Light greens

If the cat goes into the light greens, but is asymptomatic and is eating fine, is this okay?

Lily just threw me a 40 at +3. She came out and ate though, which suggests to me that she is self regulating. I obviously will not always be here at +3, but I'm thinking that if she is sorting herself out with a mild hypo she should be okay in the future?

I will retest at +5 as I really must go to uni this afternoon

 

No, it's not okay at all, Becka.

You need to intervene with carbs to bring Lily's numbers back up and you need to monitor her closely for the time being. You need to get 2 consecutive rising numbers ABOVE the nominal hypo threshold that are not influenced by food to make sure she is safe before you can leave her. It is still very early in the current cycle and the Lantus may not even have fully kicked in yet.

If you're using a human meter you need to get Lily over 50 and STAYING over 50.

If you're using a pet meter (e.g. Alphatrak) you need to get her over 68 and STAYING over 68.

Do I understand you correctly that she has eaten since you got the 40 reading?

Before you answer this post, please can you test Lily STRAIGHT AWAY to see if she's back above the correct threshold for your type of meter and then post the results in your reply.

Also can you please confirm which meter you're using when you reply.


Mogs
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Hi, I am using a medisana human meter. I retested and she was at 38. I have tried to bring her back up, I have a feeling this amount of lantus is too much? (0.5 BD). Day by day her numbers are starting to come down - But too low. I did retest as she got a 22(Turns out there was not enough blood)

 

STRAIGHT AWAY - Rub some honey or karo or glucose into her gums NOW to give her numbers a boost. Wait about 10 minutes then test again.

 

Have you plenty of test strips for your meter?

 

I have about 50 more strips. I have just put roughly a tsp on her gums and on her lips, she has been licking it off

If this is how low the lantus is putting her I think she needs a different dose. She is very sensitive to it clearly.

 

How to Treat Hypos Sticky:

http://www.felinediabetes.com/FDMB/threads/how-to-treat-hypos-they-can-kill-print-this-out.15887/

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Great that you are here, Mogs!

Becka, just so you know, if Lily starts to seizure then you won't be able to adminster honey orally. But you can still administer it up her bum.
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Lantus is very different to the likes of Caninsulin because it is a depot insulin. It stores a little 'tank' of insulin inside the cat's body. If you increase the dose then it takes time for the tank to fill up so you won't know the full effect of the increase for several 12 hour cycles after implementing the dose increase. That's why it's so important to get mid-cycle tests to know how the cat is responding to the dose increase.

This is the fifth 0.5IU dose you've given so the depot has filled up a lot by now. It's taking Lily too low. Yes, you do need to immediately decrease the dose starting at the next dose. You'll need to post asking for dosing advice before giving insulin this evening.


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Nope. Not the case.
If the insulin is working faster than the cat is able to take in food/sugar to compensate then the cat will hypo.
Some cats simply succumb to the hypo. Others have varying ability to release stored glucose from the liver in order to lift the cat out of danger. However, because this happens once (or more) this does not mean it will continue to be the case. The body can use up it's glycogen stores and cease to be able to provide extra glucose when needed.
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Glad to see you here too, Eliz.

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Ditto to all of the above....

 

She is still eating drinking etc. She seems a little more needy than usual but seems okay, I am just waiting for the sugar to take effect. I am feeding her prawns. She seems to enjoy them. She is at 128 now after the honey

 

Don't fill her up with low carb food, Becka, you may need her to be able to eat higher carb food later.

Do you have any high carb food available? If so, what?
The honey works quickly but can also wear off fairly quickly.
Food takes a bit longer to kick in but generally lasts longer in the system.
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That 128 is good to see, and is safe for now. But that may change later in the cycle....

 

I have some A/D here, Is that going to be good enough? I don't have any more high carb food.

 

Good that Lily's back into safer numbers but the boost from the honey will wear off quite quickly.

DON'T FREE FEED Lily right now (and that includes the prawns). It is vitally important that Lily doesn't get full right now. You need to control her food intake at the moment so that you can give her the right amount of food at the right carb levels to steer her up to safe numbers and keep her there.

Have you got any cat food with gravy?


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@Elizabeth and Bertie - do you know what the carb % is for a/d?

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I do have some food with chunks in gravy however I'm not entirely sure she will eat the chunks. She will probably lick the gravy though

 

@Elizabeth and Bertie - Will you be able to stay with Becka and Lily? I've got to duck away for about an hour but I can check back after that.

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The gravy is the best part....high in carbs! As long as she will eat the gravy, it's fine to use!

 

Will look it up...

 

Bingo! It's the gravy we're interested in.

Can you tell us the brand and variety of food so that we can check the carbs for you?

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It is purina gourmet gold with turkey and duck

Shall I feed her that now?

 

@Judy and Boomer - Glad to see you here too, Judy. Are you able to keep an eye on Lily and Becka?

 

Yep, I'm able to be here for a while yet, Mogs. No probs.

 

I'm here for them! But I would want other to offer dosing advice later

 

Hill's a/d is 12% cals from carbs (I think!) according to Dr Pierson's chart. So, 'medium' rather than 'high' carb.

But I see that Becka has food in gravy. Gravy is good...

 

Becka.....I wouldn't feed anything right now...128 is quite safe but you should test about 30 minutes after that 128. The 128 is only because of the honey you gave her and that won't last for long.

 

Becka, what you need to feed Lily will depend on how her numbers are going and on how long you are going to be around to monitor her.

As Judy says, there may be no need to feed right now. Let's see how Lily is at the next test.
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I'm about for the rest of the afternoon as well if needed, I'll keep an eye out.

 

Just checked the UK Gourmet Gold Turkey & Duck in Gravy - 25% kcals from carbs so should be OK for steering.

@Elizabeth and Bertie, @Judy and Boomer - So glad that you're both able to watch over Becka and Lily. (Always feel awful when I can't stay. )

@Lily-Fish - Becka, you're in good hands. Will check back in on you and Lily later on. (And be sure to post early this evening to get dosing advice - you DEFINITELY need to reduce.)


Mogs
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I just don't know how you all do this and still manage to work and leave the house from time to time. I am meant to be at uni for a seminar in ten minutes - It isn't going to happen. I missed a really important lecture this morning and I feel as if I will never leave my flat again. This is a nursing degree, so I really can not miss any hours at all (I know, I should know more about treating hypos in cats or what to do, but when it is your own family, you forget everything). I'm sorry to vent, I just really want Lily to be happy and I really want to qualify. I am in third year, so a very important one and it just feels as if Lily will never be able to be alone again.

 

Gill, you're a star!

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I'm here as well!

 

When you get onto a good dose things will become a LOT more straightforward, Becka. It might not seem like that right now but you are well on the way to getting Lily onto a good dose.


Mogs
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And you're a star too, Judy!


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(((Becka)))... I know this situation is challenging, but it won't all be 'fire fighting', honestly!
There are plenty of folks here managing their cats' diabetes and holding down a job also. It can be done...

Lily's insulin dose is too high. When she's on a more suitable dose, and safer, things will be a lot easier....
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Can't offer advice, but know you are being supported from us. You are in good hands. It really does get easier.

 

Retested, she is at 108

 

Oh, and Becka, it may even be that Lily goes into remission. Quite a few cats here do....

 

Well, that would be a dream come true!

 

She is starting to come down from the honey. I would retest in half an hour. When was the last time Lily ate?

 

She ate a couple of prawns twenty minutes ago, before that she ate some low carb (wainrights complete salmon and veg) and half a tin of applaws senior tuna with mussels. So I would say a ballpark of about half an hour thirty five minutes ago

 

Ok so I wouldn't feed her any more for a while. How often does she normally eat?

 

She is free fed usually, so she will come out and nibble throughout the day as and when. This seems to suit her

 

If she keeps slipping back do I just keep giving her honey? I know that sounds stupid but if I'm not supposed to feed her for a while I surely need to stop her dropping down like that again

 

Use honey in an emergency....it brings the level up quickly. But unfortunately it doesn't last very long so it's best to stop the levels from dropping in the fist place. We can use food for that. I'm not familiar at all with the foods you are giving her but usually food takes 30 to 60 minutes to kick in.

 

So I should test in ten minutes, then based on how far she has dropped, feed or not?

 

I've been looking at Lily's spreadsheet....did she actually have a hypo a couple of days ago? I see you've recently switched from another insulin to Lantus....I assume she was not responding to the other insulin?

 

I would test half an hour after the last test.

 

Hi there Lily the
Gourmet gold turkey and duck is High Carb 29% I use the chicken and salmon variety when I need to bring Georges numbers up. So you could use that when you see her numbers drop below 50, just a couple of tsps mind not the whole tin.

 

She was definitely not responding to the caninsulin, hence the DKA.

Thank you, that is good to know, I will give that now.

 

No you don't need to give her that now, that is for numbers under 5o

 

Okay, I won't give that now!

I will endeavour to chill out!

 

Phew glad I caught you.
Test thirty minutes after the 108 like Judy said, then if she has dropped below 50 give the HC and then post, any other number just post. She may, paws crossed just surf on blue.
Have you been using the U100 syringes?

 

Hi Becka, I think the Wainright's salmon and veg is about 12% calories from carbs, so is not technically a low carb food. And it may be that Lily's numbers would have dropped even lower if she hadn't eaten this earlier.
What foods do you normally feed her?
I'm wondering if it's possible to lower the carb content of her diet further, and reduce the need for insulin even more....? Something to think about later....

 

.....Nice deep, slow abdominal breaths to calm that vagus nerve....
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I gave her the wainrights because I thought she needed a little extra (mainly to reassure myself) when I went to uni. She is usually on the Applaws tuna and mussels, which I am fairly sure is low carb.

I have been using the U100 syringes, I will test in 5 minutes

 

Hmmm....I'm not a dosing expert so this is just my opinion and I would want some experts to please give dosage advice.....but if you switch Lily to low carb I would be tempted to not give her insulin for a few days to see if the low carb foods are enough to bring her BGs down to normal levels.

 

I would love to do that, but I am worried as she is a DKA kitty... It would be lovely to not have to shoot anymore.

 

I am wondering with Lily's very, very recent DKA history whether the moderate carbs plus an appropriate dose of insulin might actually be more beneficial as a treatment strategy in the short term? (Speculating here - no experience of this but I've often seen @Meya14 and @Marje and Gracie discuss giving a food that's a bit higher in carbs so as to allow for regular administration of insulin to promote a strong post-DKA recovery.)


Mogs
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I don't know anything about DKA so, like I said, we need some experts' opinions.

 

I think that variety (if it's the senior) is more like 14% ( I use the online calc, so stand to be corrected) @Elizabeth and Bertie do you agree it's more like MC.
http://applaws.co.uk/product/senior-tin-tuna-with-mussels/

 

Ah yes, very good point, Mogs (in light of the DKA)....

 

140!

 

That can work for some kitties, Judy. (I've used that technique with Saoirse at times). However, for info Lily has been hospitalized for DKA (twice) so she's very ketone-prone. Therefore extra caution is needed to make sure she always has enough insulin and that will very much determine the treatment approaches open to Becka.


Mogs
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Hmmm, yes, according to the 'analysis' it does come out as more 'medium carb' (my calculator makes it 14.8%)
It's odd though, because the label says it only contains tuna and mussels, with no additives; and yet the typical analysis percentages only add up to 97.5% and not 100%, so....what is the other 2.5% I wonder...? Or maybe the labelling is just incorrect...?

 

Looks like she may be going for a bit of a bounce. I would test again in an hour.

 

Thanks! I totally missed the DKA info! Obviously not the right approach to getting Lily into remission.

 

Absolutely agree.

BTW, here's a link to the forum sticky about DKA. It's a good introduction to the subject.

http://www.felinediabetes.com/FDMB/...oacidosis-dka-and-blood-ketone-meters.135952/

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@Lily-Fish

It DOES get easier!

You're doing great

 

Just popping out for an hour and half ladies, have to get his Lordships wee sample to the Vets.

Hope she continues to surf nicely in the blues for you.
And as Andy says it does get easier once you learn her patterns.

 

Thanks, may your visit to the vets treat you well (and may you not smell of the vets when you leave!)

 

Hi Becka, have you done any further tests? Just want to make sure Lily doesn't drop again

 

I have not. Clinically, she has improved, she is more alert and friendly and her paws are very warm. I'm thinking maybe a bounce. i will test again soon. How far should you put the lancet in? every time I test she yelps (doesn't matter whether it is ear or pad) I am definitely hurting her. I don't know if I'm just poking her like I'm wearing oven gloves.

 

I actually use one of the testers that humans use on their fingers. I don't think you should need to put it in very far. There is some information on this site about testing.....I'll see if I can find it.

 

http://www.felinediabetes.com/FDMB/threads/hometesting-links-and-tips.287/
Try filling a sock with rice and warming it in a microwave....I warm mine for 17 seconds. Then hold it on her ear...it will help bring the blood to the surface so testing is easier. You also want to use the upper portion of the outside edge of the ear.

 

You can use the machine for the lancets, and it won't hurt as much?

 

You definitely can, although if it clicks it could scare her. If you're freehanding the lancet, make sure the bevel is up, just like when you're inserting a syringe, and hold it at an angle. It only needs to go in about a mm.

 

This link has some of my favorite "advanced" tricks.

 

Boomer is very nervous and jumpy and I thought he would jump at the click but it doesn't bother him in the least. I don't know whether it hurts less or not but if you're having trouble free-handing it then I think the tester is worth a try.

 

I am managing to get blood, just she is yelping at me. Maybe it is because she doesn't like being held very much. She is definitely her own woman.

 

It's really a matter of personal preference. Some folks prefer to use the lancet 'freehand', and some prefer to use the lancet in the lancing device. I've tried both methods and now much prefer to use the lancet in the lancing device, partly because it's so quick, and partly because my close vision isn't that great (and the lancing device is easier to use if that's the case).
The lancing device does make a little clicking sound. But I quickly got Bertie used to that by clicking it a few times and then giving him a treat.

It really shouldn't hurt Lily much, if at all. Maybe it is that she doesn't like being held...?
I crumble a few treats for Bertie and test him while he's munching on those. That way I can get the test done really quickly and hardly have to touch him at all.

There are a few people here who prefer to test the paw rather than the ear. So, that may be another option for you if ear-testing doesn't get any easier....?
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In some cases this is correct. In a cat that is recently recovering from DKA this could be literally, dead wrong.

First, Lily's depot has not yet fully formed. It takes 5 or more days for this to occur and Lily has not been on Lantus that long.

With her numbers today, Lily's has earned a dose reduction. Your new dose going forward is 0.25u twice a day.

If you've not tried it, you can use a bit of Neosporin with Pain Relief ointment (not the cream) on Lily's ear. It will promote healing, help the blood to bead up, and dull the poke.

 

I moved to the paw yesterday and she seems like she squirms less with those. I tried to get blood from the paw though and had to lance the back foot in the end (even though I know she hates it)

 

Yes that was definitely an error; I hadn't seen that there was a DKA history.

 

My little girl has definitely bounced! 373.

 

Ah yes I think you don't need to worry about her for a while! By the way, if you haven't fed her you can go ahead whenever she's hungry!

 

Good! She was standing by the table looking up wistfully. I can let her eat now!

 

Waiting for the surgery to open and just my luck that yhe local cafe is shut on mondays, keeping warm in the car. so I thought I check in on Lily

Becka I saw on your SS that the emergency vet gave you some canininsulin syringes, I take it you are not using those?
You need to use the u100, with lantus as you probably know the caninsulin is u40. Just checking.

Nice to see she has an appetite and crisis averted.
Hope she doesn't bounce for too long

 

Hope you are warm!
Definitely not using the U40 syringes! I was very concerned when I found a used caninsulin syringe with remnants of the insulin still there. I phoned the vet and asked what was going on, they said that it was a mistake to put the syringe in the bag. I am slightly annoyed, but there you go. We shall start at the 0.25 u tonight and see how that takes her.
What time is it where you are?

 

Good job you knew the difference, could have resulted in an OD!
Hope her cycles settle down a bit for her and you

 

We can't get Neosporin in the UK. But it can help to put the teensiest, weensiest smear of Vaseline on the outer edge of the ear. That will help the blood to 'bead up'.
And pressing on the test site afterwards will help to minimise bruising.
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Yeah, I think Lily is getting bruised little paws. I used my torch earlier and I can see her little ears are all bruised so I am trying to give them a chance to heal a little before another full on assault.

 

It is amazing what their ears can tolerate. They seem to toughen up somehow (or certainly become less prone to bruising); and they also start to bleed more easily by, very helpfully, forming more blood vessels.
You may find that one ear bleeds much more easily than the other.
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Hi Becka

What a morning for you and Miss Lily. Just in case you didn't see it, I will repeat that you need to be sure and take her dose to 0.25u tonight which looks like this:

Not sure I'd call that a bounce. More likely the carbs and honey put the kabosh on her insulin duration. It's likely she may also bounce.

I know the 40 was scary and we should always get kitty up quickly. It's hard to do at first without cauisng her insulin to poop out but the emphasis has to be on getting her up. Believe me, we've all done this and it is an art to learn how to quickly raise the BG without causing kitty to lose duration and it's ECID.

Since Lily likes to take a big drop early and you have to leave, at least for the next few cycles, I would start to get a test at +1, +2, and +3 or until you have to leave (which might be before those times as I know you are trying to adjust her schedule) and sort out where she is dropping. If you can slow th drop with a bit of higher low carb food, then you can guide the numbers down.......that is the hope.

And here's a post on How to Handle Low Numbers in case you are alone when she hits a lower number.

 

I have tried to find syringes with half unit markings everywhere! at the moment I am using the syringes that have 1u markings only and they are really close together. I have managed 0.25 before now, it is just difficult! Thank you for all the advice . I will give the insulin 15 mins early this evening and keep going til I get her to the right time so I can get some early numbers.

 

I ordered some for Saoirse earlier today. They're cheapest on Amazon UK at the moment (ebay UK used to be cheaper - always worth checking both sites):

http://www.amazon.co.uk/gp/offer-listing/B00K86ZO20/ref=dp_olp_new?ie=UTF8&condition=new


Mogs
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Thanks! I didn't realise you were UK based! Good to know!
Just ordered a ton.