Also newly diagnosed

Hi, I'm new to this disease and am about to have a nervous breakdown at this rate. My cat is having a hard time stabilizing. Dirty Butt didn't look good and ended up with a low test today of 77 and I rushed her to the vet just before closing. Just in that time the vet tested her and she had dropped to 39. They gave her something and I waited there for another hour until they tested again at 285 and sent her home. She looks OK now. Of course no insulin tonight. They want her in for a curve tomorrow.

A little history. She was diagnosed with the beginning of kidney failure about six months ago, but with low numbers. She was diagnosed last Thursday with diabetes and had a curve done all day Friday. The vet put her on 2 units AM and PM. I brought her in Thursday because she was refusing to eat, which is a repeat of an infection she had a few months ago. At that time (a few months ago), her glucose was slightly above normal, nothing to worry about, no diabetes that we knew about. Clavamox took care of the infection, although we never knew what was infected. Now she is fighting an infection that seems identical. initial blood tests showed glucose at 468. I have been giving insulin on schedule until she wasn't feeling right on Sunday night. I had no home test kit, so I took her to emergency. They tested her at 344 and gave her fluids and anti nausea drug. I continued the insulin Monday and Tuesday and got a home test kit. She has been feeling much better and eating better. Tuesday night I tested her at 193 before giving her insulin. I was concerned because it was so much lower than before. It was 9:00 PM so I called the emergency vet and they said skip the insulin and call my regular vet in the morning. I tested her at 353 this morning and called my vet, she said give her 1.5 units. So I did. I came home from the grocery store and found her hiding and not looking good. I tested her at 77, then rushed to the vet. The vet is concerned because this isn't making sense.

Has anyone else had this type of fluctuation in numbers?

FYI - She was already on Fancy Feast and Friskies canned food. I switched all my cats a few years ago as I've been dealing with kidney failure in several cats for several years. They don't like the gravy or sliced versions, so I've always gotten the pate. I was kind of heavy handed with the Temptation Treats and letting her eat some of Dusty's Hill's J/D canned food, both of which have high carbohydrate content (cut her off from both last week), but it doesn't seem like cutting that out of her diet would be enough to cause much lower numbers.

 

Hi Debbie - can you tell us a little more about your kitty? Is she on antibiotics currently and what insulin are you using? Diet changes and treatment of infections can drop the blood glucose numbers. Are you able to get any mid cycle numbers to see how she responds to the insulin - it may be that the dose is a little high for her. If you can add a signature it will help people stop asking the same questions. We will help you work this out and get you back on track, numbers often read higher at the vets so good you have started home testing. There are users on the forum experienced with cats with renal disease and diabetes so any questions ask away.

 

Temptations are really high in carbs. I gave my cat a few when she was too low... Maybe 5-6 pieces and her numbers rose from 59 to 354. Makes me cringe when I think about the handfuls I've given her over the years. I'm positive it's what set of her diabetes.

Folks here will help you set up your spreadsheet and give good advice.

Make sure the wet food is the classic variety NO GRAVY.

 

(((Debbie))) Lots of hugs to you.

Here is the link to your post on the welcome forum so others can go back and read the additional info you provided.

It's actually quite common for numbers to fluctuate widely, especially when a kitty is first starting out on insulin and unregulated. Just to give you an example: Not long after we started using Lantus, Jersey's numbers went from 355 at AMPS (morning shot time) down to 77 and up to 553 in less than 12 hours.

I know you had some initial questions about testing. How are you doing with it now? Do you still need some tips and suggestions?

Are you using a human meter or an AlphaTrak? That's an important question because it tells us how to interpret the numbers. Most of us here use inexpensive human meters (e.g., Relion Micro or Confirm from Walmart). If you are using a human meter, you don't want your kitty's numbers to drop below 50. If you are using the AlphaTrak, you don't want your kitty's numbers to drop below 68.

What do we need to help you with first? I know you're dealing with a ton of issues right now, so tell us what we need to focus on right now. We'll just take it one step at a time.



Shelly

 

I am getting ready to take her to the vet this morning so they can do another curve on her. I wanted to do the curve at home, because she is so scared there, but frankly, I'm scared of the drastic drop in her numbers that happened yesterday. It takes too long to drive to the vet and my testing skills are not very good yet.

The good news is that she is feeling good as far as the infection is concerned. She is acting normal again, she is eating good, and .... sadly sitting up and pawing the air begging for Temptations. I was giving her waaay too much and wish I could explain to her why she can't have them any more.

 

Have a little honey and high carb treats/food on hand if her numbers get too low.

 

Boy you really have had a time of it but I guarantee this does get easier and with the help from this board, you'll have Dirty Butt (love the name!) and you feeling better very soon.

Unfortunately, BG tests done at the vet's office are often elevated because of the stress of a strange environment and that can lead the vet to prescribe more insulin than is needed. While you are learning to get tests consistently, it's sometimes necessary to do a curve at the vet but I would encourage you to post here for opinions about the recommended dose before dosing her again. The other problem with diabetes is that BG is constantly fluctuating. Sometimes kitty has a bad day with higher numbers and if that's when a curve is done, even at home, they don't always reflect kitty's "normal".

Most folks here test before each shot and then at least once during each day and night cycles for a total of 4 tests daily. After a short period of time, one starts to get a picture of how kitty is doing and that data is far more reliable for making dosing decisions than curves. Starting off with conservative dosing is the best way to ensure kitty doesn't go too low. Slow and steady wins this race!

 

It will get easier. I promise. Whether you are ear or paw testing, try warming the spot first. I filled a sock with rice and put it in the microwave for about 20 to 30 seconds. I held the sock on Jersey's paw for about 10 seconds. Then I put just a touch of Neosporin with pain relief on the testing spot. The Neosporin helped the blood well up. If you're testing on the ear, try to hold something (maybe a cotton ball) behind the ear when you poke. After getting the blood sample, I held a cotton ball on the site for a few seconds and then put another dab of Neosporin on the site to help it heal.

In terms of treats, you can always give Dirty Butt some pieces of plain chicken as a treat.

Hang in there!

 

Back from the vet. Another problem. I brought in my new test kit (Alpha Trak purchased from the vet) and the tech and I both took a sample at the same time, I got 250 and theirs was 306, they are two identical meters from the same manufacturer. So they are going to do a control test on both meters and test again with a third meter that is a different brand.

Since this is the second infection, I asked the vet to look up the numbers on the first infection from May, before we were even thinking of insulin. It was 250, that was at the worst point of the infection before antibiotics, and there was no glucose in the urine, so the vet attributed it to the vet visit and the infection. Now, at this point, depending on what her real numbers are today, I'm wondering if maybe we should leave her off insulin for several days and see what happens -- her diet is different, no more Temptations, no sneaking bits of dry food, and no Hills J/D?

All four of my cats are being fed 4 times a day (1/4 of a can of Fancy Feast pate each), which is a pattern I started with Dusty, my oldest and more than 3 years into kidney failure -- 8:30 am, 1:00 pm, 7:00 pm, 11:30 pm. He is slowly failing and it is hard to get him to eat, so several smaller meals a day works for him and the other cats are real happy with it. Dirty Butt is still on Clavamox, we are following the same pattern as last time, and will keep her on it another week. Last time it took until the 4th day before she was feeling and eating better, same this time. So this is probably a repeated UTI due to the kidney failure, although I never saw any problems with the litter box. The insulin is Prozinc. Now the 2 units AM and PM is obviously too high, as well as the 1.5. The vet wanted to go with 1 unit this morning, but I'm guessing that may be too high as well, especially after she calms down at home. I will need some advice for sure tonight.

I'm getting better at testing, but it is a skill. Dirty Butt is 14. I may not have mentioned but she is also blind, a genetic problem, 3 of the 4 kittens in the litter were blind. It doesn't hold her back much, but it makes a visit to the vet even worse because she feels so vulnerable, on the other hand, it makes her really easy to work with, she just tries to make herself small and doesn't fight.

I'll post again when I get her home and some more results.

 

I don't have any personal experience with Prozinc, but I've put a call out for some dosing help for you.

 

I sincerely hope that the issues are not meter related. Just a few points to clarify before you or the vet start thinking the worst.
The meter must be coded to match the strips being used in it. When you were at the vet, did you both use strips from your own vials so your respective meters were set to the right code for the strip being used? If either of the meters was tested with a strip from the wrong vial, this would explain the problem. I'd check this out before assuming the meters are faulty. Control solution won't shed any light on this problem for either of you when using your own strips.

 

Since you have two kitties with kidney problems, you may want to consider switching to a low carb, low phosphorus food, such as Wellness Grain Free Turkey, or Wellness Core Beef, Venison & Lamb. Here's a list of a few others
https://docs.google.com/spreadsheets/d/1E_HZnTcJdsr20Gpivo2ID1KQ9wlZAe1Xy3LDTDVRofU/htmlview?pli=1

 

Hi Debbie! We'd love to help you out with dosing advice. It definitely sounds like Dirty Butt needs less insulin. Especially since her numbers will probably be higher at the vet, like you said. Why don't you come over and post on the ProZinc forum? We have several folks there who have used your insulin and we tend to see those posts first...plus it's h arder to find them on the main forum since ProZinc isn't the most frequently used insulin. If you post the number you get before shots, we can definitely help you.

 

Thank you @Rachel for helping with dosing.

 

OK, back from the vet, she is good, but unfortunately, the vet tech was harsh on her and had her growling, just sitting in her carrier, when they brought her into the room. I've had her since she was 8 months old and never heard growl in 14 years, she is normally a sweet heart. She didn't stop until she realized I was there, then calmed down. She had only had a quarter of a can of Fancy Feast this morning, and just now wolfed down a half can of it. So she is definitely eating well, so not worrying about the infection any more.

The coded number was fine. They came to the conclusion that my meter is reading too low and suggested several doses of the control fluid before doing the next test. So I guess I will have to trust my meter, I have no other choice. This shows the last two days and the curve from today:

Tuesday

10:00 am = 2 units insulin (didn't get my meter until that night)
9:30 pm = 193 (under 200 so vet said to skip the insulin)

Wednesday

no insulin for 24 hours at this point
10:00 am = 353 (vet said to give insulin but lower to 1.5)
10:00 am = 1.5 insulin
3:40 pm = 77 (vet said come in immediately)
4:15 pm = 39 (at the vet's office, vet gave dextrose)
5:15 pm = 285 (vet said to skip PM insulin because of the dextrose)

Thursday - curve at vet

9:00 am = 306
9:20 am = 442
vet gave 1 unit insulin at 10:00 am
11:00 pm = 332
1:00 pm = 314
3:00 pm = 471

Vet wants me to give her 1 unit. I know the high numbers are affected by being at the vet, so should I give the 1 unit tonight? I asked the vet for the number where I should not give any insulin, she said anything below 200. Since she crashed with 1.5 at 353 yesterday, should I maybe give a .5 tonight if the number is above 200? Is .5 even a viable dose?

I noticed that on Tuesday at home, she crashed 5 hours after the 1.5 insulin. Today at the vet, her number went up 5 hours after the insulin.
Looking for the differences in the two days:

She was fed at home both days in the morning before insulin.
She had another meal at 1:00 at home on Tuesday, but no food this afternoon at the vet.
She was home and relaxed all day Tuesday, but at the vet all day today.

Can being at the vet make that much difference?

Since I need help with dosing I probably should copy this to the ProZinc forum, but I'm not sure how to copy it over.

My mind is spinning so , thank you so much for your help!

 

OK, I was able to copy this over to the ProZinc forum.

Oh, and thank you Sharon for the info on kidney failure. I don't know if Dusty will eat that food, but it would be worth a try. He is a finiky eater and getting so frail now and not eating well, that sometimes you have to stay with what works.

Thank you everyone, it is so good to know there is someone listening and helping.

 

Oh, just to top off my day, I went out and got the mail. Jury duty summons......

 

I am thinking that from your description of Dirty Butts behavior with the technition, just being around a tech she doesn't like could have her numbers all messed up. I would also tell the vet that you don't want that tech near her. That poor little girl has enough to deal with. There is no excuse for putting up with a mean tech.

 

I don't think the tech was mean on purpose, but she wasn't taking blood samples from the edge of her ear, but on top of the cartilege in the ear and squeezing real hard and they said the growling started when she gave her fluids. I don't think she is very good at it. I mean this cat was growling in the carrier the whole time I was talking to the vet. She only stopped growling when she realized I was there.

The great news is that it didn't transfer to me. The little sweet heart let me give the antibiotic pill, and put up with my 5 attempts at pricking her ear to finally get some blood tonight.

I'm kind of worried about her, she is too quiet and her test came out at 113 at 10:00 PM, so I didn't even give the .5 unit tonight. I hate to test her again, but I'm worried she may be crashing again. The vet gave her 1 unit at 10:00 AM, it has been over 12 hours since she had insulin. I'm beginning to think maybe she shouldn't be getting any at all.

 

Ugghhh, so sorry about the jury duty!

Glad to see you found your way to the Prozinc forum. For those who may want to find your post on that forum, here is the link.

Poor Dirty Butt. Being poked and prodded on by inexperienced vet techs is no good at all. She deserves lots of scritches for putting up with all of that.