? I'm worried

He has never been a picky eater but it almost seems like he is turning up his nose at the new Friskies Special Diet. Does anyone have any suggestions for making it more palatable?

My vet told me to quit testing Charlie because his numbers are going to be all over the place, just feed him, give him the reduced dose with every meal, and give it a week. Well, this morning he was really kinda sluggish and didn't want to eat. I'd given him his dose because he seemed to be starting to eat breakfast but then he abruptly stopped after a few bites. I checked his sugar and it was 48. I quick gave him some Karo syrup but then I had to leave to go to work (my employer has no concept of people needing time off).

I'm really worried he's going to go hypo while I'm at work if he doesn't eat.

 

Hi, have you already left for work, or are you still home?

And is it correct that you gave a shot at BG of 48? If so, then yes, your cat is at risk of hypo unless you take further action to prevent it. The syrup may only raise his BG for a short time.

What insulin dose did you give?

 

If you are still home but have to go out then I'd suggest you try to abort this insulin cycle by getting some high carb food on board. Syrup acts fast but wears off fast; food acts more slowly but lasts longer.

If you must go out, is there a friend or neighbour who can check on your cat for you?

 

I gave the shot and then checked his sugar after. I am at work now. I asked my neighbor to go check him and tell me what she finds. I gave him .75 unit.

 

Okey dokey,

Is there some high carb food that your neighbour could give to your kitty?
.

 

yes, I still have some of the dry stuff he used to eat.

 

my neighbor just e-mailed me and said he seems to be ok. It's been 2 hours since I left; she'll check him again shortly.

 

The insulin may only just be starting to take effect now (1.5 - 2 hrs after the shot) and it will increase in it's effect until the peak of the cycle (typically between 5 - 7 hours after the shot).

Given that there is nobody able to test your kitty's blood glucose I would strongly suggest that you ask your neighbour to feed some higher carb food as soon as possible in order to try to avoid hypoglycemia.
.

 

Sue, here is a link to info on how to handle hypoglycemia:
How to treat HYPOS - THEY CAN KILL! Print this Out!!
Are you able to send this link to your neighbour?
I'm assuming s/he isn't going to be able to hometest (?), so really it is the list of symptoms (followed by course of action) that may be of use.
Be aware that some cats show symptoms early on, and some cats don't show symptoms until the hypo is advanced.

In an 'ideal world' it would be the case that there was someone to test your kitty's blood glucose every 30 mins and take whatever action was appropriate. But this isn't an 'ideal world' situation. We do not know what your kitty's blood glucose levels are. We only know that he was given insulin at a low blood glucose number. In that situation, and in order to try to keep him safe, it's necessary to try to get some carbs onboard.

It's quite possible that the karo you gave will be out of the system by now. And ideally, it would be good if your neighbour could give a bit more karo now, and (if s/he hasn't already done so) give some high carb food also. (If you have any cat food in gravy in the house then a few drops of karo could be added to a tsp or two of gravy and given that way.)
.

 

I just got home. I am going to throw him into the car and take him to the vet.

 

OK, Sue.
Keeping fingers and paws crossed that all is well.
Please update us when you can.

Eliz

 

Sending some prayers your way......

 

Sending prayers, too!

 

Oh Charlie, you're going through it at the moment aren't you! I really hope he's OK and yes, please update when you get a chance.

(BTW Now I'm not so sure that your old test strips weren't good - with that reading, it sounds more as though the 400s might have been because he wasn't feeling good and now he's coming back down to where he usually is).

 

Hope Charlie is okay.

 

I DONT' KNOW WHAT TO DO!! I took him to the vet and the lady I usually see wasn't there so I saw one of her partners. She checked his sugar and it was over 600!!!!!!! She said I should never have given him the Karo syrup because it drove his sugar up too high and too long, doesn't think that I should do home BG testing because you never know if the meters are accurate... and she pointed out that even the 46% variance that @BJM sees between the Confirm and the AlphaTrak isn't holding up because the first time they tested him, it was off by one set of percentage points, and the next it was off by a different set of percentage points. I don't have the figures to hand, it might be in one of my earlier posts. We don't know why he was refusing food this morning; I may have tried to change his food too quickly again (he's never been a picky eater but he's also never had as many diet changes in such a short time, either). She tried to tell me either I have them do all his testing or I can just go find myself another vet. I don't know what to DOOOOOOOOOOO!!!!

 

The first thing to do - breathe! The vet doesn't get to control this situation - you're their paying (and likely paying a lot) customer so they're more dependent on you than you are on them. There are other vets out there!

Personally, if the vet is refusing to work with you and is insisting they do all his tests, I would find another vet. Home testing is so, so important - you wouldn't give a diabetic child a shot without testing their BG first so why would you do it with a cat? A cat can't even tell you if he's not feeling right like a child can!! The Karo syrup doesn't stay in a cat's system for long - that's why when we give it, we have to keep checking them afterwards to make sure they don't drop back as it wears off. And a small amount of Karo shouldn't send him over 600 from 48 anyway.

The meter variance can be 35%-40% between a human glucometer and a pet glucometer. But then there's also a 20% allowed variance on all meters (the last I heard Alphatrak doesn't necessarily conform to that as it's a legal requirement for human glucometers only). So the readings you get on the human glucometer could be a long way off an Alphatrak when you take all of that into consideration.

It is just about possible that he went lower than the 48 and bounced that high because his liver panicked, but that would be a huge, huge bounce. So, checking your meter is probably in order at this point to make sure it really isn't that far off. If you have control solution for your meter, it might be a good idea to use that to see if it comes up with a fairly accurate reading. Failing that, you can always test the meter on yourself (you're looking for the same 120 or below that you'd look for with Charlie as normal range). I won't lie - it does sting a bit (I did it myself a couple of times when I wanted to check the meter was working right) but it could be worse and that way you'd have an idea of whether your meter is close to accurate or not. Once you know that, you can take the next decisions from there...whether it's as simple as buying a new meter and sending the one you have back as faulty, or whether it does come down to needing to change vets to find someone who is more willing to work with you.

 

Oh, I should have said - if you're going to test yourself, use the smallest size lancet you've got. You don't need the bigger alternate site ones we often use on our cats for a fingertip test (though if it's all you've got you CAN use those too).

 

I suggested that some of that bounce could be a visit to the vet--it involves a half-hour car ride that he really can't stand. Maybe that's my next step. I don't have any control solution. Would I get that at WalMart?

 

He'll be ok from the syrup, going too low is WAY more dangerous. I am in the process of swtiching to a new vet that will work with me- sounds like you may be headed that way too. Sounds like you did a great job of taking care of Charlie today! my kitty liked the fancy feast classic chicken better then the friskies special diet that he is currently on. maybe you could try a different food and see if that peaks his interest?

 

Any suggestions on getting him to eat the new diet? like I said he's really not a picky eater but then I've never changed his diet 3 times in a month and a half before.

 

Yep, that could have added 100-200 points to his reading too. That's why a lot of us don't want curves and testing done at the vet when dosing's going to be based on those numbers...a lot of our kitties would end up getting too much insulin if we did that! I'm not sure if the control solution is available in store at Walmart or if it's order only - I didn't ever buy any as it seemed as easy to take 2 minutes to test me. Then again, the times I wanted a double-check always seemed to be late at night when I couldn't have bought anything anyway...always the way!!

When you're switching diets, one of the easier ways to introduce a new flavor or texture is to mix just a bit of the new food into a decent portion of the old one. Then you can gradually increase the amount of the new food each time until he's transitioned over fully to that.

And I completely agree with @KarenBlasky - too high is always safer than too low. You did the right thing in giving him syrup when you saw that 48 and don't let any vet tell you otherwise!

 

I am on the phone with a local feline specialist group. They cost more than my current vet unfortunately, although I was impressed by their information on the website and they highly recommend home testing--although they want you to use the AlphaTrak which I really can't afford; those test strips cost twice as much. I just tested his BG and it's down to 86. This is crazy.

 

The control solution is only available from Relion...You have to call them and they'll send it to you

It's a lot easier to just test yourself and see if you're getting a number that makes sense for you.

It's also very important for you to try to keep your spreadsheet updated. We really depend on seeing those numbers to help advise you

Most of us don't even bother with the vet anymore for the diabetes. The people here have much more real life experience in feline diabetes than vets do. Only time China sees a vet anymore is for routine shots, dentals and if there's something else going on that I need diagnosed (and to get scripts for insulin when needed) I think a lot of us here on the message board are the same.

If you want to try to find another vet, just call around and ask them to have the VET call you when they have some time to talk and then ask how they deal with their diabetic cat patients. That can tell you a lot about how much that vet knows....and if they won't call you, that tells you a lot too!!

 

I absolutely agree.
If the blood glucose was 48 at +12 when you gave the shot, then it's very possible he'd actually dropped lower than that. And if that is the case then it seems likely that his liver has released stored glucose into the bloodstream to raise the glucose level. This is a good thing, as it may have saved your kitty from the effects of hypoglycemia (some kitties aren't that lucky, their livers may not have responded in that way.)

Given the low numbers that you saw, you were absolutely right to give karo.
Karo can certainly raise the blood glucose quickly; but the effects of it are usually fairly short lived (that is why we often advocate giving food as well as karo/syrup)).

I am hugely relieved that your kitty is OK. It could have been a very different story.

It would really help your kitty to be safe if, from this point forward, you could get into the routine of testing his blood glucose before giving insulin.
The sequence is 1.Test, 2.Feed, 3.Shoot.
So, you test to see if the blood glucose is high enough to give insulin; then you feed (to make sure that the kitty has food on board); then you give the shot.

For folks new to dealing with diabetes (or who don't have a lot of hometesting data) the general advice is that no shot is given if the blood glucose is below 200.

I understand that this is all very stressful for you, but please know that we are here for you and we want to help.

Eliz

 

I would just tell them you can't afford the Alphatrak, but that you can provide them with a copy of the reference notes that show the difference between that and a human glucometer. I'm sure they'd rather you test with something than not test at all!!

Though I agree with @Chris & China - beyond getting a prescription for insulin and providing a copy of the ss to my vet once in a while, I haven't really spoken to my vet about Rosa's treatment except when they'd call me up to tell me they "weren't sure" that what I was doing was a good idea. I'd listen to everything, tell them I'd think about it...and then go right back to doing what I was already doing. Then again, my vet will at least let me refuse tests done in their office - they keep asking and I keep telling them there's no point. I think they've given up asking now!!

 

I am also relieved to hear that kitty is ok. I just read this entire thread and felt for you and kitty.

It is a problem with home glucose meters (we had an issue with my hubby's meter as well) and had to get the solution or get the pharmacy to do it for you. (They will do it for you). It was "off" and we had to get a new meter (free when you buy the strips). It just may be that either your meter is off and needs a new one OR...as Manxcat has so wisely said, your kitty released more glucose to deal with the hypo situation.

I have hypoglycaemia myself and I know that once I've had the "fix" (sugar/glucose then, a meal) my numbers are whacko and continue to be so for a few hours. The next day...they are fine.

I agree with everyone else here in the idea that a vet saying to NOT home monitor or go somewhere else is one to run from. I do "get" their point in so far as..."hey...if your monitor at home is 'off' and you're treating according to your monitor....we are going to keep seeing you in crisis so, best you don't do it" type of idea. Wrong...but, I do see that point to a small degree.

If this were me...I would continue on with the home monitoring AFTER I got my meter checked/the solution to check it/had the pharmacist do it AND...look for another vet who will work WITH you...not against you. (Don't worry, you're not alone with this issue as a lot of vets don't even recommend home monitoring but, will work with you if they see that you're seriously trying to take care of your cat the best that you can and using them as "guides" along the way.)

Honestly, I'm a little different minded in the idea that monitoring at home is the perfect scenario as their numbers are lower at home by far, than in the vet's office. Poor kitty might have had a panic attack in the car, on the way to the vet's which also raised BG levels on top of the Karo syrup (again...better temporarily high than too low for sure). For me...personally, doing home monitoring as well as working with a vet's numbers and coming to a compromise between the 2 numbers for dosing is my personal reassurance vs self-dosing solely. But...that's just me. Many here seem to do quite well with their own guidelines and my hat is off to them for it. They have been successful. I just prefer a vet's help in making decisions on the dosages etc.. If I do run into crisis (which happened once with my previous Sugar Kitty), I don't want to hear the old "well, you never come in or let me see him so...." type of response in an ER situation. So, I like to go mid-road with that protocol vs not seeing a vet at all for the diabetes. Again....that's just me. Doesn't make me right by any means and, only what I'm most comfortable with right now but, I do have fights with the vets LOL

Just sending you a huge hug as I am not the expert that many members in here are and I totally rely upon their kindness in helping me as well. I know how stressful and frightening this all is and not knowing what to do is probably the hardest part of it all.

Take a deep breath, have a tea or something comforting, breathe and remember....you're doing so well with what you can do.

 

I talked to them for a long time. They would be happy to take over for Charlie & it may be worth it to have someone who treats diabetic cats on a regular basis. They did say that I wasn't the only sugarcat owner that had called today! I'll have to look at BJM's stuff about the differences in the human vs Alphatrak & look for the footnotes. I called ReliOn and they are sending me the control solution but it's gonna take 1-2 weeks to get here!

 

A view of the +/- 20 % meter variance allowed by FDA.

A chart and a table of human glucometer with estimated AlphaTrak, including the +/- 20% variance.

Pictures may work better.

See my signature link Vet Interview Topics if you decide to go vet hunting.

 

@BJM I swear you're a mind reader!! I was just coming back to ask you for that exact information!!! LOLOL In fact, to all of you!!!!! I dunno what I'd do without you.

 

@BJM, Could you give me some help reading the table? I am thinking that maybe the "estimate span" is a point range, over/under? And because I KNOW the vets are going to want to know, who developed the chart and where did the info come from?

 

I think you mean +/- 20% not 29%

 

@manxcat419, you mentioned that up to 600 was an awfully high jump--I was doing some digging on the home page and found out that hypoglycemic rebound easily can take a cat's numbers up over 600. It's by some DVM who is a feline specialist. It's in an article about whether to do the glucose curves.

 

@KarenBlasky , you don't live in southwest Idaho do you? Because I'd love your vet.. The reason I moved to the Friskies Special Diet is because at Charlie's age, I'm worried about phosphorus content. His kidney values were within normal limits, but they were high-normal. Since his kidneys are already being taxed by the DM, I thought it safer to move to a low-phosphorus canned food (that won't break my budget!). It should certainly lower his chances of getting CKD, poor puss. The more I think about it, the more I think I'm tempted to give this new vet a try. One thing that impressed me, on their website they had a .pdf about feline diabetes that sounded a lot like what I see here. Something interesting--she said cats don't need to be as tightly regulated as humans because they don't get the nasty side issues that unregulated humans get--kidney failure, blindness, etc. AND.. she recommended this site for more info.

 

Yes, it's true that if they go really low, they can jump up that high when the liver releases those stored sugars and hormones to bring it back up.

It is kind of unusual to see them jump up THAT high, but it's definitely possible

 

After a low reading, they do usually bounce a bit higher, at least until they get used to low numbers. 600 from 48 in a couple of hours is a bit more than we'd usually see them jump all at once...but I forgot to factor in anything up to 200 more from vet stress, and 48 to 400 is even more possible! I guess we know his liver's working just fine though!!

 

Typo fixed.

 

The reference numbers come from Dr Rand's work. She is an internationally renowned feline diabetes researcher at the University of Queensland. The most recent article with the reference ranges was 2013. I believe it is posted in the Lantus forum somewhere. I couldn't find it before I had to leave for rehearsal.

 

I also have a 14 year old cat on Prozinc. We are far from regulated but I can not imagine treating my baby without this site.I believe this site has helped both me and my vet learn how to properly care for diabetic kitties. In the beginning my vet was also against home testing. I know he meant well as he was concerned about the cost I would incur. However, after a few months of treatment he has come to expect a printout every time I have an appointment. The last visit I arrived without the printout I had to go home and email him copy. I have never had anyone at the vets office treat me the way you were treated but if I ever did I would have switched vets immediately.
Hang in there and do not give up the home testing as I believe it is the only reason I still have my furbaby.

 

@BJM, if you aren't a vet, you oughtta be. @Spike's Mom, I may give this last vet one more chance but I am very very tempted to have at least one visit with The Cat Doctor in Boise.

And just for interest's sake, Charlie is not remotely acting hyperglycemic. He went to the water bowl, took a few laps and walked away. He's about as active as he ever gets, wandering around the house. Doesn't look anything like he did on Monday when he got so sick.

 

Here's the actual paper they wrote that cites the differences in human vs. feline-specific glucometers, if you want to check out the link! I'm going to have fun shoving this under the noses of that vet...

uq.edu.au./vetschool/content/ccah/diabetesinfo/link4.pdf

for some reason it won't let me do the link, you'll have to copy and paste it. Either that or you can google "Roomp and Rand dosing protocol"

 

How he's acting is very important. I'm glad he's obviously feeling better than he was on Monday. If a good part of that high number was vet and travel stress, chances are he's a lot lower again by now anyway. And even if he does bounce for a couple of days from a low, it's good that his body dealt with it even if it did overreact a bit!

 

I really think I'm going to have to toss this vet. She called and said I had to take two days and check my cat's ketones twice a day (I can't follow my cat around the house all day waiting for him to decide it's time to use the litter box then try to get him to hold still while I check the pee) or they do the curve in their office-- it's only $36 but I have to make two 1-hour round trips, for numbers that could very likely be way off because he'll be stressed out and running high numbers!

 

Didn't they test him for ketones while you had him there today? And although there is a link between insufficient insulin and ketones, some cats don't get ketones even when their levels are all the way up in the high range and some get them much, much earlier. I understand why testing for ketones when the levels are higher is a good thing, but I don't see what that has to do with them doing a curve in the office...and stressing him out both at the vets and with the driving into the bargain. They're still not coming up with a good reason why you shouldn't be testing his BG levels at home.

 

Management of Diabetic Cats in Vet Clin Small Anim 43 (2013) 251–266

see Table 2, especially the footnote " If a serum chemistry analyzer or plasma-equivalent meter calibrated for cats is used (eg, AlphaTRAK from Abbott Animal Health), increase the target blood glucose concentration by about 1 mmol/L, 18 mg/dL, ..."
This article discusses managing diabetic cats using human glucometers.

 

my husband and I discussed it and we are not going back to that vet. I am going to keep going as I am at home and then make an appointment with http://www.catdr.com/ for sometime in a week or so. They honestly seem like they will be much more open to what we've been doing, once I show them the studies on the human glucometers. I checked his sugars about 15 minutes ago and it was 67. I am not going to shoot him. Oh, and I may have found the trick to getting him to eat the new food.... I did mix it with some of the older stuff, and added a tablespoon of warm water. He chowed down on it.

 

Good to hear that he's eating now. And I think that's a good decision on the vet - you don't need a vet who is working against you when you're trying to do the very best you can for Charlie. And yes, 67 is too low to shoot - I know there's still a bit of a question mark over the glucometer, but you can only work with the information you have.

 

he's still doing it in a nibbling fashion on and off. He chowed down for a bit and then walked away. He's not showing ANY signs of feeling ill; he's not living at the water bowl; not vomiting or having diarrhea; energy level seems to be about what it always is. In some ways I like this better than when he was always ravenous when his numbers were scary high.

 

I did test the glucometer on myself and the numbers were probably ok. That wasn't much fun. Fortunately I knew what to do because I had gestational diabetes with my son--who made me laugh tonight when he asked if I was going to take Charlie to a "catologist"!

 

There are more pleasant experiences - but if it confirms it works, at least it's quick to do! I love the idea of a "catologist" - it makes our cats sound so important!! And if you got an accurate reading on yourself, I think it's safe to say the readings you're getting on Charlie are fine too.

 

I just took a look at their website and skimmed through their info page on diabetes. I am impressed by what I see there, they sound like the perfect vet clinic for your kitty!

 

How is Charlie doing today?
Hoping all is well.

 

I think so, too. I'm calling the old clinic today and telling them they're no longer my vet. they bloody well nearly killed my cat twice and blamed it on me.

 

good morning, thanks for asking!! He's wide awake, perky, eating his breakfast (slowly) and has a BG of 67. I'd say he's doing great!! no shot today and I'm getting a new vet.

 

Wow! There's so much good news there!

Looking at that BG this morning, and the most recent numbers on Charlie's SS, I do wonder if he's going to need insulin at all....?

 

I don't know. I just checked him and it's still under 100. I can't shoot him tonight at all. I have the SS completely updated, throwing out the garbage number we got at the vet's yesterday because I am 100% convinced what she got was hypoglycemic rebound and stress. Clinically, I don't see anything that scares me. He's up, moving around, not drinking a ton... At some point I want to see the new vet but if he needs anything at all, it's going to be a tiny dose, I think.

 

I think Charlie may just have skipped the insulin part and went straight to the OTJ trial!! As long as he's staying in normal numbers, I'd probably just keep testing twice a day and see how it goes

 

If he's acting fine and his numbers are fine, I'd say he's doing just fine. And I agree, I don't think the number you got at the vet is indicative of anything useful - of course he was stressed after the car journey and that added to a bounce would have taken his numbers all the way up.

I'm not convinced he needs insulin either - not based on how well he does without it (anti-jinx). And I do think the higher numbers you got the other day at home were because he wasn't feeling good - he might have a stronger reaction BG-wise than some other cats to feeling sick but clearly as you're using the same strips you got those higher readings with, it has to have been just a really bad day for him.

 

That's exactly what I plan to do. He's at 60 again this a.m., and it's been 48 hours since his last shot. He's suddenly decided to be a free-feeder again. That's what is up with the slow eating. I leave the food out and he nibbles at it until it's all gone when I get home, apparently because it is all gone when I get home! and as soon as I walk in the door he starts yowling for his dinner...

 

Lovely, lovely, lovely numbers....
.

 

I fired the vet this morning.......BTW, @Elizabeth and Bertie.. did you notice Charlie's full name?

 

I did indeed! And since I was born in Scotland that name always strikes a chord with me...

 

That's absolutely fine - it's less strain on his pancreas to eat a lot of small meals during the day. All of our cats are free fed (they used to be free fed dry food but now it's wet food instead). And I'd agree with letting him have an OTJ trial - his numbers are too low to give insulin anyway, so he's pretty much demanding it at this point!!

 

He kinda' isn't giving me a choice, huh? I'm just going to keep checking his sugars twice a day (actually, I think I'm going to run a curve either tomorrow or Monday just for my own information & to give to the new vet when I go see her) and see where he goes from here.

 

He really isn't at this point - it does look as though he wants off the insulin! A curve isn't a bad idea for information to give to the new vet and so that you don't have to worry that he's going a lot higher at any point (though I really doubt that he is - his numbers look pretty level). Just remember when you're running it that a one off number a bit over 120 isn't necessarily something to worry too much about - just see if he comes back down by the next test (and maybe encourage him to take a couple of bites of low carb food to give his pancreas something to work on). Other than that, the twice a day is fine - it's what we're recommended to do for a trial. You might want to mark on his spreadsheet that you're doing an OTJ trial with him so that if you do have any questions people can see what's going on.

 

I don't mind him being off the insulin at all. That would sure take away any concerns I have about my trip next month!

 

You knew he was an alcoholic but didn't know he was diabetic, too! LOL. I'm a closet (or not so closet) Jacobite & have been ever since reading Anya Seton's "Devil Water" more than 30 years ago.

 

Ha-ha! That auld 'Scots rebellion' thing is still so strong in some quarters. My great aunt, Mary Wallace, is still 'flying the flag', even though she's in her 80's now; and she still signs her Christmas cards as 'Mary 'Braveheart''....
.