Newly Diagnosed Kitty

Hello,

My cat Blu went to see his vet on Friday due to having some sores on his back legs. They looked like the hot spots older dogs get. The vet was puzzled and we also found a broken tooth as well. I felt terrible. Blu is a rescue cat and came home with me as an adult about 8 years ago. His age is estimated to be between 10-14 years old. Hard to say! The sores they know feel are related to the diabetes, so in a way I'm glad they were there so we could catch this before anything got worse.

He's a big boy, but had lost some weight and was drinking/urinating more which I now know are classic signs of this disease. He's currently 13 lbs with the vet saying she feels a good weight for him would be in the 10-12 lb range, no less. His sugar reading at the time of diagnosis was 530. She has prescribed him 3 units of lantus teice a day along with low carb high protein wet food. I'm nervous that this is a high dose to start him on from what I have read here. I start the insulin tomorrow, and he will spend Monday at the vet as I must work and don't want him to go unattended all day at the beginning of treatment in case of any hypoglycemic issues.

Any thoughts on perhaps doing 1.5 units twice a day tomorrow and talking to the vet about my concerns on Monday or is the 3 units twice a day not a terribly high dose and I am over thinking this? Any thoughts or advice on this dosage amount would be so appreciated. I'm so scared of any hypoglycemic episodes. I live alone and work a usual Mon-Fri work schedule so Blu will have to go unmonitored at times.
The vet also said to leave dry food out for now while I am at work in case of hypo which makes sense but contradicts the special wet food only diet. There's another cat in the house so leaving a tiny bit won't work bc the other cat loves the crunchy food. Aaaaah so overwhelming! I do plan on home glucose testing but right now just trying to acclimate me and Blu to the insulin injections for a week and then move onto that. The vet is supportive of that and said it will help keep the spot check and costs down, but would like to do a curve test one day and also spot check for the next couple weeks. The tooth will be coming out but not until he has stabilized.

Thanks for reading. I wrote more than planned but feels a little better to just tell "somebody" my experience so far.

 

Welcome to you and Blu!

Can you ask your vet how the 3u dose was determined? Some vets will base the dose on a cat's weight following the guidelines published by the AAHA. However, that formula is -
.25u per kg of lean body weight, twice per day. For most kitties, that comes out to 1.0 twice a day. Even if you use Blu's current weight, it comes to 1.5u twice a day. I'm not sure of their reasoning for 3.0u.

They got the diet right - low carb higher protein canned food. But I'm not sure why they suggested feeding dry for now. I know that has you stumped too, so maybe ask them to explain?

I would urge you to learn hometesting as soon as possible. Especially with the starting dose advice they gave you.

As a resource for managing feline diabetes, this place is priceless. Please ask any questions you think of, and somebody here will mostly have a good answer for you.

As far as the tooth goes. Sort of a "catch 22" there. If the tooth is causing any kind of an infection, or pain, then it will most likely raise his blood glucose levels. A lot of vets don't want to take care of dental issues "until he is stabilized". But the dental issue makes stabilization harder.

Carl

edit to add - I'm not sure about the sores on his legs. I just can't remember reading a link between sores and diabetes. Has Blu been walking on his hocks? Did they give you anything to treat the sores with?

 

Thank you for the response! I'm glad I found this site and glad it made me aware that 3 units twice a day might be too much. As I mentioned, I did the first injection tonight but did 1.5 vs. the prescribed 3 units to be safe. I did it while he was eating his wet food. Her reasoning for leaving dry out I guess was as a safety measure if he were to get hypo while I was at work there would be a source of carbs/sugars for him to have if I wasn't there and he needed sugars fast. She mentioned that the lantus takes about a week to build up in his system so a week from the start of treatment would be the most likely time for a hypo incident to occur. So the dry food would be a temporary measure until we get him totally stabilized. Just seems strange bc the dry food might also KEEP him from being stabilized in theory (my theory!).

The sores are on his hocks up by the joints of his back legs. they are about dime sized and one is bleeding (which was what prompted the vet visit.) I see him walking on his normal feet not on his hocks but he is also a cat who tends to walk a bit and and then sit down or lie down. He's never been a very active kitty. I have all hardwood floors but he tends to sleep on my bed. Maybe he has been sitting/laying on them more than I was aware of and the diabetes caused some weakening of skin tissues? Hard to say, but definitely not walking on them, I would have noticed that. They gave him an antibiotic ointment as well as an oral antibiotic to help both the sores and his bad tooth. As of now, they said a month at least before tooth surgery.

I'm thinking I will continue just the 1.5 units twice a day tomorrow and speak to the vet Monday when they are open and ask/request that we keep him at that and see how things go. I am thinking it can't hurt to start him lower and raise if it isn't enough...worst case being it may take longer to totally stabilize him if it is too small of a dose but reduces the risk of a hypo episode, especially when I can't be home during the work days to watch him. If I am missing something or thinking wrong here, please correct me!

I gave him his first 1.5 units tonight at 8:30pm. He does seem a little bit sleepy. He wakes fine when I pet him and I did play with him to see his interest level and he played a bit. Just seems a bit sedated but I might be overly nervous and overthinking. I will get a glucose monitor tomorrow and start that rather than waiting - just feeling so guilty with all the needles so quickly but I can get over it.

 

The "start low and go slow" approach is a very good idea. It's a very good way to start until you are able to home test. And once you get that meter, people here have lots of tips on "how to".

http://www.felinediabetes.com/FDMB/viewtopic.php?f=28&t=61800

 

Hi to new sugarkitty Blu and your bean. Would you share your first name with us and where you live? That way, we can give country specific advice on food and other stuff.

Carl has given you great advice as he always does. I would have suggested dropping down to the 1.5U also.

It may not be an ideal situation, but can you confine Blu to a room with food and a litter box and a cat bed while you are away at work? The food could be wet food that you leave out, does not need to be dry. There are very few dry foods that are low enough in carbs for a diabetic kitty. You could try to freeze some of the canned food, a non-stick muffin pan works well for this. We call them cat food 'cicles ;-) and you can leave one to defrost while you are away at work.

What specific food did your vet recommend? Lots of us here feed the Fancy Feast classic pates, Friskies pates, or Wellness grain free. All low carb and good for our sugarkitties.

My best advice? Deep breathing exercises. This can be a very stressful time when our beloved furry family members are diagnosed with diabetes. Calming ourselves helps to keep our kitties calm and makes it easier to give them the insulin shots and to blood test at home.

We're here to help you every step of the way in this new sugardance you are doing with Blu. It gets easier, trust me.

 

My name is Tanya and I live in Worcester, MA.

I bought a home testing kit today...the Walmart Relion micro. Got an ear prick on the first try - Blu didn't even seem to notice it! His reading was 231, I did the test right before his next feeding and insulin dose was due, so 12 hours from this mornings 8am dose. When i tested, he has had only 2 doses so far of 1.5 units of insulin, first last night and second this morning. He went into the vet Friday and his blood sugar at the time of diagnosis was in the 500's. I'm really concerned how it has dropped so quickly??? The vet said not the lantus would need up to a week to build up and start working in Blu. As mentioned, he has a tooth infection that will require removal and is getting oral antibiotics for that now - so wondering how much that contributed to the initial over 500 diagnosis sugar level, now that he has been on antibiotics for a couple days the infection should be minimizing. He's also on the wellness brand grain free chicken wet food starting yesterday.

He does seem to be sleeping a lot, but wakes without trouble and is purring and cuddly. Could be all the changes in his system along with the vet visits and nervous caregiver/needle injector :roll: He definitely seems much less interested in water already, too. Just worried because it seems much too fast for things to be working from what I was told.

Thanks for all the support, reading through advice and experiences here calms my nerves. I'm still not adept with the insulin syringes...the vet shaved a patch between Blu's shoulder blades to make things easier for now, and patiently instructed me on how to give the shot. I do the skin "tent" and firmly insert the needle, but I press the plunger fast because Blu is not happy when he is being kept still for very long. I'm not sure what angle the needle is it's happening so fast but I make sure it is all the way in and under the skin but the whole process is happening in one second! Is it possible for the needle to not be under the skin "far enough" or am I probably doing okay so long as the needle is in the tented skin all the way? It's definitely under the skin as the shaved area makes it easy to see that it is not sticking out or anything.

Thank you so very much for the advice and kind words!!!

Tanya & Blu

 

Hi Tanya in Worcester! I'm in MA too, up on the north shore area around Newburyport.

Lots of changes going on in your and Blu's lives right now. Many of those changes could be contributing to his lower BG levels.

1. vet stress can elevate the BG levels at the vets office 100-180 points
2. diet change to a low carb food can drop the BG levels up to 100 points
3. antibiotics can be helping to take the stress off his system and drop the BG also.

Keep a careful eye on Blu and keep getting those BG readings. We suggest you test always before each insulin shot, so you know your cats BG is not too low. We recommend not shooting under 200 for beginners. Then, you need to test somewhere in the middle of the 12 hour cycle, around +5 to +7 hours after the shot. This is when most cats have their lowest BG levels but some cats nadir later, some earlier. Lantus dose changes are made based on these nadirs or lows, so you want to test a bit in that +5-7 hour timeframe.

(We all live in different time zones, so the + times give us a way to all speak the same language and is a handy way to represent the times. Your 7 am may be someone elses 3 am if they are on the west coast of the US or someone elses noon if they are in the United Kingdom)

If you give Blu a pure protein treat, like a piece of plain cooked chicken or some freeze dried chicken, that works well as a bribe to get our kitties to learn to come for the shot and testing.

As long as you don't see the needle poking out the other side of your "tent" of skin, you are probably ok. You are just trying to get the insulin under the skin, not into the muscle.

 

Thank you so much. It does feel good to know this will get easier. I read articles and instructions on lancing here, and luckily you can easily see the blood vessel that run along the side of Blu's ear as he is a light colored kitty. I warm up his ear by petting/rubbing him vs the rice sock idea as he loves ear rubs. Then I hold a bunched up towel under the ear and poke with the lancet (30 guage) just held "as is", not in the holder it came with. The lancet seems to poke right through to the other side of his ear - Blu's ears are thin - I can see light right through them. Should the lancet NOT be piercing straight through the ear to the other side???

Note: I just tested again and the reading is higher after feeding and his insulin at 340. I also was more confident and the blood sample was more and wicked right up fast vs. the first time where I tried to prick just so lightly that it took some time for enough blood to wick up.

I really appreciate all the advice. I'll hold off on any more questions unless anything gets crazy (crazier??) in what seems like a house with a poor kitty pin cushion.

 

No, you don't want to poke all the way through your kitties ear, but it happens even to those of us that are very experienced.

If you hold the lancet at a 45 degree angle and then poke the ear, that might help to cut down on piercing all the way through. Having something firm to poke against is also very helpful. A pill bottle lid, folded up facial tissue, etc. Not sure if the folded up towel you are using is firm enough to poke against.

Ask all the questions you want to and need to. We'd rather have that, than leave something unanswered. We want to help you help keep your kitty safe and get him feeling better.

Are you aiming for the vein or the "sweet spot"? Here is a diagram of the capillary rich area you should be aiming for.

 

i was going right for the red vein that runs up and down on the edge of the ear. looks like i should be aiming more to the side of that closer to the ear edge from that diagram. Oh geez okay maybe I am poking too hard. I'll use something firmer behind his ear and the 45 degree angle and a lighter hand going forward! I think I was approaching lancing the same way I am with the insulin syringe and that is too firm it seems.

Again, thanks for all the help. On a sweet note, Blu was sleeping and I stopped to pet him minus any needles or medicine to give - he leaned over with a few kitty kisses and it was so heart warming as he doesn't do that often and to do it after all the stress and needles the last few days, well, it just was very touching. He is a very patient and understanding feline friend.

Tanya

 

Tanya,

It's all a learning process, and we'll keep making suggestions to make things work better for you and sugardude Blu.

If you ever need to get blood, because Blu is acting funny or the sweet spot isn't working, go straight for that vein if you need to. The area to the side of the vein, between the vein and the ear edge, has a capillary rich area and is a better spot to poke and hurts less. You may find that your 30 gauge lancets are a bit too small. Lancets of 26-28 gauge (box may be labeled "for alternate site testing") have a bigger pin for pricking and are easier to use at the beginning of this journey. Over time, that capillary rich area will actually grow new blood vessels and make it easier to get blood.

Sometimes, 2 quick pokes, close together, form a good size blood drop for testing. Also, a dab of Neosporin with pain relief ointment (not the cream version) or generic equivalent can help to numb the ear and help the blood to pool. Wipe off excess before poking. Some people only use the triple antibiotic ointment after the poke, to help heal the poke spot. Be sure to wipe off any excess, we don't want any extra to get in his eye when he is grooming himself.

You are doing very well. There is a lot to learn, but just keep asking questions.

No one likes to hear that their cat has been diagnosed with diabetes. It's frightening and stressful and oh so hard to think of one of our beloved family members being so sick. Please know that Blu will get better with time and more and more of those kitty kisses will occur and you will start to see some of his old behavior return.

As difficult as this diagnosis is to receive, there will be joy in your life also. Helping Blu to get better, testing and giving him shots will bring you closer and closer together and the bond and love you have now will grow incredibly stronger. He knows how much you are trying to help him and showed you that with those kitty kisses.

 

Welcome,
You have already gotten a lot of good advice but I will chime in with a few things that I have found to be helpful since our diagnosis in September.

1. I've had tremendous success switching Tobby over to EVO 95% and 9 Lives Super supper. He only gets a tablespoon of each twice a day which has helped him loose weight, he was at 19 pounds and is down to 17.5.
2. I stole one of my step daughter's socks, filled the toe with rice and tied it off. I microwave it for 20 seconds just to get it warm and then use that to warm up his ear AND give me that "stiffer" surface to hold his ear against when doing the prick.
3. Take you monitor in with you for every vet visit. I learned that my relion is about 30-40 points lower than the one they use. Knowing that though helps me know where he is when I do my testing.

Good luck!
Threesenough

 

Hi Tanya,

Your vet sounds like mine. She told us to leave out dry food, even said we could continue feeding him dry food instead of switching to the wet. She also started him on a higher dose of insulin than we would have here and, with the dry food, we were giving 10units twice a day and his BG wasn't moving at all. Then I found this board, cut back his dose and are finally seeing lower numbers!

You've gotten good advice but I'll add my trick for the ear poke. Until about 3 weeks ago, I took an empty pill bottle, filled it with hot water and used it to warm up his ear and it served as something on the other side as a brace. I was scared of the lancet going through his ear and pricking me. Now I use a folded up piece of tissue and have no problems. It's definitely a learning curve.

You've got some great people helping you out! Cobb was diagnosed back in April. I found FDMB the week of Thanksgiving and learned more in that week than I had in all the months preceding.

You're in good hands!
~Suzanne

 

Great! you're officially a member of the Vampire club! Here are some notes on using human vs pet-specific glucometers, what the numbers mean, and an explanation at the bottom on how to use the chart.

The difference in using a pet-specific meter vs a human meter (aside from the very high cost of the former) is mostly a matter of scale (though not exactly 1:1). Think of it as reading temperature in Celsius vs Fahrenheit. Both are correct. If you have the reference values for each, you can interpret them.

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

[Glucose reference ranges are unsubstantiated and have been removed by Moderator]

* * * * * * * * * * * * * * *​

How to use the glucose reference values chart:

When you get a test, look for the number on the chart that either equals, or contains, the test value you have. Read the information. As needed, make a decision and act.

Ex. You are a new insulin user and you test your cat before giving insulin. The test is 300. It probably is safe to give insulin.

Ex. You are an established user of Lantus, following the Tight Regulation protocol. You've tested around +5 to +7 to spot the nadir. It is 200 mg/dL. You probably need to increase the dose, following the instructions for the protocol.

Ex. Your cat is acting funny. The eyes are a bit dilated. You are concerned and test the glucose. The number is 35 mg/dL. ACK! The cat may be in a hypoglycemic state. You quickly follow the HYPO protocol linked in the glucose reference values chart. (which we really, really, suggest you print out and post on your refrigerator.)

 

Hi Tanya,
I sounds like you're doing great so far! Lots of good advice here, just like I knew you'd get.

The longer you do the ear pokes, the easier it'll be for you. I did the same thing at first, poked all the way thru, aimed for the vein. Somebody posted the same picture for me a couple of years ago too. I think that drawing was done by Sheila, and if I remember correctly, she's also from MA. Small world! I'm a MA native too, and grew up in Grafton. Most of my family is still there.

I used a cotton ball behind Bob's ear to protect my finger mostly. I also "free-handed" the lancet rather than use the device they came with. It was just much easier for me to see what I was doing.

Carl

 

Hello and welcome to the board!

You are doing a great job so far! At this stage I would recommend you set up a spreadsheet to track readings and trends. It will help us advise too and you can show your vet. Here is how but let us know if you have questions http://www.felinediabetes.com/FDMB/viewtopic.php?f=6&t=18207

Also I usually recommend 3-4 tests a day

- always before the shot - this is mandatory as you don't want to shoot when too low. As a newbie this too low number is 200 but is reduced over time once you have the data to know if its safe.
- mid cycle - 5-7 hours after morning shot depending on your schedule. This is to see how low he is going. The low point "nadir" is what you base dose changes on since you don't want him dropping too low (under 50).
- before bed (2-3hours after Pm shot) to get an idea of what his overnight plans are. If this number is less than the pre shot test number you may want to set the alarm for a test a few hours later as this implies an active cycle.


Wendy

 

Just an update -

I spoke to the vet who felt strongly about 3 units of Lantus 2X a day so we did that. I felt safter too, as the glucose monitoring on the 1.5 untits was still showing very high readings. The vet is very happy that I am home monitoring and asked if I would be comfortable doing his curve test at home this weekend. I told her I'd give it a try, and if Blu gets too irritated I'll just bring him in Monday. We'll see how it goes. The lowest I have seen his glucose go so far is 240 and that was 6 hours after his shot, so mid cycle. He seems to have readings in the low 300's when he is due for his shot and meal. He came with me overnight for Christmas night as I couldn't leave him, and did have to skip a shot as he was overexcited with the new surroundings that he didn't eat when he was supposed to. He made up for it by being best friends with everyone who visited. Blu loves strangers...always has.

The insulin shots are starting to get easier. I was initially doing them at mealtimes so I could make sure that he was eating as well as have a distraction. Now, I tap the wet food can to get him excited for meal time and just gently stabilize him between my feet and give him the shot. He hasn't flinched lately. So hopefully he's getting used to it or I'm getting better at it or a little of both.

Thanks to everyone who has taken the time to offer advice and kind words. Blu and I are very grateful and I feel much "smarter".

Tanya

 

Ok cool - but try and get some spot checks during the day as not all cats nadir at +6.

Also many cats "bounce" on a high dose which means they drop too low very briefly (maybe only a few hours) and then spike up high for 2-3 days. So to be sure Blu isn't bouncing you will want to get random tests for 3 days to check or lows.. especially if you see signs the blood glucose is starting to drop..

 

I'm having similar problems-especially with poking ears. Its going all the way through a lot-I'm using the pen after shredding her ear doing free hand-she moved quickly. I'm not using 30g too. I used a folded up paper towel on the other side. I feel so bad-her ears are looking bruised up. I hate poking her more than 2-3x day because of all of this.

 

Immediately after you get the blood drop tested, apply direct pressure to the site for a minute of so. This will reduce bruising and scabbing. (Works in people too for similarly sized punctures)

 

The pens also have a depth setting on them. If you're finding yourself poking through the ear, try a lower depth setting. With Michelangelo, We started out at the highest/deepest setting and moved our way down over the course of a few weeks. I can now get enough blood with any of the devices set to the lowest setting.