Getting the middle claw on monitoring

Okay, I'm new to all of this and could use some suggestions. I'm trying to get Nervous Pervis to let me prick his ear to get some testing in before he goes back to the vet for another $75-$100 glucose-monitoring visit on Monday. Well, he is saying, "No Way! I don't care that you house me, feed me and that saved me from a sure death. You're not pricking me with that thing."

He's not the cuddling type, as his name suggests, so he won't sit in my lap and he doesn't like being picked up. He's sweet, but very timid. I tried warming his ear with a washcloth, a small, warm-water filled pill bottle, rubbing his ears. He's suspicious of it all. I would bribe him with a treat, but we have yet to find a low carb treat that he'll eat. I can't seem to do everything I need to do and keep him situated. I tried having my DH help, but maybe I'm a control freak (I am) and didn't like his approach. I need to be able to do it on my own because I'll be the one doing it the majority of the time. He needs to do it too, but I can show him once I have it figured out.

Also, his 8 units of Prozinc shots were going fine, but now he's a bit suspicious of that, too. I can give it to him while he's eating or drinking water from the faucet, but it's not as easy as it was. I wonder if I must have accidentally hit muscle one time and he didn't like it.

Lastly, if I do get the testing started this weekend, how many tests do you think I'll need to do in order for the vet to be able to make heads or tails out of the numbers? Should I take the monitor to the vet and ask them to do some tests there to compare with their monitoring?

Thanks in advance for any suggestions.

 

Bandit fought me tooth and claw the first few weeks we tested. Here's what helped us:

1. My attitude. I started out being all "poor kitty! I hate to hurt you!", and this made things worse for both of us, because he could sense my lack of confidence. Once I changed my attitude to be, "You're getting this test, cat, whether you like it or not because you need it to save your life!", things went much more smoothly.
2. Blankets, and lots of them. I got a basket that was roughly the same size as Bandit on the suggestion of my vet, who said that ornery cats calm down when they are surrounded on all sides but the top. So Bandit went in the basket for each test, which I lined with fleece blankets, I had another fleece blanket I used to wrap him in so that only his head was free. This kept him from clawing me and trying to escape while I did the test.
3. Get the test as fast as you can. Use a thicker gauge lancet (26-28g), and make sure you're warming the ear to get the blood flowing.
4. End each test with a diabetic safe treat, no matter what it is. What kinds have you tried? It doesn't have to be a packaged treat...if there's any type of meat he likes, you could give him that. Boiled chicken or beef could work, or fish, or even raw fish or cheese. My cats like these treats a lot. Any freeze dried, meat only treats will be diabetic safe.

If you establish this as a routine--basket, test, treat, then eventually the cat gets used the routine and accepts the testing. It took Bandit a few months, but now he comes running when he hears the meter beep on and sits patiently in front of me until his test is done.

One point of concern I have...8u is a very large dose of insulin, especially if you haven't been home testing datily--how did Pervis get up to that high of a dose? Is there still dry food in his diet? If this dose was based on office curves, it's likely that he is being overdosed right now--office curves will show artifically inflated numbers that lead to chronic overdosing if caution is not used in raising the dose. It's possible he's starting to run away from the shot because it's making him feel worse, not better. 8u is a lot of insulin. Most cats on a low carb, canned diet do not need much more than 1-2u of insulin.

 

@Julia & Bandit - Thanks for the ideas. I'll try the basket and blankets. As far as treats, I've tried a couple freeze-dried meats and cooked chicken. I'll have to try cheese or maybe some cooked shrimp or fish that I have. I do need to get a thicker gauge lancet too. I'll go get some today.

Although, I don't know a lot about diabetes, I agree that we got to the the 8u really quickly. Pervis was diagnosed on January 29 and his office curves were in the 500's. When the vet told me that it was going from 6 to 8, I was angry, not just at that, but some other things that you should receive when you're paying so much and visiting so often, which I had received on prior visits. I know it might have just been a busy day, but... So, as I was typing this, I decided to contact the vet we use for our dog for his opinion. They typically charges more for services, but I talked to his office and the curves were cheaper per test. I left him a message to give me a call.

Thanks again for your help. I'll post when after my next attempt at testing or after I talk to the other vet.

 

Curves/BGs taken at the vet tend to be artificially high since vet stress can raise BG by 100 (USA) or more

 

Thanks Larry. I appreciate your input. Hopefully, I'll get going on his home testing soon.

 

You will get it.... we have all been there......be patient--read lots of the info on the stickys-
We turned a corner when I realized the correct area to prick his ear-I was aiming for the vein what was I thinking??
now I know where to prick between the vein and the edge of the ear toward the top but not the very top where there are very little never endings-
it took a while.... it is all a learning process

 

Hello! I think I am getting better at it and the next test will be a success. Pervis was a trooper tonight and after several attempts with with two people, then towel wrapping and most successful while he was drinking water. I finally got enough blood to the glucometer, but the readings weren't right. They were in the 30 range, but Pervis definitely has no signs of hypoglycemia. He's actually wasn't traumatized by the sticks at all and is out of the bedroom, which has been rare for him in the past couple months, is soaking up our petting and loving on him. I think it might have been because when I didn't get enough blood on the test strip, I tried getting more bloold on it. Could that have been what went wrong with the two tests? I tested myself (right after dinner) and I was 126, so I know the meter is working. Thank you everyone for your help. I am not giving up.

 

What meter are you using--not all cats show signs of hypo--

 

I am so happy your not giving up--sure is a pretty kitty!!
It is possible it was a bad strip but 30 ish is low--if using alpha track it is very -dangerously low.....
we have a phrase here that we tend to use often--
better too high for a day than too low for a moment-
on a human meter 30 ish is still too low for safety purposes--
I am not experienced enough to guide you so I am going to bump this up and hope to get some expert eyes on you for help-
If you change your thread title to a ? new BG reading of 30 (something like that ) I am sure a few experts here can help-
I am really glad he is acting normal but I am thinking he should have some medium carb food (just a little) .....if he is at 30 he needs to come up--
BUMP

 

I'd definitely re-test to make sure!! 30 is way too low no matter what meter you use. (Which meter are you using?)

8 units is a HUGE amount of insulin and since we don't have any data on Pervis, it's totally possible he's hypoglycemic .....they don't always show any symptoms until they start to have seizures

Where abouts in Missouri do you live @Nervous Pervis and Terri

 

I talked to my dog's vet yesterday and he didn't seem alarmed at the 8 units. I am going to test him again momentarily. I am using a Relion Micro. We are located in K.C.

 

I'm going to retest him now.

 

If he's still below 50 mg/dL, please give a teaspoon of high carb gray or a few drops of Karo syrup now.
Then, in 30 minutes, test him again.
Repeat the high carb or Karo if he is still below 50 mg/dL.
Continue this every 30 minutes until he is past his likely low point, around +5 to +7 hours post-shot for ProZinc.

And read over the following just in case you need it tonight.

How to Handle Hypos - They Can Kill

 

Well we're almost neighbors!! I grew up in KC (went to Raytown schools)....Now I live in Versailles, down by the Lake of the Ozarks so only about 1 1/2-2 hours away

Unless Pervis has been diagnosed with acromegaly or insulin resistance (IAA).....both of which take specialized blood tests only done at Michigan State University, 8 units is a lot

Treating diabetic dogs and diabetic cats is a LOT different and for him to be on 8 units after only being diagnosed Jan 29th, I really fear for his life

 

so glad the experts are here!!

 

I am having issues getting enough blood to test and I've tried four or five times this go round. I'm warming his ear with an extra warm, water-filled pill bottle. I am going to get some rice in a sock and see if that is works better. I'll check back when I'm done.

 

Just in case that was an accurate test, give some high carb NOW.

And if you have to, aim for the vein directly. It may bleed a bit profusely, but you'll get a test. Just blot firmly afterward.

 

His reading is 27. I rubbed some honey on his gums and he is eating now. There was a lot of blood, which means I probably did hit the nerve. Unfortunately, i had to take the blood from the bathroom floor because I got an error on the strip and had to move to grab a new one so Pervis escaped. I'll retake in 20 minutes or so.

 

Chris asked me to pop in. I would test 15 mins after the karo and if you get another low number like that, I think you should go to the ER as they might want him on a dextrose drip. Take the karo with you and continue to rub some on his gums.

How many hours past his shot time are you right now?

 

Do you have any high carb food like Fancy Feast Gravy Lovers? Or is he still getting dry food?

 

I think its at least +3

 

No FF Gravy lovers. He's still getting dry food and I gave some some treats that are high carb. I'll test again

 

We're 5 hours past his shot now. He had it at 7:00 PM CT.

 

Ok...we are waiting for the next test. It might take a while for dry food to kick in so I hoping the HC treats will do it. You will need to stay on top of testing tonight until he's up over 150 or so and hasn't had any high carb in a couple hours.

You need to be sure and reduce his dose tomorrow. I'm not a ProZinc user and it's kind of hard to tell you much without a spreadsheet. You might want to post before you shoot tomorrow and see if any ProZinc users are on but I'd think at least a 0.5u reduction minimum. You might need to reduce more but I'd really feel better if you posted before you shot in the morning.

If he is below 200 in the morning, you should skip the shot, ok?

 

He just had some more honey and some more high carb treats about 8 minutes ago. I have him back in the bathroom (the testing room), so I will test him here in a bit and let you know.

Yes, I will reduce his dose tomorrow or skip the shot in the morning if he's below 200. Today is my first testing day and it's been such a struggle I haven't posted anything to my spreadsheet yet.

 

Tag me or send me a private message tomorrow if you need help with setting up the spreadsheet. It will only take me seconds to do for you.

I'll wait for the next test but it should be soon, ok? The 27 was 36 minutes ago and so we should have gotten HC in him right away and tested in 15 minutes.

 

He's only back up to 30.

 

I really think you should go to the ER. I'd give him a good amount of karo, take it with you, and go. With meter variance, that is the same number.

Can you do that?

 

Update?

 

At the emergency vet now. 54

 

Keeping our paws crossed for Nervous Pervis

 

Hi Terri.

Marje asked me to look in on you in case she fell asleep. I see you took Pervis to the ER. I'm sure you're pretty stressed, but when you have a chance, we'd love an update on how things are going. For sure Pervis will need a reduction tomorrow. I hope everything is okay.

 

I hope everything is okay for you at the ER tonight.

 

Great. Big sigh of relief. I'm glad he's coming up.

For that much insulin with him not coming up more after high carb that late in the cycle, it's better to be safe than sorry.

I hope all will be fine. Thanks for updating us.

 

Thanks everyone for all your help tonight. They are keeping him overnight to monitor him. I'll post an update when I have one.

 

I'm glad you took him.

They can help you with a reasonable dose tomorrow morning.

Hope you rest.

 

Good decision. It's such a relief to know he'll be safe. Get some sleep!!

 

Thank goodness you got him in in time

Looking forward to an update and hope you were able to get some rest last night

 

what a first day!! You did great and I am so glad you posted and others were able to guide you with Mr NP
Hoping for a good vet report

 

Hello! Thanks again for all your help last night. If I wouldn't have found this forum and started glucose testing, I would not have caught Nervous Pervis's low readings and who knows what the outcome would have been.

I talked to the vet and he is now off the glucose because his readings are back up. They are suggesting a switch to Lantus He is going to remain there until later in the day so they can continue to monitor him to see if his numbers continue to rise or they level out.

I'll keep you posted.

 

@Chris and China - I moved to KC after college from St. Joseph, which is about 50 miles north. Someday, I'm hoping for warm and tropical.

 

He was overdosed on the 8 units per shot! Your initial vet could have killed him.
It may be he could be quite successful on a moderate dose of 1-2 units per shot.

If you do go with Lantus or Levemir, the cost in Canada is about 1/3 of what it costs in the US.
Check in our Supply Closet, or consider ordering from Mark's Marine.

 

I'm so glad he is well and they are cautious. If it had been one low reading and he had come up, it would have been ok to keep him at home but from what I can figure from the posts, he was in the 30s/20s close to three hours and barely budging (54) with food and karo. That's just too long.

Lantus is a great insulin as well and if you decide to switch, we would love to see you in our Lantus/Levemir insulin support group on this forum. We have lots of L/L users and lots of experience...as in all of FDMB...a very friendly and caring group of people to help. Dosing on Lantus is different than dosing ProZinc.....we dose primarily on the nadir or peak action of the insulin (lowest number) rather than the preshot.

And again, if you need help with the spreadsheet, just let me know. It's best to send me a private message as I get notifications of those quickly. To send a PM, click on our names to the left under Princess Gracie's photo and click on "start conversation".

Thanks so very much for letting us know he's well.

You and me, too, sister! I got the warm but would love the tropical.

 

Well Bermuda it's not, but I know those 50 miles can make a big difference.....the weather in KC was usually more stable and warmer than it was in St Joseph!

Good to hear they're considering going with Lantus...we have a very large bunch of other Lantus users here and we're an active group. You'll get lots of help using Lantus

Be prepared though....it's expensive! ....but we have ways around that too! Have your vet give you a written script for Lantus Solostar Pens (box of 5) instead of the 10mL vial. With the pens, you can use every last drop of the insulin, but with the vials, the insulin will "poop out" before you have a chance to use more than about half of it so you end up throwing a lot away. The pens are only 3mL each.

Read the info in this post from the Insulin from Canadian Pharmacies thread....if it weren't for Marks, a lot of us couldn't afford to keep our cats on Lantus. They're $149.99 .....Your Walmart is going to want close to $500...for the same exact thing.

You'll also need to get U100 syringes with half unit markings. All these have half unit markings and are the correct syringes for U100 insulin and are available from ADW online:
UtiCare
Monoject
Carepoint
Sure Comfort

They're also available at WalMart if you have one near you..Their Relion Brand 3/10ml, 3o or 31 gauge, 8mm insulin syringes all come with half unit markings and are only $12.58 for a box of 100

It will take about a week to get the lantus from Marks, but in the meantime we could talk about staying on the ProZinc (at a MUCH reduced dose) or figuring out a way to get you some lantus quicker.

So glad Pervis is doing better and hope he comes home later today!!

 

Yes, I agree. Unfortunately, I was following blindly.

 

Just seeing all this now. So glad you caught it and got help. The same thing happened to me the first day I joined. Smokey was hypo and I didn't know it and couldn't get to the ER. The good people here pulled us through.

Hope Pervis is feeling better and comes home today.

 

Terri,

Are you in the states? I have 30 of the Wal-Mart u100 syringes with half marks. If you do switch to Lantus I can send them to you to get started. Send me PM. If you want them.

 

So Happy Mr NP is doing well. You must feel exhausted by the stress of it all

 

I am so glad things turned out well for you after last night.

 

wow---you handled this like a pro!!
Looking forward to seeing you in lantus land....SO happy NP is a-ok!!

 

Thanks so much. I think I'm more exhausted than I feel. I got rested overnight. I think he'll get to come home this afternoon.

 

Yes, in Missouri. I'll PM you if we do switch to Lantus, which I'm guessing we will. Thanks for the offer of the u100 syringes. I appreciate it.

 

It was trial by fire. I like the vet that was at the ER. Seemed more knowledgeable about FD and was engaged in the visit. I may see you in Lantus land soon. We'll see. NP is my baby. It took over 6 months of daily coaxing, after we took him in back in 2004 for him to come out from under the bed.

 

Thanks. Your Shaak Ti looks like Pervis's half-sister, Speck(les). Love those Tortieshells and Tucson. My brother and his family live there.

 

both Torties' and Tucson are awesome I believe.

 

He is older and wiser now

 

Okay. Just talked to the vet and Pervis is now at 381, but he's not eating. I am going to pick him up in about an hour. They want me to start him on Lantus today. How much will that set me back (a $ range) if I have to fill the script at a locally (in the U.S.)? Should I ask if I can continue the ProZinc until I can get the Lantus from Canada? I'll look around on the forum too to see if I can find that info.

 

Around $450.
I'd continue with a modest dose of the ProZinc if the pre-test has him over 200 mg/dL and then see how he does before ordering the Lantus.
Many cats are more sensitive to insulin after a hypo experience so be very cautious with any insulin you give - maybe 0.5 - 1.0 units at most to start.

 

If you have issues with getting blood from the ear:

Diego's ear bleeds really well up at the tip. Not sure why, but even when he was dehydrated and not eating (and consequently not bleeding as readily) I was always able to do one little poke up at the tippy top of his ear and I get an entire drop of blood every time. I don't have anyone else to compare this to, but it seems as though this is a very vascular area. Worth making note of in case you need to get some blood on that meter quickly.

 

Thanks JC, I'll give that a try.

 

What about timing for switching Pervis off of dry food? I'm guessing I need to wait since his hypo episode yesterday and he'll be switching to Lantus soon. I'm just trying to plan for the best time to do it and am obviously not wanting to switch his food when it would be harmful to him. Leaving now to pick up the kitty now. Keep your fingers crossed that he will eat when he gets home.

 

Go Go Pervis!!

 

Getting him off the dry will really help, so the sooner you can transition him, the better. Some cats have sensitive stomachs though and switching too quickly can cause diarrhea.

I was lucky....I picked up all the dry and put down canned one day and all three of my cats loved it and had no problems with the new food

If spending several hundred dollars for Lantus isn't something you can afford right now, I'd continue with the ProZinc.....just at a drastically reduced dose

 

I did the same as @Chris & China - picked up the dry and went to all wet-
they were fine--Rico has always had a little loser stool but with the microflora from herb smith they both did just fine--
that being said every cat is different (the numbers went down about 100 just switching food to wet)

 

If you cannot of lantus now it is totally understandable--we were on pro zinc before and although I was on a modest dose he would still drop hard and fast.... I find that lantus is a more gentle landing (once they flatten out .... listening Dre??)
I would def. start over with a small dose - I do not give dosing advice but I am sure one of the others can help you with the exact dose-
so glad he is doing good!!

 

I’m not a Prozinc user but I would suggest you might want to post on that insulin support group and get an idea of what dose to give him. I wouldn’t necessarily go all the way back to 1u; he might need a lot more insulin than that and you don’t want to have him in really high numbers for long.

What dose of lantus did the vets tell you to start at?

Quite often when you switch from dry to wet, insulin needs decrease so we need to be aware of when you plan to switch him on the food. I hope his not eating at the vet is just because he’s at the vet. Please be sure and let us know if he eats when you get him home.

 

Pervis is glad to be home. He ate a bit and has come to see me on the couch to say hello. The vet took the script from me when I asked if I could continue on the ProZinc until I could get cheaper Lantus. She did later give it back to me only after I promised to fill it locally, but I guess if I do, that means I won't have a script for getting scripts from Marks Marine or other Canadian pharmacy. Pooh.

 

Your vet can't dictate where you buy your insulin!! There's no reason to even mention it to her!

They are required to give you a written script if you ask for it in most states, so don't let her intimidate you into spending 3 times as much money

 

Thanks. For the Lantus, the dosage on the script is 2u every 12 hours.

I'll test in the a.m. and give him a .5-1.0 units at most.

 

I'm glad to hear he's home, he's eating some and most of all, that you're here with us to learn how to keep him that way!!

The people here have more real life experience with treating diabetes than you'll find in any vet, so if you have the script, that's the most important part....although it's a good idea to have a vet who at least knows what insulin you're using just in case of an emergency.

I don't discuss China's diabetes with her vet at all anymore other than she asks "how much insulin is she on and how are her numbers?" and I answer her truthfully. If she does decide she wants to give me some advice, I listen politely, smile and nod....and go home and continue listening to the people here who do this dance every day and know what works.

If you decide to switch to the Lantus, we have two ways of dosing. One is called Tight Regulation Protocol and it gives your cat the best chance at remission. Dose changes are made as often as every 3 days so you're able to (hopefully) get his BG down into the normal range as quickly as possible so his pancreas can heal and resume producing insulin. It does require that he's eating only low carb canned or raw food though. TR is the only treatment that's been published in a veterinary journal so has some real scientific research behind it

The other method is Start Low, Go Slow. Doses are held for at least 7 days (which can be hard on us if they're running higher than we'd like) but some people are more comfortable going slower or can't test as much and it's a very safe method. We've had cats go into remission on SLGS too, so it really just matters how aggressive you are comfortable being.

Think about what you want to do....if you want to switch to Lantus, I can probably sell you a pen from my "stash" and it should get to you within a day or two and you wouldn't have to wait to get it from Marks in Canada (and what I have came from Marks!)

 

Just for reference--- @Nervous Pervis and Terri
When we were on pro zinc I had consulted with another specialty vet (cat and especially FD) she had us switch over "just like that" no slow transitioning-
Dre is 19 pounds --she said normally she would start 2 units 2x a day--THANK GOD WE DID NOT!! and THANK GOD I FOUND THIS FORUM!
1 unit got his BG at 74 on the 4th cycle-- (a cycle is 12 hours) we use alpha track and below 68 is dangerous-
if we had been on 2 units I have no idea what would have happened-Many of the eyes you have on you right now walked us thru some numbers that were scary at the time. I have enough data now to know how to bring him up if need be and how he responds to 1/4 unit increases-
1 thing that will help you get the most of the experts here is the more data you have the more they can be of help.
I am so relieved NP is home and ate --I hope your feeling less stressed.... all of this will be 2nd nature in no time

 

If you find that he is over 200 mg/dL with the low dose, this would be a good time to safely and slowly reduce the dry food and increase the wet low carb food, rather than adjusting the insulin.
Switch out about 20-25% per day, and keep testing to so how it affects him. The food change could reduce him from 100-200 mg/dL; one cat even dropped 300 mg/dL!

 

The vet doesn't have to know where you get the insulin. Please note from Canada it will take several days before you receive it. Target in my area will sell one pen.

Try this, call around to see who will sell one.

http://www.petdrugcard.com/lantus-coupon.html

On this forum check out the supply closet people will sell or give their unused ones.

 

I have no idea why, but the vet (a different ER vet then last night) didn't want me to use the pens, she gave me a script for a vial. Will probably switch to Lantus, but want to think about it and will let you know if I need to buy a pen.

 

Thanks for the coupon. Going to check around for prices.

 

Okay, I'll test before and after. He's already been getting a little less than a teaspoon a day of FF Classic, so I'm going to take it slow with changing and will be testing along the way. Boy, this FD stuff really cuts into my day. Good thing I can work at home as needed.

 

That's a big cat. NP used to be around that size. Now, he's around 13 pounds. I canceled tomorrows glucose curve test at the vet that had me giving him 8u every 12 hours.

 

I'm glad you thought twice about the curve. Are you looking for a new vet?

 

A lot of vets don't understand how we use the pens. They might think we use the special needles that come with them and think that we can only give doses in whole units due to that (with humans, whole unit dose changes aren't a problem....with cats, we do changes in .25 unit increments)

If you just pull the cap off the pen, there's a rubber stopper....just like a vial! We use regular insulin syringes (like the ones I sent you the picture of) and pull the insulin out of the pen, so the pens just end up being a 3ml "vial" each instead of a big 10ml vial.

With the vial, unless NP ends up being on a high dose, you're going to end up throwing about half of it away...and at $300/vial, that's a lot of money to just throw away. It will last up to about 6 months if cared for properly (and you don't drop it and break it...easy to do!) where with the pens, you get 5 "pens" and each one holds 3ml and can be used up to the last drop.

I believe that Marks in Canada will let you buy the pens even if your script says vial....they have an 800 number so I wouldn't hesitate to ask. In Canada, insulin is sold over the counter, so the pharmacist has a lot of leeway when it comes to dispensing.....and Marks knows us VERY well here!!

To illustrate how we use the pens:

 

Vet Interview Topics
Should you decide to go vet shopping.

 

Thanks for the vet interview topics. I've printed them and put them into my NP FD file. Yes, I'm going to look around I thought I'd use the one I use for my dog, but I had talked to him on Friday and he didn't think 8u of ProZinc was a lot either, so he's out. I liked the ER vet last night. I need to see if she works somewhere else too. I'm alos going to check with a friend who works at a vets office in a nearby town to see if she can find out about any vets that specialize in FD.

 

Ah, I bet you're right about the lack of understanding.

 

Oh yeah, I am. This one cost us an arm and a leg, the cost of a visit to the ER and almost the life of one special NP kitty.

 

Try here to find be local price for insulin
http://www.goodrx.com/

 

Thanks. I'll take a look at it this morning.

 

- NP testing this morning -
I gave NP around .75u ProZinc this morning. He ate some dry food mixed with FF this morning. I noticed a couple things since he came home yesterday. His back legs are really weak, which I don't think is unexpected and his pupils are dilated, which was how they were before his initial diagnosis. After he first started on insulin, his pupils went back to normal. I'll keep testing. My DH helped hold Pervis this morning, but I'll be doing the tests solo for the remainder of the morning and afternoon. I wonder if that will help or hinder his levels. He trusts me more than DH, but I'll have to make a kitty burrito to do it solo.

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