To high of a starting dose ?

The vet put Dasher on 3 unit twice a day , this morning was his first shot. I thought the dose was high especially since I've changed his diet to all wet. The vet said he would prescribe 3 units even if his BG was 100 since it had been 446 when he was diagnosed . Another poster thought it was too much and now I'm not sure what to do. Should I just lower it or call the vet and question him again.

 

Good Lord!

Lower the dose please!!! 3u is way to high of a starting dose especially with Lantus! And with a diet change as well that is playing with fire. Most cats only take .5 -1u twice a day to start with and then are slowly worked up from there. Diet change alone can drop them as much as 100 pts overnight.

Lantus is a depot insulin which means each shot builds on the next one, because it carries over from one shot to the next. So just starting out you could be fine on the first couple of shots but as the build up in his system they could sink him like a stone.

Mel and The Fur Gang

 

This dose is higher than most people start at. For example, my cat was on a high carb, dry diet when she was first diagnosed and her starting dose was 2 units of Lantus, twice a day.

There is also a formula based on weight that is used to determine a cat's starting dose on Lantus or Levemir. It should be 0.25 units of insulin per kilogram of your cat's ideal weight. So for a 5.9kg (or 13 pound cat) the initial dose would be 5.9 x 0.25 = 1.48 units (you would probably round up to 1.5 units or down to 1.25). Dosing for other types on insulin varies.

Here is a link to an online calculator to convert pounds to kilograms.

You may consider starting with a lower dose. The general motto in regards to blood glucose levels is "better too high for a day than too low for a moment."

Are you able to test your cat's blood glucose levels at home?

 

Yes definitely lower the dose. There is nothing wrong with starting low and then working up. It isn't a race. Better slow and steady. I worked up from 0.5 of a unit and at 1.25 units twice a day he was under good control and now I am reducing the dose again. In that time I learnt to test his blood glucose as much as possible.

 

Waiting on the vet to call but either way I'm dropping the dose to just under 2u. Does this sound ok?

 

You're getting a meter tonight right? I honestly wouldn't start any higher than 1u until you have a meter and are comfortable testing. Too high of numbers kill over time, but a hypo from going to low can kill almost instantly if not caught quickly. I would rather see your baby high for a few days than run the risk of having him hypo and die.

Mel and The Fur Gang

 

If you follow the link below you'll find a link to the PDF of the Roomp-Rand published protocol Management of Diabetic Cats [with Long-acting Insulin]. It contains a table with detailed instructions for starting doses and dose adjustment guidelines. It might be a good idea to print off a copy and use it as a basis for discussion with your vet? My vet and I found it very helpful to do so.

 

I responded in your thread in the Lantus TR ISG: http://www.felinediabetes.com/FDMB/viewtopic.php?f=9&t=127995&p=1319241#p1319241

 

Ok so I talked with the other vet in the office who just so happens to specialize in feline diabetes. She said 3 units is what is recommended for his weight and his BG reading. She understood my concern about the diet change and told me to go out and get a meter and start testing. She wants numbers before he eats and two hours after he eats, she said if I want to go ahead and do a curve just so we can monitor his levels, I will give 3 units tonight and go buy his meter tomorrow morning and start testing. I like that she said if I'm that comfortable in BG testing to do the curves at home and she will work with me. She did give me guidelines if the BG is too low and not giving him a shot. She spent 20 min with me going over everything and I feel she knows what's she's doing. I will keep everyone up to date.

Thank all of you for the advise.

 

Responded in TR: http://www.felinediabetes.com/FDMB/viewtopic.php?f=9&t=127995&p=1319265#p1319265.

 

So what in the heck is she talking about then...how frustrating !! I highlighted the one part below does this factor into it all? If you were me how much if any would you give him tonight?
I'm going out in the morning to get the Relion Prime meter is this one ok? Or is there another one that's better. I will be testing him throughout the day over the next few days. I'm now afraid is going to overdose and think I'll follow your lead .

Begin with 0.25 IU/kg of ideal weight BID
OR
If the cat received another insulin previously, increase or reduce
the starting dose taking this information into account. Glargine
has a lower potency than lente insulin and PZI in most cats.

 

I am a newbie and so can't really advise but if it were me and I couldn't monitor his blood glucose readings tonight I would just skip the dose. No harm will be done and you can start tomorrow when you can properly monitor your cat to keep him safe. Until then you need to look out for the signs of hypo (but also be aware that not all cats get them) . Do you know what they are? Have you checked out he stickies on handling hypo situations?

Have you checked him for ketones at all? With the urine test strip.

Other members will be able to advise better on dosing

 

I would skip tonight and start fresh in the morning. The Prime is an okay meter but fussy when starting out. I have one for my guy in remission because his readings aren't critical. And I only test him about once a month so its cheap. My favorite (I have 5 different brands) is the Relion Micro. Little more for the strips but I trust it where I can't say that about the Prime.

Mel and The Fur Gang

 

I'm sure this is all very overwhelming. I know you're getting a lot of advice from board members and the vet, but the general consensus on the boards seems to be that 3 units is too high for an initial dose.

What were Dasher's blood glucose readings like at the vet? You mentioned that he was at 446 when he was first diagnosed, but do you have any more recent readings, for example, after the diet change?

Also, the Relion Prime is a good meter. Lots of people around here use it. Once you get the meter, there are lots of great resources available for home testing. When you pick up the meter, you may also consider getting some ketone testing strips (like Bayer Ketostix) and some high carb, gravy-based Fancy Feasts in case Dasher drops too low. Finally, I just want to say that I've looked over some of your past posts and you're doing a lot of good things to keep Dasher healthy. Even though today is probably really frustrating, you're making progress and this will all be easier sooner than you think.

 

I beg to differ about the Prime I have it and stopped using it except for a back up because it was highly inconsistent even when testing myself. Yes all meters have a variance of +/- 20% but the Prime swings between Hi (over 600) to 460 on the same drop of blood.

I've been testing cats for over 4 years and multiple cats 5 of my own, 2 fosters and 6 shelter cats. Personally I wouldn't recommend it to anyone. Even with years of experience I waste more strips with the Prime than any other meter.

Its strips are cheap that's all I've found in its favor.

Mel and The Fur Gang

 

What one do you suggest I get?

 

I use the Relion Micro and I like it. I believe Mel also recommended the Relion Micro in a post in this thread. All of the Relion brand meters are available at Walmart.

 

relion micro is great and i want to add.... please believe that the people on this board are experts in feline diabetes and as they said... they would never start with 3 units. you can always work up but start low.... good luck

 

Love my Relion Micro. Of course while my mom was living I adored my One Touch Mini but the strips are pricey, but mom was diabetic as well and also used the One Touch Mini and insurance covered her strips so we shared. Mom passed 2 years ago so no more free strips.

Mel and The Fur Gang