Napa's saga

Thanks to everyone who contributes their experiences and advice here. It has been so helpful as I emerge out of denial and deal with this disease.

I made my first post in the the Lantus forum then read that intro's should be made here (very sorry). I'll post our story here (turned out to be long, sorry again) just in case any of our details would help or give comfort. The short version is that I was in denial about a lot of things, but I think the advice here has really helped me manage both the cat and my own stress. Glad I moved out of denial, wish I had done so sooner.

Cat: Napa is 13 y/o female, underweight at 7.5#. Not many past health issues except for a nasty cryptococcus infection (that was a "fun" one too).
Insulin: We are still working out the routine but Napa is now on a skinny 1.0 units of Lantus twice a day or just once depending on the BG readings.
Diet: Now just eating Soulstitic gelee wet food (3-9 % cal from carbs according to petinfo.org) and small pieces of cooked pork for a treat.

How this all started:
Napa's sister (non-biological), Nomi, has a long history of bowel issues--a big eater, always struggling with being overweight, barfing, and other stuff that goes along with bowel issues. They have always been so-called "premium" dry food eaters. We switched off chicken to duck and things were pretty good for several years. Earlier this year, however, Nomi started losing weight with very loose stools. Very shocking since this cat would vacuum up anything in sight and was perpetually plump. Vet visits ensued, declined biopsy and laprascopies, etc. Switched to fish based food (Taste of the Wild Salmon). Nomi gains weight and is fat and happy again, tho her stools are still very soft. Also started to feed some wet food, but more as treat (Soulsitic fish ones with gravy since they seemed to like that best). Nomi was also a toilet surfer so we purchased a water fountain for them.

As Nomi was recovering, I began to notice more pee in the box but didn't think much about it given the introduction of the wet food and fountain. Stupid in hindsight. And Napa started to plump up a tiny bit. This was strange because Napa has always been at perfect weight and only ate what she needed. Hmm, maybe the new food? Then in November, her weight started to drop and dropped pretty fast. So I am thinking she isn't tolerating the new food and started looking for a new fish based food (ugh, we're gonna run out of novel protein sources). I also made a vet appointment just to get her checked out. Two strange things happened before the appointment: somebody had a bad nose bleed--the walls near their beds looked like a crime scene-- and one day while sitting on my shoulder, Napa sort of passed out. I have never had a cat faint! She came too in a few minutes and seemed ok after that, but I was sure glad I had the vet appointment.

Vet visit day. Blood glucose around 450. Other things here and there off. Vet says diabetes. I say no way, could it be due to bowel issues? Vet says maybe, but try this prescription food. Napa wouldn't eat it. By this time, the only thing she would eat was the gravy food, cheapie dry food and a pork puree I made for her (she loves pork and oddly the only people food she'd eat). Start to research food. Buy Evo low carb dry. We have to go out of town for a week and ask pet sitter to try the prescription and low carb food first but give her anything she'd eat. Recheck at vet when we get home. BG still over 400. Vet says insulin 1 unit twice a day. I say ugh...how about conservative first at 0.5 per day. OK. Vet prescribes Lantus says it is the best, says it expires in a month but many people keep using it longer. Pharmacy says give us $300. Ok. Vet says bring her back in a week for a day-long visit to check response over the day. Had to learn to inject. Umm, how are you supposed draw 0.5 into this syringe?? I know I missed a few shots and only hit fur. Back to the vet in a week and ask tech if we should take a full draw to redo tests. I think I also asked about ketones. Vet then says we'll do fructosaime and not the spend the day. Grrrr mixed messages. Also, blood glucose is over 400. Vet says go up to 1.0 unit twice a day. I asked if pancreas tests would be helpful. Vet busy and distracted. Sure $250, ouch. Fructosaime came back as "fair control". Pancreas profile had several abnormalities but nothing specific for a differential diagnosis. Ask butcher if they sell pancreas tissue. No, try a Chinese market. Still on my to-do list.

Ugh, diabetes, really? I start doing more research and thankfully found this place (and have since recommended it others)! Ok, time to get out of the denial phase.

I read the STRONG recommendations here (and naturally like data), so went to buy a meter. Pharmacy says give me $15 but you also have to buy strips so give me $45 more. Learning to test was stressful and hard, especially at first but it is getting easier--just like everyone here has said it would. If you're getting started don't be a noob like me a shortcut the warming step. Finally get a reading! Test Nomi just for fun and practice (56?! isn't that low, ugh). Tested me 91 . Got a few more Napa readings over the next few days--all over the place 475, 40-something (yikes!). Read this forum some more. Learned the lingo (AMPS, huh?) and how to approach testing more systematically. Injecting insulin like a pro now. Got some pretty good meter data for 2 days. BG mostly between 100-200. Had readings under 150 at PMPS time and withheld insulin. AMPS in low 300s on the mornings after skipped nighttime doses. Napa's ears look terrible. And she gives me dirty looks. Got an iPhone app to track numbers. Want to use the spreadsheet template here but dislike Google apps. Still thinking about it.

Was also in denial about food--but, but Evo dry is a low carb food, right?! Again, listening to advice from the good folks here I'm taking her off even the small amount of low carb dry food and her favorite (probably high carb) treats she's been eating.

Issues we are still sorting out:

1. How much food. Since upping her dose she is *constantly* crying for food, something she has never done before. I was trying to not overfeed her so her BG wouldn't get so high and also to give her a set amount so I could try to understand the BG numbers better. Dropped in on the vet this am for a weight check. No weight gain :-( Vet was between appointments and we had a good long chat about Napa course, yay. Does more food mean more insulin? Vet said no, said to feed her as much as she wanted but keeping checking numbers.

2. How much testing. I want to give her ears a break from all that testing (still 2-3 pokes to get blood each time; paws didn't work out any better, and those dirty looks), but feel like I need to know the PMPS every night so I know if I should give her insulin. And then want to know the AMPS in both cases (skipped and given night time doses). I like the recommendation of AMPS + PMPS and a midpoint or two. Just want to do those in ways I can get the best information and minimize the stress. Also, just read the that TRUE meters could be suspect. Need to do more research; might need to replace.

3. How much insulin. Since she has been under 150 twice (that I know of) at the time she is due for her next shot, 1.0 might be too much. I was giving a kinda fat 1.0 where I could see a tiny bit of daylight over the 1 mark. Now I try to carefully back it down where I don't see the line. (What a pain these syringes are!) But since she seems to be mostly well over 100 during the and over 300 with skipped dose, maybe 1.0 isn't too much. Should probably keep checking for that nadir.

4. Litter box. Better, but still too much pee. Switch to Worlds Best Litter (think that is what it's called). On the positive side, Nomi's stools have really firmed up with the wet food and now I know its better for her, too.

Well, OMG I can't believe I typed all this out, but it was nice to be able to vent. I can't believe anyone would read all this lol but hope it adds to the volume of shared experiences here in a positive way.

 

Hello and welcome to the FDMB and sharing your journey with Napa with us. Would you share your first name with us?

I'm Deb and that tuxedo pictured on the right is my sugardude Wink.

I thought Napa was a place in California and D-Nile was a river in Egypt? :lol: :lol: :lol: Sorry, I couldn't resist and we sure do need to laugh to help us get through the stress of dealing with our diabetic cats.

1. How much Food. Unregulated diabetic cats can not process the food they eat properly. You may need to feed up to 50% more.
2. How much testing. Well, Lantus dose changes are based on the nadir or low point. So you need to test to find that nadir, somwehre in the middle of the cycle, usually +4 to +6 hours after the shot. Some cats nadir earlier (my Wink was around +3 to +4), some cats nadir later (+7 to +9) We recommend you always test before the shot. So you know if the BG is too low to shoot or not.
3. How much Insulin. It depends. We need to see some of those test numbers to help you out more here. I understand you may not be a fan of google, but our color coded spreadsheet really does help us to see what is going on. We are looking for patterns, and that color coding helps us to see it. Why reinvent the wheel?
4. Litter box. As the BG's (blood glucose levels) get better regulated, the pee patch sizes decrease.

Since our diabetic cats are not just a set of numbers, knowing how the 5 P's (peeing, pooping, purring, preening, playing) are as well as the appetite tell us a lot.

So, how is Napa doing with the 5 P's?

 

For food, it seems as though 0.5 to 1.0 ounces per pound of ideal weight, tweaking as needed to increase or decrease weight, divided into 2 or more feedings, seems to do well for my diabetic and civvies.

Insulin is how you control the glucose level, NOT food quantity.

Comparing a human glucometer to a pet-specific glucometer is like reading temperature in Celsius vs Fahrenheit. Both are correct. You just need to know the reference ranges to interpret what the numbers mean.

[Glucose reference ranges are unsubstantiated and have been removed by Moderator]

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How to use the glucose reference values chart:

When you get a test, look for the number on the chart that either equals, or contains, the test value you have. Read the information. As needed, make a decision and act.

Ex. You are a new insulin user and you test your cat before giving insulin. The test is 300. It probably is safe to give insulin.

Ex. You are an established user of Lantus, following the Tight Regulation protocol. You've tested around +5 to +7 to spot the nadir. It is 200 mg/dL. You probably need to increase the dose, following the instructions for the protocol.

Ex. Your cat is acting funny. The eyes are a bit dilated. You are concerned and test the glucose. The number is 35 mg/dL. ACK! The cat may be in a hypoglycemic state. You quickly follow the HYPO protocol linked in the glucose reference values chart. (which we really, really, suggest you print out and post on your refrigerator.)

 

LOL D-Nile

We moved away from the SF Bay Area right before we got these guys. Named them Napa and Sonoma (Nomi for short). We feel really silly now that we've moved back to the Bay Area.

Spreadsheet incoming this morning. Hugs to everyone who helps here.

Last night: PMPS +12 was 52 after a skinny 1 unit morning dose. Skipped the pm dose. Tripled food during the day yesterday and gave about 2oz of gravy food along with the gelee due to the 52. She seems very happy to have more food. Gah, I might have been inadvertently starving her just when she needed food to heal.

This morning: AMPS +24 was 215. Skipped the am dose for now since I have to go out of town for the night. Will test again in a before I have to leave and will consider a small dose if over 250.

The Ps: these are fair, I'd say. Tail is up, but stays hunkered down in bed a lot. Still more pee in the box then I'd like but hard to tell with 3 cats. I can check on that better this weekend when I am home.

She definitely seems to be trending downward. Maybe her pancreas is kicking back in? Maybe removing the very small amount of dry is helping? The saga continues...

 

Welcome to the FDMB! (would love to know your name too!...Napa's not the only important part of this dance)

Here's just a few things I've noticed:

Lantus needs to be given consistently twice a day...every 12 hours. If you're getting numbers that are too low to shoot, you're probably giving too much to begin with. I'd suggest dropping back to .5, getting as many tests in as you can, and seeing if we can get it so you CAN shoot twice/day. If you get a number under 200(under 150 later), we suggest that you don't shoot, DON'T feed, and post and ask for help. We DO shoot numbers in the 50's, but only when you've had a lot of testing and know your cat very well and how she reacts to both insulin and food. What we want to get to is the point where you "shoot low to stay low" (shoot a low number, stay in low numbers, and give the pancreas the best chance to heal itself)

Are your syringes marked in half unit increments? Not all of them are.

Since you have now gotten rid of all the high carb food and treats, the numbers usually do come down...which you're starting to see

If you're using a "True" meter, you might want to go ahead and swap for a different one. The True meters can be wrong, especially at the lower numbers where it's really important to be right! The big favorite around here are the Relion brands from WalMart. They're about $15 and the strips are affordable too. The Relion Confirm and Micro models both take a very tiny sample, so if you're having trouble getting blood, I think you'll love them. (and I mean it really IS amazing how little will work on those meters!) The strips are a little more than the Relion Prime, but still only about $36 for 100. Later on, when Napa's ears have "learned to bleed", you could go to the Relion Prime ..those strips are only $9 for 50. (it's always a good idea to have a backup meter anyway. It seems the time you need your meter the most (like during a hypo) is the time the battery dies or something happens and it won't work)

What size are the lancets you use to poke? Most lancet devices come with size 30 or 31 (which makes a very tiny hole), but for new ears, it's better to have a larger gauge lancet, like 26 or 28. If you're using a lancet device, the lancets themselves all fit their own device, but you can also "freehand" the poke without using the device at all. Some cats don't like that "click" when the device goes off. Once Napa's ears have "learned to bleed", you can go back to the 30/31 size

There's a lot of information here, and we all understand that the learning curve here is steep, but we're here to help you along the way. Keep asking questions! We're happy to help you any way we can!

P.S. You might want to go back to your signature line (where your link is) and add your name/Napa, the date of diagnosis, type of insulin, type of meter, food you're feeding, any other health problems Napa might have. It's just helpful to have all that automatically attach every time you post so you don't get asked the same questions over and over again

 

Along with stopping the little bit of dry food, I think you may want to eliminate some of those Soulistic food flavors from Napa's diet.

If you are feeding any of the following Soulistic canned foods, they are too high in carbs for a diabetic cat. Pure Bliss, Aqua Grill, Good Karma, Sweet Salutations, Harvest Sunrise. None of the pouches of Soulistic are low enough in carb for a diabetic cat either. Here is the link to the food chart we use.

Thank you so much for the SS and the information in your signature. It will help us to help you better and is much appreciated.

What!?! :shock: You can't tell the pee apart for your 3 cats? I have 3 too, and pee patch size, shape and where they hit in the litter box tells me exactly who went. ;-) As you can tell, we're not afraid to talk about much of anything here. Especially if talking about it helps to get our beloved kitties feeling better.

Good decision on skipping the shot last night (52!! yikes) and then this morning since you will be gone so long. Hope to see Napa slowly but surely improving.

 

Just wanted to add that the Soulistic Double Happiness while low in carbs (4%), has sugar as an ingredient.

 

Thanks all. Starting "shoot lower to stay lower today". She is much happier with more food now. This am +50 AMPS was 178. Shot ~.5

Yep, that chart is what clued me to which flavors to feed them. I am only feeding the gelee varieties and those are the lower carb ones. The high carb ones are the ones packed in gravy. I keep a few of those on hand for low BG anxiety. Thank you Bunni for pointing out the sugar in Double Happiness.

LOL. I guess you are right. Lake Napa is usually in the same place in the same box. I also switched kitty litter and that has sorta affected the clump size.

 

Urine volume is just one of several Secondary Monitoring Tools in my signature link. Have a look to see which ones will be most helpful to you.