Australia - Newly diagnosed

Discussion in 'Welcome to the Group - Post an Introduction Here' started by Linda Radley, Jul 31, 2015.

  1. Linda Radley

    Linda Radley Member

    Joined:
    Jul 30, 2015
    Hello,

    Newly diagnosed diabetic cat Aston, that I am trying to get stable and feel like I am fighting a losing battle.
    I have been searching this sight getting lots of useful and life saving information. What a great site this is!

    Vet started Aston on 10IU of long lasting Lantus. on 25th July 2015. Today I suggested that we change him to twice a day injections as his levels are all over the place. She agreed, however has given me Humulin insulin, as she did not have any Lantus.
    I am due to give Aston his first injection tomorrow morning (Australian time) and advised to give 4IU am and 4IU pm. I am not familiar with Humulin. What are peoples thoughts on the dosage level?? I do have a spreadsheet started, recoding his readings while on the LA- Lantus.
    Any advice appreciated
    Cheers
     
  2. Larry and Kitties

    Larry and Kitties Well-Known Member

    Joined:
    Dec 28, 2009
    10 or even 4 units is too high for a starting dose. The usual starting dose is 1 unit twice daily.
    Lantus is a lon lasting insulin.
    Humulin is Eli Lilly's trade name for a family of insulins with R being the fasting acting one and N being the slowest. It also comes in a mixture of N and R. N only last 8-10 hours so it is really not suitable for most cats.
    Just what Humulin did the vet give you?
    Most of use here test our cats blood sugar using a human meter. We test before each shot and periodically between shots
     
  3. Bron and Sheba

    Bron and Sheba Well-Known Member

    Joined:
    Feb 21, 2015
    Hi Linda,
    I live in Sydney. Welcome to FDMB.
    Where abouts in Australia do you live?
    Can you answer a few questions please so we can get an idea if your situation....thanks:)

    How much does Aston weigh?
    Have you been giving Aston 10 units of Lantus once a day?
    Have you been testing his blood sugar yourself, or has the vet been doing it.?
    What do you feed Aston? Canned or dry?
    If you could answer these questions it would be really helpful.

    10 units of insulin is a huge amount to give any cat, unless you have gradually worked your way up to that and been testing along the way.
    Why can't you continue to use lantus? Do you have any of the lantus left with the insulin you have been using since 25 July?y
    If the vet doesn't have any lantus, you can easily get some more at the chemist with a script from the vet.

    It sounds like your vet does not know much about feline diabetes to be honest.
    I would definitely not change to humulin insulin. It is a much harsher insulin and is shorter acting.
    I have had a look at your spreadsheet but there is nothing recorded on the sheet. Have you added anything yet?

    I am not experienced enough to give you dosing advice but I can alert some people who can help you a lot. Do not lose heart. You are in early days yet .

    Firstly if I were you I would get a blood glucose monitor from the chemist. They are about $40 and the strips are about $60 but you can get the strips cheaper on eBay once you get sorted. I use an Abbott Freestyle Optium monitor. There is also an Xceed in the same brand...both are reliable and good. And the strips are readily available on eBay. Then you can monitor Ashton's blood sugars and see the direction you are going.

    Secondly I would not start the humulin insulin at all and I would not give 10 units of the Lantus.
    Have you tested for ketones at all. You can pick up some strips from the chemist for under $10 .....they are for testing glucose and ketones.
    I will stay online til about 11 pm if you want to ask me any more questions.
    Again....welcome to this site...there are many people here who are only too willing to help you and Aston.:bighug:

    Aston is a beautiful kitty....what sort is he? Looks a bit like a Burmese from what I can see
     
  4. Voula

    Voula Well-Known Member

    Joined:
    Sep 15, 2014
    Hi Linda. As Larry said they are high starting doses. You can get a prescription from your vet and buy lantus at your chemist. I don't know anything about Humulin and can't give you any advice or opinion on it's use. Ten units of lantus is a very high dose and you would never just start a cat at that dose. The starting dose is between 0.25 units and 0.50 units per kilogram of ideal weight depending on blood glucose levels at diagnosis. For ten units of lantus your cat would have to weigh between 20 and 40 kilos and that is impossible for any cat to weigh that much. I would be seriously questioning your vet. The starting dose of lantus is described in veterinary literature and your vet should be able to look that information up if they don't know about it. I don't know about starting doses for Humulin so I can't comment on that. Hopefully more experienced members will reply soon. I live in Australia too. Welcome to the board to you and Aston too. Jacquie Rand is an Australian vet in Queensland who has written about a tight regulation lantus protocol and it is published in a veterinary journal that your vet should be able to access. Lantus is usually given twice a day but in some cats it can be given once a day but the protocol is based on twice daily dosing.
     
  5. Bron and Sheba

    Bron and Sheba Well-Known Member

    Joined:
    Feb 21, 2015
    Hi Linda
    I have just looked at your information page and see that you have an accu chek performa monitor...that is great...so you test yourself.
    Also Aston is a rescue kitty who weighs 4 Kgms and a Burmese boy.
    I see also that he was given steroids for mouth ulcers...steroids can induce diabetes in some cats.
     
  6. Linda Radley

    Linda Radley Member

    Joined:
    Jul 30, 2015
    Thanks Larry, Voula and Bron

    Bron I see you found the answers to some of of your questions.
    I fed Aston wet food twice a day - Fancy feast.
    I do still have the Lantus , it is called Lantus - glargine (rbe) long acting insulin.
    The vet said to give "5 to 10 IU when glucose greater than 18 and give if between 8 and 18 give 5 IU" of Lantus. Vet said she had given him 15 IU when she had him overnight when first diagnosed and I had been giving him 10IU once a day since 27th July.
    I am confused about the dosage now? Are you saying i can inject the long acting Lantus that i still have twice a day? and should give him 1 IU twice a day.
    The syringe I have can draw up to 30 units and it does not show 1/2 units. It has an orange cap, is this the right syringe ?
     
  7. Linda Radley

    Linda Radley Member

    Joined:
    Jul 30, 2015
    ok, I think I have fixed the spreadsheet problem now. Bron you should be able to view the data i have so far.
     
  8. BJM

    BJM Well-Known Member

    Joined:
    Oct 6, 2010
    CAUTION - too much insulin can kill your cat. Also, your vet is thinking Lantus works like NPH and the same way in cats as in dogs. That is not true.

    Yes, you can give, and should give, Lantus every 12 hours. No insulin last 24 hours in the cat.The cat has a more rapid metabolism and uses insulin faster.

    The orange capped syringe is correct. There are 30 unit U-100 syringes (orange cap) with half unit markings you just have to look around for the.

    For Lantus, a starting dose is often around 0.5 to 1.5 units per shot, based on the lower of current or ideal weight, in kilos (pounds divided by 2.2), multiplied by 0.25, then rounded down to the nearest quarter unit. Lantus has some carryover shot to shot which helps keep the glucose levels more consistent.


    We strongly advise home blood glucose testing with a human glucometer before each shot, and sometime between +5 to +7 hours post-shot, to monitor how low the glucose goes. On a human meter, it should remain above 50 mg/dL.

     
    Voula likes this.
  9. Bron and Sheba

    Bron and Sheba Well-Known Member

    Joined:
    Feb 21, 2015
    Hi Linda
    I also call lantus glargine....it can be called both names....it is the same long acting Insulin.
    The syringe I use is a BD Ultra fine 11 0.3 ml 31G x 8 mm
    It can take 30 units and has an orange top and 1 unit markings......no half unit markings. So it sounds like you have the correct syringe.
    The glargine is usually given twice a day every 12 hours. It works best when the dose is not changed except to increase or decrease after a certain number of days or decrease if the kitty goes low. You can read some of the yellow stickies on the L and L forum

    If you tell me what time you are due to give the morning dose I will alert someone so they can tell you before that time as to the dose you should give.

    Also where in Aus do you live.....just thinking of the time zones.

    The FF food sounds good. Check out this site part way down for Aussie food. Make sure the FF is the classic range with the gold band for low carb

    http://www.felinediabetes.com/FDMB/threads/food-links.133016/
     
  10. Bron and Sheba

    Bron and Sheba Well-Known Member

    Joined:
    Feb 21, 2015
    Yes I can see the SS. Great!:) Some of those readings are low especially the 1.8
    The 10 units is too much and you have earned reductions.
    Don't worry......someone will help you with the morning dose ....you will just have to log on before you give the insulin in the morning....let me know the time

    ETA we can't buy Half unit marked syringes in Australia BJM unfortunately. I just eye ball it
     
  11. Linda Radley

    Linda Radley Member

    Joined:
    Jul 30, 2015
    Thanks BJM
    I have been testing Aston BGL at home. I think I have fixed the spreadsheet to show the readings now. And yes, I did almost lose him a couple of times, now I know why?????
     
  12. Linda Radley

    Linda Radley Member

    Joined:
    Jul 30, 2015
    Bron I live in Dhurringile, Victoria and normally do his amps at 8am
    Yes I have the low carb tins of food, I actually found which ones to buy from the link you just posted. I did ask my vet about changing hid diet and she said no, don't change it, however being a diabetic myself I knew how important diet is, so went searching for info, which is how I cam across this site.
     
  13. BJM

    BJM Well-Known Member

    Joined:
    Oct 6, 2010
    Yes, I think you do know why you almost lost him. She could have killed your cat with incompetence.
    Refer your vet to Dr Rand at the University of Queensland for some much needed continuing education on feline diabetes. The Centre for Companion Animals has a number of free articles on feline diabetes for download.
     
  14. Bron and Sheba

    Bron and Sheba Well-Known Member

    Joined:
    Feb 21, 2015
    Same time zone as me...
    Ok, so before you give the insulin in the morning, log on and you should find some answers as to how much insulin you should be giving Aston. We always start low here and gradually increase so as not to miss the correct dose.
    What dose did you give Aston tonight at 8pm?

    @Wendy&Neko @julie & punkin (ga) @Chris & China @BJM
    Would you mind helping out Linda please with dosing for her kitty Aston. She is a fellow Aussie and has been told by her vet to give 10 units of insulin once a day. She has set up her SS and is using FF food and home testing.
    She would really appreciate some help with dosing. She is next due to give the AMPS which is in 10 hours from now (just looked up Vancouver time Wendy and it is 5.32am there at the moment so 10 hours on.)
     
  15. Linda Radley

    Linda Radley Member

    Joined:
    Jul 30, 2015
    Bron, I have not given Aston any insulin tonight as he had 10IU this morning???? My god i don't know how i have not killed him yet! So what do I do now? Should i inject tonight or wait until morning?
     
  16. Voula

    Voula Well-Known Member

    Joined:
    Sep 15, 2014
    From looking at your spreadsheet the dose is too high and your vet is seriously wrong with the 10 unit dose recommendation and also with the varying dose according to blood glucose levels as lantus / glargine is not dosed that way. It is so good you found this message board because your Aston would have been at risk of hypoglycemia from that insulin dose. The lowest safe glucose level when using a human glucometer is 2.8 mmol/L (50 mg/dL in U.S.) and any drop below 2.8 mmol/L or 50 mg/dL earns a reduction in dose. When using a glucometer calibrated for pets the hypoglycemia threshold where the cat earns a reduction in dose is a glucose level of under 3.8 mmol/L (68 mg/dL in U.S.). You have had too low readings every day. I will send you the link to the Roomp/Rand protocol to show your vet. I don't give dose advice but I would certainly not give Aston 10 units or even 5 units of lantus /glargine.
     
    Last edited: Aug 1, 2015
    Reason for edit: Edited to clarify the differences between human glucometers and pet glucometers as to when you need to reduce the insulin dose.
  17. BJM

    BJM Well-Known Member

    Joined:
    Oct 6, 2010
    I would skip tonight. Lantus makes little crystals under the skin which slowly dissolve to release the insulin. He's going to have a lot left to keep working.

    You might pick up some calipers to do the syringe measurements between units.

    And magnifiers will help you eyeball those, immensely!

    Ways to use Lantus effectively:
    Tight Regulation Protocol
    Start Low, Go Slow Protocol
     
  18. Bron and Sheba

    Bron and Sheba Well-Known Member

    Joined:
    Feb 21, 2015
    Yes I agree, skip tonight! Good call
     
  19. Voula

    Voula Well-Known Member

    Joined:
    Sep 15, 2014
    I don't give dosing advice but personally I would not give insulin tonight because lantus can sometimes last more than 12 hours and you risk overdosing with another 10 units or even 5 units. As the saying goes better too high glucose for a day than too low for a minute. If Aston has had ketones in his urine or gotten sick from very high glucose then I don't know but even then I would wait till the morning dose is out of his system before giving him any more insulin and as I said certainly not the dose he has been having till now. I would wait and do nothing until some more experienced people can offer their opinions.
     
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  20. Linda Radley

    Linda Radley Member

    Joined:
    Jul 30, 2015
    Thank you Voula.
    I feel sick about this! The medication the vet put Aston on for his mouth ulcers - Ovarid, which i believe lead to the diabetes being induced in the first place, did not help a bit and now I have put my cats life at risk for no gain at all.
     
  21. Voula

    Voula Well-Known Member

    Joined:
    Sep 15, 2014
    The link to the Roomp/Rand protocol is in the link that BJM posted to you.
     
  22. Voula

    Voula Well-Known Member

    Joined:
    Sep 15, 2014
    I am so happy for you that you found this message board.
     
    Linda Radley likes this.
  23. Bron and Sheba

    Bron and Sheba Well-Known Member

    Joined:
    Feb 21, 2015
    Don't beat yourself up about it. You only followed a professional's advice and did what you thought was best for Aston. You might want to look around and see if you can find a vet who know a bit more about diabetes. But know you are here, people will guide you and it will all work out. Best thing you did was join this forum!!
     
    Last edited: Jul 31, 2015
    Voula likes this.
  24. Linda Radley

    Linda Radley Member

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    Jul 30, 2015
    Thank you all.

    BJM the links are great. Thank you.

    Bron, good vets are hard to find, but i think i just found the worse one!. I think i will just stick with advice from this forum for now.
     
    Voula likes this.
  25. Bron and Sheba

    Bron and Sheba Well-Known Member

    Joined:
    Feb 21, 2015
    Hi Linda,
    I can see no one has answered re the dose. I am not sure what has happened as I alerted them and they are really good at answering them....and now it looks like they are not online.
    Can you tell me what the blood sugar level is when you take it this morning please?
    IF the BSL is BELOW 200 (11.1) do NOT give any insulin.
    If the BSL is above 200 (11.1) give 1 unit glargine. That is based on Aston being 4 kgms and giving 0.25 units per kgm
     
  26. Bron and Sheba

    Bron and Sheba Well-Known Member

    Joined:
    Feb 21, 2015
    @Sienne and Gabby
    I see you are online. Could you have a look at Aston's dosing please? I alerted some guys last night but something must have happened as no one answered. I have told Linda to give 1 unit as the AMPS was 20 minutes ago. I do not usually give dosing advice. Thanks.
     
  27. BJM

    BJM Well-Known Member

    Joined:
    Oct 6, 2010
    If you decide to go vet shopping, there are Vet Interview Topics in my signature link.

    Have you had a chance to read over the protocols and pick one?
     
  28. Linda Radley

    Linda Radley Member

    Joined:
    Jul 30, 2015
    Bron sorry I have had dramas. I also had lots of trouble getting blood, he was very agitated this morning.
    amps 17.5
    I will give 1 Iu as suggested
    Thanks
     
  29. Bron and Sheba

    Bron and Sheba Well-Known Member

    Joined:
    Feb 21, 2015
    Sorry about the dramas.........
    I am trying to find out what happened to the alerts, and why they didn't get through......
    Good you gave the 1 unit.

    Are you able to take a couple of BSLs during the day ...Say at + 4 and +6 ...that will give us an idea how things are going
     
  30. Linda Radley

    Linda Radley Member

    Joined:
    Jul 30, 2015
    Correction
    Sorry ironically my BGL are playing up as well and I have typed the wrong BGL. The amps reading was 19.5 not 17.5
    yes, I will test him through the day to see how he reacts to the dose.
    Thanks
     
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  31. Wendy&Neko

    Wendy&Neko Well-Known Member

    Joined:
    Feb 28, 2012
    Hello and welcome from me too. Sorry about the bad vet advice you got on the dose. You aren't the first we've had arrive here with a cat on way too much insulin. Thankfully you have done all the right things, are home testing and Aston is still here.:bighug: You got some good advice to back him down to 1 unit to start. However, I do want to warn you that it could take a while for the 10 units to work it's way out of his system, and you may see some wonky numbers for a while. Just stick to the same 1 unit dose, unless he goes under 2.8 (50).

    Kitties have a self protection system that can respond to lower BG numbers than they are used to, too fast a drop, or too much insulin. Here we call it bouncing. The second post here, contains a good description. Bounces are a temporary condition of higher numbers and can six cycles to resolve. Just stay the course waiting for it to go away. In some extreme cases, bounces can take longer to resolve. Here is an example of Teronto's SS. He too was prescribed 10 units once a day and it wasn't until the 9th cycle that his numbers started to come down. Those hormones and released sugars were what kept him alive from the 10U dose. I'm not saying the same thing will happen with Aston, but it is an example of what can happen with too high a dose.
     
  32. Linda Radley

    Linda Radley Member

    Joined:
    Jul 30, 2015
    +4 17.1

    Thanks Wendy. Will wait it out and see how we go.
     
  33. julie & punkin (ga)

    julie & punkin (ga) Well-Known Member

    Joined:
    Feb 17, 2011
    oh my gosh, Linda, what a scary situation. I'm just getting online today and saw Bron's tag also. Thank goodness people helped you figure out he was getting overdosed.

    I completely agree with dropping to 1.0u and holding that dose, regardless of the high numbers you see in the meantime. His blood sugar will go up and down, but I'd hang onto this dose for several days unless he goes below 50 on your glucometer. We use US #s here as our common language. I'm not sure what that translates to in the world mmol. What Wendy said is really important - the previous cat who arrived here on 10u, Teronto, continued to have high numbers for 9 cycles - 4.5 days - after his dose was reduced to 1.0u. That's how long it took for his body to calm down from being overdosed with 10u. So don't be alarmed if you have high numbers for a few days - that would not be unexpected.

    I'd stick with the Lantus/glargine - it's a much better choice of insulins for cats than the Humulin. Some of us use the Humulin R if our cats have certain issues, but the Lantus is a great basal insulin for Aston, and at this point is the only thing he needs.

    I'd invite you to post in the Lantus/Lev Insulin Support Group. Once people have a spreadsheet going they are welcome to post there - then you'll have many eyes of experienced Lantus users on you and Aston to help you move ahead after this overdose.

    Don't worry about the past error - it's not your fault and you're not the first one to have something like this happen. I arrived at FDMB with my vet having switched Punkin's insulin but him not telling me to get syringes to match the Lantus, resulting in Punkin getting 2.5x as much insulin as we thought. Fortunately no harm was done. We just learn and move on.

    :bighug:

    I'd encourage you to post on the LL ISG daily for now so we can help you keep an eye on Aston as he moves ahead after this. Just in case there is anything going on - sometimes when you're new you don't know what to look for.

    And welcome to FDMB! The best place you never wanted to be. :D
     
  34. Linda Radley

    Linda Radley Member

    Joined:
    Jul 30, 2015
    Thanks Julie,
    I will post in the LL ISG.
    Your right about having high readings. He has not dropped much today.
     
  35. Critter Mom

    Critter Mom Well-Known Member

    Joined:
    Jun 16, 2014
    For the benefit of those new to diabetes reading this thread, these values are applicable to blood glucose levels measured with a human glucometer. (The hypo threshold on a pet-calibrated meter is 3.8 mmol/L / 68 mg/dL.)

    .
     
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  36. Voula

    Voula Well-Known Member

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    Sep 15, 2014
    Excellent point Aine. I will amend my post. Thank you.
     
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  37. Critter Mom

    Critter Mom Well-Known Member

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    Jun 16, 2014
    No worries @Voula - as an Alphatrak user myself when I first joined the forum it took me ages to be 100% sure about the hypo threshold number for pet-calibrated meters.

    So few members use pet-calibrated meters that we tend to be the poor relations when it comes to mention on the board of safe pet meter BG reference ranges, and I'm always nervous that fledgling sugar moms and dads will take the human meter hypo number as a reference point when using their pet meter and accidentally letting their cat go too low/miss a signal to reduce dosage, etc. It's an easy mistake to make.
     
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  38. Voula

    Voula Well-Known Member

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    Sep 15, 2014
    I am really happy you reminded everyone of the differences in pet and human glucometers Aine. It is very important that we all are aware and yes because most people use the human glucometers it is easy to assume others do too.
     
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  39. Jan Radar

    Jan Radar Well-Known Member

    Joined:
    Jun 27, 2015
    As an AlphaTrak user and a fairly new caregiver to diabetes, I was very confused at first about this difference. I got all my beginning information from my vet and bought the AlphaTrak not knowing that a human meter would work at all on my cat. It was not until I found FDMB 3 months later that I began not being confused thanks to such helpful comments and guidance.

    I'm wondering if it would be helpful to put Aine's valuable comment above somewhere, or even in a few somewheres, in the directions (ie stickies) that new people go to often when learning. Maybe there could even be an AlphTrak stickie?? It's fairly common that people have to see new information several times before it is learned. Just a thought that could help others...
     
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  40. Critter Mom

    Critter Mom Well-Known Member

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    Jun 16, 2014
    I really like that suggestion, Jan. Great idea! :)

    .
     
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  41. julie & punkin (ga)

    julie & punkin (ga) Well-Known Member

    Joined:
    Feb 17, 2011
    We encourage people to switch to human glucometers for a variety of reasons, not the least is that our dose guideline documents use human glucometer numbers.
     
  42. Critter Mom

    Critter Mom Well-Known Member

    Joined:
    Jun 16, 2014
    I understand and appreciate the reasoning behind the encouragement, Julie. However, there may be people like me (the exception, granted) who have greater peace of mind using a pet-calibrated meter. I think it would be really helpful to have an Alphatrak sticky as Jan suggested above. I have seen new members using human glucometer reference numbers with pet meters in the past. I'm fairly switched on scientifically and I struggled to get my head around a lot of information on the board for want of an easy-to-find Alphatrak-Human Meter 'translation' document. For the sake of one sticky, I think a source of help for pet-calibrated meter users would be a valuable addition to the Feline Health FAQ section, and it could be life-saving.

    My two penn'orth.



    .
     
  43. julie & punkin (ga)

    julie & punkin (ga) Well-Known Member

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    Feb 17, 2011
    It's worth letting the moderators know of your suggestion.
     
  44. BJM

    BJM Well-Known Member

    Joined:
    Oct 6, 2010
    See my signature link Glucometer Notes, with reference ranges for the different meters.
     
  45. Critter Mom

    Critter Mom Well-Known Member

    Joined:
    Jun 16, 2014
    Thanks for the pointer, Julie. :)
     

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