Lantus Dosage Concerns - Recently Diagnosed Cat

Hi, I'm new to the boards and wasn't sure where to post this, hoping someone can help!

I brought my 15 year old maine coon into the vet three weeks ago (who has never had any health issues, always strong and robust) because he has been exhibiting excessive drinking/urination and fatigue (and weight loss, was 18lb and 14lb when we took him in). It was determined that he has Diabetes via in office blood test and a urine test done at home. His starting number in office was 446 via blood test. We were advised to start him on a high protein/low carb diet so we switched him from the Proplan Selects Dry Food to their recommended prescription Hills, but we ended up transitioning him to the Wellness Core Wet after doing more research. After a week we brought him back in and his BG was 380. We were told to continue diet as he had no ketones or we could start on oral insulin (we declined). A week later we noticed he had some loose stool and bought a ketone test which showed "trace" ketone. So we decided to bring him into emergency care at a different vet just in case, I didn't want to risk ketoacidosis. He got some fluids and found his BG was 327 but he had also lost another pound. So the vet put him on Lantus, 2 units twice a day.

My question is, is this too high dosage given his current BG in office? I told the vet that my cat is very excitable (in fact, he's always been a scaredy cat) and that the numbers were probably lower outside of the stressful car ride/vet visit. He said the dose was conservative and based on his weight, not his BG. We did buy a Freestyle Lite meter but read that in higher numbers it's inaccurate, and at the time we took a read (the day before the ER trip) it was 267. We still dont' know if that's accurate so we ordered an Alpha Trak 2 and are waiting for it to arrive any day now.

I'm just concerned that the dose is too much, especially since he's not eating as much as I want him to. He has an appetite but only takes a couple of bites and then leaves, sleeps for a few hours, comes back, leaves, sleeps, etc. never really finishing his meal. He is a larger cat, and he should really be around 16 lbs or so for his size. So is it okay to start him off with this high dose? Sunday was day one, he received 1 unit in the morning and we gave him 2 units at night. The next day we just gave him 1 unit morning again as he wasn't eating much and 2 units at night. We took a urine glucose test with ketodiastix and it showed over 2000, way on the high end of the scale but I read it takes a few days for Lantus to start showing effects. But today, after giving him 2 unit am, his urine showed 250, which is much less!

Can someone please advise? I don't want to give him too much insulin -- I'm not sure if it's okay because of his larger size/trace ketone/low carb diet???

 

If you want to start home testing immediately, you don't need to purchase the alpha trak. If you have a walmart nearby, you can purchase their Relion brand and strips - they are inexpensive, easy to use and only require a small drop of blood.

Normally, we tell people to Start Low, Go Slow - which means to start with a dose of 1 unit or even 1/2 unit and with home testing, slowly over several days, adjust the dose as needed. Once the insulin is in the cat, you can't remove it. So, by starting low and home testing, you are safer than starting at larger dose.

That being said, I have not had to deal with ketones. I do know that if you add water to the food this will help to flush the ketones out. But as far as what dose to start with, I'm not sure. You may want to visit the Lantus group and post your question there, as the people there work closely with it daily and can recommend better than I.

 

The Freestyle Lite has a habit of not reading over 300 for some reason. You didn't necessarily need to go all out on an Alpha Trak because the strips are very expensive but if you can afford it and like it by all means go for it. If you are using the AT you will have to add approximately ~30 points to any piece of literature here. For example if someone tells you "don't shoot under 200" that would actually be about 230 on your meter and when they say "hypo is less than 50" it would actually be less than 80 on your meter. "Cat calibrated" meters read a bit higher than human ones.

Yes, it's best to start off with a smaller dose since you're not home testing. 1u or even 0.5u. Do keep watching for ketones multiple times a day but don't go by those glucose dip sticks. Urine sits in the body for hours so they do not give an accurate view of your cat's real time blood glucose.

 

Hi Hillary - thanks for your response. I agree, I would like to start low and go slow, but now that I've already given him 2 unit can I go back to 1 and try that instead? The trace ketone is also something I am very concerned about. He only gets wets food and I try to add water, thanks for the suggestion, will try to add more water. Where can I find the Lantus group???

 

I did a bunch of research and thought the Freestyle Lite was the way to go since it needs a small amount of blood and then read that it's accurate at high reads. I got frustrated and just decided to order the Alpha Trak thinking it would be accurate. *sigh*

Is it okay to reduce the amount of insulin now that I've been doing: Sunday 1 unit morning/2 unit evening, Monday 1 unit morning/2 unit evening...and so far 2 unit this morning? I would feel much more comfortable with less dose but I wasn't sure because he's larger than the average cat based on type (maine coon) and his trace ketone.

 

Ketones are a big deal and it is definitely good that you take them seriously, but trace ketones are not so much an emergency as much as a warning to keep a close watch on them. Anything higher than trace you will want to see a vet though.

Yes it is ok for you to reduce the insulin now. Lantus needs to be dosed consistently, same dose AM and PM. Dosing like you are doing now could be causing him to go lower at night (most cats go lower at night naturally) and so his BG may be going up and down throughout the day from the unstable dosing.

You can dose based on weight but since you're not testing yet you want to keep it as low risk as possible. Some big cats need small doses and some small cats need big doses.

 

Thank you so much for your help. I didn't realize it needs to be consistent morning and night...I think I'm going to tell the vet I don't feel comfortable with the higher dose to start. I've been continuing to test ketone daily and it's been none-trace (hard to tell the color) so I am keeping a watchful eye. I really appreciate your help as I'm been kinda freaking out worried he's going to go hypo or that his ketones are going to get worse if I lower the dose.

 

Here is the link to the lantus group - viewforum.php?f=9

You can find it by clicking on the board index (top or bottom of page) and scrolling down to insulin support groups - there are two lantus groups listed - tight regulation and relaxed. I suggest you start with tight regulation - as that is very active.

Regarding adding water to food - I typically add 1 can of water to 1 can of food. This ensures my cats get plenty to drink with their meals....

 

Do you have a recommendation for which Relion version to get? Or will any do?

 

The Confirm or Micro are known to be reliable, both use the same strips ($36 for 100), and have a 0.3ul of blood sample size. There is also the Prime which has incredibly cheap strips but I don't know how reliable it is for cats as it just came out recently. There is also the Ultima but it uses different strips and takes a larger sample. I would avoid that one if you can get one of the others.

 

I have used the relion micro and it works great. My endocrinologist gave me a free One Touch which my vet would prefer I use, but the strips are too expensive. I liked the lancets though and do have an easier time of it on Cedric.
He is remission, so I don't give him insulin anymore and I don't test him every day.

You are on the right track ditching the dry. It took me about 3 1/2 weeks to do that, but in the long run, it was better. Cedric gets 4 small meals a day of canned food that is grain free, low carb, high protein.
I agree with Hillary regarding the dose. The gang in lantus land will tell you that it takes time. A change won't happen in a day (well, usually).

good luck!

 

Okay, I bought the Relion Comfort and we just took his blood sugar reading...it said 45?! Does this meter read low, is there any compensation to make? Earlier in the day his paw was shaking a little (I thought it was just his fatigue as he's been so tired) and his appetite increased. Does this mean he could have gone hypo or is the meter reading incorrectly? 30 minutes will be time for his next insulin shot but I am going to skip it if this number is correct. I am so glad I bought the meter tonight before giving him another shot of insulin.

 

Test again... SOMETIMES you can get a meter error if there isn't enough blood but it should be accurate...

 

I tested again about an hour later after he had a few bites to eat with both the Relion and the Freestyle...68 and 69 respectively. I skipped the insulin shot and going to call my vet tomorrow. If I would have given the shot would he likely have gone hypo? I am so happy this forum exists!

doombuggy -- I am so happy for you and your cat remission! I wish I never started Bubba on the dry. He weighed 22lbs most of his life when he used to live with our other cat...he would steal her food all the time, he had such an aggressive personality. When I moved I took him with me and thought I was doing right with chicken and brown rice blends that turns out had 30 carbs! I got his weight to 18lbs which felt like a good weight for him, no blubber tummy...and now he's so small, makes me sad. I do think the dry food caused the diabetes and I am still hopeful I can turn things around with diet and the right dose of insulin I hope for a short time. I'm spreading the word about wet food to all my kitty friends.

 

Oh dear. Yes definitely skip the shot. 45 at +11 is not good. Thank goodness you were testing!

 

Something inside kept telling me the dose was just way too high from the get go, this is why it is so important to listen to instincts. Do I need to worry that the BG will decrease without the insulin? He's out of the 12 hour window from the am shot by 4 hours. Thank you all for recommending the Relion, can't even tell you how grateful I am for posting and the suggestion to go get a meter instead of waiting!

Is +11 what I need to add to these meters for a better "cat" reading?

 

I would keep an eye on him and get one or two more tests in, sometimes Lantus can last 14+ hrs but he *should* be ok. Next time, if you ever get a number under 50, give him the gravy from a small can of gravy food (like FF Gravy Lovers). It will help bring his BG back up without making him full.

Oh sorry, the +11 means 11 hrs after you gave insulin last. I guess it was actually +11.5. But yeah that is definitely an indication of too much insulin - your cat may even be diet regulated! Keep an eye on him. The skipped shot will let the Lantus "shed" drain a bit and then you can resume shooting with a smaller dose (if he needs it!)

You do not need to add anything to human meter numbers since all of our info is written for them anyways

 

At 3am I ended up giving him some Hills Dry (ugh!) that I had from the initial diagnosis because it's the highest carb thing I had and I didn't think he needed Karo since I thought it would shoot it up way too high. I will definitely get some FF Gravy Lovers for just this type of situation in case it happens again. This morning he was at 280 which is high but not super high, don't know if it's from the Hills which has a higher carb content than I'm used to feeding him. So I gave him some food and I started him at 0.5u just to be on the safe side and I am hoping it will lower the glucose just a little so he's out of renal threshold and closer to the 180 range to start. How long will it take to build up in his system for me to notice an effect again?

Thanks for the clarification on the +11!

 

Please read the information on the Lantus forum.Whether you post there or not, you need to read the information there:

STICKY: LANTUS & LEVEMIR - NEW TO THE GROUP? PLEASE READ...
viewtopic.php?f=9&t=18139

STICKY: LANTUS & LEVEMIR - TIGHT REGULATION PROTOCOL
viewtopic.php?f=9&t=1581

STICKY: LANTUS & LEVEMIR - INFO, PROPER HANDLING, & STORAGE
viewtopic.php?f=9&t=151

STICKY: LANTUS & LEVEMIR - WHAT IS THE INSULIN DEPOT?
viewtopic.php?f=9&t=150

STICKY: LANTUS & LEVEMIR - SHOOTING & HANDLING LOW NUMBERS
viewtopic.php?f=9&t=147

Any reading of 50 or less requires a dose reduction. As you are right that you were probably started at too high a dose, giving 1/2 unit to start with is a good idea. Before increasing this dose - please read the above information and remember once the insulin is injected you can't get it out.

Good catch, of that 45 - glad you picked up a meter last night. Note that because you fed dry food, it may stay in his system for a few days. So, don't get freaked out if the numbers stay higher. Make sense?

 

Thank you, heading there to read now. I am really happy I did pick up the meter last night too, the idea of giving him this type of medicine blindly seems foolish to me but the vet made it seem like he really didn't want me pricking his ear. At this point I don't care though given what the consequences could be. Thanks for the info on the dry food. It was only 1/8 cup but I will still be on the lookout regarding the high numbers. I was planning on keeping the same dose for the next 2-3 days at least to see how he fairs.

 

The starting dose formula for Lantus is .25u per kg of ideal weight, unless the cat is underweight, and then it is .25u per kg of actual weight. Given that he's a Maine Coon, I'm going to guess that 13 lbs is quite underweight for him? If so, his starting dose should have been no more than 1.25u. Quarter units can be tricky to get the hang of when you're first starting out, so I would go with 1u. I don't think it's a good idea to start out at .5u (usually the starting dose for a small cat) considering that he has trace ketones.

It's great that you're done with the dry! Make sure that you're checking Dr. Lisa's Food nutrition list to make sure the Wellness canned foods you're feeding are low in carbs: http://catinfo.org/docs/Food Chart Public 9-22-12.pdf. A diabetic cat needs less than 10% carbs, and there are several Core foods that are a little too high. However, there are several core and regular grain free Wellness foods that are great for diabetics.

Fantastic that you're home testing already! With Lantus, you want to get at least 3 tests a day--once before each shot, and one about halfway through either cycle. Of course, you can test more than that and the more tests you get the better you'll be able to see how the insulin effects him, but 3 daily is the minimum you need to dose safely and effectively.

 

The vet said he was a little underweight, but I think he should be closer to 16lb or so. Do you think it's safe to start him at 1u since he's on a low carb diet and his numbers are not crazy high? I just want to be consistent morning and night whichever way I go. The problem is also that he doesn't eat enough. He has an appetite, but when he eats he grazes and then doesn't come back for hours since he sleeps a lot. Say I give him 1u, and I find that the next time to give a shot his numbers are where they should be, do I still give the shot?

In regards to the food, I did lots of research and did go off of that chart you linked to. Based on dry matter, the carbs he's getting are no more than 8. Thanks for the tip of testing times, I was a little confused! I think I need to work on my pricking technique because his ears looks a bit bruised.

 

They all start out a bit bruised, don't forget to lightly press the ear after you poked it to stop the bleeding and lessen the amount of bruising.

I would just keep with the .5u for right now- give it 6 full cycles and see how he does. You can always increase the insulin but you cannot take it out after it is shot. He's adjusting to the low number (causing a high number bounce response) and the dry cat food (in my cat it stayed around for DAYS- and caused his numbers) so you really don't have an idea of what his normal number is right now. The safest thing to do is keep it low and steady.

Hope this helps.

heather

 

You could also put neosporin on the bruised ears. This will help them heal.

 

The dry food I gave him is also low in carbs, it's the Wellness Core that has 11 plus the Hills that I think is around 15 (I mixed 50/50)? I only gave him 1/8 cup so I'm not sure how much that would make it go up compared to the wet food?

I skipped his shot last night because the seriously low numbers scared me, and before I gave him his food and shot this morning he was 280. I tested after the .5u about five hours later and it was 273. I guess I am concerned about the trace ketone and his weight loss, maybe .5u is too conservative? If I do 1u it would at least cut it in half from the 2u that caused the low numbers. I am home during the day so I can monitor him, unfortunately not overnight as much.

Thanks for the tips regarding the bruising and neosporin...will the neosporin affect the BG reading?

 

My cat Magic was diagnosed in Feb 2011 and was at 4 units Lantus every 12 hours. He is a siamese mix, big boned and was at 20 when diagnosed and now is about 16lbs. I've learned, thanks to everyone here, that testing is essential. Magic had a hypo crash Sunday and I think he was probably less than an hour from being gone when we got to the ER vet. His BG was below 20. Thanks to testing, I have yet to give him any insulin. He is staying stable at around 160-190 depending on when he eats. I would have given him 4units 2x a day if it wasn't for the testing. My vet is happy with his results and hes back to pretty much normal activity, too.
What I can recommend is ... trust your testing. There are tons of people here who know what they are talking about and will guide you along. Also start doing the spreadsheet to track his numbers. It helps! GL
Lisa

 

Bearing this in mind, it might be prudent to try and make any dosage increases so that the first shot of increased dosage occurs on your kitty's morning shot, as opposed to his evening one. That way you will be at home to test around his nadir (lowest BG) point, and you'll be around to pick up on any signs of a potential hypo and act on it as necessary. Also, if your cat tends to eat more during the day and sleep more at night, it is quite likely that his BG will be dropping lower at night naturally anyway.

You're doing great, and you're in the right place having found this forum!

H

 

That's very scary, so happy to hear you got to the vet in time!

I just tested him now as he's nearing the end of the first shot of the day and ready for his next shot in about 30 minutes or so. His BG is 239. So he's getting closer to where he needs to be, I will try another .5u tonight and see what comes up in the morning.

Good suggestion, Helene, I may just do that! Thanks for the words of encouragement, I really needed it today.

 

:RAHCAT

 

Grain-free doesn't always mean low carb. Starches can mean high carbs. Dry foods, even the grain-free ones, contain starches of some sort to hold the food together. In Wellness CORE, it's the potatos. Hills M/D (really, all the Hills prescription junk) is 13% carb and contains rice and corn, along with other poor quality cheap ingredients like powdered cellulose (aka wood pulp). If you can get rid of the dry food, you'll see some improvement in blood glucose numbers. But don't stop cold turkey. Slowly elminate the dry food and monitor blood glucose levels closely. Some cats have a big drop in blood glucose levels once the dry food is gone from their diet.

 

If you're not able to test nadirs, then perhaps .5u would be safer with the food change and missed meals. I am just concerned about the ketones--make sure you're keeping on top of testing for those.

When Bandit was on insulin, I was working two jobs (One full time with an hour commute there and back), and going to grad school, so testing times during the week were limited. With my commute, I could not head home and test him during the day (his shots were at 7am and 7pm, so his nadirs were 1pm and 1am). So what I did during the week was to test before each shot, and then again before I went to bed (around 10-11pm), and then I set an alarm to get up and get his 1am test and went right back to sleep. Yes, it was a pain the first week or two while I adjusted, but trust me, getting those tests certainly does reduce the amount of stress on you because you have the right information you need to safely adjust his dose, and also allows you better control over his blood glucose levels. And it also gives you much better chances of your cat going into remission, which is far easier on you and healthier for him in the long run.

One very important tool is a spreadsheet. Here's instructions on how to set one up: http://www.felinediabetes.com/FDMB/viewtopic.php?f=6&t=18207. Not only does it allow you to track your data and share it easily with your vet, but it will also allow you to get great advice from very experienced Lantus users here and on the Lantus board.

 

I know, I am very concerned about the trace ketone as well and also worried about hypo and weight loss. I've been testing him daily when I can as he's urinating much less (1-2 times overnight, about twice during the day...when he was first diagnosed he was going about 8 times in 24 hours!) and it keeps showing the same reading for ketone, the color is a cross between negative and trace (it's a little hard to tell). I can test the "nadir" during the day while I'm at home...what exactly is it and what is it supposed to show me? Thanks for the spreadsheet link, not sure what some of those terms mean, but I just found a thread that explains some of them!

Thank you all, you've been so helpful!

 

The nadir is the lowest blood glucose point, which should fall around halfway between your kitty's two daily insulin shots. This is the point at which the insulin is having the greatest effect.

So if you're injecting at 8am and 8pm, for example, kitty's nadir points should be falling around 2pm and 2am. But this can vary greatly from one cat to another, which is why it is important to BG test and get those mid-cycle numbers.

With an insulin like lantus, it is actually the nadir BG readings that determine whether or not your cat needs a dosage reduction/ increase, and not kitty's morning and evening pre-shot numbers (known as 'amps' and 'pmps' respectively). The nadir number shows what is happening at the point when the insulin is most effective, and the nadir number, in addition to what time is actually falls, is very important for deciding whether an insulin regime is working for your cat or not.

If you read through the linked topics at the top of the Lantus Tight Regulation forum, this will provide you with loads more info on how lantus works, and why those nadir numbers are so important.

H

 

Thanks for the clarification, I am planning to give him his next shot at 8:30 so I will attempt the a reading at 2:30pm this afternoon. No one will be around today to help me get the BG but I will try! I am yet to do it by myself. Will also read more about tight regulation so I can understand it better.

I checked his BG this morning, 2 hours before his next shot and it's at 160! He didn't eat that much last night so that might explain it? He's also acting a little bit more like his old self this morning.

ETA: Also, is there a better way to test for ketones besides the urine test? He only goes about 3 times in 24 hours so if I miss him I won't be able to test. Is there a way to test the blood???

 

Good on you for taking the time to work out how to help your cat, btw. It's a lot to get your head around but totally worth it.

 

Good that you are testing for mid-cycles. Once you start doing curves you can check to see when the nadir actually happens. For most cats on LEVEMIR it is around +8 to +9 so I don't know about LANTUS.

There is a way to test the blood- Precision X- costs about $100 unless it is on sale and the strips are bout $2 each and they sell them in packs of 20. I bought mine at ADW but no longer us it. If you would like to know more about it send me a PM.

I found the ketosticks to be more effective in the long run and cheaper. Sneakers threw ketones for a full 7 months until I got her regulated in early July. Always a trace, sometimes small, and the only time she was medium was after the vet visit and a terrifying blood draw (we switched vets thank goodness!). Just bear in mind that until regulated he might throw them like Sneakers did.

 

It is possible to test for ketones in blood. Some blood glucose meters also test for ketones, the Abbott FreesSyle Optimum is one that definitely does. You purchase separate test strips for ketones, in addition to the normal glucose test strips. They are a bit more expensive mind.

You may be able to get one of these meters for free from the Abbott website, I know that you can in the UK. I can't access the website as if I'm from the USA, it automatically recognises my IP as being British and forwards me to the UK site; but if you have a look around yourself you may find a link that gives you details of how to apply for a free meter.

Alternatively, you could utilise one of a few different techniques for collecting urine; suggestions include using fishtank gravel in the litter tray, or covering a section of the litter tray with cellophane. There's a link somewhere which gives details of various methods for collecting urine, I'll see if I can find it for you.

ETA: courtesy of BJM, his document Secondary Monitoring Tools gives the info needed on urine testing/ collection.

Hope all is going well for you both today!

H

 

There is also the Smart Cat litter box: http://www.felinediabetes.com/SCB/SCBindex.html It uses a non-absorbent litter so it's easy to get a urine sample to test for ketones.

Temporarily replacing the regular litter with fish tank gravel will also work. Make sure the box is clean or use a new litter box. Litter residue in the box can affect a urine test strip reading.

 

I don't think that meter is available in the US...the version they are suggesting is the Precision Xtra in US? It tests for ketones but it needs 1.5 of blood! That's a lot for a cat.
I will try some of the other methods for gathering his urine, thanks squeem3!

So I just tested him at the 6th hour: BG 137. Question, did the Lantus have enough time to build back up in him? This has been the schedule:

Sunday: 1u am/2u pm
Monday: 1u am/ 2u pm
Tuesday: 2u am/ skipped pm altogether because BG was 47 (shaky leg/ravenous appetite/think he was hypo) when it was time for his next shot.
Wednesday: he was back up to BG 280 (probably from the dry food to get him back up the night prior), so I started him on 0.5 unit am and pm. 6th hour was 237.
Thursday: 0.5 am. He was at BG 160 preshot am, 6th hour BG 137.

Do I have to worry he might go hypo again once the Lantus starts really working or is this accurate already?

 

It does take a few days for the "shed" to build back up. Think of it as adding a little water at a time to a glass - once the glass is full, then it will start to overflow.

We recommend newbies not shoot if their preshots are below 200 until you know how his body reacts to the insulin better. Just keep monitoring him. You could try getting a +2 test - if the +2 number is a good deal lower than the preshot, that might help you know if he is going to have a more "active" or lower cycle and you need to test more. It's not 100% accurate of course, every cat reacts differently to insulin!

 

Hrm. Well, preshot was 147 and I ended up giving him his shot. Yikes! At +2 (I just took it) it's at 130. Not a huge difference, I'm a little concerned it's going to be too low come +6. Will I have to wake up at 2:45am to check? This shot was his 4th cycle at 0.5u. This almost makes me wonder if I was strict about only giving him low carb wet food if he didn't need insulin after I eliminated the high carb dry. Since then it's been mostly wet food and I was giving him about 1/8 cup wellness core 11% carb dry here and there treating like a treat. Makes me wonder if that was making his numbers go up because I have not given any dry since the BG 47 and now his numbers are not even hitting 200.

Now I am concerned. If tomorrow AMPS are around 100 do I just skip the shot or lower dose to .25u?

 

He should be OK, but it can't hurt to get one check in the middle of the night if you're worried. If he isn't a gobbler like my cats, you could leave him out a bit of food so he can snack on it if he gets hungry as his numbers drop a bit.

If your AMPS is below 200, you could do a few things. You could stall without shooting or feeding and test again in 15-30 minutes. If you've got a rising number that goes above 200, go ahead and shoot. If not, you can skip the shot completely or give a smaller "token" dose. This thread has some more information about shooting and handling low numbers.

 

If it is in any way possible, please get BG readings for +4, +6 and +8. This will give the full picture regarding how low blood sugar is dropping mid-cycle.

These results will be invaluable to deciding about dosage going onwards, whether a drop to 0.25 is needed; I suspect it might be. Having these numbers will also provide you with a huge amount of peace of mind, just by letting you know how low his numbers are truly falling.

Regarding food - yes, it is possible that with a strict low carb diet he could no longer need insulin. The mid-cycle BG numbers will help you work this out.

You mentioned shaky legs/ twitching: for my Cleo this was a sign that her BG was dropping too long. Little twitches or shakes seem to be fairly indicative of hypoglycaemia.

Let us know how it goes.

H

 

I tried to take his reading overnight, but I had no luck with his ears, it's like they had no blood left! I know that's not possible, but I couldn't get anything going. He was even sleeping by the heater so they were nice and toasty.

After about ten attempts this morning (which was at +10.5), he was at 126, but he was really frustrated and stressed from trying to get the blood from his ear so it may be slightly elevated? He didn't go for any of the food I left out overnight so he must have been fine (not ravenous/hypo like Tuesday). He has a lot more strength too when trying to restrain him and his squirming is not helping! I almost think I should skip his shot in case I am unable to test to give the ears a break. But anytime you skip, you have to let the shed build back up and start all over, no? Last time when I started him off with more insulin it was during the 5th cycle that things really kicked in and that's when he was way too low -- unfortunately since I was not testing at that time I have no idea what his numbers were leading up to it.

 

You did the right thing by skipping the shot, as you are so early in this sugar dance, it is better to be as cautious as possible as you don't want another hypo situation. 126 is a good number and skipping the shot is a good call.

It is very possible that with the change of food, he may not need insulin or only need a tiny amount for a short period of time.

Keep monitoring and testing, you may want to try the other ear and also try poking front to back or back to front (which ever is the opposite of what you are currently doing) as they may help get the blood flowing. Also massage the ears, while yes they are warm, massaging gets things moving and may also help for poking.

You are doing great, don't get frustrated or discouraged and it sounds like he is a trooper with all this.

An interesting side note, once their blood sugars start to normalize, their incessant need for food drops dramatically. Maui would eat 2-3 cans of Fancy Feast at one time and now today, she may eat just 1 can a day. Yes, I have some other food (raw food) available that she supplements with. But my point is her incessant need for food, dropped significantly once her blood sugars stabilized.

 

It has been difficult to get him to eat a 1 full can of food per day, that's part of the problem. He has an appetite, he just doesn't eat a lot in one sitting, even if he comes back several times. I never noticed that he had an aggressive appetite either at the onset when he was drinking and urinating excessively, but then again I kept high carb dry food out for him to eat at all times and just filling up whenever he was done. Trying to get him to eat more is the challenge as he's now thinner too. When I was giving him dry food, he wanted wet food and vice versa. He doesn't like to be bothered all the time either, with me checking up on him, doing the ear pricks, trying to catch his urine, he's getting annoyed/stressed. So that is another frustration. However, his strength and former personality are slowly returning which is promising.

I've done both ears and having trouble with both now and they are kind of red and bruised despite neosporin. I will try more massaging and from the inside out. But now that he has more energy he's flicking his ears more, being uncooperative, kicking, etc. Before the diabetes he was crazy strong, extremely difficult to restrain at a vet's office. When I finally get a chance to test him later in the day, where would be a good number for him to be? If he starts to rise closer to 200, should I start him back up, but at 0.25u? Thanks for your help and words of encouragement!

 

I understand your frustration. I am fortunate that Maui allows me to do anything to her without a fight.

You may also want to rub petroleum jelly on his ear before testing, this way, any blood you get will bead up on the ear and not soak into fur and give you a fighting chance to test it. You can also put the blood on your fingernail and test from there, in case he is a handful and won't allow you test directly from the ear.

As far as dose, I am not the best person to say on that. May I suggest that you visit the lantus forum and post there and ask the question. They can give you an answer and fairly quickly too.


If you haven't done this yet, you may want to start a spreadsheet and post the test readings, create a signature and attach it there. It will make it easier for anyone to understand your situation quickly and see the pattern and offer recommendations.

http://felinediabetes.com/FDMB/viewtopi ... =6&t=18207

 

You are fortunate! Bubba is easily excitable and difficult to control, though he has moments of good behavior he will begin to kick and scream like a baby. I will try the petroleum jelly and see if I have better luck...it's just that sometimes I do get it to bleed but simply not enough and the tiny stuff that does come out does go into the fur so the jelly should help. The other thing that all the vets told me is that his clotting abilities are really great so I'm not sure if that is what is making it more challenging? I seem to have had pretty good luck at the beginning but now it's not easy!

I filled out a spreadsheet yesterday, going to try to add it to my signature in a bit and see if I can get some more recommendations for dosing over in the Lantus forum. Thank you!

 

Good luck. Just remember we have tricks and tips for every problem you encounter. All you have to do is ask. Articulate the problem and I'll be you someone will have a solution. I learned so much from this group.

 

Inside/backside of the ear worked! A little too well, huge beed of blood, but he clotted up right away after putting pressure on it with a tissue. So his number is 188, would put him about +7 had he received his shot. Seems high? I am thinking I will give him .25u tonight if it's still the same. Does anyone know if there is a rebound after you miss a shot? I'm off to do some research.

 

Just wanted to give an update - I started him back on Lantus after a missed shot and his BG was 93 this morning. Instead of skipping a shot again, I decided to give him 0.25u (half the already reduced dose). Since we were both home and we had all the supplies we need (Karo and some FF with Gravy) we thought it would be okay. We tested him now, an hour before his next shot and his BG is 95. If I can keep it at this stable range I will be quite happy! We did not test him mid cycle because he got so aggravated yesterday after not getting any blood try after try when we tried to take it (check out my spreadsheet!) that I didn't want to do it and I was afraid to get another inaccurate reading bc of stress. Is it possible his numbers are so low because he's not eating a ton (just about 5oz per day)??? I hope this meter is still working properly! It just seems unusual to be this low so early in this regulation process. Maybe its the strict low carb wet food? He still doesn't have a ton of energy though, also because he's a little too thin. Will the energy pick up, and will he start putting on weight now that he's more stable???

We bought some treats for him, purebites and beefeaters that are low carb that seems to be helping after the ear prick so I'm hoping I can do it more often to get an accurate picture of the nadir.

I also noticed he definitely has some form of neuropathy...his front paw is kind of squished at the wrist. I think this may be causing discomfort when he walks? I ordered some Zobaline and going to try to crush it into his food. Anyone have experience with this?

 

So his a.m. pre-shot was 93, and his p.m. pre-shot was 95?

These are likely to be the highest points over the 12 hour period. With readings that low, it is very important to know for sure how low he is dropping between shots. I know it seems like we're all repeating ourselves over and over, but those nadir readings as so important.

Please test him mid-cycle. Those numbers are rather low as it is, I'm concerned how much lower they are falling mid-cycle. A drop of only 30 or 40 points between pre-shot and the point when the insulin is having its greatest effect would in this case be enough to trigger a hypo. And that's really not a huge drop from insulin onset to point of greatest efficacy.

It sounds like your little kitty could have earned himself another dosage reduction, but only the nadir numbers will show this.

I know all too well how terrible it can feel to upset your cat by repeatedly poking their poor ears; but really, it doesn't hurt them that much at all, and compared to the alternative there is really no choice at all. Your cat will forgive you for one more poke during the day; you won't forgive yourself if you miss the warning signs for a hypo.

It sounds like you're really doing well with the food, the insulin and everything, kitty could need even less insulin than you think, and could be off the juice in no time.

But too high a dose not only risks a hypo, but also a rebound, causing a huge peak in BG levels, and screwing up the regulation you've managed to achieve so far.

Best of luck to you both!

H

 

My concern is if I skip the shot again, he will be put on a rollercoaster and I have to keep starting over. If I shave it down to about 0.1u would that be safer? I can get up in the middle of the night to test him. I completely understand your concern and I do agree, I will just have to suck it up and try to get the ear prick. I am less concerned about pricking his ears (even though I hate the bruises I've caused) and more about the frustration of him kicking and screaming while I try 10 times to get blood and come back with a big fat zero!

 

Hm. I'm hoping someone with lots of lantus experience will post a reply to your query about whether to skip tonight's dose, or not, and if so what to dose/ how much to reduce by. I don't know myself, I don't have experience of dosing with lantus other than what I've read here. I know enough to tell that with such low pre-shot numbers there is a concern about how low your kitty is dropping at nadir point. And I know that means you need to test mid-cycle. But I'm unsure as to how to respond to the situation immediately, i.e. what to dose tonight.

Do you mind if I post a link in the lantus forum to this thread, on your behalf? It's the busiest forum on this site, and is frequented by exactly the right people to provide an answer to this problem of yours. And it needs an immediate answer.

H

 

Do the kitty burrito! Wrap him up snugly in a towel or blanket until only his head is showing, and either kneel and place him between your legs or put him between your side and a couch arm, large pillow, etc. to secure him in place. It sucks, but it does get better. Scooter and I only had to do the burrito about 4 times until he decided that it was easier to be a good boy :lol: Make sure you're giving him lots of praise and treats, even if your tests are unsuccessful. Now Scooter sits in my lap and purrs the whole time... and he doesn't even shake his ear any more You'll get there!

 

Yes, please post it for me, thank you! Haven't given his shot yet and I'm about 45 mins late on it.

 

Done - viewtopic.php?f=9&t=82932&p=892090#p892090

Someone should be over here soon to advise; don't rush and dose just because you're worried about being late. An hour late is better than a completely incorrect dose.

H x

 

I hope so! Thank you for all your help

 

Is it okay to hold off this long? I'm thinking it might be okay to give him 0.1u and try to monitor him? This would be even less than what I gave him this morning. I just don't want to keep skipping shots.

 

Hello there, can you get another measurement in now to see how he is going? Lets see how he is trending. I will ask to see if I can get an expert over here soon.

 

I responded to Helen's post on the Lantus board. Obviously, I've not been following Bubba so I'm at a bit of a disadvantage.

For someone who is new to testing and diabetes management, I'm not comfortable suggesting that you shoot a low number. While this is something we do routinely with Lantus, you need to be "data ready." In other words, you need to be able to reliably test your cat and get both pre-shot and spot checks during the cycle in order to know where the nadir typically is and know how low the numbers are ranging. Given how new you are to testing, there's not enough data to know where Lantus onset and nadir are. Without this information, I would encourage you to do one of two things. You can either skip the shot or continue to stall. If you stall, do NOT feed. You will need to test every 20 - 30 min. to see when numbers start to rise. The downside of stalling is that your shot tomorrow morning will be 12-hours from when you shoot tonight. You can safely move the shot time by back to your usual time by either 15 min. at each shot or 30 min. once a day. If your schedule can't accommodate the stall, it's best to skip the shot.

You might want to take a look at this post on handling low pre-shots and low numbers. You'll note that the first part of the post relates to becoming data ready.

 

Thank you so much for your help. Okay, I will skip the shot and tomorrow morning I will test at the usual time. Then should I go back to 0.25u (which I just decreased it to) and test 6 hours in? I really don't like stopping and starting but at the same time I really don't want him going hypo again (even though it was mild last time, it was very scary).

 

One of the other members mentioned that Bubba has had a positive test for ketones. When was the last test and is he still having a positive ketone readings. If so, skipping the shot is a bad idea.

You might be better off either stalling or shooting a slightly reduced dose.

 

The test was hard to tell, it continued to look like a cross between negative and trace. I haven't been able to take a test since late Wednesday which showed the same. He is urinating less frequently now that his numbers are lowering and going overnight so I haven't been able to get a sample. The vet said he wasn't very concerned especially with his numbers being lower and the negative/possible positive reading.

 

I agree with Sienne. For any kitty that has had ketones, we like you to get some insulin in them. You can stall and keep checking every 20 minutes and shoot on the rise.

You can also shoot the reduced dose. Either way, you need to be sure and get a +1 and +2 and post if the numbers are not rising.

 

Skipped the shot last night, this morning his BG was 200 on the nose. I am going to start him back on a lower dose of 0.25u and see how he fairs in 6 hours. Thanks for the help all!