Hello from Edwin. First Lantus shot tonight.

Discussion in 'Welcome to the Group - Post an Introduction Here' started by bsmith, Feb 1, 2015.

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  1. bsmith

    bsmith Member

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    Jan 26, 2015
    I thought I would finally post an introduction for Edwin. I've received some great help posting here already: http://www.felinediabetes.com/FDMB/threads/new-diagnosis-where-to-purchase.132057/

    Edwin is a 16 year old DSH originally from Albuquerque. He was a bottle baby and probably only 2 weeks old when I got him from the shelter. I've often wondered if he was originally feral as he has prominent ear tufts. I wasn't looking for a male cat, I wanted to get two females, but he insisted he had to come home with me NOW. His sister Irene (different litter, probably a month old) came home with me at the same time. She passed from FIP in late 2002. Edwin has always tested negative for FIP, but so did Irene when she first got sick, so I decided not to get Edwin a new sibling to avoid another possible FIP infection.

    Edwin is doing pretty good for a 16 year old. He was diagnosed with kidney failure a few years ago. We've been dealing with it through diet and his numbers are pretty stable. My previous cat, prior to Edwin and Irene, lived to 17 with kidney failure and arthritis. Edwin also has arthritis in his back and hips and has been using Adequan for 3 years, so at least I have some practice giving shots.

    A little over a month ago I was putting on his vest to let him go outside and noticed that he had licked all the fur off one of his front arms. I had gotten him the vest since his hair has really thinned this past year. For most of his life he has been an indoor only kitty, but now I'm in an area where he can safely go out during the day. Plus he's old and arthritic, let him go out and have some fun as he doesn't go far and comes in when called.

    With the loss of hair on the one arm, it looked like someone had shaved him, I took him into the vet. I've never seen him get so upset at a vet appointment. His arm and the arthritis in his back and hips was really flared up. We started him on Tramadol and that seems to have really helped. He's less gimpy on the stairs, has stopped licking on his arm, and seems to be in less pain overall. Unfortunately he's started licking a patch on his side. Also, he hates the Tramadol with a passion as it makes him foam at the mouth even after I grind it up and mix it with yogurt to administer it with a syringe.

    I thought we had gotten everything, but a few weeks ago he started peeing on the bathroom floor. He has been trained to use the toilet since he was very young, which has been great; no litter to deal with. He's been very good about going where he's supposed to except for a few years ago when a new medication I started taking totally flipped him out. This time he just kept peeing on the floor, for almost two weeks, even after I tried moving him to a different bathroom. Back to the vet.

    This time I had the vet run a urinalysis to make sure it wasn't an infection or something else. Surprise, surprise, no infection, but sugar in his urine. It was almost time for his senior wellness panel to be run anyways so we did a blood test. Kidney numbers still stable, but a BG number of 400. Over the summer there had been a bit of an increase in drinking and urination, but we'd chalked up to the kidney issues. I finally gave in a bought a litter box. He's been very good about using it, but I'm still hating the litter and having it tracked all over. Oh well, it beats pee on the floor.

    So after a week of trying to find better Lantus prices and sorting out glucose meters, Edwin had his first Lantus shot of 1 unit tonight. Trying to get the glucose meter to work involved much ear stabbing and finger stabbing (after the first two tries on Edwin I switched to practicing on my own finger). Note, you need a little gravity action to get the blood into the strip, not just the capillary action. Edwin was at 203 on the ReliOn confirm (I was a 66), but we had both just gotten up from a long nap. I would like to thank Edwin for being a trooper through all the ear stabbing and I think he's already forgiven me. There was some catnip action and he seems to be doing well. Next time will be easier since I have more of an idea of what I'm doing.

    Thanks to all the posters that have already helped me and for those of you who have read through this long post. I'll be seeing you around.
     
  2. Wendy&Neko

    Wendy&Neko Well-Known Member

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    Feb 28, 2012
    Hello and welcome. Congrats on getting the blood testing going and the first shot. :) Getting those first few tests is definitely trial and error. You might want to get a test before bed just to see how Edwin is reacting to the Lantus. When you've got time, could you create a spreadsheet to record your test values? That's the common language we use here to track how kitty is doing and figure out what dosing to use. Here are the instructions.

    What food is Edwin eating now? It sounds like he's come down a couple hundred from his test at the vet. Vet stress can contribute to higher blood sugar. My non diabetic kitty once tested 150 points more at the vet than at home. Going to a low carb wet food can lower the blood sugar if you've done that in the last couple of weeks. And how much does Edwin weigh?

    We have a number of kitties here with arthritis. Another couple of options for pain meds if the Tramadol isn't doing it for you is buprenorphine or gabapentin. My Neko is on buprenorphine. I get it compounded chicken flavor so she's quite happy to take it.

    One last thing, what is your name?
     
  3. bsmith

    bsmith Member

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    Jan 26, 2015
    I just added his food and meds to my signature. I'm having to stick with Hill's K/D because of his kidney numbers, but have been giving him the canned Friskies as a treat in the evening for a couple of years. According to my vet the is about the best type of diet that you can give a diabetic cat with kidney issues; you need low protien for kidneys, but high protien for diabetes. I guess I'm lucky I've been doing this all along. I'm considering adding in a bit more canned food. Edwin weighs in at just under 10 lbs. He's been at this weight for a few years, but looks skinnier now since his fur is thinner.

    We tried buprenorphine over the summer. It didn't seem to help with the pain, but it did make him stare off into the distance a whole lot more. I've taken both Tramadol and gabapentin myself and my personal experience was that Tramadol was better on the joint pain, while gabapentin was better on the neuropathic pain. The Tramadol seems to be working well, but it makes him foam at the mouth (the vet said most cats don't do this, but he also really foams if you give him Benadryl).

    I'll definitely test before bed. I made sure to buy karo syrup today along with his glucose meter. I've seen people in insulin shock before and it's not pretty. I've been keeping an eye on him and he seems to be going about normally.

    I'll start keeping a spreadsheet as soon as I have a few more numbers.

    You can just call me by my username bsmith.
     
  4. Wendy&Neko

    Wendy&Neko Well-Known Member

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  5. bsmith

    bsmith Member

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    Jan 26, 2015
    I had not seen that site, but thanks for the link. I am somewhat familiar with kidney disease as my previous cat had it for many years before passing at 17 years old. Edwin isn't to the point of needing additional fluids from IVs at this time and seems to be managing well. If he does need subcutaneous fluids in the future, I'll sure be practiced at inserting needles :) .
     
  6. phlika29

    phlika29 Well-Known Member

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    Sep 14, 2014
    Can I suggest buying empty gelatine capsules -size 4 for the tramadol. I put a multitude if tablets in mine and remi doesn't taste a thing. You can get them from amazon etc.

    I put the tablet in the capsule, give remi a tingly bit of water from a 5 ml oral syringe and then apply a little bit of pressure to the corner of his mouth. The makes him open it. I then pop the capsule at the back and immediately follow with at least 3 ml of water from the syringe. You have to be careful syringing water into the mouth. I aim it from one side to the other and not down the throat.
     
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  7. bsmith

    bsmith Member

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    Jan 26, 2015
    I do have size 0 and 00 capsules already in stock. Hmmm...

    To begin with I was just giving him the pill coated in butter. I could get the pill in (getting the jaws open is no problem as I trained him as a kitten to let me open his mouth and put my fingers in whenever I wanted - helpful down the line). Once the pill was in, I would hold him and make him swallow for about 5 minutes. 10 minutes later the pill would come back out on its own. I don't know where he was hiding it or how he could just get only the pill back up. He is very very tricky. I'm not sure a syringe full of water after a capsule would be any less traumatic. At least this way it's the whole 3 ml syringe (2-2 1/2 ml full) at one go. Although, the capsule might cut down on the foaming. I'll give it some thought.

    I see ondaneston and Zantac on your med list. Do you have a pukey cat too? My sign that my cat had diabetes should have been that he stopped throwing up.
     
  8. bsmith

    bsmith Member

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    Jan 26, 2015
    First night numbers (will do spreadsheet soon) with ReliOn confirm

    11:40 pm 203
    12:00 am 1 unit Lantus
    5:20 am 59
    Gave some extra canned food. Eating, drinking, and acting normal.

    How often should I be testing? Also, with the ReliOn should I just be using the code on the test strips or is there an animal specific code I should change in the meter settings?
     
  9. phlika29

    phlika29 Well-Known Member

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    Those sizes are too big for a cat. Size 4 is the way to go. I guess you could try to cut it down but you don't want it getting stuck in the throat.

    Whether you put it in a gel capsule or not you should always chase it down with either water or food as certain medications can cause irritation to the throat. Also by chasing it with water there is no way they can hold it in their mouth as long as you get it to the back. Perhaps you could try the syringe without a pill see how he likes it. I don't even insert the end of the syringe. Just sort of rest it at the side of his mouth and very gently push the plunger so it just comes out slowly and he sort of just laps it up.

    How about one of those pill pockets that you get from the pet store?
     
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  10. phlika29

    phlika29 Well-Known Member

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    It depends but if possible we always get a preshot reading and then usually a +2 so that we know whether it is going to be what they call an active cycle ie the numbers are lower than the preshot and it is likely then that they will drop further. Depending on the results we might have to get more.

    So last night your

    PMPS (pm preshot) was 203
    +5 hours was 59
    He has gone quite low for the first ever dose of lantus as it builds up in the system over a few days. If you can get another test at +6 that would be great. Any lower than 50 and you need to start giving a higher carb food or honey as pre the hypo protocol. Have you read that?

    What is the normal feeding pattern. I would make a note of that on your spreadsheet too.

    I have a feeling you may need to lower her starting dose. How much does she weigh? I think it is time to start a new thread over on main asking for advice about dosage. Say what her numbers have been so far, the food she is on and how much she weighs. Is that okay? You want more eyes on your posts to make sure you get the dose right at the next shot.
     
    Last edited: Feb 1, 2015
  11. phlika29

    phlika29 Well-Known Member

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    Last edited: Feb 1, 2015
  12. Larry and Kitties

    Larry and Kitties Well-Known Member

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    Dec 28, 2009
    I size 3 as well as the smaller #4 and #5 gel caps are fine. Larger cats can also use the #2 gel caps
     
  13. Wendy&Neko

    Wendy&Neko Well-Known Member

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    Feb 28, 2012
    With the Relion, just use the numbers you get on the meter. We have dosing protocols that use the numbers from the human meters, as that's what most people here use.
    I agree with Sarah. Edwin too low for his first shot of Lantus. We consider going below 50 (on a human meter) the point at which the dose needs to be reduced. Hypo range is below 40 and we use 50 as the cutoff line to provide a bit of margin for cats on insulin. Since Lantus builds up over time, that 59 was too much of a reaction for a first shot. How about trying 0.5 units instead?

    Also, when people are new, we suggest that they don't give insulin if their preshot test is below 200.
     
  14. bsmith

    bsmith Member

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    Jan 26, 2015
    I'll start doing the +2 and +6 readings. His preshot test last night was just over 200 and his starting dose was 1 unit (he's 10 lbs). His preshot test today was 149, so no shot. I called the vet and she said to drop to just a single 1 unit shot per day (although maybe two 0.5 unit doses would be better - I'll post over on the main thread). I read over all the hypo information before starting the insulin and have karo syrup available. I'm sure glad that I was testing.

    As for the gel capsules, I forgot that they run like wire gauges. The higher then number the smaller they get. I'll try running syringe water in his mouth to see if he's okay with that. From past experience, I can say that he doesn't really like anything involving a syringe. As far as pill pockets, I've made my own from cheese before and have been rewarded with the cheese fully eaten and a licked clean pill remaining.
     
    Last edited: Feb 1, 2015
    Reason for edit: should have been 149 for today's reading
  15. bsmith

    bsmith Member

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  16. phlika29

    phlika29 Well-Known Member

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    I'm glad you started a new thread.
     
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