Question About Home Testing Results & Action Plan

Hi!

We just started home testing Rocco's glucose levels today, after not seeing much improvement since starting him on Lantus (1u/2x daily) on March 9th.

The first week and a half, everything seemed to be going well - he started drinking and urinating less - but then, the thirst came back in full swing. A few days later, we took him in for his scheduled curve. Unfortunately, we weren't 100% sure we got the shot in that morning, and when I picked him up at the end of the day, the vet said he was in the 600s all day, and that it was likely because we were not getting the shot in regularly. He shaved a bit of Rocco's neck and sent us on our way. It has definitely been easier getting the shot in now that we can see the skin, but his thirst has been staying pretty high. Finally, in order to get some answers, we decided to try home testing. We got our AlphaTRAK2 yesterday, and attempted to test his levels shortly before his insulin shot last night. Unfortunately, I didn't get enough blood for the sample and figured it was better to wait until today before trying again - I'd rather not get him all worked up and then have it be a battle every time!

Around 11:30 this morning, we decided to try again. He was SUCH a good kitty - he sat next to me and didn't struggle at all. After reading tons of advice on this forum, I was able to draw enough blood to test, and the reading was 516. He had not eaten since we'd given him his shot at 8:15am. I ended up testing him again at 3:30pm and he was 524.

Rocco is a free feeder and eats dry Purina DM. He has always eaten dry food (and I suspect that's what caused the diabetes in the first place, since he is not overweight - last checked, he was 10.4lbs and hasn't been heavier than 11lbs in 2+ years) and has thrown up every time I've tried to give him wet food in the past. Ideally, I know we would want him eating wet food, but I'm not sure how his stomach would take it.

My plan is to call the vet tomorrow as we don't have another appointment with them until 4/12 to let them know we've tested and that his BG is still high. Do you think doing a curve at home, later this week, would be a good course of action? In my non-veterinary opinion, I feel like his dose is too low and I can see daily that his hocks are getting closer to the ground and that he's struggling to get in the litter box. I hate to watch him suffer, and just sitting here, doing nothing about it, is killing me!

Any advice is much appreciated, and just let me know if you need any additional information!

 

Hi and first CONGRATULATIONS!!! on you starting home testing.

Home testing is the best you can do to help him, you want to test always before shooting him to keep him safe, besides that it would depend how much more you can test, ideally getting one mid cycle during the day and at +2 (two hours after you shoot him) at night

For now and since you are just starting so we do not have much information to decide on his dose so doing a curve would be very helpful to see how he's doing that would give you an idea if he really needs a dose adjustment is hard to say on just one or two readings ( but he probably does given the few results you have ), so do the curve and post your results ( I would suggest you do it in the lantus forum since that's the insulin you are using and there are very experienced people on it there) so that we can take a look at them and be able to give some suggestions about what to do next

Having trouble with his back legs is unfortunately a nephropathy that sometimes happens to some kitties as a result of being for a while with high glucose levels you may want to discuss with your vet starting him on zovaline to help him with that (of course together with getting his numbers down) it takes a while but they do get better

For transitioning him to wet food (make sure is low carb )try doing it slowly mixing a little bit of wet to his dry food it may take a while that way ( about two to three weeks) but he may get used to it easier if you can't you could ask here in a new thread for suggestions on low carb dry food I know there are a few available( I don't know much about it since we don't have any where I live)

 

Hello and welcome!

Congrats on getting your first home tests under your belt! I think you'll find that it really helps take some of the stress out of feline diabetes-- with testing, you have a clearer picture of what is going on, and more feeling of being in control of the situation.

Just some ideas about Rocco's situation:

1) Dry food. The Purina DM is a bit carb-y, and might be part of why his numbers remain high. There are a couple of low-carb dry foods available (Young Again, and Dr. Elsey's Clean Protein) that you might want to try now that you are home testing (you don't want to switch to low carb while shooting insulin if you aren't home-testing-- the response in blood glucose can, in some cats, be really dramatic).

2) A curve would be a good idea. He may indeed need more insulin, but you're going to need more data to be sure. His numbers could be high because he needs more insulin, but they could also be high because he is getting too much, dropping very low, and rebounding upwards in a safety measure.

3) Neuropathy. Getting his blood glucose under control will help that a lot, but the other thing that can be really helpful is B12 supplements. The one many folks here use is called Zobaline (make sure it's the one marked "for cats", as the human B12 has an ingredient that is harmful to kitties).

Glad you guys are here-- hopefully Rocco will be feeling better soon!

 

They're are better choices of low carb dry, my favorite being Young Again Zero carb food which is available on www.youngagainpetfood.com

They will send a free sample of the Young Again if you ask.

Other dry under 10 percent are epigen 90 and dr elseys clean protein chicken.

 

For dosing advice ask on the lantus boards. At the top of the lantus forum are yellow stickies describing the dosing protocols. One is Tight Regulation and the other is SLGS shoot low go slow.

 

Thanks for the advice, everyone! Our goal is to eventually get him on the wet food, I think. I read a lot of Dr. Lisa's posts yesterday on how to change dry food kitties over, and I think if we do it slowly, he'll be able to make the change without throwing up as much.

I did a PM pre-shot test (and split his ear in the process I feel like a terrible cat mom) and he was at 530. Administered the shot and two hours later... still 530. Calling the vet today to let them know my plan.

 

Very good keep testing!

And don't worry too much their ears heel pretty fast the first time I was able to get a good drop of blood I did a hole so big I thought I was going to have to buy him an earring

You can put a little bit of Neosporin on it

 

Congrats on the BG test! We've all had mishaps like yours when testing but kitty ears heal and you get better with practice.

 

I can give a few tips on neuropathy. Diamond has it in all 4 feet. Zobaline is what I have him on. You can buy if from amazon but shipping was like $5. I bought my last bottle from Walmart.com. Same price but free shipping. If you use clay litter, I suspect she may start to get litter clumping in her back feet. I switched to Blue Buffalo walnut based clumping litter and that solved that problem.
Here’s a link on more neuropathy
http://www.felinediabetes.com/FDMB/threads/feline-diabetic-neuropathy-weak-back-legs.178252/

 

I put some antibiotic ointment on it this morning, and he didn't try to run or freak out when I touched his ear, so that's a relief!

It is a serious comfort knowing I'm not the only one!

Thank you!!! I will definitely take a look at this. How do you administer the Zobaline? I'm assuming he should be regulated before we start that? When I noticed the increase in urination, I switched to Feline Pine (or similar, I think I got Exquisicat last time?) because he was getting huge clumps of litter in his back paws. The Feline Pine has worked really well for us.

 

Start the Zobaline now. It is a tasteless pill that easily dissolves in wet food. So in the meantime, you could crumble it and sprinkle it on food. You can’t overdose him either. They pee out what the body doesn’t use. I have to go to work now but will check back in tonight.

 

Oh, fantastic! I will definitely order some then. It just breaks my heart watching him struggle. I was thinking about occasionally moistening his dry food to get him a little more water when he eats before we transition to wet food, so perhaps I can mix it in with that. Thank you so much for your suggestions!!

 

The pill crushes easily between first gets and you just mix in in the food. Glad the ear is better!

 

Just tested him again - used a rice sock to warm his ear up and the blood came much more easily today! Unfortunately, he was at 550. Our vet won't be in the office until tomorrow, so I'm hoping she gives me a call first thing.

 

With his numbers ( I saw you actually did a curve yesterday ) I would suggest you talk to your vet about raising his dose to 1.25 every 12 hours and then keep that dose 6 cycles while you monitor him also I do think you should start testing him for ketones just to be safe, that's easily done with dipsticks

 

Thanks for the suggestion! I have a feeling he has been consistently this high for at least the past week and a half - if not longer - so that's a good idea. Whether or not the vet calls me back tomorrow (if I hear from her, it's usually not until 6pm), my plan is to do a full curve on Thursday. Question about AMPS - should these be taken before or after they eat? I thought it would be before, so the food doesn't mess with the BG levels, but I saw somewhere else that when you do a full curve, you want them to eat, take the sample, and then do the insulin shot. Is that different from the standard AMPS shot a lot of people do?

 

Here's the basic testing routine we recommend:

1. test every day AM and PM before feeding and injecting (no food at least 2 hours before) to see if the planned dose is safe
2. test at least once near mid cycle or at bedtime daily to see how low the BG goes
3. do extra tests on days off to fill in the response picture
4. if indicated by consistently high numbers on your spreadsheet, increase the dose by no more than 0.25 u at a time so you don't accidentally go right past a good dose
5. post here for advice whenever you're confused or unsure of what to do.

The AM/PMPSs are the same on a curve day. You just add in an every 2 hours test between AM and PM shots. You can feed his lunch just after a mid day curve test and then no more food until PM meal if you want to eliminate any food effect from your curve.

 

Your AM and PM tests actually become part of your curve, the idea is to keep your routine as normal as possible to see how he's really doing during the day

 

With numbers in the black I think I'd try 1.5

 

The dry food is likely pushing his BG high but I know you have to be careful doing any food switch because of GI upsets. There are a couple of low carb dry foods you could try: Young Again Mature Zero and Dr. Elsey's Clean Protein. Both can be ordered online and both companies will send a sample for you to try.

 

I am going to call the vet first thing tomorrow morning - I just did his PMPS and got HI. I set his food back down (after making sure he didn't eat for the 2 hours before the PMPS), and he doesn't seem interested.

 

Do you have any urine ketone test strips? If he's not interested in eating and his BG is high it's wise to check for ketones. Is there a pharmacy near you open this evening? You use the human strips. Here are some ways to do it:

• put the end of the test strip right in his urine stream as he's peeing
• slip a shallow, long handled spoon under his backside to catch a little pee - you don't need much
• put a double layer of plastic wrap over his favourite part of the litter box and poke some depressions in it too catch pee.

Most test strips have to be dipped and allowed to develop for 15 seconds before viewing the colour change in very good light.

 

Raise the dose tonight

 

I agree about raising the dose tonight. I'd go to 1.5 u as Janet suggested earlier.

 

Unfortunately, I did his shot at 8:15 so I didn't see your messages beforehand . If I see equally high numbers tomorrow with the AMPS, should I go ahead and raise the dose then? I'm about to check his levels again.

 

Yes

 

Okay, thank you! He was at 657 just now, +2 after his shot. I am SO glad I just decided to start trying to test myself. He would have been sitting this high and I never would I known, had I waited for my vet to show me how to do it. If we weren't moving in two months, I would definitely be finding another vet at this point...

 

Yes, increase to 1.5 u in the AM. Plan to buy urine ketone test strips.

 

How is Rocco this morning? I hope he's eating now

 

If you can give fancy feast classic another go it really might help. Dm is about 14% carb as opposed to 3-4% for the fancy feast. Right now the insulin is fighting against both the diabetes and the food. If that doesn't work out with the wet food ask for a free sample of the Young Again Zero carb food available at Youngagainpetfood.com

 

I am honestly not sure even 1.5 will make enough difference. How long do you think she should try 1.5 before moving to 2? The not eating thing had me concerned ketones are forming.

 

I think this is a case where holding a dose only three cycles and increasing by another 0.5 u might be wise. I mentioned urine ketone testing last night. Rocco was eating dry food only because of tummy issues when given wet.

 

How is Rocco this AM?

 

Hi everyone. Thank you all for your concern. Rocco was put to sleep this morning.

When we got up, he was breathing very heavily and he had not eaten. He would meow a few times, which he hadn't been doing. I tried to get a BG reading, but no matter how much I warmed up his ear, I couldn't get any blood. His back legs were shaking so badly, and he couldn't walk. We decided to take him to the emergency vet. They did an ultrasound and found that his body was full of fluids, and that it was blood. His body was shutting down. We decided it was time.

I know I was only here for a short time, but I greatly appreciate all of the help you have given me. You are really a great group of people and I wish you nothing but the best for you and your kitties. <3

 

I'm so very sorry you had to let Rocco go.

 

Oh no! My heart is hurting for you. I had such hope we could help. My cat died a year ago of some kind of internal bleed so I can empathize with you. So sorry it was his time to go.

 

I am so sorry.

 

Oh, I'm so sorry! How terrible! Nothing you can do with a thing like that .

Fly free, Rocco.

 

Hi Rachel and Rocco!

Home testing was the BIGGEST stress reliever for me. I was scared to start, but now we are pros. Treats have been very helpful in this process, I usually toss two freeze dried chicken treats around the room and then drop one more right next to me. Nugget knows to eat them and then come sit in my lap. She doesn't struggle when I test (though sometimes she shakes her head and goodbye blood droplet). The more you test the easier it will be to know how much of a drop of blood you need.

Something I've learned is that we are the ones who have to make the tough decisions with our sugar babies and that we sometimes rely on the vet for the final say-so. Do the at home curve and then take the vet's opinion about raising the dose into consideration... especially if you think he's suffering.

We switched immediately from free feeding dry food (purina one salmon flavor) to Organix wet canned food. Nugget loves wet food, it used to be a treat for her. I feed her a 3oz can of pate twice a day, but I smoosh the pate around with about 2 oz. of warm water to make "soup"... that way I know she's getting fluids (to avoid a UTI), and it helps her graze a little longer during the day (she eats at 6:15am and 6:15 pm). Changing her diet I think has had the biggest impact on her blood sugar levels. They were in the 300s and 400s eating dry food, and now with the wet and the Lantus insulin, we stay in the 100s and very low 200s.

Hang in there!!

 

I'm so sorry. Take care of yourself.

 

I'm sorry sending you