Newly diagnosed - totally overwhelmed

Discussion in 'Feline Health - (Welcome & Main Forum)' started by Michele&Errol, Nov 28, 2013.

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  1. Michele&Errol

    Michele&Errol Member

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    Nov 28, 2013
    Hi my 9yr old DSH Errol was diagnosed with Diabetes yesterday. I am panic stricken as I realise I have to do something quickly and I don’t feel the vet is giving me 100% correct up to date info. I’m in S. Africa, so what is relevant in the USA, may be impossible here.
    I know I have to change his diet 100%. He was brought up on Royal Canin and I changed to Hills about 2yrs ago and onto Hills Light about 1 year ago. He was never overweight really, perhaps slightly well covered, but he is a very big built cat. The vet certainly didn’t think he was overweight when I had him checked about 4 yrs ago.
    When I look back, I realise his extreme hunger was probably the beginning of diabetes, but I thought it was typical ‘always hungry cat’ syndrome. Needless to say, I feel sick at the thought of that. About 12 days ago, he started urinating and drinking excessively but I put it down to the extreme heat. Then two days ago his appetite almost disappeared. Took him to the vet yesterday am, and he was diagnosed with Diabetes. Was told with insulin, he could have another 3 – 4 yrs.
    I was given Lantus and told to administer 3 units bi-daily. Kitty wasn’t weighed, vet felt he had enough experience after 30 yrs to know how much. I had done some reading, and wanted to get a glucometer but was told I would stress kitty and myself out terribly if I tested so many times.
    I also read that PZI was a better suited insulin but we can’t get it in S. Africa.
    Also, we don’t have access to rabbit or turkey so am at a loss as to what to make a homemade diet from as all the best diets seem to be rabbit or turkey. I’m also really worried about making a balanced diet, and not causing another health issue whilst trying to fight the diabetes and possible future CKD.
    As you can probably tell, I’m in a bit of a state, when I read everything on this board I feel my chest tightening and I don’t know if I’ll be able to do everything right and in time for my cat (who is my child, along with my other 2 slightly younger cats). I’m prepared to go the extra mile but I just do not know where to start.
    I don’t want to do anything stupid and waste time so if anyone has any advice it will be greatly appreciated. I am going to get stuck into reading as much as I can on the board but it is overwhelming.
    I hope you don’t mind random questions, I will really try and search for answers before asking them, but I feel time is of the essence.
    Anyway thank you for reading this :)
     
  2. Larry and Kitties

    Larry and Kitties Well-Known Member

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    Dec 28, 2009
    Welcome. Testing your cat's blood glucose level does not really stress a cat. I current have four diabetic cats and test their blood at least twice daily with no problems. For one of them. Patches, I have been doing that for almost nine years. Yu should get a hman meter and start testing. Preferably before each insulin shot and in between shots to determine the right dose.
    You say yo are using Lansac insulin. Is that really Lantus?
    Three using twice daily is really a high starting dose. Usually the starting dose is 1 unit twice daily.
    For dies do y have any canned commercial food available? I do not know what is available is South Africa. It is hard to prepare your own food since it is hard to get the right combination of ingredients. Here is one receipe
    http://catinfo.org/?link=makingcatfood
     
  3. Michele&Errol

    Michele&Errol Member

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    Nov 28, 2013
    Thank you. Sorry about the double post, the first one disappeared only to reappear later. I'll try and delete it to avoid confusion.
    That's what I'm starting to realise - after reading the http://www.felinediabetes.com/AAHADiabe ... elines.pdf on this board, I'm starting to see it's imperative to test regularly at home. I can get a glucometer very easily, there are a few makes, is there anything specific it has to have? Is it easy to interpret the results?
    Yes, apologies, it is Lantus.
    Yes, we have some commercial tinned food which I could use until I can work out a better diet. I'm not sure the canned diet is the best, but we have Whiskas, Pamper, and a couple of others.

    OK, just read http://www.felinediabetes.com/start-low-go-slow.htm : " If your cat's blood glucose was less than 400 mg/dl (22.1 mmol/L) at diagnosis, or if your cat is on a low-carbohydrate diet, the starting dose should be only 0.5-1.0 units twice per day."
    My cat's BG was 22.4 at the vet after a 30 minute car trip with him quite stressed and crying which would make the BG level higher than normal perhaps? So should I reduce his insulin to 2U bi-daily instead of 3U bi-daily??
     
  4. Larry and Kitties

    Larry and Kitties Well-Known Member

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    Dec 28, 2009
    I would start with the canned. Typically ones without gravy are lower in carbohydrates. You want low carbs. This may help finde low-carb canned food:
    viewtopic.php?f=28&t=64843
    Most human meter are fine. What meters are available to you?
    It is not that hard to interpret BG results. To make it easier, it is recommended that your create a Google docs spreadsheet. For how see:
    viewtopic.php?f=6&t=50130
     
  5. carfurby (GA)

    carfurby (GA) Well-Known Member

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    Feb 19, 2012
    Hello and welcome. You will find a lot of helpful information here. Don't be afraid to ask questions and ask the same question more than once if you need to. We all want to the best for you and Errol.

    In regards to your question about what to feed, there was a lady that used to post here that was in South Africa. Her profile states she used this recipe from Dr. Lisa Pierson http://catinfo.org/?link=makingcatfood#The_Recipe. She also fed Fancy Feast (Varieties with 10% carbs or less). You should be able to find the carb percentages from the links Larry posted.

    I hope this helps.
     
  6. Wendy&Tiggy(GA)

    Wendy&Tiggy(GA) Well-Known Member

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    Nov 15, 2011
    3 units is a high starting dose for Lantus (which is a good insulin by the way). I would reduce it to 1 unit especially if you are making a food change. And I strongly recommend home testing as many cats go into remission with a food change. If you can find a human meter that would be great. We can advise on how to test and when etc.
     
  7. BJM

    BJM Well-Known Member

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    Oct 6, 2010
    Cat Info has a recipe for home made raw that is nutritionally complete; maybe check that for ideas.
     
  8. Michele&Errol

    Michele&Errol Member

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    Nov 28, 2013
    Thank you very much everyone. I reduced the dose to 2.5U before I read this (no internet connection today) so will it definitely be safe to reduce to 1U from tonight?
    Can you please tell me exactly how to home test? I think I have to do this pretty urgently.
    I have another problem. Yesterday evening kitty wasn't very hungry, nor this morning. This evening he has refused 5 different types of food ranging from fresh beef, fresh chicken, two types of tinned food and even dry (Orijens) which I tried as a last resort.
    What now? The vet said if he doesn't eat I cannot give him the insulin. Please help!
    He went from a raging appetite for years to not hungry - I am reading as much as I can here, but cannot work out it if is because the diet change has regulated his BG or if he has a secondary problem?
     
  9. Larry and Kitties

    Larry and Kitties Well-Known Member

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    Dec 28, 2009
    I would quickly go to a drug store and urine dipsticks that measure ketones. You can get them alone or in combination of ones that measure glucose in the urine too. If there are ketones in the urine that is serious and and er vet visit is necessary.
    Sometime diabetic cats (and people too) get what is called diabetic ketoacidosis
    http://en.wikivet.net/Diabetic_Ketoacidosis
     
  10. KPassa

    KPassa Well-Known Member

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    Oct 23, 2012
    Here are some ear testing tips to help you get started.

    As to not eating = not giving insulin, that is old and out-dated for use with other insulins (like caninsulin, vetsulin, humulin). With Lantus, you can give insulin if they're not eating but their numbers are still high. You definitely want to be home testing if you do this because they may need a reduced dose (lack of food does result in a decrease of carbs affecting glucose numbers). Either way, you really want to make sure your cat starts eating again as soon as possible, even if you have to syringe feed them. Cats can quickly develop hepatic lipidosis from not eating within just a couple of days. Diabetic cats can also go into diabetic ketoacidosis if their lack of appetite is being caused by an infection and if they're not getting enough insulin. You really want to stay on top of that and bring him back to the vet if he's still not got his appetite back because you want to prevent something more severe from happening.
     
  11. Wendy&Tiggy(GA)

    Wendy&Tiggy(GA) Well-Known Member

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  12. Michele&Errol

    Michele&Errol Member

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    Nov 28, 2013
    Thanks Larry, I don't think he's near that stage, but it is something I worry constantly about obviously and keep an eye on. I phoned the only pharmacy chain we have here and they do not stock the dipsticks. They recommended I get from a veterinary wholesaler but they'll only be open tomorrow. Even so, in this country there are certain things they only sell to vets. Ridiculous, I know.
    There is a machine which tests for both BG and ketones - I don't know how accurate it is? The strips are very expensive so wouldn't want to get it if it weren't viable.

    Thank you, I got him to eat a little boiled chicken pieces last night, and again this morning. Just enough to feel safe about giving him the Lantus but it's not balanced and I have to find something that will give him the nutrition he needs. When I read the amount he needs to eat in any 24hr period I despair of getting that into him :(
    He has not lost any weight, despite the lack of much appetite.

    Thanks Wendy, I read through that and have tried what I have, as I mentioned I managed to get him to eat a little chicken. I will syringe him if he doesn't eat, but would like to know the cause of not eating. I checked out Pancreatitis and unless it is in the very early stages with him, he shows no symptoms of that nor diabetic ketoacidosis. I realise this can change quickly.


    I am disillusioned with the vet, and am pretty sure I'm going to meet the same resistance and opposition to home testing, amount of Lansac to give, diet (they all recommend the dry food developed for FD). He was also dismissive of me as soon as I said I didn't want to feed a dry kibble with a large carbohydrate % as this is (probably) what caused the FD in the first place.
    I know as soon as I asked certain questions the shutters went down and there was total lack of interest in anything other than the protocol which they are taught at vet school. Incredibly frustrating. I will see if there is a 'FD specialist' here tomorrow, but I don't hold out much hope as I've had to deal with the closed mind attitude on various occasions. Thank goodness for this board, where more UTD information is available and where lay people are taking control of their cat's wellbeing.

    It sounds like there is no ‘standard dose’ of Insulin for a cat. They need to be monitored to give the correct amount every single day. Why would the vet be adamant that 3U is the correct amount and only want to see him in a week to check BG? I find this hard to accept.

    I have a few questions if you don't mind:
    1. Ruling out diabetic ketoacidosis and Pancreatitis, what would cause his appetite to shrink, from having been starving?
    2. Considering his appetite has diminished, why has he not lost weight?
    3. His thirst drive has also diminished. It was huge for 10 days, then 2 days after Lansac treatment it is ''normal''. Is that normal?
    4. This morning his urine was dark orange and back to the normal quantity. I know that is concentrated, and could this be due to the Lansac or does it purely mean he is not getting enough water? I've made sure his food is wet. Could he be getting enough water from his food now?
    5. Is the vet correct in saying I don't have to give the insulin exactly 12 hrs apart, if it' s more or less it is OK?

    Thank you so much for taking the time to respond.
     
  13. Larry and Kitties

    Larry and Kitties Well-Known Member

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    Dec 28, 2009
    You can give insulin, especially Lantus, when not eating full amount. In that case you have to monitor BG before shots and maybe between shots to help ensure that he will not go too low.

    1. Ruling out diabetic ketoacidosis and Pancreatitis, what would cause his appetite to shrink, from having been starving?
    Just not feeling good. Half my cats do not each much and I have to syringe feed them. The vet has not idea why
    2. Considering his appetite has diminished, why has he not lost weight?
    Do you have an accurate scale and are they being weighted at same time?
    3. His thirst drive has also diminished. It was huge for 10 days, then 2 days after Lansac treatment it is ''normal''. Is that normal?
    Yes, that is normal for an regulated kitty. If they eat only canned food (no dry), a cat would drink very little if any water.
    4. This morning his urine was dark orange and back to the normal quantity. I know that is concentrated, and could this be due to the Lansac or does it purely mean he is not getting enough water? I've made sure his food is wet. Could he be getting enough water from his food now?
    Yes.
    5. Is the vet correct in saying I don't have to give the insulin exactly 12 hrs apart, if it' s more or less it is OK?
    I usually give mine at 12 hours +/- 1/2 hour. A few years ago I was on a 18/8 hour schedule on the weekends. Not optimum at all but my cats did OK.
     
  14. Michele&Errol

    Michele&Errol Member

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    Nov 28, 2013
    Thank you Larry. You guys on this forum are a godsend. I'm sorry for all the silly questions, and I've done a fair amount of reading here but it's nice to bounce things off those who are doing it for themselves.

    I went out this morning and bought a Bayer Contour TS glucometer and have tested it on myself. It's now 16h00. Kitties eat at 07h00 and 19h00. When should I start testing his BG and how many hours apart? I read on one of the stickies that it has to be every 2hrs for the first 24hrs, and then I read somewhere else that it should be done a few times during the day after a feed. Which is correct?
    Thank you again!

    Oh, nearly forgot: I enquired about Ketostix and Ketodiastix but they've been discontinued in SA. There are some other ones, but they have an extremely short shelf life, are very expensive because they can only be purchase in quantities of 500 or 1000. So I will have to forgo those unless I can find them elsewhere.
    There is a machine which does BG and Ketones, but it requires a lot of blood so is also out of the question.
     
  15. Larry and Kitties

    Larry and Kitties Well-Known Member

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    Dec 28, 2009
    I am sort of surprised the ketostix are not available but then again I am not familiar with SA.
    There is really to reason to test every 2 hours with Errol not eating normally. I woud test before each shot and then maybe 3 and 6 hours after shot. It all depends upon how much Errol is eating and preshot BG.
     
  16. Michele&Errol

    Michele&Errol Member

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    Nov 28, 2013
    To practice, I have just tested him, he last ate at around 08h00, it's now 16h30 (8.5hrs later) and his BG says 4.3 and 4.7mmol/L. Not sure what this is in USA measurements? Is it normal, too high, too low?

    He was 22.4mmol/L at the vet clinic now down to 4.3mmol/L 4 days later at home.

    He is grooming, affectionate, and seems a bit quieter than usual. He hasn't drunk much today, but then he's really only eaten wet food.
     
  17. BJM

    BJM Well-Known Member

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    Oct 6, 2010
    He's doing well. For us US folks, we multiply those numbers by 18. The chart below has the range they fall in highlighted in blue. They are good numbers.

    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.

    < 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}
    - no shot limit for ProZinc, PZI, or other non-depot insulins

    > 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 mg/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.
     
  18. Michele&Errol

    Michele&Errol Member

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    Nov 28, 2013
    Oh I can't tell you HAPPY that makes me!!!!!!!!! I was worried because I changed his diet dramatically, not sure if that's a good thing? I caved in an hour ago and gave him a tablespoon of Hills Light just because he seemed a little flat again. I've got his insulin at 2U, what should I do - drop it to 1U or keep it at 2U?

    Thank you guys so much
     
  19. BJM

    BJM Well-Known Member

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    Oct 6, 2010
    Generally, changing the diet drastically and fast can result in GI upset. Its done now, so just keep going from here.

    How many days has he been on this dose and how many days has he been on this revised diet?

    As an FYI - we change insulin doses in quarter units - 0.25 - because cats are so small that bigger changes can miss the best dose. You have to eyeball these as no syringes measure in quarter units.

    If you're lucky, you have syringes with half unit markings. If not, you may want to get a ruler with millimeter markings and line it up to the syringe and note which mark equals 1 unit and go from there to keep your measurement consistent. No, it won't be exact unit measures, but it will be consistent.
     
  20. Michele&Errol

    Michele&Errol Member

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    Nov 28, 2013
    Thank you. He was diagnosed on Wednesday morning, vet prescribe 3U Lantus bi daily. Kitty was off food am and pm, so decided to start a wet diet immediately i.e. Thursday evening, so that's 3 full days now.
    I have 0.03U syringes which do show 1/2 U so I should be able to more or less gauge what 1/4 of a U is hopefully. Over how long a period does one do the increase or decrease?
     
  21. Michele&Errol

    Michele&Errol Member

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    Nov 28, 2013
    Gave 2U Lansac about 30 minutes after he ate at 8pm, and tested at 21h45 and it's shot up to 13.1 Is this something I must worry about, advice please!
     
  22. BJM

    BJM Well-Known Member

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    Oct 6, 2010
    You mean Lantus, not Lansac.

    And most cats demonstrate a food spike roughly 2 hours after eating.

    It helps to test, feed, and shoot within about 15 minutes time, so the Lantus can start kicking in when the food does.

    It also may help to feed 2-3 mini-meals, separated by an hour or so, to space out the incoming carbohydrate in the food.

    While you work on the spreadsheet, please report numbers as
    AMPS = morning pre-shot
    PMPS = evening pre-shot
    +1 = any test done 1 hour after insulin
    +2 = any test done 2 hours after insulin
    +# = any test done # hours after insulin.
    Why? Because we're in different time zones and interpreting the glucose level depends on its relation to the shot. Rather than having to figure out your time zone vs our time zones, this quickly lets us know how long it has been since insulin was given.
     
  23. BJM

    BJM Well-Known Member

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    Oct 6, 2010
    You may find it helpful to read over the Stickie Notes at the top of the Lantus Tight Regulation forum.

    Lantus is a depot insulin, so its effects are cumulative. In other words, the first dose takes about 5 days and any later dose takes about 3 days to stabilize due to overlap in effect.

    The estimated starting dose is the lower of current or ideal weight, in kilos, times 0.25 rounded down to the nearest quarter unit.

    How much does your kitty weigh?
    How much should your kitty weight?
    Take the lower number.
    Convert to kilos (pounds / 2.2) if needed.
    Multiply by 0.25.

    Compare this to the dose you are giving. You may want to reduce your dose if your current dose is higher. As the insulin builds up, a higher dose could be too much and lead to a hypoglycemic episode. If you don't reduce, it is critical to get tests in the +5 to +7 hours after a shot to see how low the cat is going.
     
  24. Deb & Wink

    Deb & Wink Well-Known Member

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    Jan 31, 2013
  25. Michele&Errol

    Michele&Errol Member

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    Nov 28, 2013
    Hi Deb, thanks so much. I've read through that and the only foods that we can get are the big brands, RC, Iams, Hills, Whiskas, SOME Friskies (dry kibble and poor quality wet food in sachets), SOME Fancy Feast (no pate), and then some other very low quality brands which are loaded with carbs which my cats wouldn't touch anyway. Right now I am trying to get him to eat anything that looks more or less safe and isn't purely corn and carbs like the first 3 on my list are. I will eventually have to work out a meat diet for myself but right now it's impossible to get the correct ingredients. It's not like the USA or Europe where you can order online. I also need something which is easily accessible so that I can stick to it. Fact is, my cats do not like wet food at all, are addicted to the horrid H kibble and I am battling to get any 3 of them off it. I feel like a parent with a child on a prohibited substance cat(2)_steam
     
  26. Michele&Errol

    Michele&Errol Member

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    Nov 28, 2013
    Thanks BJM, you know, the vet didn't even weigh him - said he didn't need to - and my bathroom scale is not accurate enough. Thank you for the info and explanation and when I take him back there on Thurs I will insist on him being weighed. Sigh. FD is definitely not a disease with a one size fits all generic treatment plan. Hold thumbs I can find a GOOD FD specialist this morning.
     
  27. Michele&Errol

    Michele&Errol Member

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    Nov 28, 2013
    I am trying the small meals spread out so that his BG doesn't spike. I'll be happy to get him to just eat more, and will speak to the vet today about something to increase his appetite which won't interfere with his FD or the Lantus.
    I will try and do a spreadsheet - not very PC literate hope I can manage.
     
  28. Wendy&Tiggy(GA)

    Wendy&Tiggy(GA) Well-Known Member

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    Nov 15, 2011
    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.

    Let us know if you need help with the spreadsheet!
     
  29. Michele&Errol

    Michele&Errol Member

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    Nov 28, 2013
    Ok, so I have not managed to do a curve yet with work. I will have to do it this weekend and the spreadsheet oo. The vet returned my morning call tonight, and he said to put him on an appetite stimulant. There is apparently no diabetes specialist here. I have gotten him to eat tiny amounts four times today, not nearly what I'm happy with, so hopefully the appetite stimulant will help. The bad thing is, it looks like I am going to have to resort to Hills WD or Royal Canin as he will not eat wet food at least for the interim until I can find a suitable home made diet though he is probably going to refuse to eat that too.

    Can you please explain the too low number you quoted of 200? I thought the too low number was 40? I think I've misunderstood something. Thank you.
     
  30. Wendy&Tiggy(GA)

    Wendy&Tiggy(GA) Well-Known Member

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    Nov 15, 2011
    The low number at any point in the day is 40 - if he drops under that then he earns a dose decrease and you may need to bring him up with high carb food and /or syrup.

    However the 200 number is for pre shot only. As a newbie you don't want to shoot if his pre shot test number is under 200

    Does that make sense?
     
  31. Michele&Errol

    Michele&Errol Member

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    Nov 28, 2013
    Yes thank you Wendy, it does. Until the weekend when I am able to do a curve I'm just going to check as many times as I can, which will be the 4 you recommended.
    Unfortunately I wasn't told this by the vet and I have given insulin when he was below 200 (11.11mmol/L) as I wasn't aware of this. Preshot was 154.8, an hour later it dropped to 90 and now just over 2hrs later it is 28.8 (1.6mmol/L).
    I have given some high carb food and some syrup even though he is showing no symptoms of hypo but I am now in a state of controlled panic. I won't sleep tonight and will check his GB every hour. Is there anything else I can do?
     
  32. Wendy&Tiggy(GA)

    Wendy&Tiggy(GA) Well-Known Member

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    Nov 15, 2011
    Your readings today show why you need to be careful about shooting low. When did you give him the syrup? Please test again asap as the syrup can wear off and then he could drop again. Let me know I will wait here.

    Wendy
     
  33. Michele&Errol

    Michele&Errol Member

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    Nov 28, 2013
    I gave him the syrup and food 45 minutes ago and have in the last 2 minutes taken his BG again it has risen to 5.1
    I will stay with him and check every 45 minutes if that is OK unless I need to do it more often? Thanks.
     
  34. Wendy&Tiggy(GA)

    Wendy&Tiggy(GA) Well-Known Member

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    Nov 15, 2011
    ok. Hold off on syrup and high carb for now. Measure him again in 30 minutes and see where he is and let me know. We need two readings in a row to be rising (without high carb or syrup) to be in the clear.

    Was it high carb wet you gave him or dry?

    Let me know. I will be here in 30 minutes.

    Wendy

    PS this means his dose is too high. Tomorrow lets start from scratch at 1 unit and work up slowly.
     
  35. Michele&Errol

    Michele&Errol Member

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    Nov 28, 2013
    I gave him dry Hills Light kibble as this is literally all he will eat.
    thank you Wendy.

    Yes, I've been worried about his insulin being too high. 3U was prescribed by the vet but after reading this board I lowered it to 2.5U and then was told to lower it slower in .25 increments instead which I did until I got it to 2U which is what he's on now.

    Because the Lantus is long acting, is he going to be at risk until it wears off in 9 hours, or will he be ok if his BG shows an increase at the next test?
     
  36. Wendy&Tiggy(GA)

    Wendy&Tiggy(GA) Well-Known Member

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    Nov 15, 2011
    Ok well the good news is that the dry will hang around in his system for a while so he may not drop low again soon. The bad news is we don't know how long for as dry hangs around a while and can still wear off and he could come shooting back down. Usually we just give wet and a drop syrup as it gives more control of whats going on.

    Anyway lets see where he is in 30 minutes. We might need to get some tests later as well to be sure he clears the lowest point in the cycle which is usually around +5 or +6. (5 or hours after shot)

    And definitely restart at 1 unit tomorrow.

    I will be here in 30.
    Wendy
     
  37. Wendy&Tiggy(GA)

    Wendy&Tiggy(GA) Well-Known Member

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    Nov 15, 2011
  38. Michele&Errol

    Michele&Errol Member

    Joined:
    Nov 28, 2013
    Yes thanks as soon as I took the reading I reread it a few times. Just wish I could get him to eat some more.
     
  39. Wendy&Tiggy(GA)

    Wendy&Tiggy(GA) Well-Known Member

    Joined:
    Nov 15, 2011
    How much did he eat today?
     
  40. Michele&Errol

    Michele&Errol Member

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    Nov 28, 2013
    Very difficult to give exact quantities as I have been offering him various things, most of which he has refused. About 2 teaspoons of Whiskas in the pouch, 1 1/2 chicken hearts, +-20g Hill Light, a few tiny pieces of lamb, a tablespoon of low fat milk.
     
  41. Wendy&Tiggy(GA)

    Wendy&Tiggy(GA) Well-Known Member

    Joined:
    Nov 15, 2011
    Thats probably about 100 calories. thats not too bad. Not enough, but not too bad.

    Whats his BG now? Its been 30 minutes right?

    Wendy
     
  42. Michele&Errol

    Michele&Errol Member

    Joined:
    Nov 28, 2013
    Ok, really battled to get enough blood eventually after 3 attempts. It's 8.2mmol/L as of 23h25 my time which was 4 minutes ago. Not sure what time zone you're in but probably about 6 - 8 hrs behind SA.
    (If my calculation is correct that's 147.6 )
     
  43. Wendy&Tiggy(GA)

    Wendy&Tiggy(GA) Well-Known Member

    Joined:
    Nov 15, 2011
    Yep its 4.30pm here right now.

    Ok his BG is pretty good. I would go snooze and set the alarm for another test in 2 hours to make sure it hasn't worn off. I will be here keeping an eye out for you.

    What makes you think it isn't pancreatitis?

    Wendy
     
  44. Michele&Errol

    Michele&Errol Member

    Joined:
    Nov 28, 2013
    That's the thing, he wasn't tested for anything other than the basics so I don't know for sure. I see that IDEXX does a blood test for it which they say is the most definitive diagnosis. I think we have an IDEXX in this country so will find out tomorrow.
    It says cats don't show many symptoms, but in your experience what would I be looking out for? Errol has only ever vomited if he has a hairball, has always been a very healthy cat and this diabetes seemed to come out of nowhere, which I know it didn't but there certainly weren't any signs I saw. Apart from having a very big appetite which is common to many cats apparently.

    Yes, I think I'll doze for a while and take BG again in 2 hrs as you say. I can barely keep my eyes open,not been sleeping since I got the diagnosis from the vet, waking up in a panic throughout the night. And now I feel so guilty about this hypo episode.
     
  45. Wendy&Tiggy(GA)

    Wendy&Tiggy(GA) Well-Known Member

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  46. Michele&Errol

    Michele&Errol Member

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    Nov 28, 2013
    About the only thing he will eat is what he ate before. He started leaving a little of his supper on last Tuesday evening. I took him to the vet on Wednesday morning. The week before he was his usual ravenous self. Since last Wednesday he seems not very hungry at all, and seems to only want to eat the Hills Light which he has been on for nearly a year.
     
  47. Wendy&Tiggy(GA)

    Wendy&Tiggy(GA) Well-Known Member

    Joined:
    Nov 15, 2011
    ok well its important he eats so keep him on the hills dry for now and keep trying other canned foods when you think he might want them. Then hopefully the insulin will start to do its job and he will feel better and starting eating more. and at that point we can work on transitioning the food to a good wet.

    Wendy
     
  48. Michele&Errol

    Michele&Errol Member

    Joined:
    Nov 28, 2013
    That's great advice Wendy, thanks. I shouldn't have tried to cold turkey him, I was just so worried I think I treated it all wrong. I thought the sooner I got him off the bad food the sooner he could recover and since he didn't really want to eat it anyway.. If he will eat the Hills WD instead of the Hills Light do you think I should rather let him have that and transition him over when he's feeling better?
    I spent most of Sunday trying to shop for good tinned food, to no avail. Limited choice. So I'm definitely in need of some ideas :)
     
  49. Wendy&Tiggy(GA)

    Wendy&Tiggy(GA) Well-Known Member

    Joined:
    Nov 15, 2011
    For now the goal is to get him to eat - so whatever he will eat.

    Then i would try

    Iams - maximum calorie plus is only 9% carbs.
    Hills - are all too high carb
    Royal Canin - recovery RS is 7% - otherwise they are all too high

    What kind of whiskas can you get access to? and what kind of fancy feasts? We might be able to find some low carb flavours.

    Also I sent a PM to another experienced member in South Africa to see what she feeds - I think its fancy feast but we will see.
    Wendy
     
  50. Michele&Errol

    Michele&Errol Member

    Joined:
    Nov 28, 2013
    Just tested and it's shot up to 18 (324).

    Thanks for the food ideas. I will find out exactly what Whiskas we can get. I couldn't find any FF pate of any sort, nor any Whiskas.

    Iams - maximum calorie plus is only 9% carbs : Iams SA does not import this particular one from the USA.
    Hills - are all too high carb : the only thing I could find at the 5 veterinary clinics I went to was Hills W/D which I bought a small bag of and he has just eaten a tablespoon of it. He refused point blank to even smell the Royal Canin RS
    Royal Canin - recovery RS is 7% - otherwise they are all too high : bought some tins this morning but he won't eat it.

    When I went to various supermarkets on Sunday I couldn't find any Whiskas or Fancy Feast pate. Just a very small selection of either pouches with gravy or jelly Whiskas and Fancy Feast just a few types with or without gravy. He will not even sniff any tinned food. The only food he will eat is Hills. Believe me, I have tried, and it is driving me crazy that he is so addicted to the stuff.

    At the one vet clinic I went to, the nurse said I must try the RC Diabetic Feline but she didn't have in stock so has ordered it and it should arrive at 6pm tonight. She said it has the best palatability.
    This is not what I want to be forced to do, having to feed him kibble, but the other option is starvation. Please don't think I'm not trying my best, at my total wits end. I haven't even eaten myself properly in days or slept much and am about to collapse.
     
  51. Wendy&Tiggy(GA)

    Wendy&Tiggy(GA) Well-Known Member

    Joined:
    Nov 15, 2011
    Ok you are good to sleep. he is bouncing now and may continue to do that for a day or two so just ignore the high numbers - its the bodies way of dealing with the low he had. Plus the dry won't help ;)

    Tomorrow 1 unit. Need to get you a spreadsheet too .

    nite nite!

    Wendy
     
  52. Michele&Errol

    Michele&Errol Member

    Joined:
    Nov 28, 2013
    05h00 : 18.1 (3 3/4hrs later).
    Thanks Wendy, we appreciate the help.
     
  53. Wendy&Tiggy(GA)

    Wendy&Tiggy(GA) Well-Known Member

    Joined:
    Nov 15, 2011
    No worries.. I am glad I could help.

    Just to clarify, he is now bouncing. Explained below.

    Bounces - what are they and is my cat doing them?
    When a cat isnt regulated, 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.

    Keep us updated and let me know if you need help with that spreadsheet.

    Wendy
     
  54. Michele&Errol

    Michele&Errol Member

    Joined:
    Nov 28, 2013
    He has just vomited up tiny bit of bile and 15 minutes ago had a huge drink.
    Shall I give insulin this am or miss it?
     
  55. BJM

    BJM Well-Known Member

    Joined:
    Oct 6, 2010
    What's his glucose level?
    Is it shot time?

    If he is able to keep down his food, go with the previously suggested 1 unit.
     
  56. Michele&Errol

    Michele&Errol Member

    Joined:
    Nov 28, 2013
    Hi BJM, 01h45 18.1; 05h00 18.1 (vomited small amt bile); 08h00 9.6 (missed shot); 10h23 10.3; 11h23 9.2 (+1) Hills w/d +-20gms; 14h50 19.9; 18h46 17.2 (+1 pre food and shot) +-15gms lean minced beef & +-25gms Hills w/d.
    1U given 10 minutes after eating to ensure he didn't throw up anything.
    Will take his BG in 1 hr.
    I'm working on the spreadsheet but will need some help I think. Thanks.
     
  57. Sue and Oliver (GA)

    Sue and Oliver (GA) Well-Known Member

    Joined:
    Dec 28, 2009
    Several ways to try to get him to eat the wet:
    Warm it up so it is nice and stinky.
    Add some warm water and make a gravy. Sometimes it is the texture they object to.
    Sprinkle on parmesan cheese, tuna juice, small bites of chicken or tuna or if nothing else works, crumbled pieces of dry.

    You are right; he has to eat. If he can't be persuaded yet, start slowly with a tiny bit of the wet you want him to eat and whatever he will eat. Slowly increase the wet and decrease the other. It is better to have him eat and adjust the insulin than not to have him eat at all.

    And breathe. This does not all have to be done overnight. He didn't become a diabetic in a week; he won't be fixed in a week. You are doing the important stuff. You're home testing and have him on a good insulin. You are working to get him on a good food. Take some time for yourself and enjoy him.
     
  58. Michele&Errol

    Michele&Errol Member

    Joined:
    Nov 28, 2013
    Thanks Sue. I'm getting him to eat the Hills w/d and / or the Royal Canin Feline Diabetic. He just point blank refuses to eat anything wet except some ground beef in very small amounts - even turning his nose up at tuna. I even tried crumbling some of his old food on top - no go. I will persevere with trying to get him off dry and onto wet but will have to take a bit longer than I'd like.
    This afternoon he was very quiet and seemed flat. Today 07h00 before eating 18.8mmol/L; 08h28 10.1; 15h32 16.5; 19h06 4.3 (didn't shoot at this low level). However, he started to perk up just before his supper time and is eating. The vet has prescribed Peri Actin to stimulate his appetite. Has this been used by anyone else here and did it make a difference?
     
  59. Wendy&Tiggy(GA)

    Wendy&Tiggy(GA) Well-Known Member

    Joined:
    Nov 15, 2011
    How are you getting along with the spreadsheet? Have you set up the google docs account? thats the first step.

    Also do your syringes have had unit markings? I see you are still needing to skip shots and I am wondering about reducing the dose again to 0.5.

    Wendy
     
  60. Sue and Oliver (GA)

    Sue and Oliver (GA) Well-Known Member

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    Dec 28, 2009
    Have you gotten the spreadsheet in your email yet?
     
  61. BJM

    BJM Well-Known Member

    Joined:
    Oct 6, 2010
    Just a note:
    If the glucose is really high - like over 500 and he isn't eating or is vomiting - check for ketones and it may be OK to give a token. Or decreased dose to knock the edge off the glucose level. Ask folks here.

    Rational: we've observed some vets, when they have you fast a diabetic pre surgery, may have you give half of the regular dose. Also, the body will break down fat for calories and can turn fat into glucose for use as needed. It also can break protein apart to create carbohydrate. This is why you normally don't need to give cats carbs - they can make them if needed.
     
  62. Deb & Wink

    Deb & Wink Well-Known Member

    Joined:
    Jan 31, 2013
    Both of those dry cat foods are very high in carbs. Royal Canin DD dry is 38% and Hill's W/d is around 37%.

    My foster cat Wink was on the Hill's W/d dry. It took many of these transitioning dry food addicts from dry to wet tips to get him to make the switch. I probably used 90% of those tips and tricks in that transitioning article. It took me about a month of a slow changeover and decreasing the amount of dry available while increasing the wet available. And lots of patience and persistence. But it was worth it, and Wink is still OTJ 9 months later.

    At first, Wink did not even recognize the wet food as something edible. ohmygod_smile He turned his nose up at every flavor I tried until I gave him the Fancy Feast Turkey & Giblet flavor. He loved that. Would not eat any other flavors for about a month. I was so afraid he would suddenly decide he hated the T&G and then where would we be. So, I slowly introduced other flavors, mixing in a tiny bit of a new flavor with his favorite T&G. He now eats about 6-7 flavors but still hates all the fishy flavors. :eek: :shock: :eek: Go figure. Maybe you have not hit on the right flavor to entice him yet.

    For now, your cat needs to eat most importantly. So be sure he will eat something, even if it is the higher carb dry food, and the switch over to a better low carb food may take some time. I thought the month that it took Wink to switch over to the wet food was really fast.
     
  63. Michele&Errol

    Michele&Errol Member

    Joined:
    Nov 28, 2013
    Thanks everyone. I've done the SS and hopefully it's gone through to you Sue.
    I will persevere with the wet food but it seems I may be putting him off it bearing in mind his current state : "Keep in mind that the best time to implement a diet change is when the cat is healthy. Trying to get an ill
    cat to embrace a new type of food can be problematic and a cat that is not feeling well may even develop
    a food aversion if they associate the new food with their discomfort. "
    So, I'll definitely keep on with it, but will now try and give him bits and pieces when I see he's feeling brighter. I know how easily we humans associate certain foods with periods when we feel unwell so do not want to jeopardise his chances of a quick transition. We'll get there with the food!

    Wendy, I'm using BD Micro-Fine Plus Demi syringes, man are they expensive here even at the largest chain pharmacy. I checked online and with the $ conversion rate, even more expensive to order online. I find the 100U insulin syringe far too difficult to get the exact amount (1U) so unfortunately can't use that. Also checked online for Contour TS test strips on e-bay but they are exactly the same price as here. Are there any generic test strips one can use with the Contour TS perhaps?

    I am having a huge problem with obtaining ketodiastix or ketostix. You can only get them in huge bulk quantities, their expiry day is very small and this makes them unaffordable at the moment. I'm still looking though. How long after collecting urine can it be used for checking for ketones??
    +++++++++++++++++++
    UPDATE: 1 3/4hrs post shot: Up to 20.5!!! Looking at his values on 3U and those on lower Units of insulin, to me it looks as if he should be on 3U? Please could someone help I'm really confused!
     
  64. Sue and Oliver (GA)

    Sue and Oliver (GA) Well-Known Member

    Joined:
    Dec 28, 2009
    Start a new topic and ask your dose questions (I don't use your insulin). Any time a thread gets 2 pages long, it's time to start a new one.

    The ketone are the same kind humans use. Ask at the pharmacy. I can't imagine that human diabetics have to buy in large quantities?

    I sent you a private message about the spreadsheet.
     
  65. Michele&Errol

    Michele&Errol Member

    Joined:
    Nov 28, 2013
    No, apparently the human diabetics did not buy the ketone things therefore they are not imported anymore.
     
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