Freaking out: AMPS 334, PMPS 94, 3rd day of Lantus 3U BID

Ebony (DOB 12/25/04) was diagnosed diabetic around Thanksgiving 2017 (labs before, dx after). On Vetsulin from 12/5/17 to 1/28/18, then Lantus starting 1/29/18 when we changed vets. After dx, fed Friskies Pate until vet insisted on Purina DM (for the 3rd time). Vet now wants him eating 1.25 cans of DM BID, but he won't eat more than 1/2 can at a time (tho' given a little time he'll sometimes finish 1 can). Testing with AlphaTrak2 BID (test, feed, shoot). Vetsulin was increased twice from 1U to 3U before new vet changed insulin to Lantus 3U BID (apparently based on initial BG & weight). He was a muscular 18lb cat (38" long) for almost 13 years, but at dx was 12.4lbs & is now down to 12.04lbs. The progression of events is a little easier seen on his SS.
Here's what's got me worried: Today I got home an hour late for Ebony's PMPS (normally testing at 5a/p, arrived home today at 6pm PT). This morning's test (5am PT) was 334. Tonight's ITD (6pm) test was 94. Freaked out & ran it again 5 minutes later = 99. Got real scared & gave him his food cuz I knew it would up his BG, but he only ate 1/4 can. Didn't see/remember to wait on feeding & re-test 20-30 minutes later until I re-read it while looking up what to do about low numbers. No shot while I try to figure out what to do. Tested 7pm = 185, 8pm 196. Still haven't given shot. I've tried to put all the changes to Ebony's diet, insulin, weight, & vet visits on his SS (just attached it to my signature, so hope it stuck & you can see it). I'm scared because this is only day 3 of Lantus, and I'm not supposed to do a curve until day 7. He was coming down in a nice, steady slope until tonight. Next door neighbor is also a vet, & he told me not to be scared, that I was doing well. But also said 3U was higher than he'd ever started a cat on Lantus, but he wouldn't give me dosing advice cuz didn't want to interfere with my relationship with my vet. He did recommend that if AMPS was low to call my vet.
Now, Ebony's behavior is lovey & snuggly, just like before dx. He does have neuropathy in the back legs (since Dec), and his front left leg was a little wobbly when I gave him the rest of his dinner at 8pm. I straightened it out for him, and that helped. Then, when he laid down cuz he was tired, I tipped up the bowl so he could eat more, and he did some. In all, he ate 3/4 of a can.
I don't know how to get him to eat 1.25 cans twice a day without offering it several times over several hours. The vet is insisting on only 2 feedings a day (with the insulin shot). Previous vet was ok with 4 feedings (2nd & 4th about 2-3 hrs after 1st & 3rd which were shot feedings), and he got to where he'd pretty much finish 1 can in the morning & 1 can in the evening. But that was when we were on Vetsulin. Before dx, he was free fed kibble. Immediately after dx, I found FDMB & switched to Friskies Pate (which he loves). I tried Soulistic for a few days, but he doesn't like the gelee it comes in. He likes the WalMart Pate (similar to Friskies), but the vet doesn't. So now we're on Purina DM, tho' at $2 a can it's not cheap.
So, I guess my questions are, what to do about Ebony's suddenly low number (tho' at this point I guess it's probably going to be "hold the shot" until we see what we get for the 5:00 AMPS), and how to get him to eat on the vet's schedule? It's taken me a couple of hours to update his SS, figure out where I should post, how to post, and actually write it up. So, I'm not quite as freaked out as I was a 6pm, but still really worried.
Thanks

 

Wow! Alot of info and questions. I am not an expert but i got enough knowledge to help you for now.
That dose is high. When starting you usually start at 0.5u dose.
My opinion is to skip tonight especially since he isnt eating much.

You can feed any pate with carbs under 10%. See food chart on catinfo.org. There is also a link on forum too.
You dont have to feed the vets food. Friskies is fine.
Gonna post this and look at more of your questions

 

First, the dose is probably too high....We do take into consideration the dose the cat was on before when switching, but you don't have enough data on him when he was on Vetsulin to really know how he was doing on that either.

You need to test more than just Pre-shot....at least a mid-cycle on the AM cycle (like +5 to +7) and then a "before bed" test on the PM cycle. If it's impossible to get mid-cycles on the AM, it's even more important to do them on the PM and then any time you can get them during the day (like weekends/days off)

Your Vetsulin vet also raised the dose too high and too quickly. We never increase by a whole unit....that's increasing 100% going from 1U to 2U! We only increase in .25 to .5 unit increments so we don't bypass what could be a "perfect" dose. This goes for Lantus too.

As for your vet's insistence that you feed DM, don't let him/her buffalo you. It's NO better than the Friskies pates your cat was eating before. There's nothing special in "prescription" foods....Just tell him your cat refuses to eat it, take it back, get a refund and buy more test strips!

As for feeding only twice a day, that's "old school" thinking. They actually do better on multiple small meals instead of 2 big ones. Just like humans are told to eat multiple small meals instead of 3 big ones, it's the same for our sugarcats. Now on Vetsulin, it WAS important that he eat a regular meal before you gave it because it tends to hit "hard and fast" and you want food on board when it does, but with Lantus, it's not as important.

Lantus doesn't start to usually "kick in" for 2-3 hours after the shot, so as long as kitty is willing to eat, you have 2-3 hours to let them graze and eat their regular meal.

I'd probably suggest you drop back down to 2U and start over and get tests in daily. Since we don't have any meaningful data on his time on Vetsulin, you'll have to try to get more testing in. If he continues to have Pre-shots too low to shoot, or drops into numbers that are too low, we'll know soon and have you reduce further. We don't want to completely start over because that may just lead to glucose toxicity setting in if he does need a higher than normal dose.

A general housekeeping note....can you put a line between the 28th and 29th when you changed insulins? Color it a different color and put the letters L A N T U S into the cells. It's important to make it really clear when you changed.

Now, just FYI....while the AlphaTrak is a fine meter, the cost of the strips is outrageous for most of us. If you can afford them and it's not going to effect how often you test, that's fine, but most of us here use human meters with more affordable strips. All our protocols were written for human meters too so we're very used to working with them.

ETA....as for tonight, since you don't have much data, I'd suggest you just skip and start over in the morning (as long as he has no history of ketones)

 

Feeding more meals throughout day is best for diabetics.
Sounds like your vet is reading from the book that is years ago!!
Vet has not updated his or her knowledge.
Cat loves friskies then give him friskies pate.
Always good to have some MC and HC food on hand for steering low numbers or hypo time. Karo syrup too.

You can also get a human meter at walmart or adw diabetes.com.
Many of us use Relion Confirm or Relion prime. Much cheaper than pet meter.
No 2 min timer either. Strips are much cheaper too. Like $35/100.
I also find it easier cause the relion confirm needs half the blood size drop than pet meter.

Ok hope I helped ya. You did a great job tonight!

More experienced people should chime in soon.
As far as I know, you should start in morning with 0.5u and hold for 5-7 days. If not low enough midcycle then go to 0.75u and hold 5-7 days.
The nadir is what the dose is decided upon not the preshot bg.

Ok. More should chime in soon.
Big hugs!

 

Chris, I got some same answers!! Yeah! See, I did learn alot from you!
Your better at explaining but I will get there.

Your in good hands now Christine.
Have a good night!

 

Thanks to both of you. Sorry for the ton of info, but I hadn't introduced us, really, so I figured the more background info the better. I'm still working on uploading a picture of Ebony. Might have it figured out soon.

Regarding the Vetsulin dosing, that's one of the reasons why we changed vets. The other was he wouldn't listen to me (especially after I'd been reading a bunch on this site). The new vet is better about listening, at least. Both said to test twice a day, and I must have missed the info on FDMB about testing more often (other than at curve time). I generally work from home, so testing 4 times a day is usually feasible (except for test strip costs, but I just got a bunch in, so I'm good for the moment). Both my parents are diabetic, so maybe I can use one of their meters once I run out of the Alphatrak ones.

Regarding the Lantus dose, my neighbor (a different vet) also thought it was high. I said the new vet was going off of .5U per kg of weight which is what she found for dosing info, and he said that's really closer to 2.5U per dose rather than 3U. He normally starts cats on 1U of Lantus. But he doesn't want to interfere, which I can understand. I wouldn't have gone over there if I hadn't been so scared. I'll call the new vet as soon as I can, but tomorrow's a busy day.

I've been buying my supplies & food from ADW as they have the best prices, so far. They're in Florida, and I'm in California, so I'm not sure it's worth trying to ship the food back. As it is, I have a bunch of U40 syringes that I can't use anymore. I may be able to send them back, but I'm not sure. They arrived the same day the vet switched insulin. Mighta could've sent the test strips back, but I just opened one of the canisters tonight when I multi tested cuz I freaked out. So, I'll use that one up, I guess.

I'm skipping tonight's shot completely. Stabby time is in less than 6 hours. Just tested again at 11pm, 391, so we're likely to do tomorrow's shot, but I think I'm only going to do 2U, like Chris suggested.

I did add the colored Lantus line to the SS. Hope that makes it easier.

Thanks for all the help, and walking me through my first real scare. I'm going to work for a little bit then go to bed. Gotta get up at 4:30am to take DH to work, then stab my cat.
Good night!
Christie

 

The official "starting dose" is Weight in kgs. x .25, so for 12lbs (and you use their real weight if they're underweight) that would be 1.36U so if you'd started with Lantus, we would have probably started you at 1 to 1.25U

BUT, we take into consideration the dose they were on with the other insulin. so since he was on 3U of Vetsulin, we have to take into consideration that he may need a higher dose (since he's still here even though he was getting that much)

If we dropped you all the way back to 1U and he DID need the higher dose, that's a lot of wasted time where his body would have time to build up a tolerance "glucose toxicity" and you may end up having to go to a much higher dose to "break through"

By testing more often, we'll be able to catch if we need to reduce his dose soon enough.

If you can test more than 4 times a day, that's even better! Think of your spreadsheet like it's a puzzle....if the only tests you have are along the edges and down the middle, it's hard to tell what the picture is, but if you have "pieces" scattered all over, the picture becomes clearer.

Like one day do +3, +6, +9......next day do +2, +5, +8....get random tests at different points in the cycle and you'll gradually learn when he "usually" nadir's, when he "usually" has onset and when he "usually" starts to lose duration

 

He's supposed to be 18lbs, which is about 8kg, so that calculation would be starting at 2U, anyway. I'll work on testing randomly with only 2U. I feel much more comfortable giving him 2U than I do 3U. I finally got a picture loaded!
Thanks.

 

We don't dose based on what they're supposed to be though....there's only 12lbs of cat there now, so that's where we based it from (if we're starting from scratch)

He's gorgeous! You got yourself a house panther!!

 

Thanks, yeah, he's long. Solid black with mint green eyes. This pic is from before the diabetes. He fills that chair seat from arm to arm, even curled up into a "tiny" ball like he is. When he stretches out, he's 38 inches long, and can fish stuff off the kitchen counters when he stands up. That used to be a trick of his, to stand up to get treats. Now, when we give him meat treats, we make him stand up somewhat to exercise his core & back legs cuz of the neuropathy.
Your previous comment said to use their real weight if they're underweight, which is why I mentioned the 18lbs. I guess you meant what he currently weighs, which is 12lbs.

 

yes, his real/current weight right now is 12lbs....that's where we start from. If the starting dose were based on his "ideal" weight of 18lbs, it could be too much insulin.

It sounds like 18lbs is his "Ideal" weight....the weight that is most perfect for him if he was totally healthy....not too much, not too little!

You might want to try adding some Zobaline for Diabetic Cats for the neuropathy ...it's helped a lot of cats! It's not an overnight cure, it can take months, but we've seen it do some pretty miraculous things. Getting his blood glucose under better control is the most important, but adding the Zobaline can really help too

 

Thanks. I'll look into it. Might have to wait until the next paycheck, though, as we spent all the last one getting the big box of food & supplies from ADW (not to mention buying the Lantus).