PLEASE HELP ME WITH JACKSON

Discussion in 'Feline Health - (Welcome & Main Forum)' started by Ms Leslie, Apr 16, 2021.

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  1. Ms Leslie

    Ms Leslie Member

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    After spending almost four days in Vet Hospital vet decided to start over as he wasup to 5 and that is when he became really sick with ketones and wouldn’t eat. So they wanted me to start him with 6 units once home and I didn’t because he wasn’t eating that much. So I kept him on 5 units like they told me before he enteredhospital. Three days after we brought him home Vet called and said we were starting over (after consulting with a fellow coworker an Internist). She recommended we start over at 3 UNITS not 1 so we did that. He started cutting back on drinking his water, had fewer pees and appetite was slowly coming back. Recommended this PRO PLAN Veternary DIET DM management and he gets 1/3 cup in morning with his low carb wet food and !/3 for supper with a little wet food (fussy with his wet food but now is eating DM Vet wet that is supposed to be less than 5 carbs). He only eats about 1 to 2 tsp per meal of the wet food),
    I mentioned the somogyi Effect in one of my emails to the Vet early on and wondered if he was getting too much insulin.

    Started a new curve for Jackson this morning. Now Vet trying to see if he is experiencing the Somogyi Effect so was Instructed to follow these directions.

    We tested him before he ate first thing this morning (7:45) after receiving 3 units last night and his reading was 22.6
    Then he had his breakfast and then his insulin at 8:30 (it takes him 30 minutes to eat his breakfast)
    Then at 9:00 we tested him his reading was 27.0
    9:30 am it was 23.4
    10:00 am it was 22.8
    10:30 am it was 22.3
    11:00 am it was 16.5
    Then we were to go every two hours
    1:00 pm it was 18.3
    Had his snack of low carb wet food at 1:10
    3:00 pm it was 22.1

    This is probably the fourth or fifth curve (78.00 each time). We don’t seem to be making any progress at all. One member on her told me about Dr. Elsey’s dry food and that it had almost no carbs so we are travelling to Halifax tomorrow to purchase. I know I am to go really really slow with introducing this low carb food to him (any information that would help me would be very much appreciated).
    Again Jack is maintaining his weight at 16 pounds drinks about 400 ml a day (My husband measures very accurately) and his overnight drinking is like 200 ml) and his pee seems normal.
    Spot checking for ketones appears very normal although the glucose ones clearly shows he has glucose in his pee. It is not the darkest shade but one before the last one on the chart.

    I am at my wits end. I am beginning to believe it could be from the 18 percent carbs in his dry food that is hindering his ability to lower his sugar readings. That is why my intentions are to get rid of the vet food and introduce him slowly to Dr. Elsey’s dry food (chicken or salmon??? Which one would be better? Thank you)

    I have a feeling this Vet is going to go through the same procedure she did before by upping at 1 unit at a time and I fear Jack will end up in hospital again from noteating. PLEASE can someone send me ideas or recommendations or their thoughts on what is going on. His insulin again is Lantus.

    What I do is enter this information into an app which creates the curve and email it to the Vet and then she interprets it, charges me 78 dollars and tells me to up it one more unit. THere has to be a better way. Thank you all. My blood pressure is through the roof today having to poke poor Jack so many times and his readings are still way TOO HIGH>

    THANK YOU EVERYONE: I WILL KEEP CHECKING FOR IDEAS FROM EVERYONE>. I KNOW THE SPREAD SHEET WAS RECOMMENDED AND I WILL DO THAT AS SOON AS I GET CHANCE TO FIGURE OUT HOW TO DO IT>

     
  2. Bron and Sheba (GA)

    Bron and Sheba (GA) Well-Known Member

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    Can you confirm you are testing at least daily for ketones. This is one of the most important things you can do right now. Are they negative?
    Also please give snacks of food every couple of hours. Very important
    I have to go out now but will come back online ASAP
     
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  3. Ms Leslie

    Ms Leslie Member

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    Thank you so much. I eagerly look forward to your reply. Yes, I will start feeding him a little snack every couple of hours. I haven’t been checking everyday.. did yesterday and his reading was negative for ketones.
     
    Last edited: Apr 16, 2021
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  4. Bron and Sheba (GA)

    Bron and Sheba (GA) Well-Known Member

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    Hi and welcome to you and Jack.
    I am sorry you have had such a bad start.
    It is very risky “starting over” unless ketones are being monitored very closely because dropping a cat’s insulin dose when they probably need it is inviting ketones to come in. And “starting over” rarely sorts out the problem.
    Now that you know Jack is prone to ketones it is really important they are monitored closely while he is in higher numbers and unregulated.

    Also there is no such thing as Somogyi effect in cats. Cat can bounce but that is a normal thing for cats, especially newly diagnosed one, to do. I’ll explain about more about that later.

    Lantus is a very good insulin for cats. It likes consistency and doesn’t like chopping and changing the dose too often unless it is warranted.
    It is a depot insulin and the depot needs to settle for the full effects of the dose to be felt.

    We recommend increasing and decreasing in 1/4 unit increments so as not to go past the best dose. And it is safer for the cat.
    We recommend testing before every insulin dose and during the cycles to see how low the dose is taking the cat.
    The cycles do not always stay the same. Have a look at any of the cats spreadsheets and you will see most cats, especially if that are not regulated, will have a different cycle every day...ie not stay in exactly the same numbers.
    So getting a curve for the vet on one day is not going to give you the full picture. It could be a day when Jack is bouncing, or a day when he is dropping low or just being Jack.
    What is needed is consistently getting some tests in during both the am and the pm cycles so we can get a picture of what is happening.
    If the BG drops low you would reduce the dose. We can help you with that.

    I have a few questions if you don’t mind answering them.
    What type of glucose meter are you using....human or pet?
    Will Jack eat wet food or are you having trouble swapping him over to a low carb wet diet?

    One of the first things we need to do is get you set up with a spreadsheet. Here is the link to setting it up. If you have any trouble I will ask @Bandit's Mom to help you, as that is really what we need set up with data entered before we can help with suggestions of dosing. Bandits mom won’t be online for a few more hours yet.
    Spradshhet https://www.felinediabetes.com/FDMB/forums/spreadsheets-tech-support-testing-area.6/

    Make sure you are testing every day for ketones. This is really important while we are figuring out the dose and the BGs are high, especially since the vet reduced the dose when ketones were in the picture.

    To help prevent ketones forming, make sure Jack is getting plenty to eat. More than he normal would. Offering snacks during the day and evening is a good way of doing this.
    Record all the food snacks and the ketones test results in the remarks column of the SS. That way we can see what is happening at a glance.

    In regard to the food......it is not necessary to feed a diabetic cat prescription food.
    It is no better than most canned cat food, despite their claims. And it is often higher carb and more expensive. You need to look for 10% or less carbs on the chart I am going to link for you. Canned food is much better than dry food, which is not only much higher carb but has a much lower moisture content which is not good for cats,
    In regards to Dr Esleys dry food.....I have not used it personally but there are people who do use it. Some say it could possibly raise the BG a bit. Others say it can give loose poops. But the most important thing at the moment is he eats something. That trumps everything else.
    Food chart https://catinfo.org/docs/CatFoodProteinFatCarbPhosphorusChart.pdf


    There is lots more to tell you but I don’t want to overwhelm you. We can definitely help you once you get the Ss set up and the data entered.
    If you can enter maybe a months worth of BGs that would be extremely helpful.
    There is no need to spend $78 for the vet to interpret the curve....

    if I haven’t answered any of your questions please tell me. Keep asking questions s, we are very hoppy to help you.
    Bron


     
    Last edited: Apr 16, 2021
  5. Ms Leslie

    Ms Leslie Member

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    Okay I’m hoping I can have some help as it looks complicated to set up the SS. Thank you for your great response. I will go out and buy some low carb can food tomorrow to get him started. Thank you again. I’m hoping to get the SS set up over the weekend. I will for sure start testing for ketones more now that I know I need to. How many times a day should I test per day? Once? Thank you again Bron. I am so thankful for all your help. I have hope now.
     
  6. Bron and Sheba (GA)

    Bron and Sheba (GA) Well-Known Member

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    I would test for ketones once daily to start with . If the test is negative, keep testing daily. If the test is positive, you will need to increase that to twice a day.
    Banditsmom is going to be sending you PM so keep an eye out for it. She will want some details from you and can set the SS up in 5 minutes. She is a whizz at doing them...I am hopeless!
    Try and get the data in the SS ASAP so that we can start helping you. Don’t lose hope. Feline diabetes is very manageable. You just need to get on the right track.
    You forgot to tell me what meter you are using and if Jack will eat canned food?

    I’m not sure of you are going to send the curve to the vet or not, but please don’t increase the dose by 1unit. Only increase by 1/4 unit if the vet says to increase.
    Do you have the 1/2 unit syringes?
     
  7. Ms Leslie

    Ms Leslie Member

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  8. Ms Leslie

    Ms Leslie Member

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    Yes I will not be increasing by 1 full unit only 1/4 like you recommend. The meter is an Alpha Trak 2 just like the Vet’s for cats. I will test daily and watch for ketone presence. Yes, Jack will eat wet food but only a little at a time, he likes dry food much better. But I am going to try to feed him little snacks throughout the day of wet food only and not dry food. I’ll spot check his BG once I can get him to eat only dry food. I’ll keep you informed. SOOOOO HAPPY, she will be helping me with SS. THANK YOU BRON SOOOO much. I’ll keep an eye out for her message.
     
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  9. Bron and Sheba (GA)

    Bron and Sheba (GA) Well-Known Member

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    Just be aware that removing dry food can drop the BGs by up to 100 points because dry food is high carb. Do it slowly.
    With getting tests during the cycles....mix it up. For example one day get a +2 and a +4. Another day get a + 3 and a+5. Another day get a +4 and a +6 etc. it doesn’t have to be those times but you get the idea.
    Of course if the BG is dropping you will need to keep testing to see it isn’t dropping too low. For the PM cycles try and always get a before bed test in. If that test is lower than the preshot BG it would be wise to set the alarm and test again later.
     
  10. Bron and Sheba (GA)

    Bron and Sheba (GA) Well-Known Member

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  11. Bandit's Mom

    Bandit's Mom Well-Known Member

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    Hi! I can definitely help you with setting up the spreadsheet (SS) as well as your Signature block. Will send you a PM for the info I need to set them up.
     
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  12. Ms Leslie

    Ms Leslie Member

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  13. Ms Leslie

    Ms Leslie Member

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    Hi Bron: I wasn’t sure what you meant for me to do until I recently completed the spreadsheet. I haven’t been doing the tests like you suggested but going to have to start. It pains me sooo bad to have to check his blood but I know I have to start doing it. I completed the spreadsheet with intermittent testing (few). We are concerned because his peeing and water intake is going up. He seems to have one good day and then it goes all wonky. If you can take a look at what I have there so far and tell me if you have any suggestions. I’m considering having a second opinion with another Vet. We are into our 4th month and no further ahead with this Vet. Honestly, If you wouldn’t have told me to feed Jack small snacks throughout the day, I’m not sure where we would be today. Vet only wanted me to give him two meals 12 hours apart pre his insulin. Since I started giving him small snacks (overnight as well is this okay? ) I think this is the only thing that has kept him from getting Ketones in his urine so far. I always from the get go fed him a little for lunch, I told her he gets too weak from waiting that long. Thank you Bron, when you get chance if you don’t mind having a look at the spreadsheet and I know we have to do more spot checking. Thank you for everything!
     
  14. Diane Tyler's Mom

    Diane Tyler's Mom Well-Known Member

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  15. Ms Leslie

    Ms Leslie Member

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    Thank you Diane!!!!!!! Hugs.
     
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  16. Diane Tyler's Mom

    Diane Tyler's Mom Well-Known Member

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    You are welcome :cat:
     
  17. Bron and Sheba (GA)

    Bron and Sheba (GA) Well-Known Member

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    Hi Annette,
    I’m really pleased to see you are continuing tho test for ketones! That is really important. Keep doing it daily dose the time being, especially while he is in higher numbers.
    I’m not sure you need a second opinion at the moment........what you need to be doing is testing the blood glucose every single time before you give the insulin.
    Otherwise you have no idea if it is safe to give the dose or if the BG is too low.
    Then you need to be checking the BG during the cycles to see how low the dose is taking Jack. That way we can tell if that particular dose of insulin is doing a good job or not. You need to get at least one test in each cycle.
    Looking at the SS at the moment, I suspect Jack is dropping lower during some of the cycles and then bouncing up high. The only way to see if this is happening is to be vigilant with testing.
    Increasing the dose without seeing what the current dose is doing is dangerous so please don’t do that. We don’t want Jack to have a hypo.
    Keep feeding the main meals and snacks during the am and the pm cycles....I am glad you are still giving the snacks...that is important.

    I am going to ask @Bandit's Mom to have a look at your SS as it is not transferring properly from the world to the US SS.

    I would recommend to you that you start posting every day so we can see what is happening and we can help you.
    Also if you could have a look at the two dosing methods I am going to link please. It will be much better for Jack if you are following one of the methods.
    If he is still eating any dry food, he will only be able to do the SLGS method.
    Here is the link https://www.felinediabetes.com/FDMB...-low-go-slow-slgs-tight-regulation-tr.210110/

    Looking forward to hearing back from you,
    Bron
     
  18. Diane Tyler's Mom

    Diane Tyler's Mom Well-Known Member

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  19. Bandit's Mom

    Bandit's Mom Well-Known Member

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    Hi Bron, Annette,

    Where there is text in the World tab (like "11.2 @ +1.5"), the formula in the US tab will not work since it expects a number. One has to manually enter the data in the US sheet and change the colour of the cell and font.
     
  20. Bron and Sheba (GA)

    Bron and Sheba (GA) Well-Known Member

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    Thanks @Bandit's Mom
    I also couldn’t see anything in the remarks column of the world one but I can now.
     
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  21. Ms Leslie

    Ms Leslie Member

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    Going to try using my other laptop as soon as it's charged. It may be that my laptop is too old and doesn't support the program. Thank you to both of you. I am about to enter another result from a recent test today. Bron, I will get back to you shortly. Thanks again.
     
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  22. Ms Leslie

    Ms Leslie Member

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  23. Ms Leslie

    Ms Leslie Member

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    Bron, do you mean getting one test in after morning dose and then one test in after 8:30 pm dose? I'm not sure I understand correctly. Or do you mean test 2 hours post insulin and then maybe 2 hours later from same morning dose? Sorry, I'm not sure. Annette
     
  24. Ms Leslie

    Ms Leslie Member

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    Another question. I start to feed him around 7:45 am and 7:45 pm because it takes that long for him to eat his meals. Then at 8:30 am and 8:30 pm, I give him his insultin. You mentioned you wanted me to check before the the dose was given each time, but where he has already eaten isn't his blood glucose going to higher anyway? I'm not sure when to test him because before he's eaten, isn't his blood glucose going to be naturally lower anyway? Then when he eats, it rises, correct? Just need some clarification on this and if I test after each cycle or just through the day after his morning insulin (in different increments as you explained earlier like +2 and +4, then +3 and +5 etc? Thank you
     
  25. Sienne and Gabby (GA)

    Sienne and Gabby (GA) Senior Member Moderator

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    Like Bron noted, you really need to get more tests. Lantus dosing is based on the nadir -- the lowest number in the cycle -- which typically is somewhere in the vicinity of +6. The minimum number of tests you need in 4 -- a pre-shot test before the morning (AMPS) and evening (PMPS) doses of insulin and tests during the cycle. This is the best way to insure Jack's getting enough insulin and that he's in a safe BG range. Without the test data, you may be missing when his numbers drop low enough to warrant a dose reduction.

    Please keep in mind that cats to not have as many nerve endings in their ears. Ears are places where a cat may get bitten when in the wild so from an evolutionary standpoint, the ear is a good place to poke. In addition, you need to be calm about the process. If you're anxious, Jack will know. If you have any question about how much testing a cat will tolerate, look at Gabby's spreadsheet in my signature. I was a testaholic.

    With Lantus, you do not need to wait an hour between feeding your cat and giving an injection. Lantus onset is roughly 2 hours after you shoot. (This is very different than the shorter acting insulins that require that food is on board because onset is in less than an hour after an injection.) You want to test, feed, and shoot all within a few minutes. I would give Gabby her shot when her face was in her food. You test before you give insulin to insure that your cat's BG is not too low. If you're cat's BG is at 40 at shot time, you would NOT give insulin. The pre-shot tests are the crucial way to know if it's safe to give insulin. The tests throughout the cycle tell you if numbers are dropping and whether you need to intervene to prop the numbers up as well as to see how low the dose is taking your cat. Food typically does raise BG numbers. With Lantus, if you're feeding your cat and then you test at +2, if the numbers are the same or lower than your pre-shot test, it may be signaling that numbers are dropping and your need to be closely monitoring Jack's numbers.

    Also, you do not need to feed your cat just twice a day. It's one option. Many of the caregivers here feed their cat small meals throughout the day.
     
  26. Ms Leslie

    Ms Leslie Member

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  27. Sienne and Gabby (GA)

    Sienne and Gabby (GA) Senior Member Moderator

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    Leslie --

    Did you have a question?
     
  28. Ms Leslie

    Ms Leslie Member

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    Thank you for your reply. I understand what you are saying and it makes sense. The Vets do not seem to be on the same page which is interesting. I have to tell you, I despise poking him but now know if I want all you guys help, I'm going to have to start testing at least 4 times a day. How long typically does it take to find the perfect dose? We have been dealing with the Vet now going on 4 months. So frustrating. Thank you again. I really appreciate your feedback.
     
  29. Ms Leslie

    Ms Leslie Member

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    Also Sienne, my Vet only wanted me to feed Jack twice a day. But from the get go I told her, he needs something at lunch time he was so weak from not eating. Now thanks to Bron’s instructions I also give him a snack before I go to bed, he eats it all by morning and is still maintaining his weight. I will watch video shortly. Thanks again
     
  30. Ms Leslie

    Ms Leslie Member

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    Yes, I do. I'm thinking that I check Jack's insulin before he eats and before his insulin tonite correct?
     
  31. Sienne and Gabby (GA)

    Sienne and Gabby (GA) Senior Member Moderator

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    You want to test Jack, give him his food, and give him his shot either while he's eating or immediately thereafter.
     
  32. Ms Leslie

    Ms Leslie Member

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    okay thank you for getting back to me so quickly.
     
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  33. Ms Leslie

    Ms Leslie Member

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    Hi everyone; I want to thank all of you for all your input with Jackson’s diabetes journey. I believe with all your advise (I have learned so much from all of you) and with your help have increased Jack’s snacks throughout the day and have learned to test his urine daily for Ketones. I am taking a break for awhile from entering in the SS and just going to follow the Vet’s advice and see how he makes out. To be honest, I am too timid to go on my own (with all your help and advice too) to try and bring Jack’s sugars down i.e., dosing him without Vet in accordance to his numbers. My fear is that if something happens, I won’t be able to turn to them for help. My husband is a great help with Jack and we are still going to check for ups and downs in his sugars during the day, while waiting and hoping that this is the correct base dose. He’s having a really good day today. Ate everything I put in front of him and being his little “foolish’ self. I’m still keeping all the information as it is now, if in the days to come, we are still no further ahead, I hope and pray I can come back to your forum and still have the wonderful support shown to Jack and I so far, since coming onboard. Again, thank you Bandit’s mom for helping with the SS, Bron and Sienna, and all of you!!!! Hopefully, I can come back in the very near future with some GOOD news. Again, thank you all.
     
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