? Dosing Questions Regarding Lantus...Vet is Giving Mixed Information

Good morning! My name is Mary, and I stumbled upon this site as our cat Emily was recently diagnosed with diabetes. Having no experience with diabetes in the human or animal form, this site seems like a great resource. Emily is a rescue cat and we have had her for about 4 years. We estimate her age to be 11 or 12 years old. She is a tiny little thing, averaging about 6.5 lbs, but has really "big" fur, so she seems much larger than she is! So, here is our situation...would appreciate any input. Emily was confirmed diabetic with a blood test - her numbers were in the 400's. The vet put her on Lantus, and suggested 1 unit, 2x per day. Of course the vet also suggested "prescription food", which I purchased. Emily is both a dry and wet food eater and can be quite picky. She is also a grazer...eats very little at a time, finishing her breakfast meal throughout the day and then she is fed again around dinner time. She absolutely would not eat the pate DM wet food, which was no surprise to me. I returned it. Mixed with her regular "over the counter" dry, she began to eat the DM dry. I did lots of research (mostly on this site) and tried all kinds of quality wet foods, that were high protein/low carb. I found Merrick Purrfect Bistro Thanksgiving Day Dinner, which seems to meet the carb criteria in both wet matter and dry, and she eats it! She also seems to enjoy Fancy Feast Classic seafood and fish varieties. After a few days of the insulin, my husband and I could tell it was way too much for her. She got very lethargic. So, on our own, we cut the dose down to .5 unit 2x per day. She seemed to be doing well. I could tell she gained a bit of weight back (just by petting her, she didn't seem as bony...the vet confirmed she had lost a few ounces), her appetite was good, (but not ravenous), and she was not peeing/drinking as much as she had been. We had an appointment to bring her back to the vet for the all day glucose test a few weeks after starting the insulin. I was really hopeful that with the new food, she would be able to go off of the insulin. The all day test showed that mid-afternoon, her glucose level dropped to 60, which the vet said was way too low. I was actually surprised at this, because although I do work full time, so I am not home every minute of the day, keeping an eye on Emily, I would think with a level that low, she would be almost comatose, and I never witnessed that. So her suggestion was to take her off the insulin (yay!) and keep feeding her as we had been. She wanted us to bring her back two weeks later for one mid-afternoon blood test, which we did about a week ago. Her level was back up in the mid 200's. UGH! Now, of course some of that level could be due to stress. But I do feel she is peeing a bit more, and in the last few days she seems to be eating faster than she normally does. My husband does not feel she is drinking an abnormal amount. Although i was not present at the vet appointment (my husband took her), I did not like the vet's response to the high glucose level. She said, "well, the insulin brings her level too low, and you can't give her any less than you were (.5 unit, 2x per day), so just keep her off, and bring her back in a month for another test". In the meantime, I have a 6 lb cat that really can't afford to lose any weight, and I am not certain what her true level is, as stress certainly could have played a factor in that mid-200's number. Any thoughts/suggestions on this situation would be greatly appreciated. I am almost ready to ask for Emily's records and just bring the records (not the cat) to another vet for a second opinion, but can't seem to find a vet here in Connecticut that might specialize in feline diabetes, so perhaps it will be money spent for nothing. Feeling frustrated!

 

Nonsense!! Many people here give tiny doses to their kitty. It takes a bit of practice but it's doable. First, get your hands on some U100 syringes that have half unit marks on them if yours don't. If yours do, you can learn to eyeball 0.25 u half way between marks on the barrel.

You absolutely should learn to test blood glucose at home. You can buy a human meter for this because its strips are much more economical and we can help you understand the numbers. If your vet isn't an advocate of home testing you can still do it - she's your kitty after all.

There's more experience and knowledge among the members here than most vets. We can definitely help you with your kitty. Oh, and welcome!!

 

Welcome Mary and Emily!
Agreeing with what Kris said about 0.5U not being the lowest dose of insulin .

What is she eating now? Be specific
Seems diet change really helped her so it's also possible we can tweak the diet a little more and she may be diet controlled

 

Don't have advice but wanted to say hi, I'm in CT too. Hoping you find some answers here, this site is loaded with info and the people on it are so knowledgeable and will be able to help you!

PS if you do find a specialist around here I'd love to know about it! Seems like most vets have the same idea of how to treat this condition and sometimes you have to be a little proactive.

 

So if 0.5 is too much and nothing is not enough, so 0.25. And home test with a meter to make sure she's safe!!!

 

Hi Everyone! Can't thank you enough for all taking the time to reply. With your positive, friendly and encouraging words, I am feeling more confident that we can get this under control, which is NOT the feeling I got after bringing her to the vet. UGH! So, I agree that diet may be a great place to start. Since you asked, Yong, here is the specific diet Emily is currently eating: 1/8 cup of Purina Pro Plan DM Diabetic Management DRY food 2x per day ... once in the morning, once at night. This amount was suggested to me by the vet when this food was purchased, with the idea that it would be given in addition to wet food. At first Emily turned her nose up at it, so I was combining it with her regular "over the counter" dry food. But at this point, she is eating it on its own and will for the most part, eat the 1/4 cup per day. Emily has always been a finicky wet food eater, so this is NOT a new behavior for her. I have been using this calculator when I go to the store, to help me chose foods wisely. I am hoping it is accurate, and it shows both the wet carb calculation as well as the dry carb matter. http://scheyderweb.com/cats/catfood.html When the vet prescribed both wet and dry "PRESCRIPTION" food, she suggested 1/4 can of wet 2x per day, to go along with the dry amount listed above. As mentioned earlier, Emily would not eat the wet prescription food. So, my search began. Currently she is eating: Merrick Purrfect Bistro Thanksgiving Day Dinner, Fancy Feast Cod, Sole & Shrimp Feast Classic, Fancy Feast Ocean Whitefish & Tuna Feast Classic, Fancy Feast Savory Salmon Feast Classic and most recently Fancy Feast Medleys Shredded White Meat Chicken Fare (with Garden Greens in a Savory Broth). I have been pretty much sticking to the 1/4 can (obviously I give her more when using the Fancy Feast small cans), 2x per day as originally directed by the vet for the prescription food. So, in a nutshell, she is getting 1/2 can of wet a day and 1/4 cup dry a day. Keep in mind, this is a 6.5 lb cat, so I am hopeful these amounts are enough for her, calorie wise. This past week she began turning her nose up at the Merrick Thanksgiving Day Dinner, which she had been LOVING for the last few weeks, so I started mixing in Fancy Feast, or giving her all Fancy Feast. As of today, she seems to be enjoying the Merrick again. I would like to reiterate, this is not abnormal behavior for this cat when it comes to wet food. Thoughts? Obviously I know it would be best to get her completely off of the dry. Would love some suggestions about doing with a sometimes finicky, tiny cat. (Note that she has been this small since we adopted her 4 years ago...it is not as though she has lost weight). My fear is that since she truly has no weight to lose, I could be playing a dangerous game with her, if she won't eat.

 

Hi Emily and Emily's Mom! Here's a new very handy food chart for shopping - that calculator doesn't give the 'as fed' values altho' it's usually fairly close. This one is by Dr. Lisa Pierson, this site's sponsor as well as a cat specialist. It's also currently being recommended by the AVA. Link is:
Food Chart 2017 - CatFoodProteinFatCarbPhosphorusChart.pdf

 

Hello and welcome!
You sound like you know a lot already!

If you click on Tempests SS in my signature you can see I used .25 and .10 and .12 units of insulin as .1 and .50 were too much for my kitty, so your vet is talking nonsense.
I think you have a really good plan, I would be careful with feeding too much fish though, it's addictive but also high in other not so good things.
I feed fish 2 days per week, the rest it's poultry or meat. My kitty is also fussy, so it took a lot of trial and error. As I'm in the u.k my choices are different (but in my signature) Tempest will not eat pate at all so only shredded and finely diced for her, the little princess!

I know for those who refuse wet food many people feed young again zero carbs. I believe you can request a sample from the company. Might be worth a try?

My vets did buy a huge bag of purina dry and the tins which I refused. Why pay for high carb food (and it is high carb) when you can buy supermarket stuff? I did try om nom nom and many other expensive ones, ordered especially and she would eat a few mouthfuls and not look at it again. Lol

I'm looking forward to seeing your progress with Emily (and possibly seeing a pic of the little darling hint hint )

 

I call crap on that dose comment from the vet. I have been doing less than 0.1 u of dose with Jones for quite awhile now. I have had him down to a 1 drop! Check out his SS.

Kitty needs what kitty needs.

 

Hi Kris! I would like to find these syringes with the half unit markings, but am confused on what to get...plus, we need a prescription to order here in Connecticut, so I will need to contact the vet, and she didn't seem to know anything about half unit marks, on needles, I don't feel I can ask her for advise. How crappy is that??!! Here is what I am currently using, which was upon the advise of the vet: BD Insulin Syringes with the BD Ultra-Fine needle for U-100 Insulin. 1/2 ML cc 12.7mm (1/2") long 30 Gauge She seemed to push the longer needles, not sure why. Our needles do NOT have the half markings, so based on what we are currently using, can you suggest a needle that would be similar? I have found some online with the half unit markings, but the Gauge is not the same, the needle is shorter and the capacity is 3/10 cc ... not sure how much any of this matters??? Please advise. Thank you!!

 

If you order online the store will contact the vet for the prescription. You don't have to get it.

 

The 3/10 cc ones are better because they are easier to see. The barrel size is different but a unit is still a unit. You want u100 3/10 (0.3) with half unit markings.

 

Mary, these are the one's I use and they have half unit markings: https://www.adwdiabetes.com/product/1289/monoject-ultra-comfort-insulin-syringes
I prefer the longer needle (12.7mm / 0.5") since my boy is fluffy

 

All these have half unit markings and are the correct syringes for U100 insulin and are available from ADW online: (you can enter your vet info and they will contact them to get a script if you don't have one already to submit)
UtiCare
Monoject
Carepoint
Sure Comfort
BD Ultra-Fine

They're also available at WalMart if you have one near you..Their Relion Brand 3/10ml, 3o or 31 gauge, 8mm insulin syringes all come with half unit markings and are only $12.58 for a box of 100 (although it seems a lot of WalMart employees don't realize that they DO come with half unit markings!!)

 

Thank you for the syringe information, everyone! I contacted the vet today to talk about this new approach of giving .25 dose to Emily, since according to their full-day testing, .5 2x per day was too much and her mid-afternoon number dipped too low. She responded by saying "you could just try giving her ONE .5 dose per day". I was under the impression you were supposed to give 2 doses, 12 hours apart, which is why I suggested giving her .25 2x per day. I AM NOT A DIABETES EXPERT! So, she said "yes, I could do it that way as well". I kid you not. Guys, I feel like I am getting no direction from this vet. Does anyone have an opinion on this?? Certainly giving one dose per day would be easier for me and my husband, to not be tied to that 12 hour injection schedule, but if that is not the way it is done, or if that is not effective, we wouldn't do it. Emily is clearly not "right". Seems lethargic again, peeing quite a bit ... eating seems pretty normal and water drinking is not super excessive. But, I think we need to get her back on some insulin and would like to start this sooner rather than later. Thank you for any input you may have!

 

Hi Emily's Mom,

And you are absolutely right. The nature of Lantus CLICK HERE FOR DETAILS and the fact that cat's metabolism is much faster than the humans make Lantus therapy the most effective when administered twice a day 12 hours apart.
CLICK HERE for very useful info on how to draw small/fine doses.

Do you home test? I think it is the most important think to learn to do for Emily and be sure that when you administer insulin she is in the safe to do so numbers. There are many resources on the Board to help with it. Let us know, please. I'd urge you to start home testing...

Now that the subject of this thread had changed from Intro to dosing might I ask you to either open another thread or to edit the title on this thread to something more subject appropriate? This way you'll have people stooping by answer a particular question v. saying hi. (To edit the title - go to you original post, on the upper right hand corner click on Thread Tools- Edit title. WHen subject line opens just type your current question/concern. You can also choose the question mark from the blue box on the left of the title line as your prefix - that''' attract more eyes.

Good luck with the dose! I hope it'll help Emily!

 

I'd suggest 0.25 u twice a day so she has insulin coverage over 24 hours and (possibly) better BG control. It's more work but it'd be best for your kitty. I also suggest you post on the Lantus forum where there are a ton of very experienced people to help you.

 

Well first of all Wellcome! I great you are here and asking questions is the best way of helping her.

Regarding the small doses, certainly you can give very small one, take a look at Babu's spreadsheet he got even just one drop (that would be like 0.05 unit or something around that) I think the biggest dose he got was 0.75, he is also quite skinny and was like that all his life, I totally agree you have to be careful she doesn't loose any more weight but that being said all the dry food is too high in carbs and with her numbers I think you do have a good chance to get her food controled but you'll need to home test first so that you can know what her real numbers are, the ones at the vet can be higher because of stress, Babu could go 150 points higher at the vet from what he had at home just before leaving to the vet.

I struggled with my vet and small doses a lot because Babu was always an small dose kitty , he talked of diluting the insulin (a big NO NO) and he did made me try shooting once a day , and I now know it was a big mistake, his numbers went all over the place and it probably set us back in his treatment, you need to find a dose it may even be a drop that you can give her twice a day, we can help you learn how to measure it. Thing is cats metabolize insulin different from humans and need the 12 hours dose (sorry about that, I know it can complicate life a lot)