Vet is recommending fast increases to Lantus...

Hi everyone,

I posted for the first time yesterday over in the main health board:

viewtopic.php?f=28&t=62063

I am now seeking some specific advice on Lantus. My kitty Thomas was only diagnosed last Friday, and we've gone from 0.5 units once daily (3 days) to 1 unit once daily (2 days) to 2 units once daily (yesterday) and now she's telling me to increase to 3 based on his BG readings from yesterday (summarized in my other post).

I am freaking out - on the one hand, she's my vet and my clinic is really, really good (they are a holistic vet and have provided phenomenal care in the past), but on the other hand, everything I read here tells me this is a bad plan. I really don't know what to do. Any help would be much appreciated.

Amanda (and Thomas)

 

Hi, Amanda ~

Yes, those are very fast increases to Lantus as you're thinking. And if I understand, you're giving only once daily doses now? As members have explained on the Health board, Lantus doses need to be held for several days...sometimes even 5 to 7 days...to settle in and for you to see how effective a dose will be for Thomas. And Lantus is generally more effective and safer dosed twice a day.

For our first diabetic cat, Willie, our vet had us doing once daily dosing also and had us keep increasing that daily dose. We almost had a hypo for Willie...it was a scary time. Once daily dosing doesn't work for many cats and was dangerous for our cat. We learned here on this board about twice daily dosing and switched right away to keep Willie safe.

Since you've mentioned that Thomas has an infection now, the infection is likely raising his bg numbers. As his infection clears, you want to be sure that the Lantus dose is not too high for him, Amanda.

There's good Lantus literature that you can take to your vet, Amanda. Was a link provided on the Main Health board? If not, we'll be glad to get that for you.

Hang in there, Amanda. You will get this figured out for Thomas.

Eva

 

That is way too fast of an increase for Lantus, it has to build up under the skin in depot/shed before it is available for Thomas's body to use to help bring down his blood sugar. Plus it needs to be dosed twice a day, because metabolize insulin faster than either humans or dogs, and even in humans Lantus only lasts 18 hours. So by only giving it once a day you are in effect starting over everyday because the shed never gets a chance to form and thus Thomas's body can't use the insulin that you are giving him.

Even when Lantus is given twice a day it takes about 3-5 days to fill up that shed. Basically if you think of it like this, if you take a dry piece of clay and add water to it, the clay sucks up that water but doesn't make it useable to sculpt with, you have to add more water to make it pliable and ready to use. The Lantus shed is the same way, the first dose only gets sucked up by the shed, it takes keeping that shed moist before the cat can use it to lower its bloodsugar.

Also diet will play a big part in getting Thomas on the right path, but first and foremost he needs to be eating. Once he is eating on his own again we can worry about his diet...Have you tried tempting him with his favorite foods? Deli meats, tuna, dry cat food? anything you can think of that he really loves. We need to get his appetite jump started again. Sometimes even warming up their food in the microwave so it gets nice and stinky helps.

Personally at this point even though you are still having to syringe feed him I would split his dose in two and give half in the morning and half in the evening, as close to 12 hours apart as you can. Between having an infection, and not getting enough insulin throughout the whole day he probably doesn't feel very good and doesn't feel like eating. But he really needs to be eating as well as you need to be testing him for ketones. You can get ketostixs at any human pharmacy and check his urine just like human diabetics do...Ketones can be a very deadly side effect of diabetes, and the recipe for DKA is not enough insulin, infection and not enough food...if you can get a ketone test on him and it is any higher than a trace, he needs to go to an emergency vet asap, as DKA can kill quickly.

You also can't be too hard on your vet if they have been excellent on all his other care, vets have a big job to do they have to know about a whole bunch of different types of animals usually everything from gerbils to horses, and it just isn't humanly possible to keep up with the latest treatment on very disease that every type of animal can come down with.

Also you best tool in the world to keep Thomas safe is learning to test his blood sugar at home and we can help you learn how to do that, we have taught thousands over the internet...Think you are up for learning?

Mel, Maxwell, Musette & The Fur Gang

 

Thanks for the advice so far. I need to talk to my vet about this again and perhaps send her some literature. Could someone repost it here?

Also, I am already home testing his BG - I reported my mini curve findings in reply to my original post over on the Health board...

Have tried feeding him everything I can think of (various soft foods - warmed up, sardines, tuna etc), but he just won't eat any of them so for now I think I need to syringe feed him.

He was tested for ketones on Monday and they found none, however that is where they found the bladder infection so he's on antibiotics for that right now. I'll make sure when those are done in ten days to watch him more closely and test his BG more often to make sure it isn't too much insulin at that point.

Sigh...this is really confusing. I'll be talking to my vet again tomorrow and I'm going to ask her very specifically why we can't move this to twice a day right now.

 

Hi, Amanda ~

"Sigh...this is really confusing. I'll be talking to my vet again tomorrow and I'm going to ask her very specifically why we can't move this to twice a day right now." -- Believe me, I know how frustrating this can be in the beginning, Amanda. And even good vets sometimes don't handle a lot of feline diabetes cases. My vet doesn't, but he's excellent in so many other treatments for our cats. Sometimes I think vets like to start with once a day dosing because they think it'll be easier for their clients to manage. But, unfortunately, it generally doesn't work well for cats with their faster metabolism.

There's a lot of good information here about using Lantus, including an article that might interest your vet:
http://felinediabetes.com/FDMB/viewtopic.php?f=9&t=1581
Print out this excellent article on that web page to take to your vet:
"Dosing protocol for cats on glargine or detemir using daily home monitoring of blood glucose concentrations to adjust insulin dose"

Right now, which dose are you using for Thomas, Amanda?

Eva

 

@Eva and Butters - this morning he started on 3 units once daily of Lantus. It kind of goes against the advice I received here, but I spoke to two different vets at my clinic (a holistic vet clinic), one of whom seems to have a lot of experience with FD, and they both recommended this for now, saying that we'll likely end up with 3 units twice a day but they want to see what happens with this. I should mention that my Thomas is a big guy - close to 16 pounds (used to be 18 but has lost some weight in the last few months, potentially as he became diabetic). Could the dose be based on his weight to some degree?

I had to work today but my mom (who should be given sainthood for all she does for my cats) is with Thomas and watching him for signs of any sort of change or hypo. I'll be home in less than an hour (3 hours past insulin) and will start doing another mini curve. I'm sure I'll be back here with more questions then...

 

Amanda:

I'm coming over from the Tight Regulation group where most of us do not rely on our vets for managing FD for the very reason that you are seeing. Lantus is not a once a day insulin for cats and it should not be increased at the rate your vet is increasing it. She could cause your kitty to quickly become overdosed and to miss the dose that really works for him. One of the other big mistakes vets make is dosing based on the preshot numbers without considering what the nadir (or the lowest number) of the cycle is.

There are two protocols for using lantus: one is the Tight Regulation Protocol which is a little faster paced and has a starting formula based on the kitty's ideal weight. The other is the Start Low Go Slow which starts at a lower dose and holds doses longer before increases.

Here is additional information on both:

The Tight Regulation protocol was developed based upon the premise that a cat's pancreas may be able to heal and return to producing insulin if the cat's BG is kept in a normal range, ie, 50-120. caregivers following this protocol adjust insulin doses following the protocol guidelines, to aim for that range. in order to follow the TR protocol, caregivers need to test a minimum of preshot time (to determine if it's safe to give insulin) and during mid-cycle (to find the lowest point of the cycle in order to determine dosing). if the cat is likely to get into low numbers, then the caregiver needs to test enough to keep the cat safe. basic information on the TR is here: TR. if you want to follow the TR protocol, we strongly encourage you to post daily in the Lantus TR insulin support forum for a while to learn more about how it all works. There are specific requisites to following the TR protocol. These include monitoring BG levels at least at PS, +3, +6, +9, learning the signs of hypoglycemia and how to treat it, preparing a hypo toolbox, testing regularly for ketones with urine ketostix, using the correct insulin syringes, feeding several small meals a day of a high quality, low carb canned or raw food diet.

The Start Low Go Slow protocol has caregivers start with an initial dose based upon the BG at diagnosis and whether kitty has been transitioned to a wet low carb diet, hold that dose for a week or two while testing for ketones regularly, being consistent with food and shooting every 12 hours. Once a week a curve is done (test every 2 hours for one cycle) to check for the lowest point. The low number in that curve determines any dose change for the following week. Basic information on the SLGS protocol is here SLGS. If you want to follow the SLGS protocol, you can post for advice on the Relaxed Lantus ISG, TR ISG, or Main health for guidance and support.

I agree that you need to get him eating ...that is extremely important. Also, as an infection clears, you might also see BGs coming down so it's important to keep a close eye on his numbers.

 

Re: Vet is recommending fast increases to Lantus - UPDATE

Hi all,

Just following up on yesterday's post. We decided to listen to the vet and went ahead and gave Thomas the 3 units at about 10:30am yesterday and then tried to do a bit of a curve and of course monitor for hypo. I unfortunately do not have his BG level before administering the 3 units yesterday, but he's been above 20 mmol/L (in the 360-400 mg/dl range) all week despite increases from one to two units of Lantus.

Here's what happened:

10:30am - 3 units Lantus given
2:30pm (+4) - BG 10.0 mmol/l (180 mg/dl)
4:30pm (+6) - BG 7.3 (130)
5:30pm (+7) - 7.9 (142) **food was given between this reading and the previous one
7:30pm (+9) - 7.2 (128)
10:30pm (+12) - 9.1 (165)
6:30am (+20) - 8.2 (148) **this was first thing in the morning before food was given, he hadn't eaten in about 6 hours

I am not sure what to make of these results - on 2 units once daily there'd been almost no effect - on 3 there is clearly quite an effect, but I expected more of a rise after the 12 hour mark. Is it possible he's a 24 hour dose kitty after all? Given these new eadings, will continuing 3 units once daily be too much? I'll be talking to my vet of course about this before giving him his insulin in about 2 hours, but I was curious to see what people here thought...

 

Good Morning, Amanda ~

I've been thinking about you and Thomas this morning. And worrying about you some, too...because that's what I do, worry . Have you made a decision yet about how to dose him: once a day or twice a day? If you've decided to go with your vet's recommendation of once a day dosing, could you please, please promise me, Amanda, that you'll test Thomas before every shot and also during the day and early evening? Don't let down on your testing.

As I mentioned earlier, when we were doing once daily dosing with our cat Willie, we came very, very close to a scary hypo with her. Because the Lantus was not lasting 24 hours, her blood glucose numbers were going up during the night and would be higher in the mornings. Based on those higher numbers, our vet was having us increase her daily dose fairly quickly. One afternoon, we were checking her bg and saw that we were getting a lower number than usual. We kept checking throughout the afternoon, and her numbers were not rising, just continuing to go lower. We started feeding her higher carb food to try to get her numbers up. But this frightening process with up and down numbers and Karo continued until 3 AM. I'm just SO thankful that my husband and I were home testing because that probably saved her life.

Amanda, I don't want to see you and Thomas or anyone else go through an experience like ours. That might not happen with Thomas, but please be aware that it could, especially with fast dose increases.

Of course, I really hope to hear that you've decided to change to twice daily dosing. That would be such great news.

Did you see Julia's links to these two veterinary professional articles recommending twice a day (BID) dosing with Lantus? Just wanted to be sure you've had a chance to look at them, Amanda.

If you get a chance to check in, Amanda, I hope you'll let us know how you and Thomas are doing.

Take care and TGIF,
Eva

 

Hey Eva - I did check in, the post is right above yours on this thread

 

I just had to come back to say that if Thomas were my cat, I wouldn't shoot that 3U dose this morning!

Hi, Amanda ~

Had to leave in the middle of typing my post to you, so I didn't see that you'd already posted . Sorry...

"I unfortunately do not have his BG level before administering the 3 units yesterday" -- Would have been interesting to know how high he was before the 3U. Will you be testing and shooting again at 10:30AM this morning?

I know, Amanda, if you look at just those numbers, they're looking pretty good. The concern that I have is the lowering effect and the duration of the 3U already when you've just started that dose and the Lantus depot/shed hasn't filled yet. As you continue that dose, I'm worried about steeper, extended drops in Thomas's blood glucose numbers. That's beginning to look a lot like what we went through with our cat Willie.

"but I expected more of a rise after the 12 hour mark." -- And normally that's what you'd expect to see, Amanda. I'm worried that the duration you're seeing so early into starting that 3U dose could be the beginning of an overdose.

PLEASE be careful. Are you going to be around to test Thomas often?

Eva

 

Just spoke to the vet again (actually, it was another vet - the owner of the clinic and the vet I wish my kitties got to see).

He said given Thomas's BG readings, we went too high with 3 units (especially given that his blood sugar wasn't higher this morning). He said insulin is not a linear thing and so we've obviously skipped past the threshold in going from 2 to 3, so today we're going to do the following:

-feed Thomas a good breakfast (already done - 2 hours ago)
-feed Thomas a little more before insulin (in one hour)
-test BG
-give 2.5 units insulin
-test BG frequently for the rest of the day and feed every few hours

My mom is with him now as I am at work, but she'll be there to feed him before insulin, test his BG, and give him his insulin. She'll then be staying for 2-3 hours to watch him and she knows how to test his BG and what to do if he goes hypo. I'll be going home for a bit this afternoon and will test him again. He will be on his own for a few hours potentially but I'm going to see about trying to go home a few times to test him quickly (I live a 10 minute drive from work). Then I'm around all night to watch him like a hawk and stab his ear on a regular basis

 

Amanda,
please try to post the reading BEFORE shooting the 2.5? He will have eaten twice in the 2-3 hours prior to that reading and the number will be temporarily high because of the bg boost from the food. The 2.5 may even be too much.
Carl

 

My mom is doing the BG reading as I am at work, and she is going to phone me with it BEFORE giving the insulin. Then I'll post here and call my vet and make a decision on what to do next. Thanks everyone!

 

Hi, Amanda and Carl ~

I have to be in work meetings for a few hours, so I won't be able to check back in for a while. Maybe someone on Lantus TR can take a look at this?

Eva

 

Nooooo.Too fast and is a recipe for harm to your cat. Vet did a curve? Throw those numbers OUT THE WINDOW. Most cats are stressed by the vet visits, so any numbers obtained in that fashion aren't of much use... What were the numbers the vet got? Get that info and let's see if the vet is making a call on the BG at shot times or at the lowest point, mid cycle, nadir.

My two cats are completely different. Shadoe ALWAYS tests higher at the vet; she is stressed and freezes like a rock at the vet. I test her at home before we leave, put her in the carrier, then test her when we arrive at the vet, and finally, test her when we get home and 30min later. BIG differences in the numbers... the first and last tests give decent numbers but the ones in the middle? HIGH.

Oliver is the opposite. I have to take HC food to the vet because weirdly he goes LOW at the vet office! One time I had to feed him AT the vet office to try and bring his numbers up.

So, home testing is the best way to know how your cat is REALLY doing at home and in his own comfy spots.
By your vet wanting to increase too quickly, it's obvious that she is not aware of the Lantus shed that has to be taken into account. Also, cats are NOT dosed once a day; they need shots every 12 hours as they have faster metabolisms. You will get nowhere fast with once a day shots and changing up the dose all the time. The only place you may get is overdosing your cat as this other vet said. To use a word from Judge Judy.... ridiculous!

The shed's no different than some meds your dr gives to you and you are told that you need to give it a few days to build up in your system before you will feel the effects.

You are home testing. There are many cats who never need a dose as high at 3units, so scrap that idea.
You would be wise to go with 1unit twice a day and test at home, then after 4 days or so, make a decision on the dose based on the lowest point of the cycles.

Now, let's get to the food business. If you test and feed now, then test again in 1hour, I bet you are going to see a higher number which will give you a false number to base a decision of whether to shoot or not. After another hour, that BG will come down and you may find you gave too much insulin.

The general rule is usually do not feed for TWO HOURS before shot time. Why? because you want the cat to be free of food in the system. It's really no different from being told to fast by your dr if you are having some tests done. Why? because you need your system to be free of any things that could give an incorrect reading on the tests. So NO food for TWO HOURS before the shot, and then you are getting a true empty-stomach/system BG number.

Be sure you get your mom to let you know if she is seeing a fast drop in numbers; you have some HC handy to feed if the numbers are dropping too fast? Numbers can be manipulated with food, so once you have gathered some numbers/data, we can help you see if you need to give some mini meals at certain times to slow drops.

 

Just sitting here thinking (and not working, obviously, but who are we kidding, my mind isn't really on work anyways)...at what BG level would it be appropriate to give Thomas 2.5 units today? As I said, it was pretty low this morning, hence the reduction from 3 to 2.5. Maybe if I try to figure that out now, when my mom phones I'll be able to tell her what to right away, rather than asking her to wait while I post on a forum

For example, if he's in, say, the 10-12 (180-225) range, then should I do the 2.5 units? Reduce to 2? Are there guidelines about this?

And for those who are asking, I am doing home testing, not at the vet.

Sorry for all the questions

 

Some insulin are dosed on a sliding scale...Lantus isn't one of them. Lantus is started at between .5u to 1u and is given TWICE a day. It takes about a week for the shed/depot to fill so that it starts really working for the cat. With someone that is newly diagnoised we recommend not giving ANY insulin if your reading is below 200 at shot time.

Vets see a lot of different types of animals and have to know about them all...Everyone here is or has or both been living with and treating their diabetic cats on a day to day bases...We eat, breathe, sleep and dream Feline Diabetes. We live with these cats 24/7/365.

Mel, Maxwell, Musette & The Fur Gang

 

My mom just called and his pre-shot BG is 14.3 mmol/L (about 260). He has had some to eat in the last 2-3 hours but not a ton (maybe a 1/4 can of Hills A/D total - he's only eating 3/4 of a can per day at this point given the syringe feeding).

I've told her to go ahead with the 2.5 units of Lantus but to please watch him closely and if he looks at all funny or too lethargic to do another BG and call me immediately. I'll be home in 2 hours to check on him and do another BG reading...

 

I'm very sorry but I have to say that your vet does not know what he/she is doing and he/she is putting your cat in a very unsafe situation. I'd ask him/her exactly how many FD cats he/she treats and how many have gone off insulin?

The members of the FDMB eat, sleep, live FD 24/7. We have a very large, cumulative amount of experience in dealing with FD and the different insulins. Are we vets....no; but that doesn't mean that we can't spot an unsafe situation developing and I think each of us has tried to tell you that.

Gayle is very right...if your cat gets food less than two hours prior to his shot, then you will be shooting an inflated number. If you choose to do that, then please be sure you are monitoring him very closely. I think your dose is too high, it's not consistent, and sid (once daily) dosing is not how this insulin is meant to work.

 

Hi, Amanda ~

"For example, if he's in, say, the 10-12 (180-225) range, then should I do the 2.5 units? Reduce to 2? Are there guidelines about this?" --

As Mel's already mentioned, Lantus isn't dosed on a sliding scale. In fact, Lantus isn't dosed based on the preshot numbers either but is dosed based on the nadir (low point during the cycle).

Both of the Lantus protocols on FDMB, Tight Regulation and Start Low-Go Slow, use twice daily (BID) dosing, so none of us here has the experience with once a day dosing (SID) to give you safe advice. And from my scary experience with once a day dosing for our cat Willie in 2007, once a day dosing is very risky for cats and just not something that I could ever recommend.

"I'd ask him/her exactly how many FD cats he/she treats and how many have gone off insulin?" -- I think Marjorie's question is a good and reasonable one to ask your vet, Amanda. And I'd also ask him how's he's determining the correct dose for Thomas with once a day dosing.

Amanda, since you've decided for now to go with your vet's once a day dosing at 2.5U, my suggestion to you is to stay in close contact with your vet and to be very careful in monitoring Thomas's blood glucose numbers. Be sure to test before every preshot and several times during the day and night. Since your vet has been changing the doses so fast without letting them settle in and has had you dosing once a day, I'm not sure what that has done to the Lantus depot/shed...all the more reason for you to be very vigilant in testing Thomas. What seems to be working well one day could result in a crash into a hypo or near-hypo the next...that's what happened with our cat Willie. That may not happen to Thomas, Amanda...I don't want anything like that to happen to him.

The one thing each of us has learned to do as we've been treating our cats with insulin is to be prepared for a hypo. Have you put together a hypo kit, Amanda, with high carb foods and honey or syrup? Here's some info on the forum about How to treat Hypos.

Amanda, we all want Lantus to work well for your Thomas and to work safely for him. Please keep in touch.

Eva

 

Thanks Eva - I will definitely keep in touch and already had a hypo kit put together several days ago, in anticipation of such a possibility as we get him stabilized.

I will be checking his BG in about an hour (+4) and then monitoring him very, very closely throughout the rest of tonight and tomorrow. I am being as vigilant as possible (have barely left my house all week - thank goodness I have an understanding workplace), am home testing regularly, and have been on the phone with the vet daily and will continue to do so.

I know some of you might not understand why right now it's my choice to trust the vet rather than this community, especially when I sought your advice in the first place - I part of it is that this all still very overwhelming and I am having trouble knowing who to believe and what to do, and so I am basing this on the fact that my vet clinic knows Thomas's health so well - he had many UTIs and one blockage before he came to them, and they basically saved him from a life of potential urinary track blockages by getting him on preventative homeopathics. They were the only vet clinic to address health in a holistic and preventative manner and they are very supportive of owners getting as involved as possible in providing care (they encouraged me to home test). Of course I realize all that has nothing to do with FD, but it's hard to stop trusting someone who has proved so trustworthy to date, far far more so than any other vet I've worked with, and I've had pets my whole life. I believe all of you likely DO know more than they do about this particular subject and am very much wanting to be here to get educated over time, but I suppose I feel confident enough about my ability to monitor him VERY closely that I am willing to accept the vet's decision on this particular subject for the moment. If things don't stabilize or the BG numbers seem out of whack over the next few days, then I'll revisit the BID subject with my vet at that time and I'm sure I'll be back here posting with more questions.

Interestingly and as an aside, while all of you say that once a day dosing has not worked and what I've read would support that absolutely, two of my coworkers as well as my dad all have diabetic cats who are on Lantus once daily and are totally fine. Perhaps that's part of this decision as well. ECID I suppose?

I'll keep posting about Thomas and thank you all for your concern for him - I know you only want what's best for him and I will definitely continue to engage my vet in conversation about these concerns as we go along.

Thank you!
Amanda

 

Hi, Amanda ~

Thomas is your cat, and you need to do what you think's best for him. Amanda, I'm glad to hear your plan for regular testing (and that understanding workplace helps, too :smile: ) and keeping in daily touch with your vet. That makes me feel better for you and Thomas.

"two of my coworkers as well as my dad all have diabetic cats who are on Lantus once daily and are totally fine." -- This is interesting to me, Amanda. I'd be curious to know how well regulated those cats are. Do your dad and coworkers have fructosamine tests done periodically? Are those cats on low doses of Lantus?

Since you've decided on once daily dosing for Thomas, Amanda, I hope it works out well for him. And I'm glad you're going to keep posting here about Thomas.

Please let us know how everything goes.

Take care,
Eva

 

Hi Amanda,
I am wondering about the above - Do you know if the other 3 people are home testing, what doses they are giving, and would you be able to confirm that their numbers are 'totally fine'?

I do ask because cats don't act noticeably different if they are at 42 or 420, at least my two do not. It's for that reason that we test.... there have been a few times when I would test one of my cats and find them at a too low number, but they are acting perfectly fine, and looking at me like what's YOUR problem?
If you would be able to get them to test if they are not now, and see that their cats all have numbers under 240? If their numbers are above that point, the cats' organs are in danger of damage.

I mention this issue because I think you are the only 4 people I know who are dosing once a day.

 

Amanda:

It's not that any of us are trying to sway your confidence in your vet. I have a similar situation with my Gracie....she had chronic bladder issues since she was a couple months old. I found an holistic vet who I LOVE and who was the only vet who could figure out why Gracie was having those issues and how to stop them. Unfortunately, our previous vet (also holistic) who we loved very much had finally decided the only thing left to try was steroids and that is why Gracie is diabetic. BUT...getting back to our current vet; the clinic where she practices has 5 female vets and they are all incredible....we love them and they've done so much for our cats. But what they know about managing FD could fit in an insulin syringe and they admit it. I think your condo was the one where I posted that they actually asked me to give them a presentation on FD and managing it and were so happy with what they learned. So you can love your vet and trust them....I do mine...but not with something like FD where they see few cases of it. Ask your vet about levemir and see what he/she says. If they are like my vet, she asked what it was.....and what it is is another long-duration insulin that is given every 12 hours and that we also use with FD. I am happy that my vets are asking for the education on FD.

Eva is right...the syringe is in your hand and Thomas is your cat. And I agree with her questions about the other cats being dosed sid....are they being hometested and are their caregivers closely monitoring them or are they basing it just on the fact that the kitty seems fine? The reason I'm asking is because I do monitor Gracie alot and I know her. One evening I was sitting here with her and she was perfectly fine but my gut told me to test her. In two hours from her PMPS she had dropped from 193 to 20!! And there was no visible sign at all that she was dangerously low. The only problem with getting a fructosamine test is that the kitty can be 300 at AMPS, 40 at nadir, and 300 again and the fruc test will never show that...it only gives an average of what the BG has been over the last couple weeks and so the average might be that the cat is normal even though the numbers might have been fluctuating. A lantus hypo can last over 16 hours and that is with the bean working to keep the cat safe.

FD is not simple. Very few cats just get their insulin and settle into beautiful curves. I urge you to look around at spreadsheets of those who have been around awhile. ...look at my Gracie's lantus and levemir SSs. Venture over to the Lantus TR ISG and look at these SSs: Gabby (Sienne is one of our very experienced members), Mannie, Tess, Moonie, Champ...just to name a few. You can learn alot just by looking at SSs. If we were dosing sid, you'd see even more variability in the day-to-day curves.

Eva has given you the protocols and I urge you to share them with your vet. A good vet will be open to looking at them, reading, asking questions. If your vet is not familliar with these or does not read them or says something about you taking internet advice, then it is about your vet's ego and not about Thomas.

I also wish you and Thomas the best.

 

It's your cat, you get to make the decisions based on all the information available to you (and good for you for seeking it out!) and go with what you're most comfortable with. That's not something you should ever feel bad about.

I would also love to know more details about your co-workers and dads cats. There isn't much in the way of studies I've seen on 1/day Lantus dosing, and none at all I've seen that directly compare 1/day to 2/day Lantus in diabetic cats though the expert research white-coats seem to agree that 2/day is overall the best option (and terrific results are well proven on 2/day). If your coworkers and dad are doing home testing and keeping records, that could really be helpful for anyone who might end up having no choice but a 1/day schedule due to work commitments.

 

I will definitely ask my colleagues and my dad about whether they home test, what the numbers are like etc. It would be great information for others I believe - my dad's kitty has passed away not too long ago (due to old age - she lived to be almost 18) but I'm sure he would still have that information and recall how/when she was monitored.

Thomas's BG readings today were as follows:

early morning (before food) - 8.2 mmol/L (147 mg/dl)
pre-shot (4 hours later and 3 hours after food) -14.3 mmol/L (257 mg/dl)
+3 - 12.8 (230)
+6 - 9.2 (165)

I will be testing him again at +9 in about an hour and a half, and of course in the morning both at wake up and at preshot a few hours later.

Vet and I talked again and we're going to leave the dose at 2.5 units once daily for now and see how he does over the weekend (with me monitoring and home testing) and talk again on Monday. If it seems like going to twice makes more sense at that time, we certainly will as I have no opposition to going to BID if that's what will work best.

One definite positive is that he finally ate on his own today - not his regular food, but ground beef! I had made spaghetti for dinner and as I sat eating I noticed he was sitting there eyeing me so I plucked out the ground beef chunks, got the tomato sauce off them, and gave it to him. He ate a decent amount and it's just nice to see him interested in eating something again.

Thanks again! I'll keep posting.

 

Yay Thomas for finding the joy in food again!!

 

Hi Amanda,
I'd just like to echo what Gayle said above....
One night last week I got home from work and had a voice message on the phone from a poor lady whose cat had just been dx'd that day with diabetes. When Bob went OTJ, I told my vet to feel free to share my name and number with any future patients who found out their cats were diabetic. This dear woman was the first call I'd gotten since then. Anyway, I called her back and she was in tears because she couldn't get blood for testing. So I drove over to her house to see if I could help her. I was able to help her, but my point is this. I saw this beautiful looking male orinch kitty named Louie. I had never tried to poke someone else's kitty's ears for blood, so had no idea what to expect. He was a push over, rubbing all over my legs, jumped up on the table and head butted me. You couldn't have asked for a better patient. But the thing is, she had two cats, brother and sister. And if she hadn't told me which one was diabetic, I would not have been able to tell. I'm quite postive that the female had a BG in the normal range, but she didn't look or act any differently. In fact, she was standoffish, and didn't approach me at all. The only time she came close was when he got a treat for being such a good boy. The only sign, and I didn't notice it until I got him in my lap and petted him a while, was that he was a rack of bones under all that fur. I could feel bones all along his back, and he'd dropped about 6 pounds. But he acted "normal", was very affectionate, purred while I was testing him. He'd only been tested once in his life, that day at the vet, so it wasn't like he knew it wasn't going to hurt, or that he was getting a treat for putting up with me. So I poked his ear, got blood the first time, and the meter said 361. Not terribly high, but diabetic for sure. He was at 361 on an empty belly, had been drinking and peeing buckets for several days, and hadn't had a shot of insulin yet. She was going to try the diet control route before beginning insulin, as recommended by her (and my) vet. The point is, to me, he was "totally fine". But he wasn't. And if he doesn't start to get better and his BG doesn't go down, he's not ever going to be "fine". So although your friends kitties and your Dad's kitty might have seemed totally fine, unless they have the data to show that one a day shots really had their diabetes under control, then they were not fine at all.

I have said, on Health, and other have said here that "you hold the syringe", I even added "we advise, but you decide". But what you have is one vet and three or four other people telling you one thing, with no real data to back it up, and forty or more people telling you another, with years of experience and data to back themselves up. So you should at least consider how much weight the data and evidence carries before deciding one way or the other. The most important thing, and the thing that all of us cares about above all else, is the health, safety and well being of Thomas.
Please ask your vet, and your friends, and your Dad, to give you some hard facts and evidence. If once-a-day dosing has been successful, and their cats have gone into remission, then that is information that all of us would love to see. Lots of other cats might be able to benefit from that knowledge. Find out how many cats your vet has treated this way, and how often her patients go into remission. If SID dosing works, as well or better than BID dosing, everybody wins.

I know you want only what is best for Thomas. So do we.
Carl

 

Good Morning, Amanda ~

"One definite positive is that he finally ate on his own today - not his regular food, but ground beef!" -- That's great news, Amanda! And he didn't get into the spaghetti part either . Good to know your furguy is getting interested in food again.

Thanks for posting Thomas's bg readings for Friday. Those numbers that you've posted are decent ones, Amanda, but please keep doing the regular bg readings that you're doing for Thomas. We didn't have the problem with our cat Willie until we'd been doing the increased once-a-day dose for several days. And you may not run into the same problem with Thomas...I hope not. We're all interested in seeing how this works for you and Thomas, Amanda.

It's funny, but after "talking" to you about Thomas, yesterday I ran into a woman in the pet food aisle of our grocery store who has a diabetic cat on Lantus (my husband never understands how I meet people in grocery stores :roll: ). Her vet had her doing once daily dosing for a couple of months. She said her cat was doing fairly well on the once a day dose, but her cat's preshot numbers weren't coming down so she's recently changed to twice a day dosing.

As you can tell, Amanda, many of us are interested in hearing more about how once daily dosing with Lantus has worked for your Dad and your coworkers and their kitties. And how it now works for you and Thomas.

Hope you have a good weekend with Thomas.

Eva

 

Good morning everyone,

Just checking in again with some more numbers. Thomas is still not interested in eating anything other than ground beef so I am going to cook him some of that today but keep syringe feeding him the Hills A/D as his primary food source, with the ground beef just as an extra protein.

So, to summarize but add new numbers as well, here's where we are at. Insulin is currently still Lantus 2.5 units once daily with LOTS of monitoring because he may need to move to BID, especially given what has been presented/suggested here. However, here's the numbers from yesterday into today:

Friday, January 27
early morning (before food) - 8.2 mmol/L (147 mg/dl)
pre-shot (4 hours later and 3 hours after food) -14.3 mmol/L (257 mg/dl).
+3 - 12.8 (230)
+6 - 9.2 (165)
+9 - 6.0 (108) (very low but he did not eat much between +6 and +9)
+12 - 8.6 (155)

Saturday, January 28
early morning (before food) - 8.8 mmol/L (159)
pre-short (4 hours later and 2 hours after food - this was just now) - 15.2 (275)

I am pleased to see some consistency in his morning and pre-shot numbers between yesterday and today, and I will be doing the same curve today as yesterday and of course still watching him like a hawk - I'm home all day and just out for a bit tonight. His nadir seems to be around the 9-hour mark (it was on 3 units as well).

The only minor change will be giving him some ground beef but he's not eating enough anyways right now (I'm only getting about 3/4 can to a can of Hills A/D into him each day, and he's a big 16 pound guy). So I'm slowly going to try and get his food intake up a bit but of course watch what, if anything, the additional protein and calories do to his numbers.

I'll keep reporting back - thank you for the ongoing support and concern despite the fact that this once a day thing is neither typical nor what you'd recommend. And I promise, I'll be discussing these results with my vet and with you daily and if we need to move to BID we will do that, most definitely, and in the mean time he's basically never alone and with people who are testing him every few hours and know what to do if he goes hypo. Between my partner and my mom, I have a good system of support in place for him in addition to just myself. Now if only I could get my other kitty, Milo, to not act like a raving lunatic with all this going on. He's a very highly emotional kitty to begin with - very possessive and sometimes aggressive whereas Thomas is definitely the chill, friendly one. Sometimes I feel like I'm living with Hannibal Lector and Bob Marley Seeing Thomas getting all this attention has been hard on him - the looks of jealousy are quite something. I had to move Milo's litter box to accommodate some things for Thomas and I'm pretty sure this is unforgivable in his mind. So I'm off to give Thomas his insulin and then spend some cuddle time with my physically-totally-healthy-but-emotionally-oh-so-needy other fur baby

Amanda

 

"and then spend some cuddle time with my physically-totally-healthy-but-emotionally-oh-so-needy other fur baby " -- Oh, poor dear Milo, Amanda! And I do know what you mean. Our five nondiabetic cats all feel that Butters is getting special attention...if they only knew . We let each of them jump up on the countertop and lie on Butters' testing towel so they can get extra petting and treats.

Amanda, I'm so glad you have the support of your partner and mom in taking care of Thomas. That must give you peace of mind when you need to be away from your furboy.

"I am pleased to see some consistency in his morning and pre-shot numbers between yesterday and today" -- I do think that's good, Amanda. You want to see steady, gradual shifts downward in numbers and not large, steep drops. I'm rooting for you and Thomas.

Keep in touch,
Eva

 

Hi everyone,

Just here with another question, a bit different this time. Thomas's BG readings today have been consistent with yesterday, but he is walking with a bit of a head tilt (like he is having trouble balancing, but he's walking fine, just head wobbling back and forth as he goes). My first concern was that he is Hypo but he's not - as I said, his numbers today are consistent with yesterday. His behaviour is otherwise pretty normal though he is lying down more (again, seems like he's dizzy).

Looking this up online suggests it could either be an ear infection or a stroke. Any idea how to tell which, and what to do in either case? We do have an emergency vet here in town but I'm not sure whether this is that kind of situation or whether I should just observe him tonight and tomorrow and take him in to the vet Monday morning....I know with strokes there really isn't a treatment other than observation and controlling any seizures should they occur, and he's already on antibiotics for the bladder infection (Baytril) so I'm not sure they'd prescribe anything for an ear infection anyways...

Amanda

 

Oh, Amanda, I hate to hear that your dear Thomas is having another problem. Bless his sweet heart...just can't catch a break right now, can he? Is your avatar Thomas? He's adorable, Amanda.

When you mentioned Baytril, I did some checking because I thought I'd read about central nervous system problems being less common side effects of Enrofloxacin, trade name Baytril. And here's what I found on this web site:
http://www.wedgewoodpetrx.com/learn...nographs/enrofloxacin-for-veterinary-use.html

•Cats: GI side effects include vomiting, diarrhea, anorexia, elevated liver enzymes. CNS signs include ataxia, seizures, depression; vocalization and aggression. Rare ocular toxicity may occur.

Amanda, it's the ataxia that caught my attention. Ataxia is a lack of coordination. I don't know if the Baytril is causing Thomas's problem or not. Wish there were some way you could get in touch with your vet about this before Monday.

You've probably been asked this before, Amanda, but are you checking Thomas for ketones? The problem you've described doesn't really sound ketone related, but it's something to rule out. Do you have any ketone urine test strips?

If you get a chance, you might want to post your question about Thomas's head wobbling on the Main Health board, too, since there's usually more traffic there this time of the evening. You can just copy what you've posted here in your message on the Main Health board. Maybe someone there has more experience with Baytril side effects or would recognize the symptoms you're describing for Thomas, Amanda.

Thinking of you and Thomas tonight,
Eva

 

Hey Eva,

I watched him closely for awhile and it's not so much ataxia as more just how one would walk if they were very dizzy - the actual mechanics of his legs are fine, so the lack of coordination doesn't appear to be related to the CNS. My partner gets frequent ear infections and she said that is exactly how she feels - vertigo-like, dizzy, trouble feeling balanced etc. Even when he goes to eat he seems all interested in the ground beef but then when he sits up to eat it, he looks like he no longer wants it - again, like a person who felt nauseous due to dizziness might. He also really doesn't want me to touch his ears so that makes me wonder if this is indeed an infection...

I did manage to get A vet on the phone - not mine but another one from a clinic near my house that my kitties used to go to long ago (I know it's kinda rude to phone up some vet that's not mine for free advice, but I love my kitties so much I suppose that I don't really care if I seem foolish or rude :smile: ). Anyways, she was very nice and talked to me for awhile - I gave her a mini-history and she said it sounds like vestibular disturbance caused by the diabetes - just the way it's impacting the nerves right now. He had some neuropathy in his hind legs previously that is only now starting to clear up, so it's possible this is just affecting his ears now. She said it could also be an inner ear infection but she didn't seem to think it was a stroke (he has no other symptoms of that) and said not to worry about bringing him in to Emerg, but suggested to keep watching him closely and that if this isn't clearing up by Monday to take him in to his regular vet first thing. Thanks for the info on Baytril - he's been on it for 5 days now so it seems strange that this would appear all of a sudden and he's been on Baytril before for UTIs with no ill effects. But I'll ask about that on Monday as well.

So for now it's just about continuing to watch him, which I'm already doing. And yes, that's him in my avatar. He is adorable - EVERYONE, even people who don't like cats, loves Thomas. He suckers them in by lying on his back like that with his paws tucked up like in the picture and they just can't resist

Amanda

 

P.S. Thank you for thinking of us, Eva

 

Good Morning, Amanda ~

So glad you were able to talk to that vet yesterday. That's got to make you feel better about Thomas, Amanda. How's he doing today? Still acting dizzy? If it's an ear infection, would the Baytril help clear it up? Don't know which antibiotics are generally used for that.

"I gave her a mini-history and she said it sounds like vestibular disturbance caused by the diabetes - just the way it's impacting the nerves right now." -- That's interesting, Amanda. Haven't heard of that before. Usually we think of diabetic neuropathy as affecting a cat's legs. What would be the treatment for that? Just better control of Thomas's diabetes which you're working on now?

"He suckers them in by lying on his back like that with his paws tucked up like in the picture and they just can't resist " -- He's certainly charmed me, Amanda .

Just want your dear little furfellow to feel better.

Eva

 

Just checking in again in case Eva or others are still curious about Thomas. He went to the vet today. Apparently his head tilt/zombie kitty walk was something called "idiopathic vestibular disturbance" - which basically means, "inner ear troubles that come quickly, leave on their own, but we have no idea why". The vet said that it's probably related to the neuropathy he was experiencing in his back legs and that it's entirely possible that it was irritating the nerves in his ears as well. He still has a bit of it but nothing like yesterday or Saturday thankfully. Still not eating on his own but the vet thinks once the ear stuff clears up he will feel less dizzy and want to eat. His BG readings continue to be around the 13-15 mmol/L (235-270 mg/dl) mark pre-shot and the nadir is at around 9 hours with a BG usually between 6-8 (110-145) with Lantus 2.5 units once a day.

I'm so glad that he's looking so much better today and doesn't seem quite so dizzy. Once he's eating on his own and generally stabilized we're also going to explore moving to a raw food diet - my vet is holistic and so they advocate this quite a bit. Apparently she's had quite a few kitties go into remission from their diabetes on raw food. But for now we're not making any big changes, just continuing to watch his BG and make sure this is still the correct dose of Lantus for him.

I'll keep posting here since if he does end up being a once-a-day Lantus kitty, this would be a new thing to this community it seems, and perhaps the information would be useful to others.

Amanda (and Thomas)

 

Hi Amanda,
Of course we're all still curious about how you and Thomas are doing, so please keep posting and letting us know what is going on.
Every cat is different, and because of that, every one who "appears" on the board is a learning experience, not just for you but for every one of us. Someday, there might be another "Thomas" and we can look back on your posts to help the new kitty out.
My cat Bob's treatment process was unlike any other cat I have ever seen on this board, so I understand how unique each situation is.
Carl

 

Hi, Amanda ~

It's good to get your update on adorable Thomas. Glad your vet determined the cause of Thomas's dizziness and that it will clear up on its own, Amanda. Really hope your furguy starts eating again very soon.

"Apparently she's had quite a few kitties go into remission from their diabetes on raw food." -- Did you know that FDMB has had quite a few kitties go into remission when their diets were changed from dry food to low carb canned food? Just making that change was enough to make the kitties diet controlled diabetics. But a raw food diet is great for cats, the best diet for many cats. A number of FDMB members have their cats on raw food diets.

And thanks, Amanda, for continuing to post Thomas's bg readings on his once daily dosing regimen. We're all very interested in hearing how that progresses. Please continue to do regular daily bg testing of Thomas (which I'm sure you're doing, Amanda, but I had to mention it again anyway :smile: ). So far, it sounds as though you're getting some decent, consistent numbers on the 2.5 unit dose.

Great news to hear that Thomas is looking so much better and is less dizzy!

Have a relaxing evening,
Eva

 

Hi, Amanda ~

If you're still checking in, I've been wondering how you and Thomas are doing now.

Thinking of you two this morning.

Eva

 

Hi Eva (and others) :smile:

Thomas is continuing to improve - his vestibular issues are completely gone and he's eating at least half the time on his own (so still some assist feeding but only as a supplement). I've discovered sprinkling a tiny bit of catnip on his wet food really helps, and the vet gave me some shots for nausea in case there was still a bit of that left from all the ear problems last weekend.

We're still tinkering with the Lantus a bit - since the bladder infection is now gone, his numbers have dropped a bit (nadir was as low as 3 one day - but after a meal he was fine) so we're dropping slowly - by 0.25 increments every few days, down to 2 units once daily again - to see what dose he needs now that infection and antibiotics are not playing a role. I'm still testing BG regularly of course but thus far the whole 24 hour dose thing is still working well.

Overall though he's a MUCH happier kitty this week. It's nice to see him lying on his back again (his favourite thing to do), napping in the sun, sitting on my lap while I watch TV, and generally being the happy lazy kitty he usually is.

 

Hi, Amanda ~

Good to hear that things are going well for you and Thomas. I'm so glad his vestibular issues are over and that he's started eating more on his own. It's great, Amanda, that you're working so closely with your vet to lower the Lantus doses as needed since the bladder infection is now gone. Anytime you'd care to post Thomas's bg numbers, please know that many of us are so interested.

"It's nice to see him lying on his back again (his favourite thing to do)" -- I'm smiling as I read this, Amanda...Thomas is so adorable in that position.

Eva

 

Hi Amanda
I just popped in and only scanned all the posts. But I just wanted to put in my 2 cents without having read everything preceding me properly.

PLEASE DO NOT BE AFRAID TO QUESTION AND GO AGAINST WHAT YOUR VET says. My cat Fred, who lived till 20 and was diabetic for 5 years, and who also had kidney and heart disease was given so much wrong and bad advice by so many vets and it was only when I had the guts to question and research and get second opinions did I find that out.

I just saved a new diabetic cat from the kill shelter here in NYC. (Fred died one year ago). He had to go to the vet straight away because he was in diabetic ketoacidosis. The vet got him thur that, but then started him on Lantus (at my request) before I took him home. I requested a 0.25 unit BID dose, he did that the first day, then within 3 days increased it 2.5 units. The morning I picked him up--and brought him home against medical advice when I realized what the vet was doing (he was also NOT feeding him in between shots--so the poor little guy was going hypo and then rising super high in a rebound--and then the vet would get a huge preshot number and increase the dose thinking that the insulin was not working-when in fact he was sending him into repeated hypos. They weren't testing barely at all so didn't realizing this (I got their records and saw that.)

One hour after I brought him home after his 2.5 unit dose his bg was 39.

NOW, for the past 6 or 7 weeks my kitty has been on 0.25 units---the vet would NEVER have known that this was the dose he should be on. He's consistently in the 200s now. I'm not trying to tightly regulate him at the moment because I don't have time for lots of tests. But the point is, I think he'd be dead if I gave him what the vet wanted to give him.

I have countless examples of how my past vets gave wrong advice with my Fred's ailments. So bottom line, please don't be afraid to say no to get a separate opinion, to do something differently. I insisted that my Fred be taken off the 4 heart drugs they gave him when, on day 2 of all these meds he didn't move for 10 hours. The vet got mad at me and this was very confusing and I felt bad. Finally I just stumped up the money to go to a cat cardiologist and he agreed that Fred was 19 at the time and had no reason to be onall 4 drugs since none of them were 'proven' to do anything anyway, they were just standard protocol. So he kept him on one only. But again, had I not researched it myself, and not been afraid to go against what my vet said--and let him get mad at me for not trusting his advice--(and his consulting cardiolgist's advice) this would not have happened. It's not easy and you only learn over time that vets are in no way experts in every disease for every animal, human docs aren't experts in every disease, and no vet is an expert in the chronic daily treatment of any of these diseases. So stay on these boards and get informed and then do what you think is right from an informed position--which you are doing.

good luck!