Need advice!

Discussion in 'Feline Health - (The Main Forum)' started by JanetMR, Jan 11, 2018.

  1. JanetMR

    JanetMR Member

    Joined:
    Dec 29, 2017
    My Bella was diagnosed 12/23/17. Sorry this is so long.....She had been acting “off” and had lost weight after a diet change. ( One cat in my three cat household was diagnosed with bladder stones and put on a prescription diet for urinary health/ weight loss). I figured ( ha ha) it would be easier to put all of my cats on this diet. I made the transition slowly. Bella did not tolerate this diet at all. She started vomiting. I put her back on the old food. ( dried Iams sensitive stomach supplemented by canned friskies Pate)
    Her diagnosis came 24 hours after her brother had emergency surgery for bladder/ urethra stones precipitated by the diet change.
    Her blood glucose in the office was 410. The fructosamine came back the following day at 510
    The vet sent us home with syringes and vetsulin. She got 1 unit in the office. And later that evening 1 unit from us. We were told not to bother with testing her glucose levels at home. ( I was thinking.... what????)
    After her second dose of insulin she refused to eat and looked lethargic/ eyes dialated. We took her to the emergency vet. She spent 12 hours being monitored and on glucose. Her levels averaged about 216. They sent her home off insulin.
    We returned to her regular vet several days later (The was over the Christmas holiday). We put her on a low carb high protein canned diet. We decided to do glucose levels at home to monitor her. It took a bit to get the hang of it. Her levels started off about 141, got as low as 86.. but then seemed to average in the 200’s. She’s done ok on the diet. Eats 1- 2 cans fancy feast classic per day... 4-6 small meals. I saw a new vet a couple of days ago who comes to the house and seems more familiar with feline diabetes. She recommended Lantus insulin if she needed it. I ordered it yesterday. She recommended keeping her off insulin unless her blood glucose is higher than 300. ( she has been as low as 80 and as high as 289). I have noticed that she seems “off” when her blood glucose is lower than 215.. no appetite and seems less energetic. When she is 240 or above she eats and seems to feel better.
    Long winded as it is...
    my question is:
    Am I doing the right thing by keeping her off insulin? Is there something else I should be doing? Checking ketones in urine?
    Any advice would be greatly appreciated!
    Thank you!!!
     
  2. Kris & Teasel

    Kris & Teasel Well-Known Member

    Joined:
    Aug 17, 2016
    Congrats! Best way to keep her safe. :)

    Lantus is a great insulin for many cats. If her BG has ranged from 80 to 289 with no insulin being given her pancreas might be working a little off and on. I think most of us here would say that she might need a tiny dose of Lantus to smooth out those spikes to 289. Many cats feel sub par when their BG is lower than the elevated level their body has grown accustomed to.

    I recommend you post on the Lantus forum to ask about dosing a kitty who's on the edge of needing insulin off and on. Lots of expertise there. Learning to test urine ketones is another good skill to develop. Here are some ways to do it:
    • put the end of the test strip right in his urine stream as he's peeing
    • slip a shallow, long handled spoon under his backside to catch a little pee - you don't need much
    • put a double layer of plastic wrap over his favourite part of the litter box and poke some depressions in it too catch pee.
    Most test strips have to be dipped and allowed to develop for 15 seconds before viewing the colour change in very good light.
     
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  3. JanetMR

    JanetMR Member

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    Dec 29, 2017
    Thanks. Great advice. I already bought the ketone strips and a big long handled spoon. This should be interesting.....
    It makes a lot of sense about her body being used to elevated blood glucose levels.
    I will not receive the Lantus insulin until the middle of next week. ( I still have vetsulin) hopefully she won’t need it.
     
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  4. Critter Mom

    Critter Mom Well-Known Member

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    Jun 16, 2014
    Hi Janet,

    Your vet made a good recommendation about Lantus. My Saoirse was first treated with Caninsulin (aka Vetsulin). After changing her diet to low carb food she still needed a little support from insulin but, because Vetsulin can really tank numbers I had to stop giving it to her (plus it made her feel lousy). I was able to continue Saoirse's treatment with the gentler-action Lantus and she achieved remission a few months later.

    Great that you're home testing! Makes a huge difference for all cats but the peace of mind it gives is even greater when our little ones are in relatively good numbers but still need a little help from insulin. :)


    Mogs
    .
     
  5. JanetMR

    JanetMR Member

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    Dec 29, 2017
    Wow. That sounds familiar. Thank you for the back- up!
    Do you follow the Lantus forum? I’m still trying to figure out how this site works... along with everything else.
     
  6. Critter Mom

    Critter Mom Well-Known Member

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    Jun 16, 2014
    I have a number of anxiety disorders and the Lantus board is so busy it makes me feel really panicky so I only very rarely post over there. When Saoirse was receiving her Lantus treatment there used to be a much quieter board, Relaxed Lantus, and I got support from the contributors there. Here's a link to Saoirse's 2014 spreadsheet. You might find it helpful to see the difference in a kitty's response to the two different insulins (though every cat is different, of course!).

    Saoirse's 2014 Spreadsheet

    It takes a while to get used to the ins and outs of the forum and the different boards. Be sure to shout out if you need help with particulars. :)


    Mogs
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  7. JanetMR

    JanetMR Member

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    Dec 29, 2017
    I was able to get a urine sample on Bella today. She tested “ trace” for ketones. Not sure I did it correctly.. I could find a watch with a second hand. I called her vet and left a message ( she’s off on Fridays) should I be concerned?
    What else should I do?
    Her BG was 207 this morning. She’s eating and doesn’t seem worse, just less peppy. But this is nothing new.
    Advice?
     
  8. Kris & Teasel

    Kris & Teasel Well-Known Member

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    You did the right thing by calling your vet for advice. It can be hard to distinguish negative from trace colours on the BG test strip. A watch or clock with second hands is a good idea and view the strip in really good bright light.

    If you aren't already doing it, add extra water to all her wet food meals, as much as she'll tolerate. Good hydration can help to flush out ketones. I'd test for ketones again later today and daily for several days.
     
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  9. JanetMR

    JanetMR Member

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    Dec 29, 2017
    Thanks for responding. I will try and add water to her food. I also need to figure out how to do the spread sheet so I can get help with dosing... her Lantus won’t arrive until Wednesday.
    To me this is confirmation that she does need a low dose of insulin.
     
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  10. Kris & Teasel

    Kris & Teasel Well-Known Member

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    http://www.felinediabetes.com/FDMB/threads/fdmb-spreadsheet-instructions.130337/
    There are techie people on FDMB who will help you set it up.

    Keep testing her BG and urine ketones. I suggest you call your vet tomorrow to ask about the trace ketones in light of no insulin until next Wednesday.
     
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  11. JanetMR

    JanetMR Member

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    Dec 29, 2017
    I spoke with Bella’s vet tonight. She was more concerned with her blood glucose levels than her trace amount of ketones.
    ( Bella had a roller coaster of blood glucose levels yesterday.) She seemed to think the presence of ketones were related to that.

    She told me to give her .25 of a unit of Vetsulin (that I have on hand) if her levels go above 300.
    Lantus arriving Wednesday I hope.

    I’m adding water to her wet food and will try and get another Urine sample.

    I will try and figure out the spread sheet this week end

    Thanks for the support and advice!
     
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  12. Critter Mom

    Critter Mom Well-Known Member

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    Do you have a smartphone or tablet? Usually they have a Clock app with a countdown timer or stopwatch option.

    Another trick I've used is to put a bowl of water into the microwave and use the countdown timer on that. :oops:

    Just in case you've not found these yet, here are the links:

    FDMB spreadsheet instructions

    Understanding the spreadsheet grid

    Just holler if you get stuck and we'll find someone to help you with the setup. :)


    Mogs
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  13. JanetMR

    JanetMR Member

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    Dec 29, 2017
    Thanks! I did use my phone but set for 15 minutes instead of 15 seconds. Oops.
    I have looked at the directions for the spread sheet set up. Makes my head spin. Good thing my significant other is a geek.
    Guess what we are doing this weekend?
     
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  14. Critter Mom

    Critter Mom Well-Known Member

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    Hey, ho! Some you lose. ;)

    Happy spreadsheeting! Once you get it up and running it's a doddle to use. :)


    Mogs
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  15. JanetMR

    JanetMR Member

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    Dec 29, 2017
    So... today I know I did the urine test correctly. She tested “small” for ketones ( 15 mg/dL)
    I called her vet just to be on the safe side.( left a message) Her blood glucose was 162 this morning prior to feeding her. She’s eating and seems perky and bright eyed.
    ??
    Janet
     
  16. Kris & Teasel

    Kris & Teasel Well-Known Member

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    Aug 17, 2016
    I hope your vet gets back to you. The ketone reading is up from yesterday. Typically ketones build when BG is higher and there's something else going on but there have been cases of cats having ketones with low-ish BGs. Keep up the extra water for now.
     
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  17. Critter Mom

    Critter Mom Well-Known Member

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    Have you heard back from the vets yet, Janet? For information (not to spook you) ketones can build up quickly. If you don't hear back from the vet very soon, I'd suggest calling them back to be on the safe side.

    Also, is there any way you can encourage Bella to drink a little more water in the meantime (can help flush out the ketones). I'd recommend testing again the next time she pees.


    Mogs
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    Last edited: Jan 13, 2018
  18. Kris & Teasel

    Kris & Teasel Well-Known Member

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    I was about to add that I'd be more than a little insistent that the vet gets back to you ASAP. As Critter Mom said, ketones can build quickly. The earlier they're dealt with the better.
     
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  19. Critter Mom

    Critter Mom Well-Known Member

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    Is there any way you could get a written Rx for a single Lantus 3ml pen cartridge and get it filled at a regular pharmacy sooner than Wednesday? (You can use it as a 'mini vial' and draw up the insulin using a normal U100 insulin syringe.)

    Also, it would be very, very helpful to you to have 0.3ml U100 syringes with 1/2 unit markings because it looks like Bella will only need a very small dose of Lantus and the finer graduation will make dose measurement easier.


    Mogs
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  20. Critter Mom

    Critter Mom Well-Known Member

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    PS: It's very good that Bella is eating OK.
     
  21. JanetMR

    JanetMR Member

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    Vet called back.
    She’s not too concerned. Seems to think it’s telated to her glucose level last night (237)
    As long as she’s acting ok ( she is)
    I’m pretty sure she tested “ small” yesterday... I just didn’t want it to be true.
    She’s tolerated the water added to her fancy feast. I will continue to increase fluids.
    Could this be related to the increase in protein in her diet? She’s been 17 days on the low carb high protein diet)
    Thanks for the support!

    Janet
     
  22. Critter Mom

    Critter Mom Well-Known Member

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    If Bella's getting up that high then it may be possible to give her a very small dose of Vetsulin (with the go-ahead from your vet, of course).

    The normal 'no shoot' number on a human meter is 200mg/dL. Of course, extra caution is needed when a kitty's going into a good range for part of the day without insulin support (hence the value of spot checking BG at different times of day even when a kitty is not yet receiving insulin).

    Note: Ketones typically show up a bit later in the urine than in the bloodstream.

    The normal 'formula' for ketone-related problems is:

    "Not enough food + not enough insulin + infection/inflammation/other systemic stressor"

    As I learn more, I think that "not enough calories" may be more accurate than "not enough food" per se. Forum member 'meya14' is very knowledgeable about DKA and she kicked off a very valuable discussion about the feeding requirements of ketone-prone kitties which may be helpful to you to read:

    FDMB Think Tank Discussion - Underfeeding as a Trigger to DKA

    Your question about the switch to a new diet is a good one because potentially there may be fewer calories in Bella's new food (by volume) compared to what she was eating previously.

    Some questions:

    * Is Bella underweight at the moment? (Here's a body condition chart.)

    * Is she losing weight?

    * Would Bella eat more if you offered it to her?


    Mogs
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    Last edited: Jan 13, 2018
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  23. JanetMR

    JanetMR Member

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    Dec 29, 2017
    I have vetsulin if needed. Already bought the smaller syringes. Have to wait until the Lantus is delivered.
     
  24. JanetMR

    JanetMR Member

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    Dec 29, 2017
    I am feeding her as often as she needs it/ when hungry. She eats anywhere from 1. 5 to 2.25 cans of fanct feast total. I feed her every 2-4 hours with treats freeze dried chicken in between.
    I am extremely cautious about giving insulin unless needed. She’s already had one hypo incident right after starting vetsulin. The vet is cautious as well. ( she recommends .25 unit if blood glucose is 300 or over) so far she’s been no higher than 287.
    She’s lost a bit of weight since being on the new diet. The vet attributed this to the lower carb higher protein diet.
    She’s perkier than she’s been and is hungry but not excessively so.
    I will keep a close watch on her... it’s all I’ve been doing.

    Janet
     
  25. Critter Mom

    Critter Mom Well-Known Member

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    The caution is well-deserved because of the way that Vetsulin works. As you say, Bella has already had one hypo incident.

    Be sure to keep us posted and shout for any help you need. Keep checking BG (fasting and about 2 hours after feeding) and also ketone levels - and keep in touch with the vet.

    :bighug:


    Mogs
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  26. JanetMR

    JanetMR Member

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    Dec 29, 2017
    Thanks, I will.
    Working on starting a spread sheet.

    :)
     
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  27. Kris & Teasel

    Kris & Teasel Well-Known Member

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    My guy had a bout of diabetic ketoacidosis 2 months after diagnosis so the mere mention of ketones spooks me. It took a 3 day very $$$$ stay in the vet's ICU to get him back on track and several weeks afterward at home to feel normal again. It can be very serious.
     
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  28. JanetMR

    JanetMR Member

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    I’m sorry. I’m well aware of the seriousness of the situation. We’ve already dealt with a very expensive emergency vet visit after her first
    ( blind) doses of vetsulin. I’m doing all that I can do. If her behavior changes, or she refuses food... that’s a different story.
    I adore my Bella. This is so exhausting.
     
  29. Kris & Teasel

    Kris & Teasel Well-Known Member

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    I apologize if I've made you feel that you aren't doing enough. That wasn't my intention. It's because the very idea of ketones rings my alarm bells and I don't want anyone to have to deal with it if at all possible. :bighug:

    This really is an exhausting thing to learn to treat but you're doing everything you can for your kitty. It's early days for you and things WILL get easier and more part of a routine over time.
     
  30. Critter Mom

    Critter Mom Well-Known Member

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    (((Janet)))

    It certainly is exhausting. We can all relate to how hard things are at the beginning; so much fear and uncertainty; so much to learn.

    It can help to focus on all the thing's you've already got under your belt. Bella's on a diabetic-friendly diet and you've got all your home testing and monitoring down pat! Bella's in very good - and very caring - hands. :)

    And it shows! She is a very, very beautiful girl. :cat:

    :bighug:


    Mogs
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  31. JanetMR

    JanetMR Member

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    I know you didn’t mean any harm. I so appreciate the advice, support and value of your experiences. It’s difficult because of the information overload and the fact that Bella doesn’t present as a “ typical diabetic cat” if there even is such a thing.
    Her vet keeps telling me she’s atypical.
     
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  32. JanetMR

    JanetMR Member

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    Bella tested “trace” for ketones this morning. Yah! Down from “small”yesterday.
    I added water to her canned food and she didn’t seem to mind. She is not a big water drinker... but the increase in fluids did make a difference!
    Her blood glucose levels have remained about or below 200
    Thanks for the suggestion.
    I will continue to watch her closely.

    I’m freaking out because I ordered her Lantus last week.. waiting for delivery on the 18 th. I did not realize when I ordered it that we were expecting another cold snap here ( virginia) with temperatures below freezing. It was moderate when I ordered it. I’m hoping and praying that I just didn’t waste money and it will be frozen when it gets here. :(

    This is like a cruel joke. All these things completely out of my control.

    Janet
     
  33. Kris & Teasel

    Kris & Teasel Well-Known Member

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    Hurray for a decrease in the ketone reading! Adding water to wet food is a great way to get them better hydrated because a lot of cats aren't good water drinkers. :)
     
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  34. Critter Mom

    Critter Mom Well-Known Member

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    (((Janet)))

    This is good news.

    Keeping fingers and paws crossed that all will be fine with the Lantus delivery.


    Mogs
    .
     
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  35. Critter Mom

    Critter Mom Well-Known Member

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    Hi Janet,

    Just checking in to ask how yourself and Bella are doing today.


    Mogs
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  36. JanetMR

    JanetMR Member

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    Dec 29, 2017
    Ok.
    Bella’s urine tested small for ketones again this evening. ( was trace yesterday) :(
    Her BG was a bit elevated last night @ 257
    Trying not to be discouraged.
    The Lantus should be here tomorrow... hopefully not frozen.
    She’s eating fine and I’m adding water to her food. She seems to be acting ok.
    Thanks for asking.
    The hardest part is learning to be ok no matter what.
    I plan on calling her vet tomorrow to see if she would be open to lowering her parameter for giving insulin. ( her current stance is: .25 unit for BG 300 or above) She has remained below 300.
    I appreciate your checking in.
    Thank you
    Janet
     
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  37. Critter Mom

    Critter Mom Well-Known Member

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    Hi Janet,

    Just about to pass out on sleep meds here but I'm glad you got my note. I know how worried you are about your dear Bella and I can remember how I felt in the early days after Dx. It helps not to be in a situation where one feels quite alone with all of this. :bighug:

    Glad to hear Bella's holding steady on the ketone side of things.

    I've attached a peer-reviewed, published study co-authored by Dr. Jacqui Rand of Queensland University (a world authority on feline diabetes). It's very much focused on the use of Lantus and Levemir to treat diabetic cats. It also contains an evidence-based, very comprehensive dosing protocol where the criteria are closer to what's needed in the real world cf. the somewhat arbitrary 'no insulin below 300mg/dL' criterion your vet is currently using. It might be worth your reading it through and perhaps using the document as a discussion basis for negotiating and agreeing the protocol and objectives appropriate to Bella's needs now and which may well offer her the best chance of achieving remission.

    Keeping fingers and paws crossed that all will be well with the Lantus delivery.

    :bighug:


    Mogs
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    Attached Files:

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  38. Critter Mom

    Critter Mom Well-Known Member

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    A thought: a blood sample which produces 300 on a pet meter will read lower on a human meter. If your vet is using a pet meter 300mg/dL then human BG readings over 250 (at minimum) should meet her criterion for commencement of Lantus treatment. Catch you tomorrow.

    :bighug:


    Mogs
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  39. JanetMR

    JanetMR Member

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    Thanks for the info.
    Janet
     
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  40. JanetMR

    JanetMR Member

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    Dec 29, 2017
    I haven’t gotten a urine sample today as of yet. Bella is eating ok. But, about 2 hours after about 1/3 can of food she barfed up some undigested food with some hair. She’s prone to hair balls.. long haired cat. Her BG was 174 this morning and 245 last night.
    I have another call into her vet just to let her know about her ketones and barfing episode.
    She’s a home visit vet.. doesn’t do hospitalization. ( I changed vets because my previous vet was not supportive of care for a diabetic cat.. it seemed as if no one knew what to do other than hand me insulin and syringes)
    This vet will call me back and has other diabetic cats in her practice.
    Still waiting on her Lantus.
    Trying not to worry.
    Janet
     
  41. JanetMR

    JanetMR Member

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    Dec 29, 2017
    Just spoke with the vet. She’s changing her parameters. Yeah! .25 unit if she’s 200 or over.
    Just got the pens. Can’t tell if they are frozen. Insulin is covered by packaging. Called the pharmacy. They have yet to call me back.
    How do I use these pens with a syringe????
    Help
    Janet
     
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  42. Kris & Teasel

    Kris & Teasel Well-Known Member

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    Aug 17, 2016
    Open up the pen to expose the rubber end of the cartridge. I'm not sure if the cartridge is removable or not. Doesn't really matter as you'll be inserting the syringe needle into the rubber end of the cartridge and withdrawing insulin that way, as you would from a vial. There's no need to inject a little air into the cartridge first because there's a rubber plunger inside it that gradually moves up the cartridge as the insulin gets consumed. You're not trying to withdraw against a vacuum as you are with an actual vial.
     
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  43. JanetMR

    JanetMR Member

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    Dec 29, 2017
    So, I take off the cap and insert the syringe into the rubber stopper at the end. Don’t inject air and withdraw the amount I need. Dumb question: I am putting the syringe into the area of the cartridge that is filled with air..( it’s clear with measurement markings.). how do I access the insulin? ( the insulin is in the other end of the pen covered by packaging) through the air???
    Do I refrigerate that used pen or not? Packaging says not. That doesn’t seem right.

    Pharmacy tells me there isn’t a way to tell if it was frozen. I guess if it doesn’t work that’s my answer.
    Hopefully my poor cat will survive my idiocy.
    Janet
     
  44. Critter Mom

    Critter Mom Well-Known Member

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    Hi Janet,

    Posted this link on your other thread but adding it again here in case any other members are following this thread:

    http://www.felinediabetes.com/FDMB/forums/lantus-glargine-levemir-detemir.9/

    Good stuff. :)

    I see that you've got your spreadsheet up and running but we can't access it yet. On a computer, you need to look at the top right hand side of the screen to see the 'Share' button. Click on that and set the permissions to allow anyone with the link to view the sheet.

    Fingers and paws crossed for Bella to do great on her Lantus. Needless to say, be sure to keep up with the ketone monitoring.


    Mogs
    .
     
  45. JanetMR

    JanetMR Member

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    Dec 29, 2017
    Thanks.
    I will figure out how to make the spread sheet acessable.
    J.
     
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  46. Critter Mom

    Critter Mom Well-Known Member

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    Give a shout if you get stuck and we'll find someone to help. :)


    Mogs
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  47. Kris & Teasel

    Kris & Teasel Well-Known Member

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    upload_2018-1-16_16-15-8.png This should help. :)
     
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  48. JanetMR

    JanetMR Member

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    Thanks so much!
    Perfect.
    That’s EXACTLY what I needed.

    J.
     
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