Introducing Leda

Hello. Our amazing 17 year old Leda was recently diagnosed as diabetic and we started insulin. I'm actually thrilled with the diagnosis because diabetes is treatable, and he started looking much, much better as soon as we started him on insulin (he had been losing weight and getting wobbly in his hind legs). We started on 3units of NPH twice a day, and started home testing a few days later (we're on an island, and it took a few days to track down a bg meter--we ended up with a ReliOn Prime). After monitoring and consulting with our vet, we raised the dose to 4 units (also 2x a day). Yesterday our vet switched him over to insulin glargine (generic Lantus, I think)--starting at the same dose as before, and I've had a chance to monitor him much of today. I'm appreciating all the stories, info, and accumulated experience on this site.

Madrona

 

Welcome to the message board, the best place you never wanted to be.

Terrific - you've got your signature and spreadsheet going!!!

Fixed below Just one little thing - please set the spreadsheet to share with those who have the link. There's an icon in the upper right which says "Share". Click on that and select "Anyone with the link can View".

Once you've got that going, start reading the sticky posts in the Lantus section.

Also, check my signature links for an assortment of helpful tips and resources

 

Thanks BJM! I've updated the spreadsheet to share.

 

You've got it!
Thanks.

 

Hello and welcome

 

Welcome to you and Leda

 

Hi, Madrona. Welcome to you and Leda.

Lantus works very differently to the NPH. As you may have already read here, Lantus is a depot insulin; with successive doses it builds up a 'tank' of insulin in the cat's body. I recommend that you monitor Leda's levels very, very closely - including getting some night time tests later than +2 on the PM cycle (many cats run lower at night). It takes several days for the depot to fill and a starting dose of 4IU Lantus every 12 hours is rather high. From your spreadsheet I see that after only two doses Leda was into the low blues and, based on the black AMPS today, I think it is possible she may have gone fairly low again during yesterday's PM cycle and bounced as a consequence.

I am concerned about what might happen to Leda's BG as the depot continues to fill in the coming cycles so I've put a shout out to members with a lot of Lantus experience to ask them to come and look at Leda's spreadsheet and perhaps give you some initial feedback on the Lantus dose.

Great job on the home testing and the spreadsheet, BTW!


Mogs
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Hi Madrona, and welcome to FDMB. You will find a wealth of info here about FD and lots and lots of very helpful, experienced people.

I have poked a few of our Lantus veterans and asked them to look at your spreadsheet, after Mogs gave us a head's up, so hopefully you'll be getting some feedback on the dose Leda is on and where to go from here.

Did the vet talk at all about diabetic neuropathy and vitamin B-12 methylcobalamin? If not, and the weakness in the back legs is still an issue, ask if a supplement like Zobaline would be appropriate. A lot of us here give it to our kitties and it helps tremendously.

The most important thing I can tell you right now is to ask questions. The only dumb question is the one you don't ask. We were all new once, so we know how overwhelming this can all be.

 

Hi Madrona! Welcome to FDMB!

It would help if we had a little more information before we address the question of the dose.

Is Leda eating any dry food?
How much does he weight?
Do you have any test information from the time he was on NPH? If you have anything, you can add lines at the top of the spreadsheet (insert row above) and put the info in there. It can be really helpful to see a little more if you can provide it.
Do you know the initial blood sugar test result that gave him a diagnosis of diabetes?

julie

 

Thanks Mogs, sounds like solid advice. I'm in a bit of a bind though, as I've just run out of strips (I had some trouble getting sufficient samples, so I ran through strips much faster than I expected and now I'm down to one. I've already ordered more, but they won't arrive until tomorrow). I tried to get some from the vet and from pharmacies on two of the islands, but because we went with a ReliOn Prime, I can only get the strips though Walmart, and there isn't one in the islands. I imagine one option would be to decrease the dose until I can monitor more closely (which I could starting tomorrow evening).

 

Julie,
Leda is eating wet food (varying between Wellness, Waruva Mack and Jack, Waruva Chicken, Tiki Chicken, and canned people tuna) with occasional treats of Orijen freezedried and recently a little bit of Orijen Six Fish (which is dry food, but he's gotten it as a treat--just about 10 cruchies at a time, a few times at night). If I recall correctly he weighed just under 10 pounds at the time of diagnosis (I haven't weighed him since). His hind leg wobbles disappeared after a few days on NPH--we didn't initially realize it was neuropathy since he has an odd walk anyway from when he was hit by a car as a kitten (they ended up removing the end of his femur and reshaping his muscles around it--and we've always expected arthritis to be an issue).
The top of Leda's spreadsheet is data from when he was on NPH--we didn't switch him until the evening of the 9th.
Many thanks for any advice.

 

Ah--I'm a fool--I just realized that I can go ahead and buy another meter from the local pharmacy, and some new strips, and then I'll have a back up meter which is probably a good idea in any case.

 

If you are out of strips, I would definitely give a reduced dose until you can get some more. This dose has already taken Leda almost to double digits, and we don't know what he was doing overnight. It's better to be high for a few days than to be low for a minute too long.

 

We posted at the same time. Yes, a back up meter is always a good idea. Check on the prices of strips for the ones your pharmacy carries (if they have more than one), and take that one.

 

I have the best pharmacists! They figured out how to get me and Leda a free meter with a starter tranche of 10 strips. So for the next set of tests we'll be using a Bayer Contour Next EZ. I'll plan on getting some night time readings this time.

 

Julie--I forgot to answer that in my reply, at first the vet noticed glucose in his urine, and then when he checked his blood (he used a meter) it was over 500 (I don't recall the exact number now). We took him in a few days later (after a few days on 3 units of NPH once a day) and at that time his test came in HI or over 600.
Thanks for your questions and advice!

 

The Contour Next EZ is a good meter. You can find a good deal for test strips usually on E-bay. Just be sure you get the ones for the Next, as they are different from the ones for the Contour.

 

Thanks for explaining all of that. Just an fyi, some cats are so carb sensitive that even 3 pieces of dry food can raise their blood sugar by hundreds of points, and it can last that way for another day or so. We've had people do little experiments, or caught their cat eating dry food, and reported on it. I don't know if that's the case with Leda, and I don't know the carb value of that particular dry food, but it's a possibility that is increasing his blood sugar.

At this point, I don't think that's a bad thing because of the size of the dose. If you reduce the dry food, his insulin needs may decrease.

Did the vet ever keep Leda there, test before giving the NPH and then test every few hours after that? Was that how he got the idea for the 3u dose? Do you know how that was decided on?

Can you insert a line on the spreadsheet, just above May 9th, and put something noticeable in there that says "NPH above this line, Lantus below" please? That will help clarify things. The spreadsheet is an invaluable tool in helping see what's going on.

The reason this isn't an obvious answer is because with diabetic cats, there are multiple factors that can cause high blood sugar. Even one lower number can increase a cat's blood sugar for as many as 3 days after the lower number. That's the most common situation. There is a description of this - which we call bouncing - in the second post here.

If you were starting out from scratch, we would talk about 2 options for his starting dose. We have 2 dosing choices for using Lantus or Lev with a diabetic cat. One is the Tight Regulation Protocol, which requires that he not be eating any dry food. The other is the Start Low Go Slow method, which is the only choice if he's eating dry food, even a few kibbles, on any kind of regular basis. I prefer the Tight Reg Protocol, personally, and think it is more flexible than the SLGS method, but we have people who follow both and like either one.

If you were starting with the Tight Reg, there is a weight-based formula which would result in a 10lb kitty starting on 1u of Lantus per shot. If you wanted to start with the SLGS, a kitty eating any dry food would begin with a 1u dose. We do take into consideration the doses on previous insulins, but I'm concerned that we really don't have enough information (test data) on the NPH to know whether 3u is a good dose or not.

Can you take a look at those two dosing guides that I linked above and see what you think would work best for your life?

 

You've got your signature and spreadsheet going; I'd encourage you to start posting in the Lantus/Levemir section, where everyone uses Lantus or Levemir. Plus, there are numerous sticky posts telling you how to optimize your use of this insulin.

 

Julie,
The vet based the dose on Leda's weight and his blood sugar as far as I'm aware, but he didn't run any curves-I've been sharing general information with him. He's very collaborative, so I'd be comfortable reducing the dose and discussing with him.
I'm hoping to follow the tight regulation protocol, and removing the dry food isn't an issue--he prefers wet food, I just need something I can occasionally give him when he stands on my face in the middle of the night and the freeze dried meat (which has no fillers) works for that.

 

Thanks BJM, I'll do that.

Madrona

 

@Tricia Cinco(GA) & Harvey, @julie & punkin (ga) -

Thank you, ladies, for checking in with Madrona.


Mogs
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Likewise thanks! From me and Leda!

 

You're welcome. You can start a new post on the Lantus & Lev page in the morning. We'll be looking for it.

One more question: I may have missed it, but where are you located.? You can be as vague as you want - we mainly ask so we know what time zone you're in. If you could add that to your signature block, it will prevent people from asking you over and over again.

 

To get to the Lantus/Lev group in the morning, just click here. On my screen at the top right, there is a place to click "post new thread." That's what you want. We have new people all the time, so just open a new thread and people will try to help you.

I think it would be best to not take away the dry food treats until you are also ready to reduce the dose. It would be good to be posting on the Lantus/Lev group when you are doing that so if you run into any trouble, someone can help you. There is a direct relationship between the amount of carbs eaten and the amount of insulin needed, so if you change one you'll likely need to change the other.

We gave punkin cooked chicken for pokey treats and snacks. Simmered chicken breast in water til it was done, maybe 15 minutes, then cut it in small bits (1/2" cubes). Froze most of it and kept a couple of tablespoons worth in the fridge. That would last us a couple of days. Punkin LOVED the chicken bits and any plain meat shouldn't increase blood sugar.