New member - Roxy just diagnosed

Hi everyone! I was so happy to find this forum! My cat Roxy was just diagnosed yesterday. She is 14. I’m waiting to get the insulin prescription and I’m just worried about doing the right thing up until then. She is permanently hungry and I’m worried about either feeding her too often or not enough - what’s the best strategy for now? She’s already on a high-protein low carb diet. Thanks so much, so relieved to be in the hands of experts here! Deb. We’re in Sydney Australia by the way.

 

Hi Deb, and welcome to you and Roxy. I’m in Sydney too!
Cant write much now as I’m just heading out, but I’ll link an Aussie Information sheet at the end for you.
Hopefully your vet is prescribing Lantus for you. Starting dose should be around 1 unit if Roxy is eating low carb food
Would recommend you look at home testing the blood glucose. It’s not hard and it will keep Roxy safe. You don’t need your vets permission to hometest. A lot of vets are not familiar with doing it at home and don’t encourage it.
We recommend a human meter which you can get from a pharmacy that sells human diabetic things. You will also need test strips that go with the meter, and some lancets size 26 or 28 gauge to prick the ear. Also some cotton balls to hold behind the ear as you prick.

Newly diagnosed diabetic cats are often very hungry as they are not able to utilise all the nutrients in the food. That will improve once insulin is being given. If she is not overweight, let her eats what she wants. Once you start insulin you will need to give a good meal before the dose, then a few snacks during every cycle.

If you have any questions, ask away, we are happy to answer them. Here is the info sheet
https://www.felinediabetes.com/FDMB...for-aussie-feline-diabetic-caregivers.217781/

And another one for new members https://www.felinediabetes.com/FDMB/threads/new-how-you-can-help-us-help-you.216696/
Bron

 

Thank you so much!

 

Why do you recommend a human monitor? Any recommended ones? I’m trying to get one ASAP. I’ve found what looks like a good one on eBay but it’s pet specific..? Also that pet food listing - I couldn’t find many of the ones in Woolworths, where do you get yours, which are best - and which are the higher carb ones I’ll need to get? Thank you!!

 

You can find several low carb foods at petbarn or pet stores like that. Weruva is a good brand. I have listed others also.
For higher carb foods look for the fancy feast gravy lovers. Make sure it says gravy lovers and not just gravy. I’ve listed those too in that document.
There are a few recommendations in the link I sent you for human meters. You can later buy the strips on eBay cheaper.

The pet meter is a lot more expensive to run. It’s the test strips that are the ongoing cost. Also our dosing methods are based on the human meter numbers. I have an Abbott optimum freestyle human meter. It’s a few year old now so there are newer models now. The brand is reliable.

 

Does this one look OK? I am trying to find one which will get here quickly.
https://www.amazon.com.au/Glucose-M...76260&sprefix=freestyle optium,aps,338&sr=8-4
Thanks for the food recommendations, I am a member at PetO so will go there. I bought some Gourmet Delights and Ultimates this morning, plus some Crave pates mini pots that looked good. Took her off all fish and seafood too as I've read chicken and turkey etc are better.

 

That meter looks ok.

Food wise....
Also look at the New Zealand brands I have mentioned in the document which you can get here.
Feline Naturals has a good range of quality cans
They also have freeze dried foods which are good for giving treats after testing the BG. That’s if Roxy will eat them. I feed my cats a raw home made diet and when I offered them the freeze dried treats they didn’t recognise them as food. But most cats love them.
The gourmet delights are low carb as are the ultimates. I don’t know the Crave brand as I rarely go down that aisle these days.

 

Ok I have ordered that one you recommended, this one: https://www.pharmacydirect.com.au/a...eo-blood-glucose-and-ketone-monitoring-system. Thank you! I am still waiting to get the script and I need to order right away as the vet says she is in ketosis.

 

IF SHE HAS KETONES YOU MUST START THE INSULIN NOW!
It is not safe to leave it at all. I would make it a priority to get her started ASAP.

Is she eating OK? It is also really important if she has ketones that she is eating a lot of food.
Ketones happen in diabetic cats when they have not enough insulin, and not enough food. If there is also an infection or the ketones are not address, then it can lead on to ketoacidosis (DKA) which is very serious and can be fatal if not treated.

The treatment for ketones is food and insulin and any infection treated.

 

hi Bron, thank you! It was a mobile visit and he has posted me the script - he came here on Monday and we got the result yesterday over the phone. I will message him now and ask about the ketones. Yes she is eating a lot, pretty hungry and I am feeding her whenever she wants.

 

If it’s Lantus the vet can send the script to the pharmacy electronically and you should be able to collect the insulin from there. I used to get a box of 5x cartridges which could be used in pens except you will need a syringe. The box of 5 used to cost around $100. the syringes you need for LANTUS are U-100 3/10 30 or 31 gauge 6 or 8 mm insulin syringes. If it’s another insulin you will need a different syringe.

keep feeding as much as she will eat at the moment. That’s really important.

 

Just spoke to our vet, he says not to panic, when he saw her on Monday she was strong and in good shape so he's not worried and says fluid is more important that insulin right now with regards the ketones. As long as I am feeding her when she is hungry she will be OK to wait until we can get insulin started. He was very supportive of home testing glucose and ketone levels.

 

While I agree that fluids are important with ketones, I do not agree with leaving a cat 4 days without insulin after finding ketones, I think it is reckless and asking for trouble. The problem with ketones is they can increase rapidly and it can develop into DKA which is life threatening, and very expensive to treat........in excess of $2,000.00.
We see a lot of cats arrive here with DKA.
I hope the insulin script arrives tomorrow otherwise I would be back on the phone asking for him to fax the script to a pharmacy.
One thing you could do is monitor the ketones yourself and that would give you an idea if Roxy is managing to stay OK. You just need to buy a bottle of Ketostix from a pharmacy, they are only about $10 or $12. Then you test the urine. It’s a simple test and very worth while. If there is more than a trace of ketones, you will need to be speaking to the vet. Do you think you would be able to duck out and buy those today?

Bron

 

He said he has seen lots of cats with ketones and Roxy was not presenting with worrisome symptoms so he wasn't overly concerned, some cats dip in and out of ketosis so it not necessarily a downwards slope. He said so long as she is eating and drinking she will be fine, just to keep an eye on her. I will probably be able to get the insulin tomorrow or Saturday as script should arrive any minute. I have ordered ketone strips too by express post and if they don't arrive tomorrow I will get some.

 

While it is true that it is less of a worry if she is eating and seems fine, leaving a newly diagnosed cat 4 or 5 days without insulin who had ketones at diagnosis is a big red flag. We have had cats go into DKA in that exact scenario and their owners arrive here as they are coming out of hospital. I’m not trying to scare you, just make you aware.
I hope the script for the insulin arrives tomorrow.. Please chase it up if it doesn’t.

 

Hi Bron. I finally have the right insulin coming today to my local pharmacy. The script got lost, then they ordered in the wrong kind I am picking it up this afternoon so will try testing Roxy tonight. If we can’t get a sample to test do we still dose her? She is still eating well thought obviously hungry several times a day but hard to know if she has just got used to being fed every time she asks! She often still disappears to sleep in her favourite spot all day and won’t appear til late afternoon so hope that’s a good sign.

 

Good to hear from you Deb.
How is Roxy going?
Are you testing for ketones in the urine?
I can’t believe they have stuffed up this long with the insulin. Is it still lantus?
What is the dose ordered?
Make sure you have the correct syringes for the Lantus.... U100 3/10 31 or 31 gauge 6 or 8 mm insulin syringe.

I would try testing Roxy today so you get a few practise goes in first as it’s important you are able to test beforehand.
If the BG is lower than 11 (200 US numbers) post here and ask for help.
what time are you going to give the dose so I can make sure I am online to check you have got the test ok?
Bron

 

Here is a link to home testing hints. Make sure you warm the ear with some rice in a sock warmed in the microwave..... check it isn’t too hot though.
Milk the ear towards the top to encourage blood to the area. https://www.felinediabetes.com/FDMB/threads/hometesting-links-and-tips.287/

 

Hi Bron. Thanks

How is Roxy going?
She’s going ok.

Are you testing for ketones in the urine?
Not yet - I now have the testing kit that does both so I need to read the instructions and do that.

I can’t believe they have stuffed up this long with the insulin. Is it still lantus?
yes.

What is the dose ordered?
1.5 twice a day

Make sure you have the correct syringes for the Lantus.... U100 3/10 31 or 31 gauge 6 or 8 mm insulin syringe.
I will get them when I pick up the insulin this PM. I have ordered the UK ones recommended but obviously they won’t be here for a while.

I would try testing Roxy today so you get a few practise goes in first as it’s important you are able to testbeforehand.
My vet says “No point now as it's still early on. I would do a glucose curve after 3 weeks of treatment.” I gather you don’t agree with that?

 

Definitely don’t agree with the vet about testing. I don’t know why but many vets have a head in the sand approach to testing. It is possible a cat can go hypo on its first insulin shot .... so it’s important to monitor from the beginning. A curve in 3 weeks is definitely not best practice.
It is really important to test before every shot to see it is safe to give the insulin. If you give it when the blood glucose is too low you are risking a hypo. And I have seen this happen more times than I like here where people have not tested before the shot then find their cat is in very low numbers early in the cycle.
Definately try testing today. Roxy has not been tested since diagnosis so you have no idea what her numbers might he, especially if you have swapped to a low carb diet.

How much does Roxy weigh? I think 1.5 units is too much to start on.
Are you feeding a low carb wet diet only?
Also make sure you have honey and some high carb canned food such as gravy lovers fancy feast to give in case of low numbers. Bron

 

Tagging @Bandit's Mom to talk to you about the Spreadsheet

 

I have asked him and he’s fine for me to test, guess he’s not used to owners knowing a bit more about it. She weighs around 4.5-5kg. Yes low carb only, she’s on FF Classic Pate, Ziwi Peak, Gourmet Delight pouches and Feline Naturals. I got some of the gravy lovers ones too which are in back of the cupboard! Also some dried meat treats for needles!

 

Hi @debplowman ! I can help you with setting up your spreadsheet and your signature. Will send you a PM with the details I need. Look for it in the Inbox at the top right of this page.

 

Depending on whether you are going to follow the Start Slow method or the Tight Regulation Method and given that she weighs around 4.5 kg, you would start on
0.5 units (1/2 unit) for SLGS or
1 unit for TR.
You need to hold that dose for at least 5 days to let the depot fill unless she drops under 90 (5) (SLGS) or 50 (2.8) (TR) . The numbers in brackets are the world BG numbers. The 90 and the 50 are the US numbers which are used on this forum....more about these explained in this link
https://www.felinediabetes.com/FDMB/threads/new-how-you-can-help-us-help-you.216696/

Here are the two dosing methods for you to look at to see which one suits you better.

https://www.felinediabetes.com/FDMB...-low-go-slow-slgs-tight-regulation-tr.210110/

 

It comes preloaded in a pen in 1 unit doses
So I guess she’s just getting 1 unit anyway

 

You can use the cartridge that is in the pen and draw up the insulin in a syringe, if you have the syringes.
If you want to start off with the pen, that is ok but once you need to increase or decrease, you will need to swap over to the syringes as increases and decreases are in 1/4 unit increments.

Here is a photo of the pen and the cartridge. I would keep it in the fridge, it will last much longer.


And here is where you prick the ear

 

Pharmacist showed me how to attach the needle thank goodness. Am so nervous about sticking a needle in her, I wish someone could do it first and I could learn by watching! I must watch the videos now. She is hungry and it's dinner time so I can't think I have time to do this tonight, at least it is the weekend so will have more time tomorrow.

 

Don’t forget to test the blood glucose first and if it’s under 200, post here

 

Thank you. I will. I will try and test in morning though from what I read it's kind of hit and miss to start with.. so I have to hold off giving her a dose until I get a reading. I will watch the videos with hubby later and he can help me do it in morning.

 

OMG I have just read the dosing document - SLGS vs TR.. so overwhelmed!

 

If you are feeding any dry food at all you can only do SLGS

 

I don't have syringes so can only do the GLGS to give her 1 unit. Seeing as vet wanted to start her on 1.5 I am hoping 1 will be safe to start with. I am not sure how much food she should be eating and how often. SHould I immediately start with 2 feeds 12 hours apart? She has been having 3 or 4 smaller meals. She is a little oveweight and not sure what her healthy weight should be - 4kg? She has lost a bit but looks like she's been putting it on again lately, has a bit of a tummy back again, I suppose that's a good sign?

 

I am not feeding any dry food at all.

 

Feed a good meal before the dose of insulin then I would feed a couple of snacks around +3 and +5 every cycle. That is 3 and 5 hours after the doses. A snack is about a tablespoon of food.

 

So test, then feed, then dose?

 

Correct as long as the blood glucose is high enough. Otherwise you stall, don’t feed and test again in 20 minutes to see if the BG is rising.

 

Hi guys I just got my first reading: 16.8

 

We have just given her her dinner - 1 can fancy feast

 

16.8 sounds VERY high!?!?

 

Hi Deb, so are you saying you have just got your first test done and it was 16.8 (302) and that was at PMPS?

 

it was just now, like 10 minutes ago. and yes that's what I meant. How long til I should give her the dose?

 

First of all....congratulations on getting your first test done!!
If that was the preshot BG you enter that in to the SS where it says PMPS ...1/2 way across the page.
Then next to that where it says U you enter the number of units you are giving which I think is 1 unit....is that correct?.
Make sure you put in in the correct date line of the SS

 

Sorry what exactly do I put in? 16.8? And which cell do I put it into? Can you check it's in the right place?

 

Yes it is. This is the reading before the PM shot, right?

 

Yes. 1st one ever. Haven't injected her yet. Am very nervous.

 

Any tips on best place site to inject? and I don't know when to do it? She has finished eating about 20 mins ago

 

I found that if I put Sheba onto a table and gave her something to eat, then leant over her and injected her on the far side of her belly I had a good view of what I was doing. .
Lift the skin up so it tents and then put the needle in the tent. Be careful it doesn’t come out the other side though.
You will be fine!

 

I don't even know if that worked! First time looks like I bent the needle as it was at a 90 degree angle so assumed it hadn't gone in so I put a new needle on and did it again, but the click is very subtle so I've no idea if i did it right. There was a drop of liquid on the end of the (straight this time) needle so fingers crossed. She didn't seem to react at all - is a very fine needle -do they even feel it?! I did it on the scruff of her neck as she doesn't seem to mind that.

 

You didn’t give the dose twice did you?

 

Well how would I know?! The needle was bent when I looked at it and I wasn’t sure there was a click so I assumed it hadn’t worked?!

 

Then when I looked at the dial it wasn’t at 1 either. It was under that so I must have nudged it?

 

Ok. It’s possible you have given Roxy the dose twice.
If that happens again or you are unsure if the dose went in or not...never ever give the dose again.

You will need to monitor this cycle closely now because it is possible Roxy got 2 units instead of one.
So first up let’s get a +1 and a +2 to see how she is going.that is getting a test in one hour and two hours after the shot.
Do you have some high carb food and honey available at home in case we need it?

 

Yes I have some gravy lovers

 

When I looked at the dial when the needle was bent it was on zero

 

So with that and the bent needle I assumed she didn’t get any

 

Ok that’s good.
So our plan is to test at +1 and +2 and then go from there.
Are you able to stay up and test as long as needed?

That could mean the dose was given....I don’t know, I have never used a pen.

 

I can see why you thought that.
Try not to stress about it.
We are on to it straight away and by monitoring her, we can intervene when and if needed.
Is she a good eater?

 

Yes a very good eater. Always hungry

 

Getting test was very hard. She is suspicious now

 

Are you giving her a reward each time. You can also give her a snack as you are testing her to distract her.

 

Yes did that. She was so over it by the 4/5th attempt she’d lost interest in them however.. The pen head is so fat you can’t see where you’re sticking it in so abandoned that. Then it seemed to hurt her more when I just used the needle..and she’s not a good bleeder..

 

Are you warming the ear first and then milking it towards the top before poking it’s.

 

I was milking it after poking it like the videos I watched. I will do that next time.. I will try warming it more. What is best method?

 

I would warm it, then milk it then poke it twice and see if you can get any blood. You can milk it after poking as well.

 

just took a reading - she was growling at me so badly.. - it was 14.0

 

Well done getting the reading.
So that test is probably about +1.5 (1 1/2 hours after the dose of insulin). Is that correct?
So that is a drop from the PMPS BG so I would give her a good snack of food now please.

 

Ok just given her a mini turkey pate

 

It should be dropping though right?

 

Usually there is a food bump up until around +2. If there is no food bump, it can mean that the cycle is going to be active and the BG will drop.
Can you get another test in 1 hour after the last one please?

 

Oh god I don’t fancy my chances. She was so upset with me and obviously hurt

 

It shouldn’t have hurt her to have the test. Try and remain calm when you test her
Do you have anyone to help you with the test.
It’s important that she is monitored this cycle in case she drops low.

 

Yes my daughter is here

 

Ok, that’s good. If you can get her to maybe hold Roxy gently and hum or sing to her as you get the test. Cats pick up stress in the owners and this may help.
Is there anything she particularly likes to eat? You may be able to tempt her as you test her. Most cats will settle down and don’t mind being tested at all.

 

She loves those liquid stick pouch things (Dine Creamy Treats!) but not sure of the carb value .. ? Hasn’t had one for ages. My daughter helped me with the last one. Very hard to stay calm. Can’t really see what you’re doing as she’s black..

 

Try rubbing a bit of Vaseline thinly on the ear where you prick and the blood may pool. Also make sure you are in a good light or have someone hold a torch.

 

14.3

 

14.3 .... well done getting the test!
So how long now since the insulin was given?
Are you able to update the Ss or do you need help

 

She was not happy. Think needle went in too much
Insulin was at 6:30pm. So almost 3 hours ago.

 

I think I’ve done it - can you check?

 

Ok, so the onset of insulin should have happened by now. I would give just a small snack this time of normal low carb food.
You are doing really well!
And yes I can see you have added the BGs to the SS....that is great!
Do you think you could get a test at + 5?

 

So I gave her normal low carb food last time. Should I not have done that?

 

Yes.

Can you put in the remarks column of the SS (it’s on the far right hand side of the SS) that the dose was given a second time when you thought the first dose did not get in please. It needs to be documented on the SS

 

Just giving her 1/4 can of feline naturals

 

Must be time for the +5 about now.

 

Yeah I guess

Preshot test 16.8
6:30pm insulin
8pm test - 14.3
9:15 test - 14.0

so it’s 2 hours 15 since last one?

 

+5 would be 11.30 pm our time. So yes, now

 

14.4

 

Looks like Roxy is pretty flat. I doubt she will drop too much more now. So I think you would be safe to give her a good sized snack to eat now and leave her for the night.

 

I gave her a Dine Creamy Treat which she adores, so she was quite distracted and used the lancet pen again rather than just the lancet. Used a hot wet towel in a ziplock bag microwaved for a minute. That was much better, quicker, and by myself!

 

Well done!

 

Do you know the carb content of those? It says protein 5%, fat 0.2%, ingredients chicken, tuna, thickeners, flavour prawn salmon and colour. Only 12g in each sachet.

 

I think if she got one of those every time I tested her she'd put up with it much better. AS they're only 12g in size would that be OK?

 

Thank you so much for staying up late with us.

 

I’d need to see what was in the treat to see if it is high or low carb.
Happy to stay up with you. I’m off to bed now,
See you tomorrow.

 

It says protein 5%, fat 0.2%, ingredients chicken, tuna, thickeners, flavour prawn salmon and colour. Only 12g in each sachet.

 

goodnight! and thanks again!

 

So she’s awake and bothering me for breakfast as usual

 

I’d I want the doses to be at 7 and 7 ish I guess that means I have to go test..?

 

15.4
Putting it into sheet