New Diagnosis - Lack of appetite? Canadian Glucose Monitor?

Discussion in 'Feline Health - (Welcome & Main Forum)' started by MrQuotidian, Sep 22, 2020.

  1. MrQuotidian

    MrQuotidian New Member

    Joined:
    Sep 22, 2020
    Hi, Oliver is a 13-year old male cat diagnosed on 9/19 with feline diabetes. He has always been large/overweight, around 18-20lbs. Prior to diagnosis he had started drinking a ton, was ravenously hungry, and urinating 5 times a day. He had also become pretty lethargic, dropped weight to 17.25lbs, and had become reluctant to jump up as he used to. These were the blood/urine results from the vet:

    Glucose 28.4 mmol/l = 511.7169 mg/dl <-- Had to convert this
    Fructosamine a669

    The vet prescribed 3 units of lantus, twice daily, which I started on Saturday night... This was frightening because by the next day Oliver had stopped eating much (maybe 1/10 of previous intake), and became very lethargic. I gave him only 1 unit for the next dose and he was more active by the end of the day, but have not continued regularly with the insulin since he is not eating full meals nor retuning to normal activity levels... I gave .5 units last night after feeding. Proper energy level is hard to guage because he was becoming very lethargic even before diagnosis.

    Yesterday I switched him to fancy feast wet food (he was previously a dry-food addict), and he seems to be eating a bit more... I got him to eat 2.5 (85g) cans yesterday, but at his weight, this is not quite a full meal as I understand it? He ate most of one can this morning.

    I spoke to the vet on the phone and they were not helpful, telling me to give 2 units instead of 3... That seems like way too much if he is not eating much and lethargic. I want to avoid taking him back to the vet as the stress is not good for Oliver, plus I don't entirely trust the staff. What do you all recommend as a course of action? Should I get him to eat regularly before any more insulin?

    I would like to home-test his glucose levels before giving more insulin, but I live in Canada so Walmart does not have the ReliOn brand... Any suggestions for Canadian glucose monitors? Accu-Chek and OneTouch are available at the local drug store...

    Thank you in advance - I have already learned a lot from reading other posts!
     
  2. jt and trouble (GA)

    jt and trouble (GA) Well-Known Member

    Joined:
    Dec 28, 2009
    Welcome to FDMB! We are so glad you've found us. We are a dedicated community of cat lovers that share the same ting you now do, feline diabetes. Theres a wealth of information here with good people to help you better navigate this disease.

    Boy I'm GLAD you dropped that dose! Even with Olivers weight (which is how vet dose dogs) 3 units is a high amount of insulin for newly DX'd kitty. I'm sure we can help you get this sorted.
    First please have a quick read here:
    New? How You Can Help Us Help You!
    This link will give you an idea how to better spend your time here AND help us help Oliver more
    efficiently.

    The not eating IS concerning. Did your vet say anything about keytones? They can develop when a diabetic doesnt get his insulin ans doesnt eat enough food. you can read more about that here:
    Ketones, Diabetic Ketoacidosis (DKA), and Blood Ketone Meters
    (This is not to scare you but to inform you)

    You and Oliver have landed in a safe place to learn everything you need to know about FD

    WELCOME TO OUR FAMILY:bighug:
    jeanne
     
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  3. jt and trouble (GA)

    jt and trouble (GA) Well-Known Member

    Joined:
    Dec 28, 2009
    Can you tell us what kind of insulin Oliver was prescribed?
     
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  4. jt and trouble (GA)

    jt and trouble (GA) Well-Known Member

    Joined:
    Dec 28, 2009
    btw Oliver is very handsome! :bighug:

    I'm looking for Canadians brb;):coffee:
     
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  5. Red & Rover (GA)

    Red & Rover (GA) Well-Known Member

    Joined:
    May 18, 2016
    Waving from Ontario.

    Three units of Lantus is a huge starting dose. It may be that the dose is needed but it is recommended to start with 1 unit and go up in 0.25 unit increases.

    Meters.
    Lantus is inexpensive in Canada, but strips for meters are not.
    A lot of people use the FreeStyle Lite meter (strips $80/100 - and you are going to go through more strips than you think). The advantage of the Freestyle Lite is that it takes the smallest amount of blood (0.3).
    There is a coupon for a free meter here. Just don't tell them that the meter is for a cat.
    https://www.freestyle.abbott/ca/en/order/lite.html

    There are cheaper options but the downside is that you have to order the strips online and cannot go running out to the drug store to buy more strips in an emergency. It is important to always keep at least 50-100 strips in a hypo kit.
    By the way, changing from dry food to low carb wet food can make a difference of up to 5/100 points.


    If you go with the Freestyle Lite, save up and use your PC points at Shoppers to buy the strips. If you have a senior citizen handy, take advantage of seniors days.

    One online option is the Bravo meter. The strips are half the price but it requires a 0.6 drop of blood and you need to order strips online.
    https://diabetesexpress.ca/products/bravo-meter

    There is another online glucometer and strip service. Give me a few minutes to remember who in Canada is using it. There are quite a few Canucks here.
     
  6. jt and trouble (GA)

    jt and trouble (GA) Well-Known Member

    Joined:
    Dec 28, 2009
  7. Red & Rover (GA)

    Red & Rover (GA) Well-Known Member

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    May 18, 2016
    I'm tagging @Sam&Milo&Singha who uses a subscription service for the One Touch.
     
  8. Red & Rover (GA)

    Red & Rover (GA) Well-Known Member

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    May 18, 2016
    It is recommended to do a food switch gradually.
     
  9. Sam&Milo&Singha

    Sam&Milo&Singha Member

    Joined:
    Jul 2, 2020
    Hi there from northern Ontario! I can try to write more later when I'm home from work. I have just started on the subscription plan from OneDrop (unlimited strips=most expensive, approx $108 CAD/month). The meter is free and you can order up to 300 strips at a time. It is still cheaper than the Contour Next strips that I was using per month. I would recommend checking it out. Reordering is easy from the app on your phone. It syncs the BG to the app, as well. Once I have a good amount of extra strips, I might try to drop down to a plan where it's 100 strips/month for a while. DO NOT tell them it's for a cat. Apparently that does not go over well.

    I am relatively new here but I can tell you this: the collective membership of this site is WWWWAAAAAAYYYYY more knowledgeable than any vet AND far more accessible for information when you need it (literally within minutes many times, especially in an emergency, use the 911 tag). My vet is not intimidated by this and has said I am managing my cat far better than he could.

    I have not yet invested in a blood keytone meter but when I have some extra $$, this is something I'm looking into, as well. My understanding is that high BG and lack of eating can cause ketoacidosis. In the meantime, keytone strips for urine is a good way to go, in my opinion, especially if he's peeing a lot daily. Follow him to the litter box and stick the strip in the stream of urine or buy a ladle and collect the urine that way. My strips you read at 15 secs. It gives some peace of mind.

    I hope this is helpful. Good luck. It's a steep learning curve but you won't find more expertise than with the wonderful volunteers here!
     
  10. MrQuotidian

    MrQuotidian New Member

    Joined:
    Sep 22, 2020
    Wow, thank you so much already everyone! I am also at work now so not able to properly respond, but your comments and links are very appreciated.

    I will definitely get some keto strips for testing Oliver's urine, so I can at least be sure his glucose level is not dangerously low. I should have mentioned, since giving the first dose of insulin, he is urinating and drinking much less than the elevated levels of the recent past. He urinated twice yesterday, which was his normal rate prior to his recent health problems.

    Luckily, he is eating and drinking, just at a very reduced amount (he is leaving most all the dry food in the bowl, only eating a few kernels). He ate one small can of fancy feast so far today.. I have never had much luck getting him to eat wet food in the past, but hopefully this time he takes to it. I gave him no insulin so far today (lantus).

    I guess the best short term course of action is to get testing strips to make sure he is not in hypo, encourage him to eat, and then give a small dose (.25-.5 units?) of lantus?

    Hi to Ontario! Waving from Western BC.
     
  11. jt and trouble (GA)

    jt and trouble (GA) Well-Known Member

    Joined:
    Dec 28, 2009
    This is completely NORMAL
    And we can help you with all of this as well. ;):coffee:
    Looking forward to getting to know you and hubba hubba Oliver :p
    j
     
  12. jt and trouble (GA)

    jt and trouble (GA) Well-Known Member

    Joined:
    Dec 28, 2009
    and YES I'm flirting with you cat :p:smuggrin::cool::D
     
  13. MrQuotidian

    MrQuotidian New Member

    Joined:
    Sep 22, 2020
    :cat: He's flattered, I'm sure. (But to be completely honest, while that photo of Oliver is many years old, he's still a looker in my opinion ;))

    Struck out on the lunchtime trip to Shoppers for keto test strips... Will need to do some after-work searching. and research some of blood monitors suggested. Thanks all!
     
  14. Sam&Milo&Singha

    Sam&Milo&Singha Member

    Joined:
    Jul 2, 2020
    If you get a human meter, I found strips were approx $75-$85 for 100. I blew through those in no time and was buying at least one more package of 100 in a month. No fun. At least with OneDrop I'm not freaking out about whether to buy another box or not before a pay check comes in!
     
  15. Red & Rover (GA)

    Red & Rover (GA) Well-Known Member

    Joined:
    May 18, 2016
    I spent my teens on the island. I do love a ferry ride.
    I'm tagging @Wendy&Neko in North Van for next steps and dosing advice.
     
  16. Wendy&Neko

    Wendy&Neko Senior Member Moderator

    Joined:
    Feb 28, 2012
    Hi there from the North Shore. I found near me that Safeway pharmacy was strangely enough the cheapest source for many diabetic supplies. London Drugs is also good and generally good at giving the free meter with purchase of strips. Shoppers here generally charges 10% more than anywhere else, so saving 10% on points didn't do anything for me. I started with the Freestyle. You want a meter that needs the smallest blood drop - that will make your life easier. I have gotten Ketostix over the counter, well actually just near the counter in most major stores, including Save On. Accucheck is also popular in Canada, the Onetouch needs a larger blood drop than most, though quite reliable, it's what my vet used and she compared it to the lab bloodwork results favourably.

    There are lots of options to Fancy Feast if you need to try something else. What was he eating pre diagnosis?
     
  17. MrQuotidian

    MrQuotidian New Member

    Joined:
    Sep 22, 2020
    Howdy all! Just got back from Shoppers where I discovered that the Ketostix and many diabetes items located behind the counter. Duh. Got the stix, so hopefully I can collect some urine before it would be time to give insulin. Now that I'm reading more about ketones (via the link @jt and trouble provided), I understand that this will help signal if his glucose is wildly out of control.. good to know.

    Thanks @Red & Rover @Sam&Milo&Sing & @Wendy&Neko for your recommendations on blood monitors. The freestyle lite & strips were really expensive at shoppers, so perhaps I can check at the local Safeway (or London Drugs with the cupon - thanks @Red & Rover). I like the idea of using as little blood as possible as I am not used to drawing Oliver's blood! I get that $80 for 100 strips will add up quick so I may need to look into this OneDrop system once I get a handle on this whole situation...

    Before diagnosis Oliver was devouring Royal Canin Urinary SO. This is because he once had a urinary tack infection some 10 years ago and it just became the food he ate. He has been fed from an automatic feeder for about 8 years, which would portion his meals throughout the day. In the past I'd tried to get him to eat fancy wet food at doctor's rec, but he always would eat them for a couple days and then just leave lose interest.

    Now with the fancy feast he has eaten 2 cans today, but I have to keep enticing him to eat. He only seems to like it when I have just put it in the bowl, then just licks up about 50%, before I have to entice him again.. Eventually he eats it all. From my estimation (if each can is 100 cal, and he needs something like 280 calories), 2.5 cans is not far off from where he should be. Maybe it's because he is full, but he has basically not touched the dry food all day. In the past he would hoover that up, so it's a little troubling. I've give no insulin so far today.

    Without the ability to test his glucose level (aside from urine), should I give insulin this evening after I get him to eat a bit more? I'm nervous either way :/

    I'm actually in east Van, but I do love the island. I'm new to Canada - my wife is Canadian and we moved up here last year from California.
     
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  18. MrQuotidian

    MrQuotidian New Member

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    Sep 22, 2020
    Forgot to mention - he's been pretty lethargic... Basically slept the whole day (previously there would be a couple periods of face-time every day). He is alert when I call him and is moving around the house to different spots to sleep, but definitely low energy level.. Drinking water & using the litter box. He seems to be low energy with and without the insulin, but I haven't had enough time to figure out if that's just hangover from before his diagnosis... So many variables.. tough to figure out what's going on with him.
     
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  19. Wendy&Neko

    Wendy&Neko Senior Member Moderator

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    Feb 28, 2012
    Getting those ketones test in will be a help. Lack of appetite (not enough calories in), lethargy, and not enough insulin can be a bad combination.

    Bit of a read, but this puts a lot of the pieces together: What is Feline Diabetes?

    For die hard kibble heads, or as a transition, some times freeze dried raw or air dried food (Ziwipeak) can help give a bit of crunch. With the freeze dried, you gradually add more and more water as a transition. Both options are lower carb.

    Forgot to mention SuperStore as the second cheapest source I found for diabetic supplies.
     
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  20. MrQuotidian

    MrQuotidian New Member

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    Sep 22, 2020
    Ok! I managed to collect some fresh urine from Oliver just minutes ago and tested it with a couple Ketostix, both gave negative results... So at least I know his glucose isn't off the charts... Do I have that right? He also went for a little leashed-exploration outside on the deck (something he likes to do at dusk), so I know he at least feels marginally OK.

    Still, it seems like it would be good to give him a small dose of insulin tonight? .5 units or something? I understand that no one can tell me for sure one way or the other, but any reassurance that it's not a terrible idea might help :)

    Thanks @Wendy&Neko for the link - I will read in-depth to get a better handle on the relationship between all these indicators.
     
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  21. Wendy&Neko

    Wendy&Neko Senior Member Moderator

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    Feb 28, 2012
    Ketostix measure ketones. If you see above trace levels, it means a quick visit to the vet. Lethargy and inappetence along with that are concerning. You can buy Ketodiastix to measure sugar in the urine (and a few other things).
     
  22. MrQuotidian

    MrQuotidian New Member

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    Sep 22, 2020
    Ah, I see regarding ketostix vs ketodiastix.. And if I understand, ketodiastix would only give a historical glucose level - not like measuring sugar directly in the blood, right? So testing urine will just give a ball-park idea? Thanks, I have lots to learn..

    Oliver seems to be doing a little better - I fed him some more dry and wet food around 830pm yesterday and gave .75 units lantus 30 minutes later. He woke me up at 3am for some snuggles and some additional wet & dry food. And he again snuggled with me this morning at the normal time, and ate some more at breakfast. This is beginning to look like normal behavior. I will feed him some more soon give another small dose of insulin.

    I will also see about a glucose meter today and if not perhaps ketodiastix instead. Thanks for your help all!
     
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  23. Wendy&Neko

    Wendy&Neko Senior Member Moderator

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    Feb 28, 2012
    A blood glucose meter is much preferable, you really want to know where there blood sugar is NOW, not a couple of hours ago. Blood sugars can change fairly quickly and by the time a ketodiastix tells you he's low, it's too late.

    Good to hear Oliver seems to be feeling better.
     
  24. MrQuotidian

    MrQuotidian New Member

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    Sep 22, 2020
    Oliver seems to be doing steady - appetite slowly increasing. I picked up the Freestyle Lite today and just checked Oliver's glucose shortly after his dinner.

    The reading was 14.8mmol/L . FWIW It's been 10 hours since .75 units of lantus.

    @Red & Rover or other freestlye lite user (or anyone really)... Can I compare that directly with the vet's reference range of 4.0 - 9.7 mmol/L? If that's the case I obviously want to aim to keep his levels lower.... Thanks!
     
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  25. Wendy&Neko

    Wendy&Neko Senior Member Moderator

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    Feb 28, 2012
    The vet reference range is with a pet meter. On a human meter, you want 50-120 (2.8 - 6.7). 14.8 (266) isn't bad for late in the cycle.

    If you hadn't noticed, most of us keep our blood sugar numbers in a spreadsheet. Here is the information:

    FDMB Spreadsheet Instructions:
    • Please set up a Google Spreadsheet as soon as possible. Always keep spreadsheets up-to-date! Valuable time may be lost looking for information when a spreadsheet is not up to the minute.
    • If you have not been able to transition your kitty off of DRY food yet, please note it on your spreadsheet and in your signature. A dry food diet will often require higher doses of insulin to bring numbers down. Having this information plainly visible will help us help you.
    Understanding the Spreadsheet/Grid

    Note that we use the US version of numbers here (mg/dL), because the server is in the US and so are the majority of members, and they haven't quite caught up to us on metric. The World version of the spreadsheet will automatically do the conversions for you.
     
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  26. MrQuotidian

    MrQuotidian New Member

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    Sep 22, 2020
    Great, thanks for the info & links - I have been wondering about the spreadsheets. I really appreciate you and everyone else taking the time to answer my questions!
     
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