Charlie - Help - Blood in Diarrhea/Lethargy. Scared.

My little Charlie was diagnosed with diabetes last week. We live in Amsterdam, and the vet told us her blood sugar was at 23.5 at first testing. She is on caninsulin at 2 units twice a day. It has been a week and she still seems to not be herself, which makes me real sad. On Friday we went back to the vet for a follow up test. Her blood test came in at 12.5. This was 4 hours after her morning shot. They tell us that the normal reading is between 3-8, so I guess the insulin is having some impact. The vet suggested we increase the insulin to 2.5 units twice a day, and when we did that last night, she vomited. Again this morning, she vomited after the insulin shot. Not convenient on a Saturday when vets in Europe are closed! I definitely need to learn more about this, get a glucometer, and become more independent, and I hope you guys can help me as when I read some of these posts, it all seems VERY complex. We took Charlie to the emergency vet today and they gave her a shot against vomiting. They also recommended we go back down to 2 units per day. Caninsulin seems to be the only insulin recommended in the Netherlands. I have asked about the other brands recommended on this board, and they say it's not an option so I need to give this one a try and see how it goes. Any simple advice for us parents? She's 12 years old and I hate to see her this way. From one day to the next, our sweetheart is becoming quite sad to watch. Thanks in advance for your advice.

 

Re: Meet Charlie

Hi guys and welcome to the diabetes board! I'm sorry your kitty has diabetes, but this site is the best place to learn about treating it. It is NOT a death sentence and can easily be treated.

Our kitty mocha was never on your kitties type of insulin, so I'm not sure about dosing .. we started mocha out at 1 unit of insulin, twice a day .. but she was on lantus and that is the recommended amount. On this board it's recommended that you start low, and go slow .. meaning with lantus, you start at a low dose and slowly work your way up, being sure not to miss the "right" dose that evens out their numbers.

Getting a home blood testing meter is a perfect way to test your kitty and know exactly where his numbers are. Not sure if you have walmart over there? But if you do, they sell a meter called the Relion and it's fairly cheap (sorry, it is in the US anyways!) and you can get the test strips right there as well.

I hope others will be by soon, they are so much more knowledgeable about what links to post to answer all of your questions, but I just wanted to welcome you to the board!

 

Re: Meet Charlie

Hi Charliesmom! Charlie is gorgeous! Welcome to the message board! I am relatively new here myself, so don’t have much advice to give you, but here is a link that helped me when I first started.

Newcomers frequently asked questions http://binkyspage.tripod.com/faq.html

Is Charlie eating wet food? One of the early pieces of advice I got was to switch my cat to wet food, as the carbohydrates in dry food fuels their high blood glucose numbers. It is my understanding that some cats can be regulated with just a diet change, though most will require insulin – at least for a time. My cat is a dry food addict, so I am struggling to transition her as well. Charlie’s blood glucose numbers will likely come down to some degree if you can get him on a wet food diet, assuming he has been eating dry food.

I believe Caninsulin is the same as Vetsulin (different names in different counties). You might want to post a new topic with a subject line like, “Need advice about Caninsulin/Vetsulin” that would draw the attention of those board members familiar with that specific insulin. Once you develop some connections this way, things won't seem so scary - and you can benefit from their experience.

The folks on this board are great and have helped me a great deal. Best of luck to you and Charlie!

 

Re: Meet Charlie

Hello Charlie and Mom,

We have a few members in Europe. If you put Netherlands in your subject line, you might attract their attention. I would suggest that you start hometesting today. Then you can see exactly where his blood sugar levels are and that will tell you whether he is getting too much or too little insulin. I don't know what kind of meters you have available in Amsterdam, but you want a regular human one that sips the blood and uses only a tiny sample. You want to buy lancets and a lancet device to poke his ear. (Not sure whether the gauge will be the same, but you want ones that will make a larger hole. The gauge most humans use makes too small of a hole) Make up a rice sack (thin sock filled with raw rice, warmed in the microwave until very warm but not hot) to warm his ear. (Warm ears bleed better) You can also use a prescription bottle filled with very warm water.

Here is a video that shows how it is done: Video for hometesting

If you are feeding dry food, after you get the testing down, you can change to wet low carb food. This thread has possibilities in Europe: http://www.felinediabetes.com/FDMB/viewtopic.php?f=28&t=64843 You want to be testing first, because the wet low carb can really bring down the sugar levels fast. Our Oliver went down 100 points overnight when we switched.

There do not seem to be many insulin choices in Europe other than Canninsulin. Some of our members in GB were able to get their vets to prescribe human insulins, but it is rare. We have had cats regulate on Canninsulin. The testing will help you figure out exactly how the insulin is working and you can see whether it is going to last a whole cycle or not. Once you see how it works for Charlie, there are ways we can adjust the timing and dose to help.

Keep reading and asking questions. We would love to help. My husband and I traded homes with a Dutch family from Haarlem and thoroughly enjoyed your county - many good memories.

 

Re: Meet Charlie

Hi Charlie & Mom,

Welcome to the forum - I am sorry that Charlie has diabetes but you will get an enormous amount of help here. There are a lot of people that are not that particular about Caninsulin. All ii know is that my Scamp was diagnosed in February 2012 and she got put on caninsulin (her vet wouldn't hear of anything else) and I started home testing right away and switched her over to wet food immediately. (Luckily she just likes food and lots of it - wet or dry - lol). It has been 3 weeks now since I have given her any insulin as she is now diet regulated!!

So get Charlie on a low carb wet food as soon as you can because even with caninsulin he can become diet regulated!!

Best wishes,
Alix & Scamp

 

Caninsulin Advice in The Netherlands

Thanks for your welcoming notes. We appreciate the advice and will take it in step by step. Right now we are still trying to get used to giving Charlie her insulin twice a day. It's a transition and we're getting better at it. Things haven't regulated though so I know our next step is to buy the glucose meter like some of you have suggested.

Here is a bit more background about Charlie:

She's a British Shorthair. I found her in Illinois in the year 2000 as a stray so she's now about 12-13 years old. Since then, Charlie has lived in the US and Europe. She is an indoor cat and has always visited the vet on time to get yearly checkups. The only health issue that she had happened about 6 months ago when she had to have 2 teeth removed.

Most of her life she has been a bit chubby. We have had her on prescription weight loss food for about 5 years, but it has not had an effect as we probably did not regulate the quantities as much as we should have back then. Now I feel a bit guilty about that. Charlie's weight was about 5.8 kilos (12.8 pounds) until the diabetes diagnosis. Right now she weighs 5.4 kilos (11.9 pounds). The weight loss, excessive drinking and peeing were warning signs that led us to go to the vet to get her checked out about a week ago.

She was diagnosed on June 24th, and the vet prescribed 2 units of caninsulin twice a day. Since the diagnosis, Charlie has been eating 55 grams of the food each day. It's a dry food called Hills prescription diet M/D Feline Weight Loss Low Carbohydrate Diabetic. This was recommended by our vet and she seemed to like the food and eat it until just recently.

After the follow up vet visit on June 29th, they increased the insulin dosage to 2.5 units twice a day. Charlie's vomiting on Friday night and Saturday afternoon led us back to the emergency vet on Saturday at about 5pm. They tested her blood and said it was at 18.9

This was considered high, but also normal since it was almost time for her next shot at 7pm. Still, the vet was worried that the vomiting wasn't normal, so they advised us to lower the dosage back down to 2 units twice a day for the time being.

The anti-vomit shot (cerenia) on Saturday night stopped the vomiting over the weekend. However, all the shots since then have been challenging as Charlie seems to have lost her appetite.

Sunday morning I woke up and Charlie hadn't eaten ANY of the food that I left her the night before. I tried feeding her the hills' food again, and she didn't eat it, so again we had to wait around for her to eat a little bit and she didn't eat enough. Eventually, we were able to get her to eat a little bit of tuna as that was only other thing we had in the house.

It has now been 2 and a half days of loss of appetite and lowered insulin dosages. Things don't seem normal, or else we just have to get used to a tired, strange kitty. The vet can't take us until Friday, so we have to wait until then to test her blood again.

I will look for the wet food recommended and try some of that if I can't get her to eat the Hills anymore.

Is this loss of appetite normal? When the vet did the initial blood test, they only tested for diabetes. I really don't want to put Charlie through more tests, but I read that other things could be present (pancreatitis, kidney problems, etc) so I am considering asking our vet to do another blood test.

So far I have spent $500 at the vet and the results are not as good as I had hoped for. I do feel I need the vet's help at this point as I don't know how to do this on my own and we are both working, so we don't have so much time during the day to investigate. Thanks again for your tips and if you have more, bring 'em on! We appreciate it.

 

Re: Meet Charlie

I live in Denmark and my vet started Prop on 2 units of caninsulin. First it is very possible that your cat can get otj - of the juice if you just do a few simple things. First as other have said, begin to hometest the cats bg. Caninsulin is a fast acting insulin and it need to be lowered as soon as your cats numbers egin to fall. Then get rid of the dry food. When i changed Props foodcto a 100 % wet, she went of the insulin within 10 days. At www.zooplus.com you can buy felix wet food. If you et the felix as good as it ges and felix twice as nice the carb will be around 4% where now when you are feeding dry you are most likely giving you cat more than30% carbs. But dont change the food before you bloodtest.

I have this homepage www.sukkerkatten.dk where is wrote a diary about what i did with prop to get her otj. If you use google translate i think it could help you. There also is a video of me testing props bloodglucose.

Low bloodsugar can make a cat vomit and feel really lousy. Hopetesting is the keyword and then get rid of the dry. This is a fight you can win. Good luck

 

Re: Meet Charlie

Thank you very much, Charlotte.

 

Vomiting Kitty

:shock: This morning at 7am, I tried to feed Charly the recommended foot from our vet (Hills M/D prescription diabetes). She did not eat any of it. I needed to give her a shot at this time before going to work, so I continued to try and encourage her. She just wouldn't eat it. I had 1 can of "gourmet gold with salmon - fine mousse" wet food. I tried looking this up on the website to see if it was appropriate to feed Charly this. It wasn't clear. On the list of foods available in Europe, "gourmet gold" seems to be on the list. I tried to use a calculator that I found on the internet to double check the ingredients to see if this was OK. On the back of the can it says: protein 11%, fat 7%, ash 3%, cellulose .1%, humidity/water 77%. From entering these amounts in the calculator, it seemed to be OK to feed her this. Or I did something wrong, as when I came home from work at 5pm, Charly had vomited twice again. Can anyone confirm if I fed her the wrong food?

:shock:

Also, it's now time to give her another shot. Yesterday I bought a glucometer & insulin pen (Freestyle precision was the only type available in Amsterdam at the pharmacy I went to). However, now I read a thread on this site saying that this particular brand is unreliable. UGH! On Friday I will be back at the vet (this is the soonest they can fit us in). While I'm there and they do the blood test professionally, I will also put a little drop of blood on my own glucometer to see if the reading is in line with the professional reading. This could be a way to test it's effectiveness, I think. Thoughts?

In the meantime, for tonight specifically (it's currently 7:30pm here in Amsterdam):

- Should I try to test Charly's blood now (even though I know it will be high because it's time to give her the 2nd shot today)?

Or, should I instead just encourage her to eat more dry food and then give her 2 units of insulin again?

Has anyone had these sorts of bad reactions with caninsulin? Or is this all just normal (and I'm a freaked out kitty momma) as it takes some time and practice to get her regulated properly?

Thanks for your advice, guys. And thank God for this community!

 

Re: Meet Charlie

You want her to eat before you give Canninsulin. It tends to hit hard and fast and it could take her dangerously low if you give it without food on board. The other complication is that, of course, you want to give her insulin. The vomit could have been that she didn't like the food and it upset her stomach. But it also could have been that she went low and vomited. That is why the testing is so important so you can really see what is going on. Yes, testing your meter against the vet on the same sample of blood should give you an idea. You can also test yourself and see if it gets a reasonable reading for you.

I think I would go ahead and feed dry until you can find a low carb she wants to eat. At least she has food in her stomach and you can give some insulin. If she were mine, I would reduce to one unit until you can figure out how low she is going and how the insulin is working. If the vomiting had to do with too much insulin, that is a problem.

Have you been able to get any readings with the meter?

Lots of cats quit eating the DM. It is liver based and they get tired of the taste pretty fast. The nice thing is that the vet should take back any unopened cans.

 

Anticipating First Blood Test at Home + Bought wet food

Thanks for the quick advice, Sue. She ate the dry food and we gave her the insulin. I will do my first blood test in a few hours (after the 4 hours have passed since her shot). We also bought some canned wet food options so we have some backup plans in that regard as well just in case.

 

Re: Meet Charlie

I suggest that from now on you test before you give the shot. That way you know if it's safe to give insulin. If she's too low at the shot time, she could drop too much and become hypoglycemic, or hypo. (viewtopic.php?f=28&t=15887).

Testing part way through the 12 hour cycle gives you information about how low she's going. That lets you know how well the insulin is working.

At some point you will want to do a curve. That means you test every 2 or 3 hours during a 12 hour cycle. That lets you know the duration of the your insulin - how many hours into the cycle she hits her lowest point before she begins to rise again.

And keep a chart of your test results. You can use the one here on FDMB (I don't know the link, can someone else provide it?). Or you can just write it all down.

 

Re: Vomiting Kitty

I would do that - when you're at the Vet, and they are testing the blood anyway, test your meter too & compare it to theirs. That's what I did. The Vet told me that my human glucometer was going to read at least 100 points higher than theirs.... but it was almost 50 points LOWER. After that, he was all for me testing at home.

Hope Charlie is feeling better :smile:

 

My little tiger

Friday we fed Charly wet food and took her to the vet. Big accomplishment: no vomitting!
I asked the vet to do the full blood test this time (just to be sure there are no other problems happening simultaneously that might have caused the vomitting).

Charly has now figured out that there is nothing fun about the vet. The minute I even bring out her carrying case, she starts getting stressed. Yesterday it took 3 people at the vet to hold her down for the blood test. She screamed SO LOUDLY like a tiger that all the people in the vet's office took notice, and the vet recommended us to stop for the day and not do the glucometer reading as well. So we'll wait until monday for that one.
Hopefully Charly will soon be regulated so we can see some improvements.

In the meantime, I noticed that she likes the wet food better and it seems to help in some way. We are buying one of the recommended brands, but are not sure about 1 thing. How much wet food should she get? She is currently down to 5.3 kilos (11.7 pounds) so weight loss is still important I guess. Thoughts?

 

Re: Meet Charlie

I give Prop 45 grams of wetfood every 6 hours. I put in a little water as well wich is very good for her.this amount keeps her weight stable at 5,3 kg. I want her to keep this weight.

Now that you are feeding wet, there is a big chance the 2 units of caninsulin is way to much. You really need to begin to test at home. The stress you cat is going through going to the vet to have a curve done not good and will affect the numbers by rising a lot. That will have the vt think that the insulin needed is bigger than it really is. Hometesting is th keyword and especially now when you have changed to wetfood. To low bloodsugar can kill you cat within hours, so you just have to begin.

 

We tried doing a home blood test this morning after 4 hours of insulin. Charlie wouldn't allow it and she got all stressed out, so we will try to wait until later tonight and do it again before bed. Maybe she will be more calm then.

Some more background on Charlie (which I forgot to mention):

She is a real sweet animal with us, but ever since I found her in 2000, she has been an extremely anxious, high stress, kitty. The vet has told me she has never seen a cat so stressed. Even with friends who come to the house, Charlie hisses and gets nervous. She is a declawed cat so maybe this is a contributing factor. She doesn't have all the proper mechanisms to protect herself, so when people come around that she does not trust, she gets more nervous. She basically trusts nobody except for the two of us, so this means she is most calm when it is just the 3 of us at home. I realize that her high stress could lead to a misread from the vet (even if they do the blood test there). This is why I would like to start the home testing. However, we are scared and we are struggling a bit with this. I will keep trying. Thanks for your encouragement.

 

Re: Meet Charlie

Two ideas.

Start desensitizing her to the process. Decide on a place where you will test and take her there. Pet her and talk to her and mess with her ears for a few minutes. Then give her a treat and let her go. Do that a few times, then add the warming. (rice sack or prescription bottle filled with very warm water) Few minutes, treat and praise and she goes. Hopefully once she is used to the process, the poke won't be such an isssue.

Not sure how she would feel about the kitty burrito. We used it with Oliver at first and were able to stop once he realized if he would sit still, a treat would be coming. We wrapped him in a towel with only his head showing.

Are you sure using a large enough lancet? Not sure of the European system, but we use 25-28 gauge at first to make a big enough hole. The 30-31 gauge sold for human diabetics don't usually work in the beginning. Also, put something behind the ear when you poke - a folded tissue or paper towel. We used a small makeup songe.

You might start a new thread with your testing problems to get other ideas.

 

Re: Meet Charlie

Hi Charlie's Mom,

It sounds like Charlie is a shy kitty!! My 3 cats are all declawed and do get shy around visitors - just not as badly and they quickly come around and demand attention from the visitors!!

When Scamp was first diagnosed I knew enough (& luckily so did my vet) to know that I had to start home testing as soon as possible!! This was actually before I found this site!! what worked for me is that she on occasion really wanted cuddles and if she wasn't feeling good she REALLY wanted cuddles. I would just pet her and she would settle in and I would play with her ears. Shortly after playing with her ears I would then test her blood. We both found this (quite quickly) to be a comforting and bonding time and now all I have to do is call her and she comes running (usually - she is still a cat!!).

Sue's ideas are great - the most important thing is to BREATHE!! You need to test Charlie to find out his glucose levels so that he doesn't go hypo or anything. You are trying to help him feel better so that you will feel better!! Any way that you can get him tested is good as long as it doesn't turn into a stressful situation for both of you. Scamp and I always go to the same place for her testing and she knows it means cuddles. Try and ease Charlie into a routine and find some treats that he likes (although I still have never given Scamp a treat) and try to make the testing a good experience!!

There are lots of people here that are very knowledgeable and will come up with wonderful ideas - this site has been invaluable to me! And I expect you will learn everything and anything you want to know (about feline diabetes) here!!

Good luck,
Alix and Scamp

 

Charlie has pancreatitis

We found out today at the vet that charly has pancreatitis. The vet told us the key thing we have to do is keep her away from fat. She did not prescribe any other treatment methods.

If we keep her on a wet food diet with the right wet food, I guess this will help. However, it sounds like it is incurable. Also, maybe this explains the vomitting. Is there anything else we need to be aware of?

 

Re: Meet Charlie

Jill, start a new thread with pancreatitis in the subject line. We have lots of people here dealing with it. Be sure to mention you are in Europe so they can give you food ideas.

 

First At Home Blood test accomplished!

We succeeded in doing our first blood test tonight! It has taken us many attempts over the past weeks, but we got it this time! Blood results were 23.8 just before her 2nd insulin shot of the day. We will try to do a mini-curve tonight (or as many tests as we can achieve) to see where her lowest point is and when she reaches it.

Thank you everyone, for encouraging us to do this. We're getting there. Baby steps!

 

Glucose curve - low numbers?

Charlie's blood glucose curve results thus far today:

6:45 pm (just before her insulin shot) = 23.8
7:45 pm = 17.6
8:45 pm = 15.5
11:00pm = 3.0

We haven't yet correlated our home glucometer to the vet's machine. We will do that on Tuesday July 24th at our next appointment.

For tonight, we will test again at 12am to be sure, but still, I'm already a bit concerned that her numbers are so low.
We are currently administering 2 units of insulin. I assume we should decrease the amount slightly for tomorrow morning's shot. And probably we should leave some of the M/D dry food out for her tonight. Agree? Right now Charlie is sleeping. She seems ok but her pupils look a little dilated to me.

Thoughts on next steps? This is the first time we have done a curve so I don't want to make mistakes.
Thanks for your help in advance.

 

Glucose curve

Charlie's glucose at 12am was: 3.6
Just prior, I gave her a couple kernels of the m/d dry food. I will leave a bit more out for her tonight just to be on the safe side.

 

Re: Meet Charlie

Wow, that was a significant drop. With a +4ish that low, even though you saw a small rise at the last test, can you check her again in 30 minutes? Doing the math in my head, but the 3.0 would be a 54 to us. 3.6 is only 65. You want to make sure that she's rising. Did she eat okay tonight? Keep an eye on her pupils. The numbers are not in "hypo" territory, but they are low.

Carl
ETA - yes I think reducing in the morning would be a good idea since you've just started testing.

 

Ate wet food before insulin shot

She ate a full can of wet food (beef) at 7pm just before her insulin. I will test once more in ten minutes as advised.Thanks for the quick response.

 

Re: Meet Charlie

Your 3 is a number that is still safe for nadir although we wouldn't want it to be much lower. (Multiply your numbers by 18 to get US numbers.) The more concerning issue to me is that she went down from quite high numbers to quite low ones. Unfortunately this is not uncommon with Canninsulin; it hits hard and is a bit of a roller coaster. However, I am encouraged that it is seeming to be lasting longer than it does in many cats, so it is possible that you can manipulate the dose to work for her. It's only one cycle so we can't tell if she is bouncing from the low numbers up to the high, but it is a possibility. (Her body responds to a lower number that it has seen by releasing extra glucose into her system, making her numbers rise sharply)

I would reduce the dose. IMHO I would go down to one unit and work my way back up. (Much safer to start lower and add as needed based on her numbers. You can't get the insulin out once it's shot if it was too much.) You might make food available in the 4-6 hours after the shot to slow the curve and maybe stop that drastic drop. If you decide to lower the dose, be sure to test for ketones.

Can we help you set up a spreadsheet? The World version will convert your numbers to US numbers and is a great way for us to see your dose historty when you have a question. Here are the directions: http://www.felinediabetes.com/FDMB/viewtopic.php?f=6&t=18207 If you have trouble, send me a private message (PM button on the bottom LH side of this post.

 

BG at 4.2

Her glucose levels at 12:30 were: 4.2
It's going in the right direction.

We will go to bed now and leave some dry food (m/d) out for her.
I will reduce the amount in the morning before work and look into setting up the spreadsheet tomorrow night.

Thanks everyone for your help and advice.

 

Re: Meet Charlie

Sounds like a good plan, Jill!
Carl

 

Reduced Insulin to 1.5 Units + ?'s Wet Food

We reduced Charlie's insulin to 1.5 units.
Today we slightly misfired & a very tiny bit of insulin didn't make it into the cat. This means we have to wait until tomorrow to get a true reading based on the new dosage, but generally, charlie seemed a bit more normal today so that was good.

Charly is still 5.3- 5.4 kilos. The vet told us the goal is to get her between 4 to 4.5 kilos.
Thoughts?

Also, we are thinking of switching entirely to wet food. Lately our routine is to feed 1 can of wet food with each shot, and for the in between snacks/ mini meals, to give some of the m/d hills diabetic food.
How do we determine the exact amount Yof wetfood to give in total each day? We want to be sure charlie gets enough food with each shot & avoids hypos, but also to enable the weght loss needed. How do we find that balance? 2 cans total per day (split into 4 meals)?

Do we need to stick with 1 particular kind of wet food or can we switch it up as long as they are all on the list and have low carb percentages?

 

Re: Meet Charlie

You are testing at home, right? If so, yes, I would switch to all wet low carb. When we took Oliver completely off dry, not only did his glucose levels come down 100 points, but over the next 6 months, he lost 2 needed pounds. Just watch the numbers carefully and be ready to adapt the dose.

Here's is my favorite formula for how much to feed: (Thanks, Carl)
20-30 calories per pound of ideal body weight, per day. That will keep a healthy cat at its ideal weight. The range of calories is dependent upon a few factors, one of which would be level of activity.

Some cats want variety; some would happily eat the same kind every day. Whatever makes her happy!

 

Re: Meet Charlie

Charly is doing much better with the lower dose. She is moving around more, cleaning herself, and even ran to the door to greet us today like she used to do. We gave her 1.5 units for the past 2 days. Today we also started feeding her only wet food in total. Her blood test just came out at 6.6!

Little victories. Yeah!

 

Re: Meet Charlie

That's a very nice number - when in the cycle did it come? Remember that if you get 200 or below (around 12 metric) wait 20 minutes without feeding and test again to be sure the number is rising. Even if it is rising, it's a signal to drop the dose a little.

 

Re: Meet Charlie

That test was 4 hours after her evening shot.

Not sure what you mean by 'if you get a reading of 12 wait' to make sure it's rising before feeding. Wouldn't feeding her help it rise actually?

Also, 12 seems mid range on the high side, not low. Why would that be a signal to lower her dosage? Bit new to this still so sorry for too any questions here. Just trying to make sure I understand.

This morning's pre-shot blood test at 6:30am was at 19.3. We gave her 1.5 units.

 

Re: Meet Charlie

Our arbitrary cutoff for new diabetics not to shoot is 200 so your 12 is in that same range.

We suggest waiting 20 minutes without feeding because we want a "true" number to base the dose on - not one inflated by food. For example, if food makes her number rise by 100 points and you shoot that number with a dose that would match it, you will be giving more insulin than she needs. If you didn't give food and her number was 100 points lower, the dose would be lower. (Hard to type out an explanation - does that make sense?) it's just a way we use to make this dance safer for diabetics, particularly in the beginning.

The other reason to wait and retest is that the number may be going down, not up. She could still be afected by her last dose and still be going down. You don't want to shoot a number that is still affected by insulin because then you can have overlap of the insulin and create even lower numbers. This is not likely to happen with Canninsulin as it usually does not last the 12 hours, but some cats have had longer cycles with it.

Once you have some data and can see how she reacts to a given dose on a given number, you can be more daring with the dose and perhaps shoot lower at preshot. But you want lots of data because Canninsulin does have that fast drop.

Can we help you set up a spreadsheet so when you come on needing dose advice we can see her history at a glance? Here are the directions: http://www.felinediabetes.com/FDMB/viewtopic.php?f=6&t=18207 Use the World version so it will convert for you and for us. If you need help, send me a pm.

 

Re: Meet Charlie

Hi Sue. Really not sure I get it. I'm sorry. In a moment I will get that spreadsheet uploaded so everyone can see things quickly at a glance.

Current status is:
- We gave Charlie 1.5 units this morning at 7am.
- Tonight she had diarrhea just before her 7pm shot, so just to be on the safe side, we just gave her a blood test. The test came out at 11.2

If I understand your post correctly, are you saying that anytime her blood test comes out below 12 at pre-shot, we should be cautious and not do the shot? I will do as you indicated and wait another 20-30 minutes to do another blood test then.

In the meantime, we'll also work on posting the chart to give an overview of the data we have at this stage.
Thanks again for all of your input along the way. This really is a roller coaster but we love her so we will do whatever it takes.

 

Re: Meet Charlie

Just prior to the first blood test at 7pm, Charlie ate dinner. We were supposed to give the shot right after, but when we saw the diarrhea, we decided to test her blood and the figures were at 11.2

We waited 30 minutes to do another blood test just now and her blood is now at 12.3

We need help to decide what to do next as this is supposed to be the time of her evening shot:
- Give no insulin until morning?

- Give the 2nd shot of the day of insulin (but just lower the dosage)? To 1 instead of 1.5? I read somewhere that it's also not good to raise or lower insulin amounts by more than 20%, so going to .5 does not seem like a good idea. Even lowering the dose arbitrarily seems concerning in a way.

- Give the normal amount (1.5)?

I am leaning towards not giving her anything until morning, but I am no expert in any of this so I really could use some advice. Thoughts?

 

Re: Meet Charlie

Lower the dose. I would probaly give 0,5. Since you are now on all wet, the need for insulin will be much less. So give him a small amount 0,5 andcthen by morning, see what the preshot is and maybe then deside to raise a bit

 

Re: Meet Charlie

When Someone suggest not to shoot when he is under 200 it is because in the beginning it is very difficult to know how the reaction to the dose will be, and with at fast acting insulin like caninsulin it can be dangerous to shoot on a lower number unoess you reduce the dose and continue to test during the cycle.

You should be ok with a reduced dose, but get a +2and a + 4 so you can see his reaction to the lower dose. You need the data for the next time youvare in a similar situation. If his nadir is later than +4, then try get a later test as well.

 

Re: Meet Charlie

What Charlotte said........ :mrgreen:

 

Re: Meet Charlie

Unfortunately, we misfired while trying to give the .5 unit so we stopped. Charlie has had diarrhea all night tonight and did not eat much of her food. :?

She is sleeping now so we will let her rest until morning. We left a few extra dishes of water out for her so she doesn't dehydrate. We just finished updating the spreadsheet and will try to upload now. Thanks for your quick responses as always. Doing what we can here but we can and will do better! While rewriting the spreadsheet into google docs, we noticed that a few of the times she vomited or had diarrhea were when she ate the Almo nature veal. We will try to stay away from that for awhile to see if that will help. However, it may just be a reaction to the pancreatitis. Not sure. Step by step we continue our journey to make our girl feel better.

 

Re: Meet Charlie

Here the link to Charlie's spreadsheet:

https://docs.google.com/spreadsheet/pub ... utput=html

 

Re: Meet Charlie

I can see the metric numbers but not the button we can hit to convert to US. Did you sure use the World Version of the spreadsheet?

I think you are wise to skip if she is having tummy troubles. With Canninsulin you definitely want food on board. Hope it was the one flavor that didn't agree with her.

 

Re: Meet Charlie

The spreadsheet was the one you provided. Not sure what went wrong.
We will test in the morning pre-shot and hope for a better day.

 

Re: Meet Charlie

The tech link has two different spreadsheets , the regular version and the World one. If you have the regular (and darn, it looks like you do, send me a pm and we'll fix it.

 

Re: Meet Charlie

Shoot! I am been trying to work with the world spreadsheet from the Tech forum and the one in the regular google templates. Neither one will switch from metric to US or vice versa. I'll see if some of the people more computer wise than I can help.

 

Re: Meet Charlie

The way the world spreadsheet in the link Sue gave is supposed to work is that there are two tabs, one for World (mmol) numbers and one for US (mg/dl) numbers. When you enter a number in mmol in the World tab, it is automatically converts that mmol number into mg/dl on the US tab. The tabs are listed at the top bottom of the SS and you can switch between the two. For some reason your SS does not have tabs.

Here is the World SS I just tried out: https://docs.google.com/spreadsheet/pub?key=0AktEyoSYQciQdFN6NGpnQ09PeHI1RXF1dWJEUjdsekE&output=html It works just fine.

Please try setting up a new SS. Click here to get the World template Click on the Use This Template button that is at the top. It may take a couple of seconds or longer for the template to load and to get a copy to use so be patient.

Then follow the rest of the SS instructions to get the SS published and into your signature. You can re-enter Charlie's numbers into the new SS and then delete the old SS since it doesn't work as it's supposed to.


EDIT: It looks like some of the cells in the World template aren't converting the numbers from the World tab to the US tab confused_cat You can see that in my test SS in link above by flipping between the two tabs. Whoever set up that template and posted it might not have applied the auto rule/function/whatever it is to all the cells.

I suggest using the World template in this thread instead: http://felinediabetes.com/FDMB/viewtopic.php?f=6&t=50130

 

Need Help with Hypo

This morning when we did the pre-shot blood test, Charlie came out at 24.2 (436 in US measures). She had vomited during the night and there was more diarrhea, but as we found this quite high, we decided to give her 1.5 units of insulin again. Within an hour and a half, Charlie vomited once more, so we gave her lots of water and gave her more food. Still, as we were a bit worried about how it has gone in the past few days, we decided to test a few times. 2 hours after the morning shot, her test results came out at 10 (180 in US measures). Now we just tested again 4 hours after the morning shot, and it seemed extremely low at 2.1 (38 in US measured).

We gave her a bit more food as I hope that will help stabilize things a bit and bring her up a notch. Still, I'm not sure things are on the right track. We have a vet appointment on Tuesday again, but until then, any thoughts on how we should proceed?

I'm thinking about doing another blood test in 1 hour to make sure it's going up. Then test once more before the evening shot. My gut tells me that 1.5 is too much right now (maybe just because she has been puking with diarrhea, but still). I'm leaning towards giving her 1 unit rather than 1.5 if the blood test comes out above 20 again.

Thoughts on how much should I give her if it's below 20?
If under 12, I understand we should give no shot.

 

Re: Meet Charlie

You might want to edit your post to include the "911" emergency tag as a BG of 38 (US) is an emergency -- and you will get quicker responses from the experts.

I am not an expert by any means, but in reading this board for the last month, the lowest point is going to hit Charlie at about 6 hours after you gave the shot (the nadir) -- so if he is at 38 (US) at +4, he is going to be even lower at +6 - so this could be a dangerous situation. The advice I have seen is to give high carb food and test every 15 minutes for at least the next few hours. I hope the experts will be along shortly to give you more exact advice. If you don't have any high carb food, maybe something like milk would bring the blood glucose up quickly. Also, I would say that the 436 (US) number you got this morning was probably related to the fact that you didn't give Charlie a shot last night -- so maybe the dose you are giving him of 1.5 is just too high. Again, the experts will chime in shortly, but since I was up and no one else has responded yet...I wanted to try to help.

 

Re: Meet Charlie

Here are the guidelines for treating hypo from this board: See the "very low numbers without symptoms. And again, please edit your post to include the 911 icon above and you might want to include the words "Possible hypo" in the subject line. This will draw the attention of the experts.

TREATMENT

During treatment for hypoglycemia, try to test every 15 minutes until you see the bgs begin to rise. Then continue to test until you are satisfied that the cat is out of danger.

VERY LOW NUMBERS – WITHOUT SYMPTOMS
Retest glucose using a large blood sample to make certain you have enough blood, and if you still get a very low number (under 40 mg/dL or 1.9 – 2.2 mmol/L) administer a tablespoon of corn syrup, liquid glucose, pancake syrup or honey, or INSTA-GLUCOSE and follow with food until the blood glucose numbers rise to acceptable levels. The syrup can be mixed with wet food or poured over dry if the cat will eat the mixture. If using liquid glucose, dilute with water for a thinner consistency.

LOW NUMBERS – WITHOUT SYMPTOMS
Retest glucose using a large blood sample to make certain you have enough blood, and if you still get a low number (40 – 60mg/dL or 2.2 – 3.3mmol/L) give food or treats until the blood glucose numbers rise to an acceptable level. If the cat refuses to eat even his/her favorite foods, you can syringe feed or administer a small amount of syrup.

LOW NUMBERS – MILD SYMPTOMS
Try feeding first or give a little syrup or honey followed by food until the blood glucose numbers rise to an acceptable level and the symptoms disappear. The syrup can be mixed with wet food or poured over dry if the cat will eat the mixture. If the cat will not eat, syringe feed. If your cat will eat dry, feed this first as the high carbs will help to increase his/her bgs quickly. You can then follow with his/her favorite canned food. Keep in mind that giving syrup (Karo, etc.) or honey is not enough because the effects wear off quickly. You need to follow with food.
IF IN ANY DOUBT, TELEPHONE YOUR VETERINARIAN.

LOW NUMBERS – MODERATE SYMPTOMS
Give a tablespoon of syrup, a teaspoon of liquid glucose, a tablespoon of honey or a tablespoon of sugar syrup followed by food and continue doing so until you see the blood glucose numbers rise to an acceptable level and all symptoms disappear. The syrup, honey, or glucose can be rubbed against the inside of the cat’s cheeks or on the gums for quick absorption. You can also mix the syrup with wet food or pour over dry if the cat will eat it. Continue to give syrup and food as needed and observe your cat for signs of recurring hypoglycemia. Keep in mind that giving syrup (Karo, etc.) or honey is not enough because the effects wear off quickly. You need to follow with food.
IF IN ANY DOUBT, TELEPHONE YOUR VETERINARIAN.

LOW NUMBERS – SEVERE SYMPTOMS
Rub syrup, honey, or glucose on the gums and cheeks if your cat will allow it. Another option for administering syrup, diluted liquid glucose, honey or sugar syrup to a cat who is seizuring is to fill a needleless syringe with the mixture and insert via the rectum.
NEVER TRY TO SQUIRT SYRUP, HONEY, OR GLUCOSE TO A CAT WHO IS SEIZURING AS THE CAT COULD CHOKE ON IT! RUSH TO EMERGENCY.

AGAIN! ANYTIME YOU CAT IS SEIZURING OR LIMP, RUB KARO, GLUCOSE OR HONEY ONLY ON GUMS OR ADMINISTER RECTALLY AND GET TO EMERGENCY OR YOUR NEAREST CLINIC IMMEDIATELY!!!

Remember that syrup or any other sugared syrup/preparation will spike the blood glucose ONLY for a short period of time, so food is really important with mild and moderate symptoms. Dry food (high carbohydrates) will keep the blood glucose numbers elevated longer, so it’s a better food to give during a hypoglycemic episode.

After a hypoglycemic episode cats may be more sensitive to insulin, so a reduction in dosage is generally required, especially considering too much insulin – whether due to dosage, inadequate food intake, or the cat’s changing insulin requirements – caused the hypoglycemic event in the first place. With moderate to severe episodes, your Vet may have you skip the next injection altogether.
IT IS VERY IMPORTANT THAT YOU DISCUSS YOUR CAT’S HYPOGLYCEMIC EVENT WITH YOUR VET, SO TOGETHER YOU CAN DECIDE UPON THE NEXT COURSE OF ACTION.

Always keep in mind that with low blood glucose and no symptoms, the BG you get is not as important as where it is headed. In other words, if you get a BG of 100 mg/dL or 5.6 mmol/L or less and there are still several hours or more before the insulin peaks, your need to watch your cat (and the numbers) carefully and take appropriate steps. With very low numbers and NO SYMPTOMS, a cat can be fine one moment and seizuring the next.

BE PREPARED! KNOW THE SYMPTOMS AND KNOW THE TREATMENT!

 

Re: Meet Charlie

Thank you Melanie and Ninja. We tested again. It's very difficult to test her right now as not a lot of blood is coming out of her ears even after a few pokes. We managed to get a small drop of blood and it's still coming out at 2.1 That worries me, as it makes me think that in that in between time, I wonder if her numbers went lower and they are now beginning to rise. I just gave her a tiny bit of maple syrup with a syringe in her mouth (not an easy task but she took a tiny bit). Will try to also give food and we will test again in 15 minutes.

I must admit, for Charlie's sake, this is one roller coaster ride that I wish I never got on.

:cry:

 

Re: Meet Charlie

I think you can rub the syrup on her gums. Hopefully the experts will be up soon and can help you more. It is 6:25 am Eastern time here in the US. The important thing to understand is that the danger has not passed even if Charlie's numbers are up on your next test...because the insulin will continue to push her numbers down for the next few hours -- so you will likely have to continue feeding her or giving her syrup to keep her numbers up. I really think it is that Charlie's dose is too high. She may need .5 units or maybe none at all. Hard to say...but again, hopefully the experts will chime in soon.

 

Re: Meet Charlie

I think you can rub the syrup on her gums rather than making her eat it. Hopefully the experts will be up soon and can help you more. It is 6:25 am Eastern time here in the US. The important thing to understand is that the danger has not passed even if Charlie's numbers are up on your next test...because the insulin will continue to push her numbers down for the next few hours -- so you will likely have to continue feeding her or giving her syrup to keep her numbers up.

I really think the problem is that Charlie's dose is too high. She may need .5 units or maybe none at all. Hard to say...but again, hopefully the experts will chime in soon. Can you edit the subject of your post from "Meet Charlie" to "Need help with hypo"...??

 

BG at 2.4

She's now at 2.4

It's going in the right direction.

We will test again shortly to be sure.

 

BG at 2.4

WIth the maple syrup, I could hardly get her mouth open (her blood sugar count is low but she's feisty at the moment). Guess it's normal to be grumpy if you don't feel so good. I used a bigger syringe that the vet gave me to push a small amount of maple syrup in her mouth. That was before when her numbers were at 2.1

I also gave her some more beef and she ate some of that, so that's good. I left more out in case she wants it too.

Still, as her numbers just came out at 2.4 (43 in US numbers), I think I need to give her a bit more maple syrup. I will try that now just to see if that will get her out of this crisis mode and back in the 3-5 zone.

 

Re: Charlie - Need Help with Hypo

Is there anything else she likes that would be considered higher carbohydrate than the beef? Like maybe ice cream, milk, or some food with gravy on it. Any of those would be helpful if you could get her to eat those. Again...I am hoping the experts will be along shortly to help. This is very unusual..as there are usually a few online pretty much 24/7.

 

Re: Charlie - Need Help with Hypo

You are using Caninsulin, correct?

 

BG at 2.9

Decided to retest first before giving more syrup. She is now at 2.9 (in US measures 52).

Will wait another 30 minutes then test again to be sure it continues like this and is not just a temporary spike due to the syrup.

 

Re: Charlie - Need Help with Hypo

Yes, I recall reading that the effects of the syrup wear off after a time (not sure if an hour or two), so it is important to keep testing and feeding for the next few hours so that the numbers do not drop again. I don't know anything about Caninsulin's mode of action, so hopefully someone will be here soon to let you know how long you will likely be in the "danger zone" with this. With Lantus, the insulin peaks around 6 hours and then starts to taper off over the next 6; but I just don't know if Caninsulin is similar or not. Hang in there. You are doing great!

 

Re: Charlie - Need Help with Hypo

I did just read where Caninsulin is not as long acting as Lantus, so that should get you out of the danger zone sooner. Any recent readings?

 

Charlie - Need Help with Hypo BG 3.2

We tested just now and she is at 3.2

We haven't found the exact "nadir" moment yet. See our spreadsheet to note that we only did one curve so far but I think from what the vet told us it's somewhere around the +4 mark.

From analyzing her numbers last night, we think we need to lower her insulin dosage to 1 unit max.

Unfortunately, we didn't test yesterday morning before starting, but if you look at where she was at the evening pre-test last night, her levels were at 12, which means that what we gave her in the morning lasted a long time. Last night we didn't give anything. Tried to give .5 but failed. So this morning when it was at 24.2 for her pre-test shot, we thought we should give her the full dosage of 1.2 (even though she had diarrhea and vomited the night before). Now we know this was a mistake.

We will test again before giving the shot at 7, but max amount we will give is 1 and perhaps even .5

If anyone has any thoughts on that, please do chime in.

Let's hope she keeps her food down until then. Thank you for being so responsive this morning, Melanie. We're getting there.

 

Re: Charlie - Need Help with Hypo

Wow! You all have had a difficult morning. So glad you were on, Melanie. You were great giving good advice so calmly!

Yes, Melanie is right. Canninsulin should be moving up after that six hour mark, but you want to keep testing just in case. The higher carb stuff she had may bring her up and then she could lower again. Not likely but possible.

It was probably the vomiting as much as the dose that caused her to go so low. Canninsulin without food on board can be very harsh. We need to figure what is making her vomit. How long ago did you change the food? Has she been eating one particular kind? My cats have always reacted badly to beef flavors.

Yes, I would also lower the dose.

 

Re: Charlie - Need Help with Hypo

Sue....soooo glad to see you! When Charliesmom said Charlie had dipped to 38 (US) at +4, that really scared me as I don't know anything about the action of Caninsulin.

To Charliesmom: I found this link about treatment options to using Caninsulin in the Netherlands (I believe that is where you said you are?). Not sure if this will prove helpful or not, but there is a reference to a vet who will prescribe PZI, Lantus or Levemir -- which are superior to the Caninuslin and, I believe, easier to manage (not a strong onset like Caninsulin). Hope Charlie gets along ok.

Here's the link: http://www.diabeticcatcare.com/COK/netherlands.htm

Here is an excerpt from the site:
---------
INSULINS and GETTING PZI
Most vets in European countries are on the “feed Dry Hills and use Caninsulin” plan of treatment. It is very difficult to find a vet who is willing to prescribe another type of insulin. Europaplein Dierenkliniek will dispense Lantus but they are expensive.

Dr.Tannetje Koning (holistic veterinarian) is the greatest hope for treating cats with diabetes (and other chronic symptoms) in the Netherlands. After having little success with regular diabetic protocols, she became very interested in the Tight Regulation approach to diabetes. She has now published a book on diets for carnivorous pets strongly supporting low-to-no carb wet/raw diets and home testing. Please contact Dr Koning regarding the dispensing of PZI or Lantus or Levemir. Her practice is located in Otterlo (Gelderland), however on Mondays she consults at Zoo-Natuurlijk in Amsterdam (Rivierenbuurt). She also consults in Zeewolde (Flevoland). Her website link: www.holistischedierenartsen.nl
----------------

 

Re: Charlie - Need Help with Hypo

The world is an amazing place. You have managed to find a vet in Amsterdam who will prescribe another type of insulin, and we (located here) have not! :lol:

I need to think about that a bit as having a vet who is only available 1 day per week could be a challenge.
Maybe I will try to give her a call this week just to inquire about it as a starting point.

Thanks for chiming in, Sue.

I think what's causing the vomiting is more likely to be the pancreatitis (which we still have no clue about), more than the beef. Guess we can always buy a different kind (chicken?) and try it out.

So far we stopped the hills m/d. We stopped the fish because of what I read about the extremely low quality of fish (& hazards) in cat food. We stopped the veal.

Change is the only constant.
:roll:

 

Re: Charlie - Need Help with Hypo

I have not dealt with pancreatitis, but have these articles bookmarked:

Here's a food articlePancreatitis Diet
Good information on Pancreatitis: http://www.marvistavet.com/html/body_pancreatitis__feline_.html

Good vet article on pancreatitis: http://www.idexx.com/pubwebresource...ng-pancreatitis-and-concurrent-conditions.pdf

It would be so wonderful to have a different insulin. Wonder if the vet that Melanie (amazing Melanie!) found would be your "feline diabetes" specialist and you could keep going to your regular vet for the normal stuff?

I do think you should talk to your regular vet about the complications with Canninsulin (which tends to be a harsher, shorter acting insulin as we have said) and the pancreatitis. Maybe that would prompt him to prescribe a milder, longer lasting one? Wonder if the FD vet would do a consult with you and then speak to your regular vet?

PS Spreadsheet looks great!

 

Re: Charlie - Need Help with Hypo

Im sorry you have had such a difficult morning. With everything going on, vomiting and diarrea i think you should lower the dose to 0,5. The reason for such a low dose is because you dont know if he will eat and vomit. His numbers might get a bit higher, but it will be more safe. After a few day you can raise again.
With Charlie being difficult to test, the most important tests will be the two preshots and then a +4, those are the ones you have to focus on. With him reacting so much to the caninsulin, never shoot insulin without testing.
Hope Charlie is doing better.

 

Re: Charlie - Need Help with Hypo

Hi,
So glad you have a spreadsheet.

I was looking at it and can see the pattern.
I would suggest you lower your next dose because Charlie's body will still be reacting. I would say .75.
Any time you have to skip a dose , your numbers will go up and it takes a couple of cycles to get back to where you would still be IF you hadn't skipped.
Especially since we aren't keeping food down. Food is important with that insulin.

The numbers before you skipped were already reflecting the dosage needed to be adjusted downward just a bit. ( With a few more random bg tests, that would have
shown up )

Will Charlie eat chicken or turkey? Those are more suited to cats.
I haven't seen any cats chasing cows for dinner? :lol:

I'll have to go find the link that says to try to limit beef and fish products . It may have been on www.catinfo.org
And beef doesn't help with pancreatitis. ( I'll find that one too)

So glad you made it thru. I noticed last night that no one was up, including me. I showed up for 5 minutes for a late night nadir.

 

Re: Charlie - Need Help with Hypo

I would agree with Sue above that it would be great to get Charlie on a longer acting insulin. From what I am reading, Caninsulin only lasts about 8 hours in cats and is a lot more difficult to manage (related to the timing of food and onset); so in essence your cat is going untreated for at least 8 hours every day (4 per cycle) -- if I am understanding this correctly. I also agree that you could, perhaps, have two vets - the holistic vet for helping you get a different insulin (she could be your diabetes specialist) while maintaining another vet for emergencies etc. The holistic vet may already have established relationships with other vets in Amsterdam. Don't know, but it is probably worth investigating. Once Charlie is on a better insulin, there should not be a need for as frequent vet visits in any case.

Seems so strange to me that none of the more effective insulins for cats are available in the Netherlands. There are medical studies to support their effectiveness and many thousands of people are using them, more safely than the Caninsulin and more effectively. Why do you think these insulins are not generally accepted there?

I also think Charlotte is probably right about using a much lower dose of the Caninsulin, until you can make sure Charlie is not going to throw up his food; because the Caninsulin onset appears to be quick and dramatic (unlike Lantus) -- and if there is no food balancing against the insulin when it hits, you are going to get a very low drop like you did this morning (at least that is my non-expert analysis...LOL!!). The holistic vet (if you consult with her) may be able to give you some tips on food that a more traditional vet may not know. So many of the traditional vets don't know much about feline nutrition, and prescribe "Hill" prescription food or other similar foods as though they have magic ingredients to help diabetics. Holistic vets typically know better and may have different suggestions for treating the whole pet.

Good luck!!!!!!!! PS: I am an analyst and researcher by profession so am used to finding obscure information online. I hope it is helpful to you and Charlie!!!!

PSS: You might want to remove the "911" icon from your post as the emergency is now past (I believe??). You can always put it up again if you need to.

 

Our Vet & Insulin Types

To be real honest, I've already been thinking about switching vets. Couple of reasons for that:

1. Charly had two teeth pulled about 6 months ago (they suspected an infection). Still, they would not prescribe an antibiotic after the surgery.

In general, the Dutch approach is the exact opposite of that in the US. In the US, doctors tend to overprescribe antibiotics (I think due to potential lawsuits). There are studies that show many of the superviruses exist because of this. So on the flip side, in Europe, they tend to take the opposite approach (allowing the body to heal itself first and only giving antibiotics in extreme cases). There's obviously a more balanced approach to both, and that's the middle ground we were looking for with Charly's teeth getting pulled. Still. Our vet would not consider giving an antibiotic. As it was the first time we were challenging something with her, we decided to trust her judgment.

I do not want to blame the vet now, but some of the things I have read about pancreatitis say that there are links with that and dental infections. I don't know.

2. My vet is quite young and seems to be inexperienced with diabetes. She is open to my input and is patient with me asking lots of questions in a language that is not her own, so that has been good. However, she has made some poor decisions in my opinion (raising the insulin to 2.5 ... also encouraging us to bring it back up to 2.5 after another, emergency room vet told us to bring it down to 2... etc). When my vet told us to bring it back up to 2.5, I told her NO. I insisted, gave her rationale for this, and eventually, she let it go (until next blood test, when she essentially said she would "prove to me" that I was wrong). At next blood test, Charly came out at 4 (right in the perfect range), so the vet let me stick with a 2 unit dosage.

3. My vet seems to be deathly afraid of our cat, and this rubs off on all her assistants except 1. I found Charlie 12 years ago and at the time she was a near-feral cat. It has taken her a LOT of time to trust people. She really is a big sweetheart and is wonderfully friendly with us, but there is hardly a single friend that Charlie will warm up to. So you can imagine how she is with going to the vet. She now associates the place with blood tests, rough treatment, etc. There are literally 3 people who have to hold Charlie's head, feet, and body down for my vet to give a blood test, and Charlie tends to scream like a lion. I realize she will have this reaction with most vets, but it was eye opening when we took her to the emergency vet and a new person started fresh with her. That vet was firm but not afraid.

4. In discussing caninsulin with my vet, she basically told me that the most important, serious university of veterinary medicine in the Netherlands still keeps caninsulin as their recommended insulin to prescribe. Thus, she says that all vets in this country use it. She even told me there is no other option that she prescribes or has experience with. When I mentioned some of the ones I read about on this board, she told me that some of those aren't even available in this country (or may have other names). So for the time being, as I had purchased 4 bottles of caninsulin and wanted to give this whole thing a chance, I have been sticking with it.

Most vets are closed here on Saturdays and Sundays, but I already sent an email to the vet noted above just to see if it's possible to come in and talk to her on Thursday.

This Tuesday we have another appointment with our own vet, so we will also plan to discuss a few things with her while we're there:
- We will ask for a urinalysis to test ketones (still can't find ketone strips here yet)
- We will test our home blood glucometer against the one she has to see if it's working properly
- We will inquire about another type of insulin and tell her we plan to make an appointment with a specialist

As we have already spent over 1000 Euros at the vet ($1200), I want to be cautious about too many expensive vet visits. Still, as I don't have pet insurance and am paying cash anyway, I think it's better to work with a specialist rather than a generalist. I will tell my vet this to see if she will agree to share all charlie's records with the other vet and stay on as a generalist for more emergency situations. Let's see how it goes.

We're about to do our evening test now. Based on the figures, we will likely give between .5 to .75 units. I will come back to you guys to get a final reco on that and make the call.

I cannot thank all of you enough for being there for us through this. The warmth, advice, helpfulness, and all around welcoming has made this time a bit easier on us. We thank you from the bottom of our hearts, and Charlie is better off because of your help and overall responsiveness. Seriously. Thanks a billion. ;-)

 

Re: Charlie - Need Help with Hypo

Next time you talk to her, mention "glargine" and "detemir" (rather than Lantus and Levemir) and they might ring a bell.

Carl

 

Re: Charlie - Need Help with Hypo

Evening pre-test before her 7pm shot came out at: 12.3

What do we do guys?

.5 units?
.75 units?
nothing?

:?

 

Re: Charlie - Need Help with Hypo

0.5 if you ask me. After a hypo a lot of cats are a bit sensitive to insulin, and since it is a low preshot as well i would not give anymore.

 

Re: Charlie - Need Help with Hypo

That's what I was thinking as well.

I just refer to the post above that indicated this board does not recommend shooting if results are around the 12 point mark.

With that in mind, is .5 OK if she will not eat very much?

She has been eating small amounts in the day but is not seeming very hungry.

 

Re: Charlie - Need Help with Hypo

.5

better to be safe than sorry.

 

Re: Charlie - Need Help with Hypo

It should be ok, but see if you can encourage her to eat, maybe try some tuna if she is not too hungry. Have you tried to feed her Felix as good as it seems or twice as nice. It is really low in carbs and none of my cats are having any problems with it.

 

Re: Charlie - Need Help with Hypo

We haven't found those 2 felix types yet. She is eating a little bit more. We will try giving her something else like you say and keep watching her real closely.

 

Re: Charlie - Need Help with Hypo

You can get them on www.zooplus.com they send to all over europe for free if you buy for more than 60 euro.

 

Re: Charlie - Need Help with Hypo

The link to felix http://www.zooplus.com/shop/cats/canned ... hes/190879

 

Re: Our Vet & Insulin Types

Speaking from my experience, I have found that finding a vet knowledgeable in feline diabetes has been a lot less expensive than dealing with my first, less experienced vet. My first vet did not encourage me to home test, and wanted me to bring Ninja into his office for weekly curves to get her regulated. The first thing he told me was that treating diabetic cats was expensive; and he was right-- with him it was. After I found a new vet, my costs went down dramatically. In fact, I have taken Ninja to see the new vet only once for an initial exam. My new vet used the records from my old vet (so we didn't have to re-do the blood work). And now I just let the new vet know what numbers Ninja is running and she helps me with dosage adjustments by phone. She does not charge me for this. My total expense thus far with the new vet is one $59 office visit.

I can't say the same will be true of you if you switch vets; but it stands to reason that a specialist who is an expert in feline diabetes should (hopefully) be able to coordinate treatment for you that will result in fewer emergency vet visits which should save you money in the long run. As a PS: if you do consult with the new vet and get prescribed Lantus, don't be shocked by the sticker price. It runs $120 a vial here in the US and presumably there would cost more -- but it should last up to 6 months if stored in the refrigerator. Just throwing that in.

 

Re: Charlie - Need Help with Hypo

Test

 

Re: Charlie - Need Help with Hypo

i see numbers ...
and pictures



it works....!

 

Re: Charlie - Need Help with Hypo

Charlie is GORGEOUS!!!!!!!!!! PS: Your spreadsheet shows how difficult working with Caninsulin can be -- on 7/15 Charlie went from a preshot of 428 down to a 54 within 3 hours. Same with today...from 436 preshot to a 38 within 4 hours. How can anyone reasonably manage that kind of drop? A lot of us (using other insulins like Lantus) don't even test till +5 or +6, and by that time (if using Caninsulin) the cat would be in severe hypo or worse. With Lantus it has a gradual onset so you can better see trouble coming. This 300-400 point drop on Caninsulin within a 3-4 hour period -- I do not see how people manage that without hovering over their cat and testing every hour, indefinitely. Just commenting.

 

Re: Charlie - Need Help with Hypo

Rhannon and Shadow: thanks for the feedback! Just wanted to make sure that the link I posted takes you to the version of the spreadsheet that can only be edited by me. Please let me know if you can edit also... If you can I need to change a few settings...

 

Re: Charlie - Need Help with Hypo

I can't edit the ss, so it looks like the right one.
Beautiful pics, especially the last one!
Carl

 

Re: Charlie - Help - 2 days of diarrhea & vomiting. Scared.

Hi guys. Starting to really worry now. I woke up at 5am to the sound of more throwing up. Liter box is full of diarrhea. I'm really worried for my sweet girl who has been sick for 2 days straight. nailbite_smile

:YMSIGH:

 

Re: Charlie - Help - 2 days of diarrhea & vomiting. Scared.

This is very worrying. I think I would take her to the vet and get her checked. A diabetic kitty can fail fast when she doesn't eat and has diarrhea.

 

Re: Charlie - Help - 2 days of diarrhea & vomiting. Scared.

Is there anything Charlie will eat -- say, the food she ate prior to her diagnosis? Even if it is dry food, I am thinking that it may be better for her to eat something than nothing at all (for days). When Ninja wasn't eating, my vet advised me to, "let her eat whatever she will eat" and we will worry about the rest later. Would the experts agree?

 

Re: Charlie - Help - 2 days of diarrhea & vomiting. Scared.

I looked back to your earlier posts on page 1, and it looks like Charlie has a history of vomiting after you give the Caninsulin. Is that correct? Maybe her system just can't tolerate this type of insulin. Is it possible she is allergic to it (or otherwise cannot tolerate that type?). Experts, would it make sense to discontinue the insulin for today, until she can get Charlie checked, and just feed her anything she will eat for now? She is only giving .5 of insulin anyway. What does everyone think?

 

Re: Charlie - Help - 2 days of diarrhea & vomiting. Scared.

For sure we will give no more insulin this morning at the normal 7am slot. We just called the emergency vet and they can see us at 9am. It is 5:40am now. In the meantime, we will try to give her more food and water and monitor her. Should I do another blod test now? Or is that just distirbing an already very uncomfortable little sweet kitty? :cry:

We Are both really sad over here seeing her like this.

 

Re: Charlie - Help - 2 days of diarrhea & vomiting. Scared.

When was the last time you tested her? Probably wouldn't hurt to have a current BG reading. I'm guessing the Caninsulin would have worn off by now, from last night - so Charlies BG may be high. But until you can see the emergency vet in a few hours, you might want to hold off on the insulin. Seems from reading your posts, that you give the Caninsulin and then Charlie often vomits afterwards -- a dangerous combination. But you also changed her food around the same time, so it could be the new food causing this -- or a combination of both. Keeping her hydrated would be important at this point (due to the diarrhea). And, just me (and I am no expert), I would let her eat whatever she wants today (whatever she will eat). Experts, what do you think????

I wish you had had a chance to consult with the new holistic vet before this happened, as I really feel that could be the answer -- different food and different insulin that Charlie's system can tolerate better. If Charlie's BG numbers are not running dangerously high (after your vet check today), you might want to hold off on the Caninsulin for a couple of days until you can consult with the other vet (who can prescribe other types of insulin). It's a hard decision though and one only you can make. See what the emergency vet thinks. Experts please chime in.

 

Re: Charlie - Help - 2 days of diarrhea & vomiting. Scared.

If you are not going to give any insulin this morning, then maybe just one test so you'll know what her number is, then let her ears have a break until you find out what the vet thinks.

It could be a reaction to the insulin, it could be to the food, it could be all sorts of things, and seeing the vet is your best course of action. Not eating for any length of time, and diarrhea that goes on for days are both bad things. She could also be dehydrated from the diarrhea. Hopefully it's just some sort of digestive tract infection or maybe an issue with a parasite - something that can be treated with an antibiotic or other medication.

Please let us know when you find something out,
Carl

 

Re: Charlie - Help - 2 days of diarrhea & vomiting. Scared.

I am so glad you can get her into the vet. It's so hard to figure out what might be happening. Maybe it could be a bad reaction to some of the food or maybe a pancreatits flare up. It should be okay if she will eat a little - maybe off your finger. If you got a test before you go, you could compare it to the test at the vet.

I hope they can figure out what is wrong, hopefully it will be something easy to fix. We'll be thinking about you and Charlie.

 

Re: Charlie - Help - 2 days of diarrhea & vomiting. Scared.

Did Charlie have a history of vomiting before she started the Caninsulin? Did she have a history of vomiting when you changed her food in the past?

 

Re: Charlie - Help - 2 days of diarrhea & vomiting. Scared.

How is Charlie??? I could not access this site all last night and it just came back up.

 

Re: Charlie - Help - 2 days of diarrhea & vomiting. Scared.

Hi guys,

Thank God the board is back up and running again. This has been a really rough day for all of us and we are hoping to get a good night sleep soon.

In the notes on Charlie's spreadsheet you can see some comments about what happened today. In general, however, it hasn't improved so much. She now looks like a completely drunk kitty (dilated pupils, has been hiding behind the couch all night, etc). The ER vet gave her a shot to help with the pain and a shot to help stop the vomiting. She did not give us anything against the diarrhea though, and that Charlie still has so that part is still a bit concerning.

Since we were at the vet between 9-11, we only gave her first shot of the day at 11 after getting discussing it with the vet. That one was .5 units. We tested Charly at 10pm (1 hour earlier than her planned 11PM shot) and it came out at 14.2 (256 in US terms). She has not been eating a lot, but the vet told us to force feed her some hills prescription wet food this morning, and also at 6pm when we gave her a pain pill. We did so and worked it out, but it made me sad for that kitty as I felt like she really didn't want to be held in the kitty burrito towel and given food when her tummy likely hurt. She also ate a bit of the perle fish (1/2 bag?) on her own initiative a few hours ago. For a moment there, I thought it looked like a good sign, but then she returned back behind the couch and at last blood test, she seemed very out of it.

We will try to get her to eat a bit more soon but I'm not sure it will be so easy. The pupils of her eyes look extremely dilated and a bit white-ish (like cataracts). I hope she doesn't have that coming on! In general, she seems either in pain, or else spaced out from the medication.

Do you think we should give .5 if we can get her to eat? On the one hand, that sounds theoretically reasonable, but if you look at her numbers from today in the spreadsheet, I'm a tiny bit worried that it may still be too much.

Thoughts?

To answer your question, I do not see a link with the caninsulin specifically and the vomiting. That may not be the best type of insulin to give her, but if you look at her chart you can see that the times she vomited it was either:
A. Linked to increasing the insulin too high to 2.5
B. On a day when she ate veal (this could be just a theory but who knows)?
C. Likely tied to another variable (just a thought, as it happened randomly rather than at every interval of using caninsulin).

She also had 2 very good days (only 2 in a period of 1 month, but still). Let's hope for brighter pastures ahead. nailbite_smile

 

Re: Charlie - Help - 2 days of diarrhea & vomiting. Scared.

This is really out of my league, as I am relatively new myself, so I hope others pop in here soon with suggestions -- and please take what I am saying with a grain of salt: It just seems to me that, for 30 days, the traditional vets keep giving Charlie more and more "medication" ... from pain killers, to anti vomit shots, to the Caninsulin, and Hill's "prescription" food -- and she seems to be getting worse not better and now appears to be in pain and is hiding behind the couch.

With a preshot BG of 256, which is high, but not in a critical zone -- if it were my cat (and again, I am NOT expert here), I think I would just discontinue the Caninsulin for a day (keeping an eye on her BG levels) and let all the artificial medicines get out of her system. I would also consult immediately (first thing Monday morning) with the holistic vet and see about getting Charlie switched to a different insulin. If you tell them it is an emergency, perhaps they will work you into the schedule right away.

Looking at this realistically...If what the traditional vets have been suggesting was working for Charlie, I'd say keep following their advice and keep trying it their way -- but Charlie is not improving -- and at some point, you will have to try a different direction; and I would try the holistic vet (for a second opinion) who might be able to direct you to an insulin different than Caninsulin that Charlie could try.

I would also discontinue the Hill's prescription food (there is nothing magical about the ingredients in it) and see if Charlie will eat whatever food he has traditionally been comfortable with (prior to this month). Sometimes you have to GRADUALLY introduce new foods -- or it causes gastrointestinal upset (vomiting and tummy issues)... so if you introduced the new food this month, maybe Charlie is having a reaction to that as well.

I feel SOOOO BAD for you and Charlie and wish I could help more. I was devastated that the site went down last night -- but was sending you prayers for a positive outcome. Experts...please chime in. What approach might you take if this were your kitty??

For Charliesmom: My question about the history of vomiting..I meant, "Did Charlie vomit frequently prior to this last month (before he began treatment or had a food change)?

 

Re: Charlie - Help - 2 days of diarrhea & vomiting. Scared.

I think you're completely right. I don't know exactly if it's the right thing to do right now, but as there is so much in her little body at the moment, we have decided NOT to give her any shots for tonight. This is my thinking at the moment:

This morning the test came out at 26.3 at 9:30am. We gave .5 units at 11am, and within just a few hours there was something like a 19 point drop with just the .5 units. If we give .5 now and there's a 19 point drop again, she'll could have a hypo because she only has a total of 14.5 points to go down from.

It's possible we could try to give her .25 units, but trying to measure that out on the syringe would be seriously tricky, and not worth the risk.

I agree that our vet is not working for us. That part is CRYSTAL clear. I already emailed the holistic vet yesterday (no reply yet but it's the weekend so I will try to call her tomorrow morning). We already have an appointment set up at our own vet for Tuesday at 11 as a backup plan. If the holistic vet is not available IN AMSTERDAM until Thursday, maybe we will try to get in with our own vet for Monday (instead of Tuesday) and then switch to the other vet as of Thursday? I need to think this over.

Today's bill was 270 euros. Ouch. If Charlie were feeling any better, I'd say it was all worth it, but I worry a bit that there is something more going on in her system (or that the pancreatitis is starting to make this more complex than we are able to manage. We'll have a good night sleep and take it step by step in the morning. Thanks for thinking of us and also for your prayers.

For the record: Charlie never vomited a day in her life before this last month so your theory may have some weight (or the pancreatitis flare up is causing it). Either way, bad news. :roll:

Thanks very much, and thank you also to Charlotte & Prop (who have been there for us today through their personal email address when this site crashed). No man is an island. Thanks to them for being there.

 

Re: Charlie - Help - 2 days of diarrhea & vomiting. Scared.

I agree. Personally, I would just let Charlie rest and not shoot any more Caninsulin for a day or so. Her numbers are in the 200's pre-shot which is not scary-high (so not much damage is likely being done to her in that short time); and the current method of treating her appears to be doing more harm than good - and costing you a lot of money. Did you provide the link to Charlie's spreadsheet when you emailed the holistic vet's office for an appointment? If not, you might want to include that. The vet may be able to look at the spreadsheet on Monday and, based on Charlie's numbers, advise if it is ok to discontinue the Caninsulin until she can see you on Thursday (so, provide guidance by phone). Make sure you tell them it is an emergency and that you have been to see the emergency vet over the weekend (sometimes if they know it is an emergency, they will bump you ahead of others).

If Charlie never vomited prior to this month, then logic would tell you that it is either the Caninsulin or the new food -- or a combination of both that are the likely culprits. If you read on the Caninsulin literature, it says that "in rare cases, allergic reactions to porcine insulin have been reported" and that this reaction can involve vomiting and loss of appetite. Not to say that this is true of Charlie, but it is a possibility. Maybe one you can explore with the new vet.

Lots of us out here pulling for Charlie!!!!!

 

Re: Charlie - Help - 2 days of diarrhea & vomiting. Scared.

I like Melanie's plan. She isn't super high and it seems safe to stop the insulin for a while. The important thing is to get her feeling better, eating and without diarrhea. Give her food she ate before, in small frequent amounts and see if the vomiting and diarrhea improves.

I am thinking she may have a sensitive system and the harsh drops the Canninsulin causes make her feel really crummy. Perhaps the vet can prescribe a probiotic to help her digestive issues.

 

Re: Charlie - Help - 2 days of diarrhea & vomiting. Scared.

Quick status update:

Charlie's numbers were high at pre-test this morning 22.4 (403 in US Measures) so we decided it was best to give .5 units (to keep the blood sugar in more balance) until we can find a new plan of attack. She ate a little bit during the night while we were sleeping, and we were able to force feed her a bit more of the specialist cat food from the ER vet. With this, we were able to give her a tramedol pill against the pain to hold her over for the time being.

Two positive developments:
- We are going to our normal vet now (without charlie) just to get some anti-diarrhea tablets. While we are there, I think I will also show them Charlie's chart (just as a last stitch effort to see if they have any thoughts). If not, fine. I have a backup plan. I will ask them if they can share with me copies of all her blood test full reports. Not sure they have them or will share but they should if they are professional. Then I can bring these as well to the new vet.

- I was able to get in for a 4:30pm appointment with the diabetes specialist at that holistic health center (seriously Melanie, thank you for that tip off!) I have already sent her the chart to take a look at and I hope she will have some ideas when I get there.

Charly is still hiding behind the couch. She still has diarrhea. Hopefully we can get that part under control today at minimum. I took the day off work and I will do what I can to get her feeling better.

 

Re: Charlie - Help - 2 days of diarrhea & vomiting. Scared.

That is great that you were able to get an appointment today with the diabetes specialist! Make sure you take all of Charlie's medications with you, and maybe even a list of the food you have been feeding, so the new vet is aware of what has been in Charlie's system recently. Please post again after your vet visit with an update on how Charlie is doing. Thoughts and prayers are with you today from all of us.

Melanie