Betty and Bear are scared in Ohio

Would it help to give her some dry food?

 

Betty,
You're doing great! I'll post my thoughts on what comes next later, but for now let's just get Bear's numbers up. Like BJ said, N is usually a 6-8 hour insulin, and she should start coming up some on her own after +4 or so. We'll just help her get to that point.

Carl

Negative on the dry food. It doesn't boost the numbers quick, and then it stays around and muddies the picture. I think you'll see the number rise from here on out, but we want to make sure that happens.

 

Yea! 108- Thank goodness. She is really mad, but that's ok considering the alternative. I assume I need to test again at 10:30 and make sure it is climbing. Do I give another dose of food now or should it start to rise on its own since were around the 4 hour mark?
Thanks
Betty

 

If you are going to test in 30 minutes, I would hold the food until after that test to see if she continues to climb. If she does, then you can feed, and you should be good until the +6, or even +5.5 if you want.

Carl

edit - actually it's only 15 minutes away, so yes, I'd stall on the food till after that test.

 

Just got done testing-123- Is it necessary to keep on feeding her? Also, why do we do the 5.5/6 hour test. Can I assume she is ok now?
I'll do the next test if gives valuable info, but she is growling, ect....
Thanks
Betty

 

At this point, you might go half and half high and low carb, then check in 30 minutes.

 

BMJ-If she went from 62 to 108 to 123 are we still concerned about dropping to a dangerous level now and also we are +5 on the shot . Will definitely feed and test again, but don't understand why? I know I will have to get a tougher skin and I'm doing this all for her well-being, but the amount of stress I'm putting her through is concerning me. Just feel a little better about doing it if you could give me a quick explanation.
Thanks
Betty

 

Betty,
My opinion, I think she's okay and past nadir. I would feed her and leave her be. The original point of the +6 test.... I wanted to see if she came down and went back up by +6. Her going that low that fast sort of shot that experiment to h*ll.

I don't think there'd be much value added in a +6 at this point.

Carl

 

I think that we determined the following.

1 - She drops fast and far on Novolin.
2 - She seems to follow the typical N curve. Early drop, short duration.
3 - She dropped about 150 points on a really tiny dose of N, and would have dropped farther if you hadn't been testing and caught the dip into the 50s.
4 - Continuing on Novolin, even at a tiny dose, is going to require close monitoring.

I think, after seeing this cycle, that you have two choices.

Continue with really small doses while testing, and even if you see a PS reading above 300, I wouldn't go higher than .5u per shot. Or....
Stop with the N, check at least twice a day for ketones using the urine test strips for ketones, and see the new vet on Saturday. Share all the numbers you have for Bear with them, the BG numbers, the urine glucose numbers and the dose amounts.
See what they think about switching to Lantus, or even what they think about whether insulin is needed. I think it might be, but I'm not a vet, and I can't run a blood panel. Make sure they understand that you were feeding low carb, and what you had to do to get her numbers up tonight with the karo and gravy and all.

Make sense?

Carl

 

If she's at +6, maybe just leave out the low carb and crash for the evening.

 

Thanks Carl. I was really hoping that was what I could do. It's been a rough night on everybody. Maybe sometime soon you could explain what happened tonight. I have given her 3 units before. If she had this kind of response with .5 units how did she ever survive the 3. Thank you, thank you , thank you -can't say it enough to let you know how much I appreciate your help.

I just read your other post. I really don't think I want to keep her on N anymore. Do I get the ketone testing strips from my vet or can I get them at Walmart, ect...Makes perfect sense.

BJM- Thanks for all the help. Got pretty scary there for a while and was able to handle it do to all of you. Any thoughts on staying on N until Saturday or quitting and just testing ketones?

Good night everybody-

 

I'd be inclined to halt the N, get ketostix from the pharmacy and test the urine, and check the glucose twice a day while mainting a low carb diet. And see the new vet.

 

You should be able to find the ketostix anywhere that sells diabetes supplies. Walmart, or any pharmacy should have them. Sometimes you have to ask at the counter but you don't need a prescription or anything. Your vet may have them, but they'll charge you an arm and leg for them. They're pretty cheap at Walgreens.
Much less than glucose meter strips.

The instructions are on the box, or in the box, and there is a chart with what the different colors mean after you get the test. The hard part is catching Bear while she's peeing and trying to get her to pee on the stick!

Carl

 

Hi everyone-Tested Bear today -199 am and 243 pm. I am not giving any insulin. Got my ketone detecting strips. The only thing that concerns me is getting the urine sample. The directions had FRESH in bold print. I have the special kitty litter I can use and lock her in the bathroom, but won't know how fresh. I'll just have to try to catch her going in the regular box. I have a shallow little tray I can put under her that works pretty well but have to catch her in the act. I called my other verts office today and asked to have Bear's records faxed to me. I told them that I was looking into other options for Bears insulin because I didn't like the N she was on. Figured he would find out sooner or later. Thanks again for all the help last night. Any thoughts on what I should ask my new vet on Saturday? Any specific concerns I should address? I know the basics and can fill her in on what I've done so far. It will be interesting to see if she is impressed with my initiative or if she feels that I have been free lancing too much. I wonder if she has seen this web site? Going to bed early tonight! A special thanks to Carl and BJM.
Betty
P.S. Carl-just reread your post from last night. What if I can't get a urine sample twice a day? I know you had your close call with Bob. Is it just the fact she is off insulin that can cause the ketone problem or is if her BG goes really high? Also, thanks again for all the info. Too tired tonight to dig in too much, but plan on looking it all over closely Friday night.

 

Hi Betty,

Find out if she supports:
Home testing
Low carb canned only diet
Ask how she bases initial dosage
Ask how she determines dose adjustments, and in what increments
Ask her if she is familiar with the Tight Regulation Protocol
Ask her if she's ever heard of "us", and if not, give her a link to the board!
Ask if her clients have had great success with Lantus, and a ballpark as far as remission rates.

Tricks for pee testing....
You can use aquarium gravel in place of litter. You just have to know she's just peed. It won't soak it up and you can dip the stick in the puddle. Make sure and rinse the gravel in hot water and letting it dry before you use it.
You can also put a layer of plastic wrap just under the litter, and it will catch the pee for you.
"Fresh" - as long as you can get to it in a few minutes, you should be okay.
Hey, people have gone so far as taping a ladle to a long pole and right when kitty starts to go, stick the spoon underneath! We can be creative when we need to be. :lol:
Carl

 

We like to say that there's a recipe for ketones...

Not enough insulin + not enough food + some sort of infection = ketones (But all 3 are NOT required to be taking place)

They can appear when the dose isn't high enough, which causes higher BGs. In Bob's case, he wasn't getting insulin yet, he wasn't eating well at all, but there was no infection present that the vet could find. He was also severely dehydrated.

But although they seem to show up when BGs are really high, it isn't a requirement that the BGs be high. When we worry most is when all three factors are in place at the same time.

But any time we advise "no insulin for now", we advocate ketone testing regularly. That's because they can go from zero to really high very quickly, and the sooner you detect any trace, the sooner you can react to make them go away. Once they get above "trace amounts", they are nearly impossible to "fix" without significant vet care and cost.

Carl

 

I may have been unclear - aim to test for ketones at least once a day, and blood glucose test twice a day.

My signature link on Secondary Monitoring Tools has some additional assessment methods and the one on Vet Interview Topics overlaps with most of what Carl mentioned.

 

Not enough food isn't a problem for Bear, but she has had a chronic upper respiratory problem that comes and goes. I have had her on numerous antibiotics, but nothing seems to completely knock it out. Hopefully, I'll be able to get some pee.
Betty

 

You know, an illness like a respiratory infection can raise bg levels. If Bear does well during this no insulin period, I wonder if she needs insulin at all. Finding the cause of the infection, and treating it properly, may be the answer. That is something else to ask the new vet about.

 

IDEXX lab offers several respiratory panels on blood. You might discuss sending out a sample for a panel. I thought Spitzer had feline herpes and it was something else entirely.

 

Funny you should mention that, because earlier I was wondering if a cat can have high BG and not have diabetes. I'll be sure to discuss the infection angle. Does anyone one know why Bear isn't drinking much and thus not peeing very often? When my vet was discussing the urine testing, he said a diabetic cat will drink a lot and its litter box can look like a mud puddle. I am suppose to test for ketones, but she isn't peeing much as far as I can tell. Really tired, but feel like I have to sleep on the bathroom floor with her again to try to get "fresh" urine.
Betty

 

Not drinking much leads to not peeing much. When on a low carb canned or raw diet, much of the needed moisture is in the food, so drinking a lot isn't needed.

 

Just a quick update- BG 243, finally got urine at 5:15 this morning. No trace of ketones. Yea!

 

Great news on the ketones
And while the BG is not in the normal range, it really isn't a bad number without insulin for over 24 hours.

Carl

 

Mildly to moderately elevated, but not as high as I've seen here.

Keep on hanging in 'til the vet visit.

Spacing out the food into mini-meals will help reduce any food causing glucose spikes.

 

Hi everyone-Just a quick update-Took Bear to my new vet this morning. She seemed to have a good approach. Not much too report as for as Lantus use and dosing, because she said she wasn't sure if Bear was a full out diabetic. The last 4 BG I got on Bear without insulin were all in the mdi 200's. Not perfect, but not horrible either. She wants me to drop Bear off at her office Monday morning on my way to work and she would do a complete work up on her to determine if there could be another underlying cause for the high BG. She said she totally disagreed with my other vets approach. She felt Bear may not have to be on insulin, but we'll wait and see. I''ll keep you updated.
Betty

 

Terrific news! Especially that she told you she disagreed with any advice the old vet had given you. ;-)

Please let us know what the tests show?

Carl

 

Very often, an infection will raise glucose levels. Let's hope its that easy of a fix.

The elevated glucose does support continuing to feed a low carb, canned or raw diet, so you won't need to change that.

Fingers crossed!

 

Hi -I did something stupid and accidentally left some dry food down where Bear may have been able to eat it. I am trying to switch everyone over to all wet Fancy Feast diet, but I have a few die hard dry addicts that I am trying to gradually get all on wet. I was wondering how this will affect Bear's BG numbers and urine by Monday morning when I take her to my new vet for testing. I'm sure if she got some dry it may have gone really high, but will it be calmed down by Monday or did I throw everything all out of whack? Really mad at myself because I have been so careful and tried so hard do do everything I could to get her on the right track. Thanks.
Betty

 

Dry food "sticks around" longer than canned (especially low carb canned), but it still should be clear from Bear's system by Monday.

It is hard having some kitties who refuse to conform to what you know is best for them, and dry food addicts are tough to break. That is why we call it "kitty krack". But this sort of thing happens. Naturally, it happens when you don't want it to!

I think Bear will be "over it" by Monday's vet visit. Because urine glucose will linger longer than blood glucose, there's a chance that she might show glucose in her urine, but her BG test should nullify that since blood glucose is "now", and urine glucose is just evidence that a few hours earlier, she might have had glucose in her blood. The blood glucose test is the one that matters more.

Carl

 

Hi- I'll be sure to let the vet know in case it affects her urine levels. I didn't know how her numbers would be affected because my new vet told me to stop testing for the rest of the weekend. She said to let Bear (and myself) destress so she would be relaxed as possible when I bring her in on Monday. She said she already had a good idea what was going on with her numbers since I charted them for the past two weeks and I wouln't be giving her any insulin, so she didn't see any reason to test for the rest of the weekend.

I didn't mention before that one thing my new vet said that didn't thrill me is that she didn't like the meter I am using-Relion from Walmart.
She said it fluctuated too much in her opinion and was not accurate enough. If Bear does have diabetes and I will need to give insulin, then she wants me to buy a $200 meter. I think it was an Accucheck or something that had accu in it's name.I believe it may have been for animals only. I left her my meter and asked her to check mine against hers to see how close the numbers were. Not thrilled about spending the money.

She also was not happy that my other vet had had Bear on steroids earlier with her URI. She doesn't understand why vets are so quick to use steroids to cure everything. It seems like everything I give my cats has steroids in it-ear drops, eye drops, ect

Betty

 

She probably wants to sell you an AlphaTrac, which was developed specifically for pets. It is expensive. The strips are expensive. You have to get the strips online or from your vet (can you say 'mark up'?), which makes it unhelpful if you have to monitor a hypo situation and don't have enough on hand.

There are reference numbers for using a human glucometer with pets (ex. 50 is as low as you want the cat to go) . The human glucometers are less expensive. The strips are less expensive and may be available 24/7 (ex Walmart brands).

Both types of glucometer - human or pet - have to follow the FDA requirement of being within +/- 20% of the true value. The range gets wider as the number gets higher. You aren't going to make different decisions using one over the other - high is high, low is low, and you follow the protocol.
Ex
50 -> 40 to 60
80 -> 66 to 96
100 -> 80 to 120
200 -> 160 to 240
300 -> 240 to 360

 

My guess is "AlphaTrack", which is a pet-only meter and costs $200 or more. The strips are also more expensive and I think only available from a vet.
There are some people here who use those but I think 95% or more of us use human meters. I use a Relion Micro.
You don't need to spend the extra money. Your meter will probably test 20 to 30 points lower than her meter, but that's not a problem.
There are some human meters that aren't all that good, but the Relion meters are just fine to use.

Steroids can screw up blood glucose. Sometimes diabetes can be "steroid induced", and when the steroids are removed from the picture, the condition can improve or even "go away". When was the last time that Bear was given steroids?

Carl

 

I'm happy to hear the new vet sounds up to date withe diabetes treatment! It may sound odd, but I do hope she finds some underlying something that may have caused the high glucose readings.

I believe many vets suggest the Alpha Track meter, but you really can use the one you have. Don't let the vet sell you on it, or on prescription food. Just say you can't afford them and will have to make do with what you have.

 

Hi- It probably was the Alpha Track meter. That sounds right. I just remember it started with an 'A'. I agree with all of you that it is an unnecessary expense. Bear has been off steroids for a long time. It was just a shot back in June and August. But I do have some other cats on long term steroid use for ear problems and stomatitis. I'll have to see about alternative ways to treat. Thanks
Betty