UK Noob with newly diagnosed bony kitty

Discussion in 'Feline Health - (Welcome & Main Forum)' started by Dr Schrodinger, Dec 28, 2012.

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  1. Dr Schrodinger

    Dr Schrodinger Member

    Joined:
    Dec 28, 2012
    Hi All,
    I've been reading up on these boards for the past few weeks. We live in the South of England, so please be patient with my spelling & metric units!
    One of my cats (Milo) was diagnosed 6 weeks ago & has now gone from 2 units of caninsulin twice daily to 4 units twice daily (using his funky VetPen). He crashed dramatically with ketoacidosis a couple of weeks back & was hospitalised for a few days while he was stabilised & his dosage increased. His BG seems to be stabilising but his bodyweight is still dropping (from 3.85kg to 3.71kg in 2 weeks). I'm currently waiting for his latest fructosamine results.

    He's a 12 year old indoor cat (Maine Coon cross, so he's a big chap), he's been declawed (he hails originally from the good old US of A) but we got him from a shelter here in the UK 5 years ago. He's been on high carb dry food ever since (I know, my bad), and the vet wants to keep him on this diet 'til his BG is stable. He no longer has ketones in his urine, but is still losing weight. His appetite isn't great, and he's still drinking & peeing a lot, and his faeces is more regular now. He's back to his old self with his behaviour & demeanour (he's an overly affectionate stalker!), but...

    My concern is primarily that he's just not putting the weight back on following ketoacidosis & that this *may* be remedied by a lower carb/higher protein diet. We haven't started home-testing (yet) but I am tempted to go against my vet's wishes & start him (and his overweight sister) on 80% meat food from Applaws (UK brand), whilst home monitoring his BG. Is there any other way that I can get him to eat more? I've tried cream, cheese, tuna, chicken etc. He nibbles at it but doesn't fill his belly properly.

    Any advice would be appreciated!

    Thank you for this board. It's brilliant.
     
  2. MaryB & Chester

    MaryB & Chester Member

    Joined:
    Dec 7, 2012
    Welcome to the board! There's lots of good people and good information here. I know there are a number of "international" people who understand metric and I'm sure they'll be along soon.
    We switched my Chester to wet food before we started insulin. Since you're already trying to get him stabilized, it might not be a good idea to do a big food switch right away. Changing food drastically like that can have significant effects on BG levels. Maybe you could just add in some of the good wet food as more of a supplement?
    Home testing is easy and I'm glad I'm doing it. It gives me a better idea of what goes on from day to day. We're still not regulated, but at least I can see what's going on.

    Welcome!
     
  3. BJM

    BJM Well-Known Member

    Joined:
    Oct 6, 2010
    Welcome!

    Given that he has experienced DKA, take a look at my signature link on Secondary Monitoring Tools for info on ways to test for urine ketones. If you get a positive test, its time to go to a vet, asap, because he may be headed back there.

    Plus, some of the other monitoring tactics will help provide information about his status that is a bit different from just a blood glucose - more of a "how is he feeling and behaving" assessment.

    If you start making diet changes and are not home blood glucose testing, you could wind up with a hypoglycemic episode. This can be fatal, so I strongly encourage you to learn the blood testing before you start changing the food. This will save you money as you can do the glucose curves at home without the impact of vet stress raising the numbers and resulting in incorrect dosing based on incorrect numbers.

    Caninsulin was developed for DOGS, not cats. It doesn't last long enough in cats, due to their higher metabolism. It is unlikely his BG will become stable on this, so it is prudent to consider a diet change. Here's a link on Canned cat food for EUROPEANS and International buyers which you may find helpful. Any food changes should be made gradually to reduce stomach upset and to allow you time to observe the impact on his diabetes and adjust as needed.

    Additionally, lets see about educating your vet on Lantus, as there is a proven protocol to treat diabetic cats Here are the AAHA Guidelines While the cost may seem high initially, if you get it in the pens rather than the vial, you can use almost all of the insulin in the 3 mL pen before needing to use a new one, so the cost actually works out better. And the glucose control is superior to Caninsulin.
     
  4. Elizabeth and Bertie

    Elizabeth and Bertie Well-Known Member

    Joined:
    Sep 6, 2010
    Hello and welcome to FDMB!

    I'm from the UK too (Surrey).

    I see that you've already had some great advice.

    Yes, a wet food diet would be better. My cat was on dry food too at the time of his diagnosis. That's the same for a lot of cats here too! But it's important NOT to make the switch to wet food unless/until you are able to test your cat's blood glucose at home. We can help you to learn that, if you are willing to have a go. :smile:
     
  5. Elizabeth,
    Glad you saw this - I was about to PM you since you're" in the neighborhood" :)
    From what I've read here, it seems most UK kitties are initially put on caninsulin... is it difficult to get a vet onboard with a more appropriate insulin there? I notice your sig says hypurin pzi, which is better. I'm thinking a change from caninsulin would benefit Milo.


    Dr. S,
    Did Milo's bloodwork indicate anything beyond diabetes might be in play? Given the continued weight loss, I'm wondering if his thyroid might be a factor...

    Carl
     
  6. Dr Schrodinger

    Dr Schrodinger Member

    Joined:
    Dec 28, 2012
    Thanks, People!

    Yes, I wondered why my feline was receiving canine meds.... my vet practice have looked after all my animals over the years & are very understanding of me & the furries, but I am not sure if they are in their comfort zone with DM. I believe they only have 3 diabetes patients despite it being a large practice with 3 branches in a 15 mile radius, so, it may well be the case that their own information isn't complete. Thank you for the links. I am working my way through them as I type.

    I would prefer to switch to recombinant insulin, anyway, purely from a biological & metabolic point of view. But I'm a scientist with experience of working alongside vets in the research lab, and I am reluctant to voice my opinion at this early stage and hesitant to march into the clinic brandishing pdfs, but I suppose I need to think about a more bilateral relationship with them in the long run. At the moment I am mostly worrying about my puddytat & his plummeting bodyweight. :sad:

    Remission would be the optimal outcome. How long has it taken others to achieve this?

    Elizabeth & Bertie - Great! Thank you! Same County! Who is your vet?

    Carl & Bob - We discounted thyroid issues during initial diagnosis, but it's something to keep in mind, I suppose.

    Thanks again. I'm now going to rub his paws with butter....
     
  7. Some kitties go into remission very quickly, needing only a diet change to become regulated. Some kitties never do, but lead long healthy lives. I can only speak for my kitty, Bob. It took ten weeks or so for him to become diet controlled and off the "juice". That does seem to be less time than most, but every cat is different, as we say.
    Carl
     
  8. Elizabeth and Bertie

    Elizabeth and Bertie Well-Known Member

    Joined:
    Sep 6, 2010
    Carl - Hi, I didn't see the message actually. Hope (& Baby) PM'd me! So she beat you to it! ;-)
    Yes, Caninsulin is typically what's prescribed here, and in the rest of Europe too, I think. A very few vets will prescribe Lantus/Glargine, but there aren't currently many vets who know how it works (but I think Lantus/Glargine may be promoted in the UK soon; there's a manufacturer keen to introduce it here...) Some vets will prescribe Hypurin PZI (a long lasting depot PZI (and the only available PZI here now)) if the Caninsulin doesn't work... We started out on Caninsulin, but it didn't work so we switched. Our vet was only willing to do that because I hometest. Because of the longer duration of Hypurin the vet wanted to be sure that I only gave the shots if necessary.

    Dr S - Yes, Carl's right. A switch to another insulin may be helpful.. Would you be willing to learn to hometest your cat's blood glucose? That would help you to gather evidence to show how the Caninsulin is working (or not!) in your cat's system?

    My vet is Guy at Cobham Park Veterinary Clinic.

    Eliz
     
  9. Dr Schrodinger

    Dr Schrodinger Member

    Joined:
    Dec 28, 2012
    Eliz,
    All useful information, thanks!
    I may suggest that my vet speaks to yours....actually, I might even go visit yours myself. I drive through your neck o't'woods twice a day on my commute, anyhoo!
    Oh, I can't believe I've found a local who is/has worked through the same issues! Excellent!
    I would like to start home-testing the Milo Cat. He's generally quite amenable to any kind of human attention so I think it will become quite straightforward with practice.

    You lot have really cheered me up about this!

    I wonder why UK vet practice hasn't quite cottoned on about Caninsulin, yet? Inertia in the system? Fingers in pies? Hmmmm....
     
  10. Diana&Tom

    Diana&Tom Well-Known Member

    Joined:
    Dec 29, 2009
    Hi there from another Surrey, UKer (there aren't many of us!). I don't have much to add to what others have said other than I do suggest that you follow Elizabeth's advice as closely as possible. She's been through some ups and downs with her cat Bertie but is currently in a good place and has a wealth of knowledge and experience that she is kind enough to pass on.

    Other than that - yes, I do encourage you to home-test. Knowledge is power, as they say, and seeing exactly how the insulin - any insulin - is working in your cat at a given point in the cycle is vital information to help anyone assess the overall situation.

    Best of luck!

    Diana
     
  11. Elizabeth and Bertie

    Elizabeth and Bertie Well-Known Member

    Joined:
    Sep 6, 2010
    Blimey, Diana - I'm not sure I can live up to that sales pitch! :oops: :lol:

    Eliz x
     
  12. Elizabeth and Bertie

    Elizabeth and Bertie Well-Known Member

    Joined:
    Sep 6, 2010
    Hi Juliet,

    I think 'remission' is probably the "optimal outcome" that everyone with a diabetic cat hopes for! But not every cat gets there. Some cats, like mine, have to stay on insulin permanently. But quite a number of cats DO achieve remission. And cats that are newly diagnosed (and those that haven't been diabetic for very long) seem to have the best chance.

    For some very lucky cats, all that is necessary to achieve remission is a short course of insulin and a change of diet (switching from dry carb-laden food to a low carb wet food diet). Who knows, maybe your cat will be one of the lucky ones..... But having a cat that continues to need insulin isn't the end of the world. Yes, it is a commitment on our part. But the rewards of seeing a happy and healthy cat are well worth it. cat_pet_icon

    I'd suggest that the first thing you do is learn to hometest. That will help to keep your cat safe (from hypoglycaemia) and will give you a vast amount of information about how insulin is working in your cat.

    Once you've learned to hometest you can start to phase out the dry food safely. Removing dry food can reduce the BG significantly in some cats and so must only be done with careful monitoring (including reducing the insulin dose as necessary). I live fairly close to you and so will gladly give you a hometesting demo if that is useful....?
     
  13. BJM

    BJM Well-Known Member

    Joined:
    Oct 6, 2010
    How about trying the interested owner routine ie eager to share the news, because after all, the vet can't read up on everything!
    "hey I was doing some reading and found this veterinary article on feline diabetes. I thought you might be able to look it over, then tell me what you think about the ideas"
    Or
    "Did you hear - there's a vet in Queensland who worked with a feline diabetes group in Germany and they've figured out a way to use Lantus in cats that's pretty successful if the owner is willing to do home testing and follow a low carb diet with the cat. Here's the web link if you'd like to check out some of her articles"
     
  14. Elizabeth and Bertie

    Elizabeth and Bertie Well-Known Member

    Joined:
    Sep 6, 2010
    Yes, absolutely agree with BJM about the "interested owner routine". S/he may be intrigued by what you have to say, and perhaps really interested in learning a new approach.... Or as my Granny used to say, "You catch more flies with honey than with vinegar." ;-)
     
  15. Diana&Tom

    Diana&Tom Well-Known Member

    Joined:
    Dec 29, 2009
    Great comments here - take heart that all of us really understand and are cheering you on from the sidelines!

    Diana
     
  16. Elizabeth and Bertie

    Elizabeth and Bertie Well-Known Member

    Joined:
    Sep 6, 2010
    Juliet,

    Here is a link to a good page of basic info/instructions on hometesting. It was from this page (and a hefty bit of encouragement from folks on the forum here) that I first learned to test.

    http://www.sugarpet.net/bloodtst.html

    It is important to reward your cat for every attempted test (whether successful or not). Your cat will very soon learn to associate testing with treats and cuddles. Some folks give a treat after every test. I crumble a few treats for Bertie and test him while he's eating them.

    I think probably everyone develops their own style and finds their own ways of fine-tuning the technique. It is something that you and your cat will work out together. ;-)

    Something I've found helpful is to always test in the same place, which in our case means on the end of my desk. And I only ever give treats when he's in his 'testing spot'. He never gets treats anywhere else in the house. And if he jumps up onto that spot I usually give him a treat or a cuddle or a quick brush whether I'm testing him or not. So the testing spot has become his 'happy place'. That makes life a lot easier!

    If your cat isn't used to having his ears touched, or doesn't like having his ears touched, then you can start getting him used to that - before you start testing - by holding or massaging his ear and then giving a little treat, or by incorporating 'ear-handling' into grooming sessions.
     
  17. Dr Schrodinger

    Dr Schrodinger Member

    Joined:
    Dec 28, 2012
    All useful advice, thank you people.

    We will see what Milosevitch's fructosamine results are like and then form a plan. He has wrapped himself round a couple of cans of A/D since last night, so clearly his appetite needs stimulating with stinky stuff to build him up a bit.

    In the meantime his Mum and reluctant Dad are looking at glucometers. A bipedal friend has also been recently diagnosed so we'll haggle a 2 for 1 deal if possible!

    Elizabeth - that is a very kind offer, thank you. I shall take you up on it once I've discussed things in detail with the vets.

    Thanks again!
     
  18. Diana&Tom

    Diana&Tom Well-Known Member

    Joined:
    Dec 29, 2009
    Good to see you are making plans :)

    Look on ebay for glucometers (and supplies, ie strips and lancets) - they are often sold there by human diabetics at a fraction of the cost you'd pay in a chemist.

    Oh and as for the fructosamine test - bear in mind that it will only give an average of the subject's BGs over a period of time, not a single BG at any specific point, so as BGs will vary (perhaps considerably), this isn't going to give you all the information you need. Only spot checks, which you can do at home, can do that, to see how the insulin is working at different times in the cycle.

    Keep going - a positive attitude is half the battle!

    Diana
     
  19. Udong

    Udong New Member

    Joined:
    Oct 17, 2012
    My cat was diagnosed this September and she was also in caninsulin 1unit twice a day. I followed my vet instructions and switch to md dry. After 6 weeks when I bought her for a fructosamine test. Her BG was even higher. The vet want me to increase to 1.5 units twice daily. After one week when I got my blood glucose meter, the first BG test showed high. I was thinking to switch Caninsulin to Lantus. I also stop all the prescription md dry. My cat BG gone down a lot after 3 days. I was thinking to see another month before I switch to Lantus. It happened that my cat got into remission just one month after stopping all the dry food. I think diet control is very important. Now she was off insulin for 3 weeks and her BG is between 2.8(50) -4.8(86). I still give her spot check from time to time and control her diet.

    viewtopic.php?f=28&t=85515
     
  20. Elizabeth and Bertie

    Elizabeth and Bertie Well-Known Member

    Joined:
    Sep 6, 2010
    That is a great story! :smile:
    It does illustrate - so perfectly - how vital it is for us to be actively involved in the care of our diabetic cats. Feline diabetes is a home-managed illness. If you had blindly followed your vet's advice your cat would not be in remission now; in fact you would have been perpetuating your cat's insulin dependence. Hometesting and safe removal of dry food enabled your cat to become diet-controlled.

    You really did a brilliant job. Those BG numbers are just beautiful. Well done!
    dancing_cat :RAHCAT dancing_cat
     
  21. Dr Schrodinger

    Dr Schrodinger Member

    Joined:
    Dec 28, 2012
    This ^^^ is fantastic & one hell of an achievement! Amazing work, Udong! I hope Dongdong stays insulin free. :thumbup

    My plan to switch both cats' food is to gradually switch to this low carb dry stuff first: http://www.applaws.co.uk/cat_dry.php whilst monitoring Milo's BG at home.

    Milo's sister, Lola, is a fatty (6.5kg = 14 and a half lbs??) and has been for a while. I had her bloods checked & she is normal range, she's just FAT, so she needs attention too. Once they're both on the low(er) carb dry stuff, I'll start switching them to wet. Lola is a potty-mouthed fusspot & will only lick off the gravy/jelly from wet food, and a solely wet food diet has given Milo gastritis before (but he will eat anything if he's well). So it'll be troublesome.

    Both me & my partner are out of the house 12+ hours a day & are used to free-feeding our kitties, but this may have to change, too, I suppose? They ain't gonna like change...

    Taking a little more perspective of what has happened with our animals, we have kind of let them go to seed a little, which makes me feel awful.

    We're both used to cats (these are the sixth & seventh kitty we've had together), but, we've never had indoor cats before.
    I think it's just not sunk in that:
    1. They get very little exercise
    2. They don't supplement their diet themselves.

    All our previous felines have had a 'healthy' extra diet of spiders, frogs, moths, mice, voles, bunny rabbits & birdies, which take varying amounts of energy to catch!

    Udong - you have inspired me to have a look at DIY cat food, too.
     
  22. Elizabeth and Bertie

    Elizabeth and Bertie Well-Known Member

    Joined:
    Sep 6, 2010
    Hi Juliet,

    Many of us here free-feed our cats canned/wet food. Why do you think that needs to change? Is it the weight issue?

    Don't be too hard on yourself. I think there are quite a few of us here for whom a diagnosis of FD was a real 'wake-up call'.... My cats were 'on the chunky side' until then, and eating dry food too.... Ironically, Bertie's FD diagnosis - and the switch to a proper diet - has improved the health of all five of my cats.

    There are quite a few people having a go at DIY cat food now. The appeal of it seems to be growing. I've recently started supplementing my cats' diets with home made raw food. They wouldn't touch it at first - didn't even seem to recognise it as food! - but now they're starting to look up at me with tears in their eyes when I offer them canned food! :roll:

    Eliz
     
  23. Udong

    Udong New Member

    Joined:
    Oct 17, 2012
    Thank you all for the encouragement.
    Elizabeth, you are right. If I followed my vet advice, Dongdong will be on insulin forever. I also need to pay c$200/month for fructosamine test and c$100 for the syringe and prescription food.
    Dr. Schrodinger, I hope your cat could be remission soon too. Control diet and home test are very important. I am lucky that Dongdong is so calm in blood glucose testing. I usually heat up the room where she stay. When I touch her ears are warm enough. I just get everything ready and do it quickly so that she don't get too stressed.

    My Dongdong has been on dry food all her life. She never touch canned food for I have 2 other cats that eat canned food. When she first got her insulin shots, she seems to be very hungry but still refuse to eat any wet food. While I was cooking she wants to try some of our food. I gave her some chicken breast (wash with hot water) she seems to like it. From that time on she switched to home made food. I read online that for cat 1 lb needs 15-25 calories/day. Dongdong is 12 lbs so she needs appro. 180- 300 calories each day. I usually feed her 150 gram of food per day. Here is a site that I calculate the calories, protein, fat and carbs. On the top left corner you can type in the food and search. A lot of home made food is 0 carbs. Dongdong likes her food warm. At the end of the day when her food is cool I put a little hot water to made it warm. She can not eat food that takes out from the fridge. Cold food make her vomit. I need to heated up a little first.

    http://fatsecret.com/calories-nutrition ... nt=100.000
    http://fatsecret.com/calories-nutrition ... nt=100.000

    I also add taurine as a supplement on Dongdong's home made food.
    http://allnaturalpetcare.com/blog/2011/ ... emade-foo/
     
  24. Elizabeth and Bertie

    Elizabeth and Bertie Well-Known Member

    Joined:
    Sep 6, 2010
    Juliet, have you managed to get a glucose meter yet? Reason I ask is that I've been rummaging through my diabetes supplies over the Christmas hol and realise that I have a new Contour XT meter that you could have... It only has about 8 test strips with it but they can be bought on Ebay at about half the RRP. So, if you want it, let me know and I can get it over to you this week sometime...
     
  25. Dr Schrodinger

    Dr Schrodinger Member

    Joined:
    Dec 28, 2012
    Wow!
    Yes. Please!
    I had a very confused wander around Boots this afternoon to no avail....

    I'll PM you my mobile number. I'm back at work on Tuesday, so I can pop by yours on the way home? How much do you want for it?
     
  26. BJM

    BJM Well-Known Member

    Joined:
    Oct 6, 2010
    Heads up!
    The calorie estimates for cats and dogs are different than for humans.
    8.5 calories per gram fat
    3.5 calories per gram protein
    3.5 calories per gram carbohydrate

    Also, home made diets need a number of supplements, beyond taurine, added to ensure they are nutritionally adequate. For an example recipe, please go to Cat Info.
     
  27. Dr Schrodinger

    Dr Schrodinger Member

    Joined:
    Dec 28, 2012
    Quick update:

    I met the fantastic Elizabeth & Bertie yesterday afternoon! They gave me my own glucometer kit & a practical tutorial on testing. Thank you, Bertie, and thank you Eliz & Chris!

    Once home, I immediately turned Milo's left ear into a rather ornate piece of classical English lacework, but drew nothing but dust & disgust. Poor mog.

    Gave up for a while & he had his usual 7pm injection of 4 units caninsulin. He has been drinking massively again over the past 2 days, so I wasn't hopeful. At 8.30pm I tried bleeding him again & managed to get a sample. Glucometer read 19.5mmol/l.

    I wasn't happy about this. Not at all.

    I have taken away all dry food & put both cats on canned only. Based on http://binkyspage.tripod.com/nonusfd.html, they are happily scoffing Felix Chicken in jelly. No problems with getting them feeding. They will chew my legs off if the bowls aren't on the floor promptly! I'm free-feeding them as normal.

    This morning, I tested Milo at 7am before his injection. 26.2mmol/L. I gave him his shot. I'll make myself late for work & test him again after a couple of hours to see if it's dropping at all. I fear that the Caninsulin is not even touching the sides (so to speak) & he may have to go back to the vets for an alternative insulin. We'll wait & see what his BG does today.

    Poor little chap. He's glassy-eyed & wobbly, even on this high dose. :cry:
     
  28. Elizabeth and Bertie

    Elizabeth and Bertie Well-Known Member

    Joined:
    Sep 6, 2010
    Aw, shucks, Juliet, we're blushing here. (Well, I think Bert is blushing but it's hard to tell under that black fur.... ;-) ) It was lovely to meet you too!

    Well done, you, for getting those blood tests done. Brilliant stuff!

    When you say that Milo is "wobbly" are you referring the the back leg weakness that he's had for a little while? Or is this a differnt 'wobbliness' that is just apparent this morning?
     
  29. Diana&Tom

    Diana&Tom Well-Known Member

    Joined:
    Dec 29, 2009
    Hi Juliet, I sympathise with what you're saying and completely understand your fear that the insulin is not even touching the sides... I've been there :cry: Do try to bear in mind that treating FD is a long-term thing - a marathon, not a sprint, as is popularly said here - so try to take it one day at a time. You just need to be committed and try to stay cheerful with the help of whatever floats your boat - for most of us it's wine and/or chocolate ;-)

    I'm glad you've met Elizabeth, she's brilliant (don't blush Eliz, you deserve the compliments!)

    Keep going...

    Diana
     
    Last edited: May 13, 2016
    Reason for edit: Privacy
  30. Dr Schrodinger

    Dr Schrodinger Member

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    Dec 28, 2012
    He's a little stumbly, Eliz. Not the back leg neuropathy. He's also not purring this morning, which is very out of character. I'll give it an hour & see if the insulin kicks in. It's a good job I can work from home this week.

    Diana - you're not far away either! Thanks for the encouragement, neighbouroonie! :D I am not known for my patience & my brain finds it tricky to think long-term. :YMSIGH:
     
  31. Elizabeth and Bertie

    Elizabeth and Bertie Well-Known Member

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    Sep 6, 2010
    Juliet, I know that Milo had a nasty DKA episode recently. Are you checking his pee for ketones...?
     
  32. Dr Schrodinger

    Dr Schrodinger Member

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    Dec 28, 2012
    Eliz, I haven't done a wee test since before Christmas.... I still have some 'stix left, so will have a go today.
     
  33. Elizabeth and Bertie

    Elizabeth and Bertie Well-Known Member

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    Sep 6, 2010
    Juliet, just a thought, I know this is unikely but is there any way that Milo could have had access to any anti-freeze? The reason I ask is that this is the time of year when accidental poisonings happen (cats, dogs and small children are poisoned by the stuff every year). I don't want to alarm you, just wanted to 'rule that one out'... That 'wobbly legs' thing kinda worries me....

    Edited to add: Juliet said no access to anti-freeze. Phew!
     
  34. Dr Schrodinger

    Dr Schrodinger Member

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    Dec 28, 2012
    Antifreeze? No. He's an indoor puddytat. We keep our antifreeze in the cellar, but he never goes down there (too much of a chicken!) & it's on a high shelf, anyway.

    Well, I decide to work from home completely today & am doing a full glucose curve to help persuade the vet that I'm not doing anything untoward by switching his diet.

    Shot at 7am:
    07:00 25.2mmol/L
    09:29 15.8mmol/L
    11:30 11.5mmol/L
    It seems to be going reasonably well so far, but the bleeding is tricksie, despite Milo's ears being the size of a barn door.... :D

    Eliz, you're right. This hometesting malarkey will cost a fortune in treats!
     
  35. Elizabeth and Bertie

    Elizabeth and Bertie Well-Known Member

    Joined:
    Sep 6, 2010
    Wow, Juliet, I don't think I've ever known anyone attempt a curve so soon after learning to test! :shock: Brilliant stuff!

    And you've got a nice BG drop there too. Milo should be coming up to insulin peak (blood glucose nadir) pretty soon.

    For the benefit of folks in different time zones, and using US numbers, I'll rewrite your info in 'FDMB-speak' ('AMPS' means morning pre-shot number; 'PMPS' is evening pre-shot number. To get US numbers you multiply 'rest of the world' numbers by 18. And '+2.5' means 2.5 hours after the shot was given.)

    AMPS: 25.2 (454) gave 4 units Caninsulin
    +2.5: 15.8 (284)
    +4.5: 11.5 (207)

    One of the criticisms of Caninsulin is that it can have a very short duration in cats, and can be pretty much out of the system in as little as 8 hours. So, it will be interesting to see how Milo does on this insulin.

    Is he feeling any better at the lower numbers? Any less 'wobbly'?
     
  36. Diana&Tom

    Diana&Tom Well-Known Member

    Joined:
    Dec 29, 2009
    Yes, these are heartening numbers - a nice not-too-steep-or-fast drop (which can make a poor kitteh feel very out of sorts) and at least you can see that Milo is definitely not insulin-resistant, but that Caninsulin works as it usually does. As Elizabeth says, it will be interesting to see at the next test if he levels out and stays there for a bit, or starts to climb again. One of the problems many owners have with Caninsulin is its duration (whoops, just noticed that Eliz has already said that so apologies - but maybe not such a bad thing as the more often you hear things from us on this board, the more it will start to sink in and make real sense).

    Carry on as you are, you're doing great!

    :RAHCAT :RAHCAT :RAHCAT :RAHCAT :RAHCAT

    Diana
     
  37. Dr Schrodinger

    Dr Schrodinger Member

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    Dec 28, 2012
    Well, I had a brilliant teacher!

    Yes. I'll do another test in an hour & then I'll have run out of strips, so a quick run into town is in order!

    Thank you, Eliz. I can add another one now:

    +5.5: 11.1 (200)

    Yes, I would like to see how long it lasts. One of the reasons I have thrown myself into it is because I feel powerless without the knowledge of what is happening to him. I haven't seen any of his clinical data from the vets for his previous curves & have no idea of what they fed him throughout. Having a good baseline of data from which i can make my own observations is vital if I am to improve his condition.

    He's perked up a bit & is chirruping in his Maine Coon accent, but is still wobbly on his back legs. He's not very good at taking corners today.
     
  38. BJM

    BJM Well-Known Member

    Joined:
    Oct 6, 2010
    For the wobbly hind legs, he may need supplemental methylcobalamin (methyl B-12). This may be purchased over the counter/online. It has to be the methyl version.

    OR, it could be low potassium levels - the vet would need to check that with bloodwork.
     
  39. Dr Schrodinger

    Dr Schrodinger Member

    Joined:
    Dec 28, 2012
    Aaaaaaaaaaaargh!!

    Apparently fructosamine was really high too. The vet wants to increase his dose to 5 units twice daily. Don't know what to do. :cry:

    (BTW Thanks for the tip, BJM)
     

    Attached Files:

  40. BJM

    BJM Well-Known Member

    Joined:
    Oct 6, 2010
    Your curve shows that the insulin is not lasting long enough (only 8 hours) which would support switching to one that is longer acting, such as Lantus, Levemir, and maybe a form of PZI if available in the UK (Hypurion?)

    There is a small amount of room to increase the dose (within the green band), but I'd err on the side of caution and increase by only a small amount, such as 0.25 or 0.5 units on a day I could be home to monitor for possible hypo.

    Another tactic would be testing and dosing every 8 hours, which is difficult for most folks to schedule.
     
  41. Elizabeth and Bertie

    Elizabeth and Bertie Well-Known Member

    Joined:
    Sep 6, 2010
    Juliet, a couple of questions for you...

    When was the blood sample for the fructosamine test taken? Was he only eating dry food at that time? Or during much of the preceeding two weeks?

    Do I understand you correctly that now you're testing you're phasing out the dry food and replacing with low carb wet food...?

    If 'yes' to the above then the fructosamine test info may already be 'out of date', and a dose increase should not be made on the basis of that test.

    Further, it's generally considered a good idea to only make one change at a time. Phasing out dry food and increasing insulin dose at the same time is NOT a good idea. You might end up giving Milo too much insulin....

    If you're working from home and able to test Milo this week then maybe you see how phasing out the dry food alters his BGs over the next few days, and then consider what dose increase might be appropriate after that? I agree with BJM that any dose increase should be small and also done at at time when you can monitor.

    Chin up, Sweetie - You're doing a brilliant job. :smile:
     
  42. Dr Schrodinger

    Dr Schrodinger Member

    Joined:
    Dec 28, 2012
    Yes, I agree the fructosamine test will be out of date now I've changed his diet.
    I've discussed with the vet a number of ways forward:

    1. Stick with the diet change & monitor him on the same dose.
    2. Change the insulin - but the only available alternative is Lente, at the moment. :-|
    3. Increase the insulin by a fraction & monitor him while he gets used to his new diet.

    She's not comfortable with leaving the insulin alone. If she was me then she would increase the Caninsulin & see what happens, whilst doing a full 24 hour curve. This would have to be done in the surgery, as I have to work.

    She's not happy with me changing his diet, at this stage, although, in fairness, he was supposed to be stable, when clearly he isn't. I have phased out the dry stuff completely now.

    I'm taking Milo to be checked over tomorrow first thing to rule out anything else. He's now very hot & grumpy. In the meantime I'll give him 4.5 units this evening and test his BG before I go to bed.

    Thank you.
     
  43. Diana&Tom

    Diana&Tom Well-Known Member

    Joined:
    Dec 29, 2009
    I sense your frustration but try to stay positive - you are already making great strides and this is a process, just as it would be in a human.

    You also have a head start in being a scientist because you understand a lot of the basics. When I was treating my FD cat I was all at sea 100% of the time because I just don't "do" numbers or anything related. I used to be a journalist, now I teach art - I have zero left brain function and am virtually dyslexic with numbers (or whatever the right word is). However, I just did my best, and that's all any of us can do. You're doing really really well - just carry on as you are and give yourself credit (and lots of treats!) for it!

    Diana
     
  44. Elizabeth and Bertie

    Elizabeth and Bertie Well-Known Member

    Joined:
    Sep 6, 2010
    Oh, Juliet....

    You sound SO disheartened.... (((Hugs))) to you,

    It's very early days. And I just can't believe what you've achieved in such a short time! This time yesterday you didn't know how to hometest. Today, you learned to test, did a curve (and produced a graph of that!), and removed dry food from your cat's diet. You're moving so fast that I can hardly keep up!

    I know it's difficult when our vets say one thing and the (potentially crazy) people on the internet say something else. We've all been there.... But if I had followed the advice of the vet who diagnosed Bert's diabetes then Bert would not have been alive last night to demonstate hometesting to you: That vet recommended I have Bert PTS. If Udong (whose post you were so inspired by) had followed the vet's advice about what to feed her cat then that cat would still be on insulin and not in remission now....

    Our vets advise us. People on this forum advise us. But each of us has to weigh things up and make - what we consider to be -the best choices in the interests of our cats. And it really isn't easy....

    The only advice I would give at this point is to take care with any dose increase this evening. You've only just removed dry food and Milo's BG may still be settling out as a result of that.

    And regarding insulin, there are other options. But that's for another time...

    Please don't lose heart. You should be congratulating yourself on all that you've achieved for Milo over the last 24 hours....

    Eliz x
     
  45. Dr Schrodinger

    Dr Schrodinger Member

    Joined:
    Dec 28, 2012
    Thank you, Ladies!

    Yes, I am frustrated & feeling a little powerless. I've run out of test strips & there aren't any in my town! I'll play it safe & not increase Milo's dose this evening.

    He's tottering around the house, he's just filled his belly with meat, and I have raised a few purrs & chirrups. I'll take him to the vet tomorrow along with a 6 pack of tinned food & ask them to do a 24 hour curve on him at a slightly higher dose (4.5 units) and go from there. There's no way on this earth that I'm having him eating crappy food again, but that spike after 8 hours has really pissed me off. We stick to no carbs & insulin from now on & get him stable.

    Eliz - our local s'market stocks those Thrive treats that Bertie loves so much! Milo shall have a present for when he gets out of hostible. Yay!
     
  46. Jen & Squeak

    Jen & Squeak Well-Known Member

    Joined:
    Dec 28, 2009
    just to make things more stressful for you :(

    a curve at the clinic may not be worth the cost because IF he is stressed and IF he is one of those cats who have elevated bg levels due to stress, the numbers could be inflated more than they would be home.

    honest, you do NOT need a 24 hour curve to determine how he's doing. You are testing at home and you've started a diet change which can take a few days to see full effect. If you keep him at home and monitor his urine for ketones and get pretests and spot checks, you'll know if the diet change is having sufficient effect.

    Sorry, I know this makes things tougher

    Jen
     
  47. Dr Schrodinger

    Dr Schrodinger Member

    Joined:
    Dec 28, 2012
    Don't apologise, Jen.
    I know all of this anyway, but I just don't have the test strips or the time to monitor him at the moment. The strips are on order but will take a few days to arrive. If I can't do a BG test myself, then (now his diet has changed) he needs to be monitored by someone else!
    He seems much perkier this morning. He's had his usual 4 units caninsulin, and has a massively full belly of meat (which hasn't happened in a while) and is purring his huge furry head off at me. I'll let the vet check him over, do a ketone test, and maybe keep him in to do a detailed curve to see if that spike appears again.
     
  48. Diana&Tom

    Diana&Tom Well-Known Member

    Joined:
    Dec 29, 2009
    Juliet, I'm glad to see that you have a plan - that's what's important to help you feel in control. It's so easy to throw your hands up in the air and feel powerless, with all the various things to think about. I'm also glad to hear that Milo is a happy bunny this morning - that tells you what you need to know more than anything, so you are doing something right! It is important to take note of all the little differences in behaviour, as you've detailed here - easy to overlook in our state of panic!

    I'm assuming you've ordered test strips from ebay - much cheaper than any high street chemist, although you might want to find a local supplier who you could get supplies from in an emergency.

    Cats do love Thrive, yes - rather expensive though, about £3 for a little tub from Sainsbury's. You may like to keep a little stock of cubed chicken or ham in the fridge as well, as treats. And don't forget treats for yourself too (don't under-estimate the importance of these things!)

    Diana
     
  49. Dr Schrodinger

    Dr Schrodinger Member

    Joined:
    Dec 28, 2012
    He's at the hostible for the weekend under the eye of a different Vet with different ideas.
    His BG has been high all day & she suspects Somogyi.

    BUUUUUT......NO KETONES!! Weeeeee!!

    So, plan is to decrease dose (Yay!) and do another full curve at 2 x 3 units. She asked if I wanted to do it at home (see? Different ideas!) but I declined as I want some sleep....
     
  50. Elizabeth and Bertie

    Elizabeth and Bertie Well-Known Member

    Joined:
    Sep 6, 2010
    Juliet, just PM'd you to ask how Milo is, but I see that you've posted an update here, so you don't need to reply.

    Am SO pleased to see that there's no ketones! (Phew!) dancing_cat
     
  51. Dr Schrodinger

    Dr Schrodinger Member

    Joined:
    Dec 28, 2012
    Quick update:

    Milo's BG was off the scale all day yesterday, with 'HI' every 2 hours. :shock:
    They managed to get a reading of 33.3mmol/L (600!) on the hospital analyser in the evening (i.e. top of the scale for the hand-held meters) & gave him 3 units rather than the usual 4. He wasn't tested O/N.
    This morning he was

    AMPS: 22.5 (405)
    +2: 18.7 (337)

    Looks like yesterday was truly a Somogyi day for my little man. I've just been to see him & he looks so much better. he's coming home this evening at 7pm so I can get a PMPS & shoot him in the comfort of his own home.

    He wasn't eating his tinned food, so they've given him A/D, and a bowl of Hill's W/D!!! :evil: NOOOOOOOOO!!! I managed to control my reaction (just) and they've removed it.

    27% f&*$%^** STARCH!! FOR A DIABETIC???!! ohmygod_smile The Nursie (supposedly the diabetes specialist) just really didn't get it. "But, that's designed specifically for diabetic cats & that's what we feed them...". I'm afraid my work-persona came out (I'm a University Lecturer & a Zoologist) "Now a cat's an obligate carnivore, right? It catches prey. Have a think about what a cat eats in the wild. What's the carbohydrate content of a sparrow or a field vole?". Oh dear. I managed to smooth things over in the end.

    Anyway, all good news about Milo. I'm glad he was there yesterday. I would be panicking if this had happened at home, despite their unscientific ideas about feline physiology. So it's home tonight, on a lower dose. We even managed to raise a purr out of him whilst at the Vets. Woot!! :D :D
     
  52. Elizabeth and Bertie

    Elizabeth and Bertie Well-Known Member

    Joined:
    Sep 6, 2010
    Somogyi - Gosh..... Well if that is the case thank goodness you didn't increase the dose to 5 units! :shock:

    So, the day before yesterday, when you did the curve at home, you got a normal/typical Caninsulin curve, no sign of 'rebound' pattern there. But yesterday at the vets he was 'hi' all day. I'm trying to work out what happened between those two events...

    OK, options... Hmmm....

    Could it be possible, I wonder, that there have been low BG drops happening regularly that just haven't shown up on any test data collected so far? Perhaps he's been dropping low, then rebounding, then settling out a bit, then dropping low, rebounding etc...?

    Or, could it be that the effect of removing his dry food meant that the evening dose (on the day you did the curve) was too much in those circumstances; so he dropped too low (or too fast, or both) overnight and rebounded. That would certainly be enough to cause the high readings at the vets.

    Or... Was dry food available for Milo at the vets throughout the day? In which case that might be responsible for those high numbers, or would certainly exacerbate them....

    Juliet, are there any very low readings amongst the test results collected during any of the curves done by the vet?
     
  53. Dr Schrodinger

    Dr Schrodinger Member

    Joined:
    Dec 28, 2012
    Indeed!

    Well if you look at the curve I posted again, there is only an hour between the 2 lowest numbers, and then suddenly the BG shoots up. I'm not sure how caninsulin normally 'wears off' - does it rebound so quickly usually?




    Maybe, yes.
    This is my theory, yup.
    If it was Somogyi, then rebounds can last up to 3 days, and I had no strips between that last high test & what was recorded in the clinic 12 hours later.
    The first 'Hi' test would have been +3 or +4, at 10 or 11am. We only admitted him at 9.30am which isn't enough time for any dry stuff that he may have eaten there for the sugars to be absorbed, especially considering he already had a belly full of meat. My guess is that he had been 'Hi' most of the night.

    Have a looksee: http://www.caninsulin.co.uk/Somogyi.asp ... ement_cats

    Apparently he hasn't really touched the dry stuff (thankfully) but has been stuffing his face with A/D.

    The only time he has ever been near the region of 4-5 (72-90) - that has been recorded - is on neutral insulin in the clinic. Mind you, we only have 3 or 4 curves for him in total with 2 hourly tests, so it might just be the case that low readings have gone undetected so far.

    I'll take some more tests tomorrow throughout the day & see what's happening.
     
  54. Elizabeth and Bertie

    Elizabeth and Bertie Well-Known Member

    Joined:
    Sep 6, 2010
    Caninsulin certainly can do that in cats. It has a reputation for steep drops and sudden exits. Some folks try to give three shots a day to try to compensate for this. I did that for quite a while myself (5am, 1pm and 9pm, I think) until I persuaded the vet to prescribe a longer lasting insulin....

    What was Milo's evening pre-shot number on the day you did the curve? Was it considerably higher than the morning pre-shot?
    (Edited to add; Sorry, just checked back through posts and realised you'd run out of strips at that point.)
     
  55. Dr Schrodinger

    Dr Schrodinger Member

    Joined:
    Dec 28, 2012
    So if what I recorded was actually a normal caninsulin curve, then what has happened to him yesterday, I wonder? Maybe I screwed up his injection & didn't realise? I still make the odd cock up, so maybe that was it? :shock:

    I suppose the only way to determine what's going on is simply to collect more data.
     
  56. Diana&Tom

    Diana&Tom Well-Known Member

    Joined:
    Dec 29, 2009
    What you're describing does look like a fairly typical Caninsulin curve to me - when it wears off, it often wears off fast; it's gone and that's that - but I think one of the things to bear in mind is that there isn't always a typical or normal response - various factors can come into play that can throw a curve ball at any time. Even if you're feeding exactly the same food and giving exactly the same dose, you may not always see what you expect to see... it really is an ongoing effort, as so many of us here know, and requires a lot of dedication. In other words, it's a labour of love!

    Keep smiling and remember those treats - for yourself - this is a challenge and you need to stay grounded :smile:

    Diana
     
  57. Elizabeth and Bertie

    Elizabeth and Bertie Well-Known Member

    Joined:
    Sep 6, 2010
    Juliet, I think it's pretty unlikey that you screwed up the shot. So please don't be hard on yourself. It is a possiblity that the elimation of dry food had a strong effect on reducing Milo's BG's, and perhaps the evening shot was too high a dose as a result of that.

    Or, maybe the 'somogyi' theory is the answer but the low numbers haven't yet showed up in the data collected so far.

    Or, (looking at that curve you did again) maybe the initial part of the BG drop was too fast for Milo and triggered a rebound (if more than about 5.5 mmols per hour at any point). Though, I don't think that's quite enough to account for those really high flat numbers....

    It's really hard to know exactly what happened. I do a lot of curves on Bertie (in fact every day I produce a kind of 'mini curve'...) and I know that - even with all the obvious variables under control - food, insulin dosage etc - the numbers can still vary quite dramatically, and for no obvious reason... It can just leave you scratching your head and thinking "Whut???"

    Yes, I think you're absolutely right that what is needed in Milo's case is more data.... Let me know if you run out of test strips. I had a load arrive today! ;-)
     
  58. Dr Schrodinger

    Dr Schrodinger Member

    Joined:
    Dec 28, 2012
    "Curiouser and curiouser" said Alice.

    What a beautiful curve on 3 units! Sorry about the pic quality. Rubbish phone & rubbish lights at home! His nadir was 4.9 (88), which is the lowest recorded so far. Apparently he started eating at this time, so appears to be self-regulating to an extent, and he's slowly risen to 18 by the end of the curve.

    I don't think I'll bother beating myself up about maybe screwing up an injection. :lol: If he's now responding like this on 3 units, I am happy. He's happy to be home & has already made a mess by spreading his food around the kitchen floor. Typical boy. ohmygod_smile
     

    Attached Files:

  59. Elizabeth and Bertie

    Elizabeth and Bertie Well-Known Member

    Joined:
    Sep 6, 2010
    Hi Juliet,

    How is Milo doing today? Any BG numbers from him?

    That 4.9 (88) nadir was nice yesterday. :smile:

    Eliz
     
  60. Dr Schrodinger

    Dr Schrodinger Member

    Joined:
    Dec 28, 2012
    Hi Eliz,
    No numbers for him yet today, I'm afraid.
    Yesterday:
    PMPS: 25.3 (456) EDIT: THIS WAS 2 HRS LATER THAN NORMAL.
    +4: 19.0 (342)

    So he was dropping slowly. I decided to go to bed at 1am - I was knackered. I left loads of food out for him & let him settle, and then checked him when I woke periodically throughout the night.

    This morning I thought I would shoot him blind & just watch him until this evening. I'm going to have to shoot him blind for his morning doses this week & I want him to settle down a bit into a routine, really. He hasn't been for a poo since friday, so I'm a bit worried about that. But he seems quite bright & purry today, despite being 'full', and he's still eating, so I am expecting a stinky eruption at some point!

    I'll do a PMPS & a +4 or +5 tonight & see where he's at.
     
  61. Elizabeth and Bertie

    Elizabeth and Bertie Well-Known Member

    Joined:
    Sep 6, 2010
    I don't understand. Why are you "going to shoot him blind...this week"? Did the meter pack up? :?
     
  62. Dr Schrodinger

    Dr Schrodinger Member

    Joined:
    Dec 28, 2012
    Because I honestly don't think I'll have time before I go to work. I will try, but it's taking me about 20-30 mins to do each test at the mo. I'll get up earlier & see, but I have such a massive workload at the moment I'm not sure how much I'll be able to fit into each day. I was thinking if I have to shoot him blind, I might give him 2.5 units instead of 3 in the morning? I dunno. Not sure how I'll fit everything in at the moment.
     
  63. BJM

    BJM Well-Known Member

    Joined:
    Oct 6, 2010
    Testing does get easier with time.

    Perhaps it would be helpful to use some of the Secondary Monitoring Tools listed in my signature link. They aren't as precise as blood glucose testing, but may provide useful clues on how he is doing.
     
  64. Elizabeth and Bertie

    Elizabeth and Bertie Well-Known Member

    Joined:
    Sep 6, 2010
    Hi Juliet,

    I do completely understand how life gets busy sometimes, so much so at times that there really don't seem to be enough hours in a day (I've frequently put in requests to the Almighty asking for 36-hour days, but so far she hasn't come up with the goods ;-) )

    However (well, you must have known there was a 'however' coming...) testing before each insulin shot is probably the single most important thing you can do to keep Milo safe. There is no other way of knowing whether the cat's BG is high enough to give the shot. Many of us here have done routine pre-shot tests only to find - totally unexpectedly - that one day our cat is in 'normal' numbers.

    And you got a nice nadir number yesterday. So that may well suggest that Milo is responding better to the insulin now that the dry food has gone.

    Testing can be difficult at first. But it does get a lot quicker with practice. Are there any aspects of testing that you're finding particular difficulty with? Are you finding it hard to get enough blood for a test? (That's usually the most common issue at first). Please let us know how we can help you with this...
     
  65. Hope + (((Baby)))GA

    Hope + (((Baby)))GA Well-Known Member

    Joined:
    Dec 28, 2009
    Juliet, Mishka has been on insulin for 9 yrs. 3 months and never have I given her a shot without testing. She can throw some weird numbers. Main example....her amps this morning was 57. If I had shot her without testing I very well could have put her into a hypo situation that definitely would have required an ER visit to keep her up. If I had shot her and gone out, I probably would have found her dead. She is on compounded PZI. She also still had some canned food left that she had been eating......didn't matter.......she still gave me a 57.
     
  66. Diana&Tom

    Diana&Tom Well-Known Member

    Joined:
    Dec 29, 2009
    Juliet, I am loath to stick my oar in if it's not wanted but I do urge you to think carefully about shooting without testing first. These are early days in Milo's treatment and as I think I said yesterday, he could throw you a curve ball at any time. He is your cat, of course, and you are his care-giver - but pretty well everyone here would say that it is always better to be safe than sorry.

    Diana
     
  67. Dr Schrodinger

    Dr Schrodinger Member

    Joined:
    Dec 28, 2012
    Oh, come now, people! You can lay the emotional blackmail on a bit thicker than that, can't you??!!
    Pffft. You weren't even trying there!
    I KNOW what this means and I can only do my best. The last test took 5 mins....
    We'll have a go tomorrow morning.
    He's just scored a 26.4 (476) at +10.5 which scores himself a shot and a treat (or 3).
     
  68. BJM

    BJM Well-Known Member

    Joined:
    Oct 6, 2010
    If you absolutely have to get blood, you can prick the vein. Just be prepared to get a drop on a clean fingernail for the test and to apply pressure quickly, because most vein pricks bleed profusely. With one good head shake, the room starts to look like an abbatoir! I guess that's one way to redecorate, lol.

    If you really want a guilt trip ... if this were your diabetic child, would you ever risk the chance of injecting insulin without knowing it was safe?
     
  69. Dr Schrodinger

    Dr Schrodinger Member

    Joined:
    Dec 28, 2012
    Comparing a pet with a child is invalid both ethically and in the eyes of the law, but nice try!

    Thanks for the tip all the same. And yes, obtaining a sample is the most laborious aspect, both for me & the cat. He's compliant & patient, but my aim is imprecise. I shall try freehand.
     
  70. BJM

    BJM Well-Known Member

    Joined:
    Oct 6, 2010
    Just giving you one of our frequent justifications, hence the small font.

    Legally, I generally agree, but how do you figure ethically, or even morally, for that matter? It probably depends on what assumptions folks are starting with as 'givens'. Different assumptions will logically have different conclusions.

    And ... if you are responsible for an animal's care and well-being as an owner, hired caretaker, or veterinary professional, at what point would it be considered neglect? Nonfeasance, misfeasance, or malfeasonce?
    Different animal laws the world around and really a discussion for over in Community.
     
  71. Dr Schrodinger

    Dr Schrodinger Member

    Joined:
    Dec 28, 2012
    It's not a justification.

    This all implies that I am contractually obliged to pretest my kitty, which is not the case. I am more legally obliged to follow the instructions of my vet, the qualified professional. (As are all of us on this board, regardless of which country we are in!)

    Well don't start the conversation in this thread, then?! :lol:

    Back on topic:

    Managed AMPS this morning. Got up at usual time (6am). Luckily Milo bled first time with no trouble.
    AMPS: 25.6 (461)

    Got to work at 8am as usual. :coffee:

    The last couple of nights his +4 has been disappointingly high at ~16 (288). I wonder if there may be a difference in efficacy of delivery between the VetPen I use at home & the vial/syring at the Vet? Or maybe the batch of insulin? Or maybe the home environment? Could be any or a combination of the above, I suppose....
     
  72. BJM

    BJM Well-Known Member

    Joined:
    Oct 6, 2010
    Could be a difference in depth of delivery?

    I know for Lantus, we treat the pen as a mini-vial and use the syringe to withdraw and shoot the insulin. The Lantus pens hold 3 mL of Lantus instead of the 10 in a vial, which results in less waste as sometimes a vial starts losing potency before one is done with it. Also a syringe enables us to do slight adjustments to dose - just over or under a line, in between, etc. As a scientist, that may bug you because of the imprecision; the folks here seem to make it work.
     
  73. Dr Schrodinger

    Dr Schrodinger Member

    Joined:
    Dec 28, 2012
    They are 12mm. I hadn't even thought about depth of delivery or using the cartridge as a vial! There's always waste!
    Oh Dear. Rookie error. ohmygod_smile

    Thank you!
     
  74. BJM

    BJM Well-Known Member

    Joined:
    Oct 6, 2010
    That's a hypothesism, not a fact, so not guaranteed to be the reason for differences. It just seems logical.
    Force of delivery may differ between a pen and a syringe, too, which would affect depth and possible dispersion.
    Isn't observational research fun? ;-)
     
  75. Dr Schrodinger

    Dr Schrodinger Member

    Joined:
    Dec 28, 2012
    YAY SCIENCE!!

    I'll pick up some syringes tomorrow. ;-)
     
  76. Elizabeth and Bertie

    Elizabeth and Bertie Well-Known Member

    Joined:
    Sep 6, 2010
    Hi Juliet,

    When you first came to this forum you said that your 'optimal outcome' would be remission. It strikes me that in order to help you work toward your goal what would really help you is more data about how the insulin is working in your cat now. Without data it can be nigh impossible to work out why any given number is as it is; and sometimes even with data it can be impossible to work that out because there are so many variables, not least of which is 'the cat' itself....
    confused_cat
    But the more data you collect you more you will get a 'feel' (terribly unscientific, I know!) for how your cat utilises insulin. Doing 'curves' is useful because it helps to show the pattern of the insulin cycle. Curves help us identify when the insulin starts to work ('onset'), when it reaches peak (BG nadir), and how long the typical duration is. Curves also show subtler information about, for example, the time during which the BG drops the fastest; when the drop slows down; and how quickly it rises again.

    Having that information from the curve allows us to target our ongoing BG testing more effectively. A preshot test is done, and then maybe a couple of 'spot checks' at different points of the cycle. Quite a few people who are out during the day have set their alarm clocks so that they can do a spot check during the night!

    Preshot numbers and spot checks will also help to identify changes to the numbers and to the pattern. If your cat starts to go into remission (fingers crossed here!) he will be dealing with two lots of insulin, the exogenous/injected insulin and his own... This might become apparent because the cat's preshot numbers get lower and lower. Or it might become apparent because you notice sudden drops elsewhere during the cycle: Maybe the number you get at peak is way lower than you were expecting. Or maybe the BG starts to rise after peak but then drops again after feeding the cat a snack. All of these changes are easier to pick up if you have a good feel for what the situation is 'now'. It will also help you to identify if your insulin has 'sparked out' or if you are getting poor absorption from particular shot sites.

    Eliz
     
  77. Dr Schrodinger

    Dr Schrodinger Member

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    Dec 28, 2012
    Hi Eliz,
    Yep, I know what you're saying & yes I agree. I am doing more tests than I post on here. I just haven't transcribed them yet. I did 4 last night, for e.g.
    However, overnight tests will only be possible on the weekend, as will diurnal curves, unless I can work from home (which is not looking likely this week :sad: ). Unfortunately I have to think about the bipedal inhabitants of my house as well the the quadrupedal inhabitants!
     
  78. Elizabeth and Bertie

    Elizabeth and Bertie Well-Known Member

    Joined:
    Sep 6, 2010
    Hi Juliet,

    Been wondering how Milo's weight is doing. Has he managed to gain any?
     
  79. Dr Schrodinger

    Dr Schrodinger Member

    Joined:
    Dec 28, 2012
    Hi Eliz. No. He hasn't gained a thing.
    He's more wobbly too, but is still constipated, and not eating so much. I gave him a teaspoon of olive oil & a lump of butter last night, but nowt's shifted yet.
    I'm picking up needles & insulin from the vet this evening, so will ask them what else I can do. BG was down this morning (20.2).
     
  80. BJM

    BJM Well-Known Member

    Joined:
    Oct 6, 2010
    Many of us with kitties suffering constipation use 1/8 teaspoon of Miralax (polyethylene glycol), plus plenty of water in the food (its an osmotic) to help them.
     
  81. Elizabeth and Bertie

    Elizabeth and Bertie Well-Known Member

    Joined:
    Sep 6, 2010
    Poor little Milo....

    As BJM says, Miralax is great for constipation; but sadly it's not easily available in the UK. We can buy it online from the US but it will take a couple of weeks to get here (longer term though that might be worth doing...?)

    Have you tried liquid paraffin for the constipation? Being a mineral oil it isn't digested in the way that other oils are so it just goes straight through the system... Some people put a little drizzle onto each meal until something happens.... And it should be easily available from pharmacies. There are also flavoured paste versions especially for cats (Katalax and Defurrum, one or other of which you should be able to get from your vet) But they smell of Marmite, and Marmite seems to be a 'love or hate' thing - for cats as well as people!

    The constipation may be sufficent reason alone to account for Milo's reduced appetite. (I could tell you the story of when I was put on iron treatment for severe anaemia....but I won't go there.... Suffice to say that I have some sympathy with how MIlo may be feeling.... :-| )

    If the constipation is severe then the vet may actually suggest sedating Milo and removing the hard poo manually. Does he have any leakage from his bum (Milo, I mean - not the vet.... )? Sometimes hard poo gets stuck and then you get leakage coming around that from other stuff that's backing up in the system and trying to get out of the body. ('FDMB' eh? Where else could you have conversations like this! :lol: )

    Ahem <Eliz clears her throat>.... Moving swiftly on.....

    Ongoingly, it might be helpful to try to get Milo to drink more (easier said than done, I know..), and/or to add a little water to his canned food. Water fountains really encourage some cats to drink. And some cats love the water that either chicken or fish have been cooked in. And some cats like diluted natural yoghurt.

    Re the weight gain thing, I have a cat that I'd started to worry about because he was a bit skinny. No other health problems, just getting old and a bit skinny... It was suggested to me that I upgrade his diet from regular 'food in jelly' to premium foods that had higher (and better quality) protein content; and since doing that he's put on a nice bit of weight (in just a couple of months). I started out by trying him with 'Lily's Kitchen' cat food (available from Waitrose (and online)) and that seems to have made a big difference to him. And inspired by that I'm now also feeding other foods (only available online) such as Grau 'grain free'. And strangely, not only did these foods benefit my skinny cat by adding weight to him, but they're also benefitted Bertie by being lower carb than what I was feeding before...

    If you want to try any of these foods to see if Milo will eat them just let me now and I'll set a few cans aside for you (and maybe your OH can pick them up after work one day..?)
    Edited to add; I could leave the cans on the doorstep here to be collected so that you (or OH) don't get trapped in a conversation with Chris! :lol:

    Sending 'happy poo' vibes to Milo...

    Eliz
     
  82. Dr Schrodinger

    Dr Schrodinger Member

    Joined:
    Dec 28, 2012
    I was just eating my lunch whilst reading that! *puts sammich down*

    I think I have some liquid paraffin in the cellar for cleaning the parts for my lil car. I'll have a look. He might have *ahem* laid eggs by the time I get home. I shall wait & see (how exciting...).

    He loves Applaws wet food, so I'll feed him the pumpkin stuff tonight. With respect to water, I've started adding it to all their canned food & mushing up all the chunks with a fork. I have caught Milo's sneaky sister Lola, sucking all the jelly from ALL the food that I put out for them before poor Milo even gets a sniff! Turning all their food into a meaty 'gruel' stops her greedy little tricks. Bad girl. cat(2)_steam

    Getting either of them drinking isn't a problem at all. They love water & they love running taps & the bathroom. The attached happens every morning, when they're both well.

    Thanks for the offer of the Grau. I might take you up on it. I have a couple of other brands to try at home too.

    Thanks! I'm loving the Happy Poo Vibes!!
     

    Attached Files:

  83. Elizabeth and Bertie

    Elizabeth and Bertie Well-Known Member

    Joined:
    Sep 6, 2010
    Love that photo. Is that their water bowl? Gosh, you really are keeping them well hydrated! ;-)
     
  84. Elizabeth and Bertie

    Elizabeth and Bertie Well-Known Member

    Joined:
    Sep 6, 2010
    Well, I'm happy to put together a little 'taster selection box' of foods for you to try: Grau 'grain free', Lily's, and also a couple that I get from Germany, ie Catz Finefood and Granatapet. If your cats like the German foods then I can order you some next time I order...
     
  85. Jen & Squeak

    Jen & Squeak Well-Known Member

    Joined:
    Dec 28, 2009
    Um, my cat went into remission and I never once did an all night curve. In fact, I did relatively few curves. Preshot tests and spot checks, yes.

    FWIW

    :)
     
  86. Dr Schrodinger

    Dr Schrodinger Member

    Joined:
    Dec 28, 2012
    Tonight might be interesting.
    PMPS: 12.5 (225)! Half the usual! I gave his usual 3U
    +1: 15.8 (285) He's eaten one and a half cans of applaws in the past hour.

    I'll keep testing through the nadir. Honey and high carbs are poised for deployment.

    EDIT: Happy Poo Vibes worked. He laid a huge one at the vets & they forgot all about it....
     
  87. Hope + (((Baby)))GA

    Hope + (((Baby)))GA Well-Known Member

    Joined:
    Dec 28, 2009
    Love that picture and Lola is gorgeous!. So is Milo but Lola really stands out.
     
  88. Elizabeth and Bertie

    Elizabeth and Bertie Well-Known Member

    Joined:
    Sep 6, 2010
    Oooh, interesting preshot number....
    And I'm glad Milo is feeling more comfortable! ;-)
     
  89. Dr Schrodinger

    Dr Schrodinger Member

    Joined:
    Dec 28, 2012
    PMPS: 12.5 (225)
    +1: 15.8 (285)
    +2: 15.4 (278)
    +3: 15.1 (272)
    +4: 16.6 (299)
    +6: 24.6 (443)
    .
    I was wrong. Not an interesting evening. Almost an inverted curve. Sigmoidal, even. But at least he's eaten a fair bit of chicken & had a tiny poop.
     
  90. Dr Schrodinger

    Dr Schrodinger Member

    Joined:
    Dec 28, 2012
    Hope - re: Lola - thanks! I would tell her, but she already knows!
     
  91. Dr Schrodinger

    Dr Schrodinger Member

    Joined:
    Dec 28, 2012
    Quick Milo Update:

    After a week of settling in, he's now eating properly! flip_cat

    The 'wobbly' back legs have all but gone & his coat is looking more shiny & less like he's been sleeping in a ditch. Lola is helping groom him, too.
    I am hoping his new found appetite is making him put on weight but I am too nervous to weigh him at the moment in case he hasn't.
    What I have noticed is that he is drinking & peeing far less. We only have one water bowl out at a time now, & I change the litter box less often. Both he and his sister are doing proper carnivore-style 'scat' poops now, rather than the more human-style they used to produce on their dry food. (Lola's also losing weight & her dry skin is clearing up!).

    So, as long as he keeps troughing away at the canned food, we can think about sorting those BG numbers out. I put together a spreadsheet (in my sig) & am keeping notes about his demeanour, which should help me convince the vet to switch to a new insulin. The Caninsulin really doesn't last long enough for a 12 hour cycle, and he's bouncing back up really quickly. His BGs are all over the place at the moment, but I am hoping they will settle now he's eating properly.

    Many, many thanks to Eliz & Bertie for the donation of a multi-flavour tasting bag of multinational canned foods. dancing_cat

    They've munched their way through about a dozen different species since friday! In a vegetarian household it's a very odd thing to have that many different types of meat in the kitchen, but I am very, very grateful.

    Juliet
     
  92. Elizabeth and Bertie

    Elizabeth and Bertie Well-Known Member

    Joined:
    Sep 6, 2010
    Wow, Juliet,

    Great news that Milo is feeling better (woohoo!) and that his appetite has increased!

    I'm really, really pleased to hear this. I feel that you've had quite a tough time since Milo's dx. I know his weight loss has been worrying you too. I'm SO glad that you can see some improvement in Milo now (and glad to hear that the lovely Lola is doing well too...)

    Here's hoping this is just the beginning of good things to come!
     
  93. Dr Schrodinger

    Dr Schrodinger Member

    Joined:
    Dec 28, 2012
    Yeppers, I got a bit scared & stressed. Thanks for your help & support, Eliz.

    I think I have 'shared' his spreadsheet properly now. Please let me know if you can't see it.
     
  94. Elizabeth and Bertie

    Elizabeth and Bertie Well-Known Member

    Joined:
    Sep 6, 2010
    Hi Juliet,

    Just had a look at Milo's numbers. The Caninsulin does drop him but he swings up so high again doesn't he... Do you think your vet would be willing to prescribe a longer lasting insulin if you show him/her this data?

    Eliz
     
  95. Dr Schrodinger

    Dr Schrodinger Member

    Joined:
    Dec 28, 2012
    Yes, he seems to be entirely insulin-free 6 hours post injection. Which is just rubbish. :cry:

    Nice Vetman Martin (whom I have never met) just called me back after I had left a message with Reception. He nice man. He's looking into getting hold of some Hypurin Bovine PZI for Milo & will phone back when he knows more. :D He was surprised about the amino acid similarity, but is glad we're home-testing! NicemanMartin has used Lantus before & had good results with it, but would prefer to prescribe PZI if he can acquire it easily. I don't mind which Milo tries.

    Things are looking positive. :mrgreen:

    We like nice men. Or I do anyway!
     
  96. Elizabeth and Bertie

    Elizabeth and Bertie Well-Known Member

    Joined:
    Sep 6, 2010
    Oh, thank goodness for Niceman Martin! :smile:

    Just a quick question: If Niceman Martin has had good results with Lantus why would he prefer to prescribe Hypurin..? confused_cat
     
  97. Dr Schrodinger

    Dr Schrodinger Member

    Joined:
    Dec 28, 2012
    Because he knows more about it & how cats respond to it, I suppose. He's only prescribed it once - I'm not sure why, I didn't ask, but I will. He's slightly wary of the glargine 'hype' because what has been published so far has only been a small sample size (or that was my inference, anyway).

    I told him about you & your vet, Eliz. He wasn't aware that the supply issues over PZI had resolved themselves.
     
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