another night of low numbers

I checked Lilly tonight preshot tonight her number was 100. She has not had a shot since last night at which time I gave her 1 unit and then had a reading of 64 and then 68. So I called BJ here from the board who has much more experience with these matters. After much discussion I did not give her a shot tonight and will test her in the morning.
She is much more energetic than normal and eating better tonight. I am just going to keep an eye on her tonight. Thank Goodness for BJ, I would never get a hold of my vet at this hour. Thank you again BJ for your help and patience.

Terri

 

That's wonderful you tested before you gave her insulin and I think you got wonderful advice to not shoot.

How long has Lilly been on insulin?

I read your previous posts about your vet. Remember you are the customer giving them your hard earned money, yes they have degrees but that doesn't mean they know everything. Picture your doctor telling you that you have diabetes and not to check your blood sugar and just shoot on time every day. Would you question the doctor? Would you get a second opinion? Would you take matters into your own hands and decide that testing is the way to go? It can be the same for Lilly.

When Raja was first diagnosed the vet I saw was rude, talked down to me and anytime I tried to say anything he would cut me off. He told me it was unnecessary and borderline animal abuse to test Raja's blood but I ignored that piece of advice, found this site and started home testing.

Also from reading your previous posts you said Lilly is hard to test. It will take time and patience but I bet Lilly will get better as time goes on. Make sure you praise her after you test her and give her a treat, I prefer bonito flakes (dried tuna) and the ONLY time Raja gets them is after I test her blood. She now comes running and tells ME when it's time to test because she wants her treat.

I always tell people to try to paw test. Raja HATED HATED HATED me touching her ears but she handled her paws so much better. Of course it wasn't easy the first few times but she took too it fairly quickly and now she doesn't mind it at all. Feel free to click the youtube links in my signature, I uploaded videos of me testing Raja's paw

 

good with the testing and i agree, no shot.

theoretically you could test again in a bit and see if kitty is higher or gets high enough for a shot but given the aversion to testing still on kitty's part, and the good numbers, i don't think i'd bother kitty with it tonight

 

its morning and test today preshot was 85. I am not giving her a shot this morning either, not sure whats going on here. She has not had any insulin since Sunday night at 1 unit. She seems much more like herself and feisty like she used to be.
I am not sure if I should try to call the vet or not. Knowing the vet she will tell me to go ahead and give her the shot anyway.

Terri

 

Do we have an OTJ party to plan????
I am thinking perhaps! Go LILLY GO! :dizcat

 

yep, another no shot morning. and what's happening is called remission. if your vet told you to shoot that and you did, they quite possibly could be responsible for kitty's demise. fingers crossed the good numbers continue

 

How long has she been on

If Lilly can go 14 days without insulin she is considered in remission. I can't tell you what to do but we are in our 3rd day without insulin and I plan on waiting until we've reached that milestone before I will say anything to my vet.

 

Heather

I just talked to the vet and heres what they told me go a head start her back on her insulin at 1 unit in the morning and one at night. Mind you here are here numbers. 9/25 after shot of 1 unit 64,68, did not give shot monday morning or test had early appointment. Monday night 100 pre shot, so no insulin, this morning 85 preshot so no insulin, she has not has insulin for almost two days and her numbers are looking good. Yet they are telling me not to pay attention to these numbers and give the insulin anyhow. Sure would like some opinions on this, she is on Lantus.

Terri

 

It's possible she needs a bit more insulin, but it's also possible she's reached remission. I don't agree with your vet--you don't have enough data to support shooting insulin those low numbers. If her blood sugar starts to creep back up you may need to give more insulin, but a reduced dose. 1u seems to be too much. However, if she's giving you normal numbers after 2 days without insulin, I think chances are good that she won't need more insulin. Keep testing, and that will help you know what to do.

I do not think you should shoot unless you see a diabetic number (these are all normal numbers so I say wait and don't shoot right now), and even then it should be reduced dose, not 1u.

 

I say no shot as well! WTH?????

 

What high numbers would I be looking for in order to give insulin again over 150? I am to the point I do not trust this vet anymore. I don`t want to kill my own cat. She has been acting normally for once.

 

I believe the 200 range. More will pop in and advise as we (Sugar Bean and mommy bean) were only shooting for a very very short time. I know that I decreased my 1 unit to less than .25 - eyeballing that. My spread sheet shows the numbers when I was shooting.
No shot please is my advice.

 

In general, we consider a cat in remission if their numbers are between 40-120 (with the majority of the time in double digits) without insulin, for 2 weeks. She certainly seems headed that way. If you feed her and her numbers go down, that is a sign her pancreas is working.

One way to influence these lower numbers without insulin is to experiment with food. If she is eating 8% carbs, try 4% and see if that helps move her numbers down. Works for some cats -not all.

If you get a 150, feed her and see if that brings the number down, without insulin.

 

Exactly!

there's a good chance she hasn't needed insulin for awhile if you ask me. "acting normally" can mean she was acting abnormally because the insulin was making her feel like crap because she didn't need it.

i'd like to ask your vet if they even know what normal glucose levels are. clearly they don't or they discount the use of home monitoring, which shows they are not up to date on the latest treatment protocols. there are links around here somewhere for articles from leading treatment centers about low carb diet and home monitoring being the best way to treat feline diabetes. i'm sure someone could find the links so you could forward them to your vet if you'd like.

 

I would print this out and give it to the vet, although at this point you may not need their input anymore anyway if she is going off insulin. However, it might be good to pass it along so they will recommend the right treatment for their next diabetic cat patient.

 

I'm so sorry that your vet is giving you such advice. I'd bluntly ask if they'd inject insulin into themselves or their child at non diabetic numbers without testing! WTH! Honestly!

 

I would say if the numbers are consistently above 150, you may need to give a touch more insulin. If you get one 150 or 160 and the rest are still mostly in the double digits, I would wait and see where she goes. Bandit had a few slightly higher numbers both times he went into remission, but eventually they evened out and he stayed in his normal range.

 

Even if you add 30 points (the approximate difference between a human glucometer and an animal specific glucometer), she is under 150.
here's the math:
64 + 30 = 94
68 + 30 = 98
100 + 30 = 130
85 + 30 = 115

And even if you also add 20% to your meter values (the amount of variability allowed by the FDA), the numbers would look like this:

64 + 12.8 + 30 = 106.8
68 + 13.6 + 30 = 111.6
100 + 20 + 30 = 150
85 + 17 + 30 = 132

You've barely reached 150, the 'no shoot' number for folks with a lot of data.

Monitor how much she is eating; a possibility is that she isn't eating as much if she is ill.

If and only if she goes up to or over 200, I'd suggest no more than 0.5 (1/2) units and if you can, squeeze out a drop and make it more like 0.25 units, OK?

And I think it is time to change vets - my vets office now has extended Saturday hours, and there are other vets with Saturday hours, so if time is an issue due to your mom, I can come down, pick her up, and take her there, if you need me to.

 

BJ

Thank You, I am getting sick with bronchitis or something and trying to deal with this. My mom`s friend Nancy had a bad experience yesterday with my vet where she has taken her cat and is not happy with them either. She is going to visit my mother today and is going to stop along the way and check out one of the vets you recommended to me the Canal Winchester vet and talk to them about both of our situations and I will stop as well when I get to feeling better.
Anyhow they told me to keep giving Lilly insulin anyhow 1 unit morning and night even though her numbers look good. What the hell? I am new to this and find this all very conflicting. Its like going against what a medical doctor tells you. You would think the doctor would know best.
I am at my wits end. She basically told me not to pay any attention to the numbers its not like human diabetes where you keep adjusting the dosage.

 

I know it is tough to get conflicting information, and you have so much else on your plate. All we can say is that your vet is wrong, but how much help is that? It comes down to you making a decision based on your instincts. You are testing, you can see whether she starts going up or not after missed shots and then make a decision. If she's showing nondiabetic numbers, you ARE NOT HURTING HER by not not giving insulin. Make sense?

 

Terri,
You would think the doctor would know best and I understand that frustration. But they don't always know best. The comment that troubles me is the "don't pay attention to the numbers, it isn't like human diabetes where you keep adjusting the dose". I don't get that. In a way, she's right - it isn't like human diabetes. Cats can go into remission, while I don't think that happens with a human diabetic. But just like any condition that meds get prescribed, it just seems stupid to not consider adjusting a dose if the patient improves. If you aren't supposed to pay any attention to the numbers, then why do they if you bring her in for a BG test? It sounds more like "Don't you worry about it honey, leave the doctoring to us!"

The ONLY thing that stops me from telling you to toss everything the vet is saying out the window is that I am not a Lantus user or expert. It's that whole "shed" concept that I don't quite grasp. If it were PZI where the insulin is depleted and not stored, I'd tell you to quit immediately. The way I understand it, Lantus has a "reserve" that kitty stores, and it gets used up as needed, and when you dose the cat, you replenish that "shed". I don't know how long it takes for the shed to get emptied when you skip shots - a day, two days, longer? Likewise, when the shed is empty, how long does it take to build it back up?

My hesitation is that I don't know if Lilly's continued low numbers are being influenced by whatever lantus may still be in her system, or if all of it has cleared her system. If it has cleared, then the low numbers are being kept low by Lilly on her own, which is what I hope is happening.

All that said, you've gotten feedback from people with lantus experience in this thread, and I'm sure they know what they are talking about. They know the protocal. And it seems pretty universal that they are telling you "no shot".

I really try not to be a vet basher. It's best when the vet either has a great deal of FD knowledge, or they will at least climb on the bandwagon and learn something that they can pass on to future patients like mine did. But in this case, I think your vet is giving you some crappy advice. I personally would not shoot Lilly unless you see a couple tests in a row that are out of the "normal range" that can't be explained by anything other than she isn't quite ready yet. I'd resist even thinking about insulin on any number below 150.

Can anyone who understands the "shed" explain the time frame in building it up and using it up?

Carl

 

Lantus in the body - the basic concept:

When Lantus entires the body, the slightly acid nature is neutralized by the body.
The result is small crystals of the Lantus; this is the 'shed' or 'depot'.
Over time, the body dissolves these small crystals, allowing the insulin to work.
It takes roughly 24 hours to completely clear.
We dose every 12 hours, because the amount left at 12 hours tends to be too low to control the blood glucose level.

 

I'm just going to have to quote what everyone else says and tell you that if Lilly was my cat I wouldn't give her insulin with her numbers so low. If you would like click down at my signature where it says Raja's SS and you can see her numbers, they aren't too far off from yours and I am not giving her insulin. This is our 3rd day without insulin and I feel confident enough with her numbers AND how she is acting ie not peeing near as much, not drinking the entire bowl of water and then going to the toilet to get some more, not inhaling her food that I think at this moment she doesn't need insulin.

I know it's hard to go against their wishes but ultimately YOU are in charge of Lilly and Lilly's care. It sounds cold hearted but Lilly is just another cat to them, if they tell you to dose her and you do and she goes into hypo and you have to rush her to the vet who is going to pay those bills? Do you think they will cover them for you? Do you think if Lilly ends up needing to stay overnight and tons of blood work they will just forgive that bill?

I say listen to your instincts, you've already questioned your vet which to me tells me that you don't have confidence in their level of care with Lilly, and your friend also had some problems with the vet. 2 people that dislike a vet is to me a reason to be cautious and to look for someone else. Call around and talk to vets, you don't always have to go in for an appointment. I didn't with Raja. When I decided to fire the vet who diagnosed Raja I called several vets in the area and asked questions and went with the one I felt most confident in.

 

Heather

I just looked at Raja`s spreadsheet and yes now I am understanding. Her numbers are close to Lilly`s and my cat has not yet had a shot since Sunday night. Lilly never had real high BG before she started the insulin, her numbers were in the mid 300`s. I did go with my mom`s friend Nancy to see about a different vet today she is taking her cat tomorrow at 2:00 so I will see what she has to say about the new vet. I talked to a lady in the waiting room who had been bringing her cats into this new vets office since they opened and asked her many questions about them. She was informative and said she did rescue work and brought her cats to this vet and this vet had treated some of her diabetic cats.
I will see what tonight brings when I test Lilly. I am sure I will be back on this board asking someone for advice.

Terri

 

Just wanted to say what a gooood mommy bean you are! and Lilly is so lucky to have you as a mommy bean! I am glad she found you for her. :razz:

 

The new vet sounds promising!

When I was interviewing new vets I asked them point blank how the felt about home testing and if they had heard of this board. Only one said she had and she was perfectly fine with me testing and she actually talked to me like a person rather than just a crazy cat lady. I loved her and she was wonderful, I recently moved and went back to my original vet (not the one that diagnosed Raja the first time) and I'm just as happy.

If you decide you like this new vet you'll need your records transferred, the old vet can fax the records for you.

 

Lilly is at 128 tonight so I would guess no shot again? She does not seem though like she feels very well tonight. Not as energetic and feisty. We will see what tomorrow brings. I hope she is not going to start creeping up again.

Terri

 

at this point i would say no shot. what you could do is feed a little food and then test her in a couple hours i think it is and see if she's gone up or down. if she goes down, that's proof her pancreas is working. if she goes up, then the pancreas is being lazy and you might have to help again with some insulin.

 

I think there is something else going on with this cat. She is wheezing so bad you can hear her breathing clear across the room and now she has started coughing. I think possible heart disease? Not sure she is almost 13 years old and for years the vet had her on Depo Medrol for skin problems, I think thats what caused the diabetes.Could be asthma too, but the vet said her lungs sound clear so I am not sure.
How do you detect heart disease in cat?
Terri

 

What Cindy said is what I did the other day with Raja. I checked her BG and she was up to 127 so I gave her some food and checked her BG 3 hours later and it was at 84.

If you can test her in 3 hours that would probably be helpful in determining if her 128 was a fluke or something to think about.

 

it could indeed be a heart problem.

but, breathing issues are not something to mess with and my first response to your post is she needs a dr, now. can you get hold of that new vet? is there an er around? if she is having fluid buildup, she can choke to death. gonna see if i can round up some others to get their opinion in a hurry

 

she has been wheezing like this for awhile. She was just at the vet recently.

 

so the wheezing would be considered normal for her? and the coughing? does it appear she can still breathe?

i have a heart kitty and when he gets to open mouth breathing/wheezing/coughing i have to stop him cause he's over playing and take him outside to get him to calm down and get some fresh air and get him breathing right again. unfortunately with him his heart is going to be his demise and he doesn't realize it so he overdoes it sometimes.

 

she just started coughing a bit which is not normal. How is heart disease detected? As I said she is almost 13 and plays very little anymore.Yes I think she can still breath but it looks sometimes like she is having a hard time.

 

my baby's was detected because he was breathing so rapidly that it looked like you were seeing every heartbeat. we caught him, got him to the vet and found out the poor guy was born with a bad heart. she could hear a bad heart murmur. we then had an ultrasound done to determine how bad his was and it showed the defects with his heart.

my kitty is a baby though so not sure if it's different in older kitties

 

They did tell me awhile ago they heard a murmur in her heart I think when she was in the hospital with pancreatitis. So I guess I would assume she does have heart disease? They have not told they have heard it since.

 

Heather

How is Raja doing tonight? How is BG. Hope all is still going well. I have to say I watched your video of paw testing and about passed out. I break out into a sweat every time I have to poke Lilly`s ears.

Terri

 

Lilly was at 104 this morning. So far so good. she has not had a shot since Sunday night. We will see how everything goes.

Terri

 

Raja was great tonight and this morning. Lilly is doing great! Go Lilly go!

Those videos were shot about 6 months after testing. I had to have help holding her down in the beginning. Raja was feisty!

 

WAY TO GO LILLY!!!
How is her breathing?
As far as heart disease, my Gumpy girl was fine for 14 yrs. One day, she had a seizure out of the blue, rushed to er, kept all week end. She had very high blood pressure and heart mumur. It quickly went downhill from there with many seizures, and strokes. Lots of meds and finally to the bridge. :cry: With all of that said, one of the tests we did was the ultrasound to see how bad the heart was. And some blood work that led us to believe the muscles around her heart were thicker than normal. If you would like to to find out what that was, I will be happy to look up her information for you. I received her blood work from the vet, and noticed a high count and started researching. That is one of the reasons I decided to do the ultrasound.
Gumpy also received some medication for her labored breathing. This med was a saver for her for over a month as she was able to breath more normal and seemed to have more energy.
Wishing Lilly luck!

 

Awesome! Go Lilly!

 

Terri,
Congrats on Lilly's numbers! I hope she is heading for remission, too. It sounds like it....Missy was way more playful and feisty when she was in remission.
I had a cat with congestive heart disease. He would breathe shallowly and rapidly.....caused by fluid building up around the lungs. He was diagnosed with ultrasound and echocardiogram. His congestive heart disease was a thickening of the back wall of his heart, probably caused by a virus. Because the heart was thickened, it could nt pump properly and that caused the fluid build up. We had him on furosimide (sp?) and would periodically take him in to have he fluid drained. He had a fairly good quality of life for a few years with it. ( he was 18 years when he passed) Congestive heart disease is treatable, but inevitably fatal.
I can't say with certainty that is does NOT cause wheezing or coughing, but that is not what we saw in his case.....just shallow, rapid breathng.
Mares and Miss

 

I already have another cat that had to be rushed to the emergency ER right around the 4 of July.His blood pressure was so high they were afraid his retina`s were going to detach and he would bo blind. His pupils were huge. He is my heaviest cat weighing in a hefty 22 lbs.
I am praying that Lilly does not have heart disease. I have an appoinment to take her to a new vet next Thursday at 2:00. The only problem I am going to have is I have 3 old cats and I do not have them vaccinated anymore, they never leave the house unless in a cat carrier.
All new vets want cats to be current on vaccines. I really don`t want to have Lilly vaccinated at this point, I feel she is to fragile and some of those shot are nasty.

Terri

 

i wouldn't want to risk the vaccines either. and maybe the new vet will be up to date on the concerns about vaccinating, and the revelations in recent years that we've been over vaccinating, and won't push it. my vet doesn't push anything beyond the kitten series for instance yet i have a customer who is a vet who does mobile vaccine clinics 90% of the time and barely anything at his clinic, handing the daily work over to someone else there.

just speak up with your concerns about their age, their other illnesses, vaccine associated sarcomas, and that they don't go outside and i would think any vet would understand.

even my customer that's a vet respected my decision to no longer vaccinate my cats once he found out i had already lost one kitty to vaccine associated sarcoma. and we don't really discuss what he does too much because of it as i think he knows it doesn't sit well with me.

 

Raja is 16 yes old an except for her first round if shots when she was a kitten and one other time she hasn't been vaccinated.

Just keep in mind the vet is giving you a service and you don't have to agree with everything. You can explain your reasonings for not vaccinating her and hopefully they will understand. After explaining that raja is 100% indoor and old and diabetic I've never had a vet say she has to be vaccinated to be seen.

I hope the vet visit goes well tomorrow and y'all figure what's wrong with lilly

 

Terri,
Cindy is right.....talk to your new vet about it. When our old man, Kid, was sick with the cardiomyopathy, I asked our vet about not vaccinating him, as well. Fortunately, we have an awesome vet and she said she didn't think there was any point in putting him through that.....and we didn't vaccinate.
If they are concerned about your cat's comfort and not all about the money, they should agree, esp. since she is not an outdoor kitty.
I hope that this vet proves better than your last one! I have to say I was amazed at some of the advice. When Missy was dxed, before we left our vet's office, we were hooked up with a meter (yes, she made money selling me the AlphaTrak) shown how to home test, given the URL for Binky's page, talked to about low carb, wet diet (she encouraged us for some time to go to wet food, but I resisted thinking it was better for their teeth....my bad! :roll: ) and told about this board.
I have found, with my MS, that you sometimes have to hunt to find the right fit with your doctor. We applied that to our furry kids when we didn't like our previous vets handling of our cats. Out current vet, while running a business, is obviously concerned for our cats health and comfort. Money is not the primary concern.....and that is what I am looking for. AND, she has been so supportive with ME through all of this....calling, answering questions by email....ensuring me, that as Missy's advocate and mouthpiece, that I am doing my job and my questions are expected. So, I hope you find this new vet to be along those lines.
The thing is, YOU (and your kitties) are the customer......and your vet has a job because of you! You have every right to do what you think is best for your critters. Nobody knows LIlly like you do, even if they have a degree in veterinary
medicine. They can guide you, but ultimately, you know what is best for Lilly.
Ok, I am off my soapbox. :? My fingers are crossed that your new vet is closer to the one we have!
Mares and Missy

 

I will not be able to take Lilly to the new vet. They do not take Care Credit. So I will have to call and cancel that appointment, What a damn shame. My mom`s friend Nancy just took her cat there for the very first time today for chronic constipation and they seemed to know what they were doing and she liked them but could not use her care credit either and had to go draw money out of her savings to pay for it.
So I looked through the list of vets that take care credit and none of them are very desirable. So I am stuck with what I have or try another one that may be just as bad.

Terri

 

Mares,

Thats why I am always on this board because I have no idea what I am doing, cat newly diagnosed, uncooperative vet, me ready to pass out every time I have to poke Lilly`s ears for testing, literally I break out into a sweat. Now her numbers have been down and my vet told me to give her insulin anyhow,WTH? Thank God for BJ who I have called for help and the people on this board who have been there to help every time I needed it.
Sounds to me like you had a really good vet. Had I had a vet like that I think things would have been a whole lot easier. They did not agree with me about feeding her the Fancy Feast, never heard of this, tried to send me home with DM which she won`t eat and I can`t afford, did not want me home testing, would not show me how to test. Told me to keep shooting with insulin even though her numbers have not been above 128 since Sunday. They told me just keep giving her 1 unit of insulin twice a day anyhow. I think they have lost their minds down there. Okay now I am through.
Hope she is still low tonight when I test.
Terri

 

Terri,
Don't be so hard on yourself. I was totally freaked out when Missy was dxed. I mean totally. AND I do my own intramuscular injections, so I was already familiar with needles and units and all that crap. (and believe me, that is something that takes getting used to...you are doing great!) AND I am fortunate enough to have a very good vet close to my home. And I was STILL freaked out. Then she went into remission (and hopefully Lilly is doing that) and I breathed a huge sigh of relief. I had that 4 month interval to get my mind around all this stuff and time to do some reading (and join this forum...I looked at it as a guest the first go 'round) so when she relapsed, I wasn't AS emotional. But don't think I don't still get freaky about it or depressed because I don't see her regulating.....because I do. I am still new to this, too and I get scared. Just this morning Missy was at 102. My vet said to shoot her, but at a lower dose, as long as i am here to monitor her, because she bounces so high if I give her nothing. So, I have done it twice, scared to death....and SHE GOES UP! WTH is that? Does it mean her pancreas is fried?? I certainly don't have the answers.....
So, anyway, I am just saying, if it sounded like I had it together, earlier, it is only because it was at one of those moments when I am NOT freaking out. :lol:
I am really sorry to hear you can't use that vet. They sounded nice... It has got to be frustrating for you. I just hope Lilly is headed for remission.
Give yourself a pat on the back......look at what you have done for Lilly, despite having a cat who is difficult to treat (I had one of those, too, so I know how it is) and a vet who isn't necessarily on the same page as you. I think you are doing great! I don't want to chime in on treating diabetes, because I am new to it as well. I only posted the last post because we dealt with cardiomyopathy for several years and were lucky enough to find an awesome vet. None of this is easy, at least it hasn't been for me.
My fingers are crossed for you and Lilly!!

 

Just remember, you and Lilly are doing a great job! This site is wonderful and vets I am learning are just like docs.... guessing somewhat of the time.... party favors coming your way for an OTJ (paws are crossed)...And, because of this site and your wonderfullness....she is still here, has not hypoed and is around to love love love her mommy bean!

 

I know it's not ideal but the only suggestion I can think of to find another vet is to expand your search radius. The only other thing I can think of is to explain your situation with the new vet and see if they will work out a payment plan or a reduced rate with you.

I'm sorry you've run into a roadblock but I know you'll figure out what to do about Lilly.