Introducing Eddie and a few questions.

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Fast Eddie

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Eddie is a shelter cat we adopted a number of years ago. He is a big orange tom, emphasis on big. He started out with us at 3 years at about 13 ponds, now he is 10 and about 20 pounds. Massive weight gain happened after I had a baby and the 2 cats plus baby were not allowing me to sleep, I just about ended up in the loony bin (really) and Eddie was sent on a temporary vacation. When he came home we started free feeding to try and allow for quieter nights. 4 years later he has been diagnosed as being diabetic. About a year ago he was not. He is also allergic to flea bites and generally an indoor cat. He has a little buddy, Oliver who is 8 and about 13 pounds who is asthmatic, probably seasonal allergies.

Eddie started on Lantus about 2 weeks back. Vet has him on 5.5 u once a day. Not sure I could do twice a day but will consider. He has been doing spot BG testing at $20 a poke every 3 to 5 days. First check up, he was 24 (high, converts to 432) Second check up he was low at 2.3 (45) Cat showed no symptoms other than he was hungry. I picked up a BG monitor and have started testing him here and there. First test yesterday evening was 16.8 (290) I tested again at bedtime and was about 8.8 (153) and this am was a little lower. Tried to test this evening but was unable to get enough blood. I am worried that his ears are looking a bit blue under his orange fur. His insulin dose has not changed.

Good news is that he is more alert and his eyes are brighter since starting insulin. Tonight he actually cleaned his face after dinner.

I switched him over to wet food wellness/EVO a few days into the insulin. I still have a bit of dry around and am trying some EVO dry. Both cats don't seem to like it.

Questions. What lancet would you suggest, the one I got with the meter is too fine, I have been using some I appropriated from work which seem a bit better but I don't think I can buy them but I will check at the pharmacy.
Eddie seems to have a decreased appetite now that he is on the wet food. How much should he be eating a day? Actually both cats seem to be eating less. I have the large tins, on the tin it suggests 1/2 a tin a day for a 7 pound cat, Eddie is definitely eating less than that, more like 1/4 tin or less though he pigged out on it when he first got it. I have now picked up some higher protein wet food cowboy cookout as the wellness may be too low in protein. Currently I have no scale in the house to weigh him on. The kitchen scale would never work for his heaviness.

I am an RN and work in maternity care. Quite well versed in human health. We live in Vancouver BC.

Of interest, the insulin cost $70 from the pharmacy for a 10ml vial, would have been $115 from the vet. I like my vet, he is pretty easy going, though I feel he is not up on all the latest greatest given my experience with my other kitty's asthma. If anyone in the city wants to recommend a vet, please do so, I'm on the east side of the city.
 
Poopy and I welcome you to the best place you could have found for you and Eddie! cat_pet_icon

I am not familiar with Lantus so can't address the insulin dosage, but it seems rather high. Once a day doses also seems a bit odd, especially with such a high dose. Most insulins wear off after 12 hours. There are other Lantus users here and I'm sure they know quite a bit more than I do. :smile:

And good on you for testing! :RAHCAT We find it most helpful to test prior to feeding (what we refer to as AMPS and PMPS), then give their shot after eating. A few hours later we can start testing their BG numbers to see how the insulin is working. I use ProZinc, and the lowest numbers usually happen in the 5-7 hours after the shot, so testing during those hours is helpful. Lantus users can share with you what numbers to watch for and when, and how they are used.

Lances come in different sizes. The smaller the number, the larger the needle. Using a larger needle (25-27) helps when learning how to test at home. :smile:

Switching to low carb foods is fantastic, as carbs do efffect our kitties BG numbers. Good on you again! :RAHCAT Sometimes switching to low carb can drastically reduce our kitties BG numbers and, through watching the BG numbers, we can lower the insulin amount. We have to be careful to not give too much insulin to where their numbers go into hypo. Hypo can kill quickly - something we don't want. :smile:

Welcome again! cat_pet_icon
 
Welcome fellow BCer :) Scooter was dx around Christmas. Also dealing with Lantus, however vastly different dosing regime. I'm new to the whole thing, but after lots of suggestions from forum experts and reading a lot about how Lantus works, a high dose once a day seems very strange and may be dangerous. Lantus is long lasting, but not that long. Sounds like you might need an opinion from a different vet. :sad:

and - 1/4 of a can (for BOTH the 5.5 and 12.5 oz cans) is not enough food for an obese cat. And correct me if I'm wrong experienced members, but if he doesn't start eating well, he may be at risk for hepatic lipidosis nailbite_smile
 
Fast Eddie said:
Eddie started on Lantus about 2 weeks back. Vet has him on 5.5 u once a day. Not sure I could do twice a day but will consider.
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Please do. Lantus is dosed twice a day in cats. It just doesn't last longer than that. 5.5 units once a day is a huge dose.

There are stickies over on the Lantus board with info on how Lantus works for cats and a protocol many people use: http://felinediabetes.com/FDMB/viewforum.php?f=9


What lancet would you suggest, the one I got with the meter is too fine, I have been using some I appropriated from work which seem a bit better but I don't think I can buy them but I will check at the pharmacy.
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28 gauge is a good size. Here's a chart: http://www.walgreens.com/marketing/library/centers/diabetes/lancets.jsp You can freehand the lancet or use a lancet device.
 
Welcome to FDMB!

You may want to familiarize yourself with Lantus use in felines. There's a great deal of information in the starred sticky notes at the top of the Lantus board. Below is an overview of what's contained in those notes.
  • Tight Regulation Protocol: This sticky contains the dosing protocol that we use here. There are also links to the more formal versions -- the Tilly Protocol developed by the counterpart of this group in Germany and the Queensland/Rand protocol developed by Jacqui Rand, DVM and published in one of the top vet journals.
  • New to the Group: Everything you wanted to know about this forum and more. Info on our slang, FAQs, links to sites on feline nutrition and to food charts containing carb counts, how to do a curve and the components to look for, important aspects of diabetes such as ketones, DKA, and neuropathy, and most important, info on hypoglycemia.
  • Handling Lantus: how to get the maximum use from your insulin and what to not do with it!
  • Lantus depot/shed: This is an important concept for understanding how Lantus works.
  • Lantus & Levemir: Shooting & Handling Low Numbers: What data you need in order to be able to work toward remission or tight regulation as well as information if you have a low pre-shot number or a drop into low numbers during the cycle.

Unlike with humans, cats need BID dosing due to their increased metabolic rate. If you were doing glucose curves, you would see a big swing in numbers between nadir from the shot and the last 12 hours of the cycle. Ideally, a Lantus curve is flat and you will not see this unless you are dosing BID. In addition, Lantus is a depot-type medication. By dosing once per day, you are not providing enough insulin for the depot to form plus you are losing many of the benefits of using a long-acting insulin (e.g., overlap between doses).

I would also encourage you to routinely get a pre-shot test and at least one test per cycle. Lantus dosing is based on nadir, not on the pre-shot numbers. You need to test at pre-shot to insure it is safe to give insulin but the amount you're giving is based on the nadir. I would also point out that 5.5u is a HUGE starting dose. Even if Eddie is a big guy, if we assume that 15lbs is close to his ideal weight, his twice a day dose would be 1.7u. Even doubling that dose for shooting once a day, you are still giving a very large dose. Based on the Tight Regulation Protocol that we use to guide Lantus dosing decisions, the 45 on Eddie's second BG check would have warranted a dose reduction.

Please let us know how we can help.
 
Hi and welcome to the best place you never wanted to be!

I am not a dosing expert and cannot give advice on dosing. However I can tell you what is usually recommended by those that are around here and what my experience has been, I have two diabetic cats, both are getting Lantus. I believe the recommendation is to start with a low dose, usually 1u twice a day. Since Lantus is a 12-hour insulin we give shots twice a day. It is important to get a BG at both amps and pmps (morning preshot and evening preshot) times, and also to get as many spotchecks as possible during each cycle. Most of us do our own curves and do not pay a vet to do them. We do not however base the dose on preshot #s but on nadir, the lowest point in a cycle. When we do a dose change, we hold it for 6-10 cycles b4 changing it again, unless the #s indicate otherwise, as in an extremely low PS #.

If you are following the Tight Regulation Protocol be sure and read the sticky: TR Protocol Sticky and also the other stickies have great info in them as well.

How long was it between his BG of 432 and 45? Was it during the same cycle? 45 is very low. That is quite a drop if it was during one cycle. Usually a cat on Lantus who has a BG of 45 during a cycle we say "earns a dose crease." We usually decrease by .25 units at a time. Good for you for getting a meter and starting to hometest. This will help so much. Can you create a spreadsheet for Eddie so that others can look at his BGs, that helps us help you help your cat.

Also on buying the Lantus, if you buy the pens it is much cheaper than the vial and they last a very long time. In my experience a box of 5 pens costs about what one vial costs and lasts 5-6 times longer so you may want to ask your vet to give you a scrip for the pens. The lancets do come in different sizes. His ear will eventually "learn" to bleed. Sometimes massaging it b4 poking helps.

Good for you for switching to wet food. Most of us feed exclusively wet food. Have you looked at the food charts that list carb content? Janet and Binky's food chart is a good one, I can never find the link but I'm sure s/one will come along and post it. Tinkerbell and Tawny get Friskies pate all under 8% carbs. Tawny has just gone thru an extensive illness and also gets Wellness Turkey & Wellness Chicken. You may find that a change to an exclusively wet diet will also help with Eddie's weight.

Be sure and read the stickies and visit other condos, I have gotten all my education on dealing with Tink & Tawny's diabetes here. This is a great place!
 
Hi, Welcome to FDMB. since you are already testing and have switched to low carb food you are well ahead of most beginners. :thumbup

What lancets you use is a matter of what works. Do you use the lancet device or freehand? I find that the finest lancets i can get work best for Tess, but many use thicker ones. We freehand as I feel I have a little more control. If you do freehand, hold the lancet at about a 45º angle and twist slightly as you remove it. That keep it poke open. Sometimes I need to do a quick double poke. The finer lancet seem to bruise Tess's ears less, also put pressure on the site for about 20 seconds, that minimizes bruising a lot. You can prick anywhere around the edge of the ear, between the vein and the edge. I alternate ears and move the site around. Many use neosporin w/ pain relief too, but the biggest help for sore ears is putting pressure on after the test. Also, I have found that the BD lancet seem sharper and cause less pain. Warming the ear , by rubbing or a microwaved rice filled sock helps a lot, especially in winter. Lastly, and most importantly, give a treat after each test. Tess actually purrs through the test in anticipation! :lol:

5.5 u does seem like a lot and Lantus is better dosed twice a day. Cat's metabolism is much faster than humans and it starts to lose effect sooner. W/ a 12/12 schedule we get a slight overlap and a much more even curve. Always try to get a test before shooting to be sure it is safe to shoot and try to get one about mid cycle. Lantus is dosed on the nadir of the cycle , not the preshot number. It is important to get that mid cycle test to see how effectively Lantus is working for Eddie.

Most cats need between 20 and 30 kcal per day for food. The calories are much more important than the volume. Most Merrick flavors are about 28kcal/oz, EVO 95% is about 38 and Wellness 40. The numbers on the can don't include carbs and are very inaccurate in any case, showing minimums and maximums so you really can't use them to calculate the carb values. What we want is low carb <10%, close to 5 is even better. Janet and Binky's list has been a great help to may here, but it is getting old and needs updating for new foods and changes in formulas. This list is newer and has some of the new products, but doesn't cover as much. All the info in them was collected by volunteers who contacted the pet food mfgs. and pried the actual numbers out of them. :roll:

I hope all this helps. there is a lot more info available in the Stickeys (permanent posts) at the top of the Lantus TR board.
 
Rereading through your post and the responses, the pens are much more economical in the long run. There is an "opened shelf life" for Lantus of 28 days and few of us use up a vial before then, the pens are smaller quantities in each so there is much less waste. since you are in Canada do you even need a Rx? And working in a hospital, the pharmacy may sell individual pens as they often open boxes for patients. We use u100 syringes w/ the pens just like the vials. Don't get the needles for the pens as they can only be used for full units. Just think of the pen as a mini vial.
 
Ann & Tess said:
Most cats need between 20 and 30 kcal per day for food. The calories are much more important than the volume. Most Merrick flavors are about 28kcal/oz, EVO 95% is about 38 and Wellness 40.
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Not trying to be rude, but I don't understand your math here, haha. In science, 1 kilocalorie is 1,000 calories. 20 kcal would be 20,000 calories. :-D Maybe you meant between 200 and 300?

As an example, Dr. Lisa's site recommends "at least 15 calories per pound per day" based on lean body weight. If 13 pounds was a somewhat ideal body weight for Eddie, that would be 195 cals/day for weight loss/management.

Binky's page says that a 5.5oz can of Wellness Chicken, for example has, 220 cals. So that would imply that Eddie needs to eat just under 5.5oz of it a day to meet his calorie requirements. He is eating a quarter of a can. Not good. :? Even if he's actually eating 1/4 of the 12.5 oz cans, that's still only 3.1-ish oz, or 125 cals (better but still not enough). We need to know how big the cans are first!

*omg sorry for editing this a thousand times, I kept rereading it and thinking I'm coming across as rude... sorry!!
 
Actually it is the term "calorie" used in regard to nutrition that is an inaccurate colloquialism. From Wikipedia:
How do i convert KCAL to calorie?
Answer:
They are actually exactly the same.
In scientific circles a kcal is 1000 calories but the term calorie used in dietary circles (the one used in nutritional values) is an abbreviation for kilocalories (kcals).

So 1 calorie is equal to 1 kcal
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Dr. Lisa was saying that 15 calories a day was the minimum to prevent DKA. For weight loss she recommends "13.6 X optimal lean body weight in pounds] + 70" but that this formula is often too generous for weight loss. For maintenance she says "Considering that the average 10 pound cat only needs about 200 calories per day to maintain their weight,…" That would be 20 calories per pound, more active cats can need up to 30.

There is a great chart for energy needs for cats related to weight and life stage on the Max's House site. Unfortunately you can't paste tables into the board format. This is from the site and the table is found just below it. It is very informative.
Energy needs for a cat range from 45 kcal to 80 kcal of metabolizable energy per kilogram body weight per day for adult neutered cats. The energy requirements for a typical, inactive, 4 kg. cat at maintenance is about 180 kcal/day (45 kcal/kg/day), while the energy requirement for active 4 kg. cat is about 240 to 320 kcal/day( 60-80 kcal/kg/day). Cats have no dietary requirement for carbohydrates for neither energy or glucose. Typical of carnivores, cats can receive all their energy and nutritional needs from protein and fat.
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Ah, I figured, but it still looks like some zeros were left off. I was just pointing out a typo, not trying to argue with you. Sorry...

So if his cal requirements are actually higher than my calculation, it's even more of a problem that he only ate 1/4 of a can, severity depending on can size.

And yes, Lantus is an OTC med in Canada. However, refrigerated and handled properly (not contaminated), it will last a lot longer than 28 days. My vet initially told me, and after doing some research, I found lots of people use it for up to 3-4 months or until they notice a drop in effectiveness or it gets visibly contaminated, like cloudy or floaty bits in it. The 28-day thing is meant for opened Lantus, for human use (bigger doses), kept at room temperature. I still wouldn't want to buy a big vial and have it get contaminated and have to toss it all - I get 5 x 3ml pens for $103 and unopened and refrigerated they are good for another 2 and a half years! So it lasts a long time... I think contamination and constant temp. fluctuations when you take it out of the fridge every day are what does it in.
 
hi - just want to welcome you and Eddie! you've gotten great advice - you can tell that the biggest concern people are expressing is the size of the starting dose and the once a day injection.

based upon weight, we'd have you start at about 1.5 units twice a day, with injections given 12 hours apart. you'll see much better results from this. dosage can be adjusted once we see how eddie does with it. it's far safer that way than having wild swinging blood sugar. having caught one low number, there may be more. those can become a crisis and we want to prevent that.

check back in with us and we'll help you get on the right track to get him regulated. many vets don't have much experience with diabetic cats, frankly, and often the experience they do have is with older insulins that dose differently than Lantus. people here do it 24/7/365. we'll give you a hand.
 
I wanted to drop in and say welcome.

I did not use Lantus, we used PZI, but that does seem like a very high dose and kitties are always shot 2 times a day. 12/12

My Bean is in remission now and I want to say - it is all because of the advice from here. My vet was not very well educated on fd, and wanted me to use high carb script foods, shoot 2 units, not home test and NOT read or take the advice from the internet.

As you will see in my spreadsheet below, my first successful home test, Bean was only 27! She did not have any hypo symptoms either. With the help from the folks here, I not only learned that the symptoms can happen in a moment, not to be fooled but I also got her numbers back up and she is still with me today!

I just know that without this forum, my Bean would have been given soo much insulin that it would have taken her life. The gentle encouragement from here to home test and learning when I needed to do this, the feeding routine with what to eat, and the testing routine has allowed me to enjoy her today.

Please dont be discouraged by the vet advice: foods and dosing. I have found out that this forum, where we are dealing everyday with fd, we can communicate experiences with alot more knowledge that the vet. I was very hesitant to take advice from here and go against my vet - but I did and let me say - I AM SOOO GLAD I DID!

Eddie will thank you, I promise. If I am reading your post correctly, he was dx fd and then went in remission about a yr ago?? Was that correct? If so, was that controlled by diet? All 3 of my girls now get low carb foods and raw that I grind. They look sooo much better and are soo active that it is unbelievable.

Furry paw hugs coming your way! ;-)
 
Well, last night I checked Eddie's BG at bed time 16 hours after his insulin was given before at the time of his bed time meal and he was 6.7 (around 100) or something like that, then I forgot to give him his insulin this morning before I went to work ... whoops, managed to feed the kid and both cats though. Will try and recheck BG when I get home before I give his insulin.

Still wondering if anyone in Vancouver has a good vet they can recommend.

Both spot checks at the vet were done around 5pm after morning insulin between 8 and 9 am

I will see how the single vial of lantus holds up, I read the report looking at how long lantus lasts after opening and it was only done to 28 days and the insulin was not refridgerated. Mine is refridgerated and I saw that people have had no issues with using the insulin for months from a refridgerated vial. Still $70 vrs $115 for the same product is a huge difference. Good to hear that insulin is still available without a Rx in Canada. I worked at a pharmacy years ago and I remember then that insulin did not require a Rx, thought things may have changed since then.
 
take a look at this sticky and notice that some people have had their insulin last considerably longer than 28 days. there's info in here on how to take care of it and hopefully, it will last a long time for you.

Lantus/Levemir, info, proper handling, storage

with twice a day shots a cat on lantus is going to be at its lowest point about 3-7 hours after the shot. i don't know how messed up that gets with once every 24 hour shots, so can't interpret the test results after 12 hours. but i can say that a blood glucose test of 100 is a normal non-diabetic cat number. for you to get that 16 hours after a shot would make me wonder where the cat's BG was at 6 hours after the shot.

our first concern is always safety, so if i were you, that would concern me. cats who become hypogycemic on the slower acting insulins like lantus often don't show signs until their BG is really low.
 
ohbell said:
Please dont be discouraged by the vet advice: foods and dosing. I have found out that this forum, where we are dealing everyday with fd, we can communicate experiences with alot more knowledge that the vet. I was very hesitant to take advice from here and go against my vet - but I did and let me say - I AM SOOO GLAD I DID!
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I was also hesitant to go against my vet and follow 'the internet' but following vets advice nearly killed my Vyktor too, you will see similar stories over and over. Most vets just aren't up to date with diabetes treatments. Vyktor's new vet at least admits that they don't know so much about lantus but they have seen that we are on the right track and are willing to learn as we go along. This is the best I have been able to do finding a vet in my area but it is fine because I get all the advice I need right here. So glad you found the forum for Eddie's sake!

Here is the link to help you do a profile: http://www.felinediabetes.com/FDMB/viewtopic.php?f=9&t=59890
And here is the link for doing a spreadsheet: http://www.felinediabetes.com/FDMB/viewtopic.php?f=6&t=50130

Having these set up will really help people here to help Eddie and will save you answering the same questions over and over.

I also agree with everyone else, twice a day dosing is necessary and that is a huge starting dose he is on. It sounds like you have a pretty hectic schedule so I hope you don't feel too daunted. As you get used to testing and dosing what may feel overwhelming now will just become a part of your normal routine.
 
Well I just spent considerable time making a spreadsheet for Eddie, no idea why there are a bunch of empty rows before the data starts and I can't seem to remove them.

I checked Eddie's BG when I got home today at 1245. It was 8.3 so not too bad considering he hadn't had any insulin since 7am the previous day. I debated for a while what to do next. Decided to give him 3 u of lantus at about 2pm BG was 9.9 4.5 hours out. Kitty seems to be eating better today I fed him at 7 am, 2pm, 6pm and I am going to feed him again before I go to bed. Normally he is fed 3 times a day. He has had at least one 5.5 oz can plus some kibble.

Please take a peek at his chart and keep in mind I have been giving his insulin once a day and I have been working the last few days so I haven't been able to check glucose levels earlier in the day.

Edited to add BG at 1130 is 11.7
 
Yikes, thank goodness you reduced.

Can't help you with the technical aspects of the ss but I can tell you that you will get more eyes on your post (and Eddie's ss) if you edit your original post and add the question mark icon.

Can also tell you that dry food is not a good choice for diabetics, however with Eddie's numbers the way they are you wouldn't want to take it away without further reducing the insulin or you may end up with a hypo.

People are waking up now so if you add the question mark I'm sure someone with more experience will be along to help you soon.
 
hi - just checking back in with you. being a nurse, i'm sure you know how meds work - each med needs particular doses given at particular times in order to get the outcome that is hoped for. lantus in humans can be given once a day, but cats have a much faster metabolism and must be dosed twice a day, 12 hours apart.

when i look at his spreadsheet and i see a 41, it really concerns me. when there are no tests before or after for a period of hours, you simply don't have any way to know how low eddie is getting. 30's can bring hypoglycemia, and i'm sure you understand hypoglycemia can kill in a matter of minutes. if i saw a 41 in punkin, i would give him some high carb food and retest him again in about 20 minutes to move him up into the 50's and repeat until he stayed there.

i'm not trying to scare you or make you feel badly, but truly, this is a worrisome situation. you're giving a large dose once a day with no idea what's going on before or after. at least with the 41 on 1/3 it doesn't look like there was another BG test until 1/5. we just don't want anything to happen to Eddie! :YMHUG:

if you want to try to get him back on track and keep him safe, i'd encourage you to drop his dose to 1.5units twice a day, and begin getting a preshot test (don't shoot if he's less than 200) and a mid-cycle test to see how low he's getting on it. lantus dosing is based on the nadir (lowest point) of each cycle.
 
Hi. Just wanted to chime in as a newer Lantus user. My vet prescribed a dose of 2.0 units twice a day initially as my cats in office BG was over 500. After testing at home, her highest numbers were in the high 300's to low 400's mg/dL, so not quite as high as the vet thought. It took me nearly two weeks to figure out that the 2.0 unit dose was too high. Her BG pre-shot would be over 300, then drop down and be in the 50's even 12 hours later. It got to a point where I could only give her one shot a day trying to follow the vet's advice. After reading the Lantus regulation protocols here on this site, I dropped her down to 1.0 unit twice a day and have been adjusting from there. After 6 weeks now, her numbers are staying pretty close to the normal range, although we are still working on it. I was also reluctanct to go against the vets advice, but have now realized he is not as experienced as I thought. I wish I had followed this site's advice a little sooner, as I feel I wasted the first few weeks of my kitte's treatment (not to mention the expensive test strips). Starting low and making adjustments after a few days is great advice. There are a lot of knowledgable and experienced people here, and I trust their advice. I would probably still be floundering without it. Best of Luck!
 
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