New member in need of advice

Good morning everyone. My name is Sam from Canada and I am new here. I am having a crisis with my 10 year-old cat, Milo, a beautiful long-haired cat that I adopted at 8 weeks with his brother Singha (mom was apparently a barn cat, dad obviously a Himalayan) He has been compromised health wise since he was 3 months old, frequent infections (dr says he’s immune compromised) and I’ve almost lost him many times over. His brother was diagnosed with diabetes last summer (easily controlled with 1 unit of Caninsulin 2x daily) so I thought I knew what I was doing with a diabetic cat. Milo is a whole different story.
I took Milo for testing last December because he was showing excessive thirst. Nothing showed up for diabetes but he was diagnosed with “fatty liver” and his diet was changed from S/O diet (Royal Canine) due to a former blockage to W/D (Hills) which he hated and lost weight.

By March, he had started peeing outside of the litter box and I was concerned about his weight and continued excessive thirst. I took him to my local vet (different from first one who was not local) and we did complete bloodwork again. His sugars were very high so we started 2 units and increased to 3 units Caninsulin. He had lost a ton of weight and the dr switched him to W/D (Royal Canine) which he liked and starting gaining some weight back. The peeing issue has continued and I’ve tried different litters, different boxes, switched him to BigCountry raw food (he loves it) and pet pads around the boxes. I can manage the pee thing now that I know how bad the diabetes is.
After 4 weeks, the symptoms of diabetes have not gotten any better so I took Milo back to the vet and he has lent me an AlphTrak meter to do a baseline testing every two hours. His levels never come down below 12.6 and usually range higher to high teens and into the low 20’s. I increased him to 4 units Caninsulin last night, as the vet suggested. He was 35.7 this morning! I thought the meter might be broken or I was using it wrong so I tested his brother a number of times and he’s ranging 3.5-6.3 (without having had to injections) so we hope he’s in remission??? Obviously the meter is fine.
What to do now??? I’ve requested that we change insulin. My vet is trying to get a different one. Any recommendations?? What should I be doing? It’s unlikely the insulin will come in before the weekend. I’m freaked. Please help. I am struggling with many, many other things on top of my poor sick kitty.
I appreciate any advice you can give.
Sam

 

Bloodwork

 

Chart from this week

 

Welcome to the best place you never thought you would ever be. Waving to you from central Ontario. There are a number of Canucks here.
Let me make a cup of tea and then I'll address your problem (if no one else has while I'm making a cuppa).

 

Good morning Sam and welcome to you and Shinga!

Caninsulin is not the best insulin for cats since it was made for dogs or canines hence the name. I’m glad it worked for your other cat and it does for some, but not most. Cats have a higher metabolism than dogs. They’re also grazers who do better eating more than just twice a day. So, I’d suggest switching to a gentler longer acting insulin like prozync or Lantus. Also the dose seems high. We recommend increases and decreased by .25 unit not a full unit as it you could easily miss the ideal dose that way. You may want to start Milo a a lower dose when you switch insulina. I’m not good at interpreting pet meter numbers as most of us here use human meters. There’s a formula to convert the numbers and I’m sure more experienced members will chime in soon!

How many times a day does Milo eat?

Is Milo showing any trouble with his back legs? Minnie would pee pretty much anywhere because she developed neuropathy and it was hard and eventually impossible for her to go in and out of the litter box.

here is a link for you to look over. We ask folks to add a signature and start a spreadsheet to record all the BG numbers:

http://www.felinediabetes.com/FDMB/threads/new-how-you-can-help-us-help-you.216696/

one last thing, can you please edit the title of your thread and remove the 911? We reserve that for emergencies like a cat whose BG is dropping below a safe number and needs immediate help to get back to a safe level

thank and welcome again!

 

WELCOME TO FDMB SAM! So relieved you've found us! Poor Shinga...We are a dedicated group of kitty cat lovers that share a common thread DIABETES.
You have found a SAFE place to land and we will do our VERY best to help you and Shinga. Youve already received good advice so I will stand back and let our experts help you navigate this disease and the charts you so aptly supplied.

To get you started you will be asked to set up a spread sheet AND your signature.
The signature should provide names , insulin type, meter used, and food Shinga eats. It appears at the bottom of each of your posts (in light gray) so our helpers can see,"at a glance" all Shings particulars. It will save time for all of us!

The spread sheet will track Shings numbers in a logical way so our experts can give the bast advice FROM those numbers.

you can find how to do that here:
Suggestions, Tech Support & Testing Area

Again welcome to the best site on this planet to get your Shinga in the best health possible and become a happy cat again!
jeanne

 

oops I see Ale has already provided the link my apologies.

 

Okay, a possible reason why Milo is peeing outside the box is that he feels like crap for 2 reasons.

The first reason is the high glucose numbers. It could be that you have not reached the proper dose yet or it could be (and this is the second reason) the type of insulin. Caninsulin was designed for dogs who have a different insulin metabolism. Caninsulin hits a cat hard and fast during the first part of the cycle and the insulin rarely lasts the entire 12 hours.

As Alelula mentioned above, Lantus is a much better, gentler insulin for cats. (And as a bonus, in Canada Lantus is easy on the wallet.)

Here is some reading about insulins used for cats. It is worth a read and worth showing to your vet if your vet is in doubt. Regarding the sibling, we have a saying here – ECID – each cat is different. A few cats do well on caninsulin. Most do not.

• (2018) AAHA Diabetes Management Guidelines for Dogs and Cats

When you return the AlphaTrak, tell your vet that you cannot afford the strips long term and go out and buy a human glucometer. Testing strips are expensive in Canada and the AlphaTrak strips cost around $2 a piece. Human glucometer strips are just under half the price. A number of Canadians use the FreeStyle Lite. It takes a small drop of blood. The strips run about $0.80 per.
A glucose curve only gives you the information for the day(s) of the curve. It is better and safer for a cat to be tested before each shot (to make sure the number is high enough to shoot) and a test or two during each cycle).

As Milo becomes regulated, he will feel better and the peeing outside the box should go away. In the meantime, some people have luck with A litter attractant such as Dr. Elsey's Ultra Litter (I know Petsmart carries it).
https://www.petsmart.ca/cat/litter-...er---clumping-multi-cat-strength-5018471.html

Caninsulin information can be found here:
Sticky BEGINNER'S GUIDE TO CANINSULIN/VETSULIN

I'll leave it to others more experienced to comment on your labs. @Marje and Gracie and @Wendy&Neko

 

P.S. when you look at various threads on this forum, you will see glucose numbers in the hundreds. A lot of members are in the US so the US measurement has become standard. You multiply your numbers x 18 to get US measurements. If you are looking at other spreadsheets, near the top you should see "World numbers" in blue. Click on it to see the spreadsheet in Canadian numbers.

 

Hello and welcome from a west coast Canuck. We too started on Caninsulin. It didn't last long, her numbers didn't do well on it so we switched to Lantus. The second possible reason for higher numbers is that he did something we call a "bounce". When a cat's numbers drop fast, or they drop lower than they are used to, their body dumps sugars in an effort to bring them back up to numbers they've gotten used to. It's a temporary condition, and can last a few days.

Not a problem - you don't need to buy Lantus for Levemir from the vet. It's easier, and probably cheaper, to buy it direct at any human pharmacy. Just tell them it's for your cat.

I've removed the 911, which we use for medical emergencies, and replaced the subject prefix with a ?

 

Thank tou

Thank you. I think I changed the title. I’ve been totally overwhelmed by the rest of life and the numbers/threads/info has been totally overwhelming for me to even try to tackle. I’m not sure about when I can get a spreadsheet done.

But I want to help my kitty so I’m trying. Yes, Milo was showing neuropathy (and still is) back in December which is why I was surprised that his BG didn’t indicate diabetes. Can blood tests be wrong? I have different litter boxes with lower entrances. He’s able to jump and move around pretty good so I don’t think that’s why he’s not always using the box. He usually is 2/3 inside now. The other 1/3 on let pads just in front of the boxes.
I have Milo eating 5-7 times a day, grazing a lot. I have stopped any dry food at all. Is that correct? Just the raw diet??
Thanks for any help or suggestions. I will work on what goes into a “signature”. Please give me time to get up to speed as I’m very busy with sick child and cat as well as my own knee surgery recovery etc etc.
Sam .

 

I just called the pharmacy. They have Lantus ($87/10ml) and 100 strips (monitor free) for another $86. I just want to make sure my vet gives his ok to proceed.

 

That seems on the expensive side for strips but maybe that’s normal in Canada...? Others will reply

 

Yes, always good to have the vet agree to your insulin choice. You might want to consider getting Lantus in the 5 pack of 3 ml cartridges. It costs a bit more, but the cartridges will last you longer. And if you drop one, your risk less insulin. It was my pharmacist who recommended that to me first - she had lots of kitty Lantus clients.

Do shop around for strips and Lantus - I found quite the variety of prices. Though the strip price you quote is in line with some of the pharmacies.

 

I think Red is right about maybe Milo just not feeling well. But also if she’s peeing a larger volume than she’s used to each time, she may just be rising her butt and some of the pee ends up outside. Minnie has always done that even before she was diabetic. She’s what’s called an “elevator kitty” meaning that her butt starts to rise up as she pees and the longer she’s peeing, the more likely it’s for some of the pee to land out of the litter box. I have pee pads under all my litter boxes so when that happens, it lands on the pee pads and not the floor or a matt I have to wash afterwards.

for the neuropathy, b12 methyl will help tremendously once Milo’s diabetes is regulated and I can’t tell you Minnie has recovered from it completely so something to look forward to!!

 

Thank you EVERYONE! It's a huge learning curve but I have had a little reprieve today to try and get some education and figure out the charts/signature etc. It isn't going to be perfect but I'm trying. My vet has approved the Lantus and human glucose meter. I have started a chart (AlphaTrak) with what I have done so far but I'm about to run out of test strips for it and my oldest son is heading out to pick up new insulin and meter for me. I'm awaiting a phone call to know what dosage I should start at with the Lantus and when.

With Singha (brown kitty), he was just 12 hours apart, no testing. Easy. With Milo (white kitty), I realize I'm going to have to learn a whole new procedure, which is where you all could help. My vet's son is his assistant and he was pleased I found this group and encouraged me (I was concerned they might be slighted or thinking I was not trusting them....you never know). I can't keep bothering the poor man but I need help!

I have tried attractants to the litter boxes. He doesn't seem to really prefer one type or box over the others but he always pees on the very inside edge, when he does go inside. It's almost always a very large amount (64g one day on pee pad). I have put down vapour barrier (thick plastic) to protect my floors then surrounded boxes with pet pads on top. Sometimes the volume is so large it goes under both the multi-layers of pads and even the plastic. I can handle the pee as I'm sure the reason is that he's feeling so very poorly (how could you not with BG 3-5x higher than it should be?). Clean-up is more reasonable now with pads, plastic, enzyme cleaner in spray bottle etc, mop etc. Pee is way down on my list of concerns at the moment.

I need to go test the cat, complete the AlphaTrak chart, then I will post what I have. Tonight I'll have to figure out the human meter and get another chart going. I'll probably have many more questions. Thanks in advance. You are all a literal godsend.

Sam

 

Hi there you don't have to start a new spreadsheet, when you start using the human meter you can just add above the date you start
Switched to human meter

 

Thank you. He's "down" to 17.1. Not great but better than 35.7 this morning.

 

Something to look forward to My vet is concerned that the liver difficulties might be the reason he's not responding to insulin. I hope the change to Lantus will hold some promise and once he's hopefully sorted out, we try to deal with the neuropathy. How is b12 given? Might it be hard on his liver? We have to be careful. Also, the vet said raw food was a good switch for the diabetes but not good for his liver. Arg!!!!

 

You're doing GREAT! Dont rush to get things perfect we can work around it. I'm cheering you on. YOU GOTZ THIS!

 

Hi Here is the link https://www.vitacost.com/vitacost-vitamin-b-12-methylcobalamin-5000-mcg-100-capsules-6

Alot of members use this , I use it myself you can buy it on line from Vitacost
Vitamin B-12 Methylcobalamin -- 5000 mcg - 100 Capsules
It's 17.99 just be sure this is the one you buy
The only difference is the Zobaline has 200 mcgs of folic acid
So I buy the folic acid at the supermarket and crush it up and add it to the B-12
If you can't find the 200 mcg get the 400 mcg and cut it in half
The Vitacost brand is a capsule so just open it and pour the powder on the wet food
Has no taste, no need to crush it up
The Zobaline is 33.99 for 60 pills, too expensive
I saw a big improvement I'd say 3 months, could be sooner. One capsule a day


Vitamin B-12 Methylcobalamin -- 5000 mcg - 100 Capsules

• SKU #: 835003001804
• Shipping Weight: 0.23 lb
• Servings: 100

 

How do I get the spreadsheet as an icon rather than the whole link?

 

I have a Contour human glucose meter now. Now what?? And Lantus 100 units/ml. My vet has not yet called me back about dosage/ time. Any suggestions how I use this meter. Same as the pet one? It says no coding. I’ll read the book, obviously, but I need to sort it out before his evening dose. I’m open to your thoughts.

 

bump

 

What does that mean?

 

oops sorry... bumping your thread to the top of the list.

 

Spreadsheets - we have two varieties. One for the US, one for the rest of the world. The rest of the world one is the one you need. Unfortunately yours is the US one so you'll have to use the other version and copy/paste over. Enter the data on the World tab, and it'll automatically populate the US tab for you. A lot of people here are from the US, and they haven't quite caught up to us on metric yet, so use a different measuring system. And since the board is hosted in the US, it's become the standard we use here for measuring blood sugars.

First copy the address of the spreadsheet. On your signature, type the words you want to be the link, such as "Milo's SS", highlight the words, then select the link icon - 7th from the left, and in the pop up box, paste the spreadsheet address. Save and you are done.

Use the Contour the same as you would any other meter. But you don't need to code.

The numbers will be slightly lower on a human meter - no worries. Our dosing methods are all written using human meters as the AT is relatively new. (and strips very expensive), so most use human meters.

Liver numbers being off are very common for newly diagnosed diabetics.

Dose - I'd start with 3 units for now. If the vet gives a suggestion, let us know and we can discuss. Are you feeding only the raw food now?

 

Oh dear...I’ll have to try that again. I’m only giving raw food now, no dry. Is that ok?
Should I give insulin sooner than the 9pm as I’m used to doing it twice a day, 12 hours apart. I’m thinking I should give sooner because A) he’s always high (I’ll check him again first) and B) I have more time to assess how he’s doing before heading to bed. I don’t want him in a coma while I’m asleep.

 

That's wonderful! I'm a big fan of raw myself and switched Neko over shortly after her FD diagnosis.

Are you giving the Caninsulin at 9 AM/PM? I agree, if you can swing an earlier shot time it's a good idea. If he's over 300 (16.7) at 7PM, you can probably start the Lantus then. After that, Lantus likes being shot 12 hours apart. You can move it 15 minutes a shot time, or 1/2 hour once per day. The reason I'm thinking you can shoot earlier is that Caninsulin typically doesn't last 12 hours, plus Lantus is a depot insulin, so you are likely to not see as much action for the first few day, until the depot builds. Of course, some cats like to be different. If you can get a +4 tonight, that'll tell you if you'll need to get a later test. Of course, 7AM has to work with your schedule too, so feel free to suggest what would work better for you.

 

HUGE h

HUGE help! I am used to 9am/9pm schedule with Caninsulin. I can bump it to 8am/8pm. So, does it seem reasonable to test him just before 8pm and if he’s higher than 16.7 (will the human meter read in the hundreds or how do I convert??) give 3 units? Watch his reaction? Test him again before bed around midnight? At what point would one need to give honey for a low? How do you do this? How much? He only weighs 6.6 pounds (up from 4 at his lowest)
Sorry for all the questions but I need to get some answers just in case. My vet never called back

 

World numbers times 18 = US numbers. Your Canadian meter should read in World numbers (mmol/L). And yes, 8pm if high enough, you can shoot.

The way to know how he's reacting is to test. Lantus onset is between +2 and +3, so you should have an idea if he's going to drop by then. One option is to delay the experiment until tomorrow morning, if you can monitor during the day better. You would give honey or high carb food if he's below 50 on the human meter. There aren't really any high carb raw foods I know of, but you can add corn syrup, maple syrup, or honey to his food. I did a good sized drop, which was probably about 1/8 tsp.

Do you leave food out for him overnight? I used a timed feeder that had a spot for an ice pack underneath, that kept the raw cool and safe for later feeds.

 

I got this after I went ahead. He tested around 8:15 @ 19.5 (351 US). I was nervous about 3 units so I tried 2.5 to monitor him tonight. I feed him until about midnight then leave extra out. I don’t have a way of keeping the raw cold so I don’t leave much more than what he would eat in a short amount of time. If I’m awake in the night I’ll give more. He seems ok now. I’ll test in an hour or two to see where we are at.
Thanks again for keeping me sane.
The human meter is so much easier... reads faster which helps when we’re both not excited about doing the testing. Have a good night.
Sam

 

One way to keep raw cold a little while, is to top it with an ice cube. It melts and adds water, which is good for a diabetic. If you test in a couple hours and see a big drop, post here for help.

 

I just read about u-40 needles and this insulin is u-100. I dosed him at 2.5 U-40 units. Which means it was WAY too high. More than double the 3 units recommended. Now I’m panicked to try and sleep. His BG at +3 was 225 and at +4 1/2 was 194. How long could it continue to drop??? What is the ideal range for his BG? My dr said ideally 126 but didn’t give me a range. I understand that under 50 I need to give honey or maple syrup etc.
I’m so worried. I had no idea that the needles were different depending on the insulin. I fed him some more and did the last test. I’m afraid to go to sleep now. Is anyone awake to advise me??

 

Yikes! I'm just heading to bed. Let's see if @Bron and Sheba (GA) is around soon. I see @Chris & China (GA) and @Red & Rover (GA) but they are to the east and should be asleep by now.

Luckily it's just the first dose and no depot is built. Can you test again at +6? He doesn't seem to be coming down too fast. A cat's normal blood sugars, on a human meter, are in the 50-120 range. Time spend there while on insulin can help the pancreas heal. But it's probably a little low for first cycle on Lantus.

If you feed, you could try stopping the drop (called aborting the cycle), but giving him higher carbs now. So next time you feed, add a drop or two of honey. You don't want to feed him too much, cause it'll fill him up and you may want him to be hungry later.

 

I see you have another thread going which I will answer as it has later information on it

 

I have updated Milo's spreadsheet with US numbers and tried to clearly note the switch to the human meter and change of insulin. His numbers are climbing without a shot this morning. My son is getting u-100 needles shortly. I will keep testing and if I need to give a shot early, I can do that and get up early in the morning, 12 hours later. I just want to do what is best for him. He's now up to 297 (+3) from 203 this morning. Thoughts?

 

Any history of ketones?

 

Ok..got it. I did have 2 urinalysis tests done recently and ketones did not come up as high, just BG. He's not showing any signs (other than the thirst and excessive urination that I think is linked to his high BG.)

 

I'm posting here rather than on your other thread. It gets confusing for people to have to read through two threads. Let's keep to this one.

I'm was wondering if your vet ever mentioned Milo having ketones. You would remember if he did. A previous history of ketones would impact whether you can wait to give Milo his shot (preferred) or shoot a bit early. I think you can wait. Give Milo's ears and yourself a break this afternoon. Get a +10 test just to see how he's doing. At that time, pick up any food left out. You do not want your shot number to be food influenced. At +10, you will have a better idea if a slightly earlier shot is called for.

I have a friend in NE Ontario whose vet clinic is only one day a week. The next closest clinic is 120km away. Eep!

 

We have not had a conversation about ketones; I just remember the urine tests recently didn't show anything.

I am home after at least a dozen phone calls, 2 separate trips in and out, 2 different towns, 3 stops and several hours, with the u-100 .3ml needles with half increments Trust me, the ONLY box within 150 km radius!). I'll do the +10 test and see what things look like. My vet thinks I should try 3 units; should I give the numbers here and check what everyone thinks first? I'm nervous after last night's scare.

 

Wow you've had a busy day on top of a crazy night! Glad you got the right syringes now!

I'd like to make another suggestion instead of continuing on this thread (or the other one) since they are both getting pretty long.

Why not start a new thread in the Lantus Forum? Everybody there uses a depot insulin so you'll get the most experienced help there. It's not required that you post there, but it may be better now that you're learning about a new insulin.

To help people get caught up, you can put the link to this post and your 911 post into the body of your new one so people can quickly go back and look at what's been going on. A lot of us that have been helping you here are also Lantus users so you'll still see a lot of familiar faces.

 

You should absolutely check numbers before you shoot, but that won't influence what you will shoot. We determine how to dose Lantus based on how low it takes the cat, not the preshot. Preshot checks tell you if it's safe to give insulin. Milo didn't have insulin this morning, he will be high. Don't worry, he will come down with insulin.

I think 3 units is as good a place as any to start. He got over 5 units yesterday and only got into high 100's. I believe you shot 2.5 units in a u-40 needle? That's 2.5 times 2.5 to get the dose you gave last night. So more like 6.25 units.

For the spreadsheet, it would have been easier on you to use the World spreadsheet. It has two tabs. You enter on the World tab, which automagically converts those numbers to populate the US tab.

 

Your new version of the spreadsheet looks great. The one problem with the spreadsheet, which you've noticed, is that the US spreadsheet only converts numbers. If you put anything else in the cell, like half hours etc., you have to manually overwrite the cell on the US tab.