"You're a Nurse, your diabetic cat will be fine!" NOT!!!

Discussion in 'Welcome to the Group - Post an Introduction Here' started by ELLIOTT & Fran Munschauer, Jan 1, 2016.

  1. ELLIOTT & Fran Munschauer

    ELLIOTT & Fran Munschauer Member

    Joined:
    Jan 1, 2016
    Hello, I have 8 Bichons and agreed to adopt 2 cats 6 years ago. They are beautiful unfriendly cats and now one is sick. We are"dog" people but my priority in life is to strive for the rights of all animals.However, I don't understand cats, their purpose in life and what they expect from a relationship with humans...but they are family now and we love them. Elliott was diagnosed with DM 4 days ago. Apparently differentiation of type 1 vs type 2 is not possible in cats. Frightened out of my mind, the DVM said, "You worked with serious DM patients in ER and L&D for how many years? Your diabetic cat will be fine." I am exhausted, worried and hope not to endanger Elliott during my attempts to stabilize his condition. And so, I thought that joining up with "cat" people would be of great value with regard to caring for cats in sickness and in health. Thanks for letting me join!!!
     
  2. Squeaky and KT (GA)

    Squeaky and KT (GA) Well-Known Member

    Joined:
    Jul 19, 2011
    Hi Fran, extra sweet Elliott, cat friend and 8 little droolers and PapaBean! Welcome to the best place you never wanted to be.

    First, BREATHE! ....and another! Within a couple of weeks, you'll look back and wonder what the big deal was. ...got that TShirt! :)

    Cats are unique for sure but you've got a huge leg up on lots of us when we arrived - you understand DM. Just because it's a cat doesn't make it much different. Visit the 'Feline Health' forum and read the information there. When you run across a question, just post and someone will answer. Since it's still a holiday there's not as many here at one time but someone will answer soon.

    Just like humans, testing - even using human monitors is the best way to keep our sugarcats safe and healthy.

    Welcome again and HUGS!
     
  3. Critter Mom

    Critter Mom Well-Known Member

    Joined:
    Jun 16, 2014
    Hi Fran, and welcome to you and all your two- and four-legged family members.

    I'm glad you found us. We'll do all we can to help you. It is a bit nerve-wracking in the early days after Dx, but as you learn to home test and start tracking Elliot's response to his treatment you'll start feeling better about things. Feline diabetes treatment is definitely do-able! :)


    Mogs
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  4. Bobbie And Bubba

    Bobbie And Bubba Well-Known Member

    Joined:
    Jun 15, 2015
    Hi there Fran and Welcome! You have come to the right place to help you to help Elliot and manage his FD. As Squeaky said, testing is a big part of helping to control this disease and to keep him safe. There are many meters. There is a pet meter called the Alpha Trak2 and human meters. Some use the pet meter because it is what the vets use so the numbers will match up. The meter and strips are expensive though. Most use human meters that can be purchased at any pharmacy. It typically reads a little lower than the pet meter but we have ways of compensating it. Many use Walmart's brand, Relion Micro or Relion Prime, because it only needs a tiny drop of blood. The Prime testing strips are ½ the price of the Micro but use a little bit more blood. I have use the Micro first and switched to the Prime because of cost of strips. Another good reason to test is to do your own curves at home as they will be more accurate than when the cat is at the vets and very stressed with higher numbers and it will save you cost of the vet visit that day.

    Treats: It is always nice to have treats available for your kitty. Some use it after they have tested to reward. I like using Pure Bites. I have found it at Petsmart and other pet stores. It is freeze dried and the only ingredient is the meat i.e. chicken, duck, etc. If your cat likes it, then I would go to the dog section where it is cheaper than the cat package. It is bigger chunks but no problem in breaking it up. Also, some of us use Bonita Flakes that you can get online or in an Asian grocery store.

    Conditioning for testing: To get you kitty conditioned for the testing, decide on a spot in the house where you will test and take kitty to that place and rub his ears a bit then give him a treat and release him. Do that several times before you actually test and he will start to associate the treat and ear rubbing with a treat.

    Depending on which insulin you are using, we use certain guidelines as to when not to shoot if Elliot is too low. Could you post back and tell us what insulin you are using and how many units. Then we can guide you to the appropriate forum for those peeps to help guide you with dosing.

    Food is going to be another giant step in helping you to control his FD. You will want to consider changing your food to wet, low carb food if you are currently feeding high carb dry.. It is recommended to feed food that is under 10% carbs. Here is a list of cat food to choose from. food chart you will note that the food with fish are lower in carbs however it is recommended that you only give fish once a week due to its mercury content. Many feed Fancy Feast CLASSICS, 9 Lives, PATE, Friskies Pate and Wellness NO GRAIN. Notice that I have in caps the particular type within the brand because not all flavors within a brand are low carb. This list can also be found inwww.catinfo.org If you are already giving insulin and you have not transitioned to wet, low carb cat food, be sure to test while you are transitioning. This is because by changing to low carb food, it could decrease your kitty’s number by 100 points or more therefore requiring less insulin.

    Many vets push RX food that is expensive and actually too high in carbs for our sugar cats. And there is nothing RX about it rather inconvenient to have to run to the vets for your food and a lot of cats hate the taste.

    Here's a link about RX food you might find interesting.

    The truth about prescription foods

    Give a shout out if you have any questions about anything. We are here to help.

     
  5. Critter Mom

    Critter Mom Well-Known Member

    Joined:
    Jun 16, 2014
    Fran, is Elliot on insulin yet? If yes, then if you need to switch him to low carb wet food you need to home monitor his blood glucose throughout the transition because if he's moving from a high carb to low carb diet such a change can frequently lower blood glucose concentration significantly and quickly, so his insulin dose would most likely need to be adjusted.


    Mogs
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  6. MrWorfMen's Mom

    MrWorfMen's Mom Well-Known Member

    Joined:
    Feb 18, 2015
    TAKE A DEEP BREATH! It's normal to feel totally out of your element but this will pass in short order. I think I can relate to what you are feeling because I am a retired R.N. and I remember feeling totally bewildered! I love my vet, but I think the fact that I had a medical background made the vet hesitant to get into too much nitty gritty. The fact that I cut her off at the pass when she started to explain what diabetes is didn't help and likely only served to convince her I would know how to test and give injections to my cat. Looking back, I guess I basically stepped on my own toes suggesting I knew anything at all.

    You can do this. Yes, it's a bit different when dealing with a cat as opposed to a human, but you have the basic skills already so really it's just a matter of developing a routine that works for you and Elliott. The first thing you need to do is adopt that "can do" demeanour you used in your professional capacity because cats pick up on our emotions like little sponges. The first time I went to give Menace her injection, I'm embarrassed to say my hand was shaking so bad, I thought I'd never be able to do it. Within a week or two, as I calmed down, Menace and I got the routine down pat and I wondered why I got myself into such a snit. Now Menace often comes to get me at test/shot time!

    You have already got some great starter course info. The knowledge here is amazing so ask any and all questions and you will get all the help and support you need.:)
     
  7. Jan Radar

    Jan Radar Well-Known Member

    Joined:
    Jun 27, 2015
    I would like to welcome you, Fran and Elliot, to the best place that you never thought to find yourself, a place where all of us remember how scared and uneasy we felt when a vet explains what's wrong with the kitty. More importantly this is a place where you will get the encouragement you need on the low days and the information you need to provide the best possible care to the furry one who needs your help. YOU are the most important part of the equation. YOU have the power to help Elliot feel better and we will help you with whatever you might need the best that we can. Try to relax, think positively and then start telling us what we can do to help you. Hang in there... it does get easier. :cat:
     
  8. jayla-n-Drevon

    jayla-n-Drevon Well-Known Member

    Joined:
    Oct 11, 2015
    Welcome aboard and Happy New Year….. We need more people in the world like you who open their hearts to adopting ;)
    FD is manageable/reversible and since you already have a understanding you will get it down in no time!!
    Lots of experience and wonderfully generous people who will guide you along the way. I am still fairly new but I no longer feel overwhelmed as I see cats going "off the juice" from the help of the care givers advice on this forum-I will say like the others above that testing and data is very helpful not only to keep your kitty safe but if / when you may need guidance the data will help the experienced person a leg up on how to proceed. It really does get better ;)
    Elliot is lucky to have you:cat:
     
  9. Merlin

    Merlin Well-Known Member

    Joined:
    Mar 18, 2014
    Welcome Fran and Elliot to FDMB! You have come to the right place for support. There are a lot of caring and experience folks here. You will be given a whole lot of information and at first, it will seem very overwhelming however in a couple of weeks, things will start falling into place.

    Good Reading: This is a must read. It is an excellent 18 page informative document that covers feline health and nutrition. Don't take short cuts and read it all. www.catinfo.org Also read other postings and their spreadsheets. You will learn a lot more from others.

    Home Testing: Here, we all home test. It is mandatory to understand how your kitty is reacting to the insulin and the dose. You will want to test before each shot and some additional test in between the 12 hour cycle. Another reason to home test is to keep your kitty safe. Find a place in your home where you will always perform the test and give lots of hugs before and after testing. There are many videos showing you how to test. Hometesting Links and TipsHere is a picture of where you test on your kitty. http://s106.photobucket.com/user/chupie_2006/media/testingear/sweetspot.jpg.html

    Here is another good link on Home Testing:http://www.felinediabetes.com/bg-home-test.htm

    Meters: There are many meters. There is a pet meter called the Alpha Trak2 and human meters. Some use the pet meter because it is what the vets use so the numbers will match up. The meter and strips are expensive though. Most use human meters that can be purchased at any pharmacy. It typically reads a little lower than the pet meter but we have ways of compensating those lower numbers. Many use Walmart's brand, Relion Micro, Relion Prime or Relion Confirm. The Micro and Confirm only needs a tiny drop of blood but the strips are a little more expensive than the Prime. The Relion Prime meter needs a little more blood than Micro and Confirm. They cost around $15 and the strips are around 35 cents each.

    Lancets: These are used to poke the ear to get blood. There are many different sizes (gauges). It is recommended when you are first starting out to use a 26-28 gauge. Also, it would be a good idea to pick up Neosporin WITH pain reliever to apply on the edge of the ears and don't forget to alternate ears.

    Spreadsheets: Our spreadsheet instructions are here. If you look at the signatures of the members here, you will see a link to their kitty’s spreadsheets. We keep track of all our tests. This is basically a place to collect data and help you to determine patterns, doses, etc. It also aids those that may be helping you to better understand your kitty.

    Food: There are many reasons why we are here but one is due to feeding dry cat food which is high in carbs. You will want to consider changing your food to wet, low carb food. It is recommended to feed food that is under 10% carbs. Here is a list of cat food to choose from food chartyou will note that the food with fish are lower in carbs however it is recommended that you only give fish once a week due to its mercury content. Many use Fancy Feast, 9 Lives, Friskies, etc. This list can also be found in www.catinfo.org If you are already giving insulin and you have not transitioned to wet, low carb cat food, be sure to test while you are transitioning. This is because by changing to low carb food, it could decrease your kitty’s number by 100 points or more. One last thing, many of us add water to the wet food so your kitty is getting plenty of water to flush out the toxins and to keep them hydrated.

    Hypo Kit: Always good to be prepared for possible hypo events which means that your cat has reached dangerously low numbers. It can be fatal, hence, the importance of home testing and collecting data in a spreadsheet. In each of the Insulin Forums are stickie’s labeled Hypo Links. Here is one: How to Handle a Hypo. Please print and post on your refrigerator so everyone in your household is aware of hypo symptoms. You will want to create your hypo kit that would include and not limited to; extra testing strips, honey/karo/maple syrup, high carb food, medium carb food, vet information, etc.

    Ketones: Diabetic cats are susceptible to diabetic ketoacidosis (DKA). It is best to buy testing strips that will measure (if any) ketones in the urine. One brand is Ketostix which can be found at Walmart or any pharmacy. You will want to test periodically unless you continue to get high numbers, then it is suggested to test more frequently. Ketostix typically costs around $10.

    Treats: It is always nice to have treats available for your kitty especially when testing or when they decide not to eat. I like using Pure Bites. I have found it at Petsmart and other pet stores. It is freeze dried and the only ingredient is the meat i.e. chicken, duck, etc. If your cat likes it, then I would go to the dog section where it is cheaper than the cat package. It is bigger chunks but no problem in breaking it up. Another option is to use Bonita Flakes. There is a link here somewhere that has a list of low carb treats but I don't have it right now.

    Injections: Most folks here use one of these main insulins; Lantus, Levemir and Prozinc. Two hours prior to your insulin shot, you will not want your kitty to eat. Then you will test and then feed. It is best for your kitty to eat a little before your shoot. I shoot while he is eating. The reason why you do not want your kitty to eat two hours prior to your test is because food elevates BG numbers. So you do not want to dose based on a food influenced number. Here is a link on how to give injections.http://www.felinediabetes.com/injections.htm

    If you have any questions, please be sure to post back here.
     
  10. ELLIOTT & Fran Munschauer

    ELLIOTT & Fran Munschauer Member

    Joined:
    Jan 1, 2016
    OMG..I never expected such a welcoming from all of you. I have not read all of the links because I just got back from the DVM again, as we compared the Relion meter to the Alpha that only arrived today. Relion read 527-Alpha read 450. I bought Relion because I was not comfortable giving 1.5 u NPH with "NO" BG monitoring. I am not sure if I should reply on this thread as to "I am more confused than before". I brought in a 4 day graph of Blood Glucose levels because they are all over the place. The DVM is nice and experienced but suggested, "Stop reading". However, Elliott's BG is highest in am before feeding? 415- 527. At peak hours (6h post insulin) has been 102-230 using NPH insulin.

    BUT the issue today is THE FOOD that even confused me when DVM thought he could differentiate kcal from cal leading him to believe that Fancy Feast was the problem causing high BG..The definitions are confusing, so I called Purina researchers to ask if Classic Fancy Feast low carb was the cause of the high BG and to verify that Kcal and cal with regard to "food" were equal. The expert could not attest to Fancy Feast because it has not been tested for use in diabetic cats. They do attest to D/M because it has been tested? I did not know that Purina made a prescription diet food. However, if the data is correct about FF, the carbs are low and protein is high. My DVM states that his M/D prescription food would have 60% less carbs? But he also expressed some confusion over kcals. In the end, DVM said, If I am to continue to use Classic FF, I must increase NPH to 2.0 u. I guess the confusion for me is how much lower than 0-3 % in carbs can you get? And what has Purina done to label D/M better than Classsic Fancy Feast or their Friskies? I hate spending money but for my animal family, the cost is necessary. I paid $8700.00 for 8 dogs' TEETH CLEANING. I was sick and shocked since I had anticipated no more than $3,000.00..but what could I do? I was told, "We have a "real" dentist now who is very thorough." I am going now to read all of the links you all have provided and then, research cat foods. I hate to sound cheap and will pay whatever... but the Alpha strip cost is really irritating me!! I do appreciate all of your concern and help. My dogs have had Cushings, breast CA, spinal cord surgeries, etc but for some reason the DM almost pushed me over the edge...I am sure that you are all right..In the end everything will be fine..Finally, I just received a call from my daughter, telling her of all of your responses and said, "Cat people really like their cats." She said, "No. Mom, Cat people really "LOVE" their cats."
     
  11. jayla-n-Drevon

    jayla-n-Drevon Well-Known Member

    Joined:
    Oct 11, 2015
    hi!
    lots of us use ff with success--the classics are low carb. my guy is fussy, he eats felines pride or he doesn't lol--sorry about the grammar he is laying on my other arm. i am not a fan of d/m or any science diet--i am pretty sure is higher in carb than ff others will drop in with more exact carb counts etc… your doing awesome !
     
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  12. ELLIOTT & Fran Munschauer

    ELLIOTT & Fran Munschauer Member

    Joined:
    Jan 1, 2016
    Oh my...You all have spreadsheets??? I had no idea that others took this so seriously!!! I am going to be busy today..must finish reading the links and figure out what everything stands for on spreadsheets..like +1, +2?? Hours post insulin? Also, I am used to mg re: BG...Have a great day!!!
     
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  13. jayla-n-Drevon

    jayla-n-Drevon Well-Known Member

    Joined:
    Oct 11, 2015
    the "stickys" have tons of info--the ss are great for learning your cat and how the response to a dose is as well as the advisors as they will be able to predict a pattern better to keep the kittys safe.
    yes.. we loooooove our kitts!:cat::cat:
     
  14. Critter Mom

    Critter Mom Well-Known Member

    Joined:
    Jun 16, 2014
    For spreadsheets:

    AMPS = AM preshot blood glucose level.
    PMPS = PM preshot blood glucose level.
    +1, +2, etc. = number of hours after injection.
    U = dose (in IU)

    For example, doing a daytime curve with tests every three hours, you'd fill in AMPS, U (dose), +3, +6, +9, then PMPS.

    And your daughter is spot on: we love our little ones more than words can say. :cat:



    Mogs
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    Last edited: Jan 4, 2016
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  15. Merlin

    Merlin Well-Known Member

    Joined:
    Mar 18, 2014
    How to Read a Spreadsheet

    Regarding the spreadsheet and how to read it. BJM has a great explanation which is below:


    The colored headings at the top are the ranges of glucose values. They are color-coded to clue you in as to meaning and pattern.

    Each day is 1 row. Each column stores different data for the day.

    From left to right, you enterthe Date in the first column; the AMPS (morning or AM pre-shottest) in the 2nd column and the Units i.e. the dose given in the turquoise column.

    Then, there are 11 columns labeled +1 through +11. If you test at +5 (5 hours after the shot), you enter the test number in the +5 column. If you test at +7 (7 hours after the shot), you enter the test number in the +7 columnand so on.

    Halfway across the page is the column for PMPS (evening or PM pre-shot test). To the right is another turquoise column for Units i.e. the dose given at the evening shot.

    There is second set of columns labeled +1 through +11. If you snag a before bed test at +3, you enter the test number in the +3 column. It is suggested that you test before you go to bed to ensure your kitty is safe for the night.

    We separate day and night numbers like that because many cats go lower at night and we want to see the pattern.

    The nadir (mid-cycle or somewhere usually between +5 and +7) is the lowest glucose between shots. There is a general period when it will happen which is specific to the insulin being used and testing then helps make sure your cat doesn't go too low. Some insulins like Novolin, Caninsulin and Vetsulin nadir may be at +4.
     
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  16. MrWorfMen's Mom

    MrWorfMen's Mom Well-Known Member

    Joined:
    Feb 18, 2015
    Oh Wow. Where to begin?!!

    Veterinarians get little in the way of nutritional training and what they do get is largely provided through the manufacturers of the Rx diets like Hills, Purina, & Royal Canin so take it easy on your vet. While I'm sure there are some situations where Rx foods are a good choice, feline diabetes is not one of them. Your DVM obviously has been taught well by Hills given his comment that "his M/D food would have 60% less carbs than FF". The M/D dry food if memory serves is somewhere around 18% carbs. I'm not sure what the canned food carb load is, but I seriously doubt it's 60% less carbs than FF which is pretty low!

    Calling Purina will get you in touch with call centre employees with little or more likely, no nutritional training, using canned scripts. One of our members called and asked for the medical designation of the employee she was speaking with and was told this straight out. Their job is to promote their prescription diets and legally they cannot tell you FF is ideal for diabetic cats because they have never tested it and cannot market it as such. That does not mean it's not a good diet for diabetic cats. It means they want you to buy their expensive Rx diets so they make more money!

    FF Classics (pate style) is low carb, high protein. Some of the other FF like Grilled or Gravy Lover is higher carb so you want to stick with the pates. There are many other foods available but FF tends to be amongst the most economical along with Friskies. If you go back up to message #4 in this thread, Bobbie provided you with links to food information much of which comes from a veterinarian.

    So if the vet thinks Elliott needs 1u of insulin if he eats the Rx food, there is absolutely no reason to increase the dose because of a diet of FF. It's quite possible that FF could bring about a lowering of Elliott's BG and he might need less than 1u.

    Are you sure the readings were not the other way around i.e Alpha 527 - Relion 450? The reason I ask is because the pet meters typically read higher than human meters. The reference numbers provided on this site are all based on human meter readings unless specifically stated otherwise. Pick one meter and use it for your daily testing because comparing the readings from the two types of meters will only serve to confuse and frustrate you as there is no linear or % difference that is easily calculated and meter variance allowances in both types just add to the confusion. The AT strips are expensive and the human meter will work just fine. Just make sure your vet knows which meter you are using to avoid any confusion.

    YES we cat people REALLY LOVE our cats! :)
     
  17. Squeaky and KT (GA)

    Squeaky and KT (GA) Well-Known Member

    Joined:
    Jul 19, 2011
    Oh Fran...this made me laugh like a kid. Yep we have spreadsheets and it's the best tool in my toolbox after the meter/strips and karo syrup... :) If we start overwhelming you, holler STOP! We don't mean to...
     
  18. Elizabeth and Bertie

    Elizabeth and Bertie Well-Known Member

    Joined:
    Sep 6, 2010
    Ha-ha!

    Actually not all of us have spreadsheets, Fran. :rolleyes:
    I stopped keeping a written record of my cats BG readings years ago (he's been diabetic almost 9 years).

    And some people never start keeping a spreadsheet. It's not everyone's 'cup of tea'. People's degree of involvement in their cat's diabetes varies a lot. And there are lots of reasons for that.

    But for those folks that homestest (and not everyone does that either) a spreadsheet is an immensely helpful tool. It can enable you (or those helping you) to see how the insulin dose is working; to spot patterns and trends; and to spot if the kitty is going into 'remission'. Quite a few diabetic kitties go into remission (ie. they recover enough pancreatic function to be able to have their diabetes diet-controlled, temporarily or permanently). :)

    Eliz
     
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  19. ELLIOTT & Fran Munschauer

    ELLIOTT & Fran Munschauer Member

    Joined:
    Jan 1, 2016
    WOW....lots of info...I keep a graph but Geez..you are all experts. I worry about calling the DVM again this AM but may..to ask..if Elliott is on NPH because it's cheaper and are we giving it every 12 h. because it's easier? My concern is Alpha Track this am=538 (Relion=483) and received NPH 2 u last night (12 hours ago) after eating a little 3.5 oz FF Classic. Maybe this is okay., since last peak BG lower= 236( AT) 173 (Relion)..I was told that if I "must"...to buy the One Touch Micro until the Alpha track came in but could not find it. Maybe it takes a few weeks to get things under control? However, The high AM BG concerns me and should I be surprised since NPH is not a long acting insulin? Maybe it does not matter? I just don't know...BTW, I shaved area to prevent giving insulin in fur. Elliott is 14.8 lbs and is getting only 2 little cans of Classic FF
     
  20. Squeaky and KT (GA)

    Squeaky and KT (GA) Well-Known Member

    Joined:
    Jul 19, 2011
    Hi Fran! 'NPH' insulin (mfg'd as brands: Humulin and Novolin) ....this insulin works all at one time then is finished it's cycle. Some cats do fine on the NPH insulins but many dive steeply then 'bounce' because liver panicks and releases extra counter-regulatory hormones to compensate. It usually doesn't last 12 hours BUT for some, again - it works fine. Yes it takes time to get things under control - they don't become diabetic overnight, they don't get regulated overnight. Remember, his body is used to those higher numbers, numbers closer to 'normal' will cause Mr. Liver to bring cake to the party. :)

    I think your Relion meter is doing just fine...just my opinion but you're seeing close enough numbers between the 2 meters.
     
  21. Critter Mom

    Critter Mom Well-Known Member

    Joined:
    Jun 16, 2014
    This just cracked me up! :D

    Saoirse and I have been having a crummy day. Thank you, Lyresa, for cheering me up a bit: hopefully the effect will rub off a bit on my darling girl.
    :bighug:


    Mogs
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  22. ELLIOTT & Fran Munschauer

    ELLIOTT & Fran Munschauer Member

    Joined:
    Jan 1, 2016
    Thanks for the support. I am testing three strips each time on same drop of blood. 2 from Relion and 1 from Alpha track..The "peak" read 50, 80 from Relion and 89 from Alpha Track..and then back to 450, 528, Hi, 440,538 in am and pm. DVM seems to care most about hypoglycemia, not the hyperglycemia..maybe will go get One touch micro and check all three. What's a shame is that the 50 reading was right before the 80 reading on Relion but opened two new bottles using one from each. Trusting these results is difficult and my poor cat!!! Are most using Lantus and does it really need to be discarded after one month? I just don't want to kill my poor cat!!! I just don't know what to do..Elliott will go for testing again next week serial + Fructosamine level.DVM did not seem very concerned over high BG...I really am impressed at the expert care you all provide to your loved ones!!!! Again..Thanks for your support!!!
     
  23. Critter Mom

    Critter Mom Well-Known Member

    Joined:
    Jun 16, 2014
    Provided it is refrigerated properly (stored in the body of the fridge, not the door) it should last much longer than a month. Some members here have got 6 months out of a cartridge.


    Mogs
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  24. Deb & Wink

    Deb & Wink Well-Known Member

    Joined:
    Jan 31, 2013
    The reason for the one month limit on Lantus, is because the manufacturer, never tested the product beyond one month. Not required to by law, so they didn't.

    Yes, many of us here have used the Lantus, either the large 10 mL vial or the smaller 3 mL pen, for much longer than 30 days. Watch for any cloudiness or particles in the lantus indicating that that the vial/pen is contaminated and should be tossed.
     
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  25. ELLIOTT & Fran Munschauer

    ELLIOTT & Fran Munschauer Member

    Joined:
    Jan 1, 2016
    Is it time for me to go to the diabetes forum? I do not want to wear out your lovely welcome....I AM EXHAUSTED AND VERY DISCOURAGED..Maybe it's just ME!!! But I am at the "Nobody can/will help me " stage..I started manually inserting information in "a diary" type log and nothing is in order..no graph pops up.. I saw your spread sheets believing you are using AlphaTrak or similar. Mainly, I wanted it to show you all Elliott's BG pattern on NPH..because it's awful but after 2 hours of everything not in order, I stopped and started reading about NPH, resistance to insulin, diet, stress, PZI, Lantus, etc. ARE ANY OF YOUR CATS ON NPH insulin? Are there any charts showing the BG curve of cats or a cat receiving NPH 2 u q 12 hours? After 7 days, should there be no normal BG in am or pm? I read that the longer a cat's BG remains above the "norm", the more damage occurs that prevents the pancreas (I of L) from ever producing insulin again. Of course, I realize that insulin might never be produced again anyway, but still...Poor Elliott is receiving only 2- 3 oz cans of FF classic/day=180 cal and he is 14.8 lbs. And so, I tested controls that allow variance of 100-185...and his twin brother whose BG= 60..I snuck him 1/4 c. dry kibble.They have always eaten together out of the same plate, but since dx, I sit and watch them both eat a 3 0z can. I think they are receiving 1/2 the food needed for a 14 + 20 lb cat. And so, thinking I am doing everything correctly and following orders to increase his NPH q 12 h. from 1.5 to 2.0 u (4 days ago)..I get the following: 538, 174, 490, 379, 89, 449, 545, 195, 104 or 195 (using alphatrak strips from 2 new bottles)549, 123, 409. Relion are all 30-50 pts lower. All low BG are at 1-2 pm. Insulin is administered approx at 7am and 7 pm. That is why I am wondering if the NPH cannot work long enough to keep BG down for 12 hours. I am sorry for burdening you all. I do so appreciate all of your calm and suggestions. Can anyone tell me that this is all normal and that cats are hard to regulate but in a month or two, his BG will be WNL or sort of WNL using his present Insulin protocol? I am going to take a picture of him since the avatar was when he was his usual fat self that I do so wish I hadn't let happen. I just do not/ did not know anything about cats and what to expect. My good friend who is a cat lover has bragged for year that her cats weigh about 30 lbs.for years...and..they look it. I am going to try to find some info on BG in cats on NPH..You are really great people!!! P.S. I even watched the basic video by Alphatrak and learned that the BG concentration in cats whole blood so different from humans and then I read THIS:http://animaldiabetes.com/faq.......It has your pawprint? I think. One contradicts the other and i had no idea that the "strip " has membranes that separate the plasma. It should say on the bottle if it has been "Plasma corrected " as most are, acc to another article listing Bayer, etc as most accurate. On the other hand last article does not mention the plasma difference in humans, cats, dogs...I am in way over my head..Maybe DVM was right, "Stop reading" Good night nicest (cat) people!!!
     
  26. ELLIOTT & Fran Munschauer

    ELLIOTT & Fran Munschauer Member

    Joined:
    Jan 1, 2016
    Thanks for all the clarification..I have calmed down a little and starting the spreadsheet as directed but needed to review all of cat peoples' explanations, like amps, first!!! I will probably be up all night!!!
     
  27. ELLIOTT & Fran Munschauer

    ELLIOTT & Fran Munschauer Member

    Joined:
    Jan 1, 2016
    Oh boy....I tested right before each meal and insulin and then at peak. 9pm BG 230, NPH 1.5u with meal..Then 12 hours later(+12). I test 9am = AMPS 302 and then 5-6 h later at NPH peak so +5 or +6..??
     
  28. MrWorfMen's Mom

    MrWorfMen's Mom Well-Known Member

    Joined:
    Feb 18, 2015
    I have no experience with NPH but I do believe there are folks here who have used it or still do. I believe it is an in and out type of insulin which in many cases does not last a full 12 hours in cats but some cats do just fine with it. Like humans, one insulin does not fit all. It would be a good idea to start a new thread in the Feline Health Main Forum with a title indicating you need assistance for NPH insulin to get more eyes on your situation from folks familiar with that insulin. Getting the spreadsheet started will allow folks here to see what is going on with Elliott and provide them some data to be able to give you their thoughts.

    The link you have provided (animaldiabetes.com) re: the pet meter is not for the Alphatrak meter. It is for another pet meter called Glucopet. I do not know of anyone on the board using that meter but there could be some. There are however a number of folks, myself included using the Alphatrak although the majority of members use human meters. The type of meter you use is your choice. You can get the help you need no matter which meter you use. Just keep in mind that all the reference numbers on this site are based on human meter readings unless specifically stated otherwise. There is a specific spreadsheet for use by members using a pet meter (Alphatrak) but the only difference between the spreadsheets is in how the low range of numbers are broken down because the low numbers are the really critical ones that require immediate attention.

    Cat blood composition is different from that of humans which is why pet meters programmed to read cat blood, read higher than a human meter reading cat blood. Good background info to know but not critical to the care of your cat. You really just need to decide what meter you are going to use and stick with it.

    As for whether you should be seeing some normal readings after a week of insulin...... well, the majority of folks don't see a normal reading in that short a timeframe. Getting a cat regulated is a marathon not a sprint. Sometimes it happens very quickly, but the majority have to work at it for a bit. So yes, what you are experiencing is pretty normal.

    Take a deep breath and keep taking deep breaths. You are putting so much pressure on yourself to learn everything in a few days and it just isn't possible. We all learned to deal with our cats step by step and most, if not all of us are still learning, because like every living organism, each cat is a unique individual and a great many of them have not read the rule book and don't always follow the rules! :bookworm::)
     
  29. ELLIOTT & Fran Munschauer

    ELLIOTT & Fran Munschauer Member

    Joined:
    Jan 1, 2016
    Thank you Mr WorfMen'sMom..I received and am using Alphatrak but also compare it to Relion, which is 30-80 pts lower than AlphaTrak except at Low results only 5-10 pt difference. I thought that I would find a study or graph of various insulin effects on BG in cats,or dogs.I may look at the Bayer to see if they all separate the plasma from whole blood. Alpha Trak DVD was useful re: Blood comp of human vs dog vs cat!! Readings make more sense after viewing it. However, my gut tells me that the NPH (in addition to ME) are the problems. If you and others wouldn't mind..Will you please review Elliott's BG levels on his spreadsheet? I was unable to chart 12+ hours after insulin. I always feel a little less apprehensive after reading all of your Cat Peoples' posts...
    POOR ELLIOTT'S DIABETES SPREAD SHEET ??https://docs.google.com/spreadsheets/d/1l08kgX9WSiJEenVlq2rAeC4FxEqoeAUlnBPqganucis/edit?usp=sharing
     
  30. Julia Rae

    Julia Rae Well-Known Member

    Joined:
    Jun 11, 2015
    Hugs, you will never wear us out trust me there is almost always someone on the board 25/7. I have used Novolin N and found it far too harsh for my sugar kitty and switched to lantus. My advise it to test frequently min would be before injection then every 2 hrs until you know how the insulin will work with your cat. As well as a hypo kit with High carb emergency food, med carb on top of the honey, caro syrup or maple syrup. Do not for get to take care of your self as well many hugs and welcome to the sugar dance. May your steps be fast and your hart light.
     
  31. Jeanne & Dottie

    Jeanne & Dottie Member

    Joined:
    Jan 9, 2016
    My cat Dottie and I are new here, too. We're passing out hugs. (((you)))
     
  32. ELLIOTT & Fran Munschauer

    ELLIOTT & Fran Munschauer Member

    Joined:
    Jan 1, 2016
    BTW, I thought "we" were fine until last night and then scribbled this ..I am so worried because I live in a southern state now and no longer have access to Experts at Cornell U. I can deal with the Cushings,Breast CA, herniated discs and all of the the surgeries..but DIABETES??? Elliott's DVM is great here, but not knowing anyone "really" leaves me feeling helpless to help Elliott....
    "I AM EXHAUSTED AND VERY DISCOURAGED..Maybe it's just ME!!! But I am at the "Nobody can/will help me " stage..I started manually inserting information in "a diary" type log and nothing is in order..no graph pops up.. I saw your spread sheets believing you are using AlphaTrak or similar. Mainly, I wanted it to show you all Elliott's BG pattern on NPH..because it's awful but after 2 hours of everything not in order, I stopped and started reading about NPH, resistance to insulin, diet, stress, PZI, Lantus, etc. ARE ANY OF YOUR CATS ON NPH insulin? Are there any charts showing the BG curve of cats or a cat receiving NPH 2 u q 12 hours? After 7 days, should there be no normal BG in am or pm? I read that the longer a cat's BG remains above the "norm", the more damage occurs that prevents the pancreas (I of L) from ever producing insulin again. Of course, I realize that insulin might never be produced again anyway, but still...Poor Elliott is receiving only 2- 3 oz cans of FF classic/day=180 cal and he is 14.8 lbs. And so, I tested controls that allow variance of 100-185...and his twin brother whose BG= 60..I snuck him 1/4 c. dry kibble.They have always eaten together out of the same plate, but since dx, I sit and watch them both eat a 3 0z can. I think they are receiving 1/2 the food needed for a 14 + 20 lb cat. And so, thinking I am doing everything correctly and following orders to increase his NPH q 12 h. from 1.5 to 2.0 u (4 days ago)..I get the following: 538, 174, 490, 379, 89, 449, 545, 195, 104 or 195 (using alphatrak strips from 2 new bottles)549, 123, 409. Relion are all 30-50 pts lower. All low BG are at 1-2 pm. Insulin is administered approx at 7am and 7 pm. That is why I am wondering if the NPH cannot work long enough to keep BG down for 12 hours. I am sorry for burdening you all. I do so appreciate all of your calm and suggestions. Can anyone tell me that this is all normal and that cats are hard to regulate but in a month or two, his BG will be WNL or sort of WNL using his present Insulin protocol? I am going to take a picture of him since the avatar was when he was his usual fat self that I do so wish I hadn't let happen. I just do not/ did not know anything about cats and what to expect. My good friend who is a cat lover has bragged for year that her cats weigh about 30 lbs.for years...and..they look it. I am going to try to find some info on BG in cats on NPH..You are really great people!!! P.S. I even watched the basic video by Alphatrak and learned that the BG concentration in cats whole blood so different from humans and then I read THIS:http://animaldiabetes.com/faq.......It has your pawprint? I think. One contradicts the other and i had no idea that the "strip " has membranes that separate the plasma. It should say on the bottle if it has been "Plasma corrected " as most are, acc to another article listing Bayer, etc as most accurate. On the other hand last article does not mention the plasma difference in humans, cats, dogs...I am in way over my head..Maybe DVM was right, "Stop reading" Good night nicest (cat) people!!!" Poor Elliott's Diabetes Spreadsheet:
     
  33. ELLIOTT & Fran Munschauer

    ELLIOTT & Fran Munschauer Member

    Joined:
    Jan 1, 2016
    I have read your very enlightening suggested articles only to find many many more articles and posts and spreadsheets that are everywhere on this site, that I really need to read. Because you listed some insulins, I started to notice a wide variety listed when I started on the health page; all sorts of names vetsolin? H????PTZ or Protamine Zinc and more..I thought I read somewhere that the best insulin closest to that of a cat is not manufactured anymore..Maybe I am getting mixed up. Of course, I won't change anything without DVM authorization. I have chemsticks tnat measure 10
     
  34. ELLIOTT & Fran Munschauer

    ELLIOTT & Fran Munschauer Member

    Joined:
    Jan 1, 2016
     
  35. Squeaky and KT (GA)

    Squeaky and KT (GA) Well-Known Member

    Joined:
    Jul 19, 2011
    FRAN! Slow down! BREATHE! Sit down and have a cup of coffee/tea/chocolate/wine just for FRAN!

    Yes there are several different kinds of insulin that work different ways. The ones most commonly used for cats are
    * NPH (Humulin and Novolin are manufacturers)
    * Vetsulin/Cannisulin
    * ProZinc
    * Lantus
    * Levemir

    Insulin is a hormone, not a chemical medicine like a thyroid supplement, pain med, etc. It will never be 'find the right dose and numbers will be perfect' thing. Many things affect the blood glucose levels - excitement, carbs, squirrel/bird/dog outside window, trip to vet, visitors, not feeling well. With the food - even tho' you feed what's supposed to be...say 5% carbs...one can may be 3% while another can is 7% due to the way things are 'mixed/not mixed' when making the food. Those will cause variances in numbers.

    DON'T give up on YOU! This is confusing but let me give you a bit of advice - most people seem to have to get to the I'M SO CONFUSED stage before suddenly the light dawns and it starts making sense. You're almost there!!!!! That light at the end of the tunnel isn't another train! :)

    BREATHE AGAIN! Now have another one of those 'cuppa's' for you.... :)

    BIG HUGS too...
     
  36. Bobbie And Bubba

    Bobbie And Bubba Well-Known Member

    Joined:
    Jun 15, 2015
    Hey Fran, I am going to tag @Squalliesmom as she uses Vetsulin and maybe can enlighten you. Although, I do believe she might be switching insulin because of it shortness in action and steep drops.

    If you need help getting the SS , please ask and someone will help you. I had to get someone to get mine up and going as I am quite tech challenged. Once that is in place it will help the peeps here to help you with dosing.

    It is all very overwhelming at first but, you will find your way (and we will help)
     
  37. Love-Paula aka Woodsywife

    Love-Paula aka Woodsywife Well-Known Member

    Joined:
    Sep 6, 2015
    Oh Fran, you sound overwhelmed. Breathe, and breathe again. You are home testing that is one major obstacle you accomplished. You are giving insulin, another accomplishment. You are working on your spreadsheet, this will help you see what is happening, another accomplishment.

    Look at all you achieved so far. You are doing fine. As far as feedings, is Elliott losing weight or maintaining his weight? As a reference my Smokey is a large cat. His top weight was 22-25 lbs. When I got him he was barely 12 lbs. We are maintaining 16-17 lbs looking good now on 10 ounces of food a day split into 6-8 feedings.

    One step at a time, it will all come together. Hang in there.;)
     
  38. Elizabeth and Bertie

    Elizabeth and Bertie Well-Known Member

    Joined:
    Sep 6, 2010
    Hi Fran,
    I'm just wondering if there are any members on the forum that live near you and could maybe chat with you (in person or on the phone) just to try to give some reassurance. Sometimes it can be helpful to talk to a 'real' person...:)
    Where exactly do you live?

    Huge reassuring (((HUGS))) to you, Fran.
    And I have absolute faith that you can do this feline diabetes thing! :bighug:

    Eliz
     
  39. Bobbie And Bubba

    Bobbie And Bubba Well-Known Member

    Joined:
    Jun 15, 2015
    PS. It might be a bit before Squalliesmom can be in touch as she has her hands full with her clowder of cats who all decided to give her issues.
     
  40. ELLIOTT & Fran Munschauer

    ELLIOTT & Fran Munschauer Member

    Joined:
    Jan 1, 2016
    You are all such caring people...I (now) live in Hattiesburg, MS 39402...lived most of my life in Buffalo, NY. I know no one here except DVM and MD's that I see. We are preparing our home to move to Fla. this-next year. Nothing against MS..but We feed the cats running wild and poor dogs and squirrels and Racoons daily. My 2 cats have never been outside. One neighbor shoots them (he claims)...Also, what worries me is that I never anticipated an $8700.00 bill for 7/8 dogs' teeth cleaning, I paid it but did ask "WHAT?" Now, I wonder if he is doing less worried that I won't come and have all 10 pet members cared for. In addition, after getting into the DVM website, I read study #1- Newer glucometers have a membrane that separates the plasma from the RBC's that would adjust the results. However, #2 article does not mention this and discusses how newer meters should read "Plasma corrected" or Whole blood. Both meters list "Whole blood. I ran out of A.T and using Relion (40-80 pts lower)again until Bayer meter arrives and Alpha Trak strips can be purchased online. I am counting on his behavior as an important value. That was another symptom that worried me..He let me pick him up which he never does and is back to running from me. Elliott was 20 lbs. When diagnosed he was 14.8 lbs. I noticed that his brother was looking a lot bigger and the solid urine hunks in litter pan were "huge". I hope everything will be okay. I read that these very high BG cause damage to I of L (Pancreas) every single time it is high. A Fancy Feast expert told me that he should be getting 4-5 cans/ day if 3 oz. I am feeding him one 3 oz in am and one in pm and his blood sugar with AT is still 4-500 unless at peak insulin time or using Relion. I am drinking one diet coke after another..as usual..Thanks for all the encouragement!!
     
  41. Sharon14

    Sharon14 Well-Known Member

    Joined:
    Aug 16, 2015
    Hi Fran. I live in Picayune, just down the road from you. I don't know anything about NPH insulin, so can't help with dosing advice, but I'd be glad to talk with you if you think I could be any help. One thing that would help is for you to set up a spreadsheet. That way people who are knowledgeable can help with dosing. They will also then be able to tell you if the NPH is working or if a change to another insulin would be best. If you have trouble setting it up just ask and someone will help. Also you should choose one meter and stick to it. Don't compare numbers from different meters it'll drive you crazy! Take only one test at a time and only take a second if the number seems out of the norm, or is low.
     
  42. Julia & Bandit

    Julia & Bandit Well-Known Member

    Joined:
    Dec 28, 2009
    Hello from Ithaca, NY! Bandit goes to Cornell, so I'd be more than happy to share with you their treatment recommendations! The good news is that they match many of the treatment recommendations here. The three main steps to successful treatment are 1. low carb, canned diet (any low carb, commercial diet will do-just find something that is less than 10% carbs here), 2. a slow-acting insulin like Lantus or Levemir, and 3. dose adjustments via home testing and the recommended Lantus protocol (which the members of our Lantus forum are very experienced with).

    The spreadsheet is an incredibly useful tool, so I would strongly recommend setting one up as soon as you're able! I share mine with Bandit's vet, and he'll email me with comments or dosing suggestions if he sees something he wants to talk about. It's great for dosing discussions in between visits.

    Most here are not on NPH, as it's not one of the recommended insulins for cats. Lantus and Levemir have the best results in cats, but Prozinc is also an ok choice. Unfortunately, NPH doesn't have a long enough duration of action for cats. Cats' metabolisms are twice as fast as peoples' or dogs', which is why they need the slow-acting, 24 hour insulins.

    That said, if you've already picked up and started on NPH, you might as well give it a go! There are a few cats it has worked with, in combination with diet change. I would try it for a month or so and see what sort of results you have. If you're not getting good control after 4-6 weeks, then I would strongly urge your vet to write you a script for one of the recommended insulins. We can provide studies and guidelines for you to bring your vet if you need them to help convince him/her to make the change. Lantus is very pricy in the US, but if you order from Canada the cost is much better. If you get a pack of 5 pens, it's about $175, but with proper handling they'll last you a year or more. That is the same, if not cheaper than what you're paying for the NPH, and the insulin is more effective so you'll likely see better results.

    Good luck!
     
    Critter Mom likes this.
  43. ELLIOTT & Fran Munschauer

    ELLIOTT & Fran Munschauer Member

    Joined:
    Jan 1, 2016
    Poor Elliott's Diabetes spreadsheet: https://docs.google.com/spreadsheet...xEqoeAUlnBPqganucis/edit#gid=361360320......I appreciate your offer. The NPH is worrying since I do have an understanding of various insulin on humans..NOT ON CATS. Maybe I am focusing too much on the inconsistent claims of DVM's and workings of the various meters., i.e. manufacturers or DVM's claiming potential facts. As far as the type of insulin, I have read only 1 person's use of NPH..so your point is well taken. I will take this up with my DVM after completing a serial q 2h. BG curve. Unfortunately, I believe that being a medical legal professional may be hindering my focus on Elliott. After reading, researching and calling most manufacturers and hearing the "claims" by manufacturers of meters, by manufacturers and DVM's "claims"on the appropriate pet foods, etc. my (legal) nerves became quite concerned. It seems that "cat people" figured out long ago what I am just starting to (sort of) learn. I would like to learn more about the following :"If you get a pack of 5 pens, it's about $175, but with proper handling they'll last you a year or more. That is the same, if not cheaper than what you're paying for the NPH, and the insulin is more effective so you'll likely see better results." Again, Thank You. The information provided by all of you is worth more to me than you will ever know!!!
     
  44. ELLIOTT & Fran Munschauer

    ELLIOTT & Fran Munschauer Member

    Joined:
    Jan 1, 2016
    OMG..I loved Cornell. They were involved with a shunt for my Hydrocephalic pup, my 3 Cushings disease and herniated disc dogs..but then I moved. I have just read your post. All of the "cat people" seem to be encouraging and following exactly what you have stated. I posted a spreadsheet, that,to me, looks "awful". I posted it on the medical part of your site and hoped for an honest evaluation on what to do if anyone has the time. I know that all of you have your hands full with your own loved one's....Thanks much!!! https://docs.google.com/spreadsheet...2rAeC4FxEqoeAUlnBPqganucis/edit#gid=361360320
     
  45. MrWorfMen's Mom

    MrWorfMen's Mom Well-Known Member

    Joined:
    Feb 18, 2015
    Fran, I just took a quick peek at Elliott's spreadsheet and noticed a reading of 42 at +6 today. If that reading was taken with the AlphaTrak meter as indicated on the spreadsheet, it's too low! Depending on what method you are using (either Tight Regulation aka TR or Start Low Go Slow aka SLGS) you don't want his numbers any lower than 68 on a pet meter using TR and about 90 if following SLGS. It doesn't look like you got another reading after the 42 so I hope all is well. I would strongly recommend you print out this document and keep it handy in case you have to handle any further low numbers.

    I am not familiar with NPH insulin so I cannot give you any dosing advice however, I would strongly suggest you get some dosing advice before shooting tonight. I'm thinking a dose reduction may be needed given that low drop today. If you have already given Elliott his shot, then please note that you need to make sure he does not go that low again tonight and you need to check him at +2 or +3 to see where his numbers are going and be prepared to intervene with food if he is dropping too fast.

    Last but not least, I would suggest you start a new thread with the "?" prefix asking for dosing advice to get some folks with NPH experience to assist. And should you get another low reading tonight, post with a "911" prefix to get some assistance.
     
  46. ELLIOTT & Fran Munschauer

    ELLIOTT & Fran Munschauer Member

    Joined:
    Jan 1, 2016
    Thanks for looking at my spreadsheet. I am awaiting more Alphatrak strips that will arrive tomorrow. I think it's posted= the lower readings with Relion and Bayer for past few days. Bayer was 31. I immediately gave Elliott a snack of kibble (not karo) and watched him closely even though I "thought" AlphaTrak might have been higher since it always is. Because he was not lethargic, I had trouble deciding to give him fast acting Karo? and so, I gave him 1/2 cup of Iams dry hairball cat food. The tonight's PMPS was 384 with Relion and 331 with Bayer..Again, probably much higher (unfortunately) with AlphaTrak. Also, I am purchasing 5 vials of Lantus from one of your well know members, that expires 2/2018. Another change (of course directed by my DVM when I call him tomorrow) that will probably throw me(hopefully not Elliott) over the edge again, so I do hope that I can ask for help appropriately , as you suggested. I suppose it will be like starting from scratch with all times, etc changing again.There are very few people (if any) still on NPH..and so, I was about to call DVM and purchase Lantus anyway. What a surprise to see that one of your members was selling hers. I surely hope her cat is in remission. BTW..I don't know anything about TR and SLGS. The DVM changed Elliott from 1.5 to 2 u upon d/c from hospital because I told him that he would eat only Classic Fancy Feast. I do not change anything (if that is TR) other than the snack (not yet needing karo, I didn't think) given due to the questionable BG results today. I haven't but should and will print the SS out right now...Thanks for the advice!!!!!!!!!!!!!
     
  47. Sharon14

    Sharon14 Well-Known Member

    Joined:
    Aug 16, 2015
    Glad Elliot's ok from his low number yesterday. Do start a new thread on Health as Linda suggested. It looks like the NPH is taking him down, but maybe doesn't last long enough, so a change to Lantus may be a good thing. More people will see you post on Health and be able to help you. Also if you'll fill out your signature with important info such as name, date of diagnosis, food, insulin and also link your spreadsheet that will help everyone to see your history at a glance and make it easier for them to help you.
     
  48. MrWorfMen's Mom

    MrWorfMen's Mom Well-Known Member

    Joined:
    Feb 18, 2015
    Fran, I'm so glad you successfully intervened when you got that reading of 42. Dry food takes longer to boost the BG so if Elliott will eat it, canned food is a better choice when low numbers occur. If a low number like that shows up again, it is important to get a couple of readings with rising BG numbers before letting your guard down.

    I strongly recommend you choose a meter and stick with it. Even 2 human meters will not read exactly the same! Not only is it confusing for you to see the differences in the numbers on pet vs. human meters, but it also makes it difficult if not impossible for anyone here trying to help you, to know exactly what is going on if some readings on your spreadsheet are from a pet meter and some from a human meter because of the scale difference. The reading of 42 is low on a human meter too, just more so on a pet meter and even folks following Tight Regulation would be monitoring that low a reading.

    We generally recommend a starting dose of 1u twice daily with Lantus. It is a depot insulin so it's action is much slower and flatter. It's easier to increase the dose slowly based on BG readings than it is to try to back up the dose if it's too high. Sometimes too much insulin can look like too little so starting off at a lower dose and working up is the best way to go.

    So that everyone here has access to your spreadsheet, you can add it to your signature. Go up the right top of your screen and click on your screen name. Then select "signature" from the menu list on the left side of the drop down box. This will bring up a box where you can type in details such as your name, location, details about Elliott such as weight, diet, meter you are using, any other health issues etc. and add a link to your spreadsheet. To add the link, you click on the paperclip like icon at the top of the input area and paste the google address for your sheet into the box that comes up. Then click on the "insert" button to complete the link. If you need any help with this, just holler.
     
  49. MrWorfMen's Mom

    MrWorfMen's Mom Well-Known Member

    Joined:
    Feb 18, 2015
    No apology necessary! Navigating the board can be a bit tricky at first! Your spreadsheet being added to your signature just makes it permanently available and you won't have to keep including the link in your messages when you want/need assistance. :)
     
  50. ELLIOTT & Fran Munschauer

    ELLIOTT & Fran Munschauer Member

    Joined:
    Jan 1, 2016
    I should have taken more readings soon and frequently after low BG. You are absolutely correct. At present, I test AC (before meal) and NPH in AM (AMPS).. at 6+ (presumed 6 hr NPH peak ) and AC and NPH in PM(PMPS)= 12 hours later.. DVM ordered NPH q 12 hours but only wanted me to check BG at NPH peak for some reason. When AT strips arrive, I planned on performing a serial q2h BG curve to see how the insulin is working. However, if I change to Lantus, maybe I should wait until starting the new insulin to spare Elliott the pain. I would ordinarily not purchase a drug from another person but she is listed as a "well known member" and am waiting for her instructions re: payment for 5 vials.

    Let me clarify more since I tend to ramble when upset and may have confused members: I was told to use the AlphaTrak meter but had to wait until 1/4 for arrival from DVM. I bought Relion+ NPH on 12/31. I used AlphaTrak upon arrival in pm of 1/4 and charted AT results.(in comments I wrote Relion results just for comparison). I ran out of AT strips on 1/10, not realizing I would have to order them. I bought Bayer on 1/11 because I worried and wanted 2 tests until arrival of more AT strips. I joined Amazon Prime to get quicker delivery of AT strips that should arrive today. I elected to use same drop of blood to compare results with human meters. In the event that I am unable to use AlphaTrak or run out of AT strips again (and out of pure curiosity ), I could assess importance of differences.
    In comments, I tried to list BG results from named meters being used. The ss was displayed ASAP as members told me how important it was.I did not know what else to do before knowing AlphaTrak and its strips would not be available until 1/4/2016 followed by not knowing I had to "order" more strips. Hopefully Elliott's SS will not be confusing to me (or member)s after today, as results will be only from AT, when I ask for help.
    I would love to follow your recommendation for starting Lantus . Oh geez..are you referring to that "somogyi" effect? Is it okay that I start a new insulin on my own? It would save me another $2,ooo since I am sure the DVM would insist I re-admit Elliott for trial of a new insulin. I am waiting for instructions from the seller of Lantus. I would not purchase a drug (hormone) from a person ordinarily but she is listed as a "well known member" on this forum and is selling 5 vials at a really low price. I was planning to purchase Lantus regardless but this seems like a great opportunity to save money. Not being familiar with Lantus insulin use on cats, I assumed that I will use 5 vials before 2/2018, especially since once opened the shelf life will decrease considerably.
    If any of the above is unacceptable or plain wrong, please advise me ASAP. I am completing the SS signature thing suggested right now..Thank you very much!!!!
     
  51. ELLIOTT & Fran Munschauer

    ELLIOTT & Fran Munschauer Member

    Joined:
    Jan 1, 2016
  52. MrWorfMen's Mom

    MrWorfMen's Mom Well-Known Member

    Joined:
    Feb 18, 2015
    Deep breathes Fran! This is not nearly so difficult as you may think. Let's just take this one step at a time.

    If you have decided to use the AphaTrak meter, use it for all readings and don't bother doing comparisons with the other meters. They will only serve to confuse you. Even two human meters do not produce exactly the same reading on the same drop of blood so sticking to one meter gives you a much better idea of how kitty is doing. While it's always a good idea to have a spare meter to use in a pinch, I would suggest you re-order the AT strips well before you anticipate needing them so you always have a good supply available.

    It's important to not focus on each individual reading you take. Readings fluctuate for all sorts of reasons so what we focus on is the pattern over time. As you collect more data you will start to get a much better picture of exactly how the insulin is working for Elliott.

    You can start the Lantus on your own. Other have done so quite safely and successfully with the guidance of the folks here. I would however strongly suggest you advice your vet that you are doing so to keep communications open. There is no need to go through another admission to start Lantus. In fact, starting insulin in the vet's office often results in too high a dose being prescribed due to the BG stress elevation cats often exhibit. Some cats will have BG numbers 100 or more points higher in the vet's office than they do at home. Starting at a low dose keeps kitty safe and avoids the "somogyi" effect because yes kitties can experience that too.

    The Lantus with an expiry date of Feb 2018 is fine. Please note that while the makers of Lantus test it for human use and give shelf life guidelines that are quite tight (28 days once open) based on human usage, we do not follow those guidelines. We keep our insulin in the fridge even after opening. By doing so, you can use up most if not all the insulin so the Lantus you are getting will last a long time but exactly how long will depend on what dose Elliott ends up needing.

    When you receive the Lantus and are ready to start, post in the Lantus/Levemir forum and get advice from people with years of experience using those insulins. They will help you make the transition and assist you with day to day questions. Lantus is a depot insulin so it is important to keep doses/dosing times consistent. There are two ways to use Lantus.....Tight Regulation ( TR documentation link ) and Start Low and Go Slow ( SLGS guidelines link ) . I would suggest you read through these documents and decide which method you are most comfortable with. Both are good but TR does require an exclusively canned food diet and a little more BG testing.

    One last note. Your vet may have suggested testing Elliott at mid cycle but the nadir (lowest reading) does not always fall at +6 hours post shot (they tend to be a bit of a moving target) and with the Vetsulin, I believe the nadir may be a little earlier (+4 or +5) so it would be advisable to catch some readings before 6 hours to see if Elliott is going too low on the Vetsulin. This would also help you intervene and steer him with food should he be dropping quickly.

    Just saw your latest note.....

    I know you started a thread the other day but Elliott had not had such a low reading then. I really think you should start another thread and call it something like "? Urgent dosing advice with NPH needed due to low reading of 42". That will get more attention and more specific help as I seriously think a dose reduction may be needed.

    I know this all seems so overwhelming right now, but I assure you, it gets much easier and you'll soon wonder why you got so wound up. And great job on the signature and linking Elliott's spreadsheet. I can see it just fine!:)
     
  53. ELLIOTT & Fran Munschauer

    ELLIOTT & Fran Munschauer Member

    Joined:
    Jan 1, 2016
    Wow..I didn't think of testing earlier than 6h..Smart idea..OMG..will do..hope it's not even lower!!!!!! Most BG are very high so will try to figure out a thread to start but it seems NO ONE USES NPH..I hope member, Julia Rae sends me instructions soon. If not I'll call DVM I guess..You are all soooo well informed..My poor cat!!!
     
  54. MrWorfMen's Mom

    MrWorfMen's Mom Well-Known Member

    Joined:
    Feb 18, 2015
    Your cat is darn lucky to have you! You are learning and caring for him and that's so much more than many sugar cats get. Even if others are not using NPH, there are folks who have used other faster acting insulins and with all the experience on this board, I'm sure someone can make a recommendation simply based on the numbers on your spreadsheet and their experience. It's better for Elliott to be a little too high than going too low. It certainly wouldn't hurt to call your vet and inform him/her of the "42" reading because you don't want a repeat of that or anything lower!

    Getting readings before the expected nadir can give you an idea of where things are going in a cycle so most of us will take readings at different times within the cycles along with our pre-shot tests. With Lantus the nadir is generally somewhere between +4 and +8 hours with many being between +5 & +7 hours post shot and dosing is based on the lowest readings taking the pre-shot numbers into consideration. Lantus, because it's a depot insulin has carry over so chances are good you will see lower numbers at pre-shot tests. If you graph readings with Vetsulin the picture that results is like a sharp "v" shape. With Lantus it tends to be more of a smile or grin shape.
     
  55. ELLIOTT & Fran Munschauer

    ELLIOTT & Fran Munschauer Member

    Joined:
    Jan 1, 2016
    OMG...I am going to start that new thread when I get my energy back...WELL!!!!!....I went to get his BG and my husband noticed the Insulin syringe on counter still with the Insulin..He was to give it this morning but guess forgot chasing Elliott to feed him before giving the Insulin.. SOOOO..we started checking BG's with Relion, Bayer, and found one AlphaTrak stuck to the empty bottle wall.(AT strips still not arrived) and looked back to today's AMPS and performed new tests .....Let's go with Relion..7am AMPS=440, NO INSULIN, 1pm=374 followed by NPH 2u,
    2pm=282..will continue q 2hours....But what does this say? Maybe I am starving him to death but still has high BG's? At 1 pm Frank found 1 Alphatrak strip stuck to the bottle inside and it read for 1pm= 525. A 14.8 lb cat (was 20 lbs) should be getting at least 280 calories/day, right? He is getting 2- 3 oz cans of FF Classic/day=160-180 cal/day...These poor cats need a better home and/or caretaker..This is a shame!!! When Alphatrak strips arrive today, i will start a "real" curve..What else could go wrong???
     
  56. MrWorfMen's Mom

    MrWorfMen's Mom Well-Known Member

    Joined:
    Feb 18, 2015
    BG readings will fluctuate throughout the day for various reasons including activity, eating, stress. Essentially though, because any meter is allowed a 20% plus or minus variance, those readings are not necessarily that much different.
    I don't think you are starving Elliott on 280 calories per day. Someone here posted a formula for calculating calories but I'll have to look for it. I've always used between 25 and 30 calories per pound. My 16 pound girl is on about 300 calories per day. I have another smaller kitty who is much more active and while I don't count his calories nearly so closely (he's not diabetic), I'm sure he easily takes in 300 calories or more per day but is not gaining weight. He likes to sample everyone else's food! We do have to monitor our cats calories but I wouldn't get hung up on formulas and calculating down to the exact calories as much as whether Elliott is always hungry or satisfied, losing weight/gaining weight as long as you are in the ballpark which you appear to be. Their appetites may be greater or less from one day to the next due to activity or feeling off so their intake may fluctuate a bit too. If Elliott is always hungry you can give him a little more food. If not, and he's not losing weight/gaining weight, then he's fine.

    Cut yourself and your husband some slack. You are new to this sugar dance and no harm was done by missing the shot this morning. I've been at this for almost a year and the other night I fell asleep watching TV and missed my girl's shot time so it was late and I had to adjust her schedule. Life happens! There is a lot to learn and no one learned it in a few weeks. No matter how dedicated you are to your furry kids, you and hubby need to have a life too. Like they say on an airplane, put your oxygen mask on first, then tend to those around you who need assistance. :)
     
  57. ELLIOTT & Fran Munschauer

    ELLIOTT & Fran Munschauer Member

    Joined:
    Jan 1, 2016
    he's only getting 160-180 cal/day. He's supposed to get at least 280 cal/day/ 20X14.8 lbs/indoor cat. I've put in a call to the DVM..still waiting for the call??? Now his BG is 71/Relion and 92/ Bayer...nothing making any sense..So, I don't know when to give next Insulin, since such a low BG at 4pm. He is not gaining wait. I am feeding him again now..
     
  58. MrWorfMen's Mom

    MrWorfMen's Mom Well-Known Member

    Joined:
    Feb 18, 2015
    Fran, feeding Elliott now is the perfect call. I misread your note about his food so yes you need to give him more calories and even though the vet probably told you to only feed him twice a day at shot time, feeding another meal in the middle of each cycle or smaller meals a little more frequently is quite all right and sometimes better for the cat.

    Right now you want to get his BG to start rising. It's only 3 hours since his shot so he may drop even lower. Only give him a little food, tbsp. or so and then retest him in 20 - 30 minutes. We don't want him getting too full such that he won't eat in case you need to get more food on board if he doesn't start rising. With the NPH, you are going to need to try to avoid numbers under 80-90 because it is fast acting and can cause sudden BG drops. Aiming for no lower than 80-90 on a meter. I realize the Bayer was reading 92 but we don't know which meter is more accurate so in this case go with the lower reading from the Relion and act accordingly. When you get another reading post it please and we'll decide what if anything you need to do next. If he continues to drop, you may need to use a little bit of karo or maple syrup. Do you have either of those in your pantry?

    I assume you gave Elliott the full 2u again. Is that correct?
     
    Last edited: Jan 14, 2016
    Reason for edit: Vetsulin changed to NPH
  59. MrWorfMen's Mom

    MrWorfMen's Mom Well-Known Member

    Joined:
    Feb 18, 2015
    Fran, have you got another reading yet? Please let me know how Elliott is doing.
     
  60. Jill & Alex (GA)

    Jill & Alex (GA) Senior Member Moderator

    Joined:
    Dec 28, 2009
    Welcome to the group!
    Now that Elliott has been introduced to the group, I think it would be a good idea to start a new thread in the Feline Health - (The Main Forum) sometime soon. You'll get more help and suggestions with what's going on over in the Health Forum.
     
  61. MrWorfMen's Mom

    MrWorfMen's Mom Well-Known Member

    Joined:
    Feb 18, 2015
    @Jill & Alex (GA) Fran was encouraged to post on Health the other day and did so but didn't get as much of a response as she had hoped so I guess she went back to this thread. Her cat had a reading of 71 on a human meter at +3 after his shot of NPH today and I am currently waiting for her to report back as to what her next reading was, so to avoid confusion, probably better she stick with this thread just now.
    Are you going to be on for a bit to watch this thread because I really need to run out for a bit but didn't want to leave her until I knew her cat was holding or rising BG wise. Her cat dropped to 42 yesterday and we encouraged her to get some advice on Health then but she gave the full 2u again today and is once again facing a potentially low number!
     
  62. MrWorfMen's Mom

    MrWorfMen's Mom Well-Known Member

    Joined:
    Feb 18, 2015
    Ok I see you got a reading of 107 at 6pm which would really be +5 hours post shot. I would get another reading at +6 just to make sure Elliott's BG is rising and if it's the same or lower, feed him a little more food. If it is substantially lower, you can post a "911" on the health forum to get more eyes on your situation.

    Just to recap....
    7am BG was 440
    1pm BG was 374 - gave 2u NPH
    2pm BG was 282
    4pm BG was 71 on Relion (92 on Bayer)
    6pm BG was 107

    So I would put your reading of 440 into your spreadsheet on the evening cycle side for 13Jan16 in the +11 column and put AMPS BG of 374 since that is when you gave the shot so we can track how far post shot Elliott is. Put your reading of 282 into the +1 column of your 14Jan16 day cycle, the 71 into the +3 day cycle column and the 107 into the +5 column. If you want to keep track of the Bayer reading, add it into the note column at the far right hand side of the spreadsheet.

    Your next shot would not be due until 12 hours later which would be 1AM your time however I'm sure you want to get back onto a proper schedule again so I'd recommend you skip tonight's shot especially when Elliott is now dropping into low numbers that need to be closely watched and then get back on schedule tomorrow.

    As I said before, it's clear that Elliott needs a reduction of his insulin dose however I am not sure how much to suggest. That is a question for your vet and if your vet does not recommend a reduction of at least .5 units, then I would definitely post here for advice. It's far better to have Elliott running a little high than dropping too low so I would definitely err on the side of caution and NOT give the 2u again. Even with a half unit reduction, I'd be monitoring to ensure he stays in safe numbers as that low of 42 yesterday may have made him a little more sensitive to the insulin.

    I have to run an errand so as I said, if you need any further assistance, please post on the Health forum and use "911" if it is urgent.
     
  63. Jill & Alex (GA)

    Jill & Alex (GA) Senior Member Moderator

    Joined:
    Dec 28, 2009
    Sorry, Linda. I logged out after posting...
     
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  64. Critter Mom

    Critter Mom Well-Known Member

    Joined:
    Jun 16, 2014
    For a 4kg cat - with no prior history of insulin treatment.

    For information, the TR guideline for Lantus starting dose is 0.25 IU Lantus per kg of either current weight, or per kg of ideal weight if the cat is overweight. There is also the qualifier that history of response to previous insulin(s) should be taken into consideration when determining the initial dose for cats who are starting on Lantus but who have previously received insulin treatment.


    Mogs
    .
     
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  65. ELLIOTT & Fran Munschauer

    ELLIOTT & Fran Munschauer Member

    Joined:
    Jan 1, 2016
    I just came back..been on phone with( advisor Nurse) daughter who simply told me what she would do on a med-surg unit with human. also had DVM tech on phone and one of your members called me . I do not understand the no +12 or +13 vs switch +1, or whatever for the charting..I think that I am very overtired..but will read MrWorfman's Mom's charting again later after I lie down for a little while. . I did not intend to overstay my welcome on the introduction page. I thought I was responding to some nice concerned member and all started again. I am so sorry to take up your precious time and I will try to start a thread to help me and transition to Lantus, when it arrives. You are all decent and level headed people. I am decent but, level headed at this time????? I hope to be able to give again..not just take from all of you..Again, I am sorry.

    7am BG was 440 (416 Bayer)
    1pm BG was 374 (340 Bayer) gave 2u NPH (1 AT strip found)- 525
    2pm BG was 282 (232 Bayer)
    4pm BG was 77 (92 on Bayer)
    6pm BG was 107 (Bayer) ran out of Relion
    8pm BG was 134 (Bayer) AlphaTrak strips just arrived-AT 170- NO insulin with dinner
    6am BG was 378 gave 2 u NPH with breakfast
    12pmBGwas 87 (Bayer 71) 1.5oz FF snack
     
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  66. Squeaky and KT (GA)

    Squeaky and KT (GA) Well-Known Member

    Joined:
    Jul 19, 2011
    Fran, BREATHE! and another one! No 'sorry's' needed! Take all you need, you'll 'give' later. We've all been on your 'take' end, it's our turn to 'give' now. Someone did all this for us when WE arrived! :)

    Breathe and REST! You're driving yourself crazy!
     
  67. MrWorfMen's Mom

    MrWorfMen's Mom Well-Known Member

    Joined:
    Feb 18, 2015
    Ditto to Lyresa's message! No apologies are needed but Fran, you do need to calm down and take this step by step. You are wrapping yourself into a pretzel and continuing to do so is not going to help you or Elliott. If you look back on what you have already accomplished it's pretty huge. You didn't know how to test Elliott or give him shots but you do now. Nurse or not, those are big hurdles you have already managed to get over. You WILL learn the ins and outs of taking excellent care of Elliott and you WILL, in the future, be able to help others but for now, give yourself some slack. Take deep breathes, get some rest and try to regroup. I promise, in a short while, you are going to wonder why you thought this was going to be so hard!:bighug:
     
  68. Jeanne & Dottie

    Jeanne & Dottie Member

    Joined:
    Jan 9, 2016
    Hang in there, Fran. Take a deep breath. You and I are in the same boat and they're helping me too. We'll both be ok once the initial YIKES part of the learning process is over. Just be sure you get enough sleep, even if you have to sleep only two hours at a time. ☺And don't you forget to eat, too!
     
  69. ELLIOTT & Fran Munschauer

    ELLIOTT & Fran Munschauer Member

    Joined:
    Jan 1, 2016
    I read your posts but neglected to see the suggested decrease in NPH, that I have been thinking about. Elliott was supposed to receive 1.5u but on release from hospital Dr Mayfield increased dose to 2u when he learned that he would be eating FF Classic instead of Prescription Diet. Today I began feeding him 1 (3oz) can FF after am BG+ NPH,,1 can (3 oz) after NPH peak/lowBG..and 1 can after pm BG +NPH=280 cal, instead of just 160 cal/day. I did this because he is so thin and starving at all times. When speaking with the DVM tech, I told her that the DVM only wanted the NPH peak BG taken (once/day) but I was not comfortable with this. I told her that in addition to a day or so of serials, I believed that at least 3/day were necessary for my comfort. SHE EXPLAINED that THEY determine Insulin needs based on the peak NPH level (your nadir result)..I did not know this. If that's the case, maybe Elliott should be on 1.5 u. due to the low NPH peak BG's. However, If the BG is 4-500 in am and pm, I guess I'm surprised that we can ignore those high results. I am just responding..I will go open another new thread in the "health" section as soon as I have the Lantus and meet with DVM Monday, since no one in health has much familiarity with NPH . I like all of you a lot..hope to see you when I start new thread. Based on what the DVM tech claims, I am trying to decide whether to give NPH 1.5 tomorrow.."The Scaredy Cat" (me) will decide tomorrow???
     
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  70. Jill & Alex (GA)

    Jill & Alex (GA) Senior Member Moderator

    Joined:
    Dec 28, 2009
    Don't worry. Every member who has responded here also posts on the Health Forum. ;)
     
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  71. Critter Mom

    Critter Mom Well-Known Member

    Joined:
    Jun 16, 2014
    Will keep an eye out for your new thread, Fran. :)


    Mogs
    .
     
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  72. MrWorfMen's Mom

    MrWorfMen's Mom Well-Known Member

    Joined:
    Feb 18, 2015
    I too will be watching for threads from you about Elliott!:):cat:
     
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  73. Sharon14

    Sharon14 Well-Known Member

    Joined:
    Aug 16, 2015
    Same here!
     
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  74. ELLIOTT & Fran Munschauer

    ELLIOTT & Fran Munschauer Member

    Joined:
    Jan 1, 2016
    BTW...WATCH FOR VIRUSES THAT REALLY SCREWS UP PC.....I went looking for a graph to plot BG and clicked on "free graph for cat glucose"..Suddenly my laptop went nuts. because it was brand new, I called HP who would only offer to return pc to factory settings that will take 4-5 hours. A FAKE blue screen with warnings and FAKE McAfee warnings popped up telling me to call support phone number but did not call it. BE CAREFUL..I'm on my old Dell..took awhile to get it ...will start thread soon..
     

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