Recently diagnosed and uncontrolled

Hello Everyone,

I will start off with a bit of a history and then I have many questions. I've read through a lot of information on this site but I'm having trouble making sense of it all.

Thomas
12 years old
Diagnosed on February 5 with a blood sugar of 24.4
Weighs 9lbs and has always been small
Lantus
Feeding friskies wet food with dry still around the house

We've been giving insulin for just over a month now. I've been home testing, which I'm not very good at, but maybe I'm still learning. The vet gave my 25 gauge needles which I've used a couple times and think are way too big. I've read that smaller also work, so now I'm using smaller lancets but I'm not always successful in getting any blood and feel bad poking over and over. I've only been testing once a week as per the vets instructions and we have been increasing the insulin based upon that. It's made me uncomfortable because I'm worried about getting a low.

I have not made a spreadsheet but I can describe what we have done insulin wise:

February 5: day Thomas was diagnosed, blood sugar 24.4, started on 1 unit of Lantus Every 12 hours

February 11: blood sugar 21.4 at +6 hours, insulin increased to 2 units every 12 hours

February 18: blood sugar 30.7 at +5 hours, insulin increased to 3 units every 12 hours. He was ravenous the last week

February 24: blood sugar 27.4 at +5 hours, insulin increased to 4 units every 12 hours. The vet started discussing insulin resistance and the possibility of a UTI. Thomas was given a convenia injection. Upon further research, I feel terrible about letting them give it.

March 3: blood sugar 25.6 at +5 hours, insulin increased to 5 units every 12 hours. I'm really uncomfortable giving 5 units and this is where I started doing more reading. I've only been giving him 4 units.

I have other cats, and before this diagnoses they all ate primarily dry food. I've now started feeding as much wet food as possible but there is still dry food out all the time. I'm not sure how much of the dry food Thomas eats when I'm not looking. The vet never said anything about feeding exclusively wet food from now on. From all the reading I've done, I've come to the conclusion that Thomas's sugar can never get under control while still eating dry.

So now I'm wondering how to switch. I'm willing to switch all the cats to wet food. But there is the issue of what to do with the insulin.

Do I switch back to 1 unit and start all over?

When should I do a glucose curve?

How many points do I want on the glucose curve to get the most information? Does it only take 12 hours to do a curve?

Can I poke the ear for the glucose curve?

How often should I be feeding wet food?

How do I leave wet food out for grazing?

Should I use a 0 carb food for grazing?

Are there any wet foods with 0 carbs?

How often do I need to be testing the blood sugar?

How long do I have to remain at a specified insulin dose before I increase?

I currently use and alpha trak meter, the strips are very expensive. Is it true the I can use freestyle lite strips in the meter I have?


Any info you can give would be a great help.

Thank you,

Sara

 

Hi Sara, welcome! I’m glad you are testing, it’s the best way to know how well the insulin is working. We recommend you always test before you feed and give the shot and get a test or two midcycle when possible. Your vet went up in dose very quickly. We usually increase by .25-.5 u at a time so you won’t go past the best dose. We can help you improve your testing skills too! Be sure Thomas’ ear is warm, some use a rice sock warmed in the microwave, and be sure the lancets are 26-28 gauge. For food, the Friskies wet is fine, but you will want to get rid of the dry. This could lower his BG and he will need less insulin, so don’t do it until you are testing more and I would also lower the dose at that time. What country are you located in? I can. Tag members from there to help you with specific foods and meters

 

Welcome! Quick answer with no extensive data to back it up, just a common scenario here: likely too high a dose of Lantus based on a single BG number and dose increase in too large an increment. More on all that later ...

Certainly a food switch to all low carb wet food can cause BG to drop and the current 4 u dose might be too high and will drop him too much. I'm going to suggest you don't change anything right now and get started on the basic BG testing routine we recommend (below) to accumulate a bit of a data base from which we can make a dose assessment and suggest next steps.

How about this weekend? A curve is simple: test BG every 2 hours between the AM pre shot test (info below) up to the evening PM pre shot test. Feed normally over this 12 hour interval. There'll be a total of 7 tests - not a daily occurrence, only for a curve.

Yes, almost all of us poke the ear to test. It really doesn't hurt the kitty unless you get the little marginal vein. Many people put a very thin layer of neosporin ointment (not cream) with pain relief at the end of a curve day.

Many vets will say feed only twice a day before injecting insulin. Most of us feed several small meals a day or allow the kitty to graze if that's his/her habit. The only time all food should be removed is in the two hours before the all-important pre shot BG test (info below) because you don't want food to inflate that reading. You want to know that BG is high enough for the planned dose.

Many people leave wet food out all day and many use an automatic feeder if the kitty is prone to "scarf and barf".

Wet food that's less than 10% carbs as fed is considered low carb and good for diabetics - and overweight kitties too. Here's agreat shopping resource: http://catinfo.org/docs/CatFoodProteinFatCarbPhosphorusChart.pdf

Info below in the basic testing routine.

Yes, some people do or you can switch entirely to the Freestyle Lite meter. In the US many people buy a Walmart ReliOn house brand model like the Micro or Confirm because the strips are cheaper (about $30+ for 100). A human meter will read lower than the AT pet meter but we all know how to interpret those numbers. The difference in readings is larger at high numbers but much smaller at low numbers. We focus on trends - high is too high on either meter, whether a 300 or a 450. The key thing to know is the "take action" number on a human meter is 50 and 68 on the AT meter. This isn't a hypo number, just a sign that BG is getting low and needs propping up with a snack.

Ok - that answers your specific questions. Here's something I put together that contains a lot of basic info. Go over it slowly and ask as many questions as you can thing of:
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It would help us if you set up your signature (light grey text under a post). Here's how:

• click on your name in the upper right corner of this page
• click on "signature" in the men that drops down
• type the following in the box that opens: kitty's name/age/date of diabetes diagnosis/insulin you're using /glucose meter you're using/what he eats/any other meds or health issues he has.

Another thing that will help us help you now that you've started BG testing at home is to set up a spreadsheet like the one we use here. We can all see it and look at it before offering advice: http://www.felinediabetes.com/FDMB/threads/fdmb-spreadsheet-instructions.130337/

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Here's the basic testing routine we recommend:

1. test every day AM and PM before feeding and injecting (no food at least 2 hours before) to see if the planned dose is safe
2. test at least once near mid cycle or at bedtime daily to see how low the BG goes
3. do extra tests on days off to fill in the response picture
4. if indicated by consistently high numbers on your SS, increase the dose by no more than 0.25 u at a time so you don't accidentally go right past a good dose
5. post here for advice whenever you're confused or unsure of what to do.

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Here's an explanation of what we call "bouncing". It explains why a kitty's BG can go from low to sky high:

1. BG goes low OR lower than usual OR drops too quickly.
2. Kitty's body panics and thinks there's danger (OMG! My BG is too low!).
3. Complex physiologic processes take glycogen stored in the liver (I think of it as "bounce fuel"), convert it to glucose and dump it into the bloodstream to counteract the perceived dangerously low BG.
4. These processes go into overdrive in kitties who are bounce prone and keep the BG propped up varying lengths of time (AKA bouncing).
5. Bounce prone kitty repeats this until his body learns that healthy low numbers are safe. Some kitties are slow learners.
6. Too high a dose of insulin can keep them bouncing over and over until the " bounce fuel" runs out and they crash - ie., have a hypo episode. That's why we worry so much about kitties that have had too high a starting dose prescribed by the vet and the owner isn't home testing.

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Here are some tips on how to do urine ketone testing (VERY important of BG is high and kitty isn't eating well!):

• put the end of the test strip right in his urine stream as he's peeing
• slip a shallow, long handled spoon under his backside to catch a little pee - you don't need much
• put a double layer of plastic wrap over his favourite part of the litter box and poke some depressions in it too catch pee.

Most test strips have to be dipped and allowed to develop for 15 seconds before viewing the colour change in very good light.

 

I'm in Canada.

The syringes I am using to draw up insulin only have a marker for each unit. Are there other syringes I could buy which would allow me to measure by .25 unit increments?

I'm also wondering if there's a cheaper place to get Lantus in Canada. Maybe online?

If I use the freestyle lite strips on my alphatrak meter, will it read the same as if I used alphatrak strips? Can I buy the strips at Walmart?

I feel like my cat is bouncing because my glucose readings have been all over the place. That's why I'd like to start from the beginning again.

I will do a glucose curve this weekend. I should leave him on the 4units and feed as I normally would for it?

When doing glucose testing, the vet said I should aim to hit the vein that goes around the outside of the ear. Is that correct?

The first time I heard of ketone testing was on this site so I have no supplies to do that. Good news, his BG has been high since diagnosis but he's always eaten well so far.

 

I'm trying to create a spreadsheet but I can only make it to step 3, I am unable to click on publish to the web in step 4.

 

HERES a guide to testing with a great pic of the ‘sweet spot’ you’re aiming for.
@Kris & Teasel is from Canada, so she can help with those specific questions. For the spreadsheet, I’m of no help as I couldn’t do it myself, so I’ll try tagging a couple of folks that can help. @Chris & China @Marje and Gracie

 

Waving from central Ontario. I can answer some of your questions.

Unfortunately, only half unit syringes are available. I only used whole unit syringes, but I do know that @Tracey&Jones in Alberta uses half unit syringes. Tagging her for you.

If you have been buying from the vet, don't. They jack up the price.
Lantus can be bought without prescription at any pharmacy. A number of people buy from Shoppers or Costco. A box of 5 pen vials runs between $110 to $120. The box should last you for months and months.

I never used an AlphaTrak but I can tell you that Freestyle strips can be bought at Walmart. Also at Shoppers (cheaper if you use your points). Some people bid and buy off ebay. While insulin is much cheaper here than in the US, strips are much more expensive. If you live near the border, it would be worth your while making a trip.

 

I go to Costco - 5 pens of Lantus for $95.

I use these ones. BD 3/10 ml 8mm 31 Guage - they have the half unit markings on them. At least then you can guess at the .25u dose.

 

I am getting an error message when I try to post

 

I didn't realize I could buy insulin without a prescription

 

I have been buying insulin through the vet but picking up at a local pharmacy. Approximately 200 units for $90

How many units are in each pen vial? Will I need to start using an insulin pen or do I just draw out of the vial? I'm guessing I can just draw out of it.

I will look into buying a meter and strips from the US

 

Each pen holds 300 units and we use a syringe to draw the dose using the pen as a mini vial. Wherever you decide to buy your meter always be sure to have plenty strips on hand. You do not want to run short if Thomas were to dip low and you needed to test a lot.

 

Is the pharmacy repackaging from a larger vial for you? It's recommended that you buy the original 10 mL Lantus vial (a total of 1000 units) which costs around $100 in most pharmacies (likely cheaper at Walmart or Costco). The 5 pack of pen cartridges is the best value. Each cartridge is 3 mL or 300 units for a total of 1500 units. The cost of the 5 pack can vary but it $125 at Shoppers Drug Mart (again, probably cheaper at Walmart or Costco). Each cartridge can be used as a mini vial from which you draw insulin into a syringe.

 

Feel free to send me a PM and I'll be happy to set it up for you. Just click on my name and choose "Start Conversation" so I can get some details I need

 

The pharmacy is giving me containers containing 100 units, it's where the vet sent me and how the prescription was written. I was told that each container is only good for one month once I start using it. I pay a dispensing fee each time I need a new container. I had asked about getting two containers at the same time and that would result in two dispensing fees. I am going to Costco tomorrow to buy a 5 pack and new insulin syringes. If I keep the 3ml, 300 u container in the fridge will it be good for longer than a month?
I was very receptive to starting insulin when I got the diagnosis. We actually started that day. I want to do everything possible to find the right dose for Thomas and hopefully get him in to remission. I feel that the vet did not give me much information and increasing the insulin dose has been based on very little data. I am so glad this group exists because without it I would be lost and on my own.

 

I just did a glucose curve last night, I'm wondering if someone can look at it and give me some advice.
I'm not comfortable giving Thomas his 4 u this morning because I don't think it's the correct dose but I don't know what to do.

 

I suggested in an earlier post that you gather some data at this 4 u dose while you get your testing skills honed and undertake a food switch. You did great with the testing yesterday! Where are you in the food transition? I think you should keep this dose for another day or two, implement the basic testing routine I outlined in my post #3 above and slowly introduce low carb food. You don’t need a full curve very often. One good test to get is at +2 every cycle in the coming days. It can be a predictor of what might happen later in the cycle. If the +2 BG is similar or higher than the PS test the cycle won’t likely be dramatic. If you get a significant drop at +2 it can be a sign of action to come and extra tests would be advisable. This should help you stay on top of any BG drops that need food intervention.

 

Yes. One pen lasts me about a month and half. I am on my second pen from the pack of 5.

 

You can get a lot of dosing help on the Lantus forum. Tons of expertise over there.

 

The food has been completely switched to friskies wet, they don't understand that I'm trying to leave some there for grazing.

I gave 4 u this morning, not sure if I can do any more blood sugars today because Thomas's ears look like they hurt.

I went to Costco and bought 5 Lantus pens and the syringes. They don't have the 8mm needle length anymore, they have 6mm now so I bought those. I'm hoping that's long enough.

I forgot to stop by Walmart for the freestyle strips. I'm running out of alphatrak ones after last night.

I'm looking for something to put on his for the day after I do a curve. Neosporin is not available in Canada. Is there a polysporin equivalent? Is it safe to put lanolin on his ears?

 

You want polysporin with pain relief ointment (not cream).

 

The only polysporin ointment with pain relief also has 3 antibiotics. These are all safe for him too.

Polysporin ingredients
Medicinal Ingredients (per gram) : 10,000 units Polymyxin B (as sulfate), 500 units bacitracin zinc, 0.25 mg gramicidin and 50 mg lidocaine.

Non-medicinal Ingredients (alphabetically) : butylated hydroxytoluene, cocoa butter, cotton seed oil, olive oil, petrolatum, sodium pyruvate, vitamin E.

 

That's the one I have and use on Teasel's ears occasionally.

Did you give 4 u this AM?

 

I gave 4 units this morning

 

Looking at your curve on 3/8
I conclude that 4 units is too high. This is because you have an inverse cure. That is BG goes up instead of down.

 

I agree but I'm not sure where to go from here. I don't have many data points before the curve I did because the vet told me I only had to test once a week.

It has been in the last week or so that he has drank less water and is not eating as much which I have taken as being good signs.

 

Glad the SS is set up for you. Thank you @Sharon14 for tagging me. I’ve just recently gotten back home so I’m madly trying to catch up

 

As soon as I saw the BG go up when you raised the dose from 1 unit to 2, I thought...you (as guided by your vet) missed a potential optimal dose.

See how his numbers keep increasing with each dose increase? His body is fighting the insulin and producing glucose to prevent going too low.

I would try going back and starting on 1.5 units. No dry food. Low carb wet food throughout the day. Try to see if this dose does anything at all to lower his numbers over 3 days. If not, and he's not in danger of ketones (you MUST check for ketones! My baby Dweezil died from them and we checked all the time but still couldn't save him!), raise to 1.75 or if that's too hard to measure, just under 2 units, and see what happens for another 3 days.

Get keto-diastix. Here in Australia they're sold in most pharmacies for like $10 for 50.

 

I've been so worried giving him 4 units. If you look at my spreadsheet, I've recently gone back down to 2. Would it make any sense to go back down to 1.25?

I still have to go pick up sticks to check for ketones.

I'm worried about losing him, not sure what the right thing to do is. He didn't want to eat this morning,

 

Were you able to check ketones? How is it going?

Can you test for a few days in a row? My cat ran high/low on alternating days so I almost missed the low numbers. I looked at your sheet and see a lot of high numbers, but they’re spaced out. I’m curious what’s happening on those other days.

 

If he may have ketones and doesn't want to eat, please take him to the vet.

 

I picked up some ketone strips yesterday. He ate well before his pm shot. Tested negative for ketones 4 hours after that.

I'm trying to fill in some spaces. I was unable to get enough blood for a +4 last night. I will be away for a week and my husband will be caring for him. He's not comfortable with testing and doesn't see the need for multiple sugars a day.

 

I'm glad the ketone test was negative. Keep up the ketone testing, especially while he's in high numbers.

I know you're worried about him (your post #29 above) so I'll encourage you again to post for help on the Lantus forum. I'd also suggest you do it before you leave for a week so you get a better handle on how to dose him. My worry is that if he's still in high numbers and your husband won't test he could develop ketones. They can build quickly and cause diabetic ketoacidosis - life threatening and extremely expensive to treat. I've been down that road with my kitty.

All the testing and data logging we do here is to optimize our kitty's treatment and to avoid the crises that can occur with diabetes - severe hypoglycemia and/or diabetic ketoacidosis. The testing is daunting and anxiety-causing for the care giver at the start but it truly is the way to know what is going on with your kitty. It saves lives.

 

Red & Rover, do you mean you can buy insulin without a script in Canada? Wow, I didn't know that. We need a RX to ship from Canada to the US (so I guess you have to physically purchase it in Canada to get by without a script). I plan to buy the next vial of Lantus through the online Canadian pharmacy mentioned here on the boards (sooooo much cheaper.... Lantus prices are outrageous here in the States! $300 for a bottle, yikes).

 

Ive talked to my husband about ketone testing. I'm hoping for once a day. He did really well testing the blood sugar this morning before the shot. I've asked if he could do one +6 hour everyday, we'll see what happens.

I always thought you needed a prescription, but I'm glad you don't.