Betty and Bear are scared in Ohio

I took my cat Bear to the vet yesterday due to weight loss and excess water consumption. My fear of diabetes was confirmed thru a blood test showing BG of 420. I have been reading everything I can since and feel like everything my vets has told me is wrong-using N insulin, starting out with 3 units 2X per day, no change in diet except feeding when give injection, testing urine which I have had no luck in doing since lives in a large one room cottage with 9 other cats, no mention of blood level testing, or even when to come back for follow up appointment.
I am really confused and scared I am going to send her into a dangerous low sugar situation. I work out of town and have an hour drive one way.
I'm scared I won't be able to give her her shots at the proper times and what if I give her a shot and the leave for work and she has a bad reaction. I just spent a small fortune on dental cleanings for three of my other cats and just discovered today one of my cats has a claw cuvrved inward and puncturing his paw which means another trip to the vet for him. How am I going to be able to afford all this? I would appreciate some words of encouragement, because I really do wonder if I can manage all this. I'm mostly afraid I'm going to hurt her and do more harm than good if I screw up the insulin dosage. Also is one blood test and weight loss enough to confirm a diabetes diagnosis?

 

Your post sounds like most of the first posts for members here.

The shots? You will be able to give them.... I have never done anything of the sort before, but I learned so that I could help my cat get better. You will be fine, just nervous when you first start.

Yes, the insulin N is VERY old school, is very harsh on the cat, and does not last long. It's a horrible insulin. Tell your vet you want to use Lantus or Levemir.

Now, you don't need the vet's permission to change the diet for your cats. You can switch to all wet low carb foods and it's a good idea to try it BEFORE you start any insulin because many cats are DIET CONTROLLED ..... switch to a proper diet and their numbers come way down.
Here's a list compiled by Dr. Lisa Pierson.... select foods that are under 10% carbs
http://www.catinfo.org/docs/Food%20Char ... -22-12.pdf

Now, one thing you can do is to pick up a blood glucose test meter and start testing your cat at home. You will need to know if the food change makes a big enough difference.
If you are in the US, you can pick up one of the Relion meters at Walmart and start testing right away. You can get lots of help and tips on testing here and there are plenty of youtube videos you can watch.

Once you are testing, and feeding a low carb wet diet, you will see what your cat's number really are. Sure the 420 is high, but I have to ask..... was that just the glucose number on the bloodwork or was it the value in a fructosamine test? If a vet is telling you to give an old kind of insulin, I have to wonder if your cat is really diabetic or maybe just sick.... there are plenty of things that can cause a cat to have higher BG numbers like infections, and dental issues, etc. Ask the vet if the 420 was from a single test using the vet's meter, or the glucose value on bloodwork results, or the number on a fructosamine test.

You will be fine. Pick up a Relion meter, some test strips and lancets, and a container of KETOSTIX to test urine for ketones. You will need to keep this cat from all dry food, and if possible, it would be healthier for you to switch all of your cats to a wet low carb food. Even if you get the store brand pate wet foods, it will be better than any dry food you may be feeding. If it means maybe not having to give your cat insulin, it will be worth the change of foods. One of my cats would be in the 400s if she got even a small mouthful of dry food, so I know how much it can affect a cat with diabetes.
There was one cat who came to this site, getting 20units of insulin and eating dry food. After the switch to wet food, the insulin dose dropped to 1unit.... food makes a huge difference so I would try the food change before the insulin and start home testing so you can watch the change in your cat's numbers.

 

Get the meter and hometest, change to canned food only, and do that before even giving insulin. If you have to start on that N insulin after doing the above, please start at only 1 unit and please, feed at least 1/2 hr. before shooting N. Fast acting and food needs to be on board. Suggest changing diet and home testing and then post back here before even starting the N insulin.

 

If you do need to use N, here's some info on it

Humulin Primer Info

 

First, feline diabetes is manageable. Really.

Second, home testing with a glucometer very important. It's the only way you know how the insulin is effecting Bear, if it is safe to give insulin and is he is going to low or high. And it can actually can save money by reducing trips to the vet and ER. Many vets don't think cat owners will bother with testing and don't mention it.

Third, you don't need your vet's permission to home test or to change to a low-carb food.

Where are you located in Ohio? Just town or area. We have a few active members here in Ohio who may be able to help you learn to test or recommend a vet with feline diabetes experience.

 

Hello there!
Welcome to the board. There is no need to be scared.. we can help you. It is confusing but ask lots of questions and we can help you through it!

Is one blood test and weight loss enough to confirm a diabetes diagnosis?
As Blue said above, it depends what test he did. However you can check yourself. Instead of getting the KETOSTIX Blue mentioned, get the KETO-DIASTIX. They do the same as Ketostix but also test for sugar in the pee. If you check the pee with those strips and you see sugar, its diabetes. Can you follow her when she goes pee and shove a ladle under her to catch the pee?

I am going to send her into a dangerous low sugar situation.
You wont if you test her blood. You will monitor her and know what to do.

I'm mostly afraid I'm going to hurt her and do more harm than good if I screw up the insulin dosage.
Insulin injections and testing is painless when done right. most cats dont even notice it!. And if you monitor the blood and ask lots of questions on here we can advise on dose so you dont screw it up

Wrong-using N insulin, starting out with 3 units 2X per day, no change in diet except feeding when give injection, testing urine , no mention of blood level testing, or even when to come back for follow up appointment.
Your vet sounds a little outdated. Problem with a lot of vets is that they are very good generalists but just dont have the time or resources to focus on people with diabetic cats. We do. So take the advice above - home test, ditch the dry, test her blood. You will probably need a followup to get a change of insulin. Or to meet a new vet. or Both.

I really do wonder if I can manage all this.
You can. We can help.

How am I going to be able to afford all this?
You might be able to get freebies of testing kits and supplies here
http://felinediabetes.com/FDMB/viewforum.php?f=15 but also contact DCIN who are at that link too and see if they can help - they are an organization that help diabetic cat owners with low funds

Does this make sense?

Wendy

 

i have never blogged before so not sure if I'm replying the correct way. Thanks everyone for all the advise and support. I hope I'm doing the right thing , but I decided not to give Bear the 3 units of N tonight. I had given her 3 units Saturday night around 7:00 p.m. as per my vets instructions at her appointment that morning and 3 more units this morning(Sunday) at 7:00 a.m. I only fed her canned wet-Fancy Feast for her evening meal tonight. I will go out an get a glucometer and test her levels.
I am going to call my vet in the morning and discuss this with him. There are two vets in the practice and unfortunately I got the one I don't like when I took Bear in Saturday. Is it ok that I already started her on insulin for the two times and now stop? Everyone seems to be saying to try the change in diet before I start her on N but I already did start her.

 

Your responses are fine.

Skipping the shot is a good idea. Just to check though.. the vet didnt mention her having ketones did he?

Anwyay without testing and having switched to canned food you are shooting blind and thats dangerous. Your plan to call the vet and buy a glucometer is great - but do it as soon as possible as you dont want her off the insulin too long. Ask the vet about Lantus insulin.

And pick up those ketostix or keto-diastix too.. you will need them to test for ketones.. http://www.felinediabetes.com/ketones.htm

here is another link that may be useful

Wendy

 

Frugal Feline Diabetes tips: http://binkyspage.tripod.com/frugal.html

Organizations that may be able to help with vet bills: http://felinediabetes.com/vetbills.htm

Diabetic Cats In Need: http://felinediabetes.com/FDMB/viewtopic.php?f=28&t=29083

Free home test kit from this very web site :smile: http://felinediabetes.com/FDMB/viewtopic.php?f=28&t=60261 It does take a few days to arrive by mail so it may be quicker to just head to the local pharmacy and pick up a blood glucose meter.

Instead of 3 units twice a day, give either 0.5 units or 1 unit twice a day. A lower dose can prevent a hypo from happening now that you are feeding low carb Fancy Feast.

Once you have the blood glucose meter, start learning how to test blood glucose levels. It may be frustrating at first but don't give up :smile: Here are the testing tips and videos: http://felinediabetes.com/FDMB/viewtopic.php?f=14&t=287 Daily blood glucose testing is key to managing the diabetes, just like it is for Human diabetics. You need to test before giving every single insulin shot. It is the only way to know if your cat is at a safe enough level for any isnulin to be given (over 200 mg/dl for newbies). If your cat has a hypo, you need to know exactly how low the level is and what the proper treatment is (mild hypo can be treated with corn syrup or gravy caned food, a serious hypo needs immediate home treatment with corn syrup and an immediate trip to the vet or vet ER for intensive treatment)

Many vets discourage home blood glucose testing for one reason or another, most of which are BS: it "harms" the cat, the numbers you get at home aren't accurate, etc. There are many published studies in well known veterinary journals that support home blood glucose testing. You don't need a vet's permission to test your cat at home.

 

Hi everyone-Went to Walmart and go my testing supplies. My husband and I finally got a reading after about 3 attempts. Bear cooperated up to a point and then had her fill and started squirming and trying to get away. We tested her about 3 1/2 hours after she ate. The number was 209.
What does that mean? 420 at the vets Saturday morning. We had a hard time pricking her ear; we bought the extra fine lancets so it was hard to see the needle, plus we bought lancets for the lancet tool which we didn't use because we couldn't see the needle once it was in the tool. I'm confused on when you test related to when we feed her. Test before we feed, after, does it matter? Also how much Fancy Feast should I feed her? My cats free fed on dry through out the day and got a spoonful of wet as a treat at dinner time. Per the can, it says 1 can per 3 1/2 lbs of weight which seems like a lot. My husband commented we'll have to get up a 5:00 in the morning just to be able to get all our testing done and I'm already exhausted from all the stress of worrying and getting Bear tested. I will have to test her every morning and night, right? I printed off a lot of info to go over with my vet. Thank everyone for all the help. I feel a lot better not shooting her full of insulin today since I'm not sure what's up with her yet. I'm sure I'll have more questions tomorrow. Thank so much! P.S. Just wanted to ask if Bear can have any type of treats. We always gave the cats a bedtime snack. Thanks again.

 

Hello!

Three attempts isn't bad fora first time.. It gets easier as the ears "learn" to bleed but you might want to get bigger lancets say 28g or 29g to start.. Or poke twice in close proximity. The key thing is make sure the ears are warm to touch, poke at a 45degree angle and finish with some pressure on the wound to help stem the bleeding and prevent bruising. Put a dab of neosporin on after if you think it needs it and don't forget the treat.

I don't use the lancet tool for that reason but you can freehand with those lancets to at least use them up.

One reading isn't really enough to say what's going on but 209 isn't that bad especially since she hasn't had a shot tonite.

Minimum i would measure is before each shot (so you don't shoot when she is too low) and ideally some other checks during the day sometimes but that depends on what insulin you end up with, will know more when you speak to your vet.
Anyway I would do another check tomorrow morning to see where she is then.

There is a calculation for how much to feed. Required calories per day = [13.6 X ideal weight in lbs] + 70 . You can get the calories in fancy feast here... http://www.catinfo.org/docs/Food Chart Public 9-22-12.pdf and you could tweak it depending on whether she is gaining or losing weight.


You should really give her low carb treats. Quite a few people here feed freeze dried chicken but here's a list of treats.http://felinediabetes.com/FDMB/viewtopic.php?f=14&t=9172.

Talk to you tomorrow!
Wendy

 

209 is pretty good - although it's just one number. Normal levels for a cat are 50-120 so it's still a little high, but not as bad as the 420. Cats will be stressed at the vet which will raise the numbers. You're doing great so far! Fantastic job in getting a successful test - welcome to the vampire club!

Welcome to the boards! I'm glad you found us! Please don't ever feel like you're alone - we're here and we can help! Hang in there and try to get some rest.

 

You may find that using Prozinc insulin will work better for your work schedule than using Lantus or levimer.

It is recommended to give insulin every 12 hours, however Prozinc allows more flexibility in that time frame.

No matter which insulin you use, home testing is vital.

And yes, sometimes just changing the diet is enough to kick start the pancreas to work properly again and no insulin or very little insulin for a short period of time is needed.

Keep asking questions, we are here to help.

 

Hi Betty & Bear

I'm in Columbus, OH and on weekends, could come by if you need any assistance learning how to home test.

It is generally test, feed, and shoot within about 15 minutes time, assuming the cat is otherwise doing well (no vomiting nor diarrhea which may change glucose levels)

When starting to home test, 26 or 26 gauge lancets are recommended to improve the likelihood of success.

 

Hi Betty & Bear,

I live in SE Michigan, and come to Toledo area usually once a week -- if you live in NW Ohio, I might be able to meet you and Bear.

It can be overwhelming at first -- I did use N in 2006-2007, and changed to PZI. Then in 2009, started using Levemir when i adopted Tiggy. (Norton passed away in 2008)

Hang in there!
phoebe

 

Thanks BJM and Phoebe for the offers to help. You guys are wonderful to offer. I live in Bloomville which is between Tiffin and Willard. I think I'm doing OK for now, but I am wondering about figuring out her "curve"? Not sure I really know what that is. What bothers me the most about all this is that Bear is starting to run and hide from us. I feel like I torture her in the morning trying to test her. She eats and then runs and hides, and then we have to round her up againt to give her her shot. Then I have to go to work. I hate giving her the shot and then leaving. I worried all day that maybe she had a bad reaction and I won't be there. Also, no time to let her relax and trust me again. I get home from work right when it's time to test again. We still are struggling with the ear prics so once again she is traumatized and runs and hides. Test results were 250 this morning and 229 tonight. Gave 1 unit of N both times. I'll get the bigger lancets so hopefully the testing will go better.I have a telephone conference with my vet tomorrow to discuss everything. I'll let you know if he was open to some changes. Everyone has been so helpful. I can't thank you enough for all the support.

 

Great - her glucose is coming down. Until you've collected a lot of test data to show it is safe, please don't give insulin if below 200.

Get some Neosporin w/ pain relief ointment, apply a bit to the ear a few minutes before testing, and wipe off. This reduces some of the annoyance of testing.

Always give a small low carb treat after testing, to help associate a positive thing with testing, even if testing is unsuccessful.

Find a few minutes to play or groom her that is not part of the testing time.

You might see if you could find a student in veterinary or health sciences or a hire vet tech who could help home test when you can't be home in time.

And its about a 2 hour trip one way for me. Possibly do-able on a weekend.

 

A curve is just testing every 2 hours from shot to shot.
A mini-curve is testing every 3 hours from shot to shot.
The purpose is to identify how low the dose is taking her and when she hits her lowest point.

 

Hi everyone-just a quick update. Tested Bear this morning. BG = 182. I believe I read no newbies should give insulin if below 200. Plus I would have to shoot and run-go to work. Hope I made the right decision. Thanks

 

Correct choice, since you can't be home to monitor.
As you get more data, that no shot number may be lowered slowly, if test data support it is safe.

 

Betty, it sounds like things are heading in the right direction! I'm in Bowling Green, so I'm closer than BJM if you do need help. Just let us know, OK?

 

Hi-Kind of having a bad day. Started out good with BG of 182. Feeling like I knew what I doing and on the right track. Then I talked to my vet on the phone. I had to drop off another cat at his office this morning and left him a list of questions and concerns. He basically said he only has one client using Lantus, and that client is very well off financially. He said it was very expensive and has a short shelf life. He has not had any problems using 'N'. He said he has only had one client that has every tried home BG testing and she gave up. He said I'll end up having my cat be afraid of me and too stressed. He said he has no problem with me doing it because he feels it is more accurate but believes the urine test is less stressful and is still a good tool to use to regulate. As far as food, he feels I should feed Bear like I always have in the past, even using dry because I have 9 other cats sharing a one room cottage with Bear. He said we would just regulate her based on whatever numbers I get eating what she always has. He said to stop testing and insulin now. Then on Thursday night, I should lock her up in the bathroom of the cottage with the special litter so I can test it Friday morning. I'm suppose to call him Friday with the results so he knows what her real numbers are without the stress of the vet visit. I told him I wasn't giving her 3 units of insulin, only 1 when I felt it was needed. He said don't bother with such a small dose. I've always liked my vet in the past and I need to work with him in the future. I actually have 13 cats and one dog and so I really feel I need to work with him and not just tell him that everything I've read tells me the opposite of what he wants to do. Also, Bear is stressing with the testing. I thought the ears were suppose to be a painless place to get a sample. She sure acts like it hurts and we don't seem to be getting any better at it. Tonight it was 289. I'm wondering what her true number should be if you deduct the stress factor off the 289. Maybe I added 100 points by trying to get the sample. My vet did have a point that I do have 9 other cats to think of as far as feeding and I have always left dry for them to free feed. They got a dab of wet at dinner as a treat. They are all stressing by not having food avaiable all the time. I've been trying to mainly feed everyone wet and I'm going thru a lot of cans of Fancy Feast and it's getting very expensive. The 9 other cats is making this very difficult. Well, I guess I've rambled on enough. Feeling pretty defeated right now. Thanks for allthe support and help.

 

Betty.

I have 14 cats...yes 14 two of which are diabetics and you know what...everyone here eats exactly what my two diabetics eat and it isn't dry food...Everyone here eats just regular Friskies Pate style canned food. Yes, it is pricey to feed 14 on all canned diet if you look at only the cost of the food, but I also use less litter now because less garbage in, less garbage out so to speak and I have very few vet bills either, because even my non-diabetics have improved in overall health. Even my guy that was living on pred to control food allergies had them completely go away.

Plus my one diabetic went off insulin and has remained insulin free now for over 2 years and my other one is working on going off insulin too. So there is a HUGE savings in that I no longer buy insulin for one cat and pretty soon I probably won't be getting it for the other one. So if Bear can come competely off insulin in time, why settle for regulation? As far as home testing being stressful on the kitty...both of my diabetics were adopted from this very board as diabetics, they didn't know me from Eve when I started poking their ears and giving them shots. Yet Maxwell (my guy in remission) sleeps with me every night and cuddles with me during the day. Autumn my girl working towards remission comes looking for me when it is test time and also snuggles with me every chance she gets and follows me around the house during the day...both purr through their tests. Now since these cats didn't know me at all when I started testing if I was hurting them or stressing them out I would be pulling them out from under furniture just to test not prying them out of my lap. Bear already knows and loves you, he trusts you completely...if I can form a loving bond with two stranger cats while treating their diabetes you will have a much easier time with Bear who you already have a bond with.

N is very old school and doesn't work well in cats. The three better choices would be Lantus, Levemir or Prozinc..the two L's are human insulins while Prozinc is a pet only insulin. I have used both of the Ls in my own cats and they have done wonderfully the one cat that was on N passed away so I have a personal bias against it. It hits too hard and wears off too quickly. I would seriously either try to talk this vet into a different insulin or perhaps look into a different vet that is a little more up to date on feline diabetes.

Mel, Maxwell, Autumn & The Fur Gang

 

I am not sure who was having the bad day because it sounds more like it was your vet, not a positive guy at all today!

To address some of the things he said

1. Lantus short shelf life.... Lantus lasts six months, opened, in the fridge. Does he consider that short? The bottle does say one month but that's for reasons such as the drug companies covering themselves and that most humans using it finish it well before the month since they use much higher doses.

2. Many, if not most people here home test. He obviously doesn't encourage it or more of his clients would, since its so much safer and cheaper for your cat than vet curves and also provides him more valuable information.

3. The cat will be afraid of you?? How would he know this given he has actually only ever seen one client do this and they gave up? I test both my cats, and neither are afraid of me. And a lot of people on here will feel the same. Once you get experienced testing, a week or two at most, your cat won't be bothered by it at all. Stick with it!! It's very very common to have issues at the start but it does get better!!

4. I would put money on his higher blood glucose during the day was a bounce as opposed to stress of testing.

5. Regulation will be very hard if she is still on dry as you are making the problem worse. And you feed the others dry you might end up with another couple of diabetic cats on your hands. Not ideal. Give them all the wet. And bear has even a good chance of remission if you switch to lantus and all wet food now. Best chances for her are in the first few months after diagnosis. Friskies might be cheaper since its bigger cans.

Wendy

 

To Momma of Muse-I too have a cat with food allergies that have caused her a lot of ear problems. She's on pred and ear drops. I have a male cat that is large (has some Maine Coon in him), but he is a little overweight. I have always worried he might become diabetic. Good point about spenging the money on food ratheer than vet bills.

Wendy-Thanks for the info on Lantus. I'll talk to my vet again about it. Can you explain to me what you mean about a bounce. I didn't give her any insulin this morning since her BG was decent. Thanks!

Debby-I just started working in Bowling Green in September. It's a long day because of the commute and makes it difficult to be there for Bear.
Most days I'm gone from home for around 11-12 hours. Seem like a long time when I'm supposed to be monitoring Bear. Thanks for the offering to help.

 

Dr Janice Rand of the University of Queensland Centre for Animal Health is an expert in Feline Diabetes. She and the internet group Diabetes Katzen developed a protocol for the use of Lantus in feline diabetics.
You might like to print it out, read it ... and share with your vet who is not up to date on the management of feline diabetes!

Also, the American Animal Hospital Association guidelines are in this post
Lantus/Levemir testing & dosing protocol Roomp & Rand

And by the way - Spitzer had no problem coming to me for testing and treats. So much for being afraid of me or stressed by the testing.

 

What was her BG this morning?

When a cat is first diagnosed, the blood glucose has probably been high for a while. As the numbers start to come down, the liver has to learn to adjust to the lower numbers. We call this "liver training school". But before it relearns that low numbers are ok, when the BG drops to a number lower than the liver is accustomed, OR if BGs drop low, OR if the BG drops suddenly, the liver”panics” and reacts by releasing counterregulatory hormones and glucagon. This drives the BG back up. This is what we call a "bounce".

It occurs more when you are on insulin. Bear could have gone up because she ate recently in relation to her PM test.. when did you feed her?

 

Hi, Couldn't get on the message board last night. It kept telling me I had a SQL error? Wendy-Bear's BG was 182 the other morning and then 289 that nignt. I always test her before she eats. Is that OK? My routine is to test, feed her, and then give insulin if necessary.

I have a question I'd really appreciate help on because I'm getting confused. What exactly is a unit.I use a syringe that says 50 units on it and
U-100 single use only. When I give her 1 unit it is a very small amount and I don't see how you can reduce a dose by .25. The lines are so close together how can you measure something that small. When I told my vet I gave her 1 unit rather than 3, his comment was don't bother because it was too small to do any good. Am I not understanding what a unit is?

When I talked to my vet on Tuesday he asked me to decide on a food regime(which could include dry) and just feed her that for the next few days. He said not to test her BG and give no insulin. Then on Thursday night(tonight), lock her in the bathroom with the special litter and test her urine in the morning. He wants to see what her true numbers are with her on the food I am going to feed her from now on and without the stress of being at the vets or getting her ear pricked. Then he would regulate her accordingly. I decided to cooperate somewhat with him so I can keep a working relationship with him. I am feeding her wet beef classic Fancy Feast only and am going to spend the night on the bathroom floor with tonight. I'll do the urine test tommorow moring but will also test her BG. When I call him with the results, I'll discuss getting her on Lantus.

Mamma of Muse- I figured I'd go thru around 2 cans per cat per day which = 20 cans based on 15 calories and an average weight of 9-10 lbs. How many do you go thru? Am I figuring correctly? Even a 1 1/2 cans per cat per day is a lot. Thanks!

 

Well first off we use a smaller syringe most of us use a 3/10 cc which will have 30 units in it and our syringes have .5u marks on them....there are 100 units in a cc if you are using a U-100 insulin like Lantus or Levemir. A unit is just a unit of measure like ml, cc, oz etc. And yes 1u is tiny but insulin is a very powerful hormone a drop one way or the other can make a world of difference in a little kitty body, might not do much for a large dog or a human but it can definitely do the trick in a kitty.

Now for the food question...I go though 16 cans per day as I feed (5.5oz) cans of friskies, or 5 cases of 24 cans per week. For the most part it averages out to about 1 can per cat per day but then again I have all sizes, shapes and ages here so some eat a little more and some eat a little less. Arabella being my youngest and smallest at 6lbs and she eats about 3/4 of a can to Maxwell at 14 years old and a lean mean 17lbs (he's tall and long) who eats about 1 1/2 cans per day...and trust me no one is starving here. But then again they are all fixed and most are over the age of 6 so not terribly active unless I get the laser pointer out.

Mel, Maxwell, Autumn & The Fur Gang

 

Hi Betty, I'm new here also so I'm not offering advice. I just wanted to tell you that my cat was just diagnosed earlier this week, and the vet suggested Lantus because it lasts much longer than his other options. I'm going to try to test my kitty. He's not a friendly one though.

 

Hi Rockpea, Nice to meet another "newbie". It's all pretty scary, but everyone has been so supportive and encouraging and hold your hand every step of the way. We have just started testing our cat Bear. She cooperates pretty well, but sometimes it takes us three pricks to get a good drop of blood. But I'm sure practice makes perfect and it sounds like we're both going to get a lot of practice. Good luck with the testing.

Momma of Muse- Thanks for the info. I'll have to get the 3/10 cc. I really aprreciate your input. I was really beginning to think I was doing the units wrong, because it really does seem like such a small dose. Thanks for setting me straight.

Betty & Bear

 

Yeah the board was down for an hour or so, doesn't happen often thankfully!

Your routine is fine, Especially with the insulin you feed, it's important that she eats before you shoot. But you should do some tests midday, you want to know how low she is going (critical for dose changes) and humalin n peaks 2-6hours after the shot.

A small amount of insulin can make a huge difference, you would be surprised. My Tiggy is on six units whereas my bailey is literally on two tiny drops, incredibly hard to measure. If I don't give it he goes over 250 but those two drops keep him within normal cat ranges.

Let us know how the test without insulin goes.. I assume she hasn't had any since you spoke to the vet on Tuesday?

I have 3 cats, two are diabetic they are maintaining weight. Cookie is 10lbs, not diabetic and eats 2cans FF a day, Tiggy is 17lbs and diabetic gets 3, and bailey is only 7lbs and gets 4cans but he is a difficult diabetic and struggles to maintain weight.

Wendy

 

Hi-Slept with Bear on the bathroom floor last night so it wouldn't be so hard on her being locked up alone in order to get a urine sample with the special non absorbing litter. We had a good night snuggling together and she finally peed around 5:30 am. Tested with the urine strips and got around 500. Then tested her BG and got 172. Called my vet later in the day with the results of his great experiment and am once again confused and ndon't know what to do next. Vet said meter must be wrong-no way 500 urine would show 172 BG. He may have a point because I tested a couple of my healthy cats and got in the low 50's and 60's. He said that's way too low too. I had quite a converstion with him. Didn't fight but had some heated moments. He still insisted Lantus is too expensive and short shelf life. Says he has being regulating diabetes for years successfully with N .
He wants me to test urine every day for a while, start on 3 units, and adjust accordingly based on urine. Once I get her regulated, he said I could probably only have to lock Bear in the bathroom once a week or so to test. I asked him if Bear would ever not need insulin and he said probably not. In his experiece they always end up back on it. I had faxed him the AAHA guidelines earlier and asked his office girl to please have him read it before he called me. Of course he said he never saw it. I asked him why everything I read/research says Lantus and small dosing starting out with one unit. He said N is a different type of insulin and 3 units is a small dose and I can't compare the dosing of the two since they are different.
He finally got a little snippy with me and said you have to trust him and he has been treating cats this way for years and it was how he was taught by some very good experts at Ohio State. I'm sure eveyone is saying to dump him and switch, but he is really a good vet and I have tried most of the others around my area and he is the best. He actually cleared up an ear problem with one of my cats that Akron Animal Hospital and Ohio State couldn't. Not so sure why he is so close minded on this. Any suggestions? Ran out of room so going to post another.Thanks

 

Hi again- Just wanted to make one last point and please tell me where I'm wrong, because deep down I know I am. My vets approach sounds a lot more manageable that what I am trying to do now. I'm really exhausted and I'm sure my husband who has always been very supportive is too. We both work out of town with an hour commute one way. We are getting up around 5:30 am and don't even get home until around 7:00PM. As I mentioned before I have 13 cats total and one dog. When we get home we don't even get to eat dinner. It's right to work walking the dog, testing Bear, cleaning litter boxes, feeding everyone, doing kitty dishes, ect.. It was hard to manage everything before and now that Bear is sick I'm not sure how to now. My vet said I have to consider everyones quality of life and come up with someting doable. Am I totally nuts to think he has a point? Thanks.

 

Okay hon...breathe...First off you vet is dead wrong on that the meter can't show a 172 and urine strips show a 500...because before glucose can show up on a urine strip it ha to pass through the blood stream, be filtered out by the kidneys and collected in the bladder from one time she pees to the next...of course there is more in the urine it has been collecting for hours. A glucometer measure what is in the bloodstream right now! It is kind of like comparing apples to oranges. Plus glucose strips aren't going to catch her going too low and going into hypo.

I know exactly what you mean about no real life right now...I can truly relate...if you look down at my signature I have 14 cats and a 97 lb dog. I have 2 diabetics but luckily one is in remission and the other is very stable and headed for remission I hope. Right now it is overwhelming and yes it is a steep learning curve, but you will catch on quickly. And once you find your groove it becomes as routine as brushing your teeth. I can feed 15 animals, cook breakfast, test and shoot Autumn and be out the door to take my husband to work in 30 minutes tops. Granted my husband and I have worked out a system where each of us takes assigned parts of the tasks..like while I' testing Autumn and getting her shot ready, he gathers up the food dishes and we have a set order they go on the counter, then we set it up like an assembly line. I fill, he mixes in the water. Then we feed the kitchen cats together, then he takes off to feed the ones in the bedroom and I head in to feed my 3 that are crate trained and eat seperately because they will bully the others away from the dishes to pig out. We have several that while they can live together in harmony they won't eat that way...lol So we have 3 seperate rooms we have to feed in.

As busy as you both already sound I'm sure you'[ve already got a pretty good system already figured out for the daily stuff anyhow. This just feels awkward right now because it is new, once you get the hang of it, it really does get to where you can do it in your sleep if you have to.

As far as the vet's way sounded easier....well it is, kinda, because the truly easiest way to care for a diabetic cat is to give them the best chance to go into remission and not need insulin at all. To be completely controlled by diet. Now my Maxwell was one of the lucky ones, he went into remission on 2 weeks of Lantus and a diet change to an all canned low carb high protein diet. And he just celebrated 2 years that way last November first. I've seen others go off just as quickly with a diet change and short course of insulin. But N isn't going to get him there, it just doesn't last that long in a cat's body..yes your vet might be able to get cats regulated on it, but I highly doubt that he has got many to remission with it.

Mel, Maxwell, Autumn & The Fur Gang

 

Ok here's the thing. Urine builds up in the bladder and so the less you drink and the longer you store it, the more concentrated it gets (like your own pee in the morning)
So urine glucose gives you an average of the sugar over time, and his hydration levels and how long he held the pee. Blood glucose gives you one spot value, not what he has been doing over time. So he could have started at a BG of over 400 and dropped to 172. And in that time all the extra sugar between then was going into his pee.

So of course they wouldn't match!

Second BG of 50 and 60 is perfect for a healthy cat.. They range from 50-120.

Thirdly lantus shelf (fridge) life is up to six months even though it says one month on it. That's because it's for humans and they use more and faster. I can personally attest to four months and members here can attest to six. You can ask a pharmacy for cost but I believe a vial is $150..which will last six moths.

He is right that if you give humalin and keep her on dry food she would always be an insulin controlled diabetic. However a switch to wet canned and lantus and you have a very good chance of remission.. If you do it within the first six months. I have seen it often on this forum and have seen studies that also reflect that. But if you leave it too long.. Then it can be too late. No wonder he doesn't see it often.

Really it's just a case of switching the food, switching to lantus and a little testing (before every shot, and occasional spot checks during the day - and you would want to do that whatever insulin you had). A little more testing to start though until you know her trends and find a good dose.

All your vet has to do is give you the insulin you want, you don't need his permission to do anything else and he doesn't even need to know what you are doing with testing. He works for you remember? Just be firm, insist you want to try the lantus and leave it at that. And test at home to keep her safe. If you have to test her urine, why not spend the time being safe and testing her blood instead?

Anyway it's up to you...

 

Hi,
Do you see the problem with those two statements?
I've only been "here" about a year and a half. My cat was on PZI, for about 10 weeks, and went "off the juice" in July 2011. He's diet controlled and the highest his BG has been since then was around 70. I have seen well over 100 cats, using Lantus, Prozinc and Levemir, go into remission in my time here. I've seen maybe 10, probably less, that have ended up "back on it".
I'm thinking that the reason he believes that they "always end up back on it" is because he prescribes N, has been doing so for years, and is still stuck back in the days when he learned about it from the experts at Ohio State.

I do believe that you have a tremendous amount of respect and faith in your vet. But that said, if I have the flu, I'm going to my regular doctor. When I was diagnosed with Macular Degeneration, I went to a Eye Clinic in Georgia. When they told me I might be predisposed to an unspecified "rheumatoid condition", I went to see a specialist. My family doctor was useless in those cases, other than to refer me to a specialist.

It's perfectly okay to use a familiar vet that you trust for some things. But no vet knows everything about anything. My vet is awesome! She only prescribes Prozinc. If Prozinc hadn't worked for Bob, and I needed to switch to Lantus or Levemir, I'd see another vet at her practice who prescribes that, or I'd find one that did. And my vet wouldn't take it personally.

You can do this, we can help as much as you want or need us to. But having a good vet on your side is very important too. I would hope you can reason with this guy, and he could see past his own ego or stubbornness in order to do what is best for both you and your kitty.

Carl

 

Thanks everyone-I feel so much better after reading your posts. I feel like I have been on a roller coaster ride with all the ups and downs I've felt trying to make the best decision for Bear. But I have finally come to the right decision that I can feel good about thanks to all of you. After reading Carl's post, I looked up another vet in the area that I never considered because she is known to be pretty expensive (but good). I got on her Web page and she had a library where you can do research. I typed in diabetes, of course, and guess what!!!!! Articles on Lantus-(actually stated in black and white that It can last up to 6 months if refrigerated), articles on home BG testing, articles that actually used the word remission. Would you guys suggest I take Bear to her or should I try one more time to convince my present vet to "see the light"? I really do have to keep a working relationship with him and he really is a good vet. But maybe it would be better to work with a vet that probably has some experience with Lantus. What do you think? Also, I 'm not sure what to do about the insulin until I get her on Lantus? I gave her 3 units of 'N' tonight (I'M sure you're all cringing) since those were his instructions on the phone today and I was still confused on what to do. Thanks again everyone for your help. Hope to hear from you.

 

Hi Betty,

I'm glad my post helped! Awesome that it was that easy to find one who seems to know a lot about Lantus.

You said you have 12 other cats and a dog, right? Well, you can still use your current vet for the rest of crowd, and maybe this new vet just for the diabetes? You'd still have plenty of need for your old vet, so that might take the sting out of your wanting to see a specialist for Bear?

Carl

 

Betty, the key to your old vet's attitude may be "he has been treating cats this way for years." If he is an older gentleman he may not be up on the newest treatments. This probably IS how he was taught! But state-of-the-art treatments DO change. So if I where you, I would take Bear to the other vet and tell your original vet you decided to get a second opinion. And if you continue to use the old vet for all the other critters he shouldn't be too upset.

 

Hi-Just an update. Tested Bear' urine again this morning. It was in the blue negetive range. Also did BG and it was 97. Lowest yet! I called the other vet today and discussed my situation with a vet tech. Everythning sounded good except she said they only have had one cat that has gone into remission. Not sure why not more cats OTJ. I made an appointment for next Saturday-earliest they could get me in due to my work schedule. The tech also said Bear would be required to be hospitalized for them to establish the first curve. Is that customary? I asked her how they get good BG # since Bear would be stressed. Maybe with all your help, she can have 2 cats OTJ. Bear is still going to be better off since she'll be on Lantus. Thanks again everyone for all your help.

 

Great update! when you got the 97.. when was the last time you gave insulin in relation to that?

And she just gets fancy feast now right.. no dry?

You dont need to take Bear to the vet for a curve, because they are just going to do what you are doing except they will charge you for it! Plus cats are usually so stressed at the vet that their BG is high and if thats what the vet bases his dose on then its too high. Tell them that you home test and can do the curve yourself.

But let me know on my questions above, her BG does seem to be dropping if she isnt getting insulin and we want to watch her.

Wendy

 

Hi Betty, glad you were able to talk to them and get an appointment.

Well, keep in mind that from their point of view, most people who hear "your cat has diabetes" are pretty shocked by it. I know I was, I didn't even know cats could be diabetic. So they assume that you know next to nothing. You haven't been "here" for very long, but right now you already know more about feline diabetes than the majority of people in the world.

No, a "vet curve" isn't needed or required. The only difference between what you would do at home and they would do there is the "environment" that Bear would be in. And I'm sure they'd used a special pet meter rather than a human meter. And Bear's numbers would likely be inflated due to being in a strange place with strange sounds and smells, and strange people poking and prodding him all day.

About the "only one cat in remission" thing. The best chance a cat has to go into remission on Lantus depends on a few things. The sooner the disease is detected, the better the chances. A low-carb diet is also very important. And following the "tight regulation protocol" that is followed by a lot of people here is also a big factor. Put all 3 things together, and that's the best scenario. It could be that they don't adhere to the Roomp/Rand protocol, or they don't advise a diet that is as low in carbohydrates as possible. Or that they do, but their patients don't follow their advice. Regardless, being on Lantus will certainly be better for Bear than being on "N" would be.

You can discuss with them the protocol and the diet, and an appropriate starting dose in between now and the time of Bear's appointment. If you share your data with them, they'll understand that you are further along the "feline diabetes road" than most of their new patients are.

Carl

 

Hi- I do have Bear on an all wet Fancy Feast diet now. I'm giving her one can at 7:00 am, one can at 7:00 pm, and around 1/2 can at 10:00 pm for a bed time snack. She still seems hungry though. The 97 BG was after giving her 3 units of N the previous night. After talking with my vet, he said 3 units if N is not the same as 3 units of Lantus, so I felt somewhat comfortable giving her 3 units. His directions said if urine strip showed negative then reduce dose by 2 units. So I gave her 1 unit. I kept a close eye on her because I was nervous since she was low. She was fine, but I was able to test her urine last night and it was in the bad 500-1000 range and her BG was 269. We gave her 1 unit again last night because we are only suppose to adjust after morning urine test. I'm totally confused because this morning her urine was in the blue negative again. According to his instructions if urine is negetive reduce dose by 2 units. So 1 unit less 2 units is -1 so we didn't give her any insulin this morning. Who knows what she will be tonight. She seems to be bouncing all around which I read wasn't good for her. If she is high tonight again, not sure what to do because I'm only suppose to change dose in the morning and she didn't geta a shot this morning. I'm trying to follow his instructions since N is different than Lantus. As I said earlier, I won't get into the other vet until Saturday. I'm afraid it is going to be a long week, plus I have been sleeping every night with Bear in the bathroom. I'm going to call my vet tomorrow and ask him what you do when she is low in the morning and high at night because she won't get any insulin. Saturday can't come soon enough. Sorry to write so much but wanted to fill you in on the units I have been giving her. Thanks!

 

Hi Betty,
I can understand your frustration and anxiety.
The big problem with urine glucose testing, well a couple of problems -

One, it isn't all that accurate in terms of pinning down a number. 500-1000 is a pretty "loose" measurement.

More importantly though, it's like looking at "history" rather than "current events".
It takes several hours (not sure how long, perhaps someone else can be more specific) for the blood glucose to show up as urine glucose. So it sort of gives you an idea of what her BG might have been several hours earlier, but no clue what it is at the moment you test.

You see a "negative" at the morning test, and that's telling you that maybe sometime during the night, her BG levels may have been at or close to the normal range (which is a good thing). But it doesn't tell you what her BG is "right now". So you skip the shot, and her BGs might be in the 300s, which would indicate that insulin is what she needs.

Last night, she was really high on the urine test. That means her BG a few hours earlier was probably pretty high, probably because she hadn't gotten any insulin in the morning. But the meter says 269, which is higher than normal, but not excessively high for a new diabetic cat. Giving her insulin based on a 269 on a meter would be the right thing to do, but no way would 3 units be called for. 1u, maybe. It looks like the 1u dose, at some time during the night, brought her numbers down. A few hours later, that would show up on the urine strips as "blue negative" most likely.

I agree 100% with your vet that Lantus dosing and N dosing are different worlds. They don't work the same way, and they don't last as long as the other in a cat.
This isn't a perfect analogy, but think of cold medicine.
You have the pills that say "take 2 every 4 hours as needed". That would be the "N".
Then you have the 12 hour time-release capsules that work all day or all night. That would be "Lantus".
The pills, they work for a while, but by the time four hours have gone by, the medicine is done and gone from your system.
The capsules, they last a lot longer, and when it's time for the next one, the first one is just wearing off, and you take another one that will start working once the first one has outlived it's usefulness.

3u of lantus will act more slowly, and last a lot longer. It's a "depot" insulin. Part of the shot goes towards working to lower the BG, while part of it is "stored" and helps establish a level of insulin in her body that can be used for later if needed. When used for a while, lantus will tend to keep BGs more level.
3u of N will all go towards lowering the BG soon after shooting, it'll do it's thing, and then it is "done and gone". It doesn't last until the next shot. With "N", the Bgs are going to swing from low to high more often, and with a greater degree.

As far as testing, BG testing with a meter is a lot more accurate and useful than using the urine strips.

Carl

 

Wow - already seeing a 97 BG is good news for possible remission (DIET CONTROL!!)

Since your vet does not recommend food changes - THAT is why he doesn't see remissions.

To become diet controlled, the cat needs to eat proper food.

Hang in there! It might be possible to buy one "pen" of Lantus or Levemir from someone nearby. I use Levemir for Tiggy, and buy 5-packs. Tiggy only needs 0.5u BID (half a unit twice per day), so one box of Levemir lasts us over a year.

The cost for a 5-pack from Canada is ~$125 or $25 per cartridge (which contains 300 units)

Levemir is very similar to Lantus.

 

Hi Carl-Thanks for the cold medicine analogy. Really helped me understand the difference between how N alnd Lantus work. Makes me all the eager to get her switched. I'm anxious to see what her BG will be tonight since I didn't give her any insulin this morning. Since I have been keeping Bear locked in the bathroom all night I know exactly when she is urinating. Last night she didn't go in the bathroom, so I had to let her out and caught some with a little tray when she went shortly later in the regular litter box. So she stored all that urine up from 11o the night before until 6:30 this morning. I hate this urine test. Would you know why Bear isn't drinking very much? According to my vet she would be drinking a lot so getting the urine would be easy. I'm not around her all the time plus she is in with 9 other cats so I can't say for sure how much she is actually drinking, but I sure thought I would notice her drinking more. Thanks

Hi Phoebe-Glad to hear Tiggy is on such a low dose. Sure helps with the expense. I heard Lantus is pretty expensive. Do the pens all come in 5-packs? Thanks!

 

Have to ask... is the toilet seat and lid closed? Bob was drinking from the toilet after he'd emptied the water bowl. Or from the tub if the faucet was dripping. Started to see paw prints on the seat and tub bottom before I put 2 and 2 together.

Also, it could be that Bear isn't as bad off as we think. As their BG becomes controlled, the excess drinking and peeing will go away. What may be happening is that the insulin is pushing the numbers down, maybe lower than Bear's body is used to. And the higher readings you happen to catch are due mainly to "bouncing". Has anyone explained that concept yet?

Carl

 

Hi Carl-The only water she has access to is the water bowls, so hopefully she isn't as bad as we thought. Wendy and Tiggy explained the bounce back on 1/30/13. Basically, Bear's system isn't used to the low BG so it panics and releases counter regulatory hormones. She mentioned the liver -I thought the pancreas was involved? Bear's BG was 247 tonight. Based on the urine testing method, I am not to adjust her evening dose so I didn't give her any insulin tonight. Felt like I should have given her 1 unit though. Do you think she'll be really high in the morning? I really appreciate you taking the time to help me. I read an article that a cat is better to be consistently in the 200's rather than be 100 and then 300.
I just reread your earlier post and I know you think I should have given her the one unit tonight. I guess I'll find out in the morning. I'm going to call my vet in the morning and explain how his urine test isn't working because there is no adjustment in the evening for changes. If I give her one unit at night and she is negative in the morning then she does't get any insulin all day. It will be interesting to hear his explaination.

 

The liver is involved in blood sugar regulation by detecting and compensating for levels that are too low. The liver stores a carbohydrate called glycogen. When the glucose level drops suddenly and/or gets too low, the liver release the glycogen from storage and it is broken down for glucose.

As Humulin lasts about 8 hours, I'm a bit concerned by the low levels that have resulted in no shot. Why? Because we don't know how low he went overnight.He may be risking hypoglycemia. When you need to skip a dose half the time and the other dose isn't tiny, this suggests a reduction is advisable, so the glucose levels are on less of a roller coaster. I'd encourage you to back off some.

Also, water consumption will decrease as the glucose lowers.

Edited to add: verified that it is, in fact, glycogen which is the stored sugar.
Per Wikipedia:
"Glycogen is a multibranched polysaccharide that serves as a form of energy storage in animals[2] and fungi. In humans, glycogen is made and stored primarily in the cells of the liver and the muscles, and functions as the secondary long-term energy storage (with the primary energy stores being fats held in adipose tissue)."

Glucagon:
"Glucagon causes the liver to convert stored glycogen into glucose, which is released into the bloodstream. "

 

Actually, that info is not correct. Glycogen is not released in response to low numbers or drops. The liver releases counterregulatory hormones and glucagon...which is also a hormone...in response to drops or numbers lower than the liver is used to. The numbers do not have to be really low...just lower than what the liver has come to recognize as normal.

Betty...Carl asked me to pop in. Many of us really like our vets but realize their knowledge about treating feline diabetes is very limited. I use a clinic of five female vets although we typically see the same one but I actually had them all come over for lunch one day and gave them a presentation on FD and they were amazed to find out that their knowledge was so lacking. And they are constantly in continuing education.

I think it's a bit of a viscious circle...clients tell vets they don't want to treat a diabetic cat because the vets lack the knowledge to assure them that it is a very treatable condition. I haven't really figured out why so many vets are against home testing...mine are not. But many believe you can keep a cat well enough using urine testing. I think we've dispelled that myth for you.

Lantus and levemir are the gold standard for treating cats with diabetes and are much more gentle than Novolin. They have very high rates of remission when started within the first few months of dx and when a tight regulation(TR) protocol is followed. It's imperative to combine the use of lantus with a low carb canned or raw diet for the best results. Lantus and lev are dosed vey differently from Novolin or Prozinc. For the latter two, you base the dose on the preshot. For the "L" insulins, we base dose on the nadir...or the time of peak action of the insulin..with some consideration to the PS. We hold doses for minimum times and increase/decrease by small amounts.

It would be helpful to see a spreadsheet with Wendy Bears numbers on Novolin so we could help with a starting dose of lantus.

Let us know how we can help. But I would try to get a script for lantus for either your old vet or the new one as soon as possible. Wendy Bear might start on a low dose and have great luck with without the dry food in the picture.

 

Hi Betty,

Actually you are right. It starts in the pancreas, which releases glycogen, which then triggers the liver to release glucogon, converted to glucose with other hormones like Marje said. WAY too many "G" words!

But the pancreas starts the process. I've got a great bookmark on my PC I can link you to later when I can get to it.

Carl

 

Just checking the fancy feast is the classic pates right? The others are too high carb generally.

 

If you decide to keep Wendy Bear on Novolin, you might want to read this very helpful Humulin N Primer. Novolin and Humulin N are the same...just made by different manufacturers.

 

Hi everyone -I have Bear on FF Clasic pates. Thanks Marje for popping in. Here is my attempt at a spread sheet. I'm sure there are a lot of holes since I was following my vets instructions.

1/26 am Bear diagnosed 1/26 pm 3 units
1/27 am 3 units 1/27 pm BG 209 no shot given
1/28 am BG 250 1 unit 1/28 pm BG 229 1 unit
1/29 am BG 182 no shot 1/29 pm BG 283 no shot
1/30 am BG 200 no shot 1/30 pm no shot
1/31 am no shot 1/31 no shot
2/1 am BG 172 no shot urine 500 2/1 pm 3 units
2/2 am BG 98 1 unit urine negative 2/2 pm BG 269 1 unit
2/3 am no shot given urine negative 2/3pm BG 247 no shot
2 /4 am BG 194 1 unit urine 500-1000 2/4 pm BG 153 1 unit
I hope this isn't too confusing. Thanks for all the help.
Betty & Bear
P.S. When I submitted this it scrunched the table all together so I lost the spacing. Sorry it is so hard to read.

 

Real quick but do you see the "issue" here? This method has you giving insulin on lower preshot numbers than at the times you are skipping shots. My guess is that she's dropping into low numbers after those shots, and that is causing higher numbers from bouncing. And no idea as to how far she might be dropping after those shots three or four hours later. The urine glucose tests are not helping things.

It has you giving 1 unit on a bg of 98 (2/2 am), which is dangerous since it is in the range of "normal" BG levels.

And skipping on a 247, then seeing her at a lower number the next morning.

This cat might not even need insulin, and even if she does, a much lower dose.

Carl

 

Hi Betty,

Please consider very carefully what Carl is saying in his post (copied above)...

There are some very smart and experienced people on this forum. And this forum has saved the lives of many cats - including mine. And many cats have gone into remission too following the advice of people here. From looking at your cat's BG numbers I'd say it's quite possible that your cat could go into remission too. But it's really important that you keep her safe along the way...

I know it's confusing at first. And hard work too. But it does get easier. And the folks here will help you. :smile:

(((Hugs))) to you,

Elizabeth

 

I have to agree with Carl. I'm not sure why, with the availability of much gentler insulins, you don't switch her. This insulin you are using is really harsh and the chances of her having a hypo on it are amplified. And I promise you, you do not want to see what a clinical hypo would be like for your kitty.

I'm not trying to scare you....we all are just trying to help you understand that there is a better, safer way to approach feline diabetes. We are here to help.

 

The other thing that has confused me is why both the urine and blood glucose testing? Since you are able to get blood tests, and they are a lot more "real time" and valuable...
I don't understand why your vet would want the urine tests, or have you basing a "shoot / no-shoot" decision on them. I apologize if you've already explained that and I missed it.

Carl

Edit - I realize that you plan on switching insulin as soon as this weekend. And until then, you can make the N work, but we could help you to be able to do that more logically and safely.

 

I believe Betty is taking Bear to a different vet on Saturday. She hopes vet #2 will be more up to date and put Bear on Lantus and support blood testing. Until then, she is trying to following vet #1's instructions on dose and urine testing, as well as blood testing because we are urging her to do it to be safe.

If Bear were my cat, I might just stop the insulin until I saw the new vet, but still test. It's only a few more days...

In the meantime, could someone explain to Betty about Lantus vials versus the pens? I know the pens save money in the long term, but I don't have the facts at my fingertips.

 

The pens come in a 5-pack of 3.5 ml pens. I think the total cost is about $225 - $250 for the 5-pack.
Somebody please "check my math", but I believe each pen contains 350 units of Lantus. IF your cat were on a dose of 2.5u per shot, that's enough for 70 days?

I believe the vials are 10 ml in volume, and the vial would contain 1000 units.

I googled "cost of Lantus" and got this:
http://www.bessed.com/lantusinsulinprice/

I know that there are coupons available so that you can get a discount on Lantus.

Whether you buy the vial or the pens, you would use a syringe to draw the insulin from them.

I didn't use Lantus, so I'm not certain of the shelf life. But my understanding is that long-term, the life of the pens would be longer, so it would be more cost efficient to buy the pens even though the initial cost would be higher.


Debby,
I understood that she was switching (or planning on switching) this coming weekend. I think my question was more along the lines of "why not just ditch the urine testing and go just with blood tests, especially since she's switching vets"? Using just blood tests would be much safer.

Carl

 

Hi Everyone- Today was a very stressful day-worried about Bear all day. I even called my dog walkercome early to check on her. She was ok, but here's the scoop. Bear's urine was in the 250 range this morning. According to my vet's instructions, 250 is the number we want. If she is in the 250 range then you give her the same dose as the day before which was 1 unit. I did test Bear's BG and it was 125. This is where I probably screwed up. I gave her the 1 unit. My husband and I discussed what to do. We decided on the 1 unit because we are trying to follow my presents vets instructions with the N and according to him 1 unit of N is nothing. I had told him I was afraid of a hypo situation and he said 1 unit is minimal and as long as she is eating then she'll be fine. Also, we stupidly thought the 1 unit from the day before got her to the 125 BG. At lunch time I checked the posts to the forum and based on what I read I thought I had made a bad decision. Carl keeps mentioning the bounce affect and I wondering if that isn't exactly what is going on to some extent. Her BG tonight was 245- a 120 increase. When I made my appointment with the new vet, I asked them if I should contine with the N until my appointment and they said yes. My question is- should I do what Maggies Mom Debby suggests and just quit the insulin. It is making me a nervous wreck and Bear's numbers are up and down a lot which can't be good for her. I also have another question. I am concerned about putting her on Lantus because of my work schedule. What happens if I am gone longer than 12 hours. I was following Rockpea's dilema the other night on whether she should give a shot or not and there was discussion as to whether too much time has gone by to give it. Can I do right by Bear on Lantus if I can't follow a tight protocal? I was also wondering how stress affects the BG #s at home. Bear seems to be getting more stressed every day with the testing rather than better. Tonight I had to pull her out from under the couch. How fast does the stress affect her #'s? I really appreciate everyones advise. I don't know what Bear and I would do without the support. Thanks! Betty

 

Personally I would stop the N until she sees the new vet as regardless of what the vet says..1u of N can and does cause hypo I unfortunately learned the hard way with my very first diabetic Muse...she was started on N as well, I wasn't testing yet as I had just found this site. Gave her 1u stayed up and watched her for several hours before turning in for the night, the next morning she was gone, she had hypoed and died in the night.

Life happens when it comes to dosing with Lantus...For the most part you want to try to stay on an every 12 hour shot schedule with Lantus but there are times it just isn't a perfect world and late shots happen...we have ways to fix that when it comes up, but I wouldn't worry about it right now. I think we have all at some point had to give an early shot or a late shot or even skip one here and there. That is just life, and even if a shot has to be skipped it is much better high for a day than too low for a minute.

High blood sugar kills slowly, too low can kill quickly.

Mel, Maxwell, Autumn & The Fur Gang

 

Hi Betty
One unit of N might well be "nothing" for some cats, but for other cats it's a lot. Every cat reacts to insulin differently. There's only one way to find out what one unit of any kind of insulin will do. Brace yourself for a broken record :lol:

You need to know what her BG just before you give her a shot.
You need to know how low her BG goes at the lowest point of a cycle (the nadir).
Especially with an insulin like Novolin, or with PZI or prozinc which is what I used on Bob. Those types of insulin don't last more than 8-12 hours in a cat. Once it does its job, it's all used up. It will reach the peak of its effect, then it will wear off.
An insulin like Lantus or Levemir can work longer than 12 hours, and one dose can carryover or overlap to the next.

My cat started at one unit, twice a day. He went up as high as 4 units twice a day before I saw real improvement in his numbers. As he got better, his dose was lowered to less than one unit, and then he went into remission. Some cats NEVER get anywhere close to 4 units twice a day, and for them, it would/could be fatal.

That's why we advocate testing, at least four times a day. Twice at shot time, and once per cycle between shots, because that's the only way to know whether a dose is too low, too high, or just right.

If you were to change to Lantus, you would still need to test four times a day (at least, in my opinion). But I would recommend that amount of testing no matter which insulin you choose.

I completely understand your wanting to keep following the vet's advice, but to be honest, I don't think his way is safe. In his experience, perhaps he's never had a cat that went hypoglycemic on 1 unit of N. But it can and has happened to some cats. And with some cats, blood testing is impossible, although I would have to say that in the 18 months I've been on the board, I can't remember any that were "un-testable" forever, and eventually the caregiver was able to test that way. With cats that it not possible to get blood tests, there are alternate methods for testing. But you have been able to get the blood tests with Bear. And the more often you do so, the less stressful it will be for her, and more importantly for you. I think she might be picked up on your anxiety to some degree. Cats are very empathetic and will feed off of whatever "vibe" you're generating at shot time or test time.

I explained earlier the problem with urine glucose testing. It's "historic" data that is hours old. It doesn't tell you that it is okay to shoot insulin "now" because you have no idea what her BG is "now". That's the danger I fear from using urine glucose numbers to base the dose amount, or even if it is safe to shoot.

I will let Lantus users telly you how they deal or dealt with using Lantus when you can't be home to test, or can't shoot exactly 12 hours apart. Some people just have to deal with their reality, and their schedule, and find ways to do it, and I'm sure they can give you lots of tips on how you can make Lantus work for you and Bear.

I'm sorry if I'm coming off like a "nag".

Carl

 

Hi- Carl your not nagging, your giving very constructive advice and Momma I'm so sad to hear about Muse. I am statring to think about N as a poision and not something I'm giving to help her. Maybe I should just stop giving her the N? I can't see putting her through the stress of attempting a curve test if I'm going to switch Saturday. Carl, you mentioned making the N work until then. Would it hurt Bear to be off insulin until Saturday? When my vet had me take her off the insulin for a few days earlier her numbers ranged fron 172 to 283. I could attempt a curve test, but it would have to start with her 7:00 pm shot on Wednesday. Thanks.
Betty

 

Betty,
Have you been testing for ketones in her urine? The risk in stopping any insulin is the development of ketones, which are something you never want to have to deal with.

In your shoes, if you are wanting to make sure the N dose is safe, I would test her at shot time. If you get a number that indicates insulin is needed (we usually say above 200), then you could give her one unit. But only if you will be able to test for a few hours. I would check at 2, 4, and 6 hours after the shot. By that time, she will mostly likely be past "nadir" which usually happens 4-5 hours into the cycle with a faster acting insulin like N. You could post the numbers as you get them. If you wanted to do this Wednsday night, I (and probably others) would watch for your posts.

Which time zone do you live in?

Carl

 

Hi Carl, I haven't been testing for ketones. I read a little about them before I replied back. I read basically it causes tissue starvation when glucose can't reach the brain or body. Sounds like it can happen quickly and can be very serious. Probably not a good idea to stop the insulin. Thanks for warning me because I was really ready to quit with the N. I could do the testing Wednesday night. I'm in eastern standard time. Once I find out how low she goes, can that drop be applied to every shot. Say she goes from 240 to 120 at her lowest point-drops 120 points. Then what would be the highest BG she could have that I would be safe to give her a shot? How low do you say they can safely go? Just trying to understand how I would use the results. I could post the numbers. Would you be following in case she went too low? I hate to have anyone stay up until
1:00 am. I'm heading to bed tonight, so I'll check in tomorrow morning unless I hear back from you shortly.
Thanks,
Betty

 

Re: Betty and Bear are scared in Oh

Because so many factors go into glucose levels, while you might see some consistency from time to time, there is always a possible curve ball. A hairball, more stress, a manufacturers tweaking of their recipe from time to time, and so forth, can cause gluocse levels to change unanticipatedly. You must be ever vigilent.

And the amount of drop a particular dose achieves may not be the same at different starting points. You cannot say that if 1 unit drops him 100 points then 2 units will drop him 200 points; it isn't a 100% linear relationship. At best, you may be able to make rough estimates for non-depot insulins and develop a sliding scale for ranges.

 

Hi BMJ- What is the purpose of the curve then? How do you use it? Other than to know how safe that particular shot was. How do you apply the information?

Carl-Would it be possible to do the curve starting at 6:00 pm. I could maybe arrange to get home from work sooner than usual. Then would do readings at 8,10, and 12:00. Wouldn't be such a late night.

Thanks,
Betty

 

Betty,
Quick answer since I'm heading to bed too.
Yes, I can be on to watch tomorrow night till 1 am. And I can give you some answers to the rest of your questions in berween tests
Just post your preshot number around 7pm and we can go from there. I'm on, well actually off, the east coast, so same time zone.

Carl

Just saw your last post. Sure, 6 pm works for me too. I get off work at five.

 

It answers the question "At that starting value, how low does the glucose go & for how long."

Dosing may start with a formula based on the cat's weight ... but is adjusted based on a specific cat's response. That's why you test and why dose adjustments are small and monitored. Some cats may start the day at 300 and go down to 50 on 1 unit; others may respond by not dropping below 200 with the exact same dose and starting point. ECID - each cat is different.

 

Hi Carl Quick question-took Bear's BG at 5:30 and it was 198. It was 284 this morning and gave her 1 unit. Should I go ahead and give her one unit at 6:00 so we can do tge curve as planned or is 198 under 200 so too low? Thanks Betty

 

Hi Betty,
Can you eyeball a half-unit? I think the 198 is close enough to 200 to shoot, but I'd rather opt for caution.

I would -
Test her one more time to see if the number is steady, or maybe rising. Maybe 6:15? Then feed her. If she eats good, then you can give the shot. If for some reason she doesn't feel like eating, I'd say "skip the shot". With a quicker acting insulin like N, it's more important that they eat well at shot time, because it tends to act sooner after the shot than an insulin like Lantus does.

Carl

 

Betty,
The reason for the 2nd test is because you want to be sure that the number is not falling when it's shot time. That might not be as critical with Lantus, but it is with N or Prozinc.

CArl

 

Carl- I tested around 5:30 and then I went ahead and fed her already so she would have eaten before 6:00 shot. I can try to retest but it may go up due to stress. We we lucky we got it real quick tonight, but now she is afraid of us. I could eyeball 1/2 unit. What about timing of food?
Betty

 

I'd go ahead and test and shoot now then. See if you can eyeball the half unit.

CArl

 

Carl not sure if you read my other post yet. Do you want me to go retest even though she ate?

 

Yes. The food would just be starting to hit her system now. It should be a little higher that the previous test.

 

Carl It was 338! Is tat cause I fed her. 1/2 or 1 unit?

 

I still vote for .5u. The food, and the stress could have caused an increase. Stress induced rises don't last long.

Carl

 

Carl-ok 1/2 it is. I will retest around 8:30. I going to run go give the shot. I'll check back in a few to make sure when to retest. Thanks

 

Testing at 8:30 is perfect, Betty.
Between now and then, I'll try to go back to the questions you had last night and see if I can answer them.

For now, just stick to Bear's normal feeding routine. It all depends on what numbers you see later as to whether or not she'll need "extra" food. As long as you have an idea of what she ate, and when, in relation to the shot time, that's good information to keep track of. Not just tonight, but going forward.

Carl

 

OK- She usually gets a bed time snack around 10:00. Thanks

 

Betty,
Save this to read when you have time :smile:

I had it backwards, and BJM had it right.....way too many "G" words.

The pancrease does start the process. It produces glucogon. Which then triggers the liver to convert glycogen to glucose.

This is a link to a thread that I posted in PZI last year trying to explain the whole process.
And a link to where I got all the information from.
http://felinediabetes.com/FDMB/viewtopic.php?f=24&t=67645
http://bloodsugardiabetic.com/diabetestreatment/insulin/how-the-body-regulates-blood-sugar/

 

OK, if you get the test at 8:30, it might make sense to hold off on the bedtime snack until you get the 10:30 test. But we'll know better by then.

Carl

 

Yes Betty, ketones can happen rapidly, and they can be deadly. When Bob was diagnosed, he didn't show any ketones on his labwork. I think that was on a Friday. He had a miserable weekend with no insulin because I was waiting to get it in the mail. On Monday, if I remember correctly, I brought him back to the vet. He was diagnosed "DKA" (diabetic ketoacidosis). That fast. He spent the next three days in emergency care, and the vet told me if I'd waited any longer to admit him, he most likely wouldn't have survived. Not only very deadly, but obscenely expensive to treat. It can cost upwards of $1000 per day for round-the-clock monitoring and treatment.

I think BJ gave you some good answers to that, but I'll add a comment or two. No, the results of just one cycle can't be applied to every shot. I think about the only thing that can be determined by a single cycle is if a dose is too high. If you were to see a drop down into the 50-ish range, and it's still early in the cycle (before typical nadir), then you can determine from that drop that the dose is too high. If you don't intervene by slowing or stopping the BGs from dropping into hypo territory, it'll just keep dropping. Yes, the liver will attempt to "stop it", but it can still fail to be able to do that. So you'd lower the dose, naturally.

But just one cycle, this one for example, won't give you conclusive data (unless Bear does drop really low). It will give you an idea of what to expect in the future, but you can't automatically assume that the same thing will happen on the same dose with the same preshot number.

What you can get from this cycle is an idea of how long the insulin is lasting, and how long it takes after the shot for the BGs to start to drop, when the nadir is, and when she starts rising as the insulin wears off. At this dose, she isn't likely to go too low, and that's the big reason for the .5u shot. We just want to see how it works, and do so safely.

Also, knowing what "N" does for her will help in determining what a logical starting dose of Lantus would be. It might be the same dose, higher, or lower. Testing her while keeping her on Novolin will let you do so safely, and it will ensure that she's at least getting "some" insulin from now until you switch.

CArl

 

Carl-Thanks for all the info-I'll have to take some time and really study it. Sounds like ketones are pretty nasty. So glad Bob was OK. I was just wondering if I can give Bear treats when I test her at 8:30. I have freeze dried chicken treats. Since you wanted me to hold off on bed time snack, wasn't sure if treats could mess up test results.The only time I ever give her treats is when I test.
Thanks,
Betty

 

A modest low carb treat or two isn't going to have much impact 2 hours later. Kibble is an entirely different stoy - some cats really spike with very few bites.

 

No the treats are fine. No matter what, we don't deny the reward for the getting the ear poked. Most freeze dried treats are close to zero carbs anyway. Definitely bribe/reward with the chicken treats. ;-)

Carl

 

Carl- Had a terrible time getting sample-very upset. BG=75. Yikes!
Betty

 

OK, got some high carb gravy style food? If so, a spoonful, maybe even add a couple drops of karo. And test again in 30 minutes.

Assuming this number is "valid" which you have to do when you see a low number.... then this kitty needs a very low dose of insulin, if any at all.

Carl

 

How long since you gave shot?
Have you got a can of high carb food?

What you're going to need to do is
Test
Feed a spoonful
Wait 15-30 min
Repeat until you've 2 or more rising numbers and are sure he's going up.

If necessary, wrap her in a towel.

 

Shot was at 6:15- I'll go feed her now and test in 30. Thanks

 

BJ, this would be +2.5

Carl

 

Got it.

Bett - how is he behaving?

 

She snarffed the food down and is just sitting peacefully on the floor. No signs of distress. Heading over to retest and follow directions on getting numbers up . Thanks

 

Ravenously hungry is sign of low glucose.

 

Just tested-BG 62. Gave her another spoonful with a couple of drops of karo. At what hour do you think the insulin will reach its peak?
Betty

 

N insulins last about 6 to 8 hours, so after 4 hours it may be steadily rising.

Keep going with the half hour checks, posting, and feeding a teaspoon of food.