Cant stabilise Squishy..suggestions to offer my vet?

Hello from Australia.
I am hoping you can offer some suggestions that I might mention to my vet. See my signature to see where Squishy and I are at. Since November we have only ever gotten Squishy's numbers down to 15. I made the call and pulled her from the Royal Canin Diabetic Kibble hoping that would make a massive difference but no change at all. She had a UTI recently which we hoped once cleared would allow the lantus to work. Still nothing. She went in for a Curve on Monday and 15 to 25 was all we got. Squishy is a lot happier than she has been for a long time and to be honest you wouldn't know there was anything wrong. Dancing around with her Catnip Mice and hiding them in my shoes or in her water. My vet takes a lot of guidance from me as well and all of the research I have done and read from this forum. She wants Squishy well as well. Our latest move is a fresh vial of lantus (initially my suggestion) and we reassessed my injecting skills. It appears I may have been not getting the needle beyond the dermis. Appointment to go back on Tuesday after a week on the new vial. Did I mention we are on 2 units at the moment? She mentioned maybe thyroid tests next? I have noticed since Squishy stopped the dry food her poos are very very dark and her vomits when they happen are very dark too. She eats Cats in the Kitchen and Best Feline Friends (My Aussie compatriots will recognise these) which are quite dark as well. Most of these are fish based. Is that a problem? I have discovered Ziwi Peak today and she loves the freeze dried venison bits. My vet bill is nudging $7000 k (this also includes a carpet shampooer for cleaning up her messes and accidents) I was doing urine glucose testing but Bratty Squishy would rather hold onto her wee than give me a sample in a tray of cut straws, beads or anything I can find. I am starting to worry that there is something terribly wrong with her beyond the UTI she had that is stopping the lantus working. fingers crossed I get an improvement in her numbers on Tuesday. Squishy is only 6 years old and was my son's before he moved out of town. She is my family. I am doing everything possible but I am emotionally exhausted not to mention broke financially. I am a part disability pensioner who works 3 days a week. My vet mentioned registering with Dr Linda Fleeman from Animal Diabetes Australia who offers a 3 month paid support service to the Vet and myself via phone and email. Has anyone in Australia used this service? Would love any suggestions or advice. Please no anti-vet comments.

 

Hi welcome back.
Here is your previous post from the introduction forum on late November 2015
http://www.felinediabetes.com/FDMB/threads/new-mum-from-australia.148104/

Just a couple of questions first.
Are you home testing yet?
If not I think that would be a giant step forward to getting Squishy sorted out if you did.
It is very hard for us to make suggestions if we can't see how she is going most days with the insulin.....and having a spread sheet set up with the blood sugar levels tell us how Squishy is reacting to the insulin and could tell us why you have not been able to get her regulated.
Just knowing Squishy's numbers are not going below 15 doesn't really tell us much, and I doubt anyone could give you much dosing advice based on that. So please think about home testing and setting up a SS.

I noticed you said you were feeding BFF. That is too high in carbs for a diabetic. You need to chose something 10 carbs or less. Have a look at this link.
http://www.catinfo.org/docs/FoodChartPublic9-22-12.pdf

Scroll down 9 posts on this page and you will find out information about some Australian cannned foods suitable for diabetics
http://www.felinediabetes.com/FDMB/threads/food-links.133016/

Here is the weruva cats in the kitchen page with all the info on it. These are suitable for diabetic cats. The pouches are too high for diabetics as they are all over 10 % carbs but are good to have a few for if you need to give some higher carb food in case she drops low.
http://weruva.com/catsitk-cans-nutrition.php

VERY IMPORTANT....If you go to the lower carb foods you need to be aware that Squishy's blood sugars could
drop quite a bit. So I would strongly advise you start testing first before you swap the food over to lower carb foods....otherwise she could drop very low and you would not know.

Here is the link to set up the spread sheet. If you have any trouble just yell and someone will help you.....I had to have help to get mine up and running!
http://www.felinediabetes.com/FDMB/threads/fdmb-spreadsheet-instructions.130337/

Here is the link for hometesting. It does not hurt the cat...they get used to it quickly and people will help you with starting out. Then you will be in control and know exactly what the insulin is doing to Squishy.
http://www.felinediabetes.com/FDMB/threads/hometesting-links-and-tips.287/

You can get a glucometer from most chemists for about $40.. I use an Abbott optium. Others use the accu chek performa. Those are the two most common here in Aus and the blood glucose test strips are pretty easy to buy and if you get them online they are even cheaper.

Good luck. Please keep asking questions. I know I haven't answered all yours but hopefully someone else will come along and do so.
Again welcome

 

Bron.

Thanks for responding. the Cats in the Kitchen and BFF I am feeding Squishy are all low carb less than 5%. I have researched the ones I am feeding carefully. No I am not home testing. Its not an option with Squishy and her flightiness and with me working. I am content with taking her to the vet on a regular basis to do blood tests if I have to. I have all of the testing equipment but I know that the moment I try to test her she will run. I can understand the importance of home testing if I was getting lower numbers but right now I am nowhere near getting good numbers.

these are the figures I have for BFF I am using which I located on this site.

BFF (Best Feline Friends ) also made by Weruva
BFF 2% Tuna and Chicken 234
BFF 2% Tuna and Salmon soulmates 236
BFF 2% Tuna and Shrimp Sweethearts 236
BFF 2% Tuna and Bonito Be Mine 240
BFF 2% Tuna & Tilapia Twosome 240
BFF 5% Tuna & Pumpkin Valentine 243
BFF 2% Tuna & Chicken Chuckles 234

the % is the carbs and the second number is the phos.

Squishy turns her nose up at tuna and Bonito and I don't serve the Tuna and Pumpkin...

I also use the CITK

Weruva Cats in the Kitchen canned food
5% Tu Two Tango 343
3% La Isla Bonita 166
4% Goldie Lox 252
5% Kittiy Gone Wild 412
4% Fowl Ball 180
4% Splash Dance 292
2% Chicken Frick 'A Zee 174


Thanks anyways....

 

Hi.....yes you are quite right about the BFF cans......sorry I was talking about the pouches. So her diet is quite good as far is carb content goes.
You asked if it is OK to give fish meals......it is recommended to only give a couple of fish meals a week.

Am I right in thinking Squishy was diagnosed with diabetes in about Sept or Oct last year. That is not really all that long to try and get her regulated.

A couple of things :
When a cat has the curve done at the vets it is often higher there due to stress. Most of us find the numbers are higher at the vet.
Every day does not have the same numbers. If you look at some of the spreadsheets they are different every day except for the ones that are well regulated. So it is possible she is dropping lower on some of the days you are not testing at the vets. You won't know unless you test. This is no reflection on the vet....it is just what happens. Some days Sheba will drop quite low and others she stays high.
Have you tried giving her a little treat when you test her? You would be surprised how quickly they learn there is a treat involved......waiting until she is in lower numbers before you test is not doing her any favours at all.
It is just as important to test now when she is in higher numbers as when she is in lower numbers because then you can increase the dose of the insulin slowly and safely to get her regulated. And find out why she is not getting regulated. Otherwise you are only guessing and stabbing in the dark.
It is up to you of course....she is your cat..........but I would strongly recommend you think about home testing. As you have the food down pat, it is now the single most important thing you can do to get her regulated.

All the best
Bron

 

Welcome Squishy Family! I'm sorry that you're having a hard time getting Squishy regulated, but I'm going to reiderate what Bron said, you MUST BEGIN HOME TESTING if you're ever going toast attain regulation. We've all had flighty, scared, touchy cats. They get used to it, and so will you. If the ears are too touchy, use the paw pads, they have very little feeling and bleed quite well.

Home testing will, in the long run, save you money, vets are expensive. If you had diabetic child, would you administer insulin without testing first? It's the same for your cat.

To begin testing, always take kitty to the same place, I use the kitchen counter, give kitty lots of love. Then lay her on her side on the countertop, give lots of love and petting. Do this a few times a day, for a couple days before you even try to poke. Give her a bite or two of cooked meat. You can buy freeze dried chicken, but dang, that stuff is PRICEY, this will get her used to the routine and show her it's nothing to be afraid of.

Truthfully, the first time you'll be way more upset that kitty will, but you can do it!

 

This really is true.

Saoirse was a bit edgy at times when I first started testing but I quickly started to suspect to the conclusion that it was my anxiety upsetting her, not the testing as such. Indeed, when I made a conscious effort to pretend to both of us that it didn't bother me. This relaxed Saoirse which then relaxed me, and that made testing plainer sailing for all concerned.


Mogs
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I thank you for your encouragement re home testing but I am beginning to feel that maybe this site isn't for me. I didn't want to have to mention this but I suffer from PTSD and one of the symptoms is quite bad shaking. thus you see my dilemma regarding drawing blood. I am able to manage the lantus injections due to not having to find a vein. Unfortunately the pressure that comes about home testing from even reading this posts all of this message board causes me great anguish. Its no you, its my illness. I feel I am going to fail Squishy as a result.

thank you anyways for your ideas.....I will monitor her via her urine, her demeanour and behaviour and with blood tests at the vets for now. maybe in time as I get a hold of this illness I will feel I am able to attempt Home Testing but its not for me for now,

 

Hi Squishy's Mum,

So sorry you are having to deal with PTSD.. it can be very debilitating and we do understand.
I am going to tag someone I know who also suffers from the same thing....she may be able to help in some way.
@Critter Mom
I do understand why you have reservations about testing so we will have to try and help in other ways. ( you don't need a vein by the way for testing the BSL.....just the edge of the ear)
OK...... Well you are helping Squishy a lot by giving her the right foods.
That is good you are testing the urine..........just be aware that when you get a sample it will tell you what has been happening over the last several hours since she last did a wee......not what is happening right now..But that is OK.
It is great you can test the urine.
When your vet wants to increase the insulin, can you ask her to do it in small increments?
We like it to be in 1/4 unit doses but if you can't manage that with the shaking, maybe you could try the 1/2 unit increases. If you get a magnifying glass that helps with seeing it...I use a magnifying glass every day. Most vets increase by 1 units increments which is a lot but they are probably thinking some people would not be able to do the smaller amounts. See how you go. All of us can only do what we can do! And we all understand that.

Here are some really good hints and advice from @BJM that she has in her signature. Maybe this will help.
There are a few cats that will just not allow home testing and this is what they use to monitor them. I would print this out and put on your frig for reference.
https://docs.google.com/document/pub?id=1r6ktdF7AMJCYHgPkVQWFUFy5Ag6OnbmfNfQqL3zX_88

Do you have some honey in the house in case Squishy drops low? If you need to use it and she won't eat it....you can mix it with a bit of food....or you can rub the honey on her gums. Below is a link to how to recognise and treat a hypo.......don't let it frighten you.....just print it off and put on the frig in case you need it.....you may never need to but better to be armed.
http://www.felinediabetes.com/FDMB/threads/how-to-treat-hypos-they-can-kill-print-this-out.15887/

Please stay with the forum.......you don't have to test the BSL to get help here. There are lots of very knowledgeablele people who may be able to advise you in other ways.
I will tag some of them and maybe they have some other ideas that will help you get Squishy better regulated without having to test.
@Wendy&Neko @julie & punkin (ga) @Elizabeth and Bertie @Sienne and Gabby (GA)@Chris & China
Hang in there ......we are all in this together and we all understand the stresses and pressures

 

With paw pads there's no vein searching, it's a quick poke anywhere in the pad and then you just "pump" it a few times as the blood comes easily and you only need a very tiny drop. My brother is A Vietnam Vet, a Green Beret soldier, 3 Purple Hearts and a Bronze Star for Bravery, he also has PTSD. So I understand what you're going thru as I've watched him and his difficulties for the last 40 years or so. You just do what you can when you can.

 

There is an older method which uses regular vet testing, water drunk, and urine testing to manage the diabetes which I can send to you.
You do the best you can.

 

Hi Jenny,

I'm very sorry to hear that you have PTSD (and reading between the lines I get some idea of how severe your symptoms may be). Diabetes is overwhelming for pretty much everyone, especially in the early days, but when one already feels overwhelmed to start with from the likes of PTSD the diabetes stuff can be utterly swamping.

Like you, I shake a lot; the more worried I get, the worse the shakes - and it takes little or nothing to increase the worry. Psychologically I coped with the ear testing better than giving the injections, although the shaky hands make things more awkward. Saoirse was in remission for a year and she has just restarted insulin treatment. First time round I just could not consistently get the injections right and it used to wither me to hear her whimper. I felt beyond awful, but even though my technique left much to be desired her life depended on my perseverance. Our vets only carry Lantus pen cartridges in their dispensary. Trouble is I shake so badly that I had to get them to order a 10ml vial of Lantus because I couldn't keep my hands steady enough to get the needle into the little grey rubber seal on the cartridge top. (The seal on the vial is a bit bigger and I had a greater chance of getting the needle into it. ) Thankfully second time round I'm doing better with the injections but at times when my anxiety is higher I still occasionally screw up; and it withers me the times I cause my little one to flinch. I still shake doing the blood tests, some days worse than others depending on my anxiety levels. On the iffier days my aim is a bit worse, but Saoirse and myself get through it. I just wanted to share that, even with my shakes and the crying fits when I screw things up, it might not be elegant but we manage. I hope it will encourage you to hear that success is possible - even with shaking and severe anxiety (and mine is severe - I have OCD and panic disorder with agoraphobia alongside the PTSD, and I get severe, crippling depression). There may come a time when you feel ready to give home testing a go, but if that time doesn't come you'll work out another way through.

All caregivers here have different strengths and weaknesses, and we all have to find a way to meet our little ones' diabetic needs in a way that is manageable under our individual circumstances. For example, because of my health problems there have been times when I have only been able to give my Saoirse insulin once a day. A lot of the time, the constant anxiety leaves me too exhausted to stand up. Also, because my sleep is so badly disordered there are times when the exhaustion gets so bad I pass out without warning. Saoirse's BG runs a bit lower at night and I was petrified that I'd pass out and she'd go too low while I was asleep if I gave her the evening dose of insulin. Not textbook, but necessary for our circumstances.

I really do hope you'll stick around on the forum, if only to read some of the general threads on Feline Health. There are so many hints and tips that I've gleaned from other members about all manner of practicalities of dealing with diabetes (timed feeder recommendations, for example) and they have actually helped me to find a lot of workarounds to enable me to help my girl in spite of the PTSD. I also see from your introductory thread that Squishy has had a couple of bouts of pancreatitis. I'm really sorry to hear that you have that to contend with as well, Jenny. My Saoirse also has pancreatitis. (I actually find the pancreatitis a far greater source of anxiety than the diabetes.) There's a lot of really helpful information and discussions here about pancreatitis, too.


Mogs
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I also want to encourage you to stick around. There are ways to help diabetic cats without hometesting, if that's a sticking point for you. This diagnosis overwhelms pretty much everyone, so just know that you have lots of company in it. It's daunting - but as you learn more, it gets easier. It really does.

The good news is that this place is full of ideas - you're not the first person that has not been able to hometest. We've had people with strokes or serious medical issues who learn to work around their issues and still be able to take care of their cat.

I'm not experienced with ways to monitor without hometesting, but I know there are some tips out there. One way is to measure the clumps in the litterbox - higher blood sugar is dehydrating and you'll see larger clumps of water. Of course, if you're adding a lot of water to Squishy's food, the clumps are going to be bigger anyway. If a cat is in high blood sugar, they'll be drinking a lot of water, and somewhere I've read that people can measure and monitor the amount of water their cat drinks to help them judge the blood sugar. When Punkin's blood sugar got high, he'd lay against the water bowl. Literally lay against it.

This is a product (confetti) that you sprinkle on litter and it's supposed to change color to reflect the range of the blood sugar. I haven't used it and can't speak to how good it is, but for what it's worth wanted to pass it on to you.

Hopefully others will have some more ideas for you. It sounds like your vet is going to be essential in helping with some regular curves and hopefully guide you with dosing.

This link, to the "Start Low Go Slow" dosing method, is for folks who can't test regularly, or whose cat might be eating dry food, or for some reason, just want a more conservative method to getting their cat's blood sugar regulated. Take a peek at that - you could use the tips there, combined with the data your vet gets when he does a curve, to help figure out the dose.

Also in the beginning of that link there are links to putting together a hypo toolkit, and to the signs of a hypo, that will be essential for you. Often when a cat's blood sugar is dropping into low numbers they might have some behaviors that alert their people that their blood sugar is getting low. Not every cat does that, but many will become very hungry - their body's way of signalling that their blood sugar is low and they need to eat. Everyone with a diabetic cat needs to have a hypo kit, just in case.

Hang in there, and hang in here, and people will help you figure out how to help your sweet Squishy!!

 

Bron

thank you for your support and the various links. I have been reading through them. I have been using a lot of the other monitoring methods without actually realising it. Much like I would have with my children. Monitoring water intake and output, preening and self care, fur loss, brightness of eyes, loudness of meowing at meal times, franticness for food, speed of eating meal portions, is she peeing inside or outside of litter tray (a big tell for me, if she is unwell she often pees on my bed, thank got I have a huge washing machine cos those are some late nights). Is she climbing up onto her tower or staying on the floor. Playtime, is she having her happy hour or not. is she vomiting or not etc.

I monitor her very closely in all of those aspects and learnt quickly with the 2 bouts of Pancreatitis, to get her into the vet asap if I have any concerns.

thanks again

 

I have read your link. Thank you so very much, Very helpful

 

I will do some research on the pawpads. Thank you for that and for your understanding

 

Mogs.

Thank you. I cried when I read your message. Yes some days getting the needle into the lantus vial is a challenge. I purchased one of those magnifying headbands with a light to make the vial look a million times bigger but most days I get myself more often than the vial. I have a pen but the couple of times I used it, when I was administering whole unit doses, I shook so much that it came out before the count of 10 and there was always some lantus still seeping from the needle. I find with the injection, that I am squirting it into her and its getting in there faster after I press the plunger.

I pray one day I will feel confident enough to attempt a home test but right at the moment the actual thought of it sends me back to bed for hours. My safe place.

thank you

 

If you still have the pen, you could still use it! We use the same insulin syringes we use in the vials in the pens, not the special needles that come with them. We just pull the cap off the pen and insert the same type of syringe into the rubber stopper that's in the pen. It's a little smaller target than the rubber in the vial, but I hate for you to waste that precious insulin if you can manage it!

That way you wouldn't have to try to hold the needle in for a 10 count...just push the plunger like you do now and that's the end of it.

Best of luck to you and your dear "extra sweet" Squishy!! We're all here for you and will help you in any way we can!

 

Please consider staying here! Even if you are unable to home test, this place is full of compassionate people who have so much knowledge and experience to share. They also can provide some strong shoulders to cry on when your frustration seems to reach the breaking point.

 

Does it help to rest your arm or wrist on a stable surface when you are trying to get the insulin out?

 

I don't know if this will be helpful for your situation but this is what helped me most when I started home testing. I watched all of the videos in the home testing thread Bron linked above (http://www.felinediabetes.com/FDMB/threads/hometesting-links-and-tips.287/) I picked a video that I had the easiest time following and I would watch it at least 3 times right before I tested my cat. I was actually able to play the video on my tv which helped a lot. Doing this helped me build up confidence, refresh my memory, and calm my nerves. I kept doing this until I was comfortable and familiar enough with testing that I felt I didn't need the video anymore.
We do the best we can with what we have.

 

Some good news. After struggling to get Squishy to do a wee in some plastic straws she kindly created a small dip in my doona on my bed and delivered a nice puddle for me there. I sensed she had done something wrong when she walked into the room and quickly grabbed a test stick and got a nice low reading for Glucose...2.8. Mind you the doona has since been washed and is on the line drying. (thankfully its a very hot day today so I don't need it). I know this reading doesn't give me a lot of information but for me its a big win because up until now all urine tests +++(28) or higher. Keeping a close eye on her just in case she does drop too low with the honey on hand and the high carb foods.

I cant wait to get to the Vet Tuesday morning and see what he bloods look like.

 

I've done the same. I have watched so many videos but in every case they have a Kitty that will sit still with treats...or food. I am able to inject her insulin with food in front of her but she isn't an affectionate cat. Any affection she gets its always on her terms. She will come up to me and ask for it either by headbumping me or rubbing her head against my hand. She is a lot more affectionate than she was when she first came to me and maybe in time. I do spend time trying to get her to stay on my lap and I have been gently stroking her ears on a daily basis but it may be quite a journey at I don't need her to be afraid of me.

 

I rest my elbows on my knees to help out. I don't have too much of a problem drawing the insulin with my huge magnifying lends glasses to help.

 

You might do some positive reinforcement training. To encourage her to come to you, use a treat such as a low carb food bit she likes, or a toy she likes to play with, or some cats like brushing. Do this several times a day that are not test or shot times. This essentially rewards her for being near you and over time may encourage her to hang around you more.
She may continue to be a satellite cat - around you, not on you - though it may make it easier to work with her.

 

Hi Jenny,

You are doing a phenomenal job monitoring Squishy's clinical signs and behaviours. As I learned more about Saoirse's diabetes and how to treat it I did similar and I gradually learned to correlate signs and behaviours with where her blood glucose levels were likely to be at. Indeed, the blood glucose monitoring became an adjunct to overall 'secondary' monitoring of Saoirse and it's greatest benefit was allowing me to regulate her very tightly on Lantus.

Here are some things that I noticed in Saoirse that might be helpful for you in trying to spot more 'tells' for Squishy:

1. When Saoirse is in very good numbers (within the lower part of normal range - approx 4.4 - 5.5 mmol/L as measured on a veterinary meter) her coat tends to be significantly smoother, softer, and more lustrous.

2. When she is running in the lower part of the healthy range (as in 1 above) her saliva feels thicker and more viscous.

3. Saoirse holds her head higher and tends to be more interested in her surroundings at the lower numbers.

4. Saoirse's facial expression is more 'open' and her body feels more relaxed when she's in better numbers. She looks more relaxed when she snoozes as well.

(These signs would change from hour to hour throughout the day.)

5. When she runs in the higher part of the normal range or just above she looks for food every 90 minutes or so (I feed her mini meals throughout the day because of the pancreatitis). If she's running in better numbers she looks for food on average every 2-3 hours.

6. When her numbers get a bit higher again she has a tendency to do a sort of lethargic sprawl on the floor.

7. If there were wide swings in Saoirse's BG levels while on insulin (Caninsulin in this case) she would hide.

I also log all her food and water intake (accounting for evaporation when it's left out in a bowl), her weight, the size and quantity of litter clumps she produces each day (not so easy to monitor output with your rug situation ... ) and, of course, her poops (especially the time between poops; her GI transit time seems to slow down if her numbers trend higher).

Of course, every cat is different and you're already monitoring most of these things, but I thought by comparing notes it might give you some more ideas for things that might help you with monitoring Squishy.

On the inappropriate peeing, I've seen reports of cats here who benefitted from B12 methylcobalamin supplementation (treatment for neuropathy). It might also be worth getting Squishy's potassium levels checked as that can cause weakness in the hindquarter region, too.

Mine's being tucked up on the sofa with Saoirse beside me. I'm very glad you have somewhere that makes you feel some little bit safe.


Mogs
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Woot for the successful urine test and better BG reading!

Yay!
.

 

Remember the cats in those videos have been doing this a long time. There was a first time for them too and I bet they weren't always so patient. I admit I was fortunate that my cat was used to being handled and I adopted her when she was a kitten. She is a squirmer so I always had to have a good grip on her head and ear but she doesn't seem capable of holding a grudge for more than a few hours. I remember thinking I didn't have nearly enough hands to juggle everything but eventually fell into a rhythm that worked.

It is great that you have unknowingly been using some of the other monitoring methods. It seems you have a natural ability to pick up on these things and I think you probably notice a lot of small yet meaningful changes in behavior that many other owners would miss.

 

The hypervigilance that comes with PTSD doesn't have much to recommend it, but it does tend to make a person extremely observant and intensely aware of what's going on around them; advantageous when trying to learn what a kitty's body is trying to say.


Mogs
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Its a process. I would love for her to be a snuggly cat. The best I get is her laying beside me on the bed at night. If I pay her too much attention she is gone in a flash!. I must admit she did show signs of pure affection. Not long after we got her through her first bought of pancreatitis (tube feeding every couple of hours at home and so much medication at home), she must have been feeling better and grateful. She slid under the doona with me and actually snuggled against me for a couple of nights. that was the most wonderful feeling and I took it as her saying thank you for saving her.

 

Don't we know it Mogs! I am constantly watching for the slightest change in behaviour. I think when she first took sick, like within an hour she went down hill with pancreatitis, if I hadn't been paying attention she would have passed. Still I went to work but worried all day that something was terribly wrong. Thankfully she was still alive when I got home and I got her down to the vet within minutes. Second time around I picked it up a lot sooner and she didn't get quite as sick.

 

Ditto!

That's right. A very, very sincere 'thank you, mum!'


Mogs
.

 

Great news!! Just got back from Vet and Squishy is finally responding to Lantus. Her number was quite low this morning so vet is keeping her for a couple of hours to monitor her for a hypo. A small drop in dosage and regular blood tests at the vet. My vet is very good and doesn't charge me for consultations every visit now. Just the testing. even today she wont charge me for hospitalisation. For which I am very grateful.

 

Oh, Jenny! I'm delighted to hear your good news.

Your vet sounds really thoughtful and considerate. I like that she monitored Squishy for you today, and I'm glad that the two of you have that support.

How are you keeping yourself, Jenny?


Mogs
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I am exhausted, emotionally especially but so happy. All of the watching and monitoring is working. Have had to wash my bed linen twice this week due to the Mistress letting me know that she must have kitty litter in her tray and not plastic stuff so I can take samples. We are going through a heat wave here so I need to keep my bedroom door open to get my bedroom cool enough to sleep in at night. I had a long talk with Vet this morning and she said she would rather I try to take samples from the kitty litter rather than have Squishy get into the habit of peeing on my bed. So I will just put let litter into the tray. I have noticed as long as there is some in there she does manage to leave me a small amount along side of the litter. Its all trial and error and finding out what works for her.
I am off to buy some ice trays today so I can leave some frozen food for her for when I am at work. She almost ate my arm off when I got home yesterday. Prior to Christmas I was still giving her the RC Diabetic Dry so she had something to nibble on during the day.
thank you so much for asking about me Mogs...I know you understand how hard it is. I finally got an appointment with my counsellor and am off to see her shortly for a boost up.

Cheers

 

Hi Jenny,

It's great to hear you sounding so much happier!

Just thought I'd share how I get samples for Saoirse so it might give you some ideas. On catching a pee sample, I use a fine grade, ood-based clumping litter for Saoirse. I put a double-thickness layer of cling film wrap on top of the litter in Saoirse's litter box (c. 12" x 24" length of plastic wrap off the roll; about 12" square when it's folded in two). I lay it over the spot in the litter box she uses most but I poke the middle part of the plastic square down into the litter to make a little well. It keeps most of the litter out and provides enough urine to wet a test strip. I bought some disposable plastic pipettes to make it easier to collect the urine sample from the little well. However, if I'm collecting a sample for full urinalysis I place a heavy-duty litter box liner over Saoirse's litter and then put a packet of non-absorbent beads into that. Saoirse's not fond of it, but eventually she produces.

I hear you on the emotional exhaustion; PTSD makes the worry so much more intense - and the sleep disruption doesn't help any. I hope you'll feel the better it when you've seen your counsellor.

I hope that Squishy will enjoy her meatsicles!


Mogs
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Mogs

I definitely be trying the cling wrap thing. I started using a fine clumping litter recently but as you know the urine absorbs pretty quick. I still have managed to get a sort of a reading by pressing the test strip into it. Not scientifically correct but its a guide of good or bad on top of all of the other things. Will be doing the cling wrap thingy now.

btw my name is Jenny ;-)

 

Hello All.

Just wanted to share the fact I just did my first home test! Squishy's little ear copped a bit of a hiding but she didn't complain. My wonderful vet spent time with me this morning showing me how to home test and then sent me home with the challenge. Squishy's numbers are a bit low so I am testing every 2 hours. I am quite proud of myself although leading up to the test my anxiety levels were out of this planet. I tried the latest therapy of Adult Colouring in, to try and calm me down. How hard is it to keep in the lines when you shake so much???
Squishy came up to me after and let me stroke her, as if to say, "It's Ok Mum". I think the hardest part was catching her to do the test. She hadn't forgiven me for tricking her into her carrier this morning to go to the Vets and I guess she thought we ere heading off there again.

I need a nanny nap after all of that. I think Squishy does too as she is waiting in the hallway for me, to walk with me to the bedroom.

A big thank you for your support and ideas. I am using the glad wrap in the kitty litter successfully also.

Cheers

Jenny

 

Oh Jenny - this is great news and a great big congratulations on your first home test. I just got reading through all the comments and am so delighted for you and Squishy. Squishy is a very beautiful kitty and you did an awesome job today!

 

Oh, Jenny!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!

I am absolutely made up for you. And so chuffed about this wonderful personal triumph. Happy dance!



Mogs
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I wouldn't worry about it, Jenny. Keeping inside the lines is for wimps.



.

 

Hello

its me again. I am doing ok with this home testing stuff but need some advice.

What do I do when Squishys numbers are low at injection time.

The last couple of days have been crazy and not sure if I have been doing the right thing. Dosage is currently 1.5u Lantus 2x day. Looking at reducing after a full day of testing on Thursday (my day off work)

Scenario'

Tuesday
AM...woke to find a large chunky vomit. Thought it was from Squishy gorging again.
7:30am 1.5u Lantus
2 x 80g cans of low carb wet during day (1 before and after morning shot and half left during day whilst I was at work))
7:15pm 1.5u Lantus
9:00pm. another large vomit, so I tested.
9:10pm BGL 2.6
*Nutrigel given
10:45pm BGL 3.1
Fed High Carb Wet food (10+)

Wednesday
6:50am BGL 3.7
(Withheld Lantus)
*Nutrigel and Small Amount of Royal Canin Diabetic Dry
2 x 80g cans low carb wet from morning to evening.
6:00pm BGL 10.0
(rang vet for advice)
(Withheld Lantus)

Thursday (Planned Curve Testing All Day)
7:30am BGL 15.1
7:35am 1.5u Lantus
9:30am BGL 15.1
12:40pm BGL 12.7
3:10pm BGL 8.25
6:00pm BGL 2.5 (panic)
(Delayed PM Lantus)
Nutrigel and small amount of Royal Canine Diabetic Dry.
7:30pm. BGL 5.5
More nutrigel
10:30pm BGL 16.0
(panic again and gave .5u Lantus.)

Did I do the right thing by just giving Squishy the .5u of Lantus.

I am struggling with how Lantus works.

I know there is a big delay.

I had previously arranged to discuss with Vet tomorrow as she has been on vacation for the week but would really appreciate your feedback.

I have uploaded the spreadsheet I use....its one that a Feline Diabetic Specialist here in Australia uses with a few modifications to help me. I hope you can make sense of it.

 

Hi Jenny

Very good to hear from you. You've been doing so well with the home testing!

First up, can you tell us the name of the blood glucose meter you are using, please?


Mogs
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I would say the .5 unit of Lantus wasn't wrong but it might not have been the best course. I would guess that 1.5u is a bit too high overall. a regular .5 of 1u dose might be better. I also see you gave Nutrigel when he was 5.5 which was not necessary and helped him go back up higher. Of course I've done the same thing, when you are use to high numbers you freak when you see normal ones.

 

Mogs!
I am using a human one. I don't know if you have the same where you are. Its the Accu Check Performa.

 

Thank you for responding. Yes in reflection I did over react when her BGL wasn't rising fast enough. I actually thought I saw her eyes doing something strange. One eye pupil was round, the other cats eye (if that makes sense) but it also may have been the angle her head was resting on.

I agree, 1.5u is definitely too high. We thought this last week but she had some dry last week so I wanted to go a week without dry to make sure she wasn't just bouncing? (I am not sure if I sound like I know what I am talking about)

I will test her again pre am shot and see where she is. I wont be giving her the 1.5u though. I have to work tomorrow and don't want anything to happen whilst I am away.

Again thank you.

 

That's great, Jenny. Human meter readings use a lower reference range than pet meters. I just needed to know whether it was a human or a pet meter in order to understand the blood glucose readings properly. (I use an Alphatrak 2 pet meter as my main one, but I have an Accu-check Aviva human meter as a backup.)

Well done recording this observation. It may be that Squishy's BG was a bit low. You know your little one better than anybody and you'll pick up on subtle oddities (even with the PTSD! ). They may not be significant but they are always important to record. If it was a symptomatic hypo then that could mean that Squishy becomes more sensitive to her insulin.

I've just been looking at your spreadsheet. First up it is good to see that Squishy seems to be doing well on her insulin; lovely to see her being playful.

I don't often comment on dosing but in this case it is clear that the 1.5IU dose is too high. You were right to reduce.

Important BG Number: 2.8mmol/L (US 50mg/dL)

As I see from your spreadsheet you have been diligently recording the times when Squishy has gone below this number. As you know, this reference number is the hypo threshold for your type of meter and it is a signal to intervene to bring Squishy's BG levels back up. For future reference, any and every time Squishy goes this low the dose must be reduced. You were right to intervene with additional carbs when you did and also right to be very concerned about the amount of Lantus you were giving. I hope you feel better for hearing that. (And have a .)

I'm going to follow up this post straight away with another post in which I will give a brief explanation of the 'mechanics' of how Lantus works, and also things to do about Squishy's dose going forward.

In the meantime, it is very important that you do not reduce the proportion of dry food in Squishy's diet until you sort out the right dose with your vet. (A reduction in dry food might see her numbers going too low.)

Back shortly (and have another ).



Mogs
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Mogs.

Thank you for confirming I am on track. I am more anxious than ever knowing what is happening with Squishy now that I am home testing but this is best for her. Sleep is little but I grab it when I can.

I have awoken to a rather high number of 18.4, which kind of surprised me as I though maybe the .5u of Lantus I gave later in the evening would counteract the rise that was happening as a result of the panic nutrigel dose.

I have set up a dose of 1.0u to give to her at her usual time of 7:00am.

I am working today so on your advice will leave out dry food for her.

Previous to a "low" she had last week I had totally weaned her off dry food for about 2 weeks and only gave her dry food to help life her numbers. To be honest the dry food really doesn't make a lot of different in her numbers and would be more suitable for leaving her during the days I work. She doesn't touch the wet food while I am away as by the time she is hungry again, it is dry and crusty looking.

Is it possible to keep her going on the low carb wet as well as a small amount of Royal Canin Diabetic on the days I work? I am talking a handful.

I will chat with my Vet this morning and let her know that I have dropped Squishy's dose to 1.0u. From experience (the short one I have), I need to sit on this dose for at least a week to see if it works or not.

Thanks so much for your feedback Mogs.

Very much appreciated.

 

Hi again, Jenny.

I didn't forget you earlier. I had a post almost completely typed out for you but the forum software glitches sometimes on my PC and I had to reboot. When I fired up your thread again I found that the post draft hadn't been saved. I'll try again now.

In very, very broad and highly generalised terms, there two main 'styles' of action among insulins:

1. 'In-out' insulins - the dose is injected and it is typically all used up before the next dose is given.

2. 'Depot' insulins - these work by building up a little 'tank' of insulin in the cat's body (a bit like a mini biochemical pancreas - but without an 'OFF' switch).

Lantus is a depot insulin. When you adjust a dose there can be a time lag of several cycles before the new depot level 'catches up' to the change (one cycle = 12-hour period following an insulin injection). If you're reducing a dose, the 'tank' needs to drain a bit; if you're increasing, the 'tank' takes a few cycles to get topped up. This can take 6 cycles/3 days before you get a good picture of how a dose adjustment is working.

You've done so well to get testing! You should always get a preshot test before giving insulin to make sure that Squishy's BG isn't too low to give it safely. Each day you should get one 'mid-cycle' test. At minimum you should get a 'before sleep' test about 2-3 hours after the evening dose (the PM cycle) so that you know where this particular cycle is heading and whether you need to monitor Squishy more closely. Ideally you should get a test somewhere in the AM cycle as well. These spot checks will help you to build a good picture of how Squishy is responding to her insulin.

As I said in my earlier post, if Squishy goes to 2.8mmol/L or below (human meter) you must reduce the dose starting at the next cycle and continue with that reduced dose for several cycles (at least 6 for TRP, 14 cycles for SLGS) UNLESS she goes below 2.8mmol/L again, in which case you would reduce the dose further - and so on and so forth. At this low number you also need to intervene to bring her up to safe BG numbers. (Note: if you are following the Start Low/Go Slow regulation method (SLGS) you should reduce the dose if Squishy goes below 5.0 mmol/L (human meter). If you can only run curves once a week and you can't get enough mid-cycle spot checks, the SLGS method might suit you and Squishy better than the Tight Regulation Protocol (TRP) as it is less aggressive in its approach and has a little bit more of a 'safety cushion' built into it because dose reductions are made at a higher BG level than TRP.

For the way your spreadsheet is laid out I may not be understanding it correctly (apologies if I've got it wrong!) but I think you may have a number of issues on the go here:

1. I think you may be giving insulin when Squishy's numbers are too low at preshot (I'm looking at the notes in the 'Urine Gluocse' column).

2. I think the 1.5 dose is too high. I'd actually ask your vet to look closely at the curve you did yesterday and draw her attention to the curve being 'upside down' and how low the 1.5 unit AM dose took Squishy. Also, draw her attention to the fact that Squishy had not had any insulin the day before. (Esssentially even when the depot had time to drain the 1.5 unit dose still took Squishy too low.)

3. If Squishy is going too low and you're feeding dry to bring her up again, the dry takes a while to raise the BG level so there may be a lag between feeding and the BG levels going higher. (I don't know enough about the type or amount of carbs in Nutrigel to comment on how that will affect BG over time. Does it raise BG levels quickly? If it does, then the carbs may get used up quickly (that's what happens when honey, karo or liquid glucose is given). Ask you vet about how quickly the effects of Nutrigel will wear off.

4. Squishy's higher BG levels could also have an element of bouncing due to her liver releasing more glucose into the bloodstream in response to her going low on the too-high insulin dose.

5. If Squishy doesn't eat enough in the earlier part of the cycle that may also be a factor in her going lower later in the cycle.

Squishy is definitely responding to the Lantus. If she were mine I'd ask the vet to advise on a fairly conservative dose that would be at a level likely to even out Squishy's blood glucose levels over the day and which would see Squishy in safe numbers morning and evening when her insulin doses are due. Also, I'd look to the vet to advise on a dose which would allow a 'safety cushion' where I could sort out a good feeding schedule for Squishy; one where she would be eating enough of the right food at the right time in the cycle and which would give me greater confidence and peace of mind that she would stay in safe numbers while I was asleep or had to go out.

I would also ask the vet to give me a cut-off 'no shoot' number so that I would know not to give insulin if Squishy's pre-shot blood glucose reading was below this number. I'd also ask the vet for advice on when and what to feed, especially for days when you are out and about.

If you can get Squishy's dose adjusted to a level where she's running in steadier numbers throughout the day and not going low then that should help reduce any bounce influence. Then you'd be able to work on refining her feeding schedule and that could also help even her out. (Give a shout if you'd like some ideas to try. ) Once you get that sorted out, you can always refine the insulin dose further.

Hope some of the above helps.


Mogs
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Mogs. Thanks for all of that wonderful information. I have reduced Squishy's dose to 1u with my Vets support and will monitor closely over the next couple of days.
Yes we believe the she was starting to bounce and that is probably my fault wanting to hold off reducing to see if the higher numbers weren't because I had reintroduced dry for a day or so.
In line with what you have advised she says I need to stabilise Squishy first and foremost. I am feeding her good quality food so need to have a set diet that will suit the dose.
All of your information has helped so much and I am very grateful. Starting to understand how Lantus works.
I will keep you posted.

thank you so very very much

Cheers

Jenny

 

I'm so pleased I could do some small thing to help you, Jenny.

Did the vet give you a 'no shoot' number?

Please, please keep us up to date with Squishy's progress, and any time you're not sure of what to do check with your vet and post for help here, too. Also, there are a lot of forum stickies at the top of the Lantus & Levemir support group's board where you will be able to learn much more about how Lantus works. It is a bit of a 'wall of words' PTSD-wise, but if you take it a little bit at a time, gradually it starts to sink in. Needless to say, always post for help if you need additional explanations. Myself and other members will be only too delighted to help you both.

Sending you some extra-special, anti-anxiety hugs.





Mogs
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Another thought:

Cats being living beings, their insulin needs can change slightly from day to day, so variations in BG readings are to be expected. For example, Squishy may get a bit more exercise on a particular day and that may take her a bit lower for a while. Similarly she may eat a little more at a different time of day, and her BG may be a little higher that day as a consequence but that's OK. The goal of regulation with insulin is to find the lowest dose possible to keep BG numbers in a good range without taking a kitty too low. Never, never, never hold off on dose reductions. If ever Squishy's BG goes down to 2.8mmol/L or lower (human meter) then the dose is ALWAYS too high, so you must reduce the dose straight away (as discussed above) and you need to intervene with carbohydrates to bring her numbers back up (which you have managed well!). Remember that if, at a future stage, Squishy's numbers start to trend upwards again the dose can always be readjusted. As the saying goes here, better too high for a day than too low for a minute. It is fantastic that you have cracked the home testing because you'll have much more info now to help keep your darling little girl safe and well on her Lantus (and I sincerely hope it will bring you more peace of mind, too).




Mogs
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Goood Morning Mogs!

I plan on calling the Vet to get a no shoot number that I can stick by. Up until now I have called the clinic and another vet has advised me at the moment what to do with that particular shot depending on that day.

Squishy is being so patient with me and the home testing. Its all about having everything set up in the right place before I start so I don't have to reach far. She usually tries to do a runner but there aren't many places to run to in my humble abode.

What I do it sit down on the couch and snuggle her under my arm between me and a bolster cushion. Talking to her softly. I slip my forefinger under her collar and rest my elbow on the couch on the other side of her.

I prick her ear with a lancet. A tiny meow if it hurts a little bit. I am getting quicker at it and she is squeaking less which I guess means she is adjusting to it. Its only in the last couple of days I have managed to arrange a piece of towel to hold on the wound before she escapes on me. Initially I was too busy reading the meter and she would escape with a bloody ear. I would run around after her trying to compress it, which often failed.

She has so adjusted to her Lantus Shots that I can go up to her where she is at the time it is due and just give it to her. Although when she is in a hiding mood her food on the kitchen bench is her best enticement.

I still can't believe I am actually home testing and yes it does give me peace of mind, especially now, with your's and the other members help I am understanding how the Lantus works and I don't need to panic quite so much.

I am off to do something out of the ordinary for me. Meeting a good friend for coffee.
She is trying to help me get out of the house a bit more so we are going to sit in the lovely morning sun and gossip.

Have a terrific day/evening yourself and thanks again

Jenny

 

Hi Jenny,

I enjoyed reading about how you're finding ways to help Squishy. (I use the food trick with Saoirse, too, when I'm giving her her Lantus!) I think you should give yourself THE most ginormous pat on the back for sorting out the testing. I'm so chuffed for you.

I'm really pleased to hear that you're going out with your friend for a treat. I hope you both have a lovely, lovely time. Enjoy the sunshine!

(((Jenny)))


Mogs
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Jenny, you are doing an absolutely stellar job of managing Squishy. Try cotton wool if you have trouble with a piece of towel. It doesn't flop around so you can grab it easier.Enjoy your time out with your friend... You need to see that your health doesn't get lost in the shuffle.

 

Jeanne.

Oh yes that's a much better idea. I have a heap of those makeup cotton pads in the medicine cabinet that I don't use. I have a little plastic container set up now that has my meter, lancets, test strips and will add cotton pads. Makes it so much easier to move everything around in the container.

thank you again. All of these handy hints are really helping

Cheers

Jenny

 

I am so glad to hear you are home testing successfully! I knew you could do it!

I use the round cotton makeup pads when I test and I love them. I use them as a backer to keep myself from getting pricked by accident and as a compress after testing. Another trick I use is relabeling old test strip containers and using them to hold used strips and lancets. I like having a designated place to safely store used supplies if I need to do any retesting in the same sitting. I also like the freedom of dealing with trash and sharps on my own schedule rather than having it be one more thing to juggle in the moment.

 

Ooo, I like that idea better than the cotton balls! I have a 'command central' area next to my recliner. I bought a couple of plastic mini-cabinet units..they come in either three or six drawer sizes, and I slid them into a small shelving unit about 29 inches high. I have a drawer for lancets, teststrips and meter, another drawer for antibiotic creams, drawers for fortiflora, cotton balls, scissors and ear thermometer, you name it...there's a drawer for it. The very fact that I'm so organized helps to calm ME. Moglet will know what I'm talking about. Having to jump up and hunt for things at the last minute, because I've misplaced something, will make ME stop eating.

Wish I had a drawer for donuts, heh..

 

I love the idea of a multi drawer container to put supplies in.... right now mine are in a basket and I am always digging to find stuff I need. Even the cat will "fish" for things in that basket. LOL I'm rolling laughing at the thought of a donut drawer...

 

The big, sheepish grin appeared before I even got as far as ...

 

If you build it, people will come.

.

 

Yet more terrific ideas! My tiny abode is looking more like a Vet than my home these days. One whole cupboard is full of low carb foods and stock up on syringes. ...I will certainly be using the makeup pads as a cushion for my fingers as well. There are some days where I am temped to take my own BGL whilst I have the available droplet

 

Sounds about right, Jenny!

 

I suspect more than a few of us has had the same thought about testing our own BG, I know I have, particularly when I've only had 5 hours sleep in two days, and I'm feeling shaky. I'm going to set up a smaller station in my kitchen, for Dottie's supplies, too. I have a table in there that has her scale on it, and there may be times I can inject or test her there as well.

And oh, the food! That's where my resolve about order breaks down. I have cans of food EVERYWHERE, because we have a small house and our pantry is always full to overflowing against the perils of winter. (I hate having to go out in cold weather to shop) So I stuff cans of cat food all over, like a squirrel hiding nuts. Some cat food I store in small rubbermaid tubs, that serve as stepstools for Dottie, since she hasn't had the energy of late to clamber up on benches, sofa and the recliner. It doesn't help that the vet cut her claws really short when she went through surgery.

I often will tuck one unopened can of cat food next to me in the recliner, so that it's nice and warm when I'm ready to open it for their dinner. You said Mouse temperature was pretty close to our body temp... right, Carl? Gotta love Google for information like that!

 

My heart went all gooey reading this. You are such a loving momma, Jeanne.


Mogs
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I would be in trouble if I mixed Squishy's tins of food with my small tins of flavoured tuna. My eyesight sucks at the best of times and to be honest my tuna looks more enticing than Squishy food.

 

There's always ways around that.. If there is any question about the contents of a can I mark it with a black magic marker.

 

ok. have done a curve today with Squishy's new dose of 1u. She is also having a regular small handful of Royal Canin Diabetic each day so that she has something to eat whilst I am at work. So that may be the reason for these higher numbers.

7:00am Pre Shot 18.7
7:40am 16.9
11:40am 16.4
2:15pm 17.2
6:10pm 19.1

She is due for her next shot at 7:00pm and I have drawn 1u again. In two minds to draw 1.5u but maybe I need to discuss with my vet before doing that.

I just did a urine glucose test and that is high but no signs of anything else going on..which is good.

Squishy's behaviour is normal, no extra drinking. Just a lil annoyed at me pricking her ear so often today.

Am I looking at going up to 1.5u again? All in all I just want to regulate her and the diabetic dry food allows me to get through my work day without living on constant fear she is unconscious from low BGL.

Suggestions? Sorry to be a bother again.

Jenny

Post script: A couple of vomits this morning, I think they were fur ball, but the alert was her climbing on my bed and weeing on it whilst I was there. She drank a lot of water over night and was howling for food a lot.

I have increased her dose to 1.5u for this morning and will discuss with my vet today. I am praying its just a dose adjustment and not something sinister because my $6000 vet bill so far is just overwhelming. I have managed to pay just under $4000 off.