Kathy's Cleo - Newly Diagnosed - Oceanside, CA

Discussion in 'Feline Health - (Welcome & Main Forum)' started by Kathy-and-Cleo, Jul 14, 2012.

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  1. Kathy-and-Cleo

    Kathy-and-Cleo Member

    Joined:
    Jul 14, 2012
    Hello all,

    My name is Kathy and I started poking around on this website last night after finding out my 14 year old cat, Cleo, was most likely diabetic from our vet. I decided to come out of lurker mode and say hello since we have made the decision to pursue treatment and now have lots of questions, and I'm sure only more questions as time goes on.

    Just as a bit of background, as I mentioned, Cleo is 14 years old. She has always been a bit of a chubby cat, but in the last year or two she put on another 4 lbs. despite being on food labeled for weight control-hairball control for indoor cats, with the exception of the times we could not find her usual food and resorted to "regular" cat food. She now weighs 13 lbs. At ideal weight she would probably be a small-ish cat of 7-8 lbs. Recently (approximately 6 weeks ago) we noticed her water consumption and her output had gone way up. After noticing urine scald this week we decided it was time to take her into the vet to see what was going on, since she was not doing well without intervention.

    Cleo has been a dry food only cat her whole life. Back when she was a kitten I had tried wet food for her and she literally just ignored it until it dried out! Based on that, I never bothered to try to feed her wet food.

    After reading up a lot last night and more this evening, we have switched her to wet food. Happily, for her first wet food meal tonight, after a few cautious sniffs she caught on pretty quickly and ate the half-can of Purina DM we gave her. I have already bought some Fancy Feast Classics (the poultry ones) and plan to visit our specialty pet store tomorrow to try out some Merrick's. I plan to have her on low-carb, high-protein wet food only from now on. That's the easiest part of the treatment to deal with.

    At our vet appointment yesterday, the vet did a blood glucose test at the appointment and based on the result (410ish) and the obesity, excessive water consumption and urination, he made a preliminary diagnosis of diabetes. He also drew blood and urine and had labwork done. At our consultation today we went over the bloodwork which he said confirmed diabetes - blood glucose of 411 and glucose present in the urine. The good news was there were no ketones in the urine.

    In discussion with the vet he said that because Cleo is recently diagnosed and he thinks we caught the diabetes relatively early, she stands a good chance of going into remission if treated properly. He's absolutely in favor of an immediate switch to low-carb, high-protein wet food. He was ok with the Purina DM but did not push it, by any means. He also recommended the regularly available EVO 95 or Merrick Before Grain.

    I did ask about starting with just a diet switch first, and he strongly recommended doing both a diet switch and starting insulin. Although I'm a little dubious of doing both changes at once, I am going to follow his recommendation and we are taking Cleo in tomorrow morning for her first insulin shot. We are going to be doing Lantus insulin. They will be showing us how to do the insulin shots and test blood at home. He was in favor of home testing, so that's a positive. Cleo will spend tomorrow at the vet for a "mini" glucose curve (they are not open long enough on Saturdays for a full one) but it should be ok in combination with doing our own testing at home. I'm hoping Cleo doesn't get too stressed out by being at the vet that it throws all the readings off and causes more harm.

    I guess mostly I just wanted to establish where I was coming from with questions etc.

    I feel like I've gathered a lot of information already from this board and other good websites. Incidentally, my vet even recommended this website, which is a good sign, although ironic since I had already found the website and forum last night :lol:

    Anyhow, my first question revolves around what glucose meter to get. I know there's the starter kit available above, and lots of recommendations for some of the human glucose meters. However, when I asked the vet about it he said that he strongly suggested getting one of the glucose meters calibrated (coded?) for cats since they store glucose differently in the blood. Does anyone have any knowledge of this? Is it a legitimate concern? He was recommending the AlphaTrak (2 I guess, not sure, I will ask tomorrow), which is what they use in the vet's office. However, it's pretty pricy - even on Ebay it looked like it would be about $100 for the meter, 25 test strips and 30 lancets. The test strips themselves would be about $1/strip in the future (almost 3x the price of the ReliOn ones). I would really like to know if it's going to be worth it to get the coded-for-cat meter and if anyone else knows about the made-for-human meters not being as accurate because the glucose is stored differently.

    Thanks in advance for any insight!
     
  2. Sue and Oliver (GA)

    Sue and Oliver (GA) Well-Known Member

    Joined:
    Dec 28, 2009
    Kathy, I am completely impressed with you and your vet! You have really done your homework.

    Some vets want to start kitties on insulin in their offices. I think that's reasonable, but no, you won't be able to rely on any numbers gained there. And we strongly suggest starting at .5 - 1 unit twice daily anyway. You can always increase as your hometesting numbers suggest. Hopefully your vet will start at a safe, low dose.

    Very few people here use the AlphaTrak. It is too expensive for the meter and strips, and if you run out of the strips on a Saturday evening, you have no place to get any. We use human meters. We are looking for general ranges and trends, rather than numbers. Whether the kitty is 230 or 260, you will be giving the same dose.

    Continue to read and ask questions. We'd be here to help with your sweet Cleo.
     
  3. squeem3

    squeem3 Well-Known Member

    Joined:
    Dec 28, 2009
    No, you don't need the pet meter at all. It's no more accurate than a Human meter. Plus it's expensive. A Human meter works well and all you need. It can't tell Human blood from animal blood.

    The FreeStylebrand of Human meters and any meter with "True" in the name (usually a generic store brand) do not give accurate readings so don't buy any of these. Wal Mart's Relion brand of meters is what many people here use.

    If you want, you could try diet for week first and then start insulin. Doing a diet switch while on insulin can be tricky especially if you are not testing blood glucose levels.


    You are starting insulin tomorrow (Sunday) at the vet's office and the vet will also do a curve? The curve isn't needed. All it will show is that the blood glucose levels are high, in part because your cat will most likely be so stressed out that blood glucose levels are further elevated. One Lantus shot isn't going to have any effect on blood glucose levels. It takes Lantus a few days to "build up a shed", as Lantus users here call it, before it has any effect on blood glucose levels.

    Once you are testing blood glucose levels at home, you can do your own curves. You test aprroxinately every 2 hours. Record the numbers and email it to your vet. I wouldn't do a curve on Lantus until a week or so after starting it.
     
  4. MelanieP and Ninja

    MelanieP and Ninja Member

    Joined:
    Jun 3, 2012
    Hi Kathy! I have both the Alpha Trak 2 and the Relion Micro. The Alpha Trak tends to read a little higher (marginally) but I have found no advantage to using it over the Relion Micro. Most people on this board use human meters, and are used to evaluating spreadsheets and giving recommendations based on those readings - so from that standpoint, the Relion may be more beneficial to you in the long run. My vet talked me into the Alpha Trak early on -- saying human meters could not read cat blood (I think she read this on the back of the box), so I bought it just to make her happy. Otherwise, she has been a great vet. But when I ran out of test strips and couldn't find any at 7am, I switched to the Relion Micro meter as I could get those strips at Walmart, 24/7 -- at 1/3 of the price, I might add. Other vets, like Dr. Lisa Pierson who is a feline diabetes guru and posts to this site from time to time, recommend human meters -- so it's not just the crazy "internet" people who are recommending this. Another poster, Russ, commented recently he never tells his vet that he got advice from an internet message board -- as the vet's eyes tend to glaze over and they they discount everything he is saying as nuts. LOL!!! But the people on this board (the senior people that is...not newbies like me) are experts at this and have helped save the lives of thousands of cats over the years. Some enlightened vets, like Dr. Lisa, actually recommend the FDMB as a good resource for newbies. That said, I now use my Relion Micro exclusively and just don't tell my vet so she does not have to stress about it (LOL!!). I send her the readings and she works with me to make decisions about my cat's Lantus dosage increases. Everyone is happy.

    PS: Though I am pretty new myself, I agree with Squeem3 above about getting no value from a mini curve at the vet tomorrow; and also agree that doing the diet change for a few days with at-home blood glucose testing before deciding on the Lantus dose might make a lot of sense (not for more than a few days though...see below). One of the first things I learned on this site was that Diabetes is a disease that kills slowly (if left untreated) but that too high an insulin dose can kill quickly. That's the whole point of the "start low, go slow" recommendations. Cleo's blood glucose readings at the vet are unreliable due to the stress of being at the vet (poked, prodded, in a cage and an unfamiliar environment). Even a normal cat can have significantly increased blood glucose levels in this setting (I believe it is called stress hyperglycemia). So Cleo's 411 reading at the vet could have been 311 at home. Also, as you learned, most cat's BG levels drop significantly just from a diet change alone. So a week from now, Cleo's at-home reading could be (as an example) 250 instead of 411 -- necessitating a lower starting dose of insulin. (Senior posters, please correct me if I am wrong on this).

    Here is an excerpt from veterinarian Dr. Lisa Pierson's excellent article on the subject (entire article can be found here: http://www.catinfo.org/?link=felinediabetes )
    -----------------------------
    "Many cats that are in a diabetic state no longer need any insulin when they are finally fed an appropriate low-carbohydrate diet. Others will always need some insulin but the amount necessary to maintain proper blood glucose levels is nearly always significantly reduced once the patient is on a low carbohydrate diet.

    Please re-read the previous two paragraphs carefully. If you change your diabetic cat's diet to one with lower carbohydrates, he will, in all probability, IMMEDIATELY (not days or weeks later) require a reduction in his insulin dosage. He may also immediately go into 'remission' and not need any insulin at all.

    If this warning is ignored, you may very well end up with a cat in a hypoglycemic crisis (dangerously low blood sugar) which can result in death, or brain damage.

    If you take only one point away from this page, it needs to be the understanding that if you stop pouring carbs into your cat by switching to a low-carb canned food diet (or even a dry food diet with lower carbs than you have been feeding), you MUST be aware of the probable immediate and significant impact on your cat's insulin needs."

    Dr. Lisa also says in the same article:

    "Unless the patient's clinical signs warrant immediate insulin administration, I try a diet change - with no insulin - for 5-7 days to see what impact the new diet will have on the blood glucose. In most cases, I do not agree with waiting much longer than a week to start insulin. This is because you will have the best chance of getting your cat into remission (cease needing insulin) if both diet and insulin are used very early on. The longer your cat's body is under the effects of glucose toxicity, the more his body will be damaged and the less chance of remission he will have."

    ---------------------------

    These are all things you may want to discuss with you vet. Welcome to the board!!!!!!!!!!!
     
  5. PeterDevonMocha

    PeterDevonMocha Well-Known Member

    Joined:
    Dec 28, 2009
    Hi guys ... I just want to say welcome! I am very impressed with both yours and your vet's research. This board can honest to goodness be a life saver! I went through three vets before we finally found one who was competent enough in the world of FD to help us out, but 98% of our information came from this site and we now have a "diet controlled" diabetic cat ..

    We used the relion micro with mocha because it took such a tiny amount of blood, plus we could turn off the "beep" at the end, which really bothered her .. Also, we feed her walmart brand special kitty because it fit into our budget .. you can get a 5.5oz can (she LOVES turkey and giblets) for .45 a can! I do believe it's right around 4% carbs .. most people on this board like to stick with 5% or less on carbs ..

    Anyways, continue reading, continue asking questions and make yourself at home!
     
  6. "I think she read it on the back of the box...." :lol: :lol: :lol:

    Hi Kathy and Cleo, and a big warm welcome to FDMB. It sounds like you have one of the "good vets", which is awesome. It's also great that he knows about "us"!

    You've got a great diet plan, and a great insulin planned. If you haven't already paid for the insulin, I'm agreeing with others that you could start with just a change in diet to see how beneficial that is to her BG numbers. Insulin is pretty pricey, and if you don't need it, no sense buying it yet. If you do need it, you'll be able to pick it up immediately at the pharmacy.

    Try to find out what dose the vet has in mind. If what you said is right, that she seems way overweight and should only weigh 7 or 8 pounds, her dose would most likely be lower than a chubby 13 pound cat. This is from the AAHA guidelines to treatment of diabetes in cats:
    Like I said, it sounds like your vet knows what he's doing, so he probably already knows that.

    Carl
     
  7. Kathy-and-Cleo

    Kathy-and-Cleo Member

    Joined:
    Jul 14, 2012
    Thanks for all the welcomes and input!

    Cleo is home from the vet now. Her levels were down already at the vet's all day - in the mid-200s. When we tried out the human glucose meter I bought today with the vet (a ReliOn Confirm) she tested at 161 - so a lot lower than she had been all day, which makes me wonder why the big difference, though it was also late in the day and she hadn't eaten since the early morning. Anyhow, her levels are still high, but better than the 411 from Friday! She did get her first shot of Lantus this morning and we're about to give her the 2nd dose now that she's had dinner.

    My vet is still pretty down on the idea of the human glucose meter - he was also very down on the idea of using human lancets to get the droplet of blood and I don't know why. He also wants her to come back in all day on Monday for another curve, and I'm a little hesitant - from what you all have said there won't be much of a difference yet since Lantus needs a few days to build up. I could tell she was pretty stressed from spending today at the vet so I don't want to do it unnecessarily, plus it's like $200 each time which adds up entirely too quickly.

    On the flip side, I'm pretty hesitant to keep injecting her with insulin without the vet's supervision to make sure her glucose levels aren't going too far down. The last thing I want is for her to end up with a hypoglycemic emergency. I do work Mon-Friday, so I can't stay with her Monday to do a curve myself.

    Her initial dose of Lantus is 3 units measured on a 3/10 cc needle.

    How often do you think it's necessary to check her glucose levels right now while everything is adjusting? I don't want to *not* monitor and end up with an emergency, but I also don't want to be torturing her (or me) by trying to test too often (especially with being new to this). I feel like I need a quick start guide on this :) kind of in information overload with all I have read.
     
  8. Vicky & Gandalf (GA) & Murrlin

    Vicky & Gandalf (GA) & Murrlin Well-Known Member

    Joined:
    Dec 28, 2009
    Hi Kathy,
    I see others have been answering you today. I just popped in this evening.

    You have a meter tonight right? You gave Cleo 3U of Lantus this evening?

    If so, you will need to test her blood glucose several times during the night to make sure she's safe.

    3U is a very hefty dose and with readings in the 100s earlier, it is dangerous to give that much insulin.

    Did you test before giving the shot? You must always test before giving a shot. We recommend delaying or skipping shots if the BG is below 200, at least until you get some more experience under your belt.

    I am going to pop over on the Lantus Insulin support group and get some help for you.
     
  9. Dang it, I'll take back some of my praise for your vet. 3u? Based on what? Even if he went with .25u per kg of her current "chubby weight", the dose would have been less than 2u. Totally not your fault, I'm just venting. :smile:

    She was at 161 right before eating? If you haven't shot yet, please don't until someone from Lantus gets here to help? If you have shot 3u already, please do what Vicky said and get another test around 2 hours after the shot was given?

    Carl
     
  10. If you are home testing, there is zero need to bring her in for a $200 day at the vet's clinic. His numbers won't be more accurate just because he's got a fancy expensive meter. They'll likely be higher because Cleo won't really want to be there having strangers poke and prod her all day.

    If he doesn't want you to use human lancets to get the sample, did he say how he'd like you to get it? Or does he just not want you testing her at home?

    Carl
     
  11. Kathy-and-Cleo

    Kathy-and-Cleo Member

    Joined:
    Jul 14, 2012
    I tested at the vet's office, with the vet at about 6:30 PM PST - at that time her reading was 161. I questioned the vet if we should still give her the insulin tonight, and he said yes, as long as she eats a full meal. He seemed very certain that because of how the human meters are calibrated the 161 was actually lower than her real level. I did ask him what a bottom level reading would be before we should not give the insulin and he said 150 (so she was close).

    She did eat a full dinner of wet food and we waited about 20-30 min after that to give her the insulin so the food would have time to hit her digestive system.

    For the dose, I realize this may make me sound like a moron, but I want to be sure we're talking about the same thing. The syringes they gave us say they are for U-100 insulin only and they are 3/10 CC. The syringe markers go up to 30 units, but the dosage we give her is only 3. Am I referring to the dosage correctly as 3 units as measured that way? Is this high? I have no standard of comparison, though based on the guidelines posed by Carl, this does seem high if the units we are talking about are the same.
     
  12. Kathy-and-Cleo

    Kathy-and-Cleo Member

    Joined:
    Jul 14, 2012
    Carl, he gave me some lancets from his office, but looking at them they don't seem all that different, they just don't fit in one of the lancet pen things. They are 25g I think - the tube says 25 x 5/8A.

    I don't think he's necessarily against home testing, but I kind of get the feeling that he's not really open to a lot of outside input.

    I'm very open to looking for a second opinion for Cleo, especially if anyone has a recommendation in my area (Oceanside, CA).
     
  13. Okay, I'll try to give you a quick "syringe tutorial".
    U-100 - those are the right syringes for Lantus, which is a U100 insulin. The "U" value is sort of like a potency thing. Someone else can probably explain it better than I can, but bottom line, you have the right syringes for your insulin.
    3/10cc - that means the syringe will hold a total of 30 units, or three tenths of a cc of insulin. One CC of insulin is the same as one milliliter of insulin. And there are 100 units of insulin in 1CC or 1ml.
    If the correct dose was 3u, then you should have pulled insulin into the syringe up the the third line past the "zero" line (assuming your syringes have 1 unit markings and not 1/2 unit markings.) If you did that, then you gave the amount he told you to.

    We usually advise people just starting to not shoot a number below 200, but we tend to be more cautious since nobody is sure yet how a newly diagnosed cat will react to insulin.
    Yes, 3u is "high" to us, especially when just starting out. Many cats never go that high in dose. Some do. But we advocate "starting low and going slow" for new members and kitties, so we usually advise a max starting dose of 1u at least until data from home testing can be collected for a week or longer.

    What Vicky, and I, are concerned about is that nobody really knows how Cloe will react to Lantus, not yet. That's why we advised that you get a couple of tests in tonight. You're on the west coast, so it's 10PM there? How late do you normally stay up on a Saturday night?

    Carl
     
  14. Kathy-and-Cleo

    Kathy-and-Cleo Member

    Joined:
    Jul 14, 2012
    Thanks for the quick reply! Yes, that's what I did - I gave her 3 lines past 0 worth (3 units), which is what they told us/showed us to do.

    I will get a reading from her in the next half hour or so and post it, and one more at least before I go to bed. I can stay up til midnight or 1 pretty easily and get up periodically if necessary. She just came down and jumped up on my desk and sat with me for a bit, so she seems to be feeling fine right now which makes me feel better. I will get my husband to help me out getting a reading and post it when I get it.
     
  15. The lancets he sent home with you should work great. Lancets come in several different sizes. The 25 is the gauge of the lancet. The higher the number, the smaller the diameter of the poker. 25 would be about the biggest ones you can find. Most human meters come with 30 or 33 gauge points, which are much smaller (well, they are all pretty small, but 33 is REALLY tiny in comparison). I'm glad he gave you 25's, because getting blood at first is a challenge, and those will help you to succeed more easily when poking the ear for a drop of blood.
    Have you watched any YouTube vids on how to test BG yet?
    Carl
     
  16. Good on the insulin amount. We're talking the same language!

    I'll keep an eye out for your posts. I'm on the east coast, but I don't have to work tomorrow so I'll be up for a couple hours anyway.
    Good! Try to include observations like that when you post. Sometimes we get so caught up with the "numbers" that we don't notice (or forget to ask) what we refer to as the "whole cat report". How they look, how they are acting, etc. If she's looking good, that matters. Also, remember that she doesn't know she's "sick". She just knows something isn't quite right, and that sometimes she feels good and other times not so good. In the days to come, she'll understand that for whatever reason, she's getting a lot more attention and in different ways than she's used to. And she'll figure out that getting poked by sharp things leads to treats and feeling better more often.
    Carl
     
  17. Kathy-and-Cleo

    Kathy-and-Cleo Member

    Joined:
    Jul 14, 2012
    Ok, just did a reading and her blood sugar is down to 84. This is about 2 hours past when we gave her the insulin.

    She seems to still be feeling fine though - she's alert, tail swishing around. She's not running around or anything, but she never did pre-insulin either. At what point do I need to be concerned? Should I be giving her some extra food to get blood sugar up?
     
  18. Please test her again in about 20 minutes?
    What kind of canned food do you have available? Any that isn't low-carb, like a gravy style? Don't feed yet. If her numbers keep dropping, you'll need to feed her, but only in small amounts at a time so her tummy doesn't fill up too quickly.

    Carl
     
  19. Kathy-and-Cleo

    Kathy-and-Cleo Member

    Joined:
    Jul 14, 2012
    I have a bunch of different canned foods available because I wasn't sure what she'd eat. Unfortunately, she completely refused to touch the only gravy-style I've tried with her so far (Merrick Cowboy Cookout). I tried to give her that for dinner and she wouldn't even touch it.

    All the varieties I have I bought since her diagnosis though so they're all low-carb/high-protein styles, since she was strictly on dry food previously. What I do have are Fancy Feast Classics (3 differently poultry ones), about 3/4 of a 5.5 oz can of Purina DM, two cans of EVO 95 (duck and beef varieties), a can of Weruva chicken (I think it's a gravy style, but unfortunately based on the Merrick experiment earlier I have no idea if she'll eat it), and I have samples of a bunch of different freeze dried whole meat style foods. I hit up the specialty pet store earlier today and they were great with giving me samples.

    I'm going to keep a super close eye on her and plan to retest in about 15-30 min (about 45 min to an hour from when we did the 84 reading test). Will post when we do the reading.

    Thanks for virtually holding my hand.
     
  20. You are welcome Kathy. Virtual hand-holding is what we do on occasion. :smile: I've asked someone with more Lantus experience than I'll ever have to take a look as well.

    Carl
     
  21. Kathy,
    Not saying you will need to go this route, but do you have karo syrup or honey in the pantry?
    Carl
     
  22. MJ+Donovan

    MJ+Donovan Well-Known Member

    Joined:
    Dec 28, 2009
    I'm on the east coast too and it's about 2 am now, but if we can't find anyone to sit with you, I'll stay around. I don't want to scare you, but Cleo's BG could -- *could*, but I hope not -- drop to a low level due to the amount of insulin she was given. Do you have any karo syrup, honey, or even ice cream? Would she lick some ice cream? She needs to have more carbs in her to help offset the insulin. If you have cat food with gravy, squish the gravy out and give her just the gravy. That's where most of the carbs are.

    MJ

    eta - I see I'm basically repeating what Carl said, but I don't want you to become complacent about her BG levels. They can continue to drop, so you need to keep monitoring her. She may not show any symptoms of hypo at all. My Donovan never did. But that doesn't mean those low numbers aren't dangerous to her. Keep on top of it and she should be fine.
     
  23. Kathy-and-Cleo

    Kathy-and-Cleo Member

    Joined:
    Jul 14, 2012
    Yep, we have Karo syrup, honey, maple syrup... all the quick sugar fix things except molasses. She's still very alert and acting normal for her. She just jumped up on my desk again... in fact she's laying in front of me as I type this.
     
  24. Kathy-and-Cleo

    Kathy-and-Cleo Member

    Joined:
    Jul 14, 2012
    MJ, thanks. She actually LOVES ice cream and would be overjoyed if I gave her some. I plan to retest her within the next 15 minutes. I may just go ahead and do it now since she's been so kind as to lay down in front of me.

    Incidentally, your picture of Donovan looks exactly like my Cleo. Black and white tuxedo kitties with white front paws.
     
  25. Jane & Jack & Karre the Emperor

    Jane & Jack & Karre the Emperor Well-Known Member

    Joined:
    Dec 30, 2009
    Hi Kathy - any update? Jane
     
  26. Kathy-and-Cleo

    Kathy-and-Cleo Member

    Joined:
    Jul 14, 2012
    Ok, just retested and her level is still dropping - at 69 now. She is still acting fine though. Hanging out on my desk, tail thumping (normal for her, I'd worry if it wasn't moving!), alert and paying attention to what's going on.

    I've been giving her tiny (kibble sized) pieces of freeze dried turkey as treats whenever I do the ear prick and she's liking those as treats.
     
  27. Jane & Jack & Karre the Emperor

    Jane & Jack & Karre the Emperor Well-Known Member

    Joined:
    Dec 30, 2009
    Thanks for the update, Kathy. Not too bad, the drop to 69, but you'll need to stay on this, ok? It's important since there's not much data on Cleo yet, so we can't be certain where her nadir (lowest point in the BG curve, lowest drop) is.

    It'd help to have the info on what "+ hour she is on right now. Please can you answer the following:

    What is your local time NOW?
    At what local time did Cleo get her shot?
    At what local time was your last BG-test (the 69)?

    Thanks!
    Jane
     
  28. You want to test her again in 30. Normally, you won't reach nadir until +6 after the shot. Because this is her very first day on insulin, nobody really knows what to expect in terms of the low point in the cycle timing. She could go down to 40 and you'd never know it by looking at her. But we don't want her going quite that low.
    Carl
     
  29. MJ+Donovan

    MJ+Donovan Well-Known Member

    Joined:
    Dec 28, 2009
    Treats are great, and they do learn quickly to expect them at pokey time, but those freeze-dried turkey things are like zero carb, so get some SUGAR into that girl as soon as you can. The insulin could kick in very soon.

    Can you post a time course of what has happened so far?
    i.e.
    PS 161, gave 3U Lantus
    +2 = 84
    +?? = 69

    etc

    thanks!
    MJ
     
  30. Jane & Jack & Karre the Emperor

    Jane & Jack & Karre the Emperor Well-Known Member

    Joined:
    Dec 30, 2009
    Hi Carl :)
    You posted in the alert-thread in LL that the reading of 84 was at (+2). That would put the reading of 69 at approx. (+2.5), yes? Just trying to stay on top of the timing :)
    Are you in Kathy's time zone? (We're in Cape Town. 20 to 9 in the morning here.)
    Jane
     
  31. Kathy-and-Cleo

    Kathy-and-Cleo Member

    Joined:
    Jul 14, 2012
    Local time now is 11:38 PM (I'm PST).

    Let me see if this helps summarize where we're at:

    Pre-Insulin Level at 6:30 PM PST (-1.75 hours): 161
    Dinner at 7:30 PM PST (-.75 hours)
    Insulin Shot (3U) at 8:15 PM PST (0 hours)
    Level at 10:30 PM PST (+2 hours): 84
    Level at 11:30 PM PST (+3 hours): 69
     
  32. Jane & Jack & Karre the Emperor

    Jane & Jack & Karre the Emperor Well-Known Member

    Joined:
    Dec 30, 2009
    Perfect Kathy, thanks! Breathe :) We're here.

    Please re-test BG as Carl suggested, at (+3.5)--- at the witching hour, as it were :) Until then, please make sure Cleo is in your line of sight, and just make sure she's acting normally.
    Jane
     
  33. Kathy-and-Cleo

    Kathy-and-Cleo Member

    Joined:
    Jul 14, 2012
    I think i'm going to see if I can get her to eat some karo syrup with a treat. I hate spiking her sugar, but I don't want it to fall too low.
     
  34. Hi Jane,
    I based my guess on this:

    That was at 10:30 or so her local time? So Cleo should be at +3?

    Carl
     
  35. Jane & Jack & Karre the Emperor

    Jane & Jack & Karre the Emperor Well-Known Member

    Joined:
    Dec 30, 2009
    We should be at (+3.25) right now - if you want, you can test BG again before giving karo. Otherwise, give a drop of karo and go ahead with re-test at (+3.5).

    Carl - are you in agreement with the timing sequence? Kathy posted it just a moment ago. (+3.5) = Midnight Kathy's time, yes?
    Jane

    P.S. Lots of First-Cycle-Excitement :)
     
  36. MJ+Donovan

    MJ+Donovan Well-Known Member

    Joined:
    Dec 28, 2009
    Good idea on giving her some sugary stuff. The insulin probably hasn't fully kicked in yet, so there may be more action on the horizon.

    Thanks for clarifying the timing. And please do not, no matter what tomorrow morning's pre-shot level is, shoot another 3U. You may be advised not to shoot at all and see where her BGs are with a diet change first before adding insulin to the mix. There should be a number of experienced people around tomorrow to help you with that.

    MJ
     
  37. Yes, midnight her time would be +3.5.
    Carl
     
  38. Kathy-and-Cleo

    Kathy-and-Cleo Member

    Joined:
    Jul 14, 2012
    Ok, karo syrup on treat didn't work, she wasn't going for that! I did get a fingertip full of karo syrup in her and she's happily eating about two big teaspoon fulls of ice cream at the moment. I understand the fat in ice cream will make the sugar take longer to hit her system, but I figured it beats nothing and I really really don't want her blood sugar to get too low.

    I do have honey straws that I could try if it looks necessary.

    As an update on the whole cat - she's very alert, walking fine and was super excited to get the ice cream... outwardly she's showing no signs of trouble.
     
  39. Jane & Jack & Karre the Emperor

    Jane & Jack & Karre the Emperor Well-Known Member

    Joined:
    Dec 30, 2009
    Sounds good, Kathy. For future reference: If you rub a drop or two of karo on Cleo's gums, it will get into her system without her having to do any actual "eating", ok? You're doing great. Get ready to test in a few minutes, right?

    Jane
     
  40. MJ+Donovan

    MJ+Donovan Well-Known Member

    Joined:
    Dec 28, 2009
    Some cats show no hypo symptoms at all at low numbers. Good thing she's awake. Typically Donovan would throw low numbers at me in the middle of the night, and I'd have to keep waking him up every 20-30 min to feed and test him. He was like "Woman, just let me SLEEP already".

    MJ
     
  41. Doug N Libby

    Doug N Libby Well-Known Member

    Joined:
    Jan 2, 2012
    Hey, Kathy -

    Lots of excitement! Just up for Hershey's +7 test and I read your post. I see you have several more experienced people helping you - especially Jane who is fresh and alert since it's morning in S Africa and Carl (3am our time) who I'd trust my kitty to even when he's tired, not sure if MJ is still here or not, but all of them have been at this longer than I have. Anyhoo - I mainly just wanted to wish you the best and say Hershey won't eat karo, either, but you can rub it on his gums - that'll get it into him (or her in your case) quickly.

    Libby (& Hershey, too!)
     
  42. Kathy-and-Cleo

    Kathy-and-Cleo Member

    Joined:
    Jul 14, 2012
    58 at +3.75 hours or so.

    Giving her a honey stick now (1 tsp honey).
     
  43. Jane & Jack & Karre the Emperor

    Jane & Jack & Karre the Emperor Well-Known Member

    Joined:
    Dec 30, 2009
    Good decision, Kathy. Next BG test in 15 minutes, please!
    Jane

    Sorry for the delay, my friggin' laptop is messing things up!
     
  44. MJ+Donovan

    MJ+Donovan Well-Known Member

    Joined:
    Dec 28, 2009
    Hang in there. Hopefully this is as low as she will go. Sorry you have to go through this tonight, but very glad you found FDMB.

    Are there enough other eyes here that I can hit the sack? Starting to get a little bit loopy.
    And my PC is acting wonky now, so I'm afraid my connection is going to drop.

    MJ
     
  45. Jane & Jack & Karre the Emperor

    Jane & Jack & Karre the Emperor Well-Known Member

    Joined:
    Dec 30, 2009
    I'm here, MJ. My laptop is being pissy with me too, but I'll try to fix that. I'm not going anywhere, so I can stay on this thread.
    Jane
     
  46. Kathy
    Just curious.. have you been able to get blood on the first poke? If so, I'm really glad your vet gave you those 25g pokers today:)
    Carl
     
  47. MJ+Donovan

    MJ+Donovan Well-Known Member

    Joined:
    Dec 28, 2009
    Thank you, Jane.
    And you, Cleo -- that's low enough, OK? Don't scare your momma.

    night.

    MJ
     
  48. MJ,
    I'm still here too. Thanks for coming:)
    This place ROCKS!
    Carl
     
  49. Jane & Jack & Karre the Emperor

    Jane & Jack & Karre the Emperor Well-Known Member

    Joined:
    Dec 30, 2009
    Keep breathing, Kathy :)

    A couple of things to look out for: Does Cleo have any hypo symptoms? Dilated pupils? Drooling? Shivering?

    Also, and *I do NOT think you'll need this*, have you got a bulb syringe in the house? How many test strips have you got left?

    You're doing great. Remember next BG test is coming up, k?
    Jane
     
  50. Jane & Jack & Karre the Emperor

    Jane & Jack & Karre the Emperor Well-Known Member

    Joined:
    Dec 30, 2009
    Kathy, please make sure you get a decent-sized blood sample for your next test, alright?
     
  51. Jane & Jack & Karre the Emperor

    Jane & Jack & Karre the Emperor Well-Known Member

    Joined:
    Dec 30, 2009
    We should now be at (+4) in Cleo's cycle.

    Kathy, BG update?
    Jane
     
  52. Kathy-and-Cleo

    Kathy-and-Cleo Member

    Joined:
    Jul 14, 2012
    Thanks you guys, really.

    Ok, so I have only gotten about 1/4 of the honey into her so far. She really is not a fan and is fighting pretty hard about it. I will see if I can find a syringe from when we had to give her amoxycilin a few years back.

    I've been getting blood on first or second try. I think I'm getting the hang of it already. One time I definitely poked too hard on a 2nd try and got a huge drop of blood. Had to hold some pressure on it for 30 sec or so to get it to clot.

    I'm almost out of the lancets the vet gave me, but I have a bunch I bought that are only one gauge finer (26 g instead of 25g). I'll retest her in 10 minutes, which is +4.25 from when I gave her the insulin.

    Alright, gave her 1.5 mL of maple syrup (yes, she's now had some of every sugar in the house I think). I also administered 1.5 mL of maple syrup to my couch. Oops.

    Oh, and I have lots of strips. I had bought a pack of 50 today when I bought the meter. Who knew I'd be going through them this fast?

    Going to retest her now since it's been an hour of excitement already...
     
  53. Jane & Jack & Karre the Emperor

    Jane & Jack & Karre the Emperor Well-Known Member

    Joined:
    Dec 30, 2009
    You're doing beautifully, Kathy.

    Don't worry about larger drops of blood. That just happens :) On the next test, it'd even be useful to have a large drop of blood.

    I think you'll do just fine with the 26-gauge lancets - you're getting lots of poking practice right now, after all :)

    Good job on having lots of strips! Remember to buy more tomorrow, so you've got them when you need them.

    Off you and test. I'll be here.

    If you can, post another proper time sequence from beginning of cycle (Shot time) through the (+2) and (+3) to where we are now, noting in between when you gave what food/sugar/syrup (say, at (+3.5) gave drop of karo on treat). Thanks! Keep breathing.
    Jane
     
  54. Kathy-and-Cleo

    Kathy-and-Cleo Member

    Joined:
    Jul 14, 2012
    Local time now is 12:51 AM (I'm PST).

    Let me see if this helps summarize where we're at:

    Pre-Insulin Level at 6:30 PM PST (-1.75 hours): 161
    Dinner at 7:30 PM PST (-.75 hours)
    Insulin Shot (3U) at 8:15 PM PST (0 hours)
    Level at 10:30 PM PST (+2 hours): 84
    Level at 11:30 PM PST (+3 hours): 69
    Tiny bit of karo syrup and 2 big tsp ice cream given at 12:00 AM (+3.5 hrs)
    Level at 12:15 AM PST (+3.75 hours): 58
    1/4 tsp honey and 1.5 mL maple syrup given at 12:25 AM (+4 hours or so)
    Level at 12:45 AM PST (+4.5 hours): 106 (HURRAY!!! Going back up!)
     
  55. Jane & Jack & Karre the Emperor

    Jane & Jack & Karre the Emperor Well-Known Member

    Joined:
    Dec 30, 2009
    Thanks Kathy! You're (+ Hour)-Sequence is a tiny bit muddle, but that's totally understandable after a cycle like this! I'll re-post your sequence in a minute, according to your Shot time as a starting point (*;15 PM your time).

    For now - don't go to bed just yet, ok? Try for one more test in 30 minutes, can you do that?
    Jane
     
  56. Super!
    Now you want it to stay up. The problem with sweets is that the boost can be short-lived. If you test in 20 and it falls at all, that would be when you want to give a spoonful of food, I believe.
    Jane, is that right?
    Carl
     
  57. Jane & Jack & Karre the Emperor

    Jane & Jack & Karre the Emperor Well-Known Member

    Joined:
    Dec 30, 2009
    Re: Kathy's Cleo - 1st Ever Lantus Cycle, Time Sequence

    Cleo's First Lantus-Cycle: Time Sequence (Starting Time = Unknown PMPS = 8:15pm Local Time)

    1.75hours before PMPS: BG 161
    0.75 hours before PMPS: Fed.
    PMPS - Not tested. --- 3u Lantus shot.
    (+2.25) 84
    (+3.25) 69
    (+3.75) Fed tiny bit karo and 2 tsp ice cream.
    (+4) 58 --- This was 12:15am Local Time.
    ca. (+4.25) Fed 1/4 tsp honey and 1.5ml maple syrup.
    (+4.5) 106
     
  58. Kathy-and-Cleo

    Kathy-and-Cleo Member

    Joined:
    Jul 14, 2012
    I can stay up as long as is necessary. It's a weekend, and even if it wasn't - Cleo is more important to me than a little lost sleep. Also, I'm a night owl anyhow so this isn't too bad.

    Tentatively planning to do another glucose level test at + 5 hours (although that will only be about 30 min from when I took the last one)...
     
  59. Jane & Jack & Karre the Emperor

    Jane & Jack & Karre the Emperor Well-Known Member

    Joined:
    Dec 30, 2009
    Yes, Carl. If BG falls to between 40-60 again after another 30 minutes (which would put Cleo at her +5 in her cycle, which is local time 1:15am), Kathy should feed that number again. If possible, combine a (possible) repeat-karo/syrup with a bit of canned food, since the sugary syrups etc. don't last that long and the idea os to *maintain* a safe BG until past nadir. Ideally, since this was Cleo's very first cycle, and we're not sure where her nadir is, we'd like to see her get past the (+6) without a falling BG. That's what I'd do.

    Compare the FDMB Hypo-Treatment Doc: HYPOS


    Let's use the *revised* time sequence, everyone, ok? It'll make it easier for all of us to keep track :) I.e. the upcoming test at 1:15am would be the (+5).
    Jane
     
  60. Jane & Jack & Karre the Emperor

    Jane & Jack & Karre the Emperor Well-Known Member

    Joined:
    Dec 30, 2009
    Great, Kathy!
    Regarding next BG test: You need to be comfortable. If you're not happy waiting 30 minutes, test before :) Just note the local time and correspond to cycle hour. Though as I'm posting this, I think we're only a couple of minutes away from (+5) if I'm seeing the clock correctly.
    Jane
     
  61. Jane, can you take it from here? I don't have to get up in the morning, but I do need to get up at some point today :lol:
    Kathy, you're in great hands, and there will be others around at your next shot time, so if you need advice, please post here. You might want to start a new thread for that one, but point people to this one so they can catch up.

    Carl
     
  62. Jane & Jack & Karre the Emperor

    Jane & Jack & Karre the Emperor Well-Known Member

    Joined:
    Dec 30, 2009
    No problem Carl. I'm sticking around until Kathy feels ok to go sleepus. And I'm calling in some eyes (sounds gross, but is great) for tomorrow's AM-cycle to help with decisions regarding shot or no-shot and so on.

    Kathy, have you got the (+5) yet? It's about that time :)
    Jane
     
  63. Kathy-and-Cleo

    Kathy-and-Cleo Member

    Joined:
    Jul 14, 2012
    Newest reading is 177 - way up. I updated the timeline.

    1.75hours before PMPS: BG 161
    0.75 hours before PMPS: Fed.
    PMPS - Not tested. --- 3u Lantus shot.
    (+2.25) 84
    (+3.25) 69
    (+3.75) Fed tiny bit karo and 2 tsp ice cream.
    (+4) 58 --- This was 12:15am Local Time.
    ca. (+4.25) Fed 1/4 tsp honey and 1.5ml maple syrup.
    (+4.5) 106
    (+4.75) gave about 1 tbsp. ice cream
    (+5) 177

    Her glucose levels are going way up now - all the sugar hitting her system. Should I try to get her to eat some low-carb/high protein wet food, or just leave her be?

    Also, for the future, I'm not clear on when I should be testing her glucose prior to giving her insulin each time. I'm very clear that the insulin comes 30 min or so after eating, however does the glucose reading get taken before eating, or after eating but before insulin? If after eating, how long after eating - 30 min, so it's JUST before insulin to make sure it's safe to give her the insulin?
     
  64. Ok, great:)
    I'll check back later today.
    Night!
    Carl
     
  65. Kathy-and-Cleo

    Kathy-and-Cleo Member

    Joined:
    Jul 14, 2012
    Thank you for all the hand holding and help Carl! Sleep well :)
     
  66. Jane & Jack & Karre the Emperor

    Jane & Jack & Karre the Emperor Well-Known Member

    Joined:
    Dec 30, 2009
    WELL DONE, Kathy! That (+5) is a very nice number. Now let me try to respond to your questions. I"ve also asked that others come and review this thread, so that you can get help on how to proceed for Cleo's next cycle. (I've made the request in Karre's daily condo in LL.)

    It's normal to see the BG rising after this kind of cycle - Cleo did get a good amount of sugar. Don't worry. It will clear. Many of us have been through this sort of event! You did great. Personally, I would probably still feed a little regular food, just because the nadir (lowest point) *may* still be an hour away. 177 is a good safe number, but as we know, sugar-rises don't last long, and I myself tend to err on the side of being-too-cautious. So, yes, I'd still give some regular food. I suspect some of the BOS-crew (BOS = Balls of Steel :) may have thought it'd be alright not to feed, but I think most people are still in bed right now, so perhaps, best to be extra-cautious.

    Okay, now about testing BG before giving insulin. The basics:
    The pre-shot BG test is called the AMPS (morning) and PMPS (evening) and is taken every 12 hours, because Lantus has a 12-hour effect (give or take a little, but that's how we calculate cycles).
    In the beginning, when there's not a great deal of data (BG tests complied into a spreadsheet, shortened to SS), it's important to get more than just the pre-shots, because with Lantus insulin, dosing decisions are not made so much based on pre-shots but on nadir (lowest cycle BG). That's why mid-cycle tests are so useful, especially at the start, when we're trying to figure out Cleo's "Lantus-Personality", as it were. ECID (every cat is different), and we want to know what Cleo does with Lantus, so we can help you make the safest choices for her dosage and help you assess her progress.

    Ok, now food in relation to insulin. We (with our cat Karre) stuck to the routine we adopted on our first time on FDMB (in 2008), which was "Test, Shoot, Feed". Lantus is a gentle insulin, and usually we see the nadir (lowest point in BG cycle) around the middle of the cycle, about at (+6). (Again, ECID: Karre is an early-onset kitty, for example, and his nadirs are early too, at around +3!) That's why it's normally considered safe to test, then to shoot (BG permitting), then to feed as normal (BG permitting). In the beginning, like for a Lantus-Newbie like Cleo, we like to encourage testing a bit more frequently wherever possible, so that we have more data and more safe ways to give advice.

    We tested more than most people can - I work from home, so it's no trouble with timing etc., and I'm also a bit of a chicken :) SO I always felt I needed to have as much data as I could get without being too mean to Karre's poor ears :) A good starting routine for testing would of course incluce the AMPS and PMPS, without fail - *IF* Cleo was ever quite low, for whatever reason, and you shot insulin without testing, she could be indanger of HYPO. Which is why we put you through all that drama tonight :)
    Further tests *can* include a (+1) and/or(+2) to get a sense of Cleo's onset, and a mid-cycle test (+6 is often done, but again, an hour before or after can come up as an option, to find out her usual nadir once she settles into Lantus), and a (+10) and/or (+11) to see how her late-cycle numbers are.

    But again: That's a lot of testing, and many beans (humans) can't do that for various reasons. AMPS, PMPS, mid-cycle, I'd say, are the basic ones. More, if you can.

    I hope that's helpful for now. Anything else, right now? Or are you off to bed? Well-earned, anyway! Well done again!
    Jane
     
  67. Kathy-and-Cleo

    Kathy-and-Cleo Member

    Joined:
    Jul 14, 2012
    So it's just about 2 AM PST - about +5.5 hours from the insulin shot.

    I'm going to do one more test (at around +6 hours) to see where we're at before I decide if I'm comfortable going to bed.

    I'm planning to feed Cleo breakfast at 6:30 AM. Right now planning to skip doing any insulin regardless of levels at that point, until I can get a 2nd opinion from a vet on treatment. Going to be calling around for a referral for a specialist in feline diabetes and cross my fingers they're available to discuss treatment on a Sunday!

    Just saw your reply before this went through Jane - thank you for all the info. I'm going to read through it again to make sure I got it all.

    At least in the beginning, until I know how Cleo will be eating her new diet of all wet food, I'm a little hesitant to shoot before getting her to eat, as we're still sorting out what food she'll eat. Crunchies she loves and would gobble up as fast as possible. The wet food... well not so much her favorite thing.

    In the meantime, I'm going to see if she'll eat a bit more of the diabetic friendly wet food to tide us through til the end of this Lantus cycle.
     
  68. Jane & Jack & Karre the Emperor

    Jane & Jack & Karre the Emperor Well-Known Member

    Joined:
    Dec 30, 2009
    Remember, Kathy, your shot time (when we start counting) was 8:15. SO your (+6) would be at 2:15 am :) I'd also test that one still. Good decision :)

    Your AM-Cycle, counting from last night's PM-cycle stating at 8:15pm, would be at 8:15am. Your breakfast-plan souncd a tad early to me - but I'm sure you'll have had some more feedback by that time, so not to worry. The numbers you'll get this coming AM-cycle and the next PM-cycle won't exactly be "typical" ones given the bounce (BG rise) that's begun already and that may continue for a bit.

    I do understand and sympathise with your hesitation regarding food and Cleo's preferences, that you don't exactly have sussed out yet. In time, you'll be able to get her to a more "regular" routine. For now, you need to feel comfortable and Cleo needs to stay safe :)

    I'm sure you'll receive input regarding the coming AM-cycle and the question of shot-or-no-shot. Hopefully, you'll feel comfortable trusting the advice here in addition to your vet - it can be incredibly useful to have input from more than one perspective, and FDMB is quite famous for that :) My thoughts: Given how beautifully you managed Cleo's low numbers, and how well she seems to be rising, and given that the numbers you saw (58 was the lowest, and 60 is generally the threshold, so Cleo was *just* inside the "low numbers" bracket), and there were no reported Hypo symptoms, you may not need to skip the shot *completely.* Depending on her AMPS and whatever other data you gather before then, you *may* be okay to give reduced dose or a token dose (just to keep a little something in the in-body Lantus "shed"/depot, that gets filled/emptied as cycles progress and insulin is given). Let's see what the others think!

    I'll look out for your (+6)!
    Jane
     
  69. Ann & Tess GA

    Ann & Tess GA Well-Known Member

    Joined:
    Jan 7, 2010
    Hi Kathy, I just saw the note in the Lantus forum and came over. You have been getting great advice. Boy! ohmygod_smile Baptism by fire!

    It sounds like cleo has had lots of sugary carbs tonight, so no wonder her BG is way up. The thing w/ syrup or homey is they rise the BG fast, but wear off quickly (a couple of hours) so you need to be prepared for that. But each cat is different ECID, you will get to know how Cleo responds pretty soon. This is why we suggest some higher carb food too, that keeps the BG up longer.

    On the schedule , we usually test, feed, shoot in the space of about 15 minutes. Lantus isn't like quick acting insulins where it is important to have food onboard before the shot. A Lantus shot generally doesn't start working until about 2 after the injection, but ECID. The lowest point of the cycle is usually about 6 hours after the shot, we call it the nadir, but, guess what, ECID and it can vary a couple of hours either way. Lantus dosing is based on the nadir, how low it will bring the cat's BG down not on the preshot test. The preshot test is to be sure BG isn't too low to safely give insulin, not to determine dosing.

    it is also important to give Lantus exactly 12 hours apart if at all possible. More than 15 minutes difference either way can act like a dose increase (early shot) or decrease (late shot.)

    In the morning you will probably be advised to lower the dose. Humans adjust their own doses all the time, there is no reason you can't do it for your cat. Try to get a test in an hour before the preshot test and post here asking for dose advice. This extra test combined w/ the preshot test tell us if the BG is going up or down and helps a lot in determining the dose. It also gives you time to get responses and plan out what to do.
     
  70. Jane & Jack & Karre the Emperor

    Jane & Jack & Karre the Emperor Well-Known Member

    Joined:
    Dec 30, 2009
    Hi Ann :) Thanks for recapping some of the theory points :) ALways good to have things formulated a couple different ways, making sure the info hits home! Gotta love FDMB!
    Looking out for the (+6), Kathy.
    Jane

    Edited to add: Kathy, Which meter do you use?
     
  71. Ann & Tess GA

    Ann & Tess GA Well-Known Member

    Joined:
    Jan 7, 2010
    :D :D You posted while I was typing that up, but you are right a second voice is good. Besides after typing all that I wasn't going to delete it! :lol: :lol:

    I agree w/ Jane that 6:30 is a little early to feed. A lot can change in the hour or two before the shot. Actually, we usually like to remove any remaining food 2 hours before the shot so that the preshot test is "clean", no food influence.

    Many of us do the shot while the cat is eating it distracts them and they barely notice the poke. W/ Lantus you do have some leeway for getting the food into them, onset isn't immediate. With older, fast acting insulins it was important to get them to eat first, but not w/ Lantus.
     
  72. Kathy-and-Cleo

    Kathy-and-Cleo Member

    Joined:
    Jul 14, 2012
    1.75hours before PMPS: BG 161
    0.75 hours before PMPS: Fed.
    PMPS - Not tested. --- 3u Lantus shot.
    (+2.25) 84
    (+3.25) 69
    (+3.75) Fed tiny bit karo and 2 tsp ice cream.
    (+4) 58 --- This was 12:15am Local Time.
    ca. (+4.25) Fed 1/4 tsp honey and 1.5ml maple syrup.
    (+4.5) 106
    (+4.75) gave about 1 tbsp. ice cream
    (+5) 177
    (+5.5) gave 1/3 can of Purina DM
    (+6) 249

    She's up quite a bit again, but better up than down. I'm a little worried that I went overboard giving her all the sugar and food and her glucose will just keep climbing since +6 is supposed to be the nadir...

    What time do you think I need to retest? I'd like to give her poor ears (and myself) a break if you think she's at a safe point now with her blood sugar up. I know there's danger of it coming back down suddenly when all that sugar processes out. She is hanging out at her water dish right now, so I'm not sure if that's because her body is feeling the need to process glucose out in the urine or just because she's thirsty after all the sticky sugar and the stressful day at the vet and then me poking her all night.

    I thought about what you said about her dinner time - we are trying to ultimately get her on a schedule of eating at 6:30 AM and 6:30 PM with insulin shots at 7:00 AM and 7:00 PM so we were trying to adjust her back toward those times a bit more. We were late this evening because Cleo refused to eat the first food I tried with her, which is why dinner time and thus insulin was administered later in the night than I would have liked. We will try to adjust a little more slowly and plan to give her breakfast at 7 AM now (although with all that I've given her overnight, we'll see what she eats). 7 AM is about 4.5 hours from now, so it would be +10.5 from when we gave her the insulin. I will post back then and figure out if we should give her any insulin at all in the morning. Right now I'm leaning toward not giving it until I seek out a 2nd vet opinion on this whole process.
     
  73. Kathy-and-Cleo

    Kathy-and-Cleo Member

    Joined:
    Jul 14, 2012
    Jane - I am using a ReliOn Confirm that I bought yesterday for my readings.

    Incidentally, the +6 reading (249) was a nice big sample, so I'm pretty sure it was as accurate as possible with this meter. From what I read, this is a reasonable choice of meter (fairly accurate) and cheap strips, so I went with it. My vet, as I mentioned above, is really backing the idea of getting the AlphaTrak 2, but that's a whole other story, and something else I plan to ask about in a 2nd opinion!
     
  74. Jane & Jack & Karre the Emperor

    Jane & Jack & Karre the Emperor Well-Known Member

    Joined:
    Dec 30, 2009
    I'm not at all concerned about that (+6). It's the sort or BG I would expect to see in this sort of situation. You're right, it's likely that she'll rise a bit more during this cycle - that's another reason why you may be better off giving Cleo a reduced dose or even a token dose in the morning. (Again: Wait for some more feedback. But I think it's likely you'll get this sort of advice. Even a small amount of insulin would help to clear the bounce that is *normal* after a bit of a dramatic cycle.)

    I would retest at (+11) (which would make it 7:15am your time), and then again the AMPS (at 8:15am your time), to see whether you've got a rising or a dropping number, which will influence the decision about the amount of Lantus you should shhot, *if any*. A cycle like Cleo just had can tire them out - as long as she's not displaying any worrying symptoms (and lying close to the water bowl isn't worrying *in itself*, I'd say), I don't think you need to worry about her right now.

    About feeding schedule: Let's revisit that in your next thread, when some more people have had a chance to review this one. (Remember to post a link to *this* thread in your next one, ok? Do you know how to do that?) Like Ann said, it can be useful to have pre-shot tests that aren't "spiked" by food. But ECID, and your routine-idea may suit Cleo. Let's give her a chance to have a couple of more "regular" cycles and see where we are then. Just remember to LOG/WRITE DOWN whenever you do feed her, so that that data can be assessed in relation to her BG tests, alright? (You can start thinking about starting a spreadsheet, too - but I know this is a lot of info, and we'll help you, so don't feel rushed, ok? For now, summarizing cycles in posts, like we did here, is also ok until you have time to get a SS up and running.)

    I totally understand your wanting to speak to a vet in regard to dosing. Please just try to keep an open mind as well, regarding the advice you can get here on FDMB. Some vets are great in many ways but err on the side of too much inculin, for instance (which is likely what caused tonight's dramatics for Cleo), so sometimes even vets don't get it excatly right, and people with years of dosing experience can really have valid feedback. :)

    Also: Remember that adjusting shot-times with Lantus needs to be done WITH CAUTION, and slowwwwwly. NOT more than 15 minutes change in one go, if you can avoid it. (Sometimes, life happens. We know. It's ok.)

    For now, get some rest! You've earned it. I'll make sure people look into this condo before shot-time this AM, or into your new thread if you start one. And I'll link into this one if you start a new thread and don't know how to do the links yet, k?

    Jane
     
  75. Ann & Tess GA

    Ann & Tess GA Well-Known Member

    Joined:
    Jan 7, 2010
    Shooting early is like giving an increase in insulin! We try not to adjust times by more than 15 minutes a cycle. Especially after tonight I wouldn't change the shot time by that much.

    As you noted at the beginning, better too high than too low. Yeah, there was a lot of sugar given :? , but it will clear out of her system quickly. You did great for having a situation like this your first day on insulin. :thumbup

    There is a member in San Diego, she's the closest that I know of. Her vet insisted on the Alpha Trak, too, and she had really high readings w/ the new AT2. She finally decided to go w/ the Relion. I'll PM her to come over in the morning, she is an early riser.
     
  76. Ann & Tess GA

    Ann & Tess GA Well-Known Member

    Joined:
    Jan 7, 2010
    Kathy, this link has two pdfs from veterinary journals on studies using Lantus for cats. The studies were done using HUMAN METERS!! the initial University of Queensland study by Roomp and Rand was also done using human meters. You might want to print them out and show them to your vet.
     
  77. Kathy-and-Cleo

    Kathy-and-Cleo Member

    Joined:
    Jul 14, 2012
    Well, the timing is being somewhat dictated by the fact that both my husband and I work Mon-Fri days, so we want to be able to feed her and make sure she's keeping the food down before we give her insulin and then stay with her for a little bit after the insulin shot before going to work... hence trying to move all the timing back a bit.

    I will start a new thread in the morning to figure out if we should give her any insulin tomorrow AM or not and I'll link back to this one.

    I adjusted the timing with your guys' advice in mind.

    Currently, Cleo has no food available to her (just fresh water). It's 3 AM right now, or just about. I am going to do her next glucose test at 7:15 AM and I'll post the result on the new thread. I'm going to feed her breakfast around 7:30 and hopefully have some sort of idea on giving insulin or not, or an adjusted dose by 8:00 AM. So it's a move of 15 min in the direction I need to get it to move to be able to keep the schedule during the work week.

    Thank you, ALL, once again for all the help tonight and in the future too, I'm sure! Special thanks to Carl, MJ, Jane, Ann, and my non-posting friend Elizabeth (who has gone down this road before me) for getting us through the night!
     
  78. Jane & Jack & Karre the Emperor

    Jane & Jack & Karre the Emperor Well-Known Member

    Joined:
    Dec 30, 2009
    Ni-Ni Kathy! See you later!
     
  79. Ann & Tess GA

    Ann & Tess GA Well-Known Member

    Joined:
    Jan 7, 2010
    NI NI I-) I-) I-) I-)
     
  80. Sienne and Gabby (GA)

    Sienne and Gabby (GA) Senior Member Moderator

    Joined:
    Dec 28, 2009
    Good morning, Kathy! It certainly looks like you had an exciting introduction to FDMB. When I first arrived here, someone commented that this is the best place you never wanted to be! It is an incredible place where support and expertise are readily available as you have already, no doubt, discovered.

    Several people posted on the Lantus board indicating that some help with adjusting Cleo's dose would be useful. I don't know that I'd want a repeat of last night's drama. I'd suggest using the formula in the Roomp & Rand article that Ann linked as a place to start for Cleo's dose:
    initial dose = 0.25 x ideal weight in kilograms​

    You mentioned that Cleo had gained about 4 lbs over time and that her current weight is 13 lbs. If approx. 9 lbs is her ideal weight, then you would want to drop the dose back to 1.0u if you use the above formula. I tend to think this would be a good starting dose especially since you have just switched Cleo to a more diabetes-appropriate diet.

    I also agree with what others have noted about the sequence of testing, feeding and shooting. I test and then feed and shoot almost simultaneously. Gabby's pre-shot test is within a few minutes of my feeding her and once her face is in her bowl, she gets her shot. It all takes less than 5 min.

    I like your idea of being able to give a shot and have time before you leave the house to monitor. If you can give yourself a couple of hours to get a test or two in, that would be great!
     
  81. Jane & Jack & Karre the Emperor

    Jane & Jack & Karre the Emperor Well-Known Member

    Joined:
    Dec 30, 2009
    Sienne: I just posted that dose too, in Karre's condo, as what I'd recommend to Kathy. :)

    Kathy, I hope the dose of 1.0u sounds good to you. (If you look at Karre's SS, he also started on 3u, which was too much, and pretty quick was taken down to 1u through the advice I got from "Team J" as we called them then on LL (the Lantus forum of FDMB back then) :) We also liked to refer to "Tilly's Diabetes Homepage", in case you want to have another read around the theory: Tilly's Diabetes Homepage

    Let us know if you're not comfortable and we'll make sure you get some more input, k?
    Jane
     
  82. Vicky & Gandalf (GA) & Murrlin

    Vicky & Gandalf (GA) & Murrlin Well-Known Member

    Joined:
    Dec 28, 2009
    Thank you everyone who helped Kathy last night. I knew she would be in good hands.

    Kathy, I am glad that you were here for the help. We usually see the result of this type of "first dose," after the fact and it's sometimes not a happy one. That's why I called for help for you.

    For whatever reason, some vets seem to jump to the 3U starting dose on whatever insulin. For long acting insulins like Lantus and Levemir, that is too high. 1U is a good dose to start. I believe someone linked the AAHA guidelines for treatment with Lantus which recommends 1U or the formula, which Sienne outlined.

    If not, here it is: http://www.aahanet.org/PublicDocuments/AAHADiabetesGuidelines.pdf You might want to print it out and present it to the vet, along with the results from last night. And forget about taking Cleo back for curves. They aren't necessary, you can do them yourself with more reliable results (not influenced by vet clinic stresses) and we will help you understand what the numbers mean and how to dose accordingly.

    You learned a lot last night! Not in a fun way, but you are well on your way to helping Cleo. :D
     
  83. MelanieP and Ninja

    MelanieP and Ninja Member

    Joined:
    Jun 3, 2012
    Just wanted to say to Vicky, Jane, Ann, Carl & MJ: You guys are amazing! What a phenomenal resource you all provide! Our vets are not available for calls at 2 am (or even 5:05 pm for that matter), but I continue to be impressed with the dedication of the senior members of this board. I assume the plan is that Kathy will update Cleo's preshot BG number when she gets up (pacific time) and if it's over 200, you will advise on appropriate Lantus dose for today (if any). Way to go guys!! I sure hope I never need you at 2 am, but glad to know you are out there in any case.
     
  84. Kathy-and-Cleo

    Kathy-and-Cleo Member

    Joined:
    Jul 14, 2012
  85. charliesmom

    charliesmom Member

    Joined:
    Jun 27, 2012
    Hi Kathy. Your Cleo looks like Charlie's cousin. We're new here too and had a hard day. Trial and error and thankfully, a little bit of help from my new friends. We are not on lantus yet but are learning as you are. Just wanted to wish you guys luck and a lot of patience. Hang in there. ;-)
     
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