Introduction and HELP! Pls

Hi everyone!

Thank goodness for this page. My name is Charlene and my lovely lovely diabetic cat is Sir Thomas. I've had Sir Thomas for about 5 years now, and he is somewhere between 10 and 12 years old. I got him form the shelter, and they said he was a skinny stray, and when he came to the shelter, he liked to eat all the other cat's food and was somewhere around 18 lbs when we got him, then we got him down to around 15 (still overweight I know). He is on atopica for a dermatis and constant sneezing and difficulty breathing through the snot that no other allergy medicine helped. I had a baby this year, and unfortunately, being preoccupied I missed some early symptoms. I noticed he was losing weight quite rapidly (suspected it was due to the atopica) so I took him in last week and they confirmed by sending of blood lab work that he was indeed diabetic, and it had nothing to do with his previous health concern. Because of covid, there really is no one except my husband to help and he works 60 hours a week.

His blood glucose was 18 and 19 at 2 vet visits. They instructed me to start doing a curve and test every 2 hours. Before insulin he was between 14 and 17 on the meter. Well I have a needle phobia (free exposure-therapy now, haha) so it really took me a while to figure this whole testing thing out but I kept poking him every two hours until now we consistently get it. It has now one and a half weeks since his diagnosis and he has received an insulin shot yesterday and today. Yesterday, his blood sugar was 17.7 and we gave him his starting dose of insulin (lantus, 3 units) as per the vet). Well by the morning he was at a 2! I panicked,called the vet and he instructed honey. I did this and we were able to get back up to 6. Eventually over the day he went back up to 15 by the time for his scheduled insulin dose at 8:30p. Now it is 1:30a and he is at 5.6. I am so affraid he is going to go hypo again, but he stopped eating and drinking sometime in the evening today. I have tried fancy feast, friskeys, lickable treat, freeze dried treats....everything. I will call his vet as soon as the office opens at 9 but any advice would be greatly appreciated!

 

What is his BG right now?

@Bandit's Mom

Hang in there!!

 

Thank you! his blood glucose is 5.6 on the meter. I am not even sure what to do other than to give him honey when he goes below 5. But he is not eating or drinking so any advice is really appreciated! I am scared to go to sleep with that number

 

You shouldn't go to sleep before you know for sure, his number is staying up. Honey wears of quickly, so just wait..

 

How long since you gave the shot? I can't see the SS (needs to be shared).

What diet is he on?

 

5 hours since you gave his shot? And this is his third shot of Lantus?

 

So 3 units is too high a starting dose. Especially considering that 18 or 19 mmol is not so high as far as numbers go. Especially if you throw in stress from the vet visit.

What are you feeding him? Was a food trial attempted before starting insulin? That is, if you were feeding high carb dry or canned food, was he switched to a low carb canned or raw diet to see if he can be regulated with just a diet change? Would you know if the vet tested for ketones?

 

It has been about 5 hours since the shot (2nd shot). Yesterday was his first shot at 3 units but when I woke up he was at 2 so then the vet instructed to reduce to 2 units today when he was at a reading of 14 so that is what he has had. I haven't had time to figure out the spreadsheet yet, I don't really understand the lingo but I am working on it

 

No food trial was completed, the vet gave me a prescription food he wont touch (although he now has stopped eating all together but I wonder if it is because he feels crummy).

I bought some fancy feast and he has friskeys pate but he wont touch anything at the moment. He is dehydrated and struggling to use the litterbox i think because i saw him rubbing his fanny on the ground after which he never does. I was desperate for him to eat anything so I offered him treats which worked earlier in the day, but not anymore

 

I don't even know what ketones are, but I will totally ask tomorrow! and i wondered if that was high after reading some things on here. Thank you so much for this info!

 

So 5.6 is still a safe number. No need to intervene with honey yet. Is he still refusing to eat anything at all?

For everyone to be able to view the spreadsheet, you need to go the "Share" option and choose "Anyone with link can view"

 

Thank you, I fixed it! I will figure out how to interpret it and use it (I hope! lol). Yes he is still refusing. I even tried draining the liquidy gravy out of the can he normally loves and nothing

 

What food was he eating before diagnosis? And when did he last eat today?

I would also ask the vet about why he's dragging his butt on the floor. One of the reasons is worms. My cat was doing that a couple of months back and had to be dewormed. That is not the only reason though.

Please do ask your vet about ketones too. This is very important.

 

Yes, I can see it now. You have to enter the readings in the World mmol tab and the US numbers are automatically calculated. I am assuming you are not in the US?

 

He was eating hard kibble with Satiety Support, Royal Canine. Then I bought some fancy feast and friskeys to see what he would eat along with freeze dried treats. I am not sure when he last ate (I have 3 other cats that steal) but I suspect somewhere around 5pm when I last saw him take a couple licks, but nothing significant.

He ate a treat with his insulin, and refused all food which worried me.

Oh crap, no I am in Canada...I must have the wrong sheet? I thought I clicked the right one. I will go back

 

Is he still eating kibble? Royal Canin Satiety Support?

How long is it since the last test? If it's more than an hour, can you get another one please?

 

No he is not eating the kibble or anything since this afternoon.

Royal Canin Satiety Support was his old food. Now I have tried* for the last two days to swtich him to fancy feast but no luck so then I tried friskeys and had some luck and now he is refusing all food and water.

I will go and get another test right now

 

When you can, please enter all the readings you have from the time you started testing (even if those were before you started insulin) till now on the SS.

 

Thank you for all your guidance! I added in the readings, not sure if I did it right and I think I have the right spreadsheet?

I just poked him 3 times and no blood for some reason, maybe dehydrated? I will try again

 

First of all, the dose of 3 units is too high a dose to start a kitty on.
If you are feeding a low carb wet diet, the starting dose is around 1 unit twice a day.

Do you have any food at all that he might eat. It doesn’t matter if it is unsuitable for a diabetic cat at the moment. We just want him to eat. Try sprinkling some Parmesan cheese over some food, or do you have some ham or similar meat...not great I know but we need him to eat. Or tinned sardines or salmon?
Also you may need to syringe some water into his mouth.
To see if he is dehydrated. Feel his gums....are they slippery or tacky?
Also lift up his scruff....does it snap back up stay up?

If you don’t have any Ketostix, I’m sure you probably don’t, make sure you buy some from a pharmacy as soon as possible to test the urine for ketones. This is really important. We need to establish if ketones are in the picture or not.

Is he lethargic?

 

I will fix it for you. Have sent you a request for edit access. Would have come to your gmail.

 

That is so nice of you, thank you so much. Shared!

 

that is all so helpful, thank you! Wow, so much more info than the vet. I am a vegetarian and have no other meat- UGH! I will try parm and sardines too! THANK YOU . I do have a syringe so I can do that. He is more lethargic, but still walking around from time to time (or to hide from me).

He won't let me near his gums (he hates his allergy medicine atopica that I force by syringe), but his scruff seems to fall back down, I'm not sure if "snap back" though

 

Charlene you are doing great! Hang in there! It’s always hard in the beginning without any other issues to add to it.
With the syringing, make sure you point the syringe into the side of the mouth...the cheek and not give too much at a time.
I’ll link a thread about syringe feeding which might help
https://felinediabetes.com/FDMB/threads/syringe-assisted-feeding-videos-and-tips.144367/

And here’s a link to stimulating the appetite
https://felinediabetes.com/FDMB/threads/suggestions-on-how-to-stimulate-kittys-appetite.130770/

Are you on the west or the east coast of Canada?

 

Wow, I do not understand this spreadsheet or the numbers...any chance you could point me to the thread where I can learn?

 

I have entered the BG values in the world tab (second sheet). Please do check if I have the numbers right?
Your shot time is 8:30, so we note down values with reference to that time. So 9:30 is +1, 10:30 is +2 and so on.

Some reading when things have calmed down a bit:
How to Use the Spreadsheet

 

Thank you that makes so much more sense!! And THANK YOU. Oh m gosh, I would not have it together (emotionally or for my cat!) if it wasn't for you guys and your kind help!

 

Thank you for the encouragement and the resources!! I will check those out now.

I am more western in Alberta!

 

Just re-check the values I have entered? For e.g. the reading of 3 mmol you got this morning was at 10:40am? 2 hours after this morning's shot was due?

 

@Bron and Sheba (GA) should Charlene skip the AM shot? Especially if Sir Thomas is not eating? Or go down to 1U? We will not know about ketones till she is able to speak to the vet tomorrow morning.

If no ketones, should she try a food change and only then get back on insulin?

 

More reading for another time. A food change can be attempted only when the cat is eating properly.
http://www.catinfo.org/docs/TipsForTransitioning1-14-11.pdf

 

Okay so helpful! I just rechecked and it was 2.7 so I used the sardine trick posted above and mixed with some honey and he ate some which is more than before so I am hoping it will be okay. Do I retest in 15?

And I will ask about keytones!

Just to clarify, only one daily shot at 8:30pm. So confusingly, I did the insulin at 8:30PM not 8am...so he was low at 10am the next day. Should I not do it at night? That is just the only time I have my husband home to hold the cat and my baby is in bed not interfering

 

OK, so it’s about 3.50am there, so not too many more hours before you can contact the vet. That’s good.

The shot is due at 8.30 am and the vet opens at 9 am, so I would be inclined to hold off on the insulin, call the vet first and ask if they tested for ketones.......mind you just because he may have tested negative to ketones at diagnosis, doesn’t mean he will be negative now.
I think the dose should be reduced to 1 unit unless there are ketones the urine.
I would not try a food trial first now that he has started insulin. They are not without their dangers.....ketones need to be checked daily if insulin is not being started.

Charlene, I don’t know how you are situated as far as getting to the vet early with a baby, but if you could collect a urine sample in the next few hours that could be tested for ketones at the vet, that would be good. It needs to new fairly fresh urine so closer to the opening time would be best.
Also I would ask about an antinausea injection such as cerenia as Sir Thomas could be nauseated and nauseated cats won’t eat. Also ask for some cerenia or ondansetron tablets to bring home in case he is still nauseated after the injection wears off.
My Sheba had no appetite for a few days after diagnosis and I struggled to get her to eat.

 

I have to fix the spreadsheet, it is an error, it is actually 8:30pm I have done the shot. The vet just said to stick to one time every day and didn't say more than that so we chose 8:30 when my husband is home to help but I can learn to do it on my own and change it if we need. So he got his shot at 8:30pm tonight and now it is 4am

All super helpful! Also, how does one collect a urine sample??

 

yes test again in 15 mins. 2.7 is too low. How much honey did he eat?
That’s good he ate some food.

Lantus is dosed twice a day not once a day........if he was so low at 10 am after having a dose at 8.30 pm, he could have been really low before you found the 36.
I don’t think your vet knows a lot about feline diabetes.
I think he is most likely lethargic from the low BGs.
Did you give 3 units again this the last dose.....I thought you said you gave 2 units but the SS says 3 units.

 

2.7 is low and honey was needed. It's good he ate. Please test in half an hour?

Lantus is given twice a day. Did your vet ask you to shoot 3U once a day?

Gosh! What a night for you and what a scary introduction to insulin!

 

This is my mistake. I will correct it to 2U.

 

That’s good it was 2 units not 3units. Even so, 2 units is too much so he could stay in low numbers for several hours. You will need to keep checking for several hours yet Charlene ...I am sorry but we need to keep Sir Thomas safe!

 

We have a sticky for almost everything! LOL
Tips to catch and test a urine sample

 

Yes I think you are right. I am so scared that more damage has already been done. I love this cat and will stay up all night until the vet and he is stable. Thank goodness I stumbled upon you guys.

I double checked, lantus: "give 3 units once every 24 hours"

 

Looks like you need a new vet. But our experience has been that most of them know very little about Feline Diabetes. They should at least know that Lantus is dosed twice a day for cats!

 

We just need to get him through the next several hours and keep him in safe numbers....above 3 or higher if possible to give us some leeeway.
So just keep testing and giving him snacks of food if he will eat. Someone will stay with you all the time until the insulin has worn off. That could be past 8.30am looking at yesterday’s numbers. If his BG drops low and he won’t eat you will need to rub honey on his gums.

Hopefully no damage has been done.

 

Thank you all from the bottom of my heart! he wouldn't eat anything, not even more honey sardines. I tried to rub on his gums but he hates his mouth being touched so much and wasnt very successful so I put some thinned honey in a syringe and gave it that way... got maybe 14mls so not much but I hope it helps.

So recheck every half hour? Keep rubbing honey on his gums if I can since he won't eat?

Many, many thanks!

 

Charlene I just want to double check you are using a human meter not a pet meter.
The SS is set up for a human meter but I can’t see where it is actually written anywhere what type of meter it is.
Thanks

 

Yes it is a human meter! I will update

 

Yes, well I saw a fill in vet when my vet was out so I hope that is just where it went wrong and my vet knows....but it did seem like she was consulting with him :|. I will say, that he has been excellent so far so I hope I can bring this information to him and make it work. He has done wonders in other situations!

I just retook and he is only at 3.8 then thats when I did the syringe of honey

 

It usually only takes a drop or two of honey to bring the BG up higher. Let’s see what it is next test.
If he won’t eat, you may need to keep the honey up so that the BG doesn’t drop too much.

Phew! Great!

 

3.8 (68) is better.

 

You can even apply the honey to his lips/snout so he is forced to lick it off.

ETA: I've sent you a PM asking for the test data again, so I can verify what I have entered in the SS.

 

Great tip on the honey! Okay, so he is now at 6.6. I am going to have a cat nap for an hour but my husband will get up and test him in half an hour and then I will test him at 6am (1/2 hour increments, hope that works!). As soon as the vet opens I will call with all of your information.

Again, I just cannot thank you all enough! Will update tomorrow when the vets office opens

 

@Bron and Sheba (GA) hourly tests okay for now? Since he is over 100? And no insulin tomorrow morning?

 

That sounds like a good plan.
You will need to keep testing at least for 12 hours after the dose because yesterday he was still dropping after 18 hours. Fortunately you gave him less insulin last night but even so he could still potentially keep dropping after 12hours.
The honey will only work for around 1 hour or sometimes a bit longer so be aware that the BG will drop again.
If he will eat anything that would be good.
Can you ask your husband to post the next test result do you think?

So ask the vet about the ketones at diagnosis and get a test done for ketones now. If we can eliminate them as being a problem that would be great. And if they are there, they need to be treated.
Also ask about the antinausea medications.
I’d also try and get some more canned food for him ....even a roast chicken ...the inside not the skin is tempting.
You have done a really good job looking after your boy!

 

I would keep up the half hourly at the moment because he is not eating, and the honey doesn’t last all that long and he could potentially keep dropping for several more hours if you look at how the cycle went yesterday....he did have less insulin today. But if we can keep ahead of any more drops it is much easier than having to deal with the drops and a cat that’s neauseated and not wanting to eat.

No insulin in the morning.I would skip the dose.

 

Thank you guys so much! I don't want to even think what could have happened if I didn't find this page.
So this is how the morning went:
4:55a: 6.6
6am: 9.4
8am: kept trying but he was hiding from me (although before he didn't seem to have the energy to escape me so that seemed kind of good!)
9am: 11.3

Waiting for the vet to get in to follow up on your guys suggestions!

 

Glad he's doing okay.
I hope the vet is able to clarify on ketones (whether they were present at diagnosis and another test now) and also why he is dragging his butt across the floor.

You have some sleep to catch up on! What a night it was for you!

 

Right, I forgot about the butt-dragging, I will add that! I have left a message for him to call me as well as sent him an email including the spread sheet link so I hope I can figure everything out, including keytones

It would have been a much worse night without this thread and everyone helping. I'd much rather lose some sleep and gain peace of mind for Sir Thomas . I know we are not out of the woods yet but have a much better chance turning this around now!

 

How is he doing this morning? Is he showing interest in food?

 

Yes, not his normal food but he took a treat and more sardines! he also had enough energy to go to the top of his cat tree, which he hadn't been doing so I hope that is a good sign.

 

Welcome. Waving from Ontario.
If you end up needing vet recommendations, there are a number of Albertans here.
@Christie & Maverick
@Tracey&Jones (GA)
@AmandaE
@Abdullah

 

Thank you so much!

 

Finally got to talk to the vet, he agreed that no insulin this morning was good. He said we could split the dose in the future for 830a and 830p for just one unit each instead of two units at once just like you guys said . I hope hope hope he starts eating good again, it was kind of rushed as he just squeezed me in. He said that we don't have to test for keytones yet as he has been on the lower side which is more of a concern? That kind of confused me, because if he was on the lower side why did he start with 3 units? Also I forgot to ask about the butt dragging thing, blarg!

His last most recent reading is 11.3

So the plan is, continue to monitor every 2 hours except when trend is upwards and stable and i need to sleep for the next week on 1 unit in the am and 1 unit in the pm. If he is over 9 then give insulin, if he is under 5 then give food and honey. he will review in one week so I can advocate again then. Do you guys think this sounds like a reasonable plan? I just hope he starts eating something other than sardines soon

 

I would go out and buy the bottle of Ketostix from the pharmacy yourself and test the urine for ketones.
It is recommended that FD cats that are not regulated are tested fro ketones anyway. It is so much easier to manage a trace of ketones than find your kitty really sick with large ketones.

Yes, 1 unit twice a day is much better. Since you didn’t give any this morning you can pick the time that suits best. Is 8.30 am and pm the best times for you.

Always test the BG before you give the dose
For now, if he is below 11 (200). Stall, dont feed and test 20 mins later to see if the BG is rising. Post and ask for help change the subject line so we can see you need help. Eg AMPS XXX STALLING HELP. Then we know you need help now.
Once we get more data you can drop that preshot BG to 8.3 (150) for giving the dose and eventually even lower as more data is gathered. We can help you there.
So you test, feed and then give the shot in that order. A lot of us give the shot as they are eating.

Then try and get some tests in during the cycles. +2 and +4 and +6 for example. If the BG is rising after that, you can leave it until the next preshot.
Also do this in the PM cycle. If you need to do go to bed you can get a before bed test....do this every night. . If that is lower than the preshot number, I would set the alarm and test again a couple of hours later. You can leave food out for him at night.

Dont feed for the two hours preshot as we don’t want the BG to be food influenced.
Use the remarks column in the SS to add things like how is is...is he alert or lethargic. What he is eating and how much. Are his bowels normal etc. of you do this we can see hoe he is on any giving day and it is useful information for you looking back.

Did you ask about the antinausea medication?
Bron

 

Hello from west of Edmonton!
You can get ketodiastix instead of ketostix if you want too. I think I paid 8 bucks at rexall for them.
It was useful when Rhubarb's sugars were high to tell which urine was hers. I always had to dip in the litter- she got pretty sneaky with peeing lol.

Did your vet say if he was dehydrated? If he hasn't started eating on his own yet, you may want to think about syringe feeding. If your vet is still open, you can get a few cans of a/d or recovery. If not, pet valu has tiki cat mousse kitten that syringes well.

 

Hey! I'm so sorry I'm seeing this so late, but rest assured you're in good hands with everyone that helped you out over the last little bit.

I'm in South Edmonton, I can help you out with anything you need or if you have any questions! Feel free to reach out and I can help guide you in the right direction, as the other members have

 

Thank you so much, I so appreciate that! We are in South-Central Edmonton so very close. Trying to get him stable and eating is our main concern. He has licks here and there, and I am going to ask again at the veg about an appetite stimulant. I am wondering about feeding schedules though! He was always free-fed so if you have any tips I'd love to hear .

Another Edmontonian . Thank you, I am going to go out and get either the ketodiastix or ketostix right now! They didn't say he was dehydrated, although I know now he is not drinking enough. He HATES the syringe (give him other medicine for allergies that way so he fights it so much), so I'm trying to offer him watered down food and I got about three spoonfuls in his just a minute ago, it's a start. He also so far will only eat smoked canned mackerel, but he did eat a can of that between yesterday and today. I'm going to see if I can find some without the salt. I totally forgot about a/d or recovery. I will look into that too, thank you!

Another question. Luckily, it seems that his sugars stayed above 5 last night, thank god! But before his scheduled insulin dose, he was 5.6 so we skipped it. In these cases, do we just continue to monitor throughout the day and go back to his evening dose?

Many thanks again to everyone on this thread!

 

THANK YOU! Okay, so I am going to test his blood again this am, the vet said to skip his am shot if he was below 9 and it was previously 5.6 so we have skipped so far; Do I then just monitor and resume in the evening or how long do I stall for? or is there a high number where I need to give insulin at any point in the day?

 

With you being new to giving insulin, I am not comfortable advising you to shoot a low number. I am a little rusty, and don't have the protocols handy to paste here. There is also a rule here of sorts, that whoever suggests someone shoot their lowest number be available for advice for the duration- I am too rusty for that. Someone else can give you better advice. It almost seems like he hasn't hit nadir yet. That may mean he is still too high a dose.
You may want to look into an insulin ruler for your syringe type. You may have noticed they aren't all identical. Once I started using that, I found Rhubarb's sugars to be much more predictable.

A housekeeping thing- yesterday morning you put a cdn number on the US page- need to switch that over so it converts properly

 

Unless he hits the reds or blacks today (or someone with more experience says otherwise), I would hold off until your normal shot time, or as close as possible. You want to keep a time that you can commit to every 12 hours, with only half hour drifts if needed. You also want to give a dose that you can give twice a day. If it were Rhubarb, I would give a half unit tonight with a few overnight checks, and if all still looked well, a half unit in the morning. I usually went to the side of caution though.

For stalling, iirc, you withhold food and wait 20 min. If number is going up, then you can be more confident about shooting. The problem with stalling is it shifts your schedule. You can take a peek at my 2018 nov/dec sheet and see what I did, but keep in mind that I had someone on hand for advice most times. Rhubarb also reacted a bit differently.

 

Did your vet do bloodwork? Can you post your lab results in your sheet? You can copy and paste the reference ranges from mine if they are the same as your lab.
It would be good to know what his thyroid and kidney values are at. I may just be paranoid, but with covid and the difficulties of relaying info properly over the phone, it is much easier to have a discussion with values in front of you.
Has he had a dental recently? Dental infection can cause both high sugars and loss of appetite.

 

Thank you I will change that! And really good advice about the ruler, we are using the lantus pen, and the lowest dose is one so I guess I might have to switch to syringe which terrifies me but ya gotta do what ya gotta do! I will talk to my vet about that.

I am concerned though, he wasn't eating yesterday, but I got him to eat today. Now he has only drank about 5 tablespoons all day and hasn't used the litter today, although he tried once and nothing came out so I also haven't been able to check for keytones yet. I am going to call the vet again tomorrow, I hate to take him in because I worry the stress will up his numbers then we will be fighting even more to regulate and I am getting tired staying up all night to check him but I am trying to do whatever is best for him. I just gave him his 1 unit of lantus at 830p and his BG was 13.4 at that time, rechecked at 11pm and he was still 13.4. The vet did do bloodwork but did not share the labs, so I will ask them for them in the future to keep track! How will I know when he is on the right dose? I don't want to keep changing it on him if he is getting used to it but so far day one was 3 units, day two was 2 units and day three is 1 unit so just trying to do right by him

 

You will know he is on the right dose when he is in all normal numbers. Until then you just follow the dosing method.
It takes patience and time. And it can’t be rushed.
He is doing really well for a newly diagnosed cat. I would keep getting a couple of more tests in this cycle to see what he has in mind.

 

Has he used the litter box yet? Is it urine or bm that he is having issues with?
If it is urine, and he still hasn't gone, then you need to get him seen today, even if it means going to Guardian. If it is bm, give your vet a call to see if giving miralax is an option.
Was he strictly dry food before this? Rhubarb started getting constipated with the switch to wet. She also no longer drank water. I could always tell when she got into the dry food (before microchip feeder) by her drinking water haha

 

You will definitely want syringes. You need the ability to give less than a unit. AFAIK, there is nowhere here that carries monoject brand, which I have heard have more accurate markings. I used BD u100, shortest and thinnest needle, with the insulin ruler. Pretty much every pharmacy has them. Consistency is important. Before I had the ruler, I kept a filled syringe to compare volume to.

 

He was on dry food with a quarter can of wet food at night before dx. He had one small pee, and one small loose stool, very stinky (I assume due to the many food changes, since I give him whatever I can get him to eat at the moment). Not nearly enough urinations or BMs though. I just booked for earliest next appointment which is tomorrow at 2pm but asked for a phone call today to see if I need to take him into emerg vet, still waiting for the vet to call. His BG seemed good after insulin (1 unit) until 5 hours after where it went from 9 at 3+ hours to 1.9 and 5+ hours. Syringed honey and now he seems to be doing better again at 7.2. He is acting better other than the litter, improved lethargy from before but still not 100% himself.

I will ask for the insulin in the vile tomorrow with the syringes, thank you for that! I am also going to ask to rule out other illnesses messing with his thirst and hunger and will also ask for that appetite stimulating injection that was suggested earlier. Any of tips welcome Many thanks!

 

Charlene, you need to reduce the dose of insulin to 0.75 units immediately.......ie the next dose.
Please do not give 1 unit again as it is too much insulin for him.
You will need to get the U-100. 3/10 1/2 unit syringes today so you can give the next dose.

If you see a big drop at +2 like you did at +2.5 today you need to check again sooner than +5 as that drop at +2.5 is a big red flag that is telling you to test again in an hour and to give some food to try and stop the fast drop.

 

Okay thank you! I am not sure I can find syringes and insulin before 830pm tonight, which is making me nervous. I called the pharmacy by our house and they said for animals they require a prescription on file to be able to give to me the first time. I am still waiting for the vet to see if they can give it to me, but the lady at receptionist said they have been busy with emergencies today and will get the vet to call so here I set. Any suggestions on how I can get this last minute on a Sunday? Just to confirm, human lantus is the same as the stuff for cats, right?

Thank you!

 

I just had a thought, I could go get the insulin syringes you referenced.....then could I draw it up from the lantus pen?? Is there anything wrong with doing it that way?

 

Yes, you draw the insulin from the insulin pen. Thee is a rubber stopper at one end and you put the needle into that.
Human lantus is what we use for the cats,

 

Can you drive to the vet and ask for the vet to write a prescription for the syringes?
Or can you ask the pharmacy if they will accept a ‘script owing’ from the vet and you can collect some syringes today and give them the script tomorrow.

Surely the vet/ receptionist could ring through to the pharmacy and say they will send the script later but to give you the syringes.........it’s for a diabetic for goodness sake!
Make sure the syringes are the U-100 3/10 syringes.
If you are in the US Walmart has them.

 

Okay thank you! Yes they will give me syringes no problem and i have the lantus pen so i think I am set! They just wanted the script to give me insulin to start the file i guess, it was frustrating trying to communicate the dire nature here. That diagram makes perfect sense, i am at the pharmacy now and will get the syringes you listed! Thank you!

 

I posted images of the BD half unit syringes in your other thread. If the pharmacy does not have half unit syringes, you can use whole unit syringes and eyeball the dose.
The syringes must be 3/10 cc U100 syringes with a gauge around 30.

 

P

The box of the syringes i have say:
6mm
3/10ml
Doses up to 30 units
15/64" x31G

Is this the correct one?

 

Yes!

 

Thank you so much. I bought them, and was ready to give lower dose as you suggested, but then he was only a BG measurement of 8 right before his shot so we held off and our vet finally was able to call back. We went over his numbers and symptoms of not eating and drinking and he said he thinks the insulin was too high for him(as you all said right from the beginning), to stop all insulin, and that perhaps we will just start managing it with food and see what happens from there. He said to bring him in at 2pm tomorrow and he will do an exam to make sure he is okay, see if he needs IV to be hydrated etc, go over the new numbers and he will make a plan then.

Do you guys think, given this super scary first introduction to insulin, it is okay to take him completely off it and try to adjust his food for a bit (whatever is recommended) first?

 

I would be very careful of stopping insulin altogether.
You run the risk of ketones developing when you stop insulin in a diabetic cat especially if the cat is not eating well.
Ketones can form when the cat is unable to use carbs as fuel so they start to use fat and the byproduct of that is ketones.

I don’t think Sir Thomas is ready to stop insulin.
You could have stalled and seen if the BG rose at all. Or you could have given a smaller dose.
I think the vet should have given you some antinausea medication so that Sir Thomas will eat.
Not giving insulin is not the solution. There are several smaller doses under 1 unit..... 0.75, 0.50, 0.25, 0.1, and a drop that you could have gone to if necessary.

If you are not going to give insulin ( and I don’t recommend that course of action at all) you need to go out now and buy a bottle of Ketostix from Walmart or a pharmacy and test his urine at least once a day fo ketones. Ketones can form very quickly and lead on to DKA which is a very serious illness.
The recipe for DKA in diabetic cats is not enough insulin, not enough food and an infection or inflammation..... so you can see you will have 2 of the three ingredients necessary for ketones to form and go on to DKA. I don’t want to scare you but I don’t think your vet has much idea at all about treating diabetic cats to be honest.

please don’t just leave him until tomorrow at 2 pm without insulin and not eating much and think he will be fine.

 

Okay this is good to know!
We have the syringes now to give him any smaller doses and I have the keytone strips too so I will keep working on trying to get those. He has actually started eating again as of this morning, thank god. So hopefully he will start going pee more frequently so I can catch it and get those keytones. I am hesitant to give him insulin now as his blood sugars have only gone up to 11 overnight, what dose do you think I should reduce to? Still .75 or would it be too big a drop to reduce to .5? Regardless I will keep doing the keytones now that I should see him peeing more frequently. I couldn't find any non absorbent litter in stores so I had to order and it doesn't come until wednesday, but I will try to catch him when he goes and get it that way before.
I will also ask for the anti nausea injection when we go in too. I am having no luck with pills at the moment (I pill all my cats and he is the only one I have difficulty with, no pill pockets, kitty burrito, etc has worked well for this fighter) so I think injection will be good, but honestly, I could bring him to the vet daily to get that injection if I needed because we live close.

 

For giving pills, have you tried just holding him loosely on counter in your armpit, coating pill with butter, then sticking your finger with pill right into back of mouth? It's the only way I can pill my one cat. Cheese works for Rhubarb.

You don't need non absorbent litter if it is still wet when you go to use the stick. Rhubarb got very sneaky when she knew what I was up to, so I always checked the litter. Just make sure to do a "control" test with the litter and plain water so you know there's no false positives.

 

For dosing advice, you might want to post in the Lantus forum for some more eyes, and link this thread.

 

Looking at the SS I think he should be fine with 0.75 units which is the reduced dose he went down to yesterday, especially if he is eating better.
Don’t be talked into no insulin by the vet. sir Thomas definitely needs some.
please keep posting with updates. I am very concerned for him going without any insulin.

If you are unsure what to do re dose post and ask for help.

 

Okay thank you so much, He did not get insulin last night because he was at 8, and then he was at 11 AMPS and the vet advised against so I got convinced by him. I will go back to what you say and start looking for a new vet who understands. So he has had no insulin last night or this morning. Should I start tonight again at .75 then?

 

I will tag @Bron and Sheba (GA)
for you about the dose, she should be on later on tonight

 

Let’s see what he is at PMPS but looking at the SS he has had 3 skips in the last three days and 1 unit on the other cycles and he had a drop to 1.9 (34) , so I think the best dose to go to might be 0.5 unit each cycle and see if that keeps him in good numbers.
Can you tell me how many hours until PMPS please?
Have you managed to check the urine for ketones?

 

ok! Negative for keytones so far as per my hometest; going to get the PMPS now

 

Also just a note, he went to the vet at 2pm today, so maybe that could have spiked his numbers then but i am not sure how long that stress spike lasts?

 

Can you tell us what the PMPS BG was please and did you shoot the 0.5 unit?
That’s good no ketones, can you record that in the remarks column of the SS please?

 

Just did his BG it 18.2. He went to the vet at 2pm if that effects numbers? Have not shot the 0.5 unit, waiting on your go ahead!

Edit: He seems to be eating better today. Unfortunately, I had to send my husband to take him to the vet as I had a medical appointment. he said he was not dehydrated which is great. He did not get the appetite stimulant shot (husband forgot to advocate because he said it was quite a rushed appointment. Vet said, sometimes insulin "Kick starts" and goes into remission and he thinks that happened with the insulin and to stop.

 

Yes give the 0.5 units. The dose is based on the nadir or lowest point, not the preshot number

 

I’m glad he’s eating better today.
It was an antinausea medication you needed not an appetite stimulant. If you want to give an an appetite stimulant, you need to get rid of the nausea first.
I am glad he’s not dehydrated.
I disagree with your vet. Sir Thomas has not gone into remission and he still needs insulin.
Let’s see how he goes with the 0.5 u dose. You need to hold that dose for at least 3 days..(6 cycles) unless he drops low again.
You need to look at the two dosing methods and see which one you want to follow. Once you decide please put it into your signature and the SS at the top.
https://felinediabetes.com/FDMB/thr...-low-go-slow-slgs-tight-regulation-tr.210110/

Tomorrow I will get you to start posting on the Lantus page where there are lots of people who use Lantus who can help you.
Here is the link. You post a new thread each day and in the subject line you put the date, name of cat and BG.......3/23 Sir Thomas AMPS XXX
https://felinediabetes.com/FDMB/forums/lantus-basaglar-glargine-and-levemir-detemir.9/

 

He is hiding from me; pretty sure he associates this with almost dying because he did :'(
I will work on getting him out to give it, but a quick question as I have only given the pen. Do I have to "suck back" in this needle to make sure I haven't hit a vein?