Newbie: Teronto and Pauline

Well, I'm a newbie all around. I've never in my life posted to a forum and Teronto was diagnosed with diabetes on Wednesday. Honestly, I made the appointment that morning in full belief that my husband would be taking our boy in and would not be returning home with him. It was a relief to know it was diabetes. He'd been pretty lathargic for a while, but he was still eating and drinking so I figured he was okay. It was when the potty accidents happened that I made the appointment. The first accident we couldn't pin on him since we were not home when it happened and we have another cat (his sister) and 2 toy rat terriers. It was when my husband actually see him potty on the carpet that I just KNEW this was something more. He's always used the litter box ever since we've gotten him and has never done had accidents.

So here I am. Searching the internet because I kinda feel like the vet just left us out in the wind. No pamphlet about feline diabetes, only insulin and a perscription for syringes. He did not mention home testing. Which I just think is CRAZY! My father has diabetes and wouldn't even dream of not testing in the morning. He did write some symptoms down for hypoglocima and what to do. He also told my husband to pick a dry food and stick with it. No limitation to his eating.

I did my first insulin shot with only the knowledge of my husband quickly telling me what i needed to do on Thrusday morning. Followed by a treat. How I managed to not faint is still beyond me. LOL Friday morning was easy and this morning he waited in the hall way at 6:45 for me. To him it was petting time and then treat. Silly Cat.

I went to Walmart today and picked up a Relion glucose meter. And I have to say, Teronto has to be the most tolerant cat ever as I learned how to draw his blood from his ear. His reading was 497. He's reading at the vet on wednesday was 654. He's currently on Lantus 10 units once a day in the morning. My question is, is this a normal course of treatment for a new diagnosed cat? I was thinking of testing him throughout the day tomorrow. I'm curious to know what his BG is looking like throughout the day. Has anyone else done this?

My family and I leave for Hawaii in a couple weeks for a two week vacation (I live in alaska and we had no summer so this is a much NEEDED vacation). I want to change his diet but I also have a family friend coming to stay with Teronto and house sit for us and I don't want anything bad to happen while I'm away. Do you think a few more weeks on frisky seafood sensations (which is his favorite food) will hurt him? I was also in the thinking that right now it's more important to get his BG stable and him stable vs. changing things on him that might stress him out to much, especially with me being out of town.

And my other question is canned food. What do you use? I've looked at a few but I'm not sure what is good and what I should, at all costs, stay away from.

So many questions I guess.

This forum in just a few days of just reading posts has been a god send. And any advise is greatly appreciated. I just want to care for Teronto the right way with the best knowledge I can get and my goal is to get him in remission if at all possible.

Pauline

Pauline, I have also posted a 911 linking people to your post. I don't use Lantus but I do know that is an insane starting dose and Lantus is also a twice a day insulin. Please keep an eye out for responses from the Lantus users.

Hello Terento and Pauline,

Welcome to FDMB. You will find lots of help and guidance here.
The first thing I'd like to address is 10 units sounds really high for a newly diagnosed cat.
Have you been testing any after you give the shot? Do you have numbers to share?

I hope I can get someone to come advise you on dosage but I would like to ask that you start getting more tests right away because
that starting dose just isn't right.

I'll be back in a minute.

The very first link I want to share with you is this one. Please print it, you never know when the internet might be down or there is a power failure.

How to Treat Hypo's

and you need to create a hypo kit. You need extra strips , some canned foods with gravy (medium carb and high carb), honey or karo syrup
and you will also want an extra meter as a backup with spare batteries.


I'm trying to grab some links so I'm just posting multiple postings so I can get this info to you quickly.

Unfortunately I don't have any other numbers. Just the one that the vet gave my husband at the appointment Wednesday and today after purchasing a glucose meter. I gave him his shot at 7:22 am and I tested him as soon as I got home at 4:57 pm his BG was 497. I haven't tested him since.

Would you test him?
I'm concerned about the 10 units.

Hello, Pauline,

Glad you found this site. You will find EVERYTHING you need to know, plus a wonderful group of experienced people to help you answer your questions.

I just want to second what Rhiannon said. 10 units is a very high starting dose of Lantus, which IS a twice-daily insulin. I would encourage you to test Teronto frequently to be sure the blood glucose isn't dropping unduly, and watch carefully for signs of hypo, which Rhiannon has posted.

Please feel free to post Teronto's current blood glucose result in the subject header of your post.

Food changes can have a big impact on BG, so you will want to be careful about changing food and dose at the same time. You'll find lots of good input here in the morning.

In the meantime - again - please test the BG again. What you want to do is make sure the BG has stopped dropping.

You're in the right place! Please look for some responses before you give the next dose in the morning. You'll get great input.

rhiannon and shadow said:

Would you test him?
I'm concerned about the 10 units.

Click to expand...

I agree with Rhiannon that another test now would be wise.

Other information that's useful is when you feed Teronto. It can be hard to interpret the BG result without knowing when the last food was eaten before the test.

I just tested him. Apparently the relion glucose meter won't give an number above 600. It just have me Hi. I had to look up what that meant.

I'm concerned that he will have a high number in the morning. And I'm so afraid to change dose because I don't know enough and don't want to hurt him either. And if 10 units is high would giving him more tonight be bad and if i shpuld gice him a shot how much should I give him?

Shouldn't his BG be regulated throughout the day? I guess first and foremost I need to know who makes the choice to change dosage. Should that be me? Or the Vet? Or maybe I just need to find a new vet. Because know that I think about it I remember my husband telling me he wanted to give him 12 units.

Ya. I'm about at freak out mode. I could cry right now.

I don't want to freak you out.
I know how hard this is. It's a tough situation. FD is scary and overwhelming at first.

Is it time for your next shot?
I figured you weren't going to be due untl morning.

Where do you live? What time zone?

We need more info to help with what dose?

It's Alaska time here so 952 pm. The vet told us only one 10 unit dose in the morning. So he isn't scheduled for another dose until 7 am

Lantus is a twice a day insulin and I suspect your starting dose should be something like 1 unit but I want someone who gives dosing advice to confirm that .
There are numerous reasons why, but I'm not typing fast tonight so I am hoping to have more time to help you find all the information and also give others a chance to
weigh in too.
I'm grateful that we have hours before your next dose.

Pauline,

I feel for you, because when we first came here, Kitty had been put on once-per-day at too high a dose. It's very difficult to know the right thing to do. Not all vets are experts on feline diabetes. On Monday, I'd encourage you to get a second opinion, but of course your focus is on tomorrow.

I'm not surprised that Teronto's BG is HI. One of the things that happens when there is one large dose is that Teronto's BG will go low, because of the insulin, and then bounce high again, as the body responds. It's a yo-yo response - not a good approach for healing from diabetes, and probably not fun for Teronto. It's complicated, and others can explain it better tomorrow. The main point is that this is why Lantus is given twice daily, to help smooth out that response.

The big challenge is what to do in the next day or so. I see your next shot is scheduled fairly early. Are you able to get up early enough to get more experienced voices to give you input? You'll have many east coast people here in about six hours.

10u is an extremely high dose for a cat that doesn't have a high dose condition like acromegaly or IAA. 10u would throw pretty much any cat into a severe hypo and it would probably even kill a few of them. Are you sure you are drawing 10 units and not 1? Can you show us on a syringe full of water how much insulin you are shooting?

Pauline - Just want to be clear. When we say that Lantus is a twice-daily insulin,

WE DO NOT MEAN GIVING 10 UNITS TWICE DAILY.

10 units is an extremely high dose for a newly diagnosed cat. The Lantus forum here works with a protocol developed by vets that suggests starting low - usually ONE unit twice daily - and increasing slowly, based on the cat's response, as seen through frequent testing.

:YMHUG:
Here are a few links to help you learn quickly.
This is a steep learning curve and it's easy to feel overwhelmed.

New to the group sticky


This link is one of our favorites around here for food and what to feed and why to say goodbye to dry food forever.
http://felinediabetes.com/FDMB/viewtopic.php?f=9&t=18139

our most updated canned cat food list. Choose foods lower than 10%. Some of us choose a lower number than that.
http://www.catinfo.org/docs/Food Chart Public 9-22-12.pdf


I found someone to help sooner.

Hello and welcome to FDMB, Pauline!

You've already been given great advice, and Rhiannon has posted a "sticky" from the insulin group where I myself post most of the time (the Lantus Tight Regulation group) so this is mostly reiteration:

--- 10 units is an *extremely* high dose. (I second the question of whether you are certain you gave been giving TEN units and not ONE unit? Can you please check and let us know?)

--- Lantus insulin works in 12-hour cycles and must be given TWICE daily. (The fact that your vet suggested TEN units, and ONCE daily injections, and DRY food, makes me worry that he may not have enough knowledge on feline diabetes to give you the correct instructions on how to keep Teronto safe and how to find a way to regulate his diabetes. I'm glad you are posting here!)

--- If you change your cat's food to wet food only (which is what we most often recommend, because the low carbs percentage helps greatly in accomplishing regulation), you MUST test more often than before each shot, because the BG can fall quite drastically when a cat is no longer eating high-carb dry food. You MUST also shoot a safe dose of insulin twice daily, and I do not believe 10 units is that safe dose - although you'll see from my next point that I can't tell you which dose *would* be safe.

--- We would like to help you find a safe starting dose, but it is not safe for us to do so without seeing more of Teronto's BG numbers. Sometimes, we do it, if there really is no other way to see more of that cat's numbers, but it is not generally recommended. Can you please set up a BG Spreadsheet and a Profile, so that we can try to give you input on dosing etc.?


Thanks!
Jane

My phone pooped out on me right after I took the picture. But the box of syringes says...Insulin Syringes (we got them from the Fred Meyer pharmacy) 3/10 ML CC. Doses up to 30 units. I draw the insulin up the the 10 mark.

yep .. that's 10 units.
We're going to want you to do that tiny 1 number.
But wait for someone to tell you that for certain. I am not experienced enough to tell you that's your new dose.

Hi Pauline,
I was coming back to answer your other question. Around here, most of us decide on our dose, not necessarily agreeing with our vet.
Many vets are more familiar with dosing for cannisulin ( canine insulin ) and it doesn't work the same as Lantus.
Your dose is decided by your lowest number(nadir) during a 12 hr cycle. You aren't dosing based on the highest number.
It sounds like your vet was doing that, he saw that 600plus and gave you too high a dose.

The folks here have a lot of experience with dosing and will help you do this right and take care of Teronto.
Most of us here are living , and dealing with feline diabetes 24/7. The vet tends to tell you a few things, send you on your way and have
you come back in a few weeks. They aren't holding your hand like we will do here.

We have been where you are and we know how hard it feels at first and we know how scary and unsure you are feeling.
I do want you to know that these folks are volunteers who offer you help. There can be moments, hours where you might wait for an answer
but it's still usually a lot faster than waiting for your vet to respond and get you in. Especially if they are going to tell you incorrect instructions
for this insulin, Lantus. There are so few vets out there who have experience with Lantus.
You have found the best place to get help right here.

Jane said:

Hello and welcome to FDMB, Pauline!

You've already been given great advice, and Rhiannon has posted a "sticky" from the insulin group where I myself post most of the time (the Lantus Tight Regulation group) so this is mostly reiteration:

--- 10 units is an *extremely* high dose. (I second the question of whether you are certain you gave been giving TEN units and not ONE unit? Can you please check and let us know?)

--- Lantus insulin works in 12-hour cycles and must be given TWICE daily. (The fact that your vet suggested TEN units, and ONCE daily injections, and DRY food, makes me worry that he may not have enough knowledge on feline diabetes to give you the correct instructions on how to keep Teronto safe and how to find a way to regulate his diabetes. I'm glad you are posting here!)

--- If you change your cat's food to wet food only (which is what we most often recommend, because the low carbs percentage helps greatly in accomplishing regulation), you MUST test more often than before each shot, because the BG can fall quite drastically when a cat is no longer eating high-carb dry food. You MUST also shoot a safe dose of insulin twice daily, and I do not believe 10 units is that safe dose - although you'll see from my next point that I can't tell you for certain which dose *would* be safe.

--- We would like to help you find a safe starting dose, but it is not safe for us to do so without seeing more of Teronto's BG numbers. Sometimes, we do it, if there really is no other way to see more of that cat's numbers, but it is not generally recommended. Can you please set up a BG Spreadsheet and a Profile, so that we can try to give you input on dosing etc.?

Thanks!
Jane

Click to expand...

Pauline, I'm reposting this just to be sure you see it. Rhiannon and Kathy are right in that we often suggest a low dose, like 1u, to start with.

I want to repeat that I am not comfortable suggesting any dose to you without seeing more of your cat's numbers. At the moment (it is around 10:30pm for you, yes?), your priority should be finding a way to post your cat's BG readings (ideally on a spreadsheet, see link above), so that we can give you dosing input. IF you cannot set up a spreadsheet tonight, you can post whatever BG numbers you do have right here, in this thread.

I can tell you that changing the dose to 1u (ONE unit) is most likely the next step, and it is most likely what I would recommend you shoot twice daily IF you will be testing more frequently.

Jane

It's hard to type fast enough to keep up with all of us.

I'd like to re-cap a little.

It would be great if you could start a spreadsheet. Jane gave the link to set that up. If you aren't able yet, just list everything you have
and we'll make a recap post . It sounds like you only have about 3 different test numbers thus far.

We would also like testing done at each shot time - that would be your AMPS and your PMPS and an extra test or two during each
12 hr cycle.
Those test numbers help us and you to see how Teronto responds to his shots. We need data, and so do you.

We also don't think your vet has any real experience with Lantus since the advice has already been incorrect from him.

And always ask questions, any you have even if you are repeating something. This is a lot to take in all at once.

If you are interested in changing the food right away, please let us know because that can have a big impact on the bg numbers immediately.
Ideally you change the food before you start the insulin and test and see how it affects their bg . But so many learn all of this at once and
make numerous changes which can all have a big impact.

Then if we can get you to come post over in the Tight regulation forum where everyone will see.
I did send Sienne a pm but she might not see it until morning.

I did just set up a spreadsheet and attached it to my signature....really it's nothing but the two BG readings I took today and the units I've given him.

Thank you all so much for the help. I appreciate it so much, and while Teronto can't say it he does too. Although I'm sure he doesn't appreciate my hovering over him now. All and all I just want Teronto to not only get better but to feel better always. And I feel pretty lost at the moment and scared.

It's 1044 now so I need to head to bed....not that I'll be sleeping much with the worry and thoughts going through my head. But I look forward to getting on here before his morning shot.

One more question. On the spreadsheet is says AMPS and PMPS I'm assuming that is for a am preshot BG reading and a pm preshot reading.

yes
amps am preshot
pmps pm preshot

Would it be possible for you to get a test in or maybe two before your morning shot time?
Is your shot time flexible or does it need to be where it is for a work schedule during the week?

If you would post in the Tighr regulation forum tomorrow and ask for help....

Jane might still be around. And there are a couple of others....


I'm really glad you found us. ANd that Teronto didn't dive after his shot today....

Well done, Pauline. You're very welcome.

Can you please get another test before you go to bed?

Please make sure that you post your AMPS tomorrow morning BEFORE you give ANY insulin. There will be someone around to help you with the dosing choice. (Again, though we do not generally recommend doses without more data, I would suggest that you reduce to 1u.)

Yes, AMPS/PMPS are morning and evening preshots.

Hugs
Jane

by the way,
just because you post over in TR forum doesn't mean you have to do the tight regulation.
You can also do the relaxed lantus .

It's just that posting in TR gets you the most eyes to help you along the way.
You don't even Have to be using Lantus to post there.

goodnight.

Pauline,

I realized I didn't respond to your posting how worried and scared you feel.

Many hugs to you!

So so many of us on FDMB know what you are going through now. This is can be a very overwhelming process. But: You *found* this place, and you started posting, you set up a spreadsheet, you started learning! Those are *fantastic* steps in the right direction! You are a wonderful person for caring about your kitty enough to go through all this for her. He is a very lucky cat! (At some point, maybe you can post a photo - we'd love to see him! I love his name also - how did you pick it?)

Okay... Now for some more info points! I know this will be a lot for you to take in, but I want to be certain you have this information. (Maybe consider bookmarking this thread and future ones too if you want. That way, you can refer to them again and make sure you didn't miss anything.)

Please bear with me and all the links I'm about to post for you, k? Just take your time, read through it all, print things out if you can. It's a steep learning curve, but you can do it.

So, first off, some info about LANTUS.
Lantus is a "depot drug." A depot of insulin begins building up as one starts giving Lantus injections. For the first few days, the insulin you inject goes into filling that depot. Once it is full, the insulin you inject begins working on the BG, and the effects begin to show. Lantus has cumulative action, meaning that the shots you give build up on each other. This is important for you to understand especially with regard to the very high dose your vet told you to shoot: By shooting *large* doses, which build up through the cumulative nature of Lantus, you can suddenly have a *lot* of insulin working on the BG, making it drop very low, once the depot is full and the insulin "spills over" into the cat's system. This can lead to a hypoglycemic episode, which can be extremely dangerous and even lethal. It's important to be aware of this, to keep Teronto safe.

Another FDMB member, Sienne (of Sienne and Gabby, put together a great list of threads, from the Lantus board about this insulin and the way it works. It can be very useful to print out this information. Here it is:

• 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 Roomp & Rand 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.

Next, some thoughts on DOSING:
Because Lantus action is cumulative, and because we have next to no data on how low Teronto's BG went so far, it might be a good idea NOT to give an injection at all tomorrow morning.

Instead, you can test Teronto's BG a few times, and enter the data on his SS. It will be very useful for us to see what his BG does. You could test at your AM shot time (which would be called AMBG, rather than AMPS, if you do not give an injection), and then you could test, for example, every three hours. We call this doing a "mini curve".

BUT: Before deciding whether or not to give a shot, it would be very important to know whether Teronto was diagnosed with anything other than FD.
--- Was he tested for KETONES at the vet? Ketones are produced when the body breaks down fat rather than carbohydrates for energy, and they can lead to a dangerous condition called Diabetic KetoAcidosis (DKA). There are test strips to check for urine ketones (Ketostix) - you'll see what they look like in the link I posted just now - and I strongly recommend that you buy some and begin testing Teronto's urine for ketones. DKA is very serious, and that's why testing for ketones is important.

Dosing advice given in the Lantus TR (Tight Regulation) group is based on a specific (TR) protocol. This protocol is the only one of its kind, based on *published, scientific evidence* with an immensely high rate of remission. In Sienne's summary list, there is already mention of the links which explain this protocol, but I will list them now for you as well:
--- TR Protocol on Tilly's Diabetes Homepage.
--- Queensland University TR Dosing Protocol.
--- AAHA Guidelines for Diabetes Management.

For Lantus (and Levemir, an insulin that is similar to Lantus in its action), the starting dose based on TR Protocol has been 0.25u per kg of the cat's ideal weight. The AAHA also states that even in a very large cat, the starting dose should NOT exceed 2u every 12 hours. (Your vet recommended FIVE TIMES that amount...)

It is a good idea to provide your vet with this information, either printed out or by forwarding the links to him. IF your current vet is unwilling to consider this information, I would strongly suggest that you look for a different vet. It is sometimes possible to "convert" a vet, to educate them, but sometimes it is not. ANYONE giving advice on FD, or specfic insulins, or treatment options, that is not based on a sound knowledge of the subject matter - whether they are veterinary professionals, or lay people like we are here on FDMB - puts cats at risk. That is why it is important to find out whether your vet is willing to learn. The advice he has given you so far has been very far from what is safe and accurate. If he is not willing to learn, then Teronto would be at risk if he stayed in his care and you followed his advice. Please consider providing your vet with these links, and finding out whether he is willing to learn. If not, move on. Teronto's safety is the priority.

There are many more areas of information that will be important for you to consider. Teronto's diet is one of them. Dr. Lisa Pierson's webpages about Feline Nutrition are an excellent place to start. Remember that if you make any changes to Teronto's diet, you must already have a safe starting dose and the ability to monitor his BG to make sure he stays safe.

Alright. I think that is enough for now :mrgreen:
Please consider this carefully, take your time reading through it, and post any questions you have.

You are welcome to come over to the Lantus TR group and post there. We are a large group, and we get a lot of activity, which means that you have a very good chance of getting input reasonably quickly.

I know this is a crazy amount of stuff to take in. But you can do it! And you aren't alone in this. We're here, and we are going to help you through this.
Hugs,
Jane

Welcome to the board, Teronto and Pauline. I can imagine this must be very stressful for you, and during these early days, everything seems so overwhelming. Just remember you can handle this.

At the beginning of Charlie's diagnosis (July 2012), I felt very overwhelmed. Looking back, I now realize that I had a vet who wasn't very knowledgeable about feline diabetes and who prescribed the wrong insulin for Charlie in a dose that was too high. For us that was only 2.5 units, so DEFINITELY I agree with the others that you should STRONGLY consider reducing the dose FAR lower than the 10 units to start with.

At the beginning, I remember feeling very scared. Should I trust all these strangers on the internet more than my "professionally trained vet"? Am I supposed to be taking this into my own hands to make dosing changes? It all felt like I was doing the wrong thing. What I can tell you from a little bit of experience is that the people on this board are generally WONDERFUL human beings who will help you whenever they can. They provide a great support network and most of the time are more specialized in how to handle diabetes than some generalist vets.

For us, this board has been a godsend.

I also remember feeling overwhelmed with reading material and information overload at the beginning. Try to pick up on the most important themes that you're seeing repeated. For the moment, those are probably:
- Lowering the dose from the high one you started with
- Printing off that reference sheet from Rhiannon on "how to deal with low numbers and how to handle hypos"
- Buying an emergency kit of supplies (maple syrup or karo / some "acceptable" high carb wet food ... see list above, etc).
- Relatively quickly (with the help of people on this board) switching over completely to wet food if you can

We still consider ourselves newbies too, and I just want to let you know, you're always welcome to contact us if you need any support or encouragement, or even if you feel you have a "seemingly stupid question".

I remember feeling confused by all the new jargon (HC/MC/LC/AMPS/PMPS/SS/etc). These are terms that will quickly become part of a new language for you. Don't fret. ANY time you are confused by something, ask. Nobody here ever judges you for asking questions. People generally are helpful and give answers. We've all been there.

I also remember feeling I had so many things that people were telling me to do, and I felt I had no time to do them all (IE: setting up a profile, setting up a spreadsheet, being diligent about filling in that spreadsheet after every test, being diligent about posting). You will get there. What I've learned is that 99% of the time, when people on the board encourage you to do something, it's for a good reason.

Having a spreadsheet set up with easy to access numbers helps the experts spot trends and give you better advice. Having a profile set up gives medical information about your cat in an easy to access link so that people don't have to search through many old posts to find this information.

I can tell that you're trying to do the right thing, and I promise you, if you can trust your own judgement and the advice of people on here, you'll start to make quicker decisions that help you take good care of Teronto.

If you ever need any support, just let us know and we'll try to help.

Hang in there. You can do this. For some things, you need to act fast (reducing dose .. starting to test more frequently ... getting an emergency kit on hand). Other things, you will do as soon as you are ready (reading up on everything and becoming more knowledgeable... posting more frequently on the board..etc). Just know that there are a lot of people out here rooting for you and you have support.

Hang in there,
Jill

Welcome to FDMB!!

It certainly looks like we swamped you in reading materials. Jane, Kathy, and Rhiannon have covered the basics. I want to underscore a couple of points since the front end of this learning curve is hugely overwhelming. Before you do anything else, breathe! There is a huge amount of expertise here. You also have a big advantage over many people who arrive here in that your father is a diabetic. You understand the importance of testing and you are questioning some of the information your vet has provided.

So, for the important points to concentrate on:

• Dose: Your vet has started Teronto on a dangerously high dose of insulin. There is a formula that is used for determining the initial dose of Lantus. This formula is based on the published research on the Tight Regulation Protocol that Jane linked and the AAHA (American Animal Hospital Assn) Guidelines for Diabetes Management in Cats & Dogs. It is: initial dose = 0.25u x lean/ideal body weight in kilograms. (Teronto would need to weigh 88 lbs to warrant a starting dose of 10u.) The formula usually calculates out to around 1.0u, give or take, as a starting dose. You may want to start over at a saner dose. (In defense of your vet, is there any chance that he wrote 1.0u and the decimal point wasn't clear?)
• Shooting: Lantus, all insulin, actually, is dosed twice a day in cats. A cat's metabolism is twice as fast as a humans so you need to shoot every 12 hours. By shooting once a day, Teronto's numbers could be dropping significantly during the first 12 hours and since the insulin is wearing off by the time of your next shot, at the 24 hour mark his numbers have skyrocketed. It would be like your dad getting his shot every other day. I would find a time that works for your schedule and stick with it.
• Testing: You've mastered the basics which is huge! You also understand why it's important to test at shot time -- you need to know if it's safe to give a shot. However, Lantus dosing is based on the lowest point of the cycle (the nadir). This makes it important to get spot checks during both the AM and PM cycles. During this initial phase, it may be helpful to test every 3 hours so you can learn when Teronto's Lantus onset and nadir are.
• Consistency: Unlike many other types of insulin, Lantus is a long-acting, depot-type drug. The insulin depot is one of the harder concepts to wrap your head around. Essentially, Lantus doses work in a cumulative fashion. Thus, it's important to be consistent with both shot time and dose. The guidelines in the Tight Regulation Protocol will help you to learn when to change (increase or decrease) dose. We can help you with that.
• Food: The principle here is simple -- feed low carb food. The second principle is even easier -- dry food is bad. There are any number of choices when it comes to food. Lisa Pierson, DVM has put together an incredible website on feline nutrition. She has also updated a widely used food chart that lists the carb counts of most of the available commercial foods. You will want to choose foods that are under 10% carb. Most of us feed in the 4 - 5% range.

If it seems that we are alarmed over your dose, we are. As long as Terumo wasn't experiencing an episode of diabetic ketoacidosis at diagnosis, I would encourage you to decrease your cat's dose. The high, pre-shot numbers may be the result of your cat's blood glucose numbers dropping in response to the amount of insulin you're giving and then bouncing back up to a high number 24 hours later.

Please let us know how we can help.

Did the vet actually tell you to give 10 units once a day? Or did he write it down as 1.0 units (one decimal point zero) once a day and you misread it as 10? Just want to clarify :smile: I would double check with the vet to see if he really meant for you to give 10 units and not 1 unit.

He also told my husband to pick a dry food and stick with it. No limitation to his eating.

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What dry food are you feeding your cat? Most likely it's the dry food that is keeping your cat's blood glucose levels from crashing to near fatal levels. Dry foods are very high in carbs, especially commerical brands, which keeps blood glucose levels really really high. Some brands of commerical dry foods have as much as 40% carbs per cup :shock: Think of it as a Human diabetic eating nothing but a diet of sugary high carb junk food.

But do not change your cat's diet yet. Doing so but keeping that insanse dose of insulin will result in crashing blood glucose levels.

For now just read up on proper diet. Catinfo.org is a good place to start.

And my other question is canned food. What do you use? I've looked at a few but I'm not sure what is good and what I should, at all costs, stay away from.

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Low carb canned foods are best. Brands like Fancy Feast, Friskies, Wellness, Nature's Variety, and Merrick are popular here. Butn ot all varieties within a brand are low enough in carbs for a diabetic cat. We stick with foods with under 10% carbs. Use the food chart to find out how many carbs are in a particular food: http://www.catinfo.org/docs/Food Chart Public 9-22-12.pdf This is the most up to date chart. There are two other not quite as up to date charts you can also use:
Pet Food Nutritional Values list
Hobo's Guide To Nutritional Values

And here's the list of gluten-free low carb Fancy Feast: List of low carb gluten free Fancy Feast

Just pick a couple brands of canned foods to try with your cat after you get the insulin dose issue resolved. You can free feed your cat the canned food. Most people here use a programmable timed feeder for this purpose.

Do you think a few more weeks on frisky seafood sensations (which is his favorite food) will hurt him?

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That's dry food and it's very high in carbs :shock: The very poor quality ingredients are carb-heavy: Ground yellow corn, corn gluten meal, poultry by-product meal, meat and bone meal, animal fat preserved with mixed-tocopherols (form of Vitamin E), soybean meal, animal liver flavor, ocean fish meal, phosphoric acid, salt, tuna meal, choline chloride, potassium chloride, salmon meal, crab meal, dehydrated seaweed meal,..... I don't see it listed on Binky's dry food chart (chart is old and Seafood Sensations is a farily recent food) but the food is likely in the 30%+carb range like the other Friskies dry foods that are on the chart.

It's dry foods like Friskies that causes many cats to end up diabetic in the first place. Carbs puts a huge strain on the pancrease.

If you need to feed to temporarily dry food before you eventually make the change to canned food, I suggest using a lower carb grain-free brand such as Innova EVO or Nature's Variety Instinct or Wellness CORE. BUT even a change from high carb dry to lower carb dry food can result in much lower blood glucose levels and the 10 units of insulin can result in hypo uless you are able to monitor blood gluocse levels closely every day. If I were you, I would address the insulin dose first and then slowly do the diet change.

You have every right to tell the vet that you are not comfortable with giving a huge dose of 10 units and want to start at much lower dose. The vet may balk and insist on 10 units but it's YOUR cat. If you don't feel comfortable with a treatment, you can refuse it and ask for other options. Is there another vet practice you can go to?

My two cents :smile:

Hi Pauline and welcome to the group.

Something that Kathy & Kitty did not say in her post is that when she first came on the board she too was told to give a high dose to her cat I think hers was 5 or 10 units twice a day (something close to that).

It took a while for her to trust us and realize that what everyone is saying to you know is correct. With our help, Kathy started over at 1 unit twice a day and with home testing gradually adjusted the dose. Kitty eventually went off insulin and was in remission.

I'm telling you this, because Kathy experienced the same exact as you and knows first hand how scary it is and learned to trust the advice given here. We are not nuts (ok some of us may be a little nuts ;-) ) , the point is we care deeply about our cats and seek out the best for their health and well being.

You found your way here for a reason, please have faith in us that we know what we are talking about and won't steer you wrong. Hundreds of cats have successfully gone into remission (including mine) as a result of the help from this group.

Welp. I woke up later than normal. So we missed the 7 am shot time. I haven't given him a shot at this point because I want to get an amps. But I'm really having a difficult time getting any blood to run the test and he is just not that tolerant of me this morning. I can't get him to sit in my lap for more than a second and my frustration level has gone up....which I think at this point he's just playing with me now LOL I need to get this ear/blood testing down. Any tips? I was reading something about warming the ear up.

I have no future plans on giving him 10 units of insulin anymore (I double checked the paper from the vet and it's 10 units he prescribed for Teronto once a day in the morning). Currently I work so 7 am is the best time for me to give him a shot. I did kinda question the whole 10 units at first but thought "What do I know, he's the trained professional."

Teronto got his name cause he just teronted down the hall at me when he was a kitten and it fit with his sisters name Peyote. She liked to stare in the mirror at herself and go crazy doing catty things. I will post a picture of them together. It's hard to believe that they both came from the same litter. She long haired and fluffy white with siomeese markings and beautiful blue eyes. He's short haired black with green eyes. And even personalities are so different. He's very skitish and when too many people are in the house we have to put him in our room so he doesn't stress out. He really doesn't care for strangers in mass. She on the other hand is up in everybody's business demanding attention. And I'm a strick indoor cat person with little ventures outside under strick supervision. People here have no problem running over your cat and leaving them for dead.

I will also get a profile together for him. He wasn't diagnosed with anything else. Just the diabetes. I asked my husband if they did any other tests on him and he said he didn't think so. Just the blood work. But these were his symptoms...for now before I get the profile up. He lost a lot of weight, currently he's at 14 pounds, he wa probably at closer to 16 pounds when he was feeling good, but that's a guessimate. He was severly lathargic. To the point that he would only lay down on the living room floor. He did eat and now that I think about it he drank water like there was no tomorrow. And potty accidentants.

Switching him to can food won't be a problem. He loves canned food. But Peyote NEEDs to lose weight and she just looks at me anytime I put out wet food like I'm crazy and walks away. She won't even take treats. He's all over the treats and if I'm not fast enough he'll gobble down his wet food and hers. LOL Glutton.

Okay, I'm off to try again. Hopefully I can get some test results.

That is so wonderful to hear.

There are many here using a sock filled partially with rice and warmed in the microwave. Cold ears don't bleed as easily especially
at first. The ear has to learn to bleed more readily and that takes a few weeks. The little capillaries increase in response to all the poking
over time.
Here is a picture of the sweet spot. Be sure and move up and down so you aren't always hitting the same spot.



Are you using a lancing device or just a lancet by itself.
Everyone has a different preference.
It helps to hit the spot at a slight angle.
If you have a device, which one is it? It is a lot harder the first month with a finer gauge lancet. 30 and 31 gauge are more for people.
You want a 26 or 28 gauge. It's a slightly larger hole but you won't have to stick as many times.
Be sure and give a treat even if you miss since you want Teronto to associate the test with gettiing a reward.

If you use a lancing device, it has to be flat on the ear, no angle. Besides treats, always give praise whether you get blood or not, praise, hugs and kisses go a long way.

Well...I tried multiple times to get blood and nothing. My husband pokes him once and gets enough to run several tests. LOL!

9:00 am his BG was HI again. Meaning 600+ I gave him 1 unit of insulin and will recheck him at 11...in another hour.

We did get the ultra thin lancets for the Relion meter, they don't give an actual gauge size on the box. I haven't tried the lancet pen on him....But I must admit when we first got it home I tried it on my husband and I LOL! I had to know all the specifics through actually testing. I think the clicking noise it makes might scare him off.

Hi, Pauline,

So glad you're here and making progress on finding the best dose for Teronto.

I remember you mentioned you're going away in two weeks. Who will be taking care of the kitties while you're gone? Can they test and give insulin? Something to consider as you develop your new dose and routine.

You are doing great!

K.

I thought the clicking would be a bad thing too but now it signals to my cat that i'm doing it. She likes the click.
You can practice just clicking it and giving a reward to help create the good association.
However, I'm certain since it says ultra fine, that the gauge is too fine.

The Accu-chek softclix lancing device is 26 gauge. I have that one . You may have to hunt to find one.

Are you using something behind the ear like a folded paper towel to create pressure. Something pushing on both sides of the ear.?

I set up a profile and added some picture to it. It's missing his doggie sister Roxie. I couldn't find any of them all together. guess we'll be doing a group photo soon.

Yes, we are headed to Hawaii in 3 weeks. A family friend will be here to "Teronto Sit" while we are gone. I showed him were the hypo kit is and the signs. I still need to print the Hypo Signs poster. He is not comfortable giving him shots so my dad has agreed to come over and administer the shots. Kindred Spirits.

I'm getting ready to do another BG test on him her at 12. I got sidetracked with the profile set up. What an awesome idea. Now I just need to figure out how to add some pictures on here.

I feel much calmer after some coffee, food, and rest. My moto today is RE-DO and RE-Start. and most importantly YOU CAN DO THIS.

Thanks for all the advice and knowledge.

It will make your life much simpler if you can convince Peyote to eat canned food. There will also be the added bonus that many cats will lose weight once they are on a species appropriate diet. (Dry food is full of ingredients that a cat doesn't need. Cats are obligate carnivores. All they need is protein along with certain vitamins and minerals.)

There is a great section on Dr. Lisa's feline nutrition website that discusses transitioning a dry food addict to canned food. I was driving myself crazy when Gabby was first diagnosed trying to feed her one thing and trying to feed my kitten something else. It was much easier to give them the same food.

Kathy brought up a good point. If you are going to be traveling soon, you might want to investigate getting a cat sitter. Many vet techs will do cat sitting on the side.

Well it took a little while on my own. He's just a wigglier. So while he was laying on the floor I put a soft blanket over him and used rice warmed 15 seconds in the microwave double wrapped in a ziplock to warm his ear. He really liked that and even started purring. His BG is still reading HI which is 600+. Should I up his next shot to 2 units since it looks as though nothing is happening?

No don't do that. I know it's tempting to shoot more insulin to get those numbers down but that's not how it works.

His numbers are likely so high because you are feeding him meat flavored cereal (that Friskies dry food). Ask any human diabetic if they could regulate their blood sugar well eating only cereal, Twinkies, and Coke, and if they'd feel good on that kind of diet....!

As soon as you switch to a low carb canned food you will see a significant improvement in the numbers. That's why we advise being super vigilant on testing during that food transition. Some cats go into spontaneous remission with the food change alone! My cat's numbers went from the 500's to the 300's with a diet change alone.

Lantus is also not based on preshots - Lantus is dosed based on the nadir, which is the lowest point of a cycle. We treat all preshots the same, unless they are 200 or under, which we advise newbies not to shoot, until they know how their cat responds to the insulin. I shoot Scooter in the 80's sometimes because I know how he responds to Lantus

You've been getting great advice from everyone, so I'm going to address the inevitable "what do I tell the vet?" question. First you need to decide if you can work with your vet. You have to remember that vets are not only like GP's, they have to know about a bunch of different species, too. A lot of vets don't see many diabetics, and when they do many people aren't willing to test or even treat. Always remember that you need a vet, and hopefully they will work WITH you.

My vet was cool with me doing my own research online, but not all will be open to that. There were times she suggested doses that didn't seem right to me. So I would say this: "I'm not comfortable doing that. Can we try a lower dose, like 1 unit, to start?"

There are documents on the site to help win over your vet. I think it's called "Convert a vet". I hope someone else pops in with the URL.

Teronto and Pauline said:

Well...I tried multiple times to get blood and nothing. My husband pokes him once and gets enough to run several tests. LOL!

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Don't be afraid to give the ear a firm poke with the lancet :smile:

We did get the ultra thin lancets for the Relion meter, they don't give an actual gauge size on the box.

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Those are 30 gauge, too thin to get blood with. Try a thicker gauge lancet. Since you're not using the lancet device, you can buy any brand of thicker gauge lancet. Here's a lancet comparision chart that lists gauge: http://www.walgreens.com/marketing/library/centers/diabetes/lancets.jsp Lots of people here don't use the lancet device at all.

Alright....this is officially my DO OVER!

I needed to hear the Friskies comparison to eating a twinkie. Thank you Ry & Scooter. You are absolutely right! I wouldn't let my own father (who's diabetic) eat a twinkie. Geez, I won't even let my dad have a spoon full of plain old cake when he's here visiting me. I just can't, in good conscience and responsible pet owning, let Teronto or Peyote eat junk. Soooo.....I took the list that Squeem3 posted earlier to Petco and we bought enough Wellness canned food to fed both the cats for 10 days (I plan on printing off the list so I have it handy when I shop for food for them. It was difficult to read on my phone). Expensive stuff! But it's all worth every dime if it means he will start to FEEL better. I pulled the Friskies free feed dish. NO MORE! I've also got the Wellness treats.

What's amazing to me is the nutrition labels on pet food. ARE YOU KIDDING ME? You practically have to know greek in order to interpret some of those.

So....Here's my plan.

1 unit shot at 7 am and 7 pm.
preshot BG readings
and one can of food a day split into either 2 meals or 3 meals depending on what I have going on for the day. My life is crazy busy with working full time and going to college and 2 teenage kids in the home still.

I also found an iPhone app to record BG readings, meals and shots. Thought I'd try that out too. Might be useful for when we visit the vet.

So here's my next set of questions. For feeding I read they should only get 240 calories and that it works out to be about 5.5 ounzes a day (one can). Also, do you feed them before or after you give the shot. I know I read that someplace I just can't remember where or what the answer is.

Teronto and Pauline said:

So....Here's my plan.

1 unit shot at 7 am and 7 pm.
preshot BG readings
and one can of food a day split into either 2 meals or 3 meals depending on what I have going on for the day. My life is crazy busy with working full time and going to college and 2 teenage kids in the home still.

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Sounds like a good plan to me :smile:

Your unregulated diabetic cat may need more than 1 can of food per day. Unregulated diabetic cat bodies can't full process the nutrients in the food so they are always hungry. When the diabetes is more under control the execssive hunger will go away.

So here's my next set of questions. For feeding I read they should only get 240 calories and that it works out to be about 5.5 ounzes a day (one can).

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If your cat needs to lose weight, it's suggested to feed 20 to 25 calories per pound of ideal body weight per day. I wouldn't be too restrictive in calories for an unregulated diabetic. Some diabetics lose quite a bit of weight prior to being diagnosed and need to gain back some weight.

Also, do you feed them before or after you give the shot. I know I read that someplace I just can't remember where or what the answer is.

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With Lantus, you want to feed around the same time as you test the bg and give the shot. Most people test bg and give insulin while the cat is stuffing his or her face with food. Try not to feed 2 hours before giving the insulin because that can inflate the bg level.

You'll find more info on how Lantus works for cats over on the Lantus board: http://felinediabetes.com/FDMB/viewforum.php?f=9

Hi Pauline. You want to test, feed, and shoot the insulin all within about 5 minutes. Some people like myself, test, shoot and feed. You don't want to feed first and wait, as the food will increase the BGs and you want a true BG reading that is not influenced by the food he just ate.
Please ask, if you need more clarification.

Glad that comparison helped! Wellness is great food, my cats both love it and have done well on it. It ended up being too expensive for me to feed exclusively, so now they get mostly Mixed Grill Grreat Choice from Petsmart, with a little bit of Merricks Cowboy Cookout (just picked this up - they LOVE it) and Wellness (Turkey is their fave) on the side

You can feed more than 2 meals a day if you want. It'll actually be less stress on the pancreas to feed smaller, more frequent meals. If you're not going to be home, you can freeze the canned food in an ice cube tray and pop a few cubes in their dishes before you leave - they'll thaw out over a few hours and your cats can snack on them. You could also purchase a programmable timed feeder such as the Petsafe 5 from Amazon.

Your plan sounds great! Don't forget to get a few mid-cycle blood glucose tests - this will help you see how the insulin is working and you need those numbers to make adjustments to your Lantus dose. Between 4-6 hrs after the shot is great.

Always test, feed, and then shoot! You can shoot while he's distracted with his face in the food bowl too. That works best for us

YA! I just tested him and his BG was 579....I know that's not great but after see HI for the last 3 tests and now actually seeing a number I'm SUPER EXCITED. :razz: Teronto ROCKS!

I'm even more excited to report that Peyote...his sister is digging the Wellness canned food. I've never seen her finish a canned food meal and sometimes she won't eat it at all.

I will give him his evening shot here soon.

Fantastic progress, Pauline! I'm thrilled for you!

Have you got a BG update for us?

With all the info you were given, you may have missed the idea of posting in the Lantus group? From your planned treatment approach, it sounds to me as though the TR (Tight Regulation) Lantus Group would really be a good fit for you and Teronto. We get a *lot* of activity there, which means that most often, one doesn't have to wait long at all for replies and input.

Think about it and if you want to, come on over :smile: I'll keep an eye out for you!

Hugs
Jane

Hi Pauline.
I would continue to test Teronto as much as you can, at least before every shot, and try to get at least one mid cycle test per cycle.
I would also go to a pharmacy and buy some ketone test strips, and start testing his urine for ketones whenever you can. We want to make sure he stays ketone free. If he should get ketones, then that is another vet visit. DKA is life threatening, and with the higher numbers he's been in, you want to make sure he doesn't get them.

Please keep posting, and let us know how Teronto is doing. We're here to help.