UPDATE for Tiger

Hello. I'm having a difficult time with trying to get my 9 year old cat regulated. When the vet first advised me that my cat had diabetes, he informed me of the treatment course he wanted to take. Please keep in mind that I've been going to this vet for 30 years and he has earned my trust. He suggested that I start out with NPH, which he did for 3 weeks, going all the way up to 20 units and my cats numbers still hovered around 300-400. The vet said he didn't like being at those high of numbers, so he waited a week and started on Vetsulin. He informed me about the drug being taken off the market, but said he could still get some because my cat was considered hard to regulate. So for the past 9 days the cat is on Vetsulin. The vet did 2 units a day increases and his numbers would end up falling to the low 300's, but would shoot right back up to around 700 by the next day.

So after a phone call with the vet today, he's told me that he thinks it might be pancreatic cancer. Well, obviously this upset me a great deal. Which brought me here. I'm not convinced that it's cancer. I personally think it's part the food, and the stress of having to stay in a cage all day for weeks at a time.

I have a total of 4 cats and I free feed them Hill's Science Diet indoor formula. When the cat in question (Tiger) was a younger cat, he had 2 UTI's in a row (within a month of each other) so I switched to the Science Diet as the vet told me it was lower in magnesium and ash, the cause of the UTI. Anyway, he said something about switching him over to W/D I think it was, but said since the other cats still free fed that it was best to keep him on the Science Diet. Well, now I'm starting to doubt this.

Here's what I want: to do whatever it takes within my means to get this cat well/regulated/happy. Thursday I am scheduled to go back down to the vets where I will tell him that I want to learn how to draw blood, do the strips, how to give the cat the insulin, and regulate him myself on better food and a less stress free environment. I've done some quick reading at this site regarding regulating, the hard to regulate, the food to feed them, etc. But it's all so overwhelming and I'm having a hard time taking it all in. So if someone out there has ran into this sort of problem, any advice or information would be greatly appreciated.

Please let me know if there was some information I missed or if there are any questions. I want to understand all this and I want to help my cat. Thanks to all who read this.

 

Re: New guy with questions

ohmygod_smile I have been here about 6 weeks .You have to do lots of reading Here is the place to help your cat with out all the stress of putting him in a cage..Put Help in the subjest line and what his BG is and you will get the best help ever.My vet want to start my cat off with 3 units of Lantus by the way the best insulin I think...Read the little stickes and talk to the people here They can do more for your cat them I don`t want to say but they know more then the vet ...So put ADVICE HELP in the subject line ok Do it now.... :mrgreen: Kath I have 4 cats all off the dry and onto the can for life....You have to do this a little at a time but dry food is most likely what is causing a lot of the high numbers

 

Re: New guy with questions

Hello. I am posting this in the acromegaly, cushings group that have high dosers like yourself and a lot of experience.
There are other reasons for needing a high dose if that is what it takes. Has your cat ever experienced a hypo event?

Please also post on health and put in your heading 'high dose questions please'.

Hang in there...you are in a great place for support.
Here is the group of high dosers..have a read through of the info and do introduce yourself there
viewforum.php?f=12

Kimmee

 

Re: New guy with questions

Hi - I had a high dose cat - he had a condition called Acromegaly that caused insulin resistance by flooding the body with "Insulin-like growth factor".

He just plain needed more insulin than usual.

There are a couple of other conditions - IAA Insulin autoimmune antibodies (where the body is attacking the insulin) and Cushings (affecting the adrenal glands)

There are simple blood tests for diagnosing Acromegaly and IAA -- both are done by the lab at Michigan State University. (the ONLY lab in North America that runs these tests)

Have your vet contact them directly to order these tests -- will save you a lot in "middle-man" costs and time.

The dose increases were done WAY too fast, but the very fact that your kitty was getting 20 units and not going into a coma/seizures may indicate that he does have one of these conditions.

Your vet probably does not know how we get blood for the glucose check -- he probably taps a vein, which is complicated and un-necessary for our home testing.

The human glucometers that we use are designed for Capillary blood -- NOT vein blood. We prick the edge of the ear for a tiny blood sample. Watch the videos online.

Also -- where do you live? (post city/state only)

Someone here may be able to meet you and demonstrate the technique.

Hang in there!!

 

Re: New guy with questions

Sorry wish I could help you Prayers and Angels coming to help you and your baby Kath

 

Re: New guy with questions

Hello, sorry for my absence, been under the weather.

I went to pick my cat up from the vet's office today and told him that I wanted to take the stress of being there and change him over to wet food and see if those things would help. He showed me how to get the blood out of his arm, but as indicated above that is unnecessary? The vet mentioned something about the ear, but said it wasn't as effective a reading. Please clarify. Also this morning after 22 units on a u40 syringe, he's BG was 324. But as he pointed out, that will shoot up to the 600-700's quickly. He's also giving that to the cat twice a day. He gave me less than a half bottle of Vetsulin, which doesn't seem to me that it will last that long.

Also, I haven't went out yet today to get a meter and strips. Someone mentioned that I can use a human tester and strips? Is there a brand I should look for and will will like CVS carry it? I saw on petmeds.com that there is a specific meter with a glucode chip for dogs or cats. Will I need something like this to get an accurate reading?

I live in Indianapolis, IN (south side) and will be happy to share my number if someone would rather call than type. Please PM me if that's the method you'd like to use.

Also in regards to cushings or acromegaly, I looked those up and they both indicate weight gain as a symptom. What prompted me to take the cat to the vet to begin with was he lost a lot of weight. Went from 13 pounds to 9 and looked very emaciated. As for the high units, he actually seems more himself after the does (at least on the times I visited him) so maybe a high dosage is for him. Why nothing in my life can be common is beyond me. LOL

Thanks to everyone who commented and for the support that you've shown.

EDIT: As mentioned I want to change his diet to a wet cat food. Now, the vet said to give him the 22 units twice a day, and as I understand it, switching to wet food that is low in carbohydrates will cause the BG to lower naturally. If that were to happen, I would think that 22 units would be too much, and as I understand it, too much insulin is worse than not enough. Also, since vetsulin is having these issues, should I go back to the NPH and just start completely from scratch? I simply cannot afford the Lantus.

 

Re: New guy with questions

I am in Canada my cat is on Lantus and I use a meter for people I have Free Style Lite here if you buy 100 strips we get our meter free and yes it don`t matter it works for both humans and pets only thing is to always use the same..I think anyway. Also just poke the side of the ear warm it up first you can see a video of this here ok Wrap your kitty in a towel if you have a problem warm the ear poke and test . Very easy once you get the hang of it..Hometesting is getting my Trey into remission Hope this helps...Also put ADVICE in your subject line and you will get more help OK Good luck Kath

 

Re: ADVICE for Vetsulin and other questions

Hi Brian -
Glad you made it back --

When I changed my acrocat Norton from dry food to low carb canned, his insulin needs went from 13u BID down to 8u BID. It would be a good idea to learn to test blood sugar at home.

By the way -- a human diabetic has mentioned that Lantus stings when injected cold -- so we recommend that HIGH DOSE cats use Levemir instead of Lantus.

Do a cost comparison of insulins, ok?

I buy Levemir from Canada (I live in Michigan, so Ontario is about 35 miles away) and a 5-pack of 3ml cartridges cost just under $120 at Walmart.

I have been able to use a 3ml cartridge completely -- it doesn't poop out as early as Lantus.

So.... at 22u per day, a cartridge should last you about 13 days -- and a 5-pack a bit over 2 months (65 days).
Levemir = $120 for about 65 days
from www.canadadrugsonline.com: it lists $160 for cartridges and $115 for pens


Humulin NPH costs ~$38 for a 10ml vial (1000 units) but it doesn't last 12 hours in most cats. Would you be able to inject 3 times per day TID? or every 8 hours?
If that is a viable option, a vial of N would last ~22 days (assuming the current dose)
Humulin N = $114 for about 66 days

I don't know what Vetsulin costs, but I understand it is difficult to find now.

RE: Testing
Personally, I like the MAXIMA AST meter from www.hocks.com, which ships from Indiana. (I've never seen the meter in a store)

The "Pet" meters are just marked up for the gullible. IF you were testing BOTH a cat and a dog, it MIGHT be useful to switch between. Since you only have a diabetic CAT -- stick with a human meter -- much less expensive. Cats blood sugar range is pretty much the same as humans.

These human glucometers are DESIGNED for use pricking a finger for capillary blood, so your VET is wrong about you needing to hit a vein.

My cats-only vet uses a human glucometer in her practice. She charges ~$10 for a blood glucose test (includes mini-office visit - walk in, test, walk out)

RE: WEIGHT GAIN
Your kitty will not gain weight until he is getting enough insulin. With inadequate insulin, the body is eating itself to survive - hence the weight loss.

When Norton was first diagnosed in 2006, he had lost 2 pounds in 2 months --- went from 14 to 12 lbs.
We started insulin (Humulin N) and started at 1 unit BID. We went to the vet every week for a blood sugar test at "peak" time (6 hours after injection for Norton) and adjusted the dose upward as needed.

When we got to 10u BID (approx 10 weeks after dx), he was feeling better and had gained the lost weight back. The dose increases were slower then, and we eventually got up to 13u BID (feeding dry food). Norton got up to 16 pounds.

So... between the first and second months after dx, he regained the two pounds he had lost. Over the next 10 months post-dx, Norton gained 2 more pounds. (no gain first month, 2 pound gain second month, etc)

RE: STARTING OVER
There is a risk with big dose reductions that the kitty will start to produce KETONES (test urine for presence using Keto-stix from human pharmacy)
Presence of Ketones is serious and can quickly escalate to a life threatening condition called Diabetic Keto-acidosis requiring hospitalization.

Are you on Facebook? Many of the acro-humans are more active over there, and I would be happy to introduce you.

Some Acro-"beans" (short for human beings) give their cats two different insulins -- "R" is used by vets to quickly reduce blood sugar. It is only in the cat for about 3-4 hours. The second insulin (injected at the same time as the R) kicks in later -- when the R has taken affect and reduced the blood sugar some already, so the second insulin does not have to do as much work.

"R" costs ~$45 for a 10ml vial, and most don't need to use much. Biggest cost is using 2 syringes, as re-using a syringe can contaminate your insulin vial. (my syringes cost $17.49 per 100 from www.hocks.com)

Another point ---- This forum does not get much traffic -- you will probably get more eyes posting in the Acromegaly/IAA/Cushings Cats forum. You will get a LOT more eyes posting on the HEALTH forum, but prepare yourself for people to freak out at your high dose.

Kimmee cross-posted in the Acro forum, which is how I found you here.

 

Re: ADVICE for Vetsulin and other questions

Hi Brian,
Switch to Levemir; you will not be sorry and you will have a much happier cat with way better numbers.
Testing on the ear is the most common spot used by people. You don't need to take from a vein. Here's one of many sites online to help you.
Testing on cat’s ear

All sorts of meters you can get at your local pharmacy; many people use Relion and also OneTouch or Bayer or any number of types.
With such a high dose, it may be a good idea to be testing already before you switch over to wet foods from dry because the BG numbers may drop alot and you want to know the changed numbers before you switch.
You have seen the warnings on Vetsulin, yes?
Lawsuit against Vesulin Manufacturer
Vetsulin FDAs Warning December 15, 2009


So, once you have switched to wet food, and over to a longer lasting insulin like Lantus or Levemir, you will see if the dose is still as high or if it's alot lower.
Another reason for using Lev over Lantus is that the guarantee for Lantus once open is approx 28days, while Lev is more like 42days.

There are a couple tests you can have done to test for acro and IAA insulin resistance:
IAA Test
IGF-1 (Acro) Test

As was already mentioned, if you are on facebook, there are several other people with acro cats who can help you with tips and stuff. if you are, let me know and you can add me if you like.

 

Re: ADVICE for Vetsulin and other questions

You folks are a wealth of information. Thanks to everyone who's replied.

Considering the cost of switching to Levemir as pointed out in your posts, I think I will switch. I was under the impression from my vet that it would cost around $140 a month, instead of the approx $80 a month, which I can afford better (assuming I go with the 5 x 3ml cartridges). Now I just need my vet to give me a RX for it. Do they sell it at wal marts in the US? Will they take a RX from a vet?

In regards to switching: Since my cat is already at a high dose, should I "ween" him slowly before switching? During the first 3 weeks at the vets while on the NPH, he was at 20u by the end of the 3rd week. The vet told me to take him home for a week to get the insulin out of his system. So he went from 20u a day to nothing the next day and for a week. Someone advised of ketones and that they are bad. Would slowly tapering off prevent this and should I wait a week after getting him off vetsulin before starting him on the levemir?

I am also on facebook as Brian Gossett (indianapolis) so feel free to add me. Please put a note in there about from where I know you from. Is there a group I can join there?

Also, I have read some more of the articles on this site about testing, and when to take tests, and when to feed, etc...to be honest my head is swimming. It's like learning a new language! So please be patient with me if I ask the same question again. I promise it won't be on purpose, its just a lot to take in so fast.

Thank you all again for your help and advice. I feel I've gotten further here than with my own vet.

 

Re: ADVICE for Vetsulin and other questions

Some insulins do stay in the body longer -- but not Vetsulin or Humulin N. Both are mid-acting (not short, not long) Cats metabolism is about double a human's or dog's, so Vetsulin and Humulin N last less than 12 hours in cats. Lantus, Levemir and PZI last longer than 12 hours, so we take advantage of the overlap -- injecting the next shot before the insulin is completely gone.

It is safe to give the last shot of vetsulin one day and start a new insulin the next day.

Lantus and Levemir do build up and stay in the body longer.

If you are willing to test for ketones and blood sugar, you can start at a lower dose. If you see ketones show up, increase the dose.

Ketones are treated at the vet with "R" insulin which in emergencies can be injected every few hours.

It is good to do a curve for your cat to see how he uses the insulin because "ECID" every cat is different.

We have a group on facebook "Feline Acromegaly"

And a website - similar to FDMB
http://catacromegaly.com/acmb/viewforum ... 76c5341e53

 

Re: ADVICE for Vetsulin and other questions

Hi Brian! I live in Bloomington - just down the road from you, so if you need any advice or home testing demonstrations, I can help you out.

I too agree that increasing insulin up to 20 units in only 3 weeks is insane! Dose increases in any insulin shouldn't be done in any more than 0.5u increments in the beginning (especially) - to think that your vet increased by 2 units every few days nailbite_smile

With your kitty on that high of a dose I would really really push for a test for acro or insulin auto antibodies (insulin resistance). If those come up clear, then it will be clear that kitty is on too high a dose and is in constant protection mode.

Welcome to the group! We'll help you get things figured out soon

 

Re: ADVICE for Vetsulin and other questions

Some links for you:
New to the Group

Tight Regulation Protocol
LANTUS & LEVEMIR – INSULIN DEPOT –AKA- STORAGE SHED
Lantus&Levemir – Data Ready to Shoot Low Numbers

List of Hypo symptoms
How to treat HYPOS – They can kill! Print this out!
Jojo’s HYPO TOOLKIT

That's a good start for you.

 

Re: ADVICE for Vetsulin and other questions

I think I did ok today. I was a little nervous about giving him his first shot (done by me), but it seemed to go smoothly. I even went out and bought a meter with some strips and lancets and drew blood on his ear, instead of his vein like the vet told me. I got a MUCH lower BG than the vet was telling me, 169, and that was 4 hours after I gave him the 22 units of vetsulin. The vet always said he was in the 300's. I wonder if I did something wrong.

That's my biggest fear, that I will screw something up and result in his death and it will be all my fault. Makes me appreciate what others go through with this illness. The only reason it took me 4 hours to test his BG was because I was scared. I finally knew I could put it off no longer, and to be honest, he flinched but didn't get up or run, so I guess it was ok. It's just that 169 reading made me unsure if I did it right.

But, other than him looking at me like he's going to pee on everything I own for the last month of staying at the vets, he's no worse for wear. He's a great cat. He was born in the bushes outside of my work, and the ladies in the office begged me to go rescue him before he got hit by a car or something. Sadly, one of his brothers or sisters got ran over already. It took me over an hour to coax him out with some McDonalds bacon to where I could nab him from behind. When I finally caught him, he clawed my hands up something awful!! I quickly opened the car door and tossed him in and shut the door.

He managed to crawl up inside my dashboard as I was driving home. After a few hours, I finally got him out of there, wrapped him up in a towel, and took him into my room and shut the door. I put some milk and food out and went back to work. That night I got home and he was hiding under the dresser. He had drank the milk and eat some food and even used the litter box! I was impressed. But he would NOT come out from under that dresser and hissed his fool head off.

I went to bed that night and closed my door so the other 2 cats and dog didn't come in and make things worse. I was woken up at 5am that morning to a tiger kitten kneading my chest and purring so loudly and rubbing up against my face. I knew he was going to live with me at that point. He's been the best cat ever since. So yeah, this one has a soft spot in my heart.

Sorry for the ramble, but it's late and I'm tired. Just thought I'd share. Thanks again everyone for your continued support. And Gayle, thank you for the links and the FB information. And Kelly, thank you for the offer to come up. Let's see how things progress tomorrow and if I keep getting numbers that don't match up with the vets, then I may take you up on that. The again, maybe I was right and reliving the stress of being at the vets made his numbers go down!

 

Re: ADVICE for Vetsulin and other questions

Congrats on the first of many ear pokes You did really good Brian you are on your way to helping your cats have a nice long life...Hometesting is the best thing we can do for our kits..What a beautiful rescuit story. Thank you for sharing I loved it. Hope you get to have a good rest Angels & Prayers coming to help at your home and surrounding your tiger kitty with beautiful green healing light .... :mrgreen: Kath

 

Re: ADVICE for Vetsulin and other questions

Brian,
You are not doing a single thing wrong.... your vet says kitty is in the 300s? and just how would your vet know that? By a single test or a curve while kitty is all stressed at the vet office?
Nope your number sounds fine and you see how easy it is to test by the ear.

See what spot checks you can get; I don't know exactly how Vetsulin works if you would see a drop at a sooner time but get in some practice and you will be feel better soon.

 

Re: ADVICE for Vetsulin and other questions

Good morning! After testing Tiger he was at 225, and that's 12 hours after the last 22u and him still free feeding. Not that I wasn't before, but now I'm even more concerned of the 22u twice a day. It's just these numbers are so much lower than what the vet was telling me, but then again he was doing vein taps. If at the vets office, he's probably be in the 500-700 range at this time.

I hate doing this without waiting for replies, but less is better than more. I'm going to reduce his shot to 15u and monitor throughout the day. I'd really just rather start from scratch, but I don't want to cause him more harm. I will call the vet today and see about getting him a rx for Levemir.

 

Re: ADVICE for Vetsulin and other questions

Great decision -- let's see how he does on 15u.

The BG (blood glucose) numbers that you are getting are great -- definitely the higher numbers at the vet are from stress.

If he goes below 100 today, then REDUCE the dose more -- maybe a lot more -- depends on your comfort level.

If his blood sugar goes UP from the reduced dose (15u), then he may really need the higher dose.

Congrats on joining the vampire club with your first home tests!

I'll PM you my phone number. I work 8 to 6 EST M-F but fairly flexible -- if I don't answer, I may be in a meeting or just away from my desk. Best bet is to ring me without leaving a message first. If I heard my phone ring, but just didn't make it in time, I'll call you back within a couple of minutes. If I don't call you back within ~2 minutes, either text me or call again and leave a message.

 

Re: ADVICE for Vetsulin and other questions

After I tested and dosed him this morning, I fell back asleep and didn't wake until just now. Quite unusual for me. Anyway, this was the first opportunity I had to test him, and 4 hours after he was at 165. Still far better than at the vets. I'm thinking I should call the vet and tell him either his monitor doesn't work correctly, or he should change to ear pricks instead of drawing blood. I can't imagine stress would cause such high numbers.

I think reducing the dosage was a good idea.

 

Re: ADVICE for Vetsulin and other questions

Stress can absolutely cause high numbers -- that is why we highly recommend that people learn to test at home, and take personal control over diabetes treatment for their kitty. It can be stress due to dogs at the clinic - it can be stress from people that your kitty doesn't like - it can be stress from living in a cage and not having any love.

Better to not start an argument with your vet - likely to just end up looking for a new vet.

These good numbers tell me that your kitty is responding nicely to the insulin.

If in REBOUND from too high a dose, you would be seeing 300+ at home all day long ALSO, because the liver is dumping extra sugar to soak up the overdose.

So.... while the dose is very high, it looks like your kitty does need it.

When I changed the diet, I did it gradually with Norton -- adding some Fancy Feast while he still had crunchy food available. Then changing the crunchy food from Science Diet (very high carb) to Wilderness (18% carbs) and then to EVO (8% carbs). Also gradually adding more canned food too.

 

Re: ADVICE for Vetsulin and other questions

Looks like you are heading in the right direction Keep up the good work Kath

 

Re: ADVICE for Vetsulin and other questions

Great progress so far! Vet stress can cause BGs to raise that much - it happens all the time and that's why we don't advocate basing dosing off of those stressed readings.

Those are great numbers! I wonder if he would do just as well with even less insulin. Have you thought more about the acro/IAA tests?

 

Re: HELP!!! Sudden low numbers

Food change to wet and decrease from 21u to 15u still seems to have resulted in a nice drop, if a bit scary.

If the diet change has resulted in such a quick drop, what would be a good decrease for his pm shot?

I am not familiar with Vetsulin and know it does not last as long, but that's about it.

Any suggestions on tonite's dose? I sure don't know.

 

Re: HELP!!! Sudden low numbers

Sorry if this shows as a repost, I refreshed and it wasn't there.

Last night I switched over to wet food from dry food. I gave my cat 15u at 8pm and by midnight last night he was at 159. I woke up at 4:15 and tested again and he was at 187. I woke up at 7:45 and tested, he was at 340. 15 minutes later I gave him 15u. Tested at 12:50pm, 5 hours later, and he dropped to 49. Tested again at 1:14pm and was 43. Gave wet food with a few pieces of dry mixed in, and some honey. He ate like a champ, and doesn't have any symptoms. Tested again at 1:35 and still at 43. He acts fine. Cleaning himself now after eating still more wet food.

I'm concerned about what I should give him tonight at 8pm. Currently I'm doing twice a day until I can get a better understanding of what's doing on with his BG. Please advise!

7/23/10 - dry food only
12am - 169
8am - 225 gave 15u (down from 22u the day before)
12:30pm - 165
3pm - 182
6:30pm - 247
7:45pm - 448 gave 15u at 8pm
Changed to wet food for the rest of the night.
*********************************************
7/24/10 - wet food only
12am - 159
4:15am - 187
7:55am - 340 gave 15u at 8am
12:50pm - 49 - gave more wet food with a few pieces of dry mixed in
1:14pm - 43 - gave honey
1:35pm - 43

He's sleeping and alert as I just clicked my tongue and he looked up. Any ideas?

EDIT: Just tested again at 2pm and went up to 46.

 

Re: HELP!!! Sudden low numbers

Wow! That's about all I can say about that drop right now! Holy cow ..... decrease is definitely in order, but I am trying to think of what might be an appropriate decrease. It will heavily depend on how high he gets up to by shot time too. I think if you see a pre shot value above 300 I might try taking it down to 10u since you saw such a drastic drop. If it is lower than that at shot time, then I don't know. I guess we'll have to play that one by ear. Also, be prepared for the possibility of a little bit higher numbers for the next cycle or so because of how low he got. Some cats rebound, and some do not.

 

Re: HELP!!! Sudden low numbers

Hi Brian -
Wow!
since Tiger is at mid-cycle now, he should start going up

It's a good thing you started testing. A decrease is definitely in order.

Is it possible to test Tiger's urine for ketones? If yes, you may want to start over at 1 unit BID. If ketones develop in the urine, then more insulin is needed.

The very fact that Tiger is "surfing" a long time in the "greens" (the Google spreadsheet shows numbers below 100 as "green") indicates that he is NOT experiencing REBOUND.

So -- how much of a decrease - we need more data on Tiger for the definitive answer.

Thoughts to consider:
1. having given him some honey mixed in today, don't fret if he goes back to the 400's tonight at shot time --
2. we don't know how Tiger reacts on smaller doses (based on home testing)
3. The 40's are a scary place to be -- not dangerous in itself, but right next door to it... definitely need to reduce the dose
4. a risk with large dose reductions is that Ketones will develop, which require treatment with a fast insulin "R"
5. your vet increased extremely fast - to get to over 20u in 3 weeks is too fast. The "right" dose was jumped over.
6. a risk with too much insulin is Hypo - Tiger has been amazingly resilient to these doses, so he may need more than the "average" cat

sigh - that didn't do much, did it? I guess the point is, it is a guessing game right now -- as you build up data, it will really help with making these decisions.

Well, 15u is too much with the low carb food.

Want to cut in half again, and try 7u BID? Or as Karen suggests 10u?

If you were first starting out, we would recommend starting at 1u BID and see how it goes from there.

That said -- I have had 3 diabetic cats -- the first was high dose Norton, now gone ahead (GA) -- and now Tiggy and Rusty. Tiggy and Rusty each need less than 1u BID. "Typical" diabetics.

By the way -- we happen to be in the same time zone, but most people are not -- so common practice is to post in terms of shot time (which is randomly different for everyone)

For you, that is 8 am/pm.
so 8 am would be AMPS (morning pre-shot blood sugar test and injection time)
then your next test would be posted as +5 (hrs after shot)

Gayle is also in the same time zone...

 

Re: HELP!!! Sudden low numbers

I will make a decision on how much to lower the dose when it gets closer to 8pm EST. I will test at 7:45pm and post for those around. If someone is around and can suggest, great. If not, I will go with my gut.

 

Re: HELP!!! Sudden low numbers

I can't suggest dose, but if you want to go with your gut and lower it - then do it, better too little insulin, then too much you know.

you asked about where to get insulin - any human pharmacy will sell it and yes they will take scripts from vets. you just have to give the pharmacy your pet's info so they can start a record the pet.

hopefully someone will come by to give more specific dosing advise.

 

Re: HELP!!! Sudden low numbers

Hi Brian,
First of all, GOOD FOR YOU for taking control of your Tiger's diabetes care. I read in your first post that you have a good relationship with your vet. That's terrific news! I don't want to sound like a negative nelly, but the truth of the matter is that for the 2.5 years that I've been a member of this board, there are far far FAR fewer vets who are up to date on the treatment of feline diabetes than we would like.

1) food- did someone point out Dr Lisa's website?

2) You might want to set up a spreadsheet for easier tracking of Tiger's progress. Instructions found here.

3) Here's a chart that shows you what the BG numbers MEAN. Non diabetic cats range from 40-120.

4) You might also want to read about the handling of Levemir. It works differently from NPH/Vestulin/PZI.

ps. You can get strips to test urine for presence of ketones. If Tiger has really been spending that much time above the renal threshold, I would check him. However, your tests at home so far seem to indicate his high BGs were maybe not as high as they seemed. Still a good tool to have at home.

Good luck! I love the story of how you saved Tiger and how you won him over (or, how he won YOU over).

 

Re: HELP!!! Sudden low numbers

His BG is 228 at 7:45pm EST. I will wait for some replies, but I'm thinking going to 10u from the 15u he had this morning.

 

Re: HELP!!! Sudden low numbers

Brian,

hopefully you saw my post over on health at http://felinediabetes.com/FDMB/viewtopi ... 28&t=20451 . I do not believe there is any reason to suppose your cat needs so much insulin. As long as you are willing to hometest frequently and to vigilantly check for ketones (I'd do it twice a day), there is no reason not to drop to the normal starting dose. The majority of cats do not need anywhere near as much insulin as even 5 units.

Why not do a trial right now with the 1u? We'll see if TIger is able to get decent numbers tonight and tomorrow. It would be great data upon which to make upcoming decisions.

laur

 

Re: HELP!!! Sudden low numbers

Brian,
You can go with 10u, but be ready to test and act if Tiger decides to go low again! Be sure you have lots of strips for testing.
You could also go with the 7u that was suggested - about half of the 15u.
And finally, you could also go with starting over, at 1u, but you would want to be testing for ketones as you may see some high numbers.

After his last shot, you pretty well know what to expect and do if Tiger drops low.
Hopefully others will be along to comment.

Hope all goes well on this shot!
And nice work earlier today!

 

Re: HELP!!! Sudden low numbers

I personally think the two best options with that pre shot number is to cut the dose in half (7u) or to start over at 1u. Start testing around +3 and I would test every hour just to make sure he doesn't go too low again .... especially if you go the 7u route.

 

Re: HELP!!! Sudden low numbers

I went with 7u. It felt right. I will continue to monitor him throughout the night and keep posting. Test every 2 hours ok? He's poor little ears are getting sore, he's crying when I do it anymore.

 

Re: HELP!!! Sudden low numbers

You can test him at +2.5 or +3 as not much should happen till then. If he goes low again, then it may be a very good idea to start from scratch at the 1u and see how he does.

 

Re: HELP!!! Sudden low numbers

Start testing at +3 and then test every two hours unless the number gets to 60, then I would test every hour until he is rising.

 

Re: HELP!!! Sudden low numbers

+3 hours is 104. I will test again in an hour or so to make sure. But regardless, I LOVE THIS NUMBER!

 

Re: HELP!!! Sudden low numbers

Be sure to give a small snack Good luck Kath

 

Re: HELP!!! Sudden low numbers

Post your numbers when you have them; I hope the decrease dose is going well

 

Re: HELP!!! Sudden low numbers

Looks great so far!

 

Re: HELP!!! Sudden low numbers

Ok, I'm not a Vetsulin user -- but on the same day as a hypo, I am finding Tiger's PMPS of 228 (was this BG before dinner, at dinner time, or after?) and then a +3 104 to be of concern. (dose was 7u)

Please get a +4 and let us know what it is. Have some high carb (such as a canned food with gravy) at hand.

laur

 

Re: HELP!!! Sudden low numbers

The 228 was before dinner. I fed him about 30 minutes after I gave him the 7u. I plan on testing him at +4 and maybe even +5 to be sure.

 

Re: HELP!!! Sudden low numbers

For his ears, you can use a bit of neosporin with pain relief. It helps them heal super quick.

Plus, are you staunching? While you wait for the meter to give you a number, use a tissue and apply pressure to the poked area of the ear. Helps prevent any bruising.

Also, are you giving a low carb treat after testing? My cat liked bonito flakes (which you can purchase at any asian grocery for cheap or buy the Cat Man Doo ones at pet stores for more).

 

Re: HELP!!! Sudden low numbers

+4 is 56. I am giving some carbs and will test again at +5.

 

Re: HELP!!! Sudden low numbers

This is what I thought was coming, especially since the +3 drop was so significant despite dinner after the shot.

I recommend a little syrup: karo, honey, real maple syrup, whatever. Please test at +4.5. We want to be sure the drop has stopped or significantly slowed down.

laur

 

Re: HELP!!! Sudden low numbers

+4.5 is 44.

 

Re: HELP!!! Sudden low numbers

Brian,

It helps to reward them after the testing. Many folks use freeze dried or rotisserie chix chunks as a reward.

For sore ears:
It really helps if you press firmly on the test spot for a few seconds immediately after the test.
Some folks use a bit of antibiotic ointment.

I really prefer a clear cap on the lancet pen, - hold it on the ear for a few seconds before and after you pop it, until you get a good drop. A good rub, or a warm sock help increase blood flow to the ear.

The ketone urine strips are available at any pharmacy without a prescription- you may have to ask for them. "Ketodiastyx" $13 /50

BTW I'm a mom of an acrocat- Cody, so I'm accustomed to high doses, but a couple things really make me suspicious about your guy. From what you see tonight and last shot, I would really like to see a start over at 1u, especially if/when you can get the Rx for Levemir. Do not shoot 7u tomorrow.

Levemir is less familiar to vets, so I might suggest you have the vet look on VIN (vetinary information network) for a feline internal med consultant named Alice Wolf DVM, who reassured my vet, that it works and is safe for cats.

Lev is a human u100 insulin, so there are 1000 units in a 10ml vial. Vetsulin is a u40 insulin, so it has 400 units in a 10ml vial. So, at first glance you might think vetsulin is cheaper per vial, but a u100 insulin will likely lasts 2.5x longer, assuming they both last until empty. I only give the vial example for comparison. On small doses the cartridges are best for staying "fresh'.

If it turns out that he was vastly overdosed and vet won't prescribe Levemir, you should be able to get Prozinc, a new FDA approved insulin for cats- It is far less intense than the steep drops typical of vetsulin - I'm surprised it wasnt suggested rather than vetsulin...

 

Re: HELP!!! Sudden low numbers

I strongly recommend you get some more honey into Tiger now. Offer some high carb food too, since the honey won't last very long. You might try offering some dry food and see if he will eat it this time.

laur

 

Re: HELP!!! Sudden low numbers

Definitely, its high carb gravy food with syrup time for sure- You will need to keep testing for several hours- pretty sure vetsulin lasts about 7+ hours, but at some point the numbers should keep rising

 

Re: HELP!!! Sudden low numbers

I gave him more honey and some dry kibble mixed with wet. He's chowing down now. He absolutely does not like honey. I will check him again shortly. I don't think I can stay up much longer, but will test before I go to bed. Definatly not 7 units in the morning. I guess I will just have to start over at 1u in the morning.

 

Re: HELP!!! Sudden low numbers

Usually when a cat has a hypo or near hypo experience, their hormones are very sensitive and they rebound up high the next day or 2. You are going to need to ignore that and shoot 1u until things calm down, and you get him stabilized on a LC canned food only diet. No more dry treats except in situations like tonight.

It is still possible that he is an acrocat, because the pituatary tumor hormone output fluctuates, and if it drops, it can suddenly cause low numbers because you are giving so much insulin. Acro-beans have to be vigilant on testing everyday for that reason.

Buy the ketodiastyx tomorrow- any pharmacy

You really should test again tonight. He may not be out of the woods. If BG get below 20 its not unlikely to have a seizure.

 

Re: HELP!!! Sudden low numbers

+5 is 49. Going up a bit.

 

Re: HELP!!! Sudden low numbers

Brian,

you really cannot go to bed with Tiger in this condition, sorry. He is only just holding steady on honey and high carb food. The 49 is not necessarily a true indication of an increase, since the meters can and do vary somewhat and still be within the tolerance level. One can test a single drop of blood several times and get several different answers -- within a certain range which reflects the accuracy of the meter. To be sure he is safe, you really need to stand guard over Tiger for a while longer.

laur

 

Re: HELP!!! Sudden low numbers

the honey is short lived- hang in there another 30 min so we see a nice 95 or something. and has anyone talked to you about a NO SHOOT number. Usually it 200 for newbies. Under 200, wait and retest, or dont shoot.

 

Re: HELP!!! Sudden low numbers

Brian,
Your'e in central time right? Hey its saturday - you can sleep in tomorrow.

 

Re: HELP!!! Sudden low numbers

+6 is 56. I'm in Eastern time. 2am here now. It's very hard for me to stay up due to my medication.

 

Re: HELP!!! Sudden low numbers

hopefully better, but I was hoping for better. How are you doing? I was just about to close the comp. Can you get him to eat more dry with some gravy flavor added in?

 

Re: HELP!!! Sudden low numbers

He was just eating some. This is exactly what he did this afternoon.

 

Re: HELP!!! Sudden low numbers

lets see- 56 with a 20 % meter error allowable could be 45 or 67. try to put out a bunch of dry overnight, do you have any gravy flavors- turkey and cheese? Yea sorry I'm dead also.

 

Re: HELP!!! Sudden low numbers

I really must get some sleep, especially since I have to get up at 7:45 for AMPS. Thank you all for your support and help, I don't know where I would be without you all.

 

Re: HELP!!! Sudden low numbers

Ok me too- 1u tomorrow no more drama ))

 

Re: HELP!!! Sudden low numbers

Good morning Brian,

Well, it looks like Tiger's on a huge mission!
Be sure you test and post his BG before his shot this morn .... he's a load of surprises!
All I can say is WOW, maybe Tiger will be a diet-controlled kitty at this rate.
Here's hoping the 1u this morn goes well.

I am glad you had lots of support last nite for Tiger's repeat low BG performance; it's hard to remember everything when you're new, even if you just went through a similar situation earlier in the same day!

 

Re: HELP!!! Sudden low numbers

I would be very hesitant to give Tiger even a 1u shot this morning, regardless of the AMPS BG. Reasons:

1) two shots in last 24 hours resulting in low BGs / asymptomatic hypo

2) unreliable action of Vetsulin as per the lawsuit - effect can be extended

3) conventional wisdom that cats are more sensitive to insulin after a hypo

4) fact that sometimes cats become diet-controlled after a hypo and don't need insulin any more.

Others, your comments?

laur

 

Re: HELP!!! Sudden low numbers

Interesting idea Laur; diet controlled would be great!

I think it's past Tiger's shot time of 8am so we'll see what Brian does.
I don't see him online, so we'll see.

 

Re: HELP!!! Sudden low numbers

I have to agree- I love the idea of at least waiting. Lots of good LC food, and lots of water in the food. let things settle a day.

Anyone know if Brian works M-F? That could be the one difficulty. Hate it when work gets in the way of life...

He may be sleeping, he was exhausted

 

Re: HELP!!! Sudden low numbers

Sorry I didn't start the computer up when I got up this morning.

Tiger's AMPS was 252 and I gave him 1u then fed him. Went back to bed and just woke up. His +4 is 246.

Yes, I work M-F 9-5:30 I always come home for my lunch hour at noon. If need be, I can pop in once in the afternoon as well.

How much food is too much? He's eating like a damn pig. Those things of food at 3.5 ounces each and he eats his and goes on to the leftovers of the others.

 

Re: HELP!!! Sudden low numbers

Well Tiger continues to surprise us! Don't be alarmed if he stays in the 200's today - Don't up that dose until his system calms down from those hypo situations. Boy am I glad that you are home testing now and backed down off of that 22u! I can only imagine..... nailbite_smile

 

Re: HELP!!! Sudden low numbers

Hi glad to see you starting off with 1 unit was scared for him 22u even 7u seems a lot to me Anyway Good luck with starting slow way to go when his numbers come down so will his eating Kath

 

Re: HELP!!! Sudden low numbers

Hi Brian,
How is everything going today? Did you start over at 1u?

You're doing a great job with Tiger.

 

Re: HELP!!! Sudden low numbers

I did start over at 1u this morning. He seems to be doing great.

 

Re: HELP!!! Sudden low numbers

Wonderful Tiger is going to be so happy and you too Kath :mrgreen: ;-)

 

I've been taking it easy on his poor ears today so I haven't tested him very much. Judging by the way he was acting, he seemed fine and felt he would be ok. Anyway, here's what I've got so far today.

AMPS 252, gave 1u and fed.
+4 was 246 and fed
+8.5 is 335 then fed

I was thinking just another 1u for his PM shot. Seems to me (and maybe I'm wrong) that he's staying fairly steady for it being +8.5. Laur was kind enough to donate a pen of Levemir to me, which I should get on Tuesday to replace the Vetsulin. The wet food seems to be doing all my cats good, but the loose stool is enough to make me barf. LOL

Also, I got some ketone test strips today and some neosporin with pain relief for Tiger's poor little ears. Question about the ketone strips: Tiger peed on the floor in front of the little box earlier this morning. I haven't cleaned it up just yet (its off to the side and not in the way of others getting in) and I was wondering how "fresh" the pee needs to be to use the strips. Figured that was a good way to get his urine.

So, as always, am I doing it right? Any suggestions? And get this, I was explaining this stuff to a friend of mine today, and as confused as I felt, I blurted this stuff out and actually sounded like I knew what I was talking about! I was like wow, it's sinking in! And for the first time in the past few days, I actually truly felt like I knew everything was going to be ok. And of course, you folks really help. Thanks to you all.

Brian

 

Brian, you are doing awesome! Wow, what a wild ride Tiger is giving you!!

It's preferable to get fresh urine for the test, but I would go ahead and dip the strip in the urine you have at this point. If it is negative, I would confirm that with another test later if possible.

Laur is very kind to send you a Lev pen! :smile: I suspect that the advice will be to stick with 1u for now, but let's see what others think.

 

Hi Brian,
For the loose stool, you can order some fortiflora. If you PM me your shipping address, i can send you a few packets. I'm going to the post office on Monday anyway. You just sprinkle it on the food and most cats LOOOOVE it. It is a probiotic that helps settle their little tummies.
Many cats experience some intestinal upset when switching foods abruptly.

As for the ketodiastix. Yes. Go ahead and put it in the puddle of urine. If it's negative, great. if it is positive, I would see if I could get another sample.

 

Brian,
You are doing awesome; I am sure that Tiger is finally starting to feel much much better.

So, first, for the testing - there are a few tests that you should not miss and they are the test before each shot, especially with Tiger, and catching a test just before bed. You know about the bedtime one because you got stuck with a late nite due to Tiger's low numbers. Imagine if you had just gone to bed and he went too low with no help to bring him up? Usually by our bedtime, we would have a pretty good idea where the numbers are going.

The food, while they are unregulated, it seems like they are always hungry and their legs have gone hollow. I have wondered how insulin plays into the picture because both mine started to eat more AFTER was started on the insulin. Anyways, their bodies are not able to process the foods and extract what they need so they must keep craving more.
My Shadoe was close to 20oz a day but she is down to less than half that amount now. Oliver was close to 30oz a day but I have him closer to 18oz now and even then I bet I could cut back more.

What you can do is add water to the foods; the water is very good for their bodies and fills them up. Just like people who want to cat back food and lose weight, they just increase their water intake. Since I started adding water to the foods, Oliver stops eating when he laps up all the water! I have to keep adding more water and mashing up the foods. Shadoe likes the soupy slop too. You may want to get some bigger cans of Friskies or something, just till Tiger's appetite slows down.

While you're waiting for the Lev, you can read all the stickys and get a handle on the shed and other things about Lev as it's much different than Vetsulin.
Tight Regulation Protocol
LANTUS & LEVEMIR – INSULIN DEPOT –AKA- STORAGE SHED
Lantus&Levemir – Data Ready to Shoot Low Numbers
With the Lev, you will be sticking with the same dose for about 5 days to get the shed built up.

As for the urine, you can stick the ketostix strip in the urine and see what you get. The fresher the better I think.

 

wow, I think that everything i thought of was already said- so I'll reiterate

Fortiflora is available online or at vets without a prescription (about $23/25 packets). Made by purina. cats love it and it works well on diarrhea. 1/2 half packet/day. Reestablishes good intestinal bacteria. I bet they have it at petsmart.

Yes, you can use the strips in old urine. I have used them to figure out who "wet" the carpet. I have the ketodiastyx which also test for sugar, and my second cat is a civie (non diabetic) so .... easy to tell the guilty party!

Consider the extra large cans of Friskies that they sell at some petfood stores - they are like 8 or 12 oz - like a soup can. its more economical for a pack of mini lions.

Definitely, read the stickies in the Lantus insulin support group about levemir (they are similar and it covers both). It is quite different in how its handled (no rolling) and even how you draw it out- so sorry, more to learn ohmygod_smile We recently switched to lev and like it, but it is quite different. For us, it doesn't really kick in for 3-4 hours, nadir at +8, but it lasts maybe about 13hrs, and has a very gentle easy downward movement so you don't get those sudden low number surprises. There is also a very specific protocol you use to up the dose.

Looks like he did just fine with 1u today, so you can catch up on your sleep tonight!

 

Way to go Tiger keep up the good work Brian good night sleep coming up Kath :mrgreen:

 

GMTA, guys. :lol: I was going to tuck some fortiflora in with the Lev, so Cyn doesn't need to send any. Works great as either a probiotic to help with GI issues or after antibiotics, or as a food enhancer. It sounds like Tiger is a good eater in general, but it sure pays to have fortiflora on hand for enticement for the day when the appetite is off and you need the cat to eat something.

As for the dose, Tiger's been on a heck of a rollercoaster. His body has been through a lot and needs to stabilize. Barring any further low drops, what would happen now is data gathering and a methodical approach to adjusting the dose. I think you will probably be able to stay on 1u til you get the pen in the mail, but posting your numbers will help us figure out what to do til then. What we find out now will help determine the starting Lev dose.

With the levemir, there is a specific protocol. You definitely can not "jump" the dose around. In other words, you don't adjust the dose to the preshot reading you just got -- with the exception that applies to any insulin: if the cat is getting dangerous lows, the dose gets reduced immediately.

Anyway, as the others mentioned, there is a Lantus group. It's a lot more active than the Lev group, so many Lev users post on Lantus. The two insulins are very similar in action so Lantus users can provide good advice. I had sent you some Lev links last night, and the link to the main Lantus page at viewforum.php?f=9

laur

 

Well, I need opinions. Here's a recap of today's history:

AMPS - 252
+4 - 246
+8.5 - 335
PMPS - 228

This is from 1u this morning. Should I just feed and test again before bed? Or give him 1u tonight.

 

I'd give 1u again tonight. It looks like you did not have a drastic drop today from the 1u. Make sure to test before you go to bed tonight, but you should be safe.

 

Ditto what Kelly said.

 

How is Tiger doing today?

 

Sorry was in a rush this morning and didn't have time to post.

Tiger's AMPS was 249. He's staying pretty consistent now. I will wait and see how the Levemir Laur is sending works out for him tomorrow.

They are all meowing for lunch. Have a good day all!

 

Hi Brian -- glad Tiger is doing so well --

You may want to start a New Topic -- some folks are getting stuck on page one, and don't see all the recent posts / changes that you have made.

In Lantus group, every Kitty gets a new topic ("condo") every day. While that is not necessary here in Vetsulin, it is helpful to make a new post when we get up to two pages.

Thanks!!!
phoebe

 

How did Tiger do today? You can start a new thread if you want to