Some questions to get started

We lost our diabetic Margaret in 2011 and it seems her sister/litter mate Julia didn't want to be left out of the sugar dance. She's been peeing around the house and we had her to the vet a few months ago many, many times. We tested sugar, kidneys, did blood work, x-rays, and determined it had to be behavioral. We've had a tremendous amount of stress in the house in the last year. My Mom mentioned tonight how much she was peeing and after pulling out the testing supplies (or borrowing them back from my Dad) we found her sugar to be 303. She's most certainly earned a trip to the vet tomorrow. It's been a number of years since I've done the sugar dance and even when Margaret was on insulin, she was only on it about 2 weeks and a diet change allowed her to go OTJ. So, I've been around but am still sort of new to this.

A rundown of things...
I'm perfectly fine with testing and already know how to do it so that is not a concern at all. We still have our Relion Micro meters since Dad uses them, too. I just have to get ketone strips again.

Julia already eats wet food. We just have to get her on lower carb wet.

I know how to handle the spreadsheet. I just have to set one up.

The problem...
My Mom already cares for my Dad who is bedridden and has kidney disease and has had 6+ hospitalizations within the past year. There's where we thought Julia's stress was coming from. Mom is still recovering from skin graft surgery to remove melanoma from her hand two months ago and she had week's hospitalization last Oct. I'm having surgery this Friday and will be down for I don't know how long. I explain this so if I'm a little "nutty" you'll understand the stresses we're under right now.

The problem is if indeed they put Julia on insulin, which I'm expecting they'll do, how do we handle starting this 2 days before we'll be out of the house all day at the hospital? We have a caregiver coming in for Dad but Mom and I won't be here. And even after that, I have no idea what'll be going on with my recovery. It's day surgery though.

I know I have to read the sticky notes about insulin's to figure out what I'm doing (at least to start) but can someone guide me to what insulin I should be asking the vet for? And what starting dose I'm looking at? Margaret was on Vetsulin and I know that's not an option now. I'm looking for something with the gentlest drops and long lasting. Lantus or Levemir? Something that's easy for my Mom to manage while I'm at work. I have no idea how we're going to do this when we're already running ragged but we'll get through it somehow.

Like I said, I'll be reading the sticky notes for sure. I just want to have a starting place when I go to the vet tomorrow and since I have to be up in a few hours for work, I won't have time to read anything until tomorrow evening the earliest, after the vet visit.

Thank you for any help you can provide!

One good thing...Julia earned her way into the FDMB calendar that up until now Margaret had only been allowed in! As if I needed an excuse to buy one each year. ;-) :smile:

Re: Here we go again and I have questions

So sorry about all of the stress and now your kitty showing signs of diabetes. We use ProZinc and many feel it is a good option for people who can't be around for many hours because there is no shed or build up or overlap. It lasts 10-12 hours and it is gone until the next shot. Lantus and Lev can overlap and I think more testing is better for these in the beginning anyway. Not sure cause I don't use these. But, I think they have a very high success rate with going OTJ.

Maybe Julia's numbers are a reflection of the stress and illness around her and she will go OTJ quickly too. Hope so. Best to you both!

Re: Here we go again and I have questions

Intiallly, ProZinc seems to have a steep curve with nadir around +5. With continued use, the nadir may move later and the curve become somewhat less steep.

Lantus & Levemir have extended durations of more than 12 hours in the cat, so the dose effects overlap. The curves tend to be flatter. Effects build up over time - 5 full days before the nadir guides the first dose adjustment (barring going too low), then 3 full days before subsequent nadir evaluations guide later dose adjustments.

Perhaps you might find a high school student or two interested in veterinary science to come learn how to monitor and inject a diabetic cat.

Questions

Thanks for the information! It seems Lantus/Levemir and PZI are all good options. I wish there was an insulin with not so steep drops and no shed to worry about. I'm still torn between the choices. The vet has no appointments tonight so she'll be going in tomorrow evening. I don't think we have to worry about finding someone to come test and shoot for us as we're perfectly comfortable with doing so. Not necessarily the dosing of those insulin's mind you but the act of testing and shooting we've done before. It's just getting through the weekend. I'm wondering if we get insulin tomorrow night, does it make sense to do a tiny dose on Friday or wait until Saturday when we're home to start things? Of course I don't want her staying high but I also want to be safe. She was 351 this morning. Also, I'm getting her lo carb Fancy Feast tonight to get that started, too.

Another question...
Even while Margaret was OTJ I got (almost for free with coupons) a Precision Xtra monitor that tests ketones and BG. I've never used it. Is it better to test urine for ketones? Or is this monitor okay to use in combination with or instead of?

Re: Here we go again and I have questions

There really is no "one size fits all" insulin for either cats or their caregivers.

PZI and Prozinc do not have depots. More flexible on the dosing schedule. 12/12 is ideal but you can move it more than the 30 Minutes once a day limitation with Lantus and Levimir.

You kind of have to pick one and go with it for now. You always have the option of changing to another insulin later. A number of people here have switched from one insulin to another.

Re: Here we go again and I have questions

So long as there are no ketones in the urine and you've not completely made the change to low carb food, I'd start with that before the insulin. See how much change that makes.

Thanks for all of your help! I'm getting ketone strips in about 90 min after my doctors appointment. I shouldn't have a problem getting that test in tonight.