? Hoping for some advice

Discussion in 'Feline Health - (The Main Forum)' started by C.W. Gortner, Dec 2, 2017.

  1. C.W. Gortner

    C.W. Gortner Member

    Joined:
    Nov 13, 2016
    Hi, I posted an introduction on this forum last year regarding my cat, Mommy. I know I've been absent since then. This isn't an easy post for me to write, but I'm hoping for some helpful advice and forgiveness for my ignorance.

    Per my last post: Because everyone, my idiot ex-vet included, seemed unsure as to whether our Mommy Cat was diabetic or not, we made the preventive measure of switching her and our other cat Boy to a low carb wet food exclusively last year (Friskies Classic Pate). She did fine on it, and continued acting normally. She never developed the excessive urination or drinking often associated with diabetes, as I kept a close eye on that. Nor was her appetite more increased than usual.

    Last month, however, we went on an extended vacation (two and 1/2 weeks) and employed our usual cat sitter. No issues with the sitter, as my two former ferals don't let anyone but us near them, yet once we returned home, we noticed Mommy was looking very frail and underweight - as in, extremely bony around her hips and spine, a marked shift in her. Her gait also seemed impaired. She's moving slowly, not on her hocks, but as if she's in pain, like arthritis. I thought maybe she'd been eating less due to our absence, though the sitter assured me she'd been eating, based on the empty plates, so I upped her feeding to four times daily; I'm a novelist and work at home, so that's easy to do. Mommy kept eating, but gained no weight. She also gradually became more lethargic throughout November, which was hard to quantify at first as she's always been a sedate cat who stays upstairs in her Princess Suite (the extra bedroom) and she tends to sleeps most of the day as a rule.

    Last week, however, her lethargy turned pronounced and her appetite waned considerably, so I called the vet. I became furious when the vet again requested that I home-test her urine for glucose "to be sure", because really, at this point, based on her initial blood-work and her current state, it seems clear to me that she must be diabetic and uncontrolled, at that. I searched for another vet in a panic and found one that only treats cats; we go in today at 3:30 pm. Getting ASAP appointments at vets these days in San Francisco is a nightmare, they're all booked out weeks in advance. I also enticed her appetite with tuna; she resumed eating some of her wet food with added tuna sprinkles for a while, but yesterday only a little and today not at all. She's still joining us in bed at night and comes out when we call her, she purrs and wants affection, but she's obviously not feeling well at all. And she's gotten so very thin, even her fur looks depleted. She's a ghost of the cat she was.

    In any event, I've been reading this forum diligently, all the stickies and info I can absorb. I know that with some practice and patience, I can home-test her glucose levels and do insulin shots, as well as needed curves. My questions are: If she's been an untreated diabetic for nearly two years, as now seems to be the case, is there any hope we can get her stabilized? I don't expect remission at this point, I'm aware that window may well be closed, but I'd like to try to save her and provide her with a few more years of quality life. She's a senior cat, but probably not yet in her mid-teens, maybe 12 or 13 at the most. Most likely, she's 11 or 12, based on when I first found / trapped her in the park, had her spayed, and the length of time she's lived at home with us and her son, Boy, which would be 7 years now.

    Also, is Lentus the preferred insulin to start? I realize it all depends on the cat and their response, but from all my reading, Lentus appears to be the least "harsh" initiation insulin. She may well require hospitalization today, I'm worried she might have ketatones, which would explain what looks like nausea to me when she approaches the food dish, so I'm trying to take this one step at a time. I broke down yesterday, crying like a child. I adore my cats, I rescued them, and have always been proactive in my pet care. I should never have heeded my ex-vet's "wait and see" approach. I feel guilty that my ignorance and lack of incentive aggravated Mommy's condition, though I also realize other pet owners must face this dilemma. It all felt so overwhelming at first that I seized on the diet change as the one thing I could control. Which was stupid of me, in hindsight.

    I hope we might be able to save her.
     
  2. W.K.

    W.K. Member

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    Feb 16, 2017
    Absolutely. It may take some more time and patience, but it can be done. When are you planning on starting insulin?

    I don't use Lantus or Lev but from what I understand Lantus doesn't sting as much as Lev, especially at higher doses. But every cat is different. Most of us start off with whatever insulin our vets first prescribe and then, possibly switch if we haven't seen progress over several months.

    If you're worried about ketones TAKE HER IN NOW. I don't mean to yell, but DKA can come on fast and hard. The sooner you get her in, the better.

    Don't feel guilty. You were going by what a VET said. Most of us have been in the same place, and now, ignore most of what they say regarding our sugar cats. You obviously care for her. Hindsight is 20/20.

    Edit - I see you're taking her in at 3:30. I must have read over that. Just let us know how things go.
    Keep us updated. :bighug: Hope all goes well at the vets.
     
  3. Larry and Kitties

    Larry and Kitties Well-Known Member

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    Dec 28, 2009
    I have found out that Levemir, which is very similar to Lantus, works better for my cats. Most vets seem to have more experience with Lantus than Levemir and thus your vet may be more comfortable using Lantus.
     
  4. C.W. Gortner

    C.W. Gortner Member

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    Nov 13, 2016
    got her into the carrier. She's not dead yet. She put up a fight. More later!
     
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  5. Juliet

    Juliet Well-Known Member

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    Sep 8, 2017
    How is she now?
     
  6. JanetNJ

    JanetNJ Well-Known Member

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    So how did it go
     
  7. C.W. Gortner

    C.W. Gortner Member

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    Well, just as I suspected, she's an uncontrolled diabetic. Her overworked pancreas was starting to shut down as a result and she's now in early-stage kidney failure, too, which I didn't expect and really blew me apart. She's hospitalized for 24 to possibly 48 hours: IV fluids, insulin, a glucose curve, and battery of other tests to see how she responds to treatment. That said, she had no fever. No ketatones in her urine. She was alert, non-combative with the vet or at the overnight clinic (we had to drive her to the hospital after the vet visit, as our new cat vet doesn't do overnight hospitalization). The new cat vet was very kind and understanding; of course, I cried and said it was my fault for not intervening earlier. He reassured me that her first fructosamine test result was borderline but within "normal range" and she had no indication of any kidney impairment at that time, based on her blood work. What he did point out was that her pancreatic enzymes were already elevated last year and that value, coupled with her elevated blood glucose, should have alerted my ex-vet to a diagnosis of diabetes and prompted at the very least a request for follow-up blood work within 3 months. My ex-vet never requested that or even mentioned it to me.

    I'm struggling with all this, as you can imagine. The new vet told me Mommy was most likely in early onset diabetes at the time of our visit to my ex-vet last year; but, he added, it can be challenging to determine that, at said time, taking into account her overall blood values. In other words, he didn't outright denigrate my ex-vet for negligence, but he did sound perturbed by the way things had been handled. Which of course just made me crazy, because had I known, I could have intervened and prevented this. Still, she's my cat. I should have sought a second opinion much earlier. He also said she's extremely underweight, but otherwise strong, no heart murmur or respiratory issues, and he believed it was worth trying to stabilize her. He was also clear with us: She's in acute distress right now, but should 24-hour hospitalization manage to lower her values, we might enjoy several more good years with her. When I mentioned quality of life, he said time would tell, but diabetes isn't cheap or easy to treat. No kidding. Welcome to San Francisco. Today's grand total is $3,500, hospitalization for 24 hours included. Should she need to remain in the hospital for another 24 hours, add $3000. Whatever. I'll pay. My primary concern is her welfare.

    Thanks everyone for your kindness. This is just a dreadful disease. I'll keep posting as I know more.
     
    Last edited: Dec 2, 2017
    Reason for edit: extra info
  8. Kris & Teasel

    Kris & Teasel Well-Known Member

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    You can do this and we're here to help. :)
     
  9. JeffJ

    JeffJ Well-Known Member

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    Jul 7, 2016
    Keep the spirits up. Sometimes when our kittehs get down, we can get them back up.

    Leo has had a few real low points where we were evaluating quality of life. It took money and a lot of dedicated time to get him back into shape. In each case, we got Leo back to good health. You are at a good point with your kitteh, and it sounds like you have the resources financially and emotionally to get Mommy back to good health. The rewards are great.
     
  10. C.W. Gortner

    C.W. Gortner Member

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    Nov 13, 2016
    Forgot to add, my new vet made his statement that Mommy had lost 2/3 of her kidney function and was therefore in kidney failure based on her urine sample and a few other abnormal test results. But the specialist at the hospital told me that while it's quite likely she is in early stage renal failure, it's also quite possible her renal values are adversely impacted by her current crisis and may lower and/or restore somewhat once she's been stabilized. The specialist said she has seen cases where cats present with all the blood and urine values of kidney failure but really, it's that their kidneys are overworked because of an underlying health condition that, once treated, normalizes/ lowers renal values. She cited a case of hers, a cat with repeated acute urinary blockages. All his values at the time indicated he was in kidney failure, but once the blockages were removed by surgery and his condition resolved, his renal values did, too. Hopefully, once Mommy's diabetes can be stabilized, her kidney values might lower, too, if not normalize. The specialist vet did say she'd be watching this trend as part of her overall treatment plan for the next 24 hours.

    Also UPDATE: I just called the hospital. They gave Mommy a bolus of fluids and she's tolerating it well, holding her own. Her glucose reading at the time was 700 - ! - and so they'll start insulin in the next hour, once she's better hydrated. So far, the specialist said, she's doing alright but her severe dehydration must be addressed first.
     
    Last edited: Dec 2, 2017
    Reason for edit: Update
  11. Sharon14

    Sharon14 Well-Known Member

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    Aug 16, 2015
    I once had a cat diagnosed with kidney failure, but when I took her for a second opinion I was told she had diabetes and was dehydrated. Sure enough kidneys were fine after fluid and insulin treatment. Good luck and keep us posted!
     
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  12. JanetNJ

    JanetNJ Well-Known Member

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    Jun 8, 2016
    Keep us updated
     
  13. C.W. Gortner

    C.W. Gortner Member

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    Nov 13, 2016
    Update: The hospital called me this morning. Mommy is still holding her own. She did well overnight, according to the doc. They started insulin and her glucose values are gradually lowering, which is precisely what they want. She still is not eating however, which they also say is to be expected, so they're giving her an appetite stimulant today. She did show mild ketatones in her urine and blood late last night, so borderline acidosis. Good thing we took her in when we did. There's also concern over the state of her pancreas, which is inflamed; it could be her diabetes or it could be something else, they said, but as she had no pancreatic abnormalities on her 2016 blood-work, most likely the current inflammation is part of her crisis. Nevertheless, to be sure there isn't another underlying pathology, they'll perform an ultrasound tomorrow. She therefore must remain in the hospital for another 24 hours, which we'd anticipated. I'm setting up a GoFundMe page - kidding, but oy, the prices here! How do others without resources manage this? $8000 to save my beloved cat.
     
    Last edited: Dec 3, 2017
    Reason for edit: More info
  14. Juliet

    Juliet Well-Known Member

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    Sep 8, 2017
    They get heavily in debt with loans like me.
    Hope Mommy continues to recover.
     
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  15. C.W. Gortner

    C.W. Gortner Member

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    Nov 13, 2016
    Honestly. I understand medical care is very costly, but this has me in total price-tag shock. in addition to $3500 for the first overnight stay, another nearly $4000 for the next 24 hours, with ultra-sound included. So many cats must be put down by bereaved, desperate owners because they can't afford to save them. It explains why our first attending specialist at the hospital last night cited euthanasia as an option, saying many cat owners just can't deal with a diagnosis of diabetes. We're very fortunate indeed to have the resources, even if there goes our Xmas travel this year. It doesn't matter, I couldn't go anyway because my cat sitter won't be able to inject Mommy and it's far too early after this crisis to then turn around and leave Mommy boarded somewhere for 5 days. I'll stay home and do whatever I must to help my cat, but these vet bills are outrageous. I had my dog insured since I'd adopted her as a wee puppy, which helped a lot when she later developed medical issues, but I never insured Boy and Mommy. Lesson learned. On many fronts.

    The good news is that Mommy's still holding her own. I really feared we were going to lose her yesterday. I could sense her spirit diminishing. Clearly, she has a lot of fight left in her.
     
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  16. JanetNJ

    JanetNJ Well-Known Member

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    I can definitely empathize with the expensive vet bills. In sure I reached 10k in 2017.
     
  17. Juliet

    Juliet Well-Known Member

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    I had to go to the UK last month and my pet sitter couldn’t test either. Wasn’t a holiday. My mom had a stroke. But I halved Silver’s dose and she shot blind. It was better that than no dose at all or keep safe and risk hypo.

    I’m in Canada and discovered iFinance PetCare. High interest rates but they pay your vet bill and then you owe them in monthly installments. I couldn’t bear not being able to treat him just because I couldn’t afford it.
     
  18. C.W. Gortner

    C.W. Gortner Member

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    I'm an historical novelist and do well with my books, knock on wood. My husband has a high-paying job, too. No kids. House recently paid off. Two indoor-only cats. And several feral residents in the garden. We can afford this for now, even if it will take a bite out of other areas. I would take out a loan, however, if I couldn't pay. The mere thought of putting her down is inconceivable, given that if she's stabilized, she can then be treated and regulated at home. I'll admit, I'm scared of what lies ahead - the blood testing and shots, making sure she's responding and doesn't fall into another crisis like this - but I guess it's perfectly normal to feel this overwhelmed at first. Because hubby goes to an office and I stay at home writing, most of the challenge of her daily care will fall on me. But once we can get her regulated, I assume it'll get easier. We'll develop a routine. The learning curve is just so steep at first. My head is exploding right now with insulin doses, curves, needle gauges, diet, and all that jazz, plus worry about her.

    Travel will present another challenge. Our cat sitter is great, she stays here in the house with the cats, but being ex-ferals, my freaks dislike everyone but us. They eat and do their thing, but in the 7 years they've lived here, they have never let the sitter or any other person touch them or even get near enough to touch them. So, unless Mommy shows a sudden change in personality and will let herself be injected by the sitter, when we go away - which is unavoidable - I'm going to have to board her for the duration. I loathe the idea, as she and Boy have never been apart (this hospital stay is a first and so far, Boy seems to be okay without her) but what else can I do? If she won't let herself be treated at home when we're away, I can't risk it.

    One step at a time. As a writer, I tend to project and in this situation, projecting is a recipe for disaster. I can't deal with everything at once. Thank you all for your support! At times like these, you feel really lost and helpless.
     
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  19. Juliet

    Juliet Well-Known Member

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    Sep 8, 2017
    Cross that bridge when it happens. Maybe get your sitter over when you are testing. See if your cat will let her hold while you inject. And you never know - may be OTJ before you need to go away.
     
  20. C.W. Gortner

    C.W. Gortner Member

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    Nov 13, 2016
    I love your video on how to blood test at home. just watched it. Thank you!!
     
  21. Angel's mommie

    Angel's mommie Member

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    Feb 18, 2017
    Please please please start your baby on insulin. It's never too late :); we all make mistakes (and in your case it was your vet's instructions), but it sounds like you have a good chance of giving Mommy some quality years of life. Our vet had declared that Angel was dying as he was at 5.8 lb :( two years ago -- but then I switched vets, and the new one literally saved his life, putting him on Lantus (I absolutely love Lantus). I learned to home test, and to administer shots myself -- at the beginning the home testing seemed daunting, but I watched a ton of videos on YouTube + got tips from this site and what they all said was TRUE -- that you can make it into a bonding experience with your kitty, one they actually look forward to! Angel pesters me each morning and night to be tested, believe it or not! He loves the kisses and cuddles and treats, although not the poking, which luckily only takes a few seconds. Of course it's difficult in the beginning, but I swear it gets easier and in a few days/weeks you'll be a pro.

    The Lantus literally saved Angel's life. He is now a healthy, happy cat as long as he gets his meds. I tried getting him into remission, but he's a long term diabetic who'd been in remission once before, so I gave up after trying for a few months and have simply reconciled to the fact that we have a diabetic cat whom we will almost certainly need to test and give insulin to twice a day for the rest of his life -- and that's fine by us :). He is a darling and a joy! Good luck to you!

    PS: We travel a lot, so we have a lovely vet tech who comes to give him his meds. While we're traveling we only do lantus once a day, too expensive to do twice a day visits from her.
     
    Last edited: Dec 3, 2017
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  22. C.W. Gortner

    C.W. Gortner Member

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    Question about home testing: My vets are all recommending the Alpha Trak 2. I don't mind but I hear test strips are much pricier, and you can user FreeStyle Freedom Lite Strips instead, just ignore the code error, as the result is the same. Does that sound right or should I just get another monitor? I hear human monitors run lower results for cats, so I'd prefer higher accuracy at least to start so as to not have one extra hurdle to overcome.
     
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  23. C.W. Gortner

    C.W. Gortner Member

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    Nov 13, 2016
    Thanks! She's now insulin at the hospital.
     
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  24. Angel's mommie

    Angel's mommie Member

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    Yay, good job!
     
  25. Kris & Teasel

    Kris & Teasel Well-Known Member

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    My opinion is that it's a whole lot easier to use a human meter, learn what the too high/good/too low reference ranges are on it and not bother with an AlphaTrak pet meter. If your vet insists, buy one for doing at home curves to give your vet the data. Use a human meter day to day.

    You can put Freestyle Lite strips into the AT meter but you have to do same drop comparison testing every time you open a new vial of strips. There can be different magnitudes of variation with every vial.
     
  26. JeffJ

    JeffJ Well-Known Member

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    Jul 7, 2016
    Glad to hear that Mommy kitteh is doing better. I hope you can bring her home tomorrow, and then take over the health care.
     
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  27. Angel's mommie

    Angel's mommie Member

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    I began with Alphatrak and used it for over a year because of the same reason you mention (wanted accuracy at the beginning + was trying for remission for a while), but then switched to human strips/meter -- SO much cheaper! I use Bayer Contour Next EZ. If I were to do it again, I might start with the human meter from the beginning. I spent hundreds on Alphatrak strips, especially since one inevitably ends up wasting several while learning (and even after), and now wish I'd just got the human meter as so many sensible folk on this forum do ;-).
     
  28. C.W. Gortner

    C.W. Gortner Member

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    What is the variation on human meters? Is it individual to the cat or are there generalized ranges to look it, i.e., a human test meter on a cat will give X points lower or higher? I own a OneTouch Ultra 2 already that a friend sent me.
     
    Last edited: Dec 3, 2017
  29. Angel's mommie

    Angel's mommie Member

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    Some useful tips I read/discovered :):
    (1) establish a regular testing place. Sofas are great, as you can use the arm of the sofa to hold kitty in place.
    (2) I mostly test on the inside of ear (along the edge) as there's so much less fur there and also the blood droplet shows up so much more easily.
    (3) Poke holding the lancet by hand (not that little lancet machine) -- that way you have better control and kitty does not get scared by the clicking sound
     
  30. Kris & Teasel

    Kris & Teasel Well-Known Member

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    Human meters will read lower than pet meters. The difference is fairly large (100 points +) at high BG levels but less at low BG levels. There's no simple conversion to be done because it isn't a linear relationship. The key thing to know is that the "take action" BG number is 50 on a human meter and 68 on a pet meter. That means the BG is getting too low and it's time to prop it up with a snack that's higher in carbs.
     
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  31. JanetNJ

    JanetNJ Well-Known Member

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    Oh good I hope it helps you to feel more comfortable with the idea of testing
     
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  32. JanetNJ

    JanetNJ Well-Known Member

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    The numbers are pretty close together at low numbers and more of a difference at high numbers. Normal on a human meter is 50-120 and on a pet meter it's 68-150. So while they may only be 20 digits apart at low numbers they could be 100 points or more different at high numbers. Either one will tell you if you are too high or low though.
     
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  33. JanetNJ

    JanetNJ Well-Known Member

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    I personally love the Alphatrak meter, despite the cost. If the cost isn't an issue then it's a great meter. I generally spend about $100 pet month on test strips. Adwdiabetes.com is where I get them and I always use coupon codes from Retailmenot.com
     
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  34. C.W. Gortner

    C.W. Gortner Member

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    Nov 13, 2016
    Thanks. I'm probably going to try the AlphaTrak to start.

    I called the hospital just now. Good news is, Mommy's glucose dropped from an outrageous high of 700+ last night to 245. But they added dextrose in the midday because they didn't want her dropping too fast, so she bumped up to 345. They discontinued the dextrose and will re-test her BG in an hour or so. She is responding to the insulin. However, she's still not eating. They tell me it's not uncommon, simply because she's not feeling well, but basically she has not eaten since Friday night. I'm not sure how concerning this is, given her overall state. They gave her an appetite stimulant about an hour ago and so far, it hasn't kicked in. The fact that she's not eating does worry me but I realize that in her condition, food probably just doesn't interest her right now.
     
  35. JanetNJ

    JanetNJ Well-Known Member

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    Can you bring her some of her regular food? Or a treat like fresh chicken or tuna?
     
  36. C.W. Gortner

    C.W. Gortner Member

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    Nov 13, 2016
    We just got into the car and went to visit her. I had this sense that she's refusing to eat because she's stressed out and she needs to know we haven't just left her there forever. Sure enough, as soon as she heard/ saw us, we caressed her and gave her kisses - she loves kisses - she ate nearly a full can of Fancy Feast for us. She was hungry. The specialist doc was very relieved, too, because they'd been considering a feeding tube if she continued to not eat. We'll go back again at 9:00 p.m. to coax her to dinner. Whatever it takes.
     
    Last edited: Dec 3, 2017
  37. JanetNJ

    JanetNJ Well-Known Member

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    Oh good! I'm relieved to hear she ate well!!!
     
  38. Chris & China

    Chris & China Well-Known Member

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    May 10, 2013
    That's exactly what I was going to suggest....Our kitties will eat for us a lot of the time when they won't eat for anyone else!!

    When you go back, since she's staying another night, take in a nightshirt or pajama's so she has something that smells like you while she's there. Stuff that you wear at night has the most "smell" of you.

    Sending prayers that she'll be much better tomorrow and able to come home to you!!
     
  39. C.W. Gortner

    C.W. Gortner Member

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    We went back to the hospital tonight, with one of our sleeping T-shirts to leave with her, and she was so happy to see us, she ate a full can of food. She had been eating Friskies Classic Pate flavors, a low-carb wet food (she never was much of a dry food cat) but to entice her now-fickle appetite, we brought instead Fancy Feast Classic Beef Feast and Classic Salmon. She loved those - and we really need her to eat, as she's lost 3.5 lbs since last year! Her BC is now down to 245, with food, so she is responding well to the insulin. She has a ways to go yet, of course, but I think we're on the right path. Coincidentally, I found a random thread on this forum that stated FF Classic recently underwent a formula change and are now over 10% carbs. Well, according to this carbs calculator, that's not true. Even the FF Classic Beef is only 3% carb or so. See here: http://fnae.org/carbcalorie.html

    Is FF Classic (non-gravy) okay to feed her when she comes home? She seems to really like it and the 3.oz serving size is ideal for me to manage her actual food intake as I work out her regulation cycle and curves. My other cat Boy will eat it, too.
     
    Last edited: Dec 4, 2017
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  40. Chris & China

    Chris & China Well-Known Member

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    There's a misconception going around the message board regarding the FF classics.....yes, they did change their recipe awhile back, but what happened with some cats was diarrhea or they just wouldn't eat it....the vast majority of cats that ate it before had no issues with raising of BG

    It's fine for her ....and if she likes it, that's a bonus!!
     
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  41. C.W. Gortner

    C.W. Gortner Member

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    Thank you!! Too much reading online info in too short a span of time has done fried my brain. She loved the FF and basically, if she eats well, then we can better manage her insulin dosage. The hospital staff was so thrilled that we got her to eat twice today, they applauded us as we left. She's in great hands there, but once she comes home (we have one more in-hospital hurdle tomorrow, her pancreas ultra sound, but I'm not too worried about that; I think the inflammation is part of this crisis, not a neoplasia) then we must keep her eating. She had gone off the Friskies Pate when she started to slide into this abyss, so a new food that excites her is just what she needs now.
     
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  42. JeffJ

    JeffJ Well-Known Member

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    Jul 7, 2016
    Little Dude is not diabetic. But he was at the cat hospital for a week this year. He would not eat at all there. Some cats are like that. Your kitteh will feel lots better at home.
     
  43. JanetNJ

    JanetNJ Well-Known Member

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    Are they determining if it's pancratitis? If so once she's stabilized the treatment is generally cerenia for nausea, bupe for pain,and sub q fluids for dehydration. All of that can be done at home. I'm so glad she's eating well now. Ff classic and Friskies pate foods are what most of us feed.
     
  44. C.W. Gortner

    C.W. Gortner Member

    Joined:
    Nov 13, 2016
    It was a horrible roller coaster day today. King Specialist Dick Doc called me in the mid-afternoon with the results of Mommy's ultrasound: her kidneys are impacted, she has pancreatitis with some fluid in her abdomen, and hepatic acidosis; he basically presented a very dour clinical picture, which devastated me. He said she needed another 24 hours in the hospital or we could take her home tonight, but cats with her concurrent conditions "fare very poorly at home." He intimated that should we decide to bring her home tonight, she'd keel over within 3 hours. I asked what another night in the hospital would accomplish if she was so bad off and he said, tersely, "We'd continue our supportive treatment, of course." I asked him if she had any signs of infection in her urine. No, her culture was clear. Is she in pain? No, she is not. She's resting comfortably. She's shown no sign or need for pain meds, though she is on a preventive course of antibiotics.

    Okay.

    So, of course, as soon as I hung up with him, I fell apart and called my husband at work. We both decided, in tears, that it was best for her to let her go. But I had the ultrasound values sent to my new regular vet anyway, and while I waited for her to call back, I phoned the hospital again to schedule an euthanasia time so we can be both with Mommy when she passes. Dick Doc got on the phone and said, sounding taken aback, "Wait. I wanted to have you a full clinical picture." I replied, "And you gave it to me. She's in severe kidney failure." "No," he corrected, "she has kidney 'insufficiency', which is quite common in cats her age, and her values aren't that bad, actually." Of course, then I got upset and retorted, "I don't get it. You tell me she's in kidney failure, but now her values aren't that bad?" And he said, "After I hung up with you, she ate voluntarily on her own, so she's eaten twice today on her own, and her BG is now 245, which is right where we'd like to see it at this stage." I told him that I needed a straight answer because while we want to do everything we can for her, it's not cheap and we don't want her to suffer unnecessarily, especially if there's no hope . . . He replied, quietly this time, and finally showing a hint of humanity, "Let me put it this way: If she was my cat and money wasn't an issue, I'd give her another night in the hospital." Which, to me, doesn't sound like a ringing endorsement for euthanasia. He went on to add, "There are no right or wrong choices, or any guarantees. Her long-term clinical picture and prognosis aren't great, but she is rallying thus far." No ****, Sherlock: she has acute FD and pancreatitis, but she's obviously not at death's door yet.

    Then the new regular vet called me to confirm that while the pancreatitis is indeed concerning, there are no structural changes in her stomach, which is good; her renal values are indeed within the expected "impaired" range of a senior cat, and she said (she's a very kind woman): "You must do what is best for you and for her, but she might surprise us. Your little Mommy is a fighter. Her BG has gone from astronomical to manageable, and her other values are falling slowly but steadily. I don't want to give you false hope or expectations, because the situation is serious, but just like when people are sick, each case is individual. Her prognosis long-term is poor based on her clinical picture now. Does that mean she'll die next week or in three years? No one knows. If you put her down tonight, you can't resurrect her. Should the time come sooner rather than later, or later rather than sooner, you can always make the decision then."

    So, I phone my husband again and we decide to give Mommy a chance. We love her. We can't put her down because of money, though we're not rich. I called the hospital back to pay for another night. And guess what? It's only another $748! That's right. Mr Specialist Dick had me in agony for hours, thinking my cat was dying and should be put down, and NEVER once did he mention the extra night is $2000 less than what we've paid so far.

    I'm a wreck, but I'm going to see my cat tonight. Mommy is a fighter. And we're fighting with her. I just hate vets. Their impersonal approach is like ice water thrown in your face. Don't they understand that while it might be another patient for them, to us, it's our beloved animal companion? It's as if being human or warm is a crime in their profession.
     
    Last edited: Dec 4, 2017
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  45. Juliet

    Juliet Well-Known Member

    Joined:
    Sep 8, 2017
    I am sooo sorry to hear you are going through this but please be encouraged. Docs DO NOT know everything and a lot of medical treatment is guesswork so you did the right thing. Let Mommy guide you. If she’s rallying then she wants to live. I’ll tell you what happened to us this past couple weeks to let you know I understand. My mum (reasonably young at 70) suffered a major stroke followed by a brain bleed (caused by docs putting her on Warfarin instead of the newer, better blood thinner). Two days later the family is called to say she is now in palliative care and will not survive the night. She’s in the UK. I’m in Canada. Needless to say we are devastated. I jumped on a plane expecting to attend her funeral. The docs took her off all water and food and sedated her waiting for her to pass. SIX DAYS LATER she is still alive and asking for water. Docs changed their minds took her out of palliative care and started actively treating her. She is now up and about and making phone calls.

    I say this to say - trust Mommy to lead and take what the vet says with a pinch of salt. My vet prescribed steroids and three days later asked me why she was on them! I have very little faith in the medical practice. Human and vet.
    Your regular vet sounds a lot more human tho. Can you move Mommy to her care?

    Hugs and please keep us posted.
     
  46. JeffJ

    JeffJ Well-Known Member

    Joined:
    Jul 7, 2016
    Another $750 is not horrible. It seems like much of the care can be delivered at home.

    Leo was in a real bad spot earlier this year. We went the extra mile. It cost money and a bunch of my time. But now he's doing great. It's hard making decisions when they get in bad shape.
     
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  47. C.W. Gortner

    C.W. Gortner Member

    Joined:
    Nov 13, 2016

    Unfortunately, I can't move her to the new regular vet yet. She needs a specialist for the foreseeable future, but I am going to request another internist at the practice that my new regular vet suggested. She told me this other internal specialist is warmer and more personable; that while King Doc is a respected and well regarded specialist, obviously he and I have "communication" issues. You think? But vets, like many other professions, never denigrate each other, though this guy is prime-A asshole. He heard me falling apart on the phone and it never occurred to him to say, "Hey, look. If you're unsure here, the extra night is $748. If you can do that . . .?"

    I could just strangle him.
     
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  48. JanetNJ

    JanetNJ Well-Known Member

    Joined:
    Jun 8, 2016
    Pancratitis is treatable. FD is treatable. Kidney failure, while there's no cure, can be allowed down with treatments.

    My cat Zimmy had pancratitis (and ckd)... He needed cerenia pills for nausea for 4-5 days, bupe for pain for a week, and we did daily sub q's for about 2 weeks. He was back to his normal self in about a week.

    FD is very treatable and we are here to guide you through that.

    Ckd can be delayed with lower phosphorus food /or a binder and extra fluids.

    I always said I'd my cat is willing to fight so am I.
     
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  49. tiffmaxee

    tiffmaxee Well-Known Member

    Joined:
    Nov 15, 2013
    I’m so sorry you are going through this BUT a cat that is eating does not sound like she is giving up. A cat that sick won’t eat on her own even if given an appetite stimulant. Hepatic lipidosis is from not eating. That will go away. Kidney insufficiency can be controlled. I can send you to a site and a crf list for guidance. My cat had pancreatitis for several years. It led to diabetes. That too can be treated. Neither of my cats would eat when hospitalized. Thank goodness you visited. I’m hoping for an even better report tomorrow.
     
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  50. C.W. Gortner

    C.W. Gortner Member

    Joined:
    Nov 13, 2016
    We went to see Mommy tonight. She's looking and acting so much better, brighter and very alert. She ate a full can of FF Salmon, too. She was hungry. She's now on Lantus 1u 2x day, just starting today, and her BG has been bouncing around a bit; it hit 330 at one point, but then dropped to 255. Still, she was first hospitalized at a skyrocketing 700+, so even 330, while not ideal, is a definite improvement. The attending vet tonight - thankfully, Dr Dick had gone home - mentioned to me that Mommy might be "hard to regulate". Excuse my French, but it's been less than 24 hours since she was taken off the insulin pump and onto subcutaneous injection. How the **** can they know if she's hard to regulate at this stage? If Lantus doesn't get her BG low enough, then try Lemevir. Try Vetsulin. DO your jobs! I was about to read them the riot act, but seeing as she's there for another 24 hours, I held my rapier tongue. Honestly, you'd think I was the vet. Just by being on this forum for a week, I seem to have a better grip on the situation than they do, with all their diplomas and credentials.

    FYI: Here's a picture from tonight of my cat-at-death's-door (not); the beauty we almost decided to euthanize because of Dr Dick's dour prognosis. As you can see, she is nowhere near dying at this point - though she did pee on me, as they brought us to see her in a little visiting room with no litter box and she'd been hydrated like a hippo.
     

    Attached Files:

    Last edited: Dec 5, 2017
  51. Chris & China

    Chris & China Well-Known Member

    Joined:
    May 10, 2013
    Unfortunately, that's the rule, not the exception around here. The sad facts are that vets only get 5 hours of "formal" education when they're in school on diabetes, and that is for both dogs and cats! And since they see more diabetic dogs, they tend to treat their cats like small dogs. Unless they have a special interest in feline diabetics, even if they do get continuing education, it's usually for dogs.

    The reason this forum seems to know more is because the people here deal with this disease 24/7/365...where most vets might only see a handful of diabetic cats in their entire career. We also have the time to research on the latest treatments.

    To be fair, vets can't really stay up to date on the latest treatments for every disease in every type of animal they see. If they tried, they'd never have time to see actual patients!

    SO glad to hear Mommy is acting so much better and eating so well!! Hopefully she'll be home tomorrow and you can get to the serious work of treating her the best you can and she'll have many more years of love to share with you!
     
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  52. C.W. Gortner

    C.W. Gortner Member

    Joined:
    Nov 13, 2016
    Her BG bouncing around a bit during the first weeks on Lantus isn't unusual, right? I mean, logic tells me that as her body has been accustomed to very high BG, it's going to resist a little at first, take some time to adjust and auto-regulate. I'm not clear on why they'd expect her to fully regulate in the 200s at such an early stage of her treatment. They expressed concern that she wasn't staying low enough for long enough, but she only just had her first injection. She went into the 190s on the pump but she justy had her second injection at 9 p.m. tonight, so I've called to get the most reading on her and am waiting to hear back.
     
  53. JanetNJ

    JanetNJ Well-Known Member

    Joined:
    Jun 8, 2016
    Take a look at some of our spreadsheets....MOST CATS BOUNCE around especially on the beginning. Numbers in the 300-400... Are the norm, esp the first few months. Now you said she had ketones, so that's a reason for her to stay the extra night, but numbers in the 300's are what you should expect to see for preshot numbers at thus stage.
     
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  54. Kris & Teasel

    Kris & Teasel Well-Known Member

    Joined:
    Aug 17, 2016
    This is NOT realistic. Your kitty has been to hell and back and it's very early days. The time taken to achieve regulation varies widely among cats and I'm not sure most vets appreciate this fact. My guy was diagnosed 2 years ago and I'm still working on getting him more stable. He's particularly tricky but you can get somewhere even if your kitty is hard to regulate. If you're willing to take on her FD treatment yourself with help from this forum you'll make progress for sure.
     
  55. tiffmaxee

    tiffmaxee Well-Known Member

    Joined:
    Nov 15, 2013
    It took Max a full year to get regulated. They just need to get her other issues stable and then when she’s home you will get all the help you need to regulate her.
     
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  56. C.W. Gortner

    C.W. Gortner Member

    Joined:
    Nov 13, 2016
    Thank you, everyone, SO much! I don't what I'd do without this forum as I navigate this upheaval. Specialist Dr Dick called this morning. He tried to be more personable, so I think he realized I wasn't amused by his previous icy, dour demeanor. Her BG is in the mid-400s this morning. He's upping her Lantus to 2 units twice a day, which he felt is appropriate, but he did add that yes, it's to be expected that she'll bounce around quite a bit. So, he at least acknowledged that. He told me the primary goal right now and in the foreseeable future is to keep her from developing ketatones again, and it doesn't take much insulin to prevent that. Her renal value (creatine) is 2.4, which he says isn't great, but about the best that we can expect at this point, given her overall condition, though it may lower a bit more over time. Her RBC is a bit low, too, but again, he said that if she continues to eat well and puts on weight - her appetite remains good - then that, too, should improve. He appreciated that I let her stay another night but added she's "very nervous" in the hospital and that could skewer values. Perhaps once shes back home and at ease, her overall clinical picture will improve. He didn't sound very encouraging in this respect, but I don't think he has it in him to be encouraging. I think his modus operandi is to emphasize worst case scenario, as if he fears giving false hopes or expectations that might come back to bite him in the ass.

    If all remains as above throughout the day, he'll discharge Mommy this evening. I brought up the fact that based on my copious research here and elsewhere, Lantus is a depot insulin and its efficacy really can't be fully determined for at least 5 to 7 days, as it takes time to build up in the cat's system. He was dismissive of that, saying that typically in most cats - he cites "typically, in most cats" often, like a catchphrase - Lantus is effective from onset of treatment. Whatever. I didn't care to argue with him, I just asked that should it not prove as effective as claimed, could we switch her later to another insulin? Yes, he said, there are, of course, other insulins to consider.

    Between my cat's illness and dealing with him, I need a Xanax drip.
     
    Last edited: Dec 5, 2017
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  57. JanetNJ

    JanetNJ Well-Known Member

    Joined:
    Jun 8, 2016
    2.4 creatnine is stage 2 ckd. He most likely has more years ahead of him.... That's not super high. Down the road things like sub q fluids will help... For now low phosphorus food, vitamin b 12 (that will help with neuropathy AND mild anemia), and add extra water to his food and extra water bowls around the house.
     
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  58. C.W. Gortner

    C.W. Gortner Member

    Joined:
    Nov 13, 2016
    Any specific type of vitamin B-12 for cats that you can recommend? Unfortunately, she loves FF Classic Pates of any fishy variety and I need to keep her eating. She will sometimes eat beef and poultry but she's finicky (from feral to princess in 7 years :); the only way we got her to eat at the hospital was enticing her with FF Classic Salmon Feast, which she devoured. I know fish-based foods are higher in phosphrous than is good for her, but her weight is a grave concern to everyone involved. From 9 lbs last year in April, she's now down to 6.1. They said she was "emaciated" so I need to put weight on her and keep her eating regularly, especially with insulin on board.
     
    Last edited: Dec 5, 2017
  59. JeffJ

    JeffJ Well-Known Member

    Joined:
    Jul 7, 2016
    Well, at least she did finally pee last night. Too bad it was on you. When Little Dude was at the vet for a week, he kept holding it. Then he got it all over himself (poor Dude).

    For the internist to not know details about insulin is tragic. I think many vets don't spend enough time dealing with diabetes in detail. It is unfortunate that many humans gain their knowledge from this site instead of from their vets. But I'm glad this site is here, as I learned a lot. And we haven't discussed Acromegaly yet. Hardly any vets know details about that.

    For B12 - Zobaline. Do a search in the forum, it is a common topic. Leo was on it for awhile.
     
  60. Kris & Teasel

    Kris & Teasel Well-Known Member

    Joined:
    Aug 17, 2016
    You have to deal with the most pressing issue first and that's getting her to eat and keeping her eating. Enough food and enough insulin are the weapons against ketone formation. Feed her whatever she'll eat willingly. Once she's past this crisis you can address the specific dietary needs of a kitty in early stage kidney disease.
     
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  61. C.W. Gortner

    C.W. Gortner Member

    Joined:
    Nov 13, 2016
    That's exactly what the specialist just told me when he called. He was more personable, too. They're discharging her this evening. She's coming home with a scrip for 2 units of Lantus 2x daily - she was increased to 2 units today, and it dropped her BG to 310; an anti-nausea medication, 1/8 of a pill once a day for 5 days, then two days off, and an appetite stimulant. He's also giving me a scrip for a once-weekly B12 injectable that he says can be challenging to find locally, just because many pharmacies don't carry it, so to shop around online for it; but it wasn't urgent, he said. I don't need to start the B12 right away. Basically, he said, we need her to keep eating. If she eats less than usual, he said it was okay to drop her dose to 1 unit 2x a day and make note of it. His main concern seems to be her appetite, which makes sense. He's not the friendliest dude on the planet but he is an excellent clinician by all accounts, so I guess I'm going to bite my cheek and deal with him for now, as he's been handling Mommy's case these past three days.
     
    Last edited: Dec 5, 2017
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  62. JeffJ

    JeffJ Well-Known Member

    Joined:
    Jul 7, 2016
    The Zobaline B12 is tasteless. It is a small tablet. You crush it and sprinkle it into their food.

    Plus injectable B12 is readily available. I got some directly from my vet when Leo was having issues.
     
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  63. JanetNJ

    JanetNJ Well-Known Member

    Joined:
    Jun 8, 2016
    So glad he's coming home!!! Here's a link to the zobaline. Zobaline™ (for Diabetic Cats) 3 mg x 60 tabs https://www.amazon.com/dp/B008G3LI2M/ref=cm_sw_r_cp_api_tqZjAbYB11NBJ
     
  64. PussCatPrince

    PussCatPrince Member

    Joined:
    Nov 25, 2017
    I'm still trying to learn so can offer you no wisdom at all.
    I can offer you a cyber hug from New Zealand for what you and Mommy have gone through & hope you get her eating and more stable.

    M
     
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  65. tiffmaxee

    tiffmaxee Well-Known Member

    Joined:
    Nov 15, 2013
    If the nausea medication is cerenia there is no need to take two days off. That is the old protocol. Ask which nausea medication and post here later for advice on dosing of it. The fatty liver is definitely due to tge big drop in weight so it’s impirtant to keep her eating and deal with food changes later. All this is very encouraging.
     
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  66. Chris & China

    Chris & China Well-Known Member

    Joined:
    May 10, 2013
    China's creatinine was at 2.5 in Oct 2015.....in March 2016 it was 2.2 and in July 2017 it was 2.2.....and her SDMA (the newest test for kidney disease) was normal ....10 (on a scale of 0-14) in March '16 and only 9 in July '17

    I wouldn't worry too much about the 2.4.....that's pretty normal for an older cat
     
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  67. C.W. Gortner

    C.W. Gortner Member

    Joined:
    Nov 13, 2016
    The nausea medication is cerenia.

    Where do people buy their insulin? I just got her Lantus 100 ml vial at Walgreens. $338! I need a cheaper source, as at her current dosage, this vial will only last 25 days.
     
  68. Chris & China

    Chris & China Well-Known Member

    Joined:
    May 10, 2013
    First, a 10ml vial is 1000 units and although they'll tell you it's only good for 28 days, it will last 4-6 months in the refrigerator!!

    When it IS time to get more, you can order it from Canada for a lot less....that's what most of us are doing. Here's the information on where we're ordering our Lantus
     
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  69. C.W. Gortner

    C.W. Gortner Member

    Joined:
    Nov 13, 2016
    The box says 100 units / ml. One 10 ml vial. Am I reading this wrong?
     
  70. Juliet

    Juliet Well-Known Member

    Joined:
    Sep 8, 2017
    No that’s correct. 100 units = 1 ml. You have a 10ml vial not a 100ml vial which is 1000 units as @Chris & China said.
     
  71. C.W. Gortner

    C.W. Gortner Member

    Joined:
    Nov 13, 2016
    I called the pharmacist. It is 1000 units. 100 units per ml x 10 ml vial = 1000 units. Which should last her 200 days at her current dose and that I can afford.
     
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  72. Kris & Teasel

    Kris & Teasel Well-Known Member

    Joined:
    Aug 17, 2016
    The insulin might not retain its potency after 4 to 6 months. You might end up discarding part of the vial. That's why many people but pens and use their internal cartridge as a mini vial from which to draw insulin. That cartridge is 3 mL and you can use it all up before it poops out. The pens are sold in a 5 pack. Many US people here order from Canada because Lantus is a lot cheaper here.
     
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  73. C.W. Gortner

    C.W. Gortner Member

    Joined:
    Nov 13, 2016
    I asked Dr Dick about the pens and he said the vial was more economical, but I'll get the pens next time. For now, I'll refrigerate the vial. Should I place it in a baggie or do anything else to help maintain its durability?

    I'm losing my mind. This is SO much to take in . . . I know it'll settle down once we have her on a schedule that works, but right now I feel like I'm stumbling in a tunnel.
     
    Last edited: Dec 5, 2017
  74. Kris & Teasel

    Kris & Teasel Well-Known Member

    Joined:
    Aug 17, 2016
    Put it in a small baggie, stand it up in a small container and put it near the back of a shelf in the fridge, not the door - too much jostling from the door. Some people wrap the vial in bubble wrap or similar.
     
  75. Chris & China

    Chris & China Well-Known Member

    Joined:
    May 10, 2013
    Just keep it on the shelf in the middle part of the fridge...Not on the door and not all the way in the back where it might freeze.
     
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  76. Chris & China

    Chris & China Well-Known Member

    Joined:
    May 10, 2013
    2U may also end up being too much....we only increase in .25 unit increments so we don't bypass what could be a "perfect" dose. Small changes in dose can make a big difference!!

    Once she's home, her numbers may come down quite a bit too....just being under stress at the vets office can raise some cats blood glucose 200 points!
     
    Last edited: Dec 5, 2017
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  77. C.W. Gortner

    C.W. Gortner Member

    Joined:
    Nov 13, 2016
    Mommy is finally home. She drank a lot of water from her bowl as soon as she arrived - which freaked us out a bit, but I suppose she was thirsty - used the cat box, and then promptly went to hide under the bed. I think she needs to de-stress from the hospital stay, but we'll try to entice her to eat a bit later, as her next dose of insulin is at 9 p.m. (CA time), so little over an hour from now.

    She looks so much better, more alert and bright-eyed, but after three days in the hospital, she's acting almost like the scared feral she was when I first brought her home 7 years ago. The vet techs cuddled and petted her at the hospital, they showed me pics, so she definitely had human-touch contact there, especially at night - and what's even more surprising, she let them do it. Maybe she's just bewildered at the moment. Her son Boy came up to see her, sniffed her butt, and waltzed away, as if to say, "Oh, you're home."

    Cats.
     
  78. JeffJ

    JeffJ Well-Known Member

    Joined:
    Jul 7, 2016
    I get Levemir pens from Alan Hamman on the Supply Closet subforum. He's reliable, and they are a huge discount from Walgreens. He also sells Lantus. I haven't bought from a store in over 18 months.
     
  79. Barbara & Uncle

    Barbara & Uncle Well-Known Member

    Joined:
    Oct 13, 2016
    So happy Mommy is back home with you and looking better :bighug::bighug::bighug:
    As far as "stumbling around in a tunnel" you can lean on us AND we'll try to lead the way as best we can.

    Also, whenever you're ready, you can start posting over in the Lantus/ Levemer Forum. The LL Forum is full of people with tons of experience treaty kitties using that particular type of insulin.
     
  80. C.W. Gortner

    C.W. Gortner Member

    Joined:
    Nov 13, 2016
    She came out to eat - good sign! - and I'm ridiculously proud to say that I gave her her first at-home 9 p.m. insulin dose. I was a bit of a nervous Nellie shooting her, the dose itself is so tiny and the needle so fine, it's like insulin for Lilliputians, but she seemed quite nonplussed by it.
     
  81. Barbara & Uncle

    Barbara & Uncle Well-Known Member

    Joined:
    Oct 13, 2016
  82. JanetNJ

    JanetNJ Well-Known Member

    Joined:
    Jun 8, 2016
    That's great!
     
  83. C.W. Gortner

    C.W. Gortner Member

    Joined:
    Nov 13, 2016
    I dosed her again this morning. She pee'ed a lot last night, not huge volumes (in fact, less volume by far than before this crisis) but more often. I think she wasn't peeing very much at the hospital, except when she peed on me. At around 4:34 a.m., she meowed at us in bed, where we were passed out from the last few days of stress. She was hungry and gobbled up a full can of FF. In my sleep-deprived haze, I forgot to just add her pills (which need to be cut into minute slices with a pill cutter) to her food at that time. So, this morning, while she took the insulin fine, she wasn't interested in eating; and as if she knew that I needed her to take her pills, she crept back under the bed to sleep and refuses to emerge. Being an ex-feral, she's always been far more active at night, so I'll just attempt to get her anti-nausea and appetite stimulant into her later. I left the food with the pills out on her tray in case she gets hungry, in case.

    Oy.
     
  84. JeffJ

    JeffJ Well-Known Member

    Joined:
    Jul 7, 2016
    That's good news that Mommy ate some more food. I hope she continues to improve.
     
  85. C.W. Gortner

    C.W. Gortner Member

    Joined:
    Nov 13, 2016
    She ate another can of FF today, too, and I managed to give her her pills hidden in the food. But she hasn't pooped yet. At the hospital, they had to give her an enema (yesterday) because she was backed up. Should I be concerned or wait another 24 hours to see if she poops? I know the appetite stimulant they prescribed, Mirtazapine, lists constipation as a potential side effect, but pancreatitis can cause it, too, and she had that. I just want make sure I'm doing whatever I can for her. I saw on the forum that some people here use Miralax, 1/8 teaspoon mixed into the wet food, but I don't want to get ahead of myself and add stuff ad hoc to her regimen.

    Forgot to add, I did call the hospital and they told me it wasn't a serious concern right now, as she had a "large" bowel movement there yesterday and it might take another 24-48 hours for her to poop again. I'm so hyper-vigilant at this point, even no poop gets me in a tizzy! :)
     
    Last edited: Dec 6, 2017
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  86. tiffmaxee

    tiffmaxee Well-Known Member

    Joined:
    Nov 15, 2013
    I’ve used Miralax a lot. It’s mild and can take a few days to work. It’s a dose to effect drug so if too little won’t work and too much will cause loose stool. 1/8 teaspoon once a day is the usual starting dose. Check with your vet but it should be fine. Skipping a day here and there is not alarming but after all she’s been through recently you want her as comfortable as possible. We are almost all helicopter moms and dads around here.

    Here’s a site devoted to ‘‘tis should you be interested:
    felineconstipation.org
     
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  87. C.W. Gortner

    C.W. Gortner Member

    Joined:
    Nov 13, 2016
    Thanks! I'll try some Miralax tomorrow if she doesn't poop. I don't want to schlep her back to the hospital for a $350 enema, as they suggested if she fails to deliver. We have a follow-up appointment with Dr Dick next week on Tuesday, and that'll be traumatic enough. Otherwise, she appears to be doing well. She lets me give her the shots like a champ and today, she ate nearly 3 full cans of FF. She's still peeing a bit more than I'd prefer, but her volume of urine is significantly reduced from what I was seeing at the onset of this crisis - which were large, thick pancakes of urine-soaked litter, though she never flooded the box as others have reported with diabetic cats. She's being very affectionate and she's purring, especially when we play our new game of 'I give you a shot, and you give me a shot.' I shoot her and then put the food plate before her, cooing that now it's her turn is to eat, which she does. She's always been a nibbler/grazer cat, so I have to keep wet food available for her at all hours. Thank god I work at home! If anyone but another crazy cat person could see me, baby-talking my feline into eating . . . But she's such a fighter. She almost died 4 days ago and today, she's following her son Boy around and eating pretty well, all things considered.

    She must be feeling better, too, because when she was sliding downhill last week, Boy wouldn't leave her side until we rushed her to the vet. Now, he's acting nonchalant; being a cat, he has a much better sense of these things than humans. I think he knew she was collapsing because looking back, his anxiety those last few days was evident. I'm now watching him as a gauge of her overall well-being.

    My AlphaTrak 2 arrived late tonight, so I'll start spot-testing her BG tomorrow, though Dr Dick didn't want me to start home testing until after our follow-up appointment, for reasons that remain unclear. I suspect he thinks I'll panic if her BG is high and change her dose or something equally heinous to him, though I'm still too wary to adjust her insulin until I get a trend of how her BG is reacting to the current dosage.

    I really appreciate from the heart all the advice and care you've all given me. This has been a steep, desperate learning curve for me, and the forum has helped save my sanity. I feel more in control than I otherwise would, if the forum wasn't available. I don't know what the future holds for her, with all her issues, but as long as she's willing to fight, so am I. Bless all of you and your cats.
     
  88. tiffmaxee

    tiffmaxee Well-Known Member

    Joined:
    Nov 15, 2013
    So glad you will start testing today. The danger is getting too low and not being too high. It’s important to test before insulin and food to make sure she’s not too low to inject and then get tests between 4-7 hours after as lantus is dosed on the lowest point in the cycle, the nadir.

    Eating shows she’s far from ready to check out. It sounds like she is recovering well. Miralax is mild and won’t hurt her. If no poop this morning I’d start it. It’s tasteless so you can put it in her food.
     
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  89. C.W. Gortner

    C.W. Gortner Member

    Joined:
    Nov 13, 2016
    She actually pooped a little last night. She is more energetic and eating a lot, which she wasn't doing the week leading into the crisis. Unfortunately, she's drinking more than I think is okay, about 2 cups of water a day. She's also peeing about every 2 hours or so, not massive amounts but still . . . I'm measuring her water bowl, which holds 3 and 1/2 cups of water. On the upside, she's more active, especially at night - which is quite common for her - as well as hungry, so I'm just feeding her as much as she wants because she lost so much weight. She ate a full can of FF overnight and then another this morning, so her appetite stimulant is definitely working.

    I tried to BG test her this morning before her shot, and it was a bust. I had everything ready with the AlphaTrak 2, coded the meter to the strip, put in the trip, pricked her, and managed to massage up a bead of blood. But in my haste, I smeared the blood onto the test strip and received an error 2 message, probably because I didn't touch the strip to the blood but actually tried to scrape it up, which smeared the blood on her ear. So, I screwed up and lost a test strip. She tolerated the process, but then Boy sauntered into the room, curious, and she just wanted to get away from me to join him. I know it takes practice and patience to test, so I'll try again later at the 4 hour-mark, as I went ahead and dosed her since it was time for her a.m. shot, and she still seems symptomatic to me. She's on 2 units of Lantus twice a day and only weights 6 lbs at this point, so I'm not sure if it takes a few days for Lantus to build up in her system. I read about the depot part of the insulin, but when I asked Dr Dick about it, he waved it aside, saying Lantus was merely a slow building insulin after each shot, as in, it starts to work a few hours after the shot.

    I feel like an idiot, but the BG testing makes me nervous, probably because it's a prick, blood, and I need to practice to get the hang of it - on $3 test strips!
     
    Last edited: Dec 7, 2017
  90. JeffJ

    JeffJ Well-Known Member

    Joined:
    Jul 7, 2016
    Yes, Lantus is a slow building insulin. After a couple of days, you can really start to measure effectiveness.

    The blood testing will become easier. If you take too long after inserting the strip, it will time out. You can try that with a strip, and measure it on a second hand. Once it times out, you just reinsert the strip.

    You can get FreeStyle Lite test strips for AlphaTrak 2 - on ebay. The last lot I bought was $93 for 300 strips. So around $0.30 a strip.
     
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  91. nmveasey

    nmveasey Member

    Joined:
    Nov 15, 2017
    @C.W. Gortner
    How is Mommy doing? I was thinking about her today.
     
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  92. C.W. Gortner

    C.W. Gortner Member

    Joined:
    Nov 13, 2016
    She's still doing okay. Tomorrow, she goes in for a check up - if I can snag her and get her into the carrier. She hates it. :)
     
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  93. nmveasey

    nmveasey Member

    Joined:
    Nov 15, 2017
    Good. I hope she continues to improve.
     
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  94. C.W. Gortner

    C.W. Gortner Member

    Joined:
    Nov 13, 2016
    Hi all, Mommy's follow up appointment went fine - and resulted in another highway robbery on my wallet. But I am concerned that at 12:23 p.m., which was about 3 1/2 hours since her 9 am shot, her BG as measured at Dr Dick's was 132. That's great, but significantly lower than what I'd gotten around the same time a few days ago. Dr Dick was nonplussed - "She'll bounce around a lot," he drawled - but I am not. If she's going that low only 3 hours after her first morning dose and has been on Lantus 2 units 2x a day for over a week now, shouldn't we consider adjusting (as in, lowering) her dose? Dr Dick said no, and again, while supportive of my home testing her BG, expressed concern over how daily regular home testing would affect my bond with her. I had to reply, "You're her doctor. You concern yourself over her blood tests and let me worry over our bond." What a condescending putz.

    So. I'm going to home-test her now before every shot and at the 6 - 8 hour point going forward. I'm thrilled she went so low, but I don't want to risk a hypo episode that ends becoming another thousands of dollars emergency. Have I mentioned how much I hate vets? Dr Dick spent little more than six minutes examining her, had her taken back for blood work, and charged me $500.

    I'm done with him. I'm returning to my regular vet, since the cat he thought last Saturday was dying is clearly not.
     
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  95. JeffJ

    JeffJ Well-Known Member

    Joined:
    Jul 7, 2016
    "You're her doctor. You concern yourself over her blood tests and let me worry over our bond."
    You are 100% correct.

    The 132 measurement is a bit low, but not abnormal. There can be some bouncing around. If you want us to help, please start typing in the preshot numbers, and whatever mid-term values you get. Otherwise it is challenging for any of us to provide dosing advise.
     
  96. Badtux

    Badtux Member

    Joined:
    Dec 9, 2017
    132 could mean anything. It all depends on where you caught her in the cycle, whether she was stressed at the time, etc. Institute regular checking at home at various places in her cycle. 2u of Lantus with a 132 number by itself based on where she started out wouldn't worry me, because of the way Lantus works -- if you look at the curve, it slow-releases over a 24 hour period, with a bit of delay at the beginning and trailing off at the end, thus the reason it's given at 12 hour intervals. So her blood sugar isn't going to suddenly crash, you'll get plenty of warning, assuming you're doing the testing. Get enough numbers to figure out your cat's curve, then dosage can be adjusted to move the curve -- but slowly, because nothing happens fast with Lantus. Just breathe, and relax a bit, you're past the hard part and nothing really bad is going to happen fast now.
     
  97. tiffmaxee

    tiffmaxee Well-Known Member

    Joined:
    Nov 15, 2013
    Actually treating diabetes makes the bond even stronger! I’d ditch that vet too.
     
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  98. C.W. Gortner

    C.W. Gortner Member

    Joined:
    Nov 13, 2016
    Happy New Year everyone! Hope you had a lovely holiday season.

    Update on Mommy: she's eating very well and has already gained back some much-needed weight. She looks much better, too: bright eyed, acting more like herself - more energetic and affectionate, going downstairs to hang out at night with Boy. Her usual routine. All seems to be going well, thank Bastet. However, she's still peeing and drinking a bit more than I'd prefer at night, less overall than before her diagnosis, but similar volume at times, such as two large-size paddies in the box last night, which is consistent with how it's been. Definitely less pee / less volume during the day, however, though she's always more active at night. So, the pee part is still worrying me, even if her other clinical signs are much improved. I've also been switching her injection sites, trying to shoot her more in her flank or tented skin on her lower back, as her scruff seems to result in less absorption, based on my obsessive watching of her pee routine. If I give her a flank shot (never the same site twice, of course, but within acceptable range of each other) she sometimes pees less, but of course this is totally unscientific. Sometimes, no matter where I happen to shoot, it makes no difference, and she just pees more or pees less.

    As you'll also see from my pathetic spreadsheet, establishing home testing on a regular schedule has been tougher than I'd assumed. She doesn't like it; if she sees me enter her suite with the little black bag with the monitor, she scampers right under the bed. It might be that my first ham-handed attempts disagreed with her; then again, she's still a cat. I've had to start hiding the monitor, etc. in my pocket and lure her with kisses and nibbles of food, to calm her down so she won't wiggle or attempt to flee. Also, the prick on the ear does seem to hurt her, though I try to be very gentle. I'm using Neosporin but probably need to get one with a better numbing agent; that said, I did manage to snag her this morning for a BG spot test. Her a.m. shot was at 8:15 and at 10:43 a.m. this random test was 119. Now, that seems pretty low to me, all things considered. I'm not complaining and it's only one test, but she'd eaten almost a full can of FF about an hour earlier plus her shot, so I figured she'd run higher. I realize I have to focus on trends, not one random test, so I'm trying to figure out how we get over this home-testing hump. It may just require patience and time for her to adjust, as my technique improves. Her labs from her vet follow-up, which I've added to my spreadsheet, were good: her BG was 97.

    She's still on .2 units of Lantus twice a day.

    Thanks for all your support during the crisis. You helped save my sanity!
     
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  99. Critter Mom

    Critter Mom Well-Known Member

    Joined:
    Jun 16, 2014
    Like it! :cool:

    Are you supporting the back of the ear with something? (I use a folded 1" strip of kitchen paper (4-ply when folded) wrapped around my index finger; others use little flat cosmetic cotton pads.) The bit of support really makes a difference because it makes it much easier to get a blood sample really close to the edge of the ear. With a bit of practice you can freehand the poke with a lancet and use an action similar to that you might use to prick a balloon. If you're sometimes catching the marginal ear vein when poking that might be the cause of the discomfort.

    We've found that cats tend to have a particular style: some typically run lower at night, some lower during the day. Trouble is, without enough BG data to understand what's going on it's hard to tell. For example, Mommy may actually be running lower during the daytime cycle but then bouncing up to higher numbers on the night time cycle (and producing more pee). Be sure to keep asking for hints and tips about home testing techniques. It might be worth posting on the Lantus board for more input - and suggestions on how to improve success rates when trying to test a difficult kitty! :)

    In the meantime, it might be a good idea to do spot checks on Mommy's urine to see whether there's any glucose present. That would at least tell you whether her BG levels are breaching the renal threshold. The only other thing I can suggest is getting the vet to run fructosamine tests to give you an idea of how well/poorly Mommy has been regulated over the previous couple of weeks.


    Mogs
    .
     
  100. nmveasey

    nmveasey Member

    Joined:
    Nov 15, 2017
    Glad to hear Mommy is doing better! :cat:
     

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