Brittle Diabetes

Hi all,

So I have been reading a lot of the stuff here on the forum but couldn't find much similar to my situation.

My cat Lily was diagnosed with diabetes in October 2015. She was put on caninsulin 1 unit twice daily.

Polyurea and polydipsia continued (along with her voracious appetite), as well as her losing all of her body fat and losing muscle mass.

I kept mentioning this to the vet but they put it down to her diabetes and said she would soon start to gain weight.

On Feb 18th just gone she was admitted to the vets for dehydration and DKA. She was at the vets for 8 days, in which time she nearly died twice (low bp, very high BG). Eventually she started eating and drinking again, peeing and pooping. The vet switched her to lantus insulin 1.5 u twice daily however she varied from being really low to really high.

Anyway, eventually on the Friday (26th), I got to take her home. When she arrived home she was understandably spooked and didn't want to eat much. I syringe fed her and gave her her insulin until Saturday evening when she had relaxed and wanted to eat and drink on her own. Again, I continued to feed, give insulin and repeat 12 hours later. Because of her vets stay, I couldn't get any blood from her ears for home testing.

This morning I woke up, fed her and dosed her and went (grudgingly) to uni. I got back from uni 4 hours later to find her having a massive hypo. Got her to the vet who tested her sugars. I'm from the UK, it was 1.5 mmol/l, very very low.

I don't know what to do. I have been consistent and her body isn't. She doesn't react to the insulin the same way every time. She is 12 and after such a long vets visit being poked and probed I am seriously worried it is a foregone conclusion here. The vet is trying her on a high fibre wet diet and doing some bloods. I just don't want her to suffer and I can't be at home literally 24/7 as I have to go to uni and work for a living. I'm a paranoid wreck at the moment and would really love to find a way to regulate her sugars.

Kidneys and liver so far are okay. Repeat bloods tomorrow.

She is my best friend, I've had her since she fit in the palm of my hand and I just want the best for her.

Advice please?

Thank you

 

Hi and welcome to you and Lily.

I'm very, very sorry to hear how dreadfully rough a time Lily has had over the last few weeks. I really, really feel for you both.

First up, please don't lose heart. I'm so glad you've found FDMB. It's a great place to learn more about diabetes and to get help for Lily. I'm in the UK, too. I became a member here in June 2014 when I was getting nowhere with the vets we were registered with at the time. The members here have done so much to help me to help my Saoirse and I'm sure they'll be able to help you and Lily, too.

With regard to the hypo incident it is possible the 1.5IU Lantus dose may have been too high, especially if Lily is underweight. Unlike Caninsulin where you give the dose and it is out of the system before the next insulin dose is due, Lantus is a depot insulin and successive doses build upon each other to create a 'tank' of insulin in the cat's body and it therefore takes several days before you can get a full picture of how the cat is responding to a particular dose. There are members here with extensive experience of treating their cats with Lantus and I'm sure they will be able to work with you to get the right treatment plan in place to help your beloved Lily. I'm tagging @Chris & China and @Marje and Gracie to see if they can help you.

In the meantime it would help a lot if you could post the following information:

1. Lily's current weight.

2. Lily's ideal weight.

3. Please confirm whether you are home testing Lily's blood glucose levels. If yes, which meter are you using?

4. Could you post any data you have available for Lily's BG - especially results that show the wide swing in BG levels. It is helpful to give preshot readings then the number of hours between the dose and the time of the next test (e.g. AMPS = morning preshot test; AM+4 = test done 4 hours after morning insulin dose - and similar for PM cycle.)

You may have noticed that most members have links in their forum signatures to spreadsheets with their cats' blood glucose readings. By tracking Lily's BG in a spreadsheet it will give you a much better understanding of how she's responding to her insulin and will therefore be an invaluable aid in helping you to keep her safe on insulin and improve her regulation. You'll also be able to share Lily's data with members here and they'll be able to give you better help as a consequence. You can find out how to set up a spreadsheet for Lily here. (Choose the World spreadsheet for mmol/L.) If you need help with setting it up just holler.

Hang in there. We'll do all we can to help you both.



Mogs
.

 

Welcome--
bump

 

Hi-- @Critter Mom has already tagged a few of most educated advice givers here.... I just want to add that finding a vet that is more educated in FD might be a good thing

 

@Wendy&Neko @Sienne and Gabby (GA)

 

Hello and welcome, sorry you've been through such an ordeal to date. Diabetes is definitely a manageable disease and we have many people here who've gone through DKA with their kitties.

I don't understand what this means. Are you having difficulties getting blood from her ears? The paw pad is an alternate side that some people use for getting blood.

As for dose, typically when cats transition from the shorting acting insulins to Lantus, we'll use the same dose, which would be 1.0 unit. However, given that Lily was recently DKA, we would not want to start her on too low a dose. Without information on any blood test data you have, it's very difficult for us to suggest any changes to the dose.

Are you currently testing Lily's urine regularly for ketones? It's essential for a kitty recently out of DKA to stay on top of the ketone picture. You should be test at least once a day if not more at this point. Anything above trace ketones means a visit to the vet. And make sure you are adding lots of water to her food. Water helps flush ketones. High fiber wet diets are very old fashioned ways of looking at treating diabetes - works well for dogs, not so much cats. The current thinking is low carb wet or raw food. However, don't change foods until you are regularly getting blood tests as food changes can cause sudden changes in amount of insulin needed.

 

Hi, and Thank you for the swift reply.

So, Lily is part Norwegian forest cat and is aiming for 5.5kg as her ideal weight. She has lost 1.2kg in the past month and is currently 4.3kg so a lot of weight. I just added a spreadsheet in my signature so will get onto filling that out ASAP.
I have a clinimed meter that I have been using for a while now (I had a moment of paranoia a while ago, I thought I had diabetes!). It has been very accurate for me at least, and I have checked it against an accucheck.
As I was saying, I haven't been able to get any blood from her since she got home. Her poor little ears are all bruised and battered. I feel like doing it into a pad would be so cruel that I'd only do it in circumstances I considered to be a proper emergency.
I will fill out the values I know from the weekend (these illustrate the swings I'm talking about)

(Edit: Lily's ears are very bruised and battered, hence the non bleeding. Also, I'm not sure if she has urinated today. I check the box but I'm unsure whether the wee in there is from yesterday. She usually leaves litter all over the floor when she goes but I cleared this up yesterday and today it was still clean. I'm just very worried and feel like I'm in way above my head)

Thank you again

Becka

 

Do you have any ointment you can put on her little ears to help soothe them ? A salve like ointment is what you want--even vaseline may help if you have it in the house.

 

and remember your not testing to hurt her--you are testing to keep her safe

 

Sending a cat into hypo is cruel. If you are feeding a cat a low carb treat (I use freeze dried meat or boiled meat), you'll find that kitties learn to look forward to testing. Mine often tries to lead me to the testing spot to get me testing and more importantly, giving that treat! And if you have a first aid ointment with pain relief, that can help heal and dull any soreness. Testing and knowing where your cat's blood sugar is will give you a lot more sense of control.

 

She is currently being tested in the kitty hospital. I have just filled in what I know of the BG results from when she was in the vet.

I guess I don't understand enough about diet. I just fed her what the vet suggested and she liked it. I really feel like I have completely let her down. She is so poorly I am afraid she will never regain weight or be herself again and I feel immensely guilty. It was my job to look after her.

 

You haven't let her down at all. There is a lot to learn about feline diabetes and vets have to learn about a lot of different animals and conditions. Often they get very limited training in diabetes and haven't kept up with the latest. Getting Lily onto Lantus is a good step. We can help you learn what you need to do to help Lily. I did many things wrong at first, including starting Neko on Caninsulin as per my vet's suggestion and not home testing until we got her onto Lantus. That was over 4 years ago and she's doing much better now.

There is a great website on feline nutrition written by a vet, start here: http://www.catinfo.org/ There are sections on different conditions including diabetes.

One of the reasons we are such strong advocates for home testing is that kitties can often test a lot higher at the veterinary clinic, due to stress. You don't want to decide on a dose based on a stress influenced number. My non diabetic cat once tested 11.7 at the vet and the clinic was worried he might be diabetic. At home the next day I tested him at 3.0, nice low normal numbers.

 

Thank you. I will be looking at this website this evening. Thank you so much for helping. I'll be messaging with an update tomorrow after 12.

 

Welcome to the FDMB Becka and "extra sweet" Lily!! This really is the best place you never wanted to be if you have a sugarcat! There's going to be a lot of information thrown at you quickly, so please try not to get overwhelmed....We all are managing this disease and you can too!!!

I understand Lily is still at the vet due to the hypo, correct? That's good in a way since it will give you some time to read and learn so when she comes home, you'll be better prepared.

For now, I just want to give you a little hope in the best way I know how....with a couple of pictures!
China at diagnosis in March 2013...less than 8lbs (3.6kg)....click on picture to expand
China after about 4 months on Lantus with the help of the wonderful people here at the FDMB...about 14lbs (6.4kg)

Home testing really is the key to getting Lily as healthy as possible as well as preventing things like you saw today. The vast majority of cats learn to actually look forward to their testing! (Hard to believe, but true!) The keys are to establish a routine and finding the right treat that Lily really loves...and it doesn't necessarily have to be food. Some cats do great getting cuddles or brushing as their reward.

We're all here for you and will help any way we can. Sending prayers that Lily will be home again soon!

 

Oh wow! These photos really give me faith that I will be able to sort out my lovely little kitty. I just need to get her on the correct dosage and start home testing in earnest.
This is fantastic. Look at your lovely kitty I just have to wait for the results of the blood tests tomorrow. Hopefully Lilys organs are okay. If they are, I can start. If they are not, I think it'll be a very bad outcome.
I also need to learn when to home test and how I can fit my schedule around it. Whether I have to get up very early in the morning to feed, inject, test etc.
Also, she only eats a tiny amount in the morning (she is more of a little and often kinda gal) so i'm worried that picking up the food in the morning means she isn't getting enough causing her to run low.

 

I just want you to know that when I found this board my Woody was receiving 13 units of Novolin! He had diarrhea, was vomiting, was lethargic, didn't play, meow, or anything! When I started home resting it showed he was hypoing EVERY SINGLE time I injected him. I was doing that for over a MONTH!!! Talk about feeling like the worst human being ever . But the wonderful members here helped me and now my kitties are in remission! Home testing and this board saved both my kitty's lives! You are doing great, just know that home testing is the key to all of this.

 

Many kittys here have complications either pre diabetes or diabetes related. I give fluids to both of my cats at home as do many of us. Totally doable.
I don't want to overwhelm you nor I don't want you to be discouraged if there are any complications on the blood work as I am sure many of us have had or have the same or similar complications. China is stunning quite a diva
The experts will help you with testing/dosing.... if you have questions ask away

 

That's great news about your kitties!
How many times a day should you test the BG? Twice?

 

You always want to test before shooting so you know they're high enough to have insulin at all

Then you want to try to get at least a mid-cycle test on the AM cycle and at least a "before bed" test on the PM cycle

With Lantus, dosing is based on how LOW it takes them, not how high they are at Pre-shot times, so it's important to get tests in at different times throughout the cycles so you can learn how Lily is responding

If there's no way to get mid-cycle tests on the AM cycle due to work or school, it's even more important to get tests on the PM cycle....most cats go lower at night, so that PM cycle is really important.....then on days when you're off, you'd want to get more tests during the AM cycle.

Think of your spreadsheet like a puzzle....if the only "pieces" you have are along the edges, it's hard to see what the puzzle picture is....by having "pieces" (test results) scattered throughout, the picture becomes much clearer

I'm really happy my pictures have given you hope...it's truly amazing how far back our kitties can come with the right treatment!....and the best place to get help learning about that is right here on the FDMB!

 

With Lantus, the minimum recommended is three: once before each injection to make sure it's safe to actually give insulin, and at least once a day (either AM or PM) a few hours after the insulin dose to determine how low the dose is taking the cat. Ideally, it is advisable to get a mid-cycle test in both AM and PM.

We can help you work out how to get the data you need in spite of your demanding schedule.


Mogs
.

 

If you were following the Roomp-Rand published Tight Regulation Protocol for Lantus, for Lily's current weight the maximum starting dose should have been 1.0 IU BID (0.25IU per kg). (Also, if it could have been demonstrated that Lily was getting very low nadirs at home on the Caninsulin an even lower starting dose of Lantus may have been appropriate.)


Mogs
.

 

The above information that Mogs posted is correct if a cat is in good health. With a kitty that has experienced DKA, the same rules do not apply. The fundamental principle underlying DKA is that there's an infection or inflammation present, the cat isn't getting enough calories (usually due to not eating) and isn't getting enough insulin. Thus, using the initial dose formula may only serve to underscore the not enough insulin part of this equation. Often, it's better to be feeding higher calorie/carb food in order to maximize the amount of insulin you're giving. I think you'll be better able to gauge the insulin issue once you see where Lilly's numbers are at her current dose.

Will it be possible for the vet to give you the results of Lily's BG tests so you can fill them in on her spreadsheet?

(I have an NFC kitty, as well. He's not a diabetic, though. They are an incredibly sweet breed of cat.)

 

Thanks for catching my error.


Mogs
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If you look at my profile picture, that is her currently. Considering you know NFCs well, you can see how ropey she has become. Time to get her looking like super star China!

I will request all details from the vet. Do you think I need to march in there and just tell them what I'm doing? They are suggesting putting her to sleep! If I hadn't have found you guys I would've been considering it because the way she is at the moment is scary and I feel like she feels poopy. So glad I came and found you!

So I guess I'll need sub cut fluids and equipment (for just in case), the correct food and treats and a good technique for home testing. I should really know all this, I'm a third year student nurse, but I think it has all overwhelmed me and cats are slightly different to diabetic humans. I guess it scares me not knowing how she's feeling or what she wants.

The vet is stopping insulin for a few days and attempting to diet control it. I'm calling at 12, I will discuss then and go in if needs be. I wanna switch her vets to one that knows about diabetes.

Honestly, I couldn't be more grateful to you all.

 

When the BG is unregulated cats can feel really cruddy and their body and coat condition can be atrocious. As you've seen with China the transformation that occurs as regulation improves can be nothing short of astounding. I speak from personal experience. In the early days after Dx, Saoirse had lost a fair bit of weight and her coat was in tatters: if you even looked sideways at her more would fall out.

After a few weeks of being on a species-appropriate, low carb diet and her switch to Lantus insulin our main vet (who is fairly hot on feline diabetes) was absolutely gobsmacked at the improvement in Saoirse: she had regained muscle mass and her coat was growing back beautifully. She looked like she had been swimming in the Fountain of Youth! Wish I had before and after pictures to show you. Our vet said that if Saoirse were not his patient and he was therefore ignorant of her age he would never for a minute have put fourteen years on her.


Mogs
.

 

I really disagree with your vet. I would not stop insulin in a cat that is recovering from DKA. Where are you located (city)? You may need to find a vet that is more familiar with feline diabetes and there may be a member who has a vet who will fight for your cat. This is a manageable condition. When Gabby was diagnosed, she was in DKA, had hepatic lipidosis, and pancreatitis. She was hospitalized on a kitty ICU and not a single vet ever suggested euthanasia. She lived 6.5 years with FD until her kidneys gave out.

I've never found that direct confrontation ever works with someone who thinks they know more than you. (Think about your nursing instructors!) I've found a better strategy is to let the vet know that you really want to understand what's going on (after all, you're training to be a nurse) and be an active part of your cat's treatment. Then start asking questions -- especially ones you know the answers to. For example, if the vet wants you to feed prescription food, ask what the carbs are. Let the vet know that you've found a plethora of commercial foods that are even lower in carbs. I'm attaching a journal article about the Tight Regulation Protocol. You can share it with your vet or use it for your reference. It's the research supporting TR. Vets usually have a hard time arguing with published research.

Sub-q fluids are not hard to do. The needle (aka "harpoon") is just bigger than an insulin needle. Not every cat that is recovering from DKA needs fluids, though. You need to know that your cat has no underlying cardiac condition.You can also add a fair amount of water to canned food. No one ever taught me to home test or to give a shot. I speak excellent medicalese which meant that all the vets who were treating Gabby thought I knew how to give an injection. I learned from YouTube. You're ahead of most people given your nursing training. Yes -- it's different when it's your cat but you're doing this to help Lily and that will override your understandable apprehension.

 

Sienne is right. Withholding insulin could cause Lily to get more ketones. The vets advice is very dangerous. I hope you can find another vet with more knowledge and experience with feline diabetes. We've seen a lot of kitties go through DKA on this board, and unfortunately, not all survive. My kitty J.D. was one of the lucky ones. He too was hospitalized for 8 days. I found this board, and they helped me. He lived 9 more years and passed on at 20.
Hugs to you, and prayers for Lily to return to her healthy self. Keep posting and we will help you.

 

Okay, so, update:

I have spoken to Lily's regular vet and he has completely agreed and has started her on SLGS. He has said that he has now switched her to low carb wet food and higher carb for when she eats less and he is starting with 0.5 u lantus.
He seems to now understand that I do know a little bit about diabetes. I understand she can't always have the fluids but I'd just rather have the tools to look after her at home if needs be.
The vet has said that he believes her organs are the picture of health and we just need to really work on regulating her. The vet she saw yesterday, although well meaning, doesn't know her at all. He was the one talking about euthanasia. Marcos, her regular vet is really looking out for her. I feel slightly better about it today. I can't wait to get her home so I can begin to get her into a routine.

 

Actually, testing the paw pads is no more, maybe even less, painful than poking the ears. They have very little feeling in them and bleed quite easily.

 

Ask about getting an Rx for a supply of anti-nausea and appetite stimulant meds for Lily's home medicine cupboard. It can be invaluable to have the 'tools' you need ready to hand to head off any potential inappetence issues at the pass. Also going forward you might like to consider getting a blood beta-ketone meter. The strips are pricey but a blood ketone meter can give a much earlier warning - possibly by a number of days - of increases in beta-ketone levels. (My cat is not ketone-prone (anti-jinx) but I got a BBK meter recently to monitor her after her recent operation; I've found the meter an extremely helpful addition to my monitoring toolkit because she developed a UTI after the op and her appetite has been off. With the help of the meter I'm able to keep a much better handle on her ketone levels - and getting her prompt veterinary support when necessary - while she is going through convalescence.)

I'm very glad to hear that Lily's regular vet is rooting for her and providing the support you both need right now.



Mogs
.

 

I don't understand ketones. Is there anything I can read to familiarise myself with their significance? I just need to understand how the different types of food affect the BG and ketone levels

 

I don't know about you, but I'm a lot more relieved to hear that your regular vet "gets it."

Mogs has a good point. Given the two hospitalizations for DKA, a ketone meter wouldn't be a bad idea. Abbott makes the Precision Xtra meter and NovoMax also has a blood ketone meter. Either meter and strips are available on-line through ADW. Many of us use urine ketone test strips (i.e., Ketostix). They are a good method of testing providing you can stalk Lily to the litterbox to get a urine sample. The only downside of the urine strips is that they do not give you a 'to the minute' level since waste has to form, be collected in the bladder, and your kitty needs to then urinate. This means that the levels are hours old. Blood ketone testing tells you what the levels are at the moment you're testing.

Ketones are a by-product of fat metabolism. If a cat isn't eating, its body starts to metabolize fat stores. (This is what we all do when trying to lose weight.) One by-product of fat metabolism are fatty acids which then lead to the development of ketone bodies. If metabolism continues to be pushed in this direction, electrolyte levels are affected (metabolic acidosis) and diabetic ketoacidosis develops. This is a discussion in Wiki and there's a link in the body of the article to the pathogenesis of ketones. I'm in the office and don't have all of the links to my usual resources on this computer. Any endocrine text should have a chapter on diabetes and include information on DKA. The basics are really no different in cats than in humans. If you cruise the internet, you'll find lots of information on body building sites where they discuss dietary ketosis. This will also give you a feel for what's quasi-normal vs problematic.

 

http://www.felinediabetes.com/FDMB/...oacidosis-dka-and-blood-ketone-meters.135952/

Link to lots of ketone info above. Food doesn't affect ketone levels as such, it's just not eating it that's a problem.

As far as BG goes, basically the higher the carbs the higher the BG will spike afterwards.

There is no problem free feeding lantus kitties, you just want to pick up the food 2 hours before shot time to make sure the BG test you get isn't food influenced - i.e. So you can be sure it's safe to shoot.

If you're not free feeding you are still better off feeding smaller meals more frequently than just feeding twice a day. It's less stress on the pancreas and lantus doesn't operate harshly like caninsulin so it's not necessary to have plenty of food on board before you shoot.

Furthermore most kitties (but not all) will feed themselves when they drop too low so if you're not there it can be essential for kitty to have access to food. People with gutses use timed feeders to ensure food is available as appropriate throughout the cycle. Since yours isn't a guts (unless you have others that will guts it) you can just leave it out to be eaten at will.

P.S. Vyktor is another DKA survivor whose life was saved by this board

 

Just a side note--you do not have to use the "harpoon" needle-
I use a 18 gauge/harpoon on Rico as he could care less- (he is up to fluids every other day after 6 years)-on Drevon a 20 gauge it just takes a little longer (fluids since DX with FD as his kidneys took a hit)--each cat is different... fluids are an amazing thing
Rico was DX at 11 and he is 17 this summer...

 

@Rkdavid
where are you located--maybe someone knows a vet familiar with FD in your area.....

 

I think Lily will be good on a free feed regime with the two hour gap before testing.
Again, SO glad I found this group!

 

I'm in Norwich, UK

 

Here is a video we did on How to Give Subcutaneous at Home. I know it has helped many, many members here as well as people who have seen it on YouTube.

I'm just a little concerned that the starting dose is too low. I know SLGS has you starting at 0.5u but for a cst who has been in DKA, it worries me. Remember that SLGS is a guideline and the suggestions for this approach specifically state circumstances, like the presence of ketones, may warrant "adjustments" to the guidelines.

 

Hi Becka,

If you do decide to go for a blood ketone meter the choices are fairly limited in the UK. There are some iffy ones offered on ebay and amazon.co.uk but check out the negative comments on amazon before considering the cheapies.

I went for the Abbot Freestyle Optium Neo. As a guide to price, my local pharmacy sells a box of 10 strips for the Freestyle Optium Neo for £34.95 so I assume that's RRP. You can get some better prices on strips via ebay UK (but always check the expiry with the vendor before purchasing). The cheapest strips tend to be sold by Aussie vendors. I've no experience of ordering from them but I am thinking of giving them a whirl. BTW, if you do buy a BBK meter check with your local pharmacies to see if they carry test strips for it and/or how quickly they can get them into stock for you should you need to get hold of strips in a hurry.


Mogs
.

 

I'm just trying to figure out how I will be able to leave the house (and lily on her own) without worrying she is gonna have a crisis. When she is better controlled is there less risk of a hypo? I understand she needs more love and attention now but at the same time, I'm in the navy reserves (it involves being out of the house for 8 hours on a weds evening) and also am at uni on a weds. I have obviously stopped going for the meantime as I don't want to be too far away but I feel as if now I will be constantly worrying about her every time I go out. I am ready and willing to do everything she needs to get her healthy and keep her safe but I just don't know what to do with regards actually being able to go and fulfil other commitments I have. We live just the two of us and it would be way beyond my already stretched budget to get a cat sitter for 8 hours every Wednesday.

 

Hi and welcome.

My kitty, Cinco, is also a DKA survivor. He was very near death and the vet was recommending euthanization when I found the FDMB thanks to a friend that had been in the same boat with her kitty. My vet was well-meaning, but didn't understand Lantus. The people here saved Cinco's life, and my sanity. Since then they have helped me through cancer with all four of my kitties, kidney disease, glaucoma (both my boys), blindness (Cinco), a leg amputation, hyperthyroid, a second kitty getting FD, and most recently the crossing of my two precious girls 9 days apart. You will find no more caring, generous, knowledgeable people in the world than the ones on this board. I know it's a huge leap of faith to trust a bunch of strangers in different countries over the vet you know, whose credentials you can see, but I urge you to listen to the people here and take everything into consideration. Read as much as you have time for. There are stickies at the top of the Lantus & Levemir page that contain tons of info that will help you understand. It's very overwhelming at first, but we've all been there, so ask questions and ask for clarification if you don't understand something. You are among friends.

A lot of people here use a timed feeder to make sure their kitty has access to food throughout the day. There are many available on Amazon. If you are interested, ask for recommendations.

Many here have full time jobs, families, other animals, etc., but we all figure out how to make this work. You can, too. All you need is a love for your kitty and a willingness to learn. I think you have both of those. We're all here for you.

 

An auto-feeder is a good idea. A lot of people can make recommendations and have tricks for using them with canned food (like freezing the wet food and leaving it to thaw in the feeder during the day).
I'm sorry I haven't been able to read your entire thread, but the first thing I thought about when I read your initial posts was whether your vet did an ultrasound on your kitty while she was hospitalized. Do you know if they did an ultrasound or any other imaging?

 

Becka, being gone for 8 hours shouldn't be a problem....You can just test a little before you need to leave and if Lily is running a little low, you leave down some higher carb food

Autofeeders are great too..you can program them to open when you want Lily to have access to food. The PetSafe5 autofeeder is a favorite around here

You'll also be learning about Lily over the next few weeks...when she usually hits her lowest points (the "nadir") and how she responds to different percentages of carbs.....some kitties are very carb sensitive, others can eat higher carb foods without getting much of a food spike

When it's time for you to return to your duties, you'll know so much more than you do now!! It won't stop you from worrying while you're away (not much works for any of us when it comes to "worry") but it should keep Lily safe!

 

Thanks Mogs,

I think I will buy a ketone meter as getting a urine sample from lily is like getting blood from a stone! I think it is just overwhelming to think that I'll have to be constantly worrying over poop etc when I've not had to be before this. In a way, despite her having diabetes since October now I realise what I should've been doing and I'm having the big psychological transition I should've had back then. Thank the Lord for you lot of wonderful people.

 

I wasn't taught how to give shots or test either. I guess I gave the impression that I knew what I was doing since I'm and EMT and knew what taking a blood glucose meant. I sure can fake it.

 

I knew how to give the injections the vet just wouldn't let me leave until I had proven it...

 

So the vet has put Lily on 0.5 iu Lantus once daily and he has suggested free feeding. He said she has now become so receptive to the insulin that she will respond and then go lower and lower and lower. We have agreed I check her BG in the morning before I shoot (obviously if low don't give the injection) and I check at +6 then +12. I do this for a few days, maybe til monday, to see how she is responding.
He said after a week I can do a curve, he said he will teach me how and it'll be better to do it at home so she is less stressed and we get truer readings.
I get her back tomorrow morning
Thank goodness!!

 

I am glad you are getting your girl Lily back tomorrow. Not so glad with your vet's poor advice. We have seen a very small number of kitties where once a day dosing works with Lantus. With most, you end up with really high numbers at the end of 24 hours. With a cat that's been recently in DKA, this is a dangerous choice. You want to get as much insulin and food into her as possible. Will she be on antibiotics when you get home?

 

Lantus generally requires twice a day dosing because a cats metabolism is so fast, but it's nice to see the vet is starting Lily out slowly...we just want to keep a close eye on her since she's had the DKA episode in the past

Occasionally a severe hypo will "kick start" the pancreas into working again (we don't know why, but it's happened) so while it's possible that she will respond and then go lower and lower, I don't know how your vet can "predict" that.

If Lily were mine, I'd test in the morning, if she's high enough for insulin (above 150) then I'd feed her (to make sure she'll eat) and shoot....all within about 5-10 minutes.

While you're home and able to, now's the time to collect data on how Lily is doing! I'd try to get tests in throughout the cycle, not just at +6....and if at +12 she's back above 150, I'd repeat the "test/feed/shoot" and get some tests on the PM cycle...at least a "before bed" test to make sure she'll be safe while you're sleeping (and if she's running a little low, that gives you a chance to set an alarm to get up and test later if you need to)

 

The vet has actually seen this happen, she is higher, she gets her dose and then for the next twelve hours she just continues to get lower and lower. He talked through all of the BG tests he did over the day and how the glucose just kept dropping. I think this is the reason he has decided to do free feeding and see what happens.
That seems amazing, about the pancreas being kick started!
It seems like a very good idea, test, watch her eat and then shoot.

I will get four tests a day over the weekend, then fill out the spreadsheet. I have filled the boxes but when I click on my link it comes up blank?

Hmmm....

Just glad to have my baby back tomorrow

 

As for the free feeding, a lot of us do that here because it's easier on the pancreas to deal with small, frequent meals than to deal with just a couple huge meals, but you'll want to take her food up for the 2 hours before shot times, so that when you test, you get a "true" reading without the influence of any food

Are you signed into Google when you try to enter your numbers on your spreadsheet?

 

Add me to the list of people that think it's a very bad idea to only shoot once a day. Lantus works on a 12 hour cycle, so that's like taking a 12-hour cold medicine once a day - you're only getting half the benefits. Meanwhile, Lily's BG could skyrocket and ketones return and she'll end up back in the hospital.

Yes, a cat can go lower and lower. In general, we want them to do that, but at some point in the cycle, as the insulin wears off, the numbers will climb. If they don't, there are other factors at play: too high of a dose, the pancreas is producing insulin on its own, or some illness or condition is factoring in. When your vet says he has "seen this happen", does he mean just once? Or frequently? Big difference. ECID - every cat is different, but most cats respond in a similar fashion, and that isn't it.

 

I can see all the colour coding where data has been entered on the World mmol/L tab, Chris, but I can't see the numbers. Bizarre. :-/

@Rkdavid -

Delighted to hear your baby's due home tomorrow, Becka.


Mogs
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And nothing at all on the US sheet.

 

I've been here over 6.5 years and I don't think I've ever seen a cat do well on once a day dosing. It would be better to be shooting 0.5u twice a day and monitoring Lily's BG numbers closely. You can always provide high carb food to counterbalance any low numbers and if necessary, once we see how Lily fares, reduce the dose.

My other concern is that Lily may respond with lower numbers and then either due to the insulin wearing off or due to the effect of lower numbers, bounce into high ranges. Regardless of why, Lantus is a gentle insulin and it doesn't "yank" numbers down. This could put Lily at risk for developing ketones.

Please get the blood glucose results from your vet and post them on your spreadsheet. It will help us to understand how Lily has been doing and what may make sense in terms of dosing.

 

I'm wondering why he has said only once a day then? That is very odd. How odd you can't see any numbers! I haven't written on the US sheet, just the mmol/l.

I will question him on why he has done this, maybe I'll bring him round to twice daily. Does seem odd.

 

Do you think 0.25 iu would be better? She had her insulin at 8am today and at 6pm she was at 5mmol/l

 

Personally, for a DKA cat, I think she should be on no less than 1u every 12 hours.

I can fix the SS for you. I will send you a private message and if you will give me editing rights, I can fix it. Look in the upper right corner of this page, click on "inbox" and you'll see a message from me.

 

I will ask for a full copy of her clinical notes and actually read what the vets have written. They said she may have slipped into acidosis, leading me to believe it was DKA. All will be revealed tomorrow.

 

Becka and I were conversing about the SS in a PM and she had this question which I am posting here.

My response: In the Lantus/levemir forum, we tell the caregivers that if you get 150 or under at shot time, do not feed!!! Post for help. We don't want you shooting a food spike and then have her come tumbling down on you. We might have you stall a wee bit (20-30 mins) or have you shoot a reduced dose if you can't stall since you have to go to uni in the morning. If she goes up really high, you can shoot a bit early. We can help you through this and usually get some insulin in her.

 

• I just want to let you know that you have some of the most experienced eyes offering their guidance and I know it is difficult to think that vet may not be giving you the best advice. Just remember the vet only knows what they know --what they were taught (who knows how long ago)
• In the end it is you holding the syringe and I am sure you will do what you feel is best. I guess I just wanted to let you know that you are being "submerged" with unbelievable knowledge and real life/ hands on experience of all different kinds of scenarios and illness that affect diabetes. Many vets prefer to be (over) cautious especially if they think you are not testing or testing enough.
• Good luck --

 

Yeah, I think my vet doesn't quite understand things precisely. However, I called today and her sugars have been normal on the 0.5 iu once daily. Still will challenge him on that frequency. But apparently she appears to be responding!

 

MY BABY IS HOME

 

Happy dance!

 

Honestly so much better than when I got her home on friday. I think she was having a full on hypo weekend. She is playing, engaging with me and having lots of love. I think she is a very happy girl. Todays numbers on the sheet. She is drinking but not eating yet, however she has put on a bit of weight

 

Ooh, we like news like this! I'm sure she's absolutely thrilled to be reunited with her mama bean.

I love all of Lily's AKAs.


Mogs
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So I just home tested for the first time. Cherry = Popped.

Lily is at 23.8, which is 428 US but the vet still doesn't want insulin twice daily. I am worried she will have another episode overnight. I know it takes a while to get to thirty. So, It took 4 hours to get to 23.8 from 21.9. so thats 1.9 in 4h. So say we go up 1.9 every 4h. Thats about 4.4 increase by the time I get up. I just don't want her in the danger zone. If my calculations are correct it'll be 28.2 (508) by shooting time...That is very high!

The vet says she needs to stay on this dosage until next week.

Hmm..

 

Congrats on starting to home test. The pair of you are off to a flying start!

In those numbers I think your vet is wrong. I think your vet is doubly wrong because Lily is ketone-prone and has a history of DKA. It is imperative that Lily receive enough insulin. You need to get to a dose that keeps her in safe numbers all day and which allows you to give two doses a day.

If Lily were mine I'd be looking to change vets. In a hurry. (And I'd include questions about how the practice works with cats who have a history of DKA as a major part of the interview for any potential new vets.)

If you're not already testing for ketones at home get some urine test strips today and start monitoring daily.

Is Lily eating OK?


Mogs
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She is literally more cat than she has been in a long while. She is playing, grooming, eating and drinking well, peeing and pooing...and all that other cat stuff!

The higher numbers don't seem to outwardly affect her anymore. I'll test in an hour and see where we are with it all.

I definitely realise I need to be giving more insulin than I already am. There was a caninsulin syringe with her lantus so I don't even know what dose she was having...it feels like the people at my vets don't understand enough.

 

This pattern may not necessarily indicate that a cat is responding really well to a given insulin shot.
We can also see this kind of pattern when a cat is simply 'dropping out of a bounce'.

When a cat's blood glucose drops too low her body can respond by releasing stored glucose into the bloodstream to raise the blood glucose level. The effect can be quite dramatic as the blood glucose rebounds to a much higher level. In FDMB-speak we commonly refer to this as 'bouncing'.
The body can also release counter-regulatory hormones the purpose of which is to try to keep the blood glucose high for a time (temporary insulin resistance). It's a protection mechanism. The effect can last up to a few days. But when the effect wears off the body will resume it's previous response to insulin. The blood glucose will drop again. And it's not at all uncommon to see the blood glucose continue to drop throughout the course of a day.

I concur with others here that it is highly unusual for a cat to only need one insulin shot a day. And for a cat who's experienced DKA it is extremely important that she has insulin in her system for as much of the time as possible.

(Incidentally, my own cat is one of the 'highly unusual' ones that sometimes needs only one insulin shot a day. He is something of an oddity. But I think it's because we're on a particularly long lasting insulin (Hypurin bovine PZI) and his pancreas works sufficiently well for him to be able to 'coast' for a while on his body's own insulin once his blood glucose has dropped to a certain level.)

Waving 'Hi' to you from Surrey, where it looks like being another sunny morning...

Eliz

 

Excellent news!

Going forward, you need to remember the following:

Not enough food + not enough insulin + infection (or other illness) = big risk of DKA.

Given that you know without a shadow of doubt that Lily is a ketone-prone cat you'll need to regularly monitor for ketones. Day to day it's more economical to do so with urine reagent strips but I'd still recommend the blood ketone meter to you because it can tell you 'in real time' what Lily's system is doing; invaluable when there's need for closer monitoring. A trigger to monitor more closely might be on a day when Lily's appetite may be a bit off. Keeping Lily properly hydrated is important, too, since that helps to flush ketones from the system.

Thank goodness you're now home testing.

This is my worry, too.


Mogs
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So yeah, 32.5...Hmm...that 32.5 would easily have been only about a 15 had she had 0.5 u in the evening as well. I'm not a vet, but I know this!
I have been blindly following someone who doesn't really understand what is going on and I feel like a bit of an idiot!

I will look into the ketone monitors although at the moment, the vets bills are now so crippling it is unlikely I will be able to buy anything for the foreseeable future! Maybe just the little sprinkles.

 

You can pick up the urinalysis strips for quite reasonable prices on ebay. (Be sure to check the expiration dates before ordering.)

 

I meant the actual machine!

 

I get that. I was suggesting the urinalysis strips as a more pocket-friendly alternative.

 

OH! Haha, Sorry!. So I just gave her her 0.5 iu. I'll check on her in 6 hours. She is really upset with me for testing her. It seems that it actually hurts her

 

Don't let her reaction get you down. Right now it's not as easy to get blood from her ear, but in the future, as her ears develop more capillaries from previous ear pokes..the pain will lessen and she'll become an old hand. Try to get at the very edge of the ear if possible, at the outer edge of the 'sweet spot'. Very few pain nerves there, and any jumping is more from the surprise of getting her ear pinched, than actual pain. Remember..say it over and over..".it's for her own good."

 

I'll let you off. This time ...

Not sure whether anyone has sent you a link to these useful resources on home testing:

Home testing links and tips

Testing and injecting tips (great ear diagram on this one)

Especially in the early days it helps to warm the ear longer than you think might be necessary. As you continue to test more capillaries will form in the test zones and it will get progressively easier to get a blood sample.


Mogs
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Many thanks for this. The vet seems to think poking the tiny veins from the top of the ear is the way to do it. As it is, I haven't been able yet to get the sweet spot from the edge of the ear. I think it is hurting her going from the top. Plus, with the lancet I don't know how far to push it in! I will get on the homework for now! I have 4.5 hours to figure it out. Plus, the little terror doesn't really like the Thrive treats I got for her!!

 

Lily! You thundering ingrate!!!

Try poaching a chicken breast and cutting it up into little treat-sized pieces. Keep some in the fridge and freeze the rest in small quantities so you only need to defrost enough for a day at at time.

Try folding a sheet of kitchen paper in four lengthwise and cutting it up into 1" strips. Put a thin film of Vaseline onto the edge of the ear to help the blood sample bead up instead of wicking into the fur. Once you have the ear warmed put the strip round your index finger then place finger under the ear you're testing. Use your thumb and middle finger to lightly grip the ear and paper strip in place so that the edge of the ear is taut but not overstretched; the little bit of tension will make it easier for the lancet to break the skin surface (and it helps to keep kitty's head from moving around too much). When it comes to poking, make sure you have the bevelled edge of the lancet face up. Try using the lancet freehand at a slight angle. When it comes to the actual poke think about how you'd quickly prick a balloon with the tip of a needle to make it pop. (Hope that makes sense. )


Mogs
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You're a GENIUS. I just got a lovely sample from Lily so easily (I had to use two strips but I managed to hit the sweet spot twice. She is just a wriggler)

I am genuinely so thankful for all of you lovely people. The amount of anxiety you've taken from me is immense!

She is sleeping in the sun as we speak. I am apprehensive about leaving her til next friday on this dose of insulin. I might try to do a curve on wednesday and then just present my results to the vet. She is at around 370 and rising. I think she needs 0.25 BD.

 

Yay for a successful BG test!

I like this plan. Obviously if anything weird happens in the meantime post for help.


Mogs
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Hey, I have posted this in the lantus forum, but no reply yet. Just a bit worried because her sugars have gone up since I injected her this evening. I have no idea how this has happened. Numbers are on the sheet.

Is there any reason this could happen?!

 

A rise in the first couple of hours can be perfectly normal for Lantus. Its onset isn't immediate or harsh like some of the other insulin. You've also usually just fed It looks like you reduced your dose tonight so that may affect things too.
I know you are worried about hypos, but that 27.1 was a pretty high number and you could have probably shot the 0.5U. You might see some higher numbers with giving less insulin.

 

Heh...Lily, we can all declare ourselves to be blood kin of our kitties. Mingling our blood because we 'missed' or went too deep into the ear, is a common happenstance when we're new and nervous.

I rather like the outer edge of the ear..but the tip is ok too. Not as much space to choose if you keep to the tips, though. I think there is, or was, a member who used her flashlight, and went ALL OVER the ear in her quest for the best spot on her kitty.

Remember to alternate ears, ok?

 

Lily has a little gap I have found on the outside of the ear at around the midway point. She doesn't seem to care too much if I poke that area (as long as there is a treat after- but not the treats I bought, oh no, she wants the real deal) . She has had a small piece of salmon (plain cooked- treat size) she apparently adores. Why she couldn't adore the package of freeze dried salmon pieces I bought I don't know! Finicky princess

Her sugars were 27.6 this morning, more acceptable...shot .5 and will shoot .5 tonight.

 

Well done for learning to hometest - and for finding acceptable treats!

Do we know your name? What would you like us to call you? (Sorry if I missed it... )

Eliz

 

Oh, sorry, I'm Becka. I come from Norwich UK. Lily pie is 12 and comes from Carlisle...I feel like I'm writing her a speed dating application.
Likes: playing with feathers, watching Obese: a year to save my life, and eating.
Dislikes: cats who think they know it all, cats who don't like commenting on Obese: a year to save my life, and cats who love themselves too much.

 

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Ok, so you play with feathers, and Lily watches "Obese: a year to save my life"? Or do the both of you watch and play with feathers?

Just teasing, Becka Since I play with Gizmo and Dottie, waving a Da Bird toy at them for about an hour a day, you might say I play with feathers, too And my kitties DO watch television, although they have a short attention span. Gizmo likes to watch "House", a show about a cranky doctor. I'm not sure what draws him to stare at a crabby human. And Patches, my surrogate mommy cat, would race to the screen if there were kittens being shown.

That little space you found, on the outer edge of the ear, is exactly the "sweet spot". Most of us test right there, too. It's possible to poke the center pad of the foot, too...some kitties mind that even less than the ear. The skin is a wee bit thicker there, though..my Dottie doesn't like it much.

Sick kitties have a perverse habit of not drinking, just when they need body fluid most. And when they get dehydrated, they can crash and burn pretty fast. Have your vet outfit you with a bag of fluid, a tubing kit, and some 18 gauge needles, and teach you how to rehydrate your kitty if she gets stubborn about drinking. The 18 gauge needle can look daunting, but if you keep the beveled edge of the point on the top when you slide it in, it's only a pinch for a second..and the scruff area where you will do the poke, doesn't have many nerve endings. One member here even has her cat sit on her lap when she does fluid rehydration..it bothers her kitty so little that the prospect of sitting on Mom's Lap makes the whole process a pleasure instead of something to be feared. You'll be able to tell if she's low on fluid by pinching Lily's skin...if the skin snaps back quickly, she's good to go; if the skin stays tented for a second before it slowly slides back down...she needs a refill.

This will help you both to sleep better, knowing that if all she needs is a drink to set her right..you can do it without the added expense of hauling her, (and stressing her) to the vet. Since you will probably be taking your kitty to the vet more frequently than is routine for kitties without health issues, they will usually agree to this. Rehydration can save lives..particularly since, at least for me...they always seem to need fluids over a weekend when the vet is not commonly available here.

 

We both watch it! She plays with the feathers. We have a lot of birds around our area and the pigeons leave feathers all over the place! Lily LOVES House...Again, no idea what she likes about an arrogant Hugh Laurie...She does weigh in on a lot of shows (Commenting and giving her opinion).

I have been meaning to ask about fluids, but every time I have gone in I have forgotten to. Lily has been drinking and eating well. Her numbers for today have actually been very good. Not sure about what will happen with her overnight numbers if I give her half a unit this evening too.

I guess I will just have to monitor her. But she's not too bad today.

 

Those numbers today are good to see, Becka. Lily's responded really nicely to today's shot. And it looks like she may be dropping out of a bounce (triggered by hypo a few days ago, maybe...). ...Will you be able to get a couple of tests in after this evening's shot...?
.

 

I will be able to get +2 and maybe +6 but it would require me to stay up until 0400! However, I am so worried about a hypo I likely will do this anyway...

Plus, what if her numbers are mega low in the morning...where do I go with that?

 

https://m.flickr.com/#/photos/139965299@N04/25169805689/
Lily, with her feather!

 

Much better numbers on the AM cycle, Becka. Far better than those ugly blacks last night. Can't have been much fun seeing those appear on Lily's meter.

I hope that your vet takes on board what the BG data is showing.


Mogs
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Aw, she's lovely!

.

 

Oh, that picture is so sweet! Lily has herself a trophy! And... She's beautiful!

 

So, I have to leave Lily because I'm taking my mum to lunch. She is at 3.3 now. I have left some food out for her but now I'm worrying. She is a symptomatic

 

How long after her shot did you get the 3.3? Her preshot showed as 24.1. That is a HUGE drop!!! You said she was symptomatic. How is she acting?

Could you retest to make sure the number is correct?

 

4 hours! She is eating really well and is wandering in and out of the room. I've had to leave her now...I put a bit of high carb down. She is eating it. I hope it's okay!