Unsure and trying to understand.

Greetings. My name is Sabrina, my cat is Blue. He was diagnosed last Sat at an emergency animal hospital, spent 2 days in ICU. His numbers were 369 when he was admitted.
I've since discharged him to his Vet, giving him 2 units of insulin 2x a day at 6a and 6p.
Vet encourged me to get a home testing kit, which I did. I purchased him puriena DM food dry and canned.
This morning he was at 499, then this evening he was 450.
I believe that perhaps I am doing some thing wrong, and need some advise. My vet is wonderful, however he instructed me to feed Blue, then shoot him his insulin, then take his blood sugar. In doing this, well it makes no sense. Shouldn't I be adjusting his shot to his numbers? So, if he was at 400, wouldn't I give him more shot? Say increase him to 2 1/2 units, alike if he was normal in the 100 to 120 range I would give him 1 unit? Does this sound better? Also, shouldn't he eat before I med him? If he bottomed out like he did on Tuesday at 89, wouldn't I give him his kayro syrup?
It seems to me I should take his blood sugar, then give him his shot while he's eating.
And about the food, he does not like it. I read on a board that he can eat Blue Buffalo wilderness blend, but go canned. He loves Blue Buffalo.
I'm just very new to this, and trying very hard to understand how to manage my boy. Although my vet is very concerned and helpful, I just don't think he has alot of experience dealing with this disease.

 

Welcome Sabrina and Blue! Sabrina, you have excellent instincts. You are exactly right. It's test, feed and shoot. You test before feeding because food can make blood glucose levels go up and you want to be working with a true number, not one influenced by food. Your number helps you figure out if the dose you are planning on is safe to give. Then you feed and be sure there is some food in his tummy, then shoot. (We always gave him the shot while his head was deep into his food bowl....)

You are also right about the food. Wet, lo carb is best. A vet explains why here: www.catinfo.org A number of the Blue Buffalo flavors are great. This page has Blue Buffalo on it. We try to stay below 8-10% carbs. http://binkyspage.tripod.com/CanFoodNew.html

What kind of insulin are you using? We generally encourage newbies to start at a low dose (.5 or 1 unit twice daily), test and then raise as the numbers guide you.

 

Hi there Sue and Oliver.
I'm injecting Blue with 2units 2x a day with Lantus.
Instead of using a human meter, I special ordered Blue a AlphaTrak. Pretty cool, it codes to cats.
He is such a good boy, lets me test his sugar with no fuss, takes his shots with no fuss. All he wants is love.
Would I be correct that if he were eating more food, that perhaps his blood sugar numbers would go down? If his numbers went down, wouldn't I decrease from 2 units to perhaps 1 1/2 units per shot? How do you decide how much insulin to administer?

 

Hi Sabrina, and Blue too!

I agree, very good instincts. Let us know what sort of insulin you are using. I had a question about him having to spend two days at the vet... When he was diagnosed, can you tell us what his condition was like? And what was it that convinced you he needed to get to the vet quickly? I'm wondering how badly he was doing when he was diagnosed.

The only thing that you said that I'd caution against right now is dose adjusting based on his BG readings. Your logic is good, it would make more sense to shoot more on higher numbers and less on lower numbers. The problem with that at the beginning is that you can't be exactly sure yet how much a given dose will do with his BG. When starting, you need to keep the doses consistent until you see a pattern emerge. We call that a "curve". Look at his number at shot time, and then his numbers as the insulin works, then at his number at the next shot time. Over a 12 hour cycle, his BG should curve down about half way between shots as the insulin reaches its peak efficiency, then rise back up as the insulin wears off. The numbers "in the middle are just as important as the shot-time numbers. Those will tell you what the insulin is doing.

It's awesome that your vet recommended home testing, and you've gotten the hang of it so quickly! That's usually a hurdle that takes time to hop over, and it sounds like you're there. So, testing, feeding low-carb (Blue Wilderness is a good choice), and insulin every twelve hours. That's the routine, and you are doing wonderfully so far!

The switch off that DM wet and dry is going to help. The low carb food will push his numbers down significantly. That's another reason to "start low" on doses. The dose you are giving him right now may be too high once he's eating better food.

This site is full of so much information! Don't try to take too much in at once. You'll learn as you need to. None of us "know it all", but together all of us know a great deal. You'll find that advice is there whenever you need it, help is there whenever you need it too. People are on the board around the clock, and from all over the world. Now you and Blue are a part of it too.

Welcome to both of you,
Carl in SC

 

....I have a feeling that you're about to get some advice (from someone other than me!) about the "spreadsheet" concept. That is going to be your most valuable tool in figuring out dosing.....

Carl

 

Both Carl and I use/used PZI, not Lantus. We have a forum for Lantus users on the site: viewforum.php?f=9 At the top of the page under the grey bar are some starred threads. They have great info on how best to dose Lantus, how it works, how to increase and decrease, etc. You can also post on that forum with specific dosing questions - everyone there uses your insulin.

You do want to be careful with the dose and do frequent testing if you eliminate the dry and go to all wet. When we switched Oliver over, he went down 100 points overnight. If we hadn't been watching, we would have overdosed.

 

Most likely the dose the vet has you begin at, 2 Units, is too high. I believe you said he had an 89? But otherwise he's been over 400? HIs blood glucose should not fluctuate that much.

Our recommended beginning dose for any insulin is no more than 1U, twice a day, 12 hours apart. This is especially important with Lantus because it's a very good insulin. Also, it works a little differently than other insulins the vet may have more experience with, such as Vetsulin or Prozinc/PZI. Lantus builds up slowly in the body and creates an overlap effect. Therefore giving 2 units could cause too much overlap and result in low numbers. Starting at 1 Unit is always safest and makes it easier to adjust the dose higher if needed after several days. Also, you should not adjust the dose of Lantus according to the blood glucose level when it's time to give shot. Dose is adjusted according to the lowest point in a 12 hour cycle, but a dose should be allowed to work for 3 to 5 days before deciding if a change in dose is needed.

By the way, 89 is not really low. It's actually a very good blood glucose level. But Blue may be reacting to the low number as if his body no longer realizes that's a good number. Please read about rebound: http://petdiabetes.wikia.com/wiki/Rebound

Here is a website which discusses how to manage Lantus insulin. http://www.tillydiabetes.net/en_6_protocol2.htm

Did Blue have ketones while he was at the vet for 2 days? That is a serious condition and we need to know if that happened so we can give you the best info on how to keep that from happening to Blue again.

Hope this helps. You're doing very well for Blue so far, especially by finding FDMB and asking such great questions! :thumbup

 

Thank you all of you. Wow, am I glad I found you.
Blue was a rescue. One of my girlfriends had him, and she just wasn't wild about him. Ignored him, terrible food, never pet him, if she was home she forced him outside just to get rid of him. So, in steps Sabrina.
When I got him he weighed maybe 7 lbs. He's a Hymalyan??(bad speller). Anyway, switched him to Blue Buffalo food-dry. He loved it, bulked up to 14 lbs in less than a year.
So, 2 weeks ago he just wasn't himself. I have 3 other rescue babies, so as a result hard to tell who's eating/pooping/making water in the litter box.
Then I started really watching him, he was hiding(very unusual), he's very furry so I didn't notice the weight loss.
What prompted me to take him to the emer room was that he messed in my room, and yacked. That's when I noticed the weight loss. When he was weighed in he was at 6 lbs and blood sugar 369. They did a full work up, no FIV, Lukuima(??), no infections, no blockages, just bad blood sugar and keytones??? So emergecy room doc explained that he can't process the food he eats, and the keytones are like poisen to him. The two days ICU he got IV fluids, IV insulin.
He's trying to eat, but just a nibble here and there.
I know I need to get his blood sugar stable, and I know I need to get him to eat and put on a heathy weight gain.
Giving him the shots and taking his blood sugar is easy for me, I have MS and give myself shots every day, so not my first rodeo.
Would it be better for him if maybe I were to give him more shots a day and administer less insulin in the shots for a while just to get his numbers in better shape?
Tomorrow morning I'm going to the pet store and getting him Blue Buffalo wet food.

 

The ketones.
Yes, Blue was presenting with ketones at the emerency room, and Monday and Tuesday at the Vet's office. To my knowledge he has not been further monitored for them.

 

Ketones can be very dangerous. You really need to test for them starting now, and be ready to take him back to the ER if you see signs of them. You can buy the ketone sticks at any drug store. Here is the info: ketones If I were you, I would get some tonight and take a test.

When the vet sent him home, did he indicate the ketones were gone? Did he tell you what to expect/look for?

 

No Do not give more than 2 insulin shots per day. You risk ODing your cat, especially with a long lasting insulin like Lantus.

 

He mentioned that they were still there, to start the insulin therapy and see if they resolved.

 

The idea is to reduce the dose but still give two shots 12 hours apart.

But if ketones are active, we want to be careful about the dose. I am sorry, but I think this is pretty dangerous advice from your vet. If ketones are present, the cat is in potential danger. Yes, the insulin can help, but you need to be on top of them and ready to react. So you need to be able to get tests at home.

Here is some info on DKA: http://petdiabetes.wikia.com/wiki/Ketoacidosis It is possible he had a mild case, but it is still something to be very careful with.

 

Not to sound stupid, but how do I get a urine sample from Blue??? He uses a box with litter.

 

Sabrina,
No you can't give him many small doses during the day, that's just not an effective way to use Lantus. It really has to be 2 shots, 12 hours apart for it to start to work correctly.

The vet probably considered him to be ketoacidotic (sp) or DKA. If he got fluids and insulin IV while in the ER. That's bad stuff. Bob went through it too. Do you know what they fed him there, and how? Sometimes they have to syringe feed them, and is drastic cases have to use a feeding tube. That's why ketone monitoring is important right now.
Really important that he eat. It will help him heal faster. There are all sorts of tricks you can try which I am sure you'll be given soon. Even if you just water down canned food to make it like mush, as long as he eats it. Tuna juice over it helps sometimes.

Carl

 

Ideally, you catch him peeing, and you put the ketostick in the urine stream to get a sample.

 

I am getting so much great advise.
OK, keep it at 2 shots a day. I understand and thank you for answering that question.
I perhaps need to decrease him to 1 unit per shot.
Blue Buffalo Wilderness blend wet.
Test, feed, shoot.
Create a spreadsheet and track his numbers.
Test him minimum 4x a day.
Get ketone strips at the walgreens and watch him.

 

Yes to all of the above!

And post questions as you think of them!

Carl

 

Well I can report that I did receive quite a good education tonight.
You all cleared up alot of my confusion and answered alot of my questions.
I guess I've been bumbling thru this and not asking my vet the right questions.
I can report that he has been looking a little better every day. Small improvements.
He's a real fighter.
Thank you all of you.
Sabrina

 

Please get the ketone test strips as soon as possible. There are a few ways to catch urine to stick the test strips in.

One is to just catch them at the box and stick a large spoon or ladle under their urine stream. That is if he will let you get that close while he's in there!

Another couple ideas are to get some aquarium gravel which won't absorb the pee like litter.

Some cats will pee in a box without litter.

Another nifty idea is to cover the litter with plastic wrap and the pee will usually pool in one area. Unless the cat scratches at the litter under the plastic. Some cats don't cover, so that may work.

Hope you can figure out how to test the urine. It's really important to keep an eye on the ketones. Did they give you any antibiotics to give Blue? Ketones are often caused from infection, plus not eating and/or weight loss form uncontrolled diabetes, plus not having insulin in the body. If they did not send you home with some type of antibiotic, please call them tomorrow and make sure they saw no signs of infection, such as urinary tract, which is common in uncontrolled diabetics.

I also recommend making sure he gets plenty of water, syringe it to him if you can. Cats have a low thirst drive, but hopefully since his blood glucose isn't very stable he is drinking quite a bit more than normal. He still needs extra water, it helps clear the ketones from the body.

 

It is not up to you to ask the "right" questions. It is just possible that your vet doesn't know a whole lot about feline diabetes. They are like GPs - they have to treat many different species with many different diseases. They can't be a specialist in everything. Dog diabetes is different than cat. It's hard.

 

You can temporarily replace the litter with fish tank gravel or something similar and non-absorbent. Vets sell No-Sorb plastic pellets but a little cup of that is pretty pricey. After your cat uses the box to pee, tilt the box to pool up the pee in a corner and dip the ketone test strip into the puddle.

You can also just try to catch your cat in the litter box and stick a long handled ladel under the tail to catch the pee.

There is a Human blood glucose meter that also tests for ketones. It's the Precision Xtra.

Here's the link to the spreadsheet: http://felinediabetes.com/FDMB/viewtopic.php?f=6&t=50130 This is the current way of getting a spreadsheet up and running. Then follow Part B of the original spreadsheet instruction sticky to publish your spreadsheet and get the shareable link to put in your signature.

 

Sabrina,
That's why we all are here! Everyone one of us has been in the same place you are in, and everyone of us was welcomed and calmed and helped by all the wonderful people here.

Sugarcats are special, and so are the "beans" who care for them.

Carl

 

First, Welcome to all of your family! Guess you can tell you'll get lots of help and support here!

Did I miss seeing the KIND of insulin that's being used? That is a BIG piece of this puzzle. I see discussions and dosing directions for people using both Lantus and PZI which are different than Humulin N and Cannsulin. How can we say for sure until we know this?

I iz not a grouch.....maybee I iz just confuz'd?

Welcome again and by the way, what kind of insulin are you using? ;-)

 

Lantus, previously answered.

 

I'm sorry, I gotta go get my eyes checked.............I looked 3 times and missed it every time. THANKS VICKY!

 

LOL, it's OK. When there's a lot of info in posts, it's hard to find the needle! I knew I had read it, but I had to go back and look for sure myself!

 

Lantus is a good twice a day insulin - every 12 hours.

Lantus is a very long lasting insulin that builds up in the body -- so giving different doses all the time doesn't help -- it is better to start at a low dose and gradually build up to a level that keeps him in good blood sugar most of the day (night) and not too low.

Since your kitty had ketones - pick up Keto-sticks for testing his urine for Ketones. As you discovered, DKA requires hospitalization and IV fluids, so better to catch early before it gets serious.

you can make sure the kitty litter doesn't give a false positive by wetting some litter with water and putting a ketone test strip in the wet litter. If it gives negative ketones, then you can test the wet spot in the litterbox after your diabetic kitty pees.

 

Hi Sabrina and Blue....Welcome to the FDMB Family!

Since you are already in very capable hands here and getting tons of great advice...I'll just pop in with a welcome from one Himalayan mom to another! Musette is one of my two sugarcats and she is also a rescued Himmie, as well as a DKA survivor. Thank you so much for taking Blue under your wing, sugarcats are very special and so are Himmies. IMHO.

Just remember here the only stupid question is the ones that go unasked. We don't care if we have to repeat the same thing 300 times a day. SO whatever you have a question about just ask and someone will be around to answer it.

Mel, Maxwell, Musette & The Fur Gang

 

You've gotten great advice so far, so I'll just chime in about catching a urine sample.

I use the Breeze litter system: http://www.breezeforcats.com/. One of the perks to using this type of box is that it's incredibly easy to catch a urine sample--you just remove the pad when you need one and wait for your cat to pee. I always warn people though the box is not good for kitties that have frequent problems with loose stools because they are a pain to clean up, but if that's not a problem with your cat I would definitely recommend it. There's a $10 off coupon on their site right now, too.

 

This morning at 6a I rendered 1(one) unit of insulin.
Had to go out and run errands.
at 1330 tested him at 64.
gave very little dextrox syrup, 3cc.
But the thing was, he was alert and frisky for lack of better words.
I went to the rite aide, wallgreens, and drug emporiam, no ketone strips.
wow, am i in danger zone?

 

How long (in hours) after the shot was the 60? We don't usually worry until they get down in the 40s.

Edited. See about 5 hours. He should be okay. I would test again in 30 minutes to make sure he is headed up.

 

For next time, if you see 50-60s, give a bit of his regular low carb. If 40s, try some of the gravy off a higher carb food. You want to get him up without filling up his tummy. If below 40, break out the syrup.

The syrup may take him high, but it will not be for long. Don't over react with a higher dose. Get some advice for tonight's shot.

 

just now yacked.
but syrup I gave him.
been trying to get bood, cannot.
ill wait an hour an try again

 

We would like some food in his stomach. Maybe feed him a little bit of something he really likes? It may be that the syrup didn't settle. Get another number when you can.

 

Hi Sabrina,

Welcome to the wonderful community of the FDMB. You have gotten a lot of very good information already. There is so much to absorb all at once when you are thrown into this situation. There is a very active sub-forum here for Lantus users at viewforum.php?f=9. If you could open a thread there your questions will be seen by more people who are very experienced in using Lantus. Good luck on your quest for the best health for your sugarcat, Blue!

 

Hello friends, Sabrina here.
This morning I went and vistited with a friend of mine that is a diabetic, and uses Lantis.
He's been diabetic for 10 years, so I figured he would have some insite.
I feel so much better now.
He explained to me how to trend Blue with his numbers, how to determine which flavor of the Blue Buffalo to give based on his numbers. He broke down how to read a label, what to look for, the hidden sugars and carbs. He showed me little tricks with a quick boost, how to care for the test sites. Stressed the importance that I put Blue on his leash and go for a short walk every day. We went shopping at Petsmart and selected correct foods for him, all Blue Buffalo. We took Blue with us, he's such a rock star on his leash...what a little slut for a head rub from strangers.
I have learned that Blue has a progressive but slow drop in blood sugar from 6am till around 11am. That is when he seems to have an abrupt drop. Then he leveled off till his 6pm shot. So, as a result, Blue gets 3 meals a day, not to exceed 3oz..lower cal breakfast and lunch, higher dinner hopefully, that will stablize him.
I believe the very best thing I can do for my boy is learn as much as I can, and apply that knowledge. Test test and when in doubt, test again. Record the numbers, and trend his highs and lows.
I did find the ketone strips at a little mom and pop pharmacy around the corner, tested him 3x today. Used the serving spoon method-uh thanks for that...I had no clue how to get pee from my cat!! At any rate, only a trace. So I feel much better about that. I will continue to test periodiacally. I also learned today that his breath would smell fruity or like metallic. So just more info for me to help Blue.
I feel like I'm getting a better grip on this, and Blue, Chalupa, Leo, Scooter and me will have a very very long and loving life...Soon Blue will be playing with his pals again...Thank you all of you for everything. I know where to go if I have any questions in the future.
Sabrina

 

Hi Sabrina,

Just wanted to wish you all the best and ask one question too.

I am not sure if this was mentioned in another thread or not.

Please someone correct me if I am wrong.

But did you know that with the Alpha Trak meter you either have to substract 30 points from the readings you are getting or if you are looking at one of dosing charts in the stickys you have to add 30 points to numbers on the chart. (unless it is a chart configured for Alpha Trak meters.) In others words, BG numbers 50 to 200 on the charts becomes 80 to 230 for you. Then you would know that a 60 is way to low.

It is so important to do this. Your 60 is really a 30. confused_cat

I have links and additonal info but you may already be doing this.

And if I have misunderstood what to do with the Alpha Trak meter numbers please someone chime in with corrections.

Elaine

 

Hi Sabrina,
Thanks for letting us know how it is going. Glad to see you've been able to learn so much more in a short time too!

Yes, you can smell ketones on his breath. But, testing is much more important because by the time his breath smells like ketones, the levels would be pretty high. Some people liken the odor to nail polish remover too. My vet smelled them on Bob's breath, and by that time, he was DKA, spent 3 days in emergency care, and nearly didn't make it.
Great that you have been able to successfully test using the strips! They'll give you a much earlier warning.

Carl