17 year-old tortie, so hard to get blood from her ears

Discussion in 'Welcome to the Group - Post an Introduction Here' started by Twyla17, Aug 9, 2015.

  1. Twyla17

    Twyla17 Member

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    Aug 9, 2015
    hello,
    we have a 17 year-old tortise-shell cat, recently diagnosed. the main reason i am posting here is that it is so hard to get blood from her ears. we've watched multiple videos, but it is just so hard. also, Twyla has been free-fed her whole life, so switching to feeding times is hard for us. her weight had always been fine until diabetes, which caused her to lose weight which led to us calling the vet. we're trying to do a curve and the idea of blood tests every hour or even 2 hours is totally nerve-wracking. we often try 2 or 3 times and give up without getting a reading because she is getting tired of us failing. i can't believe there aren't easier places to get a blood sample. we're so stressed out that i'm sure this makes us less likely to do a good job because we are so distrusting of our ability to do it properly. the range in her readings has been from 32 while fasting for 4 hours to 385 , 25 minutes after a big meal. also, we're trying to find out what is the best thing to treat her sample sites with. we're currently using Neosporin (sp?) ointment, but that is making her ears sticky. we've read that alcohol, hydrogen peroxide, and iodine aren't good to use. my wife is stressing out so much.
    thanks for reading this. we are new to this community and reading as much as we can. our vet currently has her taking .5u of Prozinc every 12 hours. and we feed her 20-25 minutes before a shot.
    best wishes,
    joe
     
  2. pevsfreedom

    pevsfreedom Well-Known Member

    Joined:
    Jan 16, 2015
    I use a black sock filled with uncooked rice, tie the end off, microwave for 30 seconds. I put Luna on the table and kind of hold her tight, scratching her neck while I hold the warm sock against the ear. Get it pretty warm, rest the needle on top of the skin (without pressure), and just kind of 'jab' it. Instant blood and the cat probably won't even notice. Have you tried the warm sock method yet? It makes it 100% easier. I hold the warm sock against the INSIDE of her her to warm up, place the needle on the outside, and use the sock to 'push' the needle into, a slight 'jab' is all it takes when it's warm. Also helps if you try and involve the cat, let them sniff the tools you're using. When I started I let Luna sniff the meter, the test strips, the lancet, etc. She yells at me now when it's testing time to let me know it's time for a test! Also helps if you massage the ear after the poke, if you don't see blood you can often massage it out.

    Little webcam video I took last night showing this process (quality sucks):


    Seriously once you do it 2-3 days in a row blood testing becomes 2nd nature. When I started I forced myself to do it, and it took about 20 minutes each time. Now I can do a blood test in about 15-20 seconds. You HAVE to practice, and you really need to do this if you have a diabetic cat. We've only had Luna being home tested for a month and I've already nearly got her regulated. This never would have happened if I didn't test at home.

    After I get blood, I use a piece of tissue paper, and squeeze the ear for about 10-15 seconds. This prevents bruising and stops the bleeding. I dab a tiny bit of neosporin on the poke site every single time, and rub it into the whole ear not just the poke spot to thin it out. This works quite well. You don't need to use anything else.

    What are you guys feeding Twyla? Wet or dry food? What kind of insulin, if any, is she on?
     
    Last edited: Aug 9, 2015
  3. Jan Radar

    Jan Radar Well-Known Member

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    Jun 27, 2015
    Dear Joe, first let me welcome you to FDMB. We are glad you found us. We have all been in your shoes and understand how overwhelming all this can be. So now take a deep breath and get ready for a crash course on taking care of the feline you love who needs your help to feel better. Here's a few tips to start:
    1. It will help you to know that there are few pain receptors in the ear of a cat. You are not hurting the cat when you poke. You already know that this is necessary otherwise you wouldn't have tried so hard to do it. Right?
    2. There is a "sweet spot" on the ear where you are more likely to get results. Someone will know where to find the picture and will send it to you. :). This picture really helped us when we were starting out.
    3. Warming the ear is also really really helpful. We use an old sock with about 1/4 cup of uncooked rice. We heat it in the microwave for about 16 seconds. Then we massage the ear with the sock. When you warm the ear you increase the blood flow making it much easier to get that necessary drop of blood.
    4. When we started out and were unsuccessful with getting enough blood for the test, yes that happens to all of us, we gave the cat a low carb treat and let him go. We wanted the cat to see the test as a prelude to yummy treats and as positive an experience as possible.

    Rest assured it took very little time for the cat to come to our testing site when he heard the microwave beep after the heating of the sock. He even purrs when we poke his ear. It really does get better. :)
    Please let us know what else we can help you with. You have found a wonderful community of people who are always ready to help.
     
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  4. Sue and Oliver (GA)

    Sue and Oliver (GA) Well-Known Member

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    Dec 28, 2009
    A couple other ideas: 1) use a larger gauge lancet at first (to make a bigger hole) Most kits come with 30-31 gauge for humans. 25-27 gauge may work better in the beginning 2) take a flashlight and hold it behind her ear so you can see where you are aiming. The vein runs up the side of the ear. You're aiming for the little capillaries that run off it to the edge of her ear 3) have something behind her ear to poke against. (We used a makeup sponge, other people use the rice sack or a piece of folded kleenix
     
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  5. Cat Ma

    Cat Ma Well-Known Member

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    May 21, 2015
    Hi and welcome. You are right, alcohol, hydrogen peroxide, and iodine aren't good for the cat's ears. As Jan pointed out, you are not hurting Twyla's ears by poking because cats have few nerve/pain receptors in their ears. The more you poke, the easier it will be because new capillaries will form.

    You want to aim for the area between the vein and the edge of the ear. See the picture in the first post here: http://www.felinediabetes.com/FDMB/threads/testing-and-shooting-tips.85113/

    To warm up the ears, I use a cotton headband or small wash cloth, dampen it, microwave it for about 30 seconds, put it in a ziplock bag and test it on my arm before gently applying it to CJ's ear. Be sure the bag is warm, not hot. Some people have luck just warming up their cat's ear by massaging it. I personally don't but you may find that works for you.

    Lancet/gauage size is important. Starting out, we suggest using a 26 or 28 gauge. I personally like the 26 gauage because I can get blood out faster. The lower the number, the thicker the gauge.

    It is very helpful is to use neosporin or polysporin to bead up the blood. The trick is using a very very tiny amount. A tiny dab with a q-tip is all you need. Too much will result in an error message on your meter. After you poke, gently blot off the ointment with a cosmetic pad, kleenex or paper towel.

    I use a flat cosmetic pad and fold it over the ear (see Step #3 in Sue's post above). After I poke, I blot up any blood gently with the pad. A paper towel will do fine, too. Some people use kleenex or cotton balls.

    I never thought in a million years that I could ever poke CJ. I worried she'd grow to hate me. But now she waits to be poked and our bond is stronger.

    Practice and don't be discouraged. We all started out like you did. It will get easier!
     
    Last edited: Aug 9, 2015
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  6. Cat Ma

    Cat Ma Well-Known Member

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    Great video, @pevsfreedom! You ought to add it to your signature line or to your info box.
     
    Last edited: Aug 10, 2015
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  7. Jan Radar

    Jan Radar Well-Known Member

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    Thanks @Cat Ma for the picture. I knew someone would be able to find it. :)
     
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  8. pevsfreedom

    pevsfreedom Well-Known Member

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    I added some annotations to it and some links to FDMB to make it more useful, and thanks!
     
    Last edited: Aug 9, 2015
  9. Twyla17

    Twyla17 Member

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    Aug 9, 2015
    joe: thank you so much for the thoughtful replies.

    suloni: i misunderstood where the sweet spot is -i see it clearly in the diagram now. thank you
    http://www.felinediabetes.com/FDMB/threads/testing-and-shooting-tips.85113/

    joe: we've tried heating, massaging her ear. just started using rice bag.
    for the past few years she's been eating Purina One Vibrant Maturity,
    but we've switched her to canned Natural Balance Indoor Formula and Chicken & Liver Pate Formula,
    supplemented with Evo grain-free dry food. she's currently on .5u Prozinc every 12 hours.

    Q: should we feed Twyla only twice a day. she is currently underweight, only 5lbs 3oz.
    and not let her feed freely any more
    if the care sequence is :
    7am and 7pm 1st step lancet blood test
    7am and 7pm 2nd step feed Twyla - let her digest for 20 min
    7am and 7pm 3rd step give her insulin shot
    7am and 7pm 4th step lancet blood test? after 20 min elapses /after she eats.
    remaining blood tests every 2 hrs after 7pm dinner to get the curve points for that day?

    thanks again,
    joe & suloni
     
  10. pevsfreedom

    pevsfreedom Well-Known Member

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    Wet food is good. Keep at the home testing as best as you can, once you 'get it' a few times it usually becomes a lot easier.

    5lb 3oz is pretty low. Does she eat fine? How much are you feeding? Do you know what kind of #'s she's getting? What BG level's did the vet say Twyla has? How are Twyla's teeth, does the breath stink at all? Does it smell fruity whatsoever or just plain stink, or is it ok?

    If she's not eating, I think it's well advised to let her graze on low carb canned food all day to get her weight up. Let her eat whenever he wants. You need food that is UNDER 10% carbs, this list is very useful :

    http://www.catinfo.org/docs/SortableCatFoodChartCatinfo.org2-22-13.htm

    (this is for lantus - not so sure about prozinc):
    You don't need to test immediately after eating. You test, feed, shoot - in that order. That test is called your PRE-SHOT test. You'd typically test again at +2 hours later. If you can't get that test during the day it's best to get it at night after work. During the day you want to find her 'nadir', aka the lowest point in the cycle. This is where curves are useful because you can try and find WHEN she goes the LOWEST, which is the info you use to adjust dosage.
     
    Last edited: Aug 9, 2015
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  11. Sue and Oliver (GA)

    Sue and Oliver (GA) Well-Known Member

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    We put together a protocol for ProZinc. It is in my signature in blue.
     
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  12. Twyla17

    Twyla17 Member

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    Aug 9, 2015
    ALWAYS READY TO EAT WET FOOD
    she loves the wet food
    she eats fine
    she wants to eat the wet food all the time.

    i give her 1/2 a teaspoon of wet food every 1 to 2 hrs
    between the 2 larger feedings taking place at 7:30 am & 7:30 pm
    larger feeding = 21/2 teaspoons of wet food.

    she prefers patte' to dry evo.kibble.

    BREATH
    her breath does not seem to smell bad does not smell fruity

    BG LEVELS
    when vet checked bg= 210
    she was not on her high protein diet yet

    when we checked:
    8/5: 244 after feed & before ins. shot
    8/6: 278 after feed & before ins. shot
    8/7 : 230 after feed & before ins. shot
    8/7: 0nly 32 after fasting 4hrs/after dinner/after ins. shot
    8/7: 385 after 7pm bigger 3 teaspoon feed & before her evening ins. shot

     
  13. pevsfreedom

    pevsfreedom Well-Known Member

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    It's good she's eating and breath smells fine. I would stop the dry personally and feed only the wet.

    Is she pretty small? Or just very skinny?

    Either way, 2.5 tsp's + another 4-5 tsp is no where near enough I don't think. You did mean tsp not TBSP right (which would still be pretty low).

    Luna gets 4.125 oz per feeding, which is about 25 tsp per meal, and 50 a day. She eats twice a day with maybe a 1tsp in between. The can says feed 3/4 to 1 oz of body weight daily, at 5lb she should be getting at least 5 oz a day which is ~30tsp, and probably more for weight gain.

    Check out the instructions on the can. I would feed THAT amount twice a day (to equal the total recommended amount), maybe a bit less with a few tiny tsp's inb etween like you're doing now.
     
    Last edited: Aug 9, 2015
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  14. pevsfreedom

    pevsfreedom Well-Known Member

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    That 32 is a serious and immediate concern. You need to immediately cut back on the dose and get advice from here before shooting insulin again. With #'s like that you're giving too much insulin. I don't know much about Prozinc. I'd head over to the FELINE HEALTH main forum on here and post for Prozinc dose advice with those same #'s.

    Under 40 is considered hypoglycemia and can be fatal.
     
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  15. Sue and Oliver (GA)

    Sue and Oliver (GA) Well-Known Member

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    What would be important to know is her level 5-7 hours after the shot. It's called the nadir, or lowest point of the cycle. It's possible that she is dropping low at that point and bouncing back up for the preshot test. (A bounce is when her body perceives a lower level that it has become used to and releases extra glucose. Thus her levels bounce up). If she was 32 at some point in her cycle, that is possibly what is happening.

    We generally consider that a regulated cat is in the mid to lower 200s at preshot and in double digits at nadir - but not below 50 which is approaching hypo territory.
     
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  16. Larry and Kitties

    Larry and Kitties Well-Known Member

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    I do not understand what that means.When twas the reading made with respect to last, last feed and next shot. All the "/" confuse me
     
  17. Cat Ma

    Cat Ma Well-Known Member

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  18. pevsfreedom

    pevsfreedom Well-Known Member

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    Me as well.

    Please read this:

    http://www.felinediabetes.com/hypogly.htm
     
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  19. Larry and Kitties

    Larry and Kitties Well-Known Member

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    Maybe the 32 was just a bad value. That happens sometimes. When you suspect a bad number, one that is unusually, then a tetest is called for.
     
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  20. Twyla17

    Twyla17 Member

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    we've always free-fed our 2 cats (our 11 year-old boy cat is fine and perfect weight). we're trying to figure out how to properly do a curve which would seem to mean not free-feeding but give big feedings twice a day and make sure there is no food for the two hours prior to the pre-shot glucose test.

    the 8/7 etc. were my wife listing the dates of the blood tests (ie. August 7th = 8/7)

    Twyla is a little small, but used to weigh 8.5lbs. she is thin and underweight now with the diabetes. i think my wife underestimated the size of her feedings. basically we often feed her every hour or whenever we go to the fridge ourselves. but nadir means lowest glucose while fasting, right?
     
  21. Sue and Oliver (GA)

    Sue and Oliver (GA) Well-Known Member

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    The nadir is just the lowest point of the cycle; it is not a fasting level. Especially in the beginning, when you are gathering data, we are not concerned about the food given during the 12 hour cycle. We do suggest that you do not feed 2 hours before the pre shot test; we do want that test not to be influenced by food because you are going to base the dose of your shot on it
     
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  22. pevsfreedom

    pevsfreedom Well-Known Member

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    No. Nadir has nothing to do with fasting - it's just lowest point altogether. It's a critical # while giving insulin because that's how you tell how low the insulin is making her go. If insulin IS making the cat go to 32 that is a serious problem.

    We were confused what you meant on the day of the "32". Can you elaborate on where the 32 came from, was it 4 hours after the shot?

    I think you have it right with the curve. Essentially all a curve is is testing every 2 hours. Doing a curve will really earn you some skills (and finger pokes) with home testing. I've done a few if you click "Luna SS" in my signature.

    @ 8.5 lbs I would be giving about 4 oz a meal of my Friskies Pate food, so 8 oz a day. That's about 3/4 a can of 5.5 oz food, twice a day. I'd go off the can instructions for whatever you're feeding. I think either way you guys need to feed more food - especially if Twyla is semi-ravenous when it's time to eat, means she's hungry (typically)! (Luna is always ravenous no matter how much she eats).
     
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  23. Twyla17

    Twyla17 Member

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    the reading of 32 was at about 12:30am after a 8:30pm feeding/test/shot, with 4 hours of fasting in that interim.
     
  24. Sue and Oliver (GA)

    Sue and Oliver (GA) Well-Known Member

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    Where are you in the cycle right now? Can you get a test?
     
  25. Twyla17

    Twyla17 Member

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    we just tested her at 5:40pm and got 386. her highest reading yet. her last shot was at 8:20am this morning and her next anticipated shot is at 8:20pm tonight. she's been free-feeding through the day, but we hadn't given her much food prior to this last test because i thought she was supposed to be fasting for her blood test except when she was getting her shot. i thought that we were supposed to feed her, do the test, and then shot. but now i understand it is test, then feed, then shot if test is over, say 200. sorry we seem so dumb. i know we must seem like idiots....
     
  26. pevsfreedom

    pevsfreedom Well-Known Member

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    I would NOT give insulin again until you talk to someone (like Sue) about dosing. You might want to make a thread in Feline Health, the main forum, in regards to DOSING specifically. That # is far too low and extremely dangerous and is indicative of too much insulin being administered.

    You're definitely not idiots. An idiot is someone who knows their cat is diabetic and feeds them high-carb dry food and doesn't take them to the vet and doesn't give insulin. You're doing a good job and it's absolutely a learning process. I've only been doing this barely a month and had the same questions you're having. Exactly the same actually. Weight issues, how to take blood, when to shoot, etc. Hang around this forum for a week or two and you'll learn more then you ever wanted to know about diabetes, and then some!

    Essentially you want to test, decide on a dose, feed, and then shoot. Don't worry about fasting during any of this. Also don't ever give insulin without the cat eating a full meal before hand.

    You need to:

    1) Talk to someone about dosing. Do not give insulin again at the same dose without talking to someone experienced with PZI. Your cat could go hypoglycemic and potentially die. If you gave insulin today already please continue testing because we need to know if he drops under 50 again.
    2) Read about hypoglycemia - I linked a post in here somewhere.
    3) I would feed more food in regards to the weight loss. Follow the instructions on the can for starters, and I'd give 2 big meals a day with maybe a 1tsp in the middle of that day and that's it.
     
    Last edited: Aug 9, 2015
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  27. Sue and Oliver (GA)

    Sue and Oliver (GA) Well-Known Member

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    No, you seem to be very caring kitty parents who are trying to learn as much as you can, as fast as you can. This sugar dance has a very steep learning curve in the beginning and unfortunately most vets tell people to give insulin twice daily and come back in a few weeks. That discounts the possibility that the cat may not need as much insulin as prescribed.

    So, your 386 is nine hours after her shot, right? (We don't deal in time; I am very unlikely to be in your time zone. So that number would be +9) Unfortunately, it doesn't tell us much. It may be that she is fairly high and flat and the 32 was just a bad test. Or it may be that she dropped low early in the cycle and this is a bounce back up.

    What dose are you giving?
     
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  28. pevsfreedom

    pevsfreedom Well-Known Member

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    The "32" was 8/7 I believe. Do you have any other earlier values for today Joe & Suloni?
     
  29. Cat Ma

    Cat Ma Well-Known Member

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    @Twyla17

    There's a lot to learn here and it can be overwhelming. We have been in your shoes. You are already doing the right thing being here at FDMB.

    It will be helpful if you update your signature line (in your profile) with Twyla's date of diagnosis, the insulin you use, food you feed, and other medical conditions if any. That way others will readily see the info and be able to assist you better.

    Also very helpful will be to download the spreadsheet members use here to keep track of glucose numbers to help other members assist you with ProZinc dosing.
    Spreadsheet: http://www.felinediabetes.com/FDMB/...te-a-ss-and-link-it-in-your-signature.130337/

    If you need help creating the spreadsheet, there are lots of people here who will be glad to assist.
     
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  30. Twyla17

    Twyla17 Member

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    sorry, yes, 386 was 9 hours after shot. we are giving .5u Prozinc twice a day (every 12 hours). 32 was 4 hours post shot (night time shot), fasting.
    the prior value the night she was 32 was 230. those are actually the two lowest readings we have gotten from her. all other readings have been between 244-386.
    we've only been able to get one reading today as we had two previous failed attempts to get blood.
     
  31. pevsfreedom

    pevsfreedom Well-Known Member

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    Yes if you have 5-10 minutes the spreadsheet will be an invaluable resource to people helping you. It's easy to do.
     
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  32. pevsfreedom

    pevsfreedom Well-Known Member

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    With these #'s the "32' could have been a fluke. If you get a # that's kind of crazy low or high like that do a 2nd test to make sure. If you get a 32 again or anything under 50 for that matter you need to immediately feed some HIGH CARB food with about a TSP of honey and start testing every 10-15 minutes, and also post here for help. That's a seriously low # that needs correction.

    So you'd call that 4 hours post shot "+4", and feel free to drop fasting from your vocab for now :) (It's a little confusing).

    Wish I knew more about ProZinc but I don't - I would keep trying to test as much as you can until we figure out exactly how low this dose is putting Twyla, though you're past the 'window' for the AM cycle for today (first 12 hours after morning shot). Lowest point is typically between +4 and +9 hours. I would personally be skeptical of .5 u being given tonight until I find out if that 32 was a fluke or not.
     
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  33. Sue and Oliver (GA)

    Sue and Oliver (GA) Well-Known Member

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    Hmmm. It is hard to advise because we are operating in the dark with too little data. Not your fault - you are "pedaling" as fast as you can...

    .5 is a small dose. It should be completely safe in 300+ levels UNLESS she did drop into the 30s on that dose.

    Do you have any idea what her levels were initially when she was diagnosed.

    You should be about +10 - 2 hours before her pre shot test - so it's time to cut off the food.
     
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  34. Sue and Oliver (GA)

    Sue and Oliver (GA) Well-Known Member

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    Is the Natural Balance wet or dry?
     
  35. Twyla17

    Twyla17 Member

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  36. pevsfreedom

    pevsfreedom Well-Known Member

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  37. Twyla17

    Twyla17 Member

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    the Natural Balance is canned wet food
     
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  38. Sue and Oliver (GA)

    Sue and Oliver (GA) Well-Known Member

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    So not terribly high carb. Levels when diagnosed?
     
  39. pevsfreedom

    pevsfreedom Well-Known Member

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    Hi I think you changed a setting in your spreadsheet because it makes us ask for permission now. At the top right hit SHARE and get the link for 'Anyone with a link can view' and post that into your signature.
     
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  40. Twyla17

    Twyla17 Member

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    210 when diagnosed via complete blood panel test with vet. at the time she was on normal carb kibble, Purina One Vibrant Maturity.
     
  41. pevsfreedom

    pevsfreedom Well-Known Member

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    Spreadsheet is up and running and viewable.

    Head over to the Pro-zinc forum on the main page or Feline Health and make a post called something like "Prozinc dose advice". You'll get more eyes on what to do dose-wise.
     
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  42. Sue and Oliver (GA)

    Sue and Oliver (GA) Well-Known Member

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    So it was a fructosamine test? (If so, you probably wouldn't have gotten the results that day) Or a test on her ear that day?
     
  43. Twyla17

    Twyla17 Member

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    we got her blood results 2 days later. it was a complete blood panel test. the vet drew 2 vials of blood i believe. he had us follow up with the Purina Glucotest urine squares in her litter box. then he prescribed the Prozinc and we bought the glucose meter.
     
  44. Sue and Oliver (GA)

    Sue and Oliver (GA) Well-Known Member

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    So probably a fructosamine test. Here are the levels I found

    CatsFructosamine values (µmol/L)Normal non-diabetic cats190–365Newly diagnosed diabetic cats 350–730Regulated diabetic cats:Excellent control350–400Good control400–450Fair control450–500Poor control>500Prolonged hypoglycemia<300

    It doesn't look like she was in diabetic numbers, unless I am missing something. A 210 ear test at the vet would be considered low because of the possibility of vet stress, which can raise the numbers 100+points.
     
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  45. Twyla17

    Twyla17 Member

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    the blood was removed via vial from a syringe in her leg. it was a home visit as she can't tolerate a trip to the vet. the vet didn't have a glucose meter at the visit. we didn't know why she had lost weight at this point, which was the only reason we had called the vet (because she had gone from 8.5 pounds to 5.5 pounds over the past 6 months or so. at first we thought the weight loss was just due to old age.
     
  46. Sue and Oliver (GA)

    Sue and Oliver (GA) Well-Known Member

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    The other consideration is that she was on high carb food then. Now she is eating lower carb. Our Oliver dropped 100 points overnight when we switched from high dry carb to low wet carb.

    I am really conflicted. We don't want her terribly high if we skip the shot tonight. But it would be really nice to get a clean, non food influenced test in the morning and determine the dose based on that number.

    My advice tends to be conservative and is based on the premise that it is always best for the cat to be too high for a cycle than too low for a minute. (You can always raise the dose if she is too high, but once you shoot, there is no way to get the insulin out of the cat....) And the possibility of that 32 being a valid test is scary.

    You hold the syringe. What are you thinking?
     
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  47. Sue and Oliver (GA)

    Sue and Oliver (GA) Well-Known Member

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    Dec 28, 2009
    @BJM. 210 fructosamine test?
     
  48. pevsfreedom

    pevsfreedom Well-Known Member

    Joined:
    Jan 16, 2015
    I think it matters how much they are capable of testing tonight. If you guys can get a PM curve it be useful if you give the same dose. Otherwise I -might- consider skipping tonight and doing a full CURVE tomorrow on the same dose to see what's happening around +3, +4, +5, and +6 specifically. Please spend some time reading about HYPOGLYCEMIA as well.
     
  49. Twyla17

    Twyla17 Member

    Joined:
    Aug 9, 2015
    hello Sue, we'll give her a blood test in 30 min.
    (i think we are comfortable with not giving her a shot tonight)
     
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  50. pevsfreedom

    pevsfreedom Well-Known Member

    Joined:
    Jan 16, 2015
    That might be wise. Being too high is not nearly as bad as being too low. If you guys can shoot in the AM and get a test every hour or two tomorrow after the insulin is given it would be very useful. Please familiarize yourself with hypoglycemia incase he DOES go low (under 50 is low, under 40 is an emergency).
     
  51. Sue and Oliver (GA)

    Sue and Oliver (GA) Well-Known Member

    Joined:
    Dec 28, 2009
    I think that would be good. I would go ahead and get a test at your normal +12 time. It'd be interesting to see whether the food was making a big impact previously.

    So I would expect her to be high in the am, because it would be 24 hours since her previous shot. If you can get some tests in (a +2 is nice to see if she is dropping fast, maybe a +5 and +8 to see if you can find her nadir) it will help you figure out what is really happening. I would dose 0.5 and plan to do some testing. Sound doable?
     
  52. Twyla17

    Twyla17 Member

    Joined:
    Aug 9, 2015
    369 at +12
     
  53. Twyla17

    Twyla17 Member

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    Aug 9, 2015
    strangely, her 3 highest readings have been her last 3. could giving her insulin cause her body to not produce her own insulin? at 369 should we go ahead and give her her shot tonight at +12?
     
  54. Sue and Oliver (GA)

    Sue and Oliver (GA) Well-Known Member

    Joined:
    Dec 28, 2009
    Well, she didn't go up for the last 3 hours. Up to you. If you do give her the shot, plan to get a test in 2 hours and 5-7 hours after. Print off the hypo info, just in case

    It may be that she is very carb sensitive. My thinking is that she has been eating before those high tests and, if the 32 was "real", it was a fasting test. It may be worth your while to research some low carb foods - below 8% carbs - and see if that makes a difference downward in her levels. This vet has a great food chart on her website: www.catinfo.org
     
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  55. Twyla17

    Twyla17 Member

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    Aug 9, 2015
    are there some high-protein, low-carb canned foods that are particularly recommended for a cat that needs to gain weight? i guess ones that are preferably available without prescription. i guess the Natural Balance that we are giving her aren't as low carb as we thought they were.
     
  56. BJM

    BJM Well-Known Member

    Joined:
    Oct 6, 2010
    The Fancy Feast kitten turkey and giblet is an option, plus frequent small feedings.
     
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  57. pevsfreedom

    pevsfreedom Well-Known Member

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    Jan 16, 2015
    Not saying this is happening but if the cat goes -low- from insulin they can "bounce" almost like a rubber-band back up high from the liver basically releasing glucose to 'fight' the unexpected surge of insulin. It could be ~200-220 is the 'normal' uncontrolled range, and the #'s are getting quite low from the insulin (the 32 and perhaps a few other unseen #'s), and 'bouncing' back up to 300+. Could also be carb sensitivity like Sue mentioned. What makes me think this is

    Did you find the carb % for the food you're feeding anywhere online? Some brands/types are easier than others to find info on.

    If you shoot tonight get a +2 test and perhaps set your alarm for another one around +5. If the +2 is LOWER then your PMPS then you know she might 'drop' hard number-wise during the night and you need to be on the look out basically.

    Are you finding home-testing to be any easier? :)
     
  58. Twyla17

    Twyla17 Member

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    Aug 9, 2015
    341 @ 15 because there was no evening shot.
     
  59. pevsfreedom

    pevsfreedom Well-Known Member

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    Jan 16, 2015
    That's alright. Call that +3. Give the dose tomorrow morning and try running a curve, testing +2/4/6/8/10/12 if possible and we can see how low Twyla is really going. Good work!
     
  60. Twyla17

    Twyla17 Member

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  61. Twyla17

    Twyla17 Member

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    Aug 9, 2015
    thanks pevsfreedom and all of you. tomorrow we both have work unfortunately, but we'll test after work and at intervals thereafter. we still haven't gotten any better at taking her blood yet though. sigh....
    the fifth ingredient of her Natural Balance Indoor Formula is oat bran and the 4th ingredient of her Chicken & Liver is carrots.
     
  62. pevsfreedom

    pevsfreedom Well-Known Member

    Joined:
    Jan 16, 2015
    The chicken & liver is 13%, and the indoor seems to be 16%, both of which are much too high. You wanna use something under 10%, Friskies Pate is pretty good (minus Mixed Grill flavor) at 48 cans for $25 at most stores, and Fancy Feast CLASSICS is cheap and under 7% I believe, but your food is pretty much too high carb.

    The blood will get easier, trust me. Not sure what to say about work hours, etc. Hopefully this weekend you guys can run a full curve. I might even consider trying a lower dose (.25) tomorrow until you can get a few tests in +4, +6, etc. since you guys won't be home to monitor and by the time you're home it's probably past nadir - that 32 is a super dangerous number.
     
  63. Cat Ma

    Cat Ma Well-Known Member

    Joined:
    May 21, 2015
    @Twyla17, what size gauge/lancet are you using? Starting out, we suggest using a lower number such as a 26 or 28 gauge. It will help the blood come out faster. If you are using a higher gauge, say a 30 or 31 that comes with the meter, it can be harder and take longer to draw blood. If you do have the higher # gauge, you can try poking twice or more in the same place and see if that works.
     
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  64. pevsfreedom

    pevsfreedom Well-Known Member

    Joined:
    Jan 16, 2015
    It's in their sig, they're using 31/33 gauge, so a 26/28 might be useful.
     
  65. Cat Ma

    Cat Ma Well-Known Member

    Joined:
    May 21, 2015
    @pevsfreedom, adding the annotations to the video was helpful. The only thing I'd suggest is adding a note that a 26 or 28 gauge lancet is recommended starting out. Otherwise, a lot of newbies watching will assume to start with the 31 gauge.
     
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  66. Twyla17

    Twyla17 Member

    Joined:
    Aug 9, 2015
    8/10/2015
    8:00 am
    AMPS= 294 blood sugar
    able to produce blood after in two trys - with 31 guage lancet

    i plan to give 0.5pzi before i go into work..?


    Sue, & Pevsfreedom
    , should i give her her shot?

    we'll get new low carb food tonight
    (Friskies Pate or Fancy Feast kitten turkey and giblet)
    (8:15)we just gave Twyla the patte =2 table spoons because she won't eat the evo. low carb kibble.
     
    Last edited: Aug 10, 2015
    Reason for edit: wrong lancet size listed
  67. Jan Radar

    Jan Radar Well-Known Member

    Joined:
    Jun 27, 2015
    I don't know anything about this insulin but wanted you to know that someone is trying to help...
     
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  68. Twyla17

    Twyla17 Member

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    Aug 9, 2015
    thank you Jan.
     
  69. Jan Radar

    Jan Radar Well-Known Member

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    Jun 27, 2015
    From your spreadsheet it looks like you gave the insulin already... Is that right?
     
  70. Twyla17

    Twyla17 Member

    Joined:
    Aug 9, 2015
    no not yet
    i think i should give her .25.
     
  71. Twyla17

    Twyla17 Member

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    Aug 9, 2015
    i'll give her .25 and observe her.
     
  72. Jan Radar

    Jan Radar Well-Known Member

    Joined:
    Jun 27, 2015
    First I want to say that you are doing great with your crash course on Feline Diabetes. :) in the beginning, my learning curve was straight up but when I didn't feel so alone thanks to people here on FDMB it was so much easier to study. :)

    I don't know if you've noticed that there are several areas to this message board. The area you are posting in now is the introductions area. There is also a "Feline Health" area, which is actually considered the "main" discussion area. Another area that's important to know about is groups of people who are all using the same insulin. The reason I mention this is because when you need help, you will get more assistance -more eyes if you will- by posting in the Main feline Health area. I think when dosing advice is needed it's a good idea to talk with others who use that same insulin. I hope this is making sense to you. Keep up the good work. :)
     
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  73. Jan Radar

    Jan Radar Well-Known Member

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  74. Twyla17

    Twyla17 Member

    Joined:
    Aug 9, 2015
    Jan- we'll start using the Main feline Health area board today.

    i gave Twyla .25 and am observing her. she is not behaving differently so far.

    we are so grateful for the support of you all on FDMB.
     
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  75. Sue and Oliver (GA)

    Sue and Oliver (GA) Well-Known Member

    Joined:
    Dec 28, 2009
    I think .25 will be fine. 0.5 could have been fine also, but if you aren't there to monitor, the lower dose is likely best.

    Interesting that she did not go high overnight even without insulin. Normally we'd see a very high amps without insulin for 24 hours. It'll be interesting to see how lower carb food affects her levels.
     
  76. Sue and Oliver (GA)

    Sue and Oliver (GA) Well-Known Member

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    Dec 28, 2009
  77. pevsfreedom

    pevsfreedom Well-Known Member

    Joined:
    Jan 16, 2015
    I think I would have done the same thing. We wanna find out if that "32" was a fluke or not and since you won't be home to test I think this is safest, like someone mentioned a high number for a few hours is better than a (very) low for a few minutes. You'll get more eyes over on Main Health or the ProZinc forums.

    I agree. I kind of think the yellow #'s are her more normal range, with the pinks being indicative of bouncing up from wherever low she's going.

    Do try and run a curve the next day you guys have off. Good job grabbing some new food.

    This cat food chart is fantastic:

    http://www.catinfo.org/docs/SortableCatFoodChartCatinfo.org2-22-13.htm

    Find anything under 10% carbs basically - Friskies Pate and Fancy Feast Classics are probably the two cheapest and readily available.

    You guys are doing great. Also someone mentioned to try 26 or 28 size gauge lancets - might make your first few weeks of 'poking' easier since they're bigger.
     
  78. Cat Ma

    Cat Ma Well-Known Member

    Joined:
    May 21, 2015
    As Sue suggested, it is best to post in the ProZinc forum. Sue gave you the link above. There are experienced members there who give their cats ProZinc and will be able to guide you with dosing-related questions.

    You could post in the General Forum for suggestions on what to feed your cat because she's underweight. BJM and others here gave some good suggestions. It's always helpful to have more members, who wouldn't normally check here, advise for this issue.
     
  79. Shiloh & Rhonda

    Shiloh & Rhonda Well-Known Member

    Joined:
    May 9, 2015
    @Twyla17 , no dosing advice from me. But I did want to address your original question. First I have a tortie as well. Is is that you are having trouble getting blood, or having trouble seeing it? Both will improve with time. You also mentioned any other testing sites. I know some test from the paw pads. If Twyla will let you mess with her feet, it might be easier.
     
  80. Twyla17

    Twyla17 Member

    Joined:
    Aug 9, 2015
    Shiloh,
    7:20pm Twyla ate 2 table spoons of new low carb we food we just bought after work
    8:20pm blood test with 28 gauge lancet -worked on 3rd try.
    8:20pm PMPS 348

    Yes, i am very hesittant to give her insulin .5 or .25 shot that's she's due for right now 8:28

    i will go to the PROZINC forum now.
     
  81. BJM

    BJM Well-Known Member

    Joined:
    Oct 6, 2010
    From a pre-shot of 230, with 0.5 PZI , she dropped to 32 previously!
    I would be very, very cautious in any dose.
    The higher numbers you've seen may be due to bouncing, that is, due to a low number triggering the release of stored glucose (glycogen), which zooms it back up.
    You might want 12 hours to see if it settles down. Also, dose adjustments are made based on the nadir, the lowest glucose post-shot, NOT the pre-shot tests (those are to make sure it may be safe to give insulin).
     
    Last edited: Aug 10, 2015
  82. Twyla17

    Twyla17 Member

    Joined:
    Aug 9, 2015
    thank you BJM
    i am scared to give her prozinc, i will not do so until we can determine the nadir"the lowest glucose post-shot"
    we'll try and do her full PMPS +1 through +11 tonight
    and no insulin tonight
     
  83. Twyla17

    Twyla17 Member

    Joined:
    Aug 9, 2015
    Twyla was a careful neat water drinker just 3weeks ago.
    The past week i have noticed her mouth chin cheek area fur drenched with water.
    after she drinks.

    Could it be that she is just exhausted and can't keep her-self poised
    are her whiskers not registering the water depth.
    i don't think my vet will know the answer.

    we are not noticing extra urine, clumps look the same amt. in the litter.
    we are not noticing more than usual water consumption.
     
  84. Cat Ma

    Cat Ma Well-Known Member

    Joined:
    May 21, 2015
    My first thought was excessive water consumption but since you state that is not a factor then I am wondering if she may be drooling due to a dental issue.
    I'd suggest having the vet look at her.
     
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  85. Twyla17

    Twyla17 Member

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    Aug 9, 2015
    the vet said her teeth did not look great when he visited 7/24,
    but that he was not worried about this at her age.
    she does not drool,
    i see her drink and see her getting her face into the water.
    she was not doing that last month.
     
  86. Cat Ma

    Cat Ma Well-Known Member

    Joined:
    May 21, 2015
    Dental issues can contribute to increased glucose levels and infections. That's why dental cleanings are strongly recommended for sugar cats. A member here had her 20 year old sugar cat's teeth cleaned in April.

    Other than the way she is drinking water, have you noticed anything unusual? Is she lethargic? Does she have difficulty walking? I am wondering if diabetic neuropathy might be involved.
     
    Last edited: Aug 10, 2015
  87. Twyla17

    Twyla17 Member

    Joined:
    Aug 9, 2015
    we could ask our new house call vet again for a cleaning
    i asked him if we should brush her teeth and he said he didn't think so.
    i don't know ;-( maybe i should get a new vet who will come to the house....

    she is not active. she seems very tired.
    she is slow and wobbly.
    4 years ago we took her to have her thyroid gland destroyed because - she was hyper thyroid
    she seemed a bit wobbly ever since then yet still able to jump up on counters and jump back down
    play & run away from me
    fight with our younger cat
    she had spirit and she was stronger than she is now

    during the last 2 months we've seen a decline in her "normal" energy levels.
     
  88. Twyla17

    Twyla17 Member

    Joined:
    Aug 9, 2015
    "neuropathy generally resolves once good glycemic control is achieved"
    http://veterinaryteam.dvm360.com/managing-complications-diabetic-cats
    i just read about the diabetic neuropathy in the link above.

    maybe Twyla will have smoother gait if we can get her blood sugar normalized.
    the vet told us that she is not an extreme diabetic.
    her blood glucose level was in the yellow range 210 when he did her blood panel a few weeks ago, July 24 2015.
     
  89. Nancy & Cootie (GA)

    Nancy & Cootie (GA) Member

    Joined:
    Oct 16, 2014
    Were Twyla's thyroid levels also checked recently? After my Cootie had radioactive iodine treatment for hyperthyroidism, she developed hypothyroidism. I couldn't get her blood sugar regulated until she started meds for the hypothyroidism.
     
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  90. Twyla17

    Twyla17 Member

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    Aug 9, 2015
    yes, during the week of July 24th the vet did a full blood panel and found completely normal thyroid levels
    kidney function fine
    every thing's in normal levels, except the 210 blood sugar.
    thank you for your concern and trouble shooting, everyone.
     
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  91. pevsfreedom

    pevsfreedom Well-Known Member

    Joined:
    Jan 16, 2015
    If it is (I don't know) a dental issue teeth cleaning (like home brushing) won't help, you'll need to bring the cat in and actually put her under to get the teeth cleaned. Drooling and slopping water can be a symptom of dental issues, but unless your vet specifically thinks dental IS a problem I don't know if I'd worry about it.

    You guys said you're switching foods right? I honestly think you might want to switch to the FF classics (4-5% carbs I believe) and NOT give insulin for 1-2 days, and try and get a curve during this time to see how she reacts to the lower carb food. It could be the 15-20% stuff you used before was making her BG's jump and she could barely need any insulin if any at all if she's diet controlled. 210 is not a painfully high number, and if food was an issue I'm interested if insulin is truly necessary, or if at least a good reduction is warranted.
     
  92. Twyla17

    Twyla17 Member

    Joined:
    Aug 9, 2015
    pevsfreedom,
    yes we switched foods since last night.
    joe got us the" BFF best feline friend " and "EVO the ancestral diet" canned foods based of the Forum food chart.

    we should get FFclassics if the carbs are lower than in BFF & EVO (?)

    Twylas reading this morning was 295 AMPS.
    She has finished eating her morning meal of BFF

    she growls and trys her best to escape when blood test time comes.
    i wonder if her blood sugar is higher than 210 because the blood test is stressful


    We won't be able to do more tests until 6:00 in the evening.
    So is should not give her .25 shot of the morning, and wait till the weekend for resuming shots - after curve #s that support the shots decision/or not?
    "NOT give insulin for 1-2 days, and try and get a curve during this time to see how she reacts to the lower carb food."
     
  93. Twyla17

    Twyla17 Member

    Joined:
    Aug 9, 2015
  94. Sue and Oliver (GA)

    Sue and Oliver (GA) Well-Known Member

    Joined:
    Dec 28, 2009
    I don't know what to tell you, Joe. It is looking like the 32 was a fluke or a bad test and that she tends to run in the 200s on her own. If that were the case, .25 should be fine. But it is always scary to give a shot and leave. On the other hand, I hate to see you wait 4 days before giving insulin twice daily.

    Is there a chance that you could set up an alarm and get a number 5-7 hours after the shot overnight tonight? Or, are you a certain age like me, and get up about the that time? It would really only take one nadir number to let us see how low she really goes.

    Do you give her a treat after each test? That is what really makes the process work; they come to want the treat more than they worry about the poke. PureBites are popular low carb treats at our house.
     
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  95. pevsfreedom

    pevsfreedom Well-Known Member

    Joined:
    Jan 16, 2015
    Lower the better basically, you guys can use whatever you want that's under 10%, or 5% preferably, that isn't too expensive to maintain regular use. And I agree with Sue. Could you guys set an alarm for 3am maybe this morning like she mentioned to try and grab a nadir test (around +4/5 probably)? Otherwise I think I'd feed this new super low carb food until this weekend and then see how things are. If she's still running yellow all day perhaps do .25 sunday morning and get a curve for the day. People in your prozinc thread might have more info for you. you guys are doing good - it's just hard to advise without more info re: how low twyla is going. And Im sure it's hard for a 17 year old cat to start getting his ears poked! you guys should get used to it soon and he should too. if he likes meat we gave luna small slices of 0 carb deli meat every time after she tested as a reward for a few weeks.
     
  96. Twyla17

    Twyla17 Member

    Joined:
    Aug 9, 2015
    Twyla is at the emergency vet overnight. she was very weak today, and not eating, and throwing up mostly water.
    We took her to the emergency vet because we didn't want to wait for her vet appointment tomorrow. They did tests. they said her glucose was over 600. the test they showed me didn't have a specific number, it just said ">600". they said that we couldn't trust home tests and that home tests aren't calibrated for pets. they said we had to leave her or she would likely die. she is on IV fluids. i took her blood when i got home from work today and her glucose was 293. frankly, i trust you people here more than i trust an emergency vet i don't know, but we are torn every which way. i don't know if they said she had ketones or just assumed she did. they said her potassium was low, for comparison, her potassium was 4.9 on 7/22. she is on IV fluids with potassium. she is getting phosphorus. they said she was acidic. i'm just trying to remember the things the vet said. they gave her an x-ray and are planning on giving her an ultrasound tomorrow. they are giving her antibiotics. so far it's costing us $1650. i guess we're going to try to sleep now. thanks for your kindness and concern.
    joe
     
    Last edited: Aug 17, 2015
  97. Twyla17

    Twyla17 Member

    Joined:
    Aug 9, 2015
    we just got an email of her bloodwork from the emergency vet. things that were out of range from their in-house bloodwork are
    BUN 73.2
    Calcium 7.8
    Glucose >600
    Cholesterol 216
    Sodium 165
    Potassium 2.5
    LYM 0.10
    NEU% 94.5
    LYM% 0.9
    EOS% 0.9
    MCV 60.4
    pH 7.029
    PO2 43
    Base Excess -19
    HCO3 11.5
    TCO2 13

    handwritten
    PCV 34
    TP 9.8
     
  98. Cat Ma

    Cat Ma Well-Known Member

    Joined:
    May 21, 2015
    I am so sorry to hear to hear about Twyla's setback. I know this is a very hard time for both of you. Yes, home testings are more accurate. Illness, infections and stress can raise BG levels. You both did the right thing taking Twyla to the ER. Please get some rest and keep us updated. We care.
     
  99. Cat Ma

    Cat Ma Well-Known Member

    Joined:
    May 21, 2015
    @Larry and Kitties @BJM are you able to advise?
     
  100. pevsfreedom

    pevsfreedom Well-Known Member

    Joined:
    Jan 16, 2015
    Truly sorry about all this. You guys must be a wreck. I hope Twyla is ok and they can figure out what's going on. Please call them and ask about ketones tomorrow, this sounds like a DKA crisis. If they didn't check please ask them to (for ketones, it's easy test) and ask if it is ketoacidosis.

    As far as 'not trusting a meter', that is ludicrous, plain and simple. Human meters read exactly the same as pet meters, they just use varying reference ranges. @BJM's signature how good info on this. For reference Luna rises 250+ points at the vet.

    DKA:
    Link: http://petdiabetes.wikia.com/wiki/Ketones

    Treatment involves fluids and flushing out the ketones and is quite a big deal. I hope Twyla pulls through.
     
    Last edited: Aug 13, 2015

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