? 1/7 Luci amps 291

Luci refused her tuna snack this morning - was drinking from the bathroom faucet; then from the toilet - so she's thirsty. Tested when dad got up to help hold her.

Just fed her breakfast and she's really not interested in eating much of anything. Flat out refused to touch DM wet!
Ate a very small amount of Fancy Feast wet.
Getting ready to give her 1 unit Lantus, half of what I gave her yesterday.

I suspect her elevated sugar is due to too many carby treats yesterday and perhaps the addition of the Dietetic Maintenance (DM) dry food - which is 18% carb. She really liked that and ate with gusto yesterday. Today I'm dialing that way back - hope for better results later today.

Looking for info on how long to wait after eating to give insulin???

 

Yes I’d try and cut back/remove the dry food.

FYI the prefix question mark is generally for when you’re asking a question.

 

• 0.5u BID if kitty has been switched to a wet/canned low carb diet - should I give her .5 this mornin rather than 1 ? If she had 2 yesterday?

 

Ok, I just gave her .5 u - and tried to tempt her with a salmon flake treat - she's not interested in eating much of anything. Food is there in case she changes her mind. Why no appetite today?

 

The most important thing with Lantus is consistency. If you gave her 0.5u you need to stick with that dose and follow one of the protocols in the stickies. If you're following TR the dose is held for 3 days unless her BG drops (I am not familiar with TR so you'd have to read the sticky for that one). With SLGS that I am following, you hold the dose for 7 days unless they fall below 90 on a human meter. Switching up the dose is not a good idea. You will likely find if you take her off dry food altogether, that her BG will come down significantly so you will need to test.

I know you said you couldn't test her before food - but that means your reading is going to be food influenced and therefore higher. There is a knack to testing with one person - I put my cat on a table and lean over him so he can't run off (he doesnt anyways) and then do the warm ear thing (I use a min hot water bottle) and prick, test and done. Leaning over him does help and I am coming from behind so easier angle.

If you are home today - try and do a curve - testing every two hours until his pm shot. Then you will get an idea what is going on. The lowest point (nadir) is what you want to catch - most kitties around +5 to +7. That is what you base your dosing on as well, not the am or pm reading.

 

Many people here shoot while the cat is eating after the first AM test. The cat is usually distracted, so giving the shot is easy.
To get all tests I sit on the floor with my legs crossed and wrapped around my cat at her chest level so she confined.
Juliet is right about consistency with your injections. Also, be patient. Give Lantus time to work and give Luci's pancreas time to adjust.
Transition to different foods slowly by adding a little more to the current food each day. Try topping food with fish flakes or freeze dried meats to entice your cat to eat. It's best not to feed any dry food at all.
Good Luck!
Here is a link to yesterday's post: http://www.felinediabetes.com/FDMB/...on-lantus-many-questions.189219/#post-2104724 We always include a link to the previous day's post so others can easily review your history.
Also, I believe the date in your title is wrong.

 

Good start for today! (However, unless you are a time traveller, today is 1/7 -- you have 1/9 in your subject line. Go to your first post and you can change the date.)

If you are still going to be giving Luci ANY dry food, you will need to follow SLGS until you can transition her off of the DM dry. If she's really liking the dry (many cats are dry food addicts), crush one or two pieces of kibble and sprinkle it on her low carb food. It's not ideal but it is a way to get her to eat. [@Juliet - With TR, the initial dose is held for 5 - 7 days to allow the depot to stabilize. It's the same with both TR and SLGS.]

The likely answer is that Luci may feel a bit "off" due to her BG numbers going up and down. If you talk to a human diabetic, before they start insulin, they are used to their BG being elevated -- it's what feels normal. Once they start insulin, they don't always feel so great both because they are no longer used to being in normal BG range and because their numbers are going up and down. People say they feel crappy. One tell tale sign may be that Luci is drinking a fair amount. Excessive urinating and drinking (polyuria and polydipsia -- PU/PD) are cardinal symptoms of diabetes. These will get back to more normal levels once Luci's numbers are better regulated.

If Luci isn't terribly interested in food at the moment, there are two things to be aware of. First, Lantus doesn't start to work for about 2 hours. This is called "onset" and it varies depending on your cat's metabolism. It gives you a bit of room when it comes to giving a shot. I would encourage you to get a test at around +2 or +3. If you look at the New to the Group sticky, there's a chart of what to expect during a typical Lantus cycle. Generally, the +2 number should be around the same place as your pre-shot test number. If it's much lower, you will want to monitor Luci's numbers carefully to see if they are dropping and whether you need to keep an eye on those numbers to make sure she doesn't drop too low. Should number be dropping, it may motivate her to eat or you may need to entice her to eat if she's been ignoring her food.

Because Lantus onset isn't immediate, you can test, feed and shoot in rapid succession. (This is a different scenario than with insulin that has a shorter duration than Lantus.) I would test Gabby, put her food down, and when her head was in her bowl, give her a shot. This was usually all within a few minutes. She was a very food motivated kitty and was much more interested in her food than in my poking her. She also knew that getting her ear poked meant either a treat (freeze dried chicken was a favorite) or a meal/snack.

I would not recommend doing a curve yet. There's virtually no insulin in Luci's system. With Lantus, dosing is cumulative since you have to "fill" the depot. However, because some cats have a marked response initially to insulin, I would get a test at +2 or +3 so you have some sense of where the numbers are going. Getting another test at around +6 and maybe on at +9 or +10 will begin to give you a feel for how Luci is responding. The big caveat is that if you get that early test and her numbers are dropping, you may need to test often. It will help if you can find a treat that Luci likes. Giving her a positive reinforcement every time you test is very helpful when it comes to getting her to associate testing with a treat.

I'm a terrible person to ask about how often to test -- full disclosure: I was a testaholic. I like data. I also had a kitty who was often referred to as the diving diva -- she had a every early onset and her numbers could drop like a rock. (She could start a cycle in the 400s, drop to the 40s, and soar back up to the 400s.) It made life interesting. The link to Gabby's SS (spreadsheet) is in my signature if you want to see what I mean.

 

With Lantus, we typically test, feed and shoot all withing 10 or so usually. With some of the faster acting insulins you might wait a little after they have eaten (30min or so) before you shoot.
As lantus onset is slower there is plenty of time for the food to be absorbed before the insulin onsets (starts working)
To give you an idea, I would test George, feed him and shoot him while he still had his head in the bowl. He mostly never even looked up from his food. Some cats don't like to be bothered when they are eating, but he was OK with it as are numerous others.

Could you please fill in the details of what you shot yesterday? and any previous shots you might have given. It doesn't matter if you haven't gotten any tests in those days, I would just like to have a full picture of what her treatment has been to date.

Did you give her 2u at pmps?
Was that the first insulin shot?

The food changes may have upset her tummy, has she gone for a poop? Is it normal?
The addition of the kibble may also have her feeling quite full, when did she start on the DM kibble? I do think it is a good idea to transition her off that, at 18% carbs it's going to adversely affect the BG, you want to keep carbs below 10%. FWIW my vet also recommended it, by the time she got some in I had come to this site and made the decision to go down the Low carb/wet diet road, a decision I have never regretted.

If her blood glucose (BG) was in normal numbers last night then that might reduce her appetite. When diabetic cats are in high BG numbers they become very hungry, conversely when they are in normal numbers their appetite often reduces.
If she is not feeling well that may be affecting her appetite.
Does she seem off?
Has she ever had ketones? DKA?

Here is some links to a food chart, it will give you an idea of other foods that you can use that are low in carbs.

http://catinfo.org/docs/CatFoodProteinFatCarbPhosphorusChart.pdf

https://docs.google.com/spreadsheet...m6PPfEUz9YmzMGMxkmcBk6uRR0/edit#gid=113878384

this last one allows you to search by manufacturer and parameter
http://catinfo.org/chart/index.php


Has she eaten anything yet?

 

Sue --

You mentioned in your thread (we refer to a thread as a "condo") yesterday that your vet told you to test Luci's urine for sugar. If you are home testing her blood glucose, you don't need to test her urine.

In broad terms, urine testing is at best, imprecise and at worst, unreliable. In order for a cat to produce urine, the cat has to eat and drink, wait for food to be metabolized (which is how you get the glucose reading), for urine to collect in the bladder, and for your cat to urinate. This is likely a matter of hours. So when you get a urine test, the information you're seeing is hours old. When you test BG, the results are based on what's going on immediately. This is crucial if your cat is in low numbers. It's particularly crucial because urine testing won't tell you how low the numbers are or, for that matter, how high they are -- the range is limited. Urine test strips will not detect glucose until the level is above about 180 on a blood test. In addition, you need to be sure you follow the directions carefully and the results are subject to how you interpret the color on the strip. The readings look like what I've included below. The other limitation is trying to stalk your cat to the litter box.

 

Hi all. Luci's very first insulin shot was yesterday afternoon - 2u lantus per vet instruction. Next dose skipped because of necessity. They are starting today at 0.5u thanks to all the great help yesterday and working to figure a consistent 12 hour routine for cg, dh and Luci. Sue is reading through everything, but it's still quite overwhelming. Maybe we could help her by focusing just on the basics for now: test, feed, shoot within 10 to 15 minute window; get Luci to eat (lost a lot of weight and sometimes app); post here with updates and questions; interim testing if possible.

 

And the time travel is my fault - gave example of thread title in pm. Lol.
Sue you can correct that by going to the title in the first post and edit title. There you can also choose no prefix for routine posts, question mark for important questions, or 911 for urgent/ crisis help.

 

Ok, an update. Corrected the date (thanks for that notification!)
I cannot get down on the floor with Luci while she's eating - or get down on the floor for any other reason either - I'm 64 years old and just can't get up and down off the floor - like in my younger days - so testing has to be done at counter height where I can see with my bifocals; and there's good lighting.
The other problem with getting up and down - not I've gone and hurt my back - no idea what happened but I sneezed and had the worst pain hit me in my mid/lower back area! OUCH!! So after I laid down for a few minute in agonizing pain (Luci got up on the bed to see what all the commotion was about)...I got up, took a hot shower and have been on a heating pad since. Motrin hasn't brought much relief...oh boy..so now with hubby down with the bad cold I had last week (and a little out of sorts)...Luci and her twice daily BG readings, insulin shots and now to add to it, my back goes out!!! I'm trying to take it all in stride...but there's just so much going on!!!

I'm getting instructions from the vet to check her urine - so that means prepping a little box of plastic pebbles so I can catch the urine in a clean plastic bag - we've got that pretty much down now - rinse the pebbles out in a colander and re-use - however now conflicted with the BG checking - which I'd feel like I'm getting a better reading (for now) anyway...

This morning her UA was 250+ and her BG was 251 - synced up at least!

I fed her and she only ate a small amount - I gave her .5 unit Lantus. Now we try to heal for the rest of this day - which limits my time on the computer. I just can't sit here and do this for long...

The plan is to check her BG around 7 - feed her and then Lantus at 8. Which is stretching her schedule a bit - usually by 5 or 6 she's stalking me for food. So other than trying the chicken breast (again). I cooked chicken breast tenderloins and shredded one for her - no interest (at least not now)...maybe later. No carb treats today! Only Fancy Feast which she is turning her nose up at. Her freeze dried flakes will be here tomorrow...

We will do the best we can, while we can.

 

Also the vet responded to my letting him know (he want's daily updates on Luci) and said I should give her 1 unit because she's in ketoacidosis. However I think her sugar is higher today (than I've ever seen it at home) because of all the carby food she ate yesterday. I was so excited that she was interested in eating anything at all, I may have been a bit generous with the kibble - my fault!

He included this information for my review (as if I didn't have enough information to review..OMG...overload)

 

I have the same back issues and cannot get up and down either. If you KNOW your cat will eat (as I do) - you can test and shoot up on the counter, then give him his food. As one who listened religiously to the vet before listening to the forum (and the vet increasing and increasing the dose, not understanding bouncing) - I would pay less attention to your vet and more attention here. It got to the point where I was so confused with the conflicting info from vet and forum that I said to vet "give me 10 days to try it the forum's way and if it doesnt work I'll get back to you." I gave him link to spreadsheet and did forum way. Ten days later - Silver was in remission. Vet was shocked that Silver would even let me test him at home.

Three years later he is out of remission and I have not bothered to inform the vet.

 

Are you just checking for glucose in the urine?
Or are you also checking for ketones??

Did he test her for ketones at the office? Or is he relying on data provided by you?


How is she eating? has her appetitie picked up?
If she is in ketoacidosis it is very important that you get enough calories into her?

 

He tested her urine that I took in yesterday morning.

I tested her urine with strips he gave me in a bottle..
And then I tested her BG with ReliOn Meyer that I’ve been using.

Her appetite is not good today.. she’s not interested in her FF or salmon flake or freshly prepared chicken breast tenderloin..

How do I get calories into her if all she wants is kibble?

 

If it were my cat and she needed to eat for safety sake I’d give her anything she’d eat.

 

I agree, with keytones in the mix, I’d err to feed her anything she will eat over not eating.

 

Diabetic ketoacidosis (DKA) changes everything. Was Luci hospitalized at diagnosis? The test strips that the vet gave you, do they have one or two paper-like patches on them? If Luci was in DKA, the vet is most likely wanting you to test for ketones. If you scroll up to the picture I pasted, the strips should color code to the images in the second row if you are testing for ketones. Typically, if there's one paper patch on the strip, it's a Ketostix -- a way to test for ketones. If there are 2 patches, it's a Ketodiastix -- a way to test for both ketones and glucose in the urine.

For a cat with ketones, it is very important that they get enough calories and enough insulin. Ketones typically develop because there is an infection or inflammation along with not enough insulin and not enough calories. The cat doesn't eat because she feels so lousy from the uncontrolled diabetes and this often happens at the time a kitty is diagnosed (because we don't know the cat is diabetic). When DKA occurs, your cat is burning fat stores (usually because the cat has no appetite and because there's no insulin being produced to help glucose which is the result of food being metabolized getting into the cells -- it's floating in the blood). As a result of the cat's body pulling from stored fat for energy, your cat's electrolyte balance becomes out of whack. Electrolyte imbalances are deadly serious business -- literally, deadly serious. To be completely honest, if Luci isn't eating, I'd rather you be feeding her the DM dry and we can adjust up her insulin dose to insure she's getting the calories she needs. Gabby was in DKA at diagnosis (along with pancreatitis and hepatic lipidosis). It was thousands of dollars in vet hospital bills with her being at the kitty ICU under 24 hour monitoring. I don't mean to frighten you but this is an entirely different wrinkle in Luci's treatment. That said, we see cats with DKA regularly. You can put a piece of plastic wrap over her litter so you can gather urine to test or if you stalk her to the litter box, put a spoon or ladle underneath her and get a sample to test. If the reading is more than trace, contact your vet ASAP. Also, if you can get liquid into Luci, that will help.

I completely understand about getting down on the floor. I've had both hips replaced. I don't get down on the floor. I tested Gabby on the kitchen counter for the same reasons as you stated. When my hips were really bad, she got fed and got her shot on the island. If you can't feed her off the ground, can you pull a chair over by her food and reach her to shoot while your sitting?

 

Give her some kibble, try mixing it in with some of the FF wet.
Even though it's high in carbs, at this moment, with the ketoacidosis, two things are important

• Getting enough calories
• Getting Enough insulin.

Some folk also give baby food, you need to be careful of the varieties, I'm not sure which are suitable. I've sent out a message to some other experienced members so that they will stop by and help.

Having ketones present is quite serious, can be managed at home in the early stages.

do your dip stixs just test for glucose?? or do they test for ketones??

You can get stixs that check for both at any human pharmacy.
See the ones below test glucose and ketones


Is this what you have? or do the test strips only check for glucose?
If they only check for glucose I would try and get some that check for ketones, at this point that would be really helpful to you and your vet.

Is there any sign of anything else wrong with her?
Infection?
How are her teeth? gums?

ETA
I am glad @Sienne and Gabby (GA) stopped by

 

Thanks for asking: Luci has had a problem in the past with a couple of bad teeth - in fact it was last Spring; the vet removed two teeth due to decay. Gums and teeth seem to be fine now - no mention when she was examined (asleep) in November. Recent vet did not look in her mouth.

The strips we were given are for Glucose only. Please see picture. I'll try to get to the Pharmacy soon - however with my just recently (TODAY) back problem, I'm not going to be driving anywhere for day or two (hopefully it'll be only a day or two)....to get some sticks that check for both glucose and ketones...sheesh...why didn't he give me those in the first place?

She did eat TWO FF broth/gravy packs this afternoon - those are the pouches with some food, swimming in broth or gravy. She ate both quite well...and a bit of chicken breast...but not really made much of a dent in the FF canned food. I'll be trying again at 7:30 (plan is to test at 7:30, feed even if it is FF mixed with a tiny bit of kibble and Lantus .05 u at 8 p.m.) to keep with the 12 hour schedule.

If she got .05 U at 8 a.m. should I change to 1 unit tonight? It was 2 units yesterday at 12:50 - I know someone said keep it consistent...however I'm getting conflicting info...more Lantus, less Lantus - same Lantus..watch for a few days...?

 

Sticks are for GLUCOSE only. Forgot to post the picture when I replied below.
As soon as I can drive I'll get to the Pharmacy and get the other kind of strips...(back is out of whack today!)
She ate TWO pouches of FF broth/gravy with chicken mixed in....she is eating...but just small amounts. She's so picky lately...
I'll try at 7:30 - after her next BG test (ear poke); then feed her FF mixed with a bit of kibble; then Lantus at 8 p.m.

 

You’re still building up the depot. You really do need to keep your dosing consistent.

 

Ok so .05 is the doseage for tonight - we'll stick with that for several days and see if her numbers start to fall. Fingers crossed!

 

The reason for the inconsistency is the possible ketoacidosis your vet mentioned. 0.5 is regular starting dose. Ketones could factor needing a bit more. More from the seniors, just clarifying why different recommendations. This is the ketone test I use. also seniors check in on food as gravies are high carb.
otherwise, how are you doing?

 

If you want to get a test for urinary glucose AND ketones, get Ketodiastix. They do both. (Ketostix -- like Heidi posted, only test for ketones.) On the other hand, since you have strips for testing for urinary glucose, getting Ketostix would be fine.

It's great that she's eating. That's very important.

 

http://www.felinediabetes.com/FDMB/threads/updated-tips-for-new-members.173572/#post-2105791

@Tricia Cinco(GA) & Harvey did this awesome user friendly tool for all of us. Putting it in our pm too so you can get to it without searching.

 

With a LOT of input from other veterans.