? Luci's First day on Lantus - many questions

Yesterday we saw a nice vet here in Bonita Springs, FL - who is supportive of us caring for our diabetic little girl. Luci was diagnosed in November in South Lyon, MI by a vet who said, if it was my cat, I'd put her down. So after she lost about two pounds in just under two months, I felt it was time to find a vet for support and direction - it looked like she was going to need insulin - even though her numbers appeared to be less than 200 on our ReliOn meter.

Her blood work from that visit came back this morning - as I was dropping of her urine sample; the results her BG is at 354 - too high. The vet questions the validity of our meter. ...but that's not what my questions are about today.

He wants me to collect urine each morning and do a little paper dip stick test - I'm good with that. Will report to him daily about her sugar/ketones in the urine.

One question is the high cost of Lantus - ouch! The first vial was $275 at Costco. I wish I'd had more time to research for less expensive sources - but figured I'd ask this group as soon as the dust settled from today - just getting started here!

Also, he wants to start her on Purina ProPlan Veterinary Diet - DM (Diatetic Maintenance). I have to say after her picky eating over the last few weeks - she wolfed this food down! Seemed to really love it and asked for seconds! Especially the dry food! I gave her half a can of the wet food - she ate most of it - and left some behind - as usual. So I offered her a bit of this kibble and she ate with gusto! And jumped up on the washer to see if I could spare a bit more (I was putting it into a lockable container - like for cereal) because she will break into the bag if it's anywhere within her reach! So does anyone know where I can purchase this food without buying it from the vet? I figure that's got to be the most expensive place to purchase.

Lastly, we gave her the first 2 units of insulin today after she ate her lunch - and it went ok. She did seem to notice the little poke - but otherwise seems to be tolerant of it and didn't go off hiding on me. I think the administration of the insulin will be easier than those ear pokes for obtaining the BG.

Anyone have thoughts on less expensive sources of Lantus and Dietetic Management Foods (wet and dry).

I have to say this vet is wonderful compared to the other guy in Michigan! He's asked me to email him daily so he can check our progress - and he's responded already to my first email - so I love that he's so 'involved' with his patients! He seems genuinely concerned and interested in getting Luci better! He did tell me that 33% of his diabetic cats have gone into remission once they've had insulin and diet changes. So let's hope that's where Luci is headed...Otherwise I'll be looking further for less expensive insulin - and have already been advised to be 'wary' of certain extremely low cost products on the web - as it's not sure where they source it from/what's in it. Oh boy..buyer beware.

Thank you for being there!

 

Hi. Can’t help with dosing but I am in Canada and insulin is only $75 a vial here. Most of the forum order from Marks Pharmacy and it’s shipped to them. Most also feed Fancy Feast classics or Friskies pate as it’s low carb and not expensive. Diabetic foods not necessary.

Two units is typically what vets say for starting dose but it is generally too high. Most start on 0.5. Am sure others will chime in with advice and help. If your cat has been mainly on dry food and you switch to wet food you may find insulin won’t be needed for long.

 

Hiya! So great to see you and Luci here and with another good update!

Marks marine in Canada is where most folks get their lantus for less. I've read repeatedly pens are preferable to vials.

https://rxcanada4less.com/

I'm no expert yet so hopefully someone senior will chime in @Marje and Gracie , but that's a high starting dose, especially with Luci in the low 200s. Watch her carefully.
Don't know about the food.
Yay Luci - welcome over here Sue!

 

Most of us here are buying our Lantus from Marks Marine Pharmacy in Canada

Here's all the information http://www.felinediabetes.com/FDMB/...canadian-pharmacies.49608/page-2#post-1344374

They are WONDERFUL!!!

 

Thanks @Chris & China was hoping you’d jump in with that info.

 

Hello! Welcome to you and Luci, this forum has been a lifesaver for so many and I’m glad you’ve found it!

I’m so glad you found a more supportive vet, that is a really great thing.

Dry food is usually not recommended around here for cats, especially ones with FD. I believe the only place you can buy prescription diets is from your vet. Not many here feed prescription diets as they are expensive and not necessary in most cases. There are plenty of low carb good quality wet foods to be had for a fraction of the cost.

Have a look at the stickies posted at the top of this forum and you can get an idea of how things work around here, number one is setting up a spreadsheet because it will help others to help you when we can see all of the data you are collecting. If you can’t figure out the SS, just holler, we have people who can help you with that as well. Ask all the questions you need to and know we are all here to support and help each other. Luci is lucky to have you!

 

Your vet is a little behind the times, but at least he's trying to help your kitty which is better than your last vet! You're going to receive an abundance of help and advice here and, believe me, the people here have so much more knowledge about feline diabetes than most vets. Yes, I said that!! Vets have to learn about every animal and all their ailments while here it's only feline diabetes. My cat, Champ. is going on seven years with diabetes and if it weren't for the folks here, I'd be in a loony bin. Human meters will be a bit lower than a meter that's calibrated for cats, such as a Relion meter from Walmart (good meter) or an Alpha Trak (EXPENSIVE!!). Take your meter with you to your next visit and have the vet test your cat and then you test Luci with the same drop of blood (if possible). Now you know what the variance is between your two meters. Using a human meter is just fine; just about most of us here do. Just pick a meter and use only that kind so you don't have fluctuations from different brands. Also, dry food is really not good for cats. They're what are called obligate carnivores and they really aren't equipped to handle carbohydrates and dry food is CHOCK FULL of carbs. Fancy Feast pates (the classic line) and Friskies pates are low carb and cats usually will eat them. Mine loves them. You can try to transition your kitty from the dry to the wet slowly over a couple weeks, but you should try to transition her. Veterinary prescription diets are not needed at all. Most cats won't eat them anyway. By the way, 2 units as a starting dose is really high, especially when you're changing the diet at the same time. I'm not a dosing expert, but I'm sure of that. You also need to try to shoot as close to 12 hours apart as possible, say 7 a.m. and 7 p.m. You should ALWAYS check the blood sugar before your give the insulin to make sure she isn't low. After that, you should check two hours after the shot if you need to leave for work (so you know if she's headed up or headed down and you know what kind of food to leave out for her, low carb or high carb). If you can come home at lunch to check, that's awesome. Check when you first get home and then check again at shot time. Always make sure you check her blood sugar before you go to bed, again so you know if she's headed up or headed down. I know you'll have a ton of questions and there will be plenty of people here to give you advice. Welcome to Lantus Land!!

 

Forgot to add, you can also check the supply closet here for savings or free. Just check with others on repudability for sellers. http://www.felinediabetes.com/FDMB/forums/supply-closet-for-sale-or-free.15/
(And my Mark's pharmacy link did work fine, lol)

 

Welcome. Just wanted to add, you don't need RX food for a diabetic cat. At this point you need a high quality low carb food.

I know you said she is picky, if she likes the canned DM ok, but you are better off with only canned (no dry).

I also wanted to add I buy insulin from Costco too. Be aware that vial will last several months if well cared for (kept stable in fridge). Several members thought it would last only 1 month because of the label.

So glad you are helping Luci. Please ask as many questions as you need to so we can help you!

 

Please don't feed dry or prescription. It is too high in carbs. Mango is going on a month after diagnosis and it made a BIG difference in his BG when I switched him to wet. My vet was insistent on giving him prescription food. I said sorry, this is the food I am trying. I believe you are starting on too high of a dose. I am saying this by experience. Since the switch, I am down to only 0.25 units. My vet had me all over from 2u to 3u. Please let us help you. I trust this forum and they are awesome at helping you. The best thing to do is get a spreadsheet going. And the most important thing is to check BG during the day since you don't know how she will react to a given dose. There is so much good advice and info here for you. I still am learning so much about FD.

 

I also went to Lantus website and got a 100$ off coupon. It only cost me 183$.

 

You are so close to me. I am glad you found a good vet. My vet works with me and I keep in touch with her. If you ever need help, I am just a heartbeat away! Oh, by the way, how is she doing and what dose did you give her? Please check BG!

 

Oh! So many replies... Please for this one I have taken a pic of the insulin needle (empty) with the syringe stopped (where he showed me on the 2nd line from the very bottom)..It seems like a very small amount to me. Is this really too much? Luci showed no adverse effects after getting her first injection today right after lunch. I was so pleased that she actually ate the DM! She has been terribly picky lately...every kind of lo carb I've introduced she's walked away from. Some of it she even 'scratches' over - like she does to try to cover up some nasty business...but there's nothing there to cover the replusive food with...so she walks away...disgusted...and hungry. Poor girl..

I'm supposed to give another dose later today...I guess we'll feed and shoot around bedtime...because that's all I've got for today...not getting up in the middle of the night. Her first and only dose was at 12:50 today. So I'm hoping that's long enough between doses???

 

Spreadsheet is underway. Is it not attached to my first post? Luci has been on grain free, all meat Fancy Feast or I And Love And You - until she refused to eat it (it's all meat, grain free)...so no grains or kibble of any kind since mid November. However, with that being said, her weight has been plummeting. She's lost two pounds in under two months. I was worried so decided it was time to see a vet for further instructions. At least he didn't want to start her on NovalinN - said it was too much and might send her into a diabetic low (what is the term for that?) I'm afraid that I'll do her more harm than good...because I don't know what I'm doing!

Her BG numbers are all posted based on readings from the ReliOn meter...but he thinks those numbers may be off...well they aren't 'animal' numbers, we know that...but to get a comparison of what his meter reads and mine, I'll have to go back with meter in hand so we can get a poke there...and take a test together.

For now, please bear with me...first day...hoping not to harm her. She is resting comfortably now - I wish I was!

 

Yes, it looks like just a tiny bit of insulin, but they are cats and these are human drugs. And yes, it can still be way too much. Many people here use the syringes with the half unit markings because the doses are so small. My cat gets almost 1/3 of what you are giving yours. Some get 1/8th of what you are giving, or even less, believe it or not. Insulin is not a drug, it’s a hormone and it’s powerful stuff. You may not be able to tell she is okay or not just by looking at her. When they show they aren’t okay, it’s often a very bad situation. Testing is the only way to know what’s really going on. The way this insulin works is it builds up over time, so you could give too high a dose now and not see ill effects for hours or even a couple days later.

If her first dose was at 12:50, her second dose should be at 00:50, 12 hours apart isn’t a suggestion, it’s important for this insulin to work properly. It needs to be as exact as it can be within 15-20 mins of that exact 12 hour maker.

If the DM is all she will eat right now, you can start there, you can always change food later, but if you can give the wet version over the dry it will be much easier trying to manage diabetes as the kibble takes a lot longer to clear the system than the wet.

The meters will be different, but not to worry, the TR protocol that many here follow was written with human meters. You are looking for trends more than exact lab numbers and your meter will do just fine for that. Keep reading, keep asking questions, and hopefully Luci will be feeling better and back at her ideal weight soon!

 

On your spreadsheet you are not showing amps or the dose amount. We need to see that to help. Look at mine and see what I mean

 

Yes I’d say it’s too much. My vet started me on 2u as well and I listened to forum and dropped to 0.5. Eventually he got just one drop before going into remission the first time. It’s a powerful hormone and not much is needed.

 

Kia Ora & welcome from me in New Zealand.

Thank goodness you found a half tidy vet. Not a useless one

Seems that many vets think a starting dose is 2 units with lanctus. I have now learned that was too much & that one needs to really monitor the BG to know the dose.
Vet here was and is also rather too insistent on prescription dry diet with a bit of prescription wet thrown in. Once my Tyler transitioned away from that his numbers improved quite a lot. Mid you a cat eating any food is better than a cat not eating any food.

My vet also got me doing the urine tests but those are redundant now as I home test with a BG meter that can also test for ketones.

Anyway. You are absolutely in the best place with being here and if you have your vet 100% on board then I think that's just great.

All the best.

 

Thanks for the tip on Marks Marine in Canada. However, Costco took my written prescription. It had several refills on it. How do I get it back or do I ask for another script from the vet - so I can work with this pharmacy next time?

 

Thanks for the tip. So next time I administer - which from what I'm seeing now (since her dose was at 12:50 pm) and I'm not going to get up at 12:50 a.m. to feed her and give insulin - we'll have to start fresh tomorrow. I'll feed and give a lower dose. When do you recommend I check her BG with my meter to see what her numbers are? Can I expect to see a drop in the BG after only one or two doses? The vet seemed to think this was a 'slow acting' insulin and may take a 'while'...that seems vague to me. What is a while? A day? A week?

Thanks!

 

I'm so glad you are getting many inputs. Lots of folks want to help.

Let me make 2 important points: Canned DM is OK, but what we are saying is you don't need to buy prescription. If she eats it great - feed her canned DM.

Second important point: Lantus should be given every 12 hours. If you gave a shot at mid day, the next shot must be at mid night. Please don't do it sooner even if you have to go to bed. If you don't want to wake in the night, my suggestion is you start again tomorrow at a convenient time keeping in mind both AM and PM (i.e. 6AM / 6PM). You can be +/- 15 minutes, but consistency on a daily basis is the most important thing.

 

We usually put the link into our "Signature" (the stuff you see below each of our comments)....it helps to get that filled out so we don't have to keep asking the same questions over and over again.

Information we like to have are things like:

Your name/Cats name, age, sex, date of diagnosis, type of insulin, type of meter, type of food, any other health issues? and a general location.

Then you can put the link to your spreadsheet in and "save".....that way, every time you post, the information will be there for us to see.
(click to enlarge)

hypoglycemia

Getting her blood glucose under better control will help a lot. Take a look at China's Profile (in my signature)...You'll see how far back they can come!!

 

I agree 100% - I mentioned in another posting that I did not plan to give her another dose today since the first dose was so late; we'll start fresh tomorrow morning.

 

It looks like you may not be understanding how to use our spreadsheet.

The AMPS is the AM Pre-Shot....the test you should get in the morning before feeding/shooting

The U column is for the amount of insulin you give in the morning in "units"

Then you start the "+ cells".....each cell corresponds to the number of hours since the last shot....so if (for example) you shoot at 7am and then you tested again at 10am, that's 3 hours after the shot, so the test result would go in the +3 cell....If you tested again at 2pm, that's 7 hours after the morning shot, so would go in the +7 cell.....all the way up to +11 and then you start over on the PM cycle.....the PMPS is the PM Pre-Shot test

 

Thank you so much for the info on how to modify my info! I did modify my signature and hopefully it has enough info there to be informative/helpful to those trying to help Luci and me

 

@Chris & China
Does Sue need a new rx or can she contact Mark's with the info on her current Costco rx label (refills)?

 

I am overwhelmed by that spreadsheet We haven't given any insulin until today. She wasn't tested in the AM before giving it.
I also doubt that I'll be able to get a BG test before she eats - it's a problem. I cannot hold on to her, and her ear and poke her ear all at the same time. My husband gets up an hour or so after I do - and Luci wants to eat the minute my feet hit the floor at 6 a.m. - I'm an early riser but hubby is not. So we are only able to check around mid to late morning...but never going to get a BG before she eats - she'd be climbing the walls...and I would too...watching her starve until he gets up. So..with that being said, I'm not sure how to go about getting a BG first thing .... then feeding, then shooting and then getting another BG at some point later in the day...
I'll keep working on it...but that's how things are in our home - I doubt that I'll be able to change hubby into an early riser to help out with this

 

You can try giving her something to eat while you're testing....plain baked chicken is very low carb and won't effect her numbers

It's important to get those tests in .....it's the only way to know if it's safe to give insulin at all (I'm really not being critical of you.....it can be hard at first and each of us has to find a way that works for us)

I know how your husband feels!! I am NOT a morning person and never have been...when we first started, I thought " OK....I'll just shoot at 11/11....that way I don't have to get up early and I'm always up until midnight".....well that lasted until the first couple of times China went low on the PM cycle and I ended up staying up all night to keep her safe!....so I made the decision to drag my butt out of bed at 6am so I could get Pre-shot tests early enough that I could also get +6's at noon/midnight and usually wouldn't have to worry about her between midnight and 6am.....and I could usually go back to bed in the morning...LOL

You will need a new script for Marks. I don't know if Costco would be willing to give you a copy of your script or not (couldn't hurt to ask) but once Marks has it, they'll never need another one!! Unlike here in the states (where we have to have a new script every year), once they have one on file, you can refill as long as you need it without getting another one!!

They can take a faxed script, an emailed one...heck, you can even take a picture of a script....as long as they have one!!

I just called my vet when I needed more and told her I needed to refill, found a place that was cheaper and asked her to fax it to their phone number. I didn't say anything about them being in Canada and since it's an 800 number, she didn't need to know!

 

Here's something I wrote up for others that needed help with testing...maybe it'll help you too! (substitute "her" for "him"...LOL)

It can be really helpful to establish a routine with testing. Pick one spot that you want your "testing spot" to be (I like the kitchen counter because it's got good light and it's at a good height....it also already blocked 2 escape routes due to the wall and the backsplash) It can be anywhere though...a rug on the floor, a table, a particular spot on the couch...wherever is good for you. Take him there as many times a day as you can and just give his ears a quick rub and then he gets a yummy (low carb) treat. Most cats aren't objecting so much with the poking..it's the fooling with their ears they don't like, but once they're desensitized to it and learn to associate a certain place with the treats, they usually start to come when they're called! Or even when they hear us opening the test kit!

You also have to remember...you're not poking him to hurt him...you're testing him to keep him safe and understand what's going on inside his body. There's just nothing better than truly understanding what's going on inside your kitty's body and with this disease, the more knowledge you have, the more power you have against it. The edges of the ears have very few pain receptors, so it really doesn't hurt them. Also, if you're nervous and tense, it's going to make your kitty nervous and tense too. As silly as it might seem, try singing! It forces you to use a different part of your brain!

It's also important to make sure his ear is warm. A small sock filled with a little rice and microwaved or a small pill bottle filled with warm water (check temp against your wrist like you would a baby bottle) works well.

When you're first starting, it's also important to use a lower gauge lancet, like 25-28 gauge. Most of the "lancet devices" come with 33 gauge lancets and they are just too tiny to start with. The bigger lancets (that are lower numbers) make a bigger "hole". As you poke more and more, the ears will grow new capillaries and will be easier and easier to get blood from...we call it "learning to bleed"

Finding the right "treat" will be a great help too! Freeze dried chicken, bonito flakes, little pieces of baked chicken...whatever low carb treat you can find that he really enjoys will help him to associate the testing with the treat! China's Achilles heel was baked chicken, so I'd bake a piece, chop it into bite sized pieces, put some in the refrigerator and freeze the rest to use as needed. It didn't take long for her to come any time I picked up the meter!

 

You start where you can start, but checking before shots is so important because it is possible you could have a number that is too low to give insulin or it would be very dangerous.

I know it doesn't seem like it right now, but I promise you, the ear pokies will be a quick and easy one person job in a short while! I know that probably sounds crazy to you right now, but it becomes very easy after you practice several times and you'll be a pro bg tester in no time at all!

Diabetes involves some routine changes. She may be used to getting food right away, but it won't take long to check her bg and you will get there and she will get used to the adjustment. Here's a tip, many people give a treat (low carb please) when testing so the cat comes to associate tests with treats and so actually enjoy test time because of this.

 

Hi Sue and welcome to you and Luci.

I'm going to back track a bit because I suspect it's a bit disconcerting to have people jumping in and giving you information about food and dosing and it's not what you're doing.

First, there's a ton of information in the sticky notes at the top of the board. If you start reading the notes plus all of the links in the notes your brain will explode. No one expects you to memorize everything or know all of the details. I've been around FDMB since 2009 and I still find something new when I go back to read the notes or links. There are a lot of very knowledgeable people here who are very generous with their time and experience. Please don't hesitate to ask questions.

There are 2 reasons people are concerned about your starting Luci's dose at 2.0u. First, the blood glucose (BG) reading your vet got is probably inflated due to your kitty being stressed while at the vet's office. The next time you have to go in for a visit, bring your meter. You can compare your reading with the vet's. Chances are there will be a difference due to one being a human meter which reads lower than a meter calibrated for animal blood but the numbers shouldn't be astronomically different. Even if they are vastly different,, if you consistently test with your meter, you'll be fine. If the vet is basing the dose on numbers at the office, which most vets do, there's a good chance the dose is too high.

The other issue is that the initial dose of Lantus is based on your cat's weight (providing you are considering following the Tight Regulation Protocol -- one of the dosing methods we use here). There's a formula: initial dose = cat's ideal weight in kilograms x 0.25. For most cats, this calculates out to around 1.0u. If your cat is underweight, you use your cat's current weight in the formula. If you are thinking about using the other dosing method, Start Low Go Slow (SLGS), the starting dose is 0.5u. It will take 5 - 7 days for Lantus to form a depot (there's a sticky note on the topic). Doses are typically held for 3 days (6 cycles) so the dose can stabilize unless a dose reduction is indicated. The point at which you reduce the dose differs base on which dosing method you potto use.

One caveat regarding the Tight Regulation Protocol -- you can't use that method is you continue to feed Luci dry food. The TR protocol was not researched using any dry food. It is a method that has published research behind it and has an admirable record for getting cats into remission.

As for the topic of food, if you've not read the webpage authored by Lisa Pierson, DVM on feline nutrition, it's a good read. There is also a link on the right side of the page to a food chart that contains information about the amount of carbohydrates in a large number of cat foods that are available in the US. The bottom line is you could be feeding Luci a human grade, "luxury" cat food that is lower in carbs than the prescription food and those luxury foods are a much higher quality source of protein. The DM that your giving her is largely animal by-products. A diabetic cat needs to be on a low carbohydrate diet since carbs = sugar. Feeding an 18% carb food is what we would suggest if Luci's numbers dropped into a way lower than expected (or unsafe) range. Most cats respond to high carb food, whether dry or canned, as though you were feeding them candy and cake. Low carb is below 10% and most people here generally feed far less than 10%. (I fed Gabby 4 - 5% carb and it's also what my non-diabetic cat eats.)

Any insulin that is being given to a cat needs to be given as close to every 12 hours has you can. So, given how late you started off, it makes good sense to skip tonight's shot in order to get on a schedule that will work for you. As Chris mentioned, it is imperative to get a test before you give Luci a meal and/or her insulin. If she's a bit of a pain when it comes to her meals, a bit of chicken or even a small amount of her usual food to appease her will work until she learns the routine. (Cats like routine and are very much creatures of habit. The hard part is that you will be working on changing her routine. The good news is that if you reward her for letting you get that pre-shot/pre-meal test, she'll catch on -- especially since she sounds like she's pretty food motivated.) You need to know whether it's safe to give a shot and the only way to know that is if you test before you shoot and you don't want the pre-shot test to be influenced by food otherwise you have a test result that is artificially inflated by food. Most of us test, feed, and shoot within a very small window (5 - 10 min). One other thought is that you do not need to be feeding Luci all of her meal at shot time. Most of us will spread out our cat's meal. The only time you don't want to be giving your kitty a snack is 2 hours prior to shot time. It may be if you spread out her meal, she won't want to chew your hand off at shot time.

I know I've probably added to your feeling overwhelmed. There is a lot to know at the beginning of this journey. It really does become second nature in a relatively short period of time. There are also people here pretty close to 24/7 who will do their best to answer your questions and/or provide support. This is a wonderful community that I'm sure you never wanted to join but we will help to get you through the tough times.

 

Do you need a prescription when ordering from Canada? Is that because it’s being shipped the US? We don’t need a prescription here.

 

Yes....It's OTC in Canada but it's prescription here, so they require a script at Marks ....but you do only have to provide it once! Here in the states, we have to get a new script every year, but once they have one on file at Marks, they'll refill as long as you need it

 

Overwhelmed is an understatement at this point. I'm on information overload right now - trying to read the Tight Reg Protocol...whew! Can't absorb anymore today...too exhausted. Feel like I've been on the Luci-train all day - ever since 7:30 this morning when I was off to drop her urine off at the vet's for analysis...it was non-stop since then (picking up prescription at BUSY Costco, all the way to sticker shock and finally to giving the darn shot - so late in the day, I didn't realize next dose was 12 hours! - Her BG tonight was 137 btw...best number we've seen since her diagnosis. She seems to be feeling just fine...lounging around...while I feel like collapsing. Good for her...as for me..I'm going to bed...gotta get some rest before we launch into all this again tomorrow.

 

Your vet can fax a prescription to Marks Marine. They are very helpful if you’d like to call and ask questions. I haven’t found a better price on Lantus. I order 5 pens (use them just like a vial) for about $160. Keep them in the refrigerator and they will probably last you almost a year.