Kittys Original Blood Work and Updates.

So as you can see my adventure started on Nov 10.
The vet said the results of the initial blood work was not bad. Some levels were a little off but not to such an extent that it should cause worry.
Does anybody see anything that should be addressed?

So to recap from my first thread.
I have completely changed Kitty's diet.
I have gotten rid of all the dry food. He is now on a diet of Fresh Pet Select Roasted meals, Merrick and Wellness brands. All of as %Kcal are between 1-6 carbs.
The FreshPet is the only one I am not sure of. Based on a calculation it should be just under 7 carbs.
% As Fed for all the foods are ranging between .28-2.10.

Since the 10th Kitty has been on 1 unit of Prozinc.
As you can see on the charts his initial glucose level was 474. The second test is was at 275 and today's was at 324.
His levels may have been influenced by a 5:00 AM snack that was fed to him by my better half. He was also a little more agitated once the he was on the table at the vets.

Since switching Kitty's diet his water intake has dropped substantially and it seems to be consistently less.
He wrestling with the Main Coon Cat Kitten we have. Sounds like the cat WWF some nights. So he is getting exercise. I am watching to see if he starts playing with the toys again.
Last night was the last round of antibiotics for a gum infection.
I am looking to bring him in for teeth cleaning after the Thanksgiving weekend.

Tonight I start the first round of 2 units of insulin.

So where do I go from here?
It has been suggested strongly that I do home testing. Where and what should I be looking for?
Other information I should be boning up on???

Thanks you in advance.

Sev

 

Why are you planning to increase his insulin so much?

 

When the total dose is less than 2 or 3 units, we suggest that dose increases be kept small, such as 0.25 unit (you'd have to eyeball it on a U-40). If you are going to be home to monitor and blood test, moving 0.5 units up may be done. Its generally a good idea to be home to monitor response when the dose is changed.

What we mean by home testing?
1) Doing blood glucose tests with either a peripheral ear vein sample, or a paw pad sample, using a glucometer (human or animal specific) to make sure giving insulin is safe.
2) Doing urine testing for ketones (and sometimes glucose) or, if affordable, doing blood testing for ketones. Blood testing gives you real time values; urine test values represent several hours previously.

 

What testing equipment gives the best bang for the buck?

 

I am going by the vets recommendation.
Currently I am not testing at home.
Is the amount a problem?

 

An increase of 100% sounds like a lot, don't you think? Particularly if you don't know yet how Kitty's system is adjusting to insulin. You only have the results of two BG tests since November 10, correct?

 

His levels may have been influenced by a 5:00 AM snack that was fed to him by my better half. He was also a little more agitated once the he was on the table at the vets.

Yes, his levels were probably up not only from stress but a snack. I certainly would not up him to 2 units. I would keep him at his current dose and get thee to a Walmart and buy a ReliOn meter, test strips, lancets, ketostix, etc. A lot of members use that meter. I still use my favorite.......regular One Touch Ultra.....not the mini.

You have been so focused on food, carbs, etc. that time has been lost......you could've been testing him all along.....especially with the food change. I would get the testing going ASAP and then you can continue to do food research.

 

That is correct.

I am still getting my legs under me on this.
Personally I was wondering about a full unit. However the vet is probably going by the unit increases on the syringe.
I am sure I could eyeball a .5 increase pretty accurately.
However and dont take this the wrong way, I would like more input prior to going against the doctors recommendations.

 

I am with Hope here....you've done a lot of work on the diet but without testing at home you are really missing a lot of data.

Regarding the blood work, I'd be asking your vet about the elevated albumin as that isn't what we usually see in an uncomplicated diabetes diagnosis (that I can remember)....slight ALT yes.

 

Thanks for the confirmation. Its good to know my assumption was correct.

I am completely unfamiliar with diabetes testing equipment.
The only thing I know are some names from commercials.

 

Sev, even though it sounds like a small increase, from 1 unit to 2, insulin can kill. Even .5 can make a big difference so we always increase in small amounts. One of my own non-diabetic cats tested over 300 from stress alone when at the vets. Why not buy a meter today, start testing, and then do an increase if numbers at home prove it is needed?

 

More detail on this please.
What is the significance of this?

Would a gum infection elevate this?

 

So I have been informed. I have a bottle Karo on the shelf just in case there is an incident.

I need some info on meters. Which is the most accurate?

 

Not all cats will show hypo symptoms.....they can just start seizing. Hometesting will tell you how low the numbers are going. If one of mine even looks at me weird, or throws up, I test. I always do a late nite test before going to bed too. I want to be able to sleep with peace of mind

People all have their favorites when it comes to meters but as far as money and least expensive, ReliOn from Walmart. The OTU I use is more expensive when it comes to strips.

 

His albumin is just a little high and could be from dehydration.

 

I just looked it up as well, thanks Hope. I was thinking liver but its not necessarily and likely just dehydration in this case.
Albumin is the major protein found in the body. It carries various substances through the blood and is important in maintaining pressure within the vessels. High levels indicate dehydration. Low levels indicate chronic inflammation, liver disease, kidney disease, starvation and blood loss.

There are several good meters and it comes down to a couple factors...cost and reliability. If cost (usually the strips are the $$), then bayer or one touch ultra are some of the gold standards. But walmart relion appears to be quite reliable as well, and is much cheaper. The cost of strips can really add up, usually you can get a free meter with purchase of strips.

 

A note on the dehydration.

Kitty was still on dry food when the blood test was taken.
Also he was drinking quite a bit of water and going to litter box.
He is drinking far less and not going to the box as often. So perhaps with the change of diet and the insulin that is or will come back to normal???

 

Yup. its likely just one of those things (like the slightly elevated ALT) to watch for next time he gets blood work done.

 

For the meters, accuracy, reliability and ease of use are the important factors for me.
Once I am comfortable with the testing I can start looking for something that is more economical.
What am I looking at expense wise? I am floating on an ocean of ignorance here.

 

I buy my OTU strips at http://www.diabeticcare.com for 37.50 for 50 strips. Meter usually runs about 65. Strips are more expensive in a regular store but I know I can at least buy them if I run out. I use the OTU, not the Ultra 2 or the Mini, and it was only 8 points off from lab report when I did testing comparison. It gives err reading if not enough blood, counts down in 5 seconds, easy to see blood being sipped in, can pull out an reinsert if you run out of time and haven't gotten blood yet, gives 14 and 30 day averages. I put the strip in, grab an ear, stick and sip. I am a confirmed OTU user. Don't buy anything that starts with True.

 

Sev,
Meter - I use a Relion Micro. $9.
Box of 50 strips $20 (less per strip if you buy 100)
Box of lancets for poking I think $4 or less. Recommend 28g to start, and you'll probably be able to go with a smaller (33g) later, but they all cost the same.

Ketone strips - Don't know how much they cost. I test for blood Ketones, and the strips are outrageously expensive (2-5 dollars each unless you can find them on ebay. Box of test strips is probably 50 cents a strip tops, but I have never bought any so not sure.

The knowledge that by home testing, you can save your kitty's life - priceless.

Dose - doubling the dose without testing is playing russion roulette with his life. You can't even be sure at this point in time that the 1u you have been shooting blind is safe. No, he hasn't hypo'd that you are aware of, but you really have no idea how low he's going. Also, upping the dose will most likely cause bounces or rebound. Kitty goes too low, his liver dumps glucose into the blood, and BG goes up in an instinctive effort to avoid hypoglycemia. It screws up his numbers, and makes treatment that much more difficult.

I would not increase dose AT ALL until you have been testing his BG for at least two or three days so that you have hard data that shows what the 1u dose is doing. It could potentially be too high a dose already, and already causing rebounding/bouncing. No matter how he appears to be doing, you don't really know. Kitty's are masters at hiding illness and pain. My cat went down to 44 once. He didn't display a single symptom. But he was in fact "hypo" at the time. Another 10 points and he might have been in a coma.

It's a safety issue. A life and death issue actually. The easiest way to understand it is this. Make believe that he is your infant son, who just came home from the hospital diagnosed with diabetes. He can not tell you how he feels, if his sugar is high, or his sugar is low. His life depends on safe and appropriate dosing. The only way to know if it is safe to give him insulin and how much is to poke his little finger at least twice a day to see what his BG is. He's your son. Are you going to shoot without knowing for sure it is safe?
No difference with your cat. He can't tell you how he feels, and you don't know how the insulin is going to work. We can it "shooting blind", and it can kill.

So yeah, next stop Wally World, Sev. And then come back and we'll walk you through the process.

Carl

 

Definitely get more input - I just ask questions, I don't have answers! The only things I know for sure are it's safest to start low and go slow with dosage increases, and home testing has saved many a kitty. I believe it saved mine, and might save yours at some point. Just pick up one of those recommended by the folks here and start today, then as you get more information you can change if you don't like the one you start out using. But you need to start testing today. Yesterday, even!

 

Yup, yesterday would've been a good day to start testing ;-)

 

Well it seems I have my marching orders. ;-)

So just to be clear.
The recommendation is to get diabetes testing equipment meant for humans?

 

Tough crowd around here. ;-)

 

Yes and don't forget extra test strips, lancets and Ketostix for urine/ketone testing.

 

Checking out the site now.
I like the idea of the meter giving running averages. Saves the buttons on my calculator.
Going to head down to Wally World and see what I can find.

 

almost all of us use meters and testing equipment meant for humans! You can debate this to death, or you can get on to treating your diabetic cat. If you decide you want to make a switch in meters later on then nothing holds you to a particular meter...I know I have 2 diabetic cats but I have 3 different meters. Each cat has their own meter and then I have one that I only use as a back up. It really doesn't matter which meter you use they all measure blood glucose.

Mel, Maxwell, Musette & The Fur Gang

 

Got it.
Just want to be clear so I dont make any missteps.

 

OK.
Here is what I got.

1 Reli On-Micro.
110ct of Reli-On Confirm/Micro test strips.
50ct Reli-On Ketone
210ct Reli-On 30g Lancets.

And the cat is hungry.

 

The meter is all set up.
I see the lancer has an adjustment for depth of penetration. (There is a joke in there somewhere. :roll: )

Sooooo what depth for a cat ear?

 

Sev,
Sorry, didn't mean to be so blunt. I haven't been here long, 6 months or so. About 4 months ago, I started posting a lot in this forum, sort of the unofficial "welcome wagon", greeting new people, calming down frayed nerves, trying to get people past the "newbie" sense of being scared, overwhelmed, etc.
Look back at 99% of my posts in those threads, and I'm the nicest, sweetest, most calming person in the world. I've probably rolled out the red carpet for close to 100 people it seems like, sometimes 4 and 5 in one insane night or another.

Very rarely, "blunt" works. Or at least I hope so. I'd much rather emulate Mr. Rogers than Bill O'Reily :lol:

So, glad your shopping trip was a success. Ready for the first attempt at joining the vampire club?

Carl

 

Set it about half way.
Sometimes it is a good idea to just set it, hold it close to the ear, and click it a few times to see how/if he reacts to the noise.

If halfway doesn't work, set it for "higher" penetration. You can also try it on your finger. To see if it works, and to reassure you that it really doesn't hurt him.
Carl

 

Setting 3 it is.
No reaction. Except to give me that 'What are up to now look".

Now where exactly to I nail em???

Test strip is in the unit.

 

And just to let you know - the FDA ruled that so long as the meters were within 20% of the lab value, that was good enough for home testing. This means the reading you get may be 20% lower or 20% higher than the true value ( 100 = from 80 to 120, etc).

The general idea is that the reading gives you a clue, not an absolute answer. If its preshot time and the cat is under 200 ... we suggest you delay or skip until the next shot time. When you get more data, that 200 may be lowered - it just depends on how your cat responds to the dose.

Always test before giving insulin.
Aim to get 1 or more tests in between the shots on 1 or more days, at least at the likely lowest glucose value time (nadir); some folks set a clock and get up at night to do this.
When you've changed a dose and held it for 3-5 days, do a curve where you test evey 2 hours until the next shot is due. The curve helps determine how well the insulin is working for the cat.

 

Here's a pic that shows the area you want to hit



Carl

 

Oops I did the vein.
Got a reading of 441 mg/dL

 

The test site most of us use is just outside the vein that you may see along the outside edge of the ear.

Fold up a tissue or something a bit firm to place under the ear - you won't poke yourself as easily.

If the fur is dark, look at the underside of the ear, maybe use a flashlight.

See the vein very near the edge? You're aiming between it and the edge.

Have the meter ready with the test strip inserted firmly.

Some cats get very startled - please have a towel to gently wrap around the cat, and cuddle firmly against you while testing.

Its very quick using the lancet pen. Freehand, I see a bit better and just gently push it in.

As the blood beads up, pick up the meter and put the edge of the strip in the droplet.
If the cat is struggling a lot, you can scrape the blood drop onto a fingernail and test off that.

I use the folded tissue to press on the nick firmly to help it clot while waiting for meter results.

Low carb treat and praise every time you test, even if it doesn't work.

 

The Sweet Spot

http://i106.photobucket.com/albums/m267/chupie_2006/testingear/sweetspot.jpg

Make sure the device is FLAT on the ear, not at an angle. I use a 2 setting......to deep the blood goes down and doesn't pool up. You could also put a tiny smear of vaseline along the edge so that when the blood comes up it will pool, not run. If you see a spot of blood but not enough, milk the ear by pushing from the bottom towards the spot.

 

Got it. No struggle. A little flinch as I did the vein and not the edge of the ear.

 

Meter read 441.
Now what?
Vet says 2 units. I am currently at 1.

 

forgot to mention......PRAISE, KISSES and HUGS and maybe a treat. No matter the years of testing, always praise the kitty and give kisses.

 

Did he eat before testing?

 

He gets em all the time. :smile:

 

Not that I saw.
I have not done the evening feeding yet.

So its a lot higher than I thought it would be.
Not sure what do do with the dosage now.

 

See what 1 unit does - its data!

You can add more; you can't take it out once its in!

 

Ok.
Feed em and shoot em.
When should I test him again?

 

Start 2 hours after shot. (we note it as "+2")

 

You're on Prozinc, so feed first, then shoot (about 15 minutes after feeding)

 

bare minium...is before each shot and then again at right around +6 to try to find the nadir (lowest point).

Mel, Maxwell, Musette & The Fur Gang

 

I have been shooting while he feeds. Vet never said when. I just assumed. Its already done. Dammit.

 

Please explain further.
You truncated the explanation to much.

 

Well I test Musette slightly more than what I suggested but at the very least you will want to test Kitty right before you feed and give insulin in the morning and the evening, also you will want to get at least a +6 (6 hours after insulin) to find his nadir (or the lowest point he is going to go on that dose). Since I'm home all day with Musette I test her before her am shot (AMPS) then +3 (3 hours after shot) which is her onset, then again at her nadir (+6 or 6 hours after) then again at +9 and then again right before I feed her and give her insulin at night. Mostly because in Musette's case she has been a tough cat to regulate and likes to ocassionally with no changes in her diet decide to either plunge way down or go soaring up. She is also a DKA survivor so I have to be extra careful to not let her get too high and start passing ketones.

Mel, Maxwell, Musette & The Fur Gang

 

Got it.
What about shortly after feeding?
BJM suggested 15 min after.
Kitty just had seconds like he normally does. Takes a break then comes back a couple minutes later for a few more bites.

 

I shoot Mishka while she is eating. I know Mishka and I know if she doesn't eat something is wrong. She has now decided to eat a little, then go back and eat more whereas for years she would hoover the food down, nothing left. I also would do a spot check somewhere around +3 and maybe a +6 and then before bedtime. Doing a curve you will test, feed and shoot and then every 2 hrs. (+2) you will test so you will get a +2, +4, +6 and so on. Once you see a downward movement you might want to do a test every hour till he starts to climb back up. Not every cat peaks at +6. Mishka can decide to run away with a dose and keep going till morning before peaking so I cannot shoot her because she is too low. ECID and my meter is my best friend :mrgreen: I'm more a believer in spot checks during the course of a cycle them I am doing curves. Once again, Mishka believes that every day should be different...sometimes flat, sometimes curve up, sometimes curve down, etc. After 8 years I'm used to her.

 

ohmygod_smile ohmygod_smile

That's it. I need bourbon!!!

Needles and shots and pills OH MY!!!!

Heading in to get another reading.

 

We usually recommend chocolate :lol: Have to keep sober.

 

OK.
Now its 480
Been about 1/2 hour since he ate.

 

We'd everybody go?

 

You shot 1 unit, right? Okay, food spikes them up, usually, and ProZinc as with other PZI insulin, takes a while to kick in. Remember, you are gathering data on how well 1 unit works. This disease takes a lot of patience to deal with therefore we call it the sugardance. Better a little high one time than too low one time and there wasn't enough info to go on to say raise the dose. Once in, you can't get it back out and you do not add more insulin now either.

 

Here is what I got so far as far as going to the vet.
The Feeding was around 5 AM. (Old Diet) Vet was at 7:45 474
Second visit. Feeding and shot was at about 6:30. Vet was 8 AM. 275
Third visit. Feeding and shot was at 6:45. Vet was 9:15. 326

1 unit at feedings.

First home test 441.
1 unit shot.
Second home test about 1/2 hour after feeding 480.

 

10:00 PM test came in at 381.

 

Sorry - had to go to rehearsal & am home now!

 

What time did you shoot? What + is that 381?

 

When we write up our results in a post, we often do it as follow because we're in lots of different time zones, some exactly opposite the US!

AMPS ###
+2 ###
+4 ###
etc.
PMPS ###

Where AMPS = morning pre-shot, PMPS = evening pre-shot, and +2, +4 etc are how many hours after the insulin was given.

 

About 7:00PM he got 1 unit.
10PM would be +3

 

Got it.
Just noticed my post time is an our off on the site. I am on eastern standard.

 

BJ and I are both EST too.

 

So if I collected this correctly, you have:

441 PMPS, 1 unit
480 + :30
381 + 3

Nice drop of 100 points in 3 hours; it may or may not continue that strongly. Usually a curve has a parabolic shape which may be wide and flat or narrow and steep, or ideally something in between with a smooth drop and rise.

 

That is correct.

 

Ok lets try this fresh from the morning

7:00 AMPS 433 0+
7:10 1 unit given
+1 505.
+2 421
+3 397

 

Not sure why the readings are generally lower at the vet for the same time span.

 

Being at the vet was a different day, another day, nothing is set in stone with cats and diabetes. Here is the link for setting up a spread sheet
http://www.felinediabetes.com/FDMB/viewtopic.php?f=6&t=18207

 

True. However if it remains consistent it shows a pattern.

Cool. Thank you.
I have not written any code since about 1984.

 

7:00 AMPS 433 0+
7:10 1 unit given
+1 505.
+2 421
+3 397
+4 353

 

Sev,
KT's spreadsheet is attached to my signature - I have inserted a column for the shot time and another one as a reference of my last pm test. If you so choose, you can just save mine, rename it, remove KT's numbers and go for it. It may already be set up with info that you like to keep.

We never forget that sense of programming regardless of how long ago it was....may have to brush up on today's terminology but the 'logic' is still the same....just a lot easier...

Extra scratches for fuzzybutt....

 

:lol:

Yah well the days of Ascii, HEX, Cobalt, RPG and Pascal are long behind me.

 

Sev

Time to start a new post with the date and kitty's name!

 

7:00 AMPS 433 0+
7:10 1 unit given
+1 505.
+2 421
+3 397
+4 353

 

How come?

 

Because the thread is getting too long to be.managable.

 

Ah.
Ok. Just didnt want to flood the forum with multiple threads on the same subject.
.

 

We generally do 1 post a day per cat, and call it a "condo" in some forums. Take a look under the PZI forum, which also covers ProZinc. Thats where I typically post about Spitzer.

Other posts in Think Tank and Community, for example, which are not specific to a cat, may be multiple for separate topics.

 

No problem.
Different forums use different approaches.
It works for me.