to be. The collective knowledge here is amazing.

Here is the link with everything you need to know/do to start up a spreadsheet. http://felinediabetes.com/FDMB/viewtopic.php?f=6&t=18207 It is in the Tech Support section of the board.

Hope I've helped somewhat. Have a happy Easter and keep asking questions. We'll help you help Dio!

 

Wow, so glad you started testing! That puts you way ahead. I agree with everything Vicky said. I just wanted to welcome you and add a voice here. You are blood testing and on Lantus, those are great starts. You are on a good, low carb canned food, another plus. In fact, with new diabetics, the combination is one that can bring them off insulin in some cases. Good thing you are testing as it will help you spot troubles.

I sure would keep testing with ketones strips too, since he was DKA.

 

Eek - 4 units bid seems quite high of a dose. I would suggest you take a curve or two over the next few days to get a TRUE snapshot of how the insulin in working: meaning doing lots of blood draws/reads over the course of a 12-hour cycle. You'd be able to see if the "rebound" effect is truly happening. By truly establishing the correct dose for your cat, you will also avoid having any hypo episodes. Could you do a curve and post the numbers for us?

 

High Meredith!

Is Dio still eating dry food along with the Fancy Feast? His dose is pretty high (most cats only need 1-2u). If you're still free feeding the other cats dry food and he's eating some of it, that might be keeping his BG high as well. If not, my guess would be that he's rebounding.

If he's acting hungry all the time, feed him however much Fancy Feast he wants, especially if he needs to gain a bit of weight. After he's regulated he'll act less hungry, and then you can settle on the right amount of food for him.

 

hi meredith,

i'm in the lantus support group forum and think you would do well over there. we'll help you get going and get Dio settled. everyone is in the same boat. i've just been doing it since February, but everyone there is a teacher and there are lots of experts.

good for you for getting the testing in and being on top of his care. Pop over there and open a new thread (we call them condos) and we'll be glad to help you with all the daily stuff of adjusting his dose and getting him healthy!

and the vet issue - i hear ya. it's a common problem and i have it too - i love my vet but am not positive he has enough experience with diabetic cats.

take care! julie (& punkin)

almost forgot: there are a lot of information stickies at the top of the lantus forum that are a wealth of information. you should be checking for ketones, probably, although i'm not an expert. read and re-read, especially this one for those new to Lantus:
http://www.felinediabetes.com/FDMB/viewtopic.php?f=9&t=18139

 

I posted a link to this condo in lantus, i hope you get some expert advice soon.

They have really helped me out alot over there. With their help, i got ta into remission in about 2 weeks after starting lantus.

 

Welcome Meredith and Dio!

I agree with everything that Vicky wrote. Although the starting dose of 2u may have been somewhat helpful because of the ketones it was probably too high and caused rebound to set in. I don't think that doing a curve on 4u is going to tell you much as his numbers are probably all high and flat trying to fend off that big dose. Dropping to 1u and letting that settle - and the rebound hormones wash out of his system - for 3-5 days and THEN doing a curve will tell you more. Of course, you will be testing before every shot and getting spot checks when you can.

Honestly, it does sound like your current vet is barely doing the basics. Maybe he really needed a vacation! But you might want to find a new vet anyway. And Dio may still need sub-Q fluids until he is better regulated and has gained some weight back. They will help to prevent dehydration and since he has had ketones, I think it might be wise. Just a small amount per day or every other day. You might start a new post asking about sub-Q fluid advice (in the subject line). I have used them for other things, but I don't have experience using them with a diabetic.

Here is a link to the thread about setting up a spreadsheet:
http://felinediabetes.com/FDMB/viewtopic.php?f=6&t=18207

That thread in in the Tech Support section (from the Board Index).

And, please, don't beat yourself up for not "seeing" what was going on. So many of us missed the signs as well. My Beau was just waiting for diabetes because he had chronic pancreatitis starting when he was 3 and was put on steroids for that - I also put him on weight loss dry food and thought "Wow, it's really working". Then suddenly he was too thin and flooding the litter box. He dropped about a third of his weight. So - time to just put that behind you and do what you need to to turn this around. With your background and help from this board I am sure you can do that.

 

Good afternoon guys, and welcome! I would echo what others have said... you're making all the right changes, but it sounds like your vet really doesn't have the experience with FD, let alone Lantus, to help you keep Dio safe from both DKA and hypoglycemia. Given the DKA issues, I'm concerned about dropping the dose from 4u to 1u... hopefully one of our experienced Lantus advisors will be along soon to provide you some guidance in that regard. I do think a curve, every 2 hrs for an entire 12 hr cycle, may be useful in at least confirming that the dose is too high. I would definitely test for ketones often when you can so as to ensure you don't get a repeat DKA incident. Fluids are most likely a wise choice as well.

The vet that provided our diagnosis was well-meaning, but clearly had not done her homework on how Lantus works. It is much different than the other insulins used by vets in the past, and unfortunately many of them hear about the new wonder drug at a conference but then don't do the leg work to fully understand it before handing it out to clients. They mean well, but may not have the time be fully up on FD. You may want to consider posting your general location.... one of our many members may be able to assist you in finding a more experienced vet more quickly. Willie and I have been following the Lantus protocol here since December, and I can tell you the folks here have been guardian angels. I have put Willie's life literally in their hands and I have always been steered in the right direction. His improvement has been remarkable!

I hope you will consider joining us over in the Lantus ISG. Everyone there is using Lantus or Levemir insulin (which work very similarly) and there is a ton of information that will help you keep Dio safe and getting him towards remission, or at the very least, regulated healthy numbers. We open a thread each day outlining how our kitties are doing, and you'll find in our signatures a link to our kitty's spreadsheets. It is nice to see how other cats have responded to insulin, and having a spreadsheet provides an easy way for folks to get full information when you're seeking advice, and they provide a great tool to provide to your vet as well.

So glad that you've found us here... I look forward to learning more about you and Dio!