Just diagnosed - lots of questions

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Shonna and Neko

Shonna and Neko

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My cat Neko went in for an emergency visit to the vet last Friday (9/5). She had been acting completely fine, perfectly normal, until Thursday (9/4). On that day, she vomited about 10 different times throughout the day and was very lethargic. The next morning she vomited two more times, before my husband and I got her to the vet. Diagnosis = Diabetes and ketoacidosis. She spent the weekend in an animal Urgent Care facility to try and get it all under control. She is now back home, thank goodness, and doing better.

Now that the first crisis has passed, I'm trying to get caught up on what the diabetes diagnosis means for her day to day schedule and routine. Our vet has been supportive of many of the things mentioned on this website and message board (i.e. home testing, wet canned food that doesn't have to be prescription), but less than clear when it comes to asking and answering questions. I feel like I'm missing an important key in the feeding, testing, injecting triad.

Here are Neko's basics:
11 years old
No major health problems or issues in her lifetime
Lost about 1 pound in the past 2 years (went from 12 pounds to 11 pounds)
She's an only child, currently


Insulin:
Prescribed Lantus 1.5 U, twice a day (was originally 2 U twice a day, but the vet dropped it to 1.5 on Monday). Currently, she is given her insulin during her mealtimes, per the vet.

Food:
She is fed Fancy Feast Classics Beef. She has been fed this for a couple of years.
Before the diagnosis, she was given .5 can in AM, and .5 can in the PM, with a bowl of Royal Canin Adult dry food for free grazing throughout the day.
She rarely ate much of the dry food. Since the diagnosis, we've removed all dry food, and upped the wet food to 2-3 cans a day. We're trying 1.5 cans twice a day - but she can't seem to finish either meal. We're thinking that we need to go to a 3 x day feeding schedule, though we both work during the day, so it makes it more difficult.

BG testing:
We're prepared to do home testing. We have the One Touch Ultra 2 monitor. We've taken two readings today, but we don't really know what we're doing, so we suspect we didn't take them at correct times, or often enough or something. Tested two hours after eating & insulin injection, her BG was 343. At 4 hours post she was at 291. That's the extent of our testing so far. We'd also like to do a curve, so we have a better idea of her insulin peak times, etc.


We haven't had to make much changes in the food area, but given her rise to ketoacidosis without any diabetic symptoms beforehand (i.e. no excessive drinking/urinating), we're concerned about the timing of everything.

Questions -
For daily BG monitoring, when is the best time(s) to test?
If we switch to a 3 x day feeding schedule, should we do a curve first, to find the peak insulin time, or should we switch now, wait to do a curve?
I keep reading that food and insulin should be given within an hour of each other. How does that work with a 3 x day feeding schedule?
Is she okay to "graze" on her wet food, and if so, for how long?
Is she ever allowed treats?
 
Welcome Shonna and Neko! Great job so far in your research! You are definitely on the right track and we can help. I don't have experience with DKA, but I can answer some of your basic questions.

Questions -
For daily BG monitoring, when is the best time(s) to test?
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- you want to test before each insulin injection. We call this the am pre-shot (AMPS) and pm pre-shot (PMPS). Dose changes are made based on the lowest part of the cycle so it is important to get at least one mid-cycle test in each 12 hour cycle. This can sometimes mean setting an alarm for night time tests, depending on your schedule. Unless Neko drops below 50, you want to hold the dose for about 6-7 cycles before making changes. The experienced people here can help you with adjustments as you go along.

If we switch to a 3 x day feeding schedule, should we do a curve first, to find the peak insulin time, or should we switch now, wait to do a curve?
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I would think it would be ok to do a curve when it works best for your schedule, regardless of feeding times. The more data you have, the better decisions you can make. You may find the lowest part of the cycle (nadir) may change, and it might not have any rhyme or reason to it. Every cat is different and can change over time.

I keep reading that food and insulin should be given within an hour of each other. How does that work with a 3 x day feeding schedule?
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Lantus is slow acting and builds up in the system. You want to shoot as close to a 12 hour schedule as you can (like 7am and 7pm). You don't give insulin every time you feed. Feeding smaller meals throughout the day is a good idea. It greatly helps a healing pancreas. One trick we use is to add water to canned food and freeze it in muffin tins or ice cube trays. You can then put it in an auto feeder or leave it out for kitty to eat throughout the day.

Is she okay to "graze" on her wet food, and if so, for how long?
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Some people leave food out all day. The only thing you want to do is pull the food 2 hours prior to your shot time. You don't want the glucose reading to be influenced by food.

Is she ever allowed treats?
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YES!! Boiled chicken is a favorite here. Also, PureBites freeze dried turkey, shrimp or chicken is popular. There are other brands, but any sort of single ingredient, meaty freeze dried treat will work.

It's late so I don't know that you'll get many more responses, but I hope that gets you started. This can be overwhelming at first, but keep asking questions. Welcome!
 
Thanks so much! That helps a ton. I get the basics of diabetes (my mom has it), but the timing of the little every day stuff was really confusing. Your response has really clarified it for me. We've taken care of cats with CRF, stroke, blindness, and other major health issues, but this one is new to us. Any help we can get is greatly appreciated.
 
Hi Shonna & Neko!

Welcome to FDMB. We actually have another Neko on the board, too - Wendy & Neko.

Tara gave you some great information, and I agree with her completely - lots of small meals (I probably fed Jersey 6 or 7 times a day), no food two hours before shot time, always check bg levels before each shot, and get some checks in between shots.

One other thing to add - check for ketones at home if you aren't already. You can buy ketone test strips at Wal-Mart (or pharmacies). They're with the diabetic testing supplies. Just hold the test strip under the urine stream and then compare the strip to the color-coded chart on the bottle. If ketones are present, we typically recommend calling your vet since it can be an emergency. It will be especially important to check for ketones since Neko has already had an episode of DKA.

We know you are overwhelmed with information right now and have tons of questions. Make sure you ask them all! We all remember what it was like when we first got our diagnoses, and we would love to help you however we can.

Shelly
 
Welcome Shonna and Neko!

I don't have much to add since you've already gotten some excellent advice from Tara and Shelly, but I did want to point you to the online spreadsheet we all use to help us track our BGs.

Please let us know how else we can help. :-D
 
Hello and welcome to your sweet kitty Neko. :-D My Neko was 11 when she was diagnosed too. Lantus is a good insulin for kitties. The vet who got us started on Lantus also pointed us to FDMB.

A word about glucose meters. The Onetouch is a great meter. My vet uses it in her office and has compared it with the lab results quite favorably. The one downside is that it does require a larger drop of blood and the strips are more expensive. The meter commonly used here is the Relion Confirm, available at Walmart, because it uses 1/3 the size of blood drop and the strips are cheaper. You are perfectly fine sticking with the Onetouch, but just something to keep in mind if expense is an issue.

You can even feed more than 3 times a day. Feed at injection time, then you can feed small meals after that, with the majority in the first half of the cycle. Several kitties here are free feeders. My Neko is a hoover, so I have an autofeeder to space out her meals. It also helps me if I need to be out of the house for a bit but want to make sure she has food available.

Daily ketones testing will be important as Shelly has mentioned and if you get the spreadsheet going that Kay mentioned, we'll be able to help you with dosing suggestions.

Keep asking questions, we love to help.
 
Thanks for the replies and advice everyone! We went and got some ketone testers yesterday, so we can add that to our regimen, and we've printed out the spreadsheet to use too. My Neko could be described as a Hoover as well :) so we got a timed feeder to help spread out her meals a bit while we're at work.

I feel like the whole diabetes thing is very manageable once you know what you're doing, but I always do much, much better when I have everything ordered and routine, so all of these suggestions are extremely helpful to me as I rebuild my daily schedule around this diagnosis.
 
It's nice to see you, Shonna. I hope all is going well. I actually am a very organized/routine person, too, so I complete understand what you mean.

Just a note about the spreadsheet. You mentioned that you printed it out. It's actually designed to be used online so everyone can see it. To be honest, I found that the directions for setting up the spreadsheet were a little confusing, so I had to make my own version of them. (Simple is better for me! ohmygod_smile )

I'm assuming that you're using U.S. numbers (mg/dl) rather than world numbers (mmol). If so, here are some step-by-step instructions for the spreadsheet if you would like to set it up so we'll be able to see Neko's numbers:

1. First of all, you’ll need to set up a Google account if you don’t have one already. Here’s the link for it: https://accounts.google.com/SignUp?continue=https://accounts.google.com/ManageAccount

2. Once you set up your account, make sure you are signed in to it. Then click on this link: https://drive.google.com/previewtem...U5BVEdyU1dGZmx5bnRvdG10OWc&mode=public&pli=1#

3. This will bring up the template that you can use. In the upper, left-hand corner of the page, it says “Use this template.” Click on that.

4. Now you have your own copy of the template. At the top, left-hand corner of the page, click on “File” and then choose “Rename.” You can now change the name of your spreadsheet (e.g., “Neko's SS”).

5. Once you finish entering the date, numbers, etc., you will need to publish your spreadsheet. Click on “File” again and then click on “publish to the web.” A little pop-up box will appear. You will want to make sure that the box that says “automatically republish when changes are made” has a checkmark next to it. Then click on “start publishing.”

6. Now, you need to make sure other people can see your spreadsheet. Click on the blue “share” button on the upper right-hand corner of the page. A pop-up box will appear. Where it says “private,” change that to “anyone with the link can see” and click save at the bottom of the box. (Someone mentioned a problem with this step in the instructions. If you have a problem here, please let us know.)

7. Now we have to add the spreadsheet to your FDMB account. First copy the web address that appears in the address bar on your spreadsheet. Come back to FDMB and click on “User Control Panel” at the top left-hand side of the page. Then click on the tab that says “Profile” Next, click on the tab that says “Edit Signature.” There’s a little “url” button at the top of the box where you write. Click on it. This is what will show up in the box:



Click in between the middle brackets and paste the web address for the spreadsheet that you created.

In the end, it will look something like this: https://docs.google.com/spreadsheet/.....[url] Hope that helps! Shelly
 
During step 6, the dialog box will contain a link to the published, shared spreadsheet.
Copy that and paste it in a document on your PC. You will add that link to your signature from the FDMB User Control Panel. You may wish to send it to your vet as well.
 
In the upper left of the web page, there is a line which says User Control Panel. This is where you can adjust settings for how the board displays, your signature, get private messages, and so on.
Click on that.

A new page displays, with 6 tabs along the top edge. Take a look at each by clicking on the tab and notice the topics listed on the left under each one.
Click on the tab which says Profile. You'll see a list of 4 categories: Edit Profile, Edit Signature, Edit Avatar, Edit Account Settings.

You can click on Edit Profile to put in any details you want to share in the boxes given. When you are done, you click on Submit at the bottom of the boxes.

You can click on Edit Signature to put in some details you want to show up in each post you make. This is where you put your name, your cat's name, the insulin you are using, the spreadsheet link, and any special notes such as diet limitations or other conditions which are present. You have only 255 characters, so be succinct! When you are done, you click on Submit at the bottom of the boxes.
 
Thanks everyone for the tips on the spreadsheet. I had completely missed that it could be viewed by the forum. I've since added it to my signature and updated Neko's numbers for today. We've had some issues with the BG monitoring up to this point, and had to use the vet for this to some extent. However, I think we've worked it all out and we are now doing the home testing, so hopefully we'll get some more data for the SS.
 
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