GA Introduction and Advice wanted - Sad news, and thank you.

Discussion in 'Feline Health - (Welcome & Main Forum)' started by Hannah & Boo, Jan 19, 2021.

  1. Hannah & Boo

    Hannah & Boo New Member

    Joined:
    Jan 19, 2021
    Hello!

    I apologize if this post ends up being a little all over the place. The last few weeks have been difficult and I'm a bit at my wit's end with figuring out what the best options are.

    Let me start out by saying that my kitty, Boo, is 15 years old (16 in April) and was diagnosed with diabetes when she was 8 years old. She has been on Novolin N (NPH) ever since her diagnosis, except for one short stint of trying Lantus which resulted in her being too low and we put her back on the Novolin N. She has ranged from 1-2.5 units of Novolin N 2 times a day, and is currently at 1 unit twice a day.

    For a long time I thought she was well regulated. I bought an Accu-Chek Nano for her and tested her blood sugar occasionally, but generally only when she was acting "off" or hadn't eaten. The vets always said that I did a good job with her and every time she went in for a visit they would tell me how well I was doing. However, whenever she would get the blood glucose test that measures her average for 2 weeks (I'm sorry, I forget what it is called) it would always read high (above 300mg/dL).

    Fast forward to last fall (2020)- Boo's teeth started to get quite bad. She had previously been in the vet's office to get them removed in 2018, but they decided not to remove them at that time and just cleaned them instead. This time, she had an infection in her teeth and they absolutely had to be removed. She had her two top canines removed as well as a bottom incisor in early November of 2020. Her recovery from the anesthesia seemed slow, much slower than in previous years (I thought, she's 15, so that makes sense right?). She started being very picky about her food (I had been feeding her Fancy Feast Classic diligently up to this point) and I started giving her half Fancy Feast Gourmet Naturals and half Fancy Feast Gravy Lovers. The reason I started giving her the Gourmet Naturals was because I was unable to find the Classic online during the midst of the pandemic last September and didn't think much of them being a different type of food, and I bought the Gravy Lovers by accident during this time. Predictably, once I started feeding her some of the Gravy Lovers foods, she stopped wanting any pate of any type! I'm certain that this didn't help her predicament coming up.

    She had her first serious hypoglycemic episode about a month after her dental extraction. I am convinced she was on the brink - she tested in the low 20's. We were able to get her back up after this but she seemed sluggish for several days after, understandably recovering from a very stressful and dangerous situation. I can provide more details on these episodes if it is helpful but I don't want to stress anyone out with descriptions of what was happening during them - it was pretty bad.

    We brought her back to the vet (this is early December), who tested her blood sugar and saw she was still peaking very high. They gave her subcutaneous fluids and also prescribed us a week of subcutaneous fluids (which she took like a champ), gave her a B-12 shot, and noted that she seemed to be losing weight.

    On December 22nd the vet recommended that we start giving her 2 units twice a day of her insulin because her levels were still high. The vet recommended that on days that she seemed "off" that we give her subcutaneous fluids, especially on days that she didn't eat well.

    On January 11th, Boo had a second hypoglycemic episode, just as bad as the one she had in December. I thought for sure we had lost her during this one - she went completely limp and nonresponsive, amongst other things. Somehow after hours of coaxing her to eat food and giving her quite a bit of Karo syrup, she pulled through. We had already had an appointment with her vet for the next day because she had been coughing and that was concerning us, so she went in for another exam. The vet recommended at that point that we take her off insulin completely for 10 days and then test her blood sugar after that to see where we should be. She mentioned during this time that Boo's liver was enlarged, but she noted that it could be because of her blood sugar episodes. Notably, I had been creating a curve the day that Boo had her low blood sugar episode, and she was reaching as high as 600+, and as low as mid-30's (during hypoglycemia).

    The doctors gave her another shot of B-12, subcutaneous fluids, and sent her home. For a couple of days she seemed to feel better. The vet was due to call me on Friday day to check on Boo, and during the call she mentioned the possibility of lymphoma being the cause of the enlarged liver. Almost like clockwork, that night she started to cough again and even seemed to have congestion that lasted the night and into the next day had some wheezy breathing. She still coughs occasionally. The vet said this may be because her throat could have been irritated by vomiting the week before.

    Between Friday and yesterday, Boo has seemed to decline - she is incredibly tired, sleeping or laying down most of the day. She is weak and very thin - I can easily feel her ribs. She still eats and drinks regularly, and her bowel movements are regular and she urinates fine, but she just seems to continue to lose weight and stays weak and tired. We called the Vet again yesterday after testing her blood sugar (this is before the 10-day mark, but we were growing desperate for advice), and twice in one day she tested at 463mg/dL (once before a meal, and once about 3 hours after). She advised that we give her 1 unit a day again and are now giving her weekly B-12 injections starting today. When we asked about the possible lymphoma diagnosis, she said that it is "tricky, because of the diabetes".

    We are sad, and stressed, and just want our kitty to be comfortable. It is not clear if we are talking about end-stages of life, though I certainly worry it is heading in that direction. The vet has not discussed that or brought it up, so my hope is that we can still somehow get her to pull through (if she does not actually have lymphoma).

    I realize that some of this discussion is probably above this forum's paygrade, and I appreciate that - I am looking for any advice or suggestions, any words of support. This has been the longest couple of weeks I've experienced in a long, long time. My boyfriend and I are heartbroken and haven't been sleeping well. I love my cat and I want to do anything that I can for her.

    This morning I was able to dig up some Classic Pate for her and she ate most of a can. I worry that the food we have been feeding her has been part of the problem. We gave her 1 unit of insulin and her B-12 shot. I am hoping for the best, but if anyone has any suggestions or words of advice I would truly appreciate it. I apologize if this is a super rambling thread, and please if I need to clarify anything let me know - I'm more than happy to give details where needed!

    Thank you.
     
  2. Diane Tyler's Mom

    Diane Tyler's Mom Well-Known Member

    Joined:
    Sep 21, 2018
    Last edited: Jan 19, 2021
  3. Hannah & Boo

    Hannah & Boo New Member

    Joined:
    Jan 19, 2021
  4. Diane Tyler's Mom

    Diane Tyler's Mom Well-Known Member

    Joined:
    Sep 21, 2018
    You are welcome Hannah
     
  5. Diane Tyler's Mom

    Diane Tyler's Mom Well-Known Member

    Joined:
    Sep 21, 2018
    @Hannah & Boo
    While we are waiting for a response would you like to set up a signature,
    I'll post it below.
     
  6. Diane Tyler's Mom

    Diane Tyler's Mom Well-Known Member

    Joined:
    Sep 21, 2018
    • when you get a chance ,It would be helpful if you can set up your signature so we don't have to ask you the same questions over again. Members will look at this first . Members would have to look up your previous posts to see what insulin you are using
    • It appears after each post in gray, look at mine,



    • On the left, under Settings, Click on Signature. This is where you will put information that helps us give you feedback.
      • There is a limit of two lines which may include two links; you may separate pieces with commas, dashes, | etc. This is where you paste the link for your spreadsheet, once it is set up.
      • Add any other text, such as
      • Caregiver & kitty's name (optional)
      • DX: Date
      • Name of Insulin
      • Name of your meter
      • Diet: "LC wet" or "dry food" or "combo"
      • Dosing: TR or SLGS or Custom (if applicable)
      • DKA or other recent health issue (if applicable)
      • Acro, IAA, or Cushings (if applicable)
      • Spreadsheet link. Please put the signature link on the bottom line of your signature information, on its own, so it is easy to find.
      • Please do not put any information about your location in the signature for security reasons. If you wish to add your country location, please add it to your profile.
    Be sure to click the 'Save Changes' button at the bottom. If you need help urgently it is important we know these things at a glance. We don’t want to waste valuable time finding out information.


    tap on your avatar where it says your name ,then hit profile page ,tap on that ,then go up to the very top, upper right hand side and tap on your name ,it will bring down a drop box, tap on signature, the signature will be under settings, tap on the signature then and you can start to add what I posted above, make sure you hit save ,
    Welcome to the best place you could ever be and an awesome group of people
    You can also add where you live in your profile, not your signature

    This is at the bottom of every ones post in grey
     
  7. Diane Tyler's Mom

    Diane Tyler's Mom Well-Known Member

    Joined:
    Sep 21, 2018
    We also use a spreadsheet to record our cats BG . To see how the insulin is working
    thru the 12 hour cycles , The members need to see this in order to feel comfortable giving advice on dosing.

    If you would like to set one up and have any numbers to put in that would be great.
    If you have trouble setting it up just ask , we have a wonderful member that will do it for you.

    The instructions will also tell you how the spreadsheet works

    You can look at mine it's at the end of my posts, it says Tyler's spreadsheet
    You can look at anyone's also
     
  8. Diane Tyler's Mom

    Diane Tyler's Mom Well-Known Member

    Joined:
    Sep 21, 2018
  9. Hannah & Boo

    Hannah & Boo New Member

    Joined:
    Jan 19, 2021
    Got it, thanks for the instructions! I have set up a signature and I'll look at creating a spreadsheet later today.

    Edited to ask:
    "Dosing: TR or SLGS or Custom" What does TR or SLGS mean? I entered "1 unit 2xday" but I'm not sure if that's what dosing is referring to.
     
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  10. Diane Tyler's Mom

    Diane Tyler's Mom Well-Known Member

    Joined:
    Sep 21, 2018
    Great Hannah
    I'm pretty sure that TR and SLGS does not apply when using Novolin N
    Someone will correct me if I'm wrong
    It would apply if you were using Lantus or Levemir insulin
     
    Last edited: Jan 19, 2021
  11. Hannah & Boo

    Hannah & Boo New Member

    Joined:
    Jan 19, 2021
    OK got it, thank you Diane Tyler's Mom!
     
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  12. Diane Tyler's Mom

    Diane Tyler's Mom Well-Known Member

    Joined:
    Sep 21, 2018
    Boo is a cutie :cat:
     
  13. Bron and Sheba (GA)

    Bron and Sheba (GA) Well-Known Member

    Joined:
    Feb 21, 2015
    Hi Hannah and Boo,
    I’m sorry you have been through so much.

    Home testing https://www.felinediabetes.com/FDMB/threads/hometesting-links-and-tips.287/
    I can see you are home testing...that is great! But not often.
    We recommend you test before every shot and again during the cycle. Testing before the shot will ensure it is safe to give the dose and testing during the cycle will tell you how low the dose is taking Boo and if he is in safe numbers and if the dose needs adjusting. You need to be testing every day otherwise you will risk hypos.

    And here is how to treat a hypo https://www.felinediabetes.com/FDMB/threads/how-to-treat-hypos-they-can-kill-print-this-out.15887/

    I would also seriously look at changing back to Lantus. It is a much better insulin for cats than Novolin which is a much faster and harsher insulin and not suitable for cats.
    If you are home testing the blood glucose you will be able to adjust the dose so you don’t get hypo episodes. Lantus is a longer lasting more gentle insulin.

    Has Boo been tested fro hyperthyroidism? That can cause weight loss.
    If Boo is unregulated that will also cause weight loss.
    It is possible to investigate if a cat has lymphoma if the cat is diabetic, so I’m not sure what your vet is talking about.

    Whenare you feeding Boo? Do you feed him an hour before the dose? And do you give snacks throughout the day and evening?
     
    Last edited: Jan 19, 2021
    Diane Tyler's Mom likes this.
  14. Bron and Sheba (GA)

    Bron and Sheba (GA) Well-Known Member

    Joined:
    Feb 21, 2015
    Is Boo still off insulin? It sounds like he might be back on 1 unit a day. Insulin needs to be given twice a day to be effective.
    If so I would test the urine for ketones. Taking a diabetic cat off insulin for 10 days is not safe in my opinion. If Boo needs insulin and is not getting it, he could get ketones which can be dangerous if not treated quickly.
    If he is lethargic, which it does seem he is, that is all the more reason to test the urine for ketones.
    You need a bottle of ketostix from Walmart or a pharmacy. Then get a urine sample and dip the test strip into the urine and read exactly 15 seconds later. I would tell your vet immediately if there is even a trace of ketones in the urine as Boo would need to go back on insulin.
    I would not leave testing for the ketones but go out today and get the ketostix if you don’t have any.

    Also try and get him to eat plenty of food.

    I do have to question how much your vet knows about feline diabetes.
     
  15. Hannah & Boo

    Hannah & Boo New Member

    Joined:
    Jan 19, 2021
    Hi Bron and Sheba, Thanks so much for your reply! I'll answer to the best of my abilities.
    I did notice that this board definitely prefers lots of testing, so I have been trying to test her more throughout the day. I'll definitely be adopting the "test before you shoot" method from here on out, and I'll be updating her spreadsheet accordingly. Anything I can do to help her, I will. Are there recommendations for how often in between her doses she should be getting tested? I do work during the day, but thankfully it is at home right now so I am able to test her pretty often if necessary.


    I'll definitely ask my Vet about this. I remember trying Lantus and liking it, but as soon as she had a low blood sugar episode she went straight back to the Novolin and I never questioned it because the hypo scared the bejeesus out of me at the time.
    From what I remember, Lantus was a once-a-day injection instead of twice a day. Is that correct?

    Boo has not been tested for hyperthyroidism in recent memory as far as I know, but I will request that information from my vet - she has been in and out of the office several times in the last few months and its possible they did test her but didn't mention it if her thyroid was normal.

    She's certainly unregulated right now, or poorly regulated. I have updated her spreadsheet through the tests I have done today. Unfortunately I don't have a ton of data yet, but the last 2 days of testing are up there, as well as her hypo day from the 11th.

    It is possible that my vet misunderstood my question when I was asking about the lymphoma possibility - we were discussing over the phone and there was another instance during the conversation that she misheard our question so she may have been answering a question that she heard but we did not ask (if that makes sense). She had mentioned before that treating lymphoma would be tricky in a diabetic cat, so its possible she was just re-answering that same question. I will contact her and ask for clarification.


    I have always given her dose during her dinner because it was how I was instructed to do it when she was first diagnosed as diabetic, and because she didn't notice or care about the shot as much when she was occupied by dinner. I do see that it is generally agreed that an hour, or within an hour after a meal is the better option so I do plan on adopting that plan.

    I feed Boo one can of Fancy Feast Classic twice a day (when she also gets her insulin), but she doesn't eat the entire can at once - she generally will eat somewhere between 1/4 and 1/2 of the can during her "meal" time, and then she goes back to it over the next several hours to finish it. Sometimes she still has food in her bowl when it is time to give her the next meal, but not generally very much.

    Thanks again for helping us!!
     
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  16. Hannah & Boo

    Hannah & Boo New Member

    Joined:
    Jan 19, 2021
    Boo started her insulin again yesterday (the 18th) because my boyfriend and I were concerned with her being off the insulin for 10 days. The timeline went something like this:

    Jan 11th - Boo was getting the somogyi effect from too much insulin and hypo'd at about 2am.
    Jan 12th - Boo had a vet appointment (I did not give her insulin this morning) where the Doctor recommended taking her off insulin for 10 days so we could see what her blood sugar leveled out to be, and to hopefully stabilize her system from the yo-yoing effect of having too high of an insulin dose. She also got an x-ray because the doctor felt an enlarged liver. She saw no masses and said the liver was enlarged but smooth - she thought the enlargement could have been because of diabetic issues.
    Jan 13-14 - Boo seemed to be feeling quite a bit better after getting fluids and B-12 on the 12th.
    Jan 15 - Boo started to cough and get congested in the evening. Her Vet called and mentioned the possibility of lymphoma (she showed Boo's x-ray to a colleague, and the colleague was concerned this may be the reason for the enlarged liver).
    Jan 16 - Boo continues to cough and have some wheezing in her breathing, but it seems to subside over the course of the day. She looks like she is feeling ill, she is tired and goes for food and water every hour or so. She seems weak
    Jan 17 - Boo seems weaker with every day, sleeps most of the day or rests. She still eats/drinks as before - going for something about every hour.
    Jan 18 - We contacted the Vet again because Boo continued to become weaker and more tired, even though she was eating plenty, drinking plenty, and using the bathroom regularly. The Vet agreed that we should try starting her on insulin again - 1 unit, twice a day. We give her insulin that evening after feeding her, and see a marked difference within a few hours - not much, but definitely gaining some alertness that she hadn't had in days.
    Jan 19 - We stopped by the Vet to get some B-12 - she receives the B-12 shot in the morning as well as her insulin after eating. Over the course of today she has definitely gained a bit of strength and has been more alert, though she is still far from 100%.

    I hope this helps! I'm trying to be as detailed as possible without being obnoxious :)
     
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  17. Diane Tyler's Mom

    Diane Tyler's Mom Well-Known Member

    Joined:
    Sep 21, 2018

    Hi Hannah Bron gave you some good advice
    I would test before every AMPS to make sure her BG number is safe enough to shoot
    If you are not sure you can post ? Need to know should I shoot?

    Then I would get a test @+1 , if it is much lower than the pre shot it might be an active cycle so you would need to test as needed .
    I would get a test @+1, @+3. @+5
    Then start to test at different times a day @+2. @+4. @+6.
    If you can @+8 and maybe @+10
    You want to try and fill in the SS with different times like doing a puzzle

    Night time make sure to get a PMPS to see if it's safe to shoot
    Cats tend to drop lower at night so you need to get some tests in also

    We want to see how the insulin is working for Boo and how low it's dropping and when.

    You test , feed, then wait an hour to give insulin with Novolin N
    I agree with Bron I would go back to Lantus,
     
  18. Diane Tyler's Mom

    Diane Tyler's Mom Well-Known Member

    Joined:
    Sep 21, 2018
    Lantus is given twice a day every 12 hours.
    A cat can have a hypo on any insulin, but Lantus is a longer lasting and more gentle insulin.
    That's why we test often to catch if the BG is dropping to low , we then intervene
    feeding either medium or high carb foods if needed.
    You would want to have med and higher carbs and Karo in the house
    Fancy Feast Gravy Lovers med and high carbs for that.
    I will post further down our food chart and give you some suggestions

    We can also tell you where to buy the Lantus Pens which we use like a vile
    We buy from Marks Marine in Canada it's much cheaper and 5 pens would last you at least a year. We can talk about this later if you switch to Lantus
     
  19. Bron and Sheba (GA)

    Bron and Sheba (GA) Well-Known Member

    Joined:
    Feb 21, 2015
  20. Diane Tyler's Mom

    Diane Tyler's Mom Well-Known Member

    Joined:
    Sep 21, 2018
    We do feed our cats multiple times per 12 hour cycle, it's easier on the pancreas
    The bigger meal in the morning and dinner time
    Then smaller meals in between, like maybe 2 tablespoons mixed with water
    You should add some water to all the meals

    You want to withhold food 2 hours to testing the AMPS and PMPS because you don't want it to be food influenced.

    How much does Boo weigh, is she under weight
     
    Last edited: Jan 19, 2021
  21. Diane Tyler's Mom

    Diane Tyler's Mom Well-Known Member

    Joined:
    Sep 21, 2018
    @Bron and Sheba (GA) thanks Bron for helping out :cat:
    If you see that I have given any information please let me know
     
  22. Diane Tyler's Mom

    Diane Tyler's Mom Well-Known Member

    Joined:
    Sep 21, 2018
    https://felinediabetes.com/FDMB/threads/dr-pierson-new-food-chart.174147/

    Here is the food chart we like to stay under 10% carbs, you are feeding FF Classic Pate so that is good , they are either 2 or 3 percent carbs





    You should also have these in the house if Boo ever drops too low and you need to bring her BG up. Also have honey or Karo in the house
    Such as




    Fancy Feast Gravy Lovers Gourmet Beef Feast in Gravy 20% High Carbs


    Fancy Feast Gravy Lovers Gourmet Chicken Feast in Gravy. 15% Med Carbs




    Fancy Feast Gravy Lovers Turkey Feast in Gravy. 15% Med Carbs


    Fancy Feast Gravy Lovers Chicken and Beef Feast in Gravy 15% Med Carbs

    It's mostly the gravy that has the higher carbs in it

    Look at the food link I gave you , you might see other ones you may want to try
     
    Last edited: Jan 19, 2021
  23. Diane Tyler's Mom

    Diane Tyler's Mom Well-Known Member

    Joined:
    Sep 21, 2018
    Using half unit marking syringes makes it easier to increase or decrease the insulin.
    We increase or decrease by 0.25 units


    Using syringes with a pen, cartridge, or vial:
    • U-100 3/10cc syringes with half unit markings are the best to use for drawing Lantus, Basaglar, or Levemir from vials, cartridges, and pens.
    • BD Ultra-Fine, CarePoint Vet, Monoject, GNP, UltiCare Vet Rx, Sure Comfort, and ReliOn are just some of the brands available with half unit markings.
    • Syringes come in ½ inch or 5/16 inch needle lengths. Needle gauges are 29, 30 or 31 (31 being the thinnest)
    • Full and half-unit syringe scales:
    [​IMG]
     
  24. Diane Tyler's Mom

    Diane Tyler's Mom Well-Known Member

    Joined:
    Sep 21, 2018
    Hannah I don't know how much you pay for you accu chek nano test strips
    Question when I looked up the meter you use why does it say it's discontinued?
    Just curious , you can still get test strips for it?

    If you ever want to save money most of us use The Relion Prime Meter from Walmart. It's 9 dollars
    17.88 for 100 test strips , you will be testing a lot in the beginning
    We use 26 or 28 gauge lancets, makes the ears bleed better
    Or The Relion Premier

    Just a suggextion
     
  25. Diane Tyler's Mom

    Diane Tyler's Mom Well-Known Member

    Joined:
    Sep 21, 2018
    In case you decide to switch



    https://rxcanada4less.com Marks Marine pharmacy

    Here is the link for Canada with the pens we use them like a vial because with the pens you can only increase or decrease by whole units, so you would just take your syringe and stick it in the little grey rubber stopper and just draw the insulin from that







    Lantus Solostar Cartridges 5x3ml per box (temp. gauge. ice pack, express-air mail) Brand 100u/ml 15 ml $159.99 USD
    [​IMG]
    [​IMG] Lantus Solostar PEN CAN (temp. gauge. ice pack, express-air mail) *single pen open box* Brand 100iu/ml one pen 3 ml $49.99 USD
    [​IMG]
    [​IMG] Lantus Solostar PENS 5x3ml per box (temp. gauge. ice pack, express-air mail) Brand 100u/ml 15 ml $164.99 USD
    [​IMG]
    [​IMG] Lantus VIAL Insulin (10ml per vial) (temp. gauge. ice pack, express-air mail) Brand 100u/ml 10 ml $110.99 USD


    Like I said you are better off buying the 5 pack of pens
    They will last you way over a year depending on how many units you give
    After your vet writes the first script you won't ever need another script.
    Call them and will tell you what to do
    They are very nice people

    Oh when you buy the pens they will have an expiration date on them
    Most likely 2022 or 2023 by now.
    Put them in the frig , a middle shelf
    As long as you don't puncture them they will be good until the expiration date
    So you are actually saving a ton of money


    We also use syringes with half unit markings.
    We increase or decrease by 0.25 units at a time.
    It makes it easier using the half unit syringessyringes
    For Lantus you will be using U-100 syringes
    Have your vet write the script for the 5 pack of pens
    [​IMG]
     
    Last edited: Jan 20, 2021
  26. Diane Tyler's Mom

    Diane Tyler's Mom Well-Known Member

    Joined:
    Sep 21, 2018
    Hannah just wanted to tell you that you couldn't have landed in a better place than this forum.
    There are many experienced members here , very supportive and caring.
    In my opinion they know more than most vets do when it come to diabetes
    and other things
    If it wasn't for this group and their advice and guidance my Tyler would not
    be doing the OTJ TRIAL ( Off The Juice Trial) he was on Lantus ,right now no
    insulin , in 5 more days if his BG stays as good has it has been , he will be considered in remission, will always be a diabetic but food controlled.

    You couldn't be in better hands.
    I love my vet and told her about this group, printed a ton of posts from here and gave them to her and I tell you she was so impressed. I think I taught her a few things :p
    She is always on board with me and let's me do what I want to do when it comes to
    Tyler, she works with me and trusts my decisions

    Just keep asking questions , we all did in the beginning and still do :cat:
     
  27. Bron and Sheba (GA)

    Bron and Sheba (GA) Well-Known Member

    Joined:
    Feb 21, 2015
    Hannah thanks for the detailed information about the last 10 days. you are not being obnoxious at all!
    I am SO glad Boo is back on insulin and having it twice a day.
    I can see you have the signature and the SS up and running.....fantastic!
    Looking at the SS you have reduced the dose from 2 to 1 unit of Novolin.

    It is important to also get tests in during the PM cycle as cats often drop lower at night. I would always get a + 2 and a before bed test in every night if you can. If the Bg is continuing to drop I would test again until it is on the way back up if you can.

    Continue feeding an hour before the insulin dose.
    It is also OK to give him a snack while you give the shot if that helps. I would also give him a snack at +1 and +2 as that is when the Novolin will be very active and this might stop a fast drop which can cause bouncing up into high numbers.
    And then other snacks during the cycle except for the two hours preshot.
    Did you have a chance to read the information I sent about Novolin?

    I would still test for ketones in the urine, it is really important to check there are none of those around. Can you put the result of the ketone tests in the remarks column of the SS please?

    Diane has given you lots of good information too.
    The accuchek is a good meter.

    Keep asking questions and please keep us informed as to how he is going.
     
  28. Bron and Sheba (GA)

    Bron and Sheba (GA) Well-Known Member

    Joined:
    Feb 21, 2015
  29. Hannah & Boo

    Hannah & Boo New Member

    Joined:
    Jan 19, 2021
    Got it - I had no idea that cats go lower at night, but that would answer the question of why she has never had a hypoglycemic episode during the day, it's always in the middle of the night! Which was always scary and confusing.

    I definitely have an email ready for my Vet to inquire about getting Lantus again.
     
  30. Hannah & Boo

    Hannah & Boo New Member

    Joined:
    Jan 19, 2021
    Oh wow ok. I could have sworn when I did it before it was an every 24 hours thing.. I wonder if that is in fact what we did, and because we were giving her too much she ended up with the somogyi effect on it and THAT is why we stopped giving it to her! That would make a lot of sense :( It makes me a little sad, because that was years ago.. she could have been on Lantus this entire time.

    We definitely have Karo available, and also some gravy lovers Fancy Feast which we had been feeding her regularly but have stopped ever since this all started happening. I feel awful because I am sure I made her diabetes worse when we were feeding her that - the Vet said it was OK to, so I'm kicking myself for not looking into it further.

    I am from the US - can I still buy Canadian? or will I need to find a US supplier? I'll be sending my Vet an email tomorrow regarding switching her over to Lantus.
     
  31. Bron and Sheba (GA)

    Bron and Sheba (GA) Well-Known Member

    Joined:
    Feb 21, 2015
    Diane has sent you the link above in post 24 for Marks Marine Pharmacy in Canada. you just need to get a script from your vet and fax/email it to the pharmacy and they will send you the Lantus. Once you have sent the initial script you don’t need to keep sending the scripts, but can keep ordering it.
     
  32. Hannah & Boo

    Hannah & Boo New Member

    Joined:
    Jan 19, 2021
    That sounds good - It is basically how she eats already, but I can try to do it in a more structured way where I am giving her more at feeding time and then giving her snacks in between. I have already been adding water to her meals for years so we have that covered at least :)

    When she was last at the Vet's they weighed her at 6 lbs :( She is very skinny, and certainly under weight.
     
  33. Hannah & Boo

    Hannah & Boo New Member

    Joined:
    Jan 19, 2021
    Thank you, this is super helpful! The syringes we currently use are very difficult to measure anything past 1/2 unit on.
     
  34. Hannah & Boo

    Hannah & Boo New Member

    Joined:
    Jan 19, 2021
    I can still get strips for the meter that we use, but they have recently gotten very very expensive ($100 for 50 of them when last year they were about $30 for 50).
    I'll definitely check out the Relion, thank you for the suggestion! I would be fine moving to another meter that works just as well and has cheaper test strips :)
     
  35. Hannah & Boo

    Hannah & Boo New Member

    Joined:
    Jan 19, 2021
    OK excellent, thanks very much for the information and the links!!
     
  36. Hannah & Boo

    Hannah & Boo New Member

    Joined:
    Jan 19, 2021
    Yes - after the hypo on the 11th the Vet decided she should not be on 2 units. She was experiencing somogyi effect and it was getting very very dangerous.

    I did get to read that, thank you for linking it to me! I see that the Novolin is no longer recommended for cats, since 2018. This makes me want to move over to the Lantus even more.

    Yes - I have purchased a box of Ketostix that should arrive at my home before the week's end. We are in a high risk household or I would have gone to a store for them. Hopefully getting them in a couple of days is still fine - I will certainly update her sheet once we have those.

    Thank you again for all of the helpful tips!!
     
    Bron and Sheba (GA) likes this.
  37. Hannah & Boo

    Hannah & Boo New Member

    Joined:
    Jan 19, 2021
    Oh that's fantastic!
    I remember asking about the possibility of insulin being shipped directly to us, and both the Vet and the Walmart that we generally get her insulin from were incredulous - they were certain that you cannot ship insulin.
     
  38. Red & Rover (GA)

    Red & Rover (GA) Well-Known Member

    Joined:
    May 18, 2016
    Wow. You and Boo have been through the wringer and have dodged a couple of life threatening bullets.

    If Boo has another low number episode, you can post in the forum and someone will stay with you until Boo is out of danger.

    Just in case:
    Note: some cats become insulin sensitive after a hypo.

    You mentioned in an above post that Boo does not eat as much as she should. Two cans of Fancy Feast is not enough.
    There are low carb alternatives to Fancy Feast that may have a higher calorie content.
    Look for foods under 10% carbs, then check their calorie content.
    Here is a general formula for calories.
    Required calories per day = [13.6 X optimal lean body weight in pounds] + 70

    You also mentioned somogyi effect. There's really no such thing. What you were seeing is likely "bouncing."
    Definition of a bounce: Bouncing is simply a natural reaction to what the cat's system perceives as a BG value that is "too low". "Too low" is relative. If a cat is used to BGs in the 200's, 300's, or higher for a long time, then even a BG that drops to 150 can trigger a "bounce". Bouncing can also be triggered if the blood glucose drops too low and/or too fast.The pancreas, then the liver, release glucogon, glycogen and counter-regulatory hormones. The end result is a dumping of "sugar" into the bloodstream to save the cat from going hypoglycemic from a perceived low. The action is often referred to as "liver panic" or "panicky liver". *Usually*, a bounce will clear kitty's system within 3 days (6 cycles).

    Basically, the body thinks the numbers are too low and responds by releasing a whole pile of sugar into the system. It can take up to a couple of days for a bounce to subside.

    Tagging
    @Critter Mom
    and
    @JanetNJ
    for Novolin experience.
     
  39. Hannah & Boo

    Hannah & Boo New Member

    Joined:
    Jan 19, 2021
    Thanks very much for the resources!
    Do you have any recommendations for what food could be better for her? I was under the impression that the low carbs is the most important thing, but I am struggling to find foods on the list that are as low carb and have more calories in them. I'm not certain that I can get her to eat a greater volume of food, but I can certainly try, especially if it is a new food that she might like better than the FF Classics.

    I might be able to get her to eat a greater volume of food by enticing her multiple times over the course of the day to eat more, would that be as effective? Thanks again for the recommendation. She had been maintaining a decent weight until very recently, and I fear it may be my fault for giving her Gravy Lovers food for several weeks during all of this havoc that has been going on. Could that high carb food have been contributing to her weight loss? She would eat four cans of that per day, but still be losing weight.

    I did mention the Somogyi effect, but the description that you give "bouncing" sounds like exactly what I thought the Somogyi effect was defined as.. I guess I have my definitions off, but your description of "bouncing" is certainly what I mean - she can get too low on insulin which can skyrocket her blood sugar levels and makes for a rollercoaster of blood sugar levels.

    EDIT: I also was looking through the Food Chart and it seems that some of the foods may have been renamed - for example, the entire Tiki Cat line doesn't seem to have the same names listed anymore (or maybe I just can't find the ones on the list!). Is there any good way to tell what foods may have been renamed and what they would correspond with on the list?
     
    Last edited: Jan 20, 2021
  40. Hannah & Boo

    Hannah & Boo New Member

    Joined:
    Jan 19, 2021
    Just a quick update on Boo.

    This morning she had a snotty nose and is still very lethargic. After calling the vet they are having her to come in for another checkup. I'm so nervous, and scared that she may truly have lymphoma :(

    I'll update as we hear news.
     
  41. Critter Mom

    Critter Mom Well-Known Member

    Joined:
    Jun 16, 2014
    As a precaution, make sure the vet checks for ketones.

    (((Boo)))


    Mogs
    .
     
  42. Diane Tyler's Mom

    Diane Tyler's Mom Well-Known Member

    Joined:
    Sep 21, 2018
    Hannah please let us know when you get back from the vets ♥:bighug::bighug::bighug:
     
  43. Red & Rover (GA)

    Red & Rover (GA) Well-Known Member

    Joined:
    May 18, 2016
    Some of the low carb kitten foods are higher in calories.

    Here's some more reading for you. The snotty nose may be interfering with her ability to smell food.
    I can't help you with name changes. I have not been in a pet food store since Rover passed. The neighbourhood cats get Fancy Feast and Friskies when they come for a visit.

    I hope you get some answers and a treatment plan at the vet.
     
    Diane Tyler's Mom likes this.
  44. Diane Tyler's Mom

    Diane Tyler's Mom Well-Known Member

    Joined:
    Sep 21, 2018
  45. Hannah & Boo

    Hannah & Boo New Member

    Joined:
    Jan 19, 2021
    Hi everyone,

    Thanks for the support and kind words :bighug:

    The Vet has told us that boo's snotty nose is because her gums where her dental work was done are still not completely healed. She also agreed with us about the Lantus - she wants to switch her over to it - BUT - she wants to check for systemic issues before making that change.

    Tomorrow, we will be bringing Boo to an animal hospital about an hour away to get her an abdominal ultrasound as well as a fine needle aspirate. Our doctor assures us that this test will let us know definitively if we are dealing with issues that are cropping up due to her diabetes, or something else (lymphoma is the big worry).

    I'll update again tomorrow once we get home, in the evening. Thanks again for all of the support, you are a fantastic community.

    @Critter Mom - I saw your post too late to mention to the doctor, but I did double check and on 1-12-21 they did do a "Urinalysis (SediVue Dx)" (taken from my invoice). She had been brought in at that time for her diabetes acting up, so my assumption (hope) is that urinalysis would have checked for Ketones, but I will certainly mention it after tomorrow. Thank you!
     
  46. Diane Tyler's Mom

    Diane Tyler's Mom Well-Known Member

    Joined:
    Sep 21, 2018
    Please keep us updated ok, praying for Boo ♥♥:bighug::bighug:
     
  47. Critter Mom

    Critter Mom Well-Known Member

    Joined:
    Jun 16, 2014
    Hi Hannah,

    I'm glad to hear that your vet's agreed to look at Lantus for Boo. The typical action of Novolin N is quite harsh in cats. There's not much data yet, but Boo's response looks quite typical in that BG drops like a rock early in the cycle, and then climbs steeply many hours before the next dose is due - all due to the characteristics of the insulin. Hopefully Lantus will act more gently and give Boo better duration when she switches.

    On ketones, as a general safety precaution it's advisable to test daily - especially when there's inflammation or possible infection/other systemic stressor in the picture - because if a problem develops ketone levels can build up within hours. You should be able to get urine ketone test strips at any pharmacy. More info and tips:

    Ketones, Diabetic Ketoacidosis and Ketone Meters

    Tips for Collecting Urine Samples


    Mogs
    .
     
    Diane Tyler's Mom likes this.
  48. Red & Rover (GA)

    Red & Rover (GA) Well-Known Member

    Joined:
    May 18, 2016
    If you have copies of the lab work (you are entitled to see them), you can add the results to your spreadsheet. Look for the blue LABS in the upper lefthand corner. There are people here who are quite adept at reading lab results.

    That's a big drop from 540 to 190 in 3 hours. Try to get Boo to eat something to slow the drop.
     
    Diane Tyler's Mom likes this.
  49. Critter Mom

    Critter Mom Well-Known Member

    Joined:
    Jun 16, 2014
  50. Hannah & Boo

    Hannah & Boo New Member

    Joined:
    Jan 19, 2021
    I have gotten her to eat some, and just tested her at 175. Will retest next hour to make sure that she is going up. She has some weakness in the back legs right now, it was very prominent when she first got out of her cat carrier after coming home from the vet. We are getting ketostix and will test her as soon as she pees again.

    Edited to mention that she just got up and stepped down her little kitty steps to get some water and her back legs seem much better than earlier. When she first came back from the vet she was splaying the back legs and struggling to walk. She still seems a bit weak in the back legs right now but not anywhere near as bad as earlier. She's having a drink as I type :)
     
  51. Critter Mom

    Critter Mom Well-Known Member

    Joined:
    Jun 16, 2014
    Poor girl! (((Boo))) Did they sedate her while she was at the vets?


    Mogs
    .
     
  52. Hannah & Boo

    Hannah & Boo New Member

    Joined:
    Jan 19, 2021
    Nope, no sedation today.
     
  53. Hannah & Boo

    Hannah & Boo New Member

    Joined:
    Jan 19, 2021
    I did get her to finally pee - she has been refusing to for hours, so I took her out to her bathroom and sat her there and that was apparently the prompting she needed! She tested negative for ketones - I tested the sample twice just to be sure I was doing it properly (waited 15 seconds each time and compared it to the bottle - I am certain the color never changed either time)!
     
    Critter Mom and Red & Rover (GA) like this.
  54. Hannah & Boo

    Hannah & Boo New Member

    Joined:
    Jan 19, 2021
    Very sad news.. Boo has lymphoma :(
    We are heartbroken and trying to figure out if there's anything we can do for her. Unfortunately, because of the diabetes it seems as though steroid therapy is off the table because it would raise her blood sugar. We aren't sure that any of the other options (radiation, chemo) are viable for her because of her age and diabetes, but we are waiting to hear back about the staging of the cancer to decide anything.

    For now, she is still eating and getting around OK and that's the best we can hope for, but we are absolutely devastated.

    Thanks again everyone for trying to help us regulate her, but with this diagnosis I think her diabetes is just going to be difficult no matter what. I will still be using the spreadsheet to track her - it's a great resource! Again, thank you everyone for your suggestions and help. We really appreciate everything.
     
  55. Diane Tyler's Mom

    Diane Tyler's Mom Well-Known Member

    Joined:
    Sep 21, 2018
    I'm so so sorry Hannah, I hope it was caught early. Please keep us updated , sending prayers for your sweet Boo ♥♥:bighug::bighug:
     
  56. Critter Mom

    Critter Mom Well-Known Member

    Joined:
    Jun 16, 2014
    I am very sorry to hear about Boo's diagnosis. :(

    Please let us know how things go with the oncologist. If they consider it treatable then keep in mind that, while it ultimately depends on the particulars for each cat, it is possible to give steroids to diabetic cats and adjust the insulin dose based on the cat's response. Also, age in and of itself may not be a bar to treatment (we have a 16-year-old here at the moment who's being treated with a chemo med plus pred).

    Sending prayers for you all, but especially for Boo.

    (((Boo)))

    :bighug:


    Mogs
    .
     
    Christie & Maverick likes this.
  57. Christie & Maverick

    Christie & Maverick Well-Known Member

    Joined:
    Aug 1, 2017
    I'm sorry about the diagnosis. I wouldn't completely discount the use of steroids if it will help her. You can always adjust the insulin dose if required, to manage the blood sugar levels.
     
    Critter Mom likes this.
  58. JL and Chip

    JL and Chip Member

    Joined:
    Dec 28, 2009
    How did they diagnose the lymphoma? Many of our cats have multiple issues — It’s not impossible to treat both lymphoma and diabetes concurrently.
    @Wendy&Neko
     
    Critter Mom likes this.
  59. Hannah & Boo

    Hannah & Boo New Member

    Joined:
    Jan 19, 2021
    Hi everyone,

    Thanks for the well wishes.
    They diagnosed with an abdominal ultrasound. We are still waiting on the needle aspirates to come back, but they saw issues with her liver, kidneys, intestines, and also a lymph node near her intestines. We are certainly going to see about what treatment options she has after the aspirates come back. We just want her to be as comfortable as possible at this point, and I'm mostly worried about her being able to tell me when it's "time". I do not want her to suffer, I just want her to be happy and with us as long as possible. I know this is a tricky thing to get right.
     
  60. SweetAngel

    SweetAngel Member

    Joined:
    May 30, 2014
    I'm so sorry to hear about your precious Boo.
    I know exactly what you mean, my Angel has recently been diagnosed with kidney failure and I said to the vet I want him as well as possible for as long as possible. I think you will know in your heart when she wants to go to Rainbow Bridge. Hopefully she can be happy and healthy for a good while yet. xx
     
  61. Wendy&Neko

    Wendy&Neko Senior Member Moderator

    Joined:
    Feb 28, 2012
    There are many types of lymphoma, some are very treatable. Cats can go into remission, again, depending on type of lymphoma and treatment. There are alternatives to prednisolone, which does raise blood sugar. For example, budesonide is a locally acting steroid that helps if you are dealing with small cell lymphoma in the bowels. But if a cat cannot have those alternatives and needs pred to live, then we just work the insulin dose around the prednisolone.

    You absolutely cannot diagnose which type of lymphoma with just an ultrasound. More sampling is needed. Aspirate testing only helps with some type of lymphoma, not all.

    Reading through all this, I've been wondering if it's time you switched to an internal medicine vet to help Boo. Several things about your vet make me think the situation has "gotten above his/her pay grade". Internal medicine vets are great at helping multiple conditions, and tend to be more up to date on the latest treatments with things you are dealing with.
     
  62. Hannah & Boo

    Hannah & Boo New Member

    Joined:
    Jan 19, 2021
    Thank you for the insight @Wendy&Neko . We are awaiting the results of Boo's aspirates, hopefully hearing something from the lab/vet today or tomorrow.
    Our main concern is of course Boo's comfort. She gets very stressed when she's taken out of her comfort zone (I'm sure like many cats), and she is pretty frail right now. We worry that putting her through chemotherapy would not only be too stressful for her, but because of her frailty that it would not improve her quality of life, especially for the duration. I'm definitely all for hearing alternatives of medicines we can give her - the vet has been very dismissive of using prednisolone on her because of her diabetes, and it's really disheartening. I will certainly mention budesonide and ask if it is a possibility for Boo once we hear more about her diagnosis.

    There is another Doctor at the vet that we go to that has Internal Medicine listed as a "medial interest" on her profile.. I assume this means that she is studying it but has not mastered it yet, but we will be asking for her advice going forward. We are not opposed to going to other vets in the area, but again we hesitate to have to make too many trips outside of the 1/2 hour range for Boo because it impacts her so much to have to travel. I wish we lived in a more populated area for things like this :(
     
  63. Critter Mom

    Critter Mom Well-Known Member

    Joined:
    Jun 16, 2014
    As you're already considering, seeking a second opinion may be a good idea if prednisolone is indicated as a possible therapy for Boo.


    Mogs
    .
     
  64. Wendy&Neko

    Wendy&Neko Senior Member Moderator

    Joined:
    Feb 28, 2012
    Cats handle chemo much better than people do. You an anti nausea med like ondansetron and/or Cerenia before hand to prevent nausea. The one I'm giving is once every two weeks and quite mild. Of course, that's for small cell lymphoma. Different treatment for different lymphomas. Once the cat starts getting treatment, it can help them feel better.
     
    Critter Mom likes this.
  65. Hannah & Boo

    Hannah & Boo New Member

    Joined:
    Jan 19, 2021
    I just want to thank everyone here for their wonderful support. If I ever have another diabetic cat again you can bet I'll be here every day. You guys offer a wonderful support group and service to owners and animals alike - thank you so much. I wish I had taken advantage earlier.

    Unfortunately, Boo's cancer rapidly spread and was in a lymph node pushing on her larynx. We made the sad decision to put her to sleep yesterday. It was my worst day, I've never been as sad as this before, but she was struggling to breathe and we know it was the right choice. I'll miss her every day, and the next few weeks and months will be particularly hard.

    Again, thank you everyone to contributed. We did our very best to help our girl, and she had a few really good days towards the end - no doubt in part because of the guidance you all gave us.
     
  66. SweetAngel

    SweetAngel Member

    Joined:
    May 30, 2014
    I'm so very sorry that you had such a short time with Boo. She knew she was loved, she had those precious days towards the end, and she let you know when she was ready.
    You did everything you could, with bereavements I always feel at a loss what to say because no words however heartfelt they are can bring the loved one back.
    Thinking of you and sending hugs. x
     
  67. Dyana

    Dyana Well-Known Member

    Joined:
    Dec 28, 2009
    I'm so sorry Hannah. Boo knows how much you love her.
     
  68. Critter Mom

    Critter Mom Well-Known Member

    Joined:
    Jun 16, 2014
    Oh Hannah, I'm so sorry to read your sad news, but you gave Boo a life full of love and happiness and, when the time came, you gave her the greatest gift of all in saving her from suffering.

    When I lost my Saoirse, someone sent this to me and it brought me some comfort. I hope it might bring you a little comfort too.

    The Loving Ones

    We never have enough time with them.

    (((Hannah and Spirit Boo)))

    :bighug:


    Mogs
    .
     
  69. Wendy&Neko

    Wendy&Neko Senior Member Moderator

    Joined:
    Feb 28, 2012
    My deepest sympathies Hannah. Boo will always be in your heart. :bighug: Take care of you too, this is a tough time for caregivers, especially for those complicated kitties.
     
  70. Luxe

    Luxe Member

    Joined:
    Nov 23, 2020
    So sorry for the loss of your Boo. Sending lots of hugs your way
     
  71. Gill & Mac (UK)

    Gill & Mac (UK) Member

    Joined:
    Aug 19, 2020
    That's beautiful Mogs
    Gill
     
  72. Gill & Mac (UK)

    Gill & Mac (UK) Member

    Joined:
    Aug 19, 2020
    So sorry to hear that you have lost Boo. She will live on in your heart and your memories forever.
    :bighug:cat_wings>o
     
  73. Gill & Mac (UK)

    Gill & Mac (UK) Member

    Joined:
    Aug 19, 2020
     

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