Newbie with many questions!

Discussion in 'Lantus / Levemir / Biosimilars' started by Bibi and Kira, Jul 18, 2019.

  1. Bibi and Kira

    Bibi and Kira Member

    Joined:
    Jul 10, 2019
    Hi all,
    I have so many questions I'm not even sure where to start, so apologies for dumping so much at once.
    Our 15yr old girl, Bibi, was diagnosed and started on Lantus (1 iu 8am and 8pm) on July 7. She was also started on Adequan for arthritis in elbows, hips and lumbar spine. She developed a UTI seemingly right after starting Lantus, for which she has been on Clavamox since the 15th. Since yesterday she has diarrhea and today I tried to start her on Metronidazole for that but she barely ate any of the food that I mixed it into. SHould we give her some kind of probiotic instead of or in addition to the Metronidazole? We're transitioning her to all wet food diet of DM. Right now she's at 3/4 can DM and 1/4 of her old wet food which was Natural Balance LID. No more kibble at this point. We've been giving her 3/8 can each at 8am and 8pm and 1/4 can at 2pm, when she has usually been quite hungry. The vet today asked us to only feed twice per day, which we told her we'd start tomorrow. Bibi doesn't normally eat more than 3/8 can at a time so we have doubts that she'll eat a full 1/2 can per feeding even though that's all she'll be getting. Right now we're worried that the Clavamox or something else is upsetting her stomach and she may be losing her appetite. She's lost a bit under 1 lb in weight since diagnosis. All she's done today is sleep and eat a few licks of her 2pm feeding. Also, the vet placed a Freestyle Libre Glucose Monitor on the back of her neck on July 12. We scan it with our iphones or the scanner it comes with to get her BG readings. Her numbers especially after the first couple of days have been all over the place. They've been shooting straight up and down from as low as approx. 140 all the way up to over 500; the Freestyle Libre app doesn't give you specific numbers if it's over 500, it just says it's out of range. Also my husband and I really suck at administering the shots at this point and we're never sure if it's gone in properly or not, so she may be getting very inconsistent dosing. Bibi is also on to us now and has started jumping out of the way as soon as she gets stuck with the needle, which is not helping matters. We've been sending the vet daily graphs of Bibi's BG from the app. I asked the vet point blank today "So you're not concerned about the wide swings in her numbers?" and she said no, she's more interested in her averages. Also that we should stop obsessing about the numbers and just watch her behavior (i.e. drinking and urinating and let her worry about the numbers. We would appreciate your experience and opinion on any and all of the above, especially stomach upset, how to improve our shooting technique and not freak out the cat, and most of all the wide swings where at the top she is at some unknown number over 500 sometimes for hours. Is this normal after 11 days on Lantus? Is it possibly an indication of anything else? Is she "bouncing?" Is the vet right not to be concerned as long as her averages aren't above the 300s?
    Sorry if I messed up the uploads of the graphs. This is all new! Thanks for your help!



    Bibi graph 7:15.jpg Bibi graph 7:16 .jpg Bibi graph 7:17.jpg Bibi graph 7:18.jpg
     
  2. Beth 73

    Beth 73 Well-Known Member

    Joined:
    Aug 2, 2016
  3. Bibi and Kira

    Bibi and Kira Member

    Joined:
    Jul 10, 2019
    Hi Beth, sorry I don't know what "bump" means.
     
  4. Beth 73

    Beth 73 Well-Known Member

    Joined:
    Aug 2, 2016
    It gets your message bumped back to top :) I am out of practice with this but I know one of the experts will be along shortly :bighug:
     
  5. Bibi and Kira

    Bibi and Kira Member

    Joined:
    Jul 10, 2019
    Okay, thanks.
     
  6. LizzieInTexas

    LizzieInTexas Well-Known Member

    Joined:
    Jul 25, 2016
    Can you set up the spreadsheet we use?

    There are way too many factors to give much input right now. We don't have the whole picture.

    Pain (uti) can cause higher numbers but it could be not enough insulin. Food changes can cause diarrhea but so can the AB.

    I know sometimes it is difficult but try and only change one thing at a time, that way you know what could be affecting the BG.

    Are you doing TR or SLGS? Have you read through the sticky at the top of the forum?

    Keep going! You are doing great. Take a deep breath, let it out (repeat). :bighug:
     
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  7. CandyH & Catcat

    CandyH & Catcat Well-Known Member

    Joined:
    Apr 23, 2019
    am I reading correctly, that the vet told you to transition away from Natural Balance LID (which has 11-12% carbohydrates) and onto Purina DM - or is it Purina DM Savory selects? -- assuming this is the wet (canned) formula

    some vets tell you to feed only twice a day, that's the "old school" thinking; more recent research suggests several mini meals throughout the day is better for our sugarcats

    are you feeding Bibi a tasty (low- or no-carb) treat every time you attempt to give her an injection? one that she really likes? it can make all the difference in the world

    we have a number of videos about injecting insulin and testing BG from the ear -- most of those cats in the videos are extraordinarily well behaved, but most cats will wind up calming down and acting somewhat like the video models -- I don't have those links right offhand but someone else will

    several members on the board are utilizing Freestyle Libre s -- with luck I'll remember who they are and tag them to help you out

    also, if Bibi is feeling nauseated, there are several medications which can help that -- no one wants to eat when feeling queasy ...

    welcome --

    @Larry and Kitties

    @Sarah&Soph
     
  8. Idjit's mom

    Idjit's mom Well-Known Member

    Joined:
    Apr 3, 2018
    Hi and welcome to FDMB. I am not experienced enough to answer your questions but my response will take your post to the top of the list again, and I can provide you with some ways that will make it easier for the experienced members to view your kitty's information right away.
    First is to create a signature. This is the gray text you see below our posts and displays every time you post. That way you don't have to repeat that information, and members don't have to scroll back through posts to find it.

    Setting 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 menu that drops down
    type the following in the box that opens: kitty's name/age/date of diabetes diagnosis/insulin you're using and dosage amount /glucose meter you're using/what (s)he eats/any other meds or health issues (s)he has. You can add your name, and a geographic location (sometimes the country/time zone matters) Be sure to SAVE when you are finished.

    I want to mention that we use a spreadsheet, color coded for ranges of blood sugar level tiers, that might be more decipherable to the members. It does require manual input of insulin dosage as well as testing results, as most of us manually test our cats' blood sugar, and that is not a continuous read out like you get.

    I am going to include the links to the spreadsheet instructions, and to a document explaining how to understanding the grid. They may ask that you take some of the readings from the graphs, and put them manually on the spreadsheet, or not. But you will have it to refer to if you decide to use it.
    SPREADSHEET INSTRUCTIONS

    UNDERSTANDING THE SPREADSHEET

    You can start reading the information in the yellow tagged stickies at the top of this forum. I do know that there are lots of videos on YouTube demonstrating insulin injection techniques, because when Idjit was first diagnosed I watched lots of them. Some cats will accept different injection sites better than others. I will try to find my link to a picture of different injection sites.
     
  9. Idjit's mom

    Idjit's mom Well-Known Member

    Joined:
    Apr 3, 2018
    Ok, I hope I have the correct link. The beginning (top) of the document deals with manual blood sugar testing, but scroll down for detailed injection techniques and a picture of injection sites.
    Marje and Gracie's Testing and Shooting Tips
     
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  10. Margie and Jackson

    Margie and Jackson Member

    Joined:
    Apr 26, 2019
    One thing I can say is metronidazole is very bitter and I wouldn’t advise mixing it into food, unless your vet said otherwise. I squirt the dose into a corner of his mouth.
    I would also consider a probiotic. Fortiflora has saved Jackson’s bacon in his early sick days, encouraging him to eat and getting rid of diarrhea.

    You don’t need to feed twice a day. Feeding all day is less stressful for everyone and helps with tummy trouble.

    Also, I sucked hard at giving shots, but I’m much better 3 months later. Getting new syringes for humans with short needles helped enormously. Here’s a link to mine.
    https://www.adwdiabetes.com/product...100-syringes-30g-3-10cc-5-16in-100ct-1-2-unit
     
  11. Bron and Sheba (GA)

    Bron and Sheba (GA) Well-Known Member

    Joined:
    Feb 21, 2015
    Yes it is quite normal to have numbers 'all over the place' in the beginning. Bibi could be bouncing if she has been in used to higher numbers for a while. Cats can bounce from dropping too low, dropping too fast or dropping lower than they have been used to for a while because of the diabetes. Their bodies panic and dump glucose and regulatory hormones into the blood stream and the blood sugar level shoots up. This can last for up to 6 cycles. It is quite normal especially in newly diagnosed cats.
    I would recommend you buy a human meter and learn to test the blood yourself.
    You can try some other low carb foods if your kitty doesn't want to eat what you have. Fancy feast pates are low carb, and I would feed during the day and night, not just twice a day. Feeding in the first half of the cycle is better as that is when the insulin is strongest.
    You can try some plain boiled pumpkin mashed for the diarrhoea. Either make it yourself, with nothing else added or buy some plain canned pumpkin. about a teaspoon mixed with food 2 or 3 times a day.
    It all gets easier, so try not to get too worried. Ask lots of questions.
     
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  12. Sue and Luci

    Sue and Luci Well-Known Member

    Joined:
    Nov 3, 2017
    If you're able to get to Walmart - not sure where you're located - you can purchase everything you need to test at home and purchase syringes - get the finest needle size - I use 31 (larger number = smaller gauge) and the shortest length I can find 15/64's - very tiny so you don't worry about stabbing your poor kitty or going right thru to the other side. Pinch up the loose skin on the scruff and do the little poke there while feeding a treat - I use Orejin all meat treats and Luci gets one with every poke. She's busy eating her treat while I do the poke...you can even put your kitty in the testing/poking place - use the same place every time - give a treat and some loving - and no pokes at all - soon he won't associate that place and what's going on with anything but the treat.

    I get the treats from Amazon. https://www.amazon.com/Orijen-Origi...s&qid=1563534905&s=gateway&sr=8-1-spons&psc=1

    Looking forward to seeing your spreadsheet and your signature - yes, I know...lots of things to do - but once you get it all set up it'll be easier and you'll get more help and eyes on your condos (our daily thread). Try to read some of those stickies at the top of this forum - loads and loads of information there.
     
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  13. Bibi and Kira

    Bibi and Kira Member

    Joined:
    Jul 10, 2019
    Yes I will try to set up the spreadsheet and do the signature tomorrow (Friday). Thank you.
    Hi guys I'm so grateful for these replies and I feel like an idiot that I don't know where to type my replies. I don't see any obvious place. Is that because I"m using Chrome as my browser? I guess I"ll find out if this is the right place or not!
    Yes, the vet told us to transition over completely to Purina DM canned. We are currently giving her 3/4 can of DM and 1/4 can of her old food Natural Balance LID. This is currently split up into 3/8 can 8am and 8pm and 1/4 can at 2pm. We told the vet last night that we're going to continue feeding her 3 times a day at this point as she's had so many changes in such a short time (type of food, amount of food, feeding times, insulin injections and other drugs, glucose monitor implanted on her neck, etc). Yes, we are injecting her at mealtime, but we also got low-carb treats if we need them. As for injecting, we got some of the 31 gauge, 5/16", 1/2 unit syringes yesterday and wow, they're so much easier! I wish the vet had told us to get them right away but they just sent us home with the long needles.
     
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  14. Idjit's mom

    Idjit's mom Well-Known Member

    Joined:
    Apr 3, 2018
    I use Chrome too, and you are replying just fine. Don't feel like an idiot, you are nothing of the sort. This board format is just all new to you, no worries. There is a whole lot to learn and get used to, it will happen. We usually use the Main Health forum HERE for general health questions, like asking about diet, tips on testing and shooting, what supplies you need and where to find them, etc. This forum, the Lantus forum, deals more with dosage questions and changes but, as you can see, you found caring people to answer and get you going.
     
  15. Perry & Jenn

    Perry & Jenn Member

    Joined:
    Jun 5, 2019
    You're doing great! You're giving shots, you're transitioning to wet food, and you already have a Freestyle Libre on your kitty -- that's going to give you so much good info.

    Everything is scary and confusing at first, but there are so many helpful people here. You're in good hands.

    FortiFlora is a probiotic that also happens to be really yummy. Both of my cats love it. Sprinkling some on top of the wet food might get Bibi to eat more. So you might be solving two problems at once there. You can pick it up at Petco (at mine, it's alongside the DM) or order it on Amazon.
     
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  16. Sienne and Gabby (GA)

    Sienne and Gabby (GA) Senior Member Moderator

    Joined:
    Dec 28, 2009
    Welcome to the group.

    I would strongly suspect that the clavamox is causing diarrhea. A specific probiotic, Saccomycetes boulardii (S. boulardii) is great for taking care of the problem. I linked one brand but it's available on Amazon, as well. (I would not recommend Fortiflora as a probiotic. It may work to get a cat to eat but human probiotics are far more effective and S. boulardii, in particular, will get Bibi's lower GI track back to normal pretty quickly. (Start with 1/4 capsule mixed into food twice a day.)

    You can feed your kitty any low carb canned food. There is nothing magic about Purina DM and frankly, it doesn't contain the best ingredients. Lisa Pierson, DVM has a great website on feline nutrition as well as an extensive list of canned foods along with their nutritional values, including carbohydrates. You want to be feeding your cat food that is below 10% carb -- although most of the members here feed closer to 5%, give or take. The foods on the list cover a broad price range. Prescriptions foods like DM are expensive, especially given the lower quality of the food. Bottom line, you can give Bibi whatever food she likes as long as it's low carb. You can also feed as many times as you'd like during the day. The only caveat is to not feed 2 hours prior to shot time. Feeding too close to shot time may cause your pre-shot number to be influenced by food.

    As Bron noted, it looks like Lantus is bringing Bibi's numbers to drop into lower ranges and than numbers shoot back up again. We refer to this as a "bounce." This is an annoying (to us) phenomenon albeit a pretty normal occurrence. Bounces occur if your cat drops into very low numbers, drops fast, or drops into a range that she's no longer used to. As a result of the drop, the liver and pancreas produce counterregulatory hormones and release a stored form of glucose which cause numbers to spike back up. As Bibi gets more accustomed to spending time in lower numbers, the cycles will flatten out.

     
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  17. Bibi and Kira

    Bibi and Kira Member

    Joined:
    Jul 10, 2019
    Thank you I will try to do the spreadsheet and the signature later today.
     
  18. Bibi and Kira

    Bibi and Kira Member

    Joined:
    Jul 10, 2019
    Thank you. I’ll check out that probiotic and the low-carb canned foods list. Are there one or two brands that members here really like?
     
  19. Idjit's mom

    Idjit's mom Well-Known Member

    Joined:
    Apr 3, 2018
    Many members feed Fancy Feast Classics (pate) and Friskies pate as it's low carb, lots of flavor varieties and you can get it at the grocery store. Others I remember seeing are Weruva and Tiki Cat, Tiki Cat After Dark.
     
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  20. Bibi and Kira

    Bibi and Kira Member

    Joined:
    Jul 10, 2019
    So, after one .6ml dose of Metronidazole - with vet's approval - mid-day yesterday to counteract the diarrhea, Bibi has not passed any stools since yesterday a.m. Is there something I should give her now to help her go? Should we be worried about this? Lordy, it's a rollercoaster, and not the fun kind :nailbiting:.
     

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