? Diagnosed yesterday - Questions

[Carina Josefine]

Hi, and thank you for letting me join. I have already asked wquite a few questions on Facebook, and I have gotten so much help. I have also been refered here, to ask even more. I made a presentation of my Kitty here: http://www.felinediabetes.com/FDMB/threads/this-is-kitty-my-magical-diabetic-cat.206288/

I will stick to the health information and questions in this thread.

Kitty was taken to the vet's due to a morning cough. Otherwise healthy. It was shock to find she was diabetic.
The blood sugar reading that day was 24. A week later (yesterday)she got definite diagnosis, and since then she has had readings of
19,4 (at the vets)
22,4 (after food)
19,4 (two hours after insulin)
17,1 (before food in the morning)

Question 1 - Food type:

She got Royal Canin Diabetic from the veterinarian: both wet and dry. It didn't take me much reading to understand that was not good? I have taken dry food away, and she has gotten 3 feeding of RC Diabetic wet food. I have now bought low carb wet food recomended on the UK food list (Nature's Menu), as well as an other low carm food (similar to Nature's Menu). I can not get Friskies pate in the country.

Am I right to stop giving RC and try to see if I can make her eat any of the other two types I bought?

Question 2 - Feeding times:

I have 4 other cats (5 for the winter), so originally I hope to just put Diabetic dry food out, while feeding Kitty wet food (to make her eat less dry food). But I understand that meals need to be more regular than that? And that she should not have dry food at all? So I have put away the dry food, so the other cats can be shut into an other room to eat.

How often should I give wet food? What are good healthy routines for this? I read some places twice a day is good. I don't think I can make her enough to maintain a healthy weight doing that. And if I can, won't 12 hours be a long time to go with no food? Considering blood sugar and all? This might be what is confusing me the most.

She really loves to eat, and twice a day... Its is seriously breaking my heart. Also she should not lose (or gain) weight.

Question 3 - Insuline dosage

She has gotten Levemir. The vet prescribed 3 untis twice a day to start with. I was strongly recommended in the Facebook group to NOT do this. So I started her on 1 unit, and she has been given that dosage twice. Am I right to do this? It does confuse me that the vet's recommendation is so different. (But then again she also did not know where in the ear to poke for blood - and that took me less than a minute to learn)

Question 4 - Meassuring routines

What is a good routine for this? Before feeding? So meassure - feed - insuline?
What about inbetween shots?

Questions 5 - Effect from treatment

How long does it take before you can see effect from
- Diet change:
In numbers?
In the cat's behaviour?

- Insuline?
In numbers?
In the cat's behaviour?



I do apologize if these questions are silly. I a such a newbie when it comes to this!

Spreadsheet for Kitty:

https://docs.google.com/spreadsheets/d/11qZHvbhcpdjHLQNzA6R_S44y8l5Bt37YY4lolh_9sJc/edit?usp=sharing

 

[Chris & China (GA)]

Am I right to stop giving RC and try to see if I can make her eat any of the other two types I bought?

Yes, the RC is higher in carbs than we want her on

Question 2 - Feeding times:

No dry food is good for ANY cat, but especially a diabetic. It's very hard on kidneys which are the weakest organ in all cats, but especially hard on diabetic kidneys.

Most of us feed multiple small meals instead of 2 big ones but to a certain extent, how much/when to feed has to do with which insulin you're using. With Levemir, it doesn't start to "kick in" for 2-3 hours after the shot so you can shoot as you feed (as long as the cat is willing to eat)

Question 3 - Insuline dosage

3U is a very high dose....most cats end up needing no more than 2U twice a day and many need a lot less so I'm glad you're starting at 1U! As you test and gather more data, we'll be able to tell you when you need to increase, but we only increase by .25 to .5 each time

Question 4 - Meassuring routines

What is a good routine for this? Before feeding? So meassure - feed - insuline?
What about inbetween shots?

You Test/Feed/Shoot….all within about 5-10 minutes.

You Test to make sure they're high enough to receive insulin at all
Feed to make sure they're at least willing to eat and not sick and refusing
Shoot...usually while their head is still in the bowl

Then you need to get at least 1 test mid-cycle (between 5-7 hours after the AM shot) and then at least a "before bed" test on the PM cycle.....more testing is great though!!

Questions 5 - Effect from treatment

How long does it take before you can see effect from
- Diet change: If you're going from a high carb to a low carb diet, within 3-5 days you should see better numbers
In numbers? Again, 3-5 days after a complete diet change
In the cat's behaviour?

- Insuline?
In numbers? It takes 5-7 days to "Fill the depot" using Levemir. It's kind of like a timed release medication so it takes a little while to get the depot full so it's "releasing" the right amount of insulin and you can truly see what the starting dose will do
In the cat's behaviour?

 

[Tuxedo Mom]

Welcome! I saw your post an FB and am very pleased you have come to the Forum. Lots of great information and experienced people to help you along your path.

Chris has given you lots of good information. The one thing I want to throw in is that Levemir ( which is what I use) tends to have a later onset and nadir ( lowest reading) than most other insulins. Once you are home testing and keeping track of the readings you will get a better idea how Kitty responds to it. With both my FD kitties I found that the onset was usually between 4-6 hours after the shot and nadir ranged from 8-12 hours after the shot. This can also change with each kitty, but in early testing doing a test every 3 hours a few times will give you a better feel for how Kitty will respond. The more testing you do the more you will be able to see the patterns.

Also with Levemir the starting dose is 1 unit twice a day. My remaining FD kitty is currently on 1.25 units and has only been as high as 2.5 units during the 2 1/2 years she has been treated.

Good luck with your FD journey and keep asking questions.

 

[Carina Josefine]

3U is a very high dose....most cats end up needing no more than 2U twice a day and many need a lot less so I'm glad you're starting at 1U! As you test and gather more data, we'll be able to tell you when you need to increase, but we only increase by .25 to .5 each time

My pen (Levemir Flex Pen) does not let me chose .25 or .5. It clicks into place at 1, 2 and so on. Should I ask for new ones?

You Test/Feed/Shoot….all within about 5-10 minutes.

You Test to make sure they're high enough to receive insulin at all
Feed to make sure they're at least willing to eat and not sick and refusing
Shoot...usually while their head is still in the bowl

Then you need to get at least 1 test mid-cycle (between 5-7 hours after the AM shot) and then at least a "before bed" test on the PM cycle.....more testing is great though!!

So at least 4 tests, 2 right before shots and 2 mid cycle?

Thank you so much for your help. I appreciate it so so much!

 

[Carina Josefine]

Welcome! I saw your post an FB and am very pleased you have come to the Forum. Lots of great information and experienced people to help you along your path.

Chris has given you lots of good information. The one thing I want to throw in is that Levemir ( which is what I use) tends to have a later onset and nadir ( lowest reading) than most other insulins. Once you are home testing and keeping track of the readings you will get a better idea how Kitty responds to it. With both my FD kitties I found that the onset was usually between 4-6 hours after the shot and nadir ranged from 8-12 hours after the shot. This can also change with each kitty, but in early testing doing a test every 3 hours a few times will give you a better feel for how Kitty will respond. The more testing you do the more you will be able to see the patterns.

Also with Levemir the starting dose is 1 unit twice a day. My remaining FD kitty is currently on 1.25 units and has only been as high as 2.5 units during the 2 1/2 years she has been treated.

Good luck with your FD journey and keep asking questions.

Thank you so much for taking the time to reply!

We are got the home testing devide yesterday along with the diagnosis and the insulin. I have made a spreadsheet:

https://docs.google.com/spreadsheets/d/11qZHvbhcpdjHLQNzA6R_S44y8l5Bt37YY4lolh_9sJc/edit?usp=sharing

Hopefully I will see some patterns and learn

So far I have only tested 4 times since 2 am (today is really the first day). I am so clumsy doing it, and I feel sorry for Kity that has to deal with me...

 

[Carina Josefine]

Question 6: Kitty's test showed 14,7 at her reading at 20.30 (mid cycle, she got some wet food after the test). She is due for another insulin at 2 am (in 5 hours). How low would you let your cat be, before you skip the insulin? I am so scared to make her too low.

My pen does not do .25 or .5, it only does whole numbers (it "clicks" into place and wont be adjusted)

 

[Idjit's mom]

Hi Carina, I have not done it, but I have read that others do use a syringe with a pen to draw incremental doses:
Check out this link http://www.felinediabetes.com/FDMB/threads/syringe-insulin-info-handling-drawing-fine-doses.151/
In fact, when you have the opportunity, read all the 'stickies' at the top of the Lantus and Levemir forum:
http://www.felinediabetes.com/FDMB/forums/lantus-basaglar-glargine-and-levemir-detemir.9/

Here is a video about drawing from both a vial and a pen with a syringe.

 

[Tuxedo Mom]

Thank you so much for taking the time to reply!

We are got the home testing devide yesterday along with the diagnosis and the insulin. I have made a spreadsheet:

https://docs.google.com/spreadsheets/d/11qZHvbhcpdjHLQNzA6R_S44y8l5Bt37YY4lolh_9sJc/edit?usp=sharing

Hopefully I will see some patterns and learn

So far I have only tested 4 times since 2 am (today is really the first day). I am so clumsy doing it, and I feel sorry for Kity that has to deal with me...

You are off to a great start. Home testing is so very important and using the spreadsheet gives a great visual look at the numbers. When doing the preshot test make sure Kitty has not eaten for at least 2 hours beforehand since food can raise the glucose levels and you want to make sure the levels are safe to give the shot. Testing can be a bit clumsy in the beginning, but as time goes along it will become much easier. My other FD kitty was very food motivated so a little treat after a test was all he needed to be very co-operative. My current FD kitty loves her combings and brushings so she is always rewarded with that after testing.

Kitty is lower at + 6 than at pershot which shows the insulin is working. If you are able to do another test in about 2 hours you will see if the Levemir is giving a later nadir ( as I mentioned in my previous comment). This will help in determining the pattern Levemir will have with Kitty.

Most of use syringes, since the pen device only measures in 1 unit increments. You can buy U100 syringes with 1/2 unit markings and use the pen as a 'mini vial'. This makes it much easier to do dose adjustments in smaller increments. The syringes with 1/2 unit are best since you can accurately measure 1/2 unit changes and estimate 1/4 unit changes.

These are the ones I use, but I don't know what is available where you are.

https://www.adwdiabetes.com/product/6941/bd-ultra-fine-insulin-syringes

The image on the left shows a syringe with 1/2 unit markings. Each line on the right hand side of this image is 1 unit and each line on the left side of this image is 1/2 unit marking.

You can always do a preshot test before the next shot is due and post for help if you are concerned about the number. If you get a lowish number, if possible you can stall without feeding any food and retest again in 20 minutes to see if it is rising. Because Levemir can have a very late nadir in some kitties the more tests you get the more you will see Kitty's pattern

 

[Chris & China (GA)]

My pen (Levemir Flex Pen) does not let me chose .25 or .5. It clicks into place at 1, 2 and so on. Should I ask for new ones?

No...but you need to get regular U100 insulin syringes (preferably with half unit markings) and pull the insulin out of the pen (just pretend it's a vial)

 

[Chris & China (GA)]

I have made a spreadsheet:

That's great!! Now we need you to go ahead and do your "Signature" (that information you see below all our comments)

Just click on your sign on name (top right of the board) and choose "Signature"....a new box will pop up for you to enter information into.

We like to see at least:

Your name/cats name, age, sex, date of diagnosis, type of insulin, type of meter, type of food, any other health problems or medications? and a general location.

Then you'd just copy and paste your spreadsheet link and "save" the whole thing!

 

[Carina Josefine]

Thank you all for clearing that up! I will go pharmacy when they open tomorrow and ask for those syringes. My veterinarian never told me that was an option (but then again she prescribed 3 units to start with).

I made my signature with the requested information

 

[Tuxedo Mom]

Thank you both for clearing that up! I will go pharmacy when they open tomorrow and ask for those syringes. My veterinarian never told me that was an option (but then again she prescribed 3 units to start with).

I made my signature with the requested information

Glad to see you made it back over here from FB. Good job updating your signature. You can start a new thread (post) on the Lantus/Levemir forum

http://www.felinediabetes.com/FDMB/forums/lantus-basaglar-glargine-and-levemir-detemir.9/

and include a link to this posting for background information. Use the ? icon in the title and post something like "need dosing advice" with the date included. That will alert more people that are familiar with Lantus and Levemir

 

[Carina Josefine]

Glad to see you made it back over here from FB. Good job updating your signature. You can start a new thread (post) on the Lantus/Levemir forum

http://www.felinediabetes.com/FDMB/forums/lantus-basaglar-glargine-and-levemir-detemir.9/

and include a link to this posting for background information. Use the ? icon in the title and post something like "need dosing advice" with the date included. That will alert more people that are familiar with Lantus and Levemir

Oh, I posted in the wrong forum, and can't figure out how to delete it. I'll get the hang of this... one day!

 

[Tuxedo Mom]

Oh, I posted in the wrong forum, and can't figure out how to delete it. I'll get the hang of this... one day!

No problem/ The Health forum is fine too. Most people will eventually post in the forum that relates to the insulin type they are using. It took me forever to figure out the forum and the usual processes that people use

I posted a bit more on your new thread