New member - Zephie

Hello, Everyone. My Zephie (16 y/o in two weeks) just developed diabetes this week. We are at the very beginning of our journey.

I discovered a problem a few days ago. I monitor his urine weekly and on Monday, he was positive for glucose ("1000") and has been positive every day since then. He started PU/PD as well. He is acting otherwise normal -- purring, playful, eating on his own.

He has multiple other issues (Stage 2 CKD, chronic pancreatitis, IBD, arthritis) and is under close care of an internal medicine vet. He just had his quarterly check a month ago and all labs looked great/stable.

His IM vet suggests as Step 1 to place a Freestyle Libre sensor today to monitor his BG for at least a few days before starting insulin. We are also going to get a spot BG run before placement to make sure his BG isn't so high that we need to take swifter action. We have discontinued his budesonide due to the elevated BG. He had been on a very low dose of 0.5 mg twice a week for his IBD.

My first questions have to do with the Freestyle Libre sensor. I didn't see any threads that talked about this -- do people on this board use this sensor? Is there anything I should know about it given that he is going to have it placed this afternoon?
Thank you! I am reading as much as I can on the board. I have a lot to learn as Zephie is my first diabetic cat. I have a lot of experience with lots of other feline health problems, but haven't dealt with diabetes yet.
Stacey

 

@Bron and Sheba (GA)
@Wendy&Neko
@Bandit's Mom
@Sienne and Gabby (GA)

 

Hi Stacey and Zephie and welcome to the forum. Zephie is a very handsome boy!
Yes we do have people here who use the Freestyle libre meter. It’s a human meter and most of us use the human meters here…but hand held ones. There are also pet meters available which some people use but they are much more expensive to use.
I would commend you look into also buying a glucose meter and learn to home test the blood glucose (BG) while you have the libre on. That is what we do here (hometest) and it is the best way to keep Zephie safe and to know how well the dose is working.
If you live in the US you can buy a ReliOn premier glucose meter from Walmart very cheaply.
You will also need a box of 100 test strips to go with the meter.
And a box of 100 lancets size 26 or 28 gauge
And some cotton balls to hold behind the ear when testing.
It might sound scary to test but it’s not and both you and Zephie will soon think it’s old hat!
We can give you tips and hints HERE

I would also recommend to set up our spreadsheet so you can add BG data and our signature which will tell us all about Zephie.
HELP US HELP YOU. LINK to both

I’m not sure if it’s a good idea to stop the budesonide. I’ll ask @Wendy&Neko about that.
I’d recommend you get either lantus or prozinc insulin for Zephie. If the vet wants to use any other insulin, I would question that.
And if you are not starting insulin straight away, I would recommend you buy some ketostix from Walmart or a pharmacy and test his urine for ketones. Did the vet mention if he had ketones when he was diagnosed.
Keep asking questions
Bron

 

Here is the link for the meter and test strips so you don't have to search for them
Relion Premier Classic Meter at Walmart for 9 dollars
https://www.walmart.com/ip/ReliOn-Premier-CLASSIC-Blood-Glucose-Monitoring-System/552134103

The tests strips are 17.88 for 100
https://www.walmart.com/ip/ReliOn-Premier-Blood-Glucose-Test-Strips-100-Count/575088197
At least if you need more test strips you can run into Walmart and pick them up or if you're running low you can just order them from Walmart


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

6. As the ears get used to bleeding and grow more capilares, it gets easier to get the amount of blood you need on the first try. If he won’t stand still, you can get the blood onto a clean finger nail and test from there.
When you do get some blood you can try milking the ear.
Get you finger and gently push up toward the blood , more will appear
You will put the cotton round behind his ear in case you poke your finger, after you are done testing you will fold the cotton round over his ear to stop the bleeding , press gently for about 10 or 20 seconds until it stops
Get 26 or 28 gauge lancets
A lot of us use the lancets to test freehand not the lancing device
I find it better to see where I'm aiming
Look at the lancet under a light and you will see one side is curved upward, that's the side you want to poke with

Try putting a thin layer of Vaseline on the ear so the blood will bead up

 

How well controlled is his IBD? I have an IBD kitty who cannot have her steroid dose reduced too much or she gets an IBD flair or worse (ileus). But each IBD kitty is different. What food is he eating?

I second the recommendation to get a hand held meter as a backup. For a couple reasons. First, the Libre meter can read lower in low normal numbers than a hand held BG meter. Recommendations are to test the low numbers with a hand held when you get them. Second reason to know how to home test with a hand held BG meter is if for some reason the Libre fails. Which they will do after two weeks, some do sooner. There is a FB group for Libre for pets users, that apparently is helpful in teaching you how to remove and place your own Libres, which would help with not having a gap in data should one fail. We did recently have a member say that there was a shortage of Libres in stores where she lives so she had to drive 30 miles to get one.

 

Thank you all for the warm welcome and swift replies. Answers to questions:
@Bron and Sheba (GA) : His IBD treatment has consisted of a diet change to foods that don't seem to cause him diarrhea and that are kidney-friendly. (Currently a combo of Blue Buffalo K+M kibble, Hills z/d canned, Hills d/d kibble). He has also been getting 0.5 mg budesonide twice a week -- so a very very small dose as he's been very sensitive to steroids for several years now. For example, he BG would rise on even a modest 2.5 mg prednisolone EOD. He had an endoscopy done which was equivocal. One pathologist felt it was IBD morphing into emerging SCL; the other (Dr Powers, a highly regarded pathologist) felt it was IBD and *not* SCL. So, since he was doing well, we opted to go with a baby dose of budesonide and monitor his urine weekly for any signs of emerging diabetes... which is what we found this past week. We had tabled chlorambucil until this point, but will have to revisit that issue once we get him over this diabetic crisis.

@Bron and Sheba (GA) and @Diane Tyler's Mom GA - I completely agree that I want to have a glucometer at home even though we currently the Libre (FSL). We went with the FSL as a quick and dirty place to start while I learned how to prick his ear and we could figure out at least somewhat the insulin dosing issue. I have some additional questions on that and am unsure if I should include them in this thread or not? I've been reading like crazy here but haven't gotten to that info yet about how the group prefers information and questions to be handled. Thank you both for you excellent info on meters and how to use them/prick ears etc. Zephie is a very cooperative fella so I am confident we can figure out how to do it! My meter is supposed to arrive today via OnTrac. Our internist preferred I get an AlphaTrak3 as that's what they use in the clinic and we could be comparing apples to apples. I couldn't find anywhere near me that carried them in stock, so I ordered from Chewy. Agreed that there are much cheaper options, but luckily, I have kept up insurance for Zephie, so my cost is 30%. I thought it was worth the extra cost to get a meter that would deliver the BGs comparably to his vet.

I bought the lancets and keto strips per your advice. I already have 10-value urinalysis strips that I use but good to also have dedicated keto strips. I've been testing him at least a few times per day since his BG was pretty high (400-500+) at diagnosis. No ketones so far, thank goodness but I am watching.

So the issues we've faced so far that I would need further guidance on are
1. I created a spreadsheet for him, but I don't understand how to fill it out. I looked for a guide to it, but didn't see one? Would someone be able to point me in the right direction?

2. We started 1 unit Lantus Thursday midday when he was at the vet. His BG fell into the high 200s then rose again. Per his vet's advice, we gave another unit the next morning. BG at time of injection was 397. Without a few hours, it was 120s and falling really fast. I called him vet who advised to give him sugar water. That had minimal effect and his BG dropped to 68 within an hour after that. He seemed a bit subdued (but it was also a typically sleepy time of day for him) but given the quickly dropping numbers, I took him to the vet. His stress response to being at the vet stabilized his BG and then it began to rise -- very quickly. I am 100% sure I dosed only a single unit and used the proper U-100 syringe. His response seemed very strong and it was scary. After talking to his vet again last night, we decided to cut his dose to 0.5 units once a day for at least a few days to see. So far today, his BG is in the high 200s after 4 hrs and seems to be stabilizing at that level. I know that's higher than ideal, but him dropping into the 60s so fast yesterday was concerning!

Would anyone reading be willing to let me know if I should create two separate threads for the two questions above, or is including them in this thread the way to go? Thanks so much!
Stacey

 

Keep on this thread for now.

More information on using the spreadsheet. How to Use the Spreadsheet

Since you are seeing 68 so soon after starting insulin, I'd suggest going down to a 0.5 unit dose for now and shooting that twice a day, not once. Lantus doesn't last that long in a cat. Getting the spreadsheet set up will help us help you. You are using syringes with half unit markings on them? Sometimes cats will have an initial strong reaction to insulin, that doesn't last.

 

@Stacey - Zephie's Mom
Hi Stacey can you please fill in your spreadsheet up top where it asks Date diagnosed,
insulin.
Dosing method (SLGS or TR) and the meter you will be using

Since you are feeding any kibble at all you will have to follow the SLGS method.
And add SLGS to your signature

 

@Wendy&Neko thank you! I will work on the spreadsheet.

Re dosing, internist wants me to do once/day dosing for at least a few days given his strong reaction to this initial dose so that we don't have to hospitalize him from a hypo episode. He's had some recent FIC episodes (no history of it until recently -- UTI ruled out) so she's trying to minimize stress so that he doesn't end up blocked and have all that to deal with on top of the diabetes. Her plan is that if he is OK on the 0.5 unit once/day for a few days to then increase to twice a day if his pre-shot BG is 300 or greater.

I am using U-100 syringes per the internist. They only have markings in one unit intervals, so the 0.5 unit dose is not super precise. The internist said that this is the syringe to use for Lantus. I don't know of any others that might have 1/2 unit intervals that could work for Lantus. Anyone know of that type so I can ask the internist for it?

I was really taken aback by the 68 reading given he only had 1 unit Lantus and he's a bigger guy (13#). So this kind of reaction going from 450 range to 68 from a single dose of Lantus can happen? His BG was dropping incredibly fast.
Thanks again!
Stacey

 

@Diane Tyler's Mom GA U I updated the spreadsheet with that info. I rarely use Google sheets, however, so don't know if it auto saves? I haven't filled in the BG info yet but did input the date of dx, insulin type, meter. If you don't see that updated on your end, would you kindly let me know and I will figure out how to save/update it. Thank you!

 

You need to add SLGS on your spreadsheet up top about the dosing and on your signature because you are feeding kibble
https://felinediabetes.com/FDMB/forums/lantus-levemir-biosimilars.9/

This link will tell you all about Lantus and the 2 dosing methods which will tell you when you need to increase or decrease the dose. Please read the one about SLGS , read all the yellow stickys

To add SLGS to your signature tap on your name up top then tap on signature and add SLGS then tap save

@Stacey - Zephie's Mom

 

Most vets do not have the U-100 syringes with the half unit markings, I'll give you a link where you can buy them without a vets prescription below.
We increase or decrease by 0.25 units at a time even though these do not have 1/4 increments they are easier to do that

You need the ones in the left

• Full and half-unit syringe scales:

• Don't reuse syringes. You'll not only run the risk of contaminating the vial/cartridge/pen, but re-using a syringe may be very uncomfortable for your cat:

You can order the U-100 syringes with half unit markings from Amazon without a doctors script
https://www.amazon.com/UltiCare-31-Gauge-Veterinary-Insulin-Syringes/dp/B009LTE0DO


We just eyeball when we need to increase or decrease by 0.25 units
@Stacey - Zephie's Mom

 

@Wendy&Neko

 

Thanks, @Diane Tyler's Mom GA ! Order has been placed and I've fixed my spreadsheet and signature to show SLGS. Will read the info in the links you provided. Thank you very much!

 

Not surprising given he's on a dry food diet. Neko's buddy has his first idiopathic cystitis episode one week after she had her diabetes dx. Lots of information here (by a vet nutritionist) on appropriate diets for a kitty with urinary issues: https://catinfo.org/feline-urinary-tract-diseases/

I know switching foods is tricky with an IBD kitty, but if all he needs is a novel protein diet, there are plenty of good commercially available ones. Switching from high carb "vet" foods to low carb options may be all he needs to go into remission. He also needs a good probiotic - Visbiome is the one I give my IBD girl.

If you are in the US, this is a list of some of the U-100 syringes that have half unit markings.
BD Ultra-Fine, CarePoint Vet, Monoject, GNP, UltiCare Vet Rx, Sure Comfort, and ReliOn. Depending on where you live, you may or may not need a prescription to get them. If so, you can go with the one's Diane suggested. Or get the vet to give you a prescription.

I see the spreadsheet, but none of the blood sugar readings yet.

 

@Wendy&Neko I appreciate the info on the food. It is super tricky with food for him. Diet changes in the past have nearly always triggered a massive pancreatitis flare up so we are very hesitant to change his diet right now. The last pancreatitis episode nearly did him in as it caused a partial biliary obstruction from spillover inflammation. So at least for now, we're looking at not making any dietary changes and seeing what we can do to bring down his BG into a better range. I monitor his hydration very closely as I agree that it's essential for a multitude of reasons. He has been taking Proviable for many years and seems good on it though I do have Visbiome on hand in case the Proviable stops working for him (and his sibling who also has IBD).
I put in his values on his spreadsheet. I am most concerned now by what seems like a very pronounced sensitivity to even a unit of Lantus. His BG went from > 500 to 60s two days in a row -- 1st day on 1 unit and 2nd day on 1/2 unit. Today's BGs are much more modulated but we also erred on the side of giving less than 1/2 unit if anything. (My 1/2 unit syringes are supposed to be delivered tonight via amazon!).
His super quick drop seems really odd to me but I don't have any experience to judge this. Hoping you or others may have insight here? I am planning on giving a solid 1/2 unit tomorrow and seeing what happens. Hoping I will be able to then give a 2nd dose and feel OK to go to sleep at night without worrying I will wake up to emergency low #'s.
Thanks so much.

 

@Stacey - Zephie's Mom
Hi Stacey
I see on your spreadsheet in the remarks section for 9-28 you said No Shot given since BG was 210 tonight PMPS
Internist said only give 2nd shot if PMPS >300

I'm no expert but I think you could have given insulin on 9-28 for the PM cycle
I see you are waiting for the syringes with the half unit markings to arrive
I'm tagging
@Bron and Sheba (GA)
@tiffmaxee
@Suzanne & Darcy
@Sienne and Gabby (GA)
@Angela & Cleo
to see what they say about it and to look at your spreadsheet since those BG numbers have been high
Like The said I'm no expert on giving dosing advice

I just saw you got the syringes with the half unit markings which is good

 

Thank you @Diane Tyler's Mom GA . I have my spreadsheet up to date. I was encouraged by the results for cycle 1 of 10/1 until the very end of the day when his BG bounced quickly up again after getting into the normal range. The prior two days also had less rapid rises/decreases which I thought was better than the large rapid decline folllowed by the very rapid spike up.
It's 1:45 am now my time. Having a lot of trouble getting any rest because of worry and monitoring. I know I need to get rest, though, so I can be my best for him. Our internist is not back into the office until Thurs then will be starting a 10-day vacation on Saturday. Very worried about DKA. New 1/2 unit syringes are really great -- thank you again for telling me about them.
I'd really appreciate any advice on how things are going here. Not ever having had a diabetic cat, I just have no idea if I should be terrified or not by his #'s. I am trying to stay calm and stay the course. Thanks to all here who provide so much information. I've been making my way through the info in the files.

 

The vast majority of us never had a diabetic cat before, never had to inject insulin much less do testing. It is overwhelming at first! This will get better over time. . Once you have enough data to understand his blood glucose patterns and how he responds to the Lantus and food, it'll help a lot.

It's great you are testing frequently for ketones. That's really helpful as ketones levels can change quickly and you want to catch any change as soon as possible so you can react to it.

How is Zephie's appetite? How about energy level? Him eating well and not showing any lethargy would be good signs to look for. I was happy to see he got into the 100's (blues) yesterday and not surprised he bounced. Super common for newly diagnosed cats, super annoying for us.

Now that you are giving 2 shots a day, it'll help the Lantus depot build, and I hope his numbers will get even better. When following SLGS you hold (stay with) this dose for a week so you are half way there. He may need an increase to 0.75 units, but it's too early to tell. Of course, any increase in ketones will change that plan.

 

Thank you, @Wendy&Neko ! Zephie's appetite is WNL for him. As he's mostly a free feeder, when and how much he eats can vary. Also we're in the midst of a record-setting heat wave here and when it gets this hot, none of the cats eat normally. They just go to the hottest room of the house and lounge. I have 3 other cats and all are heat-seeking missiles. His energy levels are normal. He was actually on the more playful side this morning and has been making his rounds around the house. He has arthritis so doesn't make those rounds very quickly (!) but he's definitely not seeming lethargic as of this morning.

So let's say I do see trace or higher ketones. I'm not sure what to do in that case? Certainly if he's acting poorly, I'll take him into the vet -- but not sure if I treat it as an emergency and admit him into ER? Or are there things I can do at home if I notice "trace" ketones but he is otherwise acting well? For ex, do sub Q fluids help? I am thinking of giving him some fluids today because I feel like he's a bit on the dry side. He got fluids last Thur at the vet when they placed the FSL but none since as I felt his hydration was good. But the past day or so, his gums seem on the dry side and with all the urination and heat wave here, I'm concerned about dehydration.

On the good news front, we had a much better time of getting his ear prick done this morning! Only 3 tries, which is a big improvement over the 1st time we did it last Saturday. I don't think the FSL will stay in much longer, so I want to be sure we aren't a total disaster when it comes to doing it with the hand held meter. Fairly big diff in readings between the FSL and AlphaTrak -- AMPS was FSL = 495 and AT was 444.

So questions are :
1. What to do if he tests positive for ketones? Is it always an emergency?
2. When you say ketone levels can change quickly -- how quickly? If I'm testing his urine 2x/day is that enough? He is easy to get a urine sample from, but I'm not always right there in time to catch the urine.
3. Sub Q's -- helpful if I think he might be a smidge dehydrated? His vet is fine with me giving sub Q's as needed for dehydration.
4. Does it matter where I inject the insulin? His FSL is placed slightly behind his right shoulder, so I've been giving the insulin caudal to that area in case I want to give fluids (which I'd give in his scruff towards the left shoulder due to the FSL).
Thank you!!

 

What you do if ketones show depends on the level. Anything above trace is at least a phone call with a vet, if not a visit. You should also increase his fluid intake if trace ketones show, whether it's adding water to his food or fluids (provided vet and his heart is OK with him getting fluids).

Testing ketones twice a day is a good amount.

This post has some tips on shooting, including locations:

• Testing and shooting tips

 

Thank you @Wendy&Neko . That is all very helpful information. So what I'm hearing is that if he tests "trace" ketones that I shouldn't hit the panic button, esp if he's otherwise acting OK?

And yes, his vet has cleared him for sub Q fluids (100 mls) PRN.