Brittle Diabetes

[Lily-Fish]

Hi all,

So I have been reading a lot of the stuff here on the forum but couldn't find much similar to my situation.

My cat Lily was diagnosed with diabetes in October 2015. She was put on caninsulin 1 unit twice daily.

Polyurea and polydipsia continued (along with her voracious appetite), as well as her losing all of her body fat and losing muscle mass.

I kept mentioning this to the vet but they put it down to her diabetes and said she would soon start to gain weight.

On Feb 18th just gone she was admitted to the vets for dehydration and DKA. She was at the vets for 8 days, in which time she nearly died twice (low bp, very high BG). Eventually she started eating and drinking again, peeing and pooping. The vet switched her to lantus insulin 1.5 u twice daily however she varied from being really low to really high.

Anyway, eventually on the Friday (26th), I got to take her home. When she arrived home she was understandably spooked and didn't want to eat much. I syringe fed her and gave her her insulin until Saturday evening when she had relaxed and wanted to eat and drink on her own. Again, I continued to feed, give insulin and repeat 12 hours later. Because of her vets stay, I couldn't get any blood from her ears for home testing.

This morning I woke up, fed her and dosed her and went (grudgingly) to uni. I got back from uni 4 hours later to find her having a massive hypo. Got her to the vet who tested her sugars. I'm from the UK, it was 1.5 mmol/l, very very low.

I don't know what to do. I have been consistent and her body isn't. She doesn't react to the insulin the same way every time. She is 12 and after such a long vets visit being poked and probed I am seriously worried it is a foregone conclusion here. The vet is trying her on a high fibre wet diet and doing some bloods. I just don't want her to suffer and I can't be at home literally 24/7 as I have to go to uni and work for a living. I'm a paranoid wreck at the moment and would really love to find a way to regulate her sugars.

Kidneys and liver so far are okay. Repeat bloods tomorrow.

She is my best friend, I've had her since she fit in the palm of my hand and I just want the best for her.

Advice please?

Thank you

 

[Critter Mom]

Hi and welcome to you and Lily.

I'm very, very sorry to hear how dreadfully rough a time Lily has had over the last few weeks. I really, really feel for you both.

First up, please don't lose heart. I'm so glad you've found FDMB. It's a great place to learn more about diabetes and to get help for Lily. I'm in the UK, too. I became a member here in June 2014 when I was getting nowhere with the vets we were registered with at the time. The members here have done so much to help me to help my Saoirse and I'm sure they'll be able to help you and Lily, too.

With regard to the hypo incident it is possible the 1.5IU Lantus dose may have been too high, especially if Lily is underweight. Unlike Caninsulin where you give the dose and it is out of the system before the next insulin dose is due, Lantus is a depot insulin and successive doses build upon each other to create a 'tank' of insulin in the cat's body and it therefore takes several days before you can get a full picture of how the cat is responding to a particular dose. There are members here with extensive experience of treating their cats with Lantus and I'm sure they will be able to work with you to get the right treatment plan in place to help your beloved Lily. I'm tagging @Chris & China and @Marje and Gracie to see if they can help you.

In the meantime it would help a lot if you could post the following information:

1. Lily's current weight.

2. Lily's ideal weight.

3. Please confirm whether you are home testing Lily's blood glucose levels. If yes, which meter are you using?

4. Could you post any data you have available for Lily's BG - especially results that show the wide swing in BG levels. It is helpful to give preshot readings then the number of hours between the dose and the time of the next test (e.g. AMPS = morning preshot test; AM+4 = test done 4 hours after morning insulin dose - and similar for PM cycle.)

You may have noticed that most members have links in their forum signatures to spreadsheets with their cats' blood glucose readings. By tracking Lily's BG in a spreadsheet it will give you a much better understanding of how she's responding to her insulin and will therefore be an invaluable aid in helping you to keep her safe on insulin and improve her regulation. You'll also be able to share Lily's data with members here and they'll be able to give you better help as a consequence. You can find out how to set up a spreadsheet for Lily here. (Choose the World spreadsheet for mmol/L.) If you need help with setting it up just holler.

Hang in there. We'll do all we can to help you both.



Mogs
.

 

[jayla-n-Drevon]

Welcome--
bump

 

[jayla-n-Drevon]

Hi all,

So I have been reading a lot of the stuff here on the forum but couldn't find much similar to my situation.

My cat Lily was diagnosed with diabetes in October 2015. She was put on caninsulin 1 unit twice daily.

Polyurea and polydipsia continued (along with her voracious appetite), as well as her losing all of her body fat and losing muscle mass.

I kept mentioning this to the vet but they put it down to her diabetes and said she would soon start to gain weight.

On Feb 18th just gone she was admitted to the vets for dehydration and DKA. She was at the vets for 8 days, in which time she nearly died twice (low bp, very high BG). Eventually she started eating and drinking again, peeing and pooping. The vet switched her to lantus insulin 1.5 u twice daily however she varied from being really low to really high.

Anyway, eventually on the Friday (26th), I got to take her home. When she arrived home she was understandably spooked and didn't want to eat much. I syringe fed her and gave her her insulin until Saturday evening when she had relaxed and wanted to eat and drink on her own. Again, I continued to feed, give insulin and repeat 12 hours later. Because of her vets stay, I couldn't get any blood from her ears for home testing.

This morning I woke up, fed her and dosed her and went (grudgingly) to uni. I got back from uni 4 hours later to find her having a massive hypo. Got her to the vet who tested her sugars. I'm from the UK, it was 1.5 mmol/l, very very low.

I don't know what to do. I have been consistent and her body isn't. She doesn't react to the insulin the same way every time. She is 12 and after such a long vets visit being poked and probed I am seriously worried it is a foregone conclusion here. The vet is trying her on a high fibre wet diet and doing some bloods. I just don't want her to suffer and I can't be at home literally 24/7 as I have to go to uni and work for a living. I'm a paranoid wreck at the moment and would really love to find a way to regulate her sugars.

Kidneys and liver so far are okay. Repeat bloods tomorrow.

She is my best friend, I've had her since she fit in the palm of my hand and I just want the best for her.

Advice please?

Thank you

Hi-- @Critter Mom has already tagged a few of most educated advice givers here.... I just want to add that finding a vet that is more educated in FD might be a good thing

 

[jayla-n-Drevon]

@Wendy&Neko @Sienne and Gabby (GA)

 

[Wendy&Neko]

Hello and welcome, sorry you've been through such an ordeal to date. Diabetes is definitely a manageable disease and we have many people here who've gone through DKA with their kitties.

Because of her vets stay, I couldn't get any blood from her ears for home testing.

I don't understand what this means. Are you having difficulties getting blood from her ears? The paw pad is an alternate side that some people use for getting blood.

As for dose, typically when cats transition from the shorting acting insulins to Lantus, we'll use the same dose, which would be 1.0 unit. However, given that Lily was recently DKA, we would not want to start her on too low a dose. Without information on any blood test data you have, it's very difficult for us to suggest any changes to the dose.

Are you currently testing Lily's urine regularly for ketones? It's essential for a kitty recently out of DKA to stay on top of the ketone picture. You should be test at least once a day if not more at this point. Anything above trace ketones means a visit to the vet. And make sure you are adding lots of water to her food. Water helps flush ketones. High fiber wet diets are very old fashioned ways of looking at treating diabetes - works well for dogs, not so much cats. The current thinking is low carb wet or raw food. However, don't change foods until you are regularly getting blood tests as food changes can cause sudden changes in amount of insulin needed.

 

[Lily-Fish]

Hi, and Thank you for the swift reply.

So, Lily is part Norwegian forest cat and is aiming for 5.5kg as her ideal weight. She has lost 1.2kg in the past month and is currently 4.3kg so a lot of weight. I just added a spreadsheet in my signature so will get onto filling that out ASAP.
I have a clinimed meter that I have been using for a while now (I had a moment of paranoia a while ago, I thought I had diabetes!). It has been very accurate for me at least, and I have checked it against an accucheck.
As I was saying, I haven't been able to get any blood from her since she got home. Her poor little ears are all bruised and battered. I feel like doing it into a pad would be so cruel that I'd only do it in circumstances I considered to be a proper emergency.
I will fill out the values I know from the weekend (these illustrate the swings I'm talking about)

(Edit: Lily's ears are very bruised and battered, hence the non bleeding. Also, I'm not sure if she has urinated today. I check the box but I'm unsure whether the wee in there is from yesterday. She usually leaves litter all over the floor when she goes but I cleared this up yesterday and today it was still clean. I'm just very worried and feel like I'm in way above my head)

Thank you again

Becka

 

[jayla-n-Drevon]

Hi, and Thank you for the swift reply.

So, Lily is part Norwegian forest cat and is aiming for 5.5kg as her ideal weight. She has lost 1.2kg in the past month and is currently 4.3kg so a lot of weight. I just added a spreadsheet in my signature so will get onto filling that out ASAP.
I have a clinimed meter that I have been using for a while now (I had a moment of paranoia a while ago, I thought I had diabetes!). It has been very accurate for me at least, and I have checked it against an accucheck.
As I was saying, I haven't been able to get any blood from her since she got home. Her poor little ears are all bruised and battered. I feel like doing it into a pad would be so cruel that I'd only do it in circumstances I considered to be a proper emergency.
I will fill out the values I know from the weekend (these illustrate the swings I'm talking about)

(Edit: Lily's ears are very bruised and battered, hence the non bleeding. Also, I'm not sure if she has urinated today. I check the box but I'm unsure whether the wee in there is from yesterday. She usually leaves litter all over the floor when she goes but I cleared this up yesterday and today it was still clean. I'm just very worried and feel like I'm in way above my head)

Thank you again

Becka

Do you have any ointment you can put on her little ears to help soothe them ? A salve like ointment is what you want--even vaseline may help if you have it in the house.

 

[jayla-n-Drevon]

and remember your not testing to hurt her--you are testing to keep her safe

 

[Wendy&Neko]

I feel like doing it into a pad would be so cruel that I'd only do it in circumstances I considered to be a proper emergency.

Sending a cat into hypo is cruel. If you are feeding a cat a low carb treat (I use freeze dried meat or boiled meat), you'll find that kitties learn to look forward to testing. Mine often tries to lead me to the testing spot to get me testing and more importantly, giving that treat! And if you have a first aid ointment with pain relief, that can help heal and dull any soreness. Testing and knowing where your cat's blood sugar is will give you a lot more sense of control.

 

[Lily-Fish]

She is currently being tested in the kitty hospital. I have just filled in what I know of the BG results from when she was in the vet.

I guess I don't understand enough about diet. I just fed her what the vet suggested and she liked it. I really feel like I have completely let her down. She is so poorly I am afraid she will never regain weight or be herself again and I feel immensely guilty. It was my job to look after her.

 

[Wendy&Neko]

You haven't let her down at all. There is a lot to learn about feline diabetes and vets have to learn about a lot of different animals and conditions. Often they get very limited training in diabetes and haven't kept up with the latest. Getting Lily onto Lantus is a good step. We can help you learn what you need to do to help Lily. I did many things wrong at first, including starting Neko on Caninsulin as per my vet's suggestion and not home testing until we got her onto Lantus. That was over 4 years ago and she's doing much better now.

There is a great website on feline nutrition written by a vet, start here: http://www.catinfo.org/ There are sections on different conditions including diabetes.

One of the reasons we are such strong advocates for home testing is that kitties can often test a lot higher at the veterinary clinic, due to stress. You don't want to decide on a dose based on a stress influenced number. My non diabetic cat once tested 11.7 at the vet and the clinic was worried he might be diabetic. At home the next day I tested him at 3.0, nice low normal numbers.

 

[Lily-Fish]

Thank you. I will be looking at this website this evening. Thank you so much for helping. I'll be messaging with an update tomorrow after 12.

 

[Chris & China (GA)]

Welcome to the FDMB Becka and "extra sweet" Lily!! This really is the best place you never wanted to be if you have a sugarcat! There's going to be a lot of information thrown at you quickly, so please try not to get overwhelmed....We all are managing this disease and you can too!!!

I understand Lily is still at the vet due to the hypo, correct? That's good in a way since it will give you some time to read and learn so when she comes home, you'll be better prepared.

For now, I just want to give you a little hope in the best way I know how....with a couple of pictures!
China at diagnosis in March 2013...less than 8lbs (3.6kg)....click on picture to expand
China after about 4 months on Lantus with the help of the wonderful people here at the FDMB...about 14lbs (6.4kg)

Home testing really is the key to getting Lily as healthy as possible as well as preventing things like you saw today. The vast majority of cats learn to actually look forward to their testing! (Hard to believe, but true!) The keys are to establish a routine and finding the right treat that Lily really loves...and it doesn't necessarily have to be food. Some cats do great getting cuddles or brushing as their reward.

We're all here for you and will help any way we can. Sending prayers that Lily will be home again soon!

 

[Lily-Fish]

Oh wow! These photos really give me faith that I will be able to sort out my lovely little kitty. I just need to get her on the correct dosage and start home testing in earnest.
This is fantastic. Look at your lovely kitty I just have to wait for the results of the blood tests tomorrow. Hopefully Lilys organs are okay. If they are, I can start. If they are not, I think it'll be a very bad outcome.
I also need to learn when to home test and how I can fit my schedule around it. Whether I have to get up very early in the morning to feed, inject, test etc.
Also, she only eats a tiny amount in the morning (she is more of a little and often kinda gal) so i'm worried that picking up the food in the morning means she isn't getting enough causing her to run low.

 

[Mum of two felines]

I just want you to know that when I found this board my Woody was receiving 13 units of Novolin! He had diarrhea, was vomiting, was lethargic, didn't play, meow, or anything! When I started home resting it showed he was hypoing EVERY SINGLE time I injected him. I was doing that for over a MONTH!!! Talk about feeling like the worst human being ever . But the wonderful members here helped me and now my kitties are in remission! Home testing and this board saved both my kitty's lives! You are doing great, just know that home testing is the key to all of this.

 

[jayla-n-Drevon]

Oh wow! These photos really give me faith that I will be able to sort out my lovely little kitty. I just need to get her on the correct dosage and start home testing in earnest.
This is fantastic. Look at your lovely kitty I just have to wait for the results of the blood tests tomorrow. Hopefully Lilys organs are okay. If they are, I can start. If they are not, I think it'll be a very bad outcome.
I also need to learn when to home test and how I can fit my schedule around it. Whether I have to get up very early in the morning to feed, inject, test etc.
Also, she only eats a tiny amount in the morning (she is more of a little and often kinda gal) so i'm worried that picking up the food in the morning means she isn't getting enough causing her to run low.

Many kittys here have complications either pre diabetes or diabetes related. I give fluids to both of my cats at home as do many of us. Totally doable.
I don't want to overwhelm you nor I don't want you to be discouraged if there are any complications on the blood work as I am sure many of us have had or have the same or similar complications. China is stunning quite a diva
The experts will help you with testing/dosing.... if you have questions ask away

 

[Lily-Fish]

I just want you to know that when I found this board my Woody was receiving 13 units of Novolin! He had diarrhea, was vomiting, was lethargic, didn't play, meow, or anything! When I started home resting it showed he was hypoing EVERY SINGLE time I injected him. I was doing that for over a MONTH!!! Talk about feeling like the worst human being ever . But the wonderful members here helped me and now my kitties are in remission! Home testing and this board saved both my kitty's lives! You are doing great, just know that home testing is the key to all of this.

That's great news about your kitties!
How many times a day should you test the BG? Twice?

 

[Chris & China (GA)]

You always want to test before shooting so you know they're high enough to have insulin at all

Then you want to try to get at least a mid-cycle test on the AM cycle and at least a "before bed" test on the PM cycle

With Lantus, dosing is based on how LOW it takes them, not how high they are at Pre-shot times, so it's important to get tests in at different times throughout the cycles so you can learn how Lily is responding

If there's no way to get mid-cycle tests on the AM cycle due to work or school, it's even more important to get tests on the PM cycle....most cats go lower at night, so that PM cycle is really important.....then on days when you're off, you'd want to get more tests during the AM cycle.

Think of your spreadsheet like a puzzle....if the only "pieces" you have are along the edges, it's hard to see what the puzzle picture is....by having "pieces" (test results) scattered throughout, the picture becomes much clearer

I'm really happy my pictures have given you hope...it's truly amazing how far back our kitties can come with the right treatment!....and the best place to get help learning about that is right here on the FDMB!

 

[Critter Mom]

How many times a day should you test the BG? Twice?

With Lantus, the minimum recommended is three: once before each injection to make sure it's safe to actually give insulin, and at least once a day (either AM or PM) a few hours after the insulin dose to determine how low the dose is taking the cat. Ideally, it is advisable to get a mid-cycle test in both AM and PM.

We can help you work out how to get the data you need in spite of your demanding schedule.


Mogs
.

 

[Critter Mom]

She ... is currently 4.3kg so a lot of weight.

If you were following the Roomp-Rand published Tight Regulation Protocol for Lantus, for Lily's current weight the maximum starting dose should have been 1.0 IU BID (0.25IU per kg). (Also, if it could have been demonstrated that Lily was getting very low nadirs at home on the Caninsulin an even lower starting dose of Lantus may have been appropriate.)


Mogs
.

 

[Sienne and Gabby (GA)]

If you were following the Roomp-Rand published Tight Regulation Protocol for Lantus, for Lily's current weight the maximum starting dose should have been 1.0 IU BID (0.25IU per kg). (Also, if it could have been demonstrated that Lily was getting very low nadirs at home on the Caninsulin an even lower starting dose of Lantus may have been appropriate.)

The above information that Mogs posted is correct if a cat is in good health. With a kitty that has experienced DKA, the same rules do not apply. The fundamental principle underlying DKA is that there's an infection or inflammation present, the cat isn't getting enough calories (usually due to not eating) and isn't getting enough insulin. Thus, using the initial dose formula may only serve to underscore the not enough insulin part of this equation. Often, it's better to be feeding higher calorie/carb food in order to maximize the amount of insulin you're giving. I think you'll be better able to gauge the insulin issue once you see where Lilly's numbers are at her current dose.

Will it be possible for the vet to give you the results of Lily's BG tests so you can fill them in on her spreadsheet?

(I have an NFC kitty, as well. He's not a diabetic, though. They are an incredibly sweet breed of cat.)

 

[Critter Mom]

The above information that Mogs posted is correct if a cat is in good health. With a kitty that has experienced DKA, the same rules do not apply.

Thanks for catching my error.


Mogs
.

 

[Lily-Fish]

The above information that Mogs posted is correct if a cat is in good health. With a kitty that has experienced DKA, the same rules do not apply. The fundamental principle underlying DKA is that there's an infection or inflammation present, the cat isn't getting enough calories (usually due to not eating) and isn't getting enough insulin. Thus, using the initial dose formula may only serve to underscore the not enough insulin part of this equation. Often, it's better to be feeding higher calorie/carb food in order to maximize the amount of insulin you're giving. I think you'll be better able to gauge the insulin issue once you see where Lilly's numbers are at her current dose.

Will it be possible for the vet to give you the results of Lily's BG tests so you can fill them in on her spreadsheet?

(I have an NFC kitty, as well. He's not a diabetic, though. They are an incredibly sweet breed of cat.)

If you look at my profile picture, that is her currently. Considering you know NFCs well, you can see how ropey she has become. Time to get her looking like super star China!

I will request all details from the vet. Do you think I need to march in there and just tell them what I'm doing? They are suggesting putting her to sleep! If I hadn't have found you guys I would've been considering it because the way she is at the moment is scary and I feel like she feels poopy. So glad I came and found you!

So I guess I'll need sub cut fluids and equipment (for just in case), the correct food and treats and a good technique for home testing. I should really know all this, I'm a third year student nurse, but I think it has all overwhelmed me and cats are slightly different to diabetic humans. I guess it scares me not knowing how she's feeling or what she wants.

The vet is stopping insulin for a few days and attempting to diet control it. I'm calling at 12, I will discuss then and go in if needs be. I wanna switch her vets to one that knows about diabetes.

Honestly, I couldn't be more grateful to you all.

 

[Critter Mom]

... the way she is at the moment is scary and I feel like she feels poopy.

When the BG is unregulated cats can feel really cruddy and their body and coat condition can be atrocious. As you've seen with China the transformation that occurs as regulation improves can be nothing short of astounding. I speak from personal experience. In the early days after Dx, Saoirse had lost a fair bit of weight and her coat was in tatters: if you even looked sideways at her more would fall out.

After a few weeks of being on a species-appropriate, low carb diet and her switch to Lantus insulin our main vet (who is fairly hot on feline diabetes) was absolutely gobsmacked at the improvement in Saoirse: she had regained muscle mass and her coat was growing back beautifully. She looked like she had been swimming in the Fountain of Youth! Wish I had before and after pictures to show you. Our vet said that if Saoirse were not his patient and he was therefore ignorant of her age he would never for a minute have put fourteen years on her.


Mogs
.

 

[Sienne and Gabby (GA)]

I really disagree with your vet. I would not stop insulin in a cat that is recovering from DKA. Where are you located (city)? You may need to find a vet that is more familiar with feline diabetes and there may be a member who has a vet who will fight for your cat. This is a manageable condition. When Gabby was diagnosed, she was in DKA, had hepatic lipidosis, and pancreatitis. She was hospitalized on a kitty ICU and not a single vet ever suggested euthanasia. She lived 6.5 years with FD until her kidneys gave out.

I've never found that direct confrontation ever works with someone who thinks they know more than you. (Think about your nursing instructors!) I've found a better strategy is to let the vet know that you really want to understand what's going on (after all, you're training to be a nurse) and be an active part of your cat's treatment. Then start asking questions -- especially ones you know the answers to. For example, if the vet wants you to feed prescription food, ask what the carbs are. Let the vet know that you've found a plethora of commercial foods that are even lower in carbs. I'm attaching a journal article about the Tight Regulation Protocol. You can share it with your vet or use it for your reference. It's the research supporting TR. Vets usually have a hard time arguing with published research.

Sub-q fluids are not hard to do. The needle (aka "harpoon") is just bigger than an insulin needle. Not every cat that is recovering from DKA needs fluids, though. You need to know that your cat has no underlying cardiac condition.You can also add a fair amount of water to canned food. No one ever taught me to home test or to give a shot. I speak excellent medicalese which meant that all the vets who were treating Gabby thought I knew how to give an injection. I learned from YouTube. You're ahead of most people given your nursing training. Yes -- it's different when it's your cat but you're doing this to help Lily and that will override your understandable apprehension.

 

[Dyana]

Sienne is right. Withholding insulin could cause Lily to get more ketones. The vets advice is very dangerous. I hope you can find another vet with more knowledge and experience with feline diabetes. We've seen a lot of kitties go through DKA on this board, and unfortunately, not all survive. My kitty J.D. was one of the lucky ones. He too was hospitalized for 8 days. I found this board, and they helped me. He lived 9 more years and passed on at 20.
Hugs to you, and prayers for Lily to return to her healthy self. Keep posting and we will help you.

 

[Lily-Fish]

I really disagree with your vet. I would not stop insulin in a cat that is recovering from DKA. Where are you located (city)? You may need to find a vet that is more familiar with feline diabetes and there may be a member who has a vet who will fight for your cat. This is a manageable condition. When Gabby was diagnosed, she was in DKA, had hepatic lipidosis, and pancreatitis. She was hospitalized on a kitty ICU and not a single vet ever suggested euthanasia. She lived 6.5 years with FD until her kidneys gave out.

I've never found that direct confrontation ever works with someone who thinks they know more than you. (Think about your nursing instructors!) I've found a better strategy is to let the vet know that you really want to understand what's going on (after all, you're training to be a nurse) and be an active part of your cat's treatment. Then start asking questions -- especially ones you know the answers to. For example, if the vet wants you to feed prescription food, ask what the carbs are. Let the vet know that you've found a plethora of commercial foods that are even lower in carbs. I'm attaching a journal article about the Tight Regulation Protocol. You can share it with your vet or use it for your reference. It's the research supporting TR. Vets usually have a hard time arguing with published research.

Sub-q fluids are not hard to do. The needle (aka "harpoon") is just bigger than an insulin needle. Not every cat that is recovering from DKA needs fluids, though. You need to know that your cat has no underlying cardiac condition.You can also add a fair amount of water to canned food. No one ever taught me to home test or to give a shot. I speak excellent medicalese which meant that all the vets who were treating Gabby thought I knew how to give an injection. I learned from YouTube. You're ahead of most people given your nursing training. Yes -- it's different when it's your cat but you're doing this to help Lily and that will override your understandable apprehension.

Okay, so, update:

I have spoken to Lily's regular vet and he has completely agreed and has started her on SLGS. He has said that he has now switched her to low carb wet food and higher carb for when she eats less and he is starting with 0.5 u lantus.
He seems to now understand that I do know a little bit about diabetes. I understand she can't always have the fluids but I'd just rather have the tools to look after her at home if needs be.
The vet has said that he believes her organs are the picture of health and we just need to really work on regulating her. The vet she saw yesterday, although well meaning, doesn't know her at all. He was the one talking about euthanasia. Marcos, her regular vet is really looking out for her. I feel slightly better about it today. I can't wait to get her home so I can begin to get her into a routine.

 

[Mogmom and Goofus]

Hi, and Thank you for the swift reply.

(Edit: Lily's ears are very bruised and battered, hence the non bleeding. Also, I'm not sure if she has urinated today. I check the box but I'm unsure whether the wee in there is from yesterday. She usually leaves litter all over the floor when she goes but I cleared this up yesterday and today it was still clean. I'm just very worried and feel like I'm in way above my head)

Thank you again

Becka

Actually, testing the paw pads is no more, maybe even less, painful than poking the ears. They have very little feeling in them and bleed quite easily.

 

[Critter Mom]

Ask about getting an Rx for a supply of anti-nausea and appetite stimulant meds for Lily's home medicine cupboard. It can be invaluable to have the 'tools' you need ready to hand to head off any potential inappetence issues at the pass. Also going forward you might like to consider getting a blood beta-ketone meter. The strips are pricey but a blood ketone meter can give a much earlier warning - possibly by a number of days - of increases in beta-ketone levels. (My cat is not ketone-prone (anti-jinx) but I got a BBK meter recently to monitor her after her recent operation; I've found the meter an extremely helpful addition to my monitoring toolkit because she developed a UTI after the op and her appetite has been off. With the help of the meter I'm able to keep a much better handle on her ketone levels - and getting her prompt veterinary support when necessary - while she is going through convalescence.)

I'm very glad to hear that Lily's regular vet is rooting for her and providing the support you both need right now.



Mogs
.

 

[Lily-Fish]

I don't understand ketones. Is there anything I can read to familiarise myself with their significance? I just need to understand how the different types of food affect the BG and ketone levels

 

[Sienne and Gabby (GA)]

I don't know about you, but I'm a lot more relieved to hear that your regular vet "gets it."

Mogs has a good point. Given the two hospitalizations for DKA, a ketone meter wouldn't be a bad idea. Abbott makes the Precision Xtra meter and NovoMax also has a blood ketone meter. Either meter and strips are available on-line through ADW. Many of us use urine ketone test strips (i.e., Ketostix). They are a good method of testing providing you can stalk Lily to the litterbox to get a urine sample. The only downside of the urine strips is that they do not give you a 'to the minute' level since waste has to form, be collected in the bladder, and your kitty needs to then urinate. This means that the levels are hours old. Blood ketone testing tells you what the levels are at the moment you're testing.

Ketones are a by-product of fat metabolism. If a cat isn't eating, its body starts to metabolize fat stores. (This is what we all do when trying to lose weight.) One by-product of fat metabolism are fatty acids which then lead to the development of ketone bodies. If metabolism continues to be pushed in this direction, electrolyte levels are affected (metabolic acidosis) and diabetic ketoacidosis develops. This is a discussion in Wiki and there's a link in the body of the article to the pathogenesis of ketones. I'm in the office and don't have all of the links to my usual resources on this computer. Any endocrine text should have a chapter on diabetes and include information on DKA. The basics are really no different in cats than in humans. If you cruise the internet, you'll find lots of information on body building sites where they discuss dietary ketosis. This will also give you a feel for what's quasi-normal vs problematic.

 

[Vyktors Mum]

http://www.felinediabetes.com/FDMB/...oacidosis-dka-and-blood-ketone-meters.135952/

Link to lots of ketone info above. Food doesn't affect ketone levels as such, it's just not eating it that's a problem.

As far as BG goes, basically the higher the carbs the higher the BG will spike afterwards.

Also, she only eats a tiny amount in the morning (she is more of a little and often kinda gal) so i'm worried that picking up the food in the morning means she isn't getting enough causing her to run low.

There is no problem free feeding lantus kitties, you just want to pick up the food 2 hours before shot time to make sure the BG test you get isn't food influenced - i.e. So you can be sure it's safe to shoot.

If you're not free feeding you are still better off feeding smaller meals more frequently than just feeding twice a day. It's less stress on the pancreas and lantus doesn't operate harshly like caninsulin so it's not necessary to have plenty of food on board before you shoot.

Furthermore most kitties (but not all) will feed themselves when they drop too low so if you're not there it can be essential for kitty to have access to food. People with gutses use timed feeders to ensure food is available as appropriate throughout the cycle. Since yours isn't a guts (unless you have others that will guts it) you can just leave it out to be eaten at will.

P.S. Vyktor is another DKA survivor whose life was saved by this board

 

[jayla-n-Drevon]

Just a side note--you do not have to use the "harpoon" needle-
I use a 18 gauge/harpoon on Rico as he could care less- (he is up to fluids every other day after 6 years)-on Drevon a 20 gauge it just takes a little longer (fluids since DX with FD as his kidneys took a hit)--each cat is different... fluids are an amazing thing
Rico was DX at 11 and he is 17 this summer...

 

[jayla-n-Drevon]

@Rkdavid
where are you located--maybe someone knows a vet familiar with FD in your area.....

 

[Lily-Fish]

I think Lily will be good on a free feed regime with the two hour gap before testing.
Again, SO glad I found this group!

 

[Lily-Fish]

@Rkdavid
where are you located--maybe someone knows a vet familiar with FD in your area.....

I'm in Norwich, UK

 

[Marje and Gracie]

Here is a video we did on How to Give Subcutaneous at Home. I know it has helped many, many members here as well as people who have seen it on YouTube.

I'm just a little concerned that the starting dose is too low. I know SLGS has you starting at 0.5u but for a cst who has been in DKA, it worries me. Remember that SLGS is a guideline and the suggestions for this approach specifically state circumstances, like the presence of ketones, may warrant "adjustments" to the guidelines.

 

[Critter Mom]

Hi Becka,

If you do decide to go for a blood ketone meter the choices are fairly limited in the UK. There are some iffy ones offered on ebay and amazon.co.uk but check out the negative comments on amazon before considering the cheapies.

I went for the Abbot Freestyle Optium Neo. As a guide to price, my local pharmacy sells a box of 10 strips for the Freestyle Optium Neo for £34.95 so I assume that's RRP. You can get some better prices on strips via ebay UK (but always check the expiry with the vendor before purchasing). The cheapest strips tend to be sold by Aussie vendors. I've no experience of ordering from them but I am thinking of giving them a whirl. BTW, if you do buy a BBK meter check with your local pharmacies to see if they carry test strips for it and/or how quickly they can get them into stock for you should you need to get hold of strips in a hurry.


Mogs
.

 

[Lily-Fish]

I'm just trying to figure out how I will be able to leave the house (and lily on her own) without worrying she is gonna have a crisis. When she is better controlled is there less risk of a hypo? I understand she needs more love and attention now but at the same time, I'm in the navy reserves (it involves being out of the house for 8 hours on a weds evening) and also am at uni on a weds. I have obviously stopped going for the meantime as I don't want to be too far away but I feel as if now I will be constantly worrying about her every time I go out. I am ready and willing to do everything she needs to get her healthy and keep her safe but I just don't know what to do with regards actually being able to go and fulfil other commitments I have. We live just the two of us and it would be way beyond my already stretched budget to get a cat sitter for 8 hours every Wednesday.

 

[Tricia Cinco(GA) & Harvey]

Hi and welcome.

My kitty, Cinco, is also a DKA survivor. He was very near death and the vet was recommending euthanization when I found the FDMB thanks to a friend that had been in the same boat with her kitty. My vet was well-meaning, but didn't understand Lantus. The people here saved Cinco's life, and my sanity. Since then they have helped me through cancer with all four of my kitties, kidney disease, glaucoma (both my boys), blindness (Cinco), a leg amputation, hyperthyroid, a second kitty getting FD, and most recently the crossing of my two precious girls 9 days apart. You will find no more caring, generous, knowledgeable people in the world than the ones on this board. I know it's a huge leap of faith to trust a bunch of strangers in different countries over the vet you know, whose credentials you can see, but I urge you to listen to the people here and take everything into consideration. Read as much as you have time for. There are stickies at the top of the Lantus & Levemir page that contain tons of info that will help you understand. It's very overwhelming at first, but we've all been there, so ask questions and ask for clarification if you don't understand something. You are among friends.

A lot of people here use a timed feeder to make sure their kitty has access to food throughout the day. There are many available on Amazon. If you are interested, ask for recommendations.

Many here have full time jobs, families, other animals, etc., but we all figure out how to make this work. You can, too. All you need is a love for your kitty and a willingness to learn. I think you have both of those. We're all here for you.

 

[SpecklesandMe]

A lot of people here use a timed feeder to make sure their kitty has access to food throughout the day. There are many available on Amazon. If you are interested, ask for recommendations.

An auto-feeder is a good idea. A lot of people can make recommendations and have tricks for using them with canned food (like freezing the wet food and leaving it to thaw in the feeder during the day).
I'm sorry I haven't been able to read your entire thread, but the first thing I thought about when I read your initial posts was whether your vet did an ultrasound on your kitty while she was hospitalized. Do you know if they did an ultrasound or any other imaging?

 

[Chris & China (GA)]

Becka, being gone for 8 hours shouldn't be a problem....You can just test a little before you need to leave and if Lily is running a little low, you leave down some higher carb food

Autofeeders are great too..you can program them to open when you want Lily to have access to food. The PetSafe5 autofeeder is a favorite around here

You'll also be learning about Lily over the next few weeks...when she usually hits her lowest points (the "nadir") and how she responds to different percentages of carbs.....some kitties are very carb sensitive, others can eat higher carb foods without getting much of a food spike

When it's time for you to return to your duties, you'll know so much more than you do now!! It won't stop you from worrying while you're away (not much works for any of us when it comes to "worry") but it should keep Lily safe!

 

[Lily-Fish]

Hi Becka,

If you do decide to go for a blood ketone meter the choices are fairly limited in the UK. There are some iffy ones offered on ebay and amazon.co.uk but check out the negative comments on amazon before considering the cheapies.

I went for the Abbot Freestyle Optium Neo. As a guide to price, my local pharmacy sells a box of 10 strips for the Freestyle Optium Neo for £34.95 so I assume that's RRP. You can get some better prices on strips via ebay UK (but always check the expiry with the vendor before purchasing). The cheapest strips tend to be sold by Aussie vendors. I've no experience of ordering from them but I am thinking of giving them a whirl. BTW, if you do buy a BBK meter check with your local pharmacies to see if they carry test strips for it and/or how quickly they can get them into stock for you should you need to get hold of strips in a hurry.


Mogs
.

Thanks Mogs,

I think I will buy a ketone meter as getting a urine sample from lily is like getting blood from a stone! I think it is just overwhelming to think that I'll have to be constantly worrying over poop etc when I've not had to be before this. In a way, despite her having diabetes since October now I realise what I should've been doing and I'm having the big psychological transition I should've had back then. Thank the Lord for you lot of wonderful people.

 

[Ferndoc]

I really disagree with your vet. I would not stop insulin in a cat that is recovering from DKA. Where are you located (city)? You may need to find a vet that is more familiar with feline diabetes and there may be a member who has a vet who will fight for your cat. This is a manageable condition. When Gabby was diagnosed, she was in DKA, had hepatic lipidosis, and pancreatitis. She was hospitalized on a kitty ICU and not a single vet ever suggested euthanasia. She lived 6.5 years with FD until her kidneys gave out.

I've never found that direct confrontation ever works with someone who thinks they know more than you. (Think about your nursing instructors!) I've found a better strategy is to let the vet know that you really want to understand what's going on (after all, you're training to be a nurse) and be an active part of your cat's treatment. Then start asking questions -- especially ones you know the answers to. For example, if the vet wants you to feed prescription food, ask what the carbs are. Let the vet know that you've found a plethora of commercial foods that are even lower in carbs. I'm attaching a journal article about the Tight Regulation Protocol. You can share it with your vet or use it for your reference. It's the research supporting TR. Vets usually have a hard time arguing with published research.

Sub-q fluids are not hard to do. The needle (aka "harpoon") is just bigger than an insulin needle. Not every cat that is recovering from DKA needs fluids, though. You need to know that your cat has no underlying cardiac condition.You can also add a fair amount of water to canned food. No one ever taught me to home test or to give a shot. I speak excellent medicalese which meant that all the vets who were treating Gabby thought I knew how to give an injection. I learned from YouTube. You're ahead of most people given your nursing training. Yes -- it's different when it's your cat but you're doing this to help Lily and that will override your understandable apprehension.

I wasn't taught how to give shots or test either. I guess I gave the impression that I knew what I was doing since I'm and EMT and knew what taking a blood glucose meant. I sure can fake it.

 

[Lily-Fish]

I knew how to give the injections the vet just wouldn't let me leave until I had proven it...

 

[Lily-Fish]

So the vet has put Lily on 0.5 iu Lantus once daily and he has suggested free feeding. He said she has now become so receptive to the insulin that she will respond and then go lower and lower and lower. We have agreed I check her BG in the morning before I shoot (obviously if low don't give the injection) and I check at +6 then +12. I do this for a few days, maybe til monday, to see how she is responding.
He said after a week I can do a curve, he said he will teach me how and it'll be better to do it at home so she is less stressed and we get truer readings.
I get her back tomorrow morning
Thank goodness!!

 

[Wendy&Neko]

I am glad you are getting your girl Lily back tomorrow. Not so glad with your vet's poor advice. We have seen a very small number of kitties where once a day dosing works with Lantus. With most, you end up with really high numbers at the end of 24 hours. With a cat that's been recently in DKA, this is a dangerous choice. You want to get as much insulin and food into her as possible. Will she be on antibiotics when you get home?

 

[Chris & China (GA)]

Lantus generally requires twice a day dosing because a cats metabolism is so fast, but it's nice to see the vet is starting Lily out slowly...we just want to keep a close eye on her since she's had the DKA episode in the past

Occasionally a severe hypo will "kick start" the pancreas into working again (we don't know why, but it's happened) so while it's possible that she will respond and then go lower and lower, I don't know how your vet can "predict" that.

If Lily were mine, I'd test in the morning, if she's high enough for insulin (above 150) then I'd feed her (to make sure she'll eat) and shoot....all within about 5-10 minutes.

While you're home and able to, now's the time to collect data on how Lily is doing! I'd try to get tests in throughout the cycle, not just at +6....and if at +12 she's back above 150, I'd repeat the "test/feed/shoot" and get some tests on the PM cycle...at least a "before bed" test to make sure she'll be safe while you're sleeping (and if she's running a little low, that gives you a chance to set an alarm to get up and test later if you need to)

 

[Lily-Fish]

Lantus generally requires twice a day dosing because a cats metabolism is so fast, but it's nice to see the vet is starting Lily out slowly...we just want to keep a close eye on her since she's had the DKA episode in the past

Occasionally a severe hypo will "kick start" the pancreas into working again (we don't know why, but it's happened) so while it's possible that she will respond and then go lower and lower, I don't know how your vet can "predict" that.

If Lily were mine, I'd test in the morning, if she's high enough for insulin (above 150) then I'd feed her (to make sure she'll eat) and shoot....all within about 5-10 minutes.

While you're home and able to, now's the time to collect data on how Lily is doing! I'd try to get tests in throughout the cycle, not just at +6....and if at +12 she's back above 150, I'd repeat the "test/feed/shoot" and get some tests on the PM cycle...at least a "before bed" test to make sure she'll be safe while you're sleeping (and if she's running a little low, that gives you a chance to set an alarm to get up and test later if you need to)

The vet has actually seen this happen, she is higher, she gets her dose and then for the next twelve hours she just continues to get lower and lower. He talked through all of the BG tests he did over the day and how the glucose just kept dropping. I think this is the reason he has decided to do free feeding and see what happens.
That seems amazing, about the pancreas being kick started!
It seems like a very good idea, test, watch her eat and then shoot.

I will get four tests a day over the weekend, then fill out the spreadsheet. I have filled the boxes but when I click on my link it comes up blank?

Hmmm....

Just glad to have my baby back tomorrow