Newly Diagnosed, But Done This Before!

Discussion in 'Feline Health - (Welcome & Main Forum)' started by toomanycats, Feb 7, 2020.

  1. toomanycats

    toomanycats Member

    Joined:
    Feb 7, 2020
    Hello all!
    First, I wanted to say THANK YOU! This site has provided SO MUCH information to help me navigate this diagnosis and make informed medical decisions for my cat the last 2 weeks! As the title says, I've done this before, but my last diabetic cat was a foster cat -- so the rescue made decisions & funded his medication. This time, it's my kitty, so I'm having to make more decisions to ensure we can afford to treat my cat effectively.

    My 13-year-old orange tabby named Buzzy was diagnosed 2 weeks ago with diabetes & a UTI. 2 weeks of prescription food & antibiotics haven't done the trick, so we just started insulin tonight. Thanks to all of the info on this site, I was able to obtain a Lantus pen - but bought regular syringes so that we can adjust dosage more easily. My vet originally wanted him on 0.5 units per kg body weight, which would be 2.8 units; she rounded up to 3 since we were going to use the pen until I read about using syringes with pen insulin instead - so then I asked if we could start him on 2.5 units instead. He'll be going in every Friday for a month for spot glucose & fructosamine checks. I know about home testing, but I'm more comfortable bringing him in right now. I also decided to pull him off the prescription DM food and put him on Fancy Feast Tender Liver & Chicken Classic Pate, which is more affordable AND lower carb -- both my cats are going to go on that now actually. I'm pregnant w/ our second kiddo right now, so money is very tight, so I'm doing what I can (within the bounds of what I'm comfortable with). Fortunately, we caught it early, so he's not in any sort of crisis & we can start low & slow.

    Soooo I did his first dose this evening...I hope...lol...I'm always worried it didn't go in or something. I've told his 10-year-old "sister" (my tortie, Luna) that she's not allowed to have any medical crises for 5 years :p
     
  2. Deb & Wink

    Deb & Wink Well-Known Member

    Joined:
    Jan 31, 2013
    Well, welcome back. We'll help you all we can.

    2.5 U as a starting dose is not "Low and slow" by any means.
    If still eating dry food, then starting dose of lantus is 1 Unit.
    If eating wet food already, then 0.5U starting dose of lantus is recommended.
    Changing to low carb wet food at the same time as starting the food change, could lead to hypoglycemia.
    Do you have a hypo kit ready?
    Do you know what symptoms to watch out for?
    These 2 links will help you with that.
     
  3. Deb & Wink

    Deb & Wink Well-Known Member

    Joined:
    Jan 31, 2013
  4. Deb & Wink

    Deb & Wink Well-Known Member

    Joined:
    Jan 31, 2013
    Fructosamine tests once a week are unnecessary.
    Be aware that BG spot checks done at the vet can be elevated due to "vet stress."
     
  5. Chris & China (GA)

    Chris & China (GA) Well-Known Member

    Joined:
    May 10, 2013
    On Tight Regulation (which requires a low carb canned or raw diet only) gives the best chance at remission....and has a starting dose based on weight. It's Weight (in kgs) x .25

    On SLGS, the starting dose is .5 if on a low carb canned or raw diet and 1.0 unit if there's dry in the picture.

    You can always go up in dose...Once you give it, you can't take it out again.

    As for Lantus, most of us are buying it from Canada now because it's 1/3 to 1/2 the price! Here's the Information on buying Lantus from Canada

    Please start home testing. Tests that are done at the vet's can be up to 200 points higher just due to vet stress. The vet see's those artificially high numbers, tells you to increase the dose and you go home. Kitty relaxes and you have the recipe for a tragedy.

    It's not hard and it doesn't hurt. It just takes some practice!

    Here's something I wrote up for others for testing...maybe it'll help you too!

    It can be really helpful to establish a routine with testing. Pick one spot that you want your "testing spot" to be (I like the kitchen counter because it's got good light and it's at a good height....it also already blocked 2 escape routes due to the wall and the backsplash) It can be anywhere though...a rug on the floor, a table, a particular spot on the couch...wherever is good for you.

    Take him there as many times a day as you can and just give his ears a quick rub and then he gets a yummy (low carb) treat. Most cats aren't objecting so much with the poking..it's the fooling with their ears they don't like, but once they're desensitized to it and learn to associate a certain place with the treats, they usually start to come when they're called! Or even when they hear us opening the test kit!

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

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

    For new kitties, using a heavier gauge lancet is also really helpful. A 25-28 gauge lancet pokes a bigger "hole" than a 31-33 gauge lancet does, so look for "Alternate Site testing" lancets that are usually a lower number

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

    toomanycats Member

    Joined:
    Feb 7, 2020
    Before diagnosis, he was eating a mixture of wet and dry food. I'd actually moved him to a low-protein food thinking that it was his kidneys, not diabetes, that were the problem - silly me.
    For the last 2 weeks, he has only been eating Purina DM wet food and no insulin; some improvement, but not enough.
    I'm now switching him from that to Fancy Feast.
    The clinical information I have read has said "The starting dose for glargine is 0.25 U/kg of ideal body weight, if blood glucose concentration is <360 mg/dL (<20 mmol/L) or 0.5 U/kg if blood glucose is >360 mg/dL." I know I've seen people on here stable at much lower doses, but I can only go by what I've read in the clinical information + what my vet says really...
    My cat is roughly 12 pounds, which would put him at a starting dose somewhere between 1.3 - 2.7 units. The vet actually said that the standard she uses is 0.5 U/kg - 1 U/kg, which is why she was OK with the idea of starting him at 3 units so that I could use the pen, but she also signed off on my wanting to start at 2.5.

    I've read about symptoms of hypoglycemia. I'll do my best, but I admit never having had to deal with it before.

    Def aware of spot glucose checks being elevated, which is why we're doing the fructosamine along w/ the spot check (spot check will be done 4-ish hours after dosage); my vet no longer does glucose curves and says they are no longer recommended to be done in vet offices due to the stress factor. I remember doing GCs with my last diabetic cat though (in the office; I have never checked blood glucose or urine or blood ketones at home with a diabetic cat). I may do at-home glucose testing at some point, but, again, I've never done it before.
     
  7. Deb & Wink

    Deb & Wink Well-Known Member

    Joined:
    Jan 31, 2013
    What are your expectations from this message board?
    What are you looking for?
    What are your goals in being here?
     
  8. Sienne and Gabby (GA)

    Sienne and Gabby (GA) Senior Member Moderator

    Joined:
    Dec 28, 2009
    Your vet is relying on an old formula for calculating the initial Lantus dose. The initial formula was based on cats that were hospitalized and monitored 24/7. By the time the journal article for the Tight Regulation Protocol was published, Jacqui Rand, DVM, one of the authors, reduced the starting dose formula to (ideal weight in kg x 0.25) so it was safe for people to do at home. Usually, this works out to about 1.0u give or take. The guidelines published by the American Animal Hospital Assn suggest a starting dose of 1 - 2u but they are including both Lantus and Prozinc.

    A starting dose of 2u or more is very aggressive for Lantus. Obviously, it's up to you whether you want to start at that high of a dose. If you opt to start at more than 1.0u, I would strongly suggest that you monitor your cat's blood glucose very carefully. In addition, I would recommend that you have high carb food or Karo (corn) syrup or other syrup (maple syrup, honey) on hand in case numbers drop. Likewise, have a lot of strips on hand in order to monitor if numbers drop.
     

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