Mrs. Cheng

Our cat, The Venerable Madame Cheng-I-Sao, Widow Pirate (Mrs. Cheng for short) just got diagnosed with diabetes. It's all crazy overwhelming, as I'm sure it was for most people here. The first vial of insulin was insanely expensive. We have several varieties of food in the house, NONE of which are low-carb. It's ridiculously difficult to find calorie counts on certain brands of cat food.

Our vet showed me how to inject her this morning, and it was easier than I expected, so at least that's good. I found a list of low-carb canned foods to shop for, so that's manageable. I'm still pretty overwhelmed and confused about a lot of things, but I'm really glad there's a community like this to turn to.

One thing that's confusing to me right now, is our vet said we had to bring her back within 10 days so they could do a curve, but this site's literature says "curves are not currently recommended as the typical care." If cats' glucose levels spike when they're stressed, then it makes sense to avoid doing an all-day curve at the vet's office, where she'll be scared and stressed for 8 straight hours. Should I push back against this? Should I get a meter and do a curve myself, at home where she's comfortable? Or, since her diagnosis is still new, should I go ahead and let the vet do a curve to make sure the level of insulin we're giving her is the right dose?

 

Greetings, oh Venerable Madame Cheng-I-Sao and your most honourable human, Sarah. Welcome to FDMB.

We can help you to learn how to home test. If you let us know where you are located, we can recommend suitable glucometers for you. Could you let us know which insulin your wonderful pirate kitty is receiving?

IMPORTANT: Do not attempt a transition to a low carb food until you are home testing.

Blood glucose levels can fall quickly and dramatically from the start of the transition, and therefore Mrs. Cheng's insulin requirements may decrease. Home testing will allow you to monitor the transition and, when necessary, adjust Mrs. Cheng's dosage to keep her safe during the food change.

It can take a little bit of time to get the hang of home testing, but it is the best way to help you keep your kitty safe on insulin. Key tips are to make sure the ear is warmed long enough to improve blood flow to the test area, and also to smear a thin film of Vaseline or Neosporin ointment onto the test area so that the blood droplet will bead up instead of wicking into the fur. Here are a couple of forum stickies to help you learn and improve your testing technique, and also a link to tell you how to set up a Google spreadsheet in which to store your test results. The spreadsheet is an invaluable tool to help you monitor BG patterns and it will help you with both regulation as well as safe dosing. Sharing the spreadsheet will enable experienced members here give you better suggestions when you need help.

Home Testing Hints and Tips (includes how-to videos)

Testing and Shooting Tips (includes a very useful diagram of the ear to show the 'sweet spot' for getting samples more easily.

How to Set Up a Spreadsheet and Link it to Your FDMB Forum Signature

In addition to the spreadsheet link, it is helpful to put both of your names and your insulin type into the signature. You can also add the name of your glucometer when you get one. It is very helpful to also include brief details of any other health issues/medications in the mix. Have a look at other members' signatures to get an idea of what to include.

In addition to home blood glucose monitoring, we also recommend using urine test strips to monitor regularly for ketones (e.g. Keto-Diastix). Monitoring of urine glucose levels is very crude, and does not help with gauging whether an insulin dose is safe.

As you correctly note, curves run at a vet's office may result in temporarily elevated blood glucose levels and thus give a false picture of Mrs. Cheng's typical day-to-day BG levels. Curves done in the home environment when a cat is more relaxed are more likely to provide reliable data upon which to assess dosing requirements.

The early days after diagnosis plus the vertical learning curve can be very overwhelming indeed. We've all been there, and we'll be with you and Mrs. Cheng as you learn. For now, just breathe.



Mogs
.

 

Thank you Mogs!! We're in the US, in Chicago, IL. We were prescribed Lantus, and we're starting out at just a 1 unit dose, twice a day. Mrs. Cheng's glucose levels aren't crazy high just yet, and I haven't noticed any symptoms (they found this while diagnosing a UTI), although they did say they'd like her to lose a pound or two.

Our vet techs showed us an Alphatrak meter, so I've been comparing prices on that, but I'm definitely open to suggestions for a glucometer!

Thank you so much for the links, I'm off to read the testing tips and to set up a spreadsheet!

-Sarah, humble scribe in the service of the Venerable Madame Cheng-I-Sao

 

I see your Most Venerable Mistress has you well-trained, Sarah.

Two very popular meters among US members are the Relion Micro and Relion Confirm, both available from Walmart. The test strips are very reasonably priced, unlike those for the Alphatrak. Because of species differences in plasma concentration of blood glucose, human meters read lower than veterinary meters such as the Alphatrak. It's perfectly acceptable to use a human meter to monitor a cat's blood glucose using an appropriate 'cat-adjusted' reference range.

Lantus is a very good insulin for feline diabetics. For your further edification, I've attached a copy of the published study by Kirsten Roomp and Dr Jacqui Rand (the latter of University of Queensland), Management of Diabetic Cats Using Long-acting Insulins (including Lantus). It covers the use of human glucometers for the monitoring of feline diabetics, and also their evidence-based tight regulation protocol dosing guidelines. Have a read and we'll be here to answer any questions you may have.


Mogs
.

 

A word of caution: I'm assuming that Mrs. Cheng is receiving treatment for the UTI. As it clears, her BG levels may come down again and her dose may need to be reduced. Home testing will help you keep an eye on that.

Did your vet run a fructosamine test as part of the diagnostic procedure?

.

 

Oh, this is great information! Thank you! I have a lot of reading to do.

So, yes - she has another day's worth of Clavamox for the UTI. Although: they found bacteria in the sample they ran at the vet's, but the vet's lab couldn't get an active culture to grow from it. Did she have a UTI? Was it anaerobic bacteria or something? It's a mystery.

Also yes - the vet ran a fructosamine test. That came back 698 umol/L. Last week her glucose level was 240, and this morning when they tested it, it was 160. As I understand it, these are in the range for diabetes, but pretty low?

I'll also add: I love our vet's office, or at least I have up until now. They've got us with a new doctor, and he talks very fast, and he talks over my questions, and he's been kind of dismissive of some of the things I've asked, which has not helped us in this process. :\

 

Welcome to the crazy parallel universe that is Feline Diabetes.

It's good to know that the fructosamine test was run before your vet prescribed insulin. I just wanted to check that it wasn't based on a solitary blood glucose test and a urine test. The fructosamine test looks at a longer time interval.

.