Newly Diagnosed, Using Lantus

[spuds151]

Cross-post from main forum...

Long story short, my tuxedo cat Boots was diagnosed about 3 weeks ago. He started in the mid to high-600s when starting 1u of Lantus 2x/day. No improvement after 4-5 days. Vet increased dosage to 2u 2x/day. Now fluctuates mostly from mid-400s to low-600s, though so far never got as high as he initially was.

Desperately trying to figure out a good dosage-to-food ratio that will get us seeing results. My post from the main forum goes into deeper detail, and it was suggested I cross post here to field some suggestions.

Thank you all, I'm having a tough time with this...

 

[Stacy & Asia]

Welcome to you and Boots!

I completely understand being freaked out with the high numbers and feeling like you're nowhere near the right dose. It can take awhile, unfortunately, but you can do it, and this board can help! Asia was diagnosed in late September, you can check out her spreadsheet and see how all over the place she was at first. She's still a little all over the place, but now at least, her numbers are trending in the right direction!

It's so overwhelming, but you're off to a great start, you'll get there. Spreadsheets are the main way people can see the data you are collecting and help steer you in the right direction. There are people to help you set up a SS if you have trouble. Read the stickies at the top of this forum, print them out if you can, read them often and over again (it takes a bit for it all to sink in). Ask lots of questions and don't worry if things don't make sense right away.

 

[Alicia & Maggie (GA)]

Welcome!
Does Boots eat dry food or canned food? Canned with low carbs is the way to go for a diabetic cat. Fancy Feast Classics (pate) are a good low cost place to start.
Are you testing Boots before each shot?

 

[Kathy and TiTi]

Cross-post from main forum...

Long story short, my tuxedo cat Boots was diagnosed about 3 weeks ago. He started in the mid to high-600s when starting 1u of Lantus 2x/day. No improvement after 4-5 days. Vet increased dosage to 2u 2x/day. Now fluctuates mostly from mid-400s to low-600s, though so far never got as high as he initially was.

Desperately trying to figure out a good dosage-to-food ratio that will get us seeing results. My post from the main forum goes into deeper detail, and it was suggested I cross post here to field some suggestions.

Thank you all, I'm having a tough time with this...

Welcome! We all have a tough time at first. You probably need to slowly increase the dosage until you find the right number for Spuds, who is adorable by the way.

You do need to start a spreadsheet - This woman helped me at first. @Marje and Gracie . She is the empress of spreadsheets.

There are 2 protocols you can follow to start regulating Spuds:
SLGS (Start Low Go Slow)
or TR (Tight Regulation).
You can read about these 2 methods, which are referenced in the yellow links at the top of this group's opening page.

It will take a while, but you are in the right group.

 

[Kathy and TiTi]

Just read your post in the other forum and it answered my questions!
You should go back to 1U and choose a protocol to follow. If you are around enough to test at least mid-cycle (6 hours after a shot) and before you go to bed then TR is a good way to go. You'll notice most of us test more often than that. The more data you gather by testing, the sooner patterns start to emerge to help adjust doses going forward.
Do you withhold food for the two hours prior to an injection? If not, Boots' glucose will be artificially high because of the food.
Ask LOTS of questions!

I believe it might be better to stick with the 2u that you are shooting now. It really confuses the cat's blood glucose to switch around so much. Maybe @Gill & George and @Wendy&Neko can give you more expert advice.

 

[Gill & George]

I just wanted to stop by and say hi and welcome, it's gone 1am for me so heading to bed. I've read your post on health, and I thought you might find this site by Dr Lisa Pierson quite interesting, especially with Spuds urinary issues.Catinfo.org

I dont know what the carb content of the specialist dry food is, but I would suspect it's very high.


Here's a post that Dr Lisa made on the forum, it touches on dry food and urinary issues, has links
http://www.felinediabetes.com/FDMB/...r-more-than-just-carbohydrate-content.175004/

When I've had a chance to look through his history better tomorrow I'll post some more.

ETA, are you testing for ketones? With numbers running that high I think it would be wise to test daily for those. You can use human ketostix to do that. To gather a sample from George I would scoot a large spoon under his bottom where he went for his morning pee, I couldn't get the sticky into the flow because he rides quite low when he pees.

 

[Marje and Gracie]

Cross-post from main forum...

Long story short, my tuxedo cat Boots was diagnosed about 3 weeks ago. He started in the mid to high-600s when starting 1u of Lantus 2x/day. No improvement after 4-5 days. Vet increased dosage to 2u 2x/day. Now fluctuates mostly from mid-400s to low-600s, though so far never got as high as he initially was.

Desperately trying to figure out a good dosage-to-food ratio that will get us seeing results. My post from the main forum goes into deeper detail, and it was suggested I cross post here to field some suggestions.

Thank you all, I'm having a tough time with this...

We can offer you better suggestions when we see a spreadsheet. If you send me a private message, I’ll be happy to do the spreadsheet for you. To send me a PM, pls click on “Marje and Gracie” to thevleft and then “start a conversation”.

 

[Wendy&Neko]

Hello and welcome from a fellow black and white fan. This is the greatest place you never wanted to be. The folks here saved my kitty and my sanity when I first started. Turned out my girl had a couple of high dose conditions my vet didn't know anything about. But there is a ton of knowledge and just general support that helped me gain confidence, day by day. As it turns out, my Neko also won the award for highest BG of the day most of the time when I started. Following the methods here, I eventually got her numbers under control. She survived 5 years on insulin, including many months of ugly numbers to start.

You'll notice most of the people here have a signaure that includes the SS or spreadsheet, and a few other things, like type of meter. Looks to me like you are using a pet meter or the AT. If you would like us to help you figure out where to go with the insulin dose, it'll help us help you if you fill in a spreadsheet for us to see how Boots is doing. Here are the instructions. Please take up Marje's offer.

As for food, look for low carb, preferably low phosphorus too (skip the Fancy Feast cause it's high phosphorus) with lots of water added. A week after Neko got her diabetes diagnosis, my second cat had his first crystals episode. I originally had him on high carb C/D but it was driving me crazy being food police. I ended up on the same food for both, in my case low carb raw though canned would work too. I also added glucosamine (Cosequin) as there is some thought that it helps the bladder walls.

 

[spuds151]

Thank you all for your responses - @Toebeans , @Alicia & Maggie , @Kathy and TiTi , @Gill & George , @Marje and Gracie @Wendy&Neko .

I will start a spreadsheet this weekend and I can put in the history of what was tested as I've been manually tracking it.

Boots is currently eating Friskies pate - 1/2 of a 5.5oz can in the AM and PM. I have taken away all dry food and treats since Saturday (much to the dismay of my 3 other cats). I've been testing him before both AM and PM feedings, and usually about 6 hours after either or both feedings. I haven't tested him since Sunday though because he really fights us when we try to test him, so I want to give him a few days before testing him again. I haven't tested him for ketones personally, but the vet did, and she didn't find any. I will pick up ketone testing strips.

I will also be continuing to give him the 2u 2x day until I get a full week's worth in him to see how he reacts.

I will get a signature set up for posting on this site also. Thank you all for everything.

 

[Gill & George]

Removing the dry food from his diet is great, but a word of warning, it can dramatically reduce insulin requirement.

We've seen cats go from 5u to no insulin in he space of a week.

The dry can take a couple of days to get out of their system, as you removed all dry on Saturday I would urge you to test him, I understand you wanting to give him some space, but as cats can often show no outward signs of being low until they are in a full on symptomatic hypo... It's best to be a little cautious given the feeding change.

 

[KATIE&ovie]

Welcome to the group. Ovie and I are new here too. This is the best and most helpful place to be. Everyone here is wonderful and here to answer your questions.

The spreadsheet is really easy to use and will help everyone help you. I use it from my iPhone. My vet calls is my colorful rainbow chart lol.

Poking can be hard too do. My kitty has cold ears so I have to run his ears a bunch to get the blood flowing before poking. My kitty now thinks the sound of his testing kit being opened is the snack bell. He comes running.

You are off to a great start and Boots will start to feel better soon. You've already took a huge step in his FD care by removing the dry food and home testing. You got this.

 

[KATIE&ovie]

Removing the dry food from his diet is great, but a word of warning, it can dramatically reduce insulin requirement.

We've seen cats go from 5u to no insulin in he space of a week.

The dry can take a couple of days to get out of their system, as you removed all dry on Saturday I would urge you to test him, I understand you wanting to give him some space, but as cats can often show no outward signs of being low until they are in a full on symptomatic hypo... It's best to be a little cautious given the feeding change.

Oh yeah! That is a great point.

 

[spuds151]

Removing the dry food from his diet is great, but a word of warning, it can dramatically reduce insulin requirement.

We've seen cats go from 5u to no insulin in he space of a week.

The dry can take a couple of days to get out of their system, as you removed all dry on Saturday I would urge you to test him, I understand you wanting to give him some space, but as cats can often show no outward signs of being low until they are in a full on symptomatic hypo... It's best to be a little cautious given the feeding change.

I'm not entirely sure he ate all that much of the dry food, but a little bit of it probably does go a long way in terms of BG. I initially didn't want to test him again until the weekend, but now I'm leaning towards testing him tomorrow. Fortunately my wife works from home and she is able to keep an eye on him. She regularly checks on him and is aware of what to look for and what to do if hypo comes on.

 

[Stacy & Asia]

I'm not entirely sure he ate all that much of the dry food, but a little bit of it probably does go a long way in terms of BG. I initially didn't want to test him again until the weekend, but now I'm leaning towards testing him tomorrow. Fortunately my wife works from home and she is able to keep an eye on him. She regularly checks on him and is aware of what to look for and what to do if hypo comes on.

That's awesome you have someone to share this responsibility with! The problem with looking for outward signs of a hypo is, unfortunately, they can be hypo without outward symptoms. My cat was perfectly content dropping in to the 40s and didn't seem out of sorts in any way, in fact she was purring and not bothered.

Hopefully others will add some more tip, but like Katie mentioned, some cats, if you make testing time treat time, will associate testing with a good thing and be more than happy to exchange a poke for a treat. Is Boots treat/food motivated at all? Is there some special treat you could give just at testing time? You want to give low carb treats, obviously, but give it a try.

 

[spuds151]

That's awesome you have someone to share this responsibility with! The problem with looking for outward signs of a hypo is, unfortunately, they can be hypo without outward symptoms. My cat was perfectly content dropping in to the 40s and didn't seem out of sorts in any way, in fact she was purring and not bothered.

Hopefully others will add some more tip, but like Katie mentioned, some cats, if you make testing time treat time, will associate testing with a good thing and be more than happy to exchange a poke for a treat. Is Boots treat/food motivated at all? Is there some special treat you could give just at testing time? You want to give low carb treats, obviously, but give it a try.

Oh Boots is CERTAINLY food and treat motivated. The problem is finding a diabetic-friendly treat that he likes. The freeze-dried salmon and whitefish I got has not been well received.

 

[Stacy & Asia]

Oh Boots is CERTAINLY food and treat motivated. The problem is finding a diabetic-friendly treat that he likes. The freeze-dried salmon and whitefish I got has not been well received.

I don't have a very treat motivated cat, but some things I've heard on these boards is a bit of boiled chicken, freeze dried chicken (Asia likes those, but wouldn't anymore if I gave them to her regularly ), catnip, I'm sure there are more. I would pick something that is only given at test time so he knows there's a trade to be made and he only gets this special one with tests.

 

[Marje and Gracie]

Everyone has difficulty starting out testing. Here are some Testing and Shooting Tips that might help you.

I’m not trying to scare you but just because he’s been in high numbers doesn’t mean he will stay in them. The way Lantus works is cumulative so each shot is not independent of the previous one but “layers” on to it. And it’s imoortant to remember that insulin is not a medicine....it’s a hormone so how each kitty reacts to it is different.

Unless a cat is a high dose cat (over 6u twice a day), the most we would raise a dose would be by 0.5u and that would be for cats with very consistent nadirs over 300. We’ve seen vets many, many times overdose cats by raising the dose 1u at a time.

Without testing, you don’t know where he actually is. I can’t even tell you the number of times I’ve seen cats go from 400 to 60 back to 400 in a cycle and without that mid cycle number, we would have thought the kitty was high. We have a few cats in the forum now that will start in black numbers and end in the low 100s and then head back up. Check out Girlie’s SS. (Click on the blue print to the left, click on the “US” tab at the top of the SS, and then scroll down to Oct 28 for an example.).

While we don’t know if this is happening to Boots, those high numbers you see could be from him coming down low and bouncing back up as Girlie does. And when you pull the dry suddenly and you aren’t testing....that is a bona fide recipe for disaster. Check out Scooter’s SS (click on the 2013-2014 tab at top and scroll to the last day he had kibble...2/18/2014). He was on 5.5u twice a day and when she pulled the dry, she had to completely stop the insulin. That doesn’t always happen...but it can. The dose almost always comes down fast but not always that dramatic.

We are all here for support and advice to help you and Boots put together the puzzle pieces.

ETA: my Gracie could drop into the 20s on a human meter and have not one single symptom of a hypo. However, we don’t have them hooked to monitoring machines such as EKGs so we don’t know what that might donto the brain. Also, sometimes if they drop down really low and you don’t catch it, and then they start to show symptoms, it can be a fight to get them into safe numbers and keep them there. Because Lantus is a depot insulin and the depot from a shot can affect more than one subsequent cycle, a true hypo with Lantus can last over 12 hours.

 

[Gill & George]

While we don’t know if this is happening to Boots, those high numbers you see could be from him coming down low and bouncing back up as Girlie does. And when you pull the dry suddenly and you aren’t testing....that is a bona fide recipe for disaster. Check out Scooter’s SS (click on the 2013-2014 tab at top and scroll to the last day he had kibble...2/18/2014). He was on 5.5u twice a day and when she pulled the dry, she had to completely stop the insulin. That doesn’t always happen...but it can. The dose almost always comes down fast but not always that dramatic.

Thanks for posting the link to Scooters SS, I was out and on my phone, got back home to include the link, and found you'd beat me to it.

 

[KATIE&ovie]

Oh Boots is CERTAINLY food and treat motivated. The problem is finding a diabetic-friendly treat that he likes. The freeze-dried salmon and whitefish I got has not been well received.

Oh Boots is CERTAINLY food and treat motivated. The problem is finding a diabetic-friendly treat that he likes. The freeze-dried salmon and whitefish I got has not been well received.

is Boots crazy about his friskies? That's what I use for Ovie as a treat.

 

[Gill & George]

George is very food motivated too, he really likes the origen freeze dried chicken, they are his favorite.

If he likes cooked chicken breast, some folk poach a chicken breast cut it up into small bite sized treats, you can freeze them taking out what you need for treats for the day.

 

[spuds151]

What do you guys think about low-sodium deli turkey? I haven't given that to my cats in some time now, but when I used to make turkey sandwiches regularly for myself, they would cry and cry until I gave them each a little bite of turkey.

 

[Tanya and Ducia]

What do you guys think about low-sodium deli turkey? I haven't given that to my cats in some time now, but when I used to make turkey sandwiches regularly for myself, they would cry and cry until I gave them each a little bite of turkey.

many deli meats contain corn glucose (syrup) as a preservative/ flavor sweetener enhancer or starches as thickeners - it is best to check the ingredient list before sharing it with Boots. HERE is example overview of some popular deli meat brand.

 

[spuds151]

many deli meats contain corn glucose (syrup) as a preservative/ flavor sweetener enhancer or starches as thickeners - it is best to check the ingredient list before sharing it with Boots. HERE is example overview of some popular deli meat brand.

I usually buy Dietz & Watson Gourmet Lite Turkey Breast. Their ingredients and nutrition label are right on their website. It looks like it would be okay I think...

INGREDIENTS: Turkey Breast, Water, Contains Less Than 2% Of Nonfat Dry Milk, Salt, Sodium Phosphate, Potassium Chloride. Browned In Canola Oil.

 

[Toro & Ovi]

Boots is currently eating Friskies pate - 1/2 of a 5.5oz can in the AM and PM. I have taken away all dry food and treats since Saturday (much to the dismay of my 3 other cats).

Funny.
Friskies Pate will probably work as has under 5% carbs. You can try some Fancy Feast Pate, too - same manufacturer as Friskies - FF have even less carbs (0-3%).

 

[MrPawsKitten]

Just starting out here too... glad you it a SS set up for Boots and found your way over here!

Paws started at 500+ on day of diagnosis, we eliminated dry food, and gave him 1U Lantus 2x daily... he bottomed out at 55 five days later, when I panicked and let him have about four bites of dry food - back up to 524 after 10 hours, then all the way down to 42 after another 16 hours where I had to intervene again with Fancy Feast gravy. Roller coaster ride the past 36 hours here!

So yeah, dry food can dramatically affect things....