Out of Options?

My cat was diagnosed with diabetes after I took him in for what I thought was a UTI. We have gone through on insulin and on Lantus now. I'm told that there are only two insulins for cats. I'm now giving Buggers 4 units 2x a day. His glucose was 343 this morning on 3 units. It seems he isn't responding to any of the insulin. What are my options if this insulin doesn't work. He has been on a diet of Prescription Diet M/D food. How do we know if its pancreatitis, heart disease or any of the other ailments that can cause the insulin from not absorbing.

 

Welcome to the FDMB! There are a lot of resources and members with a lot of knowledge to share.

First, I would say, you are not out of options. I need to know more to determine what is going on.

When did you start the lantus?
At what dose?
Do you home test?
How quickly did you make dose changes?
How many units did you raise at each step?
Whattests were the dose changes based on? nadirs or pre-shots? Fructosamine or BG curve at vet clinic?

It's very likely that m/d food is helping to keep the BG (blood glucose) numbers elevated.
Would you be willing to try a lower carb food than the m/d? That M/d is 14-16% carbs which we consider too high. We recommend <10% carbs. Fancy Feast classic pate style, Friskies pate style, Wellness are some of the lower cost options.

 

The Lantus was started two weeks ago(?). He was hospitalized at the vets for several days. The didn't believe we were giving him his insulin because there was no or little change with the previous insulin. No, no one has suggested to home test. I'm taking Buggers to the vet weekly to be tested. He has started Lantus and the previous insulin at 2 units. When I take him weekly, we then up the dose one unit. I don't know what tests the changes have been made on. I know she tests his blood and puts it on a accu-check like a human. I've never heard of Nadirs or pre-shots, fructosamine or BG. I actually thought the food wasn't' the best. We started him on the same food but canned. He was so hungry when we first started that I opted for the dry. This household has always had a bowl of dry out for the 4 cats we had at the time. So to ration one can a day wasn't cutting it initially. The vet told me the canned was better than the dry as far as carbs go. I'm willing to change foods to make him healthier. If I change foods, how soon would I or should I see a difference? Any particular Wellness flavor or variety?

 

Hiya,

Absolutely NOT 'out of options'...

Diabetes can seem totally overwhelming at first but it IS a disease that can be managed at home. So, 'chin up' sweetie!

In addition to Deb's questions, I would ask... Whereabouts are you? I'm guessing somewhere in the US?
And are you aware of any other health problems (or symptoms) that your cat may have.

Hang in there, hun, we really do want to help you.

Eliz

 

What is your name? I see your cats name is Buggers.

So to recap and explain some things. I did not mean to use terms you did not understand.

Lantus started about 5/15/13 at 2 units. This is a very high starting dose unless your cat weighs over 20 pounds. Most cats should be started on 1U (unit)

One unit (1U) increases of the Lantus insulin are not recommended. Our cats are so small, that such a large increase can bypass the appropriate dose. We recommend increasing in 0.25U increments.

Nadir - lowest point in the 12 hour insulin cycle
Pre-shot - blood glucose test taken before you give a shot of insulin
Fructosamine - blood test that takes an average of the blood glucose levels over the prior 3 weeks.


What size insulin syringes are you using? We recommend 3/10 cc, with 1/2 unit markings on the barrel to measure the tiny doses our cats need.

What insulin was he on before the Lantus?
How long was he on that insulin? From when ? to about 5/15/13?
How often are you giving the Lantus? This insulin is best if given BID (twice a day).
What is the diagnosis date for the diabetes?

Changes in dosing for Lantus are based on the nadir or lowest blood glucose reading in a 12 hour dosing cycle, not a single blood test. If a single blood test is how your vet has been making changes, you need to do something different.

Most of us here use human glucometers to test the blood glucose (BG) for our cats also.
What numbers did your vet get with these readings? Maybe call and ask on Monday.
Wellness, flavors from this foodchart: http://www.catinfo.org/docs/FoodChartPublic9-22-12.pdf Any of the Wellness grain free or Wellness Core grain free except for the Indoor and the Salmon/whitefish/herring flavors.

 

You definately are not out of options.

First the Lantus is a great insulin and I imagine its working fine... however...

As Deb said, the food isnt helping. Many members here feed the fancy feast classic pates, Friskies pates or Wellness grain free varieties. But here is a list of good low carb foods under 8% carbs: http://felinediabetes.com/FDMB/viewtopic.php?f=28&t=94685

I strongly recommend home testing, it will give you a much better idea of what is going on. For all we know he could start his blood high and drop real low during the day. Or he could be high all day. These could indicate not enough insulin, or even too much. And stress of being at the vet can spike blood glucose too. Home testing will tell you whats going on and we can help with that!


Wendy

 

You can go to Walmart or Krogers and buy a human glucometer and tests his bg levels at home before giving him his am and pm insulin shots. This is a good video that shows how you can do it. http://www.youtube.com/watch?v=kXyrKSJTlYA

I'm pretty new to all of this myself so I don't have much advice to give other than that. Good luck and I pray all goes well for Buggers.

Melody

 

If you are interested in learning to home test, we have a list of supplies to pick up that will cost you about $40.

 

Hi & welcome! You've been given lots of good advice here! You have lots of options. One thing: 2 weeks on Lantus is most cetainly not a very long time at all; you have to be patient. And I'm willing to bet that when you get rid of all the dry food, and feed him low carb, wet food only, he may have lower BG levels, however, it is imperative that you start testing him at home. Really--I didn't want to start hometesting my kitty, Gobbles, when he was initially diagnosed, but with the help of the FDMB members and the Lantus insulin support user group, I became a great hometester! After only 6 months since Gobbles' diagnosis, he is now no longer taking insulin Feel free to take a look at his spreadsheet; it took a while to get him in good regulation, as you'll see. We will give you all the help you ask for. Hang in there

 

I'm lost. I need a low-carb canned food for Buggers. The list that was posted states that diabetic cats need under 250 phosphorus, yet majority of them are above 250. I'm Susan by the way.

 

Hi and welcome to FDMB.

First, 4 units twice a day is a very high dose. Especially since you have only been on Lantus for such a short time. What may be happening is that you have already missed your optimal dose. When too much insulin is given, the cat's body responds by producing extra glucose in order to prevent hypoglycemia. However, this is no guarrantee that your cat will not become hypoglycemic.

My recommendation would be to start giving only 1 unit twice a day and gradually increasing over a period of weeks if needed. You will need to keep the dose consistant for at least one week. With Lantus you cannot keep changing doses per shot, it does not work that way. Also, your cat will need at least one week at a consistant dose before you can determine if it needs to be changed. It takes that long for a cat's body to adjust to the dose change.

Second, if you are feeding dry, that is also contributing to your high numbers. Dry food it high in carbs. However, before you remove dry from his diet or change to a low carb canned food, you must decrease his insulin. Right now, that may be the only thing keeping him from becoming hypoglycemic. Hypoglycemia can be extremely dangerous and possibly cause death.

It is possible that there are other reasons for the BG levels to be high, but I would try reducing the insulin first to see if that is the cause. I know this does not sound like that it makes sense, however there is a condition called Somogyi rebound. What happens is that when blood sugar levels drop too far or too fast, your pet will defensively dump stored glucose from the liver into their bloodstream, resulting in high blood sugar. So by reducing the dose and then after staying on that dose for at least one week, if needed, you can increase it by 1/2 unit. Then you stay at the new dose again for at least one week before adjusting it again. Eventually you will find your optimal dose. Most cats only need between 1 - 2 units per shot.

 

You only need the under 250 phosphorus if your kitty has chronic kidney disease as well as the diabetes. Does Buggers have kidney disease?

 

No he doesn't. Should I switch foods of consult with his vet tomorrow first?

 

susan
can you post where abouts you are from. there may be a member close to you that can meet you and go over all that you need to know. one on one with a member here is of great help

 

Before you switch foods you should start home testing as that will reduce his blood sugar! Are you willing to try that?

 

Please, stop for just a minute and take a couple of deep breaths, hold, release. Breath, hold, release. Again. Again. This will help to manage all that stress we are causing you by dumping all this information on you so quickly.

Consulting first with your vet tomorrow about the food choice is certainly one option. You may want to read the AAHA Diabetes Management Guidelines for Dogs and Cats, a vet journal article published in June 2010. http://www.aahanet.org/PublicDocuments/AAHADiabetesGuidelines.pdf It mentions feeding your cat the food with the lowest carb content your cat will tolerate.

There is nothing special about that Hill's m/d, neither the quality of the ingredients or the nutritional quality and usefulness for a diabetic cat. It is lower in carbs than a lot of other foods, but there are a lot of commercial canned foods that are even better - and cost a whole lot less to boot.

Another option would be to switch to a low carb food on this food chart: http://www.catinfo.org/docs/FoodChartPublic9-22-12.pdf Any food with less than 10% carb content, third column of numbers, is acceptable for a diabetic cat.

You don't know us. We are strangers on the internet. You don't know if you can trust us. But we do know an awful lot about feline diabetes. We probably see more diabetic cats in a week than your vet will see in a year or more.

 

I live in Grundy Center, Iowa. I don't know if I want to do home testing. One thing I remember is that when Buggers was hospitalized for several days because the vet didn't think we were giving him his insulin. No matter what we increased the insulin levels to, the glucose seemed to stay the same. While he was there, she would draw his blood periodically, she said his levels never dropped throughout the day.

What are the treatments for that smogoby thing

 

Somogyi Effect, Somogyi rebound or bouncing as we call it, is caused by a number of factors. The 'treatment' is to give your cat the correct amount of insulin.

Mainly, it takes time for a cat's body to become readjusted to lower numbers after insulin is started.

It can be caused by insulin overdose, that is too much insulin. It can be caused by those steep and rapid drops in the blood glucose numbers. . A cat not on a low carb diet sees this effect more often.

The main way we know bouncing is occurring, is by home testing. Something you have said you are not ready to start yet.

You might want to read this article to get a better understanding. http://petdiabetes.wikia.com/wiki/Somogyi_rebound Some vets do not believe in this rebound effect and will not consider it as a factor in how the cat is doing. We here have seen many cases of this happening all too frequently and are believers in the rebounding or 'Bouncing'. You only have to look at half a dozen spreadsheets to see the bouncing in action.

 

There's a lot of info to learn; you may find it useful to read my signature link on Learning Tips.

Also, you may find it useful to read my link on Secondary Monitoring Tools, especially on urine ketone testing. Ketones are a by-product of fat breakdown. Too many ketones may indicate diabetic ketoacidosis, a potentially fatal, expensive to treat, complication of diabetes.

 

What size insulin syringes are you using? We recommend 3/10 cc, with 1/2 unit markings on the barrel to measure the tiny doses our cats need.

What insulin was he on before the Lantus?
How long was he on that insulin? From when ? to about 5/15/13?
How often are you giving the Lantus? This insulin is best if given BID (twice a day).
What is the diagnosis date for the diabetes?

Yes we give him Lantus 2x a day with a 3/10 syringe. He is tested weekly before a change is made. He weighs right about 10lbs. If 4 units is too high what should he be getting and how long would have to be on it before his blood sugars drop? I'm asking because if he has somogyi it must take time to correct itself.


Susan

 

Testing weekly (if you mean just once in a week) is certainly not the way to make changes to his insulin. On Lantus, changes are made based on a cat's nadir, which is the lowest point in a 12 hour cycle; for many, many cats the nadir is reached 6 hours after the insulin shot is give. And my goodness, 4 units is very, very high--starting doses are based what your cat's normal weight should be. For a 10 pound cat, I would say the starting dose should only be 1 unit every 12 hours. I'm sure someone will jump in here regarding a starting dose for him. What should his normal weight be? The reason I'm asking is because a lot of cats have lost weight when diagnosed with diabetes....

 

I cannot answer your question re: how long he would have to be on it before his sugar drops, but the goal with Lantus is always to get kitty well-regulated with low, safe blood glucose levels. It took my Gobbles about 5 months to get "well regulate" and 6 months to go "OTJ", which means "off the juice"...for more than 2 weeks now, he has had NO insulin and I attribute that to (1) being a member of this board (2) all the help, support and education I've received here and the Lantus Tight Regulation group, and (3) following the Lantus Tight Regulation Protocol. Feel free to take a peek at Gobbles' SS and you can see how his Lantus journey went--though ECID (every cat is different); your cat may respond much quicker than him....you're on the right track by becoming a member here.

 

He has lost weight and gained it back. He is now and always been around 10lbs. He didn't lose a lot of weight. He laid at the back door for several weeks after having surgery on his mouth because of an abscess that didn't go away. He had a chicken bone sliver stuck in his mouth. We thought he was feeling well because of all that had gone on. Then he stood in front of us all and peed. I took him in thinking it was a UTI. She took him in the other room and did the analysis and told me his ketones were high and he was diabetic. We always start at 2 units for a new insulin and increase it one unit weekly. She stated that it was a week for the insulin to regulate itself. My other option is to take him to a Vet College. Maybe even call and consult with them, I asked the vet to do the same because she knows more of the terminology and medicines compared to me.

I'm hoping he won't live on insulin. TheBowHuntress, is Gobbles now on low-carb diet?

 

Here's the formula for determining the initial dose of Lantus:

The formula is initial dose = 0.25 x ideal weight in kilograms. So if at cat's normal weight is/should be 10 pounds:

10 pounds = 4.53 kilograms

0.25 x 4.53 = 1.13 units

 

We need some more specific information to help you out better. I know there are a lot of questions here, but we really do need this information to know what is going on.

1. What kind of testing is done at the vets? Is a curve done? A curve is testing every 2 hours for a 12 hour period, starting with a test just before the normal shot time.

1B. Is your cat calm and relaxed at the vet or is he nervous, scared, excited? This can raise BG readings by 180 points, takes <5 minutes and lasts for >90 minutes. The Blood glucose readings taken at the vet may be higher, much higher than they are at home.

1C. Is a single blood test done with a glucometer or other blood analyser at the vets?

All these factors can result in too much insulin being prescribed for your cat.
1D. Would you list the dates and the BG (blood glucose) numbers you got. Your vet should be able to provide you with these as well as the times they were taken.

2. How often was the dose increased? Should be no more frequently than every 3-5 days. Looks like you increased every 7 days. Is that correct?
3. How much was the dose raised each time? 0.25U? 0.5U? 1U? Should be in only 0.25U increments at a time. I see from your post that you started at 2u and increased by 1U each time. Too much, too fast. Drop the dose immediately to 1U .
4. That dose is very high. 4 units of Lantus probably means you have bypassed a good dose for your cat
5. What was the starting dose for Lantus?
6. What insulin were you using before the Lantus?
6B. What date did you start this other insulin?
7. When was your cat diagnosed with diabetes?
8. Have you ever skipped giving a shot of the Lantus insulin?
9. Are the insulin shots given 12 hours apart? Or is there some variation from day to day?

 

Yes, Gobbles is (as well as my other 2 cats) and always will be on a low-cab diet. They never get dry food now. They eat fancy feast and friskies wet catfood; any flavor that is less than 8% carbs...Increasing a whole unit a week is extremely dangerous--your cat could of been in danger of a hypo; which could result in seizures, coma and even death HOWEVER if you hometest (and I am virtually begging you to please try it--we will help you and you will get to be a "pro" at it very shortly...please consider this) you would know where his blood glucose levels are; and a spreadsheet is imperative, to keep your cat safe, to chart his blood glucose, to see what works for him, to know when adjust the dose and so that we can help you. Your vet is absolutely wrong about the "it was a week for the insulin to regulate itself"... And OMGee, yes! take him to a Vet College. I would not ask the vet to do it; is it possible to call and make an appointment? If you are going to do that, we will give you some information to print out and bring with you; most likely, the students/vets at a college know all about the Lantus Protocol.

Here's something to read, when you get a chance (I printed it out when I was a newbie and probably consulted it at least a dozen times); this would also be beneficial to take to the college: http://felinediabetes.com/FDMB/viewtopic.php?f=9&t=1581

 

And we always round down to the nearest quarter unit (0.25U) for safety and ease of measurement.

 

1. What kind of testing is done at the vets? Is a curve done? A curve is testing every 2 hours for a 12 hour period, starting with a test just before the normal shot time.

1B. Is your cat calm and relaxed at the vet or is he nervous, scared, excited? This can raise BG readings by 180 points, takes <5 minutes and lasts for >90 minutes. The Blood glucose readings taken at the vet may be higher, much higher than they are at home.

1C. Is a single blood test done with a glucometer or other blood analyser at the vets? Yes once a week I take Buggers to have his blood tested on a accu-check.

All these factors can result in too much insulin being prescribed for your cat.
1D. Would you list the dates and the BG (blood glucose) numbers you got. Your vet should be able to provide you with these as well as the times they were taken.

2. How often was the dose increased? Should be no more frequently than every 3-5 days. Looks like you increased every 7 days. Is that correct? Yes, we go every Saturday now and increase the insulin one unit.
3. How much was the dose raised each time? 0.25U? 0.5U? 1U? Should be in only 0.25U increments at a time. I see from your post that you started at 2u and increased by 1U each time. Too much, too fast. Drop the dose immediately to 1U .
4. That dose is very high. 4 units of Lantus probably means you have bypassed a good dose for your cat
5. What was the starting dose for Lantus? It was 2 units started May 22
6. What insulin were you using before the Lantus? PZI
6B. What date did you start this other insulin? Started April 17th ( these are rough estimates. I'm going by my calendar)
7. When was your cat diagnosed with diabetes? I wasn't to say April 10th maybe. I don't have an appointment listed.
8. Have you ever skipped giving a shot of the Lantus insulin? No, there was once that I missed a dose of PZI. He went out before I could give it to him. I was told it was no big deal.
9. Are the insulin shots given 12 hours apart? Or is there some variation from day to day? They are supposed to be every 12 hours. I will vary them 30 minutes because I don't want to stay up until 9:00 to give him his medicine or get up at 6:30 in the morning.

I was on the phone with my vet earlier. She stated she will call the school and see what they suggest. She hasn't had continuing ed. for a couple of years. I talked about switching foods. We have started out on Prescription Diet M/D canned. They told me to only give him one can a day but he was howling for more. We always have had a dish of dry out. Also have other cats so it was an issue to Saran Wrap Buggers food so the others wouldn't eat it. Cost to much to feed 4 cats. At least if it's Friskies they all used to eat that and not a big deal. I hope she gets a lot of suggestions. Also as far as home testing, she doesn't recommend it. She says some people will then adjust the insulin like humans, and it's not ideal. I'm fine with that at this point.

 

Please print out the 2010 American Animal Hospital Association guidelines linked above, read them yourself, and provide them to your vet. Then discuss them as they apply to your cat.

Also provide her with this link University of Queensland Centre for Companion Animal Health which has several veterinary articles by Dr Rand, an international expert in feline diabetes.

Additionally, Dr Pierson has a website http://www.CatInfo.org with a great deal of information on feline nutrition which she has researched extensively. Your vet should find that quite interesting, too.

 

So, to clarify, you have a single blood test done at the vets. done using an Accucheck glucometer. Please verify that only a single test is taken.

 

Every week before she increases the insulin. Yes. Why is this not normal?

 

Vet stress may elevate the glucose level from 100 - 180 mg/dL, even in the calm-appearing cat. Therefore, a single test in the vet's office has a high probability of being erroneous. A fructosamine is a better test of average control as it reflects the average glucose levels of the preceeding couple of weeks. However, averages do not tell you if the cat hit any hypoglycemic levels, nor if there were any periods of extreme highs.

Also, doseage adjustments for Lantus and Levemir are to be made on the nadir - not the fasting, pre-shot glucose level. Some cats may swing as much as 200-300 points between pre-shot and nadir. Ex - if you increased based on a pre-shot of 320, you could easily send your cat down as low as 20 at nadir - a potentially fatal hypo. The idea is to get a safe dose that may be given twice a day, that does not go below 50 mg/dL, and otherwise keeps the glucose levels as low as reasonably possible. This is how the Lantus Tight Regulation protocol works using home testing to monitor for safety in giving and modifying the dose.

My signature link Secondary Monitoring Tools has instructions for urine ketone and glucose testing. These are indirect, and reflect what was occuring during the previous few hours. Glucose in the urine means the renal threshold has been exceeded and glucose may be damaging organs in the body. Ketones mean that fat is being broken down for calories; too many of these may indicate diabetic ketoacidosis, which can be fatal.

 

Lantus dosing changes are based on the nadir or lowest point in the 12 hour insulin cycle. What your vet is doing is not basing the changes on the nadir. She is basing the change on some random number that has no relationship to how the insulin dose is affecting him.

Other insulins might be able to be dosed this way. Not Lantus or Levimir.

With lantus, the nadir usually occurs somewhere between +5 to +7 after the shot. Some cats are earlier. Some cats are later.

Increases of 1 unit, based on a random number taken at your vet, not the nadir, are too much of an increase at one time and not based on a scientifically based protocol. I have no idea how your vet determined this was the proper way to change the dose on Lantus but she is misinformed.

You might want to share this dosing protocol with your vet: http://www.felinediabetes.com/Roomp_Rand_2008 dosing_testing protocol.pdf This was developed by the University of Queensland, where there are some of the top feline diabetes researchers in the world.

My recommendations based on my experiences:
1. Drop the dose back to 1U, bid, 12 hours apart or as close to as feasible.
2. Feed low carb canned food, Fancy Feast classic pate or Friskies pate style
3. Learn to home test. So you can keep your cat safe. So you can adjust the dose based on the nadir you will find during testing.
4. If you do not want to home test, your vet needs to run a curve once at week. Tests every 2 hours for a 12 hour period, starting with the insulin shot time. This is the only way to find the right dose. Having the curve done at the vets will be expensive and the numbers will be inflated due to the vet stress phenomenon.
5. Increase or decrease dose in no more than 0.25U increments.

 

So what do you think? Want to give home testing a try?

 

I highly suggest it. I never did it until recently and it's made a huge difference.

 

I'm going to hold off on home testing. The vet got a return phone call from Iowa State college vet school. The vet school was in agreeance with everything she is doing. They did tell her that she should do a Curve after 10 days on the new insulin, Lantus. The school doesn't think it is somobgy effect. I am hoping it is that effect that means we can give him a lower dose of insulin. The college agrees that we should stay on this food. I will see if I can research the carb in Friskies on their website. Just to double check all the information you all have given me, which is ALOT!

 

The carbs in friskies are in the link below researched by dr Lisa Pierson DVM. Column c % calories from carbs should be less than 10%

http://www.catinfo.org/docs/FoodChartPublic9-22-12.pdf

 

If you are not going to blood glucose test, then I strongly encourage urine glucose and ketone testing. Glucose in the urine means that since the last void, the blood glucose exceeded the renal threshold and spilled into the urine. Ketones (a by-product of fat breakdown for energy) in the urine may indicate diabetic ketoacidosis (DKA). DKA is a potentially fatal, expensive to treat, complication of diabetes.

Another possible indicator for DKA is if the breath smells fruity or like nail polish remover (acetone is a type of ketone).

Monitoring water consumption is helpful - excessive thirst suggests lack of control OR another condition.

You may check for dehydration by gently pulling up the scruff then releasing. If the fur stays pulled up - tented - moderate to severe dehydration may be present. To check for mild dehydration, press your finger on the gums and release. If it pinks right back and feels moist, all is well. If the gums are sticky/tacky and it takes a while for the gums to pink up, mild to severe dehydration may be present.

Checking weight regularly is another useful assessment as continued weight loss suggests lack of control while stabilization of weight and if underweight, regaining weight suggests control is improved.

 

Hi Susie, I agree with everything that our members have said. I truly hope your kitty gets better (and stays safe) and that there are no complications such as DKA or a hypo; both of which can be deadly. Please ask any questions you may have; we truly are trying to help in the best interests of your cat. The information and experience from the members here is so vast.

The two things I read that are in your/you cat's favor is that your cat has been prescribed Lantus and a curve has been suggested (not done by the vet, but in the comfort of your home)While I certainly am not a degree'd vet, I know quite a bit more than most vets in regard to Feline Diabetes; for the past 7 months, I have had experience and have dealt with FD 24/7. My cat was diagnosed in November 2012 and I know that the information I have received here, along with the education (and esp. home testing) has saved my cat's life. I am happy to say that it has been almost a month now since he is insulin-free.

There were many times that his sugar had gone dangerously low, and if I had not intervened, he could of, and most likely may have gone into a coma and worst, could of died. Of course; I would never have known that if I wasn't testing him. And about the vet doing a curve every week? My goodness, the money it is going to cost you; doing a curve at home is a cake walk, literally would cost your less than a dollar, once you have a little bit of home testing "under the belt". I certainly saved $100s of dollars by doing my own curves, plus I didn't have to leave my cat locked in a cage for 12 hours and being jabbed by someone he didn't know.

Consider it this way: if your cat were your child--would you do the same? I consider my cat to be my child (along with the 5 human ones I have) and would never shoot insulin n them without knowing if their blood glucose was low; it could be dangerous to them. My heart goes out to you--you are receiving a lot of information from both sides and I can tell you truly love your cat and would like to see him/her healed. And then the stress and overwhelming information, having our little ones sick is/can be an overload. I have been there and done that--not fun. Hang in there; it is possible to manage FD mostly on your own, with the goal of remission. Good luck

 

So, to recap:

1. No home testing
2. curve to be done at vet in 10 days
3. food Hill's m/d canned (14% carbs)
4. Lantus 2U BID

Is this correct?

 

Yes Deb but it is 4 units BID. You all have made me feel bad because I don't want to home test After the curve, I will try the Friskies. I can't be on this expensive food for long. I have a dish out so all 4 cats eat it. I think it last 3 or 4 weeks. They all like their canned food, so it's a better alternative. I scrolled down the member list and saw one person from Iowa. I messaged her but haven't heard back. There were initials after her name, like (GD). Is that right and what does it mean?

 

GA is gone ahead or Guardian Angel, for those cats who have passed.

Friskies in the 13 oz can runs about $0.78 to $0.84 a can in Columbus Ohio and I'm feeding all 14 cats on that, about 7 cans a day. I've had cats with renal disease, before I knew about wet diets, and watching them die slowly from kidney failure was pretty awful. If a wet diet will help to prevent that, I'm going to do it. The heartache it saves me is worth it to me. Your mileage may vary.

 

Not trying to make you feel bad, just need to know the basics, so we can help you from there. We mention the no home testing because then people will suggest things like the secondary monitoring tools like BJM did.

One reason we mentioned the Friskies and Fancy Feast before, is because they are two lower costs options then the prescription foods. They are also available in a wide variety of flavors and the Hill's m/d is only available in one flavor. You know how cats can be picky and turn their nose up in the evening at a food they scarfed down in 2 minutes in the morning.

Could you tell me the members name that was from Iowa? She may not be very active on the forum right now. I'll check.

Please pick up the test strips at your pharmacy or drug store. You want the ones that check for both ketones and glucose.

A jump from 2U to 4U of lantus is a really big jump and a really high dose of insulin. That is what is getting us concerned. Too much insulin can drop the BG (blood glucose) numbers down too far, resulting in hypoglycemia.

Here are the hypo symptoms to watch for and how to treat a hypo.
http://felinediabetes.com/FDMB/viewtopic.php?f=28&t=15887

Do you have your hypo toolkit ready just in case? Here is a list of supplies in this link http://felinediabetes.com/FDMB/viewtopic.php?f=14&t=2354

 

Susie,
I will try to explain why it's important to test before giving a shot.

Human diabetics test before giving a shot; they poke the tip of their finger to get a drop of blood and then the drop is sipped up a test strip that they put into their meter.... lots of people use the accu-chek and so can you. Also, humans test during the day because they need to track how the food they are eating is affecting their numbers. If they don't keep track, they could go too low, and fall into a diabetic coma and end up in the ER. If they test and find their number is low, they adjust their dose.

So, that's what people do here for their cats; they put a test strip into the meter, then poke the edge of the cat's ear, sip the drop of blood on the strip and the meter gives them a number. If the meter shows them a low number, they may skip the shot entirely.... if they had not tested, and just gave the shot like usual, their cat could go into a coma, just like humans, and you would end up in the ER with your cat, trying to save his life.

Now, here's another reason why testing is a good idea.

How come your cat has been diagnosed as diabetic? Because blood sugar is high, pancreas is not working well, and not enough insulin is being produced.
Any other reason for this diagnosis? Sure! The cat could be eating a diet that is too high in carbs, so you could switch to a low carb wet food diet, and your cat will no longer need help with insulin shots.
Why are you giving your cat shots of insulin? Because you are helping out his pancreas, and giving it time to heal, hopefully.
How long will it take before my cat will not need insulin? It will depend on a few things.... is his pancreas not functioning 100% but just needs a rest, or is the diet just overloading the pancreas? Only time, a diet change, and maybe some insulin will give you the answer.

Now, let's say that you were feeding too many carbs, or the pancreas needed a bit of time to heal, how will you know if your cat needs less insulin? By testing his numbers, and it would sure be nice if your cat could decide to be at a low number exactly when the vet tests him but that's not likely.... First, there is vet stress and that alone will cause your cat's number to be higher at the vet, plus what if the vet tests your cat when the insulin is wearing off.... so you have vet stress + high numbers because the insulin is worn off. Let's consider another way.

You are at home, and your cat is relaxed, in his favorite spot, waiting for breakfast. You can put a strip into the meter, get an accu-check if you like, then take the meter and the lancet device to poke the edge of the cat's ear. You push the strip into the meter so that it's ready, poke the edge of the cat's ear, sip the drop up the test strip and there you go./... just like at the vet, you have a number.
Both of my two cats pretty much slept thru having their ears poked, so it's not painful. You are already measuring insulin and giving shots, so you will have no problem with home testing.

Now, let's say you test your cat just before his morning shot, and the number you get is a 79. What's that mean? Whoa! no shot because that's a great non-diabetic number!

So now you know why people are saying to home test.... they are not trying to be mean or make you feel badly, that you don't care for your cat, but rather it's the opposite! They know that you care a great deal and you are trying to do the best, but sadly, vets are not as great as we wish they were. Most of them don't bother to mention testing because they think their clients will refuse and just forget about even giving insulin at all if they have to test.

We know that you are not one of them because you are already giving shots and taking your cat to the vet every week for a single test that you could do at home.
Save yourself the time and effort of weekly trips and cut out your poor cat's stress from having to go to the vet all the time. Just pick up a meter and test strips and lancets for the poking device. Before you know it, YOU will be an expert and able to post and help others who join this site later!

Last, getting back to that pancreas of your cat's..... your giving insulin has allowed the pancreas to heal and while it could do only 80% of the work before, it's better now and can do maybe 90%, so you will get better numbers from testing before each shot, and you can drop the dose.... from 4u to 3u to 2.5u to 2u to 1.75u and so on. As the pancreas heals and needs less help from you to give insulin shots, it's going to let you know in the numbers..... lower numbers mean "I am feeling better and you don't need to help me as much."

One other thing to mention.....you are giving your cat a higher dose than the majority of diabetic cats ever need, so others are very worried for you and your cat... the reason they are pushing you to test.
There are conditions where cats DO need higher doses of insulin, much higher than you are giving your cat right now... some cats have acromegaly which is caused by a pituitary tumor secreting excess growth hormone. The condition can be treated, but the only way to know if the dose you are giving now is good, too much, or too little, is by home testing.

Every one of us here arrived knowing little or nothing at all, and we were where you are now. Worried and overwhelmed, and just wanting to get our cat better. Because we were where you are, we are paying back for all the help we got from others.

To know the road ahead, ask the man coming back.

Gayle

 

Oh, sweetie--please don't feel bad. We mean well in all of the information we're providing to you. Believe me, we truly have you & your kitty's best interest at heart, and are worried about your precious friend.

I am truly sorry if I've offended you; it is just so important to me to see your kitty get better. I, too, felt bad because I didn't want to home test; I even got mad at a lot of the members who were giving me good advice (at the time, I took it offensively and felt that these members were bullying me a little). I quit posting for a while, and lurked the boards; you can even see on Gobbles' spreadsheet in his early days when I either didn't test or tested very little.

It is very heartbreaking when I read about all the kitties who've been diagnosed. I know how it feels; I used to cry all the time--my heart was so broken as I watched my Gobbles suffering. When I finally started to take some of the advice I was given, it felt like someone was holding my hand.

I'll help you all I can. I am an advocate for feline diabetes. Feel free to PM me; I have some supplies that you may be able to use. Again, I am very sorry if I hurt you.

 

The Bow Huntress, that is how I feel. It is almost every post someone says, no one in particular, "no home testing?" It is a lot to take in and I'm new to the diagnosis and the whole dynamic of diabetes. I'm trying to take it one step at a time. At least now when I talk to my vet, I have questions about things you all have posted here. I think she thinks I'm learning some and asking her why certain things aren't being done. I've told her that I want to switch foods and I will after his curve is done next week. I asked, may be someone here would know, how much his glucose would drop if we switched foods. He is eating a food that is 14% carbs, and if I put him on one that is >8%, would I see a significant drop in his levels?

I seems that my posts get misconstrued. Buggers insulin is increased 1 unit a week. Someone posted that he jumped from 2 to 4, yes but in a 2 week time.

 

Increasing insulin by full units may skip over the optimal dose.

Changing to a low carb diet from a high carb food may reduce the glucose 100 points. I've not seen (nor gone looking) for a post saying how much change there is going from medium to low carb.

 

Hi an welcome! Don't think I've ever replied to you before, but that's only because you've already been getting such amazing help from everyone else. ;-)

One thing you can do to help us not "pester" you :lol: is edit your signature (go to "User control panel" in the top left corner of the page) and put in something like "not home testing yet" or "will start home testing on XX date" or "home testing under consideration" or something along those lines.

As for removing the dry food, we usually don't recommend doing it if you're not home testing because it can cause BGs to drop significantly (some cats as much as 100 to 200 points or more), requiring an insulin dose reduction. This steep drop in points can happen over a couple of days, a couple of weeks, or literally overnight (ECID at play again). If you do remove the dry without testing, I would suggest you reduce the dose automatically. I would suggest starting over again at 1u once the dry is completely gone because it really can have that big of an impact on numbers. Someone else might suggest a different "re-start" dose, but either way, you will definitely need to decrease the dose.

An example of how much carbs can affect a kitty's BGs is with my cat, Michelangelo, who is super carb-sensitive. He normally gets around 5% carbs or less. When he's running lower than I'm comfortable with, I'll feed him 8% carbs and his numbers will jump about 20 to 50 points from that alone. Again, ECID, depending on carb sensitivity and even if the pancreas is still working a little bit.

 

Thanks for the advise KPassa. I didn't realize that switching to canned foods would drop his glucose that significantly. I'm happy to hear that since his BG seems to stay in the mid-300's. I'm going to start with the dry to canned food switch first.

If I were to home test, how do I know or where do I learn how much insulin to draw up for his BG levels? Is there a starter Accu-Check kit or do I buy everything separate?

 

With Lantus, for most cats on low carb, wet food, they generally don't need any more than 1u as a starting dose (that's why I suggested dropping it back to 1u). When switched to low carb food, some cats might not even need that much insulin and even better, some cats simply become "diet controlled," meaning they don't even require insulin injections any more. The only way to know for sure is home testing. Since your cat has been running in the 300s, I would still think he might need a spot of insulin, at least for a little longer after the food switch. It is up to you if you feel comfortable enough using Secondary Monitoring Tools (I think someone linked to them above) and giving 1u for a bit or if you want to hold off on giving any insulin until you can start home testing or you can take him back into the vet for another curve to see how he's doing on only wet food.

As for glucometers, it depends on which one you buy. Many of us prefer the Walmart ReliOn brand because it's the least expensive when it comes to test strips (which is where the true cost of testing is at). For the ReliOns, they sell the strips separately. Some of the meters come with a lancing pen and a few lancets; some of them do not, so check the box and see what is included. If it doesn't contain a lancing device and/or lancets, you'll have to buy those separately. There's a "Getting Started" shopping list in the "3 steps" link in my signature that migh help you.

• To sum up:
• 1 glucometer (any will do, just stay away from the ones with "Tru" or "Free" in the name because those have been reported as giving incorrect results when used on cats). These usually run around $15.
• Box or two of matching strips for the glucometer. The ReliOn Prime strips are $9 for a box of 50, the ReliOn Confirm/Micro strips are $36 for a box of 100 (they don't sell boxes of 50 in my area), the Accu-Chek Nano strips are around $50 (or more) for a box of 100. The ReliOn Confirm and Micro require the least amount of blood, which is very helpful when starting out. If cost is a factor, then the Prime is the absolute cheapest around, however, don't get discouraged if you don't get a lot of "successful" tests in the first couple of weeks due to too little blood.
• A lancing device, if you want to use one (my favorite device is the Accu-Chek FastClix). If these come with the glucometer, then it's free. If not, check the Supply Closet on this board because lots of people give theirs away for free if they don't use them. Otherwise, I think these cost around $10, IIRC.
• Matching lancets for the device or a box of regular lancets if you want to try free-hand (some people prefer this method because it can give you better control). These cost anywhere from a couple of dollars for a box of 100 to around $10 for device-specific ones (like my Accu-Chek FastClix, for example, but I reuse my lancets so it comes out fairly even).
• (optional) A box of "alternate testing site" lancets - these are useful when first testing because they are a bigger gauge and help with getting blood if you're having difficulties with the smaller sized lancets.

 

Here's a shopping list

Getting started shopping list
1. Meter ie Walmart Relion Confirm or Micro.
2. Matching strips
3. Lancets - little sticks to poke the ear to get blood . new members usually start with a larger gauge lancet such as 28g or 29g until the ear learns to bleed. Optional - lancing tool.
4. Cotton balls to stem the blood
5. Neosporin or Polysporin ointment to heal the wound
6. Mini flashlight (optional) - useful to help see the ear veins in dark cats, and to press against
7. Ketone urine test strips ie ketodiastix - Important to check ketones when blood is high
8. Sharps container - to dispose of waste syringes and lancets.
9. Treats for the cat - like freeze dried chicken
10. Karo syrup/corn syrup or honey if you dont have it at home - for hypo emergencies to bring blood sugar up fast
11. A couple of cans of fancy feast gravy lovers or other high carb gravy food- for hypo emergencies to bring blood sugar up fast

 

Thanks, Wendy! I knew there was a complete shopping list floating around here somewhere. :lol:

 

some kitties actually can become diet-controlled diabetics.....mot always, but ya never know

 

The curve test went wrong today. His first draw read 422 and 1 1/2 hours later it was 483 and then 573. She found an infected pea-sized tumor on his gums. She is thinking this is for the resistance all along! She will do the curve again in 10 days after this growth is cut off today. She also is willing to try the Friskies diet and see if there is any difference after the next curve test. I'm happy that she is willing to work with me. I just wish my printer was working to show her some of the spreadsheets that are posted.

 

I'm certainly no expert, but I'd think that could cause some wonky numbers!!

Good to hear your vet is willing to work with you too. What I did was give my vet the URL of the message board so he could do a little "educating" on his own!

Be sure to only get the Friskies pate's....the ones with gravy and sauces are too high in carbs. From what I've learned, we're shooting for 10% or under

Here's a link to a list of a lot of the foods and their breakdown...Carbs is the 3rd column of numbers (scroll down a little way to find brands/flavors/types)
http://www.catinfo.org/docs/FoodChartPublic9-22-12.pdf

 

ANY infection can cause the blood sugar to rise as a result and he could come down quite rapidly once the infection is gone! Did the vet put Buggers on antibiotics too?

And a change to a low carb food will help too. But you need to be real careful here, both these things could cause an almost immediate drop in BG... especially removal of the infection.

I know you havent started home testing and I wish you would as I am very worried here about this setting Buggers up for a hypo . So...

1. did the vet recommend an insulin decrease? My cat, I am cutting the insulin in half at least and testing the urine for sugar (? can you do that? Urine test strips are cheap)
2. Test the urine for sugar - if you dont see sugar - call the vet and reduce the dose
3. Here is info on hypos - print it out and stick to your fridge!! http://www.felinediabetes.com/FDMB/viewtopic.php?f=28&t=15887 and get together a hypo kit now. We are playing Russian roulette a bit here..


IN CASE OF EMERGENCY - YOUR HYPO KIT
Put together NOW the following items and put in an easily accessible place!
Phone number of your vet
Phone number, address and map/directions to your nearest emergency vet (or phone number of the cab company and some cash/credit card)
Karo syrup, honey or corn syrup
High carb canned food with gravy – 2-3 cans
Some favourite treats
Spare pack of 25 blood glucose strips
Coffee for you

Wendy

 

She thinks the growth may have been started two months ago when he was diagnosed. So that lead to insulin resistance. I'm hoping the biopsy shows it is benign. She wanted to keep him on 4 units but I will definitely mention it to her tomorrow. You have a point that with the removal of the growth and antibiotics, that his BG will drop. I'm hoping it does greatly! Not because I want him in shock but just want him better and tired of constantly testing and raising his insulin level.

You all have been there and know that this whole process is stressful!

 

It is absolutely stressful! And that's why we're also here: to offer emotional support when you need it. Please keep us posted on how everything goes! :YMHUG:

 

The growth removed. Now I'm fighting extreme lethargy. He has only drank a little all day. The vet doesn't know if it is extremely high or low. I'm pumping him up with maple syrup. My 3 y/o is telling me he is a live and it is fine. The vet said part of the problem is he didn't eat a thing. I didn't know eating was required. There is just so much to know about this disease and there should be classed held to learn it. I get to learn as I go! :lol: The laughing face is because Lily thinks the emoticon are cool.

 

I equate this sugardance to a crash course, college master's degree level in Feline Diabetes Management. You will all receive your diplomas when your cat goes OTJ or is well regulated and you start helping others. Grading is on a Pass/Fail basis. We need everyone to pass this course to help their kitties the best they can.

Yes, there is a lot to learn. Keep asking questions. Read other new members posts. We may have mentioned something that you did not know about in another post.

 

Hi, Susie:

I am pretty new to all this FB myself, but wanted to drop in and welcome you.

My kitty was dealing with an asthma attack when they found the diabetes. Long story short, it's been about a month for me here now.

I think if there was anything I could add here is how really really important it is to home-test. Injecting insulin, or not injecting it, without testing is, in my opinion, shooting in the dark.

With testing, it gives you a bit of predictability in where kitty is going to go after the dose or without it, which is imperative for those of us who work and have busy schedules. But it also gives a HUGE peace of mind being prepared.

I considered this crash course in FB as learning backwards really. I had all the equipment...had the diabetic kitty...then learned as I went day to day with support from this awesome group, which fortunately for me, was given to me by my vet who is totally on board with the protocols here. She even borrowed me her own extra personal meter until I could get my own, complete with strips and lancets. She also has a diabetic cat.

Testing is not as traumatic to kitty as it is to us I think. I remember the first night I "attempted" to poke him...I totally had the wrong spot on the ear UGH, but he just took it and gave me faces from time to time...of course he got LOTS of treats!! That's probably why he tolerated it :lol:

I never did get a test that first night, but then I read up on that "sweet spot" on his ear, and now he comes to me, lays down, and lets me poke away (only one poke now..I'm pretty good at it now )

The next night, I tried again, and we had SUCCESS! It took just a bit to get a nice size bead, but it took only 2 pokes, lots more treats, and even after that he just stayed where he was and cat napped.

Anyway, this is just my experience, and I honestly never thought I could be able to do this. When I went in to the vet for my Crash Course in FD, they had a hospital kitty there (they also had ones out for adoption) that they wanted me to get a test on and do an injection (saline). I didn't even attempt the test, and got as far as tenting his belly, and I had a meltdown...right in front of a young very good looking male tech (UGH!!) I cried like a baby wondering how the heck am I gonna do this for Poe????

But, here I am, almost a month later....testing him several times a day and shooting him (which I think is easier ), and knowing that when I do dose him, I will know that when I test him 2 hours later after the dose where he is going for the cycle and can rest easy if I have to leave. Although, to be honest, I do always leave him food out.

Wishing you the best in this journey....this board might be the one place you don't want to be, but the best place you can be when you find yourself on this road.

 

Was Buggers put under when the growth was removed? I wonder if this is related to the anaesthetic.

I know you arent home testing but I know a way we can kinda find out if this is high or low blood sugar. Go pick up some urine glucose strips and test his pee ( I can give tips as how to do this). They are cheap ( ketostix). If there is no sugar in the urine he is low , if there is high sugar in the urine.. he is high! It gives you a kind of average over the last 12 hours or so depending on how much he drank and when he last went pee.

Wendy

 

Wendy,
Buggers was under anesthesia for his surgery. He is now hospitalized for ketosis. He stopped eating and I thought he was dead last night when I got home. I gave him syrup and took him to the vet this morning. It's a relief not to have him here as far as feeding my other cats and worrying about him in general. I keep wondering and pondering to call the vet and tell him just to put him down. Then I think this may be just a stumbling block and the biopsy may come back benign. It's so hard.

I'm thinking I should home test then I would have known last night that his blood sugar was high and not have given him syrup. I'm wondering if there is anyone that has the testing supplies that aren't using them anymore, that would be willing to pass them on to me? I just PM'ed two people that are offering them but don't know if they are gone to someone else already.

 

Hi Susie-I'm sorry ur having a hard time. My cat Bob was diagnosed about 7-8 weeks ago. He was on prozinc insulin for 6 weeks and his numbers would fluctuate between 300's and 600s. He was like a zombie and I was horribly depressed and felt helpless. I finally took him to a specialists and she ruled out other causes and changed his insulin. I'm just now starting to see it affect his numbers. Don't give up!! Everyone here is very helpful and u just have to take things one day at a time. I have a relion micro meter and supplies I can send to u if u haven't found one yet. I can overnite to u on Monday so u will receive on tues. just pm and let me know. Testing is HUGE. My vet said I'm one of only 2 ppl he's ever seen test at home. Crazy! U have to know what's going on.

 

Did you try the diabetic cats in need request in the supply closet of this board? They might help with a free meter etc http://felinediabetes.com/FDMB/viewtopic.php?f=15&t=29535

Or you could go to Walmart if you are in the US. I got these prices from the Walmart website

Relion prime $17
Pack of 50 matching strips $9
Pack of 210 lancets $6
Urine ketone test strips $7 (good to have)
Neosporin pain relief $8
Keeping your cat safe $priceless

Wendy

 

It is so hard to acclimate to home testing right away. My Abigail was on insulin for 10 months before I started. The vet who diagnosed her never mentioned it. She was very nice but the hospital where I go let her go and said she was not up to their protocol. The vet I see now is awesome and super impressed with the urine testing, and the blood glucose readings. It's a lot to take in but its the little things that get you excited. When I see their numbers in the right range. When Abigail eats! It's a process but the more you invest you most likely will have a regulated kitty.

 

I may not need anything since the vet called and is thinking Buggers has kidney failure!

 

Ok deep breaths.. This is also manageable ... Take a look at this site http://www.felinecrf.org/ but a number of people on here have cats that have both and they do just fine..

Wendy

 

There are different levels of CRF, different stages. What stage of kidney failure is buggers in?

 

I don't know what level he is in. I know this morning when the vet called that his BG was down to 61 from over 600 and he was still very lethargic. He wouldn't lift his head. The Lasix cause him to pee.

I let Buggers go. The vet was thinking that the growth that was his gums may be elsewhere and causing his poor health. He and I tried really hard for 2 months for fight his diabetic numbers so I'm done.

Thanks all for the information and help.

Susan

 

{{Hugs}}

 

Oh my gosh...I'm SO sorry...
Please accept my sincere condolences,
jeanne

For Buggers:
http://www.gratefulness.org/candles/mes ... d=18739153

 

I am so sorry for your loss. Deepest condolences
Terriy

 

You have my deepest condolences.

{{{{HUGS}}}}

 

Oh Susan--I wish I lived near you so I could give you lots of hugs. You've made the kindest and loving decision for Buggers. As the tears are flowing down my face, I'm am truly so sorry. You did everything you could and you did a great job. You've showed him just how much you love him. I seriously believe that animals have souls and therefore he's in a wonderful place, prancing around in perfect help, waiting for the day when his mommy comes home. Believe me, you did the right thing. I'll miss you on this board and I respect your decision; I've had to make that decision several times and it was one of the hardest things I've ever done in my life. With love and compassion, Kat

 

Oh Susan, I'm so sorry for your loss. We did not realize the extent of the health problems that Buggers was having.

We all reach a point where we have to decide if the quality of life for our kitties is good enough to keep them with us a bit longer or let them go. Buggers was telling you to let him go and you listened. This is the hardest and kindest decision we can make for any of our pets.

Crying tears of sympathy here with you. Take care of yourself. You have a hole in your heart now where Buggers used to be. In time, you will remember all the good times you had with him and know how blessed you were to have each other in your lives.

We have all been there. We understand and will support you in anyway we can. There is a Grief forum here. Please, when you feel able, post there all you want.

{{{{{{{Susan}}}}}}}

 

Thank you all so much. I didn't know all of his health problems either. The vet is just assuming that cancer is the underlying cause of his numbers remaining constant, more or less. She said he has been the hardest cat so far to treat, again not responding to any level of insulin. I will tell you like I told the vet, it was a relief when he wasn't here because we have other animals and always had to worry if the dog food was on the floor still, so he didn't get any and so on. I tried but he wasn't responding. The vet also stated how strong he was because he didn't pass on his own.

My 3 y/o told me after I told her that her BugABoos has died, she said we could go to the animal shelter and get another because they have lots of them. I smiled and laughed so she said see I make you smile!

 

I am so very sorry. Land softly Buggers. You have earned your wings wings_cat

 

I am so sorry and send my deepest condolences. It's never easy to make that decision, but there are times when it is the best decision...sometimes doing the right this IS the hardest thing.

Buggers now runs and pounces freely...healed and happy.

 

I'm so sorry to hear of your loss.

Fly free, sweet Buggers.

 

I am so sorry. Losing a pet is like losing a part of you. I and sending you love.