Help for a new sugar baby and his stressed out momma

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SuperSweetTerrence

SuperSweetTerrence

Member Since 2016
Hi All, I posted my welcome message not too long ago but hoping to get some advice on quite a few things.

My sugar baby Terrence is nearly 6 months new in his diagnosis and is still out of control. Currently getting 3u 2x daily of Lantus after the first 4 months on ProZinc (got up to 6u 2x daily before the switch). He is eating Friskies pate, 3xs daily and cleans up/shoves my girls out of the way to polish off their Science Diet adult. He also has a tendency to break into their bowl, even though it is a microchip Sure Flap and shouldn't be allowing it, he has found a way!

I am actually going to go look into different foods today (leaning towards switching Terrence to Fancy Feast and the dry food to EVO). I think it would be better for all of the cats in the house to be on a grain free, low carb diet so when he does break into the bowl, it won't have as dramatic of an impact. Canned is obviously ideal but we do have one super picky eater who has never taken to it. She is actually the oldest in the house (11 in June) and has always been very healthy but would be better to get her and the two 3 year olds on a high quality diet. They're on Royal Canin now but it sounds like that's not all that great. One of the youngins has a tendency to vomit after eating dry food and I have read that can be due to a grain allergy? Low carb seems to be the best way to go.

As far as my sugar baby goes, he is just INSATIABLE. He has always been a very hungry man, asking for treats and is highly food motivated, but since his diagnosis, it has been out of control. I just feel like since there hasn't been any control over his blood sugars, it's obviously a factor but I'm having a hard time deciphering the difference between behavior and diabetes related. Any thoughts?

We have attempted home testing but it is extremely stressful for Terrence (and me! Probably me more than him :banghead:). He is not a lap sitter what so ever, and doesn't like to be held so when I have to wrap him up to try and get the lancet in his ear, it tends to be a wrestling match and I know that sends his blood sugar through the roof. The only time I have had success is when he has his face shoved in his food bowl and even then is a struggle. I recently switched him to the Tidy Cats Breeze system because his urine output is enormous so I'm wondering if there is a way to test the glucose in his urine?

My family vet is a wonderful wonderful resource but I am considering taking Terrence to a specialist if there is not a significant change in his recheck on Monday. He has been 350-400+ for the past five months (and likely longer) with no improvement to speak of.

Thanks for letting me ramble. Any insight would be greatly appreciated!!

Paige
 
Hi Paige! It's really best if diabetic cats don't eat any dry food if it can be helped--but switching the other cat to a lower carb dry food just in case he gets into it is a good idea. I just wouldn't make it part of his regular diet. Dry food causes urinary tract and kidney issues, and uncontrolled diabetics already have extra strain on their kidneys.

Home testing is the most important thing you can do to keep your kitty safe and get his blood sugar under control. Vet testing often leads to overdosing because numbers are inflated by stress. Bandit fought me tooth and claw at first for testing, and I was in tears half the time. Most cats do not like it in the beginning--you're doing something new and strange to them! However, if you can get through a few weeks and make it part of their routine with some positive associations, they do come around and are ok with it. I used to have to wrap Bandit up in a blanket like a burrito to test him--now he comes running and purrs when he hears the glucose meter beep on! Here are the steps I took that helped me out a great deal.

1. Secure him in a basket or container about his size that is enclosed on the sides but open on top. This will help with him squirming. Line the basket or container with some fuzzy fleece blankets, and wrap him up like a burrito so only his head is poking out. This will help keep him secure during the wrestling portion if he's being difficult. You won't have to keep doing this once he finally accepts the testing.

2. Warm the ear with a rice sock, pill bottle with warm water, or whatever way works for you. It's much easier to get blood from a warm ear! The key is getting the drop as quickly as possible.

3. Use a thicker lancet. 26-28g are best. The 30-33g lancets are too small to get a good drop of blood. Don't worry about hurting his ear--cats have a very high tolerance for pain and fewer nerve endings in the tips of their ears than people have in their fingers. It's being restrained and you doing something new that they don't like, they're not struggling because it hurts them.

4. Figure out if you have an easier time free handing your poke with the lance or using a lancet device. I prefer the device, but many others prefer free handing . Do what works best for you! Also, back the ear with a piece of tissue or a cotton pad so you don't poke yourself, and the poke doesn't just glance off his ear.

5. Take charge with your attitude. Cats can sense if you're nervous or upset and will act accordingly. If you're focused and confident, they will sense that too. Try more, "You're getting this test, cat, because we need it to save your life!" and less "Oh, poor baby, I'm so sorry for hurting you!" It made a world of difference to me! You're NOT going to raise his blood sugar by testing him at home the way stressing him by testing at the vet will raise his blood sugar.

6. Aim for the "sweet spot". Going directly for the vein can cause bruising.


7. You may need to "milk" the spot after poking to get a big enough drop of blood. Press gently around the the outside of the poke spot to do this.

8. Apply a tiny dab of neosporin + Pain relief ointment afterwards, just in case there's any soreness or bruising at first.

9. End by giving a diabetic safe treat after every test even if it's not successful...this is very important!


You can test his urine with glucose strips (that you pick up at any drugstore), and that's a great thing to do until you get a handle on blood testing, but it's not nearly as safe or helpful as doing the meter testing. It only tells you if his blood sugar is high, and even then it won't tell you if he's dropping into hypoglycemic numbers because a cat getting too much insulin will see their numbers shoot right back up.
 
As for his appetite--uncontrolled diabetics do eat and drink a lot more than usual! Once you start getting his blood sugar under control by home testing, you'll see those symptoms get much better. :)
 
Ah THANK YOU. It makes a ton of sense about being confident and I think back to when we started injections. I was scared to death and he always shyed away but now it's like nothing and a part of our daily routines. No big deal. I have an animal specific glucometer so I will need to pick up more strips from the vet but I will definitely head to the drug store to get glucose strips and lancets to use in the mean time. How many times do you test Bandit per day? And do you adjust his insulin based on his tests? We are up so high in dosage because Terrence seems to be a true Type 2 with insulin resistance. I am I thinking his diet is what is going to be his saving grace. Not sure if adjusting the frequency of his meals will be necessary in the future.

Did you ever take Bandit to a specialist? I love my veterinarian's office and they are so good to us...but they admittedly do not have the extended expertise in treating diabetic cats, especially a difficult case like Terrence. How long did Bandit take to get under control? I just want to align my expectations and thinking. He's been so out of control for 5 months now...not sure that's normal.

Again, thanks so much! So nice to have experience pet parents to trade war stories with. Definitely increasing my confidence a bit, especially with your excellent guide on testing.
 
SuperSweetTerrence said:
.How many times do you test Bandit per day? And do you adjust his insulin based on his tests? We are up so high in dosage because Terrence seems to be a true Type 2 with insulin resistance. I am I thinking his diet is what is going to be his saving grace. Not sure if adjusting the frequency of his meals will be necessary in the future.
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Bandit has been diabetic for 7 years, but he's been in remission for most of that time (meaning he doesn't need insulin, just a low carb, canned diet), so I currently only test him about once a week or so. When he was on insulin (he was on Lantus for a year back in 2009-2010, and then again for a very short time in 2011, and most recently for several months last year), I tested him about 6-8 times a day (with a curve once a week) when his blood sugar was out of control, and about 3-5 times a day when his blood sugar was under good control (and predictable) with Lantus. The recommendations for Lantus are that you test at least three times a day--once before each shot, and then at least one mid-cycle to see how low he is dropping, but the more tests you can get, the better dosing decisions you can make. So, you do as much as you can without burning yourself out!

Because you haven't been dosing based off daily home testing, it's hard to tell if Terrence is insulin resistant or if he just hasn't reached the right dose. Getting to the right dose without going over is very important to good regulation--and it's why home testing is so vital to helping or cats get better! :) It's like trying to hit a bullseye on a dart board--would you rather try and hit that bullseye with your eyes closed, standing 20 feet away--or would you like to walk right up to the board and stick the dart in? That's the difference between having data (home blood glucose tests) to adjust your doses, and doing it from inaccurate vet testing.

SuperSweetTerrence said:
Did you ever take Bandit to a specialist? I love my veterinarian's office and they are so good to us...but they admittedly do not have the extended expertise in treating diabetic cats, especially a difficult case like Terrence. How long did Bandit take to get under control? I just want to align my expectations and thinking. He's been so out of control for 5 months now...not sure that's normal.
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I am fortunate that Bandit currently sees an internal medicine specialist at Cornell, and I am even more fortunate that he recommends all the diabetes treatment guidelines we advocate here on FDMB--unfortunately, this seems to be the exception more than the rule. Most vets just aren't very current, and they might have some pieces of treatment right, but may be off with others. That's why FDMB is such a great resource! I was also fortunate that when Bandit was first diagnosed, his vet told me I had to home test him if I wanted him to get better (and showed me how to do it right there in the office), and then told me I had to get rid of all the dry food in my house and handed me a list of low carb, commercial canned foods in different price ranges. Bandit's vet will give me input on his numbers and advice when I ask him, but for the most part, I adjust the dose myself using the recommended dosing protocols for Lantus--which you can find over in the Lantus forum. Along with a ton of helpful folks! Most people here work with their vet in getting the Lantus prescription and take their cats in for regular checkups and yearly bloodwork, but they home test and make their dosing decisions according to the recommended dosing protocols.

I think that the reason you haven't had good luck is probably for a few reasons--his dose is either too high or low (both of which will keep his blood sugar high), so you just need to find an effective dose for him, and he's been getting into high carb foods, which will also cause the insulin to be less effective. Again, daily home testing will help figure out this puzzle and put you in control so you know what's going on with him! There's a ton of very experienced, helpful people here who have a lot of experience with cats on Lantus that can help you figure this all out.

First time around for us, it took about three months to get good control over Bandit's blood glucose (BG). But we started home testing from the beginning, and using the recommended protocol a few weeks after starting insulin. Second and Third time around, I knew what I was doing, so it only took a few weeks to get him well regulated. Because of this, he went into remission much faster both times.

However, I don't think that remission is out of your reach if you start a better treatment path! I helped treat a friend's cat that was given the wrong insulin (Novolin), a dry prescription diet, and his vet did not recommend home testing. This went on for about 8 months. His owner came to me for advice when his diabetes was very far advanced--he was skin and bones, and had neuropathy so bad he couldn't walk and had to pee on a puppy pad in her kitchen. I convinced her to switch to Lantus, a low carb canned diet, and I taught her to home test and set up a spreadsheet, and we followed the recommended dosing guidelines. He improved dramatically within weeks, and it took about 4 months to get good control over his BG, and he went into remission in less than a year! So don't count yourself out of the race yet!
There is a ton of information to absorb here and lots of resources, so keep asking away! Everyone is super helpful and seriously cares about all the kitties here. :cat: Once you get a few good home tests in (and you WILL, it just takes practice), make sure you come back and get a spreadsheet set up so that you can get dosing advice from the many experienced members here.

I wish all the best for you and Terrence!
 
Hi Paige,

I'm smitten with your pic of Terrence! Very dapper. :D

I see Julia is giving you lots of great advice and tips. You've found a great place to get help and support as you work to improve Terrence's regulation. There is a tremendous wealth of feline diabetes knowledge and experience among the members here.

If you look at the signatures under most members posts you'll see links to the spreadsheets they maintain to track their kitties' blood glucose test results. The spreadsheets are a fantastic tool to learn a cat's response to insulin and to guide their treatment. (Be lost without mine.) It would be great if you could start recording your BG test results in a spreadsheet for Terrence. They look a bit busy but essentially it's just a grid that you fill in date, dose, test results and comments. Over time the recorded numbers help you to spot patterns of response which can then act as a guide to effective dosing for Terrence's needs. Below is a link to the spreadsheet instructions for you to read through. If you need help with initial set-up, just shout and we can help you get going.

http://www.felinediabetes.com/FDMB/threads/fdmb-spreadsheet-instructions.130337/


Mogs
.
 
One thing I forgot to add...animal glucometers are good and there is absolutely nothing wrong with using one if you prefer it...but the test strips can be pricy. Human glucometers also work fine for home testing, we just use a different reference range with them, and the test strips are a lot cheaper. It is more important that you can afford to test as frequently as needed, than to use a pet meter. I just wanted to throw that out there for you to keep in mind, just in case you're thinking that testing daily with the pet meter might be too expensive.
 
I'm happy to say that we had a very successful weekend of testing!! The tips you gave were beyond helpful and Terrence is already starting to get used to the idea. He is happy because he gets baked chicken as a treat and that makes a little prick in the ear worthwhile. His BG is still very high, the vet wants to go to 4u of Glargine 2x daily. I'm going to do a curve at the beginning of next week and then take him to see a specialist. I have been looking at the dosing instructions and I'm still a bit worried about adjusting him without the vet's input.

I do want to ask, what are your favorite diabetic friendly treats? He does get baked chicken as a special testing treat but I am needing something to give to him when he is "expecting it" aka when I go into the kitchen :)

Thanks so much! I will look into adjusting the meter. Will likely be cheaper to replace the type of meter rather than purchasing $65 test strips every few weeks.
 
SuperSweetTerrence said:
I'm happy to say that we had a very successful weekend of testing!! The tips you gave were beyond helpful and Terrence is already starting to get used to the idea. He is happy because he gets baked chicken as a treat and that makes a little prick in the ear worthwhile. His BG is still very high, the vet wants to go to 4u of Glargine 2x daily. I'm going to do a curve at the beginning of next week and then take him to see a specialist. I have been looking at the dosing instructions and I'm still a bit worried about adjusting him without the vet's input.

I do want to ask, what are your favorite diabetic friendly treats? He does get baked chicken as a special testing treat but I am needing something to give to him when he is "expecting it" aka when I go into the kitchen :)

Thanks so much! I will look into adjusting the meter. Will likely be cheaper to replace the type of meter rather than purchasing $65 test strips every few weeks.
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That is great! It seriously keeps getting easier from here on out, I promise! :cat:

My cats like these treats, that I get at my local pet food store: http://www.orijen.ca/products/cat-food/freeze-dried-cat-treats/. We also pick up some freeze dried chicken and salmon in the treat section at Petsmart. They also get the Fancy Feast "Purely" a few times a week as a treat (formerly Fancy Feast appetizers).

I would NOT raise to 4u. Lantus is raised in .25-.5u increments and NOT in whole units. Raising cats by whole units is dangerous. It's also impossible to know from a single curve if his current dose is too high or too low. Dose adjustments with Lantus are made from daily tests--you test once before each shot to make sure it is safe to give insulin, and then at least one test mid-cycle to see how the insulin is working in the cat. A cat on too much insulin can still test in high numbers, as their livers will dump glucose into their bloodstream to compensate for low numbers, and this lasts for up to 72 hours. Unless you catch the cycle where they drop too low, too much insulin looks just like too little insulin.

Do you have enough strips to start testing three times a day? Getting rid of the dry food will also likely dramatically lower his blood sugar and insulin need, so make sure you're testing and lowering the dose as you phase out the dry food.
 
I just bought a pound of Bonita Flakes (dried tuna) for $30 on Amazon, the same flakes at my local pet store are $15 an ounce. The pound I bought was meant for humans to use in cooking but only have 1 ingredient tuna.
 
Is this the Somogyi rebound effect? My vet and I discussed this and he did explain that it could be a possibility. I definitely do have enough strips to start testing 3x a day. I just bought a new pack of 50 so I will be good for awhile. On Friday, I did a mini curve and was testing him every 2-3 hours. In the past 5 days, he has been as low as 280 and as high as 502.

Right now, he is on 3 u 2x daily. I also feel that 4u is way too much and especially since my guy just doesn't seem to be feeling good. I'm really worried about going to these levels because it just sounds like it's working in a counter active way. Should I take him up to 3.5 units instead of 4? Or do you believe with your experience, that 3u is still too high and he in fact needs to decrease? So much to absorb, it's so hard to know what is right to do for my kiddo :arghh:
 
Ferndoc said:
I just bought a pound of Bonita Flakes (dried tuna) for $30 on Amazon, the same flakes at my local pet store are $15 an ounce. The pound I bought was meant for humans to use in cooking but only have 1 ingredient tuna.
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Thank you! My kiddo would absolutely love. I need. To look into them ASAP.
 
Critter Mom said:
Hi Paige,

I'm smitten with your pic of Terrence! Very dapper. :D

I see Julia is giving you lots of great advice and tips. You've found a great place to get help and support as you work to improve Terrence's regulation. There is a tremendous wealth of feline diabetes knowledge and experience among the members here.

If you look at the signatures under most members posts you'll see links to the spreadsheets they maintain to track their kitties' blood glucose test results. The spreadsheets are a fantastic tool to learn a cat's response to insulin and to guide their treatment. (Be lost without mine.) It would be great if you could start recording your BG test results in a spreadsheet for Terrence. They look a bit busy but essentially it's just a grid that you fill in date, dose, test results and comments. Over time the recorded numbers help you to spot patterns of response which can then act as a guide to effective dosing for Terrence's needs. Below is a link to the spreadsheet instructions for you to read through. If you need help with initial set-up, just shout and we can help you get going.

http://www.felinediabetes.com/FDMB/threads/fdmb-spreadsheet-instructions.130337/


Mogs
.
Click to expand...
I have been searching for this!! Thank you so much for making it easy to find :D
 
My vet refers to it as "rebound hyperglycemia", but yes, I believe it's also referred to as the Somogyi effect. You'll also see this with cats as they're getting regulated, even if they're not dropping too low. Their bodies get so used to high numbers that their livers think they're dropping too low--this is commonly called "bouncing" here on the boards.

I don't really feel comfortable giving dosing advice without have a full picture of where his numbers are at. Could you set up a spreadsheet and fill it in with the numbers you have? Instructions are here: http://www.felinediabetes.com/FDMB/threads/fdmb-spreadsheet-instructions.130337/

I would also edit your signature and put in a few important details--what insulin he's on, what foods he's eating, and that you're using the Alphatrak meter (this is very important because there's a different reference range with pet meters, you don't want people giving you advice based off the human meter range). Once you do that, there's a ton of super experienced people over on the Lantus boards that can give you advice on what to do with his dose: http://www.felinediabetes.com/FDMB/forums/lantus-glargine-levemir-detemir.9/. If you have any questions or need any help, please post and there will be people that can help you! I'll check back in later tonight, too, in case you need help!
 
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