Newby seeking answers

Hello, I've read and absorbed much of the information on this site, although there is much, much more. I have a few basic questions: this is my first time administering to a diabetic cat although I have lots of experience with other procedures and illnesses. This is a 16 yr old FeLV+ cat with CRF Stage 2 and elevated liver enzyme. I was really in a quandry about whether to order the Alpha Trak or the Human Glucose Monitor as has been suggested, but ended up ordering the AT which I have not received yet. Bundy the cat under discussion, was diagnosed on Friday, I received ProZinc to give 1 unit 2x a day. I gave one injection and then stopped because after reading everything I felt like I was groping in the dark not knowing what his actual BG reading was. Is that OK to wait for the kit? or should I just give the insulin regardless.
Also regarding the testing kits, can you direct me to where in the forum it discusses the differences between the human glucometer and the ones made for pets? I could not find specific info on this. I have no idea how you would use it if it weren't for pets. Also I think my vet would be more receptive to the home testing if I was using the AT, but if I were more knowledgeable about the other, perhaps she would. I've seen lots of Amazon reviews on this, people advise using the AT with the Freestyle strips which are less expensive but give the same results. Anyone know about this? I'm also curious about the Vetsulin many of you use, it seems to be less expensive, is there anywhere I can learn more about it and how it compares to Prozinc? What the differences are? Also this cat has filmy eyes, is this cataracts? My vet called it keratitis, but I'm not sure this is correct. She recommended we try tacrolimus compounded opthalmic drops and I'm wondering if this is the right medication for his condition. Not asking for prescribing, just advice, the vets aren't always the most knowledgeable about these things. So those are my questions for starters. Thanks in advance for your help!

 

This is a good starting dose. If you go with a human meter the Walmart ReliOn house brand is popular and two models, the Micro and the Confirm, work with only a tiny blood drop. Strips are $30+ for 100. If you pick up one of these you could start testing right away.

The AlphaTrak meter is going to give BG readings that are very close to what your vet would measure in clinic. The problem is the test strips are extremely expensive and that cost can be a burden if you do the amount of testing we recommend. Another issue is that the strips have to be ordered or, in some cases, purchased from your vet. You could run short at an inopportune time and restocking could be difficult.

Because of the cost issue, access to more strips very easily, etc. many people use a human meter. All human meters will read lower than a pet meter like the AlphaTrak. The difference is bigger at high BG levels and smaller at low levels. There's no easy conversion factor to use. You merely learn what too high/too low is on the type of meter you choose. The only key number you need is the "take action" number. That doesn't mean a hypo, only that BG is getting low and a small snack is needed to prop it up. That take action number on a human meter is 50 and on the AT meter it's 68. Some people buy both meters and use the human meter day to day to monitor BG and switch to the AT meter when doing a curve for the vet to look at.

Yes, some people do this. I did for quite a while. It's recommended that you do a few same drop BG comparison tests between the AT strip and Freestyle strip every time you open a new vial of FS strips. The FS strips are relatively expensive but not as much as the AT strips. I switched completely from AT meter with FS strips to the FS meter just for convenience. I have no problem assessing my cat's BG numbers from the human meter. Almost everyone here understands those numbers.

ProZinc and Vetsulin are similar in that they are "in and out" insulins - ie., dose is given, it does its thing for up to 12 hours and then it's gone. There's no overlap of doses to speak of.

Vetsulin is faster in onset, can drop BG lower and can be shorter in duration - 8 to 10 hours in some cats. It's important that kitty eats a good meal before giving insulin and that you wait up to 30 minutes before injecting. This is to have a good food "cushion" there because Vetsulin goes to work fast. It's relatively economical to use.

ProZinc is made for cats, is slower in onset, doesn't drop BG as aggressively and tends to have longer duration - 12 hours in most cats, a bit longer occasionally. Kitty needs to eat a small meal before a shot but the slower onset means it doesn't have to be a lot and you can give the shot while he's eating or right after. It's expensive though, as you know.

I don't have any experience with this so I can't answer.

I hope this helps ...

 

Yes thank you very helpful, so do you agree that testing the BG is very important and that I should not just give the injections without doing the testing first. In other words, pick up a test kit at Walmart now. I can do that. I just needed those numbers and the clarification you gave. Everyone here seems to be a lot more advanced at this, so I feel kind of in the dark about basic procedures. Should I buy urine test strips? If so, what do I buy? How do I know if my cat is DKA? I've read about that here but have no familiarity with how to diagnose. Also read that lancets are not interchangeable? You can't use any lancet on any test kit? I read somewhere that certain lancets aren't compatible with the AT for example, so what should I buy? I would need to buy just the U-40 syringes for the PZI, that was what the vet said for proper dosage, at this point, I'd rather not deal with conversion. I'm very afraid of overdosing. Thank you.

 

Oh another important question, so if the BG is normal when I test, do I skip the insulin injection? or what do I do? or what if it's low? feed a snack and retest? and if it's normal?

 

I think a Walmart ReliOn meter (Micro or Confirm) is a good choice for now. Ask at their pharmacy whether they use the same test strips. I don't know that. Lancets generally fit a certain lancet trigger device but a lot of us just free hand the poke holding the lancet by itself. Again you can ask at the pharmacy. I think most meter kits come with some lancets and you can buy more when needed.

If you get a kit today, test his BG. Normal on a human meter is 50 - 120. If he's in that range he doesn't need insulin. Here are some testing tips:
http://www.felinediabetes.com/FDMB/threads/hometesting-links-and-tips.287/

Heck, we all started where you are and learned from more experienced people here. We recommend testing urine for ketones if BG numbers are high or if kitty is acting ill, lethargic, won't eat, is vomiting, etc. You can pick up human ketone test strips at Walmart. I'll include more info on that lower down in this post. If the strip shows "trace" call your vet. If it shows "small" or higher, take him to the vet.

Yes, start with those. It would be very helpful if they have half unit marks on them. You'll need those.

 

Here's my new member's info sheet:
______________________________________________________________________________________________

It would help us if you set up your signature (light grey text under a post). Here's how:

• click on your name in the upper right corner of this page
• click on "signature" in the men that drops down
• type the following in the box that opens: kitty's name/age/date of diabetes diagnosis/insulin you're using /glucose meter you're using/what he eats/any other meds or health issues he has.

Another thing that will help us help you now that you've started BG testing at home is to set up a spreadsheet like the one we use here. We can all see it and look at it before offering advice: http://www.felinediabetes.com/FDMB/threads/fdmb-spreadsheet-instructions.130337/
.................................................................................................................................................................................................................................

Here's the basic testing routine we recommend:

1. test every day AM and PM before feeding and injecting (no food at least 2 hours before) to see if the planned dose is safe
2. test at least once near mid cycle or at bedtime daily to see how low the BG goes
3. do extra tests on days off to fill in the response picture
4. if indicated by consistently high numbers on your SS, increase the dose by no more than 0.25 u at a time so you don't accidentally go right past a good dose
5. post here for advice whenever you're confused or unsure of what to do.

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Here's an explanation of what we call "bouncing". It explains why a kitty's BG can go from low to sky high:

1. BG goes low OR lower than usual OR drops too quickly.
2. Kitty's body panics and thinks there's danger (OMG! My BG is too low!).
3. Complex physiologic processes take glycogen stored in the liver (I think of it as "bounce fuel"), convert it to glucose and dump it into the bloodstream to counteract the perceived dangerously low BG.
4. These processes go into overdrive in kitties who are bounce prone and keep the BG propped up varying lengths of time (AKA bouncing).
5. Bounce prone kitty repeats this until his body learns that healthy low numbers are safe. Some kitties are slow learners.
6. Too high a dose of insulin can keep them bouncing over and over until the " bounce fuel" runs out and they crash - ie., have a hypo episode. That's why we worry so much about kitties that have had too high a starting dose prescribed by the vet and the owner isn't home testing.

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Here are some tips on how to do urine ketone testing (VERY important if BG is high and kitty isn't eating well!):

• 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. NOTE: The"negative" and "trace" colours can be hard to tell apart.

 

Wow, this was great! just what I needed, you filled in all the blanks for me, thank you so much! I feel much more enlightened now! How do I get rid of the little picture inside my main picture, don't know how that got there

 

Not sure what you mean by the little picture inside your main picture. When I look at your avatar area, I see a photo of Bundy.

 

The little pic that shows on the head forum topic page just means you’ve replied to the thread. If you’re watching the thread, there are a pair of glasses to the right. You’re the only one to see your little pic

 

Got it!

 

I did his first test 2 hours after eating, it was 445, he hasn't had insulin yet. I will give 1 unit now. My question is using the ReliOn meter what is the normal range for cats? You said human was 50 - 120, is it the same for cats? How does 445 stack up, it sounds pretty high.

 

Sorry. I wasn't clear. Normal range for a cat as measured with a human meter is 50-120.

So - no food for 2 hours and the BG is 445 so you're giving 1 unit. Just making sure of the sequence. We normally dose AM and PM but I don't know your time zone.

 

I work nights so this works for me to give another shot at 1am however, I may scale back a little to an earlier time (slowly); he eats small amounts throughout the day, we didn't exactly withhold food, but he did not eat very much, what you would consider a minuscule amount. His last test at the vet was 300 with their Idexx Lab report. I also wanted to ask about testing frequency. Can or should I test after insulin injection to see how much it comes down? If so, how long after injection? I understand to test two hours after eating and then right before injection? or 2hrs after eating is enough? I think he needs a specialized schedule considering his eating habits, so let me know what you think. TIA!

 

One more clarification, his BG value at the vets was taken after he had fasted the entire night and morning, that was because initially he went in for some dental extractions, however in lieu of his Diabetes diagnosis, it was not considered an optimal time.

 

I described the basic testing routine up in my post #6 above. I understand your shot timing now.

Was that test of 300 a single BG test?
Re eating: is he normally a slow eater who prefers to graze? If so, that's fine as long as you remove all food for 2 hours before the pre shot BG test. ProZinc is slow enough in onset that he doesn't need a full meal before his injection. If he eats a few teaspoons that's OK and then he can graze afterward.

The BG test 2 hours after a shot is recommended if you're giving insulin on a lower than usual pre shot test or if you increase the dose. That test can give a hint of what type of cycle you might have. If the BG at that time is similar to the PS BG or only slightly lower the cycle will likely be calm. If it's 50-100+ points lower you'd retest at +3 to see if a big drop is coming.

 

This is EXACTLY what happened to me (with Maji)

 

OK I think I've got this, he's not a really slow eater, but he doesn't finish his food all at once; the BG value of 300 was part of a chemistry panel. It was not repeated at that time, his value in 10-17 was 220 but no other testing was done at that time.

 

Did a PS test just now, he was 550; I increased the insulin 1/4 unit since his readings were high this afternoon and now. Am I doing the right thing? I thought I should test for ketones although the cat seems the same as usual, however if he's running those high levels I'm assuming that accounts for his eye degradation, looks like cataracts/blindness setting in. However his reading at the vets was a lot lower. When I receive the Alpha trak tomorrow I will compare. Any other suggestions?

 

3:30am - 440

 

1:30pm today PS 310!

 

Would you be willing to set up the FDMB spreadsheet? It would be much easier for us to help.

 

Appreciate your interest and guidance, will be up shortly

 

Checking in here with all of you experts, Spreadsheet is up now, we were at 540 PS AM today and I increased insulin 1/4 unit to 1.5 U; +4 hrs. and he's at 125. Are we dropping too fast? It seems that way. I will test in two hours, just wasn't here to test him at the 2 hour+ mark this morning. Am loving this forum and the clear road map, thank you all!

 

You certainly got some action with the 1.5 u dose today! It's a good idea to do a few more tests on a cycle like this. I suggest a +6 and a +8. It'll be good reference data for later. You might see a huge bounce next cycle after a drop like this.

 

Would you suggest staying with the 1.5 u dose then? Or checking in with values to determine best action to take?

 

Spoke to our vet, she recommended no insulin change for the first week, then no more than 1/4 u increase per week if necessary, giving cat's body a chance to adjust to the insulin. She didn't give more details, I think she's annoyed that I did this on my own--oh well, whatever. But sounds like good advice. Got the AT today, there was 100 mg difference between it and Relion, the latter being the lower number. What do you think? I'll keep comparing but that's a pretty big range!

 

For which test did you compare the AT and ReliOn? The human meter will read lower and that difference is usually large at high numbers but much less at low numbers.

 

Sorry I didn't have the AT SS up yet, it was for 8 hours post injection. I just took another reading. Would you call this a bounce? Should I go back to 1.25u?

 

Yes, I think you could have a 100 point difference at that level. The black could be a bounce from the blue today. Are you giving the 1.25 u dose again after speaking to your vet? It's a good idea to keep a stable dose as you collect data. It's hard to know what's going on yet.

 

Yes, gave him 1.25u but the variation between the two readings went down on the PS test.

 

I see AMPS on your human meter SS but no entry on your AT meter SS.

 

Hi Kris, I was unable to get yesterday's morning reading on the AT, cat was flailing around and didn't want to stick him again, but I have it subsequently. I thought I would try to do a BG curve today, at least as many as I can and then maybe you can advise me of any suggested changes.

 

Good plan. How about wandering over to the ProZinc forum - good help over there. I visit regularly.

 

Difficult numbers, high on his #4 today, concerned, these seem abnormally high for this time in the cycle and he's not eating, lethargic, doesn't feel well. DKA? Will try to force feed soup and give fluids so he urinates and I can get a test strip reading.

 

Yes, definitely get a urine ketone test.