Bringing home newly diagnosed kitty tonite...need advice

Discussion in 'Feline Health - (Welcome & Main Forum)' started by Eva and Achilles, Aug 18, 2010.

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  1. Eva and Achilles

    Eva and Achilles Member

    Joined:
    Aug 18, 2010
    My beloved 11 year old kitty Achilles was diagnosed with diabetes. He spent the day at the vet yesterday for monitoring (brought him home in the evening) and we are doing the same today. We will be bringing him home in a few hours and I am terrified about what we need to do to give him the best possible care at home.

    One of my concerns is that the vet gave him Humulin N and I've read on more than one occassion on this board that this insulin is not effective. We will not know what his bloodwork shows until we pick him up this afternoon therefore I have no idea if the Humulin N is helping or not. I want to ask the vet for an rx for PZI or Lantus but I have no idea how much I should be giving him and how often. Is there a way to convert the Humulin N dosage to a PZI or Lantus dosage?

    Another grave concern is the risk of hypoglycemia. Both and I and my husband work long hours. I am terrified about giving Achilles an insulin shot tomorrow morning and leaving him home alone for 10 hours risking that the dosage may be too high and that he can become hypoglycemic.

    Should I just switch him to a high protein low carb diet for a few days and not administer the insulin? I am going to Walmart tonight to pick up the Relion meter, test strips and lancets, but I have no idea how to test. Also, I have no idea what to do with the data from the tests. In other words, what if the tests show that his BG level is over 200, how much insulin do I give him?

    This is all happening so fast and I don't know how to proceed. Can anyone calm this newbie down and walk me through what I need to do next?

    Thank you.
     
  2. pamela and tigger

    pamela and tigger Well-Known Member

    Joined:
    Dec 28, 2009
    You have come to the right place. We have all been where you are now. It will be alright. It looks like you have been reading. Good for you! It is a lot to absorb but you will get there.

    You are right. It is one of the shorter acting insulins and usually doesn't last the full 12 hours. Not a recommended insulin anymore. I am surprised your vet is still prescribing it at all. A longer acting insulin like Lantus (glargine) or levemir (detemir) would be preferred. Some vets are also prescribing Pro Zinc. As for converting the dosage it is recommended usually to start with one unit on any insulin. Some cats even less if they have a good reaction to that starting dose.

    Just leave food out for him. Some people use a timed feeder. But with a gentler insulin like Lantus or Levemir he should be alright and as long as you are hometesting.

    You could do that, switch him to a wet diet first before starting insulin. Has he been eating dry food up until now? If that is the case then witching will likely lower his blood glucose numbers and will give you a 'true' number to work with when you do start insulin.

    BUT I would not do it for longer than a few days. And if he doesn't like the switch and he doesn't eat well, you are inviting other, bigger problems. Be sure to get some Keto-diastix from the pharmacy to check ketone levels in his urine. Just as a safeguard.

    ALSO, make sure you run it by your vet first though to make sure there are no other health problems you could be interfering with. Hopefully your vet will agree to this and with prescribing another long lasting insulin. If he doesn't want to switch insulins, then I would probably be looking for another vet.

    Others will be along shortly. Just keep reading and learning. Also check out the FAQ's on this site. You can do this. It sounds overwhelming at first but it will soon be routine.
     
  3. MommaOfMuse

    MommaOfMuse Well-Known Member

    Joined:
    May 26, 2010
    Okay first things first....Breathe! You are now in the best spot in the world to help Achilles stay healthy and happy. Others will be chiming in shortly I'm sure that can offer better advice on the different insulins. But I can give you some general hints, one thing is you might want to let us know where you are at (closest major city) there is a really good chance someone here is close to you and most of them are more than willing to make a house call to walk you through the home testings. It is not as difficult as it may seem in the beginning. But it is something that is absolutely critical for gauging how your boy is doing. Also what are you feeding him now? If you can you will probably want to start switching him over to an all wet or raw diet, check out Janet & Binky's list and look for things that are less than 10% carbs, but again this is where hometesting becomes important, because diet can bring his numbers down.

    Most people here have a "no shoot" number, so if you check his BG and it is below your no shoot # then no shot. As far as Humlin N goes, no it isn't the best insulin out there for Achilles, but while you are using it make sure he eats about 1/2 hour before his shot it is one of the insulins that needs food on board. So if he doesn't eat, he doesn't get his insulin.

    I know it is all so confusing and overwhelming when we first hear our beloved kitty is a diabetic but just start by reading all the stickies on this site, ask a ton of questions, someone always has an answer.

    Other than that, Welcome to the FDMB family. We will be looking forward to getting to know you and Achilles better.

    Mel & Muse (GA)
     
  4. Sue and Oliver (GA)

    Sue and Oliver (GA) Well-Known Member

    Joined:
    Dec 28, 2009
    Wonderful that you are going to hometest. Now you will know exactly how the insulin is affecting your kitty.

    Here is the video: http://www.youtube.com/watch?v=_zE12-4fVn8 and a site for beginning testers: http://www.sugarcats.net/sites/harry/bgtest.htm

    Try the meter out on yourself first so you know exactly how it works. Make the rice sack (uncooked rice in thinish sock heated till very warm in microwave) Have lots of treats ready.

    Most of us did not get a blood sample on the first try. So if you have trouble, come on and we will get you all our tips.

    You can do this! We'll help!
     
  5. Phoebe_TiggyGA_NortonGA

    Phoebe_TiggyGA_NortonGA Well-Known Member

    Joined:
    Dec 29, 2009
    Most vets do not know how we prick the edge of the ear for a blood sample, so don't be alarmed if he/she doesn't know. They of course get blood from a vein, which is way too hard to do at home by yourself.

    We prick the edge of the ear with a "Lancet" which is like a pin with a plastic end - some people use a "lancet device" and some prefer to poke "free hand" - just holding the small lancet. I prefer to use the lancet device that came in my meter kit.

    Do practice getting blood from yourself on your fingertip to get used to how much the meter needs to get a good test result.
     
  6. Larry and Kitties

    Larry and Kitties Well-Known Member

    Joined:
    Dec 28, 2009
    If you are going to use Lantus or Levemir insulin you want a script for either the cartridges (Lantus only) or disposable pens (both) instead of the 10 ml vial. The cartridges and disposable pens come in a pack of five 3 ml cartridges or pens. This is because the insulin in the vial will very likely go bad before less than half is used. The cost per usable ml will be lower for pens/cartridges but the actual cost per mil will be higher.

    One of my kitties, Twigie is on N and is doing excellent but she seems to be the exception.
     
  7. Anonymous

    Anonymous Guest

    Eva this utube video was made by one of our members and is an excellent way to learn to hometest. It actually becomes that simple for the majority of us. Please know we will hold your hand and walk you thru each and every step of this. you are not alone. besides, it will all become rather rote after a while and your kitty may very well go into remission.
    http://www.youtube.com/watch?v=_zE12-4fVn8
     
  8. housecats4

    housecats4 Well-Known Member

    Joined:
    May 31, 2010
    Sending Prayers & Angels to help you and kitty on your road to a speedy recovery.My cat Trey was 456BG in May today he is off Luntus for 23 days. This is the best place for a DC so welcome and read a lot and don`t forget to Breath!! Kath
     
  9. Taline & Bibo

    Taline & Bibo Member

    Joined:
    Jul 19, 2010
    Welcome to FDMB,
    I'm also new here. It's been exactly one month since my cat Bibo was diagnosed with diabetes and in the beginning, my world turned upside down,and I thought this was going to be impossible for me to manage, considering Bibo is not a friendly cat, and it's almost impossible to catch him, especially during the day when he hides under the bed. BUT, I made friends here, real good supportive friends that encouraged me everyday to not give up, and I can tell you that after 4 weeks of being on this forum, I learned how to manage Bibo's diabetes, take care of him and within 2 weeks, his blood glucose numbers went down, to a level, that I haven't given him a shot in almost 3 days. Hope is there for your Achilles.
    As a new member, and newly experienced, I have few recommendations for you:
    1. Feed Achilles only wet food. (I feed Bibo Fancy Feast variety pate only, either chicken, turkey or beef, they're low in carbs).
    2. Home test Achilles, and get the numbers down on a spreadsheet, so members will see it and help you with the dosage.
    3. Start with lower dosage. Bibo is on PZI (I don't think they make it anymore), and I started him on 1u, and it was too high, so I would start with 0.5u and see what the numbers are.
    4. Start your hometsesting on the weekend, so you can be home to monitor during the day. ( I took few vacation days in the beginning), or call in sick for a day or two if you could.
    There are so many experienced and knowledgable members who are always ready to help. Please feel free to post any question, and people will rush to help you with answers. they're awesome!!
    I'm so so glad you joined the FDMB, and best of health to Achilles.

    Taline
     
  10. Eva and Achilles

    Eva and Achilles Member

    Joined:
    Aug 18, 2010
    Thank you all so much for your replies. I knew I was in the right place the moment I read a few threads. So here is latest on my buddy.

    8/17: His BG was 427 pre-insulin shot. Dr. gave him 2 units of Humulin N twice.
    8/18: His BG was 307 pre-insulin shot. Dr. gave him 3 units of Humulin N only once a day, and instructed us to give him 3 units once a day today and tomorrow morning. We picked up the BG monitoring kit from Walmart last night and started testing ourselves to get used to it for this mornings blood draw.
    8/19: His BG was 166 pre-insulin shot this morning. (I hope I did the test correctly) We gave him the 3 units as instructed, but now I am terrified that it may be too much considering his reaction to the insulin on the prior 2 days. I left out a bowl of dry food for him and my husband is going home at noon to check up on him and test his BG level. I pray that it is hovering around 100 and that it hasn't dropped too low. Anyone know when the Humulin N peaks from the time it is administered? We gave it to him at 7am after he ate a bit.

    We have been feeding him dry food pre-diagnosis but he does like wet food too, so we are slowly incorporating the high protein/low carb wet food into his dry food.

    Last night, I asked the vet why he was using Humulin N. His response was that he knows there are other inslins out there but he cannot get them. He highly recommended that we take Achilles to a specialist so that we can get the other insulins. I made an appointment for him to see Dr. Mark Peterson at the Animal Endocrine Clinic in NYC on Monday, which was the soonest he could see him. Anyone have any experience with him and the clinic?

    Another problem we are facing is that Achilles' liver enzymes keep rising even though his BG is going down. This is something that the vet wants the specialist to address.

    Thank you all for your advice and prayers. They mean the world to us. Please keep the advice coming.
     
  11. Dale

    Dale Member

    Joined:
    Dec 28, 2009
    3 units N on 166 preshot!!!

    Eva, be sure your hubby tests at noon today. I'm very worried about 3 units of N on a 166 number. N drops, in most cats, pretty quickly. Here's info on N for you.

    The N Primer
    Posted by: Kimber & Bunny (IP Logged)
    Date: April 17, 2008 05:42PM

    HUMULIN 101

    NOTE: Although this was originally written as a primer for N insulin, much of this is a GENERAL HUMULIN PRIMER with advice and experience that pertains to any of the ‘human’ insulins, including Lantus which I have found works very much like Humulin U.

    There are four kinds of Humulin Insulin: R, N (NPH), L (Lente) and U (UltraLente). Novolin is the same as Humulin N, just a different manufacturer.

    R most often is used at the vet hospital when a cat’s bg levels are very high and other health issues make it imperative to the numbers down fast. Occasionally it is used in small doses in combination with a longer acting insulin such as U but more often with the animal based insulins. Personally, I would never suggest this protocol to a novice. I would NEVER recommend R as an “only” insulin as it’s drop is very fast (some cats it takes only 15-20 minutes), very steep and it’s duration is often less than four hours.

    In cats, N tends to be the faster acting, often with rapid onset and little duration.

    N is not the easiest insulin to regulate on. However, there are several cats on this board who have been regulated on it. Bunny was regulated on Humulin N for just short of 5 years. Bunny, unlike most cats, got 12 hours duration out of the N.

    L tends to have a gentler drop and longer duration. Many cats that have a reaction to the N do better on the L because of the slower drop and the fact it stays in their system longer. (This insulin has been discontinued by the manufacturer.)

    U tends to have an even slower drop and longer duration than the L. Again, many cats adapt well to this insulin that have experienced a roller coaster ride on the N. (This insulin has been discontinued by the manufacturer.)

    Every Cat is Different, and not every cat will react the same to any given protocol or dosage. It is VITAL that all changes be discussed with your veterinarian who can talk about these options with you so that TOGETHER you can find what is best for your cat.

    There are some very important issues/points to remember when using N, most of these are pertinent for the other insulins as well.

    1. FOOD. Always make sure kitty eats about an hour before his/her shot. This will insure that kitty has food on her stomach to counteract the typical fast drop of the bg's caused by N (some cats do not drop fast on it, which is, again, why hometesting is so important!).

    Feeding an hour ahead also leaves you relatively sure the cat is going to keep the food down. Warning: We are dealing with cats here, which means nothing is guaranteed. Bunny vomited at peak, while we were asleep, and that is how we had our first hypo in over 5 years of treating diabetes.

    NOTE: Bunny free fed and seemed to know when he needed to eat, so we did not have to worry about his eating before hand. However, kitties getting timed feedings should be fed as stated.

    2. DO A CURVE/HOMETEST. This is a must with all insulins, but can really save you from hypo on N. You need to know when the insulin peaks because you need to know just how low the bg's are dropping. N, in my experience, can peak at anywhere from 2 to 6 hours. Before Bunny got sick, his peak was at around 5 (depending on exercise and food consumption) and after his cancer dx and subsequent hypo, we dropped down to two hours after shot. Needless to say, we have switched insulins.

    The importance of your peak/nadir/low number is two fold: A) You do not want to hypo your cat. High blood glucose @#$%& slow, low blood glucose KILLS FAST. B ) You cannot adjust a dosage on preshot alone. Preshot numbers can be deceiving in that if you are going too low at peak, you will have high numbers at preshot. It is kitty's body's way of saving it from overdose. Consistently high preshots without knowledge of your nadir number could mean rebound, at which point you don't need to increase your dosage you need to DECREASE.

    HORROR STORY: When we were newbies and our vet was learning this right along with us, we kept increasing Bunny's dose based on high preshots and vet visit readings. He was up to FIFTEEN UNITS OF N BID!!! Makes my stomach flip flop thinking about it now! Posted on this board that I was at my whit’s end because I could not get nice preshots. The posts I received back said, "That is WAY too much N! Start over and check your peak numbers!" He was going down to 26 at peak! YIKES! If not for the fact that Bunny free feeds, and can thus bring his numbers back up by eating, he would have died. ALWAYS FIND OUT WHEN YOUR PEAK IS AND CHECK THOSE NUMBERS BEFORE ANY INCREASE!

    When curving on N for the *first time*, in my opinion, it is good to check bg's at +2, +3, +4, +5 and again at +6. This will tell you exactly where your peak is. After the numbers start to rise, you can go back to every two hour checks. This is not the only way to do a curve; it is just my opinion on how to do your first with a new insulin, especially one as fast acting as N.

    Until you have a chance to curve, I do not recommend giving the shot at bg’s under 300 simply because you do not know yet how much of a drop you are going to get. I have sat up all night on hypo watch with several folks who were new and thus had not curved yet, only to find out their cat dropped 200 on a single unit…not good when preshots was 250.

    Hometesting Links:
    [www.gorbzilla.com]
    [groups.msn.com]

    3. SETTLE TIME/ONE CHANGE AT A TIME. Speaking of increases, just like any other insulin, allow at least two weeks between changes/increases for the change to settle/body to adjust. This includes food changes. If kitty is starting a low carb diet, do not increase insulin until the cat's body can adjust to the change. Too many changes too close together will leave you wondering which change you made gave you the result you wanted. The only exception to this rule is a decrease in dosage. If kitty is going too low (I don't like Bunny to be anywhere under 100 and I, personally, do not “shoot” under 250), definitely decrease your dose.

    4. LOOK AT THE WHOLE CAT. Many folks on this board have lovely regulation numbers that are consistently between 100-200. Some cats will not regulate that way. Bunny was mid 300's preshot (never any ketones) and low/mid 200's at peak when he was regulated. Any other change took him too low (lowest I could take him without a rebound was 180ish). He was flat on his hocks with neuropathy at dx. Once we regulated him, he started walking normal, decreased water intake and peeing and started to put some weight back on. The vet said that even though his numbers were higher than the ideal, it was obviously what worked for him. His annual FULL blood work ups, until the cancer, always showed normal.

    5. GET A FULL BLOOD WORKUP AT LEAST ONCE PER YEAR. This is all insulin’s. Because diabetes affects so many other organs, it is very important to know the kidney, liver etc are functioning properly. This test lets you and your vet get a better picture of what is going on with kitty. It also helps catch other diseases when they may still be in their early stages and thus easier to treat.

    6. SYRUP. This is just too important! If kitty is catatonic, non-responsive or having seizures, IMMEDIATELY give karo syrup, maple syrup or honey. You can rub it on their gums or the inside of their cheek.

    Even if you are on your way to the ER, the sugar spike could save your cat's life or some of the organs that are damaged during such an episode. Do not worry about getting syrup everywhere, it will wash up later. Do not worry about taking kitty's bg's too high--high sugar @#$%& slow, low sugar @#$%& fast. If possible, have someone drive while you continue to apply the syrup on the way to the doctor. It could save your cat's life!

    High carb foods such as dry food or the semi-moists like Tender Vittles are good to keep on hand as well. Why? Because if kitty is conscious/with it enough to eat, then the this will help Keep the Bg’s up longer. Syrup is a temp fix and does not maintain the needed rise.

    7. SEMI-MOIST FOOD/TREATS. Tender Vittles and other semi-moist foods/treats, milk and carrots can also cause a major spike in the bg numbers, because they all contain SUGAR. I am not saying kitty can never have these again. Quality of life is very important. Bunny has always been allowed one or two a couple times a week. I am just saying to abstain from these treats until you achieve regulation.

    8. KNOW YOUR CAT. There may come a time when kitty does not want to eat what s/he is supposed to. It is important to know what foods you can give to entice eating, as it is crucial for the cat to eat while on insulin! Also, if you are curving and kitty’s numbers start dropping too low before and/or during peak, it is lifesaving to know what to give in order to start increasing numbers. Things that have worked for myself and others: vanilla ice cream, gravy, white bread, Catsip (the milk that is made for cats, not the stuff you put on hotdogs), donuts, popcorn, dry cat food or dry cat food with tuna water dumped on it, semi-moist cat treats. You will want to know beforehand what high carb foods your cat loves, and will readily eat, so that should you find yourself in a situation where your kitty's numbers are going too low, you already have a supply on hand, and won't waste precious moments experimenting with different foods.

    9. START LOW GO SLOW. If you start too high, you could “miss” your ideal dosage. Many people have found that ½ a unit BID or 1 unit BID ends up being the perfect dosage to keep kitty in the 100-300 range.

    10. BID (TWICE PER DAY) dosing: In all the years of being on and off the FD Boards (since 10/97) I have not come across a cat that got any more than 12 hours duration on N. It is NOT a single dose per day insulin by any stretch. Increasing dosage does not make the insulin last longer, it only makes the cat’s number see-saw more, dropping them lower which causes their glucose to go higher. If your vet wants SID (one dose per day) please explain this to him/her and if they refuse to listen, PLEASE INSIST that you do twice per day dosing.
    Even on slower acting insulins like L and U, MOST cats need insulin twice per day.

    11. EVEN AFTER YOU REACH REGULATION IT IS A GOOD IDEA TO PS TEST AND/OR DO PERIODIC CURVES. Insulin needs change. Throughout the six years I treated Bunny his insulin had to be adjusted. Just because 2 units BID worked for the past 6 months, you are treating a CAT, and cats change their minds all the time! His dosage varied from 7 to 5 units over the first 5 years because his body’s needs changed. Without periodic curves, I wouldn’t have known to adjust his dosage and could have easily hypo’d him.
     
  12. tuckers mom

    tuckers mom Well-Known Member

    Joined:
    Dec 28, 2009
    Tucker first started out on Humulin N, dose was based on his weight. The N lasted about 4-6 hours for him and then he would stay high the rest of the day.

    I have to ask, do you have corn syrup, honey or maple syrup on hand in case the dose this morning is too much and your kitty starts to hypo. I don't want to alarm you but it would be best to be safe and have this on hand.

    Your vet can write you a script for Lantus or Levemir insulin if he can't get different insulins for you.

    Diabetes can cause liver enzymes to go up, so once the kitty is regulated, enzymes may go back down. But I'm no expert, see the specialist, it would be the best thing to do.

    Changing your cats food is also going to bring the numbers down naturally so keep hometesting, get pre shot numbers and some mid cycle numbers so you can see how he's doing.
     
  13. RuthV

    RuthV Member

    Joined:
    Jul 15, 2010
    Welcome to this group. I am new here - one month. No one has yelled at me or been insulting ( I guess I saw too much of that on usenet and am somewhat gunshy) and for that I thank everyone here.
    My cat, 12 year old neut'd male, was diag'd a month ago. Vet started him on Lantus, twice a day, 2 units per shot. I should think your vet could merely write a prescription which you can get filled at a pharmacy.

    I give the shot while he is eating and he has never noticed a thing. YAY.

    What I have done so far:

    switched to all wet food. ( I had him on about half an half for many months in an attempt to lose weight.) Check Binky's chart for the foods with low carb readings. I never knew you can buy Friskies in large cans to save a little money. I decided to limit the fish flavors to once a week, altho I don't remember the reason for this.

    I add abt a T. of water to the food and make a 'stew' which he likes.

    I add a pinch of Miralax to the food to alleviate constipation.

    I added a second litter box in case he's urinating more often ( it HAS tapered off) and to get us thru the night.

    I portion and space his food over five feedings a day. I have him on a strict schedule, but I am not working, so I know this could be a problem. Not at home? Then make those frozen hockey pucks of his food in small, round containers. I leave these out when we leave the house for the day.

    I had a curve done at the vet's after 3 weeks on the Lantus - she upped him to 3 units per shot now, still 12 hrs. apart.

    St. Francis at work: a new boarding place is about to open, they wl have 24 hour staff and it's run by a former nurse. I couldn't be more thrilled, as my dh was making a LOT of noise about feeling nailed down. So, check out boarding and catsitting in your area and line something up in case you have to leave town on short notice.

    Good luck - it DOES get easier.
     
  14. Eva and Achilles

    Eva and Achilles Member

    Joined:
    Aug 18, 2010
    Thank you all again.

    Hubby went home and checked Achilles' BG level and it was at 129 as of 1:30pm. That's 6 1/2 hours after administering the Humulin N insulin. I am so thrilled!! We are having a hard time getting a good drop of blood from Achillles' ear but he is being such a good sport about it. I make sure to have a treat ready for him after we're done, along with a big hug. Honestly, the hug is more for me than for him ;)

    We won't be giving him any more insulin today, but I will check his BG level tonight and again tomorrow morning before we give him another insulin shot. If it's near 129 tomorrow morning I may not give him his shot.

    I'm still worried about his elevated liver enzymes. I hope those numbers start to go down as his BG goes down and I pray that it's not an indication of another illness. So much to worry about...
     
  15. Dale

    Dale Member

    Joined:
    Dec 28, 2009
    If he's at 129 tomorrow...no, no, no...don't shoot 3 units insulin. When you get the morning number please post it, in another thread and not this one, and let us help you decide what to do. Our normal advise, unless you are using levemir/lantus insulin, is not to shoot below 150 and definitely not as much insulin as you did. I realize you were following the vets orders and you are new to all this, but 3 units is a lot of insulin on a 166, especially using N.
     
  16. pamela and tigger

    pamela and tigger Well-Known Member

    Joined:
    Dec 28, 2009
    Make sure you warm the ear first. You can do this by putting a wet washcloth into a small baggie and then heat it briefly in the microwave. Blood will come easier that way.

    The reason he was at 129 6.5 hours after the shot is probably because of the dry food (high carb). Without that he would have been much, much lower, I am sure.

    Remember what everyone has been saying, the N does not last long and your vet saying to give him 3 units once a day is so wrong. N only lasts about 10 hours at best. Then the blood glucose levels start to rise after that. Cats matabolize insulin much faster than humans or dogs. I think your vet is used to treating dogs with this insulin and dosing them once a day.

    Cats are dosed every twelve hours on Lantus, levemir, PZI and humulin N. These other insulins are more likely to last 12 hours or longer, but not humulin N. It is more harsh and has a steeper drop than the other insulins I mentioned. I hope this makes sense.

    What doesn't make sense here either with your vet is why can't he just write a prescription for you to pick up insulin at your local pharmacy. Really odd. I wonder if it is because he has never used the other insulins and doesn't know HOW to use them so doesn't feel comfortable prescribing them.

    "We have been feeding him dry food pre-diagnosis but he does like wet food too, so we are slowly incorporating the high protein/low carb wet food into his dry food."

    As you slowly replace the dry food with the lower carb wet his bg numbers will likely come down.

    What you should do is reduce his dose to one unit every twelve hours but like Dale said post here when you get the next preshot number. But I would stay with this thread when you do so that others can see what has transpired up until now or you are going to have to repeat it all over again.

    About the liver enzymes. Did you get copies of all the bloodwork your vet did? Always try to do this so you have them on hand. I wonder what his liver values were?

    I would suggest liver supplements but wait and see what the specialist says. You have a lot to deal with right now. I am sure he will be fine. My Tigger had very, very high liver values a few years ago, for months. He is fine now. The liver does heal and regenerate. Try not to worry.

    Did you get some keto-diastix from the pharmacy to check ketones in his urine? Always a good thing to do, especially in the beginning when you are still trying to get him regulated.

    As long as he is eating and has an appetite then that is good news. :) Keep us posted!
     
  17. Phoebe_TiggyGA_NortonGA

    Phoebe_TiggyGA_NortonGA Well-Known Member

    Joined:
    Dec 29, 2009
    Humulin N is usually all gone in less than 12 hours.

    So -- if his BG is over 200 this evening at "shot time", it should be ok to inject ---- however, it would be a good idea to start over at 1 unit just in case he really does not need 3 units when at home in a calm environment.

    3 units is a high dose for a newly diagnosed diabetic cat. Better to start at a lower dose and after a few days, increase a little.

    I currently have two diabetic cats adopted thru this board. Both are on low carb canned food and only need 0.25u of insulin every twelve hours -- really a tiny dose.

    So it is possible that even 1 unit is too much, as Taline found with her cat Bibo. Anyway, 1u is much safer than 3u for starting out.
     
  18. Eva and Achilles

    Eva and Achilles Member

    Joined:
    Aug 18, 2010
    I think you are right about my Vet. He readily admitted that he is not familiar with any other insulins although he knows they are out there. He doesn't know how to prescribe any other insulin so he did not want to take any chances with messing with the dosage. I think that's why he is strongly encouraging me to see the specialist. Interesting comment about him treating dogs...

    I'm so glad I left out the dry food for him to graze on during the day. We have a vial of simple syrup just in case, but it's of no use if no one is home to administer it.

    Even though it's the right thing to do, and I don't intend to stop, I can't help but feel bad about poking at Achilles several times a day to get his blood. It took my husband 5 attempts to get a drop of blood from his ear this afternoon. It's so frustrating. We are using a warm compress to warm up the ear for about 30 seconds before attempting to draw the blood, but that doesnt' seem to be working consistently.

    Okay, vent is over...thank you all.
     
  19. pamela and tigger

    pamela and tigger Well-Known Member

    Joined:
    Dec 28, 2009
    I know it can be frustrating sometimes getting blood. Even after all these years I sometimes have to poke Tigger a couple of times or more but it is so important and I just keep telling him that! He gets a treat or his meal afterwards so he puts up with it.

    I mentioned earlier about staying with this thread while Dale mentioned starting a new one. I was going to edit my post but saw you had already read it. The reason for starting a new thread is to get attention that you need dosing help in the title so people will know it is immediate. So you can do that and just copy and paste the URL from this thread in the new post. I realized afterwards what she was trying to say.
     
  20. Anonymous

    Anonymous Guest

    Eva did you watch the video i sent...the cats actually grow to enjoy the ritual. you wait and see.
    and about the 3u's, that's not in stone you know. if you get a shootable #, lets say 180, you don't want to pump 3u's at that but you can always do a skinny u.
    i'd get away from the 3u's altogther if it were me...but your shots can reflect your test #.
    it's not shoot or no shoot but rather how much to shoot.
     
  21. SaraJaye

    SaraJaye Member

    Joined:
    Aug 16, 2010
    Hi Eva,

    I am in NYC too, and my cat was dx'ed on Monday. I was in a frenzied "crash course" for 48 hours and found these amazing people here - thank goodness because I too, felt that my vet wasn't enough of a specialist! I'm finally in the groove and feel confident with the long-distance help of an amazing feline diabetes expert vet on the west coast.

    I've had a few friends suggest the Animal Medical Center on 62nd & York (I think). I have no firsthand experience there, but I have two cat-loving friends who say it's a great facility (8 floors I think) with many different kinds of specialists. Maybe someone here can give some firsthand info on this facility?

    Might be worth a phone call to ask some questions. They are open 24 hours by the way.



     
  22. Eva and Achilles

    Eva and Achilles Member

    Joined:
    Aug 18, 2010
    Achilles' BG is going up

    The rollercoaster continues. Although Achilles' BG went down to 129 yesterday afternoon it spiked to 429 at 830pm last night. In response,I gave him 1 unit of Humulin N. This morning, his BG was 456 before eating. I was too scared to give him the 3 units that the vet recommended so I opted for 1 unit again. What do you all think? Hubby is going home at lunchtime to check in on him again and retest.

    SaraJaye,I am familiar with the Animal Medical Clinic on the east side.my vet recommended that I take Achilles there. The head of endocrinology there is Dr. Mark Peterson. In addition to working at the AMC, he has his own clinic that specializes in endocrinology. He has an office on the upper west side. Achilles has an appt with him on Monday. I am happy to report back what I learn.
     
  23. Dale

    Dale Member

    Joined:
    Dec 28, 2009
    Good decision.

    You done good Eva in your decision making on how much to give. While it's probably not enough insulin, you are also making a change in his food to a lower carb which in and of itself will help lower the glucose reading. As you saw last night, N doesn't last a full 24 hours and needs food to be in the system about 30 minutes before the shot to help slow down the action of the N.

    Glad you are going to see Dr. Peterson. One of the FDMB members taught him to hometest according to Hope (Baby,GA). I forget who she said that member was. Maybe she'll chime in and tell us.

    Dale
     
  24. Hope + (((Baby)))GA

    Hope + (((Baby)))GA Well-Known Member

    Joined:
    Dec 28, 2009
    Eva, over the years I have read about Dr. Peterson and I think you have found an excellent vet to go to. You will also find that N won't do it. Not on once a day dosing and with Lantus you stand a much better chance with a new diabetic of getting him off insulin.
     
  25. Sue and Oliver (GA)

    Sue and Oliver (GA) Well-Known Member

    Joined:
    Dec 28, 2009
    Unfortunately, Eva, this is usually what Humulin does. It takes him down early and then shoots right back up. (It would be helpful to get a few readings around +4, +5. The 129 may have been his nadir or he may have gone lower and been on his way back up.) In that case, the higher numbers may be rebound from the lower ones. It is just so hard to say until you have more data.

    If I were you, I would take away the dry food as soon as you can and give 1 unit twice today, 12 hours apart. I would try to get more readings in the middle of the cycle, when possible. When you go to the new vet, hopefully you will be able to get one of the longer lasting, milder acting insulins. One unit is not likely to hurt him; it may not be enough, but better too high than too low, IMHO.
     
  26. Taline & Bibo

    Taline & Bibo Member

    Joined:
    Jul 19, 2010
    Oh Eva, I understand your frustration and great concern for Achilles. Like I said earlier in a post that I went through the same frustration a month ago, and I can tell you now that I would do it all over again , and again if I have to. It gets easier and easier by day. The most important thing for you right now is the medicine. I wish there were PZI's out there, but they discontinued it. I hear Lantus is great, and once you have a good insulin to shoot, you'll find better results. And as far as poking Achilles, the key is to poke the ultimate edge of the ear lobe,that's where you get better blood flow. I struggled so much with my Bibo, because he bit me every time I held him, and it was almost impossible to catch him (he's a difficult guy), but we managed and few weeks in to the monitoring and giving him insulin shots, along with the wet food diet, he's stable and hasn't had a shot for 4 days. You'll be surprised how many people hav had success this way. We're here to help you and support you. Please keep us posted on Achilles. Tell him we love him so much!!!

    Taline
     
  27. Eva and Achilles

    Eva and Achilles Member

    Joined:
    Aug 18, 2010
    Thanks for the quick input everyone.

    I am looking forward to getting to the new vet and getting Achilles on another insulin. In the meantime, I think I will stick to the 1 unit of Humulin N every 12 hours. Unfortunately, our ability to test him throughout the day is limited because we both work outside of the home. We should be able to test him 3 or 4 times today. He was tested this morning (that was the 459 spike) and DH will test him again at about 1pm. Thereafter, 2 more tests. One in the evening and the last before bedtime.

    He was limited to only wet food this morning and we will do the same tonight. I need to find some high protein/low carb snacks to give him after the testing. Anyone have any recommendations?

    You are all such a wonderful group of caring individuals. Thank you for sharing your knowledge, support and kindness.
     
  28. Sue and Oliver (GA)

    Sue and Oliver (GA) Well-Known Member

    Joined:
    Dec 28, 2009
    I think the dosage is a good choice. Those testing times will give you more data. Just be sure you keep track of the times and bg levels. Have you started a spreadsheet? They are pretty easy to do and as they are color coded, it is a great tool to keep track of your progress: http://felinediabetes.com/FDMB/viewtopic.php?f=6&t=16

    For lo carb snacks, I just boiled a chicken breast with no spices and cut it up into little pieces. You can also pick up snacks at the pet store - the freeze dried treats are good and so are Bonito flakes.
     
  29. MommaOfMuse

    MommaOfMuse Well-Known Member

    Joined:
    May 26, 2010
    Does he like chicken? One of Muse's favorite treats (and now all 10 civies fav) is just little bits of boiled (no oil) chicken breast. I watch for chicken to go on sale, stock up, boil up a bunch, then chop it up, stick it in freezer bags and pop in the freezer. Then when I start running low in the container in the frig, I pull another bag down to thaw. I also save the broth off the chicken, skim any fat off and use it on our drooler's food. I just freeze it in ice cube trays, pop them out when frozen and put in a freezer bag, then put a couple on his dog food to keep it moist through out the day (only drooler that grazes I have even known :D ). But I imagine it could be used to keep wet cat food moist as well.

    Mel & Muse (GA)
     
  30. SaraJaye

    SaraJaye Member

    Joined:
    Aug 16, 2010
    Halo makes this treat/snack which is 100% freeze-dried chicken; also comes in turkey or salmon. Better to buy the chicken or turkey. Must be refrigerated after opening. Petopia (Ave A &2nd St) and Whiskers (9th St. @ 2nd or 3rd Ave.) and probably lots of other places sell it.

    http://shop.halopets.com/Natural-Treats ... 1596841502

     
  31. WCF and Meowzi

    WCF and Meowzi Well-Known Member

    Joined:
    Dec 28, 2009
    Re: Good decision.

    Was it Gia? Dr Mark Peterson was Quirk's vet.
     
  32. Eva and Achilles

    Eva and Achilles Member

    Joined:
    Aug 18, 2010
    Update on Achilles' BG

    I like the boiled chicken idea. Sounds easy, and Achilles loves chicken!

    As I reported earlier today, Achilles' BG was 456 this morning. We fed him a new high protein/low carb wet food. I think it was the Wellness no grain chicken. He ate very little of it and we gave him 1 unit of Humulin N at 6AM. DH just checked in on him and his BG at 12:30pm is at 195. DH put out a small can of FF to tide Achilles over until we get home tonight. We are planning to give him another unit of Humulin N at 6PM.

    Basically, we are trying to maintain him at decent BG levels until we can get him to the specialist on Monday night.

    Please feel free to chime in with your thoughts and suggestions.
     
  33. Hope + (((Baby)))GA

    Hope + (((Baby)))GA Well-Known Member

    Joined:
    Dec 28, 2009
    Before Gia.......believe it was Sherri/Pyewacket(GA) that taught him to hometest.
     
  34. Sue and Oliver (GA)

    Sue and Oliver (GA) Well-Known Member

    Joined:
    Dec 28, 2009
    You have a great plan going - keep him safe until you get a new vet. You can see why we aren't crazy about Humulin. The drop from 465 to 195 is a steep drop and probably feels pretty crummy. But it is encouraging that he dropped that low on 1 unit - glad you didn't go for more!

    You do want to be sure he eats. Particularly with Humulin, you want food on board when the insulin hits, and to help him with the drops. If he won't eat the wet, try mixing it with the dry. (But don't leave it out that way - there is something about getting the dry wet that isn't good....can't remember exactly what.) You can also warm the wet up in the microwave until nice and stinky. Some kitties like it with parmesan cheese on top (I know, I know--we're crazy.....) You can always mix in some of his beloved chicken with the wet too. Anything to make sure he has food in his tummy.

    You and hubby are doing a great job for Achilles!
     
  35. Gia and Quirk

    Gia and Quirk Member

    Joined:
    Dec 28, 2009
    Hi Eva,

    I'm glad to hear Mark Peterson is treating diabetics again, you will like him. He has mostly been specializing in hyper thyroid for the past few years. Hope is right, it was Sherry and Pye who taught him to hometest, she also taught me. Mark was the vet who worked with Dr. Barry Sears (The Zone) to develop Quirk's experimental diet.

    Please send me a private message if you would like my phone number, I'm always available to talk.

    Gia & Quirk (GA)
     
  36. pamela and tigger

    pamela and tigger Well-Known Member

    Joined:
    Dec 28, 2009
    Re: Update on Achilles' BG

    You are doing great! We do the cooked chicken for treats too. Also the Parmesan cheese sprinkled over his food like Sue mentioned. Keep us posted over the weekend if you can. Looking forward to hearing about the vet visit on Monday too. Take care.
     
  37. Eva and Achilles

    Eva and Achilles Member

    Joined:
    Aug 18, 2010
    Arg!! BG is up again

    Twelve hours after the one unit of Humulin N Achilles' BG is back up to a whopping 467! It was 195 6 hours ago at noon. Clearly we are not getting 12 hours of relief from the one unit of Humulin N. I hate to see my guy dropping and spiking like this. I was planning to give him just one unit this evening (in fact, DH may have already done so) but I'm wondering if I should take it up to 2 units. At this pace, he will likely be in the high 100s at about midnight, only to spike again tomorrow morning. It just breaks my heart that he is going through this. Thoughts?
     
  38. Hope + (((Baby)))GA

    Hope + (((Baby)))GA Well-Known Member

    Joined:
    Dec 28, 2009
    First of all, check and make sure your hubby didn't already give him an evening shot. If not, then give him 1 unit for tonight, see what it is tomorrow morning, and if back in the 400's then go to 1.5 and see what that brings you. N is definitely a twice (b.i.d.)a day insulin and not the greatest for cats.
     
  39. pamela and tigger

    pamela and tigger Well-Known Member

    Joined:
    Dec 28, 2009
    Re: Arg!! BG is up again

    Giving more doesn't necessarily equate to longer duration, especially with this insulin if that is what you are thinking. The drop will just be steeper and then he would most likely rebound.

    Did he get any dry food today?

    Edited to add - Hope and I were typing at the same time. I was going to suggest going up to 1.5 units too but wondered about the dry food. Glad it is the weekend so you can be home to watch him and test.
     
  40. Phoebe_TiggyGA_NortonGA

    Phoebe_TiggyGA_NortonGA Well-Known Member

    Joined:
    Dec 29, 2009
    Humulin N just plain does not last 12 hours.

    Changing the dose will NOT change how long it lasts ---- only how low your kitty's BG will go during the night (or day)

    So it is better to change to a longer lasting insulin like PZI, Lantus or Levemir to get better duration.
     
  41. Eva and Achilles

    Eva and Achilles Member

    Joined:
    Aug 18, 2010
    Achilles hasn't had any dry food today.

    I am definitely switching to a new insulin come Monday when we see the new vet. Right now, I need to get this little guy through the weekend as best I can and all I have is the Humulin N to work with.

    We picked up the Keto-Diastix. Anyone have any advice as to how to collect the urine. I have another kitty so some coordination will be required.

    Thanks again.
     
  42. pamela and tigger

    pamela and tigger Well-Known Member

    Joined:
    Dec 28, 2009
    I know, Monday can't come soon enough, but you are doing fine. You are on top of things.

    If he didn't have any dry food then I would think an increase of 1.5 units is fine. I know you don't like to see these high numbers; we all know how you feel.

    With the Keto-Diastix I just hold it under the urine stream as he is going. But others use a ladle of sorts to collect it.

    I know you are doing your best. As long as he is eating I am sure everything will be fine until you see the vet on Monday. :)
     
  43. Eva and Achilles

    Eva and Achilles Member

    Joined:
    Aug 18, 2010
    Hi Pamela

    Thanks for the encouraging words.
    As it turns out, my DH took it upon himself to give Achilles 2 units last night at +12 when his BG was 467. We tested at +3.5 and he was at 239. At +6 he was down to 165. At +12 (at 630 this morning), he was back up to 448. We fed him and gave him 1 unit. Today I will test at +7 to figure out when his BG starts creeping back up.

    No luck with the kito stick yet. Can't seem to catch him when he uses the litter box.
     
  44. Sue and Oliver (GA)

    Sue and Oliver (GA) Well-Known Member

    Joined:
    Dec 28, 2009
    Eva,

    Two more ideas for collecting urine. We bought aquarium gravel and put it into the litter box. Then put it and him in a separate room and be patient. Other people have luck with putting saran wrap in the litter in the place he goes most often. (Tuck it in and cover the edges with litter. ) Either way, the urine will sit on top a while and give you time to do the test.

    Oliver was very private and he just wouldn't go if we were waiting and watching.
     
  45. Hope + (((Baby)))GA

    Hope + (((Baby)))GA Well-Known Member

    Joined:
    Dec 28, 2009
    Eva, please explain to your hubby that giving more of N WILL NOT increase the duration, as others have already stated, but it will shoot his numbers lower, maybe too low, and then he will still bounce back up. I agree with the 1.5 for now, especially with the dry food gone, till Monday's appointment.
     
  46. housecats4

    housecats4 Well-Known Member

    Joined:
    May 31, 2010
    Angels and Healing green light coming to help you DH and Achille on the right track. So no advice but my kitty was only on Lantus 2 months got 26 days no insulin Hope for a speedy recovery..You are doing a great job ;-) Kath
     
  47. Taline & Bibo

    Taline & Bibo Member

    Joined:
    Jul 19, 2010
    Hi Eva,
    How are you ? and how is Achilles? Any updates for us? Please start a new topic. Hope all is well...
    Taline
     
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