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Dr. Drew
Dr. Drew, Veterinarian
Category: Cat
Satisfied Customers: 16412
Experience:  Small Animal Medicine and Surgery
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Hi we have a 12-year-old female cat who was diagnosed with

Customer Question

Hi we have a 12-year-old female cat who was diagnosed with diabetes a year ago. The vet prescribed lantus insulin (after trying another one to which she would not respond) and she responded better, but her glycemia is still high (around 20) and she is very, very hungry all the time. Is the another solution or kind of insulin we should try?
Thanks!
Submitted: 10 months ago.
Category: Cat
Expert:  Dr. Drew replied 10 months ago.

Dr. Drew :

Hello, thanks for your question today! I am Dr. Drew, and I am a licensed veterinarian. I'll be happy to help you in any way I can.

Dr. Drew :

Please stand by, while I move your question to the Cat section.

Dr. Drew :

Lantus insulin is often regarded as the best option currently available for managing diabetes in cats.

Dr. Drew :

Now, every cat is different, and some will respond better than others.

Dr. Drew :

I don't know how much of a dose you're giving, but you mentioned daily dosing, if that's just once a day, it may need to be increased to twice a day. Very few cats can be managed on once-daily insulin.

Dr. Drew :

Another thing to look at is diet --

Dr. Drew :

cats in general, but especially cats with diabetes, need a low-carbohydrate canned diet, for optimum nutrition.

Dr. Drew :

dry foods, or canned foods with too much carbohydrate, will lead to difficulty in regulating diabetes.

Customer :

Hi Dr. Drew,

Dr. Drew :

Insulin resistance is also an issue - if there are any infections in the body, this will reduce the effectiveness of insulin.

Customer :

We give her 3 units, twice a day

Dr. Drew :

examples include dental disease, bladder infections, skin infections

Dr. Drew :

3 units twice a day, OK, that's reasonable, but could be increased if needed.

Customer :

She has been checked quite often by the veterinarian, so we do not suspect any infection, however the vet told us to be running out of solutions, and that we should consult a specialist.

Customer :

But the specialist in our locality has quite a bad reputation with cats, so we turned to justanswer

Dr. Drew :

well, if your veterinarian isn't comfortable going further in the diagnostic process, then a specialist may be the best option.

Dr. Drew :

not suspecting infection doesn't rule out infection.

Dr. Drew :

If a urine culture has not been done, then it's not been ruled out.

Dr. Drew :

urine cultures should be part of the management of any diabetic patient, as they are very prone to urinary infection, even with no symptoms.

Dr. Drew :

Also, many cats have periodontal disease, even though many veterinarians don't make a big deal about it.

Customer :

Yes a urine culture has been done and it was ok

Dr. Drew :

these are issues we need to address in trying to regulate a difficult diabetic.

Dr. Drew :

3 units is not a very high dose - so I don't see any reason why you couldn't discuss a dose increase with your current veterinarian.

Dr. Drew :

Most newly diagnosed cats are started at 1-2 units twice a day -- so 3 units is hardly a big increase over the starting dose.

Customer :

It is 3 units twice a day

Customer :

maybe I was not clear

Dr. Drew :

yes, I understand that.

Customer :

Ok we were told by the specialist that it was a maximum

Dr. Drew :

so you have spoken to a specialist already?

Dr. Drew :

I've never heard of 3 units being a maximum dose of Lantus, by the way.

Customer :

we just called to ask if the dose was a maximum since our vet was not sure and suggested we ask at that office

Dr. Drew :

I've managed lots of cats with diabetes, mostly using Lantus,

Dr. Drew :

and I've never heard, nor read, anything about 3 units being a maximum dose. I believe you have received bad information.

Customer :

ok then we will get back to our veterinarian and give her your advice, and maybe she can check further for info on dosage. Sophie is 9 pounds, so it seems to be normal to increase the dosage from what you tell us?

Dr. Drew :

I'd typically increase by one-half unit, twice a day, and allow things to stabilize for 7-10 days before rechecking.

Dr. Drew :

A 9 pound cat is an average sized cat - everything we have discussed remains true.

Customer :

Thanks a lot Dr. Drew, we will give your advice to our vet.

Dr. Drew :

you are very welcome. I hope Sophie's levels improve :)

Customer :

Hi again I just check with our injection stylus (sorry about the english, we are usually french-speaking) and it seems we can not adjust for a half unit; it is a 100-units and only allow to adjust by the whole unit, doy you know of another injection instrument for Lantus?

Dr. Drew :

U-100 insulin syringes are only marked in whole 1-unit increments; there are not, to my knowledge, any syringes marked in half-units, so you need to draw to the level halfway between 3 and 4 units.

Customer :

I am not sure it is possible with our syringe, I will check with the pharmacist, because the one we have "clicks" and does not seem to allow to stop between to marks... Thanks again

Dr. Drew :

OK, if you have an injection device like that,

Dr. Drew :

then you'd have to go up to 4 units.

Dr. Drew :

Either way, the dose increase seems necessary and reasonable.

Dr. Drew :

good luck with everything :)

Customer :

Thanks a lot! Again!

Dr. Drew :

you're very welcome :)

Dr. Drew, Veterinarian
Category: Cat
Satisfied Customers: 16412
Experience: Small Animal Medicine and Surgery
Dr. Drew and 3 other Cat Specialists are ready to help you
Expert:  Dr. Drew replied 10 months ago.
Hi Lucie,

I'm just following up on our conversation about Sophie. How is everything going?

Dr. Drew
Customer: replied 10 months ago.

Hi Dr Drew thanks for the follow-up. We changed Sophie's dosage to 4 units on wednesday night, and she seems to be a bit more calm, but no drastic change. One thing though: everybody noticed as soon as thursday that her hair, which has not been very good-looking since she was diasgnosed with diabetes, seems a lot softer. Lets hope everything goes the same way... Thanks again

Expert:  Dr. Drew replied 10 months ago.
Thank you for the follow-up -- I hope everything gets better from now on :)

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