Newly Diagnosed Teddy

My kitty Teddy was diagnosed with diabetes 3 weeks ago with a blood glucose level of 437. Main symptom was that he got very skinny (went from 12 pounds several years ago to 8 pounds). I don’t normally check his weight.

Started out Lantus dose at 2, glucose was still at 426 a week later. Went up to 2.5 and still at 426 2 weeks later. Left him at vet for the day yesterday to do a curve. She said his levels were up in the 700’s so she gave him 4 units of insulin. She wants him to come in next Monday and stay for 3 or 4 days while she “overdoses” him to see if she can get lower glucose numbers. I’m to give him 4 twice a day until then. I’m a bit nervous about that. Is 4 a high dose? I bought a blood glucose monitor, but haven’t yet tried to use it. I’m still getting comfortable with injecting the insulin.Why would his levels go higher when he’s been on insulin for 3 weeks and I’m feeding him more low carb foods (both prescription and Fancy Feast classics). He doesn’t like the wet prescription food, but enjoys the Fancy Feast. I know people on this site recommend no dry food, but I bought the expensive bag from my vet and he likes it. I have 3 other cats, and I’m not giving them the prescription food, so they have their regular kibble out at all times. Teddy eats some of their food as well. Only good news so far is that Teddy has gone up to 9.25 pounds.

 

Welcome Cruiser and Teddy. Oh I'm so glad you did some research and found this board! Yes, 4 Units is high and I cringed when I read that your vet wants to "overdose" NO! Not a good idea. It's not good for Teddy to do that.
If you want to learn about effective feline diabetic treatment this is the place. Yep, all volunteers but many, many of the members have been taking care of their cats for years, so there is a great deal of knowledge and experience here. The very basis of this board is to bring our sugar cats to the best health we can, and keep them safe!
Diet: kibble is not good for sugar cats, or any cats realistically. You can return the "prescription" food for refund, just tell them he won't eat it. Even most Rx canned food is too high in carbs. A gradual transition to eliminate dry food is best, and while you are already giving insulin, you should be testing at home. I know..eeek, but we all learned to do it and we will help you learn how.
Testing: it's the best way to keep Teddy safe. Test before every injection to be sure it's safe to do so, and test during the cycles to see how the insulin is affecting Teddy.
Insulin: There is a Lantus specific insulin forum and you can read about it and learn to use it effectively and safely.
http://www.felinediabetes.com/FDMB/forums/lantus-basaglar-glargine-and-levemir-detemir.9/
I am tagging some more experienced members to read your message @Wendy&Neko @Kris & Teasel @Bobbie And Bubba @Lisa and Witn (GA) for input on how best to go forward now.

 

Welcome.

Where to start? I don’t want to scare you, but I want to impart the seriousness of this. If what you are saying is true, and I don’t doubt it is, I would run not walk to a new vet. Honestly, if they are actually overdosing animals, I would be tempted to report them. We have seen incompetence on the part of vets in regard to diabetes more often than you would believe. Many vets see a high number and just keep increasing insulin, this is not the best way to get a cat regulated. Here we monitor sugar levels to actually find the right dose, this is a lot more monitoring than almost any vet will ever do.

In answer to your question why would sugar levels go up on an increased dose of insulin? When a cat receives too much insulin, their sugar can drop too low or even on a good dose they can go lower than their body is used to, this can cause their liver to excrete stored sugar in an effort to raise the sugar (their body thinks it is in danger and tries to compensate by raising sugar).

The starting dose was too high to begin with and with subsequent increases it is very possible your cat is on too high a dose. If that is the case, following the vets advice to administer 4 units may very well put your cat in danger.

Are there some cats that need more insulin than others? Sure, but without starting at a reasonable dose, you will never know what the correct dose for your cat is.

You are in the right place to start taking control and doing what is best for your cat. Some more experienced members will help you get to a safer dose to start helping Teddy. We want him to be safe and happy.

 

I agree with Julie. You need a vet that has more experience caring for diabetic cats. What your vet is planning to do is very dangerous for your cat. Unfortunately we have seen similar "treatments" happen on this site and the cats did not survive or were permanently harmed by the vets actions.

A good starting dose should have been 1 unit twice a day. It is then gradually increased by usually 1/2 unit over period of several weeks to find the optimal dose that works best to keep the glucose levels under control. We recommend waiting a week between increases to give the cat's body time to adjust to the new dose. By testing before every shot you will see how well the dose is working. Unless your vet is doing fructosomine test each time, which is very expensive, the test they normally do will not be accurate. Usually cats are stressed at the vets and stress will raise the glucose levels significantly. That number is not a reliable number to use for a dose change. By giving your cat too much insulin you are putting your cat at risk for hypoglycemia. This could cause permanent damage or worse.

By testing at home you will know how well the dose is working. We can help you learn to test and let you know if an increase or decrease for the dose. Don't be surprised if you discuss home testing with your vet, he tells it is not needed or only done every once in a while. A lot of vets seem to think their pet owners are not capable of home testing. However you are the person who is responsible for giving you cat the best care possible. Just think of it this way. If this was your child that needs insulin, would you give it if you didn't know it was safe to give the dose? Knowledge is power and this forum is here to give you that knowledge.

I understand you may find some of our responses intimidating. On behalf of this board I apologize if that is the case. You have a lot of very experienced people on this board and will help you learn everything you want to know about caring for a diabetic pet. It is very overwhelming at first until you find a routine that works best for you. We will help you through this journey.

My suggestion is to either update the title or start a new thread asking if any members in your are can recommend a vet that is knowledgable in feline diabetes. You should include your city, state and country. We have members all over the world and there may be someone near you.

 

No dry kibble at all. Most of the store kibble is 35-40% carb (you are setting all your cats up for developing diabetes) and the perscription one is around 15%. Even a little can send the numbers way up. You really want all of the cats on less then 10% carb..... Fancy feast classic is great for all of then. I have a link to the food list in my signature. I'm glad you are planning to learn how to home test. I have a video in my signature showing how I test my cat CC at home.

 

However do not remove the dry food until you have lowered your dose. Switching to only canned food will significantly lower the glucose levels. The best thing for all of your cats is to switch them all to canned food. It will be healthier for all of them and keep Teddy from getting into it.

 

Thanks all for your replies. I believe “overdose” was the term the vet used, but I think she just meant trying higher levels under close supervision over the 3 or 4 days she keeps him to see how Teddy responds. He actually seems to me to be doing a bit better over the past couple of days since I’ve had him on 4 units. He appears not to be drinking as much water, staying awake and more alert, and climbing on my lap as he used to (he had been keeping more to himself recently). I’m going to try to get the courage to try to do a blood sample this afternoon. I also want to ask the vet if she’s ruled out other conditions that may increase blood glucose. They did a complete blood test in order to identify diabetes as his condition, but I just want to be sure.
I will start another thread to ask about other qualified vets in the area, but I’m new to this one and prefer not to start over somewhere else. None of my cats have been to the vet in years, because it is a major job to get them into a carrier. Mom and dad started out as feral cats, and Teddy and his sister were born in my side yard. They’ve all been inside only cats for the past 9 years. Luckily for me, Teddy is the most trusting and easy to handle, but boy, does he try not to get stuffed into that carrier!

 

I'm so glad you checked back in Cruiser, and very very happy you are going to begin testing. We have a section here with videos and links about testing, and it is the best way to keep Teddy safe and see how the insulin is affecting him.
http://www.felinediabetes.com/FDMB/threads/hometesting-links-and-tips.287/
I wasn't testing very much at first either, and almost missed the beginning of a hypo with Idjit. The members here helped me intervene and it wasn't critical, but it scared me.
I have read here over the last year, that sometimes too much insulin looks like not enough, and increasing the dose is not always a good course of action.
Taking things slowly, learning to test and learning about effective diabetes treatment is going to help Teddy so much. We just want the best for him and for you.
Take a look at the Lantus forum and start reading the information there, the yellow tagged "stickies" at the top of the page.
http://www.felinediabetes.com/FDMB/forums/lantus-basaglar-glargine-and-levemir-detemir.9/

 

Success! I got a reading with Teddy on my first try (after failing the control test because I didn’t read the part about only getting the solution on one side of the test strip). His glucose level went down from somewhere in the 700’s at vet’s office (previously 426 and 437 at vet) to 369 after about 4 days on 4 units of Lantus twice a day. Still high I know, but this is his lowest reading yet. I’m sure it’s partly due to the fact that he is at home and more comfortable. I think I’ll call vet in the morning and ask if we can monitor this from home rather than have him in vet’s office for 3 or 4 days.

 

Wow, success on a first test! Congratulations, not many of us were able to do that.

If you would, please take a few minutes and create a signature so that Teddy's information is available when you post.
Setting up your signature (light grey text under a post). Here's how:
click on your name in the upper right corner of this page
click on "signature" in the menu that drops down
type the following in the box that opens: kitty's name/age/date of diabetes diagnosis/insulin you're using and dosage amount /glucose meter you're using/what (s)he eats/any other meds or health issues (s)he has. You can add your name, and a geographic location (sometimes the time zone matters) Be sure to SAVE when you are finished.

Another thing that will help us help you now that you've started BG testing at home is to set up a spreadsheet like the one we use here. You will see how the trends and patterns emerge, and members can review his/her progress before offering suggestions or advice:
http://www.felinediabetes.com/FDMB/threads/fdmb-spreadsheet-instructions.130337/
http://www.felinediabetes.com/FDMB/threads/understanding-the-spreadsheet-grid.156606/

You can certainly check with your vet, but I do know from experience that most cats' BG goes up at the vet's office. The stress of travel, strangers, other animals, being in a cage, and being away from the familiar environment does raise the BG. You are a full partner in this enterprise, and although you are just learning about how to take care of Teddy, you get some say in what happens in that treatment. A vet stay of 3 to 4 days is going to lighten your wallet or savings quite a bit, Teddy will probably not be happy, might not eat and will still be getting insulin, possibly larger doses because of stress related higher BGs. That can result in a very unhappy and possibly dangerous situation for Teddy.
Many vets just do not agree with home testing, or want you to bring them in for testing. Some because they don't know how valuable it is, or because it helps pay the bills.

I hope you will consider keeping him right at home, testing before every shot and during the 12 hour cycle between injections.
As you have read, the 4 Units he's getting AM and PM might be too much, the only way to tell is to keep testing, especially the mid cycle tests, to see how low the BG is going. He might be dropping very low, then his body is saying "uh oh" and his liver will release stored sugar and hormones to compensate..shooting the BG right up again. This does happen sometimes. That's why you test, monitor and record the data.

The kibble he is eating is also contributing to the high BG, and hopefully we can help you with the diet issues for all your furkids. All things in good time.

 

Actually, that sounds just like a method Dr. Jacquie Rand, world renowned feline diabetes researcher and one of the creators of the original tight regulation protocol with Lantus insulin, created and used prior to June of 2006 known as the Rand Protocol. The whole idea was to slightly over dose the cat while closely monitoring in a hospital setting for three days to bring glucose levels down quickly. Sound familiar?

Don't fault my peers. They're just not as old as this olddinosaur! They weren't around when this stuff was happening!

Dr. Rand lowered her dosing scale that June since caregivers began monitoring their cats at home. The lowered doses allowed caregivers to keep their kitty's at home when beginning a tight regulation protocol. A couple years later she abandoned her own protocol in favor of the German Tight Regulation Protocol with Lantus or Levemir. She joined up with laypersons from the German Katzen Forum. Their dosing protocol is called the Tight Regulation Protocol used in our Lantus, Basaglar, and Levemir Insulin Support Group today.

You might want to take a look at the dosing methods we use here on the FDMB for Lantus - Dosing Methods: Start Low, Go Slow (SLGS) & Tight Regulation. They're another option for you. Both are safer methods created for those who test kitty's blood glucose at home.


Welcome to the FDMB. Hope to see you posting often!

 

Thank you Jill, that's interesting information. I am rather new, only a year on FDMB and still (most likely always) learning. I always appreciate your input.

 

No problem. There's no way any of you would be aware of this information!

 

I strongly encourage you to begin recording his test results in the spreadsheet we have put together and post in the Lantus, Basaglar, & Levemir Insulin Support Group for dosing guidance. That 4u dose is concerning.

• FDMB SPREADSHEET INSTRUCTIONS
• UNDERSTANDING THE SPREADSHEET/GRID

In an emergency:

• How to treat HYPOS - THEY CAN KILL! Print this Out!!
• jojo and bunny's HYPO TOOL BOX
• Don't Panic! or How to Handle Low Numbers
  

 

Should the proper dose of insulin bring glucose levels down to an acceptable level almost right away or over some period of time? My thought with Teddy’s first read at home is that if 4 units brought his levels down from 700+ to 369 after 3.5 days, then it is either working and just needs more time, or he is scared out of his wits at the vet’s office. She says it wouldn’t go that high just because of his fear.

 

The effects of Lantus are cumulative. It usually takes a minimum of three days to see what a dose can do. That said, I do think it's working , but without more data it's not clear whether Teddy needs more time at this dose, if he needs an increased dose, OR if the dose is too high. That's the thing with Lantus or any depot insulin... too much insulin can look the same as not enough insulin. We really need to see more data before coming to any conclusions.

Yes, the high numbers at the vet's could very well be vet stress or white coat syndrome... whatever you want to call it. Hometesting will provide a lot of answers or at least help figure out the best way to proceed.

Edited to add:
My cat became highly stressed at the vet's

 

Thanks @Jill & Alex (GA)! I really appreciate this education. Very much so

 

I agree and becoming via a 2U increase