FDM newbies

Hi there fellow diabetic cats and owners! I'm Melissa and my diabetic cat is Nay. We live with my hubby Chris and another cat named Lexi. We have an unusual situation because we are also "fulltimers" which means we live in a motorhome fulltime and travel constantly. We're not retired; Chris still works in IT from the motorhome. I find volunteer positions which give us free camping or we stay in free places. Here's Nay on the dashboard today:



We just got diagnosed as diabetic a little over a week ago and we started Lantus 1 unit daily on Wednesday May 5th. We will not have a relationship with a vet so we are feeling overwhelmed by all the stuff we have to learn and be competent at!

We have a Walgreens generic glucometer and we are doing BS tests. Nay does not seem to get stressed when we poke him so I think they are pretty accurate. I'm still trying to figure out when to test, and have not done a glucose curve yet -- do we need to do one with Lantus which apparently does not have a peak???
So far our sugars have been consistently in the 190's with one blip up to 230 on our glucometer. We read one place that we should add 30% because we are using a human glucometer? Are the suggested glucose ranges listed on FDMB considering human glucometer numbers or animal glucometers? Nay is still drinking lots of water so I don't think we are regulated. Thank goodness we are finding so much information on the internet!
confused_cat

 

hi there and welcome!

i think Joanna & Bix live in a travel trailer/motorhome too. how cool is that!

ok, here's some info for you.....to help you get started with some things.

first, you should test before every shot, to make sure it's safe to give insulin the first place. and then you should randomly get numbers thruout the day. you don't have to get them at the same time every day.

next, a way to keep track of those numbers. you can set up a spreadsheet via these instructions
viewtopic.php?f=6&t=16

at the very least, keep track of them in a notebook. it is easier to have them accessible online though when you are asking for help or dosing advice, etc.....so i'd encourage you to work on the spreadsheet as soon as you can

and as far as numbers go, as long as you use the same meter consistently, generally the numbers you get are accurate. there are a couple that start with "true" that are questionable as far as accuracy though based on what i've been reading in the last few months here.

next, your insulin.....lantus in a human is a 24 hour insulin but no insulin is a once a day insulin in a cat. it does happen once in awhile but that is usually when a cat is working towards remission. sooooooooooo, here's some info on lantus for you to read up on
viewtopic.php?f=9&t=151
viewtopic.php?f=9&t=150
viewtopic.php?f=9&t=147

 

welcome Melissa and Nay to FDMB! Love the picture of Nay on the dashboard. It is obvious that no motor home should be without one

We just got diagnosed as diabetic a little over a week ago and we started Lantus 1 unit daily on Wednesday May 5th. We will not have a relationship with a vet so we are feeling overwhelmed by all the stuff we have to learn and be competent at!


It is overwhelming to everyone in the beginning, but you will learn and see that you can treat your Nay effectively. You have come to the right place to learn. Please read the articles on this site if you haven't already.
You might start with : http://felinediabetes.com/dummies.htm
for specific lantus info you can click on the the lantus ISG (insulin study group) forum and check out the *stickies* at the top of the page.

We welcome questions !

One note on Lantus -- you are only shooting 1x a day? lantus is usually shot 2xs a day in cats. ( every 12 hours) the peak insulin action time is *usually* 6 hours. We have a saying around here -- ECID ( Every Cat Is Different )

I think it is great you are already home testing. *Most* human glucometers work very well for cats. No need to go out and pay big bucks for an animal meter sold by a vet. The strips for all meters are the expensive part and those, of course run $$$.
I am not sure about the Walgreen brand, I have always used a one touch ultra ( you can buy the strips on ebay for a big discount from the drugstores) Others use the Walmart Relion brand quite successfully and the strips are inexpensive and easy to get.

It's also a good idea to pick up some ketone test strips at the pharmacy. ( you can read about ketones in the link I gave you and why it is very important to test for them)

I'm still trying to figure out when to test, and have not done a glucose curve yet -- do we need to do one with Lantus which apparently does not have a peak???

always test before every shot
Lantus does have a peak. As mentioned above... the *usual* peak time is at +6. You have to get to know your cat and see how the insulin works w/ him. It could be earlier or later. ECID!
So to find that out, a good minicurve can be done by testing ( the + is the number of hours after a shot is given) at +2, +4, +6, +8 ,+10 you can set aside one day and do it or get those numbers w/ a couple cycles.
when you see the approx time of nadir or peak action, you can hone in on it a little more by focusing on testing more frequently @ that time for example checking +7 and +9 .
I always liked to test at Winnie's nadir almost every cycle along w/ the preshot (PS).
Lantus is dosed based on the nadir , not the preshot number. So that is one reason why it is important to test at that time. (and that, of course, is connected up with making sure your kitty is not going too low -- the most important thing to know) I also liked to get spot checks in most days.
Later on, as you learn and collect more data on Nay, you will find that some of the later and early numbers are also good to get know( you will read more about that on the lantus stickies)

most folks here now use a spreadsheet via google and link it to their signature to post their kitty's BG numbers. It makes it easier for other members to see what is going on w/ Nay.
If you look at other members' posts you will see the link. Click to see what it looks like and see how others are testing ( of course not everyone is on lantus) to get an idea.
Winnie's numbers are on an old profile-- so my link is to that and will show you numbers but not in the spreadsheet format.

So far our sugars have been consistently in the 190's with one blip up to 230 on our glucometer.

when you are getting those numbers..... After +12? ( can you post them w/ + hour format as described above? )
Most lantus users start low and then increase the dose as needed. 1u 2x a day ( BID) is a typical starting dose.
However, if your kitty is getting those numbers after +12 on a 1x a day (SID) shot, you might want to try starting at .5u BID a day. Please post back and let us know more about when you are getting the numbers you mentioned.

also wanted to ask -- what are you feeding Nay? diet plays an important roll in treating FD. More on that when we know what you are feeding him.

ok. deep breath . ( and don't forget to exhale :smile: )
you're going to do fine.

I look forward to seeing you post back.

 

Yes, we are shooting only once a day. That was the vet's recommendation; however I am starting to see many errors in the info the vet office gave us. They also told us not to worry about ketones and tried to insist that we HAD to have an animal glucometer - they refused to teach us to test sugars since we chose not to buy the Alpha Track. I'm pretty upset because lots of stuff the vet told us was incomplete or flat out wrong!!! :shock: Maybe that Dr didn't have much experience treating feline diabetes... please tell me whatever we are doing wrong so I can learn to do it right!

We were previously free feeding Purina Indoor dry. I tried a switch to canned food a couple months ago but that gave him diarrhea so we went back to dry food. When we were diagnosed the vet sold us Hills MD dry food and said to only give him 3/4 a cup a day, feeding 3-4 times daily. He is very hungry around 5 AM and waking me up with his pleading, should I give him more food?

I have added a chart of our blood sugar testing - as you can see we do not have a lot of data yet. We are giving his medicine once a day in the PM and we've been doing a pre-test every day except today when we did a check in the morning. We tried to do one more test for y'all tonight but it turns out we must have gotten a bad batch of strips because we got strip errors 3 times and then decided to stop torturing the cat. Oh, and the glucometer I have is a "True Test" so it may have accuracy issues. But I do have another one coming in the mail which was a gift from someone; once that comes in we will start working on getting values for a mini curve.

A couple more questions - we have been giving him his shot at 5 pm. But maybe I should give it to him earlier so I can watch him for problems when his shot takes effect? Can anyone point me to some generalized blood sugar values and what they mean? I know the beginners page says to shoot for 100-200. But what is extremely high? What is low? I wish there was a chart!



Thank you, Thank You, THANK YOU!!!!

 

Yes, we are shooting only once a day. That was the vet's recommendation <snip> Maybe that Dr didn't have much experience treating feline diabetes...


many vets do not know how to treat. or about meters or diet for a diabetic cat ( other than what the pet food company rep tells them) To be fair. vets much treat many different species for all kinds of things, and I personally don't expect them to be experts in everything. As long as you have a vet that will work with you, that's the important thing. The fact that this vet would not show you how to test unless you use an alpha track tells me that he is probably not the willing to work with type.... but you may be able to convince him
otherwise if you really like this person. It is a good sign that he knew about home testing and lantus.
many vets do not.

Question -- how did your vet dx your kitty with DM ? was Nay displaying any symptoms? ( drinking a lot of water / peeing a lot ? / weight loss? but eating a lot ? ) Did the vet do a fructosimine test? ( gives a 2 week average of BG numbers. ) what were the BG numbers when your cat was first dx last week at the vets. ( numbers are often higher at the vets due to stress)

Did you read the information about lantus? When you first start, it takes 5-7 days to fill the storage shed/insulin depot ( http://petdiabetes.wikia.com/wiki/Insulin_depot )
and then the insulin will start to kick in. you are just at the 5 day point. so the lantus has not kicked in yet.
and the shed is not going to be functioning correctly/ may take longer to fill b/c you are only shooting once a day.

it takes lantus about 4 hours to kick in. You want to make sure you test at +4 to see where your cat is when lantus kicks in. and at +6 to try and catch the peak action and +8 to see if the numbers are rising.
with the ps numbers you have catching an early test isn't a bad idea either. I like tests ! )

here is a sample of what a curve *should look like* taken from the sticky in lantus isg ( also very important info on using lantus at this link please read) :

viewtopic.php?f=9&t=157

Example of a typical curve:
+0 - PreShot number.
+1 - Usually higher than PreShot number because of the last shot wearing off. May see a food spike in this number.
+2 - Often similar to the PreShot number.
+3 - Lower than the PreShot number, onset has started.
+4 - Lower.
+5 - Lower.
+6 - Nadir/Peak (the lowest number of cycle).
+7 - Surf (hang around the nadir number).
+8 - Slight rise.
+9 - Slight rise.
+10 - Rising.
+11 - Rising (may dip around +10 or +11).
+12 - PreShot number.




I have added a chart of our blood sugar testing

great. thanks

We are giving his medicine once a day in the PM and we've been doing a pre-test every day except today when we did a check in the morning. <snip>


It's very important to test before every shot. A favorite saying on this board ( I believe credit goes to dr. lisa for coining this one) -- shooting insulin w/o testing is like driving w/ a paper bag over your head.
I know you are making a great effort. I just want to make sure you understand how important testing is.


A couple more questions - we have been giving him his shot at 5 pm. But maybe I should give it to him earlier so I can watch him for problems when his shot takes effect? Can anyone point me to some generalized blood sugar values and what they mean? I know the beginners page says to shoot for 100-200. But what is extremely high? What is low? I wish there was a chart!


You really need to shoot twice a day. The insulin will not work in the vast majority of cats on a once a day dosing sced. Pick a time when you can shoot 12/12 and stick with it. If you are going to shoot at 5pm then you must be prepared to shoot at 5am. It really doesn't matter what the time is as long as it is best for you.
If you want to be home for his nadir during the day..... maybe shoot so you can test during lunch.

the values on the beginners page were for given for older insulins. normal blood glucose values for a cat are
generally considered to be 60-120. although some cats not on insulin will test in the 50s. If you read the protocol on the lantus forum it will help you understand .
viewtopic.php?f=9&t=1581

also it is VERY important that you have a hypo tool box prepared. and to know the signs:
Melissa and Popcorn's How to Treat Hypos post:
viewtopic.php?f=14&t=1122
Jojo and Bunny's hypo toolbox post:
viewtopic.php?f=14&t=2354

that gives you your answer for low .
extremely high? I'm sure everyone might give a different answer. i would say extremely high 500 and up.
very high 400 + and so on.

We tried to do one more test for y'all tonight but it turns out we must have gotten a bad batch of strips because we got strip errors 3 times and then decided to stop torturing the cat. Oh, and the glucometer I have is a "True Test" so it may have accuracy issues. But I do have another one coming in the mail which was a gift from someone; once that comes in we will start working on getting values for a mini curve.


here is the link about issues with the true trak meter:
viewtopic.php?f=9&t=4068&p=39461&hilit=true+trak+meter#p39461

some folks have used them just fine. If that's what you have please keep testing. Don't wait for your new meter.( fantastic that a friend is sending you a different meter ) If you get a number that is quite different from what you have seen before retest to check it.

The numbers on your sheet are on the border for "shooting low" for newbies . Here is the "becoming data ready to shoot lower numbers " from the lantus group:

viewtopic.php?f=9&t=147

This is why, with the numbers you are showing and only starting lantus at 1x a day, I would, if I were in your situation, lower my beginning dose to .5 u or even .25 2x a day. and monitor closely.
you will have the shed properly working for you by shooting BID, and a reduced dose for the numbers you are showing. ( I started my cat at .25 and worked up. she also had lower ps .... ) I would say talk to your vet, but your vet does not understand that lantus is a 2 x a day insulin. you can always increase your dose. ( and lower --- That is why you need a hypo tool kit prepared !! ASAP )

We were previously free feeding Purina Indoor dry. I tried a switch to canned food a couple months ago but that gave him diarrhea so we went back to dry food. When we were diagnosed the vet sold us Hills MD dry food and said to only give him 3/4 a cup a day, feeding 3-4 times daily. He is very hungry around 5 AM and waking me up with his pleading, should I give him more food?


so you just changed food the same time you started insulin? Usually not a good idea to do both until you see how your cat is going to respond to the insulin. many cats can go OTJ ( off the juice/ into remission) by food change alone. usually, a low carb canned works the best. Going to a lower carb dry will also lower numbers.
Your cat may be hungry because his numbers are going low. I would let him eat what he wants for now. (and as a check you can test him when he asks for more food )
and no more food changes for now.

What do you think ?

Read the information. Consult with another vet if you like.
and have other members weigh in with their experiences.
and get your tool box together

gosh. sorry for the book :razz: I hope it isn't too much at once. tried to cover your questions.
don't forget to breathe and keep asking questions
Best,

 

Welcome! You've gotten some great advice so far. I just wanted to mention this link: http://www.catvets.com/findadoctor/findadoctor.aspx to help you find a feline-savvy vet, wherever you are. You can also ask members here to PM you their vet recommendations so you have a list of go-to vets across the country. Though you can do a lot of the management at home, you'll need a vet partner at some points.

Again, welcome, and keep posting! People are awake at all hours here, it's an international board, so someone will likely be available to give you a hand whenever you need.

 

Hi Melissa and Nay
Welcome to the board.
I just love that picture, what an exciting life to travel.

Well, you have gotten amazing info before and look at the ss up and running already.
I could not agree more than what has been said.
Testing before a shot is essential making sure that it is safe to "shoot" the insulin
and Lantus for cats is BID, 12 hours apart.
Now every cat is different (ECID) so the "peak" is not always at +6. These are guidelines.
The more testing that is done, the more data you have.

Dry food is definiately not the way to go in treating diabetes. Low carb high protein but I would be concerned of having diet change and shotting the insulin, without getting enough tests.
Nay's numbers look pretty good so if you can get him off dry, maybe with the diet change alone he might not need insulin.
Here is the food link.http://binkyspage.tripod.com/canfood.html

Now yes it is good when you are travelling with pets to know of a vet where you are but I would like to say that I stay in one place and did not use a vet at all in treating Max's diabetes. He is now 5 weeks OTJ (off the juice, lol) WITHOUT any vet support. None of them here believed in home testing or the protocol I was following. With the help of the Lantus board and my hard work, Max is off insulin.
Everything that is done here is to keep kitties safe.
Please go over to the Lantus Insulin support group and read the "stickies" at the top of that section.
I encourage you to join the group. I would say that you will get the help and support you need for Nay right there.
Read the condo's too (the daily threads that are posted)

Keep in mind that an unregulated cat will be hungry because the food is not getting used properly due to the higher BG levels. so let Nay eat.
I should point out that we take food away 2 hours before shot time so that the reading you get testing the BG at shot time is a purer number without a possible food spike.
I would also recommend clicking on the links in my signature, ss and video. You will understand this is the best place to be, for you and Nay. Hubby too.

 

Suddenly I feel like I've been playing Russian Roullette with my cat. I am trying to read all the links you've given but some of them do not make sense because it's too much information and I'm so new to this. For example, I'm still having to look up definitions of basic words like "nadir"(lowest glucose of the day) and acronyms like AMPS and PMPS (morning preshot glucose and afternoon preshot glucose). What's an SS?

Here's an example: This link http://felinediabetes.com/FDMB/viewtopic.php?f=9&t=147 has me totally confused. Let's just start by saying that everything below "not a newbie" is beyond me at this point. The FAQ 4.4 pretty much indicates that I should not be giving my cat insulin at all or maybe a "token" dose?

His fructosamine at the vet office was 386 before changing his food. We have not seen any BS numbers like this at all at home since we switched food. He is however still symptomatic. He is drinking and urinating excessively. Otherwise his behavior and activity levels are completely normal. I don't think he has lost weight, he weighs almost 20 lbs and has always been around that weight.

We have tried canned food when he first started drinking a lot. He had exclusively canned food for 2 months and he had very stinky diarrhea every day of it. I'm going to stick with the high protein dry food for now. Maybe later we can try a canned food again but at this point too many changes would be more confusing.

Today is Day 5 of treatment. I guess this is the point where the "insulin shed" is full. Based on what you all have said and what I've read I am thinking that this afternoon I want to only give him .05 units. Maybe even .25? Should I even be giving him insulin at all with preshot #'s consistently in the 190's???

Going to town to see if the new glucometer is in. Will check this board again before giving him today's shot. I'm trying to remember to breath! nailbite_smile

 

I am so sorry for the confusion Melissa.
Of course we don't want you playing Russina Roulette with Nay
I agree with you that too many changes are not good for Nay.
ss means spreadsheet which you have started for Nay.
I see that you have a +6 from yesterday but you did not give him insulin in the morning, correct?

AMPS means the morning BG (blood glucose#) pre shot and PMPS means the evening BG# before shot.
Since the board is international we use the "+ numbers to let everyone know how many hours after a shot has been given.
For example, I used to give Max his shot at 7:00am so +6 would be 1:00pm.
I would like you to post on the Lantus board and ask for "advice" as to what you should do dose wise.
For tonight's dose, let me get some eyes over on lantus to help you out.
You can also go and post a new topic there, subject line would be New to Lantus-need dose help please.
Also what would be great is for you to link this thread with that one.
The way you do that is to open this link, right click at the top address bar, then copy and past into a new topic in Lantus.
With regards to the "shed" you have only been giving lantus once a day so the effect of the shed will not be the same as twice a day.

 

Hi Melissa

Here's one---->http://petdiabetes.wikia.com/wiki/Blood_sugar_guidelines

 

New post created in Lantus subforum as suggested. Thanks!

 

Great stuff Melissa. I saw it.
Someone will be along. Just remember that you always need to be comfortable in whatever you do. After all it is you holding the syringe.
Did you get the new meter and strips?
Also, were you abel to pick up stuff for a "hypo kit"
Usually we like canned food with gravy - the gravy is where the carb is to bring numbers up, karo syrup too just in case.
Carb content sould be about 18%. We always kept FF grilled or marinated in the house.
When did Nay last eat and have you tested again?

 

question, was the fructosamine 386, or was his blood glucose reading 386?

Fructosamine is a blood test that is usually sent out to a lab. It is a great tool for diagnosing feline diabetes because it gives a clue as to the cat's average blood glucose over a period of time, instead of just one blood glucose taken at the vet's office in a stressful situation.

They are two different tests, though, and the numbers don't correlate directly (a fructosamine of 386 doesn't mean his average blood glucose was 386). According to this chart, 386 is just barely above the range for a non-diabetic cat, and would point toward "excellent control" of a diabetic.

To answer some of your other questions, I would definitely change to shooting twice a day (BID) instead of once a day (SID). Cats' metabolisms are faster than humans, and we see far better stability among cats who are dosed twice a day. My vet recommended SID dosing too, so I just split the dose she told me to give in half and gave it twice a day, so the total amount of insulin was the same as what she said. Then I adjusted the dose from there.

Generally there is no problem shooting Lantus at around 150, even for newbies. Those of us who are not newbies routinely shoot lower than that, once we have collected enough data on our cat to enable us to do so successfully.

I hope this helps, and isn't too much information.

 

AH HA! That's a GREAT chart! Thanks a million!!!!!!

Randi/Max - we got the new meter in the mail but its ancient. The strips expired in 03. It's a Prestige LX. We did manage to get a good test with the Walgreens glucometer and right now his BG is 210. He last ate 2-3 hours ago. We have Karo and a needleless syringe in case of hypo.

Libby - I have a copy of the lab in my hands. Fructosamine was 386. Glucose read > 450 (he hates going to the vet and was very stressed out). Based on that chart he is barely diabetic! Maybe he would be better controlled with diet alone!

 

[quote="melissapeterman
Libby - I have a copy of the lab in my hands. Fructosamine was 386. Glucose read > 450 (he hates going to the vet and was very stressed out). Based on that chart he is barely diabetic! Maybe he would be better controlled with diet alone![/quote]

Sweety's vet BG was 281, her fructosamine was 487 (500 diabetic) and the diet change alone worked for us. I declined insulin, tested for ketones and got the lowest carb food on the list - it worked. Took 2 weeks after the vet wanted to start insulin for the urine test strips to come up negative and for me to get a successful meter reading.
It IS possible.
What was the scale on your fruct test?