? Hoping for some advice

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

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  1. C.W. Gortner

    C.W. Gortner Member

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    Nov 13, 2016
    Yes, I'm supporting her ear with a warm cloth, and making - or trying to make - the experience as unpleasant as possible. I kiss her, spend time with her first, brushing her (she loves that) then bring out the dreaded utensils and perform the test. My technique has improved, but her attitude has not :) I tried again today right after her morning feeding and shot; I want to obtain a semi-fasting test from overnight, but don't want to risk a scamper-and-hide-under-the bed before she gets her shot. I know that's shooting blind, but she's doing so well overall, though last night she pee'ed more again. Not rivers of urine, but one med-sized paddy and two larger-sized ones, plus the water bowl was half empty, so she's definitely drinking more at night, too. But I failed in my attempt, as the moment she ate and got her shot, she glanced at me with that sidelong look, "Yeah, I KNOW where this is heading" and she eluded me, making her mad dash under the bed, the little witch. On the upside, her revert-to-feral instinct is a great sign of improvement, as when she was really feeling lousy, she barely cared if a bomb went off. And she was always more timid and wary than Boy, though very affectionate once you gain her trust. On the downside, it's fu&#ing up my attempt to get a reading on her levels from overnight. I can get a mid-day reading more easily, while she's eating lunch. She seems more relaxed, then. It's just the morning. She's like her daddy in the morning: in no mood to be bothered.

    I'll take her into the vet at the end of the month, as scheduled, for fructosamine tests. At this point, hauling her into a carrier and forking out $500 is my only choice.
     
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  2. C.W. Gortner

    C.W. Gortner Member

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    Nov 13, 2016
    I just got a test! She had her shot at 8:20 a.m., so about an hour ago, plus food. It was 74, which is too low, right?
     
  3. Kris & Teasel

    Kris & Teasel Well-Known Member

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    Aug 17, 2016
    That's awfully low so early in the cycle. Give her a little snack of her regular low carb food if she'll eat it. Try hard to get another test no later than 30 minutes from now. There's no data for us to see where her nadir tends to be but somewhere in the +5 to +7 range is typical for Lantus.

    If there's any way you can get her trained to eat, be tested and injected in a smaller space it would be so much easier for you. Not easy I'm sure but you can see how BG testing is so important.
     
  4. C.W. Gortner

    C.W. Gortner Member

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    Nov 13, 2016
    Yeah, I panicked and called the vet. FYI: I'm using the Alphatrak monitor and apparently, a reading under 20 is considered too low, according to the company guidelines.

    Unfortunately, I don't have a smaller space. We have two bedrooms upstairs, with the living room, dining room, kitchen, sole bathroom, and my writing studio downstairs. She never comes downstairs during the day, not once in the full 7 years she's lived with us. She keeps to the upstairs bedroom all day, her Princess Suite as we call it, so that's where I have to feed, test, and dose her. There's a bed she can hide under. She only goes downstairs late at night when we've gone to bed. She's a former feral; as much as we love her and she loves us, she's not going to change. She's very cautious and fearful by nature.

    Anyway, a vet tech answered my frantic call, as my particular specialist doesn't work on Saturdays (of course). The tech basically said, "This is why we don't recommend home testing, because clients will focus on one number." WTF?! I'm really sick and tired of their holier-than-thou attitude. Then she went on to say, Lantus kicks in right away, then levels out over the cycle, so I should test her again in an hour or so, and if she's running any lower, to bring her in. When I protested that I can't bring her in or even test her if she's hiding under the bed, the tech added that Mommy's last BG via blood work was 97, so while 74 is low, it's not cause for major alarm. Yet.

    No help from the vet - which I've come to expect. But, as Mommy had eaten earlier with her shot, I managed to feed her again, about half a can of FF. She seems okay at the moment; she crept out and pee'ed, too, but she detests the testing so much that as soon as she saw me, she bolted back under the bed, so I slid food on her plate to her. I really can't even attempt to test her again until later this afternoon or possibly not until this evening, as she's hyper-vigilant right now and not amenable. I won't dose her tonight unless I have a reading. Otherwise, I'll let her coast through the night without a dose and re-test her in the morning. She'll hate me but now, I simply can't shoot blind anymore.

    And I agree, regardless of what the vet tech says. To me, 74 is too low this early in the cycle and indeed into her treatment. Two days ago at midday, or 4+ hours into the cycle, she ran at 119, which is also quite low for her. It might be she's over the crisis hump and her starting dose of 2 units twice daily is too much. If she consistently reads under 200 in the next few days, I'll cut her dose to 1 unit and see what happens. I wish she was more cooperative with home testing because now, it's simply unavoidable. For her and for me.
     
    Last edited: Jan 6, 2018
  5. tiffmaxee

    tiffmaxee Well-Known Member

    Joined:
    Nov 15, 2013
    Years ago my cat got lymphoma. She would hide under the bed making it impossible for me to get her out. I bought wooden risers for the bed from Bed Bath and Beyond. Best investment I ever made! When Max got sick no matter when I needed him I could crawl under and get him.

    We go up and down in dosing by .25 increments. When you can’t test because she’s hiding I would feed her some mc food when she’s getting low. I hope you find a way to get her tests when you need them. I can imagine how scary this is for you. I didn’t test at home at first so my vet had me come in for a nadir every few days. I remember how scared I was when the meter read 60 there.
     
    Last edited: Jan 7, 2018
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  6. Critter Mom

    Critter Mom Well-Known Member

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    WTF indeed! The most important benefit of using a home glucometer is the very ability to focus on just one number; the number that tells you your cat's blood glucose is too low! I wonder whether that vet tech would recommend human diabetics not home test their blood glucose levels ...

    That blood work 97 could have been stress-influenced (so Mommy could have been potentially running lower at home) and the 74 you caught was very early in the cycle. You were perfectly right to be concerned and to seek advice from your vet. It's disheartening that not a lot of help was forthcoming. :(

    Lantus typically has an onset about 1 hour or so after administration (although ECID) and each cycle will be influenced by the amount of insulin already in the depot. Some cycles are more active than others (a test result at +2 hrs after injection where BG is similar to or lower than the preshot BG can often signal a very active cycle where closer BG monitoring might be needed).

    Here's something that might help you to sequester Mommy if she's running low on a cycle and you need to be able to get hold of her for closer monitoring:

    Kitty Playpen

    IMG_20160218_163535.jpg


    The top cover unzips so it's really easy to reach in and pick up the cat. Plenty of room for food, bed and litter box.

    My vet gave me the following reference range (from the UK Merck Veterinary Manual, IIRC) for feline blood glucose levels as measured on pet-calibrated glucometers and lab equipment:

    3.9mmol/L (70mg/dL) - 8.3mmol/L (150mg/dL).

    Anything lower than the bottom value of the reference range means the cat is at minimum biochemically hypoglycaemic and action needs to be taken to protect the cat.

    A reading under 20 on an Alphatrak would lead me to immediately lather my cat's gums with glucose syrup and straight after I'd be legging it to the vets for emergency treatment, glucose tube in hand.



    Mogs
    .
     
    Last edited: Jan 7, 2018
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  7. tiffmaxee

    tiffmaxee Well-Known Member

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    Nov 15, 2013
    Max onset usually at +2.5 or 3 except for when he didn’t. I tried to get a +2 test because then I knew if he was going to have an active cycle. But as Mogs said ECID. Tge more days you test the better you will know how your cat reacts to lantus.
     
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  8. Critter Mom

    Critter Mom Well-Known Member

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    Jun 16, 2014
    Just had a gander at the online US Merck Veterinary Manual diabetes mellitus page which says:

    Reference range would be lab values (pet-calibrated). I am assuming that the 120mg/dL is the upper limit for non-diabetics. (Perhaps fasting BG falling in the 121-150mg/dL range might point to an animal being pre-diabetic? Pure speculation on my part here.)


    Mogs
    .
     
  9. C.W. Gortner

    C.W. Gortner Member

    Joined:
    Nov 13, 2016
    Thanks for all the support and advice. I love that kitty play pen! :)

    I've been running on fumes of late. My husband went abroad to visit his family for the holidays (he comes home tomorrow) and I'm in charge of the entire carousel here, both our indoor cats, all the household crap, plus caring for two outside ferals, one oif whom is determined to invade our home and is utterly adorable, but picks fights with Boy, so I can't let him in. I'm sleep-deprived. I freaked out today at that 74 BG reading and then was enraged by that idiot vet tech, so I watched Mommy like a hawk until 4:00 p.m. She was fine, she ate her snack and her lunch but she stayed under the bed, until she came out just as I collapsed into my bed for a nap. She jumped up next to me, licked my face over and over, and nestled beside me, purring. I started crying. Despite her odd ex-feral ways, she's so intuitive; it was as if she knew I needed reassurance. I slept for about an hour and a half, then fed her and Boy a snack at 5:45, but held back on their full dinner to keep her hungry until shot time. Then I went downstairs and played a video game (ever since she was diagnosed, I've discovered that playing video games really relaxes me, go figure. I'm in-between writing books at the moment, too, and need the distraction). At 8:40 p.m, I returned to her suite with the rest of her dinner. By then, she'd been on a nearly 13-hour cycle since her a.m. dose.

    She was hungry, waiting for me on the stairs with Boy, just like my avatar pic here. She gobbled up her food, I brushed and kissed her, then - lo and behold! - I managed to test her again. It was only about 10 minutes after she ate, so not enough time to really skewer the result. Also, because I was more relaxed and determined, as there's no avoiding home testing anymore, I switched our game plan. I held her upright against my chest so she could feel me while I knelt on the bed behind her; she seemed to prefer that to being reclined against the pillows like before, maybe she feels less vulnerable this way, and I pricked her ear - which took three pricks, as I'm going manual because that stupid lancet device clicker thing freaks her out. She dealt with it. She didn't like it, but she wiggled less and I just kept telling her over and over what a silly girl she was, and I sang her special silly song (don't ask). I got a reading of 297 this time, so I dosed her. She didn't jump off the bed and hide. She blinked at me, as if to say "Well, that sucked," and started grooming her paws. All in all, it was the best home testing experience we've had yet. If I'm relaxed about it, then she is. Or she is, mostly.

    She's all over the place right now as far as BG readings go, but that's to be expected. I'll just keep testing her twice a day as best I can. I know my cats, and my gut tells me she's running lower in the mornings and higher in the evenings; that's her particular style. Again, like her daddy. I'm a night owl, too.

    Thanks again. I feel like an idiot as I stumble through this maze of learning how to manage her diabetes.
     
  10. Chris & China

    Chris & China Well-Known Member

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    May 10, 2013
    So happy to hear tonight's test was a better experience for both of you!! I had to giggle at your "silly song" comment

    Have you ever seen our thread about the "Hokey Pokey song"?
     
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  11. Kris & Teasel

    Kris & Teasel Well-Known Member

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    Aug 17, 2016
    Yep! Hit the nail on the head here! :) Believe me, we all know how stressful this is. The early stages are the worst but it does get better. Hang in there!
     
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  12. C.W. Gortner

    C.W. Gortner Member

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    Nov 13, 2016
    She tested this a.m. at 77. So, for some reason she is running low in the morning. Now I don't know what to do. Should I dose her or wait until the evening to see where she's at? At 77, I don't feel comfortable shooting her with 2 units. Yesterday she was 74 but I had already dosed her an hour before. This time, she's this low without her a.m. shot.
     
  13. JeffJ

    JeffJ Well-Known Member

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    Jul 7, 2016
    That is too low to dose. There is variation amongst kittehs. For Leo, his no-dose number is 200 (on AlphaTrak 2).

    Some people develop sliding scales. We probably need more AMPS and PMPS readings to recommend values for Mommy.
     
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  14. JeffJ

    JeffJ Well-Known Member

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    Jul 7, 2016
    Sliding scale would be something like:
    120-150: 0.5U
    150-200: 0.75U
    200-300: 1U
    300+: 2U
     
  15. C.W. Gortner

    C.W. Gortner Member

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    Nov 13, 2016

    I'm using AlphaTrak, too. I figured as much, thanks! I won't dose her this morning. If I can manage a mid-afternoon test to see how she's trending, I will. If not, I'll just wait until the evening. I thought maybe yesterday's a.m. 74 reading was an anomaly but she came in around the same level again today, so to me, that means something. Just not sure what yet.

    Should I post in the Lantus forum or is this enough?
     
  16. Nan & Amber

    Nan & Amber Well-Known Member

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    Mar 19, 2016
    Lantus is not typically dosed on a sliding scale. Because of the "depot" nature of Lantus action, it tends to work best when dosed consistently morning and evening, so the goal is to find a dose that you can do that safely.

    That said, 74 or 77 on an AT is too low to shoot at this point. Eventually, with a lot of data and testing regularly, you might get down to that level, but definitely not now while you're still getting a testing rhythm established.

    I'm guessing that the 2.0U dose is too high, and that she might have been going even lower at night. The other possibility (less likely, but possible) is that she has very late nadirs, but that will only really be visible after you've gathered more data.

    The "hospitalization" in your sig did not involve ketones or DKA, correct? If so, a skip is probably OK. If she has ketones in her past, however, I'd suggest a different course of action, re-test in a half hour and consider shooting if she is rising in BG. Best if you haven't fed breakfast, so that you can get a non-food reading.

    It's good that she's spending some time in such good numbers!
     
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  17. Nan & Amber

    Nan & Amber Well-Known Member

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    Mar 19, 2016
    What does Mommy weigh currently? You mention that she's underweight, here are the recommendations from the Lantus board for starting doses:


    Tight Regulation (TR) dosing method:
    • the formula is 0.25 unit per kg of the cat's ideal weight
    • if kitty is underweight, the formula frequently used is 0.25 unit per kg of kitty's actual weight
    Start Low, Go Slow (SLGS) dosing method:
    • 1u BID if kitty is not on a wet/canned low carb diet
    • 0.5u BID if kitty has been switched to a wet/canned low carb diet


    2U would be a large starting dose for all but the largest cats using the more aggressive (TR) dosing method. It's not uncommon for large starting doses to be established during a vet hospitalization-- cats often experience raised BG under vet stress, plus cats are often slow to see any sort of regulation, so the vets will keep raising the dose until they see some response. Back in the lower stress environment of home, the dose that "works" in the hospital is often too large.
     
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  18. C.W. Gortner

    C.W. Gortner Member

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    Nov 13, 2016
    They did detect trace ketones during her hospitalization but no DKA. She had acute pancreatitis, but it started to resolve quickly. Her most recent lab results are on my spread sheet. She also has stage 2 kidney impairment, but her values are stable.

    She ate breakfast this morning. To establish a regular testing routine, for now I have to incorporate food. She eats and then I test her; it's much easier this way because I feed her on the bed, talk to her and pet her, and then test her within 5 minutes of eating, so the result isn't affected, as it takes about 20 minutes for food to be digested and affect the BG. She eats very regularly and often. Like I said, I'll try to test her again in the midday and see where she's at; if not, I'll wait until the evening. At her diagnosis, she was running in the high 500 - 600+ - at one point in the hospital she was so high they couldn't even get a reading!- so her reading last night of 297 is actually a vast improvement for her. I don't know if she goes lower while we're asleep, but her pee output / volume does increase significantly at night, not during the day.

    I don't know why she's running higher at night, maybe from all the food she eats during the day, i.e., it bolsters the BG? It's high protein / low carb Fancy Feast canned, but she's getting both breakfast and lunch. She also gets dinner and a decent-sized after-bedtime snack, too - nearly a full can of Fancy Feast for snack at bed - because her weight loss was so severe. She's been putting on weight now, which she needs. Food is pretty much a consistent factor with her, until the late hours of the night. For example, she had dinner last night at 8:45 p.m. and her snack at 12:30 before I went to bed. She didn't eat all her snack right away, so I don't know when she ends up finishing it, but when I get up, the plate is always bare. So, 77 may well be a morning fast reading or as close as we can get, which is still quite low.

    What a conundrum.
     
  19. C.W. Gortner

    C.W. Gortner Member

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    Nov 13, 2016
    She was 6.7 lbs at hospitalization. Ideally, she should be 8 or 9 lbs or so, she's not a large cat, however.

    In the hospital, they started her at 1u after the initial fast-acting IV insulin, but they didn't see the preferred response. She wasn't going lower enough or maintaining it if she was, so they switched her to 2u. But her last lab BG was 97, which is within normal range, and that was taken at her follow-up appointment two weeks later, which, while a short visit, was stressful for her. Very stressful, in fact; she was panting. Still, her BG showed no stress-induced hyperglycemia. Her appointment that day was at noon and she'd had her morning shot already, plus food.

    I'm also starting to suspect 2u is too high. But, how to adjust safely? I'll need to see more p.m. /a.m. values. Or maybe give her only 1.25 u tonight and see what tomorrow's a.m. test reveals? If I can even figure out how to measure 1.25 on the syringe. The hospital gave me a test sample with saline that I use to measure with, those little markings on the barrel are like hieroglyphics. Here's a pic of 2 u that they gave me. Basically, it's four notches down from the top to be 2u: ( I can't insert the pic. grr)
     
    Last edited: Jan 7, 2018
  20. Nan & Amber

    Nan & Amber Well-Known Member

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    Mar 19, 2016
    I'm glad she's eating so well! Good girl!

    One reason besides food that she's likely running higher at night is that she's "bouncing" from the earlier lows. When BG gets too low (according to the cat's body that is-- for a cat that's been diabetic for a while, that could even be a number in the 300's!), the liver "panics" and acts to bring BG back up. That's one reason it's often hard to get a cat regulated in the beginning--- the high numbers you see could be a sign that the cat is getting too much insulin, not too little! Looking at the spreadsheet, I think it's possible that Mommy has been doing some bouncing, but the good news is that if she is, her bounces are fairly short, which will make it much easier to figure out what is going on.

    At 6.7 lbs (underweight), the TR starting dose would be 0.75U. Since she's on low-carb food, SLGS would recommend 0.5U. I do think lowering the dose from 2.0U is warranted here, given the readings the past two mornings, but the low ketones reading makes things a little more complicated. I don't think I'd recommend going as low as 0.5, for example. Hopefully other people can weigh in today with ideas before your evening shot time.
     
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  21. C.W. Gortner

    C.W. Gortner Member

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    Nov 13, 2016
    I think I could try 1.25 u to start this evening. I can't insert this stupid picture of my sample syringe. If 2u is four notches on barrel from the top, then 1.25 would be 1 and a quarter notch, right? I'm using u-100 o.3 ml 31 gauge syringes. Pathetic :(
     
  22. C.W. Gortner

    C.W. Gortner Member

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    IMG_1057.JPG

    The syringe!
     
  23. Nan & Amber

    Nan & Amber Well-Known Member

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    Mar 19, 2016
    Do your syringes have half-unit markings? Here are sample syringe pics:

    [​IMG]

    If you're using syringes with half-unit markings (on the left), then yes, 2U is 4 notches (left-right-left-right). 1.25U would be 2 notches (left-right) and then halfway between the 2nd (right) and 3rd (left) notch.

    I think 1.25U is reasonable, though again let's see if other folks weigh in with an opinion here.
     
  24. Nan & Amber

    Nan & Amber Well-Known Member

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    Mar 19, 2016
    Ah, simultaneous post! But it looks like you do have half-unit markings, and your pic is of 2U.
     
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  25. C.W. Gortner

    C.W. Gortner Member

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    Nov 13, 2016
    If you're using syringes with half-unit markings (on the left), then yes, 2U is 4 notches (left-right-left-right). 1.25U would be 2 notches (left-right) and then halfway between the 2nd (right) and 3rd (left) notch.

    I think 1.25U is reasonable, though again let's see if other folks weigh in with an opinion here.[/QUOTE]


    I posted a pic. I don't know if my syringes match left or right.
     
  26. C.W. Gortner

    C.W. Gortner Member

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    Nov 13, 2016
    It's like learning Mandarin! **** me.
     
  27. Nan & Amber

    Nan & Amber Well-Known Member

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    Mar 19, 2016
    Ha! Well, I may have overcomplicated things a wee bit there... :rolleyes:
     
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  28. Kris & Teasel

    Kris & Teasel Well-Known Member

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    Aug 17, 2016
    Your syringes are like mine. The right hand scale is for whole units and the left is for half units. Reading from zero and looking at both half and full unit marks you have: zero - half unit - one unit - one and a half units - etc. That means a dose of 1.25 u would be half way between the right side whole unit mark and the left side 1.5 u mark. Does this help? It'll get easier to eyeball between marks over time. Try to be as consistent as you can when eyeballing.
     
  29. C.W. Gortner

    C.W. Gortner Member

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    Nov 13, 2016
    This would be 1.25, right? Circled approximate area in red.
     

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  30. Kris & Teasel

    Kris & Teasel Well-Known Member

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    Aug 17, 2016
    Close! You'd want the right side of your red box to come as close to exactly half way between the 1 u marks and the 1.5 u mark s you can eyeball.
     
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  31. Critter Mom

    Critter Mom Well-Known Member

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    Jun 16, 2014
    This.


    Mogs
    .
     
  32. JanetNJ

    JanetNJ Well-Known Member

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    Jun 8, 2016
    so glad it went better for you! The few weeks of testing can be hard on both human and cat... but it usually becomes routine pretty quickly. I always rewarded with some cold cuts or catnip and that made things better.
     
  33. Critter Mom

    Critter Mom Well-Known Member

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    Jun 16, 2014
    Hi C. W.,

    Some things to perhaps ponder re the high PMPS, low AMPS and more pee at night:

    1. Many cats have distinctly different BG patterns during the day and during the night, hence the real need to get mid-cycle tests on both AM and PM cycles. (IIRC the majority of cats tend to run lower at night.) Because of this response variation sometimes a dose that works well for one cycle may be too high for the other cycle.

    2. If a dose is too high it can produce an 'upside down' curve, i.e. instead of dipping from preshot BG down to nadir and then rising again back to next preshot the curve rises after preshot to a peak mid-cycle and then drops down to next preshot. There's no way of knowing whether this might be happening in Mommy's case (other than the observation of extra peeing during the night).

    3. Sometimes if the dose is too high it can produce a 'tick mark' curve: numbers fall from PS level in the early part of the cycle, get as high as (or possibly higher than) PS in the middle of the cycle and then drop down by the time of the next PS test.

    As Nan suggests above, it's also possible that Mommy might be bouncing during the night time cycle after running in unfamiliar lower numbers during the AM cycle.

    Hopefully now that yourself and Mommy are reaching detente on the testing front you'll be better able to determine what's happening. My suggestion is to try to start getting PM mid-cycle tests ASAP (sorry, Mommy!). I don't do dosing suggestions but if my kitty were in this boat I'd be monitoring as closely as possible and I'd be a bit worried that the dose might be on the high side. (Other members may have a different view.)

    They're the mutt's proverbials! :) They take only minutes to set up and they quickly fold down flat for storage. Easy to clean, too. They're really airy and quite spacious when set up; more kitty hotel than pet penitentiary.


    Mogs
    .
     
  34. JeffJ

    JeffJ Well-Known Member

    Joined:
    Jul 7, 2016
    In the picture (at 2:11pm), that looks like 1.75.
    A 1.25 dose would be just past the upper 1.0 mark.
     
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  35. C.W. Gortner

    C.W. Gortner Member

    Joined:
    Nov 13, 2016
    I just tested her again at 6:45 p.m., before her evening meal. She's due for her shot at 8:40 p.m., so she usually only gets a snack after lunch, with full dinner tied to her shot, but our schedule is out of whack today and she was hungry for dinner early, since my a.m. test, as well as it went, sent her back into hiding and she missed lunch.

    She was 161. No food. And not high at all, so . . . now what? Well, I'm not comfortable shooting her in that range, so I called my vet and got the on-call emergency doc, who remembered Mommy from her hospitalization there. The doc told me to not give her any insulin tonight and re-test her in the morning; if she's still falling within normal range, she "might" be becoming less insulin-dependent. And of course, to schedule an appointment with Dr Dick ASAP to get his input and possibly a fructosamine.

    In any event, in case she requires a reduced dose later on this week, this is 1.25, right? I redrew the line - in black - around the syringe.
     

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    Last edited: Jan 7, 2018
  36. Kris & Teasel

    Kris & Teasel Well-Known Member

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    Aug 17, 2016
    No, the black outline doesn't correspond to 1.25 u. The first long black line on the left nearest the edge of the orange cap is the zero line. The right side of your black outline is running right on top of the 0.5 u line. The black surface of the plunger sees to be sitting on the 2.0 u mark. It's a bit fuzzy to know for sure.

    Your best bet for dosing advice is the Lantus forum. There are two sets of guidelines for dosing - TR and SLGS. They were mentioned in post #120 above. Those guidelines spell out what to do if a pre shot BG is lower than usual, etc.
     
  37. tiffmaxee

    tiffmaxee Well-Known Member

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    Nov 15, 2013
    Can upyou get another test about a half hour before shot time and post on tge lantus forum?
     
  38. C.W. Gortner

    C.W. Gortner Member

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    Nov 13, 2016
    Right, I'll check there. I see the lines better now and understand. The plunger is sitting on the 2.0 mark because that's my sample syringe. So, I'd move up from there to 1.25 or wherever.
     
  39. C.W. Gortner

    C.W. Gortner Member

    Joined:
    Nov 13, 2016
    I don't think I can get another test tonight, but if the opportunity arises, I'll try. Getting two tests today was a major accomplishment and I don't want to overwhelm her, as I'm trying to establish a routine that she can deal with, that will work long-term. For now, I'm going slow and aiming for daily pre a.m and pre-p.m.
     
  40. JeffJ

    JeffJ Well-Known Member

    Joined:
    Jul 7, 2016
    I have the same kind of syringe markings. So I labeled some of the markings. One side shows 1.0 increments, the other side shows 0.5 increments.
     

    Attached Files:

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  41. C.W. Gortner

    C.W. Gortner Member

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    Nov 13, 2016
    THANK YOU!!!
     
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  42. C.W. Gortner

    C.W. Gortner Member

    Joined:
    Nov 13, 2016
    I posted on the Lantus forum, too, just in case.
     
  43. C.W. Gortner

    C.W. Gortner Member

    Joined:
    Nov 13, 2016
    Based on the markings pic sent by JeffJ, am I actually giving her 2u? When I fill the syringe, I'm counting down four notches, based on this sample syringe that the vet tech gave me at Mommy's discharge. See here, without my pen drawing. I'm taking the plunger down to the 4th notch, no farther.
     

    Attached Files:

  44. JeffJ

    JeffJ Well-Known Member

    Joined:
    Jul 7, 2016
    For your post just above "am I actually giving her 2u" - yes, that picture shows 2U. You are past the 1.5 mark, and the plunger is lined up at the 2.0 mark. You are correct, each notch is 1/2 U.
     
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  45. C.W. Gortner

    C.W. Gortner Member

    Joined:
    Nov 13, 2016
    Thanks! I called Dr Dick this morning and am now waiting on his call-back. I wasn't comfortable not dosing her last night when she came in at 161, so I gave her only 1u to see how she'd do. She tested this morning at 291, but she'd already eaten about an hour before (I'd asked hubby to please not feed her before he went to work, but of course he did so anyway, about half a can of FF). An hour later, I got up and tested her. I gave her another 1u and called the vet. I think she probably needs between 1.25 and 1.75, and no doubt I screwed up by halving her dosage last night rather than following the .25 reduction protocol, but I want to keep her safe; a day or so of higher BG is less concerning to me than a plunge into hypo and another hospitalization.
     
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  46. JeffJ

    JeffJ Well-Known Member

    Joined:
    Jul 7, 2016
    Yes, you will probably end up at 1.25 to 1.75 for the optimum dose. I also have a hard time getting the 0.25 dosage added. Since many cats and dogs get such small amounts (under 10U), one would expect 5U or 10U syringes to be readily available. It would make micro-dosing a lot easier.

    For 2 people handling 1 cat, it is important to stick to the protocol. We have a paper spreadsheet in the kitchen.
    date
    time
    BG
    dose
    comments

    And any feedings go into the comments. Also other drugs (B12, prednisolone, chemo). It is easy to do, and both people can write stuff on it.
     
  47. C.W. Gortner

    C.W. Gortner Member

    Joined:
    Nov 13, 2016
    Well, Dr Dick just called me back. To my surprise and relief, he endorsed my dose reduction to 1u 2x. He said to keep testing her morning and night, and not sweat any slight rises during the first week or so of her dose adjustment; if she goes higher than 350, however, I can add .25 u and so on, until we find the optimal dose. He said it was quite normal to have to adjust after a certain time on insulin and better we have to lower her dose than increase it from 2u, though he was, of course, grumpy. Evidently, he's not a fan of home testing, as it forces him to actually consider that a kitty parent might be competent enough to handle it, but he was impressed by my "diligence." I'll take her in to see him on 1/23 for a follow-up fructosamine, but in his opinion, she's doing much better than expected, thus far. The man is a real charmer (not).

    Go, figure. I'm wiped.

    As for our protocol here at home, hubby just thinks our cats are hungry all the time, but he assured me that he only gave her a quarter can before he left for work because she was asking him to feed her. I requested specifics on exactly how she made that request, and told him she can wait until I get up - which is shortly after he leaves, anyway - as I do the testing and the shot. Men :) However will he cope should I need to go on tour later this year for my new novel? I shudder at the very thought. He adores them but when it comes to medical stuff, he's all thumbs.
     
    Last edited: Jan 8, 2018
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  48. JeffJ

    JeffJ Well-Known Member

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    Jul 7, 2016
    Ok, then your hubby can do the AMPS test! For AMPS and PMPS, you want 2 hours of no food prior to test.

    Some cats are hungry all the time, but if they have diabetes...there are rules! Up until 2.5 years ago, I never touched a syringe. If I can learn it (as an elder), then he can too.

    Vets against home testing - yeah, we get a lot of that on the forum. Maybe some vets are doing revenue protection. If an owner doesn't test at home, then the owner is totally dependent on the vet for testing and dosing guidelines.
     
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  49. Vader723

    Vader723 Member

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  50. C.W. Gortner

    C.W. Gortner Member

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    Nov 13, 2016
    We've run into a hurdle. Mommy has decided that home testing is torture - what's worse, she now hides under the bed, right in a spot in the middle where I can't reach her, whenever it's time for her shot. I'm not sure what happened, exactly, as before I started home testing her twice a day, she jumped onto the bed every time for her meal and her shot. There was never an issue, and we weren't even home-testing that long. But the BG testing requires a prick, I know it hurts - no matter how gentle I am, it's still a poke to get blood - so she must be associating any attempt to inject / poke her with pain. We are now using 1u 2x daily and I had to back off from home testing for now, as she's not cooperating and giving her the shot is more important to me, given her situation. However, even if she's calmly in her tree nook, as she was this morning, and I kiss her and quickly shoot, without any visible reaction from her that I can see, seconds later she bolts under the bed. Mornings are easiest at this time, but nights are a nightmare, as she camps out under the bed and we have to sweep a pillow under it to get her out, corner her - while she's hissing and clearly freaked out - and give her the shot. She calms down later, even accepts affection from hubby, but she's basically avoiding me. It's frustrating and heart breaking, as we had the shot routine aced.

    We see the vet on the 23rd and I'll request a fructosamine. Sigh.
     
  51. Kris & Teasel

    Kris & Teasel Well-Known Member

    Joined:
    Aug 17, 2016
    Lantus is acidic and she might be extra sensitive to that even though the dose is small.
     
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  52. JeffJ

    JeffJ Well-Known Member

    Joined:
    Jul 7, 2016
    Maybe you could train her to come to a towel on the ground where she gets a treat. Then after a few days try a BG test there.

    You could also change the dose location. I now give Leo doses in the side shoulder and flank area.
     
  53. Critter Mom

    Critter Mom Well-Known Member

    Joined:
    Jun 16, 2014
    Another possibility: do you get a fair amount of blood when you poke Mommy's ear with the lancet? If yes, then you might be hitting the vein and not the 'sweet spot'.

    Here's a helpful diagram to check against:

    [​IMG]


    If hitting the vein, this can be a bit painful. There are very few nerve endings in the 'sweet spot' area.


    Mogs
    .
     
  54. C.W. Gortner

    C.W. Gortner Member

    Joined:
    Nov 13, 2016
    I never dose her in the same place twice, at least not on the same day. If I shoot in her scruff in the morning, then I shoot in her flank or side shoulder in the evening.

    And this abrupt change in her behavior unfortunately does correlate with trying to establish a routine of home BG testing. She flinched every time I poked her, though I wasn't jabbing indiscriminately and I gave her all the extra attention, treats, and affection as recommended. But, it's still a poke to draw blood, slight and quick as it may be. Before I started home testing - and I've only managed thus far to get in one day of two-daily BG tests to date, which led to the reduction in her insulin, as she was hitting low-to-mid 70s in the mornings before her shot - she was perfectly fine with the shot itself, she didn't even seem to feel it. She'd start eating, I'd shoot, kiss her, and she'd keep right on eating, then lick my face. She's a cat, so who knows, but she's an ex-feral cat with a highly-tuned survival instinct, despite having lived with us for 7 years, safe and sound. Poking her ear is probably not her idea of a good time. The other night, as we swiped the pillow under the bed to get her out, by the time I'd cornered her for her shot, she was hissing, her ears were flat, and she was clearly very stressed out. I held her in my arms, trying to soothe her, and her heart was pounding. She doesn't scratch or bite, thank god, but I was a mess, too. I can't do that every time I need to dose her; it's not fair to her. The more I push, the worse it will be. She needs a break and so do I. At this rate, she's reverting to the terrified cat she was when I first brought her home. I've not seen her like this since the first month of her arrival, when she camped out under the bed for three solid weeks, only venturing out for food and the litter box. She's very sweet and loving now, but she's always been more wary and fearful than Boy. She survived for years in a public park, chased by dogs and raccoons, living on her own under a bridge, with only me coming up to feed her twice a day and her son Boy as company. She's not fully domesticated, that's the reality of it. Hell, I've hired the same live-at-home cat sitter, a dear friend, every time we've gone on vacation and not once has my sitter managed to even get near one of my cats. They completely evade her. They eat and poop, but they're not interested in any contact with her - and they know who she is, they know her smell by now. I request proof of life while I'm away and my sitter sends me pics, of them huddled under the bed as if the sitter is a monster.

    I'll get a fructosamine test done on the 23rd and see where Mommy's at. Believe me, I completely understand how vital home BG testing is. I saw her levels lower to a point that Dr Dick agreed to reduce her dose, so the proof is in the pudding, as they say. But not every cat cooperates. It takes time and patience - and I'm dealing with a cat who's not been home-raised. She loves us and clearly, we adore her, but I can't terrorize her into a corner every time. She's eating well, she's playing with Boy at night again, her pee output and volume have decreased noticeably, especially since we reduced her dose to 1u, and while I realize potential hypo remains a concern, for now I'll have to risk it and pray we're on the right course. Fructosamine tests aren't ideal to monitor her and, of course, are expensive and stressful, requiring the dreaded haul to the vet, but for now, at least we have that recourse. I've done everything possible to follow the guidelines, I've devoured every thread on this forum, but if she opposes me as she's currently doing, something has to give. She needs her insulin, she nearly died a month ago, her pancreas was failing, and she was probably an uncontrolled diabetic for at least 18 months before she ended up in crisis. I remember her gradual weight loss, increased pee and thirst; and I chalked it up to aging. It's my fault for not bringing her in sooner, as looking back now, I realize she had the symptoms, but getting her into a carrier was a hurdle and . . . well, there we have it. Coulda, shoulda, woulda. I can't beat myself up over it. I did the best I could with the knowledge, or lack thereof, that I had at the time.

    I wish it were different, for both our sake. I wish I could explain to her that I'm doing all of this for her own good, that she's being an hysteric, but she doesn't understand words. She reacts to my deeds. I'm hoping that if I back off from the ear pokes until the vet visit, she'll settle down and return to the previous comfort zone we had with her shots.
     
    Last edited: Jan 12, 2018
  55. C.W. Gortner

    C.W. Gortner Member

    Joined:
    Nov 13, 2016
    Well, therein is my problem. I was hitting the vein, actually. My first ham-handed attempts were not good; that sweet spot area yielded no droplet, but the vein, which I can clearly see as her ears are translucent in light, immediately produced results. And poking the vein once, quickly, versus several pokes in the sweet spot area, seemed easier, as after three futile pokes in the sweet spot, she'd had enough. I can re-try the sweet spot once a period of rest has passed, and see how it goes, but since I'd hit the vein already, she now obviously associates the process with pain. Not that it makes me feel any better :(
     
  56. Critter Mom

    Critter Mom Well-Known Member

    Joined:
    Jun 16, 2014
    Neither were mine, that's why I thought to ask about where you were poking! I caught the vein with Saoirse several times before my technique got better. :oops:

    Couple of questions:

    1. What are you using to warm Mommy's ear?

    2. What are you using to support Mommy's ear ready for the lancet poke?


    Mogs
    .
     
  57. C.W. Gortner

    C.W. Gortner Member

    Joined:
    Nov 13, 2016
    1. I'm using a warmed cloth to warm up her ear, though rubbing/ caressing it with my fingers seems to be equally effective. Or not, as the case may be.
    2. I support the underside of her ear with my free hand, to ensure I don't poke through it, and she seemed to prefer it, as she reacted poorly to a cotton pad placed on the underside of her ear while I poked. I bought a pack of make-up cotton pads.

    As I said, I'll revisit my entire technique once the dust settles here. To my relief, she just jumped up onto the bed for lunch and was acting like herself again, until the moment I shifted away to actually fetch the popsicle stick I use to wad up her food, as she likes it wadded into a pyramid, because she licks it all over the dish and then won't eat the stray smears (can you say princess?). Then she fled under the bed. She must have thought I was going to poke her. She's not stupid.
     
  58. C.W. Gortner

    C.W. Gortner Member

    Joined:
    Nov 13, 2016
    One thing we're going to do this weekend is block off part of under the bed, as in, buy sweater storage containers and fill them with books (I have dozens of foreign editions of my novels that are just sitting in the garage) and create a corner for her, where she can hide if she needs to, but will impede these mad pillow swipes at night. We'll organize it in a way that I can still reach her flank and shoot her if need be, even if she's camped out there. I did that several times before at the start, shot her under the bed, and she was fine with it, staying close enough for me to reach before she developed this fear of the ear poke. I just need to keep her from crawling into the middle section under the bed, which is impossible to reach. That way, if she's under the bed but in a part where she can't flee because of the storage containers and the door to her suite is closed, there's nowhere else in the room she can hide where I can't reach her.

    At this point, whatever it takes.
     
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  59. Critter Mom

    Critter Mom Well-Known Member

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    Jun 16, 2014
    She might not like having something bulky in her ear. Saoirse certainly didn't. Here are some things I found helped us enormously.

    Getting the sweet spot really, really, really warm is really key to testing success, especially in the early days when you're waiting for more capillaries to form at the sweet spot (each poke you make encourages this, even if you're not successful in getting a sample each time). I was really worried about hurting Saoirse and I was beyond surprised at how very warm I needed to get her ear in order to get good blood flow to the sweet spot.

    Things got much easier test-wise for Saoirse and myself when I started warming her ears with a plastic pipette filled with heated water (see below). Some people use a small plastic pill bottle containing hot water.


    IMG_20160131_152925.jpg



    I heat the water in a cup in the microwave, fill the pipette, then stand the bulbous end of the pipette in the remaining hot water in the cup to keep it warm until I'm ready to apply it to the ear. I found it much easier to apply heat just to the test area at the edge of the ear using the pipette and Saoirse certainly found it much more comfortable. (I initially tried the warmed up cloth in a baggie but she hated the bulk and used to really wriggle when I tried to warm her ear. Consequently I couldn't warm the ear well enough and found it tricky to get reliable blood samples. Saoirse was much more calm and still when I used the pipette and my testing success rate increased exponentially!)

    I apply a very thin film of Vaseline to the sweet spot area to help the blood bead up instead of wicking into the fur.

    I also use folded 1" strips of kitchen towel as a support. (Note: having the support under the ear helps with one's own nervousness because one isn't subconsciously worried about pricking one's own finger.) I place the folded kitchen paper under the test site then wrap the ear and the paper strip round my index finger, holding the edge of the ear slightly taut with thumb and middle finger. That little bit of tension makes it easier to break the skin with the barest prick of the lancet.

    When doing the poke, make sure that the bevelled side of the lancet is facing upwards. Also, poke at a 45 degree angle to the ear, aiming about 1mm in from the edge of the ear.

    After sipping up the sample onto the meter test strip, I fold the kitchen paper over the ear and apply a little pressure to the test site for about 15 seconds to help prevent bruising.

    Hope some of the above might be of help to you when you are looking to refine your technique.

    On the positive side of things, you do know how to test now and you've got the meter there ready to use. If ever you're unsure about Mommy's behaviour and you're worried she might be running low you're in a position to check her straight away and intervene should the need arise. :)


    Mogs
    .
     
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  60. C.W. Gortner

    C.W. Gortner Member

    Joined:
    Nov 13, 2016
    Well, the detente with Mommy continues. She's definitely changed in behavior as far as the shots go. Before, she was just fine with them, didn't seem to notice or care. Now, the moment she knows it's shot time (it's as if she has a wrist watch she can check, down to the minute) she's right under the bed. I've resorted to blockading parts under the bed with pillows to corner her, just for the shot itself, and then shoot her under the bed as best I can. It's baffling to me. She'll then stay under the bed for most of morning into the late afternoon, creeping out to nibble food and use the box (not nearly as much now) but otherwise avoiding me. I talk to her, sing her song while she's hiding, so she can see I'm not always there with a needle, and she blinks at me, but if I reach under to pet her, she scoots away. Sometimes, like yesterday, when I bring up her lunch, she'll be out, waiting; she'll accept affection and won't flee the scene, though she'll recoil if I reach out to her too fast - which is very unlike her. I feel as if all the effort I've made over these past years to make her feel safe here at home with us is coming undone.

    Granted, she's always been a "bush" cat; she has trust issues and prefers hanging out in safe places, like under the bed, but I'm starting to wonder if perhaps even 1u 2x a day is too high for her now, the shots are making her feel lousy, lowering her BG too much, so she's resisting them. It's been 7 days since my last attempt to BG-test her, she's been on low-carb wet food only for nearly nearly six months - so, before her diagnosis - but I was reading here that some cats will dive into remission fast once they get proper insulin and/or require a significant reduction in dose as they get better. I thought that would never happen to her, as if she was uncontrolled for so long, but her numbers weren't overly high on the few sporadic tests I took once we started insulin, and in fact were trending toward too low on 2u. And we've reduced her dose already by 50% since she started treatment little over a month ago. Ideally, of course, I should be checking every day to see how her BG is trending on 1u but for now, that's impossible because she's being such a freak about it. I want to associate her sudden change in her to the bad experience of BG testing = pain, therefore shot must also = pain, but really? After 7 days and she's still hiding at shot time to avoid it, as if I might clobber her?

    I'm trying to be patient, to not push or traumatize her. That she's never been treat-motivated (she's never cared much for treats at all) sucks, as I can't entice her with yummy extras. But the trauma of every shot - she hisses at me in the morning, while at night, she has to be held by hubby so I can quickly shoot - is driving us both nuts.

    I might bite the bullet tonight, have hubby restrain her and get a BG test in to see where she's at before her PM shot.
     
  61. Critter Mom

    Critter Mom Well-Known Member

    Joined:
    Jun 16, 2014
    That's not an unreasonable concern, C.W. I think your plan to just go for it and check her BG tonight is wise. If you could sequester her in a bathroom for a couple of hours and also get a test in mid-cycle tonight to see how low the dose is taking her that would also be wise for Mommy's safety. If you don't have success, I'd suggest you get Mommy to the vets as soon as you can for a fructosamine test. While not as revealing as regular BG checks, in situations like yours the fructosamine test would be valuable.


    Mogs
    .
     
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  62. C.W. Gortner

    C.W. Gortner Member

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    Nov 13, 2016
    We have a vet appointment on the 23rd but if I can't get a test or two in before then, I'll call on Tuesday to see if we can get in earlier for blood work.
     
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  63. Critter Mom

    Critter Mom Well-Known Member

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    Jun 16, 2014
    I think that 's a good plan, C.W. Let us know how you get on.


    Mogs
    .
     
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  64. C.W. Gortner

    C.W. Gortner Member

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    Nov 13, 2016
    Thing is, based on what I've read, she does meet some of the criteria for remission and/or a significant dose reduction:

    She's older (for some reason, older cats go into remission more)
    She's on a low-carb wet food diet.
    She was dosed on high insulin for 4 weeks at 2u 2x daily.
    Her BG, albeit judging by my few home tests and her recent labs from the vet, were within normal range after only two weeks or so on insulin. 0n 12/12, her BG was 92 via labs from the vet.
     
  65. Critter Mom

    Critter Mom Well-Known Member

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    Jun 16, 2014
    I think the sooner you get her checked the better, C.W. I'd also give a call to the vet tomorrow to ask for advice on what to do about insulin dosing until you can get her in for testing/bloodwork.

    FWIW my Saoirse started to avoid her Caninsulin injections because the drops in BG it produced made her feel lousy (and she was in fairly good numbers at the time). She was happier when I changed her insulin (much smoother BG throughout the day) and the avoidance behaviour stopped straight away.


    Mogs
    .
     
    Last edited: Jan 15, 2018
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  66. C.W. Gortner

    C.W. Gortner Member

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    Nov 13, 2016
    Today she flattened herself against the far wall under the bed, hissing like a serpent, so despite my once-effective if traumatic pillow blockade, I had to pull her out by her scruff to deliver the goddamn shot. I cut her dose back last night to .75u to see if that makes any difference in her attitude. I couldn't get a BG test last night, she was totally uncooperative and I'm too exhausted to struggle with her.

    Calling the vet is pointless. They'll just tell me to bring her in, and we already have an appointment with Dr Dick scheduled for the 23rd. She loathes me right now, she's avoiding all contact. Not with hubby, though he has to seize her unawares and forcibly bring her onto the bed to be petted and brushed, and then she relaxes. But I'm persona non grata at the moment. I'd be relieved that she clearly feels well enough to be such a stinker, except this change in her is so unsettling, I have to wonder what is going on. I pray she's in remission. We can't go on this way. It's killing me to see her acting so traumatized. She's eating well still and peeing much less, so at least there is that.
     
  67. Critter Mom

    Critter Mom Well-Known Member

    Joined:
    Jun 16, 2014
    I'm really sorry things are so difficult for you all right now. :bighug:

    For safety, the best thing I can suggest to you, C.W., is to get Mommy in to the vet as soon as possible to get the fructosamine test (and maybe a BG spot check at the surgery - might be stress-influenced but at least it would give you some information on what's going on) and also to discuss what to do about Mommy's dose until you can be sure she's safe. If she's showing that level of avoidance behaviour at injection times it's wise to at least consider the possibility that it might be Mommy's way of telling you something's amiss.


    Mogs
    .
     
  68. Nan & Amber

    Nan & Amber Well-Known Member

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    Mar 19, 2016
    I'm not sure if anyone has suggested this yet, but in addition to a fructosamine test at the vet you also might look into getting some kind of "health monitor" additive for the litter box. I haven't used them in a long time, but I think there are several out there that will let you know whether Mommy is spilling glucose in her urine (possibly some will even give you an idea of the magnitude of the spillover). Never as exact as day-to-day blood monitoring, or even the fructosamine test, but better than nothing!
     
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  69. Red & Rover (GA)

    Red & Rover (GA) Well-Known Member

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  70. JeffJ

    JeffJ Well-Known Member

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    Jul 7, 2016
    You may want to approach her more often when you are home, and bring gifts - small treats or catnip toys. That way she doesn't always associate you with "getting medicine".
     
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  71. C.W. Gortner

    C.W. Gortner Member

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    Nov 13, 2016
    I do approach her often at home, we've always had a loving relationship. And she was just fine with the shots until I started home BG testing. I realize home testing is our goal here and I totally understand how important it is, but some cats just aren't into it; as we all know, you can't force a cat to enjoy something they don't. I've tried various new methods in the past weeks to reduce her stress and reinstate home testing; thus far nothing has changed in her attitude, other than she's less hissy with her shots, though she still obliges me to corner her under the bed. As for the home testing, I got one in on the fly, and she ran 115 at the time, about mid-cycle. It is what it is. She dislikes it.

    However, we returned to the vet today for our follow-up and she's doing really well. Her spot-check BG was 124 at the time, about an hour and a half after her a.m. shot, plus she probably manifested the usual BG stress rise due to the vet visit itself. In any event, the vet wants to reduce her Lantus dose again, this time to 1u once a day, and see if she continues to stay regulated on it. He thinks it's entirely possible that she's nearing remission, based on her weight gain and overall well being, but I'm a bit nervous about reducing her dose in half once more. I'm not finding much online to support that once-daily dosing is less effective, though it's definitely linked to less likelihood of remission. But if she's indeed nearing remission anyway, of course it would be wonderful. He said to keep a close eye on her appetite and pee / drinking on the new dosing schedule, and should her symptoms increase, to reinstate twice daily dosing and call him. He didn't think a fructosamine test would add extra information at this stage.
     
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