4/9/2020 New Member, Just diagnosed a week ago, help please

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Kristin & Snickers

Kristin & Snickers

Member Since 2020
Hi All. I am new here. My (almost) 13 yo female cat Snickers was just diagnosed with diabetes a week ago. I have begun testing at home and giving insulin. I was given a free AlphaTRAK 2 monitor by my vet.. but being a member of two facebook groups, it was suggested I purchase a human monitor. The strips for the AlphaTRAK 2 are $50 for 50. That is just NOT doable. It was however, very easy to use. I now also have a ReliOn Prime monitor, and I am wondering what differences I need to be aware of. Is there a help page on here for using this monitor, or a human monitor in general? The AlphaTRAK didn't appear to need a very large sample, but I am reading that this ReliOn needs are larger sample. Though I am not sure how much more that would be compared to the AlphaTRAK. Right now this is my main question. I'm sure more will come up. I keep track of everything. All meds I give her. All BG values and when I give insulin. I am a bit OCD. But this is super new and honestly quite scary. I feel like her life is in my hands. My biggest fear is making her hypo. The vet actually told me to give insulin every 12 hours, and told me not to bother testing for a week when she wants me to do a curve. I gave the first dose blindly, but then posted in my facebook group and learned how dangerous this is. She is also a terrible eater, which makes this all worse. She has multiple medical conditions: Immune Mediated Hemolytic Anemia, CKD, Leukopenia, and a few episodes of suspected pancreatits. In fact I wouldn't be surprised if she is having one now. So she is a very complicated case. Her diabetes is likely caused by long term use of pred for the IMHA. I'd love to get her off pred completely, but I think it keeps her eating. And I am not sure if her anemia would be negatively affected by removing pred. She is also on Atopica for this condition.

Anyway, I am rambling... I would LOVE assistance with using this new meter. Do I have to colaberate it or anything? Or just start using? I will check the book also. Anything special I need to do to use it for a cat vs human? Thank you in advance for any assistance you can provide!
 
Kristin & Snickers said:
Though I am not sure how much more that would be compared to the AlphaTRAK. Right now this is my main question.
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The AT requires 0.3....the Relion Prime and Premier take 0.5
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Kristin & Snickers said:
Do I have to colaberate it or anything? Or just start using? I will check the book also. Anything special I need to do to use it for a cat vs human?
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No calibration needed for the Relion meters....just use it. The main difference between a pet meter and a human meter is your "time to act".....With a human meter, it's under 50....with the pet meter it's under 68 (so they're actually pretty close at lower numbers) As the numbers get higher, there's more of a difference, but if your cat is running too high, it really doesn't matter if it's at 350 or 500...it's too high!

We test to keep them safe...and then we look for "trends" more than individual numbers..we ask "is the dose I'm giving now keeping my cat safe and getting them into numbers I want?"

Normal blood glucose for cats on a human meter is 50-120...on a pet meter it's 68-150

Kristin & Snickers said:
being a member of two facebook groups,
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Just a quick suggestion...the only Facebook group that's associated with this board is the Feline Diabetes group. There are other groups on Facebook and each one does things differently. Some do things a lot differently and some are closer, but it's better to stick to one way of doing things. Otherwise you could get conflicting advice. It's totally up to you though!
 

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Welcome to FDMB. We understand that finding out that your cat is diabetic is very overwhelming, but it is a very manageable disease with the proper care. You already have a great start by learning to home test.

You want to test before every shot to make sure it is safe to give insulin. Can you tell us what insulin you are using and the dose?

A low carb canned or raw food diet works best for diabetic cats. Pate flavors are usually lower in carbs than anything with gravy. Most dry food is also higher in carbs. What food are you feeding your baby?

There is a lot of information here and I encourage you to ask any questions you may have. There are a lot of experienced members here and we want to help you learn how to give the best care for your kitty.

Generally for the Relion meters, they do not need to be calibrated. Many of us use the Relion meters. One thing you should do is set your "don't shoot" number. What this means is if the reading is under the number then you either skip the dose or if it is close, delay the shot and test again later, usually within an hour. For new members we usually recommend 200 to start with. As you become familiar with how your cat responds to the dose, you eventually may lower it. It is better to skip a dose than risk you cat's glucose levels dropping too low and becoming hypoglycemic. That can be very dangerous.
 
Lisa and Witn (GA) said:
Welcome to FDMB. We understand that finding out that your cat is diabetic is very overwhelming, but it is a very manageable disease with the proper care. You already have a great start by learning to home test.

You want to test before every shot to make sure it is safe to give insulin. Can you tell us what insulin you are using and the dose?

A low carb canned or raw food diet works best for diabetic cats. Pate flavors are usually lower in carbs than anything with gravy. Most dry food is also higher in carbs. What food are you feeding your baby?

There is a lot of information here and I encourage you to ask any questions you may have. There are a lot of experienced members here and we want to help you learn how to give the best care for your kitty.

Generally for the Relion meters, they do not need to be calibrated. Many of us use the Relion meters. One thing you should do is set your "don't shoot" number. What this means is if the reading is under the number then you either skip the dose or if it is close, delay the shot and test again later, usually within an hour. For new members we usually recommend 200 to start with. As you become familiar with how your cat responds to the dose, you eventually may lower it. It is better to skip a dose than risk you cat's glucose levels dropping too low and becoming hypoglycemic. That can be very dangerous.
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I have been testing ahead of each dose, thanks to advice on FB groups. It was not recommended by my vet unfortunately, and the risk of hypoglycemia just made me uneasy. She only got one dose without a test ahead of time. But that was after her appt, where she tested over 400. She is on Lantus, 1 unit BID to start. They want a curve done a week from starting insulin, so I will do that next week.

Food is a problem for her. She is a terrible eater. For the last couple years her appetite has steadily declined. But you can see by my description of her issues, she has lots of medical conditions. She used to LOVE food, and only eat wet food. But once she started turning her nose up to canned food, I introduced dry. I have had to change it several times, because she will just lose interest. So choosing an appropriate food for her is almost not an option, right now I am doing what I can to get her to eat anything consistently. She was started on cypro (app stimulant) today to help that. It definitely helped a little, but she still needs to eat more. So right now she mostly eats dry food, which I am not thrilled with. But it makes me happy anytime I see her at her food dish!
 
I know there are a few low carb dry foods. I believe Young Again is one of them. Other members may be able to recommend other foods. We also have members that have cats with multiple health issues and they may be able to offer advice for what works with their cats.
 
Dr. Elsey's Clean Protein is another dry food option in this situation. You can buy it on Chewy, might be in some brick-and-mortar stores but I don't know which ones (and who wants to make extra shopping trips outside these days?). I think the chicken flavor is slightly lower carb than the salmon, but both are much better than the typical dry food.
 
You might want to also try FortiFlora….it's a powder that contains the same stuff they spray on kibble to make it taste so good to our kitties.

You can get it on Chewy, Amazon, lots of other online veterinary supply places....even Ebay sometimes! Some vets also keep it in their offices.

I swear I think China would eat sawdust if I sprinkled it with FortiFlora ;)
 
So her BG is 163 this morning, using the human monitor. Do I give her insulin? She is currently on 1unit BID but I have skipped some doses because it’s been fairly close to normal. I gave her 1 unit last night about 13 hrs ago. But her BG was 289 then. I do NOT want to make her hypo. Advice?
 
I'm thinking stall until you can get more advice. That is (to me) a token dose or unshootable (at face value) AGAIN I'm not one of the experts ok? Someone should be here soon.
Are you setting up a profile? It would be easier for everyone to be able to see all the details ...Like insulin type... spread sheets are very important also.
 
Are there instructions for setting up a spreadsheet? Because I looked at someone’s and was LOST. I can setup a profile today, but she is on Lantus 1 unit BID. And the vet originally didn’t ask me to test. Said I didn’t need to until I do a curve. I don’t know what would have happened if I didn’t test. I told her she is a terrible eater. Which means she’s had some low values. So testing may have saved her life.
 
How long ago was the 163? Has she eaten any breakfast? If she hasn't eaten, you can test again to see if her numbers are moving up, it might be safe to shoot then. If she has eaten, you can still re-test, we'd just have to be more conservative, trying to take the food bump into account in looking at the new number.
 
I’m sorry, I didn’t realize there were more replies. Is there an app for this message board on mobile? Just curious, as I use my phone for most of my stuff.

I have not done the spreadsheet yet. I ordered a new desk so I have room for my personal laptop. Unfortunately my work stuff is what I currently have set up. Ok.. so I did not test again this morning because she has again been light on the eating. She ate a good amount overnight last night and her number was pretty low (as I reported earlier). Then she grazed during the day today and she is now at 197. This is on a ReliOn monitor. She is supposed to be getting Lantus 1 unit BID. But I don’t know that I want to dose that low either. I didn’t dose 215 the other night because I was nervous. So scared of a hypo. I ordered insulin syringes that have 1/2 unit markings, but I don’t have them yet. If this eating doesn’t get better tonight/overnight, gonna try mirtazapine tomorrow. I tried cyproheptadine first because I know it leaves the system faster. It made her SUPER drowsy and weak. So next I’d like to see how she handles the Mirt. I think I’m going to start with 1/8 pill. That should be fun to cut! Any advice on the BG of 197?
 
Kristin & Snickers said:
Any advice on the BG of 197?
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Shoot the 1U and get a +2 to get started

At first if you get a number under 200, you should stall, don't feed and test again 20-30 minutes later to see if the number goes up without the influence of food but I'm guessing you probably already fed.

197 is the same as saying 200 (meter's aren't that exact)

I'd be happy to set up your spreadsheet for you. Just send me a PM by clicking on my name and choosing "start a conversation"
 
No, we don't have an "APP" for the message board.

You should be able to access the message board from your smartphone.
What Chris said.
 
To clarify.. I leave food down for her 24/7 because she is a terrible eater. So I can’t guarantee she will eat much overnight tonight. Another reason I hesitate to give her insulin.
 
1U is one unit of insulin. U=Unit
+2 is two hours after giving the insulin.
We count hours from the time of the insulin dose, since we live all over the world.
+1 is 1 hour after insulin, +2 is 2 hours after insulin, etc.
AMPS and PMPS are your morning and evening pre-shot tests.

Link to explain some. Understanding the Spreadsheet/Grid

p.s. If you click on the "Like" at the bottom of a post, it lets us know you have seen it and read it.
 
Kristin & Snickers said:
I leave food down for her 24/7 because she is a terrible eater.
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It's actually fine to leave food down most of the time! The only time we really don't want them eating is the 2 hours immediately before shot times so that when we get the "Pre-Shot" tests, they aren't influenced by food.

One of the nicer things about Lantus is that the shot you give "now" doesn't usually start to kick in for 2-3 hours, so it's not really necessary for kitty to eat a set amount before they can get their insulin.

Most of us Test/Feed/Shoot all in 5-10 minutes. Test to make sure they're high enough to get insulin at all, Feed to make sure they're at least willing to eat and Shoot, usually while their head is still in the bowl.

We use a + system here for times because we're all around the world...so if you say I shot at 8am this morning and now his number is ###, that doesn't mean anything to us. But if you say I shot X units at AMPS (AM Pre-Shot) and he's at ## at +3, that tells us that no matter what the real time was when you shot, it was 3 hours ago. Each cycle is 12 hours so there's an AM cycle and a PM cycle and in between are +1, +2, +3....all the way up to +11 and then it's time for the next cycle.
 
Hi All, I am very sorry I did not get back to you all. I admit I am just very overwhelmed by all of this, I needed to get off the internet for a while.

On Sunday I actually gave Snickers Mirtazapine, instead of Cyproheptadine (it made her drowsy and weak in the back legs). She responded great to the mirt. Appetite, happy, purry, all the things I heard could happen. It lasted her a good 48 hours before her appetite decreased. I only gave her 1/8 of a 15 mg tablet. So then I was looking forward to giving her another dose today. OPPOSITE has happened today. No appetite, not lovey at all, quiet and depressed. Then I noticed some slight shivering. Her breathing might be slightly higher, but she tends to tuck her face in blankets - so I'm not sure if that is why. So my first instinct is she could have serotonin syndrome. I called her specialist, talked to the doctor's coordinator. She is going to talk to the vet and get back to me. But she wasn't too concerned about her current state. I am trying to avoid bringing her in.. and I am trying NOT to freak out. This poor cat, she has been through so much in the last couple weeks. Can I give her some Cypro to counter the effects of the Mirt? I know it is the antidote. But how much? Does anyone know? They wanted me to wait a little longer see if she starts eating. UGH.

Another thing, not sure if this is important for the situation. I am still testing before insulin. This morning her BG was 273, I have her 1 unit. When this started I thought I should test, just in case. So 4.5 hours later I test and she is still 251. So the insulin didn't do much in 4.5 hrs. But she was not low, that's for sure. She is supposed to be on 1 unit BID and I use a Relion Prime for testing. Not sure if this is even relevant for the current issue, but FYI. I know no one's advice replaces that of a vet, but I would still love to hear if anyone else has seen this or if anyone thinks (from their own experience) if she would benefit from a dose of Cypro. Thank you in advance!
 
Chris & China (GA) said:
I'm so sorry nobody got back to you earlier Kristin.

How's Snickers tonight?

If you post and don't get a reply in a reasonable amount of time, comment on it again ….that new comment will bump the thread back to the top of the forum
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Yeah I checked last night, and it was still pretty close to the top.. I had a call in to her IM Specialist too, so I was hoping to hear from her fairly quickly. Boy was I wrong. She (well her "assistant") called me 6 hours later. Apparently the possibility of Serotonin Syndrome is not an emergency in their eyes. Not a single mention that her symptoms were alarming or that they thought she had that. But before they called me, only 15 mins before, I was so worried I had gone ahead and given some Cypro (2 mg). I know, super stupid, without a vet's advice. So 15 mins after that I get the call and she tells me "DO NOT GIVE THEM TOGETHER." As soon as she said that I shut down and ended the conversation. I have very little confidence in this vet anymore, and it sucks, because she has been treating her for a couple years. But thankfully, it has mostly been to keep her stable with the IMHA. I feel like we've switched over almost to crisis mode, she needs more ongoing care than she previously did and this vet only works two days a week! I know what I did was stupid, I shouldn't have given meds without a vet telling me to. But honestly, it did seem to calm her symptoms. Once it kicked in, she stopped shivering, her temp started to lower. So in my mind, it did help. But now she has the side effects of Cypro to deal with -- super weak and extra lethargic.

I am worried about her. I cannot get her to eat enough food. She barely touched food yesterday, and she threw up last night -- mostly digested food. Vomiting is extremely rare for her, thankfully. I tested her last night at 7:45 PM, she was at 345. So with that number I gave her the insulin, food or not. But this morning her BG was 195 (it is 8:30 AM here, EST). And I can't guarantee she will eat anytime soon, so I didn't give anything yet. I am waiting for her to make a trip to the litter, so I can test for ketones. I highly doubt she has any, but her eating has been terrible since Tuesday. I know not eating is a huge risk. I see so many people say that diabetes is a treatable disease. How do I treat it properly with an anorexic cat who now cannot have mirt or cypro to help her eat? I am at my wits end, she is darn miserable, and I feel terrible. Normally I expect my vet to push tests, for instance an ultrasound. But she suspects pancreatitis, as she has history with that. She tells me if she finds that, we wouldn't really change what we do -- which is true. But still, I need to get food in her. I dread the idea of force feeding and making her hate me and food even more. Honestly a feeding tube would probably be ideal, but that is also a lot to put her through in the shape she is now. I am stumped, I don't know what to do next. Plus she is anemic! That's on the back burner too, because of everything else. If that gets worse she will need a transfusion. There is just so much going on at the same time with her.. :(
 
Have you tried anti-nausea meds like cerenia or ondansetron? The appetite stimulants alone won't help much if she's still nauseated, in some ways that makes things worse. If she is found to have pancreatitis, pain meds can also help with eating (it's a very painful condition, and who wants to eat when they have abdominal pain?).

Hope Snickers is feeling better soon :(.
 
Nan & Amber (GA) said:
Have you tried anti-nausea meds like cerenia or ondansetron? The appetite stimulants alone won't help much if she's still nauseated, in some ways that makes things worse. If she is found to have pancreatitis, pain meds can also help with eating (it's a very painful condition, and who wants to eat when they have abdominal pain?).

Hope Snickers is feeling better soon :(.
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She is on 1 mg Ondansetron BID. I also give Cerenia when she seems extra icky. Or if she vomits. Currently she has so much in her system making her drowsy, between the Mirt and Cypro I gave to counter the Mirt.. I'd hate to give her anything else. I have gabepentin on hand (only a couple pills, she's never had that) and I have expired (compounded 12/2018) Buprenorphine on hand - but that never really seemed to help previously, it made her super sedate.
 
I am going to attach pix of her meds, well everything I've done the past two days. Keeping in mind
AM Meds = .18 ml Atopica, 2.5 mg Pred, 200 mcg Folic Acid, 1 mg Ondansetron
PM Meds = .18 ml Atopica, 1 mg Ondansetron, 2.5 mg Famotidine

With everything she has been given, do you think I could give some Cerenia today? She does NOT want ANYTHING to do with food today. I'm sure the bad reaction she had yesterday and the combo of Mirt/Cypro did not help her appetite in the end. But I wonder if she isn't nauseous too. She got her 1 mg of Ondansetron this AM, but it doesn't appear to be doing ANYTHING. I don't want to force feed with nausea, she will probably vomit. It is currently 10:20 AM, EST. Do you think Cerenia is OK?

OH and FYI, I've totally stopped all antibiotics to hopefully give her GI tract a break. She was on Clavamox because her WBC were higher than normal, and she had a slight fever. But it gave her diarrhea. I was trying to help that with Flagyl, it did not help.
 

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@Kristin & Snickers , can you edit your thread title to something like, "Help, no appetite, need input on meds" and use the drop-down menu to add the "?" in front of the title? I am not sure I can answer your questions, let's try to get some more eyes on this.

The other thing you could do is to start a new thread, repeating the critical information from your last few posts-- we're on post #37 here, so this thread is starting to get long anyway.
 
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