Smiffy's second episode

[Looby & Smiffy]

Hello girls - are any of you there? Elizabeth Campbell I tried to call you and left a message ..... Smiffy has just had another episode ...

I was in bed with a headache and she was lying in the bedroom next to me and I she called me and then jumped on the bed so I just spoke to her and then there was some movement and I looked round and she was having a struggle to get up and was really wobbly and in distress....

I ran downstairs and gave her some whiskas chicken and cheese treats on the bed and then went to get the glucometer - got some blood but it was the first time I have done it and left the strip in the meter for too long so by the time I got some blood on it it didn't work ...

In the meantime, Smiffy had walked into the other bedroom to sulk .... I called the Vets and a Nurse told me to put some honey in her mouth as well and wait for the Vet to ring ...... I got a stripe of honey from donwstairs on my finger and put it in her mouth ...

By the time the Vet rang she was OK or at least seemed OK she has come downstairs and wanted to go out but I want to keep an eye on her ......

I have also given her a meal of Sheba and she ate about a quarter of the sachet ...

The Vet rang me back and said that according to her fructosamine results and her curve at the surgery she was stabalised and couldn't explain these episodes .... I suggested that she was on too high a dose of insulin which he disputed but got him to agree that I would drop the dose to one unit of Caninsulin twice a day as opposed to 2 units and as we are unable at the moment to do a curve at home (husband not around to do it when I am not etc) to take her in next Wednesday morning after her morning shot and they would do a curve there again to see what her BGs are like on one unit as opposed to 2 units ......

I had to agree with him that on paper and according to the curve at the Vets she was stable but I had to question him on these episodes and that something was wrong ...

He was just about to suggest unthanasia when I told him that she was not happy and I stopped him (as he has mentioned it before) and told him that she was too bright for that .... he then said well you said she was not happy .... What I meant was that she was still a vibrant cat but not happy with the insulin and also she has been missing her Daddy ...

I don't think they are going to consider that the Caninsulin may not just agree with her .... my husband is going to go to the Practice Manager about it all guns blazing which is not going to help and has not got all the knowledge that I have now about the condition ..

Smiffy is now upstairs as I won't let her out - she is not happy ...

The Vet says that if we don't give her enough insulin by reducing the dose she runs the risk of pancreatitis and ketoacidosis so I think he wants to prove a point to me by reducing the dose to one unit and then do another curve in a weeks time ....

On 2 units when she went in for a curve at the weekend her preshot number was 21.1, then four hours later her Nadir was 6.8 and then an hour later her sugar was 12.8 so according to this they say she should not have a hypo episode ... but what else could it be?

I am completely stressed out about the whole thing and worred sick .... at least at one unit she is more unlikely to have a hypo but that might not be enough insulin to get her better

So cross I failed with the glucometer ....

 

[Catticus Maximus]

I ran downstairs and gave her some whiskas chicken and cheese treats on the bed and then went to get the glucometer - got some blood but it was the first time I have done it and left the strip in the meter for too long so by the time I got some blood on it it didn't work ...
....

So cross I failed with the glucometer ....

If you leave the strip in so long the metre shuts off, you should be able to remove the strip and reinsert it and start over.

 

[Looby & Smiffy]

@Elizabeth and Bertie @Tuxedo Mom @manxcat419 would you look at this post please and let me know what you think ..... I am beginning to agree with you all that my Vet is not so wised up as we thought he was ..... husband was cross with me for continuously questioning him about stuff and now thinks he is in the wrong .... Will Smiffy be in danger by dropping her shot to just one unit from 2 units per day and these two episodes have both occurred after a 75mg dose of Zylkene so I am wondering if there is a connection?

 

[LindaMS]

Perfectly reasonable to see a connection... stress raises BG, Zylkene reduces stress... makes sense to me

 

[Tuxedo Mom]

@Elizabeth and Bertie @Tuxedo Mom @manxcat419 would you look at this post please and let me know what you think ..... I am beginning to agree with you all that my Vet is not so wised up as we thought he was ..... husband was cross with me for continuously questioning him about stuff and now thinks he is in the wrong .... Will Smiffy be in danger by dropping her shot to just one unit from 2 units per day and these two episodes have both occurred after a 75mg dose of Zylkene so I am wondering if there is a connection?

My suggestion would be to stop the Zylkene if it has just recently been added. It is best to remove newer holistic treatments until everything else has been figured out. Since you are not positive that this is a hypo, but the symptoms are indicative of one, my personal opinion would be to drop the dose. You are using the Caninsulin pen. Is it the type that you can change the dose by 1/2 unit doses or is the one that only allows 1 unit changes?

 

[Capoo]

Hi Looby,

You have done a great job in getting some blood!
Now, what would be wonderful is that you get a reading! And I'm convinced that you can succeed in that, because you have already made the more difficult path : the blood withdrawal.

I have red all of your posts, know how it's difficult to deal with Smiffy, how much you're fighting for your baby.
But readings are the only way to understand what's happening, to understand how Smiffy uses Caninsulin, to judge the doses, to suspect an effect of Zylkene....

Let me just tell you a story that my vet told me a month ago:
His clients owned a diabetic cat, who was in remission for several months. Then, the cat started to behave strangely, was very lethargic. The owners thought that the cat was having a kind of hypo episode (symptoms were the same), and they have been feeding him with honey and high carb food for 3 long days. Then the cat was really not well (don't be afraid of the word : he was in coma), and they brought him to the vet. Verdict: their cat was having a DKA (too high numbers), and not a hypo at all!

This story is just to illustrate that without readings, no one can guess what it's currently happening.

I'm pretty sure that you can do it, and the sooner, the better!!!!

 

[Looby & Smiffy]

My suggestion would be to stop the Zylkene if it has just recently been added. It is best to remove newer holistic treatments until everything else has been figured out. Since you are not positive that this is a hypo, but the symptoms are indicative of one, my personal opinion would be to drop the dose. You are using the Caninsulin pen. Is it the type that you can change the dose by 1/2 unit doses or is the one that only allows 1 unit changes?

I will stop the zylkene ..... I can adjust the dose by half units but the Vet has suggested I go from 2 units to 1 unit for the next week ... until she gets to the Vet for her second curve

 

[Tuxedo Mom]

I will stop the zylkene ..... I can adjust the dose by half units but the Vet has suggested I go from 2 units to 1 unit for the next week ... until she gets to the Vet for her second curve

Trying one unit would be safe until you can figure out if these episodes Smiffy is having are hypos or not.

Once you are able to learn home testing you can save a lot of stress and expense by doing the curve at home. Keep on working on the home test...you will get there.

 

[Looby & Smiffy]

Hi Looby,

You have done a great job in getting some blood!
Now, what would be wonderful is that you get a reading! And I'm convinced that you can succeed in that, because you have already made the more difficult path : the blood withdrawal.

I have red all of your posts, know how it's difficult to deal with Smiffy, how much you're fighting for your baby.
But readings are the only way to understand what's happening, to understand how Smiffy uses Caninsulin, to judge the doses, to suspect an effect of Zylkene....

Let me just tell you a story that my vet told me a month ago:
His clients owned a diabetic cat, who was in remission for several months. Then, the cat started to behave strangely, was very lethargic. The owners thought that the cat was having a kind of hypo episode (symptoms were the same), and they have been feeding him with honey and high carb food for 3 long days. Then the cat was really not well (don't be afraid of the word : he was in coma), and they brought him to the vet. Verdict: their cat was having a DKA (too high numbers), and not a hypo at all!

This story is just to illustrate that without readings, no one can guess what it's currently happening.

I'm pretty sure that you can do it, and the sooner, the better!!!!

So do you think her numbers could have been too high? Somebody just suggested I omit the Zylkene as well as that seems to be a common factor to her episodes eg she didn't have Zylkene whilst she was at the Vets for a day ....... I got some blood the first time but messed up with the meter and now I have tried again and got no blood three times in a row so I don't know what I am doing wrong now ...... I don't want to stress her out too much by practising too much on her ... tried it on myself and I was 11.4!!!

So the plan is to omit the Zylkene and to drop her dose of Caninsulin to one unit twice per day ...... I can't help but think that deep down the Vet is setting me up to make a point next week when they do the curve in house again on just one unit - he insists that 2 units is the right dose .... he wouldn't be so pettty would he?

 

[Looby & Smiffy]

Trying one unit would be safe until you can figure out if these episodes Smiffy is having are hypos or not.

Once you are able to learn home testing you can save a lot of stress and expense by doing the curve at home. Keep on working on the home test...you will get there.

OK just one unit and other have said to stop the Zylkene because before I gave her that she had no episodes at all ... going to google it ... would it have dropped her glucose so low?

 

[Tuxedo Mom]

So do you think her numbers could have been too high? Somebody just suggested I omit the Zylkene as well as that seems to be a common factor to her episodes eg she didn't have Zylkene whilst she was at the Vets for a day ....... I got some blood the first time but messed up with the meter and now I have tried again and got no blood three times in a row so I don't know what I am doing wrong now ...... I don't want to stress her out too much by practising too much on her ... tried it on myself and I was 11.4!!!

So the plan is to omit the Zylkene and to drop her dose of Caninsulin to one unit twice per day ...... I can't help but think that deep down the Vet is setting me up to make a point next week when they do the curve in house again on just one unit - he insists that 2 units is the right dose .... he wouldn't be so pettty would he?

Looby there is no way to tell if the numbers are too high or too low. However when you had the vet curve done on the weekend Smiffy went from 21.1 at preshot to 6.8 at +4 after shot, so the insulin is definitely bringing the numbers down fast and hard.



ETA My suggestion to stop the Zylkene for the time being was to rule out any changes to the normal routine that could be affecting Smiffy. Did you check to make sure there was no zylitol or sugars in the Zylkene ? There is no way to tell if the Zylkene could be affecting Smiffy..either good or bad...so best to leave it out of the equation until the dosing is figured out.

 

[Capoo]

So do you think her numbers could have been too high? Somebody just suggested I omit the Zylkene as well as that seems to be a common factor to her episodes eg she didn't have Zylkene whilst she was at the Vets for a day ....... I got some blood the first time but messed up with the meter and now I have tried again and got no blood three times in a row so I don't know what I am doing wrong now ...... I don't want to stress her out too much by practising too much on her ... tried it on myself and I was 11.4!!!

So the plan is to omit the Zylkene and to drop her dose of Caninsulin to one unit twice per day ...... I can't help but think that deep down the Vet is setting me up to make a point next week when they do the curve in house again on just one unit - he insists that 2 units is the right dose .... he wouldn't be so pettty would he?

Looby,

Without readings, I don't have any idea of the current numbers of Smiffy.

Have you warmed her ear before trying to get some blood? If not, that's normal that you didn't get some blood.
One way to warm the ear is to put some rice in a socket. Then you put the socket in a microwave (Around 30 seconds, the socket should just be warm, not burning. You can evaluate this directly by taking the socket in your hand).
Then you apply the warm socket on her ear, wait let's say 10 to 20 seconds, and then use the lancet.

 

[Tuxedo Mom]

Looby,

Without readings, I don't have any idea of the current numbers of Smiffy.

Have you warmed her ear before trying to get some blood? If not, that's normal that you didn't get some blood.
One way to warm the ear is to put some rice in a socket. Then you put the socket in a microwave (Around 30 seconds, the socket should just be warm, not burning. You can evaluate this directly by taking the socket in your hand).
Then you apply the warm socket on her ear, wait let's say 10 to 20 seconds, and then use the lancet.

Looby is also on the FB page. She has tried doing a test and got the blood drop but the meter timed out on her. After that Smiffy was getting upset so she quit for the time being. But she is trying and she WILL get there

Smiffy is at +7 since the shot and appears to be doing fine at this time.

 

[Capoo]

Looby there is no way to tell if the numbers are too high or too low. However when you had the vet curve done on the weekend Smiffy went from 21.1 at preshot to 6.8 at +4 after shot, so the insulin is definitely bringing the numbers down fast and hard.



ETA My suggestion to stop the Zylkene for the time being was to rule out any changes to the normal routine that could be affecting Smiffy. Did you check to make sure there was no zylitol or sugars in the Zylkene ? There is no way to tell if the Zylkene could be affecting Smiffy..either good or bad...so best to leave it out of the equation until the dosing is figured out.

I have just checked the analytical composition of Zylkene:
For cats, a capsusle weighs 75 mg, and 65% are carbohydrates, which means around 98 mg of carbohydrates per day assuming that Smiffy takes 2 capsules per day.
That's far below the carbohydrates weight brought by dry food.

 

[Tuxedo Mom]

I have just checked the analytical composition of Zylkene:
For cats, a capsusle weighs 75 mg, and 65% are carbohydrates, which means around 98 mg of carbohydrates per day assuming that Smiffy takes 2 capsules per day.
That's far below the carbohydrates weight brings by dry food.

Looby had commented on FB:

"I think so as I have just been on the Petforum website (not one I have ever viisted before but it came up on google for Zylkene) and somebody there said that their cat was quite 'out of it' on it ..."

Looby said the two stumbling incidents have happened since she started Zylkene. At this point when trying to adjust the insulin dose I suggested that it is best not to have an unnecessary "medicines" on board since there is no way to tell whether or how the Zylkene is affecting Smiffy. Until it is figured out whether these episodes are hypos or something else the less variables the better.

 

[Looby & Smiffy]

Looby there is no way to tell if the numbers are too high or too low. However when you had the vet curve done on the weekend Smiffy went from 21.1 at preshot to 6.8 at +4 after shot, so the insulin is definitely bringing the numbers down fast and hard.



ETA My suggestion to stop the Zylkene for the time being was to rule out any changes to the normal routine that could be affecting Smiffy. Did you check to make sure there was no zylitol or sugars in the Zylkene ? There is no way to tell if the Zylkene could be affecting Smiffy..either good or bad...so best to leave it out of the equation until the dosing is figured out.

Elizabeth and Bertie says it is safe so that is good enough for me ... it is made from whey from milk that is used to calm babies or something like that and has no harmful ingredients according to Elizabeth but I am going to stop it anyway as it is was present in her system both times she has had an episode ...

 

[Looby & Smiffy]

Looby,

Without readings, I don't have any idea of the current numbers of Smiffy.

Have you warmed her ear before trying to get some blood? If not, that's normal that you didn't get some blood.
One way to warm the ear is to put some rice in a socket. Then you put the socket in a microwave (Around 30 seconds, the socket should just be warm, not burning. You can evaluate this directly by taking the socket in your hand).
Then you apply the warm socket on her ear, wait let's say 10 to 20 seconds, and then use the lancet.

When I was treating her for her episode I gave her high carb treats first and then got the meter and got loads of blood ... since then I have had no luck and that is with rubbing her eat to warm it up ..... when I got the blood I didn't warm her ear at all .... I think I am not getting the right spot ... the Alphatrack Aviva pen lancets come out from the side of the circumferecne of the end of the pen if you see what I a

I have just checked the analytical composition of Zylkene:
For cats, a capsusle weighs 75 mg, and 65% are carbohydrates, which means around 98 mg of carbohydrates per day assuming that Smiffy takes 2 capsules per day.
That's far below the carbohydrates weight brings by dry food.

is that good or bad? I only give her one capsule a day and that has only been once the day she had her first episode (Friday) and then Sunday and Monday and now Tuesday ... she was at the Vets on Saturday so didn't have any ... so she is three days into having Zylkene since she got back from the Vets ...... are you saying that the arbs are too high - not quite sure what you mean by your post? Sorry ...

 

[Elizabeth and Bertie]

Elizabeth and Bertie says it is safe so that is good enough for me

Hi Looby,
I've used it with quite a few cats and have never had a problem with it. But that is just my experience.
And as I said, I've never used it on a diabetic (Bertie is a very laid back cat these days).

Eliz

 

[Capoo]

When I was treating her for her episode I gave her high carb treats first and then got the meter and got loads of blood ... since then I have had no luck and that is with rubbing her eat to warm it up ..... when I got the blood I didn't warm her ear at all .... I think I am not getting the right spot ... the Alphatrack Aviva pen lancets come out from the side of the circumferecne of the end of the pen if you see what I a

is that good or bad? I only give her one capsule a day and that has only been once the day she had her first episode (Friday) and then Sunday and Monday and now Tuesday ... she was at the Vets on Saturday so didn't have any ... so she is three days into having Zylkene since she got back from the Vets ...... are you saying that the arbs are too high - not quite sure what you mean by your post? Sorry ...

Not at all: the content of carbohydrates is really really small, let's say 100 times less than what you can find in dry food.
So, just speaking in terms of analytical composition, the Zylkene cannot impact her BG.

 

[Tuxedo Mom]

When I was treating her for her episode I gave her high carb treats first and then got the meter and got loads of blood ... since then I have had no luck and that is with rubbing her eat to warm it up ..... when I got the blood I didn't warm her ear at all .... I think I am not getting the right spot ... the Alphatrack Aviva pen lancets come out from the side of the circumferecne of the end of the pen if you see what I a

is that good or bad? I only give her one capsule a day and that has only been once the day she had her first episode (Friday) and then Sunday and Monday and now Tuesday ... she was at the Vets on Saturday so didn't have any ... so she is three days into having Zylkene since she got back from the Vets ...... are you saying that the arbs are too high - not quite sure what you mean by your post? Sorry ...

There doesn't seem to be a problem with the carbs in Zylkene, BUT as I said until the dosing gets sorted out and hopefully you are able to master home testing, it is best not to have other variables on board. The Zylkene may have NOTHING to do with the wobbly episodes, but if it is not used right now then you won't have to wonder about it.

 

[Looby & Smiffy]

Hi Looby,
I've used it with quite a few cats and have never had a problem with it. But that is just my experience.
And as I said, I've never used it on a diabetic (Bertie is a very laid back cat these days).

Eliz

Would you recommend that I just lay off the Zylkene for now as it might be lowering her blood glucose if it is making her more relaxed? If stress can higher BG then relaxant could lower it and maybe take effect around the same time as her Nadir?

 

[Looby & Smiffy]

Not at all: the content of carbohydrates is really really small, let's say 100 times less than what you can find in dry food.
So, just speaking in terms of analytical composition, the Zylkene cannot impact her BG.

That's good but it is a common to both her episodes - doesn't it follow that if stress elevates BG then relaxant might lower BG ... sorry just repeated myself .... God I am tired now and have a splitting headache ...

 

[Tuxedo Mom]

Would you recommend that I just lay off the Zylkene for now as it might be lowering her blood glucose if it is making her more relaxed? If stress can higher BG then relaxant could lower it and maybe take effect around the same time as her Nadir?

The Zylkene may have NOTHING to do with these "stumbling" episodes. However to keep things simpler until glucose testing is done with a lower dose it is best not to have ANY other variables in the mix. This is purely a "keep things basic" approach

 

[Looby & Smiffy]

The Zylkene may have NOTHING to do with these "stumbling" episodes. However to keep things simpler until glucose testing is done with a lower dose it is best not to have ANY other variables in the mix. This is purely a "keep things basic" approach

I agree ... keep it simple and keep her food regulated too but not too little - that is the other issue that I have with the Vet that her allowance of food is too low ...... enough to be on insulin but to put her on slimming diet too may be too much ..... on the other hand I understand why they wanted to keep things consistent for the most realistic and helpful analysis of her treatment and progress ...

 

[Tuxedo Mom]

I agree ... keep it simple and keep her food regulated too but not too little - that is the other issue that I have with the Vet that her allowance of food is too low ...... enough to be on insulin but to put her on slimming diet too may be too much ..... on the other hand I understand why they wanted to keep things consistent for the most realistic and helpful analysis of her treatment and progress ...

Losing weight takes time and a kitty should never lose weight TOO fast. Right now it would be good to know how well the insulin is really working on a day by day basis. As I had said before in another post fructosamine test are really just an average reading over a couple of week time period, but won't tell if Smiffy is going too high and/or too low on a daily basis. It just gives an average not a real time reading.

 

[Capoo]

Losing weight takes time and a kitty should never lose weight TOO fast. Right now it would be good to know how well the insulin is really working on a day by day basis.

And to emphasis what Tuxedo Mom just said, the only way to know that is to have readings from the meter. I'm SURE that you will succeed in that very very soon.

 

[Tuxedo Mom]

I agree with Capoo. You have managed to get blood from Smiffy's ears today. Now it is just a matter of juggling the blood and the meter/test strips. You will get there!!

 

[Tuxedo Mom]

And after your first successful home test be sure you have a special treat for yourself to celebrate .

 

[Critter Mom]

Will Smiffy be in danger by dropping her shot to just one unit from 2 units per day and these two episodes have both occurred after a 75mg dose of Zylkene so I am wondering if there is a connection?

From my post of SATURDAY 21 MAY 10:12 BST:


[ MILE HIGH LETTERS ]

3. Another new variable is the recently-introduced Zylkene calming treatment. Firstly, if stress elevates blood glucose levels then it is reasonable to consider whether a calming treatment intended to reduce stress levels may also lower blood glucose levels. The active ingredient in Zylkene is casein which comes from whey. There is research which indicates that whey may lower blood glucose levels. (I would also wonder whether casein may have an impact on the normal counter-regulatory hormone cascade triggered when a cat is on too high a dose and needs protection from hypoglycaemia.) I recommend that you ask your vet to enquire with the manufacturer's technical department about the effect Zylkene may have on blood glucose levels. Until such time as this is known, if it were my cat I would stop giving the supplement as a safety precaution.

[ / MILE HIGH LETTERS ]

Link to original post:

http://www.felinediabetes.com/FDMB/threads/smiffys-eating-routine.157924/#post-1681430

Based on my experience of treating my own cat with Caninsulin (with close home BG monitoring) and also from seeing responses of other cats here on the same insulin, a 6.8 mmol/L nadir at a vet's office (on pet calibrated equipment) is very likely to provide far too narrow a safety buffer given the harsh action profile of Caninsulin, especially when there is a strong possibility that BG levels in the home environment are very likely to be lower. Also that nadir was was after a 14.3mmol drop from preshot BG level. Even for Caninsulin that is a HUGE drop - quadruply so for a cat on a dry, high carb diet. With such wild swings in BG it again points to Smiffy possibly feeling really lousy on this insulin (and, as myself and other members have repeatedly suggested before, may be the reason why she's trying to avoid the injections). I have heard from human diabetics that widely swinging BG levels can make them feel really rough.

The Vet rang me back and said that according to her fructosamine results and her curve at the surgery she was stabalised and couldn't explain these episodes .... I suggested that she was on too high a dose of insulin which he disputed

Based on what you post here it gives the impression that your your vet is following some sort of "recipe" (for want of a better word) for making dose decisions and not properly assessing patient insulin response on a case by case basis. Again based on your posts there is an impression that your vet is either not double-checking potential interactions between insulin and other treatments (happens) OR that you have not asked him to double-check even after the suspected hypo of a few days ago. As myself and other members have repeated before:

[ MILE HIGH LETTERS ]

Fructosamine results are USELESS as a guide to determining safety of a given insulin dose.

[ / MILE HIGH LETTERS ]

Also, as has been stated before, vet-run curves aren't great for determining safe doses either but they're better than a complete absence of testing to check effects of a given dose. That said, any dosing decisions based on vet-run curves should be very conservative to allow for falsely elevated blood glucose levels. If your vet isn't even willing to entertain the possibility that a dose may be too high that is not a good sign.

Your vet should be trying to determine the cause of the episodes, not throwing his hands up in the air.

It is taking a lot out of me to post here today but I have chosen to do so because yet again I am very concerned about Smiffy's safety.


Mogs
.

 

[Looby & Smiffy]

Losing weight takes time and a kitty should never lose weight TOO fast. Right now it would be good to know how well the insulin is really working on a day by day basis. As I had said before in another post fructosamine test are really just an average reading over a couple of week time period, but won't tell if Smiffy is going too high and/or too low on a daily basis. It just gives an average not a real time reading.

I understand about the fructosamine result and have challenged the Vet on it too .... have quoted Dr Pierson to him too as something for him to look at our of interest (tried to be diplomatic so as not to dismasculate him (!) ..... I agree with you which is why since her admission at the weekend I have insisted on feeding her more food so that she can graze a bit throughout the day without incresing it to a silly amount ....

 

[Looby & Smiffy]

And after your first successful home test be sure you have a special treat for yourself to celebrate .

No I didn't get the blood in the meter - I messed up with the meter and now I can't get her to bleed but thank you anyway! Somebody on Facebook said that the more you poke the more capilliaries develop and the more easy it becomes to get the blood?

 

[Looby & Smiffy]

I agree with Capoo. You have managed to get blood from Smiffy's ears today. Now it is just a matter of juggling the blood and the meter/test strips. You will get there!!

Tried again and couldn't get any blood but somebody on Facebook said the more you poke the more capilliaries develop and the more easy it gets to get some blood? Repeated myself again as I don't know if you see all the posts ....

 

[Tuxedo Mom]

No I didn't get the blood in the meter - I messed up with the meter and now I can't get her to bleed but thank you anyway! Somebody on Facebook said that the more you poke the more capilliaries develop and the more easy it becomes to get the blood?

Yes..the ears actually "learn" to bleed better and easier. New capillaries develop and this makes it much easier and faster to get a blood sample. Remember to do something special for Smiffy after each attempt, whether successful or not. A little treat, extra cuddle. play time...whatever Smiffy likes best.

 

[Looby & Smiffy]

From my post of SATURDAY 21 MAY 10:12 BST:


[ MILE HIGH LETTERS ]



[ / MILE HIGH LETTERS ]

Link to original post:

http://www.felinediabetes.com/FDMB/threads/smiffys-eating-routine.157924/#post-1681430

Based on my experience of treating my own cat with Caninsulin (with close home BG monitoring) and also from seeing responses of other cats here on the same insulin, a 6.8 mmol/L nadir at a vet's office (on pet calibrated equipment) is very likely to provide far too narrow a safety buffer given the harsh action profile of Caninsulin, especially when there is a strong possibility that BG levels in the home environment are very likely to be lower. Also that nadir was was after a 14.3mmol drop from preshot BG level. Even for Caninsulin that is a HUGE drop - quadruply so for a cat on a dry, high carb diet. With such wild swings in BG it again points to Smiffy possibly feeling really lousy on this insulin (and, as myself and other members have repeatedly suggested before, may be the reason why she's trying to avoid the injections). I have heard from human diabetics that widely swinging BG levels can make them feel really rough.


Based on what you post here it gives the impression that your your vet is following some sort of "recipe" (for want of a better word) for making dose decisions and not properly assessing patient insulin response on a case by case basis. Again based on your posts there is an impression that your vet is either not double-checking potential interactions between insulin and other treatments (happens) OR that you have not asked him to double-check even after the suspected hypo of a few days ago. As myself and other members have repeated before:

[ MILE HIGH LETTERS ]

Fructosamine results are USELESS as a guide to determining safety of a given insulin dose.

[ / MILE HIGH LETTERS ]

Also, as has been stated before, vet-run curves aren't great for determining safe doses either but they're better than a complete absence of testing to check effects of a given dose. That said, any dosing decisions based on vet-run curves should be very conservative to allow for falsely elevated blood glucose levels. If your vet isn't even willing to entertain the possibility that a dose may be too high that is not a good sign.

Your vet should be trying to determine the cause of the episodes, not throwing his hands up in the air.

It is taking a lot out of me to post here today but I have chosen to do so because yet again I am very concerned about Smiffy's safety.


Mogs
.

As it stands now Mogs I have demanded that we drop the dose and he has agreed to a drop from two units to one unit twice a day and I have demanded that she has more to eat (not a huge amount more) but just enough so that she can graze throughout the day ...... I have challenged him on the fructosamine results too thanks to all you girls' input .... I coped and rescued her from two possible hypo epidsodes and now know how to use the meter and have once got blood from her ear but messed up the meter and now have poked and not got blood but I will keep trying ... she is due now to go into the Vets for another curve based on her being on one unit for a week but I am far from happy let me tell you especially as for the second time he has mentioned the other unacceptable option of PTS .... I was FURIOUS within but just told him calmly that that was not an option but we have to get her treatment right ... I have talked him at least three times about ProZinc and the fact that the Caninsulin may not agree with her and bring her down too quickly .....
You are putting me on the defensive when I am really trying to do the best for Smiffy with what I have and the experience that I have ..... I am also not well and struggling to deal with this but I am b***** determined to get it right .. I have posted on my local girls group for recommenedations for a good Vet that loves cats and understands them etc so will hopefully get a result there too ...

I completely agree wtih me but please give me some credit here ....

 

[Capoo]

Lucille, what about that:
- now that you know how to home test, you test Smiffy just before the shot this evening,
- as you've decided with your vet, you decrease the dose down to 1 IU this evening,
- you skip Zylkene?

 

[Alexi]

@Looby & Smiify

You did the hard bit - which was to get some blood, so you are already on step 2 to successful home testing, (step 1 was learning how the meter works), you just have to do it again and you will succeed. If the meter times out just slip the strip out and push it back in again. Have a spare strip out in case the meter gives an error message which it can do just at the wrong moment!

Given the numbers at the vet I think you will be ok to reduce the dose and get some home testing in until you can get a feel for what numbers she is getting on the lower dose, if it needs to go up again then we can advise. Cappuccino has been bouncing all over the place so we are looking to change her insulin now but she has been up to the 30's for no apparent reason and then drops quite quickly. Smiffy may be doing the same but as she starts lower (according to the vet numbers) she may well be going too low at times.

You did well today. You can do this.

 

[manxcat419]

Based on my experience of treating my own cat with Caninsulin (with close home BG monitoring) and also from seeing responses of other cats here on the same insulin, a 6.8 mmol/L nadir at a vet's office (on pet calibrated equipment) is very likely to provide far too narrow a safety buffer given the harsh action profile of Caninsulin, especially when there is a strong possibility that BG levels in the home environment are very likely to be lower.

My issue with this is that, if we allow a 5 point difference for vet stress, that would have made Smiffy's nadir a very low 1.8. And a 5 point difference is well within the realms of possibility for vet stress. I do feel that the vet isn't allowing for vet stress when they're running the curve, so they see numbers that they think are OK but that in reality, at home and relaxed, would definitely be too low. I do have concerns, but those are about the way the vet is handling this (or not handling it depending on your point of view). I can see that you are doing everything you can to try and figure this out and to try and get home-testing started. But without proper support and the right level of concern from your vet, your job is made more difficult because you're fighting them as well as fighting to get Smiffy's acceptance of what needs to be done to help her. I know for sure you're up to fighting for the best treatment for Smiffy, but with your vet's attitude as it appears to be, a fight is probably what it's going to come down to.

 

[Catticus Maximus]

But without proper support and the right level of concern from your vet, your job is made more difficult because you're fighting them as well as fighting to get Smiffy's acceptance of what needs to be done to help her. I know for sure you're up to fighting for the best treatment for Smiffy, but with your vet's attitude as it appears to be, a fight is probably what it's going to come down to.

I agree with this sentiment. The owner is the cat's advocate as the cat does not have its own voice nor is it even capable of understanding the problem.

You can gently try to persuade your vet (it worked for me), or simply go to another vet. You can call around and ask about various vets' diabetes protocols. You could also ask for a referral to an internist.

Ultimately it is up to the owner to act on behalf of the cat. If the vet is not helping it is time to move on.

 

[Sonya NZ]

Hello girls - are any of you there? Elizabeth Campbell I tried to call you and left a message ..... Smiffy has just had another episode ...

I was in bed with a headache and she was lying in the bedroom next to me and I she called me and then jumped on the bed so I just spoke to her and then there was some movement and I looked round and she was having a struggle to get up and was really wobbly and in distress....

I ran downstairs and gave her some whiskas chicken and cheese treats on the bed and then went to get the glucometer - got some blood but it was the first time I have done it and left the strip in the meter for too long so by the time I got some blood on it it didn't work ...

In the meantime, Smiffy had walked into the other bedroom to sulk .... I called the Vets and a Nurse told me to put some honey in her mouth as well and wait for the Vet to ring ...... I got a stripe of honey from donwstairs on my finger and put it in her mouth ...

By the time the Vet rang she was OK or at least seemed OK she has come downstairs and wanted to go out but I want to keep an eye on her ......

I have also given her a meal of Sheba and she ate about a quarter of the sachet ...

The Vet rang me back and said that according to her fructosamine results and her curve at the surgery she was stabalised and couldn't explain these episodes .... I suggested that she was on too high a dose of insulin which he disputed but got him to agree that I would drop the dose to one unit of Caninsulin twice a day as opposed to 2 units and as we are unable at the moment to do a curve at home (husband not around to do it when I am not etc) to take her in next Wednesday morning after her morning shot and they would do a curve there again to see what her BGs are like on one unit as opposed to 2 units ......

I had to agree with him that on paper and according to the curve at the Vets she was stable but I had to question him on these episodes and that something was wrong ...

He was just about to suggest unthanasia when I told him that she was not happy and I stopped him (as he has mentioned it before) and told him that she was too bright for that .... he then said well you said she was not happy .... What I meant was that she was still a vibrant cat but not happy with the insulin and also she has been missing her Daddy ...

I don't think they are going to consider that the Caninsulin may not just agree with her .... my husband is going to go to the Practice Manager about it all guns blazing which is not going to help and has not got all the knowledge that I have now about the condition ..

Smiffy is now upstairs as I won't let her out - she is not happy ...

The Vet says that if we don't give her enough insulin by reducing the dose she runs the risk of pancreatitis and ketoacidosis so I think he wants to prove a point to me by reducing the dose to one unit and then do another curve in a weeks time ....

On 2 units when she went in for a curve at the weekend her preshot number was 21.1, then four hours later her Nadir was 6.8 and then an hour later her sugar was 12.8 so according to this they say she should not have a hypo episode ... but what else could it be?

I am completely stressed out about the whole thing and worred sick .... at least at one unit she is more unlikely to have a hypo but that might not be enough insulin to get her better

So cross I failed with the glucometer ....

I did that the first time I did the meter as well - discovered mine timed-out after 60 seconds. Now I put the strip in, but not fully until I have the blood.

 

[Sonya NZ]

Another technique that I found useful when getting the hang of blood taking was to insert the needle at a 45deg angle, from the side. I use a 25g needle.

 

[Looby & Smiffy]

Yes..the ears actually "learn" to bleed better and easier. New capillaries develop and this makes it much easier and faster to get a blood sample. Remember to do something special for Smiffy after each attempt, whether successful or not. A little treat, extra cuddle. play time...whatever Smiffy likes best.

I do ... give her a hug on the bed and a big pet ....

Lucille, what about that:
- now that you know how to home test, you test Smiffy just before the shot this evening,
- as you've decided with your vet, you decrease the dose down to 1 IU this evening,
- you skip Zylkene?

As we speak she is staring at her food and doesn't want to eat it so I am sitting here patiently for her decide to start eating so that she has enough on board for me to give her a one unit shot ...... she HATES the Caninsulin and I would say that she feels better in herself once it has worn off ... just now before I put the food out she was on her cat nip toy and looking at me all bright eyed ... she has stopped eating now but I know she is hungry .... she is loitering over the food on the third step of the stairs ... going to move the bowl up to her ... just a sec ......she wants me to just leave her to eat and then she willl go upstairs ....... she is eating again now ..... I am now SCARED to inject her in case she doesn't eat enough ...... waiting ... she is eating .... she will come down later to eat more ..... still eating ...... I think she has eaten enough now for the one unit ....... going to give her her shot (there was no way I could home test her before she started eating as she was already on the stairs) ....... she has finished eating and is coming downstairs and now going ot the bathroom (which is downstairs) .... I will have a look at her bowl to see how much she has eaten .... good she has not gone upstairs ......she had eaten enough so gave her one unit in the bathroom and she hissed at me .... took the bowl of food into the bathroom with the shot and she is not eating more in the bathroom (not ideal but its the best I can do tonight) .... hope this is a insight into how difficult it is .... the shot went in easily and didn't hurt her and she at least didn't lash out at me as she used to ..... here she comes and I am going to offer her a treat ..... not interested - gone up to the bedroom ... will still leave the food out for her until I go to bed ...... I then throw the rest away so that she doesn't eat too near her next shot time in the morning and is therefore not hungry enough ....... and fingers crossed now she is OK ...... will leave her in peace now ......

 

[scoobydoox]

I guess there is no way you would be willing to switch to a different insulin like lantus or levemir?

 

[manxcat419]

I guess there is no way you would be willing to switch to a different insulin like lantus or levemir?

From what I've been able to make out, the reluctance to do this isn't Looby's - it's her vet's refusal to consider that the Caninsulin may not be agreeing with Smiffy. That plus the issues with getting 'human' insulin prescribed for a cat in the UK make it a little trickier than it is for those of us in the US or elsewhere.

 

[scoobydoox]

Crittermom uses lantus and she is in the uk so it must be possible. Why not get vet referrals from the other uk members if the current vet is refusing?

 

[manxcat419]

It is possible, just not all that straightforward in a lot of cases. There has to be clear proof that Caninsulin isn't working before a human insulin can be prescribed. Without the vet's agreement as to whether or not the Caninsulin is working for Smiffy, it is close to impossible for an alternative to be given. Looby has asked about vet recommendations on the FB group today, so although she would need to confirm that, I would imagine that looking for a different vet is currently in the picture if that turns out to be what would help Smiffy the best.

 

[Looby & Smiffy]

My issue with this is that, if we allow a 5 point difference for vet stress, that would have made Smiffy's nadir a very low 1.8. And a 5 point difference is well within the realms of possibility for vet stress. I do feel that the vet isn't allowing for vet stress when they're running the curve, so they see numbers that they think are OK but that in reality, at home and relaxed, would definitely be too low. I do have concerns, but those are about the way the vet is handling this (or not handling it depending on your point of view). I can see that you are doing everything you can to try and figure this out and to try and get home-testing started. But without proper support and the right level of concern from your vet, your job is made more difficult because you're fighting them as well as fighting to get Smiffy's acceptance of what needs to be done to help her. I know for sure you're up to fighting for the best treatment for Smiffy, but with your vet's attitude as it appears to be, a fight is probably what it's going to come down to.

I specifically asked them if they took stress into account with their readings! Who says there is a difference ce of about 5 units? Trust tou but just wondered where that figure came from (so I can quote that information to the Vet (source please) ... Surely then by that estimate Smiffynwould have had a hypo at the surgery that they missed ?

 

[Looby & Smiffy]

Lucille, what about that:
- now that you know how to home test, you test Smiffy just before the shot this evening,
- as you've decided with your vet, you decrease the dose down to 1 IU this evening,
- you skip Zylkene?

Yes going to skip zylkene ... Was only giving it to her am 75 mg and down to one unit ...she later post I wrote a things were happening and couldn't test her BGbefore eating or shooting

 

[manxcat419]

Here you go - one your vet might actually listen to since it's from the makers of Vetsulin! http://www.vetsulin.com/vet/Cats_Diagnosis.aspx (third paragraph). We usually say that vet stress can raise a cat by 100-200 points on the US scale, and 5 on the international scale is a little under 100 US so I was being conservative with my estimate! Smiffy wouldn't actually hypo at the vet because the effective reading at 6.8 was higher - even a stress increased reading still counts for protection from hypo.

 

[Looby & Smiffy]

Another technique that I found useful when getting the hang of blood taking was to insert the needle at a 45deg angle, from the side. I use a 25g needle.

Ok 45 degrees .... My pen has lancets that are on settings one 1 2 3 4 etc tried 3 and then 4 and so far got no blood again .... Think I must have got the vein the first time I did it and got quite a bit of blood ......

 

[Looby & Smiffy]

Crittermom uses lantus and she is in the uk so it must be possible. Why not get vet referrals from the other uk members if the current vet is refusing?

I have ask d a number of local feiends for recommendations and have got three so far but before we change surgeries my husband wants to talk to the practice manager who is no longer practising but might have a view .... Most of our local friend sues the same Surgery but not the same Vet ..... Bit like our GP surgery .....nearly everybody only trusts one of the GPs there so she gets inundated!

 

[manxcat419]

I have the same problem with my vet - most of the vets there I actually really like, but one of them made a lot of mistakes with our cats. I had to have some fairly serious words with them and insist that if all our cats weren't put with someone else, we'd have to look for a new vet...so it is possible to do, just not always easy.