My cat recently started on lantus - please read.

Hi. I am so happy that a forum like this exists. My cat was recently diagnosed with diabetes and I have so many questions about what is happening to him and hope that people may have answers.

My cat is 14 years old (going to be 15 in August) and recently we noticed that he has been missing jumps up to the sink, etc. He took him to the vet and said it could be diabetes. They took a test and confirmed that he does indeed have it. They took his level and it was 550.

This is where the craziness starts...

My cat gets very stressed out going to the vet and he is 45 minutes away by car. During the vet visit they were not draw blood from his legs because it was too difficult to find the veins. So they took him from the office where we were into the back (where there was better lighting) to get blood. They came back about 10-15 minutes later and told me that they had to get blood from his jugular. This was the first time he ever had to get blood taken from there. I believe they got two vials.

I got my cat home after the visit and about an hour later he had a seizure. This is the first time he has ever had one. He looked confused, stumbled made a weird meow and urinated on the floor. He then went downstairs and ate a ton of food and drank a ton of water. It was really scary to see.

After his first seizure for the next day his head was twitching and it went away the next day. Things seemed to get back to normal then we started the lantus. We noticed that our cat starting having spasms in his legs and his head twitching, etc. We started to give him honey to raise his sugar per the vets instructions. It seems like it eventually stops the trembling he is having but we can't be sure as we can't watch him 100% of the time. After a week on the lantus, the cat was taking one unit, we took him to the vet and his level was at 350. The cat also lost one full pound in a week which is really scary for us. The doctor has since then suggested that we give him two units, which we are doing now, and we got him the food for diabetes that you need a perscription for. (2 weeks in)

We just got our home test kit in and last night we tried to get blood from his ear and try to test his levels ourself. It was a comedy of errors as we would get blood but the machine turned off them we had it or we would get an error message of not getting enough blood. Hopefully we can get that right soon.

My wife and I just feel like we are putting our cat through all this bad stuff, constant poking, his levels up and down, etc. We want him to have a happy life and we just feel that he hates us now for all the poking, vet trips, etc. Has anyone had this experience? Just looking for help and guidance from the community.

Thank you for reading (sorry for the long post).

 

Hi Rob,

Sorry to hear that you've been having a bit of a baptism by fire. Can you tell us whether the vet gave your kitty any insulin before the above event happened. Will get to the other stuff in a later post, but for now I just want to say that things can be very overwhelming at first but we'll do all we can to help you all and things will get easier - for you and for your kitty.


Mogs
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Hi. Thank you so much for answering. No insulin was given before that seizure. That was his initial visit to test his blood. I am just wondering if drawing from the jugular could have caused that, or maybe they missed something. It is so sad to see him like this.

 

Hi Rob and welcome.

On the He Must Hate me part. We've all been there. The key is keeping calm and positive reinforcement. Most of the time they initially hate the poking because they can tell we hate the poking. But with the reward of love before and after and an after treat they soon form a routine everyone is good with. They also after a bit often seem to realized whatever the weird servants are doing, while weird makes me feel better so I guess I'm ok with that. Many cats often get so good with everything that they actually come along and remind us that it is treat, I mean testing time.

On the seizure I really don't know But did they give him anything to calm him. It kind of sounds a bit similar to things I was told to watch out for after anesthesia.

As far as diet. You don't need the prescription. Low carb wet food like Fancy Feast classic pates, or any number of other brands work just fine.

 

I do not think that caused the seizures. It is not that unusual to get a bad bruise where they drew the blood.
Some cats resist a blood draw and the vet/assistants may injure the animal trying to get blod but I would not at all expect it to result in a seizure.

 

They always have to take my Rosie's blood from her jugular because she won't let them near her paws! But she has this every one or two weeks and has never had a reaction. Did they give him a sedative to get the blood? Xx

 

Hi everyone. No, they did not give my cat anything prior to drawing the blood.

We called the vet this morning and told them about his occasional shaking and they said they would need his blood glucose levels to better guide us. So, I guess we have to try again tonight.

I am just stressed because I want the cat to have a happy life and I was hoping we could do this through just diet and not the insulin shots. It just seems to my wife and I that things are going down hill fast with the rapid weight loss, the constant poking, the shaking, etc.

 

Are you having trouble with getting blood from the ear? Did they do a cbc on your cat?

 

We just got the machine last night. We tried for an hour but were unsuccessful. We pricked his ear a few times and drew some blood, but the machine errored twice and the last time it shut off just before we got the blood on the meter.

 

What meter are you using? There is a sweet spot on the kittys ear to prick with the lancet. Are you using a lancing device or using the needle free hand?I dont have a good grip so i put the lancet in a lancing device but take the lid off so i have something i can hold but still see exactly where i am pricking the ear. if his ears are white you should see the vein running through the ear. Have to run out will send you more when i get back

 

Thanks for the reply. Yes, we used the lancelet to stick his ear. We thought we had enough blood but maybe it was not on the correct spot.

Has anyone else notice their cat have tremors or shaking on insulin?

 

I can't answer about the shaking. You mentioned they took him to the back room. We're you present there? If not can you be absolutely without a doubt certain they gave him nothing?

As for testing. Put the strip in position in the meter just enough without turning it on. Then stick to get the drop so you see it. Push strip in rest of way, milk the ear while waiting for countdown. Then get test.

 

this explains it pretty good

I haven't experienced that with my cat on insulin but I know a cat that has that happen sometimes and is not diabetic. It sounds like something else is going on. What kind of tests did they run on your cat?

 

Hi. We were able to get his blood and test it last night at 8:30 PM thanks to the tips above. Unfortunately, his reading was 380. He is still drinking a lot and urinating a lot.

Does anyone know how long it takes to get his level to be in normal range?

 

That's the million dollar question. Every cat is different. Many factors involved. Some can be normal in weeks, go into remission, some never.

Smokey has been diabetic since 2010. When I got him in 2014 he had been without insulin for quite awhile. I knew nothing about FDMB. So even after 18 months with me I was listening to the vet. He's still not regulated but so much better than when we started.

 

Yes... Another thing to keep in mind is that I think it's 100% normal for Lantus, as a "depot" insulin, to take a while before it starts to move numbers (the depot needs to fill up). With my own cat, she had a big reaction to the very first shot, but then after that it was almost a month before I started seeing any more movement (I wasn't testing a lot mid-cycle, but still, even when I did it was like she'd never gotten a shot at all and I knew they couldn't all be furshots!). I even went out and bought a new insulin pen because I was afraid my super-unreliable fridge had frozen the pen I had and made it ineffective! But it turned out that it took that long before the Lantus got revved up and/or my cat's body got used to it and started to use it. So hang in there!

 

here is another view of the sweet spot that helped me when I first started testing.... it does get easier. Initially I was aiming for the vein.... now the sweet spot is my target and Dre doesn't even notice-Your doing a great job....

 

check this out...
http://www.felinediabetes.com/FDMB/threads/tribute-to-fdmb-from-genghis-otj-11-25.148233/

 

Really glad you posted this link, Jayla: it's a brilliant video - and a great message.


Mogs
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Bloody awesome video and really gives hope for the future- started to get a bit emotional tbh!

 

Rob - hurray to you and your family for all the effort you are going through with your newly diagnosed sugar cat. One day soon you will look back on your original post here and see how far you have come. I can't add any more than the lovely people here have already said except to say if you watched the video, Genghis is my girl. It takes vigilance and dedication, definitely, but that is something it sounds like you already have in abundance. My girl was having trouble walking and couldn't jump AT ALL (yes, I still suffer the guilt of not noticing sooner, but I attributed it to age) but with a complete diet change and a great insulin like Lantus, she is like a whole new cat. She jumps, her coat is glossy (she had terribly flakiness and poor coat quality), she PLAYS and is a good weight. She has been off insulin since November - I just checked her again last Sunday and she was in normal range. I will echo what others have said and that it will take as long as it takes. Early intervention and consistency deeply improve your chances of both getting the Lantus to keep him in normal range and, possibly, off insulin altogether. Do not lose heart!

I cannot comment on the seizures, but I will say that if you do completely change his diet from a dry food to all wet, you must be EXTRA vigilant in watching his BG numbers. I got Genghis regulated with a commercial low carb food, so absolutely as others have already said, Rx diet (too expensive and frankly not always carb-appropriate) is not necessary.

Speaking of food, diet change alone can have a very big impact on BG numbers, so do not implement the change without being prepared to monitor his levels. Based on my experience, I would also caution against the 2.0 unit dose in conjunction with the diet change until you have had a chance to see how he reacts to the first dose. Are you familiar with "bouncing"? Sometimes a cat's system panics from blood sugar going to what it perceives as dangerously low levels (being accustomed to much higher levels) and dumps glucose into the system. This can also happen after a hypoglycaemic event - if you don't have enough data, you just think "add more insulin", which makes the cat drop further and the system panics, vicious circle created. EDIT TO ADD - please be aware that Lantus is dosed on how LOW it takes your cat at nadir, or at the lowest point in the cycle, typically 4-6 hours after you have administered insulin, but as we like to say around here ECID or Every Cat is Different. Do not base the dose on a random reading or even the reading before his shot. Just my 2 cents.

I had a LOT of help from people in the main forum as well as the folks over in Lantus/Levemir. The people here have combined experience that is mind-boggling, and they are so wonderfully supportive. As my video hopefully shows, I really owe Genghis' health to them. Keep up the great work and don't be discouraged. I'm sure it seems like you are putting him through a lot, but this is a marathon, not a race and it's very likely that before long he will be jumping and playful again.

 

@jayla-n-Drevon @Critter Mom - aww, thanks for the shout out! It was a labour of love and hope my tribute can help people.

@Lily-Fish thank you so much for your comment - I really appreciate it! I am really so glad it has helped you

 

It shows! I've already bookmarked the YouTube link for future sharing with newcomers to the board. It's a terrific video with such a positive message; and exactly the message that newly arrived, overwhelmed diabetic kitty parents need to hear! And the transformation in Genghis is so inspiring!


Mogs
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Hi RobC. I read your post Wed and have been trying like mad to get signed up on a computer to this wonderful site. The reason your post struck such a cord is my 14 year old diabetic kitty was/is having the same shaking/tremors as your kitty. I have searched online and even made a video to show my vet but haven't found an answer..yet. Like you, my first thought after starting to educate myself on diabetes was hypoglycemia. But my vet told me not to test at home and just go by the Fructosamine test he ran. It came back at 106 but he still said to give Lantus insulin 1 unit every twelve hours. Since I took my guy off all dry food and he was already eating Fancy Feast Classic pates I suspected he might be going into Hypo because of the food changes. He would shake at the oddest time though. Preshot in the afternoon I would feed him and he'd start the tremors which lasted 7-8 minutes before shooting insulin. It was terrifying being in the dark about his numbers so that's when I started the dreaded home testing.

Of course when I started testing, he stopped shaking! Cats, huh? For the last few days, I thought he might be in remission so he hasn't had any insulin. Thursday, two hours after eating he started awful tremors again so I tested him but he was BG131 so it definitely wasn't hypo. I wondered if maybe it was an insulin allergy or the ups and downs of blood sugar as they're adjusting to insulin. Or just the stress of being ill? Is something else wrong even though he's had two full blood panels? It's an awful mystery and I wish I had an answer. It isn't a daily occurrence anymore so hopefully it is just getting him balanced. Anyway, I wanted to let you know you are not alone and maybe we can figure this out. If I find anything that will help, I will let you know and hope your kitty is much, much better soon. Isn't this the most fantastic site?

 

My Kenzos back twitches a lot and it started after we began insulin but no limb twitching or seizures.

 

Will&Laura, thank you so much for answering about the twitching. No seizures thank goodness but I'm still thinking maybe the tremors/shaking is caused by the ups and down of their blood sugar and the body reacting to a cranky pancreas trying to work correctly with this crazy disease.

 

Thank you all so much for the kind words. Luckily my cat has not had a seizure that I know of for a few weeks now.

Last week we texted my cats blood and it said that he was 248. We were very excited that his numbers were going down, but he was still drinking and urinating a lot. The doctor recently recommended that we go up to 3 Lantus units a day. We started him on 3 Sunday. The doctor advised us to check him Monday night at 6pm and then do a fasting test on Tuesday morning before his shot at 6AM. (We give him his daily shot on Lantus at 6AM). After a few pricks of the needle we finally got his blood and it was..........311. My wife and I were SO frustrated. I had hope that the next morning would be less. Today came (Tuesday) and the fasting blood test result was 388.

We are so upset as to why more lantus would mean a higher reading. Waiting for more directions from the doctor.

The cat just hasn't been his normal self. He hides under the bed a lot, etc.

 

Rob, it sounds like your vet doesn't understand how to dose lantus and is basing his dose on one number. Lantus dosing is based on how LOW it takes them, so it's important to get tests on every cycle in between the shots to see how low he's going. By the way, what's your kitties name? I don't see it anywhere!

Are you home testing regularly yet? I can't stress how important that is to getting him regulated. Testing before the shot each time and then testing mid-cycle on the AM cycle and "before bed" on the PM cycle will really help to know what's going on

We also have a spreadsheet we use here that's a very valuable tool. It will really help if you'll start it and keep track of the test results you get so we can help you. Here are Instructions on getting the FDMB spreadsheet

Without knowing more about how your kitty has been doing, it's impossible for us to give you much in the way of meaningful advice, but one very important thing to remember is that too much insulin can look like too little!! We have seen cats here that started in the 400's, dropped into the 40's and were back in the 400's by the next shot time. Without catching those mid-cycle numbers, it could look like the cat needed more insulin when in fact, they needed less!!

 

Hi Rob,
What is happening to you is exactly what happened with my vets (yes plural) and a lot of other peoples vets on the forum. Follow Chris's post.
Getting the frequent urinating and drinking a lot of water and eating a lot of food under control takes awhile. It was like three weeks before I noticed a change. Can you get a home curve done asap to see what his numbers are on the lantus? normally the numbers before the morning shot and the before the evening shot are actually the highest its the ones through the duration of the shot you need to see to tell how low the lantus is dropping. Are you shooting 12 hours between shots? What kind of food are you feeding? Please give us more info so we can help you and your kitty.

 

Hi everyone. Thanks so much for your responses. First, we have always called our cat "Kitty".

I talked to the vet yesterday and asked him about testing 3 times a day to get a correct reading, he said that was "overkill" and to "test the cat at 6 pm for three days in a row". So, I am not sure what to do at this point. I can't believe that there isn't an easier way to do all of this.

We recently started feeding our cat food that requires an RX to get for diabetes. With that food and the up in lantus units I was hoping for better news.

 

Kitty is a great name for a cat!! My first cat's name was Kitty!!

As for your vet, we hear that a LOT around here...that testing isn't necessary or only needs to be done occasionally. I'd be interested in knowing what your vet would do if his human child was diagnosed with diabetes and his pediatrician told him to shoot insulin into his baby without testing first!! You can bet that he'd be finding a new pediatrician!!

There's no such thing as a "prescription" food....the word "prescription" when it comes to pet food has no legal meaning.

While this particular article focuses on dog food, the same information pertains to our cats food.

There is NO "magic" in "Prescription" foods of ANY kind.

Hills has spent a great deal of money training their salespeople to "teach" our vets about nutrition...and why wouldn't they? They want to sell more products!!

Before you go out and spend a fortune just because the food has the word "Prescription" in it, I would hope you'd thoroughly read this article.

http://www.soggypaws.com/Documents/prescription_diet.pdf

What IS important when it comes to feeding our sugarcats is the same thing that's important in treating human diabetics....a low carb diet! There are lots of much cheaper alternatives to those high priced "Prescription" foods, like plain old Friskies pates, Fancy Feast Classics and 9-Lives pates. There's lots of great information on feeding our cats on Dr Lisa's website "Feline Nutrition". It's well worth the time to read.

It sounds like your vet is just not very familiar with treating feline diabetics...Welcome to the group!! There are lots of us here in the same boat!! He/she might be a fine vet in other ways, but a busy vet just doesn't have the time to stay up to date on the latest treatments for every disease in every type of animal they see. The people here do nothing but deal with feline diabetes and the diseases that tend to come with it, so there's years of real life experience here to share with you

 

What is the diabetic prescription food you're feeding? Of the prescription foods, only Purina DM canned is low enough in carbs for a diabetic. The Hills prescription diabetic food is NOT actually diabetic safe! And if you're feeding the dry prescription foods, unfortunately those are also too high in carbs. However, you don't need to feed a prescription food. There's nothing special about them if you look at the ingredients. There are many lower cost non-prescription options available. In the 7+ years Bandit has been diabetic, he's never been on prescription food.

I've attached an article below for you to print out and bring to your vet. Lantus needs to be dosed from 3 tests a day--once before each shot to make sure it's safe to give insulin, and a test mid-cycle to see how low the insulin is bringing your cat's blood sugar. The dose is adjusted from that mid-cycle test (the nadir, meaning the lowest number of the cycle). When the guidelines outlined in the article are followed, more than 80% of cats go into remission (meaning they don't need insulin anymore, just the right diet). Bandit has been in remission the large majority of the time he's been diabetic, and he's no different from non-diabetic cat in regards to his health.

Unfortunately, many vets do not know how to properly dose Lantus, because it is different than other insulins, and differently for cats than for dogs. It doesn't mean you have a bad vet, just that he probably hasn't read all the current information on treatment. Bandit's old vet got a lot of things right when he was diagnosed--she told me I had to home test, gave me a list of low carb, canned, commercial foods in different price ranges, and prescribed Lantus. But her dosing recommendations were WAY off, and if I had continued to take her dosing advice I have no doubt Bandit would not be alive today. Thank goodness I found FDMB, and found the recommended dosing guidelines for cats myself!

Bandit's old vet refused to alter her dosing advice despite the articles I brought to her (she insisted that her made-up dosing protocol was better than the published one...definitely NOT, and I could prove it with my home testing data). I found a new vet that didn't know much about feline diabetes, but was willing to read all the information I brought her and do the recommended treatments. I didn't find a vet who actually got everything right about diet, dosing, and insulin until Bandit started seeing a new vet at Cornell last year.

 

Thanks for your kind replies.

We were told by our vet that we would have to give him a needle every single day for the rest of his life. Is that not true? I could have sworn I asked him if his numbers are normal do we still have to do it, and he said yes. I would really love to get his numbers under control, his urination under control and him wanting water less. To do that without sticking him every day with needles would be so amazing.

The food we ordered and have now for him is located here (pretty sure this is it, as I am at work now): https://www.chewy.com/purina-pro-plan-veterinary-diets-dm/dp/49828

 

There is a chance of remission but its not a 100% guarantee. I am sure other members can go into better detail regarding it. I think you need to understand that giving insulin twice a day and changing his diet are just the first step in getting his current symptoms under control. It will not happen over night. For my cat it was about 3 weeks before I noticed a change and then another couple weeks before it started coming under control. This is not going to be easy at all. I really think you need to start looking deeper into the information the members are giving you here and maybe start looking for a new vet. If you look at the ingredients on that prescription food you will find it is not the best.
I know your probably thinking I just paid this vet all kinds of money to help my cat and then I come to this forum and I am being told different.
If I would of listened to the vets I am dealing with my cat would be dead right now. It was this forum that helped me get a different insulin and setup with meter testing etc to get him on the road to improvement.
You can actually consult with Dr. Pierson that owns www.catinfo.org about your cat. drpierson@catinfo.org

 

I also wanted to mention that the vet did take my cat in for an all day test one day. It was 9am to 530pm. They stuck his ear throughout the day to get his different levels. That was the same day they told us that he needed insulin going forward.

I am not sure if that is the reason he isn't having us test the tree times (morning, noon and night) every so often.

 

That's what's called a glucose curve....and curves done at the vets office are unreliable because the numbers are going to be higher than they'd be at home due to stress of being at the vets.

By home testing, you're going to get more accurate numbers (because the cat is in familiar surroundings and hasn't just been thrown in a carrier and whisked off in a car to a place he hates) as well as save the cost of having your vet do them....but the #1 reason you want to home test is because it's the ONLY way to keep Kitty safe!

High numbers take a long time to do damage to the internal organs....one low number can kill very quickly.

Is there a reason you seem to be resistant to learning to home test? It sounds like you might think that your sweet Kitty will hate you for it. I can assure you that it doesn't work that way! With a little conditioning and a yummy reward, almost all cats will tolerate testing....and most will start to look forward to it! China will come running when I start to get her testing supplies out because she knows she's going to get a yummy snack!

There are very few pain receptors in the edges of the ears....the one thing most cats don't like (at first) is that you're fooling with their ears at all, but desensitizing them is easy and soon they aren't paying any attention at all.

The Purina DM dry food is too high in carbs for a diabetic cat. Again, there's only 1 "prescription" food that's low enough and that's the canned DM....but most cats don't like it or get tired of it quickly and then refuse to eat it....and it's very expensive!! The majority of us here just feed Friskies pates, Fancy Feast Classics or 9-Lives pates and our cats are doing great on them

 

I have had 16 diabetic cats and only one has went into remission/not needing insulin

 

My wife and I want to home test, without a doubt. We just want guidance from the vet on how often to test. We even suggested to him that we do it three times a day, and he said overkill. We love our cat so much and seeing him not getting better (and his level getting higher with an increase of insulin) is really sad.

 

Unfortunately many vets are not well versed in feline diabetes and home testing.Testing should be done at a minimum before each shot and at least once between shots. If your vet had a diabetic child would they only test here and there? Of course not they would test before each shot and at least once in between each shot. So the same thing applies to our furkids.

 

I test each of my cats before each shot. I only tested between shots at the beginning for each cats and now only test between shots if I get abnormal BGs

 

Hi Rob,

Are you giving Kitty Lantus once or twice a day? I bolded a sentence in the quote above that makes me think you may only be giving one dose a day. Lantus is typically given twice a day - once every 12 hours as that is how it works best. If you can clarify, that will help some of the more experienced Lantus users give you advice.

 

Hi1 We are only giving him one shot a day.

 

Just a quick question. Do you guys test your cats blood levels before every shot you give?

I am doing the following test this weekend:
6PM last night was 353
6PM tonight
6AM tomorrow
Noon tomorrow
6PM tomorrow night

I hope that test can give my vet a better understanding.

 

no food two hours before testing. so 6am test then feed then injection. then another test 6-7 hours later. evening is same as morning. if you want to do a curve you test multiple times in a 12 hour period
i would print this and give it to your vet to read http://jfm.sagepub.com/content/17/3/235.full.pdf html

 

Hi Rob,

Unfortunately the last place you are likely to get real-world, practical advice on optimum testing frequency is from vets (with very rare exceptions). If I had followed the advice I got from vets about home BG testing being "unnecessary" or that it would "ruin the relationship" I have with my cat or "stress out" my cat then my cat would probably have died from too high a dose of insulin (set by .... yep! a vet) while I was asleep. Death by hypoglycaemia, or sickness due to chronic rebound hyperglycaemia would have done far, far more to "ruin the relationship" I have with my cat than a few ear pokes a day. I was forced to dose blind for the first couple of weeks of Saoirse's treatment and they were some of the worst weeks of my life. I was petrified that she would hypo and I wouldn't know. (Saoirse was very lethargic on Caninsulin - and my fears about not being able to spot a hypo were well-founded: she had a symptomatic hypo where I might have thought she was just tired had I not been home testing and caught the massive drop in her BG levels that triggered the hypo. That mid-cycle test saved her life.)

I am of the opinion that many vets think that cats, by default, will hate being tested because they and their staff often leave a lot to be desired when it comes to testing technique. I remember seeing the vet nurses trying to test Saoirse just after she was diagnosed and it was not a pretty sight. They were hovering over her like avenging angels and poking the wrong part of her ear; and my girl was terrified. We moved to a new practice not long after her Dx. Her now main vet has a diabetic cat himself and he gave me a testing tutorial. It was so straightforward and Saoirse was a lot calmer because he was so well practised in ear testing. Saoirse had a few grumbles with my first clumsy attempts at home, but we soon developed a routine that works for us. And our relationship? I will never ever forget the looks of utter love, complete trust, and real gratitude that Saoirse gave me while testing her when her insulin treatment started to make her feel better: she knew the testing was an intrinsic part of what was being done to help her get better. My efforts to help her feel well again - even the sharp and pointy bits - have intensified the bond between us, not weakened it.

It's good that your vet is giving you some support for home testing but I disagree with his take that three tests a day is over the top. On the contrary, I think it's the minimum requirement for safety in all cats who are newly diagnosed, not on a stable dose, or for whom there is very little test data. Once a cat's pattern of response to a particular dose of a given insulin is very well-established then preshot tests with occasional mid-cycle tests may suffice (as Larry mentions above).

You have a precious window of opportunity facing you at the moment: the best chance of getting your little one into diet-controlled remission is on a long-acting insulin and following the Tight Regulation Protocol (see attachment below). The minimum requirement for TR is 3 tests per day; 2 preshot, 1 mid-cycle. (For the group studied the average number of tests per day was 5.) TR may work for you, or it may not - but please give the document a read so that you'll be able to make a really well-informed decision about the treatment goals for your kitty. If you do decide to follow TR there is, of course, no guarantee of remission but it greatly increases the probability. Even if remission is not achieved, learning how to keep your cat tightly regulated safely will minimise the risk/impact of diabetic complications (e.g. neuropathy, CKD, impact of infections).

Even if you decide that TR is not for you and your kitty, regular mid-cycle BG testing (in addition to the AM and PM preshot tests) is the only way that you'll really find out exactly how your kitty is responding to the insulin and get the answers as to why his numbers are going up with the dose increases. Hand on heart, regular testing is probably the fastest route to helping your beloved boy feel better again.

I also echo Mary Ann's observation that human diabetics test their blood glucose levels before administering insulin to make sure it is safe. Why should things be any different for a diabetic cat?


Mogs
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It's up to you, not your vet, how many times you choose to test. More tests give you more data and allow for better control of blood glucose. The better control you have over his blood glucose, the more likely it is he will reach remission.

In order to get good control with Lantus, you must test at least 3x a day...once before each shot, and then a mid-cycle test to see how low their BG is dropping. However, it does help to get a few more tests in if you can when a cat is unregulated--it gives you a better picture if how the insulin is working and how the dose should be adjusted. If your goal is remission, you need to test this much. Chances of remission are not 100% as someone mentioned, but they are very close to it (80+%, with a low carb canned diet and dose adjustments via >3x daily testing). All four cats I have helped treat with Lantus have gone into remission and no longer needed insulin.

But not everyone's goal is remission, and some people simply aren't able for various reasons to test as frequently as needed to get tight control of BG. If that is the case, then testing minimally before each shot is needed, to make sure it is safe to give insulin.

 

I do not agree that three tests each day are necessary.
I can maintain my Badger and BunBun below 120 and I seldom take a BG between shots. I always take a preshot BG. BunBun is on 0,6 Levemir and Badger is on 0.5 Levemir and 0 to 0.2 N.

 

@RobC I'm a little late commenting here.

My vet told me to only test when I thought Smokey was acting funny. Now grant you Smokey was dx in 2010 but I only got him in 2014 after my mother became sick and I found out Smokey wasn't getting cared for.

Anyway, The night I found FDMB Smokey was hiding. At this point he was getting Vetsulin and his dry food was eliminated. When he didn't come to eat I dragged him out and tested. Well don't you know he was 34 I believe. Really really hypo. If it wasn't for FDMB that night Smokey probably would have died. Wish I could remember who stayed up and got us through the night.

The point is. Do I test now? ABSOLUTELY!!!! Before each insulin shot and before I go to bed. I usually get a test 3 hrs after shot in the morning because that is when it kicks in for Smokey. And I usually test anytime I walk out the door just in case I shouldn't walk out because he is dropping.

As much as we need the vets, they are not up to date in FD. Your vet DOESN'T have to know you test at home until you tell him. Then one day when you talk to him you mention I checked his BS and got xx. He probably won't even think twice that you did it.

Insulin can and does kill. Here is a post very recently of an accidental overdose because parent wasn't instructed to test.

http://www.felinediabetes.com/FDMB/threads/found-in-coma-in-the-morning-help.154669/

Please test and don't let this happen to you.

 

We will have to agree to disagree...without that mid cycle test it is much more difficult to see how the insulin is working to lower BG. If the dose is too high, it takes much more time for that to show up in the preshot numbers. Like I said, if your goal is remission, you need the third test. If your goal is not remission, you can get ok control with just the preshot numbers, but it is not going to be as tight.

 

I have no problem at all with periodic BG between shots but testing three times a day every day is overkill.

 

Here is how the tests panned out this weekend:
1 shot at 6AM each day of Lantus (3 units)

4/22 6PM: 353
4/23 6PM: 364
4/24 6AM: 209
4/24 NOON: 428
4/24 6PM: 376

I will speak with my vet to ask him what's next. How do these numbers look to you guys? It is weird to me that before his shot at 6AM he was 209 then after his shot 6 hours later he was 219 points higher!

 

Your only giving one shot a day?

 

Yes, I was told to give one shot a day.

 

Rob, Lantus is best every 12 hrs. Something to discuss with your vet. If you think about it, you give a shot then not again for 24 hrs.

Vets are not well versed in Lantus or FD. If I remember the product inserts states humans get it once a day. Your vet might be going by that. That also explains why the dose you are giving is getting raised, yet numbers are remaining high.

Discuss splitting the dose into 2 shots 12 hrs apart. You might see better results. If the vet doesn't agree I would consider splitting it anyway.

There is more data and people here with experience.

 

For people (or dogs) Lantus is often prescribed as a once a day shot. Kitties have a much higher metabolism and need to have the Lantus shots twice a day. Even many people need to do twice a day shots.

 

I don't believe so if the owner is willing to do it, and usually it's not that hard to get that one extra test. In my experience, it's very hard to reach remission without it. But again, it depends on what the goal is.


And I agree, you do need to do shots twice a day, cats have metabolisms that are twice as fast as people or dogs so the 24 hr insulins only last 12 hours. Please consider 2x dosing.

 

I know that I'm late to this party but I wanted to reaffirm what others have said about the dosing of Lantus twice a day.

It's important to get as close to 12 hours apart as possible. If work or something doesn't permit it then you can push one of the shots an hour late or shoot an hour early. I must also say firmly that it is very important to keep testing your cat before each injection, so that's a minimum of twice a day and in the beginning it is best to test somewhere in between the injections too. It can be easily 3 or 4 times a day and it's not overkill in the beginning (2 or 3 weeks usually). As you get your cat stabilized then you can move to testing only twice a day and hopefully you can get your kitty into remission. Too many vets tell people not to do it, my vet told me that I was torturing my cat by testing every 12 hours. You have to think about this though, sometimes humans inject several times a day and they test every single time, they get used to it and so will your cat. I know others have confessed this but I want to add that I too understand the utter frustration of all of this and it can really get to you at times. I have been balled up on the floor in tears ready to call all of it quits but I stuck it out. Once upon a time I was so scared of testing and injecting but now it's no big deal at all, I don't need to hold my cat down, he doesn't argue about the situation and sometimes he even jumps up on his spot because he knows that it's time (for a treat lol). And your cat doesn't hate you for this even though it can feel like it.

My biggest problem with testing was getting the blood sample and then I started using the sock and rice technique. I just microwave the sock with dry rice in it for about 10 seconds, then I hold his ear in one hand and just pet his ear with the warm sock. When I feel the ear get warm and see it start to turn pink from the blood flow then I know it's ready. I put the test strip in the machine, set it down and grab the sock again, I place the sock under his ear like you would with a cotton ball. The rice in the sock is firm so it makes a great brace against the ear so that it doesn't move while I use the lancet. Then it's quick, I get the drop and put it on the strip and I'm done. The longest part of it is warming up his ear, everything else takes 5 seconds at most. Once you get the hang of it, it will be like that for you too.

 

I too can relate to your dilemma and comedy of errors, my 16year old cat has just been diagnosed with diabetes again after a break of 18months. I used to feel like you the first time around that Puss would hate me and that I was hurting her. Its only been a couple of weeks again and I am sure she know what the routine again. I just warm Pusses ear with a warm cloth and then just prick the very edge of her ear with the pricker manually as I found this much easier than trying to use the lancet. We give her minced fresh fish ( low in carbs) she also has wheat free dry food as it is also low in carbs. Your cat will appreciate the effort you put in and know that you love him especially when he feels better. Puss is tested twice a day at the moment until she is stabilized.