? Lantus v Glipizide?

http://www.felinediabetes.com/FDMB/threads/help-with-deciding-not-to-inject-tonight.214363/

Our vet wants us to stop Lantus immediately and start on Glipizide instead as our Mimi is very sensitive to even 0.5unit of Lantus. Her last shot was at 4.30am this morning and she is still well below the threshold for injecting her again. We have had to skip a few times now and I am not sure that is good, but I heard Glipizide is not very effective.
I am not sure what to do and she is due her medication soon.
Thanks!

 

Maybe try a 0.25 unit dose so you can shoot twice a day? That 66 a few days ago says that 0.5 units is too much insulin. If you have any interest in remission, stay away from Glipizide. Those drugs are hard on the pancreas. By the way, what is your "no shoot" threshold? Even people using SLGS for dosing eventually work their way down to shooting anything above 90.

 

Anything below 300 is a risk for mimi as she is still not eating much and her BG still dips quickly, especially at night when we might accidentally fall asleep. We have been testing her every 2 or 4 hours for over a week now.
I also think the 0.25 around 7pm and 7am should work, but I have no idea how to be accurate with such a small amount.

 

I agree 150% with Wendy about the Glipizide. It’s been known for quite a long time that it is not effective in cats and it can actually make things worse.

If you look at THIS post and scroll down, you’ll see a diagram for 0.25u. It doesn’t have to look exactly like that as long as it’s somewhere between 0.5u and 0u and you draw it up as consistently as possible.

The concern with letting her stay too high is that if she has any infection, isn’t getting enough calories, and doesn’t have enough insulin, she is at risk for developing ketones and diabetic ketoacidosis. You should be checking her ketones every day with urine ketone strips you can buy at a pharmacy. She’s already had high ketones so it’s important to feed her as high a calorie (which is different from carbs) food as you can if she won’t eat much so you can get enough insulin in her.

 

I'll join the chorus. According to Cornell's Feline Health Center, oral diabetes meds that work for humans rarely work for cats. And, as Wendy noted, because of they way they effect the pancreas, remission is highly unlikely.

I'm concerned that your vet may have limited experience with feline diabetes. Generally, in a cat that is recently recovering from DKA, you really don't want to be skipping shots. It's too great of a risk for ketones recurring. If you're testing for ketones, can you include the information on your spreadsheet? If you're not testing, can you please pick up some Ketostiks and start testing your cat's urine. It's a cheap form of prevention. Ditto on what Marje said about calories.

 

I agree that I would stay with the Lantus and give a .25 dose. There are just a few sprinkled greens on SS and that is by no means a cat who should be off Lantus and oral medication has not proven to be effective for cats.

The more she can spend in some green numbers above 68, the better.

 

So we chose to listen to the forum we gave her 0.25 this morning around 5am. The levels dropped to 70 after 4 hours so we fed her some high protein and her BG went up a bit. So even a tiny dosage affects her and her nadir would have been even lower if we didn't feed her more than usual. I got the Dr Elseys clean protein in case we need to feed her fast as we are still very much fighting the wet food battle..
We are NOT going to give her the oral meds, after what we learned about it. I am disappointed that he told us to do that as he was the physician who treated her in the ICU. Our general vet today told us to stop the Veraflox he prescribed as well as it should be given for 7 days max and not 31 days like he suggested.
As for her ketones, the hospital reading was 0.8 through blood yesterday. We test her urine daily and so far the reading has been negative.
I am hoping that by 7pm tonight we can give her another 0.25unit. I would like to establish that pattern.

 

When Gabby was first diagnosed, she was in the ICU. The vet there was very knowledgeable -- about dogs. Once Gabby was back with her own vet -- a feline specialist -- treatment was much better. I always have to remember that vets are often asked to know every illness and how every species of animal responds and is treated. They don't know everything and are probably frustrated if they have to treat a dog, cat, snake, guinea pig, and parakeet all in one day.

 

Mimi was in a Cat Hospital and the Dr. was a feline diabetes specialist, hence the thousands of dollars spent and my disappointment.
In any case, Mimi AMPS was 139 this morning, so no shot and her nadir was 164. So no insulin was injected. Could it be that she is already in remission??

 

I don't think Mimi is in remission. Your AMPS numbers over the last several days would suggest she's not yet regulated.

 

Mimi is not in remission and her numbers are a little too high for a cat where we are worried about DKA. Cats who are ready for a remission trial are typically in all green numbers on 0.1u of insulin.

When you give insulin, if you aren’t feeding to give the insulin something to work with, numbers will drop and sometimes fast or low. Mimi could possibly be getting into the numbers she is because of the depot from the higher doses. She might need only 0.1u of insulin; or perhaps even a drop. But it looks to me like she does still need it.

 

i think that is what happened. at 10pm she tested at 542. So we have her a 0.25 and now we are back to square one. She is just refusing to eat any wet food. She will starve rather than eat wet food. The force feeding is becoming intolerable as well. We will give her another 0.25 at the 12 hour mark as her numbers are not dropping below 430. Keeping an eye on ketones, as she is now off the antibiotics.
I am not sure what to do anymore. I am close to despair at this point. I feel the only solution is to let her eat the dry food..

 

Hi--I'm new to the feline diabetes scene since Mittenz was just diagnosed a month ago. She has IBD, takes prednisolone, and won't tolerate anything besides Dr. Elsey's salmon kibble (I'm still hunting for that perfect novel protein, but that's another story). I just want to jump in here with a tepid defense of Dr. Elsey's--granted, this is from the manufacturer's website, so who knows. But in response to the Frequently Asked Question of whether their food was good for diabetic cats, their answer was "Yes. Low glycemic ingredients may reduce or eliminate the need for insulin in diabetic cats. Diabetic cats with the highest remission rates (greater than 80%) have been reported to have feeding diets with approximately 6% of energy from carbohydrates. Dr. Elsey’s cleanprotein™ delivers only 5% energy from carbohydrates as compared to leading Dietetic Management foods with levels as high as 13%."

Here's that link to their site. https://www.drelseys.com/faqs/

I just wanted to throw that in for your consideration.
Hang in there,
Lindsay and Mittenz