Newbie figuring it all out

Hi guys. I have spent the last day or two reading endlessly and am slowly coming to grips with everything.
Right now it’s only been a bit over 36 hours Jazz has been home (was hospitalised for a few days over the weekend with DKA), so very early days!!!

I am in New Zealand, so aware there are some differences!

My vet was sadly typical in advising prescription dry food, not to home test and doing curves in the clinic. So I am arming myself with as much info as I can to shift things and hopefully still have my vet supportive and on board!!

Currently Jasmine is on 1.5u caninsulin from a pen. I am aware now that this isn’t ideal for cats so I will be discussing this with my vet in the coming days.

I already had a glucometer and leftover strips from my own gestational diabetes a few years ago, so have been using those to home test her yesterday and today. Today I am attempting to get a curve on her to figure out more of where we are at and if we need a different insulin. I also want to have a curve on record to take back to my vet to show I can do it myself and not need to take her in every week!!!

I did go ahead and outright changed her diet yesterday from a crappy dry food (oops!) to friskies pate. I have seen it advised to do this slowly and not in conjunction with insulin changes, but her BGL are sooooo high that even dropping a heap by diet alone won’t bring her down to respectable levels I don’t think?? Thankfully she is happily eating this food!

I am worried about her levels being sooooo high, but aware that the whole “start low, go slow” thing too and to not just rush her down. It’s hard!

Yesterday afternoon I noticed a mild weakness in her hind legs and I’m assuming neuropathy??? Do I need to be talking to the vet about that or just finding the b12 myself??

Any and all support is very welcome. I am very confident I can handle all this, though it feels overwhelming right now. I just hope my vet comes on board and helps too!!!

Amy & Jazz

 

Hi Amy
Glad to see you made it over to the main health forum. Here is the link to your welcome post so others can see. We link all our posts for continuity
http://www.felinediabetes.com/FDMB/threads/newbie-from-nz.209747/
You are certainly making headroads into getting sorted out. I hope your vet will be supportive. Some are and some aren’t. But hopefully the vet is willing to learn along with you. FD has advanced a lot since many vets were at uni and many haven’t kept up with current treatments.

Weakness in the back legs is most likely peripheral neuropathy and it will go away eventually once the BSLs come down into more normal numbers. The vet does not have anything that can help but you can buy methyl B12 tablets for cats online called Zobaline for cats. You can order from a company called lifelink. Just google it. You can crush the tablets over the food and they are tasteless.
Any medications you buy always check they have no sugar in them as that will effect the BSLs. Zobaline is especially for cats and is fine.
Can you add to your signature what sort of glucose meter you are using, type of insulin, food being given, DKA history, weight, other medical issues please? This will be read by all who help you and will stop them having to ask you for info every time.

Is Jazz eating plenty? It is very important she is after having DKA.
If you could post the curve today that would be helpful. And I will post the link to the spreadsheet if you could get that up and start putting in the BSLs, it will help tremendously.
Jazz is gorgeous by the way. Burmese kitties are lovely cats ... beautiful natures.

SSLink
http://www.felinediabetes.com/FDMB/threads/fdmb-spreadsheet-instructions.130337/
Bron

 

Hi Amy,

I'm glad you posted over here. Lovely kitty you have! Bron has given you good information on B12 for neuropathy and you seem to have a number of things well in hand already, chief among them BG testing and a spreadsheet to log your data.

Some cats do fine on Caninsulin but the pen device prevents you from changing dose in the 0.25 u fractions we prefer. You can buy U40 syringes with half unit marks to accomplish this. Does the pen contain a cartridge of insulin? If so you might be able to insert a U40 syringe needle into it to withdraw insulin as you would from an insulin vial.

Excellent! You can probably reduce your testing to every 2 hours and still have a good curve to show your vet. The vet will likely grumble about a human meter not being accurate and so on but we all understand how to interpret these numbers here on FDMB.

That's a wise move. I agree that her BG levels now are high enough that she won't likely plummet too low with the food change.

Give her a few days at this dose to see how she settles and then you can increase by 0.25 u fractions after 4 cycles (cycle = the 12 hours after a dose) until you begin to see yellow and blue on your SS. Then, you can reduce the rate of dose increase.

Post DKA essentials:

• enough calories - feed her as much of the Friskies pate as she'll eat in several small meals a day
• enough insulin - see dosing suggestions above
• good hydration - add as much warm water to her wet food meals as she'll tolerate to help wash out ketones
• be vigilant about monitoring appetite - she MUST eat well
• buy some urine ketone test strips and test her urine for ketones daily for now.

Here are some ways to get a urine sample for a ketone test:

• put the end of the test strip right in her urine stream as she's peeing
• slip a shallow, long handled spoon under her backside to catch a little pee - you don't need much
• put a double layer of plastic wrap over her favourite part of the litter box and poke some depressions in it to 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.

 

I have her spreadsheet in my signature but will add in the other info too. Her appetite is low, but she is improving. She has never been a fat cat nor has she been ravenous or thirsty with the diabetes. I am allowing her to eat whenever she wants it for now as I understand eating is really important after DKA!! She is voluntarily going and asking for food or nibbling at bits every hour or two. Which is still not much but it’s better than me having to take her to the food and encouraging her as I was doing yesterday so I have hopes.

We are only just at the +4 point of our curve today (I’m testing hourly, as I understand caninsulin is fairly fast acting and I want a good first snapshot!) but that’s all in my spreadsheet. I think the link works??

I’ll go edit my signature now too.

 

Ah! You were replying as I was. Haha! Thank you that’s all valuable info!!!

That is the other issue I have yet to tackle: urine collecting! She has free range outside through the cat door and I have young kids in the house so need to figure out how to keep a litter tray away from kids and to keep the kids from letting the cat out!! It is summertime here so the back door is left open a lot! I might have to lock her in with us overnight with a tray and just hope she pees overnight for me to sample. I will tackle that when I can get hold of some urine sticks hopefully this week.

 

Well done Amy getting the signature and SS up and running. Kris is very experienced with DKA and will be able to help you a lot.
Keep feeding Jazz as much as she’ll eat at this stage

 

Just a thought...... are the strips you had a few years ago for yourself that you are using still in date. ?

 

Ok, just coming back in with the +5 levels and they are definitely rising from the +3 and +4. (Does this mean it’s just too fast acting and not going to last her well? Does she need a different insulin? Or just keep going for a few days still and see? I will keep tracking her today for my snapshot but spread out any further tests as obviously the nadir was at 3 hours and anything now is just going to keep going back up.

She is eating more as the day goes on though which is good! She is also just begun to wash herself more again; she hasn’t really been washing as she has been feeling sick so I am pleased seeing that!!

I have been browsing syringe options and I cannot get U40 syringes here as all insulin done for humans in N.Z. is U100! So there are literally no local suppliers of U40 syringes. I’d have to try import them and I’m not sure how viable that is.

The urine test strips are more expensive than I thought, so not sure if I can afford them this week unless my vet can get me some. I will keep looking though! I have found more strips for my glucometer for an affordable price though so will get them if my vet cannot source them cheaper.

 

No they are out of date. I know that’s not ideal but tested myself and it was an average reading so for now this is better than no testing at all.

 

They will not give a true reading.
When Sheba fell out of remission I only had out of date strips. I used them for a day until I could get in-date ones. The difference was significant. Like 23mmol down to 15 mmol with the same drop of blood. So I would definitely get new ones ASAP because Jazz could actually be a lot lower than she is reading at the moment and you dont want to be changing the dose on a faulty number.

 

You should be able to get test strips cheaper online than at the vet or the chemist. But I think you just need to get in date ones as soon as possible to get true reading first up. I used to buy mine online.

It looks like the insulin is a short duration but I’d trial it a few days more days to see if it improves. Also in date strips might change the picture.

What urine strips are you looking at.?
The ordinary urine strips are expensive but what you need are Ketostix which should be only about $10 or $12 at the chemist in the diabetic section.

 

If you can get human U100 syringes with half unit marks they can be used with this conversion chart:
http://www.felinediabetes.com/insulin-conversions.htm

 

Hi again. @flyingduster

I am trying to catch up.

I have syringes here & will help later with a UK supplier that sends to NZ.
I also have a quality meter that will do BG and also ketones. That may be better than your own. I have some supplies and will post about the supplier for that later on.

Buying from an NZ vet is ALWAYS very expensive. I will look back and think what I did for urine strips in the early days.

You won't get Zobaline B12 here in NZ. You will be able to buy something else. I have to go out but will get back to that later on.

 

Thanks all, I will order new strips today and not worry if the vet can access any or not and just get these right away.

The vet did say that the insulin she was getting at the clinic hadn’t bought her glucose down within reading of their in-house lab anyway (which just said >25) so it would seem my meter is saying similarly.

The ketostix are $40 from what I’ve seen online here!! I will do a better search though and order some if I can find them cheaper plus new blood strips regardless. For now she is doing ok and eating heaps better than yesterday so we will keep ticking along.

 

Oh I just saw this! My meter seems fine, but if the strips for yours is cheaper then that might be a good option?? It’s around $20 for 50 strips for mine I believe.

Thank you! I will wait until you’re able to come back.

 

I found ketostix for cheaper! $18 for 100 of them, so ordered them. Will hunt out the old litter box and figure out the best way to keep her inside long enough to pee to sample it. Haha.

 

That's a much better price......good hunting!

Well done getting the curve. If the BSLs only stay down for a few hours each cycle I would ask about the Glargine (Lantus) insulin. Caninsulin can work for some cats but glargine usually works well with cats and the duration of the insulin is longer than caninsulin..
I'm glad @PussCatPrince - GA has been in touch. She will have local knowledge.

 

Well I did her PMPS now and that isn’t actually drastically higher so that is comforting that things are potentially heading towards settling down more with time... haha.
I didn’t withhold food for the two hours prior to it as I sorta forgot and was more focused on her increasing appetite! But she last ate 1.5 hours prior and me taking the BGL prompted her to get up and go eat again so that worked to then give her PM shot not long after.

Yesterday she barely managed to eat half a tin of friskies, whereas today she finished yesterday’s tin and has eaten nearly half of a second tin, with still all evening and night to go yet so I am really happy her appetite is increasing!

Thank you all!!! I am feeling less and less overwhelmed as the hours go by and things are doing ok. I’m sure we will have setbacks at times, but that overwhelming feeling of devestation has passed and now I am taking back some control!

Amy & Jazz

 

@flyingduster

My strips would likely not be compatible with a CareSens meter **.

I chose the Freestyle Optimum meter which can do both BG and ketone blood testing & had good reviews. I have the meter, some strips , ketone strips & lancets for this. However if you are using the CareSens then this is of no use to you. I ordered supplies from Mediray.

Freestyle meter ongoing costs : Lancets box 100 = $15 : BG test strips box 50 = $33 : Ketone strips box 10 = $19. Is that a goer in $ terms?

I found the urine strips for BG testing and also ketone testing on offer via the vet practice to be not much cop and awkward to ensure a quality result really.

I also have the BD Microfine Demi .3ml syringes . I'm happy to send some to you to get you started until you have your own supply. Not being stingy but I am aware just how hard it is to get quality stuff here in NZ so if someone else pops up I want to be able to give a help there too. Same re the meter and strips etc.

You order the syringes from the UK through Hyperdrug.
Cost is about $65 for two boxes = 200 syringes and the postage for that about $30. All in all though it worked out at 50cents a syringe which was more realistic then anything I could find throughout NZ.

Zobaline is usually given for neuropathy but I found it to be too expensive to import in not to mention the chance of it being held up at Customs and MAF. I ended up buying Solgar Methyl B12 tablets from HealthPost and crushing them together with folic acid. This is not as perfect as Zobaline mind you but was affordable and available.

Friskies is available everywhere of course. Weruva I did not find. I had to be careful as Tyler had CKDII also.

Animates I found to be not that cost effective just like the supermarkets. In the end I was buying from Pet Co NZ

I didn't find anywhere in NZ or Oz that sold the supplement mix to add to a raw food diet.

Lanctus would be the better insulin and I know this is available as Tyler was on that.

It was also possible to gain B12 subQ injections for Tyler as his neuropathy and some other issues became quite marked. I did have to ask for this & I did feel it helped.

** For others looking in . CareSens is the NZ publically funded and NZ Pharmac backed BG meter pushed to everyone in NZ, over the better reviewed & tested Freestyle meter, despite CareSens having had dodgy reviews on safety re. readings & consistency.


.

 

thank you for all of that! There is heaps of info there!!!!

The strips for my meter are cheaper and I found cheap urine ketostix too so I am all good there.

The syringes would be great but I am happy to source my own too and you keep yours for someone in need. I can use the pen for now; it’s not as ideal but it is fine in the mean time. Thank you!

Good to know about the b12! At the moment her neuropathy is veeeeery slight, and it’s only because I know her well that I can see her slight weakness; there isn’t any real wobble or anything now as there was even only a few days ago. So for now I am just waiting to see how that heals itself as her BGL come down.

Good to know for sure that Lanctus is an option here! It’s always hard to be sure what drugs are available here so that is a relief to know and we will tackle that as needed.

Thank you!!! Just knowing another kiwi is helpful. Xx

 

I can send some syringes if you get the lanctus on the go. It will help. You won't find cheaper here than importing from the UK & you won't find the 1/2 measure mark syringes at all.

ps - I'm British . Bournemouth born and bred. Me and him iz not kiwis. Even my Tyler Pusscat Prince was British. We brought him out with us. If he did not emigrate with us then I would not have come. We are NZ citizens though . They don't do that for emigrant pets or I would have had him at the ceremony too.

Dusty , ex semi-feral . who decided she loved Ty so much she came in from the cold, is NZ bred though.

Where in NZ are you roughly. We are outside of Nelson.

 

I just went looking up syringes and they’re about $70 for 200 0.3ml U100 syringes online within N.Z. (35c each) So I’m not sure why you had such trouble and had to buy overseas. I have found quite a few places that have those for that sorta price, even trademe! Lol. So I am totally fine with ordering those myself, thank you!!

I am a kiwi, born in Dunedin and lived there pretty much my whole life until we moved to North Otago about 5 years ago and have lived here ever since!

 

Are those half measure demi syringes ? If so, brilliant. Saves on mailing costs. They were not available here when I started with Tyler 2017 & certainly not for 35c.

When dosing a cat it quite often comes to tiny half and quarter parts of a unit which all the syringe suppliers I found in NZ and Oz did not have. Heck , even my vet clinic did not have them. I didn't really want to start measuring between units with a caliper & so that is why I had to buy from off shore.
I believe Bron in Oz had the same issue and so ordered from the UK in the end.

Do you follow the albatross webcam? I won the name the albie comp in 2017 which resulted in a wonderful few days down there. We have been a few times because of the wild life. I've always been into birds.

 

I can’t be sure the syringes I found have half measures but they are 0.3ml and google shows photos with tiny measures between the whole unit lines. But I haven’t bought them either so I cannot be sure!!!

I have watched the albatross cam at times but not religiously. We used to go on drives out to the peninsular a lot but never paid up to go through the colony!

We have little blue penguins and yellow eyed penguins here in North Otago which are cute. Especially because the little blues can be seen scampering across the road near our house at times!!

 

The box will say demi or half I think. Mine does. @Bron and Sheba ?
Any syringe is better than no syringe.

I have watched the albatross cam at times but not religiously. We used to go on drives out to the peninsular a lot but never paid up to go through the colony!

That's Oamaru or close by at a guess. I have a good pal there. Runs a pizza cafe. Great Steam Punk presence too. Yup. Saw the blue & yellow eyed there too back in 1997. Last time went to the Katiki Point lighthouse near Moeraki to see if we could spot some and got lucky.

 

Yes. The syringes will say ‘demi’ or ‘ half unit’ if they are in fact 1/2 unit syringes. There are none in Australia so I doubt any in NZ. They are available through hyperdrug in the uk. They are your best bet.

 

Ah yeah well they must not be half unit then. Bugger.

And yes, I’m in Oamaru.

 

Wah. You made me really laugh. Bugger @flyingduster

You can still buy your ones if you want but use a caliper if and when it will be necessary.

I can send you some anyway. My Ty died last May just before his 20th so I don't need them now unless I stick one in the husband for being unruly . I'm happy to share.

Ooo fab. I flippin' love it down that way. If we were to settle again in NZ it would be somewhere around there and downward to Dunedin. Much more me all round. I've booted that idea around a bit with the husband . We're up in Mapua but he works out of Nelson .

People here won't know but Oamaru is a really fab little township.

@Noah & me (GA) Off topic so let's not ramble as then it is hard for folks to answer BG questions and the like but - steam punk and a fab old radio museum. Laid back. Wonderful buildings. Good vibe. You'd love it.

 

@flyingduster

Sometimes it is helpful to browse other cat's spreadsheets. Get a feel for the whole thing.

I am sure you are reading everything and all there is to read here.

Just shout.

.. and did I say that Jazz is just fabulous. More pics please.

 

I’ve got another thread going with her current (strange) BGL info so this thread probably needs to be left to disappear now. I’ll go throw some more pics of her in my intro thread!!

 

Yup . Seen it. Am watching although not familiar with the caninsulin action.

You wrote that it was good to have contact with someone in NZ so the little bit of chat was meant to help support not to detract.

The BGs are not so odd. They will hopefully settle with a little control & care.

All the best.