3/16 New Member Insulin Shot Question

[Grey's Dad]

Hi! My name's Joseph. I have eight cats and my oldest one is Grey. We think he's 16, closing in on 17 soon.
Grey's a stray boy we brought in back in 2015. The vet estimated his age at 7 back then
Last month he was diagnosed with diabetes. He was put on vetsulin 1 unit 2x/day. I am monitoring his levels with a libre device (am really not a fan of ilt, but it's cery convenient).
So for two weeks I gave him his shots and his glucose levels remained elevated
His insulin was changed to glargine yfgn 2 units 2x/day
He responded immediately to the new insulin. His numbers dropped from the 500s to the mid 250s but would rise back to the 500s eventually.
However, at least 9 days after this treatment started (the libre ran out of juice on Sunday and there were issues with the replacement on Monday), he stopped responding to the insulin and his numbers remained elevated and never dipped down after his shots
Our vet is looking into possible issues that could be causing it and we'll find out tomorrow.
Grey has kidney issues as well and was hospitalized overnight yesterday to treat dehydration.
The emergency hospital vet gave him his shots and his numbers went down from the 500s to appox 450 (there's more to share there).
As I'm typing this out, I'm realizing my question is already answere since his numbers did not dip into the 200s at the emergency hospital.
I was going to ask if I could possibly be giving grey his insulin incorrectly. Could that be happening? I know the insulin goes in him because there is no liquid on his fur. I primarily give him his shots around the shoulder area.
On another note, last night, the emergency hospital vet gave grey his shot around 9pm. His numbers dipped to 450ish.
Around 4am, he was given 1/2 a unit in his muscle and when I went to pick him up, his number was at 320.
They gave him his morning shot around 8:30ish and by noon, his numbers were in the low 100s.
They wanted me to give him another muscle shot around 4pm, but after demoing it for me, it looked too difficult as grey doesn't have much muscle mass. So instead, they asked me to up his dosage to 2.5 units 2x/day with the understanding that 2 units is typically the max for glargine. So I'll be watching him closely after his evening shot.
I'm taking him to his regular vet tomorrow to discuss his test results to see if anything could be causing the failure to respond to glargine and also to address his kidney issues and dehydration.
Any thoughts on what could be going on with him? It's puzzling to me that he was responding to the glargine and then his body stopped responding.

 

[Bron and Sheba (GA)]

Hi and welcome to the forum.
We do not recommend giving muscle injections with insulin…it should be given subcutaneously.
There could be many reasons why Joseph is no longer responding to the insulin.
What is his current dose?
What are you feeding him?

So instead, they asked me to up his dosage to 2.5 units 2x/day with the understanding that 2 units is typically the max for glargine. So I'll be watching him closely after his evening shot.
I'm taking him to his regular vet tomorrow to discuss his test results to see if anything could be causing the failure to respond to glargine and also to address his kidney issues and dehydration.

I need to correct the vet regarding the dose.2 units is not the typical maximum for glargine. Every cat is different and so are their needs. We have lots of cats on more than 2 units of glargine. And many on less.
And please do not give doses more frequently than 12 hourly.

If you would set up one of our spreadsheets and fill it with some data, we will be able to heal you. We rely on BG data for this
Here is a link to our SS, signature and hypo box.
HELP US HELP YOU

Here is a picture of where you can give the injections.

Keep asking questions. We can help you.

 

[Grey's Dad]

Hi. Thanks for response. My name's Joseph. My furry boy is Grey.
His original dosage is 2 units glargine 2x/day
The emergency hospital vet has asked me to up the dosage to 2.5 untis 2x/day.
His diet is primarily fancy feast pate and w/d prescription wet food (it's a high fiber food as he's had constipation issues in the past). My understanding is both are low carb food. He also gets some, but not much w/d prescription food kibble. he also gets at least one package of purina hydra care liquid added to his wet food to help him stay hydrated.

 

[squeem3]

@Sienne and Gabby (GA) @Wendy&Neko will have good advice on Lantus and dosing.

@Staci & Ivy any Libre tips for a newbie?

Insulin can pack a punch so 2 units may actually be too much insulin for your cat and your cat's body is responding by trying to keep levels high to prevent a hypo. A much safe dose to start with is 0.5 units twice a day. It's better to start low and increase as needed than to to start too high and deal with hypos and the panicking body. 0.5 units might not make a dent in levels but that's ok. Just have patience until you find the right dose for your cat.

Cat insulin doses vary. 2 units is not a max Lantus dose. A cat may need more insulin than that before the dose can be decreased based on blood glucose curves. My cat has been on as much as 2.75 units twice a day. A previous diabetic cat was on as much as 4 units twice a day. Some cats with acromegaly or other conditions may need a huge dose of insulin.

I would stop the WD food, both dry and canned. Neither have any magical ingredient that helps with constipation or other issue. Plus they're expensive. Carb content is on the high side and some cats are super carb sensitive. Ask the vet about using Miralax or canned pumpkin puree for the constipation.

Plain water can be added to canned food for good hydration. You don't need any special product marketed for hydration.

 

[Grey's Dad]

Thanks for the feedback. I left Grey with the vet and they did a curve on him. It looks like 2.5 units is the magic dose so far
Grey's kidney numbers were off last year and his physical exam in February showed it's worsened. After discussion with my bet, we've decided to put him on a diet that will be easy on his kidneys.
Grey had a libre device installed on him and I've finally given up on using it. Besides the expense, the needled kept bending and this last one (his fourth in less than a month) lasted seven days.
So I ordered an alphatrak 3. Still sorting out how to use it.
In the meantime I read on this board about the Relion monitor and picked one up. Gave Grey his first prick this afternoon. He yelped a little, so i guess I poked him too hard?
Is there a conversion factor for cats when using the relion or is the measurement generally close enough to be relied on?
There's a real fountain of knowledge on this board and I've learned a lot just reading around the site.

 

[Diane Tyler's Mom GA]

@Grey's Dad

Can you please fill out your signature
Here is the information we need for your signature
Just click on your name up top and then tap signature and add this information. It's at the end of everyone's post in gray letters

• Add info we need to help you:
  • Caregiver & kitty's name
  • DX: Date
  • Name of Insulin (do not include dose or frequency)
  • Name of your meter
  • Diet: "LC wet" or "dry food" or "combo"
  • Dosing: TR or SLGS or Custom (if applicable)
  • DKA or other recent health issue (if applicable)
  • Bexacat or Senvelgo (if applicable) and dates
  • Acro, IAA, or Cushings (if applicable)
  • Spreadsheet link. Please put the signature link on the bottom line of your signature information, on its own, so it is easy to find.
  • Please do not put any information about your location in the signature for security reasons. If you wish to add your country location, please add it to your profile.

Be sure to click the 'Save Changes' button at the bottom. If you need help urgently it is important we know these things at a glance. We don’t want to waste valuable time finding out information.

Read all the yellow stickys when you get a chance about Lantus one of them will explain the 2 dosing methods to follow for Lantus. They will tell you when an increase or decrease is needed.

https://felinediabetes.com/FDMB/forums/lantus-levemir-biosimilars.9/

Here are the links to our spreadsheet where we enter our cats BG numbers . If you need help setting it up just ask we have a member thT will be happy to do it for you


How to Create a Spreadsheet

How to Use the Spreadsheet

There is a link understanding the spreadsheet but I'm going to explain it anyway
About the spreadsheet
AMPS - means AM Pre Shot the first test you take in the AM ,you need to withhold food 2 hours before testing so it's not food influenced

Units is where you would put how much insulin you gave
+1 is one hour after giving insulin if you were to test then that's where you enter his _BG number
+2 two hours after giving insulin. ditto
+3 and so on until you get to PMPS - PM pre shot withhold food 2 hours before testing

+1 same as you do for AM cycle

We don't give times because we are all in different time zones that's why we use the + numbers

Tap on any members spreadsheet to see what it looks like

Just checking do you have the U-100 syringes with the half unit markings. We use these because we adjust the doses by 0.25 units at a time

Most of us use the Relion Premier Classic or any of the Relion Meters. Our numbers are based on human BG numbers . I used them with Tyler and got him into remission for over 3 years before he passed away from cancer. I can honestly say if he was still with me he still would have been in remission
The experienced members gave me their advice and I did what they suggested.

Those Alpha Trak test strips are way too expensive.
I myself would return it if you can .

At least with the Relion test strips you can run into Walmart and get them . I have even ordered them on line and got them really quick

 

[Diane Tyler's Mom GA]

He also gets some, but not much w/d prescription food kibble.

This is too high in carbs
What is the percentage of carbs on a dry matter basis?
Answer by • Jul 08, 2023
This food has a carbohydrate content of 36.8% on a dry matter basis.

Is this the dry food you are feeding
https://www.chewy.com/hills-prescri...Pao85a6OrjHWTBpobzpiMwgYbbLvjzAkaAm8lEALw_wcB

 

[Diane Tyler's Mom GA]

Grey has kidney issues as well and was hospitalized overnight yesterday to treat dehydration

If your cat has kidney issues
You can feed Weruva Pates
Low carb and low phosphorus
Always add water to wet food

low carb/ low phosphorus
if you tap on this link and look at post #32 I listed some Weruva pates for another member that's low carb/ low phosphorus with kitties with CKD
https://felinediabetes.com/FDMB/threads/new-member-11-8-and-i-am-tired.283363/#post-3124085
You can order them on line also
Have you read all the yellow stickys about Lantus/ Glargine, be sure to read the 2 dosing methods ,they will both tell you when to increase or decrease
One thing though if you are feeding any kibble at all you can only follow the SLGS Method

https://felinediabetes.com/FDMB/forums/lantus-levemir-biosimilars.9/

 

[Tim & Pookey]

Is there a conversion factor for cats when using the relion or is the measurement generally close enough to be relied on?

No conversion factor. The Relion does generally read lower than the AT3, and most of the stuff on this board references human values (Relion). Alphatrak strips are expensive too. A lot of folks opt for the human meters for those reasons.