New Member - First time fostering a diabetic cat

Hi,

New here, first post.

My two questions:
1. Are we accidentally dosing too high?
2. Should we be doing something prior to a vet visit on Friday?

See below for more information.

We are currently fostering Pookie, a 10 year old cat that was abandoned by owners because he wasn't using the litter properly. The shelter determined that he was diabetic (glucose levels around 20 mmol/L) and prescribed 1 unit 2x daily of Lantus SoloStar Glargine which comes in a 300 dose injectable pen. He was at the shelter for about three weeks. We took over as a foster with another organization about a week ago and were given U40 syringes (something I only realized today) and told to pull up to the 10 line for each dose. He's been on insulin maybe just over a month.

Within a couple of days he went into hypoglycemic seizures (very scary). There is no money in our organization for significant vet bills so we coped as best as we could with only a phone consult but we are now paranoid about giving too much. We gave him maple syrup and he came around and promptly started asking for treats. The next day we arranged for an AlphaTrak2 unit and when we tested his blood it was at 1.4 mm/L. Within 24 hrs his glucose level was back up to 20 mm/L. We drew insulin up to the 5 line on the syringe rather than the 10 line and gave him that.

We are learning how to draw blood (poor guy is very tolerant) and have been testing once or twice daily. Generally in the mornings he is around 7-8 mm/L and by the evening he is back up to 20. We have been injecting in the evenings only and giving him up to the 5 line. He has been in the 4s a few times in the mornings and in the 7s a few times at night. We tend to skip the dosage when he's low like that.

I can't find anything on using a U40 syringe to draw from the Lantus pen, so today I'm freaking out a bit and wondering if we've been giving him 5 or 10 units instead.

A potential owner is taking him to the vet on Friday to be assessed for the type and severity of diabetes. She's not afraid of a diabetic cat. Should we be doing anything different prior to the visit?

He's fairly asymptomatic - he does drink and pee a bit more, but not hugely so compared to our other cat. He's happy and affectionate. Overall I'd rather let him be high for a few more days or weeks until he gets adopted out. And he hasn't shown any litter box problems with us, so I wonder if he was just so sick before being given up.

The only wet food that he likes is Friskies pate, and I was relieved to see that it's actually not bad for him. We feed him in the morning and then a couple of times a day and then a big feed at night. He has dry food available to him overnight.

Thanks for anything you can offer. We're very new to this.

 

YES, they told you to give waaaaaay too much insulin, poor Pookie!!!!!!

Longer answer in a moment, but please DO NOT GIVE ANY MORE INSULIN until we can sort out this dosing issue.

 

Please please get U100 syringes ASAP. It is never recommended to use U40 syringes to draw up U100 insulin...since U100 insulin is more concentrated, and the syringe lines have a margin or error, it's dangerous.

The 10 line on a U40 syringe is actually 25U of a U100 insulin. If I understand correctly, you're now doing the 5 line on the U40, which is still 12.5U of Lantus. The reason he's so low in the morning is the giant dose at night is bringing him very low, too low. The his body panics and launches him up higher.

@tiffmaxee what to even do here? If my math is right he was mistakenly getting 25U Lantus once a day, at night. Now it's about 12.5U.

Edit: removed part of what I said due to Nans reply. Like she said, please do not give any more insulin until some others pop in here to help sort this out.

 

In the meantime, if you can get a spreadsheet set up with whatever info you have that would be very helpful. How to do that can be found here. Even if you don't have BG data it helps to know the dose(s) administered on each day, when the hypos were, etc

 

OK, longer answer. First, the U-40 syringes, as you know, are the wrong ones for Lantus, and they are resulting in you giving too much insulin. The conversion is 2.5x the dose you are drawing to on a U-40 syringe.

I do not use U-40 syringes, but if they are like U-100s, then the numbers on the barrel are the number of units, directly. In that case, drawing to the 10 mark would be 25U of Lantus, and to the 5 mark would be 12.5U. 1U of a U-100 insulin is a tiny amount, like a very large drop. Pookie is very very lucky indeed to have survived these doses.

Because you are using Lantus, it's not just the dose you shoot that affects BG, the previous doses will have an effect for days through what's called the "depot" (a portion of each shot "saved for later" and released over time). If he was getting (ulp!) 25/12.5U, even for just a few days, that's going to create a whopping depot with significant carryover.

Even if you get the correct syringes for him now, I wouldn't give insulin for a little while, until the depot has had a chance to reduce a bit. It is important when skipping shots to check for ketones. This can be done with little urine dipsticks they use for humans (at any human pharmacy), or you can ask the fostering agency if they have a blood ketone meter you can borrow.

Phew!!!!! Pookie is a lucky cat!

 

@Nan & Amber (GA) yes the lines on the U40 are exact number of units. So 10 on a U40 syringe is 10U of a U40 insulin.

Luckiest cat on earth indeed!

 

Drawing a U100 insulin to the 10 unit mark on a U40 syringe results in drawing up 25 units of the U100 insulin. Even 10 units of any insulin is a very high dose for a cat unless there is a desease like acromegaly.

 

Hi Larry - I had actually edited this literally right after posting to be the correct values (preoccupied, divided instead of multiplied), I'm not sure why it's showing the older info for you?

 

Thank goodness you took it upon yourself to reduce the dose and to only do it once per day! It has helped to keep him going, I'm sure.

Anything below around 3.7 on an AT2 is in hypo territory-- 1.4 is absolutely terrifying. I'm so glad you started testing and posted here! to whoever did that demo for you on the initial dosing and gave you those syringes, but it's sadly a story we've heard before (people are rushed, people make mistakes, and insulin can be very powerful in a tiny cat's body).

At least this story should have a happy ending-- fingers crossed for the potential adoption! Pookie sounds like a great cat.

 

Oh my goodness! Thanks so much for the replies, despite how scary they are.

He's seeing a vet on Friday. I have access to U100 syringes and can go pick them up. It looks like it was a mistake with the syringes more than anything.

I'm not sure I have Google Drive so I've created my own spreadsheet and posted an image here. If it's really useful I can go in and make an account on Google Drive and upload it there.

Happy to take advice on how to proceed. He's going to the potential new owner's vet on Friday. I hope she doesn't think we're completely incompetent.

Thanks again.

 

Thanks for the numbers, you're keeping really good track of things . Some general observations follow, but first: did you really shoot 2.5U this morning after getting the 7.7? Did you get any other tests after that? Please test asap to see where he is-- 2.5 on the U-40 is still over six units of the U-100 insulin, and is still a very large dose.

OK, general observations now:

1) you can really see the effects of the insulin dose, with him going low by the next shot time many days (thank goodness you didn't shoot on those times!).

2) The rebound up to the 20's is pretty typical after hitting lows. It's a reaction by the body when detecting "hypo" numbers. It's helped to save him on a few occasions, no doubt.

3) the fact that he just had a dental is very interesting. We've seen insulin needs drop dramatically after dentals; the stress of bad teeth can really raise BG, so once they're gone, BG drops.

I really wouldn't advise shooting more insulin in the next couple cycles, even with the proper syringes (and dose).

 

Re: how to handle the potential new owner and vet - I would just be very clear about what happened, and any advice/path forward given here on FDMB. I'd give her that exact same spreadsheet you posted above, every little bit of info helps.

Many vets are not well versed on diabetes (as you found out the hard way!). So the new owner's might not be either. I'd make sure the new owner knows this website exists...it has quite literally been a lifesaver for so so many cats.

I would make sure she knows NOT to change the food any time soon...that dry food he has available might just be keeping him alive. The insulin depot needs to deplete and need to find what his baseline is before changing food.

I would really really stress the importance of home testing blood glucose, testing for ketones, and having a hypo toolkit (all linked in earlier posts on the thread). The AlphaTrak is not necessary, many of us here use human meters with much success (and they cost a lot less, strips included).

From my perspective, none of this would deter from adopting a cat that I thought was a good fit for my family. I would be mad to find out I only got partial information, or wasn't prepared properly.

 

Hi Everyone,

Thanks so much for your help on this. There's some good news in some of this. It turns out that some of the syringes were the proper U100 syringes, so maybe 30%-40% of the doses were using the right syringes. I don't know which doses were and weren't though but I think it was mostly the early doses that used the smaller syringes.

I'm berating myself a bit for not noticing the differences in the syringes, but we've had some significant family drama that has kept me otherwise mentally distracted. I still feel terrible for this. I've been having a hard time letting the family drama go, but maybe this is the wakeup call I needed.

Fortunately Pookie is resilient, which should be a good selling point with the new owner. We are making sure to shower him with all the love he wants (and sometimes doesn't).

We will definitely share the spreadsheet with the vet and with the owner. This is our 15th foster and we're very open about what the owners can expect. If nothing else she can learn from my mistakes and hopefully not repeat them.

His glucose was 23.4 mmol/L this morning after eating 1/4 can of food. We weren't able to draw blood last night (poor guy is so tolerant) so I don't know what that looked like.

Based on the advice here we won't be dosing him but will test blood levels again tonight and the next few days. I'll make sure to keep you up to date and continue to ask for advice.

You guys are a godsend! Thanks for providing me the information in such a gentle manner.

ETA - how should we be feeding him over the next while? His appetite is very healthy and he'll take all the dry treats we offer as well as all the canned food.

 

Oh, that's much better if it's the U-100 syringes! Still a pretty big overdose, but much better if it's not 2.5x that!!!!

Don't beat yourself up for this, you were steered wrong from the start. As I said above, this is something we've seen repeatedly-- bad advice/demo from a vet or tech happens way more than you'd think, they just don't tend to get a lot of training in feline diabetes. And the (real) beginning cat doses do seem like they're so tiny, it just can't be right! So even without having to deal with distracting drama, the deck was stacked against you. And it's all worked out, right?

As for food going forward... if you aren't dosing (and will be doing the true 1.0U dose when it starts up again), it may not be a bad time to see how it goes to start removing his nighttime dry food and just having him eat the Friskies pate. The dry food was probably one of the things that saved him when he was getting too much insulin, but in the long run he'll be better off on all low-carb wet.

If you still want him to have access to food at night but don't want a plate of wet food sitting there (or if he's a cat that will eat anything you leave out instantly anyway), you can try freezing a couple of "catsicles", just small portions of the Friskies. They'll thaw slowly and be ready as a middle-of-the night snack for him.

In terms of amount, unregulated diabetics are often extra-hungry because their cells aren't able to utilize the glucose from the food they eat. So it's usually OK to feed a little extra at this point. Most people find that diabetics do better with multiple small meals rather than one or two large ones.

 

@Nan & Amber (GA) did you notice the time when the insulin was given?

 

Sorry, just realized I gave contradictory advice to Melissa . Her suggestion, to not change the food, is the more conservative way to go, and in thinking about it some more, I think she's right and I jumped the gun a bit. I got a little overexcited about the news that the syringes were U-100, but it doesn't change the fact that he's still got a large Lantus depot in play for the next day or two.

So, revising, I'll strike the suggestion to start removing the nighttime dry. Let's see where his numbers go without the insulin.

And I'll reiterate the strong recommendation to test for ketones when not giving insulin. That's something you really don't want any part of, trust me!

I think the last insulin was yesterday morning?

 

Not the last insulin, but in general. Look AM and PM. Not the same time.

 

Oh, you're right, I missed that! Especially on Feb 13, 9am and 6pm!

@Fog123 , another thing it seems they didn't tell you about lantus is that it works best when dosed on the 12hr schedule (whenever you get back to dosing). Dosing at 9am and then 9hrs later at 6pm means you could have gotten some extra overlap in insulin action (on top of the usual depot activity).

So, when you do get back to dosing, it's important to try to keep to the 12hr schedule (and that's also important to convey to any potential adopters).

 

I'm so grateful for all the support here!

Last dose of insulin was given yesterday morning, 9:00 am.

I'm willing to test for ketones. How do I do that? We have two cats, but his litter clumps are bigger.

He's also had the runs the last few days. He unfortunately steps in it on his way out of the litter which is a little annoying. I have no idea whether that's related to anything.

It's interesting, when I was googling about when to dose insulin prior to coming here all I saw was dose at the higher glucose levels. There was nothing about depot activity and the response. Is there a good link to where I can read more about it?

We'll test his level again this evening.

Thanks, thanks, thanks again!

 

Absolutely!

From the sticky info posts at the top of the Lantus support group's board:

What is the insulin depot?

The other info posts are really helpful too, in particular:

Dosing Methods for Lantus

Cheapest option is urine ketone monitoring, where you use a urine ketone test strip (same ones as humans us, available at Walmart or any pharmacy) but it requires catching a fairly fresh sample - and from the right cat.

Tips for collecting urine samples

There are also blood beta ketone (BBK) meters available that work in the same way as glucometers. The strips are a bit pricey but you don't need many of them and it makes ketone monitoring more straightforward (and probably more effective). Here's a link to a reply I just posted on another thread comparing the two methods:

Urine vs blood ketones and the merits of BBK meters


Mogs
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@Critter Mom, thanks for the resources!

I think we'll go for the six cycles as suggested by the depot information. That puts us to Thursday morning. His vet Appt is Friday morning. Is it even worth doing at that point?

I won't test blood tonight. We are terrible at it, he doesn't like to bleed, and I'm not sure it would make any sense in terms of us helping him.

We've been giving him small meals throughout the day.

I'll get the strips from the pharmacy tomorrow and then follow him around I guess.

You folks are wonderful! Thanks so much.

 

The syringes do change it a little bit, I was just scared of a potential 10-25U depot hanging around But I do think safer route is keep the dry for at least a few cycles til depot comes down...but I'm known to be more conservative lol

 

I personally wouldn't (but keep checking ketones!). I would just wait to see what the vet has to say, especially if you're having trouble testing BG...my guess is after the vet visit the best way forward is:

• Cut the dry and continue no insulin. Monitor BG and ketones to see how he does on low carb for a week or so
• If he was having trouble before to cause owner surrender, I'd guess he's going to need some level of insulin. Starting dose for Lantus is usually 0.5U 2x per day if low carb, and can go up to 0.25U per kg 2x per day (actual weight if underweight, otherwise ideal weight).

 

Hi - this morning he was at 19.2 mmol/L fasted, yesterday morning was 23.4 after a 1/4 can of Friskies. We have not given insulin since Feb 15 so it's been 4 cycles.

He's had a lot of diarrhea the last few days which he steps in and then tracks through the house (gross, but we forgive him). Currently being fed Friskies pates several times a day.

I have not been able to catch him peeing.

Poor guy still wants head butts and belly rubs even though we're drawing blood, washing his legs, and not sure what we're supposed to do to feed him.

Any thoughts?

Thanks again!

 

We tried several times to get blood from Pookie today and he just wasn’t having it. His hunger and urine output are doubled since we stopped insulin. Last night was the completion of his sixth cycle without insulin.

I haven’t been able to catch any per for ketones.

His vet appointment is tomorrow.

Any advice?

This is really hard. I want to do right by him.

 

Tagging @Nan & Amber (GA) because I'm not comfortable telling you to give any insulin, but she knows better than I do with Lantus. Based on symptoms it sounds like his BG is high again, but I'd rather it be high than risk going too low without being able to test him.

For now just let him eat as much low carb food as he wants, maybe even consider adding more water to it. It's important to ward off DKA especially not being able to test ketones.

What you're experiencing is normal though! We all had a rough go at starting home testing, ketone testing, etc. Have you seen the home testing tips and urine sample tips posts? I ended up buying a blood ketone meter because the urine strips were just too difficult with my cat (shy litterbox user, would take hours for him to finally go).

 

Do you have any high carb food in the house?

Have you tried covering the litter in the box with plastic food wrap?

Tips for collecting urine samples

Cats often visit the litter box just before or after eating/drinking so those might be good times to keep a closer eye on it.

It would help members replying to your posts to help you better on the insulin side of things if you could either provide an updated copy of your dosage/BG readings spreadsheet record or (ideally) if you could put the dosage and BG readings you've recorded to date into an FDMB standard shareable spreadsheet. Without that info in a format where it can be assimilated properly we're in the dark.

How to create a spreadsheet for your cat

How to use your cat's spreadsheet


Mogs
.

 

Hi--

Seconding all the Melissa and Mogs have said. I do worry a bit about the increased symptoms since stopping the insulin, and strongly suspect it's time to get him re-started on a lower dose.

If you are able to get a pre-shot test, and he's over 11 then, I think you could try the (real) 1.0U dose. Just make sure, as Mogs says, that you have high-carb food and honey ready in case he goes low again.

As for testing, is it just that no blood is coming from the pokes, or has he decided he is not a fan of the poking at all? If it's the first, try warming the ears (or warming them even more), or using a larger-sized lancet to do the pokes (usually it's best to start with 26 or 28 gauge-- the smaller number = larger lancet size).

If he's just unhappy with the poking, there are some things you can do to make it less unpleasant for him (and you!). Treats are key, but also lots of praise and love. Another thing that can help, believe it or not, is to sing during the process. Cats pick up on our moods so easily, and if you're stressed and worried about not getting a test, that'll make him worried too. Singing calms you, and calms him, even if (maybe especially if) you can't actually sing and feel silly doing it!

Keep us posted on the Pookster! Any word on the potential adoption?

 

At one time, I drug the kitty litter box to the center of the living room , where I hang out, just so I could watch when my kitty pees. Little plastic cup on the coffee table and ready to snag a sample. I used to wait quietly until the flow started and then get up with my little plastic cup and put it under his tail. You only need a little bit.

 

Woot! Finally got a blood sample!!!

It was a combination of him not bleeding, him getting tired of us poking him, and just the general stress of the last few weeks.

Watched a ton of videos. Read the advice, and took some deep breaths. First jab wasn't effective, but second one he flinched as I was jabbing him which actually caused a bigger site and more blood.

Glucose level was 14.2 mmol/L, which I know isn't great, but nor is it super sky high, particularly after 6 cycles without insulin. We've been giving several small meals a day so he was probably two hours without eating and had just started eating when I took his blood.

He's going to the potential adopter's vet tomorrow at 9:50. There are two other people after this adopter that are interested in him if she decides not to take him. So it looks good!

At this point I'm just going to let him be. Hopefully these are his last few hours with us and he finds his forever home tomorrow. He's playing at my feet as I type this.

I'll be back tomorrow with an update. Thanks so much everyone. It's been such a weepy day today with all sorts of other stuff going on. I'm going to consider this a win.

 

Here's a photo of him

 

Awwww! I wanna rub that belly!!!

(((Pookie)))


Mogs
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@Critter Mom - he loves belly rubs more than anything! I'll rub his belly for you.

 

Oh my goodness, that is the best! A floofy belly like that and a cat who likes belly rubs!!!! He's absolutely gorgeous, what an unusual color combo, like a gray and orange tabby mixed up together!

 

Thank you! I'm all for kitty belly rubs by proxy.




Mogs
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Hi everyone,

The vet recommended against the potential owner adopting the cat since she is 80 years old. We do have a young paramedic who is trying to decide between Pookie and a three legged cat so that's good. I've been sending her lots of cute photos of Pookie .

It was only a cursory exam, Pookie seems to be in good shape. The vet was very nice about our trials.

He recommended looking up Jacquie Rand. He's used her techniques to convert a few cats in his practice to not requiring insulin. We will look into this.

We're off to buy more lancets and proper syringes.

Poor Pookie had diarrhea in the car on the way home from the vet and was subjected to a bath when we got home. He's been through a lot the last couple of weeks.

 

Huge props to your vet. Jacquie Rand is a co-author of the study that underpins the Tight Regulation protocol used at FDMB (attached below).

I feel quite sad about the lady who didn't get to adopt Pookie. Fingers and paws crossed that she'll find another furbaby to love soon, and also that Pookie will find his forever person soon. In the meantime I'm glad he has you to care for him. Lucky boy.




Mogs
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The indignity!

Also sad for the potential owner, though I do understand the vet's point. Managing FD can be a lot sometimes.

 

Woohoo! We bought different lancets and were able to get blood right away. 28 gauge from Walmart. We tried singing and relaxing and it was helpful, but I think the change in gauge was the biggest change in our success. Our other ones were 33 gauge.

We've also got U100 syringes and are starting back on a real 1 unit dose 12 hours apart. We're going to start with 1 unit and see what happens.

1 unit looks like a small drop, correct?

Question for everyone, is there a link for how to handle diabetes economically? The potential adopter is trying to figure out what she needs and approximate costs. We're in Canada so not sure if that makes a difference. And I know that we can't predict emergency costs. She's willing to do the bloodwork.

Even if she doesn't take him, I should probably know the answer for someone else who might be interested.

Thanks so very much for your help! It's been a pretty steep learning curve and you folks have provided nothing but patience and good advice.

 

I'd suggest starting a new thread specifically asking Canadian members for tips on managing cost of supplies, food, etc. Your question should get better attention that way.


Mogs
.

 

I was just getting ready to ask for a picture! He's adorable!!!❤️❤️❤️❤️❤️❤️

 

I am in Canada, Nova Scotia. I have 6 cats. One is doabetic, one has EPI, 6 are normal health. Finances are a definite concern for me, I'm on disability for a stroke.
Recently I went on ebay to pick up a Contour Next EZ bg monitor - I got 100 strips PLUS a monitor for $52 CAD. I was using Aviva Accucheck which are about 90 cents a strip 2x a day from Shoppers Drug Mart. So the Contour is more economical IF YOU DHOP AROUND on ebay - watch for thosr that ship for around $15CAD, and slso ensure that the expiration date gives you time to usr them. Many are for 2022, so that's great, but even 2021 works.
The one I got on ebay is in US units, but easily convertable dividing the number by 18, and worth it for the savings.
I will also be starting to make my own cat food at home following Dr. Lisa's recipe, and the delivery of my new #12 weston grinder later this week. **Not for everyone ** , however with 6 cats, I feel guilty feeding two of them better food than others, but I can't afford tiny FF cans at 3-4 a day times 6 furkids.. I want them all to eat the same - good quality.