? Somogyi, won't eat enough, new insulin, scared silly

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Girlie's mom

Girlie's mom

Member Since 2017
Hi,
We're in Australia, so some of the food names, etc. might differ from the U.S. Links to the Australian food are in the attachment. I'm new to all of this; exhausted; and so scared I might lose Girlie!

Girlie's biggest problem: she won't eat enough. She's always been fussy, and now that is causing problems with getting her regulated with the insulin. BIG problems! One of the vets (she's at a specialist vet hospital in Sydney) suggested we might have to put her on a e-tube to syringe feed. Yikes!!

Somogyi effect/Brittle diabetes: She's all over the place with her BG: too high, too low, can't stabilize.

Insulin: She was initially on 1 unit 1x/day of Glargine (Lantus) from 20 June 2017. Brought her home on 23 June and started the Lantus in the AM. The enema really knocked her for six as she aspirated and got pneumonia, so taking a lot of medications for that in addition to her regular medications for idiopathic epilepsy, arthritis, and asthma. She got happier and perkier and better than she's been for a long time day by day. So happy! Vet wanted me to do a BG curve, so asked me to stop the insulin from 1 - 3 July.

4 July, Hypo scare: Freestyle Libre put on; gave insulin that night after food (hungry for once!); by midnight she'd dropped below 2.8 (40 md/dL) and the Libre just screamed LO LO LO. Fed her whatever she'd eat for over an hour (Hills Active Longevity; Liverwurst (she'd climb a mountain for Liverwurst): still LO so took in to vet at 2:00 am even though she looked fine on the outside: no marked behaviour changes noticeable.

5 July: BG all over the place, from too low to really high; vet gave Lantus in the AM; then rapid-acting insulin after BG way too high for over 3 hours; now trying Caninsulin. Yikes... I typed up the attached food info and insulin, etc. for the vet (attached) and visited Girlie today, bringing in her favourite foods, Drinkwell Avalon water fountain, etc.

She looked SO awful! My happy (although hypo) baby from the night before looked worse than the pre-diagnosis Girlie! She was so unwell again, although she brightened and wanted her water in the fountain immediately; recognised her food bowl and ate some of the (bad) dry Hills Active Longevity.

The problem (from vet): isn't eating enough to deal with the Lantus 1 unit; can't just give her 1/2 a unit; so trying Caninsulin (Vetsulin in the US) as can give lower doses with higher volumes of fluid

Constipation: She was so badly constipated on 20 June 2017 that she had to have an enema under anaesthetic; they cleared her out, but she's still having major issues with constipation.
 

Attachments

hello and welcome!
unfortunately, it is a bit early in the US and many experienced members are not online at the moment. I am not very experienced but I'll share what I know and also tag someone with great deal of knowledge from Australia also, I hope it'll be helpful! @Bron and Sheba .
Girlie's mom said:
Somogyi effect/Brittle diabetes: She's all over the place with her BG: too high, too low, can't stabilize.
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It is common (see my cat's SS). To determine why we need to see records of her BG, doses she was getting and to know what she eats/how often. Stabilizing is possible. And you are in the right place to get helped.

Girlie's mom said:
suggested we might have to put her on a e-tube to syringe feed. Yikes!!
Click to expand...
My cat was on E-tube and saved her life. Literally. It is easy to deal with and cats are known to do well with E-Tubes. The Tube will be your greatest tool of control how much your girl eats/drinks. Once she starts eating on her own taking out the Tube takes 10 sec, no stitches and heals well in 2 weeks.

Girlie's mom said:
Somogyi effect/Brittle diabetes: She's all over the place with her BG: too high, too low, can't stabilize.
Click to expand...
Many, many reasons for that - look at my cat's spreadsheet brittle enough, isn't she? It is fixable. Do you home test? Seeing her numbers for a period of time can help in determining the reason for all over the place numbers.

Girlie's mom said:
The problem (from vet): isn't eating enough to deal with the Lantus 1 unit; can't just give her 1/2 a unit; so trying Caninsulin (Vetsulin in the US) as can give lower doses with higher volumes of fluid
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Eating is necessary for any insulin type.

Girlie's mom said:
she had to have an enema under anaesthetic; they cleared her out, but she's still having major issues with constipation.
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Have you tried steamed/boiled pumpkin? Or is it possible to buy FortiFlora probiotic by Purina in Australia? There are other remedies, including natural/homeopathic about which others can talk to you. Maybe Bron will be able to help with what's available to you locally.

Please do not get despaired. FD is manageable. Keep posting - you will get your questions answered.
 
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If you go to your original post - upper right hand corner and click on Thread Tools you will be able to edit your Title (subject line). On the left of the title line there is drop down menu - choose ? as your prefix. This way more people will stop by to answer. I have to go to bed now - it's half past 2 in the morning here. But many from the US East coast are about to get online - edit your post, check your replies, hang in there - you are not alone to deal with all of it!
 
Thank you so, so much, Tanya and Ducia! And it will be fantastic to connect with Bron and Sheba as I'm also in Sydney. Hurray! Advice on Australian food, etc. would be fantastic.

This is only week 2 since she was diagnosed on 20 June, so I'm still on a HUGE learning curve. I do have an AlphaTRAK2, but I haven't tested yet as we got the Freestyle Libre put on. It's great, but two problems: once you go over or under a certain amount it just reads HI or LO and I have no idea how HI or LO she is. I'll have to get them to show me how to test manually, especially as I want to do that before she eats/during the day.

My big question re: food is how much is enough before she gets insulin? When she first eats, she'll have ca 20 gm (0.71 ounces) of wet food; then I move the food wherever she is and over the course of an hour I might get her to eat as much as 40 gm (1.41 ounces), but when she's had enough, that's it.

This also complicates things like the other night, when she went below 50 (2.8), and the Libre just screamed LO at me. Hence handfeeding Liverwurst for an hour, to no effect and our trip to the vet. She looked fine on the outside, but I know how dangerous hypo is from reading around here, so I was too scared to try to handle it on my own. And now she's been careening wildly at the vet's since then.

Insulin: I wonder whether it's odd within 16 days to go from 1 Unit of Lantus (Glargine) 1x/day and now to the Caninsulin (Vetsulin in the US, I think)?

I will try not to despair! It's all just so scary. The head of Animal Diabetes Australia is in Melbourne, and she's happy to consult with the ARH vets. I swear, I'm thinking of somehow getting Girlie and me to Melbourne so we can see her one-on-one. I don't imagine a 12 hour drive would be the thing right now, though, even though Girlie is a very good traveller. I'd need a driver, though!

It's SUPER to hear that the e-tube might be okay; it looked a bit daunting on YouTube last night. Thank you so much for telling me it went ok with your kitty.

I'm very thankful for your reply. I hope you had a lovely 4th! I'm going to try to take some deep breaths and start my FDMB for Girlie, even though we don't have much in the way of numbers yet.

Thank you so much!
 
Thanks so much once again, Janet! I'll set that spreadsheet up with what I have so far.

The problem seems to lie in trying to get a 0.5 dose of insulin accurately on the syringe. It does look very, very tricky. The Vetsulin (Caninsulin in Australia) has more fluid to work with for a dose; that's what the vet's intern told me today.

The main problem is that she eats so very little: 1 ounce of wet for breakfast (max) over the course of an hour or more. This - and the fact that she's now only 7 lbs (3.4 kg) is why the vet is considering the possibility of having to feed her through an e-tube.

Just out of curiosity: I'm at home right now becomes I'm recovering from an ankle surgery; how on earth do people manage a diabetic cat (in the beginning, especially) if they work full-time? I have to give Girlie credit: she waited until I started walking again before she became a full-on diabetic! Such a sweet girl...

I don't get why she could look happier by the day at home - and better and livelier than she's looking in ages - and then be a hypo time bomb underneath on 4 July. And today she looked SO AWFUL in hospital! Poor, poor baby...
 
Girlie's mom said:
Thanks so much once again, Janet! I'll set that spreadsheet up with what I have so far.

The problem seems to lie in trying to get a 0.5 dose of insulin accurately on the syringe. It does look very, very tricky. The Vetsulin (Caninsulin in Australia) has more fluid to work with for a dose; that's what the vet's intern told me today.

The main problem is that she eats so very little: 1 ounce of wet for breakfast (max) over the course of an hour or more. This - and the fact that she's now only 7 lbs (3.4 kg) is why the vet is considering the possibility of having to feed her through an e-tube.

Just out of curiosity: I'm at home right now becomes I'm recovering from an ankle surgery; how on earth do people manage a diabetic cat (in the beginning, especially) if they work full-time? I have to give Girlie credit: she waited until I started walking again before she became a full-on diabetic! Such a sweet girl...

I don't get why she could look happier by the day at home - and better and livelier than she's looking in ages - and then be a hypo time bomb underneath on 4 July. And today she looked SO AWFUL in hospital! Poor, poor baby...
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Hypos are really hard on the body. It's also possible she has started with a case of pancratitis.

The small eating has me concerned. I have a cat who is a tiny eater too. She weighs less then 6 pounds. The past couple months I started adding FortiFlora to her food and it has greatly improved her eating. I think she has gained a little weight too as her spine is not poking out anymore. Maybe that would entice your cat to eat more.
 
Girlie's mom said:
Thanks so much once again, Janet! I'll set that spreadsheet up with what I have so far.

The problem seems to lie in trying to get a 0.5 dose of insulin accurately on the syringe. It does look very, very tricky. The Vetsulin (Caninsulin in Australia) has more fluid to work with for a dose; that's what the vet's intern told me today.

The main problem is that she eats so very little: 1 ounce of wet for breakfast (max) over the course of an hour or more. This - and the fact that she's now only 7 lbs (3.4 kg) is why the vet is considering the possibility of having to feed her through an e-tube.

Just out of curiosity: I'm at home right now becomes I'm recovering from an ankle surgery; how on earth do people manage a diabetic cat (in the beginning, especially) if they work full-time? I have to give Girlie credit: she waited until I started walking again before she became a full-on diabetic! Such a sweet girl...

I don't get why she could look happier by the day at home - and better and livelier than she's looking in ages - and then be a hypo time bomb underneath on 4 July. And today she looked SO AWFUL in hospital! Poor, poor baby...
Click to expand...
To answer your question about working and managing the diabetes.... During the day you would have to just do the preshot and dose conservatively since you can't monitor, do preshots when you get home, and then test before bed, and on days off do curves. I was fortunate that last year when my cat was diagnosed I only worked full time for the first 6 weeks after diagnosis, then had off for the summer (I'm a teacher) so I was able to make it my goal to get her as regulated as possible. She had her last shot the day before school started again in the fall.


If you don't already have them, get syringes with half unit markings. Much easier.
 
Hi Girlie's Mom,
I have just seen the alert. I haven't been online much at all lately but welcome to FDMB. I am sorry you are having so much trouble getting sorted out with Girlie.
Diabetes is a very manageable disease...although I am sure you find that hard to believe at the moment.
I am wondering why the vet changed you from Glargine to Caninsulin. Glargine is a much more suitable insulin. It is very doable to draw up 1/2 unit of Glargine. Girlie would be much better to have her Glargine insulin TWICE a day 12 hours apart instead of once a day.
It will take more than a couple of days to get Girlie stabilised with the insulin., So don't start to worry she has Somogyi effect/Brittle diabetes. We all were scared and worried at first.

What food are you feeding at the moment?
If she is not eating enough, you might need to think about the E tube until she will eat. I remember when Sheba was first diagnosed she was very thin and she didn't want to eat but she started to eat after a few days on Glargine.
If Girlie is not eating much, you might need to give her some higher carb food until she is eating better instead of the normal low carb food we recommend. Then you might be able to give her the insulin.
If she drops really low again you can put some honey on her gums and that should bring her up higher.
Whereabouts are you living in Sydney? I live on the Northern Beaches.
Hang in there. We will be able to help you.:):bighug: I don't think you need to think of going to Melbourne
 
Has your vet checked for ketones in Girlie do you know?

Here are some links to Australian canned foods.
At WW you can buy the cans of Gourmet Delight which are all low carb. They are all fish based though so would not be good to use all the time.
Petbarn have Weruva cats in the kitchen brand and Wellness brands and Fancy Feast.
https://docs.google.com/spreadsheet...k5NN-xwH54OsF0NqZZfnrtuI/htmlview?pli=1#gid=0

http://www.felinediabetes.com/FDMB/...anned-food-suitable-for-diabetic-cats.134090/

If you are wanting to give some higher carb food, the pouches in the Weruva cats in the kitchen range are higher carb.
Girlie is a beautiful looking girl. I had Burmese cats years ago and they were gorgeous cats.
 
Hi Bron,
It's so great to have someone in Sydney to talk to, especially re: food - our major drama (in addition to constipation, insulin type/dosage, wild BG levels). I lived in Manly for many years but moved to Burwood to be closer to work. Girlie and I both miss being by the ocean terribly.

Thank you so much for the Aussie cat food chart! One of my vets nixed Weruva, I think because of the recalls (many articles in May 17: here's the SMH: and ABC stories: there are many more.)

Any thoughts on Whiskas Oh So Fishy? That's her favourite. I think she especially likes the texture: really mushy and wet, so easier for an old cat with a few teeth missing to eat. Still - she'll rarely eat 85 gm (2.9 oz)

Pre-Diabetes food: AM Hills Science Diet Active Longevity Dry (gobbled it up); PM Whiskas Oh So Fishy or Ultimates Indulge
Post-Diabetes DX 20 June 17: AM mixed dry Active Longevity with Hills m/d; PM same but also tried wet Friskie's feast, Gourmet delight, m/d (picked at; only ate ca 10 gm (0.3 oz) and then ignored)

The problem is she just doesn't eat much and is used to grazing during the day. AM her first go (on wet food) is usually 20-24 gm (0.7-0.8 oz), which concerns me: too small to give insulin after such a small amount? I follow her around the room, re-introduce the food, and by three hours later I might get 40 gm (1 oz) into her. Same in the evening. Not enough!

She's so little now: 3.4 kg (7 lbs), when she used to be closer to 3.6 or even 4 kg (7.9-8 lbs). She's never really gone over 4 kg: always been lean.
 
Bron and Sheba said:
I am wondering why the vet changed you from Glargine to Caninsulin. Glargine is a much more suitable insulin. It is very doable to draw up 1/2 unit of Glargine. Girlie would be much better to have her Glargine insulin TWICE a day 12 hours apart instead of once a day.
Click to expand...

Caninsulin (US Vetsulin) vs Glargine: Vet #3's position was a) you can't really do a 0.5 unit of Glargine and b) Caninsulin enables a lower dose to be given as the C has higher doses of liquid vs. G. Looking at the BD 0.3 ml U-100 syringe, getting 0.5 looks very tricky: it would be so easy to think I had 0.5 and actually have almost nothing. Any tips on that? Is there another syringe out there?

Problem(?): different vets. I've been taking Girlie to ARH since she got diagnosed w/all her ills (see signature). Our usual specialist vet (Dr Kath Briscoe) has just gone on maternity leave, so Girlie has seen three vets so far. I brought Girlie in on 5/7 at 2:00 am as she was below 2.8 (50) and wouldn't eat anymore after an hour of hand-feeding Liverwurst (after she had enough of Active Longevity); as she wouldn't eat anymore, I was scared whitless and didn't know what to do.

I know how dangerous hypo is. This is the problem: getting her to eat enough to process the insulin. Vet #3 (Dr Brown) suggested e-feeding tube as a possible necessity as Girlie isn't eating enough to regulate her with the Glargine. Girlie is still at ARH; on 5/7 she got a) Glargine at 11:00 am (Hi or Lo? don't know); then ActRapid insulin as she was really HI; then was switched to Caninsulin: all within 12 hours.

She looked AWFUL when I saw her only 12 hours after I brought her in. Poor, poor baby!

I asked them to consult with Dr Linda Fleeman (Animal Diabetes Australia), and they said they would, but don't know yet if they have.

I've decided I might as well shave my head as I'm running out of hair to pull out... (trying for humor here to counteract the unbounded anxiety and fear I feel...)

How do I know if my vet (or vets) are doing the best for her? ARH would certainly seem to be the place to go in Sydney - wouldn't it? Oh boy....
 
Initially (I think) there were Ketones, but she's not DKA. All my home urinalysis have show no Ketones but Glucose in Urine (3+), so vet said that meant she was over 15 BG as that's when Glucose shows up on the urinalysis strip.

What to do?
 
Girlie's mom said:
Initially (I think) there were Ketones, but she's not DKA. All my home urinalysis have show no Ketones but Glucose in Urine (3+), so vet said that meant she was over 15 BG as that's when Glucose shows up on the urinalysis strip.

What to do?
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The reason I asked about the ketones is because Girlie is not eating and she needs insulin. The "recipe" for DKA is not enough food, not enough insulin and an infection. So I think it is important that she is tested each day for ketones just to make sure she doesn't have any until she is more stabilised.
She needs to eat and at this point I would try her with any food to make sure she is eating....except I would avoid dry food if you can. There are some high calorie per gram foods out there....I don't know what they are but the vet should know. Girlie might eat those until her appetite improves.
Another thought...have they given her anything for nausea? She may be feeling sick.
I have just had 3 grandchildren arrive for the day...school holidays...so I will get back to you as soon as I am organised and will answer the other questions.
The early days can be hard, especially if there are added problems like you are having. You are doing so much trying to help Girlie......the best thing you have done is join this forum....people live with feline diabetes 24/7 and are very knowledgeable about it.
Will be back soon:bighug:
 
Girlie's mom said:
Caninsulin (US Vetsulin) vs Glargine: Vet #3's position was a) you can't really do a 0.5 unit of Glargine and b) Caninsulin enables a lower dose to be given as the C has higher doses of liquid vs. G. Looking at the BD 0.3 ml U-100 syringe, getting 0.5 looks very tricky: it would be so easy to think I had 0.5 and actually have almost nothing. Any tips on that? Is there another syringe out there?
Click to expand...

Yes it is possible to give 0.5 units of Glargine. On the forum we advise increasing or decreasing the dose by 0.25 units when the dose of insulin needs changing. I always used a magnifying glass to see it better. There are no 1/2 unit marked syringes here in Australia but they can be bought overseas. A friend of mine on the forum got some for her cat from overseas and when her cat passed away she sent them to me. I don't have any left now. If you are interested I will try and find out where she got them from. In the meantime I would be asking the vets to try going back to the glargine insulin, it is a gentler insulin and more suited to cats. Another option is to buy some calipers which makes it easy to dial up the dose in a syringe. I have never use them but many others have. Not sure if they are in Australia.

Girlie's mom said:
Problem(?): different vets. I've been taking Girlie to ARH since she got diagnosed w/all her ills (see signature). Our usual specialist vet (Dr Kath Briscoe) has just gone on maternity leave, so Girlie has seen three vets so far. I brought Girlie in on 5/7 at 2:00 am as she was below 2.8 (50) and wouldn't eat anymore after an hour of hand-feeding Liverwurst (after she had enough of Active Longevity); as she wouldn't eat anymore, I was scared whitless and didn't know what to do.
Click to expand...

Many vets do not know a lot about feline diabetes. They know more about canine diabetes which is different to cats. They have many animals and many diseases with all these animals so unless they have had a lot to do with cat diabetes, they can make poor judgement calls.

Girlie's mom said:
I know how dangerous hypo is. This is the problem: getting her to eat enough to process the insulin. Vet #3 (Dr Brown) suggested e-feeding tube as a possible necessity as Girlie isn't eating enough to regulate her with the Glargine. Girlie is still at ARH; on 5/7 she got a) Glargine at 11:00 am (Hi or Lo? don't know); then ActRapid insulin as she was really HI; then was switched to Caninsulin: all within 12 hours.
Click to expand...

I would ask for a copy of all the blood sugar levels (BSL) they have taken in the hospital and what insulin they have given. Girlie is your cat and you are paying the bill so you are entitled to have all the information that is available about her. You are on a big learning curve (we all were in the beginning) and all this will help you understand how she reacts to insulin. You will need to be guided by the vet with the e-feeding tube. The main aim is to have food in Girlies tummy so she can get the insulin she needs and get over this hump. It will get much easier.
Glargine onset...when it starts to work ...is usually about 2 hours after the insulin is given (+2) so you don't need to get all Girlie's food in before the insulin. As long as she has had a good feed by the time onset occurs. And there is no reason why she can't still graze all day or most of the day. Glargine is a longer acting insulin than Caninsulin is.

Girlie's mom said:
How do I know if my vet (or vets) are doing the best for her? ARH would certainly seem to be the place to go in Sydney - wouldn't it? Oh boy.
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This is a hard question. ARH certainly looks a good hospital but whether they have anyone there who is very experienced in feline diabetes is the question. When my Sheba was very ill at the beginning of this year I was sent to a medical specialist (about something not related to her diabetes) and she was asking me all sorts of questions about feline diabetes. To be fair she was not a feline diabetes specialist but it was clear I knew an awful lot more about feline diabetes than she did.
You are Girlie's advocate so you need to do what you feel is best for her. Don't be afraid to speak up and ask questions and ask for copies of reports.

I am going to tag a couple of people who might be able to help with the Girlie's not eating much (and the high cal foods) and also the calipers.
@Wendy&Neko @Chris & China @Marje and Gracie
 
Thank you all SO MUCH for your help! I don't know how I would have gotten through these past few days without all of you. Bron, you're a star - the Australian food list is such a help. And the calipers videos are great, Wendy and Neko: thank you so much.

FINALLy, some good news from the vet! She's off the two antibiotics (aspirated post-enema and got pneumonia). They've given her Mirtazapine, and she's cleaning her plate. She's finally eating. Fingers crossed that this continues and the e-tube can be avoided for now.

Insulin: She's still HI on Caninsulin (over 20 / 400 - 499 range); today, they had to give her a rapid-acting insulin after several hours to get it down again. As it doesn't seem to be working for her, they're going to try to switch back to 1/2 Unit of Glargine tonight, track her carefully, and if she continues to eat well, they might try 1 unit. If she stabilizes, they'll let her come home on Sunday (Oz time).

Food: The vet wants her to stay on the wet foods she's familiar with for now: getting her to eat and getting the insulin regulated are the primary goal. Both the Indulge Ultimates and Whiskas Oh So Fishy wet are low in carbs, so that's good. Bron, the vet gave a thumbs up to both the Holistic and Wellness, but we'll gradually try to introduce those once she's a bit more stable and still eating well. She even had a poo today: I have to laugh at myself: I'm excited because my constipated cat had a poo.

I'm going to attach a couple of pics in the next post: Girlie (beautiful at 10 yo); Girlie getting acupuncture for arthritis; and Girlie with the Freestyle Libre she had put on a few days ago. If anyone thinks it might be useful, I could write up a post about my experience with the Freestyle Libre.

I'm so exhausted I can't see straight: too much stress and anxiety since her diagnosis and all of the serious problems we've had. I'm afraid I've been forgetting to take care of myself and focusing exclusively on Girlie.

I cannot thank all of you who've responded to this post and to my initial introduction: I am so, so grateful that FDMB and all of you have been here for me during this scary time.
 
Girlie at 10 yo: beautiful, healthy girl: IMG_1802 ed2.jpg

Girlie getting acupuncture for her arthritis the first time in June: sat still as a stone the whole time: IMG_2972 AcuCat sm.jpg

Girlie withe the Freestyle Libre put on a few days ago: IMG_3044.JPG
 
Girlie's mom said:
Thank you all SO MUCH for your help! I don't know how I would have gotten through these past few days without all of you. Bron, you're a star - the Australian food list is such a help. And the calipers videos are great, Wendy and Neko: thank you so much.

FINALLy, some good news from the vet! She's off the two antibiotics (aspirated post-enema and got pneumonia). They've given her Mirtazapine, and she's cleaning her plate. She's finally eating. Fingers crossed that this continues and the e-tube can be avoided for now.

Insulin: She's still HI on Caninsulin (over 20 / 400 - 499 range); today, they had to give her a rapid-acting insulin after several hours to get it down again. As it doesn't seem to be working for her, they're going to try to switch back to 1/2 Unit of Glargine tonight, track her carefully, and if she continues to eat well, they might try 1 unit. If she stabilizes, they'll let her come home on Sunday (Oz time).

Food: The vet wants her to stay on the wet foods she's familiar with for now: getting her to eat and getting the insulin regulated are the primary goal. Both the Indulge Ultimates and Whiskas Oh So Fishy wet are low in carbs, so that's good. Bron, the vet gave a thumbs up to both the Holistic and Wellness, but we'll gradually try to introduce those once she's a bit more stable and still eating well. She even had a poo today: I have to laugh at myself: I'm excited because my constipated cat had a poo.

I'm going to attach a couple of pics in the next post: Girlie (beautiful at 10 yo); Girlie getting acupuncture for arthritis; and Girlie with the Freestyle Libre she had put on a few days ago. If anyone thinks it might be useful, I could write up a post about my experience with the Freestyle Libre.

I'm so exhausted I can't see straight: too much stress and anxiety since her diagnosis and all of the serious problems we've had. I'm afraid I've been forgetting to take care of myself and focusing exclusively on Girlie.

I cannot thank all of you who've responded to this post and to my initial introduction: I am so, so grateful that FDMB and all of you have been here for me during this scary time.
Click to expand...
So glad she's eating better! That's huge!
 
JanetNJ said:
So glad she's eating better! That's huge!
Click to expand...

Janet, I'm doing a virtual happy dance because she's cleaning her plate (NEVER does that) and she had a poo! I can't do a real happy dance because I'm still recovering from ankle surgery, but I feel like a mountain of fear and stress has lifted off of me. I so, so hope that we can do the Glargine instead of the Caninsulin (which doesn't seem to work for her anyway).

Now I just have to learn how to do manual BG tests which I really want to do as you all have made me realize how incredibly important that is. I'll start my spreadsheet, as well.

I've watched your video repeatedly, Janet: it's really, really great. Thank you again so much for making it.
 
Darrah, I am so happy to read your latest post and to hear that Girlie is eating. That is wonderful and I know it must be a great relief for you. Great she has also managed to do a poo. We all get excited about cat's poos!:joyful:

I am glad they are swapping back to Glargine and starting off with 1/2 unit. I do hope they will give it twice a day. Please encourage them to do so as it only works for about 12 hours and if it isn't given for another 12 hours, Girlie will go back to high numbers until she gets the next dose. 1/2 unit twice a day 12 hours apart is much more effective than 1 unit once a day.

I was very interested to read about the freestyle libre. I have not seen that before.
Please keep us updated with how Girlie is going.
Love the photos....she is a beautiful girl.
Bron
 
Girlie has been getting Zydax injections for her arthritis since 2013; I believe Zydax is the Australian version of Adequan. We started on 1x/week injections every three months, but then moved to 1x/month, and we really noticed the difference. Girlie's 18 years old now, though, and the arthritis in her hind legs is really making life difficult for her: huge muscle loss. She's been getting Meloxicam every day, and I've completely reorganized the house so she doesn't have to jump: easy access everywhere for her. You'd get a good laugh if you saw what's surrounding my bed at the moment: all geared to help her.

Then the vet suggested trying the acupuncture in June. Little did I know that she was already diabetic and that she was extraordinarily constipated. Still, she was markedly better after the first treatment: then the diabetes set her on fire, so acupuncture is on hold. If you can find someone who really knows what it's doing, I'd give it a go. Girlie really took to it, but she is so incredibly good about everything I put her through medically. She doesn't even seem to notice the Freestyle Libre sitting on her shoulder, for example.

She hates pills, though, and I'm horrible at giving them to her unless they're tiny ones...
 
Girlie's mom said:
Janet, I'm doing a virtual happy dance because she's cleaning her plate (NEVER does that) and she had a poo! I can't do a real happy dance because I'm still recovering from ankle surgery, but I feel like a mountain of fear and stress has lifted off of me. I so, so hope that we can do the Glargine instead of the Caninsulin (which doesn't seem to work for her anyway).

Now I just have to learn how to do manual BG tests which I really want to do as you all have made me realize how incredibly important that is. I'll start my spreadsheet, as well.

I've watched your video repeatedly, Janet: it's really, really great. Thank you again so much for making it.
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I didn't realize she had pneumonia! Once the infection is cleared it should be easier to get the bg down! You do that Snoopy dance!!!

Glad the video is helping you. If we can help with testing in anyway don't hesitate to ask.
 
Bron and Sheba said:
Darrah, I am so happy to read your latest post and to hear that Girlie is eating. That is wonderful and I know it must be a great relief for you. Great she has also managed to do a poo. We all get excited about cat's poos!:joyful:

I am glad they are swapping back to Glargine and starting off with 1/2 unit. I do hope they will give it twice a day. Please encourage them to do so as it only works for about 12 hours and if it isn't given for another 12 hours, Girlie will go back to high numbers until she gets the next dose. 1/2 unit twice a day 12 hours apart is much more effective than 1 unit once a day.

I was very interested to read about the freestyle libre. I have not seen that before.
Please keep us updated with how Girlie is going.
Love the photos....she is a beautiful girl.
Bron
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She is so beautiful (to me), and an absolute velcro cat; I love her so very, very much.

The Freestyle Libre is relatively new here in Oz, I think. I haven't done manual BG testing yet; that's next to learn on my list. They put the Libre on her, compared the readings to manual BG tests, and sent me home with her. I just put the reader next to the white thing and I get a BG reading. The only problem is that if it goes over 25, it just says HI, and if it goes under 2.8, it just says LO. Of course, the first night I was testing her resulted in LO LO LO and me having to take her to the ARH emergency, where she's been ever since. But fingers crossed, now that she's eating with the help of the Mirtazapine, we might finally start getting out of the woods.

The Libre can stay on for two weeks. Some animals are annoyed by it, but Girlie just ignores it. For someone like me who's new to all this, hasn't done a manual BG test yet, and who wants to do a 24-hour curve, or test in an instant, this is a godsend. Until it says LO or HI and I panic, that is!
 
Bron and Sheba said:
There are no 1/2 unit marked syringes here in Australia but they can be bought overseas. A friend of mine on the forum got some for her cat from overseas and when her cat passed away she sent them to me. I don't have any left now. If you are interested I will try and find out where she got them from.
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Bron, that would be fantastic re: how/where to buy 1/2 unit 100 IU syringes from overseas. If they won't post them to me directly, then I'll get my Uncle to forward them on. I'll check with Customs on Monday to see if they have problems with importing syringes from the U.S. or Canada.

Next stop: buy a big magnifying glass, I guess! I spent time today studying a syringe, and hitting that 1/2 unit spot blind looks rather daunting, to be honest. The last thing I want to do is stuff up by giving more than a 1/2 unit or nothing at all.
 
JanetNJ said:
I didn't realize she had pneumonia! Once the infection is cleared it should be easier to get the bg down! You do that Snoopy dance!!!

Glad the video is helping you. If we can help with testing in anyway don't hesitate to ask.
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It's been so hard on her recovering from the anesthesia and the enema and the resulting pneumonia, as well as now being a diabetic. She's had to take so many meds since 20 June: 2 antibiotics, insulin, and then her regular meds for the arthritis, idiopathic epilepsy and asthma. I was beginning to feel like all I was doing was shoving things down her little throat several times a day. She was so good about everything except the pill, but that's because I'm awful at giving pills. If I were her, I wouldn't have wanted to eat much, either, to be honest.

Anyway! Doing that Snoopy dance! Happy, happy, happy. Fingers crossed for tomorrow...
 
Girlie's mom said:
Bron, that would be fantastic re: how/where to buy 1/2 unit 100 IU syringes from overseas. If they won't post them to me directly, then I'll get my Uncle to forward them on. I'll check with Customs on Monday to see if they have problems with importing syringes from the U.S. or Canada.

Next stop: buy a big magnifying glass, I guess! I spent time today studying a syringe, and hitting that 1/2 unit spot blind looks rather daunting, to be honest. The last thing I want to do is stuff up by giving more than a 1/2 unit or nothing at all.
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Yes you can get the 1/2 unit syringes sent to you from overseas no problem. No need to ring customs. But before you order any, you need to make sure she will be having the Glargine insulin, otherwise you will need a different syringe for the caninsulin.
Getting a magnifying glass is a good idea. I always used it, no matter what the dose.
 
Here's a video on where to place the pill and open the mouth. Her other tricks are nice but always use the water not just as her "if you want to". Dry pilling is not a nice experience for anyone or any kitty. My boy hates getting pilled too but he's getting better with tiny pills :)
 
My Neko also took acupuncture for her arthritis. It helps with pain relief and really helped her. I see no reason not to continue the treatments. I supplemented with daily acupressure that the vet showed me how to do. Neko was also on buprenorphine daily for pain. Meloxicam/metacam can be hard on kidneys and Neko's kidneys were already compromised.
 
@Girlie's mom and @Tanya and Ducia

I'm so sorry to get here so late....I haven't been on the board in a few days. I'm so very glad she's eating!!!!

And I want to address Somogyi. Somogyi is thought to occur from a chronic overdose. It was hypothesized as an occurrence in humans but there is some doubt as to whether it actually occurs and there is no indication that it does occur in cats. While many vets will categorizing "bouncing" as Somogyi, it isn't.

Bouncing, like Girlie is doing, is a common occurrence in diabetic cats. When cats are diagnosed, they've been at higher numbers for a while and the body (liver, pancreas) has become accustomed to this new BG. When the numbers come down as a response to insulin....not even low but lower than where they have been or the numbers drop rapidly....the liver and pancreas react to keep the body safe by releasing glucagon and counterregulatory hormones which drive the BG up.

Cats bounce until they don't. We've seen some cats here bounce the entire time they are diabetic. Others learn to flatten out. The right dose and a good feeding strategy can help with bouncing.
 
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Marje and Gracie said:
Cats bounce until they don't. We've seen some cats here bounce the entire time they are diabetic. Others learn to flatten out. The right dose and a good feeding strategy can help with bouncing.
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Thanks so much for that info, Marje! Girlie has been in hospital since 4 July when her BG went way low. They tried Caninsulin (Vetsulin) for a few days, but then put her back on Glargine as the Caninsulin (Vetsulin) wasn't doing anything: she's still having high BG. Every day (and through the night) they have to give her ActRapid as she's been way too high for too many hours. She's also still having issues with constipation. They put her on Mitrazapin, so she's finally been eating; she had an U/S today, but liver, kidneys, pancreas ok (considering her age and conditions), so nothing there that should be affecting her appetite.

She's been through the wars for the past 3 weeks with an enema, pneumonia, continued constipation, not eating enough, bouncing BG levels, and so many new meds (on top of her usual ones) to try to tackle each problem. The vet wants to stay on the Glargine & try to tackle issue by issue (e.g. the constipation) & go slowly and give her body time to recover and adjust. The problem is she can't really come home while they're having to give her ActRapid during the day and night when she's too high. They're concerned about me doing the ActRapid or missing the need for it (because I'm asleep) and then having big issues because of that (hypo or too hyper for too long). I'll have to search for what being too high for too long does on FDMB...

Given what she's gone through in the past 3 weeks, I'm assuming (?) that it might not be surprising that she's bouncing like a mad thing. How does one handle it if a cat bounces the entire time? I guess I shouldn't borrow trouble, but I am curious...

Marje, I watched both of your videos: your tribute to Gracie is so wonderful. I am so, so sorry for your loss!
 
Wendy&Neko said:
My Neko also took acupuncture for her arthritis. It helps with pain relief and really helped her. I see no reason not to continue the treatments. I supplemented with daily acupressure that the vet showed me how to do. Neko was also on buprenorphine daily for pain. Meloxicam/metacam can be hard on kidneys and Neko's kidneys were already compromised.
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Thank you so much, Wendy! I'll ask about the acupressure once Girlie is a bit steadier and we go back to the acupuncture. Thanks so much!
 
Yong said:
Here's a video on where to place the pill and open the mouth. Her other tricks are nice but always use the water not just as her "if you want to". Dry pilling is not a nice experience for anyone or any kitty. My boy hates getting pilled too but he's getting better with tiny pills :)
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Thank you so much! Girlie (and I) do better with liquid meds or very small pills; it seems like giving a pill should be straightforward when the vets do it. The video is very helpful: much appreciated. :)
 
I asked the vet for Girlie's medical records, but they said they don't give the actual hospital record out. She will pull together what I want, though, so I'm going to ask for her three last blood test results (2015 - 2017); and BG and insulin record while in hospital. Is there anything else that would be critical to get from them?
Again, thanks so much, everyone. I'm thankful every day that I found FDMB.
 
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Hi Darrah, I have been wondering how Girlie was. I'm sorry you haven't got her home yet.
Have the vets tried increasing the dose of insulin slightly, if she is continuing to have high numbers?
Pumpkin cooked and mashed, nothing added at all, is really good for both constipation and diarrhoea. You could try adding 1/2 teaspoon to her food twice a day and see if that helps. You could increase it to a teaspoon twice a day if it is not working. Most cats like pumpkin.
I am going to tag the lady who gave me the 1/2 unit syringes to see if she can remember where she ordered them. She is not online much so it may take awhile before she responds.
@sarahtee ...hi Sarah can you remember where you ordered the 1/2 unit syringes from? Thanks:)
 
Bron and Sheba said:
Hi Darrah, I have been wondering how Girlie was. I'm sorry you haven't got her home yet.
Have the vets tried increasing the dose of insulin slightly, if she is continuing to have high numbers?
Pumpkin cooked and mashed, nothing added at all, is really good for both constipation and diarrhoea. You could try adding 1/2 teaspoon to her food twice a day and see if that helps. You could increase it to a teaspoon twice a day if it is not working. Most cats like pumpkin.
I am going to tag the lady who gave me the 1/2 unit syringes to see if she can remember where she ordered them. She is not online much so it may take awhile before she responds.
@sarahtee ...hi Sarah can you remember where you ordered the 1/2 unit syringes from? Thanks:)
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Hi Bron and Darrah - the company in the UK with the U-100 1/2 unit syringes is Hyperdrug.
Here is a link to the product.
When I ordered, they emailed me to say that some imports are destroyed by Customs and was I happy to accept the risk of that happening. My order came through with no issues. I would hazard a guess that it's medication imports that are more likely to be screened, rather than equipment such as syringes...
 
sarahtee said:
Hi Bron and Darrah - the company in the UK with the U-100 1/2 unit syringes is Hyperdrug.
Here is a link to the product.
When I ordered, they emailed me to say that some imports are destroyed by Customs and was I happy to accept the risk of that happening. My order came through with no issues. I would hazard a guess that it's medication imports that are more likely to be screened, rather than equipment such as syringes...
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Thank you so much! I'll get them ordered straight away. Doing a joyful Snoopy dance here! I'm also going to get calipers just in case those can help while I'm waiting...
Thank you again!
 
Girlie's mom said:
Thank you so much! I'll get them ordered straight away. Doing a joyful Snoopy dance here! I'm also going to get calipers just in case those can help while I'm waiting...
Thank you again!
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The 1/2 unit markings made it much easier to do 1/4 unit changes, I found.
Sending you lots of vines that things get easier for your Girlie soon.
By the way, I hadn't seen the Libre before - it looks like a great piece of tech for kitties (or human beans) who aren't bothered by it!
 
@Girlie's mom Darrah, your siggie says Girlie is on Caninsulin (5 July) - if she's back on Lantus/Glargine it might be good to put that info there.
I know you need different syringe types for the different types of insulin, and I'd hate for you to be ordering the wrong type because I assumed Girlie was on Lantus...
 
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Girlie's mom said:
Thanks so much for that info, Marje! Girlie has been in hospital since 4 July when her BG went way low. They tried Caninsulin (Vetsulin) for a few days, but then put her back on Glargine as the Caninsulin (Vetsulin) wasn't doing anything: she's still having high BG. Every day (and through the night) they have to give her ActRapid as she's been way too high for too many hours. She's also still having issues with constipation. They put her on Mitrazapin, so she's finally been eating; she had an U/S today, but liver, kidneys, pancreas ok (considering her age and conditions), so nothing there that should be affecting her appetite.

She's been through the wars for the past 3 weeks with an enema, pneumonia, continued constipation, not eating enough, bouncing BG levels, and so many new meds (on top of her usual ones) to try to tackle each problem. The vet wants to stay on the Glargine & try to tackle issue by issue (e.g. the constipation) & go slowly and give her body time to recover and adjust. The problem is she can't really come home while they're having to give her ActRapid during the day and night when she's too high. They're concerned about me doing the ActRapid or missing the need for it (because I'm asleep) and then having big issues because of that (hypo or too hyper for too long). I'll have to search for what being too high for too long does on FDMB...

Given what she's gone through in the past 3 weeks, I'm assuming (?) that it might not be surprising that she's bouncing like a mad thing. How does one handle it if a cat bounces the entire time? I guess I shouldn't borrow trouble, but I am curious...

Marje, I watched both of your videos: your tribute to Gracie is so wonderful. I am so, so sorry for your loss!
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Thank you for the info and I'm sorry she is still at the vet. Many of us hear have experience with using fact acting insulins (one we use here in the US is called "R") in combination with a long duration insulin. Often in the US, the vets will stop using the long duration insulin while they give the rapid insulin because they can have a little more control over the numbers. Using both insulins requires a lot of monitoring

One issue with rapid acting insulins is that, if they aren't given properly and at the correct time in the cycle in conjunction with the long lasting insulin, it can make bouncing even worse. So I hope they know what they are doing.

We do have lots of experience around here using both insulins together but it does require a lot of work on the caregivers part.

Thank you so much for watching Gracie's
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videos. She was well loved her in L/L Land and is my heart and soul kitty. I miss her horribly every day.
 
Marje and Gracie said:
Thank you so much for watching Gracie's
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videos. She was well loved her in L/L Land and is my heart and soul kitty. I miss her horribly every day.
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Oh Marje! I completely understand. I've had Girlie since she was a kitten, and she's now 18 years old which is - apparently - pretty ancient for an Australian Burmese. I can't imagine my life without her, and I know that I have to count all of my time with her now as absolutely precious as the vet would be surprised if she has another year. I've never had a relationship or connection with an animal like this, so I have an idea what you mean when you said that Gracie is your "heart and soul kitty." What a beautiful way to put it, Marje!
I have another cat who adopted us (Girlie was not impressed and makes sure he knows his place on a regular basis); he's a real sweetheart, and most people like him better than Girlie. Max is sweet, and I'm glad I've been able to make his life a happy one, but Girlie is my world.
Anyway: my heart goes out to you. But what a wonderful tribute you created for Gracie!
 
sarahtee said:
@Girlie's mom Darrah, your siggie says Girlie is on Caninsulin (5 July) - if she's back on Lantus/Glargine it might be good to put that info there.
I know you need different syringe types for the different types of insulin, and I'd hate for you to be ordering the wrong type because I assumed Girlie was on Lantus...
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I've fixed it; still learning how to do things here. She's back on the Glargine/Lantus, currently 1.5 U 2x/day but still really high. I'm working on her spreadsheet now. Thank you so much for jumping in to help - I really appreciate it. I've been a bit stressed out by all of this, unfortunately. Huge learning curve! But it's so much better to be able to talk to people who've been there before for reassurance and suggestions.
 
Everyone here was really supportive when our cat Max was diagnosed. It does help to be able to chat with others who have BTDT, especially when everything is so new.

Hoping Girlie's numbers come down for you soon.
 
Girlie's mom said:
Oh Marje! I completely understand. I've had Girlie since she was a kitten, and she's now 18 years old which is - apparently - pretty ancient for an Australian Burmese. I can't imagine my life without her, and I know that I have to count all of my time with her now as absolutely precious as the vet would be surprised if she has another year. I've never had a relationship or connection with an animal like this, so I have an idea what you mean when you said that Gracie is your "heart and soul kitty." What a beautiful way to put it, Marje!
I have another cat who adopted us (Girlie was not impressed and makes sure he knows his place on a regular basis); he's a real sweetheart, and most people like him better than Girlie. Max is sweet, and I'm glad I've been able to make his life a happy one, but Girlie is my world.
Anyway: my heart goes out to you. But what a wonderful tribute you created for Gracie!
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Thank you....how is Girlie today? I hope she's home. :bighug::bighug:
 
Bron and Sheba said:
Darrah, I had a lovely Burmese girl called Ming and I had her for 21 years. And my tonkenese...half Burmese, half Siamese .....was 22 years old when she died.
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Thank you for that news...I don't know why the vet said she probably only has another year: she has lots of issues, but they don't seem insurmountable. Perhaps I'm kidding myself; I'm not a vet, after all. We'll see how she goes.
I started a new thread: Girlie is proving challenging again. It's almost midnight now (in Oz) and I still haven't given her insulin: not sure what to do so waiting for a reply; the emergency vet wasn't too helpful about why/how/when. Oh boy! It's going to be a long night...
 
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