Tentative Diagnosis of Diabetes Mellitus & Kidney Disease

Discussion in 'Feline Health - (The Main Forum)' started by sirswithin, Jul 14, 2013.

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  1. Wendy&Neko

    Wendy&Neko Well-Known Member

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    Re: Tentative Diagnosis of Diabetes Mellitus & Kidney Diseas

    Is Pharmasave where you bought your syringes? It could be I got the free sharps box because I got my syringes at Save-on. When it's full, just return and they give you an empty one in return.

    Have you done your +2 test yet?
     
  2. Wendy&Neko

    Wendy&Neko Well-Known Member

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    Re: Tentative Diagnosis of Diabetes Mellitus & Kidney Diseas

    Sorry, missed your post while I was typing. Looks like Grady is likely going to have a nice but not too low cycle tonight. We usually ask people to get a +2 test with Lantus, because it can give us an idea what the cycle is going to look like. If the +2 is the same as preshot, you'll likely have a normal lantus cycle. If it's lower, then it'll be an active cycle which means you might have to test more to make sure he's safe. If it's higher, then it'll be a quieter cycle. You are probably OK with just a test before bed if you can. Do you leave food out for him overnight to snack on? If he's at 200 or above in the morning, then it's safe for the shot. If below, post and ask for help.
     
  3. sirswithin

    sirswithin Member

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    Re: Tentative Diagnosis of Diabetes Mellitus & Kidney Diseas

    Yes, I got the syringes and insulin at Pharmasave because it's close by. He generally doesn't snack during the night because he doesn't like it when his wet food dries out. I'll do another test before retiring for the night.
     
  4. Deb & Wink

    Deb & Wink Well-Known Member

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    Re: Tentative Diagnosis of Diabetes Mellitus & Kidney Diseas

    Have you tried adding a little bit of water to his food. About one tablespoon, mix and stir. That helps to prevent the food from drying out.
     
  5. sirswithin

    sirswithin Member

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    Re: Tentative Diagnosis of Diabetes Mellitus & Kidney Diseas

    He tends to get weirded out by that but I'll leave a little bit out overnight and wet it down.
     
  6. sirswithin

    sirswithin Member

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    Re: Tentative Diagnosis of Diabetes Mellitus & Kidney Diseas

    Final reading of the night 185.4.
     
  7. sirswithin

    sirswithin Member

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    Re: Tentative Diagnosis of Diabetes Mellitus & Kidney Diseas

    Spiked up high this morning. 424.8. 1 unit of insulin given.
     
  8. Wendy&Tiggy(GA)

    Wendy&Tiggy(GA) Well-Known Member

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    Re: Tentative Diagnosis of Diabetes Mellitus & Kidney Diseas

    I wonder how low he went last night, he was dropping still middle of the night.. The reading you took at +4 was likely not the lowest point (nadir) . Now I don't think he went too low, but maybe lower than he has seen in a while. This could have triggered a "bounce".. If so, he may stay high all day and then come back down. It's very normal.


    Bounces - what are they and is my cat doing them?
    When a cat is first diagnosed, the blood glucose has probably been high for a while. As the insulin starts to take effect and numbers start to come down, the liver has to learn to adjust to the lower numbers. We call this "liver training school". But before it relearns that low numbers are ok, when the BG drops to a number lower than the liver is accustomed, or if BGs drop low, or if the BG drops suddenly, the liver”panics” and reacts by releasing counterregulatory hormones and glucagon. This drives the BG back up. This is what we call a "bounce". Bounces can take up to 72 hours to clear so we are generally careful about increasing doses during the bounce. Once the bounce clears, then you can see the "real" numbers and determine if the dose needs to go up or down.

    Wendy
     
  9. sirswithin

    sirswithin Member

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    Re: Tentative Diagnosis of Diabetes Mellitus & Kidney Diseas

    Afternoon reading 248.4 before feeding.
     
  10. Wendy&Tiggy(GA)

    Wendy&Tiggy(GA) Well-Known Member

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    Re: Tentative Diagnosis of Diabetes Mellitus & Kidney Diseas

    Looks like bounce is clearing. Be interesting to see PMPS. Might want to get a +11 so we can prep in advance if he is under 200 again.

    Numbers looking nice though.
     
  11. sirswithin

    sirswithin Member

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    Re: Tentative Diagnosis of Diabetes Mellitus & Kidney Diseas

    397.8 an hour before shot time. Should I test again in an hour or just shoot and then feed?
     
  12. Wendy&Tiggy(GA)

    Wendy&Tiggy(GA) Well-Known Member

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    Re: Tentative Diagnosis of Diabetes Mellitus & Kidney Diseas

    Test. Always test before the shot. Its a good habit to get into, its good data and you never know when they will surprise you

    Maybe not a bounce then. But anyway the lantus is still settling in..
     
  13. sirswithin

    sirswithin Member

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    Re: Tentative Diagnosis of Diabetes Mellitus & Kidney Diseas

    A couple of hours after shot and meter reading is 453.6, the highest yet. Seems odd.
     
  14. Wendy&Tiggy(GA)

    Wendy&Tiggy(GA) Well-Known Member

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    Re: Tentative Diagnosis of Diabetes Mellitus & Kidney Diseas

    Its just the first week still. Could still be a bounce from the other night. and the depot is still building. We just keep going for the week and we can adjust the dose after that.

    Wendy
     
  15. sirswithin

    sirswithin Member

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    Re: Tentative Diagnosis of Diabetes Mellitus & Kidney Diseas

    Literally off the charts this morning. 597.6! Tested twice just to make sure.
     
  16. Wendy&Tiggy(GA)

    Wendy&Tiggy(GA) Well-Known Member

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    Re: Tentative Diagnosis of Diabetes Mellitus & Kidney Diseas

    It does sound like he is bouncing. Just to check though - he isnt getting into any dry is he? Dry treats?

    Keep checking for ketones.

    Wendy
     
  17. sirswithin

    sirswithin Member

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    Re: Tentative Diagnosis of Diabetes Mellitus & Kidney Diseas

    I did put a few pieces of kibble in a bowl to try to get him to eat more. But when I say a few I mean you can actually count them. So, while he probably did eat some dry stuff, it wasn't a lot. It was a little freaky when the meter couldn't read any higher. Next test is at one.
     
  18. Wendy&Tiggy(GA)

    Wendy&Tiggy(GA) Well-Known Member

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    Re: Tentative Diagnosis of Diabetes Mellitus & Kidney Diseas

    no kibble!!! Freeze it. Some cats are very carb sensitive and even a few pieces can spike their blood sugar for over 24 hours.

    You want to tempt him to eat more try sprinkling freeze dried chicken or parmesan or oregano on it. or fortiflora.

    Wendy
     
  19. sirswithin

    sirswithin Member

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    Re: Tentative Diagnosis of Diabetes Mellitus & Kidney Diseas

    Test numbers still maxing out the meter.
     
  20. Wendy&Tiggy(GA)

    Wendy&Tiggy(GA) Well-Known Member

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    Re: Tentative Diagnosis of Diabetes Mellitus & Kidney Diseas

    You are testing for ketones right?

    Wendy
     
  21. sirswithin

    sirswithin Member

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    Re: Tentative Diagnosis of Diabetes Mellitus & Kidney Diseas

    Last time was a couple of nights ago. Came back negative. I'll try again tonight.
     
  22. Wendy&Tiggy(GA)

    Wendy&Tiggy(GA) Well-Known Member

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    Re: Tentative Diagnosis of Diabetes Mellitus & Kidney Diseas

    Sounds good. I suspect this is a bounce combined with kibble .. so hopefully it will clear tomorrow. Bounces can last 72 hours and this is a hard one which makes me wonder how low he went on the night of the 27th.

    No more kibble. :)

    Wendy
     
  23. sirswithin

    sirswithin Member

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    Re: Tentative Diagnosis of Diabetes Mellitus & Kidney Diseas

    The kibble has been banished. I don't like bounces.
     
  24. Wendy&Tiggy(GA)

    Wendy&Tiggy(GA) Well-Known Member

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    Re: Tentative Diagnosis of Diabetes Mellitus & Kidney Diseas

    Nobody does. But its early days and patience is key here. Many cats bounce and gradually the bounces get less so the cat spends more time in normal blues and greens.. and then hopefully.. the bounces stop and the cat goes into remission.

    I give my Bailey 5 pieces of kibble and his blood glucose doubles.. and it lasts for over a day.

    As long as we dont have ketones then high blood sugar wont hurt him short term.

    Wendy
     
  25. sirswithin

    sirswithin Member

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    Re: Tentative Diagnosis of Diabetes Mellitus & Kidney Diseas

    I tried sprinkling some oregano on some of the food he wouldn't eat. He sniffed it then walked away. Same for the parmesan. I have a feeling no matter what I do he's just going to do things his way. We end up throwing a lot of cat food away.
     
  26. Wendy&Tiggy(GA)

    Wendy&Tiggy(GA) Well-Known Member

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    Re: Tentative Diagnosis of Diabetes Mellitus & Kidney Diseas

    How much is he eating every day? Is he not eating enough..?
     
  27. Deb & Wink

    Deb & Wink Well-Known Member

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    Re: Tentative Diagnosis of Diabetes Mellitus & Kidney Diseas

    Wendy asked me to look at Grady's SS and condo. I think there could be several things going on here, not just one cause to kick those numbers into high gear. Here are some possibilities:

    1. Grady is very carb sensitive. Dry food can stick around in the digestive system for 24-48 hours or more. Wendy has already suggested that you do not give any more dry food and I concur. We can do a food test later with some higher carb wet food to see how carb sensitive Grady might be. We don't want to do that now because of these high numbers though. Let's leave the food test for later.

    2. Fur shot. This morning could have been a fur shot, where all or some of the insulin did not go in. I'm suggesting that because the insulin seemed to have no affect on Grady's BG numbers at +5. One way to check for a fur shot is to run your hand lightly through the fur after the shot and check for any wetness. If you feel that wetness, than either the needle poked through the tent of skin or some leaked out afterwards.

    3. Bounce. He bounced from the skipped shot on 7/26 AM AND could have gone lower on 7/28 PM to get a second bounce for that high number for this mornings reading.

    4. 7/29 AMPS and +5 could have been a bad test. Whenever you get numbers that do not seem to be in line with what you have been getting, it's always a good idea to get another test within a few minutes to confirm. (I see you did that this AM. Good job!)

    5. An infection is kicking in, like a UTI or kidney or teeth or something. That could be causing higher numbers. Wink could shoot up 50-100 points in the first day or two of a UTI/diarrhea episode coming on.

    Again, I want to say I think it's a combination of some of these factors, not all, but some. Really difficult to say which ones. No matter. He is too high. We need to get those numbers down, but I'm not sure how low he would drop on an increase and we are still waiting for the bounce to clear.

    Please, try really hard to get a Ketone test tonight on Grady. Those high numbers concern me. In combination with his reduced appetite, that is a big concern.

    I'd like to see this evenings PMPS but I need to head off to bed early tonight, early morning for me and I won't be able to be on the board in the morning. I would suggest you shoot the 1U tonight if Grady is over 200. Stall, with no food and retest in 30 minutes if he is under 200.
     
  28. rhiannon and shadow (GA)

    rhiannon and shadow (GA) Well-Known Member

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    Re: Tentative Diagnosis of Diabetes Mellitus & Kidney Diseas

    Hello.
    I saw Wendy's post asking for input.

    on the food....
    I called Nutro when they changed all their formulas because I liked one of the old ones which is now gone.
    They claimed that in this new line, the low carb ones are the senior canned recipes.... they ranged from 1% to 4% carb. There are 4 flavors in existence.
    I suspect the adult ones are not low carb.

    This might be contributing to the high bgs.


    Deb has some good points on possibilities too.

    I would suggest that you try to get a +7 or a +8 or +9....in the evening cycle just to get some data to see where Grady's going. Just try to wake up somewhere in the wee hours once and grab a test.
    With the little data there is so far ( it's only been a few days , afterall ) it appears that Grady is bouncing from blue numbers..... and goes to the red.....
    but then these new blacks.....

    there might have been something lower in the missed area. ( that's my personal opinion)
     
  29. sirswithin

    sirswithin Member

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    Re: Tentative Diagnosis of Diabetes Mellitus & Kidney Diseas

    547.2, so he has come down. I also thought I had done a fur shot when the numbers didn't go down after insulin and as a matter of course I run my hand across his fur to see if it's wet. It wasn't. I usually go to bed around 1:30 am so I'm able to do a few more tests in the meantime. Thanks for all the input! We only have a few cans of the Nutro and only give them to Grady when he absolutely won't eat anything on the approved list. Good to know only the Seniors are low carb.
     
  30. sirswithin

    sirswithin Member

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    Re: Tentative Diagnosis of Diabetes Mellitus & Kidney Diseas

    Figured out part of the problem. There was an air bubble trapped in the end of the vial. I was wondering why he wasn't reacting to the injections anymore. Because he wasn't being injected with anything except air! As it's such a small amount it's very difficult to differentiate between liquid and air. Now that I know what to look for it won't happen again. He definitely got tonight's shot. I'll test him again in a couple of hours. Should he have any food? He's just sleeping right now. Grady eats about 1.5 - 2 3oz cans of food per day. If we try to give him more he'll just leave half of it behind and then we end up throwing it out.
     
  31. sirswithin

    sirswithin Member

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    Re: Tentative Diagnosis of Diabetes Mellitus & Kidney Diseas

    493.2 at +2. Will test again at +5.
     
  32. Wendy&Neko

    Wendy&Neko Well-Known Member

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    Re: Tentative Diagnosis of Diabetes Mellitus & Kidney Diseas

    The BD syringes are notorious for their bubbles and I find a very uneven level of quality between them. I find using a magnifying glass to look at what's in the syringe helps. When you put the syringe in the Lantus cartridge/vial, make sure you have the plunger pushed in hard. I usually draw out .5 -1 unit extra, then pull the syringe out. I then pull the plunger down a little to form an air pocket at the top, then flick the syringe to dislodge bubbles. Bubbles seem to like to go up to the air pocket. Then depress the plunger to expel the air. Then I take a look with the magnifier to make sure I've gotten rid of all bubbles. If not, pull back the plunger again and flick and repeat until bubble-less.
     
  33. sirswithin

    sirswithin Member

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    Re: Tentative Diagnosis of Diabetes Mellitus & Kidney Diseas

    Reading at +5 388.8 heading in the right direction finally. My issue with the air bubble was with the vial rather than the syringe. I would tip it back and forth to try and dislodge any bubble before sticking the syringe in, but I guess it just stubbornly stuck in the neck where I couldn't see it. This last time I gave the vial a flick and up it popped. Certainly a lot to learn in this ongoing process. It feels like I've been doing this forever already and it hasn't even been a week.
     
  34. Wendy&Tiggy(GA)

    Wendy&Tiggy(GA) Well-Known Member

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    Re: Tentative Diagnosis of Diabetes Mellitus & Kidney Diseas

    yay he is coming down! Glad you discovered the problem.

    Wendy
     
  35. sirswithin

    sirswithin Member

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    Re: Tentative Diagnosis of Diabetes Mellitus & Kidney Diseas

    284.4 this morning
     
  36. Wendy&Tiggy(GA)

    Wendy&Tiggy(GA) Well-Known Member

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    Re: Tentative Diagnosis of Diabetes Mellitus & Kidney Diseas

    coming down!! yay!
     
  37. sirswithin

    sirswithin Member

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    Re: Tentative Diagnosis of Diabetes Mellitus & Kidney Diseas

    Wow, down to 113.4 at +5
     
  38. Wendy&Tiggy(GA)

    Wendy&Tiggy(GA) Well-Known Member

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    Re: Tentative Diagnosis of Diabetes Mellitus & Kidney Diseas

    get a +6?
     
  39. sirswithin

    sirswithin Member

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    Re: Tentative Diagnosis of Diabetes Mellitus & Kidney Diseas

    109.8 at +6
     
  40. Wendy&Tiggy(GA)

    Wendy&Tiggy(GA) Well-Known Member

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    Re: Tentative Diagnosis of Diabetes Mellitus & Kidney Diseas

    i want to see green ;) wanna go for a +7?

    Wendy
     
  41. sirswithin

    sirswithin Member

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    Re: Tentative Diagnosis of Diabetes Mellitus & Kidney Diseas

    No thanks. I can only really do that while I'm on my lunch. I can only test before the shot at 8:30am, 1pm when I go home for lunch (maybe around 2pm just before I leave for work again), then any time between 5:30 pm and 1:30 am. Thankfully, I get an hour for lunch and I only live five minutes away.
     
  42. Wendy&Tiggy(GA)

    Wendy&Tiggy(GA) Well-Known Member

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    Re: Tentative Diagnosis of Diabetes Mellitus & Kidney Diseas

    Ah well.. nice to see some blues though! Hopefully we see some greens soon! How many shots do you think were missed due to the air bubble?
     
  43. sirswithin

    sirswithin Member

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    Re: Tentative Diagnosis of Diabetes Mellitus & Kidney Diseas

    I think it was two shots. I've noted it on the spreadsheet as a reminder of my stupidity.
     
  44. Wendy&Tiggy(GA)

    Wendy&Tiggy(GA) Well-Known Member

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    Re: Tentative Diagnosis of Diabetes Mellitus & Kidney Diseas

    It's good to note it, but you aren't stupid. I don't know if I would have guessed it was a trapped air bubble either. Are you using a vial or pens?
     
  45. sirswithin

    sirswithin Member

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    Re: Tentative Diagnosis of Diabetes Mellitus & Kidney Diseas

    We've got five 3mL vials, so that should last a fairly long time.
     
  46. Wendy&Tiggy(GA)

    Wendy&Tiggy(GA) Well-Known Member

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    Re: Tentative Diagnosis of Diabetes Mellitus & Kidney Diseas

    Small Vials? I didn't know they came in small vials, just the white flat pack of 5 plastic grey pens, or 10ml glass vial in a white box.

    Wendy
     
  47. sirswithin

    sirswithin Member

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    Re: Tentative Diagnosis of Diabetes Mellitus & Kidney Diseas

    Meter reading 162. Skipped insulin injection. The vials are actually cartridges for an injection pen, but it amounts to the same thing.
     
  48. Wendy&Tiggy(GA)

    Wendy&Tiggy(GA) Well-Known Member

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    Re: Tentative Diagnosis of Diabetes Mellitus & Kidney Diseas

    Ahahhaha.. I use the pens too and those air bubbles are a pain. Don't inject air into them, as they are designed with pressure that pushes the insulin down.

    To get the insulin, first press the plunger of the syringe to expel all air, and keep holding the plunger pressed firmly while inserting into the pen's stopper. Otherwise there is air in the rubber flexible end of the plunger that will get in.

    If you do get air in there, turn the pen with the stopper end up in the air and flick till all the air is at the top, then remove with a syringe. Helps a bit.

    And watch out when you get towards the end of the pen, as it tends to be mainly air then.

    Wendy
     
  49. sirswithin

    sirswithin Member

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    Re: Tentative Diagnosis of Diabetes Mellitus & Kidney Diseas

    It's good to be back! 320.4 this morning. Gave .75 unit shot. Now off to work I go! Yay.
     
  50. sirswithin

    sirswithin Member

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    Re: Tentative Diagnosis of Diabetes Mellitus & Kidney Diseas

    203.4 at AMPS +5
     
  51. Wendy&Tiggy(GA)

    Wendy&Tiggy(GA) Well-Known Member

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    Re: Tentative Diagnosis of Diabetes Mellitus & Kidney Diseas

    Ok good.. weekend starts soon!
     
  52. sirswithin

    sirswithin Member

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    Re: Tentative Diagnosis of Diabetes Mellitus & Kidney Diseas

    PMPS 306
     
  53. sirswithin

    sirswithin Member

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    Re: Tentative Diagnosis of Diabetes Mellitus & Kidney Diseas

    Reading went up to 320.4 at +2. It was Amie's first turn at giving Grady his insulin. Everything looked fine. I held the skin while she put the needle in and injected the insulin. But you know how the stuff has a very strong scent? I could smell it afterwards, when usually I can't, so now I don't know if he actually got his shot or not. It's not like you can give him another one "just in case". We'll do another test later on and wait for the morning shot, I guess.
     
  54. sirswithin

    sirswithin Member

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    Re: Tentative Diagnosis of Diabetes Mellitus & Kidney Diseas

    +4 reading at 235.8, so it came down quite a bit over the next two hours. Still don't know why it went up at +2
     
  55. Wendy&Tiggy(GA)

    Wendy&Tiggy(GA) Well-Known Member

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    Re: Tentative Diagnosis of Diabetes Mellitus & Kidney Diseas

    Could have gone right through and given a fur shot. I always touch to make sure it hasn't gone all the way through and then again after to check for wetness and sniff my finger.

    Some cats get a food spike at +2. But in this case it looks like its just within meter error.
     
  56. sirswithin

    sirswithin Member

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    Re: Tentative Diagnosis of Diabetes Mellitus & Kidney Diseas

    Back up to 437.4 for the AMPS
     
  57. sirswithin

    sirswithin Member

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    Re: Tentative Diagnosis of Diabetes Mellitus & Kidney Diseas

    Down to 360 at lunch.
     
  58. Wendy&Tiggy(GA)

    Wendy&Tiggy(GA) Well-Known Member

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    Re: Tentative Diagnosis of Diabetes Mellitus & Kidney Diseas

    Are you able to get some spot checks in this weekend to fill in the data a bit?
     
  59. sirswithin

    sirswithin Member

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    Re: Tentative Diagnosis of Diabetes Mellitus & Kidney Diseas

    Will try to fill in the gaps where I can.
     
  60. Deb & Wink

    Deb & Wink Well-Known Member

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    Re: Tentative Diagnosis of Diabetes Mellitus & Kidney Diseas

    Thanks, more tests to fill in the gaps on the SS are always appreciated. We know how tough this can be to fit into your life.

    Hoping to get a better handle on the dose for your kitty.

    Sending some {{{{{hugs}}}}} and de-stress vines your way. Hang in there.
     
  61. Wendy&Tiggy(GA)

    Wendy&Tiggy(GA) Well-Known Member

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    Re: Tentative Diagnosis of Diabetes Mellitus & Kidney Diseas

    Do you guys in BC get the civic holiday Monday too?
     
  62. sirswithin

    sirswithin Member

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    Re: Tentative Diagnosis of Diabetes Mellitus & Kidney Diseas

    Yup, it's a long weekend here. 212 at +9. Been out most of the day. Got some freeze dried chicken. He does not seem interested. He's turned his nose up at pretty much every treat I've ever tried, with the exception of process cheese slices.
     
  63. sirswithin

    sirswithin Member

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    Re: Tentative Diagnosis of Diabetes Mellitus & Kidney Diseas

    Since we were running low on meter strips, my wife popped out on Friday and picked up a package of 50 from a pharmacy in our neighbourhood. They were approximately a dollar each. Does anyone know of a less expensive source for these strips?
     
  64. Wendy&Tiggy(GA)

    Wendy&Tiggy(GA) Well-Known Member

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    Re: Tentative Diagnosis of Diabetes Mellitus & Kidney Diseas

    eBay. You can get a pack of 100 and free lancets for $50 incl shipping. Less if you are willing to watch and bid. I use shorebird medical in NY. Takes a couple of weeks since they ship USPS so you need to plan in advance. Ie http://www.ebay.ca/itm/Bayer-Contou...LH_DefaultDomain_0&hash=item3ccb88e8e1&_uhb=1

    Did your meter arrive? Should come with some free strips too ;)
     
  65. sirswithin

    sirswithin Member

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    Re: Tentative Diagnosis of Diabetes Mellitus & Kidney Diseas

    Nope, still no meter. I'm thinking their estimate of 4-6 weeks was probably accurate.
     
  66. Wendy&Tiggy(GA)

    Wendy&Tiggy(GA) Well-Known Member

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    Re: Tentative Diagnosis of Diabetes Mellitus & Kidney Diseas

    Must have changed it because when I ordered mine and a few friends did a year ago, it came by purolator in a few weeks.

    So far things are looking good with this dose but we may need to practice shooting low soon.. It's something all newbies need to learn to do, shoot low to stay low if you want to get good control or remission.

    Read up on this http://www.felinediabetes.com/FDMB/viewtopic.php?f=9&t=147

    And next time he has a low preshot under 200, stall. Don't feed or shoot, and come on here and start a new thread with a 911 so you catch our attention and we will come and advise. We will help you shoot at a lower number safely.

    Meanwhile let's give this dose a little longer and revaluate.
    Wendy
     
  67. sirswithin

    sirswithin Member

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    Re: Tentative Diagnosis of Diabetes Mellitus & Kidney Diseas

    Pretty good day Saturday. Numbers were in the 200s or less for most of it.
     
  68. Wendy&Tiggy(GA)

    Wendy&Tiggy(GA) Well-Known Member

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    Nov 15, 2011
    Re: Tentative Diagnosis of Diabetes Mellitus & Kidney Diseas

    Great numbers - looks like the dose is working well so far. Now we want some greens please. If we dont see any greens by end tomorrow we may increase 1/4 unit - but can you get some more tests in today and tomorrow we want to be sure he isnt dropping low and you are missing it. Like last night at +4 he was 157 - after that I would have tested every hour or two to see if he dropped further.

    Tomorrow also can I suggest a AMPS +3 and +5?

    Wendy
     
  69. sirswithin

    sirswithin Member

    Joined:
    Jul 14, 2013
    Re: Tentative Diagnosis of Diabetes Mellitus & Kidney Diseas

    I will try my best. That +4 was at 12:30 am and I was feeling pretty wiped, nodding in and out of consciousness on the couch. I'll see if I can get more data to analyze.
     
  70. Wendy&Tiggy(GA)

    Wendy&Tiggy(GA) Well-Known Member

    Joined:
    Nov 15, 2011
    Re: Tentative Diagnosis of Diabetes Mellitus & Kidney Diseas

    The amps tests I suggested might be good enough..
     
  71. sirswithin

    sirswithin Member

    Joined:
    Jul 14, 2013
    Re: Tentative Diagnosis of Diabetes Mellitus & Kidney Diseas

    Caught the lowest reading at 2:30 in the morning at 146. So very tired.
     
  72. BJM

    BJM Well-Known Member

    Joined:
    Oct 6, 2010
    Re: Tentative Diagnosis of Diabetes Mellitus & Kidney Diseas

    Note on naps!

    The human sleep cycle is about 45 minutes.
    If you try to wake in the middle of a sleep cycle, it is usually more difficult to do and you may feel pretty crappy.
    If you try to wake at the end of a sleep cycle, it is usually easier to do, plus you may actually feel somewhat rested.

    Thus, if you need to nap between tests (or whatever), make it a multiple of 45 minutes.
    Ex
    1.50 hours
    2.25 hours
    3.00 hours
    Etc.
     
  73. Wendy&Tiggy(GA)

    Wendy&Tiggy(GA) Well-Known Member

    Joined:
    Nov 15, 2011
    Re: Tentative Diagnosis of Diabetes Mellitus & Kidney Diseas

    Great job! Today an amps+3 would be good as well as your usual preshots. If he doesn't dip into green today then its 1 unit starting tomorrow.
     
  74. sirswithin

    sirswithin Member

    Joined:
    Jul 14, 2013
    Re: Tentative Diagnosis of Diabetes Mellitus & Kidney Diseas

    Got the AMPS +3 and +5. Down to 155 in the afternoon.
     
  75. Wendy&Tiggy(GA)

    Wendy&Tiggy(GA) Well-Known Member

    Joined:
    Nov 15, 2011
    Re: Tentative Diagnosis of Diabetes Mellitus & Kidney Diseas

    Ok great! Now tomorrow morning I am thinking a dose increase will be needed to 1 unit unless you see a green today. However I am going to recommend at this point you transition over to the Tight Regulation Board. http://www.felinediabetes.com/FDMB/viewforum.php?f=9

    Reason I suggest this is that they are more experienced on that board around dosing and will help you maintain momentum, plus there is a great sense of community. I myself post there every couple of days for my 2 cats for them to keep an eye on them. As long as you post every day or two they will continue to watch your cat, and advise where needed.. esp if you have a question! You are doing a great job with Grady and they will help keep things on track, esp if/when you start to get into lower numbers. I will continue to check on you too.

    Here’s how to post:
    Every day ( or as often as you can) you open a new thread/post. We call them "condos" (short for condition report, or the home you live in and the cat trees some people have)

    Subject line: The subject has the date/cats name and BG readings ie 06/23 CATname AMPS 400 +2 333 + 5 224. You add a ? icon if you have a question. You should update your subject line in the very first post for the day as you get a reading, or whenever you have a question. For your first post put "newbie" also in your subject so everyone can welcome you!

    Contents: The contents of your post have a quick update on how your cat is feeling as regards the 5Ps ( peeing. pooing, preening, playing and purring) and any questions and a link to your previous post ie : Today CATname was in a good mood, playing and eating well. But he is peeing a lot and his BG is really high. Should I increase the dose?

    There is no rush to post there. I like to suggest that people go over to their insulin specific support group and check it out. Read the Stickies at the top of the Topics section. Read a few condos posted by other members. Get a feel for how the forum works. See if you think it would be a good fit for you.

    But you are always welcome to post here in the Feline Health forum for as long as you want.
     
  76. d0zivyhoo

    d0zivyhoo Member

    Joined:
    Nov 21, 2012
    Re: Tentative Diagnosis of Diabetes Mellitus & Kidney Diseas

    Hi all.

    Wow, the group has been just awesome with the replies on this matter. If I didn't thank all of you enough when I was a newbie, I'm thanking you now on behalf of all newbies.

    Anyway, due to the differences between Canadian and U.S. values, I thought this website would be very helpful in this case (I will also post this separately):

    http://dwjay.tripod.com/conversion.html

    In has been an invaluable tool for me, as I am from the U.S., and I am now living part of the time in Canada. So, it is the only way I can decipher Sarah's labs here.

    The site contains just about anything you can imagine from a lab, including glucose. So, that reading of 21mmol/L was U.S. 378 mg/ml

    Now for the good news. Your kitty can still have a long life, but it will take effort on your part. Sarah just celebrated her 16th birthday a month ago. She has been CKD for a solid two years now and diabetic for 10 months. She has never crashed and still screams at me for meals. But, she does require a lot of my time.

    Okay, now for the other portion: ckd in conjunction with diabetes. I’m sorry this is so long, but I didn’t see anyone providing information on this opposing combination of dietary problems.

    Did I miss kitty's phosphorus lab value? EXTREMELY important here, especially when deciding which foods to feed. Also, I didn’t see a Urea/BUN value.

    VERY good that you got kitty off of k/d - I'm fairly certain that is why my cat now has diabetes (the CKD was first). Her pancreas is totally shot, so she will always be on insulin. If you can, I highly recommend getting an fPL or ultrasound to determine your kitty's pancreas health, because that will give you an idea of your future and if diet and insulin will ever get kitty off the juice at some point. I’m really glad that I know, because I would be very frustrated she is still on insulin if I had any hope otherwise.

    Next, with multiple vets' approval, I am feeding 1/2 Hill's m/d (diabetic) and 1/2 Royal Canin Renal LP (not the gravy flavor). The combination cuts down on the fat and carbs of the renal diet, while Sarah benefits from the additional nutrients included in the renal diet. The Hill's m/d has the lowest phosphorus content of just about any non-renal food out there. You really want a canned food with < .5% on a dry matter basis. The m/d is .69% and the Royal Canin is .47%. So, we are just slightly higher at .58%. Sarah’s phosphorus has always remained excellent. You can use phosphorus binders, but they are not without their side effects.

    Whatever you do, do not go back to dry food. Not only will it be higher in carbs/sugars, but it is very hard on kidney cats who need every ounce of moisture they can get. The other good news with the m/d is it is so that Sarah does not turn up her nose at the Royal Canin, and I can mix all of her meds in there without pilling.

    Treats: I give Sarah a very small chunk of skinless chicken breast as a treat, and she goes nuts for it. I cut up a chicken breast and place about six tiny cubes in a snack size zip lock. I do this for as many chucks that I have, place one bag in the fridge and the rest in the freezer. When I am down to three chunks, I remove a bag from the freezer and place it in the refrigerator for the future. Due to the kidneys, no more than two chunks a day so you don’t overdo the protein.

    Next, I know it’s another expense, but it is very important that you get kitty’s blood pressure checked. A mobile vet is your best bet, because a trip to the vet always raises the value. If your cat has high blood pressure (which is very common with CKD), it is important to start meds asap. Not dealing with it can cause blindness and/or heart muscle damage. It can also cause glaucoma.

    Your kitty’s creatinine value is indeed high. It could be a sign of high protein in the diet and/or dehydration. You can test yourself by making a skin tent by pulling up kitty’s scruff about the shoulders. If it goes back down slowly, check the gums for moisture. If not wet, kitty is dehydrated and probably would benefit from subcutaneous fluids. Yes, I know, another thing to worry about, but it will save your cat’s life in the long-run. Adding water to the wet food will indeed help, but with a creatinine that high, if I were you, I would talk to my vet about sub-q’s asap.

    Other things to keep a close eye on: potassium levels. Too low will cause kitty to walk on the back hocks. Too high will do the same. Yes, I know, ugh. Also diabetic neuropathy will cause the same behavior and a very weak back end.

    Hang in there. I know this is all so overwhelming, especially with multiple issues.

    If you want to email me privately, please do so. I am now on the Sunshine Coast, and if it will help you, I’d be happy to talk with you by phone.

    Hugs, DZ and Sarah
     
  77. sirswithin

    sirswithin Member

    Joined:
    Jul 14, 2013
    Re: Tentative Diagnosis of Diabetes Mellitus & Kidney Diseas

    Wow, that was all a little overwhelming. I never received Grady's phosphorous number or his Urea/BUN values. They just told me his glucose level (324), his creatinine level (278) and that his sodium and chloride levels were low. It was over the phone at my place of work so I was just frantically writing things down as they were thrown at me. His scruff does go down after being pulled up and his gums look wet. He was at the vet last weekend giving a urine sample for a culture, which came back negative, and they didn't mention anything about him looking dehydrated. Before the diagnosis he was on a higher protein diet, both wet and dry, trying to get him away from the crappy kinds of food. Now he only eats the wet food that is 5% or less in carbs and less than 250 in phosphorous. He absolutely hates water added to his food. Doesn't matter if it's straight from the tap or distilled, he just walks away. I've read so many negative things about Hills Prescription Diet foods I've steered well clear of them. Not only does Grady not like them, along with Royal Canin, they are quite expensive and only available at the vet's. The vet did recommend getting his blood pressure taken, so I might get that taken care of next weekend. Now next I have to find a way to tell the vet I didn't follow her dosage instructions (1.5 units) when they ask for his numbers. Thanks for all the great advice and support!

    Last reading 241 at AMPS +11. Looks like I won't be shooting low tonight.
     
  78. Wendy&Tiggy(GA)

    Wendy&Tiggy(GA) Well-Known Member

    Joined:
    Nov 15, 2011
    Re: Tentative Diagnosis of Diabetes Mellitus & Kidney Diseas

    Just show the vet your spreadsheet and bring the meter with you. If your vet is good he will see the dose and be happy with the readings.. Although most vets don't like under 200 though but their goal isn't remission..
     
  79. sirswithin

    sirswithin Member

    Joined:
    Jul 14, 2013
    Re: Tentative Diagnosis of Diabetes Mellitus & Kidney Diseas

    Jumped up to 1 unit this morning. All seemed to go well.
     
  80. sirswithin

    sirswithin Member

    Joined:
    Jul 14, 2013
    Re: Tentative Diagnosis of Diabetes Mellitus & Kidney Diseas

    250 AMPS to 313 at +5 at new 1 unit dosage. Don't know why the spike in numbers. The injection definitely took this morning (no fur shot). I think my wife may have fed him shortly before I got home for lunch, but it would've only been the BFF Tuna & Salmon.
     
  81. Wendy&Tiggy(GA)

    Wendy&Tiggy(GA) Well-Known Member

    Joined:
    Nov 15, 2011
    Re: Tentative Diagnosis of Diabetes Mellitus & Kidney Diseas

    I am thinking he could be bouncing off a middle of the night low. If it is a bounce he will come back down.But it also means he may have gone green last night drat it and we missed it.

    Did you get a chance to look at the other board?

    Wendy
     
  82. sirswithin

    sirswithin Member

    Joined:
    Jul 14, 2013
    Re: Tentative Diagnosis of Diabetes Mellitus & Kidney Diseas

    I have migrated over there and posted a couple of times. One thing that's been nagging me is food scheduling. I'm really at a loss as to when I should be feeding Grady in relation to when I'm taking meter readings and giving him his insulin. Right now it's kind of all over the place with the exception of shot time, where he does not get food two hours prior but immediately following. Other than that there's no specific feeding times. Is there something I should be doing regarding feeding times and ear poking times?
     
  83. BJM

    BJM Well-Known Member

    Joined:
    Oct 6, 2010
    Re: Tentative Diagnosis of Diabetes Mellitus & Kidney Diseas

    With a depot insulin like Lantus, test, feed, & shoot at AM & PM preshot tests, within about 15 minutes

    Unless dealing with a possible hypo, pick up food at +10 so there are 2 hours food free before your pre-shot tests.

    Mini-meals may be done, or freezing some and putting out to be nibbled as it thaws, or using a timed feeder help reduce the impact of food on glucose levels. If your cat will graze, you may put out all the food at one time - it won't hurt him.

    Test around bedtime to see if anything looks like it needs attention before you go to bed. Sometimes you'll get a surprising drop and need to stay up and monitor.

    Test around nadir - 5-7 hours post shot - when possible, as that is when the lowest values will often happen

    A full curve - testing every 2 hours from pre-shot to pre-shot - is helpful in observing the full response to Lantus.

    A mini-curve - testing every 3 hours from pre-shot to pre-shot - is also helpful when you don't as much data.

    Whenever <50, its test, feed 2 teaspoons gravy, 30 min wait, repeat, until numbers are safe.
     
  84. sirswithin

    sirswithin Member

    Joined:
    Jul 14, 2013
    Re: Tentative Diagnosis of Diabetes Mellitus & Kidney Diseas

    I've just been reading some of the posts on here about how and where to inject the insulin and it seems a little different from what the vet tech showed us. She demonstrated by pinching the skin between the shoulder blades and exposing skin between the thumb and forefinger, then insert the needle, draw back slightly to make sure there's no blood, and inject. Now I'm reading that a possibly better location for absorption of the insulin is along the flank. And from the videos I've been watching, I'm supposed to be making a tent and injecting into the front wall rather than between my fingers. Also, lumps in the form of scar tissue may form around the scruff after too many injections. I haven't been able to find any flank injection videos, but I might give this a try at the next shot.
     
  85. Wendy&Tiggy(GA)

    Wendy&Tiggy(GA) Well-Known Member

    Joined:
    Nov 15, 2011
    Re: Tentative Diagnosis of Diabetes Mellitus & Kidney Diseas

    You are using the bd ultra fine ii 5/16" syringes?

    You don't need to aspirate (pull back to check for blood) since the needle is so short and you are ensuring your are shooting into skin with that technique (or tenting). Just pull the skin up to form a tent, or pinch it like you have been doing and inject at a shallow angle to the body. The goal really is to inject under the skin.

    You can certainly use the scruff but many of us rotate sites to avoid scar tissue etc.. So I do scruff and upper and lower flanks on each side. See here http://www.bd.com/ca/diabetes/english/page.aspx?cat=14501&id=14874
     
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