Webber's Status at the vet with Insulin

I just got off the phone witht he tech and this is the info I got. I am not happy at all because he has never read this high at home. I knew the stress of being at the vet would make it spike! But I digress...

They are testing with their glucometer and mine to get an understanding of how they compare.
AMPS - 423 (vet glucometer) 329 (my glucometer)------HE HAS NEVER READ THAT HIGH ON MY GLUCOMETER AT HOME
They gave him 4 units

+3 - 380 (vet glucometer) 269 (my glucometer)----a little closer to some of my readings at home

He has not really eaten much while being there (I was afraid of that). They are going to test again at +6, +9 and +12.

With the numbers I was getting at home I would be very weary of starting him on 4 units. I will see what the vet says when I pick him up. It is going to be a long long day for me and Webber nailbite_smile

 

Definitely not 4u, on ANY insulin. I feel I can say that without repercussion. We find the very best way to get to the proper dose is to start low, and go slow. Let the body get used to the insulin on board, rather than trying to beat the bg's into submission, which can lead to an overdose cycle that will ultimately endanger your cat.

We do not take really "count" vet curves as anything that reflect how your cat will actually do on insulin. Lovely to see a curve and all that, but you are not dealing with realistic numbers when it happens at the vet as stress and abnormal eating habits invalidate the results.

 

Absolutely wrong! A cat is not started out at 4 units! Paije, how far do you want to push this? ie how willing are you to say no to the vet?

Jen

 

I agree with you completely Carolyn. I agreed to take him in because that is what she really wanted, but I am thinking that it is a waste of time and money. He is not behaving at all the way he will at home. I was thinking I would start him at 0.5unit or 1unit at the most.

My poor poor baby :cry:

I wonder if they will let me go see him?

 

He is your cat....

 

Paige, your instincts to be concerned are correct.

Did they tell you what kind of insulin it is?

I would say that if you are not up for a confrontation tonight, and your kitty does not have a complicating condition like ketones or anything else for which he needs to be hospitalised, I think you can bring him home and monitor him and re-start him at 1 unit... of whatever insulin it is. Cats do not get regulated at the vet offices. Then, you can look around for another vet if you like. If you like this vet other than your concerns today, please talk to him about the starting dose of insulin and tell him that you will gladly send him an email of the spreadsheet everyday if he is really worried about the dose being too low.

Also, I wonder if they are using blood from a vein or from the ear for both meters... Also... if one meter is off, who's to say it has to be yours!?

What are the two meters being used?

 

They must let you see him. If they do not, take him out of there immediately. Even when it's been "against policy" to let clients in the back, I have always insisted. Sundance was never in a cage that I did not see personally. That is actually how I knew one vet was not feeding her the food I instructed them to feed and with which I provided them. I spoke to the assistant who got the vet and said, "This is not her food. What's going on?" They explained that they didn't think my food was right for her because she was diabetic. I had to state that she was diet controlled - DIET controlled - and she got that way on the food I provided not the kibbles of corn they were trying to force upon her. UGH. From then on I always had an instruction sheet and did not leave until the vet had signed off on it with me. The new vets never had a problem with that. ;-)

 

Could you not put your food down and 'demand' that you can see him?
I have no idea of course how your relationship with your vet is and what the possibilities are.

I myself would seriously get over there and correct a few things. But again, that is depending on the vet, on myself, the cat, the knowledge of the vet, my trust in the vet, my trust in the knowledge of the vet and so on....

You must feel horrible right now.
I have my fingers and Spacey's paws crossed for you guys.

 

I think Ella means put your foot down... I went back in the thread to see if you had mentioned lunch. :lol:

 

Jen,

I don't know what to do. I already have him there. Should I maybe go get him and find another vet that will let me start the injections at home in peace?

I am so confused....and at work, but getting absolutely nothing done.

There is not way that I will start with those # of units at home. My husband agree's that this is a high dose, but tries to appease me by saying that he is in safe hands if something happens today.

 

I would just show up. I think .5u is just fine if that is what you are thinking you would be comfortable starting with. Remember you are the person holding that syringe at the end of the day. I say go get him ;-)

 

Yeah, the other things is that I gave them my lantus. If the techs are used to PZI they may not be familiar with giving Lantus. Ugh, I am leaving and going to go check on him. I must go with my gut.

Thanks everyone. I will keep you posted.

 

Well, there are 2 ways to look at this. First, stress may likely prop up those bgs so he doesn't OD there, and if he DID OD then he would be well treated. Or, you could show up a bit early to take him home but first talk with the vet about the dose and if you aren't satisfied with the vet's response then call a new vet once you get home.....

 

Webber is YOUR CAT. If the vet gets pissed off that you want to be a strong advocate, then it's time to find a new vet. I personally approve any medications before they are given; not just to make sure I agree with treatment (or want to get a second opinion), but also to have some idea/control of how much I'm being charged. And I ALWAYS provide my own food, even if the cat is only there for a couple hours.

4 units seem like a ridiculous place to start, and potentially dangerous. You are very likely to skip right over the ideal dose by starting so high. If I were in your position, I'd pick up Webber asap, and maybe start looking for a new vet. You need to go with your gut, and don't let the vets push you around. Ideally you would have a vet who is willing to have an intelligent conversation with you, open to outside (possibly more current) information, and not just a bully. Webber can't speak for himself, and is counting on you.

Sorry if I sound a little hostile, but I've witnessed a lot of vet bullying and it really gets my goat.

 

Oh right, you had the Lantus... you are so on top of things. Yea... you know best for him, really you do. Like I said, if there are no other complications, you can deal with it today and find a new vet (if that's your decision) in the next couple of days. If you can, let your vet know your concerns. He may work with you or you may leave him with some food for thought.

 

Oops

 

Always the best way to go....

 

In my opinion your clinic and vet were irresponsible to administer such a high dose of insulin (is it Lantus? In the other thread you mention taking "your pens") to a newly diagnosed cat. Especially if he will not eat while there. The not eating in itself negates values they are getting in relation to how much insulin he will need.

I read through your previous thread and can see that you already have a good grasp of what's important regarding diabetes treatment via diet and insulin.

If you feel the clinic and vet have disregarded your instructions or have acted irresponsibly, then by all means, it is your right to remove him. We can be here to help you should problems arise.

If you or your husband feel he'd be better off there in case he becomes hypoglycemic, then perhaps he should stay there through the course of the day. At least that way if he goes too low on the 4U, they will have record of it and there will be no disputing the dose is too high. And he can receive treatment if he becomes symptomatic. I'm not trying to scare you, but the reality of the longer lasting insulins is that although they take a bit to ramp up, they are still powerful.

Keep us posted. Good luck! You're doing a fantastic job for Webber!

 

I feel better. I went straight to the vet office and ask to see him. They were very nice and let me go back there and take him out of the cage. I was able to go in a room with him and love on him, let him walk around and get him to eat some. Their last reading was 256 (vet meter) and 216 (my meter). I felt much better seeing where he was today and getting to love him. He is doing fine and they are taking care of him.

I will still talk with the vet tonight about her perspective, etc.

Thank you all for helping me not feel crazy and being supportive for an overly controlling kitty momma.

 

Great, glad he's ok!

I hope your vet is supportive of your plan to do 0.5 or 1.0!

Jen

 

Remember, even the best glucometers have an error variance. I can't remember what it is. 10%?? 20%?? So the numbers between the two meters aren't so different, in fact if the variance is 20%, the numbers are almost identical.

 

+/- 20%

 

The last BG was 122 (vet) and 84 (mine). I found out that they add 40 to their glucometer values. That means they were almost identical.

Thank god I was there to pick him up, because they could not even get him out of the cage for his last test. :-x Which is even more of a reason for me to insist that I test him at home the next time.

The vets plan for Webber--- give him 4units once a day for 2 weeks and then test him again.

I am going to test his AMPS and if he is still below 200 I was told to call and get the vet to advise me on how much to give. Because I am pretty darn scared to start him off that high. I am going to go to the Lantus Land and post some questions there.

Overall he is doing well and is very happy to be home. Went straight to the food dish.

And the journey continues.....

 

You know.....maybe I do need to get a new vet. I just realized that no one showed me how to give the injections. They also did not tell me if I give the insulin before I feed him or after??

Please help.....do I shoot before or after breakfast?

 

You are right to be looking for more information. 4 units is far too high to start and definitely too much to give if the pre-shot BG number is anywhere near the latest numbers you reported. Also, once-a-day dosing simply doesn't work as a starting point. A few cats end up there when they are nearing the point where they won't need insulin, but starting there is not correct.

I'm very glad you brought Webber home. Please post lots of questions so that people can guide you as you need advice.

(General disclaimer: What I say above is what I have learned from reading on this board. It does not reflect personal experience. If experienced people tell you something different than what I have said, please listen to them instead of me!)

 

Paije

Read the stickies over on the lantus board. Your best bet is to start low, especially considering how well your cat responded to a diet change. I don't know what to say about your vet, except that he scares me. I don't know if you can find a way to work with them or not; they don't follow proper protocols for lantus and haven't shown you how to treat your cat!

Jen

 

Yes Jen I agree. I think I will be looking for someplace else. The other thing is that the vet was not even the one to tell me all of this. The tech called the vet on the phone (because she had already left) and then relayed the info. I really liked her, but since webber's diagnosis I am not too sure. I hardly ever get to talk to "her". It is always through someone else.

To give her the benefit of the doubt I do not think that she has any cats on Lantus. She is used to PZI. I seem to be talking myself into looking for another vet as I am typing, lol.

 

Uh. You need a new vet Paige. That's not only an extremely risky dose, but dosing only once a day means the second half the day, he does not have any insulin on board. It's a 24 hour insulin in humans only, cats metabolize insulin roughly twice as fast. Earlier you were comfortable doing 1/2u or 1u. I think 1/2u would be perfectly safe to start with tomorrow morning. Do not shoot anything tonight, your cat was 84 late in cycle, and if he gave 4u this morning.. well it boggles the mind. Lantus CAN continue working after 12 hours, and that's a megadose, please test again. If he is lower, report back here ok?

 

Carolyn,

Just tested ---BG was 100.

Also, on the SS what color am I aiming for? Greens? confused_cat

 

wow.. how many hours since last shot?

 

15 hours since very first shot

 

I know this looks like a good thing, but I want you to be ready for him to go pretty high tomorrow. This will be his first day in normal non-diabetic numbers since before he got sick. This sudden low can also cause him to STAY high for more than 1 or 2 cycles. On the Lantus ISG, it's called rebound. You have to wait for it to clear, and keep shooting the same dose, whether you're starting at 1/2u or 1u. Be patient, it will pass, but the insulin will appear to have almost no effect whatsoever and you may see him higher than you've ever seen him.

Lantus works by building up in the body, and it works very slowly. It's easy to become impatient, or worry that you've chosen too low a dose. Hold steady, for at least one week at the same dose, and especially through the next few cycles while the rebound clears. Take a good look at the sticky notes in the Lantus ISG forum to help yourself understand how Lantus works while you're waiting. (((hugs))) get a good night sleep tonight, you've had a long day, but you've really hit the ground running and we're proud of you :smile:

 

Thank you for this info and preparing me for what may come tomorrow. One more thing--what is a "cycle"?

 

You're welcome, just didn't want you to be shocked at anything crazy happening tomorrow A cycle is the amount of time from one dose to the next... the 12 hours from one shot to the next. And, btw, there are no insulins on the market today that last 24 hours in a cat, human insulin or animal insulin. So if you hear that again, you will know it's incorrect.

 

Paige, please do go to the Lantus section and read all the stickies. Twice. Learn how that insulin works and how the treatment uses the way it works to benefit the kitties. It's a longer lasting insulin - lasting longer than 12 hours. But it does not last 24 hours. So, by giving 1 unit twice a day, there is a point of overlap that is good because it is the time that the first shot is wearing off and next shot is starting to work. This helps keep the BG levels smoother than them going from high to low to high again - from empty to full to empty.

Also, please read about the insulin depot - also called the shed - and how that works. It takes patience to treat diabetic cats and it can't be done in a few hours or a few days.

Do ask all the questions you have - even if you've asked them before. Everyone is here to help and the ISGs are a great place to learn about the insulin you are using. You may also ask for help here for more general questions or an emergency.

Some vets and people think that one high dose will last longer. It does not. It sends the BG lower but it still wears off in the same time as a lower dose. So once a day isn't going to work for starters.

Does this all make some sense to you? It's hard when you are disappointed in your vet. But you can do this.

 

Hi Paige -

I would also like to state that I don't think Webber should be on that high of a dosage at this time. Please listen to others advice and post again here or in Lantus Land asking for advice before you give him a shot again.

Six, who has been on Lantus since 12/18, has just finally moved up to 1.5 unit BID (twice a day) and his numbers are still hanging out in the 300, sometimes 200s. Six started in the 500-600s...and he's doing great even though his numbers are not where they need to be. It's been a slow, gradual process, but by taking things slowly I know I am not putting him at greater risk. It's funny, I was just thinking how much better he is looking and acting AND he still has a way to go to get his numbers near normal.

I adore my vet, I know she is brilliant, but I think this is her first use of Lantus with a cat (or if not, it's been limited). I have shared with her what I am learning from this board and she is receptive. I also ALWAYS talk to her when discussing dosing and not a vet tech. That would make me wary...so I would insist on talking to the vet when talking about Webber.

As suggested, read the stickies and about the Tilly protocol...it will help you understand more of what you should do for Webber. Also, hangout on the Lantus board and read other kitties postings/spreadsheets with numbers similar to Webber. It's not a perfect system, but it has helped with seeing trends with other cats similar to Six's numbers...to see how long they have been on Lnatus, to see their doses, read the notes when doses changes, etc. You will learn a lot in one week hanging out in Lantus Land and reading other kitties spreadsheets. Take it slow with Webber as you are learning.

Don't worry about advocating for Webber and upsetting your vet (though I am not sure you are worried)...my vet always says "You know (insert animal's name here) best." It sounds like there's still some potential with your vet, but make sure you are very clear that you are a part of the decision making process and with education, you will feel more comfortable expressing that thought.

I know how much you love Webber! You have done a great job asking questions and making changes as needed before starting the insulin! Keep it up.

 

I agree with the others. DO NOT GIVE 4 units. Unless your cat has been tested for acromelgly (sp) and requires higher doses, the recommended starting dose is 1 unit or even 0.5 units.

You could end up with a hypo situation and not even realize it. If you go over to Lantus forum and read about Nicole and Baby, you will see that she accidently gave 5 units instead of 0.5 unit. Read her thread, it's 6 or 7 pages long by now, but it's a great lesson on how to handle a too high dose given.

Additionally, I also think you ought to seek out a new vet. I believe I recommended this to you before, when you were contemplating whether or not to take your cat into the vet for the day of testing and I suggested that it was not necessary and a waste of money and unnecessary stress on your cat. Anyhow, you want a vet that will actually speak with you and not just through a vet tech. You also want a vet who will partner with you and give you as much time as you need to learn and practice and figure stuff out.

My new vet, did that - she showed me how to inject insulin and had me practice (drawing insulin from a vial and then using saline solution to do the injection), she let me do this until I felt comfortable. She also answered all my questions and was honest when she said, I don't know, but I'll find out.

It's important that you are comfortable with the vet after all you are paying for their services and this is your cat.

So, that's just my 2 cents. Hope it helps.

 

Yes everything that you all have posted has helped. I have been in LL most of the day watching Nicole and Baby go through a really tough day. I could not get BG level this evening so I have decided to wait another day when both Webber and I have calmed down.

This is my LL Condo for today. http://felinediabetes.com/FDMB/viewtopic.php?f=9&t=1601

 

Paige..here checking on Webber.... xoxoxoxo

 

Bless your heart Nicole. You should be taking care of Baby. You are one strong woman! You have held yourself together so well. ohmygod_smile

I tried at least three times with Webber's ears and three times with his pad. But his body is not cooperating. We are going to give him a rest for one more day. Luckily his BG's on diet alone were not too bad.

 

Paige, it is Ok..it takes time to get BG. Try at an angle with the lancet if that helps. I free hand the ear & go in at an angle & we finally are drawing blood easily. Today though..has made me a Pro at drawing blood..ugh! Anyway..I do thank you for your support & will be anxious to see Webbers #s in the morning. If anything..my experience today..should definitely convince you to start very low! My vet was supportive of starting at .5 I am the dumb A** who gave 5.0 mistakenly...anyway... they said they had heard of Lantus & were familiar.
The ER Vet tonight was very, very kind..but she even had to have me spell Lantus a few times & my personal vet..I feel like I am educating her on the peaks, etc. which is kind of scary since I am sooooo new!
Thanks again for everything & let us know if you need anything!!