Newly Diagnosed

Hello. I'm new to this and had a question I thought someone here might be able to help with.

Our cat, MeowMeow, was diagnosed in late November 09 with diabetes. He started insulin in December and his numbers were all over the chart. So after looking on this board realized the Vetsulin our vet initially prescribed probably wasn't the best bet so since then he has been on Lantus (3u. twice daily) Since being on the Lantus his numbers stay in uppper 300's to 500's. He was initially diagnosed with only results from blood work. No other test were done. So my question is can diabetes be diagnosed with blood test only and what is the likely hood that he could have been misdiagnosed?

MeowMeow was a 14lb active cat. He is 11 yrs old. When diagnosed he was down to 8.5lbs and very lathargic. Any advice you might have would be greatly appreciated. Thank you in advance for your time.

 

Hi and welcome!

We need a bit more information from you before we can responsibly answer your questions, so please let us know:

Weight loss and lethargy can have many causes, was MM also ravenously hungry while losing weight? Peeing rivers?

Was the blood test a fructosamine? If so, it is definitive for diagnosing diabetes. If not, what other tests were done? Was MM checked for any other conditions?

Are you testing blood glucose at home? If so, would you please share your numbers with us. If not, please be aware that stress often levates blood glucose so tests taken at the vet clinic are often erroneous.

What was the starting dose of Vetsulin? Was it increased? On what basis? What was the starting dose of Lantus? Have you increased? If som how and why?

What are you feeding? Have you read www.catinfo.org , the source of the most balanced information on feline nutrition?

 

Yes he was very hungry, drinking a lot, peeing a lot. I am not sure what kind of blood work was done but our vet suspected diabetes and tested for that. No other test were done or conditions checked to my knowledge. His urine has never even been checked.

We are testing at home and our vet said just to check it once a week or whenever we thought it necessary and adjust his dosages based on that. I realize that this is not adequate however we do the best we can. He doesn't like the test and it takes two of us to test him. We test using his ear.

His vetsulin dosage started at 1 unit 3 times a day. Increased to 2 units twice daily which brought his numbers to 250 but the went back up to 336 so the dosage was changed to 3u in the am and 2 in the pm. Then he went up to 481 then down to 79. The vet then changed dosage of vetsulin to 2u and 1u.

We switched to Lantus 1-23-10 starting at 2u twice daily. Where his numbers stayed between 400 and 494. On 2-5-10 his dosage was upped to 3units twice daily and his numbers have been 477, 378 and 510. We test him 4 hrs after his a.m. dosage.

He is eating Wellness Core dry and Friskies can. It seems whenever his behavior changes for the better his numbers are higher. He is not drinking and peeing excessively but he still eats a lot.

Thanks again for your help.

 

I cannot give dosing advice but want you to know you are in the BEST place to get this undercontrol. Please listen to the advice given. These people live in the trenches with this disease. It is manageable.

Welcome to the best site on the planet!

Jeanne

 

Hi and welcome to FDMB :mrgreen:

Ok, your on what I would consider to be one of 'the' insulins of favour :mrgreen:

Got to try and work this order out right-

You need to go to pharmacy and get ketodiastix (urine sticks). These test for something called Keytones-life threatening to kitty.
Do you have any bg numbers you can share?
I would say (though I am saying this without any numbers from you) that you need to cut dose back to 1u BID (Term used for twice daily)
This is the usual starting dose recommended here, regardless of the insulin being administered. This is to ensure people (k/a beans) don't miss kittys ideal dose (lot of cats here on less than 1u BID)
However, at same time, must check with ketodiastix (one big reason cats get keytones is through lack of insulin so have to test for until kitty regulated)

When drop to 1u, imeediately (not before) stop wellness core.

Dry food is terribly high in carbs, which is what raises bgs so high (and probably the biggest factor in kitties becoming diabetic)
If you look at the top, you will see Janet and Binky's foodcharts. Go through these andlook for LC foods with less than 10% carbs (my preference is less than 5%-only cos that's what kitties get from natural food source, mice)

You musn;'t stop that dry until you cut dose as that could be the only thing that is keeping kitty's numbers up.

You need to test bg before each shot, +1 would be helpful (will show you how much food effects their bg). then +6. This is usually the nadir for Lantus (lowest number seen in the cycle)
With Lantus, you base your dose on the nadir number NOT the preshot number.
Then, I would go and look in tech forum and follow instructions for setting up spreadsheet-easy to record kitty's numbers, it's in colour-great reference not only for you but those that will help you with dosing etc. We find a lot of vets sadly just don;t have the knowledge and with Lantus they dose like they do with vetsulin. Vetsulin short acting, Lantu long acting, toatlly dofferent way to use properly.

Then come and post in Lantus Insulin support group (ISG)
Can also go in LL ISG and read the stickies at the top-will give you lots of good info on how Lantus works and how to use etc.

You've come to the right place :mrgreen:

 

I think the very very most important thing you need to do FIRST, is to get comfortable with home glucose testing. It is not really hard at all for most of us, once you learn some of the tips of the trade. PLEASE see our Health links at http://www.felinediabetes.com/FDMB/viewforum.php?f=14

also there are videos online that might help you learn home testing. This is SOOOOO important. If you and kitty are so stressed you may not really be getting a true picture of his status.

I dont think you mentioned which meter you use for testing. Some meters require much less blood so it makes testing a lot easier. Possible meters you might want to consider would be:

- the Walmart brand Relion MICRO which uses a tiny bit of blood and the strips are very reasonable.

-Another even less expensive option, which I am now using is the Maxima which is available online through Hocks.com (see the green box link at the top of this page). It uses .5 microliters (and I think the Relion uses either .3 or .5) . I just bought meter and 100 strips for less than $40. Replacement strips are $16.50 / 50 strips.

-The One Touch ultra, as a comparison uses 1 microliter, which is a pretty big drop of blood, however it is also favored by some and reportedly accurate. Strips are pricey.

-Some folks warn against certain drug store chain meters with True... in the name, due to accuracy I believe.

As soon as you get more comfortable testing, taper off the evil dry food. Yes, it makes a huge difference in BG. It is important to know how to test, so you can make sure kitty is safe using insulin when he stops getting the dry food.

Welcome and please keep checking us out. Many here can help you!

 

The most important thing you need to know is that insulin doses are never adjusted based on preshots or even less frequent testing. The important number is the nadir, the lowest number of the cycle. Unless you know how low MM is going you don't have the most vital information you need to judge increases.

I'm sure your reading here has shown you we test before every shot and take spot checks to track the action of the insulin. When you chart this data you have the necessary information to make adjustments. If you increase without it, blindly, that is, you are at huge risk for rebound, It's possiblel that's what's happening to MM right now.

You don't say how long you stayed at each dose before increasing. All insulins need time to settle, meaning no changes for a week to 10 days. And when changing insulins it's best to go back to .5 or 1 unit, by starting at 2 units you may have been too high since starting the Lantus.

Lantus works differently from other insulins and the Lantus forum in the Insulin Study Groups is the best place to get detailed advice on its use, it has been too long since my cat used Lantus to advise you in detail.

 

(Sorry about making this two posts, but this board is cutting off my answers. As I was saying...)

As for testing, it always took two of us to test Quirk, it became a family bonding time. I want to stress that without the testing we would not have known that he had gone into remission, there's your carrot.

Take the time to read our FAQs and ask the Lantus folks about rebound testing. And please keep us updated on MeowMeow's progress.

Gia & Quirk (GA)

Guilt trips are a detour from life

 

Thank you all for your help so far. I purchased a new meter today, relion micro, which only needs .3 microl of blood and actually managed to do a glucose test without needing a second pair of hands. I will decrease his Lantus dose tonight and then eliminate the wellness core he has been eating. I plan to try more frequent test and go from there. Thanks again. I will keep you posted.

 

Dry has more condensed calories, so be sure you increase the wet food quantity a lot, and leave it available especially if you aren't keeping an eye on him. Some cats need to transition off the dry in stages. Just keep a close eye on the testing THROUGH the cycle at intervals, not just preshot, so you have an idea that his numbers are safe. It will drop his numbers

Have you read the Health links at viewforum.php?f=14
Print the hypo info now so you have it ready. Cats have gone into hypo by dropping the dry food without adjusting the insulin.

Next steps:
- start a BG spreadsheet so we can see exactly "what and when" in order to advise you. Go to the Tech forum to find directions to do this. viewtopic.php?f=6&t=16

-find your way to the Lantus ISG (Insulin support group) which is where you can find out more about Lantus and post your test details to adjust your dosing. viewforum.php?f=9

-Test for ketones in his urine. Go to ANY pharmacy window and ask for ketosticks. You do NOT need a prescription. They cost about $14 for a bunch (50?) Stalk him in the litter box and try to wet a stick in the stream (fresh urine) count exactly 15 sec and compare the color on the bottle. Presence of ketones above 'trace' means stop everything right now and go to the vet.

At a pet store buy dehydrated 100% chicken breast treats to use as a reward for testing.

Good job so far! We want to help so check back

 

Yes, please give us more information.
How are things?

What BG test results are you shooting? Did you give insulin today? What was his level before you gave insulin and before eating?

 

VERY, very good advice, Nancy.