My newly diagnosed diabetic cat

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Christy & Gilbert

Christy & Gilbert

Member Since 2013
My Gilbert has been diagnosed w/ diabetes. I noticed him drinking large quantities of water & his urine output is excessive. He has also lost quite a few lbs in a short period of time & it has come off around his back & hind area leaving his backbone very noticeable. I got the reli-on test kit & am testing him regularly. He has been on Novulin 70/30 insulin for about 3 wks & I have been feeding royal canin diabetic dry food which he is not crazy about & I haven't read many good reviews about so I am currently trying Blue Wilderness...he loves dry food so much or I would take him off completely. I have also changed him from friskies wet food in sauce to friskies pate wet food for lower carbs. He is 13-14 lbs. His #s were around 300-350 before diet change & insulin. Started @ 2 units 2 x day for 7 days or so & his #s were going to high 400s, so called vet & she said increase dose to 3 units which I did & it seems like he got the somogyi effect where he was very high & then quite low for a few hours. He has gotten in the low to mid 100s a few times, but it is not consistent & seems like he does better w/ a lower dose. I have done a lot of research & decided to change him to 100% beef PZI, but upon my vet calling in the prescription to a Texas pharmacy & me calling to pay for it, they said they cannot ship to Arkansas. The AR pharmacies only make human PZI. I have also read good reviews about Lantus. I am so confused about what to do & am hoping somebody w/ experience can help me out. My Gilbert is going downhill & I really feel that it can be turned around if I just knew what to do!
 
Hello and welcome to the board!

Great job on testing! I think it would help a lot to stop the dry entirely. Maybe you can find a low carbs dry?

Lantus and PZI are good insulins..however until you get them, can you get some mid cycle tests for me and maybe do a spreadsheet? The key thing with most insulins, to judge how well they are working, is to see how low the cat drops on them. The spreadsheet will help me see that plus look for trends etc.


http://www.felinediabetes.com/FDMB/viewtopic.php?f=6&t=18207


Wendy
 
I went to google doc & did spreadsheet, but mine doesn't look like yours...hope you can understand it...I am new to this & did my best. Thank you so much for your help!



Blood Sugar Record Chart
For

Date Wake-Up Morning Lunch Afternoon Dinner Evening Bedtime
05-18-13 1 unit @ 7 392@6:30 Started royal canin diabetic dry food & low carb wet...feed 1/2 - 3/4 cup dry daily & 1/2 can wet morning & 1/2 can wet evening
05-19-13 2 unit @ 7 445@8:30 371@5:30 2u@7
05-20-13 2 @ 7 374@2 2u@6
05-21-13 2@7:45 390@10 4u@7
05-22-13 4@7 267@9 480@5:45 4u@6:30 266@10
05-23-13 4@6:30 561@6:15 518@2:30 2@6:30
05-24-13 5u@7 500@7 404@6 4@6:45 346@10:45
05-25-13 4u@7 446@6:50 206@9:30 201@4:50 4@8 545@8
05-26-13 3.5@8:15 336@8:15 4@8:30 537@8:30
05-27-13 3.5@7 510@7 464@8 252@10 3.5@6:30 455@6:30 115@11:45
05-28-13 3.5@6:50 470@6:50 3.5@7 498@7
05-29-13 3.5@6:15 431@6:15 288@1:15 3.5@5:30 402@4:50 578@9:30 fed his regular dry food @ supper
05-30-13 3@7 276@7 191@10 3@5 366@5
05-31-13 3@8:15 396@8:15 159@12:30 3@7 407@7
06-01-13 3@7 316@7 3@7 456@7
06-02-13 3@7 433@7 146@11:45 3@6:50 405@6:50
06-03-13 3@7:15 441@7:15 3@6:45 535@6:45
06-04-13 3@7 416@7 3@7:30 336@7:30
06-05-13 1.5@7 456@7 1.5@7 358@7
06-06-13 1.5@7:50 298@7:50 2@6 364@6 291@9:45
06-07-13 3@7:50 360@7:50 2.5@7 405@7 289@10:40
06-08-13
06-09-13
06-10-13
06-11-13
06-12-13
06-13-13
06-14-13
06-15-13
06-16-13
06-17-13
 
Hello.

It would help if we could get you a spreadsheet like we have. If you are having trouble, ask for help. We have quite a few people here who can help
you set it up. (i'm not good at it myself)

Lantus and Levemir are the better choices for a cat. They have the best success with these two choices.
Even if your vet isn't familiar with them, we can help. There are many experienced people here.
Many of them are more experienced with these insulin choices than some vets.
With their help, I was able to get my cat into remission.


The change in food is a good plan.
There is only one dry food I would ever recommend. But for a diabetic, wet is better as they need all the water in their bodies that you can
manage. We have lists of good food choices.
Finding the one(s) your cat will eat is what is important.
 
Could someone please explain what a few things mean? I don't understand the spreadsheets...amps? +1,+2, etc.? 400-499, 300-399,etc.? & what does OTJ stand for? Thanks so much.
 
We actually recommended NOT feeding dry food. Yes, we know many cats love dry food, but it honestly is not good for them. For the detailed list of reasons, please see this link: http://www.catinfo.org - Dr. Lisa explains it all.

There are three insulins that are good for cats - Lantus, Levimer and Prozinc. I see you were trying to get PZI. If you want to try that type of insulin, ask your vet to either order it for you or you can order prozinc online with a prescription from the vet. For example 1800petmeds.com sells it.

However, if you want to change insulins immediately, then ask the vet to write a prescription for Lantus Solostar Pens or Levimer flex pens. You can then take the prescription to any human pharmacy and get it filled.

Here is a link for lantus to get a discount card that will make the pens $25 each I believe: http://www.lantus.com/sign-up/default.aspx

Here is a link for Levimer $25 off.

https://docs.google.com/leaf?id=0BwpbGEEvO1H9YjIzMDFmNzMtNjdjMy00Nzg3LWIzNTQtMzZjOWNkZGVjMjRi&hl=en

If you don't already have U100 insulin needles (syringes), you will need to get a box to use with these insulins. Do not use the needles that are sold with the pens.
 
christy said:
Could someone please explain what a few things mean? I don't understand the spreadsheets...amps? +1,+2, etc.? 400-499, 300-399,etc.? & what does OTJ stand for? Thanks so much.
Click to expand...

AMPS = morning (AM) pre-shot (PS) number. Meaning the test you take before giving insulin
PMPS - evening( PM) pre-shot (PS) number. Meaning the test you take before giving insulin

+1,+2+3 etc - are the hours after you give the shot.

Since we are in different time zones, we don't talk in time, such as 8:00, 9:00, 9:30 etc. because your 8:00 may be my 10:00. Rather we talk in hours since giving the shot. We divide it into 12 hour increments (AM and PM) as you are supposed to give insulin 2 times a day 12 hours apart.

So, if you normally give your shot at 8:00 am and 8:00 pm - this is considered 0 on the clock or AMPS, PMPS.

Then if you test at 10:00 - that test is +2 .

The ranges and colors you see 100-199, 200-299, etc. is how we break up the test results. Every glucose test you take will fall into a set of ranges and when you enter the number on the spreadsheet it will automatically color the spreadsheet. So when you see us write he is in the greens or blues or reds, etc. It means the bg levels are within that 100 point range. It makes it easier for all to understand what is happening quickly with the cat.

Make sense now.

Take a look at Maui's spreadsheet, and hopefully that will now make sense.
 
I would also like to know more about the pens...just googled them, but didn't find any helpful info. Are they cheaper than the 10ml vials? Sounds like they are a lot cheaper. Do you use U100 needles to draw out of them? Am I on the right track? Thanks.
 
Go to the lantus website and you will see a pic of the pen and a description: http://www.lantus.com/

Remember, this site is geared for people not cats. However, it does explain the pen.

Pic of Lantus vial: http://images.search.yahoo.com/images/v ... =FreeCause

Pic of pen: http://images.search.yahoo.com/images/v ... =FreeCause

But simply put, the pen is a much smaller version of the vial. It does contain a small vial inside and holds a smaller amount of insulin than the vial.

The reasons we like this:

1) it holds a smaller amount of insulin - if you drop and break a vial, you have to buy a new one, if you drop and break a pen (which is more unlikely) you did not waste all your insulin and still have more pens to use
2) if the insulin goes bad, you are not wasting an entire vial of insulin and have more pens to use
3) Unopened insulin if stored properly should be good through and sometimes past the expiration date.


Yes, treat the pen as you would a vial. Because it essentially is the same thing, just a smaller vial in a plastic container. Use your insulin syringe (U100) to draw out the insulin same as you would a standard vial

While the upfront cost for a box of pens may be more than one vial, for a cat's needs, you are getting a better bargain for the reasons above.
 
Each individual pen is 3 mL, vs 10 mL in a vial.
1 mL has 100 units of insulin and thus use U-100 syringes
Kept refrigerated, on a non-moving shelf, you can get about 4-6 months out of 1 pen.
Often the dose is between 0.5 to 2.0 units twice a day
At a total of 4 units per day, once opened, 1 pen lasts 75 days and 1 vial lasts 250 days but may lose strength after 6 months. This makes using a pen more economical, although the upfront cost can give you sticker shock.
Most places sell them as 5 packs, though a hospital pharmacy or warehouse club like Sams may sell them individually.

Your current insulin mix only lasts abou 6-8 hours per shot due to cats rapid metabolism. If you pick up the food at +6 hours from the shot, that will help keep it from rising so high before the next shot. The nadir - lowest point post-shot - will be around +3 to +4 hours after the shot.
CAUTION: the nadir should not go below 50 mg/dL or your cat may become hypoglycemic (too low blood glucose), do not keep increasing the dose based on the pre-shot without making sure the nadir is above 50!
 
Most insulins are best given on a consistent schedule, like 7 am and 7 pm.

I see from the dates and test numbers you listed in you posts, that you are giving the insulin shots at radically different times during the day., from day to day.

Is this because of your work schedule or some other commitment?

AM shots have been 7, 7, 7, 7:45, 7,6:30, 7, 7, 8:15, 7, 6:50, 6:15, 7, 8:15, 7, 7, 7:15 etc.
PM shots have been 6:30, 7, 6, 7, 6:30, 6:30, 6:45, 8, 8:30, 6:30, 7, 5:30, 5, 7, 7, etc

This is too much variation in the shot times I think.
 
Yes...I need help fining the spreadsheet like you guys have. I am trying to ween my boys off of dry food @ the moment. Gave very little this morning & lots more wet. My diabetic Gilbert & his brother Pete have been free fed all there life & are fed together...so this is sort of a challenge. I am leaning toward Lantus since I cannot get the all beef PZI.
 
I have asked another member if they will help you with the sheet.

Moving all the cats to a low carb wet is a great idea .. Means hopefully you won't have this issue in another cat, plus its better for their kidneys.

Lantus is a great insulin too... It's what I use in both my boys and there is a lot of support for you here if you choose it.

Wendy
 
If you do go with the Lantus, remember to have your vet write the prescription for the Lantus Solostar pen and use the link back about 6 posts to sign up for the Lantus Savings Card. It will save you a lot of money.

Of course, if you are in Canada, no prescription required for insulin.
 
Christy

I'm the member Wendy asked to help you with the SS.

I am going to send you a private message to get some info to help you. If you look at the top left side of your web page in this forum, you will see "User Control Panel" and it will say "1 new message" when I send you the PM. Just click on that and you can click on the message from me. :-D
 
What are some thoughts on insulin? My vet has him on Novolin 70/30 & does not seem to be working well. I have not read good reviews about humulin insulin for cats. She is wanting me to try Lente next, but have read that all beef PZI is best for cats, which I cannot get. My next choice is Lantus, but notice that people are giving Levemir & Human PZI. What are the differences?
 
You want Lantus, Levemir, or the human PZI because they will last longer in the cat than your current 70/30 mix does. That only lasts about 8 hours, so unless you shoot every 8 hours, there are 4-6 hours with no insulin, due to the cat's faster metabolism.
 
christy said:
What are some thoughts on insulin? My vet has him on Novolin 70/30 & does not seem to be working well. I have not read good reviews about humulin insulin for cats. She is wanting me to try Lente next, but have read that all beef PZI is best for cats, which I cannot get. My next choice is Lantus, but notice that people are giving Levemir & Human PZI. What are the differences?
Click to expand...

One of the main differences in the insulins are duration, onset, nadir or peak action.

PZI and Prozinc are in and out insulins. Shot goes in, gets used up in the 12 hour cycle, done. No overlap between shots. Not all cats can get the full 12 hour duration. Some cats only get 8-10 hours duration. More flexible with scheduling changes in your shot times. Still best given on a 12/12 hour schedule. Can be dosed on a sliding scale once enough test data has been gathered to see how your cat reacts to the insulin. There is no dosing protocol that has been developed through research on making changes to the dose. It's more of a case of finding what will work with your cat. Not sure how long the PZI and Prozinc vials can stay viable, but Prozinc website says more than a month.

Lantus and Levemir and both depot type insulins. Some of each shot, goes into storage, some goes to work right away. Long duration 14-18 hours. Onset for Lantus around +2, Levimir around +4. Nadir for Lantus around +5-+7. Nadir for Levimir around +8-+10. Overlap between shots so you always have some insulin at work. Not as flexible with scheduling changes in your shot times. Best given on a 12/12 schedule but people have done 11/13, 10/14 and made it work. Same dose AM and PM. Dosing protocol developed by Roomp and Rand. Modifications of that through member experience here on this board, Variations in that dosing protocol, SLGS, TR and Relaxed. Slightly higher upfront cost. Savings coupons available for both. Vials can stay usable and effective for 4-6 months. Lantus pens often used to the last drop but higher up front cost.
 
Deb, I have the savings card...fixing to go to pharmacy for Lantus. Do you use the pen or a vial? Do you just draw out of the pen like you would a vial? Pens are 3 ml? If I gave 2u 2xday how long will pen last?
 
Lantus is 100 units per mL
3 mL pen = 300 units
@ 1 unit BID, lasts 150 days
@ 2 unit BID, lasts 75 days

10 mL vial = 1,000 units
@ 1 unit BID, lasts 500 days, but insulin may deteriorate by 6 months or so, even if kept refrigerated on a stable shelf.
@ 2 unit BID, lasts 250 days

You use a U-100 syringe to withdraw the insulin from the pen, not the needle tips; tell pharmacy you don't need them.
 
Just went to pharmacy & the lantus savings card won't work for me because my vet doesn't have NPI # (National provider id #) which they understand most or all vets don't have. The box of 5 pens would be $300 & the vial $180. How did you guys get the savings card to work for you? I even called lantus about it & they said it would have to come from a medical doctor to have NPI#.
 
People here have gotten 4-6 months with proper care. The manufacturer only tested for 28 days. That is why the 28 day limit is on the vial and instructions.
 
Got the 10ml vial of Lantus this afternoon. My pharmacist cut me some slack on the price...God bless her. I really wanted to go the pen route, but after getting the savings card it wouldn't work & they were a lot more than the vial. Maybe next time? I sure hope this new insulin works for him...I have faith that it is going too.
 
Any suggestion on where to start in units with dosing on lantus? I have been giving 3-3.5u 2xday of Novulin 70/30 w/ not much success. Started out @ 2u 2xday. I am thinking of starting w/ 1.5 or 2u 2xday. My vet just called in script...no instructions.
 
christy said:
Any suggestion on where to start in units with dosing on lantus? I have been giving 3-3.5u 2xday of Novulin 70/30 w/ not much success. Started out @ 2u 2xday. I am thinking of starting w/ 1.5 or 2u 2xday. My vet just called in script...no instructions.
Click to expand...

The recommendation is 70% of the current insulin:
0.7 * 3.5 = 2.45
Round down for safety = 2.0 units, or 2.25 (you eyeball it between the half unit marks)
Apparently this is only for switches to Levemir.

Another formula is the minimum of (current weight or ideal weight) in kilograms * 0.25 = starting dose.

Or start low go slow: 0.5 to 1.0 units.
 
Can you do a horizontal line and put in bold when you started Lantus on your SS so we can easily refer to it?

Heres a few things on Lantus

- Lantus does best on consistency - same dose am and pm. Every 12 hours give or take 15-30mins.

- For the first 5-7 days you want to hold the same dose to let it settle in. Lantus is a depot insulin which means it needs to slowly build in his body. Then you can see how well its working.

- Lantus dose changes are based on the nadir - or lowest point of the day.. not the preshot numbers. So its important to get mid cycle tests (5-7 hours after shot) before you decide to make a dose change.

Hows the food transition coming along?

Wendy
 
Wendy, Marge is setting my SS up. She has been having problems. Gilbert was 160 this evening @ insulin time which is weird(usually 400s) so I just gave him .5 of the new Lantus. I was scared to give any more since his # was very low for him & it is new to us. I have had him on very restricted dry food the last 3 days & that may just now be kicking in. I feed him w/ his bubby Pete & Pete is not at all thrilled w/ the lack of dry food & is losing weight (not a terrible lot, but enough to show). Neither have really ever liked wet food all that much & I am having a hard time finding something they will gobble up. Have been trying low carb FF, Friskies, & 9 Lives. :-| Do you have any suggestions on food?
 
This may help you with a food transition from dry to wet. Lots of good tips in this article by vet Dr. Lisa Pierson. http://www.catinfo.org/docs/TipsForTransitioning1-14-11.pdf I used a lot of these to get my cat Wink, a dry food addict, from high carb Hill's W/D to Fancy Feast classic pate and Friskies pates.

It took 3 weeks of concerted effort, but it finally paid off.

Probably the best tip, was mixing some of the wet into the dry. Either crushing some dry and sprinkling it on top of the wet food or "chip and dip" method. Gradually cutting down on the amount of dry and replacing it with an equal amount of wet over a period of time works.

Let the cats natural hunger come into play. If you are used to free feeding, take the food away after 30 minutes and put it down again several hours later.
 
you could try a product called Stella & Chewy's freeze dried raw food dinners. while it is a raw food product, it is dry food and is intended to be served with added water. My non-diabetic gave me a hard time about losing her dry food and someone told me about this food and it seems to be a good substitute. Maui likes it and it hasn't affected her glucose levels.

it comes in different flavors and while a bit pricey, might be worth a try. you can serve dry and slowly add a little water to see if they will eat it.

http://www.petfood.com/item/stella-and- ... od/498360/

here is where i get it online, you can look it up to see what local stores sell it.
 
I've finished with the SS and put in all the Novolin data as well as a horizontal line showing when Lantus was begun tonight.

One thing on the lantus dose, when switching from ANY insulin other than levemir, the 70% is NOT used to calculate starting dose.

Because Gilbert has not been on insulin long, I would suggest his starting dose for lantus should be calculated as recommended for TR protocol which is:

.25u/kg of ideal weight OR if kitty is underweight than .25u/kg of actual weight

If Gilbert's ideal weight is 13 lbs then the starting dose would be:
13/2.2 = 5.9 x .25 = 1.47u.

His initial lantus dose then could be from 1.25u - 1.5u. If you are concerned about the dose, start at 1.25u .....which is what i would recommend because after the depot fills, if numbers are not coming down, we can up to 1.5u.
 
Christy

Have you been shooting the last couple days or did you actually stop insulin for a couple days before you started the Lantus tonight?

How much have you cut back the dry food? Did you test anymore tonight? I think it would have been better to skip this shot...that is a low number for your first Lantus shot.

When I gave you the starting dose, I was assuming you we're still shooting novolin up until the time you started Lantus.

If you were not, then it might be best to leave the dose at .5u ....especially if you have stopped dry food....and see what he does. We can always fast track him up.

It's also important with Lantus that you get spot checks each cycle as well as a PS test.
 
Marje, He was on the Novulin up till yesterday evenings Lantus shot which was @ 7pm w/ .5 because of his low #, but then he was in high 300s @ 11pm :cry: Gave him 1.25 this morning @ 7 with his # being low 300s. I will get his actual #s later & put on SS. I found it, but how do I get it to this site & can I update it from here or do I always have to go to google doc? He is down to about 10 pebbles morning & evening, but not eating wet food much either :cry: I always pre test before shots & will spot ck him. Thanks so much for the SS setup & all the help!
 
with lantus, you need to be consistent with the dose - in other words - you are not supposed to change the dose amount every time you give insulin. and the dose is not solely based on the pre-shot number.

please take some time to read the very important information on the lantus forum, here is an excerpt: http://felinediabetes.com/FDMB/viewtopic.php?f=9&t=1581


"General" Guidelines:

Hold the initial starting dose for 5 - 7 days (10 - 14 consecutive cycles) unless the numbers tell you otherwise. Kitties experiencing high flat curves or prone to ketones may want to increase the starting dose after 3 days (6 consecutive cycles).

Each subsequent dose is held for a minimum of 3 days (6 consecutive cycles) unless kitty earns a reduction (See: Reducing the dose...).

Adjustments to dose are based on nadirs with only some consideration given to preshot numbers.


Increasing the dose:

Hold the dose for 3 - 5 days (6 - 10 consecutive cycles) if nadirs are less than 200 before increasing the dose by 0.25 unit.

After 3 days (6 consecutive cycles)... if nadirs are greater than 200, but less than 300 increase the dose by 0.25 unit.

After 3 days (6 consecutive cycles)... if nadirs are greater than 300 increase the dose by 0.5 unit.


Reducing the dose:

If kitty drops below 40 (long term diabetic) or 50 (newly diagnosed diabetic) reduce the dose by 0.25 unit. If kitty has a history of not holding reductions well or if reductions are close together... sneak the dose down by shaving the dose rather than reducing by a full quarter unit. Alternatively, at each newly reduced dose... try to make sure kitty maintains numbers in the normal range for seven days before reducing the dose further.

If an attempted reduction fails, go right back up to the last good dose.

Try to go from 0.25u to 0.1u before stopping insulin completely.


Random Notes:

Because of the cumulative nature of Lantus and Levemir:
An early shot = a dose increase.
A late shot = a dose reduction.

A "cycle" refers to the period of time between shots. There are 2 cycles in one day when shooting twice a day.

Sometimes a dose will need to be "fine tuned" by adding some "fat" or "skinny-ing up" the dose.
 
[quote="christy I will get his actual #s later & put on SS. I found it, but how do I get it to this site & can I update it from here or do I always have to go to google doc? He is down to about 10 pebbles morning & evening, but not eating wet food much either :cry: I always pre test before shots & will spot ck him. Thanks so much for the SS setup & all the help![/quote]

To update the ss, you have to go to Google docs, sign on and then update your spreadsheet in Google. Have you ever used a spreadsheet format? Ever used google docs? It saves the document automatically for you in the Drive folder. I bit different from all those Microsoft programs where you need to save the changes.

Marje put the SS in your signature, but that is a read only link so the rest of us here can see what is going on. You do not need to do anything more to get the SS to the site since it is in your signature now. We just click on the words "Gilbert's Spreadsheet and we are there".
 
Christy

Thanks for entering the numbers. I sent you the instructions for editing the SS but I am glad Deb helped out on that :-D

I was pretty sure you had been shooting Novolin and then switched directly to Lantus. I feel better about the 1.25u dose knowing that. Glad you checked him again last night. Great job!

Keep in mind that as the Lantus depot fills and you continue to cut the dry back, you may need to drop the Lantus dose.
I'm not sure if it has been explained how Lantus and Levemir work but they are depot insulins. The first several shots you give go towards filling the depot. Once the depot is full, the cat starts to use the shot you are giving. Both the "L" insulins have a cumulative nature so one shot builds upon the preceding one.

Hillary made good points about not dosing on the preshot and not changing the dose. You should hold this dose for a minimum of 5-7 days unless he drops below 50.

Also remember that the L insulins like consistency so shooting every 12 hours will help numbers be less wonky. However, it is not always possible to shoot every 12 hours. Do the best you can. Remember that:

An early shot acts like a dose increase
A late shot acts like a dose reduction

It's really important to be careful about how often you shoot earlier than +12. You might not see the effect in the current cycle, but you may likely see a big drop in subsequent cycles, especially if you do it very often. I would be cautious on shooting early often.

If you have schedule issues, that's ok...let us know. We've helped many other members who couldn't shoot at +12 every cycle.
 
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