Newly diagnosed and still at the vet

Hello,
My 14yr old cat Tucker was diagnosed with diabetes last Tuesday, and he's still at the vets. They tell me they still can't regulate his levels. Yesterday they were 50 in the morning, and 350 at night. Although I know nothing about cat diabetes from personal experience, I want to bring him home now. I have a glucose meter and bought a variety of wet food recommended online. Do you think he'd be better off with me monitoring his BG, or should I wait for the vet to release him back to me? 8 days seems way too long.
I have another cat at home, who's 10 yrs old. She has been changed over to wet food already. I've been practicing by checking her BG levels. (They're averaging about 50)
I miss my friend!

 

Are there any complications? Have they mentioned DKA or ketones? There are some complications with high blood sugar that are not treatable at home.

But in general, we don't think cats can be regulated at the vet. They are stressed with all the strange noises and people and may not be eating well. Stress raises glucose levels. Have you asked your vet if you test at home, can you do the monitoring and call in his numbers to the office daily?

 

I'm not aware of any complications. They sent his blood sample for testing and said there were no other problems. I asked if I could bring him home and monitor his levels. They said I could bring him home, IF I would bring him back in to the vet 2x a day for testing. I mentioned Tucker is probably stressed and that could affect his BG levels. They responded with "he's fine, quietly laying in the back of the kennel".
I think Tucker would be better off at home. I think I will tell the vet I will pick him up in the morning.

 

It is hard to challenge a vet, but it makes no sense to me that they need to test twice daily. He's your cat; you're the customer. Maybe take in your meter and show them you can test - compare your meter to theirs on the same sample of blood. (what meter are you using? People have had concerns with the "True" meters. If he uses the AlphaTrak, it will most likely read lower than yours, that's okay. We are looking for trends and patterns; a difference of thirty points is not important)

 

I have the ReliOn Micro glucose meter. I think we will have a meeting tomorrow, the Vet and I.
I have no problem taking my own health decisions into my hands. I guess I'm just nervous with my cat and going into unchartered waters! Thanks for the pep talk!

 

I am confused. Are they wanting to keep your kitty at the clinic until they regulate him?
If that is the case and there is no other condition they are treating him for, then this makes no sense (to me).

It looks like you have prepared yourself for treating his diabetes. Great job!

Unless I am missing something, I would go get my cat and bring him home! I might ask for a very, very, VERY good explanation as to why they insisted to keep my cat in unfamiliar surroundings and away from home for something that could be treated at home. I would also ask for a refund and kitties medical records.

Can we help you find a vet in your area who supports hometesting?

 

There is no reason for your cat to be at the vet for 8days unless the cat has some serious life threatening condition, and feline diabetes is certainly not what I call life threatening.

No animal is going to be regulated at a vet office, none.

I would contact the vet and inform the vet that you are picking up your cat and bringing him home today.
What insulin is the vet using? What sorts of dosing has been done?

Seriously, Chris, there is no reason for Tucker to be at the vet for so long. Your vet should have advised you about Tucker being diabetic and told you about giving insulin shots and how to home test. Some cats take weeks and months to become regulated so your money is being wasted by your poor Tucker stuck at the vet, with both of you unhappy. Stress alone could be keeping Tucker's numbers high - the majority of cats test higher at the vet office then return to lower numbers when they get back home.

Call the vet and say you are coming to pick up Tucker and the prescription for insulin - you would do well with Lantus or Levemir - and you can hometest just fine so there is no reason for your vet to deny your taking YOUR cat home. You do NOT have to take your cat to the office to be tested 2x a day; that's ridiculous. I would not wait till tomorrow.

 

Thanks everyone for the support and information. I will be off to pick Tucker up first thing in the morning!

 

Great to hear you are picking Tucker up in the morning.
Be sure to get copies of all test results, and get a copy of their notes that contain all of the testing the vet has been doing on Tucker's BG.

I am sure that Tucker is going to be so very happy to see you and to come home where he belongs.

 

and if you do ask for a RX for lantus or levemir, ask for the pens, not the bottles. initial cost is more but these last a lot longer than the bottle. it is 5 pens

 

I've found it helps to show up to the vet armed with information; here are the American Animal Hospital Association guidelines that your vet should be referring to: http://www.aahanet.org/PublicDocuments/AAHADiabetesGuidelines.pdf.
Note p. 218 (4), where it says "Precautions and Details." and explains that home testing is easier and more accurate, and should be strongly encouraged by the vet. It also gives insulin recommendations (Levemir (detemir) works about the same as Lantus (glargine) even though it's not mentioned here, so that is also a recommended insulin). And it also states that IF a vet decides to monitor a cat the first day of insulin (optional since numbers will be stress inflated anyway), after that one day the cat should be treated as an outpatient.

If your cat has been there for 8 days trying to get "regulated", then this shows that your vet does not understand how feline diabetes treatment works, and it actually makes me terrified for your cat that they are increasing the insulin dose there too much too quickly in an attempt to "regulate" him (which is NOT going to happen at the vets office--it usually takes weeks or months to regulate a cat, and you simply can't do it in a stressed environment feeding the wrong diet). It took two months to get Bandit regulated, and 4 months to get Sydney regulated. Also, they may have decided with their stress-inflated testing that your cat needs to be on a large dose of insulin--keep in mind that once you get home and feed Tucker the recommended low carb, canned diet, giving a large dose of insulin can cause a deadly hypoglycemic incident. You want to start with a low dose, around 1u. Do NOT accept a script for Humulin N (NPH) insulin. While good for dogs, this insulin is dangerous and mostly ineffective in cats.

 

Thanks everyone for all the helpful information. I have an appointment at 4 today to meet with my vet and discuss everything. Tucker is comming home with me today! I've printed up the "AAHA Diabetes Management Guidelines" to give to the vet.

 

If your vet is not receptive to this information, do not be intimidated or let him dictate to you. There are many vets who are in alignment with the views expressed on this board and willing to let you be a partner in your pet's care. If you tell us where you are from, members in your area can give you recommendations for vets, if you need them. Once you find a vet who specializes (or is fully knowledgeable in feline diabetes care), your vet expenses will be dramatically lower. I changed from my first vet (after racking up a lot of bills) and could not be happier.

Also...I would say that BEFORE you inject your cat with insulin at home, get the input from the experts on this board (not me) on the dosage. Many inexperienced vets start too high and this causes high fluctuations in the blood glucose numbers -- sending the blood glucose very low and then rebounding to high numbers. And that may be exactly what is happening at the vet based on what you describe above...very low numbers and then very high numbers. But the experts on this board will be able to guide you -- in conjunction with your current vet (if he/she is receptive) or your new vet in the event that he/she is not. Above all remember the motto of the board is "start LOW (related to the insulin dose) and go slow."

You will be fine. This is not as hard as it looks at first -- and the kind folks here will guide you every step of the way.

 

Tucker is happily sitting in my lap purring and giving me kisses, BUT I'm a bit confused !!!!
The vet has him on 6 units of Humilin, at 8:30am and pm. He said his most recent highs and lows were 90 and 130.
I tested him when I got home at 5pm and his BG was 78. He ate some canned food, and spent an hour cleaning himself.
I tested him 2 hrs after eating and his BG was 51. Had me nervous, so I tested him again at 8:30 and his BG was 54.
I don't plan on giving him his 8:30pm dose....

I asked the vet why he was using Humulin and not pro zinc. He said there is a shortage of pro zinc and he can't get the proper amount of it that he needs. He didn't want to start Tucker on it, and then have to switch insulin types.

Should I skip this eves dose?

 

Absolutely! So glad you are testing! Those are non diabetic numbers. We tell new diabetics not to shoot under 200.

 

Yes, by all means! You do not want to give insulin to a cat when they have a BG of 51!

When is the last time they gave insulin?

Give them a call tomorrow and ask them for a prescription of Lantus.

Did you get an explanation for why they kept your cat?

 

I wanted to get that out fast.

But seriously, your vet is frightening. Why would he be giving 6 units of any insulin to a new diabetic whose numbers were in the near normal range? Much less a harsh insulin like Humulin. We suggest starting at .5 to one unit and increasing slowly by small amounts. 6 units of insulin is a huge amount!

If I were you, I would continue to test and record the numbers. Meanwhile, I would be looking for a new vet. This advice could have easily killed your cat, if you just had given the insulin and hadn't been testing. You may not need insulin if he stays in these ranges.

 

They gave him the last shot at 8:30 this morning.
The vet told me Tuckers levels went all over the board, going into the 400's and then fell into the 50s a few times. That worried him, and he wanted to keep him until it leveled out more.

 

That doesn't make sense to me. One, Humulin is not likely to give level cycles to any cat, at any dose. It is a harsh insulin that has a rapid onset and doesn't last long. And anytime a cat goes down into the 40-50 range with a harsh insulin, it is logical to lower the dose, not raise it. A vet should realize that the numbers he gets at his office will likely be unreliable. That's why FD specialist vets endorse home testing.

I'm just glad you are testing at home. Keep it up and if he goes above 200, then you'll need to explore a better insulin and I would say, a better vet. Truly, if you had given 6 units at 54, your cat would have hypoed.

 

Chris-
In all seriousness, it would be a really good idea to look for other vets in your area who use Lantus or PZI, and encourage (or at least approve of) hometesting. If you let us know what area you are in, we can probably find someone on the board with recommendations.

Were you able to get copies of the records so you know when they took tests, what the BG's were, insulin increase dates, type of food fed/when, etc. These are going to be important for you to have whether you treat at home on your own, or partner with another vet.

We don't mean to be harsh. So often we see vets with little knowledge of current diabetes research, protocols, and tx. On the flipside, there are just as many out there who will work with you to do what is best for your cat.

I am glad your cat is home. I'm sure you are both thrilled (I would be!). I think you will both sleep better by each others sides tonight.

I think Sue's idea to continue testing is a good idea. I would hold off on insulin a few cycles, depending on where the numbers go. Ask the vet for a lantus pen prescription. I definitely would reconsider shooting 6u no matter how high his BG until things get sorted out.

 

It didn't make sense to me for the BG levels to go down after eating either, especially almost 9 hours after he was injected at the vet.
Also, Tucker seems to be drinking a lot of water. I might be paranoid....
I live in Parkersburg, WV. Anyone know of a good vet?

 

Hi Chris- I started a post on this forum to alert any members who may know.
http://www.felinediabetes.com/FDMB/viewtopic.php?f=28&t=75747

I'm also asking around in other places.

 

If the numbers go down after eating, it can mean the pancreas is working. This is a good sign!

What larger town is it near or what section of WVA? I sent a pm to Barbara and Thumper in VA. Maybe they know someone in WVa...

 

Well, Charleston, WV is a little over an hour away. Marietta, Ohio is 30 minutes. Columbus , Ohio about 1 1/2 hrs.

 

Last night I checked Tuckers BG at 11:30PM and it was 68.
This morning at 7AM he tested at 219. Should I hold off on the 8:30AM injection ? Or do I give him a smaller dose?

 

Hi, Chris. I'm from Athens WV. I'm a little too far away to give vet advice, but I thought I'd pop in and say "hi."

I'm glad you brought Tucker home. Sounds like you're on track with feeding and home testing. I don't know much about Humilin, but from what I've heard it's not really a good choice for kitties. It hits fast and hard, then wears out quickly. My boy, Cassie, is on Prozinc, and i haven't had trouble getting ahold of it (of course, one vial last 4-5 months, so maybe I've been lucky). 6u is probably too high. If you're going to be around to keep an eye on things, you may want to try a reduced dose of 1u to see what it does. Check every 3-4 hours and see how low Tucker has dropped. Once you have some sort of idea how he responds to that dose we can find one that works.

 

Thanks Bookw0rm. I need to go to work, so I think I'll NOT dose him this morning.
I hope to find a good local vet to change to a better insulin for Tucker soon.

 

Argggh. Your vet did exactly what I was afraid they were doing, which was use the wrong insulin, not understand how the cat's pancreas works, and then seriously overdose him. Giving 6u of Humulin N in the first week of treatment is insane, and you're lucky your vet didn't kill your cat. I would NOT go back to that vet or take any advice from them for anything concerning his diabetes. If you want, you can try and educate them if they are willing, but with someone that far behind you would be doing all the teaching.

When a cat drops into low blood sugar, their pancreas will release a hormone called glucagon--this is like the opposite of insulin. It tells the liver to release glucose into their blood stream to counteract the low blood sugar. So the more a cat is overdosed and dropping into low numbers, the more their numbers will bounce back up and hit very high numbers. This keeps happening until eventually the pancreas can no longer keep up with the low blood sugar, and you have a severe and potentially deadly hypo incident. That your vet does not know this and kept increasing the dose despite seeing very low numbers is simply unacceptable and very dangerous, in my opinion. You certainly did the right thing NOT giving him insulin once you got home. considering that those very low numbers at the vet were stress inflated already, giving a dose like that at home once your cat relaxed and his blood sugar had lowered some would not have ended well.

Here's the dosing protocol for Humulin N: http://www.uq.edu.au/ccah/docs/diabetesinfo/link2.pdf. Note where it says "Lente [Vetsulin] is the 3rd insulin of choice and NPH [Humulin N] the 4th of choice insulin for control of diabetes mellitus in cats, behind glargine [Lantus] or detemir [Levemir] (1st choice) and PZI (2nd choice), Lente and NPH result in lower remission rates compared to longer acting insulins." Also note that it states the dose is not to exceed 1u for the first week, and not raised by more than 1u every two weeks.

However, I would get a different insulin ASAP. Humulin N has a very low remission rate and is pretty ineffective in cats because of it's poor duration of action with cats' faster metabolisms. Call around to other vets in your area and ask if they prescribe Lantus, and/or say you have a diabetic cat that's already been diagnosed by another vet and you want to switch to Lantus. You should be able to find someone who'll be able to get you the script.

Here's an article that you can also bring to your or a new vet to get the prescription, if you encounter some resistance.


Here's a link to the dosing protocol for Lantus that's outlined in the article, which has the very high remission rate: http://www.uq.edu.au/ccah/docs/diabetesinfo/link4.pdf. This is very useful information to have because some vets can be great in most aspects of treatment, and then not know how to correctly dose the insulin in cats (many want to raise the dose too much to quickly, albeit not at the same insane rate your current vet did).

Sorry if this post sounds a little rant-ish. Most vets don't know every single detail of diabetes treatment with cats, so it's very common for diabetic cat owners to stray from their vet's advice once they've educated themselves. Vets are general practitioners that must know many general things about many different diseases for many different animals, so it's unrealistic to expect every vet to get feline diabetes treatment perfect. As long as the vet is fine with you taking charge of your own cat's treatment a bit (and many vets welcome and encourage this), then getting something wrong is not necessarily a reason to leave your vet. However, given the dangerous nature of your vet's treatment, I would not only leave, I would make them very aware of exactly why I was leaving, because it might just save the life of the next diabetic cat that shows up at their office. I'd also put up a huge stink about the bill for keeping your cat and subjecting it to their "treatment" for eight entire days. If you've paid the bill already, I would demand at least a partial refund--what they did is ridiculous.

 

When I checked his BG at 8:30am it was 235. I decided to stay home and give Tucker a 1 unit dose.
He was very active and ate well. I checked his BG at noon and it was 24 ! Quickly gave him a gravy pouch of food and retested an hour later at 56. He's very alert, tail wagging and walks without a problem. Just pooped in his litter pan too! (found out he didn't last night, and pooped on the carpet twice) Not sure where he's peeing. Sophie the 10yr old maine coon is growling and hissing at Tucker anytime he gets near her. I guess she liked being #1 cat for a week.

The vet is out of the office till tonight. I talked with the assistant and explained I want to switch Tuckers insulin to Lantus, and for the vet to call me back.
Should I have them order the vial or pens? Are they very expensive? ..or should I ask for Pro Zinc from another vet? (mine can't get enough )
Thanks Julia and Bandit, Sue and Oliver, Carolyn and Latte, MelanieP and Ninja.... and everyone else.
I keep rereading the info, hoping it sinks into my head!

 

Chris: The BG of 24 you got today is an EMERGENCY! You need some expert eyes on the insulin and dose moving forward. I would tell you that you never give insulin or increase the dosage based on one BG test (though it is hard not to have that knee-jerk reaction to give insulin when you see a high number). It just doesn't work like that. Tucker's BG of 235 this morning could have been high because his BG fell low yesterday (sometimes their body releases glucose to combat the low BG due to insulin) and had you not stayed home to watch Tucker, it would have been a hypo situation (with a BG of 24!). Julia explained this nicely in her post from earlier today.

Experts: Should Chris discontinue the Humulin and wait to see what Tucker's numbers look like for a day or two before starting Lantus (this is assuming his vet will give him a prescription for Lantus)? I ask that because he got some pretty low numbers last night and dangerous numbers today (24 on 1 unit); and if Chris is planning to switch insulins, would you not want to get a feel for what Tucker's BG is going naturally (since he is swinging so wildly on just 1 unit of this Humulin)?

Chris, this is not a recommendation, it is a question for the experts here. They need to guide you on what to do today, tomorrow, and how to safely switch to the Lantus or other insulin. I would advise you to do NOTHING with the insulin until someone here provides guidance, and continue to check Tucker's BG levels.

As to the cost of Lantus, I use it and it is expensive -- something like $120 for a vial + the syringes (you have to use U100 syringes with this insulin) -- but the good news is that the vial can last up to 6 months if properly refrigerated and handled -- so over time, the cost is not that much.

PS: You might want to attach the 911 icon above to your post, as numbers like you got today are an emergency. You will get more responses that way. PS: You handled the hypo numbers like a pro!

 

Hi MelanieP,
I was worried about not giving his 1st home dose last night, and really questioned not giving a dose again this morning. I can't believe it dropped that low with only 1 unit. I called the gluco-meter company to send me a "control" sample, just to make sure it is working properly.
What would you have done with a BG of 235 ? Is there a reference chart I could study as to levels?
Yesterday I felt good making the decision not to give the evening dose of 6 units, which probably would have killed him.
Yet today, with 1 unit, I could have killed him. I'm a wreck.... he had no symptoms at a BG of 24.

He's eating wet canned food only now. No dry at all. Not the DM food the vet was. Maybe that's causing the swings?
The cost of Lantus would be doable for me. Are pens better value overall?
How often should I be checking Tuckers BG levels? He's patient with me not always getting it right and having to redo it. Poor thing will have sore ears!
I normally work 8:30-5, plus a lot of evenings and weekends. This will be tough.....

 

I did a google search and it looks like there's a VCA hospital near you:http://www.vcahospitals.com/dudley-avenue. Your first exam is free, and I'm pretty sure that VCA requires that their vets remain currrent, and I know that all vets at VCA near me (in Syracuse, NY) prescribes Lantus, and recommends hometesting (they may try to sell you an alphatrak pet meter, but you just say no thank you. We all use human meters and they work just fine since all the dosing protocols are written for human meters anyway). I could be mistaken, but I believe that treatment guidelines are the same for VCAs throughout the country, but I would call or make an appt. (since it's free anyway), and talk to them about Lantus. Go armed with information, as well as your cat's records.

If that doesn't work, I would just start calling Parkersburg vets near you and ask them if they prescribe Lantus or Levemir to any of their diabetic cats, and if they support home testing (If they say yes, but we want you to buy the Alpha trak, that's fine--you can just tell them once you get theere you're already home testing with your human meter. Vets make $ off the Alphatrak so some vets push them). When you get a vet that says yes and yes, make an appointment. Parkersburg is big enough that I am sure there is a good vet somewhere in town. It just may take several phone calls to find them.

Lantus and Levemir have the best remission rates in cats, so I would start with one of those. Get a script for the pens, because even though they are more expensive up front, they save you a ton in the long run because you use almost every last drop of insulin. They'll last you at least 6 months, but more likely a year or more. A 10 ml vial will go bad before you can use it all up. Do not get the needle tips that come with the pens, get script from the vet for .3cc, 5/16", 31-33g syringes with half unit markings. You can get a box of 100 at Walmart for about $13 bucks. Walmart or Costco pharmacies usually have the cheapest prices on insulin, too.

Here's the link to $25 off coupons for Lantus or Levemir pens, whatever you get: http://felinediabetes.com/FDMB/viewtopic.php?f=15&t=36964. Lantus makes you fill out a questionnaire now before you can print the coupon, just fill it out in your name but you can answer with your cat's info (for example, feline diabetes is close to type II) and use it anyway. There's nothing that restricts it from being used with veterinary scripts.

 

Yes 24 is a hypo situation! Keep checking his BG. Do you have any higher carb (gravy) canned foods at your house? Can you run out very quickly and get some? What about karo syrup or honey, or perhaps some high carb treats? You want to boost his blood sugar and get it back into a normal range. Luckily, Humulin N wears off quickly (within 4-6 hours).

You may want to test him for a few days on the low carb diet before giving any insulin at all. About 25% of cats go into remission from diet change alone. Also, I'm pretty sure your cat had several hypo incidents at the vet--after a hypo incident cats are often very, very sensitive to insulin.

 

What would I have done? Based on Tucker's numbers last night of 78 and 51, when I saw the the spike this morning of 235, I would probably have given him nothing (particularly since the Humulin driven numbers are kind of meaningless anyway). Tucker's numbers have been fluctuating so wildly -- even on 1 unit, and as Julia pointed out, Humulin is not a good insulin for cats anyway. Julia is an expert so I hope she will read this and post again to give you guidance. There are many other experts who will probably check the board throughout the afternoon or maybe this evening (after work). If it were my cat, I would give no insulin for a day or two just to see where the real BG numbers are. If you were switching from any other insulin than the Humulin, you might be able to estimate this -- but it seems to me that the Humulin fuled BG numbers are worse than NO numbers on which to base a starting dose. Do you think your vet will prescribe Lantus for you? If so, that will be a very positive step forward.

Until you hear from the experts on this though...do not give more insulin. Honestly Chris, I have seen, just in the last month when someone's cat goes into hypo BG numbers -- like Tucker did today -- that assuming the cat doesn't die from this, sometimes they come out the other end not needing any insulin at all. Strange but I have seen it happen here recently. NOT something anyone would want to risk intentionally; but what I am telling you is that Tucker's insulin needs may have been greatly diminished by what happened today -- so give NOTHING until you hear from experts like Julia or others.

 

Chris: Based on what Julia is saying above, assuming you gave the Humulin this morning at 8:30 EST, you should be out of the danger zone so you would not need to keep feeding high carb foods. Is that right Julia?

J

 

Excellent....Julia posted while I was still writing! Chris, as you see she recommends trying Tucker on a low carb diet with no insulin for a few days and checking his BG levels. That way you can see if he still needs insulin at all...and if so, what level will work best for him. I agree with Julia about getting in to see a vet who routinely prescribes Lantus and is supportive of hometesting. You might want to delay picking up your prescription of Lantus for a day or two -- on the off chance that Tucker may not (paws crossed) need it anymore. Might save you a few bucks.

Julia, you are the BEST!!!!!!!!

 

Sorry, I guess I am confused--he does not have a BG of 24 right now, but it was 24 earlier today? How long ago?

I would wait 5-7 days and keep testing a few times a day before giving any more insulin. As I mentioned, about 25% of cats go into spontaneous remission from diet alone, and on top of that your cat is probably sensitive to insulin from the probable hypoglycemia at the vet.

If you see numbers start to creep up into mostly the 200+ range, then you might want to start insulin (I would get that script for Lantus, but wait to fill it until you're sure he needs it).

You don't want to give insulin based on one higher number; when a cat goes to low, their blood glucose will spike afterwards. You need to get several tests throughout the day, and see what the overall picture is.

How is Tucker's weight? Is he overweight/underweight at all? That can make a difference in how long you try diet change before starting insulin.

 

OK, the 24 was about 3.5 hours after the 1u dose, and an hour later (after feeding) he was at 56? You do need to check again to make sure he isn't dropping back down. Humulin usually peaks by +4 after the shot, but you don't have a long enough history with Humulin to know that for sure. If you see a lower number than 56, feed him some more. If he'll be satisfied with just the gravy you can give him that (that's where most of the carbs are) so that his belly doesn't fill up too much.

Carl

 

fwiw, i wouldn't do anything for the next couple days. don't contact the vet, don't order any other insulin, and don't give any insulin. kitty has been overdosed now for at least 8 days. their body is freaking out. that is what is causing the swings in the numbers. i would just feed and spot check for a couple days and let kitty's body calm down, readjust, and go from there. if let's say, you do nothing with insulin for the rest of today and tomorrow and late saturday/sunday he's sky high (300+) then i might contact the vet about getting a prescription for lantus and then start on a miniscule dose, probably 0.25 to 0.5 unit twice a day.

you're probably gonna see higher numbers again today but that is to be expected from dropping way too low today. the body will try to save itself. whatever you do, don't react by shooting more insulin.

if by chance the diet change was enough and the numbers don't climb back up over the weekend, you won't have to get any insulin at all

 

Great advice from Julia and Cindy. And if you do end up needing insulin, I would agree - go with Lantus or Levemir. Get tje 'scrip now so you can pick it up quickly if you end up needing it.
There is a current shortage of Prozinc and you would probably have a hard time finding it.

Carl

 

Julia: Chris said it was 24 around noon EST; he fed gravy meal and got it up to 56 at 1pm. Original shot was 8:30 am. So I think he weathered the hypo ok, but was concerned that he needed expert guidance about discontinuing the Humulin and how to get started on the Lantus. As I told Chris, if it were my cat I would just stop the Humulin immediately...but wanted to get expert opinions on that since I don't really know. But I think the recommendation to stop insulin for a few days and see what the levels look like naturally makes sense. Thanks again!

 

Here's a link that tells you how to set up a spreadsheet to keep track of his numbers (like you see in many of our signatures): http://felinediabetes.com/FDMB/viewtopic.php?f=6&t=18207

When you get a chance, set one up and post it in your signature. It's incredibly helpful not only in letting you visualize your data, but also in putting in a form that makes it easy for people here on the boards to give you dosing advice.

All I have to say, thank goodness you were so proactive in educating yourself while Tucker was at the vet.

 

Chris: Make note of these names -- the diabetes cavalry, so to speak -- Julia & Bandit, Carl & Bob in SC, Cindy + Mousie, and many others -- are all experts at this and can give you good solid advice moving forward. You can send them a private message if you need to (the PM button to the right of the name) or if you have an emergency, just post here using the 911 icon and they will swoop in to help you. Just like the cavalry. Thanks guys!!!!!!!!!!!!!!

 

I just checked Tuckers BG and it's 110.
Earlier with the 24BG at noon, I gave him a foil package of a gravy food. He has eaten some Classic FF that I put out since then too. My Maine coon was hungry.....

It helps not feeling totally alone in this situation... Thanks all

 

Good. The 110 indicates the worst is over and he's back into safer numbers.

Carl

And now that you joined the board, "alone" isn't going to happen again. :smile:

 

you're definitely out of the woods today so no need for more gravy or karo

that number may be up due to the gravy so it might drop back down a little as the effects of the gravy wears off. it very well could continue up a bit though due to the body kicking out it's reserves to protect itself. just tell Tucker it's ok, you guys are taking the day off, take a deep breath and enjoy the rest of the day.

 

Don't forget to check BG readings over the next few days and update your post daily to provide Tucker's BG readings without any insulin. That way the experts can guide you on next steps. I can help you set up a spreadsheet if you'd like. Just send me a PM.

Melanie

 

I will keep Tucker off the insulin until further notice. I will try and get to the spreadsheet to fill in numbers. I have a big work project to work on, so I might just post his BG numbers.
I will call the VCA Animal Hospital as suggested, just to check about the Lantus availability. They're pretty close.
Thanks again to ALL !! I think I need a nap....

 

OK.... Tuckers BG at 6PM was 223. At 9PM tonight it's 406. I tried to put together the SS, so I hope that helps.
From what you guys taught me, this high spike is expected after the very low BG this morning.
Tomorrow morning hopefully it's a bit down?

 

Could be a bounce, but hard to know with Humulin. I would wait to give insulin because his numbers are just so volatile right now. if his pancreas is working, a little food might bring the numbers down.

But I would test for ketones to keep him safe.

http://petdiabetes.wikia.com/wiki/Ketoacidosis

 

Chris: Great job getting that spreadsheet together! That's exactly what the experts need to see. Keep using the spreadsheet and in a few days (or sooner if you are feeling anxious about it) update your post to ask for input from the cavalry. Julia suggested waiting approximately 5 to 7 days without insulin before deciding whether or not to start Tucker on the Lantus. If you are feeling anxious prior to then or see some alarming numbers, free to ask for intermediate feedback from the experts about how they feel the numbers are trending - and if you need to change the current plan.

As Carl suggested earlier, if a vet will give it to you, you might want to go ahead and get the prescription for Lantus -- but don't pick it up yet. Would be good to have it available for pickup at the pharmacy if it turns out you need it after all. And continue to feed the low carb wet food only (no access to dry). I think that is the plan recommended by the experts earlier today.

PS: I am from West Virginia too (born in Morgantown) though now I live in Gainesville Florida. You are doing a phenomenal job at this!

 

Thanks Sue. He's been eating very well. Almost too much I think. But of course I can't tell for sure since he's off the dry food. He ate that as he wanted all day long.

Thanks Melanie. I will try and get that prescription and have it ready for pick up like you say.
I hope I can sleep through the nite. His BG levels will be on my mind.
I'm putting my trust in the good people on here!

 

Sue, I guess I just have to calm down. I checked the BG at 11PM and it was down a bit to 385.
Thanks everyone for helping me through an emotional day....

 

Man, baptism by fire! You poor thing. By the way here's a link in case your cat ever gets low BGs again: http://www.felinediabetes.com/FDMB/viewtopic.php?f=28&t=15887 You may want to print this out and put it in a place you can get to it quickly. That's what most of us here do. I can't believe you had a 24! Glad you kittie is doing better.

 

Chris: You really don't need to lose sleep over this. In fact, since you are giving him no insulin for a couple of days, this is the time to relax as little (though continue to test). In the beginning, almost all cats spike high (mine was in the 500's for more days than I care to remember). Diabetes is a disease that harms your cat slowly. While you want to bring Tucker into regulation as soon as possible, a few days of high numbers is nothing to fret about. The experts feel you need to let Tucker's system clear itself out from all the Humulin and stress of high and low BGs over the last few weeks so they can guide you properly on a starting dose of Lantus, if needed.

I know it's hard not to worry, but seriously, Tucker will be fine. Get some sleep.

 

Thanks Melanie. I needed to hear the #s. At least Tucker is eating well.
Poor Sophie, the maine coon, is still growling everytime Tucker is near, and hiding under the bed. She's not been eating as well. She actually comes into the kitchen and if she sees Tucker, turns around and leaves. She has to be hungry! I know she wants her kibble. She's a big girl at 20 pounds.
My kitchen counter is full of different canned foods, like a test kitchen! I mark the cans with a "Y" or "N" depending if the cats like it. I did find out they love the Shrimp!
Well, it's time to call around and check which vet uses Lantus.

 

Did Sophie and Tucker get along fine before his vet stay? Maybe if you pay extra attention to Sophie, she will calm down (maybe she feels Tucker is stealing her thunder..LOL!!). As to feeding Sophie kibble, the collective opinion of the folks here is that she would be much better off eating wet food (any wet food) over the dry, though low carb would be best for her too -- so that she and Tucker should roughly be eating the same thing. Here's a good article from a feline nutrition expert (and veterinarian) explaining why: http://www.catinfo.org/

I am soooo with you on the "test kitchen" with the Y and N. My non-diabetic cat decided yesterday that Fancy Feast is no longer to her liking and wouldn't eat all day -- until I went to PetSmart and got her different food. I solicited input from the folks on this board (see topic "Need your Top 5 Food Recommendations") so those recommendations might help you as well. I might also add that what my princess does not like at 6 am, may seem delicious to her at 10 am -- so you can't judge within the first hour. Sometimes they just aren't hungry (and it isn't necessarily the food).

 

The Vet assistant just called and said they have a prescrition for Lantus ready for me!
What type of needle is used? U40 or U 100? She said usually they use U40 for cats...... I want to make sure I get everything I need!

 

U100 for sure, and get the syringes that hold 30 units or less of product. My original vet gave me U100 syringes that held 100 units -- and it was very difficult to dose on the smaller amounts (markings too small to see). Again, just pick up the prescription but don't fill it for now until the experts advise on next steps. Mine are Walgreen's brand .3ML, 31 gauge needle, 5/16" needle length, U-100 syringes for 30 units or less. They're about $16 for 100 (if I am remembering correctly).

 

Thanks Melanie....... I want to be ready just in case I need to fill the prescription!

 

MAke sure the needles have 1/2 unit markings on it. they may even have a choice of short or long needles. Personally, I prefer the short needles. Ask the pharmacist and double check before you leave.

FYI - Walmart sells the syringes for about $13/box of 100.

 

Will do Hilary. Thanks

 

Aww, poor Sophie can smell the vet smell on him!

 

Just popping in to check on Tucker; looks like you had an interesting day yesterday. I'm glad you decided to wait and see what his numbers look like without insulin for a few days. With that kind of dramatic drop there's not telling what he went through at the the vet.

You definitely want U100 needles (w/ half unit markings) with lantus; in WV you shouldn't need a prescription for the syringes, although last time I went to Walmart they made me fill out some info (like buying sudafed). Same for test strips--you should be able to get them OTC as well, although you may have to ask at the pharmacy.

Good luck with the lantus if you end up needing it. I'll keep an eye out on your thread until you're settled.

 

WOW on yesterday! :shock:
Sounds like you are developing a plan (watch and wait...intervene with lantus if BG's start getting consistently high).

I think someone suggested, but you may want to wait on picking up the lantus until you know for sure your little guy is going to need the insulin. Sounds like the diet change is making a big difference already.

What kind of numbers are you getting today? How is Tucker feeling?

And yes, as Dale implied....Sophie is growling and irritated because Tucker has a new smell on him...THE VET! Kitties don't like the vet. :lol: I have never dealt with 2 cats in the household, so I am not sure if there is anything you can do to help or if they just get over it. Maybe someone else can answer that for you.

 

Tuckers numbers today are: 8AM - 431 , 12 noon - 362, 3PM - 400

He's acting pretty normal, except for using Sophies hiding spaces! She is not amused.... I
His appetite is good. Sleeps a normal amount. Pooped in the litter pan. Peed in the corner of the livingroom.(ugh!)
I have to feed Sophie in a different room since she likes Gravy sensations, and Tucker will push her away from the bowl to get at it.(I don't let him eat that now)
He's really good about getting his ears pricked. Doesn't bother him at all, and even stays in my lap afterwards.
Maybe I'll give Tucker a bath to devetsmell him....NOT!

 

Maybe you could apply a few drops of "Eau de Gravy Sensations" behind Tucker's ears since it is Sophie's favorite. She might like him better then. LOL!! Seriously...you could try what they advise when introducing a new cat to the household -- get a towel and rub Sophie down (to get her scent on the towel), then rub that on Tucker (transferring smells). You could also try treating Sophie when Tucker is in the room - so she associates his presence with something good. Another thing you could try is to play with them both together... like a string type toy that they can both chase. Or...if Sophie likes capnip you could try crushing and rubbing a little of that in Tuckers fur. Never tried that one but who knows??

 

Well geeesh! I did not realize you had a spreadsheet when i asked what kind of numbers Tucker was having! ohmygod_smile
Sorry about that! :?

I'm not sure if anyone has sent you the links to information about Lantus. Here they are, just in case. Might be good to start reading up on how it works, how to handle it, protocol, etc.
New to the Group:
http://www.felinediabetes.com/FDMB/viewtopic.php?f=9&t=18139

TIght Regulation Protocol (I think there is information on Start Low/Go slow, too):
http://www.felinediabetes.com/FDMB/viewtopic.php?f=9&t=1581

Info, Proper Handling, Storage
http://www.felinediabetes.com/FDMB/viewtopic.php?f=9&t=151

Insulin Depot/Storage Shed
http://www.felinediabetes.com/FDMB/viewtopic.php?f=9&t=150

Shooting/Handling Low Numbers
http://www.felinediabetes.com/FDMB/viewtopic.php?f=9&t=147

It's a lot of reading and takes time to digest. But its good to get started on it, if you have not already. :mrgreen:

One other thing, while you are waiting to start the insulin, if numbers are high it would be a good idea to test for ketones. You can get a box of what are called "ketostix" at most pharmacies. You want to try and catch Tucker urinating mid stream.

Maybe once you decide to get the lantus (or even now), start a new post asking for help with any questions you have pertaining the insulin. :mrgreen:

I'm so glad you are here and that Tucker is safe (and happy).

 

Thanks for the reading info. It makes more and more sense everytime I read some of the articles or posts.
I've been brushing both cats with the same comb, hopefully mixing their smells. I can't say they loved each other the past 10 years. It's more like Tucker is in charge, and Sophie just takes it. Tucker likes to be loved and in my lap all the time. Sophie is the independant big girl, occasionally in my lap on her terms. They mostly live seperate lives in the same house... This new attitude from Sophie is interesting.

10PM BG is 405. Goodnight all and thanks for the support.

 

Chris: I see you started your Lantus today at 1 unit! I hope it will go much better than the Humulin for you. Keep an eye on Tucker's numbers and be careful about dosing tomorrow morning if his preshot BG numbers are under 200. Sometimes it takes a while to determine the right dose. You can always post here if you have any questions and the more experienced members will guide you. Good luck!!!

 

Thanks Melanie! His BG is 65 right now. Gave him a teaspoon of gravy...... we'll see

 

You are now at +5, is that correct? If so, his number could still go lower. Hopefully the more experienced members will jump in here to comment, but it seems like you are on track with the gravy. Also, let them advise you about the dose for tomorrow morning, as your starting dose of 1 unit may be too much for Tucker (after his ordeal with the Humulin and low BGs from last week.

 

Yes, +5. I'll be checking him again shortly. Have more gravy and syrup ready if needed.

 

Have you been reading the other thread from tonight "BJs Rough Start"? He had a similar situation, so there is some good advice on that string as well. But hopefully the more experienced folks will be along shortly to assist.

 

Yes, I saw BJ's Rough Start.....oh boy
I just tested Tucker it's +5.5=76
The spreadsheet is not letting me enter it. Showing error

 

Not sure I understand the +11.5 -- you're saying at 11:30 the BG was 76 and that this is a +5 reading (more or less...that you gave the shot at 6pm). Is that correct? That's good, maybe a result of the gravy.

 

Sorry, getting confused. It should be +5.5

 

I understand. Hillary will be along shortly to advise how much longer you will need to test, if at all

 

I started a new thread on the Lantus site. "Tucker now on Lantus"
I doing OK with him tonight. Will keep checking his BGs. Thanks.

 

ok doing good here - get another test in 30 minutes and let's see if it continues to rise.

if it doesn't - then 2 teaspoons of gravy and test in 30 minutes

as for the ss - not sure what the problem is, maybe just start a new line with the info and delete the bad line

given the previous hypo situation on humulin, it is very possible that tucker is insulin sensitive and 1 unit may be too much insulin. so depending on his numbers, IF you give insulin on the next time, you may want to give 0.5 units.

either way - post the pre shot number BEFORE shotting tomorrow.

 

Hi Hillary. I plan on doing a +6 shortly to see where it is.
That would be 75 minutes since the gravy

 

Hi Chris,

Just to recap...
You shot Lantus for the first time tonight and gave 1u on a PMPS of 349

At +3 you got a 165
at +4.5 you got a 65 and fed a spoonful of gravy
at +5.5 you got a 76

Is that right, and have you fed any more at any time since shot time?

Carl

 

Hi Carl,
All those were correct. I just did a +6 and it's down again to 47. Just gave some more gravy, a tablespoon full.
He free feeds canned food.

 

OK, so he wants to play that way! With a 47, that means the first little boost didn't hold his numbers up where you want. So giving more gravy was the right thing to do. Can you test again in 20 minutes? If it isn't any or much higher, then more gravy at that time.

Carl

 

Will do. I had to go find him. He actually went to bed, my bed!
This time I gave him a bit more gravy then last time. Will check on the half hour. Thanks

 

well it is bed time after all and are you sure it;s your bed? according to my cats, it's their bed and they just let me use it...

 

He always follows me to bed. Guess I was late and he went without me!

 

Doing great, Chris. Is he doing ok...not getting too full? We want to just use the gravy in case he's running low for a while so we don't get him too full.

Carl and Hillary have given good advice. Test, if his number is below 50, give a tsp of HC gravy, post his number for u s, and then retest 30 min after the gravy.

 

Tuckers +6.5 is 57. Gave him just a bit more gravy.
The SS is not allowing me to make any notes on the far right, like I did before.

 

Good number and good on more gravy. See you in 30 minutes?

RECAP so everyone doesn't have to keep scrolling up and down:

PMPS 349 1u
+3 165
+4.5 65 (tsp gravy)
+5.5 76
+6 47 (tblsp gravy)
+6.5 57 (tsp gravy)

 

Yes sir. All correct! Will check on the hour again. Thanks Carl

 

Great job Chris and Carl ( thanks for the recap).

Next time you test, if he's still in the 50s or above, let's give him one tsp of low carb food, k?

 

Hi Marjorie,
I free feed him canned food, so he isn't hungry right now (of course). The gravy I use is from Gravy sensations food. I could give him some of that. He loves it!

 

The point about giving him low carb food once he's up is it helps to keep the numbers from coming back down on you.

Numbers resulting from HC gravy/food or karo wear off and may drop after about two hours when the HC wears off. The low carb food will help the numbers stay up as the HC wears off.

However, Tucker earned a dose reduction tonight so he's proven his point...so you just need to get his numbers up. To that end, you can add a tsp of HC gravy to his LC food.

 

PMPS 349 1u
+3 165
+4.5 65 (tsp gravy)
+5.5 76
+6 47 (tblsp gravy)
+6.5 57 (tsp gravy

Now at +7 BG is 64. I gave him some of the meat pieces to eat. So tomorrow you think .5U ?

 

Good!

Normally, we would reduce by .25u. I've seen this kind of drop cycle before with shooting a new insulin. It sometimes will last a couple cycles.

If you want to be conservative and extra safe, I'd say you could shoot .5u tomorrow and see where he goes with it. If he doesn't hold the reduction, you can always take him back up. But you can't get insulin out of a cat once it's in. So it's probably a wise move to take him to .5u and see what he can do.

 

My question is.... I planned on injections at 6AM EST, only about 4 1/2 hrs from now. Even if I give him .5U, isn't that too soon to do it at 6AM?
Tomorrow I have an office meeting at 9AM I can't miss.

 

I would see what he does in the next few hours. These low numbers might result in him bouncing up. If he does, you can shoot the .5u and get a +2 before you leave. If its higher than the PS, he will probably continue up. If its the same or close to PS, he will probably come down. If its much less than the PS, it's probably going to be an active cycle.

What I'd like you to do is post your +11 in the Lantus ISG. Dyana is up early and on line. I'll email her and let her know to check in with you and help you decide what to do.

 

Will do. Thanks Marjorie for your help!

 

You're welcome.

Chris...please be sure you get two, rising, non HC food influenced numbers before you call it a night on testing.