How do I know when my kitty is in remission

Discussion in 'Feline Health - (The Main Forum)' started by Mum of two felines, Jan 31, 2016.

  1. Mum of two felines

    Mum of two felines Member

    Joined:
    Dec 7, 2015
    Buzz is the second SS below. This weekend I've taken him completely off dry food and feeding 2 meals and 2 small meals. Yesterday when I gave him his 1 unit he went down to 31 so today I gave him .5 and he went down to 26. Do I stop giving him his injections? I go back to work tomorrow so I won't be around if he gets that low again! My vet doesn't believe in home monitoring - he's not even sold on me going totally canned. I am feeding him canned prescription diet w/d and I just know if I could get the approval to move to friskies he would be in remission. Oh, what do I do? I know the vet won't believe me if I call and say and tell them his glucose levels. :(
     
  2. Mum of two felines

    Mum of two felines Member

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    Dec 7, 2015
    Oh, they are both on Novalin.
     
  3. Larry and Kitties

    Larry and Kitties Well-Known Member

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    Dec 28, 2009
    The rule is two weeks below 120 without insulin. Buzz could be on the way of OTJ. Are you feeding a low-carb canned?
     
  4. Mum of two felines

    Mum of two felines Member

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    Dec 7, 2015
    I am feeding prescription diet w/d canned. Not the best for him, but I can't tackle the insulin tracking and his diet together with the vet. I have to choose the lesser and I know the canned is very expensive, but if I can get him OTJ I won't mind. Then, maybe the vet would listen to me about his diet.
     
  5. Chris & China

    Chris & China Well-Known Member

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    May 10, 2013
    The W/D canned you've been feeding is high carb at about 25% carbs and is overall a lousy food.

    If you look at the ingredient list, you'll see "powdered cellulose" which is nothing but a fancy word for "sawdust"

    Buzz looks like an excellent candidate for being diet controlled and the only thing he may need to live a long, OTJ life is the switch to a low carb food....Friskies pate's, Fancy Feast Classics and 9-Lives pates are all low carb and (in my opinion) contain better ingredients than the W/D

    You don't need your vets "approval" to change foods....just make sure if you change to low carb, you're testing frequently (especially if you continue giving ANY insulin at all)

    It will be hard for your vet to argue with you if the results are positive! (although we know some of them still will)

    With Buzz, I think it's very much worth getting him off the W/D and onto a low carb canned diet and stop the insulin for now....see how he does. Going into the 20's and 30's on the AlphaTrak, the high carb W/D is probably the only reason he's still alive....those are WAY too low

    If he can stay in normal numbers (68-about 150 on the AlphaTrak) for 2 weeks, he's considered "in remission"
     
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  6. manxcat419

    manxcat419 Well-Known Member

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    Jan 14, 2015
    I just looked at both spreadsheets - whose is the first one? That one looks almost as crazy for numbers...from 12 units to 3 in just 2 days and still with a reading of 30 on just a fraction of the dose from 2 days ago! I would agree with Chris that switching the food may well be all that's necessary...but I think that might actually apply to both cats, not just to Buzz. I didn't even ask my vet about switching food - they managed to sell me just 3 cans of DM (I opened one and tried giving it once to no avail and went out and bought Friskies pates the next morning based on advice from all the great people here). I just didn't mention food to them at all until weeks and weeks later at a check up - they asked what Rosa was eating, and I just told them she was getting Friskies pates. By then, her numbers spoke for themselves and no-one argued with me. :)
     
  7. Critter Mom

    Critter Mom Well-Known Member

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    I've replied on your other thread (and I've also put a request out on the board for members with Novolin experience to come to your assistance as soon as possible).

    Please can you put back the higher carb food and get dosing advice as soon as possible. For the numbers you're seeing on Buzz's BG readings, they are in the NORMAL RANGE FOR A NON-DIABETIC CAT who is not on insulin! I urge you to get advice before giving any more insulin to Buzz and also getting advice about reducing Woody's dose further.


    Mogs
    .
     
  8. Chris & China

    Chris & China Well-Known Member

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    May 10, 2013
    @Mogs.....she's currently feeding W/D canned from what I understand

    I agree with you though that the high carb food is probably the only thing that's kept her kitties alive with those super low numbers

    My point was that IF you go to a low carb food, that may be all that Buzz needs to be able to be OFF insulin completely
     
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  9. Critter Mom

    Critter Mom Well-Known Member

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    Jun 16, 2014
    @Chris & China - That's exactly how I read your post, Chris. :) Sorry if I caused any confusion. I'm just being a bit of a Ma Hen on this one and trying to cover all bases because I'm worried about the insulin situation.

    If Buzz were mine and I knew the full situation re risk of infection, ketone status, etc., I'd withhold and monitor closely. Looking at the response to the dose reductions in both kitties I wonder whether the only reason Woody's a bit higher is that he might be more carb sensitive than Buzz (but that is pure conjecture on my part - no evidence base). As I posted above I don't know Novolin but I'm wondering about Woody: could the dose reductions also result in a drastic reduction in glucose production by the liver and could that then cause additional difficulties? (Asking the question - don't know the answer.)


    Mogs
    .
     
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  10. Mum of two felines

    Mum of two felines Member

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    Dec 7, 2015
    We'll , I am not giving Buzz his insulin until his BG starts rising. I believe the reason why my kitties weren't going into their moderate symptoms was I was told to keep dry out so they could eat if they started feeling bad. The problem I seem to have now is I have 19 strips and my order won't be here til Wednesday. I know, I shouldn't run out, but I wasn't paying attention when I was doing both their curves. I started with close to 80 strips and have used 60 in the last 3 days. Checking twice when those numbers were low and sometimes my kitties shook their ears/heads and lost the drop of blood and wasted a strip.

    My plan is not to give Buzz insulin and I'll check before every feeding. That will use 5 of those strips.
    With Woody I'll test before feeding, +2 hours and + 5 hours tonight and maybe reduce insulin in the am back to 3 and check at + 8 when I get home from work. Then test before feeding and again at +2 and +5 tomorrow and Tuesday. That will use 14 of those 19 strips I have. Hopefully I don't need to start Buzz back on insulin if so I'll be out checking him and possibly running out :(. I will keep dry out for Woody, but not Buzz unless he starts needing insulin. They will be separated for the daytime.
     
  11. billysmom (GA)

    billysmom (GA) Member

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    Feb 26, 2015
    You might want to get a human meter to use as backup for those times when you run out of strips. Get one from someplace local where you can get strips on short notice. Many here use the relion meters from walmart. Target also has one people use called the up and up.. Human meters run lower than pet calibrated meters, but most people here use human meters and will understand those numbers. Just make clear what meter you are using when posting here or when talking to your vet. It's best to stick to one meter but if you you're low on strips you gotta do what you gotta do. Some people use the freestyle lite strips in the alphatrak meter and claim there isn't too much variance. It might be a good stopgap until you get more alphatrak strips. There was a recent thread about what code to use.
     
    Last edited: Jan 31, 2016
  12. Critter Mom

    Critter Mom Well-Known Member

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    Hi there,

    I'm glad to hear about Woody improving and I very much support your decision to skip insulin for Buzz. It's a very good idea to keep the two kitties separate and to keep Buzz on the lower carb food. I would not give Buzz any more insulin until you have got advice from your vet (and hopefully from someone with Novolin experience here). He is in 'non-diabetic' numbers. Be sure to tell this to your vet.

    Re the insulin dose, the higher number before a dose is due is not guiding you well about safe dosing. Numbers might be rising high at the end of the cycle to counteract how low Woody went earlier in the cycle and the insulin is just dropping his his numbers like a rock again as soon as it's administered. Right now you need to look at the nadir - how very low the dose is taking Woody - to make safe dosing decisions. As you saw last night after giving 5 units again even though the preshot test was nearly 300 Woody's BG completely tanked to another dangerously low number within a couple of hours.

    The 3 unit dose you gave yesterday morning took Woody dangerously low yet again so THE 3 UNIT DOSE IS STILL TOO HIGH.
    I'm not a vet and I haven't used Novolin but if Woody was my cat and I was treating with Novolin and got numbers that low I would reduce the dose below 3 and still monitor BG closely. I would also be sure to feed higher carb food. It is better to have a cat a bit higher for a short time than dangerously low for a minute.

    You must keep Woody's blood glucose levels ABOVE 68. Any dose that takes him below that number is too high and must be reduced - AND STAY REDUCED.

    Please feed him higher carb food and continue to do so until you get decent advice on the Novolin dosing.

    Please always test at +2 at the very latest. Woody starts going low early in the cycle. Keep monitoring. (See below for human meter info.) If Woody is under 100, keep testing every 30 minutes. If he goes to 68 or lower:

    1. Give Woody a small amount of honey or karo immediately to bring his numbers up quickly.
    (NB - the honey/karo will wear off quickly. It's not enough on its own to keep Woody in safe numbers. See point 2.)

    2. Immediately after the honey/karo feed Woody some of your w/d canned food. This will help to raise his numbers in the medium term and doesn't wear off as fast as the honey/karo.

    3.
    For the numbers you've been seeing, I would also give Woody some high carb kibble at this time (to help keep numbers up later in the cycle) and make sure he has free access to food with a lot of carbs all the time.

    Please test frequently to keep Woody safe because he stays low for a long time. Please leave high carb food out for him all the time until you sort out a lower, safe dose for him.


    If Woody only gets his lowest reading (nadir) in the 100s it would be better and safer right now. You can monitor his urine for ketones.

    I note you're low on test strips. As Billy's Mom recommends above get to a store (or preferably ask someone else to go for you) and buy a human meter and plenty of test strips. If you need to go yourself make sure Woody is at an OK number and leave lots of high carb food out for him to graze. (If you don't have urine test strips for ketones it would be wise to pick up some of these when you go for the meter.) Get home as quick as you can and test Woody as soon as you get back.

    As Billy's Mom advises above, human meters read lower than the Alphatrak but for now I would still advise you to not let numbers go below 70 on a human meter either (much safer in these circumstances). When you start using human meter strips put a note in the spreadsheet so that people replying to your posts will know what the readings mean.

    I assume that you'll be ringing your vet about dosing this morning. Please keep us posted with how you get on and ask any questions that you can think of. We'll do all we can to help you.



    Mogs
    .
     
    Last edited: Feb 1, 2016
  13. Squalliesmom

    Squalliesmom Well-Known Member

    Joined:
    Jun 26, 2015
    I use Vetsulin, which is a lente insulin just like Novolin, and it works in much the same way, with the same actions. I can't imagine why your vet started your kitties on such high doses, much less why he told you to increase Woody's dose to 15 units when his BG was 226. That's WAY too much insulin! On top of that, vet stress can raise BG by as much as 100 pts, as well, and your vet should have taken this into consideration. We recommend not giving any insulin at all if BG is under 200, unless you have a lot of experience with insulin dosing.

    I am very scared for Woody. I am not a vet and I am in no way giving dosage advice, but I have to stress to you that these high doses have a very great potential to bring about the death of your Woody! If he was my cat, I would drop his dose to a MUCH lower amount, and adjust upward from there, if need be. Better high for a day or two than too low for even a moment, those lows can kill!!!

    I left my vet of many years because we disagreed on almost every aspect of treating my cat's diabetes. She over-prescribed insulin doses, she did not believe in home testing and did not want me to do it, particularly, and we clashed in a big way over which food was appropriate and acceptable for a diabetic cat. He is doing great with the help of the wonderful people here and a new vet. Something for you to think about.

    Please keep us posted. Fingers and paws crossed that all goes well! :):):)
     
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  14. Callao

    Callao New Member

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    Jan 11, 2016
    @Mum of two felines, I'm fairly new too so I don't have advice. But I do have experience having a vet who is set in her ways and does not approve of home testing or changes to low-carb diets. This made my first 3 weeks treating Callao very stressful on a number of levels. I felt strongly that I should be doing home testing and changing diet, so I ended up finding a vet who is willing to work with me on these things. We've seen dramatic improvements with Callao since switching her to a low-carb wet food on Jan 28 (recent, I know, but we're excited nonetheless). Prior to the switch, her curves could drop from >500 to <60 in 2 hours after a "low" dose of insulin (1 u Lantus, which we were giving twice a day). With the food switch over the weekend, I monitored her closely while also dropping her insulin dose significantly (0.1-0.4 u twice a day) to avoid her going hypo. Her curves since the switch have been soooo much better, none of these wild swings yet that we used to see almost daily before the switch.

    However you decide to treat your kitties, I hope you can find a vet willing to work with you. You know your cats best, and you are their only voice and advocate to the human world. Stay strong and know that you are a wonderful mum to your babies!
     
  15. Mum of two felines

    Mum of two felines Member

    Joined:
    Dec 7, 2015
    Well I called the other vet in town and the only difference between the two is she wants me to bring my kitties in every 2 weeks, 5 hours after they have eaten and had their injection. They want owners to feed prescription hill food but will consider the canned. Not interested in changing to another vet just to go through the fight I will currently have with the one I already have. He's been their vet since they were kittens and was my Pom's vet for 16 years. So, I'll start looking in the larger town 35 miles south of us, uuggggghhhhh. I guess if I don't find one there I can go 4 hours west to Colorado Springs. Pretty bad that K-State is so reverend here and no one is open to home monitoring and working with the owners of pets.

    And while I'm on the rant of how irritating our vets are in this small town, I went to the pharmacy (because it's 40 minutes to the Target one way) to pick up the free style lite strips. You want to know how much this pharmacy is charing for 50? $86 flipping dollars!!!!!!!!! I will make sure I never run low again!!!!(then business owners wonder why people go out of town to shop)
     
    Last edited: Feb 1, 2016
  16. Critter Mom

    Critter Mom Well-Known Member

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    Jun 16, 2014
    I'm sorry to hear that you're having difficulty finding a supportive vet. :( I went through similar when Saoirse was first diagnosed. We moved to a practice nearer home shortly after her Dx and her new vets are much more progressive in their approach to feline diabetes. It's certainly a big help.

    Very good to see Woody in safer numbers today on the 1 unit dose. What did you feed him today?



    Mogs
    .
     
    Last edited: Feb 1, 2016
  17. Mum of two felines

    Mum of two felines Member

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    Dec 7, 2015
    1 part friskies and 2 parts canned w/d.
     
  18. Critter Mom

    Critter Mom Well-Known Member

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    Jun 16, 2014
    Thanks for the info.

    Was that a higher proportion of the w/d canned than you were feeding when Woody's numbers went really low over the last few days?

    Also, how are you doing for testing supplies (glucose test strips and ketone strips)?

    .
     
  19. Shenandoah

    Shenandoah Member

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    Nov 25, 2015
    I know you probably don't want to do that, but if you decide it's necessary then I'm happy to refer you to my vet in Colorado Springs.
    She's not an expert in diabetes, but she was the one who introduced me to this site, told me there were options other than prescription diet, gave us Lantus (the best insulin for kitties) when we started on it, and had her tech teach me how to home test - while she would do curves there, she explained to me that having her do it was less accurate because of stress.
    She's really great, and willing to work with us. She definitely seems a lot more knowledgeable about diabetes than many of the vets I hear about on this site.
    Just let me know if you want her name and I can pass it along.
     
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  20. Mum of two felines

    Mum of two felines Member

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    Do we have private messaging here?
     
  21. Mum of two felines

    Mum of two felines Member

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    Dec 7, 2015
    I was just feeding w/d over the weekend. Of course I put out the dry when he got too low.
     
  22. Mum of two felines

    Mum of two felines Member

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    Dec 7, 2015
    I went to the little pharmacy here in town because Target is 40 minutes away, one way. I got the freestyle lite for $85 for 50!
     
  23. Critter Mom

    Critter Mom Well-Known Member

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    Jun 16, 2014
    Thanks for the clarification on the food situation and glad to hear you got some supplies. Is it just the Freestyle strips that you purchased? Or did you get both the meter and the strips?
     
  24. Mum of two felines

    Mum of two felines Member

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    Dec 7, 2015
    After $85 I decided I'd just code my alphatrax. I looked at other human meters and the pharmacy had all of the test strips at the same price.
     
  25. Critter Mom

    Critter Mom Well-Known Member

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    Jun 16, 2014
    I'm going to tag Linda (@MrWorfMen's Mom) to see if she can offer you some advice on using the Freestyle strips with the Alphatrak meter. (I've not done so therefore I don't know about coding and any other special considerations that you may need to be aware of when using Freestyle strips with the Alphatrak.) I'd suggest that you don't change the mix of Friskies and w/d that you're giving now until you get input on this. If you want to continue with the food transition, I'd suggest only changing the ratio very slightly each day (per my previous posts) and monitor closely throughout. If you are going to change the proportions I suggest that you do so on a daytime cycle (assuming that you're able to test frequently enough to keep Woody safe). With the non-native test strips in the mix I'd suggest not letting Woody go below 90 until you get a better idea of how the Alphatrak and Freestyle strips are working. Linda may have more input on this.

    If Woody were mine and I was working with a harsh insulin like Novolin I would be inclined to be very, very conservative about insulin dose. Watch the insulin dose very carefully, pay heed to the nadir blood glucose levels, and post for help if Woody goes low again.

    I need to sign off for the night. I hope all goes OK.


    Mogs

    EDITED TO ADD:

    I just had a quick look at Woody's spreadsheet and I see you've increased his dose to 2 units Novolin. I recommend in the strongest terms that you don't reduce the number of carbs in his food until you know what that dose is going to do. And monitor him very closely.
    .
     
    Last edited: Feb 1, 2016
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  26. MrWorfMen's Mom

    MrWorfMen's Mom Well-Known Member

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    Feb 18, 2015
    Hi and belated welcome to FDMB. Are you sure you only got 50 strips for $85 because even with our dollar tanking here in Canada (when compared to US $), it's just under $80 for 100 strips but the box here is exactly the same size as the box for 50 AT strips. If that's what they charged you for 50, that is highway robbery! YIKES! For that you could buy AT strips!

    I am not advocating use of the FS strips in the AT meter, but they will work. Since you need to do so , it is imperative that you have your AT meter set on one of the cat codes (known codes are 08, 37, 38, and 93) to get a reasonably accurate result. Do NOT use the code on the FS strip vial as that is for use only with older FS human meters or the 07 code mentioned in the AT meter literature because it applies only to the older AT meters.

    If you choose to continue using the FS strips in the AT meter, it is also imperative that you keep some AT strips on hand to do baseline checks of your results with the same drop of blood, each time you open a new vial of FS strips or alternately, use AT meter control solution to ensure the strips are readings within the expected range. Also double check any unexpected, especially low FS strip readings using an AT strip. I haven't read everything on your thread yet but I'm assuming you ran out of AT strips due to events requiring more testing than usual so for now you could just take a second reading with an FS strip to double check.

    I did cross checks of the two strip types with the same drop of blood and found my results to be within about 8% on average (they topped out at 10% and many were within 5%. Others who use the FS strips in the AT meter have indicated results within about 5%. The difference may depend on the code each of us had our meter set to or on how high or low readings are. I myself was dealing with rather high readings when I did my cross checks.

    I am 99% sure the FS and AT strips are the same and the only thing different is that the AT meter needs the right code to give you the most accurate reading. All meters have an allowed variance in their results of up to +/- 20% and using the FS strips in the AT meter adds another variance into the picture so your results, while in the ballpark, may not be as accurate as is possible. If there are only 4 cat codes (we don't know exactly how many might exist), then you stand a 25% chance of getting pretty accurate readings. The AT strips are batch tested to determine the correct code for each batch which is why they are so much more expensive than the FS strips.

    If you have any other questions about this, please don't hesitate to holler.
     
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  27. Chris & China

    Chris & China Well-Known Member

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    May 10, 2013
    Yes.....just click on the name of the person you want to talk to and choose "Start a Conversation"....then watch your "Inbox" for notifications
     
  28. MrWorfMen's Mom

    MrWorfMen's Mom Well-Known Member

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    Feb 18, 2015
    Yes there is private messaging. To use that feature you simply click on the avatar of the person you wish to communicate with and click on the option of "Start a Conversation". :)
     
  29. Mum of two felines

    Mum of two felines Member

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  30. MrWorfMen's Mom

    MrWorfMen's Mom Well-Known Member

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    Feb 18, 2015
    You have my complete empathy. Our dollar has tanked and I darn near collapsed at Walmart today picking up a few groceries and Menace's insulin. I think everything here has increased by about 25%. We never had nearly the bargains for strips that are available in the US but our insulin has been much cheaper. I think it just cost me an extra $10 for Menace's insulin today too. I don't want to think about being a diabetic either!
     
  31. Mum of two felines

    Mum of two felines Member

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    Dec 7, 2015
    Well, I guess Buzz is not OTJ but, he does have some sort of infection so maybe that's what is wrong.
     
  32. MrWorfMen's Mom

    MrWorfMen's Mom Well-Known Member

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    Feb 18, 2015
    Don't be disheartened just yet. After those low numbers, Buzz may be bouncing and if you still have higher carb food (w/d?) in the mix, that would have a bearing too. I notice Woody has taken a pretty steep dive tonight so you need to keep an eye on him tonight. If you need/want to go to bed soon, perhaps a little extra food for Woody would help level him out but I'd make sure he is rising before letting my guard down. I think the 2u tonight may have been a bit much. Woody likely bounced today after that 37 last night making it look like the 1 unit wasn't sufficient.

    You are getting quite the workout between the two of them! :blackeye:
     
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  33. MrWorfMen's Mom

    MrWorfMen's Mom Well-Known Member

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    Feb 18, 2015
    Just noticed Woody appears to be rising now! Thank goodness as they really are making you work hard these days! I'd make sure Woody is continuing to rise before hitting the pillow!
     
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  34. Mum of two felines

    Mum of two felines Member

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    Dec 7, 2015
    And to top it off they both picked up some type of an infection. Their eyes are matted and they are now on antibodies. Buzz's temp was 103, Woody was 102.5. They are beginning to dislike my chair, lol.
     
  35. Mum of two felines

    Mum of two felines Member

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    Dec 7, 2015
    By the way, I get really nervous when those numbers are in the 300s for Woody and the mid 200s for Buzz. Should I be?
     
  36. MrWorfMen's Mom

    MrWorfMen's Mom Well-Known Member

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    Feb 18, 2015
    I know those numbers are concerning and you don't want either of them staying in the 200 and 300's any longer than necessary but if they both have infections, that alone can raise their numbers. It's far better for them to be in those higher numbers for few days than too low for even a second so I wouldn't determine doses based on one day of higher readings! Both of them have proven they get to normal numbers and go really low with too much insulin on board so with an infection in the picture, you really just have to ride out those higher numbers and monitor closely. When the infections clear, the numbers will no doubt start dropping again.
     
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  37. Critter Mom

    Critter Mom Well-Known Member

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    Jun 16, 2014
    If you're dealing with an infection BG numbers could drop unexpectedly when a cat recovers; yet another reason to be cautious with your dosing and feeding. Diabetes management requires patience: as is oft noted here it's a marathon, not a sprint. Dose safety must always be the first and most important principle.

    Make sure your cats get plenty to eat and plenty of fluids. Mix some water into their food to make sure they're properly hydrated. With the infection in the mix it is vitally important that you test daily for ketones. (If you don't have the urine test strips your local pharmacy should carry them; get some ASAP.) Be doubly careful about testing Buzz for ketones while waiting for the infection to run its course. Please, please post for Novolin dosing advice if his numbers trend upwards - and remember that a tiny dose made his BG completely tank. If either of your cats go off their food even slightly or if they show trace ketones contact your vet ASAP for advice on when to bring them in for examination. If either of them show more than trace ketones you need to take them to a vet immediately for treatment. (Without emergency treatment they would be at very high risk of developing DKA - diabetic ketoacidosis.)

    The numbers you need to really, really, really worry about are the 20s, 30s, 40s, 50s and low 60s. Having a cat running a little high is not ideal and brings its own set of challenges and cautions but a hypo can kill in minutes.

    If you haven't done so already, please print out and study the following document then keep it somewhere you can grab it quickly in an emergency:

    How to Treat Hypos: They Can Kill

    Here is another document which provides details of things you need to have in your hypo toolkit:

    Hypo Toolbox


    Mogs
    .
     
    Last edited: Feb 2, 2016
  38. manxcat419

    manxcat419 Well-Known Member

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    Jan 14, 2015
    I just took a look at Woody's spreadsheet. If he was bouncing it looks as though he's cleared it - that's a huge drop between pre-shot and +2 this morning. Please monitor him as closely as you can with plenty of testing over the next hour or two...he could very well be heading low again today.
     
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  39. Julia & Bandit

    Julia & Bandit Well-Known Member

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    Dec 28, 2009
    I just wanted to offer a suggestion with the vet--many people here have arrived at FDMB to discover that their vets were not recommending the right treatment for their cats. It doesn't necessarily mean the vet is a bad vet, just that they haven't gotten up to date on the current treatment recommendations. Vets are general practitioners, and they have to know a lot about many different animals. Some vets are grateful when you do your own research and bring them up to speed--and some still insist on continuing a course of treatment that is not good for your cat. So I would try bringing your vet the sources of the information we are giving you, and see what happens. If he changes his tune and will work with you the way you want, then he may be a keeper. If he doesn't want to work with you, move on to the next vet and do the same thing. I think you'll find most vets will change their minds once you bring them information they can trust (and not just the word of the crazy internet cat people:cat:).

    Here's a link to the AAHA guidelines to print out. I'll highlight the parts you'll want to point out to him.

    On food (p. 217-218):
    Limit carbohydrate intake.18-21
    • Dietary carbohydrate may contribute to hyperglycemia and glucose toxicity in cats.
    • Provide the lowest amount of carbohydrate levels in the diet that the cat will eat.
    • Carbohydrate levels can be loosely classified as ultralow (<5% ME), low (5% to 25% ME), moderate (26% to 50% ME), and high (>50% ME).
    and

    Canned foods are preferred over dry foods. Canned foods provide:
    • Lower carbohydrate levels.
    • Ease of portion control.
    • Lower caloric density; cat can eat a higher volume of canned food for the same caloric intake.
    • Additional water intake.
    Dr. Pierson's chart with the carb levels in prescription and commercial cat foods can be found here. You can point out that the carb levels in the Hills W/D are way too high for a diabetic cat, while many commerical foods have acceptable carb levels.

    On Insulin (p. 218):

    The insulin preparations with the appropriate duration of action in most diabetic cats are glargine [i.e. Lantus] (U-100) or the veterinary-approved human protamine zinc insulin (PZI U-40).31

    This panel does not recommend the veterinary-approved porcine zinc (lente) insulin [i.e. Vetsulin] suspension as the initial treatment for the cat, because its duration of action is short and control of clinical signs is poor.

    Humulin has a similar duration of action to Vetsulin, so it is not a recommended insulin for cats. I've attached a second article for you to print out (at the bottom of this message) that discusses the proper dosing and treatment with the recommended insulins for cats, Lantus, Levemir, and Prozinc.

    On Home Testing (p. 218):

    Home monitoring of BG is ideal and strongly encouraged to obtain the most accurate interpretation of glucose relative to clinical signs.34 Most owners are able to learn to do this with a little encouragement, and interpretation of glucose results is much easier for the clinician.

    and

    • Use extreme caution when interpreting a "high BG" in the cat. It is important to discern between stress hyperglycemia and hyperglycemia that needs treatment. Use all laboratory findings and the clinical examination when evaluating response to insulin
    • Be aware that chronic insulin overdose may not only result in clinical hypoglycemia (seizures, coma), but also the development of sustained hyperglycemia and insulin ineffectiveness following secretion of insulin antagonists (catecholamines, glucagon, cortisol, growth hormone) that combat hypoglycemia.35
    • In-clinic blood glucose curves (BGCs) are more likely to be affected by stress hyperglycemia than BGCs generated at home. Veterinarians should be cautious of high glucose results and subsequent overzealous increases in dose.
    If these don't bring your vet around to the correct treatment recommendations that you want to do, then it's definitely time for a new vet. I would bring the other vet (who wants to do the in-clinic curves every 2 weeks) the same information and see if she will work with you with the treatment that YOU want to do. Most vets are good vets and want the best outcome for the animals they treat--I think once they have the same information you do you'll have a much easier time.
     

    Attached Files:

    Last edited: Feb 2, 2016
  40. Larry and Kitties

    Larry and Kitties Well-Known Member

    Joined:
    Dec 28, 2009
    When I adopted Badger about 1 2/2 years ago he had erratic BGs. Sometimes little decrease and sometimes a PS would be less than 50. He was on about 5-7 units of insulin. I tried Lantus, Levemir, N, BCP PZI and ProZinc. BCP together with a little N seemed to work the best. All this time hid did have polyps in is left ear which were tried with Baytril Otic. Last September I bit the bullet and had a dental done but only secondary to surgical removal the polyps. After tying different antibiotics to get the ear infection resolved after removal (pus came out during removal), I can maintain Badgers BG below 150 with about 2.2 units of insulin twice daily
     
  41. Mum of two felines

    Mum of two felines Member

    Joined:
    Dec 7, 2015
    Darn it! Mogs you were correct 2 is way too much! I thought with the 451 that the 2 wouldn't take Woody too low, wrong again!!! I am glad we have a snow day today so I can be monitoring him. Ggrrrr!!!! I guess 1 unit is what I'll stick with for a while.
     
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  42. Mum of two felines

    Mum of two felines Member

    Joined:
    Dec 7, 2015
    And he did!!! Gave him Karo and food!!!
     
  43. manxcat419

    manxcat419 Well-Known Member

    Joined:
    Jan 14, 2015
    Good work! :) And I see you have a snow day, so thankfully you can be home to keep monitoring him. :) He might bounce again later on, but I would keep the dose low regardless as he's proved the 2 units is too much for him.
     
  44. MrWorfMen's Mom

    MrWorfMen's Mom Well-Known Member

    Joined:
    Feb 18, 2015
    So glad you are home today! Sometimes snow days are a blessing! 2 units is obviously more than Woody needs so ignore those high numbers and stick with a lower dose for now!
     
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  45. Squalliesmom

    Squalliesmom Well-Known Member

    Joined:
    Jun 26, 2015
    As I stated before, I am not a vet, and cannot give dosing advice However, I can tell you what I would do if this was happening to my cat. If Woody was my cat, I would put him on just 1 unit twice a day, for at least the next 3-4 days, to see if his BG won't level out. His having numbers in the 200-300s for a few days wont hurt him (a lot of vets even consider a cat well-regulated if he is below 250) but those drops into numbers below 68 have the very real potential to kill him. And factoring in an infection makes this even more potentially harmful. I know 1 unit doesn't seem like much, and you may ultimately need to increase it, but insulin is a very powerful hormone (not a medicine) and it's always best to start low and only increase in incremental doses. It is also imperative, in his case, to stay with one dose for a few days, until you start to see how he responds, and can determine his nadir (lowest point in the cycle). I know it's tempting to want to increase his dose every time you see a high number, but for now, if he was mine, I would let it ride out for a few days at 1 unit.
     
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  46. Critter Mom

    Critter Mom Well-Known Member

    Joined:
    Jun 16, 2014
    I am always super cautious about my own little one and I extend that caution to the kitties here. I don't know much about Novolin at all but, like Lucy (@Squalliesmom), Saoirse's first insulin was Caninsulin (a.k.a. Vetsulin). Caninsulin's action can be very harsh and, like Novolin, it can drop BG like a rock so I do have some experience of massive BG drops and the impact of changing diet from w/d to a low carb food through my treatment of Saoirse.

    In the early stages of Saoirse's treatment when I was transitioning Saoirse to low carb food from w/d (the dry version - even higher in carbs than the w/d canned) I wanted to reduce the dose to leave a safety cushion so that Saoirse would not go too low, as I had no idea of how the reduction in carbs would affect her BG levels but I had read the warnings. (Dr Lisa Pierson of catinfo.org cannot stress highly enough how big an impact the drop in carb load can have on a cat's blood glucose numbers.) It was very early days and I still had a lot to learn and I was not yet sure of how to manage her insulin doses. Our vet at the time advised me to stick with the 3 unit dose she was on even though I was changing her food. I didn't think that was wise but I didn't trust my own judgment. Reluctantly I followed his recommendation. Thankfully I was home testing because that night Saoirse's blood glucose fell from a preshot of 310 down to 77 within three hours of the dose (measured on Alphatrak 2) - a drop of 233 points . You'll note that 77 is above the nominal 'hypo threshold' of 68 for Alphatraks. Saoirse had a symptomatic hypo at the 77 - ABOVE the nominal threshold! When I went to do her 'before bed' BG check I could wake her but she was not properly responsive. When I picked her up her body was limp and heavy. Had I not been home testing I might have just thought she was sleepy. Home testing saved her life that night (and I'm very grateful to the FDMB members who helped me that night).

    I skipped insulin completely the next day and evening because I was scared and much too exhausted to be sure of staying awake to feed Saoirse through another low. I spoke to the vet during the day and he advised a drop down to 2 units for the following day. The preshot the following morning was 400 so I gave the 2 units per the vet's instructions. Five hours later Saoirse's blood glucose was at 113 - a drop of nearly 300 points!!! I was guided by the preshot (as advised by the vet) instead of the nadir - but I didn't know to the differ then. With harsh insulins you need to take both into account but ALWAYS the nadir should trump the preshot as a guide to dosing decisions.

    For information, Saoirse went from 3 units BID to 1.0 IU AM / 0.5IU PM within 3 days of starting the diet transition (hence my advice to you to get a safe dose FIRST before even attempting to reduce the amount of carbs in Buzz and Woody's food).

    After that second - even bigger - drop I made the decision to use Saoirse's data - specifically the nadir data - to guide my dosing decisions. I continued to discuss her dose with the vets for a little while but always, always, always the final decision on what dose to give was dictated by Saoirse's LOWEST blood glucose levels, and I gave less and less weight to the vet's input. It may be that I have given her less than was optimum at times but with this approach there is always tomorrow to refine her dose. I do seek opinions here from time to time but ultimately it is Saoirse's blood glucose data that 'calls the shots' in this house. This approach has served us very well and it has kept my beloved girl safe. :)

    As I have advised in earlier posts, I'm not a vet but I do care passionately about the safety and well-being of every cat on this board. I try to use my own experience - good and bad - to shorten learning curves and also to save others from the difficulties I've encountered along the way. I hope I have been able to help you a little bit.


    Mogs
    .
     
    Last edited: Feb 2, 2016
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  47. Mum of two felines

    Mum of two felines Member

    Joined:
    Dec 7, 2015
    Both my cats were on dry w/d during the day because I knew they dropped but I was at work until last Friday. Now they'll only get it if they go hypo. I am feeding them canned w/d with only a 1/3 friskies. So, do I just go back doing only w/d? They are both eating more at the scheduled times with the friskies pâté mixed in. The reason I'm not keen on the vets advice is he wanted to up Woody's level to 15 from 13 last week when he test 226 at the vets at +9. They went from1 to 13 in 12 days when Woody was in the hospital to set his amount. It seems he's only concerned with the high number and the number he's reading at his office.
     
  48. Squalliesmom

    Squalliesmom Well-Known Member

    Joined:
    Jun 26, 2015
    Just to add to what Mogs said, when Squallie was first diagnosed my vet at the time put him on 5U of insulin to start, and then increased it to 7U a few days later (I was feeding the high-carb Prescription" dry food the vet had recommended). At the time I was unaware that I should transition him very slowly to low carb wet food, and I made the switch to fast. Thank heavens I was home testing! Squallie had a hypo and I was terrified, but thanks to the wonderful people here who talked me through how to handle it, major disaster was averted and he survived it. After that event his insulin went from 7U to 2u, and ultimately down to 1U. For various other health reasons his BG is very high right now, in the 400-500s, and I have just today raised his dose from 2 to 2.5U. His nadirs till this point have been in the low to mid 100s, at their lowest. I will not increase his insulin again, if needed, until 3-5 days have passed and I can see exactly where that dose will take him.
     
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  49. MrWorfMen's Mom

    MrWorfMen's Mom Well-Known Member

    Joined:
    Feb 18, 2015
    My inclination food wise would be to not change anything for a couple of days while holding the dose at 1u. That way you can see what that dose is doing and whether any further changes in dose are needed without having the food situation complicating things further. Once you know what 1u is doing, then you could slowly start transitioning them over to a higher ratio of Friskies to w/d until you have them on Friskies exclusively. When do you go back to work? My concern is that the removal of the large amount of carbs in that dry food has already had a huge effect on their BGs and Friskies I believe is lower in carbs than the canned W/D so removing the W/D totally now may lower their insulin needs even more. With both not feeling well, now is not the time to be adding more complications into the puzzle. One step at a time to keep the boys safe! This is a marathon NOT a sprint!
     
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  50. Squalliesmom

    Squalliesmom Well-Known Member

    Joined:
    Jun 26, 2015
    I'm sorry, there's no way to put this nicely - I think your vet had a bout of temporary insanity when he upped Woody's dose from 13 to 15U based on a BG of 226, taken at the vet's, at +9 hrs! First of all, a BG of 226 should not warrant a dose that large (it"s a HUGE dose!) unless your cat is insulin-resistant. Secondly, BG taken at the vet"s have a tendency to be a fair bit higher than usual due to stress. And thirdly, at 9+ hrs there is a very strong probability that BG is rising, or starting to rise, from an earlier, lower number. That lower number is the one you need to know before making any big changes.

    AT this point I would stick with the food that you have been feeding them and NOT worry about transitioning to low carb until you have Woody's dose figured out. Best to tackle just one problem at a time, and that is the most pressing one.
     
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  51. Mum of two felines

    Mum of two felines Member

    Joined:
    Dec 7, 2015
    Ok you are making sense. I guess it is a marathon, not a sprint. I know all of you have been through this and you know how I am feeling, wanting to get to the finish line so our fur babies can be healthy. And, I think I'll have to go back to work tomorrow, but since I live only 3 blocks away I can slip out over lunch +5 and be home by +9.5. Next week will be tricky since I will be having P/T conferences, but I think I still make it home to check on them at +5 and +9.5. It'll be trickier on Thursday when I have conferences through the injection time. My hubby can give the injection, but he doesn't test :(. Then, I'll be home for 4 days a week from this weekend!

    Would you keep Buzz on the w/d also?
     
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  52. Critter Mom

    Critter Mom Well-Known Member

    Joined:
    Jun 16, 2014
    Seriously??? Why was Woody in hospital for so long?



    Mogs
    .
     
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  53. Squalliesmom

    Squalliesmom Well-Known Member

    Joined:
    Jun 26, 2015
    Yes, for the time being, I would keep them both on their usual food.
     
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  54. Squalliesmom

    Squalliesmom Well-Known Member

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    Jun 26, 2015
  55. MrWorfMen's Mom

    MrWorfMen's Mom Well-Known Member

    Joined:
    Feb 18, 2015
  56. Mum of two felines

    Mum of two felines Member

    Joined:
    Dec 7, 2015
    Because they couldn't get his high number down to under 150. Looking back I am wondering if he was hypoing there. I wanted to bring him home, but I hadn't found this site. And I was trusting our vet because, you know, he's the educated one. And I had just lost my dear 18 year old Pom, Kosmo, just 2 weeks before and the vet had taken such good care of him for 16 years! I took Woody in because he had a huge lump on his back and it was acting funny. So they removed that, cleaned his teeth, cleaned his anal glands, and I brought him home for 1 1/2 days. On that Saturday morning I woke up there were at least 7 piles of vomit. I rushed him back to the vet and they ran tests. That's when they found his BG was in the high 400's. They kept him for the 12 days to get that high number down. I started questioning them if we needed to start thinking about his quality of life because he looked awful at the vets. Then, low and behold his number met the threshold. After I found this site I suggested I do home monitoring and his wife said the numbers would be all over the place and wouldn't be useful. They did give me the canned food! And now I am stuck!
     
  57. MrWorfMen's Mom

    MrWorfMen's Mom Well-Known Member

    Joined:
    Feb 18, 2015
    You are not stuck! You have us here to help. ;)

    Often vets think home testing is a waste of time but you have proven them wrong numerous times in the past few days with both your boys because without home testing you could have lost one or both of them! There is nothing like hard evidence to convince a vet to reconsider their position on testing at home and you now have that in spades.

    As Julie said, most vets are general practitioners who have to know a little about a lot. That doesn't make them experts with anything but the most common of ailments they see day in and day out. Diabetes is not one of those every day situations. Every cat is different...so is every guardian and treatment/care has to be tailored accordingly. Unfortunately, vets are used to telling clients what to do so they continue to use antiquated methods of dealing with diabetes. Frankly they probably just don't see/treat many diabetic cats. And sadly too many are not willing to admit they are out of their element!

    My cat is a prime example. My vet has experience with diabetes and several diabetic patients. She started her career in an emergency vet setting so she's seen her fair share of diabetics but my girl is a rare cat and she has my vet totally flummoxed! But my vet admits it! My vet tried to discourage me from testing Menace for IAA saying it's highly unlikely and so rare that it would be a waste of money to test. But when I told her I didn't care about the money but wanted to get to the bottom of what was going on, my vet immediately agreed. I think it's important to have a vet who is willing to work with you and understand that you are on the front lines 24/7 and they only see the cat for short visits all of which are stressful for the cat. With diabetes, that stress usually means the vet has a false view of what the BG levels really are. In short, what you do when at home to keep your boys safe and sound and healthy is entirely up to you no matter what your vet says!
     
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  58. MrWorfMen's Mom

    MrWorfMen's Mom Well-Known Member

    Joined:
    Feb 18, 2015
    I think if I were you, knowing how these guys have been dropping into dangerous numbers, it would be wise to consider missing a shot if no pre-shot test can be taken on Thursday. You've got a few days to watch and see how the boys are doing so no decision needs to be made right now but I just wanted you to know this is an option with the insulin you are using as long as there are no ketones in the picture. If ketones are present, then perhaps a reduced dose would be in order but I'd get dosing advice here before doing that!
     
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  59. Mum of two felines

    Mum of two felines Member

    Joined:
    Dec 7, 2015
    How the heck do you catch urine on a cat who refuses to even go at the vet?
     
  60. manxcat419

    manxcat419 Well-Known Member

    Joined:
    Jan 14, 2015
    And that is exactly how I often get around my vet too. They think things won't work, but as long as there's no potential for harm and it's only my money at stake, I tell them that as it's my money and there's no risk to the cat I want to try anyway. Quite often I can get agreement for things that they would never generally recommend (often because of cost or limited effectiveness in a majority of cases) that way. I don't mind having to be the front line on researching things as long as I can persuade them to work with me, not against me! :)
     
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  61. manxcat419

    manxcat419 Well-Known Member

    Joined:
    Jan 14, 2015
    I'm lucky - Rosa will usually try and pee on either the vet or the tech at some point during an appointment. They know now to catch as much as they can when she does that! Other than that, clean aquarium gravel in a litter box works as long as you don't need a sterile sample.
     
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  62. MrWorfMen's Mom

    MrWorfMen's Mom Well-Known Member

    Joined:
    Feb 18, 2015
    There are a number of tricks folks use but you have to be a stealth Mom! As April said, clean aquarium gravel is one option. Some folks can actually hold a ladle under kitty's butt to get a sample. :woot: (I'd like to see that happen in my world! ) Others put plastic wrap into the litter box and hope kitty pees on it. Of course with two cats it means either following them around to see who has gone or separate them with a litter box shortly after eating because that's usually when pee happens! I'm not gonna tell you it's easy but it can be done.
     
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  63. Mum of two felines

    Mum of two felines Member

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    Dec 7, 2015
    Mine won't even go if I'm anywhere close. If we happen to walk up on them they'll glare at us. There is no where around here that sells aquarium rock, I'll have to wait til I go to Walmart Saturday.
     
  64. Mum of two felines

    Mum of two felines Member

    Joined:
    Dec 7, 2015
    To check the ketones do I need a sterile sample?
     
  65. Chris & China

    Chris & China Well-Known Member

    Joined:
    May 10, 2013
    No...a sterile sample isn't needed

    Here are some Urine Testing Tips
     
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  66. Critter Mom

    Critter Mom Well-Known Member

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    Jun 16, 2014
    I would almost agree with the above. I would not start a food transition until the infection is resolved. If holding the 1 unit dose while the infection is unresolved I would also watch out for any major upward trend in NADIR BG levels while holding the dose (worry of DKA). If the dose is held and nadirs trend higher over a number of cycles, post for advice about dosing before increasing.

    [Emphasis mine]

    Please think back: Did your vet ever mention diabetic ketoacidosis, DKA or ketones to you when Woody was hospitalised? Was Woody given any other treatments during the 12-day stay? (If yes, which treatments?? This is really important. Can you let us know as soon as possible, please?


    Mogs
    .
     
  67. Mum of two felines

    Mum of two felines Member

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    Dec 7, 2015
    They told me he was dehydrated and they were needing a urine sample. But they told me the results were ok.
     
  68. Larry and Kitties

    Larry and Kitties Well-Known Member

    Joined:
    Dec 28, 2009
    No sterial sample required. It does have to be a fresh or relativelu fresh when you test
     
  69. MrWorfMen's Mom

    MrWorfMen's Mom Well-Known Member

    Joined:
    Feb 18, 2015
    Good points Mogs!
     
  70. Mum of two felines

    Mum of two felines Member

    Joined:
    Dec 7, 2015
    Can you explain what is happening in my kitties bodies? Why did Woody's BG go to 451 and then dropped to 86? And how high do let his BG go before I get worried? It scared me at 451. And what is NADIR
     
  71. Mum of two felines

    Mum of two felines Member

    Joined:
    Dec 7, 2015
    And Buzz? Would you give him a dose at 250?
     
  72. manxcat419

    manxcat419 Well-Known Member

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    Jan 14, 2015
    I think Woody was bouncing from the very low numbers he'd had for a few days. Bounces are his body's reaction to those low numbers and can make a cat run high for up to 6 cycles (3 days). There can sometimes be one extra-high reading right before the bounce breaks and they come back down. High numbers long-term aren't the best for him, but it's much safer to have them run too high than too low. The damage from high numbers doesn't happen as quickly where the damage from low numbers can be fatal within minutes if not treated correctly with high carb food/syrup/honey etc. Nadir is the lowest number they get to during the cycle.

    Buzz could also be bouncing from that 26 just 2 days ago - that was a really extremely low number on an Alphatrak. I notice you did give him insulin last night but at a higher dose than the one that took him down to 26. It's possible that some time during the gap in testing between the 221 on your sheet and the 149 he dropped low again because we know that even 0.5 unit can drop him extremely low and he had 1 unit last night. So that could potentially have triggered a new bounce, though there is no actual proof that that's what happened. I don't know whether I'd give insulin or not because I'm not familiar with Novolin - hopefully someone else can help you with that. But if you do give a dose, I would suggest it needs to be less than 0.5u.
     
  73. Mum of two felines

    Mum of two felines Member

    Joined:
    Dec 7, 2015
    How has my kitties stayed alive! Buzz came home and we were giving him 3 units. I kept reducing it because even befor home testing I was seeing him go hypo! Why wasn't my vet worried about that! They have gone through 2 tubes of NutraCal in a month! And half that time I wasn't home testing, just watching. Why didn't he tell me to back off on the insulin!!!!
     
  74. Mum of two felines

    Mum of two felines Member

    Joined:
    Dec 7, 2015
    Oh, I know, they told me to free feed because he was hypoing and to keep them separated because Woody was eating too much!!!! This was on their dry w/d. When I went to canned w/d they told me to keep the dry out for Buzz.
     
  75. Critter Mom

    Critter Mom Well-Known Member

    Joined:
    Jun 16, 2014
    Thanks for the info. Will write more about this later.

    For now, can you tell us the background to how Buzz was also diagnosed as a diabetic?


    Mogs
    .
     
  76. Critter Mom

    Critter Mom Well-Known Member

    Joined:
    Jun 16, 2014
    PS - Did the vets run fructosamine tests for Buzz and Woody as part of their diagnostics?

    .
     
  77. Mum of two felines

    Mum of two felines Member

    Joined:
    Dec 7, 2015
    He was vomiting and peeing outside the litter box. His vomit was grayish, he is a black kitty, and I figured he had a UTI. He did and they kept him and ran tests. That's when they found his high BG. I believe his number was mid 300s and they kept him for 2 days. They said nothing about kidney function - they did say he was fine though. He was diagnosed in August. It scares me to think about how long he was on 3 before I started, on my own, reducing his dose. Looking back maybe Buzz's UTI and stress caused those high numbers? They were both free feeding on hills prescription diet w/d (the best cat food for overweight kitties I was told) efore he was diagnosed, then I wen to feeding 2 times a day. He dropped 2 pounds from August to January. He's gained a pound back after I started leaving food out because of their hypo symptoms. I think both have been hitting these 40 30 and 20'for awhile
     
  78. Mum of two felines

    Mum of two felines Member

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    Dec 7, 2015
    They ran urinalysis and no significant findings all within normal range.
     
  79. Critter Mom

    Critter Mom Well-Known Member

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    Jun 16, 2014
    That's what I'm wondering about, too, hence my question about the fructosamine test. The fructosamine test is used in the diagnosis of diabetes because it will provide a gauge of the average blood glucose levels for a week or more before the blood sample was taken. High blood glucose readings and/or high glucose levels in urine at time of initial examination at a vet's office aren't a strong enough basis for a diabetes diagnosis on their own - especially if a cat has an infection. Also, classic clinical signs such as excessive drinking, peeing and hunger are not exclusive to diabetes.

    How long before Dx were they being fed the w/d dry? (It's like kitty cornflakes.)


    Mogs
    .
     
  80. manxcat419

    manxcat419 Well-Known Member

    Joined:
    Jan 14, 2015
    They stay alive because you're free-feeding with a high carb food. And because of those bounces - that's a liver response to a too-low glucose level. The liver releases glycogen to bring the BG back up. It does tend to over-compensate which is why kitties bounce for days sometimes, but in this case that's a good thing. Vets often just don't quite 'get' it - the instructions I came home with the day Rosa was diagnosed were to not home-test, to switch her food to prescription DM from the very high-carb dry she'd been on. And that if she showed any signs of hypo to take rub karo on her gums and take her to the ER...none of that is really a good or safe management technique for diabetes. I'm just grateful I found this board before everything went horribly wrong! And now you've found the board too, you'll get your boys sorted out because you're dedicated and want them to be well.
     
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  81. Mum of two felines

    Mum of two felines Member

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    Dec 7, 2015
    We'll one f the kitties were peeing a large amount, but we don't know which since they share 3 litter boxes.
     
  82. MrWorfMen's Mom

    MrWorfMen's Mom Well-Known Member

    Joined:
    Feb 18, 2015
    Believe it or not there are some vets who do not think cats go hypo or at least not very easily. While cats are resilient creatures with an ability to boost their glucose levels quickly due to stress/activity(hunting) etc. that doesn't mean they can't go hypo when receiving insulin from a bottle which cannot be controlled by the cat's normal biological mechanisms. I think this fact is often forgotten or not considered by some vets. The problem is that cats will compensate as long as they have the reserves to do so. If the reserve gets used up, and kitty can't compensate for those seriously low numbers, the results can be catastrophic. Once a cat goes into seriously low numbers, they can also be more sensitive to insulin for a time which is another reason why you need to be really careful about dosing right now.
     
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  83. Mum of two felines

    Mum of two felines Member

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    Dec 7, 2015
    Would that test show up on my bill as a separate line item?
    And they've been on w/d for years. Probably 3 if not 4 years. Before that it was purina indoor hair ball.
     
  84. Mum of two felines

    Mum of two felines Member

    Joined:
    Dec 7, 2015
    Right now I want to completely stop the insulin, clear up their infection, change to friskies totally and then see where thy are!!!!
     
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  85. MrWorfMen's Mom

    MrWorfMen's Mom Well-Known Member

    Joined:
    Feb 18, 2015
    That is interesting because I never had a fructosamine done for diagnostic purposes. Here it's used like a human A1C to determine regulation status and quite frankly with my experience I wouldn't trust it for either purpose but that's a topic for another day.
     
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  86. Critter Mom

    Critter Mom Well-Known Member

    Joined:
    Jun 16, 2014
    I've been trying to give your vets the benefit of the doubt but the above makes me really concerned about their level of understanding of diabetes; they should have advised you to reduce the dose.

    @MrWorfMen's Mom - what are your thoughts?


    Mogs
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  87. Critter Mom

    Critter Mom Well-Known Member

    Joined:
    Jun 16, 2014
    I couldn't say. I guess it depends on the vet's invoicing system.

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  88. Critter Mom

    Critter Mom Well-Known Member

    Joined:
    Jun 16, 2014
    I agree that it's pretty useless for regulation purposes because it shines no light on highs and, more importantly, lows. However, when diabetes is suspected and there's only a BG test (possibly influenced by vet stress) and perhaps a positive urine glucose test plus clinical signs upon which to base a provisional diagnosis the fructosamine test would provide some evidence of elevated blood sugars for a significant period and would therefore lend more support to a diabetes diagnosis. Otherwise you could end up in the situation where a cat has temporarily elevated BG levels due to, say, an infection and (to the best of my knowledge) in such circumstances insulin treatment would, I assume, be contraindicated as the BG elevation would be transient.


    Mogs
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  89. Mum of two felines

    Mum of two felines Member

    Joined:
    Dec 7, 2015
    Woody just came in at 393 +10. Please tell me not to worry!
     
  90. manxcat419

    manxcat419 Well-Known Member

    Joined:
    Jan 14, 2015
    That's a bounce. He went low, and his liver kicked in and over-compensated with glycogen. Once you can get him settled on a lower dose where he doesn't drop so low, he won't go as high either. And please believe me, bounces are horrible to see because of the high numbers, but they aren't anything you need to worry about. In fact they're proof that he compensates well for low BG!
     
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  91. MrWorfMen's Mom

    MrWorfMen's Mom Well-Known Member

    Joined:
    Feb 18, 2015
    re:"they told me to free feed because he was hypoing "

    I'm not sure I can share my true thoughts in mixed company!:arghh::banghead::banghead::banghead::banghead::banghead: That has got to be one of the most ridiculous things I've heard from a medical professional and believe me I've heard some doozies! That's the equivalent of pumping gasoline onto a burning house! Seriously, if it were me, despite the hassles of changing vets and the distance you might have to go, I really think that unless your vet is willing to listen and learn, you'd be far better off without him/her because I wouldn't trust them with a field mouse at this point.

    I highly suggest your next visit be made with the management document Julia provided a link to above in one hand and your spreadsheet in the other and have a heart to heart talk about them endangering your boys rather than helping them and see what kind of reaction you get. If they don't relent on their old ways, then it's time to move on.
     
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  92. Critter Mom

    Critter Mom Well-Known Member

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    Jun 16, 2014
    It's not quite that simple, especially for Woody. He is getting high numbers and he has an infection. I'm concerned about the risk of his developing ketones. If you change diet you run the risk of triggering a digestive upset and that could lead to lack of appetite. Lack of insulin, lack of calories and presence of infection is a trio you want to avoid like the plague at the best of times because they can lead to ketones and then very quickly to DKA.

    Going back to Woody's 12-day hospital stay that's very unusual for just diabetes. It's more like the amount of time a cat would be hospitalised for DKA treatment. Of course, I am brainstorming here. It would be wise to enquire of your vet at the earliest opportunity whether Woody was producing ketones at that time. If he was then you need to be more vigilant for ketones on an ongoing basis, especially when there is infection present: cats with a prior history of producing ketones may have an increased risk of becoming ketotic again.

    393 @ +10 <<< This is frustrating and upsetting to see (and likely a bounce off the earlier low).

    66 @ +3 <<< This is worrying and shows the dose is too high.


    Mogs
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  93. Mum of two felines

    Mum of two felines Member

    Joined:
    Dec 7, 2015
    That's exactly what I am going do! They have been our vet since the kitties were kittens. And like I said earlier they were my Pom's vet for 16 years and pulled him out of bronchitis and swollen trachea 5 years in a row. But, maybe I am seeing an equivalent of an ear nose and throat doctor instead of a heart doctor.
     
  94. Critter Mom

    Critter Mom Well-Known Member

    Joined:
    Jun 16, 2014
    Hi all,

    My thanks to everyone who has pitched in to help @Mum of two felines, Woody and Buzz. As most of you know I've got chronic health problems and I'm going to have to duck out now because I am absolutely shattered and I may not be around much for the next few days - I desperately need rest. I'm glad you're all here to keep an eye on things.

    :bighug:


    Mogs
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  95. MrWorfMen's Mom

    MrWorfMen's Mom Well-Known Member

    Joined:
    Feb 18, 2015
    In all fairness to your vet, they may have provided excellent care to your Pom but probably don't see/treat that many diabetics and the treatment of individual diabetic cats is not as cut and dry as dealing with other ailments. But if they won't listen and work with you and most importantly, admit to their shortcomings in dealing with your boys, then it's time to move on. The sign of a true professional is to know when they are out of their element and admit it rather than blundering along putting lives at risk.
     
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  96. Critter Mom

    Critter Mom Well-Known Member

    Joined:
    Jun 16, 2014
    Some vets can be absolutely brilliant at most things but sometimes not so much with the diabetes. I hope you'll be able to find a way through this with your vets; you've got great history with them. Bear in mind that we can't see the whole picture (e.g. tests that your vet ran, etc.) so we can't fully appreciate the decisions your vet has made WRT Buzz and Woody's diabetes treatment (especially if DKA may have been in the picture earlier.) That said, I stand by my concerns about their advising you to free feed instead of reducing the dose. (And they could benefit from reading what Dr Lisa Pierson has to say about feline nutrition at catinfo.org. ;) )


    Mogs
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  97. MrWorfMen's Mom

    MrWorfMen's Mom Well-Known Member

    Joined:
    Feb 18, 2015
    @Critter Mom Go have a good rest Mogs. We'll be watching for your return after you regroup!:bighug::bighug:
     
  98. Mum of two felines

    Mum of two felines Member

    Joined:
    Dec 7, 2015
    T
    The only weird word is on 12/22 after the urinalysis was moderate amount of leukocyte. Before Woody's surgery they ran a feline profile, everything was within normal limits. Less than 7 days later he had a UTI and the glucose test was 456. LEU: ++ UTI GLU: 2000 Diabetic
     
  99. MrWorfMen's Mom

    MrWorfMen's Mom Well-Known Member

    Joined:
    Feb 18, 2015
    Leukocytes are white blood cells and they can be elevated as a result of inflammation, infection, trauma etc. so chances are this was a sign of the UTI starting.
     
  100. Critter Mom

    Critter Mom Well-Known Member

    Joined:
    Jun 16, 2014
    [Emphasis mine]


    @MrWorfMen's Mom, @manxcat419 - You OK to run with this?

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