Chloe2

This chorus of online "voices" is expressing the very high level of concern for we have for Chloe. We're not trying to mess with you, antagonize you, confuse you or set you against your vet. Please think about what we're saying.

Unless you know with 100% certainty that those recent lime green numbers are flukes or errors, they're the reason we're saying 1 unit is too high a dose. Too much insulin will last longer than it should and will push BG down lower than is good for the cat. Instead of having a nadir at +5 to +7 it can happen at +8 or later. It can keep the BG suppressed longer so it's not rising by PMPS the way it should be. That's why you came home at the end of the day, did a test and found her down to 30 one day and 43 another. Add to that Chloe not eating all day - which can cause a further lowering of BG - and you have a potentially very dangerous situation.

It's the weekend so one way you can shed some light on this is to decide on your own to do a curve, even a less intensive one where you test AM/PM pre shot as well as +3, +6 and +9. Try this at a dose of 1 u if you wish. You might even have time to get a few before evening shot tests tonight to fill in some gaps from today.

 

I don't understand you. She became hypoglycemic when her dose had been increased to 1.25 u. Her numbers were great on 1 u.

 

I am going by your advice that if she is under 200 no shot. The vet didn't say anything different.

 

I'm going to test for PM in a few minutes, although she had dinner about an hour ago. Based on the test, I will decide whether to give her insulin with your advice.

 

Actually, those lime green numbers were dangerously low. And you had another one with a 1 u dose. You can have almost a full curve with nice numbers and then get a single lime green. You'd want to retest to be sure it's a valid number. If it is, that's the number you have to pay attention to when evaluating the dose. It trumps all the others. If that dose is able to cause a big drop into very low numbers then it's too high for that point in time. Safety is the number one priority when giving insulin.

 

405. She's getting 1 u in a couple minutes unless you think it will kill her. btw, the vet didn't like those low numbers either and agreed that I should have taken her to the ER. But the lime green (from yesterday) was probably a fluke because an hour later she was in the 200's.

 

You can give 1 u on that red number. It's likely a bounce from being lower earlier today. You can't be certain yesterday's lime green was a fluke because their BG can rebound from a low to a much higher number very, very quickly. Having a run of low numbers can leave them extra sensitive to insulin for a few cycles afterward. This can show as exaggerated and erratic responses to insulin. There's a lot to pay attention to when you're using insulin. It's a very powerful hormone and affects many physiological processes.

 

Unless I'm filling out the spreadsheet wrong, the AM doses I gave those days was 1.25. btw, the vet said, and I agree, that the intervals are way too small on the syringe to measure quarter units.

 

1 u will probably be ok although the number is elevated because she ate recently. In the future pick up the food at least two hours prior to preshot testing so the numbers are not food influenced. If you are unsure you could do a "skinny" 1 which would be just under the line.

 

So you're saying that it can go from 326 in the am to 43 in 12 hours, and then from 43 to 284 in the space of only ONE hour? I also don't understand why you all think 1 unit is too big a dose when you were giving 2-3 units to your cat before she went into remission.

 

Yes, that is correct.

 

Yes, it can. Have a look at my cat's SS on March 05/17 PM and Apr 03/17 AM to see a couple of examples that are almost as extreme. It's actually a good idea to look at other spreadsheets occasionally to get an idea of how different cats respond to different insulins at different doses.

 

So would mine, if I had listened to the first vet who treated him.

The problem with vets is that they get very little training in vet school about Feline Diabetes. They get more training about Canine Diabetes and then apply that knowledge to treat cats. You can't do that - dogs and cats have completely different metabolisms and cannot be treated the same when it comes to diabetes.

For what it's worth, vets also get practically no training in feline nutrition, either. If they did, they would know that cats are obligate carnivores, and understand what that means. If that were true, they would NEVER recommend dry food. That's science and common sense.

The reason the folks on here know so much about FD is because, contrary to our vets, we spend 24/7 dealing with it! We eat-sleep-breathe-LIVE it day after day.

If your cat has had anything to eat two hours or more before a test, that test will be food-influenced. You cannot make good - safe - dosing decisions based on a food-influenced blood glucose.

Everybody's cat is different, and handles the insulin differently. This just goes to highlight what we are saying about insulin being a powerful hormone, rather than just a pat and patented medicine that can be dosed the same by everyone!

 

The doses that different cats need varies widely from fractions of a unit to 15 or 20 units or more in cats with certain medical conditions. There's also little correlation between the size of the cat and the insulin needs.

 

For some cats 1 unit might make very little difference... For others it plummets the numbers. Your cat seems to be very reactive.

 

Every cat needs a different dose. It's ALL pet specific.
If you look at my spreadsheet you will see on 4/11/17 AM CYCLE Chuck jumped from 168 @+5 to 475 @+7. One hour and he jumped over 300 points with insulin on board. It is possible to increase that much that fast. It's even more common when you're at the end of the 12 hour cycle.
On 3/25/17 pm cycle he jumped from 319 to 537@+2 after his dinner and shot. Food can bring them up quick too.

 

I tried to give her the shot while she was eating, but she moved and the needle was bent all the way back, so I don't know how much she got although the syringe was empty. I then gave her a skinny 1 u because her number was so high. I'll check her later.

 

So you gave her two shots this morning?

 

Please check +2 and +4 at least. Leave food out too. You could have overdosed her.

 

Even if you don't know how much got in her that first time, it could have been the full amount. Please keep a very close eye on her numbers today.

 

You may want to contact your vet to ask what you should do if that happens in the future and what you should do about it today.

 

@srk3cats This is what we call a "fur shot", for obvious reasons. For future reference, we recommend you never give any more insulin after a potential fur shot, because there is really no way to know how much insulin kitty actually did get. Better to be high for a day than too low for a moment; those low numbers can quickly become fatal. You will need to monitor Chloe pretty closely today, in case she got an overdose.

 

Thanks for the advice, but I had to go out all morning and I only gave her a half-dose. Her number had gone down when I returned, but still too high. As you said: better too high than too low.

Please do not use the word 'overdose' or say that I'm going to kill her. It makes me want to leave this group.

 

I don't think anyone meant to imply that you are going to kill Chloe. Overdosing can happen to any of us - and has, to many! It's just what happens when a dose is, or has become, too high. It doesn't imply any judgement. I hope you won't leave the group; you have several people here who have been consistently answering your questions and trying to help, when needed.

 

Just got home from the library and shopping. Chloe was sitting up in bed. Chico had been outside all these hours because he ran out when I opened the door. He was eager to get inside, even though I have NOT turned on the AC yet. When the weather gets hot like this, I get cranky. Sorry, I love Chloe.

 

I only use the word overdose to explain the dose being too much. It's not used in a negative way. Certainly not used to imply you've done something to intentionally hurt her. (sorry it came off that way) I have done it myself and probably will do it again- unintentionally. It's one of the big pain in the butts of feline diabetes. Their need for insulin can change without much warning and a once safe and normal dose becomes too much. The best way to try to prevent this is to get some mid cycle tests in when you can. From all my testing I could tell by +2 about how low (usually how high) he was going to get. He didn't do the best on prozinc and my SS proves it.
We are all here only to help you (and the other members) become the best you can with treating her diabetes. There's a lot of experienced "crazy cat people" here and have Chloe's best interest at heart as I'm sure you do every day! I hope she reaches remission! That's the dream for us all here. Healthy cats in remission..
I don't think I've seen a post from anyone (yet) that was really meant to be nasty or rude. I've read some that I was initially put off by but with further explanation I realized it was not meant to come off that way.
We all try our best to be polite and considerate while giving advice, instructions, or asking questions. I hope you do stick around because I believe this is one of the best places to get great information on feline diabetes and the people are very caring.

 

How come when I ask vets, they haven't heard of this forum? Sometimes you give me contradictory information such as free feeding. Vet says 'no', people here say 'yes'.

 

My vet told me not to do so many blood glucose tests (her ear is getting pretty ragged) and to stick with the 1 unit dose until we do a thorough curve in a couple weeks. I've decided just to do a daily PM reading about 8 PM.

 

We actually have some members of the forum who are vets, so it's not unknown to all vets, lol. Free feeding can be a problem if kitty is prone to weight gain. However lots of diabetic kitties do better eating several small meals throughout the day, rather than one or two larger ones. Here is a link to a wonderful article, written by a vet, on feline nutrition and feeding. Check it out, it's well worth the read! www.catinfo.org

Some vets do seem to feel that testing is unnecessary, or should be very limited. I do not understand this attitude; your pet is very much like a child, dependent on it's caregiver for it's safety and well-being. I certainly would not give insulin to my child without checking to make sure it is safe to do so, and checking periodically to make sure it remains safe throughout the cycle! The number of times you test is, ultimately, up to you; not us, not the vet, just you and what you feel is necessary for you to keep Chloe safe.

 

My vet hadn't heard of the forum when Sam was first diagnosed in 2015, but after Sam went into remission, and I told my vet about it, he started reading here to learn more about how to manage feline diabetes. It's changed the way he approaches treatment for diabetic cats.

 

The vet who wrote the catinfo article is the same vet who wrote the survey of cat foods attached to this forum. I would like to know more about her. Is there a feline medical journal like the AMA? About the frequency of testing: I've decided to keep the dose at 1 unit and test just once a day at 8 pm. She still cries out when I poke her ear and when I give the insulin shot. If I notice any strange behavior, like last night, I will also test immediately. I will free feed her the dry hypoglycemic food during the day until it is all gone. I won't buy it anymore. These are the decisions I have made taking into consideration both my vet and your advice. This is causing me a lot of stress in addition to my job, and although this sounds selfish, I don't want Chloe to pick up on this stress.

 

I found this: http://journals.sagepub.com/doi/figure/10.1177/1098612X15571880? I can understand about 80% of it, but it's a good, scientific study. I noticed that the unit adjustments are in increments of .5 units. Also, one figure shows how much higher the numbers are when you do a home curve vs. a clinic curve. Those are just the tables, the full text is at http://journals.sagepub.com/doi/full/10.1177/1098612X15571880.

 

From:
Discovering the reasons underlying difficult-to-control diabetes in cats: in the first of a two-part series, an internist reviews the insulin-related, client-related, and patient-related problems that can make a diabetes management regimen ineffective. Here is a step-by-step approach to identifying and addressing problems that underlie cases of poor diabetic regulation in cats
Audrey K. Cook
Veterinary Medicine 105.3 (Mar. 2010): p106.

"There are various ways to monitor diabetic cats. If patients are doing well (that is, they are maintaining optimal body weight with minimal polyuria and no signs of hypoglycemia), measuring serum fructosamine concentrations is an excellent monitoring tool. However, correctly identifying patient-related problems generally requires frequent blood glucose measurements. Serum fructosamine concentrations or urine glucose tests do not provide enough information to reliably identify problems and guide insulin therapy in problem diabetics. Measuring blood glucose concentrations in cats poses some challenges, as many feline patients experience substantial stress-related hyperglycemia. Consequently, blood glucose measurements made in a clink setting may be a poor reflection of glycemic events at home. In addition, many cats have substantial day-to-day variability in blood glucose measurement--in any environment. (1) As at-home monitoring facilitates the collection of more data points, a more reliable picture may be generated. It is for these reasons that many practitioners are now moving away from in-clinic glucose curves on cats.

Instead, clients are taught how to obtain samples from their cats at home. The modern handheld glucometers are easy to use, and many appear to be reliable. (2) They require only a tiny drop of blood, which can be collected with a lancet or needle from the ear or foot. In addition, studies have confirmed that capillary blood glucose readings are clinically comparable to results from venous sampling. (3)"

 

Considering the extremely low numbers you have had pre shot, I do hope you will reconsider and at least test Chloe before each shot so you don't shoot on a hypo number.

Good luck with your treatment plan!

 

Unfortunately most vets are like a general practice doctor. There are veterinary specialist but they tend to be expensive. One specialist hospital near me is Cornell University Animal Hospital. I read all their info after joining here to see what more they had to offer and to compare it to the info I found here.
I LOVE my vet. She's absolutely wonderful but she did say in our last visit that cats can NOT get Cushings disease. I know this to be FALSE. Cats can absolutely get cushings disease. But until that is an issue I won't worry about it. So it's best to "question" what your vet says and at least do some independent research like you have already started. The best tool you can have is to study and learn as much as possible on it and that will help reduce your stress level. I was a complete nut job when I first started dealing with feline diabetes and occasionally I still am!
In the end YOU are the one treating your cat. We can only help better understand the numbers you're getting when you test and make suggestions on your approach to treating her. These are all suggestions made with a level of experience that most vets don't have with day to day treatment.
I agree with Rachel that the two pre-shot tests are the most important. Like you've seen the on the pm cycles of 4/11 and 4/13 those tests showed you that she was far too low for a shot of insulin. Any insulin given that low would probably have killed her and you couldn't have known that without those tests.
I think you're going in the right direction by setting up a game plan. Make a daily routine of when to test, feed, then shoot. If you notice her acting strange or sleeping too much or not responding to stimuli it's a good idea to test. You don't HAVE to free feed. I don't. I give Chuck most of his meal then he gets about an ounce more split up into two snacks because he gets an upset stomach when he goes too long without eating. He will binge drink water then puke it back up. Usually does this on my table I swear it's payback.
To help her ears heal you can put some triple antibiotic ointment with pain relief on her ears. It works great on Chuck's.
I wish you and Chloe the best. Ask questions here if you want and we will try our best to help you find the answers you need.

 

I beg to differ. This is taken from the article you cited. This figure from that article shows the opposite.

 

It's proving that the stress of having it done at a clinic makes the numbers go much higher. Okay, I see that I didn't phrase it very well. Basically, it's much better to do at home.

 

That's correct. I misunderstood what you meant in the sentence I italicized and underlined. Because stress is less of a factor at home, the BG readings taken at home more truly reflect what the cat's body is doing under normal conditions. That's why we pay very close attention to low numbers.

 

Thank you for the tip about using antibiotic ointment. I was thinking of using olive or coconut oil in case she ingests it and it's poisonous to her.

 

Actually, I'll go back to 7am and 7 pm because I leave for work at 7:30 and I always forget something when I rush. But I will stick with the 1 unit dose unless she goes hypo. On Mondays and Wednesdays, I have a pottery class that doesn't end until 7:30 pm. Last time I went, I was so involved that I forgot to look at the clock and didn't get home until about 8pm. Last Wednesday, I missed it altogether because I took Chloe to the vet. I read somewhere that it's okay to be up to an hour late giving the insulin. Is that true?

 

Yes, ProZinc has some flexibility in timing of doses because it's what we call an "in and out" insulin - ie., the dose lasts about 12 hours and then it's gone so there's little to no overlap effect. A good rule of thumb is plus or minus an hour when life gets in the way. Day to day, though, the more consistency of timing the better.

 

I'm glad you'll be able to test before each shot!