Overwhelmed Mom

Our cat George (who is a neutered male about 10 years old) was diagnosed about a month and a half ago and we started on Lantus and Hills D/M Canned. He was doing better and starting to put some weight on until about a week ago. The vet asked me to increase his insulin, as he was still high (in the 500-600 range) when we went in for our last curve. So we went up to 3 units twice a day and now he doesn't want to eat, which means I can't give him his insulin. We switched over to Purina M/D Canned and he still isn't interested in eating. He acts like he is hungry and just waiting for something else to show up. I have looked at the food charts until I went cross eyed and I don't know what to do.

I downloaded the spreadsheet to track his progress, but have no idea how to use it.

I am extremely overwhelmed with the process and the vet doesn't seem to be very helpful with managing this issue.

Any advice would be appreciated.

 

Good morning and welcome to FDMB.

Can you answer the following questions so we can help you?

1) What was your starting insulin dose & has it changed since then? If so, when & by how much?

2) Do you hometest? If so, when are you testing?

3) When you had the 500 reading, where was it taken? If at the vet, were the results from a glucose reading or a fructosomine test?

There is a good chance that you have missed your optimal dose and the 3 units is too high. If you are hometesting, can you test him and give us his reading?

You do not need to feed prescription foods. Most cats stop eating it anyway. Many of us feed our cats canned Friskies or Fancy Feast. Try to stay away from any flavor that have the word Gravy in the name.

 

I will do my best to answer

1) What was your starting insulin dose & has it changed since then? If so, when & by how much?

we were at one unit (I don't even know what that means) and now we are at three.

2) Do you hometest? If so, when are you testing?

I don't home test, I bought a glucometer and have no idea if I got the right one or how to use it.

3) When you had the 500 reading, where was it taken? If at the vet, were the results from a glucose reading or a fructosomine test?

I have no idea what the difference is.

I wish I understood more. I have been reading, but I just don't have the jargon down yet and the vet isn't telling me much of anything to be helpful.

 

Fructosamine reflects average glucose over time; blood glucose is a single point in time.

Which glucometer did you get?
Follow its instructions to set it up with the date and time.
Follow its instructions to test yourself.

How to test on the ear:
Just inside the outer edge of the ear is a small blood vessel.
We use the lancet to prick between this blood vessel and the outer edge of the ear about 1/3 of the way up from the head.
Then use the glucometer to test the drop of blood just as it describes in the product instructions.

For the spreadsheet - did you follow the instructions to place the spreadsheet in your own Google account? Once it is there, you can choose to let others see it for review.
The columns on the spreadsheet include
AMPS - morning pre-shot glucose test - enter the glucose value you obtained
PMPS - evening pre-shot glucose test - enter the glucose value you obtained
Units - insulin dose given
+1 - any test 1 hour after giving insulin - enter the glucose value you obtained if you tested then
+2 - any test 2 hours after giving insulin - enter the glucose value you obtained if you tested then
etc

We reference the time that way because many people are in different time zones. This approach means you can quickly see when a test was done with respect to the shot, without doing time calculations.

 

Changing foods may drastically change the glucose level in your diabetic cat. Once you are comfortable home testing, you may gradually change the food about 20-25% per day, to reduce GI upset and so you can adjust the insulin dose as the glucose level changes.

The food chart at Cat Info lists the percent of calories from protein, fat, and carbohydrate. Select foods which have less than 10% in the column marked C. These foods include any Friskies pate or Fancy Feast Classic pate.

 

Good morning and welcome! I'm so glad you found us. First and foremost, what is your first name? Where are you from (state)?

I know how scary it is was when my cat was first diagnosed. I was stressed, in denial and felt helpless for him and myself. We're here for you and will help you every step of the way.

I'm Kat and Gobbles is my 11 year old, neutered kitty. He was diagnosed with FD (feline diabetes) in November of last year and went into remission this past May. We live in Ohio. He was on Lantus. When he was first diagnosed, he had lost two pounds, was eating and drinking like there was no tomorrow, was peeing large puddles in his litterbox, his hair was dull and lackluster, and he was lethargic. Today he is like his "old self": eating a normal amount of food, gained back almost three pounds, has a shiny, thick coat, peeing normal, playing and an all around happy cat. Without the help and guidance of the good folks here at FDMB, I don't know if he'd still be with me.

I read that you have a glucometer. Is it a human glucometer? What is the name of it? Most of us use a human glucometer here. It sounds like you are ready and willing to hometest, which is one of the first steps in managing George's FD; it will keep him safe and help you to track his progress. When Gobbles' was first diagnosed, I was leery of and frankly, scared, to hometest him. With the helpful tips and videos that are available here, I learned to hometest in just a few days. You will need a tube of neosporin (or generic triple antibiotic); a lot of us use the variety that has "pain relief" in it. After each poke, it is important to put a tiny dab of neosporin on the poke area to inhibit infection. You also need a box of lancets (these are the small plastic things with a tiny needle at the end).

What is George's demeanor? Is he laid back or more of a "scared-y cat"? Does he sit still well for you? One of the most important things when hometesting is for you, the caregiver, to try to relax and not stress out. Please give it a try today and ask for all the help you need.

As for George's blood glucose number (BG), you'll have that number as soon as you get your first successful test.

Further, how much does George weigh? What is his ideal weight?This information will help to determine a good insulin dose for him.

 

I just got the Target Up and Up glucometer. If this is not good, let me know and I can exchange it since I haven't opened it yet. I got small lancets, I read I might want to try larger ones until I get this going correctly.

Thank you for the step by step, I think I can handle that! Once I get us going on the home testing I will upload it to google.

What do I do if he won't eat his food, change it completely all at once or mix it together with his old? If he doesn't eat then I can't give him his insulin, so then what?

Karen from Maryland

George is very laid back and a sweet cat. Very lovey guy. Used to sleep next to me in bed before this all set in, now he barely comes over for a scratch these days. He will sit well for me so I am sure I can do this I just need to relax! I am a type A person so I stress very easily!

George is down to about 9 1/2 pounds. He was up in the 13-14 range before this all started. He is a big cat, I know he is well below his ideal weight. The vet never told me what he should be at for an ideal weight. Will ask today.

Thank you very much for the advice. I should have come here earlier on in the process. I just thought we were on the right track until now.

 

If you can today, definitely return it. Go to your local Walmart and get a ReliOn glucometer and box of strips (that are made for whichever model you choose). I used a Relion Prime; some use the Confirm or Confirm Micro. The strips are the cheapest on the market,too. I believe if you buy the Prime model and 50 strips, your cost will only be about $20-25. If you don't see the strips on the store shelves--ask the pharmacy for them as sometimes they keep them behind the pharmacy counter.

Let us know. And as BJM stated, you gradually change his food. He shouldn't get his insulin if he is not eating--but there are variables and I suggest you post the question of no food = no insulin, on the board. As for brand/variety of food: I suggest trying Friskies Special Diet Turkey & Giblets, Friskies Special Diet Ocean Whitefirsh, Fancy Feast Chunky Chicken or any of the Fancy Feasts (pate) Classics. You do not want to switch his food at once as, along with insulin, it may drop his BG too low. And there's a chance that George MAY be able to become a diet-controlled (no insulin) kitty!

Perfect! That's how Gobbles is, and I can relate to the Type A person; in fact, I'm probably a Type AA :lol:

He's about the same size as Gobbles. Someone here will suggest a good safe, starting dose.

Do you/George have a vet appointment today?

 

Even if he is not eating, if his glucose is way, way high, giving some insulin may be indicated. You've been giving 3 units; when my vet had me fast Spitzer before a dental, she had me give half of the regular dose. You might ask your vet if that would be OK.

While you're at the pharmacy, also pick up some urine ketone/glucose testing strips such as KetoDiaStix (or equivelant generic). You may need to ask the pharmacy counter for these.

If he is really, high, he is at risk for diabetic ketoacidosis and/or hepatic lipidosis, as he is breaking down fat for calories. A by-product of fat breakdown is ketones. Too many ketones may result in diabetic ketoacidosis, a potentially fatal complication of diabetes. If too much fat goes to the liver, it can overwhelm it and totally mess up all the digestive processes; this is feline hepatic lipidosis. A clue is if the skin or whites of the eyes starts turning yellowisn (jaundice). It too may require expensive intervention with the vet.

He might also have times when he goes too low and develops hypoglycemia. We have instructions oh how to deal with that here.

 

The recommended starting dose of Lantus is calculated from lean weight in kilograms multiplied by 0.25
9.5 lbs / 2.2 * 0.25 = 1.2 units

Increases in dose are typically made in 0.5 or 0.25 unit amounts. It sounds like your vet has been increasing whole units at a time. Is that correct?

I'll note that the m/d food has 14% calories from carbohydrates and the DM food has 3% calories from carbohydrates. What was the reason for the switch to the higher carb food?

 

Hello and welcome to the board!

heres a shopping list below and some home testing tips. https://docs.google.com/document/d/13c_CPZVKz27fD_6aVbsguadJKvjSrSAkD7flgPPhEag/pub

let us know how you get on with the testing - some cats bleed better than others. and then we can work on his spreadsheet together.

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 with pain relief 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

 

Good Morning Karen

How are you today? And how is George? We use a "scale", and I'm using that term loosely, to gauge how a cat may be feeling. Below is a copy & past from BJM's Secondary Monitoring Tools to explain said scale:

The 5 Ps

Purring - is the cat exhibiting customary signs of contentment or happiness?
Playing - will the cat play and interact with others?
Preening - is the cat maintaining its fur and cleanliness?
Peeing - occurs, and is a normal volume?
Poohing - fecal material is formed and passable?

Constipation may happen with a food change; adding a tablespoon or so of water may help, plus ensures the cat is hydrated properly.


Did you get a chance to speak to his vet? Have you tested his blood glucose level? If so, what number did you get?

Have a lovely weekend :mrgreen:

 

I think we are doing better. I am starting to come to terms with all this and trying not to be so overwhelmed with it all and take it in stride.

The biggest thing that made me feel better is finding a good food that he likes. I got really overwhelmed looking at all the food grids! I am working on moving him over to wellness grain free canned food. He loves it. He is eating like a champ now!

We got a Walmart Relion Micro tester with all the appropriate accessories. Well we did a blood glucose test a few times this weekend while we were visiting the grandparents, just practicing since I am getting used to all this. First reading which was mid afternoon yesterday was 334 today's reading mid morning was 433. I know he is still high. I also moved him back to 2 units of insulin until I can get the vet on the phone. I don't think he was doing well on the 3 units at all.

George is doing find on the 5P scale. He was a lot more active yesterday than he has been all week, he actually played with me!! The only issue is he is a bit on the high side for peeing and the poop is a little on the smooshy side, but I chalk that up to the fact we are still transitioning off the Hills Prescription canned food that gave him squishy poop before.

When should I be testing him? I know I found the chart to keep track of is, but I can't seem to find it now, can someone point me in the right direction to find the chart so we can start recording our data?

BJM - Yes my vet was increasing one unit at a time, which I thought was too much. Change to the other food was just that she was recommending the superscription food. He hated both foods, so we are going with the Wellness Grain Free since he seems to really like it.

Wendy and Tiggy, thanks for the list, I think we have all that except the Ketone urine test strips on hand, will be getting those this week.

Does anyone know where to get needles that show less than one unit? If I need to go to 1/4 and 1/5 units, it is so hard to see on the syringes we have.

 

It really is a lot to take in and can be overwhelming at times. It will get easier, believe me. I was a complete "basket case" initially--ask anyone :lol:

The Wellness grain-free canned foods are all in the range that are appropriate for diabetic cats; I looked at the grid, and they all appear to be 6% or less in carbs--that alone can bring George's BG levels down. Good job!

That's a great choice of glucometers and the test strips are a great price. 334, 433 are high--but George is newly-diagnosed and finding the
"right" dose can take time (and he may go OTJ eventually--there is a VERY good chance of that). Three units is high and even two units is high. If he were my cat, I would drop him down to 1 or 1.25 units.

As his pancreas heals and his blood glucose comes down, he will pee less. Are you testing for ketones? It is real important to do so, especially when cats are in higher numbers. The smooshy poop should ease up with the diet change; just keep an eye on it.

Always test him before each and every shot. We advise putting his food up 2 hours before test time, so that the test is a more accurate, truer test reading and not influenced by food. If you get a reading of 200 or lower, do not give him any insulin; you do not want to put him in danger of hypo-ing. As you build data on him, that "don't shoot at 200 or lower" rule can change, but always, always ask for help. It is also a good idea to get a "mid-cycle" test and a "before bed" test. Additional tests will help to keep him safe and will build data/history as to how he reacts to insulin. There are variables as to "when to test", but for starters ALWAYS test before each shot and try to get a few more tests. If someone doesn't get to it before me, I will post a link that will help you put together a spreadsheet for George.

You can buy needles that will measure in half units (.5, 1.0, 1.5, 2.0, etc...) here: http://www.americandiabeteswholesal...e-insulin-syringes_1316.htm?source=SiteSearch. You can also purchase them at Walmart and some pharmacies (not necessarily the same brand that I referenced, but other brands that are U-100 half-unit 3/10 cc syringes). If you use the "ADW" link at the top of the page, the FDMB gets a small percentage of purchases. There are no syringes that measure in quarters or fifths. The 31 gauge needles are very fine and 5/16" is considered a short needle.

Have any more questions?

 

Good job on the testing!!! Hopefully we should see his sugar come down with the change to wellness.. transition it slowly though or you could have diarrhea!

here is a link to the spreadsheet we use - let me know if you need help with it : http://www.felinediabetes.com/FDMB/viewtopic.php?f=6&t=18207

i usually advise four tests a day:

- always always before every shot - you dont want to shoot when too low - which as a newbie is 200 - come on here and ask for help if your preshot number is under 200.
- mid cycle when Lantus hits its peak which is 5-7 hours after the shot if you schedule allows. We base dose changes on the lowest point ( nadir) of blood sugar during the day which in theory is at this time
-before bed (2-3 hours after the evening shot). If this number is a bit lower than the evening preshot number then you might want to set the alarm for mid night cycle test as this can mean an active cycle.

Wendy

 

If the feces continue to be smushy, you might try giving him a probiotic, such as FortiFlora (many vendors sell it at out shopping partner Amazon - link at top of page). My cats all love it; some do not.

 

Terrible day today.

Ate half his breakfast, I don't think I got his shot in right.

He laid in a closet all day.

Took Pre Dinner Test and he was 590!!!!

Came down to eat, finished eating and puked it all up.

NOW WHAT?

Do I give him a shot?

OMG, I am at my wits end, trying to manage him and a 6 year old has me about to crack.

 

He is very high so I would shoot but make sure you get a test at +2 ( two hours after the shot) to see what he is doing and maybe even set the alarm for a mid night test (+5 to +7) if he is coming down significantly.

Sounds like he ate too fast and puked it up (scarf and barf) so spread it out on the plate to slow him down or give him smaller meals over the next few hours. Ask the 6 year old to do it

Its a steep learning curve but it gets better..

Wendy

PS really need that spreadsheet

PPS edited to add (hugs) . before you know it he will be feeling better and so will you!

 

Phhhewww, he finally ate and I gave him his shot. Seems better.

I looked at the spreadsheet and am a bit confused as to how to fill it out. I will search around for instructions and start logging the information.

 

Ok next dumb question, I am about to get ketones test strips, how do I collect his urine to do this test?

 

Ok here's how to catch urine.. https://docs.google.com/document/d/1quta5WLEjdO0Y_t2dAYSwN84h-LNZWxOdtVsJDKZ16A/pub

Here's how to do the spreadsheet..
Every row is for a new day.
AMPS is your a.m. Pre Shot test number
U is dose you gave at that time
PMPS is your p.m. Pre Shot number
The numbered columns are the hours after the Shot. So in +3 you fill in a test you took at 3 hours after the shot.


Wendy

 

See my signature link Secondary Monitoring Tools for tips on this as well as other assessments you may wish to make.

 

Ok next question, do I test his blood sugar before or after he eats?

 

Its test, feed, shoot.

 

Can you share the spreadsheet with us? I would like to see the numbers

Wendy

 

I started the spreadsheet two days ago.

I tested him tonight before dinner and got 119! I was thrilled!

He has been perky and a lot more active today too.

I will post the sheet as soon as I get myself all signed up for google.

Thanks to all who have helped, I am starting to feel like we are getting somewhere!

 

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}
- 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.

 

Here is a link to George's Sheet

 

It does not appear to be a spreadsheet for me.

 

Did you follow these instructions to create the Spreadsheet? http://www.felinediabetes.com/FDMB/viewtopic.php?f=6&t=18207

 

Thats a weird page I am seeing???

 

Thats a weird page in your link.. I am seeing this..

 

Sorry about that I had the conversion set to off and didn't realize it....

Link in my signature works correctly now.

 

Ok great! Nice blue the other day and good you didn't shoot but next time you see a preshot under 200 I would get a +2 anyway because the more data the better. Over time you will need the data to prepare for shooting low.. You shoot low to stay low..

Maybe read this http://www.felinediabetes.com/FDMB/viewtopic.php?f=9&t=147

Wendy

 

George is probably bouncing from a combination of that skip the other day and the low number. We'll need to give him up to 72 hours to settle down with the BG numbers.

Keep on testing and keep us updated if you would please. Thanks.

 

I have updated our sheet.

George's Sheet

We seem to be hovering in the mid to high 300's. What would be our next step?

 

I think raise the dose to 2.5. But also you really really need to get some night tests. Many cats drop low at night and I worry if thats happening here - even the test is just 2-3 hours after the nighttime shot.

Wendy

 

I am going to try to get a night time reading tonight.

What would it mean if he is dropping low at night?

I added a column for his weight too to see how we are doing there.

 

It would mean his dose is too high which is why I am little worried about increasing without the extra data. If you can get a night time test for the next few days it would confirm that. Many cats do drop at night and not so much during the day - my Bailey does it frequently.

Weight column is a great idea - once every two weeks is more than enough though to see whats going on.

Wendy

 

Wendy thanks for the information. The support of this board has really helped me get comfortable with his issue. I can not thank everyone enough.

I will get night readings before I do anything else.

I was checking his pee, I am not sure how "fresh" the pee was that I was testing. But he was negative last time I tested it.

He has been generally much more alert and more like himself every since I switched his food around.

 

Mark that on your SS in your comments too - ketones negative.

Without nighttime tests you are missing half your data so a couple of days of tests at night will tell us a lot

keep us updated!

Also maybe read this when you get a chance: http://www.felinediabetes.com/FDMB/viewtopic.php?f=9&t=1581

Wendy

 

Oh geez. I should have read that a while ago! Sorry!

 

No its fine - a while ago you might not have known enough to understand it - plus we dont want to overwhelm you too much at once. its a lot to learn so we try and give it out in small chunks.



Wendy

 

Ok I tested this morning and the readings were all over the place... I did three all within about 2 minutes of each other.

I am starting to worry about the consistency and reliability of the Relio Micro we got.

First reading 409, second 365, third 291.

If they were closer I wouldn't be so stressed, but that is a huge difference.

Any thoughts?

 

The FDA allows meters to vary + or - 20% from what a lab would get.

If the ranges overlap, the tests may be considered the same.

So
80% <= test <= 120%
327.2 <= 409 <= 490.8
292.0 <= 365<= 438.0
232.8 <= 291<= 349.2

Note that 120% of your lowest value is greater than 80% of your highest value.
The ranges overlap and the tests may be considered equivalent.
Also, the 'true' value likely falls in the range of 327.2 to 349.2.

 

I have updated his sheet.

I am going to try to get a reading tonight too. I screwed up this morning routine and missed his reading and shot (bad mom).

George's Sheet

Any advice would be appreciated. He is doing well on his food and eating well, so I am not sure what our next steps are.

 

You are NOT a "bad mom', just a very busy one. Sometimes, you just can't do it all or the cat won't cooperate. I always try to leave a few extra minutes 5-10, before I head to work. Murphy's law number 683 - the cat will throw up just before you are ready to leave for work, making you 10 minutes late. ohmygod_smile

 

Ok question on numbers today

AMPS 315 / +7 140 / PMPS 180

Do I give a dose tonight or not?

Should I move over to a Lantus group at this point?

 

Ok skipping shot and he has the most terrible squishy poo. Just ordered some FortiFlora, hope it arrives soon.

 

Can you get a +2? Its always a good idea to get more data as a prep to learn how to shoot low. For now you dont want to shoot under 200 but over time, as George gets into normal numbers, you will need to learn how to do this.

heres a primer: http://www.felinediabetes.com/FDMB/viewtopic.php?f=9&t=147

Wendy

 

Food changes done quickly may cause diarrhea. The FortiFlora may help, as may a teaspoon or two of plain yogurt with active cultures in it (if not milk intolerant!)

 

Hows things going? i saw some nice blue preshots the other day and no data since then.. hope all is ok?

Wendy

 

Had a few good days, but we seem to keep hovering in the mid 300's. I know I need to get some night numbers. Will attempt this week to do so.

George's Sheet

Recommendations?

 

Definately want to know whats going on at night - last night he went to 149 and I wonder if he kept dropping. Next time you see something like that drop I would strongly recommend you set the alarm for another test in an hour or two because its very likely he is dropping low.. and if he goes under 50 then we dont want to increase his dose - we will be decreasing!!

Plus if he did drop low last night then he may be bouncing for the next day or two

Wendy

 

I will get some additional numbers today and tomorrow.

He is putting on weight and his coat looks great.

Not drinking or peeing nearly as much as he was. Seems like this aspect is almost normal now.

 

Well, sounds like some of the clinical signs are improving. Now, if we could only get the BG's to come down. :YMSIGH:

Come on George, we know you have it in you to show your mommabean what you can do with that insulin! Work that juice!

 

Got some more numbers. Not sure what to make of it all.

 

Would be wiling to add a teeny bit more data to your signature? Like insulin you are using, and meter. Diagnosis date, your name and cat's name , food you are feeding would be nice to see also. Thanks for considering this.

You've gone to a second page, so it takes some hunting to find out this information.

Looks like George is still bouncing from that furshot. He get's down to the blues ok, but then shoots back up. Because of that fur shot, I think you need to hold the dose for a bit to see how he settles out. I do think an increase is in George's future.

 

I am thinking too that George may be consistently going low at night...The thing is that if he is dropping low at night you need to know how low - is it under 50? If so , he would need a decrease. If not, he may need an increase. But without knowing for sure its hard to know.

Like last night you saw two dropping numbers - its a shame you didnt get another test around +7. Maybe next time you see that trend? Or for a couple of nights get a PMPS +3 and sleep till + 9 and get a test then?


Wendy

 

I added more info in my signature and will try harder to get more night time numbers.

 

Thank you for adding more information to your signature. We really appreciate it.

 

More numbers.

 

Hmm.. If he did drop low the night of the 8th then he could be bouncing for up to 72 hours. (bounces explained below). So I would wait one more day. If you start to see him drop into blue I would strongly recommend you start to test every couple of hours, more if he hits green. Even if its overnight (sorry).

Reason I say test more is we need to see how low he is going... because if he is dropping below 50 we would want to decrease!. However if he isnt going anywhere under 100 then on Thursday morning I would increase.

Wendy

 

Wendy - thanks for the info on the bounces.

I am trying to be real vigilant with our schedule and I will do my best to get some overnight numbers. Should have gotten one at 3:00am when he woke me up for food!

 

Any readings for the last few days?

Wendy

 

I uploaded new numbers.

I have not been able to stay up over night with him to do overnight readings. Will try in the next few days.

 

OMG. I just got a green reading on George at +5 today!! I am shocked! I checked it twice to make sure the meter was right. :shock:

I guess I need to do over night numbers asap to see what is going on!

He is maintaining his weight and acting a lot more playful lately. Peeing is down and his drinking is as well.

Keeping my fingers crossed we are on the right path here.

On a side note, what do people feed/give their cats for hairball prevention?

 

Can you get a test in an hour? It may drop further!

I put a small dab of vaseline on my cats paw to help with hairballs. He licks it off.

 

Just got 113.

 

And now you have an estimate of where his nadir is likely to be.

Nice green!!!

 

Been a while. I have updated our sheet and did a few overnight readings. (Which seem to be mixed).

Clinically he is doing great. Eating well and gaining his weight back. He is drinking, peeing, pooing all normal. He is playful and has started sleeping in our bed again.

His numbers seem to be consistently in the 300s, which is still high, but he acts like his old self..... I am not sure which way to go with the insulin at this point. The overnight readings don't give me a real clear path. I am going to try to get some more numbers. What are good intervals to do overnight?

Thanks for the assistance!!

 

You really need to see how low he is going, as that is how Lantus doses are usually adjusted.

Any tests you can get from +5 to +7 hours after the shot are helpful in checking this. (Some folks set the alarm clock to check!)

 

Thanks for the guidance. Will start setting the alarm clock and getting more numbers.

 

I agree with BJ, he may well need a dose increase but its impossible to tell without checking he isnt dropping too low during the day or night..

 

I second BJ and Wendy; good information.

 

Just did a +7 today in the afternoon and he came up with 95!!!

Pu the updated numbers in his sheet.

 

That's a nice number!

 

ahahah!! so its unlikely that the 95 is the lowest number he had all day. I think you need to do more tests during the day to try and see how low he is going! I would have gotten another test in an hour if I had seen that 95. You want to see how low he is doing because if he drops under 50, you want to decrease the dose by 1/4 unit! And decreases = good.

So I suggest, over a period of 3 days try and test every 3-4 hours (more often if you see blue or green). The reason I say do it for 3 days is that if he is dropping too low he could bounce for up to 72 hours and you want that bounce to clear.

Wendy

 

I upped his insulin thinking that was the correct thing to do because I was getting some high numbers in between the shots. Don't think it is doing any good.

He is doing so well clinically, if I was not taking readings I would not think he was diabetic. Everything seems almost back to normal for him. Perky, wants to play, pee and water consumption is normal. Sleeping the bed with us again on a regular basis. Seems like his normal self.

I am going to be more vigilant this week and take more readings. I really need to get him under control.

My vet and I just had words. I am mad that a vet would be mad at me for taking control of my cat's diabetes. Sorry that we have not been in to do your expensive curves lately.... Finding a new vet that will work with us.

 

Since you are home testing, you can do your own curves and save yourself a lot of money and get more accurate readings in that less stressful home environment. Vets don't like it because of the liability issues plus it's a loss of revenue for them.

Sorry to hear your vet is not cooperative and on board with your diligent care of George and your desire to get him feeling his best. New vet on the horizon as you said.

The clinical symptoms, or what we call the 5 P's (purring, preening, playing, pooping, peeing) do sound like they are improving and George is sounding more like his old self. Remember, a cat is more than their BG readings.

How is his appetite these days?

It's difficult to know what to suggest without seeing some more mid-cycle numbers, to see how low the insulin is dropping George. Even sometimes, a test at night, just before you head off to sleep can help to fill in the big picture and give us more of an idea of what is happening here and see some sort of pattern.

Do you think you could try for a regular before bed test?

 

Thanks for the support. I just cried my eyes out this afternoon.

His appetite is good. Eating and pooing are normal. I would say all 5 Ps are pretty much back to normal.

I will definitely add a routine night time reading. I hope to be able to do some overnight numbers as well this week.

Thanks to all for the help and guidance!

 

There is a link to some Vet Interview Topics in my signature.

 

BJM - Thanks for the note on the link. Going to take these with us to our appointment.

 

Updated his numbers from last night - 58 at +4!!! I took it a few times to make sure.

This morning was a good number. I went down to 2 on his insulin as I don't think that pushing him up last week did him any good.

Going to keep getting more numbers at night, as I think that is when he dips the lowest.

 

Those low numbers can be a shocker! Not surprised you retested to double check.

Good catch on that +4 58 BG last night! George probably dropped even lower later in the cycle, so a drop in dose today was a good call. Personally, I'm not a stickler for a drop below 50 to earn a dose reduction. We don't know for sure, but I suspect George did drop below 50.

Don't be surprised if George has high numbers for a few cycles. With the low of 58, it's very likely he will bounce. A bounce can take up to 72 hours or 6 cycles to clear. Be patient and try to hold this dose for a few more days. Well, that is unless George has other ideas and drops below 50.

My crystal ball sees more tests at night to find how low he is dropping.

I see you have been noting suspected fur shots on your SS. Any way we can help you to try to reduce the number of those fur shots? Perhaps, review what you are doing for the shot or suggest a different needle length or tenting method?

 

I had a few lousy shots this past week. I swear I get the needle in and get a good shot then I pet the area I just shot and smell my hand for the insulin, and if I smell it then I give myself a big smack angry(2)_cat and figure it was a fur shot....

I just need to get his fur better matted down so I can better see the needle.

 

I always preferred the shorter needles. Less chance of poking the needle out the other side of the tent of skin.

You could always try cutting or shaving a small patch of fur along his sides, to help you see better.

I think I was lucky with Wink. He was in such horrible shape, the shelter had cut out some patches of fur, plus his BG's were so out of control that his fur was patchy and spotty because it had just fallen out. Very easy to see down to the skin. Once his fur started to grow back, it was more of a challenge. Plus, Wink was skinny so it was easy to tent up the skin. That tenting is harder to do when there is more of a fat layer.

 

Met our new vet today and she is very supportive of our test at home method!!

She agrees with getting more overnight numbers and suggested a reduction in the insulin as well.

So happy!

 

Hows things going now?

Wendy

 

I updated his sheet. Numbers are still high and all over the place.

Vet wanted me to reduce his dose which I did. We went down to 1.5.

He is at the vet overnight tonight until Thursday for medical boarding (have a business trip and hubby doesn't do shots). :sad:

I like the new vet, just still worried about the numbers. (Even thought clinically he is doing great!) The vet even said he was in great condition for being a diabetic.

 

I am glad he is doing well but I honestly think his numbers are too high and I hope you are regularly checking his urine for ketones.
We want him spending more time in yellow blue and green. However he could be doing this at night and bouncing up again for pre shot. Remember the lantus curve... and many cats drop lower at night than during the day as you have seen...

+0 - PreShot number.
+1 - Usually higher than PreShot number because of the last shot wearing off. May see a food spike in this number.
+2 - Often similar to the PreShot number.
+3 - Lower than the PreShot number, onset has started.
+4 - Lower.
+5 - Lower.
+6 - Nadir/Peak (the lowest number of cycle).
+7 - Surf (hang around the nadir number).
+8 - Slight rise.
+9 - Slight rise.
+10 - Rising.
+11 - Rising (one of the quirks of Lantus/Levemir: some cat's blood glucose numbers dip around +10 or +11... not to be confused with nadir).
+12 - PreShot number.


Wendy