Belle- New Diagnosis

[AmandaL&Belles]

Hi everyone. We are in uncharted territory with my Belles, 8 y/o. We are recently diagnosed on Friday May 28. Among a new diagnosis, we are also fighting a UTI and ear infection. My girl has been on RC Urinary S/O for the last year as she is prone to crystals. She now (whether due to UTI or just feeling yuck from high sugars), will barely eat anything. I understand the concept of a proper diet with diabetes, but right now we are trying to get her to eat anything. She will not eat her regular food, and we have tried pates and morsels with gravy (which she tends to like a little, but barely eats any of the meat, mostly licks gravy even when I mash it up). We just started at home testing 3 days ago, so that in itself is a feat when we are able to accomplish it. I only have three readings so far (PLEASE DONT BE HARSH, I see it often when people aren't doing the exact right thing with their bubs, but we are trying and learning!). And yes I will start using the spreadsheet when we are more comfortable with testing.

We have been prescribed Lantus, 4u twice a day (which seems like an extremely high starting dose to me, so I've been using my nursing judgment based off how much she eats). I know, start low and go slow. I also understand the importance of regular interval testing and not as I have done it so far. Like I said, it's a learning curve for all of us here. The first 2 days, I did give the 4u as told but we were not testing at that point, and she ate basically the same as she is eating now, very little. I'm obviously terrified of the lows.

Readings:
May 31, 2021 at 1700- 26.9 mmol (484.2 mg/dl) [1unit after eating]
June 1, 2021 at 1645- 20.7 mmol (272.6 mg/dl) [1unit after eating]
June 2, 2021 at 0600- 10.8 mmol (194.4 mg/dl) [no insulin yet]
I hope I have provided sufficient information for someones input and hope that someone can advise. What should we do in a situation like we have currently, with a BS of only 10.8 and eaten a small amount? Should I withhold, should I give a very small amount of Lantus? TIA

 

[Marina & Chico]

Welcome to the forum Amanda, you will find a lot of very useful information here and support. When you say it has been harsh to start with, trust me ALL of us have been there, i can promise it will get easier very quickly

4U of insulin seem crazy high even more when Belle isn't eating very well and considering that you are not testing yet.

For starters please read this sticky which will give you guidelines on how to set up a spreadsheet and how to set up a signature. This information will be needed for anyone giving any dosing advice. It would be useful to have even the 3 values you have posted here in the spreadsheet.

Testing has been a harsh start for us as well, it helped us to give Chico a treat after each test, very soon he learned to associate the treat with testing so he wasn't protesting anymore. Another life savior was warming the ear with a sock full of rice, the warmer the ear the easier is to get a blood sample, therefore less stressing the kitty.

Good luck and hopefully someone more experienced will help you with an advise regarding the starting insulin dose.

 

[Suzanne & Darcy]

I would not give 4 units of insulin to my kitty without knowing what his blood glucose level is both before I shoot and later in the cycle so I know how he is responding to that dose. It is not a good idea to start at such a high dose anyway (as I think you already have said). I am not being critical or judgemental. I'm just saying that I couldn't handle doing that (it would make me sick with worry). I remember when I first started testing. I was in tears on more than one occasion (and my kitty is very compliant). I never thought I would be very successful at getting blood out of his ear and I thought I was going to really hurt him. He soon became quite used to it and to getting his treat afterwards!

 

[Summer and Susie (GA)]

Welcome, Amanda. This group will help you navigate the diabetes journey with your kitty. Home testing is critical. Preshot test are the most important. I'm fairly new and can't advise but I wanted to give you a helpful tip on the testing. Get some Vaseline and rub a thin layer over Belles ear tips before testing. I do it first thing in the morning and it lasts pretty much all day. When you poke for the blood it will "bead" up and not smear into her fur. It makes it so much easier to get a test. Other more expert people should be along to help advise you. Setting up your spreadsheet and signature will help them help you. Don't panic. You are in the right place!

 

[Emily R]

Welcome, Amanda! You're in good hands here. While the amazing folks who run this place are making their rounds this morning, go ahead and start getting your testing and dosing numbers into a spreadsheet ("SS" around here). You should also get a signature started that has some "at-a-glance" info that will help if you are looking for words of wisdom or you have an emergency. Here's a handy-dandy Getting Started Guide to help you start gathering your data in a way that folks here can help and offer advise.

New diagnosis land is absolutely terrifying, but you're in the right place. <3 I hope Belle is having a good morning! When we got my kitty's diagnosis, he was in ketoacidosis and he was barely eating, too. We had him on an appetite stimulant for close to a month when we got him home from the vet. If I had it to do all over again, here's the only thing I would have done differently: Zen wasn't dangerously underweight for most of the time when we got him home. When Zen was on the appetite stimulant, he was eating enough, but he still wasn't gaining weight very well--there was a point where I still would have classified him as underweight but not scarily so, and that's the point where I would have pivoted to only giving him diabetic-friendly food only instead of just trying desperately to keep him eating. That said, having a full stomach when you give insulin is vital to controlling the dosing process. The second we made the change, Zen's numbers started getting better, and he actually gained weight because he wasn't hyperglycemic all the time (which can cause weight loss). I also found that Zen is just really bad at eating wet food, so we ended up blending the morsels into the gravy while we were trying to get him to eat. That helped a lot. He was getting frustrated with his inability to pick up the morsels with his tongue like he could his old dry food, and also his legs were hurting him because the neuropathy had set in. You may want to see if Belle likes eating from a slightly more elevated bowl so that she doesn't have to squat. That was a game changer for us.

Wish you the very best of luck getting started, Amanda! It's a lot of information to take in and it can be overwhelming, but my biggest advise to folks starting out is to document as much as possible, and start to learn exactly how your cat typically responds to certain types of foods and also to her insulin. Hang in there-- Belle will be making gains in no time!

 

[AmandaL&Belles]

I didn’t mention it, but she is actually overweight. By 4-5 ish pounds, she’s a big 16.5 lb gal! and her Urine showed no ketones when tested! Perhaps I will try the elevated bowl. She did have a shot of cerenia on Friday and a tab yesterday morning but it didn’t seem to make that much of a difference in her appetite.

 

[Butters & Lyla]

June 2, 2021 at 0600- 10.8 mmol (194.4 mg/dl) [no insulin yet]
I hope I have provided sufficient information for someones input and hope that someone can advise. What should we do in a situation like we have currently, with a BS of only 10.8 and eaten a small amount? Should I withhold, should I give a very small amount of Lantus? TIA

Welcome. For brand new people, we recommend when preshot is <200 that you stall without feeding and post for help, which it looks like you did. The stall should be for 15 -20 minutes and then you check the BG again. This allows you to see whether kitty is on the rise or not, which helps inform a decision on whether to shoot and how much. Sorry nobody responded to you around your shot time. It can be a little slow on the board at that time of day. What did you end up doing?
I agree that 4u seems like much too high a starting dose. What did the vet base this on?

Here is a post of tips on how to stimulate a kitty's appetite. Butters was also a gravy licker/sucker for a while (pre-diabetes), and has periods of inappetence. So I feel your pain. During that period, I found using dehydrated raw food and mixing in a little bit of sardine or tuna (or just the juice) worked for her. Paws crossed you find something that works for Belle. Have you tried an appetite stimulant? I sometimes use cyproheptadine for Butters. Just a very tiny amount of it works wonders for her.

 

[Emily R]

She did have a shot of cerenia on Friday and a tab yesterday morning but it didn’t seem to make that much of a difference in her appetite.

I found the same to be true of Zen. The cerenia was helpful if he was nauseaous, but not really an appetite stimulant. The appetite stimulant Zen was on was called Mirtazapine. Though, honestly, forti-flora ended up being the thing that gets him to consistently eat. The link @Butters & Lyla provided is a great resource!

 

[Butters & Lyla]

If nausea is the reason Belle won't eat, I'd recommend trying Ondansetron. You can give that to her along with Cerenia if needed or on its own. Ondansetron seems to work better in some cats, including Butters. If not eating even on anti-nausea meds, then you could try adding an appy stim like cyproheptadine.

 

[Diane Tyler's Mom GA]

Always aim for the sweet spot warm the ears up first rubbing them with your fingers or you can put rice in a sock and put it in the microwave, test it on the inside of your wrist to be sure it's not to hot, like you would test a babies bottle. You can fill a pill bottle with warm water and roll it on the ears also.Just keep rubbing the ears with your fingers to warm them up

6. As the ears get used to bleeding and grow more capilares, it gets easier to get the amount of blood you need on the first try. If he won’t stand still, you can get the blood onto a clean finger nail and test from there.
When you do get some blood you can try milking the ear.
Get you finger and gently push up toward the blood , more will appear
You will put the cotton round behind his ear in case you poke your finger, after you are done testing you will fold the cotton round over his ear to stop the bleeding , press gently for about 20 seconds until it stops

 

[AmandaL&Belles]

Welcome. For brand new people, we recommend when preshot is <200 that you stall without feeding and post for help, which it looks like you did. The stall should be for 15 -20 minutes and then you check the BG again. This allows you to see whether kitty is on the rise or not, which helps inform a decision on whether to shoot and how much. Sorry nobody responded to you around your shot time. It can be a little slow on the board at that time of day. What did you end up doing?
I agree that 4u seems like much too high a starting dose. What did the vet base this on?

Here is a post of tips on how to stimulate a kitty's appetite. Butters was also a gravy licker/sucker for a while (pre-diabetes), and has periods of inappetence. So I feel your pain. During that period, I found using dehydrated raw food and mixing in a little bit of sardine or tuna (or just the juice) worked for her. Paws crossed you find something that works for Belle. Have you tried an appetite stimulant? I sometimes use cyproheptadine for Butters. Just a very tiny amount of it works wonders for her.

I’ve been attempting to get her BS for the last couple hours. My boyfriend fed her in between *eye roll*... he’s learning more than I am as I do understand concept of insulin and BS from my nursing background. I ended up holding the insulin and still attempting another glucose. She needs a little break. I’m not sure if the vet based it off her BS of 22 at the visit and her weight, or some other rationale. I called to discuss my concerns and obviously they agree less or no insulin based off what she eats. But not much other advice. When my boyfriend gave her food, it was her kibble (and I do know this is not the best for diabetes.... but given our struggle right now, we will take what we can get). She did eat some freeze dried salmon after we attempted BS testing and seemed to really like that

 

[Katherine&Ruby]

Hi Amanda and welcome! Testing was the HUGEST challenge for me at the beginning as many here who have followed my journey with Ruby know very well! I was freehanding a lancet and just couldn't get the blood out quickly enough before Ruby flicked her ears or got squirmy. Are you using a lancing device? I found that one with a clear cap like this one was a total game changer: https://caretouchusa.com/product/lancing-device-with-ejector/. I would always follow the testing with food, so Ruby knows now that when the warm sock goes in the microwave, she's going to be rewarded with a yummy treat so she hops right up on the chair and waits for me to test her, purring the whole time.

You're right that getting Belle to eat anything right now is important. I know that if the only thing Ruby wants to eat is kibble or fish, she's very nauseous. If Cerenia did not help, I'd go with all of the suggestions Lyla and Emily made and add maybe another possibility of giving her famotidine, or Pepcid, an antacid. Here in the US you can get it in 10 mg doses and I cut the pills into quarters for 2.5 mg doses. I give her one twice a day along with an anti-nausea, either Cerenia and/or ondansetron, and that helps get her to eat. There are more natural solutions as well that I've tried that work more gently against an acidic tummy and can be given every day, like a few drops of apple cider vinegar in food or slippery elm bark powder. Here is a link to using slippery elm (it's a site for IBD kitties, but the advice it gives for understanding and curing nausea in general is very helpful): https://www.rawfeedingforibdcats.or...es-slippery-elm-bark-powder-instructions.html.

 

[Suzanne & Darcy]

Amanda... I think I forgot to say welcome! Welcome. Please forgive me for not saying that first. I got worried about the 4 units for your baby girl. And I had a vet appointment this morning so I was quite distracted. I'm glad you are here. It's honestly the best place to be for your girl.

 

[Wendy&Neko]

Adding the link to your similar post on Feline Health: https://felinediabetes.com/FDMB/threads/belle-new-diagnosis.248113/ where I stressed the importance of ketones testing when you have infection, inappetance, and possibly not enough insulin. Ketones levels can change quickly, I've seen examples where they've gone from trace to high in a day. So daily testing at home is recommended, especially if high numbers, or infection/inappetance.