Trying to Determine Next Steps

Linus is getting increasingly lethargic.

I am going to call the vet tomorrow and ask if they will just give him the simple BG test which is $22.00 and ask that she write the prescription for the insulin. I am going to ask that she not do the Fructosamine test which is 88.00 and the other test they were recommending. I mentioned in my into thread that my costs have been extremely high since he was diagnosed.

My other challenge is that if I am able to get him started on insulin this week, I have to go out of town this weekend, and I only have someone who can feed him. The neighbor surely will not be able to give him insulin shots while we are away. If this is the case, would it be better to get him started on the insulin after we return next Sunday so we can be her to monitor him?

I have no idea if the vet will be willing to cooperate with my request for the regular BG test or if she will just write an Rx for Linus.

 

If insulin is prescribed I'd wait until after your weekend away to start it. Let us know which insulin you end up getting.

 

Update:

I just spoke with the doctor, she is just going to write me the prescription. No testing required.

I mentioned that I plan on learning about how to do the curves testing so that I can do it, she told me I didn't need to buy all that equipment, they only do curves testing when there is complications. She said I shouldn't have to stick the kitty so much. They would just have him come in for a BG test in about 3 weeks, which would cost about $22.00. She said most of my expenses are behind me.

I told her I was going out of town this weekend, leaving early Saturday and returning Sunday afternoon and she said it would be okay to start him on the insulin before I leave.

She told me to just make an appointment to come by and they will show us how to give the injections.

I'm going to pick up the prescriptions this afternoon. The insulin is Lantus.

Thoughts?

ETA: It can't be that simple, right?

 

That's great that you are going to start Lantus.

I agree you don't need more testing at the vet. I disagree that you don't need to test at home.

 

Ummm ... nope. We're big proponents of testing BG at home to keep your kitty safe. I'd also wait until after your weekend away to start insulin. Kitties can have an unpredictable response to insulin, especially at the start. What Lantus dose was prescribed?

 

Glargine Insulin u100
Give 2 units subcutaneously twice a day.
She said it would be okay for him to miss 3 doses it might make him feel better before I leave.

It is going to be a challenge to find the insulin before the end of the week. I was out of the office with a doctor's appointment today, I was out in training all last week. Work is going to be strenuous for the rest of this week.
Can I vent, I should be happy to be going to see my family... but this is a bit much right now.

 

Vent away ... we all understand the extra burden FD puts on top of everything else in life. I, personally, wouldn't start with a 2 u dose, especially just before going away and with no BG testing routine in place. Give the issue some thought, read more on the forum and see what you'd be most comfortable with. You can probably predict what we'll say. You have to decide if it's the way you want to proceed.

 

I agree with starting with less than recommended for certain, just based on my personal experience with medicine. We want just enough to get us back to normal, we don't want to swing in the wrong direction. I'm concerned with the usual 12 hour gap in time that I am away from on week days, not to mention being gone for 40 hours straight. I cut the trip way short. The reunion starts Friday, we are waiting until Saturday morning to leave and then we are turning around and coming back Sunday morning. it's about a 6-7 hour drive.

 

I think you'll have more peace of mind if you wait to give insulin after your return. A few more days of high BGs isn't going to make much difference in the long run but one episode of too low when you aren't aware can be a huge problem.

 

I totally agree with Kris and Janet's disagreements . One way we like to look at it here is, we wouldn't blindly dose a human child with insulin without daily testing, our fur babies are no different. My Aunt's guilt me with the same thing "Aww his poor ears, you shouldn't stick him so much". My Spreadsheet is just one, where if I wasn't home testing and just kept giving him full doses, I would have sent him hypo. If anyone saw Maury right now, you can't even tell his ears have been poked once! . Home testing also lessened my anxiety with worrying how his BG was doing, of course it's still there (especially when I have to be gone all day - 9/10 hours) but if he acts like he's going low, I can spot check him and know his BG right there.

In addition to your Vet saying to start and then skip 3 doses, Lantus is a depot insulin, it can take a few days just to get that going. So if you were to start, build it up some, then skip 3 doses it will make the depot kind of wonky. Given I haven't used Lantus yet, we are making the switch. There is lots of information in the "Sticky's" in the Lantus thread.

Lastly, keep in mind the management of diabetes is a marathon, not a sprint. It still may take time for Linus to get back into normal ranges and there is no 100% guarantee he'll go into remission.

With that, I hope you can enjoy your trip and if you're not starting insulin before you go you might be able to relax a little more. Linus should be OK for another couple days. We're here to support Linus and YOU

 

Linus was in good spirits and getting around yesterday, and now this morning he won't eat. This is the first time this has happened. I may have to get him started ASAP! I don't know what else to do at this point.

 

Have you tested him for ketones? You can pick up test strips at any pharmacy. This is important, ketones can be very serious.

 

I am at work now. Plan to go to the Pharmacy at lunch if I can get away. This is why I'm thinking I need to find someone who can adopt Linus. I am just not physically, or mentally available for him when he needs me the most it seems.

 

What would we do if there is Ketones? give insulin?

 

Post another thread on this forum asking for information about rehoming Linus if you aren't able to care for him. There are a number of members here who have adoptees from people who couldn't look after their FD kitty for one reason or another.

 

If ketones are trace when you test, call your vet for advice. Anything more than trace needs immediate vet attention because there's a risk of diabetic ketoacidosis (DKA) setting in and that's a very serious complication.

 

I have two things to offer you:

1. Treating FD seems an insurmountable obstacle at first but does get much easier over time as you learn the skills and build a new routine. It's not as onerous as it feels to you right now when you're facing an avalanche of new information and things to do. There are many people here who successfully fit it in while working full time outside the home or dealing with other complex family/health issues. I know we all have different levels of tolerance for things like this and I certainly don't want to make you feel bad if you decide that you can't help Linus.
2. You can post on this forum asking for information about rehoming him if, after more thought, you decide this won't work for you. There are several members on FDMB who have taken in kitties from owners who can't care for their FD for one reason or another.

Take some time to think more about it. Ask questions here. We can help you learn to look after him while still having your own life.

 

Can someone please post the ketone testing kit that we can purchase from Walgreens or Walmart? I'm trying to get someone to help me while I am at work.

 

I use Relion ketone test strips. From Walmart
https://www.walmart.com/ip/ReliOn-Ketone-Test-Strips-50-count/33574014
Sometimes they're not on the shelf and you have to ask at the counter.

 

Thank you, do you mind telling me how you collect the sample? We don't have a special littler box, we use regular litter.

 

My cat let's me stick a spoon under him while he pees. Others have had success using some plastic wrap in the litter box catching urine in the folds. Still others simply hold the test strip in the urine stream. You only need a tiny amount of urine. Be sure to time the test exactly as the directions state to get accurate results.

ETA most use a long handled spoon

 

My cat goes in the same spot all the time perhaps we can put something in his favorite spot that can catch some of his urine... I'm trying to brainstorm about cat pee while in a meeting at work...

Life is funny.

 

If your kitty isn't shy about you looking at him while he's in the box, slipping a shallow, long-handled spoon under his backside to catch some urine works really well. You only need enough to wet the end of the test strip. Make sure you time it properly (usually 15 sec) so the colour develops to the correct point. View it under a good strong light.

 

I am not home, was hoping to get someone to help. Does the urine have to be fresh out of the kitty or can we create a "reservoir" in the litter box and collect from a not fresh sample?

 

Honestly just work on one hurdle at a time!! My Tribby was just diagnosed last February and it was very overwhelming!

I'd worry just about starting the insulin and home testing first. Don't worry about other things right away unless you have to! One step at a time.
Many pharmacies will give you a BG meter for free if you buy a certain amount of test strips. My pharmacy is great about holding expired test strips and lancets for me because they know it's for a cat. Great help!
Wait until you get back and start giving insulin and BGT's. See how it goes for a few weeks. It's eazy peazy now to test and give insulin to my cat. Under 5 minutes and she even wakes me up in the morning when it's time.
Just focus on one thing at a time! Otherwise it's overwhelming!
I work crazy hours as well. I treat her right before I leave and usually as soon as I get home.
Can the clinic keep your kitty over the weekend and start the insulin for you or would that be horribly expensive? Don't assume they know how to do ear pricks for BGT though. Lol. We reside in a special world of special talents us diabetic kitty caretakers.
Reasses in a few weeks and see how you feel. If its still too much it's fair to find a new home but look carefully. Many people with a diabetic cat would take another no problem.
It does get easier I promise.

 

I was willing to wait until I return from my trip but today for the first time, Linus did not want to eat. He has been begging for food non stop. That has me really worried. It's just Tuesday, that means we won't be able to start him until Sunday afternoon / early evening.

I'm a mess, totally not focused on my job, which is going to get me into huge trouble.

 

Ps. You can get a ketones test kit with hydromorphic sand at most pet stores. I personally don't test for ketones regularily but I have the kit just in case I need to.
The kit comes with the sand to substitute for your litter, and test strips. Plus a nozzle thingy to suction up the urine.

 

I'm a mess, totally not focused on my job, which is going to get me into huge trouble.[/QUOTE]

I know right?! The first few days after diagnosis are a blur for me. My first blood tests didn't work either but we got there with practice. With insulin less is better to start off with I agree.

Can the vet clinic board him for the weekend and treat him or do they have a vet tech willing to cat sit and start him? Do you know any nurses? They are great at giving insulin.
Call and ask because you never know!

 

I know right?! The first few days after diagnosis are a blur for me. My first blood tests didn't work either but we got there with practice. With insulin less is better to start off with I agree.

Can the vet clinic board him for the weekend and treat him or do they have a vet tech willing to cat sit and start him? Do you know any nurses? They are great at giving insulin.
Call and ask because you never know![/QUOTE]
My Vet doesn't board, and she is expensive! We are doing good to have someone come and feed the cats while we are away.

 

The urine should be fresh, Within an hour according to the Relion instructions. What are you feeding now, still Purina DM?

 

Yes, the Purina DM

 

Do you have some other food to try, maybe Fancy Feast Classic, or Friskies Pate? Some cats get tired of the DM and quit eating it.

 

Oh my gosh, that expensive $2.00 per can food!!
I am going to the pharmacy today, I will pick up some Fancy Feast Classics and see if that helps!

I just found out that Walmart has an OTC insulin
- Novolin N and R ...

I'm trying to see if I can get a deal on Lantis. Walmart said they will not break a 5 pen box. So that's a no go. It's $288.02 per vial.

 

You don't want Novolin R, that's a fast acting insulin usually used in ER situations to get BG down fast or Extremely experienced members with high dose kitties.
You could try to purchase your Lantus form Canada from Marks Marine Pharmacy. It is what I am about to do for my order

 

Novolin is not a good insulin for cats. It's too fast acting and doesn't last long enough. Many of us buy Lantus from Canada, not sure how long it takes to get it, but in the meantime you can call around to find a pharmacy that will sell a single pen, or check out the Supply Closet forum. Many of us have bought from Alan and he will often sell singles. http://www.felinediabetes.com/FDMB/forums/supply-closet-for-sale-or-free.15/

ETA The pens are a better deal than the vial. They will last a long time if kept properly, while the vial will often lose effectiveness before its used up. You'll need syringes to draw the insulin from the pen rather than using the pen needles.

 

So the Pens are better than the Vials. No one I called so far wants to break the box. ..oy!

 

Check out the Supply Closet. A lot of people get their insulin from Alan. A few get theirs from Jeffrey.

http://www.felinediabetes.com/FDMB/...resh-sealed-box-of-5-for-100-exp-2019.176841/

 

I get my insulin from Alan. It looks like he has a pretty good deal on Lantus right now!

 

Did you see this post on Supply Closet? http://www.felinediabetes.com/FDMB/threads/lantus-vial.179521/
While pens are better this might hold you over until you can order pens from Canada

 

If you do plan on getting Lantus from the Supply Closet or from Marks in Canada, you should do it soon. While all Lantus is shipped express in special boxes to try and keep it cool, Marks will not ship when the weather gets too hot.

 

Thank you @Yong and @Red & Rover (GA) and @sharon and @CassWTribby @Kris & Teasel I appreciate each and every one of you.
I went to my pharmacy and got a vial of Lantus because Linus is getting worse not better. I am going to start him on it tonight, I am going to see if I can find someone to administer while we are gone (if we go)
I could not find a pharmacy to break a box of pens. I couldn't take up more time at work to figure that out today.

Can you please point me to a YouTube of the best way to administer the insulin? I have looked at some YouTubes with demonstrations that conflicts with what I have read here.
Also the best way to preserve the insulin.

ETA: I pray I will be in a better position to take advantage of deals, and Canada, etc at a later time.

 

Usually you get a "how to inject insulin" tutorial from a vet tech at your vet's clinic. They often tell you to use the scruff of the neck and that can work until you build your skill level. Basically, regardless of shot location, you grasp some skin firmly between thumb and index finger and lift it up high enough to form a "tent". Feel for the depression that is the "tent door" and that's where you poke the needle in using a forward but very slightly downward direction. Use a spot that's in the middle of the "tent door".

If I recall, a dose of 2 units twice a day was prescribed. We would strongly recommend starting at 1 unit twice a day for safety's sake. It's also best to keep the two doses as close to 12 hours apart as you can. Lantus is a depot insulin in that a part of each dose goes to filling a depot under the skin that acts as a sort of time release mechanism. It takes a few doses for this depot to fill properly. The insulin works best when the depot is full and stable in size (its size depends on how large the dose is). Varying the dose AM to PM or varying the timing of the shots can alter the depot and that can lead to some unpredictable responses.

The Lantus vial should be stored in your fridge on a main shelf, not in the door. Put it in some sort of small container that protects it and keeps it from getting knocked around. Lantus, like all insulins, can be affected by heat and being dropped or banged around. Be careful not to drop it when it's out for use - very $$$ accident.

Does this help? Maybe you can let us know what confusion you have regarding how to inject. Are you planning to tackle testing blood glucose at home? We think it's the single most important tool in keeping kitty safe, monitoring his response to insulin and helping you take the steps that will get him regulated sooner.

 

Is rolling the vial appropriate?

I plan to test. I bought a meter and some strips. The vet keeps advising me to just get him on the insulin. They offered to show me how but I could not get to their office before they closed. I left work early to get the insulin, I could not do that and make it to the vet in time.

 

You don't really have to do that with Lantus. It's a solution, not a suspension like some other types of insulins are. Always check it for clarity before use. It should be crystal clear throughout with no floaties or little "snowflakes" in it.

 

When you get a chance check THIS out, lots of good info on Lantus

 

A huge YES! to the testing. Never mind what the vet said. Do you feel as though you have enough info to give a shot tonight? Ask anything else that comes to mind.

 

My son and I gave him the shot at 7:30 pm and he ate a good bit of Fancy Feast Classics. I will keep reading and will start testing soon, I'm just exhausted at the moment with all today's activities. Work was crazy busy, but I was so distracted by my worry about my baby! I did some reading about how to avoid Ketones I will work diligently to make sure Linus eats and drinks. I got him to drink by putting water in a big coffee mug and sloshing it around with my finger. That is hard for him to resist!

 

Whatever it takes! Many of us add some warm water to all the wet food meals to make a sort of "stew". It's a really good way to boost hydration, flush out their bladder and ketones if they're there and can help with constipation too.

 

Excellent! Did you give the 2 unit dose? We need to know that if you need help later.

 

We can help you learn what you need to know so you can keep Linus safe, healthy and happy. I said it before - this WILL get easier. I absolutely guarantee it.

 

Yes, my son insisted that we follow doctor's orders. I need to get along with him because I need his help. I was able to get him to read info on this site which is amazing! I will read to see what it looks like if the cat goes from hyper to hypo. I will read every day I just got overwhelmed by everything today, especially while I was at work. I felt like I was just trapped. But my soon can help with the evening dose so that's a huge relief. Linus ate! That's huge!

http://www.felinediabetes.com/FDMB/...insulin-info-handling-drawing-fine-doses.151/

 

I'm glad he ate!!!

 

I raised my frige temp because it gets a bit cold in there, which we like but I read that Lantus should be stored between 36 and 42 degrees

 

I understand completely. Most of us followed the vet's instructions to the letter - at the beginning. I know I did.

We understand this too. I remember that shocked/'deer in the headlights"/OMG how am I going to deal with this? feeling like it was yesterday. This is the place for all the help and support you'll need. Try to take in the info in small chunks because it can become overwhelming. A lot of it will be confusing or meaningless to you at this point. Ask questions - no question is a stupid question.

 

Here's a task for you:
http://www.felinediabetes.com/FDMB/threads/fdmb-spreadsheet-instructions.130337/
This spreadsheet is the one we strongly encourage you to set up ASAP. It's the first thing we look at before offering advice and is viewable by all members. It's also a good way to track Linus's blood glucose data and the colour coding for various BG ranges will tell you at a glance how he's doing. At the beginning you won't be able to read and interpret the data easily but there are many very experienced people here who can. They can look at it and tell you whether the insulin dose is too high, too low, why his BG went up or down, etc.

 

I'm going to throw in the Signature instructions too now http://www.felinediabetes.com/FDMB/threads/editing-your-signature-profile-and-preferences.130340/

Should you need help, we won't have to waste time asking some basic questions

 

How is Linus this AM?

 

He is much more alert this morning, but he is not moving around much. His appetite is coming back, he ate a good little bit of Fancy Feast Classics at 5:00 am and then at 7:30 am when I gave him his shot. He drank the smallest bit of water. We are doing everything we can do entice him to drink water.

He used to steal water out of my glass of water and I used to fuss at him about that. I put a glass of water out for him to drink this morning and asked him to drink up.
I'm at work now. I'm trying to figure out how I can get someone to give him two doses of his insulin while we are away. We can give him one dose before we leave Saturday, so he will need a Saturday night dose and a Sunday morning dose. We will be back in time for the Sunday evening dose. We have a challenge with the other cat eating up his food. The pet sitter is going to have to keep them separated and will have to make sure Linus eats, they can't just feed and leave like in days past.

 

In a pinch, you can skip those two doses and pick up where you left off on Sunday evening. It's very early in Linus's treatment so it won't have that much impact and it would be a lot easier for you. Linus is a lovely boy!!

 

Try mixing a little water in with the Fancy Feast.

 

Thanks @Sharon14 and @Kris & Teasel - my son said he is moving around from room to room down stairs, he won't go upstairs now. Poor baby sleeps downstairs by himself now.
He seemed more alert this morning than he did yesterday. I was so worried about him, that is why I started the insulin. I had to do something!!

 

It'll get better.

 

I'm glad he's a little better! Have you tried testing his glucose yet?

 

Congratulations on your first shoot !! that's a huge step .

I'll get better, I know is complicated sometimes, specially with a full time work, but as you get the hang of it and develop a new routine for you and him, it'll get better really. Also as his numbers start to go down he'll feel better and you will notice it, but this is a slow process so patience is important.

Also try and get the ketones test it will give you peace of mind to know that even if his blood glucose is not controlled (it will take a while before he's regulated ) he's ok and not to put any more pressure on you, but an other thing that will help you, is home testing, I know that if I knew no ketones and what his glucose level was when I left home for work that really helped me be less worried about him

 

Not yet. I got a meter and strips, forgot all about the lancets and the Neosporin....
I woke up every hour on the hour last night and had to fight the urge to run down stairs.
My son found out that our litter does not appear to be reactive, he tested the litter after Linus had a pee and it had trace ketones. We know we have to come up with a better testing system.

 

Someone has a little spunk today!

 

Lancets: get thicker ones for now like 26 - 28 gauge. It'll be easier to get a blood drop.

Neosporin: get the version with pain relief. Some people use it often because it helps the blood to bead on the ear and it soothes after the poke. I use Polysporin (similar) with pain relief only after he's had a day of many pokes. I put some on his ear at the end of the day.

Litter: not sure what you mean by reactive. Do you mean it won't allow you to get a ketone test result or that it doesn't affect the result?

Trace ketones: if this was the result from damp litter, it's not reliable. If it had been from Linus's pee directly, it's a "pay attention" sign.

Ways to test urine ketones:

• shallow, long-handled spoon slipped under his bum while he's peeing to catch a few drops (my method - very easy/successful)
• double layer of plastic food wrap over his favourite area in the box and push some depressions into it to catch pee
• test strip held right in the urine stream as he's peeing.

It has to be fresh urine right out of the cat. Most strips take 15 seconds for the colour to develop and they're best viewed in really good light to decide on the colour.

 

He is such a cute little guy! About the lancets, there are two options--you can get the larger ones @Kris & Teasel mentioned and just prick his ear by hand, or you can get a "lancet device." With the device, you just hold it against the ear and press a button, and the needle pops down and pricks the ear. Some cats don't like the little popping sound the device makes; others (like mine) don't care at all. You can try whatever method of ear pricking sounds easiest to you--just don't panic if one doesn't work! You can try the other, and there are tons of tricks you can use to get a good blood sample. I have to use the device.

Quick encouraging story: when I started, I had to prick my cat's ear multiple times every time I got a sample. He would go and hide, and I would cry. Then it got easier--I could get it on the first or second try and he wasn't really upset. And now I can get a sample *while he is sleeping*--he doesn't even fully wake up. He just opens his eyes a crack, gives me a little bit of a dirty look, and closes his eyes again with a sigh. He jumps up on the counter in the morning, wanting his "special time"--he got to where he actually liked the morning test and injection because it meant he got lots of petting and a special (low-carb, of course!) snack. He is off insulin now, and I've had to substitute brushing him--he doesn't want to give up his ritual I never, never, never would have predicted that! This whole thing truly will get better, as everyone is saying, and you are doing a great job!

 

I had a report that Linus is hungry today and he peed!! So that means the bugger is drinking water.

DS didn't test the pee but we know when he makes his pee brick in the litter. LOL

I am going to get on the case with the testing. I we just have to make it through this week. I'm peddling as fast as I can.

@Squeakycats Thank you for the kind and encouraging words!
@Kris & Teasel - Thank you for the information and I am taking them as action items!

 

Sorry if my response seemed cursory or abrupt. I was trying to pack a lot in as concisely as I could. I'm a big fan of lists, bullet points, etc.

 

That is exactly what I need!! Please don't apologize I appreciate your help!

I found a pet sitting service that can give Linus his shots and make sure he eats well, etc.

Linus is using the litter box and he is eating well today!

 

That is all great news!!!!!

 

Linus is alert, eating, drinking and peeing normal amounts. I will be working on testing when I return from my trip.

Thanks again everyone. I have all of the important info in this thread bookmarked!

 

Glad to hear he's feeling better!!! Enjoy your trip!

 

A quick update:
Our trip went well this past weekend and Linus received quality care in our absence. When I woke up this morning, Linus was at my bedroom door waiting for me to get up. He hasn't been upstairs in over 10 days!
I was so surprised and happy to see him! He was very steady when he walked downstairs. His appetite is fully back, he is really enjoying Fancy Feast classics. I am going to get myself settled and rested (I drove 12 over hours this past weekend) and I will start reading about testing when I am recovered.

Thanks again everyone for your support!

 

Glad it all worked out!! Not sure if anyone else has tried this with regards to Ketone testing. I wasn't able to get a spoon under Beenie because she squats so low there's practically no room between her bum and the litter . I wasn't quick enough to slide plastic in nor did I really want to use a special litter.

I read about a trick online and its been working for us. I use Worlds Best Cat Litter. I took a clean sample of litter and wet it with water and tested it with a ketone test strip to make sure there was no "reaction". Now I stalk Beenie when she goes, and this has to be very quick, soon as she lifts her tush up I stick the ketone test strip in the pool of urine right before it gets soaked up by the litter. The strip gets soaked with urine and I read it 15 seconds after. Works well and hope its another option if others are unsuccessful the other ways. The key would be to test the litter you do use with water and a clean sample of litter.

Now if my males cats had to have their urine tested I could probably catch it mid stream. They both need the high sided litter pans because they rise as they pee

 

That's great news

 

Glad your trip went ok and good luck with the testing

 

My son told me about that method. It appears that our litter is non-reactive. We just have to get our timing correct.