Day One For Jax on Lantus with Numbers..

Thanks you guys @Veronica & Babu-chiri @Chris & China
,..I know there's so many people who find there way here with the new news with their cats and how to deal with the condition with lots of questions, and this board has really helped, and I'm greatful. Whoever might be reading this... I thought I'd post how his first day and numbers went on insulin. I was starting out yesterday to give Jax 1/2 unit of Lantus - 2 times a day,...but I only ended up giving him the first shot only. He's 9.4 pounds, almost ten. It was kind of late by the time I got back with necessary supplies because I wanted to be home with him to keep an eye on him after I gave him the shot. I did a couple extra tests becuase it was first shot.
12:15 he got his first shot right after BG test ..his BG was 257 on the ReliOn Prime meter
1:00 BG was 240
2:15 BG was 220
5:35 BG was 168 (*Nadir)
7:20pm BG was 212
10:00pm BG was 185

Because this being his first shot, and at Nadir, when his BG dropped almost 100 points from 257 to 168, ..when I took his last BG test yesterday to decide for shot #2 and his BG was 185 - I thought I'd err on the side of caution if his BG dropped again by almost a hundered at Nadir ..that would've been real close to 90 so I skipped it.

I got up at 5 AM today, took his food away, so could test BG at 7AM and it was almost exactly what it was at start of yesterday - 1 point lower 256
So I gave him shot #2 in his flank, becuase not a lot of fat near his ribs right now. I gave him 1/2 unit which is the dose I'm planning to stay at for his first week. I can see he feels the needle, but was careful and I'm thinking it went in ok, because I didn't feel any wet after, but it's tricky because 1/2 unit is such a small amount. Maybe will shave a spot of fur. Also, I thinnk becuase the insulin is cold, besides the stick, think he certainly can sense the colder insulin,..but I don't know,..I tried to keep it upright for a minute or two to try to help take the temp down a bit but it's such a small amount,..but I know these small amounts and this Insulin being as strong as it is,..it's critical to be exact so that's what I'm most concerned about, that, and that I keep the vial steril and pull over the amount I need and flick it to get out the air and push up to make the exact dose, after I've removed the needle from the vial to not contaminate the insulin. I actually think he improved yesterday and had a better day than he has had in a long time. He got some Orijen freeze dried treats, but I'm trying to keep the food within reason, (He ate about a 5.5 oz can of Merricks Pate over 4-5 measls Chicken / Duck / and Beef flavors) and I was suprised he didn't seem to be asking me for food as much and I thought he looked a little more content, but I don't know I could be imagining it or hoping,...but 168 BG at Nadir was the lowest his BG has been in months, so I'm thinking, positive affect, and I'm glad to see this morning it was same as start of yesterday and hadn't done some crazy spike. Sticking to the " Go Low, Go Slow " for his introduction. How does the depot buildup tend to work? I know the shots wear off, but does the depot idea mean that his pancreas is getting acclimated basically again,,hopefully to start performing and regulating itself again?

 

Hi and welcome. Here’s some info on what the depot is.

http://www.felinediabetes.com/FDMB/threads/lantus-levemir-what-is-the-insulin-depot.150/

When you have time I recommend that you read all the yellow stickies. They are really helpful. I copied the one in handling low numbers because my boy liked to drop low at night when there weren’t too many folks around.

It would also be helpful for you to start a spreadsheet so we all can track Jax’s progress. While you are at it add a signature includin date of dx, type of insulin, type of meter used, what food you are feeding, any other medical issues, SLGS, and any other info you find relevant so that we don’t keep asking you the same questions. Ask as many questions as you need. Lots of us like to help and we all remember what it’s like when we started. You are at the best place you never wanted to be at for supposed.

 

Spread sheet instruments.

http://www.felinediabetes.com/FDMB/threads/fdmb-spreadsheet-instructions.130337/

 

Hi and welcome! It will be great to get the spreadsheet set-up to see the colors change as Jax is responding to insulin. Hope you don't need to skip another shot. Any skipped shot should be recorded in your spreadsheet as "NS" (no shot). You will need a few days for the depot to become established and stabilized. I hope the sticky re: depot answers your questions, but if not, please ask, because we all had questions too when getting started.

Congrats on home testing. This will help with your first goal (safety). Your next goal should be consistency. You are going to want consistency in dose (1/2 U) and consistency in terms of schedule (every 12 hours).

I don't think the shots are uncomfortable for him. There are some reports of a much larger dose stinging, but in small amounts, and with a small needle, most cats don't even feel it. Sometimes they detect we are nervous, so that makes them nervous. I give my Rosie shots when she is eating - with her head down in the food bowl I can shoot in the scruff and she doesn't even notice. If you see him reacting to the flank, you might try the scruff.

 

Ok.. @tiffmaxee thanks...I added some info in my sig. I put down what I thought seemed relevant. HiGH readings, possibly due to high stress, not sure...out of 3 different vet visits to 3 different vets, this blood labs trip was noticeably more stressed, they gave him kitty straight jacket and muzzle after I asked, (i was not in the room.) Maybe becuase he got blood taken and urine. Other two vets (rabies shot -- and yesterday's vet visit/ different vet to get Lantus script and exam)..he was real good at both those, didn't make a peep. Delayed committing to insulin while trying to get numbers down with diet and supplements to no avail. Also, only got copy of blood labs from last Feb from vet this last week,, as I knew I was going to take Jax to a new vet. Vet I took him to for the labs (which were sent out) were really difficult to work with. Gave me hard time trying to get prescription referral becuase even tho being shipped to my address, (someone else was paying in the beginning.) Also, this vet was difficult when I was trying to get copy of my blood labs last week, which confirmed, good choice to not go back. Also, high glucose was the only thing he mentioned,..and now as you can see he neglecdted to mention Ketones or other High indications I put in my sig I also did my first Ketone test this morning and i think I went past 15 seconds,..but result matched Mod-High ...but he is acting same as he has last four months..and right after Ketone test took him outside for supervised visits and he chased a couple lizards and jumped up on cinder block wall a few times. ..but then took him back inside,..as he's indoor cat. He seems to be acting normal. I'll keep checking everything tho

 

Wow, you have been through the ringer! I hope you find a vet that can help. I’d concentrate on one that addresses his other issues. You will get all the help you need here with FD.

The sig is perfect! Now when you get a chance all we need is the ss started. If you need help setting it up just holler and someone will help.

I love the name Jax. I had a friend with a cat and mistakenly wrote Jax for Max. So we called minjje Jax and hers Jax2, lol. After I lost Max and got my kittens I was going to name one Jax but kept the names given to them by the Rescue.

I wonder if the high numbers came down once the ketones were gone. That’s one thing I didn’t need to learn about with Max. He did have slightly elevated ALT which seemed to accompany his chronic pancreatitis which led to his diabetes dx. Your numbers are just slight elevated so not concerning I would think.

Congrats on home resting. It took me a few weeks to get to that point.

 

So I only stated giving insulin yesterday, and been watching this board and DCC board,...and learned a lot through both boards and have gotten great tips to get me to today. As mentioned by someone at DCC board,..they suggested,..." well both boards practice different protocols, they are different, and i should choose one so as to not conflict the protocols, for Jax sake. " I have to say I hate to think I have to pick one, becauase the end aim is the same. I can't help but feel this TR regiment at DCC that overlaps shots, so as to administer next shot before insulin completely leaves. .. like Lantus, 10 hour shots, instead of 12 seems to make sense, to avoid spikes and letting the insulin completely run down. Also, DCC seems like they have a more strict food list and feeding schedules they ask you to stick to, and I have to admit, I would welcome that, becuase in the last four months, I have not gotten a lot of sleep as I was toying around with supplement and diet remedies trying achieve remission, and Jax has kept me up multiple times crying for food. Sort of just thinking out loud, becuase I know I need to set up a spreadsheet and would be too much to set up one on each site,..need to pick one

 

That's really good advice... very wise. At this point, it is in Jax's best interest to choose one or the other.

Methods/protocols usually offer guidelines/suggestions/safeguards based on the method itself. Mixing and matching can often be the fastest way to getting into trouble without knowing it... before one fully understands the insulin used as well as how their cats responds to food and the insulin used.

Good luck with your decision and wishing you the best!

 

Hello and welcome to you and sweet Jax. I knew a Burmese Dax that lookeed a little like Jax.

Here is a post of yours on the Health forum, that can give people a little more history on your situation.

For feeding schedules, it's great if you stick to a schedule. I did. And I used an automatic feeder to provide those meals if I wasn't at home.

Picking a dosing method helps if you are looking for suggestions/advice on dosing. However, if you are feeding some dry food, the decision is made. Start Low Go Slow is what you'd use here. Tight Regulation (TR) requires feed all low carb wet or raw food. The Orijen treats are great, my kitty loved them too.

 

Please retest as soon as you can to verify those results! In the mean time, I would call the vet to tell them of the result. They may want you to bring him in immediately. Anything above "trace" on a ketone urine strip almost always involves a vet visit... more often than not hospitalization. Ketones can be fatal. The only thing that's holding me back from screaming "take him to the vet" is that you've said he's acting normal and you may have gone beyond 15 seconds before reading the stick. Not lethargic at all?? How's his appetite?


Edited to add: Given Jax had "high" ketones at diagnosis, I'd definitely call your vet before they close for the day.

 

@Jill & Alex (GA) Jax is doing great... peeing, pooping, eating lots, drinking moderate amounts of water too, went outside...chased some lizards on a short supervised visit. Eaten 3x today and napping.

so far day 2 ..think I have this right.. so far appetite is good and think the insulin is helping what he is eating go a little further

+00.00.......256.......0.5 units
+02.75......263.........(he did eat a small amount of Merricks Duck pate around 1.5 oz and also small handful of Orijen freeze dried treats
+07.00......199........ate another further 1.5 oz of Merricks and 8-10 Orijen freeze dried treats

Also,..I was just reading more on the Ketone Page on DCC board links and he has not exhibited any of the extreme or high symptoms, . his behavior is inline with his last four months and he is acting normal for all purposes, and on all wet food hi protein since diagnosis last Feb...Jax had that high Ketones listing on his blood lab when it was done in Feb , but no crystals present...that vet, who I already decided not going back to and did not go back to yesterday...never even mentioned the Ketones on the blood labs,..just that his glucose was in diabetic renge.

*edit...I just now did a quick test too,...opeed up the door to see if he wanted to get up and go out,...got right up and trotted to the door,..so giving him another visit outside but definitely keeping an eye on him and have been testing 3X bg during cycle

 

This is great news!

However, it's rare, but possible for a cat to be throwing ketones without exhibiting the usual symptoms... we've seen it happen here more than once. I'd still let your current vet know what's going on because it can be serious and can become worse in no time at all. If I were in your shoes, I'd also stalk Jax for more urine to test. It may have been a faulty test, but you'll want to know one way or the other as soon as possible. Throwing ketones can quickly lead to developing diabetic ketoacidosis... life-threatening and very expensive to treat.

If Jax is throwing ketones, the usual insulin dosing guidelines are thrown out the window in order to get as much insulin into the cat as safely as possible. We can help you with that once you know "if" he's actually throwing ketones.

FYI: The basic recipe for developing DKA = an insufficient supply of insulin + inappetance + infection OR other systemic stresses.

Let us know how we can help...

 

Hi and Welcome to L & L. Bubba threw ketones too and was as high as 5.5 using a ketone meter. He was only in the mid 200's BG. Be vigilant with testing him for ketones, and add extra water to his food as the extra water helps to flush the ketones.

If he stops eating, you need to have him seen by your vet as the formula that Jill posted above is the recipe for DKA. Bubba had no symptoms at all when he was throwing ketones. Luckily, he did not stop eating for me and we got as much insulin safely in him. So that said, you don't want to skip shots.

 

@Jill & Alex (GA) Ok,..so Jax went outside and ran around some more,..came back in drank more water, and then ate another 10+ Orijen treats. I stlaked him and I just got another Ketone test, and counted...did it twice - once stuck it under him while he was peeing,...counted looked at the result and stuck another after that into the urine in the little box and both came box inbetween trace and small, it's the ReliOn brand Ketone strips. He is not exhibiting any exteme signs of ketoacidosis, and based off his insulin numbers today, It looks like since he's still above 150 was going to give him another 1/2 unit of Lantus at 7pm, which would be 12 hours from his last,..but maybe he should get it now. I did add extra water to his food too. *edit, and I just put another handful of Orijen treats in his bowl and he got right up right away when he saw the packet coming out. Maybe he should get a full unit of insulin instead of 1/2?

 

Yaaaay!! Like Bobbie said, continue giving him extra water however he'll take it... by syringe or mixed in food and continue testing him for ketones once or twice a day.

I think you should stick with the 12/12 schedule for now. He's not in immediate danger.

Hate to say this, but without a spreadsheet, I don't like to give dosing advice... not trying to be a pain. Just don't want to do harm since I don't have the data in front of me to support any dosing decisions.

 

sounds right, appreciate your input..., ..not gonna change his dose, and I'll keep on with the ketone testing couple times daily. Also on DCC posted and got back..." He's been diabetic for awhile and not been symptomatic and I would think he'd have developed DKA before now if he was going to. Doesn't mean he couldn't but you're monitoring him and his levels are trace to low and you're on top of it "

.. Ok so,.. gonna keep his carbs as low as I can, and as much water as possible going and keep him on his regular dose and schedule

 

This is a common misconception. Some cats do much better on a little higher low carb foods. For example, Alex was extremely carb sensitive... even a small piece of freeze-dried chicken could cause a 30 - 50 point rise in BG numbers depending on when it was given in the cycle. That said, she did best on foods with 4 - 5% kcal from carbs.

For your reading pleasure:

• Feeding Low Carb vs Lower Carb Foods
• Carb sensitivity - thoughts

Experiment and see what works best for Jax. Up to 10% kcal from carbs is still considered "low carb".

 

Nice to see he's getting some lower numbers, and remember getting him regulated is going to be a slow process it will take time, sometimes even months so you will have to be very very patient, and given his medical history as regular with his shoots as possible.

And keep a very close eye on him even if he's not showing any symptoms now because this ketones issue can develop into diabetic ketoacidosis very quickly and it means some serious problem