New here. Hello!

Hi everyone! I work in rescue, and we currently have a cat in our group with diabetes. I am trying to get the poor guy managed (with the help of his foster) with very limited resources and a vet tech that truly believes that a fasting BG level in the 200 is "managed"... Maybe it is, what do I know. That just seems a little high to me. Anyways, one of your members just lost her kitty, and was nice enough to donate all of her supplies to our rescue, and we got to talking, and she recommended this forum. So I'm looking forward to talking with everyone, and hoping to gain a lot of much needed information to help Brimley, and any future diabetic cats that enter our rescue.

 

Welcome to FDMB.
You're right - 200 mg/dL isn't what we' d aim to get as the lowest glucose during the day. Starting out, though, we do suggest 200 mg/dL as a 'no shot' limit until there has been enough test data to show it would be safe to shoot lower.
What insulin, dose, and glucometer type are you using?
And check out my signature links Glucometer Notes and Secondary Monitoring Tools.

 

Brimley is using Novolin, 15units 2x a day. The foster hasn't had his own glucometer, so he's been bringing him in weekly for checks. I'm sure that's not the most accurate. One of the items donated today was a ReliOn Glucometer, so I plan on sending that home with the foster when he comes in for his check on Friday. The one we've been using is an animal specific meter, I can't remember the brand name.

 

15 units???? or 1.5 units? I really hope you mean the latter.
Here is a guide on using Novolin or Humulin N.

 

I wish that I had mistyped that, but no, I truly mean 15 units. It looks like the first thing we need to do is check his glucose curve? So far we've only been checking his fasting glucose, and for the past month or so that's only been once a week. Now that I can send the foster home with his own meter, I should be able to get a curve over the weekend. Can anyone give me a game plan for that? I'm still sifting through all of the information... It looks like we should check his BG before the shot, then 2, 3, 4, 5, and 6 hours after the shot? How many days should we do this? How do we do this over night? I can't exactly expect the foster to sit up all night with Brimley... He has a job and is in college... Also, Brimley has currently been getting fed at 9am and 9pm, and then given the shot as soon as he was done eating, but I'm reading that you should give insulin an hour or so after they eat? So it sounds like we need to change that... It says not to change more then one thing at a time... So should I change the timeline between food and insulin before, after, or at the same time that we measure the curve?

 

A standard curve is from pre-shot to pre-shot, with serial tests every 2 hours. Generally, you do it every week or two. Otherwise, you want to get pre-shot tests, and a test between +3 to +4 whenever possible, as that is likely to be around the nadir for N. The curve will show if the N is lasting longer than 6-8 hours.

If he goes below 50 mg/dL on a human glucometer, the foster should be prepared to intervene with Karo syrup and plenty of test strips. Here is our home management protocol for How to Handle a Hypo. Make sure the foster has this printed out.

Give the N about 30-60 minutes after the food so the glucose is starting to rise when the insulin is starting to kick in.

What are you currently feeding him? If it is retail dry food, that may be the only thing saving his life, so keep the food the same until the home testing is going well.

The other possibility for the high dose is that you may have a cat with one of the high dose conditions of acromegaly, insulin auto-antibodies, or Cushings. How big is he? How did the initial dose get determined? How fast and by how much was it raised each time? (if you can find out, that can help us determine what may be most helpful for him.)

Maybe edit the post title and put HIGH DOSE CAT there.

 

Thank you! I'll make sure to print that for the foster. He said that he could definitely get a curve this weekend, so hopefully that will help shed some light. As for the details, most of that information should be in his folder, which the foster has, as long as our tech kept record (which is not a guarantee...), but let see what I remember without the folder. Brimley was pulled into our rescue from the local pound at the beginning of January. There was obviously something wrong with him. He was extremely anti-social, he walked weird (kind of crouched down, almost belly crawling?) and was a bit wobbly. He was extremely underweight, to the point that you could see his hips and his spine. He also seemed to tire easy, though I'm not sure I would call him lethargic.
I think around the beginning of February I started noticing that he was urinating excessively. He was in a community pen at the time, so it took a while to even notice let alone figure out the culprit. I pestered the tech until she agreed to run blood tests. I don't remember the exact numbers, but his glucose was high. I would say 400+? Finally got him a vet appointment on March 2nd, and the vet started him out on 2 units twice a day. The fasting BG when the vet saw him was almost 500. On March 9th, the vet bumped him to 4 units twice a day, March 11th it was 6, March 16th up to 8 units twice a day, and then I don't have any records until April 2nd when he got bumped up to 12 units twice a day. The foster took him home on April 25th, and by that point he was up to 15 units twice a day.
Brimley attacks his food like he's starving every time he is fed, and has been known to go to extreme measures to steal food, including eating the household plants (none were toxic, thankfully). I'm starting to wonder if this is because his levels are dipping too low, so I guess we'll see this weekend. He is still underweight, despite how "well" he eats. I saw "well" because he is eating hills prescription w/d right now, half wet half dry. I personally wouldn't feed any of their prescription foods to any of my animals, but I'm a food snob and I know it. (My 2 cats and 2 dogs are all fed prey model raw) Anyways, I would like to switch him to a lower carb wet food and completely nix the dry, but one change at a time, so I'll wait on that until we see the results of his curve test.

Does that help any? Did I miss anything? I can't figure out how to change the title...

 

Those dose increases were so fast, that I'm concerned his appetite is due to being overdosed. As much as possible, have the foster check about +3 to +4 hours post shot, the probable nadir for N. Around here, we increase the dose 0.25 to 0.5 units at a time, depending on the nadir values.
Would the foster like to join us here?

 

Yeah, the more I'm reading, the more I'm suspecting that he is being overdosed... I'll ask his foster if he wants to join up when I see him tomorrow.

 

So glad you found us, sounds like Brimley really needs our help. I just want to reiterate what BJM has already said in relation to diet - do not change it until we can see what's going on. Also there is a fabulous spreadsheet here http://www.felinediabetes.com/FDMB/...te-a-ss-and-link-it-in-your-signature.130337/ that the foster can use to record Brimley's test results.

For home testing tips go here http://www.felinediabetes.com/FDMB/threads/hometesting-links-and-tips.287/

 

Quick question. I was checking out the tracking spreadsheet. What does AMPS/PMPS stand for? And what does U stand for?

 

So I just looked, and Brimley hasn't had a read at all in like 3 weeks. He's coming in tomorrow, probably just going to spend the day with me so I can monitor him while I take his curve. So I'll be going in a little more blind then I had realized. Should I start a new thread over in the health board, rather then clogging up the welcome board?

 

Sorry, spamming my own post, but I think I figured out the answer to my previous question. AMPS/PMPS is AM/PM Pre Shot? And the U is for units, ie how much insulin given?

 

Yes, that's right. I'm SO GLAD you found this forum, you've probably saved Brimley's life. Typically, insulin is increased over 3 test cycles, so 72 hours, and only by .25 to .50 increments.

 

So assuming that his levels are going too low, at what speed should I be decreasing his insulin?

 

I'd think .50 every 48 hours would be prudent, but there are more knowledgeable people than I on here.

You'll probably get faster responses if you start a thread in the Health forum, I think there's a section for Novolin. You'll probably have to re type everything to give everyone there the best picture of what's been going on.

 

Post in Health. The Humulin/Novolin section seldom has any posters.