Hi! Newbie with an out-of-date vet

Hi everyone. I'm blown away by how thorough and active this community is. You guys are awesome, and were exactly what I needed today.

Got the diagnosis this afternoon, and unfortunately took my vets advice at his word, bought everything, and then came home and read a bunch of info on this site. Turns out, my vet did pretty much everything wrong. Prescribed Humalin insulin, gave me U40 syringes for a U100 insulin, sold me Hills WD dry food (not low carb), and scheduled in-office testing (didn't mention home testing as an option).

My question is: should I print out the AAHA Diabetes Guidelines and try to educate the guy, or just move on and find a more modern vet?

Background: Cheshire is a 6yo male, indoor only. Lost a lot of weight (dropped from about 17lbs to 12.5lbs) in a couple months. I took him to the vet this morning, they did blood work, x-rays and other tests, and glucose was at 368, and was the only reading that was off. Told me to administer insulin "up to the first line on the syringe" twice a day after feeding, 12 hours apart. Told me if he gets wobbly or stumbling and seems sluggish, I'm to give him a little corn syrup (like a diabetic keeps a piece of candy to eat).

I've managed to give my first insulin injection tonight (I know it'll soon be routine, but it was a big deal this first time). I'm worried about the U100/U40 issue, so I only gave about half as much as instructed. I figure that I'm probably giving him the right dose (about 1 U). If the vet's wrong, I would be giving him 2.5U, which could cause hypoglycemia. If I'm wrong and the vet accounted for the difference (not freaking likely), then I'm just giving him a half dose, and that's not too bad, since you're supposed to start slow anyway. I'll consult the vet (or a new one, depending on your advice) on Monday to try to clear things up.

Everything I've learned online tonight makes me really doubt this guy's competence. Is that normal? Is it normal for vets not to stay up-to-date? Or did I get bad one and need to move on? (I recently moved and my cats never had issues before, so I don't have a strong relationship with any vet).

Anyway... again, thanks to everyone who makes this site so comprehensive. I couldn't believe how perfect it is.

 

Hi Chris, looks like you posted at a rather slow time. Here is my advice (am kind of new myself) about the vet. I would try to educate him (providing you like him) about what cats who are diabetic need/should have because the truth is, your vet likely rarely sees diabetic kitties. They just don't know what is the correct way to treat them. I would not expect my OB-GYN to treat diabetes and know what to do, so that is how I view it. They are generalists and feline diabetes is rare enough where they just don't keep up with the latest protocols. Perhaps your vet would welcome all of the information we have here on this site. If not, then I would most definitely find a new one.

First, I would not feed the cat the dry cat food so you can go out and get some Fancy fEast classics (pate style) for now from Dr. Pierson's list which you can find all over this site, making sure they are under 8% carbs.

I also agree with the dose decrease that you did on your own to start because my understanding is that Humulin is fast acting, does not last long and can drop your cat's BS very quickly. Also, I would go out and get testing supplies today and home-test the cat. A Relion meter from Walmart, test strips and lancets. (26-28 gauge is best in the beginning) and someone will help you to set up a spread sheet. The testing is not that hard althought it seems like it in the beginning. Get some low carb treats for your kitty and begin by just rubbing his ears and then giving him the treat (Pure Bites freeze dried chicken is a favorite around here)

Humulin is not the best insulin for cats, but others here have used it, so I guess that until you can get him to prescribe a different insulin (ProZinc, Lantus, Levemir are the 3 most use here) I guess it is preferable to having no insulin. Also, buy some ketone strips so you can test for this also.

Someone with more experience will be along soon to help you. Just wanted to welcome you and help you not to feel so overwhelmed! :YMHUG:

 

Thanks Joyce - appreciate the welcome. I think 2am on a Friday is a slow time everywhere. And thanks for putting the vet stuff in perspective and the validation on what I've done with the insulin. Makes me feel a lot more confident in where were are this morning.

As it happens, I *have* to travel two hours to visit family this weekend, so looks like Cheshire's taking his first road trip today. I'll be learning how to test blood sugar from my grandmother's house tonight.

 

I think the first thing to do would be to get a human meter, start testing, switch to low carb wet food and forget about insulin for the time being because you do NOT say a cat is diabetic based on a single glucose reading.
If a cat is sick or upset, you could get a high reading.
If a cat is very carb sensitive, you would get high readings.
In order to confirm the cat is diabetic, you want a vet to do a fructosamine test which is an average of the cat's numbers over the last few weeks, and that result being high would confirm.

Since this vet is nobody to you, I would say to get a decent vet. All you need to ask a vet is "What insulin do you prescribe for diabetic cats?" To me, I want to hear an answer of Lantus or Levemir. If it's Humulin, I'd say thankyou, leave and never go back there.

Return the bad dry food and say your cat won't eat it. Refer to Dr. Lisa's list and select foods under 10% carbs.
catinfo.org/docs/FoodChartPublic9-22-12.pdf

Get any human meter except the FreeStyle or TRU meters as they have given bad readings to many users.

Gayle

 

Hello and welcome to the FDMB. The best place you never expected to be. We have a broad range of knowledge about feline diabetes and should be able to help you with most any question. We live and breathe feline diabetes 24/7 and can help you with the day-to-day management of this new sugardance you have embarked on.

First thing. Take a deep breathe, hold, release, take a deep breathe, hold, release, repeat as necessary.

Second, I think you want to verify that your cat is diabetic. Is your cat peeing a lot and large puddles? Is he always thirsty? Is he eating a lot but still losing weight? Is the fur greasy looking and/or flaky huge chunks of dandruff? Is your cat walking on his hocks? Any other clinical signs your bet used to diagnose the diabetes?

A single blood test at the vets is not a definitive diagonosis. BG (blood glucose) levels can be higher from many causes, including vet stress which can raise the BG 180 points in 5 minutes and last for 90 minutes or more or infection (think teeth).

One of the least expensive ways to do this verification yourself, is to borrow a glucometer from a friend or relative or buy a human glucometer like the Relion Confirm, Micro or Prime from Walmart, some test strips and lancets. A fructosamine test is another way to help confirm diabetes in cats.

Third, Change the food. Change the food first to canned food like Fancy Feast pate style or Friskies pate style or the Wellness pates and you may see your cat's BG drop 100 points or more just from the diet change. Hill's has a guarantee on their food. Take it back to your vet and you should get a full refund.

Fourth, vet change/education.

As a starting point, I would print out the AAHA Diabetes Management Guidelines for Dogs and Cats, a vet published article from June 2010. I suggest printing one copy for you, and one to share with your vet. It's difficult for a vet to keep current with the latest treatments for all diseases and conditions with the different animals they treat. It's easy to dump a vet and find a new one, but educating your current vet is also an option too. We can help with that.

The Merck Veterinary manual does recommend Lantus as the first choice for diabetic cats. Humulin N is often prescribed if you tell your vet you want to save money. In the long run, since the Humulin N does not work as well in cats, (step drops, short duration, steep rises), you often end up with another insulin anyway. Lantus savings card at the manufacturers website. Most people buy the Lantus Solostar pens and you need the prescription written for the pens, and Taget sells them one at a time.

BJM has some vet interview questions in the signature. I've copied them here in case you wanted a starting point for interviewing a new vet.

 

Just what insulin was prescribed?

 

Larry she wrote - Prescribed Humalin insulin, gave me U40 syringes for a U100 insulin, sold me Hills WD dry food (not low carb), and scheduled in-office testing (didn't mention home testing as an option).

 

Thanks Deb and Gayle. Appreciate both of your perspectives on the vet and the diagnosis. It did seem pretty loose and easy.

He has lost a lot of weight. this was what spurred the trip to the vet to begin with. He seems to be drinking and peeing more, but I never really paid attention before.

There's definitely something going on, but i'm hopeful diet will make a big difference. Made the switch to low carb canned Friskies today.

 

If you are giving the Humulin N insulin and have changed the diet to low carb wet food, there is an increased chance of hypoglycemia (a hypo).

We strongly recommend home testing the BG (blood glucose) if this is the case. You do not want your cat Cheshire to drop too low and experience a hypo.

Here are some symptoms. I strongly suggest you print this out and keep with your hypo tool kit.
hypos treatment and symptoms As this article states, many cats have no symptoms.

Here is your hypo tool kit

 

Welcome to FDMB!

Since you've just changed to canned low carb food and may not be home testing yet, you might skip the insulin until you learn to test and are sure its needed.

My reasoning: A glucose of 368 at the vets office may be 100 mg/dL due to high carb dry foods and up to 180 mg/dL due to vet stress. Subtract 280 from 368 and you get 88 mg/dl ... which would be a normal number in a non-diabetic cat. Changing the food will drop the glucose level within a few days. Getting back home from the vet may drop the glucose by the next day.

If you've no long term relationship with the vet and want to find a new one, you can do a Google maps search on "Veterinarian near street address, city, state" and you'll get a list of vets near you.

 

Thanks BJM, the warning is helpful.

I got a Relion meter and tested the whole family tonight, about 8 hours after any of us had eaten... so that's the nadir, right?

Cheshire tested at 98, which is right in the normal range according to the chart on Wikipedia. This is his second day on low-carb food and about 0.5U of Humalin twice a day. I've just fed him, so we'll do another test about an hour after eating (that's the right time, isn't it?). I'm hoping (like every person before me, right?) that his case is mild and can be controlled with diet.

The first test *was* stressful, but mostly for me. I think the process and being restrained is the hard part - just like you all wrote, I don't think he felt the prick at all. The real trick was locking us in the bathroom (small & confined) with a slice of deli turkey (even I like that as a snack!).

Thanks again for all of you guy's time and expertise on this. It's amazing what this spread out group of kind, dedicated people has built.

 

With the Humulin N, that +8 might not be the nadir. Many cats nadir earlier on Humulin. He might have been coming back up already by +8. Need some tests at other times to see.

You should test at pre-shot before you have fed.

When was his shot this evening? Did you test before that?
It won't hurt to get at test +1 after he has eaten. Humulin often onsets or begins to work by then.
Then test somewhere in the +4 to +6 time frame.

 

Hmm. Deb, your post makes me think I may be confused. My understanding is that I'm supposed to give insulin after he eats - should I be giving it before?

The first test tonight - where he came back at 98 - was pre-feeding and pre-shot. I was hoping to get another blood glucose reading after he ate in order to determine if he needed insulin (per BJM's concerns).

Unfortunately, my second attempt at the BG test went worse. He tolerated being pricked and restrained better, but I couldn't get him to bleed, despite pricking him 6 times. So I gave up for tonight and gave him his insulin shot for the night.

The first time I tested, he bled perfectly the first time, without any ear-warming or anything. This time, he's dry as a vampire. I'll try warming them in the morning. He just doesn't like his ears being touched, so I have to restrain him, and he hates that, too. It's a big fight, and it's going to get really old, really fast if this is what every day is supposed to be like. Sigh.

Also, can we get a warning label on dry cat food or something? I'm pretty angry at them.

 

With the fast acting insulins like Humulin and Caninsulin, you feed first then shoot insulin. You should test before that feed and shoot to see if it's OK to give insulin. On this forum, we say not to give insulin if the cat is under 200 when we test prefood and preshot, because you don't have enough testing data to see how the cat will react.

Warming the ears makes a big difference in the bleeding. I have an old film canister container that I fill with hot water and hot that against her ear for a few seconds. Always reward with a no carb treat after the test and soon they'll associate the test with the treat.

We had a vet that put us on Caninsulin first, but I stuck with her because I like her for the non diabetes related issues, and now we are on Lantus.

 

It wasn't clear to me from your post when or if you got a pre-shot test.

With those fast onset insulins like the Humulin you are using, you test, feed and wait 30-45 minutes, then shoot the insulin. It's good if you can get another test within minutes of giving the Humulin. If you can't, you can't.

That test before you give the insulin is called the pre-shot test. The test before you shoot the insulin. Other tests during the day are referred to in the + hour format. We call those tests in the middle of the cycle, the mid-cycle tests. With shorter duration insulins like Humulin, this mid-cycle is more likely to be around hours +3 to +5.

I would not have given any insulin with a pre-shot test of 98. Not with the Humulin. I wouldn't shoot under 200 with the Humulin if this were my cat.

"Better too high for a day, than too low for a minute."

We need a spreadsheet (SS) set up for you asap. It think it will help to clear up some of the confusion. Do you need help in setting that up and linking it into your signature?

 

Thanks for pointing out the spreadsheets, Deb. Really, really helpful to have your template to imitate. Got a spreadsheet set up for Cheshiretonight. Added a morning and evening weight column. His weight is what worried me first, and he's still thin, so I want to track that. And it's one measurement I *know* I can do right every time.

Unlike the BG test. Managed to get one good reading after dinner, but the attempt two hours later failed. He's catching on and getting more irritable about all the hassle. The +1 was 189. Am I right to think that's a decent place to be right after eating, and that it implies a significantly lower number before the meal? Or is none of this that orderly, and I should stop trying to assume patterns?

Thanks again... I just can't get over how many people you help here.

 

I can access your SS just fine. Love what you named it by the way. :lol: :lol: :lol:

Did you actually use our SS template and just rename yours? Not sure why you got rid of the line with the color coding for the BG ranges? There is automatic conditional formatting on our SS template. :? did you follow these instructions? ss setup and link to your signature

Are you giving him a low carb treat with every test? To help keep him happy. List of low carb healthy treats here. Other options are brushing Cheshire if he likes that, or ear/chin/head scritchies if he loves that. Most cats will learn to come for the treats.

Depends on what he was before the shot of insulin and before food. You did not get that pre-shot test. That is one test we highly recommend every single time. Shot or no shot. That one is key. So, we don't know how much of a rise it was from the no food to the food number.

It is a decent number that 189. Below renal threshold which is good because it means no excess glucose spilling into the urine.

 

Thanks Deb... I'm going to owe you a drink soon for all the advice you're giving me.

For the spreadsheet, I didn't find the instructions on the spreadsheet, but I'm handy around Excel so I just recreated it. I can add the color coding line - I picked milder tones of the same base colors, just out of personal preference. Sorry for any confusion.

As for treats at testing time, oh yes. He gets a slice of delicious deli turkey (not a long-term solution, but what I have on hand right now). He'll come into the guest bathroom (the torture room) and loves the treat. He just knows what's coming now and is more evasive and folds his ears back. He's not vicious or anything, we're just past the phase where I can trick him. Hopefully he'll just accept it pretty soon.

Thanks for the list of healthy treats, too - I hadn't found that, either. There's so much knowledge compiled here... this place is the Mayo Clinic of feline diabetes.

Also, thanks for the pointer about the pre-shot test being the most important. I didn't realize that, so I'll prioritize that. I tried 3 times (couldn't get blood again) pre-dinner last night, and just gave up, then tried again after and was successful.

I see Wink went OTJ in March - huge congrats! And you've got a pretty awesome SS title, too.

 

Here are the SS creation instructions. http://www.felinediabetes.com/FDMB/viewtopic.php?f=6&t=18207 They are over in the Tech Support forum. Most new members miss them so we give people the link here.

Oh yeah, I sometimes forget that Wink's SS is the only place where I have his full name. ;-) I ran out of space in my signature and had to shorten and ditch some things.

It takes time to become proficient. We tell people to make 3 attempts, give a treat successful or not, and come back later to try again. Also, the ears "learn to bleed" and it gets easier. What actually happens is that new capillaries form, angiogenesis.

No drink required. Just paying it forward. When you get more comfortable with the sugardance, you can post in other people's topics too. Even it it's just to say "I'm really new too and have learned so much from these folks."

Ah yes, the "torture room". Wink was pretty accepting from the beginning. And I found the Halo Liv-a-little freeze dried chicken treats. Wink would jump through hoops to get one of those. I crushed them and sprinkled them on his food when he did not want to eat.

Here's another handy and informative document. ear testing psychologyWe probably did not point you to it, because we try not to overwhelm new members that are already in total shock with the diagnosis.

Read through other peoples posts. There are probably lots of other things to learn from them too.

 

Whats a low bard food? (july 13 comments column) No more shakespeare? lol.

Lets see how his numbers are the next few days, he might keep dropping and not need the insulin. If he stays at this level he will need to go back on eventually but we might be able to tweak him down further with a switch to a lower carb food again before that happens if need be. Friskies pates can be as high as 11% carbs whereas Fancy Feast pates are as low as 4% - and some cats are more carb sensitive than others.

Are you testing the urine for ketones?

Wendy

 

Hi Deb - Thanks for the cat psychology link - was really helpful and changed the way I approached the situation... and it was easier today. I got blood every time - three times in one day! Haha.

Wendy - you're exactly right - no Shakespeare or Chaucer for Cheshire. Thanks for pointing it out - I must have typed that when I was tired. Sometimes my fingers get a mind of their own.

I'm not testing for ketones... I thought that was only necessary for pretty high numbers. Do I have that wrong?

His PMPS came in at 235 today. I'm having to mix dry and wet food to transition his sister to wet, and I suspect he managed to sneak a few kibbles this morning. So he got a 0.5 dose this evening and was a nice, pretty 78 at 1.5+. He has been having a little diarrhea, I think from the quick diet change. It must suck for him, so I hope his bowel adjust soon.

He's losing weight still, which concerns me. It could be diarrhea weight, but still. He used to be a 17lb cat in December, and now he's 11.5. He's a large - long, tall - cat. And being on a low carb diet, I just don't see how he's going to put weight back on. Does anyone have advice on managing weight?

 

Testing for ketones when unregulated is important. Too much fat breakdown for calories may lead to diabetic ketoacidosis.

 

Before you decide Cheshire needs to gain more weight, you may want to look at this cat body condition score and see where your cat falls on the chart.

Cats don't need carbs to gain weight. Adding more protein, 15-20% of the daily calorie intake can help.

 

Ketones can happen at ANY level of BG, so it's not just high numbers.
Many cats are just prone to ketones; not enough food + not enough insulin + possible infection... that's the recipe for ketones / DKA.

I would not worry more about the weight problem because as you get to the good dose of insulin and are feeding good low carb wet food, the weight loss will stop and if a gain is needed, the cat will put on what is needed.

Yes, the diet change can be disruptive, but he should soon settle nicely. I'd remove ALL the dry and be done with it for both cats... it's not good for cats, so stick with wet and donate the dry to a local shelter or rescue.

I think you said you are giving Humulin insulin..... not a good insulin because you will get a huge drop in the first few hrs, then the numbers will rise again soon. Humulin does not last the full 12hrs, so switching to Lantus or Levemir will be your best choices. Lots of info has been given for Humulin; did you get the link for info on Humulin?
Humulin Primer Info

As has been said, Humulin is a very harsh insulin, so you may want to test, give a meal, then shoot 30min later with a dose based on the BG before eating. If you got a 235, then shot a 0.5u which pulled that number down to 78 by +1.5, you can see how fast the number can be yanked down...for all you know, if you remove all the dry food, you won't need any insulin at all. If the cats are eating wet food, there is no need for the dry at all.

When you can, do a curve, testing every 2 hrs after a shot. The curve will show you how the insulin is affecting the numbers and how long the insulin is lasting.
Because you are giving Humulin, I would suggest you test at shot time, feed a meal then wait 30min, test again and give a 0.5u shot. Make the next tests at +1, +3 and every 2 hrs. You will see how everything is playing together: Humulin and dose, food.

Gayle

 

when you see another reading like that 78 can you get a test a few hours later? We really need to know how low he is going. I also wonder if you want to try 0.25 twice a day instead of 0.5 once. the 0.5 might be too much - if he needs any at all so would like to know how low he is dropping.....

 

Thanks Wendy, Gayle and Deb.

Deb - on body condition, I hadn't seen that chart before. Ches has dropped from a 7 to a 3 in about 3 months. But I'm seeing the point in the advice you and others are giving me: get the diabetes handled and the rest will sort itself out. He's thin, but he's not starving.

Gayle - Thanks for linking to the "definitive" guide on Humulin. I'd gotten bits and pieces, but not the whole picture before. I need to switch, but I hate throwing that $90 away. I know, it's not that much in the big picture, but it adds up. But if another $90 gets better insulin with a better chance of getting him into remission... that's worth it.

Wendy - I think you make a good point on the .25 twice a day idea. I'm noticing patterns in his blood glucose. He's normal range in the morning (150ish) and then a bit high (230s) when I get home in the evening. My assumption is that it's creeping up during the day. Maybe .25 twice a day will keep him more even.

One of the complicating factors has been that my vet sold me the wrong needles (40U) for my insulin, so I've been converting the dose manually. I need to throw that box of needles away, too, along with the Humulin, and get the right needles. That vet cost me a lot of wasted money. Sigh.

So, shopping list: 100U needles, ketone test kit, and next week, new insulin.

I think I'll try to do a curve tomorrow. How big a difference is it whether you test every 2 vs. 3 hours. It's a yardwork day so I need to schedule around tests, that's all.

Thanks again you all - you've done more for my sanity that I would have thought possible. Hope you're having a good Friday.

 

Please don't throw the needles out - post them in supply closet for anyone using ProZinc, where they can do some good, or give them to DCIN if they can use them!

 

You said something that jumped out of the page at me. Stress. Will stress cause High BG numbers? When Sherbert is at the vets, the place is full of dogs and by the time we get seen he's ready to jump out a window. They test him from the leg and get readings in the 500s. When we home tested we were in the 300s. Still too high I know, but we also have a female cat that likes to terrorize Sherbert. We have 2 other male cats. All are rescues and all are different personalities. When we took Sherbert to the Animal Hospital down the street to get a 2nd opinion, she got a reading in the 300s. There were no dogs anywhere and Sherbert actually laid on the counter very peacefully. I asked the vet if stress could cause elevated numbers and the one at my vet's office said highly unlikely, and the dr at the animal hospital said it could. Just like the food. The Vet at the vet's office said dry kibble and the dr at the animal hospital said wet. Such conficting answers. No wonder we the caregiver cannot get this dreadful disease regulated. I am not giving up. I am going to make Sherbert better.

 

Darn double posting!

 

Yes, causes higher BG numbers. "Vet Stress" can raise BG's 180 points within 5 minutes and last up to 90 minutes.

It's a major reason your test numbers at home are lower. Your cat is in more comfortable and familiar surroundings, less stressful.

Skinni, I see you have started your own post already and introduced yourself. We like to give individualized suggestions.

 

Stress can impact the numbers.

Chris - I see that Cheshire has been vomiting and not eating well. Can you let us know about other symtpoms? Is he sitting hunched up? How much is he eating? Are you testing for ketones? I am concerned about DKA and pancreatitis and want to be sure he is eating enough

Wendy

 

Hi Wendy - Sorry I didn't reply; I didn't see your post until just now.

He did vomit, but only once. That morning I had fed him and then did the BG test half an hour later. I think the stress of it freaked him out. He hasn't vomited again, and hasn't shown any other symptoms. We're getting in a routine with testing, and it's getting easier and less stressful. Fewer treats, fewer bloodless pricks, and much quicker all around. Much of which is thanks to you and the other amazing people here.

I came back to my thread to ask for insulin recommendations. I'm asking my vet this week to switch of Humulin. Seems like all the cool kids are using Lantus or Prozinc. Is there any real reason to choose one or the other? Is the Lantus coupon the big difference? Do you have to get the pens? Or are the pens so awesome I won't mind having another half-used box of syringes?

 

The glucose levels between shots seem to be smoother on Lantus than on ProZinc, to me.

There is a tested protocol for using Lantus which has an over 80% rate of remission ( getting off insulin and being diet-controlled.

ProZinc, on the other hand, may be used with a sliding scale.

 

Tested protocol with an 80% remission rate seems like a pretty rock-solid reason to me. Thanks, BJM!

 

Now that I've convinced you (*evil grin*), take a moment to go up to the Control Panel, find your signature and edit to put in a few tidbits of info folks will want to know about you and your kitty

names of you and kitty
date your diabetic was diagnosed (has to do with some of the decision making about low numbers), approx age, gender, weight
insulin used
meter - if AlphaTrak/pet-specific, make the font larger so it sticks out as the numbers are on a slightly different scale.
other notes you'd like to put in, esp if there are any food problems.

All that in about 250 characters or so.

And then pop over to the TR forum, read the sticky posts, and introduce yourself as directed.

 

Another bonus of Lantus is the Lantus Tight regulation board is very active and can advise a lot if you are on that insulin! http://www.felinediabetes.com/FDMB/viewforum.php?f=9

Once we get you settled on the new insulin we can advise on how to post there when you are ready.

Once you get the Lantus and syringes etc let us know and we can advise on starting dose etc too

Wendy

 

Vomiting could be a food allergy. If it happens again, note down what food you fed him before it happened (this is how I figured out Mikey was allergic to red meats).

There's also Levemir (works similarly to Lantus), however, it's a "newer" insulin in the feline diabetes world and isn't mentioned in the AAHA Guidelines. Most people who have switched from Lantus to Levemir like it better.

If you get Lantus, you want the pens because it comes with this Savings Card that guarantees you pay only $25 per pen for up to 6 pens. You also use the syringes (and not the pen needles!) as if the pen were a vial instead, so you don't have to worry about yet another batch of syringes going to waste. :smile:

 

Thanks for understanding my irrational cheapness - if the pens could be used with regular syringes was actually one of the questions in my head.

And good point about the allergy. It was Friskies Salmon, so I'll add that the the spreadsheet.

I think I realized a stupid mistake this morning. Ches's BG readings have been higher, every pre-meal, and back up at about 6+. Turns out, I'd bought Friskies Mixed Grill, which is 11% carb, and the cats liked it most, so they've been eating it almost every day. I'm not sure how I made the mistake, but I've made the switch back to a <9% carb food, and am hoping to get back into the prettier blues and yellows again. And should get Lantus tomorrow, so... might be a good weekend.

 

Hi Chris. Welcome to LL. it looks like you have Cheshire started on the right path now. Our vet originally prescribed Humulin N also. He agreed to do research on Lantus when we told him about it and subsequently enthusiastically switched our kitty to that. We saw a big improvement in our kittly's (PurrFace) mood.

Again welcome and have a great day.

 

A couple of times now, when I've done a BG test around +5 or +6, Ches will score a high reading - like 375 tonight (he ate more around +5 - he's still skinny, so I let him eat whenever he's hungry). We're still on Humulin N (the vet wants to do his homework before switching, which I can respect), but I'm wondering if I should be giving Ches another small dose of Humulin to bring him back down? Isn't that what a human would do? Any thoughts?

 

Because Humulin N lasts only 6-8 hours in the cat, some folks choose to shoot 3 times a day (TID), or about every 8 hours.

If this can work for you, take the total daily dose and divide by 3, then give that amount every 8 hours (or as close to that as you can manage). That'd be 2 units / 3 = 2/3 unit ... might go with either 0.5 or 0.75 units every 8 hours.

If the cat has not had problems with diabetic ketoacidosis, it also helps to pick up the food around +5 hours after the shot as it is wearing off and the glucose is starting to rise.

 

Feeding more food after the insulin has done it's maximum lowering effect, will make the BG shoot up higher quicker. With the Humulin N only lasting 6-8 hours, feeding food after about +4 could be making him go much higher quicker.

 

If your goal is remission and diet control dont let your vet take too long researching. The window for remission is only about 6 months from diagnosis and you want to get started ASAP.

Wendy

 

How are things going with Cheshire?

 

Hey KPassa - thanks for checking in. Things are pretty unchanged over here.

I've just finished my mini-research-brief and proposed treatment plan, which I'll be delivering to the vet tomorrow. My goal is to be switching to Lantus this weekend (when I'll have time to do the initial close monitoring).

If anyone wants to see the brief (and/or make any recommendations): https://docs.google.com/file/d/0By1ctcDEMTONaFh5WFoxU0JFX3c/edit?usp=sharing

My vet was hesitant to make changes without doing some research, so I compiled a couple of key articles (including the Tight Regulation Protocol) and am proposing a specific treatment plan.

Anyway, I'm up way too late for a work night. Have a nice Monday everyone!

 

Good prep for the vet. The following, perhaps as an appendix, may be helpful to include.

Here are some glucose reference ranges used for decision making using a human glucometer:

< 40 mg/dL
- Treat as if HYPO
- At nadir (lowest point between shots) in a long term diabetic (more than a year), may earn a reduction.

< 50 mg/dL
- If before nadir, steer with food, ie, give modest amounts of medium carb food to keep from going below 50.
- At nadir, often indicates dose reduction is earned.

50 - 130 mg/dL
- On insulin - great control when following a tight regulation protocol.
- Off insulin - normal numbers. (May even go as low as the upper 30s; if not on insulin, this can be safe.

> 150 mg/dL
- At nadir, indicates a dose increase may be needed when following a tight regulation protocol.

180 - 280 mg/dL
- Any time - The renal threshold (depending on data source and cat's renal function) where glucose spills into the urine.
- Test for ketones, glucose is too high.

>= 280 mg/dL, if for most of the cycle between shots
- Uncontrolled diabetes and thus at risk for diabetic ketoacidosis and hepatic lipidosis
- Follow your insulin protocol for dose adjustments
- Test for ketones; if more than a trace level of ketones, go to vet ASAP.

 

Thanks BJM - I'll bring that as a quick-reference, too. Hope you're well!

 

Let us know how the vet visit goes tomorrow. Hope all your research and information gathering pays off with a better insulin, like the Lantus you say you want to switch to.

 

Well, that was a let down. The vet's response was pretty unenthusiastic - kind of flipped through it, but didn't engage when I started explaining it to him. He's a very ho-hum guy, like a mix between Eeyore and Charlie Brown with a cajun accent. The feeling I got was a bit like "Seriously? Sigh. Ok." He said he'd call me within a day or two, but I had to prompt him on it. I just get the impression he doesn't want to be bothered...

Which is why I spent the last half hour calling vets and asking about what insulin they prescribe and what their boarding costs are. Even if he calls in the prescription I want, this guy has lost my business. I'm engaged, interested, motivated, and he's just not getting on board. Not good enough. I hate having spent this much money with him already, but I'm not going to drag him along.

 

At least he didn't outright dismiss you!

See my signature link Vet iNterview Topics for additional considerations when choosing your next vet.

 

Wow! Bummer! That vet is a bit disappointing. Maybe he was having a bad day. It can be difficult for vets to keep up with all the latest info on all the diseases and issues they see with the various animals they treat. They can have liability concerns too, with a medication like Lantus if they have never used it before and are not sure how to manage diabetes with this new to them drug. It can be a learning experience for the vet too, if they are willing to take on the challenge.

Still, you live in an area where you should be able to find another vet so those phone calls should turn something up. Hope you find another vet that is more responsive to your needs. Remember to get a copy of all the records from your current vet. You paid for all those tests, you are entitled to copies of all the results.

You know that all of us here will be supportive of whatever you want to do. We're engaged, interested and motivated to get your cat feeling the best he can. Our goal is remission if possible. You never know, so let's reach for that brass ring for your cat Cheshire.

 

This is fantastic work! Would you mind if I share it with others in the future as a "case study" type thing to help others to get their vets to switch? Your (current) vet might not be interested, but other vets might!

 

Sure thing, KPassa, though let's see if it works first, lol.

Yep, it's a challenge for all parties involved, and if this vet won't step up and do his job, I'll be glad to give my money to someone else. He works for me, and I just don't think he realizes that.

And thanks for the interview tips, BJM! I need to just start checking your sig first every time I have an issue/question.

I spent some time on the Reporting tab of my spreadsheet tonight to set up a graph of the overall and monthly BG curve. Kind of please with how it's turned out (though the limitations in Google Spreadsheets can chafe a bit). I'd handle the data collect a bit more automatically in Excel, but, c'est la vie. Maybe it'll be useful to someone. Or maybe someone's already done it better!

 

Monthly average is kinda cool. What's the 1,2,3, Etc.. Is that hourly average? Not sure how useful that is if so since nadirs vary as do bounces.

I have an offline line chart that shows all readings over time which is interesting for trends...

 

The 1, 2, 3 is hours after shot - so you can see how it averages out and get a sense of what the curve looks like. The chart shows what the average reading at +1 was overall, then in July, Aug, etc. Next row is average reading at +2 overall, July, Aug, etc. And so on. Then the graph visualizes those hourly averages. It might hide some of the variance in nadirs/bounces, but mainly I wanted to confirm my sense of when the insulin wears off.

 

So the vet came through and prescribed the Lantus... which I just paid an arm and a leg for. The card sign-up site wouldn't let me registered and I haven't had time to call... so I just paid for it. I figure it'll last 6-9 months, so I'll fight the coupon again then. I want to be able to monitor closely when I switch to Lantus, so I'm waiting for Saturday morning... new chapter beginning! Thanks a ton to you guys for encouraging me to push for this.

The brief went over well, too, once he sat down and read it. I put the spreadsheet on top, and he'd just never seen a client do anything like that before. Hopefully it'll spur him to educate himself a bit.

 

Congratulations on getting your vet to prescribe the Lantus. After the presentation you did, building your case as to why you wanted to use that insulin and the research you included, I don't see how he could have said no.

Have you been over to the Insulin Support Group for Lantus TR and read the documents at the beginning of the topics section labeled Sticky.......? Lots of good information there.

We'll be waiting to see how Cheshire does on the Lantus. Wishing for all the best for him.

 

Yay for the vet! It's not necessarily a bad thing if they're out-of-date; it's only bad if they're not willing to work with you. ;-)

I noticed on your spreadsheet that Dinah vomited from the Friskies Poultry Platter perhaps? It does contain fish, which many cats are allergic to. Keep track of what you feed her when she vomits and see if there's any correlation in the ingredients. Other common allergens are beef (which Mikey is allergic to) and even poultry.

 

Deb, thanks for the pointers about the stickies - will definitely read before starting on Saturday.

KPassa - fish in the "poultry platter"?! That's terrible, deceptive marketing. Dinah and Cheshire have different tastes, so I've got to start doing a better job of monitoring her, too. Thanks for the heads-up... that's really bizarre.

 

Well you got the lantus and thats a great start!

You decided on a starting dose? heres the protocol i would use which also recommends a dose based on weight: http://www.felinediabetes.com/FDMB/viewtopic.php?f=9&t=1581

Wendy

 

Hey Wendy - dose is exactly what I'm thinking about. I'm a little eager to update my sig to say "Lantus", too.

The TR Protocol would suggest 1.3U based on weight. We've been doing 1U of Humulin, and depending on which food he's on, getting into the mid-low 100s at nadir. So I'm hesitant to start any higher than 1U, and there's part of me that thinks I should start at 0.5U just to be on the safe side.

There are practical factors that play into this, too:

I'll be able to monitor him extensively over the weekend, so I'll get two cycles of frequent readings. But Mon-Wed, I'll be at work all day, so testing will be limited.

What's worse is that on Thursday, I fly to California for 8 days, during which time he'll be boarded. He hasn't been diagnosed long and I don't have a good vet (and I'm not boarding him with my crappy vet, anyway). So I feel like I need to be quite conservative with this initial period. He's going to stay at a vet hospital (they want him to stay in the hospital ward, but I don't love that idea - I'd rather he be in one of the "cat condos" with a outside view), so I know they can handle a hypo situation, but I'd rather not risk it.

So, how do you feel about a 0.5U starting dose for the first two weeks? I know this isn't an ideal way to start, but my only other option is to leave him on 1U of Humulin for the next two weeks, and I'm just as worried or more about it.

All ideas/advice appreciated.

 

0.5 sounds totally fine, will the vet be testing his blood?

 

Yes, it's one of the requests I'm making. Though it won't be as frequent as what I would do. I have to negotiate that, but I'm planning to ask for a AMPS, +6 and PMPS, and telling them not to shoot if the PS is less than 200. That sound right?

 

That works. And give them the LC food and treats too.

Wendy

 

Hahaha!

So, the plan was to give the first injection of Lantus this morning so I could monitor the first cycle closely all the way through. Cheshire has other plans. His BG was 126 this morning, which I understand to mean no shot (below 200 = no shot, right?).

Since I'm brand new to Lantus - should I inject him at 126 anyway? Should I test again in an hour (after he's eaten) and then if he's higher, start the cycle then?

 

Actually, think I found my own answer: Lantus dose changes are based more on the nadir than the PS tests (though they're a factor).

So, I should give the 0.5U starting dose, and start monitoring. And start a thread in the Lantus forum. I'm going to miss this one.

 

First as a newbie to lantus I wouldn't shoot under 200 since we don't have data to know what he will do. But if you did, please get a test at +2 for sure to see what Cheshire plans are for the day and if is lower, get more tests in..

Lantus is a depot insulin and so takes a few days to build up in the cats system however chesh might still have some old insulin in there that will impact things.

The depot means it takes a few days to see any impact of a dose change too which is why we hold the dose a few days before making changes. And hold it a week when starting out (unless BG drops below 50 which earns a decrease immediately )

Don't worry about moving forums, many of us are over there too and u can always ask questions here too..