Insulin checks

Hi: Maybe I'm really stupid, but for the life of me, I cannot figure out why almost all on this site, check your cats' blood glucose, several times a day? That's not necessary, if you know your cat well. I just wanted some feedback on this. My Vet. told me I should not get on this website. I guess I get too upset. I don't want to stick George more than I have to. If I can tell he is not feeling well, of course I'll check BG. Any suggestions?

 

Hi, many are in the newly diagnosed process so checking having the bg day curves is the way to learn. And when something else in medical urgency happens as DKA, Pancreatitis, Fever, Hypos e.t.c. So that is what is going on here.

 

Sorry to hear your vet is telling you not to visit. I imagine they probably get a lot of owners claiming they read something online that is opposite to what the vet is telling them and they get tired of it.

We check multiple times a day because many, many times you can't physically tell if your cat's blood sugar is too high or low. It has nothing to do with "knowing" your cat. Cats hide their pain, you don't want to wait until it's visible to intervene. Hypoglycemic numbers especially can go unnoticed until we do a check. I dare say a large portion of us have at some point done a "routine" check only to nearly have a heart-attack when the meter reads dangerously low levels. We also check because it's important to know how low (or not low enough) the insulin is taking our cats to make proper dose adjustments. How will you know that your cat's pancreas is getting better and needs less help if we're not doing spot checks each day? A diabetic person will check their own blood sugar several times a day, it's expected. Yes, there are some caregivers who are "poke happy" and will test 7+ times a cycle but honestly as long as you're getting a couple tests in between cycles you're collecting data and keeping your cat safe.

 

I mean, I'm pretty new here and I'm sure someone more experienced can chime in. But to be honest, especially because both myself and my kitty are new to all of this, I find testing often has been very helpful. I usually test both at AMPS/PMPS, which is necessary to make sure his BG is high enough to shoot (my second day giving insulin, he went hypo unexpectedly, that's the day I went out and bought a meter and found out he was indeed too low, and knowing this both helped me to make sure he was safe, and avoid a vet visit because if I wasn't able to know whether his numbers were coming up, or going back down...I'd have ended up with a hefty bill at the vet). I also test in the middle of his cycle, and I've been able to find patterns. If I wasn't testing him, I might accidentally assume he was regulated... not knowing his BG is way too high by +8 and drops again by +12. I also have certain days where I do at home curves, so I can find out exactly how his insulin is affecting him. BG at the vets office is often artificially high from stress, and if he happened to be having a bad day the day he went in for a curve, I may have ended up making some bad dosing decisions (or my vet would have, not knowing what his numbers are like at home).

Why does testing upset you? Cats have very few nerve endings at the edge of their ears, my boy barely even notices the poke. He looks forward to it even because he knows he gets a treat after! Of course this takes some time, but it happened rather quickly for us. I was very hesitant at first too, and my vet told me I would be "torturing" my cat by testing him at home. After finding this board I immediately realized this was nonsense, this board is filled with people who take such good care of their kitties, there was no way they were going to "torture" them. And when I tried it for myself and got the hang of it, I understood for myself that's absolutely not what is going on.

The other reason I decided to respond to this is because I'm a third year med school student. I understand first hand how frustrating it can be to doctors when their patients come in and try to dictate their care because of something they read on WebMD, or some other website. I was very hesitant to disregard things a professional who went to school for 8 years and had a degree on the wall was telling me. And I don't completely disregard, I think there is a happy medium between the two. But the question is, how much do they really know about diabetic cats? How far removed are they from vet school, and how often do they really see it in their practice? Treating feline diabetes has come quite a long way from the time many of our vets have last researched the condition. If I had a condition that my primary doctor hadn't seen in a long time, or wasn't up to date in treatment options, I would see a specialist. Unfortunately, that's not something we have access to with feline diabetes. So I come here. To the people who have years experience treating the condition, and are up to date with research on the condition. I don't need to see a degree on the wall to know they know what they're talking about.

It's ingrained in medical professional's brains to be wary of patients who are looking for information on the internet. But really, your vet should have no problem with you wanting to be involved in your cats treatment. You're doing your own research, and that should be encouraged. I just don't agree that it's a "bad" thing in this case.

Some people here do test a ton, and you should do what you're comfortable with, but it looks like you're new here too, and I think there's a lot to be learned from doing tests in the beginning. And I wouldn't give my child insulin without knowing it's safe to do so, so I wouldn't do it to my kitty either. Therefore I'll never stop doing the AMPS/PMPS tests.

Lastly, it get's easier. It's a learning curve for both you and your kitty, you guys will get the hang of it.

 

Very well said

 

I beg to differ and I’ve been here almost ten years. You cannot possibly imagine the things I’ve seen:

• Members waking up to their cat being at 30 when the cat was safely in the 200s and flat when they went to bed
• Cats bouncing and diving (which is very common until the liver gets used to normal numbers) which can result in the BG going low quickly
• A very long-term and experienced member whose cat had been extremely stable and predictable for years coming home to find her cat in full blown hypoglycemia; he didn’t make it. She “knew” her cat as well as anyone I’ve seen here.
• People who didn’t test at all or not very often based on their vet’s advice but found us in the middle of the night when the cat was in hypoglycemia; some made it, some didn’t.

My kitty was diabetic 5.5 years and, believe me, I knew her. That didn’t stop her from dropping out of nowhere into the 20s. And, not once, did she show any signs of it. As an example, one night when we went to bed, she was at 120. Being on Levemir, I knew she’d come down a bit more even though she’d been flat. I checked her in two hours and she was at 60. I fed her two big tsp of low carb food and tested her in 30 minutes and she was at 24.

Insulin is a hormone, not a medication. Absorption can vary up to 50% from shot to shot at the same dose. Insulin syringes are ridiculously inaccurate by as much as 0.5u from the same lot in some circumstances. So, no matter how well you know your cat, there are things outside your control.

Lastly, we’ve been doing this here 24/7 for decades. Our members live and breathe FD. That cannot be said for a vet and most of them have never even seen a spreadsheet and could not likely figure out the patterns if they did see one. That’s not meant to be disparaging to vets; it’s just they don’t get that much training and they don’t deal with it as much as we do.

Cats adjust very well to being tested. Let me ask you this: if you had a diabetic child, would you just shoot the same dose of insulin over and over without ever checking it’s BG? Ask your vet the same question.

 

Unless you are a diabetic or working very closely with diabetic cats/people, you aren't going to understand the nuances. It's very tricky. Unlike a lot of other medical issues, you don't get to have a simple prescription of take one in the morning and one at night and you are fine. Diabetes is very much disease where you have to keep measuring and adjusting. I have a diabetic friend (type 2). For years he has worn a 24/7 needle taped to his tummy and has a meter that reads the device constantly. He says having the rate of change is very beneficial in managing his diabetes. I often see him when we have lunch together and he sometimes has to give additional shot and other times he's looking for an appropriate sugary drink. He has been diabetic every since I've known him for 15 years, so he's not new to the game, and he's always measuring. He also has sticks himself in the finger several times a day to calibrate his meter. He said you get used to it and he doesn't even notice.

If BG goes too high you feel awful, but if it goes too low you can die. So it's really critical to have enough measurements to make sure you don't go too low.

As for "Dr. Google", I use her often..... as an educational tool. It helps me ask my vet or doctor questions and be able to interpret what they say. In a couple of instances I have asked the right question or mentioned some other symptom I hadn't realized was important and the vet has provided better advice. Heck, if it were easy, we wouldn't need doctors!

When Gypsy was diagnosed with diabetes, my vet (of 20 years) sent me home with 6 sheets of info, needles, insulin and told me to buy the Alphatrak meter and to give 2 units twice a day. I suspect he has realized by now that I always go to the internet. Still, I was a bit taken aback by his response.

As others have also pointed out, many of the people posting regularly are relatively new here and they are trying to get their cat regulated. If you've not dealt with diabetes, it can seem like people are going overboard with testing. You should ask your vet why they don't like this site.

 

Oh on all these years, altogether 31 years from when I was 20 and having rescued all my babies all by myself and with their age when getting older getting all sorts of heavy medical things, and I being 52 now, I have a human doctor and especially a 50 year old human nurse, who knows if there is anyone more apted, in case I get diabetes and so on myself, it is me.
On an annual wide range blood tests check in fall 2017 they also measure the human diabetes equivalent to our cats fructosamine (even if their time frame differ) the ACH-something, and I was showing to be slightly above those 3 months it measures, so they sent me off to a human diabetes nurse and while waiting I simply just took Simba's Bayer Contour and put myself on an extensive full days bg checks, after food an everything, even after coffee, and wrote it all down nicely on a paper and had with me to the human diabetes nurse. That one did another of this the humans 3 months ACH-something tests but then I was fine.
I had a bit of fun though, since with Simba getting his diabetes in 2006 I'm not a diabetes beginner, on the human diabetes doctors and nurses expense - I am a strict vegetarian since 40 years ... and what a problem wouldn't I be to human diabetes for them in regulating only eating vegetarian food .
I would have to start eat Simba's and Gustav's food

 

I can only repeat what's already been said but hopefully in a way that connects more with you Sylvia. We're about the same age, have probably both been around cats forever and if you're even the least bit like me I thought I knew most of this and everything else already. As for medical information from the internet I'd rather have Dr. Phil and Judge Judy over for dinner. It's the experience of the thousands of members here that made me more aware of every aspect of a cat's general health, diabetes is just one part of it. I never knew so many things could go so wrong so fast.
I did have one diabetic cat who was textbook perfect, loved car rides to the vet and leaped onto the kitchen table to be tested. My next sugar cat was more typical, I thought I knew him like all of us do but until someone showed me I never knew his heart had enlarged to the point it tore the cardiac sac, he had cardiomyopathy, he had rotten teeth that could not be extracted without killing him. He hid all of this from me like all cats do and my only insight into his day to day health was my meter. He was what we refer to as a bouncer and I never did get him regulated despite years of trying.
On a bad day I could probably be best described as an old fart who is resistant to change. Coming here made me a better person and a much better caregiver to our cats.

 

A lot of people start out listening 100% to their vets then end up in a crisis situation that acts as a wake up call and causes them to start researching for themselves then they end up here seeking help. I see it over and over again. Most vets do not know very much about feline diabetes or nutrition. They just do not. The amount of their training that is spent in these areas is very minimal. When Mia was first diagnosed, the vet told me 1) to feed her 'prescription' dry food and 2) that testing would damage the 'animal/human bond'. Both were completely false. To her credit, after I did my own research and called her back to explain to her my findings regarding wet vs dry food, she did her own research then called me back to apologize for giving me incorrect information initially. She acknowledged that high quality protein, low-carb wet food was the best option. A lot of vets would not even have been willing to do that. (By the way, if you have not already been there, catinfo.org is a website created by a vet who is well known for her work in feline nutrition.) One of my biggest frustrations in the beginning was trying to find a vet who seemed to actually have accurate knowledge and experience with feline diabetes. The more I learned, the more I struggled with the incorrect information the vets were telling me. Finally, I was fortunate enough to find a very respected Internal Medicine Specialist who knew his stuff. It was a relief to have a conversation with a doctor who did not tell me anything that was contrary to what I had learned for myself, and he even commended me for my knowledge and hands-on involvement in Mia's care.

Knowing your cat, frankly, has very little to do with it. Clinical symptoms are very important - excess drinking, urination and hunger, weight loss, behavior - but they by no means tell the full story with diabetes. Some people test more than others. I will go so far as to say that some people get a little carried away, but testing is so important. If you do not test before every shot, you cannot know for sure that it is safe to give the planned insulin. Glucose is dynamic, so you never know when a lower-than-expected number might come out of no where. With some insulin types, the onset occurs fairly quickly, so the danger is even greater. Mid-cycle tests (between shots) allow you to see the impact of the insulin. This data is important in making dosing decisions. If a dose is taking a cat's glucose too low so as to put them in danger, the dose needs to be decreased; likewise, if a cat's glucose is staying too high all the time after they have been on a dose several days, a dose increase is needed. If you can catch the glucose going too low, you have time to intervene before it gets bad. The alternative is to wait until you see visible symptoms which means it is already bad. I cannot tell you how many times people have frantically posted because their cat all the sudden could not get up or even move or was having a seizure. Why wait for that??

I find data from daily testing to be the most valuable. If you do just an occasional curve, you are seeing numbers for one 12 hour period. I have seen curves done while a cat was experiencing a 'bounce' from having gone too low. The curve alone looked like the cat needed more insulin, but with data from other cycles prior to that, it was obvious the cat actually needed less insulin. Fructosamine tests give you the average over the previous 2 to 3 weeks, but they don't show you if a cat is having wide swings. Regular daily testing gives you the best overall picture of what is going on. If tight regulation (which hopefully turns into remission) is your goal, it is imperative. It is not cruel or painful if done correctly. Mia jumps up in her testing spot in her tower and holds her ear towards me for me to test then she dives in to eat her chicken treat. It's all part of our little routine. As far as that first vet's statement that it would damage the 'animal/human bond', the opposite proved to be true. Mia is even more of a mama's baby than she was before all of this.

 

I think this is absolutely spot on. I joined a diabetes group and checked out this forum when my cat was first diagnosed and I only stayed for barely any time at all before I left. It was just too overwhelming for me; all the advice was almost completely contradictory to what the multiple vets I’d seen had told me, and honestly there are some members who are.... intense. It stressed me out too much, so I decided to listen to them, which was a mistake. I loved most of Sophie’s vets and I know they truly did care about her, even saved her life a time or two, but I spent A LOT of time and even more money with no results, other than a nearly deadly hypo. So I finally joined the board, and after 2 months she was in remission, 14 months after she was first diagnosed.

And I’ll just echo again that it has nothing at all to do with knowing your cat. I know my cat better than anyone. I know exactly how long to pet her before she gets overstimulated and bites. When someone else is petting her, I know exactly when to tell them to stop before they get bit. I know how long I can hold her before she gets mad. I know what her tail twitches and meows mean. But I absolutely did not see her hypo coming. The only symptom she had was that she threw up, which was not usual for her considering that she frequently eats too fast and then vomits. And then she nearly died, because I was not home testing.

I definitely think that some people test their cats more than is necessary, but I think there are many members who are either retired or work from home so it’s not inconvenient for them to do so and if their cat tolerates it, then no harm done. But I don’t think a handful of tests a day is excessive at all, and I think it’s absolutely necessary for keeping your cat safe.

 

There is one word repeated in almost every post here, "test". You're not injecting something, clipping anything or extracting something. It's just a test.
I wasn't very good at poking holes in a cat at first and had no support network (years before I came here) but I had a patient and trusting cat and a great vet who showed me everything and explained why I had to do it. I've always said Nigel was a textbook cat and he was but in those first days and weeks the cat I thought I knew could scare the beejeebers out of me. I have his notebook here, on his second curve he registered LOW on my old meter, below 50! I phoned my vet and she asked what Nigel was doing. He had just zoomed down the stairs, took a few steps and leaped on the table where I was sitting without missing a beat. His tail in the air and his eyes shining bright, that was my little man Nigel. He has been gone a long time now and I miss him very much but I could have killed him that day had I been napping instead of doing a curve. No one enjoys poking holes in their cat, it's part of the program and we all deal with it.
Does Nigel look in any way distressed or mistrustful of me?