Newly diagnosed 6 year old, in South America

Good evening everyone! Holly had been steadily losing weight, and I suspected diabetes right away. I was told by the people at Petsmart (where I adopted her) that torti's have a higher rate of diabetes than many other breeds. Unfortunately, they are not equipped here in Bogota for cats as well as they are dogs. Fancy Feast is not sold here, and I tried to bring two cases back recently. One case of 24 cans was taken at customs as I had brought back too much. I had someone else bring me another case that made it through. It's the diet she was on before we moved here last year, and I suspect she may have had controlled diabetes prior to our move. The good thing is that the diabetic supplies are much cheaper here than in the states. I have a Lantus pen, and just found out I should not be using it directly. The amount they have her on (which is not effective) is .01 of a unit. The pen isn't marked for it. I have to guess. I'll look for syringes tomorrow, but I doubt they have them marked for that either. Her sugars are still very high after nine days of insulin. All her labwork/notes are in Spanish. Doing the best I can, and am looking at options to get her the food she needs. I'm thinking .01 is WAY too low. When her nose is dry, I can't get blood no matter how warm her ear is. Any suggestions/comments would be appreciated. Thanks!

 

Hello and welcome to the FDMB, the best place in the universe to help your diabetic cat.

The three keys to diabetes treatment are

1. good, long duration insulin - Lantus is one of these so your set there.
2. food - low carb canned diet, <10% carbs
3. home testing - to keep your cat safe, to adjust the insulin dose, to have better control of the situation and more information to work with.

For food, look for foods without grains, no potatoes, no peas or vegetables or fruits. There is a topic that talks aboutFood for European and International buyers. I don't know if any of the foods mentioned there are available in Columbia. I don't think we have had many South American members.

Again, I do not know what glucometers may be available where you live. You want to find one with a low cost of test strips. That is where your major expense will occur.

The only South America info on food I could find was for Brazil.

 

Hi and welcome to the group.

we typically suggest when starting on insulin to start at either 1/2 (0.50) unit or 1 unit twice a day.

It's great that you can easily get lantus and supplies, and you are right, using the pen needle is not ideal for dosing for a cat - check out the pharmacies to see if they sell U100 insulin syringes with 1/2 unit markings - you want the syringes to be 0.3 cc, I used 31 gauge 5/16 inch length

so it would read like this - 0.3 cc 31 gauge x 5/16"length

the length is a short needle (my personal preference) and 31 gauge is a very thin needle (you may find 30 or 29 gauge) and that's fine too. the important thing is that size be 0.3 cc ( which is 30 units or less) and the 1/2 unit markings will help you with micro dosing.


as far as food - what canned food options do you have available? check out Dr. Lisa's food comparison chart, to see if any of the available foods are on the list. The ideal is under 10% carbs. I typically use 0-7% carb foods. http://www.catinfo.org - look down the right side of the page for the chart.

if none of the foods that are sold in the US are available locally, then the next best thing is to read the ingredients - share them with us and we can do our best to see if they have any questionable ingredients.

questionable ingredients include - rice, wheat, grains, carrots, potatoes, peas, etc. Essential anything that is a carb - you want to avoid that as much as possible.

You may even want to consider a raw food diet. You can make raw food and freeze it and this way you will know exactly what is in it. of course that is assuming Holly will eat it. Maui will but my civvie Buster won't.

Are you home testing? It is the only way to know for sure if it is safe to give insulin and to know how the insulin/food is working for Holly. You can buy a meter, matching strips and lancets from a pharmacy. You should pick up ketostix to test for ketones in the urine.

And don't worry, we can help teach you how to test even from a distance.

so supplies you need:

glucometer - do not get any meter that has TRU in the name or freestyle meters with butterfly strips - several people have had issues with them. Relion , Bayer, OTU are good choices (if available)

strips - that match the meter

lancets - that either fit the lancet device if you want to use it and if not, then any lancets they have - just remember to get ones that are 28 or 29 gauge. the way the gauge is designed is the lower the number the thicker the needle.

neosporin - or any brand of antibiotic ointment with pain relief - to rub on ear after testing to help with bruising

ketostix or ketodiastix - to test uriine for ketones

you will also want to put a hypo kit together, just in case she ever drops too low, you will have this together so you don't panic or worry about what to do. here is the link for putting one together - viewtopic.php?f=14&t=2354

and here is the link on how to treat hypos - viewtopic.php?f=14&t=1122

so, how else can we help you?

 

Hello and welcome to the board

here are some home testing tips which might help you get some blood: https://docs.google.com/document/d/13c_CPZVKz27fD_6aVbsguadJKvjSrSAkD7flgPPhEag/pub

Also you might find some foods on here that are low carb and available in SA: https://docs.google.com/document/d/1NSWUx2ak7wcs2_G5TXr7BhPMrU7CVmW_3ouKPTUQhhA/pub

Wendy

 

If you wind up needing to make your own cat food, the Cat Info site has a recipe.

It also notes that about 1/6 of a canned food maybe replaced with plain, cooked, meat or poutry, wich may lower the carb calories too.

 

Thanks everyone! I am home testing with a one touch ultra mini. I should be able to find the correct syringes to use instead of the pen for injections. The only US food they have here (canned) is Friskies, and I did add chicken or fish to this food before I got a supply of Fancy Feast. I've been reading that the Lantus metabolizes much faster in cats than in humans and cats should get this twice daily, not just once. Her sugar levels were high before the insulin and are now even higher. (Mid-300's to now 450 and up.) It is a micro dose of insulin. (.01) The vet is having me test her this weekend right before the insulin and then two hours after. Last night it went down, tonight it went up. On Monday, I'll get these results to the vet to change her dosage. I have honey on hand in case of a hypo incident. I haven't found corn syrup yet.

I do have friends that go back and forth, and I come back every few months. I was actually supposed to be there now, but there are no caregivers here that provide the medical care Holly needs while I'm gone. I may have a vet student interested in helping out next time. It's just a matter of how to get the food here without them thinking I'm bringing it in to sell. I've looked at some home food recipes. The meat won't be a problem, but finding any needed supplements may be. Again, may have to bring them from the states.

I know she's not feeling well today. Our weather here ranges from the upper 40's to the 70's all year round, humidity is not a problem, so unlike the sweltering states, she's not reacting to the weather.

If only I spoke feline...

 

What is she doing? Is she licking her lips? Showing interest in food and then turning away?

If yes - that could be signs of nausea and if you can get regular pepcid 10 mg size and give her 1/4 tablet, that may help with the nausea feeling.

Do not use pepto bismol or immodium - those aren't good for cats.

What local brands of food are available? What are the ingredients? They may be ok to use depending on the ingredients.

So, I'm curious, what are doing in South America and which country are you in?

 

Hey there

Can you track your results on a spreadsheet so we can help advise better and see whats going on? http://www.felinediabetes.com/FDMB/viewtopic.php?f=6&t=18207
You really want to get 4 tests a day if you can:

- Always before you give every shot. As a newbie you dont want to shoot under 200 yet until you have enough data to know how Holly will behave when you do.
- Mid cycle - 5-7 hours after morning shot to see how low Holly is dropping
- Before bed - 2-3 hours after evening shot - to see what Holly's nighttime plans are.If this number is the same or lower than the preshot test you might want to set the alarm for another test mid night cycle as it usually means an active cycle.

If you have honey then you dont need the corn syrup.

Sooner you get the syringes the better - more accurate for smaller dosing - you want ones with 1/2 unit markings if you can find them

Wendy

 

Hi Shelly,

 

Hillary, she's in Bogata which is in Columbia.

 

I moved to Colombia a year ago to teach English. I'm now taking some time off to learn Spanish.

It has been difficult to get blood from Holly's ears - she has a tendency towards dehydration. When her nose is dry, I know I can't get blood, but I try anyway. Trying to do a curve or get results more than three times a day right now is not possible. I've been keeping track of her injection times and blood sugars along with what type of food she's eating. I have a table I set up to keep track of everything. Looking at what I have from the eleventh, when we started insulin, she doesn't have any regular cycle. She can be high or low in the morning and the same after the insulin. I've tested her before and after eating, and again I get highs and lows as if what she's eating has no affect on her sugar level.

I have another older cat (Luna-12 years) who is healthy and prefers the dry food. I'm leaving very little of that out during the day and I do not leave it out at night. Holly doesn't like the dry stuff, so I'm lucky there.

For the insulin, I'm not even giving a half unit and it is only once a day. It's .01, less than the amount of blood I get from her ear for a test. She's still not feeling well today. I think she's constipated again. I have a laxatone-like product here I have to give her a few times a week. She turned down her food this morning - very unlike her. She has been drinking a little bit of water and her nose is wet. I just got a reading of 503, and she's eaten very little all day. Much less than usual.

She is licking her lips. I'm on my way out to get the syringes and I'll get some Pepcid. Do I just give her a few drops? I assume this may help with the constipation too?

 

We have some tips ( above) that might help. Do you freehand or use a tool? Key points from those tips include

- using a larger lancet ie 28 or 29g
- having something hard behind the ear to press against
- making sure the ear is really warm

Can you set up the spreadsheet? We have looked at hundreds of cats sheets and should be able to see a trend or whats going on, even if you cant. Now of course, if she regularly gets dry food that can well be keeping her high. You are sure she isnt eating any? The laxatone product doesnt have sugar in it does it?

Lantus is supposed to be dosed twice daily - every 12 hours for best effect.

503 is pretty high, are you testing for ketones?

1/4 pill of pepcid ad (one pill = 10mg famotidine) is enough. You can give it twice a day - make sure its the pepcid ac though as other ones have calcium etc in them.

Wendy

 

Thanks - I must have skipped over where you said you are in Bogota. Cool that you are teaching. A friend of mine went to South Korea to teach English. Personally, I'd prefer Colombia. ;-)

Since you are giving such a small amount of insulin and she is staying relatively high, I suggest two things:

1) dose her every 12 hours (2 times a day) or BID as we call it
2) give her 0.50 unit not 0.01 unit -

What you are giving is barely a drop and probably why it's not having much effect and only giving it once a day, means she goes 12 hours without insulin and that's not good.

I wouldn't get too concerned about doing a curve. Rather, I'd like to see you get set tests in even 3 each cycle is fine to start. And by cycle, I mean every 12 hours. So a total of 6 tests a day.

Pre shot
2 hours after shot
4-6 hours after shot

As you get used to testing and her ears start to bleed better, you can always test more, we will never tell you not to. :lol:

 

If you feed canned food, add some extra water. I add about 1 tablespoon per ounce of wet food. Think applesauce consistency. Or you can make it even soupier to get more water in her and keep her hydrated.

You can use canned plain pumpkin or squash or baby food squash to help with the constipation. It can help with diarrhea too. Start with 1 tablespoon added to the food.

Or get some Miralax (polyethylene glycol 3350 is the generic). Start with 1/8 teaspoon a day and work your way up until the poop is soft. Then work your way back down on the dose. Always add extra water to the wet food when giving the Miralax as it is an osmotic that draws water from the rest of the body. I simply mix the Miralax into Wink's food. He sometimes needs it 2x a day.

Pepcid is a pill. You want the plain, not the complete, 10 mg. Only give 1/4 of a pill (2.5 mg) 30 minutes before feeding.

 

Got the syringes - thanks for the info! I'm pretty sure she's not eating much dry food, if at all. She much prefers the canned. I pick up the dry during the night - neither cat has access to it. The vet gave me the laxatone. It's a combination of petroleum jelly and mineral oil. She wouldn't lick it off her paw this morning. :?: They don't have canned pumpkin here, but I'll check the baby food section. They have a LOT of fresh squash, maybe one of them will be similar. I'll ask around.

Just an FYI - they don't have canned or frozen foods like in the states. Everything is fresh - even the herbs and some spices are fresh and whole.

They don't have Pepcid. I have Gastrum, the only one they had with the same ingredient, Famotidine, 10 mg. It does warn about liver and kidney issues. Holly had high liver readings before the diabetes was diagnosed. They even thought she might have had FIP based on some marginal readings. Do you think it's safe to give her this medicine?

I gave her a teaspoon of milk (lactose-free) to aid in the constipation issue. Vet recommended it last time. Holly had to have an enema at the doctors a couple of weeks ago because nothing would work, even the milk.

The vets here do not know much about this. They called in an endocrinologist to help with the diagnosis and dosing. I guess the endocrinologist didn't know about the Lantus only working 12 hours either. Should I go ahead and start dosing twice daily? I'm hesitant to change anything - I am going to the vet tomorrow afternoon for the diabetes check. If she doesn't poop, I might try and go earlier. They might need to give her another enema.

My medical Spanish is improving faster than my basic...

 

I am not testing for ketones. I'm not sure the vet would know about that for the cat. This is seriously DOG country. :smile:

 

Ok so I would wait on twice daily dosing till you get the syringes (? Which will be when?) .

Normally pharmacies will carry urine ketone test strips but I have no idea about South American pharmacies so maybe get someone to ship you them from the US if you can't find them..

Wendy

 

I've got Holly's current table attached here. Sorry, but I don't use excel or google docs if I can help it. I prefer to make my own tables in word. Faster and easier for me to work with. If you think I need to add another column, let me know. the W and D are for wet and dry. If I see her eat a little dry food it's a small d. Mostly W's because she usually eats a LOT of canned food.

I just got the syringes. It will still be difficult to get the right amount - 0.01 of a unit.

 

That's fine... but its not easy for us to work with... if you want us to help you. So if you won't use our standard format you will likely get less eyes and help than you otherwise would.

The reason we have our sheet is it allows us to track trends and issues really quick.. Which is what you want if there is a problem. Our sheet is good in that it says how many hours after the shot the reading is without doing math all the time.did you look at our sheet? It's not hard. And given you could be tracking results for months, word will get unwieldy as it can run to many pages.

If you still insist in using word can you at least build a table and make it more like ours?

 

I have looked at the spread sheet in google docs. At some point, I'll see about starting a second table in google docs, but I have to keep this table I've started for the vet. Holly possibly has other undiagnosed health issues, or they could all be related to the diabetes. All I need to know right now is does the insulin get her sugar down. I think that's why they started so low, 0.01 units.

Right now, her blood sugar is 553, and she won't eat. I've called and left a message for the vet. My question now is, do I give her insulin? She didn't even want her treats after the ear stick. Constipation must be very bad. Should I give her the Pepcid equivalent I have even though it warns about liver and kidney issues? Her liver tests were high. Since her sugar is so high, should I give her a half unit? Even though she won't eat?

I have syringes now and can give her a more accurate dose. My gut says to give her the pepcid, crushed up in a feeding syringe of watery food then giving her a half unit of insulin and watching her carefully. The honey is ready if needed, but her sugar is so high...

 

Yep i would give her 1/4 pepcid and 0.5 units of insulin as Hilary suggested. On the 0.3cc syringes, that's a very small amount, the very first 1/2 unit mark. I will try to find a picture.

Then get a test at + 2 (2 hours after shot) and let us know where she is at.

Wendy

 

Thank you so much! I've got everything ready to go! I will post again in a couple of hours...

 

and don't give her any more milk - most cats are lactose intolerant and this could be contributing to the constipation.

If you can find baby food squash or fresh squash to puree - that would be good to add to her wet food daily and then you can back off the "pepcid" (or local name). You may also want to see if you can give her probiotics. While yogurt is a milk product, for now if you can get plain yogurt - without added flavors or sugar you could try mixing that in her food if you can't find the squash (pumpkin).

If you cannot get probiotics locally, you can order it online. Check to see if you can get Purina forti flora, or maybe you can find this or something similar locally - http://www.vitacost.com/jarrow-formulas ... lus-2-5-oz - and even being dog country, they may have something available for dogs that you can use.

It is important that we get her eating as not eating will cause other problems. If you need to syringe feed her. when you go to the vet - ask the vet to give you a feeding syringe - hopefully they will have it and be able to give you one - if they don't, you can always pull the needle out of an insulin syringe and use that as a feeding syringe.

 

Holly's blood sugar is now 527 after increasing the dose to .5 unit. I've spoken to the vet. We're going in first thing tomorrow morning. Should I dose her again in the morning? I did tell the vet about the twice a day dosing and the minimum starting dose.

I think the Pepcid helped a little bit. She's walking slowly, but she's still using her legs to climb.

The milk here is lactose free and processed a little differently. If I give her too much it will give her diarrhea. She only gets a teaspoonful or so. It's one of their remedies for cat constipation. Not so sure it works - I've only done it twice and it didn't work either time. :YMSIGH:

I do have a feeding syringe, thank goodness. I watered down some canned food earlier and stuck the crushed Pepcid in it. SInce so many people here can't have lactose, I have a LOT of lactose free products to choose from. I can even get lactose free yogurt! That is a great idea - I hadn't thought about the probiotics. Lots of health food stores here, I'm sure they've got something.

Everyone has been great, helping me out. I will try and do the spread sheet, but it is going to take some time.

 

Yes, she should get another 0.5U dose in the morning, 12 hours from the time of this evenings shot.

The type of squash we use here for the constipation are the winter type squashes like pumpkin, butternut, acorn. If you can find any of those similar orange or yellow fleshed winter squashes there in Bogata, you could cook it up and freeze it.

 

I've been trying to get the spreadsheet downloaded onto my computer. I don't have internet all the time, so I need to work with it on the computer and then upload it whenever necessary. There is no save option and the download won't work on google docs for some reason. I've tried copying it, renaming it and then trying to download it, and sending it to myself in an email, but nothing has worked. I can't think of another option. Any suggestions would be welcome! Thanks much!

 

It takes a couple of days to see the impact of a dose change because Lantus is a depot insulin and it builds up in their systems. I made a few changes to your word doc to make it better for us - see attached.

 

Thank you so much! I'll get started on the spreadsheet.

After a scary two days of getting fluids at the vet, Holly is doing a little better and is eating and drinking. With the BID dosing and .5 unit, I've just recorded her lowest reading since this whole thing started - 360. I asked the vet about ketones - she doesn't know where to get strips. They only check ketones through the lab. She also didn't know how to use the glucometer. I think when these things happen down here they just put the animals down.

Sonogram tomorrow to make sure she does not have an obstruction somewhere. Antibiotic day two - Pepcid equivalent seems to be helping. (I don't dose these at the same time.) Just hoping Holly can hang on until the sugars get regulated.

Vet wants her to try Science Diet a/d canned. Says it's high protein. If I remember correctly, the dry ones were not good at all. I didn't check the cans. I'll go back and see what they are rated.

 

A/D is a medium carbohydrate food and only comes canned, I believe. Check the food chart at Cat Info. It is intended to get weight back on fast and get the cat eating again.

 

Glad to hear that Holly is getting better. We all get so scared and worried when our cats are sick and in the hospital. You must be so relieved to have her back home with you. Hope she continues to improve. Was it the lack of food or the dehydration that prompted you to take her to the vet? If she gets dehydrated again, I'd recommend that you ask your vet about getting the fluids and giving them yourself at home. It's easy. I've done it for several cats. We have youtube vidoes we can share on how to give fluids.

The Hill's Prescription Diet A/D canned is 12% carbs in calories, 15% carbs on a dry matter basis. Higher than we like to see. It's certainly going to be a bit of a challenge to find a lower carb food down there in Columbia. If she needs to gain the weight and she will eat this food, go ahead and give it to her. The insulin dose can be increased slightly to work around the food issue. It's more important that she eat something so don't worry or stress over the slightly higher carb content. Let's just get her to eat more.

Human diabetics get urine ketone testing strips at the drugstore or pharmacy or chemist. People trying to lose weight with a high protein diet will also buy urine ketone test strips to check their ketones. Two ideas to help you figure out where to buy them. We use the human ones for testing our cat's urine.

We have testing tips on how to use the glucometer. Here: top ear testing tips

Making it easier on Holly for the ear testing, AKA Ear Testing Psychology

Once you learn to home test Holly's ears with the glucometer, you can show your vet. It's so easy and a little education goes a long way. Maybe you can start a trend of home testing cats in Bogata. That would really uplift my spirits if I thought I could make an impact like that.

Please keep us posted. You're part of our FDMB family now and we worry about family when we haven't heard from them in a few days.

Remember to take some time to relax and do something fun and soothing for yourself. We want the mommabean (female human), to be relaxed, happy, contented, lower stress levels, and getting some restful sleep. Please, take good care of yourself, ok?

 

Thanks!

It's been a rough couple of days for Holly. (The internet is not as reliable here as it is in the states.) Two full days of fluids and she still had an impaction. I suspected this when she had no bowel movements for a few days. This is what prompted me to get her to the vet. Flushed her out again, just like a couple of weeks ago. She does not have an obstruction - they did a sonogram. Her sugar levels are now below 350 - the lowest since this started. She is eating some of the Fancy Feast now, with a little added water. I'm keeping her away from my other cat, separating them when I leave the apartment. Luna occasionally picks on Holly.

Holly is now on an antibiotic, day four, I believe the translation is for Baytril. She gets a half tab daily. Her urine output has decreased markedly and she is passing blood clots. She is not straining or crying. I've read up on UTIs, crystals, cystitis, etc. Holly is eating and drinking almost normally, so I'm not too worried about the blood clots or decreased urine at this point. I know to watch her and get her to the vet if any other symptoms on the lists show up. She won't lick the laxatone off her paw anymore. I got some tuna in oil and I'll give her a little every day to help. I'm also looking for mineral oil. The dry food is now with Luna, away from Holly. Luna hates the Fancy Feast I have. :YMSIGH: Don't want my other cat to develop diabetes.

Holly is not out of the woods yet. She went from 14 pounds (two or three pounds over weight) down to 8 on a good day. It was the weight loss that I noticed a couple of months ago that got me to the vet. She did have a minor case of dandruff on her backside which I attributed to the dryer climate here. Now I know better. It was probably the first sign, back in March or April probably. :YMSIGH: If only I had known...

 

Those blood levels, are they preshot or nadir?

The dandruff could be the diabetes.. They don't feel as well and don't clean as well..

 

Both these levels are preshot, with little or no food. I make sure she eats before I give her insulin and retest two hours later. I'm not able to test two hours after the morning shot because I'm in class Monday through Friday. I do wait about 30 minutes to check for reactions before I leave. I'm getting ready to test after the last injection - 341 preshot. Her poor ears are so small, and they've been stuck so much. She is starting to rebel a little.

 

Can you get neosporin pain relief there? Apply a little to her ears to ease them. And always with the treats after.

Maybe vary your midday tests, like mid cycle instead of two hours after. Check to see how low she is dropping during the day.. Lantus usually hits its max action 5-7hours after shot and you need to know where she is then.

Wendy

 

Well, her two hour post shot is 516. The last two nights, the sugar levels went down two hours after. Now it's much higher. I did wonder when I gave her tonight's shot if it all went in. I wish I could be here tomorrow morning to test her after the insulin. I will check it Saturday and Sunday.

I tried to get her midday after class today. Unsuccessful - she always comes running when she hears the treat bag. I hadn't thought about the Neosporin. I brought some from the states. Not something they have readily available here.

I didn't know that about the Lantus, five to seven hours later. That makes the midday tests more important, doesn't it? I do have a few midday readings - they range from 365 - 534. Since she's been up and down with the fluids, impaction, and likely infection, I'm not surprised the readings are all over the place. Hopefully, things will settle down and we'll see a difference with the insulin response.

 

Could be a bounce off a low number today..

 

I'm surprised that you are only giving AB's once a day. I've always been told to give twice a day. Maybe it's that dog thing in Colombia where they give dogs once a day and are transferring the same to cats..... confused_cat confused_cat

Might be worth discussing with the vet and maybe it will help her to feel better sooner.

Have you had any success in sourcing "pumpkin" like products to mix with her food? Do you have Miralax or anything similar available? You may want to get some and add that to her food 1/4 teaspoon once a day with lots of added water may help with the constipation.

 

Holly looks better today. Her eyes are big and bright, she's been eating and drinking. I've added a teaspoon or two of water to the food every time I feed her. I found a squash-like substitute I'll try tomorrow. She won't eat the tuna in oil. Still looking for mineral oil just in case. I did find plain yogurt, no sugar added, pro-biotic, and lactose free. (One of the advantages of living in a lactose-intolerant culture.) I tried mixing some with just a few drops of lactose-free milk to thin it out. She wouldn't eat it.

However, both readings this evening were "HI", pre and (3 hours) post shot. I'm kind of at a loss as to what to do now. If it's still "HI" in the morning, and since her sugars are so high to start with, should I increase to 1 unit instead of .5? This is also before I give her the antibiotic, just in case it might affect the reading.

The anti-biotic, Baytril equivalent, is for both dogs and cats, once daily. It does seem to be helping. Her eyes don't have the runny goop anymore. Do you think it's better to give her a 1/4 BID?

I try to make sure her ears are "clean" and my hands are too before I test her. Would trace amount of neosporin cause readings to go off the charts?

 

The neosporin doesn't affect the readings. I think she is higher because of the infection and/or not being regulated. How many days have you been on the 0.5 dose?

Have you been able to put together a google spreadsheet yet? It will be helpful for others to see it and be better able to give you specific guidance.

You also may want to start posting on the lantus forum to get more dose specific advice. Please note they are numbers driven there and will ask that your spreadsheet be attached to your signature in order to really help.

Here is the link to set up the spreadsheet (ss) and link it to your signature: viewtopic.php?f=6&t=18207


In the meantime, here is information from the lantus forum, that may help you decide if it's time to increase the dose:


Many Lantus and Levemir users in this forum have been successful following a somewhat modified version of this Tight Regulation Protocol for the last few years. These "general" guidelines are based on anecdotal evidence and personal experiences of laypersons frequenting the forum.

"General" Guidelines:

- Hold the initial starting dose for 5 - 7 days (10 - 14 consecutive cycles) unless the numbers tell you otherwise. Kitties experiencing high flat curves or prone to ketones may want to increase the starting dose after 3 days (6 consecutive cycles).

- Each subsequent dose is held for a minimum of 3 days (6 consecutive cycles) unless kitty earns a reduction (See: Reducing the dose...).

- Adjustments to dose are based on nadirs with only some consideration given to preshot numbers.


Increasing the dose:

- Hold the dose for 3 - 5 days (6 - 10 consecutive cycles) if nadirs are less than 200 before increasing the dose by 0.25 unit.

- After 3 days (6 consecutive cycles)... if nadirs are greater than 200, but less than 300 increase the dose by 0.25 unit.

- After 3 days (6 consecutive cycles)... if nadirs are greater than 300 increase the dose by 0.5 unit.

Reducing the dose:

- If kitty drops below 40 (long term diabetic) or 50 (newly diagnosed diabetic) reduce the dose by 0.25 unit. If kitty has a history of not holding reductions well or if reductions are close together... sneak the dose down by shaving the dose rather than reducing by a full quarter unit. Alternatively, at each newly reduced dose... try to make sure kitty maintains numbers in the normal range for seven days before reducing the dose further.

- If an attempted reduction fails, go right back up to the last good dose.

- Try to go from 0.25u to 0.1u before stopping insulin completely.

Random Notes:

Because of the cumulative nature of Lantus and Levemir:
An early shot = a dose increase.
A late shot = a dose reduction.

A "cycle" refers to the period of time between shots. There are 2 cycles in one day when shooting twice a day.

Sometimes a dose will need to be "fine tuned" by adding some "fat" or "skinny-ing up" the dose.



You can give the baytril as you are or if you prefer to divide into two doses daily, you can do that too. Up to you, whatever is easier and working.

 

No, I haven't had the time to do a spreadsheet yet. Lots of things going on down here, unfortunately. Trying to get to it this weekend.

She's been on this dose for five days. According to some information, (I had to look up nadir - I still don't understand that one and there is no way the vet here can explain it) I should increase her dose another .5 and give her a full unit. This is based on how high her blood sugars have been running, if I read it correctly.

I'm still not sure what the abbreviations are across the top of the spreadsheet. I assume the "+numbers" are the hours after the shot? AM and PM PS look like the insulin dose I give her. Thanks for filling in the numbers I had already posted - it helps figure out what I'm doing, if I'm reading it correctly. The early doses say 1, and it should be .01. Does that matter? I'll see if I can get the numbers in before her two hour post-test.

Her reading this morning was 492. She had no dry food at all last night, I made sure of that. She's been eating well, begging for food, and finally pooped. She wouldn't lick the laxatone off her paw, so I took a pea sized amount and stuck it in her mouth last night. Holly is grooming herself again. I know she's feeling better, but that is probably the antibiotic working.

Another question I had was for pancreatitis, if that could be causing problems. There is a special blood test for this in the states and Canada, and I've emailed the lab to see if they know if this test is available down here.

 

AM PS = morning pre-shot test

PM PS = evening pre-shot test

Turquoise column is units of insulin given

+# = number of hours since the shot

 

Can you update the excel document I provided above instead? Lets take a better look at her numbers to see what she is doing before a dose increase.

Nadir is the lowest blood sugar of the day... Lantus lasts 12 hours so the highest blood sugar is often just before the shot. Then after the shot the lantus kicks in and brings the blood down to the low (nadir). Then the lantus wears off and the blood sugar goes back up again. its like a curve.. but of course not every cat follows this curve:

Example of a typical Lantus curve:
+0 - PreShot number.
+1 - Usually higher than PreShot number because of the last shot wearing off. May see a food spike in this number.
+2 - Often similar to the PreShot number.
+3 - Lower than the PreShot number, onset has started.
+4 - Lower.
+5 - Lower.
+6 - Nadir/Peak (the lowest number of cycle).
+7 - Surf (hang around the nadir number).
+8 - Slight rise.
+9 - Slight rise.
+10 - Rising.
+11 - Rising (may dip around +10 or +11).
+12 - PreShot number.

Now, you dont want to increase the dose unless you know what the nadir is, because when you increase its the nadir that will be impacted.and you dont want that too low.

I assume the "+numbers" are the hours after the shot? yes
AM and PM PS look like the insulin dose I give her. AMPS and PMPS are the preshot readings. U is the dose.
if I'm reading it correctly. The early doses say 1, and it should be .01. Does that matter? I'll see if I can get the numbers in before her two hour post-test. Werent you giving 1 unit?

Wendy

 

The Laxatone may be contributing to her higher BG levels, since it has sugars in it.

 

I've attached a spreadsheet for Holly's levels. Her sugars are all over the place, and an insulin injection may or may not bring them down. It seems like she is not reacting to them at all.

The laxatone equivalent I'm using down here does not list any kind of sugar in the ingredients.

No, I was not giving one unit. It was .01 of a unit, extremely low. The endocrinologist based her dosage on a variety of things. She did some calculations and showed me the numeric value and demonstrated how much, so the .01 was correct based on what she showed me. Seriously, like a drop off a pin, it was so tiny.

Holly does have an infection of some kind, and is on antibiotics once again. I've been in touch with a lab in the states that developed a blood test for pancreatitis, just to see if it is available here.

I'm getting ready to do another pre-test. It's almost time for her shot.

I did find a yellow type squash. I cooked it down and pureed it. Both cats were very interested in it. I added a small amount to the wet food with added water. Both girls ate it! The only baby food I've found here are fruits. No vegetables or meats - everything is cooked and served fresh, mashed up as needed. I was hoping at least to find some meats. I'm still looking though.

 

Holly's latest reading is 549. I did not hit save this morning when I updated her chart - her +2 reading was 450.

 

In my opinion, Holly needs more insulin, sooner than later. I would increase the dose to 1U with the next shot.

Her numbers are way too high and we need to get them lower. That means more juice (insulin).

 

Thanks again everyone! I thought I had read somewhere to increase every four days as needed, which is now overdue. I will give her one unit tomorrow morning. She's already had her dose tonight. Other than her sugar readings, she's doing much better. Grooming, eating, drinking - a week ago I thought I was going to lose her. How much squash should she get? Should it be a little every day? A teaspoon? She's about 7.5 pounds right now. I froze the batch in an ice cube tray so I can use what I need.

 

one to two teaspoons mixed into food should be fine

and dose increase is a good idea

 

Latest reading tonight 557 at +2. It went up. I will definitely give her one unit in the morning.

 

An infection will spike her blood sugar for sure. Might come down when the infection is cleared.

Lets hope the 1IU works better.

Wendy

 

Holly is doing much better! I've had the vet remove the port we had kept in for dehydration. The additional water in the food and the squash has kept her hydrated and regular. The dose is now 1.0 BID, and we even went under 200 at one point! It does seem her sugars go up quite a bit at night. It just registered HI again on the meter. Here is her updated chart. Her early morning readings seem to be okay, they are definitely decreasing! Any suggestions? I know she can't get into Luna's food during the day. Luna is in a separate room with the door closed, and I pick it up when I let her out.

Without everyone's help here online, she would not have made it, I have no doubt about that. I'll be speaking to the vet and the endocrinologist and I will pass along all this information as best I can (as they only speak Spanish). Thank you, from the bottom of my heart - I still have my little girl!

 

After several days of doing well, her blood sugar spiked again. Last night pre-shot was Hi, +3 it was 400, and this morning re-shot was HI again. After I gave her shot, she vomited up all her food. I noticed she had literally inhaled her food, and thought in the absence of any other symptoms that might have caused the problem. I'm skipping class again today to watch after her. I don't leave food down at night - I make sure she's eaten around 10 PM and she's fed again around 6 AM. Should I leave some food down for her during the night?

I'll check her sugars again in an hour. Hopefully I'll still have internet then.

 

Holly has now kept some food down. Her blood sugar at +3 is 597, coming down from HI. I'll check again in 3-4 hours.

 

I see your kitty has had some issues with constipation. You might find Feline Constipation a useful site to read over.

I suspect the reason you've not gotten much response is that your spreadsheet is attached as a document file. Here's a thought - take the document you use, and just upload it, with instruction to convert it to a google doc. Then, when you need to update it, do a copy and paste of the new info from your workd processor to the Google Docs version.

 

Thanks - I've been adding the squash (no pumpkin here) and it is working. Unfortunately, I can't use google docs as I don't have regular access to the internet. Long story, but cutting and pasting won't work in google docs on my computer. :YMSIGH: Someone here converted it for me to more closely resemble the spreadsheet. Holly is doing better now, keeping food down since this morning. Her sugar levels are still high, which I'm not surprised. I am still trying to find ketone strips. They only test for these in the outside lab - the vet doesn't know where to get them. I suspect it's bad, but again, I have to find out what the level is and then tell the vet what Holly needs. Even the endocrinologist doesn't know what to do.

 

Try a human hospital and suggest the vets consult with a human endocrinologist.

 

That's not a bad idea. I have a Colombian doctor friend, but he's on vacation. But I do have a dentist friend who's here - she might be able to find out something! Thanks! I don't speak Spanish well enough to explain the problem myself - I do have friends who can help. I'll also check with them and have them check with their docs! Great idea! Thank you so much!

 

Draft some simple words and questions using Google Translate, then translate back into English to check it.

 

Absolutely. I've used it before, I just have to be careful since it's "Spanish" spanish, and Colombian spanish uses different words sometimes. Between GT and my "Spanglish", it's usually okay. I've had friends come with me whenever possible too. The vet here didn't even know how to use the glucometer's strips; I had to show her how they worked. Even if I use Spanish, they are not experienced with this. I'm in dog country, and animals are put down when the going gets tough.

 

If you keep updating the word doc then that will work fine for us. excel would be better but we can live with word. Would help a bit more if you can color code the numbers. I have updated the word attached to get you started!

Anything under 100 = green
between 100-200 = blue
200-300 yellow
300-400 pink
400-500 red
500+ black

Also dont assume the nadir is +6, it does vary in cars so you might want to get some more spot checks esp when you see number under 200 when you might want to get another test in an hour to see if he drops further


Wendy

 

Holly is improving greatly. She is gaining some of her weight back and is now playful and crying for food all the time. I feed her small meals 3-4 times a day. The other cat's food (wet and dry) is kept locked in another room. Holly has no way to get to it unless she can walk through walls.

We have another appointment with the endocrinologist tomorrow morning. Holly's levels seem to be much higher at night, and I was wondering if her morning shot should be increased to 1.5. She has hit a 184 once during the day, and close to 200 another time. I have color coded the numbers since it's a word document. (Thanks Wendy!) I did change from pink to purple for the 300's. On my computer, the red and the pink were too close to see the difference.

I test during the day when I'm home. I leave school for lunch so I can at least have one test during the +5/+7 timeframe. This weekend, I'll see if I can get a couple more in during the day to get a better idea. There have been a couple of times where Holly sees a bird or other distraction and pulls away - I'm not sure if the shot was completed or not. :/ Luna, my other cat, comes over to sit next to Holly when it's testing time. Very sweet.

 

Here are some glucose reference ranges used for decision making using glucometers. Human glucometer numbers are given first (mg/dL). Numbers in parentheses are for non-US meters (mmol/L). Numbers in curly braces are estimates for an AlphaTrak.

< 40 mg/dL (2.2 mmol/L) {< 70 mg/dL for an AlphaTrak}
- Treat as if HYPO if on insulin
- At nadir (lowest point between shots) in a long term diabetic (more than a year), may earn a reduction.

< 50 mg/dL (2.8 mmol/L) {< 80 mg/dL for an AlphaTrak}
- If before nadir, steer with food, ie, give modest amounts of medium carb food to keep from going below 50 (2.8).
- At nadir, often indicates dose reduction is earned.

50 - 130 mg/dL (2.8 - 7.2 mmol/L) {80 - 160 mg/dL for an AlphaTrak}
- On insulin - great control when following a tight regulation protocol.
- Off insulin - normal numbers. (May even go as low as the upper 30s (1.7 mmol/L){60s for an AlphaTrak}; if not on insulin, this can be safe.

> 150 mg/dL (8.3 mmol/L) {> 180 mg/dL for an AlphaTrak}
- At nadir, indicates a dose increase may be needed when following a tight regulation protocol.

200 mg/dL (11.1 mmol/L) {230 mg/dL for an AlphaTrak}
- no shot level for beginners; may slowly reduce to 150 mg/dL (8.3 mmol/L) {180 mg/dL} for long-acting insulins (Lantus, Levemir, and ProZinc) as data collection shows it is safe

180 - 280 mg/dL (10 - 15.6 mmol/L) {may be 210 - 310 mg/dL for an AlphaTrak}
- Any time - The renal threshold (depending on data source and cat's renal function) where glucose spills into the urine.
- Test for ketones, glucose is too high.

>= 280 mg/dL (15.6 mmol/L) {may be >=310 mf/dL for an AlphaTrak}, if for most of the cycle between shots
- Uncontrolled diabetes and thus at risk for diabetic ketoacidosis and hepatic lipidosis
- Follow your insulin protocol for dose adjustments
- Test for ketones; if more than a trace level of ketones, go to vet ASAP.

 

Second, its time to bump up the dose for both shots. Your mid-cycle/nadir values are all above 150, so increase 0.25 units. You'll have to eyeball it on the syringe, there are no marks for 0.25.

After 3 days on the new dose, you'll need to recheck around the nadir, which you'll see on the preceding reference guide indicate a possible dose increase.

Depending on the time you have available, you may want to follow the Tight Regulation protocol or the Start Low Go Slow protocol

Since I know you internet is iffy, print or save the files to PC so that you can review them at your leisure.

 

I agree with BJM. It's definitely time to increase the dose for both the morning and evening shots. Holly's numbers are too high most of the time and went need to see more numbers under 200, preferably even lower.

 

Thanks everyone! The vet is pleased with Holly's improved appetite and appearance, but her sugars are of course way too high. Instead of increasing the dose, she wants to change the insulin to Novolin N, .2, q 12 hours. I've read this is not a good choice for cats. Is Levimir/Detemir a better choice if available here?

I'm not changing until I feel confident about what I'm changing to, and in the meantime, I'm increasing the Lantus dose, .25 as recommended here.

Do I still need to give her any squash with her meals? She's had such a bad problem with constipation, I'm giving her a tiny bit every day. Is it better to only give it every few days? Just when I notice she's having a problem?

They want to do a curve on her next Friday after she's been on the new insulin a few days. They've run a test for pancreatitis - we'll know Monday. They do have a silicon based non-absorbable litter, but I'm allergic to silicon. The aquarium rocks here are indeed treated with certain things for fish, and I'm afraid even after I wash them they could alter any ketone test. Looks like Holly will need to go in a locked area with an empty litter box, unless anyone has a better idea - and so many people here do! I know she would not be with me any longer if it were not for everyone here.

THANKS SO MUCH! (Weekend is coming, and it's a holiday on Monday. Cross your fingers for my internet!)

 

No, the Novolin N is a horrible insulin for cats. It's ok for dogs with their slow metabolism, but not for cats. Most cats only get 6-8 hours control with the Novolin N and it drops them like a rock very early in the cycle and then shoots them up high as the insulin peters out.

I think you have not found a high enough dose of the Lantus yet. We need to have you hold the increased dose for 3-5 days ( 6-10) cycles and then we reevaluate. If Holly's nadirs are still not below 200, we need to increase again. We like to see the cats nadir's down in the 50-120 range. Many cats can be diet controlled with the right food and the right dose, gradually changing the dose up or down as needed. Right now, Holly needs those increases. I think we need more frequent increases before you consider a different insulin.

Levimir/Detimir would be much, much better than the Novolin N or Vetsulin or Humulin N for your cat Holly. But first, I'd give the Lantus more of a chance, increasing the dose more frequently than you have been.

I wish you would post daily, so we could help you more. But your internet access does not permit that, I'm sure.

If she is still constipated, giving the squash daily is a good idea. I give my sweet kitty Wink and one of my civies Delta, Miralax daily, 1/8 teaspoon to help with there harder poops. I increase it to twice a day if the poops are getting harder. The squash/pumpkin is serving the same purpose so I would continue to give that to your cat Holly. The squash adds more fiber, helping Holly to poop better. I'd keep it up indefinitely.

 

Absolutely not

He is not familiar with Lantus. It does not work the same as Novolin. It will not drop him like a rock he way novolin does. It has an onset around 2 hours, a nadir around 6 hours and lasts 12 hours. Novolin lasts 6-8 hours in the cat.

You should increase the Lantus, as we noted previously.See my signature link Secondary Monitoring Tools for tips on urine testing.

 

NONONONONONO. You dont want novolin - its a horrible insulin for cats - its very harsh, very fast acting and wears off fast and very hard to regulate a cat on. Plus its unlikely for remission. Its better for dogs. Stick to the lantus.

What weight is she now? How much fancy feast does she get a day? What would you say her ideal weight is? I want to work out if she is getting enough calories but while she is unregulated I would feed her as much as she wants to keep her weight up.

Other ideas to collect pee:
- use lentils instead of gravel
- stick a ladle under her butt - or a little tray made out of foil
- cover the litter in cling wrap so she pees on it. Sprinkle a little litter on top
- buy a non clumping litter - you can test 1 tablespoon of it mixed with plain water. If the strips show nothing, then do the same for 1 tablespoon of peed on litter. And double the results.

Lastly I just think your vet needs to be patient - I agree your dose needs to increase. Lets try 1.25 for 3-5 days to see how that goes but also get a before bed test 2-3 hours after evening shot - we want to be sure she isnt dropping low at night like many cats do.
Wendy

 

Thanks again, everyone. This is from the endocrinologist - she's nice, but this is really new territory for them. I have found several guides for vets in dealing with feline diabetes. Which one would be the best one (most recent?) to print up and get translated for them? I went to the vet and told them about the Novolin N and about increasing the Lantus. I'm going to stick with the Lantus for now and increase the dosage.

Lentils! Great idea! Or the saran wrap! Also good! We have LOTS of different kinds of dried beans here.

I'll increase the dose tonight and stay up to watch her and get another test after her nighttime shot. It's a three-day weekend here so I can spend more time watching her on this new dose.

I need to change my signature to reflect no fancy feast right now. It's souped-up Friskies (now called Felix down here) pate style only, with lots of extra protein. Chicken or fish, no pork or beef.

 

you asked about leaving food out overnight for her and YES that is perfectly fine to do. You may discover that she eats more overnight and it may help with the bg levels as well.

Did you look in the pharmacies and look at the diabetes section to see if you can find the ketostix there?

Maybe you can translate it into spanish and ask the pharmacist for the container.

The box should look like this: http://www.amazon.com/Ketostix-Reagent- ... B0000532GJ

Or they may have it out of the box and then it should look like this:
http://isearch.shopathome.com/?user_id={09264f5b-4105-48ff-973b-99ec5c903ff4}&q=ketostix+image

If you can't get it locally or at the hospital, are you able to order online and have it shipped? Or have someone in the US buy and ship it to you?

Just some more thoughts. Glad to see that she is doing better and you are sticking with Lantus. Remember it's an excellent insulin, you just need to find the right dose.

 

I do have the test strips. Thanks. I found a pharmacy about ten blocks away that has a lot of specialty items. I got their last box.

Getting things sent here is unfortunately expensive and time consuming. Most people who can afford it fly to the states every few months, go shopping, and bring things back in their luggage. Tried to bring FF back from the states and half was confiscated and tossed. (I had bought two boxes of 24 and some single cans.Total.) I now have a letter from the vet and I might have to go to the customs people and get their permission. That could take a long time. And some money under the table. :/ However, if anyone wants to come and visit....

 

The AAHA Diabetes Management Guidelines for Dogs and Cats might be a good place to start with educational material for your vet on diabetes. Vet journal published in June 2010.

The Merck Veterinary Manual has a short article on diabetes.

This article by Rand and Marshall, Understanding Feline Diabetes Mellitus: pathogenesis and management is from top diabetes researchers. Published in 2009.

This one, with the original Roomp and Rand Lantus protocol, may already have a Spanish language version. It's from the College of Veterinary Sciences in Santa Fe, Argentina website. Original published in Journal of Feline Medicine and Surgery in April 2009.

I hope those help you.

 

Hows things going now?

Wendy

 

I haven't had a chance to update her file yet - but I had a big surprise today! Her +6 reading today was 157! The lowest it's been since this all started!

I upped her insulin a week ago to 1.25, but sugar was still doing the roller coaster. Two days ago I started 1.5. Her pre-shot reading was 172 tonight! Two low ones in a row.

WOW! I'm hesitant to give her 1.5 again with such a low reading, even though I know it's still high. I have honey if I need it. Based on what I've read, it is still okay to give her the shot, but I'm tempted to lower the dose given her propensity for the roller coaster sugars.

Any advice?

 

Maybe stall 30minutes to see what she is doing(going up or down).. So don't shoot or feed and retest in 30. Then if she is going up I would shoot but definately get another test at +2 as that will tell you her plans for the night.. If its lower than preshot you might want to set the alarm for anther test later on..

 

Thanks! She's already eaten - her food is ready as soon as the test is done. Holly is begging for food all the time and I have her on a schedule now. I'll test again in a bit and see what's going on. I still can't believe today's readings. Still a long way to go, but definite progress!

 

Ok well you should be ok to shoot her normal dose or a reduced dose if you aren't comfortable.. but definately get a +2..

Do you have syrup and strips just in case?

 

Back over 400. Sigh. Also turns out the ketone strips I bought are for blood ketones. I'm going to see tomorrow if one of the pharmacies can order the product available in Argentina, Keto-Diastix. I have the supplier and their phone number. Thanks for your help!

 

Could be a bounce -

Bounces - what are they and is my cat doing them?
When a cat is first diagnosed, the blood glucose has probably been high for a while. As the insulin starts to take effect and numbers start to come down, the liver has to learn to adjust to the lower numbers. We call this "liver training school". But before it relearns that low numbers are ok, when the BG drops to a number lower than the liver is accustomed, or if BGs drop low, or if the BG drops suddenly, the liver”panics” and reacts by releasing counterregulatory hormones and glucagon. This drives the BG back up. This is what we call a "bounce". Bounces can take up to 72 hours to clear so we are generally careful about increasing doses during the bounce. Once the bounce clears, then you can see the "real" numbers and determine if the dose needs to go up or down.
The insulin depot - what it is and why it effects your cat’s BG numbers

 

157!!!!! Congratulations on that blue number! Now, how about showing us some green? :mrgreen:

Way to go Holly! :RAHCAT

As you gather data, you can lower your shoot/no-shoot number. Over in the Lantus TR forum, the threshold is 150.

 

Hows things going now?

Wendy