Need Hand Holding :-/

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Alexa and Reuben

Alexa and Reuben

Member Since 2012
Hi, My name is Alexa and my Kitty`s name is Reuben. He is an almost 15 year old Siamese, who was diagnosed with diabetes and pancreatitis last December. The vet put him on Minodiab, and he has been taking it until now - 5mg tab twice a day. It has stopped working, and he is drinking and eating and peeing non-stop. We have since moved to a new state, and have not been able to find a good vet here. The best one, who the show dog crowd love and say is a genius, thinks blood glucose testing is irrelevant. So I am on my own. I finally got the courage up to test him just now (he Reallllllly didn`t want me to), and it is 500 with Ketones. I`m using the Optium Xceed Meter, and I think the Ketone reading on this machine is valid, from what I`ve read. I just called Costco and asked what kind of Insulin they sell, and they have Lantus (and Levemur, Novormit, Novorapit and Humalog). I am thinking that the Lantus is what we need? and I need to know how much to give him. I am relieved to finally know what is happening to him - as this has been going on for a good while now. He is a Prince, and has put up with so much - so I am excited to finally give him insulin so he can stop suffering. Can anyone help us? I am hoping to be able to give him his first injection tonight, but if we have to wait until tomorrow I guess he will survive! He has been eating Lisa Pierson`s homemade food recipe, (cooked, not raw - as I am worried about the pancreatitis), for a month now. Thank you so much, Alexa and Reuben.
 
Hi Alexa and Reuben.

What was the ketone result? This is from your Optium Xceed Meter manual:

When:
•Blood ß-Ketone result is
between 0.6 and 1.5 mmol/L
and blood glucose result is
16.7 mmol/L (300 mg/dL)
or higher:
What It Means:
A problem requiring medical
assistance may be occurring.
What to Do:
Contact your healthcare
professional. Follow his or
her instructions for sick
day management.
Monitoring
Blood ß-Ketone
133-243 Manual,G3b,Eu,En 5/17/04 3:10 PM Page 55
53
When:
•Blood ß-Ketone result
remains high or becomes
higher than 1.5 mmol/L:
What It Means:
You may be at risk of
developing diabetic
ketoacidosis (DKA).3-7
What to Do:
Contact your healthcare
professional immediately.
"HI" Result
What It Means:
Your meter has determined
that your blood ß-Ketone result
is higher than 6.0 mmol/L, or
there may be a problem with
the test strip.
What to Do:
Monitor your blood ß-Ketone
again with a new test strip. If
HI shows on the display
window again, contact your
healthcare professional
immediately.

I'm sure that was all geared for human patients, but ketones are nothing to mess around with.
 
You said:
"I just called Costco and asked what kind of Insulin they sell, and they have Lantus (and Levemur, Novormit, Novorapit and Humalog). I am thinking that the Lantus is what we need?"
Lantus and Levirmir are find. However, if you are i the USA yu will need a prescription for the insulin and maybe the syringes.
 
In OK and TX, I could get Humulin N without a script altho' one was required for Lantus/Lev. I don't know about the others...

I second Dyana, ketones aren't anything to mess with...nasty stuff.

HUGS!
 
Thank you for answering us, Squeaky and KT! I`m on my way out the door to get Levemir right now, no scrip needed. We'll see about the ketones after the insulin gets going, as we`re really on our own without veterinary help - due to geography. Reuben is holding steady, eating a ton, looking good; glazed eyes and sleeping all the time, but moving around well when he is awake, jumping and running, talking and purring. I am so grateful for the help, Hugs back!!
 
Definitely Lantus or Levemir. Humulin N is terrible for most cats. You will most likely need a prescription for the insulin and syringes unless you are in Canada.
 
Oh my goodness! I answered Dyana and Larry and Kitties, but I don`t see the posts!! If I made an error and they didn`t go through, I`m so sorry!! I`m running out the door to get Levemir right now and will report in when I get back. I asked about dosage, among other things, in my lost posts.... Thank you guys sooo much for being here for us! Hugs!
 
Hi Alexa and welcome to the group.

would you tell us where you are located? We may have members in your area who can help and also provide vet recommendations.

The best insulins to use for a diabetic cat are: Lantus, levimer or prozinc.

Lantus and levimer are human insulins, and yes you can purchase it at costco - if you visit the supply closet board, there are coupons for both of these insulins.

If you opt for one of these insulins - you want to get the pens and not the vial. While the cost may be a little higher, given that you will be dosing small amounts, a pen will last you longer than a vial and you get 5 in a box. Unopened pens are good until the expiration date. So, ask for the latest they have.

Prozinc is also a good insulin. However, there is a concern that the stock is very low for this product.

Each of these insulins work differently, so I recommend that you read the "starred" information that is at the top of the insulin support group forums for the insulins, so you better understand how to handle it, how it works and how to use it.

You will need a script for the insulin and depending on your state, you will need a script for the insulin syringes - yes you want to purchase insulins syringes that are used for the vial and not the needles that can be sold with the pens. (again those are designed for humans not cats).


Now tell us how else we can help you and remember you are not alone.

If someone else is posting at the same time you are, you will see those posts at the top, just scroll down and your text is there and hit the submit button again and your posts will publish.

-------
Removed incorrect information regarding prozinc and stating it wrongly.
 
Okay, so the pens work!! I was looking for Levemir - which I could Only find in the pen presentation - but I thought they wouldn`t work on a cat, so I got Lantus instead... I`m going back out to get the Levemir box of 5 pens right now. And you guys will tell me how it works!!! I live in Xalapa, Mexico. It`s a big city (750,000 population), and the capital of the state of Veracruz, here in the jungle mountains an hour from the Gulf of Mexico. I`ll be right back with the Levemir! Thanks so much everybody, it is so amazing to have your support! :-)
 
You CANNOT use the pen needle device that goes with the pens - you merely use the insulin cartridges as mini vials - they have a rubber stopper on the end. The needle device for the pens only go up in 1.00 unit increments which is too high and even then they do not measure accurately because humans use far larger doses than cats so they have more wiggle room. Lantus or Levemir will work, if you already have the Lantus I do not know if you can return it... you WILL need to buy syringes for either insulin though!!
 
Thank you Ry and Scooter, for explaining about the rubber stopper! I was looking on the Insulin Support page about Levemir, and it was so over my head. But I`m sure it will all come together in the morning, after I go buy the Levemir box set of 5 pens. I doubt I can return the Lantus, but it was a tiny vial and I can donate it to a clinic in my neighborhood, and I want to use the Levemir. I bought BD Ultra Fine 0.3 mL short needles, is this correct?
 
reuben'smom said:
We'll see about the ketones after the insulin gets going, as we`re really on our own without veterinary help - due to geography.
Click to expand...

WAIT!!!

You have to deal with the ketones before starting insulin. It may be that your meter was just warning you to check for ketones since the value was high. However, if there are ketones present, you should not start insulin without knowing his potassium level. Insulin drives potassium into the cells. If he already has a low plasma potassium and you start injecting insulin, you could make his levels even lower. Potassium is very critical for proper muscle function, including the heart muscle. A severely hypokalemic cat could end up in cardiac failure.

I know it's difficult because of your location but honestly, you should not be treating this on your own without having veterinary care available if needed. This board is not a substitute for veterinary care. You really should find a way to have a vet you can call on when necessary.
 
Thank you soo much Deanie and Boo! I wasn`t thinking clearly about this, too much stress! I finally got through to our vet, (he has been on vacation) and we will see him tonight or tomorrow morning. I loved your video a lot, thank you :-) and, it gave me good perspective.
 
In the meantime, make sure he gets lots of water. If he doesn't drink it on his own, you can add it to wet food and also syringe it into him - if you have one that doesn't have a needle in it.

You may also want to ask the vet for a food syringe, to use at home.

And whether you use lantus or levimer, both are very good insulins. You will need to purchase insulin syringes - they need to be U100 syringes, and get the ones that are 0.3 cc with 1/2 unit markings. You can get long or short needles (my personal preference is short needles). Whichever you get, make sure they have the 1/2 unit markings.

It will make it much easier when it comes to micro dosing - giving less than 1 unit of insulin.

Also, be sure to keep the insulin in the refrigerator, do not shake or roll. This helps it last longer.

Here is the link to the main lantus board - where the starred information is located, this will help you to get started on understanding your insulin - lantus and levimer:

viewforum.php?f=9
 
Thank you Hillary and Maui! He is eating and drinking Enormous amounts on his own; I can barely keep up making the food for him! I have a box of the 100U 0.3ml syringes - with half unit measurements and short needles. I will use the Lantus that I bought yesterday (which is carefully stored in the fridge - no jostling :-) ). So, I think we are ready to go after the vet visit! I am still giving him the Minodiab, for whatever help it might be right now. And, thank you for the link to the Lantus board, I will calmly read it this afternoon.
 
Minodiab is glipizide, an oral hypoglycemic drug. This is NOT recommended for use in cats, because it further damages the pancreas by forcing it to produce insulin and is mostly ineffective in cats. It's only recommended if the owner is refusing to do insulin therapy and about to euthanize the cat. I would highly suggest stopping all of the glipizide immediately and beginning insulin therapy instead. Insulin allows the pancreas to rest and heal, which is why so many cats can go into remission with the right insulins.

Absolutely do not continue the glipizide if you're starting insulin!
 
Thank you Julia and Bandit for your concern! :-) Reuben has been on glipizide since December (the old vet insisted that insulin was not the correct therapy!), and it has made me nervous the whole time. We are waiting to start insulin until after visiting the new vet tomorrow, so I just figured I`d keep everything the same until then. I am so very relieved to be getting the glipizide out of the picture though, and out of his body!
 
Hi Everybody, We just got the test results back for Reuben's BG and Ketones. The glucose is at 425 and Ketones are 5ml/deciliter. The vet says we can go ahead with insulin at .5 unit. What is the recommendation here? Also, we want to shoot for remission, and I would like to know which insulin people have had success with post-Glipizide. And lastly, I am reading the insulin pages here in preparation, and am unable to load the spreadsheet with either of the suggested methods! I await everyone's input and advice before taking any action. Thank Youuuu :-)
 
I know you already purchased the lantus and honestly, it is a good insulin, and one that many kitties have gone into remission with.

0.5 unit is a very safe starting dose and goes with what we say, start low and go slow. Meaning start with a low dose 1 unit or 0.5 unit and slowly over several days adjust the dose based on test results.

Here is a link to the spreadsheets, see if this works: viewtopic.php?f=6&t=18207

If you still have problems, people can help you.
 
Okay, I`ll use the Lantus :-) I think I just got the spreadsheet attached on the signature successfully, is it there? I`m feeling quite overwhelmed suddenly about starting the insulin, and I think I need major hand holding :-/ Where is the best place for this, should I post over on the Lantus Board?
 
If you have a positive test for ketones, I don't understand why your vet didn't keep your cat, unless you don't want the vet to handle this, of course.

I suggest that you put "Ketones Positive: Help" in your headline and post in Lantus TR right away. I don't know what 5 ml/deciliter means in regard to ketones, and maybe it's okay, but I think someone might be able to give you some advice if you post to show it's a ketones positive test. Keep the 911, too.
 
Okay, I`ll post just as you say in Lantus TR. The vet said that it was a low number that I should start insulin; I certainly would like a confirmation on this so hopefully someone will know. Thank you :-)
 
Is there any way you can locate Ketostix? These are strips that you dip into your cat's urine stream that give you a reading on urinary ketones. They should be available at a pharmacy.

Not many people use the brand of ketone meter you're using and as a result, it's hard to interpret the results you're getting. Blood ketones tend to be a "to the minute" reading and more accurate than urinary ketones as long as you know what the results mean. With the Ketostix, any reading above "trace" can be critical. I can't emphasize Deannie/Boo's point enough. If the parameters of your meter are the same as one of the other ketone meters, Reuben could be in trouble. On the Precision Xtra meter, any reading above 3 mmol/L requires veterinary treatment. Being able to have the results from the Ketostix to compare with the blood ketone reading will help you (and us) to know what the results mean.

How is Reuben acting? Is he behaving in his usual way?

Usually, ketones develop as a result of infection/illness, not enough insulin, and not eating. It sounded like Reuben's appetite is good. As others have suggested, add water to his food. This will help to flush ketones from his system.

If it's not obvious, we take ketones very seriously. The presence of ketones, if they get beyond what can be safely dealt with at home (i.e., "trace" levels), can develop into diabetic ketoacidosis (DKA) quickly. As Deannie noted, DKA effects electrolyte levels which, if seriously altered, can be life threatening.
 
Low energy/lethargy is a symptom of ketones. You are going to need to be aggressive with managing this at home. You'll want to test for ketones if you see ANY change in behavior, especially not eating. You'll still want to test regularly. Did you check to see if there's anywhere on-line you can order the Ketostix? The strips for a ketone meter tend to be rather expensive. Getting started on insulin, if this is just a trace level of ketones, is critical. (It will also help if you indicate the units of measurement when you give a ketone reading. Because the majority of members here are from the US, we use mmol/L not ml/dL. The conversion you provided helps.)

Have you tested Reuben's blood glucose? If so, can you start to list the numbers on your spreadsheet. Your test before you give a shot is your AMPS or PMPS. The column marked "U" is for the dose (in units) of insulin you gave. You said your vet told you to start at 0.5u so that's the number that goes in that column. The +# columns indicate how many hours it's been since you gave a shot. So, if you test 2 hours after you gave Reuben is shot, that's your +2 number. We use this system since there are people here from all over the world and in different time zones. It allows us to know where your cat is in the insulin cycle.

When you have a chance, please read the starred sticky notes at the top of the Lantus board. They will help to get you oriented to using Lantus.
  • Tight Regulation Protocol: This sticky contains the dosing protocol that we use here. There are also links to the more formal versions -- the Tilly Protocol developed by the counterpart of this group in Germany and the Queensland/Rand protocol developed by Jacqui Rand, DVM and published in one of the top vet journals.
  • New to the Group: Everything you wanted to know about this forum and more. Info on our slang, FAQs, links to sites on feline nutrition and to food charts containing carb counts, how to do a curve and the components to look for, important aspects of diabetes such as ketones, DKA, and neuropathy, and most important, info on hypoglycemia.
  • Handling Lantus: how to get the maximum use from your insulin and what to not do with it!
  • Lantus depot: This is an important concept for understanding how Lantus works.
  • Lantus & Levemir: Shooting & Handling Low Numbers: What data you need in order to be able to work toward remission or tight regulation as well as information if you have a low pre-shot number or a drop into low numbers during the cycle.
 
In my opinion, your vet doesn't even need to know you are home testing, but you have to have a vet. Wow, you are in Mexico, ok.

Your cat needs to be checked for an infection, and may need antibiotics. Otherwise, you are continuing to risk ketones, and it is very worrisome that he has already tested positive for trace amounts. If he tests positive for more than trace, you might end up spending a lot of money to save him. In any event, if he does test positive for more than trace the vet has to treat him. You can't do it alone at home. If you can't get a urine test or you can't get the Ketosticks, and he stops eating (I don't know how long -- maybe if he hasn't eaten in 12 hours -- anyone else have an opinion?), I would take him to the vet for a ketone test if he were my cat.

You also need periodic blood tests for your cat that only a vet can do. You don't have to follow your vet's advice on raising the insulin dose, etc., but it is very encouraging that your vet started your cat out at 0.5u of Lantus. That's what would be recommended here -- that or 1.0u.

As far as raising the dose, it is not recommend here to go up by more than 0.25u per increase. At lot of vets will tell you to go up by 1.0u or even 0.5u. I wouldn't want to do that after my experience with my sugarcat. How to measure 0.25 units? You need syringes that have 1/2 unit markings on them, but it looks like you got them -- the 3/10 U-100s. You can do a search here for how to get an extra 1/4 of a unit in the syringe instead of 1/2 a unit or look through the stickies until you find that info.

If you get antibiotics give them by mouth. Do not let your vet give the cat an injection of Covenia -- a shot that lasts for up to 14 days. The "convenience" is not worth it. If the cat has a bad reaction to the antibiotic you cannot get that substance out of his system for up to 2 weeks. This is especially true with a cat that has uncontrolled diabetes. With an oral antibiotic that causes a bad reaction it should be out of his system in no less than 24 hours. Write "NO antibiotic shot; NO Convenia" all over the consent forms.

If you miss with the syringe and some of the insulin goes through the other side of the skin tent you were making to inject the insulin, please DO NOT give another injection. Please, wait the required 12 hours before you give him more insulin no matter what his BG readings are. You have no way of knowing how much insulin he got, and it is dangerous to give more insulin earlier than the 12 hour point. See "Lantus Depot" sticky above.

Hope all is well, and you can get the supplies you need for your cat.
 
Hillary & Maui said:
Hi Alexa and welcome to the group.
snip
Prozinc is an animal based insulin and also a good insulin. However, there is a concern that the stock is very low for this product.
Click to expand...

Prozinc is NOT and animal-based insulin. It is for animals only, not humans.
What is ProZinc™ (protamine zinc recombinant human insulin)?
PROZINC is a sterile aqueous protamine zinc suspension of recombinant human insulin indicated for the reduction of hyperglycemia and hyperglycemia associated clinical symptoms or signs in cats with diabetes mellitus. 1 It is the first FDA-approved protamine zinc insulin for cats.
from:
http://www.prozinc.us/faq/faq.html

PziVet was a animal (bovine) based insulin for cats.
 
Pretty darn confusing for there to be Prozinc and PZI that are two entirely different things. I know I thought people were just abbreviating ProZinc as PZI when I first found this site. Good thing I didn't use either.
 
Hello all the way to Mexico!

I'll let you know my cat Sneakers threw trace ketones for well over a month before I got her insulin high enough. It was always a trace and sometimes when up to small if she got stressed (vet visits and blood draws :shock: ) but it always came down again. It really meant I just didn't have enough insulin in her system yet- she ate fine and she is a lazy, lazy girl so trying to see if she was lethargic was a joke :roll: .

You know your cat- you've been watching her with diabetes for a while now. You know when something has changed- the vet doesn't. I knew she hadn't changed much even when she had ketones but I made sure she ate and had plenty of water. And she pees for a good 20 seconds- long enough to stick the stix in AND count to 15 :lol: . I'd finish counting before she finished peeing sometimes. That's diabetes.

Just test, at least once a day, twice if you can. Monitor her intake and output. Once you start getting the data and we see how much she drops we can intelligently raise the dose. Bear in mind that Lantus will have a 'shed' or 'depot' to fill- keep an eye on the ketones- Sneakers actually went up to small for a day and then started going right back down, two weeks later she had none and we are going on 2 months without them.

Good luck.
 
You mentioned that you can't find ketostix in the pharmacy - typically they are included with the diabetes supplies. If there is a pharmacist where you go, ask him/her where they have them. It's possible it may be behind the counter and you just have to ask for it.
 
max&emmasmommie said:
Pretty darn confusing for there to be Prozinc and PZI that are two entirely different things. I know I thought people were just abbreviating ProZinc as PZI when I first found this site. Good thing I didn't use either.
Click to expand...
Could not agree more, Dale! And since Prozinc is just the brand name for "Protamine Zinc Insulin" many people assume PROZINC = PZI, which as Larry pointed out, is not right, or at least very misleading. When PZIVet was discontinued, Prozinc was developed to be a suitable replacement. Wish they could have called it something else!

Carl
 
PZI is a generic term. It stand for protamine zinc insulin. Protamine zinc is an additive that extends the duration of the insulin. The insulin can be recombinant human insulin, bovine insulin or something else too.
 
Hi, We have two threads going at the same time -- one in Health and one in Lantus TR, and it can get confusing and you might miss something important. We should probably try to stick with one or the other. Would you like to choose one that you will check and tell us which it is? Thank you.

I posted this over on the other thread and I should post it here to clarify:

Sienne (and Gabby) and Jill (and Alex) know far more about diabetes (and ketones) than I do; that's for sure! Thanks you two for adding to this thread after my post.

You wrote in a different post:

have not been able to find a good vet here. The best one, who the show dog crowd love and say is a genius, thinks blood glucose testing is irrelevant. So I am on my own.
Click to expand...

I don't know what the vet (or you) meant by "irrelevant," but I don't want you to give up on having a vet involved in the care of a 15 year old cat that you clearly love enough to treat for diabetes, so I wrote:

You also need periodic blood tests for your cat that only a vet can do
Click to expand...

I did mean that you can't find out if your cat has many other problems besides diabetes without the kind of laboratory that a vet uses to test a "blood panel." Sometimes those tests can tell you more about how you should handle the diabetes. Just knowing his BG readings and whether he has ketones is not always enough. I'd like to know if my cat had a high white blood cell count if I were in your shoes, for example. For a cat that is 15 years old, as yours is, I would want to see periodic panels (some people do them every 6 months) when a cat is this old and catch anything that might be a problem as early as possible. For instance, did your vet do any test for kidney issues? I would want that done, if I were you.

I wrote:

You don't have to follow your vet's advice on raising the insulin dose, etc., but it is very encouraging that your vet started your cat out at 0.5u of Lantus. That's what would be recommended here -- that or 1.0u.
Click to expand...

Looks like I was wrong on that 0.5u dose. Make sure you check out Sienne and Jill's answers about this. As far as the vet's advice, please don't avoid going to the vet just because he thinks blood glucose testing is "irrelevant," for the reasons I stated above or because he gave the wrong dose to start with, etc. You don't "have to" follow his advice if you are not comfortable with it, but don't count the vet out entirely. When you posted for the first time, you seemed to be afraid to start giving insulin until someone here agreed it was okay despite the fact that the vet said to do it. If what the vet is telling you to do doesn't make sense to you, you "should" be able to talk to your vet about what he/she is recommending until you are comfortable -- that doesn't always happen, and if your vet isn't willing to discuss it with you, please post on here and see if you can feel comfortable with the advice you get here. Ultimately, you are going to have to do the best you can under the circumstances.

I wrote:

As far as raising the dose, it is not recommend here to go up by more than 0.25u per increase. At lot of vets will tell you to go up by 1.0u or even 0.5u. I wouldn't want to do that after my experience with my sugarcat.
Click to expand...

Your situation is different as Sienne pointed out. You have ketones to worry about which is why I wanted you to post over here in TR in the first place -- very serious stuff. My experience was different, and you may have to raise the dose by more ("may" being the operative word). Sienne and Jill and a few others here know a lot of details, and they will (almost) always chime in if something is said that isn't quite right or is misleading in the way it was worded, thank goodness.

We are all here rooting for you. Hope your baby gets better soon, and keeps eating well.
 
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